Solitary brain metastasis as only recurrence of a carcinoma of the bladder.

A case of solitary brain metastasis from a transitional carcinoma of the bladder occurring 20 months after resection is presented. The patient underwent gross total removal followed by external irradiation and intravenous chemotherapy. The tumor in this quite unusual occurrence had a very characteristic aspect, both operatively and at pathologic examination. We believe that these patients should be managed aggressively whenever possible.

[The "double J" endo-ureteral prosthesis. Experience apropos of 21 cases]. / La prothèse endo-urétérale "double J". Expérience à propos de vingt et un cas.

Following Finney's work on the subject, the authors propose an endo-ureteral diversion using the new double J ureteral catheter stent. In the light of their experience of 21 cases, the authors stress the speed and simplicity of this very minor operation, and propose wider indications.

Effect of calcium restriction on renal excretion of oxalate and the probability of stones in the various pathophysiological groups with calcium stones.

To evaluate the adequacy of simple calcium restriction for patients with idiopathic calcium stones the effect of 5 days of calcium restriction without oxalate restriction on renal excretion of calcium and oxalate, and the corresponding probability of stones were assessed in 50 controls and 48 patients. Renal excretion of calcium decreased and that of oxalate increased significantly in all groups but the importance of the changes was critically dependent upon the underlying pathophysiological condition. The probability of stones decreased only in patients with absorptive hypercalciuria type II owing to the usual excessive calcium intake and increased in those with absorptive hypercalciuria type I and renal hypercalciuria, which are associated with true hyperabsorption of calcium and represent the 2 forms of idiopathic hypercalciuria. We believe that simple calcium restriction is beneficial for patients with idiopathic calculi only when the hypercalciuria is caused by exaggerated intake of calcium, since it increases the probability of stones in patients with idiopathic hypercalciuria. Calcium restriction always is associated with an increase in oxalate excretion, suggesting that simultaneous oxalate restriction should be added in all cases to decrease the probability of stones.

[The surgical treatment of incontinence in the male (author's transl)]. / Traitement chirurgical de l'incontinence chez l'homme.

The authors undertake a complete review of the various techniques used for the surgical treatment of urinary incontinence in the male. Urethral repair (Young operation) has been abandoned. Creation of a smooth muscle sphincter in bladder gives approximately 32% continence. Use of the anal sphincter to ensure continence of the urethra gives approximately 60% good results. Urethral or bladder neck suspension by aponeurotic strips have given only 42% good results. Perineal muscular plasty procedures resulting a certain compression of the urethra have given approximately 68% good results. Perineal prostheses, despite a certain number of complications (fistulae, infections, urethral erosions) give 37% good results when all the published series are grouped together. Continence prostheses (Scott or Rosen) have given the same percentage of favourable results: 60%. In this review, the authors report the 13 operations which they have performed with insertion of a Kaufmann prosthesis with, in the long term, 6 continent patients out of the 13. Radiological analysis of micturition in these patients with a good result would appear to suggest to the authors that the Kaufmann prosthesis does not act only by simple compression of the urethra but provides a still tonic urethra with a support which enables it to play a role in continence. So much so that the prior study of the efficacy of urethral compression could be used to choose between the insertion of a Kaufmann prosthesis or the immediate recourse to artificial sphincters.