Journal d'urologie最新文献

There are several therapeutic procedures for stenosis of the ureter. Ileal plasty is indicated in case of extended stenosis or those located in the pelvis when the poor quality of the bladder prevents use of a bladder flap. We report 6 surgical cases from 1977 to 1993, there were 4 women and 2 men, mean age 34 years. There was an inflammatory cause in 4 cases (tuberculosis or bilarziosis), retroperitoneal fibrosis in 1 case and idiopathic stenosis in 1. Radiographically, the stenosis was unilateral in the iliac area (3 cases), unilater in the pelvis (1 case) and bilateral and iliopelvic in 2 cases. Associated lesions included bladder injury with a small sclerotic bladder in 3 cases. Partial unilateral was used in 2 cases, bilateral U ileoplasty in 1 and ileouretero-cecocystoplasty in 3. Results were good in 5 cases with a follow-up from 2 months to 7 years. The patient with bilateral U ileoplasy without an antireflux procedure had massive bilateral reflux with renal failure and urinary infections. Ileoureteroplasty is indicated in case of extensive stenosis of the ureter. Results are good if an effective antireflux system is installed.

Moxisylyte chlorhydrate is a selective alpha-blocker of the post-synaptic alpha 1-adrenoreceptors. It has been used since 1992 for self-injections to induce erection. Tolerance has been studied in open trials in 143 men using 20 mg per intracavernous injection. Among these subjects, 104 were followed for 11 months. Self-administration was performed 7,509 times, i.e. 49.1 injections per subject over a mean period of 307 days. No severe side effects were observed. A total of 1,041 undesirable effects were reported by 90 subjects (75.1%), including mechanical disorders (28.2%) such as pain and burning sensation at injection, hematomas and ecchymoses. Nodules developed in 0.08% of these cases but always regressed. In 71.8% of the cases, the undesirable events was imputable to moxisylyte: dry mouth (2.73%), somnolence (1.9%), sinus congestion (0.71%). No case of priapism was reported. Long-term evaluation showed a reduction in the main undesirable effects with time. This fall off in the mechanical events could be explained by the subjects become for familiar with the technique. Pharmacological effects remain to be analysed. Added to the good tolerance, this result suggests that self-injection can be proposed as a first intention treatment for impotency.

Bladder leiomyosarcoma is a rare neoplasm. Early diagnosis, cystectomy, radiation therapy and chemotherapy seem to improve prognosis. The authors report one case of a leiomyosarcoma of the bladder in a seventy year old woman. There has been no evidence of recurrence after partial cystectomy, with more than a two-year follow up. Clinical, histological, therapeutic and prognostic aspects of this unusual tumor are discussed.

Small cell carcinomas of the prostate are rare. These tumors exhibit morphologic and functional neuro-endocrine characteristics. They are a highly aggressive. New therapeutic protocols are being developed in order to be effective against these tumors, particularly those unresponsive to hormonotherapy.

We report a case of bladder-renal reflux in a patient with hereditary single kidney who had undergone three previous surgical corrections. The reflux was treated by simple extravesicle reimplantation.

We opted for a symphysiotomy approach in the management of cervico-urethro-vaginal fistulae in two patients. This approach offers an excellent exposure of the region of the bladder neck. After section of the symphysis pubis with a Gigli's wire saw, the anterior wall of the bladder was taken down to the fistulae and we excised the fistulous tract. Longitudinal closure of the fistulae and the bladder followed. Results were satisfactory and there were no urinary incontinence.

Ex-situ protection of donor organs for transplantation with initial cold perfusion is routinely used. The superiority of the Histidin-Tryptophyn-Ketoglutarate solution (HTK) has been demonstrated in animal models and clinical use. On the other hand, nephron sparing surgery for surgical or functional solitary kidneys has been proved effective for many years. Due to widely used ultrasound and computerized tomography, the incidence of small renal tumors has increased. Therefore, new concepts in conservative renal surgery are gaining more popularity. In this study we report about 11 patients with renal masses in a functional solitary kidney. For the first time, all enucleations were performed with continuous in-situ perfusion with HTK-solution. Despite extensive tumors with central extension, complete in-situ tumor resection and kidney reconstruction were possible. There were no intraoperative complications. Postoperatively, one kidney was lost secondary to renal artery embolism. Urine production started within one hour postoperatively in all cases. No further patient needs haemodialysis. Postoperatively, renal function was largely unchanged except for a transient minor elevation of the serum creatinine. There were no changes of serum creatinine. There were no changes of serum electrolytes and no cardiac failures under HTK. The indication, the surgical procédures and the first clinical results of continuous in-situ perfusion with HTK-solution for conservative renal surgery are presented.

Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.

1. The indication for treating BPH can be established very precisely today. It is important to select the alternative procedures with a good workup for individual therapy. 2. A large volume prostate with proven obstruction is an indication for TURP or open prostatectomy, still the best choice of treatment with the best longterm results concerning all obstructive parameters. In future there may be less surgery due to the other possibilities but teaching and handling the gold standard should not be forgotten in using alternative techniques. 3. Especially for high risk patients there are minimal invasive methods so that a permanent catheter in a patient should be an exception. 4. Also with new medications we expect better results. Prostate selective alpha-blockers and reduction inhibitors probably also in combination of both may be sufficient therapy for many patients. It has to be examined whether minimal invasive instrumental treatments like transurethral thermotherapy can be compared with medication. The most important result of the discussion in the last years was improving the clinical workup for finding the indication for surgery. Too many new instrumental methods appeared at the same time and we are in a period of selection and investigation to know which technique can be compared with the gold standard of TURP. Also in using minimal invasive therapy the indication must be very clear because also the new techniques are not totally free from complications.