[Rigid ureteroscopy and the pulsed laser. Apropos of 325 treated calculi]. / Urétéroscopie rigide et laser pulsé à colorant. A propos de 325 calculs traités.

A pulsed dye laser (Candela) was used in our lithiasis treatment center during the period 02/88-09/89 to remove 325 calculi in 278 patients, requiring 285 endoscopic instrumentations. The pulsed laser allowed to obtain fragmentation of 318 calculi, 238 of which were reduced to thin sand and 80 to coarser fragments. The latter were either cleared using a Dormia probe or further disintegrated by electrohydrolytic shock wave treatment or extracorporeal shock wave lithotripsy (ESWL). No complication imputable to laser stone fragmentation was noted. Failure of stone clearance was chiefly due to the nature and shape of the stone (black, smooth monohydrated calcium oxalate calculi). The thinness of the laser fiber has made it possible to use small caliber ureteroscopes, thereby increasing the reliability of ureteroscopy. Coupled with ESWL (EDAP LT01), this technique has caused the rate of open surgical removal of ureter confined calculi to fall from 11% to 1%.

Ileal low-pressure bladder replacement: Camey type II. Stapling technique and preliminary results (57 cases, 1987-1989).

In keeping with the basic principles of Camey's procedure and with a view to improve continence, we decided in 1987 to experiment with the technique of ileal low-pressure bladder replacement (Camey II). We introduced the stapling technique in order to save time and to obtain watertight, reliable sutures. 57 patients underwent a Camey II intervention following radical cystectomy. Follow-up was 3-24 months. No operation mortality was observed and only 5 perioperative complications were recorded. Continence during the day and at night increased rapidly with Camey II (50% at 3 months, 90% at 6 months). Camey II improves the patients' quality of life; the procedure is simple, fast and reliable thanks to the stapling technique.

Pulsed dye laser in the treatment of 325 calculi of the urinary tract.

The pulsed dye laser (Candela) has been used from February 1988 to September 1989 in order to treat 325 stones in 278 patients. A total of 285 endoscopies has been performed. The pulsed laser has helped to achieve the fragmentation of 318 stones. Laser fragmentation has not induced any complication at all. The main failures can be attributed to the nature and shape of the stone. Thanks to the thin laser fiber, the use of small diameter ureteroscopes has increased the reliability of ureteroscopy. The use of this technique combined to extracorporeal shock wave lithotripsy (ESWL) has reduced the rate of open surgery for ureteral stones down to less than 1%.

[External radiotherapy after radical prostatectomy for cancer of the prostate, stage C or DI. Preliminary study]. / Radiothérapie externe après prostatectomie radicale pour cancer de la prostate, stade C ou D1. Etude préliminaire.

Between february 1985 and february 1988, 45 patients upstaged to stages C or D 1 cancer after radical prostatectomy, were treated by adjuvant radiotherapy with a view to control the risk of local recurrence and distant metastases. Radical prostatectomy has a low morbidity (less than 10%) whereas the radiotherapy morbidity rate is important (40% with 10% severe complications). With an average 33.4 months follow-up, we observe cancer dissemination in 37.7% of the cases and local recurrence in 13.3% of the cases. The prognosis seems to be worse, on one hand when the urethral margins are invaded and/or when the seminal vesicles are macroscopically invaded (C3) and on the other hand when the pelvic nodes are macroscopically invaded. Radiotherapy avoids locals recurrence in some cases but does not permit a general control of the disease. This observation leads us to recommend an early postoperative hormonotherapy in patients upstaged to stage C3 or with positive nodes.

[Pharmacologic study of nicergoline in the pathology of the cervico-prostatic sphincter]. / Etude pharmacologique de la nicergoline dans la pathologie cervico-prostatique.

An urodynamic survey and an E.M.G. of the striated sphincters were performed in 20 patients presenting with prostatism, before and after infusion of either nicergoline or placebo, under double-blind conditions. Statistical analysis was performed and demonstrated a significant decrease in the tone of the bladder neck, the prostate, the striated sphincter and the bladder; impoverished electromyographic activity of the striated sphincters; increased maximal and mean urine flow and decreased post-voiding residue. The authors stress the efficacy of nicergoline in cervico-prostato-sphincteric syndromes.

[Uretero-ileal anastomosis using the modified Leduc-Camey technic. Surgical technic]. / Anastomose urétéro-iléale selon la technique de Leduc-Camey modifiée. Technique chirurgicale.

A modified Leduc-Camey technic for uretero-ileal anastomosis was used in 96 patients over a period of one year, complications related to this type of anastomosis, and requiring recovery surgery, being noted in 2 cases. When compared with more than 300 anastomoses performed using the original Leduc-Camey technic, this modified procedure using absorbable sutures appeared to be simple, effective and very rapid. It is a valid method for Camey type reconstruction bladders and also for Bricker type or Kock's pouch type continent diversion operations.

[Radical prostatectomy in cancer of the prostate. Our experience apropos of 55 cases with 3-year follow-up]. / La prostatectomie radicale dans le cancer de la prostate. Notre expérience à propos de cinquante-cinq cas avec trois ans de recul.

The authors report their experience of retropubic radical prostatectomy for prostatic cancer. They have performed 55 prostatectomies over a period of 3 years. Their indications are essentially stage B (35 cases) and stage C1 (20 cases). The post-operative morbidity was low and no cases of incontinence were observed. Post-operative impotence generally occurs when the cavernous nerves are interrupted. However, erection was preserved in two cases when Walsh's technique was used.

[Pheochromocytoma with multiple localizations manifested by a hemorrhagic bladder tumor]. / Phéochromocytome à localisations multiples révélé par une tumeur vésicale hémorragique.

Pheochromocytoma is an endocrine tumor derived from neuroectodermal tissue. Pheochromocytomas usually arises in the adrenal glands but may develop in other organs. We report a case of pheochromocytoma of the bladder with hematuria as the presenting symptom. This tumor was removed by partial cystectomy. Following this procedure, biologic disorders persisted (catecholamines, vandylmandelic acid and metanephrines) leading to the diagnosis of an adrenal pheochromocytoma. The patient recovered after removal of the adrenal tumor. Discussion, review of the literature and bibliography.

[Evaluation of erection disorder]. / Bilan d'un trouble de l'érection.

A multidisciplinary approach to screening for a disorder of erection has been applied over the last 7 years and involves dynamic and particularly physiologic explorations. When an organic etiology cannot be excluded during the first consultation and after a clinical examination, the basic paraclinical investigation used is the measurement of nocturnal erections (NPT). Although NPT remains the key-examination, it may be necessary to request vascular exploration, mainly study of the Döppler effect, a neurologic examination to include peripheral and autonomic nervous systems and endocrine tests.

[Hydraulic penile prostheses in the surgery of impotence. Our experience in 20 cases with a 2-year follow-up]. / Prothèses péniennes hydrauliques dans la chirurgie de l'impuissance. Notre expérience sur vingt cas avec deux ans de recul.

The authors report their experience of the implantation of inflatable penile prostheses in the surgical management of impotence. They have implanted twenty prostheses with a followup of two years to three months. The overall results are very satisfactory in terms of the quality of the sexual life of the couple (85%). On the other hand, the postoperative morbidity rate is high, with 40% of complications including 20% requiring reoperation.

[Urodynamic study of urinary incontinence appearing in the fifth month of pregnancy and persisting after delivery. The role of progesterone]. / Etude urodynamique d'une incontinence d'urine apparue au cinquieme mois de la grossesse et persistant après l'accouchement. Rôle de la progestérone.

The authors report a case which highlights the role of progesterone in stress incontinence. On the other hand, slight defects of the urethral sphincter do not prevent a return to normal continence.

[Simplified technic of antereflux implantation of the ureters in total cystoprostatectomy with immediate replacement of the bladder by an ileal graft]. / Technique simplifiée d'implantation anti-reflux des uretères dans les cysto-prostatectomies totales avec remplacement immédiat de la vessie par greffon iléal.

The authors describe a simplified technique for a "ureter-intestinal graft" antireflux anastomosis in cystoprostatectomy, with immediate replacement of the ureter by an intestinal graft, using Camey's procedure.

[Personal experience of sleep plethysmography in the differential diagnosis of erection disturbances (author's transl)]. / Notre expérience de la pléthysmographie de sommeil dans le diagnostic différentiel des troubles de l'érection.

The authors feel that penile erection during sleep represents the first stage in the investigation of erection problems. The aim is to distinguish between psychogenic impotence the organic impotence. The authors simultaneously perform plethysmography and an electroencephalogram during sleep. Sixty five patients have been investigated in this way. In 44 cases the occurrence of nocturnal penile erection led to the conclusion of a psychogenic origin whilst in 21 cases the results of plethysmography were pathological. Amongst these 21 patients, undergoing vascular investigations, 12 underwent revascularisation of the corpora cavernosa and 12 the insertion of an erection prosthesis. It may be noted that revascularization using the epigastric artery gave widely disparate results: 2 good results amongst 9 patients, with one failure and six inadequate erections. The authors emphasise the fact that there is little alteration in sleep in cases of organic impotence and that phases of paradoxal sleep recur periodically without any great variation in the plethysmographic curve. By contrast, in functional impotence, sleep is invariably disturbed. A whole series of factors are involved in the assessment of the results: total duration of sleep, duration of paradoxal sleep, ratio of paradoxal sleep to total sleep, total erection time, total time in maximum erection and the ratio of erection time to paradoxal sleep. Analysis of sleep is thus a fundamental factor in the proper interpretation of the results of plethysmography in an importance sufferer.

Successful autotransplantation of an intra-abdominal testis by microsurgery.

An intra-abdominal testis in a 12-year-old child was successfully transplanted to the scrotum by a microvascular technique. The result after 12 months is promising. Problems of ischaemia in testicular autotransplantation and technical problems in testes with a short spermatic pedicle are emphasized.