Publications by authors named "Kays Chaker"

53 Publications

Life-threatening complication due to double-J stent: renal subcapsular hematoma.

J Surg Case Rep 2022 Jul 30;2022(7):rjac329. Epub 2022 Jul 30.

Urology Department, La Rabta Hospital, Tunis, Tunisia.

The double-J ureteral stent is a standard procedure in daily urological practice. Although considered as safe, this approach is fraught with several complications. These complications are of limited severity and resolve with symptomatic treatment. In some cases, serious and life-threatening complications, such as infection and subcapsular hematoma, can occur. In the literature, a few cases of subcapsular renal hematoma secondary to ureteral stent insertion have been reported. Herein, we report a case of renal subcapsular hematoma combined with hemorrhagic shock in a 67-year-old patient who had a ureteral stent insertion one month ago.
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http://dx.doi.org/10.1093/jscr/rjac329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341300PMC
July 2022

An unusual cause of painful ejaculation in a young patient: Zinner syndrome.

Ann Med Surg (Lond) 2022 Jul 10;79:103982. Epub 2022 Jun 10.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Introduction: and importance: Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. While the majority of patients remain asymptomatic and are discovered incidentally, others present symptoms such as micturition or ejaculatory difficulties, or pain. We report a case of Zinner syndrome in a 32-year-old patient with painful ejaculation and discuss the diagnosis and treatment difficulties.

Case Presentation: A 32-year-old married patient was consulted for pelvic pain associated with painful ejaculation that had been evolving for six months. The clinical examination was normal. Routine laboratory studies of blood and urine were normal. The patient was explored by ultrasound which showed the absence of the right kidney and the presence of a 7 cm right lateral prostatic cystic mass. On MRI, the right kidney was not visualized. Multiple cysts were seen in the right seminal vesicle. Surgical excision of the cyst by laparotomy was performed. The patient had an uneventful recovery and was discharged on the third postoperative day.

Clinical Discussion: Congenital malformations of the seminal vesicles are often associated with those of the ipsilateral upper urinary tract, as the ureteral and seminal vesicle buds originate from the mesonephric duct. The syndrome often occurs in the second and third decades of life, especially after the onset of sexual activity. The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation. Diagnostic modalities include ultrasound, MRI, and cystoscopy. In patients with symptoms, the therapeutic management of the cyst includes ultrasound-guided aspiration and laparoscopic or open surgical excision.

Conclusion: Seminal vesicle cysts associated with homolateral renal agenesis or hypoplasia are a rare urologic anomaly. The treatment depends on the patient's symptoms. surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms.
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http://dx.doi.org/10.1016/j.amsu.2022.103982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289330PMC
July 2022

Unusual association between testicular tuberculosis and microdeletion of the Y chromosome in an infertile patient with azoospermia.

Ann Med Surg (Lond) 2022 Jul 25;79:104068. Epub 2022 Jun 25.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Introduction: and importance: Infertility affects approximately 10-15% of couples worldwide. Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, testicular cancer, varicocele, and others. Herein, we report a case of an unusual association between testicular tuberculosis and microdeletion of the Y chromosome in an infertile patient and we discuss the diagnostic and therapeutic difficulties.

Case Presentation: A 36-year-old patient, a smoker, with no previous history consulted our department for primary infertility for 2 years. The clinical examination was normal. The sperm count showed azoospermia. karyotype analysis confirmed the diagnosis of a microdeletion of the Y chromosome. A testicular biopsy was performed. The microscopic analysis did not find any sperm cells. However, the histopathological examination was in favor of testicular TB. The patient received 6 months of anti-TB treatment. He remained azoospermic.

Clinical Discussion: Azoospermia is defined as the absence of sperm in the ejaculate in two different samples. This condition is classified as obstructive and non-obstructive. The etiology of this condition is either an intrinsic testicular deficiency or an insufficient production of gonadotropins. Genetic and chromosomal abnormalities should be investigated due to the higher incidence in azoospermic patients compared to the normal population. Testicular causes are dominated by infections, trauma, ischemia, and iatrogenic causes such as chemotherapy and radiotherapy. Genetic causes are dominated by Klinefelter syndrome and Y-chromosome microdeletions.

Conclusion: Azoospermia is a frequent cause of male infertility. Several causes are incriminated such as hormonal abnormalities, infections, genetic disorders, and others. In some cases, this condition can be multifactorial.
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http://dx.doi.org/10.1016/j.amsu.2022.104068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289408PMC
July 2022

Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery.

Ann Med Surg (Lond) 2022 Jul 28;79:104067. Epub 2022 Jun 28.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Introduction: Iatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it's not promptly diagnosed and managed.

Objective: The aim of our study was to report our experience in the management of this pathology.

Materials & Methods: This is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005-2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients' charts.

Results: The average age of the patients was 42.6 (21-61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure.

Conclusions: Injuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention.
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http://dx.doi.org/10.1016/j.amsu.2022.104067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289392PMC
July 2022

Adult bladder rhabdomyosarcoma: A case report.

Urol Case Rep 2022 Sep 20;44:102134. Epub 2022 Jun 20.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Rhabdomyosarcomas (RMS) are mesenchymal tumors that develop at the expense of striated muscle fibers. It accounts for 6% of childhood malignancies. Rhabdomyosarcomas of the genitourinary tract also occur in children but are distinctly uncommon in adults. We report a case of bladder rhabdomyosarcoma in a 72-year-old patient who presented with gross hematuria and discuss difficulties of diagnosis and treatment.
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http://dx.doi.org/10.1016/j.eucr.2022.102134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9234586PMC
September 2022

Predictive factors for failure of conservative management in patients with emphysematous pyelonephritis.

Ann Med Surg (Lond) 2022 Jun 4;78:103930. Epub 2022 Jun 4.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Introduction: Emphysematous pyelonephritis (EPN) is a severe form of life-threatening renal infection. Conservative treatment represents the gold standard in the management of EPN, but nephrectomy remains appropriate in certain situations.

Objective: The aim of our study was to report our experience in the conservative management of emphysematous pyelonephritis and to identify the predictive factors of failure of conservative treatment.

Patients And Methods: This is a retrospective study including all patients treated for emphysematous pyelonephritis in our department between January 2015 and December 2020. The first-line treatment was conservative based on antibiotic therapy and drainage in case of an obstructive cause. A nephrectomy was performed in case of failure of the conservative approach. Epidemiological, clinical, biological, therapeutic, and evolutionary data were collected from the patients' files. Statistical analysis was made using SPSS version 28.

Results: 41 patients were included in our study. The mean age was 64.4 years old [28-91] with gender ratio of 0.46 (13H/28F). Diabetes mellitus was present in 75.6% of cases. The mean presentation delay was 3.28 days (Kaiser and Fournier, 2005; Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007; Dutta et al., 2007; Dutta et al., 2007; Deoraj et al., 2018 Sep; Rahim et al., 2021 Mar; Maheshwari, 2021 Jul-Sep) [1-11]. In CT scan, 21 patients had class 1 EPN, 9 had class 2 EPN, 8 had class 3 EPN and 3 had class 4 EPN. The obstructive origin was found in 24 cases. Initially, 25 patients (60.9%) presented with severe sepsis and 7 patients (17.07%) developed a septic shock. Seven patients required nephrectomy with a mean delay of 2.12 days (Kapoor et al., 2010; Aswathaman et al., 2008; Agha et al., 2020; Huang and Tseng, 2000; Falagas et al., 2007) [2-6]. Five patients with septic shock refractory to conservative treatment and two patients whose evolution was marked by the occurrence of secondary septic shock. In the univariate analysis, thrombocytopenia, initially septic shock, and the need for hemodialysis were the predictive factors of failure of conservative management in patients with emphysematous pyelonephritis.

Conclusion: Emphysematous pyelonephritis is a serious condition with significant mortality. The optimal management is based on conservative treatment in most cases. However, patients requiring hemodialysis and with thrombocytopenia and initially septic shock should be considered candidates for emergency nephrectomy.
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http://dx.doi.org/10.1016/j.amsu.2022.103930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9207130PMC
June 2022

Functional outcomes of surgical treatment of varicocele in infertile men: Comparison of three techniques.

Ann Med Surg (Lond) 2022 Jun 4;78:103937. Epub 2022 Jun 4.

Urology Department, La Rabta Hospital, Tunis, Tunisia.

Introduction: Among identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate.

Objective: The goal of this study was to compare different surgical techniques in terms of morbidity and fertility results.

Patients And Methods: It is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques.

Results: Post-operative complication rates were comparable (p = 0,94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0,29 for the sperm concentration and p = 0,49 for the progressive mobility). Spontaneous pregnancy was better (p = 0,03) for patients who have had a varicocelectomy in a sub-inguinal way.

Conclusion: All of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better.
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http://dx.doi.org/10.1016/j.amsu.2022.103937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9207144PMC
June 2022

Giant adrenal myelolipoma in a young female patient: a case report.

J Surg Case Rep 2022 May 28;2022(5):rjac213. Epub 2022 May 28.

Urology Department, La Rabta Hospital, Tunis, Tunisia.

Myelolipoma is a rare, benign, non-secreting tumor and its pathophysiology is of metaplasia of the cells of the adrenal cortex into reticuloendothelial cells. Although they are often small and asymptomatic, some cases of giant adrenal myelolipoma cause symptoms such as chronic pain. Few cases of adrenal myelolipoma have been reported in the literature. We present a case of a large right adrenal myelolipoma in a 26-year-old female patient, who presented with an adrenal mass, and discuss the challenges of diagnosis and treatment.
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http://dx.doi.org/10.1093/jscr/rjac213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9155172PMC
May 2022

Unusual presentation of an intra-abdominal testicular seminoma in an adult.

Urol Case Rep 2022 Jul 20;43:102119. Epub 2022 May 20.

La Rabta Hospital: Department of Urology, 1007, Rue Jbal Lakhdhar, Tunis, Tunisia.

Intra-abdominal testicular tumors are characterized by their rarity and insidious progression. They are often revealed in adulthood in the form of a pelvic mass. This study reports a new case of an intra-abdominal seminoma in a 57-year-old patient which presented with isolated left flank pain, which is an unusual symptom. CT scan revealed a large pelvic mass along with a second retroperitoneal mass that was responsible for left hydronephrosis. Surgical excision of the pelvic mass was performed and the diagnosis of seminoma was confirmed by histopathology.
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http://dx.doi.org/10.1016/j.eucr.2022.102119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133741PMC
July 2022

A simple score for predicting urinary fistula in patients with renal hydatid cysts.

Libyan J Med 2022 Dec;17(1):2084819

Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisie.

Hydatid cyst is a major health problem in developing countries. The kidney is in third position of organs affected by hydatid cyst. One of the complications of renal hydatid cyst is a urinary fistula. The purpose of this study is to identify preoperative predictive factors of urinary fistula in renal hydatid cyst and to develop a scoring system for this disorder. We retrospectively analyzed all patients operated for renal hydatid cysts between January 2000 and December 2020. We divided our patients into two groups according to whether or not the renal hydatid cysts opened in the urinary tract. Predictive factors of the presence of a urinary fistula have been studied to obtain a simple score to predict the presence of a urinary fistula. Differences were considered significant if p < 0.05. Urinary fistula was detected in 33 of 96 patients. Univariate analyses showed significant differences in patient age, cyst size, location, hydaturia, eosinophil count, and platelet count between patients with and without urinary fistula. In multivariate analyses, hydaturia (p < 0.005), eosinophil count >500/mm, (p = 0.01), cyst diameter >5 cm (p = 0.02), and upper or lower renal pole location (p = 0.003) were significant and independent predictors of urinary fistula. A score was developed to predict the opening of the cyst in the urinary tract. The total score varies between 0 and 15. The resulting area under the receiver operator characteristic curve was 0.798 (95% CI, 0.726-0.866; p = 0.023). At a cutoff point ≥8, the specificity achieved was 100%. Preoperative detection and management of urinary fistula are important issues in the treatment of renal hydatid cyst. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with renal hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.
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http://dx.doi.org/10.1080/19932820.2022.2084819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9176375PMC
December 2022

Erectile function outcomes following surgical treatment of ischemic priapism.

Ann Med Surg (Lond) 2022 May 29;77:103696. Epub 2022 Apr 29.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Introduction: Ischemic Priapism is defined as an abnormally prolonged state of erection, exceeding 6 h, often and irreducible, occurring without any sexual stimulation. Ischemic priapism has a fatal consequence on the sexual function of men if it's not promptly managed. This pathology can cause erectile dysfunction and this can alter the quality of life of patients.

Objective: The aim of our study was to determine the factors influencing erectile function after treatment of ischemic priapism.

Patients And Methods: This is a ten-year retrospective, descriptive and analytic study of 40 patients who consulted the urology department at the university hospital center for treatment of ischemic priapism (2010-2019).

Results: We included 40 patients in our study. The mean age was 35.2 [18-62]. Duration of priapism varied from 20 to 360 h (mean 76.6). The most common etiology of priapism was sickle cell disease in 65% of cases. The mean preoperative IIEF-5 score was 23 [21-26]. All patients underwent corporal aspiration with an injection of ephedrine, but detumescence was observed in only 10% of cases. Thirty-six patients had a distal shunt with detumescence in approximately 70% of cases. Eleven patients underwent a distal shunt but seven patients had definitive fibrosis. After the episode of priapism, only eight patients retained normal erectile function. The mean postoperative IIEF-5 score was 14 [ 7-26]. We noted an improvement in erectile function in 8 patients treated with tadalafil. In multivariate analysis, we have demonstrated that a treatment delay exceeding 48 h, fibrosis and the necessity of a distal shunt significantly affects postoperative erectile function (p = 0.001; p = 0.002; p = 0.002 respectively).

Conclusion: According to our study, delayed management exceeding 48 h, fibrosis and the necessity of a surgical distal shunt are three independent factors affecting erectile function after treatment of ischemic priapism.
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http://dx.doi.org/10.1016/j.amsu.2022.103696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142696PMC
May 2022

[The prognostic value of preoperative neutrophil-to-lymphocyte ratio in patients with non-metastatic renal cell carcinoma].

Prog Urol 2022 Jul 20;32(8-9):585-592. Epub 2022 May 20.

Service d'urologie, hôpital la Rabta, université de Tunis El Manar, Tunis, Tunisie.

Introduction: The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio in non-metastatic renal cell carcinoma.

Patients And Methods: We retrospectively analyzed the records of patients with non-metastatic renal cell carcinoma who were operated between 2004 and 2020 at our institution. The Kaplan-Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox's proportional hazards regression models were utilized to analyze the association between neutrophil-to-lymphocyte ratio and oncological outcomes.

Results: We included 202 patients. Patients with higher neutrophil-to-lymphocyte ratio had larger tumors (P=0.03), higher ASA score (P=0.014), clinical symptoms (P=0.04), sarcomatoid differentiation (P=0.03) and tumor necrosis (P=0.02). The rates of recurrence-free survival and metastasis-free survival were significantly lower in patients with a high neutrophil-to-lymphocyte ratio than in those with a low ratio (P=0.017; P=0.036 respectively). Multivariate analysis identified the neutrophil-lymphocyte ratio as an independent predictor of recurrence-free and metastasis-free survival (P=0.021; P=0.001 respectively).

Conclusion: A higher neutrophil-to-lymphocyte ratio has been associated with a symptomatic renal cancer with a significant prognostic factor for both recurrence-free and metastasis-free survival.

Level Of Proof: 3.
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http://dx.doi.org/10.1016/j.purol.2022.03.007DOI Listing
July 2022

An unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract; a case report.

Urol Case Rep 2022 Jul 13;43:102113. Epub 2022 May 13.

Urology Department La Rabta Hospital, Tunis, Tunisia.

The occurrence of urothelial carcinoma and tuberculosis in the same kidney is exceptional. To our knowledge, a few cases have been reported in the literature. Herein, we report a case of an unusual association between renal tuberculosis and urothelial carcinoma of the upper urinary tract in a 61-year-old patient and discuss the diagnosis and treatment difficulties.
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http://dx.doi.org/10.1016/j.eucr.2022.102113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121246PMC
July 2022

Bladder lymphoepithelioma-like carcinoma: a case report.

J Surg Case Rep 2022 May 6;2022(5):rjac209. Epub 2022 May 6.

Urology Department La Rabta Hospital, Tunis, Tunisia.

Bladder lymphoepithelioma-like carcinoma is a rare entity. It represents a particular variant of urothelial carcinoma characterized by an important infiltrating power. Therapeutic management of this cancer is not codified. Surgery associated with chemotherapy seems to be the best therapeutic option. Few cases of this tumor have been reported in the literature. We report a case of bladder lymphoepithelioma-like carcinoma in a 52-year-old patient who presented with gross hematuria and discusses difficulties of diagnostic and treatment.
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http://dx.doi.org/10.1093/jscr/rjac209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090511PMC
May 2022

Bladder carcinosarcoma with rhabdomyoblastic differentiation: a rare case report.

J Surg Case Rep 2022 May 5;2022(5):rjac206. Epub 2022 May 5.

Urology Department, La Rabta Hospital, Tunis, Tunisia.

Carcinosarcoma is a distinct neoplasm consisting of bidirectional differentiation toward epithelial and mesenchymal cells. Bladder localization is rare and the association with a rahbdomyoblastic component is exceptional. Few cases of bladder carcinosarcoma with rhabdomyoblastic differentiation have been reported in the literature. We present a case of a bladder carcinosarcoma in a 68-year-old man who presented with terminal hematuria and discuss difficulties of diagnostic and treatment.
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http://dx.doi.org/10.1093/jscr/rjac206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9071998PMC
May 2022

Calcified double J stent removed at 10 years: a case report.

Pan Afr Med J 2022 2;41:94. Epub 2022 Feb 2.

Departement d'Urologie, Hospital la Rabta, Tunis, Tunisie.

In our current practice, the use of JJ probes has become extremely frequent. However, incrustation and fragmentation of JJ leads are still relatively common and sometimes complicate removal. A 61-year-old woman with a history of hysterectomy ten years ago, she had a double J endo-ureteral stent for preoperative identification of the right ureter. The patient has forgotten the double J stent. She currently has right lower back pain and urinary tract symptoms of urinary. Uroscan revealed a very important right hydronephrosis, a fully calcified right double J stent with a calcification of 6 cm at the level of the lower loop. She had, at first, a cystotomy allowing the extraction of the lower part of the calcified stent and secondly a pyelotomy to extract the rest of the double J stent. The operative follow-up was simple. The use of a double J probe to divert the urinary tract is an effective and generally well tolerated technique. Regular monitoring prevents complications.
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http://dx.doi.org/10.11604/pamj.2022.41.94.30722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994453PMC
April 2022

[Colorenal fistula complicating renal tuberculosis: a case report].

Pan Afr Med J 2021 12;40:91. Epub 2021 Oct 12.

Service d'Urologie, CHU Mongi Slim la Marsa, Tunis, Tunisie.

Urogenital tuberculosis is little suspected and known by clinicians. Colorenal fistulas, although rare, are complex forms of renal tuberculosis occurring in patients with advanced-stage disease. They generally occur in the ascending and descending colon. We here report the clinical case of a 58-year-old female patient presenting to the Emergency Department with severe acute left pyelonephritis. Abdominal CT scan objectified left pyonephrosis with left colorenal fistula. The patient had poor clinical, biological outcome despite resuscitation measures and antibiotic treatments. Urgent left nephrectomy was performed with disconnection and drainage of colorenal fistula. Histology showed renal tuberculosis. The patient received antibacillary drugs according to 2ERHZ/4RH guidelines. The treatment of this type of TB should be adequate to avoid recurrences that could be more complicated to manage.
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http://dx.doi.org/10.11604/pamj.2021.40.91.30518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607944PMC
December 2021

Bilateral renal abscess fusing with the psoas on the right: A case report.

Urol Case Rep 2022 Jan 19;40:101951. Epub 2021 Nov 19.

Departement of Urology, La Rabta Hospital, Tunisia.

Renal abscess is a medical and surgical urological emergency whose diagnosis has been improved by modern imaging. It often poses a problem of therapeutic management between antibiotic therapy or the association of a drainage. Most abscesses are unilateral, the bilateral nature of the abscessed lesions suggests a hematogenous diffusion. We report a case of a bilateral renal abscess fusing to the psoas muscle on the right that progressed well with antibiotic treatment and percutaneous drainage.
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http://dx.doi.org/10.1016/j.eucr.2021.101951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626646PMC
January 2022

An unusual association of adenocarcinoma and isolated tuberculosis of prostate gland.

J Surg Case Rep 2021 Nov 17;2021(11):rjab504. Epub 2021 Nov 17.

Department of Urology, Faculty of Medicine Tunis, La Rabta Hospital, University Tunis Manar, Tunis, Tunisia.

Adenocarcinoma of prostate is the most common primary prostatic malignancy in the world. Isolated prostate tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. We report two cases of adenocarcinoma and tuberculosis of the prostate. The patients were 83 and 74 years old, respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and prostate-specific antigen were abnormals. The diagnosis of prostatic tuberculosis and adenocarcinoma was made by histologic analysis after transurethral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis and hormonotherapy. Tuberculosis and malignancy may co-exist in some cases and clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.
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http://dx.doi.org/10.1093/jscr/rjab504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601768PMC
November 2021

Prostatic lithiasis complicating granulomatous prostatis of tuberculous origin: About a case report.

Urol Case Rep 2022 Jan 1;40:101875. Epub 2021 Oct 1.

Departement of Urology, La Rabta Hospital, Tunisia.

Urogenital tuberculosis remains a frequent disease in our country. It is the most common extra-pulmonary location. Prostatic involvement is extremely rare. We report the observation of a prostatic lithiasis complicating a granulomatous prostatitis of tuberculous origin, revealed essentially by obstructive and storage lower urinary tract symptoms. The diagnosis was suspected on imaging and clinical findings and confirmed by histology. Treatment consisted of endoscopic resection of the prostate associated with endoscopic ballistic lithotripsy. Prostatic lithiasis is a rare condition with a poorly elucidated ethiopathogeny. The origin of tuberculosis should be evoked in front of this affection.
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http://dx.doi.org/10.1016/j.eucr.2021.101875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8498221PMC
January 2022

Venous thrombosis of the pampiniform plexus after coronavirus infection (COVID-19): A case report.

Urol Case Rep 2021 Nov 27;39:101860. Epub 2021 Sep 27.

Departement of Urology, La Rabta Hospital, Tunisia.

Because of an increased hypercoagulable state, a significant proportion of COVID-19 patients develop various and extensive venous thromboembolic complications. We report the case of a young patient with a history of pneumopathy related to COVID-19 disease, in whom the diagnosis of thrombosis of a pampiniform plexus vein was made on color doppler ultrasound data. We adopted a conservative treatment with good clinical and radiological evolution. To our knowledge, this is the second association of venous thrombosis of the pampiniform plexus with COVID-19 disease.
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http://dx.doi.org/10.1016/j.eucr.2021.101860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475016PMC
November 2021

Inguinal bladder hernia: a case report.

J Surg Case Rep 2021 Sep 21;2021(9):rjab386. Epub 2021 Sep 21.

Department of Urology, La Rabta Hospital, Tunisia.

Inguinal hernia is a common disorder that requires urgent and adequate surgical management. Multiple organs may be associated with inguinal hernias, but bladder involvement is rarely seen. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or intravenous urography confirms the diagnosis. We report a case of inguinal hernia involving the bladder at the right side with a 72-year-old man. We performed a hernia repair after reintegration of the bladder.
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http://dx.doi.org/10.1093/jscr/rjab386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458905PMC
September 2021

Double retroperitoneal hydatid localization: About a case report.

Urol Case Rep 2021 Nov 31;39:101824. Epub 2021 Aug 31.

Departement of Urology, La Rabta Hospital, Tunisia.

The hydatid cyst is a parasitic pathology which is endemic in Tunisia and presents a public health problem.Hydatid cysts located in the retroperitoneum, especially around or in the kidney, are rare and only represent 5% of visceral locations. The kidney is the most commonly affected organ of the urinary tract.The psoas muscle is an uncommon location and not less than 70 cases have been cited. We report the Case of an unusual presentation of a right kidney hydatid cyst associated with a psoas muscle location. To our knowledge, this association of double retroperitoneal location has not been reported in the literature.
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http://dx.doi.org/10.1016/j.eucr.2021.101824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417297PMC
November 2021

Ureteral diverticulum complicated by urinary lihiasis: About a case report.

Urol Case Rep 2021 Nov 17;39:101810. Epub 2021 Aug 17.

Departement of Urology, La Rabta Hospital, Tunisia.

Ureteral diverticulum is a rare urinary malformation and can frequently lead to urinary complications. It can be congenital, acquired or an abortive ureteral duplication. Most are treated conservatively. A surgical indication is made in case of symptomatic or complicated diverticulum. It can be congenital, acquired or an abortive ureteral duplication. Most of them are treated conservatively. A surgical indication is given in case of symptomatic or complicated diverticulum. and recurrent total hematuria. Radiological investigations confirmed the diagnosis of congenital ureteral diverticulum complicated with lithiasis.
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http://dx.doi.org/10.1016/j.eucr.2021.101810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403537PMC
November 2021

Mediastinopulmonary sarcoidosis mimicking metastatic renal cell carcinoma: About a case report.

Urol Case Rep 2021 Nov 17;39:101809. Epub 2021 Aug 17.

Departement of Urology, La Rabta Hospital, Tunisia.

There is a well-established association between sarcoidosis and many solid and hematologic malignancies, but it is less commonly described in patients with renal cell carcinoma. The majority of the cases described presented local sarcoid-like reactions in the immediate vicinity of the tumor with comparatively few reports of the disease further away. In view of the relatively small number of cases, there remains great uncertainty about the clinical behavior of sarcoidosis in renal cell carcinoma. In this observation, we illustrate a case of mediastinopulmonary sarcoidosis, which behaved like a true paraneoplastic syndrome of a renal tumor.
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http://dx.doi.org/10.1016/j.eucr.2021.101809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379659PMC
November 2021

Renal hydatidosis masquerading as xanthogranulomatous pyelonephritis: a new case report.

J Surg Case Rep 2021 Jul 19;2021(7):rjab306. Epub 2021 Jul 19.

Faculty of Medicine Tunis, Department of Urology, La Rabta Hospital, University Tunis Manar, Tunis, Tunisia.

Human hydatid disease is still endemic in pastoral and rangeland areas, with temperate climate, mainly in the southern shore of the Mediterranean, particularly in the Maghreb countries. Renal localization is rare although it is the most frequent site of the urinary tract. Its clinical evolution remains silent for long time, and the diagnosis is often elusive for years. Renal hydatid cysts may pose a problem of differential diagnosis. Our case concerns a renal hydatidosis misdiagnosed as a xanthogranulomatous pyelonephritis, treated by total nephrectomy.
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http://dx.doi.org/10.1093/jscr/rjab306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289321PMC
July 2021

Carcino-sarcoma of the urinary bladder with cartilaginous differentiation: About a case report.

Urol Case Rep 2020 Jan 17;28:101053. Epub 2019 Oct 17.

Departement of Urology, La Rabta Hospital, Tunis, Tunisia.

Carcinosarcoma of the bladder is a very rare and aggressive tumor with poor prognosis. We report a case of a 61 year-old-male who presented a terminal hematuria. Ultrasounds revealed a mass at the dome and the right of urinary bladder. A transurethral resection of the bladder tumor was performed. A pathological examination revealed a pT1 hight grade carciono-sarcoma of the urinary bladder with cartilaginous differentiation. Cystoprostatectomy with Bricker diversion and lymph node dissection were performed. The pathological examination of the surgical specimen revealed no residual tumor lesion.
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http://dx.doi.org/10.1016/j.eucr.2019.101053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818139PMC
January 2020

[Evaluation of protocols on the use of analgesics for pain management in patients with extracorporeal shock wave lithotripsy (ESWL)].

Pan Afr Med J 2019 8;32:109. Epub 2019 Mar 8.

Service d'Urologie, Hôpital La Rabta, Faculté de Médecine de Tunis, Université de Tunis, El Manar, Tunisie.

Extracorporeal shock wave lithotripsy-related pain is the largest limiting factor in this technique. Our study aimed to compare the effectiveness of different types of analgesics for pain management used during ESWL sessions. We conducted a prospective study of 300 patients with urinary lithiasis justifying ESWL treatment. The patients were randomized to three groups: group I, included 100 patients who received intramuscular injection of 2cc of physiological saline solution (placebo), group II included 100 patients who received intramuscular injection of ketoprofen 100mg while group III included 100 patients who received lidocaine and prilocaine topical cream. Visual Analog Scale (VAS) was used to assess pain 10 minutes after and at the end of the session. Mean VAS score 10 minutes after and at the end of ESWL session was 3.7 and 4.91 respectively. There was no significant difference among the three groups with respect to: epidemiological data (age, sex, BMI, patient's history) and the characteristics of the renal stone (side, size, location, presence or not of double-J ureteral catheter). Eleven patients in the Group I terminated treatment early, with a significant difference compared to the other groups (p=0.003). VAS score 10 minutes after and at the end of ESWL session was statistically higher in Group I compared to Groups II and III (p < 0.001). Moreover, ESWL session was significantly more effective in Groups (II and III) compared to Group I (p<0.001). Pain treatment is necessary during ESWL sessions. Two painkillers molecules were assessed, which showed good pain control as well as an increase in the effectiveness of lithotripsy.
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http://dx.doi.org/10.11604/pamj.2019.32.109.17690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560981PMC
July 2019

An adrenal cystic lymphangioma: A case report of a rare tumor.

Urol Case Rep 2019 May 1;24:100843. Epub 2019 Feb 1.

Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia.

Cystic lymphangioma is a rare benign tumor developing from lymphatic endothelial cells, and is usually described in the neck or axilla. We report a new case of an adrenal cystic lymphangioma fortuitously found in a 37-year-old patient. This case report and review of the literature bring new insights into the diagnostic difficulty and management of cystic lymphangioma of the adrenal gland.
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http://dx.doi.org/10.1016/j.eucr.2019.100843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563211PMC
May 2019
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