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Ureterocele or congenital pseudocystic dilatation of the terminal portion of the ureter due to persistence of Chwalla's membrane is frequent in female adults (17-35%) in its orthotopic form. It expands the short submucosal segment of the normally situated ureter and may be intravesical or extravesical. The diagnosis is primarily radiological based on intravenous urography (IVU) and endoscopy (urethrocystoscopy). Treatment depends on the site of the ureterocele, the clinical context, associated anomalies and especially the dimensions. Endoscopic treatment has numerous advantages and deserved to be more widely used.

We report the case of a young pregnant woman with a malignant tumour of the kidney suggestive of oncocytoma. Because of the pregnancy, preoperative staging consisted of abdominal ultrasound and magnetic resonance imaging. Caesarean section was performed. Several days later, surgical exploration of the kidney was performed with tumourectomy and frozen section analysis: radical nephrectomy was finally performed. The definitive histology was chromophobe renal cell carcinoma. This is a rare tumour of the kidney, with its own characteristics allowing histopathological diagnosis and with a better prognosis than renal cell carcinoma. In the literature, pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.

The expert who review a medical record in a liability suit is required to determine whether the tests performed were necessary and, above all, whether they were adequate. In France, physicians are legally required to use adequate diagnostic and therapeutic means, especially in complicated cases. When this obligation is not fulfilled, the urologist is often held responsible since he or she is in charge of interpreting the tests and drawing final conclusions. Urologists are rarely criticized for performing too many investigations. The urologist is not considered liable for complications that occur during the performance of a necessary test: in this case, the physician who performed the test is legally responsible.

In France, a physician is considered liable for a medical error only if the appropriate diagnostic and therapeutic means were not used. The urologist who evaluates a patient is responsible for the diagnosis of renal carcinoma and for assessing the spread of the disease and deciding whether surgery is indicated. The urologist coordinates the various investigations and interprets results in the light of each individual patient's characteristics. In most renal carcinomas, only simple imaging techniques are needed: renal ultrasonography and an intravenous urogram or a CT scan. Further techniques may be required to assess disease spread according to the French Urology Association's Oncology Committee, only abdominal ultrasonography and a chest film are "absolutely required", the other imaging techniques being "desirable" or "optional".

The card-index study of specialized insurance companies allowed the analysis of 82 cases concerning urological surgical procedures. Forty-two cases went to the Civil Court, 10 to the Penal Court and 5 to the Administrative Tribunal, while 5 cases were simply declared to insurance companies without judiciary consequences. Sixty-two cases concerned private plaintiffs surgeons and 34 cases concerned non specialist urologic surgeons. Sixteen plaintiffs were compensated, 9 after a conciliatory agreement and 7 after trial. There were no penal condemnations (one case on the waiting list). Impotence was the most frequent cause for complaint which was compensated. Next, came incontinence generally secondary to endoscopic resection. Retrospectively, 19 cases seemed to be unwarranted due to the dishonesty of patients (3 patients were prosecuted for unwarranted procedures). On the other hand, 32 cases seemed to be due to a lack of information given to the patients themselves or to their families, either before of after the incriminated act. The risk of prosecution is relatively low in urology. It could be decreased by careful management of the medical chart, by rapid analysis of complications and by a constant effort to inform the patient and his family.

Ultrasound and histological sections were taken of 34 prostate units removed from fresh cadavers. Ultrasonography seems to raise more problems than it solves; only 73% of the normal prostates were homogeneous under ultrasound. Ultrasonography visualized nodular structures requiring biopsy in 71% of the cases of prostatic adenoma. There were too few cases of malignant tumors in the sample to warrant a conclusion. They were highly evolved. Ultrasonography gave strong grounds for suspicion, but they could be easily diagnosed clinically.

The authors report two cases of pregnant women suffering from exstrophy of the bladder. One of the patients had been operated on in childhood for reconstruction of the bladder, and the other had undergone Coffey's operation, so that both were able to lead practically normal lives in adulthood. Three children were born by prophylactic cesarean. Exstrophy of the bladder is often associated with other urological, genital or, on occasion, orthopedic, malformations. This article analyzes the consequences of these malformations on the course of pregnancy and delivery, and the consequences of pregnancy on the urinary tract or on the different types of surgical reconstruction. The indications for the type of delivery (natural passages or cesarean section) are discussed in the light of the author's personal experience and a review of the literature.

All the testicular tumors found among the inhabitants of the Indre-et-Loire department between 1978 and 1987 were reviewed. There was a total of 122 tumors, i.e. a direct standardised incidence rate of 4.55/100,000. The incidence increased over the years 1978-1982, with an abrupt decrease at 50% in 1983 and the increase since then has been minimal. There was an excessive morbidity rate of 22% for patients living in an urban environment. There was no preferential side for the tumor. The histological types of the tumors permit to distinguish three types of populations: non seminiferous germ cell tumors (51.3%) at the age of 30 years; seminoma (41.3%) at the age of 40 years and lymphoma (7.4%) at the age of 74 years. An indirect standardisation revealed an excessive rate of 22% for the socioprofessional category of employers and a rate of 28% for artisan, business men and company directors. The study confirms the known notions about the age and the histologic distribution of testicular tumors. The highest incidence rate of all the French departments, the drop in the rate of this growth curve in 1983 and the over representation of the employee category appear to be the most specific notions in the Indre-et-Loire department.