Biomedical subjects
Publications and source records attributed to R Rabii.
The objective of this study was to illustrate the diagnostic and therapeutic aspects of renal haematomas based on 3 cases observed in the Casablanca urology department and a review of the literature. In 50% of cases, the haematoma is secondary to adenocarcinoma or angiomyolipoma, requiring specific treatment.
Description of a case of peritonitis in a 60-year-old diabetic woman. Emergency laparotomy revealed a purulent effusion derived from a pyonephrotic and calculous left kidney. The patient was cured by left nephrectomy.
Ganglioneuroma is a rare tumour in adults. We report the case of a 26-year-old woman admitted in our department with right renal colic. Ultrasonography and computed tomography showed a heterogeneous retroperitoneal mass measuring 8 x 7 cm in diameter and displacing the ureteropelvic junction and right kidney anteriorly and laterally. The preoperative diagnosis was retroperitoneal tumour. Surgical exploration revealed a totally resectable retroperitoneal tumour with a histological diagnosis of ganglioneuroma.
Mucocele of the appendix is a rare lesion. Rupture of appendicular mucocele into the psoas is uncommon. We report a case of a 77-year-old man, with psoas tumor on abdominopelvic ultrasonography and computed tomography. The preoperative diagnosis was type III hydatid cyst of the psoas, psoas tumor or retroperitoneal mass. Surgical exploration revealed an appendicular mucocele ruptured into the psoas. Appendicectomy was performed with an uneventful postoperative course after 3 years. The authors discuss the diagnostic and therapeutic problems raised by this rare lesion.
We report an unusual case of primary transitional cell carcinoma in the bulbar urethra. The patient was a 52-year-old man with a history of sexually transmitted disease. The clinical presentation was bladder retention with urethral bleeding. Radiological examination and cystoscopy showed a bulbar urethral tumor. The pathological diagnosis was Grade III transitional cell carcinoma with invasion of the corpus spongiosum (T2). Partial resection of the urethra was performed and the patient has been without evidence of disease for two years.
The authors report an uncommon case of torsion of an inguinal undescended testis occurring in a 15-year-old child. He consulted seven days later for isolated left inguinal pain. Physical examination showed a left inguinal mass, and only the right testis was palpable within the scrotum. Sonography revealed left inguinal mass with echogenic and heterogeneous contents in keeping with undescended testis. The diagnoses of testis tumor or testis torsion were suggested. Surgical exploration revealed a mass suggesting a testis tumor. Orchidectomy was performed. Histological examination showed that the mass corresponded to a necrotic ischemic testis without tumor cells. In the light of this case, the authors analyse the diagnostic aspects and management of torsion of an undescended testis.
Bladder tumours in women. Epidemiological aspects and treatments, based on a series of 48 cases. Bladder tumours are more frequent in men than in women, in whom they present certain epidemiological, clinical and therapeutic characteristics. The authors report a retrospective study of 48 cases of bladder tumour in women, observed in the urology department over a 20-year period. These tumours represented 4.2% of all bladder tumours. The patients had a mean age of 59 years (range: 29 to 77). Only one patient was a smoker (2%). Haematuria was present in 93% of cases, and signs of bladder irritation were present in 60% of cases. All tumours were transitional cell carcinomas. The tumour was classified as stage 0 in 10 cases (20.9%), stage A in 15 patients (31.2%), stage B in 22 patients (45.8%) and stage C in 1 case (2.1%); no patients (0%) were classified as stage D. Our therapeutic protocol was established as a function of the stage of tumour invasion. For example, superficial tumours were treated conservatively by transurethral resection, either alone or combined with intravesical instillation. Radical surgery was performed whenever possible for invasive tumours. External urinary diversion was performed in 11 cases, ureterosigmoidostomy in 3 cases and enterocystoplasty in 5 cases. The clinical course of the 15 superficial tumours was marked by recurrence in 5 cases, while that of the 23 invasive tumours was marked by local recurrence (3 cases), renal failure (1 case) and 3 deaths.
Thirteen women were operated for cystocele associated with urinary stress incontinence. Cystoceles were grade I in 6 cases, grade II in 6 cases and grade III in 1 case. Five patients underwent retropubic colposuspension according to Burch (3 cases) and M.M.K. (2 cases). Eight patients were treated by RAZ's technique associated with anterior colporaphy in order to reduce the cystocele. In this latter group, only one recurrence was observed and was treated by repeat colporaphy with good results. Colposuspension associated with anterior colporaphy is a reliable method for the treatment of cystocele with urinary stress incontinence, associated with low morbidity and short hospitalization. Its results are probably comparable to those of retropubic colposuspension, at least for a 6 months follow-up.
The objective of this study was to analyse the epidemiological profile of urinary stones based on one thousand cases observed in our institution over a 10-year period. The mean age of the patients was 45 years and two-thirds of patients were males. The kidney was the commonest site of stones, in 57.8% of cases. The stone was radiopaque in 86.4% of cases and was a staghorn calculus in 12.2% of cases. An associated renal malformation was observed in 10.4% of cases. Urinary stones is therefore a common disease, essentially observed in a young population and characterized by recurrence. It therefore constitutes a public health problem and prevention consists of detecting recurrences and treating stone-inducing factors.
We report a case of a 24-year-old male patient with cystic dilatation of the seminal vesicle associated with renal agenesis and megaureter. This patient complained of left renal colic with pollakiuria. We performed intravenous urography and ultrasound showed a cyst in the seminal vesicle associated with left megaureter and right renal agenesis. Treatment consisted of resection of the cyst and reimplantation of the left ureter into the bladder. No postoperative complications were observed. This association is rare and can be explained by the common embryological origin of the seminal vesicle and kidney and ureter. Its diagnosis is now facilitated by ultrasound and CT. The treatment of this tumor is surgical only when the lesions are responsible for clinical symptoms.
The authors report an unusual case of renal colic occurring in a 44-year-old docker. Intravenous urography showed right ureteral extrinsic compression by an osteophyte of the 3rd lumbar vertebra. After failure of medical treatment, the patient was operated with resection of the osteophyte. The postoperative course was uneventful with reduction of pain.
The bladder and urethra can be the site of various types of foreign bodies. The authors report two cases of low urinary tract foreign bodies. The first case concerned a young man with psychiatric disorders who introduced a condom into his bladder and the second case was an elderly patient with a history of self-dilation who introduced a safety pin into his urethra. In the light of these two cases, the authors review the diagnostic features and management of bladder and urethral foreign bodies.
The authors report a rare case of hydatid cyst of the psoas muscle in a 28-year-old woman, operated for vertebrospinal hydatid cyst. The patient presented with a left iliac fossa mass. Ultrasonography and computed tomography contributed to the preoperative diagnosis, despite negative hydatid serology. A retroperitoneal approach by left lumbotomy with partial pericystectomy was performed. In the light of this case, the authors discuss the diagnostic and therapeutic problems raised by hydatid cyst of the psoas muscle.
The authors discuss the diagnostic and therapeutic aspects of primary pyogenic abscess of the psoas muscle based on a series of 5 cases. Five patients between the ages of 15 and 64 years (mean: 38.2 years) were admitted to the urology department between January 1994 and December 1996 with fever, abdominal pain and low back pain, and psoitis in 1 case. The mean delay to consultation was 42 days. Clinical examination revealed a painful mass in the lumbar region and flank in 5 cases. Leukocytosis was detected in 5 patients. Radiological examination demonstrated loss of the lateral border of the psoas in 4 cases. Ultrasonography showed an enlarged psoas muscle in every case with a hypoechoic mass in 2 cases and a heterogeneous mass in the other 3 cases. Computed tomography, performed in 2 patients, confirmed the ultrasound findings in 1 case and excluded the diagnosis of type IV hydatid cyst of the psoas muscle in the other patient. The abscess was evacuated by percutaneous drain in 1 patient requiring a second percutaneous drainage for reconstitution of the abscess. Surgical drainage was performed immediately in 3 patients and after failure of antibiotic treatment in 1 patient. The hospital stay did not exceed 7 days after surgical drainage, but was 25 days after the first percutaneous drainage and 20 days after the second percutaneous drainage. The authors emphasize the multiple advantages and efficacy of surgical drainage of psoas abscess.
We report 108 cases of ureteropelvic junction obstruction corresponding 54 males and 48 females, with a mean age of 33 years. Pain was the commonest symptom. Delay in diagnosis was 3 and a half years. The diagnosis was made by IVP allowing our patients to be in different stages : Stage I (12 cases), stage II (39 cases), stage III (25 cases), stage IV (32 cases). We did not operate on 10 patients presenting with allow stage. 61 patients were operated by a conservative procedure : dismembered pyeloplasty (58 cases), YV pyeloplasty (3 cases). Nephrectomy was performed in 37 patients (34%). This high nephrectomy rate was due to be delayed in diagnosis.
Various techniques of ureteral reimplantation have been described for different indications. After a retrospective study concerning 109 cases and 178 ureteral reimplantations, the authors propose the selective indications for each technique noting the most important results. The indications for reimplantations are numerous and varied: enterocystoplasty (60 cases), iatrogenic lesion of the pelvic ureter (11 cases), inflammatory stenosis (13 cases), renal transplantation (20 cases), primary megaureter (4 cases), stenosis of reimplantation (2 cases). 5 techniques were used in this study: Leduc-Camey, Leadbetter-Politano, Direct, Manchette, Lich-Gregoir. We conclude that in ureterodigestive reimplantation, Leduc-Camey modified method is indicated. In renal transplantation, Lich-Gregoir is the ideal technique. In primary megaureter, the Leadbetter-Politano procedure possibly with ureter modelling improves the results. In iatrogenic lesions of the pelvic ureter, Leadbetter-Politano technique and possibly a hitch-bladder gives a good result.
Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.
The authors report an uncommon case of a 74-year old man with prostatic cancer revealed by pelvic mass. Ultrasound exam and CT-scan showed a bilateral laterorectal mass with high density. Presence of such a mass in an old patient is very suggestive of lymph nodes than retroperitoneal tumor. Serum prostate specific antigen (PSA) is rather helpful in such conditions. Biopsy of the mass allows confirmation of the prostatic cancer diagnosis. Bilateral Surgical pulpectomy is performed in combination with oral hormonal therapy. Follow-up after 6 months showed a good course or ultrasound exam and PSA level.