[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.

Interaction Effects of Plasma Vitamins A, E, D, B9, and B12 and Tobacco Exposure in Urothelial Bladder Cancer: A Multifactor Dimensionality Reduction Analysis.

The study aimed to examine circulating vitamins A, E, D, and B12 and folate in patients with urothelial bladder cancer (UBC) and detect potential interaction effects of these micronutrients on UBC risk. A case-control study was conducted on 262 UBC patients and 254 matched controls. Vitamins A and E were assessed by ultra performance liquid chromatography, and vitamins D and B12 and folate were assessed by immunological methods. Binary logistic regression models were used to test associations of plasma vitamins tertiles with UBC risk. A multifactor dimensionality reduction method (MDR) was applied to assess interactive effects of the vitamins and tobacco on UBC risk. Higher levels in vitamins A, E, and D were associated with lower occurrence of UBC. No significant association was observed in plasma folate or vitamin B12 with UBC. There were redundancy interactions of plasma vitamin D with tobacco and with plasma vitamin A on UBC risk. Even though the study could not ascertain causality, the findings suggest that vitamins A, E, and D might be protective against UBC. Vitamins A and D interact antagonistically with each other's and with tobacco to modulate UBC risk. These interactions should be taken in consideration for the prevention of UBC.

Haplotype-based association of Vascular Endothelial Growth Factor gene polymorphisms with urothelial bladder cancer risk in Tunisian population.

BACKGROUND/AIM: Accumulated data suggested that Vascular Endothelial Growth Factor is a major mediator in vasculogenesis, angiogenesis and recently in tumorigenesis. Therefore, we aimed to investigate for the first time the association between VEGF gene variants (-2549I/D (rs35569394), -2578C/A (rs699947), and +936C/T (rs3025039)) with urothelial bladder cancer (UBC) in Tunisian population. METHODS: A total of 218 UBC patients and 204 controls were recruited and genotyped by Polymerase Chain Reaction technique. Odds ratios (OR) and 95% confidence intervals (CIs) were used to access the association between the VEGFA gene polymorphisms and UBC. RESULTS: We found a significant decreased risk association of -2578 C/A polymorphism with UBC (OR (95% CI), 0.62 (0.41-0.94), P = .026) for CA genotype and (OR (95% CI), 0.40 (0.21-0.76), P = .005) for double homozygous mutant genotype. No associations were found in case of both polymorphic sites of VEGF, vis. -2549I/D and +936C/T, respectively. Haplotype analysis revealed a strong linkage disequilibrium between -2578C/A and -2549I/D and CIC combination is the significant haplotype associated with increased risk of UBC (OR (95% CI), 3.63 (1.47-8.97), P = .005). Regarding tumor grade/stage and family history of cancer, no associations were found for -2578C/A polymorphism. CONCLUSION: CIC haplotype of VEGF gene may be important risk factor for UBC development in Tunisia.

Blunt scrotal trauma in adults: A multi-institution study evaluating the American Association for the Surgery of Trauma organ injury grading scale About 107 cases.

PURPOSE: The authors evaluated the usefulness of the American Association for the Surgery of Trauma (AAST) testis injury scale based on preoperative scrotal ultrasonography (US) and physical examination compared to peroperative findings. METHODS: A retrospective review was performed on 107 patients (mean age=29,2±5.8 years) with a testis blunt trauma treated between January 2005 and August 2015. All patients underwent surgical scrotal exploration. Preoperative US was performed in all cases. Testis trauma was classified according to the AAST organ injury scale, preoperatively based on physical examination and scrotal US and then compared to peroperative definitif grading scale. RESULTS: Of the included patients, 14 were found to have abnormal testis contours on US, 25 had a rupture of the tunica albuginea, with a sensitivity of 70,8% and a specificity of 71,2%. Orchidectomy was performed in 12 cases, partial orchidectomy in 32 and tunica albuginea repair in 35 patients. CONCLUSIONS: Through this series, US was not a specific and sensitive exam to really precise the severity grade of testis trauma. Pre- and preoperative findings were significantly different. Thus, we continue to support history and clinical findings and we encourage surgical exploration when testis lesion is suspected.

Bladder Cancer is Associated with Low Plasma 25-hydroxyvitamin D Concentrations in Tunisian Population.

Little evidence suggests an impact of vitamin D on bladder cancer risk in Caucasians. This study aimed to investigate association of plasma 25-hydroxyvitamin D (25-OHD) with urothelial bladder cancer (UBC) risk in Tunisians. A case-control study included 250 patients with UBC and 250 healthy controls. Plasma 25-OHD was assessed by a competitive chemiluminescence immunoassay. Vitamin D deficiency and insufficiency were defined as 25-OHD <30 nmol/L and 30 to 49.99 nmol/L, respectively. Logistic regression models adjusting for gender, age, smoking status, duration of smoking, occupational exposure, and season were applied. Vitamin D deficiency (50.4% vs. 34.8%; P < 0.001) and insufficiency (40.4% vs. 26.8%; P < 0.001) were more frequent in patients than controls. Multivariate analysis showed that UBC is associated with vitamin D deficiency [odd-ratio (95% confidence interval), 3.71 (1.76-7.80); P = 0.001] and vitamin D insufficiency [2.65 (1.40-5.01); P = 0.003]. Other predictors of UBC were female gender, tobacco use, smoking duration, and occupational exposure. Plasma 25-OHD concentrations are low in Tunisian patients with UBC. These findings support experimental and epidemiological evidence of protective role of vitamin D against UBC but could not ascertain causal relationship. Further prospective studies and clinical trials are warranted to check causality.

Long-term outcome of intravesical bacillus Calmette-Guérin therapy with maintenance for urinary bladder carcinoma in situ: About 47 cases.

INTRODUCTION: Data concerning the efficacy of intravesical Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder are limited. OBJECTIVES: We analyzed long-term outcomes of instillation therapy with BCG to treat bladder CIS, evaluated its effectiveness and safety and searched for prognostic factors that could predict disease recurrence and progression. METHODS: Between March 1994 and December 2010, 47 patients (male: 40; female: 7) with median age of 59,5 years (range 40-76 years), diagnosed with bladder CIS underwent weekly BCG instillations (75 mg of Pasteur strain) for six weeks followed by 6 monthly instillations. Patients were collected from four different institututions.Proven bladder CIS diagnosis was made through random biopsy (n=19), macroscopic lesion (n=28) and urinary cytology (n=6).Primary, concomitant, and secondary CIS was found in 13 (27,6%), 28 (59,6%) and 6 (12,7%), patients, respectively. RESULTS: The median follow up period was 67.5 months (range 60-116 months).The recurence rates were 15,4%, 35,7% and 50% respectively in group I,II and III at 5 years follow-up. The overall complete response rate was 68%.The five-year progression-free survival rate was 87.2%.Several factors, such as age (<60 or >60 years), gender, previous transurethral resection and type of CIS, were examined by multivariate analysis to predict recurrence and progression. None of them was an independent prognostic factor.Bladder irritation symptoms were the main BCG adverse effects. There were no severe adverse effects requiring discontinuation of drug administration.Radical cystectomy was performed in 5 patients. Extravesical involvement was identified in only one patient. During follow-up period, none died of bladder cancer. CONCLUSION: Therapy with BCG is remarkably effective and safe for primary CIS and concomittent CIS, which might be a prognostic factor. We didn't find any significant risk factor. Recurrence and disease progression including extravesical involvement should be carefully monitored over the long-term after BCG therapy.

[Atypical renal cysts]. / Les kystes atypiques du rein.

BACKGROUND: Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management. AIM: To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features. METHODS: Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings. RESULTS: According to histological findings, 7 among the 10 type III lesions were benign (70%). However, only one case of benign tumor was noted in type IV lesions (8.3%). There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors. CONCLUSION: Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible.

[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.

Pelvic leiomyoma associated with intermediate risk prostate cancer: A case report.

Pelvic leiomyoma in male patients is a very rare occurrence and its association with prostate cancer is a unique clinical situation. This study reports a new case of a 9 cm pelvic Leiomyoma associated with intermediate-risk localized prostate cancer in a 68-year-old patient. The leiomyoma was discovered fortuitously after an MRI was performed in the context of prostate cancer work-up. Surgical excision of the pelvic mass along with a radical prostatectomy were performed and the diagnosis of leiomyoma was confirmed by histopathology.

Segmental renal vein thrombosis: An unusual complication of acute pyelonephritis.

Renal vein thrombosis is not a common manifestation in the context of acute pyelonephritis. We report the case of a 29-year-old female diabetic patient that was admitted to our department for an episode of complicated acute pyelonephritis. Initial imaging showed a left lower polar abscess of 27 mm and urine cultures grew community acquired K. Pneumoniae. Two days after the patient was discharged, she was readmitted with worsening symptoms. Repeat imaging showed stability in the size of the abscess and revealed a left lower segmental vein thrombosis. The patient responded favorably to antibiotics and heparin-warfarin therapy.

Bilateral renal hydatid disease associated with complex urolithiasis: A case report.

INTRODUCTION AND IMPORTANCE: The association of bilateral renal hydatid cysts and complex urolithiasis is unprecedented. We herein report the case of a patient presenting with both diseases. CASE PRESENTATION: A 56-year-old female patient with a history of chronic kidney disease presented with right flank pain. Imaging revealed bilateral kidney cystic lesions associated with right spontaneous large ureteric streinstrasse and multiple calyceal stones. The right sided mass was exophytic and measured 56 mm and the left sided lesion measured 35 mm. Semi rigid right ureteroscopy was performed along with a right partial nephrectomy and a right pyelotomy which allowed for renal and ureteral stone extraction. Histopathology report concluded to a hydatid cyst. The decision was to monitor the left-sided lesion. CLINICAL DISCUSSION: The association of bilateral renal hydatidosis and right urolithiasis is unprecedented in literature. The lesion presented a differential diagnosis problem with a cystic malignancy. Thus, the decision was to perform a right partial nephrectomy. The combination of ureteroscopy and a single right flank incision was sufficient to treat the renal lesion as well as to obtain stone free status. Once the histopathological report concluded to a hydatid cyst, the decision was to monitor the left sided lesion. A more aggressive approach could be proposed however it would have been detrimental to the patient's renal function. CONCLUSION: When presented with an association of bilateral renal masses and urolithiasis, a methodical step-by-step approach is necessary in order to treat both diseases while minimizing patient morbidity.

Prostatic lithiasis complicating granulomatous prostatis of tuberculous origin: About a case report.

Urogenital tuberculosis remains a frequent disease in our country. It is the most common extra-pulmonary location. Prostatic involvement is extremely rare. We report the observation of a prostatic lithiasis complicating a granulomatous prostatitis of tuberculous origin, revealed essentially by obstructive and storage lower urinary tract symptoms. The diagnosis was suspected on imaging and clinical findings and confirmed by histology. Treatment consisted of endoscopic resection of the prostate associated with endoscopic ballistic lithotripsy. Prostatic lithiasis is a rare condition with a poorly elucidated ethiopathogeny. The origin of tuberculosis should be evoked in front of this affection.

An unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract; a case report.

The occurrence of urothelial carcinoma and tuberculosis in the same kidney is exceptional. To our knowledge, a few cases have been reported in the literature. Herein, we report a case of an unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract in a 61-year-old patient and discuss the diagnosis and treatment difficulties.

Adult bladder rhabdomyosarcoma: A case report.

Rhabdomyosarcomas (RMS) are mesenchymal tumors that develop at the expense of striated muscle fibers. It accounts for 6% of childhood malignancies. Rhabdomyosarcomas of the genitourinary tract also occur in children but are distinctly uncommon in adults. We report a case of bladder rhabdomyosarcoma in a 72-year-old patient who presented with gross hematuria and discuss difficulties of diagnosis and treatment.

Bilateral renal abscess fusing with the psoas on the right: A case report.

Renal abscess is a medical and surgical urological emergency whose diagnosis has been improved by modern imaging. It often poses a problem of therapeutic management between antibiotic therapy or the association of a drainage. Most abscesses are unilateral, the bilateral nature of the abscessed lesions suggests a hematogenous diffusion. We report a case of a bilateral renal abscess fusing to the psoas muscle on the right that progressed well with antibiotic treatment and percutaneous drainage.

Isolated penile schwannoma: A rare case report.

Schwannoma is a benign nerve tumor composed of cells of the schwann nerve sheath. Only about twenty cases have been reported in the literature to our knowledge. We report an isolated case of schwannoma of the penis in a 56-year-old man who presented a nodule of the penis in the balanopreputial groove that had been progressively increasing in size for three years. Anatomopathological and immunohistochemical criteria allowed for a positive diagnosis. Treatment consisted of surgical excision followed by rigorous surveillance.

Isolated prostatic tuberculosis and review of literature.

Tuberculosis (TB) is one of the most important infectious diseases, particularly in the world. Amongst the genitourinary organs, prostatic TB is less common. We report an 68 year old patient, immunocompetent who presented obstructive and irritative symptoms of the lower urinary tract. A history of pulmonary tuberculosis was not present. The digital rectal examination was suspicious and PSA was a normal. The biopsy results did not reveal any malignant lesions but the transurethral resection of the prostate performed for voiding purposes showed prostatic tuberculosis. A very good clinical and biological improvement was observed after chemotherapy anti-tuberculosis.

Erectile function outcomes following surgical treatment of ischemic priapism.

Introduction: Ischemic Priapism is defined as an abnormally prolonged state of erection, exceeding 6 h, often and irreducible, occurring without any sexual stimulation. Ischemic priapism has a fatal consequence on the sexual function of men if it's not promptly managed. This pathology can cause erectile dysfunction and this can alter the quality of life of patients. Objective: The aim of our study was to determine the factors influencing erectile function after treatment of ischemic priapism. Patients and methods: This is a ten-year retrospective, descriptive and analytic study of 40 patients who consulted the urology department at the university hospital center for treatment of ischemic priapism (2010-2019). Results: We included 40 patients in our study. The mean age was 35.2 [18-62]. Duration of priapism varied from 20 to 360 h (mean 76.6). The most common etiology of priapism was sickle cell disease in 65% of cases. The mean preoperative IIEF-5 score was 23 [21-26]. All patients underwent corporal aspiration with an injection of ephedrine, but detumescence was observed in only 10% of cases. Thirty-six patients had a distal shunt with detumescence in approximately 70% of cases. Eleven patients underwent a distal shunt but seven patients had definitive fibrosis. After the episode of priapism, only eight patients retained normal erectile function. The mean postoperative IIEF-5 score was 14 [ 7-26]. We noted an improvement in erectile function in 8 patients treated with tadalafil. In multivariate analysis, we have demonstrated that a treatment delay exceeding 48 h, fibrosis and the necessity of a distal shunt significantly affects postoperative erectile function (p = 0.001; p = 0.002; p = 0.002 respectively). Conclusion: According to our study, delayed management exceeding 48 h, fibrosis and the necessity of a surgical distal shunt are three independent factors affecting erectile function after treatment of ischemic priapism.

Functional outcomes of surgical treatment of varicocele in infertile men: Comparison of three techniques.

Introduction: Among identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate. Objective: The goal of this study was to compare different surgical techniques in terms of morbidity and fertility results. Patients and methods: It is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques. Results: Post-operative complication rates were comparable (p = 0,94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0,29 for the sperm concentration and p = 0,49 for the progressive mobility). Spontaneous pregnancy was better (p = 0,03) for patients who have had a varicocelectomy in a sub-inguinal way. Conclusion: All of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better.

Predictive factors for failure of conservative management in patients with emphysematous pyelonephritis.

Introduction: Emphysematous pyelonephritis (EPN) is a severe form of life-threatening renal infection. Conservative treatment represents the gold standard in the management of EPN, but nephrectomy remains appropriate in certain situations. Objective: The aim of our study was to report our experience in the conservative management of emphysematous pyelonephritis and to identify the predictive factors of failure of conservative treatment. Patients and methods: This is a retrospective study including all patients treated for emphysematous pyelonephritis in our department between January 2015 and December 2020. The first-line treatment was conservative based on antibiotic therapy and drainage in case of an obstructive cause. A nephrectomy was performed in case of failure of the conservative approach. Epidemiological, clinical, biological, therapeutic, and evolutionary data were collected from the patients' files. Statistical analysis was made using SPSS version 28. Results: 41 patients were included in our study. The mean age was 64.4 years old [28-91] with gender ratio of 0.46 (13H/28F). Diabetes mellitus was present in 75.6% of cases. The mean presentation delay was 3.28 days (Kaiser and Fournier, 2005; Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007; Dutta et al., 2007; Dutta et al., 2007; Deoraj et al., 2018 Sep; Rahim et al., 2021 Mar; Maheshwari, 2021 Jul-Sep) [1-11]. In CT scan, 21 patients had class 1 EPN, 9 had class 2 EPN, 8 had class 3 EPN and 3 had class 4 EPN. The obstructive origin was found in 24 cases. Initially, 25 patients (60.9%) presented with severe sepsis and 7 patients (17.07%) developed a septic shock. Seven patients required nephrectomy with a mean delay of 2.12 days (Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007) [2-6]. Five patients with septic shock refractory to conservative treatment and two patients whose evolution was marked by the occurrence of secondary septic shock. In the univariate analysis, thrombocytopenia, initially septic shock, and the need for hemodialysis were the predictive factors of failure of conservative management in patients with emphysematous pyelonephritis. Conclusion: Emphysematous pyelonephritis is a serious condition with significant mortality. The optimal management is based on conservative treatment in most cases. However, patients requiring hemodialysis and with thrombocytopenia and initially septic shock should be considered candidates for emergency nephrectomy.