[The role of open nephrolithotomy in the treatment of coralliform stones: a series of 53 patients]. / Place de la néphrolithotomie à ciel ouvert dans le traitement du calcul coralliforme: à propos d'une série de 53 patients.

This study aims to discuss the role of open surgery in the treatment of renal lithiasis, including coralliform stones, with the advent of new less invasive techniques. We report a series of 53 cases of coralliform stones whose data were collected in our Hospital during a period of 7 years, from January 2011 to January 2018. The patients underwent open nephrolithotomy by lombotomy. The mean post-operative length of stay was 10 days. The immediate and early postoperative outcomes were simple in 36 patients, 6 patients underwent blood transfusion, 2 had severe sepsis in the postoperative period, 5 had infection of the wall and 4 had urinary fistula, secondarily managed by endoscopic drainage. Residual stones were found in 9 cases (16.9%). Stones were essentially treated by extracorporeal lithotripsy. Late outcomes were characterized by renal atrophy in 2 patients, lithiasic recurrence in 9 patients, an improvement in creatinine clearance in 9 patients and a slight worsening in 5 patients. Open surgery presents the risk of multiple complications and it is not recommended for first-line treatment of renal lithiasis. However it is important to determine which patients would benefit from open nephrolithotomy.

[Bladder leiomyosarcoma: about 3 cases]. / Le léiomyosarcome de la vessie: à propos de 3 cas.

Bladder leiomyosarcoma is a rare highly malignant tumor. It can occur in children and adults with a maximum incidence in patients over 60 years of age. It mainly affects men, with a sex ratio of 3/1. Its clinical features are non-specific and dominated by the haematuria. Endoscopic resection of the bladder associated with anatomo-pathological examination allow the diagnosis. Its treatment remains controversial due to the rarity of cases reported in the literature. Neoadjuvant chemotherapy followed by radical cystectomy is the treatment of choice, if the patient's clinical condition permit. We report 3 cases of bladder leiomyosarcoma treated by radical cystectomy and with uneventful postoperative course.

[Intrauterine device: about a rare complication and literature review]. / Le dispositif intra-utérin: à propos d'une complication rare et revue de la littérature.

The intrauterine device (IUD) is the most common contraceptive method used in the world. Transuterine migration is a rare complication, accounting for 1/350 - 1/10000 insertions in the literature. We report the case of a 40-year old patient, who had had an IUD insertion 12-year before, presenting with pelvic and right lower back pain associated with intermittent hematuria and burning during urination. Radiological assessment showed calcific deposits on intra bladder IUD. The patient underwent cystostomy, without any difficulty, allowing stone and IUD extraction. A urinary catheter was left in place for 5 days and then withdrawn. The postoperative course was uneventful.

[Metastatic paratesticular liposarcoma]. / Liposarcome paratesticulaire métastatique.

We report the dramatic case of a 18-year old patient with immediately metastatic round cells paratesticular liposarcoma. It is a rare tumor that develops in the fatty tissue surrounding the testicle and the spermatic cord. Clinical and radiological signs are nonspecific and diagnosis is usually based on surgical specimen examination. The treatment involves radical inguinal orchiectomy, sometimes extended to adjacent structures. Adjuvant radiation therapy could be used in the case of locally advanced mass or incomplete resection. Despite its slow progression, prolonged monitoring is required due to the high risk of late recurrence.

[Scrotal fistulas revealing mucinous adenocarcinoma of the scrotum: about a case]. / Fistules scrotales révélant un adénocarcinome mucineux du scrotum: à propos d'un cas.

Scrotales fistulas are rare and often represent secondary lesions of tuberculosis. Mucinous adenocarcinomas are tumors containing at least 50% of extracellular mucus. They occur most commonly in the rectosigmoid; scrotal location is rare. We report the case of a 54-year old patient, with no particular past medical history, with secondary mucinous adenocarcinoma of the scrotum revealed by scrotal fistulas. The patient had suffered from recurrent scrotal fistulas for two years, with no other associated signs. Clinical examination showed multiple scrotal fistulas with discharge of thick pus. Rectal examination was normal. Urological examinations (IVU, UCRM, cystoscopy, …) were normal, the assessment of infectious diseases as well as the detection of BK virus in urine and sputum were negative. Biopsy of sample of scrotal tissue was in favor of moderately differentiated mucinous adenocarcinoma. Immunohistochemical examination was in favor of primary colorectal cancer. Patient's evolution was marked by the occurrence of complex anal fistulas, which appeared on MRI as active, supplying several pelvic peritoneal collections resulting in fleshy buds. There is no consensus on the therapeutic approach due to the rarity of this cancer. Surgical resection is the treatment of choice for this disease. Preoperative chemotherapy and radiation therapy are recommended for this type of cancer, but their role is not well established. The patient underwent primary neoadjuvant chemotherapy and radiation therapy, before abdominoperineal excision.

[Neuroendocrine carcinoma of the bladder: about 5 cases]. / Carcinome neuroendocrine de la vessie: à propos de 5 cas.

Neuroendocrine carcinoma of the bladder is a rare histological entity, characterized by the ability to metastasize quickly and associated with a poor prognosis. The purpose of this study was to analyze the clinical, histological, therapeutic and prognostic characteristics of neuroendocrine carcinoma of the bladder. We conducted a retrospective study collecting data from the medical records of 5 patients in the Department of Urology, at the Ibn Sina University Hospital during the period between January 2008 and June 2015. The average age was 63 years. Four males and one female were involved in the sudy. The neuroendocrine carcinoma was pure in four cases and impure or associated with urothelial component in one case. In two patients metastases were present at initial diagnosis. In one case, cystectomy was performed followed by neoadjuvant chemotherapy; chemoradiotherapy was performed in two cases and palliative chemotherapy in the other two cases. The median survival was 10 months. Only one patient was alive, with a follow-up period of 20 months. The management of neuroendocrine carcinoma of the bladder is not standardized, several therapeutic options have been proposed: surgery, radiation therapy and chemotherapy.

[Tubulopapillary carcinoma in a 17-year-old female patient: a case report and review of the literature]. / Carcinome tubulo-papillaire chez une jeune de 17 ans: à propos d'un cas et revue de la littérature.

Tubulopapillary carcinomas account for 10% of renal cell carcinomas. They are more frequent in men than in women (sex ratio:8/1). The average period is the sixth decade. There are two anatomopathological types:the 1 corresponding to a proliferation of basophilic cells and type 2 corresponding to a proliferation of eosinophilic cells. We report the case of a 17-year old female patient with no particular past medical history presenting to the emergency department with pain in the right lumbar fossa and in the right flank associated with hematuria evolving for two days before admission, with loss of body weight and deterioration of the general status. Clinical examination on admission showed poor general condition. The patient was apyretic with blood pressure of 110 mmhg/70mmhg and a heart rate at 110 beats per minute. Abdominal examination based on patient's inspection showed curvature of the right flank with tenderness, and guarding on palpation. Hemoglobin levels in the blood were 6 g/dl requiring transfusion. Abdominal scan showed voluminous right renal inferior polar tissue formation measuring 10 cm/7.8 cm with peri-renal effusion of 17 mm thickness. Two days after admission patient's evolution was marked by deglobulisation associated with accentuation of the abdominal pains. The patient underwent hemostatic nephrectomy. Total enlarged right nephrectomy was performed via subcostal incisions. Histological examination revealed type 2 tubulopapillary carcinoma. Chest CT scan did not show secondary tumors.

[Deep dorsal penile vein thrombosis revealing Behcet's disease]. / Thrombose de la veine dorsale profonde de la verge revelant une maladie de Behcet.

Deep dorsal penile vein thrombosis (DDPVT)is a rare and little known urologic emergency. It requires an early etiological and symptomatic approach to preserve erectile function and prevent recurrences. This study reports a case of dorsal penile vein thrombosis revealed by spontaneous priapism that didn't resolve adequately and confirmed by penile Doppler ultrasound. After management of priapism and DDPVT, the etiological investigation revealed Behcet's disease whose diagnosis was based on the association of a major criteria, such as oral aphthous ulcers with 3 minor criteria such as: genital aphthous ulcers, ocular involvement, and a positive skin pathergy test within 24h. The patient underwent etiological treatment with good clinical evolution and preservation of erectile function.

[Primitive benign retrovesical schwannoma: an extremely rare tumor, a case report]. / Schwannome benin primitif retrovesical: une tumeur très rare à propos d'un cas.

Schwannoma is usually a benign tumor of nervous origin arising from Schwann sheath cells. It is an extremely rare tumour because of its low incidence and its retrovescical localization. Histological and immunohistochemical examinations confirm the histological type as well as the benign or malignant origin of schwannoma. Because of the risk of recurrence and malignant transformation, excision must be complete. We report the case of a 39 years old patient, hospitalized for chronic pelvic pain accompanied by a sensation of heaviness, lower urinary tract irritation and urinary hesitancy. Diagnostic imaging (ultrasound, CT scan, MRI) of the pelvis showed a left-lateralized retrovescical mass with a thin wall, measuring 68x70x70 mm exerting mass effect on the bladder and the sigmoid. The surgical procedure, a midline laparotomy, allowed the removal of a well encapsulated retrovesical mass. Histological and immunohistochemical examinations concluded to a benign schwannoma. Recidivism and malignant transformation, although rare after surgery, impose postoperative clinical monitoring and annual CT scanning.

[What role does botulinum toxin play in the treatment of benign prostatic hyperplasia?] / Quelle est la place de la toxine botulique dans le traitement de l'hyperplasie bénigne de prostate?

Botulinum toxin (BT) was first used in urology for the treatment of neuro-urological disorders such as bladder sphincter dyssynergia and incontinence due to neuropathic detrusor overactivity. Its action is now clearly demonstrated and it is now widely used in treating neurogenic neuropathic detrusor overactivity. May the botulinic toxin constitute an effective treatment for benign prostatic hyperplasia (BPH)? Intraprostatic BT injection has recently been investigated as a treatment for BPH. It appears that intraprostatic BT injection produced a statistically significant improvement in urinary symptoms with no significant side effects and may therefore represent an interesting minimally invasive alternative to conventional treatment of BPH. The benefits of using it are the simplicity of its implementation, the lack of reported side effects and a longer duration of action. Carefully conducted prospective, controlled studies on larger number of cases are now needed to confirm these early results. This study aims to assess the state of current knowledge of the mechanisms of action of BT in prostate disease and the results of major clinical trials for BPH.

Malignant renal epithelioid angiomyolipoma associated with abdominopelvic hydatid cysts: a case report.

INTRODUCTION: The World Health Organization defines epithelioid angiomyolipoma as a potentially malignant mesenchymal neoplasm characterized by proliferation of predominantly epithelioid cells and as closely related to the triphasic (classic) angiomyolipoma. It can be benign, potentially aggressive or malignant. The pathologist's role is crucial in making a positive diagnosis, providing appropriate patient management and assessing prognosis. In this report, we present a case of a patient with an epithelioid angiomyolipoma and hydatid cyst association. To the best of our knowledge, such an association has not been reported previously in the literature. CASE PRESENTATION: A 70-year-old Arabian woman presented to our hospital with a 6-month history of a right lumbago and weight loss. Computed tomography objectified a mid-right renal tumor, several locoregional lymph nodes and four abdominopelvic cystic formations. The patient underwent a right nephroureterectomy and removal of abdominal and pelvic masses. Histologically, the tumor corresponded to a proliferation of large eosinophil cells, polygonal or ovoid, with epithelial appearance, and associated with thickened, hyalinized vessel walls, fat cells and bundles of smooth muscle cells. Mitoses were estimated at 2 per 50 high-power fields. In immunohistochemical study, epithelioid tumor cells expressed S-100 protein and Melan-A. The diagnosis of malignant epithelioid angiomyolipoma was made. The wall of the abdominopelvic cysts was eosinophilic and lamellar, corresponding to the cuticular membrane of hydatid cysts. CONCLUSION: In our patient, careful histological examination and immunohistochemical study allowed us to make the correct diagnosis of angiomyolipoma in its malignant form. The association with hydatid cysts is what makes our case original.

Renal oncocytoma: experience of Clinical Urology A, Urology Department, CHU Ibn Sina, Rabat, Morocco and literature review.

Renal oncocytoma is a rare and benign renal tumor. Only few cases have been reported in Moroccan populations. In the present study, we report our experiences in the diagnosis, management and follow-up of this disease. We report on six cases of renal oncocytoma indentified between 1990 and 2008 in the urology department of "CHU Ibn Sina" in Rabat. These six cases are listed among 130 kidney tumors reported during the study period. We assess the clinical, radiological and therapeutic features of the patients and we review literature. Six cases of renal oncocytoma, representing 4.6% of all primitive kidney tumors treated in our institution during the study period. The mean age was 53 ±9.7 years (range 34 to 61 years). One patient was asymptomatic at presentation, five patients (83%) had flank pain and two (33%) had macroscopic hematuria. The tumor was right sided in 4 cases (66%) and left sided in 2 cases (33%). All patients underwent CT scan which showed, in three cases, a centrally located stellate area of low attenuation. The clinical suspicion of oncocytoma was made preoperatively in only 3 patients by imaging studies, but the suspicion of renal cell carcinoma persist and all patients were treated with radical nephrectomy. Definitive diagnosis was made in all cases postoperatively. All the tumors were well circumscribed but unencapsulated. The mean tumor size was 8,75±2,04 cm. Four patients were classified at stage pT2 and two at stage p T1. Most of the pathological features in our patients were typical of this entity. Predominant cell type was a typical oncocytoma with general low mitotic activity. No extension to peri-nephric fat tissue or lymphovascular invasion was observed. After a mean follow-up of 36 months (range 26-62 months), there was neither recurrence nor death from oncocytoma. Accordingly, the disease-specific survival was 100%. Renal oncocytoma has a benign clinical course with excellent long-term outcomes. In our series, it happened mostly in females and is more frequently symptomatic. Although radical nephrectomy is the usual treatment, a conservative approach should be considered whenever there are signs of clinical and radiological presumptions.

[Vesicosphincteric disorders and neurosyphilis]. / Troubles vésico-sphinctériens et neuro-syphilis.

Voiding disorders secondary to neurosyphilis have now become rare. The authors report a case of a patient with arthritis of the knee associated with dysuria and chronic urinary retention. Urethrocystography showed a large bladder with post-voiding residual urine. Urodynamic assessment revealed detrusor areflexia. The aetiological diagnosis was neurosyphilis. Serological tests for sexually transmitted diseases must be systematically performed in patients presenting with idiopathic voiding disorders.

[Treatment of phimosis with locally applied 0.05% clobetasol propionate. Prospective study with 108 children]. / Traitement du phimosis par application locale de propionate de clobétasol 0,05%. Etude prospective chez 108 enfants.

OBJECTIVE: This study was designed to evaluate the efficacy of topical application of corticosteroid cream in the treatment of phimosis in children and to compare the results obtained with those reported in the literature. MATERIALS AND METHODS: In the context of a prospective study conducted between January 1997 and November 2001, 108 children with a mean age of 5.9 years, presenting with true phimosis preventing retraction of the foreskin, were treated by twice-daily application of 0.05% clobetasol propionate cream for 10 days. The results were evaluated at one month and then every six months by a urologist in the outpatients department. A second course of treatment identical to the first was proposed in the case of failure or partial efficacy. RESULTS: 96 children were evaluated with a mean follow-up of 14 months (range: 6 to 24 months). Seventy nine children (82%) are cured after a first course of treatment. In the remaining 17 children, 2 were treated by circumcision and 15 received a second course of treatment resulting in cure in another 9 cases. The final cure rate was therefore 92%. Among the six failures, 4 children were circumcised, corresponding to a total of 6 circumcisions out of this series of 96 cases of phimosis (6%). No local or systemic adverse effects related to steroid therapy were observed and no recurrence of phimosis was observed during the study. CONCLUSION: This study confirms the efficacy and safety of local steroid therapy in the treatment of phimosis in children. Surgical treatment of phimosis should therefore be reserved for failures of medical treatment and has now become much less frequent.