[One-stage bilateral rigid ureteroscopy]. / L'urétéroscopie rigide bilatérale au cours de la même séance opératoire.

OBJECTIVE: To evaluate the results of one-stage bilateral rigid ureteroscopy for the treatment of bilateral ureteric stones and to identify predictive factors of failure. MATERIALS AND METHODS: From January 1995 to June 2006, 61 patients were hospitalised for bilateral ureteric stones. Fifty patients, that is, 100 renal units were treated by first-line one-stage bilateral rigid ureteroscopy using an 8 F rigid ureteroscope and a ballistic lithotriptor. A complete statistical analysis (bivariate analysis completed by multivariate analysis) was performed to identify predictive factors of intraoperative failure. RESULTS: The overall success rate per patient (success on at least one side) was 92% (with bilateral success in 70% of cases). Statistical analysis revealed a statistically significant difference between the two failure/success groups for mean stone diameter (p < 0.1%), site (p = 0.6%) and degree of cavity dilatation (p = 4%). Similarly, a strong statistical correlation was observed between these variables and intraoperative failure. The intraoperative complication rate was 4% (two patients) and the postoperative complication rate was 16%, corresponding to minor complications in every case (low back pain, fever) not requiring a supplementary procedure. CONCLUSION: One-stage bilateral rigid ureteroscopy achieved satisfactory results similar to those of unilateral ureteroscopy. Predictive factors of failure were: stone diameter (greater than 15 mm), stones in the lumbar ureter and marked cavity dilatation.

[Intravesical migration of intrauterine device resulting in stone formation]. / Migration intra-vésicale de dispositif intra-utérin compliquée de lithiase.

The migration into the bladder of an intrauterine contraceptive device (IUCD) by uterine perforation is a rare complication. We report two cases of IUCD which migrated into the bladder and subsequently became calcified. The two patients having had their IUCD respectively for 3 and 13 years. Revealing signs were related to bladder irritation for the first patient and hematuria for the second. The diagnosis was suggested on the plain abdominal X-ray and on ultrasound and was confirmed by cystoscopy. Ballistic lithotripsy of the bladder stone with endoscopic extraction of the IUCD was then performed. Performing a transvaginal sonographic examination of the pelvic organs, especially of the uterine anatomy is interesting before insertion of an intrauterine contraceptive device (IUCD), and repeat transvaginal sonographic examinations immediately after the insertion and 4-12 weeks later are advisable. This approach would permit early detection of any complications related to insertion of the IUCD.

[Retroperitoneal schwannoma. Diagnostic and therapeutic outcome]. / Schwannome rétropéritonéal. Démarche diagnostique et thérapeutique.

Two cases of retroperitoneal benign schwannoma are described with a review of literature. Are analysed the clinical and anatomopathologic features of this rare tumor and the methods of diagnosis. The treatment is the surgical ablation of the tumor commonly easy and complete. When malignancy is established, adjuvant procedures add little to life expectancy and total surgery is done likely to be effective.

[Attempted classification of scrotal contusions]. / Essai de classification des contusions scrotales.

We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.

[Contusions to the pathologic kidney. A retrospective study, apropos of 34 cases]. / Les contusions sur rein pathologique. Etude rétrospective, à propos de 34 cas.

The authors report a retrospective study of 34 cases of blunt renal trauma affecting a pathological kidney out of a total of 156 cases of renal trauma. The patients were between the ages of 3 and 60 years, with a male predominance (sex-ratio: 2.4). The predominant cause of trauma was a household accident, in 15 cases (44%). The clinical features were dominated by haematuria and pain. The underlying renal disease was dominated by renal stones (15 cases, 44%) and ureteropelvic junction (UPJ) abnormality (10 cases, 29%). Twelve patients with benign trauma and minimal underlying renal disease were treated conservatively. Surgery was indicated in the remaining 22 patients, but only 20 were actually operated. Nephrectomy was performed in 9 patients and partial nephrectomy was performed in 3 patients. Treatment consisted of UPJ plasty in 2 cases, uretero-caliceal anastomosis in one case, stone surgery in 4 cases and suture of ruptured renal pelvis in one case. The postoperative course was marked by the development of a urinary fistula in 1 patient, cured by drainage and deterioration of hydronephrosis in one patient. Lastly, one patient died from Wilms' tumour. This disease therefore tends to have a fairly benign course, which nevertheless depends on the underlying renal disease.

[Rupture of the excretory urinary tract due to a lithiasis of the pelvic ureter]. / Rupture de la voie excrétrice urinaire sur lithiase de l'uretère pelvien.

A case of rupture of the urinary tract related to lithiasis of the pelvic ureter is reported. Outcome was favorable after percutaneous drainage of the urinoma and removal of the stone using a Dormia catheter. Clinical diagnosis was readily established on the patient's history and on ultrasound and intravenous urogram findings.

[Gangrenous conditions of the perineum and the genital area. Apropos of 15 cases]. / Les états gangréneux du périnée et de la sphère génitale. A propos de 15 observations.

The authors report 15 cases of gangrene of the perineum and genital organs: 10 patients with urological lesions (urethral stricture: 6 cases, benign prostatic hypertrophy: 3 cases, bladder stones: 1 case) and 5 patients with Fournier's disease. The unexpected recrudescence of this disease, its persistent severity, the limits of our understanding of the pathogenesis and the therapeutic problems involved, led the authors to analyse this series of cases which, despite an apparent diversity of aetiologies, retained common anatomical, bacteriological and therapeutic features. They stress the importance of emergency surgery, appropriate antibiotics and postoperative intensive care. The mortality remains high (5 patients in this series died).