[Sacral neuromodulation with InterStim™ system: Results from the French national register]. / Neuromodulation sacrée avec le système InterStim™ : résultats du registre national français.

AIM: To analyse current practice patterns and to evaluate (long-term) effectiveness and adverse events of sacral neuromodulation with InterStim™ Therapy based on data collected in a national register and to discuss the strengths and weaknesses of the register. PATIENTS AND METHODS: This is a French multicenter prospective observational trial including patients with a permanent implant (2003-2009). Voiding diary variables and patient satisfaction were analysed based on last follow-up visit since implantation. RESULTS: One thousand four hundred and eighteen patients (median age: 63 years, 1206 females) were included in the database (median follow-up: 12 months). One thousand and eighty-nine patients had non-neurological disease. The principal diagnosis was overactive bladder syndrome ([OAB], n=1170) and retention (n=151). Implantation occurred in 1358 patients; 1172 patients had greater than or equal to one registered follow-up. Clinical improvement of greater than or equal to 50% was seen in 447/527 patients with OAB at 12 months follow-up (median number of voids per 24 hours decreased from 15 at baseline to 8 at 12 months) and in 42/54 of patients with retention (median number of catheterization per 24 hours dropped from 5 at baseline to 0 at 12 months). Clinical improvement remained relatively stable up to 60 months. Median patient satisfaction with treatment was between 60 and 80%. Five hundred and twenty-four patients had at least one adverse event; loss of efficacy (n=244) occurred most frequently. CONCLUSIONS: In this large database sacral neuromodulation with InterStim™ Therapy seems to be an effective treatment through routine practice in the long-term (up to 60 months) for patients refractory to medical treatment.

[Value of the Goebbel-Stoeckel operation in the treatment of neurogenic bladder in girls]. / Intérêt de l'opération de Goebbel-Stoeckel dans le traitement des vessies neurogènes chez la fille.

Repeated catheterisation and drugs with a pharmacodynamic action are not always able to ensure perfect continence in children with meningomyeloceles. To treat uncontrollable incontinence, the authors propose an aponeurotic suspension of the bladder neck as described by Goebbel-Stoeckel in order to increase the peripheral resistance. At the same time, sufficient bladder compliance can also be obtained either by means of pharmacodynamic treatment or by enlargement enterocystoplasty. The aim is to obtain catheterisation every 4 to 6 hours without any incontinence. Young girls constitute the ideal indication for this programme as catheterisation is safe and easily accepted. Ten girls underwent Goebbel-Stoeckel operation, associated with sigmoido-cystoplasty in 6 cases. Eight of these girls are now perfectly continent with a normal social life, including one case with a follow-up of 12 years and a pregnancy. The authors stress the need, in cases of enterocystoplasty, to resect almost all of the pathological detrusor and to use the caecum rather than the hypertonic sigmoid.

[Urologic surgery in prone position using an antistatic fitted mattress]. / Chirurgie urologique en position ventrale sur matelas moulant antistatique.

The prone position is often used in urologic surgery: posterior approach for pyeloureteral procedures, repair of vesicovaginal fistulas... Positioning of the patient and intraoperative ventilation are facilitated by use of an antistatic, fitted mattress.

[Pyeloureteral duplications in the adult: diagnostic means and therapeutic indications. Apropos of 20 cases]. / Duplicités pyélo-urétérales de l'adulte: moyens diagnostiques et indications thérapeutiques.

Complicated pyelo-ureteral duplication in the adult may be revealed by recurrent pyelonephritis or urinary leakage. The diagnosis can be performed by combined urography and ultrasound scan. The management is rarely conservative. In most cases, it consists in hemonephrectomy. The ureterectomy is partial, extending up to the pelvic brim in the case of a fine ureter. If the ureter is dilated, however, the ureterectomy must be subtotal, in order to avoid postoperative infectious recurrence.

[Post-anastomotic stenosis in atresia of the esophagus. Study apropos of 23 cases]. / Sténoses post-anastomotiques dans les atrésies de l'oesophage. Etude à propos de 23 cas.

Between 1977 and 1984, a total of 23 patients with post-anastomotic stenosis after surgery for esophageal atresia were treated conjointly by the ORL and digestive surgery departments of Hôpital Trousseau, France. Most cases were type III atresias treated by direct anastomosis, favoring factors for stenosis being gastro-esophageal reflux, post-anastomotic fistula and the surgical act. Stenosis usually develops early, provokes only moderately severe symptomatology and requires treatment by dilatation mainly, in association with anti-reflux medication. Prognosis was usually good in the 23 cases reported, 21 being able to take food normally. Surgery should be reserved for cases with severe reflux and for those with persistent stenosis.

[Polycystic renal dysplasia in children]. / La dysplasie rénale multikystique chez l'enfant.

Ultrasonography has profoundly modified the diagnostic conditions of polycystic renal dysplasia in children. Non-palpable forms, which were previously most frequently missed, can now be detected during the antenatal period. In infants, ultrasonography generally provides a definite diagnosis, which can be confirmed by aspiration-opacification of the cysts. On the basis of a series of 40 cases and a review of the literature, the authors discuss the therapeutic implications of these new data. Surgery remains essential in cases of palpable polycystic renal dysplasia, especially when it is complicated. However, in the sub-clinical forms, as the risks of malignant degeneration and the incidence of post-operative complications are minimal in the one case and undefinable in the other, surgical excision is possible but not essential.

[Urethral fistula following reconstructive surgery of hypospadias. Apropos of 34 cases]. / Fistules urétrales après chirurgie réparatrice pour hypospadias. A propos de trente-quatre cas.

Thirty-four children, ten of them coming from another Surgical Center, underwent repair for urethral fistula after hypospadias reconstructive surgery, over a period of three years (1985-1987). After the first operation, there was no recurrence in 59% (20 cases). Currently, all fistulas have been closed, except in 3 cases. Closure by direct suture was used in 30 cases (88%). The best results were observed with suture in three planes and without diversion, on an outpatient basis (91% of success for 12 cases). The Leveuf method is a safe operation for complex penile fistulas after repeated surgery.

[Percutaneous nephrolithotomy in 1984. Technics, results, indications]. / La néphrolithotomie percutanée en 1984. Techniques, résultats, indications.

Percutaneous nephrolithotomy - PCNL - was made possible by technological progress, with the introduction of nephroscopes, lithotomy forceps, and mechanical, ultrasonic or electrohydraulic lithotriptors. The procedure includes four stages. First needle puncture of the inferior or middle calyx. Secondly, dilatation of the pathway and creation of a tunnel. Thirdly, investigation of the collecting system. And, finally, extraction of the stone. The results of 302 published cases show a success rate of 87 per cent, a complete failure rate of 13 per cent, and residual stones in 10 per cent of cases. The complication rate is 7 per cent, with hemorrhage and sepsis in roughly equal proportions. A few other complications are occasionally reported, such as colic wounds, perirenal collections, traumas of the ureteropelvic junction, pneumothorax, or a stone left in the lumbar wall. There was one case of death. The hospitalization period is the same as for lombotomy, but the return to work is more rapid. The best indications are pelvic and inferior calyceal stones (with a success rate of over 80 per cent). Despite their enthusiasm for this procedure, the authors feel that is still remains to be seen or whether it will in turn be superseded by ultrasound lithotripsy.

Adsorption kinetics of laterally and polarly flagellated Vibrio.

The adsorption of laterally and polarly flagellated bacteria to chitin was measured, and from the data obtained, a modified Langmuir adsorption isotherm was derived. Results indicated that the adsorption of laterally flagellated Vibrio parahaemolyticus follows the Langmuir adsorption isotherm, a type of adsorption referred to as surface saturation kinetics, when conditions are favorable for the production of lateral flagella. When conditions were not favorable for the production of lateral flagella, bacterial adsorption did not follow the Langmuir adsorption isotherm; instead, proportional adsorption kinetics were observed. The adsorption of some polarly flagellated bacteria exhibited surface saturation kinetics. However, the binding index (the product of the number of binding sites and bacterial affinity to the surface) of polarly flagellated bacteria differed significantly from that of laterally flagellated bacteria, suggesting that polarly flagellated bacteria adsorb to chitin by a different mechanism from that used by the laterally flagellated bacteria. From the results of dual-label adsorption competition experiments, in which polarly flagellated V. cholerae competed with increasing concentrations of laterally flagellated V. parahaemolyticus, it was observed that laterally flagellated bacteria inhibited the adsorption of polarly flagellated bacteria. In contrast, polarly flagellated bacteria enhanced the adsorption of V. cholerae. In competition experiments, where V. parahaemolyticus competed against increasing concentrations of other bacteria, polarly flagellated bacteria enhanced V. parahaemolyticus adsorption significantly, whereas laterally flagellated bacteria only slightly enhanced the process. The direct correlation observed between surface saturation kinetics, the production of lateral flagella, and the ability of laterally flagellated bacteria to inhibit the adsorption of polarly flagellated bacteria suggests that lateral flagella represent a component of bacterial structure that is important in the adsorption of laterally flagellated bacteria to surfaces. A model for adsorption events of laterally flagellated bacteria is proposed, based on the evidence presented.

Scanning electron microscope observation of the swarming phenomenon of Vibrio parahaemolyticus.

Scanning electron microscopy was used to study the production of lateral flagella and the swarming phenomenon in Vibrio parahaemolyticus. Differences in the size and diameter of the sheathed, polar flagellum and lateral flagella were apparent in these preparations. Swarming of V. parahaemolyticus was found to be similar to the swarming of Proteus spp. in that swarm cells which are heavily flagellated and elongated are formed.

[Urodynamic study of the behavior of detubulated ileocystoplasties according to feeding]. / Etude urodynamique du comportement des iléocystoplasties détubulées en fonction de l'alimentation.

Twenty-three patients having undergone enterocystoplasty with a detubulated graft has an urodynamic study on an empty stomach and after a standardized meal. All patients (average age 62.9 years) had been operated more than 6 months earlier, and 30% still presented with urine leakages at night. The urodynamic study included a cystomanometric measurement with rapid water filling, an urethral profile and a micturating cystography. It was repeated 60 to 90 minutes after a meal composed of glucids, lipids and protids. Feeding had variable effects on the intestinal graft: increase in peristaltic intensity and/or earlier onset of contractions (10/23); apparently paradoxical decrease in contractions (6/23); sometimes no modification (7/23). This short work without any obvious physiopathological explanation has led us to advocating breaking up feeding for patients who were improved by the meals.

[Obstruction after uretero-vesical reimplantation in children. Apropos of 40 cases]. / Obstacle après réimplantation urétéro-vésicale chez l'enfant. A propos de 40 cas.

Fourteen cases of obstruction after ureteroneocystostomy in children have been cured by surgery between 1972 and 1986; nine patients were referred from outside our hospital. This failure as been observed after reimplantation of simple thin ureter (29 cases) megaureter (7) or duplication (4). The diversity of lesions, of which 52 percent were ischemic stenosis, required surgery without any preconceived idea. A new reimplantation is often necessary, usually with Politano-Leadbetter procedure, and, if necessary, with a hitch-bladder. The operation is successful in 85 percent of patients, but the result is uncertain when the operation is late or when the value of renal parenchymal is initially poor.

Bladder tumors invading the lamina propria (stage A/T1): influence of endovesical bacillus Calmette-Guérin therapy on recurrence and progression.

47 patients with transitional cell bladder carcinoma invading the lamina propria (stage A/T1) were treated from 1984 to 1986 by complete transurethral resection followed by 1-3 cycles of endovesical bacillus Calmette-Guérin instillations, and followed 14-64 months by cytology, endoscopy and bladder biopsies, 64% achieved a complete response, 36% recurred (recurrence rate/100 months/patient 2.2), 21% progressed to muscle invasion. Duration of treatment, tumor size or type (solid vs. papillary), presence of carcinoma in situ bore no relation to the final result. The preceding history of T1 bladder tumor appeared associated with a higher risk of progression although not reaching statistical significance. The results were compared to those obtained by transurethral resection in a similar group of 50 patients treated from 1982 to 1984 and followed up 12-100 months, 90% recurred and 34% progressed to muscle invasion with a recurrence rate/100 months/patient of 9.22. Keeping in mind the limits of a nonrandomized historical comparison, it appears that endovesical bacillus Calmette-Guérin therapy alters favorably the recurrence pattern of T1 bladder cancer.

[Treatment of urinary stress incontinence in women by percutaneous cervico-cystopexy. Gitte's operation: contribution of intraoperative ultrasonography. Apropos of 47 patients]. / Traitement de l'incontinence urinaire d'effort de la femme par cervicocystopexie percutanée. Intervention de Gittes: apport de l'échographie per-opératoire. A propos de 47 patientes.

Between March 1988 and February 1991, 47 patients with urinary stress incontinence (USI) were treated by Gittes' operation, suspension thread traction being determined by perioperative ultrasonography in 31 of these cases. All patients were re-examined on February 1992 after a mean follow-up of 26 months (range 12 to 24 mths). The global success rate (recovery and improvement) was assessed as 72% at 3 months and 56% at follow-up. Rated as a function of closure pressure (CP), the success rate at evaluation was 62% with normal CP, 42% with CP low for age, and 33% with CP < 30 cm H20. For the 31 patients with perioperative ultrasonography examination the success rate was 80% at 3 months and 70% at follow up. As a function of CP the rate was 83% at follow up with a normal CP, 50% with a CP low for age, 37.5% with a CP < 30 cm H20. Although Gittes' operation is a simple, fairly non-aggressive intervention, results diverge widely from those obtained with "classical" techniques. Optimization of indications is essential, therefore, only patients with pure USI without hypotonia of the sphincter obtaining maximum benefit from the intervention, carried out preferably under perioperative by control ultrasonography.

[Ureteropelvic junction syndromes: antenatal diagnosis]. / Les syndromes de la jonction pyélo-urétérale de diagnostic anté-natal.

Seventy-four hydronephrosis by uretero-pelvic obstruction, discovered by antenatal real-time ultrasound, have been managed on sixty-one children. Three groups, with a specific management, are distinguished. The minimal forms have been only watched over (15 cases). The average forms have been operated (49 cases); considering the results (3 immediate complications and 2 early stenoses), it seems better to wait for 4 months to operate and to place a drain in renal cavities. In major forms (silent kidney on IVP), the diagnosis and therapeutic management use the percutaneous nephrostomy (10 cases). The interest of antenatal diagnosis of uretero-pelvic obstructions is to allow to operate, not only before the renal deterioration emphasizes, but principally before septic complications.

[Treatment,in girls, of ectopic ureters, due to duplication, using reimplantation of the single pathological ureter into the bladder]. / Traitement chez la fille des uretères ectopiques sur duplication par réimplantation dans la vessie du seul uretère pathologique.

Mostly the ectopic ureter belongs to the upper pole in urinary tract duplications. In the pelvis, the two ureters are clearly separated. The only dissection of the ectopic ureter is in no case dangerous for the ureter of the lower pole. Therefore the reimplantation of the ectopic ureter can be performed separately. This only reimplantation of the ectopic ureter has been performed 9 times, without any mortality nor morbidity. The scar is almost invisible and the child is cured without any risk for the upper pole and saving the whole of the renal parenchyma. If the upper pole is functional, which happened in 1/4 of the cases, this technique is the best way and the less dangerous to recovery.

[Partial splenectomy for epidermoid cysts of the spleen in children. Apropos of 3 cases]. / La splénectomie partielle dans les kystes épidermoïdes de la rate chez l'enfant. A propos de trois cas.

Three cases of epidermoid cyst of the spleen treated by partial splenectomy are reported on children. The diagnosis rests now on the ultrasonography. The operative indication is systematic because of the risks of complication. The polar localisation of the cysts permits one to make a conservative surgery. The partial splenectomy is a technique of choice in this benign tumoral pathology. Postoperative digital intravenous subtraction angiography demonstrated the good vascularization of the remaining part of the spleen.

Ecology and taxonomy of bacteria attaching to wood surfaces in a tropical harbor.

Water, sediment, and wooden pilings, samples of which were collected from a harbor in Puerto Rico during the course of a long-term study of biofouling of wood treated with creosote and related compounds, were found to support growth of microbial populations, the dominant taxa of which included Hyphomicrobium, Hyphomonas, Pseudomonas, Vibrio, and Bacillus. New wood exposed to the harbor water was rapidly colonized by Hyphomicrobium vulgare. Old pilings in an advanced stage of biodeterioration maintained a diverse bacterial microflora, representatives of which were also found widely distributed in the water column and sediment. Evidence for bacterial species succession was obtained, indicating that microbial interactions are important for attachment to, and subsequent colonization of, wood surfaces in the marine environment.

Clinical experience with a new pulsed dye laser for ureteral stone lithotripsy.

We treated 45 patients (46 ureteral stones) with a new pulsed dye laser. A 250 mu. fiber was used through a rigid (40 stones) or flexible (6) ureteroscope. Stones were in the upper (5 cases), middle (5) or lower (36) third of the ureter. Stone composition was calcium oxalate dihydrate (34 patients) or monohydrate (7), struvite (2) or uric acid (2). Of the calculi 36 (78%) were fragmented, including 14 that also required simultaneous basket removal of fragments. Ten stones were not fragmented: 6 because of the pure monohydrate composition and 4 due to malfunction of the laser. No damage to the ureteral wall was noted. Retrograde rigid ureteroscopy with laser lithotripsy was effective for lower and middle third ureteral stones. Flexible ureteroscopy with laser lithotripsy was effective (impacted stones) but difficult for upper third ureteral stones.

Laser lithotripsy of ureteral calculi: initial experience with a new pulsed dye laser.

Thirty-two patients with ureteral calculi ranging in size from 5 x 5 to 12 x 18 mm underwent lithotripsy with a new pulsed dye laser (Pulsolith, TMI). In 24 cases, the patients were entirely free of stones following laser lithotripsy alone, or with adjunctive stone basket removal. There were three instances of equipment failure and five calcium oxalate monohydrate stones that did not respond to laser energy.