[Testicular plasmocytoma: a case report]. / Le plasmocytome testiculaire: a propos d'un cas.

BACKGROUND: Extramedullary plasmocytoma is rare, with less than 50 reported cases and only 8 cases of primary testicular plasmocytoma. AIM: Report of a new case CASE: This report concerns a 65-year-old patient presenting an enlargement of the testis. The diagnosis of testicular plasmocytoma was made on histological examination. There was no evidence of bone marrow involvement or systemic signs of myeloma. This case will be studied with a review of the literature.

[Ureteric valves: a report of two cases]. / Les valves de l'uretère: à propos de deux observations.

Ureteric valves are a rare cause of ureteric obstruction. Fifty cases have been described in the literature. We report two new cases. The first is of a 12-year-old child with left multiple ureteric valves associated to bilateral vesico-ureteric reflux. The patient was treated by uretero-ileoplasty with unfavourable evolution to renal failure. The second case is that of a proximal ureteric valve discovered in a 30-year-old woman who had postpartum acute pyelonephritis. Treatment consisted in ureteric resection-anastomosis with favourable outcome. Based on a review of the literature, we discuss epidemiologic, etiologic, diagnostic and therapeutic aspects of this malformation.

[Renal actinomycosis: a case report]. / Actinomycose rénale: a propos d'une observation.

This report describes the case of a 26-year-old patient hospitalized for spontaneous abdominal pain. Palpation during clinical examination demonstrated a mass in the right abdomino-pelvic cavity. Radiological examination visualized the presence of grains suggestive of actinmycosis. The patient responded favorably to antimicrobial therapy. Actinomyces israeli is a gram-positive anaerobic bacterium that can cause tumor-like lesions usually on the face and neck and more rarely on retroperitoneal structures. Because renal involvement can require nephrectomy, diagnosis of renal actinmycosis must be made during pre-operative work-up. Ultrasound-guided needle biopsy of the lesion can achieve diagnosis and avoid nephrectomy since medical treatment using antimicrobial therapy is effective.

[Bladder herniation]. / Hernie Vésicale.

Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.

[Excavated right pleuro-pneumopathy with fever]. / Une pleuro-pneumopathie droite fébrile excavée.

Respiratory manifestations are rarely observed in pyonephrosis. We report a new case revealed by lower respiratory infection with Escherichia coli empyema. Ultrasound and computed tomography rectified the diagnosis.

Combination of ballistic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia: report of 120 cases.

PURPOSE: We report our experience with the combination of ballistic lithotripsy (BL) and transurethral resection of the prostate (TURP) in 120 patients with benign prostatic hyperplasia (BPH) and bladder stone(s). PATIENTS AND METHODS: The mean stone size, appreciated by measuring the greatest diameter, was 18.5 mm (range 10-80 mm). The mean prostate volume was 35.4 cc (26-62 cc). All procedures were monitored under direct endoscopic control with a videocamera. RESULTS: Lithotripsy and evacuation of fragments was performed in an average time of 27.5 minutes (10-80 minutes). The only intraoperative complication was mild hematuria in 38 patients (32%), which did not affect vision for TURP. The mean resection time was 42 minutes (range 15-65 minutes). Four patients experienced mild postoperative bleeding, and one patient had clot retention. The mean hospital stay was 1.2 days (range 1-4 days). CONCLUSIONS: Combined BL and TURP is effective, safe, and economical.

Ureterovaginal fistulas complicating laparoscopic hysterectomy: a report of two cases.

Three ureterovaginal fistulas occurred following laparoscopic hysterectomy in two patients. Inadvertent burn of the distal ureter by a unipolar electrocautery was thought to be the cause. Avoidance of unipolar cautery to achieve hemostasis of uterine arteries would have prevented these urologic complications.

[Echographic aspects of fused kidneys. Apropos of 2 cases]. / Aspects échographiques des reins concrescents. A propos de 2 cas.

Coalescent kidney is a rare variety of fused kidneys, clinical manifestations observed with the greatest frequency being a more or less painful abdominal mass, digestive disturbances and a complicating infection, calculus, renal failure or hematuria. Straight abdominal films (SAF), ultrasound tomography, SAF after colon insufflation and IVU can usually establish the diagnosis. Results of ultrasound imaging of this rare variety of ectopic kidney have apparently not been published. Apart from any complicating factor, the coalescent kidney corresponds to a discoid shaped subumbilical prespinal mass of oblong section. It appears as two highly echogenic central zones encircled by a less dense zone. No separation exists between the right and left portion, and furthermore a kidney cannot be identified in either lumbar fossa. These findings are useful for identification of a retroperitoneal mass, ultrasound imaging being of importance when IVU supplies insufficient data.

[Uretero-uterine fistula: what is the role of ureteroscopy?]. / Fistule urétéro-utérine : quelle place à l'urétéroscopie ?

We present a case of uretero-uterine fistula that occurred following cesarean section complicated by postoperative peritonitis subsequent to failure of the uterine sutures. The distal and the proximal ends of the ureter were successfully explored by ureteroscopy. We discuss the contribution of ureteroscopy in ureter exploration and endoscopic treatment of uretero-uterine communications.

[Laparoscopic spermatic vessel ligation in the treatment of varicocele: report of 129 procedures]. / La ligature sous coelioscopie des vaisseaux spermatiques dans le traitement de la varicocèle: à propos de 129 interventions.

With the improvement of laparoscopic techniques in the hands of urologists, a minimally invasive therapy can be offered to patients. We report retrospectively our experience in the laparoscopic treatment of varicoceles. A total of 93 patients with 129 varicoceles were treated by a laparoscopic approach, the mean age was 29 years (12-47), with 57 left varicoceles and 36 bilateral varicoceles. Indications for treatment were infertility in 51 patients and pain in 42 cases. The mean duration of the operation was 40 min (25-85) for bilateral varicoceles, and 24 min (15-65) for left varicoceles. All our patients were operated the day of their admission and 52 patients left the hospital 8 h after the intervention. We report 2 incidents with conversion to open surgery in one case. The pregnancy rate after surgery in patients with infertility was 21%, the recurrence rate was 4%. Laparoscopic spermatic vein ligation in the treatment of varicocele is a minimally invasive procedure, simple, fast and is not a contraindication for other procedures in case of recurrence.

[Spontaneous perirenal urinoma during nephritic colic]. / Urinome périrénal spontané survenant au cours d'une colique néphrétique.

A case has been reported of the spontaneous rupture of the kidney during an attack of nephritic colic. This rare complication is due to excessive pressure in the renal cavities caused by an obstructive ureteral calculus. Complete resolution of the urinoma was obtained after endoscopic fragmentation of the calculus and double J stenting.

[Emphysematous pyelonephritis: report of 3 cases]. / La pyélonéphrite emphysémateuse: à propos de trois cas.

Emphysematous pyelonephritis is a rare and life-endangering suppurative infection characterized by the production of gas in the renal parenchyma and perirenal space. It affects mainly patients with diabetes mellitus. Authors report three cases of emphysematous pyelonephritis and insist on the role of radiological investigations in diagnosis. Through an exceptional case of emphysematous pyelonephritis revealed by hematemesis, they remind the progression route of infection from retroperitoneal to mediastinal space. Prognosis of emphysematous pyelonephritis depends on the patient's general health status and rapidity of diagnosis and treatment. Percutaneous drainage is an alternative to major surgery and is particularly indicated in cases of single kidney or in an inoperable patient.

[A triple association: renal malacoplakia, bilateral vulvar hypertrophy, upper limb algodystrophy]. / Triple association: malacoplakie rénale, hypertrophie vulvaire bilatérale, algodystrophie des membres supérieurs.

The authors report a case of malakoplakia of the left renal parenchyma, an uncommon site for an inflammatory disease first described in the bladder by Michaelis and Guttmann in 1902 and Von Hansmann in 1903. This case was observed in a 24-year-old girl with no urological history, presenting with bilateral vulval hypertrophy and reflex sympathetic dystrophy of the upper limbs, in whom malakoplakia of the left kidney was discovered incidentally. Intravenous urography showed two large kidneys with a stretched appearance of the renal pelvis. Pathological examination of the partial nephrectomy specimen revealed the diagnosis of malakoplakia, an inflammatory diseases of the renal parenchyma. The pathogenesis has been only partially elucidated, but probably involves a disorder of macrophage function.

[Testicular non-Hodgkin's lymphoma. Report of 2 cases]. / Lymphome malin non Hodgkinien testiculaire. A propos de 2 cas.

We report two cases of non Hodgkin malignant lymphoma of the testis observed in two patients 36 and 32 years old. Diagnosis was made on pathological examination after orchiectomy. One patient had an involvement of the lung and Waldeyer's ring and the other presented cerebral involvement. Despite combination chemotherapy and external beam radiation therapy, the disease progression was rapid and fatal in the first patient (19 months) while the second had multiple cerebral relapses and died by disease progression 21 months after orchiectomy.

[Ambulatory urological surgery]. / La chirurgie urologique ambulatoire.

Ambulatory surgery offers to patients to be treated on an outpatient basis. Strict criterious, social, surgical and medical must be associated to authorize this type of hospitalisation. From January 1998 to December 1999, 1882 patients (46% of our operative activity) were treated on an outpatient basis, to undergo an endoscopic surgery (66%), conventional surgery (20%) or other (14%). 9 patients remain a supplementary night because of post-operative fever in 5 patients and an incomplete recovery in 4 patients. No patient was rehospitalized for complication. In this series, ambulatory surgery has proved its advantages, without loss of patients' security, if selection criterious were respected.

[Management of percutaneous nephrolithotomy complications by shock wave lithotripsy. A report of 82 consecutive cases]. / Prise en charge des complications de la néphrolithotomie percutanée par lithotritie balistique. A propos d'une série de 82 NLPC consécutives.

In this paper, authors assessed the complication rate of percutaneous nephrolithotomy (PCNL) through a consecutive series of 82 PCNL performed on 80 patients with renal calculi (48 men and 32 women). Patients' mean age was 42 years. Stones were located in the pelvis or lower calyx in 75% of cases with a diameter exceeding 20 mm in 56%. 11 Patients had intraoperative problems: one ureteral false passage, one renal perforation by a ureteral stent, three cases of hemorrhage, three cases of punctate perforations of excretory cavities. In one case, nephrostomy tube fell and could not be replaced. 6 patients had post operative complications: three patients had postoperative fever, one patient developed acute pyelonephritis and two patients had transient urinary leakage after nephrostomy tube removal. After reviewing the literature, authors conclude to the low complication rates of PCNL.

["Aggressive" angiomyxoma of the vagina. A case report and review of the literature]. / Angiomyxome "agressif" du vagin. A propos d'un cas et revue de la littérature.

Aggressive angiomyxomas are rare soft tissue tumours. They are mainly found females. Steeper and Rosai described these tumors for the first time in 1983. The diagnosis and the treatment are difficult. The recurrence is frequent. The authors report a case of aggressive angiomyxoma of the vagina and the pelvis, diagnosed in a 34-old-woman. They discuss clinical symptoms and different signs allowing the diagnosis. Therapeutic management is also discussed.

[Anterior anal sphincter approach in the management of urethral-rectal fistulas: a case report]. / La voie antérieure trans-ano-sphinctérienne dans la prise en charge des fistules uréthro-rectales: à propos d'un cas.

Urethrorectal fistula is a rare disease which is easy to diagnose, but which essentially raises a problem of the choice of the most appropriate surgical technique. A review of the literature on the subject shows that, over the last decade, various teams have developed the anterior and posterior trans-anp-sphincteric approaches. We report a case of an acquired urethrorectal fistula associated with anal incontinence treated via an anterior trans-ano-rectal perineal incision. The exposure provided by this incision facilitates simultaneous cure of the fistula and repair of the anal sphincter.

[Bladder pheochromocytoma]. / Le phéochromocytome vésical.

OBJECTIVE: Report of a new case of a rare bladder tumour: bladder phaeochromocytoma. MATERIAL AND METHODS: A 45-year-old patient presented with paroxysmal symptoms consisting of headaches, palpitations, tinnitus and excessive sweating after each micturition. Complementary investigations: ultrasonography, intravenous urography and magnetic resonance imaging, suggested a circumscribed tumour with a 2 cm long axis in the bladder dome, and the diagnosis of bladder phaeochromocytoma was proposed. Partial cystectomy was performed. RESULTS: The postoperative course was uneventful and the subsequent outcome was favourable with resolution of all symptoms with a follow-up of 28 months. Histological examination of the operative specimen confirmed the diagnosis of bladder phaeochromocytoma. CONCLUSION: Bladder phaeochromocytoma is a rare tumour. Treatment of this lesion requires the same preparation as for any other site of phaeochromocytoma. Partial cystectomy ensures radical and effective treatment. Long-term surveillance is necessary, as recurrences or metastases have been described 20 and 40 years after treatment.

[Repair of urethrocutaneous fistula with double skin flap. Report of 32 cases]. / Réparation des fistules uréthrocutanées par double lambeau cutané. A propos de 32 cas.

OBJECTIVES: Urethro-cutaneous fistula constitutes the main complication of urethroplasty for hypospadias. The frequency of this complication ranges from 12 to 90%. The multiplicity of fistula closure techniques, reflects the difficulty involved in repairing these lesions. The authors evaluated fistula repair by a double pedicle skin flap according to the Wise technique. MATERIAL AND METHODS: 32 patients were treated: 18 had already undergone 34 attempted repairs of urethro-cutaneous fistulas complicating urethroplasties (9 Mathieu, 17 Duplay and 6 Leveuf) for anterior penile (9), middle penile (14) and penoscrotal hypospadias (9). In 14 cases, the Wise technique was the first procedure used to repair the fistula. RESULTS: The authors obtained 29 successes. The 3 failures concerned fistulas after Duplay urethroplasties to correct penoscrotal hypospadias. The overall success rate of this technique in our series (90%) was therefore close to that reported by Wise (5 out of 6 successes), who described this technique in 1977. CONCLUSION: The Wise technique is a good technique for repair of large, recurrent urethro-cutaneous fistulas after several attempts of repair.