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ABSTRACT: RéSUMé: La fistule artério-urétérale (FAU), qui survient immédiatement après une cystectomie, est une complication exceptionnelle et grave. De nos jours, seulement quelques cas sporadiques ont été signalés dans la littérature. Elle se manifeste presque exclusivement par une hématurie brutale, massive et intermittente pouvant être à l'origine d'une instabilité hémodynamique menaçant le pronostic vital du patient à court terme. Son diagnostic doit être fait sans retard. Les explorations radiologiques restent peu spécifiques et peu sensibles et se basent essentiellement sur l'artériographie. Le traitement est non codifié selon l'état général du patient et surtout de la nature de la fistule. Nous décrivons un cas de FAU faisant suite à une pelvectomie antérieure et nous discuterons à l'aide d'une revue de la littérature les aspects diagnostiques, thérapeutiques et pronostiques de cette complication.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada 12/2012; 6(6):E263-6. · 1.24 Impact Factor
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ABSTRACT: Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic.
In this review, we report the case of a 61-year-old Tunisian woman presented to the emergency unit with a 4-hour history of abdominal pain diffused at both flanks, ultrasounds was performed to remove a surgical emergency, showed a peri-renal fluid collection with heterogeneous parenchyma.We followed by a CT scan, which confirmed the diagnosis of renal infarct. The patient was treated by heparin at a curative dose, and the outcome was favorable.
Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain and with risk factors to this disease. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.A review of the literature was performed and the case is discussed in the context of the current knowledge of this condition.
Journal of Medical Case Reports 06/2012; 6(1):153.
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La Tunisie médicale 01/2011; 89(1):86-7.
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La Tunisie médicale 01/2011; 89(1):100.
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La Tunisie médicale 01/2011; 89(1):101.
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ABSTRACT: To identify the factors involved in failure and post-operative complications of retrograde rigid ureteroscopy (URS) in the treatment of ureteric stones in children.
This is a retrospective study, including 33 children who underwent 34 rigid URS (one case bilateral) for obstructive ureteric stones over a period of 10 years. Patient age, sex, presenting symptoms, stone size and location, operative technique, surgical outcomes and complications were recorded. Ureteroscopy was done in a manner similar to that in adults. Statistical analysis was performed using the Mann-Whitney U, the Chi-square or Fisher's exact test.
There were 33 children (22 girls and 11 boys) with a mean age of 10.8 years (range 4-16 years) presenting 34 stones. The site of stones was pelvic in 24 cases (70.5%), iliac in 2 cases (6%) and lumbar in 8 cases (23.5%). The mean size of stones was 10.9 mm (5-22 mm). The success rate was 91%. There were no intraoperative complications. Post-operative complications rate was 21%. Factors associated with failure were size, localization of the stone, and delay of surgery. Factors associated with post-operative complications were size of the stone and operative time.
The rigid URS in children is a reliable and effective treatment option in the management of ureteric stones. Favorable factors for success of the procedure are pelvic stone and stone size <10 mm.
Pediatric Surgery International 02/2010; 26(5):501-4. · 1.25 Impact Factor
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ABSTRACT: To evaluate the effect on the oncological outcomes and recurrences at the prostatic urethra of simultaneous transurethral resection of bladder tumor (TURBT) and benign prostatic hyperplasia (TURP).
The records of 85 men (group 1) who had undergone simultaneous TURBT and TURP at our clinic between 1986 and 2006 and fulfilled the inclusion criteria were retrospectively analyzed and compared with those of 85 men (group 2) who had undergone TURBT only during the same period. Clinicopathologic parameters, recurrence and progression rates, and recurrence rates in the bladder neck and prostatic urethra were determined and compared.
There were no statistically significant differences in clinicopathologic parameters between the 2 groups. At a mean follow-up of 35.2 and 33.1 months in groups 1 and 2, respectively, only 1 patient developed recurrence in prostatic urethra or bladder neck in each group. There were no statistically significant differences between the 2 groups in follow-up time, recurrence, progression or recurrence in the prostatic urethra, and bladder neck.
According to our results, simultaneous transurethral TURP and TURBT can be safely performed without increasing the risk of tumor recurrence in the prostatic urethra.
Urology 09/2009; 75(6):1392-5. · 2.43 Impact Factor
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ABSTRACT: Single system ectopic ureter is a rare congenital malformation of the urinary tract, frequently associated with genital tract malformations. We report the first case of an adenocarcinoma arising in an ectopic ureter in a woman and mimicking uterine cervical adenocarcinoma. A 34-year-old woman, previously diagnosed as having bicornuate uterus, presented with post-coital bleeding. On gynecological exam, there were two cervixes with a small nodule on the left cervix. After nodule biopsy, the initial diagnosis was adenocarcinoma of the uterine cervix. Pelvic ultrasound and magnetic resonance imaging demonstrated an ectopic tumoral ureter draining a dysplastic pelvic kidney and inserted in the cervix of a bicornuate uterus. The patient was treated by radical hysterectomy and left nephroureterectomy. Pathological exam demonstrated an adenocarcinoma arising in the ectopic ureter. We suggest that this case could be an argument for recommending regular follow-up for women with ectopic ureter for detecting malignant transformation.
International Urogynecology Journal 05/2009; 20(11):1393-5. · 1.83 Impact Factor
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ABSTRACT: Müllerian duct cysts result from an abnormality in regression of the Müllerian system. They may occasionally give rise to symptoms. We report an unusual case of acute urinary retention in an old man caused by a giant Müllerian duct cyst. A 77-year-old man presented with of acute urinary retention. After bladder drainage, digital rectal examination found a large soft supraprostatic mass. Transrectal ultrasound and computed tomography scans revealed a large multilocular retrovesical cystic mass. The patient underwent open surgical resection of the cyst. Histologically, the cystic lesion was lined with stratified cubocolumnar cells, consistent with a Müllerian duct cyst. Acute urinary retention in the elderly is not always related to prostatic diseases. Other causes, even congenital ones, may be involved.
Cases Journal 01/2009; 2:203.
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ABSTRACT: Congenital polyps of the posterior urethra are rare lesions, and have often been described in boys. The polyps are benign lesion usually lined by a transitional epithelium, but cases of squamous or intestinal metaplasia have been reported.We report a case of a 10 years old boy referred for hematuria and dysuria.The voiding cysto urethrogram revealed a filling defect in the posterior urethra. At cystourethroscopy, a polyp of the posterior urethra was found and resected transurethrally. Histological examination showed a polyp with a fibro muscular core covered by focal gastric metaplasia with fundic gland. To our knowledge this is the first reported case of gastric metaplasia of urethral polyp.
Cases Journal 01/2009; 2:9119.
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ABSTRACT: 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.
Urology 10/2007; 70(3):591.e9-10. · 2.43 Impact Factor
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ABSTRACT: Testicular Leydig cell tumours are uncommon. Bilateral synchronous lesions are exceptional. They cause isosexual pseudo precocious puberty in childhood. The histological diagnosis of malignancy is sometimes difficult to establish and it can be made retrospectively when lymph nodes involvement or visceral metastasis appear in the follow-up. We report a case of a 9 year-old boy presenting bilateral Leydig cell tumour of the testis treated by bilateral radical orchiectomy who developed 2 years after the intervention a pulmonary metastasis.
Annales d Urologie 09/2003; 37(4):213-6. · 0.36 Impact Factor
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ABSTRACT: Simple urachal cyst is a rare pathology in the adults. The diagnosis is rarely established clinically, it is based on ultra sonography and confirmed by anatomo-pathology. The authors report one case of urachal cyst in a 42-year-old patient who present bladder irritation symptom. The diagnosis has been established by ultra sonography. The mean complications of urachal cyst are infection and degenerescence. The treatment is usually surgical.
La Tunisie médicale 09/2002; 80(8):497-9.
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ABSTRACT: Penoscrotal elephantiasis is a rare disease outside of filariasis endemic regions. The authors report a case of primary penoscrotal elephantiasis treated by complete surgical resection of the pathological tissue and penoscrotal reconstruction, with a good functional and cosmetic result. The complementary investigations indicated and the various treatment options are analysed in the light of a review of the literature.
Progrès en Urologie 05/2002; 12(2):337-9. · 0.58 Impact Factor
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ABSTRACT: Renal oncocytoma is a rare, benign tumour, which is rarely diagnosed preoperatively. The authors report 5 cases of renal oncocytoma operated over a 10-year period. Based on a review of the literature, the various complementary investigations allowing a preoperative diagnosis and the indications for conservative surgery are discussed and analysed.
Progrès en Urologie 03/2002; 12(1):84-8. · 0.58 Impact Factor
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ABSTRACT: Testicular Leydig cell tumours are uncommon. Bilateral synchronous lesions are exceptional. They cause isosexual pseudo precocious puberty in childhood. The histological diagnosis of malignancy is sometimes difficult to establish and it can be made retrospectively when lymph nodes involvement or visceral metastasis appear in the follow-up. We report a case of a 9 year-old boy presenting bilateral Leydig cell tumour of the testis treated by bilateral radical orchiectomy who developed 2 years after the intervention a pulmonary metastasis.
Annales d'Urologie. 37(4):213-216.
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ABSTRACT: L'éléphantiasis péno-scrotal s'observe surtout dans les pays d'endémie filarienne. En dehors de ces pays, il est le plus souvent secondaire à une chirurgie ou à une radiothérapie pelvienne. Plus rarement, il est primitif ou idiopathique. OBSERVATION H.F., âgé de 40 ans, nord africain, ouvrier journalier et père de 4 enfants, a consulté pour un important lym-phoedème chronique du pénis et des bourses évoluant depuis 4 ans, gênant la marche et l'activité sexuelle. Aucun antécédent de maladie vénérienne, de séjour en zone d'endémie filarienne, de traumatisme scrotal, de chirurgie ou de radiothérapie pelvienne ou autres anté-cédents (insuffisance cardiaque, insuffisance rénale, hypoprotidémie) n'étaient notés. L'examen clinique trouvait un éléphantiasis péno-scro-tal respectant le gland et les deux membres inférieurs (Figure 1). Le reste de l'examen était sans particulari-tés. La recherche de micro-filaires dans le sang ainsi que la sérologie de la filariose étaient négatives. La sérologie de la chlamydiae, faite dans le cadre de la recherche d'une lymphogranulomatose vénérienne était aussi négative. La lymphographie isotopique bipédieuse était stricte-ment normale, notamment il n'y avait pas de blocage lymphatique ni d'hypertrophie ganglionnaire. Le diagnostic retenu a été celui d'un éléphantiasis péno-scrotal primitif. Le traitement chirurgical a consisté en une résection du scrotum éléphantiasique tout en ménageant du tissu scrotal sain au niveau de la racine des bourses (Figure 2). Ce tissu a permis une reconstruction scrotale de bonne qualité. La peau pénienne atteinte a été aussi réséquée et remplacée par une greffe de peau libre mince (7/10ème de mm) prélevée au niveau de la cuisse. L'examen anatomo-pathologique de la pièce opératoire a mis en évidence un important oedème du derme pro-fond et de l'hypoderme avec dissociation du muscle scrotal par l'oedème et la fibrose, associé à un infiltrat inflammatoire du derme superficiel avec une hyperké-ratose orthokératosique du revêtement épidermique, évoquant un lymphoedème scrotal non filarien.
