[Sclerotherapy of idiopatic hydrocele with polidocanol: a study about 190 cases]

To evaluate the efficacy and side-effects of Polidocanol used as sclerosing agent for testicular hydrocele. One hundred and ninety men, with a median age of 55,9 years [40-89], treated for idiopatic hydrocele were assessed. After puncture and aspiration, the empty sac was instilled with 3% Polidocanol. We recorded recurrence, complications and associated pain on a visual analogue scale. With a median follow-up of 19 months, The cure rate of hydroceles after one sclerotherapy session was 62,1%, and the overall cure rate using the procedure was 82,6%. Re-instillation was done for recurrences in 41% of patients. Polidocanol therapy was almost pain-free. A low rate of complications was observed. Polidocanol is a useful sclerosing agent for treating testicular hydrocele. Due to its ease of administration, low frequency of complications, high rate of effectiveness, and excellent tolerability; we recommend sclerotherapy with polidocanol as the primary treatment for hydroceles

[Renal colic in pregnancy and lactation: diagnostic and therapeutic approaches]

Renal colics due to urinary stones are also common in women of childbearing age whether pregnant or not. Through a review of literature, we evaluated diagnostic and therapeutic approaches in renal colic in pregnancy and lactation. Review of literature. The clinical diagnosis is sometimes difficult requiring additional medical imaging based on ultrasound. Other radiological investigations using X-rays are formally forbidden. The prescription of analgesic treatment during pregnancy and lactation must take into account mainly the teratogenic risk in addition to maternal risk by altering drug pharmacokinetics during pregnancy. During pregnancy, NSAIDs are prohibited because of their teratogenicity effect. Salicylates and opiates should be used with care, especially in cases of threat of confinement. Paracetamol remains the treatment of choice. Salicylates and corticosteroids should be used with caution during lactation

[Oncological and functional results of 50 consecutive radical prostatectomies]

To evaluate the Oncological and functional results and to clear risk factors of biochemical recurrence in patients with prostate cancer treated by retropubic prostatectomy. Retrospective analysis of 50 consecutive retropubic radical prostatectomies performed between January 1999 and January 2008. Biochemical recurrence was defined by PSA > 0.2 ng/ml. Univariate analysis of prognostic factors of biochemical recurrence was performed. The study of the urinary continence and the sexuality is essentially based on a meticulous interrogatory. The biochemical recurrence-free survival was 68%. Significant risk factors on univariate analysis were: number of positive biopsy, the percentage of positive biopsy, perineural invasion, Gleason score, clinical stage, pathological stage, and tumour volume. On the functional plan, only one patient is totally incontinent. The return to a normal sexuality appears uncertain, the sexual potency was satisfactory among 5 patients [10% of the patients operated and 55,5% of the patients having had a nervesparing techniques]. Our oncoligical results are acceptable and are quite comparable to literature. This while guaranteeing the satisfactory functional results essentially basing on an acquirement of a continence quasi-perfect

[Eosinophilic cystitis: review of nine cases]

Eosinophilic cystitis is a rare inflammatory pathology. It remains a poorly understood entity. To report a series of adult cases of eosinophilic cystitis mimicking a bladder tumor. Retrospective study of cases of eosinophilic cystitis collected in an urology department. Diagnosis was established on a spontaneous bladder perforation in one case and on hematuria in the eight other cases. Histopatholgy studies confirmed the diagnosis. Eight patients underwent an endoscopic resection of bladder lesions followed by medical therapy with nonsteroidal anti-inflammatory drugs and cortimoxazole. An ileal bladder enlargement was performed in one case. Regular follow-up didn't reveal any recurrence. Eosinophilic cystitis is a rare disease simulating a tumor of bladder. Its clinical presentation is not specific and final diagnosis is based on pathology. Endoscopic resection will help to pathologic diagnosis. Associated to corticoids and antihistaminic drug endoscopic resection constitute the treatment of choice

[Ejaculation prematuree et retardee]

Frequently met in clinical sexology as in general medicine, ejaculatory troubles had a multifactorial etiopathogeny and are subjects to controversies. Their therapies remain difficult despite different possible approaches

Spinal anesthesia for endoscopic urological surgery- low dose vs. varying doses of hyperbaric bupivacaine

The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures. Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 [Gr I], 7.5 [Gr II] or 10 mg [Gr III] of hyperbaric bupivacaine 0.5% combined with 25 micro g of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons, satisfaction, were noted. The maximum number of blocked segments was 14 +/- 1 [Gr I], 15 +/- 2 [Gr II] and 16 +/- 2 [Gr III]. Time to T12 regression was significantly shorter for Gr I [53 +/- 13 min] than for Gr II [69 +/- 20 min] or Gr III [94 +/- 14 min]. Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1[51 +/- 18 min] than in Gr II [86 +/- 19 min] and in Gr III [138 +/- 21 min]. Ephedrine was used for 16 patients in Gr III [9.8 +/- 12.2 mg], 5 patients in Gr II [3.7 +/- 7.8 mg] and 2 patients in Gr I [0.5 +/- 1.5 mg]. The difference is statistically significant between Gr III and the other groups. These results suggest that the use of a low dose of bupivacaine [5 mg] added to fentanyl [25 micro g] for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 micro g fentanyl

[Recurrent obstructions after resonance stent placement in the treatment of ureteral compression from malignant disease]

Background: The Resonance ureteral stent is a newly developed all-metallic double-pigtail ureteral stent allowing a palliative diversion on a patient with malignant ureteral obstruction

Aim: To define selection criteria of good candidates for Resonance stent

Case: A 62-year-old woman was admitted to the emergency department with complaining of severe right flank pain and anuria. Twelve days earlier, we had placed retrogradely a ureteral metallic Resonance stent [Resonance: Cook Ireland Ltd, Limerick, Ireland] for the treatment of a ureteral compression from pelvic recurrence of an appendical colloid mucosal carcinoma in a solitary functionning right kidney. A percutaneous nephrostomy catheter was placed, and an antegrade nephrostogram demonstrated complete distal ureter obstruction. The patency of the ureteral stent was restored spontaneously and then, nephrostomy catheter was removed. Two weeks later, she presented with obstructed ureteral stent. Percutaneous nephrostomy was performed and Resonance stent was removed definitively. Ureteroscopy with biopsy confirmed the tumor extension into the ureteral lumen

Conclusion: The risk of subsequent obstruction after Resonance metallic ureteral stent placement is real. Patients with intra-ureteral tumour extension are presumably not good candidates for Resonance stent management

[Management of serious renal trauma. About 2 cases]

Management of serious stage 3 of Chatelain renal trauma has advanced, due to the development of radiologic investigation techniques, towards a less surgical attitude. We report two cases of serious stage 3 renal trauma. In spite of the importance of the parenchymal injuries revealed by CT scan, it was decided not to resort to surgery. The clinical course was good, and repeated Ct scan controls showed nearly completely healed injuries. Surgery shouldn't be recommended in case of stage 3 blunt renal trauma in patients hemodynamically stable or stabilized

[Ureteral injuries in gynaecologic surgery]

Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the cas of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject

[Intra vesical explosion during an endoscopic resection of a vesical tumor]

The intra vesical combustion of hydrogen and oxygen, form one mixture of explosive gas. Intra vesicale explosion during trans urethral resection is one rare incident. Its most dangerous manifestation during is vesical rupture. We demonstrate one case of intra vesical explosion during one endoscopic resection of one in the anterior face tumor of bladder. Damages on bladder are small. By going back to literature, we try to discuss the origin of intra vesical hydrogen and oxygen as well as the different preventive measures