Cystadenome papillaire de l'epididyme: un nouveau cas

Le cystadenome papillaire de l'epididyme est une tumeur paratesticulaire benigne rare. Se presentant comme une masse epididymaire uni ou bilaterale. Son association avec le syndrome de Von Hippel-Lindau est frequente; en particulier dans les lesions bilaterales. Nous rapportons l'observation d'un patient age de 36 ans; qui presentait depuis un an des douleurs scrotales gauches; une grosse bourse chronique; sans fievre ni signes fonctionnels urinaires. L'examen avait mis en evidence une masse testiculaire dure; irreguliere et indolore sans adenopathies inguinales ni masse abdominale. L'echographie scrotale avait montre une masse testiculaire gauche solide hypoechogene bien limitee de 3 x 2;5 x 2;2 cm. Les marqueurs tumoraux etaient normaux (BetaHCG : 2 UI/j; AlphaFoetoProteine : 2;94 UI/l). La masse testiculaire a ete exploree a travers une incision inguinale gauche. A la palpation; c'etait une tumeur testiculaire dure. Une orchidectomie gauche a ete realisee. L'examen anatomopathologique de la piece d'exerese avait conclu a un aspect morphologique et immunohistochimique d'un cystadenome papillaire sereux borderline paratesticulaire sans signe d'invasion. A travers notre observation et les donnees de la litterature; nous proposons de mieux definir le diagnostic clinique et anatomopathologique ainsi que le traitement de ces tumeurs testiculaires rares

[Hydatic kidney cyst: 90 case reports]. / Kyste hydatique du rein: à propos de 90 cas.

The hydatid cyst of kidney is rare, it ranks third among all visceral localisations. The authors report a series of 90 cases renal hydatid cyst from 1972 to 2000. The middle age is 36 years with female predominance. Renal hydatid cyst often has a suggestive clinical presentation; flank mass in 84%, pain in 74% and sometimes a specific presentation hydaturia in 29%. The hydatid serology is positive in 55% and preferring ultrasonography and computed tomography in diagnosis of renal hydatid cyst. Surgical treatment is now well defined. Conservative treatment occupes a predominant place 84% and resection of the proeminent dome is usually efficient. Total nephrectomy should only be considered in the case of a completely destroyed kidney (16%) of cases. Post-operative course is generally uneventful and reexpansion of renal parenchyma is observed in 93% indicating the benign nature of this disease.

[Renoduodenal fistula. A case report]. / Fistule rénoduodénale. A propos d'un cas.

The fistula between kidney and duodenum is rare. It occurs mostly in case of pyonephrotic kidney. The authors report one case of renoduodenal fistula, discovered peroperatively in 41 years old man who underwent a subcapsular nephrectomy for right pyonephrosis upon pelvic lithiasis. Through a review of literature, the authors discuss diagnostic aspects of this complication.

[Symptomatic bladder calculi: diagnostic and therapeutic aspects]. / Hydrocalice symptomatique: aspect diagnostique et thérapeutique.

The authors report the case of a 50 years old woman who consulted with bilateral lumbar pain and urinary infections. Intravenous Urography (IVU) showed bilateral renal and bladder stones. Treatment was by upper polary nephrectomy in the left kidney. Removing all urinary and bladder stone. We then the removed surgically renal stones in the right kidney. Using this case as an we discuss the diagnosis and therapeutic aspects of the hydrocalyx.

[Emphysematous pyelonephritis: a case report]. / La pyélonéphrite emphysémateuse: à propos d'un cas guéri.

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.

[A rare cause of urinary obstruction: urogenital tuberculosis]. / Cause rare d'anuries obstructives: la tuberculose urogénitale.

The authors reported a rare cause of urogenital tuberculosis complicated by an obstructive acute renal failure in 44 years old man with solitary anatomic kidney. The authors insisted of using the upper urinary tract opacification by percutaneous nephrostomy for diagnosis, the urogenital tuberculosis with this exploration, we can suspected the tuberculosis by abnormalities of the radiologic imagine, and confirmed the koch bacilli urinary into urinary tract. The upper chance of positives of finding koch bacilli in higher than urinary bladder.

[Bladder stone surrounding a foreign body: a case report]. / Lithiase vésicale englobant un corps étranger: à propos d'un cas.

The bladder can be the site of various foreign bodies. We report one case of bladder stone including a foreign body in a 24 years old man with a psychomotor deficiency who was admitted for pyuria, block miction and bladder symptoms. The pelvic X-Ray film showed a bladder stone including a sewing needle. We analysed the diagnosis, aspect and therapeutic management of this case.

[Local recurrence of paratesticular rhabdomyosarcoma]. / Récidive locale d'un rhabdomyosarcome paratesticulaire.

We report an uncommon case of scrotal recurrence of embryonal paratesticular rhabdomyosarcoma in 19 year old man after 3 years later. The diagnosis was suspected clinically and confirmed by histopathology study after resection of the scrotal tumor. About this case, the authors discuss the diagnosis and the management of this tumor.

[Renal angiomyolipoma complicated by retroperitoneal hematoma]. / Angiolipome rénal compliqué d'un hématome rétropéritonéal.

Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

[Pheochromocytoma and von Recklinghausen's disease]. / Phéochromocytome et maladie de von Recklinghausen.

The association between von Recklinghausen's disease and pheochromocytoma is present about 10% of cases. We report a case of 49 years old women who presented with elevated blood pressure and von Recklinghausen's neurofibromatosis. Laboratory examination showed a marked level in the urinary excretion of cathecholamine. The computed tomography showed a right adrenal tumor suggesting a pheochromocytoma. The adrenalectomy was realised by transabdominal approach and the histological examination confirmed a benign pheochromocytoma. The authors discuss the pathogenetic hypothesis of this rare pathological association, the diagnostic methods and the therapeutic procedure.

[Surgical complications of nephrectomy in living donors]. / Les complications chirurgicales de la néphrectomie chez le donneur vivant.

Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.

[Anatomoradiologic correlations in prostate benign hypertrophy. Report of a series of 220 cases]. / Corrélations anatomoradiologiques dans l'hypertrophie bénigne de la prostate. A propos d'une série de 220 cas.

In our daily practice, the reliability of ultrasonography (US) and digital rectal examination (DRE) is limited by many factors. The aim of our study is to correlate between the prostatic volume assessed by the DRE, the pre operative US results and the actual weight of the enucleated or endoscopic resection benign prostatic hyperplasia (BPH). We report a serie of 220 patients with BPH treated by endoscopic resection or by open surgery. The mean age is 65 years (40-90 years old). Ultrasonography was performed in 92% of the cases, and transrectal ultrasound only in 8%. All our patients either underwent endoscopic resection (49.6%) or adenomectomy (50.4%). We found a high correlation between the prostatic volume assessed by DRE and by ultrasonography (r = 0.79; P < 0.0001) and the weight of the piece of surgical adenomectomy (r = 0.701, P < 0.0001). However, the volume of benign prostatic hyperplasia assessed by US did not correlate with the piece of endoscopic resection (r = 0.214, P < 0.05). This study and a review of recent literature enabled us to notice the various anatomical and radiological factors implicated in this correlation.

[Intradiverticular bladder tumors. Three case reports]. / Les tumeurs de vessie intradiverticulaires. A propos de trois cas.

The bladder tumours in vesical diverticula is rare, and the poor prognosis, because it was often with early invasion. We reported three cases of bladder tumours in vesical diverticula, with delay of diagnosis two, eight and twelve months respectively. The radiology exploration suspected the diagnosis and the histology biopsy confirmed a diagnosis of primary transitional cell carcinoma in two cases: PTa GI and T2 GII, and in an other case it was a invasive epidermoid carcinoma. The first patient was dead by urethral resection of the bladder tumour. The second required a cytoprototectomy and the last patient. The treatment consisted of radiotherapy and chemotherapy. We insisted of the particularity diagnosis, histology and therapeutic for bladder tumour in vesical diverticula and the early diagnosis in order to have a good prognosis.

[Kidney cancer. Report of 170 cases]. / Le cancer du rein. A propos de 170 cas.

PURPOSE: The goal of this study is the analysis of the diagnostic and therapeutic aspects of this affection which is usually discovered at a delayed stage in our context. MATERIAL AND METHODS: A retrospective study of 170 renal cancer, collected during a period of 15 years (1985-2000). Ninety-two men and 78 women were studied, their mean-age was 50 years (15-81 years). The diagnosis was relied on clinical, radiological and histological arguments. RESULTS: Lumbar pain, hematuria and enormous mass were present in 85 cases (50%). The ultrasound and computed exams permitted the diagnosis and also evaluated the venous and locoregional extension. The treatment consisted on large nephrectomy practiced in 114 patients (67%), abstention in 56 cases (33%) due to the advanced stage of the tumor. The histological exam concludes to clear cell adenocarcinoma in 91.2% of cases. CONCLUSION: The authors deplore the delayed diagnosis of renal cancer in our context which is responsible of a high rate of abstention (33%); and underline the interest of the early diagnosis for an adequate management.

[Seminal vesicle cyst associated with ipsilateral renal agenesis]. / Le kyste de la vésicule séminale associé à une agénésie rénale ipsilatérale.

UNLABELLED: The seminal vesicle cyst associated with ipsilaterale renal agenesis is a rare entity. Through this case report, we analyse the clinical aspects, the importance of imaging techniques and the various therapeutic possibilities. The patient, age 24, presented perineal pain accentuated at ejaculation. The digital rectal examination showed a pre-rectal lump. Transrectal ultrasound plays an important role both for the diagnosis and the treatment. The treatment was perineal aspiration under transrectal echography control. The follow-up was satisfactory. CONCLUSION: The seminal cyst with ipsilareral renal agenesis is a rare congenital malformation, transrectal ultrasound is an excellent imaging technique for diagnosis, the perineal aspiration of the cyst constitutes a therapeutic alternative.

[Pyonephrosis: diagnosis and treatment: report of 14 cases]. / Pyonéphrose: diagnostic et traitement: à propos de 14 cas.

Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.

[Perforated duodenal ulcer: laparoscopic treatment of perforation and ulcerous disease]. / Ulcère duodénal perforé: traitement coelioscopique de la perforation et de la maladie ulcéreuse.

STUDY AIM: The aim of this retrospective study was to report a continuous series of 44 perforated duodenal peptic ulcers operated on through laparoscopic approach with curative treatment of the peptic ulcer disease for socioeconomic purpose. PATIENTS AND METHOD: From February 1995 to May 1996, 44 patients were operated on laparoscopically. There were 42 men and two women (mean age: 36 years). All patients had peritonitis with pneumoperitoneum in 68%. Duodenal peptic ulcer was known in 12 patients and antecedent of episodic epigastric pain were present in 27. Four trocads were used. The diagnosis was confirmed by abdominal exploration and peritoneal lavage was performed with physiological serum. RESULTS: The procedures were: suture of perforated ulcer associated with posterior vagotomy and anterior seromyotomy (n = 6), with troncular vagotomy and pyloroplasty (n = 24) and single suture (n = 1). A conversion into laparotomy was necessary in 13 patients (29.5%). There was no mediastinitis, no postoperative death. Peritonitis by leakage occurred in two patients who were reoperated by laparotomy; mean duration of hospital stay was 5.5 days. With a one-year follow-up, all patients were in good condition, free of pain. CONCLUSION: With laparoscopic surgery, diagnosis of peptic ulcer perforation was confirmed, peritoneal lavage was perfectly done, duodenal perforation was sutured and surgical treatment of the peptic ulcer disease was performed, which is important in poor countries.

[Should ipsilateral adrenalectomy be performed systematically during radical nephrectomy for renal cancer?]. / La surrénalectomie ipsilatérale doit-elle être systématique lors de la néphrectomie élargie pour cancer du rein?

The authors present a retrospective study of 46 patients with renal cell carcinoma treated by radical nephrectomy including ipsilateral adrenalectomy. CT scan showed a normal adrenal gland in all patients. Histology revealed the absence of adrenal metastasis in all patients. Ipsilateral adrenalectomy is not systematically required in radical nephrectomy.

[Complications of urinary calculi]. / Les complications de la lithiase urinaire.

Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.