[Perineo-transpubic approach to the management of posterior urethral post-traumatic rupture]. / La voie périnéo-trans-symphysaire dans le traitement des ruptures traumatiques de l'urètre postérieur.

OBJECTIVE: To study the place of the perineal-trans-pubic approach in the treatment of the posterior urethral post-traumatic rupture operated late, and to evaluate its results. PATIENTS AND METHODS: Twenty-four patients whose had a total posterior urethral post-traumatic rupture were treated in our department in a stage of urethral strictures. All patients underwent perineal transpubic urethroplasty. In this study we detailed a technique description of the approach and a clinical evaluation of our results. RESULTS: This technique allows having a direct approach of the posterior urethra, to perform a tension free end to end urethral suture. The backward is about 3 years. We assessed 3 cases of recurrent urethral strictures. The cases of erectile dysfunction assessed were mainly related to the initial pelvic trauma. Finally this approach had not orthopaedic squall in all cases. CONCLUSIONS: Comparing to others, the perineal transpubic approach is the best one to manage the posterior urethral injuries treated with late. It gives a satisfactory results with a few disadvantages.

[The female urethral diverticula: apropos of 21 cases]. / Le diverticule de l'urètre féminin, à propos de 21 observations.

PURPOSE: Our goal is to study the clinical, radiological and therapeutic particularity of the female urethral diverticula via a retrospective study of 21 cases. PATIENT AND METHODS: Twenty one females, with a mean age of 37 years (range 15 to 62 years) presenting an urethral diverticula, were treated between 1988 and 2000. Clinical examination made diagnosis in all cases. Cystorethrography shown a direct image of diverticula in 100% of cases and intravenous Pyelography in only 24% of cases. The urethral diverticula was excised via a transvaginal approach in all cases. RESULTS: Eighteen patients had favourable immediate outcome. Three patients presented an urethrovaginal fistula treated surgically in one case and by bladder drainage in one case. The last patient refused treatment and she was lost to follow-up. After a median follow-up of 54 months (range 18 to 120) only three patients have some urinary urgency that was treated by anticholinergics. CONCLUSION: Female urethral diverticula is a rare disease, the diagnosis is easy and only surgical excision gives good results.

[Giant retroperitoneal liposarcoma: report of a case]. / Le liposarcome rétropéritonéal géant: à propos d'un cas.

Liposarcoma is a rare and primary malignancy developed from mesenchymal tissue. We report the case of a 32-year-old woman who had a complete exeresis of a 15 cm retroperitoneal myxoid liposarcoma. Three months later, a 9 cm local recurrence was excised and radiotherapy was performed. In 2000, a local recurrence and an intestinal localisation of the liposarcoma were observed. The retroperitoneal tumor could not be removed and she had an intestinal resection followed by chemotherapy. With the literature data, we review the pathological, therapeutic and prognostic aspects of this tumor.

[Retroperitoneal schwannoma. Case report]. / Le schwannome rétropéritonéal. A propos d'un cas.

Retroperitoneal schwannoma is a rare tumor originating in the neural sheath. We report the case of a 48 year-old women. She had a ten year history of lumbal pain. The abdominal sonography had revealed a left retroperitoneal tumor that compresses the left renal cavities. The abdominal CT scan visualized a 56 mm, homogenous, well demarcated, retroperitoneal mass with a low attenuation. This mass with multiple enhanced septa is separated from the left adrenal gland. The diagnosis of a cystic lymphangioma is made. We perform surgical exeresis of the tumor by a left lumbal laparotomy. The pathology examination concludes in an altered schwannoma with Antoni B patterns. Retroperitoneal schwannoma is a primary neural benign tumor with a good prognosis. The management is surgical.

[Retroperitoneal ganglioneuroma. Report of a case]. / Le ganglioneurome rétropéritonéal. A propos d'un cas.

Retroperitoneal ganglioneurom is a primitive, rare and benign tumor originating in the neural sheath. We report the case of a 27-years old man. An abdominal sonography had revealed accidentally a 60 mm, well demarcated tumor. The left renal vein was compressed an forced back. This tumor was located in front of and internal to the left kidney. The CT scan confirmed this tumor. A left subcostal laparotomy was done. The tumor was soft and movable. A total exeresis was performed. The pathology examination had conclude in a benign ganglioneuroma. The follow-up was six years and half. Retroperitoneal ganglioneuroma is a benign tumor with a good prognosis. The treatment is surgical.

[Intrauterine device migrating to the bladder]. / Dispositif intra-utérin migré dans la vessie.

Transuterine migration of an intrauterine contraceptive device (IUCD) is a rare complication. The authors report a case of IUCD which migrated into the bladder and subsequently became calcified. This 34-year-old woman had been fitted with an IUCD for 4 years. She presented an unwanted pregnancy and signs of disabling cystitis at the end of pregnancy. The diagnosis of migration of the IUCD into the bladder with secondary calcification was suggested on the plain abdominal x-ray and on ultrasound and was confirmed by cystoscopy. Ballistic lithotripsy of the bladder stone with endoscopic extraction of the IUCD was then performed.

[Diagnostic and therapeutic advantages of rigid ureteroscopy: retrospective study of 304 cases]. / Apport diagnostique et thérapeutique de l'urétéroscopie rigide: étude rétrospective à propos de 304 cas.

Uretroscopy has become a common tool for the diagnosis and management of the upper urinary tract. Between April 1994 and Decembre 1999, 304 ureteroscopy procedures were performed. The most common therapeutic procedure was stone manipulation in 299 cases (distal ureter 259 cases, mid-ureter 23 cases, lumber ureter eight cases and staged in nine cases). Procedure was made by a rigid ureteroscope 8.5 Ch or 11.5 Ch. Dorinia was used in 175 cases (57.5%) with or without fragmentation by ultrasound. Therapeutic ureteroscopy was also used to remove a double-J stent that had migrated into the pelvic ureter in one case and in three cases of ureteral tumor. It was used in one case to confine the extrinsic compression of a ureteral stenosis. Median follow up was 12 months (6-36 months). The overall success rate was 87.6%. Results are comparable in men and women (P = 0.8). Success rate was 90% in single lithiasis and 76.2% in case of numerous stones (P = 0.0094). There was a statistically significant difference in success rate between stones 15 mm or under in size (89% stone-free) and those 15 mm (66% stone-free) or larger. In conclusion, rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesion.