Sachse urethrotomy versus endoscopic urethrotomy plus transurethral resection of the fibrous callus (Guillemin's technique) in the treatment of urethral stricture.

OBJECTIVES: Advances in endoscopic instrumentation and technique have expanded the urologist's armamentarium for effective and safe treatment of urethral strictures. This prospective study included 80 patients who presented with single, iatrogenic, annular strictures of the bulbar urethra. The length of the stricture was 1 to 2 cm, with an average of 1.5 cm. METHODS: Patients were randomly divided into two groups: group A, 40 patients who underwent direct-optical endoscopic urethrotomy with a guide catheter via cold-knife incision at the 12 o'clock position (Sachse urethrotomy), and group B, 40 patients who underwent double direct-optical endoscopic urethrotomy with a guide catheter via cold-knife incisions at the 11 and 1 o'clock positions, followed by transurethral resection of all scar tissues (Guillemin's technique). The results obtained were analyzed and compared at 6 months, 12 months, 24 months, 3 years, and 5 years postoperatively by clinical evaluation, uroflowmetry, and retrograde and voiding urethrographies. RESULTS: Group A obtained 95% good results at 6 months, 85% at 12 months, 55% at 24 months, 45% at 3 years, and 25% at 5 years. Group B obtained 98% good results at 6 months, 95% at 12 months, 90% at 24 months, 80% at 3 years, and 70% at 5 years. CONCLUSIONS: The differences between the two groups are not significant at 6 and 12 months (P > 0.05). They are statistically significant after 24 months, 3 years, and 5 years (P < 0.05).

Massive haemorrhage of inoperable bladder carcinomas: treatment by intravesical formalin solution.

Numerous modalities of treatment have been used in the past to control massive bladder haematuria, with varying degrees of success. Formalin has been used in urology only for the treatment of intractable haematuria of inoperable bladder carcinomas, usually as the last resort when all other nonsurgical attempts have failed and before more aggressive surgical measures are considered. Eight patients with bladder tumours classified T2 (2 cases), T3 (2 cases) or T4 (4 cases) and 2 patients with radiation cystitis were assessed as being beyond the scope of even palliative surgery, severe haemorrhage being present in all cases. The treatment was instituted in all cases by intravesical instillation of a 10 per cent formalin solution under general anaesthesia. Four patients received 4 and 6 instillations, respectively, the former over 4 weeks and the latter over 10 months. The bladder was filled completely and an indwelling-catheter introduced, the formalin solution being left in the bladder for 5 to 30 min (mean: 12 min). Haematuria was absent after 1 to 25 days (mean: 11 days) in 9 cases. The 10th patient died before arrest of haemorrhage. Survival after instillation was 65 days to 27 months (mean: 11.5 months). The outcome was fatal within 4 months or less in 3 cases and 4 patients died of renal failure within 3 months, one within 65 days after instillation. In 4 cases, treatment with formalin reduced bladder capacity to less than 100 ml. Other complications included retroperitoneal fibrosis (1 case), urinary incontinence (3 cases) and severe frequency and nocturia (3 cases). This procedure should therefore be reserved for terminal cases unable to support more aggressive therapy.

Human bladder urine oxygen content: implications for urinary tract diseases.

Urine dissolved oxygen (DO) was measured in 40 healthy subjects and 115 patients divided into 4 groups according to their disease. Group 1 (20 patients) had lower urinary tract infection (UI), Group 2 (30 patients) had urinary stone disease (USD), Group 3 consisted of 50 end-stage chronic renal failure patients (CRF) and 15 patients in Group 4 were affected by influenza viral infection (IVI). Urinary and arterial PO2, PCO2 and pH were also measured in 20 healthy subjects. The other 20 healthy volunteers were subjected to submaximal exercise and afterwards urinary DO was estimated. Results revealed that in healthy subjects urinary DO or PO2 is not correlated with urinary pH or arterial pH, PO2 and PCO2. Also, urinary DO did not significantly vary on consecutive days. Urinary DO reflects mainly the renal metabolic state, being increased in conditions of decreased kidney metabolism such as CRF. Submaximal physical exercise, fever or urinary tract infection may significantly reduce urinary DO, whereas DO remains unaffected in uncomplicated USD. Human urinary DO is related to serum creatinine and urine volume. Our results indicate that urinary DO may be a useful indicator in clinical practice.

[Iatrogenic injuries to the distal ureter during gynecologic interventions]. / Les traumatismes iatrogènes de l'uretère pelvien dans les interventions gynécologiques.

Surgical injury to the ureter is an important problem that confronts the urologist, the gynecologist and the general surgeon. The authors report 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) observed after gynecological surgery between January 1985 and January 1995. The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. Open surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 patients unilateral and in the remaining 2 patients both ureters were damaged. As regards treatment, the authors recommend immediate repair, whenever the lesion is noticed at operation. In the post-operative period, ureteral stent or double pigtail stent insertion using balloon dilatation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureterovesical implantation, using the psoas hitch bladder procedure or the Boari-Cassati-Küss procedure if the lesion is in the lower ureter or a transuretero-ureterostomy if it is in the upper ureter.

Benign fibroepithelial ureteral polyps. Report of 3 cases.

Three rare cases of benign ureteral polyps are presented. The rareness of benign mesenchymal ureteral tumors and the difficulty in pre-operative differential diagnosis from malignant epithelial are remarkable. The diagnosis is made on characteristic appearance at operation and is confirmed by frozen section and histological examination.

[Bilateral testicular metastasis of an adenocarcinoma of the prostate]. / Métastases testiculaires bilatérales d'adénocarcinome de la prostate.

Secondary testicular tumors are very rare. Since 1935, approximately 200 cases have been documented in the international literature. Testicular metastases of prostatic carcinoma are reported more frequently and other common primary tumor sites are the lung, kidney, colon, stomach and other sites. A review of the literature revealed 43 cases originating from prostatic carcinoma with 4 bilateral cases. The authors add a rare case of bilateral metastasis to the testis originating from prostatic carcinoma. This patient had been treated by transurethral resection of the prostate and bilateral orchidectomy 24 months previously.