Endoscopic meatotomy in the treatment of ureterocele: results in adult patients

To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a "smiling mouth" meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate

Diagnostic et prise en charge des cystites à éosinophiles

La cystite à éosinophiles est une pathologie inflammatoire de la paroi vésicale. Elle est rare, il n'existe pas des recommandations établies concernant sa prise en charge. Il s'agit d'une étude rétrospective ayant concerné dix observations de cystites à éosinophiles diagnostiquées et prises en charge dans notre service entre 2006 et 2017. L'âge moyen des patients était de 46 ans. On a noté une prédominance masculine. Un terrain atopique était noté dans 3 cas. Le mode de présentation le plus fréquent était des signes urinaires irritatifs dans 9 cas, une hématurie macroscopique dans 8 cas et des algies pelviennes dans 6 cas. Une hyper-éosinophilie sanguine était présente dans 4 cas. La cystoscopie avait montré des pétéchies dans 5 cas, un aspect pseudo-tumoral dans 4 cas et était normal dans un cas. Pour les formes pseudo-tumorales une résection endoscopique a été pratiquée. Quatre patients ont été traités par les anti-inflammatoires non stéroïdien, avec amélioration des symptômes. Six malades ont été surveillés. Après un recul moyen de 50 mois, aucune récidive n'a été rapportée. La cystite à éosinophiles est une pathologie rare. La présentation clinique est non spécifique. La prise en charge repose sur des moyens médicaux non invasifs dans les formes peu symptomatiques

Management strategies and root causes of missed iatrogenic intraoperative ureteral injuries with delayed diagnosis: a retrospective cohort study of 40 cases

Abstract Background Intraoperative iatrogenic ureteral injuries represent rare technical surgical complications with the potential for adverse patient outcomes, particularly when the diagnosis is delayed. Ideally, these technical complications are recognized and repaired intraoperatively. This study was designed to investigate the root causes and outcomes of missed intraoperative ureteral injuries at a tertiary urology referral centre in Tunisia. Methods This is a retrospective cohort study in a tertiary urology referral centre in Tunis from January 1st, 2015, to December 31st, 2020, including all patients with iatrogenic ureteral injury, not diagnosed intraoperatively. The factors associated with the success of endoscopic treatment and those associated with the unfavourable evolution were investigated. Results A total of 40 iatrogenic ureteral injuries were included. Gynaecological surgery was responsible for 85% of ureteral injuries, mainly during hysterectomies (55%). The symptoms were dominated by low back pain (37.5%) and pyelonephritis (25%). Endoscopic treatment was attempted in 22 cases, it was sufficient in 12 cases. Ureteral injury required surgical treatment in 24 cases, and ureteroneocystostomy was performed in 16 cases. Nephrectomy was performed in eight cases, representing 20% of injuries, including three cases as the first treatment for late-diagnosed cases with a destroyed kidney. In the analytical study, endoscopic treatment was sufficient in 50% in case of ureteral fistula versus 27% in case of ureteral stenosis (p = 0.04). Nephrectomy was performed in 10% of cases when ureteral injury was diagnosed within the first month postoperatively compared to 60% of cases when this delay exceeded one month (p = 0.004). Conclusion Iatrogenic ureteral injuries discovered postoperatively are mostly secondary to gynaecologic surgery. Although endoscopic treatment is usually performed as a first treatment, a more aggressive surgical is often necessary, with a nephrectomy rate of 20%

Discovery of Renal Tuberculosis in a Partial Nephrectomy Specimen Done for Renal Tumor

The association of renal cancer and renal tuberculosis is uncommon. While the incidental discovery of renal cell carcinoma in a tuberculous kidney is a classical finding, the discovery of tuberculous lesions after nephrectomy for cancer is exceptional. We report the case of a female patient aged 60 who had a partial nephrectomy for a 5 cm exophytic kidney tumor. Pathological examination concluded that renal clear cell carcinoma associated with follicular caseo tuberculosis

Pseudotumoral Eosinophilic Cystitis

Eosinophilic cystitis is a rare inflammatory disease of the bladder which origin and pathogenesis are unknown. Since the first description in 1960, hundreds of cases have been reported, 20 Pseudotumor forms. We report a case of cystitis eosinophils in tumor-form, a patient of 72 years without urological or allergic history. The patient was treated with endoscopic resection alone. The outcome was favorable with disappearance symptoms and no recurrence at 1, 3 and 6 months controls. We carry a literature review of cystitis eosinophils on the different clinical manifestations, the means diagnostic and therapeutic modalities

Le lymphangiome kystique rétropéritonéal: à propos de 5 cas et revue de la littérature

Le lymphangiome kystique est une tumeur bénigne malformative rare des vaisseaux lymphatiques à localisations diverses. La localisation rétropéritonéale est moins fréquente comparée à celle mésentérique. Sa présentation clinique est polymorphe. Le diagnostic est évoqué par l'imagerie mais il nécessite une confirmation histologique. Le traitement de choix est chirurgical. Notre objectif est d'étudier les manifestations cliniques, les complications, les aspects diagnostiques et thérapeutiques de cette tumeur. Nous rapportons une série de 5 cas de lymphangiomes kystiques rétropéritonéaux (4 femmes et un homme) opérés dans notre service entre les années 2004 et 2014. Leurs dossiers ont été examinés rétrospectivement. Le suivi était basé sur l'examen clinique et l'échographie abdominale. L´âge moyen était de 45 ans. Le suivi moyen était de 32,6 mois. La symptomatologie révélatrice la plus fréquente était les douleurs et/ou une masse abdominale. Le scanner abdominal était l'examen le plus utile au diagnostic. Une exérèse complète était réalisée d'emblée chez quatre patients et elle était différée après cinq ans de surveillance par une échographie annuelle chez un. Dans un cas, on a eu recours à une néphrectomie. Aucune récidive ni complication n´ont été notées chez les 5 patients. le lymphangiome kystique à localisation rétropéritonéale est une affection rare. Sa prise en charge thérapeutique repose sur une exérèse complète, de cas de lésions symptomatiques ou de complications, pour limiter le risque de récidive. Cette dernière peut être différée chez les patients asymptomatiques.The Pan African Medical Journal 2016;2

Voluminous Incidental Oncocytic Neoplasm of the Adrenal Gland With Uncertain Malignant Potential

A 74-year-old man presented with right flank pain and a palpable mass in the left flank. Blood pressure was normal. Contrastenhanced computed tomography (CT) showed a 17 × 16 × 12 cm retroperitoneal mass over the left kidney, solid and heterogeneous. There were also 3 retro aortic lymph nodes and bilateral renal lithiasis. Twenty four-hour urinary metanephrines and normetanephrines were normal. The patient underwent a resection of the mass with left adrenalectomy by a lumbar incision. Histological findings revealed an adrenal oncocytic neoplasm (AON) with uncertain malignant potential. Six months after surgery, CT control showed neither local nor distant recurrence

Superselective embolisation of bilateral superior vesical arteries for management of intractable hematuria in context of metastatic bladder cancer

Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem. Percutaneous embolisation is a mini-invasive option to handle this situation. We report a case of a patient with a metastatic bladder cancer and who presented with an abundant hematuria and severe anemia. After failure of endoscopic resections and “flush” of radiotherapy haemostatic and refusal of cystectomy by the patient, he was treated by superselective embolisation of bilateral superior bladder arteries with excellent immediate results. The technique is safe and effective in the short term. The long-term effectiveness requires further investigation

[77] Adult urinary lithiasis and chronic renal insufficiency in 32 cases

Objective: To specify the clinical, metabolic and aetiological characteristics of stone diseases complicated by chronic renal failure. Renal lithiasis is a common, highly recurrent disease that can be complicated by chronic renal failure, which is usually prevented by early diagnosis and adequate medical and surgical management. Methods: Over a 10-year period from 2008 to 2018, we collected 173 patients with a confirmed urolithiasis aetiology, amongst which 32 had chronic renal insufficiency with a creatinine clearance of <60 mL/min at the time of the diagnosis. Results: There were 19 men and 13 women (sex ratio 1.58) with a mean (range) age of 51.59 (32–72) years. The prevalence of renal failure was 18.47%. Two patients had end-stage renal disease. Lithiasis was bilateral in 24 cases and unilateral in eight. In all, 21 patients underwent surgery with nephrectomy in 10, 17 patients had extracorporeal lithotripsy, and four patients had a percutaneous nephrolithotomy. The average time between the onset of lithiasis disease and the aetiological diagnosis was 12 years. In regards to aetiologies we noted: hyperoxaluria in eight cases (primary: five cases, food: three cases), hyperparathyroidism in five cases, a metabolic syndrome in five cases, hyperuricuria in five cases, a lithiasis of infection in six cases (isolated: two cases, associated with a metabolic cause: four cases), cystinuria in two cases, and distal tubular acidosis in one case. Conclusion: The high percentage of chronic renal failure in our patients was the result of late aetiological diagnosis and management. The aggravating factors were infections and nephrectomies