Aggressive angiomyxoma is a rare benign mesenchymal tumor with local infiltrative potential and a high risk of local recurrence. Its occurrence in the paratesticular region is exceptional. We report the case of an 86-year-old male patient, with no significant past medical history, managed in our Urology Department for a recurrent paratesticular aggressive angiomyxoma. The patient underwent surgery three times for successive local recurrences, which were histologically confirmed. The current evolution is marked by a small, asymptomatic local recurrence under surveillance. This case illustrates the diagnostic difficulty, the complex surgical management, and the importance of prolonged follow-up for this rare entity.

Penile gangrene is a rare but severe clinical emergency, typically linked to advanced diabetes or chronic renal failure. We report the case of an 85-year-old male with a severe cerebrovascular history who presented with apparently localized glans gangrene. Although a standard partial penectomy was initially planned, intraoperative exploration revealed extensive deep corporal necrosis, ultimately necessitating an immediate conversion to a total penectomy. This case strongly highlights that surface clinical signs frequently underestimate deep tissue damage. Therefore, advanced preoperative imaging, particularly MRI, is crucial, and informed consent must explicitly include the potential need for total penectomy during unexpected surgical findings.

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic infection of the kidney, occasionally extending to adjacent organs. We report a 45-year-old woman with recurrent renal colic and left flank pain. Imaging showed a “bear paw” kidney with staghorn calculi and infiltration of the pancreatic tail. After antibiotic therapy, en bloc nephrectomy with splenopancreatectomy was performed. Histology confirmed XGP extending into the pancreas. Recovery was uneventful. Pancreatic involvement in XGP is extremely rare and may mimic malignancy; recognizing characteristic imaging features is crucial for accurate diagnosis and surgical planning.

Renal cysts are usually asymptomatic, and superinfection is rare. We report the case of a 90-year-old woman presenting with fever, flank pain, and vomiting. Laboratory tests showed leukocytosis and elevated C-reactive protein. CT imaging revealed an infected upper-pole renal cyst with inflammatory changes, without obstruction. Intravenous antibiotics (third-generation cephalosporin plus aminoglycoside) led to rapid improvement. Follow-up imaging demonstrated partial cyst regression and a small renogastric fistula, which closed spontaneously after one month of continued medical therapy. This case highlights an exceptionally rare complication of an infected renal cyst successfully managed without intervention.

Intra-vesical foreign bodies can be of variable nature and etiology, their introduction can be voluntary or not. The motivations most frequently associated with the presence of foreign bodies within the bladder are of a sexual or erotic nature. Various objects have been inserted into the bladder and many patients fail to remove them themselves and are very embarrassed to seek medical advice, which is the origin of a clinical picture which is most often atypical which occurs in a patient particular terrain.

Cystic adrenal tumors are rare with an incidence of approximately 0.06% in the general population. Four main histological types are distinguished: Endothelial cysts of lymphangiomatous or angiomatous origin, pseudocysts, epithelial cysts and cysts of parasitic origin. Surgery is recommended for signs of complications, suspicion of malignancy and large size. In other cases, simple surveillance can be proposed. We report here a case of a lymphangiomatous endothelial cyst of the adrenal gland. The objective is to recall the clinical characteristics and to specify the diagnostic contribution of imaging as well as the therapeutic modalities of this entity.

Urachal villous adenoma is a rare entity. We aimed to share a case of a giant villous adenoma that was treated surgically. Surgery was uneventful and flow up was normal.

Renal cell carcinoma (RCC) is rare in children and is usually found in late children. We present a case of a 14 year-old boy who presented with right lumbar pain. CT-scan showed a tumor in the upper pole of the right kidney measuring 15 cm. He underwent radical nephrectomy and histopathologic examination revealed RCC. No adjuvant therapy was given. After three years and half, there is no evidence of recurrence.

Isolated shwannoma of the urinary bladder is a very rare entity. We report a case of a shwannoma of the bladder that was diagnosed by an MRI and confirmed by histopathology after the patient underwent TURB.

Giant adrenal cysts represent rare clinical entities that are usually discovered incidentally. Here, we describe a patient who presented with nonspecific upper abdominal left pain. Imaging studies revealed a huge left adrenal cyst. Routine laboratory tests and endocrine function tests were all normal. The patient underwent surgery, and the cyst was completely removed with total adrenalectomy. Histological examination revealed a benign epithelial adrenal cyst.The postoperative course was uneventful and the patient had no evidence of recurrence during a 3-year follow-up. We discuss the diagnosis and management of adrenal cysts.

Objective. - To evaluate the influence of continent external urinary diversion type Mitrofanoff on male sexuality.Material and methods. - Between 1992 and 2011, 140 patients underwent continent urinary diversion type Mitrofanoff at an academic hospital. Among 76 men, 46 were interviewed about their sexuality after this operation. This study was performed using a set of validated questionnaires (IIEF, DAN PSS and Urolife), grouped by the model of the CTMH. Patients were divided according to their marital status: group 1: patients married before surgery (15 cases), group 2: patients married after surgery (7 cases) and group 3: singles (24 cases).Results. - In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology.Conclusion. - To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre- and postoperative evaluation will better clarify the factors affecting sexuality in these patients. (C) 2015 Elsevier Masson SAS. All rights reserved.

La perforation vésicale au cours de la résection transurétrale de tumeur de vessie est une complication largement sous-estimée. Si un simple drainage par sonde vésicale suffit dans la majorité des cas, le recours à la conversion chirurgicale reste rare. Nous rapportons 19 cas de perforation vésicale nécessitant une conversion chirurgicale par laparotomie. Il s’agit d’une perforation intrapéritonéale ou sous-péritonéale importante. Les caractéristiques cliniques, les résultats oncologiques à long terme, l’incidence et le temps d’apparition de la localisation extra-vésicale ainsi que la survie des patients présentant cette complication ont été étudié. La survie globale a été mesurée par la méthode de Kaplan-Meier. L’âge moyen est de 65 ans. Un antécédent de résection noté dans 12 cas, la taille moyenne de la tumeur est de 4,9 cm. La perforation est intrapéritonéale chez 15 patients et extrapéritonéale chez les 4 autres. Elle intéressait la face latérale dans 14 des cas. Le diagnostic est peropératoire dans 17 cas. Deux plaies grêliques étaient diagnostiquées. La majorité des tumeurs était de haut grade (15 cas) et classée au moins pt1 dans 15 cas. La progression était observée dans 5 cas. Deux récidives extra-vésicales étaient notées (paroi antérieure et psoas) survenant respectivement à 5 et 15 mois. La survie moyenne est de 41 mois, respectivement de 75 %, 50 % et 25 % à 1, 3 et 5 ans. Cette survie chute de façon significative dans le groupe des TVIM. La perforation vésicale au cours d’une RTUV nécessitant une réparation chirurgicale semble être plus fréquente chez les patients âgés présentant une tumeur de la face latérale sur une vessie déjà réséquée. Le taux de récidive et de progression seraient augmenté contre une baisse de la survie globale. Le taux de dissémination métastatique est faible mais précoce imposant une surveillance rapprochée.

Objective. - To study sexual dysfunctions (SD) among patients suffering from multiple sclerosis (MS).Materials and methods. - Prospective study concerning 49 patients with MS questioned about their sex life. In addition to an interview, we used 2 indexes to measure sexual function: IIEF15 for males and FSFI for females. Other information was collected concerning the duration of the MS, the level of disability and the repercussions on the couple's relationship and quality of life.Results. -The prevalence of SD was 46.9% with 70% for males and 34% for females. The most frequent problem for males was erectile dysfunction. Women experienced mainly a reduction in orgasm and a lowering of libido. The MS itself affected all the SF-36 items but no correlation was found between the SD and quality of life. Neither did we note significant repercussions on the couple's relationship. We did however observe a correlation between the frequency of SD and marriage. No correlation was found between the frequency of SD and the severity of the disability, age, level of education and duration of MS.Conclusion. -MS entails a multitude of disorders that patients struggle to deal with. However, they do not speak about SD. Our characteristic culture can certainly explain several differences observed between our work and the literature. (C) 2015 Elsevier Masson SAS. All rights reserved.

Purpose. - Deep dorsal vein thrombosis of the penis is spontaneously remitting benign throm-bophlebitis. We propose to describe clinical assessment, diagnosis and differential diagnosis of deep dorsal vein thrombosis of the penis and to observe its natural course over time.Patients and methods. - Seven patients between ages of 13 and 50 years who self-presented for swelling penile, had diagnosis of deep dorsal vein thrombosis of the penis. Initial history, examination and Doppler ultrasound were undertaken. This was supplemented by blood screening for coagulation defects.Results. -All patients consulted for a painful penis. Priapism were noted in three patients. Doppler ultrasound which realized in all cases, revealed thrombosis of the deep dorsal vein of the penis. The first aetiology of the venous thrombosis was hemopathy (three cases). Early anticoagulants with low molecular weight heparin were instaured. Patients with priapism were treated with aspiration and irrigation of the corpa cavemosa and had good evolution. Specific treatment (chemotherapy, corticosteroid) was used in two patients. However, definitive erectile dysfunction persists in two patients. One among these patients had clinical history of priapism.Conclusion. - Dorsal vein thrombosis of the penis should be considered as a urologic urgency. Its natural course tends to be one of spontaneous resolution. Usually a benign condition, careful etiological search with risk factors is needed to avoid missing exceptional causes. But, followup is of utmost importance because risk of erectile dysfunction, which need early diagnosis, effective treatment and psychological support. (C) 2014 Elsevier Masson SAS. All rights reserved.

Herein, we report a rare case of metastasis of prostate cancer in the orbit with pertinent literature review. Although, prostate cancer can metastasize in any organ, yet orbital metastasis indicates an aggressive disease course with eminent loss of vision. Very few similar cases have been reported in the literature. (C) 2014 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V. Open access under CC BY-NC-ND license.

Les complications urinaires des fractures du bassin constituent une pathologie grave survenant souvent chez des patients jeunes et pouvant mettre en jeu la qualité de la miction et le pronostic vital. On se propose de tenter d’établir une éventuelle corrélation entre le type de l’atteinte osseuse et la gravité des lésions urinaires associées. Il s’agit d’une étude rétrospective portant sur 62 patients ayant présenté une complication urinaire suite à une fracture du bassin, traités au service d’urologie de Sfax. Il s’agissait d’hommes jeunes (98 % des cas), souvent victimes d’un AVP (56 % des cas). L’empâtement sus-pubien était le signe le plus suggestif de rupture vésicale. L’urétrorragie (30 patients) était le signe le plus évocateur de rupture urétrale, imposant alors un cathétérisme sus-pubien. Une opacification antérograde et/ou rétrograde et ou l’uroscanner ont permis d’établir le diagnostic positif. Nous avons alors diagnostiqué 12 ruptures vésicales dont 6 sous-péritonéales et 6 intra-péritonéales, 34 ruptures urétrales dont 5 partielles, 6 lésions doubles urétro-vésicales. Les fractures des cadres obturateurs étaient les plus pourvoyeuses de rupture urétrale complète, suivies par les disjonctions de la symphyse pubienne. Les lésions urinaires à type de contusion compliquaient souvent des fractures stables, alors que les lésions doubles de l’urètre et la vessie étaient associées à des fractures instables. Devant tout traumatisme du bassin, il faut savoir évoquer précocement le diagnostic de lésions du bas appareil urinaire. La gravité des lésions urinaires reste fonction de l’instabilité des fractures du bassin qui en sont responsables.

Le ganglioneurome est une tumeur neurogène bénigne, rare, qui se développe à partir des cellules ganglionnaires sympathiques et qui se localise essentiellement dans la région rétropéritonéale. Nous rapportons cinq cas de ganglioneuromes rétropéritonéaux, ayant eu une exérèse complète de la tumeur avec évolution favorable. Le diagnostic a été confirmé par l’examen anatomopathologique. La fréquence, le diagnostic, les données de l’imagerie et le traitement de cette tumeur rare sont discutés.

Introduction: Leydig cells tumors of the testis are uncommon, representing between 1 and 3% of the testicular tumors and for which the natural history and therapy are debated between radical orchitectomy and organ-sparing surgery.Subjects and methods: We report three new cases of Leydig cells tumors, treated in our department and we discuss the clinical, diagnostic and therapeutic aspects of this uncommon tumor.Results: The mean patient age was 29 years (23-37 years). Medical referral was for a testicular pain in two and gynecomastia in one case. All patients were treated surgically, through an inguinal incision and the procedure included clamping of the spermatic cord. During surgery, frozen section were analyzed in two cases and the tumor enucleation with organ-sparing surgery was performed. The other patient had an unilateral orchidectomy and controlateral tumorectomy. The mean follow-up was 40 months with no local recurrence.Conclusion: Patients diagnosed with Leydig cells tumors have a good prognosis; this study shows the safety of conservative surgery treatment, provided it is subsequently followed by close surveillance, as it preserves maximum fertility, and these tumors usually have a favorable prognosis. (C) 2013 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V.