Hypogonadism in hemodialysis patients: a first snapshot of prevalence and predictive factors in Tunisian patients.

Introduction: patients with chronic kidney disease commonly exhibit testosterone deficiency. We aimed through the current study to assess the prevalence and the risk factors of hypogonadism in male patients on hemodialysis and to establish their relationship with erectile dysfunction. Methods: we conducted a cross-sectional study based on data collected from hemodialysis male patients. Sociodemographic and clinical data as well as hormone levels were collected from January 2017 to December 2017. Sex hormones were measured in all subjects. The International Index of Erectile Function was used to evaluate erectile dysfunction. Data were expressed as mean ± standard deviation, and frequencies (number), and proportions (%). Results: one hundred and ten: 55 male hemodialysis patients were recruited. The level of follicule-stimulating hormone, luteinizing hormone and prolactin were high and the level of testosterone was low in the hemodialysis group. Hypogonadism was significantly linked to advanced age, anemia, and absence of treatment by erythropoietin. The incidence of erectile dysfunction was high and the erectile function score was low. Testosterone significantly dropped in patients with erectile dysfunction. Conclusion: hypogonadism was so prevalent in the hemodialysis men and it was associated with erectile dysfunction. Future studies are needed to determine the effect of testosterone therapy on erectile dysfunction.

Refeeding syndrome after radical cystoprostatectomy: A case report.

Described as a potentially lethal condition that occurs in undernourished patients, refeeding syndrome (RFD) is a severe electrolyte disturbance that includes low intracellular serum concentrations of phosphor, magnesium and potassium in patients undergoing inappropriate oral or parenteral renutrition. We report a case of RFD in a 50-year-old male patient that occurs 22 days after a radical cystoprostatectomy. The patient was anorexic after the surgery, the body mass index decreased to 12,36 kg/m2. The concentrations of albumin, magnesium, phosphor, and calcium were low. The Patient was admitted into the intensive care unit for severe cachexia and poor general condition 24 after introduction of parenteral nutrition (1500 Kcal/day). The evolution was lethal with multiple organ failure.

Paediatric cystolitholapaxy using mini PCNL-kit through the Mitrofanoff stoma.

Bladder stones are a common complication after augmentation cystoplasty and urinary diversion. However, the treatment of recurrent cystolithiasis in neuropathic children remains a real challenge for urologists and open procedures may be associated with significant morbidity. Currently, mini-invasive management options are available in the therapeutic armamentarium. Herein, we reported a case of Mitrofanoff cystolitholapaxy using a mini PCNL-kit, in a 14-year-old patient with the history of neurogenic bladder due to myelomeningocele managed by bladder augmentation. This technique has been previously described but we have added a unique modification using Nelaton catheter for carefully dilating the Mitrofanoff stoma before inserting an Amplatz sheeth and we report tips and tricks to guarantee a stone free status with one single procedure. Using high energy Holmium laser, this approach is safe and effective even with large stone burden.

Prostatic rhabdomyosarcoma revealed by acute urinary retention.

Rhabdomyosarcoma of the urinary tract is very rare among young adult and the survival has improved significantly. The challenge of such location is to ensure better functional outcomes like continence and sexuality without compromising the overall survival. Throughout this case, we bring new insights into the conservative management of prostatic sarcoma and we focus on the role of radio-chemotherapy for local disease control.

Training of Tunisian future urologists: how to improve it ?

BACKGROUND: The lack of continuous evaluation of training tools in medicine, especially in developing countries, represents a brake to the development of the latter. AIM: To establish an inventory of the training facilities available to residents in urology in Tunisia, to assess their satisfaction and their expectations, and to propose solutions to improve residents training. METHODS: An anonymous questionnaire was sent by E-mail in 2015 to all residents in urology in Tunisia. The questionnaire addressed demographic characteristics, educational resources used and desired, the current medical and university curriculum and evaluation of the training. RESULTS: Among 33 residents, 66.6% responded to the survey. Medical staff, courses organized by the national college of urology, reading french-language articles and daily activity in operating room were the most used pedagogic resources. Training was judged unsatisfactory by 59.1% of respondents because of a lack of theoretical training in 18.1% of cases, a lack of practical training in 13.6% of cases and both of them in 27.2% of cases. Training on animals and simulator, creation of an educational booklet, use of online course materials, and the institution of a mentoring process during residency were rated favorable by the majority of respondents. CONCLUSION: The majority of residents in urology in Tunisia believe their training is unsatisfactory. The E-learning, improved access to surgical training in animals and simulator, better information on existing resources and strengthening of companionship through tutoring should enhance satisfaction.

[Impact of alfuzosin 10 mg once daily on quality of life in Tunisian patients with lower urinary symptoms suggestive of benign prostatic hyperplasia]. / Impact de l'alfuzosine lp 10 mg sur la qualite de vie chez les patients avec troubles urinaires du bas appareil suggestifs d'une hypertrophie benigne de la prostate.

BACKGROUND: Incidence of benign prostatic hyperplasia (BPH), one of the most common conditions affecting adult men, increases dramatically after the age of 50. The various symptoms of BPH, which include lower urinary tract symptoms (LUTS), can adversely affect quality of life (QoL) and sexuality and 1-Blockers are the most frequently prescribed oral medications as first-line treatment. AIM: The objectives of this study try to evaluate QoL and sexuality in patients requiring treatment by Alfuzosin 10mg once daily according to physician decision in current practice and to identify patient's profile treated with Alfuzosin 10 mg under daily practice conditions by Tunisian urologists. METHODS: 730 patients presenting a symptomatic BPH were enrolled in this study by 40 urologists. The impact of treatment on patient's QoL and sexual dysfunction were checked at every visit before treatment and at 3 and 6 months using "International Prostate symptoms score" (IPSS) and "Male Sexual Health Questionnaire - Ejaculatory Dysfunction" (MSHQ - EJD) questionnaire. RESULTS: BPH affect Qol and near half of the patients reported sexual disorders. The treatment compliance to Alfuzosin was very good with a regular intake in 92% of the cases. Quality of life significantly improves during visits: the global IPSS score decreases from 18.8 at baseline to 9.5 at 6 months. The same favorable evolution was observed with the bother score which decreases from 4.0 at baseline to 1.6 at 6 months, and with MSHQ - EJD score which increases from 10.5 at first visit to 11.4 at 6 months. CONCLUSION: Alfuzosin 10 mg administered for 6 months provides a marked improvement in patients presenting symptomatic BPH not only on LUTS but also in QoL and sexual disorders.

[Sclerotherapy of idiopatic hydrocele with polidocanol: a study about 190 cases]. / La sclérothérapie au polidocanol dans le traitement des hydrocèles vaginales idiopathiques : Etude à propos de 190 cas.

AIM: To evaluate the efficacy and side-effects of Polidocanol used as sclerosing agent for testicular hydrocele. METHODS: One hundred and ninety men, with a median age of 55,9 years (40-89), treated for idiopatic hydrocele were assessed. After puncture and aspiration, the empty sac was instilled with 3% Polidocanol. We recorded recurrence, complications and associated pain on a visual analogue scale. RESULTS: With a median follow-up of 19 months, The cure rate of hydroceles after one sclerotherapy session was 62,1%, and the overall cure rate using the procedure was 82,6%. Re-instillation was done for recurrences in 41% of patients. Polidocanol therapy was almost pain-free. A low rate of complications was observed. CONCLUSION: Polidocanol is a useful sclerosing agent for treating testicular hydrocele. Due to its ease of administration, low frequency of complications, high rate of effectiveness, and excellent tolerability; we recommend sclerotherapy with polidocanol as the primary treatment for hydroceles.

[Prevalence of benign prostatic hyperplasia in general practice and practical approach of the Tunisian general practitioner (Prevapt study)]. / Depistage de l'hypertrophie benigne de la prostate en medecine generale en Tunisie: etude Prevapt.

BACKGROUND: Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with ageing in men. BPH presents as lower urinary tract symptoms (LUTS). AIM: The aim of this study is to assess the prevalence of LUTS suggestive of BPH in 50 years or older men in general medicine and to evaluate the management of these patients by general practitioners. METHODS: This cross-sectional, prospective, multi-centre epidemiological survey, included all men with an IPSS (international prostatic symptoms score) > or =8. The management by general practitioners was analysed including complementary examinations and treatment. RESULTS: Among 4602 outpatients recruited by 88 general practitioners, 434 patients had an IPSS > or =8 and were included in the study. The prevalence of LUTS/BPH was 16.1%. The prevalence showed a linear increase with age. The prevalence was 7% at the age 50-59 years, 17.4% at the age 60-69 years and 33.4% in 70 years and over men. LUTS were the main reason of consulting general practitioner in 45.4% of cases. 72.6% of patients were with moderate symptoms (IPSS 8-19) and 26.4% of patients were with severe symptoms (IPSS 20-35). Quality-of-life score was 0-2 in 10.3% of patients, 3-4 in 52.2% of patients and 5-6 in 37.5% of cases. The management by general practitioner was then a watchful waiting in 14.7% of cases, to refer the patient to an urologist in 13.7% of cases, to ask for complementary examinations in 71.6% of cases and to treat in 73.4% of cases. Only 37.4% of patients with suspect prostate malignancy were referred to the urologist. In cases of treatment alpha blocker was the treatment choice in 77% of the cases. CONCLUSION: LUTS/BPH are frequent in Tunisia. It occurs in one third of men over 60 years and one fifth of men over 70 years. With the progressive ageing of Tunisian population, this pathology may constitute a public health problem. It is therefore urgent to elaborate recommendations concerning the management of this disease, specifying the role to play by the urologist and the general practitioner.

[Endoscopic resection of benign prostatic hyperplasia in men over 80 years of age: a retrospective study of 184 cases]. / La resection endoscopique de l'hypertrophie benigne de la prostate chez les personnes ages de plus de 80 ans: etude rertospective a propos de 184 cas.

OBJECTIVE: The aim of the present study was to evaluate the outcome of transurethral resection of the prostate for benign prostatic hyperplasia in men over 80 years. MATERIAL AND METHOD: 184 men over 80 years underwent transurethral resection of the prostate for benign prostatic hyperplasia. Serious concomitant disease was found in 48.92% of cases. RESULTS: The mean operating time was 49 min ( 20 - 160mn). Others conditions found at surgery were treated during the same operation in 33.68% of cases. Peroperative complications were reported in 15 patients (8.15%) and immediate post operative complications were reported in 14 patients (7.60%), with died of 3 patients. The complications at 6 month after surgery in 172 available for followup were reported in 11 patients (6.39%). CONCLUSION: Transurethral resection of the prostate for benign prostatic hyperplasia in men over 80 years has a good outcome with an acceptable morbidity and mortality.

[Ureteritis cystica. Case report and review of the literature]. / Ureterite kystique a propos d'un cas et revue de la litterature.

The authors report one case of ureteritis cystica in 40 years old women. The diagnosis was confirmed by histologic examination. The epidemiologic, etiopathogenic, radio-diagnosis and therapeutic aspects are discussed with a review of literature.

[Chyluria]. / La chylurie.

Chyluria is the passage of chyle into the urine giving it a typical milky appearance, it's due to a communication between lymphatic and urinary system. Filariasis is the most frequent cause of chyluria. Considering the infrequency of chyluria in our environment, a literature review is made, explaining the most frequent etiological data, as well as clinical signs, diagnostic means, conservative and surgical procedures in the treatment of this process.

[Ureterocele in adults complicated with calculi: diagnostic and therapeutic features. Report of 20 cases]. / Urétérocèle de l'adulte compliquée de calculs: aspect diagnostique et thérapeutique. A propos de 20 cas.

STUDY OBJECTIVE: The authors study the various diagnostic and therapeutic aspects of adult ureterocele and evaluate the place of endoscopic treatment. MATERIALS AND METHODS: This retrospective study was based on 20 cases of ureterocele in adults complicated by stones and observed between January 1990 and December 2001. This series consisted of 8 men and 12 women with a mean age of 48.3 years (range: 24-75 years). The clinical features were dominated by low back pain. The diagnosis of ureterocele was based on intravenous urography in 19 patients and was discovered on endoscopy in one patient. The ureterocele affected a single ureter in 16 cases (80%) and a duplex ureter at the expense of the upper renal segment in 4 cases. All patients were treated by endoscopic horizontal meatotomy with stone fragmentation and extraction. The mean operating time was 27 min (range: 18-58 min). RESULTS: The postoperative course was uneventful in 19 patients. One patient developed postoperative sepsis. All patients were reviewed clinically and radiologically at 3 months and at 6 months. Satisfactory results were obtained in every case with no residual stones and resolution of low back pain. Only one patient presented vesicoureteric reflux which had resolved on the follow-up urethrocystography performed at 6 months. CONCLUSION: Adult ureterocele complicated by stones is a well tolerated, rare entity that can often be easily diagnosed. Endoscopic meatotomy is easy to perform and gives good results. The associated stones constitute an additional argument in favour of endoscopic treatment.