[Mean biopsy length: an objective criterion of the quality of prostatic biopsies]. / La longueur moyenne des biopsies prostatiques: un critère de qualité objectif.

OBJECTIVE: To evaluate the quality of prostatic biopsies (PB) by studying the mean biopsy length (Lm) and its impact on the result. MATERIALS AND METHOD: Prospective study on 78 consecutive PBs (extended 10 biopsy protocol) performed for PSA > 4 and < or = 12 ng/ml. Biopsy reports were standardized and computerized and indicated a global PB quality criterion and Lm. Biopsies were classified by Lm. The presence of carcinoma was studied in each group. RESULTS: The mean age was 67.5 years (50-80). The mean Lm of PB described as good quality (46.15%) was 11.8 mm (8.5-13.8) versus 6.6 mm (2.1-10.7) for the other PBs (53.85%) (p< 0.001). Lm was < 8 mm for 38% of PBs and > or = 12 mm for 23%. 31.8% of PBs with Lm < 10 mm detected a cancer versus 41.2% of PBs with Lm > or = 10 mm (p>0.1). The mean cumulative length of carcinomatous sites of positive PBs with Lm < 10 mm was 9.42 mm (1-39) versus 18.42 min (1-60) for Lm > or = 10 mm (p<0.001). CONCLUSIONS: A standardized protocol does not guarantee the quality of PB. Lm is an objective criterion indicative of the global quality of PB. An Lm < 10 mm underestimates cancer detection. PB must be interpreted according to an objective quality criterion indicated in the conclusion of the report.

[Early metastatic dissemination after nephro-ureterectomy for upper urinary tract tumour: a possible role of laparoscopy?]. / Dissémination métastatique précoce après néphro-urétérectomie pour tumeur de la voie excrétrice supérieure: quelle responsabilité de la coelioscopie?

Laparoscopic nephro-ureterectomy has been proposed as an alternative to conventional double-incision surgery to treat upper urinary tract tumours. A case of hepatic and pulmonary metastatic dissemination four months after laparoscopic nephro-ureterectomy for pT3 N0 M0 intra-renal urothelial carcinoma raises the question of the possible role of laparoscopy in the rapidly unfavourable course of the disease. This case is discussed in the light of a review of the literature.

[Organization and innervation of striated muscle fibers of the striated sphincter in the rat]. / Organisation et innervation des fibres musculaires striées du rhabdosphincter du rat.

OBJECTIVES: To determine the organization of striated muscle fibre (FMS) of the rat striated sphincter (SS) and to characterize the motor endplates (MEP). MATERIAL AND METHODS: The urethras of 30 male and female rats were studied. Two thousand hematein-eosin stained serial sections and 800 sections simultaneously stained for MEPs and nerve endings were studied. RESULTS: The SMFs of the SS are organized in the urethral wall in four symmetrical bands. MEPs are predominantly found in the cranial third of the SS (22 MEPs per section). Sixty sixteen per cent of MEPs were situated in the lateral regions. Motor units were composed of a maximum of five SMFs. CONCLUSION: The SMFs of the SS are organized in four symmetrical bands. Myoconnective insertions of SMFs emphasize the importance of the connective tissue in their contractile action. They are innervated by a single MEP, in the same way as skeletal striated muscle fibres. In the SS, MEPs are predominantly located laterally to the right and to the left. The specific organization of motor units suggests an original mechanism of reinforcement of muscle contraction of the SS.

The striated urethral sphincter in female rats.

The aim of this study was to give a microscopic description of the organization, the innervation and the slow or fast type of the striated fibers of the external urethral sphincter in the female rat. Conventional methods for photonic microscopy and immunochemistry were applied to cross and longitudinal sections of snap-frozen urethra. With hematoxylin-eosin stained cross sections, striated fibers are of small diameter and attached directly to the surrounding connective tissue. They are innervated by cholinergic endplates as shown by acetylcholinesterase techniques and alpha-bungarotoxin binding. The histological aspects of the cross sections as well as the distribution of endplates along the length of the sphincter suggest an organization of the fibers in four bundles, possibly acting as a photographic diaphragm does. Like striated skeletal muscle fibers, the fibers bind monoclonal antibodies against dystrophin with subsarcolemmal distribution and against desmin which visualizes striations. All the fibers express fast myosin heavy chains and very few co-express slow myosin heavy chains as determined by immunocytochemistry. We are taking advantage of the diaphragmatic organization of the striated sphincter to develop a longitudinal section as a model of chronic incontinence to test the efficiency of grafted myoblasts provided by fast striated skeletal muscle.

Pinball calculus in a ureterosigmoidostomy.

We report a complication during the treatment of lithiasis with extracorporeal shock wave lithotripsy in a patient with a ureterosigmoidostomy. This woman presented with renal colic bilaterally and renal insufficiency and was found to have an extremely mobile calculus. A significant gaseous reflux from the sigmoid colon was found to propel the solitary calculus in a retrograde fashion across the ureteroileal anastomosis up the ureter into one kidney, and then later, after re-descent to the level of the anastomosis, up into the opposite kidney. After several days of playing hide and seek with this migrating calculus, using extracorporeal shock wave lithotripsy, the patient became stone free.

[Cavernosal metastases from bladder tumour after cystoprostatectomy]. / Métastases caverneuses de tumeurs de vessie après cystoprostatectomie.

OBJECTIVE: To evaluate the predictive factors for cavernosal metastases after cystoprostatectomy for transitional cell bladder cancer. MATERIAL AND METHOD: Between February 1998 and January 2002, 61 men were treated by cystectomy for transitional cell bladder cancer (56 total cystoprostatectomies and 5 partial cystectomies). Five patients (8%) subsequently developed cavernosal metastases. The assessment criteria were classified into three categories: clinical history, histological findings on the operative specimen and follow-up data. RESULTS: The metastasis was observed an average of 8.4 months (range: 3-17) after cystoprostatectomy. Three of the 5 patients had a history of transurethral procedure at the same time as resection of a high-grade invasive bladder tumour: a urethral recurrence concomitant with the penile metastasis was observed in these cases. In 4 out of 5 cases, the bladder tumour was multifocal, involving the bladder neck, extensive and high-grade (> or = pT3 G3). Vascular tumour emboli were detected on the cystoprostatectomy specimen in 4 cases. All urethral sections performed during cystectomy were negative. All 5 patients died with a mean survival of 7 months (range: 1 to 21 months). CONCLUSION: The development of penile metastases after cystectomy appears to be frequently associated with the presence of extensive tumour (> or = pT3) on the operative specimen, involving the bladder neck, with a high histoprognostic grade and with the presence of tumour embolus. No transurethral procedures should be performed at the same time as resection of an obviously invasive bladder tumour. Health urethral sections do not exclude the risk of penile metastases.

[Epidemiology of urological emergencies in a teaching hospital]. / Epidémiologie des urgences urologiques en Centre Hospitalier Universitaire.

OBJECTIVES: To quantitatively evaluate the emergency activity of a teaching hospital urology department. To determine the epidemiology of urological medical and surgical emergencies. MATERIAL AND METHOD: Single-centre prospective study conducted in one of the 9 teaching hospital urology departments of the Paris region equipped with an emergency room. The on-call team consisted of an intern and a hospital student on the spot, a Senior Registrar on call. Evaluation was based on daily computer records of all consultations performed by the intern outside of the urology department, and all emergency surgical operations performed during the out-of-hours period (8:00 p.m. to 8:00 a.m.). RESULTS: A total of 1,715 consultations were performed, 15.6% of which required admission to hospital. Eleven per cent of consultations in the emergency department were transferred from another centre. Emergency surgery was performed in 5% of cases. 37 multi-organ harvests and 54 renal transplantations were also performed during this same period. Mean age: 53.18 years (range: 15-100). 12% of patients were over the age of 80 years. Sex-ratio: 78% of males, 22% of females. The most frequent presenting complaint was low back pain (25%). The diseases most frequently encountered were infectious (19.2%). 30% of emergency surgical operations were performed for drainage of obstructive pyelonephritis. Bladder tumours were the cancers most frequently responsible for emergency consultations (35%) and traumatology represented 8.7% of emergency consultations. CONCLUSION: Urological emergencies in a teaching hospital constitute a distinct clinical activity, which requires specific material and human resources. This exhaustive study could be used as a basis for review of the organization of the management of urological emergencies.