[Laparoscopic spermatic vessel ligation in the treatment of varicocele: report of 129 procedures]. / La ligature sous coelioscopie des vaisseaux spermatiques dans le traitement de la varicocèle: à propos de 129 interventions.

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.

Megapenis associated to corpus spongiosum agenesis with scrotal and pelvic hemangiomas.

An exceptional case of megapenis associated with corpus spongiosum agenesis and multiple hemangiomas of the scrotum, perineum and pelvis is reported. This is the first case in which three exceptional malformations are associated.

Combination of ballistic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia: report of 120 cases.

PURPOSE: We report our experience with the combination of ballistic lithotripsy (BL) and transurethral resection of the prostate (TURP) in 120 patients with benign prostatic hyperplasia (BPH) and bladder stone(s). PATIENTS AND METHODS: The mean stone size, appreciated by measuring the greatest diameter, was 18.5 mm (range 10-80 mm). The mean prostate volume was 35.4 cc (26-62 cc). All procedures were monitored under direct endoscopic control with a videocamera. RESULTS: Lithotripsy and evacuation of fragments was performed in an average time of 27.5 minutes (10-80 minutes). The only intraoperative complication was mild hematuria in 38 patients (32%), which did not affect vision for TURP. The mean resection time was 42 minutes (range 15-65 minutes). Four patients experienced mild postoperative bleeding, and one patient had clot retention. The mean hospital stay was 1.2 days (range 1-4 days). CONCLUSIONS: Combined BL and TURP is effective, safe, and economical.

Hydatid cyst of the kidney. A report of 147 controlled cases.

OBJECTIVES: We report our experience in the management of 147 hydatid cysts of the kidney over an 11-year period. MATERIAL AND METHODS: The records of 147 patients operated for hydatid cysts of the kidney between 1985 and 1996 were reviewed in order to address patient's symptoms at presentation, radiological findings, diagnostic tests and surgical outcome. All patients were managed with open surgery. No preoperative or postoperative antiparasitic medication was used. RESULTS: Lumbar or lumbo-abdominal pain was the most frequent symptom (84%). Hydaturia was observed in 28% of the cases. Preoperative diagnosis was based upon intravenous pyelography (IVP), ultrasound and serology tests. CT scan was performed only in litigating cases (15%). In 20 cases, damage to the renal parenchyma was so extensive as to justify nephrectomy. Abstention concerned 5 involutive type V cysts. The remaining patients had an excision of the prominent part of the cyst (partial cystopericystectomy). Postoperative course was smooth in all cases. Postoperative IVP (3-6 months) showed a restituo ad integrum in 80% of the cases and residual pelvicaliceal distortions in 20%. CONCLUSIONS: Diagnosis of hydatid cyst of the kidney is based mainly on ultrasonography and IVP. Open surgery is the treatment of choice with excellent results.

[Ambulatory urological surgery]. / La chirurgie urologique ambulatoire.

Ambulatory surgery offers to patients to be treated on an outpatient basis. Strict criterious, social, surgical and medical must be associated to authorize this type of hospitalisation. From January 1998 to December 1999, 1882 patients (46% of our operative activity) were treated on an outpatient basis, to undergo an endoscopic surgery (66%), conventional surgery (20%) or other (14%). 9 patients remain a supplementary night because of post-operative fever in 5 patients and an incomplete recovery in 4 patients. No patient was rehospitalized for complication. In this series, ambulatory surgery has proved its advantages, without loss of patients' security, if selection criterious were respected.

[Periurethral injection of silicone microparticles in the treatment of sphincter deficiency urinary incontinence]. / Injection périurétrale de microparticules de silicone dans le traitement de l'incontinence urinaire par insuffisance sphinctérienne.

OBJECTIVE: To assess the mid-term efficacy of periurethral injection of silicone micro-implants in women with urinary incontinence due to intrinsic sphincter deficiency. MATERIAL AND METHODS: Between July 1992 and March 1999, 25 women (mean age 65.17 +/- 13.5 years) with intrinsic sphincter deficiency underwent periurethral injection of silicone micro-implants. Urodynamic investigations were performed prior to and after surgery. The subjective degree of continence was also assessed for 3 years. RESULTS: Subjective success rate were 80%, 72%, 65%, 60%, and 60% at 6 weeks, 3 months, 6 months, 1 year and 3 years, respectively. Post-operative maximum urethral closure pressure was significantly increased (post-op 32.35 +/- 18.04 cm H2O versus pre-op 23.68 +/- 9.4 cm H2O; P < 0.01) No serious operative or postoperative complication occurred. CONCLUSION: In spite of time-dependent decrease in success rate periurethral silicone micro-implants injection remains an effective and safe procedure for women with urinary incontinence due to intrinsic sphincter deficiency.

[Repair of urethrocutaneous fistula with double skin flap. Report of 32 cases]. / Réparation des fistules uréthrocutanées par double lambeau cutané. A propos de 32 cas.

OBJECTIVES: Urethro-cutaneous fistula constitutes the main complication of urethroplasty for hypospadias. The frequency of this complication ranges from 12 to 90%. The multiplicity of fistula closure techniques, reflects the difficulty involved in repairing these lesions. The authors evaluated fistula repair by a double pedicle skin flap according to the Wise technique. MATERIAL AND METHODS: 32 patients were treated: 18 had already undergone 34 attempted repairs of urethro-cutaneous fistulas complicating urethroplasties (9 Mathieu, 17 Duplay and 6 Leveuf) for anterior penile (9), middle penile (14) and penoscrotal hypospadias (9). In 14 cases, the Wise technique was the first procedure used to repair the fistula. RESULTS: The authors obtained 29 successes. The 3 failures concerned fistulas after Duplay urethroplasties to correct penoscrotal hypospadias. The overall success rate of this technique in our series (90%) was therefore close to that reported by Wise (5 out of 6 successes), who described this technique in 1977. CONCLUSION: The Wise technique is a good technique for repair of large, recurrent urethro-cutaneous fistulas after several attempts of repair.

[Bladder pheochromocytoma]. / Le phéochromocytome vésical.

OBJECTIVE: Report of a new case of a rare bladder tumour: bladder phaeochromocytoma. MATERIAL AND METHODS: A 45-year-old patient presented with paroxysmal symptoms consisting of headaches, palpitations, tinnitus and excessive sweating after each micturition. Complementary investigations: ultrasonography, intravenous urography and magnetic resonance imaging, suggested a circumscribed tumour with a 2 cm long axis in the bladder dome, and the diagnosis of bladder phaeochromocytoma was proposed. Partial cystectomy was performed. RESULTS: The postoperative course was uneventful and the subsequent outcome was favourable with resolution of all symptoms with a follow-up of 28 months. Histological examination of the operative specimen confirmed the diagnosis of bladder phaeochromocytoma. CONCLUSION: Bladder phaeochromocytoma is a rare tumour. Treatment of this lesion requires the same preparation as for any other site of phaeochromocytoma. Partial cystectomy ensures radical and effective treatment. Long-term surveillance is necessary, as recurrences or metastases have been described 20 and 40 years after treatment.

[Management of percutaneous nephrolithotomy complications by shock wave lithotripsy. A report of 82 consecutive cases]. / Prise en charge des complications de la néphrolithotomie percutanée par lithotritie balistique. A propos d'une série de 82 NLPC consécutives.

In this paper, authors assessed the complication rate of percutaneous nephrolithotomy (PCNL) through a consecutive series of 82 PCNL performed on 80 patients with renal calculi (48 men and 32 women). Patients' mean age was 42 years. Stones were located in the pelvis or lower calyx in 75% of cases with a diameter exceeding 20 mm in 56%. 11 Patients had intraoperative problems: one ureteral false passage, one renal perforation by a ureteral stent, three cases of hemorrhage, three cases of punctate perforations of excretory cavities. In one case, nephrostomy tube fell and could not be replaced. 6 patients had post operative complications: three patients had postoperative fever, one patient developed acute pyelonephritis and two patients had transient urinary leakage after nephrostomy tube removal. After reviewing the literature, authors conclude to the low complication rates of PCNL.

[Results of artificial sphincter for the treatment of sphincter incontinence]. / Résultat du sphincter artificiel en cas d'incontinence sphinctérienne.

47 patients were treated since 1987 by implantation of an artificial sphincter. The majority of female patients were operated for bladder neck hypermotility. In the male population, incontinence was mostly a complication of prostatic surgery. The indication, preoperatory assessment, surgical techniques and results are discussed. During a mean follow-up of 38 months, 92.9% of females remained perfectly continent and results were good in 76.7% of males. The results are similar to those reported in the literature.