[Tuna: clinical retrospective study addressing mid-term outcomes]. / Tuna: étude rétrospective à propos de 28 patients, résultats et évaluation du retraitement à 20 mois.

PURPOSE: To estimate the efficiency and morbidity of the radiofrequency (Tuna) for treatment of symptomatic benign prostatic hyperplasia (BPH) in patients with medical treatment failure. MATERIAL AND METHODS: Between September 2003 and July 2007, 31 patients, mean age 59,5 years (50-76), were treated for BPH with Tuna. Patients had initially received medical treatment, which happened to fail and Tuna was offered as surgical treatment. Available clinical data of 28 patients was retrospectively analyzed. Mictionnel status was estimated with International Prostatic Symptoms Score (IPSS), urinary peak flow (UPF) and post void residual urine (PVR). Quality of life issues were also addressed. Efficiency of treatment was estimated on the evolution of these parameters after an average follow-up of 20 months (5-47). To estimate morbidity of treatment, peroperative and late complications were assessed. RESULTS: Twenty-eight patients were included in the study. At a mean follow-up of 20 months, a significant improvement of the mictionnel status was found for the IPSS, the quality of life, the Qmax (p<0,001) and the PVR (p<0,005) and quality of life. Morbidity was verified as minimal in the series. At a follow-up period of 20 months, 15 patients (53,6%) had stopped medical treatment, 10 patients (35,7%) pursued medical treatment and three patients (10,7%) had undergone another type of surgical treatment for BPH. The rate of re-treatment in the series was 46,4%. Among the group of patients without any medical treatment (15 patients), 10 patients reported satisfactory quality of life. CONCLUSION: Tuna is a technique with significant good results for the treatment of LUTS-BPH. The main advantage of this technique is its low morbidity, however, the rate of retreatment was observed as high. Series of patients with long-term follow-up should provide evidence to objectively define the role of Tuna in BPH surgical treatment.

Implantation of anterior sacral root stimulators combined with posterior sacral rhizotomy in spinal injury patients.

Brindley-Finetech sacral anterior root stimulators combined with posterior sacral rhizotomy were implanted in 68 males and 28 females with spinal cord lesions. In 9 patients the electrodes were implanted extradurally in the sacrum, and in 90 patients they were implanted intradurally (3 patients had a second extradural implant after a first intradural implant). Three patients died from causes unrelated to the implant. Of the 93 surviving patients, 83 used their implants for micturition and 82 were fully continent. The mean bladder capacity increased from 206 ml preoperatively to 564 ml after the operation. Three patients had a preoperative vesicorenal reflux that disappeared after surgery. In all, 51 patients used the stimulator for defecation. Erection was possible with electrical stimulation in 46 males and was used for coitus by 17 couples. Secondary deafferentation at the level of the conus was performed four times. Three patients who had a cerebrospinal fluid leak were operated on again. Two implants had to be removed because of infection. Sacral anterior root stimulation combined with sacral deafferentation is a welcome addition to the treatment of neurogenic bladder in spinal cord injury patients.

[Electrostimulation of nerve roots in neurogenic bladder]. / L'électrostimulation vésicale radiculaire.

Thirty per cent of the patients with spinal injuries present chronical urinary problems. For these, G.S. Brindley's technique represents an important progress. It includes a section of posterior roots to control detrusor hyperexcitability and a stimulation of anterior roots to empty the bladder. The equipment is now perfectly reliable and the technique has been defined. Indications are essentially unstable bladders with incontinence and certain hypoactive bladders. The following results were obtained: continence is obtained in 90% of patients; complete bladder emptying in the majority of cases with very marked reduction of urinary infections; improvement of erection and regularization of intestinal transit. The complications of the surgery are uncommon but serious (CSF leaks, postoperative denervations, sepsis and material failure).

[Electrostimulation of anterior sacral nerve roots in the treatment of central neurogenic bladders. G.S. Brindley's technique. Results of the 40 first French cases]. / L'électrostimulation des racines sacrées antérieures dans le traitement des neuro-vessies centralies. Technique de G.S. Brindley. Résultats des 40 premiers cas français.

The results of the first 40 cases who underwent implantation of a sacral anterior root stimulator (G.S. Brindley) in France are reported. One patient die two years after implantation from an unrelated cause. 39 patients are using electrostimulation with a 6 month to 8 year follow-up. 90% have a satisfactory continence and no longer require an incontinence appliance. 82% of the patients have a post-void residue of 0 to 50 cc. Urinary infection rate has dramatically decreased. Bladder capacity and compliance have increased, and urethral closure pressure has decreased according to posterior rhizotomy. Possible side effect of total posterior rhizotomy from S2 to S4 could be stress incontinence.

Evolution of bladder contraction in course of time after implantation of a sacral anterior root stimulator.

We reviewed bladder contraction evolution after sacral anterior root stimulator implantation in thirty patients operated on from 1984 to 1991. Two patients underwent a complete denervation with a reinnervation within a maximal time of seventeen months. One patient underwent a lesion, like a neuropraxia with a complete recovery at four months. Five patients have undergone a partial denervation with a recovery of miction by neurostimulation within the time of eighteen months. In three patients, bladder contraction disappeared for various reasons.

Adjuvant drug therapy: a review of 30 cases of sacral anterior root stimulator.

Implantation of a sacral anterior root stimulator in spinal cord injured patients must achieve two main goals to maintain a vesicosphincteral balance: complete bladder voiding and correct continence. During the postoperative period, difficulties may arise or persist with either an incontinence due to an insufficient deafferentation with bladder hyperreflexia or an incomplete voiding because of an insufficient contraction of detrusor and/or too high urethral resistances (vesicosphincteral dyssynergia). A third of our patients required specific therapies after implantation to promote interstimulation continence and complete bladder voiding. Regarding continence, adjuvant therapies are effective for bladder hyperreflexia in connection with a too-partial deafferentation. On the other hand, these therapies have little effect on low bladder compliance. In regard to bladder voiding, nonsurgical treatments are equally effective. These treatments (parasphincteral infiltrations, alpha-blockers) must not be permanent, but allow a reharmonizing between expulsive strengths and urethral resistances. Eighty percent of our patients who required adjuvant therapies have been improved significantly. This confirms the efficiency of adjuvant therapy and speaks for patience.

[Electrostimulation of anterior sacral nerve roots in spinal cord injury patients (evaluation of the 1st 25 cases)]. / Electrostimulation des racines sacrées antérieures chez le blessé médullaire (bilan des 25 premiers cas).

The authors analyse the first 25 patients with spinal cord injuries treated by G. Brindley's technique based on section of the posterior sacral nerve roots to control detrusor hyperexcitability and electrostimulation of the anterior sacral nerve roots to ensure bladder emptying and to facilitate erection and defecation. The indications for this technique are essentially unstable bladders with incontinence and certain hypoactive bladders. The following results were obtained: Acquisition of continence in 90% of cases. Bladder capacity was always greatly increased. Almost complete bladder emptying in the majority of cases. Very marked reduction in urinary tract infection. Regularization of intestinal transit. The complications of this surgery were uncommon but serious: C.S.F. leaks, Postoperative denervations. Sepsis. Material or cable failure.

[Electrostimulation of the anterior sacral nerve roots. An International Congress--Le Mans--24-25 November 1989]. / L'électro-stimulation des racines sacrées antérieures. Colloque international--Le Mans--24 et 25 novembre 1989.

Electrostimulation of the anterior sacral nerve roots in patients with spinal injuries according to the technique described by G. S. Brindley was the subject of an International conference held in Le Mans on 24th and 25th November, 1989. The equipment is now perfectly reliable and the technique has been well defined. Section of the posterior nerve roots increases bladder capacity and promotes continence. Stimulation of the anterior nerve roots contributes to correct bladder emptying. Two other benefits can be expected: improved defecation and erection. Complications are uncommon, but this technique must be reserved for failures of rehabilitation and uroneuropharmacoloical techniques.

Extradural implantation of sacral anterior root stimulators.

A technique for extradural deafferentation of the S2 to S5 segments and extradural implantation of stimulating electrodes is described, and its application to twelve patients with spinal cord lesions is reported. Nine patients use their implants for micturition, and seven are fully continent. The advantages and disadvantages of this technique compared with the more usual intrathecal procedure are discussed.

Total androgen blockade with Zoladex plus flutamide vs. Zoladex alone in advanced prostatic carcinoma: interim report of a multicenter, double-blind, placebo-controlled study.

A double-blind, placebo-controlled, randomized, multicenter study was undertaken to investigate the effects of Zoladex plus flutamide vs. Zoladex plus placebo in patients with advanced prostatic cancer. Interim analysis has revealed no differences between the 2 groups in objective or subjective responses at 6 months' follow-up or in overall survival and time to disease progression at 15 months' follow-up.

Zoladex as primary therapy in advanced prostatic cancer. A French cooperative trial.

From April 1984 to May 1986, 129 patients with prostate cancer entered a prospective trial with a new LH-RH agonist, Zoladex. Mean age was 72 years (range of 45-94 years) and, in most cases, patients had metastatic disease, not previously treated by chemotherapy or hormone therapy. Patients received a monthly injection of 3.6 mg. Serum testosterone was lowered into the range of castrate levels after 4 weeks of treatment. In 105 evaluable patients at 3 months, a 65% partial response (PR) rate was observed, with 11% stable and 24% progressive disease. Median time to progression was 37 weeks. Analysis of objective criteria revealed 30% PR for prostate volume and 51% CR-PR for prostatic acid phosphatases. Seventeen percent of lytic metastases had recalcified. One hundred twenty-nine patients were evaluable for toxicity. Endocrinological side effects were common: decrease in libido, 92%; impotence, 86%; hot flushes, 48%; and breast swelling or tenderness, 9%. Nonendocrinologic side effects were rare. The treatment is generally well accepted by patients owing to the convenient depot formulation and to the minor side effects.

[Choice of a technic in the treatment of primary vesico-renal reflux in the adult]. / Choix d'une technique pour le traitement du reflux vésico-rénal primitif chez l'adulte.

This article compares five techniques for the surgical management of primary vesicorenal reflux in adults, with reference thirty six cases. The techniques used were Bischoff (8), Lich-Gregoir (6), Politano-Leadbetter (8), Glenn-Anderson (10) and Cohen (4). Surgery provided good results in 30 cases and poor results in six. The best results were registered with the advancement techniques (Glenn-Anderson and Cohen).

[Colonic changes in perinephritis. Value of double contrast examinations (author's transl)]. / Expression colique des périnéphrites. Valeur de la technique d'exploration en double contraste.

The differential diagnosis of cancer and abscesses of the kidneys with perinephritic inflammatory masses is sometimes difficult. In these cases, radiological examination of the colon can be of great value by demonstrating the presence of inflammatory colonic perivisceritis. Double contrast examination can reveal the presence, not only of an inflammatory type of narrowing, but characteristic changes in the mucous folds of the transverse "in palisade" type with thickening extending throughout the circumference of the colon. These appearances are totally different from those observed in malignant colonic perivisceritis. The use of double contrast examination of the colon, in cases of renal masses and associated fever, can enable the choice to be made of an adequate route of approach (lumbotomy), of it demonstrates the characteristic appearances of inflammatory perivisceritis.