Angiomyolipome rénale: à propos de huit cas

L'angiomyolipome est la tumeur bénigne la plus fréquente des masses dolides du rein, elle représente un cadre de fréquence de 1 à 3% des tumeurs du rein, sa composition histologique est faite de trois  contingents: graisseux, fibres musculaires lisses et vasculaires a des proportions variables, elle sévit sur un cadre sporadique et peut s'exprimer dans un cadre congénitale comme manifestation de la sclérose  tubéreuse de Bourneville. Nous rapportons l'expérience du service d'Urologie B du CHU IBN Sina de Rabat  dans la prise en charge de huit cas d'angiomyolipome sur une période s'étalant sur six ans en précisant les manifestations cliniques, données de l'imagerie, le résultat histologique et la conduite thérapeutique. Les manifestations cliniques ne lui sont pas spécifiques, elle peut se manifester par des lombalgies, crise de colique néphritiques, hématurie, masse palpable dans le flanc. La TDM reste l'examen radiologique le plus sensible en mettant en évidence la présence de graisse au sein de la masse, l'histologie confirme le diagnostic et il n'y a aucun consensus qui régit la prise en charge de ce type de tumeur, on peut admettre une surveillance pour les petites masses de moins de 4 cm et traité les formes symptomatiques ou qui  dépasse les 4 cm par embolisation ou chirurgie partielle ou totale. Les nouvelles thérapeutiques focales peuvent révolutionner la prise en charge de ce type de tumeur bénigne, mais les études sont toujours en cours.Key words: Angiomyolipome, scanner, histologie, embolisation, néphrectomie totale, néphrectomie partiell

Penile Gangrene and Necrosis Leading to Death Secondary to Strangulation by Condom Catheter

Condom catheters are widely used in the management of male urinary incontinence, bedridden patients, and geriatric population. They are considered to be safe; however they are associated with serious complications in case of an incorrect use. We report a dramatic case of penile strangulation by condom catheter tardily discovered till occurrence of necrosis and gangrene leading to death in an elderly bedridden and diabetic man. Through this case we emphasize the importance of patient education for the correct use of condom catheters and remind care providers to maintain a high level of sensibility to complication generated from long-term use of condom catheters

Variables altering the impact of respiratory gated CT simulation on planning target volume in radiotherapy for lung cancer

BackgroundRespiratory gated CT simulation (4D-simulation) has been evolved to estimate the internal body motion. This study aimed to evaluate the impact of tumor volume and location on the planning target volume (PTV) for primary lung tumor when 4D simulation is used.MethodsPatients who underwent CT simulation for primary lung cancer radiotherapy between 2012 and 2016 using a 3D- (free breathing) and 4D- (respiratory gated) technique were reviewed. For each patient, gross tumor volume (GTV) was contoured in a free breathing scan (3D-GTV), and 4D-simulation scans (4D-GTV). Margins were added to account for the clinical target volume (CTV) and internal target motion (ITV) in 3D and 4D simulation scans. Additional margins were added to account for planned target volume (PTV). Univariate and multivariate analyses were performed to test the impact of the volume of the GTV and location of the tumor (relative to the bronchial tree and lung lobes) on PTV changes by more than 10% between the 3D and 4D scans.ResultsA total of 10 patients were identified. 3D-PTV was significantly larger than the 4D-PTV; median volumes were 182.79 vs. 158.21cc, p=0.0068). On multivariate analysis, neither the volume of the GTV (p=0.5027) nor the location of the tumor (peripheral, p=0.5027 or lower location, p=0.5802) had an impact on PTV differences between 3D-simulation and 4D-simluation.ConclusionThe use of 4D-simulation reduces the PTV for the primary tumor in lung cancer cases. Further studies with larger samples are required to confirm the benefit of 4D-simulation in decreasing PTV in lung cancer

Bladder rupture secondary to bladder tumors: A gateway to peritoneal carcinoma ?

We report a case of spontaneous bladder rupture due to bladder carcinoma. A 62-year-old man presented to the emergency department with acute urine retention; two days later, the patient presented with abdominal distension and a large intraperitoneal effusion on CT scan, as well as a breccia in the bladder.Exploratory laparotomy confirmed a definitive diagnosis: bladder rupture due to bladder carcinoma. He underwent radical cystectomy.Surgery is recommended to treat carcinomatous bladder rupture. Rapid diagnosis is essential to optimize patient outcomes. The possibility of spontaneous bladder rupture should not be overlooked as a differential diagnosis in cases of acute abdomen

Prostatic Abscess on Xanthogranulomatous Prostatitis: Uncommon Complication of an Uncommon Disease

Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Only few cases have been reported in the English literature. Xanthogranulomatous prostatitis is usually an incidental finding after needle biopsy or transurethral resection of the prostate in patients suffering from low urinary tract symptoms. We report the case of a 59-years-old patient diagnosed with prostatic abscess managed by transurethral resection of the prostate. Histopathological examination of resected prostatic tissue revealed abscessed xanthogranulomatous prostatitis with no evidence of malignancy. Xanthogranulomatous prostatitis presenting as a prostatic abscess is a rare finding. To the best of our knowledge our case represents the fourth case of xanthogranulomatous prostatitis presenting as prostatic abscess reported in the English literature so far

Lymphoepithelioma-Like Carcinoma of the Bladder: A Case Report of a Rare and Particular Variant of Urothelial Carcinoma

Lymphoepithelioma-like carcinoma of the bladder (LELCB) is a rare variant of urothelial carcinoma first described by Zukerberg in 1991 and confirmed as a variant of urothelial carcinoma by the WHO classification of tumors of the urinary system. LELCB is characterized by a marked infiltration of lymphocytes in the area involved by the tumor which may coexist with the conventional urothelial carcinoma. LELCB are classified according to the percentage of lymphoepithelioma component within the tumor with the prognosis depending on the percentage. We report a new case of pure LELCB occurring in 63-year-old woman presenting with hematuria. Ultrasonography and cystoscopy revealed a large tumor on the left lateral wall of the bladder. Transurethral resection of the bladder tumor (TURBT) was performed. Pathological and immunohistochemical analysis revealed a high-grade muscle-invasive LELCB (G3pT2). The patient underwent an adjuvant systemic chemotherapy with no recurrence after a ten-month follow-up. To our knowledge, this is the second Moroccan case of LELCB reported in the English literature. Although its rare occurrence prognosis and ideal therapeutic management of LELCB have not been clearly established yet, literature findings encourage the adoption of a conservative approach in treatment of LELCB

A case report of giant paratesticular myxoid liposarcoma

Liposarcomas are an uncommon occurrence in the paratesticular region that makes about 20 % of all sarcomas. The clinical appearance is an inguinal lump, which can resemble a hydrocele or hernia. There would be no conventional treatment accessible because it is such a rare disease. We report the case of a 68-year-old man with paratesticular myxoid liposarcoma. Ultrasound and CT-scan came back in favor of a paratesticular tumor. A high inguinal orchidectomy has been done and the diagnostic of myxoid liposarcoma was first evoked by histology and confirmed by molecular biology. At 12 months follow up the patient remains tumor free

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies