[Hydatic kidney cyst: 90 case reports]

The hydatid cyst of kidney is rare, it ranks third among all visceral localisations. The authors report a series of 90 cases renal hydatid cyst from 1972 to 2000. The middle age is 36 years with female predominance. Renal hydatid cyst often has a suggestive clinical presentation; flank mass in 84%, pain in 74% and sometimes a specific presentation hydaturia in 29%. The hydatid serology is positive in 55% and preferring ultrasonography and computed tomography in diagnosis of renal hydatid cyst. Surgical treatment is now well defined. Conservative treatment occupes a predominant place 84% and resection of the proeminent dome is usually efficient. Total nephrectomy should only be considered in the case of a completely destroyed kidney (16%) of cases. Post-operative course is generally uneventful and reexpansion of renal parenchyma is observed in 93% indicating the benign nature of this disease.

[Symptomatic bladder calculi: diagnostic and therapeutic aspects]

The authors report the case of a 50 years old woman who consulted with bilateral lumbar pain and urinary infections. Intravenous Urography (IVU) showed bilateral renal and bladder stones. Treatment was by upper polary nephrectomy in the left kidney. Removing all urinary and bladder stone. We then the removed surgically renal stones in the right kidney. Using this case as an we discuss the diagnosis and therapeutic aspects of the hydrocalyx.

[Bladder stone surrounding a foreign body: a case report]

The bladder can be the site of various foreign bodies. We report one case of bladder stone including a foreign body in a 24 years old man with a psychomotor deficiency who was admitted for pyuria, block miction and bladder symptoms. The pelvic X-Ray film showed a bladder stone including a sewing needle. We analysed the diagnosis, aspect and therapeutic management of this case.

[Emphysematous pyelonephritis: a case report]

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.

[A rare cause of urinary obstruction: urogenital tuberculosis]

The authors reported a rare cause of urogenital tuberculosis complicated by an obstructive acute renal failure in 44 years old man with solitary anatomic kidney. The authors insisted of using the upper urinary tract opacification by percutaneous nephrostomy for diagnosis, the urogenital tuberculosis with this exploration, we can suspected the tuberculosis by abnormalities of the radiologic imagine, and confirmed the koch bacilli urinary into urinary tract. The upper chance of positives of finding koch bacilli in higher than urinary bladder.

[Local recurrence of paratesticular rhabdomyosarcoma]

We report an uncommon case of scrotal recurrence of embryonal paratesticular rhabdomyosarcoma in 19 year old man after 3 years later. The diagnosis was suspected clinically and confirmed by histopathology study after resection of the scrotal tumor. About this case, the authors discuss the diagnosis and the management of this tumor.

[Renal angiomyolipoma complicated by retroperitoneal hematoma]

Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

[Pheochromocytoma and von Recklinghausen's disease]

The association between von Recklinghausen's disease and pheochromocytoma is present about 10% of cases. We report a case of 49 years old women who presented with elevated blood pressure and von Recklinghausen's neurofibromatosis. Laboratory examination showed a marked level in the urinary excretion of cathecholamine. The computed tomography showed a right adrenal tumor suggesting a pheochromocytoma. The adrenalectomy was realised by transabdominal approach and the histological examination confirmed a benign pheochromocytoma. The authors discuss the pathogenetic hypothesis of this rare pathological association, the diagnostic methods and the therapeutic procedure.

[Surgical complications of nephrectomy in living donors]

Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.

[Anatomoradiologic correlations in prostate benign hypertrophy. Report of a series of 220 cases]

In our daily practice, the reliability of ultrasonography (US) and digital rectal examination (DRE) is limited by many factors. The aim of our study is to correlate between the prostatic volume assessed by the DRE, the pre operative US results and the actual weight of the enucleated or endoscopic resection benign prostatic hyperplasia (BPH). We report a serie of 220 patients with BPH treated by endoscopic resection or by open surgery. The mean age is 65 years (40-90 years old). Ultrasonography was performed in 92% of the cases, and transrectal ultrasound only in 8%. All our patients either underwent endoscopic resection (49.6%) or adenomectomy (50.4%). We found a high correlation between the prostatic volume assessed by DRE and by ultrasonography (r = 0.79; P < 0.0001) and the weight of the piece of surgical adenomectomy (r = 0.701, P < 0.0001). However, the volume of benign prostatic hyperplasia assessed by US did not correlate with the piece of endoscopic resection (r = 0.214, P < 0.05). This study and a review of recent literature enabled us to notice the various anatomical and radiological factors implicated in this correlation.

[Retrovesical pseudocyst : difficult diagnosis of one case and literature review]

Retrovesical localization of a cystic mass is rare. The authors report one observation of hematic retrovesical pseudocystic formation having a difficult diagnosis. In the light of this observation, different diagnostic patterns of cystic and pseudocystic retrovesical formation are discussed.

[Intradiverticular bladder tumors. Three case reports]

The bladder tumours in vesical diverticula is rare, and the poor prognosis, because it was often with early invasion. We reported three cases of bladder tumours in vesical diverticula, with delay of diagnosis two, eight and twelve months respectively. The radiology exploration suspected the diagnosis and the histology biopsy confirmed a diagnosis of primary transitional cell carcinoma in two cases: PTa GI and T2 GII, and in an other case it was a invasive epidermoid carcinoma. The first patient was dead by urethral resection of the bladder tumour. The second required a cytoprototectomy and the last patient. The treatment consisted of radiotherapy and chemotherapy. We insisted of the particularity diagnosis, histology and therapeutic for bladder tumour in vesical diverticula and the early diagnosis in order to have a good prognosis.

[Yolk sac tumor. Report of a case]

Yolk sac tumor is rare in adult. We report a case in a young man aged of 23 years treated by orchiectomy, chemotherapy and retroperitoneal lymphadenectomy. Diagnosis is based on pathology who shows other cellular contingents. Treatment is based on orchiectomy and chemotherapy is indicated for residula masses. The prognosis is bad because metastasis is frequent.

[Percutaneous nephrostomy in emergencies. Report of 42 cases]

PURPOSE

Through this work we are going to demonstrate the interest and the contribution of the percutaneous nephrostomy in obstructive anuria and in pyonephrosis.

PATIENTS AND METHODS

It is a retrospective study concerning 42 cases. The average age of the patients is 50 years (19-80 years). The sex-ratio is 26 men for 16 women. The nephrostomy was realized in first intention or after failure of ascent stent on 33 patients for an obstructive anuria and nine patients for a pyonephrosis.

RESULTS

Improvement of the renal function was noted in 100% of obstructive with anuria and apyrexy in every case of pyonephrosis. No major complication arose during the realization of the nephrostomy. The long-term prognostic depends on the etiology.

CONCLUSION

The percutaneous nephrostomy constitutes a saving, effective and temporary solution in the strategy of the coverage of obstructive anuria and pyonephrosis.

[Kidney cancer. Report of 170 cases]

PURPOSE

The goal of this study is the analysis of the diagnostic and therapeutic aspects of this affection which is usually discovered at a delayed stage in our context.

MATERIAL AND METHODS

A retrospective study of 170 renal cancer, collected during a period of 15 years (1985-2000). Ninety-two men and 78 women were studied, their mean-age was 50 years (15-81 years). The diagnosis was relied on clinical, radiological and histological arguments.

RESULTS

Lumbar pain, hematuria and enormous mass were present in 85 cases (50%). The ultrasound and computed exams permitted the diagnosis and also evaluated the venous and locoregional extension. The treatment consisted on large nephrectomy practiced in 114 patients (67%), abstention in 56 cases (33%) due to the advanced stage of the tumor. The histological exam concludes to clear cell adenocarcinoma in 91.2% of cases.

CONCLUSION

The authors deplore the delayed diagnosis of renal cancer in our context which is responsible of a high rate of abstention (33%); and underline the interest of the early diagnosis for an adequate management.

[Seminal vesicle cyst associated with ipsilateral renal agenesis]

The seminal vesicle cyst associated with ipsilaterale renal agenesis is a rare entity. Through this case report, we analyse the clinical aspects, the importance of imaging techniques and the various therapeutic possibilities. The patient, age 24, presented perineal pain accentuated at ejaculation. The digital rectal examination showed a pre-rectal lump. Transrectal ultrasound plays an important role both for the diagnosis and the treatment. The treatment was perineal aspiration under transrectal echography control. The follow-up was satisfactory.

CONCLUSION

The seminal cyst with ipsilareral renal agenesis is a rare congenital malformation, transrectal ultrasound is an excellent imaging technique for diagnosis, the perineal aspiration of the cyst constitutes a therapeutic alternative.

[Giant scrotal condyloma acuminata: a case report]

In this study, the case has been reported of a scrotal tumor in a 50-year old male admitted with a large warty lesion at the base of the scrotum which resembled a giant condyloma accuminatum (Buschk-Lowenstein tumor). The HIV serology was negative, but the papillomavirus findings were positive. A complete resection of the tumor was performed. The histological findings confirmed the diagnosis of condyloma accuminatum without evidence of degenerative development into a squamous cell carcinoma. The clinical course was favorable, and no local recurrence was observed at 16 months follow-up. The problems that are frequently encountered in the diagnosis and therapy connected with this type of tumor have also been discussed.

[Extra-adrenal pheochromocytoma discovered peroperatively]

In this study, an uncommon case has been reported of an ectopic pheochromocytoma without the presence of any clinical symptoms. The radiological investigations showed a right retroperitoneal tumor without any kidney involvement. The diagnosis was established by biopsy and subsequent histological findings. In the course of surgery as the large tumor mass was being removed, tachycardia was observed which caused the resection to be performed as rapidly as possible. Once the tumor had been removed, bradycardia occurred, followed by cardiac arrest: although the latter was stabilized after cardiac massage, the patient died one hour after the operative field had been closed. In addition to this case report, the diagnosis, therapeutic strategy and prognosis regarding an ectopically located pheochromocytoma have been discussed.

[Leiomyoma of the urinary tract]

Leiomyomas of the urinary tract are benign and uncommon forms of tumor. In the present study, two cases have been described of leiomyomas situated in the bladder. Following this description, the pathological characteristics and the diagnostic and therapeutic aspects of these lesions have been examined. The clinical symptomatology depends on the tumor site, and this type of lesion is more frequently found in women.. Treatment mainly consists of endoscopic resection, but may involve cystectomy. The prognosis for patients with this type of tumor is invariably favorable.

[Phenotype B primitive adrenal lymphoma, diagnosed by percutaneous aspiration biopsy]

The authors report a case of primary adrenal lymphoma in a 30-year old-female who complained of lumbar pain and was in poor general condition. Ultrasonography and CT scan revealed a heterogeneous mass with necrosis in the left adrenal gland. Non-Hodgkin's lymphoma of B-cell origin was determined by ultrasound-guided aspiration biopsy of the adrenal mass. Taking this case and the findings in the literature into consideration, the features of this disease have been reviewed and the problem of diagnosis, treatment and prognosis have been examined.

[A new case of pseudotumoral renal tuberculosis]

The incidence of urogenital tuberculosis is still frequent and constitutes a current public health problem in Morocco, a country in which tuberculosis is endemic. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon, and in this study this disease has been described in a young patient. The radiological findings suggested the possibility of this lesion being renal cancer. The preliminary diagnosis was corrected and a definitive diagnosis of pseudotumor was made following pathological examination of the surgically-removed kidney.

[Bivalve anatrophic nephrolithotomy]

PURPOSE

In the era of lithotripsy, surgery gets a limited place in the management of renal stones. This study has for a goal to evaluate the practice, indications and results of anatrophic nephrolithotomy in the treatment of staghorn calculi.

PATIENTS AND METHODS

Between 1998 and 1999, six patients, mean age 37 years, had complete staghorn calculi treated by anatrophic nephrolithotomy, and two patients had a bilateral lithiasis. After lombar incision, the kidney was incised on the convexity after pedicular control. In this way, we have extracted all lithiases. The nephrorrhaphy permits hemostasis and parenchymal reparation. A ureteral stent was placed.

RESULTS

The operatory follow-up was simple; hemostasis was controlled by fast extraction of the lithiasis and nephrorrhaphy. The operating time was 70 minutes (40-110). The stone free rate was 100% without alteration of renal function, patients with bilateral lithiasis have been operated twice time.

CONCLUSION

The anatrophic nephrolithotomy is a safe technic without risk of haemorrhage or renal function alteration.

[Stab wound to the left solitary kidney: report of a case]

A forty-four-years old man with a left solitary kidney presented a stab wound in the left lumbar region. Upon admission, the patient was hemodynamically stable, the abdominal ultrasonography showed a small perirenal hematoma and the intravenous pyelography was normal. Two days later, he had no hematuria and was discharged from the hospital, with a computed tomography scan control two weeks later. Unfortunately, seven days later, the patient was admitted to emergency for left lumbar pain, a 40 degrees C fever and pyuria. The creatinine level was 72 ng/mL, and the computed tomography scan showed a large urohematoma. The patient was operated and required partial upper polar nephrectomy for distorted upper pole with infected hematoma. A large hematoma was removed and a nephrostomy tube was introduced. The renal function returned to normal six days postoperatively and the nephrostomy tube was removed after nephrostogram at 12 days. Concerning this uncommon case, we emphasize the advantage of the computed tomography scan and the necessity of emergency management in a patient with solitary traumatic kidney.

[Isolated testicular tuberculosis: report of a case]

In this study, a case has been reported involving a 66-year old male who was admitted for scrotal pain on the right side with possible testicular involvement, but with no associated urinary disorder. At physical examination, the right testicle was found to have increased in volume: this was further confirmed by ultrasonography, but the findings were insufficient to exclude the hypothesis of testicular cancer. An exploratory orchidectomy by upper inguinal route was therefore carried out, and histopathological examination showed the destruction of testicular tissue by several granulomas, and caseous necrosis with giant cells. Antibacterial chemotherapy was administered after an i.v. urography found no evidence of abnormality or urinary disorder, thereby eliminating an active site of genitourinary tuberculosis. This case shows the importance of considering testicular tuberculosis in the differential diagnosis of testicular enlargement in a region where this disease is endemic, despite the absence of systemic pulmonary and urinary signs of tuberculosis.

[Fibrous pseudotumor of the vaginalis testis: report of a case]

In this study, the authors have reported a case of a benign fibrous pseudotumor of the tunica vaginalis testis in a 24-year old man who was admitted with a left scrotal mass. Scrotal ultrasound and surgical investigation demonstrated the presence of a left testicular tumor; radical orchiectomy was performed by inguinal route. Microscopic examination revealed a pseudotumor of the testicular tunica vaginalis. As this is an uncommon lesion and preoperative diagnosis is difficult, unnecessary radical orchidectomy is often carried out.

[Retroperitoneal sarcoma: report of 6 cases]

Retroperitoneal soft tissue sarcomas (RPS) are uncommon tumors. The diagnosis is frequently made later in the evolution of the disease due to the absence of specific symptomatology. Surgery with total resection of the tumor is the treatment of choice, but is only possible in 38 to 75% of cases. Six cases of RPS have been retrospectively reviewed; the mean time to diagnosis was 5 months; diagnosis was established via CT scan, which determined the retroperitoneal tumor location and its relationship to the neighboring organs. The most common symptoms were the presence of an abdominal mass and accompanying abdominal pain; signs of urinary and vascular compression were not found until later. Surgery with total resection was performed in 4 cases, and with partial resection in 2 cases. The histological findings were as follows: 3 liposarcomas, 2 rhabdomyosarcomas, and 1 fibrosarcoma. Tumor recurrence developed in 2 cases (liposarcomas), necessitating further surgery and complete resection. Two patients were lost to follow-up. RPS are characterized by locoregional relapse and metastases. Disease outcome depends on the histological type, tumor grade, and on the possibility of carrying out complete resection.

[Pyonephrosis: diagnosis and treatment: report of 14 cases]

Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.

[Surgical treatment of traumatic ruptures of the posterior urethra]

OBJECTIVES

To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra.

MATERIAL AND METHOD

35 patients with a mean age of 25 years (range: 7 to 79 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pelvis. When rupture of the posterior urethra was diagnosed, the subsequent management depended on the patient's general condition and associated lesions. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. This approach was applied in 16 patients (Group I). The other 19 patients (Group II) were only operated at the sixth month, after stabilization of all traumatic lesions.

RESULTS

Results were assessed in terms of the quality of the urinary stream, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continence was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexual impotence was observed in 18.7% (Group I) versus 5.3% (Group II).

CONCLUSION

Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sexual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, treated endoscopically, but with a lower incidence of sexual impotence.

[Renal leiomyoma. Case report]

The authors report a case of renal leiomyoma observed in a 56-year-old man. This cyst presented in the from of loin pain. Computed tomography revealed a homogeneous renal tumor. Treatment consisted of radical nephrectomy. Histological examination of the specimen showed benign renal leiomyoma.

[Should ipsilateral adrenalectomy be performed systematically during radical nephrectomy for renal cancer?]

The authors present a retrospective study of 46 patients with renal cell carcinoma treated by radical nephrectomy including ipsilateral adrenalectomy. CT scan showed a normal adrenal gland in all patients. Histology revealed the absence of adrenal metastasis in all patients. Ipsilateral adrenalectomy is not systematically required in radical nephrectomy.

[Isolated bilateral adrenal metastasis from renal cancer. Case report]

The authors report an uncommon case of bilateral synchronous adrenal gland metastases from left renal cell carcinoma. The diagnosis was established by abdominal ultrasound and computed tomography. The surgical approach initially consisted of left radical nephrectomy and ipsilateral adrenalectomy. Histologically, the tumor of the left adrenal gland was identical to the left renal cell carcinoma. Subsequent contralateral adrenalectomy showed an adrenal metastasis identical to the left renal cell carcinoma. Patient follow-up was good with no recurrence of the disease after one year. This is an uncommon case for renal cancer. The treatment and prognosis are discussed.

[Prostatic abscesses. A review]

We review the literature to the diagnosis and therapeutic aspect of prostatic abscess. The prostatic abscess having become an uncommon disease. The diagnosis of prostatic abscess has been nearly made by transrectal ultrasound and computed tomography scan. The best diagnostic method is considered to be the transrectal ultrasound. The choice therapy was intravenous antibiotic, and drainage by ultrasound guided transperineal percutaneous puncture.

[Perineal recurrence of resected penile cancer. A case report]

The authors report an unusual case of perineal recurrence of squamous carcinoma of the penis in a 50-year-old, white man, circumcised during infancy and operated 5 years previously for stage T3N0M0 squamous carcinoma of the penis by total amputation of the penis. Clinical examination revealed a very large, infected perineal tumour associated with bilateral inguinal lymphadenopathy. This stage T4N2M0 tumour was treated palliatively by cystostomy, emasculation with perineal tumour reduction and antibiotics. The patient became afebrile and the infection resolved and was referred to the radiotherapy department for further treatment.

[Pheochromocytoma. Report of 10 cases]

We report 10 cases of adrenal pheochromocytoma seen over a period 15-years. A female predominance was noted (8 women/2 men). Patients were aged between 16-46 years with a mean of 34 years. Clinical manifestations consisted of hypertension observed in all cases, with vasomotor symptoms (90%). Time to consultation was prolonged (mean: 23 months). CT scan performed in 7 cases showed pheochromocytoma in all cases, located on the right side in 6 cases, while one pheochromocytoma was located in Zukerkandal organ. All patients were operated via anterior approach and adrenalectomy was performed. A favourable course was observed in 90% of cases with normalisation blood pressure. One death was noted. Histological examination showed no malignancy in all cases.

[Diagnostic and therapeutic problems of an atypical cyst of the kidney]

Atypical renal cyst raises diagnostic and therapeutic problems. The authors report a case of atypical renal cyst which raised numerous diagnostic and therapeutic problems. The authors discuss theses problems in the light of this case. A farmer consulted for right lumbar pain without hematuria and hydaturia. Hydatic serology was negative. Ultrasonography and CT scan showed atypical cyst in favour of hydatic cyst. Surgical investigations showed a necrotico-hemorragic cyst, and cystectomy was performed. Histological examination revealed a chronic inflammatory process without malignancy. One year after the operation, clinical and radiological examination were normal.

[Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case]

Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.

[Lithiasis and ectopic pelvic kidney. Therapeutic aspects]

Kidney in ectopic position is dysplasic, and associated to other malformations. The advent of a lithiasis in these conditions rises questions about therapeutic options. We report on five observations of pelvic ectopic kidney with urinary lithiasis. Patients were aged from 16 to 42 years. Kidney was non functional in two cases, or with normal appearance sized 10 to 12 cm. We performed total nephrectomy in two cases, pyelolithotomy in the other cases. Surgical approach was subperitoneal via iliac route. A dismembered pyeloplasty was associated in one case. All patients did well. Radiologic control at 6 and 12 months showed no recurrence in a well functioning kidney. Surgical lithotomy is advocated as a treatment in urinary lithiasis affecting ectopic kidney. It is an easy procedure which permits correction of other associated malformations.

[Tumors of the bladder in women. Epidemiologic and therapeutic aspects. Apropos of 40 cases]

Bladder tumours in women. Epidemiological aspects and treatments, based on a series of 48 cases. Bladder tumours are more frequent in men than in women, in whom they present certain epidemiological, clinical and therapeutic characteristics. The authors report a retrospective study of 48 cases of bladder tumour in women, observed in the urology department over a 20-year period. These tumours represented 4.2% of all bladder tumours. The patients had a mean age of 59 years (range: 29 to 77). Only one patient was a smoker (2%). Haematuria was present in 93% of cases, and signs of bladder irritation were present in 60% of cases. All tumours were transitional cell carcinomas. The tumour was classified as stage 0 in 10 cases (20.9%), stage A in 15 patients (31.2%), stage B in 22 patients (45.8%) and stage C in 1 case (2.1%); no patients (0%) were classified as stage D. Our therapeutic protocol was established as a function of the stage of tumour invasion. For example, superficial tumours were treated conservatively by transurethral resection, either alone or combined with intravesical instillation. Radical surgery was performed whenever possible for invasive tumours. External urinary diversion was performed in 11 cases, ureterosigmoidostomy in 3 cases and enterocystoplasty in 5 cases. The clinical course of the 15 superficial tumours was marked by recurrence in 5 cases, while that of the 23 invasive tumours was marked by local recurrence (3 cases), renal failure (1 case) and 3 deaths.

[Laparoscopic adrenalectomy. A general review of a current technic]

The anatomical situation of the adrenal gland explains the diversity of the surgical incisions used for adrenalectomy. Laparoscopic adrenalectomy was first performed in 1992. It allows eradication of small adrenal lesions, which are often incidental findings. There are two routes of laparoscopic access to the adrenal gland: transperitoneal and retroperitoneal. Laparoscopy allows excellent operative exposure, reduction of postoperative pain and hospital stay and rapid convalescence. Retroperitoneoscopy, by allowing direct access to the retroperitoneum, is more rapid than the transperitoneal route.

[Hemospermia]

Haemospermia is a relatively frequent symptom in urology, especially in young subjects. It is often benign, but is important because of the anxiety it can cause to the patient. The predominant aetiology of haemospermia is prostatic and seminal vesicle disease. Iatrogenic aetiologies, generally without severity, are due to the development of instrumental diagnosis and treatment in urology. Recent progress in the field of medical imaging, particularly transrectal ultrasonography and magnetic resonance imaging, has greatly contributed to the diagnostic and therapeutic approach to haemospermia.

[Contralateral aneurysm-like adrenal gland metastasis of a renal adenocarcinoma]

The authors report a case of adrenal metastasis contralateral to a renal cell carcinoma in a 74-year-old patient who had undergone right radical nephrectomy for renal cell carcinoma. Nine months later, computed tomography revealed a hypervascular mass considered to be an aneurysm of the splenic artery. Arteriography led to the diagnosis of hypervascular adrenal tumour. Left adrenalectomy was performed. Histological examination showed a metastasis from renal cell carcinoma. This is an unusual form of renal cancer metastasis. Its treatment and prognosis are discussed.

[Calculus-induced anuria. Apropos of 25 cases]

The objective of this study was to analyse the clinical and therapeutic aspects of stone-induced anuria based on the analysis of 25 cases. The mean age of the patients was 51 years. The stones were bilateral in 54% of cases, and consisted of uric acid stones in 52% of cases. The diagnosis was based on laboratory and radiological findings. Dialysis was indicated in eight patients because of major metabolic disorders. Urinary diversion was performed by insertion of a ureteric catheter or percutaneous nephrostomy. The medium- to long-term prognosis was favourable in two-thirds of cases, but 3 immediate deaths were observed due to delayed diagnosis.

[Seminal vesicle cyst associated with homolateral renal agenesis and megaureter. Apropos of a case]

We report a case of a 24-year-old male patient with cystic dilatation of the seminal vesicle associated with renal agenesis and megaureter. This patient complained of left renal colic with pollakiuria. We performed intravenous urography and ultrasound showed a cyst in the seminal vesicle associated with left megaureter and right renal agenesis. Treatment consisted of resection of the cyst and reimplantation of the left ureter into the bladder. No postoperative complications were observed. This association is rare and can be explained by the common embryological origin of the seminal vesicle and kidney and ureter. Its diagnosis is now facilitated by ultrasound and CT. The treatment of this tumor is surgical only when the lesions are responsible for clinical symptoms.

[Epidemiology of urinary lithiasis]

The objective of this study was to analyse the epidemiological profile of urinary stones based on one thousand cases observed in our institution over a 10-year period. The mean age of the patients was 45 years and two-thirds of patients were males. The kidney was the commonest site of stones, in 57.8% of cases. The stone was radiopaque in 86.4% of cases and was a staghorn calculus in 12.2% of cases. An associated renal malformation was observed in 10.4% of cases. Urinary stones is therefore a common disease, essentially observed in a young population and characterized by recurrence. It therefore constitutes a public health problem and prevention consists of detecting recurrences and treating stone-inducing factors.