Xanthogranulomatous pyelonephritis in adults: clinical, biological, radiological and therapeutic main findings in diffuse and focal forms. About 42 cases.

INTRODUCTION: Xanthogranulomatous pyelonephritis (XGPN) is a particular form of chronic renal suppuration characterized by the destruction of renal parenchyma and its replacement by a granulomatous tissue containing xanthomatous cells. OBJECTIVE: To report and describe the main clinical, biological, radiological and therapeutic aspects of xanthogranulomatous pyelonephritis in adults in focal and diffuse forms. METHODS: This was a monocentric retrospective study involving 42 cases of XGPN operated and histologically confirmed between 2005 and 2015. We included in our study the patients belonging to any age, of both sexes, with a preoperative CT and whose XGPN diagnosis was confirmed histologically. Clinical, biological, bacteriological, radiological data and surgical procedures were collected and analyzed. RESULTS: The mean age was 50 years (34-79) with a sex ratio of 0.61. The XGPN was diffuse in 88% and focal in 12% of cases. Clinical symptoms were dominated by low back pain (95%), fever (64%) and recurrent urinary tract infections (41%). Urine culture was positive in 67% of cases and Escherichia Coli was the most isolated germ (36%). 64% of patients had inflammatory anemia and 57% of patients had an inflammatory biological syndrome. Ultrasound and CT revealed obstruction of the urinary tract in all cases: a lithiasic cause in 90% of cases and the rest were isolated cases of retroperitoneal fibrosis, abnormal pyelo-ureteral junction, ureteral stenosis and pyelo-ureteric duplicity. A peri-renal abscess and / or psoas was associated in 6 cases (14%). The preoperative diagnosis was often pyonephrosis (50%). Neoplasia was suspected in 4 cases. The treatment consisted in a radical nephrectomy for all patients preceded by drainage of the excretory pathways in 41% of the cases and drainage of a collection in 21% of the cases. CONCLUSION: The XGPN is a rare entity whose diagnosis is difficult. This is suspected on a cluster of clinical and biological arguments and can be evoked on the preoperative CT. The kidney cancer is the main differential diagnosis.

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.

Idiopathic scrotal calcinosis: A new case report.

Scrotal calcinosis is a rare benign pathology and its etiology is still discussed. The main complaint is mostly aesthetic. The treatment of extended forms is a one-staged excision. The aim of our study was to study clinical and anatomopathological aspects and report our surgical management of a case of diffuse scrotal calcinosis. We report a case of 24-year-old patient who consulted for painless scrotal nodules lasting for 2 years. Scrotal calcinosis diagnostic was based on clinical examination. The treatment was a one-staged scrotal excision taking all nodules and the plasty of the scrotum. The diagnosis was confirmed by a histopathological examination of surgical specimen.

Functional Bladder Paraganglioma Treated by Partial Cystectomy.

Paraganglioma is a rare neuroendocrine tumor that arises from the autonomic nervous system. The urinary bladder paraganglioma accounts for less than 0.1% of bladder tumors. It remains a challenging entity to diagnose and treat due to its rareness and the lack of specific symptoms. Treatment modalities include transurethral resection and cystectomy (partial or total). The authors report a new case of an isolated paraganglioma of the urinary bladder in a 52-year-old female patient that underwent partial cystectomy. This case aims to remind the clinical, histological and therapeutic features of this rare tumor.

Percutaneous Nephrolithotomy (PCNL): Standard Technique Versus Tubeless - 125 Procedures.

INTRODUCTION:  Tubeless percutaneous nephrolithotomy (PCNL) is the non-placement of a nephrostomy tube at the end of the procedure. The benefits of a nephrostomy tube placement are numerous as it provides adequate renal drainage. It may also tamponade bleeding and allow for an easier second-look nephroscopy. However, these advantages are mostly theoretical, and the majority of authors consider the nephrostomy tube as a source of morbidity. OBJECTIVES: The aim of this report was to study the efficiency, safety, and morbidity of tubeless PCNL by comparing it to the standard technique. METHODS: This is a unicentric retrospective study of 125 patients who had undergone PCNL for renal lithiasis. We divided the patients into two groups: the standard PCNL group (n = 74) and the tubeless PCNL group (n = 51). The rates of good outcomes, complications, duration of hospitalization, and the degree of postoperative pain were compared between these two groups. RESULTS: There were no statistically significant differences between the two groups in age, gender, history, and the number of stones treated. There were more staghorn stones in the PCNL group with nephrostomy (p = 0.007) and more pelvicalyceal stones in the tubeless group (p = 0.037). Patients who had the standard PCNL had larger stones (p = 0.008). Patients who had a tubeless PCNL had more postoperative infectious complications than the standard PCNL group (p = 0.042). No statistically significant differences were noted for other complications, good outcomes (p = 0.13), postoperative pain (p = 0.51), and duration of hospitalization (p = 0.16). CONCLUSION: According to the majority of authors, tubeless PCNL is considered a safe and efficient technique. It also provides advantages with less postoperative pain and duration of hospitalization. We believe that a selection bias may exist in most published work concerning routine nephrostomy tube placement.

Transformation of a prostatic adenocarcinoma into squamous cell carcinoma after luteinizing hormone-releasing hormone (LHRH) agonist and radiotherapy treatment.

Squamous cell carcinoma of the prostate is rare and represents 0.5% to 1% of prostatic carcinomas. Transformation of prostatic adenocarcinoma into squamous cell carcinoma after LH-RH agonist intake has been reported in only 8 cases in the literature. To our knowledge, our case is the second pure squamous cell carcinoma observed after hormonotherapy and radiotherapy. We reported a case of a patient with prostatic adenocarcinoma treated by radical prostatectomy followed by radiotherapy. Eleven years later, he had a vesical recurrence of prostatic adenocarcinoma. Our patient had an endoscopic resection followed by injections of Triptorelin. Six months later, he developed a local recurrence of a squamous cell carcinoma.

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.