[Primary tumors of the upper urinary tract. Apropos of 49 cases and a review of the literature]. / Les tumeurs primitives de la voie excrétrice urinaire supérieure. A propos de quarante-neuf observations et revue de la littérature.

We report 49 tumors of the upper urinary tract treated between 1980 and 1988. Intravenous pyelography with direct opacification technics gave the diagnosis in 83.7% of patients. Ultrasonography and computed tomography were only reliable for tumors of renal pelvis. Urinary cytology gave good results only in high grade invasive transitional cell carcinoma. Nephro-ureterectomy is always recommended.

[Long-term evaluation of the treatment results of male urethral stenosis]. / Evaluation à long terme du résultat des traitements des sténoses de l'urètre masculin.

287 urethral strictures were treated between 1974 and 1984. Two-stage urethroplasty provided 47.6% of good results at 5 years, although there was a possibility of very delayed recurrences. Endoscopic urethrotomy only gave 26% of good results at 5 years, while 30% of good results were obtained after dilatation with Olbert's sound. Endourethral techniques do not compete with two-stage urethroplasty, provided they are performed repeatedly.

[Treatment of stenoses of the urethra. 2]. / Traitement des sténoses de l'urètre. Deuxième partie.

This is a comparative study in 183 patients of the treatment of urethral stenoses by two-stage urethroplasty, internal endoscopic urethrotomy and urethrotomy via the Olbert catheter. Urethroplasty (39 patients) was preferentially carried out in patients with moniliform stenosis greater than 2 cm long in the penile and penoscrotal urethra. There was no significant difference in the indications for the two forms of urethrotomy. Good results were obtained for the 3 techniques in about 80% of cases but there was significantly higher complication rate with surgical urethroplasty. The failure rate of the 3 techniques did not differ significantly. The cost of treatment, on the other hand, greatly differed depending on the technique. Surgical urethroplasty was 2.8 times more costly than internal endoscopic urethrotomy and 10.4 times more costly than Olbert catheter urethrotomy. Olbert catheter urethrothomy was 3.7 times cheaper than internal endoscopic urethrotomy.

[Diagnostic and therapeutic problems posed by renal or para-renal masses of cystic appearances]. / Problème diagnostiques et thérapeutiques posés par des masses rénales ou para rénales d'allure kystique.

The authors report some forty cases of renal masses, cystic in appearance and having raised a certain number of diagnostic or therapeutic problems. These masses included 7 cystic carcinomas, 3 benign tumors of cystic appearance and 28 cysts including 2 infected and 2 hydatid cysts. No paraclinical investigation is infallible in confirming the nature of the mass in doubtful cases, and pre-operative diagnosis is more easily obtained by investigation including the majority of standard imaging methods often completed by puncture. Amongst clinical factors which raise doubts as to the benign nature of the cystic mass seen, hematuria remains the most important, other symptoms and signs being of little significance. With regard to imaging, septate calcified masses with echoes within them, with a thick wall or high CT scan density are theoretically suspect. The same applies to masses having rapidly increased at two successive investigations or where puncture fluid is bloody. In all cases if proof of the benign nature cannot be obtained, surgical exploration would appear to be required.

[Cancer of the penis. Technic of amputation limited to the glans]. / Cancers du pénis. Technique d'amputation limitée au gland.

The authors report an original technique of glans resection without section of the cavernous bodies. A caverno-cutaneous suture enables a neo-glans to be obtained from the distal, tapering part of the cavernous bodies. This technique is used for small and superficial tumors without lymph nodes and located far enough from the balano-preputial fold.

[Parapyelic cysts]. / Les kystes para-pyéliques.

Parapyelic cysts present particular characteristics in relation to cystic disease of the kidney. Their intrasinusal development in contact with vascular and canalar elements of the renal hilum explains their often explosive symptomatology and the frequent need for surgical excision of the cyst--procedure difficult to accomplish and nearly always incomplete. Four cases are reported, including 2 with cysts communicating with excretory pathways, and symptoms, signs and diagnostic and therapeutic aspects discussed. Arguments are in favor of an acquired pathogenicity of these cysts (communication with excretory pathways, contingent presence of smooth muscle fibres in the cyst wall).

[The vena cava in surgery of renal cancer in the adult]. / La veine cave dans la chirurgie du cancer du rein de l'adulte.

In a series of 171 radical nephrectomies performed by the authors, 10 patients presented vena cava extension (5.8%). The extension was infrahepatic (stage C) in 6 cases, retrohepatic (stage B) in 1 case and involved the right auricle (stage A) in 2 cases, while the upper limit of the thrombus could not be defined in the remaining case. All patients were operated upon. There was one post-operative death (stage B), while the other patients had an uncomplicated post-operative course, despite the need for open-heart surgery in two cases. Seven patients died from metastatic after an interval of 2 and 4 years. The prognosis is therefore reserved, but seems to be better than in the case of lymph node metastases, justifying an aggressive surgical approach.

[Reflections on a series of 39 cases of primary vesico-renal reflux in adults]. / Réflexions sur une série de trente-neuf cas de reflux vésico-rénal primitif de l'adulte.

The authors report thirty nine cases of primary vesicorenal reflux in adults, involving sixty nine ureters. The series includes two women for every three men, with an onset normally in the twenties (the average age was 28 years and 6 months). In 86.6% of the patients, the disorder was revealed by urinary infections, and the case history extended back over an average of eight years. The urinary infection had a severe impact on the renal parenchyma, so that 54% of the patients presented with bilateral parenchymal lesions. Isotopic cystography appears to provide a more sensitive diagnostic tool than conventional radiological cystography, and the radiation effects are far less pronounced, so that the examination can be repeated more frequently in search of intermittent refluxes in patients with pyelonephritic lesions. The surgical management is by uretero-vesical reimplantation. The authors presently prefer Cohen's technique, which gives 88% good results. On the other hand, after surgical élimination of the urinary infection, the pyelonephritic lesions or renal insufficiency are irreversible, but they remain stable.

[Tumors of the upper urinary tract. Analysis of a series of 85 cases]. / Les tumeurs de la voie excrétrice haute. Analyse d'une série de 85 observations.

Case-reports of 85 patients with upper urinary tract tumors were reviewed. Mainly affected were males (87% of cases), particularly over 60 years of age, the principal presenting sign being hematuria. Other signs such as renal colic, lumbago or infections were observed more rarely. The renal pelvis was affected in 52 of the 85 patients (two of these were bilateral), multiple tumor foci being present in only 6 cases. Most tumors were epitheliomas (62 papillary and 13 non-papillary), with 52 of these at the superficial stage (0 or A), 21 at stage B 1 and 5 at stage B II or C. Based on Broders' classification, 48 were grade II and 16 grade III tumors. Prognosis was routinely poor in 5 patients with a stage B or C tumor and lymph node extension. Diagnosis is by intravenous urography, although retrograde ureteropyelography has its place, with increasing interest being given to ultrasound and computed tomography examinations combined with routine cystoscopy. If no particular contraindications exist, the preferred treatment is a total one-stage nephro-ureterectomy without curettage (52 cases), although curettage was performed at the same time in 9 other patients. Conservative surgery has only a limited application: 6 patients had segmental resections of the ureter and 2 patients underwent tumorectomy. Postoperative mortality was particularly loco: 4 patients (4,7%), mainly from vascular or respiratory diseases. (4,7%), mainly from vascular or respiratory diseases. Bone (5 cases), pulmonary (3 cases) and medullary (1 case) metastases represented the main cause of death during the year following surgery, all these patients having infiltrating tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of endoscopic urethrotomy (author's transl)]. / Les résultats de l'uréthrotomie endoscopique.

The authors report the results of 63 internal urethrotomies for urethral stenosis performed during a four year period. The essential sites were perineal and the most frequent aetiology iatrogenic, particularly after prostatectomy. Overall, the authors obtained 18 satisfactory results, 2 severe complications, 24 failures and 17 patients are too recent to assess or were lost from sight. A second endoscopic urethrotomy gave only very little chance of a definitive recovery. Although the results were not constantly excellent, the series studied by the authors shows that endoscopic internal urethrotomy offers the possibility by a simple technique of obtaining a certain number of durable successes whilst not interfering with the subsequent performance of other types of urethroplasty. Finally, in a certain number of cases endoscopic internal urethrotomy facilitates subsequent dilatations.