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Needle bladder neck suspension for female urinary stress incontinence have been largely modified since the original description by A. Pereyra in 1959. The procedure utilized is known as modified Pereyra or raz bladder neck suspension. The hallmark of this operation is the blunt dissection of the endopelvic fascia, the anchorage of the periurethral fascia and the pubourethral ligament, the fixation of the sutures over the rectus muscle. Out of 40 patients, 14 are evaluable with a 6 months follow up: 12 are cured, 1 is improved and 1 is unchanged. This first experience and literature analysis suggest that this procedure is particularly useful in obese patients, in case of cytoscele or in case of other perineal surgery (i.e., vaginal hysterectomy, cure of rectocele).

From 1971 to 1979, 55 patients were treated for bladder cancer at the Henri-Mondor Hospital using a treatment protocol combining low dose pre-operative external beam radiation followed by iliac node dissection, limited partial cystectomy (or sometimes for T1 tumors, a trans-urethral resection) and curietherapy with iridium 192. The 5 year disease free survival was 37/55 (67%). The rate of local recurrences plus second tumors within the bladder was 16% (9/55). These results are compared with other conservative modalities of treatment of bladder cancer.

A new surgical technique is proposed to preserve severe ruptured renal allografts requiring surgical exploration. Renal corsetage using an absorbable mesh provided a continuous external compression for these friable and fragile kidneys. Two cases treated successfully with this method are reported.

Development of serum assays for prostate-specific antigen (PSA) has provided physicians with a new marker for carcinoma of the prostate. PSA was compared to prostate acid phosphatases (PAP), the reference serum marker, in 162 patients including 54 patients with carcinoma of the prostate (CP), 84 patients with benign hypertrophy of the prostate (BHP), and 24 controls free of prostate disorders. PSA appeared more sensitive but less specific than PAP. Results showed that PSA is not suitable for routine screening in the population at large where BHP is common. In BPH, the rise in PSA concentrations parallels the size of the hypertrophy. However, in patients with CP, PSA seems more sensitive than PAP for evaluating tumor spread and response to treatment. The prognostic bearing of increased levels in patients with apparently localized carcinomas remains to be elucidated.

Renal uptake of 99m Tc DMSA was used to evaluate the renal function of 16 healthy subjects (controls) and 115 patients with various urinary tract diseases. Scintigraphic examination was carried out 6 hours after an intravenous injection of the product. In the 16 controls Tc DMSA uptake was 25.7 +/- 2.48% in the right kidney and 24.4 +/- 2.86% in the left kidney. In 36 patients with one single hypertrophied kidney, there was a correlation (r = 0.850) between creatinine clearance and Tc DMSA uptake, which was higher than in normal subjects (39.23 +/- 9.9%). In the group of 68 patients with unilateral (31) or bilateral (37) renal disease, a significant correlation (r = 0,725) was observed between kidney-to-kidney ratios of urea clearance and Tc DMSA uptake, so that renal impairment could be quantified. Quantitative scintigraphy did not appear to be of assistance in the remaining 11 patients with obstructive uropathy, as it overestimated renal function. The results obtained with 99 m Tc DMSA scintigraphy should be helpful in choosing between nephrectomy and conservative surgery and in assessing the degree of compensatory hypertrophy in single kidneys.

The bowel is not always suitable for cystoplasty. The use of a vicryl mesh lined with a peritoneal flap was investigated as material for partial replacement of the bladder. The procedure was performed on 20 rats divided into two groups. A partial cystectomy was first performed, then a cystoplasty was done using either a free peritoneal flap (group 1) or a vicryl mesh combined with a peritoneal flap (group 2). The results were evaluated using intravenous pyelography, macroscopic examination and histological analysis within one month. In group 1 (7 cases), there was one urinary fistula. In group 2 (13 cases), no fistula was observed but stones occurred in three cases. The histological analysis revealed good reconstruction of urothelium in both groups. Partial resorption of vicryl was observed at one month with organization of neo-muscular fibers. The vicryl prosthesis was well accepted and, when covered by a peritoneal flap, provided a strong and water-tight material for bladder replacement. The vicryl mesh increased the risk of stone formation in the presence of urinary tract infection.

The choice of optimal suture material for reconstructive microsurgery of the deferens duct was investigated in the rat. The study was performed on normal deferens ducts and those dilated by proximal ligatures. The absorbable thread (10.0) studied provided a more satisfactory morphological and functional result than a non-absorbable single-filament thread of identical caliber. These findings suggest that this material should be used in clinical practice.

Antibodies against diethylstilboestrol were detected in prostatic cancer patients treated with diethylstilboestrol (DES). Direct radioimmunoassay (DRIA) was performed in 109 patients divided into three groups: a control group of 33 patients (group I), a group of 38 patients treated by DES and free of cardiovascular complications (group II), and a group of 38 patients treated by DES with cardiovascular complications (group III). Antibody count was significantly higher in group III than in the two other groups (p less than 0.05). These results suggest that DES antibodies may play a role in estrogen-associated cardiovascular toxicity. For this reason, DES should not be used in patients with a positive assay.

The orthopaedic treatment of hyper-kyphosis should not be unique. If the principles of treatment are different in relation with the thoracic or thoraco-lumbar localisation of the apex of the deformity, it is necessary to distinguish for the middle thoracic curve two types of patients: these in whom the kyphosis and the lordosis are balanced (the cast must diminish the lumbar lordosis and the imbalanced posterior types with a great kyphotic curve and a short compensatory lordosis which is important not to be diminish by the treatment. The principles of plaster casting are described in the two types; emphasizing on the unlucky aspect of the sternal support in the middle thoracic kyphosis and in the necessity of the thoracic modification if we wish to obtain a good result. The active expiratory reeducation is capital before and during the treatment.

In situ versus extra-corporeal and microvascular reconstruction are discussed in relation to the treatment of renal branch artery disease. Ten cases are reported: 4 aneurysms, 1 atherosclerosis, 1 trauma, 1 embolism and 1 dissection. In three cases, the disease involved only the segmental artery branches and in seven cases both the main artery and the branches. An in situ procedure was performed in 5 cases and extra-corporeal surgery was necessary in 5 others. Four of the kidneys were iliac autotransplanted. Anatomical and immediate functional results were good in ten cases, but there was one postoperative death by heart failure due to a mitral disease. In our series extracorporeal and microvascular surgery were not routinely used for the treatment of renal artery branch disease. But these procedures can widen the indications for renal revascularisation, which then replaces medical treatment or a nephrectomy.

Schistosoma haematobium eggs may occasionally be found in the renal parenchyma, usually with no pathological consequences, the main risk to the kidney being obstruction of the urinary tract by bilharzial lesions. Egg deposits in the submucosa and muscles of the excretory tract induce obstruction and sclerosis, mainly in the ureters. Bilateral stenosing bilharzial ureteritis results in mechanical obstruction of the renal function, sometimes, unfortunately, accentuated by sepsis and pyelonephritis. This condition is a strong indication for surgical repair of the stenotic lesions of the urinary tract, which must be performed before the onset of irreversible damage to the renal function.

A patient with severe acute pyonephritis and septicaemia had persistent symptoms of infection despite appropriate chemotherapy. Although no obstruction was seen on ascending ureteropyelography, exploratory lumbar incision was considered. However, computerized tomography (CT scan) failed to show any obstacle or collection of pus but indicated diffuse infection of kidney. Medical treatment was continued and the patient recovered. This case and a review of the literature has prompted the authors to compare CT scan with conventional contrast-radiography methods in septicaemias of renal origin. It appeared that intravenous and ascending uretero-pyelography are often at fault, and the latter is known to carry iatrogenic risks. CT scan is of considerable help when looking for foci of infection and is proposed as a deciding examination in septicaemias with or without signs suggestive of renal lesions.

A short or damaged right renal vein can make renal transplantation a difficult procedure. In some extreme situation the renal vein has been prolongated using autologous saphenous graft [1], bovine arterial heterograft [2], and polytetrafluorethylene vascular prosthesis [3]. In the case of kidneys harvested from cadaveric donors the veina cava is a providential material to prolongate the right renal vein. This procedure has been utilized before in case of grafts damaged during their removal [4] or systematically to extend the right renal vein [5,6]. We report the use of veina cava to prolongate right renal vein successfully in 100 grafts in a series of 304 renal transplantations.

Microsurgery is the procedure of choice for vasectomy reversal. The aim of this study was two compare two different suture materials for vasovasectomy - a nonresorbable material (nylon 10/0 with a BV 6 needle), which is widely used, and a resorbable material (polyglycolic acid, also with a BV 6 needle), which has not yet been evaluated for this use. 28 Sprague-Dawley rats were operated on under microscope. Two groups were then compared, group A with nylon (n = 14) and group B with polyglycolic acid (n = 14). In each group, 8 animals had a vas deferens section and 6 had a previous vasectomy by ligature. Ten days postoperatively, the patency rate of the anastomosis was evaluated by the presence of sperm on both sides of the suture line. The contractility was assessed by mechanical stimulation. The existence of a sperm granuloma was considered as indicative of a non functional anastomosis. Three days later a fertility test was performed, lasting three months, and the number of litters was checked. The rats were sacrificed after three months, and each vas deferens was examined histologically or by electron microscope. The macroscopic results were: 57% patent anastomoses in group A and 77% in group B. 16% patent anastomoses after ligature in group A (n = 6) and 75% in group B (n = 6). The pregnancy rate was 54% in group A and 77% in group B. After previous ligation, the corresponding figures were 20% and 83% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Microsurgical transversal section and repair of canine kidney was presented as a model to study the condition required for an atraumatic nephrotomy. The investigation was carried out by two methods. In a first series five kidneys were injected by coloured resins after transection and microsurgical repair. Results were evaluated by cast examination of vascular net work. In a second series, transection and repair were made by an "ex-situ" procedure on seven dogs. The repaired kidney was autotransplanted in the opposite fossa iliaca. Long term renal function was evaluated after controlateral nephrectomy, by arteriography, biologic data and DMSA Tc 99 m scintiscan. The good results showed that microsurgery is useful in atraumatic nephrotomy and now a new tool in intrarenal access.

Seventeen recent cases of spontaneous renal septicemia with acute renal failure are reviewed, confirming the need for a diagnostic and therapeutic strategy to restore the fluid balance, if necessary with the aid of an artificial kidney, and the urgency of treating local infection and the pathogenic agents involved. The case review also suggest that the high mortality rate of this infection, estimated by some observers at 50 p. cent, can be greatly reduced by early radical urological treatment.