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Lymph node metastases are rarely detected during radical prostatectomy (55/647 patients in our series or 8.5%) and several authors consider that lymphadenectomy is unnecessary in most cases. Criteria based on clinical stage, PSA and tumor grade have been elaborated in order to avoid pelvic lymph node dissection in a low risk population. It is commonly admitted that patients with clinically localized prostate cancer, a PSA level < 10 ng/ml, and a Gleason score < 7 could be spared a pelvic lymphadenectomy. In our series, these patients account for 12% of positive nodes. The best treatment for prostate cancer patients with a nodal disease is controversial. We compare the evolution of two groups of patients: radical prostatectomy alone or combined with an immediate adjuvant hormonal treatment. We observe a difference between the two groups for biological progression (PSA failure) but not yet for clinical progression nor for survival as our mean follow-up in only 6 years.

Numerous hypospadias correction techniques were described in the literature. The technique varies according to the position of the meatus and the importance of the chordee. These new techniques and the care taken in the manipulation of the tissues tend to decrease complications like stenoses and fistulas, frequent in the long urethroplasty. The correction of hypospadias should conform to aesthetic and plastic surgery. More than 300 corrections were carried out in our service. Surgical technique varied in the long run. Currently, we choose as often as possible a correction in one time: release of the chordae and urethroplasty. Straightening of the penis is obtained on one hand by release of the cutaneous chordae and wide dissection of the hypoplastic urethral plate and one or more dorsal plications according to Nesbit are carried out if it proves necessary. In the distal, glandular and coronal forms, the correction is of type M.A.G.P.I. (meatal advancement, glanduloplasty). The complication rate is extremely low. The aesthetic and functional result is very satisfactory. In the proximal forms, Duckett technique is used only in the obligatory cases given the large number of complications. It is generally replaced by Onlay technique. The urethral plate is left in continuity and serves as support to the pedicled and vascularized flap. In the intermediate situations with a middle shaft hypospadias, Mathieu technique is again of application. The aesthetic and functional result of this type of surgery requires good knowledge and careful application of the technique adapted to each case.

Urethral duplication is a less frequent malformation. The Williams classification, which is currently admit, classifies them in sagital, hypospadias or complex and collateral duplications. They can be complete, incomplete or reduced to an incomplete sinus. The most severe cases are often accompanied by multi-abnormality syndromes. Clinical manifestations are various: asymptomatic, urinary infection, incontinence, double urinary stream,... We will report two new cases of incomplete epispadias duplication. The first case presents a purulent flow from the fistula, the second a frank epispadiac status. In both cases, corrective surgical treatment was performed, after a complete balance-sheet. The embryological, diagnostical and therapeutical aspects of the different forms of urethral duplication will be studied based on data from literature.

The observation presented is based on one patient 18 years old who presents a paratesticular rhabdomyosarcoma stage I. A radical orchidectomy through on inguinal incision with high ligation of the spermatic cord was performed. We have omitted retroperitoneal lymph node dissection. The patient was treated by postoperative chemotherapy with V.A.C. during five weeks. Our patient remains disease free one year post-surgery, but after that, he presents suddenly a symptomatic bone metastasis of the thigh-bone and a massive metastatic pulmonary spreading, without retroperitoneal lymph nodes on the CT-scan. A multidisciplinary approach has considerably improved the prognosis of this tumor. Some reports suggest that routine retroperitoneal lymphadenectomy may be unnecessary for patients with no evidence of nodal involvement on CT-scan. The recent literature insists on problems cause by retroperitoneal lymph node involvement, but our clinical caused must induce us not to underestimate the potential of hematogenous spreading of this tumor.

The varicocele is benign pathology which sometimes involves disorders of testicular growth. Those can cause a hypofertility. We saw in a retrospective way the 243 patients having been treated by percutaneous embolisation from May 1985 to August 1993. At 150 patients being 1 year at least of postoperative retreat, 70% of cases present a cure, 15% of patients repeated and were taken again surgically. At 8% of patients, the embolisation was not technically possible for reasons of vascular anomalies or spasm of the vein during the procedure. The morbidity of this technique is low, this involves therefore a right choice of the treatment of the varicocele which does not prevent any surgical treatment in the event of repetition or in the event of technical failure.

Urethral stenosis in children is rare. Between 1961 and 1993, only five specific retrospective studies were published. Between January 1987 and December 1992, thirty-three children, i.e. thirty boys and three girls, were observed in our institution for urethral stenosis. Their ages ranged from two and half months to seventeen years. Etiology was congenital in six, traumatic in two, inflammatory in two and iatrogenic in thirteen patients. In additions, ten stenoses were consecutive with hypospadias repair. Seventeen patients underwent first-line endoscopic internal urethrotomy. Success rate was ninety-one percent. Two patients underwent a successful second similar procedure. Repeating this procedure more than twice and second-line urethrotomy doesn't improve success rate. It appeared that internal urethrotomy proved to be more effective in short and recent stenosis. Fourteen patients underwent urethroplasty by using various techniques, of whom only five first-line urethroplasty. Its indication in case of multioperated or complicated stenoses may explain the poor global success rate of about fifty percent.

Five cases of acute allergic reaction to latex are reported. Four of those were diagnosed during surgery and presented anaphylactic shock. One was suspected before surgery by systematic screening and dramatic presentation was avoided. Increasing frequency of latex allergy is reported in the literature and is usually seen in patients with extensive neurosurgical or urological histories, or by peoples currently exposed to natural rubber products (medical staff). Systematic screening in history before surgery is important so that exposure to latex should be avoided in suspected cases.

Seventy one patients were treated with mepartricin or placebo in three urological centres for a mean duration of 102 days (extremes: 60 and 142 days). An analysis of the results was carried out for 34 patients in the placebo group and 36 patients in the mepartricin group. The results indicate a significant improvement in both the placebo group and the mepartricin group. The irritative and obstructive symptoms are improved in the active treatment group with a response rate of the order of 70%, compared to approx. 45% in the placebo group. An improvement of the values on the flow meter, though not statistically significant, is observed following treatment with mepartricin, compared to the placebo group. There were no significant differences in the evolution of the prostate gland volume, determined by ultrasound in the placebo group and the active treatment group. Side-effects were minor and only one patient reported epigastric pain.

From 1986 to 1989, diagnostic laparoscopy was performed in 12 boys, before operation of non-palpable testes. Cryptorchidism was unilateral in all but one case. Preoperative physical examination and ultrasonographic studies of the inguinal region had been performed in all of them and failed to localize the testis. Laparoscopy demonstrated six intra-abdominal testes in five children: five testes were brought down into the scrotum and one was removed because endoscopic diagnosis of complete epididymo-testicular dissociation. Four of the seven other boys were not operated on because of laparoscopic findings. In the last three cases, systematic surgical exploration of the inguinal region was performed and demonstrated total atrophy of the testis. Performed in good condition the procedure is very safe and simple to achieve. It does not increase significantly the duration of the operation and gives objective elements for the operative procedure.