Evaluation of tension-free vaginal tape procedure. Its safety and efficacy in the treatment of female stress urinary incontinence during the learning phase.

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate preliminary results of tension-free vaginal tape (TVT), a new surgical procedure, performed during the learning phase for the treatment of stress urinary incontinence. MATERIAL AND METHODS: One-hundred consecutive patients underwent surgery, between June 1998 and December 1999, by six different senior surgeons. Indications were socially annoying urinary stress incontinence which persisted after complete physical therapy education. Preoperative examination included a urodynamic evaluation program. Surgical procedure was performed according to Ulmsten technique under local, regional or general anaesthesia. Results were evaluated by self-evaluation questionnaire and the patients were followed for at least 1 year. RESULTS: Perioperative complications were: 14 bladder injuries and one urethral perforation without sequelae (except prolonged bladder drainage up to 3 days). Postoperative complications were: 13 retentions including 3 persistent after 1 month. During the learning phase (50 first patients) bladder injuries, retention and dysuria were more frequent. Progressively, local anesthesia was abandoned while most of the 50 remaining patients had TVT performed under epidural anesthesia. Functional results were divided into 3 groups according to preoperative urethral closure pressure (UCP) and eventual concomitant prolapse repair (PR): (1) UCP >25 cm H2O no PR (59 patients): 39 were totally dry without any instability, 13 dry with de novo (4) or persistent (7) instability and 5 were moderately improved. (2) UCP <25 cm H2O no PR (25 patients): 11 were dry without instability, 5 dry with instability, 6 were improved and 4 failed. (3) PR (15 patients): 9 were dry, 4 were improved and 2 failed. For 2 patients a bladder erosion due to the tape occurred (7 and 11 months) after the TVT procedure. CONCLUSIONS: During the learning phase, bladder perforation (22%) and retention (20%) were much more frequent than previously reported. Nevertheless, our results confirm that TVT appears to be an efficient procedure: 97% of patients were cured or improved when UCP >25 cm H2O, 85% when UCP <25 cm H2O and 87% when a PR was associated.

Electrovaporization of the prostate with the Gyrus device.

PURPOSE: To assess the efficacy and the safety of a new transurethral endoscopic device using bipolar electrocautery, the Gyrus system. This system permits rapid prostate tissue removal by endoscopic vaporization with little bleeding and no pad return using saline irrigation and therefore eliminating TURP syndrome. PATIENTS AND METHODS: Forty-two patients (mean age 70; range 49-90 years) with symptomatic benign prostatic hyperplasia (BPH) without suspected cancer, confirmed by digital rectal examination and PSA tests, were treated between October 1998 and February 1999 with the Gyrus and evaluated at 1 and 3 months postoperatively by the International Prostate Symptom Score (IPSS) and maximum urinary flow rate. RESULTS: No postoperative bleeding necessitating catheterization for postoperative retention occurred. The duration of the procedure was < or = 30 minutes in 12 patients, 30 to 60 minutes in 27 patients, and >60 minutes in 3 patients. The mean time of postoperative continuous bladder irrigation was 1.2 days (0.5-3 days). The mean catheterization time was 1.4 days (range 0.5-5 days). Urethral stricture requiring treatment occurred in two patients. Dysuria was reported by four patients (mild two, severe two). The postoperative hospitalization was a mean of 2.2 days. The mean peak flow rate increased from 7.9 to 19.7 mL/sec at 3 months, and the IPSS decreased from 16 to 9 at 3 months. CONCLUSION: Our preliminary results with a bipolar electrode for electrovaporization of the prostate using the Gyrus suggest that it is a useful and safe endoscopic device. It appears to be an effective treatment for BPH; however, long-term results (i.e., 1-year follow-up) should be evaluated. This pilot series permits a comparative study with TURP to assess the benefits for patients and the health care system.

[The glucagonoma syndrome. Review of the literature. Apropos of a case]. / Le syndrome de glucagonome. Revue de la littérature. A propos d'un cas.

A patient with typical clinical and biochemical features of a glucagonoma also presented obvious signs of hypokalemia, indicating combined secretion of renin by the tumor. The latter was voluminous, was located in the tail of the pancreas and was of a malignant nature as shown by the development of secondary hepatic metastases. Syndromes associated with glucagonoma and mixed or combined insular tumors are reviewed in detail.

[Large non-covered abdominal eviscerations. Secondary parietal repair]. / Grandes éviscérations non couvertes de l'abdomen. Réparation pariétale secondaire.

In the technique described, the area of granulation tissue is first separated from the small bowel from which it originates and entirely removed. The internal borders of the rectus abdominis sheath are then brought together after being released by a wide lateral dissection of the skin and by a long counter-incision in the anterior surface of the sheath. The presence of a fistula or an enterostomy does not preclude the operation : indeed, they can be suppressed at the same time. Eight patients were treated by this simple technique which does not require prosthetic material. The results were satisfactory, with a durably strong abdominal wall.

[Echotomographic, scanographic and anatomic study of a case of cystic dilatation of the common hepatic duct]. / Etude échotomographique, scanographique et anatomique d'un cas de dilatation kystique du canal hépatique commun.

The authors describe the case of a 16-year-old African woman presenting with a cystic dilatation of the common bile duct associated with a dilatation of the left intrahepatic bile duct, hepatic fibrosis and portal hypertension. The disease was revealed by a non-infectious cholestatic syndrome. The diagnosis was made before the intervention by abdominal ultrasonography and computed tomography. A choledococyst-jejunostomy was performed which led to progressive normalisation of liver function. This report emphasizes the possibility of simultaneous lesions at different levels of the biliary tree in patients with choledocal cysts. The prognosis depends upon the state of the liver. A liver biopsy is therefore mandatory when an operation is performed. In the present case, the follow-up is too short to assess the regression of the biliary cirrhosis as described in the literature.

[Rehabilitation of Mikulicz's drain. An irreplaceable procedure in difficult drainage]. / Réhabilitation du sac de Mikulicz. Un procédé irremplaçable dans les drainages difficiles.

Following technical consideration on the use of Mikulicz's drain, with emphasis on introduction and irrigation with hydrogen peroxide, the authors describe its advantages: wide drainage, extraperito-nealization of the septic focus and removal without general anaesthesia. Such advantages clearly overcome the drawbacks which are now reduced by a strict and well codified application of this type of drain: prolonged purulent discharge, fistulae and incisional hernias are rare. Nowadays, the Mikulicz's drain is mainly indicated in diffuse peritonitis (notably post-operative) difficult bleeding control, pelvectomy and hepatectomy.