[Leiomyosarcoma of the urinary bladder treated using laparoscopic cystectomy and bladder replacement by enterocystoplasty: about a case]. / Léiomyosarcome vésical traité par cystectomie laparoscopique avec entérocystoplastie de remplacement: à propos d'un cas.

Our study aims to report a new case of leiomyosarcoma of the urinary bladder, a rare tumor, and to propose a new therapeutic approach, given the non-consensual nature of its treatment. A 31-year old patient, with no particular previous history, presented with total haematuria with clot formation. The clinical and paraclinical assessment showed a voluminous solid tumor mass occupying the apex of urinary bladder and extending to the right lateral wall, with infiltrating appearance, without lymph node involvement or invasion of local or distal organs. Surgical management was based on total laparoscopic cystectomy and bladder replacement by enterocystoplasty. The postoperative course was uneventful. Radiological examinations at 3, 6, 12 and 24 months showed no recurrence. Thus, adaptive surgery should be proposed on a case-by-case basis, to improve the quality of life of patients suffering from this condition.

Bladder cancer in the second trimester of pregnancy: tough decisions. A case report with review of the literature.

We report a rare case of a patient presenting with a nonmuscle invasive papillomatosis transitional cell carcinoma of the bladder in the second trimester of pregnancy. We describe the management dilemmas encountered and the challenging treatment option selected to optimize outcome for the patient and infant. Close collaboration between urologists, obstetricians and medical colleagues is needed for optimal, safe and effective management of bladder tumours during pregnancy.

An unusual presentation of primary male genital tuberculosis.

Urogenital tuberculosis is a rare disease; however, it is the second most common location for tuberculosis after the lung. Currently, incidence of urogenital tuberculosis is increasing due to factors such as a higher prevalence of immunosuppression (especially that caused by human immunodeficiency virus infection) and drug abuse. Herein a new case of male genital primary tuberculosis is reported presenting as a scrotal tumor; the originality of this observation lies in its unusual pseudotumor form.

Renal cell carcinoma of native kidney in renal transplant recipients.

OBJECTIVE: To evaluate the prevalence, prognosis and possible risk factors of renal cell carcinoma (RCC) of the native kidney in renal transplant recipients. PATIENTS AND METHODS: We retrospectively re-examined the follow-up data of 373 consecutive renal transplant recipients at our institution between August 1993 and September 2004. We collected the data of all de novo RCC of the native kidney in the current analysis. RESULTS: Of the 373 patients examined, 12 tumours of the native kidney were diagnosed in 10 individuals. The mean ages at transplantation and diagnosis were 33 and 45.8 years, respectively. Thirteen malignancies were discovered fortuitously. Among the renal ultrasonograms there were two false-negative results. The mean tumour size was 21 mm. Nephrectomy was performed in all cases. Among the 12 kidney malignancies, there were five conventional RCCs and seven papillary RCCs. Half of all tumours were Furhman Grade 3 lesions, and pT1aN0M0 tumours also accounted for all malignancies in the current cohort. One of the 10 patients died, from progression of metastases 6 years after diagnosis. One patient had a local recurrence 2 years after diagnosis. The other eight patients were alive with no evidence of disease at the time of the current report. No significant relationship was detected between RCC occurrence and clinical patient characteristics. CONCLUSIONS: There appears to be a greater risk of RCC of the native kidney in patients with end-stage renal disease. The present results suggest that an annual examination of the native kidney before and after renal transplantation is essential.

Late metastasis of renal cell carcinoma to the submaxillary gland 10 years after radical nephrectomy.

Renal cell carcinoma metastasis to the submaxillary gland after tumor nephrectomy has not been previously recorded in the literature. Most reported cases have involved the parotid gland. We report in this article the first case of solitary submaxillary gland metastasis from clear cell renal cell carcinoma in an 83-year-old man who presented 10 years after primary treatment. The submaxillary gland was excised with preservation of the facial nerve.

Laparoscopic excision of seminal vesicle cyst revealed by obstruction urinary symptoms.

Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two-thirds are associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis. We report a case of video laparoscopic ablation of seminal vesicle cysts.

The use of isolated sigmoid colon segment for vaginal replacement in young adults.

PURPOSE: Vaginoplasty for congenital atresia, a component of the Mayer-Rokitansky-Kuster syndrome, or for gender confirmation, may be achieved by several techniques. This report focuses on the efficacy of rectosigmoid neocolporrhaphy (RSNC) for primary vaginal replacement. MATERIALS AND METHODS: From 1990 to 2002 we evaluated six patients 16-33 years old (average age 23) who required vaginal replacement. The diagnoses included the Mayer-Rokitansky syndrome in two cases, classic bladder exstrophy in 1 and male pseudohermaphrodites in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients. RESULTS: A minimum of 1 year of followup is available in five of the six patients (mean of 32 month). Patients treated with sigmoid vaginoplasty had functional neovagina. with excellent cosmetic results and without excessive mucous production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In the two patients managed by nonoperative perineal self-dilatation, there was little success noted and the two patients became surgical candidates. CONCLUSIONS: Experience with this group of patients leads us to believe that isolated sigmoid segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.

[Endoscopic realignment for post-traumatic rupture of posterior urethra]. / Le réalignement endoscopique dans la rupture post-traumatique de l'urètre postérieur.

PURPOSE: To analyse the long-term results of treatment of posterior urethral disruptions with endoscopic realignment, and to assess the efficacy, simplicity and benefit of this technique. MATERIAL AND METHODS: Between 1989 and 2001, thirty six patients were treated by endoscopic realignment for traumatic rupture of the posterior urethra. The analysis of the results took in consideration the quality of urinary stream, the continence and the erectile function. RESULTS: With a mean follow-up of thirty four months (12 to 72 months), the 36 patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output. This result was obtained after internal urethrotomy in 13 patients (36.1%), and after transperineal urethroplasty in two patients. Only 7 patients (19.4%) developed an impotence. CONCLUSION: The endoscopic realignment can be considered like initial treatment of all post-traumatic rupture of the posterior urethra. This simple and little aggressive technique doesn't compromise the recourse to another type of ulterior treatment and resulted in negligible morbidity. The secondary urethral strictures are short and accessible to an endoscopic urethrotomy.

[Renal cell carcinoma before the age of 40: prognostic factors]. / Le carcinome à cellules claires du rein avant 40 ans: facteurs pronostiques.

OBJECTIVE: To study the prognostic value of tumour diameter, TNM stage, Führman's nuclear grade and CD44 adhesion molecule expression in renal cell carcinoma (RCC) before the age of 40 years. MATERIAL AND METHODS: Nineteen patients under the age of 40 (12 males and 7 females; mean age 30.8 years), undergoing total nephrectomy for RCC were included in this study. Tumour diameter, TNM 1997 stage, and Führman's nuclear grade were defined for each tumour. Standard CD44 adhesion molecule (CD44H) expression was evaluated semiquantitatively by immunohistochemistry on each tumour. The prognostic value of the various variables was determined by Mann-Whitney and Chi-square tests and survival analysis was performed by the Kaplan-Meier method. RESULTS: Six patients (31.5%) died from their cancer with a mean follow-up of 81.4 months. Mean tumour diameter was 9 +/- 4.5 cm. Tumours were Führman I/II in 4 cases, Führman III/IV in 15 cases, T1/T2 in 14 cases and T3/T4 in 5 cases. CD44H expression was high (> or = 20%) in 9 cases (47.3%). The prognostic factors identified in this study were: tumour stage (p = 0.01), grade (p = 0.04), venous extension (p = 0.001) and CD44H overexpression (p = 0.003). CONCLUSION: Prognostic factors of renal cancer in patients under the age of 40 years do not appear to be different from those of older patients. The prognostic factors identified in this study must be validated by multicentre studies based on larger populations.