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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.

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.

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.

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.

Les paragangliomes rétropéritonéaux non fonctionnels sont des tumeurs rares. Ils sont souvent asymptomatiques et peuvent atteindre des dimensions importantes. Les auteurs rapportent le cas d'une tumeur rétro péritonéale, découverte au cours d'un examen tomodensitométrique réalisé chez une femme âgée de 49 ans en raison de douleurs abdominales non spécifiques. Les formes malignes, plus fréquentes que les formes bénignes, présentent un envahissement locorégional et métastasent tardivement. Le traitement de ces tumeurs nécessite une exérèse chirurgicale la plus complète possible puisque le pronostic en dépend. Il n'existe par contre pas de consensus sur l'utilité des thérapeutiques complémentaires qui peuvent néanmoins constituer un appoint à titre symptomatique.

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.

Nous rapportons dans cet article trois cas de carcinome rénal à cellules chromophobes. Le carcinome chromophobe se voit essentiellement à la cinquième décennie et représente 5% des tumeurs rénales. Il existe deux sous types de cancer à cellules chromophobes: le type clair (70%) et le type éosinophile. La variante à cellules éosinophiles doit être distinguée de l'oncocytome. Ce dernier se caractérise par une cicatrice fibreuse centrale d'aspect stellaire. Le carcinome chromophobe et l'oncocytome peuvent même coexister dans le cadre du syndrome de Birt-Hogg-Dubé. Certaines tumeurs appelées hybrides partagent des caractéristiques architecturales et cytologiques de ces deux tumeurs. Le pronostic du carcinome chromophobe est favorable. Il est le plus souvent limité au rein et de bas grade nucléaire. Il semblerait donc licite dans les cas ou un examen extemporané mettrait en évidence une tumeur chromophobe, de limiter l'intervention à une néphrectomie partielle si elle est techniquement réalisable.Key words: Carcinome à cellules chromophobes, néphrectomie, pronostic

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

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.

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.

Objectifs L’uretroplastie anastomotique termino-terminale est une technique qui garde son interet dans la gestion de l’uretre post-traumatique. Methodes nous presentons le cas d’un jeune patient de 17 ans victime d’un AVP avec une rupture complete de l’uretre bulbaire, l’incision en U renverse, la dissection des differents plans, liberation de l’uretre, la realisation de l’anastomose uretrale termino-terminale par PDS 4-0. Resultats La duree operatoire a ete de 100 min, les pertes sanguines furent estimees a 100 cc. La sortie a j3 avec ablation des lames de Delbet, le patient a ete suivi en consultation avec un recul de 6 ans sans recidive. Conclusion l’uretroplastie anastomotique termino-terminale muqueuse contre muqueuse est une technique efficace et fiable dans le traitement de l’uretre post-traumatique non manipule.