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Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP.A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines.Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system.Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD.

La fibrose rétropéritonéale (FRP) est une pathologie rare caractérisée par la formation d´une plaque fibro-inflammatoire dans l´espace rétropéritonéale en avant de l´aorte abdominale, responsable d´un engainement des uretères. Le tableau clinique n´est pas spécifique et la pathologie est souvent révélée par une uropathie obstructive. Nous avons mené une étude descriptive rétrospective étendue sur 10 ans, de janvier 2006 à décembre 2016, réalisée dans les services d´urologie B et de néphrologie du Centre Hospitalier Universitaire Ibn Sina. Nous avons inclus 18 patients dans l´étude dont 11 hommes et 7 femmes, avec un âge moyen de 51,4 ans ± 11,2. Le diagnostic a été révélé par des douleurs lombaires chez 14 patients. L´insuffisance rénale obstructive était présente chez 15 de nos patients et le diagnostic de FRP a été posé par l´uroscanner. Le bilan étiologique notait des antécédents de néoplasies pour 2 patients, de pathologies inflammatoires pour 2 autres patients et une chirurgie rétropéritonéale chez un patient. On notait l´association de prises médicamenteuses chroniques chez plus de la moitié des patients. Le traitement comportait un double volet: une sonde double J systématique chez tous les patients et un traitement systémique par de la corticothérapie et des immunosuppresseurs selon le profil évolutif. Le traitement par urétérolyse a été réalisé d´emblée chez 3 patients. L´évolution a été favorable avec une nette amélioration de la fonction rénale chez 12 patients. La rechute est survenue chez 2 patients après 2 ans de suivi. L´association de signes généraux à une insuffisance rénale obstructive doit faire évoquer le diagnostic de FRP. La recherche de causes secondaires devrait être systématique, avec un accent particulier à mettre sur le syndrome d´hyper IgG4 et les pathologies néoplasiques.

The objectives of this study were to evaluate the impact of preoperative urine culture and the infected nature of stones on the occurrence of postoperative urinary sepsis.A prospective monocentric study included 29 patients operated on for urolithiasis between January and June 2018.Postoperative urinary sepsis was observed in 4 patients (14%). Urinary colonization rate on preoperative CBU exam was 27.6% (8 of 29) while the rate of colonized stones was 31% (9 of 29). The occurrence of urinary sepsis was observed in 37.5% (3 of 8) of patients with urinary colonization, compared to 44.4% of patients with colonized stones (4 of 9). By comparing the bacteriological results observed during sepsis, the germs isolated in postoperative urine were the same found in the culture of stones. The chemical nature of the colonized stones was mainly calcium oxalate (monohydrate, dihydrate) P=0.02. There was a statistically significant correlation between the preoperative urine culture, the bacteriological culture of stones and the postoperative urinary sepsis (P=0.05, P=0.005) respectively.Our study demonstrated a strong association between the bacteriological culture of stones and postoperative urinary sepsis superior to preoperative urine culture. It makes it possible to anticipate the occurrence of sepsis in patients requiring many endoscopic treatments. However, several multicentric prospective series may prove necessary to validate these results.3.

Amongst the unanswered questions regarding prostate cancer (PCa), the optimal management of oligometastatic disease remains one of the major concerns of the scientific community. The very existence of this category is still subject to controversy. Aim of this systematic review is to summarize current available data on the most appropriate management of oligometastatic PCa. All relevant studies published in English up to November the 1st were identified through systematic searches in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database. A search was performed including the combination of following words: (prostate cancer) and (metastatic) and [(oligo) or (PSMA) or (cytoreductive) or (stereotaxic radiotherapy) or (prostatectomy)]. 3335 articles were reviewed. After title screening and abstract reading, 118 papers were considered for full reading, leaving a total of 36 articles for the systematic review. There is still no consensus on the definition of oligometastatic disease, nor on the imaging modalities used for its detection. While retrospective studies suggest an added benefit with the treatment the primitive tumor by cytoreductive prostatectomy (55% survival rate vs 21%, p

Testicular feminization, or the androgen insensitivity syndrome, is a rare disease. Because of various abnormalities of the X chromosome, a male, genetically XY, has some physical characteristics of a woman or a full female phenotype. Indeed the androgen insensitivity syndrome occurs because of a resistance to the actions of the androgen hormones, which in turn switches the development towards the aspect of a woman. We report a case of complete androgen insensitivity syndrome in a 30 years old woman who presented primary amenorrhea. We aim to improve our knowledge of this illness from the data that provides us this study, and a review of the literature.

Nous rapportons le cas d’un patient présentant un kyste de la vésicule séminale droite symptomatique. Au terme du bilan (échographie pelvienne et endo-rectale, tomodensitométrie abdomino-pelvienne et l’imagerie par résonance magnétique), le patient était opéré et bénéficiait d’une ablation du kyste. A la lumière de cette observation, l’épidémiologie, le diagnostic et les options thérapeutiques sont discutés.The Pan African Medical Journal 2016;25

L'absence de la veine cave inférieure (VCI) est une anomalie congénitale peu fréquente, au retentissement clinique habituellement discret. Nous rapportons le cas d'un jeune homme de 19 ans, au passé de pesanteurs pelviennes chroniques, présente un épisode d'hématurie macroscopique chez qui l'échographie rénale a montré un hématome péri rénal. L'uroscanner puis l'angioscanner mettront en évidence un hématome périrénal et une agénésie segmentaire de la VCI dans sa portion sous rénale et une agénésie partielle de veine iliaque droite, avec drainage azygos et volumineux réseau de suppléance péri rénal. Nous rapportons le cas d'une agénésie du segment sous rénal de la VCI et de la veine iliaque droite.

Les tumeurs para testiculaires sont des tumeurs rares et complexes qui ont une symptomatologie insidieuse et pauvre. Les formes bénignes représentent 70%. Le lipome para testiculaire étant le type le plus fréquent. L'examen clinique est peu spécifique. L'examen échographique est la pierre angulaire pour assoir le diagnostic. Le traitement chirurgical s'impose en cas de tumeur symptomatique, l'histologie étant habituellement typique permet la confirmation diagnostique. Le pronostic est bon malgré d’éventuelles récidives.

The partial substitution of the ureter using a pediculated double short segments of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization.

Introduction Lymphoepitheliomas are malignant epithelial tumors of the nasopharynx characterized by an important lymphoid proliferation at histological examination. Lymphoepithelioma-like carcinoma is a rare tumor of the bladder for which the therapeutic strategy is not clearly defined. Case presentation We report the case of a 64-year-old Moroccan man who presented with macroscopic hematuria. Investigations revealed a muscle-invasive lymphoepithelioma-like carcinoma of the bladder. Therefore he underwent a radical cystoprostatectomy with a good outcome. Conclusion This case illustrates pathogenic, clinical and therapeutic features of this unusual tumor.

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, bénigne

Les tumeurs de vessie constituent les tumeurs les plus fréquentes de l'appareil uro-génital chez l'homme, le type histologique est dominé par le carcinome urothéliale, la localisation primitive du lymphome malin est extrêmement rare et constitue souvent une surprise diagnostique quand elle est retrouvée. Nous rapportons à travers cette observation le cas d'un patient pris en charge au sein de notre formation qui a bénéficié, suite a un bilan d'hématurie objectivant une formation bourgeonnante intra vésicale a l’échographie abdominale, d'une résection transurétrale de la vessie d'un polype géant dont les résultats anapathologies sont revenus en faveur d'un lymphome primitif de la vessie, le patient a bénéficié d'une chimiothérapie adjuvante a base de RCHOP, les suites étaient simples et une surveillance cystoscopique et scannographique n'a pas objectivé de récidive avec un recul de 18 mois. Le lymphome primitif de la vessie est une entité rare, sa chimio sensibilité fait de ce type de tumeur une maladie curable, le diagnostic est histologique et vu la rareté de l'affection aucun consensus n'est standardisé.

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.

Les tumeurs de vessie sont rares avant 40 ans et ne représentent que 1 à 4% de l'ensemble de ces tumeurs. Notre étude s'est intéressée au profil épidémiologique, caractère histologique ainsi que le profil évolutif. Nous avons réalisé une étude retrospective sur une durée de 10 ans entre mars 2004 et mars 2014, nous avons traité 850 patients pour tumeur de vessie dont 36 était âgé de moins de 40 ans. Le diagnostic était posé devant des arguments cliniques, radiologiques et endoscopiques, la cystoscopie avec résection tumorale a précisé la nature histologique et son grading ainsi que le degré d'infiltration. 23 patients avaient une tumeur de vessie non infiltrant le muscle et 13 avaient une tumeur infiltrant le muscle. Le taux de récidive global est de l'ordre de 36,4%, 22% pour la tranche d’âge 20-30 ans et 46% pour la tranche d’âge 31-40 ans. Le risque de progression et de décès est respectivement de 8% et de 6,1%. Il ressort que les tumeurs superficielles ont une meilleure évolution chez les sujets de moins de 30 ans. Les tumeurs infiltrantes sont plus fréquentes et souvent évoluées suggérant un potentiel évolutif particulier. Leur pronostic est fonction du stade tumoral, sans corrélation avec l’âge.

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.

This report describes a case of primary osteosarcoma of the testis in a 60-year-old man. Treatment consisted of an inguinal orchiectomy with no adjuvant therapy. The patient is alive and doing well without recurrent disease at 18 months after diagnosis. Only three reports have been published on primary osteosarcoma of the testis. The origin of this tumor from undifferentiated mesenchymal cells or from a malignant transformation of pre-existing teratomatous elements is still unclear. Management guidelines are difficult to establish due to the rarity of such tumors, but inguinal orchiectomy with careful follow up appears to be sufficient treatment.

To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults and to determine the incidence of its main complication, vesico-ureteric reflux.Retrospective study of 14 cases of ureterocele in adults observed between March 1989 and August 2004, corresponding to 7 males and 7 females with a mean age of 39 years (range: 17-73 years). The ureterocele was observed in a context of single ureter in 13 cases (94%) and duplicated ureter arising from the superior renal unit in one patient (7%). The ureterocele was complicated by stones in 9 cases (64%). Endoscopic meatotomy was performed in 13 patients, while immediate resection of the ureterocele followed by Hendren ureterovesical reimplantation was performed in one patient with major proximal repercussions.The postoperative course was uneventful in all patients including the patient treated by conventional surgery. Postoperative follow-up consisted of clinical and radiological assessment at 3 months and 6 months. Endoscopic treatment was effective in every case with resolution of low back pain and absence of residual stones when the ureterocele was initially complicated by stones. In contrast, de novo vesicoureteric reflux appeared secondarily in 5 patients (38.5%) but persisted at 6 months in only one patient, who required re-operation: resection of the ureterocele and Hendren ureteric reimplantation.Endoscopic meatotomy can be considered to be the firstline treatment for ureterocele in adults in the absence of severe dilatation of the proximal urinary tract. Its main complication remains vesico-ureteric reflux. Radiological surveillance by urethrocystography therefore appears to be essential.

Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.

A case of seminal vesicle with ipsilateral renal agenesis is presented. In the light of this case, symptomatology, diagnosis and treatment option are discussed.

The authors report two cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. We describe the technique of prelevement and injection. The immediate results confirm the efficacity of this procedure. The long-term follow-up will allow us to adopt it and to give it some modifications.

The York Mason approach appears to be one of the most suitable techniques for the treatment of prostato-rectal fistulas, as it provides a maximum chance of success with no morbidity, as no cases of anal incontinence have been reported to date. The authors report a case of prostato-rectal fistula secondary to transurethral resection of the prostate for benign prostatic hyperplasia treated by the YORK MASON posterior trans-anosphincteric approach.

Two patients presenting complex tuberculous ureteral strictures on an only existing kidney were treated with definitive double J stent changed every 6 months. This treatment modality was well tolerated. On the basis of two cases and literature review, different therapeutic measures are discussed.

In order to evaluate the long-term results and complications, the authors reviewed the files of 14 adult patients operated for the first time for hypospadias.This study was based on retrospective analysis of the files of 15 adults between the ages of 17 and 36 years operated for hypospadias between 1989 and 1999. The findings of the first visit concerned the site of the urethral meatus, the presence and severity of chordee and the primary and secondary sexual characteristics. Urine culture was performed in all patients.The follow-up was 12 months to 8 years. Six of the 15 patients were treated by urethroplasty alone and 9 patients underwent urethroplasty with correction of chordee. 40% of patients (3 cases of anterior hypospadias, 2 cases of midpenile hypospadias and 1 vulviform hypospadias) obtained a good long-term result. In the case of complications (fistula, stenosis or distal necrosis of the tube), a single reoperation allowed good results to be achieved in 80% of the series.The results of treatment of hypospadias in adult patients differ from those obtained in children despite the use of similar surgical techniques.

Bladder exstrophy is a malformation which the incidence is estimated at 3.3 per 100,000 births. It is usually treated in the first hours of life. The authors report three cases of bladder exstrophy treated in adult life with continent urinary diversion such as Benchekroun continent ileocaecal bladder (CICB). After a literature review on the management of bladder exstrophy, they studied clinical and therapeutical particularities of the bladder exstrophy in adulthood.

The authors report a case of transitional cell carcinoma of the left ureteral stump in a 66-year old man treated by nephrectomy for pyonephrosis 6 years previously and cystoprostatectomy for bladder tumour 13 years previously. In the light of this case and based on a review of the literature, they essentially discuss the diagnostic and aetiopathogenic problems raised by this disease.

The authors report 2 cases of prostatic leiomyosarcoma. The first patient was not operated because of a severely debilitated state and died a fortnight after admission to hospital. The second patient underwent cystoprostatectomy with ilio-obturator lymph node dissection. Resection margins and lymph node dissection were negative and no further treatment was required. With a 10-year follow-up, the clinical and radiological assessment was normal. The diagnostic and therapeutic aspects of this rare prostatic tumour are discusses.

Inflammatory pseudotumors are uncommon benign tumors of unknown etiology which may develop at several anatomical sites, e.g., the airways and gastrointestinal tissues, soft tissues, the orbit, the spleen, or the lymph nodes. The renal site is extremely rare, and presents the problem of differential diagnosis as the clinical and radiological aspects of this tumor are similar to those of an adenoma or an angiomyolipoma, and suggest the presence of a carcinoma, in particular a cystic renal carcinoma which is also a rare form of tumor. There is therefore a risk that this benign lesion could be misdiagnosed. Due to the good prognosis associated with this type of tumor, in cases where the definitive diagnosis has been established no surgical procedure is necessary. However, the difficulty in making this diagnosis preoperatively means that in general the organ has to be surgically removed so that a histological analysis can be made and the negative or positive findings confirmed. In the present study, the case of an inflammatory pseudotumor of the kidney has been described. In this instance, radical nephrectomy of the left kidney was carried out as the disease was presumed to be renal cell adenocarcinoma. However, the histopathological analysis was negative as regards malignancy, and indicated the presence of an inflammatory pseudotumor. This article raises the question of the problem in establishing a preoperative definitive diagnosis, as a correct diagnosis is often only confirmed following nephrectomy (in cases where the contralateral kidney is healthy).

Leiomyosarcoma of the prostate is rare neoplasm that accounts for less than 0.1% of prostate malignancies. A number of treatment approaches have been adopted including radical surgery, radiotherapy and chemotherapy, but in no instance has a successful outcome been obtained. Prostate leiomyosarcoma has a poor prognosis, although survival time can vary. For these reasons, it is important to correctly identify this disease and report its occurrence, type of treatment, and the response to therapy of each patient diagnosed as having leiomyosarcoma of the prostate in an attempt to improve our understanding of the natural history of these lesions.

The authors report a rare case of testicular non-Hodgkin's malignant lymphoma (NHML) in a 21-year-old man with a fatal outcome. In the light of the literature, they analyse the clinical features, clinical course and treatment of this lymphoma.

A retrospective study has been made of 81 cases of percutaneous nephrostomy (PCN) which were treated during the period 1989-1998. The mean patient age was 41 years (age range: 21-66 years). The reasons for the diversion via nephrostomy catheter were oligoanuria (43 cases), pyonephrosis (34 cases), and evaluation of renal function (four cases). The initial disease was found to be malignant in 23.25% of cases of oligoanuria, with six cancers of the cervix, three bladder cancers and one prostate cancer. Lithiasis was the main etiology in subjects with benign disease, and was the causative factor of oligoanuria in 55.8% and pyonephrosis in 67.6% of cases, i.e., a total of 47 cases (58%). PCN catheter placement was successfully carried out in 100% of cases, and resulted in improved renal function, and/or in the treatment of the initial infectious syndrome in the majority of cases. PCN is an excellent technique for upper urinary tract drainage due to its simplicity, efficacy, ease of insertion, low cost and satisfactory results. It is a minimally invasive technique, which necessitates only the use of a local anesthetic, a sound knowledge of the human anatomy involved, a trained operator and a minimum of material.

Between January 1990 and December 1997, 61 patients with renal calculi underwent percutaneous nepholithotomy. In the immediate postoperative period, 49 renal units (80.3%) were stone-free. At three months, our overall success rate was 91.8% after spontaneous elimination of non-significant residual calculi (3 mm). Complications were observed in 9.8% (six cases); hemorrhage and sepsis were the major complications. Percutaneous nephrolithotomy is an effective, safe and reliable alternative to the open operation.

We retrospectively investigated 63 patients suffering from 71 staghorn calculi, who were treated with primary surgical monotherapy, in order to determine long-term. results and the fate of the residual stones.Mean follow-up was 2.6 years. There were 63 patients (32 men, 31 women). The treatment was pyelolithotomy alone in 26 cases; nephrolithotomy alone in 14 cases; pyelolithotomy associated with nephrolithotomy in 18 cases; percutaneous nephrolithotomy (PCNL) in two cases; extracorporeal shock-wave lithotripsy (ESWL) in one case; and nephrectomy in ten cases.At the conclusion of therapy the stone-free rate was 94.1%. The complication was septic complications in 12 patients, hemorrhage that needed transfusion in five case and fistula in one case. After four and six years, two patients developed renal insufficiency and two patients had a recurrence of stones.Primary surgery of complex staghorn calculi is justified because of its better results than PCNL associated with ESMIL.

Squamous cell carcinoma of the male urethra is exceptional, as all urethral tumours represent less than 1% of urinary tract tumours. Treatment depends on the stage and site of the lesion, but the prognosis remains very poor despite aggressive treatment, including mutilating resection surgery with or without associated radiotherapy. However, the current hope for patients with squamous cell carcinoma of the urethra resides in radiotherapy-chemotherapy combination protocols based on the results obtained in squamous cell cancers of the oesophagus and anus.

The authors report a retrospective study concerning 18 patients having major renal trauma. The patients study group was comprised of 11 males (61%) and seven females (39%) with a mean age of 23 years. The etiologic agents were traffic accident (eight cases), falls (five cases) and stab wounds (five cases). Gross hematuria was present in all the patients. After radiologic investigations the renal injuries were classified according to the American Association for Surgery of Trauma. Two patients were in stage V, seven in stage IV and nine in stage III. Three patients were operated in emergency for hemodynamic instability, two had a total nephrectomy and one a partial nephrectomy. Five patients underwent surgery between the 5th and 7th day, three had a suture of the renal parenchyma under a nephrostomy, one a partial nephrectomy and the third a total nephrectomy. Two patients had only a urinary drainage by placement of an ureteral stent in order to diminish the urohematoma. Eight patients were treated conservatively and all were in stage III. The mean retreat was 16 months. There was no mortality and among the eight patients who underwent surgery, none had complications, aside from two wound infections. The patients who were managed conservatively had good progression; they all had a control by computed tomography which showed that the urohematoma had decreased. None of the patients developed hypertension or infection of the urohematoma.

Urethral stricture, mainly consisting of cases of inflammatory stricture, is a frequent occurrence in Morocco. Numerous techniques have been proposed to treat these disorders, including internal endoscopic urethrotomy (IEU). Initially described by Otis and Maisonneuve using a blind approach, IEU was then further developed by Saches who carried out direct vision urethrotomy. It rapidly became established as the method of choice for primary treatment of urethral stricture, and classical surgery was limited to those cases in which this method had failed. However, although this technique is relatively simple and appears to be efficient, there is in fact a high relapse rate, necessitating repeated IEU; therefore at present there is a tendency to return to the classical methods of anastomotic resection and urethroplasty after the second or third IEU. Although the relapse rate is low for short, single or bulbar strictures, it is high for penile strictures and for those with accompanying severe periurethral fibrosis. In this study, we have reported the results of a homogeneous series of 149 cases of urethral stricture treated by internal urethrotomy. The aim of this retrospective study was to better define the indications for adopting this technique, and also to determine the reasons for failure. The various alternatives to IEU (resection, plasty) have been examined, as has their respective failure rate.

The authors report a case of paratesticular thabdomyosarcoma in a young adult. This tumour is more frequent in children than in adults. Rhabdomyosarcoma is the commonest variety of soft tissue sarcoma in children and young adults. It represents 6.5% of all malignant tumours in paediatrics with an annual incidence of 4 to 7 cases/million children. The primary paratesticular site is considered to have a good prognosis in comparison with other rhabdomyosarcomas, despite the frequency of retroperitoneal lymph node invasion. This superficial site allows rapid diagnosis and consequently often complete resection of the tumour. The multidisciplinary treatment of paratesticular rhabdomyosarcoma has improved control of the disease with a 2-year survival of 80%.

Primary lymphoma of the adrenal gland is an exceptional site for non-Hodgkin's malignant lymphoma, as fewer than 50 cases have been reported in the international literature. To our knowledge, this is the first reported case of intraoperative discovery. The diagnosis of primary adrenal lymphoma can be suggested in the case of bilateral involvement and adrenal insufficiency, but there are no specific clinical or complementary criteria. The main differential diagnoses are adrenal metastases and adenomas. Management is often that of an incidentaloma. Primary NHML of the adrenal gland has a poor prognosis with a mean survival of 15 months. Only one case with a survival of 8 years has been reported in a patient treated with adjuvant radiotherapy, while basic treatment consists of combination chemotherapy. Our patient was treated by adrenalectomy followed by close surveillance.

The authors report a series of 68 cases of renal cancer observed over a 9-year period. Patients consisted of 33 women (49%) and 35 men (51%), with a mean age of 53 years (range: 23-85 years). The clinical features were polymorphic, dominated by loin pain (44%), haematuria (37%), a lumbar mass (19%), alteration of the general state (7%). The diagnosis was established by ultrasonography in 59 patients and CT-scan in 63 patients. The mean tumour diameter was 11 cm (4-22 cm) and two cases presented bilateral tumours. The time to diagnosis ranged from 1 month to 7 years. Staging reflected the advanced stage of the cancer. Treatment was surgical for 58 patients (58%). A lumbar incision was performed, in 40% of cases. Radical nephrectomy was performed in 82%, and partial nephrectomy was performed in 3% of patients. Histological examination of the specimen showed renal cell carcinoma in 75% of cases. The lymph nodes removed were invaded in 20% of cases. The mean follow-up was 29 months (6 to 84 months), normal at one year for 44 patients (86%) and at 5 years for 16 patients (31%). Tumour recurrence in the renal compartment was observed in 2 patients (4%). Asynchronous metastases occurred in 11 patients (21.5%) after 21 months. (range: 12-48 months). The overall 5-year survival was 100% T1, 69% T2 and 50% T3.

In an 8-year period, 10 patients/1,280 developed bladder neck sclerosis following prostatectomy--an incidence of 0.78%. The mean age is 66 years (range 45-88).clinical signs of the disease are characteristic of infravesical obstruction confirmed by uroflow and X-ray examination. The best results for the treatment of the contracture were obtained after bladder neck incision and transuretral resection of the bladder neck contracture which gave--with mean follow-up of 12 months (range 7-24 months)--0% incidence of recurrence but after bladder neck dilatation it rose 100%.

Between 1989 and 1996, 1,280 patients aged 41 to 100 years were operated for BPH. 70% of patients were treated at the stage of complications such as acute urinary retention, haematuria, bladder stones or renal failure. 549 patients (42.9%) were treated by transvesical prostatectomy (TVP), 668 patients (52.18%) underwent transurethral resection (TURP) and only 63 (4.92%) were treated by bladder neck incision (BNI). Early postoperative complications essentially consisted of infections: wound infection (15%), followed by vesico-cutaneous fistula (2%), epididymo-orchitis (0.7%) and urinary tract infection (1.5%). Late post-operative assessment revealed retrograde ejaculation in 100% of cases after transvesical surgery, 80% of cases after TURP and almost no cases (4%) after BNI. The permanent urinary incontinence rate was 1.18% after TURP and 1.0% after transvesical surgery. The shortest mean postoperative stay was 5 days in the BNI group versus 12.5 days after transvesical surgery. Finally, the postoperative mortality, essentially due to septic shock and myocardial infarction, was (0.8%). The BPH complication rate is proportional to the delay in diagnosis and management. Transurethral resection remains the most effective treatment with the lowest morbidity.

To review the diagnostic and epidemiological aspects and especially to demonstrate the value of emergency surgical treatment.In 8 years (1989-1996), 56 fractures of the penis in 55 patients were surgically repaired as an emergency procedure immediately after admission. The skin incision was often elective and longitudinal. After evacuation of the haematoma, the fracture was sutured with slowly resorbed suture material. The presence of a concomitant urethral lesion was systematically investigated and repaired.The mean age was 30 years, and 72.75% of patients were unmarried men. The mean operating time was 40 min and the mean hospital stay was 1.5 days. The immediate postoperative course was always favourable. In 36 long-term evaluable patients, sexual activity was resumed with no difficulties of erection or intromission. No case of chordee of the penis was observed, but two patients presented a cicatricial nodule.Fracture of the penis is a rare disease and is diagnosed clinically. Emergency surgical treatment is the only guarantee of a good functional prognosis.

In Morocco, hydatid disease is endemic and constitutes a major problem of public health. Renal echinococcal cyst ranks third after pulmonary and hepatic locations. We report a case of renal echinococcal cyst diagnosed during percutaneous nephrolithotomy which was treated endoscopically. To our knowledge, this situation has not been reported previously in the literature.

Retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is an interesting approach to urological surgery. We report our initial experience with retroperitoneal laparoscopic adrenalectomy.Between January 1995 and April 1997, 23 adrenalectomies were performed by retroperitoneal laparoscopy in 10 men and 12 women. The patients were placed in the lateral decubitus position and 5 trocars were used. The retroperitoneal working space was created by digital dissection and was completed by insufflation without balloon dissection. The surgical indications were Conn's adenoma in 12 cases, Cushing's adenoma in 4, bilateral adrenal hyperplasia (Cushing's disease) in 1 (treated in a single procedure), a nonfunctioning adenoma in 2, pheochromocytoma in 2 and adrenal metastasis in 1.We removed 7 right and 16 left adrenal glands in an average operating time of 97 minutes (range 45 to 160). Average tumor size was 26 mm. (range 10 to 40). Average hospital stay was 3.3 days (range 1 to 10). Blood loss was minimal. Postoperative analgesic requirements were moderate. Conversion to open surgery was not necessary. The morbidity rate was low, with 1 postoperative hematoma and 1 case of persistent fever (greater than 38.5C).Retroperitoneal adrenalectomy is a reliable and effective technique. At our institution retroperitoneal laparoscopy is now the standard adrenal surgery procedure for tumors less than 5 cm.

Rigid ureteroscopy has become a common tool for the diagnosis and management of several diseases of the upper urinary tract. Between April 1990 and April 1996, 92 ureteroscopy procedures were performed in 88 patients in the B Urology Department of Avicennes hospital for diagnostic or therapeutic purposes. The commonest therapeutic procedure was stone manipulation (72 cases). The overall success rate was 90.8% (Distal ureter: 89.6%, mid ureter: 80%, lumbar ureter: 100%) and the complication rate was 4%. Therapeutic ureteroscopy was also used to dry ureterovaginal fistula (4 cases) and ureteral fistula with retroperitoneal urinoma (2 cases), and to remove a double J stent which had migrated into the pelvic ureter (3 cases). Diagnostic ureteroscopy was performed for 7 ureteral strictures including 3 extrinsic compressions and 4 ureteral strictures all treated with dilatations after biopsy. One false passage was observed among diagnostic ureteroscopy procedures. Rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesions.

The objective of this paper is to report an exceptional case of solitary contralateral perirenal metastasis from a renal cell carcinoma. Investigation of this 62-year old patient, presenting with isolated haematuria, revealed a tumour, 9 cm in diameter, in the upper pole of the right kidney, associated with contralateral metastasis in the left perirenal fat. A right radical nephrectomy and left lumpectomy including the fat around the tumour were performed via a bilateral subcostal incision. Pathological staging was pT3b N0 M1, Fuhrman grade III. With a follow-up of eight months, this patient was asymptomatic with a normal radiological assessment.

In this multicenter study, the yearly national evaluation of tumors of the kidney was out by the Oncology Committee of the French Association of Urology.During the period from April 1, 1992, to March 31, 1994, 1486 patients from 54 centers were included in this study. For each patient, an individual chart was created, in which age, gender, discovery circumstances of the tumor, radiologic and biologic workup, treatment, TNM classification, and histologic features of the tumor were recorded.The mean patient age was 62.1 years, and the male-to-female ratio was 2:1. Forty percent of the tumors were discovered accidentally. A radical nephrectomy was performed in 93% of the cases, and in 7% of the cases, conservative management was adopted. Medical treatment was chosen in 5% of the cases. The patient distribution according to classification was as follows: pT1 = 8%, pT2 = 53%, pT3a = 21%, and pT3b = 18%. Lymph node involvement was observed in 9% and visceral metastasis in 6% of the cases. The incidental tumors were intracapsular in 80% of the cases. From the histologic point of view, the majority of the tumors were clear cell adenocarcinoma (66%). The mean tumor maximum dimension was 6.4 +/- 3.5 cm; it was significantly greater in symptomatic patients and patients with poor prognostic indicators (involvement of the adrenal gland, inferior vena cava, and/or lymph nodes and visceral metastasis). Adrenal gland involvement or inferior vena cava involvement were each observed in 4% of the cases. Fourteen percent of the patients had multicentric tumor spread, which was influenced by neither the tumor size nor the cell type. The nuclear grade was established in 66% of the cases and was significantly correlated with involvement of the perirenal fat and the lymph nodes.This study allowed the authors to centralize one-fifth of all new cases of adenocarcinoma of the kidney in France in the course of a year. It enabled them to evaluate precisely the current epidemiologic profile of this disease among those patients.

The treatment of ureteric strictures in renal transplantation used to be surgical, but has recently benefited from progress in endourology. The authors report the case of a renal transplant recipient who developed late stricture of the ureterovesical reimplantation of the transplant. After percutaneous nephrostomy, which restored good renal function, retrograde endoureterotomy was performed using an Acucise ureterotome balloon, followed by ureteric modelling on a 7F double J stent for 2 months. With a follow-up of 18 months, renal function was normal and ultrasonography showed residual hypotonia of the transplant cavities and no vesicorenal reflux was detected by retrograde voiding cystourethrography. Acucise retrograde endoureterotomy can constitute a simple endourological treatment for late ureteric strictures in renal transplantation.