Strangulation of the Penis by a Metallic Ring: Prevention Is Better Than Cure.

Strangulation of the penis is a rare condition that requires emergency management. Several objects, metallic or not, can be placed on the penis to increase sexual performance or for self-erotic intentions especially in psychotic patients with unusual sexual impulses. The problem of removing the foreign body and repairing the damage is a real challenge for the practitioner and a great stress for the patient. We report a case of a 42-year-old schizophrenic patient who presented to the emergency department for a strangulation of the penis secondary to a metal ring placed at the base of the penis 10 days before the consultation without urinary disorder. A review of the literature allowed us to highlight the different clinical pictures of penis strangulation and the therapeutic methods and to highlight the importance of psychiatric care of sexual behaviour in chronic psychotics.

Blunt scrotal trauma in adults: A multi-institution study evaluating the American Association for the Surgery of Trauma organ injury grading scale About 107 cases.

PURPOSE: The authors evaluated the usefulness of the American Association for the Surgery of Trauma (AAST) testis injury scale based on preoperative scrotal ultrasonography (US) and physical examination compared to peroperative findings. METHODS: A retrospective review was performed on 107 patients (mean age=29,2±5.8 years) with a testis blunt trauma treated between January 2005 and August 2015. All patients underwent surgical scrotal exploration. Preoperative US was performed in all cases. Testis trauma was classified according to the AAST organ injury scale, preoperatively based on physical examination and scrotal US and then compared to peroperative definitif grading scale. RESULTS: Of the included patients, 14 were found to have abnormal testis contours on US, 25 had a rupture of the tunica albuginea, with a sensitivity of 70,8% and a specificity of 71,2%. Orchidectomy was performed in 12 cases, partial orchidectomy in 32 and tunica albuginea repair in 35 patients. CONCLUSIONS: Through this series, US was not a specific and sensitive exam to really precise the severity grade of testis trauma. Pre- and preoperative findings were significantly different. Thus, we continue to support history and clinical findings and we encourage surgical exploration when testis lesion is suspected.

Predictive factors of urinary incontinence after radical prostatectomy: Systematic review.

PURPOSE: To determine the predictive factors of urinary incontinence (UI) after radical prostatectomy (RP) for localized prostate cancer. METHODS: Review of the French and English literature between 1996 and 2015 treating risk factors of UI after RP. RESULTS: We identified 46 articles to be analyzed. Preoperative risk factors of UI were age, BMI, prostate surgery history, the sphincter deficit, bladder instability, the quality of the surgical technique (preservation of neuro-vacsulaire strips, blood loss) The morphology of the prostate on MRI and the importance of the loss of urine after the removal of the bladder catheter. CONCLUSION: Several risk factors have been implicated clinical order (age, obesity, prostate surgery history, preoperative ED), urodynamics, radiological (the shape of the prostatic apex) and other depending in the surgical technique.

Prevalence of erectile dysfunction in patients consulting urological clinics: multi-centric survey in the algerian west.

AIM: to make an inventory of the prevalence, the severity, the reasons for the patient's consultation and the therapeutic measures indicated by urologists for erectile dysfunction (ED) in the west of Algeria. METHODS: This survey was conducted among 4 urologists. All male patients, aged over 18 years, presenting to clinics during the study period of 2 months were included. Data collection was based on a self-administered questionnaire on socio-demographic data, comorbidities especially urological and sexual health history. The evaluation of ED was achieved by the single question of John B. McKinlay. One more question was asked to evaluate trouble reported by the patient's partner. RESULTS: This survey included 185 patients. It showed a high prevalence of ED (59.5%), correlated with age. The mean age was 61 ± 13 years. Thirty four percent of patients had severe ED. The reason for consultation was dominated by prostatic diseases (70%), the ED accounted for only 9% of the reasons for consultation. Only 26% of patients reported having talked previously to a doctor about their ED. These disturbances were "unacceptable" for 25% of patients and "moderately acceptable" for 30%. A minority of patients (16%) was treated medically for their ED (half of them received PDE5 inhibitors alone or in combination). CONCLUSION: This first survey in the urological Algerian community emphasizes the importance of sexual dysfunction in patients consulting in urology. Although the prevalence of ED is important, few patients consult specifically for this reason. As a result, treatment is limited. Better physician awareness of the problem of ED is recommended.

Pre-existing renal lesions revealed after renal trauma, Difficulties in diagnosis and accountability: About 14 cases.

OBJECTIVE: Pre-existing renal lesions (PERL) may interfere with the patho-physiology of trauma, alter the radiographic imaging and influence the therapeutic approach. The aims of this study were to record the PERL found incidentally during blunt renal trauma, to specify the place for effective conservative management and to determin the estimated partial permanent disability (PPD). PATIENTS AND METHODS: The medical records of 14 patients with PERL and blunt renal trauma were reviewed. In each patient, pre-existing renal abnormalities, clinical symptoms, CT scan study findings, associated injuries, therapeutic approach, the accountability criteria and the estimated PPD were recorded. RESULTS: There were 11 men and 3 women with a mean age of 35,6 years (range 19-66 years). Renal trauma was due to a traffic accident in 8 patients. Renal damage appeared to be disproportionate to the severity of the trauma (minor trauma). They had a lower rate of associated trauma to other abdominal organs (four patients only). Urinary stones were present in 5 patients, pelvi-ureteric junction obstruction in 3, horseshoe kidny in 3, ectopic kidney in 2 and upper urinary tract carcinoma in one case. Early nephrectomy was required in three cases for hemodynamic instability. Ureteral stenting was indicated in 3 cases. Six patients were operated later because of their underlying renal pathology. A conservative treatment was possible only in 7 of cases. The PPD related to renal trauma varide from 0 to 13% in all cases. CONCLUSION: PERL may complicate a negligible renal trauma while in some cases they may be of vital importance for the patient's final outcome. The imaging findings are crucial but may be confusing. The therapeutic approach is, to a large extent, dependent on the type of PERL and the severity of damage, and is often conservative in the hemo-dynamically stable patient. Accountability link may be difficult to establish and the PPD depends on the PERL and the renal injuries severity. FUNDING: We have no involvement with funding in this case. Ethical approval: Not required Conflicts of interest: None.

Long-term outcome of intravesical bacillus Calmette-Guérin therapy with maintenance for urinary bladder carcinoma in situ: About 47 cases.

INTRODUCTION: Data concerning the efficacy of intravesical Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder are limited. OBJECTIVES: We analyzed long-term outcomes of instillation therapy with BCG to treat bladder CIS, evaluated its effectiveness and safety and searched for prognostic factors that could predict disease recurrence and progression. METHODS: Between March 1994 and December 2010, 47 patients (male: 40; female: 7) with median age of 59,5 years (range 40-76 years), diagnosed with bladder CIS underwent weekly BCG instillations (75 mg of Pasteur strain) for six weeks followed by 6 monthly instillations. Patients were collected from four different institututions.Proven bladder CIS diagnosis was made through random biopsy (n=19), macroscopic lesion (n=28) and urinary cytology (n=6).Primary, concomitant, and secondary CIS was found in 13 (27,6%), 28 (59,6%) and 6 (12,7%), patients, respectively. RESULTS: The median follow up period was 67.5 months (range 60-116 months).The recurence rates were 15,4%, 35,7% and 50% respectively in group I,II and III at 5 years follow-up. The overall complete response rate was 68%.The five-year progression-free survival rate was 87.2%.Several factors, such as age (<60 or >60 years), gender, previous transurethral resection and type of CIS, were examined by multivariate analysis to predict recurrence and progression. None of them was an independent prognostic factor.Bladder irritation symptoms were the main BCG adverse effects. There were no severe adverse effects requiring discontinuation of drug administration.Radical cystectomy was performed in 5 patients. Extravesical involvement was identified in only one patient. During follow-up period, none died of bladder cancer. CONCLUSION: Therapy with BCG is remarkably effective and safe for primary CIS and concomittent CIS, which might be a prognostic factor. We didn't find any significant risk factor. Recurrence and disease progression including extravesical involvement should be carefully monitored over the long-term after BCG therapy.

Extracorporeal lithotripsy in patients with hemophilia: systematic review.

BACKGROUND: The management of urolithiasis in patients with haemophilia poses a real challenge to the urologist. AIM: We conducted a systematic literature review to assess the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of urolithiasis in hemophiliacs. METHODS: A systematic review was conducted by using the National Library of Medicine (PubMed) search engine between January 1985 and June 2013. We've used these key words: "haemophilia" and "extracorporeal shock wave lithotripsy". All articles dealing with the treatment of nephrolithiasis by ESWL in patients with hemophilia were included. Two independent reviewers extracted the data from each article. The data was included into a systematic review and analyzed. RESULTS: A total of 12 medical articles were selected with a total of 25 patients. The stone size varies from 6 to 21 mm. The substitution of the deficient clotting factor started the day before the ESWL. ESWL was effective in all patients except one after 1-6 sessions / patient. An ultrasound was performed after the procedure to look for potential bleeding complications. The judgment of the substitution therapy depends on the patient's condition, the presence of hematuria and the absence of signs of bleeding. Major bleeding complications were observed in 4 patients. CONCLUSIONS: With effective substitution of deficient clotting factors, ESWL is a safe and low morbidity method in the treatment of urinary calculi in hemophiliacs.

PSMA-PSA clones controlled by full Akt phosphorylation (T308+,S473+) recapitulate molecular features of human prostate cancer.

BACKGROUND: (PSMA+,PSA+) and (PSMA+,PSA-) are the two most individual clones that we have previously identified during prostate cancer (PC) progression. However, molecular signatures associated with these distinct PSMA-PSA prostate clones and their specific correlation with disease outcome is yet to be defined. AIM: Since Akt is a major pathway involved in the critical activating events that leads to malignant form of the disease, we studied the involvement of full Akt activation (T308+,S473+) connected with serum PSA levels, tissue PSMA expression and angiogenic activity on the emergence of (PSMA+,PSA+) and (PSMA+,PSA-) PC clones. METHODS: The study was carried out in 6 normal prostate, 25 benign prostate hyperplasia (BPH) and 23 (PC). Immunohistochemical analysis was performed to study the expression of PSMA, PSA, pAkt(T308), pAkt(S473) and CD34 in prostate tissues. The evaluation of angiogenesis was made by CD34 immune marker. Serum levels of PSA were assayed by Immulite autoanalyser. RESULTS: The most relevant result showed that, among PC patients with pAkt (T308+,S473+) profile, patients that exhibit the (PSMA+,PSA+) clone have .higher serum PSA levels, tissue PSMA expression and angiogenic activity than those with (PSMA+,PSA-) clone. Although have the same (PSMA+,PSA+) prostate clone, BPH patients have distinct molecular-biological features compared to PC patients among pAkt (T308+,S473+) profile. In fact, among patients with maximal Akt activation, the (PSMA+,PSA+) PC clone is characterized by higher serum PSA levels, tissue PSMA production and intensive angiogenic activity than (PSMA+,PSA+) BPH clone. CONCLUSION: These findings emphasize the potential role of the full Akt activation (T308+,S473+) in expansion of several PSMA-PSA prostate clones capable of driving both human PC initiation as well as progression to a metastatic phenotype. Pinpoint patients according to PSMA-PSA clones could recapitulate the histological and molecular features of human PC and may offer a novel approach for controlling metastasis.

PSMA/PSA ratio evaluated by immunohistochemistry may improve diagnosis of prostate cancer.

Prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) measured in serum are not fully satisfactory as biomarkers of prostate cancer (PC). Results obtained in this article indicated that PSMA/PSA ratio evaluated by immunohistochemistry in normal prostate (NP), benign prostatic hyperplasia (BPH), and PC at the individual level could be a useful tool for diagnosis and prognosis of PC. PSMA and PSA were equally expressed in NP and the PSMA/PSA ratio was 1.22 ± 0.15. Data also indicated that PSMA/PSA ratio fluctuates in BPH and PC compared to NP. In BPH, the PSMA/PSA ratio was around 0.47 ± 0.02, whereas it's significantly increased in PC, about 4.95 ± 0.83. In parallel, the highest PSMA/PSA ratio was associated with high intratumoral angiogenesis in PC patients with (PSMA+,PSA+) profile.

Imaging findings of urinary tuberculosis on computerized tomography versus excretory urography: through 46 confirmed cases.

BACKGROUND: Imaging findings of urinary tuberculosis (TB) on excretory urography (IVP) and CT have been reported to be nonspecific although CT may provide detailed informations. We performed a retrospective study of patients with proven urinary TB to compare imaging findings on IVP and CT and to make a systemic approach to imaging analysis of urinary TB. METHODS: Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls. RESULTS: CT was most sensitive in detecting any renal parenchyma cavities (p=0.01), hydronephrois (p=0.0005), ureteral stricture (p=0.03) and walls thickening of the renal pelvis / ureter (p< 0.0001). Four imaging patterns were noted in 20 IVPs (43%) and 34 CTs (74%) with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding. CONCLUSIONS: Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB.