Le cancer de la verge à propos de deux cas. Pathologie rare : les difficultés de la prise en charge

Introduction : Le cancer de la verge est une prolifération maligne des cellules formant les tissus du pénis. C'est une pathologie rare. Le pronostic est favorable si le traitement est précoce. Notre but était de rapporter les deux cas de cette pathologie, en informant sur son épidémiologie, surtout les difficultés sur sa prise en charge. Patients et méthodes : C'est une étude de cas clinique sur deux patients présentant un cancer du pénis dans le service d'urologie du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona d'Antananarivo, Madagascar. Les paramètres étudiés sont la prévalence et la prise en charge de cette pathologie. Résultats : Nous avons observé une diminution de la prévalence. La difficulté de la prise en charge est causée par la pauvreté. Conclusion : Malgré la rareté de cette pathologie, sa prise en charge est encore difficile dans notre pays. La difficulté est due à la pauvreté

[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Bladder neck traumatic rupture in children]. / Rupture traumatique du col vésical chez l'enfant.

Transverse rupture of the bladder neck injury is rare in children. We report a new case in a 10-month boy with urinary peritonitis. Diagnosis was intraoperative. Surgical treatment in emergency with urethrovesical anastomosis protected by a perivesical drain and a large-bore urinary catheter was performed without urogenital complication.

[Spontaneous intraperitoneal rupture of hydronephrosis in an infant]. / Rupture spontanée intrapéritonéale d'une hydronéphrose.

Spontaneous intraperitoneal rupture of hydronephrosis is a rare complication. We report a case in a 30-month old boy admitted for fever, with a temperature up to 38.5°C, and abdominal distension. The diagnosis was made intraoperatively. The treatment consisted of an emergency internal urinary diversion and a deferred definitive cure of the pyelo-ureteral junction stenosis. Surgical management in two steps is more prudent and beneficial.

[A case of extravaginal twisting of spermatic cord]. / Un cas de torsion supravaginale du cordon spermatique.

Extravaginal twisting of the spermatic cord is rare and its management is still open to debate. We report the case in a 12-day-old boy with right testicular pain evolving since birth. Scrototomy revealed a complete twist of the extravaginal spermatic cord. The testis was already necrotic and the intervention consisted in orchidectomy and orchidopexy. Twisting of the extravaginal cord remains a surgical emergency, which allows contralateral orchydopexy.