Simultaneous testicle and epididymis vasculitis revealing granulomatosis with polyangiitis.

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatous vasculitis, which predominantly affects small-sized blood vessels. We aimed to report a case of GPA involving testicles and epididymis taken for malignancy. A 75-year-old patient was admitted for a painful left testicular mass. There was no extra urogenital manifestations on examination and the workup was unremarkable. Histological findings after orchidectomy revealed granulomatous inflammation of the testis and epididymis with fibrinoid necrosis and necrotic vasculitis consisting with the diagnosis of GPA. Further investigations regarding ear, nose, throat, pulmonary, and renal involvement were negative. Proteinase 3 antineutrophil cytoplasmic antibodies (PR3-ANCA) test was negative. Furthermore, infectious diseases especially tuberculosis were ruled out. Based on histopathological findings, limited GPA was diagnosed. The patient was treated with methotrexate and prednisone with good outcome. There was no relapse after 1 year of follow-up. Isolated urogenital involvement may occur at the onset of GPA and can be taken for malignancy. Histopathological findings are the gold standard for the diagnosis. Treatment is based on steroids and immunosuppressive drugs.

Changes in urinary stone composition in the Tunisian population: a retrospective study of 1,301 cases.

BACKGROUND: Studies that evaluate the effect of age on stone composition are scarce. The aim of this study was to highlight the changes in epidemiological characteristics (stone composition and location) of urolithiasis according to patients' age. METHODS: We studied 1,301 urolithiasis patients with age ranging from 6 months to 92 yr (781 males and 520 females). Stone analysis was performed using a stereomicroscope and infrared spectroscopy to determine the morphological type and molecular composition of each stone. RESULTS: The annual average incidence of new stone formation was 31.7 per 100,000 persons. In 71.8% of cases, calculi were located in the upper urinary tract. Compared to other age groups, children and old men were more affected by bladder stones. Calcium oxalate monohydrate was the most frequent stone component, even though its frequency decreased with age (59.5% in young adults and 43.7% in the elderly, P<0.05) in favor of an increase in uric acid stones (11.5% in young adults and 36.4% in the elderly, P<0.05). Struvite stones were rare (3.8%) and more frequent in children than in adults. CONCLUSIONS: The analysis of these data showed that urinary stones in Tunisian patients are tending to evolve in the same direction as the stones in patients from industrialized countries.

[Uroflowmetry in children: Prospective study of normal parameters]. / Débitmétrie de l'enfant: étude prospective des paramètres normaux.

INTRODUCTION: Uroflowmetry is the simplest urodynamic test to study the lower urinary tract. Uroflowmetry parameters, especially maximum flow rate, are important, but are difficult to interpret due to the lack of normal uroflowmetry data in children. OBJECTIVE: The objective of this prospective clinical study was to evaluate normal uroflowmetry parameters in a prospective series of 202 children between the ages of 5 and 15 years. MATERIALS AND METHODS: We prospectively studied uroflowmetry in a series of 202 children between the ages of 5 and 15 years. Children with voiding disorders, or a psychiatric or neurological illness were excluded. The following variables were determined: age, body surface area (BSA (m2)), maximum flow rate (Qmax (ml/s)), voided volume (V (ml)) and maximum flow time (TQmax (s)). RESULTS: Qmax increased with age, V and BSA in both sexes and was greater in girls. In girls between the ages of 5 and 6 years, mean Qmax was 15.8 for a mean V of 173 and BSA less than 1.06 and, in girls between the ages of 13 and 15 years, mean Qmax was 26.2 for a mean V of 327 and BSA greater than 1.06. TQmax also increased with age, V and BSA and was greater in boys. In boys between the ages of 5 and 6 years, mean TQmax was 6.5 for a mean V of 174 and BSA less than 1.6 and, in boys between the ages of 13 and 15 years, mean TQmax was 7.4 for a mean V of 332 and BSA greater than 1.6. A positive correlation was demonstrated between age and uroflowmetry parameters and the most significant correlation was observed between age and Qmax in both sexes. CONCLUSION: This study on normal uroflowmetry parameters in children not presenting any voiding disorders demonstrated a significant difference, in both sexes, between Qmax and TQmax in relation to age, V and BSA. Uroflowmetry could therefore be useful in the diagnosis of infravesical obstruction.

[Adrenal myelolipoma]. / Le myélolipome surrénalien.

Adrenal myelolipoma is a benign, non-secreting tumour, which can be complicated by pain or retroperitoneal haemorrhage. The diagnosis is based on CT or preferably MRI. Surgery may be necessary in the case of complications. The contribution of interventional radiology has not been reported in the literature and selective embolization has also not been previously reported.