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Objective: To evaluate the morbidity of living donor kidney harvesting and the long-term medical consequences and impact on quality of life (QoL)., Material and Methods: Retrospective analysis of medical and surgical data for 114 living kidney donors in a single teaching hospital between 1977 and 2005. Complications were evaluated in relation to the surgical approach and body mass index (BMI) using a Chi-square test or Fisher's exact test. Changes in renal function (serum creatinine, creatinine clearance), proteinuria and blood pressure (BP) were studied by Student's t test or a Mann-Whitney U or Wilcoxon nonparametric test. Long-term QoL was evaluated by the MOS SF-36 questionnaire and a local questionnaire and was then compared to that of the French general population., Results: The median follow-up was 63 months. The morbidity of kidney harvesting was significantly correlated with the surgical approach (p = 0.018) and a BMI > or = 25 kg/m2 (p = 0.014). No mortality was observed in this series. A moderate elevation of serum creatinine was observed during follow-up (mean serum creatinine increased from 82.2 micromol/l [+/- 16.3] to 104.5 micromol/l [+/- 19.9]), and mean creatinine clearance decreased from 113.4 ml/min [+/- 27.6] to 76 ml/min [+/- 29.9]. Little impact was observed on proteinuria and BP and QoL was not altered by kidney harvesting., Conclusion: The perioperative complication rate is correlated with BMI and a flank incision. Kidney harvesting lowers glomerular filtration, but clearance remained stable during follow-up. Macroalbuminuria or hypertension may be observed, but their frequency is not higher than in the general population. The QoL of living donors is not altered. Clear information for the general public would allow promotion of living donor transplantation.

Solitary fibrous tumours (SFT) are mesenchymal tumours that usually arise from the pleura. Renal SFT are exceptional (9 cases reported in the literature). The authors report a new case discovered during assessment of HT and treated by radical right nephrectomy. The histological appearance is characteristic: a tumour with a fibrous centre, composed of a monomorphic proliferation of spindle cells, with positive CD 34, CD 99, and bcl 2 labelling. The prognosis after complete resection is generally favourable.

Obstructive renal failure is a rare but serious complication of pregnancy. Although most cases are due to extrinsic compression, renal tract obstruction can also be due to intraluminal precipitation of sulfadiazine prescribed for maternofoetal toxoplasmosis. The diagnosis is suggested by clinical history, ultrasound (radiolucent stones situated anywhere in the renal tract) and especially analysis of the urine pellet (wheat sheaf formation of yellowish crystals). Urinary drainage by double J stent or percutaneous nephrotomy is indicated in the absence of clinical improvement in response to symptomatic treatment and adequate alkaline rehydration. The risk of sulfadiazine crystallization must be systematically prevented by a sufficient water intake and urinary alkalinization right from the start of treatment.

Acute DIC is a rare, but life-threatening complication of metastatic prostate cancer. The authors discuss the treatment modalities in the light of three cases and a review of the recent literature. The key to treatment of DIC is treatment anti of the tumour. Androgen blockade is indicated in hormone-dependent tumours. This treatment can sometimes be completed by low-dose oral anticoagulants. Chemotherapy is the treatment of choice of acute DIC during the hormone resistance phase.

Objective: Although erectile dysfunction is today considered as a frequent disease, few patients actually seek for medical advice and take medication. The purpose of the study was therefore to analyse use and behaviour of men with erectile dysfunction., Material and Methods: The study, performed between the 12th April and the 21st May 2002, involved 10,000 men 18 to 70 years old and consisted in self-administered questionnaires including 55 items (5099 questionnaires were eligible for analyse)., Results: Despite a high prevalence of erectile dysfunction (25%), increased with age (44% in the men aged 45 and over), the study showed that only 22.2% of men with erectile dysfunction take medical advice with 36.9% of them take medication. Men generally think erectile dysfunction is not very common in comparison to other diseases, and correlate it with stress and tiredness. However, men with erectile dysfunction (particularly those over 45) mention diseases as hypertension, prostatic and cardiovascular diseases. 94% of men would take medical advice if their problems should repeat. However, obstacles to consultation still remain for men presenting with erectile dysfunction and especially the difficulty to talk about sexuality with their physician (for 63% of men)., Conclusion: This study confirms the high prevalence of erectile dysfunction and that few men concerned actually seek for professional assistance and take medication. Moreover, it demonstrates the major contribution of the physician in opening the dialogue on sexual problems because men are frequently embarassed or afraid to discuss this sensitive topic.

Introduction: The TVT system has revolutionized the management of female stress urinary incontinence (SUI). Less favourable results have been observed in patients with urinary incontinence associated with a low maximum urethral closing pressure (MUCP). The objective of this prospective study was to evaluate the efficacy of TVT in this situation., Material and Methods: From October 1999 to June 2001, 22 patients between the ages of 53 and 84 years (median: 66.7 years) were operated for SUI with an MUCP < 25 cm H2O (mean: 17.6 cm H2O, range: 6 to 22 cm H2O) present for more than 8 months (range: 8 to 48 months). Three patients also had associated urgency. The Ulmstem manoeuvre was positive in every case and the Bonney manoeuvre was positive in 19 patients. Insertion of TVT was associated with sacral colpopexy in two patients. Success of treatment was defined by complete absence of incontinence and voiding disorders after the operation., Results: One patient was lost to follow-up. The median follow-up was 7.5 months (range: 3 to 27 months). The mean duration of bladder catheterization was 1.3 days (range: 1 to 5 days). Fifteen patients were completely cured by TVT (71.4%). In these cases, uroflowmetry and post-voiding volume were not affected by the operation. Treatment was ineffective in 6 patients (4 cases of uncontrolled leaks, one case of de novo urge incontinence, one case of postoperative dysuria with a post-voiding residue of 120 ml)., Conclusion: The TVT system appears to be an effective method for the treatment of most patients with SUI associated with severe manometric sphincter incompetence. However, these favourable results need to be confirmed by a longer follow-up.

Non-typhus Salmonella urinary tract infections are rare. Based on a clinical case and a review of the recent literature, the authors analyse the diagnostic setting and discuss the necessary investigations and treatment modalities. Non-typhus Salmonella urinary tract infections generally occur in a predisposed clinical setting, such as immunodepression or acquired (stones, schistosomiasis) or congenital uropathy. As in the present case, it can also be the first clinical expression of AIDS, which must be systematically investigated. Antibiotic therapy must be continued for at least two weeks and consists of a third generation cephalosporin or fluoroquinolones, but the prognosis is directly related to the underlying clinical condition.