How to Manage a Dysfunction of the Efferent Segment in Continent Cutaneous Urinary Diversion (Hydraulic Reservoir)? A Retrospective Study of 10 Cases

"Continent cutaneous reservoirs after cystectomy remain an invaluable treatment option for a well-defined subset of indications. The continence mechanism largely determines the treatment success in terms of patient satisfaction and quality of life. Any dysfunction is considered a failure by both patients and surgeons. A retrospective study was made from 2003 to 2013 (13 years) with the aim to characterize the hydraulic valve dysfunction in patients who underwent a cystectomy with continent urinary pouch. A total of ten patients were included in this study. The main age was 44 years. The indications of cystectomy were pelvic tumors (62%); vesico-vaginal fistulas (20%); bladder extrophy (10%); hypospadias (4%) and complicated uretral strictures (4%). An hydraulic continent valve according the Benchekroun process was made for all our patients. After a median follow-up of 36 months; the main related efferent segment complications were fistulas in the top of the valve or ""pinhole fistula"" in 25% of cases; the externalized prolapse of disinserted valve in 25% of cases; and the progressive desinvagination with urinary incontinence in 50% of cases Continent catheterizable urinary diversion remains a treatment option for a well-defined subset of indications. There is little consensus regarding the different options for the efferent segment; which has the greatest influence on patient satisfaction."

[Vaginoplasty from peritoneal tube of Douglas' poutch for androgen insensitivity syndrome (two case reports)]. / Vaginoplastie utilisant le péritoine du cul-de-sac de Douglas pour le traitement du syndrome d'instabilité aux androgènes (à propos deux observations).

The androgen insensitivity syndrome (AIS) formerly known as testicular feminization is transmitted on a recessive X-linked. Its diagnosis is usually made at puberty if primary amenorrhea is present because the external genitalia are female. We report the case of two sisters aged 30 and 18 years, with testicular feminization syndrome discovered during the exploration of primary amenorrhea. Clinical examination found fairly well developed mammary glands, an hypertrophied clitoris, two formations in the labia majora corresponding to the testicles and agenesia of vagina. The uterus has not been seen on pelvic ultrasound and computed tomography scan of the pelvis. Cytogenetic analysis has objectified the chromosomal formula: 46 XY. We performed a vaginoplasty using peritoneum from the pouch of Douglas, a clitoroplasty and bilateral orchiectomy. The result was excellent. A neovagina with a depth of 6 cm was created. After 6 months of follow-up, the two sisters keep beautiful vaginal cavities with regular digital dilation. Peritoneum vaginoplasty is a simple and easy method for creating a neovagina with minimal complications. Its anatomical and functional results are satisfactory.

Seminome spermatocytaire: a propos d'un cas et revue de la litterature spermatocytic seminom

Le seminome spermatocytaire est une tumeur rare; representant moins de 2des cancers du testicule; survenant essentiellement chez le sujet age. Nous rapportons une nouvelle observation d'un patient age de 48 ans. La tumeur se presentait comme une proliferation de cellules en nappes compactes; avec 3 types cellulaires; des cellules de petite taille; des cellules intermediaires et des grandes cellules. Il n'a ete retrouve ni contingent sarcomateux; ni seminome classique. L'analyse en immun histochimie n'a retrouve aucune expression des cellules tumorales pour les anticorps classiques testes; notamment l'Ac anti PLAP et les marqueurs lymphoides. Le seminome spermatocytaire doit etre reconnu; car son evolution est tres favorable et ne necessite qu'une simple orchidectomie; en l'absence d'un exceptionnel contingent sarcomateux ou de metastase ou une chimiotherapie s'impose

[Encrusted cystitis due to Corynebacterium urealyticum]. / Cystite incrustante àCorynebacterium urealyticum.

We reported the case of a 61 year-old man who presented an encrusted cystitis by Corynebacterium urealyticum associated with bilateral hydronephrosis four months after adenomectomy complicated by vesicocutaneous fistula. Medical treatment by quinolones and oral acidification of the urine allowed regression of the encrusted calcifications and resolution of the hydronephrosis.

[Bladder infiltrating tumor: retrospective study of 225 cases]. / Tumeurs infiltrantes de vessie: étude rétrospective à propos de 225 cas.

The authors report a retrospective serial of 225 patients presenting an infiltrating bladder tumor. The infiltrating tumors represent 29.2% of bladder tumors. The middle age of our patients is 59 years with a sex-ratio of 7.3. In the histology, 80% of the tumors are a cell transitional carcinoma and 65% of the patients are classified stage T3T4. The surgical treatment has could be achieved at 73.3% of the cases and 66.7% of the patients had a radical cystectomy. The urinary diversion was essentially an continent urostomy using Benchekroun's hydraulic valve. At 28 months mean follow-up, a locoregional recurrence has been noted from 18% of the Tur achieved alone and 4% of the radical cystectomy. A metastasis has been noted from 18% of the patients and this in a mean delay of 12 months.

[Neurogenic bladder: report of 73 cases]. / Les vessies neurogènes: à propos de 73 cas.

The authors report their experience of neurogenic bladder about 73 cases during 16 years. The analysis of the data permits to affirm that the neurogenic bladder remained a rare pathology, that their aetiologies is acquired in 87.6% of the cases with a predominance of spinal cord traumatisms, which explains the predominance of the pathology among the young subject of masculine sex (middle age of 32 years, sex-ratio is 2.5). The clinical signs are represented by urinary incontinence that constitutes the main motive of consultation, followed by obstructive signs and frequent miction associated to urge miction. The explorations put in evidence an important rate of complications because of the diagnostic delay. The therapeutic management aims to assure a most complete draining of the bladder to low pressure, to assure the continence or at least to manage the incontinence while assuring the comfort and the patient's autonomy.

[Perinephretic phlegmon: about 36 cases]. / Le phlegmon périnéphrétique: à propos de 36 cas.

The authors report a series of 36 cases of perinephric phlegmon during 15 years. The patients are 27 men and 9 women. Mean age was 37 years (ranging between 25 and 70). The promoting factors of PPN are diabetes (27.8%), and kidney calculi (22.3%). Delay diagnosis is more than 3 weeks in 80% of the patients. The clinical symptomatology was dominated by pain, fever and flank mass. Diagnosis is carried out by ultrasonography in 84% and by CT scan whenever it is done. The common germs are negative Gram bacilli and staphylococcus. The treatment consists in antibiotherapy associated to a percutaneous drainage of the collection in 6 patients (16.7%) and a surgical drainage in 30 patients (83.7%). The follow-up are favorable in all cases.

[Vesico-vaginal fistula: report of 1050 cases]. / Les fistules vésico-vaginales: à propos de 1050 cas.

The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.

[Superficial pT1G3 bladder tumor: 24 case reports]. / Les tumeurs superficielles de vessie pT1G3: à propos de 24 cas.

The authors report 24 patients presenting a transitional tumor of bladder pT1G3 collected between January 1996 and December 2000. They represent 19% of the superficial tumors of bladder. Two patients had of straightaway a cystectomy after resection for an unverifiable tumor by endoscopy and another after a second resection discovering a real pT2. Only 5 patients received a BCG therapy is 24% of the cases. A recurrence without progression has been noted in 38% of the cases and a progression in 19% of the patients. These last patients had a cystectomy and with a follow-up to 28 months, no recurrence has been noted.

[Inflammatory pseudotumor of the bladder: a new case report]. / Pseudotumeur inflammatoire de la vessie: à propos d'une nouvelle observation.

Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. Inflammatory pseudotumour (IPT) of the urinary bladder is a benign proliferate lesion which can simulate clinically and histologically a sarcoma. A case of an inflammatory pseudotumor of the urinary bladder in a 18-years-old man is presented. This patient presented with sudden onset of gross painless hematurial related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as rhabdomyosarcoma but subsequent reviews were consistent with a benign process resembling nodular fasciitis. This rare, benign and presumed non-neoplastic, reactive lesion must be differentiated from sarcomas of the urinary bladder. Immunohistochemistry seems to be the method of election in differentiating inflammatory pseudo-tumor from other spindle cell proliferations of the bladder. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.

[Prostatic tuberculosis. Two case reports]. / La tuberculose prostatique. A propos de 2 cas.

The authors report 2 cases of prostatic tuberculosis. The patients are 59 and 62-years-old respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and PSA were abnormals. The prostatic biopsy was negative. The diagnosis of prostatic tuberculosis was made by histologic analysis after transuretral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis.

[Urethral diverticulum in men following ureteroplasty: four case reports]. / Diverticules de l'urètre chez l'homme après urétroplastie: à propos de 4 cas.

The author reports a serie of 4 cases of male urethral diverticulum. All cases were acquired origin. They are complication of urethroplasty. Diagnosis is clinical, based on the development of a perineal mass or phlegmon. This diagnosis is confirmed by cystourethrography. Treatment is by open surgery and consists on diverticulectomy and repair urethra in one stage. Two steps are necessary as the reported cases, where they are urethral stenosis or a inflammatory involvement of the peridiverticulum tissues. This treatment achieves good results.

[Giant hydronephrosis: two case reports]. / Hydronéphrose géante: à propos de deux cas.

Giant hydronephrosis is uncommon. Ureteropelvic obstruction represent the more frequent cause. In 1939, Stirling defined it as the presence of more than 1000 ml of fluid in the collecting system. The Authors report two cases with ureteropelvic obstruction causing giant hydronephrosis. The treatment includes pyeloplasty in the first case and nephrectomy in the second case.

[Macronodular adrenal hyperplasia: a case report]. / L'hyperplasie macronodulaire des surrénales: à propos d'un cas.

This case report describes a 53-year old man with Cushing's syndrome due to Adrenocorticotropic Hormone (ACTH) independent bilateral adrenocortical macronodular hyperplasia (AIMAH). His plasma cortisol showed no diurnal rhythm and was unsuppressable by high-dose dexamethasone. Plasma ACTH was undetectable and did not respond to corticotrophin-releasing hormone. The aetiology of this rare disease remains uncertain. The treatment is based on bilateral adrenalectomy.

[Pathological pelvic kidney. Apropos of 11 cases]. / Le rein pelvien pathologique. A propos de 11 cas.

The diseases ectopic kidney is a rare malformation. It can be associated with other urological or nonurological malformation. We report 11 cases observed between 1980 and 1998. They were five females and six males with a mean age of 28 years. The clinical symptomatology was dominated by pain and urinary symptoms. Diagnosis was based on the IVP data and ultrasonography. Renal stone and hynronephrosis were each associated in five cases and one patient had renal stone associated with hydronephrosis. The treatment consisted on a iliopelvic approach and extraction of the stone and or pyeloplasty. In three cases a nephrectomy was realised for muet kidney or pyonephrosis. The outcome was good in ten cases and one patient had a pyelo-ureteral secondary stenosis managed by endoscopy.

[Anterior urethral injury. Report of 23 cases]. / Traumatismes de l'urètre antérieur. A propos de 23 cas.

UNLABELLED: We reviewed our experience in managing anterior urethral traumatic rupture. PATIENTS AND METHODS: Between January 1986 and December 1998 a total of 23 consecutive male patients with anterior urethral trauma were studied prospectively, including a clinical and radiographic of the pelvis examination, excretory urography and retrograde urethrography. The average patient age was 29 years (range 19 and 65 years). The mechanism of injury was represented by the blunt perineal trauma in 17 cases and the cavernous body rupture in six cases. Clinical manifestations are dominated by the urethrorragia (19 cases), urinary retention (16 cases), perineal hematoma (14 cases). Radiological imaging have shown a pelvic fracture (six cases), urethral rupture (17 cases) and bladder rupture (three cases). Therapeutic procedure realized in emergency in six patients having a cavernous body lesion and delayed repair in 17 other patients. RESULT: The outcame was favorable in 12 patients and recurrence stenosis has occurred in 11 patients who are corrected by optical urethrotomy (four cases), end-to-end anastomosis (two cases), B. Johanson urethroplasty (three cases) urethroplasty by penile skin (one case), dilations (one case). CONCLUSION: Suprapubic cystostomy with healing control of the partial ruptures, delayed end-to-end anastomosis for total ruptures and immediate reparation of the urethral rupture when associated with a penile fracture are even the best warrant of a correct functional recovery.

[Adrenal gland ganglioneuroma]. / Ganglioneurome surrénalien.

The authors report a case of adrenal ganglioneuroma in a 25 year old woman. This rare and benign tumor is localized in the adrenal gland in 20% of cases. Considerations on diagnosis, pathogenesis and management are discussed.

[Malignant adrenal cortical neoplasms. Report of 22 cases]. / Cortico-surrénalomes malins. A propos de 22 cas.

OBJECTIVES: Analysis of the treatment of a series of patients with adrenal cortical carcinoma. MATERIAL AND METHODS: This series consists of 22 patients (15 women and 7 men) with a mean age of 35 years (range: 23 to 58 years). 55% of patients had a non-secreting tumour; 45% of tumours were associated with excessive hormonal secretion. The tumour was located on the right side in 12 cases and on the left side in 11 cases (the tumour was bilateral in 1 case). Ultrasound and CT were sufficient for localization of the tumour. The patients were classified as stage I: 3 cases, stage II: 2 cases, stage III.: 8 cases, stage IV: 9 cases, according to MacFarlane's classification. RESULTS: Adrenalectomy was performed in 18 patients. Two patients died during the operation and another 8 died within the first four years. Eight patients are currently alive, including 7 with no signs of recurrence; one patient presented a large local recurrence 39 months after adrenalectomy. CONCLUSION: Surgery remains the only effective treatment at the present time. The diagnosis of adrenal cortical carcinoma must be made as early as possible.

[Perineal lipoma and accessory scrotum]. / Lipome périnéal et scrotum surnuméraire.

An accessory scrotum associated with perineal lipoma is extremely rare. We report a case of a median lipoma of the perineum in an accessory scrotum. The literature is reviewed.