Eosinophilic cystitis induced by bacillus Calmette-Guerin (BCG) intravesical instillation.

Eosinophilic cystitis is a rare and uncommon inflammatory bladder disease, in which the pathophysiology is unclear; only a few cases of such disease induced by intravesical instillations have been described. We report a case of eosinophilic cystitis after intravesical bacillus Calmette-Guerin (BCG) instillation for nonmuscle-invasive transitional cell carcinoma of the bladder. To our knowledge, this report is the first case of eosinophilic cystitis induced by intravesical BCG therapy.

[Hydatid cyst of the spermatic cord]. / Kyste hydatique du cordon spermatique.

The authors report the third published case of hydatid disease of the spermatic cord and describe its unusual presentation in the form of hydrocele. Hydatid disease is endemic to some countries, where it constitutes a real public health problem. It can affect all organs of the body. However, primary involvement of the spermatic cord is exceptional. Implantation of the hydatid larva is essentially haematogenous. The positive diagnosis is based on ultrasound. Eosinophilia is neither constant nor specific and only contributes to the diagnosis when it is positive. However positive hydatid serology has a diagnostic and prognostic value. Resection of the roof of the cyst is the treatment of choice.

[Skin metastasis from invasive bladder tumour]. / Métastase cutanée d'une tumeur vésicale infiltrante.

Metastatic spread of advanced transitional cell bladder carcinoma rarely involves the skin. However, the presence of a skin metastasis indicates at least microscopic dissemination of cancer cells to the liver or lung, corresponding to a poor prognosis. The authors report a new case of single skin metastasis during the course of a poorly differentiated stage pT3a N0 M0 transitional cell bladder carcinoma. The patient died 5 months after the appearance of the skin metastasis.

[An experience of individual and early diagnosis of prostate cancer in a Tunisian centre]. / Une expérience de diagnostic individuel et précoce du cancer de la prostate dans le centre de la Tunisie.

INTRODUCTION: The introduction of prostate specific antigen (PSA) and progress in transrectal ultrasound and ultrasound-guided prostatic biopsies have allowed considerable progress in the diagnosis of prostate cancer. However prostate cancer is still usually diagnosed at an advanced stage in Tunisia. METHODS: We prospectively evaluated the prevalence of localized prostate cancer in the population of a Tunisian centre during a screening programme. This study included all men consulting for a urological problem between January 1998 and June 2001, between the ages of 50 and 75 years with an estimated life expectancy of at least 10 years. Screening consisted of digital rectal examination (DRE) and total and free PSA assay. Systematic ultrasound-guided prostatic biopsies (9 biopsies) were performed in the case of a suspicious DRE, total PSA between 4 and 20 ng/ml and a free PSA/total PSA ratio less than 25%. RESULTS: 642 patients were screened. 521 patients (81%) had a PSA less than 4 ng/ml, 23 had a suspicious DRE and PSA less than 4 ng/ml. No cancer was detected by prostatic biopsies. 92 patients (14%) had a PSA between 4 and 20 ng/ml and 44 of them had a free PSA/total PSA ratio less than 25%. Prostatic biopsies were performed in 59 of these 92 patients with PSA between 4 and 20 ng/ml and revealed 18 cancers: 3 stage pN+ and 15 stage pN0, including 1 stage pT3 and 14 stage pT2 after radical prostatectomy. 14 cancers detected in a population of 642 men (2.2%) were therefore stage pT2. 29 patients (4.5%) had a PSA higher than 20 ng/ml. All underwent surgical prostatic disobstruction demonstrating adenocarcinoma. A total of 47 cancers (7.3%) were therefore detected. CONCLUSION: Early individualized screening is possible in Tunisia and allows the detection of localized prostate cancer in 77% of patients with PSA less than 20 ng/ml. The use of prostatic biopsies in the case of abnormal screening tests improves the management of prostate cancer in Tunisia.

[Ureterocalicostomy: indications and results based on a series of 16 patients]. / L'anastomose urétéro-calicielle: indications et résultats d'une série de 16 patients.

Formerly considered to be a salvage or last resort technique before nephrectomy, ureterocalicostomy can be indicated in certain well defined situations, when strictly dependent drainage of urine is essential. Due to its particular indications, this procedure is rarely performed and operators have limited experience. The authors report 17 cases of ureterocalicostomy performed in 16 patients: 8 cases obtained an excellent long-term result with absence of clinical signs, urinary tract infection and proximal dilatation of the neo-junction. 4 cases obtained a good result with resolution of clinical symptoms and bacteriological signs and improvement of the dilatation on intravenous urography. 3 cases obtained a poor result with persistence of clinical symptoms and dilatation on intravenous urography. 2 nephrectomies were subsequently performed 4 years and 10 years after ureterocalicostomy for non-functioning kidney and for chronic pyelonephritis.