Résumé
Objective: To evaluate the role of flexible ureterorenoscopy in diagnosis and treatment of lateralizing essential haematuria
Patients and Methods: Twenty-three patients suffering from unilateral haematuria were included in the study and underwent flexible ureterorenoscopy. Their age ranged from 17 to 68 years [mean age: 36 years]. Unilateral gross haematuria was demonstrated cystoscopically. The patients were subjected to a careful history taking, full laboratory and radiological investigations which, however, failed to localize the cause of haematuria. We therefore applied flexible ureterorenoscopy on the affected ureterorenal unit
Results: The collecting system was inspected in 21/23 patients. Discrete lesions were identified in 11 patients [haemangioma on a renal papilla in six, small vascular lesions in three, a small calculus in one and a small papillary growth in one]. Non-specific abnormalities [erythema of the infundibulum or abnormal configuration in the renal papilla] were found in six patients. No lesion was detected in 4 patients. Patients with non-specific abnormalities were biopsied and coagulated. The remaining 11 patients with discrete lesions underwent laser fragmentation of the calculus, nephroureterectomy for the papillary transitional cell carcinoma [TCC] and 9 patients underwent fulguration with or without biopsies. The haematuria resolved in all patients with discrete lesions. Patients with non-specific abnormalities had a poor outcome in our series, since all had recurrent or persistent bleeding. Follow-up ranged from 6-18 months [mean 9 months]
Conclusion: Flexible ureterorenoscopy can be of value in the diagnosis and treatment of lateralizing haematuria. Patients with discrete lesions respond well to endoscopic treatment [electrocoagulation]
Résumé
Objectives: We are presenting our experience with a systematic approach in the management of congenital penile curvature [CPC]
Patients and Methods: Between 1993 and 2000, 62 cases of CPC were treated. Ten of 34 cases [30%] presenting with ventral curvature were corrected via excision of the dysgenetic tissue and complete mobilization of the corpus spongiosum only. Two cases [6%] had a minimal corporeal disproportion that required a ventral longitudinal deep intercorporeal incision. Six cases [18%] were managed with Nesbit's procedure, and tunica albuginea plication [TAP] was done in 8 cases [24%]. These cases required mobilization of the neurovascular bundle [NVB]. Four patients [12%] had a small phallus and required ventral grafts [dermal in two and venous grafts in another two]. The remaining four patients [12%] had a short urethra and were managed by excision of the tethering corpus urethrae and neourethral reconstruction. Cases presenting with lateral curvature [14 patients] were managed by a lateral longitudinal incision at the point of maximum curvature followed by TAP in 10 cases [71%] and Nesbit's procedure in four [29%]. Dorsal curvatures [6 cases] were managed by ventral Nesbit in four [67%] and ventral TAP in the remaining two cases [33%]. Patients with a complex curvature [8 cases] were managed by sequential TAP on an individual basis according to the results of intraoperative artificial erection in 5 cases [63%] and by complete penile disassembly: The follow-up period ranged from 6 months to 2 years, and the results were satisfactory in the majority of patients. None of our patients developed impotence. Penile haematoma occurred in 6.4% and penile numbness in 19% [persistent in 3%], while foreign body sensation was felt in 8%. None of our patients experienced painful erections beyond three months after operation. A residual curvature was noticed in 9.6%, and it required a second step Nesbit's procedure in only 3%
Conclusion: Management of CPC can result in a very high success rate as long as a systematic stepwise approach is applied with an appropriate preoperative patients counseling. We recommend the limited use of Nesbit's procedure [unless TAP fails to correct the curvature] together with a gentle handling of the NVB