2022 Recommendations of the AFU Lithiasis Committee: Percutaneous nephrolithotomy.

Percutaneous nephrolithotomy (Labate et al.) is the standard procedure for the treatment of large (≥2cm) kidney stones. The patient can be in prone or modified supine position. The puncture is performed under fluoroscopy and/or ultrasound guidance. The stone-free rate seems to be comparable between miniaturized and standard PCNL. Procedures performed with smaller diameter instruments tend to be associated with significant lower blood loss, but longer procedure times. The limitation of the number of percutaneous tracts results in better preservation of the kidney function and lowers the risk of complications. The use of tranexamic acid during PCNL may be interesting for reducing the bleeding risk, the transfusion rate, and possibly the intervention duration. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.

[Management of adult's renal and ureteral stones. Update of the Lithiasis Committee of the French Association of Urology (CLAFU). General considerations]. / Prise en charge urologique des calculs rénaux et urétéraux de l'adulte. Mise au point du Comité Lithiase de l'Association Française d'Urologie (CLAFU). Aspects généraux.

The Lithiasis Committee of the French Association of Urology (CLAFU) aimed to update the current knowledge about urolithiasis. This update will be divided into four parts: 1) general considerations; 2) the management of ureteral stones; 3) the management of kidney stones; 4) metabolic assessment and medical treatment of urolithiasis. Recent technicals advances helped the urologists to improve stones management: new extracorporeal shockwave lithotripsy (ESWL) devices, new flexible ureterorenoscopes, development of laser fragmentation. ESWL, semi-rigid and flexible ureteroscopy and the percutaneous nephrolithotomy (PCNL) remain currently the main therapeutic options. The first part of this update deals with the description and classification of stones, preoperative assessment, post-operative management and clinical follow-up. Main criteria of therapeutic choices are stone location, stone composition and stone size. Stone composition is assessed with infrared spectrophotometry analysis and its hardness is correlated with U.H. density on CT scan assessment. Preoperative assessment consists in urinary cytobacteriological examine, urinary PH, blood creatininemia, hemostasis. Low-dose CT scan is recommended before urological treatment. The result of the treatment must be done 1 or 3 months later with plain abdominal film and ultrasonography. Medical management of urolithiasis will be based on stone composition, metabolic and nutritional evaluation. Treatment success is definited by absence of residual fragments. Annual follow-up is recommended and based either on plain abdominal film and ultrasonography or low-dose CT scan.

[Place of the flexible ureterorenoscopy first choice for the treatment of kidney stones. Survey results practice committee of the AFU lithiasis completed in 2011]. / Place de l'urétérorénoscopie souple en première intention pour le traitement des calculs du rein. Résultats de l'enquête de pratique du comité lithiase de l'AFU réalisée en 2011.

UNLABELLED: The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation. METHODS: Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney. RESULTS: Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient. CONCLUSION: The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL).

[Pathologic diagnosis and management of flat lesions of urothelium detected with aminolevulinic acid (Hexvix®)]. / Diagnostic anatomopathologique et prise en charge clinique des lésions planes urothéliales détectées à l'aide de l'acide aminolevulinique (Hexvix®).

INTRODUCTION: The aim of the study was to review the most important flat lesions, to demonstrate the difficulty of classifying several lesions, to introduce to urologists the new problems linked to FD and to suggest new models for accurate analysis. MATERIALS AND METHODS: Data about urothelial carcinomas and flat lesions and fluorescence were searched on MEDLINE by using the following keywords: cystoscopy; fluorescence; flat lesion; carcinoma in situ; metaplasia; bladder carcinoma. RESULTS: No evidence 1 level data was available. Flat lesions are a new challenge in pathology and urology. As urologists have a better sight of bladder lesions with fluorescence diagnosis (Hexvix(®)), pathologists will be asked in the future to evaluate more frequently flat lesions, which are sometimes difficult to classify and for which interobserver agreement is not always evident. CONCLUSION: It is essential to determine accurate histologic criteria, able to recognize flat lesions of the bladder and permitting adequate patients' treatment. Further studies with larger cohort of patients are needed to validate preliminary results obtained with fluorescence and to improve our knowledge of the natural history of these tumours.

[Simultaneous bilateral percutaneous nephrolithotomy: Series of 60 cases]. / Néphrolithotomie percutanée bilatérale en un temps: série de 60 cas.

OBJECTIVE: Retrospective evaluation of the efficacy and morbidity of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL). METHODS: From January 1993 to July 2009, 60 patients have undergone SB-PCNL over a series of 1709 PCNL. Thirty men and 30 women, mean age 45 years old (13-78), were treated for bilateral renal stones (120 kidneys) of 1177 mm(2) (268-4972 mm(2)); 25 were complete staghorn stones. RESULTS: Operating time for the first side of PCNL was 80 min (30-270) and 45 min (10-90) for the opposite side. Overall OR occupation was 188 min (90-360). Forty-five patients were stone free after one session; 15 patients (25%) have a complementary treatment to be stone free: five PCNL (one bilateral); eight ESWL (four with JJ stent) and two flexible ureteroscopy. No blood transfusion was required. Renal function was unchanged at 1 month. Clavien grade for complications were as follows: two grade IIIb, one grade IVa and one grade IVb. Hospitalization stay was 4±4.9 days (2-35) taking account of two major sepsis (one pulmonary and one septicemia). CONCLUSION: SB-PCNL was well tolerated with comparable morbidity and efficacy to PCNL performed on each side in two separate sessions. Nevertheless, SB-PCNL has to be performed for selected patients in expert centers.

[Results of nephron-sparing surgery for renal cell carcinoma of more than 4 cm in diameter]. / Résultats de la néphrectomie partielle pour les carcinomes à cellules rénales de plus de 4cm.

To date, radical nephrectomy (RN) remains the gold standard treatment for renal cell carcinoma (RCC) larger than 4 cm. However, from the early 1990's, improvements in surgical techniques have lead to the development of nephron-sparing surgery (NSS) for small renal tumours of less than 4 cm in diameter. This surgical procedure avoids nephronic waste with an acceptable morbidity and similar oncological outcomes compared to radical surgery. Recent large published series did not show any difference between NSS and RN in terms of oncological safety. Specific and disease-free five-year survival rates (82% to 97.3% and 81% to 97.3%, respectively) have confirmed the safety of NSS. Regarding laparoscopic NSS, the technique is still under evaluation and only mid-term outcomes are available so far. However, these studies are still limited and longer follow-up is needed before any definitive statement can be made. Current guidelines recommend NSS only in case of RCC of less than 4 cm in diameter in elective indications. In daily practice however, surgical teams are pushing back the limit above the threshold of 4 cm. More and more surgeons are either considering anatomical location or technical expected difficulties rather than just the tumour size. NSS leads to higher risk of bleeding, especially in case of tumours larger than 4 cm. Therefore, it is absolutely necessary to investigate thoroughly the vascularization of the tumour to avoid such complications with exhaustive and accurate preoperative imaging.

[Characteristics of encrustation of ureteric stents in patients with urinary stones]. / Caractéristiques des incrustations des endoprothèses urétérales chez les patients lithiasiques.

INTRODUCTION: The goal of this prospective study was to characterize ureteral stents encrustation in stone formers. MATERIAL AND METHODS: We report the results of a study based on 658 double-J stents (412 men and 246 women) collected from patients with in situ urinary calculi. The mean age was 48.2+/-16.0 years without differences between genders. Ureteral stent encrustation was analysed by infrared spectroscopy. Results are expressed according to the main component. RESULTS: The mean indwelling time was 73.5+/-73.2 days. The main component in stent encrustations was calcium oxalate (43.8%), essentially the monohydrate form (27.1%), followed by proteins (27.4%), calcium phosphates (16.4% with 8.4% brushite), and uric acid (5.2%). Struvite, detected on 49 stents, was the main component in 2.4% of cases. Significant differences according to gender and age were found: calcium oxalate monohydrate, which represented 24.5% in 20 to 29 years old men class increased to 37.0% in 50 to 59 years class and then decreased in older patients. Calcium oxalate dihydrate increased with age up to 70 years in women while it felt dramatically in man beyond 50 years old. Brushite was more abundant in young men (20.4% in patients aged 20-29 years) and was decreasing beyond this age while it remained in stable proportion for all age classes in women. Increasing prevalence of uric acid encrustations with age was observed, especially in men beyond the age of 70 years. Mineral encrustations increased with the indwelling time, the part of mineral being preponderant after 15 days: 7,3% of the stents had become massively encrusted within 113 days mean period. The comparison between biomaterials showed that silicone stents were significantly less encrusted than polyurethane stents. CONCLUSION: Stent encrustation constitutes a serious complication of ureteral stent use in stone formers. Lithogenic factors should be considered for the prevention of stent encrustation in these patients.

Anatomic and functional results of transperitoneal-transvesical vesicovaginal fistula repair.

OBJECTIVES: To evaluate the anatomic and functional results of transperitoneal-transvesical repair of simple and complex vesicovaginal fistulas (VVFs). METHODS: Between 1978 and 1995, 30 VVFs in 28 patients (mean age 44.6 years, range 21 to 80) were treated by way of a transperitoneal-transvesical approach. VVFs were secondary to hysterectomy in 67.8% of cases; 46.7% of VVFs were considered complex fistulas. Fifty percent of the VVFs were retrotrigonal and 40% were trigonal. A flap was interposed in 70% of cases. The vaginal fistula orifice was left open in 66% of cases, and 33% of VVFs required ureteral reimplantation. The mean duration of bladder drainage was 15.8 days (range 6 to 42), and the mean follow-up was 30 months (range 23 days to 14.6 years). The anatomic and functional results were evaluated by physical examination, cystoscopy, and a self-assessment questionnaire. Success was defined as the disappearance of the fistula. RESULTS: The overall success rate was 85% (24 of 28). The success rate was 87.5% for simple VVFs, 71% for complex VVFs, 93% for retrotrigonal VVFs, 66% for cervicotrigonal VVFs, and 80% for fistulas requiring ureteral reimplantation. Postoperative voiding disorders were reported in 38% of patients. CONCLUSIONS: Transperitoneal-transvesical repair of simple and complex VVFs remains the reference treatment for a disease that has become rare in countries with a well-developed healthcare system, but that is disabling and poorly tolerated by patients after the treatment of another disease.

Guidelines on urolithiasis.

OBJECTIVES: A project was initiated by the Health Care Office of the European Association of Urology in order to formulate common recommendations and guidelines for the treatment of patients with urolithiasis. The basic task for the working group therefore was to extract and evaluate evidence from the literature in order to reach a consensus on how these patients could best be managed. METHODS: Extensive reviews of the literature together with a thorough and detailed discussion of the various topics, by a working group including of experts from several European countries, provided the basis for a consensus overview of urolithiasis and its management. RESULTS AND CONCLUSIONS: Recommendations are given for the management of patients with acute stone colic and for active removal of stones from the ureter and kidney. Moreover, the principles for risk evaluation of patients with recurrent stone formation and appropriate recurrence preventive treatment are given.

[Male urinary incontinence and dynamic graciloplasty]. / Incontinence urinaire masculine et graciloplastie dynamique.

Only a few surgical treatments are available for male urinary stress incontinence and artificial urinary sphincter remains the reference treatment. It is associated with a certain morbidity and specific technical limitations and can therefore not always be used in a given patient. Stimulated graciloplasty could constitute a useful alternative treatment in exceptional situations. The objective of this study was to review the technique, the indications already defined apart from urinary incontinence and the results of stimulated graciloplasty in urology.

[High intensity focused ultrasound (HIFU) in urology]. / Les ultrasons focalisés de haute intensité (UFHI) en urologie.

INTRODUCTION: Focused ultrasound is now well known to urologists in the context of its validated application in extracorporeal lithotripsy. High Intensity Focused Ultrasound (HIFU) represents a potential therapeutic modality for tissue destruction due to its very high energy and its capacity to precisely reach a target with a very short emission time. The authors review the current state of art of HIFU in urology at a time when its indication in prostate cancer is being defined. MATERIAL AND METHOD: After a brief description of the main physical principles of ultrasound and the main data determining focussing of high energy ultrasound, the main machines available (research and clinical) are described. The published clinical literature concerning the tissue destructive action in urology is reviewed. RESULTS: HIFU has been used in urology to treat renal, vesical, prostatic (BPH and cancer), and external genital organ lesions. Purely extracorporeal machines are gradually being replaced by intracorporeal procedures, especially transrectal techniques for prostatic lesions. The quality of ultrasound detection of the target still limits the use of this minimally invasive modality. The intervening tissues are spared with a good therapeutic efficacy on the target tissues, provided optimal firing parameters are used. CONCLUSION: HIFU has a demonstrated potential in the treatment of prostate cancer and studies conducted by several teams have defined the technique and its efficacy. Other indications have been studied, but must be validated by further clinical trials. The future will probably see the design of machines adapted to a specific target tissue rather than a single multidisciplinary extracorporeal machine.

[Assessment of hemorrhage risk of transvesical prostatectomy with bladder neck cerclage]. / Evaluation du risque hémorragique des adénomectomies transvésicales avec cerclage du col.

OBJECTIVE: Evaluation of blood loss and predictive factors of haemorrhagic complications of transvesical prostatectomy. MATERIAL AND METHODS: From January 1994 to December 1998, 202 patients with a mean age of 70.5 +/- 7.4 years (range: 46.6-89.3 years) were operated for benign prostatic hyperplasia with a mean prostate weight of 86 +/- 33 g. Transvesical prostatectomy was performed with bladder neck cerclage and suction drainage of the prostatectomy site for 48 hours. 107 patients donated blood preoperatively (mean: 2.8 +/- 0.7 units) to allow possible autotransfusion. Blood losses were evaluated by determining haematocrit during hospitalisation, the quantity of blood collected intraoperatively and the presence of postoperative bleeding possibly requiring surgical revision. RESULTS: The calculated overall blood loss was 435 +/- 306 ml of RBC, i.e. 1783 ml for an haematocrit of 30%. A high ASA score was significantly related with higher blood loss and preoperative anticoagulant treatment. No predictive factor for intraoperative bleeding (mean: 519 +/- 327 ml) was identified. Absence of the median lobe and a high ASA score were also predictive factors of postoperative bleeding. Age, operating time, prostate weight, recent urinary tract infection, preoperative drainage, preoperative haematocrit, and preoperative blood donation (autotransfusion) did not significantly influence the volume of blood loss. CONCLUSION: Apart from the ASA score, no predictive factor for the severity of bleeding associated with transvesical prostatectomy was defined in order to identify a group of patients at higher risk of severe bleeding.

[Materials used in treatment of stress urinary incontinence with suburethral sling]. / Les matériaux utilisables dans le traitement de l'incontinence urinaire d'effort par bandelette sous-uréthro-cervicale.

Suburethral sling is a classical method of surgical repair of female stress urinary incontinence (SUI). Initially reserved for SUI due to sphincter incompetence, this method now appears to be indicated for other types of SUI. A large number of organic and synthetic materials have been used in published series. The long-term functional results reported in the literature vary between 65 and 98%, regardless of the materials used. Some of the complications observed are specific to the type of material. Synthetic slings appear to be associated with a higher complication rate. It is too early, based on data of the literature, to determine the real role of Prolene tape (TVT).

[Treatment of complicated renal colic in patients treated with indinavir: value of double J stents]. / Traitement des coliques néphrétiques compliquées chez les patients traités par indinavir: intérêt des endoprothèses double J.

OBJECTIVE: Evaluation of the treatment of complicated ureteric stones in patients treated with indinavir. PATIENTS AND METHODS: From March 1997 to May 1998, 10 patients (7 males, 3 females, aged 30 to 56 years), treated by triple combination therapy for HIV infection, were drained for stones attributed to indinavir (CRIXIVAN), which had become obstructive and complicated. The duration of treatment with indinavir ranged from 14 days to 2 years. No patient had a history of urological disease. One patient presented with bilateral stones. All patients presented complicated clinical features: fever in 3 cases; severe pain in 8 cases, with delayed excretion more than 4 hours on IVU in 6 cases. All stones were radiolucent except for one slightly radioopaque stone. The stone was situated in the lumbar ureter in 3 cases, iliac ureter in 1 case and pelvic ureter in 8 cases. RESULTS: In 10 out of 11 cases, a double J stent was inserted, preceded by drainage by simple ureteric catheter (infected urine) in 1 case and by percutaneous nephrostomy (PCN) with antegrade insertion of the stent (failure of the retrograde route) in 1 case. No complementary stone fragmentation or extraction treatment was necessary after this procedure. Stents were left in place for 3 to 7 weeks. In one case, a stone of the lumbar ureter required PCN followed by extracorporeal lithotripsy. CONCLUSION: In the case of complications requiring a urological procedure, insertion of a double J stent allows curative treatment of very friable indinavir stones, which are fragmented by passage of the stent.

[How to plan the treatment of prostatic adenoma today?]. / Comment concevoir aujourd'hui le traitement de l'adénome prostatique?

Surgical treatment, mainly transurethral resection of the prostate, still remains the reference treatment for benign prostatic hyperplasia (BPH). Two studies conducted in the Urology Department of the Pitié-Salpêtrière Hospital have tried to define certain characteristics of this surgery. The first study tried to evaluate the long-term outcome of patients operated for benign prostatic hyperplasia. Analysis of 881 replies to a questionnaire sent to 3,147 patients operated for BPH (between 1976 and 1989) assessed functional status (by Madsen's symptom score), quality of life (by Fowler's method), and sex life (by two specific questions), with a follow-up ranging from 5 to 14 years. At this follow-up, 90% of patients declared to be satisfied with their voiding status, 95% considered their quality of life to be excellent and about 50% had maintained a sex life. The second study was designed to evaluate the morbidity of this treatment in elderly patients. A group of 33 operated patients over the age of 80 was compared to a control group composed of 66 patients between the ages of 60 and 70 years, treated in a similar way, in the same centre and in the same year. Morbidity was higher in the first group, but age itself did not appear to constitute a poor prognostic factor for surgery; it only intervenes by allowing certain complications of benign prostatic hyperplasia (acute retention) to create emergency situations complicating the perioperative period. Following demonstration of the short-term and long-term efficacy of this conventional surgery, many new technologies were subsequently developed in order to reduce perioperative discomfort, anaesthetic requirements, duration of catheterization and hospital stay. Some of them constitute a new approach to endoscopic surgery, such as prostatic tissue vaporization techniques (electrovaporization, laser contact vaporization), which have a comparable efficacy to that of TURP, while reducing bleeding, catheterization time and hospital stay. However, the duration of postoperative irritative symptoms is much longer. Other techniques use a thermal effect to obtain coagulation necrosis of prostatic tissue, using various energy sources: microwaves (thermotherapy), laser (interstitial laser), radiofrequency waves (TUNA). These techniques are perfectly adapted to outpatient surgery with local or regional anaesthesia. They do not interfere with continence, sexual function, but may be followed by high dysuria or retention rates, with a variable cathererization time, sometimes several weeks. Finally, urethroprostatic stents are easy to insert, provide a solution in critical situations and have replaced old indwelling catheters. The current choice of treatment therefore comprises several approaches: more effective, but still purely symptomatic medical treatment, safe conventional surgery providing excellent long-term results, but generating a certain perioperative discomfort and a certain morbidity, or, on the contrary "minimally invasive" techniques, greatly simplifying the therapeutic procedure, but whose morbidity has not yet been determined and whose results are still uncertain.

Multicenter trial of the quantitative BTA TRAK assay in the detection of bladder cancer.

BACKGROUND: Human complement factor H-related protein (hCFHrp) is produced by several bladder cancer cell lines and may be useful as a cancer marker. The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs, symptoms, or preliminary test results. METHODS: The BTA TRAK assay, a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine, was compared with exfoliative cytology in 220 patients (155 men, 65 women; mean age, 64.2 years) presenting with signs, symptoms, or preliminary diagnostic results suggestive of this disease. Cystoscopy was the standard of detection. RESULTS: In the 100 patients found to have bladder cancer, the overall sensitivities of the BTA TRAK assay (at a previously determined decision threshold of 14 kilounits/L) and cytology were 66% (66 of 100) and 33% (33 of 100), respectively (P <0.001). The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grades I and II and for stage Ta and T1 tumors. In contrast, the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69% (83 of 120) and that of cytology was 99% (119 of 120; P <0.001). The specificity of the BTA TRAK assay was higher in patients without benign or malignant genitourinary disease other than bladder cancer (76%; n = 89) than in patients with these conditions. When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone, increases in overall sensitivity and equivalent specificity were observed. CONCLUSION: Because of its relatively high sensitivity, the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer.

Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer.

OBJECTIVE: To compare the BTA stat test (BTA stat), a new one-step immunochromatographic assay that can be performed in the urologist's office or in the laboratory, to voided urine cytology and bladder wash cytology (cytology) in the diagnosis and monitoring of cancer of the bladder (BC). METHODS: BTA stat and cytology were performed in a double-blinded, prospective, clinical study on specimens from 240 subjects (68 females; mean age of subjects: 64 years) suspected of having BC. RESULTS: In 107 subjects with final diagnoses of BC confirmed by cystoscopy or cystoscopy and biopsy, the overall sensitivities of BTA stat and cytology were 65 and 33%, respectively. For tumor grades I, II, and III, the sensitivities of BTA stat were 39, 67 and 83%, respectively. Those of cytology were 4, 20 and 69%. Nine subjects had a diagnosis of 'suspicious for bladder cancer'. The specificities of BTA stat and cytology in the 124 subjects without BC were 64 and 99%, respectively. In the subjects with a history of BC (n = 74), the specificities of BTA stat and cytology were 72 and 99%, respectively. The specificity of BTA stat was lower in subjects with benign or malignant genitourinary disease other than BC (46%) than in subjects without genitourinary disease (71%). CONCLUSIONS: The BTA stat test is considerably more sensitive than cytology in the detection of BC and can replace cytology as an adjunct to cystoscopy in the diagnosis and follow-up of patients with BC. However, due to low specificity, BTA stat should not be used without first ruling out potential interferences such as infections, renal disease and cancer, or genitourinary trauma.

[Empirical treatment of urinary infections in urologic surgery]. / Traitement probabiliste de l'infection urinaire en chirurgie urologique.

Emergency prescription of empirical antibiotic therapy is justified in a context of febrile urinary tract infection, or to shorten the preoperative period in a hospitalised infected patient. The severity of the infection, its origin (community or nosocomial), morphological characteristics of the bacteria on direct examination, and urinary dip-stick data must be taken into account to select the most appropriate antibiotic while waiting for the antibiotic susceptibility test results.

[Colonic tubular adenoma following ureterosigmoidostomy: CT features]. / Adénome colique tubuleux après urétérosigmoïdostomie: aspect tomodensitométrique. à propos d'un cas.

We report a case of benign colonic tubular adenoma arising in a 36-year-old female at the site of ureterosigmoidostomy performed 25 years before. The tumor was revealed by recurrent episodes of pyelonephritis; hydronephrosis was present. On colonic enema, the tumor appeared lobulated, 4 cm in diameter. CT scan showed a multiloculated mass, which enhanced after injection. Pathology revealed a tubular adenoma of the colon with cystic dilatation of glandular structures. The role of imaging studies in the follow-up of patients after ureterosigmoidostomy is discussed.

[Review on the use of CO2 in laparoscopy surgery]. / Mise au point sur l'utilisation du CO2 en coelio-chirurgie.

Laparoscopic surgery is one of the treatment modalities available to urologists, who must be familiar with the concepts of the physiology of CO2 and its clinical consequences. CO2 is absorbed during insufflation, leading to hypercapnia, reaching a steady-state from the 20th minute. The insufflation pressure must be between 10 and 14 mmHg. Intraoperative surveillance is based on oxygen saturation (pulse oximeter) and capnography, which measures the CO2 concentration of expired air. The causes of hypercapnia must be prevented: untimely recovery, retroperitoneal dissection, excessive intra-abdominal pressure. If hypercapnia occurs, the patient must be exsufflated and the operation should be resumed after a certain interval. The specific complications of laparoscopy (gas embolism, arrhythmias, pneumothorax) can be avoided by respecting the rules of security and by maintaining surveillance during recovery. The pain due to diaphragmatic peritoneal irritation can also be decreased by complete exsufflation.