[Primary tumors of the upper urinary tract. Apropos of 49 cases and a review of the literature]. / Les tumeurs primitives de la voie excrétrice urinaire supérieure. A propos de quarante-neuf observations et revue de la littérature.

We report 49 tumors of the upper urinary tract treated between 1980 and 1988. Intravenous pyelography with direct opacification technics gave the diagnosis in 83.7% of patients. Ultrasonography and computed tomography were only reliable for tumors of renal pelvis. Urinary cytology gave good results only in high grade invasive transitional cell carcinoma. Nephro-ureterectomy is always recommended.

[Results of the surgical treatment of impotence due to venous leakage by insertion of a prosthetic venous tourniquet. 26 patients reviewed with a 1-year follow-up]. / Résultats du traitement chirurgical de l'impuissance par fuite veineuse par mise en place d'un garrot veineux prothétique. Vingt-six malades revus avec un an de recul.

Twenty-six patients have been operated by pericavernoplasty with a band of synthetic material. After 1 year, 61.6% had a good result. Venous leaking is certainly a disease of the corpora cavernosa.

[The results of urethro-cervicolysis after surgical over-correction of stress urinary incontinence. Apropos of 10 cases]. / Les résultats des urétro-cervicolyses après hypercorrection dans la chirurgie de l'incontinence urinaire d'effort. A propos de dix observations.

Between 1985 and 1988, 10 female patients between the ages of 35 and 76 years, suffering from dysuria after surgical correction of urinary stress incontinence (7 sub-urethral bands, 3 colposuspensions) were observed. The abnormality of the course of the urethra compressed anteriorly against the symphysis pubis, observed on clinical examination and on intravenous pyelography as well as urodynamic investigations allowed this dysuria to be attributed to a cervico-urethral obstruction resulting from over correction during the initial surgical operation. The 10 patients were treated by urethro-cervicolysis (9 out of 10) associated with repeated colposuspension in 3 cases. The overall results were disappointing as although 8 of the 10 patients were improved at 3 month, only 4 out of 9 were still improved at 6 months. These poor results raise the question of the value of combining urethro-cervicolysis with colposuspension and possible VY plasty of the bladder neck.

[Long-term evaluation of the treatment results of male urethral stenosis]. / Evaluation à long terme du résultat des traitements des sténoses de l'urètre masculin.

287 urethral strictures were treated between 1974 and 1984. Two-stage urethroplasty provided 47.6% of good results at 5 years, although there was a possibility of very delayed recurrences. Endoscopic urethrotomy only gave 26% of good results at 5 years, while 30% of good results were obtained after dilatation with Olbert's sound. Endourethral techniques do not compete with two-stage urethroplasty, provided they are performed repeatedly.

[Urinary calculi. Current role of in situ dissolution]. / Calculs urinaires. Place actuelle de la dissolution in situ.

The two cases reported here illustrated the advantages of urinary stone dissolution in situ. One patient had bilateral urate calculus with anuria; the other had recurrent staghorn calculus. In both cases a nephrostomy stent was installed percutaneously and the calculi were dissolved by irrigation.

[Urodynamic study of urinary incontinence in elderly women. Apropos of 108 cases]. / L'exploration urodynamique de l'incontinence urinaire de la femme âgée.

Clinical and urodynamical study of 108 patients old of more than 70 years and presenting urinary incontinence showed the frequency of vesical instability and dysuria (maximum out put less than 15 ml/s).

[Treatment of stenoses of the urethra. 2]. / Traitement des sténoses de l'urètre. Deuxième partie.

This is a comparative study in 183 patients of the treatment of urethral stenoses by two-stage urethroplasty, internal endoscopic urethrotomy and urethrotomy via the Olbert catheter. Urethroplasty (39 patients) was preferentially carried out in patients with moniliform stenosis greater than 2 cm long in the penile and penoscrotal urethra. There was no significant difference in the indications for the two forms of urethrotomy. Good results were obtained for the 3 techniques in about 80% of cases but there was significantly higher complication rate with surgical urethroplasty. The failure rate of the 3 techniques did not differ significantly. The cost of treatment, on the other hand, greatly differed depending on the technique. Surgical urethroplasty was 2.8 times more costly than internal endoscopic urethrotomy and 10.4 times more costly than Olbert catheter urethrotomy. Olbert catheter urethrothomy was 3.7 times cheaper than internal endoscopic urethrotomy.

[Impotence caused by venous leakage. Placement of a prosthetic venous bandage]. / Impuissance par fuite veineuse. Mise en place d'un garrot veineux prothétique.

A new treatment of impotence by venous leakage is reported. It consists of tying the dorsal and lateral aspects of the cavernous body with a bandage of synthetic material. The bandage, inserted on the bulbo-cavernous muscles, restores a "carter effect" and prevents venous leakage during erection. This technique has been used in 20 patients, with satisfactory results in 10 who were followed up for more than 4 months.

[Diagnostic and therapeutic problems posed by renal or para-renal masses of cystic appearances]. / Problème diagnostiques et thérapeutiques posés par des masses rénales ou para rénales d'allure kystique.

The authors report some forty cases of renal masses, cystic in appearance and having raised a certain number of diagnostic or therapeutic problems. These masses included 7 cystic carcinomas, 3 benign tumors of cystic appearance and 28 cysts including 2 infected and 2 hydatid cysts. No paraclinical investigation is infallible in confirming the nature of the mass in doubtful cases, and pre-operative diagnosis is more easily obtained by investigation including the majority of standard imaging methods often completed by puncture. Amongst clinical factors which raise doubts as to the benign nature of the cystic mass seen, hematuria remains the most important, other symptoms and signs being of little significance. With regard to imaging, septate calcified masses with echoes within them, with a thick wall or high CT scan density are theoretically suspect. The same applies to masses having rapidly increased at two successive investigations or where puncture fluid is bloody. In all cases if proof of the benign nature cannot be obtained, surgical exploration would appear to be required.

[Cancer of the penis. Technic of amputation limited to the glans]. / Cancers du pénis. Technique d'amputation limitée au gland.

The authors report an original technique of glans resection without section of the cavernous bodies. A caverno-cutaneous suture enables a neo-glans to be obtained from the distal, tapering part of the cavernous bodies. This technique is used for small and superficial tumors without lymph nodes and located far enough from the balano-preputial fold.

[Treatment of urethral stenosis. 1]. / Traitement des sténoses de l'urètre. Première partie.

The treatment of urethral strictures has considerably developed over recent years: surgical urethroplasty has been perfected at the same time as internal urethrotomy has gained a new lease of life as a result of endoscopy. Urethral dilatation by means of probes used for arterial stenoses constitutes another interesting development in this field. We reviewed our case files with a double objective in mind: to determine the reasons for our changing therapeutic practices and the results of these three methods. Our study was also interesting because it was the first time that the incidence of this therapeutic development on the economic consequences of this disease, which generally affects professionally active adults, has been assessed. Several factors can be taken into consideration: however, as the length of time off work and the cost of concomitant drug treatments were unable to be determined with sufficient accuracy by our survey, we finally assessed the duration and the number of hospital admissions for each patient. Although only fragmentary, these data appear to reflect fairly accurately the economic impact of the treatments used.

[Parapyelic cysts]. / Les kystes para-pyéliques.

Parapyelic cysts present particular characteristics in relation to cystic disease of the kidney. Their intrasinusal development in contact with vascular and canalar elements of the renal hilum explains their often explosive symptomatology and the frequent need for surgical excision of the cyst--procedure difficult to accomplish and nearly always incomplete. Four cases are reported, including 2 with cysts communicating with excretory pathways, and symptoms, signs and diagnostic and therapeutic aspects discussed. Arguments are in favor of an acquired pathogenicity of these cysts (communication with excretory pathways, contingent presence of smooth muscle fibres in the cyst wall).

[The vena cava in surgery of renal cancer in the adult]. / La veine cave dans la chirurgie du cancer du rein de l'adulte.

In a series of 171 radical nephrectomies performed by the authors, 10 patients presented vena cava extension (5.8%). The extension was infrahepatic (stage C) in 6 cases, retrohepatic (stage B) in 1 case and involved the right auricle (stage A) in 2 cases, while the upper limit of the thrombus could not be defined in the remaining case. All patients were operated upon. There was one post-operative death (stage B), while the other patients had an uncomplicated post-operative course, despite the need for open-heart surgery in two cases. Seven patients died from metastatic after an interval of 2 and 4 years. The prognosis is therefore reserved, but seems to be better than in the case of lymph node metastases, justifying an aggressive surgical approach.

[Impact of pregnancy on the bladder and urethra. Prospective study]. / Incidence de la grossesse sur la vessie et l'urètre. Etude prospective.

In connection with a prospective study of 200 expectant mothers, the authors discuss the disorders of the lower urinary tract in the course, and at the end, of pregnancy, which are reversible in the vast majority of cases. They also describe the physiopathological mechanisms of lasting sequelae and the precautions to be taken at the time of childbirth in women identified as high-risk vesico-urethral cases.