Combined laparoscopic and vaginal approach for nephrectomy, ureterectomy, and removal of a large rectovaginal endometriotic nodule causing loss of renal function.

A late consequence of ureteral endometriosis is the silent loss of renal function caused by progressive "enclosure" of the lower part of the ureter by the endometriosis. In our experience, in cases of severe loss of renal function with cortical atrophy and residual kidney function (evaluated by Tc99 DMSA scintigraphy) of less than 15%, removal of the endometriosis combined with ureterolysis does not allow recovery of renal function. A nonfunctioning kidney associated with hydronephrosis is a risk factor for vascular hypertension, recurrent pyelonephritis, or kidney stones and therefore an indication for nephrectomy. By means of a case report, this paper describes the combination of laparoscopic nephrectomy, ureterectomy, removal of the rectovaginal endometriotic nodule, and extraction of the kidney through the vagina

Tumeur testiculaire et gynécomastie : à propos de deux cas cliniques

Gynecomastia is a benign proliferation of the glandular tissue of the male breast, which results from an increase in the ratio of estrogen to androgen activity. Testicular tumours represent a rare but potentially severe cause of gynecomastia, and they require an early treatment. In the absence of another obvious aetiology, a testicular neoplasm should always be ruled out in adults with a gynecomastia of recent onset or painful. We report here the cases of two young men with a gynecomastia leading to the diagnosis of testicular tumour (seminoma with a component of hCG-positive syncytiotrophoblastic cells). We will review here how to evaluate gynecomastia, the clinical and biological signs which should suggest the diagnosis of a testicular neoplasm, the types of testicular tumours potentially associated with gynecomastia, and the responsible mechanisms

RÉFLEXION SUR LA PRISE EN CHARGE DE L’HYDRONÉPHROSE ANTÉNATALE

Si l’hydronéphrose anténatale (HNA) est la malformation congénitale la plus fréquente, sa prise en charge est cependant controversée surtout en ce qui concerne le bilan à réaliser et l’intérêt d’une prophylaxie. Des études récentes remettent en doute l’indication systématique d’une cystographie à la recherche d’un reflux associé tout comme le bénéfice de l’antibioprophylaxie sur la survenue d’infection urinaire. Une approche moins agressive est discutée tenant compte essentiellement des données échographiques obtenues en postnatal. Nous proposons un algorithme de prise en charge tenant compte de ces données

Rhabdomyolysis and muscle infarcts associated with intra-operative compression.

Editor, Rhabdomyolysis is a well known complication associated with anaesthesia and surgery, carrying serious consequences for the patient, and associated medicolegal issues.1 Multiple mechanisms are involved in its pathogenesis.1 Among these, patient malpositioning is a ‘classical’ cause. Minimally invasive robotic surgeries, including radical prostatectomy, require long operating times in dedicated positions, increasing the risk of positioning-related complications. [...

The Sick Breast Lobe Has a Testicular Counterpart.

A 31-year-old patient underwent a left orchiectomy in 2012 for a pT1 mixed germ cell tumor, mainly consisting of seminoma, associated with extensive germ cell neoplasia in situ (GCNIS) in the residual surrounding parenchyma. In view of these findings, surveillance of the right testis by ultrasound was performed, which showed in October 2018 a lesion of 11 mm in the inferior and a lesion of 7 mm in the superior part of the testicular parenchyma. Intraoperative frozen section was performed on the lesions, showing that both consisted of pure seminoma. [...

Diverticulose vésicale liée à un syndrome de la corne occipitale

Nous rapportons le cas d’un enfant ayant consulté pour des diverticules vésicaux récidivants, multiples et volumineux. Le bilan étiologique a permis d’identifier un syndrome de la corne occipitale, de transmission récessive liée au chromosome X, responsable d’anomalies du tissu conjonctif causées par un trouble du métabolisme du cuivre. Ce cas rappelle l’importance d’une démarche diagnostique approfondie face à des diverticules vésicaux particulièrement nombreux et développés, après exclusion d’un obstacle.[Multiple bladder diverticula caused by occipital horn syndrome]. We report on the case of a child who presented with recurrent, multiple, and voluminous bladder diverticula. Bladder diverticula are defined as a herniation of the mucosa through the bladder muscle or the detrusor. Causes are numerous and diverticula can be classified into primary congenital diverticula (para-ureteral - or Hutch diverticula - and posterolateral diverticula); secondary diverticula (resulting from chronic mechanical obstruction or from neurological disease; and diverticula secondary to connective tissue or muscle fragility. The latter is seen in disease entities such as prune belly syndrome, Ehlers-Danlos syndrome, cutis laxa syndrome, OHS (occipital horn syndrome), Menkes disease, and Williams-Beuren syndrome. In this patient, the cause of these diverticula was OHS, a genetic, recessive X-chromosome-linked syndrome, responsible for abnormal tissue caused by a disorder in copper metabolism. This case reminds us of the importance of pushing the diagnostic workup when presented with multiple and/or large bladder diverticula, and in particular to search for rare malformation syndromes after exclusion of an obstacle