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Saadi A, Bedoui MA, Mokadem S, Zaghbib S, Boussaffa H, Bellali M, Ayed H, Bouzouita A, Derouiche A, Allouche M, Chakroun M, Slama RB. Anatomy and anatomical variations of adrenal veins and its application to adrenal venous sampling. Surg Radiol Anat 2024; 46:543-550. [PMID: 38429406 DOI: 10.1007/s00276-024-03331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Our aim was to study the anatomy of the left and right main adrenal veins (LAV and RAV) and to identify their anatomical variations in order to see the practical application of these findings to adrenal venous sampling (AVS). METHODS Our work is based on dissection of 80 adrenal glands from fresh corpses in the forensic medicine department. We studied the number, the drainage, the direction and the level of termination of the main adrenal veins. RESULTS The average length of the LAV was 21 mm. It ended in 100% of cases at the upper edge of the left renal vein with a mean connection angle of 70° and after an anastomosis with the lower phrenic vein in 36 cases(90%). The average length of the RAV was 9 mm. It ended in 100% of cases at the level of the retro hepatic inferior vena cava (IVC) mainly on its posterior face in 21 cases (53%) and on its right lateral border in 18 cases (45%). The mean angle of the RAV in relation to the vertical axis of the IVC was 40°, with extremes ranging from 15° to 90°. CONCLUSIONS AVS seems to be easier on the left than on the right side because of the greater length of the adrenal vein (21 mm vs. 9 mm) and a greater angle of connection (70° with the left renal vein vs. 40° with the IVC), which explains the lower success rate of cannulation and the more frequent occurrence of blood sample contamination on the right side.
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Affiliation(s)
- Ahmed Saadi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Mohamed Ali Bedoui
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia.
| | - Seif Mokadem
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Selim Zaghbib
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Hamza Boussaffa
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Mohamed Bellali
- University of Tunis El Manar, Faculty of Medecine of Tunis, Charles Nicolle Hospital, Department of Legal and forensic medicine , Tunis, Tunisia
| | - Haroun Ayed
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Abderrazek Bouzouita
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Amine Derouiche
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Mohamed Allouche
- University of Tunis El Manar, Faculty of Medecine of Tunis, Charles Nicolle Hospital, Department of Legal and forensic medicine , Tunis, Tunisia
| | - Marouene Chakroun
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
| | - Riadh Ben Slama
- University of Tunis El Manar, Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of Urology, Tunis, Tunisia
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Saadi A, Mokadem S, Bedoui MA, Zaghbib S, Hermi A, Bellali M, Boussaffa H, Ayed H, Bouzouita A, Allouche M, Chakroun M, Slama RB. A cadaveric anatomical study of the adrenals: vascular relationship. Endocrine 2024; 83:483-487. [PMID: 37932646 DOI: 10.1007/s12020-023-03585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
The adrenal gland is a retroperitoneal organ with intimate relationships with neighboring organs but also with the large retroperitoneal vessels. Our aim was to study the vascular relationships of the adrenal gland with the large abdominal vessels. Our work is an anatomical dissection of 80 fresh cadaveric adrenals. The subjects didn't have a history of retroperitoneal surgery. Dissection conditions were similar to those in the living. All measurements were made in situ. On the right side, the average distance between the adrenal gland and the renal vein (DR) was 13 mm (0-20). In one case, the adrenal gland laid directly on the right renal vein (DR = 0). The average length L, over which the right adrenal gland entered behind the inferior vena cava (IVC), was 8 mm (0-12). In 4 cases, the right adrenal was lateral to the IVC and in 6 cases the length L exceeded 10 mm. On the left side, the mean distance DL, separating the adrenal gland from the left renal vein was 8 mm with extremes ranging from 0 mm to 18 mm. In eleven cases, the adrenal gland laid directly on the left renal vein. The right adrenal gland has a close relationship with the IVC and is often located behind it. This close relationship helps to explain the increased incidence of IVC lesions during surgery. The left adrenal gland has an intimate relationship with the left renal vein and often lies on top of it. This explains the risk of injury to the left renal pedicle during left adrenal surgery.
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Affiliation(s)
- Ahmed Saadi
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Seif Mokadem
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Mohamed Ali Bedoui
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia.
| | - Selim Zaghbib
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Amine Hermi
- University of Tunis El Manar Faculty of Medicine of Tunis, Anatomy department, Tunis, Tunisia
| | - Mohammed Bellali
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of legal and forensic medicine, Tunis, Tunisia
| | - Hamza Boussaffa
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Haroun Ayed
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Abderrazek Bouzouita
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Mohamed Allouche
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of legal and forensic medicine, Tunis, Tunisia
| | - Marouene Chakroun
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Riadh Ben Slama
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
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Bedoui MA, Saadi A, Zaghbib S, Mokadem S, Boussaffa H, Hermi A, Ayed H, Bouzouita A, Chakroun M, Ben Slama R. Risk factors for sepsis and mortality in patients with emphysematous pyelonephritis : a series of 68 cases (case series). Ann Med Surg (Lond) 2024; 86:240-244. [PMID: 38222707 PMCID: PMC10783401 DOI: 10.1097/ms9.0000000000001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Emphysematous pyelonephritis (EPN) is a rare and severe necrotizing infection of the kidney with a high rate of complications and mortality. Our aim was to investigate risk factors of urosepsis and mortality in case of EPN. Materials and methods Between January 2010 and December 2022 the charts of patients diagnosed with EPN were retrospectively reviewed. Patients medical records were collected and data including demographics, BMI, EPN type, the organism causing the infection and biochemical variables were registered. The authors performed an univariate and multivariate logistic regression analysis for sepsis, septic shock, and mortality. Statistical significance was defined as a P-value of <0.05. Results Our study included 68 patients (63% females, mean age 58.6 years old). Forty-eight patients (70.6%) had diabetes. Half of the patients (50%) presented with sepsis and 11 patients (16.2%) developed a septic shock. The following factors were associated with sepsis by univariate analysis: diabetes (P=0.01), higher blood sugar on admission (P=0.01), higher leukocytic count (P<0.001), higher lymphocytic count (P<0.001), and lower platelet to leukocytes ratio (P<0.001). Multivariate regression analysis revealed that the main risk factors of urosepsis were the leukocytic (OR: 85.7; 95% CI: 9.177-800.486; P<0.001) and lymphocytic count (OR: 6.65; 95% CI: 1.228-36.050; P=0.028). Neither of the variables was significantly associated with a higher risk of mortality. Conclusion Leukocytic and lymphocytic count on admission are independent simple predictors for sepsis in patients with EPN.
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Affiliation(s)
- Mohamed A. Bedoui
- Department of Urology, Faculty of Medicine of Tunis, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
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Saadi A, Bedoui MA, Zaghbib S, Boussaffa H, Mokaddem S, Nacef IB, Ayed H, Bouzouita A, Derouiche A, Khiari K, Chakroun M, Slama RB. Validation of the Aldosteronoma Resolution Score as a Predictive Resolution Score of Hypertension After Unilateral Adrenalectomy for Primary Aldosteronism in a North-African Population. World J Surg 2023; 47:2776-2783. [PMID: 37667066 DOI: 10.1007/s00268-023-07155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Unilateral primary aldosteronism (UPA) is the most frequent surgically curable form of endocrine hypertension. Adrenalectomy is the cornerstone of treatment for UPA, but outcomes after surgery are variable. Aldosteronoma Resolution Score (ARS) is a four-item predictive score for the cure of hypertension after adrenalectomy for UPA and has been demonstrated to be valid in different populations. We aimed in this study to validate the accuracy of this score in a North-African population. METHODS Between 2000 and 2021, the charts of 71 Tunisian patients who underwent laparoscopic adrenalectomy for UPA were retrospectively reviewed. Postoperative outcomes were assessed using the primary aldosteronism surgical outcome (PASO) criterion. The accuracy of the ARS was determined retrospectively by receiver operating characteristic curve and area under the curve. RESULTS Thirty-four patients (48%) had complete clinical success according to the PASO criteria. Multivariate regression analysis revealed that the main determinants of complete clinical success were the absence of diabetes (OR: 5.205), a BMI <30 (OR: 4.930), a number of antihypertensive medications ≤2 (OR: 8.667), a plasma ARR >332 (OR: 4.554) and an ARS score ≥3 (OR: 2.056). Cure rates were, respectively, 21.1, 51.6, and 66.6% for patients with a score ARS 0-1, 2-3, and 4-5. The AUC of the ARS was 0.837. CONCLUSION The ARS is a sufficiently predictive score in our North-African population. It may be used preoperatively to predict the outcome after adrenalectomy in these populations.
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Affiliation(s)
- Ahmed Saadi
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Mohamed Ali Bedoui
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia.
| | - Selim Zaghbib
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Hamza Boussaffa
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Seif Mokaddem
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Ibtissem Ben Nacef
- Department of Endocrinology, Charles Nicolle Hospital, University of Medicine of Tunis, Tunis, Tunisia
| | - Haroun Ayed
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Abderrazek Bouzouita
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Amine Derouiche
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Karima Khiari
- Department of Endocrinology, Charles Nicolle Hospital, University of Medicine of Tunis, Tunis, Tunisia
| | - Marouene Chakroun
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Riadh Ben Slama
- Department of Urology, Charles Nicolle Hospital, University of Medicine of Tunis, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
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Aouini H, Saadi A, Boussaffa H, Zaghbib S, Chakroun M, R BS. A juxtaglomerular cell tumor revealed by a hemorrhagic stroke. A case report. Urol Case Rep 2023; 50:102535. [PMID: 37621391 PMCID: PMC10445440 DOI: 10.1016/j.eucr.2023.102535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
With about 110 cases reported in literature, juxtaglomerular cell tumors are rare. We report a 25 years old patient who was admitted in neurology for a hemorrhagic stroke secondary to a cerebral aneurysm rupture due to high blood pressure. Etiological investigations showed a solid mass of the left kidney. A radical nephrectomy was realized and pathological examination and immunohistochemical profile concluded to juxtaglomerular cell tumor. The originality of this observation is based on the mode of presentation of a rare renal tumor by a malignant high blood pressure.
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Affiliation(s)
- H. Aouini
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - A. Saadi
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - H. Boussaffa
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - S. Zaghbib
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - M. Chakroun
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ben Slama R
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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Saadi A, Bedoui MA, Zaghbib S, Mokadem S, Boussaffa H, Hermi A, Ayed H, Bouzouita A, Derouiche A, Chakroun M, Slama RB. Can radiological scores predict difficulties in removal of encrusted ureteral stents? Urolithiasis 2023; 51:108. [PMID: 37612572 DOI: 10.1007/s00240-023-01482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
In the present study, we aimed to report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems in patient management. This is a retrospective study of patients who underwent various surgical procedures to remove encrusted ureteral stent. Encrusted stent grading was performed using KUB and FECal grading sytems. FECal grading system scored from Grade 1 to Grade 5 according to stone size, location, and degree of stent incrustation and the KUB score is the sum of the stone burden scores of three different parts of an encrusted stent within the kidney, ureter, and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. We compared these two classifications for the prediction of perioperative outcomes. Fifty patients were included in the study (52% female, mean age 48 years). The mean time from ureteral stent insertion until diagnosis of encrustation was 11.4 ± 13.6 months. High-grade incrustations (FECal Grade 3, 4, and 5) accounted for 62% of cases. The mean KUB score was 9.8 ± 2.7. The average number of procedures required to remove the stent was 1.71 ± 1.38. Multimodal surgery was required to remove 42% of the stents. Both, a total KUB score ≥ 9 and high-grade FECal classification were found to be significant predictors of longer operative time (> 100 min), need for multiple surgeries, and need for invasive surgery. While high-grade FECal classification showed a significant association with need for multimodal surgery (OR 6.92, p = 0.008), a total KUB score ≥ 9 showed no association (OR 2.91, p = 0.086). These two scores seem to be good indicators in predicting difficulties for surgical management of encrusted ureteral stent with a clear advantage of the FECal score in terms of prediction of multimodal surgery.
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Affiliation(s)
- Ahmed Saadi
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Mohamed Ali Bedoui
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia.
| | - Selim Zaghbib
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Seif Mokadem
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Hamza Boussaffa
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Amine Hermi
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Haroun Ayed
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Abderrazek Bouzouita
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Amine Derouiche
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Marouene Chakroun
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
| | - Riadh Ben Slama
- Urology Department, University of Medicine of Tunis, Charles Nicolle Hospital, 9th April 1938 Boulevard, Bab Saâdoun, 1007, Tunis, Tunisia
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Saadi A, Bedoui MA, Zaghbib S, Boussaffa H, Mokaddem S, Nacef IB, Ayed H, Derouiche A, Khiari K, Chakroun M, Ben Slama R. Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism. Front Endocrinol (Lausanne) 2023; 14:1205988. [PMID: 37635962 PMCID: PMC10454906 DOI: 10.3389/fendo.2023.1205988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Unilateral primary aldosteronism (UPA) is the most frequent surgically curable form of endocrine hypertension. Adrenalectomy is the cornerstone of treatment for UPA, but outcomes after surgery are variable. The cause of resistant hypertension after surgery is still a matter of debate. Our aim was to investigate cure rates after surgery and to evaluate preoperative factors that might influence the surgical outcome. Methods Between 2000 and 2021, the charts of 71 Tunisian patients who underwent laparoscopic adrenalectomy for UPA were retrospectively reviewed. Preoperative medical records were collected and follow-up data (1-158 months) were registered. Antihypertensive medication doses were calculated using defined daily doses (DDD) and postoperative outcomes were assessed using the Primary Aldosteronism Surgical Outcome (PASO) criterion. Results Of 91 enrolled patients, 71 (59% women, mean age 46 years, median length of follow-up 21 months) were suitable for evaluation. Thirty-four patients (48%) had complete clinical success according to the PASO criteria. The most relevant factors associated with complete clinical success on univariate analysis were: absence of diabetes (p= 0.007), low body mass index (BMI) (p= 0.001), lower preoperative DDD (p= 0.01), preoperatively controlled blood pressure (p= 0.024), higher plasma aldosterone to renin ratio (ARR) (p= 0.001), adenoma subtyping (p <0.001) and aldosteronoma resolution score (ARS) (p= 0.002). Multivariate regression analysis showed that the major predictors of complete clinical success were absence of diabetes (OR: 5.205), a BMI < 30 (OR: 4.930), a plasma ARR > 332 (OR: 4.554) and an ARS ≥ 3 (OR: 2.056). Conclusion Complete and partial clinical response rates were achieved in respectively 48 and 43% of cases. The main predictors of complete resolution of hypertension were absence of diabetes, low BMI, high plasma ARR and high ARS. Taking these factors into account may help identify patients at risk of persistent postoperative hypertension who may require long-term surveillance and medication.
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Affiliation(s)
- Ahmed Saadi
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Ali Bedoui
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Selim Zaghbib
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hamza Boussaffa
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Seif Mokaddem
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ibtissem Ben Nacef
- Department of Endocrinology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Haroun Ayed
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Amine Derouiche
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Karima Khiari
- Department of Endocrinology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Marouene Chakroun
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
| | - Riadh Ben Slama
- Department of Urology, University of Medicine of Tunis, Charles Nicolle Hospital, Tunis, Tunisia
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Zaghbib S, Saadi A, Boussaffa H, Ayed H, Slama MRB. Management strategies and root causes of missed iatrogenic intraoperative ureteral injuries with delayed diagnosis: a retrospective cohort study of 40 cases. Patient Saf Surg 2023; 17:21. [PMID: 37496033 PMCID: PMC10373270 DOI: 10.1186/s13037-023-00372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Intraoperative iatrogenic ureteral injuries represent rare technical surgical complications with the potential for adverse patient outcomes, particularly when the diagnosis is delayed. Ideally, these technical complications are recognized and repaired intraoperatively. This study was designed to investigate the root causes and outcomes of missed intraoperative ureteral injuries at a tertiary urology referral centre in Tunisia. METHODS This is a retrospective cohort study in a tertiary urology referral centre in Tunis from January 1st, 2015, to December 31st, 2020, including all patients with iatrogenic ureteral injury, not diagnosed intraoperatively. The factors associated with the success of endoscopic treatment and those associated with the unfavourable evolution were investigated. RESULTS A total of 40 iatrogenic ureteral injuries were included. Gynaecological surgery was responsible for 85% of ureteral injuries, mainly during hysterectomies (55%). The symptoms were dominated by low back pain (37.5%) and pyelonephritis (25%). Endoscopic treatment was attempted in 22 cases, it was sufficient in 12 cases. Ureteral injury required surgical treatment in 24 cases, and ureteroneocystostomy was performed in 16 cases. Nephrectomy was performed in eight cases, representing 20% of injuries, including three cases as the first treatment for late-diagnosed cases with a destroyed kidney. In the analytical study, endoscopic treatment was sufficient in 50% in case of ureteral fistula versus 27% in case of ureteral stenosis (p = 0.04). Nephrectomy was performed in 10% of cases when ureteral injury was diagnosed within the first month postoperatively compared to 60% of cases when this delay exceeded one month (p = 0.004). CONCLUSION Iatrogenic ureteral injuries discovered postoperatively are mostly secondary to gynaecologic surgery. Although endoscopic treatment is usually performed as a first treatment, a more aggressive surgical is often necessary, with a nephrectomy rate of 20%.
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Affiliation(s)
- Selim Zaghbib
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia.
| | - Ahmed Saadi
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia
| | - Hamza Boussaffa
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia
| | - Haroun Ayed
- Urology department, Charles Nicolle Hospital, 1001 Boulevard du 09 Avril, Tunis, Tunisia
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Saadi A, Maatougui J, Hermi A, Mokadem S, Boussaffa H, Zaghbib S, Bellali M, Allouche M, Jrad M, Ayed H, Bouzouita A, Derouiche A, Chakroun M, Ben Slama MR. Management of blunt renal trauma on pre-existing diseased kidneys: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:2432-2436. [PMID: 37363469 PMCID: PMC10289701 DOI: 10.1097/ms9.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 06/28/2023] Open
Abstract
Pathological kidney trauma is a special entity. Congenital or acquired lesions may interfere with clinical presentation, radiological imaging, and the therapeutic approach. Objective Our objective was to determine the clinical, radiological, and therapeutic features of this entity. Materials and methods The medical records of 37 observations were retrospectively collected from January 1992 to February 2022. All cases were explored by a kidney ultrasound and/or a computed tomography scan, and classified according to the American Association of Surgery of Trauma. Pre-existing renal abnormalities were found in 37 patients among 203 (18.2%). The most common underlying lesion were urolithiasis (37.8%) followed by pyelo-ureteral junction syndrome (32.4%). Surgical abstention was decided in 11 cases, four nephrectomies were performed as a matter of urgency, and seven nephrectomies were performed remotely. The cure of uropathy was performed after an average delay of 3 months. Conclusion Kidneys with underlying pathology are habitually more susceptible to trauma. Contusions are often benign contrasting with a high nephrectomy rate.
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Affiliation(s)
| | | | | | | | | | | | - Mohamed Bellali
- Department of Legal Medicine
- Department of Foresnic Medicine, Faculty of Medicine, Faculty Tunis Manar, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Allouche
- Department of Legal Medicine
- Department of Foresnic Medicine, Faculty of Medicine, Faculty Tunis Manar, Charles Nicolle Hospital, Tunis, Tunisia
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Hermi A, Boussaffa H, Saadi A, BelHadjKacem L, Chakroun M, Slama RB. Giant retroperitoneal leiomyosarcoma: a case report. J Surg Case Rep 2023; 2023:rjad172. [PMID: 37064072 PMCID: PMC10097552 DOI: 10.1093/jscr/rjad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/12/2023] [Indexed: 04/18/2023] Open
Abstract
Retroperitoneal leiomyosarcomas are rare tumors, mostly malignant. They are silent slow growing, and at the time of diagnosis, they are often of a considerable size. Management necessitates en bloc resection of the mass with adjacent organs, which is often challenging due to large size of the tumor. Herein, we present a case of 59-year-old male patient presenting for surgical management of 190 × 150 × 140 mm retroperitoneal leiomyosarcoma.
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Affiliation(s)
- Amine Hermi
- Correspondence address. Tel: 00216.55.704.699; E-mail:
| | - Hamza Boussaffa
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Ahmed Saadi
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Linda BelHadjKacem
- Department of Pathology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Marouene Chakroun
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Riadh Ben Slama
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
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11
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Hermi A, Saadi A, Mokadem S, Boussaffa H, Zaghbib S, Haroun A, Bouzouita A, Derouiche A, Chakroun M, Ben Slama MR. Retrovesical hydatid cyst: an unusual location of hydatid disease about a case series. Ann Med Surg (Lond) 2023; 85:722-726. [PMID: 37113869 PMCID: PMC10129112 DOI: 10.1097/ms9.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/25/2023] [Indexed: 04/29/2023] Open
Abstract
Hydatid disease is an endemic zoonosis in regions with temperate climates where pastoral farming is common. Retrovesical localization is rare. Given the rarity of this entity, the lack of personal clinical experience, and the difficulty with detecting early symptoms, the diagnosis remains elusive for years. Methods This is a 30-year retrospective, descriptive and analytic study of seven patients who were hospitalized and operated on in the Department of Urology during 30 years (1990-2019). Outcomes The average patient age was 54 years (range: 28-76). Signs of bladder irritation were the predominant presenting complaint. No cases of hydaturia were noted. Preoperative diagnosis was based on ultrasonography and serology tests. Hydatid serology was positive for three patients. In three cases, a hydatid cyst of the liver was associated. A partial cystopericystectomy was performed for five patients, it was total for one patient. The resection of the prominent dome was realized once. No cystovesical fistula was found. The mean postoperative stay was 16 days. The postoperative course was uneventful for five patients. Urinary fistula occurred in one patient. One case of infection of the residual cavity was observed. One patient had a retroperitoneal cyst recurrence requiring reoperation. Conclusion The preoperative diagnosis of retrovesical hydatid cysts is based mainly on ultrasonography. Open surgery is the treatment of choice. Different approaches are possible. Given the rarity of this entity, management should be guided by experienced experts.
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Affiliation(s)
- Amine Hermi
- Corresponding author. Address: Department of Urology, Faculty of Medicine, Charles Nicolle Hospital, Tunis, Tunisia 1007. Tel.: +216 5570 4699. E-mail address: (A. Hermi)
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12
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Hermi A, Boussaffa H, Saadi A, Blel A, Chakroun M, Ben Slama M. Prostate adenocarcinoma metastasis to the testis: A new case report. Urol Case Rep 2023; 48:102392. [PMID: 37035722 PMCID: PMC10074503 DOI: 10.1016/j.eucr.2023.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/19/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Prostate cancer (PCa) in the second most common cancer in men worldwide. It commonly metastasizes to the bone, lymph nodes, liver and lungs. Synchronous or metachronous testicular metastasis is a rare finding, generally diagnosed incidentally after bilateral orchidectomy for hormonal management in patients with advanced PCa, or at autopsy. We report a case of a 55-year-old male, presenting a PCa and who developed a single testicular metastasis treated by radical orchidectomy, while he was under hormonotherapy.
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Affiliation(s)
- A. Hermi
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
- Corresponding author.
| | - H. Boussaffa
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - A. Saadi
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - A. Blel
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - M. Chakroun
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - M.R. Ben Slama
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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13
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Mokadem S, Saadi A, Hermi A, Boussaffa H, Chakroun M, Ben Slama MR. Two brothers with congenital bulbar urethral stricture: case report of a very rare condition. J Surg Case Rep 2023; 2023:rjad072. [PMID: 36860355 PMCID: PMC9970558 DOI: 10.1093/jscr/rjad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
Congenital urethral stricture is rare. It has been reported in only four sets of brothers. We report the fifth set of brothers. Cases of two brothers aged 23 and 18 years old diagnosed with low urinary tract symptoms are presented. We diagnosed an apparently congenital urethral stricture in both brothers. Internal urethrotomy was performed in both cases. Both are asymptomatic after 24 and 20 months of follow-up. Congenital urethral strictures are probably more frequent than we think. We suggest that a congenital origin should be considered if there is no history of infections or trauma.
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Affiliation(s)
- Seif Mokadem
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Ahmed Saadi
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Amine Hermi
- Correspondence address. Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia. Tel: 00216 71 764 033; E-mail:
| | - Hamza Boussaffa
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Marouene Chakroun
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
| | - Mohamed Riadh Ben Slama
- Department of Urology, Charles Nicolle Hospital, University Tunis Manar, Faculty of Medicine Tunis, Tunis 1001, Tunisia
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Saadi A, Bedoui M, Zaghbib S, Mokaddem S, Ben Nacef I, Boussaffa H, Ayed H, Derouiche A, Khiari K, Chakroun M, Ben Slama R. Predictors of successful outcome after adrenalectomy for primary aldosteronism. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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15
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Zaghbib S, Saadi A, Boussaffa H, Bedoui M, Bouzouita A, Derouiche A, Hedri H, Abderrahim E, Ayed H, Chakroun M, Ben Slama R. Vascular complications of renal transplantation: Risk factors and impact on graft survival. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Yacoub A, Ayadi A, Ayed W, Ayari S, Chebbi S, Magroun I, Ben Afia L, Mersni M, Mechergui N, Brahim D, Ben Said H, Bahri G, Youssef I, Ladhari N, Mziou N, Grassa A, M'rad M, Khessairi N, Krir A, Chihaoui M, Mahjoub S, Bahlous A, Jridi M, Cherif Y, Derbal S, Chebbi D, Hentati O, Ben Dahmen F, Abdallah M, Hamdi I, Sahli F, Ouerdani Y, Mnekbi Y, Abaza H, Ajmi M, Guedria A, Randaline A, Ben Abid H, Gaddour N, Maatouk A, Zemni I, Gara A, Kacem M, Maatouk I, Ben Fredj M, Abroug H, Ben Nasrallah C, Dhouib W, Bouanene I, Sriha A, Mahmoudi M, Gharbi G, Khsiba A, Azouz M, Ben Mohamed A, Yakoubi M, Medhioub M, Hamzaoui L, Azouz M, Ben Attig Y, Hamdi S, Essid R, Ben Jemia E, Rezgui B, Boudaya MS, Hassine H, Dabbabi H, Fradi Y, Cherif D, Lassoued I, Yacoub H, Kchir H, Maamouri N, Khairi W, Ben Ammar H, Abaza H, Chelbi E, Merhaben S, Neffati W, Ajmi M, Tarchalla S, Boughzala S, Gazzeh M, Gara S, Labidi A, Touati H, Nefzi AM, Ben Mustpha N, Fekih M, Serghini M, Boubaker J, Zouiten L, Driss A, Meddeb N, Driss I, Walha S, Ben Said H, Bel Hadj Mabrouk E, Zaimi Y, Mensi A, Trad N, Ayadi S, Said Y, Mouelhi L, Dabbèche R, Belfkih H, Bani M, Moussa A, Souissi S, Trabelsi Werchfeni B, Chelly S, Ezzi O, Ammar A, Besbes M, Njah M, Mahjoub M, Ghali H, Neffati A, Bhiri S, Bannour R, Ayadi S, Khouya FE, Kamel A, Hariz E, Aidani S, Kefacha S, Ben Cheikh A, Said H, Dogui S, Atig A, Gara A, Ezzar S, Ben Fradj M, Bouanène I, M'kadmi H, Farhati M, Dakhli N, Nalouti K, Chanoufi MB, Abouda SH, Louati C, Zaaimi Y, Dabbeche R, Hermi A, Saadi A, Mokaddem S, Boussaffa H, Bellali M, Zaghbib S, Ayed H, Bouzouita A, Derouiche A, Allouche M, Chakroun M, Ben Slama R, Gannoun N, Kacem I, Tlili G, Kahloul M, Belhadj Chabbah N, Douma F, Bouhoula M, Chouchene A, Aloui A, Maoua M, Brahem A, Kalboussi H, El Maalel O, Chatti S, Jaidane M, Naija W, Mrizek N, Sellami I, Feki A, Hrairi A, Kotti N, Baklouti S, Jmal Hammami K, Masmoudi ML, Hajjaji M, Naaroura A, Ben Amar J, Ouertani H, Ben Moussa O, Zaibi H, Aouina H, Ben Jemaa S, Gassara Z, Ezzeddine M, Kallel MH, Fourati H, Akrout R, Kallel H, Ayari M, Chehaider A, Souli F, Abdelaali I, Ziedi H, Boughzala C, Haouari W, Chelli M, Soltani M, Trabelsi H, Sahli H, Hamdaoui R, Masmoudi Y, Halouani A, Triki A, Ben Amor A, Makni C, Eloillaf M, Riahi S, Tlili R, Jmal L, Belhaj Ammar L, Nsibi S, Jmal A, Boukhzar R, Somai M, Daoud F, Rachdi I, Ben Dhaou B, Aydi Z, Boussema F, Frikha H, Hammami R, Ben Cheikh S, Chourabi S, Bokri E, Elloumi D, Hasni N, Hamza S, Berriche O, Dalhoum M, Jamoussi H, Kallel L, Mtira A, Sghaier Z, Ghezal MA, Fitouri S, Rhimi S, Omri N, Rouiss S, Soua A, Ben Slimene D, Mjendel I, Ferchichi I, Zmerli R, Belhadj Mabrouk E, Debbeche R, Makhloufi M, Chouchane A, Sridi C, Chelly F, Gaddour A, Kacem I, Chatti S, Mrizak N, Elloumi H, Debbabi H, Ben Azouz S, Marouani R, Cheikh I, Ben Said M, Kallel M, Amdouni A, Rejaibi N, Aouadi L, Zaouche K, Khouya FE, Aidani S, Khefacha S, Jelleli N, Sakly A, Zakhama W, Binous MY, Ben Said H, Bouallegue E, Jemmali S, Abcha S, Wahab H, Hmida A, Mabrouk I, Mabrouk M, Elleuch M, Mrad M, Ben Safta N, Medhioub A, Ghanem M, Boughoula K, Ben Slimane B, Ben Abdallah H, Bouali R, Bizid S, Abdelli MN, Ben Nejma Y, Bellakhal S, Antit S, Bourguiba R, Zakhama L, Douggui MH, Bahloul E, Dhouib F, Turki H, Sabbah M, Baghdadi S, Trad D, Bellil N, Bibani N, Elloumi H, Gargouri D, Ben Said M, Hamdaoui R, Chokri R, Kacem M, Ben Rejeb M, Miladi A, Kooli J, Touati S, Trabelsi S, Klila M, Rejeb H, Kammoun H, Akrout I, Greb D, Ben Abdelghaffar H, Hassene H, Fekih L, Smadhi H, Megdiche MA, Ksouri J, Kasdalli H, Hayder A, Gattoussi M, Chérif L, Ben Saida F, Gueldich M, Ben Jemaa H, Dammak A, Frikha I, Saidani A, Ben Amar J, Aissi W, Chatti AB, Naceur I, Ben Achour T, Said F, Khanfir M, Lamloum M, Ben Ghorbel I, Houman M, Cherif T, Ben Mansour A, Daghfous H, Slim A, Ben Saad S, Tritar F, Naffeti W, Abdellatif J, Ben Fredj M, Selmi M, Kbir GH, Maatouk M, Jedidi L, Taamallah F, Ben Moussa M, Halouani L, Rejeb S, Khalffalah N, Ben Ammar J, Hedhli S, Azouz MM, Chatti S, Athimni Z, Bouhoula M, Elmaalel O, Mrizak N, Maalej M, Kammoun R, Gargouri F, Sallemi S, Haddar A, Masmoudi K, Oussaifi A, Sahli A, Bhouri M, Hmaissi R, Friha M, Cherif H, Baya C, Triki M, Yangui F, Charfi MR, Ben Hamida HY, Karoui S, Aouini F, Hajlaoui A, Jlassi H, Sabbah M, Fendri MN, Kammoun N, Fehri S, Nouagui H, Harzalli A, Snène H, Belakhal S, Ben Hassine L, Labbene I, Jouini M, Kalboussi S, Ayedi Y, Harizi C, Skhiri A, Fakhfakh R, Jelleli B, Belkahla A, Fejjeri M, Zeddini M, Mahjoub S, Nouira M, Frih N, Debiche S, Blibech H, Belhaj S, Mehiri N, Ben Salah N, Louzir B, Kooli J, Bahri R, Chaka A, Abdenneji S, Majdoub Fehri S, Hammadi J, Dorgham D, Hriz N, Kwas H, Issaoui N, Jaafoura S, Bellali H, Shimi M, Belhaj Mabrouk E, Sellami R, Ketata I, Medi W, Mahjoub M, Ben Yacoub S, Ben Chaabene A, Touil E, Ben Ayed H, Ben Miled S, El Zine E, Khouni H, Ben Kadhi S, Maatoug J, Boulma R, Rezgui R, Boudokhane M, Jomni T, Chamekh S, Aissa S, Touhiri E, Jlaiel N, Oueslati B, Maaroufi N, Aouadi S, Belkhir S, Daghfous H, Merhaben S, Dhaouadi N, Ounaes Y, Chaker K, Yaich S, Marrak M, Bibi M, Mrad Dali K, Sellami A, Nouira Y, Sellami S, Anane I, Trabelsi H, Ennaifer R, Benzarti Z, Bouchabou B, Hemdani N, Nakhli A, Cherif Y, Abdelkef M, Derbel K, Barkous B, Yahiaoui A, Sayhi A, Guezguez F, Rouatbi S, Racil H, Ksouri C, Znegui T, Maazaoui S, Touil A, Habibech S, Chaouech N, Ben Hmid O, Ismail S, Chouaieb H, Chatti M, Guediri N, Belhadj Mohamed M, Bennasrallah C, Bouzid Y, Zaouali F, Toumia M, El Khemiri N, El Khemiri A, Sfar H, Farhati S, Ben Chehida F, Yamoun R, Braham N, Hamdi Y, Ben Mansour A, Mtir M, Ayari M, Toumia M, Rouis S, Sakly H, Nakhli R, Ben Garouia H, Chebil D, Hannachi H, Merzougui L, Samet S, Hrairi A, Mnif I, Hentati O, Bouzgarrou L, Souissi D, Boujdaria R, Kadoussi R, Rejeb H, Ben Limem I, Ben Salah I, Greb D, Ben Abdelghaffar H, Smadhi H, Laatiri H, Manoubi SA, Gharbaoui M, Hmandi O, Zhioua M, Taboubi F, Hamza Y, Hannach W, Jaziri H, Gharbi R, Hammami A, Dahmani W, Ben Ameur W, Ksiaa M, Ben Slama A, Brahem A, Elleuch N, Jmaa A, Kort I, Jlass S, Benabderrahim S, Turki E, Belhaj A, Kebsi D, Ben Khelil M, Rmadi N, Gamaoun H, Alaya Youzbechi F, Brahim T, Boujnah S, Abid N, Gader N, Kalboussi S, Ben Sassi S, Loukil M, Ghrairi H, Ben Said N, Mrad O, Ferjaoui M, Hedhli L, Ben Kaab B, Berriche A, Charfi R, Mourali O, Smichi I, Bel Haj Kacem L, Ksentini M, Aloui R, Ferchichi L, Nasraoui H, Maoua M, Chérif F, Belil Y, Ayed MA, Alloulou Y, Belhadj S, Daghfous J, Mehiri N, Louzir B, Abbes A, Ghrab A, Chermiti A, Akacha A, Mejri O, Debbiche A, Yahiaoui C, Binous M, Tissaoui A, Mekni K, El Fekih C, Said MA, Chtioui S, Mestiri S, Smaoui H, Ben Hamida S, Haddar A, Mrizek N, Gares N, Zaibi A, Bouazizi N, Gallas S, Lachhab A, Belhadj M, Hadj Salem N, Garrouch A, Mezgar Z, Khrouf M, Abbassi H, Souissi D, Hamra I, Ben Mustapha N, Abessi I, Boubaker F, Bouchareb S, ElOmma Mrabet H, Touil I, Boussoffara L, Knani J, Boudawara N, Alaya W, Sfar MH, Fekih S, Snène H, Boudawara N, Gargouri I, Benzarti W, Knaz A, Abdelghani A, Aissa S, Hayouni A, Mejri I, Kacem M, Mhamdi S, Daboussi S, Aichaouia C, Moatemri Z, Chaachou A, Fsili R, Ben Ghezala H, Ben Jazia A, Brahmi N. 2022 TUNISIAN NATIONAL CONGRESS OF MEDICINE ABSTRACTS. Tunis Med 2023; 101:62-64. [PMID: 37682263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 09/09/2023]
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Zaghbib S, Chakroun M, Saadi A, Boussaffa H, Bouzouita A, Derouiche A, Ben Slama R, Bacha M, Abdallah Taieb B, Ayed H, Chebil M. MO967: Lymphocele After Renal Transplantation: Management, Risk Factors and Impact on Transplant Survival. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Lymphocele after renal transplantation remains a common complication, despite all the technical precautions taken, in particular the ligation of lymphatic vessels. Its incidence varies according to the series, depending on the diagnostic methodology, and whether or not it is systematically screened.
This study aims to investigate the risk factors for lymphocele and its impact on transplant survival.
METHOD
We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Clinical presentation and management of lymphocele were studied. Then, the characteristics of patients who presented a lymphocele were compared with those of the rest of the population including characteristics related to the recipient, the donor, the transplant and the procedure to identify risk factors. The impact of lymphocele on patient and transplant survival was then studied.
RESULTS
A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%. Lymphocele occurred in 51 patients (7.1%). The lymphocele was asymptomatic in 80%, and clinical manifestations were related to the compression of the transplant or its important size, requiring active treatment, most often percutaneous (13.7%). The lymphocele did not require treatment in 42 cases (82.4%) with disappearance in 90.5%. Revision surgery for a lymphocele was necessary in two cases.
The risk factors for lymphocele were a cadaveric donor (P = 0.003) and an advanced age of the recipient (P < 0.001). No predictive factors related to the transplant (vascular anatomy), or procedure (location and type of anastomoses, ischemia time) were identified.
Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. The occurrence of a lymphocele did not influence the survival of the transplant (P = 0.25) (Figure 1).
CONCLUSION
Our study showed that lymphocele is usually asymptomatic, not requiring a specific treatment in most cases with a high rate of spontaneous disappearance with no impact on transplant survival. Risk factors were a cadaveric donor which may reflect the absence of careful ligation of the transplant's lymphatic vessels in the context of urgent, sometimes multi-organ, cadaveric procurement and advanced recipient age.
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Affiliation(s)
| | | | - Ahmed Saadi
- Charles Nicolle Hospital, Urology, Tunis, Tunisia
| | | | | | | | | | - Mongi Bacha
- Charles Nicolle Hospital, Nephrology, Tunisia
| | | | - Haroun Ayed
- Charles Nicolle Hospital, Urology, Tunis, Tunisia
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Zaghbib S, Chakroun M, Saadi A, Boussaffa H, Bouzouita A, Derouiche A, Ben Slama R, Bacha M, Abdallah Taieb B, Ayed H, Chebil M. MO968: Vascular Complications of Renal Transplantation: Risk Factors and Impact on Graft Survival. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac087.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Despite the progress made in renal transplantation, vascular complications can occur, jeopardizing the prognosis of the transplant.
This study aims to investigate the risk factors of vascular complications and their impact on transplant survival.
METHOD
We performed a retrospective longitudinal descriptive study including all patients who had a kidney transplant in a Urology department from 1986 to 2017. Transplant Vascular complications included: Arterial thrombosis (AT), Venous thrombosis (VT), hemorrhagic complications (hemorrhage and hematoma) and arterial stenosis (AS). The potential risk factors for vascular complications that were investigated included characteristics related to the recipient, the donor, the transplant and the procedure. The impact of vascular complications on transplant survival was then studied.
RESULTS
A total of 720 patients were included with a mean age of 32.7 years. The transplant was from a living donor in 79% and a brain-dead donor in 21%.
AT occurred in 15 patients (2.1%) and VT occurred in 10 patients (1.4%). Risk factors for vascular thrombosis were recipient age >35 years (P = 0.001; OR = 10.78), recipient smoking (P = 0.005; OR = 1.8), multiple arteries (P < 0.001; OR = 1.45) and prolonged warm ischemia (P = 0.02). Perirenal hematoma occurred in 11 patients (1.5%) and hemorrhage occurred in six patients (0.8%). The risk factors for bleeding complications were a prolonged pre-transplantation dialysis time (P = 0.03; OR = 1.35), and prolonged warm ischemia (P = 0.02; OR = 1.26). AS was the most frequent vascular complication, occurring in 20 cases (2.8%) and no risk factors were identified.
Transplant survival was 77.9% at 5 years, with a median survival of 15.9 years. Vascular thrombosis led to the loss of the transplant in all cases, and externalized hemorrhage significantly reduced transplant survival (P < 0.001). Perirenal hematoma (P = 0.42) and transplant artery stenosis (P = 0.25) had no impact on transplant survival (Figure 1).
CONCLUSION
Our study showed that the vascular complications impacted the survival of the transplant and that they were related to factors related to the recipient, the transplant and the procedure insisting on a multidisciplinary and personalized management for each case.
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Affiliation(s)
| | | | | | | | | | | | | | - Mongi Bacha
- Charles Nicolle Hospital, Nephrology, Tunisia
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Zaghbib S, Chakroun M, Boussaffa H, Saadi A, Ayed H, Chebil M. Ejaculatory duct reflux revealed by chronic scrotal swelling in an adult. Urol Case Rep 2022; 42:101992. [PMID: 35059297 PMCID: PMC8760482 DOI: 10.1016/j.eucr.2022.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022] Open
Abstract
Ejaculatory duct reflux is rare and few investigations have focused on this entity, which is usually described in children. This study reports a new case of unilateral ejaculatory reflux in a 32-year-old patient, with a history of urethroplasty at the age of 5 for hypospadias, who presented for right chronic scrotal swelling. Urethrocystscopy showed an anterior urethral stricture and a gaping opening of the right ejaculatory duct. CT scan with opacification through the right ejaculatory duct, showed a dilated right seminal vesicle, associated to a reflux in the right deferent vas and epididymis, which was dilated explaining the scrotal swelling.
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Affiliation(s)
- Selim Zaghbib
- Corresponding author. Charles Nicolle Hospital, Boulevard du 9 Avril, Tunis, Tunisia.
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Saadi A, Mokadem S, Chakroun M, Hermi A, Boussaffa H, Ayed H, Allouche M, Bouzouita A, Derouiche A, Ben Slama MR, Hamdoun M, Chebil M. A cadaveric anatomical study: anatomy and anatomical variations of left adrenal vein. Surg Radiol Anat 2022; 44:689-695. [PMID: 35362770 DOI: 10.1007/s00276-022-02930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Control of adrenal vein is the key of adrenal surgery. Its anatomy can present variations. Our aim was to study the anatomy of the main left adrenal vein (LAV) and its anatomical variations. METHODS Our work is based on dissection of 40 cadavers. We studied the number of LAV and the drainage of the main adrenal vein as well as its level of termination. We measured its length, its width and the distance between its termination level and the termination level of the gonadal vein (GV). RESULTS The average length of the LAV was 21 mm its mean width was 5 mm. It ended in 100% of cases at the upper edge of the left renal vein after an anastomosis with the lower phrenic vein in 36 cases (90%) and without anastomosis with the lower phrenic vein in four cases (10%). The left adrenal vein ended at the upper edge of the left renal vein either at the same level as the termination of the left GV in 14 cases (35%) or within the termination of the left GV in 26 cases (65%) by an average of 8 mm. The LAV was unique central vein in 22 cases (55%) and in 12 cases (30%), a major central adrenal vein with several small veins was found. CONCLUSIONS The LAV is usually unique but there are variations in number. There are also variations in the level of its termination in the left renal vein as well as its anastomosis. During surgery, in case of difficulty, the left GV and the adrenal-diaphragmatic venous trunk could be used as benchmarks.
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Affiliation(s)
- Ahmed Saadi
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia.
| | - Seif Mokadem
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Marouene Chakroun
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Hermi
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Hamza Boussaffa
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Haroun Ayed
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Allouche
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Department of Legal and Forensic Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Abderrazak Bouzouita
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Derouiche
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Riadh Ben Slama
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Moncef Hamdoun
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Department of Legal and Forensic Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Chebil
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
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Zouari S, Saadi A, Chakroun M, Zaghbib S, Setti Boubaker N, Boussaffa H, Bouzouita A, Derouiche A, Ben Slama R, Ayed H, Chebil M. Predictive factors of recurrence of urethral strictures after a first internal uretrotomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00935-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zouari S, Saadi A, Htira Y, Ben Nacef I, Chakroun M, Zaghbib S, Boussaffa H, Bouzouita A, Derouiche A, Ben Slama R, Khiari K, Ayed H, Chebil M. Management aspects of urinary tract infection in diabetic patients: A national survey among different specialties. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zouari S, Saadi A, Marouene C, Zaghbib S, Htira Y, Boussaffa H, Bouzouita A, Derouiche A, Ben slama R, Ben mami F, Ayed H, Chebil M. Diététique des patients porteurs de lithiase urinaire : point de vue du médecin généraliste. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zouari S, Saadi A, Chakroun M, Saadi H, Boussaffa H, Bouzouita A, Derouiche A, Ben slama R, Ayed H, Chebil M. Le rôle de l’examen cyto-bactériologiquedes urines préopératoire et de l’infection urinaire symptomatique postopératoire dans la récidive d’une sténose urétrale après urétrotomie interne endoscopique. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zaghbib S, Chakroun M, Saadi A, Boussaffa H, Znaidi N, Rammeh S, Ayed H, Chebil M. Isolated bladder metastasis from lung adenocarcinoma: a case report. J Surg Case Rep 2021; 2021:rjab195. [PMID: 34055288 PMCID: PMC8159194 DOI: 10.1093/jscr/rjab195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 11/12/2022] Open
Abstract
Cancers of extra bladder origin represent between 2 and 12% of bladder neoplasms and are most often secondary to contiguous bladder invasion. Metastasis from distant organs is exceptional, especially from pulmonary adenocarcinoma with <10 cases identified over the last 20 years. We report here a new case of a 55-year-old patient with a recently diagnosed pulmonary adenocarcinoma referred to the urology department for macroscopic hematuria. Computed tomography scan showed, in addition to the lung mass of the right lower lobe with a right mediastinal adenopathy, a thickening of the right lateral bladder wall. Cystoscopy showed inflammatory lesions on the bladder mucosa, which biopsy with immunohistochemical examination revealed to be tumoral proliferation in the lamina propria realizing the same immunohistochemical profile of the primary lung tumor (CK7+/TTF1+/CK20-/PSA-). The patient was treated with palliative platinum-based chemotherapy and unfortunately died 5 months after diagnosis.
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Affiliation(s)
- Selim Zaghbib
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Ahmed Saadi
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hamza Boussaffa
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Nadia Znaidi
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Haroun Ayed
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Chebil
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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Boussaffa H, Chakroun M, Saadi A, Zaghbib S, Meddeb K, Ayedi M, Bouzouita A, Derouiche A, Ben Slama M, Mezlini A, Ayed H, Chebil M. Is the percentage of teratoma in the orchiectomy specimen predictive of teratoma in retroperitoneal residual masses after chemotherapy in nonseminomatous germ cell tumors? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)36273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ayari Y, Boussaffa H, Taktak T, Ghorbel Z, Sellami A, Ben Rhouma S, Nouira Y. Locally advanced squamous cell carcinoma of the renal pelvis masquerading as emphysematous pyelonephritis. Urol Case Rep 2019; 27:100780. [PMID: 31687340 PMCID: PMC6819774 DOI: 10.1016/j.eucr.2018.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022] Open
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Boussaffa H, Saadi A, Chakroun M, Bibani H, Bouzouita A, Derouiche A, Ben Slama R, Ayed H, Chebil M. Facteurs prédictifs d’instabilité hémodynamique peropératoire au cours de la surrénalectomie pour phéochromocytome. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Boussaffa H, Saadi A, Chakroun M, Bibani H, Bouzoutta A, Derouiche A, Benslama R, Haroun A, Chebi M. Facteurs de risque de persistance de l’hypertension artérielle après chirurgie des tumeurs surrénaliennes. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boussaffa H, Jabloun A, Saadi C, Daib A, Ben Abdallah R, Gharbi Y, Hellal Y, Kaabar N. Valves de l’urètre postérieur : facteurs déterminants les résultats à long terme. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zaghbib S, Chakroun M, Saadi A, Boussaffa H, Bouzouita A, Derouiche A, Ben Slama MR, Ayed H, Chebil M. Severe penile injury due to condom catheter fixed by a rubber band: A case report. Int J Surg Case Rep 2019; 64:120-122. [PMID: 31634783 PMCID: PMC6806461 DOI: 10.1016/j.ijscr.2019.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 12/11/2022] Open
Abstract
Condom catheter is frequently used to manage male urinary incontinence but should not be used carelessly or overlooked. Even if they are rare, penile strangulation and gangrene may occur and are severe complications. Treatment is based on debridement, broad-spectrum antibiotics and skin grafting. It may result in partial or total penectomy. Proper care and routine maintenance of condom catheters are mandatory in order to prevent devastating complications. Appropriate care is necessary, especially in debilitated and psychiatric populations.
Introduction Condom catheters are considered as a safe tool in the management of male urinary incontinence, yet complications may occur, especially in debilitated patients, with psychiatric disorders. Presentation of case A 58-year-old paraplegic man, suffering from schizophrenia, who had been using condom urinary catheters, was referred to our department for “penile injury”. Interrogation revealed that he was placing a rubber band tightly around his penis to maintain the condom. Examination showed a 4 cm defect interesting the proximal portion of the penis including the corpus spongiosum and the urethra. A surgical repair was performed, consisting in covering the defect using the surrounding tissue. Unfortunately, the patient developed penile gangrene four weeks after surgery. A partial penectomy was performed. Discussion Condom catheters are known as a safe tool to manage urinary incontinence in male patients, providing an adequate care. Long-term use may result in complications including urinary tract infection (40%) and skin injuries ranging from inflammation to gangrene. Gangrene, secondary to strangulation of the penis, is however uncommon. These complications are more common in debilitated patients with poor medical care or psychiatric disorders. In case of necrosis, debridement should be performed, which may result in a partial or a total penectomy if necessary. Conclusion Condom catheter is frequently used to manage male urinary incontinence but it should not be used carelessly or overlooked as it can cause severe complications such as penile strangulation and penile gangrene.
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Affiliation(s)
- Selim Zaghbib
- Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia.
| | | | - Ahmed Saadi
- Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hamza Boussaffa
- Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Amine Derouiche
- Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Haroun Ayed
- Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Chebil
- Departement of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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Taktak T, Boussaffa H, Ouanes Y, Zaghbib S, Sellami A, Ghorbel Z, Chelly I, Rhouma SB, Nouira Y. Unexpected skin lesions secondary to metastasis of urothelial carcinoma. Int J Surg Case Rep 2019; 64:177-179. [PMID: 31670145 PMCID: PMC6831817 DOI: 10.1016/j.ijscr.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 11/28/2022] Open
Abstract
Skin metastases of urothelial bladder carcinoma are rare. The inflammatory presentation, as seen in our case, is exceptional. Diagnosis requires immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastasis is poor.
Introduction Metastatic spread of urothelial bladder carcinoma (UBC) rarely involves the skin which is associated with a poor prognosis. We present a rare case of UBC with cutaneous metastases which is exceptional by its inflammatory clinical form. Presentation of case A 62-year-old male was diagnosed with a non-metastatic muscle invasive transitional cell bladder carcinoma invading the anterior wall of the rectum. Cisplatin-based chemotherapy was indicated but refused by the patient. Three months later, he developed cutaneous lesions in the left axilla and the right inguinal fold. These lesions were budding, nodular and inflammatory corresponding to carcinomatous metastasis on skin biopsy which urothelial origin was confirmed by immunohistochemical analysis. The patient died four weeks later after multi-organ failure. Discussion Skin metastasis of transitional cell carcinoma of the bladder are uncommon, representing 0.84% of all cutaneous metastases. The inflammatory presentation, as seen in our case, is rarer than the other types and is usually due to a lymphatic extension. The clinical appearance of cutaneous metastases might mimic other common dermatologic disorders; Thus, diagnosis requires histological confirmation by microscopic examination and immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastases is generally poor with a median disease-specific survival of less than 12 months Treatment is palliative and is principally based on chemotherapy, analgesics and psychological support. Conclusion Cutaneous metastases secondary to urothelial bladder carcinoma are exceptional especially in its inflammatory presentation. Diagnosis is based on immunohistochemical study. Treatment is based on chemotherapy and the prognosis is poor.
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Affiliation(s)
- Tarek Taktak
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hamza Boussaffa
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Yassine Ouanes
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Selim Zaghbib
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ahmed Sellami
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Zinet Ghorbel
- Department of Anatomopathology, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ines Chelly
- Department of Anatomopathology, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sami Ben Rhouma
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Yassine Nouira
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Ayari Y, Ben Rhouma S, Boussaffa H, Chelly B, Hamza K, Sellami A, Jrad M, Nouira Y. Metachronous isolated locally advanced pancreatic metastasis from chromophobe renal cell carcinoma. Int J Surg Case Rep 2019; 60:196-199. [PMID: 31233964 PMCID: PMC6597480 DOI: 10.1016/j.ijscr.2019.05.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/26/2022] Open
Abstract
Isolated pancreatic metastasis from renal cell carcinoma is relatively rare and it's usually seen in clear cell renal cell carcinoma (CCRCC), but its occurrence from chromophobe renal cell carcinoma is extremely rare. Pancreatic location is often diagnosed during routine surveillance imaging for the primary lesion. Patients in whom the pancreas is the only metastatic site and who are fit enough to undergo pancreatic surgery appear to be good candidates for the surgical treatment chemotherapy can improve the quality of life but not survival. It is necessary a long- term follow-up for patients treated for tumors with known low-grade metastatic potential and relatively good prognosis such as chromophobe renal cell carcinoma.
Introduction Metastasis to the pancreas is relatively uncommon occurrence. Isolated pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare and it’s usually seen in clear cell renal cell carcinoma (CCRCC), but its occurrence from chromophobe renal cell carcinoma (chRCC) is extremely rare, due to its relatively low-grade metastatic potential. Presentation of case The authors report an unusual case of metachronous isolated pancreatic metastasis, in a 65-year-old female patient two years after left nephrectomy for chRCC, diagnosed during routine surveillance imaging and confirmed after a CT-guided pancreatic biopsy. Discussion The pancreas is an elective site for metastases from RCC, and this particularity has been reported by several studies, but only described for CCRCC. In the English literature there is only one case of pancreatic metastasis from chRCC diagnosed in an autopsy study. Surgical resection of metastasis remains the most effective treatment, particularly for pancreatic metastases from chRCC, since radiotherapy, chemotherapy, hormonal therapy, and targeted therapy have generally proved ineffective for metastatic chRCC. In case of an unresectable disease, surgical or endoscopic palliation in association with palliative chemotherapy can improve the quality of life but not survival. Conclusion This case highlights the unique behavior of chRCC with an unusual site of metastasis, and the necessity of long-term follow-up after primary tumor removal, even if it is known for a low-grade metastatic potential and a relatively good prognosis.
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Affiliation(s)
- Y Ayari
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia.
| | - S Ben Rhouma
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
| | - H Boussaffa
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
| | - B Chelly
- Department of Anatomopathology, La Rabta University Hospital, Tunis, Tunisia
| | - K Hamza
- Department of Anatomopathology, La Rabta University Hospital, Tunis, Tunisia
| | - A Sellami
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
| | - M Jrad
- Department of Radiology, La Rabta University Hospital, Tunis, Tunisia
| | - Y Nouira
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
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Ayari Y, Ben Rhouma S, Boussaffa H, Krarti M, Charfi L, Jrad M, Nouira Y. Malignant rhabdoid tumor in a solitary kidney arising in an adult patient with chronic obstructive renal calculi. Int J Surg Case Rep 2019; 58:85-87. [PMID: 31022624 PMCID: PMC6479740 DOI: 10.1016/j.ijscr.2019.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Malignant rhabdoid tumor (MRT) is one of the most aggressive and lethal malignancies in pediatric oncology, MRT of the kidney is an uncommon renal tumor in children and it's extremely rare in adult patients. With only seven previously reported adult cases in the English-literature, to our knowledge this is the first case that is associated with renal calculi. PRESENTATION OF CASE We present the case of a 65-year-old man with an MRT arising in a solitary kidney with multiple enlarged lymph nodes that compressing the inferior vena cava. DISCUSSION Malignant rhabdoid tumor of the kidney was originally described as a "rhabdomyosarcomatoid" variant of Wilm's tumor due to the resemblance of cells to rhabdomyoblasts, now this type of tumor is recognized as distant and unique malignant renal tumor. It affects usually children before the age of 2 years. Tumor tissue sampling is required to make the diagnosis of MRTK, based on either nephrectomy, core biopsy, or autopsy specimens. There is no established standard of care due to the paucity of cases. Surgery is considered to be the first choice of treatment if possible. CONCLUSION This case report reinforces the importance of recognizing this entity in the adult population, and discuss the possible treatment options of this rare and highly aggressive tumor.
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Affiliation(s)
- Y Ayari
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia.
| | - S Ben Rhouma
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
| | - H Boussaffa
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
| | - M Krarti
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
| | - L Charfi
- Department of Anatomopathology, Institute Salah-Azaïz, Tunis, Tunisia
| | - M Jrad
- Department of Radiology, La Rabta University Hospital, Tunis, Tunisia
| | - Y Nouira
- Department of Urology, La Rabta University Hospital, Tunis, Tunisia
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Alami Aroussi A, Fouad A, Omrane A, Razzak A, Aissa A, Akkad A, Amraoui A, Aouam A, Arfaoui A, Belkouchi A, Ben Chaaben A, Ben Cheikh A, Ben Khélifa A, Ben Mabrouk A, Benhima A, Bezza A, Bezzine A, Bourrahouat A, Chaieb A, Chakib A, Chetoui A, Daoudi A, Ech-Chenbouli A, Gaaliche A, Hassani A, Kassimi A, Khachane A, Labidi A, Lalaoui A, Masrar A, McHachi A, Nakhli A, Ouakaa A, Siati A, Toumi A, Zaouali A, Condé AY, Haggui A, Belaguid A, El Hangouche AJ, Gharbi A, Mahfoudh A, Bouzouita A, Aissaoui A, Ben Hamouda A, Hedhli A, Ammous A, Bahlous A, Ben Halima A, Belhadj A, Bezzine A, Blel A, Brahem A, Banasr A, Meherzi A, Saadi A, Sellami A, Turki A, Ben Miled A, Ben Slama A, Daib A, Zommiti A, Chadly A, Jmaa A, Mtiraoui A, Ksentini A, Methnani A, Zehani A, Kessantini A, Farah A, Mankai A, Mellouli A, Zaouali A, Touil A, Hssine A, Ben Safta A, Derouiche A, Jmal A, Ferjani A, Djobbi A, Dridi A, Aridhi A, Bahdoudi A, Ben Amara A, Benzarti A, Ben Slama AY, Oueslati A, Soltani A, Chadli A, Aloui A, Belghuith Sriha A, Bouden A, Laabidi A, Mensi A, Ouakaa A, Sabbek A, Zribi A, Green A, Ben Nasr A, Azaiez A, Yeades A, Belhaj A, Mediouni A, Sammoud A, Slim A, Amine B, Chelly B, Jatik B, Lmimouni B, Daouahi B, Ben Khelifa B, Louzir B, Dorra A, Dhahri B, Ben Nasrallah C, Chefchaouni C, Konzi C, Loussaief C, Makni C, Dziri C, Bouguerra C, Kays C, Zedini C, Dhouha C, Mohamed C, Aichaouia C, Dhieb C, Fofana D, Gargouri D, Chebil D, Issaoui D, Gouiaa D, Brahim D, Essid D, Jarraya D, Trad D, Ben Hmida E, Sboui E, Ben Brahim E, Baati E, Talbi E, Chaari E, Hammami E, Ghazouani E, Ayari F, Ben Hariz F, Bennaoui F, Chebbi F, Chigr F, Guemira F, Harrar F, Benmoula FZ, Ouali FZ, Maoulainine FMR, Bouden F, Fdhila F, Améziani F, Bouhaouala F, Charfi F, Chermiti Ben Abdallah F, Hammemi F, Jarraya F, Khanchel F, Ourda F, Sellami F, Trabelsi F, Yangui F, Fekih Romdhane F, Mellouli F, Nacef Jomli F, Mghaieth F, Draiss G, Elamine G, Kablouti G, Touzani G, Manzeki GB, Garali G, Drissi G, Besbes G, Abaza H, Azzouz H, Said Latiri H, Rejeb H, Ben Ammar H, Ben Brahim H, Ben Jeddi H, Ben Mahjouba H, Besbes H, Dabbebi H, Douik H, El Haoury H, Elannaz H, Elloumi H, Hachim H, Iraqi H, Kalboussi H, Khadhraoui H, Khouni H, Mamad H, Metjaouel H, Naoui H, Zargouni H, Elmalki HO, Feki H, Haouala H, Jaafoura H, Drissa H, Mizouni H, Kamoun H, Ouerda H, Zaibi H, Chiha H, Kamoun H, Saibi H, Skhiri H, Boussaffa H, Majed H, Blibech H, Daami H, Harzallah H, Rkain H, Ben Massoud H, Jaziri H, Ben Said H, Ayed H, Harrabi H, Chaabouni H, Ladida Debbache H, Harbi H, Yacoub H, Abroug H, Ghali H, Kchir H, Msaad H, Ghali H, Manai H, Riahi H, Bousselmi H, Limem H, Aouina H, Jerraya H, Ben Ayed H, Chahed H, Snéne H, Lahlou Amine I, Nouiser I, Ait Sab I, Chelly I, Elboukhani I, Ghanmi I, Kallala I, Kooli I, Bouasker I, Fetni I, Bachouch I, Bouguecha I, Chaabani I, Gazzeh I, Samaali I, Youssef I, Zemni I, Bachouche I, Youssef I, Bouannene I, Kasraoui I, Laouini I, Mahjoubi I, Maoudoud I, Riahi I, Selmi I, Tka I, Hadj Khalifa I, Mejri I, Béjia I, Bellagha J, Boubaker J, Daghfous J, Dammak J, Hleli J, Ben Amar J, Jedidi J, Marrakchi J, Kaoutar K, Arjouni K, Ben Helel K, Benouhoud K, Rjeb K, Imene K, Samoud K, El Jeri K, Abid K, Chaker K, Abid K, Bouzghaîa K, Kamoun K, Zitouna K, Oughlani K, Lassoued K, Letaif K, Hakim K, Cherif Alami L, Benhmidoune L, Boumhil L, Bouzgarrou L, Dhidah L, Ifrine L, Kallel L, Merzougui L, Errguig L, Mouelhi L, Sahli L, Maoua M, Rejeb M, Ben Rejeb M, Bouchrik M, Bouhoula M, Bourrous M, Bouskraoui M, El Belhadji M, El Belhadji M, Essakhi M, Essid M, Gharbaoui M, Haboub M, Iken M, Krifa M, Lagrine M, Leboyer M, Najimi M, Rahoui M, Sabbah M, Sbihi M, Zouine M, Chefchaouni MC, Gharbi MH, El Fakiri MM, Tagajdid MR, Shimi M, Touaibia M, Jguirim M, Barsaoui M, Belghith M, Ben Jmaa M, Koubaa M, Tbini M, Boughdir M, Ben Salah M, Ben Fraj M, Ben Halima M, Ben Khalifa M, Bousleh M, Limam M, Mabrouk M, Mallouli M, Rebeii M, Ayari M, Belhadj M, Ben Hmida M, Boughattas M, Drissa M, El Ghardallou M, Fejjeri M, Hamza M, Jaidane M, Jrad M, Kacem M, Mersni M, Mjid M, Sabbah M, Serghini M, Triki M, Ben Abbes M, Boussaid M, Gharbi M, Hafi M, Slama M, Trigui M, Taoueb M, Chakroun M, Ben Cheikh M, Chebbi M, Hadj Taieb M, Kacem M, Ben Khelil M, Hammami M, Khalfallah M, Ksiaa M, Mechri M, Mrad M, Sboui M, Bani M, Hajri M, Mellouli M, Allouche M, Mesrati MA, Mseddi MA, Amri M, Bejaoui M, Bellali M, Ben Amor M, Ben Dhieb M, Ben Moussa M, Chebil M, Cherif M, Fourati M, Kahloul M, Khaled M, Machghoul M, Mansour M, Abdesslem MM, Ben Chehida MA, Chaouch MA, Essid MA, Meddeb MA, Gharbi MC, Elleuch MH, Loueslati MH, Sboui MM, Mhiri MN, Kilani MO, Ben Slama MR, Charfi MR, Nakhli MS, Mourali MS, El Asli MS, Lamouchi MT, Cherti M, Khadhraoui M, Bibi M, Hamdoun M, Kassis M, Touzi M, Ben Khaled M, Fekih M, Khemiri M, Ouederni M, Hchicha M, Kassis M, Ben Attia M, Yahyaoui M, Ben Azaiez M, Bousnina M, Ben Jemaa M, Ben Yahia M, Daghfous M, Haj Slimen M, Assidi M, Belhadj N, Ben Mustapha N, El Idrissislitine N, Hikki N, Kchir N, Mars N, Meddeb N, Ouni N, Rada N, Rezg N, Trabelsi N, Bouafia N, Haloui N, Benfenatki N, Bergaoui N, Yomn N, Ben Mustapha N, Maamouri N, Mehiri N, Siala N, Beltaief N, Aridhi N, Sidaoui N, Walid N, Mechergui N, Mnif N, Ben Chekaya N, Bellil N, Dhouib N, Achour N, Kaabar N, Mrizak N, Mnif N, Chaouech N, Hasni N, Issaoui N, Ati N, Balloumi N, Haj Salem N, Ladhari N, Akif N, Liani N, Hajji N, Trad N, Elleuch N, Marzouki NEH, Larbi N, M'barek N, Rebai N, Bibani N, Ben Salah N, Belmaachi O, Elmaalel O, Jlassi O, Mihoub O, Ben Zaid O, Bouallègue O, Bousnina O, Bouyahia O, El Maalel O, Fendri O, Azzabi O, Borgi O, Ghdes O, Ben Rejeb O, Rachid R, Abi R, Bahiri R, Boulma R, Elkhayat R, Habbal R, Rachid R, Tamouza R, Jomli R, Ben Abdallah R, Smaoui R, Debbeche R, Fakhfakh R, El Kamel R, Gargouri R, Jouini R, Nouira R, Fessi R, Bannour R, Ben Rabeh R, Kacem R, Khmakhem R, Ben Younes R, Karray R, Cheikh R, Ben Malek R, Ben Slama R, Kouki R, Baati R, Bechraoui R, Fakhfakh R, Fradi R, Lahiani R, Ridha R, Zainine R, Kallel R, Rostom S, Ben Abdallah S, Ben Hammamia S, Benchérifa S, Benkirane S, Chatti S, El Guedri S, El Oussaoui S, Elkochri S, Elmoussaoui S, Enbili S, Gara S, Haouet S, Khammeri S, Khefecha S, Khtrouche S, Macheghoul S, Mallouli S, Rharrit S, Skouri S, Helali S, Boulehmi S, Abid S, Naouar S, Zelfani S, Ben Amar S, Ajmi S, Braiek S, Yahiaoui S, Ghezaiel S, Ben Toumia S, Thabeti S, Daboussi S, Ben Abderahman S, Rhaiem S, Ben Rhouma S, Rekaya S, Haddad S, Kammoun S, Merai S, Mhamdi S, Ben Ali R, Gaaloul S, Ouali S, Taleb S, Zrour S, Hamdi S, Zaghdoudi S, Ammari S, Ben Abderrahim S, Karaa S, Maazaoui S, Saidani S, Stambouli S, Mokadem S, Boudiche S, Zaghbib S, Ayedi S, Jardek S, Bouselmi S, Chtourou S, Manoubi S, Bahri S, Halioui S, Jrad S, Mazigh S, Ouerghi S, Toujani S, Fenniche S, Aboudrar S, Meriem Amari S, Karouia S, Bourgou S, Halayem S, Rammeh S, Yaïch S, Ben Nasrallah S, Chouchane S, Ftini S, Makni S, Manoubi S, Miri S, Saadi S, Manoubi SA, Khalfallah T, Mechergui T, Dakka T, Barhoumi T, M'rad TEB, Ajmi T, Dorra T, Ouali U, Hannachi W, Ferjaoui W, Aissi W, Dahmani W, Dhouib W, Koubaa W, Zhir W, Gheriani W, Arfa W, Dougaz W, Sahnoun W, Naija W, Sami Y, Bouteraa Y, Elhamdaoui Y, Hama Y, Ouahchi Y, Guebsi Y, Nouira Y, Daly Y, Mahjoubi Y, Mejdoub Y, Mosbahi Y, Said Y, Zaimi Y, Zgueb Y, Dridi Y, Mesbahi Y, Gharbi Y, Hellal Y, Hechmi Z, Zid Z, Elmouatassim Z, Ghorbel Z, Habbadi Z, Marrakchi Z, Hidouri Z, Abbes Z, Ouhachi Z, Khessairi Z, Khlayfia Z, Mahjoubi Z, Moatemri Z. 46th Medical Maghrebian Congress. November 9-10, 2018. Tunis. Tunis Med 2019; 97:177-258. [PMID: 31535714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Ayari Y, Taktak T, Boussaffa H, Ghorbel Z, Zehani A, Sellami A, Ben Rhouma S, Nouira Y. Retroperitoneal extra-adrenal non-Hodgkin lymphoma: An uncommon presentation. Urol Case Rep 2018; 23:34-36. [PMID: 30560056 PMCID: PMC6288313 DOI: 10.1016/j.eucr.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
Primary retroperitoneal non Hodgkin lymphoma is extremely rare, its diagnosis is often difficult and it may requires a time consuming and a costly diagnostic workup. We report the case of a 46-year-old patient complaining of abdominal fullness and dorsal pain, who was diagnosed with an extra-nodal non-Hodgkin lymphoma presenting as a unique and large retroperitoneal mass. The suggested diagnosis was a malignant retroperitoneal tumor and the patient underwent an excision of the tumor throw a lombotomy followed by an R-CHOP chemotherapy regimen with good outcome.
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Affiliation(s)
- Y Ayari
- Department of Urology, La Rabta University Hospital, Tunisia
| | - T Taktak
- Department of Urology, La Rabta University Hospital, Tunisia
| | - H Boussaffa
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Z Ghorbel
- Department of Anatomopathology, La Rabta University Hospital, Tunisia
| | - A Zehani
- Department of Anatomopathology, La Rabta University Hospital, Tunisia
| | - A Sellami
- Department of Urology, La Rabta University Hospital, Tunisia
| | - S Ben Rhouma
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Y Nouira
- Department of Urology, La Rabta University Hospital, Tunisia
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Boussaffa H, Naouar S, Ati N, Amri M, Ben Khelifa B, Salem B, El Kamel R. Neoplasm of a supernumerary undescended testis: A case report and review of the literature. Int J Surg Case Rep 2018; 53:345-347. [PMID: 30471627 PMCID: PMC6260374 DOI: 10.1016/j.ijscr.2018.10.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022] Open
Abstract
Polyorchidism is a rare congenital abnormality. To the best of our knowledge, this is the first report of leiomyoma in supranumerary testis (SNT). Most cases of polyorchidism are found incidentally during surgery for inguinal hernia, undescended testes, torsion or testicular tumor. There is no consensus regarding the management of SNT. If the SNT is scrotal, most authors recommend conservative management. If nonscrotal SNT is found incidentally during surgery, orchiectomy could be performed because of increased risk of malignancy. Treatment of intratubular germ cell neoplasia includes surveillance, orchiectomy, or low-dose external radiation.
Introduction Polyorchidism, defined as the presence of more than two testicles, is a rare congenital abnormality of the male genital tract. There is no consensus regarding the management of supranumerary testis (SNT) due to its rareness. To the best of our knowledge, this is the first report of leiomyoma in SNT. Presentation of case We report the case of a 41-year-old man with two right testes sharing a common vas deferens and separate epididymides. Orchiectomy of right testes was performed. Pathology examination found that the superior testis was the site of a leiomyoma and the lower tesits was the site of an intratubular germ cell neoplasia (IGCN). Orchiopexy and biopsy were later performed for the left testis. Histology was compatible with IGCN. We opted for follow-up to avoid risks of hypogonadism. Discussion Polyorchidism is usually asymptomatic and found incidentally during surgery for inguinal hernia, undescended testes as in our case, torsion, hydrocele or testicular tumor. If the SNT is scrotal, and there is no other indication for surgery, most authors recommend conservative management with regular ultrasound follow-up. If nonscrotal SNT is found incidentally during surgery, orchiectomy could be performed because of increased risk of malignancy. Treatment of IGCN includes surveillance, orchiectomy, or low-dose external radiation. Conclusion Different factors come into account for polyorchidsm management: the drainage system, the fertile potential of the supernumerary gonad, and its localization. In cases of uncomplicated polyorchidism, a conservative treatment, with US or MRI follow-up seems to be a rational choice without surgical complications.
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Affiliation(s)
- Hamza Boussaffa
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia.
| | - Sahbi Naouar
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Nidhal Ati
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Mohamed Amri
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | | | - Braiek Salem
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Rafik El Kamel
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
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Ayari Y, Sellami A, Boussaffa H, Zehani A, Ben Rhouma S, Nouira Y. About a case of paratesticular myxoid liposarcoma. Urol Case Rep 2018; 21:27-28. [PMID: 30155408 PMCID: PMC6111029 DOI: 10.1016/j.eucr.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/11/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022] Open
Abstract
Paratesticular liposarcomas are relatively common sarcomas in the paratesticular region, however, the myxoid variant is considered very rare. Due to the infrequency of this malignant disease, no standard treatment would be available. Multiple treatments have reported in literature with different results. Herein, we presented a case of paratesticular myxoid liposarcoma in a 67-year-old man originating from the right paratesticular soft tissue.
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Affiliation(s)
- Yassine Ayari
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Ahmed Sellami
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Hamza Boussaffa
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Alia Zehani
- Department of Anatomopathology, La Rabta University Hospital, Tunisia
| | - Sami Ben Rhouma
- Department of Urology, La Rabta University Hospital, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta University Hospital, Tunisia
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Ati N, Chakroun M, Boussaffa H, Essid MA, Saadi A, Ayed H, Bouzouita A, Cherif M, Ben Slama R, Derouiche A, Chebil M. Female urethral diverticulum containing calculi: A rare and tricky condition. Urol Case Rep 2018; 21:101-103. [PMID: 30263891 PMCID: PMC6157463 DOI: 10.1016/j.eucr.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/17/2018] [Indexed: 11/29/2022] Open
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Boussaffa H, Jabloun A, Saadi C, Tarchallah D, Daib A, Abdallah R, Malek R, Hellal Y, Gharbi Y, Kaabar N. Étude sur 20 ans de la dysplasie rénale multikystique : y’a-t-il un argument précoce pour la néphrectomie ? Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Naouar S, Boussaffa H, Amri M, Naouar R, Braiek S, El Kamel R. Giant urethral diverticulum calculus revealed by peri-urethral abscess. Tunis Med 2018; 96:391-392. [PMID: 30430479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Urethral diverticulum of the male is uncommon. We report a case of bulbar urethraldiverticulum with contained giant calculus presenting as left inguino-scrotal swellingsecondary to peri-urethral abscess in a 40 year-old male. In the light of this case Weemphasize the importance of investigation for the presence of urethral diverticulum in youngmale individuals presenting with voiding disturbances to preventrelated complications.
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