Prosthetic reinforcement of varicose saphenous vein grafts for infrainguinal bypass.

Use of varicose saphenous veins for infrainguinal bypass is often contraindicated because of the risk of immediate rupture or long-term aneurysm. In this report we describe four cases in which prosthetic reinforcement allowed successful femoropopliteal bypass grafting using highly varicose saphenous veins while preserving normal endothelium. No thrombosis or any other complication was observed after a mean follow-up of 41 months.

[Malignant neuroendocrine tumor of the bladder: an entity not to be unrecognized]. / Tumeur neuro-endocrine maligne de vessie: une entité à ne pas méconnaître.

The authors report a case of primary malignant neuroendocrine bladder tumour. This rare bladder tumour presents the morphological and immunohistochemical characteristic common to all neuroendocrine tumours observed in other organs. The urologist must recognise this histological entity, which requires multidisciplinary management.

[Percutaneous colposuspension with fixation to the suprapubic fibrous tissues]. / Colposuspension percutanée avec fixation au fibreux sus-pubien.

OBJECTIVES: The authors conducted a long-term evaluation of a modification of the Peyrera-Raz procedure by creation of a fixed point in the suprapubic fibrous tissue. MATERIAL AND METHODS: The authors report a series of 38 patients who, despite pelvi-perineal rehabilitation, presented urinary stress incontinence corrected by Bonney's manoeuvre. Treatment consisted of Peyrera-Raz percutaneous colposuspension modified by superior anchoring of the sutures to the suprapubic fibrous plane. Preoperative assessment consisted of clinical and urodynamic examination. Postoperatively, patients were regularly reviewed in the outpatients department and long-term evaluation of the results was performed by means of a telephone questionnaire. RESULTS: The technical modification did not introduce any particular practical difficulty or any specific infectious or painful morbidity. Postoperative self-catheterizations, for an average of 14 days, were required in 6 patients. 9/38 (24%) presented recurrence of their incontinence within the first 6 months; reoperation by a suburethral sling allowed definitive correction of the disorders. 29/38 (76%) were satisfied or very satisfied with the result of their operation with a mean follow-up of 3.2 years, although 6 of them presented minimal incontinence on very intense, unusual efforts. CONCLUSION: Percutaneous colposuspension, modified by superior anchoring of the sutures to the suprapubic fibrous tissue, allows effective treatment of urinary stress incontinence with limited morbidity in 3/4 of cases, with a mean follow-up of more than 3 years.

[Recurrent febrile infections of the urinary tract and diverticulum of the urachus]. / Infections multirécidivantes fébriles du tractus urinaire et diverticule de l'ouraque.

The urachus can present a partial or complete obliteration defect. If the defect is situated in its vesical extremity, it then forms a diverticulum. The authors report a case of diverticulum of the urachus in a young adult, responsible for recurrent febrile urinary tract infections since the beginning of adolescence. The diagnosis was suggested by ultrasonography and magnetic resonance imaging and confirmed by cystoscopy and histological examination. Treatment consisted of complete surgical resection via a suprapubic incision.

New experimental model of ureteropelvic junction obstruction allowing easy access for percutaneous surgery.

To assess the usefulness of an experimental model of ureteropelvic junction (UPJ) obstruction designed to facilitate subsequent percutaneous surgery, a right UPJ obstruction was created in 10 pigs by an open retroperitoneal surgical approach. With the pig in the left lateral decubitus position, a 0.038-inch Terumo guidewire was inserted via a 1-cm longitudinal upper-third ureterotomy and advanced up and down so as to bridge the UPJ from the flank to the urogenital opening. A UPJ obstruction was then induced by securing two 2-0 chromic gut ties, separated by an interval of 1 cm, over the Terumo guidewire and a 6F ureteral catheter, which was removed immediately after this procedure. After closure of the ureterotomy, the kidney was anchored horizontally to the muscle wall, and the Terumo guidewire was coiled subcutaneously in the flank and fixed to the urogenital opening. Each pig developed marked hydronephrosis, diagnosed by ultrasonography, after a mean interval of 8.3 days. Retrograde ureteropyelography confirmed this pronounced dilation of the right collecting system above a tight UPJ stricture (mean length 1.17 cm). Subsequent percutaneous access to the UPJ over the Terumo guidewire in the lateral decubitus position was facilitated by the almost-horizontal plane of dilation (mean operating time 14 minutes). Pathologic examination of the UPJ revealed mild periureteral fibrosis, but the muscle layer and urothelium remained normal. We have developed a reliable and reproducible model of secondary UPJ obstruction especially designed for percutaneous surgery. This model should provide a better understanding of current endoscopic techniques such as endopyelotomy and could help to promote new treatment concepts such as percutaneous endoscopic pyeloplasty.

[Intradiverticular bladder tumors. Five case reports]. / Tumeur de vessie intra-diverticulaire. A propos de 5 cas.

OBJECTIVE: To define the diagnostic and therapeutic approach to intradiverticular bladder tumour. METHODS: Five cases are reported in which initial diverticulectomy was followed by cystectomy in one case, systemic MVAC chemotherapy in 2 cases and concomitant radiotherapy-chemotherapy (CRC) in 2 cases. RESULTS: One patient has died (MVAC), one patient is in partial remission (MVAC) and three patients are in complete remission (1 cystectomy and 2 CRC). CONCLUSION: Intradiverticular bladder tumour is a disease with a poor prognosis, whose histological features require aggressive treatment. Concomitant radiotherapy-chemotherapy appears to be a useful alternative.

[Dissecting aneurysm of the external iliac artery. An unusual course of endofibrosis in an athlete]. / A nevrisme disséquant de l'artère iliaque externe. Une evolution inhabituelle de l'endofibrose du sportif.

A 42-year-old man was consulted because of a pain in his left leg. He was a highly trained biker since 20 years. The echo-Doppler and arteriography evidenced a stenosis, probably due to endofibrosis of the external iliac artery. In addition, it showed an aneurysm and an intimal dissection of this artery. The arteriography confirmed this diagnosis, and normal aspect of the other arteries. Neither conservative nor endovascular treatments were possible because of the anatomic lesions. We resected the external iliac artery and performed a by-pass with the great saphenous. The result at the 5th month was clinically good. The echo-Doppler control did not show any abnormality. The natural course of the endofibrosis of athletes is unknown, although stenosis, revealed by intermittent claudication is usually observed. Only a few cases of dissection and no aneurysmal degeneration have been described before.

Eversion of the rectum. A simplified technical approach to ileoanal anastomosis.

Eversion of the rectum allows complete excision of the rectum. Here, we describe a modification of the stapling technique of ileoanal anastomosis, which leads to a safer anastomosis.

[Hypothyroidism and immunotherapy using interferon or interleukin for metastatic renal adenocarcinoma]. / Hypothyroïdie et immunothérapie par interféron ou interleukine pour adénocarcinome rénal métastasé.

The authors report a case of hypothyroidism occurring during cytokine treatment of metastatic renal cancer. This is a relatively rare complication of immunotherapy, whose aetiopathogenesis remains unclear. Possible hypotheses include an autoimmune process or direct toxicity. Thyroid function tests at the start of immunotherapy and regular monitoring are therefore recommended during treatment with interferon and/or interleukin. If hypothyroidism is not recognised, its clinical symptoms and signs could be attributed to cytokine toxicity, leading to unwarranted discontinuation of treatment when L-thyroxin replacement therapy would have been sufficient.

[Laparoscopic drainage of a lymphocele after radical prostatectomy]. / Drainage laparoscopique d'une lymphocèle après prostatectomie radicale.

A laparoscopic procedure used to achieve transperitoneal drainage of a lymphocele that developed three months after radical prostatectomy for prostate cancer is described. The lymphocele wall was resected through a peritoneal opening. After drainage of the lymphocele, a corner of the omentum was inserted into the cavity. Preoperative aspiration of the lymphocele and computed tomography allowed accurate evaluation of the relationships of the lymphocele with the blood vessels, urinary tract, and digestive tract. These investigations also ruled out an infection and established the diagnosis of lymphocele. Laparoscopic drainage has the same indications as conventional internal drainage and readily allows to perform the same procedures. As a conventional internal drainage and readily allows to perform the same procedures. As a simple procedure associated with low morbidity, laparoscopic drainage could be used as the first-line treatment for large, symptomatic, recurrent lymphoceles developing after pelvic surgery, in particular after extraperitoneal procedures such as radical prostatectomy, provided there is no infection, the lymphocele is readily accessible, and the surgeon is experienced in the use of laparoscopic techniques.