[Impact of alfuzosin 10 mg once daily on quality of life in Tunisian patients with lower urinary symptoms suggestive of benign prostatic hyperplasia]. / Impact de l'alfuzosine lp 10 mg sur la qualite de vie chez les patients avec troubles urinaires du bas appareil suggestifs d'une hypertrophie benigne de la prostate.

BACKGROUND: Incidence of benign prostatic hyperplasia (BPH), one of the most common conditions affecting adult men, increases dramatically after the age of 50. The various symptoms of BPH, which include lower urinary tract symptoms (LUTS), can adversely affect quality of life (QoL) and sexuality and 1-Blockers are the most frequently prescribed oral medications as first-line treatment. AIM: The objectives of this study try to evaluate QoL and sexuality in patients requiring treatment by Alfuzosin 10mg once daily according to physician decision in current practice and to identify patient's profile treated with Alfuzosin 10 mg under daily practice conditions by Tunisian urologists. METHODS: 730 patients presenting a symptomatic BPH were enrolled in this study by 40 urologists. The impact of treatment on patient's QoL and sexual dysfunction were checked at every visit before treatment and at 3 and 6 months using "International Prostate symptoms score" (IPSS) and "Male Sexual Health Questionnaire - Ejaculatory Dysfunction" (MSHQ - EJD) questionnaire. RESULTS: BPH affect Qol and near half of the patients reported sexual disorders. The treatment compliance to Alfuzosin was very good with a regular intake in 92% of the cases. Quality of life significantly improves during visits: the global IPSS score decreases from 18.8 at baseline to 9.5 at 6 months. The same favorable evolution was observed with the bother score which decreases from 4.0 at baseline to 1.6 at 6 months, and with MSHQ - EJD score which increases from 10.5 at first visit to 11.4 at 6 months. CONCLUSION: Alfuzosin 10 mg administered for 6 months provides a marked improvement in patients presenting symptomatic BPH not only on LUTS but also in QoL and sexual disorders.

Interstitial cystitis: elements of diagnosis and place of histopathological examination. About 16 cases.

BACKGROUND: Interstitial cystitis (IC) is a rare disease, of difficult diagnosis. The diagnostic utility of histopathological examination of bladder biopsy remains controversial. AIM: We conducted a retrospective study to assess the frequency of interstitial cystitis, to analyze its clinical presentation and the data from the paraclinical examinations. We discuss the steps and criteria of diagnosis, as well as the place of histopathological examination for diagnosis. METHODS: Sixteen patients diagnosed with IC were followed in the Urology Department of the Sahloul University Hospital between 1996 and 2013. The diagnosis was suggested by clinical history and confirmed on the basis of clinical symptoms and results of the paraclinical explorations: urodynamic assessment, cystoscopy and bladder biopsy. RESULTS: Six men (37.5%) and ten women (62.5%), with an average age of 56 years complained of pelvic pain and urination disorders for two years on average before the diagnosis. The urodynamic study found decreased bladder compliance in 13 cases and bladder instability in nine cases. Cystoscopy demonstrated inflammatory mucosa in 13 patients (81%). Histologically, the classic ulcerative form accounted for 50% of the cases. The number of mast cells was high in both the mucosa and the muscular in 12 cases, both in the classical and non-ulcerative forms. CONCLUSION: The IC remains a diagnosis of exclusion. The first line of diagnosis is patient selection based on symptoms and an exclusion of diseases with similar presentation. Vesical biopsy is useful for confirmation and classification of the disease.

[Hydatid cyst of the spermatic cord]. / Kyste hydatique du cordon spermatique.

The authors report the third published case of hydatid disease of the spermatic cord and describe its unusual presentation in the form of hydrocele. Hydatid disease is endemic to some countries, where it constitutes a real public health problem. It can affect all organs of the body. However, primary involvement of the spermatic cord is exceptional. Implantation of the hydatid larva is essentially haematogenous. The positive diagnosis is based on ultrasound. Eosinophilia is neither constant nor specific and only contributes to the diagnosis when it is positive. However positive hydatid serology has a diagnostic and prognostic value. Resection of the roof of the cyst is the treatment of choice.

[Primary large-cell neuro-endocrine carcinoma of the bladder]. / Carcinome neuro-endocrine à grandes cellules primitif de la vessie.

Primary large-cell neuro-endocrine carcinoma of the bladder is a rare aggressive tumour with a very poor prognosis. The authors report the case of 78-year-old male patient with primary large-cell neuro-endocrine carcinoma of the bladder and discuss the pathological and therapeutic aspects of this tumour in the light of a review of the literature.

Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control.

INTRODUCTION: Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control. METHODS: Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one. RESULTS: The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001. CONCLUSIONS: Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs.

[Ureterocalicostomy: indications and results based on a series of 16 patients]. / L'anastomose urétéro-calicielle: indications et résultats d'une série de 16 patients.

Formerly considered to be a salvage or last resort technique before nephrectomy, ureterocalicostomy can be indicated in certain well defined situations, when strictly dependent drainage of urine is essential. Due to its particular indications, this procedure is rarely performed and operators have limited experience. The authors report 17 cases of ureterocalicostomy performed in 16 patients: 8 cases obtained an excellent long-term result with absence of clinical signs, urinary tract infection and proximal dilatation of the neo-junction. 4 cases obtained a good result with resolution of clinical symptoms and bacteriological signs and improvement of the dilatation on intravenous urography. 3 cases obtained a poor result with persistence of clinical symptoms and dilatation on intravenous urography. 2 nephrectomies were subsequently performed 4 years and 10 years after ureterocalicostomy for non-functioning kidney and for chronic pyelonephritis.

[An experience of individual and early diagnosis of prostate cancer in a Tunisian centre]. / Une expérience de diagnostic individuel et précoce du cancer de la prostate dans le centre de la Tunisie.

INTRODUCTION: The introduction of prostate specific antigen (PSA) and progress in transrectal ultrasound and ultrasound-guided prostatic biopsies have allowed considerable progress in the diagnosis of prostate cancer. However prostate cancer is still usually diagnosed at an advanced stage in Tunisia. METHODS: We prospectively evaluated the prevalence of localized prostate cancer in the population of a Tunisian centre during a screening programme. This study included all men consulting for a urological problem between January 1998 and June 2001, between the ages of 50 and 75 years with an estimated life expectancy of at least 10 years. Screening consisted of digital rectal examination (DRE) and total and free PSA assay. Systematic ultrasound-guided prostatic biopsies (9 biopsies) were performed in the case of a suspicious DRE, total PSA between 4 and 20 ng/ml and a free PSA/total PSA ratio less than 25%. RESULTS: 642 patients were screened. 521 patients (81%) had a PSA less than 4 ng/ml, 23 had a suspicious DRE and PSA less than 4 ng/ml. No cancer was detected by prostatic biopsies. 92 patients (14%) had a PSA between 4 and 20 ng/ml and 44 of them had a free PSA/total PSA ratio less than 25%. Prostatic biopsies were performed in 59 of these 92 patients with PSA between 4 and 20 ng/ml and revealed 18 cancers: 3 stage pN+ and 15 stage pN0, including 1 stage pT3 and 14 stage pT2 after radical prostatectomy. 14 cancers detected in a population of 642 men (2.2%) were therefore stage pT2. 29 patients (4.5%) had a PSA higher than 20 ng/ml. All underwent surgical prostatic disobstruction demonstrating adenocarcinoma. A total of 47 cancers (7.3%) were therefore detected. CONCLUSION: Early individualized screening is possible in Tunisia and allows the detection of localized prostate cancer in 77% of patients with PSA less than 20 ng/ml. The use of prostatic biopsies in the case of abnormal screening tests improves the management of prostate cancer in Tunisia.

[Skin metastasis from invasive bladder tumour]. / Métastase cutanée d'une tumeur vésicale infiltrante.

Metastatic spread of advanced transitional cell bladder carcinoma rarely involves the skin. However, the presence of a skin metastasis indicates at least microscopic dissemination of cancer cells to the liver or lung, corresponding to a poor prognosis. The authors report a new case of single skin metastasis during the course of a poorly differentiated stage pT3a N0 M0 transitional cell bladder carcinoma. The patient died 5 months after the appearance of the skin metastasis.

[Benign schwannoma, a rare retroperitoneal tumour]. / Tumeur rétropéritonéale rare: schwannome bénin.

Primary retroperitoneal tumours are rare in adults. Among retroperitoneal tumours derived from nervous tissue, schwannoma is defined as a tumour arising from neurilemma or Schwann nerve sheath cells. It is a very rare tumour, especially in the retroperitoneal site (0.2%). Its diagnosis is immunohistological, and treatment is surgical, consisting of complete resection of the mass due to the risk of malignant degeneration. The authors report the case of a 38-year-old patient admitted with isolated right lumbar pain. Imaging (ultrasound and CT urography) revealed a retroperitoneal tumour measuring 6 x 9 cm. Resection was performed by right thoraco-pleuro-laparatomy. The immunological and histological study concluded on benign schwannoma. With a postoperative follow-up of two years, the patient has not presented any recurrence of this retroperitoneal schwannoma.

A more accurate detection of codon 72 polymorphism and LOH of the TP53 gene.

The polymorphism at codon 72 of the TP53 gene has been extensively studied for its involvement in cancerogenesis and loss of heterozygosity (LOH) detection. Usually, the exon 4 of the TP53 gene is amplified by polymerase chain reaction (PCR) on DNA extracted from blood and tumor tissues, then digested by AccII. In the case of heterozygosity, the comparison of AccII profile from blood and tumor DNA PCR products allowed the identification of a potential LOH in the TP53 locus. This method can be hindered by a partial AccII digestion and/or DNA contamination of non-tumor cells. To circumvent these problems, we have developed a new approach by using the AccII restriction site between exon 4 and exon 6. The PCR amplification of exon 4-6, followed by AccII digestion allowed us to detect without ambiguity any LOH case.

No evidence of correlation between p53 codon 72 polymorphism and risk of bladder or breast carcinoma in Tunisian patients.

The TP53 gene, frequently mutated in human cancers, carries several polymorphisms. The one most informative and studied concerns codon 72; a single base changes the CGC (arginine) to CCC (proline). The arginine form was considered to be a significant risk factor in the development of cancer. However, various reports on this polymorphism are controversial. We carried out the same investigation in two groups of patients, a group with bladder cancer and another with breast cancer, and in healthy controls in two regions of our country, using an improved PCR-RFLP method. The number of Arg/Arg, Arg/Pro, and Pro/Pro genotypes was as follows: 21, 23, 3 and 13, 19, 2 for patients (total 47) and controls (34), respectively, in the first group; 18, 9, 3 and 19, 26, 4 for patients (30) and controls (49), respectively, in the second group. Statistical analysis of the genotype and allele frequencies did not reveal any difference between patients and controls in both groups except for a weak difference between the homozygotes to heterozygotes in the second group with a chi square of 4.1 (P = 0.045); the number of breast cancer patients is actually low (30) and should be increased in order to assess such a conclusion. Our overall results are therefore not consistent with a high risk associated with TP53 codon 72 polymorphism in breast and in bladder cancers.

[Bilateral Leydig cell tumor of the test: a case report]. / Tumeur testiculaire bilatérale à cellules de Leydig: à propos d'un cas.

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.

[Urachal cyst in the adult. A case report and review of the literature]. / Kyste de l'ouraque chez l'adulte. A propos d'un cas revue de la litterature.

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.

[Retrovesical hydatid cyst: diagnosis and treatment in 8 cases]. / Le kyste hydatique rétrovésical: aspects diagnostiques et thérapeutiques à propos de 8 cas.

INTRODUCTION: Hydatid cyst represents a real public health problem in Tunisia. Retrovesical hydatid cyst is rare (6% to 7%). It is considered to be an "aberrant" or "ectopic" site defined by the development of the parasite in the subvesical and retrovesical fat. MATERIALS AND METHODS: From 1988 to 2001, 8 patients with retrovesical hydatid cyst were hospitalised and operated in our Urology department at Sahloul Hospital in Sousse, Tunisia. The mean age of our patients was 41 years (range: 8 to 75 years). Signs of bladder irritation were the most frequent presenting complaint. Only one case was diagnosed on computed tomography performed for assessment of lumbar contusion. Total resection of the cyst and pericystic tissues was performed in 5 patients, with partial resection in the other cases. RESULTS: The postoperative course was uneventful and only one patient developed suppuration of the residual cavity, which responded favourably to antibiotics and ultrasound-guided drainage. CONCLUSION: The retrovesical site of hydatid cyst is rare and treatment is essentially surgical.

[Renal oncocytoma: report of 5 cases]. / Adénome oncocytaire du rein: à propos de 5 cas.

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.

[Surgical treatment of penile-scrotal elephantiasis]. / Traitement chirurgical d'un éléphantiasis péno-scrotal.

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.

Fistule artério-urétérale après une pelvectomie antérieure : Complication rare et grave.

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.

Bilateral renal infarction following atrial fibrillation and thromboembolism and presenting as acute abdominal pain: a case report.

INTRODUCTION: Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic. CASE PRESENTATION: 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. CONCLUSION: 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.

Eosinophilic cystitis induced by bacillus Calmette-Guerin (BCG) intravesical instillation.

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.