[Double hemorrhagic complication of endo-urologic drainage in single kidney]. / Double complication hémorragique d'un drainage endo-urologique sur rein unique.

Hemorrhage is the most worrisome complication of percutaneous renal procedures, and usually occurs early in the postoperative period. The incidence of severe arterial injury is 1 to 2%. We report a patient who had 2 bleeding episodes on a solitary kidney. The first, which occurred early after the procedure, was due to an arteriocaliceal fistula treated by coil embolization. The second bleeding episode occurred two weeks later, and was caused by erosion of a lumbar artery; it was embolized by microparticles. To our knowledge, this is the first report of the imaging findings. In summary, when bleeding occurs after endourologic procedures, renal as well as extrarenal parietal causes should be investigated.

Vein grafting of tunical incisions in the treatment of Peyronie's disease.

The effectiveness of vein grafting of tunical incisions of Peyronie's plaques in straightening the penis, with preservation of normal erectile function is evaluated. Eighteen patients with Peyronie's disease were surgically treated with a vein patch graft technique to correct their penile curvature. Transverse relaxing incisions were made on the tunica albuginea where a curvature was identified by an artificial erection. A vein graft from the saphenous vein was sewn into the defect created by relaxing incisions. If there was evidence of a residual curvature after the vein grafts were sewn in, a plication of the contralateral surface of the tunica albuginea was performed. The saphenous vein grafting alone was sufficient to straighten the penis 90 to 100% in 50% of patients. Of twelve patients who were potent preoperatively, one required postoperatively an occasional intracorporeal injection to maintain erection. Two of the impotent men regained their potency postoperatively. None of the patients lost sensation in the glans or shaft of the penis. Penile shortening was reported in three patients. No decrease in the penis rigidity was noted. Patients were discharged within 5 days of the procedure. There were no immediate complications. Fifteen of our sixteen followed patients resumed intercourse in eight weeks. We found that plaque incision in the venous grafting is much easier than the other incisional and excisional procedures described in the literature, and may lead to successful correction of penile deformity without compromising potency, penile length and sensitivity.

Management of posttraumatic posterior urethral disruption.

We reviewed our experience with 17 cases of posterior urethral disruption due to traumatic pelvic injuries. In all cases, a suprapubic cystostomy was performed at first. For blunt injuries, urethroplasty was delayed for 6 months in average. For most of the penetrating injuries (3/4), we performed immediate debridement and primary repair. Resulting bulbous or membranous strictures less than 3 cm long were treated with one-stage perineal excision-reanastomosis urethroplasty. Membranous strictures longer than 3 cm were managed with a combined transpubic-perineal repair, while bulbous defects longer than 3 cm were treated with a scrotal pedicled island flap. The overall restricture rate was 25%. Those having had initial repeated urethrotomies displayed a 100% restenosis rate. Incontinence rate was 12.5% Erectile dysfunction occurring in 42% of our patients is a sequela of the pelvic injury and was found to be directly related postoperatively to its presence at the time of surgery.

[Implantation of the Ultrex type inflatable penile prosthesis. Four years experience]. / Implantation de prothese pénienne gonflable type Ultrex. L'experiencede 4 ans.

During the last 4 years, 12 patients had an implantation of the AMS Ultrex2 penile prosthesis : 4 of these patients were impotent after a cystoprostatectomy, 4 patients had vascular insufficiency, 2 patients had psychogenic impotency, one patient was diabetic and one patient had a spinal cord injury. The complication rate was low (16%): one patient necessitated a surgical revision of the prosthesis after disconnection of the tubulure. A second patient had a urethral stenosis treated by dilation. The degree of satisfaction of both patient and partner was satisfactory.

Piezolith extracorporeal shockwave lithotripsy: the Hotel-Dieu de France experience.

A total of 1500 patients underwent treatment with the Wolf Piezolith 2300 extracorporeal shockwave lithotripter for renal, ureteral, and bladder stones. Follow-up data were available at 3 months for 1435 patients. At that time, the overall stone-free rate was 82.7%: 82.4% for patients with renal stones, 81.0% for those with ureteral stones, and 100% for those with bladder stones. The overall success rate was 92.3%: 93.8% for patients with renal stones, 87.1% for those with ureteral stones, and 100% for those with bladder stones. The auxiliary treatment rate was 14.9%, and the retreatment rate was 53%. The effectiveness quotient was 49.2%. The Wolf Piezolith 2300 is an effective treatment for most stones smaller than 30 mm.

Microsurgical high inguinal varicocelectomy with delivery of the testis.

This study describes the results of 50 consecutive cases of varicocelectomy by the inguinal approach. The testicle is delivered through a small inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under optical magnification. The testicular artery, the lymphatics and the vas deferens are identified and preserved. All internal spermatic veins are ligated. 94 varicocelectomies were performed in 50 men. Follow-up period extended from 12 months to 24 months. No hydroceles, no clinical recurrences and no wound infection were found. One scrotal hematoma occurred and resolved progressively. Preoperative and postoperative semen analysis were obtained. The changes in sperm count mean value (million/cc) (20 to 28.6) (p < 0.005), per cent normal forms (42.9 to 52.1%) (p < 0.005) and per cent motility (31.5 to 39.2%) (p < 0.005) were significant. The pregnancy rate was 10 of 21 couples available for follow-up (47.6%). This technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele clinical recurrence.

[Incidentally discovered adrenal tumor: myelolipoma]. / Tumeur surrénalienne de découverte fortuite: le myélolipome.

The wider application of increasingly sensitive ultrasonography and CT scanning has created a new problem for clinical management: the incidental discovery of asymptomatic adrenal lesions. These lesions, also called "incidentalomas" may be due to a large variety of etiologies, and although most of them prove to be benign cortical adenomas, diagnostic confirmation is frequently impossible preoperatively. For this reason, a general approach, based on the relative prevalence of benign and malignant, clinically silent adrenal masses, has been defined. This same approach is usually needed in the case of myelolipoma, a rare form of benign and silent adrenal neoplasms, containing hematopoietic and fatty elements. Actually, computed tomographic aspect of such tumors is very evocative but not pathognomonic, so it doesn't eliminate the possibility of malignant lesions, especially in the presence of heterogeneities. Because of these limitations and awaiting the development of more specific diagnostic procedures, it seems cautious to approach these tumors like incidentalomas in general.

[Various aspects of uretero-ureteral reflux in incomplete ureteral duplication]. / Différents aspects du reflux urétéro-urétéral dans la duplication urétérale incomplete.

This study is a complete review of the common complications related to incomplete ureteral duplication, and based on three clinical cases. These complications include: Recurrent urinary tract infections with pyelonephritis; non functioning of one or both kidney units; Urinary lithiasis and the uretero-ureteral reflux secondary to retrograde ureteral peristalsis. Finally, the surgical treatment of the uretero-ureteral reflux depends on the clinical and radiological symptoms of the patients. Heminephrectomy in case of a non functioning renal segment. Excision of one ureteral segment converting an incomplete ureteral duplication into a bifid pelvis. Conversion of an incomplete duplication into a complete ureteral duplication if the common segment is near the bladder. Nephroureterectomy should be considered in case of non functioning kidney with type IV vesico-ureteral reflux.

[The artificial sphincter in the treatment of urinary incontinence]. / Le sphincter artificiel dans le traitement de l'incontinence urinaire.

During the period from August 1988 until August 1991, 31 patients who had urinary incontinence of different etiologies underwent implantation of an artificial sphincter AMS 800 at the Urology service in Hotel-Dieu de France Hospital. (26% Spinal cord injury; 42% Post op, complicate; 32% Congenital anomalies). After a follow-up of 5 to 36 months (means 24 +/- 10 months) the 28 patients in whom the sphincter was kept implanted, 26 (93%) patients achieved complete continence day time as well as nocturnal. 2 patients (7%) still have mild stress urinary incontinence. Follow-up was five months, and maximum three years. The sphincter was removed in 3 (10%) patients who had infection of the prosthesis. The above results are in favor of the implantation of this type of prosthesis.