Acta urologica Belgica最新文献

Ejaculatory duct(s) obstruction(s) (EDO) may be responsible for as much as one third of azoospermia- or severe oligospermia-related infertility; it's clinical presentation also includes some low urinary tract irritative symptoms, such as repeated epididymitis, pelvi-perineal pain, hematospermia and other ejaculatory disturbances. The diagnosis of EDO is based on patient's history, semen analysis (hypospermia, azoospermia, low fructose level), and transrectal ultrasound (TRUS), which can demonstrate seminal vesicle(s), vas ampulla(s) and/or ejaculatory duct(s) dilatation, Müllerian or utricular cyst, and ejaculatory duct(s) or seminal calcification(s). Confirmation of the suspected diagnosis, if needed, requires classical vasography or TRUS-guided seminal tract puncture and vesiculography. Treatment is usually successfully achieved with transurethral endoscopic procedures: retrograde ejaculatory duct(s) catheterisation, dilatation, incision or resection; seminal tract endoscopy is seldom performed. Very few complications occur; evaluation of long term results is lacking. Indications of such endoscopic procedures remain to be defined, especially in cases of partial EDO.

The authors review the current conservative management of ureteric stones. The physiopathology of the renal colic is analyzed with its implications in the medical treatment. The role of NSAID is enhanced. Stone size and stone location are to be considered when evaluating the possibility of spontaneous passage of the stone. Stones less than 3 mm in diameter of the lower ureter will pass spontaneously in 90% of the cases while stones more then 6 mm in the upper ureter will not pass in most cases. The role of stone dissolution in uric acid and cystine stones is discussed. SWL is not controversial in the management of upper stones less than 15 mm in size. The authors report their experience with SWL of ureteric stones in upper, middle or lower ureteric stones with a success rate of respectively 87%, 65% and 84%.

Ureteric injuries are encountered with increasing frequency. Adequate definitions and etiologies are discussed. All treatment modalities are summarised with special attention for the use of JJ stents, the different endourological approaches and "urological pearls".

Controversy exists about the timing of surgery in neonates and infants with congenital anomalies such as refluxing and/or obstructing megaureters and ectopic ureteroceles. Discussion acuminates to the fact whether or not early reconstruction causes irreversible damage to the urodynamic properties of the bladder. Between 1986 and 1992, 49 neonates and infants with obstructing or refluxing megaureters and 23 neonates and infants with ectopic ureteroceles have been operated in our hospital with a mean follow-up of 7.3 years. Reimplant surgery consisted of a modified Politano Leadbetter procedure, ureterocele surgery consisted of complete excision of the ureterocele, including the urethral part, with reconstruction of the urethra, bladder neck and bladder base combined with ureteral reimplants. Urodynamically no unexpected changes or deteriorisation have been seen in any of the patients. Bladder capacity for age, especially in the reflux group, averages 200%. Two of the ureterocele patients needed clean intermittent catheterisation for several years. Results of reflux cure in megaureter surgery were disappointing in ureters with a flat diameter between 6 and 9 mm's that were not recalibrated leading to the conclusion that in young children recalibration of the distal ureter should be done from 6 mm's upwards. No post-operative ureteral obstruction was observed in any of the cases. The conclusion is that early major reconstructions of the lower urinary tract causes no specific harm to the urodynamic properties of the bladder and pelvic floor, provided that the surgery is performed by specialised pediatric urological surgeons. The reported urodynamic problems in this patient group are probably related to lack of experience to deal with dysfunctional voiding habits that are quite common in these children, also after successful surgery. These micturation problems are not related to the surgical procedures, they are the result of pre-existing urodynamic changes of bladder function in these children.

The extensive use of serum prostate specific antigen in early PCa diagnosis has been limited by the far from perfect sensibility and specificity of this test. The value of prostate specific antigen density (PSAD) to enhance prostate cancer detection in patients with PSA serum levels below 10 ng/ml is limited due to controversial results. We have compared the value of PSAD of the transition zone (PSA-T) dividing serum PSA by transition zone volume to the PSAD for early prostate cancer prediction in patients with PSA levels under 10 ng/ml. PSAD and PSA-TZ were calculated in patients with histologically proved located prostate cancer or with benign histology. We have defined a cut-off value of 0.35 ng/ml/cc for PSA-TZ with both a sensitivity and a specificity in predicting prostate cancer of nearly 90%. For PSAD around 0.15 ng/ml/cm3, PSA-TZ value was significant in prostate cancer. This study showed that PSA-TZ could be a new accurate parameter for prostate cancer prediction in patients with PSA below 10 ng/ml.

Optimal duration of immunotherapy treatment by BCG for the prevention of recurrences of superficial bladder cancer is still unknown. We have studied the evolution and duration of the cellular immunity response at the peripheral level after BCG intravesical instillations. Our results show that immunity activation after BCG is of short duration and don't take more than 6 months. Our results support, strengthen and partially allow to explain the utility of maintenance treatment by BCG following 6-weekly instillations.

Aspergillosis prostatitis is rare but more frequent to immunodeficiency people. We report a case of aspergillosis prostatitis associated with pulmonary tuberculosis, after a corticosteroid treatment for retroperitoneal fibrosis to Methysergide.

The early diagnosis of bladder cancer is central to the effective treatment of the disease. Presently, the detection of bladder tumors relies on cystoscopy and there are no methods available to easily and specifically identify the presence of bladder cancer cells. A variety of new technologies and potential tumor markers are being studied in bladder cancer and some are being translated into clinical use. It is important to realise that all available results on the diagnostic value of tumor markers do not allow firm clinical recommendations, but tests based on biomarkers will undoubtedly influence the management of bladder cancer in the near future.

To better characterize risk factors of progression (or recurrence) of prostate cancer after radical surgery, we analysed clinical and biological preoperative characteristics and post-operative pathology results in a series of 179 patients who underwent radical prostatectomy between January 1, 1993 and December 31, 1994. The mean follow-up in the series is 36 months (24-36). 39 patients treated before radical prostatectomy by hormonotherapy or surgery (TURP, TULIP) were excluded from analysis. 28 patients treated with immediate adjuvant therapy were also excluded from the study on risk factors of recurrence. Clinical understaging is 37% (50/134 patients with stage T1-T2 have extracapsular extension or invasion of seminal vesicles). Preoperative PSA value is related to the pathologic stage. Extracapsular disease was found in 17% and 46% when PSA was < 4 ng/ml or > 10 ng/ml respectively, thereby confirming the poor staging value of preoperative PSA alone. Analysis of the surgical margins demonstrates a statistically significant difference (p = 0.018) between patients with a preoperative PSA < 10 ng/ml (22% of positive margins) and those with a PSA > 10 ng/ml (42% of positive margins). Predictive factors of recurrence were analyzed in the 112 patients who have not received pre- or postoperative treatment. The respective impact of clinical stage, preoperative PSA value, Gleason score, invasion of prostatic apex, capsular perforation, surgical margins, invasion of seminal vesicles or of pelvic lymph nodes, and invasion of intraprostatic, intracapsular or extraprostatic nerves were evaluated. In T3 cases, we observe 50% recurrence (but only 4 patients fall into this group) versus 14% in clinically localized tumors (T1c-T2c). No recurrence is detected when preoperative PSA is < 4 ng/ml; on the contrary 21% of patients with a PSA > 10 ng/ml recurred. Infiltration of the apex does not influence prognosis. In our experience, capsular perforation is a worse prognostic factor than positive surgical margins, the respective rate of failure being 25% and 17% respectively. Invasion of extraprostatic nerves increases the risk of failure compared to capsular perforation alone (31% vs 18%). Seminal vesicles invasion significantly worsens prognosis (50% vs 13% recurrence respectively; p = 0.024). All patients with positive lymph nodes recurred (p = 0.001).

Two cases of retroperitoneal benign schwannoma are described with a review of literature. Are analysed the clinical and anatomopathologic features of this rare tumor and the methods of diagnosis. The treatment is the surgical ablation of the tumor commonly easy and complete. When malignancy is established, adjuvant procedures add little to life expectancy and total surgery is done likely to be effective.