Yassine Nouira

Hydatid Cyst of the Kidney

Objectives: We report our experience in the management of 147 hydatid cysts of the kidney over an 11–year period.Material and Methods: The records of 147 patients operated for hydatid cysts of the kidney between 1985 and 1996 were reviewed in order to address patient’s symptoms at presentation, radiological findings, diagnostic tests and surgical outcome. All patients were managed with open surgery. No preoperative or postoperative antiparasitic medication was used.Results: Lumbar or lumbo–abdominal pain was the most frequent symptom (84%). Hydaturia was observed in 28% of the cases. Preoperative diagnosis was based upon intravenous pyelography (IVP), ultrasound and serology tests. CT scan was performed only in litigating cases (15%). In 20 cases, damage to the renal parenchyma was so extensive as to justify nephrectomy. Abstention concerned 5 involutive type V cysts. The remaining patients had an excision of the prominent part of the cyst (partial cystopericystectomy). Postoperative course was smooth in all cases. Postoperative IVP (3–6 months) showed a restituo ad integrum in 80% of the cases and residual pelvicaliceal distortions in 20%.Conclusions: Diagnosis of hydatid cyst of the kidney is based mainly on ultrasonography and IVP. Open surgery is the treatment of choice with excellent results.

Retrovesical Hydatid Disease: A Clinical Study of 27 Cases

Objectives: We report our experience with 27 cases of retrovesical hydatid cysts (RVHC) and discuss the pathogenesis , diagnosis and treatment of this hydatid location. Materials and Methods: We retrospectively reviewed the clinical files of 27 patients with RVHC admitted to our institution from January 1984 to December 2000. Results: The predominant presenting symptom was burning micturition (13 cases). Physical examination revealed a pelvic mass in 17 patients. Preoperative diagnosis was based upon ultrasonography, intravenous pyelography, and serology tests. CT was performed in 10 patients. We noticed that RVHC can be subdivided into two categories: those that develop mainly in the peritoneal cavity (intraperitoneal type; 18 cases), and those that develop mainly in the confined pelvic cavity (subperitoneal type; 9 cases) and are more liable to induce ureteral compression and more difficult to approach surgically. One patient died before operation. Twenty–six patients were operated and had either a total (9 cases) or partial pericystectomy (17 cases). Four patients underwent closure of cystovesical fistulas. Two patients had ureteral reimplantation. Postoperatively, 1 patient died with septic shock and 1 was reoperated for peritonitis. Mean postoperative hospital stay was 8 days. Conclusions: The preoperative diagnosis of RVHC is based mainly on ultrasonography. Open surgery is the treatment of choice.

How to insert a double J stent in laparoscopic retroperitoneal dismembered pyeloplasty: a new technique.

Antegrade placement of double J stent during laparoscopic pyeloplasty is technically demanding and time consuming, especially when operating in the retroperitoneal space. We report a new, time-saving method to antegrade insertion of a double J stent that we use in retroperitoneal laparoscopic dismembered pyeloplasty. This technique employs the recovery of a guidewire introduced retrograde through an open tip ureteral catheter placed in the mid-ureter at the beginning of the procedure and brought into the sterile area. The guidewire issued through a laparoscopic port will be used in the antegrade insertion of the double J stent. We used this technique in 6 consecutive retroperitoneal laparoscopic dismembered pyeloplasties. The stent was correctly placed in all 6 cases in less than 5 minutes without any difficulty. This is a simple and straightforward technique.

The pre-looped intracorporeal knot: a new technique for knot tying in laparoscopic surgery.

PURPOSE Intracorporeal knot tying in laparoscopic surgery is time-consuming and difficult to learn. We present a new technique, that we call the pre-looped intracorporeal knot technique, which obviates the difficulties and saves time. MATERIALS AND METHODS We devised a homemade suture ring that allows the introduction of the suture thread wrapped on the needle driver and ready for knot tying simply by pulling on both extremities of the thread. RESULTS Our experience with this technique proved it to be easy to apply and to learn. CONCLUSIONS The prelooped intracorporeal knot technique allies the sophistication of intracorporeal knot tying to the easiness and simplicity of the extracorporeal classic suturing. It renders intracorporeal knotting an easy and rapid task to achieve.

Ureterovaginal fistulas complicating laparoscopic hysterectomy: a report of two cases

Three ureterovaginal fistulas occurred following laparoscopic hysterectomy in two patients. Inadvertent burn of the distal ureter by a unipolar electrocautery was thought to be the cause. Avoidance of unipolar cautery to achieve hemostasis of uterine arteries would have prevented these urologic complications.

Megapenis Associated to Corpus spongiosum Agenesis with Scrotal and Pelvic Hemangiomas

An exceptional case of megapenis associated with corpus spongiosum agenesis and multiple hemangiomas of the scrotum, perineum and pelvis is reported. This is the first case in which three exceptional malformations are associated.