Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience

BACKGROUND

Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys.

OBJECTIVES

The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy.

METHODS

From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes.

RESULTS

Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis.

CONCLUSIONS

For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.

Abrikossoff's tumor of the penis: a case report

Background

Granular cell tumors (GCTs) also called Abrikossoff's tumor are rare tumors of often benign neurogenic origin, mainly located in the craniocervical region, rarely found in the external genitals. We report in this article the case report of a purely cutaneous case of rare clinical presentation at the level of the penis.

Case presentation

We report the case of a man, aged 54, with no history, consulted for a nodular lesion on the penis evolving for a year. a nodular cutaneous plate, indurated 3 cm in large diameter, painless and mobile in relation to the deep plane. The lymph node areas were free, and the remainder of the skin examination was without abnormalities.

Conclusions

Granular cell tumors (GCTs) also called Abrikossoff's tumor are rare tumors of often benign neurogenic origin, mainly located in the craniocervical region, rarely found in the external genitalia, the diagnosis is based on anatomopathology study completed by immunohistochemistry, and treatment consists of complete surgical excision of the tumor.

Transvaginal and transobturator autologous vaginal tape cystocele treatment: About an uncommon case

Background

Case presentation

Conclusions

•

Since the transvaginal mesh ban autologous tissue repair has become the cornerstone of all vaginal prolapse surgery.

•

Autologous tissue repair is easy, fast and inexpensive and postoperative fibrosis provides sufficient support for quality anchorage.

•

Techniques using autologous material on the basis of TVT and TOT techniques seems to have a high tolerance and long-lasting functional effectiveness.

Safety and feasibility of same-day discharge laparoscopic radical prostatectomy: a systematic review

Purpose

Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP.

Methods

A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines.

Results

Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system.

Conclusions

Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00345-022-03944-1.

Laparoscopic nephrectomy: Moroccan experience of 68 cases

Background

The aim of this study was to analyze the feasibility and the safety of laparoscopic nephrectomy in the treatment of pathologies of the upper urinary tract through the experience of the Urology B department.

Methods

We have retrospectively and monocentrally selected patients who underwent laparoscopic nephrectomy from January 2017 to December 2019. The collection was carried out on archived files, based on demographic, clinical and perioperative data. The primary endpoint was the occurrence of complications and secondarily the length of the operation and the length of hospital stay. The statistical analysis was carried out using the SPSS software.

Results

A total of 68 patients were included in our series. The average age of our patients was 57.8 years. There was a slight female predominance: 39 female patients (57.4%) for 29 male patients (42.6%). Indications for nephrectomy were dominated by renal tumor (33.82%) followed by lithiasis (16.17%) and non-functioning kidney (16.17%) at the same rank. During the study period, 31 (45.6%) simple nephrectomy, 26 (38.2%) total nephrectomy, 1 (1.5%) partial nephrectomy and 10 (14.7%) nephroureterectomy were performed in our department. In our series, the average operating time was 180 min. Estimated blood loss averaged 321.8 ml with extremes of a few milliliter to 1100 ml. Intraoperative complications were reported in 10 (14.7%) patients; conversion was necessary in 6 cases (8.82%). The postoperative follow-up was straightforward in 53 (77.94%) patients with an average hospital stay of 3.6 days. The rate of postoperative complications according to Clavien–Dindo was 22.1%. Histological examination of the nephrectomies carried out in our department revealed mainly chronic non-specific pyelonephritis in 24 (35.3%) patients, followed by renal cell carcinoma in 23 (33.82%) patients and urothelial carcinoma in 9 (13.2%) patients.

Conclusion

Laparoscopic nephrectomy appears to be an efficient and reliable technique. This technique has led to a significant improvement in operative morbidity, mainly represented by the length of hospital stay, operating time and blood loss.

Histology of variants of urothelial carcinoma of the bladder: a Moroccan series of 39 cases

Background

The variant of urothelial carcinoma (UCV) is a rare and aggressive histological entity; its therapeutic management remains debated.

Methods

Between January 2017 and October 2019, 39 patients were diagnosed retrospectively with urothelial carcinoma with a histological variant. The aim of this study was to analyze the clinico-pathological and therapeutic aspects of these variants to better understand this invasive disease.

Results

In 39 cases, 36 (92%) were men and 3 (8%) were women; the average age was 62 years; 54% of patients had a ≥ cT3 stage with clinical lymph node involvement in 28% and 23% had distant metastases, 36% of patients were treated with RC and 54% by other therapeutic and 10% refused RC. No patient received neoadjuvant chemotherapy. Lymph node involvement was 28.5%. The two predominant histological types were squamous and micropapillary differentiation between the operating piece and bladder biopsy 28.5%, 30% and 21.5% and 13%, respectively. The overall survival at 20 months was 70 and 40% for RC and the other therapeutic (TURB alone or a TURB with an adjuvant), respectively. There was no significant difference in survival between the two groups (p = 0.27).

Conclusion

UCVs are heterogeneous groups of tumors which are increasingly identified due to their distinct morphological characteristics with variable clinical prognosis. Therapeutic management is not in favor of cystectomy in our study. However, a prospective study using a larger cohort is still necessary to validate our results.

Leiyomyosarcoma of the inferior vena cava with right renal invasion: about a case report

Background

Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor that develops from the wall of the IVC and can be confused with many other retroperitoneal tumors. We report the observation of a man with leiomyosarcoma of the vena cava which invades the right kidney.

Case presentation

56-year-old man who has seen progress for right back pain for over a year. His thoraco-abdominal-pelvic scanner found a right tumor process measuring 18 × 13 × 18 cm invading the right kidney and the inferior vena cava, heterogeneous in nature, which is enhanced after injection of iodinated contrast product, pushing back the liver and the gall bladder. A border of separation persisted between the mass and the abdominal and thoracic walls. His biological assessment was normal. He underwent an open right nephrectomy with intraoperative bleeding requiring a transfusion of 2 red blood cells. The patient's follow-up period was 8 months without local recurrence or secondary localization.

Conclusion

The LMS of IVC is a tumor whose management is not yet well codified. Surgery is the only therapeutic means that gives good results, when it is possible. But long-term recurrences remain frequent, which therefore requires prolonged monitoring of these patients.

Study of risk factors for urinary colonization in patients with the double J catheter

Background

The aim of this study is to evaluate the prevalence of urinary colonization in patients with the JJ stent and to define the predictive factors associated with this colonization.

Methods

This is a monocentric prospective study (between January 2013 and April 2017), conducted in the department of Urology B of Ibn Sina Hospital in Rabat. One hundred and forty-five double ureteral stents carried by 120 patients, 25 of which had bilateral double ureteral stent, were examined. The bacteriological profile of the urine of our patients was followed by the completion of an initial urine examination and another at the time of the removal of the JJ. The comparison of the means was made by the Student's test and the Mann–Whitney test for continuous variables and by the KHI-2 test and Fisher's test for qualitative variables. The threshold of significance is set at 0.05.

Results

The rate of colonization of JJ stent was 35.8% (43 out of 120). The urinary colonization rate was 31.7% (38 out of 120). Average time of indwelling of JJ stent was 90 days.

On double ureteral stent culture, we identified Escherichia Coli as the most predominant colonizing pathogen (47.3% of probes) followed by Enterococcus faecalis and Klebsiella pneumoniae (18.4% and 15.8%, respectively). 11.5% of colonized patients developed infectious complications (5 out of 43) and have been treated successfully except a patient who died from septic shock.

In univariate analysis, diabetes mellitus (p = 0.007, OR = 4.1, CI = 1.46–11.48), urgent establishment of JJ (p = 0.03, OR = 4.61; IC = 1.08–19.6) and time of indwelling of the JJ (p = 0.05, OR = 1.89, CI = 0.95–3.77) were the predictive factors for urinary colonization in patients with JJ. In multivariate analysis, these three factors were statistically associated with this risk: diabetes mellitus (p = 0.005, OR = 0.23, CI = 0.08–0.64), the urgent establishment of JJ (p = 0.05, OR = 0.26, CI = 0, 06–1.04) and time of indwelling of the JJ more than 30 days (p = 0.007, OR = 4.29, CI = 1.49–12.37).

Conclusion

The prevalence of urinary colonization in patients with the double J stent was 31.7%. Diabetes mellitus, time of indwelling of the JJ more than 30 days and urgent JJ ​​ establishment are associated with a higher risk of these urinary colonizations.

Strict monitoring is therefore recommended in patients with these risk factors. These results should be confirmed by multicenter and randomized studies to analyze the development of urinary tract infections in colonized patients.

Testicular epidermoid cyst: about a case report and a review of the literature

Background

The testicular epidermoid cyst is an exceptional benign tumor. The presumptive diagnosis is facilitated by the development of medical imaging (echo-Doppler, elastography, contrast-enhanced ultrasound, MRI). The confirmatory diagnosis is histological.

Case presentation

We report the case report of a 37-year-old man who had a history of repetitive orchitis. He had complained of right scrotal discomfort for 6 months with no associated urinary symptoms. We performed an extemporaneous biopsy given the uncertain diagnosis (Fig. 3), and the histological examination was in favor of a mature teratoma. This prompted us to perform a right orchidectomy. The postoperative was simple. The final histological examination tipped in favor of an epidermoid cyst of the testicle. The patient was seen again at one month, and his clinical examination was normal.

Conclusion

The testicular epidermal cyst is a rare benign tumor of the testicle. Currently, conservative surgery has become the gold standard thanks to the development of medical imaging to differentiate between the both forms of TEC, and it retains certain limits which lie in the differential diagnosis with the teratoma requiring large multicenter studies to better characterize these two entities.

[Retroperitoneal fibrosis at the Ibn Sina University Hospital of Rabat: about 18 cases]

La fibrose rétropéritonéale (FRP) est une pathologie rare caractérisée par la formation d´une plaque fibro-inflammatoire dans l´espace rétropéritonéale en avant de l´aorte abdominale, responsable d´un engainement des uretères. Le tableau clinique n´est pas spécifique et la pathologie est souvent révélée par une uropathie obstructive. Nous avons mené une étude descriptive rétrospective étendue sur 10 ans, de janvier 2006 à décembre 2016, réalisée dans les services d´urologie B et de néphrologie du Centre Hospitalier Universitaire Ibn Sina. Nous avons inclus 18 patients dans l´étude dont 11 hommes et 7 femmes, avec un âge moyen de 51,4 ans ± 11,2. Le diagnostic a été révélé par des douleurs lombaires chez 14 patients. L´insuffisance rénale obstructive était présente chez 15 de nos patients et le diagnostic de FRP a été posé par l´uroscanner. Le bilan étiologique notait des antécédents de néoplasies pour 2 patients, de pathologies inflammatoires pour 2 autres patients et une chirurgie rétropéritonéale chez un patient. On notait l´association de prises médicamenteuses chroniques chez plus de la moitié des patients. Le traitement comportait un double volet: une sonde double J systématique chez tous les patients et un traitement systémique par de la corticothérapie et des immunosuppresseurs selon le profil évolutif. Le traitement par urétérolyse a été réalisé d´emblée chez 3 patients. L´évolution a été favorable avec une nette amélioration de la fonction rénale chez 12 patients. La rechute est survenue chez 2 patients après 2 ans de suivi. L´association de signes généraux à une insuffisance rénale obstructive doit faire évoquer le diagnostic de FRP. La recherche de causes secondaires devrait être systématique, avec un accent particulier à mettre sur le syndrome d´hyper IgG4 et les pathologies néoplasiques.

[Bacteriological correlation of urinary stones and preoperative urine culture: Is there a significant impact on postoperative infectious risk? (Moroccan experience)]

AIM

The objectives of this study were to evaluate the impact of preoperative urine culture and the infected nature of stones on the occurrence of postoperative urinary sepsis.

MATERIAL AND METHODS

A prospective monocentric study included 29 patients operated on for urolithiasis between January and June 2018.

RESULTS

Postoperative urinary sepsis was observed in 4 patients (14%). Urinary colonization rate on preoperative CBU exam was 27.6% (8 of 29) while the rate of colonized stones was 31% (9 of 29). The occurrence of urinary sepsis was observed in 37.5% (3 of 8) of patients with urinary colonization, compared to 44.4% of patients with colonized stones (4 of 9). By comparing the bacteriological results observed during sepsis, the germs isolated in postoperative urine were the same found in the culture of stones. The chemical nature of the colonized stones was mainly calcium oxalate (monohydrate, dihydrate) P=0.02. There was a statistically significant correlation between the preoperative urine culture, the bacteriological culture of stones and the postoperative urinary sepsis (P=0.05, P=0.005) respectively.

CONCLUSION

Our study demonstrated a strong association between the bacteriological culture of stones and postoperative urinary sepsis superior to preoperative urine culture. It makes it possible to anticipate the occurrence of sepsis in patients requiring many endoscopic treatments. However, several multicentric prospective series may prove necessary to validate these results.

LEVEL OF EVIDENCE

3.

[Malignant renal epithelioid angiomyolipoma (EAML): about a rare case]

L’angiomyolipome rénal épithélioïde malin (AREM) est une entité pathologique rare longtemps considérée comme lésion hamartomateuse et dont le diagnostic positif est purement immuno-histochimique, microscopiquement, il se caractérise par des cellules mononuclées épithélioïdes a cytoplasme clair présentant des atypies cytonucléaires sévères, et exprimant les marqueurs musculaires lisses et mélanocytaires (HMB 45). Nous rapportons un cas rare d’AREM diagnostiqué après analyse anatomopathologique d’une tumeur retropéritonéale dont l’origine ne pourrait être précisée préalablement par la tomodensitométrie.

[Favorable evolution after medical treatment in three cases of emphysematous pyelonephritis: about 3 cases]

La pyélonéphrite emphysémateuse est une infection nécrotique du rein caractérisée par la présence de gaz au sein du parenchyme rénal, des cavités excrétrices ou des espaces péri rénaux. Il s'agit d'une forme grave pouvant engager le pronostic vital. La prise en charge reste controversée: entre l'attitude chirurgicale et le traitement purement médical, il existe une place pour le drainage percutané. Nous rapportons 3 cas de PNE traité par des antibiotiques seuls avec une bonne évolution, nous montrons à travers que le traitement médical pourrait suffire.

Penile Gangrene and Necrosis Leading to Death Secondary to Strangulation by Condom Catheter

Condom catheters are widely used in the management of male urinary incontinence, bedridden patients, and geriatric population. They are considered to be safe; however they are associated with serious complications in case of an incorrect use. We report a dramatic case of penile strangulation by condom catheter tardily discovered till occurrence of necrosis and gangrene leading to death in an elderly bedridden and diabetic man. Through this case we emphasize the importance of patient education for the correct use of condom catheters and remind care providers to maintain a high level of sensibility to complication generated from long-term use of condom catheters.

Bilateral kidney matrix stones: a rare case

Kedney matrix stones are a rare form of calculi. Flank pain and urinary tract infections (UTI) are the most common presentations of matrix calculi. The diagnosis is usually made at surgery, but some preoperative radiographic findings might be suggestive. Open surgery was the method of choice for treatment. However, combination of ureterorenoscopy and percutaneous nephrolithotomy (PCNL) was found to be safe and effective. We report a rare case of renal and ureteral matrix stones that were diagnosed and treated by open surgery. We also describe its clinical, radiological and therapeutic features through a review of the literature.

[Seminal vesicle cyst: about a case]

Nous rapportons le cas d’un patient présentant un kyste de la vésicule séminale droite symptomatique. Au terme du bilan (échographie pelvienne et endo-rectale, tomodensitométrie abdomino-pelvienne et l’imagerie par résonance magnétique), le patient était opéré et bénéficiait d’une ablation du kyste. A la lumière de cette observation, l’épidémiologie, le diagnostic et les options thérapeutiques sont discutés.

Fibrose rétropéritonéale: revue de littérature

La fibrose rétropéritonéale (FRP) est une maladie rare, caractérisée par la présence d’un tissu fibro-inflammatoire aberrant qui se forme souvent autour de la portion sous-rénale de l’aorte abdominale et des artères iliaques. Une obstruction urétérale est souvent observée. Récemment, la FPR idiopathique est rapportée parmi les manifestations de la maladie à IgG4. L’imagerie joue un rôle important dans le diagnostic de la FRP. Les glucocorticoïdes sont le traitement de référence, utilisés en monothérapie ou en association avec d’autres agents médicamenteux. En cas d’échec des mesures conservatrices, la chirurgie peut être proposée. Récemment, des techniques minimalement invasives ont été utilisées.

Zinner's syndrome: report of two cases and review of the literature

BACKGROUND

Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs between the 4th and the 13 h gestational week, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. Cysts of the seminal vesicle may appear with a mass effect, dysuria, epididymitis, or obstruction of the gastrointestinal and genitourinary tracts. Approximately two thirds of them are associated with ipsilateral renal agenesis, because both the ureteral buds and seminal vesicles originate from the mesonephric (Wolffian) duct. They were first described by Zinner in 1914, and 200 cases of seminal vesicle cysts associated with ipsilateral renal agenesis have been reported in the literature. Most patients with this anomaly are asymptomatic until the third or fourth decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Transrectal ultrasonography provides good visualization of the pelvic structures and allows guidance for aspiration of the cysts.

CASE PRESENTATION

We present two cases of seminal vesicle cyst. The first patient had dysuria, increased frequency of urination, and haematuria. He was operated and benefited from a removal of the cyst with right ureterectomy and left ureteral reimplantation. The second patient had disorder of the digestive transit and he benefited from a laparoscopic removal of the cyst.

CONCLUSIONS

Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Usual symptoms that are caused by the seminal vesicle cysts are bladder irritation and obstruction as well as pain in the perineum and scrotum. Epididymitis is frequently found. Treatment consists to removing the seminal vesicle cyst.

Urethral hemangioma: case report and review of the literature

Hemangiomas are benign vascular tumors. They are the prerogative of the liver and skin. And genitourinary localizations are rare and have only been rarely reported in the prostat, bladder, ureter or the perineum. In the light of published cases, urethral hemangiomas are mostly found in males. Few cases of hemangioma in the female urethra were reported. We report a cavernous hemangioma of the urethra in a 61 years old patient who presented bleeding from the urethra and micturition disorders. Physical examination revealed a tumor 3 cm x 2 polyploid arising from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma.

Leiomyoma: a case report of a rare benign tumor of the female urethra

Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. It often appears in females during their reproductive age (from menarche to menopause); the mean age of their appearance is approximately 41 years. Less than 100 cases were reported in the literature. We hereby report a case of a 52-year-old White woman who presented with complaints of dysuria and urinary tract infection. The mass was completely removed by transvaginal excision with a rim of normal tissue. Histopathological studies confirmed the urethral leiomyoma. The patient remained asymptomatic and there was no evidence of recurrence in the followup.

Penile cancer: about ten cases at the University Hospital of Rabat, review of the literature

The aim of our study was to report the status of penile cancer sites in the urology department at the University Hospital of Rabat and evaluate long-term results of surgical treatment of this cancer. Patients and Methods: Between 1989 and 2015, 10 patients were treated for penile cancer. 10 cases were retrospectively reviewed and the following data were recorded: mode of revelation, seat, staging, TNM stage, treatment, evolution and survival. The mean age of patients was 58,1 years (48-81 years). All patients had squamous cell carcinoma of the penis. Six patients had a partial amputation of the penis, and three patients underwent total amputation. The median size of the lesion was 4.25 cm (1.5-8 cm). All tumors had a distal seat (gland- Furrow balanopreputial), 8 were localized and non-invasive (PT1 - PT2) and 2 had infiltrated the urethra (PT3). Four patients had lymph node localization. A single bilateral lymphadenectomy was performed and was positive only on one side, with a node <3 cm and no extracapsular extension. Two patients were referred for chemotherapy, a neoadjuvant referred to basic (Bleomycin - Methotrexate, Cisplatin) the other in a palliative goal. Median follow-up was 42 months (6 -72mois). Four patients died, one of which was presented immediately with metastatic mode. Six patients were alive at last node or local recurrence negative. Cancer of the penis seems rare in Morocco. His oncologic and functional outcomes (sexual and urinary) depend on the precocity of the treatment. The surgery of lymph node resection with lymphadenectomy remains the reference treatment.

Cavernous hemangioma of the bladder: an additional case managed by partial cystectomy and augmentation cystoplasty

Cavernous Hemangioma of the Bladder (CHB) is benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent complain. CHB is suspected by cystoscopy and radiologic findings and confirmed by pathologic examinations. Management is controversial due to the bleeding risk of this highly vascularized lesion. Partial cystectomy is the treatment of choice for surgically accessible lesions. However, it appears that small lesions could be treated using transurethral resection. Since CHB is a rare case, we report another case treated successfully with a partial cystectomy associated with an augmentation cystoplasy.

[Not Available]

Le syndrome du canal d’Alcock – ou névralgie pudendale – est lié à la compression chronique du nerf pudendal dans la fossette ischio rectale ou au niveau du ligament sacroépineux. Le diagnostic du syndrome d’Alcock est surtout clinique. Les examens complémentaires sont dominés par les explorations électrophysiologiques et le test de bloc anesthésique. Le diagnostic repose sur des critères bien précis, soit les critères de Nantes. La prise en charge doit être globale, comprenant un traitement médicamenteux, des infiltrations, des techniques de neuromodulation, et dans les cas graves ou résistants, un traitement chirurgical qui consiste à libérer le nerf pudendal. Les névralgies pudendales peuvent être rencontrées après traitement d’une incontinence urinaire d’effort par bandelettes sous-urétrales (TVT). Ce syndrome motive des consultations en urologie, car la douleur intéresse le territoire du périnée et des organes génitaux. Des signes urinaires peuvent aussi accompagner cette douleur. Il est donc judicieux de connaître cette pathologie.

[Para testicular lipoma: about a rare case]

Les tumeurs para testiculaires sont des tumeurs rares et complexes qui ont une symptomatologie insidieuse et pauvre. Les formes bénignes représentent 70%. Le lipome para testiculaire étant le type le plus fréquent. L'examen clinique est peu spécifique. L'examen échographique est la pierre angulaire pour assoir le diagnostic. Le traitement chirurgical s'impose en cas de tumeur symptomatique, l'histologie étant habituellement typique permet la confirmation diagnostique. Le pronostic est bon malgré d’éventuelles récidives.

Partial substitution of the ureter using a double short segments of the ileum following the Monti procedure

The partial substitution of the ureter using a pediculated double short segments of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization.

L’éjaculation prématurée : Approche psychosomatique et prise en charge

L’éjaculation précoce est une dysfonction sexuelle très fréquente, caractérisée par la perte de contrôle de l’éjaculation, qui entraîne une anxiété de performance et, par conséquent, une altération de la qualité de vie des patients et de leur partenaire. Son étiopathogénie est multifactorielle et sujette à controverse. L’approche thérapeutique reste difficile malgré les divers traitements possibles.

[Vesico-sigmoid fistula complicating intestinal hydatid disease: report of a rare case]

La fistule colo-vésicale sur une hydatidose sigmoidienne est une entité pathologique exceptionnelle. Nous rapportions une nouvelle observation, ou seront rappelées les principales données diagnostique et thérapeutique de cette affection.

L’absence segmentaire et congénitale de la veine cave inférieure: cause rare de l’hématurie macroscopique, à propos d’un cas

L'absence de la veine cave inférieure (VCI) est une anomalie congénitale peu fréquente, au retentissement clinique habituellement discret. Nous rapportons le cas d'un jeune homme de 19 ans, au passé de pesanteurs pelviennes chroniques, présente un épisode d'hématurie macroscopique chez qui l’échographie rénale a montré un hématome péri rénal. L'uroscanner puis l'angioscanner mettront en évidence un hématome périrénal et une agénésie segmentaire de la VCI dans sa portion sous rénale et une agénésie partielle de veine iliaque droite, avec drainage azygos et volumineux réseau de suppléance péri rénal. Nous rapportons le cas d'une agénésie du segment sous rénal de la VCI et de la veine iliaque droite.

Secondary reconstruction of vaginal stenosis using a posterior labial perforator based Falandry flap

The aim of vaginoplasty should be the creation without excessive morbidity of a neovagina that will be satisfying in appearance, function and feeling. The multitude of methods described in the literature indicates the fact that an ideal approach has not yet been found. In this paper the authors describe the technique for repairing vaginal stenosis by interposing between the vaginal walls, a skin flap pedicled removed using the Falandry technique at a high lip. We achieved a satisfactory result.

[Diverticulum of the female urethra: about 18 cases]

Le diverticule de l'urètre ou poche sous urétrale est une affection rare, d’étiopathogénie non clairement établie, le diagnostique est clinique confirmé par l'urétrocystographie et le traitement est principalement chirurgicale consistant en une diverticulectomie par voie transvaginale. Nous rapportons l'expérience de notre service dans la prise en charge de cette affection en présentons une étude rétrospective sur une durée de 14 ans (entre 2000 et 2014) où on a pris en charge 18 patientes qui présentait un diverticule de l'urètre, l’âge moyen était de 36 ans, une symptomatologie urinaire ramenait les patientes à consulter où le diagnostic de DU a été posé par examen clinique confirmé en précisant ses caractéristiques en urétrocystographie, la prise en charge était chirurgicale et consistait en une diverticulectomie par voie transvaginale. Les suites post-opératoire était simples, la sonde vésicale retirée en moyenne 5,8 jours après l'intervention, on n'a noté aucune complication chez toute nos patientes, hormis un cas de récidives repris. Devant des troubles mictionnels récidivants de la femme, il est indispensable de rechercher un diverticule uréthral à l'examen clinique. La diverticulectomie transvaginale est l'intervention de choix offrant les meilleurs résultats.

[Angiomyolipoma of the kidney: about eight cases]

L'angiomyolipome est la tumeur bénigne la plus fréquente des masses dolides du rein, elle représente un cadre de fréquence de 1 à 3% des tumeurs du rein, sa composition histologique est faite de trois contingents: graisseux, fibres musculaires lisses et vasculaires a des proportions variables, elle sévit sur un cadre sporadique et peut s'exprimer dans un cadre congénitale comme manifestation de la sclérose tubéreuse de Bourneville. Nous rapportons l'expérience du service d'Urologie B du CHU IBN Sina de Rabat dans la prise en charge de huit cas d'angiomyolipome sur une période s’étalant sur six ans en précisant les manifestations cliniques, données de l'imagerie, le résultat histologique et la conduite thérapeutique. Les manifestations cliniques ne lui sont pas spécifiques, elle peut se manifester par des lombalgies, crise de colique néphritiques, hématurie, masse palpable dans le flanc. La TDM reste l'examen radiologique le plus sensible en mettant en évidence la présence de graisse au sein de la masse, l'histologie confirme le diagnostic et il n'y a aucun consensus qui régit la prise en charge de ce type de tumeur, on peut admettre une surveillance pour les petites masses de moins de 4 cm et traité les formes symptomatiques ou qui dépasse les 4 cm par embolisation ou chirurgie partielle ou totale. Les nouvelles thérapeutiques focales peuvent révolutionner la prise en charge de ce type de tumeur bénigne, mais les études sont toujours en cours.

Rhabdomyosarcome paratesticulaire (RMSP) multimétastatique: à propos d’un cas

Nous rapportons, dans le présent article, le cas clinique d’un RMSP découvert à un stade tardif chez un adolescent, dans le but de confirmer l’évolution fatale de cette pathologie au potentiel métastatique « affreux ». Nous discutons aussi les causes du retard diagnostique, l’implication du sous-type histologique comme facteur pronostique et la place de la chimiothérapie dans le traitement des formes évoluées de la maladie.

[Bladder tumor in young patients: about 36 cases]

Les tumeurs de vessie sont rares avant 40 ans et ne représentent que 1 à 4% de l'ensemble de ces tumeurs. Notre étude s'est intéressée au profil épidémiologique, caractère histologique ainsi que le profil évolutif. Nous avons réalisé une étude retrospective sur une durée de 10 ans entre mars 2004 et mars 2014, nous avons traité 850 patients pour tumeur de vessie dont 36 était âgé de moins de 40 ans. Le diagnostic était posé devant des arguments cliniques, radiologiques et endoscopiques, la cystoscopie avec résection tumorale a précisé la nature histologique et son grading ainsi que le degré d'infiltration. 23 patients avaient une tumeur de vessie non infiltrant le muscle et 13 avaient une tumeur infiltrant le muscle. Le taux de récidive global est de l'ordre de 36,4%, 22% pour la tranche d’âge 20-30 ans et 46% pour la tranche d’âge 31-40 ans. Le risque de progression et de décès est respectivement de 8% et de 6,1%. Il ressort que les tumeurs superficielles ont une meilleure évolution chez les sujets de moins de 30 ans. Les tumeurs infiltrantes sont plus fréquentes et souvent évoluées suggérant un potentiel évolutif particulier. Leur pronostic est fonction du stade tumoral, sans corrélation avec l’âge.

[Place of beating heart bypass surgery in kidney cancers with supradiaphragmatic invasion: about seven cases]

Ce travail vise à analyser les résultats de la néphrectomie avec thrombectomie atrio-cave sous circulation extracorporelle (CEC) chez sept patients ayant un cancer du rein avec envahissement cave supra-diaphragmatique et de discuter les indications opératoires. Sept patients, six hommes et une femme dont l’âge varie entre 46ans et 65ans, ont été opérés d'un cancer du rein avec extension atrio-cave. L’écho-doppler a toujours permis la mise en évidence de l'extension veineuse mais la limite supérieure du thrombus était formellement identifiée par l'examen tomodensitométrique quatre fois, et par la résonance magnétique nucléaire dans tous les cas. Tous les patients ont été opérés sous CEC à cœur battant en normothermie. Un seul décès postopératoire est survenu. La durée du séjour en réanimation a été de 4,5 jours. Cinq patients ont eu à distance une dissémination métastatique. Cinq malades ont eu une médiane de survie de 11,5 mois (de 7 à16). Un malade a subi une métastasectomie pulmonaire 6 mois après la néphrectomie. L'exérèse des thrombi atrio-caves a été facilitée par la CEC avec une mortalité et une morbidité postopératoires acceptables mais les résultats à distance ont été décevants. Cette intervention ne peut être proposée qu'aux patients n'ayant aucune extension locorégionale et générale décelable, ce qui souligne l'importance des examens morphologiques préopératoires.

[History of pelvic prolapse]

The history of pelvic prolapse back to the era of the pharaohs, about 1500 years before Christ. Hippocrates practiced succussion. Grenades, pieces of soaked linen were used as pessaries.Over the centuries, the eolution in understanding of this female pathology led to different treatment modalities, some of which we can currently seem strange.

Névralgies pudendales : À propos de trois cas

Les névralgies pudendales, ou syndrome du canal d’Alcock, sont des douleurs périnéales déclenchées par la position assise et dont le diagnostic est clinique. La positivité des blocs anesthésiques confirme ce diagnostic. Cependant, les conduites thérapeutiques restent parfois subjectives. Par l’analyse de trois cas cliniques de patients suivis en consultation d’algologie, nous essayons de distinguer entre les patients qui nécessitent un traitement chirurgical d’emblée, et ceux qui peuvent être mis sous traitement médicamenteux exclusif. Nous découvrons également la valeur du facteur temps dans la prise en charge de cette maladie invalidante.

Syndrome de levée d’obstacle : physiopathologie et prise en charge

Le syndrome de levée d’obstacle est une polyurie massive faisant suite au traitement d’une insuffisance rénale obstructive. Les mécanismes physiopathologiques sont multiples : un état de surcharge hydrique qui dépend du caractère complet ou incomplet de l’obstacle, des anomalies tubulaires (atteinte de la capacité de dilutionet de concentration des urines, diminution de la réabsorption dusodium, fuites de potassium, troubles de l’acidification des urines, insensibilité des cellules tubulaires à l’hormone antidiurétique), ainsi que des facteurs biochimiques et immunologiques sont mis en jeu. La levée d’un obstacle nécessite une surveillance clinique et biologique stricte (diurèse horaire, état hémodynamique, état d’hydratation, créatininémie, urémie, ionogramme sanguin). Letraitement a pour but d’éviter les troubles hémodynamiques etmétaboliques graves, et repose sur le principe de la compensation des pertes hydroélectrolytiques.