Renal epithelioid angiomyolipoma: a case report and literature review.

BACKGROUND: Renal epithelioid angiomyolipoma is a recently recognized variant of angiomyolipoma, closely simulating renal cell carcinoma both clinically and histologically. Only a relatively small number of cases of epithelioid angiomyolipoma of the kidney have been reported. AIM: To highlight clinicopathological features of this rare tumour. OBSERVATION: We report herein a new case of renal epithelioid angiomyolipoma in a 38-year-old male with no stigmata of tuberous sclerosis. The tumour was composed of diffuse sheets of epithelioid cells, small numbers of adipocytes and occasional blood vessels. Immunohistochemically, neoplastic cells were immunoreactive for HMB-45, but negative for cytokeratin. The patient showed no evidence of recurrence or metastatic disease one year after radical nephrectomy. CONCLUSIONS: Epithelioid angiomyolipoma may be locally aggressive and can metastasise; therefore, long-term post-operative follow-up is mandatory.

Paratesticular angiomyofibroblastoma: case report and review of the literature.

Angiomyofibroblastoma is a rare, benign, mesenchymal tumour occurring mainly in the female genital tract, and more rarely, in males. We present a new case of angiomyofibroblastoma arising in the left inguinal region of an 83-year-old man. The tumour was well circumscribed and measured 60 mm in maximum dimension. On microscopic examination, the tumour was composed of small spindle cells without atypia within a fibrous and myxoid stroma where scattered mononuclear inflammatory cells were found around the capillaries of the stroma. Immunohistochemical studies showed positive staining of tumour cells for vimentin, desmin, smooth muscle actin and CD34, and negative staining for PS100 and oestrogen and progesterone receptors. These histological findings are consistent with angiomyofibroblastoma. The patient was followed up for 4 years without recurrence.

[Testicular plasmocytoma: a case report]. / Le plasmocytome testiculaire: a propos d'un cas.

BACKGROUND: Extramedullary plasmocytoma is rare, with less than 50 reported cases and only 8 cases of primary testicular plasmocytoma. AIM: Report of a new case CASE: This report concerns a 65-year-old patient presenting an enlargement of the testis. The diagnosis of testicular plasmocytoma was made on histological examination. There was no evidence of bone marrow involvement or systemic signs of myeloma. This case will be studied with a review of the literature.

[Renal actinomycosis: a case report]. / Actinomycose rénale: a propos d'une observation.

This report describes the case of a 26-year-old patient hospitalized for spontaneous abdominal pain. Palpation during clinical examination demonstrated a mass in the right abdomino-pelvic cavity. Radiological examination visualized the presence of grains suggestive of actinmycosis. The patient responded favorably to antimicrobial therapy. Actinomyces israeli is a gram-positive anaerobic bacterium that can cause tumor-like lesions usually on the face and neck and more rarely on retroperitoneal structures. Because renal involvement can require nephrectomy, diagnosis of renal actinmycosis must be made during pre-operative work-up. Ultrasound-guided needle biopsy of the lesion can achieve diagnosis and avoid nephrectomy since medical treatment using antimicrobial therapy is effective.

[Ureteric valves: a report of two cases]. / Les valves de l'uretère: à propos de deux observations.

Ureteric valves are a rare cause of ureteric obstruction. Fifty cases have been described in the literature. We report two new cases. The first is of a 12-year-old child with left multiple ureteric valves associated to bilateral vesico-ureteric reflux. The patient was treated by uretero-ileoplasty with unfavourable evolution to renal failure. The second case is that of a proximal ureteric valve discovered in a 30-year-old woman who had postpartum acute pyelonephritis. Treatment consisted in ureteric resection-anastomosis with favourable outcome. Based on a review of the literature, we discuss epidemiologic, etiologic, diagnostic and therapeutic aspects of this malformation.

[Excavated right pleuro-pneumopathy with fever]. / Une pleuro-pneumopathie droite fébrile excavée.

Respiratory manifestations are rarely observed in pyonephrosis. We report a new case revealed by lower respiratory infection with Escherichia coli empyema. Ultrasound and computed tomography rectified the diagnosis.

[Bladder herniation]. / Hernie Vésicale.

Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.

["Aggressive" angiomyxoma of the vagina. A case report and review of the literature]. / Angiomyxome "agressif" du vagin. A propos d'un cas et revue de la littérature.

Aggressive angiomyxomas are rare soft tissue tumours. They are mainly found females. Steeper and Rosai described these tumors for the first time in 1983. The diagnosis and the treatment are difficult. The recurrence is frequent. The authors report a case of aggressive angiomyxoma of the vagina and the pelvis, diagnosed in a 34-old-woman. They discuss clinical symptoms and different signs allowing the diagnosis. Therapeutic management is also discussed.

[Laparoscopic spermatic vessel ligation in the treatment of varicocele: report of 129 procedures]. / La ligature sous coelioscopie des vaisseaux spermatiques dans le traitement de la varicocèle: à propos de 129 interventions.

With the improvement of laparoscopic techniques in the hands of urologists, a minimally invasive therapy can be offered to patients. We report retrospectively our experience in the laparoscopic treatment of varicoceles. A total of 93 patients with 129 varicoceles were treated by a laparoscopic approach, the mean age was 29 years (12-47), with 57 left varicoceles and 36 bilateral varicoceles. Indications for treatment were infertility in 51 patients and pain in 42 cases. The mean duration of the operation was 40 min (25-85) for bilateral varicoceles, and 24 min (15-65) for left varicoceles. All our patients were operated the day of their admission and 52 patients left the hospital 8 h after the intervention. We report 2 incidents with conversion to open surgery in one case. The pregnancy rate after surgery in patients with infertility was 21%, the recurrence rate was 4%. Laparoscopic spermatic vein ligation in the treatment of varicocele is a minimally invasive procedure, simple, fast and is not a contraindication for other procedures in case of recurrence.

Megapenis associated to corpus spongiosum agenesis with scrotal and pelvic hemangiomas.

An exceptional case of megapenis associated with corpus spongiosum agenesis and multiple hemangiomas of the scrotum, perineum and pelvis is reported. This is the first case in which three exceptional malformations are associated.

Combination of ballistic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia: report of 120 cases.

PURPOSE: We report our experience with the combination of ballistic lithotripsy (BL) and transurethral resection of the prostate (TURP) in 120 patients with benign prostatic hyperplasia (BPH) and bladder stone(s). PATIENTS AND METHODS: The mean stone size, appreciated by measuring the greatest diameter, was 18.5 mm (range 10-80 mm). The mean prostate volume was 35.4 cc (26-62 cc). All procedures were monitored under direct endoscopic control with a videocamera. RESULTS: Lithotripsy and evacuation of fragments was performed in an average time of 27.5 minutes (10-80 minutes). The only intraoperative complication was mild hematuria in 38 patients (32%), which did not affect vision for TURP. The mean resection time was 42 minutes (range 15-65 minutes). Four patients experienced mild postoperative bleeding, and one patient had clot retention. The mean hospital stay was 1.2 days (range 1-4 days). CONCLUSIONS: Combined BL and TURP is effective, safe, and economical.

The pre-looped intracorporeal knot: a new technique for knot tying in laparoscopic surgery.

PURPOSE: Intracorporeal knot tying in laparoscopic surgery is time-consuming and difficult to learn. We present a new technique, that we call the pre-looped intracorporeal knot technique, which obviates the difficulties and saves time. MATERIALS AND METHODS: We devised a homemade suture ring that allows the introduction of the suture thread wrapped on the needle driver and ready for knot tying simply by pulling on both extremities of the thread. RESULTS: Our experience with this technique proved it to be easy to apply and to learn. CONCLUSIONS: The prelooped intracorporeal knot technique allies the sophistication of intracorporeal knot tying to the easiness and simplicity of the extracorporeal classic suturing. It renders intracorporeal knotting an easy and rapid task to achieve.

[Emphysematous pyelonephritis: report of 3 cases]. / La pyélonéphrite emphysémateuse: à propos de trois cas.

Emphysematous pyelonephritis is a rare and life-endangering suppurative infection characterized by the production of gas in the renal parenchyma and perirenal space. It affects mainly patients with diabetes mellitus. Authors report three cases of emphysematous pyelonephritis and insist on the role of radiological investigations in diagnosis. Through an exceptional case of emphysematous pyelonephritis revealed by hematemesis, they remind the progression route of infection from retroperitoneal to mediastinal space. Prognosis of emphysematous pyelonephritis depends on the patient's general health status and rapidity of diagnosis and treatment. Percutaneous drainage is an alternative to major surgery and is particularly indicated in cases of single kidney or in an inoperable patient.

Ureterovaginal fistulas complicating laparoscopic hysterectomy: a report of two cases.

Three ureterovaginal fistulas occurred following laparoscopic hysterectomy in two patients. Inadvertent burn of the distal ureter by a unipolar electrocautery was thought to be the cause. Avoidance of unipolar cautery to achieve hemostasis of uterine arteries would have prevented these urologic complications.

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.

Retrovesical hydatid disease: a clinical study of 27 cases.

OBJECTIVES: We report our experience with 27 cases of retrovesical hydatid cysts (RVHC) and discuss the pathogenesis, diagnosis and treatment of this hydatid location. MATERIALS AND METHODS: We retrospectively reviewed the clinical files of 27 patients with RVHC admitted to our institution from January 1984 to December 2000. RESULTS: The predominant presenting symptom was burning micturition (13 cases). Physical examination revealed a pelvic mass in 17 patients. Preoperative diagnosis was based upon ultrasonography, intravenous pyelography, and serology tests. CT was performed in 10 patients. We noticed that RVHC can be subdivided into two categories: those that develop mainly in the peritoneal cavity (intraperitoneal type; 18 cases), and those that develop mainly in the confined pelvic cavity (subperitoneal type; 9 cases) and are more liable to induce ureteral compression and more difficult to approach surgically. One patient died before operation. Twenty-six patients were operated and had either a total (9 cases) or partial pericystectomy (17 cases). Four patients underwent closure of cystovesical fistulas. Two patients had ureteral reimplantation. Postoperatively, 1 patient died with septic shock and 1 was reoperated for peritonitis. Mean postoperative hospital stay was 8 days. CONCLUSIONS: The preoperative diagnosis of RVHC is based mainly on ultrasonography. Open surgery is the treatment of choice.

[Ambulatory urological surgery]. / La chirurgie urologique ambulatoire.

Ambulatory surgery offers to patients to be treated on an outpatient basis. Strict criterious, social, surgical and medical must be associated to authorize this type of hospitalisation. From January 1998 to December 1999, 1882 patients (46% of our operative activity) were treated on an outpatient basis, to undergo an endoscopic surgery (66%), conventional surgery (20%) or other (14%). 9 patients remain a supplementary night because of post-operative fever in 5 patients and an incomplete recovery in 4 patients. No patient was rehospitalized for complication. In this series, ambulatory surgery has proved its advantages, without loss of patients' security, if selection criterious were respected.

Hydatid cyst of the kidney. A report of 147 controlled cases.

OBJECTIVES: We report our experience in the management of 147 hydatid cysts of the kidney over an 11-year period. MATERIAL AND METHODS: The records of 147 patients operated for hydatid cysts of the kidney between 1985 and 1996 were reviewed in order to address patient's symptoms at presentation, radiological findings, diagnostic tests and surgical outcome. All patients were managed with open surgery. No preoperative or postoperative antiparasitic medication was used. RESULTS: Lumbar or lumbo-abdominal pain was the most frequent symptom (84%). Hydaturia was observed in 28% of the cases. Preoperative diagnosis was based upon intravenous pyelography (IVP), ultrasound and serology tests. CT scan was performed only in litigating cases (15%). In 20 cases, damage to the renal parenchyma was so extensive as to justify nephrectomy. Abstention concerned 5 involutive type V cysts. The remaining patients had an excision of the prominent part of the cyst (partial cystopericystectomy). Postoperative course was smooth in all cases. Postoperative IVP (3-6 months) showed a restituo ad integrum in 80% of the cases and residual pelvicaliceal distortions in 20%. CONCLUSIONS: Diagnosis of hydatid cyst of the kidney is based mainly on ultrasonography and IVP. Open surgery is the treatment of choice with excellent results.

[Spontaneous perirenal urinoma during nephritic colic]. / Urinome périrénal spontané survenant au cours d'une colique néphrétique.

A case has been reported of the spontaneous rupture of the kidney during an attack of nephritic colic. This rare complication is due to excessive pressure in the renal cavities caused by an obstructive ureteral calculus. Complete resolution of the urinoma was obtained after endoscopic fragmentation of the calculus and double J stenting.

[Repair of urethrocutaneous fistula with double skin flap. Report of 32 cases]. / Réparation des fistules uréthrocutanées par double lambeau cutané. A propos de 32 cas.

OBJECTIVES: Urethro-cutaneous fistula constitutes the main complication of urethroplasty for hypospadias. The frequency of this complication ranges from 12 to 90%. The multiplicity of fistula closure techniques, reflects the difficulty involved in repairing these lesions. The authors evaluated fistula repair by a double pedicle skin flap according to the Wise technique. MATERIAL AND METHODS: 32 patients were treated: 18 had already undergone 34 attempted repairs of urethro-cutaneous fistulas complicating urethroplasties (9 Mathieu, 17 Duplay and 6 Leveuf) for anterior penile (9), middle penile (14) and penoscrotal hypospadias (9). In 14 cases, the Wise technique was the first procedure used to repair the fistula. RESULTS: The authors obtained 29 successes. The 3 failures concerned fistulas after Duplay urethroplasties to correct penoscrotal hypospadias. The overall success rate of this technique in our series (90%) was therefore close to that reported by Wise (5 out of 6 successes), who described this technique in 1977. CONCLUSION: The Wise technique is a good technique for repair of large, recurrent urethro-cutaneous fistulas after several attempts of repair.