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The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.

One hundred and ninety nine patients complaining of genuine stress incontinence not previously treated underwent Burch colposuspension. The operation has been either isolated (42.2%) or associated to a vaginal repair (36.2%) or associated to a vaginal repair and a sacral hysteropexy (21.6%). No serious operative complication occurred. The overall rate of postoperative complications was of 14% without significant difference between the surgical procedures. The overall clinical cure rate for stress incontinence was 90%. The rate of failure was significantly higher when the Burch operation was performed alone. The failures were revealed mostly in the six first months, confirming the stability of the results (20 months average follow-up). The present data confirms that Burch colposuspension is effective in stress urinary incontinence. The authors recommend a systematic association to a vaginal repair and, in case of bladder descent, to a sacral hysteropexy.

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.

On the basis of a series of 9 patients (12 renal units) gathered over 19 years, the authors analyze the current possibilities of treatment of cystine lithiasis. They first describe the characteristics of this litiasis, which is rare but serious, being naturally prone to recurrence because it is caused by a genetic defect. The development of extracorporeal lithotripsy raised great hopes for the treatment of this lithiasis, but it was soon realized that cystine strones were hard to break. However, even the mere fragmentation of the stones improves the dissolving action of the various drugs proposed to modify the pH of urine. The authors consider that open surgery by means of posterior vertical lumbar section still is indicated for larger stones, and percutaneous nephrolithotomy seems to be a very useful technique, either exclusively or as a complement of extracorporeal lithotrity.

On the basis of a retrospective series of 74 patients with adenocarcinoma of the prostate, the authors study the survival of these patients according to the clinical stage of the lesion when treated with cyproterone acetate. Biologically speaking, the authors have studied the evolution of the blood testosterone level, as well as of PSA and PAPs. Their conclusion is that the PSA is an excellent indicator of the efficacy of the cyproterone acetate treatment. Its fast decrease proves treatment efficacy, while a new rise indicates the resumption of evolution of the neoplastic process and must lead to change the therapeutic approach.

On the basis of a series of 62 files gathered over 18 years, the authors study vesicorenal reflux in duplication of the ureters. The abnormally was bilateral in 10 cases, and a total of 206 ureters was analyzed. Clinically, fever and a urinary infection are the usual expression. While intravenous pyelography allows assessing the condition of the upper urinary tract, retrograde cystography demonstrates the reflux and indicates its degree. This study confirms that the reflux mainly occurs in the lower pelvis and that it is very marked (stage II + stage III = 62.9%). Three categories of patients should be distinguished: infants younger than age 2; children from age 2 to age 15; and adults. Purely medical treatment was disappointing, and surgery seems to by far the best solution. However, the solution is different according to whether or not another malformation is associated with duplication and reflux. In the latter case, the surgical procedure is simple, while in the former there often is a complex pathology which sometimes raises difficult surgical problems, especially in children.

On the basis of 133 cases, the authors analyse the clinical features and the modalities of the treatment of vesicorenal reflux in children under age 2. The number of girls is higher than that of boys. The diagnosis is most often established between 0 and 6 months of age, with a very marked peak between 0 and 1 month. The usual warning sign is a urinary infection with fever. Pyerography is normal in every second case, and retrograde cystography is the key examination, which confirms the reflux and establishes its side and degree (bilateral reflux in 53% of cases, stage II in 48% of cases). 33 children were operated at once. Another 100 first had a medical treatment, ie. urinary antibiotics, on the basis of strict criteria that are listed here. This medical treatment has been very disappointing: 20 children were lost to follow-up and 47 had secondary surgery. When surgery is necessary, advancing plasty according to Cohen's procedure yields excellent results: 98.6% of 76 operations were successful. The authors therefore think that Cohen's procedure is widely indicated, even in children under age 2.

Principal technical features are described briefly based on a personal series of use of the procedure in 35 cases. The patient is placed in decubitus; a parietal approach is performed while avoiding the genitofemoral nerve; the incision can be enlarged downwards and above all upwards (subperiosteal segmental resection of 12th rib). The lateral posterior vertical lumbotomy possesses the advantage over classical lateral lumbotomy of being less disturbing to muscle, being less painful postoperatively, and never leading to eventration. It also reduces hospital stay. It presents the disadvantage, however, of providing only a narrow view of the operation zone, which limits its use to simple procedures such as exeresis of pyelic and upper lumbar ureteral calculi. It is dangerous, on the contrary, and should not be used in surgery of coralliform stones.

In a 6 cases report of stones developed in horseshoe kidney in children, from 25 months old to 14 years old, diagnosis and surgical problems are analysed. Another urological malformations have to be researched mainly vesico renal reflux and pyelo ureteric junction obstruction. Diagnosis is usually made when stones give complications where septic obstruction is not rare and can be severe in children. Pre and intra-operative sonography can currently do the stone localisation. Surgical management of stones developed in horseshoe kidney seems to be done still by open surgery because new techniques as Eswl or percutaneous lithotripsy can be difficult to perform or dangerous in children on this malformation. Number of operations can often be higher than in adults, to do both treatment of the stone and associated malformation as PUJ obstruction, mainly if there are infected and septic complications.

The authors, after personally observing three cases, review the literature on breast cancers in patients with prostatic cancer treated by estrogens. The authors' three cases are all metastatic breast cancers, and one has also a renal cancer. These three cases are added to the 22 reported in the literature which include 13 metastatic cancers, 6 primary breast cancers, and 3 cancers of unspecified nature. The seriousness of these breast involvements is obvious when they are a manifestation of tumor dissemination. The authors discuss the possible responsibility of the estrogen therapy in the development of the breast cancer. The downhill course and the appearance of breast cancer with generalized dissemination evinces an important decrease in the patient's immunity which allows metastases and multiple tumors to occur.

The author reports 4 cases of severe delayed irradiation complications which required partial or complete secondary amputation of the penis for sequelae of local therapy with Iridium. After reviewing the modes of spread of carcinoma of the penis and the various therapeutic possibilities in the light of these 4 cases, the author raises the question as to whether such conservative treatment by interstitial radiotherapy is well-founded. He would tend to suggest immediate surgery giving an identical result at the price of much shorter treatment and which would be free of the complications reported following radiotherapy.

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.

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.

Based on the personal observation of two cases and a series of 40 patients reported in the literature, the specific problems related to injuries to horseshoe kidney are evoked. The first case involved crushing of the isthmus against the spine recognized at operation on the 5th day and suggested by urography, CT scan and arteriography data. Abstention from surgery in the second case was decided on initial urography and ultrasound findings and the rapid, spontaneously favorable course. A literature review failed to provide much original data related to the anatomical anomaly, too frequently detected during emergency surgery. The only particularity is related to rupture of isthmus which may damage upper excretory pathways; this explains the interest for the authors of pyelostomy in case of conservative surgery in this context. When surgery is indicated this should be reserved to severe forms and postponed. It is important to carry out arteriography in addition to urography and a CT scan because of the particularity of the vascularization of this type of kidney: the anterior transperitoneal approach appears to be the best adapted.

On the basis of a case of partial nephrectomy of a single functioning kidney performed with immediate success in a 77-year-old woman, the author reviews the main data from the literature concerning this particular treatment of carcinoma of the kidney. In the great majority of cases the carcinoma required partial nephrectomy only because the affected kidney was single. Operative mortality was low : 2.6 %. Three year survival is 61 % of cases and it is important to note that terminal renal failure and recurrences in the remaining portion of the kidney are rare. Metastases represent the chief cause of death. Survivals ranging from 6 to 14 years have been reported. When the fact that the kidney is single is not because of nephrectomy for a carcinoma, the prognosis after partial nephrectomy is the same as that after wide excision for carcinoma (in patients with both kidneys). When the opposite kidney had been the site of a carcinoma and even more so in the presence of metastases, the prognosis becomes far less good. With a single kidney, the development of a carcinoma does not necessarily imply the need for total excision of the kidney followed by intermittent haemodialysis. A partial nephrectomy is worth the attempt when it appears to be reasonable. A number of particular technical features are emphasised : - the need for prior arteriography which defines the respective topography of the tumour and the renal vessels, - the safety of temporary clamping of the renal artery when the kidney is made hypothermic by cooling using ice piled up in contact with the kidney, - the possibility of performing such an excision in situ via an appropriate surgical approach.

The authors report a series of 190 surgically treated cases of ectopic testicles. After comparable dissection in the two different groups, two different types of fixation were used. In the 66% where the testicle was fixed in traction, Leveuf method, there were 17% failures, whereas with the "in-dartos" method there were only 4% recurrence. In analyzing the failures in each group the authors stress the importance of the character of the operation. The majority of the failures are in the cases of highly placed abdominal testicles, and in those needing a certain amount of traction. However, the difference in results of the two groups is so striking that the authors find the "in-dartos" method definitely superior to the Leveuf method, when used in comparable cases.

The authors report 2 cases of a condition often overlooked by the urologist: incrusted cystitis. It shows up clinically with severe urinary troubles and bladder calcifications. In fact the main finding is calcified plaques in the mucosa causing an inflammatory reaction and mimicking a tumor. Histologic examination of endoscopic biopsies rules out tumor and reveals a calcified necrotic mucosa. A high degree of alkalinity of the urine makes the diagnosis of incrusted cystitis after ruling out tuberculosis and bilharziasis. Acidifying the urine clears up the trouble and brings the bladder mucosa back to normal. According to the literature, 3 factors are necessary for the development of incrusted cystitis: a ureolytic microbe capable of releasing ammonia, alkalinity of the urine resulting from this, and a bladder with lesions of cystitis whatever might be the cause. A number of diagnostic errors are possible, but the most serious one is mistaking it for a calcified malignant tumor of the bladder. For this a biopsy is essential to prove the absence of a tumor. The treatment consists of 3 stages: excision of the calcified plaques (mostly by endoscopy), sterilization of the urine (nalidixic acid would be the best agent) and acidification of the urine.

Of 18 cases of embryonic carcinoma seen over the last 13 years, 10 were classified as inferior to stage III and were treated without glandular curettage: 5 by combined chemotherapy and radiotherapy, 3 by chemotherapy alone and 2 by radiotherapy alone. All patients have survived beyond 2 years (2 to 11 years). The attitude is considered as too restrictive which implies treating only when secondary recurrence occurs, since certain patients are lost to view. Moreover, curettage has a higher morbidity than chemotherapy. Routine chemotherapy without glandular curettage would appear to be indicated for stages a priori I and II.

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.

Since 1960, cyclophosphamide has been widely used in the treatment of solid malignant tumors, certain hematological and systemic diseases and indeed even in renal transplantation. However, while the efficacy of the product is certain, it became rapidly apparent that this molecule had a definite toxicity for urinary endothelium, in particular that of the bladder. This toxicity is due to certain metabolites of the molecule and to the fact that urine stagnates in the bladder reservoir. It is manifested principally by hemorrhagic cystitis which is always difficult to treat and which is sometimes life threatening for the patient. However, cyclophosphamide can also induce malignant bladder tumors with a poor prognosis. Since 1971, 56 cases of bladder cancer due to cyclophosphamide have been published. It is therefore a rare lesion generally manifesting itself by hematuria and sometimes occurring a long time after discontinuation of treatment. At the time of first examination, 2/3 of these tumors were widely infiltrating and despite major surgery (50% of cases required immediate total cystectomy) the prognosis was very poor due to the fact that the bladder cancer added its own degree of gravity to that of the initial disease which justified the introduction of treatment. All the authors who have studied this problem therefore stress the necessity of avoiding cyclophosphamide when another molecule may be effective and especially when it is not a malignant condition which is being considered.

The authors sought to assess the efficacy and tolerance of a new oral form of nalidixic acid in the treatment of infections encountered in urological surgery. The study was based upon 30 cases. The urine was considered to be infected when more than 10(5)/ml organisms were present. Amongst 27 patients undergoing surgery, in 26 cases the operation was an endo-cavitary procedure involving the upper or lower urinary tract. The 3 non-surgical cases consisted of one patient with cystitis and two with prostatitis. In 6 patients, treatment was preventive, the urine being sterile before urological surgery. In the other 24, infection was present at the time that treatment was begun. E. coli present in 20 patients was the predominant organism in the series. Tolerance of treatment was perfect in 27 cases. In the 6 cases of preventive treatment, prescription of the drug prevented a postoperative infection. In the 24 patients receiving curative treatment, there were 7 failures (29%) and 3 late recurrences (12.5%). Failures were all the more frequent when the dose was lower. The authors equally felt that the prescription of 4 grams per day in one case was unsuitable. Organisms isolated when treatment was seen to have failed were all resistant to nalidixic acid. In the context of urological surgery, where there is often a cause of reinfection (catheters), the prescription of a high dose of the drug is an essential factor in decreasing the risk factor inherent in treatment.

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.

Penile metastases are uncommon lesions. They are most often secondary to a primary pelvic cancer (bladder, prostate, rectum). The appearance of a penile lesion may differ; priapism may or may not be present. The mode of dissemination is still controversial. The authors report one case and review the literature on penile metastases secondary to prostatic cancer. The essential point of their observations is the prolonged survival of their patient (7 years) whereas in the literature, the prognosis of these lesions is a rapidly fatal outcome.

On the basis of a case of thoracic ectopic kidney, discovered following trauma and diagnosed at laparotomy (since it was confused with rupture of the left diaphragm) the authors review certain data concerning this rare malformation (150 published cases). --The site of origin of the renal artery may be used to distinguish on the one hand between true intra renal ectopic kidney with the renal artery arising from the aorta and secondly trans-diaphragmatic herniation of a kidney with a kidney with a normal vascular pedicle through a hernia, most often congenital, and equally often right as left. --Clinically, at the time of a routine examination or following trauma, chest X-ray reveals an opacity at the base of the thorax, the low and posterior topography of which is suggestive of the diagnosis and and IVP is then indicated. In the absence of violent trauma, the diagnosis of traumatic hernia is eliminated. The distinction between true ectopic kidney and congenital trans-diaphragmatic hernia becomes a false problem since there is no need for treatment in either case.

Diffusion of flumequine into human renal and prostatic tissues was studied. Chemical characteristics and the natural antibacterial spectrum of the compound are described and its rapidity of absorbtion emphasized, blood levels being detected 30 minutes after administration. Maximum plasma levels were reached after 2 to 3 hours and were of the order of 17 mcg/ml, half-life being approximately 10 hours. Plasma protein binding capacity was 60 to 70%, indicating liposolubility enabling diffusion into prostatic parenchyma. Flumequine was recovered in the urine 2 hours after oral administration, maximum urinary concentrations being reached after between 3 and 6 hours, and being of the order of 280 mg/ml after single-dose 40 mg administration. The product was still recovered from the urine 12 hours later, and 60 to 70% of the dose administered after 24 hours, including 20.6% of active form. To evaluate renal and prostatic tissue diffusion 2 series of patients were studied 10 after renal surgery and 14 prostatic operations. Diffusion was excellent into renal parenchyma since the mean ratio between renal tissue and plasma concentrations was 2.41. Urine concentrations were even more extraordinary since the ratio was 136. In contrast, prostatic tissue concentrations were lower than plasma concentrations, the ratio between the two being 0.26, although levels is prostatic tissue were still sufficiently elevated to be effective against germs sensitive to flumequine.

Haemangiopericytomas are vascular tumours derived from Zimmerman's pericytes, the cells surrounding blood capillaries which correspond to the smooth muscle cells in the arterial and venous walls. This rarely observed tumour is usually found in the limbs (more than 50 p. cent of cases) or the face. Pelvic haemangiopericytomas are most frequently observed in women, and are then of uterine origin, their occurrence in men, and in the perivesical space, being exceptionally rare (seven cases reported in the publishing literature). The authors describe such a case, and review the clinical and radiological characteristics of the lesion. Diagnostic difficulties are emphasized, as confusion with a sarcoma can arise, even after histological examination. Surgical excision should be conducted routinely, but local recurrence or pulmonary metastases may occur in view of the potential malignancy of these tumours. Complementary cobalt therapy is therefore justified.

After a very precise anatomical review, the authors report the results of an anatomo-radiological study involving 244 urography films. The usual length of the 12th rib is 11 cm, with a width of 1 cm in the female and 1.5 cm in the male. The costo-lumbar angle was 45 degrees in 3/4 of the films. The kidney was often lower in the female than in the male. The renal artery was almost always given off at the level of the 12th rib or below, whilst at the level of the hilum, the renal artery and 12th rib having crossed, the artery was always above the 12th rib. Study of 173 usable cases of patients operated upon by lumbotomy revealed the following data: --lumbotomies on the 12th rib never opened the pleura, and gave rise to transient wall pain (7%) and one single case of abdominal wall hypotonia (1.4%) with no incisional hernias; --lumbotomies over the 11th rib were associated with 13% of cases of damage to the pleura, 16% of spontaneously resolving wall pain, 7 cases of prolonged parietal hypotonia and one incisional hernia out of 60 lumbotomies; --lumbotomies sub-jacent to the 12th rib were associated with residual abdominal wall pain in 3 cases out of 16. Lumbotomies over the 11th rib are associated with the risk of section of the superficial and deep abdominal branch of the 12th nerve and are hence those exposing to the greatest risk of abdominal wall hypotonia and neuralgia. Incision over the 12th rib would thus appear to be that associated with the least abdominal wall complications.

The author reports a case of severe disturbance of micturition due to a cystitis in a 17 years old adolescent. As no cause was found, a biopsy was taken by endoscopy which revealed an inflammatory process involving the full thickness of the bladder wall with a great many eosinophils. The particular interest of this case presentation resides in the effectiveness of the immuno-suppressive treatment. Three tablets of Imuran for six weeks led to the cure of this patient. The authors review the literature of this rarely published condition. They classify it into the broader group of interstitial cystitis. The authors cite their case as an argument in favour of the auto-immune origin of these interstitial cystitis. The effectiveness of immuno-suppressive therapy is the best proof.

The authors report a case of necrosed carcinoma oif the kidney presenting clinically with fever and a large abdomino-lumbar palpable mass and developing thirty years after functional exclusion of the kidney by tuberculosis. The two particular features were: displacement by the tumour or calcifications in this known mastic kidney, and the poor vascularisation of a necrosed tumour irrigated by an artery of small calibre. The association of tuberculosis and carcinoima, although rare, is no less well known: discovery of a carcinoma in a nephrectomy specimen (for tuberculosis), discovery of tuberculosis in the parenchyma around a carcinoima of the kidney. The rarest possibility remains that of development of a carcinoma of the kidney in a kidney non-functioning and mastic for years, but is sufficiently rare not to be an argument in favour of the excision of all non-functional tuberculous kidneys after adequate antituberculous therapy.

Based on a personal series of 10 cases seen over a 10 year period, the characteristics of the inversed bladder papilloma are reviewed. Affecting men mainly, and presenting nonspecific signs (hematuria, disorders of micturition or secondary infections), these lesions can be detected by urography and particularly cystoscopy, enabling their extraction by endoscopic resection and histological examination. Histology findings serve to exclude some other tumors or pseudotumors (papillary tumors, urothelial carcinoma, proliferative cystitis). Various histogenic theories are discussed, preference being given to suppression of the term inversed papilloma in favor of adeno-urothelioma. Recurrence after treatment occurred in one case only. One patient had an inversed papilloma associated with a papillary tumor. Typical histology findings and usual benign course enable a good prognosis to be given for these curious tumors.

The authors report 17 personal cases of lithiasis of the upper urinary tract discovered in the course of pregnancy. They discuss the diagnostic and therapeutic problems, taking into account the double risk of mother and foetus. The essential diagnostic sign is renal colic, with or without fever. Spontaneous excretion of these calculi is possible, but in 8 of the 17 cases, a ureteric catheter had to be passed or an operation was required. Neither the delivery nor the health of the infants delivered seemed to be harmed by this renal calculi disease. The authors recall that the most common cause of non-obstetrical abdominal pain in the course of pregnancy is in fact urinary calculi. The incidence is about 1 cases of lithiasis per 1,000 pregnancies. It appear that a physiological hyperparathyroidism of pregnancy is responsible for a hypercalciuria which could be a factor favouring the development of lithiasis during pregnancy. The important point is to know how to distinguish those forms of pyelonephritis of pregnancy which are due to a stone obstructing the upper urinary tract, as any purulent retention in the upper tract can lead to a pyonephrosis, a bacteraemia or even a septicaemia. The presence of the foetus makes interpretation of a plain abdominal film difficult. In any case, its indication is questionable, whenever the urine is septic, particularly with Proteus.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report five cases of adenomatoid tumour of the tunica vaginalis. Two cases were located on the epididymis and two on the tunica albuginea of the testis. In each case, a limited excision of the tumour without removal of the testis resulted in a cure, confirmed by a follow-up of three years. A histological examination at the time of the operation revealed the exact nature of the lesion in each case, thereby preventing the unnecessary excision of the gonad. The authors then review the literature on the subject with particular mention of the histopathology, the classification of these tumours, the clinical features and the treatment. They stress that in the majority of cases, mesotheliomas of the tunica vaginalis are benign and can be treated with limited excision and conservation of the testis. However, a few malignant forms have been described, hence the need for a careful histological examination.

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.

Two cases of glans penis epidermoid carcinoma after lichen sclerosus and atrophicus or balanitis xerotica obliterans are discussed. Relationship between both diseases are analysed but remain not clear. Balanitis xerotica obliterans gives foreskin and urethral meatus stenosis that required circumcision. Glans carcinoma can be observed many years later even after circumcision. The knowledge of lichen sclerosus and atrophicus is important to do circumcision at the beginning of the disease with a long term follow-up of these patients to realize a glans penis biopsy if necessary. Most of lichen sclerosus and atrophicus are not recognized and the frequency would be higher than reported.

The authors present the case of a patient undergoing late surgery following bilateral trauma of the renal hilum. Despite revascularization and a certain urine output the patient remains on hemodialysis. A highly pragmatic study of the literature follows the clinical presentation.

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.

The author reports two cases of perineal wounds with section of the membranous urethra, one operated upon as a delayed emergency (36 hours) and the other as an emergency via a double hypogastric and perineal approach which permitted the opening of the bladder, anterograde catheterisation of the posterior urethra, liberation of the ends of the urethra and their preparation, mobilisation of the anterior urethra and finally end-to-end suture. Both patients seen with a follow-up of 6 months and one year had an excellent mictional result and preservation of erection. The author emphasises the following: --the need for confirming integrity of the bladder by I.V.U.; --the possibility of operating as a delayed emergency after packing of the wound, under cover of bladder drainage via a suprapubic catheter; --the need for a double hypogastric and perineal approach for lesions of the posterior urethra; --the usefulness of urethral catheter for 5 days and drainage of the urine by cystostomy for 3 to 4 weeks. Neither of the patients required secondary dilatation (at least within the limits of the period of postoperative follow-up).

The authors report on three new cases of tumours growing in bladder diverticula. If an intravenous urogram (IVU) of high quality is obtained and properly interpreted--in almost all cases a diverticular lacuna will be seen. Such an IVU picture is most suspicious in a patient with haematuria. The impossibility, for technical reasons, of exploring the interior of the diverticulum endoscopically means that the diagnosis cannot be ruled out. These tumours have a bad prognosis: 13% 3 year survival and 5% survival at 4 years. The authors reach the conclusion which is in agreement with the literature, that these tumours need to be treated radically.