[Surgical treatment of priapism: experience of 56 cases in an African setting]. / Traitement chirurgical du priapisme expérience de 56 cas en milieu Africain.

Since priapism is uncommon, treatment is controversial and difficult. In this article we describe a practical, well-documented approach for management of priapism in countries with a high incidence of sickle cell disease. This approach is based on our experience including a total of 56 black patients (49 adults and 7 children) as well as on the results reported in the literature. The patients in our series were examined and treated by the same physician over an 18 year period in various African countries, i.e., Burkina (n = 8), Chad (n = 12), Gabon (n = 19), and Niger (n = 17). Etiologies and pathophysiology are reviewed. In all cases, surgical treatment involved diversion from corpora cavernosa. In the 51 cases with follow-up periods of 3 months or longer, results were considered as excellent in 17 cases (33 p. 100), partial in 5 (9.8 p. 100), and unsuccessful in 29 (56.8). Since 1984, needle drainage with a unilateral transglandular cavernosal-spongiosum shunt based on the technique described by Al Ghorab's has led to better results with immediate detumescence in 80 p. 100 of cases and a long-term success rate of 52 p. 100 (13/25 cases with sufficient follow-up). Except in cases involving sickle cell anemia in which concomitant medical treatment of priapism can be useful, immediate surgical treatment is the only technique effective in avoiding secondary impotence, which was common in our series (58.6). Our p. 100 needle drainage technique appears to be the method of choice for simplified achievement of a unilateral transglandular cavernosal-spongiosum shunt.

[The annual meeting of the American Association for Cancer Research (AACR), Toronto (Ontario), 18-22 May 1995]. / Le 86e congrès de l'American Association for Cancer Research (AACR), Toronto, Ontario, 18-22 mai 1995.

The state of the art concerning major biological phenomenons of importance for current research on urological cancers is first briefly presented, followed by notes on the more outstanding presentations in this field. These notes are organized in a synthetic fashion, in order to point to the meaning of the hypotheses and findings presented, when taken together, as they pertain to the understanding of the mechanisms at play in urological cancers, as we see them in 1995. Some concepts seem to have now reached a point where we can expect to see some applications in a not so distant future: in prostate cancer, it is confirmed that the machinery of apoptosis is functional even in the hormone-insensitive cells, suggesting that its enhancement might be useful in these often difficult situations; techniques to detect circulating malignant cells, which have been greatly refined (RT-PCR of PSA and PSM), are now extremely sensitive and may prove unvaluable in providing intermediate end points to compare the relative efficacy of treatment regimens in clinical trials; the symposium on prostate cancer screening by PSA dosage was an excellent opportunity to review extensively the data available on this topic, but -as expected- it could not decide on some essential issues; in bladder tumors, data on the expression of adhesion molecules (CD44 variant) are still preliminary, but some provocative observations have been reported (presence on mature ARN, only in bladder cancer cells, of intronic sequences that have not been excised); in renal cell cancer, a considerable amount of knowledge has accumulated on the von Hippel-Lindau gene, a putative anti-oncogene, and work is in progress to define the function of its protein; finally, pathways essential to understanding and treating cancer have been dissected, particularly the apoptosis-proliferation network, and the involvement in it of p53, Waf-1 and the bcl-2 gene family cascade.

Cancer serum index: a useful nonspecific test as a parameter in multimodality screening and assessment of patients with cancer of the prostate.

A satisfactory, simple test for screening and monitoring of patients with prostatic cancer is still being sought. We suggest the use of a nonspecific test in combination with other tests. The ratio of two serum proteins (alpha 1 acid glycoprotein [AGP] and prealbumin [PAB]), may be useful markers for a cancer serum index (CSI). By separating serum components by gradient polyacrylamide gel electrophoresis, staining and quantitating these proteins by scanning densitometry, and dividing the area of AGP by that of PAB, indices can be obtained. In a test of sera from 450 patients with prostatic cancer, other urologic problems, and normal controls, CSIs of 360 sera presently decoded were found to be: (Formula: see text). The CSI should prove highly valuable when used in combination with selected prostatic cancer tests.

[Renal autotransplantation or iliac transposition of the kidney after section of its vascular pedicle. Apropos of 2 personal cases. Review of 100 published cases]. / Auto-transplantation rénale ou transposition iliaque du rein après section de son pédicule vasculaire. A propos de 2 cas personnels. Revue des 100 cas publiés

Two cases of auto-transplantation of the kidney are presented. The first was carried out without prior planning during a ureterolysis procedure for retro-peritoneal fibrosis with a single kidney, by virtue of per-operative thrombosis of the renal artery. The second was used in the treatment of hypertension due to bilateral atheromatous renal artery stenosis with a lesion at the main bifurcation of the artery. In both these cases in which the surgical indication was related to the artery, the ureter was left intact. After 2 and 1 years respectively, the results are good. The important points of operative technique and tactics are emphasised. The order of the technique is important. It resembles that of homo-transplantation but in this case section and reimplantation of the ureter may be avoided. Preservation of the disconnected kidney is ensured by refrigeration with intra-arterial perfusion. Even if only for a short time, it consistently avoids the development of ischaemic tubulopathy. Ex-sito surgery, studied here in detail, is used in dealing with intra-hilar arterial lesions, tumours of both kidneys or a single remaining kidney, complicated cases of lithiasis etc. The results of the 100 known cases of renal auto-transplantation are analysed. They are good in 84 cases. The indications are discussed with regard to the different types of arterial, ureteral, neoplastic, traumatic and miscellaneous lesion.