[Is it necessary to perform urine culture systematically prior to double J ureteral stent removal?] / Est-il nécessaire de faire systématiquement un ECBU avant l'ablation d'une sonde double J ?

OBJECTIVE: To assess the value of systematic urine culture before ureteric double j removal. MATERIAL AND METHODS: This prospective audit was performed to assess the validity of our current clinical practice. A cohort of informed patients without clinical signs of urinary tract infection and without predefined risk factors were programmed for ureteral double j stent removal in an outpatient setting. Urine was sampled for culture immediately before the procedure. Patients had to complete a self-questionnaire 15 days following stent removal, inquiring about tolerance and complications which were to be analyzed according to the culture results. The primary endpoint was the occurrence of febrile urinary tract infection. RESULTS: Among the 56 participants, immediate preoperative urine culture revealed colonization in 9 patients (16.1%) and contamination in 6 patients (10.7%). A significant association was found between bacteriuria and double j placement following surgery with urinary tract injury (P<0.02) and diabetes (P<0.009). Two patients had fever including a man with sterile urine and a woman with Staphylococcus Aureus infection. No hospitalization was necessary. Twelve patients reported functional signs with lumbar pain being the most common. There was no significant association between functional signs and patients' clinical characteristics. CONCLUSION: This evaluation was not in favor of modifying our protocol of care i.e. the lack of performing neither antibiotic prophylaxis nor systematic urine culture before JJ ureteral stent removal in a selected population. LEVEL OF EVIDENCE: 4.

[Pathology of the processus vaginalis in urological practice]. / La pathologie du canal péritonéo-vaginal en pratique urologique.

PURPOSE: To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. PATIENTS AND METHODS: We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. RESULTS: A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. CONCLUSION: Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. LEVEL OF EVIDENCE: 5.

[Scrotal calcinosis: clinical and therapeutic aspects in 5 cases]. / La calcinose scrotale : aspects cliniques et thérapeutiques à propos de 5 cas.

Scrotal calcinosis is a rare pathology and etiology still discussed. We report five cases in patients without particular history of another disease. Clinical examination revealed scrotal wall with painless nodules of various sizes producing a whitish substance, pasty. The phosphate levels were normal in all patients. They all had a resection of the lesions associated with scholarships plasty recovery. Histopathological study revealed calcified epidermoid cysts in 4 cases.

[Testicular bilharzioma by Schistosomia haematobium: about two cases]. / Bilharziome testiculaire à Schistosomia haematobium: à propos de deux observations.

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area.

[Renal bilharzioma: A case report]. / Bilharziome rénal : à propos d'une observation.

Renal bilharzioma is an exceptional localization that occurs as a complication of urogenital bilharzioma. The authors report the case of a renal bilharzioma, in a 7-year-old patient, being considered as a nephroblastoma. The investigations revealed a large abdominal mass with solid component. She underwent neoadjuvant chemotherapy and radical nephrectomy. The histological examination of the specimen concluded to renal bilharzioma. The authors underline the difficulty of differential diagnosis with nephroblastoma. The diagnosis is often made after surgery by histological examination of the specimen.

[Complications of transrectal prostate biopsy]. / Complications de la biopsie prostatique transrectale.

OBJECTIVES: The aim of this study was to report the transrectal prostate biopsy complications, to identify the factors involved in their occurring and to insist on their prevention. PATIENTS AND METHODOLOGY: It is a prospective study interested on patients managed in the urological and andrological service in Aristide le Dantec Hospital in Dakar for prostate tumour from February 2002 to March 2004 and in whom the indication of prostate biopsy was performed. All the patients fulfilling the including criteria were taken in care according to a same protocol that was a transrectal sextant biopsy This act was performed under preventive antibiotherapy based on fluoroquinolones started one day before and going on three days after biopsy associated to a rectal preparation performed the same day of biopsy At the end of the biopsy the patient was managed externally during three days after biopsy Following parameters were studied: age of patients, the histopathological results and the post operative complications. RESULTS: Two hundred and four (204) biopsies were performed. The median age of the patients was 69.1 years with the extremes of 42 years and 93 years. The global rate of complications was 13.5% with a majority of bleeding. There no major complication registered. Rectal and urethral bleeding was over in 24 hours. The complete urine retention was under the form of a unique happening complication. The distribution of complications according to the results of the biopsy did not reveal any particularity. CONCLUSION: The rectal preparation associated to preventive antibiotherapy seems to reduce infectious complications.

[Surgical treatment place in the management of prostate cancer: report of 96 cases]. / Prise en charge chirurgicale du cancer de la prostate à Dakar: analyse d'une série de 96 cas.

INTRODUCTION: The goal of this study is to access the surgical management of the prostate cancer. PATIENTS AND METHODS: It was a retrospective study including 96 cases of prostate cancer between June 2002 and December 2004. Parameters studied for every patient was: age, the complaints, results of rectal digital examination, the initial TPSA rate, gleason score, results of extension, the clinical grade according to TNM 2002 classification, the treatment and the future of treated patients. RESULTS: The mean age of our patients was 70.9 years with extremes of 50 years and 93 years. The complaints at presentation were dominated by prostatism (43.5%) and urine retention (37.7%). At rectal digital examination, the prostate was suspicious of cancer in 42.7%. The majority of our patients (79.8%) had a TPSA rate superior to 20 ng/ml. The examination revealed that the tumour was an adenocarcinoma in all patients. The majority of our patients (50.3%) had a gleason score inferior to 7. The extension outcome revealed: a loco-regional extension in 63 patients, dorso-lombar bone metastases in 19 patients and absence of secondary localisation in 14 patients. The repartition of patients according TNM classification was as following: T1 (1%), T2 (14.6%), T3 (18.8%) and T4 (65.6%). The patients were managed as following: bladder neck resection (surgically or endoscopically), pulpectomy and radical prostatectomy. CONCLUSION: To ameliorate the prostate cancer management, the highlights of radical prostatectomy is imperative as the spreading of endoscopic surgery in the place of opening surgery.

[Chronic prostatitis: clinical and therapeutical aspects]. / Prostatites chroniques: aspects cliniques et therapeutiques.

AIM: To insist on clinical and therapeutical aspects of chronic prostatitis. PATIENTS AND METHODS: The authors relate a prospective study about 30 patients who were followed for chronic prostatitis. All patients were treated and followed up to 6 months. RESULTS: The mean age of the patients was 31,82 years. Sixty percent of them where send by a physician after failure of medical treatment. Mean delay before consultation were 31.5 months. The main symptoms were pain (pelvic pain, perineal pain, or post ejaculatory pain). The distribution of patients according to the US NIH has shown 13 cases of category II, and 17 cases of category III. Outcome of these patients was favourable in ten cases for category II and nine cases for category III. CONCLUSION: If important efforts were realized for classification and diagnostic approach, many patients often fair to respond to treatment.