Le kyste hydatique du rein fistulisé dans les voies urinaires, prise en charge diagnostique et thérapeutique A propos de 14 cas

Objectif: l’hydatidose est une pathologie fréquente au Maroc et constitue un problème majeur de santé publique. La localisation rénale de cette parasitose est rare. Les formes s’accompagnant de plus d’une fistulisation dans les voies excrétrices présentent des particularités diagnostiques etthérapeutiques qui seront décrites dans cet article.Patients et méthodes: 14 patients présentant un kyste hydatique du rein fistulisé dans la voie excrétrice urinaire ont été inclus dans l’étude de 2002 à 2008. Les variables étudiées ont été : l’âge moyen, les antécédents, la symptomatologie clinique, l’imagerie, le traitement et l’évolution.Résultats: L’âge moyen était de 38 ans (21-54). La douleur lombaire a été retrouvée chez tous les patients et l’hydaturie chez 8 patients. L’échographie réalisée chez tous les patients a montré 6 cas de kyste hydatique de type III et 8 cas de type IV selon la classification de GHARBI. L’uroscanner a confirmé la nature hydatique de la masse et deux cas de rein non fonctionnel. L’hydaturie et la dilatation des cavités excrétrices ont été les principaux éléments orientant vers le diagnostic. Le traitement a consisté en une résection du dôme saillant et la fermeture de la fistule chez 12 patients; huit d’entre eux ont eu une néphrostomie per-opératoire après cure de la fistule et deux patients une montée de sonde urétérale double crosse en pré-opératoire, les deux autres n’ont pas été drainés. Les deux patients restant ont eu une néphrectomie. Les suites ont été marquées par une fistule stercorale colique chez un patient et deux cas d’infection de paroi.Conclusion: Tout kyste hydatique du rein doit avoir un bilan d’imagerie comportant un uroscanner avec des clichés tardifs à la recherche d’une fistulisation dans la voie excrétrice urinaire. Il est conseillé de mettre en place une sonde urétérale en préopératoire à visée diagnostique et thérapeutique.Mots clés : Rein, kyste hydatique, fistule dans les cavités excrétrices, drainage sonde urétérale double crosse, sutures en deux plan

Use of Biomarkers in the Evaluation and Treatment of Hypertensive Patients

The current definition of hypertension is based on blood pressure values, and blood pressure also drives treatment decisions, is the most important treatment monitoring tool and helps estimating risk of hypertension related organ damage. In an era of precision medicine additional biomarkers are needed in the diagnosis and management of patients with hypertension. In this review we outline the areas in which functional, imaging and circulating biomarkers could help in a more individualised definition of hypertension and associated risk. We will cover biomarkers for diagnosis; of pathophysiology and prediction of hypertension; response to treatment, organ damage; and to monitor treatment. A clear focus is on the vasculature, the heart and the kidneys, whereas we see a need to further develop biomarkers of cerebral function in order to diagnose cognition deficits and monitor changes in cognition in the future to support addressing the growing burden of hypertension associated vascular dementia

Urachal Sinus Surgery: Clinical Picture

The urachus is a fibrous cord, a remnant of the duct, which in the embryo, connects the bladder with the allantois duct [1]. The urachus can be the site of two types of lesions: on the one hand, congenital anomalies resulting from a defect in the obliteration of the allantois duct (diverticula, fistulas, cysts, sinus), and on the other hand, acquired lesions, essentially of a tumoral nature and most often malignant (urachus carcinoma) [2]. We report the clinical picture of a 28-year-old patient, with a history of uropathology since childhood (hypospadias), chronic renal failure since 2017 under dialysis, neobladder type Mitrofanoff since 2009, admitted for the management of an umbilical abscessed collection. Abdominal MRI revealed a superinfected urachus sinus. The treatment consisted of complete open excision of the sinus (Figure 1) from the umbilicus to the urinary bladder. The postoperative course was simple. Figure 1: The resected specimen (urachal sinus (black arrow), bladder wall (white arrow). A purulent umbilical discharge is often indicative of the presence of a urachus sinus; ultrasound and fistulography are sufficient for the diagnosis [3]. Excision of the urachus sinus by surgery is the standard treatment in this clinical situation [4].</jats:p

Giant Pyelic Stone: Clinical Image

The management of giant stones of the upper urinary tract remains a challenge for the urologist because of the potential risk of treatment-related complications [1]. We report as a clinical picture the case of a 42-year-old patient received for chronic right lumbar pain in whom the CT scan performed revealed the presence of a giant pyelic stone (Figure 1a and 1b) whose dimensions on the sagittal plane are 43.1mmx41.5mm. The patient underwent an open pyelolithotomy in our department, which allowed the extraction of a giant pyelic calculus of 12cm (Figure 1c). The postoperative course was simple.</jats:p

Radical Nephroureterectomy: A Clinical Image

Upper Urinary Tract Urothelial Carcinoma (UTUC) remain rare. Radical Nephroureterectomy (RNU) is the Gold standard for management of these tumours. We are reporting a clinical image of a 45-year-old patient admitted in emergency for left lumbar pain (nephritic colic). The checkups requested computed tomography scanner showed a nephromegaly and left hydronephrosis upstream of a suspicious parietal thickening of the lumbar ureter with cortical and functional repercussion, neighborhood infiltration, and atypical lateral-aortic ganglia. Left lower calicial lithiasis of stasis, pancreatic nodular lesion and the left adrenal gland. The patient was a candidate for an open Radical Left Nephroureterectomy (RNU) (Figure 1). Figure 1: Radical Nephroureterectomy (RNU) picture U (Ureter) R (Renal). There are prognostic factors of tumors of the upper urinary excretory tract, which are the patient’s status, the preoperative, the operation and the anatomopathology [1]. According to current literature data, the oncology outcomes of radical nephrouretrectomy by laparoscopic are lower than those of open RNU surgery [2].</jats:p

Giant Testicular Cancer: Clinical Picture

Testicular tumour is the most malignant cancer in young males 15 to 34 years of age. Its accounts for 1% of all male cancer and 5% of urological malignancy [1]. The management of this type of cancer is radical inguinal orchiectomy which is the gold standard for the diagnosis and initial management of a suspected testicular cancer. Trans -scrotal orchiectomy is discouraged because scrotal violation is associated with higher rates of local recurrence and altered pathways of metastatic dissemination [2]. We report a young patient 23 years old. History: Chronic smoking, cannabis. Admitted for large bursa evolving for 14 months. The history of the disease dates back to 14 months by the gradual increase in the volume of the bursa with an alteration of the general status with a weight loss estimated at 10kgs. Clinical examination showed: right hemi-scrotum increased in volume with a hard consistency with a left testicle repressed in extreme lateral and some inflammatory lesions. Right testis was not palpable with a cord repulsed and glued to the inguinal orifice. The ultrasound of the scrotal content showed: large right testis hypervascularized with moderate anterior cloisonnae hydrocele, bilateral testicular microlithiasis. Tumor markers: Lactate Dehydrogenase (LDH) 229IU, beta-Human Chorionic Gonadotropin (beta-hCG) 29.73mUI/ ml, Alpha-Foetoprotein (AFP) 400IU/ml. Patient benefited from a complete pre-operative assessment that did not object to any abnormality. Programmed for a right inguinal orchiectomy and reduction scrotoplasty (Figure 1).</jats:p