Ann Urol
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The authors report a series of 50 cases of rupture of the corpora cavernosa observed over a 20-year period. The patients had a mean age of 27 years (16-55 years). ⋯ All patients were treated surgically, with evacuation of the haematoma and suture of the tunica albuginea (48 cases), suture of the corpora cavernosa and corpus spongiosum (1 case), and fascia lata corporoplasty (1 case). A favourable course was observed in 30 cases, while 11 patients presented painful erection, and 9 patients developed induration and deviation of the penis.
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The authors report a case of apparently isolated bilateral adrenal phaeochromocytoma in a 25-year-old man presenting with abdominal pain and neurosensory signs of HT, but ignored and complicated by heart failure. Ultrasonography and abdominal CT revealed a bilateral adrenal tumour. ⋯ Treatment consisted of right adrenalectomy and left tumour excision. The postoperative course was uneventful, and 3-year follow-up showed regression of the functional symptoms and control of blood pressure without any other treatment.
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Perineal war wounds involve the anterior perineum or urogenital perineum and posterior perineum or ano-sphincteric perineum. They are rare in civilian practice and in war practice, as only a small and hidden surface of this anatomical region is exposed to damaging agents. An isolated wound of the perineum is rarely life-threatening, but always threatens the functional prognosis of these patients, who have a mean age less than 30 years. ⋯ The basic principles of surgical treatment remain urinary diversion by a large cystostomy tube for urogenital lesions, faecal diversion by terminal colostomy for ano-sphincteric lesions, conservative debridement of the margins of the anal or urethral wound, debridement and drainage of contaminated soft tissues and connective tissue spaces. First-line immediate suture of the urethra or edges of the anal wound must be considered according to the defect, and the septic and haemorrhagic context. When ideal repair cannot be performed, alignment over an urethral catheter, urethrostomy, fixation-identification of the urethral or anal extremities constitute intermediate procedures allowing secondary urological and proctological specialized procedures in these patients.
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From a series of 316 cases of war wounds, the authors selected those cases in which the entry or exit wound was situated between the iliac crests and the inferior gluteal fold and report a series of 21 wounds (including 17 assault gunshot wounds) involving the perineal, pelvic and/or gluteal regions. Wounds of these regions are characterized by their immediate severity (10% mortality in this series), due to the complexity of combined lesions (urethra, rectum, hip, abdominal and vascular lesions) and the severity of sequelae. ⋯ Based on this series and a review of the literature, the authors discuss diagnostic problems (risk of missing abdominal penetration, a retroperitoneal rectal wound or an articular wound). Principles of treatments are also described (wide debridement and drainage, systematic colostomy for wounds of the rectum and large soft tissues wounds, systematic cystostomy for bladder and urethral wounds and alignment of urethral wounds whenever possible, articular lavage and immobilization by external fixation of hip wounds).
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The bladder and urethra can be the site of various types of foreign bodies. The authors report two cases of low urinary tract foreign bodies. The first case concerned a young man with psychiatric disorders who introduced a condom into his bladder and the second case was an elderly patient with a history of self-dilation who introduced a safety pin into his urethra. In the light of these two cases, the authors review the diagnostic features and management of bladder and urethral foreign bodies.