Paratesticular solitary fibrous tumor: A case report.

Paratesticular solitary fibrous tumors are a very rare benign tumor that are usually low-grade neoplasms of pericytes and myofibroblast-like cells. They're slow growing and painless. We report a case of a male patient of 32 years old who came to our medical structure complaining about the appearance of scrotal mass, painful sometimes. Investigations revealed a scrotal mass which was surgically removed. Immunohisochemical study concluded to the presence of a solitary fibrous tumor.

Forensic aspects of trauma to the male external genitalia (TMEG), analysis of a series of 84 cases.

Objectives: Describe the medico-legal aspects of trauma to the male external genitalia by specifying their epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics. Materials and methods: Retrospective study spread over a period of 3 years (2017-2019) concerning adult patients with trauma to the male external genitalia consulting in the surgical emergency and forensic medicine departments of the Ibn Rochd University Hospital Center in Casablanca. Results: We collected 84 cases of TMEG within the framework of evaluation of bodily injury aimed at fixing the duration of Total Temporary Incapacity (TTI) and the rate of Permanent Partial Incapacity (PPI). There was a predominance of bursa trauma (85.7%) followed by penis trauma (14.5%). The average age of the patients was 39 years (17-61 years). Road accidents are the cause of 42% of cases. Regarding bursa trauma, the clinical symptomatology was dominated by pain (100%) and increased scrotal volume (50%). Scrotal ultrasound found the main lesion to be scrotal hematomas (35.71%) followed by ruptures of the tunica albuginea (9.5%). Surgical exploration was indicated in 45.23% of cases, of which (38%) was conservative treatment.For trauma to the penis, the clinical examination revealed 1 case of fracture of the cavernous body, a hematoma of the penis in only 1 patient, a superficial wound of the penis in 1 patient and the rest of the patients (9 cases) showed no lesions. Surgical treatment was indicated in only one patient. The average duration of temporary total incapacity was 17.5 days and the average rate of partial permanent incapacity was 4%. Conclusion: Physicians who are experts in the evaluation of bodily injury are frequently confronted with the evaluation of the damage resulting from the TMEG. The medico-legal evaluation of these traumas remains difficult and very varied requiring a perfect knowledge of the mechanisms of these traumas, of the therapeutic and evolutionary principles helping in the judicial decision.

Acute orchiepididymitis: Epidemiological and clinical aspects: An analysis of 152 cases.

INTRODUCTION: Orchiepididymitis is an inflammation of the testis and epididymis. Epididymitis, orchitis, and true orchiepididymitis are all examples of orchiepididymites. They are the most frequent cause of adult acute scrotal pain. OBJECTIVES: to investigate the epidemiological, clinical, paraclinical, therapeutic, and evolutionary characteristics of acute orchiepididymitis in the urology department of University Hospital Center. MATERIALS AND METHODS: This is a three-year retrospective, descriptive study of 152 patients who consulted the urology department at the university hospital center for treatment of orchiepididymitis (2017-2019). RESULTS: In our study, 152 patients were included. The average age was 49,5 years (17-82 years). The average of consultation delay was 7 days. Prostatic pathology was found to be the main medical antecedent in 18.5% of patients, and transurethral resection of the prostate was found to be the main surgical antecedent in 8.5% of cases. Clinical examination revealed that the predominant clinical symptom was painful inflammatory bursa in 94% of cases, followed by lower urinary tract disorders in 57.5% of cases, and fever in 10% of cases.A germ was isolated in 26 cases after a systematic cytobacteriological examination of the urine (CBEU) (17%). All patients received medical treatment, and 21% of them were received urgical treatment. In 84.5% of cases, the outcome was favorable. CONCLUSION: Acute orchiépididymitis is a common cause for a consultation to the emergency room. Diagnosis is based on clinical examination and ultrasound. Because of the frequency of complications and sequelae that might influence fertility in the long term, it is a diagnostic and therapeutic emergence.

[Epidemiological profile and analysis of predictive factors of organ donation refusal in the Moroccan population]. / Profil épidémiologique et analyse des facteurs prédictifs du refus du don d'organe chez la population marocaine.

Organ donation is influenced by several factors. A better understanding of the reasons for organ donation refusal would allow an increase in the number of donors. The objective of our study is to assess the knowledge and position of the general Moroccan population considering organ donation and to determine the factors that influence their positions. In this study, socio-demographic data, knowledge and attitude towards organ donation and reasons for refusing organ donation were collected from 677 Moroccan participants. Although only 1% of participants are enrolled in the donor registry, our survey showed that 64.7% of participants are in favor of organ donation. The level of education, the socio-professional category, the marital status, the ethnic origin and the medical coverage are the socio-demographic factors most discriminating concerning the will to donate organs or not. The binary logistic regression made it possible to identify the factors that prevent organ donation, namely the problem of confidence in the health system, personal and religious reasons but also the lack of valid reasons. Thus, a better knowledge of the legislation in force and of the position of the Islamic religion as well as the establishment of training and information programs through advertising campaigns will promote organ donation. LEVEL OF EVIDENCE: 3.

Lesion of the urethra and corpus spongiosum in the event of a misstep of the coitus without fracture of the corpus cavernosum: About one case.

INTRODUCTION: Traumatic lesions of the anterior urethra during coitus strikes are essentially described as lesions associated with 20 percent of corpus cavernosum fractures. However, no cases of isolated lesions of the urethra and corpus spongiosum in the context of sexual trauma seem to be reported in the literature. Thus, we report the observation of a patient who was diagnosed with a corpus spongiosum fracture associated with a penile urethra injury during a coitus lapse. PRESENTATION OF CASE: Patient aged 36 years with no particular pathological history, other than unprotected sexual intercourse, who has been admitted to the urology service for urethrorrhagia due to a sexual traumatism. A forced angulation and then a cracking followed by an instantaneous detumescence was described by the patient. On examination we noted a normal-looking penis without angulation or eggplant haematoma, with the presence on palpation of a small infra-centimetric hematoma on the ventral surface of the middle part of the penis. Surgical exploration was therefore indicated in front of the isolated urethrorrhagia, and which objectified a fracture of the corpus spongiosum measuring 1 cm at the level of the distal part of the penis. A linear lesion of the urethra was associated at the same level. The patient was therefore sutured with these two lesions. The postoperative course was simple with removal of the bladder catheter three weeks later with satisfactory urination and urinary stream. DISCUSSION: sexual trauma is described as a rupture of the corpora cavernosa, resulting from forced flexion or twisting of the erect penis that can be associated in about 20 % of cases with ruptures of the urethra. We described a trauma occurrence that is similar to the one in the definition responsible of a lesion of the anterior urethra but no lesions of the corpora cavernosa have been objectified. CONCLUSION: the absence of similar cases reported in the literature leaves this type of lesion subject to ambiguous behaviour. Indeed, this brings us back to questions about the pathophysiological mechanisms of sexual lesions of the urethra in order to better codify the indication for surgical exploration, even in front of a normal looking penis.

Post-traumatic adrenal hematoma: A case report and revue of literature.

Post-traumatic adrenal hematoma, which has rare but severe complications, is a difficult to diagnose condition. Only computed tomography, which is often performed systematically during lesional assessments of violent thoraco-abdominal trauma, can confirm the diagnosis. Symptoms are often masked by associated visceral or parietal lesions. Standard biological examinations are generally not very helpful. We will describe the case of a 47-year-old man who presented with a right adrenal hemorrhage following a road accident, for only associated lesion, a fracture of the middle arch of the first and 8th ribs, and the transverse process L1.

Retrocaval ureter: A case report and review of the literature.

Retrocaval ureter is a rare malformation. We report a case of right retrocaval ureter of type 1. The usual clinical manifestation being lumbar pain due to obstruction of the upper urinary tract, asymptomatic forms can also be encountered. Since the diagnosis was based on the CT-scan, the treatment was uncrossing with uretero-ureteral anastomosis by lumbotomy, with a satisfactory long-term result.

[Evaluation of the tolerance of the ureteral catheter JJ by the use of the USSQ self-questionnaire]. / Évaluation de la tolérance de la sonde JJ par l'utilisation de l'auto-questionnaire USSQ.

OBJECTIVE: Evaluation of the quality of life patients with a ureteral catheter JJ (US). METHOD: This study was conducted from 01/2016 to 15/02/2017, including all patients operated on a rise of US. The USSQ questionnaire (Ureteral Stent Symptom Questionnaire) validated in French in 2010 was filled during the perioperative period with SU in place (S1), 4 weeks after putting the US (S2) and 4 weeks after removal of the US (S3), it is grouped into 6 sections: urinary symptoms, body pain, general condition, professional impact, sexuality, other problems. The Wilcoxon test was used to compare the statistical averages. RESULTS: We identified 150 patients including 89 women (59.3%) and 61 men (40.7%). The average age of our patients is 49.5 years. The quality of life appeared to be significantly altered in all areas explored by the questionnaire: urinary symptoms had a mean score one week after the US rise (S1) was 29.5 versus 25.3 at four weeks after ablation (S3) of US at P<0.0001), pain persisted at four weeks after US ablation at an average S3 score of 10.6 versus 14.5 at S1 at P=0.003. The patients' EG was also altered after the placement of the SU: S1 of 16.6 versus S2 18.5 (P<0.0001), the presence of a US did not have a great impact on the activity professional active patients: active (S1 of 14.9 versus S3 of 13.3 P=0.6). But it was a sexual disability of the sexuality carrier: average score of 5.3 in S1 vs. 5.2 in S3 for a value=0.122. There is no significant difference if the US is raised urgently or in a scheduled manner. CONCLUSION: US appears to have a significant impact on the quality of life of patients. LEVEL OF EVIDENCE: 3.

[Predictors of catheter-related bladder discomfort]. / Facteurs prédictifs de l'inconfort lié à la sonde vésicale.

INTRODUCTION: Establish a descriptive epidemiological profile of patients with Catheter Related Bladder Discomfort (CRBD) and identify its predictive factors. MATERIAL AND METHOD: Between June 2019 and December 2019, 300 patients have been evaluated. Different parameters were taken into account including: sex, age, body mass index (BMI), historical health data, duration and indications of the urinary catheterization, type of the transurethral catheter used, lubrication of the catheter and the existence of CRBD. We grouped our patients according to the intensity of CRBD syndrome. The various factors likely to be correlated with the occurrence of CRBD were subject of a univariate then multivariate analysis. RESULTS: 300 patients were included. The average age was 49 years (133 men and 167 women). 68 patients (22.6%) had history of urinary catheterization. 19% of patients were catheterized for acute urinary retention, while 81% were catheterized before surgery. The average duration of the urinary catheterization was 2.5 days. 54% showed CRBD symptoms, including more than 92% on the first day of the urinary catheterization. The significant risk factors in multivariate analysis were: the caliber of the catheter ≥18 Fr, the absence of lubrication, laparotomy, age <50 years, Cesarean and urinary catheterization medical history. CONCLUSION: This study identified various factors incriminated in the occurrence of CRBD. The role of the hospital practitioner is to prevent this syndrome by reducing predictive factors, particularly the technical ones. LEVEL OF EVIDENCE: 3.

[Male genital self-mutilation: A case series]. / Automutilation des organes génitaux externes chez l'homme.

INTRODUCTION: Genital self-mutilation is a rare phenomenon that often occurs on a psychotic ground. Its diagnosis is clinical and its management involves a coordinated action of urologists and psychiatrists. MATERIALS AND METHOD: We report a retrospective monocentric series of 14 cases of genital self-mutilation (penis and testicles), collected from January 2000 to May 2019. In addition to psychiatric care and according to the type of lesions, we performed implantations of penis, cutaneous urethrostomies, hemostatic ligature of spermatic cord, ablation of rings. The implantations of the penis were done without microscope or magnifying glass and on the basis only of an end-to-end anastomosis of the erectile bodies and the urethra. Sexual abstinence was indicated for 6weeks. RESULTS: The average age of our patients was 31.5years. We have identified ten cases of penis section including two incomplete, two cases of strangulation of penis by a metal ring, an isolated wound of the glans and three cases of testicular ablation, two of which were associated with a section of penis. We performed as first line: 5 penis reimplantation, 5 cutaneous urethrostomy, 2 ablation of strangulation rings and 3 hemostatic ligature of the spermatic cord. Three reimplanted patients had fairly satisfactory immediate operating suites: 2 patients healed well with good penile sensitivities, while one patient presented with a loss of penile skin sensitivity. The other two patients, on the other hand, presented on D1 a necrosis of the reimplanted stump, requiring an amputation and cutaneous urethrostomy. Also, necrosis of the strangulated penis was observed in one case and also required a second operating time with an amputation of the necrotic penis and a cutaneous urethrostomy. One patient died on D7 by autolysis. From a distance, the sexual and urinary function of reimplanted patients could not be assessed because they were lost to follow-up. Only a few patients who received a skin urethrostomy were seen at follow-up consultations. And with an average follow-up of 3years, no functional urinary disorder was found in them. CONCLUSION: The management of genital self-harm requires coordination between urologist and psychiatrist. With our conditions the results are mixed and penile reimplantation should ideally be done under a microscope with an experienced surgeon. However, it can be attempted as long as possible, with the possibility of making an urethrostomy in the second time in case of failure. The pillar of care for these patients, however, lies in a good psychiatric balance because they are not immune to recurrence or autolysis. LEVEL OF EVIDENCE: 3.

[Pyelo-ureteral junction syndrome in horse-shoe kidney. Report of 13 cases]. / Syndrome de jonction pyélo-urétérale sur rein en fer-à-cheval. A propos de 13 cas.

The pelviureteral junction upon a horse shoe kidney remains a frequent congenital malformation. The authors report 13 cases collected during a period of 16 years and treated surgically. The review of literature permits to discuss the different therapeutic means.

[Granulomatous prostatitis (report of 6 cases)]. / Prostatite granulomateuse (à propos de 6 cas).

A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.

[Youssef's syndrome]. / Le syndrome de Youssef.

Youssef's syndrome is an uncommon form of vesico-uterine fistula, caracterized clinically by the association: amenorrhea cyclic, hematuria without urinary leakage. This entity is the result of pressure gradient between uterin cavity and bladder reservoir. We report on one case.

[Diffuse xanthogranulomatous pyelonephritis: clinical, anatomopathologic, and therapeutic features. Report ot 9 cases and review of the literature]. / Pyélonéphrite xanthogranulomateuse diffuse: aspects cliniques, anatomopathologiques et thérapeutiques. A propos de neuf cas et revue de la littérature.

Diffuse xanthogranulomatous pyelonephritis is a rare chronic pyelonephritis. This study permitted us to notice the various histological, clinical, radiological, and the different means diagnoses of this affection. Retrospectively series of nine patients is reported. The median age was 43 years. The commonest clinical presentation was urinary tract infection, and lumbar pain. Urine culture identified a bacteria in seven cases (77%). Intravenous urography recovers silent kidney (five cases), hydronephrosis (two cases), chronic pyelonephritis (one case) and renal stones in six cases (67%). Treatment consisted of nephrectomy. No specific biological or radiological signs of this affection can be identifying this lesion in preoperative. The diagnosis was revealed by the histological examination of the removed kidney. The outcome is favorable after a follow-up of six months to four years. The clinical features of the pyelonephritis xanthogranulomatous is not specific. Magnetic resonance imaging can give a specificity to this affection. Only histological examination is able to established the definitive diagnosis.

[Treatment of primary pyogenic abscess of the psoas: retrospective study of 18 cases]. / Traitement de l'abcès primitif à pyogène du muscle psoas: étude rétrospective à propos de 18 cas.

The primitive abcess of psoas muscle is a rare affection which involves mainly the young. The authors report 18 cases of primitive pyogenic abcess of psoas collected during a period of six years in the urology service of UHC Ibn Rochd Casablanca. The purpose of this review is to discuss the different therapeutic attitudes. The study concerned 11 men and seven women, their mean age was 35 years. The mean delay of evolution was 45 days. The physical exam found a psoitisis (five cases) and a flunk swelling (14 cases). The ultrasound exam showed the collection which was hypoechogenic in seven cases and heterogenous in 11 cases. The CT scan showed an heterogenouse hypodense collection without enhansment in seven cases. The use of antibiotherapy alone (four cases) and percutaneous drainage (four cases) permitted the recovery just respectively in one and two cases. Fifteen patients (83%) were operated through a postero-lateral lumbotomy route without costal resection. The bacteriological exam of the pus found a Staphylococcis aureus (ten cases) and Escherichia coli (two cases). The evolution was favorable in 14 cases; one patient was dead at fifth day post operatively by heart infarction. For the authors, the surgical drainage remains the treatment of choice.

[Kidney cancer and pregnancy]. / Cancer rénal et grossesse.

Renal cancer is rare in pregnant women. Through a study of two cases, the authors underline diagnostic, therapeutic and pathogenic aspects of this association. Two female patients, 26 and 34 years old, were admitted for renal tumor, discovered respectively at the first and the second trimester of pregnancy. Investigation's exams for tumor extension were negative. They were based on ultrasound exam (2 cases), CT scan (1 case) and chest X ray (2 cases). The histological examination concluded to a bright cell carcinoma. In the former case, evolution was marked by spontaneous abortion at the fifth post-operative day, and the absence of metastasis after 16 months. In the second case, the evolution was worse because of metastasis occurrence four months after normal delivery. Pregnancy represents a privileged period for the discovery of renal tumor. Exams of tumor extension must consider pregnancy age. The treatment is similar to that of usual renal cancer and is associated to a simultaneous supervision of the pregnancy.

[Report of 2 cases of prostatic abscess]. / L'abcès prostatique à propos de deux cas.

Prostatic abscess is a rare disease. In the light of two cases, the authors discuss the diagnostic and therapeutic aspects of this disease. Two patients, aged 17 and 55 years, presented nonspecific clinical features. Medical imaging (US, CT) established the diagnosis by showing a loculated cystic prostatic mass. Treatment consisted of transurethral drainage and antibiotics with a favourable course in both cases. Prostatic abscess is a rare disease for which the diagnosis has been facilitated by progress in medical imaging. The treatment of choice remains transurethral endoscopic drainage.

[Surgical treatment of traumatic ruptures of the posterior urethra]. / Le traitement chirurgical des ruptures traumatiques de l'urèthre postérieur.

OBJECTIVES: To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra. MATERIAL AND METHOD: 35 patients with a mean age of 25 years (range: 7 to 79 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pelvis. When rupture of the posterior urethra was diagnosed, the subsequent management depended on the patient's general condition and associated lesions. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. This approach was applied in 16 patients (Group I). The other 19 patients (Group II) were only operated at the sixth month, after stabilization of all traumatic lesions. RESULTS: Results were assessed in terms of the quality of the urinary stream, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continence was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexual impotence was observed in 18.7% (Group I) versus 5.3% (Group II). CONCLUSION: Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sexual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, treated endoscopically, but with a lower incidence of sexual impotence.

The use of long-term defunctionalized bladder in renal transplantation: is it safe?

OBJECTIVE: Evaluation of the use of defunctionalized bladder in renal transplantation, concerning surgical complications. METHODS: In order to assess the complication rate of ureteral reimplantation in long-term defunctionalized bladder, we compared 20 patients on haemodialysis for more than 15 years (group I) with another 20 patients on haemodialysis for less than 5 years (group II). None of these patients had renal failure due to urological causes or neurogenic bladder. Non-stented extravesical ureteroneocystostomy was done routinely in all patients except 1 in group II who underwent Politano-Leadbetter ureteroneocystostomy and 7 patients in group I who underwent Politano-Leadbetter (3 patients) and pyelo-ureteral anastomosis using the recipient's native ureter (4 patients). The amount of residual urine was insignificant (<100 cm(3)) in both groups. RESULTS: The mean postoperative bladder catheterization period was 7.8 days in group I and 4.2 days in group II. Postoperative urinary tract infections were observed in 9 cases of group I and in 4 cases of group II. No surgical complications occurred in patients of group II, while there were 6 patients with surgical complications in group I: stenosis after a pyelo-ureteral anastomosis (1 case), stenosis after a ureterovesical anastomosis with Politano-Leadbetter technique (1 case), urinary fistulae (3 cases; 1 with Politano-Leadbetter ureteroneocystostomy and 2 cases with pyelo-ureteral anastomosis), and vesico-ureteral reflux (1 case with Politano-Leadbetter ureteroneocystostomy). These 6 cases had the lowest bladder capacity (30-150 cm(3)) among our 40 patients. Graft losses were comparable between the two groups and were not due to surgical complications. CONCLUSION: Small defunctionalized bladders can be used in kidney transplantation, but it may represent an increased surgical risk due to difficulty in performing ureteral reimplantation.

[Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case]. / Péritonite par rupture spontanée d'une pyonéphrose au cours d'une grossesse. A propos d'un cas.

Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.