Cystic changes in adult human kidneys after ureteral obstruction: microdissection studies.

Five kidneys from patients suffering from ureteral obstruction were selected for the study; from each, 100 nephrons and 20 collecting ducts were studied using Darmady's microdissection technique. Whereas three kidneys showed macroscopic cysts, microscopically, all kidneys displayed dilation and diverticulation of the nephrons particularly of the loop of Henlé and of distal convoluted tubules. Some dilatation of the collecting ducts was also noticed.

Percutaneous 17 beta-estradiol in treatment of cancer of prostate.

A natural estrogen, 17 beta-estradiol, was given percutaneously to 21 patients with untreated cancer of the prostate. The follow-up lasted three to six months, and the results of the survey were encouraging. The hormonal controls showed good plasma diffusion of estrogen, a significant drop in plasma testosterone, and decreased hypophyseal secretion as shown by lower follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Triglycerides and very low density lipoproteins (VLDL) which are considered to be good indicators of cardiovascular risk were unchanged.

Diverticula on distal tubule, simple renal cysts, and ureteral obstruction. Causal relationship.

A case of obstruction on a localized kidney zone is reported. Obstruction was considered a precipitating factor in the morphogenesis of diverticula on the distal tubules and the simple cyst, found exclusively in the adjacent renal parenchyma to the obstruction.

Abdominoperineal-prostatocystectomy for infiltrating bladder carcinoma.

Combined abdominoperineal prostatocystectomy was described eighty years ago but has fallen into disuse. The authors performed this operation, two surgeons working simultaneously, in 14 patients with deeply infiltrating bladder carcinoma. Although 1 patient died postoperatively, morbidity has been minimal. The combined approach makes the cystectomy easier and allows excellent drainage through the perineum.

Extracorporeal shock-wave lithotripsy to remove calcified ureteral stents.

A patient was seen with a large calcification of the renal end of a silicone catheter placed to intubate a cutaneous ureterostomy. Because of the stone, withdrawal of the catheter was impossible, and the patient presented with obstruction and dilatation of the renal cavities along with febrile bacteriuria and renal failure. Extracorporeal shock-wave lithotripsy, done under intravenous sedation, was found to be an effective noninvasive method to treat such a complication of long-term urinary drainage.

Effects of pulsed dye laser lithotripsy on tissues. Experimental study in the canine ureter.

This experimental study demonstrates the absence of irreversible tissue damage after lithotripsy with a pulsed dye laser. The absence of thermal damage with this laser is due to the beam divergence capacity at the end of the fiber and to the short pulse, which generates very low thermal effect. These results as a whole confirm the safety of the pulsed dye laser and indicate that it can be used for clinical treatments in humans.

Epidemiology of prostatic cancer.

The worldwide incidence of prostatic cancer derived from data published by the Union Internationale contre le Cancer and the International Red Cross Committee has been estimated to be 200,000 new cases each year. Cases occur predominantly in the USA (75 per 100,000) and in northern Europe (40 per 100,000), whereas the incidence is low in Asia. Comparison of clinical series and autopsies confirms the high incidence of cancer in older age groups, although not all cases are seen clinically. Mortality increases more slowly than the incidence of the disease, indicating that diagnosis and treatment are increasingly effective. Aetiological factors remain the subject of much discussion, without any criteria appearing to be dominant.

[TULIP: transurethral ultrasound-guided laser-induced prostatectomy. One-year clinical results]. / TULIP: transurethral ultrasound-guided laser-induced prostatectomy. Résultats cliniques à un an.

The TULIP (transurethral ultrasound-guided laser-induced prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 microns wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.

[Complete ureteral avulsion. Complication of vaginal delivery of an infant dying in utero during the second trimester of pregnancy]. / Avulsion urétérale complète. Complication de l'évacuation par voi basse d'une mort in utero du deuxième trimestre.

The authors report a case of complete avulsion of the ureter occurring during the vaginal evacuation of a fetus that had died in utero in the second trimester. This case leads us to discuss the diagnostic and therapeutic measures that should be taken in this kind of situation. At present there are people who wish to increase the number of indications for second trimester terminations of pregnancy. As this is so, we wish to draw attention to a rare but very serious complication of late evacuation of the uterus, namely damage to the ureter.

[Treatment of advanced prostatic cancer with a gonadorelin agonist, dTrp6 LHRH. 41 cases]. / Traitement du cancer de la prostate évolué par un agoniste de la gonadoréline, le DTrp6 LH-RH. Quarante et une observations.

Forty-one patients with prostatic cancer were treated with DTrp6 LH-RH, a luteinizing hormone releasing hormone agonist. Thirty-eight of them had advanced cancer with either metastases or major local spread. In all cases with plasma testosterone levels were normal before treatment, the LH-RH agonist brought them down to values observed after surgical castration. An objective response ("improvement" or "stabilization") was obtained in 68% of the patients, but virtually all "improved" patients were those without previous hormonal treatment. As with all LH-RH agonists, the pharmacological castration produced by DTrp6 LH-RH is of considerable value in the treatment of prostatic cancer, especially since this compound, unlike estrogens, does not seem to cause cardiovascular accidents. However, transient hyperandrogenism may occur during the first days of treatment (as it did in 9 of our patients) and may be responsable for an acute flare-up of the tumoral process, as suggested by 2 of our cases. The concomitant administration of an anti-androgenic drug should perhaps be considered.

[Benign prostatic hypertrophy. Treatment using local hyperthermia]. / Hypertrophie bénigne de la prostate. Traitement par hyperthermie localisée.

The authors have used local hyperthermia in the treatment of benign prostatic hypertrophy (BPH). The "Promeditech" device consists of a computer-controlled microwave hyperthermia system which warms up the prostate through a probe inserted into the rectum. Forty-three patients aged from 57 to 81 years were treated. All presented with severe voiding symptoms and were considered for surgery. Treatment was applied once a weeks for 5 weeks without anaesthesia and on an out-patient basis. At each session, hyperthermia was maintained at 42.5 to 43.5 degrees C for 60 minutes. Objective and subjective criteria for treatment were: post-voiding residual volume, voided volume, maximum flow rate and frequency, urgency, dysuria and nocturia respectively. These parameters were determined for all patients before and after treatment. Results were evaluated at 3 months and 6 months. Objective improvement was observed in 45 p. 100 of the patients, and subjective improvement in 58 p. 100. In 4 out of 5 patients fitted with an in-dwelling catheter for more than 3 months, it was possible to remove the catheter. This procedure must be more widely tested, but it seems to be particularly appropriate for two kinds of patients: those who do not accept retrograde ejaculation and those who are considered poor surgical risks.

[Hemostasis of the preprostatic veins in total cystoprostatectomy. Anatomical bases]. / Hémostase des veines préprostatiques dans la cystoprostatectomie totale. Bases anatomiques.

An anatomical study has enabled the authors to propose a diagrammatic description of pre-prostatic veins, the haemostasis of which is one of the difficult stages in total cystoprostatectomy for cancer. These veins are surrounded by the pubovesical ligaments but they are separated from the membranous urethra by a cleavage plane which can be used to control venous bleeding.

[Renal angiomyolipoma. Diagnostic value of magnetic resonance imaging]. / L'angiomyolipome rénal. Intérêt diagnostique de l'imagerie par résonance magnétique.

Owing to the wider use of ultrasonography, renal angiomyolipoma is now diagnosed with increasing frequency. Within a few months, 10 female patients were explored by ultrasounds, computerized tomography and nuclear magnetic resonance (Magniscan 5,000, 0.5 Tesla). At ultrasonography the lesion was hyperechogenic in 9 cases and heterogenic in 1 case. At computerized tomography 7 patients had a strongly hypodense lesion and 3 had a lesion of slightly positive density. At magnetic resonance imaging the lesion produced a characteristically loud signal similar to that of fatty tissues. In practice, ultrasonography and computerized tomography combined provide the diagnosis in most cases. In case of doubt, especially since the tumour may be small and asymptomatic and the lesions multiple and/or bilateral, magnetic resonance imaging with its fat-like loud signal confirms the diagnosis and leads to partial resection. When no complications are present, it may even suggest that surgery is unnecessary.

[Treatment of epidermoid carcinoma of the penis]. / Traitement du cancer épidermoïde de la verge.

Epidermoid carcinoma of the penis is a rare type of cancer. Treatment of the primary lesion consists of amputation, although curietherapy can be effective in some cases as a conservative treatment. The prognosis is determined by the presence of absence of lymph node invasion, but the therapeutic strategy to be used when invaded lymph nodes are present remains controversial. Lymph node dissection is the only effective treatment of metastatic adenopathy, but its high morbidity rate limits its indications.

[Oxaluria in urinary lithiasis]. / Oxalurie dans la lithiase urinaire.

The normal value of oxaluria, as determined by gasliquid chromatography, is about 30 mg/24 h. In most cases of renal stone formation (60-70%) the stones are composed of calcium oxalate alone or associated with calcium phosphate. The more evolutive the disease, the higher the oxaluria. The part played by oxaluria in renal stone formation and the need to include its determination in regular examinations of stone formers must be stressed. Treatment of hyperoxaluria is both medicinal and dietetic : control of oxalic acid-rich food intake and reduction of the intestinal absorption of oxalate caused by calcium-deprived diets. The diet must be completed by therapeutic measures aimed at reducing the oxaluria and increasing the urinary factors preventing crystallization.

[Sexual disorders after an operation for benign prostatic hypertrophy]. / Troubles sexuels après intervention pour hypertrophie bénigne de la prostate.

A prospective study was conducted on the sexual function of 70 patients undergoing transurethral (48 cases) or transvesical (22 cases) prostatectomy for benign prostatic hypertrophy. 22 patients with no sexual activity before operation, remained sexually inactive after surgery. Frequency of intercourse and penile erection remained generally unchanged after operation. Retrograde ejaculation was observed in 33 patients (69%). Only one patient complained of total loss of potency after operation. Orgasm was maintained in all other patients; however 25 patients considered it to be "different". 4 of the sexually active operated patients (8%) and 7 of their partners complained of lack of sexual satisfaction after operation.

[Urinary incontinence following prostatectomy. Results of cervico-urethral plasty using Tanagho's tubular vesical flap]. / Incontinence des urines après prostatectomie. Résultats de la plastie cervico-urétrale par lambeau vésical tubulé selon Tanagho.

Seven patients suffering from urinary incontinence after prostatectomy were treated by cervico-urethral plasty with a tubular vesical flap. Results were good or very good in four cases, and fairly good in one. There were two setbacks. The procedure should be reserved to patients not afflicted with vesical instability, cervico-urethral obstruction or fibrosis of the anterior surface of the bladder. Patients suffering from the last two conditions require an artificial sphincter after removal of the obstructive lesions.

[Bilateral kidney cancer in a patient with Von Hippel-Lindau disease]. / Cancer du rein bilatéral chez une patiente atteinte d'une maladie de Von-Hippel-Lindau.

A case of bilateral renal carcinoma in a female patient presenting with Von-Hippel-Lindau disease is reported. Many different lesions may be associated in this autosomal dominant disease and the presence of renal involvement must be investigated in every patient. Renal carcinoma, often bilateral, is now frequently treated by conservative methods. It is always necessary to conduct an epidemiological survey in the entire family.

[Infiltrating cancer of the bladder with lymph node invasion: is total cystectomy justified?]. / Cancer infiltrant de la vessie avec envahissement ganglionnaire: la cystectomie totale est-elle justifiée?

In order to assess the potential benefits of radical cystectomy in bladder cancer associated with pelvic lymph node metastasis, a retrospective study compared 2 groups of patients with T2-T3 N+ bladder cancer: 10 treated by radical cystectomy and 14 treated conservatively once the diagnosis of nodal metastasis had been established by fine needle node aspiration or lymphadenectomy. The survival rates were identical in both groups: 80% of the patients died within 2 years, 60% during the first year after diagnosis, mainly due to distant metastasis. No patient in the conservative arm required salvage cystectomy because of local progression. It is concluded that radical cystectomy is of little benefit in T2-T3 N+ bladder cancer, a disease which is no longer amenable to purely local treatment.

[Urogenital complications of abdominoperineal resection of the rectum for cancer]. / Complications uro-génitales des amputations abdomino-périnéales du rectum pour cancer.

While operative traumas of the excretory tract are rare, mictional and sexual sequelae often complicate rectal resections for cancer. Although relatively rare, mictional disorders, which mainly affect males, are as often neurogenic as obstructive, and are, in that event, frequently due to iatrogenic urethral stenoses. The neurogenic disorders require an extremely sensitive semiological analysis before contemplating the slightest procedure on the prostate, which may provoke definitive urinary incontinence. Retrograde ejaculation and impotence are frequent, and the latter can be attenuated by a penial prosthesis.