[Surgical treatment of penile curvature: primum non nocere]. / Traitement chirurgical des courbures de verge: a propos d'une série de 45 patients.

OBJECTIVE: This study was designed to evaluate the medium-term results of surgical treatment of penile curvature by tunica albuginea plication of tunica albuginea resection-prosthetic graft. MATERIALS AND METHODS: A retrospective study of 45 patients operated for penile curvature was performed: 38 were treated by tunica albuginea plication and 7 were treated by tunica albuginea resection-graft. Each patient returned for early (1 month), medium-term (3 months-1 year) and long-term (total mean follow-up of 34 months) postoperative review. RESULTS: Patients operated by plication were satisfied in 88.6% of cases. Significant shortening of the penis was observed in 52% of cases and one in five patients complained of disabling shortening; other complications were rare. The global satisfaction rate among patients operated by resection-graft was 29%, with 57% of residual curvature and 15% of postoperative erectile dysfunction. CONCLUSION: Tunica albuginea plication is a simple and effective technique with low morbidity for the treatment of penile curvature. Tunica albuginea resection followed by Goretex graft gives unsatisfactory results and is associated with considerable morbidity in the treatment of complex penile curvature.

[Endoscopic management of urothelial tumours of the upper urinary tract]. / Prise en charge endoscopique des tumeurs urothéliales du haut appareil urinaire.

OBJECTIVE: The reference treatment for filling defects of the upper urinary tract is nephroureterectomy with excision of a perimeatal bladder segment. The authors evaluated the role of endoscopy and laser in the management of filling defects of the upper urinary tract. MATERIAL AND METHODS: Filling defects of the upper urinary tract were evaluated by biopsies performed during ureteroscopy followed by 10 Watt Holmium-YAG laser vaporisation. High-grade or incompletely vaporised tumours or multifocal tumours or tumours more than 2 cm in diameter received complementary treatment. Low-grade and completely vaporised tumours were followed by ureteroscopy at 3 months and then every 6 months. The authors conducted a prospective study from March 2002 to September 2004. Fifteen consecutive patients were managed according to this protocol. The mean age was 70 years (range: 53 to 85 years). Thirty nine tumours were treated. The mean tumour diameter was 1.05 cm (range: 0.3 to 2.5 cm). RESULTS: In this series of 15 patients treated according to this protocol, 39 tumours were diagnosed and treated. The grade was determined by biopsy in 66% of cases. Seven patients have a median recurrence-free survival of 18 months (range: 12 to 34 months). Overall, conservative management was able to be performed in twelve patients, corresponding to a 22-month kidney preservation rate of 80%. Two patients died during follow-up, one from prostatic cancer and the other from invasive urothelial bladder tumour. One patient who had had recurrence ans had been re-treated was lost for report. CONCLUSION: Filling defects of the upper urinary tract can be investigated by ureteroscopy to obtain a histological diagnosis and to perform treatment by laser vaporisation. Complementary treatment is then performed depending on the histological results, either by complementary vaporisation or by nephroureterectomy. Laser treatment ensures a high kidney preservation rate but with a recurrence risk. Conservative endoscopic treatment, which is considered to be acceptable in cases of necessity, may also be useful in the context of small, unifocal, minimally invasive tumours with a normal contralateral kidney.

[Management of serious infectious complications of transobturator suburethral tape: report of 2 cases]. / Conduite a tenir face a une complication infectieuse grave d'une bandelette sous-uréthrale transobturatrice: a propos de 2 cas.

Suburethral TVT tape has become immensely popular since its invention in 1995. A new transobturator surgical approach was proposed in 2001, resulting in a modification of the quality of the tape available from various suppliers. The authors present 2 cases of obturator foramen abscess related to suburethral Uratape, occurring a long time after the procedure and requiring complete removal of the tape. These infections can be prevented by using good quality tape, which must be made from monofilament large-mesh woven polypropylene. The tape must be completely removed as early as possible in the case of vaginal erosion, even asymptomatic, via a transobturator approach, if necessary.