[Metastase from lobular breast carcinoma on the ileal patch of augmentation]. / Métastase de carcinome lobulaire mammaire sur un patch iléal d'entérocystoplastie.

Patients treated with bladder augmentation have a higher risk of developing bladder cancer than the general population. In these patients, tumours are most frequently primary bladder cancers. Metastasis in an augmentation cystoplasty is extremely rare and here we describe the first case of metastasis from lobular breast carcinoma in an ileal patch. A 52-year-old woman, with a medical history of invasive lobular breast cancer, presented with gross hematuria seven years after an ileal augmentation cystoplasty. A large bladder mass was found exclusively on the enteric patch, with lymphadenopathies from iliac vessels to right kidney hilum. Asurgical resection of the ileal segment with trigonal preservation was performed, associated with a complete cytoreduction. The bladder was reconstructed with a new ileal segment. Pathology confirmed the diagnosis of metastatic lobular breast carcinoma. Patients treated with augmentation cystoplasty need a close and long follow-up to detect the warning signs of tumor development. We herein report our experience of a metastatic lesion on the enteric part of a cystoplasty. Unusual characteristics of the bladder tumor and personal oncologic history of the patient may be suggestive of a secondary lesion.

Les patients traités par entérocystoplastie d'agrandissement présentent un risque plus important que la population générale de développer un cancer de vessie. Chez ceux-ci, les masses vésicales sont le plus souvent des cancers primitifs de la vessie. Les métastases au niveau d'iléocystoplasties sont très rares et nous décrivons le premier cas de métastase d'un carcinome lobulaire du sein sur patch iléal. Il s'agit d'une patiente de 52 ans, se présentant pour hématurie macroscopique survenue sept ans après une iléocystoplastie d'agrandissement. Elle a également été traitée antérieurement pour un carcinome lobulaire du sein. Une large masse vésicale est visualisée sur le patch intestinal uniquement, avec des adénopathies s'étendant des vaisseaux iliaques au hile rénal droit. Nous réalisons une exérèse du segment iléal avec préservation du trigone, associée à une cytoréduction tumorale complète. La vessie est reconstruite avec un nouveau segment d'iléon. L'analyse pathologique confirme le diagnostic de carcinome lobulaire métastatique. Les patients porteurs d'entérocystoplastie d'agrandissement nécessitent un suivi à long terme pour détecter les signes évocateurs d'une tumeur vésicale. Nous rapportons notre expérience d'une lésion métastatique exceptionnelle sur patch iléal d'agrandissement vésical. Des caractéristiques inhabituelles de la tumeur vésicale ainsi que l'historique oncologique du patient pouvaient suggérer une lésion métastatique.

[Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation]. / Évaluation urodynamique de patients guéris d'incontinence urinaire d'effort post-prostatectomie radicale après implantation d'une bandelette sous-urétrale transobturatrice.

INTRODUCTION: The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence. PATIENTS AND METHODS: In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®). RESULTS: Urodynamic studies were performed after a median time of 9months (min 4 - max 34) following sling implantation. Postoperatively, a rise of 11cm H2O in median MUCP (P=0.09) and an increase of 14mm in median FUL (P=0.13) were observed. None of the urodynamic changes was statistically significant. CONCLUSIONS: Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies. LEVEL OF EVIDENCE: 4.

[A case of autoinjection of vaseline under penis skin]. / A propos d'un cas d'auto-injection pénienne de vaseline.

We report the case of a 24-year-old rumanian patient who came to the emergency department complaining of glans penis pain and tight phimosis; he claimed to have undergone an injection of vaseline under penis skin. We review the literature on various nonmedical practices of penile foreign body injection to enlarge and thicken the penis.