[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

Les contusions des bourses et de leur contenu: a propos de 30 cas

The authors report 30 scrotal contusions; the lesions they discovered [hematoceles, recent trauma of the testis. scrotal or calcified hematoma ..] showed that it is better to operate all contusions of the scrotum. They emphasize the interest of ultra sound exploration of the testis