[Which technic for which form of hypospadias?]. / Quelle technique pour quel hypospadias?

Based on our experience of 700 interventions for hypospadias from 1980 to 1995, the author describes the important factors to take in consideration to decide upon the ultimate technique to use. This choice is quiet easy for a mild or severe hypospadias, and is essentially based on the use of the Transverse Island Flap, used as a tube or as on Onlay, depending the existence of chordee and curvature, the surface of the prepuce and the length of the urethral defect. For cases of distal hypospadias, the choice of the right technique is even more difficult. Factors to be considered are, chordee or not, aspect and localisation of the meatus, the shape and the volume of the glans, the quality of skin recovering the distal urethra and presence or not of corpus spongiosum at the level of the distal urethra. The author discusses the importance of all this parameters, combined or not, in the choice of which technique for which hypospadias.

[Trans-glandular urethral advancement for distal hypospadias. A 16-year experience]. / Avancement uréthral transglandaire (A.U.T.) pour hypospadias distal. Seize ans d'expérience.

Eighty six patients where operated by the urethral transglanular advancement technique. During this period, we modified the reconstruction of the meatus to prevent the uncosmetic appearance of the meatus, resulting from the initial technique. The results were excellent. In 40 patients (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis with a follow-up of at least 7 to 16 years after the intervention. In conclusion, we think that the fear of ischaemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilisation, is unjustified.

[Transverse island flap for the correction of mild and severe hypospadias]. / Le lambeau préputial transversal pédiculé pour la correction d'un hypospadias moyen et sévère.

After presentation of the results in 225 patients operated for hypospadias by the Transverse Island flap technique, the author describes the operative technique, the advantages and limitations. Two variations upon the technique, the onlay and the dorsal pediculated flap are described as possible alternatives, each with its own indications.

Colpopromontoriopexy.

This is a review article about the colposacropexy and the colpopromontoriopexy in the treatment of vaginal prolapse. We reviewed the literature through the eyes of a urologist dealing with genuine stress incontinence. The treatment of genuine stress incontinence without sphincterdeficiency consists in the correction of the anterior compartment prolapse. Preoperative it is important to examen the middle and the posterior compartment of the vagina in order to achieve good postoperative results. Most urologists cure genuine stress incontinence with an abdominal approach. The combination of a colposuspension and a colpopromontoriopexy is an operation that corrects anterior, middle and posterior compartment prolapse by the same approach without significant more complications or bloodloss.

Urethral advancement for distal hypospadias: 14 years' experience.

76 patients with distal hypospadias were operated on with this technique. The technique is first shortly described. A modification of the meatal reconstruction prevents the uncosmetic flattening of the glans. The overall results were excellent. In 40 cases (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis in a follow-up of at least 5-14 years after the operation. We conclude that the fear of ischemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilization is unjustified.

Undiversion after previous cystectomy and Bricker derivation.

A 45-year-old man operated in 1989 for bladder cancer by a Bricker diversion was suffering from intractable eczema and stoma problems. A undiversion was unavoidable. A 'Camey type' diversion having been performed, a simple ligation of the membranoprostatic urethra seemed impossible but was in fact surprisingly easy. After introduction of a Béniqué sound, a simple opening in a kind of diaphragm at the proximal end of the ligated urethra made it possible to anastomose the created pouch. The patient remained continent during day- and nighttime.

Down-staging prostate cancer. Is it possible by androgen depletion and Mitomycin C therapy?

The study was carried out in order to investigate the possibility of tumor reduction in prostate cancer patients. As a reduction of the primary tumor was observed with hormonal treatment and complete response of soft tissue tumor markers with Mitomycin C, this combined treatment was given in seven patients to evaluate if it was able to down-stage those cases which were thought to be incurable (T3N1-2M0/T4N0-2M0). Although the clinical evaluation suggested a significant down-staging, the explorative lymphadenectomy was unable to confirm this. The proposed treatment is able to reduce the tumor bulk significantly of the primary cancer as well as of its metastases; progression during the treatment was not seen.

[General considerations on and the role of internal urethrotomy in the treatment of urethral stricture]. / Considérations générales et place de l'urétrotomie interne dans le traitement du rétrécissement de l'urètre.

After stressing the importance of a precise diagnosis, the author defines the place of internal urethrotomy, which is certainly not always the first-line treatment that some would claim, due to its poor success rate and because an endoscopic reoperation is sometimes much less harmless than it appears. The importance of perfect anaesthesia for urethral surgery is then emphasised in view of the particular demands of this surgery. Finally, the author reviews the various approaches to the urethra and opening of the stricture.

[Urethroplasty using a full-thickness free skin graft]. / Urétroplastie par greffe libre de peau totale (GLPT).

Full-thickness free skin graft urethroplasty is an excellent technique for the cure of urethral strictures. Based on his experience of 250 cases since 1977, the author describes the indications and limitations related to surrounding tissues and to the graft itself. A rigorous and precise technique, described in detail in this paper, is the key to success.

[Stricture of the urethral meatus and the navicular fossa]. / Rétrécissements du méat urétral et de la fosse naviculaire.

A review of the literature concerning strictures of the meatus and fossa navicularis reveals that few techniques are entirely satisfactory, apart from major techniques which are difficult to perform. The author describes an easy technique which gave perfectly satisfactory results in the majority of 36 cases, 17 of which have a follow-up of more than 5 years.

Ureteroneocystostomy in the neuropathic bladder associated with high-grade reflux.

Between 1976 and 1987, a total of 25 ureteroneocystostomies were performed in 17 patients with neuropathic bladder associated with high-grade reflux III-V. An overall success rate of 82.4% is reported. Special complications included postoperative renal deterioration, especially after tapering of megaureters. During follow-up, contralateral reflux was noticed in 44% after unilateral treatment of reflux. Preoperative cystoscopy to define trigone abnormalities is mandatory.

[Hypospadias: lessons from the past and future perspectives]. / Hypospadias: leçons du passé et perspectives d'avenir.

The author presents a technique for the surgical cure of distal hypospadias. The basic idea is a doubly infolded transversal vascularised skin flap, partially de-epithelialized to allow complete repair of the glans over it. Personal experiment.

Uretero-aortic fistula: a severe complication of ureterocutaneostomy.

A case of uretero-aortic fistula after total cystoprostatectomy with a single stoma cutaneous ureterostomy is described. The literature is reviewed.

[A study of the causes of staghorn calculi]. / La recherche des causes du calcul coralliforme.

A thorough metabolic evaluation of all staghorn stone patients seems justified, considering the results obtained by the study of 27 such cases. Pak's ambulatory screening test, slightly modified, was used. This allowed the finding of a hypercalciuria in more than 50% of the cases, a hyperuricosuria in 63% of the cases and a hyperoxaluria in one case out of five. A metabolic anomaly was not detected in two patients. Although urinary tract infection, present in 75% of the cases is essential to the genesis of a staghorn stone, the question raises whether metabolic anomalies are not the primary cause of the stone formation.

Distal urethral and meatal stricture repair. Aesthetic technique.

The author presents a technique for the surgical cure of distal urethral and meatal strictures. The basic idea is a double infolded vascularised skin flap, partially desepithelialised to allow complete repair of the glans over it.