Acta urologica Belgica最新文献

Standard radical nephrectomy entails en bloc removal of the kidney together with Gerota's fascia and the ipsilateral adrenal. Thanks to the refinement of imaging techniques (ultrasound, CT and MRI), smaller tumors are being diagnosed. In addition, direct extension to the adrenal gland or adrenal metastasis can be detected in most cases. This is why several authors reserve adrenalectomy for large and/or upper pole tumors or abnormal appearing glands on preoperative CT-scan. However, preoperative diagnosis is not always accurate. Furthermore, micrometastatic adrenal invasion at the time of nephrectomy and late recurrences in the persistent adrenal have been documented, so that partisans of adrenalectomy only spare the adrenal in exceptional cases. The authors have reviewed several series in the litterature as well as there own, and conclude that ipsilateral adrenalectomy can be omitted for small middle- or lower pole tumors when the adrenal appears normal on CT and during the surgical intervention.

Even if the first radical prostatectomy was performed more than ninety years ago by Hugh Hampton Young, it's only during the 20 last years that an anatomical approach to this technique has been developed, to reduce the number of complications routinely described. The evolution of the procedure allow us how to make the operation safer, to perform it in a bloodless field and increase the possibility to preserve continence and potency. We would like to show you how two simple technical variations for the control of dorsal vein complex and the vesico-uretral anastomosis can, at our opinion, decrease the number of operative and postoperative complications. A retrospective review was performed on 168 clinical localised prostate cancer patient (stages T1 to T2 N0 M0) treated in our hospital between December 1987 and March 1998. All these patients underwent retropubic radical prostatectomy with pelvic lymphadenectomy. The preoperative clinical stage was T1 for 48.2% and T2 for 51.8%. The mean age of the patients at operation was 64.4 years and the mean PSA level at diagnosis was 12.4 ng/ml. Our results revealed that 97% of the patients are now perfectly continent and that the continence was immediately recovered by 16% at the removal of the bladder catheter.

Whenever trauma of the urethra is suspected a "test" catheterisation is potentially bad and useless. Retrograde urethrography should be performed before use of any catheter. Doctors in urgency department should be trained to do this. Suprapubic diversion under imaging guidance is the best solution when trauma is diagnosed. In complete rupture without extreme displacement of both ends of the urethra, reconstruction is foreseen at day 7 to 10 after trauma. Bleeding is stopped at that moment and elasticity of the tissues is still sufficient. A second urethrogram the day before intervention is advocated for better judgement of the lesions. Endoscopy with a flexible endoscope from above is performed as the first step of the operation. Minor distances or incomplete lesions of the urethra can be coped with endoscopic realignment. Distances of more than 1 cm are treated by open perineal route only leaving the pelvic hematoma closed. This technique should be restricted to referee centers in view of the small numbers of cases.

We report the case of a 25 year-old man presenting Reiter's syndrome (urethritis, conjunctivitis and oligoarthritis). This clinical triad is a particular expression of reactive arthritis. A genital or enteric infection can be responsible for the onset. Presence of HLA B27 histocompatibility antigen is a genetic factor favoring the development of Reiter's syndrome. Many organs or systems can be affected. In addition to eradication of the initiating infection, treatment is mainly symptomatic and management is multidisciplinary.