[Ureteral replacement using an ileal graft of reduced diameter. A preliminary report]. / Le remplacement urétéral par un greffon iléal de diamètre réduit. Rapport préliminaire.

Extensive or even complete loss of the ureter of a functioning kidney makes it impossible to restore the normal continuity of the urinary tract by any available surgical technique. An ileal loop of appropriate length, anastomosed to the bladder with its entire lumen, is the only tissue suitable for replacing this missing ureter; this results in the formation of a megaureter or a vesical diverticulum which, although contractile, presents dimensions and conditions of anastomosis which predispose to the development of vesico-ileal reflux and a risk of torpid infection and dangerous reabsorption of the urine. We consider that it would be useful to use the ileum to create a contractile, reduced calibre tube with properties similar to those of the ureter. This technique, which has rare indications, is feasible as illustrated by the 5 cases reported here, corresponding to 7 uretero-ileoplasties modelled according to this technique. Results were satisfactory with a follow up of 6-24 months.

[Long-term results of male urethral stenosis]. / Résultats à long terme des sténoses de l'urètre masculin.

Long-term outcome in 142 patients after endoscopic or surgical treatment or urethral stenosis were evaluated. Results seem disappointing. Development of new therapeutic methods is desirable: the principle of use of an endoprosthetic material for stenoses of the bulbar urethra is described, and the operative technique and preliminary results are reported.

[Quantitative renal DMSA scintigraphy after extracorporeal lithotripsy]. / Scintigraphie rénale quantitative au DMSA après lithotripsie extra-corporelle.

This study reports the results of renal DMSA isotope scan before and after EDAP extracorporeal lithotripsy in 106 patients. An isotope scan was performed before lithotripsy and on the fourth day after lithotripsy and again on the 90th day when alterations were observed on the first post-lithotripsy scan. The assessment of any sequelae was based on the scale of colours of the spectrum, which revealed three types of modifications. The analysis of the results is divided into three periods according to the development in our lithotripsy technique: high firing rates had a success rate of only 40%, with renal scars on isotope scans in 2/3 of cases; low frequency firing rates had a 55% success rate and induced minor changes which were virtually always reversible; in contrast, low frequency firing rates during the 3rd period had a 60% success rate with scars on isotope scans in 1/3 of cases. These isotope scan modifications also depended on the site of the stone. In conclusion, lithotripsy definitely induces renal modifications. The renal parenchyma cannot remain indifferent to lithotripsy beyond a certain threshold. A homogeneous multicentre study with a common protocol is necessary to compare the various lithotriptors and to define cautious and coherent indications for each lithotriptor in the treatment of renal stones.

["Wallstent" endoprosthesis in recurrent urethral stricture in men]. / L'endoprothèse "Wallstent" dans les sténoses récidivantes de l'urètre masculin.

Many patients are condemned to repeated urethral dilatations because of the poor efficacy of treatment for male urethral stricture. The authors have recently used a new urethral prosthesis: a metal-reinforced, meshed tube which opens in the urethra and maintains a it open allowing the urothelium to grow over. The prosthesis therefore becomes incorporated in the wall of the urethra. they have implanted this prosthesis in 21 patients with a mean age of 61 years, essentially in the bulbar urethra, for longstanding strictures measuring 5 to 35 mm and unresponsive to currently available treatments. The endoscopic insertion of the prosthesis is performed after dilatation. The mean follow-up is 9 months. The stricture was correctly treated in all patients (three patients required two sessions). The follow-up of these patients is short and the stability of these favourable results needs to be confirmed by a longer follow-up.