Emphysematous pyelitis: epidemiological, therapeutic and evolutive features.

AIM: Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. METHODS: The data of six patients managed for emphysematous pyelitis were collected and analyzed. RESULTS: The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dedifferentiated -- renal parenchyma. Outcome was good. CONCLUSION: Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy.

[Collecting duct carcinoma associated with renal stones]. / Le carcinome des tubes collecteurs de Bellini associé a des calculs rénaux.

Collecting duct carcinoma is an extremely rare disease, representing less than 1% of all renal tumours. The authors report the case of a 72-year-old patient presenting with right low back pain associated with episodes of total macroscopic haematuria. Imaging showed a heterogeneous mass in the upper pole of the right kidney associated with pyelocaliceal stones. Multiple secondary lesions were observed in the liver. Macroscopically, the mid-renal tumour was 7.5 cm in diameter surrounding the stone-containing pyelocaliceal cavities. This tumour had spread to the cortex and invaded the perirenal fat. Histologically, the tumour was composed of ducts lined by cells with a hobnail appearance in an abundant desmoplastic and neutrophil-rich inflammatory stroma. Immunohistochemistry showed very intense labelling of tumour cells with cytokeratins: KL1, 7, 19, and 34_E12 and slightly less intense labelling with UER, Vimentin, EMA, and BNH9, while cytokeratin 20 was negative. The diagnosis of Fuhrman grade 3 collecting duct carcinoma associated with renal stones and liver metastases was adopted. The patient died postoperatively. The main differential diagnosis was urothelial carcinoma with a glandular component. In the present case, the diagnosis was made more difficult by the concomitant presence of renal stones. The diagnosis was established by histology and immunohistochemistry.

[Inverted papilloma of the bladder: diagnosis and course]. / Le papillome inversé de la vessie: diagnostic et evolution.

OBJECTIVE: To analyse the diagnosis, treatment and clinical course of inverted papilloma of the bladder MATERIALS AND METHODS: Between January 1980 and January 2004, 12 patients with an inverted papilloma of the bladder were included, representing 0.36% of all bladder tumours treated over the same period. RESULTS: This series consisted of 10 men and 2 women with a mean age of 62 years (range: 42-83 years). The most frequent presenting complaint was macroscopic haematuria (10/12 cases), associated with signs of bladder irritation in 8 cases. This lesion was solitary and frequently located in the trigone (7/12 cases). An associated transitional cell carcinoma was diagnosed in 5 cases. CONCLUSION: Inverted papillomas of the bladder are rare, benign tumours that can be associated with urothelial carcinoma, requiring rigorous surveillance.