[Recurrent urethral stenosis treated with a Urolome Plus stent implantation: intermediate multicenter follow-up]. / Sténose urétrale récidivante traitée par implantation d'un stent Urolume Plus: suivi multicentrique à moyen terme.

We present the medium-term results of 33 patients treated with Urolume Plus urethral stent between August 1990 and June 1996 in 9 Belgian and Luxembourg centers. They all had previous treatments for bulbo-membranous urethral stricture, but without sustained benefit (dilatation, internal urethrotomy, or/and urethroplasty). The mean age of the stricture was 5.4 years (+/- 4). The stent was inserted easily during a short hospitalisation. Median time of follow-up is two years (6 months to 4 years). Maximum flow rate at last follow-up was 20.7 ml/sec (+/- 7), and 83.3% of the patients were satisfied with the stent. In 70% of the cases, the stent achieved its purpose of maintaining a good urethral lumen. In 5 patients (15.15%), stricture recurred inside the stent and in 2 patients (6.06%) a new stricture appeared on another site. Among these 7 patients, 5 were satisfactorily treated by endoluminal resection (4 cases) or dilatation (1 case). There were 2 real failures (= 6%): one patient who has refused any complementary endoscopic treatment and the other one who is still undergoing repeated urethral dilatations. Having respected the right indications for this device, we are satisfied of the results. It is a good alternative after failure of other treatments for bulbar-membranous stricture.

[Preliminary results of extracorporeal lithotripsy under local anesthesia using a multimodal generator (Tri-gen Compact Direx C)]. / Résultats préliminaires de lithotritie extracorporelleLsous anesthésie locale avec un nouveau générateur multimodal (Tri-gen Compact Direx C).

From April till October 1994, 64 patients were treated with the new generation of Direx lithotriptors, the Trigen Compact. The treatment was given in one-day clinic. The preparation is made of an intravenous hydratation, Dipidolor intra-muscular, Voltaren intra-rectal and Emla on the skin in the area of the shocks. Only 38 patients are estimated at three months. The first results are encouraging, with globally 78% of good results (stone free or residual fragments inferior to 5 mm) and 22% of failure. The best results (90%) are obtained with the ureteral stones. The results of the treatments of caliceal and pyelo-lithiasis are a little bit less good, with respectively 78 and 71% of good results. These data should become better when all the patients will be estimated at 3 months.

The experience of the CHU Liège with conservative surgery in the management of upper urinary tract tumors.

A review of 20 cases of conservative surgery for urothelial tumors of the upper tract is presented. The morbidity is limited; the recurrence rate is around 15% in the ipsilateral urinary tract with a mean follow up of 41 months. Conservative surgery does not seem to carry a higher fatal risk as compared to more radical surgery. It has indications in some cases which are defined.

[Diagnostic approach to candidates for radical prostatectomy: value of echographic staging]. / Approche diagnostique des candidats à la prostatectomie radicale: intérêt de la stadification échographique.

The last 118 candidates to RPV in the urological department of the CHU Liège were retrospectively analyzed in regard of echographic patterns, anatomopathology and PSA levels. The local extension of the cancer was defined following its echographic patterns with reference to the TNM classification (UICC, 1992). The PSA density (PSAd) and the histological grade of the bioptic specimens were studied. There is a good correlation between the echographic stage, the mean level of PSAd and the anatomical extent of the cancer on the surgical specimen. In cancers classified as T2, 2 sub sub-groups may be identified with different prognosis: T2A and T2B in which a nodal extension or an extra-capsular growth is present in 1/3 of the cases and T2C in which such an extension is observed in one half of the cases. In biopsy grades IV or V, a microscopic involvement of the nodes is observed in 50% of the cases. In the remaining 50% with negative nodes, the surgical specimen shows an extra-capsular extension in 2 cases out of 3 (roughly, 80% of the grades IV-V are over the possibility of cure with surgery alone). The analysis of the specific echographic patterns identifies 3 morphological aspects which seem to carry a bad prognosis: posterior capsular deformity, junctional irregularity and heterogeneity of the lesion. The analysis of PSAd and of the tumoral volume measured by ultrasounds identifies 2 clear-cut values (PSAd > 1 and volume > 3 cm3) over which we now advocate a coelioscopic LAD (important risk of positive nodes).