[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.

[The prognostic value of preoperative neutrophil-to-lymphocyte ratio in patients with non-metastatic renal cell carcinoma]. / Signification pronostique du rapport préopératoire neutrophiles-lymphocytes dans le cancer du rein non métastatique.

INTRODUCTION: The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio in non-metastatic renal cell carcinoma. PATIENTS AND METHODS: We retrospectively analyzed the records of patients with non-metastatic renal cell carcinoma who were operated between 2004 and 2020 at our institution. The Kaplan-Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox's proportional hazards regression models were utilized to analyze the association between neutrophil-to-lymphocyte ratio and oncological outcomes. RESULTS: We included 202 patients. Patients with higher neutrophil-to-lymphocyte ratio had larger tumors (P=0.03), higher ASA score (P=0.014), clinical symptoms (P=0.04), sarcomatoid differentiation (P=0.03) and tumor necrosis (P=0.02). The rates of recurrence-free survival and metastasis-free survival were significantly lower in patients with a high neutrophil-to-lymphocyte ratio than in those with a low ratio (P=0.017; P=0.036 respectively). Multivariate analysis identified the neutrophil-lymphocyte ratio as an independent predictor of recurrence-free and metastasis-free survival (P=0.021; P=0.001 respectively). CONCLUSION: A higher neutrophil-to-lymphocyte ratio has been associated with a symptomatic renal cancer with a significant prognostic factor for both recurrence-free and metastasis-free survival. LEVEL OF PROOF: 3.

Left-sided congenital heart lesions in mosaic Turner syndrome.

In the era of the diseasomes and interactome networks, linking genetics with phenotypic traits in Turner syndrome should be studied thoroughly. As a part of this stratagem, mosaicism of both X and Y chromosome which is a common finding in TS and an evaluation of congenital heart diseases in the different situations of mosaic TS types, can be helpful in the identification of disturbed sex chromosomes, genes and signaling pathway actors. Here we report the case of a mosaic TS associated to four left-sided CHD, including BAV, COA, aortic aneurysms and dissections at an early age. The mosaicism included two cell lines, well-defined at the cytogenetic and molecular levels: a cell line which is monosomic for Xp and Xq genes (45,X) and another which is trisomic for pseudoautosomal genes that are present on the X and Y chromosomes and escape X inactivation: 45,X[8]/46,X,idic(Y)(pter→q11.2::q11.2→pter)[42]. This case generates two hypotheses about the contribution of genes linked to the sex chromosomes and the signaling pathways involving these genes, in left-sided heart diseases. The first hypothesis suggests the interaction between X chromosome and autosomal genes or loci of aortic development, possibly dose-dependent, and which could be in the framework of TGF-ß-SMAD signaling pathways. The second implies that left-sided congenital heart lesions involve sex chromosomes loci. The reduced dosage of X chromosome gene(s), escaping X inactivation during development, contributes to this type of CHD. Regarding our case, these X chromosome genes may have homologues at the Y chromosome, but the process of inactivation of the centromeres of the isodicentric Y spreads to the concerned Y chromosome genes. Therefore, this case emerges as an invitation to consider the mosaics of Turner syndrome and to study their phenotypes in correlation with their genotypes to discover the underlying developmental and genetic mechanisms, especially the ones related to sex chromosomes.

Giant prostatic adenocarcinoma revealed by bilateral edema of the lower limbs.

Adenocarcinoma of the prostate affects up to 70 % of men over 80 and is the second leading cause of cancer related death in men. We reported an unusual case of a giant prostatic adenocarcinoma compressing bilaterally the 2 external and internal iliac veins that was revealed by a bilateral edema of the lower limbs after histological confirmation the patient was treated by radiotherapy and hormone therapy with a clinical amelioration.

Mucinous tubular and spindle renal cell carcinoma revealed by a trauma of the kidney: a case report.

BACKGROUND: Mucinous tubular and spindle cell carcinoma is a rare renal tumor. It has been recognized as a distinct entity in the 2004 World Health Organization tumor classification. Since then, several dozen of these tumor have been reported with additional complementary morphologic characteristics, immunohistochemical profile, and molecular genetic features that have further clarified its clinicopathologic aspects. CASE PRESENTATION: We report the case of a 52-year-old male African patient who was found to have a mucinous tubular and spindle renal cell carcinoma on a nephrectomy specimen for a severe kidney trauma. CONCLUSIONS: This tumor has a histological spectrum ranging from low to high grade, which includes sarcomatoid differentiation that can confer the tumor an aggressive clinical course.

A case of liposarcoma of the spermatic cord.

Para-testicular liposarcoma develops from the fatty tissue surrounding the spermatic cord and covers the testicle and epididymis. It is an extremely rare pathological entity. We report the case of a 58-year-old african man who presented with a tumor mass developed from the right spermatic cord. Right orchidectomy with wide excision of the tumor was challenging due to the significant size of the mass. The histological examination of the surgical specimen favored a paratesticular liposarcoma.

The modified 5-item frailty index as a predictor of perioperative risk in patients undergoing percutaneous nephrolithotomy.

INTRODUCTION: The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL. METHODS: A database of patients undergoing PCNL, between 2015 and 2022, was analyzed. Patient frailty was assessed using the mFI-5 index. The mFI-5 index was calculated based on the presence of the five co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 ≥ 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospitalization: total hospital length of stay, reoperation, and unplanned readmission. RESULTS: From a total of 320 PCNL patients included for analysis, 54.06% (n = 173) were not frail, 17.81% (n = 57) were intermediate, and 28.12% (n = 90) were severely frail. Frail patients were likely to be older (p = 0.002) and have a higher American Society of Anesthesiologists score (p = 0.001), chronic kidney disease (p < 0.001). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p = 0.042), significant blood loss (p = 0.036) and require intensive care units admissions (p = 0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require reoperation (p = 0.001), and unplanned readmission (p = 0.02). CONCLUSION: Frailty assessment appears useful in stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.

Prognostic significance of the preoperative platelet-lymphocyte ratio in nonmetastatic renal cell carcinoma: cross-sectional study.

The prognostic significance of the platelet-lymphocyte ratio (PLR) in nonmetastatic renal cell carcinoma (RCC) is controversial, although it has been established as a prognostic factor in several cancers. Objective: The objective of our study was to evaluate the prognostic significance of the PLR in patients with nonmetastatic RCC. Patients and methods: The authors performed a retrospective analysis of patients with nonmetastatic RCC who were operated between 2004 and 2020. Five years recurrence-free survival and metastasis-free survival were calculated. The prognostic significance of the preoperative PLR was assessed. The Kaplan-Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox's proportional hazards regression models were utilized to analyze the association between PLR and oncological outcomes. Differences were considered significant if P<0.05. Results: Two hundred and two patients were included. The mean follow-up was 56.8±3 months. Patients with a higher PLR had larger tumors (P=0.02), higher ASA score (P=0.001), symptomatic forms (P=0.01), and more frequent tumor necrosis (P=0.02). Recurrence-free survival and metastasis-free survival rates were significantly lower in patients with high PLR than in those with low ratios (each P<0.005). Multivariate analysis identified PLR as an independent predictor of recurrence-free survival (P=0.002) and metastasis-free survival (P<0.001). Conclusion: A higher PLR was associated with aggressive renal cancer. In addition, the PLR was a significant prognostic factor for both recurrence-free survival and metastasis-free survival in patients with nonmetastatic RCC.

Massive hydronephrosis due to obstruction by upper urinary tract urothelial carcinoma with compression of the inferior vena cava.

A 78-year-old woman presented with tachypnea, abdominal distension, bilateral lower limb edema, and hematuria. A contrast-enhanced CT scan of the abdomen and pelvis was performed, which revealed a significant left-sided hydronephrosis upstream of an upper urinary tract urothelial carcinoma (UUT-UC). The patient underwent a left open nephroureterectomy, and approximately 10 L of fluid were evacuated. Follow-up examinations did not show any recurrence of abdominal swelling.

Isolated emphysematous prostatitis: A very rare entity.

Emphysematous prostatitis is characterized by their rarity and its severity. It often occurs in older diabetics. This study reports a new case of an isolated emphysematous prostatitis in a 66-year-old patient which presented with mental confusion and severe sepsis. Computed tomography revealed intra parenchymal air bubbles of the prostate which evolved well after early resuscitation and rapid and effective antibiotic therapy. Emphysematous prostatitis is an uncommon but potentially serious disorder that has the potential for causing problems if not diagnosed at the early stage and treated promptly.

Ocular abscess: An extremely rare complication of transurethral resection of the prostate.

Ocular abscess following transurethral resection of the prostate is an rare complication. We report the case of a male who developed an ocular abscess with purulent melting of the eye after undergoing TURP for benign prostatic hyperplasia. The patient successfully underwent the TURP procedure. However, he developed a right epididymitis and subsequently an ocular abscess on the same side. Treatment involved dual antibiotic therapy for the epididymitis, followed by incision of the ocular abscess and intravenous antibiotics. Multidrug-resistant Escherichia coli was identified in both ocular and postoperative urine cultures. This case highlights the rarity and potential serious complications following TURP.

Bladder colloid carcinoma: A case report.

Non-urothelial bladder cancers are rare. We report the case of a 72-year-old who consulted for terminal hematuria evolving for three months. Computed Tomography scan showed a tumor of the anterior wall of the bladder. The patient underwent a transurethral resection of the bladder tumor. The histological examination of the tumor showed a bladder colloid carcinoma. The extension evaluation showed pulmonary and bone metastases. The patient received chemotherapy.

A round cell sarcoma of the bladder following radiotherapy: A case Report.

Sarcomas are uncommon and extremely aggressive malignancies. Sarcomas of the bladder are exceedingly rare. We report the case of 67-year-old female patient having had 20 years ago a total hysterectomy with bilateral adnexectomy followed by adjuvant external radiotherapy to an undifferentiated uterine sarcoma, was presented with hematuria. An abdomino-pelvic Computed Tomography (CT) Scan was done showing a 5 cm budding lesion of the bladder floor. An anterior pelvectomy with external urinary diversion was undergone. The histological examination showed a high grade urothelial carcinoma infiltrating the muscle with a sarcomatoid component.

Bladder endometriosis: A serious disease.

Urinary tract endometriosis (UTE) is a very rare but serious form of infiltrating endometriosis because of the risk of urinary tract obstruction and loss of renal function. We report the case of A 42-year-old female patient admitted for intense right back pain with lower urinary tract disorders. An abdomino-pelvic ultrasound was done showing right uretero-hydronephrosis. Ureteroscopy showed an inflammatory-like stenosis of the right pelvic ureter. Given the young age of the patient, the poor quality of the right kidney, we opted for a right total nephro ureterectomy. The anatomopathological examination showed a bladder endometriosis .

Pelvic ureteral angiomyoma mimicking urothelial carcinoma: A case report.

BACKGROUND: Angiomyoma is a rare benign tumor that can occur in any organ with smooth muscles. No one has already described an angiomyoma of the ureter. CASE PRESENTATION: We report the case of a 44 year old woman who presented with intermittent hematuria and left flank pain. The diagnosis of left ureteral tumor was evoked by the scannographic aspect. She underwent a radical nephro-ureterectomy. Final histological examination concluded to ureteral angiomyoma. DISCUSSION: Angiomyoma is rare benign smooth muscle tumor with a vascular component. Symptomatology depends on the organ that angiomyoma is developed from, and is usually mimicking malignant tumors. CONCLUSION: Symptomatology, radiologic findings are mimicking urothelial carcinomas, however the pathology corrected the diagnostic error.

A case of pheochromocytoma in pregnancy: A syndromic association.

BACKGROUND: Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms. Concurrent pheochromocytoma in pregnant women can lead to severe complications and death due to associated catecholamine excess. CASE PRESENTATION: A 37-year-old pregnant woman, without medical or surgical history, gravida 1 para 0, was diagnosed with pheochromocytoma through biochemical and imaging tests at 20 weeks of gestation. Perioperative management included a multidisciplinary approach, symptom stabilization with medical treatment. An open right adrenalectomy was than performed at 23 weeks of gestation. DISCUSSION: Pheochromocytoma is a rare but important cause of hypertension in pregnancy. It should be included and investigated as a differential diagnosis in cases of labile hypertension in pregnant women with or without associated symptoms. CONCLUSION: A correct diagnosis in all pregnant women with severe hypertension and a multidisciplinary management are mandatory to obtain optimal results and avoid deleterious effects at delivery.

Traumatic renal injury revealing a horseshoe kidney: A case report.

Having a kidney disease is a major risk factor of renal injury during blunt traumas. We present a case of abdominal blunt trauma due to motor-vehicle accident in a 48 year old male patient. Abdominal computed tomography scan showed a high-volume retroperitoneal hematoma with rupture in the isthmus of the horseshoe kidney with active contrast-enhanced extravasation. He underwent a partial nephrectomy of the left lower pole.

Pancreatic pseudocyst mimicking a left kidney abscess: a case report.

BACKGROUND: Pancreatic pseudocyst are fluid filled sacs that develop as a result of dissection of pancreatic enzyme tissue. While most commonly found near the pancreas, they can also rarely occur in other areas such as the perirenal region. CASE PRESENTATION: This study reports a new case of an infected perirenal pancreatic pseudocyst mimicking a left kidney abscess in a 46-year-old North African patient with history of recurrent acute pancreatitis, who presented with left lumbar region pain and fever. Computed tomography revealed a left perirenal collection that turned out to be an infected pancreatic pseudocyst, The diagnostic was first suspected based on the medical history of the patient and confirmed by biochemical examination detecting a high level of pancreatic enzymes in the computed tomography-guided percutaneous drainage fluid. The patient evolved well after early resuscitation, rapid and effective antibiotic therapy, and computed tomography-guided percutaneous drainage of renal collection. CONCLUSION: Pancreatic pseudocyst is an uncommon disorder, which may present at a complicated stage and that must be considered in patients with a history of pancreatitis.

Predictive factors of bladder tumor recurrence after radical treatment of upper urinary tract cancer.

INTRODUCTION: The main problem after Radical Nephroureterectomy (RNU) for localized non-metastatic upper urinary tract urothelial cancer (NM-UUT-UC) is bladder recurrence. AIM: To identify factors of bladder recurrence of localized NM-UUT-UC after radical treatment. METHODS: It is an analytical and observational study that was conducted in the department of urology of La Rabta Hospital in Tunis. We collected the data of patients diagnosed with localized NM-UUT-UC who had RNU between 2005 and 2019. RESULTS: The mean age of the 73 eligible patients was 68 years (±11). The sex ratio was 5/2. Macroscopic hematuria was the revealing clinical sign in 66% of patients, while low back pain was the most frequent sign in 88% of patients. The most frequent tumor stage was pT1 in 20 patients while 32% of them had a pT2-T3 stage. Bladder recurrence was reported in 22% of patients with a median time of nine months [4-27] and extremes of three and 69 months. Factors of bladder recurrence in the univariate analysis were smoking, tumor localization in the ureter and the extravesical excision of the intramural ureter and bladder cuff. On multivariate analysis, the only independent predictor of bladder tumor recurrence was ureteral location (OR=3.65; CI95%=[1.02-13.1] ; p=0.047). CONCLUSION: Tumor localization in the ureter was an independent predictor of bladder recurrence after radical treatment for localized NM-UUT-UC.

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.