Search

To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment.The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects.The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair.Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

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.

Sixteen cases of vesicovaginal fistulae (including 14 urethrovaginal fistulae), were treated vaginally using Martius' procedure. The authors describe the technique for the interposition of a labial fat pad, between the bladder and the vagina. The results are good. Thirteen patients have been cured. In one case a second was necessary using Guittes technique. There was two failures.

To specify the clinical and therapeutic peculiarities of complex vesico-vaginal fistulas.55 cases of complex vesico-vaginal fistulas are reported. After the clinical diagnostic all the patients had an intravenous excretory urogram. The fistulas were classified according to the Benchekroun classification.The mean age was 34 years (17-70 years). The diagnostic was made clinically in all the patients. Thirteen patients had an abnormal intravenous excretory urogram. The treatment was made by a vaginal way in 45 patients, by an abdominal way in three patients and by a mixed way in two patients. Four patients had an urinary diversion and one refused the treatment. Among the 50 patients whose fistula was treated, 44 (88%) were continent whom 26 (52%) after one operation, 15 (30%) after two operations and three (6%) after three operations.The complex vesico-vaginal fistulas as all the vesico-vaginal fistulas are diagnosed clinically. The intravenous excretory urogram is indispensable to search an associated ureteral lesion. The treatment is surgical and usually needs the interposition of a vascularised graft.

We report one case of retroperitoneal liposarcoma treated by surgery and radiotherapy. With the literature, we discuss the pathologic and therapeutic aspect of this lesion.

We describe a cheap and simply technique of percutaneous nephrostomy which can be used anywhere. It consists, under local anesthesia, of insertion of a drain into renal cavity using only a needle, a sheat and dilatator. With this technique, we placed 81 PCN with 97% of success, without complication.

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.

Obstetric vesico-vaginal fistulas are frequent in North Africa. The objective of this paper is to analyse the epidemiologic and therapeutic factors, basing our study on 114 cases of vesico-vaginal fistulas.From February 1989 to December 1998, 114 patients with a mean age of 33 years (range: 17 to 76 years) were admitted to the department of urology for urogenital fistulas, classified as a function of the site of the fistula into 3 types, according to Benchekroun's classification: type I: urethrovaginal fistula (39.96%); type II: cervicovaginal fistula (11.40%); type III: vesicovaginal fistula (52.63%). Investigation of each patient comprised complete physical examination with laboratory and radiological assessment. Treatment was only performed after a minimal period of 3 months.The majority of fistulas occurred in young multiparous women living in rural zones, predominantly due to an obstetric aetiology (87%). 183 reconstructive operations were performed in 114 patients, i.e. 1.73 operations per patient. Cure was obtained in 87 patients (76.3%) with 37% for type I, 92% for type II and 100% for type III. Twelve intermediate results (fistulas were closed, with persistent stress incontinence or frequency) and 16 failures (persistence of a residual fistula or need for urinary diversion) all concerned type I fistulas.It appears that VVFs represent a public health problem in North Africa and that their surgical treatment is still technically difficult.

Retrospective, comparative study of the long-term results of endoscopic realignment and surgery in the treatment of complete rupture of the posterior urethra.Between 1989 and 1998, 40 men were managed for traumatic posterior rupture of the membranous urethra: 30 were treated by endoscopic realignment for complete rupture while 10 were treated by surgery (perineal or transsymphyseal incision) for a long stenosis (3 cm) secondary to extensive rupture of the urethra.With a mean follow-up of 30 months (12 to 72 months), all patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output (Qmaxor = 15 ml/s). This result was obtained after internal urethrotomy in 7 patients (23.33%) and transperineal urethroplasty in one patient. Six patients developed persistent impotence (20%). For the ten patients treated surgically, the voiding stream was considered to be satisfactory (Qmax15 ml/s in 6 patients while 4 developed short strictures accessible to endoscopic urethrotomy. Nine patients are continent, while one completely incontinent patient with perineal fistulas required a continent cystostomy. Four out of 10 patients reported sexual impotence.Endoscopic realignment of complete rupture of the membranous urethra is a simple, minimally aggressive technique, ensuring optimal preservation of continence and sexuality in young subjects.

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.

Female urethral cancer is a rare urologic malignancy, it is about 0.02% of genito urinary cancer in woman. Prognosis remains poor and it depends of staging of disease. Applying combined modality treatment (radiation and surgery) may produce local control and increase the survival.

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.

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.

Our purpose was to study aetiopathogenic, diagnostic and therapeutic aspects of ureterovaginal fistulas.A retrospective study concerned 10 ureterovaginal fistulas. The main causes were gyneacoligical and obstetrical procedures. The diagnosis was based on clinical considerations and intravenous pyelography in all cases. Various therapeutic methods were used: Fistulas has managed in three cases by ureteroneocystostomy. Five cases were managed with ipsilateral ureteroureterostomy, the segment of ureter below the fistula was identified using ureteroscopic perforation of this segment in three cases. In one case the fistula was successfully managed by ureteroscopic placement of ureteral stent. In case whose fistula was developed after cancer pelvic we choice abstention.Late radiology showed success of the procedure in 7 patients and persistance of hypotony in 2 cases treated by u reteroneocystostomy.Ureterofistula is rare, but a relative frequent complication of pelvic surgery whose prevention is the most efficient treatment. Ureteroureterostomy is a good procedure when ureteroscopy is performed.

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.

Infiltration of the prostate is frequent in the course of leukaemia. It is usually asymptomatic or may present in the form of classical bladder neck obstruction. The diagnosis is generally established during investigation of the prostate by biopsy or during treatment by resection. The authors report two cases of prostatic involvement in chronic lymphocytic leukaemia.

The authors report two cases of isolated tuberculosis of the prostate. This is a very rare site. The symptoms are not specific and the diagnosis is usually made on histological examination. Treatment is based on antituberculous chemotherapy.

Urethro-rectal fistulas, consisting of prostato-rectal fistulas and fistulas communicating between the bulbo-membranous urethra and the rectum, are rare, easily diagnosed diseases, which essentially raise a problem of choice of surgical technique. Although the predominant aetiology is currently iatrogenic, many other less frequent aetiologies can also be responsible. Treatment is usually surgical with a large number of possible incisions. In the light of 5 cases, the authors review the various surgical techniques allowing cure of these fistulas, and indicate the advantages and disadvantages or each one.

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.

27 percutaneous endopyélotomies were performed in 27 patients from February 1989 to January 1996 to treat 20 cases of congenital hydronephrosis and 7 cases of acquired stenosis. Strictures of uretero-pelvic junction were treated by electrocautery with postoperative drainage using a double J stent in 11 cases, or Redon drain in 16 cases. The evaluable results for 25 patients with a mean follow-up of 11 months showed an overall success rate of 80%. This technique is the treatment of choice for acquired stenosis and stage I and II congenital hydronephrosis (Cendron).

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 authors report a case of renal cell carcinoma discovered incidentally in a 52-year-old woman with hepatorenal and pancreatic polycystic disease. Treatment consisted of partial nephrectomy with no adjuvant therapy. After a 3-year follow-up, the patient is still alive with normal renal function and no signs of recurrence. The pathogenesis and therapeutic modalities are discussed in the light of a review of the literature.

Between July 1990 and December 1995, 52 patients with lower ureteral calculi were treated by rigid ureteroscopy in the "B" Urology department of Avicenne Hospital. The use of ureteroscopy facilitated Dormia extraction (58%) or ultrasonic lithotripsy fragmentation (17%) or removal of the stone with the two procedures (21%). The overall success rate was 92.3% with a 2% retreatment rate. Complications were rare (3 of 52: 5.8 percent). The mean hospital stay was 3.3 days. Based on our findings, we conclude that rigid ureteroscopy for lower ureteral stone removal is effective with low morbidity and shorter hospital stay.

A series of 32 treated cases of Fournier's gangrene is analysed. All patients were male, their age ranged from 19 to 89 years. In 16 cases (50%) the aetiology of gangrene was urethral (37.5%), anorectal (12.5%) and in the 16 remaining cases (50%) there was no identifiable cause. Mortality was high (28%) despite broad spectrum antibiotics and aggressive surgical debridement. This mortality was essentially associated to advanced age, debilitated state, delay in diagnosis and toxi infectious context. The average hospital stay was 26.5 days.

Urinary drainage by indwelling double J ureteral stent is well documented in the urologic literature. We used these stents in 91 patients. The majority of stents were placed endoscopically (68%). Indications were: -Ureteral obstruction (39 cases) such as tuberculous ureteral strictures, obstruction due to urolithiasis and pelvic malignancies. -Upper urinary tract surgery (29 cases) mainly pyeloplasty, pyelolithotomy, ureterovaginal fistula repair and ureteroneocystostomy. -Adjunct to endourologic treatment (16 cases) such as ureteroscopy and endopyelotomy. -Preparation for extracorporeal lithotripsy (7 cases). The complication rate associated with placement of double J stents was minimal (6.6%). The major complication was migration (3 cases). The average drainage time was 5.8 weeks. In view of these results we conclude that double J stent is safe, effective and has minimal complications.

Nine female patients with a urethral diverticulum were admitted to our center over a six period: The clinical symptomatology was not specific. The diagnosis has been performed by voiding and retrograde cysto-uretrogram. The surgical treatment consisted in the excision of the diverticula, with the patient in the supine position. No perioperative morbidity was observed.

The authors report on 7 cases of benign, symptomatic renal cysts treated by percutaneous sclerosis using Betadine solution. The mean size of the cysts was 8 cm and we obtained progressive collapse of all of them. This technique was a simple and effective methode with good results. Indeed, 85% of the cysts disappeard, and only one patient retained a small asymptomatic residual cavity.

Between February 1989 and February 1994, 38 patients with lower urinary tract lithiasis were treated by ultrasonic lithotripsy. Mean size of the stone was 23 x 19 mm, extreme being 5 mm-50 mm (over 20 mm in 27 patients). Transurethral lithotripsy has been performed in 36 patients, and percutaneous cystolithotripsy in 2 patients. Some desintegration was complete in 37 cases, and the only failure was a case in which the stone was too hard. Morbidity was zero. Ultrasonic lithotripsy for urethral and bladder stones appears to be a safe, effective and simple method of treatment.

A personal series of 600 cases of vesicovaginal fistula is reviewed. Patients could be classified as a function of site of fistula into 3 groups: I. urethrovaginal fistula (31%); II. cervicovaginal fistula (22%); III. vesicovaginal fistula (46%). Etiology was mainly obstetrical (94%), as was multiparity (69%). An associated lesion was detected in 11% of cases (uterine, ureteral and rectal). Surgery was performed after a minimum period of 3 months with the following results. Type I fistulae, using a low approach and requiring urethral refection, showed good results in only 53% of cases. Type II fistulae, usually treated through a low approach (80%), were relieved in 80% of cases, with the reservation that reinforcement of bladder neck was often necessary. Type III fistulae, treated by a high (60%) or low (40%) approach were nearly always corrected (98%). In 2 cases of destroyed urethra unable to benefit from urethral plastic surgery, bladder repositioning with continent cystostomy was satisfactory. 72 cases with irrecuperable destroyed bladder received definitive high diversion: 34 Coffey, 5 Bricker, and since 1975, 33 continent ileocecal bladders using Benchekrouns' technique.