Androgens in patients with benign prostatic hyperplasia before and after prostatectomy.

Plasma androgens [testosterone (T), 17beta-hydroxy-5alpha-androstan-3-one (DHT), androst-4-en-3,17 dione(A), and dehydroepiandrosterone (DHEA)] as well as 17 hydroxyprogesterone were measured in a group of patients (age 60-80 yrs.) with benign prostatic hyperplasia (BPH) just before prostatectomy and compared to values obtained in subjects of similar age without signs of BPH. The most important difference was observed in the mean DHT level which was significantly (P less than 0.025) higher than in the control group; mean T and free testosterone levels in BPH patients were slightly higher (P less than 0.05) in the age group 70-80 yrs; whereas in age group 60-70 mean values were similar to those observed in normal controls. Mean A, DHEA and 17 OHP and E2 levels were not significantly different in BPH patients when compared to age matched controls. 2-5 months after prostatectomy, T and DHT levels were significantly higher than immediately preoperatively. The preoperative stress may have influenced the preprostatectomy values.

Enterocystoplasty after cystoprostatectomy for bladder cancer. Time-saving technical modifications.

Enterocystoplasty, to construct a functional and continent bladder in male patients following cystoprostatectomy, can be simplified and shortened by some modifications. Partial pubectomy will allow a precise and bloodless section of the membranous urethra preserving the external sphincter and a watertight anastomosis with 10 to 12 stitches between the urethra and the intestinal bladder. Use of automatic intestinal suture devices. Passing the ureteral stents through stab wounds in the intestinal wall and out to the skin. An easy method for bringing the urethral catheter in the right horn of the intestinal bladder. These modifications will reduce the operating time to seven hours.

Blind-ending bifid and double ureters.

Bifid and double blind ureters are two rare congenital anomalies of the upper urinary tract. Usually they are incidental findings. Occasionally, they are associated with urinary tract infection, but the symptoms are not specific. The key to diagnosis is a careful urethral cystoscopy and retrograde pyelogram. Asymptomatic patients without urinary tract infection require no treatment. When symptoms or infection are present, excision of the blind branch is required with antireflux reimplantation of the normal ureter if needed.

Results of urometabolic evaluation in 127 patients with renal calculous disease.

One hundred twenty-seven selected stone formers were evaluated. With the simple ambulatory tests proposed by Pak for metabolic screening and a complete urologic evaluation an anomaly was found in more than 90 per cent of the cases. The patients were divided into three groups: (1) patients operated on for staghorn stones; (2) patients with episodes of spontaneous stone eliminations or young people with only one stone episode; and (3) patients operated on for stone disease. No significant differences were noted except for the occurrence of urinary tract infection and for struvite and calcium oxalate occurrence in the different groups. Urinary tract infection combined with a metabolic disorder appear to make the evolution from small kidney stone to staghorn stone a reality.

Early adjuvant adriamycin in superficial bladder carcinoma.

A multicenter study was performed in 110 patients with superficial transitional cell carcinoma of the bladder. Adriamycin (50 mg/50 ml) was administered intravesically within 24 h after transurethral resection of TA-T1 (O-A) bladder tumors. Instillation was repeated twice during the first week, then weekly during the first month and afterwards monthly for 1 year. The tolerance was evaluated in these 110 patients, and 29 patients presented with local side-effects. In 24 of these patients chemical cystitis was severe enough for them to drop out of the study. No systemic side-effects were observed. Recurrence was studied in 82 evaluable patients after 1 year of follow-up and in 72 patients followed for 2-3 years (mean 32 months). Of the 82 patients studied after 1 year, 23 had primary and 59 recurrent disease. Of the 82 evaluable patients, 50 did not show any recurrence after 1 year (61%), while 32 presented with one or more recurrences (39%). Of these recurrences, 27 were T1 tumors while five progressed to more highly invasive lesions. In patients that were free of recurrence during the first year, 80% remained tumor-free during the 2- to 3-year follow-up period. Of the patients developing one or more recurrences during the first year, only 50% presented with further recurrence once the instillations were stopped. The beneficial effect of Adriamycin appears obvious and might be related to the drug itself, the early and repeated instillations after TUR, or both.

Preliminary clinical experience with meptazinol, a new analgesic.

The analgesic effect of intravenous meptazinol at various dosage levels was studied in 30 patients suffering from acute renal colic. Out of a total of 41 injections (dose range: 20 to 120 mg.) a favourable analgesic response was recorded on 39 occasions. The onset of action was rapid with the minimun duration of action of 1 hour. Higher doses increased the drug's action but were accompanied by nausea and dizziness. There was no overall effect on blood pressure or heart rate.

[Which technic for which form of hypospadias?]. / Quelle technique pour quel hypospadias?

Based on our experience of 700 interventions for hypospadias from 1980 to 1995, the author describes the important factors to take in consideration to decide upon the ultimate technique to use. This choice is quiet easy for a mild or severe hypospadias, and is essentially based on the use of the Transverse Island Flap, used as a tube or as on Onlay, depending the existence of chordee and curvature, the surface of the prepuce and the length of the urethral defect. For cases of distal hypospadias, the choice of the right technique is even more difficult. Factors to be considered are, chordee or not, aspect and localisation of the meatus, the shape and the volume of the glans, the quality of skin recovering the distal urethra and presence or not of corpus spongiosum at the level of the distal urethra. The author discusses the importance of all this parameters, combined or not, in the choice of which technique for which hypospadias.

[Transverse island flap for the correction of mild and severe hypospadias]. / Le lambeau préputial transversal pédiculé pour la correction d'un hypospadias moyen et sévère.

After presentation of the results in 225 patients operated for hypospadias by the Transverse Island flap technique, the author describes the operative technique, the advantages and limitations. Two variations upon the technique, the onlay and the dorsal pediculated flap are described as possible alternatives, each with its own indications.

[General considerations on and the role of internal urethrotomy in the treatment of urethral stricture]. / Considérations générales et place de l'urétrotomie interne dans le traitement du rétrécissement de l'urètre.

After stressing the importance of a precise diagnosis, the author defines the place of internal urethrotomy, which is certainly not always the first-line treatment that some would claim, due to its poor success rate and because an endoscopic reoperation is sometimes much less harmless than it appears. The importance of perfect anaesthesia for urethral surgery is then emphasised in view of the particular demands of this surgery. Finally, the author reviews the various approaches to the urethra and opening of the stricture.

[Urethroplasty using a full-thickness free skin graft]. / Urétroplastie par greffe libre de peau totale (GLPT).

Full-thickness free skin graft urethroplasty is an excellent technique for the cure of urethral strictures. Based on his experience of 250 cases since 1977, the author describes the indications and limitations related to surrounding tissues and to the graft itself. A rigorous and precise technique, described in detail in this paper, is the key to success.

[Stricture of the urethral meatus and the navicular fossa]. / Rétrécissements du méat urétral et de la fosse naviculaire.

A review of the literature concerning strictures of the meatus and fossa navicularis reveals that few techniques are entirely satisfactory, apart from major techniques which are difficult to perform. The author describes an easy technique which gave perfectly satisfactory results in the majority of 36 cases, 17 of which have a follow-up of more than 5 years.

The GAP (glans approximation procedure) for distal hypospadias. Technical aspects.

We present some technical aspects of the GAP procedure for distal hypospadias repair. About 20 GAP procedures have been performed to date. Although immediate postoperative results were very encouraging with only 2 fistulae and 1 meatal stenosis, follow-up is too short to conclude on the validity of the technique. In particular the cosmetic result of this technique based on our preliminary experience, makes it an extra tool for the surgeon interested in hypospadias repair. We therefore want to present some of the technical aspects.

The Arap modification of the MAGPI: experience in 72 patients.

Since july 1991 the Arap modification of the Meatal Advancement Glanduloplasty Incorporated (MAGPI) is used for repair of minor anterior hypospadias. Seventy-two boys have been treated by this technique since then. Follow-up is longer than 2 years in half of the patients. The functional and cosmetic result, as estimated by the surgeon and an urologist who did not perform the operation was excellent in 64 patients (89%). In 3 patients the functional result is good but the cosmetic result is poor. In 2 patients meatal stenosis developed of which 1 was treated by dilatation and 1 by meatotomy. In 3 patients there was complete loss of the suture lines resulting in hypospadias which was repaired by other techniques. Ten patients underwent praeputioplasty with the procedure. In 4 patients the sutureline lost partially necessitating circumcision. The Arap modification of the MAGPI is presented as a good technique for the repair of minor anterior hypopadias.

[Trans-glandular urethral advancement for distal hypospadias. A 16-year experience]. / Avancement uréthral transglandaire (A.U.T.) pour hypospadias distal. Seize ans d'expérience.

Eighty six patients where operated by the urethral transglanular advancement technique. During this period, we modified the reconstruction of the meatus to prevent the uncosmetic appearance of the meatus, resulting from the initial technique. The results were excellent. In 40 patients (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis with a follow-up of at least 7 to 16 years after the intervention. In conclusion, we think that the fear of ischaemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilisation, is unjustified.

[Balanopreputial hypospadias]. / L'hypospadias balano-préputial.

Magpi's technique is described. It is an excellent procedure for the cure of the majority of cases of coronal or just subcoronal hypospadias, but its use is contra-indicated in the presence of a very large meatus, a thin, transparent, distal urethra, or a deeply grooved glans. In these cases, other techniques are required.