[PET/CT and biochemical recurrence of prostate adenocarcinoma: Added value of 68Ga-PSMA-11 when 18F-fluorocholine is non-contributive]. / TEP/TDM et récidive biologique d'adénocarcinome prostatique : apport du 68Ga-PSMA-11 lorsque la 18F-fluorocholine n'est pas contributive.

INTRODUCTION: Since April 201, we have introduced PET/CT using a ligand of prostate-specific membrane antigen labeled with gallium-68 (PSMA-11). We aimed to evaluate its positivity rate and impact in patients presenting biochemical recurrence of prostate cancer whose 18F-fluorocholine (FCH) PET/CT was non-contributive. PATIENTS AND METHOD: Patients were prospectively included between April and December 2016. PET/CT was performed 60min after injection of 2MBq/kg of body mass of 68Ga-PSMA-11. Three anatomical areas were considered: prostatic lodge, pelvic lymph nodes and distant locations. The impact of PSMA-11 PET/CT was assessed by comparing changes in therapeutic strategy decided during multidisciplinary meeting. RESULTS: Thirty-three patients were included. The mean PSA serum level measured on the month of the PSMA-11 PET/CT was 2,8ng/mL. Twenty-five (76%) PSMA-11 PET/CT were positive, 7 (21%) negative and 1 (3%) equivocal. Of 11 patients whose FCH PET/CT showed equivocal foci, PSMA-11 PET/CT confirmed those foci in 5 cases. Follow-up was available for 18 patients (55%). PSMA-11 PET/CT results led to a change in management in 12 patients (67%). CONCLUSION: 68Ga-PSMA-11 PET/CT is useful in detecting recurrence of prostate cancer, by identifying residual disease which was not detected on other imaging modalities and by changing management of 2 patients out of 3. LEVEL OF EVIDENCE: 5.

[Neurological and vascular preservation during laparoscopic radical prostatectomy]. / Préservation neurologique et vasculaire au cours de la prostatectomie totale laparoscopique.

The objective of the cavernous nerve preservation is to avoid injury of the unmyelinated nerve fibers and arteries destined to the corpora cavernosa. Dissection anatomical plans could be inter or extra fascial allowing complete or partial neurovascular bundle preservation. The technique is chosen according to the carcinological evaluated risk and anatomical characteristics. Accessory pudendal arteries preservation must be performed when such an artery is identified in order to improve the chance of recovery of spontaneous erections.

[Teaching laparoscopic urologic oncology. The Memorial Sloan-Kettering Cancer Center experience]. / Formación en oncología urológica laparoscópica. La experiencia del Memorial Sloan-Kettering Cancer Center.

OBJECTIVE: We outline the structure of the clinical and training program of laparoscopic urologic oncology at Memorial Sloan-Kettering Cancer Center. We discuss the steps and key elements necessary in acquiring lapa roscopic proficiency. MATERIAL AND METHOD: The program lasts 2 years and trains fellows and faculty. For fellows, the program consists of a 6 months high volume laparoscopic oncology rotation, during which dry lab, animal lab, vide review and operating room experience are required. For faculty, the program consists of 1 accredited continuin medical education course, 20 hours of dry lab, 1 session animal lab, observation of laparoscopic cases, first assistant in a minimum of 15 laparoscopic cases, performing laparoscopic cases under mentoring. RESULTS: 8 fellows have completed the training, 4 of whom have completed their fellowship and are in academic centers, performing advanced laparoscopy. The laparoscopic approach represents on average 80% of their urologic practice. Three attendings are performing laparoscopic surgery with mentoring. CONCLUSION: The goals of a surgical education program should be the standardization of the acquisition o surgical skills and assessment of the performance in a uniform setting to ensure the maintenance of the acquisition of skills and to develop programs to teach new skills.

Laparoscopic radical prostatectomy: an evolution in surgery.

The late 1990s witnessed an unprecedented evolution in the surgical approaches to the prostate thru the eye of the laparoscope. Initially taken with doubt, laparoscopic radical prostatectomy (LRP) has gained tremendous popularity and widespread implementation at specialized centers worldwide becoming the standard in many of them. LRP represents a technically demanding laparoscopic procedure but it can be performed systematically with standard techniques. Obvious advantages are shorter convalescence and markedly lower operative blood loss without compromise of cancer control. Long-term functional and oncological results are maturing but early reports of positive surgical margin rates and freedom from prostate-specific antigen (PSA) recurrence rates after LRP are encouraging. Early quality of life results of postoperative urinary and sexual function appear similar to those in open surgical series. The real challenge for laparoscopic surgeons entails a paradigm swift, one that breaks off from the traditional and bias impetus, and tests the instruments, procedures, techniques differences and evaluates outcomes in a prospective controlled and randomized manner. If achieved, the laparoscopic movement may give rise to a generation of forward thinking surgeons generating a wealth of clinical evidence for their patients.

Ablation of superficial bladder tumors with focused extracorporeal pyrotherapy.

OBJECTIVES: We report the first experimental studies of focused extracorporeal pyrotherapy. METHODS: Focused extracorporeal pyrotherapy has been used to treat superficial bladder tumors in a Phase II protocol in 25 patients. In 5 cases, for technical reasons, pyrotherapy was not used. In 20 patients (10 under general anesthesia and 10 under spinal anesthesia), the mean treated volume was 3 cm3 with an average of 300 shots and a mean skin focused length of 90 mm. Treatment time was 44 minutes; hospital stay was 2 days. Postoperatively, two skin burns and one acute retention were observed. RESULTS: Of 20 patients, 15 (75%) had a normal urinary cytology bladder ultrasonography and cystoscopy at 1 month. In 67% of patients with primary tumor, there was no recurrence at 1 year; 33% had recurrent tumors. No infiltrative tumor or metastases have been observed during this follow-up (3 to 21 months). CONCLUSIONS: These encouraging results show that ablation of superficial bladder tumor is feasible. The technique must be improved to allow treatment of larger tumor volume in a shorter time.

Laparoscopic radical prostatectomy: assessment after 240 procedures.

Radical prostatectomy can be successfully performed by transperitoneal laparoscopy by a urologic team experienced in laparoscopy and radical prostatectomy. Operative and postoperative morbidity rates are low. Postoperative pain is minimal, allowing reduction of the length of hospital stay. The oncologic results seem satisfactory based on short-term follow-up. The improvement of the quality of intraoperative vision related to magnification of the image allows a more precise procedure. This subjective improvement of the quality of dissection should reduce the usual functional sequelae of conventional radical prostatectomy, such as incontinence and impotence. This finding needs to be confirmed by a larger series of patients with longer follow-up. Laparoscopic radical prostatectomy is now performed routinely and is proposed as a first-line surgical treatment for localized prostatic cancer at the authors' center.

Laparoscopic partial nephrectomy in the pig: comparison of three hemostasis techniques.

BACKGROUND AND PURPOSE: Control of intraoperative bleeding is the main technical difficulty encountered during laparoscopic partial nephrectomy. The objective of this study was to compare the efficacy and morbidity of three renal parenchymal hemostasis techniques: high-frequency bipolar electrical current, high-frequency unipolar spray electrical current, and ultrasound during laparoscopic partial nephrectomy performed in pigs without vascular control. MATERIALS AND METHODS: A standardized laparoscopic transperitoneal right lower-pole partial nephrectomy was performed in 27 pigs with a mean weight of 65 +/- 5 kg. The pigs were divided into three groups according to the technology used: Group 1 = bipolar electrical current, Group 2 = unipolar spray electrical current, and Group 3 = ultrasound. Intravenous urography was performed on the 28th day. The kidneys were then removed for histologic examination, and the pigs were sacrificed. The criteria evaluated were intraoperative and postoperative complications, blood loss, renal function, and thickness of the parenchymal lesions induced. The Kruskal-Wallis nonparametric test for comparison of medians was used for statistical analysis of the data (P < 0.05). Data from pigs that died before the end of the study were excluded from the analysis. RESULTS: All partial nephrectomies were performed laparoscopically, and all pigs were alive at the end of the operation. The postoperative complication rate was 11% (N = 3): two pigs died before the end of the study, one from hemorrhage on Day 6 (Group 2), and the other from prolonged reflex ileus with sacrifice of the pig on Day 7 (Group 3). One pig developed an asymptomatic urinoma (Group 2). Blood loss was significantly lower when ultrasound was used (P = 0.026). Global renal function was not significantly altered in the various groups. The median thickness of tissue necrosis and fibrosis detected in the scar zone was 6 mm (range 4-10 mm) and was similar in the three groups. CONCLUSION: Partial nephrectomy can be performed by laparoscopy without vascular control in the pig. Coagulation by ultrasound appears to present an advantage in terms of limitation of blood loss compared with coagulation by bipolar or unipolar spray electrical currents without presenting any benefit in terms of preservation of the renal parenchyma.

Laparoscopic radical prostatectomy: the lessons learned.

PURPOSE: To evaluate the operative, oncologic, and functional results of laparoscopic radical prostatectomy based on an initial series of 350 patients. PATIENTS AND METHODS: Between January 1998 and May 2000, 350 consecutive patients underwent laparoscopic radical prostatectomy according to our technique. The study of operative morbidity was based on all intraoperative and postoperative complications. The oncologic assessment was based on clinical, laboratory, and intraoperative and postoperative pathological data. Postoperative functional results were assessed by the ICS-male self-administered questionnaire. RESULTS: No deaths were observed in this series. Conversion was required in seven cases, exclusively among the first 70 patients. The mean operating time was 217 +/- 59 minutes, including the lymphadenectomy phase that was considered necessary in 21.4% of patients, and 195 +/- 56 minutes for the most recent 200 patients. The mean intraoperative blood loss was 354 +/- 250 mL. The overall transfusion rate was 5.7% and 2.8% in the last 250 patients. Intraoperative complications were reported in 14 patients (4%), and the reoperation rate was 3.7%. The mean postoperative bladder catheterization time was 5.8 +/- 3.3 days, and the catheter could be removed before the 5th day in 41% of patients. The mean hospital stay was 6 +/- 3.9 postoperative days (range 2-33 days). By pathologic stage, the positive surgical margin rate was 3.6% for pT2a specimens (3 patients), 14% for pT2b specimens (29 patients), 33% for pT3a specimens (12 patients), and 43.5% for pT3b specimens (10 patients). In the first 75 patients with pT2N0/Nx negative-margin specimens and a follow-up of >12 months, the PSA concentrations was <0.2 ng/mL in 92% of patients. The continence rate (no protection necessary either during the day or at night) among the first 133 patients was 85.5% and the postoperative erection rate was 59% among 22 selected consecutive patients. CONCLUSIONS: This study confirms the value, in our experience, of the laparoscopic approach to radical prostatectomy, which allows satisfactory cancer control associated with low perioperative morbidity and encouraging functional results in terms both of continence and erectile function.

Retroperitoneal laparoscopic nephrectomy: animal and human anatomic studies.

Retroperitoneal laparoscopic nephrectomy with CO2 insufflation was performed in 11 goats. The hemodynamic and blood gas repercussions of retroperitoneal laparoscopy were compared during the first 30 minutes with those induced by intraperitoneal laparoscopy. With the animal placed in the left lateral supine position, the hemodynamic and blood gas changes were similar with the two techniques and had a similar time course. The technical feasibility of retroperitoneal laparoscopy in animals was confirmed in the fresh human cadaver. The technical feasibility of retroperitoneal laparoscopy and the absence of any particular hemodynamic and blood gas repercussions encourage us to develop this approach for clinical upper urinary tract surgery.

Laparoscopic radical prostatectomy: a review of techniques and results worldwide.

Laparoscopic radical prostatectomy (LRP) is currently performed in multiple centers world-wide, with several different surgical approaches and techniques utilized. A comprehensive review of the published literature worldwide on laparoscopic radical prostatectomy was performed to outline the evolution of this technique, and to review the published surgical, oncological and functional results. A systematic review of peer reviewed articles concerning laparoscopic radical prostatectomy was obtained using Medline query. LRP is being performed in multiple centers worldwide, using a variety of surgical approaches and technologies. Analysis of perioperative parameters, including surgical blood loss, operative time, complications and convalescence, demonstrates a low morbidity and shows a clear trend in improvement with increased experience. The functional results, as recorded by postoperative urinary and sexual functions, appear encouraging. The reported positive surgical margin rates decrease with more recent series. Oncological results and cancer control rates as measured by PSA recurrence and disease-free intervals are difficult to ascertain in the immature series published to date. LRP has witnessed tremendous popularity and widespread implementation in specialized centers worldwide. LRP represents a technically demanding laparoscopic procedure with a difficult learning curve, but can be performed systematically with standard techniques. The advantages include shorter convalescence and markedly lower operative blood loss, with quicker removal of the urinary catheter. Long-term functional and oncologic results are not yet available.

[Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions]. / Prostatectomie radicale coelioscopique. Première évaluation après 28 interventions.

OBJECTIVE: Evaluate the technical feasibility of laparoscopic radical prostatectomy, its carcinological efficacy and per- and post-operative morbidity. PATIENTS AND METHODS: We performed radical prostatectomy using a new laparoscopic technique in 28 patients between February 1 and August 31, 1998. RESULTS: Radical prostatectomy was achieved totally by a laparoscopic approach in 24 patients (86%). No conversion was required in the last 14 patients. In 9 patients (32%) ilio-obturator node resection was also performed as indicated by preoperative extension work-up. Mean operative time was 270 minutes. The only major complication was one rectal wound (patient n degree 8) which had a benign course after suturing under laparoscopy. The bladder catheter was removed a mean 7.7 days after the procedure. Five patients (18%) required transfusions (mean 2.7 units, range 2-3). Rapid discharge on day 3 was possible due to rapid pain relief postoperatively. Tumor classes were pT2 in 26 patients, NO in 9, NX in 17. The surgical border was doubtful at the apex in one case. The last prostate specific antigen assay was below detectable levels (< 0.1 ng/ml) in 16 patients (89%) among the 18 with levels know prior to the procedure. Continence was assessable in 20 patients after a 1 to 6 month follow-up. Continence was perfect in 18 patients and becoming so in 12. Sexual activity was not assessed in this series due to the short follow-up. CONCLUSION: Radical prostatectomy can be reasonably performed as a routine laparoscopic procedure by a well-trained team. The cancerological results in this series were equivalent to those with conventional retropubic surgery and morbidity was very low. Improved operative vision was considerable, allowing much more precise dissection. The laparoscopic technique appears to be an important improvement for radical prostatectomy and should help improve functional outcome.

[Extracorporeal lithotripsy in the treatment of upper urinary tract lithiasis]. / La lithotritie extracorporelle dans le traitement de la lithiase du haut appareil urinaire.

The advent of extra-corporal shock-wave lithotripsy in the eighties totally changed management strategies for renal and ureteral lithiasis of the upper urinary tract. Currently, approximately 80% of all patients can benefit from lithotripsy with an overall success rate of about 75%. Although classical surgery has a higher success rate of about 90%, extra-corporal shock-wave lithotripsy has many advantages. First there is a very low risk of morbidity (pain, immobilization, complications) for this outpatient treatment. Second, the overall cost, including that of preventive treatment, is low as illustrated by the major reduction in the number of cases of pyonephritis on stones and of corraliform lithiasis. The apparent safety of shock-wave therapy should not mask the risk of unacceptable indications: small stones which may resolve spontaneously or inversely very large stones carrying the risk of residual fragments and renal damage. Long-term morbidity remains to be evaluated, but the management of upper urinary tract lithiasis now relies heavily on shock-wave therapy alongside conventional surgery and percutaneous or endoscopic methods.

[Post-traumatic stenosis of the membranous urethra]. / Sténoses post-traumatiques de l'urètre membraneux.

Secondary urethral stricture is the most serious complication of traumatic rupture of the membranous urethra, directly related to the treatment of the rupture. In a series of 45 patients treated for urethral rupture with a minimal follow-up of 5 years, 30 developed stricture (66%). An urethral guide, inserted in 31 cases, was responsible for the stricture in 26 of these cases (84%). This stricture developed rapidly (average of 7.4 months), whether the initial rupture was complete or incomplete and was longer (average of 35 mm) in the case of complete rupture. End-to-end urethrorraphy performed between the 15th and 35th day in 14 patients was complicated by 4 secondary strictures (28%). The treatment of the stricture depended on the initial treatment of the rupture and the radiological length of the stricture. In the case of stricture secondary to an urethral guide, end-to-end urethrorraphy for a stricture less than or equal to 40 mm (12 cases) and 2 stage urethroplasty for a stricture greater than 40 mm (4 cases) achieved a good result in 68.8% of cases. The strictures secondary to end-to-end urethrorraphy (4 cases) were treated by direct vision urethrotomy (3 cases) with 100% of immediate good results and by urethral telescoping (1 case) complicated stress urinary incontinence.

[Varicocele in children and adolescents. Is surgical treatment justified?]. / Varicocèle de l'enfant et de l'adolescent. Le traitement chirurgical est-il justifié?

Varicocele , a disease essentially observed in adults, is underestimated der-estimated in children and adolescents, in whom, for the majority of authors, , the therapeutic management is surgical although the benefits in terms of fertility are unknown. Forty-eight children and adolescents, seen between 1978 and 1983, were followed by clinical examination and subsequent sperm count with a mean follow-up of 5.20 years. The presence at the first examination of the subsequent development of testicular atrophy is a pejorative element in the disease: 12% of children simply followed developed left testicular atrophy at puberty associated with severe anomalies of the sperm count. Persistent testicular atrophy after surgery was synonymous with anomalies of the sperm count in all of these children. Regression of moderate atrophy was observed in three children after surgical cure, but the pre- and post-treatment sperm counts were normal.

[Emphysematous pyelonephritis and perinephritis]. / Pyélonéphrite et périnéphrite emphysémateuses.

The authors report an eighth case of emphysematous perinephritis and a new case of emphysematous pyelonephritis. The general features of these two diseases and their similarities are described: middle aged diabetic women, clinical picture of sepsis, gas images projected over the renal area with delayed excretion on intravenous pyelography, computed tomography reveals the exact site of the emphysematous images (perinephritic and or intraparenchymal). Emphysematous perinephritis may be an early form of emphysematous pyelonephritis. Surgical drainage of the renal compartment allows conservative management at this early stage.

[Injuries of the posterior urethra. Apropos of 57 patients excluding iatrogenic injuries]. / Les traumatismes de l'urètre postérieur. A propos de cinquante-sept patients à l'exclusion des traumatismes iatrogènes.

Between 1973 and 1986, 57 patients presented with a fracture of the pelvis with rupture of the posterior urethra. All of these patients were treated as an emergency and were then followed periodically with a minimal follow-up of 2 years. There were 4 cases of rupture of the prostatic urethra and 53 cases of rupture of the membranous urethra, including 32 complete ruptures and 21 partial ruptures. In the case of rupture of the membranous urethra, initial treatment, in 34 cases, was realignment by guiding catheter either immediately (25 cases) or deferred emergency (9 cases) and, in the other 19 cases, end-to-end urethrorrhaphy or urethroplasty (2 cases) as a deferred emergency (15th to 32nd day). The results were evaluated on the maximal flow/second and the flowmetry curve, intravenous pyelography with micturating and post-micturating films and the need for dilatations or reoperations. In the cases treated by realignment by guiding catheter, 28 of our 34 patients (82%) developed secondary stenosis which is difficult to treat because of the large amount of granulation tissue and fibrosis, although the best results were obtained by end-to-end urethrorrhaphy (75%). In contrast, repeated dilatations and optical urethrotomies were failures. Deferred emergency end-to-end urethorrhaphy, in 17 cases, ensured a good immediate result in 60% of our patients. Secondary stenosis (7 cases) was always short and easily accessible to optical urethrotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Urodynamic study of obstruction induced by vesicoureteral reflux surgery with submucosal advance in beagle female dogs]. / Etude urodynamique de l'obstruction induite par une chirurgie du reflux vésico-urétéral par avancement sous-muqueux chez la chienne beagle.

The treatment of veslcoureteric reflux by submucosal advancement is effective in human clinical practice on nondilated refluxing ureters, with a low morbidity. In contrast, the results of this technique in the presence of concomitant disease such as megaureter appear to be less favourable and could be due to obstruction induced by the reflux surgery. The objective of this study was to evaluate the urodynamic modifications of ureterovesical reimplantation in 10 female Beagle dogs. Left ureterovesical reimplantation by submucosal ureteric advancement was performed in each animal which constituted its own control. The morphological results were assessed by intravenous urography and retrograde cystography. The urodynamic study was conducted during another surgical operation performed, on average, around the 18th postoperative week. A 6F two-channel probe was inserted on each ureter: while a pump delivered a constant infusion (2 then 5 ml/min) into one channel, the ureteric pressure was measured by the other channel. The bladder pressure was recorded by a bladder catheter. For each infusion rate, the increased pressure in the reimplanted ureter was compared to that measured in the control ureter, as a function of the bladder pressure. The subsequent morphological evaluation demonstrated the absence of any repercussions on the upper urinary tract and the absence of vesicoureteric reflux and paraureteric diverticulum. An initial increase in the basal ureteric pressure was observed at the beginning of the infusion and was significantly higher in the operated ureter than in the control ureter (for an infusion rate of 2 then 5 ml/min, p = 0.0008 and 0.00029, respectively). The mean ureteric pressures increased in parallel, but those recorded in the reimplanted ureter were significantly higher than those recorded in the control ureter (p < 0.01). Ureteric pressure peaks were only recorded on the reimplanted left ureter at an infusion rate of 2 ml/min. These results suggest that, in this experimental model, the resistance to passive flow was higher in the reimplanted ureterovesical junction than in the control ureterovesical junction.

[Lumbar endoscopy: analysis and evaluation of 10 primary operations]. / La lomboscopie: analyse et bilan des 10 premières interventions.

The authors report their experience of the first 10 patients operated by upper urinary tract lumboscopic surgery. Lumboscopy is performed in the lateral supine position and a simple technique for creation of retropneumoritoneum is described. In 4 patients, the planned nephrectomy could be performed because of poor anatomical conditions (peripyelitis and/or perinephritis). Lumboscopy allowed complete renal exploration, two nephrectomies, two resections of the roofs of compressive parapelvic cysts and one lumbar ureterolithotomy. The ease and rapidity of lumboscopic dissection makes it a valuable alternative to laparoscopy.

[Update of the morbidity of radical retropubic prostatectomy: retrospective analysis of 100 consecutive operations during the period 1996-1997]. / Actualisation de la morbidité de la prostatectomie radicale rétropubienne: analyse rétrospective de 100 interventions consécutives pendant la période 1996-1997.

OBJECTIVE: To retrospectively evaluate the morbidity of radical prostatectomy, with the exception of sexual complications, based on a recent single-centre series. MATERIAL AND METHOD: From January 1996 to January 1998, the morbidity of 100 consecutive patients undergoing radical retropubic prostatectomy was compared to the morbidity of the first 150 patients operated by the same technique in our department for the period 1983-1993. The perioperative morbidity was studied retrospectively on case files, while continence was evaluated in the last 50 patients by a self-administered questionnaire. Sexual complications could not be evaluated objectively for methodological reasons and were not addressed in this study. RESULTS: The single operative complication was a rectal injury (1%). The transfusion rate was 31%. The early complication rate was 23% with a major complication rate of 5% (four thromboembolic complications and one gastrointestinal haemorrhage). The most frequent minor complications (18%) were wound abscess (5%). The reoperation rate was 3%. The mean duration of vesical catheterization was 7 days (range: 4-30) and the mean hospital stay was 8 days (range: 5-30). With a mean follow-up of 14 months, 73% of patients are perfectly continent, with no incontinence pads, while 15% of the patients required incontinence pads "as a precaution". Incontinence required implantation of an artificial sphincter in 2 patients (2%). Only one patient developed stenosis of the anastomosis requiring internal urethrotomy. The reduction of morbidity in these 100 recently operated patients compared to the first 150 operated patients concerned the transfusion rate (31% versus 65%), the reoperation rate (3% versus 8%) and the minor complication rate (18% versus 32%). The reduction of operative morbidity partly explains the reduction of mean duration of vesical catheterization (7 days versus 15 days), and hospital stay (8 days versus 18 days); the anastomotic stenosis rate was also decreased from 17.3% to 1%. CONCLUSION: This study confirms the reduction of overall morbidity of retropubic radical prostatectomy. This improvement is probably multifactorial: increased operative experience and better postoperative management. These retrospective data must be taken into account in the diagnostic and therapeutic decisions concerning localized prostate cancer.

[Treatment of interstitial cystitis with sub-trigonal cystectomy and enterocystoplasty]. / Traitement de la cystite interstitielle par cystectomie sus-trigonale et entérocystoplastie.

Eight patients with interstitial cystitis were treated by supratrigonal cystectomy and enterocystoplasty. The indications for this procedure are functionally disabling interstitial cystitis refractory to conservative treatment and associated with severely altered cystomanometric parameters. 6 patients obtained an excellent functional result and 2 patients obtained a poor result, due to sphincter hypotonia responsible for total incontinence in one case.