[Inguinal lymphatic metastasis of cancer of the testis: staging and therapeutic approach]. / Les métastases ganglionnaires inguinales des cancers du testicule: stadification et attitude thérapeutique.

Inguinal lymph node metastases from testicular tumors are reported in 2% of cases. Between 1980 and 1990, two patients in a series of 54 testicular tumors, presented with inguinal node metastases. In there two cases and in the cases in the literature, it is well known, that testicular tumors in patients who have had the lymphatics disrupted by prior scrotal or inguinal surgery, or tumor-contaminated scrotum, can metastasize primarily to the ipsilateral inguinal nodes. Even in the absence of other retroperitoneal metastases, these testicular tumors must be considered to be stage IIA. Owing to the efficacy of primary or secondary chemotherapy, ipsilateral inguinal node dissection is not necessary in nonseminomatous testicular tumors. For testicular seminoma, an additional inguinoscrotal radiotherapy is necessary. Survival rate for testicular tumors with isolated metastatic inguinal nodes, particularly in tumor-contaminated scrotum, is not significantly different, compared to a group of patient without inguinal nodes.

[Ureter-aorto-iliac prosthesis cross-over and a tumor of the ureter]. / Croisement uretère-prothèse aorto-iliaque et tumeur de l'uretère.

Ureteric stenoses sometimes occur after the insertion of aorto-iliac prostheses. Two cases of neoplastic ureteric stenosis, independent of the ureter-prosthesis crossing are reported, indicating the possibility of such lesions after aorto-iliac prosthetic surgery.

[Extra-corporeal lithotripsy (EDAP LT 01) in urinary lithiasis]. / La lithotripsie extra-corporelle (EDAP LT 01) dans la lithiase urinaire.

Five hundred and twenty six extracorporeal lithotripsies have been performed for renal and ureteric stones. Using low frequencies (1.25 to 2.5 cycles per second), extracorporeal lithotripsy was performed without anaesthesia and without premedication in 85% of cases. 91.9% of patients treated were followed and reviewed after one and three months: 292 (55%) were successes, 124 (22.5%) obtained partial results, 122 (22.5%) were failures. The best results were obtained in stones less than 20 mm in diameter. The results could only be improved by a second session of extracorporeal lithotripsy. Scintigraphic scars observed after high frequency lithotripsy and not observed after low frequency lithotripsy were again seen after renewal of the firing head.

[Urinary tract infection and surgical disorders of the lower urinary tract]. / Infection urinaire et affections chirurgicales du bas appareil urinaire.

Infection is a constant concern during perioperative period. Bacteremia occur during intervention and immediate postoperative period. They are the risk of acute complications, mainly septic shock with a high mortality rate. Escherichia coli is the germ most often found, then Enterococcus and other gram-negative germs. Diagnosis of an urinary infection is made difficult because the presence of a vesical catheter; so, 10(3) bacteria per ml. have to be considered as pathological. Two therapeutic behaviours can be considered in practice: suitable antibiotherapy in obvious infections, but sterilization of urines must not delay surgical intervention, short-time peri-operative prophylaxis cephalosporins of the 2nd or 3rd generation are most often utilized. Overseas, trimethoprim associated with sulfamides can be administrated per os every 2 hours before surgical intervention, at the time of anesthesia for example.

[The role of surgery in acute epididymitis]. / Place de la chirurgie dans les épididymites aiguës.

One third of the acute épididymitis (A.E.) admitted in the Military Hospital in Marseilles have been operated, i.e. 33 cases; out of them the last 12 cases have been systematically monitored by ultrasonography. Twice out of three times, clinical picture suggested a possible twisting that led to an emergency surgical exploration. Interest of ultrasonography of the scrotum is underlined as far as diagnosis is concerned but also in monitoring A.E. Indeed, despite medical treatment (antibiotics + anti-inflammatory drugs), it is possible that some A.E. are evolving either to abscess or to their "vascular" form; The ultimate form of the acute epididymo-orchitis is necrosis of the testis. This is due to, or amplified by, vascular compression linked up with edema. Surgical intervention has therefore to investigate by inguinal path the entire spermatic cord and the épididymis-testis system, and to apply the "decompression technique" requested.

[Extracorporeal lithotripsy in urinary calculi using the LT 01 EDAP]. / Lithotripsie extra-corporelle avec le EDAP LT 01 dans la lithiase urinaire.

Three hundred and sixty nine extracorporeal lithotripsies for renal stones have been performed using the EDAP apparatus (ultrasound detection, piezoelectric destruction). In 7.1% of cases, the stone could not be located. By using low frequencies (1.25 to 5 cycles per second), extracorporeal lithotripsy was able to be performed in 82% of cases without anaesthesia and without premedication. 96.5% of patients treated have been followed and reviewed at one and three months: 169 (61%) cases were successful, 59 (21.3%) were partial results and 49 (17.7%) were failures. The best results were obtained in stones less than 20 mm in diameter. A poor result can only be improved by a second session of extracorporeal lithotripsy. The scintigraphic scars observed after high frequency extracorporeal lithotripsy were not observed when low frequencies were used. This new outpatient extracorporeal lithotripsy procedure without anaesthesia currently represents 79% of our primary indications in renal stones.

[Ureteral war injuries. Apropos of 3 African cases]. / Les plaies urétérales de guerre. A propos de trois observations africaines.

The war ureteral gunshot wounds (W.U.G.W.) are, in practice, scarce but not an exception. They are to be suspected in every war abdominal injury. Urethral catheterization, microscopic hematuria research, simple X-Ray and I.V.P. have to be undertaken; but it's never easy in wartime circumstances. Investigation must be carried out during intervention: ureteral exploration in case of retroperitoneal hematoma or wound. Three observations illustrate these main difficulties. Unfortunately diagnosis is often done in post-operative time when a complication arises. The treatment is now well known: adequate debridement, anastomosis or reimplantation and drainage.

[Urethral stricture in Africa. Urologic complication of sexually transmitted diseases in the male in Africa]. / Le rétrécissement uréthral en Afrique. Complication urologique des maladies sexuellement transmissibles chez l'homme en Afrique.

Urethral stricture is a very frequent and severe complication of sexually transmitted diseases in African male. It is very often largely sclerous and inflammatory as the patients come to consultation very late. Urethral repair techniques are analysed, so the principles of surgical procedure. When urethral stricture is brief and "catheterisable", and in case of recurrence, endoscopic dilatation or endoscopic internal urethrotomy must be performed in the first place. In the others cases, in order, we advise: free skin graft urethroplasty (Devine), pedicled vaginal urethroplasty (Kishev), scrotal flap urethroplasty (Blandy), and the two-stage urethroplasty. In fact this choice depends on the urethral and peri-urethral lesions and on the operator's practice.

[Management of sexually-transmitted diseases diagnosed in women in tropical Africa]. / Conduite à tenir face aux maladies sexuellement transmises déclarées chez la femme en Afrique tropicale.

Taking into account their own experience and very numerous recent publications, the authors proposed an easy protocol towards diagnosed S.T.D., in African woman. Diseases are classified according to symptomatology: clear infection in case of cervico-vaginitis, ulcerations (painful or not), tumural formations, and also during salpingitis or infertility. They particularly emphasize cervico-vaginitis manifestations which represent one visit out of three in Gynecology Departments. For each infection, they recall its symptomatology, diagnosis and efficient treatment. They strongly recommend to keep in mind, in Africa, multi-microbial associations.

[A case of ureteral bilharziasis followed for 22 years]. / A propos d'une bilharziose uretérale suivie pendant 22 ans.

The authors report on one case of urinary schistosomiasis monitored for 22 years. It illustrated the problems posed by the "bilharzial uretero-hydronephrosis". They analyse the different therapy problems which have to have been successively solved: Low double ureteral stenosis. The difficulty to be certain of such a stenosis is recalled. The possibility of a reflux or an ureteral atony must be eliminated. True stenosis must be operated without delay; Kidney cancer revealed 20 years later through chronic renal failure by vesico-ureteric reflux caused by the first surgical intervention (latero-lateral vesico-ureteric anastomosis); Iatrogenic vesico-ureteral reflux, treated by uretero-vesical implantation on "psoic" bladder with anti-reflux submucous path. The future of such a chronic renal failure is linked to the capability of the remaining ureter to ensure an acceptable passage of urine, and to the rehabilitation possibility of the kidney. Finally, the authors recalled the difficult therapeutic indications in case of ureteral attack due to bilharziosis.

[Genitourinary bilharzioma. Isolated cases of vesical bilharzioma and epididymal bilharzioma]. / Le bilharziome génito-urinaire. Un cas de bilharziome vesical et un cas de bilharziome épididymaire isolés.

The authors report on two isolated cases of bilharzioma: one vesical revealed by an hematuria and one epididymal constituting an intrascrotal mass. Clinical signs did not oriented toward these diagnosis and biology was helpless. Serodiagnosis by hemagglutination was negative, but immunofluorescence was more reliable. On the contrary both tumors were detected by echotomography of which the efficiency is determinant for the diagnosis and must be underlined. Only anatomopathology was able to confirm the diagnosis of tumor. As a matter of course, surgical exploration and excision are necessary in these types of tumors with negative biology. In both cases, effects were isolated. In one patient, infestation was old and already treated; in the second one, infestation was probably light. The authors recall also bilharzioma physiopathology. Frequency of vesical bilharzioma is about 20% of genito-urinary schistosomiasis while epididymal bilharzioma reaches only 0.29 to 4.8%. Direct line between bilharzioma and cancer is likely but controversial, schistosomiasis beeing a true irritative agent.

[Cancer of the penis in Cambodia]. / Cancer de la verge au Cambodge.

The prevalence of penis cancer in Cambodia is comparable with some Far-East and Latino-American countries. Circumcision performed as a religious observance among Jews or undergone as a regular practice among older Moslems children (the Islam Kmers in Cambodia) might provide an indirect protection against this kind of cancer. It indeed helps in ensuring proper personnal hygiene and in improving the detection, the treatment and the aftercare of all the mild lesions which possibly can pave the way to cancer. Out of of 253 observed cases recorded during a 10 years period (from 1960 to 1970), 164 were treated and followed up by the same surgical team from 1964 to 1970. They stress on those etiopathogenic factors and make possible a description of the reported "anatomoclinical" forms. The use of radiumtherapy either by contact or by means of needles is quite effective; however, when corpora cavernosa are involved, it will be often necessary to perform either a partial amputation or to an emasculation in case of entirely overspreading lesions. As metastases are of rare occurence, it is regarded as a "mild cancer"; however the sequelae due to the treatment are far from small importance. Through better personnal hygiene, detection, treatment, and surveillance of inflammations and benign tumors, with the renforcement of circumcision as a regular practice for every case of phimosis or chronic lesions, an effective prevention of this kind of cancer will expectedly be carried out in Cambodia and its prevalence will be reduced to a rate similar to that in European countries.

[Uterine ruptures overseas]. / Les ruptures utérines outre-mer.

Obstetrical hysterorrhexis, accident that has been described for a long time, is still of special concern in rural villages where sufficient health care facilities are not available. This accident is always serious, leading to the death of the newborn baby and, too frequently, to the death of the mother. A number, however, could be avoided with a better training of the paramedical staff, so that neither inadequate actions nor uncontrolled use of oxytocics be done. The author advocates to perform a systematic examination of the uterus after every difficult or outlasting delivery or having required either manual or instrumental help. That remains the best way to save the uterus of the mother and sometimes her life itself.