[Results of the treatment of renal lithiasis by percutaneous nephrolithotomy: apropos of 115 cases]. / Le résultat du traitement de la lithiase rénale par néphrolithotomie percutanée: à propos de 115 cas.

OBJECTIVES: The objective of this study was to analyse the results of percutaneous nephrolithotomy (PCNL), which was recently introduced into Tunisia, in order to determine its place among the treatment options for renal stones. MATERIAL AND METHODS: Our retrospective study was based on 115 consecutive PCNL procedures performed between April 1994 and November 1997. The stone was a single pelvic stone in 13 cases, lower caliceal in 15 cases, lower pyelocaliceal in 28 cases, partial staghorn in 20 cases, total staghorn in 16 cases and multiple pyelocaliceal in 23 cases. In our series, ultrasound lithotripsy constitutes the procedure of choice for renal stone fragmentation. RESULTS: A good result was obtained immediately in 67% of cases. This figure is lower than that published in the literature because of the complexity of the stones and the high failure rate due to the learning curve, involving 6 members of the team. In the case of failure, the procedure was converted to conventional surgery under the same anaesthetic in 20 patients. Residual stones, observed in 23 patients, were successfully treated by extracorporeal shock-wave lithotripsy (ESWL) in 79% of cases. By combining PCNL and ESWL, the good result rate was 80%. The mortality rate of this series was 0.8% and the morbidity rate was 7.5%. Complications were generally rare and often minor. CONCLUSION: PCNL occupies an important place in the treatment of renal stones. The results depend on the site, size and number of stones and on the operator's experience.

[Leiomyosarcoma of the bladder: apropos of 2 cases]. / Le léiomyosarcome de la vessie: à propos de deux cas.

The authors report two cases of bladder leiomyosarcoma, an extremely rare invasive bladder tumour, with a very poor prognosis due to very early local invasion. The definitive diagnosis can only be established by histological examination. The treatment modalities for this histological type of bladder tumour have not been standardized and remain controversial. However, the treatment of choice appears to be radical prostatocystectomy preceded by neoadjuvant chemotherapy when compatible with the patient's general state.

[Spontaneous subcapsular hematoma of the kidney during periarteritis nodosa]. / Hématome spontané sous-capsulaire du rein au cours d'une périartérite noueuse.

The authors report a case of spontaneous bilateral subcapsular haematoma of the kidney in a patient with polyarteritis nodosa. Although often easy to diagnose, the aetiology of these spontaneous subcapsular haematomas is sometimes difficult to establish despite ultrasonography and computed tomography. The authors emphasise the value of arteriography in these cases, which may reveal pathognomonic signs of polyarteritis nodosa. In this case, the diagnosis was established on the basis of arteriographic findings and the American College of Rheumatology criteria and not on histological criteria.

[Renal tuberculosis with pseudotumoral form: apropos of a case]. / La tuberculose rénale à forme pseudo-tumorale: à propos d'un cas.

The authors report about one rare case of renal tuberculosis in a pseudo-tumoral form, which had radiologic appearances compatible with a kidney cancer invading soft tissue. The fast spontaneous evolution towards fistulization allowed confirming the diagnosis of urinary tuberculosis. The outcome with treatment was favorable. The authors recommend that needle biopsy should be made in cases of doubtful kidney tumors to provide an exact diagnosis.