Treatment of urological complications related to aorto-iliac pathology and surgery.

OBJECTIVES: Proximity of ureters with iliac arteries makes them prone to damage by aorto-iliac pathology or surgery. The aim of this retrospective study is to analyse the incidence, the predisposing factors, and the optimal treatment of ureteral stenosis (US) or leakages (UL). DESIGN: Retrospective study. MATERIAL: Fifty-one ureteral lesions in 41 patients referred to the urologist in a fourteen years period in the same institution. METHODS: Lesions are classified in three groups: A, preoperative; B, less than 3 months postoperatively; and C, more than 3 months postoperatively. Group A comprises 10 abdominal aortic aneurysm (AAA) patients; eight of the AAA are of the inflammatory type. Group B comprises 16 patients, 11 US and 9 UL. Group C comprises 15 patients and 15 US. RESULTS: Endoureteral treatment was successful in most of the group B patients. Some of them, however, had to be submitted to secondary open surgery, so that the global success rate is 70% in group B. In group C, the response is poor following endourological treatment alone (12.5% success) and open surgery is more often needed (3 ureterolyses and 1 nephrectomy). Global success rate is 40%. CONCLUSION: Early diagnosis is associated to better results with less invasive procedure; late diagnosis is accompanied by a lower success rate of endourological treatment and requires more often primary open surgery.

Female incontinence: critical analysis of diagnostic procedures.

Urodynamic procedures when required as part of the evaluation of female urinary incontinence should be tailored to the individual case. A wide range of tests are available which are reviewed with hints to which will add most information to previously obtained clinical data.

The Kropp-onlay procedure (Pippi Salle procedure): a simplification of the technique of urethral lengthening. Preliminary results in eight patients.

OBJECTIVE: To lengthen the urethra to increase bladder outlet resistance in adolescent girls with a neurogenic bladder. PATIENTS AND METHODS: During a 2-year period (1992-94), eight girls (mean age 13.5 years, range 9-19) underwent a Kropp-onlay urethral lengthening associated, for six of them, with a bladder augmentation. Seven of the eight patients patients were spina bifida and confined to a wheelchair. One patient had had a previous transverse myelitis. A Benchekroun hydraulic value (in three cases) and a Malone procedure (in two cases) were performed at the same stage. The technique of Kropp-onlay urethral lengthening, which creates a flap value mechanism which leaks when the bladder is too full, is described and illustrated. RESULTS: Seven of eight patients were dry during the day and four were occasionally damp during the second part of the night. One could not be dry for more than 2 h during the day but had a very hyperactive detrusor. She developed two bladder stones which required an open vesicotomy. One developed a urethral fistula requiring a second Kropp-onlay procedure and became dry afterwards. Two patients, who did not undergo a bladder augmentation, needed oxybutinin therapy to obtain a satisfactory result. Post-operative urodynamic measurements are discussed. CONCLUSION: The Knopp-onlay urethral lengthening is easier to perform than the original Kropp procedure. The preliminary results are similar to those of alternative techniques (e.g. urethral suspension) but long-term reliability of this technique remains unknown.

Testis tumor: the problem of the undescended testis.

The increased incidence of testicular cancer occurring in the undescended testis is well documented. Ten to 12% of cryptorchid testes are demonstrated in all series of testicular cancer which is in keeping with a 4 to 10 times increase of the risk. A lot of work is being carried out to elucidate the etiological factors that could explain this increase. A common etiological endocrine factor might be implicated. As it is well known that orchidopexy does not prevent subsequent malignancy, its effects on the histology of the testis and tumor pattern is studied with consideration of age at orchidopexy. Carcinoma in situ (Cis) first discovered in the infertile male population and seen many years before invasive cancer may provide a useful tool for follow-up of cryptorchid patients. According to the results of this work, management of cryptorchid testes is planned as either orchidopexy or orchidectomy, and time and place for biopsies is decided. Life-long follow-up is advocated.

Original lithotomy positioning for transperineal extracorporeal shockwave lithotripsy for distal ureteric calculi with Tripter X1.

Extracorporeal shockwave lithotripsy (ESWL) has been initially designed for stones located in the kidney and the upper ureter. Our lithotripter is no exception. Its components (the table and the orientation of the semi-ellipsoid reflector) are adapted for the treatment of kidney or lumbar ureter stones. However, the elements forming the unit of treatment (the table, the C-arm and the Tripter) can be modified in such a way that focalization of stones of the lower ureter becomes possible through a perineal exposure. The aim is to avoid the pelvic bone shield while a good focalization of the stone is realized. From June 1989 to March 1991, 35 patients were treated for distal ureteric stones by ESWL in this original positioning.

[Ureteroscopic resection of a fibrous polyp of the ureter]. / Resection urétéroscopique du polype fibreux de l'uretère.

From a new case of fibroepithelial polyp in a 41 year old woman, we reviewed literature on this rare and benign pathology, for which differential diagnosis with malignant tumor is most often obtained surgically. We emphasize both diagnostic and therapeutic advantages of endoscopic approach of this lesion.