Search

Resume But La prostatite aigue represente la principale complication des biopsies prostatiques (BP); elle necessite parfois une hospitalisation et un traitement antibiotique adapte. Ce travail a etudie les germes en cause pour suggerer une antibiotherapie probabiliste. Patients et methodes L’etude retrospective (de 2000 a 2006) dans 2 centres a inclus les 17 patients ayant ete hospitalises pour prostatite aigue apres BP sur 1216 biopsies. Une documentation bacteriologique a ete realisee avec urocultures, hemocultures, identification du germe et antibiogramme. Resultats Tous les patients avaient eut une antibioprophylaxie par une fluoro-quinolone systemique monodose prise au moins 1 h avant la BP. L’identification des bacteries a ete possible dans quatorze cas: E.Coli (neuf cas), Proteus mirabilis (un cas), Klebsiella pneumoniae (un cas), Enterococcus fecalis (un cas), Staphylococcus Spp (un cas), Clostridium Perfringens (un cas). L’ECBU uniquement a ete positif dans 6 cas (35%), les hemocultures uniquement dans 3 cas (17%), urocultures et hemocultures positives et concordantes dans 5 cas (29%). Une haute resistance de l’E.Coli pour les fluoro-quinolones a ete retrouvee dans 88% des cas et pour cotrimoxazole dans 77% des cas. Par contre le germe etait sensible aux cephalosporines de deuxieme et troisieme generation (C2G et C3G) et a l’amikacine dans 100% des cas. La prostatite a ete associee a une orchi-epididymite (3 cas), une retention aigue d’urines (4 cas) et une endocardite d’Osier (1 cas). Conclusions Devant une prostatite aigue apres biopsie, l’identification du germe necessite obligatoirement la realisation d’hemocultures associees a l’ECBU. Le traitement antibiotique probabiliste est base sur l’utilisation d’une C2G ou C3G, associee ou non avec l’amikacine selon l’intensite du tableau clinique.

Balloon catheter dilatation is a low-cost alternative to open surgery in patients with ureteral strictures, leading to low morbidity and short hospitalization. The goal of this study was to evaluate the results of this technique in patients with inflammatory ureteral strictures or ureteroenteric strictures after radical cystectomy. Twenty-five ureteral strictures in 20 (15 male, 5 female) patients were consecutively treated by high-pressure balloon dilatation: 14 cases of ureteroenteric stricture (9 after ileal cutaneous diversion, and 5 after orthotopic enterocystoplasty) and 11 of ureteral stricture from various inflammatory causes (tuberculosis, iatrogenic injury, radiation therapy, parasitosis). Dilatation was performed by an antegrade (ureteroenteric strictures) or retrograde (inflammatory strictures) approach using a balloon insufflated up to 10 to 20 atm for 5 to 15 minutes. The ureter was stented for a mean time of 2.1 months (range 1-5 months). Results were evaluated clinically and radiologically (intravenous urogram or CT scan). Immediate success was assessed by intraoperative radiologic monitoring. Long-term success was defined as the absence of recurrence of the stenosis after 6 months. Nineteen procedures were successful among the 23 evaluable cases. With a mean follow-up of 16 months (range 6-39 months), the long-term success rate was 52%: 40% in ureteral strictures and 61% in ureteroenteric strictures. Five strictures secondary to cutaneous diversion and six caused by radiation therapy recurred after dilatation. After cutaneous diversion, the failure occurred mostly at the anastomosis and involved the crossed-over ureter. This study shows that high-pressure balloon dilatation of ureteral strictures has a high early success rate and a long-term success rate of 52%. It can therefore be considered as an alternative to open surgery.

Partial ureteral duplication in an inverted Y is evidenced by the presence of a ureter duplicated at a variable level before reaching the bladder, in either an orthotopic or an ectopic position. A case of ureteral duplication at the level of the renal hilum with opening of a ureter at the level of the epididymis is reported. The description of this original case is compared with the data in the literature. The stages of organogenesis of the superior excretory pathway leading to ureteral ectopia and ureteral anomalies of number are reviewed.