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

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

Resume Buts – preciser les particularites cliniques et therapeutiques des fistules vesicovaginales complexes. Materiel et methodes – 55 cas de fistules vesicovaginales complexes sont rapportes. Apres le diagnostic clinique, toutes les patientes ont eu une urographie intraveineuse (UIV). Les fistules ont ete classees selon la classification de Benchekroun. Resultats – l'âge moyen etait de 34 ans (17–70 ans). Le diagnostic a ete clinique chez toutes les patientes. Treize patientes avaient des anomalies a l'UIV. Le traitement s'est fait par voie vaginale chez 45 patientes, par voie abdominale chez trois patientes et par voie mixte chez deux patientes. Quatre patientes ont eu une derivation urinaire et une a refuse tout traitement. Parmi les 50 fistules traitees, la continence a ete retablie chez 44 (88 %) patientes dont 26 (52 %) apres une seule intervention, 15 (30 %) apres deux interventions et trois (6 %) apres trois interventions. Conclusion – les FVV complexes comme toutes les FVV sont diagnostiquees cliniquement. L'UIV est indispensable pour rechercher une lesion ureterale associee. Le traitement est chirurgical et necessite souvent l'interposition de tissus bien vascularises.

Resume Les auteurs decrivent la technique de reparation des fistules vesicovaginales selon le procede de Martius. C'est-a-dire par interposition entre la vessie et le vagin, d'un lambeau graisseux preleve au niveau d'une grande levre. Sur 16 malades traitees selon cette technique, 13 ont ete gueries. Dans un cas, une suspension type Guittes a ete necessaire, alors que dans deux cas l'echec a ete considere comme definitif.

Resume Objectifs – L'approche pragmatique du traitement de la gangrene de Fournier. La physiopathologie et les etiologies sont rappelees. Methodes – Les auteurs rapportent une serie de 51 cas de gangrene perineoscrotale, traites de 1989 a 1998, l'âge de nos patients etait de 19 a 89 ans. Pour chaque patient nous avons analyse les circonstances de decouverte, les donnees de l'examen physique. Le traitement a consiste en l'excision chirurgicale large de tous les tissus necroses, associe a une reequilibration hydroelectrolytique et antibiotherapie parenterale a large spectre. Resultats – Pour 20 malades, aucune etiologie n'a ete retrouvee (39 %). Par ailleurs, la cause potentielle etait dans 33 % des cas, une stenose uretrale, une infection anorectale dans 28 %, et inconnue dans 19 %. La duree moyenne d'hospitalisation a ete de un mois. Trois patients ont eu une orchidectomie unilaterale, six patients une colostomie. Un catheter sus-pubien a ete mis en place dans 17 cas. L'evolution a ete fatale dans 19 cas (18 %), cette mortalite etant essentiellement associee a l'existence de tares et aux complications toxi-infectieuses. Conclusion – La gangrene de Fournier est une reelle urgence urologique, potentiellement letale, qui necessite une antibiotherapie agressive associee a une excision chirurgicale large de tous les tissus necroses.

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.

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).

Resume L'exstrophie vesicale est une pathologie malformative dont l'incidence est estimee a 3,3/100 000 naissances. Elle est habituellement prise en charge dans les premieres heures de la vie. Les auteurs rapportent trois cas d'exstrophie vesicale traites a l'âge adulte par une derivation externe continente type vessie ileocaecale de Benchekroun (VICC). Apres une revue de la litterature sur la prise en charge actuelle de l'exstrophie vesicale, ils precisent les particularites cliniques et therapeutiques de l'exstrophie chez l'adulte.

Resume Les auteurs rapportent une serie de trois cas de syndrome de Youssef colliges sur une periode de 10 ans. Les fistules etaient toutes secondaires a une cesarienne. Le diagnostic a ete pose par l’examen clinique dans un cas. L’urographie intraveineuse (UIV) a ete realisee chez toutes les patientes et n’a visualise la cavite uterine que dans un cas. Dans les cas restants, le diagnostic a ete pose par l’urethrocystographie retrograde et mictionnelle (UCRM). Le traitement a ete chirurgical pour deux patientes, la 3 e patiente a refuse l’intervention chirurgicale. Avec un recul moyen de 15 mois, le resultat juge sur la disparition des signes cliniques a ete bon chez les deux patientes operees. Le but de ce travail est d’etudier les aspects etiopathogeniques, diagnostiques et therapeutiques du syndrome de Youssef.

Resume Nous rapportons un cas de liposarcome retroperitoneal traite par la chirurgie et la radiotherapie. A travers une revue de la litterature nous discutons les aspects diagnostiques et therapeutiques.

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

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

Mesonephric adenocarcinoma of the urinary bladder is a rare tumour, whose origin is still uncertain. The authors report the case of a 19-year old woman hospitalized for a huge pelvic mass revealed by hematuria. Trans-urethral biopsy showed the mesonephric nature of this mass. The treatment consisted of an anterior pelvectomy with total colpectomy, associated to complementary radiotherapy. With a follow-up of 30 months, the patient is still alive without recurrence or metastasis. The etiopathogenic, histologic and therapeutic aspects of this tumour are reviewed.

Objectives Vaginoplasty for congenital atresia, a component of the Mayer-Rokitansky-Kuster syndrome, or for gender confirmation may be achieved by several techniques. This report focuses on the efficacy of rectosigmoid neocolporrhaphy (RSNC) for primary vaginal replacement. Patients and Methods From 1990 to 2002 we evaluated six patients 16 to 33 years old (average age 23 years) who required vaginal replacement. The diagnosis included the Mayer-Rokitansky syndrome in two cases, classic bladder exstrophy in one and male pseudohermaphrodism in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and the rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients. Results A minimum of one year follow-up (mean: 32 months) was available in 5/6 patients. The patients treated with sigmoid vaginoplasty had a functional neovagina with excellent cosmetic results and without excessive mucus production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In two patients managed by nonoperative perineal self-dilation, little success could be noted, and they became candidates for surgery. Conclusion Our limited experience with this group of patients leads us to believe that the isolated sigmoid segment provides a self-lubricating neovagina with a low rate of failure and revision, with very good cosmetic results and without the need for routine dilation. L'Utilisation du colon sigmoїde dans le remplacement vaginal chez les jeunes adultes Objectifs : La vaginoplastie pour atresie congenitale, un element du syndrome de Mayer-Rokitansky-Kuster, ou la confirmation du sexe peut etre accompli par plusieurs techniques. Cette etude demontre l'efficacite de la neocolporrhaphie du rectosigmoїde premiere (RSNC) dans le remplacement vaginal. Patients et Methodes De 1990 a 2002 nous avons evalue six malades âges de 16 a 33 ans (âge moyen 23 ans) chez qui on a realise un remplacement vaginal. Le diagnostic a inclu le syndrome Mayer-Rokitansky dans deux cas, exstrophie vesicale classique dans un cas et pseudo-hermaphrodisme viril dans trois cas. Le vagin a ete reconstruit en utilisant un segment du sigmoide isole long de 15 cm place entre la vessie et le rectum et anastomose a l'introitus chez quatre patients. La procedure de Frank a ete utilisee chez deux patients. Resultats Un suivi minimum d'un an chez 5 patients a ete observe (moyenne de 32 mois). Les patients traites par vaginoplastie sigmoidienne avaient un neovagin fonctionnel avec d'excellents resultats esthetiques, sans secretions muqueuses excessives et ne necessitant pas de dilatations iteratives repetees. Trois cas de stenose de la jonction mucocutanee ont ete traites par plastie Y-V chez un patient et par des autodilatations chez deux patients avec peu de succes et les deux patients sont devenus candidats pour une dilatation chirurgicale. Conclusion Notre experience limitee avec ce groupe nous permet croire que ce procede de neovaginoplastie sigmoїdienne permet d'avoir un neovagin autolubrifie, un taux d'echec et de revision bas, avec de tres bons resultats esthetiques et sans recours aux dilatations. African Journal of Urology Vol.10(2) 2004: 96-100

Primary renal non Hodgkin's lymphoma is a rare disease. The authors report a case of primary follicular lymphoma of the kidney diagnosed on nephrectomy specimen in a 53 year old man. In the light of this case and a review of the literature, aetiopathogenic, diagnostic and therapeutic aspects are discusses.

To analyse the long-term results of treatment of posterior urethral disruptions with endoscopic realignment, and to assess the efficacy, simplicity and benefit of this technique.Between 1989 and 2001, thirty six patients were treated by endoscopic realignment for traumatic rupture of the posterior urethra. The analysis of the results took in consideration the quality of urinary stream, the continence and the erectile function.With a mean follow-up of thirty four months (12 to 72 months), the 36 patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output. This result was obtained after internal urethrotomy in 13 patients (36.1%), and after transperineal urethroplasty in two patients. Only 7 patients (19.4%) developed an impotence.The endoscopic realignment can be considered like initial treatment of all post-traumatic rupture of the posterior urethra. This simple and little aggressive technique doesn't compromise the recourse to another type of ulterior treatment and resulted in negligible morbidity. The secondary urethral strictures are short and accessible to an endoscopic urethrotomy.

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

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.