Iatrogenic bladder stone formation on absorbable suture 3-years after radical prostatectomy.

Vesical calculi formation on absorbable sutures is rare. The case of a 68-year-old white man, who had formed a large bladder stone on absorbable suture 3 years after radical prostatectomy, is reported. Endoscopic lithotripsy of the bladder calculi was performed and the suture was removed.

[Results of long-term treatment of inoperable cancer of the bladder with cisplatin and concurrent irradiation: prognostic factors of local control and survival]. / Résultats à long terme du traitement des cancers de vessie inopérables par cisplatine et irradiation concomitante: facteurs pronostiques du contrôle local et de la survie.

PURPOSE: Therapeutic strategies for muscle invasive bladder cancer are currently evolving. A recent European randomized study has shown that neoadjuvant chemotherapy does not improve the chance of cure or and radiotherapy would provide better results but there is a need to identify by prognostic factors patients who may benefit from such a conservative strategy. MATERIAL AND METHODS: One hundred and nine patients with localized muscle-invasive bladder cancer, who were not candidates for radical cystectomy, were treated with concomitant cisplatin and radiation therapy. Their mean age was 71. Thirty-six percent of the patients had T3B-4 tumors, and 37% had benefited from prior macroscopically complete transurethral resection (TUR). Pelvic irradiation consisted of 40 to 45 Gy and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg/m2/d for 5 days) was delivered during the second and fifth weeks of radiation therapy. RESULTS: Median follow-up was 73 months. The projected 5-year locoregional control rate was 43% for the 109 patients and 55% for the 86 patients with complete response. The projected overall 5-year survival rate was 36% for all patients and 44% for complete responders. Univariate analysis of prognostic factors was carried out for local control, and survival. The local control was statistically better in patients with good performance status, T2-3A, complete initial TUR, and in patients without hydronephrosis. In terms of overall survival, four factors were significant: the performance status, T-stage, absence of hydronephrosis, and complete response. By multivariate analysis, performance status, hydronephrosis and T-stage were significant factors for local control, while T-stage and complete response were the strongest determinants for survival. CONCLUSION: Concurrent cisplatin and radiation therapy is a potentially locally curative treatment for 43% of patients with muscle-invasive bladder cancer not candidates for radical surgery. Clinical T-stage and hydronephrosis have a significant and independent prognostic value on local control but appears not discriminant enough to select patients for conservative treatment.

Laparoscopic tumorectomy of renal carcinoma recurred in remaining kidney.

Nephron sparing surgery is the standard treatment for small, peripherally located renal cell carcinoma. To reduce the morbidity of nephron sparing surgery laparoscopy was proposed. A case of renal carcinoma recurred in the remaining kidney successfully treated by laparoscopic approach is reported.

Successful transarterial embolization of idiopathic renal arteriovenous fistula.

A case of idiopathic renal arteriovenous fistula in a 46-year-old woman presenting intensive right renal colic associated to massive hematuria is reported. The renal arteriography confirmed the diagnosis and embolization of the fistula was performed. The transarterial embolization was successful no recurrence is observed after one year follow-up.

[Apropos of 1 case of paratesticular papillary serous cystadenocarcinoma]. / A propos d'un cas de cystadénocarcinome papillaire séreux paratesticulaire.

The occurrence within the testis or paratesticular tissue of serous tumors, similar to ovarian tumors, is rare. This article reports a primary serous paratesticular cystadenocarcinoma in a 39 year-old man. From data of the literature, we offer guidelines for diagnosis, histogenesis and treatment of this rare tumor.

[Endoscopic transvesicoparietal exteriorization of ureteral catheters]. / Extériorisation transvésicopariétale endoscopique des sondes urétérales.

Endoscopic introduction of catheter into the ureter for drainage has long been a common procedure, and recent advances in endoscopic urology have widened its indications. The ureteral catheter is usually exteriorized through the urethra and attached to the urethral catheter, but with this technique it tends to descend spontaneously and to create infections which are a possible cause of ureteral stenosis. A technique of endoscopic transvesicoparietal exteriorization of ureteral catheters without incision has been developed in 1982. The problems encountered in exteriorizing the ureteral catheter through the lumen of a suprapubic trocar have now been solved by using a bipodal forceps introduced into the trocar.

[Extensive nephrectomy in severe forms of cancer of the kidney in the adult]. / Néphrectomie élargie dans les formes graves du cancer du rein de l'adulte.

Resection of renal tumours may be useless when the staging procedures reveal that the disease is too far advanced. A retrospective study of 100 radical nephrectomies for renal cell carcinoma distinguished the following groups: advanced cancers in young patients; cancers in patients over the age of 70 years. Despite the limited follow-up of this series, the study of survival demonstrates the following points: the difficulty of predicting the degree of lymph node involvement on pre-operative staging, the value of an anterior sub-costal and abdominal approach which facilitates radical nephrectomy in elderly and fragile patients, the poor prognosis of lymph node invasion and metastases, although some patients have survived for 12 months after resection of metastatic tumours.

[Benign prostatic hypertrophy. Surgical treatment. Value of surgery by a high approach]. / Hypertrophie prostatique bénigne. Traitement chirurgical. Valeur de l'intervention par voie haute.

Transurethral resection of the prostate is not a new procedure for the treatment of adenoma of the prostate but is being increasingly used. This fact is incontrovertible and all urologists perform transurethral resection for small adenomas. For large adenomas we still believe surgical removal is the best method. The results of resections of the prostate reported in the literature are not good enough to cause us to change our mind (80% good results after one or several procedures with an 8% incontinence rate!). To allow a more accurate evaluation we compared our personal results with surgical removal to the results of resections performed in our unit and reported in the literature.

[Vesico-renal reflux detected in adults. Apropos of 37 cases]. / Le reflux vésico-rénal découvert chez l'adulte. A propos de trente-sept observations.

The authors report a series of thirty seven patients presenting with vesicorenal reflux. The circumstances leading up to the discovery of the disorder, and the urographic and cystographic findings are described. of the 37 patients, 9 were treated medically, 6 by nephrectomy, and 22 by ureteral reimplantation, involving, in some of the cases, an extravesical dissection of the ureter.

[Urologic complications in adult kidney recipients]. / Complications urologiques chez les transplantés rénaux adultes.

In this article, the authors study the complications following all the kidney transplantations performed in their hospital between 1969 and 1980. During this period, 580 patients underwent 637 transplantations, including 120 (19%) with urological complications: urinary fistulae (49%), stenoses (28%), vesicorenal refluxes (13%), and calculi (10%). The postoperative mortality rate was 2.7%. Some patients presented with two or more complications. The circumstances of the discovery of the sequelae and the treatment prescribed are described in each case and a comparative study is made with other transplantation centers.

[Treatment and course of advanced bladder cancers. Retrospective study of 29 cases]. / Traitement et évolution des cancers de vessie évolués. Etude rétrospective de vingt-neuf cas.

A retrospective study of 29 patients with extensive but non metastatic bladder cancer (T234N+ M0) demonstrated once more the dreadful prognosis of advanced bladder cancer. Only 4 patients are alive without evidence of recurrence with a follow up of 12 to 64 months. The 11 patients whose tumor was too extended for radical cystectomy had a similar survival rate and better quality of survival than the 18 patients who underwent total cystectomy. Recurrence appears quickly (mean time : 11 months) and is mostly metastatic. This study led us to change our therapeutic attitude. We now use systemic preoperative polychemotherapy and we no longer perform radical cystectomy in bulky nodal metastasis.

[Recurrence of a urothelial carcinoma in an ileal neo-bladder. Apropos of a case]. / Récidive sur une néo-vessie iléale d'un carcinome urothélial. A propos d'un cas.

Recurrences of bladder carcinoma on ileal loop are rare (8 cases reported). We report herein the first case of recurrence after enterocystoplasty (Camey procedure).

[Controlled study of the effects of Pygeum africanum extract on the functional symptoms of prostatic adenoma]. / Etude contrôlée des effets de l'extrait de Pygeum africanum sur les symptômes fonctionnels de l'adénome prostatique.

Two random groups of sixty patients each were given an extract of pygeum africanum in one group, and a placebo in the other. The results highlight the placebo effect (50 per cent of cases), and that the extract provided an overall improvement in the functional symptoms. The differences between the two treatments were statistically significant for nocturnal frequency, difficulty in starting micturition, and incomplete emptying of the bladder.

[Thyroid metastasis of a kidney cancer]. / Métastases thyroïdiennes d'un cancer du rein.

The authors report a case of multiple thyroid metastases in a patient who had undergone excision of a renal adenocarcinoma eight years previously. At the first operation, there had been no sign of any metastases. A benign thyroid adenoma was also found.

[Unusual tumors of the testis. Apropos of 22 cases]. / Les tumeurs rares du testicule. A propos de vingt-deux cas.

The authors report their experience of rare non-germ-cell tumours of the testis over a period of 10 years. The criteria of benign disease, justifying testicular preservation in 5 out of 7 cases of epidermoid cysts, are defined. Four cases of Leydig cell tumours, including 3 with gynaecomastia, are described. Three cases of adenomatoid tumours with conservative surgery, 3 lymphomas, 2 mature teratomas and 2 cysts of the rete testis are also reported. The place of ultrasonography is defined and the possibility of conservative surgery is discussed in relation to a review of the recent literature.

[Radiotherapy of localized prostatic cancer: follow-up of 48 patients. G.C.C.P. (Cooperative Group for the Study of Prostatic Cancer)]. / Radiothérapie des cancers de prostate localisés: 48 malades suivis plus de dix ans. G.C.C.P. (Groupe Coopératif d'Etude du Cancer de la Prostate).

OBJECTIVE: To evaluate the safety and long-term efficacy of curative-intent radiation therapy in patients with apparently localized prostate cancer. METHOD: 48 patients with T < 3 M0 prostate cancer recruited between 1981 and 1985 received regular clinical follow-up for at least ten years or until their death. Radiation therapy was given according to the protocols established by Ray and Bagshaw. RESULTS: Radiation therapy was safe and effective in most patients. The rate of escape phenomenon was less than 10% after two years. Tumor control rates were greater than 80% after five years and 50% after ten years. Unfortunately, local remission, even when prolonged, did not necessarily indicate a complete cure: 20% of local recurrences developed five to 11 years after radiation therapy. CONCLUSION: Radiation therapy may be the best first-line treatment in men older than 75 years of age and in those whose life expectancy seems shorter than ten years, but should probably not be considered curative.

[The anterior subcostal transperitoneal approach in urological practice (author's transl)]. / La voie d'abord antérieure transpéritonéale sous costale en urologie.

Fifty-three surgical operations, including 43 enlarged nephrectomies for cancer, were conducted employing the anterior transperitoneal approach along the costal margin. This technique has been used for the last 4 years for excision of renal cancers, as well as certain difficult nephrectomies (pyonephrosis, repeated kidney operations), and for surgery on the renal vessels, the adrenals, and the peri-aortic lymphatics. The approach is solid and easy to enlarge, and gives direct access to the diaphragm, the large vessels, the renal pedicle, and the upper pole of the kidney. As only the abdomen is incised, morbidity is low.

[Xanthine urinary calculus in a patient with Lesch-Nyhan syndrome. Apropos of a case]. / Calcul urinaire de xanthine chez un patient porteur d'un syndrome de Lesh Nyhan. A propos d'un cas.

The authors report a case of xanthine stones in a 12-year-old child with Lesh Nyhan syndrome treated by allopurinol at the dose of 10 mg/kg/24 hours. This type of urinary stone is unusual and its structure was confirmed by spectrophotometric analysis. This type of stone, in the context of Lesh Nyhan syndrome, suggests the presence of allopurinol treatment. Discontinuation of this treatment prevents recurrence of xanthine stones.