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Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.

We report one case of retroperitoneal liposarcoma treated by surgery and radiotherapy. With the literature, we discuss the pathologic and therapeutic aspect of this lesion.

Objective: To approach the treatment of Fournier's gangrene. So, pathophysiology and etiology are recalled., Methods: The authors present 51 cases of Fournier's gangrene treated from 1989 to 1998, their age ranged from 19 to 89 years. Data were collected on admission signs and symptoms, physical examination. Aggressive surgical debridement of all necrotic tissues was performed, Intravenous antibiotics and resuscitation fluid were also administered., Results: All patients were male. In 20 cases (39%), there was no identifiable cause, and in 31 cases (61%), the etiology of gangrene was urethral (33%), anorectal (28%) and unknown (19%). The average hospital stay was 30 days. Three cases underwent unilateral orchidectomy, six colostomy and in 17 cases, a suprapubic catheter was inserted. Mortality was high (18%) and essentially associated to debilated state and toxi-infectious context., Conclusion: Fournier's gangrene is a true urologic emergency potential lethal, which requires aggressive antibiotic and surgical treatment.

Bladder exstrophy is a malformation which the incidence is estimated at 3.3 per 100,000 births. It is usually treated in the first hours of life. The authors report three cases of bladder exstrophy treated in adult life with continent urinary diversion such as Benchekroun continent ileocaecal bladder (CICB). After a literature review on the management of bladder exstrophy, they studied clinical and therapeutical particularities of the bladder exstrophy in adulthood.

Between January 1990 and December 1997, 61 patients with renal calculi underwent percutaneous nepholithotomy. In the immediate postoperative period, 49 renal units (80.3%) were stone-free. At three months, our overall success rate was 91.8% after spontaneous elimination of non-significant residual calculi (< 3 mm). Complications were observed in 9.8% (six cases); hemorrhage and sepsis were the major complications. Percutaneous nephrolithotomy is an effective, safe and reliable alternative to the open operation.

Rigid ureteroscopy has become a common tool for the diagnosis and management of several diseases of the upper urinary tract. Between April 1990 and April 1996, 92 ureteroscopy procedures were performed in 88 patients in the B Urology Department of Avicennes hospital for diagnostic or therapeutic purposes. The commonest therapeutic procedure was stone manipulation (72 cases). The overall success rate was 90.8% (Distal ureter: 89.6%, mid ureter: 80%, lumbar ureter: 100%) and the complication rate was 4%. Therapeutic ureteroscopy was also used to dry ureterovaginal fistula (4 cases) and ureteral fistula with retroperitoneal urinoma (2 cases), and to remove a double J stent which had migrated into the pelvic ureter (3 cases). Diagnostic ureteroscopy was performed for 7 ureteral strictures including 3 extrinsic compressions and 4 ureteral strictures all treated with dilatations after biopsy. One false passage was observed among diagnostic ureteroscopy procedures. Rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesions.

A case of recto-rectal congenital development cyst is described in 35-year-old man. This cyst presented in the form of voiding symptoms. Computed tomography revealed the relation and components of the development cyst. Treatment consisted of complete surgical excision via a transabdominal approach.

The authors report a series of 40 cases of genitourinary tuberculosis diagnosed and treated in the department of urology "B" of Avicenne hospital over a 7-year period. The objective of this study is to define the various diagnostic and therapeutic aspects of this disease. The patients were predominantly males (62.5%) with a mean age of 40 years. 25% of cases reported a history of extra-urinary tuberculosis. The very polymorphous clinical presentation is dominated by signs of cystitis (45%). Intravenous urography is frequently suggestive of the diagnosis based on the appearance and multiplicity of the lesions. The radiological lesions most frequently encountered were silent kidney (19 cases) and small tuberculous bladder (11 cases). The definitive diagnosis was established by pathological examination in 38 cases (biopsies, operative specimens, prostatic resection chips) and/or by demonstration of AFB in 2 cases (urine, pus). Tuberculostatic treatment was administered to all patients, either alone (5 cases) or, more usually, in combination with surgical and/or endo-urological treatment (35 cases), reflecting the magnitude and severity of the destructive and scar lesions.

Between July 1990 and December 1995, 52 patients with lower ureteral calculi were treated by rigid ureteroscopy in the "B" Urology department of Avicenne Hospital. The use of ureteroscopy facilitated Dormia extraction (58%) or ultrasonic lithotripsy fragmentation (17%) or removal of the stone with the two procedures (21%). The overall success rate was 92.3% with a 2% retreatment rate. Complications were rare (3 of 52: 5.8 percent). The mean hospital stay was 3.3 days. Based on our findings, we conclude that rigid ureteroscopy for lower ureteral stone removal is effective with low morbidity and shorter hospital stay.

From June 1990 to June 1996, 18 patients with ureteric injuries were treated in our institution. All ureteric lesions were diagnosed post-operatively and repaired early (2 cases) or after a delay (16 cases). 4 patients underwent exclusive endourological treatment, 10 patients underwent repair by open surgery without preliminary endourological procedure, and in the remaining 4 patients, the two methods were combined. In this group, ureteroscopy, which facilitates intraoperative identification of the ureteric segment below the lesion, allowed end-to-end ureteric anastomosis, which, in the light of our results, constitutes the reference surgical technique.

Urinary drainage by indwelling double J ureteral stent is well documented in the urologic literature. We used these stents in 91 patients. The majority of stents were placed endoscopically (68%). Indications were: -Ureteral obstruction (39 cases) such as tuberculous ureteral strictures, obstruction due to urolithiasis and pelvic malignancies. -Upper urinary tract surgery (29 cases) mainly pyeloplasty, pyelolithotomy, ureterovaginal fistula repair and ureteroneocystostomy. -Adjunct to endourologic treatment (16 cases) such as ureteroscopy and endopyelotomy. -Preparation for extracorporeal lithotripsy (7 cases). The complication rate associated with placement of double J stents was minimal (6.6%). The major complication was migration (3 cases). The average drainage time was 5.8 weeks. In view of these results we conclude that double J stent is safe, effective and has minimal complications.