Helical CT and 3D reconstruction of ureteropelvic junction obstruction: accuracy in detection of crossing vessels.

PURPOSE: The purpose of our study was to evaluate the accuracy of 3D helical CT and its value in surgical planning for the treatment of ureteropelvic junction obstruction (UPJO). METHOD: CT scans and 3D reconstruction of renal vessels and the renal pelvis were performed in 20 cases of UPJO treated by open surgery. We analyzed scans in search of a vessel at the junction and its position relative to the UPJ. Helical CT scans and 3D reconstructions were correlated with macroscopic surgical findings. RESULTS: CT scans demonstrated the presence of a UPJO in all cases. Crossing vessels were present at the junction in 13 of 20 cases. The vessel crossed the junction posteriorly in six cases and anteriorly in seven cases. Macroscopic surgical findings were in agreement with helical CT reconstructions in 100% of the cases. CONCLUSION: Axial scans together with 3D reconstruction are an accurate way of detecting crossing vessels when UPJO occurs, and the choice of the most adequate surgical technique is facilitated.

[Cowper's gland: anatomic, physiological and pathological aspects]. / Glandes de Cowper: aspects anatomique, physiologique et pathologique.

Cowper's glands are small appendages of the male genital tract, that are sometimes observed on intravenous urography voiding films. They are involved in the immune defence of the genitourinary tract, play a role in fertility, and secrete many glycoproteins, including PSA. They can be visualized in the form of a duct image parallel to the urethra, sometimes associated with opacification of the gland on IVU. This image can be differentiated from a fistula, extravasation of contrast agent, urethral duplication, or an artefactual image, by the course parallel to the urethra, the upper limit not exceeding the urogenital diaphragm, and the position of the orifice. These glands can be affected by neoplastic, infectious, stone and especially cystic disease: syringocele. The physician should think of these glands in patients with unusual genitourinary symptoms in order not to miss disease of these organs, and to prescribe appropriate treatment.

[Feasibility of "Valsalva Leak Point Pressure". Prospective study]. / Faisabilité du "Valsalva Leak Point Pressure". Etude prospective.

OBJECTIVE: To prospectively evaluate the feasibility of determination of the Valsalva Leak Point Pressure (VLPP). PATIENTS AND METHODS: From 1st January to 31st July 1996, 155 consecutive patients investigated for urinary incontinence with no pelvis static disorder performed Valsalva manoeuvres during cystomanometry in order to determine the VLPP. The examination was performed in the standing position at a filling volume of 200 cc with then without a vesical pressure transducer. The mean age of the patients was 54 +/- 16 years (range: 16-84 years). RESULTS: The mean maximal intensity of abdominal straining pressure measured by the intravesical transducer was 72 +/- 28 cm of water. The VLPP could not be determined in 50.4% of cases, as the abdominal straining pressure during the Valsalva manoeuvre was less than 60 cm of water. No correlation was observed between abdominal straining pressure and patient age (r = 0.13; p > 0.1). CONCLUSION: Leak Point Pressure cannot always be determined by the Valsalva method. Other techniques of progressive increase of intravesical pressure must be investigated.

[The role of endoscopy in the diagnosis and treatment of keratinizing and desquamating malpighian metaplasia of the kidney pelvis]. / Place de l'endoscopie dans le diagnostic et le traitement de la métaplasie malpighienne kératinisée et desquamante du bassinet.

Keratinized squamous cell metaplasia of the renal pelvis (KSMRP) is a rare lesion, difficult to differentiate from urothelial tumour on the basis of the usual morphological examinations. It is therefore usually diagnosed retrospectively, on histological examination of a nephroureterectomy specimen. However, as its benign nature justifies conservative treatment, preoperative recognition of this lesion is essential. Upper urinary tract endoscopy, which allows diagnosis and treatment of this disease, is therefore very important in this context. Endoscopy is indicated when KSMRP is suspected clinically in a doubtful case of urothelial tumour of the upper urinary tract, in a context of passage of soft stones or a history of renal stones or upper urinary tract infection. Ureteroscopy constitutes the first step to confirm the diagnosis. It must be completed by a percutaneous procedure to eradicate any residual lesion, which could be responsible for recurrence. We report a case of KSMRP in a solitary kidney treated by retrograde and percutaneous endoscopic surgery.