Relevant genetic polymorphisms and kidney expression of Toll-like receptor (TLR)-5 and TLR-9 in lupus nephritis.

Toll-like receptor (TLR) genetic polymorphisms may modify their expression causing inflammatory disorders and influencing both susceptibility and severity of lupus erythematosus. We aim to determine whether TLR-5 and TLR-9 gene polymorphisms are implicated in the susceptibility to systemic lupus erythematosus (SLE) and lupus nephritis (LN) and to evaluate their expressions and distributions in renal LN patients' biopsies. The frequencies of two SNP in the TLR-9 gene and one in the TLR-5 gene was examined in 106 SLE patients (among them 37 LN patients) and in 200 matched controls by polymerase chain reaction-restriction fragment-length polymorphisms (PCR-RFLP) analysis. TLR-9 and TLR-5 expressions were assessed by reverse transcription (RT)-PCR and immunohistochemistry carried on LN renal biopsies compared to healthy renal tissue. A significant genotypic and allelic association was revealed between TLR-9-rs352140 and both SLE and LN (P < 0·05). The TLR-9 transcript level was significantly higher in LN biopsies compared to control (P < 0·05). This increase was observed histochemically in the tubulointerstitial compartment. TLR-9 was detectable in LN glomeruli patients but not in normal control glomeruli. No allelic nor genotype association was found with TLR-5-rs5744168 in SLE. but the T allele and the TT genotype were raised significantly in the LN group (P < 0·05). A significant increase in TLR-5 gene expression in LN biopsies, which contrasted with normal kidneys (P < 0·05), was confirmed by an intense and diffuse staining for TLR-5 only in LN tubules (P < 0·05). Our data show that TLR-5 and TLR-9 are susceptible genes to LN and that their expression is dysregulated in LN patients' kidneys, supporting a role of these mediators in the pathogenesis of LN.

[Male sexuality after external continent urinary diversion type Mitrofanoff]. / Étude de la sexualité masculine après dérivation urinaire externe continente de type Mitrofanoff.

OBJECTIVE: To evaluate the influence of continent external urinary diversion type Mitrofanoff on male sexuality. MATERIAL AND METHODS: Between 1992 and 2011, 140 patients underwent continent urinary diversion type Mitrofanoff at an academic hospital. Among 76 men, 46 were interviewed about their sexuality after this operation. This study was performed using a set of validated questionnaires (IIEF, DAN PSS and Urolife), grouped by the model of the CTMH. Patients were divided according to their marital status: group 1: patients married before surgery (15 cases), group 2: patients married after surgery (7 cases) and group 3: singles (24 cases). RESULTS: In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology. CONCLUSION: To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre- and postoperative evaluation will better clarify the factors affecting sexuality in these patients.

Nosocomial outbreak of Myroides odoratimimus urinary tract infection in a Tunisian hospital.

We report a nosocomial outbreak of urinary tract infection caused by Myroides odoratimimus, previously called Flavobacterium odoratum, in the urology unit of a Tunisian hospital. From May to November 2010, seven isolates of M. odoratimimus were recovered from urine. Pulsed-field gel electrophoresis clearly differentiated these isolates into two possibly related clones from two different periods. All patients but one had urinary calculi and underwent endourological surgery. All Myroides isolates were resistant to all antibiotics tested. Three patients were successfully treated with ciprofloxacin and rifampicin. Clinicians should be aware that M. odoratimimus may induce serious and prolonged nosocomial outbreaks of urinary tract infections.

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.

Evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle).

OBJECTIVE: To study the evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle) (ECUD-M) associated with ileocystoplasty. PATIENTS AND METHODS: Over 18 years from 1992 to 2009, ECUD-M with ileocystoplasty was performed in 120 patients with mean age of 25.5 years. Renal impairment was evident in 43 patients (17 children and 26 adults). RESULTS: Ninety percent of patients demonstrated a neurologic bladder and mild to moderate renal failure. Initially, all patients underwent continuous bladder drainage for a mean of 3 weeks. Renal function improved in 35 patients, although with persistent mild renal insufficiency. The other patients demonstrated moderate persistent residual renal insufficiency. During a mean follow-up of 10 years (range, 1-18 years), renal function returned to normal in 13 patients, stabilized at lower values in 15, and remained moderate in 5. After a mean follow-up of 8 years (range, 6-12 years), renal failure gradually worsened, increasing to higher values in 6 patients and leading to hemodialysis in 4. One patient underwent living-donor kidney transplantation, with good evolution. CONCLUSION: ECUD-M with ileocystoplasty can lead to normalization unless stabilizationof impaired residual renal function by eliminating the obstructive factor provides self-adequate management of the diversion. The procedure delays for the need forhemodialysis therapy, and enables patients to prepare for kidney transplantation into a previously reconstructed lower urinary tract.

Primary adenocarcinoma in a kidney allograft: a case report and review of the literature.

De novo tumors are common complications after solid organ transplantation. Lymphoma and skin cancers are the most frequently observed malignancies. However, graft carcinomas can be observed to be five times more frequent after kidney transplantation compared to their incidence in the general population. We report a case of a 49-year-old female who developed an early adenocarcinoma of the graft as revealed by acute renal failure. She underwent transplantectomy and chemotherapy with hemodialysis therapy. Carcinoma of the graft is a rare but serious complication usually occurring late after transplantation. Close monitoring of a kidney recipient using abdominal ultrasound may detect this complication at early stages, which may improve the prognosis. Similarly, good screening of donors may prevent tumor transmission.

Primary Plasmacytoma of the Testis with no Evidence of Multiple Myeloma: a New Case Report and Literature Review

Plasmacytomas of the testis are extremely rare tumours; especially when occurring in the absence of a previous or concurrent diagnosis of multiple myeloma. We report a new case of solitary testicular plasmacytoma; with immunohistochemical studies showing monoclonal cytoplasmic production of IgG lambda light chains; in a 51-year-old man who had no evidence of multiple myeloma 3 years after the orchiectomy

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.

[Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. / Dérivation urinaire de Mitrofanoff. Mécanismes physiques et explication urodynamique de la continence.

OBJECTIVE: To analyze the urodynamic parameters and the mechanisms of continence of Mitrofanoff urinary diversion. MATERIAL AND METHODS: Urodynamic assessment was performed via the stoma in 11 patients with continent urinary diversion according to the Mitrofanoff principle. The mean age of the patients at the time of the operation was 29 years. The appendix, used as conduit in all cases, was anastomosed to the skin of the right iliac fossa. Ileocystoplasty was performed in 10 patients. The urodynamic assessment was performed after a mean follow-up of seven years (range: five to 12 years). RESULTS: Reservoir pressures after filling did not exceed 20 cm H2O in nine cases. Uninhibited contractions were recorded in two patients with an enlarged bladder with pressures not exceeding 30 cm H2O. Appendix pressures during filling were always higher than bladder pressures. The mean pressure measured at the end of filling was 75 cm H2O (range: 45 to 90 cm H2O). After the Valsalva maneuver, these pressures were between 80 and 150 cm H2O with good transmission. The mean conduit closing pressure was 70 cm H2O (range: 40 to 90 cm H2O). The mean functional length of the conduit was 5 cm (range: 2.6 to 7.2 cm). CONCLUSION: The Mitrofanoff diversion is mainly characterized by the high intraluminal pressure in the continent conduit. A low bladder pressure is essential to maintain a perfectly continent diversion.

Successful Treatment of Homozygous Cystinuria with Captopril

Objective : Cystinuria is an autosomal recessive hereditary disorder associated with nephrolithiasis and its attendant complications. Traditional management using oral alkali; D-penicillamine; or mercaptopropionyglycine in an attempt to increase urinary cystine solubility is often unsuccessful due to intolerable side-effects. The aim of this study was to determine; if captopril could reduce urinary cystine excretion in homozygous cystinuric patients. Patients and methods : Three cystinuric patients with a history of multiple cystine stones despite previous traditional therapy were treated with 150 mg captopril daily for 3 years after determination of their baseline 24-hour urine cystine excretion. Cystine excretion studies were repeated subsequently at 6-month intervals. Results : The baseline 24-hour urine cystine excretion was within the expected limits for homozygous cystinuria in all patients (1072; 862 and 959 mg cystine per gm creatinine per 24 hours). After institution of captopril treatment; all patients had a significant decrease in urinary cystine levels (374; 313 and 451 mg cystine per gm creatinine per 24 hours). No patient experienced recurrent nephrolithiasis or adverse drug effects. Conclusion : We conclude that captopril can significantly decrease urinary cystine excretion in patients with homozygous cystinuria. Captopril should be considered an alternative to traditional drug management of cystinuria

Screening of Y chromosome microdeletions in Tunisian infertile men.

The aim of this study was to establish the prevalence of Y chromosomal microdeletions in infertile Tunisian men. Three groups of infertile men, 65 normospermic, 53 oligozoospermic and 45 azoospermic, were tested for Yq microdeletions detection by multiplex polymerase chain reaction (PCR) using specific Y chromosome AZF regions tagged site markers (STS). One group of 13 healthy men was used as the control group. Six STS were tested (2 in each AZF region). The general prevalence of AZF microdeletions was 16%; in azoospermia and severe oligospermia groups, it was higher (29% and 30.5%, respectively). Significant differences were found with moderate oligospermic and normospermic groups (p < 0,05). AZFc microdeletions were the most frequent, and 55% of AZFc deleted patients were oligospermic. No deletions were detected in the control group. These results add to the growing literature data, showing that microdeletions of the Y chromosome is an important cause of severe spermatogenetic defect and confirm that deletion in AZFc region is the most common and is compatible with residual spermatogenesis.

[Traumatic unilateral renal artery thrombosis and protein C deficiency. A case report]. / Thrombose post-traumatique de l'artère rénale et déficit en protéine C. A propos d'un cas.

Post traumatic renal artery thrombosis is rarely described in the literature. This pathology can result from stretch injury to inelastic intima of the renal artery, or by the direct flow to the abdomen causing compression injury to the renal artery against the vertebral column. However, the association of this pathology with hematologic diseases (in particular protein C deficit) was never described. We report an observation of a 28-year-old man with an uneventful history who was admitted to the intensive care unit for traumatic head injury associated with post traumatic renal artery thrombosis requiring nephrectomy. The etiologic investigation of this thrombo-embolic complication reveals a protein C deficit. Our patient was improved under treatment. This original observation confirms that post traumatic renal artery thrombosis can be associated with hematologic diseases (in particular protein C deficit).

[Verrucous carcinoma of the kidney: report of 2 cases]. / Carcinome verruqueux du rein: à propos de deux cas.

The verrucous carcinoma is an unusual shape of well differentiated squamous cell carcinoma, first described at the ORL region; the kidney location is rare; the risk factors are represented essentially by lithiasis and/or urinary infection; the clinical symptom is not specific. Diagnosis is facilitated by radiological investigations and particularly excretory urogram/ultrasound; certainly diagnosis is pathological. The nephro-ureterectomy with collar resection of the bladder is the choice treatment. We report two observations and we clarify clinicopathological aspects of this type of carcinoma and we discuss the prognosis.

[Primary malignant paratesticular tumors: report of six cases]. / Les tumeurs malignes primitives paratesticulaires: à propos de six cas.

The authors report six cases of primary malignant paratesticular tumors. They reexamine the literature and emphasize the influence of the histopathological type of these tumors on the prognosis. Survival of the patients is better when tumors are differentiated and detected early.

[Primary paratesticular malignant tumors: report of 6 cases]. / Les tumeurs malignes primitives paratesticulaires: à propos de six cas.

The authors have made a study of 6 cases of malignant primary paratesticular tumor, and have also included a review of the literature on this topic. They emphasize the importance of the effect of histopathological type of tumor on disease outcome. There is an improved survival potential in cases where the tumors are differentiated, and discovered at an early date.

[Carcinosarcoma of the bladder: a case report]. / Carcinosarcome de la vessie: une observation.

Carcinosarcoma of the urinary bladder is a uncommon tumor with characteristic histopathologic and immunohistochemical findings; his histogenesis have still not been clear; the prognosis seems to be improved by radical cystectomy and adjuvants therapies. We report a case of 47 years old women suffering from suprapubic pains, dysuria and hematuria of five months duration and had a 10 cm suprapubic mass that was found on physical examination. Radiographically, the tumor invaded the dome of the urinary bladder and causes bilateral hydronephrosis. Microscopically it was an urinary bladder carcinosarcoma. Our objective is to discuss the histogenesis, the anatomoclinical and prognosis of these rare tumors.

[The pathological prostatic utricle: two case reports]. / L'utricule prostatique pathologique: à propos de 2 observations.

The prostatic utricle is a small vestigial diverticulum on the posterior surface of the prostatic urethra. It is considered to be pathological when it is abnormally dilated. The prostatic utricle is revealed by signs of vesical irritation and dysuria, sometimes associated with a retrovesical mass on examination. The authors report two cases of pathological prostatic utricle. The first case was an 11-year-old boy presenting with dysuria. Retrograde cystourethrography confirmed the diagnosis. The utricle was resected via a transtrigonal intravesical approach. The second case was a 25-year-old man who presented with dysuria associated with a pelvic mass. IVU and ultrasonography suggested a diagnosis of retrovesical cyst. This patient underwent incomplete resection of the utricle via a retrovesical approach. Based on a review of the literature, the authors emphasize the need to look for a prostatic utricle in a young subject presenting with dysuria, particularly in patients with a malformation of the genitourinary tract (hypospadias, renal agenesis). All pathological prostatic utricles must be treated surgically. The incision is transtrigonal in medium-sized utricles and transperitoneal in large utricles. The utricular cavity must be resected as completely as possible.

[Renal cell adenocarcinomas. Report of 64 cases]. / Adénocarcinomes du rein. A propos de 64 cas.

The authors report 64 renal cell carcinomas observed in 64 patients over a period of 14 years (1982-1995). The mean age was 58 years (range: 20 to 80 years). Male involvement was observed in 34 cases (53%). The clinical symptoms were nonspecific, consisting of haematuria (26 cases), back pain (33 cases) and tumour (8 cases). Twenty patients presented with paraneoplastic syndromes and 4 presented with metastases. The tumour was an incidental finding in 6 cases. Fifty two patients were treated by radical nephrectomy and two by partial nephrectomy. The tumour was associated with venous involvement in 2 cases, lymphatic involvement in 4 cases and distant metastases in 2 cases. The overall 5-year survival was 37% with a poor prognosis in the case of lymph node involvement or metastases and in the case of secondary local recurrence (4 cases) or distant metastases (2 cases).

[Kidney contusions and traffic accidents. Apropos of the Tunisian experience]. / Contusion rénale et accidents de la voie publique. A propos d'une expérience tunisienne.

The authors report a retrospective series of 45 cases of blunt renal trauma from a total of 685 cases of blunt abdominal trauma observed between 1989-1993. This multicentre trial was designed to illustrate the severity of this type of trauma and to place it in the context of road accidents in Tunisia.