Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications

Anastomoses urétérales laparoscopiques entre donneur et receveur post greffe de rein pour reflux vésico-urétéral ou sténose du greffon

Les complications urétérales des patients greffés rénaux sont classiquement traitées par une reprise chirurgicale ouverte. Ce travail a voulu évaluer la faisabilité de reconstructions urétérales du greffon par voie mini-invasive. Nous avons revu les dossiers de tous les patients ayant bénéficié d’une telle intervention sur 3ans, et comparés leurs résultats à ceux des patients ayant bénéficié d’une approche classique par chirurgie ouverte. Les patients ayant pu bénéficier d’une approche mini-invasive ont eu une période post- opératoire plus simple (antalgie mieux contrôlée, retour vers une alimentation normale plus rapide, départ de l’hôpital plus précoce). L’efficacité des deux approches était similaire à moyen terme. La sécurité de l’approche mini-invasive était équivalente (taux de complications identiques). Ce travail confirme la faisabilité des reconstructions urétérales mini-invasive chez les patients greffés, leur efficacité et leur sécurité. Elles offrent les avantages d’un abord mini-invasif avec des résultats similaires à une approche par chirurgie ouverte. Une comparaison plus large peut être faite avec d’autres indications de chirurgie reconstructive urologique. Tout comme notre travail, l’analyse de plusieurs procédures intéressant l’uretère (pyéloplastie, anastomoses urétéro-urétérales, réimplantation urétérales sur vessie psoïque avec ou sans flap selon Boari, urétéroplasties avec greffon de muqueuse buccale) de même que celle d’autres procédures de reconstruction (promontofixation, plastie du col vésical) ou d’onco-urologie (prostatectomie, cystectomie) semble également plébisciter une approche robotique, sans pour autant bénéficier d’un niveau de preuve élevé

Urologie

Les progrès urologiques de cette dernière année restent, comme l’année précédente, sous le sceau des rapides avancées technologiques, notamment celles du laser et de la robotique. Cette dernière va contribuer à faire évoluer la chirurgie ambulatoire, notamment pour certaines interventions et sous-populations de malades porteurs d’un cancer du rein ou de la prostate. Elle est également en train d’exercer une nouvelle percée dans le domaine de l’incontinence féminine, en ce qui concerne la mise en place du sphincter urétral artificiel. Enfin, un nouveau laser est sur le point d’offrir sa polyvalence en termes de chirurgie endoscopique lithiasique ainsi que celle de l’hypertrophie bénigne de la prostate. Face à cette pression technologique, il faut rigoureusement valider à court et moyen termes les véritables avantages espérés

Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma.

Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications

Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications

Traitement médicamenteux des troubles mictionnels de l’homme : l’essentiel pour le médecin généraliste

En raison de l’importante prévalence des troubles mictionnels masculins et du développement d’une pharmacothérapie de mieux en mieux ciblée, le praticien interniste-généraliste se trouve depuis plus d’une décennie en première ligne pour leur prise en charge médicamenteuse. Dans la perspective d’améliorer cette gestion partagée, nous présentons les deux principaux syndromes obstructif et irritatif, ainsi que leur traitement pharmacologique, afin de pérenniser le transfert de connaissances et la coordination entre le praticien-généraliste et l’urologue

Contraception masculine : quelles options actuellement disponibles ?

La contraception masculine ne représente qu’une faible proportion de la contraception mondiale. Pourtant, des moyens sûrs et efficaces existent et sont disponibles avec un taux d’échec faible, comme la vasectomie ou, dans une moindre mesure, le préservatif. D’autres méthodes dites naturelles telles que l’abstinence périodique ou le retrait sont utilisées malgré leur efficacité moindre. Enfin, certaines méthodes sont en cours d’évaluation ou de développement comme les contraceptions thermique, hormonale et non hormonale. Bien que certains résultats préliminaires soient encourageants, l’efficacité de ces méthodes reste variable et parfois difficilement reproductible. Elle nécessite encore des contrôles et validations concernant leur sûreté pour une utilisation à long terme.Male contraception plays a small role in global contraception. However, safe and effective means exist and are available with a low failure rate, such as vasectomy or to a lesser extent, condoms. Other so-called natural methods are used despite being less effective, such as periodic abstinence or withdrawal. Finally, new methods are currently being evaluated or developed, such as thermal contraception, hormonal and non-hormonal contraception. Although preliminary results are encouraging, the effectiveness of these methods remains variable and sometimes difficult to reproduce, and still requires controls and validation regarding their safety over long-term use

Thérapies ciblées en oncologie digestive

Targeted therapies are relatively new molecules available for the oncologist. These drugs target a specific step of the cellular development and interfere with the intracellular signalization pathways. Amongst all others, EGF- and VEGF-pathways are currently targeted by these selective therapies. Modulating EGF and VEGF significantly improves overall survival and progression-free survival for many advanced or metastatic tumors as colorectal cancer, gastric cancer, gastrointestinal stromal tumors or hepatocellular carcinoma. Targeted therapies have a specific action site, a simple administration mode and are relatively well tolerated. In the future these molecules will probably be used "à la carte" for tumors that appear to be refractory to other drugs

Histologic Confirmation of a Biochemical Recurrence After Radical Prostatectomy by Performing 3-Dimensional Transrectal Ultrasonography-guided Biopsy With Fusion to Magnetic Resonance Imaging

To obtain a histologic confirmation of biochemical recurrence after radical prostatectomy, which still remains a challenge. Historically, biopsy protocols have been designed but have provided rather unsatisfactory results. We report the first case of histologic confirmation of a biochemical recurrence in the prostatectomy bed by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance images

Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications