46,XX male syndrome with mullerianosis of the urinary bladder: A new clinical entity.

Müllerianosis of the urinary bladder is a rare entity characterized by the presence of an admixture of at least two types of müllerian tissue in the muscularis propria of the bladder. We report the case of a 43-year-old male patient presented for urological evaluation due to episodes of total gross hematuria. Physical examination revealed ambiguous external genitalia. Abdomiopelvic CT scan revealed a tumor at the level of the bladder floor. Transurethral resection of the bladder lesions was done and histopathological studie confirmed the diagnosis of müllerianosis. Karyotype analysis showed a 46 XX male syndrome.

Does kidney transplantation with multiple arteries affect graft survival?

INTRODUCTION: We compared short- and long-term outcomes of renal transplants with single versus multiple arteries. PATIENTS AND METHODS: We retrospectively analyzed data from kidney transplants from 208 living donors performed between 1994 and 2010. Renal grafts were divided into two groups: single renal artery (n = 164) versus multiple renal arteries (n = 44). The groups were compared regarding early and late vascular and urological complications. Patient and graft survivals were compared using Kaplan-Meier survivorship curves with comparisons using the log-rank test. RESULTS: Both groups were comparable regarding acute rejection episodes, posttransplant hypertension, postsurgery renal artery stenosis, and urologic complications. Only hemorrhagic complications and renal artery thrombosis were significantly higher in the multiple renal arteries group (P = .027 and .03, respectively). Warm ischemia time was significantly longer in the multiple renal arteries group without any influence on the incidence of acute tubular necrosis (P = .2). Mean creatinine clearance at 1 year was 65 versus 50 mL/min/1.73 m(2) (P = .5) and at 5 years, 60 versus 55 mL/min/1.73 m(2) (P = .1) for the single versus multiple renal arteries groups, respectively. Return to hemodialysis was necessary for 18.8% of the single and 16.1% of the multiple renal arteries group. CONCLUSION: The use of an allograft with multiple renal arteries is a safe, successful surgical procedure, that does not influence patient or graft survivals or increase surgical complication rates provided the surgical team is evolved with technical skill.

118 cas de tuberculose urogenitale dans le Sud Tunisien

Objectif : Etudier les caracteristiques epidemiologiques; cliniques; therapeutiques et evolutives de la tuberculose urogenitale dans la region du Sud Tunisien. Patients et methodes : Etude retrospective de 118 cas de tuberculose urogenitale issus des regions du Sud et du Centre tunisiens. Le diagnostic a ete confirme chez tous les malades par un faisceau d'elements cliniques; biologiques; radiologiques; et/ou histologiques. Resultats : Il s'agissait de 81 hommes et 37 femmes ages en moyenne de 38 ans. Les manifestations cliniques revelatrices etaient dominees par les signes irritatifs du bas appareil urinaire (57;6). Les signes generaux ont ete observes dans 25;4des cas. Le diagnostic de certitude a ete obtenu par preuve bacteriologique (49;2); biopsie vesicale positive (12;7); et analyse anatomopathologique d'une piece d'exerese operatoire (68;6). Le traitement a consiste en une chimiotherapie anti-bacillaire chez tous les patients; en association avec une chirurgie d'exerese (70;3); une chirurgie de reconstruction (18;6); et/ou des manoeuvres endoscopiques (13;6). 80des patients etaient suivis regulierement avec un recul moyen de 6 ans. L'evolution a ete favorable dans 85;3des cas. Conclusion : La tuberculose urogenitale reste une maladie d'actualite; elle represente une maladie grave du fait des risques multiples qu'elle peut engendrer; particulierement sur la fonction renale.). Les signes generaux ont ete observes dans 25;4des cas. Le diagnostic de certitude a ete obtenu par preuve bacteriologique (49;2); biopsie vesicale positive (12;7); et analyse anatomopathologique d'une piece d'exerese operatoire (68;6). Le traitement a consiste en une chimiotherapie anti-bacillaire chez tous les patients; en association avec une chirurgie d'exerese (70;3); une chirurgie de reconstruction (18;6); et/ou des manoeuvres endoscopiques (13;6). 80des patients etaient suivis regulierement avec un recul moyen de 6 ans. L'evolution a ete favorable dans 85;3engendrer; particulierement sur la fonction renale

[Surgical treatment of varicocele improves fertility and facilitates medically assisted procreation]. / Le traitement chirurgical de la varicocèle améliore la fertilité et aide à la procréation médicalement assistée.

PURPOSE: To assess the effect of varicocelectomy in sperm quality and natural pregnancy and to determine if it can change couple candidacy for assisted reproductive technology (ART) procedures. MATERIALS AND METHODS: We performed a retrospective study about 164 infertile men with varicocele associated to sperm abnormalities. We divided our patients into four groups, according to the total motile sperm count (TMC). Group 1 includes 21 azoospermic men, group 2 includes 62 patients who had a TMC strictly less than 1.5x10(6), group 3 includes 22 patients who had a TMC between 1.5 and 5x10(6) and group 4 includes 59 patients who had a TMC strictly greater than 5x10(6). All patients underwent surgical or percutaneous embolisation to repair varicocele. RESULTS: After treatment, the mean spermatozoid concentration and motility were significantly increased, respectively from 24.8 to 29.2x10(6)spermatozoids per millilitre and 14.4 to 23.2%. Spontaneous pregnancy was observed in 59 couples (35.9%). Concerning the couples who had no pregnancies (105), 51 (48.5%) showed increase of the TMC, which allowed them to change the foreseen preoperative ART by an other one more simple. CONCLUSION: Varicocelectomy has a significant potential not only to improve sperm quality and natural pregnancy, but also to downstage the level of ART needed to male infertility management.

Management of major blunt renal lacerations: is a nonoperative approach indicated?

OBJECTIVES: The aim of the study was to determine whether a nonoperative approach is able to reduce renal parenchymal loss after renal trauma. METHODS: Sixty-four consecutive patients with major blunt renal lacerations were treated from 1988 to 1999. Initial management was conservative. In group 1 (35 patients) delayed hemorrhage, persistent urinoma or hemodynamic instability were dealt with by open surgery. In group 2 (29 patients), most complications were dealt with using endoscopic procedures; open surgery was reserved exclusively for major complications. RESULTS: In group 1, 7 patients were not operated and 28 patients were managed surgically. Twenty (57%) patients underwent total (8) or partial (12) nephrectomy. In 8 patients the surgical intervention was open drainage of perinephric collection (6) and/or renorrhaphies (2). Four patients in this group developed urinary fistulae treated successfully with ureteral stents. Length of hospital stay was 9.6 days (3-25 days). In group 2, persistent hemodynamic instability led to nephrectomy in 1 case. The remaining 28 patients were managed conservatively, with endoscopic ureteric stenting in 5 cases. A persistent urinary extravasation with hyperthermia led to open drainage of perinephric urinoma (5) and renorrhaphy (2). No delayed nephrectomy was necessary. Average hospital stay was 12 days (5-21 days). Only 1 patient in this group developed hypertension. CONCLUSION: For most patients and with close follow-up available, conservative treatment represents a real alternative to open surgery in major blunt renal lacerations. In our experience, open surgery usually results in loss of renal parenchyma.