[Prognostic value of markers of aggressiveness of urinary bladder tumours evaluated by immunohistochemistry]

Study the expression of the following immunohistochemical markers in Tumours of the bladder: Proliferating Cell Nuclear Antigen [PCNA], Ki67 antigen [MIB1], the C-erbB2 proto- antigene, the tumor suppressor gene p53, the receptor for epidermal growth factor [EGF-R], the apoptosis suppressor gene bcl2, the carcinoembryonic antigen [CEA] and epithelial membrane antigen [EMA]. Study of retrospective series of 30 patients having tumours of the urinary bladder. The expression of PCNA with a cut-off value of 14% is correlated with recurrence [P = 0.010]. The expression of PCNA with a cut-off value of 1% is correlated with tumour stage [P = 0.003]. The expression of MIB1 with a cut-off value of 47% is correlated with recurrence [P = 0.010]. The expression of MIB1 with a cut-off value of 47% is correlated with the tumour progression in stage and/or in grade [P = 0.007]. The expression of C-erbB2 with a cutoff value of 28% is correlated in the tumour grade [P = 0.007]. The other antibodies didn't demonstrate a prognostic value. MIb1 and PCNA being correlated with recurrence, they can be useful with the decision of the rhythm of the endoscopy. The correlation of C-erbB2 with the tumour grade could serve to better graduating bladder tumours

[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

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

[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

[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

[Cryptorchidism in adult. About 81 cases]

Cryptorchidism is more often diagnosed and treated in pediatric age. Its occurrence in adult provides oppotunity to study its spontaneous course. This study has been realized on one series of 81 flies of patients cryptorchides of age superior than 14 years. Cryptorchidism was unilateral in 87.6% of cases and bilateral in 12.4% of cases. The higher the location, the more important the glandular atrophy and histological lesions.Global rate of secretory azoospermia was 93% in relation with a seminiferous disertion and an intersitial fibrosis. The lesions are important when cryptorchidism is bilateral. In two patients there was a progression to malignancy. Occasional cases of return to normal semen after orchidopexy have been reported, and that should preclude systematic orchidectomy advocated by some. Orchidopexy remain a treatment of choice even in adults