Hydatid cyst of the kidney: diagnosis and treatment.

Renal echinococcosis is relatively uncommon compared to liver and lung localizations. Kidney involvement represents 4% of confirmed cases of hydatid disease. We reviewed the clinical findings of a personal series of renal hydatidosis with emphasis on diagnostic and therapeutic issues. A total of 178 renal cysts were collected over a period of 33 years from 1963 to 1996. Clinical, radiologic and laboratory data are analyzed. Radiologic exploration has had an interesting evolution, with the appearance of ultrasonography and computed tomography. Diagnostic accuracy has been greater since the availability of ultrasonography and immunologic studies. Their contribution to the diagnosis of renal hydatid disease is important. We try, with our experience of ultrasonography in the matter of renal hydatid cysts, to underline the role of this exploration. The treatment of hydatid cyst of the kidney is surgical. Renal-sparing surgery, cystectomy plus pericystectomy, is possible in most cases (75%). Nephrectomy (25% of cases) must be reserved for destroyed kidneys resulting from aged cysts opening into the excretory cavities and complicated by renal infection. Whether conservative or radical, the first surgery performed is cystectomy, with germinate membrane removal after controlled evacuation and opening of the cyst, making the subsequent steps of surgery easier.

[Vascular complications of kidney transplantation]. / Complications vasculaires de la transplantation rénale.

We report a retrospective analysis of 100 renal transplantations, mainly from related living donors. The rate of vascular complications was 9%: one arterial hemorrhage due to partial suture failure; one lymphocele; two arterial thrombi, one in the inferior artery leading to fistulization by ureteral necrosis and death following septic rupture of the artery, and one in the renal artery requiring graft removal; and five arterial stenoses, one which regressed spontaneously, one treated by endoluminal angioplasy, one treated surgically, one controlled by medical treatment and one which could not be treated due to secondary hemodialysis after graft rejection. In this series of 100 transplantations, vascular complications were the cause of 16.5% of deaths and 12.5% of post-graft hemodialysis.

[The treatment of ureteroceles complicated by calculi]. / Traitement des urétérocèles compliquées de lithiase.

In a series of 13 adults with calculi in ureteroceles, 10 cases underwent endoscopic meatotomy associated with endoscopic lithotripsy. In 2 bulky ureteroceles with calculi, the authors performed excision of the ureterocele and reimplantation of the ureter. In one case, the authors successfully performed extracorporeal lithotripsy. The authors obtained good results in all cases. Endoscopic meatotomy with lithotripsy is a very useful procedure for treatment of small or medium sized ureteroceles with calculi in adults.

[Retrocaval ureter. Apropos of 6 cases]. / L'uretère rétro-cave. A propos de 6 cas.

The authors report six cases of retrocaval ureter discovered in quite various circumstances. A genital malformation associated to the retrocaval ureter was found in only one case. Five of our six patients were operated. Four of them underwent uncrossing of the ureter relative to the vena cava, and a patient underwent nephrectomy because her kidney was destroyed. The sixth patient was not operated because there was no impact on the excretory cavities of the kidney. This series and the review of the literature allow specifying the course of action for this pathology.

[Renal tuberculosis with pseudotumoral form: apropos of a case]. / La tuberculose rénale à forme pseudo-tumorale: à propos d'un cas.

The authors report about one rare case of renal tuberculosis in a pseudo-tumoral form, which had radiologic appearances compatible with a kidney cancer invading soft tissue. The fast spontaneous evolution towards fistulization allowed confirming the diagnosis of urinary tuberculosis. The outcome with treatment was favorable. The authors recommend that needle biopsy should be made in cases of doubtful kidney tumors to provide an exact diagnosis.

[Retrovesical hydatid cyst. Apropos of 2 cases]. / Le kyste hydatique rétro-vésical. A propos de deux cas.

A hypogastric mass compressing the bladder in an adult, in a zone endemic for hydatid disease, should raise to suspicion of a retrovesical cyst, especially as the cyst sometimes opens into the bladder resulting in haematuria and hydatiduria. Intravenous urography and ultrasonography facilitate the topographical diagnosis. Treatment is surgical: transperitoneal cystectomy and pericystic resection as extensive as possible with exploration of the abdomen looking for other sites (liver, mesentery, omentum). This treatment was successful in the two cases reported here. In conclusion, a stable cure can be obtained by adopting a well defined therapeutic approach to these rare lesions.

[The valves of the ureter. Apropos of 2 cases]. / Les valves de l'uretère. A propos de deux cas.

The authors report two cases of congenital ureteral valves of the upper third of the ureter complicated by renal stone in two children and diagnosed by I.V.P. The two patients underwent a resection of the pathological segment and a pelvic-ureteral anastomosis successfully. The review of the literature data regarding ureteral valves allowed to emphasize the uncommon of the bilateral form complicated by renal stone and the better preoperative diagnosis by ureteroscopy and antegrade pyelogram.

[Cancer of the urachus]. / Le cancer de l'ouraque.

We report a case of mucin-producing adenocarcinoma of the urachus. Preoperative diagnosis was established by computerized axial tomography. An en bloc resection was performed, including the urachus with supravesical mass and bladder dome.

[Calcified necrosing cystitis]. / La cystite nécrosante calcifiée.

Calcified necrotising cystitis is an urological curiosity, the authors report two cases. With subsidence of the acute process, regeneration and fibrosis take place, with contracture of the bladder and reduction of its capacity. Augmentation ileocystoplasty was performed with success in one case. The clinical and therapeutic aspects of this rare disease are discussed.

[Role of in situ alkalinization in the treatment of obstructive uric acid lithiasis]. / Place de l'alcalinisation in situ dans le traitement de la lithiase urique obstructive.

The authors report a series of 9 reno-ureteral obstructive uric acid calculi with recourse first to percutaneous nephrostomy. After attempt of stone dissolution by in situ alkalinization, the role of such a method among other uric acid stones management techniques is discussed.

[Role of in situ alkalinization in the treatment of obstructive uric acid lithiasis]. / Place de l'alcalinisation in situ dans le traitement de la lithiase urique obstructive.

The authors report a series of nine reno-ureteral obstructive uric acid calculi initially treated by percutaneous nephrostomy. After attempting stone dissolution by in situ alkalinization, they discuss the place of such a method among the various treatments for uric acid stones.

[Fistulas and ureteral strictures after kidney transplantation. Diagnosis and treatment]. / Fistules et sténoses urétérales après transplantation rénale. Diagnostic et traitement.

We report our experience of 4 urine fistulas and 4 ureteral strictures after renal transplantation. Percutaneous nephrostomy was performed on all patients. The diagnosis was established by antegrade pyelography. Nephrectomy was performed on 2 patients because of failure of drainage and formation of an infected urine collection due to an extended ureteral necrosis. Abstention was elected in one case as renal function did not improve due to associated chronic rejection. In 5 cases, renal function quickly improved with drainage: 2 were operated on immediately, and one after failure of endo-urological treatment of a urine fistula. Antegrade dilatation has been used successfully in one stenosis. In the last case, a double pigtail stent allowed a urine fistula to close. Percutaneous nephrostomy seems to be best method of drainage when ureteral obstruction or fistula is suspected in renal transplant patients, and permits diagnosis by antegrade pyelography. Percutaneous management may be a satisfactory way of treatment for limited stenosis or fistulas.

[Tumors of the bladder in patients under 40 years of age]. / Les tumeurs de vessie chez le sujet de moins de 40 ans.

It is often stated that younger patients have a better prognosis than their older counterparts. From the records of 17 men and 2 women, aged 40 years or less it appears that bladder carcinoma in patients 30 years-old or less have a favorable prognosis. Disease occurring at age 30 to 40 has a much worse prognosis and is no different from that affecting the older age groups.

[Cervico-prostatic incision in the treatment of benign prostatic hypertrophy. Apropos of 40 cases]. / L'incision cervico-prostatique dans le traitement de l'hypertrophie bénigne de la prostate. A propos de 40 cas.

The authors report on the results of 40 cases of cervico-prostatic incision for benign prostatic hypertrophy. Evaluation of the prostatic gland was based only on rectal examination. Operative technique is simple. We have treated patients with prostatic hypertropy less than 30 g. Young men with prostatic hypertrophy greater than 30 g have been treated by this technique, to preserve antegrade ejaculation. Success rate was 90% at 6 months and 85% at 18 months. Retrograde ejaculation was observed in 21% of the patients following treatment.

[T1 bladder tumors. Can they be considered superficial?]. / Tumeurs de vessie T1. Peut-on les considérer comme des tumeurs superficielles?

The authors report about a series of 60 cases of superficial (Ta and T1) bladder tumors and study their evolution towards infiltration according to the grade, size and number. 16% of the T1 tumors evolved towards infiltration and/or metastatic spread after a period of 42 months. In our opinion, T1 tumors can be regarded as superficial tumors. However, our therapeutic attitude is cautious because of pejorative factors of prognosis: high grade, multiple foci, and size exceeding 5 cm.

[Results of detubulate enterocystoplasty. Apropos of 17 cases]. / Résultats des entérocystoplasties détubulées. A propos de 17 cas.

From January 1988 to October 1989, 17 patients underwent radical cystectomy for bladder cancer. They had a bladder replacement by Hautmann pouch. Good results were obtained after a period of observation of 6 to 24 months. Two patients died. Hyperchloremic acidosis was observed in 20% cases. The urinary continence was achieved in 13 patients who were willing to wake up twice every night. One patient preferred the collecting device. Our study showed that the Hautmann pouch is a particular low pressure reservoir with a capacity of 200 ml to 800 ml, and assessed the mechanism of loss of urine at night in one case. The urinary continence was achieved after a good training period and depended on patient's cooperation. This technique permitted to obtain a very satisfactory diurnal and nocturnal continence in our patients, however a longer follow up is mandatory to confirm the efficiency of this method on long term basis.

[Value of a scrotal myocutaneous flap in the repair of penile and urethral skin loss]. / Intérêt du lambeau myocutané scrotal dans les réparations de perte de substance cutanée pénienne et urétrale.

The authors report a case of a large penile skin and urethral defect repair using a scrotal myocutaneous flap. The modalities, advantages and defects of the method were detailed. This technique permitted to obtain a very satisfactory result. Then we extended it to the failures of the hypospadias and epispadias reconstruction.

[The first thirty months of kidney transplantation in Tunisia]. / Les trente premiers mois de transplantation rénale en Tunisie.

Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period.