[Aspects of evolving urogenital tuberculosis. 60 cases]. / Les aspects évolutifs de la tuberculose urogénitale. A propos de 60 cas.

Based on the results of a retrospective study of 60 patients treated between January 1984 and December 1994, the authors review the current clinical features of urogenital tuberculosis. The sex-ratio shows a male predominance of 65%. The mean age is 48 years. Cystitis and low back pain are the main symptoms of the disease. IVU, performed in all patients, showed pathological images in 98.3% of cases. Urine culture was positive in 23 out of the 50 cases in which it was performed. Serious forms were relatively frequent, with bilateral lesions in 12 cases, associated with renal failure in 4 of them, or unilateral renal destruction in 43 cases. All patients were treated with triple- or quadruple-agent tuberculostatic therapy. 54 patients required one or several surgical procedures: 43 nephrectomies, 7 ureterovesical reimplantations, 11 augmentation enterocystoplasties, 1 Bricker ureteroileostomy, 3 ureterostomies, 1 ureteric resection and 4 epididymectomies. Two patients admitted in a context of deterioration of the general state died during the days following admission. 56 patients were reviewed with a minimum follow-up of 6 months. Two were cured by medical treatment alone. Among the 54 operated patients, clinical improvement was obtained in 43 patients (91%) and radiological improvement was obtained in 33 of the 36 cases in which IVU was performed (91%). In conclusion, despite the various anti-tuberculosis campaigns, urogenital tuberculosis remains a serious disease, essentially because of the delayed diagnosis.

[The treatment of ureteroceles complicated by calculi]. / Traitement des urétérocèles compliquées de lithiase.

In a series of 13 adults with calculi in ureteroceles, 10 cases underwent endoscopic meatotomy associated with endoscopic lithotripsy. In 2 bulky ureteroceles with calculi, the authors performed excision of the ureterocele and reimplantation of the ureter. In one case, the authors successfully performed extracorporeal lithotripsy. The authors obtained good results in all cases. Endoscopic meatotomy with lithotripsy is a very useful procedure for treatment of small or medium sized ureteroceles with calculi in adults.

[Isolated, spontaneous hematoma of the kidney. Report of 2 cases]. / L'hematome spontane et isole du rein. A propos de 2 cas.

Spontaneous hematoma under the renal capsula is a rare pathology. The authors report two cases with one male and one female aged respectively of 50 and 63 years. The symptomatology is presented by right renal aches associated with repetitive and total hematuria in male and atypical abdominal aches in female. The radiological explorations (IVP, renal sonography and Computered Tomography) had conclude in a renal cancer in the two cases. The diagnosis is made by the pathologic study. Some etiology may be searched such as malignant tumor, an angiomyolipoma, vascular abnormalities and disturbance to the hemostasis. If no etiology is find, a nephrectomy or a simple supervision can be discussed.

[Female hypospadias. Apropos of 3 cases]. / L'hypospadias féminin. A propos de trois observations.

Female hypospadias (FH) is a rare congenital abnormality caracterised by total or partial agenesy of uretero-vaginal septum. We report there cases of this anomaly. In one case, FH was isolated. In the others two, it was associated with other genital abnormalities. The diagnosis was established in adult age. Urinary incontinence is the most constant revealing symptom. Treatment consists of an uretral reconstruction using the anterior wall of vagina. In one case, associated vaginal atresia was treated during the same operation. Perfect continence and good bladder emptying was noted in two cases. One patient had been reoperated to perfect the continence.

[Trans-symphyseal approach in the treatment of cervico-urethro-vaginal fistulas. Apropos of 2 cases]. / La voie trans-symphysaire dans le traitement des fistules cervico-urétro-vaginales. A propos de 2 cas.

We opted for a symphysiotomy approach in the management of cervico-urethro-vaginal fistulae in two patients. This approach offers an excellent exposure of the region of the bladder neck. After section of the symphysis pubis with a Gigli's wire saw, the anterior wall of the bladder was taken down to the fistulae and we excised the fistulous tract. Longitudinal closure of the fistulae and the bladder followed. Results were satisfactory and there were no urinary incontinence.