[Unusual complication of self-catheterization in a patient with a continent stoma]. / Complication inhabituelle d'un auto-sondage chez un patient porteur d'une stomie continente.

The authors report a case of acute urinary retention due to a knot in the the catheter, in a patient performing self-catheterization. They describe a simple technique for emergency relief of retention, by creating additional apertures in the catheter, and then discuss the preventive measures of this type of complication.

[Diagnostic value of Stamey's test in chronic prostatitis]. / Valeur diagnostique du test de Stamey dans les prostatites chroniques.

OBJECTIVES: Analysis and technical details of Staomey's fractionated urine cultures, the reference method for the evaluation and bacteriological diagnosis of chronic bacterial prostatitis, but the application of which has been rarely described in the literature. METHOD: Stamey's test is based on comparative analysis of urine samples representative of the urethra, bladder and prostatic secretions obtained by prostatic massage. This method allows the demonstration of bacteria in the urine or prostatic secretions in the presence of bacterial prostatitis, in contra with non-bacterial prostatitis and prostatodynia. The sampling conditions require a sufficiently full bladder and the samples must be collected according to rigorously sterile procedure. The first step of the examination must not be preceded by urethral swabbing and the urine samples must have a well defined volume. Prostatic secretions are obtained by a prolonged massage of each lobe of the prostate gland. RESULTS: Bacterial prostatitis is confirmed by the presence of bacteria in the prostatic secretions and U3 in numbers largely exceeding the bacterial counts of the other samples. In the case of lower urinary tract infection, the test must be repeated after disinfection of the bladder urine. The pathogenic role of Gram positive bacteria is confirmed by isolation of a high bacterial count on several occasions. The pathogenic role of Ureaplasma urealyticum and Chlamydiae trachomatis is more controversial, while the role of Trichomonas vaginalis is unlikely and fungal prostatitis is very rare. Semen culture is less reliable than Stamey's test in the diagnosis of prostatitis. CONCLUSION: The diagnosis of chronic prostatitis is difficult due to the absence of typical clinical symptoms, specific ultrasonographic signs and the sometimes difficult interpretation of the culture results. Stamey's test is a reference diagnostic examination provided it is performed according to a rigorous methodology.

[Genital prognosis of boys with bladder exstrophy or epispadias with incontinence. Apropos of 14 cases]. / Avenir génital des garçons atteints d'exstrophie vésicale ou d'épispadias avec incontinence. A propos de quatorze cas.

Bladder exstrophy and epispadias with incontinence are associated with urinary tract and genital anomalies. The genital and sexual aspects were studied in 14 adolescent or adult males (12 exstrophies and 2 epispadias). The appearance of the penis was satisfactory in fifty percent of cases. Erections were always preserved but normal ejaculations were present in only one half of cases. Fertility potential was reduced. The improvement of surgical technique, and especially penile lengthening, has greatly improved sexual intercourse for these patients.

[Hemorrhagic gastro-duodenal ulcers. In which cases should emergency surgery be performed?]. / Ulcères gastro-duodénaux hémorragiques. Lesquels faut-il opérer en urgence?

From January 1983 to December 1987, 127 patients with bleeding peptic ulcer were admitted to hospital. The mean age of the 85 males was 57 years and 72 years for 42 females. All but four of the patients were managed medically after emergency endoscopy. Twenty-seven patients required surgical operations (21.2%): seven for cataclysmic haemorrhage, eight for persistent haemorrhage, twelve for recurrent bleeding. An analysis of factors leading to the necessity of surgical haemostasis was undertaken by considering the clinical status, endoscopic findings and laboratory results. The size of the ulcer (greater than 2 cm) was the most significant parameter (less than 0.01). Five other criteria (rectal bleeding) shock, endoscopic signs of recent haemorrhage, gastric or duodenal posterior ulcer) were also significant (p less than 0.05). Considering the gravity of these patients (six deaths among twenty-seven), clinical trials in bleeding peptic ulcer disease should only include patients in the high risk group.