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Aims: To describe and evaluate a novel technique of spermatozoa retrieval from patients suffering from infertility secondary to refractory retrograde ejaculation., Method: Prospective study to compare mobility and vitality of spermatozoa obtained from urine (U) after oral modification of chemical parameter (PH, Osmolarity) versus from endovesical instillation of sterile spermatozoa culture medium before ejaculation (F). Patients were their own controls. Twelve month prospective follow-up was achieved to document the results of assisted procreation., Results: Eight patients were included and mobility and vitality were improved in all patients after F technique was compared to U technique. With U technique, eight patients on eight had negative defrost test; after F technique, seven patients on eight had a positive defrost test and could therefore have access to assisted reproduction techniques. Four couples had five ICSI and obtained three pregnancies leading to five births., Conclusion: Endovesical instillation of sterile spermatozoa culture medium before ejaculation was a safe and effective technique to improve spermatozoa quality in male infertility related to refractory retrograde ejaculation., (Copyright © 2010. Published by Elsevier Masson SAS.)

Aim: Evaluate urinary continence after radical prostatectomy., Materials and Method: Recent series about urinary continence were studied., Results: In seven articles analyzed, continence fluctuated between 63.6 and 91.9%. Evaluation benchmarks were depending on study. Unlike self-questionnaires, objective criteria (pad test) should be more reliable. Carcinologic prognostic factors were not implicated directly. The most frequently preoperative risk factors of incontinence were: age, BMI. Peroperative parameters, attesting of surgical difficulties could have a functional impact. Bladder neck preservation could affect the recovery velocity but not functional results. Length of catheterization and lack of urinary rehabilitation could be influent. The mean of continence evaluation after radical prostatectomy was different for each study., Conclusion: Comparability was difficult because operative technique, group's features and mean of functional evaluation were different from study to study. Several risk factors were found but without consensus. It would be necessary to separate carcinologic and functional risk factors., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Aim: To describe medium-term functional results of Transurethral Needle Ablation (TUNA) to treat symptomatic benign prostatic hyperplasia (BPH) refractory to medical treatment., Materials and Method: Patients who completed at least 2 years follow-up after TUNA were systematically offered a reevaluation including: Flowmetry, PSA, symptom score (IPSS), satisfaction index visual analogic scale (VAS) and a treatment impact evaluation with a Likert scale (ranging from much worse to much improved)., Results: From December 2002 to January 2007, 45 patients were treated with TUNA under local regional anaesthesia (prostatic block). Twenty-seven of them were followed-up longer than 24 months (median follow-up 44 months [26-52]). Changes in the selected outcomes were: increase in Qmax from 9.5 mL/s preoperatively to 9 mL/s at 6 month and 11.5 mL/s after 2 years; increase in IPSS from 19.3 before TUNA to 16.3 at 6 month and 16.5 after 2 years. About subjective evaluation, 58% of patient gave a satisfaction VAS>or=6, and the improvement index was greater or equal to +1 in 67% of case., Conclusion: In this initial monocentric experiment, despite a modest improvement of objective parameters and a 20% of retreatment rate, TUNA give contentment and improvement sensation for 60% of patients who were treated for non-efficiency of medical treatment for benign prostatic hyperplasia.

Objective: This study reports the preliminary national results of permanent Iodine 125 implant brachytherapy for the treatment of localized prostate cancer with a follow-up of 4 years., Material and Methods: The authors analyse a series of 260 patients treated consecutively according to the same technique (single-centre, with estimated dosimetry and the use of fixed implants) in terms of morbidity, recorded prospectively, and in terms of cancer control. In the group of 260 patients with stage T1-T2 prostate cancer 68.4% belonged to the low-risk group (PSA < 10 and Gleason score < 7), 28.4% belonged to the intermediate-risk group (PSA > 10 or Gleason score > 6) and 3% belonged to the high-risk group (PSA > 10 and Gleason score > 6). The mean follow-up was 29.5 months (range: 8-56 months). Adverse effects were dominated by obstructive and/or irritating voiding disorders in the majority of cases, with progressive improvement in 98% of cases. Acute urinary retention required drainage in 10.7% of cases. An endoscopic disobstruction operation was performed after at least 6 months in 2.3% of cases. Anorectitis was reported in 21.91% of cases: stage I in 20.3% and stage II in 1.5%, treated medically in every case. In the year following implantation, 34.2% of patients complained of erectile dysfunction that was successfully treated medically. Analysis of the dosimetric data after implantation demonstrated a learning curve in which optimal coverage of the therapeutic target by the dose of irradiation prescribed was obtained between the first 20 and 30 patients. This systematic, patient-by-patient analysis allowed optimization of the implantation technique, especially by ensuring better coverage of the base and anterior part of the prostate., Results: The 3-year laboratory recurrence-free survival was 93.8% for all patients and 97. 7% for the good prognosis group. Fifteen of the 16 recurrences occurred during the first 18 months of the experience. The results of this study are concordant with those of North American teams at the same stage of experience. In this programme, optimization of the technique and patient selection criteria achieved excellent results in terms of morbidity and cancer control. The authors propose elective brachytherapy to the group of patients with a poor prognosis, a prostate volume less than 50 ml and with no obvious urinary functional disorders. An analysis is underway to confirm these results with a longer follow-up.

Epidermoid cyst of the testis is a rare benign tumour. The diagnosis is strongly suggested by ultrasound and MRI. Conservative surgery is possible in the case of a small isolated lesion and requires intraoperative histological confirmation. It is a constantly benign tumour that must be distinguished from testicular teratomas, justifying the search for associated neoplastic contingents requiring orchidectomy.

Unlabelled: The Gleason score obtained on prostatic biopsies is an essential element in the treatment decision for localized prostate cancer. The objective of this study was to evaluate the correlation between the biopsy Gleason score and the definitive Gleason score and to propose a classification into 3 groups in order to improve this correlation., Material and Methods: One hundred radical prostatectomies were performed between 1995 and 1998. Eighty four of these patients underwent 6 biopsies. The Gleason score of the biopsies and operative specimens were compared. The concordance between the biopsy Gleason score and the operative specimen Gleason score was initially analysed score by score. The concordance was then established according to three groups, well differentiated tumours (score 2-4), moderately differentiated tumours (score 5-7), poorly differentiated tumours (score 8-10)., Results: The concordance between the biopsy Gleason score and the operative specimen Gleason score was perfect in only 37% of cases. A 1-point difference of the score was observed in 35.7% of cases and a 2-point or greater difference was observed in 27.3% of cases. By classifying patients into 3 groups, the concordance increased from 37% to 72.6%., Conclusion: The classification of patients into three distinct groups (well, moderately and poorly differentiated tumours) increases the concordance between the biopsy Gleason score and the definitive Gleason score. However, the limitations of the biopsy Gleason score must be kept in mind, particularly in the case of low-grade tumours.

Objectives: To evaluate the efficacy and to describe the modalities of use of terazosin hydrochloride dihydrate, prescribed under conditions of routine clinical practice to a vast population of patients with benign prostatic hyperplasia (BPH)., Material and Methods: 1,624 patients suffering from BPH and requiring medical treatment were included in this multicentre open clinical trial performed by 983 general practitioners. After a one-week titration phase, terazosin was administered for 4 weeks at the dosage of 5 mg per day as a single dose in the evening at bedtime. The efficacy of treatment was assessed by the variation of the IPSS score between inclusion and the end of treatment, the treatment response rate (at least 3 point reduction of the IPSS score) and the course of the quality of life score. The safety of treatment was evaluated by clinical interview and physical examination at each visit and by analysis of all adverse events occurring during the trial., Results: A mean 45.8% improvement of the IPSS score (corresponding to a mean decrease of 8.81 points) was demonstrated between D0 and D35 (p < 0.001). The treatment response rate was 91.8%. A mean improvement of 2.11 points (p < 0.001) of the quality of life score was obtained. Complementary subgroup analysis (moderate dysuria n = 775 and severe BPH n = 702) showed that the efficacy of treatment was independent of the initial severity of the voiding disorders. The clinical safety of treatment was considered to be good in 92.5% of cases by the investigators. The incidence of adverse events attributable to treatment and related to a fall in blood pressure was 2.6%. Less than half (20/43, i.e. 1.25% of the population) of the patients experiencing this type of adverse event had to discontinue treatment. The ease of use of treatment was considered to be good in 85.2% of cases., Conclusion: Terazosin constitutes an effective symptomatic treatment for BPH when surgery is not indicated, whether the initial disorders are moderate or severe. The safety of treatment appears to be perfectly satisfactory, in a patient series representative of the general practice outpatient population concerned by BPH (age, state of health, concomitant treatments). The one-week progressive dose regimen allows cautious introduction of treatment and generally does not raise any problems of acceptability.

Objective: To refine the pretreatment staging of localized prostate cancers., Material and Method: Prospective study on 50 total prostatectomy specimens from men with apparently prostate-confined adenocarcinoma. Preoperative assay of the free PSA/total PSA ratio and analysis of this ratio according to the presence of capsular effraction, capsular invasion and positive margins., Results: Significant difference of this ratio according to the presence or absence of capsular effraction (13.2% versus 18.9%), capsular invasion (12.4% versus 17.5%) and positive margins (11.6% versus 16.3%)., Conclusion: The free PSA/total PSA ratio can be useful for staging of prostate cancer, but this needs to be confirmed by a large-scale prospective study.

The possibility of maintaining and studying human prostatic cancers in an in vitro and in vivo environment has allowed the development of rare but essential tools to study many aspects of the biology of these cancers. Although none of the available models is perfect, the sum of the studies conducted with these models over more than 20 years constitutes the basis for major progress in our understanding of this disease. The most widely used cell lines (cultured in vitro) are PC-3, DU-145 and LNCaP. They are limited by the fact that they are essentially androgen-independent cell lines, derived from metastatic sites. Due to the slow growth of prostatic cancers, it is very difficult to obtain cancer cell lines which can be transplanted in immunodeficient animals (such as athymic mice) and only a few xenografts are currently available, some of which, like PCV-82, LuCaP 23, CWR-22, are androgen-dependent or sensitive. These models can be used to study host-tumour interactions as well as endocrinological interactions, stroma-tumour cell interactions, and to analyse molecular phenomena related to stages of hormone dependence and hormone resistance. In vitro and in vivo models of metastatic prostatic cancer have also been developed and appear to have a crucial impact on the understanding of metastatic mechanisms and new therapeutic approaches. This paper describes the main experimental models developed from human prostatic cancers, their main characteristics, their value compared to clinical cancers and some of the major studies conducted with these models. Due to the exponential progress in molecular biology techniques and oncogenetics, it appears essential to increase the number and diversity of experimental models of prostatic cancer in order to advance research concerning the crucial phenomena occurring during the course of this disease, from oncogenesis to currently incurable metastatic stages.

Objectives: To describe the technique and present the results obtained with the Miami reservoir, a continent urinary diversion, after pelvic exenteration for advanced gynaecological tumours., Methods: A Miami reservoir was performed in 12 patients between January 1993 and January 1995. A detubed right colonic reservoir was created using automatic resorbable staples. The ureters were reimplanted into the reservoir using an anti-reflux system and continence was ensured by forming a tube with the terminal loop of ileum and by using a Bauhin valve, which can be reinforced when it is incompetent. Regular postoperative follow-up was conducted (6 to 26 months) with monitoring of laboratory parameters, intravenous urography, opacification of the reservoir, urodynamic assessment of the continent diversion., Results: There were no surgical complications related to the urinary diversion. Urinary continence was obtained in every case and after medical treatment of residual peristaltic contractions of the detubed colonic reservoir in 2 patients. Protection of the upper urinary tract was satisfactory after 2 years of follow-up, without stenosis or reflux of the uretero-colonic anastomoses. The mean capacity of the colonic reservoir was 465.5 +/- 101 ml at 6 months, with filling pressures lower than 20 cm H2O., Conclusion: The Miami reservoir is a continent urinary diversion which is relatively easy to perform and reliable in terms of continence and protection of upper tract. However, a longer postoperative follow-up is required. The quality of life of young patients after pelvic exenteration is improved due to this type of contingent diversion which avoids the need for an abdominal urine collector, although it requires intermittent self-catheterization.

Based on a retrospective study of 52 patients with prostatic adenocarcinoma and bone metastases (stage M1b), the authors analysed the following prognostic factors at the time of diagnosis: age, general status, bone pain, haemoglobin, local tumour volume, ureteric repercussions, pre and post-treatment PAP and PSA levels, Gleason score, and metastatic spread on bone scan. This study demonstrated two predominant prognostic factors for the appearance of early or late therapeutic escape: tumour differentiation established by the Gleason score (P = 0.003), stage of the disease, i.e. local tumour volume (p = 0.001) and bone mass invaded on bone scan (p = 0.0002). The other prognostic factors can be deduced from these two parameters. Qualitative analysis of the initial bone scan allowed patients with peripheral bone metastases to be distinguished from those with exclusively axial involvement. The two-year survival was 50% in patients with peripheral metastases versus 93% in patients without peripheral metastases (p < 0.05). Although bone metastasis constitutes a decisive prognostic factor, the detection of peripheral bone metastases appears to be a factor of poor prognosis.

Prosthetic surgery for impotence has been transformed by the development of inflatable prostheses in the place of older semirigid models. Despite the popularity of this new technique, it raises certain questions concerning the functional results and complications of this surgery, which have only occasionally been studied concomitantly in the literature. The sexuality of patients has generally been evaluated on the basis of answers to a questionnaire sent to the patients. This study reports our experience, compared to the data in the literature, based on 58 insertions of inflatable prosthesis between October 1987 and October 1991. After rigorous patient selection and a mean follow-up of 30 months, the surgeon evaluated the objective results (mechanical functioning of the prosthesis, complications) and subjective results (sexuality) in 51 patients. 69.4% of patients presented an anomaly of prosthesis function, 10.3% developed an infection of the prosthesis, 34.5% required removal of the prosthesis, 59% declared that they were satisfied sexually and sexual activity was restored in 55%. This study therefore appears to contradict the optimistic data reported in the literature.

Supernumerary urethra, a rare anatomical anomaly, can be explained by various embryological theories, accounting for the multitude of classifications proposed. Its diverse, minor or very severe clinical manifestations suggest the diagnosis, which is confirmed by retrograde and voiding cystourethrography. Treatment is surgical or, more rarely, endoscopic.

The authors evaluate the accuracy and practical applications of flow cytometry (FCM) on bladder lavage fluid in the diagnosis and follow-up of bladder tumours. The apparatus used was a Coultronics Epics Profile II cytofluorograph. Two hundred and fifteen samples were obtained with a yield of 86%. The specimens were preserved in ethanol. The staining was performed on whole cells with preservation of the cytoplasm. The analysis of a control group of 45 patients confirmed that the FCM study of ploidy was specific (0.97 for normal bladders and 0.8 for inflammatory lesions). Four aspects were evaluated: Correlation between FCM and the histological type of the tumour: a significant difference was observed between the control group, the invasive tumour group (p < 0.01) and the carcinoma in situ group (< 0.001). A significant difference was observed in the case of high-grade PTA and PT1 tumours. No significant difference was observed between FCM and classical cytodiagnosis when this technique was performed by a trained cytologist. Predictive value of FCM for the recurrence of PTA and PT1 tumours: 40 patients were followed with a mean follow-up of 13 months. The relative risk of recurrence in the case of a tumour with an abnormal FCM was 2 (p < 0.05). FCM and monitoring of conservatively treated tumours: 30 patients with normal endoscopic examination after endoscopic resection of a PTA or PT1 tumour underwent cytometric analysis and cytodiagnosis. In the case of an abnormality on cytometry, randomised bladder biopsies and urography were performed. The positive predictive value for the presence of a lesion not diagnosed by cystoscopy and detected by FCM was 0.38 +/- 0.26. FCM and intravesical chemotherapy: 16 patients with PT1 tumours and abnormal FCM received BCG therapy (11 patients) or mitomycin C instillations (5 patients). A significant difference (p < 0.01) was observed between the 2 treatments in terms of normalisation of cytometry.(ABSTRACT TRUNCATED AT 400 WORDS)

An outpatient urodynamic study allows simultaneous recording of bladder, urethral and abdominal pressures over a long duration with physiological bladder filling and under outpatient conditions. One hundred and eighteen outpatient urodynamic recordings were performed in patients presenting with disturbances of micturition such as urinary incontinence or dysuria. In the group of incontinent patients, the outpatient urodynamic recording was superior to the standard urodynamic assessment for the diagnosis of unstable bladder (p < 0.001). In the group of dysuric patients, the outpatient urodynamic recording allowed a precise evaluation of the detrusor activity and a simplified assessment of micturition. Its use combined with a urecholine test allows analysis of the onset, duration and intensity of action of the drug in comparison with a standard test.

The authors report three cases of postoperative urinary fistulae repaired by means of fibrin glue. This new therapeutic approach avoids the need for a difficult reoperation.