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The authors report one case of vesical paraganglioma, not suspected in a 50-years-old female patient who presented gross hematuria as only symptom. The patient was not hypertensive. Radiologic and endoscopic investigations revealed a trigonal submucosal tumour. Complete transurethral resection of the tumor was performed with no intraoperative complications. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. There has been no recurrence for 18 months after transurethral resection.

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The authors report a retrospective serial of 225 patients presenting an infiltrating bladder tumor. The infiltrating tumors represent 29.2% of bladder tumors. The middle age of our patients is 59 years with a sex-ratio of 7.3. In the histology, 80% of the tumors are a cell transitional carcinoma and 65% of the patients are classified stage T3T4. The surgical treatment has could be achieved at 73.3% of the cases and 66.7% of the patients had a radical cystectomy. The urinary diversion was essentially an continent urostomy using Benchekroun's hydraulic valve. At 28 months mean follow-up, a locoregional recurrence has been noted from 18% of the Tur achieved alone and 4% of the radical cystectomy. A metastasis has been noted from 18% of the patients and this in a mean delay of 12 months.

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The authors report their experience of neurogenic bladder about 73 cases during 16 years. The analysis of the data permits to affirm that the neurogenic bladder remained a rare pathology, that their aetiologies is acquired in 87.6% of the cases with a predominance of spinal cord traumatisms, which explains the predominance of the pathology among the young subject of masculine sex (middle age of 32 years, sex-ratio is 2.5). The clinical signs are represented by urinary incontinence that constitutes the main motive of consultation, followed by obstructive signs and frequent miction associated to urge miction. The explorations put in evidence an important rate of complications because of the diagnostic delay. The therapeutic management aims to assure a most complete draining of the bladder to low pressure, to assure the continence or at least to manage the incontinence while assuring the comfort and the patient's autonomy.

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We report our experience with treating the vaginal aplasia by vaginoplasty used sigmoid graft in about three cases. Two patients presented with the Rokitansky-Kuster-Hauser syndrome and one a gender reassignment for intersex. Anatomic and functional results were satisfactory with no vagina stenosis. All three are sexually active. The sigmoid colon is the best choice for interposition vaginoplasty.

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The authors report a series of 36 cases of perinephric phlegmon during 15 years. The patients are 27 men and 9 women. Mean age was 37 years (ranging between 25 and 70). The promoting factors of PPN are diabetes (27.8%), and kidney calculi (22.3%). Delay diagnosis is more than 3 weeks in 80% of the patients. The clinical symptomatology was dominated by pain, fever and flank mass. Diagnosis is carried out by ultrasonography in 84% and by CT scan whenever it is done. The common germs are negative Gram bacilli and staphylococcus. The treatment consists in antibiotherapy associated to a percutaneous drainage of the collection in 6 patients (16.7%) and a surgical drainage in 30 patients (83.7%). The follow-up are favorable in all cases.

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The authors describe a case of enterovesical fistulas in a patient with Crohn's disease that presented exclusively as urinary symptoms manifesting as bladder tumor. Ultrasound examination showed a normal upper urinary tract and a bladder tumor. Cystoscopy examination revealed a bladder tumor at the retrotrigonal region without showing the fistula orifice. Transurethral resection of the tumor revealed an inflammatory pseudotumor of the urinary bladder at the results of histological studies. Magnetic resonance imaging showed a normal upper urinary tract but a bladder tumor and a sigmoidovesical fistula. The results of barium contrast studies established the presence of numerous enterovesical fistulas. Partial resection of the ileum, ileostomy, colostomy and suture of the bladder fistulas was performed. Histological diagnosis of the affected ileum was Crohn's disease. The clinical features, natural history and treatment of enterovesical fistula secondary of Crohn's disease were discussed.

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The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.

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The authors report 24 patients presenting a transitional tumor of bladder pT1G3 collected between January 1996 and December 2000. They represent 19% of the superficial tumors of bladder. Two patients had of straightaway a cystectomy after resection for an unverifiable tumor by endoscopy and another after a second resection discovering a real pT2. Only 5 patients received a BCG therapy is 24% of the cases. A recurrence without progression has been noted in 38% of the cases and a progression in 19% of the patients. These last patients had a cystectomy and with a follow-up to 28 months, no recurrence has been noted.

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Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. Inflammatory pseudotumour (IPT) of the urinary bladder is a benign proliferate lesion which can simulate clinically and histologically a sarcoma. A case of an inflammatory pseudotumor of the urinary bladder in a 18-years-old man is presented. This patient presented with sudden onset of gross painless hematurial related to large polypoid and ulcerated bladder masses found on endoscopy. Initial pathological analysis was interpreted as rhabdomyosarcoma but subsequent reviews were consistent with a benign process resembling nodular fasciitis. This rare, benign and presumed non-neoplastic, reactive lesion must be differentiated from sarcomas of the urinary bladder. Immunohistochemistry seems to be the method of election in differentiating inflammatory pseudo-tumor from other spindle cell proliferations of the bladder. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.

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The author reports a serie of 4 cases of male urethral diverticulum. All cases were acquired origin. They are complication of urethroplasty. Diagnosis is clinical, based on the development of a perineal mass or phlegmon. This diagnosis is confirmed by cystourethrography. Treatment is by open surgery and consists on diverticulectomy and repair urethra in one stage. Two steps are necessary as the reported cases, where they are urethral stenosis or a inflammatory involvement of the peridiverticulum tissues. This treatment achieves good results.

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Adenocarcinoma of urethra is a rare tumour, which occurs more often in female than in male. The localizations on bulbomenbranous urethra, most frequent, have worse prognostic than those of penile urethra. Because of scarcity of these tumours there is not therapeutic consensus. The treatment is based on the tripod surgery, more or less mutilating, chemotherapy and radiotherapy associated or managed in a separate way. We report the case of a young patient with adenocarcinoma of the posterior urethra treated by a protocol of radio-chemotherapy.

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Sarcomatoid carcinoma of the kidney is an uncommon tumor associated with a very poor prognosis. Because this tumor can be occasionally difficult to distinguish from renal sarcoma, immunohistochemistry and electronmicroscopy are sometimes necessary for diagnosis. Therapy is actually essentially surgical because if adjuvant therapies should follow radical nephrectomy, no standardized regimen has been at present defined.

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Wolfram's syndrome is an autosomal recessive neurodegenerative disease. The major manifestations consist of diabetes mellitus and bilateral optic atrophy and are sufficient to establish the diagnosis. Urinary manifestations constitute an integral part of the syndrome, as they are present in up to 62% of cases and represent one of the major causes of morbidity. Three cases allow emphasize the difficulty of treatment, which is essentially symptomatic, and largely guided by the results of the various complementary investigations, especially urodynamic assessment. Although the causes of this syndrome are multifactorial and complex, it appears that the urinary lesions are at least temporarily improved by correction of excessive bladder pressure.

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