[Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]. / Résultats du réalignement endoscopique précoce des ruptures de l'urètre postérieur post-traumatique.

INTRODUCTION: Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. PATIENTS AND METHODS: We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. RESULTS: Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). CONCLUSION: Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty.

Comparison of long-term results according to the primary mode of management of injury for posterior urethral injuries.

INTRODUCTION: The management of post-traumatic rupture of the posterior urethra remains controversial, leaving the choice between early endoscopic realignment (EER) or suprapubic catheterization with deferred urethroplasty. The objective is to compare the results of endoscopic realignment and those of urethroplasty in terms of voiding. PATIENTS AND METHODS: We underwent a retrospective study collating all patients managed for post-traumatic complete urethral rupture between 2010 and 2020. These patients were subdivided into two groups: a first one including those who had an endoscopic realignment and a second one including those who had a deferred urethroplasty. We studied the quality of voiding and the complications that occurred in each group. The success of the technique was defined by the resumption of a satisfactory voiding, and the absence of recourse to the urethroplasty in case of endoscopic realignment. Satisfactory voiding was defined by a Qmax ≥ 15 mL/s and a post-void residual (PVR) < 150 ml by ultrasound. RESULTS: Fifty-eight patients were identified. The mean age was 32 ± 12 years. Endoscopic realignment was performed in 26 patients. Satisfactory voiding was reported in 16 patients (61.53%). Recourse to internal urethrotomy after realignment was reported in 7 patients (26.92%). Three failures of endoscopic realignment were reported, necessitating an urethroplasty. Two patients reported urinary incontinence. Urethroplasty was performed in 32 patients. Satisfactory voiding was noted in 22 patients (68.75%). The use of internal urethrotomy after surgery was reported in 5 patients (15.62%). Three patients had treated urinary incontinence. Comparing the two groups, there was no significant difference in postoperative IPSS, flow rate (Qmax), post-void residual urine volume (PVR), satisfactory voiding, and stress urinary incontinence. CONCLUSION: The voiding outcomes were comparable for both techniques. We conclude that endoscopic realignment can be indicated in first intention, provided certain conditions are met, in order to minimize the morbidity of prolonged suprapubic drainage.

Acute obstructive pyelonephritis due to pyosalpinx: a case report.

BACKGROUND: A pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic inflammatory disease. CASE PRESENTATION: We report the case of a 54-year-old Africain female patient, who presented with sustained high-grade fever, right flank pain, and severe acute storage low-urinary-tract symptoms. Computed tomography showed signs of acute obstructive pyelonephritis with a right tubular juxtauterine mass with complex internal fluid and thick enhancing walls exerting a mass effect on the right ureter. A drainage of the right excretory cavities by a JJ stent was performed. An ultrasound-guided aspiration of the collection was also performed. CONCLUSION: A pyosalpinx can then exert a mass effect on the excretory cavities, thus causing an acute obstructive pyelonephritis. A double drainage coupled with an effective antibiotic therapy is then necessary.

Penile gangrene due to improper application of a condom catheter: a case report.

BACKGROUND: Fournier's gangrene is a rare, fulminant, and usually localized necrotizing soft tissue polymicrobial infection of the perineum, with occasional extension up to the abdominal wall. CASE PRESENTATION: We describe an unusual case of penile gangrene in a 64-year-old Tunisian man suffering from urinary incontinence secondary to cerebrovascular accident. Gangrene developed due to continuous tourniquet effect on the penis caused by a condom catheter. Although source control was achieved with aggressive debridement, careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock. CONCLUSION: Use of condom catheters is not without complications. Careful placement, strict hygiene, and regular monitoring of the local condition are necessary.

Life-threatening complication due to double-J stent: renal subcapsular hematoma.

The double-J ureteral stent is a standard procedure in daily urological practice. Although considered as safe, this approach is fraught with several complications. These complications are of limited severity and resolve with symptomatic treatment. In some cases, serious and life-threatening complications, such as infection and subcapsular hematoma, can occur. In the literature, a few cases of subcapsular renal hematoma secondary to ureteral stent insertion have been reported. Herein, we report a case of renal subcapsular hematoma combined with hemorrhagic shock in a 67-year-old patient who had a ureteral stent insertion one month ago.

Giant adrenal myelolipoma in a young female patient: a case report.

Myelolipoma is a rare, benign, non-secreting tumor and its pathophysiology is of metaplasia of the cells of the adrenal cortex into reticuloendothelial cells. Although they are often small and asymptomatic, some cases of giant adrenal myelolipoma cause symptoms such as chronic pain. Few cases of adrenal myelolipoma have been reported in the literature. We present a case of a large right adrenal myelolipoma in a 26-year-old female patient, who presented with an adrenal mass, and discuss the challenges of diagnosis and treatment.

Bladder carcinosarcoma with rhabdomyoblastic differentiation: a rare case report.

Carcinosarcoma is a distinct neoplasm consisting of bidirectional differentiation toward epithelial and mesenchymal cells. Bladder localization is rare and the association with a rahbdomyoblastic component is exceptional. Few cases of bladder carcinosarcoma with rhabdomyoblastic differentiation have been reported in the literature. We present a case of a bladder carcinosarcoma in a 68-year-old man who presented with terminal hematuria and discuss difficulties of diagnostic and treatment.

Bladder lymphoepithelioma-like carcinoma: a case report.

Bladder lymphoepithelioma-like carcinoma is a rare entity. It represents a particular variant of urothelial carcinoma characterized by an important infiltrating power. Therapeutic management of this cancer is not codified. Surgery associated with chemotherapy seems to be the best therapeutic option. Few cases of this tumor have been reported in the literature. We report a case of bladder lymphoepithelioma-like carcinoma in a 52-year-old patient who presented with gross hematuria and discusses difficulties of diagnostic and treatment.

An unusual association of adenocarcinoma and isolated tuberculosis of prostate gland.

Adenocarcinoma of prostate is the most common primary prostatic malignancy in the world. Isolated prostate tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. We report two cases of adenocarcinoma and tuberculosis of the prostate. The patients were 83 and 74 years old, respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and prostate-specific antigen were abnormals. The diagnosis of prostatic tuberculosis and adenocarcinoma was made by histologic analysis after transurethral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis and hormonotherapy. Tuberculosis and malignancy may co-exist in some cases and clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Carcino-sarcoma of the urinary bladder with cartilaginous differentiation: About a case report.

Carcinosarcoma of the bladder is a very rare and aggressive tumor with poor prognosis. We report a case of a 61 year-old-male who presented a terminal hematuria. Ultrasounds revealed a mass at the dome and the right of urinary bladder. A transurethral resection of the bladder tumor was performed. A pathological examination revealed a pT1 hight grade carciono-sarcoma of the urinary bladder with cartilaginous differentiation. Cystoprostatectomy with Bricker diversion and lymph node dissection were performed. The pathological examination of the surgical specimen revealed no residual tumor lesion.