Comparison of the Bard BTA test with voided urine and bladder wash cytology in the diagnosis and management of cancer of the bladder.

OBJECTIVES: To compare the Bard BTA test, a simple latex-agglutination test for cancer of the bladder (BC) that can be performed in less than 3 minutes in the urologist's office, with voided urine or bladder wash cytology in the diagnosis of subjects suspected of having BC on the basis of symptoms or recent abnormal cystoscopy or intravenous urography. METHODS: The study was performed at three medical centers in 414 subjects (147 female and 267 male; mean age 60 years), 345 of whom (83%) had no prior history of BC. The cytologic examinations were performed by pathologists unaware of the results of the BTA test. RESULTS: Cystoscopy or cystoscopy and biopsy revealed BC in 71 subjects (17%). The overall sensitivities of the BTA test and cytology were 70% and 25%, respectively. The specificities of the BTA test and cytology in the 337 subjects without BC were 90% and 100%, respectively. The sensitivities of the BTA test by tumor grade were 17%, 64%, and 92% for grades 1, 2, and 3, respectively; those of cytology were 17%, 14%, and 44%. Regression analysis suggests that tumor grade but no other study variable explains the sensitivity of the BTA test. CONCLUSIONS: The BTA test is considerably more sensitive than cytology in the detection of BC. For urologists who use cytology in the diagnosis and follow-up of patients with BC, the BTA test may replace cytology.

Imaging of angiomyolipomas.

In this article we review renal angiomyolipomas (AMLs) from cases in the world literature and 60 cases from our own institution. We also analyze the role and the place of the various imaging techniques in the detection and diagnosis of AMLs. Discussion is focused on the natural history of this benign neoplasm as an isolated form or as a part of the tuberous sclerosis (TS) complex or as part of a third less certain group of multiple AML without stigmata of TS. We also consider the growth patterns and hemorrhagic risks of AML to help define an approach to the current management of this lesion.

[Spermatocytic seminoma. Apropos of 4 cases]. / Les séminomes spermatocytaires. A propos de 4 observations.

The records of 4 patients treated for a spermatocytic seminoma between 1974 and 1993 were reviewed. We described pathological and clinical features of this entity of seminoma which differs from those of classic seminoma. Spermatocytic seminoma is an essentially non metastasizing neoplasm unless complicated by the rare development of a sarcomatous component or metastatic spread.

High-flow priapism in children: immediate treatment by selective embolization.

We present a case of a high-flow priapism related to a posttraumatic aneurysm in a ten-year-old boy treated by selective embolization. Patient history and thorough physical examination often lead to the diagnosis of high-flow priapism. Colour-coded duplex ultrasonography confirms the diagnosis, and treatment consists of angiographic embolization.

[Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: evaluation of objective and subjective parameters. A placebo-controlled double-blind multicenter study]. / Wirksamkeit eines Extraktes aus Pygeum africanum in der medikamentösen Therapie von Miktionsstörungen infolge einer benignen Prostatahyperplasie: Bewertung objektiver und subjektiver Parameter. Eine placebokontrollierte doppelblinde Multizenterstudie.

The efficacy of an extract of Pygeum africanum in the treatment of micturitional disorders due to benign prostatic hyperplasia was tested in a multicentre double-blind trial versus placebo. Capsules containing 50 mg of Pygeum africanum extract or placebo were administered at a dosage of 1 capsule in the morning and 1 capsule in the evening over a period of 60 days. 263 patients were included in this study, which was carried out in 8 centres in Germany, France, and Austria. Evaluation was mainly based on quantitative parameters such as residual urine, uroflowmetry and the precise monitoring of diurnal and nocturnal pollakiuria. Treatment with the Pygeum africanum extract led to a marked clinical improvement: a comparison of the quantitative parameters showed a significant difference between the Pygeum africanum group and the placebo group with respect to therapeutic response. The characteristic subjective symptoms of micturitional disorders, which were evaluated by the patients in a qualitative manner, were also significantly improved by administration of Pygeum africanum extract. Overall assessment at the end of therapy, showed that micturition improved in 66% of the patients treated with Pygeum africanum extract, as compared with an improvement of 31% in the placebo group. The difference was significant at the statistical level of p less than 0.001. During therapy with Pygeum africanum extract, gastrointestinal side effects occurred in 5 patients. Treatment was discontinued in three of those cases.

["Metastatic" Crohn's disease of the penis]. / Maladie de Crohn "métastatique" du pénis.

Inflammatory genital cutaneous involvement of Crohn's disease is a rare complication. In a 23 year old man, who had colonic Crohn's disease treated by colectomy 3 years earlier, a phimosis revealed a penile localisation of Crohn's disease. "Metastatic" locations of Crohn's disease are defined by granulomas sitting at a distance from the injured bowel. Their clinical manifestations are misleading and their course is independent of the digestive disease. In our patient, after failure of classical therapy, cyclosporin A permitted a slow regression.

[Value of iliac direct-view retroperitoneoscopy (or "extraperitoneal pelvioscopy") in the assessment of lymph node invasion by pelvic cancer]. / Valeur de la rétropéritonéoscopie iliaque à vision directe (ou "pelvioscopie extrapéritonéale") dans le bilan d'extension ganglionnaire des cancers pelviens.

Iliac retroperitoneoscopy, also called extraperitoneal pelviscopy (EPP), is a form of direct vision endoscopy derived from mediastinoscopy; It allows biopsies of pelvic lymph nodes. In view of the poor accuracy of radiological investigations for pelvic lymph node metastasis (N+) detection, EPP was performed in 210 patients with apparently resectable neoplasms (bladder n = 116, prostate n = 81, cervix n = 12, endometrium n = 1). Among 174 patients without radiologic evidence of metastasis (N-), EPP assessed 47 N+ patients and failed in 1 case, requiring a laparotomy (one N+ patient). Among 36 N+ patients after radiologic examinations, EPP assessed 20 N- patients and failed in 1 case, requiring a laparotomy (one N+ patient). Among 124 N- patients after EPP, a further laparotomy showed 8 N+ cases (false negative). Thus, out of 210 patients, EPP corrected the radiologic findings in 67 cases and drastically modified the therapeutic indications. Considering its absence of contraindications, EPP can be performed more often than laparoscopic pelvic lymphadenectomy techniques. Furthermore, its exploration field is not limited to the interiliac area. Its overall reliability is 95% in staging lymph node involvement of pelvic neoplasms.

[X-ray computed tomography and echography in the diagnosis of subcapsular hematoma of the kidney]. / Apports de la tomodensitométrie et de l'échographie dans le diagnostic des hématomes sous-capsulaires du rein.

Results and diagnostic value of computed tomography and ultrasound imaging in subcapsular hematoma of the kidney are discussed in relation to data from 9 cases. A positive diagnosis could be made in each case from CT scan images, but results of ultrasonography were less evident. An etiological diagnosis is difficult to establish and extreme caution is recommended before excluding a tumoral lesion, even in patients developing hematomas during anticoagulant treatment. Arteriography remains a valid examination since analysis of a large subcapsular hematoma by a CT scan is often risky, and a small cortical tumor may remain undetected.

[Multilocular cyst of the kidney. Characteristics of the imaging appearance]. / Kyste multiloculaire du rein. Particularités de l'imagerie.

Investigations in a patient with a multilocular cyst of kidney included urography, ultrasonography and computed tomography. Urography images showed a mass occupying the lower half of the left kidney with a lacunar image of pelvis, the association of these two elements suggesting a possible cancer of kidney. Ultrasound and computed tomography imaging demonstrated the fluid nature of the mass with absent partitioning. Findings were compared with data from the pathologic specimen which showed a main unilocular cyst with multiple satellite smaller cysts and a thick intrapyelic formation composed of microcystic aggregates. Pre-operative diagnosis of multilocular cyst was assisted by the use of modern imaging techniques: ultrasound and CT scan, which demonstrated a partitioned renal cystic lesion. Diagnosis is still difficult in atypical forms, however, and the relative frequency of an intrapyelic cyst protrusion is emphasized.

[Acute cystitis in women over 50 years of age. Efficacy of pefloxacin with single dose and norfloxacin for 10 days]. / Cystite aiguë chez la femme de plus de 50 ans. Efficacité de la péfloxacine en dose unique et de la norfloxacine prescrite pendant 10 jours.

This multicentre, open, randomized trial, involving 482 patients and conducted by private practitioners, compared the effectiveness and safety of a single 800 mg dose of pefloxacin and of a 10 days' course of norfloxacin 400 mg bid. in the treatment of uncomplicated acute cystitis in women aged over 50 years. Clinical effectiveness was evaluated on days 17-19 and 28-32 respectively, and bacteriological effectiveness on days 15-17 and 26-28 respectively. The median time taken for the symptoms to disappear was 2 days with pefloxacin and 3 days with norfloxacin (P < 0.001). Irrespective of the nature of cystitis and the patients' age, no significant difference could be found in eradication of the pathogens. Undesirable side-effects were recorded in 7.8 percent of patients under pefloxacin and in 8.8 percent of those under norfloxacin (P = 0.68); gastrointestinal disorders were predominant. The acceptability of treatment, as judged by the patients themselves, was regarded as excellent by 55 percent of women treated with single dose pefloxacin and by 37.6 percent of those treated with norfloxacin (P = 0.001).

[Rupture of the patellar ligament one month after treatment with fluoroquinolone]. / Rupture du ligament patellaire un mois après traitement par fluoroquinolone.

Musculoskeletal disorders including arthralgia and myalgia are adverse effect common to all fluoroquinolones. We report a case of spontaneous rupture of the patellar ligament in a 37-year-old man participating in leisure sports which occurred one month after a three-week course of Ciprofloxacine(R). Several cases of tendon ruptures have been reported in the literature, including the patellar tendon. Unusual features in our case were the one-month delay before tendon rupture and the absence of inaugural signs. We reviewed the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discussed proper management. Care must be taken when prescribing fluoroquinolones for patients at risk. Close follow-up is most important.

[Treatment of idiopathic retroperitoneal fibrosis: ureterolysis of corticoid therapy?]. / Traitement de la fibrose rétro-péritonéale idiopathique: urétérolyse ou corticothérapie?

Steroid therapy has been used as a treatment for idiopathic retroperitoneal fibrosis for the past ten years and more. In 14 out of a series of 19 patients, this treatment was well-tolerated and successful. It acts quickly. The results of medical treatment compare favorably with those of surgical ureterolysis. In the authors' view, steroid therapy is therefore the treatment of choice for this complaint, and surgical management should be confined to the relatively rare setbacks of medical treatment, and to patients who do not tolerate steroids.

[Uterus didelphys with a blind hemi-vagina and homolateral renal agenesis]. / Utérus didelphe avec hémi-vagin borgne et agénésie rénale homolatérale.

The authors report a case of bicervical bicornuate uterus with a blind hemi-vagina associated with homolateral renal agenesis. A review of the embryology and the various etiopathogenic theories for this rare anomaly are presented and the therapeutic principles are discussed.

[Apropos of 2 cases of oculo-orbital metastases of a prostatic epithelioma]. / A propos de deux cas de métastases oculo-orbitaires d'un épithélioma prostatique.

The authors report one case of choroid metastasis and one case of orbital metastasis from a prostatic carcinoma. A review of the literature confirms the exceptional nature of these metastatic sites (28 cases), which constitute a poor short-term prognostic factor. Palliative hormonal treatment allows regression of the ophthalmic signs without modifying the course of the disease.

[Pyelomanometry in obstructions of the upper urinary tract. Apropos of 26 cases]. / La pyélomanométrie dans les obstructions du tractus urinaire supérieur. A propos de vingt-six observations.

Pyelomanometry can be used in cases of ambiguous dilatation, to measure the pressure in the upper urinary tract during constant-flow perfusion through a percutaneous catheter (Whitaker's test). After recalling the principles of this method, and the technical procedure, the authors go on to discuss twenty six cases, analyzing the results, and comparing the advantages of this procedure with other methods of exploration.

[Nonseminomatous testicular tumors. Diagnostic strategy. Apropos of 53 cases]. / Tumeurs testiculaires non séminomateuses. Stratégie diagnostique. A propos de cinquante-trois observations.

The authors define a diagnostic strategy designed to establish the most reliable clinical staging on the basis of a series of 53 cases non-seminomatous testicular tumours. The value of each complementary laboratory and radiological examination is analysed in terms of its performance and its morbidity and a selective staging procedure is proposed. Finally, the role of retroperitoneal lymphadenectomy is discussed, as it appears that, with the development of chemotherapeutic protocols, this procedure will gradually disappear from the staging of early tumours to become an essentially therapeutic procedure. However, lymphadenectomy is still part of the authors' current staging protocol for clinical stage I tumours as it remains the only way to define the extension of the tumour with certainty.

[The Whitaker test. Apropos of an obstacle not to be ignored]. / Le test de Whitaker. A propos d'un obstacle à ne pas méconnaître.

Since 1980, 35 pyelomanometric procedures have been performed in the Department of Clinical Urology for dilatations of the upper urinary tract of uncertain etiology. During two recent procedures, pressure measurements were modified by an extra-urinary obstacle caused by the patient's position. Our experience confirms the value of the Whittaker test as well as the need for a faultless technique.

[What can be expected from suspension of the bladder neck in effort incontinence of urine? 85 operated cases (author's transl)]. / Que peut-on attendre de la suspension du col vésical dans l'incontinence urinaire d'effort? A propos de 85 opérées.

Among the large number of technics proposed to cure effort urinary incontinence in women, two types of operation are usually considered: --indirect cervico-cystopexy or colopexy (Marshall-Marchietti-Krantz operation or its derivatives); --operations of catapult type or suspension of the bladder neck, e.g. Goebell-Stoeckel's operation. The latter was chosen exclusively by us over the last ten years. We have thus grouped together 85 cases of effort urinary incontinence operated and followed up for a period of 1 to 11 years. At five years, this operation gave 82.85% good results and a delay of two years seemed to us the minimum necessary to assess these results. We noted 6 failures (7.05%) and 4 relapses (4.7%). Suspension of the bladder neck is often disputed and even denigrated. Some authors consider it is the best operation available especially in cases of relapse of effort incontinence [21]. Its technical difficulty has been reproached. Our objective thus double: --describe our technic of musculo-aponeurotic suspension of the bladder neck; --give our results emphasising the long term results. We thus hope to prove that this operation maintains its place in the treatment of effort incontinence.

[Laparoscopic lumbo-aortic lymphadenectomy in early-stage non-seminomatous germ cell tumors of the testis: Why? How?]. / Le curage lombo-aortique laparoscopique dans les tumeurs germinales non séminomateuses (TGNS) du testicule aux stades précoces: pourquoi? Comment?

OBJECTIVES: Laparoscopic lumbo-aortic lymphadenectomy is proposed in order to decrease the morbidity of pretreatment lymph node dissections for early stage NSGCT of the testis. Two approaches are presented and compared retrospectively: the transperitoneal approach and the extraperitoneal approach. MATERIAL AND METHODS: From 1991 to 1999, 57 patients with clinical stage I (50) to IIA (7) NSGCT underwent pretreatment laparoscopic investigation of the para-aortic lymph nodes: 32 transumbilical transperitoneal dissections and 25 internal iliac extraperitoneal dissections were performed. RESULTS: Only the 19 patients with lymph node invasion received chemotherapy. All serious complications occurred in the transperitoneal group: 1 case of chylous ascites and 2 cases of transient neurological complications, 2 cases of permanent ejaculation failure and 2 extranodal recurrences among the 38 pN0 patients. CONCLUSIONS: Laparoscopy, especially extraperitoneal, appears to be a safe, effective and appropriate modality for pretreatment lumbo-aortic lymph node evaluation in early stage NSGCT of the testis.

[A priori benign Leydig cell testicular tumor: enucleation or radical orchidectomy?]. / Tumeurs testiculaires à cellule de Leydig a priori bénignes: énucléation ou orchidectomie radicale?

The histological sections of 5 patients treated for clinically benign Leydig cell testicular tumour (LCTT) were reviewed according to histological criteria presumptive of malignancy. The absence of any sign of severity was only verified in a single case, as none of the other tumours could be considered to be strictly benign. In the light of these findings, great caution is required in conservative indications, especially as these tumours, when they are malignant, are particularly serious due to the inevitable diagnostic delay and their absence of radio- or chemo-sensitivity.