Acta urologica Belgica最新文献

Stress incontinence represents 77 to 91% of female urinary incontinence, 10% of witch are sphincterial incontinence. The specific treatment of sphincterial incontinence is of periuretral injections or calls for an artificial sphincter. We present the retrospect of 12 patients having undergone several surgical treatments and having at last the benefit of an artificial sphincter since 1990. In majority, these patients had been operated for bladder neck hypermobility. The indication, preoperatory evaluations, surgical technics and results are discussed. During the mean follow-up of 40.5 months, 91.7% of patients are perfectly continent. The results are equal to those of other publications.

The aim of this study is to judge the effectiveness of the new treatment of varicoceles, introduced in 1987 by Tauber: the antegradal scrotal sclerotherapy of varicoceles. From february 1996 to april 1998, we have realised 150 antegrade embolisations of varicoceles. The study is lead on 75 patients with mean time follow-up of 12 months. Patient's mean age is 20 years. 85% of patients had a grade 3 left varicocele and 15% a grade 2 left varicocele. The criterium of success rests on the lack of veinous flow-back during clinical examination, which is than confirmed by doppler-ultrasound. Clinical success is obtained in 87% of the cases and the doppler control is normal in 80% of the cases. We have 9% of minor complications, and no major complication. The number of failures in our study is higher than in Tauber' study, but is the same as those described in the other procedures of treatment of varicocele. On the other hand the surgical procedure is simple and the morbidity is low.

Ductal ("endometrioid") adenocarcinoma of the prostate is a rare variant of prostatic carcinoma which may have a different clinical presentation than the more common acinar adenocarcinoma. Ductal adenocarcinoma usually involves the urethra and the large periurethral prostatic ducts with direct spread through the more peripheral ductal system. Centrally located tumours have a much better prognosis than tumours involving the deep prostatic parenchyma. Local recurrence rate is high and five-year survival rate is as low as 24% for adenocarcinomas that have spread to the peripheral prostatic ducts. Although there have been some doubts about the role of hormonal therapy in ductal ("endometrioid") adenocarcinoma of the prostate, it is now agreed that therapeutic regimens should not be different from those offered to patients with conventional acinar adenocarcinoma.

We report an uncommon case of a 38-year-old woman who admitted for bladder lithiasis undergoing repeated surgical management and being apparently recurrent. The intravenous pyelography and retrograde urethrocystography clear the urinary tract. Biologic evaluation eliminates any metabolic or endocrine cause. The confirmation of a factitious origin is given by fluorescence X analysis of the extracted stones which conclude to calcium carbonate structure and psychiatric care. The self-intromission of these calculi into the bladder is due to the personality disorder being in the frame of Munchausen's syndrome. Two years later, no recurrence is noted and an excellent psychiatric care is achieved.

Inverted papillomas are benign urothelial tumors. The majority of cases occur in the bladder, while inverted papillomas of the upper urinary tract are very rare. The association of inverted papillomas of the bladder and urothelial malignancy is documented, but the incidence is low. Inverted papillomas of the upper urothelial tract coexist frequently with urothelial malignancy. Close follow-up with urography and cystoscopy is mandatory in such patients. We describe a case with synchronous bilateral ureteral inverted papilloma and a transitional cell tumor of the bladder, illustrating the strong association of upper urothelial tract inverted papilloma and urothelial malignancy.

Introduction: The optimal treatment of ureteric lithiasis continues to be a point of discussion, as there are different treatment modalities. Conservative treatment, EWSL, ureteroscopy (URS), percutaneous litholapaxy, and (laparoscopic) ureterolithotomy, all have there place in the treatment of ureteric lithiasis. In order to evaluate if ureteroscopy is a valuable alternative to ESWL in the treatment of ureteric lithiasis, an analysis of all the ureteroscopies performed in our institution was made and these results were compared with results (both ESWL and URS) described in literature.

Patients and methods: During the period 1990 till 1997, 292 patients underwent in our institution in total 354 ureteroscopies for ureteric lithiasis. In all procedures a rigid 9 Fr. ureteroscope was used, together with laser lithotripsy or pneumatic lithotripsy as fragmentation device.

Results: Overall success rate in our series was 90.1%, with distal and middle ureteric stone location being more favorable (94% and 95%) than proximal location (73%). Overall complication rate was 7.6% (including minor complications, such as ureteral mucosal tear), for which open surgical intervention had to be performed in 2.3% of cases.

Conclusions: Although invasive, ureteroscopy proved to be a very competitive alternative to ESWL, when treating ureteric lithiasis. Success rates are equal, if not better, using ureteroscopy when compared to ESWL. Complications of ureteroscopy are infrequent, but do exist. Therefore ureteroscopy should be performed by experienced urologists.

Prostate laser operation (PLO) is expensive; but without special fibres--that means f.i. NdYAG- or better Diode-laser--and simple reusable bare fibre it costs only about 20BEF/operation, 872 cases were operated in this way. Bare fibres enable a non-invasive but also invasive coagulation technique as well as an effective laser-cutting. High risk patients and patients under anticoagulation treatment are no contradiction against laser operation. The same laser can be used for many indications in urology--as cheap as in prostate therapy--besides in nearly all medical compartments interdisciplinary especially in smaller hospitals or outpatient therapy.

In a retrospective study four questions concerning urodynamics and lower urinary tract symptoms (LUTS) were answered: Do obstructive symptoms correlate with bladder outlet obstruction? Does the symptom urgency correlate with bladder instability? What is the value of a free uroflow study in men with LUTS? Should all men with LUTS have pressure-flow studies before surgery? The authors state that urodynamic investigation is very important before surgery in patients with LUTS.

A vesico-uterine fistula with vaginal urinary incontinence secondary to cesarean section is reported. Diagnosis was made clinically, radiologically and endoscopically. Conservative management failed. Surgical repair was successful. The literature is reviewed, and the treatment options (conservative management--surgical intervention) are discussed.

This case illustrates in a 55 year old man a testicular metastasis from a prostatic TCC occurring fourteen years after a bladder localisation of the same type. To our knowledge no other similar observation has been reported in the literature so far. Metastatic disease should be considered in the differential diagnosis of testis tumours arising in patients with a history of urothelial TCC from bladder, ureter or even prostate as described here.