[Continence disorders in hereditary spinocerebellar degeneration. Comparison of clinical and urodynamic findings in 55 cases]. / Les troubles de la continence dans les hérédo-dégénérescences spino-cérébelleuses. Confrontations des données cliniques et urodynamiques dans 55 cas.

Urodynamic exploration with cystometry was performed at random on 55 of the 195 patients suffering from hereditary spinocerebellar degeneration (Friedreich's disease 43 cases, Pierre-Marie hereditary ataxia nine cases, Strumpell-Lorrain disease three cases). The authors observed disturbances in continence without urinary disorders, even when the bladder was atonic. In the case of Friedreich's disease, among the 18 patients with urgent urination or with urinary leakage, the bladder was found to be normal in only two cases. Although 25 patients evidenced no urinary disturbances, a through study revealed nine abnormal bladders. In the case of Pierre-Marie disease, six normal bladders and three pathological bladders were found. A single abnormal bladder was found in Strumpell-Lorrain disease. Two types of pathological bladder were observed: the atonic bladder was compared with the traumatic bladder, and was found primarily in conjunction with peripheral sensory disturbances. The hypertonic bladder appears when sensory involvement is not evident. The authors discuss the pathophysiology of these disturbances of continence.

[Hereditary degenerative spinocerebellar diseases in Tunisia with manometric studies in bladder disorders (author's transl)]. / Les hérédodégénérescences spino-cérébelleuses en Tunisie, avec étude cystomanométrique des troubles sphinctériens. 204 cas de maladies de Friedreich, de Pierre marie et de Strumpell-Lorrain.

During a survey conducted in Tunisia in 1978, 204 cases of hereditary degenerative spinocerebellar diseases were discovered among members of 117 families. The cases included 109 patients with Friedreich's ataxia, 28 with Piere Marie's heredo-ataxia, 20 with Strumpell-Lorrain's disease, and 47 with intermediary forms. The latter group included incomplete forms of Friedreich's and Pierre Marie's diseases. The onset or progression of the disease was linked to a febrile episode in 25 p. cent of the cases. Emphasis is placed on the presence of bladder sphincter disorders in approximately one third of the patients with Friedreich's or Pierre Marie's diseases. Manometric studies in 17 cases demonstrated the presence of normal bladders in 4 cases, hypertonicity of the bladder in 5 patients, and hypesthesic retention-type bladders in 5 other cases. In 3 patients the disorder was difficult to classify. These results show that sphincter disorders should not constitute a criterium for exclusion of the diagnosis of spinocerebellar degeneration.

Retrovesical rare tumor: the schistosomial spermatocyst.

A case of large retrovesical tumor in a 50 year-old man is reported here. The diagnosis of schistosomial spermatocyst was made by histopathology. The authors underline the difficulty of the topographic diagnosis in large retrovesical masses.

[Echographic aspects of fused kidneys. Apropos of 2 cases]. / Aspects échographiques des reins concrescents. A propos de 2 cas.

Coalescent kidney is a rare variety of fused kidneys, clinical manifestations observed with the greatest frequency being a more or less painful abdominal mass, digestive disturbances and a complicating infection, calculus, renal failure or hematuria. Straight abdominal films (SAF), ultrasound tomography, SAF after colon insufflation and IVU can usually establish the diagnosis. Results of ultrasound imaging of this rare variety of ectopic kidney have apparently not been published. Apart from any complicating factor, the coalescent kidney corresponds to a discoid shaped subumbilical prespinal mass of oblong section. It appears as two highly echogenic central zones encircled by a less dense zone. No separation exists between the right and left portion, and furthermore a kidney cannot be identified in either lumbar fossa. These findings are useful for identification of a retroperitoneal mass, ultrasound imaging being of importance when IVU supplies insufficient data.

[Uretero-vaginal fistula. Apropos of 30 cases]. / Les fistules urétéro-vaginales. A propos de 30 cas.

The authors report 30 cases of uretero-vaginal fistulae collected in the department of Urology at Charles Nicolle's Hospital in Tunis. The majority of patients are multipare between 28 and 47 years old. The main causes remain gynecological and obstetrical procedures. The main motive of consultation was leaking of urine from the vagina; unfortunately the attendance to our clinic was late. IVP was performed in all cases; in 22 cases it showed a dilatation of the ureter, pelvis and calyces, on one side; in 3 cases it showed a non functional kidney and in 5 cases it was normal. Retrograde uretero-pyelography was performed for seven patients, twice in case of non functional kidney and five times after a normal IVP. In all cases it showed extravasation of contrast medium at the level of the fistula and the proximal portion of the ureter was not opacified. Treatment was by: reimplantation of the ureter in the bladder in 21 cases; end to end ureteric anastomosis in 5 cases; nephrectomy in 3 cases; in one case the fistulae healed by drainage. Control IVP was performed after a while and showed: success of the procedure in 15 cases; no change in 4 cases; an affected kidney in one case. Unfortunately diagnosis is never made at the time of surgery and this underlines the absolute necessity to check the ureter if there is any doubt about its integrity. In case of post operative complications it is important to request an IVP as soon as possible. In large fistulae reimplantation of the ureter by the Leadbetter-Politano technique, with fixation of the bladder to the psoas muscle, gave the best result in our hands. Postoperative follow up is necessary to detect any stenosis or reflux.

[Complete bladder retention secondary to a herpetic genital infection. Report of a case. Review of the literature]. / Rétention vésicale complète secondaire á une infection génitale herpétique. Rapport d'un cas. Revue de la littérature.

The authors report their experience of acute urinary retention due to genital herpetic infection. The data gathered by physical examination and laboratory investigations are of great diagnostic value. The urodynamic investigation provides a better comprehension of the pathogenesis of the phenomena. Bladder drainage is urgent. Complete resolution within a few days to three weeks is the general rule.

[Clear cell epithelioma of the kidney in a child. Apropos of a case]. / L'épithélioma à cellules claires du rein chez l'enfant. A propos d'un cas.

The authors report a case of renal hypernephroma in a child. This is an uncommon tumour which is very rarely diagnosed preoperatively. Its treatment is exclusively surgical. As in adults, the prognosis depends on the stage of the tumour at the time of discovery.

[Pelvic kidney. Apropos of 50 cases]. / Le rein pelvien. A propos de cinquante cas.

The pelvic ectopic kidney is a relatively rare congenital anomaly. It is situated below the horizontal level of the iliac crest. Fifty cases, collected over twelve years, are reported here: 47 unilateral PEK, 2 bilateral PEK, 1 solitary PEK. The main clinical patterns are outlined. The healthy ectopic kidney (18 cases): clinical complaints are derived from adjacent organs. The diseased ectopic kidney (32 cases). Urinary symptoms reveal the anomaly. Renal stones (21 cases) and uretero-pelvic junction disease (7 cases) are the most frequent lesions encountered. The diagnosis is based on IVP data. Ultrasonography and computed tomography are of great help: they avoid useless and expensive complementary investigations when clinical symptoms are misleading. Ectopic kidney should be treated as if it were in its normal position. However, surgical procedures that may be performed might be particularly difficult because of different anatomical environment and non-systematized blood supply.

[Role of the unstable bladder in certain pathologies of the lower urinary tract]. / Place de l'instabilité vésicale dans certaines pathologies du bas appareil urinaire.

The authors report their experience of 57 cases of unstable bladder, 20 cases of which were neurogenic in origin. It is a frequent disease encountered in 19% of cases. The sex ratio is one male/one female. Infants are not spared (17 cases). Unstable bladder is a urodynamic concept; therefore, diagnosis of certitude is based on cystometry. The analytic study enables the authors to underline the clinical symptoms, to establish the urodynamic criteria of detrusor hyperactivity and to enumerate the side effects on bladder and renal function. The different etiologies, organic or functional, of detrusor hyperreflexia are exposed. Finally, the therapeutic possibilities are discussed.

[Contribution of x-ray microanalysis to the study of the growth of a urinary calculus]. / Apport de la microanalyse x à l'étude de la croissance d'un calcul urinaire.

Growth mechanisms of urinary calculi were studied using a scanning electron microscope (SEM) and an x-ray microanalyser (WDS). The observations obtained by SEM and x-ray mapping suggest with calcium, phosphorus, magnesium, sulfur and potassium a possible schema of growth mechanisms for urinary calculi.

[Vesico-uterine fistula. Apropos of 5 cases]. / Les fistules vésico-utérines. A propos de cinq cas.

Five cases of VUF have been observed by the authors over a period of 15 years, reflecting the rarity of this condition. Based on a review of the literature, the authors present an exhaustive study of the various aspects of VUF: 1) aetiopathogenic features: they emphasise the rarity of the disease and its aetiology which is currently dominated by caesarean section; 2) clinical features with little variability in the symptoms (urine leak from the vagina with or without associated menouria) and the usually simple diagnosis based on a thorough clinical examination and routine complementary investigations (IVP, cystography...); 3) lastly the therapeutic aspects, based on surgical cure, which is almost always satisfactory. On the basis of their experience and their results, VUF constitutes a benign lesion, but a source of discomfort, which should be prevented.

[Urinary tuberculosis and bladder tumors. A case report]. / Tuberculose urinaire et tumeurs de vessie. A propos d'un cas.

The authors report the case of a patient presenting with both a bladder tumor and urinary tract tuberculosis. The bladder tumor was treated by transurethral resection and instillation of mitomycin C. The author describes this case and discusses this unusual association.

[Genitourinary malacoplakia. Apropos of 5 cases. A review of the literature]. / Malacoplasie génito-urinaire. A propos de cinq cas. Revue de la littérature.

The authors report 5 new cases of malakoplakia: 2 with kidney, 1 with prostatic and 2 with testicular involvement. The symptoms are not clinically specific, but pseudo-tumor forms are predominant. Four cases were treated by removal of the organ. Owing to a better understanding of its etiopathogenic mechanism, this disease can be treated by long-term antibiotic, cholinergic agonists and vitamin C therapy.

[Renal ectopic pheochromocytoma. A case report]. / Phéochromocytome ectopique rénal. A propos d'une observation.

The authors report the case of an ectopic pheochromocytoma without any clinical symptoms or laboratory signs which simulated a renal tumor during clinical and complementary investigations. The diagnosis was established by histology. The ectopic pheochromocytoma and the diagnostic problems of silent tumors are discussed.

[Renal transplantation from related live donors. Results and survival]. / Transplantation rénale à partir de donneurs vivants apparentés. Résultats et survie.

We report a retrospective study of 91 renal transplants from related live donors carried out at the Charles Nicolle Hospital, Tunis, between 1986 and 1993. There were 27 HLA-identical and 64 semi-identical. Classical immunosuppression based upon corticosteroids and azathioprine was used in the majority of cases. Surgical complications occurred in 15.4% of cases. 56% of patients had at least one acute rejection attack. There were 4 deaths, 3 related to infection and one to septic arterial rupture. Return to hemodialysis was related to chronic rejection in 5 cases and to recurrence of the initial nephropathy in one case. 5-year actuarial survival was 94% for recipients and 81% for grafts. In this series, acute rejection had no negative influence on graft survival and the difference between graft survival between HLA-identical and semi-identical patients was not statistically significant.

[Ureteral stenoses and fistulas after kidney transplantation]. / Sténoses et fistules urétérales après transplantation rénale.

We report a retrospective study of 100 renal transplants, the majority using kidneys from related live donors. We saw 6 ureteric stenoses and four fistulas. Three relatively small stenoses and two limited fistulas were treated percutaneously, all of them successfully. The transplant had to be removed in two patients with a ureteric fistula. Four stenoses and one fistula were treated successfully by open surgery. Actuarial survival of grafts with a urological complication was significantly shorter than that of transplants free of such lesions.

[Iatrogenic urethral stenosis. Apropos of 100 cases]. / Le rétrécissement urétral iatrogène. A propos de 100 cas.

Iatrogenic causes of stenosis of urethra appear to be increasing in frequency. 100 cases out of a total of 582 patients being of iatrogenic origin. The principal cause is the use of a urethral catheter. Various therapeutic methods are used, preference being given quite clearly to internal urethrotomy. Prevention is of fundamental importance and is based on the less untimely routine use of urethral catheters, particularly after general surgical operations and in intensive care.

[Asymptomatic tumors of the adrenal glands. Apropos of 5 cases]. / Tumeurs asymptomatiques de la surrénale. A propos de 5 cas.

Five "silent" adrenal tumors were reported. 3 of them were very large. Excision of tumor was enlarged to adjacent organs in 3 cases. On palpation a mass was felt in three cases, and in two cases the mass was accidentally discovered by ultrasound. Operation was performed with the diagnosis of adrenal mass in four cases. Microscopic examination revealed the tumor to be pheochromocytoma in 3 cases and adrenal cortex mass in two cases. Malignancy is confirmed from metastasis. Treatment was only surgical. Since no reliable preoperative investigations are yet available to assess the nature of adrenal masses, their surgical excision is indicated for microscopic examination.

[Reparation of sequelae of penile-scrotal and perineal gangrene. Apropos of 4 cases]. / Réparation des séquelles des gangrènes péno-scrotales et périnéales. A propos de 4 cas.

The authors report different techniques for surgical reconstruction of the sequelae of penile, scrotal and perineal gangrene. The repair of skin defects and the reconstruction of the scrotum requested several interventions. Where the scrotal skin loss was limited to a 1/2 of scrotum, the testis could be covered by mobilising the surrounding rim. When the disease was confined to the penis or inguinal region, skin cover has been provided by free grafts. More elaborate techniques of skin cover were necessary when the disease was extended to the whole scrotum: a fasciocutaneous flap from the thigh was used for reconstruction of the scrotum. The scrotal myocutaneous flap was used to cover skin and anterior urethral loss of tissue.

[The 1st 100 kidney transplants performed in Tunisia and their surgical complications]. / Les 100 premières greffes rénales réalisées en Tunisie et leurs complications chirurgicales.

The authors report their experience of renal transplantation based on the first 100 transplantations performed in Tunisia. The absence of legislation concerning organ harvesting from brain dead subjects has favoured renal transplantation from living donors. 20 surgical complications are reported and analysed.