Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck.

OBJECTIVE: To determine whether anterograde ejaculation is preserved after transurethral resection of both the prostate and bladder neck (TURP and TURBN). PATIENTS AND METHODS: Between 1994 and 1997, 45 patients (mean age 53.2 years, range 42-62) with bladder neck obstruction and small obstructive adenomas (< 35 g) underwent TURP/TURBN, preserving part of the supramontanal prostate and prostatic urethra for > 1 cm from the verumontanum. They were assessed before and after 0.5-2 years to determine the type of ejaculation, symptom scores and sexual function, and compared with 10 similar patients who had undergone a conventional TURP. RESULTS: With preservation of > 1 cm of the supramontanal prostate, anterograde ejaculation was maintained in 80% of the patients, whereas only one patient in the control group retained anterograde ejaculation. CONCLUSIONS: The preservation of anterograde ejaculation after TURP (in approximately 20% of cases) and after transurethral incision of the prostate (> 90% cases) reported in the literature probably relates more to the presence of an adequate amount of residual prostatic tissue than to the existence of a hypothetical 'pre-prostatic sphincter'.

Rome pouch: pre-peritoneal continent ileal reservoir with hydraulic valve.

We present our experience with a modified technique for constructing a continent ileal reservoir, using the terminal ileum in a pre-peritoneal position. The ureters were implanted using the Le Duc-Camey technique; the Benchekroun valve was used as a continence mechanism. This technique was used in 18 patients and its advantages and complications are discussed.

[Pre-peritoneal trans-ileal uretero-cutaneostomy. Apropos of 41 cases]. / Uretero-cutaneostomia trans ileale pre-peritoneale. A proposito di 41 casi.

In the last 15 years we have used a modified version of the classic Bricker for external urine derivation in 41 cases (32 cases of neurobladder and 9 cancer of the bladder). This modification essentially involves placing the ileal loop in front of the peritoneum, in a superficial position which facilitates urethroileal anastomosis especially when trying to prevent reflux. The positioning of the loop greatly reduces urine stasis and ureteral stenosis, which in the classic Bricker is due to the ureter crossing the meso. We hope this technique will be used more widely in view of the excellent results obtained (low morbidity with hardly any complications).

[Urethroplasty for repairing recurrent urethrocele and loss of urethral substance: apropos of 41 cases]. / Uretroplastica per la riparazione dell'uretrocele recidivo e perdita di sostanza uretrale: a proposito di 41 casi.

Recurrent urethrocele is not often successfully treated surgically because, as it is well known, pre-operative sterilization of the urethrocele is difficult, especially when it is very large. Furthermore the incomplete excision of the corpus callosum, because of the loss of urethral tissue this involves, often leads to post-operative fistulas and stenoses. This is why, very often, there are relapses no matter what technique is adopted. In 1978 both Juraschek and ourselves published a technique, derived from Monseur, in which the urethrocele and the corpus callosum were completely excised. The resulting loss of urethral tissue was remedied with the albuginea from the ventral surfaces of the corpora cavernosa after a 180 degrees rotation of the urethra. The results of this treatment in 41 cases of recurrent urethrocele are given in this paper. The follow-up period for the patients was from 15 to 2 years. Results have been excellent with very few complications (2 post-operative fistulas and 2 urethra stenoses). There have been no relapses.

Urethroplasty of recurrent urethrocele: study of 41 cases.

Recurrent urethrocele is not often successfully treated surgically because, as is well known, pre-operative sterilization of the urethrocele is difficult, especially when it is very large. Furthermore the incomplete excision of the corpus callosum, because of the loss of urethral tissue this involves, often leads to post-operative fistulas and stenoses. This is why, very often, there are relapses no matter what technique is adopted. In 1978 both Juraschek and ourselves published a technique, derived from Monseur, in which the urethrocele and the corpus callosum were completely excised. The resulting loss of urethral tissue was remedied with the albuginea from the ventral surfaces of the corpora cavernosa after a 180 degrees rotation of the urethra. The results of this treatment in 41 cases of recurrent urethrocele are given in this paper. The follow-up period for the patients was from 15 to 2 years. Results have been excellent with very few complications (2 post-operative fistulas and 2 urethra stenoses). There have been no relapses.

[Continent pre-peritoneal uretero-ileostomy with a hydraulic valve. A personal technique]. / Uretero-ileo-cutaneostomia pre-peritoneale continente con valva idraulica. Tecnica personale.

A continent ileal reservoir has been realized. The reservoir is placed outside the peritoneum, in a pre-peritoneal position, in order to allow its fixation by adhesions to the abdominal wall. Furthermore, a Benchekroun's hydraulic valve, adopted as a continent mechanism, is placed distant from the reservoir, by means of a long anti-peristaltic ileal loop, which further prevents the effects of the reservoir enlargement. The reservoir is made up using 40 cm of detubulized ileum; on the afferent loop (10 cm long) the right ureter is implanted according to the Camey-Le Duc technique, on the efferent loop (25 cm long) the left ureter is implanted according to the same technique. The remaining 15 cm of the ileum are used to realize a Benchekroun's hydraulic valve which is exteriorized by means of a skin stoma, placed on the left abdominal wall. With this technique, 18 patients have been operated; the follow-up period is 3 years for the first cases.

[Continent urinary diversion using a pre-peritoneal ileal graft and Benchekroun's hydraulic valve]. / Dérivation urinaire continente utilisant un greffon iléal pré-péritonéal et la valve hydraulique de Benchekroun.

The authors describe the creation of a continent pre-peritoneal ileal urinary reservoir with Benchekroun's valve. This system, performed on 10 occasions with no postoperative complications and currently perfect results, has the following advantages: decreased risk of distension of the reservoir because of its pre-peritoneal position, protection of Benchekroun's valve due to its distance from the reservoir at the end of the antiperistaltic loop, the great ease of creation of the diversion and the superficial situation facilitating any subsequent surgical revisions.

[Long-term results of spinal cord electrostimulation in the treatment of micturition disorders associated with neurogenic bladder]. / Résultats à long terme de l'électrostimultation de la moelle dans le traitement des troubles mictionnels des neurovessies.

The authors report their experience of long-term (7 years) spinal electrostimulation (SES) in 34 cases of neurogenic bladder (spina bifida: 4 cases; traumatic paraplegia: 3 cases; multiple sclerosis: 23 cases; arachnoiditis: 4 cases). SES, performed via the epidural route, reduced urgent micturition and urge by 90%, urge incontinence by 70% and dysuria by 50%. In the majority of patients, urodynamic evaluation revealed a significant reduction in detrusor hyperactivity and uninhibited contractions, an increase in the electrical activity of the striated sphincter, a significant reduction (80%) in vesico-sphincteric dyssynergy with improvement in flow and an increase by more than 70% in the vesical capacity. After three years, the efficacy tended to slowly decrease and became significantly reduced over 5 years. After 7 years, only 2 of the first 10 cases continued to use SES. SES represents a non-aggressive technique and, at the present time, warrants widespread use due to its safety and simplicity.