Modified Denis technique: a simple solution for maximal hemostasis in suprapubic prostatectomy.

OBJECTIVES: To describe our experience with a modified Denis technique for hemostasis in suprapubic prostatectomy. METHODS: We reviewed the charts of 78 patients who underwent suprapubic prostatectomy using a modified Denis technique between September 1996 and June 2001. After adenomectomy, we performed a bladder neck removable partition purse-string suture, and the prostatic fossa was drained. Patients were followed up for hemorrhagic complications and bladder neck strictures for 12 months. RESULTS: The mean intraoperative hemorrhage amount was 264 mL (range 160 to 510). The postoperative irrigating fluid volume was 2000 mL (range 500 to 4500), and the bladder irrigation duration was 24 hours in 70 patients (89.8%) and 48 hours in 8 patients (10.2%). Postoperative hemorrhage, measured by the prostatic fossa drain, was 0 mL in 48 patients and had a mean value of 55 mL (range 10 to 90) in 30 patients. No hemorrhagic complication was noted. None of our patients had transfusion, bladder clot formation, or late hemorrhage. One case (1.3%) of bladder neck stricture developed. CONCLUSIONS: This modified Denis technique is very effective and easy to perform and to learn. It has solved all our hemorrhagic problems in suprapubic prostatectomy.

[Clear cell sarcoma of the kidney: 3 case reports]. / Sarcome à cellules claires du rein (à propos de trois observations).

UNLABELLED: Clear cell carcoma of the kidney is a distinct, highly malignant pediatric neoplasm. Its occurrence in adults is extremely rare and the subject of isolated case reports. MATERIAL AND METHODS: We report 3 cases of clear cell sarcoma of the kidney in one men and two women between 23 and 65 years old (mean age is 40 years). A radical nephrectomy with hilar lympgh node dissection was accomplished. A combination chemotherapy regiment (cisplatin and doxorubicin) was performed on 6 cycles in 1 case. The other 2 case was not underwent chemotherapy or radiation. RESULTS: In the patient underwent the combination chemotherapy there was not evidence of tumor in the abdomen and thorax on CT Scan 4 years later. In one of the two patient not underwent chemotherapy or radiation, the CT scan revealed a left psoas reccurrence three month later; therapy consisted for surgery without chemotherapy or radiation. Four month later, tfe CT scan revealed a reccurrence in the left retroperitoneal region and liver and speen metastasis. The patient was dead two month later. The other patient not underwent chemotherapy or radiation was dead seven month after nephrectomy. CONCLUSION: Optimal treatment is unknown, and surgery; radiotherapy and chemotherapy are used alone but mostly in combination.