[Vesicouterine fistulas: an experience of 17 years]. / Les fistules vésico-utérines: une expérience de 17 ans.

OBJECTIVE: To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment. MATERIALS AND METHODS: The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects. RESULTS: The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair. CONCLUSION: Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

[Migration of an intrauterine device into the bladder. Report of a case]. / Migration intravésicale d'un dispositif intra-utérin. A propos d'un cas.

PURPOSE: We report an uncommon case of a bladder lithiasis arising from an intrauterine device (i.u.d.). CASE REPORT: A female patient with i.u.d. for 13 years consulted for frequent episodes of cystitis. Patient evaluation demonstrated a bladder stone. RESULTS: Treatment was cystolithotomy, which dislodged two stones. One stone was attached to the IUD. CONCLUSION: Bladder calculus arising from an IUD is very rare. We review the literature.

[Benign prostatic hypertrophy: clinical and therapeutic aspects. Review of 1,280 cases]. / L'hypertrophie bénigne prostatique: aspects cliniques et thérapeutiques. A propos de 1,280 cas opérés.

Between 1989 and 1996, 1,280 patients aged 41 to 100 years were operated for BPH. 70% of patients were treated at the stage of complications such as acute urinary retention, haematuria, bladder stones or renal failure. 549 patients (42.9%) were treated by transvesical prostatectomy (TVP), 668 patients (52.18%) underwent transurethral resection (TURP) and only 63 (4.92%) were treated by bladder neck incision (BNI). Early postoperative complications essentially consisted of infections: wound infection (15%), followed by vesico-cutaneous fistula (2%), epididymo-orchitis (0.7%) and urinary tract infection (1.5%). Late post-operative assessment revealed retrograde ejaculation in 100% of cases after transvesical surgery, 80% of cases after TURP and almost no cases (4%) after BNI. The permanent urinary incontinence rate was 1.18% after TURP and 1.0% after transvesical surgery. The shortest mean postoperative stay was 5 days in the BNI group versus 12.5 days after transvesical surgery. Finally, the postoperative mortality, essentially due to septic shock and myocardial infarction, was (0.8%). The BPH complication rate is proportional to the delay in diagnosis and management. Transurethral resection remains the most effective treatment with the lowest morbidity.

[Rigid ureteroscopy. Apropos of 88 cases]. / Urétéroscopie rigide. A propos 88 cas.

Rigid ureteroscopy has become a common tool for the diagnosis and management of several diseases of the upper urinary tract. Between April 1990 and April 1996, 92 ureteroscopy procedures were performed in 88 patients in the B Urology Department of Avicennes hospital for diagnostic or therapeutic purposes. The commonest therapeutic procedure was stone manipulation (72 cases). The overall success rate was 90.8% (Distal ureter: 89.6%, mid ureter: 80%, lumbar ureter: 100%) and the complication rate was 4%. Therapeutic ureteroscopy was also used to dry ureterovaginal fistula (4 cases) and ureteral fistula with retroperitoneal urinoma (2 cases), and to remove a double J stent which had migrated into the pelvic ureter (3 cases). Diagnostic ureteroscopy was performed for 7 ureteral strictures including 3 extrinsic compressions and 4 ureteral strictures all treated with dilatations after biopsy. One false passage was observed among diagnostic ureteroscopy procedures. Rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesions.

[Vestigial retrorectal dermoid cyst. Apropos of a case]. / Kyste dermoïde vestigial rétro-rectal. A propos d'un cas.

A case of recto-rectal congenital development cyst is described in 35-year-old man. This cyst presented in the form of voiding symptoms. Computed tomography revealed the relation and components of the development cyst. Treatment consisted of complete surgical excision via a transabdominal approach.

[Psychological, sexual and social aspects of bladder exstrophy in adulthood. Analysis of 3 cases]. / Aspects psychologiques, sexuels et sociaux de l'exstrophie vésicale chez l'adulte. Analyse de 3 cas.

Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.

[Treatment of stafhorn calculi. Report of 71 cases]. / Traitement des lithiases coralliformes complexes. A propos de 71 cas.

OBJECTIVE: We retrospectively investigated 63 patients suffering from 71 staghorn calculi, who were treated with primary surgical monotherapy, in order to determine long-term. results and the fate of the residual stones. MATERIAL AND METHODS: Mean follow-up was 2.6 years. There were 63 patients (32 men, 31 women). The treatment was pyelolithotomy alone in 26 cases; nephrolithotomy alone in 14 cases; pyelolithotomy associated with nephrolithotomy in 18 cases; percutaneous nephrolithotomy (PCNL) in two cases; extracorporeal shock-wave lithotripsy (ESWL) in one case; and nephrectomy in ten cases. RESULTS: At the conclusion of therapy the stone-free rate was 94.1%. The complication was septic complications in 12 patients, hemorrhage that needed transfusion in five case and fistula in one case. After four and six years, two patients developed renal insufficiency and two patients had a recurrence of stones. CONCLUSION: Primary surgery of complex staghorn calculi is justified because of its better results than PCNL associated with ESMIL.

[Percutaneous endopyelotomy. Apropos of 27 cases]. / Endopyélotomie percutanée. A propos de 27 cas.

27 percutaneous endopyélotomies were performed in 27 patients from February 1989 to January 1996 to treat 20 cases of congenital hydronephrosis and 7 cases of acquired stenosis. Strictures of uretero-pelvic junction were treated by electrocautery with postoperative drainage using a double J stent in 11 cases, or Redon drain in 16 cases. The evaluable results for 25 patients with a mean follow-up of 11 months showed an overall success rate of 80%. This technique is the treatment of choice for acquired stenosis and stage I and II congenital hydronephrosis (Cendron).

[Youssef syndrome (vesico-uterine fistula): three case reports]. / Le syndrome de Youssef (fistule vésico-utérine): à propos de trois observations.

The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.

[Complex vesicovaginal fistula. Report of 55 cases]. / Fistules vésicovaginales complexes. A propos de 55 cas.

OBJECTIVE: To specify the clinical and therapeutic peculiarities of complex vesico-vaginal fistulas. MATERIAL AND METHODS: 55 cases of complex vesico-vaginal fistulas are reported. After the clinical diagnostic all the patients had an intravenous excretory urogram. The fistulas were classified according to the Benchekroun classification. RESULTS: The mean age was 34 years (17-70 years). The diagnostic was made clinically in all the patients. Thirteen patients had an abnormal intravenous excretory urogram. The treatment was made by a vaginal way in 45 patients, by an abdominal way in three patients and by a mixed way in two patients. Four patients had an urinary diversion and one refused the treatment. Among the 50 patients whose fistula was treated, 44 (88%) were continent whom 26 (52%) after one operation, 15 (30%) after two operations and three (6%) after three operations. CONCLUSION: The complex vesico-vaginal fistulas as all the vesico-vaginal fistulas are diagnosed clinically. The intravenous excretory urogram is indispensable to search an associated ureteral lesion. The treatment is surgical and usually needs the interposition of a vascularised graft.

[Martius' technique in the treatment of complex vesicovaginal fistula]. / Technique de martius dans le traitement des fistules vésiculovaginales complexes.

Sixteen cases of vesicovaginal fistulae (including 14 urethrovaginal fistulae), were treated vaginally using Martius' procedure. The authors describe the technique for the interposition of a labial fat pad, between the bladder and the vagina. The results are good. Thirteen patients have been cured. In one case a second was necessary using Guittes technique. There was two failures.

[Paratesticular rhabdomyosarcoma in the young adult]. / Rhabdomyosarcome paratesticulaire de l'adulte jeune.

The authors report a case of paratesticular thabdomyosarcoma in a young adult. This tumour is more frequent in children than in adults. Rhabdomyosarcoma is the commonest variety of soft tissue sarcoma in children and young adults. It represents 6.5% of all malignant tumours in paediatrics with an annual incidence of 4 to 7 cases/million children. The primary paratesticular site is considered to have a good prognosis in comparison with other rhabdomyosarcomas, despite the frequency of retroperitoneal lymph node invasion. This superficial site allows rapid diagnosis and consequently often complete resection of the tumour. The multidisciplinary treatment of paratesticular rhabdomyosarcoma has improved control of the disease with a 2-year survival of 80%.

[Cancer of the female urethra. Report of 2 new cases]. / Cancer de l'urèthre féminin. A propos de deux nouvelles observations.

Female urethral cancer is a rare urologic malignancy, it is about 0.02% of genito urinary cancer in woman. Prognosis remains poor and it depends of staging of disease. Applying combined modality treatment (radiation and surgery) may produce local control and increase the survival.

[Malignant testicular non-Hodgkin's lymphoma in a young subject]. / Lymphome malin non hodgkinien testiculaire du sujet jeune.

The authors report a rare case of testicular non-Hodgkin's malignant lymphoma (NHML) in a 21-year-old man with a fatal outcome. In the light of the literature, they analyse the clinical features, clinical course and treatment of this lymphoma.

[Adenocarcinoma of the kidney associated with polycystic kidney treated by conservative surgery (apropos of a case)]. / Adénocarcinome du rein associé à une polykystose rénale traité par chirurgie conservatrice (a propos d'une observation).

The authors report a case of renal cell carcinoma discovered incidentally in a 52-year-old woman with hepatorenal and pancreatic polycystic disease. Treatment consisted of partial nephrectomy with no adjuvant therapy. After a 3-year follow-up, the patient is still alive with normal renal function and no signs of recurrence. The pathogenesis and therapeutic modalities are discussed in the light of a review of the literature.

[Uretero-vaginal fistula. Therapeutic alternatives concerning 10 cases]. / Fistules urétéro-vaginales. Alternatives thérapeutiques à propos de 10 cas.

OBJECTIVE: Our purpose was to study aetiopathogenic, diagnostic and therapeutic aspects of ureterovaginal fistulas. STUDY DESIGN: A retrospective study concerned 10 ureterovaginal fistulas. The main causes were gyneacoligical and obstetrical procedures. The diagnosis was based on clinical considerations and intravenous pyelography in all cases. Various therapeutic methods were used: Fistulas has managed in three cases by ureteroneocystostomy. Five cases were managed with ipsilateral ureteroureterostomy, the segment of ureter below the fistula was identified using ureteroscopic perforation of this segment in three cases. In one case the fistula was successfully managed by ureteroscopic placement of ureteral stent. In case whose fistula was developed after cancer pelvic we choice abstention. RESULTS: Late radiology showed success of the procedure in 7 patients and persistance of hypotony in 2 cases treated by u reteroneocystostomy. CONCLUSION: Ureterofistula is rare, but a relative frequent complication of pelvic surgery whose prevention is the most efficient treatment. Ureteroureterostomy is a good procedure when ureteroscopy is performed.

[An unusual complication of anterograde endopyelotomy: ureteral intussusception (a case report)]. / Une complication exceptionnelle de l'endopyélotomie antérograde: l'invagination urétérale (à propos d'un cas).

Endopyelotomy has recently found a new place in the treatment of stenosis of the pyeloureteral junction, and it can represent a treatment of choice. We report an unusual case of antegrade ureteral intussusception after antegrade endopyelotomy in a 30 year-old young woman with a solitary kidney, which caused proximal ureteral obstruction. These intussusceptions were probably caused by double CH endoprosthesis. These iatrogenic injuries required surgical resection with calicoureterostomy.

[Fractures of the penis: apropos of 56 cases]. / Les fractures du pénis: à propos de 56 cas.

OBJECTIVES: To review the diagnostic and epidemiological aspects and especially to demonstrate the value of emergency surgical treatment. PATIENTS AND METHODS: In 8 years (1989-1996), 56 fractures of the penis in 55 patients were surgically repaired as an emergency procedure immediately after admission. The skin incision was often elective and longitudinal. After evacuation of the haematoma, the fracture was sutured with slowly resorbed suture material. The presence of a concomitant urethral lesion was systematically investigated and repaired. RESULTS: The mean age was 30 years, and 72.75% of patients were unmarried men. The mean operating time was 40 min and the mean hospital stay was 1.5 days. The immediate postoperative course was always favourable. In 36 long-term evaluable patients, sexual activity was resumed with no difficulties of erection or intromission. No case of chordee of the penis was observed, but two patients presented a cicatricial nodule. CONCLUSION: Fracture of the penis is a rare disease and is diagnosed clinically. Emergency surgical treatment is the only guarantee of a good functional prognosis.

[Treatment of urethro-rectal fistulas. Apropos of 5 cases]. / Traitement des fistules uréthro-rectales. A propos de 5 cas.

Urethro-rectal fistulas, consisting of prostato-rectal fistulas and fistulas communicating between the bulbo-membranous urethra and the rectum, are rare, easily diagnosed diseases, which essentially raise a problem of choice of surgical technique. Although the predominant aetiology is currently iatrogenic, many other less frequent aetiologies can also be responsible. Treatment is usually surgical with a large number of possible incisions. In the light of 5 cases, the authors review the various surgical techniques allowing cure of these fistulas, and indicate the advantages and disadvantages or each one.

[Primary non-Hodgkin's malignant lymphoma of the adrenal gland. Case report and review of the literature]. / Localisation primitive d'un lymphome malin non hodgkinien de la surrénale. A propos d'un cas. Revue de la littérature.

Primary lymphoma of the adrenal gland is an exceptional site for non-Hodgkin's malignant lymphoma, as fewer than 50 cases have been reported in the international literature. To our knowledge, this is the first reported case of intraoperative discovery. The diagnosis of primary adrenal lymphoma can be suggested in the case of bilateral involvement and adrenal insufficiency, but there are no specific clinical or complementary criteria. The main differential diagnoses are adrenal metastases and adenomas. Management is often that of an incidentaloma. Primary NHML of the adrenal gland has a poor prognosis with a mean survival of 15 months. Only one case with a survival of 8 years has been reported in a patient treated with adjuvant radiotherapy, while basic treatment consists of combination chemotherapy. Our patient was treated by adrenalectomy followed by close surveillance.