[Treatment of urethral strictures by endoscopic internal urethrotomy: anatomical and functional results in a series of 244 cases]

To evaluate the results of a homogeneous series of urethral strictures treated exclusively by endoscopic internal urethrotomy and to determine the factors that may predict the outcome. Between 1989 and 2007, 244 patients were treated for urethral stricture. All of them were subjected to endoscopic direct vision internal urethrotomy [DVIU]. 34.3% of good results were achieved after the first DVIU. Mean follow-up was 3.5 years. No mortality was encountered, while the rate of morbidity was.5%. Better results were achieved in patients with short [<2 cm] and single strictures in the proximal urethra. Mean post-operative catheterization was 2 days; a further extension of the catheterization time did not yield any significant improvement. Unsatisfactory results [65.5%] were found in patients with large urethral strictures located in the distal urethra or in elderly patients. 62.5% of the patients showed a satisfactory outcome after a second urethrotomy, while the other patients required urethral dilatation or urethroplasty. DVIU is a simple procedure which does not have a high rate of morbidity and requires short hospitalization. With a steady success rate of around 75.4% after a follow-up of 3.5 years we feel that DVIU can be recommended as treatment of choice for all short, single and proximal urethral strictures, preferably in young patients without previous interventions on the urethra

[Tumors of the male urethra. A study of 7 cases]

To study the epidemiological, diagnostic and therapeutic features of primary tumors of the male urethra. In this retrospective study we evaluate 7 cases with tumors of the male urethra seen at our department over a period of 16 years [1989 -2005]. The following parameters were studied: the age of the patients, their medial history, clinical signs and symptoms, imaging and treatment modalities used and follow up. The patients' mean age was 56.1 years. Medical history revealed episodes of urethritis in 4 cases and treatment of cervico-urethral strictures in 4 cases. All patients complained of chronic irritating and obstructive symptoms - most patients presented with more than one symptom. Acute urinary retention was found in 5, bleeding per urethram and pyuria in 5 cystourethrography and confirmed by urethrocystoscopy and biopsy. All our patients were found to have squamous cell carcinoma. The tumor was localized in 6 patients. Treatment consisted endoscopic transurethral resection in one patient. Two patients were subjected to surgery. One of them with a stage T3N0M0 tumor of the prostatic urethra underwent urethrectomy in combination with cystoprostatectomy followed by urinary diversion [Coffey], while the other patient with a tumor at the bulbomembranous urethra [stage T4N0M0 with scrotal invasion] was subjected to penectomy and orchidectomy combined with perineal urethrostomy. Both these patients received adjuvant radiotherapy. Excision of a penile phlegmon was carried out in 3 patients. In one of them a urethral stent was left indwelling, while two were subjected to cystostomy. Due to bilateral lymphatic invasion, the remaining patient received preoperative radiotherapy, but he died three months later due to lung metastases. None of our patients received chemotherapy. Mean follow up was 9.5 months. At the end of the follow-up period 3 patients [one treated endoscopically and the two patients that had been subjected to surgery] were disease-free, while one patients had died and the 3 remaining ones were lost to follow up. Despite the availability of a variety of treatment modalities, tumors of the male urethra still have a poor prognosis. Due to their rarity, it is difficult to properly evaluate the treatment options which mainly depend on the tumor stage and whether or not there is lymphatic invasion

[Genito-urinary tuberculosis inthe male, apropos of 22 cases]

An evaluation of the epidemiological, clinical, prognostic and therapeutic characteristics of male genito-urinary tuberculosis, complemented by review of the literature. We retrospectively studied 22 patients with confirmed genitor-urinary tuberculosis. The diagnosis was based on clinical, bacteriological, radiological and histological findings and radiological examination. The most common presenting symptom was chronic epididymitis [11 patients] followed by scrotal fistula [6 cases], obstructive uropathy [3 cases], hydrocele [6 cases] and infertility [1 case]. Clinical examination revealed epididymal nodules in 11 and hydrocele in 10 patients. Leucocyturia was found in one patient. Scrotal ultrasound demonstrated epididymal lesions in 8 cases. The definite diagnosis was based on histological examination of resected specimens [13 cases], biopsy specimens [8 cases] and on the discovery of the tubercle bacillus in the urine [1 case]. Intravenous urography, which was carried out routinely, detected associated urinary lesions in 5 cases. The follow-up was uneventful in all patients. The diagnosis of male isolated genitor-urinary tuberculosis is difficult in the absence of an endemic prevalence of tuberculosis. Any longstanding epididymo-orchitis should raise the suspicion of tuberculous etiology, especially in cases with hypofertility. Medical treatment has proven effective in early diagnosed cases, while surgery is reserved for resistant or complicated cases

[Buschke - Lowenstein tumor. A case report and review of the literature]

Buschke-Lowenstein tumor or giant condyloma acuminatum is a pseudo-tumoral verrucous lesion. It is a sexually transmitted disease caused by human papilloma virus [HPV] which carries the risk of local invasion and recurrence and malignant degeneration. Surgery remains the treatment of choice. We herein report the case of a 38-year-old man who presented with a fungating, cauliflower-like tumor affecting the genitor-perineal region. Complete resection of the tumor yielded a very satisfactory outcome and the patient was recurrence-free at follow-up one year after surgery

[Treatment of iatrogenic ureteral injuries. A propos of 24 cases]

To evaluate the diagnosis and treatment of 24 patients with ureteral injury at our institution. In this retrospective study we evaluated 24 patients [22 females and 2 males] with ureteral injury treated at our institution between June 1993 and June 2005. The average age was 41 years [range 22-65 years]. the majority of ureteral injuries occurred during gynecological surgery [22/24 cases = 92%]. The time elapsed between the ureteral injury and diagnosis was 5 months on average; only in one case [3.8%], the injury was discovered during surgery. Four patients were treated endoscopically while ureteroscopy and end-to-end anastomosis was applied in 5 and open surgery in 15 cases. End-to-end ureterorraphy with placement of a double-J catheter was necessary in one patient, where endoscopic treatment had failed. After an average follow-up period on 60 months, loin pain had resolved in all cases. On radiological evaluation, a residual uretero-pyelocalyceal hyptony was noted in 5 cases and a satisfactory ureteral passage without strictures in the others. No nephrectomy was necessary in this series. Ureteral injury is most often secondary to gynecological surgery. In the majority of cases endourologic repair is the treatment of choice. It is recommended to pass ureteral catheters pre-operatively in order to ease the repair of the injury

[Foreign bodies of the bladder [report of 4 cases]]

Foreign bodies of the bladder have been amply reported in the literature either describing their origin or the circumstances of insertion. Their presence may often be a consequence of questionable actions performed by mentally unstable persons, but it might also be due to an accidental insertion during transvesical medical procedures or to migration of the foreign body from the perivesical area during interventions on surrounding areas. The authors herein report four different kinds of vesical foreign bodies: a textiloma, a calculus formed on a non-absorbable suture filament attached to the bladder wall, migration of osteosynthetic material and migration of an intrauterine device

[Bilateral hemorrhagic renal angiomyolipoma. Case report and review of the literature]

Renal angiomyolipoma is a rare benign tumor representing 0.3% of renal tumors. In its bilateral from it is frequently part of a hereditary syndrome, such as tuberous sclerosis of Bourneville [TSB]. We report the case of a 32-year-old who has been followed up for TSB since 1995. In April 2004 she was hospitalized after several episodes of total hematuria with blood clots in the bladder causing severe exsanguination and the need for repeated blood transfusions. Serum creatinine was normal. Ultrasound and CT scan showed the presence of bilateral renal angiomyolipomas. The bleeding could be controlled by arterial embolization of the right kidney. One month later, the patient was admitted again with massive hematuria and hemorrhagic shock, and right nephrectomy was done to achieve hemostasis. The follow-up period of 24 months has been uneventful

[Delayed end-to-end anastomotic repair of post-traumatic posterior urethral rupture]

Objective: To analyse the long-term results of the treatment of post-traumatic posterior urethral rupture by delayed bulboprostatic anastomotic repair and to evaluate the efficacy and advantages of this technique

Patients and Methods: Between February 1989 and February 2004, 15 patients underwent delayed bulboprostatic anastomotic repair of post-traumatic posterior urethral ruptures. The results were evaluated taking into account the quality of micturition, continence and erectile function

Results: After an average follow-up period of 34 months [range: 12 - 72 months], all our 15 patients were continent and voided with a satisfactory flow. To achieve this result, 5 patients [33.3%] had to undergo internal ureterotomy. Only 4 patients [26.7%] reported erectile problems

Conclusion: Delayed bulboprostatic anastomotic repair remains the "gold standard" in the treatment of post-traumatic posterior urethral rupture. Compared to other methods of treatment of post-traumatic stenosis of the ureter, this technique allows for a long-term success with minimal complications

[Primary adenocarcinoma of the bladder. Observations on 7 cases]

Objective: The analysis of the etiopathologic, diagnostic and therapeutic aspects of the primary adenocarcinoma of the bladder

Patients and Methods: We report on a series of 7 cases of primary adenocarcinoma of the bladder out of a total of 564 cases of bladder tumors seen at our institution during a period of 14 years [1989-2003]. All 7 patients with primary adenocarcinoma of the bladder presented with gross hematuria. Treatment consisted of chemotherapy using 5-fluorouracil [5-FU] in 3 cases where the tumor was locally advanced or metastatic; radical cystectomy with bilateral pelvic lymph node dissection and urinary diversion in 2 cases where the tumor was located in the bladder neck and trigone; partial cystectomy with pelvic lymph node dissection and bladder augmentation ileoplasty followed by an adjuvant chemotherapy in one case where the tumor was located at the dome of the bladder, and transurethral bladder resection followed by a chemotherapy with intravesical instillation of mitomycin-C in the remaining patient with superficial lesions. Follow-up ranged from 6 months to 15 years with a mean follow-up of 93 months

Results: The two patients treated by radical cystectomy had no recurrence after 12 months, while the patient treated by transurethral resection followed by intravesical instillation of mitomycin-C was free of disease 15 years after the intervention. The patient treated by partial cystectomy did not show any local recurrence after 10 months. Among the patients treated by chemotherapy [5-FU], a partial response was achieved in two with a mean survival of 12 months, while the remaining patient died within 6 months from treatment

Conclusion: Adenocarcinoma of the bladder is often diagnosed late. No consensus on therapy has been achieved so far. Radical cystectomy remains the gold standard for organ-confined tumors. Superficial lesions are very rare and may be treated conservatively

[ treatment of urinary stones by extracorporeal shock wave lithotripsy]

Until the beginning of the eighties, the surgery was the only way to extract calculi localized in the kidney or the ureter. The extra-corporeal lithotripsy, who allow fragmentation of calculi by shock waves, was the most important discover. Nowadays it is the most useful method for the treatment of calculi. This field knows an important development with the appearance of new machines more and more performant. The objective of this study is to evaluate the clinical results after one year's experience with a new generation lithotriptor the lithostar multiline tm [siemens]. The authors treated 147 patients ages between the ages of 8 and 73 years, presenting with renal stones in 67.23% of cases,ureteral stones in 31,07% of cases and bladder stones in 1,69% in cases.The mean stone diameter was 14mm [3-34mm]. An average of 3846 [range 1500-6000] shock waves were applied with a mean energy level of 4.29 [range 1.5-7]. The success rate was 62% for the renal stones,82% for lumbar ureter and 60,7% for the pelvic stones.the morbidity was low [10% of renal colic, 5% of obstructive stone and 1.4% of pyelonephritis]. The [siemens] multiline tm lithostar is a new generation lithotriptor, efficient and with a low morbidity.These data indicates the limits of the efficacy nature of a modem lithotriptor for the pelvic stones

use of isolated sigmoid colon segment for vaginal replacement in young adults

Objectives: Vaginoplasty for congenital atresia, a component of the Mayer-Rokitansky Kuster syndrome, or for gender confirmation may be achieved by several techniques. This report focuses· on the efficacy of rectosigmoid neocolporrhaphy [RSNC] for primary vaginal replacement

Patients and Methods: From 1990 to 2002 we evaluated six patients 16 to 33 years old [average age 23 years] who required vaginal replacement. The diagnosis included the Mayer-Rokitansky syndrome in two cases, classic bladder exstrophy in one and male pseudohermaphrodism in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and the rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients

Results: A minimum of one year follow-up [mean: 32 months] was available in 5/6 patients. The patients treated with sigmoid vaginoplasty had a functional neovagina with excellent cosmetic results and without excessive mucus production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In two patients managed by nonoperative perineal self-dilation, little success could be noted, and they became candidates for surgery

Conclusion: Our limited experience with this group of patients leads us to believe that the isolated sigmoid segment provides a self-lubricating neovagina with a low rate of failure and revision, with very good cosmetic results and without the need for routine dilation

[Primitive cancer of the urethra]

Objective: We report six cases of primitive cancer of the urethra out of a total of 1109 cases of urologic cancers hospitalized during a period of 12 years

Patients and Methods: From 1990 to 2001 six patients [four males, two females] were hospitalized for cancer of the urethra. The tumors were analyzed according to the classification of Grabstald. All the patients were explored by retrograde urethrocystography showing an irregular image of the urethra and at times opacifying the sinus ways. Urethrocystoscopy showed the site of the tumor and its aspect and allowed for diagnostic biopsies. In five cases it revealed an epidermoid cancer and an adenocarcinoma in one case. The treatment used depended on the stage of the disease and the general condition of the patients. Two patients underwent radical pelvectomy without any adjuvant treatment. Two patients with disseminated disease received palliative treatment by radiotherapy. The two remaining patients having refused surgical treatment were also treated by radiotherapy alone

Results: Overall, the average rate of survival was 17.5 months [3 to 60 months]. The best results were achieved with surgical treatment. Two of the patients referred to the oncologist for palliative radiotherapy died within 3 and 6 months, respectively. One patient treated by radiotherapy alone after having refused surgical treatment presented 6 months later with a long post-radiation stenosis of the urethra. Since the patient still refused surgical treatment, he was treated by final cystostomy. The last patient also treated by exclusive radiotherapy is being followed up by the radiologists

Conclusion: Primitive cancer of the urethra is rare. Its semiology is not very specific which explains the frequently delayed diagnosis. It is the meticulous examination of the urethra which allows the diagnosis. The treatment of choice is surgery and/or radiotherapy

Endoscopic treatment of vesico-ureteral reflux by injection of fat: report on 2 cases

The authors report 2 cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of fat. We describe the technique of fat harvesting and injection. The immediate results confirm the efficacy of this procedure. The long-term follow-up will allow us to adopt it and to add modifications, if necessary