A. Bouzouita

Intérêt de l’acide tranexamique dans les résections endoscopiques urologiques : étude prospective randomisée

BACKGROUND Endoscopic urological procedures (transurethral resection of the prostate TURP/transurethral resection of bladder tumor TURBT) are not without risk of significant bleeding. This risk is due to the vascular nature of the tissues and their high levels of fibrinolytic enzymes in the tissues and urine. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid (TXA) in reducing blood loss in patients undergoing TURP/TURBT and transfusion requirement. METHODS This study was a prospective, randomized, double-blind, placebo controlled clinical trial. One hundred and thirty-one patients of ASA physical status I or II, undergoing TURP (60 patients) or TURBT (71 patients) were randomly allocated to receive IV TXA: bolus of 10mg/kg at the induction of anesthesia followed by infusion of 1mg/kg/h intraoperatively and for 24h postoperatively or an equal volume of saline (control group). Blood loss was evaluated in terms of reduction in the serum hemoglobin level (delta Hb=Hb H24-Hb H0). RESULTS There was no difference between two groups in terms of transfusion requirements and episodes of retention. TXA did not significantly reduce mean blood loss compared with placebo during TURP (1.37±0.69 vs. 1.72±1.23g/dL respectively, P=0.256) or TURBT (1.15±0.95 vs. 1.07±0.88g/dL; P=0.532). No thrombotic complications were noted in any patient. CONCLUSION Tranexamic acid did not reduce transfusion requirements or perioperative blood loss in transurethral resection of the prostate or bladder tumor. LEVEL OF EVIDENCE 4.

Localisation iléale d’un carcinome à cellules rénales révélée par une invagination iléo-cæcale

The lung, the liver, the bone tissue and the brain are the most frequent sites for renal cell carcinoma metastasis. Small bowel metastasis from renal cell carcinoma is rare, with only few cases published. We report the case of ileal metastasis from operated kidney cancer revealed by ileocolic intussusception and causing intestinal obstruction in a 32-year-old woman.

Liposarcoma of the spermatic cord: A case report and review of literature

a Department of Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, Boulevard 9 Avril, Tunis El Manar University, Tunis, France Department of Pathology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Boulevard 9 Avril, Tunis El Manar University, Tunis, France c Department of Urology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Boulevard 9 Avril, Tunis El Manar University, Tunis, France

Purple urine bag syndrome, a disturbing urine discoloration

Purple urine bag syndrome (PUBS) is a rare and disturbing situtation for patients relative and the care team. Its mainly observed in long term bedridden with an indwelling urinary cathter use patients. PUBS is usually harmless and asymptomatic, but it may lead to severe conditions with a considerable morbidity and mortality. Authors report a case occurring in a 78 years old male patient, describing clinical and evolutive features, and discussing physiopathology and managment of PUBS.

Female urethral diverticulum containing calculi: A rare and tricky condition

A female urethral diverticulum (UD) is an uncommon clinical entity. It occurs in 0.6–6% of the female population. The diagnosis is often delayed as the symptoms can be misleading. The complications are mainly local consisting in malignant degeneration, urinary infection and stone formation. The latter is reported in 1.5–10% of cases. The key steps in the management of UD with calculi are: a high index of suspicion, the use of imaging studies and open surgical excision. Through presenting a case of female UD with calculi and a literature review, we deal with the diagnostic, therapeutic and evolutive aspects of this pathology.

Splenogonadal fusion - a rare cause of scrotal swelling: a case report

BackgroundSplenogonadal fusion is a rare and benign condition. Diagnosis is challenging for clinicians. Despite its indolence, diagnosis is often confirmed after orchidectomy. Surgery is mandatory, particularly to rule out the extremely rare association with malignancy.Case presentationWe report a case of splenogonadal fusion in a 38-year-old North African man presenting a palpable scrotal mass. We describe clinical aspects, pathogenic hypothesis, radiological features, as well as surgical management principles.ConclusionsSplenogonadal fusion is rarely suspected and diagnosed preoperatively. A diagnosis is made once an ectopic testicular mass is associated with cryptorchidism and suggestive radiological signs. A better knowledge of the clinical and radiological features of splenogonadal fusion provides an opportunity for conservative surgery.

Transitional Bladder Cell Carcinoma Spreading to the Skin

Cutaneous metastases from bladder malignancies are rare. We report the case of a 74 year old man who underwent cysto-prostatectomy and adjuvant chemotherapy for a pT3b N+ bladder transitional cell carcinoma. Four months later, he presented with skin disseminated pigmented lesions. Skin biopsy confirmed cutaneous metastasis from urothelial carcinoma.

Clear Cell Adenocarcinoma of the Female Urethra, Mimicking Cystocele

Clear cell adenocarcinoma of the urethra is an extremely rare neoplasm mainly described in women. Anterior pelvic exenteration was the treatment performed in most reported cases. It seems to have poorer prognosis than urothelial carcinomas.

652 SURGICAL TREATMENT OF POST-TRAUMATIC COMPLETE URETHRAL RUPTURE: DEFERRED URGENT URETHRAL SUTURE OR DELAYED REPAIR?

OBJECTIVE To compare the results of deferred urgent surgical treatment and delayed repair in post-traumatic complete urethral rupture. PATIENTS AND METHOD Between 1986 and 2003, sixty patients were operated for complete rupture of the posterior urethra. In the absence of any serious visceral or skeletal lesions, 32 patients were operated within five to ten days (Group I). In 28 cases (Group II), patients were operated 8 months after the injury via a perineo-transsymphyseal approach. RESULTS The mean age of these patients was 28 years (range: 18 to 53 years). With a minimum follow-up of 2 years (range: 2-14 years), the urine stream was considered to be satisfactory in 90% of patients of group I and in 100% of cases of group II. Continence was perfect in 91% of patients in the two groups. Erectile dysfunction was observed in 22% of cases of Group I versus 28.5% of cases of Group II. CONCLUSION Deferred urgent end-to-end urethral suture and delayed urethroplasty give globally comparable results. Deferred urgent end-to-end urethral suture must be performed whenever possible. The perineo-transsymphyseal approach must be reserved to the treatment of large stenoses in multi-operated or delayed repair patients.