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.

[Extracorporeal lithotripsy of upper urinary tract stones in children]. / Traitement par lithotritie extracorporelle des calculs du haut appareil urinaire de l'enfant.

OBJECTIVE: The objective of this study was to evaluate the efficacy of extracorporeal lithotripsy for the treatment of urinary stones in children. MATERIAL AND METHODS: From November 2002 to November 2004, 34 children from the department of paediatric urology of Rabat children's hospital, aged 3 to 15 years (mean age: 6 years), including 15 children under the age of 6 years, were treated for symptomatic urinary stones in the extracorporeal lithotripsy centre with a Lithostar Multiline lithotriptor adapted to the treatment of adults as well as children, even very young children. At the time of treatment, all 34 children had normal blood pressure, normal blood urea and creatinine, normal clotting parameters, sterile urine and no urinary tract obstruction. All children under the age of 6 years were treated under ketamine sedation. RESULTS: Treatment required a variable number of sessions from 1 to 3 (mean: 1.5) and concerned 38 stones: 30 renal stones including 6 staghorn and 8 ureteric stones. The number of impacts delivered per session ranged from 1,500 to 3,500 for renal stones (mean: 2,500 impacts), with a maximum of 5,000 impacts for ureteric stones (mean: 3,250 impacts). Three months after the last lithotripsy session, 30 patients presented no fragments. No lesion of the treated kidney or adjacent organs was demonstrated on follow-up ultrasound performed 3 to 6 months after treatment. CONCLUSION: Evaluation of the results confirms the efficacy of extracorporeal lithotripsy for the treatment of even very large urinary stones in children, even in very young children. Extracorporeal lithotripsy is now the first-line treatment for-urinary stones in children.

Communication between consultants and referring physicians: a qualitative study to define learning and assessment objectives in a specialty residency program.

BACKGROUND: Outpatient consultation constitutes a major part of medical practice. However, little is known about the skills which should be taught to residents in order for them to improve their consultant-referring physician relationships. PURPOSES: To specify the consultant skills which are required to ensure an effective communication between specialists and referring physicians. METHODS: A qualitative study based on (a) a literature search and (b) focus group interviews. RESULTS: Skills thus identified and described are classified in two groups: observable skills and principles/attitudes. CONCLUSIONS: The consensual specification of these abilities permits a greater efficacy in the teaching of consultant skills.