Journal d'urologie最新文献

Uretroprostatorectal fistulas occur rarely, often due to trauma or iatrogenic causes. We observed a case caused by a gun wound and present our surgical route for treatment. The deep situation of these fistulae explains the difficulty in surgical access. Several routes have been described. We used the posterior transanosphincter route proposed by York Mason. This technique has the advantage of direct access for the fistula. Success rate is high and morbidity is limited. No fecal incontinence has been reported in the literature.

Several, more or less successful, medical treatments have been proposed for idiopathic male infertility. We assessed the effect of high-dose FSH (150 IU) in patients with idiopathic oligospermia in comparison with patients given low doses. In the high-dose group, there was a significant rise in spermatozoid concentration (p < 0.0001), mobility (p < 0.0001) and morphology (p < 0.007).

Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.

Objective: Assess the surgical treatment of iatrogenic stenosis of the ureter.

Methods: Seventeen cases of iatrogenic stenosis of the ureter operated between 1991 and 1995 were reviewed. There were 10 women and 7 men, mean age 52 years with pelvic (n = 12), iliac (n = 4) and lumbar (n = 1) stenosis. Ten persons had ureterovesicular reimplantation, including 6 with psoic bladder, 2 with homolateral ureteroureterostomy and 5 with ureteroileoplasty. Mean follow-up was 24 months.

Results: Treatment was successful in 14 patients. There were 3 failures, 2 recurrences with reflux which were treated by reoperation with success.

Conclusion: Our results were in agreement with those reported in the literature. Classical surgery gives sur results in case of endourologic treatment of iatrogenic stenosis of the ureter.

Objective: To study efficacy of our diagnostic approach in patients with haematuria, as well as the information provided by the different tests.

Patient and methods: The computerization of our emergency department, and the study of the data base have permitted us to study retrospectively 722 cases of hematuria seen at our center over a period of 10 months. The relation between the benign or malignant etiology of the hematuria, and the presence or absence of associated symptoms and the intensity of the hematuria is shown, as well as the relation between the intensity of the hematuria and the decrease in the hemoglobin rates detected.

Results: Fifty eight percent of the 722 patients, 39% of them due to neoplasm. The intensity of had one symptom only hematuria was significantly superior in the patients with the final diagnosis of neoplams. The accomplishment of reactive strip, basic imaging techniques and urine sediment has permitted in our series to direct the diagnosis in 67.3% of patients. Cystoscopy has shown great efficacy in diagnosing the cases of monosymptomatic hematuria with normal radiological studies.

Conclusion: Monosymptomatic hematuria deserves a work-up to rule out malignancy. Reactive strip, urine sediment, KUB and ultrasonography allow to direct the diagnosis in most cases.

The authors report a retrospective study of 12 cases of urethral diverticuli in women, observed over 17 years (1977-1994) at the department of urology in Casablanca. The mean age was 40 years. The reason of consultation was iterative cystitis (10 cases), the perception of the diverticulum by the patient in 50% of cases. The clinical examination permitted the diagnosis in all the cases. Intra-venous pyelography and retrograde cystogram led to a better analysis of the diverticulum. All our patients have been operated on by a vaginal approach, the resection of the diverticulum being made in 12 cases. During follow-up, one patient presented a recurrence, and another has been admitted for dilatation of a meatal stenosis.

Nine female patients with a urethral diverticulum were admitted to our center over a six period: The clinical symptomatology was not specific. The diagnosis has been performed by voiding and retrograde cysto-uretrogram. The surgical treatment consisted in the excision of the diverticula, with the patient in the supine position. No perioperative morbidity was observed.

Endorectal surface coil magnetic resonance imaging (MRI) was used in the local staging of prostate cancer in 47 patients. We used an 1.5 Tesla General Electric magnet. Fast spin echo sequences were acquired in all cases. All pathological specimen were reviewed by one pathologist. Pathological study showed that 19 patients had a locally confined cancer of the prostate (pT2), and 28 had an extraglandular extension (pT3). MRI correctly predicted a pT3 tumor in 15 of 28 cases, and a pT2 tumor in 18 of 19 patients. MRI was 70% accurate in the differenciation of stage pT2 from stage pT3 cancer. One case was overestimated and 13 cases were underestimated. The latter 13 patients had microscopic extracapsular invasion only.

A case of paratesticular rhabdomyosarcoma in a 23 year-old patient is reported. Clinical signs are like any intrascrotal tumor. Scrotal ultrasound, CT scan and immunohistochemical markers are necessary for the diagnosis and stadification of this cancer. Orchidectomy followed by radiotherapy and/or chemotherapy is the usual treatment. Prognosis depends on the tumoral stage.

Thirty-three patients with azoospermia of apparently excretory origin underwent surgery for epididymis-deferens anastomosis and/or epididymal sperm puncture. Pathology examinations of the epididymal fluid and biopsies of the testicles or epididymis were performed at surgery. Based on the clinical presentation, sperm results and per-operative findings, patients were divided into six groups by etiology: idiopathic azoospermia (n = 5), post-infectious azoospermia (n = 15), agenesia of the excretory (n = 6) or secretory (n = 3) ducts, vasectomy (n = 2), and obstruction of the ejaculatory ducts (n = 2). Peroperative identification of spermatozoa at epididymal puncture or biopsy was statistically more frequent in patients with agenesis of the excretory ducts than in patients with post-infectious or idiopathic azoospermia. Biopsies of the testicle led to the diagnosis of secretory azoospermia in 3 cases and revealed a functional parenchyma in all the other groups of patients. Epididymis-deferens anastomosis was performed in 45% of the cases and was successful in 13%. Rate of fertility with the intracytoplasmic sperm injection was 33%; there was no difficulty in using fresh or frozen sperm. Clinical pregnancy was continued to term with frozen sperm. This study confirms that testicular function is preserved in excretory azoospermia. With or without epididymis-deferens anastomosis, epididymal spermatozoa can generally be preserved for later use. Couples should however be counselled on the delays to contraception which may vary from months to years.