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To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment.The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects.The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair.Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

Objectives Vaginoplasty for congenital atresia, a component of the Mayer-Rokitansky-Kuster syndrome, or for gender confirmation may be achieved by several techniques. This report focuses on the efficacy of rectosigmoid neocolporrhaphy (RSNC) for primary vaginal replacement. Patients and Methods From 1990 to 2002 we evaluated six patients 16 to 33 years old (average age 23 years) who required vaginal replacement. The diagnosis included the Mayer-Rokitansky syndrome in two cases, classic bladder exstrophy in one and male pseudohermaphrodism in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and the rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients. Results A minimum of one year follow-up (mean: 32 months) was available in 5/6 patients. The patients treated with sigmoid vaginoplasty had a functional neovagina with excellent cosmetic results and without excessive mucus production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In two patients managed by nonoperative perineal self-dilation, little success could be noted, and they became candidates for surgery. Conclusion Our limited experience with this group of patients leads us to believe that the isolated sigmoid segment provides a self-lubricating neovagina with a low rate of failure and revision, with very good cosmetic results and without the need for routine dilation. L'Utilisation du colon sigmoїde dans le remplacement vaginal chez les jeunes adultes Objectifs : La vaginoplastie pour atresie congenitale, un element du syndrome de Mayer-Rokitansky-Kuster, ou la confirmation du sexe peut etre accompli par plusieurs techniques. Cette etude demontre l'efficacite de la neocolporrhaphie du rectosigmoїde premiere (RSNC) dans le remplacement vaginal. Patients et Methodes De 1990 a 2002 nous avons evalue six malades âges de 16 a 33 ans (âge moyen 23 ans) chez qui on a realise un remplacement vaginal. Le diagnostic a inclu le syndrome Mayer-Rokitansky dans deux cas, exstrophie vesicale classique dans un cas et pseudo-hermaphrodisme viril dans trois cas. Le vagin a ete reconstruit en utilisant un segment du sigmoide isole long de 15 cm place entre la vessie et le rectum et anastomose a l'introitus chez quatre patients. La procedure de Frank a ete utilisee chez deux patients. Resultats Un suivi minimum d'un an chez 5 patients a ete observe (moyenne de 32 mois). Les patients traites par vaginoplastie sigmoidienne avaient un neovagin fonctionnel avec d'excellents resultats esthetiques, sans secretions muqueuses excessives et ne necessitant pas de dilatations iteratives repetees. Trois cas de stenose de la jonction mucocutanee ont ete traites par plastie Y-V chez un patient et par des autodilatations chez deux patients avec peu de succes et les deux patients sont devenus candidats pour une dilatation chirurgicale. Conclusion Notre experience limitee avec ce groupe nous permet croire que ce procede de neovaginoplastie sigmoїdienne permet d'avoir un neovagin autolubrifie, un taux d'echec et de revision bas, avec de tres bons resultats esthetiques et sans recours aux dilatations. African Journal of Urology Vol.10(2) 2004: 96-100

The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.

Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.

The authors report two cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. We describe the technique of prelevement and injection. The immediate results confirm the efficacity of this procedure. The long-term follow-up will allow us to adopt it and to give it some modifications.

Sixteen cases of vesicovaginal fistulae (including 14 urethrovaginal fistulae), were treated vaginally using Martius' procedure. The authors describe the technique for the interposition of a labial fat pad, between the bladder and the vagina. The results are good. Thirteen patients have been cured. In one case a second was necessary using Guittes technique. There was two failures.

To specify the clinical and therapeutic peculiarities of complex vesico-vaginal fistulas.55 cases of complex vesico-vaginal fistulas are reported. After the clinical diagnostic all the patients had an intravenous excretory urogram. The fistulas were classified according to the Benchekroun classification.The mean age was 34 years (17-70 years). The diagnostic was made clinically in all the patients. Thirteen patients had an abnormal intravenous excretory urogram. The treatment was made by a vaginal way in 45 patients, by an abdominal way in three patients and by a mixed way in two patients. Four patients had an urinary diversion and one refused the treatment. Among the 50 patients whose fistula was treated, 44 (88%) were continent whom 26 (52%) after one operation, 15 (30%) after two operations and three (6%) after three operations.The complex vesico-vaginal fistulas as all the vesico-vaginal fistulas are diagnosed clinically. The intravenous excretory urogram is indispensable to search an associated ureteral lesion. The treatment is surgical and usually needs the interposition of a vascularised graft.

We report one case of retroperitoneal liposarcoma treated by surgery and radiotherapy. With the literature, we discuss the pathologic and therapeutic aspect of this lesion.

We report an uncommon case of unilateral spontaneous hematoma of the right adrenal gland in a 22-year old young man. Preoperative diagnosis was made by ultrasonography and CT-scan. A right adrenalectomy was performed. Pathological evaluation showed an isolated hematoma without adrenal abnormalities. The diagnostic and therapeutic aspects are discussed.

Bladder exstrophy is a malformation which the incidence is estimated at 3.3 per 100,000 births. It is usually treated in the first hours of life. The authors report three cases of bladder exstrophy treated in adult life with continent urinary diversion such as Benchekroun continent ileocaecal bladder (CICB). After a literature review on the management of bladder exstrophy, they studied clinical and therapeutical particularities of the bladder exstrophy in adulthood.

Obstetric vesico-vaginal fistulas are frequent in North Africa. The objective of this paper is to analyse the epidemiologic and therapeutic factors, basing our study on 114 cases of vesico-vaginal fistulas.From February 1989 to December 1998, 114 patients with a mean age of 33 years (range: 17 to 76 years) were admitted to the department of urology for urogenital fistulas, classified as a function of the site of the fistula into 3 types, according to Benchekroun's classification: type I: urethrovaginal fistula (39.96%); type II: cervicovaginal fistula (11.40%); type III: vesicovaginal fistula (52.63%). Investigation of each patient comprised complete physical examination with laboratory and radiological assessment. Treatment was only performed after a minimal period of 3 months.The majority of fistulas occurred in young multiparous women living in rural zones, predominantly due to an obstetric aetiology (87%). 183 reconstructive operations were performed in 114 patients, i.e. 1.73 operations per patient. Cure was obtained in 87 patients (76.3%) with 37% for type I, 92% for type II and 100% for type III. Twelve intermediate results (fistulas were closed, with persistent stress incontinence or frequency) and 16 failures (persistence of a residual fistula or need for urinary diversion) all concerned type I fistulas.It appears that VVFs represent a public health problem in North Africa and that their surgical treatment is still technically difficult.

To study the aetiopathogenics, diagnostic and therapeutic aspects of this pathology.The authors report a series of 10 vesico-uterine fistulas observed over à 10 years period. The mean age was 32 years(30-40). The fistulas were secondary to cesarian section in 6 cases and to abnormal delivery in 4 cases. The symptomatology was an urinary leakage from the vagina in 6 cases, an isolated cyclic hematuria in 3 cases and the association of the two signs in one case. The diagnostic was established on clinical examination in 8 cases. Intraveinous urography was performed in all the patients and visualised the uterine cavity in only 8 cases. In the 2 remaining cases a retrograd cystography was performed and demonstrated the opacification of the uterine cavity. The treatment was surgical in 9 cases. One patient who had a menuria has refused the operation.The diagnostic of the vesico-uterine fistulas is often based on clinic examination but often necessitate recourse to complementary examinations mostly in the menouria forms. The intraveinous urography does not establish the diagnostic in all the cases but is an indispensable complementary investigation because it permits searching for an associated ureteral injury. With a mean recoil of one year the results judged on the disappearance of the clinic signs was good in all the patients.The vesico-uterine fistulas are often secondary to cesarian section or abnormal delivery. Their treatment is surgical but is above all preventive by the improvement of the obstetric taking care and avoiding the vesical injuries in the course of the cesarian section.

Female urethral cancer is a rare urologic malignancy, it is about 0.02% of genito urinary cancer in woman. Prognosis remains poor and it depends of staging of disease. Applying combined modality treatment (radiation and surgery) may produce local control and increase the survival.

A retrospective study has been made of 81 cases of percutaneous nephrostomy (PCN) which were treated during the period 1989-1998. The mean patient age was 41 years (age range: 21-66 years). The reasons for the diversion via nephrostomy catheter were oligoanuria (43 cases), pyonephrosis (34 cases), and evaluation of renal function (four cases). The initial disease was found to be malignant in 23.25% of cases of oligoanuria, with six cancers of the cervix, three bladder cancers and one prostate cancer. Lithiasis was the main etiology in subjects with benign disease, and was the causative factor of oligoanuria in 55.8% and pyonephrosis in 67.6% of cases, i.e., a total of 47 cases (58%). PCN catheter placement was successfully carried out in 100% of cases, and resulted in improved renal function, and/or in the treatment of the initial infectious syndrome in the majority of cases. PCN is an excellent technique for upper urinary tract drainage due to its simplicity, efficacy, ease of insertion, low cost and satisfactory results. It is a minimally invasive technique, which necessitates only the use of a local anesthetic, a sound knowledge of the human anatomy involved, a trained operator and a minimum of material.

Between January 1990 and December 1997, 61 patients with renal calculi underwent percutaneous nepholithotomy. In the immediate postoperative period, 49 renal units (80.3%) were stone-free. At three months, our overall success rate was 91.8% after spontaneous elimination of non-significant residual calculi (3 mm). Complications were observed in 9.8% (six cases); hemorrhage and sepsis were the major complications. Percutaneous nephrolithotomy is an effective, safe and reliable alternative to the open operation.

We retrospectively investigated 63 patients suffering from 71 staghorn calculi, who were treated with primary surgical monotherapy, in order to determine long-term. results and the fate of the residual stones.Mean follow-up was 2.6 years. There were 63 patients (32 men, 31 women). The treatment was pyelolithotomy alone in 26 cases; nephrolithotomy alone in 14 cases; pyelolithotomy associated with nephrolithotomy in 18 cases; percutaneous nephrolithotomy (PCNL) in two cases; extracorporeal shock-wave lithotripsy (ESWL) in one case; and nephrectomy in ten cases.At the conclusion of therapy the stone-free rate was 94.1%. The complication was septic complications in 12 patients, hemorrhage that needed transfusion in five case and fistula in one case. After four and six years, two patients developed renal insufficiency and two patients had a recurrence of stones.Primary surgery of complex staghorn calculi is justified because of its better results than PCNL associated with ESMIL.

Nephrobronchial fistulas following pyonephrosis associated with urolithiasis are a rare occurrence. The possibility of severe problems arising during surgery should be taken into considerations; both the surgeon and the anesthetist should be fully informed of the specific risk factors involved. A favorable outcome mainly depends on the appropriate treatment and timely management of any thoracic complications. Although this rare pathology has been described in detail in the literature, the problems encountered during anesthesia and surgery have not been fully reported. This study therefore provides new data, as a case has been reported of a 38-year old female who underwent surgery for pyonephrosis; disease management and prognosis problems have been discussed.

The authors report a retrospective study concerning 18 patients having major renal trauma. The patients study group was comprised of 11 males (61%) and seven females (39%) with a mean age of 23 years. The etiologic agents were traffic accident (eight cases), falls (five cases) and stab wounds (five cases). Gross hematuria was present in all the patients. After radiologic investigations the renal injuries were classified according to the American Association for Surgery of Trauma. Two patients were in stage V, seven in stage IV and nine in stage III. Three patients were operated in emergency for hemodynamic instability, two had a total nephrectomy and one a partial nephrectomy. Five patients underwent surgery between the 5th and 7th day, three had a suture of the renal parenchyma under a nephrostomy, one a partial nephrectomy and the third a total nephrectomy. Two patients had only a urinary drainage by placement of an ureteral stent in order to diminish the urohematoma. Eight patients were treated conservatively and all were in stage III. The mean retreat was 16 months. There was no mortality and among the eight patients who underwent surgery, none had complications, aside from two wound infections. The patients who were managed conservatively had good progression; they all had a control by computed tomography which showed that the urohematoma had decreased. None of the patients developed hypertension or infection of the urohematoma.

Our purpose was to study aetiopathogenic, diagnostic and therapeutic aspects of ureterovaginal fistulas.A retrospective study concerned 10 ureterovaginal fistulas. The main causes were gyneacoligical and obstetrical procedures. The diagnosis was based on clinical considerations and intravenous pyelography in all cases. Various therapeutic methods were used: Fistulas has managed in three cases by ureteroneocystostomy. Five cases were managed with ipsilateral ureteroureterostomy, the segment of ureter below the fistula was identified using ureteroscopic perforation of this segment in three cases. In one case the fistula was successfully managed by ureteroscopic placement of ureteral stent. In case whose fistula was developed after cancer pelvic we choice abstention.Late radiology showed success of the procedure in 7 patients and persistance of hypotony in 2 cases treated by u reteroneocystostomy.Ureterofistula is rare, but a relative frequent complication of pelvic surgery whose prevention is the most efficient treatment. Ureteroureterostomy is a good procedure when ureteroscopy is performed.

The authors report the case of a woman presenting with urethrovesical rupture and vaginal fistula following pelvic trauma. This is a rare lesion, only 30 cases were reported in the literature [12]. The diagnosis may be initially missed, as it requires a meticulous emergency uro-gynaecological examination. Lesions involve the bladder and almost all of the urethra, injuring both the smooth and the striated sphincters. Treatment by reconstructive surgery after good exposure of the fistula achieved a good anatomical result and a moderate functional result.

The authors report a series of 68 cases of renal cancer observed over a 9-year period. Patients consisted of 33 women (49%) and 35 men (51%), with a mean age of 53 years (range: 23-85 years). The clinical features were polymorphic, dominated by loin pain (44%), haematuria (37%), a lumbar mass (19%), alteration of the general state (7%). The diagnosis was established by ultrasonography in 59 patients and CT-scan in 63 patients. The mean tumour diameter was 11 cm (4-22 cm) and two cases presented bilateral tumours. The time to diagnosis ranged from 1 month to 7 years. Staging reflected the advanced stage of the cancer. Treatment was surgical for 58 patients (58%). A lumbar incision was performed, in 40% of cases. Radical nephrectomy was performed in 82%, and partial nephrectomy was performed in 3% of patients. Histological examination of the specimen showed renal cell carcinoma in 75% of cases. The lymph nodes removed were invaded in 20% of cases. The mean follow-up was 29 months (6 to 84 months), normal at one year for 44 patients (86%) and at 5 years for 16 patients (31%). Tumour recurrence in the renal compartment was observed in 2 patients (4%). Asynchronous metastases occurred in 11 patients (21.5%) after 21 months. (range: 12-48 months). The overall 5-year survival was 100% T1, 69% T2 and 50% T3.

Desmoid tumours are rare lesions with a local invasive potential and a risk of recurrence, considered to be benign due to the absence of metastases. They are classified as fibromatoses and may be associated with Gardner's syndrome. The authors report an unusual case, in a 33-year-old woman, of a desmoid tumour invading the right ureter with upper tract dilatation. Etiologic factors (traumatic, hormonal, auto-immune...) are discussed, together with the treatment of choice to lower the risk of recurrence.

We report an uncommon case of a bladder lithiasis arising from an intrauterine device (i.u.d.).A female patient with i.u.d. for 13 years consulted for frequent episodes of cystitis. Patient evaluation demonstrated a bladder stone.Treatment was cystolithotomy, which dislodged two stones. One stone was attached to the IUD.Bladder calculus arising from an IUD is very rare. We review the literature.

We report an uncommon case of a 38-year-old woman who admitted for bladder lithiasis undergoing repeated surgical management and being apparently recurrent. The intravenous pyelography and retrograde urethrocystography clear the urinary tract. Biologic evaluation eliminates any metabolic or endocrine cause. The confirmation of a factitious origin is given by fluorescence X analysis of the extracted stones which conclude to calcium carbonate structure and psychiatric care. The self-intromission of these calculi into the bladder is due to the personality disorder being in the frame of Munchausen's syndrome. Two years later, no recurrence is noted and an excellent psychiatric care is achieved.

27 percutaneous endopyélotomies were performed in 27 patients from February 1989 to January 1996 to treat 20 cases of congenital hydronephrosis and 7 cases of acquired stenosis. Strictures of uretero-pelvic junction were treated by electrocautery with postoperative drainage using a double J stent in 11 cases, or Redon drain in 16 cases. The evaluable results for 25 patients with a mean follow-up of 11 months showed an overall success rate of 80%. This technique is the treatment of choice for acquired stenosis and stage I and II congenital hydronephrosis (Cendron).

Rigid ureteroscopy has become a common tool for the diagnosis and management of several diseases of the upper urinary tract. Between April 1990 and April 1996, 92 ureteroscopy procedures were performed in 88 patients in the B Urology Department of Avicennes hospital for diagnostic or therapeutic purposes. The commonest therapeutic procedure was stone manipulation (72 cases). The overall success rate was 90.8% (Distal ureter: 89.6%, mid ureter: 80%, lumbar ureter: 100%) and the complication rate was 4%. Therapeutic ureteroscopy was also used to dry ureterovaginal fistula (4 cases) and ureteral fistula with retroperitoneal urinoma (2 cases), and to remove a double J stent which had migrated into the pelvic ureter (3 cases). Diagnostic ureteroscopy was performed for 7 ureteral strictures including 3 extrinsic compressions and 4 ureteral strictures all treated with dilatations after biopsy. One false passage was observed among diagnostic ureteroscopy procedures. Rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesions.

The authors report a case of renal cell carcinoma discovered incidentally in a 52-year-old woman with hepatorenal and pancreatic polycystic disease. Treatment consisted of partial nephrectomy with no adjuvant therapy. After a 3-year follow-up, the patient is still alive with normal renal function and no signs of recurrence. The pathogenesis and therapeutic modalities are discussed in the light of a review of the literature.

Endopyelotomy has recently found a new place in the treatment of stenosis of the pyeloureteral junction, and it can represent a treatment of choice. We report an unusual case of antegrade ureteral intussusception after antegrade endopyelotomy in a 30 year-old young woman with a solitary kidney, which caused proximal ureteral obstruction. These intussusceptions were probably caused by double CH endoprosthesis. These iatrogenic injuries required surgical resection with calicoureterostomy.

Between July 1990 and December 1995, 52 patients with lower ureteral calculi were treated by rigid ureteroscopy in the "B" Urology department of Avicenne Hospital. The use of ureteroscopy facilitated Dormia extraction (58%) or ultrasonic lithotripsy fragmentation (17%) or removal of the stone with the two procedures (21%). The overall success rate was 92.3% with a 2% retreatment rate. Complications were rare (3 of 52: 5.8 percent). The mean hospital stay was 3.3 days. Based on our findings, we conclude that rigid ureteroscopy for lower ureteral stone removal is effective with low morbidity and shorter hospital stay.

Urinary drainage by indwelling double J ureteral stent is well documented in the urologic literature. We used these stents in 91 patients. The majority of stents were placed endoscopically (68%). Indications were: -Ureteral obstruction (39 cases) such as tuberculous ureteral strictures, obstruction due to urolithiasis and pelvic malignancies. -Upper urinary tract surgery (29 cases) mainly pyeloplasty, pyelolithotomy, ureterovaginal fistula repair and ureteroneocystostomy. -Adjunct to endourologic treatment (16 cases) such as ureteroscopy and endopyelotomy. -Preparation for extracorporeal lithotripsy (7 cases). The complication rate associated with placement of double J stents was minimal (6.6%). The major complication was migration (3 cases). The average drainage time was 5.8 weeks. In view of these results we conclude that double J stent is safe, effective and has minimal complications.

Nine female patients with a urethral diverticulum were admitted to our center over a six period: The clinical symptomatology was not specific. The diagnosis has been performed by voiding and retrograde cysto-uretrogram. The surgical treatment consisted in the excision of the diverticula, with the patient in the supine position. No perioperative morbidity was observed.

The authors report two cases of condylomas of the bladder. They describe the histological, clinical, radiological and endoscopical aspects of this exceptional injury of the bladder. The prognostic and treatment are discussed.

The authors report a case of retroperitoneal fibrosis secondary to actinomycosis with consequences on the urinary tract. They insist on the difficulty of diagnostic, the antibiotic's sensibility and the evolution towards fibrosis which can lead to renal function deterioration.

The authors report on the treatment of 3 ureterovaginal fistulas using a method preserving the segment of ureter below the fistula. In one case, the fistula was successfully managed by ureteroscopic placement of ureteral stent. Two other cases were managed with ipsilateral ureteroureterostomy, where the segment of ureter below the fistula was identified using ureteroscopic perforation of this segment.

The authors report on 7 cases of benign, symptomatic renal cysts treated by percutaneous sclerosis using Betadine solution. The mean size of the cysts was 8 cm and we obtained progressive collapse of all of them. This technique was a simple and effective methode with good results. Indeed, 85% of the cysts disappeard, and only one patient retained a small asymptomatic residual cavity.

Between February 1989 and February 1994, 38 patients with lower urinary tract lithiasis were treated by ultrasonic lithotripsy. Mean size of the stone was 23 x 19 mm, extreme being 5 mm-50 mm (over 20 mm in 27 patients). Transurethral lithotripsy has been performed in 36 patients, and percutaneous cystolithotripsy in 2 patients. Some desintegration was complete in 37 cases, and the only failure was a case in which the stone was too hard. Morbidity was zero. Ultrasonic lithotripsy for urethral and bladder stones appears to be a safe, effective and simple method of treatment.

About three cases of ovarian vein syndrome and a review of the literature, on overall study of this rare entity is done addressing its different pathogenie, clinical, radiological and therapeutic aspects. The authors stress the importance of ureteroscopy with biopsy in order to confirm the diagnosis of the ovarian vein syndrome.

We report our experience of continent urostomy about 160 cases. This study described the continence mechanism by the hydraulic valve. This one is made by isolating of 14 cm long ileal loop which is invaginated. It was adapted to six reservoirs: 142 ileocecums, 9 ileal pouchs, 4 bladders, 3 sigmoids, 1 rectum and 1 colonic transverse segment. The follow-up was few months to 14 years. 145 patients are continent, the continent urostomy was well tolerated by the upper urinary tract. The complications of the valve and their management are analysed.

A personal series of 600 cases of vesicovaginal fistula is reviewed. Patients could be classified as a function of site of fistula into 3 groups: I. urethrovaginal fistula (31%); II. cervicovaginal fistula (22%); III. vesicovaginal fistula (46%). Etiology was mainly obstetrical (94%), as was multiparity (69%). An associated lesion was detected in 11% of cases (uterine, ureteral and rectal). Surgery was performed after a minimum period of 3 months with the following results. Type I fistulae, using a low approach and requiring urethral refection, showed good results in only 53% of cases. Type II fistulae, usually treated through a low approach (80%), were relieved in 80% of cases, with the reservation that reinforcement of bladder neck was often necessary. Type III fistulae, treated by a high (60%) or low (40%) approach were nearly always corrected (98%). In 2 cases of destroyed urethra unable to benefit from urethral plastic surgery, bladder repositioning with continent cystostomy was satisfactory. 72 cases with irrecuperable destroyed bladder received definitive high diversion: 34 Coffey, 5 Bricker, and since 1975, 33 continent ileocecal bladders using Benchekrouns' technique.