Journal d'urologie最新文献

We analyzed the results of our first 26 laparoscopic pelvic lymph node dissections performed in patients with cancer of the prostate and compared our findings with those obtained in a series of 16 laparotomy dissections. The two groups were comparable for plasma serum prostate specific antigen level (21.04 +/- 19 ng/ml vs. 29.3 +/- 12.8; p = 0.15 Student's unpaired t test), clinical stage at rectal examination and pathology stage. There was a significant difference in the number of post-operative days (4.3 +/- 2.45 days vs. 2.29 +/- 1.55 days; p = 0.025 Student's unpaired t test). The number of nodes removed was comparable (p = 0.35 Fischer exact test). Laparoscopic dissection of pelvic nodes is an interesting alternative to open surgery. Postoperative hospitalization is shorter and operative time is acceptable.

Between December 1991 and December 1993, 74 BPH patients with an increased operative risk and concomitant diseases such as diabetes mellitus and hypertension were submitted to a transurethral incision of the prostate (TUIP). After TUIP, patients were randomized to two different groups: group 1 was followed without additional treatment and group 2 received an LHRH analogue for the first 6 months of follow-up. With respect to transurethral resection of the prostate (TURP), TUIP has been shown to demonstrate a lower perioperative morbidity. This advantage has lent further support to this technique as a valid alternative for patients in poor general conditions who are at high risk with more invasive procedures. One of the limits of TUIP is the long-term effectiveness. Aim of this study was to ascertain whether in patients with BPH and an increased operative risk who require immediate and definitive treatment but with a low perioperative morbidity, the long-term effectiveness of TUIP can be stabilized by the administration of an LHRH analogue. At present postoperative follow-up ranges from a minimum of 24 months to a maximum 48 months (mean 38.4 months). Perioperative morbidity rate associated with TUIP was 8.1%. In the group randomized to combination therapy (TUIP + LHRH analogue), the clinical condition of the patients was not modified by LHRH analogue treatment and none of the patients withdrew from treatment. Loss of sexual potency occurred in all patients on LHRH analogue, however, none of these patients discontinued treatment for this reason. At the end of the cycle of hormone treatment, sexual potency returned to pretreatment values in 69.5% of patients after a mean of 3.2 months. In this study the objective efficacy of the treatment was evaluated using flow rate measurements, and the subjective assessment of outcomes, using the International Prostate Symptom Score. Statistically significant differences between the two groups (TUIP alone or TUIP + LHRH analogue) (p < 0.01) were reported at 6 months and were still maintained at 24 months of follow up. Results emerging from this investigation confirm that TUIP may be considered extremely safe procedure with low operative risk. In selected BPH patients who are at high risk, with a more invasive procedure and who must be submitted to immediate and definitive treatment, the association of an LHRH analogue seems to increase the long-term effectiveness of TUIP. Five year follow-up studies are still in progress.

Authors report on a case of emphysematous pyelonephritis in a woman affected with diabetes and renal failure. In order to avoid chronic dialysis, no nephrectomy was performed and the patient was treated only with drugs. Full recovery was obtained, without worsening of the renal function.

A retrospective study was conducted during 8 years to determine the epidemiological features of condyloma and its complications in patients attending urology consultations in Lomé teaching hospital. During this period, 257 cases (218 males, 38 females) of condyloma were diagnosed. The condyloma represented the fifth cause of consultation in urology, after genito-urinary infection (n = 1214), prostatic dysuria (n = 1095), vesicovaginal fistula (n = 849), lower tractus urinary lithiasis (n = 500). The average age of the patients was 28 years (range: 14-57). In 51 cases the condyloma were associated with others sexually transmitted diseases: 25 cases of gonococcal infection, 11 cases of chancroid, 9 cases of vaginal candidiasis, and 6 cases of genital trichomoniasis. We noted 41 cases of urological complications: 19 cases of urinary infection, 13 cases of retention of urine, 7 cases of urinary forked jet, and 2 cases of urethrorrhagia. The results of this study shows that, the condyloma is commun sexually transmitted disease seen in urology clinic. Its classically benign course in patients males, were predominant, in this sex, by the urinary infection and urological mechanical accidents.

We report our experience with Richter spinofixation in association with Bologna cervicocystopexy. Eighteen patients underwent surgery for voluminous prolapse. Spinofixation did not lead to complications. This technique allows a vaginal approach in cases where only an abdominal operation was possible before. Incontinence results were similar to those with the Bologna procedure alone with the additional improvement of allowing a permeable vagina. Currently mean follow-up is 13 months, but these encouraging results suggest that this association should be continued in the future.

On the basis of their importance for nephron-sparing surgery in tumors of the superior pole of the kidney, we analyzed 3-dimensional endocasts of the intrarenal structures. In 86.6% the superior pole was related to 3 arteries involved in its resection. Management of the superior (apical) segmental artery is in general simple as well as the ligature of the artery related to the anterior surface of the upper infundibulum. Ligature of the branch of the posterior segmental artery, that is related to the upper infundibulum, is critical due to the risk of injuring this segmental artery with loss of a great portion of renal parenchyma. The posterior segmental artery (retropelvic artery) is involved and must be preserved in all cases of superior pole resection. A retropelvic vein with its upper dorsal plexus was present in 69% of the cases. This vein must be previously ligated to provided safe management of the arteries during superior pole resection.

The authors report 5 cases of bladder herniation through inguinal ring. All the patients were males aged between 52 and 72 years with a mean of 63 years. The clinic symptoms were non specific. In four cases the diagnosis was made by IVP. In the fifth case the bladder herniation was discovered after an incidental opening of the bladder during a right inguinal hernia repair. Four patients were operated on for replacement of the bladder and repair of the hernial ring; the procedure followed was Mac Vay technique in two cases, Shouldice in one case and placement of a Mersuture prosthesis in another case. The fifth patient was operated on because of major constraint related to his general conditions. Results was quite satisfactory in all operated cases with a mean control of 24 months.

This retrospective study is concerned 28 patients hospitalized with acute obstructive renal failure at the department of nephrology in UHC Ibn-Rochd between 1988 and 1995. The objective of this study was to determine the clinical, étiological, therapeutical and evolutive aspects of the acute obstructive renal failure. It concerned 21 men and 7 women, their mean age is 52 years old. The main symptoms were anuria (85%) and lumbar pain (75%), the mean delay of consultation was 42 days. The diagnosis of the acute obstructive renal function and the presence of obstacle on the upper urinary tract. The obstacle was a stone in 19 cases, cancer in 8 cases and one case of retroperitoneal fibrosis was noted. Treatment of the cause was done whenever possible. Treatment was often palliative in the tumoral pathology. We observed 3 deaths (10.5%), 16 recoveries (58%), 6 cases of residual renal failure (21%), 3 cases of terminal chronic renal failure (10.5%) and 4 cases of recurrence. The lithiasic etiology of acute obstructive renal failure led to a high short-term mortality (15.5%), an effective etiologic causative treatment (69.5%) and a high rate or restoration of the renal function (69.5%). On the other hand, in the neoplastic etiology, there were no short-term mortality, but a frequent course to chronic renal failure.

Therapeutic approach to 36 children with blunt trauma of the kidney is reported. Generally, conservative attitude was applied. In case of type II or type III lesions, according to the Hodges classification, or when a urohematoma does not regress or worsens, we propose endoscopic drainage to avoid complications. Seventy percent of the patients, seen 2 years after the trauma, were free of complications. These patients will be reassessed again, many years after the initial trauma in order to determine the long-term results of this conservative attitude.