[Cancerous stricture of the urethra]. / Les rétrécissements cancéreux de l'urètre.

When certain strictures which have been treated for a long time start to bleed, the possibility of carcinoma should be considered. However, cancer may present in the form of more recent and deteriorating dysuria. The diagnosis is based on urethrography which shows a narrow and tortuous pass. Biopsy should be performed under urethroscopic guidance. The cancer is usually in the bulbomembranous segment. Treatment is disappointing. Wide excision is very badly disabling.

[Urethral stricture. A history. From antiquity to the 18th century]. / Rétrécissement de l'urètre. Historique. De l'antiquité au XVIIIe siècle.

Long undistinguished from the other causes of lower urinary tract obstruction, stenosis of the urethra was truly individualized only in the XVIIIth century. Throughout this long history, treatment opposed repeated dilatations, capable of maintaining an acceptable urethral caliber, and methods aimed at directly destroying the stenosis, thereby ensuring permanent recovery.

[The anterior and transperitoneal approach in the surgery of the kidney and ureter]. / La voie d'abord antérieure et transpéritonéale dans la chirurgie du rein et de l'uretère.

Because of the variety of situations encountered in surgery of the kidney and ureter, the methods of approach to these organs need to be diversified. In this context, the authors discuss the place of the anterior and transperitoneal approach, based on a series of 573 cases. Its principal indications are: excision of large kidney tumours or pseudo-tumours, conservative treatment of hydronephrosis, removal of pelvic calculi, staged operations or operations on bilateral lesions, re-operations resulting in secondary nephrectomy or repair of the collecting system. The modalities, advantages and disadvantages are discussed and the authors stress the complications which may result from opening of the peritoneum. Overall, the anterior and transperitoneal approach, in the situations in which it is indicated, is an easy and safe operative technique, superior to the usual sub-peritoneal approaches. Its results are very satisfactory; they should overcome reservations which have surrounded this technique for so long and should give it a definite place beside the classical approaches, which nevertheless remain supreme.

[Interstitial cystitis. Current aspects]. / La cystite interstitielle. Aspects actuels.

Fifty-five cases of interstitial cystitis are reported, symptomatology in these 43 women and 12 men being of a severe nature: diurnal and nocturnal pollakiuria, supra-pubic pain. Disorders were always permanent and had been present for at least 6 months, diagnosis being confirmed by endoscopy. Initial bladder filling demonstrated the most important lesions (Hunner's ulcer) and allowed determination of bladder capacity. Decompression and a repeat vesical repletion showed mucosal hemorrhagic spots, establishing the diagnosis of interstitial cystitis. Biopsy forceps were used to obtain fragments of bladder wall for optical microscopy in all cases and electron microscopy in several patients. Histologic findings were compared with two control groups: a group of 30 patients with pollakiuria and dysuria but absence of hemorrhage during bladder distention; a group of 9 patients operated upon for other lesions and with normal bladders. Extracellular deposits were searched for in freshly frozen fragments (liquid nitrogen) in 10 patients, while 24 patients underwent immunologic tests. Finally electron microscopy was used to study vesical epithelium to detect epithelial cell junction. In contrary, optical microscopy by immuno-histochemistry was used to study cytoskeletal keratin filaments. Two groups in this series were distinguished: one with major forms (18 cases) and one with minor forms (37 cases) of the affection. In major forms, affecting elderly patients with reduced bladder capacity, lesions on endoscopy and first distention were apparent as Hunner's ulcer and hemorrhage covering the non-ulcerated mucosa with petechiae. Initial distention in minor forms showed normal mucosa with, on decompression and repeat distention, the appearance of hemorrhagic sub-mucosal spots in the mobile bladder structures.

[Interstitial cystitis. Apropos of 11 cases]. / La cystite interstitielle. A propos de onze observations.

The authors report eleven cases of interstitial cystitis, and discuss two different aspects of the disease: the classic form, with reduced bladder capacity and Hunner's ulcer, and the early form, which is diagnosed by cystoscopy under general anesthesia, and bladder biopsy. The hallmark of this early form is the discovery of multiple petichiae in the bladder mucosa during the second distension of the bladder.

Progressive muscular dystrophy. Functional improvement after a renal allograft.

From his first years a child showed signs of a primary and rapidly developing muscular dystrophy. The diagnosis was established by an increased serum CK level and by electromyography and muscle biopsies. Afterwards this child developed a severe renal deficiency which needed binephrectomy and the graft of a normal kidney. During the few months just after the graft, the disability increased and the patient could not stand upright by himself. Later on, he gradually became able to walk on his own and without bracing. He could climb stairs and stand up from the floor. The CK activity returned to normal. At present, 4 years after the graft (the patient is 16 years), the improvement of his functional abilities is constant, although the CK activity has increased again. In this article we give evidence that this patient suffers from a primary muscular dystrophy. We discuss the type of dystrophy concerned. We believe that it is the graft of a normal kidney which was responsible for the improvement observed, and not the physiotherapy or the drugs administered after the graft.