A cadaveric anatomical study: anatomy and anatomical variations of left adrenal vein.

PURPOSE: Control of adrenal vein is the key of adrenal surgery. Its anatomy can present variations. Our aim was to study the anatomy of the main left adrenal vein (LAV) and its anatomical variations. METHODS: Our work is based on dissection of 40 cadavers. We studied the number of LAV and the drainage of the main adrenal vein as well as its level of termination. We measured its length, its width and the distance between its termination level and the termination level of the gonadal vein (GV). RESULTS: The average length of the LAV was 21 mm its mean width was 5 mm. It ended in 100% of cases at the upper edge of the left renal vein after an anastomosis with the lower phrenic vein in 36 cases (90%) and without anastomosis with the lower phrenic vein in four cases (10%). The left adrenal vein ended at the upper edge of the left renal vein either at the same level as the termination of the left GV in 14 cases (35%) or within the termination of the left GV in 26 cases (65%) by an average of 8 mm. The LAV was unique central vein in 22 cases (55%) and in 12 cases (30%), a major central adrenal vein with several small veins was found. CONCLUSIONS: The LAV is usually unique but there are variations in number. There are also variations in the level of its termination in the left renal vein as well as its anastomosis. During surgery, in case of difficulty, the left GV and the adrenal-diaphragmatic venous trunk could be used as benchmarks.

Prostatic condyloma acuminata: An uncommon endoscopic discovery in an asymptomatic 68-year-old male.

Prostatic condyloma acuminata is a rarely encountered clinical manifestation primarily linked to low-risk subtypes of human papillomavirus (HPV), such as HPV-6 and HPV-11. Unlike the more common anogenital presentation, prostatic condyloma acuminata remains an infrequent phenomenon, necessitating a nuanced approach to diagnosis and management. We present a case report involving a 68-year-old patient with an intricate medical history, where the discovery of prostatic condyloma acuminata presented diagnostic challenges and clinical intricacies.

Primary testicular non-Hodgkin lymphoma. a 10-year Tunisian single-institute experience.

BACKGROUND: Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used. AIM: To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma. METHODS: We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables. RESULTS: Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later. CONCLUSION: Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL.

Two brothers with congenital bulbar urethral stricture: case report of a very rare condition.

Congenital urethral stricture is rare. It has been reported in only four sets of brothers. We report the fifth set of brothers. Cases of two brothers aged 23 and 18 years old diagnosed with low urinary tract symptoms are presented. We diagnosed an apparently congenital urethral stricture in both brothers. Internal urethrotomy was performed in both cases. Both are asymptomatic after 24 and 20 months of follow-up. Congenital urethral strictures are probably more frequent than we think. We suggest that a congenital origin should be considered if there is no history of infections or trauma.

Air gun accident: A case report of a penile injury.

Air rifle, although considered as a toy, can cause injuries ranging from trivial to very grievous. The severity of injuries depends on the type of air rifle, the distance of firing, and the anatomic site at which the bullet hits. We present a case involving a young boy, who was accidently hit by an air rifle while playing. The Bullet penetrated the penis through the glans to be lodged in between the distal extremities of the corpus cavernosum behind the urethra. The surgical treatment was performed and the results were good.

Oncocytoma with a vascular extension, associated with a papillary carcinoma: A case report.

This is a case report about a patient which presents with two right renal tumors, one of them being an oncocytoma with typical histopathological features and renal vein extension. Recent studies show that despite renal vein thrombus being a histological sign of malignancy; when associated with renal oncocytoma, it should not alter the benign prognosis of oncocytoma, and a simple follow-up may be carried. Further explorations should be done when easily available, and when the histopathologic diagnosis of oncocytoma is uncertain, to rule out the differential diagnosis of a chromophobe renal cell carcinoma, oncocytic variant.

Inflammatory suppurated tumor of urachus mimicking a malignant urachus adenocarcinoma.

This is a case report about a patient presenting with a urachal mass mimicking a urachus adenocarcinoma. Cystoscopy showed a vesicourachal patent diverticulum. Histological findings after the removal of the umbilicus, urachus, urachal tumor, as well as a bladder cuff, consisted of a nonspecific polymorphous suppurative inflammatory infiltrate. Urachal adenocarcinoma is an aggressive tumor with poor prognosis if not treated while it is still localized. Surgical excision is the only recommended treatment that offers the best chances of survival. As no preoperative procedure has been proven accurate enough to rule out the diagnosis of adenocarcinoma, surgery appears to be inevitable.

Coexistence of multiple clear cell papillary renal cell carcinoma with renal oncocytoma: a case report.

Clear cell papillary renal cell carcinoma (CCPRCC) is a new entity, previously known as unclassified renal cell carcinoma, and initiallly identified in patients suffering of end-stage kidney failure. It is extremely rare to see this new entity associated with others renal malignant lesions. Case presentation: The authors report a case of a female 65-year-old suffering from end-stage kidney failure for 10 years, who presented with a double left renal tumor, composed by an oncocytoma associated to multiple CCPRCC, a very rare entity. A radical left nephrectomy was realized by lumbotomy, with an uneventful postoperative course. Histological examination was challenging. Immunohistological examination showed diffuse positivity of cytokertain 7. No local recurrence nor metastatic progression were found during the 12 months of follow-up. Clinical discussion: CCPRCC, is a new entity, previously known as the unclassified rena cell carcinoma, is a malignant renal tumor, initially reported in patients at end-stage kidney failure. Oncocytoma is a well-known rare benign renal tumor. The association of both is rare, and should be kept in mind, especially when scanoguided diagnosis biopsy is realized. Histopathological confirmation may be challenging, given the recent identification of CCPRCC. The nuclei disposal toward the luminal surface is a characteristic pathological landmark of CCPRCC. Immunohistopathological examination is of great help, showing a distinctive profile: diffuse staining for cytokertain 7 and carbonic anhydrase IX. Conclusion: CCPRCC is a new malignant pathological entity in renal tumors. It can be associated with other benign renal lesions. This should be taken into consideration while histopathological examination, mainly of scanoguided biopsy cores.

Retrovesical hydatid cyst: an unusual location of hydatid disease about a case series.

Hydatid disease is an endemic zoonosis in regions with temperate climates where pastoral farming is common. Retrovesical localization is rare. Given the rarity of this entity, the lack of personal clinical experience, and the difficulty with detecting early symptoms, the diagnosis remains elusive for years. Methods: This is a 30-year retrospective, descriptive and analytic study of seven patients who were hospitalized and operated on in the Department of Urology during 30 years (1990-2019). Outcomes: The average patient age was 54 years (range: 28-76). Signs of bladder irritation were the predominant presenting complaint. No cases of hydaturia were noted. Preoperative diagnosis was based on ultrasonography and serology tests. Hydatid serology was positive for three patients. In three cases, a hydatid cyst of the liver was associated. A partial cystopericystectomy was performed for five patients, it was total for one patient. The resection of the prominent dome was realized once. No cystovesical fistula was found. The mean postoperative stay was 16 days. The postoperative course was uneventful for five patients. Urinary fistula occurred in one patient. One case of infection of the residual cavity was observed. One patient had a retroperitoneal cyst recurrence requiring reoperation. Conclusion: The preoperative diagnosis of retrovesical hydatid cysts is based mainly on ultrasonography. Open surgery is the treatment of choice. Different approaches are possible. Given the rarity of this entity, management should be guided by experienced experts.

[Emphysematous pyelonephritis. Epidemiological, clinical, biological, bacteriological, radiological, therapeutic and prognostic features. Retrospective study of 30 cases]. / La pyélonéphrite emphysémateuse. Particularités épidémiologiques, clinico-biologiques, bactériologiques, radiologiques, thérapeutiques et évolutives. Etude rétrospective de 30 cas.

BACKGROUND: Emphysematous pyelonephritis is an uncommon, necrotizing bacterial infection of the kidney. It is a severe, life threatening affection. AIMS: To study the epidemiological, clinical, biological, bacteriological and radiological features of this affection, and to describe its therapeutic management and prognostic characteristics. METHODS: We conducted a retrospective study including 30 patients who were treated for an emphysematous pyelonephritis, in Charles Nicolle hospital department of urology, from 1987 to 2009. RESULTS: Emphysematous pyelonephritis generally affects adults. It is especially favored by diabetes and urinary tract obstruction. Escherichia coli is the main causative agent. Uroscan is the key of diagnosis. It is both medical and surgical emergency; the treatment combines intensive care with appropriate antibiotics and often drainage. Nephrectomy may be necessary from the outset, or after drainage failure. Prognosis is poor, with a high mortality rate (23 %), in our series. CONCLUSION: Management of emphysematous pyelonephritis poses real problems. This affection is still threatening, despite of advances in intensive care.

Segmental testicular infarction: A case report of a rare condition.

Segmental testicular infarction(STI) is a rare unknown condition. Clinical presentation is non-specific and management is unconsensual. We report clinical and surgical management of a segmental testicular infarction. A 18-years old adult presented to emergency with acute right testicular pain. The only triggering factor was a stressful situation. Examination revealed a slightly swollen, non-ascending testicle with no inflammatory signs. We suspected spermatic -cord torsion(SCT), we decided to explore it surgically. Exploration showed a well-demarcated infarcted inferior pole of right testicle. Partial orchiectomy was performed. STI is a rare entity often clinically confused with SCT. Diagnosis is based on intraoperative findings.

The effect of tobacco, XPC, ERCC2 and ERCC5 genetic variants in bladder cancer development.

BACKGROUND: In this work, we have conducted a case-control study in order to assess the effect of tobacco and three genetic polymorphisms in XPC, ERCC2 and ERCC5 genes (rs2228001, rs13181 and rs17655) in bladder cancer development in Tunisia. We have also tried to evaluate whether these variants affect the bladder tumor stage and grade. METHODS: The patients group was constituted of 193 newly diagnosed cases of bladder tumors. The controls group was constituted of non-related healthy subjects. The rs2228001, rs13181 and rs17655 polymorphisms were genotyped using a polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: Our data have reported that non smoker and light smoker patients (1-19PY) are protected against bladder cancer development. Moreover, light smokers have less risk for developing advanced tumors stage. When we investigated the effect of genetic polymorphisms in bladder cancer development we have found that ERCC2 and ERCC5 variants were not implicated in the bladder cancer occurrence. However, the mutated homozygous genotype for XPC gene was associated with 2.09-fold increased risk of developing bladder cancer compared to the control carrying the wild genotype (p = 0.03, OR = 2.09, CI 95% 1.09-3.99). Finally, we have found that the XPC, ERCC2 and ERCC5 variants don't affect the tumors stage and grade. CONCLUSION: These results suggest that the mutated homozygous genotype for XPC gene was associated with increased risk of developing bladder. However we have found no association between rs2228001, rs13181 and rs17655 polymorphisms and tumors stage and grade.

Bellini duct carcinoma revealed by cutaneous metastasis: A case report.

INTRODUCTION: Cutaneous metastasis of renal cell carcinoma is rare and the majority of these metastases are asynchronous. The scalp and face are the major sites of metastases, followed by the chest and abdomen. However, the entire body surface can be affected. When diagnosed, patients are multi-metastatic in 50-80% of cases during follow-up post nephrectomy. CASE PRESENTATION: We report here a patient who consulted a dermatologist for multiple skin nodules that appeared 3 months prior. A skin biopsy of a nodule was performed and the pathological examination and immunohistochemistry profile confirmed a metastasis of Bellini Carcinoma, which is a renal cell carcinoma of the collecting duct. A thoraco-abdomino-pelvic scan showed a left renal tumor locally advanced with lung and liver metastases. Chemotherapy was indicated and the patient died four months after diagnosis. DISCUSSION: Bellini carcinoma is a very rare type of carcinoma of renal cell origin with a very poor prognosis as it is diagnosed already at a metastatic state in the vast majority of cases. After analysis of the data from the literature, our case is the second reported case of a Bellini carcinoma revealed by cutaneous metastases. The peculiarity of our observation is metastases occurred on all four limbs and at the trunk level, and the asymptomatic characteristic of Bellini's carcinoma, which is a rare situation. CONCLUSION: The originality of this observation is based on the mode of presentation of a rare renal tumor by an even rarer metastasis of the skin.

Severe penile injury due to condom catheter fixed by a rubber band: A case report.

INTRODUCTION: Condom catheters are considered as a safe tool in the management of male urinary incontinence, yet complications may occur, especially in debilitated patients, with psychiatric disorders. PRESENTATION OF CASE: A 58-year-old paraplegic man, suffering from schizophrenia, who had been using condom urinary catheters, was referred to our department for "penile injury". Interrogation revealed that he was placing a rubber band tightly around his penis to maintain the condom. Examination showed a 4 cm defect interesting the proximal portion of the penis including the corpus spongiosum and the urethra. A surgical repair was performed, consisting in covering the defect using the surrounding tissue. Unfortunately, the patient developed penile gangrene four weeks after surgery. A partial penectomy was performed. DISCUSSION: Condom catheters are known as a safe tool to manage urinary incontinence in male patients, providing an adequate care. Long-term use may result in complications including urinary tract infection (40%) and skin injuries ranging from inflammation to gangrene. Gangrene, secondary to strangulation of the penis, is however uncommon. These complications are more common in debilitated patients with poor medical care or psychiatric disorders. In case of necrosis, debridement should be performed, which may result in a partial or a total penectomy if necessary. CONCLUSION: Condom catheter is frequently used to manage male urinary incontinence but it should not be used carelessly or overlooked as it can cause severe complications such as penile strangulation and penile gangrene.

[Laparoscopic treatment of ureteral stones. Report of 31 cases]. / Le traitement des calculs de l'uretere lombaire par lomboscopie: a propos de 31 cas.

THE AIM: To state the efficiency and the place of lumboscopy in the treatment of ureteral stones. METHODS: We report 31 cases of patients operated by lumboscopy for ureteral stones from January 2001 to December 2005. In most of cases, the indication is stone which size is higher than 15 mm. RESULTS: The mean operating time is 91 min and the rate of conversion to open surgery is 9.7%. 9 (29%) postoperative complication is noted. The mean hospital stay is 5 days. No ureteral stricture or kidney destruction is noted with a mean follow-up of 34 months. CONCLUSION: Lumboscopy is a safe and effective technique in the treatment of the ureteral stones with a low rate of complications. It can replace open surgery in most of cases.

[Diagnosis and treatment of eosinophilic cystitis]. / Diagnostic et prise en charge des cystites à éosinophiles.

Eosinophilic cystitis is an inflammatory disease of the bladder wall. It is rare, so there are no standard treatment guidelines. We conducted a retrospective study of 10 patients with eosinophilic cystitis diagnosed and treated in our Department between 2006 and 2017. The average age of patients was 46 years; there was a male predominance. Three patients were atopic. The most common symptoms were irritative urinary symptoms in 9 cases, macroscopic haematuria in 8 cases and pelvic pain in 6 cases. Four patients had high levels of eosinophils in their blood. Cystoscopy showed petechiae in 5 cases, pseudotumor in 4 cases. It was normal in one case. Patients with pseudotumor underwent endoscopic resection. Four patients were treated with nonsteroidal anti-inflammatory drugs, with improvement in symptoms. Six patients were monitored. After a mean follow-up interval of 50 months, no recidivism was reported. Eosinophilic cystitis is rare with non-specific clinical manifestations. Patients with little symptomatic eosinophilic cystitis undergo non-invasive medical treatments.