[Vesicouterine fistulas: an experience of 17 years]. / Les fistules vésico-utérines: une expérience de 17 ans.

OBJECTIVE: To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment. MATERIALS AND METHODS: The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects. RESULTS: The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair. CONCLUSION: Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

Traitement des sténoses de l'urètre par urétrotomie interne endoscopique: résultats anatomiques et fonctionnels d'une série de 244 cas

Evaluer les résultats d'une série homogène de sténoses urétrales traitées de façon univoque par urétrotomie interne endoscopique (UIE) et d'étudier les éléments à valeur prédictive du résultat.Patients et méthodes. Entre 1989 et 2007, 244 patients ont été hospitalisés pour sténose de l'urètre. Ils ont bénéficié d'une UIE sous contrôle de la vue. Résultats.Il y a eu 34,3% de bons résultats après la première UIE. Le recul moyen était de 3,5 ans. La mortalité était nulle et la morbidité était évaluée à 5%. Le résultat était d'autant meilleur que le geste concernait une sténose courte (inférieure à 2 cm), unique sur l'urètre proximal. La durée moyenne du cathétérisme post-opératoire a été de 2 jours; maintenir ce cathétérisme au delà n'a pas apporté d'amélioration significative. Les mauvais résultats (65,6%) ont été rapportés dans les cas de sténose étendue, siégeant sur l'urètre distal ou concernant des patients âgés. 62,5% ont été guéris après une deuxième urétrotomie, les autres cas ont nécessité des séances de dilatations urétrales d'entretien, voire un geste de plastie. Conclusion. L'UIE est une intervention simple, dépourvue de morbidité majeure et ne nécessitant qu'une hospitalisation courte. Avec un taux de succès stable de l'ordre de 75,4% à 3,5 ans, il nous paraît licite de proposer l'UIE en première intention pour toute sténose urétrale courte, unique, proximale et qu'elle survient chez un sujet jeune, sans antécédents urétraux

Les tumeurs de l'uretre chez l'homme. A propos de 7 cas

Objectif : Etudier les aspects epidemiologiques; diagnostiques et therapeutiques des tumeurs primitives de l'uretre chez l'homme. Patients et methodes : Il s'agit d'une etude retrospective portant sur 7 cas de tumeurs de l'uretre masculin colliges dans notre institution sur une periode de 16 ans (1989-2005). Plusieurs parametres ont ete analyses a savoir l'age des patients; les antecedents; les signes cliniques; l'imagerie et le traitement ainsi que le suiviResultats: L'age moyen des patients etait de 56;1 ans. Les antecedents montraient des uretrites a repetition (4 cas) et une stenose cervico-uretrale traitee (4 cas). Les circonstances de decouverte de la tumeur etaient des signes irritatifs et obstructifs chroniques chez tous nos patients; une notion de retention aigue d'urine chez 5 patients; une uretrorragie et une pyurie dans 5 cas et une alteration de l'etat general dans 3 cas. La plupart de nos patients avaient plus d'un signe. Le diagnostic a ete evoque par l'uretrocystographie retrograde et mictionnelle et confirme par l'uretrocystoscopie avec biopsie. Tous nos patients avaient un carcinome epidermoide. La tumeur etait diagnostiquee au stade locoregional dans 6 patients. Le traitement etait endoscopique (une resection trans-uretrale) chez un patient et chirurgical dans 2 cas: uretrectomie associee a une cystoprostatectomie et une derivation urinaire type Coffey chez un patient qui presentait une tumeur de l'uretre prostatique stade T3N0M0: amputation de verge avec uretrostomie perineale et orchidectomie chez un patient qui presentait une tumeur au niveau de l'uretre bulbomembraneux (stade T4N0M0 avec atteinte scrotale). Une radiotherapie adjuvante a ete realisee dans ces 2 cas. Un parage chirurgical d'un phlegmon de verge provoque par la tumeur de l'uretre a ete realise chez 3 patients avec la mise en place d'une sonde vesicale a demeure dans un cas; d'une cystostomie definitive chez les 2 autres. Le dernier patient avait un envahissement ganglionnaire bilateral et a ete confie pour radiotherapie preoperatoire; mais 3 mois plus tard il a developpe des metastases pulmonaires et il est decede. La chimiotherapie n'a pas ete utilisee chez nos malades. Le recul moyen etait de 9;5 mois. Trois patients ont ete en remission complete: deux avaient beneficie d'un traitement chirurgical et un d'un traitement endoscopique. Un patient est decede et les 3 autres ont ete perdus de vue .Conclusion: Les tumeurs de l'uretre masculin restent d'un pronostic gravissime malgre les divers traitements proposes. Leur rarete rend difficile l'evaluation des moyens therapeutiques qui seront fonction de l'extension ganglionnaire et du stade de la tumeur

La tuberculose genitale masculine : a propos de 22 cas

Objectif : Rapporter les particularites epidemiologiques; anatomo-cliniques; pronostiques et therapeutiques de l'atteinte genitale masculine de la tuberculose avec revue de la litterature. Patients et methodes : Il s'agit d'une etude retrospective portant sur 22 cas de lesions genitales de tuberculose confirmees. Le diagnostic a ete pose sur un faisceau d'arguments cliniques; bacteriologiques; radiologiques et histologiques. Un traitement anti-tuberculeuse a ete instauree systematiquement. La surveillance a ete clinique; biologique et radiologique. Resultats: Les motifs de consultation ont ete par ordre de frequence decroissant : l'epididymite chronique (11 cas); une fistule scrotale (6 cas); une hydrocele (6 cas); une retention d'urine (3 cas) et une sterilite (1 cas). L'examen clinique a retrouve un nodule epididymaire dans 11 cas et une hydrocele dans 10 cas. Une leucocyturie sans germe a ete retrouvee dans un cas. L'echographie scrotale realisee a mis en evidence des lesions epididymaires dans 8 cas. Le diagnostic de certitude a ete pose sur l'examen anatomopathologique des pieces operatoires (13 cas); de fragments biopsiques (8 cas); et par la decouverte du bacille de Koch dans les urines (1 cas). L'urographie intraveineuse realisee systematiquement a retrouve des lesions urinaires associees dans 5 cas. L'evolution a ete favorable dans tous les cas.Conclusion: L'atteinte tuberculeuse isolee des organes genitaux masculins est de diagnostic difficile en dehors d'un contexte endemique tuberculeux. Une etiologie tuberculeuse doit etre suspectee devant toute orchiepidydimite trainante; particulierement sur terrain debilite ou devant une notion d'hypofertilite. Le traitement medical reste efficace en cas de diagnostic precoce; alors que la chirurgie est reservee aux cas resistants ou compliques

L'uretrorraphie termino-terminale tardive dans la rupture post-traumatique de l'uretre posterieur

"Objective: To analyse the long-term results of the treatment of post-traumatic posterior urethral rupture by delayed bulboprostatic anastomotic repair and to evaluate the efficacy and advantages of this technique. Patients and Methods: Between February 1989 and February 2004; 15 patients underwent delayed bulboprostatic anastomotic repair of post-traumatic posterior urethral ruptures. The results were evaluated taking into account the quality of micturition; continence and erectile function. Results: After an average follow-up period of 34 months (range: 12 - 72 months); all our 15 patients were continent and voided with a satisfactory flow. To achieve this result; 5 patients (33;3) had to undergo internal ureterotomy. Only 4 patients (26.7) reported erectile problems. Conclusion: Delayed bulboprostatic anastomotic repair remains the ""gold standard"" in the treatment of post-traumatic posterior urethral rupture. Compared to other methods of treatment of post-traumatic stenosis of the ureter; this technique allows for a long-term success with minimal complications."

Tezosentan, an endothelin receptor antagonist, limits liver injury in endotoxin challenged cirrhotic rats.

BACKGROUND/AIMS: Lipopolysaccharide (LPS) induces liver injury which is associated with upregulated endothelin (ET)-1 production. The aim of this study was to investigate the effects of tezosentan, a non-selective ETA and ETB receptor antagonist, in LPS challenged rats with cirrhosis. METHODS: Rats with cirrhosis received LPS and then tezosentan or placebo one hour later. Four hours after LPS administration, rats were killed to measure serum transaminase activity and plasma tumour necrosis factor alpha (TNF-alpha) levels. Hepatic inducible nitric oxide synthase (iNOS), myeloperoxidase (MPO), a marker of neutrophil infiltration, and cyclooxygenase (COX)-2 expression were also measured. RESULTS: LPS administration significantly decreased arterial pressure and significantly increased plasma endothelin levels. Following LPS and tezosentan administration, serum aspartate aminotransferase and alanine aminotransferase activities were similar to those in the control group while they were increased by more than 700% with LPS alone. Plasma TNF-alpha levels were significantly lower in rats receiving LPS and tezosentan (182 (38) pg/ml) compared with those receiving LPS alone (821 (212) pg/ml). Tezosentan significantly decreased hepatic MPO activity and hepatic neutrophils but had no effect on LPS induced iNOS or COX-2. Survival rate was significantly higher in rats receiving LPS plus tezosentan (80%) than in rats receiving LPS alone (50%). CONCLUSION: In LPS challenged cirrhotic rats, tezosentan administration prevents LPS induced liver injury by decreasing intrahepatic neutrophil infiltration. In addition, tezosentan increases survival in these rats.

[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.

[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.

Role of small-conductance Ca2+-dependent K+ channels in in vitro nitric oxide-mediated aortic hyporeactivity to alpha-adrenergic vasoconstriction in rats with cirrhosis.

BACKGROUND/AIMS: In vitro studies have shown that cirrhotic aortas are hyporeactive to the contractile effect of vasoconstrictors because upregulated endothelial nitric oxide-synthase (NOS) overproduces nitric oxide (NO). Although stimulation of endothelial small-conductance Ca2+-dependent K+ (SK(Ca)) channels may elicit vasorelaxation in normal arteries, the role of these channels in cirrhosis-induced hyporeactivity is unknown. Thus, the aim of the present study was to investigate the role of endothelial SK(Ca) channels in cirrhosis-induced, NO-mediated, in vitro aortic hyporeactivity to alpha1-adrenergic vasoconstrictors. METHODS: Isolated thoracic aortas from cirrhotic and normal rats were used. The effects of apamin, a selective SK(Ca) channel blocker, were measured on the vascular reactivity to phenylephrine. In addition, SK(Ca) channel protein expression was studied. The effects of iberiotoxin and charybdotoxin, blockers of other K(Ca) channels, were also studied in cirrhotic aortas. RESULTS: Apamin suppressed cirrhosis-induced aortic hyporeactivity to phenylephrine in an endothelium-dependent, NOS-inhibitor-sensitive manner. SK(Ca) channel protein was overexpressed in cirrhotic aortic walls. Iberiotoxin abolished cirrhosis-induced aortic hyporeactivity to phenylephrine in an endothelium-dependent but NOS-inhibitor-resistant manner. Charybdotoxin did not induce any significant increase in phenylephrine-elicited contraction. CONCLUSIONS: In cirrhotic aortas, the overexpression and overactivity of endothelial SK(Ca) channels contributes to in vitro NO-mediated hyporeactivity to the contractile action of alpha1-adrenergic agonists.

Role of nitric oxide in hepatopulmonary syndrome in cirrhotic rats.

The hepatopulmonary syndrome (HPS) is characterized by intrapulmonary vascular dilatations and an increased alveolar-arterial oxygen difference (AaPO(2)). Exhaled nitric oxide (NO) concentrations are elevated, suggesting that pulmonary NO overproduction may be the mechanism underlying HPS. We investigated whether common bile duct ligation in rats results in lung NO overproduction and whether normalization of NO synthesis by a 6-wk course of N(G)-nitro-L-arginine methyl ester (L-NAME) (5 mg x kg(-)(1) x d(-)(1)) prevents HPS. Untreated cirrhotic rats showed increases in AaPO(2) and in cerebral uptake of intravenous (99m)Tc-labeled albumin macroaggregates (indicating intrapulmonary vascular dilatations), with decreases in pulmonary vascular resistance and in pulmonary vasoconstriction induced by angiotensin II and hypoxia. Increases were found in exhaled NO; pulmonary total and calcium-dependent NO synthase (NOS) activities; and pulmonary expression of inducible and, to a lesser extent, endothelial NOS. Accumulation of intravascular macrophages accounted for the inducible NOS expression. L-NAME normalized AaPO(2), brain radioactivity, pulmonary vascular resistance, reactivity to hypoxia and angiotensin II, exhaled NO, and NOS activities. These findings suggest that HPS and the associated reduced response to pulmonary vasoconstrictors seen in untreated cirrhotic rats are related to increased pulmonary NO production dependent primarily on increases in the expression and activities of inducible NOS within pulmonary intravascular macrophages.

[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.

[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.

[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.

[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.