Abdellatif Koutani

The use of isolated sigmoid colon segment for vaginal replacement in young adults.

Purpose: Vaginoplasty for congenital atresia, a component of the Mayer–Rokitansky–Kuster syndrome, or for gender confirmation, may be achieved by several techniques. This report focuses on the efficacy of rectosigmoid neocolporrhaphy (RSNC) for primary vaginal replacement. Materials and methods: From 1990 to 2002 we evaluated six patients 16–33years old (average age 23) who required vaginal replacement. The diagnoses included the Mayer–Rokitansky syndrome in two cases, classic bladder exstrophy in 1 and male pseudohermaphrodites in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients. Results: A minimum of 1year of followup is available in five of the six patients (mean of 32month). Patients treated with sigmoid vaginoplasty had functional neovagina. with excellent cosmetic results and without excessive mucous production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In the two patients managed by nonoperative perineal self-dilatation, there was little success noted and the two patients became surgical candidates. Conclusions: Experience with this group of patients leads us to believe that isolated sigmoid segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.

Les fistules vésico-utérines : une expérience de 17 ans

OBJECTIVE To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment. MATERIALS AND METHODS The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects. RESULTS The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair. CONCLUSION Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

Aspects psychologiques, sexuels et sociaux de l'exstrophie vésicale chez l'adulte. Analyse de 3 cas

Resume Malformation congenitale rare, l’exstrophie vesicale est habituellement traitee en periode neonatale. A partir de 3 observations d’exstrophie vesicale chez l’adulte (2 hommes et 1 femme, âges de 21 a 25 ans), les auteurs soulignent l’importance des troubles psychologiques, sexuels et sociaux induits par cette affection traitee a cet âge. Sont exclus de cette etude les problemes urinaires. La conclusion qui se degage de cette analyse, est d’operer cette malformation tot, si possible des la naissance, afin d’en minimiser les consequences.

Lymphoepithelioma-like carcinoma of the bladder: a case report

IntroductionLymphoepitheliomas are malignant epithelial tumors of the nasopharynx characterized by an important lymphoid proliferation at histological examination. Lymphoepithelioma-like carcinoma is a rare tumor of the bladder for which the therapeutic strategy is not clearly defined.Case presentationWe report the case of a 64-year-old Moroccan man who presented with macroscopic hematuria. Investigations revealed a muscle-invasive lymphoepithelioma-like carcinoma of the bladder. Therefore he underwent a radical cystoprostatectomy with a good outcome.ConclusionThis case illustrates pathogenic, clinical and therapeutic features of this unusual tumor.

Le syndrome de Youssef (fistule vésico-utérine) : à propos de trois observations

Resume Les auteurs rapportent une serie de trois cas de syndrome de Youssef colliges sur une periode de 10 ans. Les fistules etaient toutes secondaires a une cesarienne. Le diagnostic a ete pose par l’examen clinique dans un cas. L’urographie intraveineuse (UIV) a ete realisee chez toutes les patientes et n’a visualise la cavite uterine que dans un cas. Dans les cas restants, le diagnostic a ete pose par l’urethrocystographie retrograde et mictionnelle (UCRM). Le traitement a ete chirurgical pour deux patientes, la 3 e patiente a refuse l’intervention chirurgicale. Avec un recul moyen de 15 mois, le resultat juge sur la disparition des signes cliniques a ete bon chez les deux patientes operees. Le but de ce travail est d’etudier les aspects etiopathogeniques, diagnostiques et therapeutiques du syndrome de Youssef.

Leiomyosarcoma of the prostate: a study of two cases.

Leiomyosarcoma of the prostate is rare neoplasm that accounts for less than 0.1% of prostate malignancies. A number of treatment approaches have been adopted including radical surgery, radiotherapy and chemotherapy, but in no instance has a successful outcome been obtained. Prostate leiomyosarcoma has a poor prognosis, although survival time can vary. For these reasons, it is important to correctly identify this disease and report its occurrence, type of treatment, and the response to therapy of each patient diagnosed as having leiomyosarcoma of the prostate in an attempt to improve our understanding of the natural history of these lesions.

Bilateral kidney matrix stones: a rare case

Kedney matrix stones are a rare form of calculi. Flank pain and urinary tract infections (UTI) are the most common presentations of matrix calculi. The diagnosis is usually made at surgery, but some preoperative radiographic findings might be suggestive. Open surgery was the method of choice for treatment. However, combination of ureterorenoscopy and percutaneous nephrolithotomy (PCNL) was found to be safe and effective. We report a rare case of renal and ureteral matrix stones that were diagnosed and treated by open surgery. We also describe its clinical, radiological and therapeutic features through a review of the literature.

Cavernous hemangioma of the bladder: an additional case managed by partial cystectomy and augmentation cystoplasty.

Cavernous Hemangioma of the Bladder (CHB) is benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent complain. CHB is suspected by cystoscopy and radiologic findings and confirmed by pathologic examinations. Management is controversial due to the bleeding risk of this highly vascularized lesion. Partial cystectomy is the treatment of choice for surgically accessible lesions. However, it appears that small lesions could be treated using transurethral resection. Since CHB is a rare case, we report another case treated successfully with a partial cystectomy associated with an augmentation cystoplasy.

Traitement endoscopique du reflux vésico-urétéral par injection sous-méatique de graisse autologue. A propos de deux cas

The authors report two cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. We describe the technique of prelevement and injection. The immediate results confirm the efficacity of this procedure. The long-term follow-up will allow us to adopt it and to give it some modifications.

Prostatic Abscess on Xanthogranulomatous Prostatitis: Uncommon Complication of an Uncommon Disease

Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Only few cases have been reported in the English literature. Xanthogranulomatous prostatitis is usually an incidental finding after needle biopsy or transurethral resection of the prostate in patients suffering from low urinary tract symptoms. We report the case of a 59-years-old patient diagnosed with prostatic abscess managed by transurethral resection of the prostate. Histopathological examination of resected prostatic tissue revealed abscessed xanthogranulomatous prostatitis with no evidence of malignancy. Xanthogranulomatous prostatitis presenting as a prostatic abscess is a rare finding. To the best of our knowledge our case represents the fourth case of xanthogranulomatous prostatitis presenting as prostatic abscess reported in the English literature so far.