[Laparoscopic promontofixation]. / Promontofijación laparoscópica. Nuestra técnica.

OBJECTIVES: The pathology of the pelvic floor, including the urinary incontinence, the anal incontinence and the genital prolapse, is very dominant, concerning approximately a third of the adult women. It is fundamental that this musculature supports a good function, because of the weakness of the pelvic floor produces urinary incontinence, cysto and rectocele, genital prolapses and sexual dysfunctions. The above mentioned pathology can be corrected by laparoscopic promontofixation, whatever the previous history of pelvic surgery, including the placing of prosthetic material. In this article we describe the above mentioned intervention. MATERIAL AND METHODS: Preoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30° Trendelenbourg position. After the introduction the trocars, initial surgery comprises anterior dissection of promontory after incision of the posterior peritoneum with the patient placed beforehand in a Trendelembourg position. After that, we make interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arc. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. RESULTS Y CONCLUSIONS: The technique allows the correction of the dysfunction of the pelvic floor and incontinence with good anatomical and functional results. Postoperative secondary haemorrhage and gastrointestinal occlusion may occur. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis may occur after several months and seems relatively independent of the prosthetic material used.

Nerve sparing laparoscopic radical prostatectomy: our technique.

PURPOSE: To describe our technique of nerve sparing laparoscopic radical prostatectomy (LRP). We present the oncological and functional results (potency and urinary continence). MATERIAL AND METHODS: LRP has become standard at our institution based on experience with more than 2800 consecutive cases operated on between 1997 and 2005. From May 2003 to March 2005 a total of 677 LRP were performed, 425 consecutive patients candidates for a nerve sparing technique have been operated using the intrafascial approach. The challenge of our technique is to remove the prostate without any thermic and mechanic traumatism, avoiding dissection of outer layer. Oncological data were assessed by pathological examination and post-operative PSA level. Functional results were assessed with a self questionnaire. RESULTS: By pathological stage, 2 pT2a specimens (7.4%), 7 pT2b specimens (21%), 44 pT2c specimens (24%), 63 pT3a specimens (43%), 11 pT3b specimens (46%) were found to have positive surgical margins (SMs). In 86 specimen (59%) positive SMs were focal inframillimetric. Median follow-up was 11 months (range 1-22). The continence rate (no leakage/no pad) was 95% at 6 months, confirmed at 12 months among 202 patients. For 137 patients, potency rate was 58.5% at 12 months. CONCLUSION: Intrafascial LRP provides satisfactory results in regard to recovery of continence and sexual function. Long-term progression and survival outcome are necessary before this procedure should be offered as a replacement for interfascial nerve sparing technique.

[Laparoscopic promontofixation technique]. / Technique de promontofixation laparoscopique Laparoscopic promontofixation technique.

Laparoscopic promontofixation often remains possible whatever the previous history of pelvic surgery, including the placing of prosthetic material. Preoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30 degrees Trendelenbourg position. After the introduction of trocars, initial surgery comprises interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arch. The anterior face of the promontory is then freed after incision of the posterior peritoneum with the patient placed beforehand in a Trendelenbourg position. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. Postoperative secondary haemorrhage and gastrointestinal occlusion may occur. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis (1.6 to 10% depending on the series) may occur after several months and seems relatively independent of the prosthetic material used.

[Penile metastasis of recto-sigmoid adenocarcinoma. Apropos of a case]. / Métastase pénienne d'un adénocarcinome recto-sigmoïdien . A propos d'un cas.

Metastases to the penis from rectocolic adenocarcinoma are extremely uncommon with 50 cases reported; the diagnosis is often delayed and the prognosis is very poor. The choice between an aggressive surgical approach and a palliative treatment is difficult, but surgery seems to give the best results in limited penile lesions. The authors report a case of metastatic involvement of the penis by a recurrent rectocolic adenocarcinoma in a 42 year old patient. A MR scan was performed before surgical treatment of both lesions.

Somatostatin receptors in prostate tissues and derived cell cultures, and the in vitro growth inhibitory effect of BIM-23014 analog.

We investigated somatostatin receptors (SSTRs) in surgical specimens of prostate cancer and benign prostate hyperplasia (BPH), a normal immortalized epithelial cell line (PNT1), epithelial cancer cell lines, and stromal cells in short-term culture derived from normal and BPH biopsies. Cross-linking studies with 125I-Tyr11-SRIF-14 (125I-SRIF) and the SRIF analog 125I-BIM-23104 identified one major 57-kDa band both in surgical specimens and in epithelial and stromal cells cultures. In membrane-enriched fractions and whole stromal cells from a normal prostate and from one BPH, a single type of SSTR was characterized (Kd = 6.10(-9) and 10(-8) M, respectively, Bmax = 1.6 pmol per mg of proteins). mRNA for SSTR1 was detected in all epithelial and stromal cells tested except for PNT1, while SSTR2 mRNA was detected in one BPH stromal cell culture. BIM-23104 had no effect on the in vitro growth of the epithelial cells tested. Conversely, 10(-10) M BIM-23104 induced >50% growth inhibition of stromal cells after 6 days in culture. These results may have implications for therapeutic strategies using SRIF analogs in BPH and prostate cancer.

[A modified cervico-prostatic incision technic in hypertrophic adenoma in young subjects desiring to preserve ejaculation]. / Technique modifiée du sillon cervico-prostatique dans les adénomes dysectasiants du sujet jeune désirant conserver des éjaculations.

The treatment of bladder neck obstruction by transurethral resection of the prostate is responsible for retrograde ejaculation, which is poorly tolerated by our younger patients. Bladder neck incision, initially proposed as treatment for bladder neck sclerosis and for small prostates, was performed according to a modified technique in 36 patients with a mean age of 57.6 years (range: 41-72 years), with benign prostatic hypertrophy less than 30 grams and wishing to retain antegrade ejaculation. This technique consists of creating a deep groove with the resector hook extending from the ureteric orifice to 5 mm above the verumontanum, incising the full thickness of the detrusor and prostatic urethra as far as the retrocervical fat. This preserves a supramontanal ring of urethral muscle whose contraction during orgasm prevents retrograde ejaculation of semen. Resection of the median lobe was also performed in 8 patients, while sparing the cervical muscular ring. The mean follow-up was 2.4 years (range: 4-84 months). Dysuria was very considerably improved in 32 patients (91.5%), with a Madsen score of less than 2. Antegrade ejaculation was preserved in 32 patients (91.5%). Two patients had to undergo secondary prostatic resection because of persistent dysuria (these 2 patients retained antegrade ejaculation). Unilateral bladder neck incision, sparing a supramontanal muscular ring is an easy, rapid technique with low morbidity, effective in the treatment of prostatism due to a small prostate (less than 30 grams). It is the operation of choice in young patients with small prostates who wish to retain antegrade ejaculation.(ABSTRACT TRUNCATED AT 250 WORDS)