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35 patients underwent ureterosigmoidostomy between 1986 and 1996, corresponding to 25 males (71%) and 10 females (29%) with a mean age of 48 years (range: 21 to 81 years). 25 (71%) of these patients had invasive bladder cancer, 4 (12%) had a vesicovaginal fistula, 3 (9%) had bladder exstrophy and 3 (9%) had urethral trauma. All patients had normal renal function. In 2 patients, the ureter was dilated and in 3 other patients, one kidney was silent. The postoperative course are marked by death in 2 cases (6%) due to myocardial infarction, mechanical obstruction in 2 cases (6%), anastomotic dehiscence in 2 cases (6%). The mean follow-up was 4 years (range: 2 to 10 years). Eight patients (22%) developed impaired renal function, isolated hyperchloraemic acidosis was observed in 10 cases (28%), hypokalaemia was observed in 2 cases (6%), and episodes of acute pyelonephritis were reported in 4 cases (11%). Radiological signs of upper urinary tract deterioration were observed in 6 cases (17%). A tumour of the sigmoid colon was observed in one case after a follow-up of 10 years. 25 patients (72%) remain dry throughout the night, while 8 (22%) need to empty their rectum during the night. The poorly tolerated Coffey diversion was replaced in 6 patients (17%). The objective of this study is to analyse the results of ureterosigmoidostomy and to emphasize the advantages and disadvantages of this urinary diversion technique.

The authors report a series of 50 cases of rupture of the corpora cavernosa observed over a 20-year period. The patients had a mean age of 27 years (16-55 years). The commonest mechanism was sudden and forced manipulation of the erect penis (31 cases). The diagnosis is simple in view of the stereotyped clinical features, dominated by penile pain (48 cases), penile haematoma (36 cases) and crackling (25 cases). All patients were treated surgically, with evacuation of the haematoma and suture of the tunica albuginea (48 cases), suture of the corpora cavernosa and corpus spongiosum (1 case), and fascia lata corporoplasty (1 case). A favourable course was observed in 30 cases, while 11 patients presented painful erection, and 9 patients developed induration and deviation of the penis.

Priapism is a rare disease, characterized by prolonged, painful and irreducible erection, not resulting in ejaculation. It is an andrological emergency with a poor prognosis, as the risk of impotence is 50% despite appropriate management. Treatment is essentially surgical. The authors report their experience of 16 cases of priapism observed over a 15-year period. The mean age of the patients was 36 years (range: 21 to 56 years). The diagnosis was clinical. The mean time to consultation was 8 days (range: 1-28 days). Priapism was secondary to neuroleptics in 6 cases (37%), chronic myeloid leukaemia in 2 cases, sickle-cell anaemia in one case, radiotherapy in 1 case and the cause remained unknown in 6 cases (37%). Treatment was surgical in every case and consisted of spongiocavernous anastomosis in 11 patients (Winter's procedure in 1 case, Al-Ghorab's procedure in 6 cases and transperineal in 4 cases, with saphenocavernous anastomosis in 5 cases). The overall failure rate of surgical treatment was 37%. The success rate of spongiocavernous fistula was 70% and the authors preferred the Al-Ghorab type of spongiocavernous fistula.

The authors report a series of 45 cases of ureterovaginal fistula (UVF) observed over a 25-year period. The patients had a mean age of 34 years (20 to 50 years). 32 UVF (71%) were secondary to obstetric procedures and operations and 13 UVF (29%) were due to hysterectomy for gynaecological diseases. The clinical features were dominated by urine leak via the vagina with persistent micturition (68.8%) and low back pain (40%). UVF was associated with vesicovaginal fistula in 11 patients and acute renal failure was observed in 4 patients. IVU confirmed the diagnosis in 36 patients (87%) and revealed 23 cases of uretero-hydronephrosis and 4 silent kidneys. Retrograde ureteropyelography, performed in 4 cases, confirmed the diagnosis of UVF. The lesion was situated on the right side in 26 patients and was bilateral in the other 3 patients. The commonest lesion was section (48.8%). Treatment consisted of ureterovesical reimplantation (27 cases), Boari-Küss bladder flap of (3 cases), psoas bladder (5 cases), nephrectomy (2 cases), end-to-end anastomosis (2 cases), appendico-ureteroplasty (2 cases), double J stent (2 cases) and ileoureteroplasty (1 case). The course was favourable in 35 patients (77%).

The authors report a case of paratesticular rhabdomyosarcoma in a 21-year-old patient. The clinical features were dominated by left loin pain, inguinoscrotal pain and scrotal swelling. Transillumination was negative. Laboratory markers (alpha-foetoprotein, beta HCG) were normal. Testicular ultrasound showed an enlarged testis, comprising heterogeneous nodules with infiltration of the spermatic cord. Abdominal ultrasonography and CT scan showed a latero-aortic retroperitoneal lymph node mass and a large left kidney. Chest x-ray was normal. Treatment consisted of radical orchidectomy. Histological examination of the operative specimen confirmed the diagnosis of paratesticular rhabdomyosarcoma. The patient was treated by chemotherapy and subsequently developed recurrence with metastases.

The authors report their experience of 11 cases of renal angiomyolipoma over an interval of 20 years, observed in 10 women (90.9%) and one man (9.1%) with a mean age of 46 years (range: 21 to 63). Clinical symptoms were dominated by loin pain (100%), haematuria (45.4%), lumbar mass (72.7%), fever (18%). In one woman, AML was associated with "tuberous sclerosis". Preoperatively, the diagnosis was established by ultrasound and CT scan in 45.4% of patients. The size of the tumour varied from 7 to 14 cm in 10 patients and in one patient was only about 3.6 cm. Two women had bilateral tumours. Treatment consisted of total nephrectomy in 7 patients, partial nephrectomy in 3 patients and tumourectomy in one patient. The purpose of this study is to analyse the epidemiologic, diagnostic and therapeutic aspects of this disease.

We report a case of spontaneous rupture of a bladder diverticulum. A 65-year-old man presented with urinary retention and serious infection. At clinical examination, the patient had a distended abdomen, tenderness of the left flank and left lumbar region and benign prostatic hyperplasia. Urinary catheterisation yielded bloody and purulent urine. CT scan showed a paravesical collection extending to the left lumbar region. Blood count showed anaemia and leukocytosis. Emergency surgical exploration found a large infected bladder diverticulum with necrosis and perforation of the wall. Treatment consisted of resection of the necrotic tissue and suture of the diverticulum neck. Convalescence was uneventful.

Ureteric trauma constitutes a serious disease which can induce renal complications. Ureteric trauma is often iatrogenic, mainly due to gynaecological surgery. The authors report a series of 42 cases of ureteric trauma observed over a 20-year period. These patients consisted of 33 females (78%) and 9 males (21%) with a mean age of 38 years (range: 20 to 65 years). 24 ureteric lesions (57%) were secondary to obstetric procedures and operations, 9(21%) were due to gynaecological operations (hysterectomy), ureteroscopy was responsible in 3 cases, 2 lesions were due to lumbar sympathectomy, one case was secondary to resection of the rectum and 2 cases were secondary to abdominal trauma. The most frequent lesion was ureteric section (21 cases), usually affecting the pelvic ureter. Iatrogenic lesions were associated with iliac vessel ligation (1 case) and vesicovaginal fistulas (8 cases). The clinical features were dominated by vaginal urinary fistula (33 cases) and low back pain (15 cases). The diagnosis was essentially based on IVU, which showed ureterohydronephrosis in 18 cases and a silent kidney in 2 cases. Eight ureteric lesions were diagnosed at operation, 31 after an interval of 3 to 20 days and 2 after an interval of 3 months. Treatment consisted of ureterovesical reimplantation in 17 cases, Boari-Kuss bladder flap in 3 cases, psoas bladder in 6 cases, end-to-end ureterorraphy in 5 cases, ileoureteroplasty in 3 cases, nephrectomy in 2 cases, appendicoplasty in 1 case, double J stent in 2 cases. The course was marked by the development of hydronephrosis (4 cases), ureteric stenosis (2 cases), vesico-ureteric reflux (1 case), urinary fistula (2 case) and lengthening of the ileal graft (1 case).

Two prostatic cysts have been diagnosed by us since 1993. The first patient presented with dysurial the second cyst was discovered incidentally. Transrectal ultrasound examination was useful for diagnosis. Treatment was a puncture--aspiration of the cyst in the first case, and abstention in the second one. A review, of the epidemiological, pathological and therapeutic aspects of the prostatic cysts is presented.

Renal trauma remains a topical subject due to its high incidence and the fact that it still raises therapeutic problems. The features of this disease were reviewed by means of a retrospective study of 30 cases of renal trauma observed over a 10-year period. The patients consisted of 27 males (90%) and 3 females (10%), with a mean age of 27 years (range: 20 to 60 years). The aetiology was largely dominated by road accidents (53%), falls (26%) and assaults (16%). Trauma was unilateral, predominantly affecting the left side (60%). The clinical features were dominated by haematuria (93%) and low back pain (90%). Trauma was associated with skeletal or visceral lesions in 46.6% of patients. Assessment of the lesions was based on IVU, ultrasonography and CT. Eight patients (26.6%) presented with moderate or minimal trauma (Chatelain stage 1 and 2) and were treated medically. Twenty-two patients (73%) were operated: 6 of them underwent total nephrectomy and 16 were treated conservatively. Seven of the operated patients subsequently developed complications.

Gangrène of the male external genitalia (GMEG) is characterized by necrotizing cell evolving toward necrotizing of the soft tissues of the male genitalia and possibly death. The cause may be primary infection called Fournier's gangrene (5%) or secondary infection (95%) due to general or local factors. GMEG is a real urinary emergency because of its local and general complications which lead to death in 20% of cases. Precocious and massive antibiotherapy, a surgery to unbridle and possibly reanimation, oxygenotherapy, urinary diversion or colostomy, are required. We have treated 55 men with this affection from january 1988 to may 1996. Mean age was 58 years (range 20 to 85). The prodromial period was about 12 days. Toxi-infectious shock was noted in 8 patients (14%). Six patients (10%) developed renal acute insufficiency. Lesions were localized to the male external genitalia in 24 cases and stretched to the inguinalis, to the abdomen or to the thorax in 34 patients. The cause was a stricture of urethra in 23 cases (41%) diabetes in 18 cases (32%), anal abscess in 7 cases (13%). No etiology was found in 6 cases (10%). Emergency treatment involved three antibiotics, surgery to unbridle necrotizing tissue in all patients, reanimation in 20 patients (35%), oxygenotherapy in 4 patients (7%), colostomy in 2 cases and urinary drainage in 23 patients (42%). Free skins grafts were necessary in 6 patients (10%), 5 patients (9%) died due to septic shock. On the basis of these observations and a review of the literature, we analyzed the ethiopathogenic, bacteriological and therapeutic aspects of this affection marked by high mortality in spite of therapeutic progress.

We report our experience of continent sigmoidostomy. The technique consisted in urinary diversion with sigmoid pouch and hydraulic valve. Eleven patients underwent this procedure (10 men and 1 women, mean age 48 years, range 20 to 77 years). Indications were bladder tumor in 7 cases, bladder exstrophy in 2 patients, neurogenic bladder in 1 case and 1 bladder with a small capacity secondary to a stricture of traumatic urethra. The pouch was made according to the detubularized model. The sigmoid was opened on its antimesenteric edge, leaving the distal portion of the sigmoid intended to do the sigmoid valve. The posterior edges of the colonic segment opened were alined then secured by a Dexon 3/0 whipping then the anterior adges were secured, as the former after reimplantation of the ureters according to Camey Leduc or Politano Leadbetter's procedure. The post operative follow-up was marked by a fistula of the pouch in one case treated by securing it. All the patients were continent day and night. The purpose of this study was the description of the technique and the results of the continent sigmoïdostomy.

We report two cases of retroperitoneal liposarcoma that required multiple surgical excisions for locoregional relapse diagnosed by surveillance based on CT-scan. One patient has had adjuvant radiotherapy. With the literature review, we discuss the pathologic and therapeutic aspects of these lesions.

Herald's lesion located in the bladder is an non-specific extrinsic inflammatory lesion. This pseudotumoral neoformation often results from a pathologic process of the pelvis (95%). Recurrent cystitis is the main symptom. The diagnosis is difficult and cystoscopy and biopsy is the basic investigation. Surgical treatment must remove the original lesion with partial or total cystectomy. Epidemiologic, pathologic and therapeutic aspects of this disease are discussed.

The authors reported their experience using detubularized ileal pouch and Benchekroun hydraulic valve. They obtain continence in all patients, and antireflux in only 12 of them. 30 patients were operated according to this technique from January 1986 to December 1992. The main indication was represented by vesical tumors, treated by cystoprostatectomy. 90% of the patients operated this way are continent, when 10% were reoperated to achieve continence. They point out in the follow-up the steady state of renal function, and radiologically, the improvement or at least the stabilization of pyelo-ureteral dilatation, and the absence of ureteral reflux, especially when antireflux system was performed using Benchekroun hydraulic valve.

The authors present one case of ectopic ureteric orifice in a vagina in young patient. Clinical investigation suspected a diagnostic. Ultrasonography and computed tomography didn't find renal tissue, but vaginography was most conclusive. The nephroureterectomy brought a cure of disease.

Bladder pheochromocytoma is a rare tumor. The authors report a new case and imaging modalities for localizing extrasurrenal pheochromocytomas are reviewed.

The authors describe an ureteroileoplasty with a new anti-refluxing technique. A subtotal ureteroplasty is carried out, anti-refluxing proceeding is made. This one is based on Benchekroun's hydraulic valve principle. A transversal ileostomy is carried out 8 cm below the uretero-ileal anastomosis, which is invaginated and fixed to the proximal layer of the ileostomy with Dexon 3/0, the ileostomy is then closed using Dexon 2/0. The hydraulic valve may then ensure anti-reflux.

A series of 200 continent Benchekroun pouchs are presented. This original technique, with a hydraulic continence valve, provided a 91.5% continent rate. A review of the literature puts this technique into perspective.