[An MRI study of primary testicular tumors]. / Etude IRM de 14 cas de tumeurs testiculaires primitives.

Magnetic resonance imaging (MRI) is a high performance tool for morphological assessment and tissue characterization in the presurgical work-up of scrotal tumors. A wait-and-see attitude is now possible for benign lesions identified as epidermoid cysts. Pathology examination remains more pertinent for an exhaustive assessment of local extension, but MRI can provide a convincing, if not definitive, distinction between seminomatous and non-seminomatous germ cell tumors.

[Bladder herniation in a inguinal-scrotal hernia complicated by acute renal insufficiency]. / Extériorisation vésicale dans une hernie inguino-scrotale compliquée d'une insuffisance rénale aiguë.

We report one case of massive inguino-scrotal bladder herniation which was responsible for an acute obstructive renal insufficiency. The different types of bladder hernias and their anatomic factors are described. The clinical-radiological findings and surgical management are discussed.

[Bladder hemangioma: a rare cause of hematuria. Apropos of a case. Review of the literature]. / L'hémangiome vésical: une cause rare d'hématurie. A propos d'une observation. Revue de la littérature.

The authors report a clinical case of multiple vesical haemangioma, a rare congenital benign vascular tumour essentially affecting children and young adults. These tumours may be solitary or multiple, and essentially spread to the bladder wall. They are sometimes associated with other sites, such as in the rare Klippel-Trenaunay-Weber syndrome. Usually presenting in the form of macroscopic haematuria, they are essentially diagnosed by endoscopy. Depending on the case, treatment consists of partial cystectomy or laser photocoagulation, rather than endoscopic resection, which is haemorrhagic and incomplete, or radiotherapy, which is insufficient. Selective arterial embolization is rarely used.

[Perineal-genital wounds in war medicine. Apropos of 18 cases]. / Les plaies périnéo-génitales en pratique de guerre. A propos de 18 observations.

Perineo-genital wounds involving the anterior perineum or the urogenital perineum are uncommon; 1-4% of all war wounds. We report 18 cases observed in war situations. Isolated uretrogenital wounds are rarely life-threatening, but the functional prognosis is always compromised in these men whose mean age is under 30 years. Debridements should be limited and all isolated lesions should be repaired early with tight suture of the cavernous body albuginea, preservation of viable testicular and adnexal tissue (but the rate of orchidectomy is greater than 50%), and immediate suture of any wound to the urethra rather than simple alignment. In war situations, these wounds are usually caused by perforating or blast trauma. The wounds are complex, with damage to the soft tissues, sometimes involving lesions to the anal sphincter, the gluteal masses or the abdomino-pelvic structures. Laparostomy for hemostasis is justified. The risk of sepsis is high, requiring triple antibiotics, cystostomy, careful debridement, discharge drainage or possibly colostomy. Treatment of urogenital lesions is a secondary operation in these cases but must not be neglected if the mictional and sexual functions are to be preserved.

[Non-iatrogenic injuries of the ureter]. / Les plaies non iatrogènes de l'uretère.

The increasing number of non-iatrogenic ureteric injuries can be explained by the increasing crime rate in certain large cities and by the performance of intensive car teams, both in civilian practice civil and in a context of war. The discovery of an ureteric injury during salvage laparotomy for vascular or visceral lesions is no longer exceptional. The initial diagnosis is missed in 10 to 20% of cases, due to the absence of any specific clinical signs, as radiological opacification of the urinary tract is rarely performed and the clinical situation is dominated by associated lesions. The treatment of ureteric injuries is guided by the severity and septic nature of associated lesions and the ballistic context. When the ureteric lesion is short and associated lesions are limited, urinary continuity can be restored, after debridement of the extremities, by end-to-end anastomosis for the upper 2/3 and by direct vesical reimplantation or into a psoas bladder for the lower 1/3. Drainage is ensured is by an externalised ureteric catheter or a double J stent and must be kept in place for at least 3 weeks. In the presence of a defect of the upper two-thirds of the ureter, mobilization of the kidney and the renal pedicle or transureteroureterostomy may be considered. In the case of unstable haemodynamic status, very septic associated lesions or in the presence of multiple fragments, urinary diversion by nephrostomy or in situ ureterostomy is indicated. Extensive contusion of the ureteric wall must be intubated to prevent fistula secondary to necrosis. Nephrectomy is inevitable in 10 to 20% of patients.

[Perineal injuries in wartime]. / Les plaies périnéales en pratique de guerre.

Perineal war wounds involve the anterior perineum or urogenital perineum and posterior perineum or ano-sphincteric perineum. They are rare in civilian practice and in war practice, as only a small and hidden surface of this anatomical region is exposed to damaging agents. An isolated wound of the perineum is rarely life-threatening, but always threatens the functional prognosis of these patients, who have a mean age less than 30 years. In war practice, these wounds are often associated with lesions of adjacent of sacral, buttock or abdomino-pelvic regions. This article is confined to perineal war wounds in men. Lesions of the urethra and anus and rectum, as well as lesions of the genital appendages and pelvic nerves, leave micturating, gastrointestinal and sexual sequelae, which are sometimes permanent. These sequelae must not be exacerbated during investigation and surgical repair, despite the unfavourable emergency context, associated lesions and the time required to repair them. The basic principles of surgical treatment remain urinary diversion by a large cystostomy tube for urogenital lesions, faecal diversion by terminal colostomy for ano-sphincteric lesions, conservative debridement of the margins of the anal or urethral wound, debridement and drainage of contaminated soft tissues and connective tissue spaces. First-line immediate suture of the urethra or edges of the anal wound must be considered according to the defect, and the septic and haemorrhagic context. When ideal repair cannot be performed, alignment over an urethral catheter, urethrostomy, fixation-identification of the urethral or anal extremities constitute intermediate procedures allowing secondary urological and proctological specialized procedures in these patients.

[Firearm wounds of the lower urinary tract in men. Surgical management in emergency context]. / Les plaies par arme à feu du bas appareil urinaire chez l'homme. Prise en charge chirurgicale dans le contexte de l'urgence.

The lower urinary tract is injured in less than 1% of all firearm wounds in men. In war medicine, blast wounds occur in 75% of the cases while in civil medicine ballistic injuries are more frequent. When the bladder and the posterior urethra is involved, the projectile usually follows a path through the gluteal muscles and pelvis. A perineal genital path is usually found for injuries to the anterior urethra. This explains the frequency of associated vascular and colorectal lesions in pelvic wounds and genital injuries in perineal wounds. Bone and muscle injuries occur in both situations. A mental reconstruction of the projectile path is required for a precise diagnosis of the lesions, together with the clinical examination (urine outlet, miction impossible with or without bladder extension, urethral bleeding) and most importantly standard x-ray of the pelvis in search of bone lesions and the projectile. Urethrography should always be performed whenever the urethra is injured in all civil wounds. However, the final diagnosis of the lesions can only be made at surgery. Urology procedures, usually performed by polyvalent surgeons, should be simple, rapid and reliable. It is important to preserve urinary and genital functions in these young subjects usually under 30 years of age. Cystostomy and drainage is the strict minimum. In addition, depending on the infectious and hemodynamic status, conservative excision of damaged tissue is needed prior to primary closure. Wounds involving the bladder can be closed in 95% of the cases. Closure is simple for wounds involving the superior portion of the bladder. For deeper wounds involving the trigone endovesical suture is used after intubing the ureters. Ureteral drainage is mandatory when the bladder is highly damaged and cannot be closed. Urethro-prostato-membranous wounds should also be repaired to avoid inevitable fibrosis of fistulization. However, access to the apex of the prostate causes major bleeding and there is a risk of injuring the sphincter or erection nerves, particularly by surgeons inexperienced in urogenital surgery. When massive bleeding cannot be controlled by clamping the two hypogastrics, symphysiotomy, rather than symphysectomy, is recommended. In other cases, aligning the urethral extremities may be sufficient. Short wounds to the anterior urethra should be cleaned and the extremities spatulated and anastomosed on a guide when they can be closed. In other cases, a perineal or penile urethrostomy is created. Associated wounds involving the anus and rectum require colostomy, emptying the excluded rectum and wide pelvic-perineal drainage. An attempt should be made to repair the rectum or the sphincter. Genital lesions require early repair: tight suture of the albuginea of the cavernous bodies with or without a patch, preservation of viable testicular parenchyma and adnexal tissues (but orchidectomy is necessary in 50% of the cases).

[MRI aspects of filaria scrotum elephantiasis. MRI-anatomopathological correlations]. / Aspects IRM de l'éléphantiasis scrotal filarien. Corrélations IRM-anatomopathologiques.

We report a case of filaria scrotum elephantiasis explored by MRI. MRI and pathological description of the three muscular layers (superficial, medium, deep) were well correlated.

[Gunshot injuries of the ureter]. / Les plaies projectilaires de l'uretère.

The increased incidence of gunshot injuries of the ureter (GIU) can be explained by increased of armed violence in some large cities and by the performance of intensive care teams, both in civilian practice and in a context of war. The discovery of a GIU, during salvage laparotomy for vascular or visceral lesions is no longer exceptional. We report 5 cases of abdomen gunshot wounds with ureteric trauma treated between 1987 and 1994 by three surgical teams. The data in the literature and the principles of ballistic wounds are analysed. Theses lesions are initially misdiagnosed diagnosis in 10 to 20% of cases, as there are no specific clinical signs, radiological opacification of urinary tract is rarely performed, and septic nature of associated lesions and the ballistic context of the trauma guide the treatment of GIU. When the ureteric lesion is short and associated lesions are limited, the continuity of the urinary tract can be restored after debridement of the extremities by end-to-end anastomosis for the upper 2/3 and direct vesical reimplantation or into a psoas bladder for the lower 1/3. Drainage is ensured either by a bladder catheter or by a double J stent, for a minimal duration of 3 weeks. When there is a defect of the upper two-thirds of the ureter, mobilization of the kidney and its pedicle or transureteroureterostomy may be required. Urinary diversion by nephrostomy or in situ ureterostomy is indicated when the haemodynamic state is unstable and the associated lesions are very septic or in the presence of multiple lesions. Extensive contusion of the ureteric wall must be intubated to prevent fistula formation due to necrosis. Nephrectomy should be avoided in these patients with a mean age of 27 years.

[Acute obstructive renal failure and scrotal complete hernia of the bladder. Apropos of a case, review of the literature]. / Insuffisance rénale aiguë obstructive et hernie scrotale complète de la vessie. A propos d'une observation, revue de la littérature.

Massive herniation of the bladder into the scrotum is uncommon and can have a deleterious effect on the upper urinary tract. We report a case where complete scrotal hernia of the bladder lead to obstructive renal failure due to torsion of the trigone. Most simple bladder hernias can be explained by a prostate or uretral obstacle. The mechanism in our patient with no known prostate or uretral disease was the passage of the bladder via a defective inguinal canal caused by excessive obesity. This type of massive hernia has been reported in Sumo boxers. The effect on the upper urinary tract may be related to a fold in the terminal ureter or more exceptionally in the trigone. Immediate treatment requires urine drainage above the obstacle and intensive care. After stabilization, the anatomic position of the excluded bladder is re-established with reconstruction of the inguinal area, usually with a prosthesis. Any obstacle below the bladder must be removed.

[Goodpasture syndrome: role of an epidemiological factor? Apropos of two cases]. / Le syndrome de Goodpasture: rôle d'un facteur épidémiologique? A propos de deux observations.

Goodpasture's syndrome is a rare pneumorenal syndrome. Although the antigenic target of this auto-immune disorder is now known, its etiology remains debated. We report two cases of Goodpasture's syndrome occurring in similar epidemiologic conditions concerning the moment the disease began, the age and sex of the patients, their place of residence and work and manipulation of chemicals. Thus, a common environmental factor could have been the trigger event of the Goodpasture's syndrome. The epidemiologic features of this disease are reviewed.

[Strangulated urethral prolapse in a young woman: a rare urological emergency]. / Le prolapsus étranglé de l'urètre chez la femme jeune: une urgence urologique rare.

Total prolapse of the urethral mucosa in women is an uncommon lesion, observed at the two extremes of reproductive life. Strangulation of urethral prolapse is a rare complication whose emergency treatment is essentially surgical. The authors report a case of strangulated urethral prolapse in a 43-year-old woman, for which several pathophysiological mechanisms can be proposed: first delivery by forceps, poorly repaired perineal tear, untreated early menopause at the age of 40 years. Urethral prolapse in elderly women has become much less common since the introduction of hormone replacement therapy for menopause. Other physiopathogenic factors may be responsible for this prolapse, such as thrombosis of the juxtameatal submucosal veins, laxity between the mucosa and submucosa or uretrodetrusor dyssynergia. The diagnosis of strangulated urethral prolapse is based on the discovery of a very painful, violaceous, inflammatory circular mucosal tumour surrounding the urethral meatus. If rapid reduction of the prolapse is not obtained with systemic and topical oestrogen therapy, the strangulated mucosal flap must be resected surgically, followed by apposition of the urethral mucosal and submucosal planes. This suture, in tissues which are always inflamed, must be calibrated and the urine must be drained by bladder catheter for about ten days. Meatal stricture is the principal complication of this surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Scrotal temperature in 258 healthy men, randomly selected from a population of men aged 18 to 23 years old. Statistical analysis, epidemiologic observations, and measurement of the testicular diameters]. / Etude de la température scrotale chez 258 hommes sains, sélectionnés par tirage au sort dans une population d'hommes de 18 à 23 ans. Analyse statistique, observations épidémiologiques et mesure des diamètres testiculaires.

Scrotal hyperthermia can induce certain alterations in spermatogenesis. The basal scrotal temperature used to define hyperthermia is usually 33 degrees C. However, no study, conducted according to a strict methodology has validated this mean measurement. We therefore randomly selected 258 men between the ages of 18 and 23 years from a population of 2,000 young French men seen at the National Service Selection Centre in order to measure the scrotal temperature over each testis and in the median raphe in order to determine the mean and median values for these temperatures. For a mean room temperature of 23 +/- 0.5 degrees C with a range of 18 to 31 degrees C, the mean right and left scrotal temperature was 34.2 +/- 0.1 degree C and the mean medioscrotal temperature was 34.4 +/- 0.1 degree C. Scrotal temperature was very significantly correlated to room temperature and its variations. It was therefore impossible to define a normal value for scrotal temperature. Only measurement of scrotal temperature at neutral room temperature, between 21 and 25 degrees C, is able to provide a reference value for scrotal temperature. In this study, the mean scrotal temperature under these conditions was 34.4 +/- 0.2 degree C, i.e. 2.5 degrees C less than body temperature. In the 12.9% of cases with left varicocele, left scrotal temperature was significantly higher than in the absence of varicocele and was also higher than right Scrotal temperature. The authors also determined the dimensions of the testes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ureter-aorto-iliac prosthesis cross-over and a tumor of the ureter]. / Croisement uretère-prothèse aorto-iliaque et tumeur de l'uretère.

Ureteric stenoses sometimes occur after the insertion of aorto-iliac prostheses. Two cases of neoplastic ureteric stenosis, independent of the ureter-prosthesis crossing are reported, indicating the possibility of such lesions after aorto-iliac prosthetic surgery.

[Inguinal lymphatic metastasis of cancer of the testis: staging and therapeutic approach]. / Les métastases ganglionnaires inguinales des cancers du testicule: stadification et attitude thérapeutique.

Inguinal lymph node metastases from testicular tumors are reported in 2% of cases. Between 1980 and 1990, two patients in a series of 54 testicular tumors, presented with inguinal node metastases. In there two cases and in the cases in the literature, it is well known, that testicular tumors in patients who have had the lymphatics disrupted by prior scrotal or inguinal surgery, or tumor-contaminated scrotum, can metastasize primarily to the ipsilateral inguinal nodes. Even in the absence of other retroperitoneal metastases, these testicular tumors must be considered to be stage IIA. Owing to the efficacy of primary or secondary chemotherapy, ipsilateral inguinal node dissection is not necessary in nonseminomatous testicular tumors. For testicular seminoma, an additional inguinoscrotal radiotherapy is necessary. Survival rate for testicular tumors with isolated metastatic inguinal nodes, particularly in tumor-contaminated scrotum, is not significantly different, compared to a group of patient without inguinal nodes.

[Supernumerary testis and homolateral varicocele. Apropos of a case, study of spermatogenesis and review of the literature]. / Testicule surnuméraire et varicocèle homolatéral. A propos d'une observation, étude de la spermatogénèse et revue de la littérature.

Polyorchidism is a rare abnormality. A case is reported of a small scrotal supernumerary testis associated with a large varicocele. A torsion of this testis probably occurred and the vascular pedicle seemed atrophic. Despite abnormal fertility with oligozoospermy the accessary testis was removed. A review of relevant literature is made giving details of embryology of this anomaly.

[Echoguided renal needle biopsy. Technique and results. Report of 413 examinations]. / La ponction-biopsie rénale échoguidée. Technique et résultats. A propos de 413 examens.

Blindly executed for a long period with only X- Ray detection, renal biopsy benefits nowadays of precision and security of real-time echoguiding. The authors describe their technique without bondage between needle and transducer and comment their results about 413 examinations.