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To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m

Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence.The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day.Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group.AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings.4.

To identify various clinical presentation leading to the diagnosis of mid-urethral sling (MUS) complications and to analyze the functional outcomes after surgical management of these complications.Retrospective observational monocentric study of all patients treated by MUS section or removal, between December 2005 and October 2019, in a pelviperineology centre.During this study, 96 patients were included. MUS complications surgically managed were vaginal mesh exposure (48 %), urethral mesh exposure (17 %), bladder mesh exposure (10 %); dysuria (30 %), pain (6 %), and infection (3 %). The mean time to diagnosis was 2 years. This diagnosis delay was caused by a non-specific and heterogeneous symptomatology. Surgical management consisted in MUS partial removal (79 %) and MUS simple section (21 %) with low perioperative morbidity. At three months follow-up, 36 patients (53 %) had stress urinary incontinence (SUI), including 13 (19 %) de novo (meaning no SUI before MUS section/removal) and 19 (28 %) had overactive bladder, including 9 (13 %) de novo. Half of the patients with SUI after MUS section/removal were able to be treated by a second MUS with a success rate of 83 % at 3 years.Clinical presentation of MUS complications is heterogeneous. Surgical treatment was associated with low morbidity in our study. Post-operatively, half of the patients had SUI and a second MUS was a relevant treatment option after proper evaluation.4.

Active surveillance (AS) of sporadic renal angiomyolipomas (AML) is under-utilised because of an old dogma fearing a life-threatening retroperitoneal hemorrhage when tumour size exceeds 4cm. The objective of this study was to report the outcome of AS in patients with sporadic AML greater than 4cm.The results of AS in 35 patients managed for sporadic renal AML greater than 4cm were analysed. During AS, tumour growth, occurrence of new symptoms and/or complications, discontinuation of AS protocol, reason for discontinuation as well as subsequent treatment options were reported.Within a median follow-up of 36 months, 16 (46 %) patients discontinued AS at the end of the study period (mean follow-up 55±66, median 36 months). Patients who discontinued AS were more symptomatic at diagnosis but had similar age, mean tumour size and sex ratio. Active treatment-free survival was 66 % at 5 years. Retroperitoneal hemorrhage was reported in 3 (8.5 %) patients. None of these bleedings required transfusion or monitoring in an intensive care unit. Other reasons for discontinuation were pain (37 %), patient preference (19), changes in the radiological appearance of the tumour (19 %), and hematuria (6 %).This study showed that AS in AML bearing patients was feasible even in the setting of tumours larger than 4cm. More than 50% of the patients were still on AS at 5 years. Discontinuation of AS was not related to bleeding complications in most cases.3.

The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS).Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group).Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age70 years, recurrent UTI, and post-void residual volume100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure40cmHThese new guidelines should help to harmonize clinical practice and limit exposure to antibiotics.4.

Managing urethral diverticula is challenging because of recurrence rate and postoperative complications. Herein, we report a standardized, single-institution experience of surgical treatment of urethral diverticula in women. The medical record of 37 female patients treated for urethral diverticula between 2005 and 2017 in a single institution were reviewed. All patients were operated in a standardized genupectoral position using a technical artifice called the pacifier trick to inflate diverticula throughout the procedure and facilitate its dissection. Symptoms at diagnosis, imaging findings, surgical parameters, postoperative complications, and recurrence rates were collected and are presented. Median age was 39 ± 11 (range 21–67) years. At diagnosis, recurrent urinary tract infections (UTI) (67%), vaginal mass (46%), pelvic pain (43%), dyspareunia (27%), and urinary incontinence (UI) (24%) were the most commonly reported symptoms. Median operative time was 98 ± 31 (range 40–150) min. After a mean follow-up of 1 year, recurrence occurred in one (3%) patient. Immediate de novo postoperative UI decreased from 27% immediately after surgery to 3% after pelvic physical therapy. Pathological analyses found no malignant histology. Surgical management of urethral diverticula in women is technically demanding. With our standardized pacifier-trick technique, satisfying anatomical and functional results were achieved.

Our objective was to describe the progressive introduction of photoselective vaporization of the prostate (PVP) in an academic department of urology in an outpatient care setting and report our outcomes after the first 100 cases.Since May 2014, XPS GreenLight™ (Boston Scientific-AMS, USA) PVP in the treatment of benign prostatic hyperplasia was introduced in our department. A prospective local registry was opened to collect patients' demographics, preoperative characteristics and surgical outcomes including operative time, length of stay, catheterization time, and postoperative complications as well as functional outcomes. We also assessed limitations to the outpatient care setting.Conversion to TURP was reported in 6 % for uncontrolled bleeding. Overall, 21 % patients needed more than 1-day catheterization. After 6 months of follow-up, 3 patients (prostate volume 50, 117, and 178mL) had reintervention (second PVP). Ninety days' complications were reported to be up to 6 % (3 urinary obstructions, 1 prostatitis, 1 transfusion and a severe sepsis). After 8 months, an 80 % plateau of outpatient care setting was achieved. Anesthesiologists counter-indicated outpatient care in 59 % of the cases.A progressive introduction of the PVP in an outpatient care setting is associated with a low complication rate. A plateau was achieved in less than 100 procedures. The major limitation of the outpatient care setting was patients' competitive comorbidities and not disease characteristics.4.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the effectiveness of repeat mid-urethral sling after a failed primary sling for stress urinary incontinence. METHODS: A total of 112 women with recurrent stress incontinence after primary mid-urethral sling underwent a repeat procedure between 2000 and 2011. All patients had a preoperative clinical and urodynamic evaluation. Outcomes were divided into three groups: cured (no more leaks), improved (decrease of leaks), or failed. RESULTS: All patients had urethral hypermobility and 12.9 % had intrinsic sphincter deficiency [maximum urethral closure pressure (MUCP) ≤ 20 cmH2O]. Median MUCP was 41 cmH20. Overactive bladder was found in 5.7 % of women. The second sling placed was one of the following: retropubic Tension-free Vaginal Tape (49 %), transobturator tape (48 %), or mini-sling (3 %). No intraoperative morbidity was reported. After the second sling was placed, 68 (60.7 %) patients were subjectively cured and 18 (16.1 %) improved (76.8 % success overall) with a mean follow-up of 21 months. Success rates were 72.2 and 81.8 % for transobturator and retropubic slings, respectively, with no significant difference. Multivariable analysis showed higher odds of cure and improvement with the retropubic approach after adjusting for MUCP. Late complication rates were comparable to those observed after a first sling. Urodynamic parameters were not associated with postoperative success. CONCLUSIONS: Repeat mid-urethral sling for recurrent female stress urinary incontinence is nearly 77 % successful in a group of patients with persistent urethral hypermobility. A retropubic approach might be preferred for patients with low urethral closure pressures.

Objective: The aim of the study was to assess the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape Uratape ® to treat female stress urinary incontinence. Patients and Methods: 183 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. ® procedure (October 2001 to March 2003). 26 patients were previously operated for incontinence. 26 patients were operated at the same time for their genital prolapse. Mean age was 56 years (29–87). 50/183 patients were having mixed incontinence. A non-elastic, polypropylene tape (UraTape ® , Mentor-Porges) with a silicon coated central part was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Results: Mean follow-up was 7 months (1–21). At 1 year follow-up 80.5% of the patients were completely cured and 7.5% were improved. The overall peri-operative complication rate was 2.2% with no vascular, nerve or bowel injury. 6 patients (3.3%) had post-operative urinary retention. Conclusion: The present multicentric study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. ® as an effective and safe technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair.

To report a linguistically validated French version of the PISQ-IR (the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA-Revised).PISQ-IR is a valid, reliable, and responsive measure of sexual function in both sexually active or inactive women with pelvic floor disorders. Validation process was performed according the IUGA guidelines. The French version of the PISQ-IR was developed after two independent translations (EnglishFrench), one back translation (FrenchEnglish), cognitive debriefing with a sample of 25 women with pelvic floor disorders attending the gynecologic clinic in the university hospital of Nîmes and a critical review by experts in the field of urogynecology and sexuality.The PISQ-IR is a self-administered questionnaire, which overcomes some shortcomings of the initial version. Questionnaire includes 20 questions, the first one to clarify sexual activity: part 1 of the questionnaire is for non-sexually active women and contains 5 questions and the second part is for sexually active women and contains 12 or 14 questions depending on whether or not the women has a partner.This paper reports the linguistically validated French version of the PISQ-IR. Psychometric validation of the French PISQ-IR is currently ongoing and when completed, the scoring system will be shortly published in addition to the definitive version of the questionnaire.

Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes.The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies.

Treatments of pelvic organ prolapse are pelvic floor rehabilitation, surgery by abdominal or vaginal route, with or without prosthesis, and pessaries. Since last decade, increasing elderly patients seen for pelvic organ prolapse require to redefine the place of the obliterative vaginal surgery, among the existent surgical procedures. Our objectives were to describe the morbidity associated with colpocleisis, to determine the anatomical results of colpocleisis, and patient's satisfaction.Retrospective case series of 27 patients who underwent a vaginal closure (Lefort) between 2004 and 2010.Twenty-seven patients underwent an obliterative vaginal surgery for genital prolapse. The mean age was 79 years (range 74.5-82.5). The mean surgical time was 70 minutes (range: 60-87.5). We did not notice any per-surgical complication. During follow-up (median: 3 years, extremes: 1-10 years), the global satisfaction rate was 94%. Objective cure rate, defined as the absence of prolapse to the hymen, was 96% (26/27). Only one (3.7%) case of pelvic organ prolapse recurrence occurred and needed surgery.The current study showed that Lefort colpocleisis technique was associated with a good patients' satisfaction and functional results in a population aged over 75.

Review of the literature that formed the basis for drafting the guideline on the sub-uretral sling in the first-line surgical treatment of female stress urinary incontinence. Medline database query since the introduction of TVT on the questions of various chapters and sub-chapters of the present article. The use of tapes made of polypropylene monofilament exclusively, knitted, is recommended to the exclusion of any other material. Regarding the choice of procedure, the objective cure rate of transobturator and retro-pubic routes cannot be evaluated clearly because of vague evaluation criteria from one study to another. Without adequate clinical trials proving their efficacy and safety, the mini-bands can so far be recommended to treat female stress urinary incontinence. Moderate overweight does not affect the results of laying tape. In patients with severe obesity, surgery to correct obesity is even better than surgery for incontinence. Age is not a contra-indication. If the patient is young and nulliparous, it is reasonable to advise her to postpone surgery after her last pregnancy. In case of multiparous patient, the risk of vaginal delivery does not seem sufficient to suggest a cesarean section. To conclude, sub-urethral slings are the first-line surgical treatment of female stress urinary incontinence.

To evaluate the efficacy and to report the follow-up of transvaginal repair of genital prolapse using a tension free vaginal mesh.Twenty-eight women were treated for genital prolapse with the Prolift technique and followed prospectively. Preoperative prolapse treatment, associated treatment, complications were reported. Postoperatively, efficacy and complications were reported. Patients were examined at one, three, six and 12 months then yearly. Treatment failure defined as Pelvic Organ Prolapse Quantification (POP-Q) stage II or more.The mean age was 68 years. The median follow-up was 12 months. Ten (35%) and 14 (50%) patients had a stage II and III/IV cystocele respectively. Nineteen (67%) patients had stage II/III rectocele. We reported one bladder injury (3.5%) sutured during surgery and one haematoma (3.5%) requiring secondary management. Important buttock pain appeared in two patients (7%) treated with a total mesh on day 1 and 6 weeks after surgery respectively. They were both relieved after cutting one posterior arm of the mesh. De novo stress incontinence appeared in one (3.5%) patient and urgency in two (7%) patients. Mesh exposure occurred in one (3.5%) patient requiring a minimal surgical management. One patient (3.5%) declared dyspareunia. Success was reached in 96.5% patients.The transvaginal mesh was a safe and efficient technique to treat genital prolapse.

To define the anatomical landmarks allowing precise vesiculectomy to be performed during radical prostatectomy for cancer.12 non-formalin-preserved anatomical subjects were dissected as during retropubic and perineal prostatectomy, with and without coloured latex vascular injection.Three anatomical landmarks were defined: 1) Denonvilliers' fascia; 2) vas deferens; 3) arteries supplying the seminal vesicles.These three anatomical landmarks ensure: complete resection, preservation of adjacent anatomical structures and elective haemostasis.

The maximum closure pressure (MCP) of the urethra, measured by the urethral profile, constitutes an index of urinary continence. The objective of this study, in a large population of women, was to evaluate the possible variations of MCP and functional length (FL) of the urethra, according to the position of a urodynamic probe designed to perform lateral sectorial measurements.Measurements were performed between July and December 1998, in 230 patients with a mean age of 55 years, using a probe perfused with water and equipped with an urethral side orifice. We compared, by analysis of variance for repeated measures, MCP and mean FL at 0 o'clock (MCPm0, LFm0), 3 o'clock (MCPm3, LFm3), 6 o'clock (MCPm6, LFm6) and 9 o'clock (MCPm9, LFm9).The values for MCPm and LFm obtained according to the rotation of the probe were as follows: MCPm0 = 65.68 +/- 12.46 cmH20, MPCm3 = 55.44 +/- 16.97 cmH20, MCPm6 = 58.07 +/- 15.85 cmH20, and MCPm9 = 53.85 +/- 16.89 cmH20, LFm0 = 28.92 +/- 5.32 mm, LFm3 = 30.18 +/- 6.82 mm, LFm6 = 32.40 +/- 6.82 mm and LFm9 = 30.83 +/- 6.07 mm.LCP may variable considerably in the same subject according to rotation of the probe. In our series, MCPm at 0 o'clock was significantly higher than MCPm at 3 o'clock, 6 o'clock and 9 o'clock. This difference appears to increase with age. The lowest values for MCPm were observed at 3 o'clock and 9 o'clock. The MCPm at 6 o'clock was intermediate and the closest value to the mean pressure calculated from MCPm in the four positions. On the other hand, FL varied only slightly according to the position of the probe.

To assess the contribution of a questionnaire in the evaluation of patients operated for urinary stress incontinence.From 1988 to 1996, 42 patients underwent bladder neck suspension for urinary stress incontinence. Only 7 patients had no history of pelvic surgery, 24 patients presented pure urinary stress incontinence and 19 presented mixed incontinence, 37 patients were evaluable with a mean follow-up of 2 years. The evaluation consisted of two aspects: clinical assessment, based on review of the case files, showing that 77% of patients were continent, and a questionnaire (non-validated translation of "Q7" and "UD16"). This questionnaire evaluated quality of life (7 items) and symptoms. Each item was scored from 0 to 3.To interpret the results we divided the three main scores into three intervals, the first third corresponding to good results. The percentage of good results for the overall score, quality of life score and symptom score was 62%, 73% and 46% respectively. The most discriminative questions of the questionnaire can be used to analyse urine leaks related to effort, urgency episodes of incontinence. A score of 0 or 1 was considered to be a good result. The percentage of good results for these three questions was therefore 72%, 60% and 64%, respectively.The cure rate therefore varies as a function of the criteria selected: the questionnaire allows the urologist to more accurately assess the patient's postoperative state.

To study the improvement of prostatic cancer detection provided by ten strictly systematized transrectal prostatic biopsies.This prospective study was conducted in 162 patients submitted to a series of 10 ultrasound-guided transrectal prostatic biopsies due to the presence of elevated PSA and/or an abnormality on digital rectal examination. Five biopsies were taken from different sites in each lobe: 2 biopsies were inserted between the 3 biopsies usually performed in the standard protocol, while maintaining the angle of entry of the needle recommended in this protocol.The complication rate was 1.85% with the 10-biopsy technique. Prostatic cancer was detected in 40.1% of the 162 patients. The percentage diagnostic improvement provided by the 10-biopsy protocol in the overall patient population was +3.1% compared to the standard protocol. The highest percentage diagnostic improvement was observed in the group of patients with PSAor = 10 ng/ml (+4.9%) and in the group of patients with an ultrasound prostatic volumeor = 40 cc (+4%).The most marked diagnostic improvement appears to be related more to sampling of prostatic zones presenting a statistically increased risk of cancer (peripheral zone) than to the increased number of prostatic biopsies performed.

Evaluate the frequency and assess curative and preventive measures against urinary lithiasis in patients treated with indinavir.Fourteen HIV seropositive patients who developed severe and acute flank pain were included. Four of the patients receiving 800 mg indinavir t.i.d. had fever (38.5 degrees C) or delayed secretion (2 h). Delay from indinavir treatment onset was 1 to 321 days. During the same period, 155 patients had been treated with indinavir. Clinical features, radiology and laboratory results were recorded in addition to an analysis of the lithiasis if possible.Transient moderate renal failure occurred in 8 patients. Mean urine pH was 6. Serum phosphorus, calcium, and uric acid, liver tests and urinalysis were normal. A JJ ureteral stent was inserted in 4 cases due to complications. In all cases, fluids, analgesics and antispasmodics provided favorable outcome. Inversely, nonsteroid antiinflammatory drugs given in 2 patients had a deleterious effect on renal function. The lithiasis was eliminated in 3 cases and infrared spectrophotometry demonstrated a structure compatible with indinavir monohydrate.The formation of urinary lithiasis is a frequent complication of indinavir therapy (9%). Hyperhydration and urine acidification are usually successful but emergency drainage is required in approximately 3% of cases. Nonsteroidal antiinflammatory drugs should be avoided due to the risk of renal toxicity. A precise evaluation of fluid intake and diet, drug associations and personal history is needed to recognize patients at risk of recurrent lithiasis formation.

The use of absorbable staples for enterocystoplasty allows a marked reduction of the operating time. The long-term results on continence need to be evaluated at result term before adopting this technique.Eight patients underwent "W" enterocystoplasty performed with absorbable staples according to the so-called "Detroit" technique, with direct uretero-ileal anastomosis. The continence of these patients was evaluated by clinical follow-up and urodynamic assessment (3 patients). Quality of life was studied by a questionnaire sent to the patient.The mean operating time was 5 hours 20 minutes, the plasty was performed in 25 to 35 minutes. The mean follow-up was 18.7 months, during which two uretero-ileal strictures were diagnosed. 7 of the 8 patients have a good diurnal continence (no leaks) and 1 patient has moderate continence (1 protection). Nocturnal continence was considered to be good in 3 cases, moderate in 2 cases and poor in 3 cases (1 protection). Four of the patients evaluated by questionnaire reported urinary disorders.The use of absorbable staples allows a definite reduction of the operating time, for a modes excess cost and satisfactory functional results.

High-pressure dilatation catheters have been proposed as an alternative to open surgery in the treatment of ureteric strictures because of the low morbidity and short hospital stay. The objective of this study was to evaluate the results of this technique in patients with inflammatory ureteric strictures or uretero-ileal strictures.From April 1991 to September 1996, 25 strictures were treated by antegrade or retrograde dilatation with a high-pressure balloon catheter followed by stenting with a double J stent for an average of 2.1 months (1-5): 14 uretero-ileal strictures (tuberculosis, schistosomiasis, iatrogenic, radiotherapy). A good immediate result was defined as intraoperative rupture of the stricture under fluoroscopic control. A good long-term result was defined as absence of recurrence of the stricture, evaluated clinically and radiologically (IVU and/or ultrasonography).The good immediate result rate was 82% (19 out of 23 strictures, with 2 non-evaluable cases). One intraoperative complication was observed (double J stent advanced too for into the ureter). 22 strictures were evaluable after removal of the double J stent and the good long-term result rate was 64% with a mean follow-up of 8.5 months (0.3-24). 8 patients developed a recurrence: 4 after Bricker, 3 with inflammatory strictures after radiotherapy and J with peritoneal carcinomatosis.This study shows that high-pressure balloon catheter dilatation of non-neoplastic ureteric strictures provides good results and can be considered to be the first-line treatment for these lesions.

Human immunodeficiency virus (HIV) infections often lead to urological disorders, including tumors, infections and micturitional disturbances. It often is difficult to identify the origin of voiding disorders but the most frequent causes are infections (prostatitis and so forth), obstruction (cervico-prostatic or urethral) and neurological (encephalitis, myelitis, polyradiculoneuritis and so forth). We determined the etiologies, therapy and clinical outcome of micturitional disturbances in the acquired immunodeficiency syndrome.Between February 1989 and September 1992 we studied prospectively 39 HIV positive patients with voiding symptoms, such as straining, urinary retention, frequency and urgency. Each patient underwent a thorough neurological and urological examination, along with radiological evaluation of the urogenital tract and nervous system. Urodynamic evaluation was performed to specify the etiology and type of disturbance before treatment. The patients were followed for 2 to 24 months (mean 9) and 34 (87%) had urodynamic abnormalities, including a hyperactive bladder, bladder sphincter dyssynergia and a hypoactive bladder.The cause of the voiding disorder was neurological in 61.5% of the cases, and the 2 most frequent disorders were cerebral toxoplasmosis and HIV encephalitis. Treatment was usually given to relieve symptoms with drugs acting on the detrusor-sphincter complex. A total of 22 patients (57%) had lasting improvement, while 17 (43%) died 2 to 24 months (mean 8) after onset of the voiding symptoms.A micturition problem is an unfavorable event since it usually indicates a neurological cause.

To evaluate whether the percentage of biopsy tissue invaded by tumour provides any supplementary information to laboratory and/or biopsy data (Gleason, number...) in the preoperative staging of patients with localized prostatic cancer (T1-T2).170 patients with a mean age of 65.05 +/- 6.12 years and a mean PSA of 22.5 +/- 21.4 ng/mL were submitted to radical prostatectomy (RP) for T1-T2 prostatic cancer. 110 patients were submitted to a series of 6 transrectal prostatic biopsies to establish the diagnosis. We evaluated the percentage of biopsy tissue invaded. This parameter, as well as the Gleason score and the preoperative PSA, were studied in comparison with pathological criteria of the operative specimen (capsule status, resection margins) and postoperative PSA.The cut-off value of 10% of invaded biopsy tissue was calculated as being the most discriminant for the prediction of resection margins, capsule status and progression of laboratory parameters. When less than 10% of biopsy tissue was invaded, there were 31.2% positive margins (RM+). 28% of invaded capsules (pT3), and 21.7% of laboratory progression (P+) versus 44.1%, 71.4% and 47%, respectively, when more than 10% of tissue was invaded. The Gleason score of the biopsy did not improve this prognostic evaluation. The mean quantities of invaded biopsy tissue were statistically different between pT3 and pT2, RM+ and RM-and P+ and P-. When only one positive biopsy was invaded by less than 10%, 87.5% of these operated patients remained stable, RM- and pT2.On an individual level, the percentage of invaded tissue does not reflect the degree of extension or progression of localized prostatic cancer. Only a single positive biopsy invaded over less than 10% of its length is statistically correlated with a good prognosis.

Determine the incidence of prostate cancer in patients consulting for common miction disorders and serum prostatic specific antigen (PSA) between 4 and 10 ng/ml.A total of 153 patients consulted for miction disorders. In 107 of them, the digital examination was abnormal and PSA was between 4 and 10 ng/ml. Transrectal sonography and prostatic biopsies were performed in these 107 patients. We determined the number of cancers detected and assessed the contribution of PSA density (PSAD) to diagnosis. In patients undergoing radical prostatectomy, invasion of the capsule (C+) and positive exeresis section (M+) were recorded.Cancer of the prostate was diagnosed in 29.4% of the patients on the basis of at least 1 of the 6 biopsies. This rate was 47.8% in patients with an abnormal and 21.5% with a normal digital examination. Radical prostatectomy was performed in 32 patients: 50% of them were C+ and 33% M+.Biopsy of the prostate is indicated in patients with an abnormal prostate at digital examination when PSA is between 4 and 10 ng/ml. When the prostate appears to be normal, PSAD may be helpful in determining when to perform a biopsy. Intermediary serum PSA levels do not guarantee favorable pathological characteristics.

To evaluate whether or not a single positive prostatic biopsy out of six systematic ultrasound-guided biopsies, is reliably correlated manner with favourable histopathological features of the tumour on the radical prostatectomy (RP) specimen.In a series of 158 patients undergoing RP for clinically localized prostatic cancer, 15.2% had only one positive biopsy out of 6 systematic biopsies. We compared the rates of capsular effraction (C+) and positive resection margins (RM+), assessed on the operative specimen, in this group of patients with a single positive biopsy (group 1) and in the group (group 2) diagnosed by more than one positive biopsy. The postoperative biological progression rate (P+), defined as an immediate or secondary postoperative elevation of PSA beyond 0.1 ng/ml by polyclonal assay, was also evaluated in the two groups. The Gleason score was evaluated and compared on biopsies and on RP specimens.29.2 of cases were C+, 16.7% were RM+ and 26% were P+ in group 1, versus 70%, 46.5% and 49.5%, respectively, in group 2. All differences were statistically significant. All patients in group 1 with less than 10% of prostatic tissue invaded on the positive biopsy had stage P2, while all patients with 100% of the length of the biopsy invaded by tumour had stage P3. The Gleason score was accurately predicted by the positive biopsy in 39% of cases and was underestimated in 39% of cases.A single positive prostatic biopsy out of six systematic biopsies is a useful predictive factor of local extension, but, in the individual patient, does not guarantee favourable histopathological characteristics of the tumour, nor a favourable course of the disease.

The practical approach to the treatment of priapism is complicated by the rarity of this disease. Treatments for impotence by intracavernous injection of vasodilators have considerably increased the incidence of prolonged erections, although "antidote" protocols, when instituted rapidly, ensure detumescence in most cases. The objective of this study was to define a practical and rigorous approach based on comparison of our results with those reported in the literature concerning the management of priapism.This series consists of fifteen consecutive cases observed in adults over a ten-year period. The pathophysiology and aetiologies are recalled. The authors evaluate the percentage of detumescence after primary treatment and after retreatment and discuss the incidence of secondary impotence. This information is compared with the data of the literature in order to define a practical approach.After a trial intracavernous injection of vasoconstrictors, creation of a cavernospongiosa fistula provided the best results with a 60% detumescence rate after primary treatment and 80% after retreatment. All treatments combined, 53.3% of good results were obtained after primary treatment and 66.7% after retreatment. In the long-term, 50% of patients with a sufficient follow-up are impotent.As a result of systematic surveillance of patients treated by an intracavernous injection protocol, the number of priapisms induced in our institution has remained stable over recent years. Patients treated for priapism within 36 hours have a better short-term and long-term prognosis.

Manifestations of urological involvement, including tumour development, infection and impaired micturition are frequent in patients with acquired immunodeficiency syndrome. The frequency and consequences of dysuria itself are difficult to evaluate due to the concomitant effects of underlying infections, obstructive or neurological pathologies.Thirty-nine HIV-positive patients presenting impaired micturition including isolated dysuria, urine retention pollakiuria or urge incontinence were followed prospectively from February 1989 to September 1992. Each patient underwent a complete neurological and urological examination. Imaging included CT-scan or magnetic resonance imaging of the brain or spinal cord, echography of the bladder and prostate, intravenous pyelography or ascending and micturition urethrocystography as required. Urinary function tests were used to determine the cause and exact type of impairment to establish therapeutic protocols.A neurological origin was found in 61.5% of the cases. Cerebral toxoplasmosis and HIV encephalitis were the most commonly found causes. Symptomatic relief was obtained in most patients with bladder- sphincter active drugs. After a mean follow-up of 9 months (range 2-24 months), long-term improvement was achieved in 57.9%. Seventeen patients (44%) died within a delay of 2 to 24 months (mean 8 months) after onset of dysuria.Signs of impaired micturition are frequently encountered in HIV-infected patients. A full work-up is needed for diagnosis and treatment adaptation. Neurological disease is the most frequent underlying cause and would appear to be a sign of poor prognosis.

Fifty five women with a mean age of 59 years, suffering from urinary stress incontinence (U.S.I.), were treated by endoscopic percutaneous cervicocystopexy (Stamey's operation), 39 patients (71%) suffered from pure U.S.I. and 16 (29%) presented a combination of stress and urge incontinence. Bonney's manoeuvre was positive in every case. With a mean follow-up of 21.5 months, 30 patients (58.8%) were completely continent, 9 (17.6%) presented occasional incontinence with intense effort, 12 (23.5%) were failures and 4 patients were lost to follow-up. The complications were minimal. The results were less favourable in patients with a history of pelvic surgery, particularly for correction of U.S.I., associated urge incontinence, detrusor hyperactivity or low urethral closure pressure, although one half of the patients in this group were nevertheless cured. Stamey's operation is a simple, reliable, easily reproducible technique which gives good results at the cost of low morbidity, short hospital stay and a low cost.

Urinary incontinence due to sphincter incompetence constitutes a major source of disability. The AMS 800 artificial urinary sphincter allows durable restoration of satisfactory continence in patients who are often unresponsive to any other forms of treatment. 45 men underwent implantation of a peribulbar urethral (40) or pericervical (5) artificial sphincter over a 5-year period. Incontinence was secondary to prostatic surgery in the majority of cases (33). The technique, which is now well defined, consisted of urinary drainage via a bladder catheter for 8 days and activation of the sphincter after 1 month. The mean follow-up is 30 months. 36 (80%) of the patients are continent, including 27 (60%) without revision and 9 (20%) underwent unsuccessful revision resulting in partial or complete removal or permanent inactivation of the prosthesis (sepsis, urethral erosion, defective prosthesis). Strict patient selection, a rigorous implantation technique and standardised management of any incidents are key elements in the success of this procedure.

The authors report a retrospective study of 223 surgical colonic carcinoma (1978-1987), the rectal carcinoma left out of them because of disparity in technical aspects. The total post-operative mortality rate was 9.4 per cent, made of great mortality in emergency (31 per cent) and in palliative surgery (17 per cent). Out of emergency, the mortality of curative surgery is 3.7 per cent. Surgical procedure was mechanical in 96 per cent with incidence of leakage in 3.9 per cent. The total survival rate is 53 per cent after 5 year follow-up, 70 per cent after curative surgery and 89 per cent for the first level (A) in DUKE'S classification. There is only a problem for the choice in size of resection for the sigmoid side (50 per cent of the cases). Contrary to recent studies, in our experience the post-operative mortality rate and survival rate are different with sigmoidectomy or left colectomy. Then the authors think that every model of resection has to be choice according age of patient and classification of carcinoma.