[Tumour diameter: Predictive criterion of intraoperative haemodynamic variations in adrenal phaeochromocytoma surgery]. / La taille tumorale : critère prédictif des variations hémodynamiques peropératoires dans la chirurgie du phéochromocytome surrénalien.

OBJECTIVE: To evaluate the correlation between tumour diameter and intraoperative haemodynamic variations during adrenalectomy based on a series of 15 operated cases of adrenal phaeochromocytoma. MATERIAL AND METHODS: Seventeen adrenalectomies for adrenal phaeochromocytomas were performed between January 1997 and March 2007. Two laparoscopic adrenalectomies were excluded to ensure a homogeneous series. The mean age of the patients was 39 years (range: 29-75). The hypertensive peak was defined according to the recommendations of the European Society of Hypertension (blood pressure greater than 140/90mmHg). Intraoperative blood pressure was measured and recorded every 10minutes during the operation. RESULTS: The median diameter of unilateral tumours was 6cm (range: 3-11) and the median diameter of bilateral tumours (two cases) was less than 6cm. The mean operating time was 135minutes (range: 120-170) for tumours greater than or equal to 6cm versus 105minutes (range: 90-145) for tumours less than 6cm. Operating time was increased by an average of 30minutes for tumours greater than or equal to 6cm. Hypertensive peaks were recorded in seven out of eight cases (87.5%) for adrenal phaeochromocytomas greater than or equal to 6cm, and in three out of seven cases (29%) for adrenal phaeochromocytomas less than 6cm (P=0.04). CONCLUSION: Tumour diameter is a decisive predictive factor of intraoperative haemodynamic variations in adrenal phaeochromocytoma surgery.

[Place of serum HCG assay in the follow-up of non-HCG-secreting testicular seminomas]. / Place du dosage sérique de l'HCG dans la surveillance des tumeurs testiculaires séminomateuses non sécrétantes.

OBJECTIVE: Human chorionic gonadotrophin (HCG) is secreted by 10 to 20% of seminomas. The authors evaluated variations of serum total HCG levels in patients with normal baseline levels for the surveillance of treated testicular seminomas in order to determine the value of assay of this tumour marker in the follow-up of testicular seminoma. PATIENTS AND METHODS: Retrospective study from January 1988 to March 2007, including 95 cases of operated testicular cancer, including 28 seminomas, 25 of which did not secrete HCG (baseline total HCG less than 15 IU/L). Patients were reviewed periodically: every three months for one year, every six months during the second year, then annually, comprising of clinical examination, CT examination and assay of tumour markers (HCG, LDH and AFP). RESULTS: Mean follow-up was 77.5 months (range: 6-120). Twenty-five patients had a total HCG level less than 15 IU/L three months after orchidectomy. Serum HCG remained stable at less than 15 IU/L in all patients with a follow-up of more than three years. Two patients developed non-regional lymph node recurrence with no modification of the serum HCG level. CONCLUSION: All treated non-HCG-secreting seminomas with or without recurrence had stable and normal HCG levels throughout follow-up, which raises the question of the value of HCG assay in the follow-up of these patients following histological confirmation of the diagnosis.

[Perineoscrotal pain after InVance suburethral sling: Cadavre anatomical study]. / Les douleurs périnéo-scrotales après soutènement urétral prothétique type InVance : étude anatomique sur cadavres.

OBJECTIVE: The authors investigated the anatomical basis for prolonged perineoscrotal pain after InVance bone-anchored male sling for the treatment of urinary incontinence after prostatic surgery in order to propose technical advice to reduce the frequency of this complication. MATERIAL AND METHOD: The authors dissected three formalin-preserved male cadavres and reviewed the literature on perineal anatomy and complications of the surgical technique. RESULTS: Cadavre dissections demonstrated the origin, course and termination of the perineal nerve, a branch of the pudendal nerve derived from the S2-S3-S4 sacral nerve roots. Its superficial branch, accompanied by its blood supply, ensures sensory innervation of the anterior part of the perineum and posterior surface of the scrotum. This branch is situated in the zone of lateral dissection towards ischiopubic rami. Potential lesions of this nerve could be due to coagulation of the vascular pedicle, stretching during lateral dissection towards ischiopubic rami, or damage to its anastomoses with the scrotal branch of the lateral cutaneous nerve of the thigh during exposure of the sites of implantation of ischiopubic screws. CONCLUSION: Trauma to the superficial perineal nerve is probably responsible for perineoscrotal pain after InVance perineal surgery. This operative trauma must therefore be reduced by identifying the bulbourethral muscle before dissecting laterally and by limiting the use of coagulation.