Place du traitement chirurgical sous circulation extracorporelle à cœur battant dans les cancers du rein avec envahissement cave supra-diaphragmatique : à propos de sept cas

Ce travail vise à analyser les résultats de la néphrectomie avec thrombectomie atrio-cave sous circulation extracorporelle (CEC) chez sept patients ayant un cancer du rein avec envahissement cave supra-diaphragmatique et de discuter les indications opératoires. Sept patients, six hommes et une femme dont l'âge varie entre 46ans et 65ans, ont été opérés d'un cancer du rein avec extension atrio-cave. L'écho-doppler a toujours permis la mise en évidence de l'extension veineuse mais la limite supérieure du thrombus était formellement identifiée par l'examen tomodensitométrique quatre fois, et par la résonance magnétique nucléaire dans tous les cas. Tous les patients ont été opérés sous CEC à cœur battant en normothermie. Un seul décès postopératoire est survenu. La durée du séjour en réanimation a été de 4,5 jours. Cinq patients ont eu à distance une dissémination métastatique. Cinq malades ont eu une médiane de survie de 11,5 mois (de 7 à16). Un malade a subi une métastasectomie pulmonaire 6 mois après la néphrectomie. L'exérèse des thrombi atrio-caves a été facilitée par la CEC avec une mortalité et une morbidité postopératoires acceptables mais les résultats à distance ont été décevants. Cette intervention ne peut être proposée qu'aux patients n'ayant aucune extension locorégionale et générale décelable, ce qui souligne l'importance des examens morphologiques préopératoires

Leiomyoma: a case report of a rare benign tumor of the female urethra

Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. It often appears in females during their reproductive age (from menarche to  menopause); the mean age of their appearance is  approximately 41 years. Less than 100 cases were reported in the literature.We hereby report a case of a   52-year-old White woman who presented with complaints of dysuria and urinary tract infection. The mass was completely removed by transvaginal excision with a  rim of normal tissue. Histopathological studies confirmed the urethral leiomyoma. The patient remained asymptomatic and there was no evidence of recurrence in the followup.Key words: Leiomyoma, smooth muscle, tumor, urethr

Angiomyolipomes épithélioïdes rénal bénin: à propos de deux cas

Les angiomyolipomes épithélioïdes rénaux (AMLeR) sont des tumeurs rares (identifiées chez moins de 0,1 patients pour 1000 habitants) et représentent 8% des angiomyolipomes (AML) opérés. Il a longtemps été considérécomme un hamartome mais plusieurs articles récents font penser qu'il s'agir d'une tumeur dérivant de cellules épithélioïdespérivasculaires. L'angiomyolipome épithélioïde est une forme rare d'angiomyolipome à potentiel malin, composé decellules épithélioïdes posant des problèmes de diagnostic différentiel avec les carcinomes à cellules rénales. L'immunohistochimie,en révélant la positivité des cellules épithélioïdes au marqueur HMB45 est essentielle au diagnostic. Les auteursrapportent l'aspect tomodensitométrique et histologique d'angiomyolipomes épithélioïdes chez deux patientes.Pan African Medical Journal 2015; 2

Le léiomyome rétro-péritonéal: à propos de 2 cas

Les tumeurs bénignes du muscle lisse sont fréquentes dans le tractus gastro-intestinal et génito-urinaire, et rares au niveau rétro péritonéal.Leur prévalence parmi les tumeurs rétropéritonéales primitives a été estimée entre de 0,5 à 1,2%. Une situation qui conduit à des erreurs de diagnostic. On rapporte dans cet article deux cas de léiomyome rétropéritonéal (LRP) retrouvés chez des femmes âgées entre 47et 54 ans. L'imagerie a mis en évidence une masse rétro-péritonéale, ce qui a motivé une exérèse totale de la tumeur. L'examen anatomopathologique de la pièce opératoire a posé le diagnostic de léiomyome rétro-péritonéal. L'évolution sans récidive était bonne.Key words: Léiomyome, rétropéritoine, tumeur rétropéritonéale, chirurgi

Fistule vesico-sigmoïdienne compliquant une hydatidose intestinale: à propos d’un cas rare

La fistule colo-vésicale sur une hydatidose sigmoidienne est une entité pathologique exceptionnelle. Nous  rapportions une nouvelle observation, ou seront rappelées les principales données diagnostique et thérapeutique de cette affection.Key words: Fistule vesico-sigmoidienne, hydatidose intestinale, bénign

Penile cancer: about ten cases at the University Hospital of Rabat, review of the literature

The aim of our study was to report the status of penile cancer sites in the urology department at the University Hospital of Rabat and evaluate long-term results of surgical treatment of this cancer. Patients and Methods: Between 1989 and 2015, 10 patients were treated for penile cancer. 10 cases were  retrospectively reviewed and the following data were recorded: mode of revelation, seat, staging, TNM stage, treatment, evolution and survival. The mean age of patients was 58,1 years (48-81 years). All patients had squamous cell carcinoma of the penis. Six patients had a partial amputation of the penis, and three patients underwent total amputation. The median size of the lesion was 4.25 cm (1.5-8 cm). All tumors had a distal seat (gland- Furrow  balanopreputial), 8 were localized and non-invasive (PT1 - PT2) and 2 had infiltrated the urethra (PT3). Four patients had lymph node localization. A single bilateral lymphadenectomy was performed and was positive only on one side, with a node <3 cm and no  extracapsular extension. Two patients were referred for  chemotherapy, a neoadjuvant referred to basic (Bleomycin - Methotrexate, Cisplatin) the other in a palliative goal. Median follow-up was 42 months (6 -72mois). Four patients died, one of which was presented  immediately with metastatic mode. Six patients were alive at last node or local recurrence negative. Cancer of the penis seems rare in Morocco. His oncologic and functional outcomes (sexual and urinary) depend on the precocity of the treatment. The surgery of lymph node resection with lymphadenectomy remains the reference treatment.Key words: Penile Cancer, total penectomy, Partial penectomy, lymphadenectom

[66] Right transperitoneal laparoscopic ureterolithotomy

Objective: To report our experience of laparoscopic ureterolithotomy and its effectiveness, as this technique is an excellent alternative to ureteroscopy in the treatment of large ureteric stones. Methods: We present a laparoscopic right lumbar ureterolithotomy in a 55-year-old patient with obstructive pyelonephritis on two lumbar calculi measuring 18 and 20 mm, respectively. Results: Urinary drainage was ensured by percutaneous nephrostomy, which was placed preoperatively and removed 15 days postoperatively; there were no postoperative complications, and a fast learning curve. Excellent results were obtained, with no residual fragments. Conclusion: Laparoscopic ureterolithotomy is an effective and reliable surgical procedure with better results (without residual fragments) compared to ureteroscopy

[67] End-to-end anastomotic urethroplasty for post-traumatic complete rupture of the membranous urethra

Objective: To report our experience and the feasibility of end-to-end anastomotic urethroplasty, as this is an excellent technique for the management of post-traumatic urethral stricture. Methods: We present an end-to-end anastomotic urethroplasty in a 17-year-old patient who had abdominopelvic polytrauma at the point of impact. Upon review, the lesional balance revealed a splenic rupture with haemoperitoneum and complete rupture of the membranous urethra, clearly visible on anterograde and retrograde opacification, and fractures of the pubis and the orthopedically treated ischium. The patient underwent an urgent splenectomy for haemostasis with suturing of a grievous wound. After a period of 3 months urethroplasty was performed. Results: Two tips to gain sufficient length of the urethra: the mobilisation of the anterior urethra and the separation of corpora cavernosa in the median line. Two solutions are possible to better individualise the upstream end: the use of a soft fibroscope light or the Beniquet, as in our patient. The urethral anastomosis was performed mucosa against mucosa, the bladder catheter was removed 1-month postoperatively, with a follow-up of 5 years without recurrence. Conclusion: End-to-end anastomotic urethroplasty is a reliable technique for the treatment of post-traumatic urethral stricture

[57] Bacteriological analysis of urinary stones: correlation with preoperative cytobacteriological examination of urine

Objective: To analyse the bacteriological correlation between preoperative cytobacteriological examination of urine (CBEU) and urinary calculi, and to evaluate the impact of chemical nature on the bacteriological stones. Methods: This was a prospective single-centre study including 42 patients who underwent urolithiasis surgery between January and April 2018. Bacteriological culture of the removed stones was systematic. Mean comparisons were made by the Pearson chi-square test and Fisher’s test for qualitative variables, with statistical significance set at P < 0.05. Results: The average age of our series was 56 years, with a male predominance of 83.3%. Bladder opening was performed in 45.2% of our patients. The rate of urinary colonisation was 33.3% (14/42). The rate of infected stones was 35.7%. Of the identified pathogens, Escherichia coli was found in 40% of the infected stones, followed by Enterococcus faecalis (20%), and Staphylococcus coagulase negative and Pseudomonas aeruginosa (13.3%). There was a significant correlation (P < 0.001) between preoperative CBEU and bacteriological analysis of the stones. The infected stones were principally calcium oxalate monohydrate and struvite (P = 0.03, P = 0.01). Conclusion: There is a significant correlation between the bacteriological culture of urinary stones and preoperative CBEU results. A negative preoperative CBEU can guarantee the sterility of urinary calculi in 89.2% for avoiding postoperative infectious complications after surgical manipulation of these stones

[21] Implementation of an enhanced recovery after surgery (ERAS) protocol for radical cystectomy: a Moroccan single-centre experience

Objective: To evaluate the impact of the implementation of an enhanced recovery after surgery (ERAS) protocol on functional results after radical cystectomy (RC) for bladder cancer, as RC is a major surgery with significant morbidity and mortality risks. Methods: We conducted a monocentric prospective study from March 2017 to April 2018. Patients who underwent RC for bladder cancer at our institute after introduction of the ERAS protocol were compared with a control group of patients who previously underwent surgery with a standard protocol (control group). Primary endpoints evaluated were: length of hospital stay, rates of complications, gas recovery time, and first defaecation. The comparison of the means was performed using the Student’s test for quantitative variables, and the Pearson chi-square test and the Fisher’s test for the qualitative variables; statistical significance was considered at a P < 0.05. Results: We studied 45 consecutive patients, 17 operated upon with the traditional protocol and 27 according to the ERAS protocol. The mean hospital stay was 9.4 vs 11.7 days, in favour of the ERAS group (P = 0.05). The gas recovery time was longer in the control group, at 69.8 vs 36.4 h (P < 0.001). The delay of the first defaecation was less in the ERAS group, at 126.6 vs 64.6 h (P < 0.001). The general postoperative complication rate was 31% in the control group and 24.4% in the ERAS group. The rate of gastrointestinal complications was higher in the control group, at 8.8% vs 2.2%. Conclusion: Despite the heterogeneity in ERAS protocols, which are different from one centre to another, its application significantly reduced the length of hospital stay and tended to reduce the rate of general and gastrointestinal complications, and the time to gas recovery and first defaecation