S Bennani

Kyste hydatique du rein : à propos de 90 cas

Resume Le kyste hydatique renal (KHR) est relativement rare et se place au 3 e rang apres celui du foie et du poumon. Notre etude porte sur une serie de 90 cas de KHR colliges en 28 ans (1972–2000). L’âge moyen de decouverte est de 36 ans, avec une predominance feminine. La symptomatologie est souvent parlante (masse du flanc dans 84 %, lombalgie dans 74 %) et parfois specifique (hydaturie dans 29 %). La serologie hydatique est positive dans 55 % des cas. Les types III et IV sont les plus frequents 70 cas (78 %). Le traitement est chirurgical, la chirurgie conservatrice occupe une place preponderante (84 %), la resection du dome saillant est largement suffisante. La nephrectomie totale ne se concoit que devant un rein completement detruit (16 %). Les suites operatoires sont generalement simples et la reexpansion du parenchyme renal est notee dans 93 % des cas, temoignant de la benignite de cette affection.

A baseline-controlled, open-label, flexible dose-escalation study to assess the safety and efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction.

Although sildenafil citrate (Viagra®) has demonstrated effectiveness in the treatment of erectile dysfunction (ED), the dosing regimens often used in clinical trials may not always match those employed in clinical practice. This study was undertaken to further assess the efficacy and safety of sildenafil taken as required in male outpatients 18 years of age and older with ED (n=71). It was conducted as a placebo-baseline–controlled, open-label, flexible dose-escalation study, with sildenafil (25,50, or 100 mg) administered for 8 weeks following a 4-week placebo run-in. Efficacy variables included questions 3 and 4 of the International Index of Erectile Function (IIEF), other IIEF domains, patient event logs, and quality-of-life (QOL) assessments. Treatment with sildenafil resulted in improvements from baseline in all IIEF domains analyzed (all P<0.0001), as well as overall QOL and amelioration of specific sexual and social relationships (all P<0.0001). Sildenafil was well tolerated. One participant discontinued treatment because of adverse events. Results suggest that flexible dosing with oral sildenafil is safe and has beneficial effects on all indices of erectile function and QOL.

La pyélonéphrite emphysémateuse : revue de la littérature à propos d’un patient décédé

Resume La pyelonephrite emphysemateuse est definie par la presence de gaz d’origine bacterienne au sein du parenchyme renal et dans les espaces perirenaux. Bien que rare, c’est une affection grave, car non traitee, son evolution reste fâcheuse et sa mortalite varie de 50 a 90 % des cas. Le germe responsable le plus souvent est l’ Escherichia-coli dans 60 % des cas. Nous rapportons une observation d’un patient de 50 ans non connu diabetique qui consulte en urgence pour des lombalgies gauches febriles avec pyurie, hematurie et une alteration profonde de l’etat general evoluant depuis 2 mois. Le diagnostic de pyelonephrite emphysemateuse a ete confirme par la tomodensitometrie. Malgre une triple antibiotherapie adaptee a la fonction renale, l’institution d’une insulinotherapie et la correction des troubles hydroelectrolytiques, le patient est decede dans un tableau de choc septique associe a une hemorragie digestive. A travers cette observation et une revue de la litterature, les auteurs discutent les differents caracteres cliniques et therapeutiques de cette affection. Son pronostic ne peut etre ameliore que par une nephrectomie pratiquee en urgence immediatement apres une courte reanimation.

Les léiomyomes de la voie excrétrice urinaire

Resume Les leiomyomes de la voie excretrice urinaire sont des tumeurs benignes rares. Nous rapportons deux cas de leiomyomes a localisation vesicale. A travers ces observations, nous analysons les aspects anatomopathologiques, diagnostiques et therapeutiques de ces tumeurs dont le pronostic est toujours favorable.

Le cancer du rein. À propos de 170 cas

PURPOSE The goal of this study is the analysis of the diagnostic and therapeutic aspects of this affection which is usually discovered at a delayed stage in our context. MATERIAL AND METHODS A retrospective study of 170 renal cancer, collected during a period of 15 years (1985-2000). Ninety-two men and 78 women were studied, their mean-age was 50 years (15-81 years). The diagnosis was relied on clinical, radiological and histological arguments. RESULTS Lumbar pain, hematuria and enormous mass were present in 85 cases (50%). The ultrasound and computed exams permitted the diagnosis and also evaluated the venous and locoregional extension. The treatment consisted on large nephrectomy practiced in 114 patients (67%), abstention in 56 cases (33%) due to the advanced stage of the tumor. The histological exam concludes to clear cell adenocarcinoma in 91.2% of cases. CONCLUSION The authors deplore the delayed diagnosis of renal cancer in our context which is responsible of a high rate of abstention (33%); and underline the interest of the early diagnosis for an adequate management.

Insuffisance rénale aiguë par hydronéphrose

Acute renal failure due to hydronephrosis is a rare pathology. It can occur unilaterally, or as a pyelo-ureteral junction (PUJ) bilateral syndrome. In the present study, two cases have been reported. The diagnosis was based on ultrasonographic findings which showed hydronephrosis, and on descending pyelo-ureterography (DPU), which demonstrated an absence of opacification. Infection was present in one case. Preliminary treatment consisted of percutaneous nephrostomy, followed by surgical pyelo-ureteral resection and Anderson-Hynes pyeloplasty which gave good results (95% success rate), and which enabled a satisfactory recovery of renal function to be obtained.

Phéochromocytome et maladie de von Recklinghausen

The association between von Recklinghausens disease and pheochromocytoma is present about 10% of cases. We report a case of 49 years old women who presented with elevated blood pressure and von Recklinghausens neurofibromatosis. Laboratory examination showed a marked level in the urinary excretion of cathecholamine. The computed tomography showed a right adrenal tumor suggesting a pheochromocytoma. The adrenalectomy was realised by transabdominal approach and the histological examination confirmed a benign pheochromocytoma. The authors discuss the pathogenetic hypothesis of this rare pathological association, the diagnostic methods and the therapeutic procedure.

Lithiase vésicale englobant un corps étranger : à propos d'un cas

The bladder can be the site of various foreign bodies. We report one case of bladder stone including a foreign body in a 24 years old man with a psychomotor deficiency who was admitted for pyuria, block miction and bladder symptoms. The pelvic X-Ray film showed a bladder stone including a sewing needle. We analysed the diagnosis, aspect and therapeutic management of this case.

Torsion du cordon spermatique sur testicule non descendu (A propos de deux cas et revue de la littérature)

ResumeLa torsion sur testicule non descendu reste une affection exceptionnelle. Elle survient le plus souvent chez l’adulte jeune; son étiopathogénie est mal connue.Deux observations colligées dans le service d’urologie du centre hospitalier Averroès de Casablanca sont rapportées. Le tableau clinique comporte une douleur abdominale d’apparition brutale sans fièvre avec une masse inguinale palpable et une vacuité scrotale homolatérale. L’échographie abdominale met en évidence une masse d’échostructure tissulaire hétérogène. L’exploration chirurgicale faite en urgence retrouve un testicule nécrosé en ectopie inguinale dans les deux cas. Une orchidectomie est réalisée et l’étude anatomopathologique ne montre pas de signe de malignité.La prise end charge des torsions sur testicules non descendus consiste en une exploration chirurgicale urgente La place de l’imagerie semble être restreinte. L’abord inguinal permet de réaliser le diagnostic, la détorsion, l’abaissement et la fixation dans la bourse homolatérale en cas de testicule viable.AbstractTorsion of an ectopic testis is an exceptional disease and mostly occurs in young adults. Its etiopathogenesis has not been elucidated.The authors report two cases. The clinical presentation consisted of sudden onset of abdominal pain without fever, associated with a palpable inguinal mass and a homolateral empty scrotum. Abdominal ultrasound showed a mass with a heterogeneous echogenicity. Emergency surgical exploration revealed a necrotic inguinal ectopic testis. Orchidectomy was performed and pathological examination did not reveal any signs of malignancy.The management of torsion of an undescended testis revealed by a mass with homolateral empty scrotum consists of urgent surgical exploration.Medical imaging appears to have a limited role. An inguinal incision allows diagnosis, detorsion, reduction and fixation in the homolateral scrotum.