[Acute toxicity in 50 patients with prostate cancer treated with conformal radiation therapy]. / Evaluation de latoxicité aiguë chez 50 patients atteints de cancer de la prostatetraités par radiothérapie conformationnelle.

PURPOSE: To report our experience with 3D conformal radiotherapy for prostate cancer. MATERIAL AND METHODS: We reviewed our first 50 patients diagnosed with prostate cancer. Median follow-up was 27 months (16-40 m). Median age 68 (52-74). T stage was: T1c = 12 ; T2a = 14; T2b = 10; T2c = 2; T3a = 10; T3b = 1 and T3c = 1. Gleason score (GS) 4-6 50% and GS 7-8 50%. Pretreatment PSA value of < 10 ng/ml 36%, 10-20 ng/ml 32% and > 20 ng/ml 32%. Forty patients received androgen ablation therapy 2 to 6 months before radiation. 3D conformal radiotherapy was used to allow a smaller amount of rectum and bladder to be in the high dose volume. An 18 Mv linear accelerator was used. The first 21 patients received 66 Gy, 28 patients received 70 Gy and one 74 Gy. RESULTS: The mean prostate volume was 45 cc for patients who received androgen ablation and 54 for the others (p = 0.02). The percentage of volume receiving more than 50 Gy (V50) was calculated for the rectum and bladder. The median V50 was 30% (10-55) for the rectum and 36% (5-70) for the bladder. Based on the RTOG grading (gr) for acute toxicity, there was no gr 3 gastrointestinal (GI) toxicity and only 1 gr 3 genitourinary (GU) toxicity. There were 9 gr 1 and 5 gr 2 GI toxicity, 10 gr 1 and 5 gr 2 GU toxicity. With our actual follow-up we have 2 late morbidities: gr 2 GU and one erectile failure. CONCLUSION: 3D conformal radiotherapy for prostate cancer has a good toxicity profile. Longer follow-up is needed to assess late toxicity and clinical outcome in this series.

[Complications of percutaneous nephrostomy. Apropos of 481 procedures: the value of puncture of the median calices]. / Complications des nephrostomies percutanees. A propos de 481 procédures: intérêt de ponctionner le calice moyen.

The authors report on a series of 481 percutaneous nephrostomy procedures, and describe the complications encountered. 163 percutaneous nephrostomies for drainage and 318 percutaneous stone removals, were performed between 1985 and 1995 in the Radiology Department of Hôtel-Dieu de France Hospital under fluoroscopy. One tract was needed for PN but more than one was sometimes necessary for percutaneous stone removal. Complication rate was identical to the results reported in the literature. Complications were more frequently encountered when the upper calyx was punctured (intercostal approach), mostly pleural lesions. Puncture of the middle and inferior calyx were associated with the same rate of complications, but with different degrees of severity. Major complications (80% of cases of hemorrhage, including all arteriovenous fistulae and pseudoaneurysms) were encountered with the puncture of the lower calyx while those associated with the puncture of the middle calyx were minimal. Thus, puncture of the middle calyx is the least morbid. It is recommended by the authors, whenever possible.

Treatment of staghorn calculi by percutaneous nephrolithotomy and SWL: the Hotel Dieu de France experience.

To evaluate the combined approach of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patients. The stone surface area ranged from 654 to 3042 mm2 (1535 mm2 on average). During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients. A double-J stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatient basis approximately 2 weeks after PCNL. The mean hospital stay was 4.4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, and a residual stone rate of 7%. With a follow-up of 52 months on average, the global stone growth rate was 17%, being 4.4% only among the stone-free group and 27% among the group with insignificant residual fragments. The global transfusion rate was 10%. Percutaneous stone debulking combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi. Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate while reducing the morbidity and hospital stay.

Vein grafting of tunical incisions in the treatment of Peyronie's disease.

The effectiveness of vein grafting of tunical incisions of Peyronie's plaques in straightening the penis, with preservation of normal erectile function is evaluated. Eighteen patients with Peyronie's disease were surgically treated with a vein patch graft technique to correct their penile curvature. Transverse relaxing incisions were made on the tunica albuginea where a curvature was identified by an artificial erection. A vein graft from the saphenous vein was sewn into the defect created by relaxing incisions. If there was evidence of a residual curvature after the vein grafts were sewn in, a plication of the contralateral surface of the tunica albuginea was performed. The saphenous vein grafting alone was sufficient to straighten the penis 90 to 100% in 50% of patients. Of twelve patients who were potent preoperatively, one required postoperatively an occasional intracorporeal injection to maintain erection. Two of the impotent men regained their potency postoperatively. None of the patients lost sensation in the glans or shaft of the penis. Penile shortening was reported in three patients. No decrease in the penis rigidity was noted. Patients were discharged within 5 days of the procedure. There were no immediate complications. Fifteen of our sixteen followed patients resumed intercourse in eight weeks. We found that plaque incision in the venous grafting is much easier than the other incisional and excisional procedures described in the literature, and may lead to successful correction of penile deformity without compromising potency, penile length and sensitivity.

Management of posttraumatic posterior urethral disruption.

We reviewed our experience with 17 cases of posterior urethral disruption due to traumatic pelvic injuries. In all cases, a suprapubic cystostomy was performed at first. For blunt injuries, urethroplasty was delayed for 6 months in average. For most of the penetrating injuries (3/4), we performed immediate debridement and primary repair. Resulting bulbous or membranous strictures less than 3 cm long were treated with one-stage perineal excision-reanastomosis urethroplasty. Membranous strictures longer than 3 cm were managed with a combined transpubic-perineal repair, while bulbous defects longer than 3 cm were treated with a scrotal pedicled island flap. The overall restricture rate was 25%. Those having had initial repeated urethrotomies displayed a 100% restenosis rate. Incontinence rate was 12.5% Erectile dysfunction occurring in 42% of our patients is a sequela of the pelvic injury and was found to be directly related postoperatively to its presence at the time of surgery.

[Implantation of the Ultrex type inflatable penile prosthesis. Four years experience]. / Implantation de prothese pénienne gonflable type Ultrex. L'experiencede 4 ans.

During the last 4 years, 12 patients had an implantation of the AMS Ultrex2 penile prosthesis : 4 of these patients were impotent after a cystoprostatectomy, 4 patients had vascular insufficiency, 2 patients had psychogenic impotency, one patient was diabetic and one patient had a spinal cord injury. The complication rate was low (16%): one patient necessitated a surgical revision of the prosthesis after disconnection of the tubulure. A second patient had a urethral stenosis treated by dilation. The degree of satisfaction of both patient and partner was satisfactory.

Piezolith extracorporeal shockwave lithotripsy: the Hotel-Dieu de France experience.

A total of 1500 patients underwent treatment with the Wolf Piezolith 2300 extracorporeal shockwave lithotripter for renal, ureteral, and bladder stones. Follow-up data were available at 3 months for 1435 patients. At that time, the overall stone-free rate was 82.7%: 82.4% for patients with renal stones, 81.0% for those with ureteral stones, and 100% for those with bladder stones. The overall success rate was 92.3%: 93.8% for patients with renal stones, 87.1% for those with ureteral stones, and 100% for those with bladder stones. The auxiliary treatment rate was 14.9%, and the retreatment rate was 53%. The effectiveness quotient was 49.2%. The Wolf Piezolith 2300 is an effective treatment for most stones smaller than 30 mm.

Microsurgical high inguinal varicocelectomy with delivery of the testis.

This study describes the results of 50 consecutive cases of varicocelectomy by the inguinal approach. The testicle is delivered through a small inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under optical magnification. The testicular artery, the lymphatics and the vas deferens are identified and preserved. All internal spermatic veins are ligated. 94 varicocelectomies were performed in 50 men. Follow-up period extended from 12 months to 24 months. No hydroceles, no clinical recurrences and no wound infection were found. One scrotal hematoma occurred and resolved progressively. Preoperative and postoperative semen analysis were obtained. The changes in sperm count mean value (million/cc) (20 to 28.6) (p < 0.005), per cent normal forms (42.9 to 52.1%) (p < 0.005) and per cent motility (31.5 to 39.2%) (p < 0.005) were significant. The pregnancy rate was 10 of 21 couples available for follow-up (47.6%). This technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele clinical recurrence.

[Augmentation cystoplasty and intermittent catheterization in neurogenic bladder]. / Cystoplastie d'augmentation et cathétérisme intermittent dans les vessies neurogènes.

An enterocystoplasty was done on 17 paraplegic adults patients (Beit Chahab Hospital for Handicapped) with hyperreflexic neurogenic bladder secondary to an accident of the supra-sacral medulla. These patients were incontinent, had urinary tract infections, vesico-renal reflux or autonomic dysreflexia. Detubularized ileum was used in 16 cases and sigmoid in one. Ureteral reimplantation was performed on one patient; implantation of an artificial urinary sphincter for one patient and an injection of a periurethral Teflon paste was also done for one patient. After 16 months of follow-up all patients are continent on self intermittent catheterization. The upper urinary tract is stable or improved. No autonomic dysreflexia. Thirteen patients have an asymptomatic untreated bacteriuria.

[Transitional tumor of the right kidney with vena cava thrombus. Report of a case]. / Tumeur transitionnelle du rein droit avec thrombus de la veine cave. A propos d'un cas.

Transitional cell carcinoma of the kidney with vena caval tumor thrombus is a rarity with 12 cases reported in the literature. We review in this article the elements of the diagnosis and possible treatment modalities.

[Treatment of hypospadias with a transverse preputial pediculated flap]. / Traitement de l'hypospadias par le lambeau pédiculé préputial transverse.

With a better understanding of the penile vasculature, many one-stage techniques were proposed for mid-shaft and posterior hypospadias repair including the Duckett's technique with the transverse preputial island flap (TPIF). We performed the Duckett's technique on 25 patients with penile hypospadias with the following results: no cases of meatal stenosis and three cases of urethro-cutaneous fistula (12%). The three cases of urethro-cutaneous fistula were reported in the first 15 patients where the neo-urethra was closed in one layer but no case of fistula was reported in the last 10 patients where the noe-urethra was closed in two layers: the difference is significative (p < 0.05). In conclusion, the Duckett's technique with the two-layer closure technique of the neo-urethra is a good alternative for penile hypospadias repair.