[Laparoscopic sentinel lymph node (SLN) dissection for clinically localized prostate carcinoma: results obtained in the first 70 patients]. / Détection laparoscopique des ganglions sentinelles dans le cancer localisé de la prostate: résultats obtenus chez 70 premiers patients.

OBJECTIVES: The lymph node metastasis is an important prognostic factor in prostatic cancer. The aim of this prospective study was to evaluate the relevance of the sentinel lymph node biopsy by laparoscopy in staging locoregional patients with clinically localized PC. PATIENTS AND METHODS: A transrectal ultrasound-guided injection by 0.3 mL/100 MBq (99m)Tc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad(®) Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free. RESULTS: Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases. CONCLUSION: The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.

[A rare complication of disk surgery: ureteral fistula. Apropos of a case following counter-lateral laminectomy]. / Une complication rare de la chirurgie discale: la fistule urétérale. A propos d'un cas après laminectomie contro-latérale.

The authors report a new case (to be added to the 10 already published in the literature) of damage to the ureter during surgical treatment of a herniated disc. Instruments seeking the hernia perforate the prevertebral ligament and damage the ureter. The diagnosis should have been made rapidly in the light of a difficult postoperative course, the discovery of a pre and laterovertebral effusion by echography and the presence of haematuria and pyuria. In fact the diagnosis was made late, by urography, in the presence of a mass in the flank. Attempted treatment by insertion of a uretic catheter failed and the situation was finally resolved by a second end-to-end ureterorrhaphy after mobilisation of the kidney. The possibility of damage to the ureter during surgery for a disc hernia and the therapeutic possibilities with preservation of the kidney when the diagnosis is made sufficiently early should be familiar to all: neurosurgeon, orthopaedic surgeon and urologist.

[Detrusor inactivity in central spinal cord lesions. Hypothesis of inhibitory hyperreflexia of sympathetic origin]. / Inactivité du détrusor dans les lésions médullaires centrales. Hypothèse d'une hyperréflexie d'inhibition d'origine sympathique.

In connection with two observations of suprasacral complete spinal cord patients showing a clear sublesional spasticity and paradoxically and inactive and unreactive detrusor, the authors discuss the mechanisms that are usually considered: vesical distension, sacral peripheric neurogenic lesion, reflex inhibition of the detrusor of somatic origin. They express the hypothesis of an inhibition hyper-reflex of sympathetic origin, reversible under phenoxybenzamine treatment, consider the urodynamic evaluation and the therapeutic treatment and compare this type of neurogenic vesical dysfunction to that of the spinal shock.

[Left renal vein thrombosis with exception diagnostic circumstances. Success of an unusual surgical treatment]. / Thrombose veineuse rénale gauche de circonstances diagnostiques exceptionnelles. Succès d'un traitement chirurgical inhabituel.

The presentation of cystitis associated with lumbago in a young woman lead to the discovery on IVU of left pyelitic irregularities. Ultrasound demonstrated a non-homogeneous lateral pyelitic mass. Because we suspected a vascular aetiology, we performed arteriography: arteries were normal, the renal vein was not visualized, but opacities caused by peripyelitic varices being drained by a much dilated lumbo-ovarian vein which gave a normal intramyometrial phlebographic picture, were seen. Selective catheterization of the renal vein was not possible to perform. Was this then a case of agenesis or thrombosis? Tomography didn't help decide. The persistence of severe pain contraindicated lumbotomy, and the presence of a wide but flat and impermeable renal vein. A complete denervation of the kidney was carried out. The normal artery and the ovarian vein were preserved intact. The follow-up was straight forward-routine IVU was normal. The pains disappeared.