Journal d'urologie最新文献

In order to improve the results obtained by cystectomy alone and to determine the possibilities of conservative treatment in invasive bladder cancer, we designed a prospective study using a combination of 5-FU--Cisplatin and concomitant radiation therapy, followed either by cystectomy or additional chemoradiotherapy. Sixty six patients (pts) with T2-T4 operable untreated invasive bladder cancer were entered into the study. Treatment was begun in all patients by trans-urethral resection (complete in 30 pts) and followed by 5-FU-Cisplatin combination with concomitant bifractionated split course radiation therapy. The neo-adjuvant irradiation dose was 24 Gy delivered in 8 fractions over 17 days, according to a modified bifractionated split course schedule. Each fraction delivered 3 Gy, twice on day (D1, D3, D15 and D17. The patients received concomitant Cisplatin (15mg/m2/d) and 5-FU (400mg/m2/d) on day D1, D2, D3 and D15, D16, D17. A control cystoscopy was performed six weeks after completion of the neoadjuvant program. Patients with persistent tumor underwent cystectomy. Complete responders were treated either by additional chemoradiotherapy (group A) or cystectomy (group B). At control cystoscopy, 51 of the 66 patients (77%) had histologically documented complete response. Among the 51 patients with complete tumor regression 31 were treated by conservative chemoradiotherapy and 20 underwent cystectomy. With a mean follow-up of 35 months, five responders developed recurrent pelvic disease (4/31 in group A and 1/20 in group B). Metastatic disease, which developed in 22 patients, occurred more frequently in the non responders (93%) than in responders (16%). Disease free survival at 5 years was 51%; it was significantly better in responders than in non responders. There was no difference in survival between groups A and B. This neoadjuvant chemoradiotherapy combination, easy to implement and well-tolerated even in elderly patients, provides a high CR rate. It may prove to be effective in inoperable patients and may be proposed as conservative treatment in patients with a complete response to the initial course of chemoradiation.

Based on the experience of the treatment of 341 patients, applying transrectal hyperthermia, transuretral hyperthermia and TUT methods, the results in different groups of patients are assessed. Transrectal hyperthermia was used for the treatment of 40 patients with a first stage BPH, 39 patients with a first stage BPH combined with a chronic prostatitis, 34 patients with a second stage BPH combined with chronic prostatitis, 30 patients after acute urinary retention, 24 patients with suprapubic diversion. TUT was used in 54 patients, and TUMH in 46 patients with BPH. Conclusions suggest use of these methods for the treatment of BPH in general, and for complicated BPH in particular. It has been proposed that, provided these methods are properly used, they are most effective for patients after acute urine obstruction and suprapubic diversion.

Eighteen patients with stress urinary incontinence and normal maximal closure pressure underwent Burch procedure with pelvioscopy. A small (3 cm) incision is necessary to introduce the pelvioscope which allowed suture under visual control. Six month clinical results were 93% success and 7% improvement.

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.

We examined 67 adolescents aged 11 to 14 years referred for left varicocele. Atrophy of the testes was present in 38 (75%). Several techniques, including laparoscopic surgery were used. The best method appears to be ligation of the spermatic veins via an inguinal approach without touching the artery if possible. Recurrence (5%) is always caused by missing a vein. Growth of the testis occurred in all cases after treatment of the varicocele.

Peak flow rate data (Qmax) are important for diagnosis of lower urinary tract obstruction. However, the lack of uroflowmetry studies in children, makes their interpretation difficult. With this aim, we studied 167 boys classified in four groups according to their age (G1: n = 48, 6-7 years; G2: n = 43, 8-9 years; G3: n = 37, 10-11 years; G4: n = 39, 12-14 years). We studied in all children, weight, height, body surface area, peak flow rate (Qmax) and the correspondant urinary volume (Vol). Means and standard deviations of Qmax (ml/sec) were: 15 +/- 5 (G1), 15 +/- 5 (G2), 17 +/- 5 (G3) and 22 +/- 7 (G4) respectively. Corresponding urinary volumes (Vol) (mean standard deviation-in ml) were: G1 = 123 +/- 75; G2 = 122 +/- 79; G3 = 158 +/- 96 and G4 = 162 +/- 101. We found a significant correlation (p < 0,01) between Qmax and Vol in groups G2, G3 and G4; and between Qmax and height in groups G1 and G4. The authors demonstrated a positive correlation between maximum flow and voided volume, and an increase of Qmax with age.

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.