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Objectifs : Le but de cette A©tude est d'A©valuer l'impact de l'implementation du protocole ERAS aprA¨s cystectomie radicale pour tumeur de vessie. MatA©riels et mA©thodes : Il s'agit d'une A©tude prospective monocentrique comparative d'un groupe tA©moin avec un protocole standard regroupant les cystectomies opA©rA©es pour tumeur de vessie de Mars 2017 en Avril 2018, et un groupe ERAS . Les critA¨res de jugement A©valuA©s A©taient les dA©lais de reprise de gaz, de la premiA¨re dA©fA©cation, la durA©e du sA©jour hospitalier. RA©sultats : Au total, 45 patients ont A©tA© inclus, 18 patients tA©moin et 27 patients ERAS. La moyenne du sA©jour hospitalier A©tait de 9,4j vs 11,7j ; p= 0,05 en faveur du groupe ERAS. Le dA©lai de reprise de gaz en heures A©tait plus A©levA© dans le groupe tA©moin (69,8 vs 36,4 ; p=

Background Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor that develops from the wall of the IVC and can be confused with many other retroperitoneal tumors. We report the observation of a man with leiomyosarcoma of the vena cava which invades the right kidney. Case presentation 56-year-old man who has seen progress for right back pain for over a year. His thoraco-abdominal-pelvic scanner found a right tumor process measuring 18 × 13 × 18 cm invading the right kidney and the inferior vena cava, heterogeneous in nature, which is enhanced after injection of iodinated contrast product, pushing back the liver and the gall bladder. A border of separation persisted between the mass and the abdominal and thoracic walls. His biological assessment was normal. He underwent an open right nephrectomy with intraoperative bleeding requiring a transfusion of 2 red blood cells. The patient's follow-up period was 8 months without local recurrence or secondary localization. Conclusion The LMS of IVC is a tumor whose management is not yet well codified. Surgery is the only therapeutic means that gives good results, when it is possible. But long-term recurrences remain frequent, which therefore requires prolonged monitoring of these patients.

Background The testicular epidermoid cyst is an exceptional benign tumor. The presumptive diagnosis is facilitated by the development of medical imaging (echo-Doppler, elastography, contrast-enhanced ultrasound, MRI). The confirmatory diagnosis is histological. Case presentation We report the case report of a 37-year-old man who had a history of repetitive orchitis. He had complained of right scrotal discomfort for 6 months with no associated urinary symptoms. We performed an extemporaneous biopsy given the uncertain diagnosis (Fig. 3), and the histological examination was in favor of a mature teratoma. This prompted us to perform a right orchidectomy. The postoperative was simple. The final histological examination tipped in favor of an epidermoid cyst of the testicle. The patient was seen again at one month, and his clinical examination was normal. Conclusion The testicular epidermal cyst is a rare benign tumor of the testicle. Currently, conservative surgery has become the gold standard thanks to the development of medical imaging to differentiate between the both forms of TEC, and it retains certain limits which lie in the differential diagnosis with the teratoma requiring large multicenter studies to better characterize these two entities.

Resume But Les objectifs de ce travail etaient d’evaluer l’impact de l’examen preoperatoire des urines et du caractere infecte des calculs sur la survenue du sepsis urinaire postoperatoire. Materiel et methodes Une etude prospective monocentrique a inclus 29 patients operes de la lithiase urinaire entre janvier et juin 2018. Resultats Le sepsis urinaire postoperatoire a ete observe chez 4 patients (14 %). Le taux de colonisation urinaire sur l’ECBU preoperatoire etait de 27,6 % (8 sur 29) alors que le taux de calculs colonises etait de 31 % (9 sur 29). La survenue d’un sepsis urinaire a ete constatee chez 37,5 % (3 sur 8) des patients ayant une colonisation urinaire, par rapport a 44,4 % des patients ayant des calculs colonises (4 sur 9). En comparant les resultats bacteriologiques observes lors du sepsis, les germes isoles dans les urines postoperatoires etaient les memes retrouves dans la culture des calculs. La nature chimique des calculs colonises etait principalement l’oxalate de calcium (monohydrate, dihydrate) p = 0,02. Il existe une correlation statistiquement significative entre l’examen preoperatoire d’urine, la culture bacteriologique de calculs et le sepsis urinaire postoperatoire (p = 0,05, p = 0,005) respectivement. Conclusion Notre etude a mis en evidence une forte association entre la culture bacteriologique des calculs et le sepsis urinaire postoperatoire superieure a celle de la culture urinaire preoperatoire. Elle permet d’anticiper la survenue d’une septicemie chez des patients necessitant de nombreux traitements endoscopiques. Cependant, plusieurs series prospectives multicentriques peuvent s’averer necessaires pour valider ces resultats. Niveau de preuve 3.

Background The aim of this study is to evaluate the prevalence of urinary colonization in patients with the JJ stent and to define the predictive factors associated with this colonization. Methods This is a monocentric prospective study (between January 2013 and April 2017), conducted in the department of Urology B of Ibn Sina Hospital in Rabat. One hundred and forty-five double ureteral stents carried by 120 patients, 25 of which had bilateral double ureteral stent, were examined. The bacteriological profile of the urine of our patients was followed by the completion of an initial urine examination and another at the time of the removal of the JJ. The comparison of the means was made by the Student's test and the Mann–Whitney test for continuous variables and by the KHI-2 test and Fisher's test for qualitative variables. The threshold of significance is set at 0.05. Results The rate of colonization of JJ stent was 35.8% (43 out of 120). The urinary colonization rate was 31.7% (38 out of 120). Average time of indwelling of JJ stent was 90 days. On double ureteral stent culture, we identified Escherichia Coli as the most predominant colonizing pathogen (47.3% of probes) followed by Enterococcus faecalis and Klebsiella pneumoniae (18.4% and 15.8%, respectively). 11.5% of colonized patients developed infectious complications (5 out of 43) and have been treated successfully except a patient who died from septic shock. In univariate analysis, diabetes mellitus (p = 0.007, OR = 4.1, CI = 1.46–11.48), urgent establishment of JJ (p = 0.03, OR = 4.61; IC = 1.08–19.6) and time of indwelling of the JJ (p = 0.05, OR = 1.89, CI = 0.95–3.77) were the predictive factors for urinary colonization in patients with JJ. In multivariate analysis, these three factors were statistically associated with this risk: diabetes mellitus (p = 0.005, OR = 0.23, CI = 0.08–0.64), the urgent establishment of JJ (p = 0.05, OR = 0.26, CI = 0, 06–1.04) and time of indwelling of the JJ more than 30 days (p = 0.007, OR = 4.29, CI = 1.49–12.37). Conclusion The prevalence of urinary colonization in patients with the double J stent was 31.7%. Diabetes mellitus, time of indwelling of the JJ more than 30 days and urgent JJ ​​ establishment are associated with a higher risk of these urinary colonizations. Strict monitoring is therefore recommended in patients with these risk factors. These results should be confirmed by multicenter and randomized studies to analyze the development of urinary tract infections in colonized patients.

Urothelial carcinomas (UC) are likely to have particular morphological features that distinguish them from the typical form. These original aspects are called “histological variants of urothelial carcinoma”. They can constitute all or part of the tumor and concern mainly muscle invasive UC and high grade. Their frequency varies according to the type, but the knowledge of these variants is essential because of the diagnostic difficulties, and the implication of their presence on the prognosis.

Highlights • Falandry and Martius’ techniques were used firstly for vesico-vaginal fistulas with satisfying long-term functional results. • The same techniques are feasible and safe for rectovaginal fistula repair. • In this case series, patients had an improvement of their self-image and health-related quality of life. • Temporary colostomy is recommended before this reconstructive surgery., Introduction Rectovaginal fistula (RVF) is defined as an abnormal communication between the anterior wall of the rectum and the posterior wall of the vagina. Many surgical techniques have been described in the treatment of RVF. However, none has proved its superiority. The aim of the study was to evaluate the functional results of surgical treatment of RVF using Martius and Falandry techniques in order to assess the feasibility and the efficacy of these techniques which were first described for vesico-vaginal fistulas. Methods The study was a retrospective case series conducted in a single centre: Department of general surgery at Ibn Sina University Hospital in Rabat. We included patients with rectovaginal fistula consecutively recruited from 2011 to 2014. 10 patients developed RVF after surgery for rectal cancer (9 cases), uterine cancer (1 case). One patient had RVF for ano-rectal malformation. Colostomy was performed before the treatment of fistula in 9 cases (82 %). They underwent surgical treatment using Falandry (8 patients) and Martius techniques (3 patients) performed by an experienced urologist surgeon. Results No postoperative complications were recorded. Time to discharge was postoperative day 3–4. There was a complete disappearance of RVF in 8 patients (72.7 % of cases), relapse in 2 cases (18 %), and failure in one case (9%). The average follow-up was 12.6 +/-10 months. Functionally, no long-term cases of fecal incontinence or dyspareunia were noted. Conclusion The choice of surgical technique in the treatment of RVF remains difficult because of poor literature data and absence of consensus. RVF repair results either by Martius or Falandry techniques are encouraging with low morbidity.

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.

Cases of rectal foreign bodies (RFB) insertion are frequently encountred in the last years, leading to many complications, while many patients tends to obscure the context. This entity represent a particular form of rectal injuries that can be more lethal with the peritoneal involvement. However, combination of genitourinary injuries to rectal injuries doesn't worsen the prognosis. We report a case of a RFB injury leading to an extraperitoneal rectal injuri with a recto-vesical fistula that was managed effectively conservatively with successive CT Cystogram follow-ups.

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.

Introduction: The Bladder Cancer Index (BCI) is a validated questionnaire for health-related quality of life in patients with bladder cancer (BC). Objective: To translate the original BCI into an Arabic validated version. Subjects and methods: For translation and validation, we proceeded in 5 steps: (1) Authorization of translation by the authors of the original BCI. (2) Translation from English to Arabic. (3) Submission of the translated version into Arabic to a committee of readers. (4) Backward translation to ensure there was no discrepancy between the two versions during the reverse translation. (5) Qualitative linguistic validation of the document obtained from seven patients having BC. Results: Translation was authorized in February 2015. The reading committee that evaluated the clarity of the text admitted the version with minor revisions. The questionnaire was finally tested on seven patients with bladder tumor treated in the department of urology B at Ibn Sina Teaching Hospital. They all responded to the questionnaire without understanding nor filling difficulty. Therefore, no major changes were made following this qualitative assessment. Conclusion: This Arabic version of BCI questionnaire will enable researchers from Arab countries to use a measurement tool validated and recognized internationally to assess QOL in patients with BC. Keywords: Bladder Cancer Index; Bladder cancer; Questionnaire; Backtranslation; Quality of life; Health-related quality of life; Arabic

INTRODUCTION Orthotopic neobladder (ONB) and ileal conduit (IC) are the most commonly practiced techniques of urinary diversion (UD) after radical cystectomy (RC) in bladder cancer patients. Data in the literature is still discordant regarding which UD technique offers the best HR-QoL. OBJECTIVE The objective was to compare HR-QoL in patients undergoing ONB and IC after RC, through a systematic review of the literature and meta-analysis. MATERIAL AND METHODS We performed a literature search of PubMed, ScienceDirect, CochraneLibrary and ClinicalTrials.Gov in September 2017 according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The studies were evaluated according to the "Oxford Center for Evidence-Based Medicine" criteria. The outcome measures evaluated were subdomains' scores of Bladder Cancer Index BCI: urinary function (UF), urinary bother (UB), bowel function (BF), bowel bother (BB), sexual function (SF) and sexual bother (SB). Continuous outcomes were compared using weighted means differences, with 95% confidence intervals. The presence of publication bias was examined by funnel plots. RESULTS Four studies met the inclusion criteria. The pooled results demonstrated better UF and UB scores in IC patients: differences were -18.17 (95% CI: -27.49, -8.84, P=0.0001) and -3.72 (95% CI: -6.66, -0.79, P=0.01) respectively. There was no significant difference between IC and ONB patients in terms of BF and BB. SF was significantly better in ONB patients: the difference was 12.7 (95% CI, 6.32, 19.08, P

Obstructive acute renal failure is both a medical and a surgical emergency. The first treatment modality is urological by relief of obstruction. Post-obstructive diuresis is an abnormal condition of prolonged polyuria, involving both excessive solute and water loss, after acute drainage of obstructed urinary tract system. Physiopathology mechanisms are multiples. In most patients, diuresis will resolve once the kidneys normalize the volume and solute status and homeostasis is achieved. Post-obstructive diuresis can occur in up to 50% of patients with substantial urinary tract obstruction and can be life-threatening if it becomes pathologic. It can be detected by hourly monitoring of diuresis. Medical treatment of post-obstructive diuresis consists of oral or intravenous fluids adjusted to the findings of clinical examination, diuresis (volume and electrolytes) and close monitoring of patient. Fluid compensation should be tapered off over several days. Patients at high risk of post-obstructive diuresis should be identified and appropriately monitored.

Cystitis glandularis or glandular metaplasia of the urinary bladder, is a benignreactive metaplasia of the urothelium, which occurs in the context of chronic irritation, in less than 2% of the general population. It is a condition in most casesasymptomatic, but also characterized by nonspecific symptoms and paraclinical findings, which is why this condition is underdiagnosed. Its evolution is mainly focused on the risk of malignant degeneration. This condition affects men much more commonly than women. Two forms of cystitis glandularis are recognized: typical and intestinal form. They differ in their histology, incidence, difficulty of diagnosis, and possible association with adenocarcinoma of the bladder. Diagnosis of certainty is histological by careful analysis of chips from bladder endoscopic resection. This rare pathology is managed by endoscopic bladder resection, with repeated cystoscopy as a monitoring tool. Extensive surgical is needed in severe or recurrent cases. We present here-in a case of a female patient having cystitis glandularis presenting with lower urinary tract symptoms. We review equally data reported in literature. To the best of our knowledge our case represents the fourth case of cystitis glandularis affecting a female patient reported in the English literature so far.

Resume Le carcinome tubulo-mucineux et fusiforme du rein CTMF est une entite clinico-morphologique rare recemment decrite dans la classification OMS 2004. Son pronostic est favorable mais son histogenese n’est pas encore etablie. Nous rapportons deux cas cliniques chez deux patientes, âgees respectivement de 39 et 70 ans. Le tableau clinique est identique chez les deux malades represente par des lombalgies gauches. A la TDM abdominale, un processus tumoral qui se rehausse faiblement apres injection du produit de contraste. Le traitement a consiste en une exerese totale de la tumeur dont l’examen anatomopathologique a objective un carcinome tubulo-mucineux et fusiforme du rein de bas grade de malignite de Fuhrman. L’evolution etait favorable chez les deux patientes avec un recul de 5 ans et 2 mois chez la premiere et le deuxieme 9 mois. A travers cette observation nous rapportons cette entite rare dont la reconnaissance est capitale pour les cliniciens et les pathologistes vu son pronostic qui est tout a fait favorable.

Resume Introduction L’ileus postoperatoire survient a des degres differents, chez la majorite des patients operes d’une cystectomie radicale, ce qui entraine une prolongation du sejour hospitalier. L’utilisation du chewing-gum a demontre son efficacite en matiere de raccourcissement des delais de reprise de transit et de la duree de sejour hospitalier dans plusieurs interventions chirurgicales. But Evaluer l’interet de l’utilisation du chewing-gum en postoperatoire chez les patients operes d’une cystectomie radicale, par le biais d’une revue systematique de litterature avec meta-analyse. Materiel et methodes Nous avons realise une revue de litterature dans les bases de donnees MedLine, Scopus, CochraneLibrary et ClinicalTrials.Gov en mars 2017 selon les recommandations du « Cochrane Handbook for Systematic Reviews of Interventions » et « Preferred Reporting Items for Systematic Reviews and Meta-Analyses » (PRISMA). Les etudes ont ete evaluees selon les criteres « Oxford Centre for Evidence-Based Medicine ». Les criteres de jugement evalues etaient les delais de reprise de gaz, de la premiere defecation, la duree de sejour hospitalier, les taux des complications postoperatoires generales et gastro-intestinales. Les variables continues et dichotomiques ont ete comparees respectivement par le biais des differences moyennes ponderees et des odds ratios, avec intervalles de confiance a 95 %. La presence des biais de publication a ete examinee par les graphiques de type « funnel plots ». Resultats Trois etudes (274 patients au total) repondaient aux criteres d’inclusion. Les resultats combines ont mis en evidence une diminution de 11,82 heures du delai de reprise de gaz (95 % IC : −15,43, −8,22 h, p Conclusion Le chewing-gum peut etre recommande en postoperatoire chez les patients operes d’une cystectomie radicale afin d’ameliorer les delais de reprise de transit.

L’angiomyolipome rénal épithélioïde malin (AREM) est une entité pathologique rare longtemps considérée comme lésion hamartomateuse et dont le diagnostic positif est purement immuno-histochimique, microscopiquement, il se caractérise par des cellules mononuclées épithélioïdes a cytoplasme clair présentant des atypies cytonucléaires sévères, et exprimant les marqueurs musculaires lisses et mélanocytaires (HMB 45). Nous rapportons un cas rare d’AREM diagnostiqué après analyse anatomopathologique d’une tumeur retropéritonéale dont l’origine ne pourrait être précisée préalablement par la tomodensitométrie.

Résumé: L’abcès prostatique est causé généralement par les entérobactéries rarement par le staphylococcus aureus. Sa mortalité et morbidité ont baissé depuis l’introduction des antibiotiques à large spectre. Souvent les signes sont non spécifiques. Le diagnostic est rendu aisé grâce à l’échographie endorectale. Le drainage percutané (périnéal ou transrectal) sous contrôle scanographique ou plus fréquemment sous échographie endorectale, permet une évacuation rapide des abcès, tout en évitant une anesthésie générale. Il s’agit d’une technique efficace et moins invasive que le drainage chirurgical ou la résection transuréthrale de la prostate. Nous insisterons à travers cette observation que ce site potentiel d’infection doit être reconnu. Abstract: Prostatic abscess is usually caused by enterobacteria rarely by staphylococcus aureus. Its mortality and morbidity have declined since the introduction of broad-spectrum antibiotics. Often the signs are nonspecific. Diagnosis is made easy by endorectal ultrasound. Percutaneous drainage (perineal or transrectal) under CT or more frequently under endorectal ultrasound, allows rapid evacuation of abscesses, while avoiding general anesthesia. This is an effective and less invasive technique than surgical drainage or transurethral resection of the prostate. We will insist through this observation that this potential site of infection must be recognized. Mots clés: Abcès, Prostate, Staphylococcus, Diabète, Drainage, Keywords: Abscess, Prostate, Staphylococcus, Diabetes, Drainage

Objectifs Afin de traiter une stenose de l’uretere pelvien, de multiples choix s’offrent au chirurgien. Il nous parait que la reimplantation uretero-vesicale sur vessie psoique pourrait etre la technique ideale, vu qu’elle arrive a joindre simplicite, reproductibilite, et grâce a la laparoscopie, mini-invasivite. Methodes Nous rapportons ici le cas d’un patient âgee de 68 ans, ayant beneficie un an auparavant d’une RTUV pour un polype vesical perimeatique gauche, dont l’etude anatomo-pathologique s’est revelee benigne, qui consulte pour des lombalgies gauches. L’uro-scanner a retrouve une uretero-hydronephrose gauche avec stenose de l’uretere pelvien. La cystoscopie n’a pas retrouve de meat ureteral gauche. Il a ete decide de realiser une reimplantation uretero-vesicale sur vessie psoique par voie laparoscopique. Resultats L’intervention doit debuter par le decollement parieto-colique. S’en suit l’ureterolyse qui doit respecter l’adventice ureterale. La limite inferieure de l’ureterolyse est la fibrose. Le deuxieme temps est l’abord du Retzius et la dissection des faces homolaterale et anterieure de la vessie. La corne vesicale doit atteindre facilement et sans tension le muscle psoas. L’uretere est spatule et catheterise, la vessie est fixee au psoas, et le dernier temps est celui de la reimplantation. Nous optons pour la technique de Lich-Gregoir qui est totalement extra-vesicale. La duree d’intervention etait de 2 heures et 10 minutes. Les pertes sanguines etaient negligeables. Conclusion La reimplantation uretero-vesicale sur vessie psoique par voie laparoscopique peut, avec une standardisation des gestes et une bonne connaissance de l’anatomie, devenir accessible a tout jeune chirurgien en formation.

Objective To evaluate the prevalence of urinary colonisation in patients with JJ catheters and to define the risk factors associated with these colonisations, as urinary colonisation in patients with JJ catheters plays a key role in the physiopathology of urinary tract infections. Methods This was a monocentric prospective study between January 2013 and April 2017. In all, 145 JJ ureteric catheters in 120 patients, 25 of which had bilateral probes, were examined. The bacteriological profile of the urine of our patients was followed by the completion of an initial cytobacteriological examination of urine and another at the time of removal of the JJ catheter. The comparison of the means was performed using the Student’s test and the Mann–Whitney test for continuous variables and by the chi-square test and Fisher’s test for qualitative variables. The threshold for statistical significance was set at P Results The rate of colonised JJ probes was 35.8% (43/145). The urinary colonisation rate was 31.7%. The rate of urinary colonisation in patients with colonised probes was 71.1%, compared to 9.1% for non-colonised probes. Of the identified pathogens, Escherichia coli was found in 38.1% of the colonised probes; Klebsiella pneumoniae was second (19.1%), followed by Enterococcus faecalis (16.6%). The same bacteria isolated in the JJ probes were found in the urine. Diabetes mellitus (P = 0.001), emergency JJ placement (P = 0.02), and JJ implantation time (P = 0.01), were risk factors for urinary colonisation in patients with JJ probes. Conclusion The prevalence of urinary colonisation in patients with JJ catheters was 31.7%. Diabetes mellitus, prolonged JJ implantation, and emergency JJ placement were associated with a higher risk of urinary colonisation.

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

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.

Emphysematous pyelonephritis is a necrotic infection of the kidney characterized by the presence of gas within the renal parenchyma, the secretory cavities or the perirenal spaces. It is a severe condition that could be life-threatening. Patient’s management remains controversial and is based either on surgery or on medical treatment. Percutaneous drainage can be also used for the treatment of these patients. We report 3 cases with EPN treated with only antibiotics. Patients’ evolution was favorable. These results show that medical treatment could be sufficient.Keywords: Emphysematous pyelonephritis, diabetes, uroscanner, medical treatment

We report the case of a 28-year-old man with an extensive engine of the bulbar and penile urethra, who had been evolving for 2 years and was responsible for daily urethrorrhages. A first attempt at electrocoagulation was a failure because of its intentionally incomplete nature to avoid a risk of cicatricial stenosis. Arteriographic exploration did not reveal any lesions that could benefit from embolization. It was possible to coagulate the angiomatous lesions with a side-firing laser fiber. The immediate aftermath was simple. No urethral catheter was placed postoperatively the patient resumed painless urination. A second session, 7 months later, was necessary to complete the treatment at the angiomatous urethral locations, not visible at the first session, which caused bleeding to become minimal. The decline is 6 months without recurrent bleeding. The use of the Laser therefore seems interesting in the treatment of Urethral hemangiomas.

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.

Clinical-Medical Image: We report a case of a young patient brought to emergency department by police ambulance for management of gunshot injury after getting shot by a policeman. First clinical examination found a conscient and hemodynamically stable patient and a huge ecchymosis of external genitalia with deviation and swelling of penile with a puncture wound on the left side of the base of the penis probably corresponding to the exit orifice of the bullet. Ultrasonography with Doppler was found a bilateral rupture of cavernous bodies as well as a left testicular hematoma without rupture of the tunica albuginea and an extensive hematoma of the right inguinal region. CT-scan revealed a complex sub-trochanteric fracture of the femur with a wound at the superficial femoral artery (Figure 1). Surgical repair was performed with initially a venous bypass for the femoral artery and suture of the cavernous bodies. No urethral lesion was found and he was operated one month later for his fractured femur (Figure 2). External genital gunshot injuries are rare both in war field and in civil practice. Its occurrence in civilian practice makes it possible to establish good diagnostic and therapeutic strategies given the availability of complementary exploration means. Ballistic traumas are the result of penetration into the body of a projectile. No physical theory can predict with certainty the behavior of a projectile in the human body. Damages are greater when projectiles collide with dense structures such as bones resulting in a high energy transfer. CT-scan help to assess with great sensitivity the associated lesions in this case it allowed diagnosing other serious and life-threatening associated injuries.

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.

Objectifs Depuis le premier article de morales, les instillations de BCG en intravesical ont su s’imposer comme le traitement adjuvant de reference pour la prise en charge des TVNIM. Actuellement, les instillations sont indiquees a la fois dans les tumeurs de vessie de risque intermediaire et de haut risque. La realisation des instillations de BCG dans de bonnes conditions est essentielle a la reussite du traitement. Methodes L’enquete a ete realisee entre le 1er novembre et le 31 decembre 2018 aupres d’urologues en formation (internes et residents) et d’urologues qualifies (specialistes et enseignants) via un questionnaire format papier, ou sur Internet (Google Forms®). Les recommandations sur lesquelles nous nous sommes basees sont, par ordre alphabetique : ANZUNS 2018 (Australia and New Zealand Urological Nurses Society), AUA/SUO 2016 (American Urological Association et Society of Urologic Oncology), BAUN 2010 (British Association of Urological Nurses), CCAFU 2012 et 2018–2020 (Comite de cancerologie de l’Association francaise d’urologie), EAU 2018 (European Association of Urology), EAUN 2015 (European Association of Urology Nurses) et NCCN 2018 (National Comprehensive Cancer Network). Resultats Quatre-vingt-quatorze urologues ont repondu a cette enquete. Pres de 20 % ne remettent pas a leurs patients de documents explicatifs ou ne realisent pas une consultation pendant laquelle leur sera explique le protocole. Soixante pour cent ne realisent qu’un seul ECBU au debut de la cure, 40 % en realisent un avant chaque seance. En cas de colonisation, 73 % preferent traiter le patient et reporter la seance plutot que la realiser sous couverture antibiotique. Dans 68 % des cas, l’urologue realise lui-meme la seance, contre 32 % des cas ou il la delegue a un infirmier. Dans pres de 90 % des cas, cet infirmier n’a pas beneficie de formation specifique. Quatre-vingt pour cent des operateurs ne sont pas totalement proteges lors de l’acte. Conclusion En conclusion, nous avons ainsi degage 4 principaux axes d’amelioration. Le respect des recommandations est essentiel et primordial, et permet la protection du patient et de l’operateur. En effet, la survenue d’effets indesirable est la cause principale d’abandon des instillations de BCG.

Le néphrome kystique multiloculaire est une tumeur kystique rénale rare, bénigne et avec excellent pronostic. Cependant, le diagnostic préopératoire est difficile. Seule l’étude anatomopathologique permet de l’affirmer. Nous rapportons le cas d’un néphrome kystique multiloculaire diagnostiqué chez une patiente de 55 ans, occasionnant des douleurs lombaires gauches. L’uro-scanner a montré une image kystique classé Bosniak II. La patiente a bénéficié d’une résection complète du kyste. Dans cet article, nous décrivons la présentation clinique, les caractéristiques radiologiques, et l’histopathologie du néphrome kystique ainsi que sa prise en charge.MOTS CLÉS: néphrome kystique; kyste du rein Multilocular cystic nephroma is a rare benign renal tumor with excellent prognosis. Preoperative diagnosis remains impossible. It is discovered only by histological study. The authors report the case of a 55 years-old patient who presented with left lower back pain. Clinical examination was normal. Uro-scan showed a Bosniak II renal cyst. The patient underwent a complete resection of the cyst and histology was in favour of multilocular cystic nephroma. In this article, we describe the clinical and radiological features, and histopathology of cystic nephroma and its management.”KEYWORDS: Cystic nephroma; renal cyst

La fibrose rétropéritonéale (FRP) est une maladie rare, caractérisée par la présence d’un tissu fibro-inflammatoire aberrant qui se forme souvent autour de la portion sous-rénale de l’aorte abdominale et des artères iliaques. Une obstruction urétérale est souvent observée. Récemment, la FPR idiopathique est rapportée parmi les manifestations de la maladie à IgG4. L’imagerie joue un rôle important dans le diagnostic de la FRP. Les glucocorticoïdes sont le traitement de référence, utilisés en monothérapie ou en association avec d’autres agents médicamenteux. En cas d’échec des mesures conservatrices, la chirurgie peut être proposée. Récemment, des techniques minimalement invasives ont été utilisées.

Clinical Image: A 40 years old without a specific history who presents hypogastric pain associated with urinary signs type dysuria, pollakiuria. Biologically renal impairment with creatinine at 45 mg/l/min, ECBU is negative. Radiologically, abdominal ultrasound objective absence of visualization of the two kidneys with a pelvic renal ectopia is the seat of multiple stones, supplemented by an abdominal CT without injection of contrast product which confirms the presence of a dilation. Kidney laminating the parenchyma on a pancake lithiasic pelvic kidney driving back the bladder in the anterior. After discussion with the patient, an exploratory umbilical laparotomy with possibly nephorolithotomy for the extraction of the stones was proposed but the patient refused the procedure. Pancake kidney is rare and usually asymptomatic. Surgical intervention may be needed at complicated cases. Careful preoperative scrutiny of imaging can guide surgical therapy. More research is needed to establish the standard management of these patients.

Objectif La clitoro- ou clitoridomegalie, correspond a une augmentation de taille anormale du clitoris. Chez l’adulte, les criteres dimensionnels sont, selon Brodie, une longueur minimale de 27,4 mm, et une largeur de 8 mm. Methodes Nous rapportons ici le cas d’une patiente âgee de 26 ans, sans antecedents personnels, qui consulte pour une amenorrhee primaire avec signes d’androgenisation (hirsutisme, voix grave…). L’examen clinique a revele la presence d’une clitoromegalie avec persistance du sinus urogenital. La patiente a d’abord beneficie d’un caryotype en faveur d’un caryotype feminin sans anomalie (46, XX). Des explorations ulterieures ont montre un deficit en 21-hydroxylase, avec une hyperplasie congenitale bilaterale des surrenales, pour laquelle elle a ete mise sous corticotherapie. Elle a beneficie, selon son souhait, d’une clitoridoplastie. Resultats La mise en place de fils de soie en debut d’intervention au niveau des levres et du gland permet une bonne exposition. L’incision coronale est le premier temps de la chirurgie. La dissection doit etre tres anatomique et suivre les plans des differents fascias afin de permettre une conservation du pedicule balanique, etant donne que le gland fera office de clitoris. Pour avoir les resultats esthetiques escomptes, il est necessaire de clamper les corps caverneux le plus proche possible de la base avec une traction, et creer un nouvel orifice proximal pour exterioriser le neo-clitoris. Conclusion La clitoridoplastie pour ambiguite sexuelle est une chirurgie qui, avec une standardisation des gestes et une bonne connaissance de l’anatomie, peut devenir accessible a tout chirurgien.

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.

ResumeFraley a décrit en 1966 un syndrome douloureux rénal correspondant à un hydrocalice supérieur lié à une compression extrinsèque du pied du calice par un obstacle vasculaire. Le plus souvent asymptomatique, de découverte radiologique fortuite, la condition peut parfois se révéler lors des complications. Nous rapportons le cas d'une patiente présentant un syndrome douloureux de la fosse lombaire lié à une sténose par compression du pied de la tige calicielle supérieure par un pédicule vasculaire. Le diagnostic est posé devant les données d’échographie, urographie intraveineuse, et urétéropyelographie rétrograde (UPR). Le traitement chirurgical a consisté à un décroisement avec anastomose término-terminale (infundibuloplastie de la tige calicielle supérieure) sur une sonde urétérale double J. Evolution a été marquée par la disparition précoce de la douleur lombaire. Le contrôle radiologique après 3 mois objective une nette amélioration de la dilatation et une désobstruction infundibulaireAbstractFraley in 1966 described a painful renal syndrome corresponding to upper hydrocalycosis related to extrinsic compression of the neck of the calyx by a vascular pedicle. Mostly asymptomatic with incidental radiological discovery, the syndrome may present with complications. We report the case of a patient with a painful left loin associated with stenosis of the upper caly ceal neck due to compression by a vascular pedicle. The diagnosis is based on ultrasound data, intravenous urography, and retrograde ureteropyelography. Surgical treatment consisted of an end-to-end anastomosis (infundibuloplasty of the upper calyceal neck) on a double J ureteral catheter. Follow up was marked by the early disappearance of loin pain. Radiological assessment after 3 months revealed a significant improvement in the dilatation and a resolution of the infundibular obstruction.

Background Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs between the 4th and the 13 h gestational week, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. Cysts of the seminal vesicle may appear with a mass effect, dysuria, epididymitis, or obstruction of the gastrointestinal and genitourinary tracts. Approximately two thirds of them are associated with ipsilateral renal agenesis, because both the ureteral buds and seminal vesicles originate from the mesonephric (Wolffian) duct. They were first described by Zinner in 1914, and 200 cases of seminal vesicle cysts associated with ipsilateral renal agenesis have been reported in the literature. Most patients with this anomaly are asymptomatic until the third or fourth decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Transrectal ultrasonography provides good visualization of the pelvic structures and allows guidance for aspiration of the cysts. Case presentation We present two cases of seminal vesicle cyst. The first patient had dysuria, increased frequency of urination, and haematuria. He was operated and benefited from a removal of the cyst with right ureterectomy and left ureteral reimplantation. The second patient had disorder of the digestive transit and he benefited from a laparoscopic removal of the cyst. Conclusions Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Usual symptoms that are caused by the seminal vesicle cysts are bladder irritation and obstruction as well as pain in the perineum and scrotum. Epididymitis is frequently found. Treatment consists to removing the seminal vesicle cyst.

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, urethra

Hemangiomas are benign vascular tumors. They are the prerogative of the liver and skin. And genitourinary localizations are rare and have only been rarely reported in the prostat, bladder, ureter or the perineum. In the light of published cases, urethral hemangiomas are mostly found in males. Few cases of hemangioma in the female urethra were reported. We report a cavernous hemangioma of the urethra in a 61 years old patient who presented bleeding from the urethra and micturition disorders. Physical examination revealed a tumor 3 cm x 2 polyploid arising from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma.Pan African Medical Journal 2016; 23

La fistule vesico-vaginale sur tumeur de vessie est extremement rare. Nous rapportons un cas de fistule vesico-vaginale (FVV) neoplasique chez une patiente de 54 ans, menopausee, sans antecedent chirurgical ou de traumatisme obstetrical recent. La biopsie des berges de la fistule est revenue en faveur d’un carcinome urothelial. A la lumiere de cette observation, nous discutons les formes etiologiques ainsi que les differentes strategies therapeutiques respectives des FVV. The Pan African Medical Journal 2016;25

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

RésuméIntroductionUne révolution est née en 1980 de l'utilisation par Chaussy et ses collaborateurs de générateurs électriques de haute énergie permettant de fragmenter un calcul rénal par des ondes de choc focalisées, donnant naissance à la LEC.Le but de ce travail était d’évaluer l'efficacité de la LEC dans le traitement des calculs du groupe caliciel inférieur dans le service d'urologie « B ». En effet, deux problèmes se posent : en premier lieu la fragmentation des calculs volumineux et, en second lieu, l’élimination des fragments résiduels.Matériel et méthodesNous avons mené une étude rétrospective portant sur 18 patients porteurs de 18 calculs rénaux siégeant au niveau du groupe caliciel inférieur qui ont été traités par lithotripsie extra corporelle au service d'urologie « B » a l'hôpital Ibn-Sina de Rabat durant la période comprise entre Janvier 2005 et Décembre 2009.La taille des calculs a été déterminée en mesurant sur des clichés d'abdomen sans préparation la moyenne des deux diamètres, minimum et maximum, des calculs.On a également pris en considération les particularités anatomiques intra-rénales selon les critères de Sampaio; La longueur de la tige calicielle inférieure, Le diamètre de la tige calicielle inférieure, et L'angle infundibulo-pyélique.RésultatsDeux patients soit 11.1% sont devenus Stone Free après deux séances de LEC, 4 patients soit 22.2% ont présente des résultats intermédiaires et sont devenus Stone Free en associant aux deux séances de LEC un geste complémentaire: Pour deux entre eux, une montée de sonde double J pré LEC. Pour les deux autres, une séance de NLPC post LEC pour fragments résiduels inférieurs de 15mm, le calcul initial mesurant 20mm. Douze patients soit 66.6% ont présenté un échec par persistance de fragments résiduels malgré un nombre moyen de séances de LEC de 4.2 (3 à 5 séances).Chez ces patients on a eu recours a un traitement chirurgical ainsi sept d'entre eux ont bénéficies d'une Lombotomie et trios d'une NLPC et deux patients ont été perdu de vue.Il n'y avait aucune complication majeure à déplorer au cours ou dans les suites des séances de LEC.ConclusionDans notre série la taille du calcul, l'angle pyélo-caliciel sont des éléments prédictifs du succès de la LEC pour calcul caliciel inférieur.Donc Malgré la relative simplicité de la LEC et sa faible morbidité l'indication doit être mûrement réfléchie et prenant en considération les facteurs prédictifs du succès pour le traitement d'un calcul caliciel inférieur.AbstractIntroductionA revolution was born in 1980 in use by Chaussy and his staff of high-energy generators to break a kidney stone by focused shock waves, giving rise to the Act.ObjectivesThe purpose of this study was to evaluate the efficacy of ESWL in the treatment of lower caliceal group calculations in the urology department “B”. In fact, two problems: first the fragmentation of large stones and, secondly, the elimination of residual fragments.Subjects and methodsWe conducted a retrospective study of 18 patients with 18 renal stones sitting at the lower caliceal group who were treated by extracorporeal lithotripsy in urology department “B” a Ibn Sina hospital in Rabat during the period between January 2005 and December 2009.The size of the calculations was determined by measuring on clichés of abdomen without preparation the average of two diameters, minimum and maximum calculations.We also took into account the specific anatomical intra-renal according to the criteria Sampaio: The length of the stem caliceal lower, the diameter of the stem caliceal lower, the angle infundibulo-pelvic.ResultsTwo patients or 11.1% became Stone Free after two sessions of ESWL, 4 patients or 22.2% have this intermediate results and became Stone Free by combining the two sessions LEC a complementary gesture: For two of them, a rise of double J stent pre LEC, for the other two, one session PCNL residual fragments post ESWL for lower than 15mm, the initial calculation measuring 20mm, twelve patients was 66.6% presented a check by persistence of residual fragments despite an average of 4.2 ESWL sessions (3-5 sessions).These patients were used for surgery and has seven of them received a lumbotomy and trios of PCNL and two patients were lost.There were no major complications during or to deplore in the aftermath of the sessions of CEM.ConclusionIn our series, the size of the calculation and the angle pyelo-caliceal are predictors of success of ESWL for lower caliceal calculus.So despite the relative simplicity of the CEA and its low morbidity the indication should be carefully considered and taking into account predictors of success for the treatment of lower caliceal calculation.

RésuméObjectifLe but de notre travail était de rapporter l’état des lieux du cancer du pénis dans le service d'urologie au CHU de Rabat et d’évaluer les résultats à long terme du traitement chirurgical de ce cancer.Patients et méthodesEntre 1989 et 2009 : 6 patients ont été traités pour cancer du pénis.Les 6 cas ont été revus rétrospectivement, et les données suivantes ont été relevées : mode de révélation, siège, bilan d'extension, stade TNM, traitement, évolution et survie.RésultatsL’âge moyen des patients était de 60.5ans (48 - 81ans). Tous les patients avaient des carcinomes épidermoïdes de la verge.Trois patients ont eu une amputation partielle du pénis, et deux patients ont subi une amputation totale.La taille médiane de la lésion était 4.4cm (1.5-8cm). Toutes les tumeurs avaient un siège distal (gland- Sillon balano-préputial), 4 étaient localisés et non invasives (PT1 – PT2) et 2 avaient infiltré l'urètre (PT3).Deux patients ont présenté une localisation ganglionnaire (N2 et N1).Un seul curage ganglionnaire bilatéral a été réalisé et s'est avéré positif d'un seul côté, avec un ganglion < 3cm, et absence de dépassement capsulaire.Deux patients ont été adressés pour chimiothérapie, l'un à visée néo-adjuvante à base de (Bléomycine - Méthotréxate-Cisplatine) l'autre dans un objectif palliatif.La médiane de suivi était de 33 mois (6 -72mois). Deux patients sont décédés dont un qui s’était présenté d'emblée avec un mode métastatique et l'autre suite à une décompensation cardio-vasculaire.Quatre patients étaient vivants aux dernières nouvelles sans récidive locale ni ganglionnaire.ConclusionLe cancer du pénis semble rare au Maroc si l'on se réfère au faible nombre pris en charge au sein de notre CHU. Son pronostic carcinologique et fonctionnel (sexuel et urinaire) dépend de la précocité de la prise en charge. La chirurgie d'exérèse avec curage ganglionnaire reste le traitement de référence.AbstractObjectiveTo report the state of the penile cancer in the urology department at the University Hospital of Rabat and evaluate long-term results of surgical treatment of this cancer.Patients and methodsBetween 1989 and 2009; six patients were treated for penile cancer. The six cases were reviewed retrospectively and the following data were recorded: mode of presentation, site, staging, TNM stage, treatment, evolution and survival.ResultsThe mean age of patients was 60.5 years (48-81 years). All patients had squamous cell carcinoma of the penis.Three patients had a partial amputation of the penis, and two patients underwent total amputation. The median size of the lesion was 4.4cm (1.5-8cm). All tumors had a distal location (glans, corona), 5 were localized and non-invasive (PT1 - PT2) and one had infiltrated the urethra (PT3).Two patients had a nodal involvement (N2 and N1).A single bilateral inguinal lymph node dissection was performed and was positive on one side, with a lymph node ≤ 3cm, and the absence of capsular extension.Two patients were referred for chemotherapy, one referred on a neo-adjuvant-basis (Bleomycin - Methotrexate, Cisplatin) and the other in a palliative goal.The median follow-up was 33 months (6-72 months). Two patients died, one of which was presented immediately with a metastatic mode and the other due to cardiovascular decompensation. Four patients were alive at last count without local recurrence or lymph node.ConclusionCancer of the penis appears to be rare in Morocco considering the small number managed in our hospital. Oncological and functional prognosis (sexual and urinary) depends on the timeliness of treatment. The surgical resection with lymphadenectomy remains the standard treatment.