Interstitial cystitis: elements of diagnosis and place of histopathological examination. About 16 cases.

BACKGROUND: Interstitial cystitis (IC) is a rare disease, of difficult diagnosis. The diagnostic utility of histopathological examination of bladder biopsy remains controversial. AIM: We conducted a retrospective study to assess the frequency of interstitial cystitis, to analyze its clinical presentation and the data from the paraclinical examinations. We discuss the steps and criteria of diagnosis, as well as the place of histopathological examination for diagnosis. METHODS: Sixteen patients diagnosed with IC were followed in the Urology Department of the Sahloul University Hospital between 1996 and 2013. The diagnosis was suggested by clinical history and confirmed on the basis of clinical symptoms and results of the paraclinical explorations: urodynamic assessment, cystoscopy and bladder biopsy. RESULTS: Six men (37.5%) and ten women (62.5%), with an average age of 56 years complained of pelvic pain and urination disorders for two years on average before the diagnosis. The urodynamic study found decreased bladder compliance in 13 cases and bladder instability in nine cases. Cystoscopy demonstrated inflammatory mucosa in 13 patients (81%). Histologically, the classic ulcerative form accounted for 50% of the cases. The number of mast cells was high in both the mucosa and the muscular in 12 cases, both in the classical and non-ulcerative forms. CONCLUSION: The IC remains a diagnosis of exclusion. The first line of diagnosis is patient selection based on symptoms and an exclusion of diseases with similar presentation. Vesical biopsy is useful for confirmation and classification of the disease.

Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control.

INTRODUCTION: Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control. METHODS: Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one. RESULTS: The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001. CONCLUSIONS: Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs.

[Impact of alfuzosin 10 mg once daily on quality of life in Tunisian patients with lower urinary symptoms suggestive of benign prostatic hyperplasia]. / Impact de l'alfuzosine lp 10 mg sur la qualite de vie chez les patients avec troubles urinaires du bas appareil suggestifs d'une hypertrophie benigne de la prostate.

BACKGROUND: Incidence of benign prostatic hyperplasia (BPH), one of the most common conditions affecting adult men, increases dramatically after the age of 50. The various symptoms of BPH, which include lower urinary tract symptoms (LUTS), can adversely affect quality of life (QoL) and sexuality and 1-Blockers are the most frequently prescribed oral medications as first-line treatment. AIM: The objectives of this study try to evaluate QoL and sexuality in patients requiring treatment by Alfuzosin 10mg once daily according to physician decision in current practice and to identify patient's profile treated with Alfuzosin 10 mg under daily practice conditions by Tunisian urologists. METHODS: 730 patients presenting a symptomatic BPH were enrolled in this study by 40 urologists. The impact of treatment on patient's QoL and sexual dysfunction were checked at every visit before treatment and at 3 and 6 months using "International Prostate symptoms score" (IPSS) and "Male Sexual Health Questionnaire - Ejaculatory Dysfunction" (MSHQ - EJD) questionnaire. RESULTS: BPH affect Qol and near half of the patients reported sexual disorders. The treatment compliance to Alfuzosin was very good with a regular intake in 92% of the cases. Quality of life significantly improves during visits: the global IPSS score decreases from 18.8 at baseline to 9.5 at 6 months. The same favorable evolution was observed with the bother score which decreases from 4.0 at baseline to 1.6 at 6 months, and with MSHQ - EJD score which increases from 10.5 at first visit to 11.4 at 6 months. CONCLUSION: Alfuzosin 10 mg administered for 6 months provides a marked improvement in patients presenting symptomatic BPH not only on LUTS but also in QoL and sexual disorders.

[Primary large-cell neuro-endocrine carcinoma of the bladder]. / Carcinome neuro-endocrine à grandes cellules primitif de la vessie.

Primary large-cell neuro-endocrine carcinoma of the bladder is a rare aggressive tumour with a very poor prognosis. The authors report the case of 78-year-old male patient with primary large-cell neuro-endocrine carcinoma of the bladder and discuss the pathological and therapeutic aspects of this tumour in the light of a review of the literature.

[Hydatid cyst of the spermatic cord]. / Kyste hydatique du cordon spermatique.

The authors report the third published case of hydatid disease of the spermatic cord and describe its unusual presentation in the form of hydrocele. Hydatid disease is endemic to some countries, where it constitutes a real public health problem. It can affect all organs of the body. However, primary involvement of the spermatic cord is exceptional. Implantation of the hydatid larva is essentially haematogenous. The positive diagnosis is based on ultrasound. Eosinophilia is neither constant nor specific and only contributes to the diagnosis when it is positive. However positive hydatid serology has a diagnostic and prognostic value. Resection of the roof of the cyst is the treatment of choice.

[Ureterocalicostomy: indications and results based on a series of 16 patients]. / L'anastomose urétéro-calicielle: indications et résultats d'une série de 16 patients.

Formerly considered to be a salvage or last resort technique before nephrectomy, ureterocalicostomy can be indicated in certain well defined situations, when strictly dependent drainage of urine is essential. Due to its particular indications, this procedure is rarely performed and operators have limited experience. The authors report 17 cases of ureterocalicostomy performed in 16 patients: 8 cases obtained an excellent long-term result with absence of clinical signs, urinary tract infection and proximal dilatation of the neo-junction. 4 cases obtained a good result with resolution of clinical symptoms and bacteriological signs and improvement of the dilatation on intravenous urography. 3 cases obtained a poor result with persistence of clinical symptoms and dilatation on intravenous urography. 2 nephrectomies were subsequently performed 4 years and 10 years after ureterocalicostomy for non-functioning kidney and for chronic pyelonephritis.

[Retrovesical hydatid cyst: diagnosis and treatment in 8 cases]. / Le kyste hydatique rétrovésical: aspects diagnostiques et thérapeutiques à propos de 8 cas.

INTRODUCTION: Hydatid cyst represents a real public health problem in Tunisia. Retrovesical hydatid cyst is rare (6% to 7%). It is considered to be an "aberrant" or "ectopic" site defined by the development of the parasite in the subvesical and retrovesical fat. MATERIALS AND METHODS: From 1988 to 2001, 8 patients with retrovesical hydatid cyst were hospitalised and operated in our Urology department at Sahloul Hospital in Sousse, Tunisia. The mean age of our patients was 41 years (range: 8 to 75 years). Signs of bladder irritation were the most frequent presenting complaint. Only one case was diagnosed on computed tomography performed for assessment of lumbar contusion. Total resection of the cyst and pericystic tissues was performed in 5 patients, with partial resection in the other cases. RESULTS: The postoperative course was uneventful and only one patient developed suppuration of the residual cavity, which responded favourably to antibiotics and ultrasound-guided drainage. CONCLUSION: The retrovesical site of hydatid cyst is rare and treatment is essentially surgical.