We report a case of sperm cell seminoma caused by trauma. The data in the literature indicate the frequency is less than 5 % of all seminomas. This case was exclusively located in the gonads and was a pure form. Orchidectomy with high ligature of the cord and adjuvant radiotherapy at the dose of 25 Gy centered on the para-aortic and subdiaphragmatic chains is adequate treatment. When inguinoscrotal surgery is performed, this zone must be irradiated with 25 Gy. Prognosis is satisfactory: 5-year survival is 100 % with this protocol.
We report a case of sperm cell seminoma caused by trauma. The data in the literature indicate the frequency is less than 5% of all seminomas. This case was exclusively located in the gonads and was a pure form. Orchidectomy with high ligature of the cord and adjuvant radiotherapy at the dose of 25 Gy centered on the para-aortic and subdiaphragmatic chains is adequate treatment. When inguinoscrotal surgery is performed, this zone must be irradiated with 25 Gy. Prognosis is satisfactory: 5-year survival is 100% with this protocol.
Bladder outlet obstruction in women is a rare entitiy, and difficult to diagnose. In our series most of the patients had previous history of gyneco-obstetric or urological procedures. Cystometry enabled us to diagnose the coexistence of bladder instability and obstruction in 38 % of the patients. We did not find statistically significant differences between the patients with and without BI in terms of degree of obstruction measured by uroflowmetry and pressure/flow studies. Pressure/flow studies and Uroflowmetry had been the essential key in the diagnosis of obstruction in our series. Cysto-urethrography and urethroscopy were normal in over 50 % of patients. The urethral calibration was abnormal in 16 % of the cases.
Considering the poor long term results with the bladder neck suspensions, the poor results with the retropubic approach in obese or intrinsic sphincter deficiency and the complexity of the classical retropubic sling procedure, a simple vaginal sling urethropexy approach was developed. The vaginal mucosa is opened at 12 o'clock under the urethra. Dissection of the endopelvic fascia is undertaken. Polypropylene sutures are placed at the 4 corners of a free 2 x 4 cm rectus abdominis muscle flap which is suspended under the bladder neck transvaginally. Polypropylene sutures are tied at the rectus muscle through a 3 cm suprapubic incision. 25 patients were operated by one single surgeon. 7 had previous uretropexies. Previous hysterectomies: 8. Average age: 57. Average weight : 67.6. Severe stress incontinence was demonstrated in 23 patients. 9 patients had mixed incontinence. Average protective pads per day pre-op : 4.1. OR time : 93.8 min. Blood loss was minimal. 10 patients had transient post op retention (24 days average). 1 bladder perforation. 2 incisional hernias. 6 suprapubic wound infections. Average hospital stay : 5.95 days. The average follow up was 22 months. All patients were either cured (76 %) or improved. 73 % were satisfied (questionnaire). Despite a longer OR time, and the incidence of transient post op retention, this vaginal sling urethropexy approach is a simple and efficient procedure. It can be useful in previously operated or obese patients. It is easier to perform than the more conventional retropubic or combined (retropubic and vaginal) sling urethropexy.
We report on a case of hydatic cyst of the kidney, in a 12 year-old male, revealed by an acute urinary retention. After a brief report of the common signs of this parasitic disease, we emphasize the importance of hydaturia and acute urinary retention as another revealing sign of this disease.
Gangrene of the male external genitalia (GMEG) is characterized by necrotizing cell evolving toward necrotizing of the soft tissues of the male genitalia and possibly death. The cause may be primary infection called Fournier's gangrene (5 %) or secondary infection (95 %) due to general or local factors. GMEG is a real urinary emergency because of its local and general complications which lead to death in 20 % of cases. Precocious and massive antibiotherapy, a surgery to unbridle and possibly reanimation, oxygenotherapy, urinary diversion or colostomy, are required. We have treated 55 men with this affection from january 1988 to may 1996. Mean age was 58 years (range 20 to 85). The prodromial period was about 12 days. Toxi-infectious shock was noted in 8 patients (14 %). Six patients (10 %) developed renal acute insufficiency. Lesions were localized to the male external genitalia in 24 cases and stretched to the inguinalis, to the abdomen or to the thorax in 34 patients. The cause was a stricture of urethra in 23 cases (41 %) diabetes in 18 cases (32 %), anal abscess in 7 cases (13 %). No etiology was found in 6 cases (10 %). Emergency treatment involved three antibiotics, surgery to unbridle necrotizing tissue in all patients, reanimation in 20 patients (35 %), oxygenotherapy in 4 patients (7 %), colostomy in 2 cases and urinary drainage in 23 patients (42 %). Free skins grafts were necessary in 6 patients (10 %), 5 patients (9 %) died due to septic shock. On the basis of these observations and a review of the literature, we analyzed the ethiopathogenic, bacteriological and therapeutic aspects of this affection marked by high mortality in spite of therapeutic progress.
We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.
Testicular metastasis of prostate cancer rarely occurs. Bilateral localization is exceptional. We report a new case of prostate adenocarcinoma with bilateral testicular metastasis. The diagnosis was made on clinical and ultrasonic arguments, and confirmed on the pathological specimen. Treatment consisted in a bilateral orchidectomy, associated with nonsteroid androgens.
Three cases of symptomatic umbilical residues revealed by hematuria and/or mictional disorders are reported. Ultrasonography, computed tomography and magnetic resonance imaging visualized an aspecific formation of the bladder dome. Total exeresis requiring partiel cystectomy in all cases was curative (tow years follow-up). All clinical signs have disappeared.
We report an unusually uncommon case of genitourinary rhabdomyosarcoma in a child which was chemoresistant and complicated by a primary psoas abscess which presented as a pelvic mass associated with an abscess of the right iliac fossa. Ultrasound and CT investigations suggested the diagnosis of a centropelvic tumor which was confirmed at puncture-aspiration. MRI was most contributive giving a precise description of the local extension. Intensive multi-drug chemotherapy would appear to have improved outcome in patients with poor-prognosis Maurer group III tumors. In exceptional cases when no tumor response is obtained, carcinological surgery with large dissection, possibly with adjuvant radiotherapy, is indicated. Percutaneous drainage of the deep psoas abscess is as effective as classical surgery and spares the abdominal wall, particularly important if a second operation should be needed. Multidisciplinary management is required for the treatment of this highly malignant tumor.
We report an unusual case of urethra polyp in a young child which caused obstruction of the lower urinary tract. Endoscopy was successful.
We report our experience of continent sigmoidostomy. The technique consisted in urinary diversion with sigmoid pouch and hydraulic valve. Eleven patients underwent this procedure (10 men and 1 women, mean age 48 years, range 20 to 77 years). Indications were bladder tumor in 7 cases, bladder exstrophy in 2 patients, neurogenic bladder in 1 case and 1 bladder with a small capacity secondary to a stricture of traumatic urethra. The pouch was made according to the detubularized model. The sigmoid was opened on its antimesenteric edge, leaving the distal portion of the sigmoid intended to do the sigmoid valve. The posterior edges of the colonic segment opened were alined then secured by a Dexon 3/0 whipping then the anterior adges were secured, as the former after reimplantation of the ureters according to Camey Leduc or Politano Leadbetter's procedure. The post operative follow-up was marked by a fistula of the pouch in one case treated by securing it. All the patients were continent day and night. The purpose of this study was the description of the technique and the results of the continent sigmdidostomy.
A series of 32 treated cases of Fournier's gangrene is analysed. All patients were male, their age ranged from 19 to 59 years. In 16 cases (50 %) the aetiology of gangrene was urethral (37,5 %), anorectal (12,5 %) and in the 16 remaining cases (50 %) there was no identifiable cause. Mortality was with (28 %) despite broad spectrum antibiotics and aggressive surgical debridement. This mortality was essentially associated to advanced age, debilitated state, delay in diagnosis and toxi infectious context. The average hospital stay was 26,5 days.
We report on the case of a young pregnant woman who had a malignant tumor of the kidney. The pregnancy did not change the gold standard therapy : radical nephrectomy. Because of the pregnancy the preoperative staging consisted of an abdominal ultrasound and a magnetic resonance imaging for the local extension, and of a chest X-ray looking for pulmonary metastases. According to the literature pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.
Two prostatic cysts have been diagnosed by us since 1993. The first patient presented with dysurial the second cyst was discovered incidentally. Transrectal ultrasound examination was useful for diagnosis. Treatment was a puncture - aspiration of the cyst in the first case, and abstention in the second one. A review, of the epidemiological, pathological and therapeutic aspects of the prostatic cysts is presented.
We report two cases of retroperitoneal liposarcoma that required multiple surgical excisions for locoregional relapse diagnosed by surveillance based on CT-scan. One patient has had adjuvant radiotherapy. With the literature review, we discuss the pathologic and therapeutic aspects of these lesions.
We report on 4 cases of urinary stone observed in patients treated with the drug Crixivan(R) (Indinavir Sulfate) and review the literature. Comments include stone composition, clinical aspects, treatment and prevention.
We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.
Hemangioma of urinary tract are unusual, being about 2 % of all hemangiomas. We present a case of a glans penis hemangioma. There is controversy concerning their treatment and outcome. Our patient was treated with a Neodymium : Yag laser irradiation, with complete morphological recuperation.
Hemangioma of urinary tract are unusual, being about 2% of all hemangiomas. We present a case of a glans penis hemangioma. There is controversy concerning their treatment and outcome. Our patient was treated with a Neodymium: Yag laser irradiation, with complete morphological recuperation.
