[Total prostatectomy with preservation of erection. Surgical technic]. / La prostatectomie totale avec préservation de l'érection. Technique chirurgicale.

The authors describe their technique to preserve the erector nerves during a radical retropubic prostatectomy. In the first part, the different phases of the operation are described. The 2nd part consists of discussion based on the author's experiences (20 cases of nerve preservation in a series of 115 radical prostatectomies). The authors stress the insufficient oncological follow-up and the risk of an incorrect indication due to understaging of the cancer in pre-operative period.

[Radical prostatectomy in cancer of the prostate. Our experience apropos of 55 cases with 3-year follow-up]. / La prostatectomie radicale dans le cancer de la prostate. Notre expérience à propos de cinquante-cinq cas avec trois ans de recul.

The authors report their experience of retropubic radical prostatectomy for prostatic cancer. They have performed 55 prostatectomies over a period of 3 years. Their indications are essentially stage B (35 cases) and stage C1 (20 cases). The post-operative morbidity was low and no cases of incontinence were observed. Post-operative impotence generally occurs when the cavernous nerves are interrupted. However, erection was preserved in two cases when Walsh's technique was used.

[Pharmacologic study of nicergoline in the pathology of the cervico-prostatic sphincter]. / Etude pharmacologique de la nicergoline dans la pathologie cervico-prostatique.

An urodynamic survey and an E.M.G. of the striated sphincters were performed in 20 patients presenting with prostatism, before and after infusion of either nicergoline or placebo, under double-blind conditions. Statistical analysis was performed and demonstrated a significant decrease in the tone of the bladder neck, the prostate, the striated sphincter and the bladder; impoverished electromyographic activity of the striated sphincters; increased maximal and mean urine flow and decreased post-voiding residue. The authors stress the efficacy of nicergoline in cervico-prostato-sphincteric syndromes.

[Hydraulic penile prostheses in the surgery of impotence. Our experience in 20 cases with a 2-year follow-up]. / Prothèses péniennes hydrauliques dans la chirurgie de l'impuissance. Notre expérience sur vingt cas avec deux ans de recul.

The authors report their experience of the implantation of inflatable penile prostheses in the surgical management of impotence. They have implanted twenty prostheses with a followup of two years to three months. The overall results are very satisfactory in terms of the quality of the sexual life of the couple (85%). On the other hand, the postoperative morbidity rate is high, with 40% of complications including 20% requiring reoperation.

[Pheochromocytoma with multiple localizations manifested by a hemorrhagic bladder tumor]. / Phéochromocytome à localisations multiples révélé par une tumeur vésicale hémorragique.

Pheochromocytoma is an endocrine tumor derived from neuroectodermal tissue. Pheochromocytomas usually arises in the adrenal glands but may develop in other organs. We report a case of pheochromocytoma of the bladder with hematuria as the presenting symptom. This tumor was removed by partial cystectomy. Following this procedure, biologic disorders persisted (catecholamines, vandylmandelic acid and metanephrines) leading to the diagnosis of an adrenal pheochromocytoma. The patient recovered after removal of the adrenal tumor. Discussion, review of the literature and bibliography.

[Long term results of electric stimulation of the conus medullaris in a case of neurogenic bladder]. / Résultats éloignés de la stimulation électrique du cône médullaire, en cas de vessies neurologiques.

The authors present long term results (19 to 45 months: Average 37 months) of electrical stimulation of the conus medullaris in neurologic bladder. In 3 cases, the result remain excellent: efficient stimulation, normal micturition, absence of residual urine. In 6 cases, after a long period of normal function, the micturition is poor with residual urine, eventhough the conus medullaris stimulation always produces a satisfactory contraction of the detrusor. In four cases the relapse is due to disease of the external sphincter region, poorly or untreated. In female patients the results are better than in male patients, with positive results in 2 of the 3 women and 1 of the 6 men. The authors find that their results can be compared with those of B. NASCHOLD, originator of the method. They emphasize the necessity of a close collaboration with the urologist to maintain excellent results.

[4 cases of Horton's temporal arteritis. Hypothesis on the possible correlations with rheumatic polymyalgia]. / Quattro casi di arterite temporale di Horton. Ipotesi sulle possibili correlazioni con la polimialgia reumatica.

Giant cell arteritis (GCA) or temporal arteritis is an entity of unknown aetiology and uncertain autonomy for the close relationship with polymyalgia rheumatica (PMR). This work describes four patients with GCA alone. All patients had clinical and laboratoristic evidence of the disease and were treated with steroids. The distribution of HLA antigens showed an increased occurrence of DR4 and B8 antigens. Unfortunately, the small number of patients and the short period of observation don't allow to prove the exact nature of the link between GCA and PMR.

[Uretero-ileal anastomosis using the modified Leduc-Camey technic. Surgical technic]. / Anastomose urétéro-iléale selon la technique de Leduc-Camey modifiée. Technique chirurgicale.

A modified Leduc-Camey technic for uretero-ileal anastomosis was used in 96 patients over a period of one year, complications related to this type of anastomosis, and requiring recovery surgery, being noted in 2 cases. When compared with more than 300 anastomoses performed using the original Leduc-Camey technic, this modified procedure using absorbable sutures appeared to be simple, effective and very rapid. It is a valid method for Camey type reconstruction bladders and also for Bricker type or Kock's pouch type continent diversion operations.

Morbidity of radical retropubic prostatectomy following previous prostate resection.

A total of 153 patients with prior prostate surgery underwent a radical retropubic prostatectomy for carcinoma of the prostate. Ninety-seven patients had undergone transurethral resection of the prostate (TURP), and 56 patients had undergone suprapubic transvesical prostatectomy (SPP). In 115 patients, the diagnosis of malignancy was made at the time of transurethral resection or enucleation. No perioperative deaths occurred and no patient suffered rectal injury or ureteral transection. Operative time and blood loss were similar between the TURP and SPP groups and were not different in a group of patients who had not had prior prostate surgery. Early and late complications occurred in eight patients (5.2%), of whom seven had had previous TURP. Complete urinary control was achieved in 96% (147) of the patients; stress incontinence was present in 4% (6 patients); and no patient was totally incontinent. Postoperative complications and the occurrence of stress incontinence were not related to the time elapsed between the previous prostate surgery and the radical prostatectomy. Sexual function was preserved in 32 (71%) of the 45 patients in whom we performed a nerve-sparing radical prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 77 (67%) of the stage A patients. Twenty-nine (25%) of the stage A and 13 (34%) of the stage B patients had pathological evidence of disease extension beyond the confined prostate. Follow-up was 6-92 months, with a mean of 32 months. Four patients died of prostatic cancer, two patients died without cancer, and five have evidence of disease progression; 142 (93%) are alive without evidence of disease. Although radical prostatectomy sometimes is more difficult after previous prostate surgery, operative complication rates, patient morbidity, and the opportunity for surgical cure are not different from those seen in patients with no history of previous prostate operations.

Successful autotransplantation of an intra-abdominal testis by microsurgery.

An intra-abdominal testis in a 12-year-old child was successfully transplanted to the scrotum by a microvascular technique. The result after 12 months is promising. Problems of ischaemia in testicular autotransplantation and technical problems in testes with a short spermatic pedicle are emphasized.

Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive cases.

We describe our experience and complications of radical retropubic prostatectomy. From March 1983 through December 1990, 620 consecutive patients have undergone an anatomical radical retropubic prostatectomy for the treatment of prostatic carcinoma. The surgical technique we used is described. In 167 patients the procedure included preservation of the neurovascular bundles. There were no modifications in the surgical technique during this period. There were no operative deaths. Mean operating time was reduced from 3 hours in the first 100 patients to 1.5 hours in the last 220 patients. The average blood loss was reduced remarkably as well. There were only 3 cases of rectal injury, which were closed primarily and healed completely. One patient died of acute myocardial infarction 12 days after an uneventful operation. This patient accounted for the only perioperative death in our experience. Early complications occurred in 43 patients (6.9%), including only 2 cases (0.3%) of anastomotic urinary leakage. The late complication rate, excluding incontinence and impotence, was 1.3%. No patient was totally incontinent. Among the patients who were followed for 1 year or longer 95% achieved complete urinary control and 5% experienced stress urinary incontinence. Preservation of sexual function in patients who underwent a nerve-sparing operation was achieved in 71%. Our results indicate that radical retropubic prostatectomy can be performed with low morbidity and without affecting the quality of life in the majority of patients.

Radical prostatectomy in the management of stage-A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 11 of the 29 stage-A1 patients (38%) and in 66 of the 86 stage-A2 patients (77%). 14% of the stage-A1 patients and 29.5% of the stage-A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients are alive, and only 3 patients suffered disease progression. These 3 patients were among the stage-A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. 26 patients who also had evidence of disease extension are alive without evidence of disease. These data demonstrate that patients with stage-A disease are at risk for disease progression if left untreated and, with morbidity as low as achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.

Radical prostatectomy in the management of stage A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimens in 11 of the 29 stage A1 patients (38%) and in 66 of the 86 stage A2 patients (77%). Fourteen percent of the stage A1 patients and 29.5% of the stage A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients were alive at the time of this study and only 3 patients suffered disease progression. These 3 patients were among the stage A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. Twenty-six patients who also had evidence of disease extension were alive without evidence of disease. These data demonstrate that patients with stage A disease are at risk for disease progression if left untreated and with a morbidity as low as that achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.

Urinary continence following radical retropubic prostatectomy.

Between 1983 and 1989, 484 men (46-82 years old) underwent radical retropubic prostatectomy for prostate cancer. Six months after surgery, 434 patients (90%) achieved complete urinary control; stress incontinence was present in 50 patients (10%) and no patient was totally incontinent. Of the 398 patients who were followed up for more than 1 year, 377 (95%) achieved complete urinary control and 21 (5%) experienced stress incontinence. Prior open prostatectomy or transurethral resection of the prostate had no influence on the return of urinary control. Pathological stage and preservation or not of the neurovascular bundles also had no significant influence on the long-term state of continence. Age was the only factor that adversely affected the return of urinary continence. The average interval between surgery and return of continence was shorter in patients less than 70 years old. When the impact of age was examined 1 year or more after surgery, no significant difference was noted between the age groups. Several technical considerations that contribute to these results are discussed, especially the use of a gradual approach to the apex of the prostate to facilitate exposure and haemostasis and to preserve as much of the striated urethral sphincter as possible.

Preservation of urinary continence and potency after cystoprostatectomy.

Between 1980-1989 a total of 349 patients underwent one-stage radical cystoprostatectomy and an orthotopic bladder substitution. 278 patients underwent the Camey I bladder replacement and in 71 patients a detubularized ileal loop was utilized (Camey II). 75 patients underwent a potency-sparing cystectomy (32 patients of the Camey I and 43 patients of the Camey II groups). All patients were followed at least one year and had continence and potency assessment. Among the patients who underwent the Camey I procedure, 66% achieved daytime continence and 21% night-time continence 6 months after surgery. One year after surgery 86% of patients had normal continence during the day and 47% was continent during the night. 14% of patients had episodes of day-time incontinence one year after surgery. Among the patients who underwent the Camey II bladder replacement 86% achieved day-time continence and 59% night-time continence 6 months after surgery. At one year after surgery 91% was continent during the day, 72% was dry during the night and only 9% had episodes of diurnal incontinence. Potency was achieved in 24 of 32 patients (75%) with the Camey I bladder substitution, and in 34 of the 43 patients (79%) with the Camey II bladder substitution. Our data demonstrate that excellent rates of continence and potency are achievable in the post-cystectomy population. Patients with the Camey II bladder replacement achieve continence earlier than patients with the Camey I bladder substitution. Diurnal continence is slightly better after the Camey II procedure, one year after surgery, but the difference is not statistically significant. Nocturnal continence is significantly better with the Camey II bladder substitution.

Pulsed dye laser in the treatment of 325 calculi of the urinary tract.

The pulsed dye laser (Candela) has been used from February 1988 to September 1989 in order to treat 325 stones in 278 patients. A total of 285 endoscopies has been performed. The pulsed laser has helped to achieve the fragmentation of 318 stones. Laser fragmentation has not induced any complication at all. The main failures can be attributed to the nature and shape of the stone. Thanks to the thin laser fiber, the use of small diameter ureteroscopes has increased the reliability of ureteroscopy. The use of this technique combined to extracorporeal shock wave lithotripsy (ESWL) has reduced the rate of open surgery for ureteral stones down to less than 1%.

[Rigid ureteroscopy and the pulsed laser. Apropos of 325 treated calculi]. / Urétéroscopie rigide et laser pulsé à colorant. A propos de 325 calculs traités.

A pulsed dye laser (Candela) was used in our lithiasis treatment center during the period 02/88-09/89 to remove 325 calculi in 278 patients, requiring 285 endoscopic instrumentations. The pulsed laser allowed to obtain fragmentation of 318 calculi, 238 of which were reduced to thin sand and 80 to coarser fragments. The latter were either cleared using a Dormia probe or further disintegrated by electrohydrolytic shock wave treatment or extracorporeal shock wave lithotripsy (ESWL). No complication imputable to laser stone fragmentation was noted. Failure of stone clearance was chiefly due to the nature and shape of the stone (black, smooth monohydrated calcium oxalate calculi). The thinness of the laser fiber has made it possible to use small caliber ureteroscopes, thereby increasing the reliability of ureteroscopy. Coupled with ESWL (EDAP LT01), this technique has caused the rate of open surgical removal of ureter confined calculi to fall from 11% to 1%.

Ileal low-pressure bladder replacement: Camey type II. Stapling technique and preliminary results (57 cases, 1987-1989).

In keeping with the basic principles of Camey's procedure and with a view to improve continence, we decided in 1987 to experiment with the technique of ileal low-pressure bladder replacement (Camey II). We introduced the stapling technique in order to save time and to obtain watertight, reliable sutures. 57 patients underwent a Camey II intervention following radical cystectomy. Follow-up was 3-24 months. No operation mortality was observed and only 5 perioperative complications were recorded. Continence during the day and at night increased rapidly with Camey II (50% at 3 months, 90% at 6 months). Camey II improves the patients' quality of life; the procedure is simple, fast and reliable thanks to the stapling technique.

[Personal experience of sleep plethysmography in the differential diagnosis of erection disturbances (author's transl)]. / Notre expérience de la pléthysmographie de sommeil dans le diagnostic différentiel des troubles de l'érection.

The authors feel that penile erection during sleep represents the first stage in the investigation of erection problems. The aim is to distinguish between psychogenic impotence the organic impotence. The authors simultaneously perform plethysmography and an electroencephalogram during sleep. Sixty five patients have been investigated in this way. In 44 cases the occurrence of nocturnal penile erection led to the conclusion of a psychogenic origin whilst in 21 cases the results of plethysmography were pathological. Amongst these 21 patients, undergoing vascular investigations, 12 underwent revascularisation of the corpora cavernosa and 12 the insertion of an erection prosthesis. It may be noted that revascularization using the epigastric artery gave widely disparate results: 2 good results amongst 9 patients, with one failure and six inadequate erections. The authors emphasise the fact that there is little alteration in sleep in cases of organic impotence and that phases of paradoxal sleep recur periodically without any great variation in the plethysmographic curve. By contrast, in functional impotence, sleep is invariably disturbed. A whole series of factors are involved in the assessment of the results: total duration of sleep, duration of paradoxal sleep, ratio of paradoxal sleep to total sleep, total erection time, total time in maximum erection and the ratio of erection time to paradoxal sleep. Analysis of sleep is thus a fundamental factor in the proper interpretation of the results of plethysmography in an importance sufferer.