Exploring retroperitoneal fibrosis: Insights, challenges, and treatment approaches.

Retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory condition characterized by abnormal tissue growth around the abdominal aorta and iliac arteries, usually encasing adjacent structures like the ureters. Its etiology remains most of the time idiopathic, but secondary causes, including malignancies and medication use, account for a minority of cases. This review aims to consolidate recent advancements in understanding RPF, focusing on its pathophysiology, diagnosis, and treatment. Literature search was conducted using databases like PubMed, with emphasis on recent publications. Biomarkers such as elevated CRP levels and imaging techniques like CT scans and MRI play pivotal roles in diagnosis and monitoring. Medical management primarily revolves around corticosteroids, with adjunctive therapies like tamoxifen and immunosuppressants showing promise. Surgical intervention, typically ureterolysis, becomes necessary in cases of urinary tract obstruction. This review studies the importance of a comprehensive approach to RPF management, integrating medical and surgical modalities for optimal patient outcomes.

Subcapsular renal collection of idiopathic origin: An exceptional entity.

Spontaneous renal subcapsular effusion is a rare condition, diagnosis is suspected on ultrasound and confirmed by a computed tomography (CT) scan. Treatment options include mainly percutaneous drainage and surgery. Authors report the case of a young female patient treated at our department of Urology B, university hospital center Ibn Sina, Rabat, MOROCCO. The patient underwent a minimally invasive treatment approach, which yielded excellent results.

Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience.

BACKGROUND: Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys. OBJECTIVES: The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy. METHODS: From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes. RESULTS: Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis. CONCLUSIONS: For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.

Congenital anterior urethral diverticulum in a young man: A case report and review of the literature.

Congenital anterior urethral diverticulum is a rare entity that can occur at any age but exceptionally in adults. Its diagnosis is suspected clinically by obstructive symptoms of the lower urinary tract most often associated with a penoscrotal ball. Its management consists of a diverticulectomy associated or not with a urethroplasty depending on the size of the diverticulum. We discuss through a case report the clinical and therapeutic aspects of this rare entity.

Transvaginal and transobturator autologous vaginal tape cystocele treatment: About an uncommon case.

BACKGROUND: Pelvic organ prolapse (POP) significantly impairs women's quality of life. The literature reports that nearly one in five women will require surgery in their lifetime, and nearly 40.6% involve anterior wall repair, specifically cystocele. Several techniques and surgical approaches have been used for cystocele management. These were performed by transvaginal and/or transabdominal approach and involved the use of native tissue or prosthesis. Nevertheless, since the transvaginal mesh ban recommended by the FDA and learned societies, autologous tissue repair has become the cornerstone of all vaginal prolapse surgery. CASE PRESENTATION: We hereby present the case of a 71-year-old widow who had undergone three vaginal deliveries. The patient reported that she no longer had sexual intercourse. The preoperative functional signs observed included: stress urinary incontinence, urinary urgency, dysuria and disabling vaginal ball feeling. The management strategy chosen in consultation with the patient was a repair using autologous material via the vaginal route. The vaginal strips were passed through trans-obturator and retro pubic route allowed support of the bladder. CONCLUSIONS: This technique using autologous material was easy, fast and inexpensive. It was developed on the basis of the TVT and TOT techniques and stood out for its tolerance and long-lasting functional effectiveness. It avoids all the complications due to polypropylene trans-vaginal prostheses that led to the banning of trans-vaginal mesh.

Safety and feasibility of same-day discharge laparoscopic radical prostatectomy: a systematic review.

PURPOSE: Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP. METHODS: A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. RESULTS: Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system. CONCLUSIONS: Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD.

[Retroperitoneal fibrosis at the Ibn Sina University Hospital of Rabat: about 18 cases]. / Fibrose rétropéritonéale au CHU Ibn Sina de Rabat: à propos de 18 cas.

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the formation of a fibro-inflammatory plaque in the retroperitoneal space in front of the abdominal aorta. It is responsible for the sheathing of the ureters. It is characterized by unspecific clinical signs, and it is often detected based on obstructive uropathy. We conducted a retrospective, descriptive study in the Department of Urology B and in the Department of Nephrology of the Ibn Sina University Hospital over a period of 10 years from January 2006 to December 2016. The study enrolled 18 patients, including 11 men and 7 women, with an average age of 51.4 years ± 11.2. Diagnosis was based on lumbar pain in 14 patients. Obstructive renal failure was reported in 15 patients and the diagnosis of RPF was based on uroscanner. Etiological assessment revealed 2 cases with a history of neoplasia, 2 cases of inflammatory disease and 1 case of retroperitoneal surgery; chronic drug intake was noted in more than half of the patients. In all patients, treatment was based on double J stent placement, while systemic treatment with corticosteroids and immunosuppressants was used on the basis of the evolutionary profile. Ureterolysis was immediately performed in 3 patients. Outcome was favorable, with significant improvement in renal function in 12 patients. A relapse occurred in 2 patients after 2 years of follow-up. Retroperitoneal fibrosis (RPF) should be suspected in patients with general signs associated with obstructive renal disease. Secondary causes should be systematically investigated, with particular emphasis on hyper IgG4 disease and neoplastic diseases.

[Malignant renal epithelioid angiomyolipoma (EAML): about a rare case]. / Angiomyolipome rénal épithélioïde malin (AREM): à propos d'un cas rare.

Malignant renal epithelioid angiomyolipoma (EAML) is a rare disease which has long been considered a hamartomatous lesion. Positive diagnosis is purely based on immunohistochemical investigation. Microscopically, it is characterized by mononuclear epithelioid cells showing a clear cytoplasm with severe cytonuclear atypies and expressing smooth muscle cell markers and melanocytic markers (HMB 45). We here report a rare case of EAML diagnosed after anatomopathological examination of a retroperitoneal tumor whose origin wasn't predetermined by CT scan.

[Favorable evolution after medical treatment in three cases of emphysematous pyelonephritis: about 3 cases]. / La pyélonéphrite emphysémateuse à évolution favorable après traitement médical: à propos de 3 observations.

Emphysematous pyelonephritis is a necrotic infection of the kidney characterized by the presence of gas within the renal parenchyma, the secretory cavities or the perirenal spaces. It is a severe condition that could be life-threatening. Patient's management remains controversial and is based either on surgery or on medical treatment. Percutaneous drainage can be also used for the treatment of these patients. We report 3 cases with EPN treated with only antibiotics. Patients' evolution was favorable. These results show that medical treatment could be sufficient.

Prostatic Abscess on Xanthogranulomatous Prostatitis: Uncommon Complication of an Uncommon Disease.

Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Only few cases have been reported in the English literature. Xanthogranulomatous prostatitis is usually an incidental finding after needle biopsy or transurethral resection of the prostate in patients suffering from low urinary tract symptoms. We report the case of a 59-years-old patient diagnosed with prostatic abscess managed by transurethral resection of the prostate. Histopathological examination of resected prostatic tissue revealed abscessed xanthogranulomatous prostatitis with no evidence of malignancy. Xanthogranulomatous prostatitis presenting as a prostatic abscess is a rare finding. To the best of our knowledge our case represents the fourth case of xanthogranulomatous prostatitis presenting as prostatic abscess reported in the English literature so far.

Lymphoepithelioma-Like Carcinoma of the Bladder: A Case Report of a Rare and Particular Variant of Urothelial Carcinoma.

Lymphoepithelioma-like carcinoma of the bladder (LELCB) is a rare variant of urothelial carcinoma first described by Zukerberg in 1991 and confirmed as a variant of urothelial carcinoma by the WHO classification of tumors of the urinary system. LELCB is characterized by a marked infiltration of lymphocytes in the area involved by the tumor which may coexist with the conventional urothelial carcinoma. LELCB are classified according to the percentage of lymphoepithelioma component within the tumor with the prognosis depending on the percentage. We report a new case of pure LELCB occurring in 63-year-old woman presenting with hematuria. Ultrasonography and cystoscopy revealed a large tumor on the left lateral wall of the bladder. Transurethral resection of the bladder tumor (TURBT) was performed. Pathological and immunohistochemical analysis revealed a high-grade muscle-invasive LELCB (G3pT2). The patient underwent an adjuvant systemic chemotherapy with no recurrence after a ten-month follow-up. To our knowledge, this is the second Moroccan case of LELCB reported in the English literature. Although its rare occurrence prognosis and ideal therapeutic management of LELCB have not been clearly established yet, literature findings encourage the adoption of a conservative approach in treatment of LELCB.

Penile Gangrene and Necrosis Leading to Death Secondary to Strangulation by Condom Catheter.

Condom catheters are widely used in the management of male urinary incontinence, bedridden patients, and geriatric population. They are considered to be safe; however they are associated with serious complications in case of an incorrect use. We report a dramatic case of penile strangulation by condom catheter tardily discovered till occurrence of necrosis and gangrene leading to death in an elderly bedridden and diabetic man. Through this case we emphasize the importance of patient education for the correct use of condom catheters and remind care providers to maintain a high level of sensibility to complication generated from long-term use of condom catheters.

Zinner's syndrome: report of two cases and review of the literature.

BACKGROUND: Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs between the 4th and the 13 h gestational week, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. Cysts of the seminal vesicle may appear with a mass effect, dysuria, epididymitis, or obstruction of the gastrointestinal and genitourinary tracts. Approximately two thirds of them are associated with ipsilateral renal agenesis, because both the ureteral buds and seminal vesicles originate from the mesonephric (Wolffian) duct. They were first described by Zinner in 1914, and 200 cases of seminal vesicle cysts associated with ipsilateral renal agenesis have been reported in the literature. Most patients with this anomaly are asymptomatic until the third or fourth decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Transrectal ultrasonography provides good visualization of the pelvic structures and allows guidance for aspiration of the cysts. CASE PRESENTATION: We present two cases of seminal vesicle cyst. The first patient had dysuria, increased frequency of urination, and haematuria. He was operated and benefited from a removal of the cyst with right ureterectomy and left ureteral reimplantation. The second patient had disorder of the digestive transit and he benefited from a laparoscopic removal of the cyst. CONCLUSIONS: Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Usual symptoms that are caused by the seminal vesicle cysts are bladder irritation and obstruction as well as pain in the perineum and scrotum. Epididymitis is frequently found. Treatment consists to removing the seminal vesicle cyst.

Urethral hemangioma: case report and review of the literature.

Hemangiomas are benign vascular tumors. They are the prerogative of the liver and skin. And genitourinary localizations are rare and have only been rarely reported in the prostat, bladder, ureter or the perineum. In the light of published cases, urethral hemangiomas are mostly found in males. Few cases of hemangioma in the female urethra were reported. We report a cavernous hemangioma of the urethra in a 61 years old patient who presented bleeding from the urethra and micturition disorders. Physical examination revealed a tumor 3 cm x 2 polyploid arising from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma.

[Seminal vesicle cyst: about a case]. / Kyste de la vésicule séminale: à propos d'un cas.

We report the case of a patient with symptomatic seminal vesicle cyst on the right side. Imaging examinations (pelvic and endorectal ultrasound, abdominal-pelvic tomodensitometry and MRI) were perdormed and the patient underwent surgical removal of the cyst. In light of this case study, epidemiology, diagnosis and treatment options are discussed.

Bilateral kidney matrix stones: a rare case.

Kedney matrix stones are a rare form of calculi. Flank pain and urinary tract infections (UTI) are the most common presentations of matrix calculi. The diagnosis is usually made at surgery, but some preoperative radiographic findings might be suggestive. Open surgery was the method of choice for treatment. However, combination of ureterorenoscopy and percutaneous nephrolithotomy (PCNL) was found to be safe and effective. We report a rare case of renal and ureteral matrix stones that were diagnosed and treated by open surgery. We also describe its clinical, radiological and therapeutic features through a review of the literature.

Penile cancer: about ten cases at the University Hospital of Rabat, review of the literature.

UNLABELLED: The aim of our study was to report the status of penile cancer sites in the urology department at the University Hospital of Rabat and evaluate long-term results of surgical treatment of this cancer. PATIENTS AND METHODS: Between 1989 and 2015, 10 patients were treated for penile cancer. 10 cases were retrospectively reviewed and the following data were recorded: mode of revelation, seat, staging, TNM stage, treatment, evolution and survival. The mean age of patients was 58,1 years (48-81 years). All patients had squamous cell carcinoma of the penis. Six patients had a partial amputation of the penis, and three patients underwent total amputation. The median size of the lesion was 4.25 cm (1.5-8 cm). All tumors had a distal seat (gland- Furrow balanopreputial), 8 were localized and non-invasive (PT1 - PT2) and 2 had infiltrated the urethra (PT3). Four patients had lymph node localization. A single bilateral lymphadenectomy was performed and was positive only on one side, with a node <3 cm and no extracapsular extension. Two patients were referred for chemotherapy, a neoadjuvant referred to basic (Bleomycin - Methotrexate, Cisplatin) the other in a palliative goal. Median follow-up was 42 months (6 -72mois). Four patients died, one of which was presented immediately with metastatic mode. Six patients were alive at last node or local recurrence negative. Cancer of the penis seems rare in Morocco. His oncologic and functional outcomes (sexual and urinary) depend on the precocity of the treatment. The surgery of lymph node resection with lymphadenectomy remains the reference treatment.