Hydatid cyst of the kidney: diagnosis and treatment.

Renal echinococcosis is relatively uncommon compared to liver and lung localizations. Kidney involvement represents 4% of confirmed cases of hydatid disease. We reviewed the clinical findings of a personal series of renal hydatidosis with emphasis on diagnostic and therapeutic issues. A total of 178 renal cysts were collected over a period of 33 years from 1963 to 1996. Clinical, radiologic and laboratory data are analyzed. Radiologic exploration has had an interesting evolution, with the appearance of ultrasonography and computed tomography. Diagnostic accuracy has been greater since the availability of ultrasonography and immunologic studies. Their contribution to the diagnosis of renal hydatid disease is important. We try, with our experience of ultrasonography in the matter of renal hydatid cysts, to underline the role of this exploration. The treatment of hydatid cyst of the kidney is surgical. Renal-sparing surgery, cystectomy plus pericystectomy, is possible in most cases (75%). Nephrectomy (25% of cases) must be reserved for destroyed kidneys resulting from aged cysts opening into the excretory cavities and complicated by renal infection. Whether conservative or radical, the first surgery performed is cystectomy, with germinate membrane removal after controlled evacuation and opening of the cyst, making the subsequent steps of surgery easier.

[Vascular complications of kidney transplantation]. / Complications vasculaires de la transplantation rénale.

We report a retrospective analysis of 100 renal transplantations, mainly from related living donors. The rate of vascular complications was 9%: one arterial hemorrhage due to partial suture failure; one lymphocele; two arterial thrombi, one in the inferior artery leading to fistulization by ureteral necrosis and death following septic rupture of the artery, and one in the renal artery requiring graft removal; and five arterial stenoses, one which regressed spontaneously, one treated by endoluminal angioplasy, one treated surgically, one controlled by medical treatment and one which could not be treated due to secondary hemodialysis after graft rejection. In this series of 100 transplantations, vascular complications were the cause of 16.5% of deaths and 12.5% of post-graft hemodialysis.

[Ureteral stenoses and fistulas after kidney transplantation]. / Sténoses et fistules urétérales après transplantation rénale.

We report a retrospective study of 100 renal transplants, the majority using kidneys from related live donors. We saw 6 ureteric stenoses and four fistulas. Three relatively small stenoses and two limited fistulas were treated percutaneously, all of them successfully. The transplant had to be removed in two patients with a ureteric fistula. Four stenoses and one fistula were treated successfully by open surgery. Actuarial survival of grafts with a urological complication was significantly shorter than that of transplants free of such lesions.

[Renal transplantation from related live donors. Results and survival]. / Transplantation rénale à partir de donneurs vivants apparentés. Résultats et survie.

We report a retrospective study of 91 renal transplants from related live donors carried out at the Charles Nicolle Hospital, Tunis, between 1986 and 1993. There were 27 HLA-identical and 64 semi-identical. Classical immunosuppression based upon corticosteroids and azathioprine was used in the majority of cases. Surgical complications occurred in 15.4% of cases. 56% of patients had at least one acute rejection attack. There were 4 deaths, 3 related to infection and one to septic arterial rupture. Return to hemodialysis was related to chronic rejection in 5 cases and to recurrence of the initial nephropathy in one case. 5-year actuarial survival was 94% for recipients and 81% for grafts. In this series, acute rejection had no negative influence on graft survival and the difference between graft survival between HLA-identical and semi-identical patients was not statistically significant.

[The 1st 100 kidney transplants performed in Tunisia and their surgical complications]. / Les 100 premières greffes rénales réalisées en Tunisie et leurs complications chirurgicales.

The authors report their experience of renal transplantation based on the first 100 transplantations performed in Tunisia. The absence of legislation concerning organ harvesting from brain dead subjects has favoured renal transplantation from living donors. 20 surgical complications are reported and analysed.

[T1 bladder tumors. Can they be considered superficial?]. / Tumeurs de vessie T1. Peut-on les considérer comme des tumeurs superficielles?

The authors report about a series of 60 cases of superficial (Ta and T1) bladder tumors and study their evolution towards infiltration according to the grade, size and number. 16% of the T1 tumors evolved towards infiltration and/or metastatic spread after a period of 42 months. In our opinion, T1 tumors can be regarded as superficial tumors. However, our therapeutic attitude is cautious because of pejorative factors of prognosis: high grade, multiple foci, and size exceeding 5 cm.

[Urinary tuberculosis and bladder tumors. A case report]. / Tuberculose urinaire et tumeurs de vessie. A propos d'un cas.

The authors report the case of a patient presenting with both a bladder tumor and urinary tract tuberculosis. The bladder tumor was treated by transurethral resection and instillation of mitomycin C. The author describes this case and discusses this unusual association.

[Fistulas and ureteral strictures after kidney transplantation. Diagnosis and treatment]. / Fistules et sténoses urétérales après transplantation rénale. Diagnostic et traitement.

We report our experience of 4 urine fistulas and 4 ureteral strictures after renal transplantation. Percutaneous nephrostomy was performed on all patients. The diagnosis was established by antegrade pyelography. Nephrectomy was performed on 2 patients because of failure of drainage and formation of an infected urine collection due to an extended ureteral necrosis. Abstention was elected in one case as renal function did not improve due to associated chronic rejection. In 5 cases, renal function quickly improved with drainage: 2 were operated on immediately, and one after failure of endo-urological treatment of a urine fistula. Antegrade dilatation has been used successfully in one stenosis. In the last case, a double pigtail stent allowed a urine fistula to close. Percutaneous nephrostomy seems to be best method of drainage when ureteral obstruction or fistula is suspected in renal transplant patients, and permits diagnosis by antegrade pyelography. Percutaneous management may be a satisfactory way of treatment for limited stenosis or fistulas.

[Results of detubulate enterocystoplasty. Apropos of 17 cases]. / Résultats des entérocystoplasties détubulées. A propos de 17 cas.

From January 1988 to October 1989, 17 patients underwent radical cystectomy for bladder cancer. They had a bladder replacement by Hautmann pouch. Good results were obtained after a period of observation of 6 to 24 months. Two patients died. Hyperchloremic acidosis was observed in 20% cases. The urinary continence was achieved in 13 patients who were willing to wake up twice every night. One patient preferred the collecting device. Our study showed that the Hautmann pouch is a particular low pressure reservoir with a capacity of 200 ml to 800 ml, and assessed the mechanism of loss of urine at night in one case. The urinary continence was achieved after a good training period and depended on patient's cooperation. This technique permitted to obtain a very satisfactory diurnal and nocturnal continence in our patients, however a longer follow up is mandatory to confirm the efficiency of this method on long term basis.

[The first thirty months of kidney transplantation in Tunisia]. / Les trente premiers mois de transplantation rénale en Tunisie.

Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period.

[Value of a scrotal myocutaneous flap in the repair of penile and urethral skin loss]. / Intérêt du lambeau myocutané scrotal dans les réparations de perte de substance cutanée pénienne et urétrale.

The authors report a case of a large penile skin and urethral defect repair using a scrotal myocutaneous flap. The modalities, advantages and defects of the method were detailed. This technique permitted to obtain a very satisfactory result. Then we extended it to the failures of the hypospadias and epispadias reconstruction.

[Comparative study of tubulate enterocystoplasty and low pressure bladder. Apropos of 20 cases]. / Etude comparative des entérocystoplasties tubulées et des vessies à basse pression. A propos de 20 cas.

The goal of this presentation is to report the results on morbidity and continence of 20 consecutive patients who, from January 1985 to December 1988, underwent bladder reconstruction after cystectomy for bladder cancer. In ten cases the neo-bladder was a classic ileocystoplasty and in the ten others it was a "low pressure neo-bladder". We compared the two groups although they were not randomized. There was no stadification difference in tumors nor in clinical status. The clinical results were described. There have been four temporary urinary fistulas in the group of low pressure bladder (LPB), and four in the group of classic ileocystoplasty (CI). In the group of LPB, 7 from 8 patients were completely dry day and night and voided every two for three hours while among the 9 patients with CI, 4 were continent day and night.

[Signet ring cell carcinoma of the bladder. Apropos of a case]. / Carcinome à cellules isolées en bague à châton de la vessie. A propos d'un cas.

Signet ring cell adenocarcinoma of the bladder is a very rare tumor. It presents similar to the linitis plastica type of gastric adenocarcinoma. The authors report a new case and analyze the medical literature in order to specify the diagnostic problems and the histogenesis of this tumor.

[Renal ectopic pheochromocytoma. A case report]. / Phéochromocytome ectopique rénal. A propos d'une observation.

The authors report the case of an ectopic pheochromocytoma without any clinical symptoms or laboratory signs which simulated a renal tumor during clinical and complementary investigations. The diagnosis was established by histology. The ectopic pheochromocytoma and the diagnostic problems of silent tumors are discussed.

[Reparation of sequelae of penile-scrotal and perineal gangrene. Apropos of 4 cases]. / Réparation des séquelles des gangrènes péno-scrotales et périnéales. A propos de 4 cas.

The authors report different techniques for surgical reconstruction of the sequelae of penile, scrotal and perineal gangrene. The repair of skin defects and the reconstruction of the scrotum requested several interventions. Where the scrotal skin loss was limited to a 1/2 of scrotum, the testis could be covered by mobilising the surrounding rim. When the disease was confined to the penis or inguinal region, skin cover has been provided by free grafts. More elaborate techniques of skin cover were necessary when the disease was extended to the whole scrotum: a fasciocutaneous flap from the thigh was used for reconstruction of the scrotum. The scrotal myocutaneous flap was used to cover skin and anterior urethral loss of tissue.