A baseline-controlled, open-label, flexible dose-escalation study to assess the safety and efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction.

Although sildenafil citrate (Viagra) has demonstrated effectiveness in the treatment of erectile dysfunction (ED), the dosing regimens often used in clinical trials may not always match those employed in clinical practice. This study was undertaken to further assess the efficacy and safety of sildenafil taken as required in male outpatients 18 years of age and older with ED (n=71). It was conducted as a placebo-baseline-controlled, open-label, flexible dose-escalation study, with sildenafil (25,50, or 100 mg) administered for 8 weeks following a 4-week placebo run-in. Efficacy variables included questions 3 and 4 of the International Index of Erectile Function (IIEF), other IIEF domains, patient event logs, and quality-of-life (QOL) assessments. Treatment with sildenafil resulted in improvements from baseline in all IIEF domains analyzed (all P<0.0001), as well as overall QOL and amelioration of specific sexual and social relationships (all P&<0.0001). Sildenafil was well tolerated. One participant discontinued treatment because of adverse events. Results suggest that flexible dosing with oral sildenafil is safe and has beneficial effects on all indices of erectile function and QOL.

[Ureterovaginal fistulas. A report of 17 cases]. / Fistules urétéro-vaginales. A propos de 17 cas.

OBJECTIVE: Our purpose was to study aetiopathogenic, diagnostic and therapeutic aspects of ureterovaginal fistulas. STUDY DESIGN: A retrospective study concerned 17 ureterovaginal fistulas in 16 patients. The main causes were gyneacological and obstetrical procedures. The diagnosis was based on clinical considerations and intravenous pyelography in all cases. Three vesicovaginal fistulas were associated with iatrogenic ureteral lesions. Various therapeutic methods were used: psoas-bladder hitch procedure (11 cases) and Boari-Küss flap (4 cases). In two patients, fistulae healed by drainage after ureterolysis. RESULTS: Late radiology showed success of the procedure in 14 patients and persistance of ureteral dilatation in 2 cases treated by Boari-Küss procedure. CONCLUSION: Ureterovaginal fistulae are a relatively frequent complication of pelvic surgery. Psoas-bladder hitch is the procedure of choice in such fistulae cure and prevention is the most efficient treatment.

[Urinary tract tumor in a horseshoe kidney diagnosed after renal trauma]. / Tumeur de la voie excrétrice sur rein en fer à cheval découverte lors d'un traumatisme rénal.

The discovery of a urinary tract tumor in a horseshoe kidney following renal trauma led the authors to report this case. They emphasise the fact that this association is very rare, the importance of follow-up urography in cases of renal trauma, and that the persistence of urographic abnormalities justifies the use of computed tomography. They also indicate the technical details of horseshoe kidney surgery.

[The role of corticotherapy and endoscopy in the treatment of urogenital tuberculosis]. / Place de la corticothérapie et de l'endoscopie dans le traitement de la tuberculose uro-génetale.

Despite the efficacy of new tuberculostatic agents, urogenital tuberculosis still constitutes a threat to renal function due to fibrosis secondary to healing of the lesions. The authors studied the place of corticosteroids, and endoscopic and percutaneous procedures in the treatment of 86 cases of urogenital tuberculosis. Corticosteroids were coprescribed with tuberculostatic agents in 20 patients: 16 ureteral strictures were treated with 8 success and 8 failures, 8 contracted bladders were treated with 5 success and 3 failures. Three cases of retraction of the renal pelvis were treated by corticosteroids with 2 successes and one failure. Ureteral stricture was treated by retrograde ureteral stenting in 5 cases and by percutaneous antegrade ureteral stenting in one case with 4 successes and 2 failures. This study more clearly defines the indications for corticosteroids and endoscopic treatment with particular reference to new endoscopic surgery techniques.

[Pathological horseshoe kidney. Therapeutic aspects]. / Le rein en fer à cheval pathologique. Aspects thérapeutiques.

The authors report the various therapeutic modalities of uropathies associated with horseshoe kidney, based on a series of 20 pathologic horseshoe kidneys, associated with 12 cases of renal stones, 5 ureteropelvic junction obstructions, 3 kidney tumors, 2 cases of pyonephrosis and finally 1 traumatic horseshoe kidney. The specific anatomic and surgical features of this uncommon malformation are emphasized and the therapeutic features of each uropathy associated with horseshoe kidney are discussed.

[Isolated retrovesical and retroperitoneal hydatid cysts. 5 case reports]. / Les kystes hydatiques rétro-vésicaux et rétro-péritonéaux isolés. A propos de cinq cas.

In the light of five cases of isolated retrovesical and retroperitoneal hydatid cysts, the characteristics of these rare locations are reviewed and the hypotheses of pathogenesis are discussed. An abdominal or abdomino-pelvic mass is the most frequent sign. Ultrasonography and computed tomography are valuable in the diagnosis of these lesions. Partial cysto-pericystectomy via an extraperitoneal approach is the treatment of choice for these hydatid cysts.

[Traumatic rupture of the corpus cavernosum. 25 case reports and literature review]. / La rupture traumatique du corps caverneux. A propos de vingt-cinq cas et revue de la littérature.

On the basis of a series of twenty-five cases of traumatic rupture of the corpus cavernosum and a review of literature, the characteristics of this rare affection are reviewed. This injury typically occurs in young adults. The most frequent mechanism is rough manipulation of the erect penis. Urethral injury is associated in 10 per cent of patients. The characteristic history and physical findings usually yield the diagnosis. The preferred form of management is early surgical repair of the tunical defect, by distal circumferential incision. Post-operative complications are rare (8 per cent). The treatment of associated urethral injuries and late complications resulting from untreated rupture is reviewed.

[Infrared spectrometry and urolithiasis. Report of 80 cases]. / Spectrophotométrie infrarouge et lithiase urinaire. A propos de 80 cas.

Urolithiasis is a frequent disorder that is characterized by its recurrence following treatment and which can affect between 3-20% of the population, with an incidence that differs from country to country. The aim of the present study was to determine the composition of the calculi, and the remain characteristics of this pathology in Morocco. A series of 80 calculi was therefore analyzed by Fourier transform infrared spectroscopy. The findings showed that calcium monohydrate oxalate was the main lithiasic component, indicating that hyperoxaluria plays a major role in the formation of the calculi. The component identified were as follows: calcium oxalate (58.75%), calcium phosphate and magnesium phosphate (17.5%), uric acid (15%), and urate (8.75%). In 91.25% of cases, the calculi were of mixed composition. Regular patient follow-up is advocated and subjects should be informed of the risk factor involved, as urolithiasic recurrence was observed in 10% of the cases in this series.

[Bilateral renal angiomyolipoma associated with tuberous sclerosis: report of a case]. / Angiomyolipome rénal bilatéral et sclérose tubéreuse de Bourneville: à propos d'un cas.

The authors report a case of bilateral renal angiomyolipoma, associated with tuberous sclerosis revealed by abdominal pains, in a 30-year-old man. The diagnosis, suspected by the clinic and ultrasonography, is affirmed by CT scan. In light of this case, the authors review the features of this disease, the ambiguous character of angiomyolipoma, the prognosis and choice of management. Several elements incited us to adopt therapeutic abstention with regular monitoring of the patient for this begin tumor with slow evolution.

[Epidemiology of urinary lithiasis]. / Epidémiologie de la lithiase urinaire.

The objective of this study was to analyse the epidemiological profile of urinary stones based on one thousand cases observed in our institution over a 10-year period. The mean age of the patients was 45 years and two-thirds of patients were males. The kidney was the commonest site of stones, in 57.8% of cases. The stone was radiopaque in 86.4% of cases and was a staghorn calculus in 12.2% of cases. An associated renal malformation was observed in 10.4% of cases. Urinary stones is therefore a common disease, essentially observed in a young population and characterized by recurrence. It therefore constitutes a public health problem and prevention consists of detecting recurrences and treating stone-inducing factors.

[Seminal vesicle cyst associated with homolateral renal agenesis and megaureter. Apropos of a case]. / Kyste vésiculaire séminal associé a une agénésie rénale homolatérale et un méga-uretère. A propos d'un cas.

We report a case of a 24-year-old male patient with cystic dilatation of the seminal vesicle associated with renal agenesis and megaureter. This patient complained of left renal colic with pollakiuria. We performed intravenous urography and ultrasound showed a cyst in the seminal vesicle associated with left megaureter and right renal agenesis. Treatment consisted of resection of the cyst and reimplantation of the left ureter into the bladder. No postoperative complications were observed. This association is rare and can be explained by the common embryological origin of the seminal vesicle and kidney and ureter. Its diagnosis is now facilitated by ultrasound and CT. The treatment of this tumor is surgical only when the lesions are responsible for clinical symptoms.

[Ureteropelvic junction syndrome in adults. 108 cases in 102 adults]. / Le syndrome de la jonction pyélo-urétérale chez l'adulte. 108 cas chez 102 adultes.

We report 108 cases of ureteropelvic junction obstruction corresponding 54 males and 48 females, with a mean age of 33 years. Pain was the commonest symptom. Delay in diagnosis was 3 and a half years. The diagnosis was made by IVP allowing our patients to be in different stages : Stage I (12 cases), stage II (39 cases), stage III (25 cases), stage IV (32 cases). We did not operate on 10 patients presenting with allow stage. 61 patients were operated by a conservative procedure : dismembered pyeloplasty (58 cases), YV pyeloplasty (3 cases). Nephrectomy was performed in 37 patients (34%). This high nephrectomy rate was due to be delayed in diagnosis.

[Ureteral reimplantation]. / La réimplantation urétérale.

Various techniques of ureteral reimplantation have been described for different indications. After a retrospective study concerning 109 cases and 178 ureteral reimplantations, the authors propose the selective indications for each technique noting the most important results. The indications for reimplantations are numerous and varied: enterocystoplasty (60 cases), iatrogenic lesion of the pelvic ureter (11 cases), inflammatory stenosis (13 cases), renal transplantation (20 cases), primary megaureter (4 cases), stenosis of reimplantation (2 cases). 5 techniques were used in this study: Leduc-Camey, Leadbetter-Politano, Direct, Manchette, Lich-Gregoir. We conclude that in ureterodigestive reimplantation, Leduc-Camey modified method is indicated. In renal transplantation, Lich-Gregoir is the ideal technique. In primary megaureter, the Leadbetter-Politano procedure possibly with ureter modelling improves the results. In iatrogenic lesions of the pelvic ureter, Leadbetter-Politano technique and possibly a hitch-bladder gives a good result.

[Primary adenocarcinoma of the bladder: report of a case]. / L'adénocarcinome primitif de vessie: à propos d'un cas.

The authors a case of primary adenocarcinoma of the bladder and studied the clinical, histological, therapeutical and evolutive aspects of this unusual tumor. It is a rare neoplasm that occurs for less than 2% of all bladder tumors and it is more prevalent in males between 50 and 60 years. The symptoms, exepting mucusuria, are non-specific, and hematuria is by far the most frequent presenting symptom. Different etiologies have been theorized, but this tumor is generally thought to arise through transitional epithelial metaplasia. The diagnosis is based on the pathologic anatomy examination. The treatment still not codified, but all of the authors advocate early aggressive surgery. The prognosis is poor.

[Multiple bilateral renal hydatidosis. A case report]. / Hydatidose rénale bilatérale multiple. A propos d'un cas.

The authors report one case of multiple bilateral hydatid cyst of kidney associated to brain and spleen localizations, after intra cardiac rupture. They point out the rarity of the bilateral kidney localization of hydatidosis, explain the dissemination mode, and stress the role of computed tomography for the pre-operative diagnosis. The treatment is above all surgical and adapted to each case. The post-operative results are satisfying. Complementary medical treatment could be useful.

[Retroperitoneal liposarcoma. Two cases]. / Le liposarcome rétropéritonéal. A propos de deux cas.

Concerning two cases of liposarcomas developing in the retroperitoneal space, the characteristics of these rare tumors are reviewed. They are the most frequent mesenchymal tumors. Often, they are uncovered by palpable abdominal mass or when they compress adjoining organs. Computed tomography has proved valuable in the diagnosis of these lesions. Surgical removal is the treatment of choice. Recurrences are frequent and prognosis is poor.

[Obstructive anuria. Thirty cases]. / Anuries obstructives. A propos de 30 cas.

The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology.

[Percutaneous alcoholization of simple serous cysts of the kidney]. / Alcoolisation percutanée des kystes séreux simples du rein.

Benign renal cysts are usually asymptomatic: They require a minimally invasive treatment if they cause complaints such as flank pain or other compressive complications. During a 6 month period, 14 patients were treated for benign renal cyst using an ultrasound guided puncture. Presenting complaints were flank pain (12 cases), hypertension (1 case), polycythaemia (1 case). Only cyst of 5 centimeters diameter or more were assigned to this treatment. After needle puncture, the cyst was evacuated and then filled with sterile 95% alcohol. Clinical and anatomical results, after 6 months, were good in 9 cases, 2 cases showed good anatomical results with persistence of initial symptoms, and there were 3 failures corresponding to large cysts of 10 cm diameter or more. Percutaneous alcoholization of moderate benign cysts is a safe, simple and reliable method.