[To analyse diagnosis, management and prognosis of florid cystitis glandularis (pseudoneoplastic entity)]. / La cystite glandulaire pseudo tumorale.

PURPOSE: To analyse diagnosis, management and prognosis of florid cystitis glandularis (pseudoneplastic entity). PATIENTS AND METHODS: A retrospective study of 6 consecutive patients with florid cystitis glandularis seen at the department of Urology of Monastir (Tunisia) from January 1996 to July 2006. All patients underwent ultrasonography, and cystoscopy. Computed tomography (CT) was performed in four patients and magnetic resonance imaging (MRI) in one patient. RESULTS: The six patients, all of whom were male, ranged from 22 to 68 (average 42) years of age. The most common complaints was haematuria. Radiological examination and cystoscopy suggested a bladder tumor in all patients. Histopathology revealed features of cystitis glandularis of intestinal type. Features of the pelvic CT and MRI were consistent with the diagnosis of pelvic lipomatosis in one patient. The endoscopic resection was performed in 5 patients. Recurrence occurred in one of these 5 patients within one and 7 years of follow-up. The other patient had developed a low compliance small-capacity bladder and bilateral ureteral obstruction. A total cystoprostatectomy and ileal neobladder construction was considered, but it was declined by the patient. The patient was treated with anti-inflammatory drug (Indometacine 100 mg/day). CONCLUSION: Cystitis glandularis may be mistaken for bladder tumor The diagnosis is histological. Treatment is based on eradication of the irritative factors and endoscopic resection of the tumoral masses. The clinical course is unclear, requiring long-term fellow-up.

[Conservative management of renal haemangioma: value of a synergistic combination of flexible ureteroscopy and CT angiography]. / Traitement conservateur d'un hémangiome rénal: intérêt de la synergie urétéroscopie souple et artériotomodensitométrie.

Renal haemangioma (RH) is a rare congenital vascular lesion that is frequently responsible for macroscopic haematuria. This lesion is difficult to diagnose preoperatively despite progress in imaging techniques. These diagnostic difficulties account for the high rate of radical treatment (nephrectomy or nephro-ureterectomy) due to a suspicion of renal carcinoma or upper urinary tract tumour. However, conservative diagnostic and therapeutic management can be performed by a combination of CT angiography, flexible ureteroscopy and selective embolization.

[Prostate cancer: comparative study of stage T1a and stage T1b]. / Cancer de prostate: étude comparative stade T1a et stade T1b.

OBJECTIVE: To compare the epidemiological profiles and histoprognostic factors of two groups of prostate cancer: T1a versus T1b. MATERIALS AND METHODS: Between January 1996 and December 2005, 1359 patients were operated for benign prostatic hyperplasia (BPH) in our urology department. All patients had a PSA less than 4 ng/ml, an adenomatous prostate on digital rectal examination with a homogeneous appearance on prostatic ultrasonography. The population of patients with prostate cancer was classified into group 1 (stage T1a) and group 2 (stage T1b). The following parameters were studied: age at diagnosis, PSA, volume of prostatic tissue removed (by resection or enucleation), histological findings. RESULTS: In this series of 1359 operated patients (762 by endoscopic resection and 597 by transvesicalprostatectomy), 44 (3.23%) had prostate cancer Group 1 comprised 18 patients (40.9%) and group 2 comprised of 26 patients (59.1%). Group 1 had a mean age of 74.7 years, a mean PSA of 2.36 ng/ml and a mean prostatic volume of 37.16 ml. Corresponding values for group 2 were 74.4 years, 3.11 ng/ml and 26.3 ml, respectively The Gleason score was low (2-4 and 5-6) and no grade 4 was observed for any of the patients of group 1, while 50% of patients of group 2 had a high Gleason score (7-10). CONCLUSION: The incidence of stage T1a and T1b prostate cancer is low due to the increasingly systematic use of PSA. The volume of the prostate and transitional zone does not influence the stage T1a and T1b prostate cancer detection rate. T1b cancer has a poorer prognosis than stage T1a cancer.

[Uroflowmetry in children: Prospective study of normal parameters]. / Débitmétrie de l'enfant: étude prospective des paramètres normaux.

INTRODUCTION: Uroflowmetry is the simplest urodynamic test to study the lower urinary tract. Uroflowmetry parameters, especially maximum flow rate, are important, but are difficult to interpret due to the lack of normal uroflowmetry data in children. OBJECTIVE: The objective of this prospective clinical study was to evaluate normal uroflowmetry parameters in a prospective series of 202 children between the ages of 5 and 15 years. MATERIALS AND METHODS: We prospectively studied uroflowmetry in a series of 202 children between the ages of 5 and 15 years. Children with voiding disorders, or a psychiatric or neurological illness were excluded. The following variables were determined: age, body surface area (BSA (m2)), maximum flow rate (Qmax (ml/s)), voided volume (V (ml)) and maximum flow time (TQmax (s)). RESULTS: Qmax increased with age, V and BSA in both sexes and was greater in girls. In girls between the ages of 5 and 6 years, mean Qmax was 15.8 for a mean V of 173 and BSA less than 1.06 and, in girls between the ages of 13 and 15 years, mean Qmax was 26.2 for a mean V of 327 and BSA greater than 1.06. TQmax also increased with age, V and BSA and was greater in boys. In boys between the ages of 5 and 6 years, mean TQmax was 6.5 for a mean V of 174 and BSA less than 1.6 and, in boys between the ages of 13 and 15 years, mean TQmax was 7.4 for a mean V of 332 and BSA greater than 1.6. A positive correlation was demonstrated between age and uroflowmetry parameters and the most significant correlation was observed between age and Qmax in both sexes. CONCLUSION: This study on normal uroflowmetry parameters in children not presenting any voiding disorders demonstrated a significant difference, in both sexes, between Qmax and TQmax in relation to age, V and BSA. Uroflowmetry could therefore be useful in the diagnosis of infravesical obstruction.

[Laparoscopic live donor nephrectomy: surgical technique and results]. / Preélèvement laparoscopique du rein de donneur vivant: résultats et aspects chirurgicaux.

OBJECTIVE: To report the results of laparoscopic live donor nephrectomy (LLDN) and to describe our technique. MATERIAL AND METHODS: We retrospectively reviewed 47 laparoscopic live donor nephrectomies performed between January 1999 and July 2005. Several parameters were studied: donor clinical characteristics, intraoperative and postoperative complications, operating time and warm ischaemia time. This series comprised 26 women (55.31%) and 21 men (44.68%) with a mean age of 48 +/- 20 years. Donor nephrectomy was mainly performed on the left kidney (85.37%). It was performed by lumbar endoscopy in the first 20 cases and by laparoscopy in 27 cases. Kidney extraction was performed via an incision between two trocar orifices for the first cases and via an iliac incision for the last 18 cases. RESULTS: The mean operating time was 189 min with a mean blood loss of 127 ml. Warm ischemia time was 6 minutes. Open conversion was required in two cases: renal vein injury in one case and an obese donor with difficulties of dissection in the other case. Surgical revision was required in only one case (haemoperitoneum secondary to genital vein injury). A trocar orifice abscess was observed in one case and prolonged ileus was reported in 2 cases. In the recipient, a urinary anastomotic fistula was observed secondary to ischaemic necrosis of the distal segment of the ureter. Late complications were essentially vascular (19.14%). A right renal graft was lost due to an error of compatibility. Mean serum creatinine was 132 +/- 6.5 micromol/l at 3 months for the other recipients. CONCLUSION: Our experience confirms the feasibility and efficacy of laparoscopic live donor nephrectomy. Intraoperative and postoperative complications and the conversion rate were low. Renal function was rapidly restored in the recipient. The morbidity of this technique is low, but there is a high risk of vascular complications at the beginning of the operator's experience.

[An unusual testicular tumour: splenogonadal fusion]. / Une tumeur testiculaire inhabituelle: fusion splénogonadique.

Splenogonadal fusion is a rare congenital anomaly that is often discovered at operation or autopsy. The diagnosis is difficult, but could be based on preoperative scintigraphy and frozen section histological examination to avoid useless orchidectomy. It is a benign lesion, which must be distinguished from testicular tumour.

[Adrenal myelolipoma]. / Le myélolipome surrénalien.

Adrenal myelolipoma is a benign, non-secreting tumour, which can be complicated by pain or retroperitoneal haemorrhage. The diagnosis is based on CT or preferably MRI. Surgery may be necessary in the case of complications. The contribution of interventional radiology has not been reported in the literature and selective embolization has also not been previously reported.

[Encrusted cystitis]. / La cystite incrustée.

Encrusted cystitis is a chronic inflammation of the bladder mucosa associated with calcified deposits induced by numerous bacteria in an alkaline medium. Corynebacterium urealyticum or group D2 is most frequently incriminated. Encrusted cystitis is a rare disease with non-specific clinical features. The diagnosis may be suspected on imaging, but is often only established later on histological findings. Treatment of this disease is based on appropriate antibiotics with acidification of the urine. The authors report a new case of encrusted cystitis in a 78-year-old woman and review the literature on encrusted lesions of the urinary tract.

[Florid glandular cystitis]. / La cystite glandulaire floride.

INTRODUCTION: Florid glandular cystitis is a rare benign bladder tumour, which can simulate a malignant lesion. MATERIAL AND METHODS: Over a period of fifteen years, we have observed one case of recurrent florid glandular cystitis. RESULTS: This 48-year-old patient presented with terminal haematuria and right low back pain with a history of endoscopic resection of a bladder tumour. Ultrasound showed a solid mass of the bladder base. Intravenous urography showed bilateral uretero-caliceal dilatation, predominant on the right, with a filling defect of the bladder base. CT urography showed invasion of the vesicoprostatic fat and endoscopy revealed a trigonal tumour 5 cm in diameter. Histology concluded on florid glandular cystitis of the intestinal type. Improvement of the symptoms was observed on the fifth postoperative day after resection of the tumour. CONCLUSION: Florid glandular cystitis is a rare benign bladder tumour. The diagnosis is based on clinical examination, radiology and histological examination. Treatment is essentially surgical.

[Intussusception in adults. Thirteen case reports]. / Invaginations intestinales de l'adulte. A propos de 13 cas.

This study was retrospective. The authors analyse the clinical, etiological and therapeutic aspects of the intestinal intussusception based on 13 adults observed over 14 years in the surgical department of the university hospital in Monastir. This disease was rare because accounted for 2.6% of all cases of intestinal obstruction. The diagnosis was made in the majority of cases during the operation (8/13). Abdominal pain was noted in all cases. The underlying pathologic processes were identified in 69%. Operation was required in every case. During the surgery, the lead point was identified in the small bowel in 12 cases and in the colon in one case. An intestinal tumor was found in four patients (39%), only one of which was malignant. Adult intussusception is an unusual cause of abdominal pain and bowel obstruction. It requires preoperative diagnosis. Operative management is always necessary because this condition is almost always secondary to definable lesion.

[Congenital mesoblastic nephroma]. / Le néphrome mésoblastique congénital.

Mesoblastic nephroma is a rare renal tumour mainly observed in neonates and young infants. The authors report a case in a 5-day-old new-born infant presenting with an isolated abdominal mass occupying the left hypochondrium and flank. Ultrasonography demonstrated a 4 cm heterogeneous mass in the lower pole and middle of the left kidney. CT showed an intensely contrast-enhanced heterogeneous mass. The patient was treated by left radical nephrectomy with an uneventful postoperative course. The outcome was favourable without recurrence with a follow-up of one year. Mesoblastic nephroma is considered to be a benign tumour. The diagnosis is suggested by clinical, ultrasonographic and CT findings. Treatment is based on radical nephrectomy. In the light of this case, the authors discuss the clinical, radiological and therapeutic aspects of this tumour.

[Transverse ectopic testis]. / Ectopie testiculaire transverse.

Transverse ectopic testis (TET) is a rare form of ectopic testis. The authors report the case of a 2-month-old infant presenting with right inguinoscrotal hernia and ectopic left testis with an impalpable testis. Opening of the hernia sac revealed two testes with two distally fused vasa deferentes. The contralateral testis was easily descended by translocation through the other inguinal canal. A favourable result was obtained with two testes situated in a normal position. In the light of this case, the authors emphasize the clinical and therapeutic features of this anomaly.

[Leiomyoma of the urinary bladder]. / Le léiomyome de la vessie.

Benign mesenchymal tumors of the bladder are rare. Leiomyoma is the most common mesenchymal tumor of the bladder. We report a new case. A 50-year-old woman presented with total hematuria. Complementary investigations (ultrasonographic, intravenous urography) showed an intravesical solid mass, arising from the bladder dome. Cystoscopic examination suggested a benign tumor, which was confirmed by pathologic assessment of biopsy. Partial cystectomy was performed. Postoperative course was uneventful. Pathologic examination showed a leiomyoma. Leiomyoma of the urinary bladder is a rare benign tumor. Its prognosis is good, the treatment being exclusively surgical.