Search

Secondary deep vein thrombosis due to a mass effect on the venous system has been reported in the literature. Venous thrombosis is frequently seen in the lower extremities; however, when seen at the iliac level, the mass effect of an underlying pathology must be considered. Identifying such etiologies guides the management and reduces the risk of recurrences., Case Presentation: In this report, the authors present a case of an extended iliofemoral vein thrombosis caused by a giant retroperitoneal abscess (RA) in a 50-year-old woman with underlying type 2 diabetes mellitus, presenting with painful left leg swelling and fever. Color venous Doppler ultrasonography and computed tomography scan of the abdomen and pelvis findings were compatible with a left voluminous RA compressing the left iliofemoral vein with an extended deep vein thrombosis., Conclusions: The mass effect on the venous system is rare in RAs, but it must be kept in mind. In light of this case and literature review, the authors highlight the diagnosis and management difficulties in handling this unusual presentation form of a RA., Competing Interests: There are no conflicts of interest., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: vesicovaginal fistula (VVF) is the most common type of urogenital fistula. The laparoscopic approach to VVF repair offers the advantage of minimally invasive surgery with similar principles to the open trans-abdominal approach. The purpose of our study was to evaluate the transperitoneal laparoscopic approach as a minimally invasive tool for VVF repair., Methods: this was a retrospective study including 14 patients with VVF who underwent transperitoneal laparoscopic fistula repair between 2016 and 2020 in the urology department of the university hospital, Kairouan. Patients had undergone surgery at least six months after their primary gynecological surgery and were followed during 9 months after laparoscopic fistula repair. Data regarding patients' characteristics, operative data, and outcomes were gathered. The main outcome was the success rate of VVF closing and postoperative complications., Results: fourteen patients were included. The patient's mean age was 34.8±8.2years. Size of fistula varied from 0.5 to 2cm and all the VVF were supratrigonal. The mean operative time was 145±23.4 minutes with no significant blood loss. The mean hospital stay was 4±1.4 days without major complications. Regarding analgesia, paracetamol was used for the first two days to meet the analgesia needs of all patients, and morphine was used in three cases (21.4%). During follow-up, two patients were re-operated for early recurrence (14.2%) and the total success rate was 85.7% (12 patients)., Conclusion: the laparoscopic repair of VVF is a safe, effective, minimally invasive procedure, and without major complications., Competing Interests: The authors declare no competing interests., (Copyright: Ameni Bouattour et al.)

Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades. We present a case of a liposarcoma of the spermatic cord in a 45-year-old male complaining of a progressive painless swelling in the right inguinoscrotal region. Ultrasonography and computed tomography findings were compatible with liposarcoma of the spermatic cord. We performed a right radical orchiectomy with a wide resection of the mass. Histological examination confirmed the diagnosis and showed a pleomorphic subtype. The mainstay of management of spermatic cord liposarcoma is wide excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant radiotherapy should be considered in cases at high risk for local recurrence. Long-term surveillance is mandatory. Liposarcoma of the spermatic cord is an uncommon para testicular tumor which should be part of the differential diagnosis of inguinoscrotal mass. A radical inguinal orchiectomy with wide resection of the soft tissue mass and the spermatic cord are the key to longest local and systemic disease-free survival., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Comparatively to scrotal gangrene, isolated penile gangrene is very rare due to the rich blood supply of the organ. It is thought to be initiated by a traumatic or vascular insult to the penis. This condition requires parenteral antibiotic therapy and serial debridement of necrotic tissue. Split thickness skin graft is thought to be the best approach to cover penile skin loss. We share our experience on the presentation of an isolated penile gangrene in a 35-year-old male. In the light of this case, we review the predisposing factors and the management of this entity., Competing Interests: The authors declare that they have no conflict of interest., (© 2021 Published by Elsevier Inc.)

Urogenital tuberculosis is a rare and severe disease since it causes serious consequences. Often, diagnosis may be delayed because of its multiple presentation forms and clinical features. Usually, the recognition is easy to hold, but in certain cases the presentation form can be misleading which can exclude the diagnosis. We present two cases of unusual form of urogenital tuberculosis from which clinical features were taken for a malignant cancer at the beginning. The first case is about a young woman with renal lesions then proceeding to radical nephrectomy. The second case is about a 48 years old patient who had a radical cystectomy to treat an urothelial carcinoma (classified as pT1G3) along with squamous metaplasia (25 %). In both cases, the histologic investigation revealed the presence of a granulomatous reaction with giant cells and caseous necrosis which confirms the diagnosis of tuberculosis. Through the study of these two cases and literature review, we mark the different diagnosis and treatment difficulties handling these unusual presentation forms., (Copyright © 2020. Published by Elsevier Ltd.)

Antibiotic prophylaxis (ATBP) is one of the specific measures for the prevention of surgical site infections, whose impact has been quantified in clean or clean-contaminated surgery. Our study aims to evaluate the conformity of ATBP practices and the adherence to the prescribing protocols adopted in our Hospital. We conducted a clinical audit retrospective observational study, evaluating antibiotic prophylaxis practices in our Hospital in the month of March 2015. The primary study endpoint was the overall compliance of the observed practices with the 5 major criteria defined by the French National Authority for Health (FNAH). We followed the guidelines of the French Society of Anesthesia and Intensive Care published in 2010. The study included 150 patients who had undergone surgery in the Department of General Surgery, Orthopaedics and Urology. The overall compliance rate was 33.3%. The compliance with each of the 5 major criteria defined by the FNAH was 74% for the indication; 84% for the time between injection and incision; 60% for the choice of ATB; 89.3% for the dose of the first injection and 72% for the duration of ATBP. The compliance was variable depending on the Department; better compliance was reported in the Department of Urology, in scheduled surgery and when the prescriber was an anesthetist-resuscitator. A global strategy including organization, education and restriction, could lead to a real improvement in the rate of compliance with ATBP practices. Successive audits should be carried out regularly in order to evaluate the impact of the undertaken actions., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Background: The lack of continuous evaluation of training tools in medicine, especially in developing countries, represents a brake to the development of the latter., Aim: To establish an inventory of the training facilities available to residents in urology in Tunisia, to assess their satisfaction and their expectations, and to propose solutions to improve residents training., Methods: An anonymous questionnaire was sent by E-mail in 2015 to all residents in urology in Tunisia. The questionnaire addressed demographic characteristics, educational resources used and desired, the current medical and university curriculum and evaluation of the training., Results: Among 33 residents, 66.6% responded to the survey. Medical staff, courses organized by the national college of urology, reading french-language articles and daily activity in operating room were the most used pedagogic resources. Training was judged unsatisfactory by 59.1% of respondents because of a lack of theoretical training in 18.1% of cases, a lack of practical training in 13.6% of cases and both of them in 27.2% of cases. Training on animals and simulator, creation of an educational booklet, use of online course materials, and the institution of a mentoring process during residency were rated favorable by the majority of respondents., Conclusion: The majority of residents in urology in Tunisia believe their training is unsatisfactory. The E-learning, improved access to surgical training in animals and simulator, better information on existing resources and strengthening of companionship through tutoring should enhance satisfaction.

Urethral diverticulum of the male is uncommon. We report a case of bulbar urethraldiverticulum with contained giant calculus presenting as left inguino-scrotal swellingsecondary to peri-urethral abscess in a 40 year-old male. In the light of this case Weemphasize the importance of investigation for the presence of urethral diverticulum in youngmale individuals presenting with voiding disturbances to preventrelated complications.

Introduction: Polyorchidism, defined as the presence of more than two testicles, is a rare congenital abnormality of the male genital tract. There is no consensus regarding the management of supranumerary testis (SNT) due to its rareness. To the best of our knowledge, this is the first report of leiomyoma in SNT., Presentation of Case: We report the case of a 41-year-old man with two right testes sharing a common vas deferens and separate epididymides. Orchiectomy of right testes was performed. Pathology examination found that the superior testis was the site of a leiomyoma and the lower tesits was the site of an intratubular germ cell neoplasia (IGCN). Orchiopexy and biopsy were later performed for the left testis. Histology was compatible with IGCN. We opted for follow-up to avoid risks of hypogonadism., Discussion: Polyorchidism is usually asymptomatic and found incidentally during surgery for inguinal hernia, undescended testes as in our case, torsion, hydrocele or testicular tumor. If the SNT is scrotal, and there is no other indication for surgery, most authors recommend conservative management with regular ultrasound follow-up. If nonscrotal SNT is found incidentally during surgery, orchiectomy could be performed because of increased risk of malignancy. Treatment of IGCN includes surveillance, orchiectomy, or low-dose external radiation., Conclusion: Different factors come into account for polyorchidsm management: the drainage system, the fertile potential of the supernumerary gonad, and its localization. In cases of uncomplicated polyorchidism, a conservative treatment, with US or MRI follow-up seems to be a rational choice without surgical complications., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Testicular tumor of adrenogenital syndrome is a rare and benign anomaly usually presenting as bilateral testicular masses. It is the most important cause of infertility in adult male congenital adrenal hyperplasia. Distinction between testicular tumors of adrenogenital syndrome and Leydig cell tumors can be problematic; it is based on clinical, histopathologic, immunohistochemical and endocrine features. Biopsy is advised in cases of longstanding tumors in infertile patients and when surgery is indicated. Fertility preservation is a key management goal in testicular tumor of adrenogenital syndrome. In stages 2 and 3, intensified glucocorticoid treatment is recommended as a first step treatment. Sparing surgical approach is preferred for tumors of stage 4 and steroid unresponsive masses. Magnetic resonance imaging is recommended before surgery. The only indication of surgery in stage 5 is testicular pain., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature., Methods: The case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed. The medical records included age at presentation, medical history, physical examination, operative findings and the results of follow-up. The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration., Results: In six cases the testis was preserved and orchiopexy was performed, while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case. Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h. From six patients treated by orchiopexy, two patients suffered from testicular atrophy at a mean of 24 months., Conclusion: Testicular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage. The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.

Objective To review with our experience the predictors of stone-free status after extracorporeal shock wave lithotripsy (ESWL) on urinary stones. Methods The records of 68 consecutive patients with urinary stones treated with ESWL were reviewed. Patient age, sex, body mass index (BMI), stone dimension, stone Hounsfield density (HD) and stone composition determined by infrared spectroscopic analysis were studied as potential predictors. Results Stone Hounsfield density and stone composition were found to be the only predictors of treatment outcome. Stones with lower mean HU levels were more successfully fragmented. The stone density threshold that best distinguished between the outcome groups was 1000 HU. Higher ESWL success rates were found with uric acid and calcium oxalate dihydrate stones. Conclusions The results of our study have shown that stone Hounsfield density and stone composition predict for ESWL success.

Scrotal elephantiasis (scrotal lymphoedema) is essentially observed in filaria endemic zones. It is very rare outside of these zones and is usually idiopathic, and rarely congenital or secondary. The authors report two cases of scrotal elephantiasis treated by wide resection of the pathological scrotal wall and penoscrotal repair with a good functional and cosmetic result.

The authors report three cases of cyst of the urachus, one of which was complicated by infection. This diagnosis is only rarely established clinically. The current performance of ultrasonography allows very precise analysis of the anterosuperior surface of the bladder, which may reveal the diagnosis. The authors discuss the problems raised by cysts of the urachus and emphasize the importance of clinical history, physical examination and complementary investigations, particularly CT which should allow the diagnosis of this disease, which needs to be treated surgically.

The authors present six cases of cystic renal cancers which raised preoperative and intraoperative diagnostic difficulties. Computed tomography is currently the most reliable diagnostic examination. The diagnosis of complicated benign cyst must be made cautiously and persistence of doubtful images must lead to surgical exploration. The authors try to up-date the diagnostic strategy for atypical cysts based on recent progress in medical imaging and propose a practical approach to treatment.

Renal lymphomas, essentially secondary, are the commonest site of lymphoma in the urinary tract: 68% of cases. Apparently primary renal lymphoma is very rare and difficult to diagnose. The authors report the case of a 55-year-old patient admitted with solid tumour of the right kidney. Radical nephrectomy was performed. Histological examination revealed renal lymphoma. Postoperative assessment looking for other sites was negative. Based on a review of the literature, the authors analyse the epidemiological and diagnostic aspects of isolated lymphomas of the kidney.

Testicular microlithiasis is an uncommon condition in which calcified concretions fill the lamina of seminiferous tubules. It has a specific appearance on sonography with diffuse intra testicular echogenic foci without acoustic shadows. Testicular microlithiasis can be associated with various entities and frequently with primary testicular neoplasm. The authors report a new case of testicular microlithiasis diagnosed by sonography in a 14-year-old boy with epididymo-orchitis. Based on a review and discussion of the literature, the authors emphasize the importance of regular and protracted ultrasound follow-up and monitoring of serum tumour markers to allow early detection of primary testicular neoplasm.

We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.

Phaeochromocytoma is an endocrine neuroectodermal tumour usually located in the adrenal gland, but occasionally arising in other organs. The authors report a case of a vesical phaeochromocytoma presenting with haematuria. Radiological and endoscopic investigations revealed a right laterovesical submucosal tumour. Partial cystectomy was performed. The normality of the postoperative endocrine survey suggested disappearance of the tumour and absence of any other sites.

The authors report 15 cases of gangrene of the perineum and genital organs: 10 patients with urological lesions (urethral stricture: 6 cases, benign prostatic hypertrophy: 3 cases, bladder stones: 1 case) and 5 patients with Fournier's disease. The unexpected recrudescence of this disease, its persistent severity, the limits of our understanding of the pathogenesis and the therapeutic problems involved, led the authors to analyse this series of cases which, despite an apparent diversity of aetiologies, retained common anatomical, bacteriological and therapeutic features. They stress the importance of emergency surgery, appropriate antibiotics and postoperative intensive care. The mortality remains high (5 patients in this series died).

Paraganglioma is rare neoplasm. The authors report two new cases. The first case was a 36 year-old woman who presented with post-micturitional episodes of hypertension. Radiologic and endoscopic investigations showed a left submucosal bladder neck tumor. A partial cystectomy was performed under neuroleptanalgesia. The postoperative course was uneventful is simple. The second case was a 61 year-old woman who presented with a non secreting para-aortic paraganglioma.

215 uretero-pelvic obstruction syndrome among 194 adult patients are analysed. 56.8% of them are of stage III or IV. Lithiasis is a frequent complication (41.8% of cases). The other congenital anomalies are very rare. The diagnosis is based on intravenous pyelography with use of furosemide test when the obstruction is moderate. 178 uretero-pelvic plasties are performed, the resection-anastomosis has retrained our choice. It was done in 119 cases with good results in 85.6 cases. Failure are due to error of indication or technical defect. The high level of nephrectomies (25%) is explained by the very important number of advanced and complicated cases. Among the less symptomatic patients, 37 haven't been operated on and were controlled. All except one remained stable.