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Objectifs Les automutilations des organes genitaux externes sont des blessures infligees le plus souvent sans intention suicidaire. Survient dans la majorite des cas sur un terrain psychotique mais parfois secondaire a d’autres troubles tels que dysfonction erectile et chez les patients transsexuels. L’automutilation genitale est une situation tres grave avec des repercussions urologiques et sexuelles parfois handicapantes. Sa gestion impose une collaboration entre urgentistes, urologues et psychiatres. Methodes Une etude retrospective ayant comme objectif d’analyser les principales caracteristiques des automutilations des organes genitaux externes pris en charge dans notre service depuis janvier 2010 au decembre 2019. Notre etude est basee sur l’analyse complete des observations medicales des patients hospitalises au service d’urologie sur une periode etalee de janvier 2010 au decembre 2019. Les limites de notre etude etaient la difficulte de realiser l’interrogatoire avec les malades concernes, pour cela on a realise la fiche d’exploitation. Resultats Lors de cette etude nous rapportons une serie de cas de sexe masculin âges entre 30 ans et 55 ans. Le type de lesion est variable : 7 cas d’amputation totale ou partielle de la verge et un seul cas d’autocastration des testicules. Quatre-vingt-dix pour cent des cas etudies avaient presente un terrain psychiatrique. La prise en charge etait une uretrostomie chez 7 cas sur 8 cas. L’evolution des patients ayant beneficies d’une reimplantation de la verge a ete marquee dans la plupart des cas par la necrose. Conclusion L’automutilation genitale est une situation tres grave et rare. Significations psychiatriques tres importantes et repercussions urologiques et sexuelles parfois handicapantes.

Objectif: Etudier les corrélations entre la dysfonction sexuelle et le profil clinicobiologique de l’insuffisant rénal chronique en hémodialyse (HD) au CHU Hassan II de Fès, MarocMatériel et méthodes: Nous avons réalisé une étude transversale descriptive et analytique à propos de 73 patients incluant les malades des deux sexes âgés de plus de 18 ans et suivis pour insuffisance rénale chronique (IRC) en stade d’HD. Une recherche de dysfonction sexuelle ainsi que l’étude de paramètres cliniques: âge, comorbidités, durée d’HD, néphropathie initiale et biologiques: taux d’hémoglobine, ferritine, LH, FSH, prolactine, oestradiol et testostérone ont été réalisés.Résultats: L’âge moyen de nos malades était de 45,5+/-1,5 ans avec une médiane de 45 ans. Environ 56% des malades étaient de sexe masculin. La néphropathie diabétique (11 cas, 15%) et la néphroangiosclérose (14 cas, 19,2%) étaient les néphropathies initiales les plus fréquentes. La durée moyenne de dialyse était 101,9+/-6,17mois. La fréquence de la dysfonction sexuelle était de 78% tous grades confondus. Les patients présentant une dysfonction sexuelle avaient un âge plus avancé, un début de dialyse plus ancien et des troubles hormonaux significativement plus marqués que les patients sans dysfonction sexuelle. La téstostéronémie était basse chez 32 patients et a été significativement plus bas chez les hommes présentant des troubles sexuels (p = 0,020). Les concentrations de l’estradiol n’étaient pas liées à la dysfonction sexuelle chez les femmes (p = 0,345).Conclusion: Certains facteurs cliniques et perturbations biologiques peuvent aider à la compréhension de l’étiopathogénie de ces troubles. Une approche globale peut être proposée basée sur une optimisation des facteurs intervenants. Notre étude souligne l’intérêt d’une surveillance clinique, biologique et hormonale de ces patients.Mots clés: dysfonction sexuelle; insuffisance rénale chronique terminale; hémodialyseEnglish Title: Correlations between sexual dysfunction and end stage renal disease patient’s clinical and biological profilesEnglish AbstractObjective: To determine the correlation between sexual dysfunction and the clinical and biological profiles of chronic renal failure patients on hemodialysis (HD) at the Hassan II university teaching hospital, Fez, Morocco.Patients and methods: We conducted a descriptive and analytical crosssectional study that included male and female patients over 18 years of age diagnosed with end stage renal disease requiring hemodialysis. All patients answered a personal questionnaire on their sexuel activity. We studied clinical parameters such as age, comorbidities, hemodialysis duration, initial nephropathy and biological parameters such as hemoglobin, ferritin, LH, FSH, prolactin, estradiol and testosterone.Results: The present study was conducted on 73 patients. The mean age of our patients was 45,5+/-1,5. Diabetic nephropathy (11 patients, 15%) and nephrosclerosis (14 patients, 19.2%) were the most frequent initial nephropathies. The mean duration of dialysis was 101.9 + /-6.17 months. The prevalence of sexual dysfunction was 78%. Ageing, years of hemodialysis and hormonal abnormalities correlated significantly with the appearance of sexual dysfunctions. Testosterone level was low in 32 patients and was significantly lower in men with erectile dysfunction (p = 0,020). There was no significant correlation between estradiol levels and sexual dysfunction in women (p = 0,345).Conclusion: Some clinical factors and biological disorders may help to understand the pathogenesis of sexual dysfunction. A global approach can be proposed based on the correct management of these intervening factors and the optimization of biological and hormonal surveillance and management of intervening factors.Keywords: sexual dysfunction; end-stage renal failure; renal dialysis

The pure embryonal rhabdomyosarcoma of the testis is a very rare entity, and an aggressive tumor of children and young adolescents. The paratesticular rhabdomyosarcoma is more common, and it develops from the mesenchymal tissue of the spermatic cord, epididymis, or tunica vaginalis. Pure testicular localization is rarely reported. We report a 17-year-old with a pure embryonal rhabdomyosarcoma of the testis which develops after orchidectomy and is a rapid local recurrence. In light of this case report, we discuss the diagnostic, risk of recurrence, and the management of this particular case.

Les tumeurs non urotheliales de la vessie representent souvent un defi diagnostique et therapeutique. Cela est du a la rarete de ces tumeurs, car elles representent moins de 5 % des tumeurs de vessie toutes confondues. La plupart des cas de carcinome epidermoide peuvent etre attaches a une etiologie precise quoique le mecanisme pathologique reste tres peu connu. Ces tumeurs ont, en general, un pronostic defavorable a fortiori si elles sont decouvertes a un stade avance. Le traitement est essentiellement chirurgical dans la plupart des cas. L’etablissement d’un protocole bien codifie de prise en charge therapeutique est limite par la rarete des cas decrits. Nous rapportons une revue globale de la bibliographie recente concernant les tumeurs non urotheliales de la vessie en tirant le maximum de conclusions quant a leur prise en charge.

Objectifs Le tabou sur la sexualite ainsi que toute pathologie qui touche la sphere genitale feminine demeure persistant dans la societe arabo-musulmane marocaine. La cystocele est frequente et souleve des problemes d’approche diagnostique et therapeutique dans notre contexte. Objectif Evaluer l’impact de la promontofixation cœlioscopique pour cystocele en termes de qualite de vie et de sexualite dans ce contexte socioculturel particulier. Methodes Il s’agit d’une etude prospective descriptive et analytique des patientes ayant eu une cystocele de stade superieur ou egal a 2 selon la classification pop-q, traitees par promontofixation cœlioscopique entre 2011 et 2017. Quarante et une patientes ont ete operees, mais seulement 34 ont accepte de participer a l’etude. La qualite de vie et la sexualite etaient evaluees a l’aide des versions francaises validees des auto-questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PFIQ 7) et Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ 12). Une evaluation systematique par ces questionnaires a ete realisee en pre- et en postoperatoire (a 3 mois). Resultats L’âge moyen etait 55 ans. Il s’agissait d’une cystocele isolee dans 70 % des cas et de grade 3 chez 55 % des cas. Une bandelette anterieure unique a ete utilisee chez 30 patientes. Aucune patiente n’a eu d’hysterectomie. Le stade pop-q et le score popdi-6 etaient significativement lies (p = 0,04). Par contre, aucune relation significative n’a ete retrouvee avec les scores pisq12 (p = 0,23) et PFDI-20 (p = 0,42). Le score PISQ-12 etait, quant a lui, statistiquement lie aux score PFDI-20 (p = 0,01) a 3 mois du postoperatoire, les 3 scores ont ete significativement ameliores : score pfdi-20 (113,28 vs 37,6 ; p Conclusion Malgre les difficultes socioculturelles que nous avions rencontrees lors de la realisation de notre travail, nos resultats ont pu reaffirmer l’impact positif de la promontofixation sur la qualite de vie chez nos patientes. A notre connaissance, il s’agit de la premiere serie arabo-musulmane publiee qui traite cette question.

L’acanthosis nigricans fait partie des syndromes paraneoplasiques rares. En effet, ce syndrome est le plus souvent rencontre chez les patients porteurs d’adenocarcinomes. Neanmoins, d’autres cancers peuvent etre associes a ce syndrome paraneoplasique cutane qui est le plus souvent un facteur de gravite du cancer. Les auteurs rapportent une observation d’acanthosis nigricans maligne associee a un carcinome urothelial de vessie. Le patient est decede cinq mois apres l’apparition de l’acanthosis nigricans.

Résumé L’éléphantiasis pénoscrotal est une pathologie rare en dehors des pays d’endémie filarienne. C’est une pathologie bénigne, mais qui peut devenir handicapante en gênant le rapport sexuel et parfois même la miction. Nous rapportons trois cas d’éléphantiasis pénoscrotal primitif, traités par une résection chirurgicale complète du tissu pathologique et une reconstruction pénoscrotale, avec un bon résultat fonctionnel et esthétique. Nous mettons le point, à travers notre expérience et une revue de la littérature, sur les aspects diagnostiques et la prise en charge thérapeutique de l’éléphantiasis pénoscrotal.

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.

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 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.

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.

Résumé Les tumeurs testiculaires à cellules de Leydig sont rares, elles représentent entre 1 et 3 % de l’ensemble des tumeurs testiculaires. L’atteinte bilatérale synchrone est exceptionnelle. Découverte dans 20 % des cas lors de la première décennie, elle peut être retrouvée dans toutes les tranches d’âge, le diagnostic étant effectué après 50 ans dans 25 % des cas. Le diagnostic est classiquement suspecté devant une anomalie sécrétoire intéressant les hormones sexuelles et seule l’histologie confirme le diagnostic. Nous rapportons le cas d’un patient âgé de 25 ans qui présente une tumeur bilatérale synchrone à cellules de Leydig traité par orchidectomie unilatérale et tumorectomie controlatérale.

La cryptorchidie est une anomalie de la migration testiculaire au cours de la vie fœtale. Son etiopathogenie est toujours mal connue, elle est en relation avec un hypogonadisme hypogonadotrophique lors de la grossesse. Elle constitue le facteur de risque principal de la genese d’un cancer du testicule, risque majore quand il s’agit d’anomalie bilaterale. Les auteurs se proposent de faire une mise au point sur ce sujet en rapportant le cas d’un patient de 41 ans consultant pour une masse abdominale d’apparition recente et a developpement progressif avec des bourses vides. Le patient a bien evolue apres orchidectomie et abaissement du testicule controlateral.

La dissemination metastatique d’un carcinome urothelial de la vessie est rarement revelee par une metastase cutanee; neanmoins, ce genre de localisation signe le passage des cellules neoplasiques au niveau du foie et du poumon ou moins a un stade microscopique d’ou le pronostic fâcheux de cette localisation. Les auteurs rapportent une observation de metastase cutanee unique au decours de l’evolution d’un carcinome urothelial de vessie. Le patient est decede quatre mois apres l’apparition de la metastase cutanee.

The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.

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.

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.

Two patients presenting complex tuberculous ureteral strictures on an only existing kidney were treated with definitive double J stent changed every 6 months. This treatment modality was well tolerated. On the basis of two cases and literature review, different therapeutic measures are discussed.

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.

Bladder exstrophy is a malformation which the incidence is estimated at 3.3 per 100,000 births. It is usually treated in the first hours of life. The authors report three cases of bladder exstrophy treated in adult life with continent urinary diversion such as Benchekroun continent ileocaecal bladder (CICB). After a literature review on the management of bladder exstrophy, they studied clinical and therapeutical particularities of the bladder exstrophy in adulthood.

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.

To study the aetiopathogenics, diagnostic and therapeutic aspects of this pathology.The authors report a series of 10 vesico-uterine fistulas observed over à 10 years period. The mean age was 32 years(30-40). The fistulas were secondary to cesarian section in 6 cases and to abnormal delivery in 4 cases. The symptomatology was an urinary leakage from the vagina in 6 cases, an isolated cyclic hematuria in 3 cases and the association of the two signs in one case. The diagnostic was established on clinical examination in 8 cases. Intraveinous urography was performed in all the patients and visualised the uterine cavity in only 8 cases. In the 2 remaining cases a retrograd cystography was performed and demonstrated the opacification of the uterine cavity. The treatment was surgical in 9 cases. One patient who had a menuria has refused the operation.The diagnostic of the vesico-uterine fistulas is often based on clinic examination but often necessitate recourse to complementary examinations mostly in the menouria forms. The intraveinous urography does not establish the diagnostic in all the cases but is an indispensable complementary investigation because it permits searching for an associated ureteral injury. With a mean recoil of one year the results judged on the disappearance of the clinic signs was good in all the patients.The vesico-uterine fistulas are often secondary to cesarian section or abnormal delivery. Their treatment is surgical but is above all preventive by the improvement of the obstetric taking care and avoiding the vesical injuries in the course of the cesarian section.

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.

Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate.

The authors report a retrospective study concerning 18 patients having major renal trauma. The patients study group was comprised of 11 males (61%) and seven females (39%) with a mean age of 23 years. The etiologic agents were traffic accident (eight cases), falls (five cases) and stab wounds (five cases). Gross hematuria was present in all the patients. After radiologic investigations the renal injuries were classified according to the American Association for Surgery of Trauma. Two patients were in stage V, seven in stage IV and nine in stage III. Three patients were operated in emergency for hemodynamic instability, two had a total nephrectomy and one a partial nephrectomy. Five patients underwent surgery between the 5th and 7th day, three had a suture of the renal parenchyma under a nephrostomy, one a partial nephrectomy and the third a total nephrectomy. Two patients had only a urinary drainage by placement of an ureteral stent in order to diminish the urohematoma. Eight patients were treated conservatively and all were in stage III. The mean retreat was 16 months. There was no mortality and among the eight patients who underwent surgery, none had complications, aside from two wound infections. The patients who were managed conservatively had good progression; they all had a control by computed tomography which showed that the urohematoma had decreased. None of the patients developed hypertension or infection of the urohematoma.

To study the long-term morbidity and efficacy of ureteroileoplasty in a retrospective series of 18 patients.12 men and 6 women with a mean age of 50 years underwent ureteroileoplasty with unilateral replacement in 15 patients and bilateral replacement in 3 patients. A total of 21 units renoureteral units were repaired by this technique. The pelvic ureter was replaced in 16 renoureteral units, the lumbar ureter was replaced in 1 case and the entire ureter was replaced in 4 cases. The commonest ureteral lesions were strictures secondary to ureteroscopy or ureterolithotomy (40%). All patients had normal renal function, except for one patient with serum creatinine of 224 mumol/l.With a mean follow-up of 25 months (range: 3 to 64 months) all ureteroileoplasties were patent with no major morbidity. Only the patient with preoperative renal failure developed hyperchloraemic acidosis with deterioration of her renal function.In the absence of renal failure, ureteroileoplasty is an operation with low morbidity achieving good medium-term results.

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.

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.

Background: Penoscrotal Elephantiasis is a rare disease outside areas where filariasis is endemic. It is a benign disease but can become disabling in that it can make sexual relations difficult and sometimes even affect urination. We report four cases of primitive penoscrotal elephantiasis treated with complete surgical resection of pathological tissue and penoscrotal reconstruction, with good functional and aesthetic results. We update, through our own experience and a review of the literature, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis.

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.