Biomedical subjects
Publications and source records attributed to R Aboutaieb.
The pelviureteral junction upon a horse shoe kidney remains a frequent congenital malformation. The authors report 13 cases collected during a period of 16 years and treated surgically. The review of literature permits to discuss the different therapeutic means.
A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.
Diffuse xanthogranulomatous pyelonephritis is a rare chronic pyelonephritis. This study permitted us to notice the various histological, clinical, radiological, and the different means diagnoses of this affection. Retrospectively series of nine patients is reported. The median age was 43 years. The commonest clinical presentation was urinary tract infection, and lumbar pain. Urine culture identified a bacteria in seven cases (77%). Intravenous urography recovers silent kidney (five cases), hydronephrosis (two cases), chronic pyelonephritis (one case) and renal stones in six cases (67%). Treatment consisted of nephrectomy. No specific biological or radiological signs of this affection can be identifying this lesion in preoperative. The diagnosis was revealed by the histological examination of the removed kidney. The outcome is favorable after a follow-up of six months to four years. The clinical features of the pyelonephritis xanthogranulomatous is not specific. Magnetic resonance imaging can give a specificity to this affection. Only histological examination is able to established the definitive diagnosis.
The primitive abcess of psoas muscle is a rare affection which involves mainly the young. The authors report 18 cases of primitive pyogenic abcess of psoas collected during a period of six years in the urology service of UHC Ibn Rochd Casablanca. The purpose of this review is to discuss the different therapeutic attitudes. The study concerned 11 men and seven women, their mean age was 35 years. The mean delay of evolution was 45 days. The physical exam found a psoitisis (five cases) and a flunk swelling (14 cases). The ultrasound exam showed the collection which was hypoechogenic in seven cases and heterogenous in 11 cases. The CT scan showed an heterogenouse hypodense collection without enhansment in seven cases. The use of antibiotherapy alone (four cases) and percutaneous drainage (four cases) permitted the recovery just respectively in one and two cases. Fifteen patients (83%) were operated through a postero-lateral lumbotomy route without costal resection. The bacteriological exam of the pus found a Staphylococcis aureus (ten cases) and Escherichia coli (two cases). The evolution was favorable in 14 cases; one patient was dead at fifth day post operatively by heart infarction. For the authors, the surgical drainage remains the treatment of choice.
Youssef's syndrome is an uncommon form of vesico-uterine fistula, caracterized clinically by the association: amenorrhea cyclic, hematuria without urinary leakage. This entity is the result of pressure gradient between uterin cavity and bladder reservoir. We report on one case.
Renal cancer is rare in pregnant women. Through a study of two cases, the authors underline diagnostic, therapeutic and pathogenic aspects of this association. Two female patients, 26 and 34 years old, were admitted for renal tumor, discovered respectively at the first and the second trimester of pregnancy. Investigation's exams for tumor extension were negative. They were based on ultrasound exam (2 cases), CT scan (1 case) and chest X ray (2 cases). The histological examination concluded to a bright cell carcinoma. In the former case, evolution was marked by spontaneous abortion at the fifth post-operative day, and the absence of metastasis after 16 months. In the second case, the evolution was worse because of metastasis occurrence four months after normal delivery. Pregnancy represents a privileged period for the discovery of renal tumor. Exams of tumor extension must consider pregnancy age. The treatment is similar to that of usual renal cancer and is associated to a simultaneous supervision of the pregnancy.
OBJECTIVES: To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra. MATERIAL AND METHOD: 35 patients with a mean age of 25 years (range: 7 to 79 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pelvis. When rupture of the posterior urethra was diagnosed, the subsequent management depended on the patient's general condition and associated lesions. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. This approach was applied in 16 patients (Group I). The other 19 patients (Group II) were only operated at the sixth month, after stabilization of all traumatic lesions. RESULTS: Results were assessed in terms of the quality of the urinary stream, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continence was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexual impotence was observed in 18.7% (Group I) versus 5.3% (Group II). CONCLUSION: Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sexual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, treated endoscopically, but with a lower incidence of sexual impotence.
Prostatic abscess is a rare disease. In the light of two cases, the authors discuss the diagnostic and therapeutic aspects of this disease. Two patients, aged 17 and 55 years, presented nonspecific clinical features. Medical imaging (US, CT) established the diagnosis by showing a loculated cystic prostatic mass. Treatment consisted of transurethral drainage and antibiotics with a favourable course in both cases. Prostatic abscess is a rare disease for which the diagnosis has been facilitated by progress in medical imaging. The treatment of choice remains transurethral endoscopic drainage.
OBJECTIVE: Evaluation of the use of defunctionalized bladder in renal transplantation, concerning surgical complications. METHODS: In order to assess the complication rate of ureteral reimplantation in long-term defunctionalized bladder, we compared 20 patients on haemodialysis for more than 15 years (group I) with another 20 patients on haemodialysis for less than 5 years (group II). None of these patients had renal failure due to urological causes or neurogenic bladder. Non-stented extravesical ureteroneocystostomy was done routinely in all patients except 1 in group II who underwent Politano-Leadbetter ureteroneocystostomy and 7 patients in group I who underwent Politano-Leadbetter (3 patients) and pyelo-ureteral anastomosis using the recipient's native ureter (4 patients). The amount of residual urine was insignificant (<100 cm(3)) in both groups. RESULTS: The mean postoperative bladder catheterization period was 7.8 days in group I and 4.2 days in group II. Postoperative urinary tract infections were observed in 9 cases of group I and in 4 cases of group II. No surgical complications occurred in patients of group II, while there were 6 patients with surgical complications in group I: stenosis after a pyelo-ureteral anastomosis (1 case), stenosis after a ureterovesical anastomosis with Politano-Leadbetter technique (1 case), urinary fistulae (3 cases; 1 with Politano-Leadbetter ureteroneocystostomy and 2 cases with pyelo-ureteral anastomosis), and vesico-ureteral reflux (1 case with Politano-Leadbetter ureteroneocystostomy). These 6 cases had the lowest bladder capacity (30-150 cm(3)) among our 40 patients. Graft losses were comparable between the two groups and were not due to surgical complications. CONCLUSION: Small defunctionalized bladders can be used in kidney transplantation, but it may represent an increased surgical risk due to difficulty in performing ureteral reimplantation.
Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.
Bladder tumours classically affect the elderly, but can also occur in young adults. The authors studied the prognosis of these tumours in patients under the age of 40. In their experience, these tumours represent 3.27% of all bladder tumours. 26 patients with a mean age of 34 years (20-40 years), 8 under the age of 30, were studied. There was a marked male predominance (23 males, 3 females). The tumour was a transitional cell carcinoma in 25 cases and a squamous cell carcinoma in 1 case. It was superficial in 11 cases and invasive in 15 cases. Transurethral resection and cystectomy were performed in 9 cases of superficial tumours and 11 cases of invasive tumours, respectively. In the group of superficial tumours, a favourable course was observed in 7 cases, with 3 cases of recurrence and 1 case of progression. In the group of invasive tumours, a favourable course was observed in 6 cases, recurrence was observed in 2 cases and 5 patients died. Superficial tumours therefore have a better prognosis in subjects under the age of 30. Invasive tumours are more frequent and often advanced, suggesting a marked potential for progression. Their prognosis depends on tumour stage, and is not correlated with age.
Bolande's tumour or congenital mesoblastic nephroma is essentially a tumour of infants under the age of one year and is rare in adults, in whom only 10 cases have been described. The authors report the 11th case in a 30-year-old woman, in whom a right renal tumour was discovered during ultrasonography at 34 weeks of pregnancy. Radical nephrectomy was performed after delivery, with a favourable course at 3 years, with no recurrence or metastasis. The aetiopathogenic and diagnostic aspects are discussed, with emphasis on the possibility of a hormonal inducing factor in the histogenesis of this tumour.
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.
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 two cases of cystitis glandularis revealed by hematuria and urinary retention. Cystitis glandularis is a rare disease, caused by metaplasia of the vesical submucosa, probably related to a chronic irritative factor. In its minor form, it has the same clinical features as simple cystitis, but its major pseudoneoplastic form may be mistaken for bladder tumor. The diagnosis is essentially histological. Treatment is usually medical, based on eradication of the irritative factors. Surgery is performed in the case of complications of this disease. The clinical course is unclear, requiring long-term surveillance.
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.
Many patients with urinary incontinence due to neurogenic sphincter insufficiency are treated by intermittent catheterization combined with drug therapy. A few refractory cases require surgical treatment. The authors report 5 cases of neurogenic bladder in 3 men and 2 women with a mean age of 20 years. The neurological lesion was secondary to spina bifida (2 cases), spinal cord trauma (2 cases) and leprosy (1 case). All patients complained of urinary incontinence due to sphincter atonia, with normal bladder compliance. We opted for continent cystostomy using the Benchekroun hydraulic valve. One death occurred during the postoperative period as a result of an anaesthetic accident. Reopening of the bladder neck occurred in 3 patients and required revision and one patient developed bladder stones 6 years after the operation. The functional results were considered to be excellent. Continent cystostomy using Benchekroun!! technique appears to be a reliable method in the treatment of urinary incontinence due to sphincter incompetence in selected patients.
We reviewed the charts of 58 patients who underwent orthotopic bladder replacement after total cystoprostatectomy for muscle invasive bladder cancer. Mean age was 56 years. As described by Camey, 60 centimetres of small bowel, are isolated, detubularised then folded upon itself to form a U shaped reservoir, which is anastomosed to the urethra. Death occurred in 5%. Urologic complications observed were: urinary leakage (15%), ureteral reflux (6.8%), ureteral stenosis (8.6%) and stones of the neobladder (5.1%). 64.2% of the patients were immediately continent during the day. Nocturnal continence was obtained for 50% immediately and for 80% three months postoperatively. Detubularised and U shaped cystoplasty achieve a low pressure reservoir, with protection of the upper urinary tract, and a diurnal continence. Nocturnal continence is achieved later.