[Pharmacologic treatment of urinary dysfunctions]. / Traitement pharmacologique des dysfonctions urinaires.

After reviewing the nervous control of the lower urinary tract, the author defines the action of various drugs on the bladder, bladder neck, urethra (smooth and striated sphincter). The drugs are classified according to their stimulant or blocking effect on the sympathetic and parasympathetic nervous systems and alpha and betadrenergic receptors. Drugs acting on smooth and striated muscle fibres are then studied and the iatrogenic adverse effects of these drugs are mentioned.

[Retro-iliac ureter. A new pathogenetic hypothesis. Proposal of an anatomic classification. A study from a review of the literature]. / Uretère rétro-iliaque. Nouvelle hypothèse pathogénique. Proposition d'une classification anatomique. Etude à partir d'une revue de la littérature.

Rétroiliac ureter is a rare congenital anomaly. The authors propose a new pathogenic hypothesis and an anatomical staging and present an analysis of this rare disease based on a review of the world literature.

[Neurotransmission and the lower urinary system]. / La neurotransmission et le bas appareil urinaire.

Various substances, called neurotransmitters, act as a chemical relay between the nervous and the tissue of the lower urinary tract. Some play also a role inside the muscle cell modulating the activity of the myofibrils. To allow a better pharmacochemical approach, these substances are described, their activity analyzed, with the purpose of helping specialists concerned by investigation or treatment of the lower urinary tract, to be able to act on their activity or change their pathologic abnormalities.

[Neurophysiopathology of spinal lesions, evaluation of the 80s. Post-injury assessment and treatment of the neurogenic bladder in the acute period]. / La neurophysiopathologie de la lésion médullaire, bilan des années 80. Le bilan post-traumatique et le traitement de la neurovessie à la période aiguë.

This introductory presentation deals with the recent pathophysiological aspects of the post-traumatic spinal cord lesion and the population concerned. The neurophysiology of the bladder and its sphincters is summarized so as to try and explain some disturbances occurring during the acute phase following a spinal cord injury; their clinical and urological aspects and the methods of bladder drainage.

[Cockett's syndrome and retro-iliac ureter. A previously unknown and original association apropos of a case and review of the literature]. / Syndrome de Cockett et uretère rétro-iliaque. Une association méconnue et originale à propos d'un cas et revue de la littérature.

The authors report a case of Cockett's syndrome discovered by ilio--cava angiography at a patient who was operated on a bilateral retro-iliac ureter which occasioned an important renal insufficiency. After a review of the literature, it appears it is the first case published with such a pathologic association mentioned.

[Neurotransmission and the lower urinary tract]. / La neurotransmission et le bas appareil urinaire.

The neurotransmitter activity in the lower urinary tract is very complex. This paper reviews the main substances, known today, their agonists, antagonists, metabolic pathways and their action and discusses the site of action of neuropharmacological substances. The existence of a non-adrenergic, non-cholinergic pathway, in parallel with the sympathetic adrenergic and the parasympathetic cholinergic pathways is thus clearly admitted.

Surgical treatment of the static perineal modifications in spinal cord or cauda equina lesions.

Severe dysuria, due to insufficiency of the perineal floor associated during micturition with a posterior tilting of the prostate-bladder block in lower or in associated upper and lower motor neuron lesions, can be treated surgically by a prostato cytso pexy. Since 1971, eight patients with post-traumatic conus and/or cauda equina lesions have been treated by this intervention. On the follow-up the satisfactory results appear to remain stable. An alternative surgical technique using the abdominal pyramidalis muscle is described so as to fix the prostate, associated with a bladder-pexy. The recurrence of dysuria, after the intervention, has always been caused by an additional lower urinary tract pathology. The comfort of the patients has been greatly improved.

[The silent kidney. Evolving ultrasonic picture of emphysematous pyelonephritis: the vanishing kidney. Apropos of a case]. / Le rein sourd. Aspect évolutif échographique de la pyélonéphrite emphysémateuse: l'évanescence rénale. A propos d'un cas.

The authors report the progressive disappearing of the sonographical image of a previously visualized kidney in a case of emphysematous pyelonephritis. They have called the sonographic vanishing kidney "the sign of the Deaf Kidney". The non-visualisation of a kidney with advanced emphysematous pyelonephritis is due to the infiltration of the perirenal environment by a gas envelope and the filling of the excretory cavities by gas. The perirenal gas-bag forms a shield against ultrasonic waves. The sonographer must be aware of the eventuality of not being able to individualize a renal structure when wrapped in gas. He must then ask for a zonography of the renal area in order to confirm the gas-containing collection in the kidney.

[Renal obstruction during pregnancy. Internal drainage using the JJ ureteral probe]. / Blocage rénal pendant la grossesse. Drainage interne par sonde urétérale JJ.

The advantage of using JJ ureteral stent during pregnancy in case of ureteral obstruction is shown two clinical observations. We use ultrasonography to control the site of this catheter during the operation and for the follow-up of the patients.

[Medical treatment of metastatic cancer of the kidney with a combination of vinblastine and recombinant interferon alpha IIa. Result of a phase I-II trial]. / Traitement médical du cancer du rein métastatique par l'association vinblastine-interferon alpha IIa recombinant. Résultat d'un essai de phase I-II.

Usual treatments of metastatic renal cell carcinoma are not efficient. Phase II trials using Interferon alpha showed a low response rate (10 to 15%). We have conducted a phase I-II trial using a combination of Vinblastine and Recombinant alpha 2 A Interferon in 21 patients. The response rate is of 43% including 1 complete and 8 partial remissions, 5 stabilizations and 8 progressive diseases. In spite of important side effects, these results are promising.

[Anuria due to bilateral ureteral blockage by the iliac pedicles (retro-iliac ureters)]. / Anurie par blocage urétéral bilatéral sur les pédicules iliaques (uretères rétro-iliaques).

The authors report a case of bilateral retro-iliac ureter with renal failure. The transvascular segments of the ureters were eliminated, and the two ureters were reanastomosed in front of the iliac vessels.

[Fielding's intervention in vesico-ureteral reflux and its limits]. / L'intervention de Fielding dans le reflux vésico-urétéral et ses limites.

Vesico-ureteric reflux in adult patients with normal and dilated ureters (88 ureters) was treated surgically by Fielding's procedure. The authors describe this technique with their own modifications, and discuss the results.

Paraganglioma of urinary bladder.

The literature is reviewed and 2 new cases of paraganglioma of the urinary bladder, 1 malignant and 1 benign, are presented. One patient had no classic symptoms of vesical paraganglioma, and diagnosis was made postoperatively by means of light and electron microscopy. Differentiation between malignant and benign endocrine tumor cannot be made histopathologically and biochemically. The preoperative diagnosis of bladder paraganglioma is established when there is a combination of atypical urinary symptoms and elevation of catecholamines in the urine or blood. The risk of dangerous vasomotor changes needs a multi-team approach for diagnosis and surgical treatment. The pathologic features, histochemical reactions, ultrastructural characteristics, histogenesis, methods for early diagnosis, and detection of multiple localizations or metastasis are briefly discussed. A precise family history should be obtained in any patient with an extra-adrenal paraganglioma to facilitate early diagnosis of tumors in previously unaffected family members or of additional tumors in affected relatives.