Assessment of isokinetic knee strength in elite young female basketball players: correlation with vertical jump.

AIM: To explore the isokinetic concentric strength of the knee muscle groups, and the relationship between the isokinetic knee extensors strength and the vertical jump performance in young elite female basketball players. METHODS: Eighteen elite female basketball players performed a countermovement jump, and an isokinetic knee test using a Biodex dynamometer. The maximal isokinetic peak torque of the knee extensor and flexor muscles was recorded at four angular velocities (90°/s, 180°/s, 240°/s and 300°/s) for the dominant and non-dominant legs. The conventional hamstring/quadriceps ratio (H/Q) was assessed at each angular velocity for both legs. RESULTS: There was no significant difference between dominant and non-dominant leg whatever the angular velocity (all P>0.05). However, the H/Q ratio enhanced as the velocity increased from 180°/s to 300°/s (P<0.05). Furthermore, low to high significant positive correlations were detected between the isokinetic measures of the knee extensors and the vertical jump height. The highest one was found for the knee extensors peak torque at a velocity of 240°/s (r=0.88, P<0.001). CONCLUSION: The results accounted for an optimal velocity at which a strong relationship could be obtained between isokinetic knee extensors strength and vertical jump height. Interestingly, the H/Q ratio of the young elite female basketball players in the present study was unusual as it was close to that generally observed in regular sportsmen.

[Treatment of ureteral calculi: report of 152 calculi]. / Traitement des calculs de l'uretère: à propos de 152 calculs.

OBJECTIVE: To define the therapeutic approach to ureteric stones. MATERIAL AND METHODS: 137 patients with 152 ureteric stones were treated between January 1990 and January 1997. Sixty seven stones (44%) were situated in the lumbar ureter, 16 stones (10%) were in the iliac ureter, 69 stones (46%) were in the pelvic ureter. These stones were treated by extracorporeal shock-wave lithotripsy (ESWL), ureteroscopy and, more rarely, ureterotomy. RESULTS: One hundred and three stones were treated in a single session, while 31 required two ESWL sessions. Treatment eliminated 82% of ureteric stones: 89% of lumbar ureteric stones, 31% of iliac stones and 85% of pelvic stones. Ureteroscopy was performed as first- or second-line treatment in 34 cases. It successfully treated 97% of ureteric stones: 100% of pelvic and lumbar stones and 91% of iliac stones. Three patients were successfully treated by ureterolithotomy for a lumbar ureteric stone and two for iliac ureteric stones. CONCLUSION: SWL is the reference treatment for stones of the lumbar ureter. Ureteroscopy is justified after failure of ESWL for stones of the pelvic and iliac ureter, as it gives excellent results.

Urinary continence following radical prostatectomy assessed by a self-administered questionnaire.

OBJECTIVES: A total aim of this study was to assess the incidence of urinary incontinence in patients following radical prostatectomy and determine the factors that may influence this incidence. METHODS: A total of 135 men underwent radical retropubic prostatectomy at our center between 1987 and 1997. 120 patients were sent a questionnaire regarding preoperative and postoperative voiding habits. Data collected included preoperative and postoperative continence status, interval to postoperative continence status, associated urinary symptoms, willingness to undergo radical prostatectomy again if need be and additional postoperative procedures. Patient age, date of surgery, number of neurovascular bundles resected at prostatectomy and duration of follow-up were also noted. RESULTS: Of the 120 patients, 116 (96.7%), a mean of 65.2 (range 48-76) years old, responded to the questionnaire. Mean follow-up was 4.3 years (range 1-10.8). Continence was defined as no regular use of pads. Our overall urinary incontinence rate was 14.4%. Of the respondents, 88. 8% (103/116) had achieved final continence status by 6 months postoperatively, and 95% (110/116) would undergo surgery again if need be. Of the patients considered incontinent postoperatively, 66. 6% had associated urgency. Age, year of surgery, number of neurovascular bundles resected at prostatectomy, preoperative urinary leakage of postvoiding dribbling, postoperative pelvic floor exercises, and anastomotic stricture had no significant impact on postoperative continence status. CONCLUSIONS: Using an anonymous self-administered questionnaire, we found a 14.4% incontinence rate after radical prostatectomy. These results allow patients to have realistic expectations when counseled prior to this operation.

[Urinary continence after retropubic radical prostatectomy: retrospective study with self-administered questionnaire]. / Continence urinaire après prostatectomie radicale rétro-pubienne: étude rétrospective par autoquestionnaire.

OBJECTIVES: To precisely evaluate the incidence of urinary incontinence after radical prostatectomy and its impact on quality of life. MATERIAL AND METHODS: A self-administered questionnaire was sent to 116 patients operated between 1987 and 1996. Preoperative and postoperative urinary continence, the time until urinary continence was achieved, the presence of urgent micturition, the degree of discomfort caused by urinary incontinence and associated voiding disorders were assessed. RESULTS: The questionnaire response rate was 96.6%. The urinary incontinence rate (continuous use of pads) was 13.4%. No predictive factor for postoperative urinary incontinence was identified. Urge incontinence was present in 31.3% of cases. 85% of patients claimed to be satisfied with the operation and 95.4% declared that they would be willing to undergo radical prostatectomy again. CONCLUSION: The incidence of urinary incontinence after radical prostatectomy is acceptable and the morbidity that it generates is well tolerated and has little impact on quality of life.

Spontaneous rupture of orthotopic detubularized ileal bladder replacement: report of 5 cases.

PURPOSE: We defined the mechanisms responsible for rupture of orthotopic, detubularized ileal bladder replacement. MATERIALS AND METHODS: We reviewed retrospectively the records of 5 cases of ileal neobladder rupture treated at our center between 1985 and 1995. RESULTS: The interval to perforation varied from 3 to 60 months after surgery. The perforation site was typically the upper part of the right limb of the reservoir. We observed an acute episode of bladder over distension immediately before perforation in 2 cases and a chronic state of neobladder over distension in the 3 remaining cases. Bacterial infection was associated in 4 cases. Intraperitoneal adhesions were an associated mechanism for rupture in only 1 case. We found chronic ischemic changes weakening the bladder wall to be an additional factor for rupture in the 3 cases associated with chronic over distension. CONCLUSIONS: Acute or chronic over distension of the neobladder is the main factor for spontaneous rupture of orthotopic detubularized ileal bladder replacement. Chronic ischemic changes of the bladder wall, possibly facilitated by detubularization and the variability of the mesenteric circulation, are additional factors that lead to perforation.

Twenty-year experience with jejunal conduits.

OBJECTIVES: To assess the results of jejunal conduit urinary diversion, with particular attention to electrolyte imbalance and long-term renal function. METHODS: From 1976 to 1994, 50 patients underwent urinary diversion using a short jejunal loop (10 to 12 cm) placed transperitoneally. Of these patients, 18 received pelvic irradiation before diversion. Renal function and configuration of the upper urinary tract were assessed by creatinine clearance and excretory urography. RESULTS: Median follow-up was 26 months (3 to 204). Of 50 patients, 22 had a follow-up more than 5 years later (median 86 months). Eight patients (16%) underwent 10 revision procedures postoperatively. Late complications related to urinary diversion included renal calculi (12%), parastomal hernia (6%), pyelonephritis (4%), ureterojejunal obstruction (4%), and stomal prolapse (2%). Electrolyte imbalance occurred in 2 patients (4%) and was easily corrected by 4 g sodium bicarbonate. No significant decrease in creatinine clearance (P = 0.6) was found in 22 patients with a follow-up of more than 5 years; however, of these patients, 2 had a decrease in creatinine clearance of greater than 20%, due to ureterojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurred and increased in 1 and 2 cases, respectively, and renal scarring occurred and progressed in 2 and 2 cases, respectively. CONCLUSIONS: Urinary diversion using a short length of jejunum placed transperitoneally is a reliable procedure and gives good long-term renal function. Electrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation.

[Augmentation ileocystoplasty in neurologic bladder]. / L'iléocystoplastie d'agrandissement dans les vessies neurologiques.

OBJECTIVE: The authors evaluated the results of augmentation ileocystoplasty in patients presenting with neurogenic urinary incontinence. MATERIALS AND METHODS: A prospective study was conducted in 36 patients (25 women, 11 men) 30 of whom simultaneously underwent a bladder neck continence procedure. The mean follow-up was 32.2 months. RESULTS: Daytime continence was obtained in 32 patients (88.8%). Thirty patients (83.3%) were continent a night. The upper urinary tract did not deteriorate. One patient developed bladder stones and 2 presented a vesical perforation. Urodynamic studies showed an increased functional bladder capacity and compliance (p < 0.001) and loss of uninhibited bladder contractions. CONCLUSION: Augmentation ileocystoplasty is an effective and reliable surgical procedure after failure of conservative management. However, long-term complications can occur and regular surveillance is necessary.

[Prognostic value of a positive single ultrasound-guided prostatic biopsy regarding tumor volume and intracapsular nature of prostatic adenocarcinoma]. / Valeur pronostique d'une unique biopsie prostatique échoguidée positive sur le volume tumoral et le caractère intracapsulaire de l'adénocarcinome prostatique.

OBJECTIVE: Study of the value of a single positive prostatic biopsy in the staging of prostatic carcinoma and the significance of the tumour volume. METHOD: The clinical, laboratory and pathological parameters were studied in 27 prostatectomized patients with a single positive prostatic biopsy. RESULTS: The length of tumour invasion on the biopsy was 2.6 mm (evaluation on 25 biopsies). Six patients (23%) had an extracapsular tumour and 21 (78%) had a significant tumour volume. Among the 16 patients with a length of tumour invasion < or = 3 mm, 13 (81%) had a significant tumour volume. 25% of patients with less than 3 mm of invasion on the biopsy and a Gleason score < or = 6 and 12% of patients with less than 3 mm of invasion and a PSA < or = 10 ng/ml had a non-significant tumour volume. CONCLUSION: The presence of a single positive prostatic biopsy is not sufficient to determine the pathological stage of a prostatic carcinoma. In this retrospective study, the majority of patients with a single positive biopsy had a significant tumour volume > 0.5 cc. No preoperative predictive factor of tumour volume was demonstrated.

Retroperitoneoscopy: a laparoscopic approach for adrenal and renal surgery.

OBJECTIVES: Retroperitoneoscopy has gained acceptance for urologic surgery. We assessed the safety and efficacy of this procedure for renal and adrenal surgery. METHODS: Since December 1994, 20 patients (18 to 75 years old) have undergone laparoscopic adrenalectomy and nephrectomy, including simple nephrectomy in 8, partial nephrectomy in 1, radical nephrectomy in 2, tumorectomy with cyst excision in 1, and adrenalectomy in 8. The retroperitoneal space was created by blunt dissection with the index finger, completed by insufflation, without balloon dissection. RESULTS: Average kidney size was 65 m (range 50 to 108), and average adrenal tumor size was 31 mm (range 20 to 40). The average operating time was 127 minutes (range 60 to 180) for nephrectomy and 84 minutes (range 45 to 140) for adrenalectomy. The average hospital stay was 3 days (range 1 to 7) for nephrectomy and 2.4 days (range 1 to 4) for adrenalectomy. Average blood loss was 65 mL for both nephrectomy and adrenalectomy. Conversion from the laparoscopic procedure to open surgery was never required. Peritoneal effraction and ureteral injury occurred in only 4 patients and 1 patient, respectively. CONCLUSIONS: The laparoscopic retroperitoneal approach is safe and effective for simple renal nephrectomy and for excision of small adrenal tumors. Perioperative morbidity and hospital stay are reduced.

[Antiandrogen withdrawal syndrome in the hormonal treatment of metastatic prostatic cancer in hormonal escape]. / Syndrome d'arrêt des antiandrogènes dans le traitement hormonal du cancer de la prostate métastatique en échappement hormonal.

A fall in the PSA level after stopping antiandrogens has been described at the stage of hormonal escape of prostatic cancer treated by complete androgen inhibition. The authors report a new case. The patient was offtially treated by pulpectomy and nitulamide for N+ prostatic carcinoma (PSA: 165 ng/ml). At the stage of hormonal escape, discontinuation of nitulamide induced a reduction of the PSA. Replacement of nitulamide by cytoproterone acetate was followed by a renewed increase of PSA, which again decreased after stomming cyproterone acetate. Three years later, the PSDA level was 3.5 ng/mg. This syndrome is probably due to mutation of the androgen receptor. In hormonal escape, suspension of all antiandrogens apart from LHRH analogues is recommended and can be followed by a temporary fall of PSA. No other antiandrogen must be administered in the place of the previous drug.

[Laparoscopically-controlled lymphadenectomy in localized cancer of the prostate]. / La lymphadénectomie sous contrôle coelioscopique dans le cancer localisé de prostate.

Laparoscopic lymphadenectomy was performed among 15 patients. The average age was 65.5 years. The group was made of 13 T2 and 2 T3. The average time of procedure was 175 min (90 à 240 min). The average number of lymph nodes removed laparoscopically from these patients was 5.3 on the left and 6.4 on the right. Metastatic nodes were found in 5 cases (33%) and among all these 5 patients the PSA level was above 30 and/or the Gleason score > 6. We noticed 3 major complications (2 bowel and 1 vascular injuries). Radical prostatectomy was made in 8 patients and nevertheless this intervention did not become more difficult. As a conclusion, this is a procedure which allows a good node staging but the complication rate is still high and will decrease with experience. The merits of such a method are still to be evaluated in localized prostatic cancer.

[A review of 72 renal artery stenoses in a series of 715 kidney transplantations in children]. / Revue de 72 sténoses de l'artère rénale dans une série de 715 transplantations rénales chez l'enfant.

In a series of 715 renal transplantations performed between 1973 and 1989, 72 cases of renal artery stenosis (RAS) in 69 children (9.7%) were managed at Hôpital Necker Enfants Malades. Forty cases of RAS were treated exclusively by antihypertensive drugs. A good result was obtained in 82.5% of cases. Thirty three transluminal angioplasties (TLA) were performed in 23 children with 26 RAS. A good clinical result was obtained in 15 children with a total of 17 stenoses, corresponding to a success rate of 65%. Transluminal dilatation of anastomotic stenoses always failed. There were no cases of transplant thrombosis. Eleven RAS were operated, including 5 after failure of TLA. Eight patients (73%) obtained a clinical improvement. There were 2 postoperative thromboses. Antihypertensive treatment must be administered in every case. If medical treatment fails, and with the exception of anastomotic stenoses, TLA should be the first-line procedure, while surgery is reserved for failures of TLA and for anastomotic stenoses.

[Proper use of prostate specific antigen]. / Le bon usage de l'antigène spécifique de la prostate.

Prostate specific antigen (PSA) has become the best marker for prostatic carcinoma. PSA is secreted by the glandular cells of prostatic epithelium and is specific for any normal, hyperplasic and tumoral prostatic tissue. PSA is excreted in blood that render its dosage accessible for clinical purpose. Two different tests are now used: Tandem test R is a radioimmunological test (N1:0-4 ng/mL), and Pros check test uses an immunoenzymatic method and is considered to be more sensitive (N1: < 2.5 ng/mL). PSA increases of 35 ng/mL for every other gram of hyperplastic prostatic tissue and of 3.5 ng/mL by gram of prostatic cancer. This test allows detection of prostate carcinoma with a positive predictive value of 49% when PSA > 4 ng/mL and 75% when PSA > 10 ng/mL. However, only biopsies will confirm the diagnostic of prostate cancer. For the patients with an increased PSA and no cancer founded by random biopsies, an increase of PSA level in the next year suggests prostate carcinoma. When the diagnostic of prostate cancer has been made, a PSA < 15 ng/mL suggests a low stage carcinoma (B1 or B2). When PSA > 75 ng/mL, there is a high probability that this cancer is node positive. Between this values, PSA cannot make the difference between stage B, C or D. The more sensitive test (Pros check) must give undetectable level after radical prostatectomy. For high stage lesion treated by hormonotherapy, or chemotherapy or radiation therapy, PSA is a good indicator of response to therapy and recurrence after therapy.

[Pelvic lymphatic excision using laparoscopy. Its value in the staging of tumors of the bladder]. / Curage ganglionnaire pelvien par voie coelioscopique. Intérêt dans le bilan d'extension des tumeurs de vessie.

Laparoscopic surgical procedures are being evaluated in urologic diseases including bladder cancer. Patients with apparently localized tumors may have lymph node involvement indicating disseminated disease for which locoregional treatments are inadequate. Laparoscopic lymphadenectomy may be useful for staging, since neither noninvasive procedures nor intraoperative examination of lymph nodes removed during cystectomy are completely reliable. The technique is described in detail. Benefits in bladder cancer patients remain to be determined.

[Scrotal trauma. Report of 33 cases]. / Traumatisme des bourses. A propos de 33 cas.

We report a serial case study of 33 patients from May 1980 to November 1990 presenting a scrotal contusion. In 2/3 of cases, the physical examination showed a scrotal oedema or an hematocele. Ultrasonography showed a testicular injury while clinical examination was subnormal in 2 patients. In the other cases, ultrasonography showed an hematocele without asserting in all cases the traumatic rupture of the tunica albuginea. 27 patients have been surgically explored: 14 ruptures of the testicle, 3 intratesticular haematoma, 3 scrotal open traumatic injuries, and 7 extratesticular haematoma. Only 3 orchidectomies were required for the 6 patients who have not been explored surgically, the testis was normal at one month. The follow-up of these young patients is difficult, 11 had been seen again at 1 month. At long term follow-up, three patients had been seen at 1, 3 or 6 years without testicular after-effects.