Original research E36case series AbstractIntroduction: Xanthogranulomatous pyelonephritis (XGPN) is an atypical form of chronic pyelonephritis referred to as the ''great imitator'' because the clinical and radiological findings closely resemble other pathological entities, especially for the focal forms. Distinguishing focal XGPN from renal cancer is preoperatively difficult. Methods:We report a total number of 12 pseudotumoural XGPN cases diagnosed and treated in our department. The aim of this study is to try to better understand the clinicopathological profile of XGPN and improve its management. Results: The mean age of patients was 51.52 years. Gender ratio was 0.71. An obstructive renal calculus was noticed in nine patients (75%). Only one patient (8.3 %) presented with loin pain associated with fever, weight loss, asthenia, and increased biological inflammation markers. A bifocal mass was noticed in one case (8.3 %). The average size of the tumour was 6.58 cm. The mass was cystic in three cases (25 %). Perinephral fat strand, thickening of Gerota's fascia, hydronephrosis, and presence of renal calculi was noticed in all solid tumour cases. XGPN was suspected in only one case (8.3%), a percutaneous biopsy showed XGPN lesions treated by antibiotics and a double J drainage. Radical nephrectomy was performed in eight patients (66.7 %) and three patients underwent partial nephrectomy (25 %). No recurrence of XGPN has been noted. Conclusion: Pseudotumoural XGPN is a rare benign disease of the kidney. Its treatment should be conservative. Lack of knowledge of this disease may explain the high rate of abusive nephrectomies. These data should be considered in the future.

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Introduction Paratesticular tumors are rarely observed among scrotal neoplasm. Various types of benign lesions are described. Cavernous hemangioma belongs to uncommon epididymal benign tumors. Clinical and sonographic features are not conclusive and diagnosis requires histological confirmation. Case Presentation Authors report a case of an epididymal hemangioma in a 56-year-old patient, consulting for a painful scrotal swelling. As malignancy was suspected, he underwent inguinal orchiectomy. Histological examination confirmed the diagnosis of cavernous epididymal hemangioma. Clinical and therapeutic aspects of this rare entity are discussed. Conclusion Epididymis is an infrequent location of cavernous hemangioma. Diagnosis is rarely made preoperatively as symptoms and radiological aspects are not specific. Conservative surgery must be attempted once feasible for aesthetic and functional purposes.

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The aim of the study was to test whether the VDR FokI polymorphism is associated with the risk of urothelial bladder cancer (UBC) in Tunisians. The study included 200 unrelated patients with UBC and 200 healthy controls. Genotyping of the VDR FokI polymorphism was determined by PCR-RFLP method. Plasma 25-hydroxyvitamin D concentrations were measured by immunoassay. Binary logistic regression model was applied to test how the association of VDR FokI polymorphism is independent of potential confounding factors. Genotype distribution (FF, 45 vs. 55 %; Ff, 52.1 vs. 47.9 %, and ff, 12 vs. 5.5 %, respectively) and allele frequencies (F, 66.5 vs. 74.8 % and f, 33.5 vs. 25.2 %, respectively) were significantly different between UBC patients and controls. The "ff" genotype [OR (95 % CI), 2.66 (1.24-5.73); p = 0.012] and "f" allele [1.49 (1.09-2.02); p = 0.010] were associated with increased risk of UBC. The association remained significant in multivariate analysis. Stratified analyses showed that VDR FokI polymorphism is only associated with UBC risk in ever-smokers, subjects exposed to chemical carcinogens and those with plasma 25-hydroxyvitamin D over 12 μg/L. The "f" allele of VDR FokI polymorphism is associated with a higher risk of UBC in Tunisians, especially in smokers as well as subjects with occupational exposition and subjects without vitamin D deficiency. These results should be replicated in other ethnic groups and the influence of other genetic factors and environments on this association should be investigated.

Purpose: To evaluate potential associations between 4 nephrometric scoring systems, namely the PADUA (preoperative aspects and dimensions used for anatomical classification), RENAL (radius endophytic/exophytic nearness anterior posterior location), ABC (arterial-based complexity), and MAP (Mayo adhesive probability) scores and their individual components, with surgical and oncological outcomes of patients undergoing a partial nephrectomy. Materials and Methods: A consecutive, monocentric cohort of partial nephrectomy patients was retrospectively analyzed. PADUA, RENAL, ABC and MAP nephrometry scores were determined from preoperative axial images. Unadjusted and adjusted associations between overall scores, individual components, surgical approach, complications and oncological outcomes were determined using univariate and multivariate logistic regressions. Results: A total of 189 partial nephrectomies were performed in 181 patients, via an open or a laparoscopic approach. Among scoring systems, only the MAP classification, which assesses adherent perinephric fat, was associated with severe surgical complications as well as with operative time (p<0.05). Among all components of the PADUA and RENAL scores, only proximity of the tumor to the collecting system was associated with overall surgical complication rates, while the diameter of the tumor influenced the operative time (p<0.05). The ABC score was not relevant. Male gender, antiplatelet therapy, and a laparoscopic approach were associated with higher overall surgical complication rates (p<0.05). The number of oncologic recurrences during follow-up was too low to run statistical analyses. Conclusion: Nephrometry scores could be simplified to predict surgical complications after partial nephrectomy. In this framework, adherent perinephric fat seemed to be strongly associated with an increased risk of surgical complications.

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