Relevant genetic polymorphisms and kidney expression of Toll-like receptor (TLR)-5 and TLR-9 in lupus nephritis.

Toll-like receptor (TLR) genetic polymorphisms may modify their expression causing inflammatory disorders and influencing both susceptibility and severity of lupus erythematosus. We aim to determine whether TLR-5 and TLR-9 gene polymorphisms are implicated in the susceptibility to systemic lupus erythematosus (SLE) and lupus nephritis (LN) and to evaluate their expressions and distributions in renal LN patients' biopsies. The frequencies of two SNP in the TLR-9 gene and one in the TLR-5 gene was examined in 106 SLE patients (among them 37 LN patients) and in 200 matched controls by polymerase chain reaction-restriction fragment-length polymorphisms (PCR-RFLP) analysis. TLR-9 and TLR-5 expressions were assessed by reverse transcription (RT)-PCR and immunohistochemistry carried on LN renal biopsies compared to healthy renal tissue. A significant genotypic and allelic association was revealed between TLR-9-rs352140 and both SLE and LN (P < 0·05). The TLR-9 transcript level was significantly higher in LN biopsies compared to control (P < 0·05). This increase was observed histochemically in the tubulointerstitial compartment. TLR-9 was detectable in LN glomeruli patients but not in normal control glomeruli. No allelic nor genotype association was found with TLR-5-rs5744168 in SLE. but the T allele and the TT genotype were raised significantly in the LN group (P < 0·05). A significant increase in TLR-5 gene expression in LN biopsies, which contrasted with normal kidneys (P < 0·05), was confirmed by an intense and diffuse staining for TLR-5 only in LN tubules (P < 0·05). Our data show that TLR-5 and TLR-9 are susceptible genes to LN and that their expression is dysregulated in LN patients' kidneys, supporting a role of these mediators in the pathogenesis of LN.

[Male sexuality after external continent urinary diversion type Mitrofanoff]. / Étude de la sexualité masculine après dérivation urinaire externe continente de type Mitrofanoff.

OBJECTIVE: To evaluate the influence of continent external urinary diversion type Mitrofanoff on male sexuality. MATERIAL AND METHODS: Between 1992 and 2011, 140 patients underwent continent urinary diversion type Mitrofanoff at an academic hospital. Among 76 men, 46 were interviewed about their sexuality after this operation. This study was performed using a set of validated questionnaires (IIEF, DAN PSS and Urolife), grouped by the model of the CTMH. Patients were divided according to their marital status: group 1: patients married before surgery (15 cases), group 2: patients married after surgery (7 cases) and group 3: singles (24 cases). RESULTS: In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology. CONCLUSION: To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre- and postoperative evaluation will better clarify the factors affecting sexuality in these patients.

[Continent urinary diversion (Mitrofanoff principle). Physical mechanisms and urodynamic explanation of continence]. / Dérivation urinaire de Mitrofanoff. Mécanismes physiques et explication urodynamique de la continence.

OBJECTIVE: To analyze the urodynamic parameters and the mechanisms of continence of Mitrofanoff urinary diversion. MATERIAL AND METHODS: Urodynamic assessment was performed via the stoma in 11 patients with continent urinary diversion according to the Mitrofanoff principle. The mean age of the patients at the time of the operation was 29 years. The appendix, used as conduit in all cases, was anastomosed to the skin of the right iliac fossa. Ileocystoplasty was performed in 10 patients. The urodynamic assessment was performed after a mean follow-up of seven years (range: five to 12 years). RESULTS: Reservoir pressures after filling did not exceed 20 cm H2O in nine cases. Uninhibited contractions were recorded in two patients with an enlarged bladder with pressures not exceeding 30 cm H2O. Appendix pressures during filling were always higher than bladder pressures. The mean pressure measured at the end of filling was 75 cm H2O (range: 45 to 90 cm H2O). After the Valsalva maneuver, these pressures were between 80 and 150 cm H2O with good transmission. The mean conduit closing pressure was 70 cm H2O (range: 40 to 90 cm H2O). The mean functional length of the conduit was 5 cm (range: 2.6 to 7.2 cm). CONCLUSION: The Mitrofanoff diversion is mainly characterized by the high intraluminal pressure in the continent conduit. A low bladder pressure is essential to maintain a perfectly continent diversion.

[Surgical treatment of varicocele improves fertility and facilitates medically assisted procreation]. / Le traitement chirurgical de la varicocèle améliore la fertilité et aide à la procréation médicalement assistée.

PURPOSE: To assess the effect of varicocelectomy in sperm quality and natural pregnancy and to determine if it can change couple candidacy for assisted reproductive technology (ART) procedures. MATERIALS AND METHODS: We performed a retrospective study about 164 infertile men with varicocele associated to sperm abnormalities. We divided our patients into four groups, according to the total motile sperm count (TMC). Group 1 includes 21 azoospermic men, group 2 includes 62 patients who had a TMC strictly less than 1.5x10(6), group 3 includes 22 patients who had a TMC between 1.5 and 5x10(6) and group 4 includes 59 patients who had a TMC strictly greater than 5x10(6). All patients underwent surgical or percutaneous embolisation to repair varicocele. RESULTS: After treatment, the mean spermatozoid concentration and motility were significantly increased, respectively from 24.8 to 29.2x10(6)spermatozoids per millilitre and 14.4 to 23.2%. Spontaneous pregnancy was observed in 59 couples (35.9%). Concerning the couples who had no pregnancies (105), 51 (48.5%) showed increase of the TMC, which allowed them to change the foreseen preoperative ART by an other one more simple. CONCLUSION: Varicocelectomy has a significant potential not only to improve sperm quality and natural pregnancy, but also to downstage the level of ART needed to male infertility management.

[Traumatic unilateral renal artery thrombosis and protein C deficiency. A case report]. / Thrombose post-traumatique de l'artère rénale et déficit en protéine C. A propos d'un cas.

Post traumatic renal artery thrombosis is rarely described in the literature. This pathology can result from stretch injury to inelastic intima of the renal artery, or by the direct flow to the abdomen causing compression injury to the renal artery against the vertebral column. However, the association of this pathology with hematologic diseases (in particular protein C deficit) was never described. We report an observation of a 28-year-old man with an uneventful history who was admitted to the intensive care unit for traumatic head injury associated with post traumatic renal artery thrombosis requiring nephrectomy. The etiologic investigation of this thrombo-embolic complication reveals a protein C deficit. Our patient was improved under treatment. This original observation confirms that post traumatic renal artery thrombosis can be associated with hematologic diseases (in particular protein C deficit).

[Urogenital lesions and fistulas. What's going on in Tunisia?]. / Plaies et fistules uro-génitales. Qu'en advient-il en Tunisie?

The authors report a series of 22 cases of post-obstetrical genito-urinary lesions. In addition, they analyse the cases of 12 patients suffering of vesico-vaginal fistulae (9) or uretero-vaginal fistulae (3). They point out evident regression of these fistulae in this country which become of simple type and also emphasize on preventive measures which should be taken to reduce even more its frequency.

[Bladder calculi in women. 10 cases]. / Le calcul vésical chez la femme. A propos de 10 cas.

The authors report a series of 10 cases of a stone in the bladder in women and describe the main characteristics of this condition. They point out that infection in particular plays a role not only in the causation of these stones but also in the development and complications. They emphasize that early treatment of the stone is important and that the urine should be sterilised as this will reduce the risk of morbidity especially in pregnant women.

[Primary paratesticular malignant tumors: report of 6 cases]. / Les tumeurs malignes primitives paratesticulaires: à propos de six cas.

The authors have made a study of 6 cases of malignant primary paratesticular tumor, and have also included a review of the literature on this topic. They emphasize the importance of the effect of histopathological type of tumor on disease outcome. There is an improved survival potential in cases where the tumors are differentiated, and discovered at an early date.

[Pseudotumoral lipomatosis of the renal sinus]. / La lipomatose pseudo-tumorale du sinus rénal.

Two cases of pseudotumoral lipomatosis in the renal sinus and responsible for clinical symptoms and radiological renal alterations are reported. Emphasis is put on the misleading features of this disease which may suggest a malignancy. Outcome is consistently favorable. Computed tomography ensures the preoperative diagnosis, avoiding an unnecessary nephrectomy.

[Calculous anuria. Apropos of 63 cases]. / L'anurie calculeuse. A propos de soixante-trois cas.

Sixty-three cases of anuria secondary to renal stones were treated in the Sfax urology department between 1982 and 1990. The presenting symptoms are frequently polymorphic and non-specific. The prognosis of these patients largely depends on the infectious complications associated with anuria, the delay in management and, most importantly, the course of preexisting renal failure. Fifteen deaths (24%) were observed in this series, despite emergency urinary diversion and appropriate treatment to eliminate the obstruction.

[Encrusted pyelo-ureteritis]. / La pyélo-urétérite incrustée.

The authors report a case of right encrusted pyelo-ureteritis with no other sites, either in the bladder or on the other side. They discuss possible theories of pathogenesis of the encrusted plaques, and question how far corynebacterium, group D2, could be concerned in the genesis of such lesions.

[Perinephric phlegmon. Current aspects of diagnosis and treatment. Apropos of 20 cases]. / Le phlegmon péri-néphrétique. Aspects actuels du diagnostic et du traitement. A propos de vingt cas.

The authors report a series of twenty patients presenting with perinephric abscess. Percutaneous management was performed in 4 cases. Considering the benefit of the modern imaging techniques, the authors discuss the current diagnostic, therapeutic and prognostic modalities of this disease.

[Primary malignant paratesticular tumors: report of six cases]. / Les tumeurs malignes primitives paratesticulaires: à propos de six cas.

The authors report six cases of primary malignant paratesticular tumors. They reexamine the literature and emphasize the influence of the histopathological type of these tumors on the prognosis. Survival of the patients is better when tumors are differentiated and detected early.

[Nephrectomy in children. Apropos of 55 cases]. / Les néphrectomies chez l'enfant. A propos de cinquante-cinq cas.

Based on a series of 55 children undergoing nephrectomy, the authors describe the clinical, laboratory, radiological, therapeutic and prognostic features for each aetiology. They define the criteria for resection of the affected kidney.

[Bladder tumors in patients under 40 years of age]. / Tumeur vésicale chez les sujets d'âge inférieur à 40 ans.

A total of 13 patients under the age of 40 years were treated for bladder carcinoma. One child had a bladder sarcoma. 8 patients had a superficial transitional cell carcinoma with no evidence of recurrence after endoscopic resection. Four patients had invasive bladder carcinoma. Superficial bladder carcinoma would appear to have a good prognosis in patients under 40 years of age.

[Staghorn calculi in children. 32 cases]. / La lithiase coralliforme de l'enfant. A propos de trente-deux cas.

The authors report thirty-two cases of children with staghorn calculi treated in the department of urology H. Bourguiba, Hospital of Sfax. Such calculi are frequently seen in young boys over the age of 6 years. Urinary tract infection by Proteus is the main etiologic factor of lithogenesis. Surgical treatment, still the most advocated, is laborious; it must ensure complete stone removal, while protecting renal function.

[Urinary calculi in a geriatric setting]. / Lithiase urinaire en milieu gériatrique.

The authors report a retrospective series of 174 patients with urolithiasis. They were all age between 65 and 88 years. This group represents one tenth of all patients treated for urinary stones in the Urology department of Sfax over the last decade. Neither the clinical symptoms nor radiological findings observed in this group differed from those other patients hospitalized for urolithiasis; on the other hand associated diseases related to aging appear to be well represented which alters the management, prognosis and outcome in this type of patients.

[Carcinosarcoma of the bladder: a case report]. / Carcinosarcome de la vessie: une observation.

Carcinosarcoma of the urinary bladder is a uncommon tumor with characteristic histopathologic and immunohistochemical findings; his histogenesis have still not been clear; the prognosis seems to be improved by radical cystectomy and adjuvants therapies. We report a case of 47 years old women suffering from suprapubic pains, dysuria and hematuria of five months duration and had a 10 cm suprapubic mass that was found on physical examination. Radiographically, the tumor invaded the dome of the urinary bladder and causes bilateral hydronephrosis. Microscopically it was an urinary bladder carcinosarcoma. Our objective is to discuss the histogenesis, the anatomoclinical and prognosis of these rare tumors.

[Traumatic rupture of the anterior urethra. Apropos of 18 cases]. / Les ruptures traumatiques de l'urèthre antérieur. A propos de 18 cas.

The authors report a retrospective series of 18 cases of rupture of the anterior urethra, with a mean age of 25 years (range: 10 to 45 years). The mechanism of the lesion was trauma by falling onto the perineum (12 cases), road accident (4 cases) and sexual intercourse (2 cases). Urine drainage was ensured by suprapubic catheter (15 cases) or urethral catheter (1 case). The two cases of rupture of the urethra associated with lesions of the corpora cavernosa required urgent surgical repair. In the other cases, simple urine drainage was sufficient to treat partial ruptures of the urethra (11 cases) with only one case of urethral structure. However, end-to-end urethrorraphy was performed in the 4 patients with total rupture of the urethra, with early failure in 3 cases, attributed to delayed surgery. Finally, the course of urethral rupture associated with rupture of the corpora, cavernosa was favourable in terms of both micturition and sexual function.

[Male internal pseudohermaphroditism or a man with a uterus]. / Le pseudo-hermaphrodisme mâle interne ou homme à utérus.

Mullerian structures were discovered during cure of bilateral ectopic testes in a 14-year-old boy. The original feature of this case was the presence of both testes on the same side. The Mullerian structures were left in place as they were intimately adherent to the vas deferens. This attitude was adopted as no degeneration of these structures has been described and because of the possibility of reproduction of these patients during adulthood.