Fracture of the penis: management and long-term results of surgical treatment. Experience in 300 cases.

BACKGROUND: Herein, we present the largest series of penile fracture ever published. We evaluate the clinical presentation, the outcome of the treatment and the prognosis. METHODS: We retrospectively studied patients with penile fracture treated from 1975 to 2005. RESULTS: Three hundred patients were included in this study. The mean patient age was 30 years (range, 18-68 years). Out of these patients, 57 (19%) patients were injured during sexual intercourse, whereas 180 (60%) patients were injured during masturbation. The mean time from injury to presentation was 26 hours. The diagnosis was clinical in all cases. No further investigation was needed for confirming the diagnosis. Five patients had urethral bleeding with urethral lesion. All patients were treated by immediate surgery. All of the patients had a tunica albuginea tear that was promptly repaired. At follow-up (mean time of 7 years), 14 patients presented mild curvature, which had not hindered intercourse in 10 patients. The Nesbit intervention was performed in four patients. Penile pain at intercourse developed in four patients (1.3%) and at erection in six patients (2%). Erectile dysfunction was observed in two cases (0.6%). CONCLUSION: Penile fracture has typical clinical signs. Early surgical treatment is associated with a low incidence of late complications. The high frequency in our area is neither because of physical nor genetic particularities. It is probably because of sociocultural characteristics.

Clinical presentation and outcome of bladder schistosoma-unrelated squamous cell carcinoma: report on 33 consecutive cases.

BACKGROUND: Pure squamous cell carcinoma (SCC) is a rare entity in Western countries. The management of SCC still remains similar to that of transitional carcinoma, although it is a different entity. A retrospective review is helpful in understanding the epidemiologic aspects, pathogenesis, and treatment and prognosis of schistosoma-unrelated SCC. PATIENTS AND METHODS: Between 1987 and 2002, 30 men and 3 women had been treated for pure SCC of the bladder, not related to bilharzias. RESULTS: The mean age of patients was 59 years (range, 29-83 years). They constitute 1.2% of all bladder tumors. At presentation, 2 patients had a distant metastasis. Eleven patients (34%) had a bladder stone with recurrent urinary tract infection; they had been treated since age 6-17 years. Twenty-one patients underwent radical cystectomy, followed by chemotherapy in 2 cases. At a mean follow-up of 5 years, 14 patients (66.6%) died of locoregional disease, with associated metastasis in 5 cases. Seven patients (33.3%) are alive without any evidence of disease. The survival rate was correlated with tumor stage. CONCLUSION: The unrelated SCC has an unfavorable prognosis, mostly caused by the locally advanced disease at the time of presentation. Distant metastases are not rare. The transfer of novel chemotherapy regimens and preoperative radiation therapy should be considered because pelvic recurrences are the leading cause of progression in SCC.

[Retroperitoneal leiomyosarcoma: report of 3 cases]. / Les leiomyosarcomes retroperitoneaux: à propos de 3 cas.

BACKGROUND: Retroperitoneal leiomyosarcomas are neoplasma which are best treated with complete exeresis. AIM: We reported three new cases of retroperitoneal Leiomyosarcoma operated during last ten years. CASES: The authors reported 3 cases of Retroperitoneal leiomyosarcomas in 3 patients (2 men and a woman) aged respectively 53, 55 and 57 year-old. Incomplete resection was performed in the 3 cases because of the important local extension. All patients died 18, 19 et 51 months after diagnosis.

[Retroperitoneal ganglioneuroma. A case report]. / Le ganglioneurome rétropétritonéal. A propos d'un cas.

BACKGROUND: Ganlioneuroma is a rare, benign, neurogenic tumor originating from the neural sheath and frequently localized in the retroperitoneum. AIM: Report of a new case. CASE: We report a case of a 36-year-old woman presenting isolated right lumbar pain. Computed tomography revealed a heterogeneous, right, retroperitoneal mass, 13 cm in diameter. Complete resection of the tumor and right nephrectomy were performed. Histology confirmed the diagnosis of ganglioneuroma. Follow-up was 10 months with no recurrence. Through this case, we discuss diagnostic, therapeutic and prognostic aspects of this disease.

[Surgical treatment of post-traumatic complete urethral rupture: deferred urgent urethral suture or delayed repair?]. / Le traitement chirurgical des ruptures urétrales complètes post-traumatiques : l'urétrorraphie en urgence différée ou la réparation retardée?

OBJECTIVE: To compare the results of deferred urgent surgical treatment and delayed repair in post-traumatic complete urethral rupture. PATIENTS AND METHOD: Between 1986 and 2003, sixty patients were operated for complete rupture of the posterior urethra. In the absence of any serious visceral or skeletal lesions, 32 patients were operated within five to ten days (Group I). In 28 cases (Group II), patients were operated 8 months after the injury via a perineo-transsymphyseal approach. RESULTS: The mean age of these patients was 28 years (range: 18 to 53 years). With a minimum follow-up of 2 years (range: 2-14 years), the urine stream was considered to be satisfactory in 90% of patients of group I and in 100% of cases of group II. Continence was perfect in 91% of patients in the two groups. Erectile dysfunction was observed in 22% of cases of Group I versus 28.5% of cases of Group II. CONCLUSION: Deferred urgent end-to-end urethral suture and delayed urethroplasty give globally comparable results. Deferred urgent end-to-end urethral suture must be performed whenever possible. The perineo-transsymphyseal approach must be reserved to the treatment of large stenoses in multi-operated or delayed repair patients.

The learning curve of transrectal ultrasound-guided prostate biopsies: implications for training programs.

OBJECTIVE: To assess the quality of specimens obtained from prostate biopsies performed by urology residents and evaluate the number of procedures required to perform high-quality transrectal ultrasound (TRUS)-guided prostate biopsies. MATERIALS AND METHODS: Between 2006 and 2009, 770 patients underwent TRUS-guided prostate biopsies in our academic center. During the 6 semesters of this period, 24 residents (4 per semester) performed 1 session of 5.6±1.5 procedures each month for a total of 33.6±9 procedures during the study. The first session was performed with a senior urologist. Prostate cancer detection rate and standards of quality (average length of prostatic core biopsy specimens and absence of prostatic tissue) were retrospectively studied between the beginning and the end of each semester. RESULTS: A total of 12,760 biopsy cores were performed for 770 procedures. Mean patient age (64.5±6.1 years), and median prostate-specific antigen (8.7±3.7 ng/mL) were comparable between the study periods. The average length of biopsy cores significantly improved (+10%) from the first (12±2.7 mm) to the last month (13.2±2.1 mm) with a plateau after 12 procedures. Overall, cancer detection rate was 47% and was stable during the semester (41.3% the first month vs 44.1% the last month; P=.39). On univariate and multivariate analysis the mean length of biopsy specimens was associated with the number of procedures (P<.001) and the number of cores performed (P<.001). CONCLUSION: Twelve procedures are necessary to perform high-quality TRUS-guided prostate biopsies without compromising prostate cancer detection. In current training programs, we strongly recommend that residents have direct supervision for a minimum of 12 cases before they are allowed to perform TRUS-guided biopsies with indirect supervision.

Kidney trauma with underlying renal pathology: is conservative management sufficient?

To evaluate the pre-existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma, determine their importance, and suggest guidelines for effective management, including conservative treatment, we reviewed 180 patients who were hospitalized with blunt renal trauma between 1992 and 2008. Thirty of the 180 (16.6%) patients had PERL, which had been undiagnosed. The mean follow-up was 5 years (range 1-9 years). There were 24 men and 6 women with a mean age of 30 years (range 14-80 years). The most common cause of blunt renal injuries was falls and sports. Renal stones were present in 14 patients, pelvi-ureteric junction obstruction in 12, ectopic kidney in two, and megaureter and renal cyst in one case each. Ureteral stenting was used in four cases, and early nephrectomy was required in the other four. Fourteen patients underwent surgery for the PERL and not trauma, with a pyeloplasty in eight cases, partial nephrectomy in three cases, percutaneous nephrololithotomy in two cases, and ureteroneocystostomy in one case. In our study, the conservative treatment was possible in 73% of cases. We believe the published data support increasing conservative attempts in the hemodynamically stable patient.

Endoscopic bridge operating-guide device applied for intracorporeal antegrade ureteric stenting during laparoscopic pyeloplasty.

AIM: To describe our novel technique of laparoscopic pyeloplasty with an antegrade placement of a ureteral stent with a bridge operating-guide device (BOGD). METHODS: After completing the posterior suture line of the dismembered pyeloplasty, a guidewire is inserted through the BOGD and grasped within the renal pelvis. Then, the BOGD is removed and the ureteral stent advanced until it is positioned in the renal pelvis, and the lower end of the stent lies in the bladder. The anastomosis is completed. Fifteen patients underwent the laparoscopic placement of ureteral stents with this technique. RESULTS: With this method, the ureteral stent insertion is very convenient and time saving (the mean time for inserting a stent was 5 minutes). The stents were successfully inserted in all patients. CONCLUSIONS: This technique is reliable and effective in laparoscopic ureteral operations. It uses an endoscopic urological equipment, and costs are reduced.

Prognostic factors of recurrence after vesicovaginal fistula repair.

PURPOSE: We evaluate the prognostic factors of recurrence in patients after the surgical repair of vesicovaginal fistula. MATERIALS AND METHODS: From 1985 to 2002, 73 women with vesicovaginal fistula underwent late (> 3 months) surgical repair. A multivariate analysis of the data was performed with the EPI-INFO software. All P-values were two-sided, with odds ratio and 95% confidence intervals. RESULTS: A total number of 73 patients underwent 97 procedures with a mean rate of 1.38 procedures/patient. The overall surgical success rate was 86.7%. Multivariate analysis demonstrated that recurrence was statistically significant for multiple fistulas (single vs two or more), fistula size (>10 mm), fistula type (Type I vs Type II), fistula etiology (obstetrical vs non-obstetrical) and the presence of urinary tract infection before the repair. Recurrence risk was fivefold higher for both the size and the type of the fistula, threefold higher for obstetrical etiology and 4.5-fold higher for multiple fistula. The interposition of flaps was a protective factor for recurrent cases. The surgical approach was not a significant prognostic factor of recurrence. CONCLUSION: Successful closure of a vesicovaginal fistula requires an accurate and a timely repair using procedures that exploit basic surgical principles. Multiple fistula, size and type of the fistula, and obstetrical etiology were the recurrence risk factors. We recommend in all patients with multiple risk factors for recurrence, the interposition of flaps.