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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.

The incidence of renal stones in pregnant women is 1 in 1500. The diagnosis may be made more difficult by the particular anatomo-physiological conditions of pregnancy. Ultrasonography is not always sufficient to localise the stone and can be completed by intravenous urography, which is not contraindicated in pregnant women. In more than one half of cases, the stones are eliminated spontaneously during conservative treatment. The urologist may need to intervene in the case of complicated stones: internal or external urinary diversion is generally sufficient to palliate the problem until term. As extracorporeal lithotripsy is contraindicated in pregnant women, some authors recommend ureteroscopy or percutaneous nephrolithotomy when radical treatment is required. Surgical treatment is very rarely indicated.

Six female patients with a mean age of 40 years presenting with a suburethral diverticulum were treated between August 1990 and October 1992. The commonest functional symptoms were recurrent urinary tract infections (2/3 of cases) and post-voiding urethral discharge (1/2 of cases). Clinical examination revealed a tender anterior vaginal mass in only one half of cases. Only retrograde and voiding cystourethrography and transvaginal ultrasonography always demonstrated a direct or indirect image of the diverticulum. The suburethral diverticulum was resected via a transvaginal approach in the ventral supine position after sterilisation of the urine by prolonged antibiotic therapy. Urine drainage was generally ensured by a suprapubic catheter allowing antegrade cystography on the 15th day, prior to clamping then removal of the catheter. All but one of the patients immediately regained satisfactory micturition without dysuria or stress incontinence. Restoration of micturition was delayed in one patient with feelings of incomplete bladder emptying, but she urinated normally at three months. Postoperative imaging (retrograde and voiding cystourethrography, transvaginal ultrasonography) demonstrated resolution of the diverticulum in 5 cases. One patient had persistent signs of a small, residual diverticulum on antegrade cystography on the 15th day. Suburethral diverticulum is a rare disease of middle-aged women for which transvaginal surgical excision in the ventral supine position gives very good results.

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.

Seventy patients (mean age: 66.5 69 y) were submitted to TRUS-guided prostate biopsies for increased prostate speci®c antigen (PSA> 4 ng=ml). Mean PSA was 10.5 10.9 ng=ml. In this new protocol, ®ve biopsies were performed in each lobe. Beside the three standard biopsies (taken at 45 angle), two additional biopsies (one at the base and one at the mid-lobe) were taken at a 30 angle sampling the peripheral zone. An additional peripheral biopsy was taken at the apex if there was a prostate volume> 50 cm. This biopsy protocol took place on an outpatient basis. Results

Portal vein anomalies are rare. One of the more frequent is pre-duodenal portal vein (50 cases). The case report is describing a pre-pancreatic but retroduodenal portal vein discovered in an operation for chronic pancreatitis. No case report has been found in the literature. This paper presents embryological discussion and surgical consequences in pancreatic surgery.

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.