[Favorable evolution after medical treatment in three cases of emphysematous pyelonephritis: about 3 cases]. / La pyélonéphrite emphysémateuse à évolution favorable après traitement médical: à propos de 3 observations.

Emphysematous pyelonephritis is a necrotic infection of the kidney characterized by the presence of gas within the renal parenchyma, the secretory cavities or the perirenal spaces. It is a severe condition that could be life-threatening. Patient's management remains controversial and is based either on surgery or on medical treatment. Percutaneous drainage can be also used for the treatment of these patients. We report 3 cases with EPN treated with only antibiotics. Patients' evolution was favorable. These results show that medical treatment could be sufficient.

[IIA2-Y-type urethral duplication]. / Duplicité de l'urètre de type IIA2 en "Y".

Urethral duplications are extremely rare congenital malformations. The most used classification is that of Effmann and Lebowitz, describing 6 types of urethral duplications. The under type IIA2-Y is one of the most rare duplications corresponding to duplicated urethra originating from the bladder neck and extending toward the ectopic perineal or anal insertion. We here report the case of a 32 year patient, with no previous personal history, suffering from urinary leakage during and after urination since childhood. Clinical examination showed a bottleneck at the level to the perineum initially suggesting urethral fistula. However, the absence of fistula-associated urinary disorders as well as urinary leakage since childhood refuted this assumption. The patient underwent Micturating Retrograde Urethrocistography after perineal orifice catheterization confirming well systematized tract. Surgical exploration was based on excision of the duplicate urethra after hydrophilic catheterization by inserting hydrophilic guidewire up to its anastomosis at the level of the prostate. The examination of the surgical specimen confirmed the diagnosis of supernumerary urethra.

[Cavernous metastasis from blader tumor]. / Métastase caverneuse d'une tumeur de vessie.

The incidence of cavernous metastases after radical treatment for bladder tumor is exceptional and is approximately 1%. The mean time between surgery and the occurrence of metastases is 8 months. In some cases they occur after 10 years. Diagnosis is confirmed by biopsy, which shows their urothelial origin. Here we report the case of 56-year old patient, with a history of smoking, having undergone total cystoprostatectomy in January 2017, who presented 2 months later with induratio penis plastica with no other sign associated. Priapism and gangrene of the penis of infectious origin have been suspected but, given the patient's clinical condition, the more likely diagnosis was cavernous metastasis. On two occasions the patient refused biopsy: during two consultations at 15 days interval (A, B). The patient accepted to undergo biopsy during the 3th consultation (C, D). Biopsy confirmed the diagnosis of cavernous metastasis.

[Kaposi's sarcoma of the penis in a HIV-seronegative patient]. / Sarcome de kaposi penien chez un patient seronegatif.

Sarcomas of the penis account for less than 5% of all tumors of the penis. They are dominated by Kaposi's sarcoma that mainly affects HIV-positive patients. However, recent studies have shown a relationship between Kaposi's sarcoma and HHV-8 infection (Human herpes virus-8), which explains why this sarcoma occurs in non-immunocompromised and HIV-seronegative patients. We here report the case of a 72-year old patient, with no previous medical history, reporting of gradual onset of tumor-like granulation tissue of 3 years duration at the level of the gland, without secondary location. Given the patient's clinical condition, epidermoid carcinoma or sarcomatoid carcinoma of the penis were suspected. Initial biopsy was negative, the second was in favor of Kaposi's sarcoma, confirmed by immunohistochemistry. The patient underwent chemotherapy.

[Urethral ectropion may hide a carcinoma!] / Un ectropion urétral peut cacher un carcinome!

The incidence of female urethral cancer is rare and accounts for 0.02% of all women's cancers. It is dominated by epidermoid carcinoma, which most commonly develops in the distal portion of the urethra, extending to inguinal lymph nodes. The diagnosis is confirmed in the distal forms on the basis of uretrocystoscopy with biopsy. Abdominopelvic MRI allows to determine tumor extension as well as its infiltration into tissues and peri-urethral organs. As in superficial tumors of the distal urethra, simple circumferential resection of the urethra associated with resection of the adjacent portion of the anterior surface of the vagina is sufficient. We here report the case of a 59-year old diabetic and hypertensive female patient presenting for irritative lower urinary tract symptoms, associated with vulvar mass. Clinical examination showed mucosal ectropion extending from the urethral meatus associated with extensive local inflammation. The patient underwent wide excision of the ectropion which was diagnosed as squamous cell carcinoma. Abdominopelvic MRI was normal.

[Post traumatic vesicocutaneous fistula]. / Fistule vesico cutanée post traumatique.

We here report the case of a 43-year old motorcyclist who was initially examined in the emergency department for injuries following a road accident with a car. The patient had pelvic trauma with extensive symphyseal disjunction (A). He underwent orthopedic treatment based on weight compensation. During the two weeks immediately following the trauma, patient's evolution was marked by the occurrence of fistulous orifice at the level of the inner right thigh (B) associated with urinary outflow and wounds due to local skin maceration around the fistula. Radiologically, abdominopelvic CT scan at extended injection-to-scan acquisition time showed contrast extravasation laterally, into the bladder and at the level of the right thigh root due to subperitoneal rupture of the bladder (C). Uretrocystography objectified symphyseal disjunction visible on the non-contrast abdominal X-ray film. Moreover, uretrocystography showed fistulous track after uterovesical opacification (D). Standard laboratory tests were normal. Given the subperitoneal rupture of the bladder and the absence of associated lesions, conservative treatment by prolonged bladder drainage with urethral catheter and local care of the fistulous orifice were performed. Patient's evolution was marked by complete drying up of the fistula.