Ischemia of the Penis and Fingertips Secondary to Calcifying Uremic Arteriolopathy.

Calcifying uremic arteriolopathy (CUA), also called calciphylaxis, refers to the calcification of the walls of the arteries of medium and small caliber, causing ischemic skin lesions. Diagnosis should be made if ischemic lesion develops in a patient with chronic renal failure (CRF), and it is confirmed based on clinical, radiological, and histological criteria. Generalized CUA characterized by ischemia of the penis (IP) along with other localizations of cutaneous ischemia is exceptional, and the morbidity and high mortality rate associated with this entity most often warrant multidisciplinary and conservative management.

[Prevalence and severity of erectile dysfunction in patients with type 2 diabetes in the Department of Urology at the University Hospital Center Hassan II, Fez, Morocco: a cross-sectional study of 96 cases]. / Dysfonction érectile chez les patients diabétiques type 2, prévalence et gravité au Service d´Urologie du Centre Hospitalier Universitaire de Fès, Maroc: à propos de 96 cas (étude transversale).

INTRODUCTION: type 2 diabetes is a very common condition which, in some patients, may cause erectile dysfunction. The purpose of this study is to determine the prevalence and severity of erectile dysfunction in patients with type 2 diabetes attending the Department of Urology. METHODS: we conducted a cross-sectional and descriptive study in the Department of Urology at the University Hospital Center Hassan II in Fez using a self-administered questionnaire encompassing an "International Index of Erectile Function-5" test based on 5 questions with routine blood test results in diabetic patients. RESULTS: a total of 96 anonymous questionnaires were distributed over a 12-month period. The average age of patients was 53.5 years, 35% (n=34) of them were active smokers. Diabetes had progressed for over 10 years in 54% (n=52) of cases. Three patients were treated with diet alone, 32% (n=31) with oral antidiabetic drugs, 31% (n=30) with insulin therapy alone and 31% (n=30) with insulin and oral antidiabetic drugs. Only 11% (n=11) of patients had HbA1c below 7%. Patients reporting erectile dysfunction accounted for 70% (n=67) of surveyed patients. The proportion of patients with erectile dysfunction according to the International Index of erectile function-5 was 88% (n=84). The onset of erectile dysfunction had started more than 3 years earlier in 63% (n=60) of patients. Disorders started progressively in 90% (n=86) of patients. Screening rate was 37.5% (n=36), only 30% (n=29) of patients received phosphodiesterase type 5 inhibitors, then intracavernous injection or both. Forty-two per cent (n=40) of patients had either macro or micro-angiopathic complications. CONCLUSION: erectile dysfunction is a common but little suspected condition in diabetic men. Hence, the importance of systematic screening in any diabetic patient and of adequate treatment for sexual and cardiovascular disorders.

[Multiple stones of the prostatic urethra associated with anejaculation revealing spinal dysraphism such as tethered cord syndrome at the base of the spinal canal in a young man: about an exceptional case]. / Multiples lithiases de l'urètre prostatique associées à une anéjaculation révélant un dysraphisme spinal à type de syndrome de moelle bas attachée chez un jeune homme: à propos d'un cas exceptionnel.

Spinal dysraphism (or spina bifida) is a neurological disorder representing the first cause of congenital urological disability. It has several clinical manifestations, vesicosphincteric and sexual disorders are frequent and rarely isolated, belonging to motor disorders, orthopedic, sensory, digestive or even cognitive impairments. Tethered cord syndrome at the base of the spinal canal is a complication of spinal dysraphism. This disorder is often detected in children, may be asymptomatic and found in adults. Bladder sphincter disorders are the main cause of morbi-mortality due to uronephrologic complications with a significant alteration in quality of life. This justifies specific management and multidisciplinary and strict monitoring. We here report an exceptional case of spinal dysraphism such as tethered cord syndrome at the base of the spinal canal found incidentally in an adult patient during an etiological assessment of lithiasis of the prostatic urethra associated with anejaculation .

[Tuberculous vesicovaginal fistula complicated by bladder stones: about an exceptional case]. / Calculs vésicaux multiples compliquant une fistule vésico-vaginale d'origine tuberculeuse: à propos d'un cas exceptionnel.

Vesicovaginal fistula (VVF) continues to be a major public health problem in developing countries. Given the particular association of VVF with stones, the question that arises is whether the fistula is primary or secondary to bladder stone and then whether to use single-stage or two-stage treatment. But what is special about this study is that these rare clinical features are due to tuberculosis. We here report the case of a 62-year old female patient with a history of treated tuberculous spondylodiscitis. The patient had been declared cured 4 years before. For the previous 2 years she had been suffering from continuous urinary incontinence. Clinical examination showed almost complete vaginal synechia. Complementary scannography and cystography showed the presence of 3 stones on the way to the VVF. The largest stone measured 6cm along its longer axis with passage of contrast material into the uterovaginal cavity through the fistula. The patient was admitted to the operating room where she underwent cystolithotomy with ablation of the stones that were on the way to the fistula, biopsy of the fistulous tract and single-stage closure of the VVF in two layers without interposition of the autologous tissue. Anatomopathological results confirmed the presence of active tuberculosis on the way to the fistula, requiring resumption of antibacillary treatment for 9 months. During the follow-up visit at 3, 6 and 9 months the patient showed good clinical status with absence of urinary incontinence. VVF secondary to tuberculosis associated with urinary stones appears very little in literature. Our case demonstrates the feasibility of antibacillar medical treatment associated with single-stage surgical treatment with very satisfactory results despite the history of our patient and the duration of his disease.

[Metastatic bladder metachrone to a kaposi sarcoma cancer at a therapeutic impasse: about a case]. / Impasse thérapeutique pour une tumeur de la vessie métastatique métachrone à un sarcome de kaposi: à propos d'un cas rare.

Chemotherapy is the treatment of choice for a metastatic urothelial bladder cancer. We here report a rare case of metastatic bladder cancer associated with Kaposi sarcoma posing a serious risk of aggravation of the new neoplasia. It was necessary to entrust the patient to his family.

A rare pure embryonal rhabdomyosarcoma of the urinary bladder in an adult successfully managed with neoadjuvant chemotherapy and surgery: a case report.

BACKGROUND: Rhabdomyosarcoma of the urinary bladder in adults is an extremely rare malignant neoplasm that develops from the bladder wall. CASE PRESENTATION: We report our experience of a rare case of rhabdomyosarcoma of the bladder in a 45-year-old Moroccan man who was successfully managed with neoadjuvant chemotherapy and surgical excision of the mass; he was disease free at 24-month follow up. CONCLUSIONS: To the best of our knowledge, this is the first reported case of a rare embryonal rhabdomyosarcoma of the bladder that was managed with neoadjuvant chemotherapy and surgery. This is why further studies using a large number of patients with a greater longitudinal follow up will be required.

[Neglected scrotal trauma revealing embryonic paratesticular rhabdomyosarcoma: about a case]. / Un traumatisme scrotal négligé révélant un rhabdomyosarcome embryonnaire para-testiculaire: à propos d'un cas.

Embryonic paratesticular rhabdomyosarcoma is a rare mesenchymal tumor constituting a diagnostic and therapeutic emergency. Localized forms have a favorable prognosis. Multimodal treatment is the gold standard and it is based on surgery, multidrug chemotherapy and radiotherapy, with excellent overall survival rate. We here report the case of a 17-year old patient treated in our Department for embryonic fusiform cell paratesticular rhabdomyosarcoma causing clinical confusion. This study aims to highlight the specific features of this disease.

[Giant hydronephrosis associated with ureterocele complicated by ureteral lithiasis]. / Hydronéphrose géante sur urétérocèle compliquée de lithiase urétérale.

Giant hydronephrosis is defined as an extensive dilation of the pyelocaliceal cavities occupying a large part of the abdominal cavity or as a dilation filled up with more than a liter of urine overflowing the median line. This is due, more often, to pyelo-ureteral junction syndrome. Obstruction due to ureterocele complicated by lithiasis is a very rare cause of giant hydronephrosis. We here report the case of a 45-year old patient with a history of right lumbar pain which hadn't been investigated, presenting with abdominal mass evolving over the last few years associated with intermittent constipation. Clinical examination showed asymmetrical abdominal distension with dullness above the median line. Ultrasound showed multi-compartmentalized fluid-filled mass occupying all the right abdominopelvic region and pressing the digestive structures. Uroscanner showed right giant ureteropyelocaliceal dilation (pyelon measuring 15.2cm) completely eroding the renal parenchyma with absence of contrast agent excretion, upstream of ureterocele complicated by a stone measuring 2cm. Laparoscopic nephroureterectomy was performed. Post-operative suites were simple.

[Unusual intraurethral foreign body in a schizophrenic adolescent: about a case]. / Corps étranger intra urétral inhabituel chez un adolescent schizophrène: à propos d'un cas.

Self- insertion of foreign body is a common practice for self-injure or erotic purpose in patients with chronic psychosis. The diagnosis is sometimes difficult if it is reported late or if the patient does not cooperate; hence the interest of complementary imaging assessment. Treatment was based on two steps: the extraction of the foreign body by endoscopy or open surgery and psychiatric treatment of the mental illness. We report the uncommon case of a 16-year old schizophrenic adolescent who had introduced a needle into the urethra 2 years before. Diagnosis was based on retrograde and mictional uretrocystography. The needle was removed with endoscopy as well as with technical artifices, without using open surgery despite the length of time the incident had occurred. The patient underwent complementary psychiatric treatment.

Urolithiasis secondary to primary obstructive megaureter in an adult: a case report.

BACKGROUND: Primary obstructive megaureter is relatively uncommon in adults. This condition usually regresses spontaneously or is treated during infancy. It can remain asymptomatic for decades until adulthood when symptoms may manifest in the event of complications or during a routine radiologic imaging. Primary obstructive megaureter has been reported to favor stone formation in the upper urinary tract. CASE PRESENTATION: We present the case of a 35-year-old Moroccan man who had a 10-year history of intermittent left flank pain and hematuria. A computed tomography urogram revealed a left megaureter with giant ureteral and renal calculi. CONCLUSIONS: Primary obstructive megaureter should be a differential diagnosis in an adult with hydroureteronephrosis associated with urolithiasis especially when there is kidney impairment. Through this case report we will discuss the diagnosis and management of primary obstructive megaureter associated with urolithiasis in adults.

Myxoma of the kidney - an unusual benign renal tumor: a case report.

BACKGROUND: Myxomas are rare benign soft tissue tumors. The kidney is an unusual location for this tumor. For this reason, less than 15 cases of renal myxoma have been reported in the English literature. There are no specific clinical and radiological features reported for this tumor that allow a preoperative diagnosis enabling a conservative treatment. CASE PRESENTATION: We report another case of renal myxoma found in a 50-year-old Moroccan woman who presented with a right dull flank pain. An abdominal computed tomography scan objectified a suspected malignant renal mass. Thus, radical nephrectomy was performed. Histopathology of the specimen revealed the typical appearance of a myxoma. CONCLUSIONS: The objective of this report is to add another case report of this rare benign renal tumor to the literature. This benign tumor with excellent prognosis has no specific preoperative features that could justify a conservative management; a radical approach remains the therapeutic option for now.

[Aggressive renal angiomyolipoma extending to the renal vein: about a case and literature review]. / Angiomyolipome rénal agressif avec extension à la veine rénale: à propos d'un cas et une revue de la littérature.

Renal angiomyolipoma is a benign tumor. It is characterized of three different components: muscular, vascular and greasy. Their distribution is variable. Diagnosis is based on the identification of the intratumoral greasy component on CT scan and MRI. In exceptional circumstances, this tumor may be aggressive with locoregional and venous extension (renal vein and inferior vena cava). We here report the case of a 37-year old patient with voluminous renal angiomyolipoma extending to the renal vein.

[Retroperitoneal fibrosis: about 12 cases]. / La fibrose rétropéritonéale: à propos de 12 cas.

Retroperitoneal fibrosis (RPF) is rare. It is characterized by the gradual transformation of retroperitoneal adipose tissue into a fibrous mass surrounding the aorta, the inferior vena cava and the urinary tract responsible for progressive alteration in the renal function. It usually manifests as lumbar pain associated with renal failure and biologic inflammatory syndrome. We report 12 cases of retroperitoneal fibrosis in order to determine its clinical, radiological and therapeutic features. We conducted a retrospective study of 12 patients with retroperitoneal fibrosis whose medical data were collected in the Departement of Urology at the University Hospital Hassan II, Fes over a period of 9 years (2005-2013). The study involved ten men and two women. Clinical symptomatology was very variable, dominated by lumbar pain in all patients and hydrocele in 1 patient. Laboratory tests showed renal failure in all patients and inflammatory syndrome in 10 patients. The diagnosis of retroperitoneal fibrosis was suspected in all patients on ultrasound showing obstruction of the upper urinary tract without visible obstacle. The diagnosis was confirmed by abdominal CT scan without contrast that objectified a retroperitoneal tissue lesion enveloping the vessels and the urinary tract. Nine patients had idiopathic retroperitoneal fibrosis. Two patients had perianeurysmal fibrosis and one patient had post-radiation fibrosis. All patients underwent urinary drainage by double J. ureteral catheter. Seven patients underwent corticosteroid therapy. Six patients had an improvement of clinical and laboratory test outcome with disappearance of pain and improvement of the general condition. This study confirms the rarity of retroperitoneal fibrosis, the difficulty of diagnosis, pain associated with inflammatory syndrome and renal failure as common manifestations. Abdominal CT scan without contrast is the gold standard for definitive diagnosis. Urinary drainage is essential in most cases as well as regular monitoring of patients.

Isolated localization of Rosai Dorfman disease as renal mass: a case report and review of literature.

We report a rare case of an elderly woman presented with right renal mass with invasion of renal vein and several small lymphadenopathy in the hilar area. The diagnosis of kidney cancer is suspected and the patient underwent open radical nephrectomy, surrenalectomy and lymphadenectomy dissection. The pathologic examinations find a rosai dorfman disease. This unusual benign entity is uncommon in the kidney, but in medical imaging, it may simulate an infiltrative renal neoplasm, especially a lymphoma or leukemia or even renal cell carcinoma. A comprehensive literature review was undertaken to summarize the clinical and pathologic features of this disorder.

[Conservative treatment in diabetic patients with emphysematous pyelonephritis: about five cases]. / Le traitement conservateur de la pyélonéphrite emphysémateuse chez les patients diabétiques: à propos de cinq observations.

Acute emphysematous pyelonephritis (EPN) is a severe kidney infection. Early and effective treatment is essential to reduce high mortality rates due to this disease. Our study aims to highlight the clinical and paraclinical features as well as the peculiarities of therapeutic management of this disease and focus on the possibility of conservative treatment in diabetic patients. We analyzed the medical records of patients with EPN treated in the Department of Urology at the Hassan II University Hospital, Fez between January 2004 and January 2010. For each medical record we described clinical, paraclinical and therapeutic features as well as patient's evolution after treatment. We here report the case of 5 female patients whose average age was 45,6 years. All patients were diabetic. Lithiasic obstruction of the upper urinary tract was found in 3 patients (60%). The diagnosis was made by means of abdominal CT scan. All patients underwent resuscitation measures including antibiotic and insulin therapy. Conservative surgical procedure was performed in all cases. Indeed, surgical drainage of perirenal collections was performed in two cases, percutaneous renal drainage in one case and drainage using double-J ureteral catheter in 2 cases. Clinical and radiological evolution was excellent with renal preservation in all patients Emphysematous pyelonephritis is a rare and serious complication, especially in diabetic patients. Diagnosis is based on CT scan. Surgical treatment should be conservative in most cases, apart from severe forms, especially in diabetic patients who have potential risk of chronic renal failure.

[Diagnostic criteria and management options for renal angiomyolipoma: about 8 cases]. / Les critères diagnostiques et les particularités de prise en charge de l'angiomyolipome rénal: à propos de 8 cas.

Renal angiomyolipoma is a benign renal tumor with a fatty component. We here report a series of 8 cases in order to describe diagnostic criteria and management options for renal angiomyolipoma. We studied 8 cases of renal angiomyolipomas over a 4-year period. All patients underwent ultrasound and abdominal CT scan. The diagnosis was confirmed on the basis of imaging data in all the cases. Two patients had been treated for Bourneville's tuberous sclerosis since childhood. The average age was 42 years. Ultrasound showed a hypoechoic heterogeneous aspect in all the cases. CT scan allowed the detection of the fatty component. Radiological diagnosis of renal angiomyolipoma is mainly based on the detection of the fatty component. Its association with Bourneville's tuberous sclerosis is an additional diagnostic argument.

Suicide attempt by self-stabbing of the bladder: a case report.

INTRODUCTION: The presence of foreign bodies in the bladder often falls within questionable practices in psychiatric settings or in iatrogenic instances such as during endoscopy or migration of foreign bodies around the bladder remaining after surgery on organs close to the bladder. Psychiatric disorders have been reported in patients admitted for self-introduction of foreign bodies in the bladder during an act of sexual satisfaction. However, to the best of our knowledge, no similar case in the context of suicide has been reported in the English-language literature. CASE PRESENTATION: A 56-year-old Moroccan man known to have untreated paranoid schizophrenia and a history of several previous suicide attempts was presented to the emergency unit of our hospital after self-stabbing with a 15 cm sewing needle. His stab wound was located at the hypogastric region of the abdomen, with full penetration of the needle into the abdomen. A computed tomographic scan showed a breach on the dome of the bladder responsible for extravasation of the contrast dye, which revealed a peritoneal cavity effusion of average abundance and a suspected lesion of the left pelvic ureter. An exploratory laparotomy was performed. Approximately 1000 mL of widely dispersed fluid was observed in the abdominal cavity. During exploration of the bladder, two centimetric intrabladder breaches were found, one of which was a breach of the left pelvic ureter without other associated lesions. The breaches were sutured, and a ureteral catheter was mounted. The patient's post-operative follow-up was unremarkable. CONCLUSIONS: The wide variety of ways that foreign bodies are introduced into the lower urinary tract pose diagnostic and therapeutic difficulties for the urologist. Management of these patients is facilitated by the use of endoscopy.