Massive hemoperitoneum due to uterine perforation by the Bakri Balloon, during the treatment of postpartum hemorrhage.

The current case describes a very rare complication of Bakri Balloon during the treatment of postpartum hemorrhage; a massive hemoperitoneum with a hemodynamic shock, due to a migration through the right broad ligament, with an anterior uterine rupture, and an irreversible wound of the right uterine artery. This event occurred even if the unfold placement was controlled with ultrasound guidance, to a patient who has never had abdominal surgery (Cesarean section included).

Effect of transurethral resection of the prostate on erectile function: a prospective comparative study.

The effect of transurethral resection of the prostate (TURP) on erectile function is still controversial, and available evidence is conflicting. One of the possible mechanisms of post-TURP erectile dysfunction (ED) is direct thermal injury to the erectile nerves. The aim of this study was to investigate the effect of TURP on erectile function. Fifty patients undergoing TURP for obstructive benign prostatic hyperplasia (HBP) were prospectively included in the study, and 50 age-matched patients undergoing transurethral resection of the superficial bladder tumor were also prospectively included as a control group. All patients completed the international index of erectile function (IIEF-15), the international prostatic symptom score (IPSS) and the Hospital Anxiety and Depression Scale at inclusion in the study and then at the 3- and 6-month follow-up evaluation. Capsular perforations during TURP were prospectively reported by the operating surgeon. There was a significant improvement of erectile function in the TURP group despite the onset of ejaculation disorders in 70% of the patients. Improvement of erectile function was also found in the subgroup of patients with capsular perforation during TURP. Comparison with the control group showed that at preoperative evaluation, patients in the TURP group had more severe urinary symptoms and worse erectile function than did those of the control group. At the postoperative period, the IPSS score became comparable in the two groups, with major improvement of erectile function in the TURP group. We concluded that TURP improved erectile function in HBP patients with severe urinary symptoms. This improvement of erectile function was observed even in case of capsular perforation.

Traitement de l'incontinence urinaire post-operatoire de l'homme par bandelette sous uretrale: a propos de 16 cas

Objectif: Evaluer les resultats preliminaires de la mise en place d'une bandelette sous uretrale pour le traitement d'incontinence urinaire suite a une chirurgie prostatique chez l'homme selon la technique de Comiter modifiee (sans vissage osseux). Patients et methodes: Entre janvier 2005 et decembre 2006; 16 patients ont ete pris en charge pour incontinence urinaire qui apparut apres chirurgie prostatique. Une bandelette de polypropylene fixee sur le perioste des branches ischio-pubiennes par des fils de nylon et comprimant l'uretre bulbaire a ete mise en place. L'evaluation pre et post-operatoire a ete basee sur l'examen clinique et le nombre de protections utilisees par jour. Les patients ont ete revus a un mois post-operatoire; puis tous les trois mois. Resultats: Avec un recul moyen de 18 mois; 11 patients sont continents ne necessitant pas de protection et 3 patients sont nettement ameliores. Un echec a ete note chez un patient qui avait presente initialement une incontinence severe. Un autre patient a developpe une infection de la bandelette necessitant son retrait et a ete exclus de la serie pour l'evaluation fonctionnelle. Nous n'avons pas constate de douleurs perineales persistantes ni d'erosion uretrale ni d'osteite. Conclusion: Notre modification de la technique selon Comiter semble avoir des resultats satisfaisants comparables avec la technique originale. Elle presente un avantage economique certain par rapport a d'autres kits du marche

[One-stage bilateral rigid ureteroscopy]. / L'urétéroscopie rigide bilatérale au cours de la même séance opératoire.

OBJECTIVE: To evaluate the results of one-stage bilateral rigid ureteroscopy for the treatment of bilateral ureteric stones and to identify predictive factors of failure. MATERIALS AND METHODS: From January 1995 to June 2006, 61 patients were hospitalised for bilateral ureteric stones. Fifty patients, that is, 100 renal units were treated by first-line one-stage bilateral rigid ureteroscopy using an 8 F rigid ureteroscope and a ballistic lithotriptor. A complete statistical analysis (bivariate analysis completed by multivariate analysis) was performed to identify predictive factors of intraoperative failure. RESULTS: The overall success rate per patient (success on at least one side) was 92% (with bilateral success in 70% of cases). Statistical analysis revealed a statistically significant difference between the two failure/success groups for mean stone diameter (p < 0.1%), site (p = 0.6%) and degree of cavity dilatation (p = 4%). Similarly, a strong statistical correlation was observed between these variables and intraoperative failure. The intraoperative complication rate was 4% (two patients) and the postoperative complication rate was 16%, corresponding to minor complications in every case (low back pain, fever) not requiring a supplementary procedure. CONCLUSION: One-stage bilateral rigid ureteroscopy achieved satisfactory results similar to those of unilateral ureteroscopy. Predictive factors of failure were: stone diameter (greater than 15 mm), stones in the lumbar ureter and marked cavity dilatation.