[Initial results of a novel technique for sperm retrieval in male infertility due to refractory retrograde ejaculation]. / Résultats préliminaires d'une nouvelle technique de recueil du sperme vésical en présence d'éjaculation rétrograde réfractaire au traitement médical.

AIMS: To describe and evaluate a novel technique of spermatozoa retrieval from patients suffering from infertility secondary to refractory retrograde ejaculation. METHOD: Prospective study to compare mobility and vitality of spermatozoa obtained from urine (U) after oral modification of chemical parameter (PH, Osmolarity) versus from endovesical instillation of sterile spermatozoa culture medium before ejaculation (F). Patients were their own controls. Twelve month prospective follow-up was achieved to document the results of assisted procreation. RESULTS: Eight patients were included and mobility and vitality were improved in all patients after F technique was compared to U technique. With U technique, eight patients on eight had negative defrost test; after F technique, seven patients on eight had a positive defrost test and could therefore have access to assisted reproduction techniques. Four couples had five ICSI and obtained three pregnancies leading to five births. CONCLUSION: Endovesical instillation of sterile spermatozoa culture medium before ejaculation was a safe and effective technique to improve spermatozoa quality in male infertility related to refractory retrograde ejaculation.

[Urinary incontinence following open prostatectomy or laparoscopy for local prostate cancer. A review of relevant literature]. / Incontinence urinaire après prostatectomie ouverte ou laparoscopique pour cancer prostatique localisé. Une revue de la littérature.

AIM: Evaluate urinary continence after radical prostatectomy. MATERIALS AND METHOD: Recent series about urinary continence were studied. RESULTS: In seven articles analyzed, continence fluctuated between 63.6 and 91.9%. Evaluation benchmarks were depending on study. Unlike self-questionnaires, objective criteria (pad test) should be more reliable. Carcinologic prognostic factors were not implicated directly. The most frequently preoperative risk factors of incontinence were: age, BMI. Peroperative parameters, attesting of surgical difficulties could have a functional impact. Bladder neck preservation could affect the recovery velocity but not functional results. Length of catheterization and lack of urinary rehabilitation could be influent. The mean of continence evaluation after radical prostatectomy was different for each study. CONCLUSION: Comparability was difficult because operative technique, group's features and mean of functional evaluation were different from study to study. Several risk factors were found but without consensus. It would be necessary to separate carcinologic and functional risk factors.

[Two-years follow-up of radiofrequency thermotherapy for urination disorders due to benign prostatic hyperplasia]. / Résultat à deux ans de la thermothérapie prostatique par radiofréquence pour troubles mictionnels liés à l'HBP.

AIM: To describe medium-term functional results of Transurethral Needle Ablation (TUNA) to treat symptomatic benign prostatic hyperplasia (BPH) refractory to medical treatment. MATERIALS AND METHOD: Patients who completed at least 2 years follow-up after TUNA were systematically offered a reevaluation including: Flowmetry, PSA, symptom score (IPSS), satisfaction index visual analogic scale (VAS) and a treatment impact evaluation with a Likert scale (ranging from much worse to much improved). RESULTS: From December 2002 to January 2007, 45 patients were treated with TUNA under local regional anaesthesia (prostatic block). Twenty-seven of them were followed-up longer than 24 months (median follow-up 44 months [26-52]). Changes in the selected outcomes were: increase in Qmax from 9.5 mL/s preoperatively to 9 mL/s at 6 month and 11.5 mL/s after 2 years; increase in IPSS from 19.3 before TUNA to 16.3 at 6 month and 16.5 after 2 years. About subjective evaluation, 58% of patient gave a satisfaction VAS>or=6, and the improvement index was greater or equal to +1 in 67% of case. CONCLUSION: In this initial monocentric experiment, despite a modest improvement of objective parameters and a 20% of retreatment rate, TUNA give contentment and improvement sensation for 60% of patients who were treated for non-efficiency of medical treatment for benign prostatic hyperplasia.

[Techniques, indications and results of permanent prostate brachytherapy for localized prostate cancer]. / Techniques, indications et résultats de la curiethérapie interstitielle par implants permanents dans le cancer localisé de la prostate.

Permanent seed brachytherapy as a monotherapy is an appropriate treatment in patients with low risk localized prostate cancer such as intraprostatic cancer, T1-2 stage, PSA less than 10 ng/mL, low tumour volume, well differentiated cancer (Gleason score less than 7), gland size less than 50 mL, no micturition symptoms that could decompensate after implantation. A brachytherapy program needs a specialized multidisciplinary team with the collaboration of urologists, radiotherapists (authorized person to manipulate radioactive elements), and physicists. The 10-year oncologic and morbidity results have been published in the literature and are comparable to those of other standard treatments of localized prostate cancer such as radical prostatectomy and external beam radiation therapy.

Impact of recombinant human granulocyte colony stimulating factor on dose intensity and toxicity of three cycles of methotrexate, vinblastine, doxorubicin and cisplatin in patients with previously untreated urothelial bladder carcinoma.

This single arm, open labeled, non randomized study was aimed to evaluate the toxicity of 3 cycles of MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) with rhG-CSF (5 micrograms/kg/day from day 3 to day 14), on 14 patients with previously untreated infiltrating bladder carcinoma, 42 cycles were administered. Chemotherapy toxicity was very low, with 7% of neutropenia grade 3 or 4.4% of thrombocytopenia grade 2, no mucositis above grade 2 and no nadir sepsis. Bone pain related to rhG-CSF occurred in 14% of cycles. 88% of the cycles were given at full dose without any delay and mean relative dose intensity was 96.4% (RDI was 100% for 9 patients). One patient achieved a complete pathological response (cystectomy: 1) and 6 clinical responses with negative transurethral resection. Addition of rhG-CSF to MVAC chemotherapy allows a high dose intensity of MVAC with very low toxicity over 3 cycles. This association should be compared to standard MVAC or intensified regimens to evaluate efficacy, toxicity, and cost effectiveness.

Construction of a urinary sphincter by means of an electrically stimulated striated muscle: experimental procedure and urodynamic results on canine model.

A canine model of urinary neosphincter using electrically stimulated autologous striated muscle is described. The superior belly of canine sartorius was activated by a pacemaker with an intermittent low frequency stimulation (0.5-1 pulse per sec) during 7 weeks. Then, the muscle graft was passed around the urethra and sutured back on to itself to form a neosphincter. The surgical procedure was easy to perform and with no complication. Urethral pressure profile was performed initially (T0), and when the muscle was in peri-urethral position, before (T1) and during electrical stimulation (T2). The continence parameter readings (maximal urethral closure pressure MUP, functional length FL, continence zone CZ, and continence area CA) increased from T0 to T1, and from T1 to T2. We noted: 1) 28%, 38%, 52%, and 86% increases for the MUP, FL, CZ, and CA respectively from T0 to T1, 2) 10%, 41%, 30%, and 43% increases for MUP, FL, CZ, and CA respectively from T1 to T2. Chronic low frequency stimulation could transform a skeletal fast-twitch type 2 muscle into a slow-twitch fatigue-resistant type 1 muscle. In this study, morphological changes of the stimulated muscle were noted, whereas phenotype was unchanged. This dynamic autologous neosphincter may be a new alternative to the artificial urinary sphincter prosthesis with fewer complications. Further studies are ongoing to evaluate the efficacy of such a neosphincter as continent system for bladder substitution after pelvic exenteration for pelvic cancers.

[Botulism toxin in practice]. / Toxines botuliques: utilisation pratique.

Botulinum toxins (A and B) are neurotoxins derived from Clostridium botulinum. Clostridium are anaerobic bacteria. C. botulinum produces exotoxins (A to G) with distinct antigenicities. The neurotoxins inhibit the release of the neurotransmitter acetylcholine from the axon terminals of motor neurons. Botulinum toxin is officially used in clinic for the treatment of muscular hyperactivity (strabismus, blepharospam, cervical dystonia). Botulinum toxins are also used in non recognized clinical applications: neurogenic incontinence, palmar and axillary hyperhidrosis, chronic anal fissure. The respective formulations of Botox, Dysport and Neurobloc are described. Special considerations for administration are introduced.

[Bret's plastic operation on the uterus (author's transl)]. / Hystéroplasties de Bret.

A comparison of our results with those in the literature confirms that Bret's plastic operation on the uterus is valuable in the cure of septate uterus with two cavities in infertile patients who have had several spontaneous abortions. In spite of this it is advisable to take care to select cases and to be guided by the classical indications for plastic operation on the uterus. The number of abortions (more than 2) is the major criterion but it is often difficult to confirm that the infertility which results is due to the malformation and not to associated pathology. The problem is even more complex when it is a question of sterility rather than repeated abortions.

[Water and electrolytes disorders in apudocarcinomas (author's transl)]. / Les troubles hydroélectrolytiques des apudomes.

The authors report an analytic study of hydroelectrolytic disorders in patients with APUD tumors. In most of the cases a diarrhea occurs. The type of this diarrhea is: -- a motrice diarrhea (in the great majority of carcinoid tumor and medullary carcinoma of the thyroid); -- a secretory diarrhea (W.D.H.A.): it is the case in gastrinoma (gastric hypersecretion), in secretinoma (pancreatic hypersecretion) and in vipoma (intestinal hypersecretion). The others disorders could be no diarrhea dependant (hyponatremia by ADH hypersecretion, hypercalcemia). The personal cases of the authors are: 12 medullary carcinoma of the thyroid, 19 enteraminoma and 2 others apudomas.

[Impotence caused by venous leakage. Placement of a prosthetic venous bandage]. / Impuissance par fuite veineuse. Mise en place d'un garrot veineux prothétique.

A new treatment of impotence by venous leakage is reported. It consists of tying the dorsal and lateral aspects of the cavernous body with a bandage of synthetic material. The bandage, inserted on the bulbo-cavernous muscles, restores a "carter effect" and prevents venous leakage during erection. This technique has been used in 20 patients, with satisfactory results in 10 who were followed up for more than 4 months.

[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.

[Urinary calculi. Current role of in situ dissolution]. / Calculs urinaires. Place actuelle de la dissolution in situ.

The two cases reported here illustrated the advantages of urinary stone dissolution in situ. One patient had bilateral urate calculus with anuria; the other had recurrent staghorn calculus. In both cases a nephrostomy stent was installed percutaneously and the calculi were dissolved by irrigation.

[Treatment of cavernous venous incompetence by insertion of a pericavernous prosthetic band]. / Traitement de l'incompétence veino-caverneuse par mise en place d'une bandelette prothétique péricaverneuse.

The authors present a series of 30 patients treated by pericavernoplasty involving insertion of a prosthetic venous tourniquet. At 1 year, 60% of the patients obtained a good result. The preoperative selection criteria were: impossibility of penetration without manual assistance, normal arterial Doppler and hormone assays, high erection induction and maintenance flow rates, failure of simple medical treatments and perineal rehabilitation. The current problem concerns the objective evaluation of the compliance of erectile tissues. A possible approach in the future could be cavernous biopsy, which would allow the proposal of either venous surgery or the immediate insertion of a prosthesis.

[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.

[Female vesical instability: etiologic problems in 209 cases]. / Instabilité vésicale féminine: problémes étiologiques. A propos de 209 cas.

Based on a series of 209 cases, the authors investigate the aetiological factors responsible for vesical instability in adult females. Fifty five p. cent of patients suffered from incontinence due to isolated urgency. These patients presented a history of neurological disturbances in 21 cases, total hysterectomy in 22 cases and surgery for incontinence in 54 cases. Sixty p. cent of cases presented with genital prolapse. There were 7 cases of urinary tract infection, 2 cases of renal stones and 2 bladder tumours. Urodynamic studies revealed 60 dysuric syndromes. The responsibility of urinary tract infection or genital prolapse in the development of vesical instability is questionable. Nevertheless, the frequency of genital prolapse in the present series argues in favour of deficiency of the perineal musculature which decreases the capacity for inhibition of the detrusor. Lastly, 40% of patients did not have any neurological causes or any vesical or adjacent pathology. These cases were described as idiopathic vesical instability for which the aetiopathogenesis remains unknown.

[The results of urethro-cervicolysis after surgical over-correction of stress urinary incontinence. Apropos of 10 cases]. / Les résultats des urétro-cervicolyses après hypercorrection dans la chirurgie de l'incontinence urinaire d'effort. A propos de dix observations.

Between 1985 and 1988, 10 female patients between the ages of 35 and 76 years, suffering from dysuria after surgical correction of urinary stress incontinence (7 sub-urethral bands, 3 colposuspensions) were observed. The abnormality of the course of the urethra compressed anteriorly against the symphysis pubis, observed on clinical examination and on intravenous pyelography as well as urodynamic investigations allowed this dysuria to be attributed to a cervico-urethral obstruction resulting from over correction during the initial surgical operation. The 10 patients were treated by urethro-cervicolysis (9 out of 10) associated with repeated colposuspension in 3 cases. The overall results were disappointing as although 8 of the 10 patients were improved at 3 month, only 4 out of 9 were still improved at 6 months. These poor results raise the question of the value of combining urethro-cervicolysis with colposuspension and possible VY plasty of the bladder neck.

[Treatment of urethral stenoses by dilatation with the Olbert catheter. A propos of 50 cases]. / Traitement des sténoses urétrales par dilatation à la sonde d'Olbert. A propos de cinquante observations.

The method of treating urethral strictures described in this article is inspired from the technique for percutaneous angioplasty, using an inflatable catheter. It provides good immediate results in 80% of cases, regardless of the localization of the stricture and the previous treatment.

[Obstetric and neonatal consequences of urinary infection during pregnancy]. / Conséquences obstétricales et néonatales de l'infection urinaire gravidique.

In this article, the authors study the real obstetrical and neonatal effects of urinary infection in pregnant women. Basing themselves on 225 cases of gravidic urinary infection, the authors discuss asymptomatic bacteriuria, the need of early diagnosis in risk patients, and the use of regular post-treatment monitoring, in view of the fact that, even when well-treated, this complaint is apt to recur.

[Results of the surgical treatment of impotence due to venous leakage by insertion of a prosthetic venous tourniquet. 26 patients reviewed with a 1-year follow-up]. / Résultats du traitement chirurgical de l'impuissance par fuite veineuse par mise en place d'un garrot veineux prothétique. Vingt-six malades revus avec un an de recul.

Twenty-six patients have been operated by pericavernoplasty with a band of synthetic material. After 1 year, 61.6% had a good result. Venous leaking is certainly a disease of the corpora cavernosa.

[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.