Plasmablastic lymphoma clinically presenting in the urinary tract.

Plasmablastic lymphoma is a high-grade B-cell lymphoma that poses major diagnostic problems and carries an extremely poor prognosis. This tumor was first described in the oral cavity of HIV+ patients but has since been identified in other sites and in seronegative patients. We describe 2 cases of plasmablastic lymphoma of the urinary tract that both presented with hydronephrosis. One occurred in an HIV+ patient and harbored a MYC translocation; the other, in an HIV- patient with no translocation detected.

Management of unusual genital lymphedema complication after Fournier's gangrene: a case report.

BACKGROUND: Fournier's gangrene is a bacterial infection characterized by necrotizing fasciitis, skin and soft tissue involvement, and eventually myositis of the perineal region. Aggressive debridement of devitalized tissue and overlying skin is of paramount importance, but often leaves large defects to be reconstructed. The present case reports successful extensive perineal defects coverage following Fournier's gangrene and management of subsequent penile lymphoedema impairing sexual function in a young patient. CASE PRESENTATION: Following perianal abscess drainage, a healthy young man presented with scrotal pain. Fournier's gangrene was diagnosed and treated with multiple surgical debridements. Tissue excision extended through the entire perineal area, base of the penile shaft, lower abdominal region, the inner thighs, and gluteal region, corresponding to 12% of the total body surface area. After serial debridements and negative pressure dressings, the defect was covered by two stages of skin grafting. Graft take was 90%. Healing was achieved without hypertrophic or retractile scar. However, chronic penile lymphedema remained and was first treated with compressive garments for 2 years. Upon failure of this conservative approach, we performed a circumcision, but only a "penile lift" allowed a satisfactory esthetical and functional result. CONCLUSION: Fournier's gangrene can be complicated by a chronic lymphedema of the penis. Conservative treatment is likely to fail in severe cases and can be treated surgically by "penile lift".

High-power potassium-titanyl-phosphate laser fibres for endovaporization of benign prostatic hyperplasia: how much do they deteriorate during the procedure?

OBJECTIVE: • To assess the residual power delivered at the tip of a high-power (80 W) potassium-titanyl-phosphate (KTP) laser (80 W Green Light PV(TM), Laserscope(®); American Medical Systems, Minnetonka, MN, USA) at the end of a photoselective vaporization of the prostate (PVP) procedure, as well as the deflection angle of the laser beam. MATERIALS AND METHODS: • In total, 65 laser fibres were collected at the end of PVP procedures indicated for symptomatic benign prostatic hyperplasia over a period of 17 months. PVP was performed by two senior urologists. • The power of laser beam at tip exit was measured for each fibre at the end of the procedures using a photodiode whose signal was amplified, and then quantified by a volt multimeter. • The deflection angle was measured using a graduated sphere. RESULTS: • Approximately 70% of fibres delivered less than 40 W at the end of the procedure, which is less than the vaporization threshold. • Some 9% of fibres had lost their diffraction capacity with a significant alteration of laser beam angulation. These values were not operator dependent. CONCLUSIONS: • The data show that a large proportion of laser fibers deliver a significantly underpowered beam at the end of the procedures. • This seems to be caused by peroperative destruction of the fibers, which results in a progressive loss of efficacy of PVP during procedures.

[Renal mass biopsy: usefulness and indications]. / Biopsies des masses rénales: utilité et indications.

Whereas renal biopsy is routinely performed in nephrology for the management of renal failure or follow-up of kidney grafts, it has historically been seldom used in urology for the work-up of kidney tumours because of its low yield. Since a few years however, some authors recommend to biopsy select renal lesions to improve their diagnosis and management. Indeed, biopsy technique has evolved, leading to better tissue sampling. Moreover, the risk of tumoral seeding of the needle tract has proven to be negligeable. Renal biopsy appears now to be useful for managing atypical solid renal lesions, those < or =3 cm, possible neoplastic lesions in solitary kidneys, bilateral renal tumours, putative renal metastasis, so as lesions in functionally deficient kidneys.

[Management of neurogenic bladder]. / Prise en charge de la vessie neurogène.

The neurogenic bladder is a complex entity whose clinical presentation ranges between a micturition and continence dysfunction. A specialized work-up which entails a well oriented patient history, a neuro-urologic pelvic examination so as a video-urodynamic study allows to caracterize functionally neurogenic bladders. This enables to diagnose a failure to store and/or to empty. Whether medical or surgical, management is further coordinated on a multidisciplinary basis by the urologist who is in charge of bringing together medical and paramedical caregivers. The patient may also benefit of a multidisciplinary consult. Regular long-term follow-up is essential, in order to ensure optimal equilibrium between storage and emptying bladder function, and to prevent significant renal and infectious complications.

[Living donor nephrectomy: the minimally invasive evolution]. / Prélèvement de rein chez le donneur vivant: l'évolution mini-invasive.

Living donor kidney transplant has considerably expanded over the last ten years, in order to increase the pool of renal donors. Selection and extensive work-up of the kidney provider is of paramount importance. The technique of harvesting has evolved simultaneously with minimally-invasive surgery. In our experience, the most appropriate technique is performed through hand-assisted retroperitoneoscopic access, since it ensures the high security of open harvesting, and provides the donor with the minimal invasiveness of endoscopic surgery.