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.

[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.

[Retrovesical hydatid cyst. Apropos of 2 cases]. / Le kyste hydatique rétro-vésical. A propos de deux cas.

A hypogastric mass compressing the bladder in an adult, in a zone endemic for hydatid disease, should raise to suspicion of a retrovesical cyst, especially as the cyst sometimes opens into the bladder resulting in haematuria and hydatiduria. Intravenous urography and ultrasonography facilitate the topographical diagnosis. Treatment is surgical: transperitoneal cystectomy and pericystic resection as extensive as possible with exploration of the abdomen looking for other sites (liver, mesentery, omentum). This treatment was successful in the two cases reported here. In conclusion, a stable cure can be obtained by adopting a well defined therapeutic approach to these rare lesions.

[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.

[Calcified necrosing cystitis]. / La cystite nécrosante calcifiée.

Calcified necrotising cystitis is an urological curiosity, the authors report two cases. With subsidence of the acute process, regeneration and fibrosis take place, with contracture of the bladder and reduction of its capacity. Augmentation ileocystoplasty was performed with success in one case. The clinical and therapeutic aspects of this rare disease are discussed.

[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.

[Role of in situ alkalinization in the treatment of obstructive uric acid lithiasis]. / Place de l'alcalinisation in situ dans le traitement de la lithiase urique obstructive.

The authors report a series of nine reno-ureteral obstructive uric acid calculi initially treated by percutaneous nephrostomy. After attempting stone dissolution by in situ alkalinization, they discuss the place of such a method among the various treatments for uric acid stones.

[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 valves of the ureter. Apropos of 2 cases]. / Les valves de l'uretère. A propos de deux cas.

The authors report two cases of congenital ureteral valves of the upper third of the ureter complicated by renal stone in two children and diagnosed by I.V.P. The two patients underwent a resection of the pathological segment and a pelvic-ureteral anastomosis successfully. The review of the literature data regarding ureteral valves allowed to emphasize the uncommon of the bilateral form complicated by renal stone and the better preoperative diagnosis by ureteroscopy and antegrade pyelogram.

[Treatment of prostato-rectal fistulae. Apropos of 5 cases]. / Traitement des fistules prostato-rectales. A propos de 5 cas.

The authors report 5 cases of prostato-rectal fistulae. Two men were treated by a posterior approach and two by an abdominal approach because of associated lesions. They review all of the techniques of approaching the prostato-rectal fistulas. The transsphincteric approach provides excellent exposure and reliable closure of prostato-rectal fistulas: the concern for possible anal incontinence is unfounded. Additional security can be obtained by performing a colostomy beforehand.