[Extravesical antirefluxplasty (author's transl)]. / Die extravesikale Antirefluxplastik.

The indications and the detailed technique of extravesical antirefluxplasty are presented. Realized on 409 ureters (247 cases), extravesical antirefluxplasty has been successful in 95% of these cases. The failures, i.e., obstructions (1,5%) and persistent reflux (3%), are analized.

[The physiopathology of vesicoureteral reflux (author's transl)]. / Die Physiopathologie des primären vesikoureteralen Refluxes.

The tightness of the ureterovesical junction depends on all the structures composing the terminal and intra-mural ureter. The muscular, collagenic, and elastic fibers of the ureter constitute a mesh net which is stretched during bladder distention and closes the ureteric orifice as a valve. Congenital vesico-ureteric reflux results from a primary structural insufficiency of the terminal ureter or insufficiency of the bladder wall backing. As embryology shows primary reflux can be caused by a high ectopic implantation of the ureter. It results from the development of an ureteric bud appearing in a lower than normal position on the Wolffian duct. This results in a higher and more lateral opening of the ureteric orifice in the bladder which leads to a shorter intra-mural tunnel predisposing it to reflux. Secondary or acquired refluxes are associated with chronic obstructions (i.e. neurogenic bladder--lower urinary tract obstruction), and inflammatory lesions. Their pathogeneses are described and discussed. The maturation of the ureterovesical junction is considered a mechanism involving a reduced likelihood of secondary reflux. It may also, during the first years of life, palliate some minimal structural deficiencies of the intra-mural ureter, but growth and development are unlikely to normalize an ureter presenting at birth with a severe constitutional anomaly.

[Prostate hypertrophy. Surgical experience in Belgium. Multi-center study of 1,140 patients of 80 years and older]. / Prostaathypertrofie. Chirurgische ervaring in België. Multicenter studie over 1.140 patiënten 80 jaar en ouder.

An inquiry organized by the Belgian Society of Surgery brought data on the mortality and morbidity of surgery on patients of 80 years and older for benign prostatic hypertrophy in a total number of 1,140 operations. Consensus exist to see this surgery as planned surgery. The mortality was 73 (6.3%) without statistical difference between endoscopic and open surgery. The morbidity of 824 patients was 165. This last figure relates to the big series in the literature. The mortality is in direct relation to the age of the patients. Evaluation of cardio-pulmonary risk (70.8% of the mortality), operation on indication at earlier diagnosis and prospective studies on the risk of operation in this population group are indicated.

[Late urological complications of reconstructive surgery of the aortic bifurcation (author's transl)]. / Les complications urologiques tardives de la chirurgie reconstructrice du carrefour aortique.

Ureteral obstruction following aorto-iliac or aorto-femoral dacron prosthesis has rarely been described. It seems, however, as shown in our three cases, that this complication is more common than was previously believed. In all three cases, ureteral obstruction was attributed to retroperitoneal fibrosis enclosing the graft. The threat of such a complication should lead the surgeon to carry out intravenous urography in all patients with a vascular prosthesis.

The trigonointestinal implantations.

The author reports the indications, operative technique and long-term results of trigonosigmoidostomy in 26 cases of bladder exstrophy. The long-term results were considered as excellent in 20 cases, satisfactory in 4 and bad in 2. Even after a long period of up to 20 years, the function of the ureterotrigonal junction remains intact and ascending pyelonephritis does not occur. Social life is normal and sexual function is possible. In cases when internal diversion is counterindicated, the trigone can be successfully implanted into an isolated loop of the ileum or colon.

Haemostatic prostatic adenomectomy.

1,500 cases of retropubic adenomectomy with preventive ligation of the prostatic arterial pedicles and trigonisation of the posterior urethra are presented. The technical details are described. The mortality rate is 0.7%. One of the most frequent complications is pulmonary embolus, lethal in only 0.3% of the cases. In moderate and large adenomas, by the efficiency of haemostatic control and the quality of the late results, the procedure has given more satisfaction than other types of surgical or endoscopic adenomectomies.

The avascular nephrotomy.

A simple and innocuous method for colouring the renal cortex is proposed. It makes visible, during the operation, the line of demarcation between different arterial areas and allows the performance of nephrotomies with minimal trauma to the renal parenchyma and a minimum of subsequent renal destruction by ischaemia. It is indicated as a complement to renal hypothermia, for the removal of complicated and extensive lithiasis; it can also be helpful in easier cases when hypothermia in not required.

Uretic obstruction secondary to aortic femoral bypass graft.

Ureteric obstruction after aortic femoral bypass grafting is reported in 2 cases. This complication may occur more frequently than is suspected. In these 2 cases the ureter lay in its normal position in front of the graft whilst in most reported cases the ureter was passing behind the graft. Treatment is discussed.