[Youssef syndrome (vesico-uterine fistula): three case reports]. / Le syndrome de Youssef (fistule vésico-utérine): à propos de trois observations.

The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.

[Psychological, sexual and social aspects of bladder exstrophy in adulthood. Analysis of 3 cases]. / Aspects psychologiques, sexuels et sociaux de l'exstrophie vésicale chez l'adulte. Analyse de 3 cas.

Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.

[Endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. Two case reports]. / Traitement endoscopique du reflux vésico-urétéral par injection sous-méatique de graisse autologue. A propos de deux cas.

The authors report two cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. We describe the technique of prelevement and injection. The immediate results confirm the efficacity of this procedure. The long-term follow-up will allow us to adopt it and to give it some modifications.

[Retroperitoneal liposarcoma. Case report]. / Liposarcome rétropéritonéal. A propos d'un cas.

We report one case of retroperitoneal liposarcoma treated by surgery and radiotherapy. With the literature, we discuss the pathologic and therapeutic aspect of this lesion.

[Percutaneous nephrostomy: use of a simple inexpensive material in emergencies in precarious conditions]. / La néphrostomie percutanée: utilisation d'un matériel simple peu onéreux dans des conditions d'urgence en situation précaire.

We describe a cheap and simply technique of percutaneous nephrostomy which can be used anywhere. It consists, under local anesthesia, of insertion of a drain into renal cavity using only a needle, a sheat and dilatator. With this technique, we placed 81 PCN with 97% of success, without complication.

[Perineoscrotal gangrene: report of 51 cases. Diagnostic and therapeutic features]. / Gangrène périnéoscrotale: à propos de 51 cas. Aspects diagnostiques et thérapeutiques.

OBJECTIVE: To approach the treatment of Fournier's gangrene. So, pathophysiology and etiology are recalled. METHODS: The authors present 51 cases of Fournier's gangrene treated from 1989 to 1998, their age ranged from 19 to 89 years. Data were collected on admission signs and symptoms, physical examination. Aggressive surgical debridement of all necrotic tissues was performed, Intravenous antibiotics and resuscitation fluid were also administered. RESULTS: All patients were male. In 20 cases (39%), there was no identifiable cause, and in 31 cases (61%), the etiology of gangrene was urethral (33%), anorectal (28%) and unknown (19%). The average hospital stay was 30 days. Three cases underwent unilateral orchidectomy, six colostomy and in 17 cases, a suprapubic catheter was inserted. Mortality was high (18%) and essentially associated to debilated state and toxi-infectious context. CONCLUSION: Fournier's gangrene is a true urologic emergency potential lethal, which requires aggressive antibiotic and surgical treatment.

[Spontaneous hematoma of the adrenal glands]. / Hématome spontané de la surrénale.

We report an uncommon case of unilateral spontaneous hematoma of the right adrenal gland in a 22-year old young man. Preoperative diagnosis was made by ultrasonography and CT-scan. A right adrenalectomy was performed. Pathological evaluation showed an isolated hematoma without adrenal abnormalities. The diagnostic and therapeutic aspects are discussed.

[Unusual form of adrenal pheochromocytoma: asymptomatic cystic mass]. / Une forme rare de phéochromocytome surrénalien: masse kystique asymptomatique.

We report an adrenal cyst discovered in a 26-year-old woman with abdominal pain. Imaging (ultrasonography, computed tomography) demonstrated a 12 cm adrenal cystic mass suggestive of hydatic cyst of adrenal. She undergoes surgical exploration, when blood pressure increases. Pheochromocytoma diagnosis is reconsidered. Cystic pheochromocytoma is a rare tumour of the adrenal gland that can pose a diagnostic challenge.

[Transitional cell carcinoma on ureteral stump after nephrectomy for pyonephrosis]. / Carcinome à cellules transitionnelles du moignon urétéral après néphrectomie pour pyonéphrose.

The authors report a case of transitional cell carcinoma of the left ureteral stump in a 66-year old man treated by nephrectomy for pyonephrosis 6 years previously and cystoprostatectomy for bladder tumour 13 years previously. In the light of this case and based on a review of the literature, they essentially discuss the diagnostic and aetiopathogenic problems raised by this disease.

[Bladder exstrophy in the adult: therapeutic features. Report of 3 cases]. / L'exstrophie vésicale chez l'adulte: aspects thérapeutiques. A propos de trois cas.

Bladder exstrophy is a malformation which the incidence is estimated at 3.3 per 100,000 births. It is usually treated in the first hours of life. The authors report three cases of bladder exstrophy treated in adult life with continent urinary diversion such as Benchekroun continent ileocaecal bladder (CICB). After a literature review on the management of bladder exstrophy, they studied clinical and therapeutical particularities of the bladder exstrophy in adulthood.

[Obstetrical vesico-vaginal fistula. Report of 114 cases]. / Les fistules vésico-vaginales obstétricales. A propos de 114 cas.

OBJECTIVE: Obstetric vesico-vaginal fistulas are frequent in North Africa. The objective of this paper is to analyse the epidemiologic and therapeutic factors, basing our study on 114 cases of vesico-vaginal fistulas. METHODS: From February 1989 to December 1998, 114 patients with a mean age of 33 years (range: 17 to 76 years) were admitted to the department of urology for urogenital fistulas, classified as a function of the site of the fistula into 3 types, according to Benchekroun's classification: type I: urethrovaginal fistula (39.96%); type II: cervicovaginal fistula (11.40%); type III: vesicovaginal fistula (52.63%). Investigation of each patient comprised complete physical examination with laboratory and radiological assessment. Treatment was only performed after a minimal period of 3 months. RESULTS: The majority of fistulas occurred in young multiparous women living in rural zones, predominantly due to an obstetric aetiology (87%). 183 reconstructive operations were performed in 114 patients, i.e. 1.73 operations per patient. Cure was obtained in 87 patients (76.3%) with 37% for type I, 92% for type II and 100% for type III. Twelve intermediate results (fistulas were closed, with persistent stress incontinence or frequency) and 16 failures (persistence of a residual fistula or need for urinary diversion) all concerned type I fistulas. CONCLUSION: It appears that VVFs represent a public health problem in North Africa and that their surgical treatment is still technically difficult.

[Urogenital tuberculosis. Experience in 10 years]. / Tuberculose uro-génitale. Expérience de 10 ans.

OBJECTIVE: To review the clinical, imaging and therapeutic aspects of urogenital tuberculosis. MATERIAL AND METHODS: From April 1989 to April 1999, 57 patients with urogenital tuberculosis were reviewed in our department. This series consisted of 32 males and 25 females with a mean age of 40 years (range: 18 to 72 years). RESULTS: The most frequent clinical symptoms were irritative symptoms (47.3%). Fever, anorexia and weight loss were rare (11%). 16% of patients had an isolated genital lesion. 14% presented with renal failure (mean serum creatinine: 18 mg/l). Only 3 cases (5.2%) presented with bacilluria. Urography showed abnormalities in 80% of cases. The most frequent abnormality was a non-functioning silent kidney in 23 cases (40.3%). The positive diagnosis was based on bacteriological (5 cases) and histological data (52 cases). Treatment consisted of antituberculous chemotherapy in all patients, in combination with surgery (75%), and/or endourological procedures (26.3%). Nephrectomy is still indicated for non-functioning tuberculous kidneys in order to prevent the development of hypertension, abscess and fistulas. CONCLUSION: The diagnosis of urogenital tuberculosis is difficult and often late. A surgical or endourological procedure is often necessary to preserve renal function and to improve quality of life.

[Comparative results of the treatment of post-traumatic ruptures of the membranous urethra with endoscopic realignment and surgery]. / Résultats comparatifs du traitement des ruptures post-traumatiques de l'urètre membraneux par réalignement endoscopique et chirurgie.

OBJECTIVE: Retrospective, comparative study of the long-term results of endoscopic realignment and surgery in the treatment of complete rupture of the posterior urethra. MATERIAL AND METHODS: Between 1989 and 1998, 40 men were managed for traumatic posterior rupture of the membranous urethra: 30 were treated by endoscopic realignment for complete rupture while 10 were treated by surgery (perineal or transsymphyseal incision) for a long stenosis (> 3 cm) secondary to extensive rupture of the urethra. RESULTS: With a mean follow-up of 30 months (12 to 72 months), all patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output (Qmax > or = 15 ml/s). This result was obtained after internal urethrotomy in 7 patients (23.33%) and transperineal urethroplasty in one patient. Six patients developed persistent impotence (20%). For the ten patients treated surgically, the voiding stream was considered to be satisfactory (Qmax > 15 ml/s in 6 patients while 4 developed short strictures accessible to endoscopic urethrotomy. Nine patients are continent, while one completely incontinent patient with perineal fistulas required a continent cystostomy. Four out of 10 patients reported sexual impotence. CONCLUSION: Endoscopic realignment of complete rupture of the membranous urethra is a simple, minimally aggressive technique, ensuring optimal preservation of continence and sexuality in young subjects.

[Prostatic leiomyosarcoma (report of 2 cases)]. / Léiomyosarcome prostatique (à propos de deux cas).

The authors report 2 cases of prostatic leiomyosarcoma. The first patient was not operated because of a severely debilitated state and died a fortnight after admission to hospital. The second patient underwent cystoprostatectomy with ilio-obturator lymph node dissection. Resection margins and lymph node dissection were negative and no further treatment was required. With a 10-year follow-up, the clinical and radiological assessment was normal. The diagnostic and therapeutic aspects of this rare prostatic tumour are discusses.

[Unusual testicular tumor: Leydig, Sertoli, and granulosa cell mixed tumor]. / Une tumeur testiculaire rare: tumeur mixte à cellules de Leydig, de Sertoli et de la granulosa.

We report an unusual case of a mixed granulosa-Sertoli-Leydig cell testicular tumor in a 16 year old man, who presented with bilateral gynaecomastia. A few cases have been published in the literature. Based on a case report, the authors describe the clinical, histopathological and therapeutical features of this rare affection.

[Urethral diverticulosis in women. Analysis of 15 cases]. / Diverticules de l'urèthre chez la femme. Analyse de 15 cas.

OBJECTIVE: To evaluate the aetiopathogenic, diagnostic and therapeutic aspects of urethral diverticula in women. MATERIAL AND METHODS: Over a 10-year period (January 1990 to December 1999), 15 patients with a mean age of 36 years (range: 25 to 46 years) with urethral diverticulum were included in this study. The mean parity was 2 with a history of long and difficult delivery in 6 cases. All patients presented lower urinary tract symptoms with a clinical diverticulum on gynaecological examination (14 cases) or on retrograde and voiding cystourethrography (14 cases) or intravenous urography (one case). Diverticulectomy was performed via a transvaginal approach in the dorsal position. RESULTS: There were no postoperative complications. All patients were reviewed with a mean follow-up of 3 years. The urinary symptoms had completely disappeared in 14 cases. One patient was reoperated for recurrent diverticulum. CONCLUSION: Young women with recurrent voiding disorders must be examined for the presence of urethral diverticulum that can be confirmed by cystourethrography. Transvaginal diverticulectomy in the lithotomy position is the operation which ensures the best results.

[Inflammatory pseudotumors of the kidney: a case report]. / Les pseudotumeurs inflammatoires du rein: à propos d'un cas.

Inflammatory pseudotumors are uncommon benign tumors of unknown etiology which may develop at several anatomical sites, e.g., the airways and gastrointestinal tissues, soft tissues, the orbit, the spleen, or the lymph nodes. The renal site is extremely rare, and presents the problem of differential diagnosis as the clinical and radiological aspects of this tumor are similar to those of an adenoma or an angiomyolipoma, and suggest the presence of a carcinoma, in particular a cystic renal carcinoma which is also a rare form of tumor. There is therefore a risk that this benign lesion could be misdiagnosed. Due to the good prognosis associated with this type of tumor, in cases where the definitive diagnosis has been established no surgical procedure is necessary. However, the difficulty in making this diagnosis preoperatively means that in general the organ has to be surgically removed so that a histological analysis can be made and the negative or positive findings confirmed. In the present study, the case of an inflammatory pseudotumor of the kidney has been described. In this instance, radical nephrectomy of the left kidney was carried out as the disease was presumed to be renal cell adenocarcinoma. However, the histopathological analysis was negative as regards malignancy, and indicated the presence of an inflammatory pseudotumor. This article raises the question of the problem in establishing a preoperative definitive diagnosis, as a correct diagnosis is often only confirmed following nephrectomy (in cases where the contralateral kidney is healthy).

Leiomyosarcoma of the prostate: a study of two cases.

Leiomyosarcoma of the prostate is rare neoplasm that accounts for less than 0.1% of prostate malignancies. A number of treatment approaches have been adopted including radical surgery, radiotherapy and chemotherapy, but in no instance has a successful outcome been obtained. Prostate leiomyosarcoma has a poor prognosis, although survival time can vary. For these reasons, it is important to correctly identify this disease and report its occurrence, type of treatment, and the response to therapy of each patient diagnosed as having leiomyosarcoma of the prostate in an attempt to improve our understanding of the natural history of these lesions.

[Complex vesicovaginal fistula. Report of 55 cases]. / Fistules vésicovaginales complexes. A propos de 55 cas.

OBJECTIVE: To specify the clinical and therapeutic peculiarities of complex vesico-vaginal fistulas. MATERIAL AND METHODS: 55 cases of complex vesico-vaginal fistulas are reported. After the clinical diagnostic all the patients had an intravenous excretory urogram. The fistulas were classified according to the Benchekroun classification. RESULTS: The mean age was 34 years (17-70 years). The diagnostic was made clinically in all the patients. Thirteen patients had an abnormal intravenous excretory urogram. The treatment was made by a vaginal way in 45 patients, by an abdominal way in three patients and by a mixed way in two patients. Four patients had an urinary diversion and one refused the treatment. Among the 50 patients whose fistula was treated, 44 (88%) were continent whom 26 (52%) after one operation, 15 (30%) after two operations and three (6%) after three operations. CONCLUSION: The complex vesico-vaginal fistulas as all the vesico-vaginal fistulas are diagnosed clinically. The intravenous excretory urogram is indispensable to search an associated ureteral lesion. The treatment is surgical and usually needs the interposition of a vascularised graft.

[Martius' technique in the treatment of complex vesicovaginal fistula]. / Technique de martius dans le traitement des fistules vésiculovaginales complexes.

Sixteen cases of vesicovaginal fistulae (including 14 urethrovaginal fistulae), were treated vaginally using Martius' procedure. The authors describe the technique for the interposition of a labial fat pad, between the bladder and the vagina. The results are good. Thirteen patients have been cured. In one case a second was necessary using Guittes technique. There was two failures.