Acta urologica Belgica最新文献

Antiinflammatory drugs are the first choice in the treatment of the acute nephretic colic. This is due to their fast and direct action on the ureteral wall. The use of antispasmodics are still controversial and opioïds are not indicated. During the acute crisis, an hydric restriction should be associated to the medical treatment. After the crisis an increase of diuresis could help to "wash out" the stone. A spontaneous elimination can be expected, especially if the stone is small and located in the third part of the ureter. The ureteral rupture is rare but serious and must be treated by antibiotics and some time to be drained. The rapidity of a more aggressive treatment is function of numerous factors.

Metabolic evaluation remains cornerstones in the treatment and prevention of recurrence in patients with urolithiasis. The various chrystallographic, biological and radiological investigation should be done only in patients presenting recurrence and/or given risks factor of recurrences. The choice of the investigation is guided by the knowledge of the pathophysiological phenomena and should thus be adapted to each patient. Results should be analyzed by a multidisciplinary team. This aspect will be developed in the next paragraph.

Objectives: To study the prognostic value of the prostate-specific antigen (PSA) response and its relationship with other initial prognostic factors during the treatment of advanced prostatic carcinoma with total androgen blockade.

Methods: Five hundred forty-six patients with advanced loco-regional (M0) or distant metastatic (M1) prostatic carcinoma treated with flutamide combined with either orchiectomy or LHRH analogues were included in this analysis. Initial patients characteristics and the PSA response were evaluated in relation to progression-free survival using a univariate and multivariate (Cox regression) analysis.

Results: The following prognostic factors were indicative of a decrease in progression-free survival: the absence of PSA normalization (< 4 ng/ml) after 3 or 6 months, M1 stage, high G grade, ECOG performance status > 1, presence of pain and absence of dysuria. In M1 patients the combination of PSA normalization after 3 or 6 months with initial G grade and ECOG performance status had the strongest predictive value.

Conclusions: This study demonstrates that PSA normalization after 3 or 6 months along with initial tumor stage, grade and health status of the patient are the most important prognostic factors related to progression-free survival in the hormonal treatment of advanced prostatic carcinoma.

Extracorporeal shock wave lithotripsy is actually the most popular treatment in the urolithiasis. However, different factors influence the choice of the best treatment. Great progresses appeared in the conception of performing endoscopic material which led to minimize morbidity. Percutaneous approach is very popular but require expensive material and trained operator. Indications for open surgery were reduced but didn't completely disappear. We review in the next paragraph the literature of the last five years.

Although most ureteral stones can be treated with Extracorporeal Shock Wave Lithotripsy (ESWL) and endourology, there still is a small percent of patients whose stones can not be treated with minimally invasive techniques and thus require open surgery. Retroperitoneoscopic surgery is a good alternative for this subgroup of patients. It provides a direct access to the retroperitoneum, less morbid than an open operation and provides a better cosmetic result. On the very rare occasion open surgery with ureteral reimplantation to the bladder is required in those patients with lower ureteral stones. We have seen 1297 patients with stones larger than 5 mm in the ureter during the last 7 years. Among those undergoing watchful waiting 82% were stone-free; and that was 2.4% of all ureteral stones. Among those 1258 patients whom required a treatment 82.1% underwent in situ ESWL and 74.5% of them were rendered stone-free. In 8.9% of the patients ureteroscopy was performed (50% primary, and 50% for failed ESWL) with a stone-free rate of 75.8%. Open stone surgery was required in 8.9%, and retroperitoneoscopic surgery for ureteral stones was performed in only 0.15% of all patients. The best form of treatment for a ureteral stone is watchful waiting and the patient passing the stone without any intervention. Although that is the best scenario, this is a very painful condition and unfortunately most patients require some form of treatment. While ESWL for upper and mid ureteral non-obstructing and non-impacted stones is highly effective, stones in the lower ureter can be successfully treated via ureteroscopy. There still are some patients who require open surgery and retroperitoneoscopic surgery can be an alternative for this subgroup of patients offering a less morbid and better cosmetic result.

Improvements in ureteroscope design and technique have led to increase the success of diagnostic and therapeutic ureteroscopy while decreasing morbidity. Most important complications have been categorized in the following manner: access complications, preoperative complications and early and late postoperative complications.

Objectives: Prognosis of patients who have been treated by radical prostatectomy, because of prostatic carcinoma, is dependent on a number of factors. In this study we try to determine these factors, their relationship with each other, their relationship with progression of disease and the prognostic value of this relationship.

Methods: "Progression" (or relapse) of disease is defined as clinical evidence of local or general recurrence and/or isolated elevation of postoperative PSA level more than 0.2 ng/ml (Hybritech) at two consecutive outpatient visits. In our institution, 62 radical retropubic prostatectomies were performed over a period of 66 months. Without any exclusion, these patients were included in the analysis (with respect to "progression"), which consisted of bi- and multivariate analyses, Kaplan-Meier estimations and multivariate survival analyses using the "Cox proportional hazards model". Median follow-up time was 32 months.

Results: "Progression" was seen in 24.5% of cases, after a median progression-free interval of 13 months. Overall survival and freedom from "progression" (FFP) after 32 months were respectively 98.11% and 81.11%. Significant relations can be demonstrated between on one side preoperative PSA level, and on the other side "progression". FFP after 32 months for pathological T3-T4NO-1 tumors is 67.12% compared to 100% for pathological T2 tumors; FFP after 32 months is 88.98% for Gleason score of resection specimen < 7 and 73.86% for Gleason score > or = 7. Age, preoperative PSA level, Gleason score of resection specimen, surgical margin and 1-month-postoperative PSA level have in our analysis significant value (p < 0.05) in predicting "progression".

Conclusions: Most in the literature described predictive factors for "progression" are fairly well reproduced in our analysis. Elimination of bias from applied (neo-)adjuvant therapy and less heterogeneity of the study group would most certainly improve this reproducibility.

Diagnosis of the stone is based on anamnesis, physical examination and radiological investigation. Anamnesis and physical examination need to be supported by knowledge of the neuroanatomy of the urinary upper tract. Radiological investigation should be both non toxic and effective. Gold standard radiological examination in the evolution of urolithiasis remains the echography. Urography leads to be replaced by helical scanner less toxic and more efficient. This review tries to present the different possibilities of investigations in the diagnosis of urolithiasis.

The pancreaticoduodenocystostomy has become the most acquired technique to perform a combined pancreas-kidney-transplantation. This operation shows some disadvantages. There sometimes are urological problems. In this article, we describe two patients, who showed urethral problems due to this operation. At the same time, we would like to describe the possible causes and the preferable treatment of this rare complication. We advise to start with a conservative treatment and, if problems persist, to consider an intestinal conversion.

Spontaneous retroperitoneal hemorrhage from the kidney was first described in 1700 by Bonet. Wunderlich gave his name to this rare syndrome in 1856. Up to now, 250 cases are reported. This disease entity is associated with an underlying pathology, which may be a benign tumor such an angiomyolipoma or a malignant tumor such renal cell carcinoma. We report two cases whose presenting features were those of this syndrome. We discuss the radiological characteristics including intravenous pyelography, renal angiography, computerized tomography and magnetic resonance imaging. Preoperative diagnosis is corroborated by surgical exploration and radical nephrectomy. We conclude in recommending computerized tomography as the examination of choice.