Three hundred and sixty nine extracorporeal lithotripsies for renal stones have been performed using the EDAP apparatus (ultrasound detection, piezoelectric destruction). In 7.1% of cases, the stone could not be located. By using low frequencies (1.25 to 5 cycles per second), extracorporeal lithotripsy was able to be performed in 82% of cases without anaesthesia and without premedication. 96.5% of patients treated have been followed and reviewed at one and three months: 169 (61%) cases were successful, 59 (21.3%) were partial results and 49 (17.7%) were failures. The best results were obtained in stones less than 20 mm in diameter. A poor result can only be improved by a second session of extracorporeal lithotripsy. The scintigraphic scars observed after high frequency extracorporeal lithotripsy were not observed when low frequencies were used. This new outpatient extracorporeal lithotripsy procedure without anaesthesia currently represents 79% of our primary indications in renal stones.
Five hundred and twenty six extracorporeal lithotripsies have been performed for renal and ureteric stones. Using low frequencies (1.25 to 2.5 cycles per second), extracorporeal lithotripsy was performed without anaesthesia and without premedication in 85% of cases. 91.9% of patients treated were followed and reviewed after one and three months: 292 (55%) were successes, 124 (22.5%) obtained partial results, 122 (22.5%) were failures. The best results were obtained in stones less than 20 mm in diameter. The results could only be improved by a second session of extracorporeal lithotripsy. Scintigraphic scars observed after high frequency lithotripsy and not observed after low frequency lithotripsy were again seen after renewal of the firing head.
Piezo-electric extracorporeal lithotripsy with ultrasonographic detection is performed with the following material according to the following technique: 1) A mobile firing head connected to the lumbar region by a simple inflatable cushion filled with sterile water. At the centre of the firing head, a 5 MHz real time transducer is used to locate the stone. 320 piezo-electric elements, arranged around the transducer, can induce, when focussed, a pressure of about 900 bars at the focal point in vitro. The focus is 15 mm X 5 mm. The generators are electronic. 2) The technique requires: understanding of ultrasonography in order to precisely locate the stone which, when it is intrarenal, is only missed in 1% of cases in our experience. Stones of the iliac ureter are not visible. Treatment requires the patient's confidence so that, due to the quality of the piezo-electric wave, no anaesthesia is necessary. The firing time should be relatively long (45 min to 1 hr) in order to ensure good fragmentation. 26% of patients require retreatment. Secondary complications are rare (3% of endoscopic treatments). The technique is now proposed in 90% of cases without admission to hospital. The simplicity of the manipulation of the apparatus must not mask the fact that it is a technique which requires perfect mastery. Only urologists familiar with stone pathology and who are able to treat the complications of lithotripsy by endoscopy or by surgery should perform extracorporeal lithotripsy.
An inquiry concerning the prevalence of urinary incontinence for the moroccan women has been archived about 1000 women aged more than 18 years to study prevalence, epidemiology and risk factors of urinary incontinence. 271 women among the 1000 women said that they had suffered from the mictional disorder at least one time during the last month, let 27.1%; 48.7% of the incontinent women are from 30 to 60 years; 22.5% are less than 30 years old, and 8.85% are more than 75 years old. Among these 271 women, 49.44% suffered from leakage after making an effort; 42.80% an imperiosity, and 7.76% spontaneous leakage. Seventy per cent among these women had level of study at least medium; 85.97% among these women suffered the discomfort; but 8.48% of them had been consulted for this disorder, 78.96% are able to consult a medical and to have a clinical or paraclinical exams. The elements who are responsible of this disorder are: menopause, parity, the use of forceps, the weight of first child birth over 3.5 kg, the perineal tearing. Among the medical antecedents we find: chronic bronchitis, urinary infections, chronic constipation, diabetes, and in the other way among surgical antecedents are: hysterectomy and prolapsus cure.
The authors report their experience of 1,126 cases of posterior vertical lumbar incision. The essential indication for this approach is stones in the renal pelvis or lumbar ureter (788 cases). The authors subsequently extended the indications for this incision to all plastic operations on the pyeloureteric junction (56 cases) and the extraction of certain staghorn calculi (114 cases). The posterior approach is anatomically simple and direct. It has the advantage of causing less muscular mutilation with a simpler postoperative course.
Between 1989 and 1996, 1,280 patients aged 41 to 100 years were operated for BPH. 70% of patients were treated at the stage of complications such as acute urinary retention, haematuria, bladder stones or renal failure. 549 patients (42.9%) were treated by transvesical prostatectomy (TVP), 668 patients (52.18%) underwent transurethral resection (TURP) and only 63 (4.92%) were treated by bladder neck incision (BNI). Early postoperative complications essentially consisted of infections: wound infection (15%), followed by vesico-cutaneous fistula (2%), epididymo-orchitis (0.7%) and urinary tract infection (1.5%). Late post-operative assessment revealed retrograde ejaculation in 100% of cases after transvesical surgery, 80% of cases after TURP and almost no cases (4%) after BNI. The permanent urinary incontinence rate was 1.18% after TURP and 1.0% after transvesical surgery. The shortest mean postoperative stay was 5 days in the BNI group versus 12.5 days after transvesical surgery. Finally, the postoperative mortality, essentially due to septic shock and myocardial infarction, was (0.8%). The BPH complication rate is proportional to the delay in diagnosis and management. Transurethral resection remains the most effective treatment with the lowest morbidity.
From 1979 to 1992, 101 radical cystectomy with caecoplasty were performed by the same operator (MR). Mean age of the patients was 62 years with a sex-ratio: 10 males/1 female. The indications were: Transitional Cell Carcinoma in 89 cases, neurologic bladder in 5 cases, interstitial cystitis in 3 cases tuberculosis bladder in 3 cases and lymphoma in one case. The operative mortality was 3% and postoperative morbidity was 8%. The surgical procedure consisted of performing a neo-bladder with ileocaecal segment. The technique of ureterocaecal implantation changed during the study period. On a functional point of view, 28 ureterocaecal stenosis were reported (15%). It were rare (2.4%) with the last ureterocaecal anastomosis technique. The diurnal continence rate was 100%. The nocturnal continence rate was only 25%. On uroflowmetric point of view, the detubularization permitted to obtain low pressure bladders with 15% rate of atonic bladder. Transverse taeniamyotomy of the caecum permitted to increase the uroflowmetric performance of the bladder without atonic risk. The 5 and 10 year overall actuarial survival rate were respectively 5% and 30%. Tumoral stage was a significant prognostic factor. An adjuvant chemotherapy was performed in 28 patients. The 5 year actuarial survival rate of the patients with a chemotherapy was 82% versus 28% for the patients without chemotherapy (p < 0.01). Caecocystoplasty after radical cystectomy was a reliable technique in our experience.
We report 108 cases of ureteropelvic junction obstruction corresponding 54 males and 48 females, with a mean age of 33 years. Pain was the commonest symptom. Delay in diagnosis was 3 and a half years. The diagnosis was made by IVP allowing our patients to be in different stages : Stage I (12 cases), stage II (39 cases), stage III (25 cases), stage IV (32 cases). We did not operate on 10 patients presenting with allow stage. 61 patients were operated by a conservative procedure : dismembered pyeloplasty (58 cases), YV pyeloplasty (3 cases). Nephrectomy was performed in 37 patients (34%). This high nephrectomy rate was due to be delayed in diagnosis.
The preoperative assessment required for the creation of a vascular access for hemodialysis is reviewed in relation to a series of 104 patients. The immediate or early failure rate works out at 11%, which is in line with the experience reported in the literature for other series. Emphasis is laid on the good results that can be obtained in polycystic disease, an on the difficulty of creating an access in patients under continuous ambulatory peritoneal dialysis. The preoperative management of patients with chronic renal insufficiency is also discussed.
The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.
110 patients presenting with a prostatic adenoma sufficiently symptomatic to be treated medically, but not requiring surgical management, were included in a controlled test whose effectiveness was assessed after one month on the basis of objective criteria (nocturnal pollakiuria, urinary output, postmictional residue) and subjective criteria (dysuria, patients' opinions). PA 109 appeared significantly more effective than a placebo, especially in the objective criteria (p less than 10(-9]. Perfectly tolerated, clinically and biologically, this efficacy was again found in a supplementary study of forty seven patients, with a mean follow-up of 14.6 months, and over 2 1/2 years in some cases. Under the study conditions, and on the basis of the study criteria, PA 109 seems a good treatment for mictional disorders associated with non-surgical adenomas of the prostate.
In eleven patients with impassable urethral stenoses, we attempted retrograde catheterisation with an angiographic guide under fluoroscopic control. The stenosis was able to be negotiated with the guide in 10 cases (91% success). After dilatation by dilators (coaxial or rigid) or by Olbert's angioplasty balloon, we were able to introduce a Foley catheter into the bladder. The only failure was caused by a very marked separation of the two ends of the urethra due to trauma. This simple and effective method constitutes an alternative to immediate surgical treatment of endoscopically impassable urethral stenoses.
Eleven patients with stenosis of an uretero-ileal anastomosis following Bricker's operation underwent endoscopic dilatation of these stenoses via an inferior approach with Eder-Puestow's apparatus or Savary's dilators. The preliminary results were favourable in 7 patients with clinical, endoscopic and radiological improvement. An uretero-ileal drainage catheter was inserted in each case and was changed regularly after the operation. In one patient, a stone trapped in the anastomosis was able to be removed via the endoscopic procedure. No complications were observed. The two technical failures required surgical re-operation in one case and dilatation via a superior approach with an inflatable balloon catheter. This technique demonstrates the value of gastrointestinal endoscopy in the treatment of certain complications in patients with a urinary diversion using a segment of the intestinal tract.
The authors report their experience of 11 cases of renal angiomyolipoma over an interval of 20 years, observed in 10 women (90.9%) and one man (9.1%) with a mean age of 46 years (range: 21 to 63). Clinical symptoms were dominated by loin pain (100%), haematuria (45.4%), lumbar mass (72.7%), fever (18%). In one woman, AML was associated with "tuberous sclerosis". Preoperatively, the diagnosis was established by ultrasound and CT scan in 45.4% of patients. The size of the tumour varied from 7 to 14 cm in 10 patients and in one patient was only about 3.6 cm. Two women had bilateral tumours. Treatment consisted of total nephrectomy in 7 patients, partial nephrectomy in 3 patients and tumourectomy in one patient. The purpose of this study is to analyse the epidemiologic, diagnostic and therapeutic aspects of this disease.
The authors report a series of 11 urethrorectal fistulas observed over a 25-year period. The mean age of the patients was 37 years (range: 15 to 70 years). The aetiologies were surgical trauma (5 cases), fracture of the pelvis (2 cases), inflammatory lesions (3 cases), and one fistula was congenital. The clinical features were dominated by urine discharge from the anus (11 cases), urinary tract infection (8 cases), spurious diarrhoea (6 cases), faecaluria (4 cases), pneumaturia (2 cases). Digital rectal examination was normal in 7 patients. IVU demonstrated opacification of the rectum in 5 out of 8 cases. Cystourethrography, performed in 9 patients, demonstrated the communication in each case. Urethrocystoscopy visualized the fistula in each case in which it was performed. Treatment consisted of bladder drainage by urethral catheter in all patients, allowing closure of the fistula in 2 patients. Colostomy was performed in 2 patients, internal urethrotomy and urethral catheter was performed in 2 cases. Surgical closure of the fistula was performed in 7 patients, via an abdominoperineal (3 cases), perineal (2 cases), transperitoneal (1 case) or transanosphincteric incision (1 case).
The primitive retroperitoneal tumors are tumors which diagnosis isolate and thus the prognosis is poor. The authors assess the resectability of these tumors and the therapeutic results. We performed a retrospective study during 5 years, 11 patients were reviewed, in the unit of visceral surgical emergency of UHC Ibn-Rochd in Casablanca. The median age was 44 years old. The revealing signs were pains (67%), abdominal mass (54%), and compressive signs in 78%. The diagnosis was based on the computerized tomography in 10 cases (90%), the ultrasound sonography in 3 cases, and the IVU in 3 cases when it was necessary. The treatment was surgical in all cases. The resection was curative in 58%, 1 patient received chemotherapy. Histologically, the mesenchymatous variety was the most frequent (68%) and almost malignant (80%), the ectodermic origin was noted in 3 cases, and the vestigial in 1 case. The long-term follow-up was characterized by recurrence in 4 cases and 3 patients were lost to follow-up. The prognosis of the primitive retroperitoneal tumors is poor, because of a late diagnosis, and the malignant, and recurrent potential of these tumors.
Analysis of this series of cases reveals the following points: complementary investigations (computed tomography, magnetic resonance imaging) sometimes suggest the diagnosis, the oncocytic nature is often a surprise pathological finding, it is difficult to determine whether the lesion is a pure oncocytoma and the exact grade cannot be determined on frozen section, the choice between radical surgery and conservative surgery is made even more difficult, the study of the course of the disease raises the question of whether the term of oncocytoma should not be reserved to low grade tumours.
The authors report the case of a 35-years-women with a thoracic disc herniation, who presented with seven years history of episodic acute ureteric colic. An early diagnosis of a spinal disc herniation was made difficult by the absence of neurological findings. Imaging studies showed no lesion in the genito-urinary tract. Magnetic resonance imaging demonstrated a postero-lateral disc herniation at T10-T11 level. The pain disappeared immediately after surgery decompression. A literature search showed that acute ureteric colic associated with a lower thoracic disc herniation has not been previously reported.
Nephrectomy in childhood is an ultimate indication. It is realised in case of severe deterioration of the renal function or neoplastic affection of the kidney. We report a retrospective study on a series of 80 patients. Mean age was 5 years with extremes from 2 months to 14 years. Abdominal mass, pain, infection and haematuria were the mostly encountered revealing symptoms. The main aetiology was nephroblastoma. No laparoscopic nephrectomy was realised. Follow-up was uneventful except for the troubles existing prior to surgery.
The diseases ectopic kidney is a rare malformation. It can be associated with other urological or nonurological malformation. We report 11 cases observed between 1980 and 1998. They were five females and six males with a mean age of 28 years. The clinical symptomatology was dominated by pain and urinary symptoms. Diagnosis was based on the IVP data and ultrasonography. Renal stone and hynronephrosis were each associated in five cases and one patient had renal stone associated with hydronephrosis. The treatment consisted on a iliopelvic approach and extraction of the stone and or pyeloplasty. In three cases a nephrectomy was realised for muet kidney or pyonephrosis. The outcome was good in ten cases and one patient had a pyelo-ureteral secondary stenosis managed by endoscopy.
The authors report on their experience with high energy radiation therapy in early-stage (I/II) carcinomas of the prostate. Among 191 cases of biopsy-proved carcinomas of the prostate, there were 111 stage I and II tumors, including 83 T1, T2 intracapsular tumors. 78 of the 111 patients received curative radiation therapy. Delivered doses did not exceed 65 to 70 grays to the prostate and 50 grays to the pelvis. High energy radiation was used. Extension of the lesions was determined using lymphography, abdominal and pelvic CT, and surgical removal of lymph nodes. Among the 78 irradiated patients, success rates at five years were 65% for the 52 T1-T2 tumors and 38% for the 26 T3 N0 tumors. Selection of patients, technical conditions and long term results are discussed, as well as the problems met in determining the stage of the tumor accurately. High energy radiation therapy can control localized carcinomas with a satisfactory quality of survival.
The authors discuss the vesicovaginal fistulas seen at the Central Hospital in Yaounde. Rectomyoplasty was widely used for treatment. Fortunately, public health policies have succeeded in reducing the incidence of this condition.
The demand for the reversal of vasectomy in the treatment of sterility has been increasing over the past decade. Microsurgery is acknowledged to be the best non-traumatic procedure for this reconstruction. This article reviews 115 patients treated by microvasovasostomy over a period of six years. Evaluation of the results shows 76% of patients with a positive seminal analysis, and 52% informed the authors that their partners were pregnant. In addition to the technical aspects (i.e. the non-traumatic manipulation of tissues using microsurgical procedures) the titer of antisperm bodies in the patient's serum and seminal plasma seems to play some part in the recovery of fertility.
We have reviewed the first 116 cases of uretero-renoscopy using rigid ureteroscopes. Procedures were done for either diagnostic or therapeutic purposes (27 and 2 respectively), and for stone manipulation (87). The overall success rate for stone removal was 73%. The success rate for removal of stones the proximal two-thirds and distal third of the ureter were 38% and 83% respectively. Stones larger than 10 mm. Were successfully removed in 64% of cases. In 13 cases (11%), ureterolithotomy was necessary to successfully remove the stone. Diagnostic ureteroscopies for pathology of the ureter were 100% successful. The factors which affected success and failure rates, e.g. stone size, stone composition, ureteral abnormality and operator experience are delineated.
Ureterovesical junction dysfunction in congenital or acquired neurogenic bladders represents a threat for the renal parenchyma. In order to evaluate the incidence, mechanisms of development and preventive and curative treatments proposed in diseases of the ureterovesical junction associated with neurogenic bladders, the files of 119 children were retrospectively evaluated. 68 patients suffered from congenital neurogenic bladder and 51 had an acquired neurogenic bladder. In the congenital neurogenic bladder group, vesico-ureteric reflux was observed in 22 cases (32%) and dilatation was observed in 18 cases (26.5%), while 21 patients had both dilatation and reflux. In the acquired neurogenic bladder group, reflux was observed in 8 cases (16%) and dilatation was observed in 3 cases (10%), one of whom had both reflux and dilatation. The predominant mechanism of decompensation of the ureterovesical junction in the two groups was a combination of low compliance and high peripheral resistance. In patients with abnormalities of the ureterovesical junction, the incidence of associated parenchymal lesions was similar (30%) whether neurogenic bladder was congenital or acquired. The disparities between these two comparable patient groups, the preventive and curative treatments proposed and their results are analysed in comparison with the data reported in the literature.
During the last 4 years, we have performed 1200 renal scintigraphies in children under the age of 6 years: 57% of dynamic renal scintigraphies using MAG3 for antenatally diagnosed uropathies (mainly pelvic dilatations and megaureters), 36% of static renal scintigraphies using DMSA for renal sequelae of pyelonephritis with or without vesicoureteric reflux, and 6% of direct isotope cystography for follow-up of vesicoureteric reflux. Renal scintigraphy, which provides low radiation hazards (1 mSv), is now a major imaging modality for paediatric urinary tract disease.
With the improvement of laparoscopic techniques in the hands of urologists, a minimally invasive therapy can be offered to patients. We report retrospectively our experience in the laparoscopic treatment of varicoceles. A total of 93 patients with 129 varicoceles were treated by a laparoscopic approach, the mean age was 29 years (12-47), with 57 left varicoceles and 36 bilateral varicoceles. Indications for treatment were infertility in 51 patients and pain in 42 cases. The mean duration of the operation was 40 min (25-85) for bilateral varicoceles, and 24 min (15-65) for left varicoceles. All our patients were operated the day of their admission and 52 patients left the hospital 8 h after the intervention. We report 2 incidents with conversion to open surgery in one case. The pregnancy rate after surgery in patients with infertility was 21%, the recurrence rate was 4%. Laparoscopic spermatic vein ligation in the treatment of varicocele is a minimally invasive procedure, simple, fast and is not a contraindication for other procedures in case of recurrence.
The authors report a series of 13 horseshoe kidneys observed over a 22-year period. All patients are men with a mean age of 39 years (20-65 years). The clinical features were dominated by abdomino-lumbar pain (nine cases). The horseshoe kidney was associated with renal stones in nine cases, uretero-pelvic junction syndrome in five cases and pyonephrosis in one case. The specific anatomic and surgical features of this rare malformation are emphasized and the therapeutic features of each uropathy associated with horseshoe kidney are discussed.
We report a series of 13 infants with failed surgery for pyeloureteral junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either re-fashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ. Of the 258 surgically treated, 232 (90%) had a post operative course without complication or need for reoperation. The failure rate was significantly higher in infants operated before the age of 4 months (8/65: 12.3%) when compared with those over 4 months of age (5/193: 2.59%). The use of postoperative drainage via a nephrostomy significantly reduced the percentage of early complications (e.g. fistula) but did not affect the final failure rate. The severity of the obstruction at presentation correlated with a bad outcome after reoperation. Of the cases which resulted in failure after reoperation (7/258: 2.7%) all occurred in cases of severe obstruction with parenchymal damage. While the failure of surgery is often evident early (persistent fistula, urinoma, non functioning kidney on IVP) this may only become obvious some years later. Reoperations were successful in half of the cases irrespective of the time between the initial operation and the reoperation. Long term follow up of all infants operated for PUJ obstruction is recommended.
Thirteen patients were operated for bladder carcinoma, from November 1987 to September 1988, using a Camey type II low pressure ileal bladder replacement. Clinical, radiological and urodynamic findings were studied. Diurnal continence was always acquired at three months. In terms of nocturnal continence, only 75 percent of the patients are comfortable, while two patients require oxybutinin to remain continent. Urodynamic exploration showed a low pressure in 8 patients, but a high pressure peak in 4 patients. Radiological study showed integrity of the urinary tract. This work confirmed the improvement obtained with the Camey II procedure. Nevertheless, it also shows the failure of the method with occasional high pressure peaks. We think that a more anatomical bladder reconstruction, such as Hautmann Pouch, may improve the results for nocturnal continence. This needs to be confirmed by a comparative study.
We report 13 cases of renal oncocytoma. Urinary symptoms occurred in only 3 cases. The patient's age ranged from 41 to 74 years with an average of 62.3 years. The mean tumor diameter was 5.6 cm (range: 1.5-14). Diagnostic features of ultrasonography, CT scan and, in some instances, angiography were suggestive of renal oncocytoma in 2 patients, but never affirmative, 4 patients were treated by partial nephrectomy. No local or metastatic recurrence was observed with a mean follow-up of 30.8 months, ranging from 6 to 96 months. We assume that the term renal oncocytoma should be restricted to tumors exclusively composed of regular oncocytic cells with an eosinophilic granular mitochondria-rich cytoplasm and an absence of malignant potential. Diagnostic imaging characteristics may sometimes suggest the diagnosis of renal oncocytoma, but cannot eliminate the main differential diagnosis, i.e. granular renal cell adenocarcinoma. When the tumor is small and unifocal, nephron sparing surgery may be considered. Whether or not the diagnosis has been confirmed by fine needle aspiration, conservative surgery must be controlled by intraoperative frozen sections of the tumor and surgical margins.
The pelviureteral junction upon a horse shoe kidney remains a frequent congenital malformation. The authors report 13 cases collected during a period of 16 years and treated surgically. The review of literature permits to discuss the different therapeutic means.
All urinary stones should undergo detailed studies to identify those related to drug therapy. Among 520 stones analyzed by infrared spectrophotometry, we found 13 drug-induced stones (13/520: 2.5%). Drug-induced stones were caused by glafenine in 7 cases, piridoxylate in 4 cases, triamterene in one case and an unknown organic compound in one case. Glafenine stones appear to develop more readily in infected urine. Triamterene stones are often associated with uric acid disorders. Piridoxylate induces the formation of glyoxylate which is responsible for hyperoxaluria and formation of oxalocalcium stones.
The authors report on thirteen patients who developed a variety of symptoms after transurethral resection of the prostate; confusion, seizures, blurred vision with mydriasis, nausea and vomiting, bradycardia, and hypotension. This post-resection syndrome is caused by resorption of a large amount of the hypotonic solution used during the surgical procedure and containing 1.5% glycine. Postoperative sodium levels were assayed in all patients and consistently found to be low (105 to 124 mEq/l). Serum glycine was measured in three patients and the very high levels found suggest that absorption of glycine during transurethral resection of the prostate may contribute to the symptoms of encephalopathy.
Endovascular sclerosis of the spermatic veins would seem to be the first step in the management of varicoceles, if these are considered to be responsible for hypofertility. In a series of 132 cases, the success ratio was 94 per cent on the right and 96 per cent on the left. The recurrence rate of 2 to 4 per cent would seem lower than in the case of surgical treatment (6 to 10 per cent). Moreover, the social and economic price of this ambulatory treatment is far lower. Surgical management would thus seem only indicated in the event of failure, and in the event of anatomical variations in the veins.
The results of 134 patients who underwent 150 treatments with the EDAP lithotriptor are reported. The first patients were treated with a frequency of 150 Hz under general anesthesia, with a success rate of 64%. In order to decrease the pain induced by the shocks waves, the frequency was lowered (20 Hz and 10 Hz), so that treatment could be performed under neuroleptic analgesia. The success rate was respectively 84% and 90%. A second treatment was required in 11% of the patients and 9% have undergone auxiliary endoscopic manoeuvres preoperatively. Morbidity was extremely low with only 3% of ureteral obstruction. The gradual reduction of anesthesia constitutes an advance in lowered morbidity and costs; in addition, the possibility to repeat the treatments makes the management of complex lithiasis easier.
Glandular, coronal or penile hypospadias is a more complicated disorder than at first sight appears. This article reviews 135 cases, and discusses the constituent elements-meatal ectopy, with or without meatal stenosis, ventral penile curvature, skin chordee and webbed or twisted penis. No urethroplasty was performed in twenty two boys with glandular or coronal meatus, the treatment being by circumcision or preputial plasty. Of the 113 patients undergoing urethral repair, 91 (80.5%) suffered from no complications in the postoperative course, but 22 (19.5%) developed complications. The most common was a urethrocutaneous fistula (16). Thirteen of these were successfully closed in an additional operation. Six patients developed meatal stenosis or urethral strictures (5.3%), and were treated by meatal dilatation (4), meatostomy (1) or endoscopic urethrotomy (1). The overall results of one-or two-stage urethroplasty, with or without further surgical treatment for fistula or stenosis, were good or very good in 96.5% of cases. We approve the present trend towards one-stage repair, using Mathieu's technique for distal penile hypospadias without penial curvature, Duckett's technique for all medial or proximal penial hypospadias, or for distal penial hypospadias with chordee, or MAGPI for glandular or coronal hypospadias. The best age for surgical treatment must be decided in the light of technical requirements, psychological stress factors and schooling. The authors advocate the performance of a single-stage operation at around three years of age, in order to limit the psychological stress arising not only from the disorder, but also from the need for hospitalization, which should therefore be kept down to the minimum.
The author reports a case of primary mega-ureter in a 14 year old girl, associated with a familial polycystic disease of the kidney. This association has no incidence on the surgical management of the mega-ureter. The operation consists in a ureterovesical reimplantation by a transvesical approach after remodelling of the ureters, using Hendren's procedure.
We report a new case of renal cancer in the context of Von Hippel Lindau (VHL) disease in a 14-year-old girl. To our knowledge, this is the youngest case reported in the literature. VHL disease is now well known and its prognosis is related to renal cancer, which occurs very early in the patient's life, requiring adequate surveillance of patients carrying the VHL gene to ensure early diagnosis of the cancer, screening of family members and treatment, preferably conservative when permitted by the size and number of tumours, in these patients who are predisposed to developing other renal tumours, in order to delay bilateral nephrectomy and the need for dialysis or even transplantation, to a maximum.
A study of fourteen cases of Peyronie's disease with an evaluation of the hemodynamics of the erectile function shows that erectile dysfunction, as a complication, is mainly due to abnormal venous drainage from the corpora cavernosa. This article discusses the therapeutical conclusions to be drawn, in the light of the results of seven operations.
Bladder exstrophy and epispadias with incontinence are associated with urinary tract and genital anomalies. The genital and sexual aspects were studied in 14 adolescent or adult males (12 exstrophies and 2 epispadias). The appearance of the penis was satisfactory in fifty percent of cases. Erections were always preserved but normal ejaculations were present in only one half of cases. Fertility potential was reduced. The improvement of surgical technique, and especially penile lengthening, has greatly improved sexual intercourse for these patients.
Cystoplasty is the ideal method of bringing back normal urinary flow after cystectomy, and the authors have used this procedure in fourteen cases. The cecum is mobIlized with its vascular pedicle. Bowel continuity is readily and safely restored with the aid of suturing forceps (TA 55, GIA). The cecum is carefully cleaned of all fecal matter. Two UCN join the ureters and the cecum, to which the trigone, the cervix vesicae, or the prostatic or membranous urethra is anastomosed, depending on the case. Three benign cystopathies, four recurrent diffuse papillomatoses and seven vesical carcinomas were treated in this way, with excellent results.
Prior to the introduction of antibiotics, the treatment of pyelonephrosis frequently consisted of nephrectomy to remove the non-functional kidney, which was a potentially dangerous source of systemic infection. This approach was later modified as a result of the advances made in antibiotic therapy, and included vigorous antibiotic treatment and prompt drainage of the kidney. At present, percutaneous nephrostomy provides a means of draining off the pus and determining a possible residual renal function. In this study, 14 cases of pyonephrosis were observed over a 7-month period. Lumbar pain was noted in 70% of cases, painful lumbar contact in 5 cases and fever, shivering and pyuria in all cases. Cytobacteriological urine analysis showed the presence of Escherichia coli in 7 patients, Proteus in 4 patients, and in 3 cases abacterial leucocyturia; in 2 patients with only one functional kidney, renal insufficiency was observed. In all cases, the diagnosis was confirmed by ultrasonography. The main etiological factors were urinary lithiasis in 10 patients (71%), followed by uropathy of the pyeloureteral junction in 4 patients (29%). Treatment consisted of primary nephrectomy in 10 cases; in 3 cases, primary nephrostomy was performed with a positive outcome and recovery of renal function in 2 subjects; in one case of renal failure treated by nephrostomy followed by conservative surgery, the patient did not survive. In conclusion, nephrectomy is advocated as the treatment of choice in the case of a damaged kidney and a normal contralateral kidney. Conservative treatment should be envisaged particularly in the case of a single kidney, or if the patient's state of health is poor. The best treatment consists of the detection and cure of the lithiasis which is the main etiological factor in this pathology.
The authors report 14 cases of squamous cell carcinoma of bladder over a period of 20 years. All patients were male, with a mean age of 56 years. A history of urogenital bilharziasis was reported in 2 patients and 10 patients were smokers. Hematuric cystitis was the commonest presenting feature and infiltration of the bladder base was detected on rectal palpation in 10 patients. The patients consulted late in the course, at the stage of upper urinary tract repercussions (11 cases) and computerized tomography showed locoregional extension in 5 cases. 12 total cystoprostatectomies were performed and 2 patients were treated exclusively by radiotherapy. The long-term course was marked by urethral recurrence in 3 patients. The etiopathogenesis, diagnosis, treatment and clinical course of these tumors, which are often aggressive, are reviewed.