[Renal hydatid cyst: radiologic features and therapy]. / Kyste hydatique du rein : aspects radiologiques et thérapeutiques.

Hydatid disease is endemic in some Mediterranean countries. Kidney is a relatively rare site, representing 2 to 3 % of all visceral sites. The diagnosis of hydatid cyst of the kidney is suspected in epidemiological, clinical, radiological and biological arguments. It remains clinically silent for a long time and only presents at the stage of complications. Ultrasound can suspect the hydatid nature of the lesion in 50 % of cases. Computed tomography and magnetic resonance imaging are helpful in the event of problem of differential diagnosis. The standard treatment for renal hydatid cyst is resection of the prominent dome and nephrectomy is indicated in cases of destroyed kidney.

Mule bite to the male genitalia with complete penile and anterior urethra amputation: unusual case and review of the literature.

Animal bite is rare with few cases reported in the literature. The morbidity of animal bites is directly related to the severity of the initial wound. Most victims are boys, and dog bites are the most common injury. Infectious complications are unusual, since treatment is sought early (Wein 2007). Thus, urologists are not usually familiar with management and principles for treating this condition. The authors report the case of a 38-year-old male with a severe mule bite injury to the genitalia causing complete penile and anterior urethra amputation and scrotal wound with no involvement of its contents. To our knowledge, no such case had ever been reported in the medical literature. This kind of emergencies is challenging for urologists.

[Combined inguinal hernia repair and transurethral resection of the prostate (TURP) for benign prostatic hypertrophy]. / Cure de hernie inguinale et résection transurétrale de l'adénome de prostate en un seul temps opératoire.

OBJECTIVE: Our aim was to evaluate the outcome of transurethral resection of prostate (TURP) and inguinal hernia repair performed in a single session. METHODS: Data was obtained retrospectively for 31 patients (mean age 65 years) who underwent simultaneous TURP and inguinal hernia repair. Most patients had lower urinary tract symptoms related to BPH such as acute urinary retention, recurrent bladder retention, or severe dysuria. Twenty-one patients had simple inguinal hernia and ten had large inguinoscrotal hernia. Operations were performed in 23 patients under spinal anesthesia. Bassini's operation was the most common herniorrhaphy technique (23 patients). RESULTS: We observed good outcomes in 86% of the patients. The morbidity rate was 10.7%, the mean postoperative stay was 3.6 days (2-6 days). There was no recurrence of inguinal hernia. CONCLUSION: Combining TURP and inguinal hernia repair in one session decreases the number of procedures and anesthesias, hospital stay, and thus direct health costs and does not result in an increase in operative or postoperative morbidity.

[Renal stab wounds: about 20 cases]. / Plaies rénales par arme blanche: à propos de 20 cas.

OBJECTIVE: To assess the indication for operative and nonoperative management of renal stab wounds in patients hospitalised over the last six years. PATIENTS AND METHODS: Retrospectively studied of 20 cases over the last six years with penetrating kidney trauma, managed in two urologic departments of Marrakech and Casablanca. We studied the signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine), associated lesions, treatment and complications. The imaging procedures comprised abdomen ultrasonography and abdomen computed tomography scan (CT). RESULTS: The mean age was 25-year-old (range: 14-50 years), macroscopic hematuria was present in 95%. The weapon introduction site was the left lumbar fossa in 15 cases, the right lumbar fossa in four cases and the left flank in one case. Six patients (30%) presented with haemodynamic instability. Anaemia (<10g/dl) was found in 14 cases (70%) and blood transfusion was necessary in eight cases (40%). According to the American Association of Trauma Surgery (AATS) classification of kidney trauma, our patients were classified as follows: Grade I (two cases), Grade II (four cases), Grade III (six cases), Grade IV (five cases) and Grade V (three cases). The conservative management was adopted for 15 patients (75%), and two patients had a double pigtel ureteric stent for an important leakage of the contrast product. A CT scan was systematically performed ten days after the trauma and the kidney traumas lesions were often stabilized. Nephrectomy was performed for 5 patients (25%) grade IV (two cases) and grade V (three cases). The patients were discharged after a mean period of 12 days (six to 33 days). CONCLUSION: The development of interventional radiology, endourological drainage techniques and medical intensive care helps to limit the complications and to manage conservatively with a correct resuscitation for selected patient. A grade V is a surgical indication.

Les abcès du psoas: aspects diagnostic et therapeutique

Objectif: Décrit pour la première fois en 1881 par Mynter1, l'abcès du psoas est une maladie rare. Les auteurs rapportent leur expérience dans la prise en charge de cette pathologie. Patients et méthodes: De janvier 1999 jusqu'en décembre 2002, quinze observations d'abcès du psoas, 12 hommes (80%) et 3 femmes (20%), d'âge moyen de 53 ans (27 - 70 ans), ont été colligées dans notre service. Le délai moyen d'hospitalisation est de 6 semaines (2 semaines - 24 semaines). L'interrogatoire permettait de reconstituer l'histoire de la maladie et une enquête étiologique. Tous les patients ont été explorés par le couple abdomen sans préparation et échographies abdominales. Neuf patients ont eu un uro-scanner. Le drainage chirurgical par une petite incision de 5 cm a été effectué chez 12 patients. Le traitement étiologique a été réalisé ultérieurement chez 9 patients. Résultats : La symptomatologie clinique était faite de fièvre chez 9 malades (60%), d'un psoïtis chez 6 malades (40%), d'une masse lombaire chez 5 malades (33%) et d'une masse inguinale chez 3 malades (20%). Une hyperleucocytose oscillant entre 13000 et 34000 /mm3 a été trouvée chez tous les malades (54%). Les germes les plus fréquemment isolés sont le staphylocoque doré (54%), le bacille de Koch (38,4%), Escherichia coli (15%) et Klebsiella (8%). L'abcès du psoas était primitif chez 4 malades (26.6%) et secondaire chez 11 malades (73.3%). Le traitement chirurgical qui consiste à drainer largement la collection purulente a été réalisé chez 8 malades par voie lombaire antérolatérale extra péritonéale et par voie inguinale haute chez 4 malades. Trois de nos malades ont bien évolué sous traitement médical associé à un drainage percutané. L'évolution immédiate est favorable chez tous nos malades. Conclusion: L'abcès primitif du psoas reste de pathogénie obscure. C'est un piège diagnostique pour le clinicien. Le diagnostic clinique précis de l'abcès et la sanction thérapeutique ont bénéficié des données récentes de l'imagerie moderne. Le traitement chirurgical reste la référence en cas d'échec du drainage percutané