Radiographic prognostic criteria for extracorporeal shock-wave lithotripsy: a study of 485 patients.

OBJECTIVES: We studied 485 patients treated by extracorporeal shock-wave lithotripsy (ESWL) using an ultrasound electrohydraulic apparatus in an effort to define radiographic criteria for better patient selection for ESWL. METHODS: Results were assessed according to plain x-ray nephrotomography and ultrasound. The criteria for measuring success (stone free [SF]) excluded all residual fragments. After per-criteria analysis of the results, a multivariate analysis as well as an analysis of stone composition by infrared spectroscopy were performed. RESULTS: The SF rate was 57.5% (279 of 485). Calculi that were smooth, denser than bone, located in the lower calyx, and larger than 15 mm had less satisfactory results despite a greater number of impulses. A correlation was established between the radiographic appearance of the calculus, its composition, and ESWL results. Rough, less dense calcium oxalate dihydrate yielded satisfactory results (65%), whereas smooth, dense calcium oxalate monohydrate led to less conclusive results (41%). Multivariate analysis demonstrated the predominant influence of radiographic calculus profile on the results: rough, less dense calculi yielded a 79.4% SF rate, whereas smooth, dense calculi yielded a 33.6% SF rate. CONCLUSIONS: We propose that patients with dense, smooth calculi located in the lower calyx and larger than 15 mm be treated by other techniques, such as percutaneous nephrolithotomy. This would not only increase the ESWL effectiveness rate, but would also reduce the cost of treating kidney stones.

[Results of extracorporeal lithotripsy with ultrasonography-guided hydroelectric lithotriptor: study on 546 patients, prognosis factors]. / Résultats de la lithotritie extra-corporelle par lithotriteur hydroélectrique à repérage échographique: étude sur 546 patients, facteurs pronostiques.

OBJECTIVE: To investigate the existence of simple radiographic prognostic criteria, applicable on an outpatient basis, predictive of the result of extracorporeal lithotripsy (ECL). METHODS: This study was based on 546 patients treated by ECL using a hydroelectric apparatus. The results were evaluated on plain nephrotomographies and ultrasonography performed at the third month. Success was defined as the elimination of all residual fragments, regardless of their size, without fragments (WF). Analysis concerned 485 files after exclusion of patients lost to follow-up. Prognostic factors were evaluated criterion by criterion, and then by multiple ascending regression multivariate analysis. RESULTS: The fragment-free rate according to our criteria was 57.5%. Significantly poorer results were obtained for stones denser than bone (p < 0.001), smooth (p < 0.001, larger than 12 mm (p < 0.01), situated in the inferior calyx (p < 0.005), despite an increased (p < 0.005) number of ECL sessions and the number of shocks received. A correlation was established between the radiographic appearance of the stone, its predominant spectrophotometric nature (> or = 50%) and the results of ECL. Good results were obtained in 65% of spiculated, low-density Weddellite stones versus 41% of cases of dense, smooth Whewellite stones. Multivariate analysis of the predominant radiographic appearance of the stones showed that spiculated, low-density stones were completely eliminated in 79.4% of cases, and dense, smooth stones were completely eliminated in 33.6% of cases (p < 0.001). CONCLUSION: In this study, smooth, dense stones larger than 12 mm, situated in the inferior calyx appear to be particularly resistant to ECL. On the basis of this result, the authors propose a prospective clinical trial to compare the results of ECL and primary percutaneous nephrolithotomy in this type of stone with a high risk of failure.

[Multiple myeloma of the testis]. / Localisation testiculaire d'un mylome multiple.

The testis is a rare site of multiple myeloma. The authors report such a case in a patient with a 7-year history of multiple myeloma. Transinguinal castration was performed. Six months after the operation, the patient did not have any other extramedullary sites, but the disease progressed rapidly with diffuse bone pain and end-stage renal failure. The diagnosis and management are discussed in the light of a review of the literature.

Systematic removal of catheter 48 hours following transurethral resection and 24 hours following transurethral incision of prostate: a prospective randomized analysis of 213 patients.

The interval before removal of the catheter used in prostatic transurethral surgery depends to a great extent on the surgeon, with a frequently empirical orientation. We conducted a prospective, randomized and controlled study of 213 patients who underwent transurethral surgery for benign prostatic hyperplasia. The catheter was removed systematically 24 hours after transurethral incision and 48 hours after transurethral resection of the prostate (group 1-52 and 54 patients, respectively) or the catheterization interval was determined by each surgeon in accordance with the usual criteria (group 2-52 and 55 patients, respectively). No statistically significant differences were noted between these 2 groups in regard to complications. We conclude that systematic removal of the catheter at the aforementioned periods is cost-effective, safe and comfortable for the patient.

[Tumors of the Bellini collecting tubules. Apropos of a case]. / Tumeur des tubes collecteurs de Bellini. A propos d'un cas.

Based on a personal case and a review of the literature, the authors describe the particular features of renal tumours arising from the papillary ducts of Bellini. The most remarkable feature of this rare lesion, which has a very poor prognosis, is that it arises in the medullary zone of the kidney. The histological diagnosis is often difficult to confirm and immunohistochemical techniques are essential. The possible role of adjuvant chemotherapy following nephrectomy and the type of regimens used are discussed.

[Simplified vesico-urethral anastomosis after radical retropubic prostatectomy for cancer. A preliminary comparative study]. / Anastomose vésico-urétrale simplifiée après prostatectomie radicale rétropubienne pour cancer. Etude préliminaire comparative.

The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.

[Vesico-urethral anastomosis after radical prostatectomy in cancer: Vest-Mayo's simplified technique]. / L'anastomose vésico-uréthrale après prostatectomie radicale pour cancer: technique simplifiée selon Vest-Mayo.

The authors describe the technique of anastomosis without vesicourethral suture after radical prostatectomy for cancer. The operative details are described with a brief analysis of the principal complications observed in the first 14 patients operated with preservation of the bladder neck. These results are compared with the in the literature concerning this old technique recently revised by the Mayo Clinic surgical team in 1988.

Prognostic value of histological grade and nuclear grade in renal adenocarcinoma.

We conducted a retrospective study of 237 cases of clinically localized renal adenocarcinoma treated at our department between November 1971 and December 1991 by radical nephrectomy. The parameters considered were tumor extension (pT stage), histological grading and nuclear grading. If the histological grade proved to be of little informational value in regard to survival, nuclear grade and pT stage had significant impact. On the other hand, nuclear grading considered in a given stage provided no significant influence. We conclude that nuclear grading cannot predict the outcome of patients at the same surgical stage.

[A technical device for the percutaneous extraction in monobloc of various renal calculi larger than 10 mm]. / Un artifice technique pour l'extraction percutanée en monobloc de certains calculs rénaux supérieurs à 10 mm.

The authors present a technical device consisting of a modification of the operating channel for stone extraction by percutaneous nephrostomy. For selected stones, widening of the lips of the operating channel allows the stone to be rapidly and entirely removed without the need for ultrasound or hydroelectric fragmentation, which is always associated with a risk of leaving residual fragments. The aim of this technical device is to ensure complete absence of residual fragments with a minimum of risks for the renal parenchyma.

[Prostatic cancer between 50 and 60. A more than 20-year-long retrospective study. Apropos of 65 case reports]. / Le cancer prostatique entre 50 et 60 ans. Etude rétrospective sur plus de 20 ans. A propos de 65 observations.

Sixty five 50 to 60 year old patients have been treated for prostatic cancer over a 21 year period. Twenty four had a local prostatic cancer (A1, A2, B1, B2) and 41 (63.2%) a locally advanced or metastatic (D1, D2 disease at diagnosis. The mean age was 56 years old. As being as retrospective study, miscellaneous treatments were done. The 5 and 10 years survival, analysed with the Kaplan-Meier method, was 61% and 31% respectively. According to the stage of cancer, the 10 year survival was 72% and 5% for (A-B) and (C-D) respectively. For well differentiated tumors, 5 years survival was 67% instead of 36% for undifferentiated ones. The 10 year survival was 36% for well differentiated tumors with 6 on 8 patients who survived with a mean of 11.6 ears. The authors discussed the benefit of an early diagnosis of prostatic in the 50-60 year old men group which is 4% of the total prostatic cancer diagnosed within the same period. They analysed the influence of PSA and transrectal sonography interest at this age.

[Ectopic ureteral orifice into the seminal duct with homolateral renal agenesis: contribution of ultrasonography]. / Abouchement ectopique de l'uretère dans le tractus séminal avec agénésie rénale homolatérale: apport de l'échographie.

Based on an incidental case of ectopic ureteric orifice in the seminal tract associated with homolateral renal agenesis, the authors demonstrate the value of ultrasonography, particular transrectal, both for diagnosis and follow-up. Digital rectal examination is the key to the diagnosis, combined with ultrasonography and urography. The indications for surgery depend on the clinical symptoms and signs.

[Calcified renal cancers. 7 case reports]. / Les cancers calcifiés du rein. A propos de 7 observations.

The authors report a series of 7 patients with calcified renal cancer (5 men and 2 women with a mean age of 51 years). The calcifications had a variable appearance:arcuate (1 patient), disseminated throughout the mass (5 patients), mixed (1 patient). The distribution according to stage was as follows: T1: 1 patient, T2: 3 patients, T4: 3 patients. Five patients were treated by radical nephrectomy, but surgery was impossible in 2 patients due to the local extension of the tumour. Two patients are alive with no signs of recurrence (follow-up: +7 years and +7 months), 1 died 10 years after his nephrectomy, from myocardial infarction, 1 was lost to follow-up and 3 died within several months. These 3 patients had a spindle cell renal cancer. In the light of this series, the authors situate calcified renal cancers in relation to other calcified renal masses (of various origins) and in relation to adult renal cancers. They demonstrate that any calcified renal mass must raise the suspicion of cancer and they describe the diagnostic approach to such a hypothesis.

[Cystinic lithiasis. Current aspects of the urologic treatment]. / La lithiase cystinique. Aspects actuels du traitement urologique.

On the basis of a series of 9 patients (12 renal units) gathered over 19 years, the authors analyze the current possibilities of treatment of cystine lithiasis. They first describe the characteristics of this litiasis, which is rare but serious, being naturally prone to recurrence because it is caused by a genetic defect. The development of extracorporeal lithotripsy raised great hopes for the treatment of this lithiasis, but it was soon realized that cystine strones were hard to break. However, even the mere fragmentation of the stones improves the dissolving action of the various drugs proposed to modify the pH of urine. The authors consider that open surgery by means of posterior vertical lumbar section still is indicated for larger stones, and percutaneous nephrolithotomy seems to be a very useful technique, either exclusively or as a complement of extracorporeal lithotrity.