A new MDCT technique for the detection and anatomical exploration of urogenital fistulas.

OBJECTIVE: We tested a new MDCT technical protocol, combining i.v. and intravesical positive contrast agent and intravaginal neutral contrast agent, that optimizes exploration of urogenital fistulas. We examined three patients (four CT examinations in total) with this technique and proved that a preexisting subtle ureterovaginal fistula that was under treatment was still present, though clinically silent. CONCLUSION: The proposed MDCT examination protocol provides important information to help detect subtle urogenital fistulas.

[Medical therapy for ureteral stones: high versus low fluid intake]. / Traitement médical de la tithiase urétérale: restriction versus chasse hydrique?

The mainstays of renal colic medical treatment are first to provide efficient pain relief, and second to facilitate migration of the ureteral stone or dissolve it. In the ambulatory setting, non steroidal anti-inflammatory drugs are the treatment of choice of pain relief. To facilitate stone migration, the debate between hydric restriction and hyperhydration remains somewhat open. Besides that, alpha-blockers and anti-calcic agents appear to speed up stone explusion, whereas stone chemolysis acts on a longer time scale.

[Indications for low-dose CT in the emergency setting]. / Indications au CT low-dose aux urgences.

CT delivers a large dose of radiation, especially in abdominal imaging. Recently, a low-dose abdominal CT protocol (low-dose CT) has been set-up in our institution. "Low-dose CT" is almost equivalent to a single standard abdominal radiograph in term of dose of radiation (about one sixth of those delivered by a standard CT). "Low-dose CT" is now used routinely in our emergency service in two main indications: patients with a suspicion of renal colic and those with right lower quadrant pain. It is obtained without intravenous contrast media. Oral contrast is given to patients with suspicion of appendicitis. "Low-dose CT" is used in the frame of well defined clinical algorithms, and does only replace standard CT when it can reach a comparable diagnostic quality.

Laparoscopic treatment of mucinous urachal adenocarcinoma with mucocele.

We present a case of an asymptomatic 76-year-old woman treated laparoscopically for an urachal mucocele owing to a nonmetastatic urachal mucinous adenocarcinoma. Since laparoscopic en bloc resection of the urachus and partial cystectomy, the patient has been healthy and disease-free for 12 months. Modern surgical treatment of urachal adenocarcinoma is discussed in the light of this case.

Percutaneous cryoablation of small kidney tumours under magnetic resonance imaging guidance: medium-term follow-up.

OBJECTIVE: Minimally invasive treatment of small kidney tumours remains a challenge. Cryoablation has recently been advocated for such neoplasias. However, few series evaluating this therapeutic regimen are as yet available. The goal of this retrospective study was to evaluate the initial clinical experience of magnetic resonance imaging (MRI)-guided percutaneous cryotherapy of small renal tumours. MATERIAL AND METHODS: Seven patients with small renal tumours [mean diameter 21 (11-30) mm] underwent percutaneous renal tumour cryoablation using the Cryo-Hit delivery system. The procedure was performed in an MRI interventional unit, using a 0.23 Tesla open MRI imaging system. Five men and two women were included in the group. The average age was 61.5 (34-84) years. The patients had a solitary kidney (n = 2), renal insufficiency (n = 4) or a kidney graft (n = 1). The intervention was performed under general anaesthesia. Average time for the whole procedure was 235 min with 26 min of effective treatment time. Mean follow-up was 28 (7-43) months. RESULTS: All tumours were successfully ablated. There were no perioperative complications. Mean hospital stay was 2.4 (2-5) days. One patient stayed for 5 days because therapeutic anticoagulation had to be reinitiated. No significant change in the perioperative value of the serum creatinine was noticed. No radiographic evidence of disease recurrence or new tumour development was identified during the follow-up. CONCLUSIONS: In this small group of patients, percutaneous renal tumour cryoablation under MRI guidance was efficient and carried no morbidity. Hospital stay was remarkably shorter than that of surgically treated patients. At medium-term follow-up, no recurrence has been identified, but long-term follow-up is required.

Blood splash injury: an underestimated risk in endourology.

BACKGROUND AND PURPOSE: Mucocutaneous and transconjunctival exposure are important portals for the transmission of blood-borne infections to surgeons and health-care workers. Despite this knowledge, few surgeons or their assistants wear protective equipment for procedures perceived to be affiliated with less risk. This study investigates the potential risk of mucocutaneous and transconjunctival blood splash injury during common laparoscopic and endourologic procedures undertaken using standard video endoscopy equipment. MATERIAL AND METHODS: Masks combined with eye shields were consecutively collected from the surgeon, surgical assistant, and theater nurse after a variety of endourologic procedures over a 4-month period. These were analyzed macroscopically for visible blood droplets. Modern forensic techniques were then instituted to assess for nonvisible blood exposure. RESULTS: Eye shields from 118 procedures performed by five surgeons were collected. Two hundred and thirty-six masks were examined for visible and visually enhanced evidence of blood contamination. In total, 48.5% of surgeons' masks, 29.5% of assisting surgeons' masks, and 31.8% of scrub nurse masks were positive for either visible or visually enhanced blood contamination. In terms of evidence of blood splash, 84.2% of laparoscopic nephrectomies, 66.7% of pyeloplasties, and 58.3% of flexible ureteroscopies tested positive. CONCLUSION: Splash injuries remain commonplace, even with the use of video endoscopy equipment. Therefore, all health-care workers should be encouraged to wear eye and face protection when undertaking both endoscopic and laparoscopic urologic procedures. These observations may have broader implications relevant to all minimally invasive surgical procedures, because they demonstrate a much greater potential risk of blood-borne disease transmission during surgery than has been previously appreciated.

[The therapeutic dilemma of the early invasive bladder cancer]. / Le dilemme thérapeutique du stade micro-invasif du cancer de la vessie.

Transitional tumours of the bladder are classically divided in superficial (lesions of the mucosa and the submucosa) and invasive (infiltrating the detrusor) cancers. However, the recurrence and progression rate of submucosal urothelial cancers is highly variable. Therefore, management of such neoplasias is very challenging, some patients requiring a cystectomy, whereas others can be managed less invasively with endoscopic resection eventually associated with intravesical chemotherapy. We review herein the prognostic factors which help us to orientate our patients. We also emphasize the importance of the subclassification of the micro-invasive stage, and its practicability, which is reliable and simple, as opposed to the general belief.

[Treatment of symptomatic prostatic hypertrophy with the KTP-80 laser]. / Traitement de l'hypertrophie symptomatique de la prostate par le laser KTP-80.

Macroscopic per and post-operative hematuria contributes significantly to hospitalisation time and to the morbidity of conventional surgery of symptomatic prostatic hypertrophy. It requires in fact transient anti-coagulation interruption, so as eventually a window with platelet anti-agregants. The newly available 80-Watts Potassium-Titanyl-Phosphate laser markedly reduces post-operative hematuria, and allows operating the increasing population of patients under platelet anti-agregants, or event those who need therapeutic anticoagulation. This series reports on our initial experience with a technique which decreases remarkably post-operative catheterization and hospitalisation time, and whose obstruction relief is efficient, but needs to stand the test of time.