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L’infertilite secondaire se definit comme l’impossibilite d’obtenir une nouvelle grossesse pour un couple ayant deja procreer dans le passe. Sur une periode de 16 ans, 49 patients sont venus consulter pour un probleme d’infertilite secondaire d’origine masculine. Un bilan clinique et para-clinique a permis de conclure sur l’origine de l’infertilite. L’âge moyen de ces patients etait de 33,6 ans (de 26 a 44 ans). Les enfants vivants obtenus auparavant dans ces couples etaient en moyenne de 1 par famille, representes par une fille deux fois sur 3, et un garcon une fois sur 3. Les resultats obtenus chez ces patients montrent que l’infertilite est due a la presence d’une varicocele pour 15 malades soit 31% des cas, la presence d’une infection pour 14 patients soit 29%, et la presence d’une varicocele associee a une infection dans 11 cas soit 22%. deux etiologies principales se degagent dans le cadre de ce bilan. Cependant, certaines causes restent evidentes, comme les interventions chirurgicales avec ablation de la prostate ou des testicules, ou certains traitement cytotoxiques.

The objective of this study is to evaluate the safety of local anaesthesia by pudendal nerve block (PNB) for insertion of TVT or TOT suburethral tape for the treatment of female urinary incontinence.PNB is performed by bilateral injection between the anus and ischium. The pudendal nerve, detected by electrostimulation, is anaesthetised by a solution of Naropeine and Carbocaine. Anaesthesia is systematically completed by abdominogenital and genitofemoral nerve blocks and by deep infiltration in the vagina. Perioperative and postoperative pain was assessed by visual analogue scale (VAS).Nine patients were treated by suburethral tape under PNB between November 2002 and January 2003. The mean age was 65.5 years (range: 46 to 87 years). TVT was used in 6 cases and TOT was used in 3 cases. PNB was well tolerated by the patient in 66% of cases. Eight patients (88%) did not experience any pain during the operation. The majority of patients (88%) were very satisfied with the anaesthesia. One patient experienced residual pain for 3 weeks. The technique is easy to perform by the anaesthetist and did not modify the surgical technique. This technique is relatively inexpensive.This preliminary study on a limited number of cases shows that PNB appears to be a good alternative to the usual anaesthesia techniques for insertion of suburethral tape.

The management of female stress urinary incontinence has been markedly improved by the suprapubic tension-free vaginal tape (TVT) and transobturator tape techniques. The objective of our study was to assess the feasibility of this type of technique in males based on cadavre dissection.A 300 mm x 15 mm polypropylene tape was inserted via a transobturator approach on a cadavre stored in the refrigerator at 4 degrees C and on three cadavres stored in formalin. The technique was almost identical to that used in females. It requires a midline perineal incision in the raphe and two small lateral incisions. The deep transverse muscle of the perineum was opened with scissors. The needle was introduced via the lateral incisions and its progression was guided by a finger introduced into the perineal orifice. The cadavre was then sectioned sagittally to verify the course of the tape and its relations to adjacent structures.The operative technique did not raise any particular problems. Dissection revealed that the tape crossed the deep transverse muscle of the perineum and the levator ani muscle, before travelling towards the obturator foramen. The tape avoided the bladder, prostate, corpora cavernosa, and pudendal pedicle.The transobturator tape technique therefore appears to be feasible in males. It does not appear to comprise any particular risks for adjacent organs. This anatomical study appeared to be essential before considering an in vivo application.

Non-iatrogenic post-traumatic arteriovenous fistulas of the kidney raise a diagnostic and especially therapeutic problems. The authors report their experience based on 3 cases of arteriovenous fistulas treated by selective embolization during diagnostic arteriography.In a series of 18 patients urgently admitted to hospital for kidney trauma during 2000, 3 patients presented a secondary arteriovenous fistula diagnosed on arteriography. All patients were initially treated by surveillance in the surgical ward. The diagnosis of arteriovenous fistula was subsequently suspected following recurrence of haematuria with a moderate fall in haemoglobin in two cases, and secondary appearance of lumbar pain without anaemia in the third case. For the two patients with secondary haematuria, arteriography demonstrated an arteriovenous fistula associated with an arterio-caliceal fistula. For the last patient, Doppler ultrasound suggested the diagnosis of arteriovenous fistula, which was confirmed by the arteriography.Selective embolization by "coils" and particle was performed during arteriography and ensured closure of the fistulas in every case. The postoperative course was uneventful for all three patients. With a mean follow-up of 7 months, no recurrence of the fistula has been observed. The remaining renal parenchyma is functional with preservation of renal function.The risk of arteriovenous fistula must be kept in mind in any case of lumbar trauma. Arteriography with selective embolization allows good control of these secondary fistulas while preserving a maximum of functional renal parenchyma, and therefore appears to be the treatment of choice of this complication.