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W Kerkeni,
A Bouzouita,
H Jarraya,
M S Selmi,
M Cherif,
A Derouich,
N Kourda,
C Dziri,
R Zermani,
M R Ben Slama, M Chebil
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ABSTRACT: The lung, the liver, the bone tissue and the brain are the most frequent sites for renal cell carcinoma metastasis. Small bowel metastasis from renal cell carcinoma is rare, with only few cases published. We report the case of ileal metastasis from operated kidney cancer revealed by ileocolic intussusception and causing intestinal obstruction in a 32-year-old woman.
Progrès en Urologie 01/2013; 23(1):73-5. · 0.58 Impact Factor
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ABSTRACT: La formation de calculs dans un diverticule de l’urètre est une situation rare, pouvant être rencontrée chez l’homme. Nous
rapportons le cas d’une patiente, âgée de 54 ans, qui a consulté pour des troubles urinaires irritatifs associés à une sensation
de boule dans le vagin. Les explorations clinique, radiologique et endoscopique ont confirmé le diagnostic de diverticule
urétral compliqué de lithiase. L’exérèse du diverticule et l’extraction des calculs ont été réalisées avec succès par voie
vaginale.
Stone formation in a urethral diverticulum is rare and may be encountered in men. We report the case of a 54-year-old woman
who reported lower urinary tract symptoms and a tender periurethral mass. Clinical, radiological and endoscopic investigations
confirmed the diagnosis of lithiasis in a urethral diverticulum. Transvaginal diverticulectomy and removal of calculi were
performed successfully.
Mots clésFemme–Urètre–Diverticule–Calcul
KeywordsWoman–Urethra–Diverticulum–Calculi
Pelvi-périnéologie 05/2012; 6(3):174-176. · 0.07 Impact Factor
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ABSTRACT: The dysfunction of the catheter in peritoneal dialysis (PD) is a frequent complication. However, perforation of organs are rare, particularly that of the urinary bladder. This requires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 05/2012; 23(3):552-5.
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ABSTRACT: The renal carcinoma is situated in the third rank of the urologic cancers. It is metastatic in a third of the cases, when we made the diagnosis of the cancer. Lungs, bone, the liver, the suprarenal gland and the brain stay metastatic sites of preference. Some metastatic locations are anecdotal and made the object of some publications. We report the case of a cardiac metastasis of renal carcinoma at an old patient 81 years old operated for cardiac tumor.
Progrès en Urologie 07/2011; 21(7):492-4. · 0.58 Impact Factor
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M Ounissi,
T Gargah,
M M Bacha,
K Boubaker,
H Hedri,
E Abderrahim,
A Derouich,
R B Slama, M Chebil,
T B Abdallah,
A Kheder
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ABSTRACT: Malformative uropathies are a frequent cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Medical management of urinary tract infections and advances in surgical reconstruction procedures resulted in good outcomes of kidney transplantation among these patients. The aim of this article was to describe the epidemiological profiles and outcomes of patients who underwent transplantation for ESRD related to malformative uropathies.
Among 493 kidney recipients at our center from 1986 to 2009, 47 had malformative uropathies as the cause of ESRD. We retrospectively studied the incidence of acute rejection episodes, acute tubular necrosis, as well as patient and graft survivals, comparing these results to those observed in patients without malformative uropathies using chi-square tests for qualitative parameters and nonpaired Student t tests for continuous variables. Log-rank tests were used for comparisons of survival curves.
The 47 patients, representing 9.53% of our kidney transplant recipients, included 27 men and 20 women (sex ratio=1.35) with an overall mean age of 27.6±9.1 years (range, 10-49). The common etiology was vesico-ureteral reflux (78.7%). Hemodialysis was the main RRT modality (68%) with a median duration of 41 months. Also, 82.9% of patients received transplants from living donors. Acute tubular necrosis occurred in 4 of these (8.5%) versus 22.06% of the other patients (P=.03). Acute rejection episodes were observed in 13 of these patients (27.6%) versus 23.1% of the other patients (P=not significant [NS]). After a cumulative follow-up period of 3744 months (median, 41.8 months), 5 patients had died (1.6 death/y/100 patients) and 5 had lost their allografts and returned to dialysis (1.6 case/y/100 patients). Graft survival rates at 1, 5, and 10 years were 97.8%, 93.2%, and 79.9%, which were comparable with 95.9%, 87.6%, and 78.9% among the other patients, respectively (P=NS). Patient survival rates at 1, 5, and 10 years were 100%, 88.5%, and 82.6% versus 96%, 87.6%, and 79.6%, respectively (P=NS).
Kidney transplantation in patients with malformative uropathies is increasingly frequent. The incidence of acute rejection episodes as well as patient and graft survivals were comparable with those of subjects without malformative uropathies.
Transplantation Proceedings 03/2011; 43(2):437-40. · 1.00 Impact Factor
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M Cherif,
M Ounissi,
C Karoui,
K Boubaker,
I Helal,
F Ben Hamida,
E Abderrahim,
F El Younsi,
A Kheder,
A Derouich,
M Sfaxi,
R Ben Slama, M Chebil,
R Bardi,
I Sfar,
T Ben Abdallah,
Y Gorgi
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ABSTRACT: Despite initiatives to increase cadaveric donation, there is still a shortfall in donor organs. Kidneys from living donors now makes a significant contribution to increasing the number of organs available for transplantation in Tunisia. We performed a retrospective study of 405 kidney transplantations, including 321 (79.3%) from living donors performed from June 1986 to December 2007. We obtained information on only 162 (50.4%), namely, 64 men (39.5%) and 98 women (60.5%), whose mean age at the time of donation was 42.3 ± 12.2 years. Twelve (8.22%) perioperative complications occurred: wound infections (n = 4), pneumothorax (n = 4), phlebitis (n = 1), hematomas (n = 2), and urinary infection (n = 1). The mean follow-up period was 117.4 ± 74.4 months. Hypertension occurred in 42 donors (25.9%) with mean values of 134 ± 20 for systolic and 79 ± 10 for diastolic blood pressure. Twelve donors (7.4%) developed proteinuria (mean proteinuria, 0.08 ± 1.25 g/d). Renal insufficiency was found in 28 donors (19.44%), 2 of whom developed chronic renal failure requiring dialysis at intervals of 36 and 84 months. In both cases, we diagnosed a familial form of focal segmental glomerulosclerosis. Two donors (1.2%) died within 10 years after kidney donation due to senility. The relatively favorable outcomes suggest that living-donor kidney transplantation is an acceptable approach, in view of the superior results it yields in recipients. However, efforts to increase the number of cadaveric donors in Tunisia should be made. It is also important to develop a registry of long-term kidney function after kidney donation.
Transplantation Proceedings 12/2010; 42(10):4311-3. · 1.00 Impact Factor
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ABSTRACT: Lymphocele is a well-known complication of renal transplantation. Presenting symptoms are nonspecific; most patients are entirely asymptomatic. Herein, we have reported a case of lymphocele due to an asymptomatic lymphatic Wuchereria bancrofti filariasis with deterioration of graft function. A 53-year-old man with end-stage renal disease secondary to vascular disease was admitted 40 days after transplantation with vague, isolated abdominal pain. An abdomen and pelvis ultrasound examination demonstrated a cystic structure in the renal hilus. Graft function deteriorated, so the patient underwent puncture of the lymphocele followed by povidone iodine sclerotherapy. In the percutaneous drainage, we noted a fine whitish strand 4-mm thick similar to the shape of the stent, a part of which seemed to go into the transplantation fossa. Parasitological examination showed an adult female worm of W bancrofti measuring 6 cm. The test for microfilaremia was negative. The patient was treated for 10 days with a combination of Ivermectin and Albendazole associated with Doxycycline. The collection rapidly decreased after worm treatment. This case describes a post-renal transplantation lymphocele due to asymptomatic lymphatic filariasis.
Transplantation Proceedings 09/2010; 42(7):2808-12. · 1.00 Impact Factor
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ABSTRACT: To identify the risk factors of post renal transplant lymphocele.
Over a period of 20 years (1986-2006) we carried out 377 renal transplants on 372 patients. Thirty cases of lymphocele were recorded (8%). The medical history of patients was retrospectively examined in order to identify the risk factors of this complication among the data relating to recipents, donors, the operation itself and post operative incidents. The different parameters liable to correlate with the incidence of lymphocele were subjected to a univaried then multivaried statistical study.
Unifactorial analysis identified four predictive factors related to the incidence of lymphocele. They were the age of the recipient greater or equal to 35 years old, the cadaverous origin of the transplanted organ, the duration of ischemy greater or equal to 24hours for the kidneys of deceased donors, and immunosuppressor treatment associated with Mycophenolate mofetil-Cyclosporine. The only independent risk factor significant in multifactorial analysis was the cadaverous origin of the transplanted organ.
Our study showed that the cadaverous origin of the transplanted organ would appear to play an important role in the genesis of post renal transplant lymphocele. A better preparation of the organs of cadaverous origin before their implantation with meticulous ligature of the hilum of lymph nodes could reduce the incidence of this complication. This observation, as well as the benefit of such a procedure, remains to be confirmed by studies on a larger scale.
Progrès en Urologie 04/2010; 20(4):301-6. · 0.58 Impact Factor
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ABSTRACT: Plasmocytoid urothelial carcinoma is a rare subtype of tumour of the urinary bladder. Its clinical and histopathological features have not been well characterized. There are few reports of this type of tumour. We report a case of 65-year-old man who was operated in our department for bladder tumour. The pathological diagnosis was high-grade urothelial carcinoma with plasmocytoid component. The patient died shortly thereafter from liver and bone metastasis.
Pathologica 12/2009; 101(6):253-4.
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ABSTRACT: Herein, we report the results of kidney transplantation in 9 of 376 patients who underwent kidney transplantation at our center between 1986 and 2007 because of chronic renal failure associated with autoimmune disease. Four of the 9 patients had systemic lupus erythematosus, 3 had Wegener granulomatosis, and 2 had Goodpasture syndrome. Six patients received organs from living donors, and 3 received cadaver organs. Infections were frequent and included cytomegalovirus and urinary tract infection in most cases. There was no difference in occurrence of metabolic and cardiovascular complications in our study patients compared with other transplant recipients. Incidence of allograft loss (n = 1) was similar to that in our entire transplantation population, with an overall rate of 2.9%. We conclude that kidney transplantation is a reasonable therapeutic option in patients with autoimmune disease with end-stage renal disease because of good graft and patient survival compared with kidney recipients without autoimmune diseases.
Transplantation Proceedings 09/2009; 41(7):2781-3. · 1.00 Impact Factor
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ABSTRACT: Cigarette smoking and genetic susceptibility are the two factors most closely associated with bladder cancer development. This study sought to determine the effect of smoking and genetic polymorphisms in xenobiotic metabolizing enzymes on the histological stage and grade of bladder tumors in Tunisian patients. A total of 97 patients with urothelial cell carcinomas were examined with respect to smoking status, NAT2 (N-acetyltransferase 2), GSTM1 and GSTT1 (glutathione S-transferase Mu 1 and teta 1) genotypes distribution. Our data have reported that tobacco; NAT2, GSTM1 and GSTT1 genotypes were not associated with bladder tumor stage. When we studied the superficial bladder tumor group, we have shown that in smokers tobacco was associated with the development of low-grade tumors. Conversely, non-smoker patients carrying altered NAT2 genotypes were with a 3.67-fold increased risk of developing superficial high-grade tumors (P = 0.02; RR = 3.67; 95% CI: [1.40-9.62]).
Bulletin du cancer 06/2009; 96(5):E23-9. · 0.67 Impact Factor
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ABSTRACT: Primary adrenal lymphoma is a rare condition. Only 70 cases were described in the literature. Adrenal lymphoma is often bilateral and in most of the cases of B-cell type. T-cell lymphoma is exceptional. The prognosis is bad and patient can die early because of acute adrenal insufficiency. We report a case of a 70-year-old man who was admitted for acute adrenal insufficiency due to primary bilateral adrenal T-cell lymphoma. He had corticotherapy and surgical exploration for intra-abdominal sepsis. He died because of multivisceral deficiency. Clinical features and imaging are not specific. (18)F-FDG PET Scan is an excellent mean to detect malignant tumor of adrenal gland. Percutaneous needle biopsy is useful to determine histology. The standard treatment is chemotherapy.
Annales d Endocrinologie 07/2008; 69(3):249-53. · 0.74 Impact Factor
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ABSTRACT: Retroperitoneal laparoscopy is a recent alternative to conventional surgical treatment of ureterolithiasis. The objective of this study was to evaluate the place of retroperitoneal laparoscopic ureterolithotomy.
The authors report 50 cases of retroperitoneal laparoscopy for lumbar ureter stones performed in 49 patients between January 2001 and December 2006. The indications were a very large (>15 mm) obstructive stone in the lumbar ureter in 88% of cases, failure of extracorporeal shock wave lithotripsy (ESWL) in 6% of cases and refusal of ESWL in 6% of cases.
The mean stone diameter was 17 mm (range: 10-35 mm). The stone was removed by retroperitoneal laparoscopy in 46 out of 50 cases (92%). The mean operating time was 97 min. (range: 35-170 min.). The surgical conversion rate was 8%. Ten patients (20%) developed a urinary fistula requiring secondary drainage by double J ureteric stent. The mean hospital stay was 6.8 days. No cases of ureteric stenosis or kidney destruction was observed with a mean follow-up of 32 months.
Retroperitoneal laparoscopic lumbar ureterolithotomy is a safe, effective and minimally invasive technique which could constitute an alternative to open ureterolithotomy in the majority of its current indications.
Progrès en Urologie 06/2008; 18(5):281-7. · 0.58 Impact Factor
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ABSTRACT: To define the clinical, laboratory and morphological features of emphysematous pyelonephritis, as well as the treatment modalities, with particular emphasis on the need for urgent treatment.
Between 1987 and 2004, 21 patients were treated for emphysematous pyelonephritis. Epidemiological, clinical, laboratory and radiological data, treatments and clinical outcome were retrospectively collected for all patients.
This series comprised 15 women and six men with a mean age of 54.6 years. All were diabetic. Upper urinary tract obstruction was demonstrated in 47.6% of cases. The left kidney was affected in 14 patients and the right kidney was affected in six patients. Only one patient had bilateral pyelonephritis. The diagnosis was established by CT in every case. All patients received appropriate intensive care. Treatment was purely medical in one case. Emergency nephrectomy was performed in 12 patients, emergency surgical drainage was performed in three patients, percutaneous drainage was performed in two cases and ureteric catheter drainage was performed in three patients. The mortality rate in this series was 23.8%.
Emphysematous pyelonephritis is a serious infection. Early diagnosis is essential, particularly in diabetic patients. The positive diagnosis is based on computed tomography and treatment is now increasingly conservative.
Progrès en Urologie 03/2008; 18(2):102-7. · 0.58 Impact Factor
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ABSTRACT: Cystic nephroma is a benign renal neoplasm. Since its initial description, there has been much debate regarding its origin. Preoperative diagnosis of Cystic nephroma is difficult to achieve. The differential diagnoses of Cystic nephroma are recently described mixed epithelial and stromal tumours of the kidney and cystic renal cell carcinoma. The Authors report three cases of Cystic nephroma and illustrate the clinical, radiological and histological features of this renal neoplasm.
Pathologica 01/2008; 99(6):446-9.
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S Béji,
E Abderrahim,
H Kaaroud,
H Jebali,
T Ben Abdallah,
F El Younsi,
F Ben Moussa,
F Ben Hamida,
A Sfaxi,
M Blah, M Chebil,
M Ayed,
R Bardi,
Y Gorgi,
A Kheder
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ABSTRACT: Arterial hypertension often present after kidney transplantation is of multifactorial origin. The aim of this study was to determine the role of donor and recipient factors in the development of hypertension after renal transplantation. We retrospectively analyzed the data of 280 patients transplanted between 1985 and 2005, who still had functioning grafts at 1 year after transplantation. We recorded donor and recipient parameters. One hundred eighty-seven patients (66.8%) were hypertensive. Upon multivariate analysis of recipient factors, pretransplant hypertension (odds ratio) [OR]: 8.5, 95% confidence interval [CI]: 4.5 to 16.1); serum creatinine level > 130 micromol/L at 6 months (OR: 2.5, 95% CI: 1.3 to 4,7), male gender (OR: 2.02, 95% CI: 1.2 to 3.4), and chronic rejection (OR: 2.4, 95% CI: 1.2 to 4.7) were independent predisposing factors. Among donor factors, age was significantly associated with arterial hypertension upon univariate analysis. In conclusion, recipient factors, especially pretransplant hypertension, contribute to the disorder in renal transplant patients.
Transplantation Proceedings 10/2007; 39(8):2580-2. · 1.00 Impact Factor
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ABSTRACT: Primitive neuroectodermal tumors (PNET) of the kidney are rare and highly aggressive malignancies. We report a case of 28-year-old male with PNET of the kidney with inferior vena caval thrombus. Immunohistochemistry revealed strong positivity for CD99 and weak positivity for vimentin. Neuron-specific enolase (NSE), chromogranin and cytokeratin were negative. Patient underwent nephrectomy and six cycles of polychemotherapy the patient was in partial remission. He underwent two further cycles of high dose chemotherapy and died 9 months after diagnosis due to liver metastases. The diagnosis of renal PNET must be considered in young patients with renal neoplasm, particularly those with advanced disease at presentation. Achieving exact diagnosis has important clinical consequences.
Pathologica 05/2007; 99(2):57-60.
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La Tunisie médicale 01/2006; 83 Suppl 12:64-7.
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H Kaaroud,
El Jeri,
S Béji,
F Ben Moussa,
F Ben Hamida,
S Turki,
H Hedri,
T Ben Abdallah,
A Khedher, M Chebil,
H Ben Maïz
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ABSTRACT: We studied the clinical, therapeutic and progressive characteristics of retroperitoneal fibrosis.
We analysed the observations of retroperitoneal fibrosis diagnosed between 1980 and 2002 in our hospital, from the summaries of 15 patients exhibiting retroperitoneal fibrosis (RPF). Therapeutical supervision was based on biology and radiology.
There were 11 men and 4 women with a mean age of 44.5 years ranging from 28-64 years. Pain was predominantly lumbar or abdominal in all patients. An inflammatory syndrome was observed in all patients and renal failure in 11. Radiological examinations revealed single or bilateral in 14 cases and the fibrosis plaque in 13 cases. Treatment consisted in corticosteroids alone in 9 patients, surgery alone in 3 cases and surgery with corticosteroids in 3 patients. Ten relapses (range: 1-5) occurred in 4 patients when corticosteroids were stopped. After a mean follow-up of 36 months (range:18 days-11 years), one death was observed, 12 patients had normal renal function and 2 patients had persistent moderate renal failure.
This study confirms the rarity of retroperitoneal fibrosis, the difficulty in its diagnosis, the frequency of pain, inflammatory syndrome and renal failure. Corticosteroids are efficient and regular follow-up is required.
La Presse Médicale 03/2005; 34(3):213-7. · 0.67 Impact Factor
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European Urology Supplements 03/2005; 4(3):231. · 1.83 Impact Factor
