Biomedical subjects
Publications and source records attributed to A Joual.
The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology.
Benign renal cysts are usually asymptomatic: They require a minimally invasive treatment if they cause complaints such as flank pain or other compressive complications. During a 6 month period, 14 patients were treated for benign renal cyst using an ultrasound guided puncture. Presenting complaints were flank pain (12 cases), hypertension (1 case), polycythaemia (1 case). Only cyst of 5 centimeters diameter or more were assigned to this treatment. After needle puncture, the cyst was evacuated and then filled with sterile 95% alcohol. Clinical and anatomical results, after 6 months, were good in 9 cases, 2 cases showed good anatomical results with persistence of initial symptoms, and there were 3 failures corresponding to large cysts of 10 cm diameter or more. Percutaneous alcoholization of moderate benign cysts is a safe, simple and reliable method.
The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.
Isolated retrovesical location of hydatid cyst is a very uncommon condition. Clinical patterns appear after a long course of the cyst. They are represented by hypogastric mass associated with compressive manifestations. Ultrasonography is essential for diagnosis and identification of other sites. When diagnosis is unclear, then CT scan plays a role. Cystectomy and pericystic resection, as extensive as possible, is the adequate treatment that gives successful results in most cases.
Perineo-scrotal gangrene is a necrotizing infection of the tissues of the perineum and scrotum. It accounts for 0.6% of our hospitalizations. The commonest etiology is urologic (86% of our cases). A proctologic origin was found in 6%, while the condition appeared to be primary in 8%. Concomitant diseases were found in 37% with diabetes the commonest. The diagnosis is clinically evident. The majority of patients are seen late (5 to 10 days) and the necrotizing process spreads rapidly. This is a multidisciplinary emergency, requiring intensive care, antibiotics, surgical excision of all necrotic tissues and possible urinary and/or fecal diversion. Extensive skin loss requires surgical cutaneous reconstruction procedures. The prognosis is severe, with a 12% mortality rate in our series.
Malacoplakia is a chronic inflammatory disease which specificity is pathological: Von Hansemann's cells and Michaelis-Gutmann's bodies. Renal localization is very rare. Two cases have been collected, the diagnosis having been done in the two cases on a nephrectomy specimen. Because there is no specific symptomatology to renal malacoplakia, the presence of a particular context should suggest the diagnosis and lead to renal needle biopsy. Thus nephrectomy could be avoided. The primum movins of the affection is a trouble of the phagocytosis. The place of surgery in the treatment of renal malacoplakia remains uncertain due to the lack of experience with the medical treatment. The latter is based on the prescription of cholinergic drugs, and has proved some efficacy in other localizations, as bladder.
Concerning one case of male urethral diverticulum, the characteristics of this rare affection are reviewed. Long standing urethral catheter and urethroplasty are the more frequent etiologies of this affection. The diagnosis is clinical, based on the discovery of tumefaction on the urethral track which pression makes spring up urine through urethral meatus. The urethrogram confirms the diagnosis. Surgical approach consists on the resection of the diverticulum and urethrography in one or two stages, based on diverticular neck size and tissue vascularization.
The authors report a retrospective study collecting ten cases of priapism over fifteen years. Clinical diagnosis is evident. Idiopathic priapism is most frequent of all the medical treatments available, no one seems to be efficient. Among surgical procedures draining the venous blood from the cavernous bodies, spongiocavernous shunt (Al-Ghorab) has been a simple, fast and effective method in the last five patients. Functional result depends on the age and especially on the precocity of the surgical treatment. Therefore priapism is an andrologic emergency.
Concerning one case of male urethral diverticulum, the characteristics of this rare affection are reviewed. Carriage for long time of urethral catheter and urethroplasty are the more frequent etiologies of this affection. The diagnosis is clinic, based on the discovery of tumefaction on the urethral track which pression makes spring up urine through urethral meatus. The urethrography confirms the diagnosis. Surgical approach consists on the resection of the diverticulum and urethrorrhaphy in one or two stages, based on diverticular neck size and sheet quality.