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While bladder rupture is most of the time secondary to external injury such as trauma or iatrogenic events, spontaneous bladder rupture (SBR) is a rare condition which is mostly associated with bladder cancer, neurologic bladder or radiotherapy. We report a case of a 63-year-old patient with an invasive squamous cell bladder carcinoma who presented acute peritonitis caused by a SBR while being prepared for radical surgery. CT-scan helped to confirm diagnosis and emergency cystectomy was performed. SBR should be considered in differential diagnosis of peritonitis. On time diagnosis and adequate surgery could improve its prognosis.

BackgroundThere are several factors explaining the difference in the spread of SARS-CoV-2 infection including the BCG vaccination. This fact is supported by the concept of beneficial non specific effect of this live vaccine associated to its interaction with the immune system.Our study aims to identify the correlation between the universal BCG vaccination policy and the mortality attributed to COVID-19.MethodsWe conducted an epidemiological study in which we collected COVID-19 pandemic data of April 11th, 2020 from the web site worldometers.info. The exclusion criteria for our study were a number of inhabitants less than one million, low-income countries according to the World Bank classification, a total number of infection cases less than 500 and countries that have performed less than one hundred tests per million inhabitants.ResultsCountries that never had universal BCG vaccination policy have a higher mortality (correlated to performed diagnostic tests) attributed to SARS-CoV-2 infection (pWe found that the year of introduction of vaccination influenced significantly the mortality. Countries that started immunization policy before 1960 had more favorable results (p=0.049).For countries that started the BCG vaccination after 1960, countries with current policies have lower mortality attributed to SARS-CoV-2 infection than countries that have stopped immunization (p=0.047).ConclusionsCountries that have a BCG vaccination policy have a lower mortality attributed to SARS-CoV-2 infection. The populations of countries that applied this immunization before 1960 are more protected even if this universal policy has been interrupted.

Carcinosarcoma of the bladder is a very rare and aggressive tumor with poor prognosis. We report a case of a 61 year-old-male who presented a terminal hematuria. Ultrasounds revealed a mass at the dome and the right of urinary bladder. A transurethral resection of the bladder tumor was performed. A pathological examination revealed a pT1 hight grade carciono-sarcoma of the urinary bladder with cartilaginous differentiation. Cystoprostatectomy with Bricker diversion and lymph node dissection were performed. The pathological examination of the surgical specimen revealed no residual tumor lesion. Keywords: Carcinosarcoma, Bladder, Cystoprostatectomy

Resume Introduction La gangrene de Fournier est une fasciite necrosante rapidement progressive du perinee et des organes genitaux externes avec un pronostic evolutif pejoratif. C’est une urgence medico-chirurgicale justifiant une prise en charge multidisciplinaire. Le but de ce travail etait de determiner les caracteristiques epidemiologiques, cliniques et therapeutiques de cette pathologie. Materiels et methodes Nous avons realise une etude retrospective, monocentrique, colligeant les patients pris en charge pour gangrene de Fournier entre janvier 2000 et septembre 2019. Nous n’avons pas inclus les patients qui presentaient des suppurations perineales sans veritable gangrene et ceux dont le suivi etait inferieur a un an. Resultats Soixante-neuf patients ont ete pris en charge. L’âge moyen des patients etait de 56 ans. Deux tiers des patients etaient diabetiques et 20,2 % avaient des antecedents de chirurgie perineale (abces de la marge anale, abces de la fesse, chirurgie hemorroidaire). Le delai moyen entre le premier signe et la consultation etait de 8 jours. Des douleurs perineo-scrotales associes a des lesions œdemato-erythemateuses etaient retrouves chez tous nos patients. Des crepitations neigeuses ont ete notees dans 50 % des cas. Un choc septique a ete constate chez 13 % de la population etudiee. La mortalite etait de 31,9 %. Tous les patients ont recu une triple antibiotherapie et ont eu un debridement chirurgical large et immediat. 58 % des patients ont eu une chirurgie de seconde phase (suture secondaire, greffe cutanee) avec resultats esthetiques satisfaisants dans 43,5 % des cas. Une oxygenotherapie hyperbare a ete indiquee dans 21,7 % des cas avec un bon resultat clinique (un recul moyen de 24 mois). Le delai moyen de cicatrisation etait de 14 jours en cas d’oxygenotherapie hyperbare et de 28 jours en l’absence de ce traitement. La duree moyenne d’hospitalisation etait de 20 jours avec des extremes de 13 a 44 jours. Le terrain, le delai de prise en charge ainsi que l’etendue de la necrose etaient les principaux facteurs pronostiques. Conclusion La gangrene de Fourier est une urgence urologique medico-chirurgicale. La prise en charge doit etre precoce afin de reduire le taux de mortalite qui reste encore eleve et les sequelles esthetiques et fonctionnelles. Le processus de cicatrisation peut integrer l’oxygenotherapie hyperbare et la pression negative utilisant le systeme VAC. Pour les pertes de substances etendues la chirurgie plastique peut etre indiquee.

Paraganglioma is a rare neuroendocrine tumor that arises from the autonomic nervous system. The urinary bladder paraganglioma accounts for less than 0.1% of bladder tumors. It remains a challenging entity to diagnose and treat due to its rareness and the lack of specific symptoms. Treatment modalities include transurethral resection and cystectomy (partial or total). The authors report a new case of an isolated paraganglioma of the urinary bladder in a 52-year-old female patient that underwent partial cystectomy. This case aims to remind the clinical, histological and therapeutic features of this rare tumor.

Despite being one of the most common primary tumors in the world, colon cancer only metastasizes to the penis in singular cases. We report the case of a 53 year-old male presenting with hematuria, pain and induration of the penis 2 and half years after the diagnosis of left colon cancer. CT scan demonstrated involvement of the corpus spongiosum and corpora cavernosa with enlarged external inguinal lymph nodes and asymptomatic metastasis in the liver and lungs. The finding of a penile lesion in a cancer patient is an alarming sign and should indicate a disseminated disease. The prognosis of penile metastasis is poor.