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.

Pleomorphic rhabdomyosarcoma (RMS) is a rare tumor with an aggressive behavior, described mainly in adulthood. Herein we present two cases of paratesticular pleomorphic RMS in 71- and 16-year-old patients with metastases at initial diagnosis. Histological, immunohistochemical, and ultrastructural findings were essential to confirm diagnosis. Few months after radical orchiectomy, both patients died before or just after starting adjuvant chemotherapy.

Urachal anomalies are rare affections due to incomplete closure of urachus during foetal period. Colo-urachal-cutaneous fistula is an uncommon complication of urachal anomalies. Only three cases have been reported so far in the literature. Herein, we report a new case in a 51-year-old patient presenting with umbilical feculent discharge lasting for 4 weeks. Diagnosis was made by computed tomography. After en bloc total surgical excision followup was uneventful.

RésuméLa cystite gangréneuse compliquée d'une perforation en intrapéri-tonéal est une pathologie extrêmement rare. Le facteur étiopatho-génique principal est l'ischémie de la paroi vésicale. L'intoxication alcoolique comme facteur à l'origine d'une ischémie pariétale cons titue un mécanisme complexe mais grave du fait de l'étendue des lésions et du terrain sur lequel se greffe cette complication. Ce cas clinique rapporte l'observation d'un patient de 36 ans, alcoolique chronique, hospitalisé en raison d'un tableau clinique de péritonite aiguë; L'exploration chirurgicale a révélé une gangrène localisée de la vessie à l'origine d'une perforation spontanée en intrapéritonéal. Après réparation chirurgicale, la fonction et la capacité vésicales sont revenues à la normale.

ObjectivesTo report the long-term outcome of laparoscopic retroperitoneal pyeloplasty (LRP) in adults.Patients and methodsThirty patients underwent LRP for primary pelvi-ureteric junction obstruction (PUJO). Anderson–Hynes dismembered pyeloplasty was used in 28 patients and a Foley Y–V pyeloplasty in two. A JJ stent was inserted antegradely during the procedure. Patients were reviewed at 1 month after LRP for stent removal, and then at 6 and 12 months routinely, using excretory urography.ResultsThe mean patient age was 29.7 years, with a female predominance of 60%. Conversion to open surgery was mandated by dense adhesions secondary to previous pyelonephritis in three patients, and difficulty in suturing in one. The mean (range) operative duration was 228 (190–280) min. There was a crossing vessel in 11 patients and it was not transposed in any. The mean hospital stay after LRP was 4.2 days. The mean (range) follow-up was 60 (29–106) months. Of the 26 patients who had complete laparoscopic procedures, 23 had no evidence of obstruction on long-term postoperative intravenous urography and/or diuretic renography.ConclusionLRP combines the high functional success rate of open pyeloplasty in the long term and the minimally invasive morbidity of laparoscopy.

No abstract

RésuméLa suppuration d'un carcinome rénal nécrosé a été rapportée seulement trois fois dans la littérature et demeure une circonstance exceptionnelle de découverte de cancer du rein. Le tableau clinique et radiologique est trompeur, et c'est l'évolution défavorable malgré un traitement approprié qui doit évoquer le diagnostic de cancer rénal. Nous rapportons un nouveau cas de carcinome rénal révélé par un abcès du rein.