An 18-cm-large renal arteriovenous fistula treated by nephrectomy.

Idiopathic renal arteriovenous fistulas are extremely rare. They are believed to occur as the result of congenital renal artery aneurysm that erodes into an adjacent vein. We report a case of a 48-year-old man in whom we discovered fortuitously a painless mass of the right flank. Computed tomography revealed a huge renal artery aneurysm with giant arteriovenous fistula in the absence of any clinical stigmata. Given the size of the fistula and the partial destruction of the renal parenchyma, nephrectomy was successfully performed.

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.

[Intestinal invagination after vagotomy in adults]. / Invagination intestinale après vagotomie chez l'adulte.

Intestinal intussusception is a rare condition in adults. In most cases, it is caused by a benign or malignant intestinal tumor. Primitive forms are infrequent, and their occurrence following troncular vagotomoy has never been described in the literature, according to our knowledge. Two cases of post-vagotomy jejuno-jejunal intussusception are reported.

[Bladder leiomyosarcoma: report of a case]. / Léiomyosarcome de la vessie: à propos d'un cas.

Leiomyosarcoma of the urinary bladder is an extremely rare disease. In this study, which also includes a review of the literature, a new case of urinary bladder leiomyosarcoma has been reported in a 65-year old male, which was detected during an investigation of total hematuria accompanied by burning upon micturition. The clinical examination was normal, but ultrasonography followed by bladder endoscopy showed the presence of a large bladder tumor. The definitive diagnosis of this type of tumor can only be made after histological and immunohistochemical investigation, and to avoid unnecessary surgery it is essential to first differentiate it from an inflammatory pseudosarcoma. Although in the present study the outcome following total cystoprostatectomy was favorable at 3 months follow-up, in general the prognosis is uncertain due to the potentially invasive character of this type of tumor. Given the limited number of studies on the subject treatment still remains controversial, but is essentially based on surgical excision, possibly with adjuvant chemotherapy.

[Paratesticular rhabdomyosarcoma]. / Rhabdomyosarcome paratesticulaire.

The authors report a case of embryonal paratesticular rhabdomyosarcoma in a 9-year-old child and discuss the treatment modalities in the light of data from the literature.