[Pyelo-ureteral junction syndrome in horse-shoe kidney. Report of 13 cases]. / Syndrome de jonction pyélo-urétérale sur rein en fer-à-cheval. A propos de 13 cas.

The pelviureteral junction upon a horse shoe kidney remains a frequent congenital malformation. The authors report 13 cases collected during a period of 16 years and treated surgically. The review of literature permits to discuss the different therapeutic means.

[Granulomatous prostatitis (report of 6 cases)]. / Prostatite granulomateuse (à propos de 6 cas).

A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.

Revisiting the enzymes stored in the laticifers of Carica papaya in the context of their possible participation in the plant defence mechanism.

In the tropical species Carica papaya, the articulated and anastomosing laticifers form a dense network of vessels displayed in all aerial parts of the plant. Damaging the papaya tree inevitably severs its laticifers, eliciting an abrupt release of latex. Besides the well-known cysteine proteinases, papain, chymopapain, caricain and glycyl endopeptidase, papaya latex is also a rich source of other enzymes. Together, these enzymes could provide an important contribution to plant defence mechanisms by sanitising and sealing the wounded areas on the tree.

[Acute renal insufficiency due to hydronephrosis]. / Insuffisance rénale aiguë par hydronéphrose.

Acute renal failure due to hydronephrosis is a rare pathology. It can occur unilaterally, or as a pyelo-ureteral junction (PUJ) bilateral syndrome. In the present study, two cases have been reported. The diagnosis was based on ultrasonographic findings which showed hydronephrosis, and on descending pyelo-ureterography (DPU), which demonstrated an absence of opacification. Infection was present in one case. Preliminary treatment consisted of percutaneous nephrostomy, followed by surgical pyelo-ureteral resection and Anderson-Hynes pyeloplasty which gave good results (95% success rate), and which enabled a satisfactory recovery of renal function to be obtained.

[A new case of pseudotumoral renal tuberculosis]. / Un nouveau cas de tuberculose rénale à forme pseudotumorale.

The incidence of urogenital tuberculosis is still frequent and constitutes a current public health problem in Morocco, a country in which tuberculosis is endemic. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon, and in this study this disease has been described in a young patient. The radiological findings suggested the possibility of this lesion being renal cancer. The preliminary diagnosis was corrected and a definitive diagnosis of pseudotumor was made following pathological examination of the surgically-removed kidney.

[Surgical treatment of traumatic ruptures of the posterior urethra]. / Le traitement chirurgical des ruptures traumatiques de l'urèthre postérieur.

OBJECTIVES: To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra. MATERIAL AND METHOD: 35 patients with a mean age of 25 years (range: 7 to 79 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pelvis. When rupture of the posterior urethra was diagnosed, the subsequent management depended on the patient's general condition and associated lesions. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. This approach was applied in 16 patients (Group I). The other 19 patients (Group II) were only operated at the sixth month, after stabilization of all traumatic lesions. RESULTS: Results were assessed in terms of the quality of the urinary stream, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continence was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexual impotence was observed in 18.7% (Group I) versus 5.3% (Group II). CONCLUSION: Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sexual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, treated endoscopically, but with a lower incidence of sexual impotence.

[Perineal recurrence of resected penile cancer. A case report]. / Récidive périnéale d'un cancer de la verge opéré. A propos d'un cas.

The authors report an unusual case of perineal recurrence of squamous carcinoma of the penis in a 50-year-old, white man, circumcised during infancy and operated 5 years previously for stage T3N0M0 squamous carcinoma of the penis by total amputation of the penis. Clinical examination revealed a very large, infected perineal tumour associated with bilateral inguinal lymphadenopathy. This stage T4N2M0 tumour was treated palliatively by cystostomy, emasculation with perineal tumour reduction and antibiotics. The patient became afebrile and the infection resolved and was referred to the radiotherapy department for further treatment.

[Traumatic rupture of the corpus cavernosum]. / La rupture traumatique du corps caverneux.

Traumatic rupture of the corpus cavernosum is relatively frequent in the authors' experience. Based on the study of a series of 80 cases and a review of the literature, the authors analyse the diagnostic and therapeutic aspects and outcome of this disease. The patients in this series had a mean age of 30 years. Meticulous and intimate clinical interview demonstrated that the commonest mechanism is forced manipulation of the erect penis (68%). Clinical examination localized the site of the fracture (proximal: 57%, distal 43%). The fracture was unilateral (78 cases), rarely bilateral (2 cases) and associated with complete rupture of the urethra (1 case). Treatment was surgical in 79 patients. A distal semicircumferential incision was used in the case of bilateral rupture, distal rupture and associated urethral lesion (34 cases). A favourable course was observed in 86% of cases. However, 9 postoperative complications (12.5%) were observed (6 cases of fibrous plaques, 3 cases of chordee of the penis), due either to the extent of the haematoma or to the delay in treatment. Traumatic rupture of the corpus cavernosum is a disease of young adults, which requires early surgical treatment with an approach adapted to the type of lesions.

[Treatment of cystoceles with urinary stress incontinence]. / Traitement des cystocèles avec incontinence urinaire d'effort.

Thirteen women were operated for cystocele associated with urinary stress incontinence. Cystoceles were grade I in 6 cases, grade II in 6 cases and grade III in 1 case. Five patients underwent retropubic colposuspension according to Burch (3 cases) and M.M.K. (2 cases). Eight patients were treated by RAZ's technique associated with anterior colporaphy in order to reduce the cystocele. In this latter group, only one recurrence was observed and was treated by repeat colporaphy with good results. Colposuspension associated with anterior colporaphy is a reliable method for the treatment of cystocele with urinary stress incontinence, associated with low morbidity and short hospitalization. Its results are probably comparable to those of retropubic colposuspension, at least for a 6 months follow-up.

[Tumors of the bladder in women. Epidemiologic and therapeutic aspects. Apropos of 40 cases]. / Tumeurs de vessie chez la femme. Aspects épidémiologiques et thérapeutiques. A propos de 48 cas.

Bladder tumours in women. Epidemiological aspects and treatments, based on a series of 48 cases. Bladder tumours are more frequent in men than in women, in whom they present certain epidemiological, clinical and therapeutic characteristics. The authors report a retrospective study of 48 cases of bladder tumour in women, observed in the urology department over a 20-year period. These tumours represented 4.2% of all bladder tumours. The patients had a mean age of 59 years (range: 29 to 77). Only one patient was a smoker (2%). Haematuria was present in 93% of cases, and signs of bladder irritation were present in 60% of cases. All tumours were transitional cell carcinomas. The tumour was classified as stage 0 in 10 cases (20.9%), stage A in 15 patients (31.2%), stage B in 22 patients (45.8%) and stage C in 1 case (2.1%); no patients (0%) were classified as stage D. Our therapeutic protocol was established as a function of the stage of tumour invasion. For example, superficial tumours were treated conservatively by transurethral resection, either alone or combined with intravesical instillation. Radical surgery was performed whenever possible for invasive tumours. External urinary diversion was performed in 11 cases, ureterosigmoidostomy in 3 cases and enterocystoplasty in 5 cases. The clinical course of the 15 superficial tumours was marked by recurrence in 5 cases, while that of the 23 invasive tumours was marked by local recurrence (3 cases), renal failure (1 case) and 3 deaths.

[Retroperitoneal ganglioneuroma. Apropos of a case]. / Le ganglioneurome rétropéritonéal. A propos d'un cas.

Ganglioneuroma is a rare tumour in adults. We report the case of a 26-year-old woman admitted in our department with right renal colic. Ultrasonography and computed tomography showed a heterogeneous retroperitoneal mass measuring 8 x 7 cm in diameter and displacing the ureteropelvic junction and right kidney anteriorly and laterally. The preoperative diagnosis was retroperitoneal tumour. Surgical exploration revealed a totally resectable retroperitoneal tumour with a histological diagnosis of ganglioneuroma.

[Appendiceal mucocele disclosed by a psoas tumor. Apropos of a case]. / Mucocèle appendiculaire révélé par une tumeur de psoas. A propos d'un cas.

Mucocele of the appendix is a rare lesion. Rupture of appendicular mucocele into the psoas is uncommon. We report a case of a 77-year-old man, with psoas tumor on abdominopelvic ultrasonography and computed tomography. The preoperative diagnosis was type III hydatid cyst of the psoas, psoas tumor or retroperitoneal mass. Surgical exploration revealed an appendicular mucocele ruptured into the psoas. Appendicectomy was performed with an uneventful postoperative course after 3 years. The authors discuss the diagnostic and therapeutic problems raised by this rare lesion.

[Primary urothelial carcinoma of the urethra. Apropos of a case]. / Carcinome urothélial primitif de l'urètre. A propos d'un cas.

We report an unusual case of primary transitional cell carcinoma in the bulbar urethra. The patient was a 52-year-old man with a history of sexually transmitted disease. The clinical presentation was bladder retention with urethral bleeding. Radiological examination and cystoscopy showed a bulbar urethral tumor. The pathological diagnosis was Grade III transitional cell carcinoma with invasion of the corpus spongiosum (T2). Partial resection of the urethra was performed and the patient has been without evidence of disease for two years.

[Bladder tumors in young patients]. / Les tumeurs de vessie chez le sujet jeune.

Bladder tumours classically affect the elderly, but can also occur in young adults. The authors studied the prognosis of these tumours in patients under the age of 40. In their experience, these tumours represent 3.27% of all bladder tumours. 26 patients with a mean age of 34 years (20-40 years), 8 under the age of 30, were studied. There was a marked male predominance (23 males, 3 females). The tumour was a transitional cell carcinoma in 25 cases and a squamous cell carcinoma in 1 case. It was superficial in 11 cases and invasive in 15 cases. Transurethral resection and cystectomy were performed in 9 cases of superficial tumours and 11 cases of invasive tumours, respectively. In the group of superficial tumours, a favourable course was observed in 7 cases, with 3 cases of recurrence and 1 case of progression. In the group of invasive tumours, a favourable course was observed in 6 cases, recurrence was observed in 2 cases and 5 patients died. Superficial tumours therefore have a better prognosis in subjects under the age of 30. Invasive tumours are more frequent and often advanced, suggesting a marked potential for progression. Their prognosis depends on tumour stage, and is not correlated with age.

[Cystitis cystica glandularis. A study of 2 cases]. / Les cystites glandulo-kystiques. Etude de deux observations.

The authors report two cases of cystitis glandularis revealed by hematuria and urinary retention. Cystitis glandularis is a rare disease, caused by metaplasia of the vesical submucosa, probably related to a chronic irritative factor. In its minor form, it has the same clinical features as simple cystitis, but its major pseudoneoplastic form may be mistaken for bladder tumor. The diagnosis is essentially histological. Treatment is usually medical, based on eradication of the irritative factors. Surgery is performed in the case of complications of this disease. The clinical course is unclear, requiring long-term surveillance.

[Bilateral testicular metastasis of cancer of the prostate]. / Métastases testiculaires bilatérales du cancer de la prostate.

Testicular metastasis of prostate cancer rarely occurs. Bilateral localization is exceptional. We report a new case of prostate adenocarcinoma with bilateral testicular metastasis. The diagnosis was made on clinical and ultrasonic arguments, and confirmed on the pathological specimen. Treatment consisted in a bilateral orchidectomy, associated with nonsteroid androgens.

[Cystic cancer of the kidney]. / Le cancer kystique du rein.

Cystic renal cancer is uncommon and raises real preoperative diagnostic problems, requiring the use of medical imaging, and sometimes even surgery. The authors report 3 cases of cystic renal cancer in 2 men and 1 woman, aged 87, 67 and 20 years, respectively. Three patients presented with the urological triad (haematuria, pain and lumbar mass). Ultrasonography suggested the diagnosis of cystic cancer in all 3 cases. Computed tomography was performed in 2 patients and more precisely confirmed the ultrasound findings. Selective arteriography, performed in one patient, confirmed the hypothesis of malignancy. Surgical exploration resulted in radical total nephrectomy. Histology confirmed the diagnosis of adenocarcinoma. The course was favourable in 2 cases after a follow-up of 4 years. One patient presented a local recurrence with pulmonary metastases 6 months after the operation. A review of the literature illustrates the diagnostic difficulties of this form of renal cancer.

[Hydatid cyst of the psoas muscle. Apropos of a case]. / Kyste hydatique du psoas. A propos d'un cas.

The authors report a rare case of hydatid cyst of the psoas muscle in a 28-year-old woman, operated for vertebrospinal hydatid cyst. The patient presented with a left iliac fossa mass. Ultrasonography and computed tomography contributed to the preoperative diagnosis, despite negative hydatid serology. A retroperitoneal approach by left lumbotomy with partial pericystectomy was performed. In the light of this case, the authors discuss the diagnostic and therapeutic problems raised by hydatid cyst of the psoas muscle.

[Primary pyogenic abscess of the psoas muscle. Apropos of 5 cases]. / Les abcès primitifs à pyogène du psoas. A propos de 5 cas.

The authors discuss the diagnostic and therapeutic aspects of primary pyogenic abscess of the psoas muscle based on a series of 5 cases. Five patients between the ages of 15 and 64 years (mean: 38.2 years) were admitted to the urology department between January 1994 and December 1996 with fever, abdominal pain and low back pain, and psoitis in 1 case. The mean delay to consultation was 42 days. Clinical examination revealed a painful mass in the lumbar region and flank in 5 cases. Leukocytosis was detected in 5 patients. Radiological examination demonstrated loss of the lateral border of the psoas in 4 cases. Ultrasonography showed an enlarged psoas muscle in every case with a hypoechoic mass in 2 cases and a heterogeneous mass in the other 3 cases. Computed tomography, performed in 2 patients, confirmed the ultrasound findings in 1 case and excluded the diagnosis of type IV hydatid cyst of the psoas muscle in the other patient. The abscess was evacuated by percutaneous drain in 1 patient requiring a second percutaneous drainage for reconstitution of the abscess. Surgical drainage was performed immediately in 3 patients and after failure of antibiotic treatment in 1 patient. The hospital stay did not exceed 7 days after surgical drainage, but was 25 days after the first percutaneous drainage and 20 days after the second percutaneous drainage. The authors emphasize the multiple advantages and efficacy of surgical drainage of psoas abscess.

[Continent urinary diversion in neurogenic bladders]. / Dérivation vésicale continente dans les vessies neurologiques.

Many patients with urinary incontinence due to neurogenic sphincter insufficiency are treated by intermittent catheterization combined with drug therapy. A few refractory cases require surgical treatment. The authors report 5 cases of neurogenic bladder in 3 men and 2 women with a mean age of 20 years. The neurological lesion was secondary to spina bifida (2 cases), spinal cord trauma (2 cases) and leprosy (1 case). All patients complained of urinary incontinence due to sphincter atonia, with normal bladder compliance. We opted for continent cystostomy using the Benchekroun hydraulic valve. One death occurred during the postoperative period as a result of an anaesthetic accident. Reopening of the bladder neck occurred in 3 patients and required revision and one patient developed bladder stones 6 years after the operation. The functional results were considered to be excellent. Continent cystostomy using Benchekroun!! technique appears to be a reliable method in the treatment of urinary incontinence due to sphincter incompetence in selected patients.