[Surgical management of urinary tract endometriosis: 12 cases]. / Prise en charge chirurgicale de l'endométriose de l'appareil urinaire : à propos de 12 cas.

OBJECTIVES: Our study aimed at evaluating, retrospectively, the outcome of the surgical management of urinary tract endometriosis. PATIENTS AND METHODS: Twelve women with a mean age of 36,4 were recruited between 1994 and 2007. They all had a histologically-proven and surgically-treated endometriosis of the urinary tract. RESULTS: Seven of them had a unilateral ureteric localization, two had a bilateral ureteric localization and three had a vesical localization. One patient with bladder nodules underwent a partial cystectomy and the two other patients with bladder localization underwent a transurethral resection. Out of the nine patients who had a ureteric localization of endometriosis, seven had a ureterectomy and re-implantation with bladder psoas hitching and had no recurrence. CONCLUSIONS: Our experience showed that ureterectomy and re-implantation with bladder psoas hitching is probably the best way of preventing recurrences in the case of urethral endometriosis. In the case of bladder endometriosis, transurethral resection did not appear as the most effective treatment although it remains an acceptable alternative, especially as far as premenopausal women or young women wishing to conceive are concerned.

[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.

[Hepatitis after treatment with cyproterone acetate. Apropos of a case]. / Hépatite après traitement par acétate de cyprotérone. A propos d'un cas.

Regarding a case of little-differentiated adenocarcinoma of prostate in a 79-year old male patient undergoing antiandrogenic corticosteroid therapy (cyproterone acetate), the authors describe a rare complication related to treatment with the drug. Cytolytic icterus, without cholestasis, occurred eleven weeks after starting the treatment without metastasis of the primary cancerous lesion, and regressed when administration of the antiandrogenic agent was interrupted. This description is compatible with toxic hepatitis. This is a rare complication, which should be differentiated from stasis icterus consecutive to treatment with progestogens. Its diagnosis precludes also primary or drug-induced secondary tumors or degenerative hepatic lesions. A knowledge of this complication by the urologist is important, so the latter might not conclude too hastily to metastatic extension of primary cancer of prostate. Withdrawal of the patient from antiandrogenic therapy is mandatory, and management should incorporate complete biological investigation of liver function, CT scans and, depending upon the case, liver biopsy as the only means of studying this exceptionally rare complication.

[Flexible ureteroscopy. Diagnostic and therapeutic significance. Apropos of 15 cases]. / L'urétéroscopie souple. Intérêts diagnostique et thérapeutique. A propos de 15 observations.

The authors analyse the results of a preliminary report of 15 cases of ureteric stones treated by flexible ureterorenoscopy and one case of radiolucent renal stone in the left lower renal calyx. Stone fragmentation was complete in 11 cases with 1 small residual fragment in the lower ureter, 1 perforation was immediately operated without any further complication and in one case, it was impossible to advance into the ureter. Flexible ureterorenoscopy is valuable for diagnosis of filling defects in the lower calyx and for treatment of stones in the upper and middle ureter.

[Value of posterior vertical lombotomy in the surgical treatment of calculi of the lumbar ureter. Apropos of 42 cases]. / Intérêt de la lombotomie verticale postérieure dans le traitement chirurgical des calculs de l'uretère lombaire. A propos de 42 cas.

Whereas surgery is no longer used for treatment of pyelocaliceal and lower ureter lithiasis, it remains a valid method in lithiasis of lumbar ureter poorly accessible to endoscopy. A direct approach to lumbar (or pelvic) ureter by posterior vertical lombotomy considerably reduces operation time, pain and duration of hospital stay and disability. Results in a series of 42 cases indicate that surgery remains an excellent and perhaps most effective therapy for lumbar ureter calculi, with the condition that the conventional posterolateral lombotomy be abandoned.

[The pedicled lateral flap. Its use in the treatment of anterior hypospadias]. / Le lambeau latéral pédiculé. Son utilisation dans la cure des hypospadias antérieurs.

Many methods exist for repair of anterior penile hypospadias but one of the most commonly used is certainly Mathieu's operation. However, this procedure can give rise to different complications due essentially to necrosis of a cutaneous flap brought anteriorly to reconstitute the missing portion of urethra. Based on the pedunculated cutaneous flap described by Blandy for use in urethral shortening, a proposal is made to obtain the flap for canal reconstruction laterally, this allowing conservation of its total vascularization and thus avoiding the risk of ischemic necrosis.

[Parotid metastases of clear-cell adenocarcinoma of kidney. Apropos of 2 cases]. / Les métastases parotidiennes de l'adénocarcinome à cellules claires du rein. A propos de 2 observations.

Two patients presented parotid metastases from adenocarcinoma of kidney. These metastases are rare and may reveal or develop during the course of a cancer of kidney. In the former case diagnosis presents certain difficulties. Treatment of single metastases is by parotidectomy and nephrectomy, prognosis being similar to that of the renal adenocarcinoma.

[Aberrant renal papilla. Peroperative nephroscopy. Conservative surgery. Apropos of a case]. / Les papilles rénales "aberrantes". Néphroscopie peropératoire. Chirurgie conservatrice. A propos d'une observation.

Principal characteristics of "aberrant papillae" are described, this curious embryologic anomaly being generally detected from the hematuria provoked. Intravenous urography reveals the presence of a persistent lacuna in a calix or of the pelvis, radiologic evidence of the abnormal papilla. Ultrasound and CT scan imaging provide few supplementary data. The most frequent differential diagnosis is from a pyelocaliceal tumor, the known risk of evolutory changes in the latter explaining why most "aberrant papillae" are treated by nephrectomy or even nephroureterectomy. The use of nephroscopy or ureteroscopy should allow, as in the case reported, these abusive nephrectomies to be avoided in the future.

[Resection of the inferior vena cava and tumor of the excretory duct: diagnostic and prognostic problems]. / Résection de la veine cave inférieure et tumeur de la voie excrétrice: problèmes diagnostiques et pronostiques.

The authors present a case of transitional cell carcinoma of the renal pelvis with inferior vena cava involvement. Two types of vena cava involvement are discussed: thrombus or nodes. The CT scan appears to be the best examination to preoperatively diagnose the type of invasion in order to be able to select the optimal treatment. However, these two types of involvement have a poor prognosis and surgery abstention may be justified. Chemotherapy may be useful in these cases.

[Management of isolated angiomyolipoma of the kidney]. / Conduite à tenir devant un angiomyolipome isolé du rein.

Four patients presented isolated angiomyolipomas of kidney in the absence of any form of phakomatosis such as Bourneville's disease. The tumor was removed by partial nephrectomy in only one case, after histology of a fresh specimen confirming the presence of an angiomyolipoma without signs of cancer. In another patient it was impossible to perform conservative surgery because of dissemination of the angiomyolipoma throughout the kidney. Symptomatology suggestive of the disorder includes lumbar pain, kidney tumor and more rarely hematuria. Diagnosis is difficult despite availability of ultrasound and CT scan imaging, which has supplanted renal arteriography. Confirmation requires histology of a fresh specimen. Operative treatment is essential to avoid the risk of intra- and peri-tumoral hemorrhage, particularly during pregnancy. Partial nephrectomy or excision of tumor is possible when the diagnosis has been established, if excision involves healthy parenchyma and if after strict hemostasis at least one third of renal parenchyma remains.

[Non-secreting malignant tumors of the adrenals. Apropos of 3 cases]. / Tumeurs malignes non sécrétantes de la surrénale. A propos de 3 observations.

Tow of three patients seen with malignant tumor of adrenals had very large lesions and the outcome was rapidly fatal. Excision of tumor was possible in the third case and the patient is in good health two years after operation. Clinical signs are infrequent and diagnosis of an adrenal lesion is mainly dependent on combined ultrasound-scan imaging, with confirmation by histology. Differential diagnosis is necessary between adrenal cortex adenoma and pheochromocytoma. Malignancy is suspected from signs of extratumoral invasion and a tumor weight of over 100 g. Histologic findings are not always specific. Treatment is almost exclusively surgical, complementary therapy being unnecessary in non-secreting pheochromocytoma. Attempts to treat malignant adrenal cortex masses by o,p-DDD have not improved prognosis. The chance discovery of a small tumor requires either routine excision of mass to prevent progression of certain malignant tumors, or simple surveillance, particularly after 50 years of age, since many of these tumors are benign: the decision for choice of therapy is a debatable subject.

[Mature retroperitoneal ganglioneuroma in the adult. A case]. / Ganglioneurome mature rétropéritonéal de l'adulte. Une observation.

Mature ganglioneuroma, a benign nervous tumor of sympathetic origin, is an uncommon diagnosis in adults, particularly when it is located in the retroperitoneal region. Embryology provides an explanation for detection of this tumor in the adrenal glands. The fortuitous discovery of a lesion of this type in a patient with a homolateral renal adenocarcinoma provoked diagnostic and therapeutic problems that are discussed and analyzed.

[Inferior vena cava thrombus in nephroblastoma in a child. Diagnostic, surgical and prognostic problems]. / Le thrombus cave inférieur dans le néphroblastome de l'enfant. Problèmes diagnostique, chirurgical et pronostique.

The authors report a case of a child Wilm's tumour with inferior vena cava obstruction. The diagnostic, technical and prognostic features are discussed. Ultrasonography appears to be the best diagnostic method to confirm thrombus in the vena cava and allows the choice of an appropriate surgical technique. The presence of vena cava thrombus does not alter the prognosis.