[Is intracavernosal corticosteroid infiltration really useless in Peyronie's disease?]. / L'infiltration intracaverneuse de corticoïdes est-elle réellement sans intérêt dans la maladie de Lapeyronie?

UNLABELLED: The value of intracavernosal corticosteroid infiltration remains controversial or may even be contraindicated in Peyronie's disease, as it is considered to be ineffective and a source of morbidity. OBJECTIVE: To retrospectively analyse the efficacy and safety of intracavernosal corticosteroid infiltration in a selected population only presenting clinical criteria of the acute phase of Peyronie's disease (pain and/or recent onset < 6 months). MATERIAL AND METHOD: Intracavernosal corticosteroid infiltration (weekly or twice-weekly) was performed in or around the plaque. Evaluation was based on clinical criteria according to the course of pain, the nodule and curvature and the rates of improvement, resolution, stabilization and deterioration of these criteria were studied. RESULTS: In a series of 271 patients, 123 presented criteria of the acute phase of Peyronie's disease. Forty five of these patients were treated exclusively by intracavernosal corticosteroid infiltration. The mean age was 52 +/- 8 years. The number of intracavernosal infiltrations was usually less than 10 (n = 40) with less than 8 injections in the majority of patients (n = 36). Follow-up was 6 months. There were no cases of clinical deterioration. The best results were observed on pain, which decreased (13.6%) or totally resolved (61.4%). Curvature was decreased (20.5%), the plaque decreased (25%) or disappeared (9%). When intracavernosal corticosteroid infiltration is ineffective, it appears useless to administer more than 3 injections. No morbidity was observed. CONCLUSION: In our population, the reputation of inefficacy and morbidity of local corticosteroid therapy appears to be unjustified. There were no cases of deterioration, but, on the contrary, stabilization and especially very marked and rapid efficacy on pain, but a lesser efficacy on curvature and plaque. Local steroid therapy appears justified during the acute phase, as the injection allows corticosteroids to exert their anti-inflammatory action in situ in line with the pathophysiology of the disease. A standardized, multicentre, prospective, randomized, placebo-controlled study could confirm our impressions.

Long-term results of transperitoneal laparoscopic fenestration in the treatment of simple renal cysts.

The aim of this paper was to assess long-term results of transperitoneal laparoscopic fenestration in the treatment of symptomatic simple renal cysts. Fifteen consecutive patients (7 men, 8 women), with a mean age of 51 years (range, 36-79 years), underwent transperitoneal fenestration of simple renal cysts (SRC) at our institution from 1994 to 2001. Data were collected by reviewing patients' clinical files, conducting telephone interviews regarding symptoms, and followup renal ultrasonography (US). There were 15 symptomatic cysts (10 parenchymal, 5 peripelvic) ranging in diameter from 3.5 to 20 cm (mean, 8 cm). All patients had lumbar pain and in four (26.6%) the collecting system was compressed by the cysts. Fenestration was carried out laparoscopically in all patients. There was no mortality and no postoperative complications were recorded. No malignancies were detected at final histopathology. Mean length of stay was 2.5 days. All patients were available for long-term followup. At a mean of 60 months (range, 22-93 months) from surgery, three patients (20%) complained of slight discomfort in the lumbar area not requiring any analgesic. No recurrence of the cysts was seen on US. Two asymptomatic patients (13.3%) developed additional cysts originating from sites different than the one operated on. Laparoscopic fenestration of SRC is safe and effective in the long term to relieve patients from symptoms.

[Efficacy of extracorporeal lithotripsy in acute renal colic: prospective study about 57 consecutive patients]. / Efficacité de la lithotritie extra-corporelle dans la phase aiguë de la colique néphrétique. Etude sur 57 patients consécutifs.

INTRODUCTION: This study was designed to evaluate the efficacy of ESWL in the management of acute renal colic. MATERIAL AND METHOD: From January 2003 to August 2003, 102 patients were hospitalised for renal colic. We treated 57 patients by ESWL using an EDAP LT 02 apparatus. Successful treatment was defined by stone fragmentation on the plain abdominal x-ray at 24 hours associated with resolution of pain after only one ESWL session. RESULTS: The overall complete success rate after only one ESWL session was 49%. Results according to site: UPJ stones: 46% of success, lumbar ureter: 14%, iliac ureter: 33%, pelvic ureter: 66%. According to size: < 5 mm: 57% of success, 6 to 10 mm: 70%, 11 to 15 mm: 27%, > 15 mm: 0%. No difference in success rate was observed according to the cumulative energy delivered or according to the duration of ESWL sessions. CONCLUSION: ESWL can be considered to be a first-line treatment for acute renal colic. Its best indications correspond to pelvic or UPJ stones less than 10 mm in diameter. We believe that it is useless to exceed a duration of 30 min per ESWL session at a frequency of to 2 Hz.

[Persistent hematuria after embolization for hemorrhagic complication following percutaneous nephrolithotomy: value of the study of red blood cell volume in urine]. / Hématurie persistante après embolisation pour complication hémorragique d'une néphrolitotomie percutanée: intérêt de l'étude du volume des globules rouges dans les urines.

Percutaneous nephrolithotomy is associated with a high risk of complications, particularly bleeding, which makes it a potentially invasive technique. Management of haemorrhagic complications sometimes requires the use of embolization. Recurrence after embolization can occur as a result of revascularization or recanalization of vessels, but post-embolization infarction can also lead to persistent haematuria. The authors report the clinical case of a 36-year-old patient presenting with recurrence of severe haematuria after two successive highly selective embolizations. Analysis of the mean corpuscular volume of red cells in the urine confirmed the parenchymal and non-vascular origin of the bleeding, corresponding to a post-embolization syndrome. This analysis therefore constitutes a simple way to avoid repeated embolization or surgical exploration.

[Value of laser ureteroscopy with semi-rigid ureteroscope in the treatment of stones less than 2 cm situated above the iliac vessels : Report of a retrospective series of 460 consecutive cases]. / L'urétéro-rénoscopie laser dans le traitement des calculs de moins de 2 cm situés au-dessus des vaisseaux iliaques: à propos de 460 cas consécutifs.

OBJECTIVE: To evaluate the value of retrograde ureteroscopy in the treatment of stones less than 2 cm situated above the iliac artery. MATERIAL AND METHOD: Between September 1989 and December 1998, 460 consecutive patients, aged 14 to 86 years, presenting with stones situated above the iliac vessels and measuring less than 2 cm were initially managed by fine (7.5 F) semi-rigid ureteroscopy with CANDELA laser fragmentation in the majority of cases. All operations were performed under general anaesthesia with continuous muscle relaxation. The operation was performed by the same operator in every case. In 50 cases (10.65%), a complementary extracorporeal lithotripsy session was performed following the operation and in 13 cases (2.82%) a second ureteroscopy was necessary. RESULTS: 352 patients (76.5%) were free of any residual fragments after a single laser ureteroscopy session. 415 patients (90.21%) were free of any stone fragments at the 3rd postoperative month. Complications consisted of 28 cases of ureteric perforations, which were all cured by double J stenting, and 7 cases of minor haematuria during the operation. No long-term complication was observed. CONCLUSION: Ureteroscopy with laser lithotripsy using a fine, semi-rigid instrument, is a reliable technique to treat stones situated above the iliac vessels, provided appropriate anaesthesia and continuous muscle relaxation are ensured. This procedure is associated with a low morbidity and therefore constitutes an effective alternative in the case of failure of ESWL for the treatment of stones less than 2 cm situated above the iliac vessels.

[TVT: prospective study comparing pre- and postoperative clinical, urodynamic and quality of life criteria]. / La bandelette TVT: étude prospective comparant des critères cliniques, urodynamiques et de qualité de vie pré et post-opératoire.

INTRODUCTION: This prospective study on TVT compared preoperative and postoperative urodynamic in order to evaluate the effects of TVT on the detrusor-sphincter synergy, and quality of life criteria by means of a validated questionnaire. MATERIAL AND METHOD: From August 2000 to March 2002, the authors conducted a prospective study on two sites, Nice and Marseille, on 37 patients. The inclusion criteria were clinical and urodynamic. A questionnaire evaluating the severity of incontinence and its impact on daily life was completed preoperatively and postoperatively. Thirty TVTs were placed under local anaesthesia and seven TVTs were placed under general anaesthesia. Patients were reviewed at least 6 months (mean: 9 months; range: 6 to 19 months) after the operation. Statistical analysis was based on a test for paired series, patient by patient, with an a risk of 5%. RESULTS: Eight cases of unilateral bladder perforation (21.6%) were treated by catheterization for 48 hours and 6 cases of transient acute urinary retention (16.2%) were also treated by catheterization. No haemorrhagic or infectious complications were observed. Thirty one (83.7%) patients were completely cured of their incontinence, 5 (13.5%) were improved and there was one failure. Six (75%) of the 8 patients with a urethral closing pressure less than 30 cm H2O, 6 were cured and 2 (25%) obtained a marked improvement. All criteria were compared in the same patient preoperatively and postoperatively. The maximum flow rate on uroflowmetry was significantly lower postoperatively, but no difference was observed for preoperative and postoperative detrusor sensitivity, urodynamic bladder capacity or urethral closing pressure. No de novo detrusor instability was observed. Mean severity scores and impact of incontinence scores were much lower postoperatively. CONCLUSION: The efficacy of TVT does not appear to be correlated with the severity of sphincter incompetence and did not modify the detrusor-sphincter synergy of the patients of our study. The use of a questionnaire appears to be useful and should be recommended in order to more accurately evaluate the efficacy of the surgical procedure and the improvement of the patient's quality of life.