Cigarette smoking and genetic susceptibility are the two factors most closely associated with bladder cancer development. This study sought to determine the effect of smoking and genetic polymorphisms in xenobiotic metabolizing enzymes on the histological stage and grade of bladder tumors in Tunisian patients. A total of 97 patients with urothelial cell carcinomas were examined with respect to smoking status, NAT2 (N-acetyltransferase 2), GSTM1 and GSTT1 (glutathione S-transferase Mu 1 and teta 1) genotypes distribution. Our data have reported that tobacco; NAT2, GSTM1 and GSTT1 genotypes were not associated with bladder tumor stage. When we studied the superficial bladder tumor group, we have shown that in smokers tobacco was associated with the development of low-grade tumors. Conversely, non-smoker patients carrying altered NAT2 genotypes were with a 3.67-fold increased risk of developing superficial high-grade tumors (P = 0.02; RR = 3.67; 95% CI: [1.40-9.62]).

BACKGROUNDHerein, we present the largest series of penile fracture ever published. We evaluate the clinical presentation, the outcome of the treatment and the prognosis.METHODSWe retrospectively studied patients with penile fracture treated from 1975 to 2005.RESULTSThree hundred patients were included in this study. The mean patient age was 30 years (range, 18-68 years). Out of these patients, 57 (19%) patients were injured during sexual intercourse, whereas 180 (60%) patients were injured during masturbation. The mean time from injury to presentation was 26 hours. The diagnosis was clinical in all cases. No further investigation was needed for confirming the diagnosis. Five patients had urethral bleeding with urethral lesion. All patients were treated by immediate surgery. All of the patients had a tunica albuginea tear that was promptly repaired. At follow-up (mean time of 7 years), 14 patients presented mild curvature, which had not hindered intercourse in 10 patients. The Nesbit intervention was performed in four patients. Penile pain at intercourse developed in four patients (1.3%) and at erection in six patients (2%). Erectile dysfunction was observed in two cases (0.6%).CONCLUSIONPenile fracture has typical clinical signs. Early surgical treatment is associated with a low incidence of late complications. The high frequency in our area is neither because of physical nor genetic particularities. It is probably because of sociocultural characteristics.

Arterial hypertension often present after kidney transplantation is of multifactorial origin. The aim of this study was to determine the role of donor and recipient factors in the development of hypertension after renal transplantation. We retrospectively analyzed the data of 280 patients transplanted between 1985 and 2005, who still had functioning grafts at 1 year after transplantation. We recorded donor and recipient parameters. One hundred eighty-seven patients (66.8%) were hypertensive. Upon multivariate analysis of recipient factors, pretransplant hypertension (odds ratio) [OR]: 8.5, 95% confidence interval [CI]: 4.5 to 16.1); serum creatinine level > 130 micromol/L at 6 months (OR: 2.5, 95% CI: 1.3 to 4,7), male gender (OR: 2.02, 95% CI: 1.2 to 3.4), and chronic rejection (OR: 2.4, 95% CI: 1.2 to 4.7) were independent predisposing factors. Among donor factors, age was significantly associated with arterial hypertension upon univariate analysis. In conclusion, recipient factors, especially pretransplant hypertension, contribute to the disorder in renal transplant patients.

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17–64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from ‘true’ penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.

We report a case of segmental infarction of the testis in a 55-year-old man. Past medical history included 12 years of type II diabetes and hypertension. The patient presented with a 2-month history of testicular pain and was found clinically and sonographically to have a testicular tumour. The pathological examination of the partial orchiectomy specimen revealed segmental infarction of the testicle secondary to diabetes microangiopathy. We propose diabetes microangiopathy as a localization and aetiology of segmental testicular infarction. A possible testicular sparing procedure through an inguinal approach may be considered in cases of testicular masses for which the clinical and imaging findings are suggestive of focal testicular infarction.

Purpose To investigate retrospectively the clinical and epidemiological characteristics, and method of treatment of childhood urolithiasis, a major urological problem in Tunisia. Materials and methods The records of 525 children with urolithiasis treated in Tunisia between 1990 and 2004 were reviewed in a multi-centric study with regard to age at diagnosis, sex, history, and physical, laboratory, and radiologic findings. Metabolic evaluation when performed included serum electrolytes, calcium, phosphorus, uric acid, 24-h urine collection for calcium and creatinine, and a sodium nitroprusside test for cystine. In all cases urine specimens were sent for culture. Results The stone was located in the upper tract in 420 (80%) and lower tract in 105 children. Of the urine cultures, 40% were positive. Metabolic investigation was performed in 201 patients and was normal in 170 (84%). Urinary stasis secondary to a urinary tract anomaly that led to the formation of stones was found in 77 patients. Stones were treated by surgery (80%), extracorporeal shock wave lithotripsy (ESWL) (5%) and ureteroscopic extraction (4%), and percutaneous nephrolithotomy was performed in 10 patients (2%). The stone passed spontaneously in 9% of cases. Conclusion The use of ESWL and endourological methods of treatment for childhood urolithiasis must be generalized, with open surgery being reserved for particular and complex cases.

Sarcomatoid renal cell carcinoma (SRCC) is an uncommon, aggressive renal cell carcinoma (RCC) accounting for 1.2% to 12.3% of renal cell carcinomas. SRCC may arise from any RCC subtype as it probably results from the de-differentiation of any renal epithelial malignancy. SRCC is characterised by a rapid progression and high metastatic rate. Currently there is no specific effective treatment for it. We report a new case of a 32-year-old man presented with two months backache. Ultrasound revealed a 7.5 cm heterogeneous mass at the inferior pole of the left kidney. A nephrectomy was performed. Histological study diagnosed a sarcomatoid renal cell carcinoma. The patient was doing well 6 months after initial surgery and then was lost to follow-up.

Le carcinome sarcomatoide du rein est une tumeur renale tres rare dotee d'un tres mauvais pronostic. Nous en rapportons ici une observation. Il s'agit d'une femme de 68 ans admise pour douleurs du flanc droit avec un episode d'hematurie. Les differentes investigations ont revele une tumeur siegeant au niveau du pole superieur du rein droit avec une extension a la graisse peri-renale. Une nephrectomie elargie a ete pratiquee et le diagnostic anatomopathologique definitif a conclu a un carcinome sarcomatoide renal.

Introduction: Iatrogenic stenoses of the ureteropelvic junction are now essentially treated by endoscopic techniques. However conventional surgery is sometimes required to treat severe or extensive stenosis. The authors report the use of ureterocalicostomy to treat 5 patients with complex lesions.Material and Methods: Between 2001 and 2003, the authors treated five patients with iatrogenic stenosis of the ureteropelvic junction. Two of these patients had a history of percutaneous nephrolithotomy and the other three had undergone conventional pyelotomy, complicated by pyelocaliceal avulsion in one case. The diagnosis was confirmed by double anterograde and retrograde opacification in four patients and intravenous urography in one patient. It was decided to perform ureterocalicostomy due to the extent Of the lesions. Inferior ureterocalicostomy was performed after lower pole nephrectomy in all cases.Results: The mean follow-up was 21 months (range: 20 to 27 months). Three patients had an uneventful postoperative course and satisfactory radiological follow-up. One patient rapidly developed stenosis that was treated successfully by endoscopy and another patient obtained a poor result requiring nephrectomy.Conclusion: Ureterocalicostomy requires laborious surgical dissection and meticulous ureterocaliceal anastomosis, but it is a useful technique in some cases of severe and extensive iatrogenic stenosis of the ureteropelvic junction.

La survenue de carcinome rénal après transplantation est plus fréquente que chez la population générale. Il survient le plus souvent sur le rein natif, néanmoins des cas de carcinome sur greffon rénal ont été décrits dans la littérature. Nous rapportons un cas d'adénocarcinome sur greffon rénal survenu chez un jeune homme âgé de 30 ans, insuffisant rénal chronique, hypertendu et dialysé qui a bénéficié d'une greffe rénale à partir d'un donneur apparenté vivant (la mère). Le bilan pré-opératoire (artériographie, échographie, urographie intraveineuse) était normal. En per-opératoire l'opérateur signale la présence d'une lésion multiquistique mesurant 1 cm du pôle inférieur du greffon. Le greffé a été mis par la suite sous traitement immunosuppresseur et l'évolution était favorable. Le malade a gardé pendant deux ans une bonne fonction rénale, et à l'occasion d'un contrôle systématique l'échodoppler pratiqué a mis en évidence une tumeur polaire inférieure du greffon, confirmée par le scanner. Le bilan d'extension était négatif. Le malade a eu une détransplantation avec retour à la dialyse. L'étude macroscopique a montré une tumeur polaire inférieure de 7/5 cm bien circonscrite non encapsulée d'aspect polychrome à la coupe répondant histologiquement à un carcinome à cellules rénales grade II de Furhman.

OBJECTIVE:To evaluate the results of treatment of ureteric stones by ESWL as a function of various parameters, size, site and number of stones treated, in order to more precisely define the indications and consequently improve our results.MATERIAL AND METHODS:This study was based on 201 patients treated by ESWL for ureteric stones. The stones were situated in the lumbar ureter in 151 cases (73.6%) and in the pelvic ureter in 50 cases (26.4%). The size of the treated stones was less than 1 cm in 63.6% of cases and between 1 and 2 cm in 36.4% of cases. Treatment was performed by a Chinese hydroelectric lithotriptor with fluoroscopic and ultrasonographic detection, the ZM III.RESULTS:The results of treatment were not influenced by the site (lumbar or pelvic) of the stone and a good result (fragmentation and complete elimination of the stone) was obtained in 67.6% of cases. However, the difference of the results according to the size of the stone was statistically significant (p < 0.05), with a good result in 75.6% of cases when the stone diameter was less than 1 cm and 55.5% of cases when the stone diameter was greater than 1 cm.CONCLUSION:ESWL remains the first-line treatment for ureteric stones regardless of their site with better results for radiopaque stones less than 1 cm in diameter. An endoscopic procedure (double J stent) can be proposed before ESWL in some cases, such as solitary kidney or large stones, to decrease the complications.

Le phéochromocytome extrasurrénalien est une entité rare. Le diagnostic doit être évoqué devant des signes de phéochromocytome avec absence de tumeur des surrénales. Nous rapportons ici quatre cas de phéochromocytomes ectopiques en précisant leurs particularités cliniques et leur démarche diagnostique.

Prostatic carcinoma is exceptional in young adults before the age of 30. It is often diagnosed at a late, clinically advanced stage with a poorly differentiated histological type. Treatment is usually palliative and the prognosis is very poor with a mean survival of 6 months. The authors report a new case in a 25-year-old patient with locally advanced poorly differentiated prostatic carcinoma and a Gleason score of 10 treated by endocrine therapy, radiotherapy and chemotherapy with a good clinical and radiological course with a follow-up of two years.

Extra-adrenal pheochromocytoma is rare. The diagnosis must be evoked in signs of pheochromocytoma with absence of tumor of the adrenal. We report four cases of ectopic pheochromocytoma while specifying their clinical particularities and diagnosis procedure.