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1.
Ann Urol (Paris) ; 37(3): 113-6, 2003 Jun.
Article in French | MEDLINE | ID: mdl-12872600

ABSTRACT

Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.


Subject(s)
Bladder Exstrophy/complications , Bladder Exstrophy/psychology , Sexual Dysfunction, Physiological/etiology , Adult , Age Factors , Bladder Exstrophy/surgery , Female , Humans , Interpersonal Relations , Male , Social Behavior , Stress, Psychological
2.
Ann Urol (Paris) ; 35(4): 229-33, 2001 Jul.
Article in French | MEDLINE | ID: mdl-11496600

ABSTRACT

OBJECTIVE: To approach the treatment of Fournier's gangrene. So, pathophysiology and etiology are recalled. METHODS: The authors present 51 cases of Fournier's gangrene treated from 1989 to 1998, their age ranged from 19 to 89 years. Data were collected on admission signs and symptoms, physical examination. Aggressive surgical debridement of all necrotic tissues was performed, Intravenous antibiotics and resuscitation fluid were also administered. RESULTS: All patients were male. In 20 cases (39%), there was no identifiable cause, and in 31 cases (61%), the etiology of gangrene was urethral (33%), anorectal (28%) and unknown (19%). The average hospital stay was 30 days. Three cases underwent unilateral orchidectomy, six colostomy and in 17 cases, a suprapubic catheter was inserted. Mortality was high (18%) and essentially associated to debilated state and toxi-infectious context. CONCLUSION: Fournier's gangrene is a true urologic emergency potential lethal, which requires aggressive antibiotic and surgical treatment.


Subject(s)
Fournier Gangrene/diagnosis , Fournier Gangrene/therapy , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Perineum , Scrotum
3.
Ann Urol (Paris) ; 35(3): 154-8, 2001 May.
Article in French | MEDLINE | ID: mdl-11424334

ABSTRACT

Bladder exstrophy is a malformation which the incidence is estimated at 3.3 per 100,000 births. It is usually treated in the first hours of life. The authors report three cases of bladder exstrophy treated in adult life with continent urinary diversion such as Benchekroun continent ileocaecal bladder (CICB). After a literature review on the management of bladder exstrophy, they studied clinical and therapeutical particularities of the bladder exstrophy in adulthood.


Subject(s)
Bladder Exstrophy/surgery , Adult , Female , Humans , Male , Urinary Diversion/methods , Urinary Reservoirs, Continent
4.
Prog Urol ; 11(1): 62-7, 2001 Feb.
Article in French | MEDLINE | ID: mdl-11296648

ABSTRACT

OBJECTIVE: To review the clinical, imaging and therapeutic aspects of urogenital tuberculosis. MATERIAL AND METHODS: From April 1989 to April 1999, 57 patients with urogenital tuberculosis were reviewed in our department. This series consisted of 32 males and 25 females with a mean age of 40 years (range: 18 to 72 years). RESULTS: The most frequent clinical symptoms were irritative symptoms (47.3%). Fever, anorexia and weight loss were rare (11%). 16% of patients had an isolated genital lesion. 14% presented with renal failure (mean serum creatinine: 18 mg/l). Only 3 cases (5.2%) presented with bacilluria. Urography showed abnormalities in 80% of cases. The most frequent abnormality was a non-functioning silent kidney in 23 cases (40.3%). The positive diagnosis was based on bacteriological (5 cases) and histological data (52 cases). Treatment consisted of antituberculous chemotherapy in all patients, in combination with surgery (75%), and/or endourological procedures (26.3%). Nephrectomy is still indicated for non-functioning tuberculous kidneys in order to prevent the development of hypertension, abscess and fistulas. CONCLUSION: The diagnosis of urogenital tuberculosis is difficult and often late. A surgical or endourological procedure is often necessary to preserve renal function and to improve quality of life.


Subject(s)
Tuberculosis, Urogenital , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Tuberculosis, Urogenital/diagnosis , Tuberculosis, Urogenital/therapy
5.
Prog Urol ; 11(1): 86-90, 2001 Feb.
Article in French | MEDLINE | ID: mdl-11296655

ABSTRACT

The authors report 2 cases of prostatic leiomyosarcoma. The first patient was not operated because of a severely debilitated state and died a fortnight after admission to hospital. The second patient underwent cystoprostatectomy with ilio-obturator lymph node dissection. Resection margins and lymph node dissection were negative and no further treatment was required. With a 10-year follow-up, the clinical and radiological assessment was normal. The diagnostic and therapeutic aspects of this rare prostatic tumour are discusses.


Subject(s)
Leiomyosarcoma/diagnosis , Prostatic Neoplasms/diagnosis , Adult , Humans , Leiomyosarcoma/surgery , Male , Middle Aged , Prostatic Neoplasms/surgery
6.
Ann Urol (Paris) ; 35(6): 339-43, 2001 Nov.
Article in French | MEDLINE | ID: mdl-11774767

ABSTRACT

OBJECTIVE: To specify the clinical and therapeutic peculiarities of complex vesico-vaginal fistulas. MATERIAL AND METHODS: 55 cases of complex vesico-vaginal fistulas are reported. After the clinical diagnostic all the patients had an intravenous excretory urogram. The fistulas were classified according to the Benchekroun classification. RESULTS: The mean age was 34 years (17-70 years). The diagnostic was made clinically in all the patients. Thirteen patients had an abnormal intravenous excretory urogram. The treatment was made by a vaginal way in 45 patients, by an abdominal way in three patients and by a mixed way in two patients. Four patients had an urinary diversion and one refused the treatment. Among the 50 patients whose fistula was treated, 44 (88%) were continent whom 26 (52%) after one operation, 15 (30%) after two operations and three (6%) after three operations. CONCLUSION: The complex vesico-vaginal fistulas as all the vesico-vaginal fistulas are diagnosed clinically. The intravenous excretory urogram is indispensable to search an associated ureteral lesion. The treatment is surgical and usually needs the interposition of a vascularised graft.


Subject(s)
Vesicovaginal Fistula/diagnosis , Adolescent , Adult , Aged , Female , Humans , Middle Aged , Vesicovaginal Fistula/complications
7.
Prog Urol ; 11(6): 1335-9, 2001 Dec.
Article in French | MEDLINE | ID: mdl-11859677

ABSTRACT

The York Mason approach appears to be one of the most suitable techniques for the treatment of prostato-rectal fistulas, as it provides a maximum chance of success with no morbidity, as no cases of anal incontinence have been reported to date. The authors report a case of prostato-rectal fistula secondary to transurethral resection of the prostate for benign prostatic hyperplasia treated by the YORK MASON posterior trans-anosphincteric approach.


Subject(s)
Fistula/surgery , Prostatic Diseases/surgery , Rectal Fistula/surgery , Fistula/etiology , Humans , Male , Middle Aged , Prostatectomy/adverse effects , Prostatic Diseases/etiology , Rectal Fistula/etiology , Surgical Procedures, Operative
8.
Ann Urol (Paris) ; 34(4): 249-53, 2000 Aug.
Article in French | MEDLINE | ID: mdl-10994144

ABSTRACT

The authors report a retrospective study concerning 18 patients having major renal trauma. The patients study group was comprised of 11 males (61%) and seven females (39%) with a mean age of 23 years. The etiologic agents were traffic accident (eight cases), falls (five cases) and stab wounds (five cases). Gross hematuria was present in all the patients. After radiologic investigations the renal injuries were classified according to the American Association for Surgery of Trauma. Two patients were in stage V, seven in stage IV and nine in stage III. Three patients were operated in emergency for hemodynamic instability, two had a total nephrectomy and one a partial nephrectomy. Five patients underwent surgery between the 5th and 7th day, three had a suture of the renal parenchyma under a nephrostomy, one a partial nephrectomy and the third a total nephrectomy. Two patients had only a urinary drainage by placement of an ureteral stent in order to diminish the urohematoma. Eight patients were treated conservatively and all were in stage III. The mean retreat was 16 months. There was no mortality and among the eight patients who underwent surgery, none had complications, aside from two wound infections. The patients who were managed conservatively had good progression; they all had a control by computed tomography which showed that the urohematoma had decreased. None of the patients developed hypertension or infection of the urohematoma.


Subject(s)
Kidney/injuries , Nephrectomy , Adolescent , Adult , Female , Hematuria/etiology , Hemodynamics , Humans , Kidney/pathology , Kidney/surgery , Male , Retrospective Studies , Treatment Outcome
9.
Prog Urol ; 10(3): 411-7, 2000 Jun.
Article in French | MEDLINE | ID: mdl-10951934

ABSTRACT

OBJECTIVES: To study the long-term morbidity and efficacy of ureteroileoplasty in a retrospective series of 18 patients. MATERIALS AND METHODS: 12 men and 6 women with a mean age of 50 years underwent ureteroileoplasty with unilateral replacement in 15 patients and bilateral replacement in 3 patients. A total of 21 units renoureteral units were repaired by this technique. The pelvic ureter was replaced in 16 renoureteral units, the lumbar ureter was replaced in 1 case and the entire ureter was replaced in 4 cases. The commonest ureteral lesions were strictures secondary to ureteroscopy or ureterolithotomy (40%). All patients had normal renal function, except for one patient with serum creatinine of 224 mumol/l. RESULTS: With a mean follow-up of 25 months (range: 3 to 64 months) all ureteroileoplasties were patent with no major morbidity. Only the patient with preoperative renal failure developed hyperchloraemic acidosis with deterioration of her renal function. CONCLUSION: In the absence of renal failure, ureteroileoplasty is an operation with low morbidity achieving good medium-term results.


Subject(s)
Ileum/transplantation , Ureteral Diseases/surgery , Female , Humans , Male , Middle Aged , Peristalsis , Radiography , Retrospective Studies , Time Factors , Ureteral Diseases/diagnostic imaging , Urologic Surgical Procedures/methods
10.
Prog Urol ; 10(6): 1173-6, 2000 Dec.
Article in French | MEDLINE | ID: mdl-11217555

ABSTRACT

OBJECTIVE: To study the aetiopathogenics, diagnostic and therapeutic aspects of this pathology. MATERIALS AND METHODS: The authors report a series of 10 vesico-uterine fistulas observed over à 10 years period. The mean age was 32 years(30-40). The fistulas were secondary to cesarian section in 6 cases and to abnormal delivery in 4 cases. The symptomatology was an urinary leakage from the vagina in 6 cases, an isolated cyclic hematuria in 3 cases and the association of the two signs in one case. The diagnostic was established on clinical examination in 8 cases. Intraveinous urography was performed in all the patients and visualised the uterine cavity in only 8 cases. In the 2 remaining cases a retrograd cystography was performed and demonstrated the opacification of the uterine cavity. The treatment was surgical in 9 cases. One patient who had a menuria has refused the operation. RESULTS: The diagnostic of the vesico-uterine fistulas is often based on clinic examination but often necessitate recourse to complementary examinations mostly in the menouria forms. The intraveinous urography does not establish the diagnostic in all the cases but is an indispensable complementary investigation because it permits searching for an associated ureteral injury. With a mean recoil of one year the results judged on the disappearance of the clinic signs was good in all the patients. CONCLUSION: The vesico-uterine fistulas are often secondary to cesarian section or abnormal delivery. Their treatment is surgical but is above all preventive by the improvement of the obstetric taking care and avoiding the vesical injuries in the course of the cesarian section.


Subject(s)
Cesarean Section/adverse effects , Fistula/etiology , Urinary Bladder Fistula/etiology , Uterine Diseases/etiology , Adult , Female , Humans , Pregnancy
11.
Ann Urol (Paris) ; 33(4): 243-51, 1999.
Article in French | MEDLINE | ID: mdl-10510704

ABSTRACT

Between 1989 and 1996, 1,280 patients aged 41 to 100 years were operated for BPH. 70% of patients were treated at the stage of complications such as acute urinary retention, haematuria, bladder stones or renal failure. 549 patients (42.9%) were treated by transvesical prostatectomy (TVP), 668 patients (52.18%) underwent transurethral resection (TURP) and only 63 (4.92%) were treated by bladder neck incision (BNI). Early postoperative complications essentially consisted of infections: wound infection (15%), followed by vesico-cutaneous fistula (2%), epididymo-orchitis (0.7%) and urinary tract infection (1.5%). Late post-operative assessment revealed retrograde ejaculation in 100% of cases after transvesical surgery, 80% of cases after TURP and almost no cases (4%) after BNI. The permanent urinary incontinence rate was 1.18% after TURP and 1.0% after transvesical surgery. The shortest mean postoperative stay was 5 days in the BNI group versus 12.5 days after transvesical surgery. Finally, the postoperative mortality, essentially due to septic shock and myocardial infarction, was (0.8%). The BPH complication rate is proportional to the delay in diagnosis and management. Transurethral resection remains the most effective treatment with the lowest morbidity.


Subject(s)
Prostatectomy , Prostatic Hyperplasia/surgery , Adult , Aged , Aged, 80 and over , Humans , Length of Stay , Male , Middle Aged , Postoperative Complications , Prostatic Hyperplasia/pathology , Retrospective Studies , Treatment Outcome , Urinary Incontinence/etiology
12.
Prog Urol ; 9(1): 137-41, 1999 Feb.
Article in French | MEDLINE | ID: mdl-10212967

ABSTRACT

Urethro-rectal fistulas, consisting of prostato-rectal fistulas and fistulas communicating between the bulbo-membranous urethra and the rectum, are rare, easily diagnosed diseases, which essentially raise a problem of choice of surgical technique. Although the predominant aetiology is currently iatrogenic, many other less frequent aetiologies can also be responsible. Treatment is usually surgical with a large number of possible incisions. In the light of 5 cases, the authors review the various surgical techniques allowing cure of these fistulas, and indicate the advantages and disadvantages or each one.


Subject(s)
Rectal Fistula/surgery , Urethral Diseases/surgery , Urinary Fistula/surgery , Adult , Aged , Follow-Up Studies , Humans , Male , Middle Aged , Pelvis/injuries , Postoperative Complications , Prostatectomy/adverse effects , Prostatic Hyperplasia/surgery , Radiography , Rectal Fistula/diagnostic imaging , Rectal Fistula/etiology , Time Factors , Urethral Diseases/diagnostic imaging , Urethral Diseases/etiology , Urethral Stricture/complications , Urinary Fistula/diagnostic imaging , Urinary Fistula/etiology
13.
Ann Urol (Paris) ; 31(2): 89-91, 1997.
Article in French | MEDLINE | ID: mdl-9245254

ABSTRACT

Between July 1990 and December 1995, 52 patients with lower ureteral calculi were treated by rigid ureteroscopy in the "B" Urology department of Avicenne Hospital. The use of ureteroscopy facilitated Dormia extraction (58%) or ultrasonic lithotripsy fragmentation (17%) or removal of the stone with the two procedures (21%). The overall success rate was 92.3% with a 2% retreatment rate. Complications were rare (3 of 52: 5.8 percent). The mean hospital stay was 3.3 days. Based on our findings, we conclude that rigid ureteroscopy for lower ureteral stone removal is effective with low morbidity and shorter hospital stay.


Subject(s)
Ureteral Calculi/therapy , Ureteroscopy , Adolescent , Adult , Aged , Evaluation Studies as Topic , Female , Humans , Lithotripsy , Male , Middle Aged
14.
J Urol (Paris) ; 103(1-2): 32-4, 1997.
Article in French | MEDLINE | ID: mdl-9765777

ABSTRACT

A series of 32 treated cases of Fournier's gangrene is analysed. All patients were male, their age ranged from 19 to 89 years. In 16 cases (50%) the aetiology of gangrene was urethral (37.5%), anorectal (12.5%) and in the 16 remaining cases (50%) there was no identifiable cause. Mortality was high (28%) despite broad spectrum antibiotics and aggressive surgical debridement. This mortality was essentially associated to advanced age, debilitated state, delay in diagnosis and toxi infectious context. The average hospital stay was 26.5 days.


Subject(s)
Fournier Gangrene/therapy , Genital Diseases, Male/therapy , Abscess/complications , Adult , Age Factors , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Anus Diseases/complications , Cause of Death , Critical Illness , Debridement , Fournier Gangrene/etiology , Genital Diseases, Male/etiology , Humans , Male , Middle Aged , Rectal Diseases/complications , Retrospective Studies , Shock, Septic/complications , Survival Rate , Urethral Stricture/complications , Urinary Incontinence/complications
15.
Ann Urol (Paris) ; 31(6-7): 339-43, 1997.
Article in French | MEDLINE | ID: mdl-9509233

ABSTRACT

The authors report a series of 40 cases of genitourinary tuberculosis diagnosed and treated in the department of urology "B" of Avicenne hospital over a 7-year period. The objective of this study is to define the various diagnostic and therapeutic aspects of this disease. The patients were predominantly males (62.5%) with a mean age of 40 years. 25% of cases reported a history of extra-urinary tuberculosis. The very polymorphous clinical presentation is dominated by signs of cystitis (45%). Intravenous urography is frequently suggestive of the diagnosis based on the appearance and multiplicity of the lesions. The radiological lesions most frequently encountered were silent kidney (19 cases) and small tuberculous bladder (11 cases). The definitive diagnosis was established by pathological examination in 38 cases (biopsies, operative specimens, prostatic resection chips) and/or by demonstration of AFB in 2 cases (urine, pus). Tuberculostatic treatment was administered to all patients, either alone (5 cases) or, more usually, in combination with surgical and/or endo-urological treatment (35 cases), reflecting the magnitude and severity of the destructive and scar lesions.


Subject(s)
Tuberculosis, Urogenital/diagnosis , Adolescent , Adult , Aged , Antibiotics, Antitubercular/therapeutic use , Antitubercular Agents/therapeutic use , Biopsy , Combined Modality Therapy , Constriction, Pathologic/therapy , Cystitis/diagnosis , Cystitis/drug therapy , Cystitis/microbiology , Cystitis/surgery , Female , Humans , Isoniazid/therapeutic use , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Nephrectomy , Prostatic Diseases/diagnosis , Prostatic Diseases/drug therapy , Prostatic Diseases/microbiology , Prostatic Diseases/surgery , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Stents , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgery , Tuberculosis, Renal/diagnosis , Tuberculosis, Renal/drug therapy , Tuberculosis, Renal/surgery , Tuberculosis, Spinal/complications , Tuberculosis, Urogenital/complications , Tuberculosis, Urogenital/drug therapy , Tuberculosis, Urogenital/surgery , Ureteral Diseases/therapy , Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/drug therapy , Urinary Bladder Diseases/microbiology , Urinary Bladder Diseases/surgery , Urography
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