Assessment of divided renal function by renography. Validation in patients with separate urine collections from each kidney.

Divided renal function was measured by 99mTc-DTPA renography using a gamma camera and a computer-assisted program. In 14 patients with permanent bilateral ureterostomies (7) or temporary ureteric catheterization (7), split renal function was calculated by analysis of the initial phase of the kidney activity-time curve and measured simultaneously by conventional clearance techniques. A high correlation was found between individual clearances measured by computation and by the conventional procedure. The correlation coefficient between the results obtained by the two techniques was 0.94 (P less than 0.001). A high correlation was also shown to exist between the computed clearance and the renal uptake of mercury after administration of 197HgCl. It is concluded that 99mTc-DTPA is particularly useful for the measurement of divided renal function without the need for urine collection.

[Computer stimulation of endoscopic resection of the prostate]. / Simulateur de résection endoscopique de prostate.

The number of urologists in need of training is increasing whereas the number of resections of the prostate is falling. Patients are less and less willing to have their procedure serve for young residents to learn the technique of endoscopic resection of the prostate. Despite teachings and videoendoscopy, this procedure remains difficult to learn. We decided to develop a simulator for endoscopic resection after having seen the remarkable model of endoscopic simulation developed by French gastroenterologists and presented at the computer science workshop of the AFU symposium. The hypercard program, the laservision disk, and the CD ROM project were elected as a good introduction to this challenging although not unsurmountable problem. We had to adequate our goals to the resources of French urologists: the Macintosh II is the most sophisticated affordable computer. Computerization of the televised images of the endoscopic procedure and formalization of the gestures of the operator are required. Conventional image synthesis programs for use with the Mac II are either very slow or very limited. Conventional simulation programs are highly mathematical. Computerized images take up considerable memory space and large capacity disks or optical disks are required. The urologic laservision to which we contributed in 1986 contains few endoscopic images of the prostate but served as a basis for devising a methodology. Object programming with hypercard and animated image programs for Macintosh computers will be the starting points for our project that will benefit from the significant advances announced by Apple concerning color image file maintenance.

[Clinical epidemiology using an electronic value-added tabulator. Application to cancer of the prostate in TNM classification and in calculating Kaplan-Meier curves]. / Epidémiologie clinique sur tableur électronique avec valeur ajoutée. Application en cancérologie prostatique à la classification TNM et au calcul des courbes de Kaplan-Meier.

The authors have been using the WHO-TNM 1977 classified, modified in 1982, for prostatic cancer for more than ten years. This classification has been considered to be insufficient to allow precise choice of therapeutic determinants and to accurately evaluate the results of treatments. A new WHO TNM 88 classification has been recently published and has raised many controversies in the urological literature which complicates the development of this classification. The authors have developed a value added system of TNM scoring using the Excel programme on a personal computer, which tries to integrate the various classifications 78-82-88. Very precise rules must be determined for information collection, the most reproducible medical indicators must be selected and they must be made as objective and as pertinent as possible. The rules of the WHO classification must then be formalized and introduced into the expert system as rules of production. The system allows optimal transcription of the scores from one classification to another, depending on the political orientations of the necessity of translation. Lastly, the system calculates, in real time, the actuarial survival and/or Kaplan-Meier curves for all of the events identified by an indicator for the patient files entered into the system.

[The 4-stage continence-micturition cycle. The presentation of a urodynamic, diagnostic and therapeutic abacus]. / Le cycle continence-miction à quatre temps. Présentation d'un abaque urodynamique, diagnostique et thérapeutique.

The complexity of the mode of operation of the bladder and urinary sphincter has led to the development of a number of temporospatial physiologic models that divide the process of micturition into several stages in order to facilitate investigations. Ten years ago, the authors described a two-stage continence-micturition model intended to improve the accuracy of studies of urodynamic disorders and thus contribute to the development of more effective and more rational therapeutic solutions. A large number of diseases can affect the distal urinary tract and recent advances in neurophysiology [10] have made the selection of the appropriate therapy extremely complex. Consequently, the authors have developed a decision analysis system that simultaneously confronts diseases, urodynamic manifestations, risks for the patient, and the main therapeutic approaches available. In 1985, they increased the number of stages in their continence-micturition model from two the four. This four-stage model has provided satisfactory result when used with an abacus for modeling observed biologic phenomena. In addition to offering simulation exercises for teaching purposes, this abacus provides the means for studying the instantaneous urodynamic situation (correspondences between cycle time points, symptoms, and effects of treatments) and determining the effect of various medicosocial events on the course of the bladder and sphincter dysfunction. The authors hope this abacus will be an attractive aide to the understanding of the complex function of the distal urinary tract.

[Nucleolar organizers: NOR. New prognostic factors in prostatic cancer. Preliminary results in 20 cases]. / Les organisateurs nucléolaires: NOR. Nouveaux facteurs pronostiques dans le cancer de la prostate. Résultats préliminaires á propos de vingt observations.

The authors present a preliminary series if two groups of ten patients with advanced prostatic cancer with sufficient follow-up in whom the study of nucleolar organizers (NOR) was performed according to a new light microscopy argentaffin technique. This original technique was developed by D. Ploton at the CHU de Reims. The principles of the technique are presented. The interpretation of the results, very dispersed at the present time, leads the authors two us two new clinical and histological indicators estimating the degree of severity of the prostatic cancer: the index of clinical severity based on the quality of survival and its duration from time T0 and the multifactorial index of histological severity based on the WHO classification, Gleason grade and NOR.

[Color processing of ultrasonographic images in extracorporeal lithotripsy]. / Colorisation des images échographiques en lithotritie extra-corporelle "C.I.E.L.E.C.".

A number of technical difficulties are encountered in the ultrasonographic detection of renal stones which unfortunately limit its performance. The margin of error of firing in extracorporeal shock-wave lithotripsy (ESWL) must be reduced to a minimum. The role of the ultrasonographic monitoring during lithotripsy is also essential: continuous control of the focussing of the short-wave beamand assessment if the quality of fragmentation. The authors propose to improve ultrasonographic imaging in ESWL by means of intraoperative colour processing of the stone. Each shot must be directed to its target with an economy of vision avoiding excessive fatigue. The principle of the technique consists of digitalization of the ultrasound video images using a Macintosh Mac 2 computer. The Graphis Paint II program is interfaced directly with the Quick Capture card and recovers the images on its work surface in real time. The program is then able to attribute to each of these 256 shades of grey any one of the 16.6 million colours of the Macintosh universe with specific intensity and saturation. During fragmentation, using the principle of a palette, the stone changes colour from green to red indicating complete fragmentation. A Color Space card converts the digital image obtained into a video analogue source which is visualized on the monitor. It can be superimposed and/or juxtaposed with the source image by means of a multi-standard mixing table. Colour processing of ultrasonographic images in extracoporeal shockwave lithotripsy allows better visualization of the stones and better follow-up of fragmentation and allows the shockwave treatment to be stopped earlier. It increases the stone-free performance at 6 months. This configuration will eventually be able to integrate into the ultrasound apparatus itself.

[Treatment of female stress urinary incontinence with cystocele by Gore Tex colpofixation and Burch operation]. / Traitement de l'incontinence urinaire féminine d'effort avec cystocèle par promontofixation utérine au Gore Tex et intervention de Burch.

OBJECTIVE: We treat female urinary stress incontinence (USI) with cystocele with or without associated genital prolapse by a combination of sacral colpopexy and Burch anterior colposuspension. We evaluated the results of a consecutive series of 77 patients completing a telephone interview after a mean follow-up of 40.6 months (range: 15 to 74 months). MATERIAL AND METHODS: From January 1991 to December 1995, 77 patients (mean age: 56.7 years) underwent Gore-Tex sacral colpopexy and Burch colposuspension for USI. Levator ani myorrhaphy was also performed in 53 severe cases. Incontinence was severe in every case, and associated with stage > or = 2 cystocele in 93% of cases. Urodynamic assessment revealed detrusor instability (DI) in 17.3% of cases and sphincter insufficiency (SI) < or = 35 cm H2O in 11.9% of cases. The main complications were: 4 haemorrhages requiring transfusion of one unit, 2 wound abscesses, one wall haematoma, and one small bowel obstruction at the 4th month, treated surgically. RESULTS: Six patients were lost to follow-up (good early results) and 2 files could not be analysed with sufficient follow-up (patients died from other diseases). Good results were defined by at least two of the following criteria: patient satisfied, no incontinence and no need for protective pads. We obtained 59 successes (85.5%) and 10 failures (14.5%). The results remained stable over time with 88.8% of success after a follow-up of more than 60 months (20 patients). Nine of the 10 failures occurred during the first year. They were demonstrated by the survey, while the post-operative follow-up at one month had been satisfactory. No specific treatment was therefore proposed. The two main factors of failures were DI and severe SI. Three times more failures were observed when the preoperative closure pressure were less than 30 cm H2O. CONCLUSION: Sacral colpopexy combined with Burch operation is a reliable solution for repair of USI with marked cystocele. It ensures good initial results which persist at one year and in the long-term.

[Current role of coagulase-negative staphylococci in urology]. / Place actuelle des staphylocoques à coagulase négative en urologie.

Coagulase-negative Staphylococci (CNS), considered for many years to be commensal bacteria of the skin are now recognized as major agents of nosocomial infection. Bacterial factors (increased resistance), host factors (immune status) and multiplication of the portals of entry (presence of foreign material) have contributed to the increased incidence of nosocomial infections. The importance of the role of NCS in urology is due to their great capacity to colonize catheters and most prostheses. The particular organization of these bacteria into a conglomerate called biofilm is responsible for prosthetic infections, which can impair renal function and can sometimes be life-threatening. The authors review the current increase of the number of CNS isolated in urology departments and describe the various therapeutic strategies that can be proposed to eradicate these bacteria.

[Nucleolar organizers in superficial bladder tumors. Prognostic analysis of 37 observations]. / Les organisateurs nucléolaires (NORs) dans les tumeurs superficielles de la vessie. Analyse pronostique à propos de 37 observations.

Nucleolar Organisers (NORs) are intranucleolar segments of DNA coding for ribosomal RNA. The agyrophilic proteins (AgNOR) associated with NORs allow them to be cytolabelled on paraffin sections. The number of NORs (NOR index) is correlated with cellular proliferation and has a diagnostic and prognostic value in neoplastic disease. The AgNOR method was analysed in a series of 37 superficial bladder tumours with different clinical courses. The NORs were counted in normal urothelium, on superficial tumours used to establish the diagnosis of the disease and on recurrent superficial tumours. The NOR index was 4.54 for normal urothelium, 5.89 for non-invasive superficial tumours, 7.33 for invasive superficial tumours, and 9.75 for invasive recurrences. These results demonstrate an increase in nucleolar argyrophilia with invasion and invasive potential of superficial bladder tumours which were initially homogeneous for stage and grade. The AfNOR method could constitute a new method of early histoprognostic evaluation for urothelial tumours.

[Pharmacologic stimulation of ejaculation with midodrine hydrochloride (Gutron) for medically assisted reproduction in spinal injury]. / Stimulation pharmacologique de l'éjaculation par le chlorhydrate de midodrine (Gutron) dans l'aide médicale à la procréation du blessé médullaire.

INTRODUCTION: Midodrine hydrochloride (Gutron) is proposed to induce ejaculation in spinal injury patients desiring paternity as an alternative to vibromassage, electrostimulated ejaculation and surgical collection of spermatozoa. The authors report their experience in 10 spinal injury patients. PATIENTS AND METHODS: 14 trials of pharmacologically-induced ejaculation were performed in a context of medically assisted reproduction (MAR) in 10 spinal injury patients (7 with paraplegia > T11; 1 with paraplegia < or = T11; 2 with quadriplegia) an average of 4.5 years after the injury. Patients had a mean age of 28.5 years (range: 18 to 36 years). Nine had persistent reflex erections. After IC injection of prostglandin E, 10 to 30 mg of Gutron was administered by slow i.v. infusion. Spermatozoa were collected during antegrade ejaculation and/or in previously alkalinised urine. RESULT: Ejaculation was obtained in 10 cases (71.4%), either antegrade (7 cases), or retrograde (3 cases). The 4 failures corresponded to ejaculation failure in 3 cases and adverse effects of Gutron (hypertension) in 1 case. However, storage of spermatozoa could be performed in only 4 cases (40%), as pyospermia or severe necrospermia were observed in 6 cases. CONCLUSIONS: Midodrine hydrochloride gives good results in terms of ejaculation in spinal injury patients. However, the quality of semen collected is often poor due to the long interval since the initial trauma. Midodrine hydrochloride, ideally used after antibiotic treatment, can nevertheless constitute an alternative to other techniques.

[Prostatic abscesses: what treatment to propose?]. / Abcès prostatiques: quelles thérapeutiques proposer?

Microscopic abscesses of the prostate (< 1 cm) are usually treated by antibiotics with good prostatic diffusion, such as fluoroquinolones, for a minimum of 4 to 6 weeks. Complementary surgical drainage is generally required for larger abscesses or in case of an unfavourable course. The main points of discussion in the literature are the type of drainage and the incision that should be performed. Prostatic abscesses used to be drained via perineal incisions, but with a high mortality. The use of effective antibiotics has significantly improved the morbidity of prostatic abscesses. CT-guided percutaneous drainage (perineal or transrectal), or more frequently transrectal ultrasound-guided drainage, now allows rapid and effective evacuation of the abscess, without the need for general anaesthesia. The perineal route allows a simple J stent to be left in place for several days to ensure complete drainage, but it is not universally accepted. Transurethral exposure is indicated for periurethral prostatic abscesses.