Continent urinary diversion using an artificial urinary sphincter.

We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra-prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure-regulating balloon is implanted within the area of abdominal pressure, retroperitoneally. After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow-up of 20 months. These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir. Although long-term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.

[Pyeloureteral lieberkuhn adenocarcinoma after trans-intestinal ureterostomy for bladder exstrophy]. / Adénocarcinome lieberkunien pyélo-urétéral après urétérostomie trans-intestinale pour exstrophie vésicale.

The authors report a case of pyeloureteric adenocarcinoma in a urinary diversion inserted for bladder exstrophy and in a context of chronic pyelonephritis secondary to renal stones. The various aetiopathogenic hypotheses are discussed. Renal stones and chronic inflammation very probably played an important role in the development of this type of adenocarcinoma in the urothelium.

[A case of hemangiopericytoma of the pelvis]. / A propos d'un cas d'hémangiopéricytome du bassin.

Haemangiopericytoma is an uncommon tumour of vascular origin. The authors report a case of one of the rarer sites of this tumour in man: paravesical pelvic haemangiopericytoma. Although modern imaging techniques have provided useful information concerning the hypervascular and clearly demarcated appearance of this tumour which displaces but does not invade adjacent organs, its diagnosis can only be established by histology. Its degree of malignancy and its invasive potential are unclear. The risk of local recurrence and metastases in more than one half of cases justifies wide surgical excision, possibly combined with adjuvant radiotherapy, and long-term follow-up.

[Intestinal implantation of an artificial sphincter]. / Implantation intestinale de sphincter artificiels.

In order to restore anal sphincteric function, artificial AMS sphincter was used with his 3 components: the peri-intestinal cuff giving anal sphincter tone, the pump used for active opening and the pressure regulating balloon. In the same fashion a continent valve may be created on an intestinal segment as a part of a reconstructed bladder. In this case the pump may be replace by a subcutaneous port allowing fluid injection to adjust volume and pressure in the cuff. Two patients with fecal incontinence related to sequela of a high imperforate anus syndrome were implanted. Follow-up is greater than 1 year with normal continence in the day for the first case (degree 2) and continence day and night in the second case. Artificial valve has been implanted in seven cases of neobladder pouch (or related situations), with in 4 cases very good results and in 3 cases a failure (Follow-up 3-36 months).

[Calibrated cicatrization of internal urethrotomies over spiral metal endoprosthesis. Preliminary study]. / Cicatrisation calibrée des uréthrotomies internes sur endoprothèse métallique spiralée. Etude préliminaire.

The authors have developed a new model of flewible metal prosthesis to maintain the urethral calibre throughout the period of healing and epithelial restoration following internal urethrotomy. It consists of a large intravesical spiral, a shaft within the prostatic and sphincteric urethra and a spiral in the bulbar and anterior urethra. This prosthesis, implanted in 7 patients for periods ranging from 2 to 5 months, provides additional calibration following internal urethrotomy, but a longer follow-up is necessary to assess its real efficacy.

[Peri-ureteral granuloma after teflon injection for vesico-ureteral reflux]. / Granulome péri-urétéral après injection de Téflon pour reflux vésico-urétéral.

Based on two cases of correction of vesicoureteric reflux by endoscopic Teflon injection associated with a marked foreign body reaction, the authors analyse the tolerance of this substance for this type of treatment. On reviewing 29 cases of reflux, they found 3 failures (10%) of the method with 2 foreign body granulomas (7%). These complications, related to the use of Teflon, have been rarely reported in the literature, which essentially refers to the risks of migration of Teflon.

[Rectal stenoses caused by carcinoma of the prostate. Apropos of 9 cases]. / Sténoses rectales des carcinomes prostatiques. A propos de neuf observations.

Rectal strictures are rare complications of prostatic cancer and are considered to be a sign of poor prognosis. The authors report 9 cases. In 5 cases, the cancer was already diagnosed and had been treated by endocrine therapy. All patients died during the months following onset of the intestinal symptoms despite diversion colostomy (4 cases) and high dose oestrogen therapy. Rectal strictures therefore have the same poor prognosis as escape from endocrine therapy. In 3 cases, the stricture was the presenting sign of the cancer in one case, the cancer was already known and treated by radiotherapy; in this case, survival depends on the hormone sensitivity of the cancer and one patient survived for 7 years with subsequent closure of the colostomy.

[Direct cutaneous ureterostomy with myoplasty using a pedicled flap of the rectus abdominis]. / Urétérostomie cutanée directe avec myoplastie par lambeau pédiculé de muscle grand droit.

Many methods have been reported to prevent the development of stomal stenosis following direct cutaneous ureterostomy, thus avoiding catheterizations with their attendant complications, and improving patient tolerance. Nevertheless, although lessened, the risk of stenosis persists in narrow ureters. In order to improve local trophicity and help maintain a wide, flexible intraparietal segment, the authors have developed a technique of cutaneous ureterostomy using a muscle flap from the rectus abdominis muscle and a V-shaped skin flap. This procedure was used on 20 ureters, including 12 dilated ureters and 8 narrow ureters. Follow-up was 3 months to 2 years. In 18 cases, no catheterization was needed, and no stenoses or complications were observed. In one case, stomal stenosis developed on a dilated, irradiated ureter from a non-functioning kidney. An indwelling catheter was used in one narrow ureter with a stenosis proximal to the abdominal wall. These preliminary results suggest that this technique is beneficial. Further studies with a larger number of patients and longer follow ups are needed.

[Coarctation of the aortic isthmus. Apropos of a case treated successfully]. / Coarctation athéromateuse de l'isthme de l'aorte. A propos d'un cas traité avec succès.

The authors report and discuss the rare case of a female patient age 55 years, with a atherosclerotic stenosis of the aortic isthmus with hypertension. The lesion was resected using partial veno arterial bypass with a dacron graft, literature on this case is reviewed.