Biomedical subjects
Publications and source records attributed to M Hachimi.
The authors report a case of transitional cell carcinoma of the left ureteral stump in a 66-year old man treated by nephrectomy for pyonephrosis 6 years previously and cystoprostatectomy for bladder tumour 13 years previously. In the light of this case and based on a review of the literature, they essentially discuss the diagnostic and aetiopathogenic problems raised by this disease.
We report an uncommon case of unilateral spontaneous hematoma of the right adrenal gland in a 22-year old young man. Preoperative diagnosis was made by ultrasonography and CT-scan. A right adrenalectomy was performed. Pathological evaluation showed an isolated hematoma without adrenal abnormalities. The diagnostic and therapeutic aspects are discussed.
INTRODUCTION: In order to evaluate the long-term results and complications, the authors reviewed the files of 14 adult patients operated for the first time for hypospadias. MATERIAL AND METHODS: This study was based on retrospective analysis of the files of 15 adults between the ages of 17 and 36 years operated for hypospadias between 1989 and 1999. The findings of the first visit concerned the site of the urethral meatus, the presence and severity of chordee and the primary and secondary sexual characteristics. Urine culture was performed in all patients. RESULTS: The follow-up was 12 months to 8 years. Six of the 15 patients were treated by urethroplasty alone and 9 patients underwent urethroplasty with correction of chordee. 40% of patients (3 cases of anterior hypospadias, 2 cases of midpenile hypospadias and 1 vulviform hypospadias) obtained a good long-term result. In the case of complications (fistula, stenosis or distal necrosis of the tube), a single reoperation allowed good results to be achieved in 80% of the series. CONCLUSION: The results of treatment of hypospadias in adult patients differ from those obtained in children despite the use of similar surgical techniques.
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.
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.
OBJECTIVE: Our purpose was to study aetiopathogenic, diagnostic and therapeutic aspects of ureterovaginal fistulas. STUDY DESIGN: A retrospective study concerned 10 ureterovaginal fistulas. The main causes were gyneacoligical and obstetrical procedures. The diagnosis was based on clinical considerations and intravenous pyelography in all cases. Various therapeutic methods were used: Fistulas has managed in three cases by ureteroneocystostomy. Five cases were managed with ipsilateral ureteroureterostomy, the segment of ureter below the fistula was identified using ureteroscopic perforation of this segment in three cases. In one case the fistula was successfully managed by ureteroscopic placement of ureteral stent. In case whose fistula was developed after cancer pelvic we choice abstention. RESULTS: Late radiology showed success of the procedure in 7 patients and persistance of hypotony in 2 cases treated by u reteroneocystostomy. CONCLUSION: Ureterofistula is rare, but a relative frequent complication of pelvic surgery whose prevention is the most efficient treatment. Ureteroureterostomy is a good procedure when ureteroscopy is performed.
The authors report a case of paratesticular thabdomyosarcoma in a young adult. This tumour is more frequent in children than in adults. Rhabdomyosarcoma is the commonest variety of soft tissue sarcoma in children and young adults. It represents 6.5% of all malignant tumours in paediatrics with an annual incidence of 4 to 7 cases/million children. The primary paratesticular site is considered to have a good prognosis in comparison with other rhabdomyosarcomas, despite the frequency of retroperitoneal lymph node invasion. This superficial site allows rapid diagnosis and consequently often complete resection of the tumour. The multidisciplinary treatment of paratesticular rhabdomyosarcoma has improved control of the disease with a 2-year survival of 80%.
In this study, a case of emphysematous pyelonephritis has been reported in a 70-year old diabetic male with a non-functional contralateral kidney. In spite of appropriate medical treatment and surgical drainage, the outcome was negative. The case in question concerned a rare form of the disease, i.e., emphysematous pyelonephritis, a severe and necrotizing infection which is characterized by the presence of intraparenchymal gas produced by anaerobic bacteria, and the rapid development of acute sepsis or septic shock. Medical treatment alone is seldom sufficient, and surgical intervention, in most instances consisting of radical nephrectomy rather than surgical drainage, is advocated due to the extent of the necrotic lesions.
Urethral stricture, mainly consisting of cases of inflammatory stricture, is a frequent occurrence in Morocco. Numerous techniques have been proposed to treat these disorders, including internal endoscopic urethrotomy (IEU). Initially described by Otis and Maisonneuve using a blind approach, IEU was then further developed by Saches who carried out direct vision urethrotomy. It rapidly became established as the method of choice for primary treatment of urethral stricture, and classical surgery was limited to those cases in which this method had failed. However, although this technique is relatively simple and appears to be efficient, there is in fact a high relapse rate, necessitating repeated IEU; therefore at present there is a tendency to return to the classical methods of anastomotic resection and urethroplasty after the second or third IEU. Although the relapse rate is low for short, single or bulbar strictures, it is high for penile strictures and for those with accompanying severe periurethral fibrosis. In this study, we have reported the results of a homogeneous series of 149 cases of urethral stricture treated by internal urethrotomy. The aim of this retrospective study was to better define the indications for adopting this technique, and also to determine the reasons for failure. The various alternatives to IEU (resection, plasty) have been examined, as has their respective failure rate.
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.
Squamous cell carcinoma of the male urethra is exceptional, as all urethral tumours represent less than 1% of urinary tract tumours. Treatment depends on the stage and site of the lesion, but the prognosis remains very poor despite aggressive treatment, including mutilating resection surgery with or without associated radiotherapy. However, the current hope for patients with squamous cell carcinoma of the urethra resides in radiotherapy-chemotherapy combination protocols based on the results obtained in squamous cell cancers of the oesophagus and anus.
OBJECTIVE: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: Primary surgery of complex staghorn calculi is justified because of its better results than PCNL associated with ESMIL.
A retrospective study has been made of 81 cases of percutaneous nephrostomy (PCN) which were treated during the period 1989-1998. The mean patient age was 41 years (age range: 21-66 years). The reasons for the diversion via nephrostomy catheter were oligoanuria (43 cases), pyonephrosis (34 cases), and evaluation of renal function (four cases). The initial disease was found to be malignant in 23.25% of cases of oligoanuria, with six cancers of the cervix, three bladder cancers and one prostate cancer. Lithiasis was the main etiology in subjects with benign disease, and was the causative factor of oligoanuria in 55.8% and pyonephrosis in 67.6% of cases, i.e., a total of 47 cases (58%). PCN catheter placement was successfully carried out in 100% of cases, and resulted in improved renal function, and/or in the treatment of the initial infectious syndrome in the majority of cases. PCN is an excellent technique for upper urinary tract drainage due to its simplicity, efficacy, ease of insertion, low cost and satisfactory results. It is a minimally invasive technique, which necessitates only the use of a local anesthetic, a sound knowledge of the human anatomy involved, a trained operator and a minimum of material.
Between January 1990 and December 1997, 61 patients with renal calculi underwent percutaneous nepholithotomy. In the immediate postoperative period, 49 renal units (80.3%) were stone-free. At three months, our overall success rate was 91.8% after spontaneous elimination of non-significant residual calculi (< 3 mm). Complications were observed in 9.8% (six cases); hemorrhage and sepsis were the major complications. Percutaneous nephrolithotomy is an effective, safe and reliable alternative to the open operation.
Nephrobronchial fistulas following pyonephrosis associated with urolithiasis are a rare occurrence. The possibility of severe problems arising during surgery should be taken into considerations; both the surgeon and the anesthetist should be fully informed of the specific risk factors involved. A favorable outcome mainly depends on the appropriate treatment and timely management of any thoracic complications. Although this rare pathology has been described in detail in the literature, the problems encountered during anesthesia and surgery have not been fully reported. This study therefore provides new data, as a case has been reported of a 38-year old female who underwent surgery for pyonephrosis; disease management and prognosis problems have been discussed.
OBJECTIVE: To study the aetiopathogenics, diagnostic and therapeutic aspects of this pathology. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Female urethral cancer is a rare urologic malignancy, it is about 0.02% of genito urinary cancer in woman. Prognosis remains poor and it depends of staging of disease. Applying combined modality treatment (radiation and surgery) may produce local control and increase the survival.
The authors report a rare case of testicular non-Hodgkin's malignant lymphoma (NHML) in a 21-year-old man with a fatal outcome. In the light of the literature, they analyse the clinical features, clinical course and treatment of this lymphoma.