[Color doppler echography in the exploration of vasculogenic impotence]. / Echographie-doppler couleur dans l'exploration de l'impuissance d'origine vasculaire.

102 patients with suspected vasculogenic impotence were evaluated with color doppler sonography. Measurement of normal systolic and diastolic velocities were obtained from the cavernosal arteries of patients responding by a full erection after intra-cavernosal injection of 20 mg of Papaverine. A correlation with cavernosometry was obtained in 61 patients and with selective internal pudendal arteriography in 11. The 10 patients with abnormal arteriograms had a systolic velocity < 25 cm/sec. 13 out of the 15 patients with an end diastolic velocity > 5 cm/sec had a venous leak defined by a maintenance flow rate of erection during cavernosometry > 25 ml/mn. End diastolic velocity is an excellent index of the function of the veno-occlusive system, provided the systolic velocity remains at a normal value. In case of arterial insufficiency, a diastolic flow < 5 cm/sec is of no value and cavernometry is mandatory to detect a mixed arterio-venous impotence. The addition of color doppler sonography permitted a more rapid detection of vessels and an easily reproducible measurement of velocities which makes color doppler sonography an excellent screening test for examining patients with potential vasculogenic impotence.

[Technical problems raised by renal puncture in the percutaneous extraction of coralliform calculi]. / Problèmes techniques posés par la ponction du rein dans l'extraction percutanée des calculs coralliformes.

Initial puncture and dilation of nephrostomy track(s) remain difficult procedures in percutaneous extraction of staghorn calculi. Technical s adjuvants are necessary and are exposed in detail. The choice of the needle, of the wires and of the catheters for initial puncture and ureteral catheterization is explained. Techniques of "Y" tract and double puncture are exposed. Severe complications (3 cases) are reported. Extraction of up to 90% of the stone can be expected if these technical adjuvants are optimally used.

[Transrenal percutaneous treatment of urinary fistula. Apropos of 19 cases]. / Traitement par voie percutanée transrénale des fistules urinaires. A propos de dix-neuf cas.

Percutaneous nephrostomy (PCN) was used to treat 16 ureteral fistulas, two ileal fistulas following ileo-cystoplasty, and one pelvic fistula. Discharge resolved in all cases. PCN alone achieved complete recovery of the ileal and pelvic fistulas. Insertion of a wire-guide through the fistula into the bladder and stenting of the ureter for 5 to 20 days with a 8 to 10 F multi-side-hole catheter was possible in 12 of the ureteral fistulas and ensured complete recovery in every case. Because of complete stenosis, this procedure failed in the four other cases of ureteral fistula, and surgery was therefore required. Transrenal percutaneous treatment of urinary fistulas is a simple, effective procedure requiring only local anesthesia, and can be recommended in recently operated patients, and when retrograde catheterization is inadvisable (ileo-cystoplasty).

[Percutaneous nephrostomy and its applications. Personal experience]. / La néphrostomie percutanée et ses applications. Expérience personnelle.

211 percutaneous nephrostomies (PCN) have been performed on 189 patients under combined fluoroscopic and reel time ultra-sound guidance. 4 major complications occurred with consisted in one hemorrhage and 3 septicemias. Indication of the PCN was diagnostic in 35 cases and therapeutic in 176 cases. Decompression of pyelo-caliceal system (89 cases) among with 72 in emergency, drying of an urinary fistula (8 cases), balloon dilatation of benign ureteral stenoses (18 cases) and treatment of 60 renal stones (3 dissolutions and 57 extractions). Results showed the drying of the fistula in all cases, the long term success of the balloon dilatation in 50% cases and 80% success rate of stone extraction.

[Percutaneous nephrostomy under echographic guidance. Apropos of 31 cases]. / Néphrostomie percutanée sous guidage échographique. A propos de 31 cas.

31 percutaneous nephrostomies (P.C.N.) were realised under a combination of real time ultrasound and fluoroscopic guidance. No failure in placement of the nephrostomy tube was noted. 13 complications were noted in 9 patients: 3 were major, consisted in 1 severe hemorrhage and 2 septicemia and 10 were minor, mainly caused by secondary displacement of the tube. Three indications of P.C.N. are related to upper urinary tract obstruction: 1) Overdistension and fever or pain associated with poor patient's condition. 2) Short-term obstructions. 3) Diagnosis of the nature or location of the obstruction when other techniques don't provide the solution, and/or evaluation of renal function. The drainage of some ureteral fistules represent the fourth indication. P.C.N. allows ureteral antegrad catheterization and its applications. Results are discussed and present or future applications of interventional uro-radiology are related.