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Resume Introduction L’objectif de cette etude etait de comparer les resultats en terme de continence et de qualite de vie entre la prostatectomie radicale retropubienne et la prostatectomie radicale cœlioscopique, selon le meme principe de dissection retrograde a partir de l’apex. Materiel et methode La serie etait composee de 120 malades ayant eu une prostatectomie radicale retropubienne et 131 patients ayant eu une prostatectomie radicale cœlioscopique. Ces interventions ont ete realisees dans le service de chirurgie urologique et andrologique du CHRU de Limoges entre janvier 2002 et septembre 2005. L’evaluation de la continence etait realisee par le moyen d’un autoquestionnaire anonyme envoye au domicile du patient. L’evaluation de la douleur etait realisee par l’etude d’echelle d’evaluation analogique et la consommation morphinique. Les facteurs predictifs de la continence ont ete analyses. Resultats Les deux groupes etaient comparables en terme de stade pathologique, score de Gleason et l’âge. Il y avait plus de patients avec des antecedents de resection endoscopique de prostate et d’obeses dans le groupe cœlioscopie. Il n’y avait pas de difference significative du degre de continence entre cœlioscopie et laparotomie (71 % versus 76 % ; p > 0,05), du delais de retour a la continence (13 semaines versus neuf semaines ; p > 0,05), du degre d’incontinence urinaire legere (14 % versus 13 %) modere (7 % versus 6 %) et severe (7 % versus 5 %). Le taux de stenose secondaire de l’anastomose etait egalement superposable. L’âge est apparu etre un facteur predictif de continence, notamment pour le delais moyen de retour a la continence. Le poids du patient, le poids de la prostate, le stade TNM n’ont pas ete des facteurs predictif d’incontinence. Par ailleurs, le taux d’incontinence etait de 40 % pour les prostatectomies de rattrapage apres radiotherapie. La duree du sondage vesicale etait de 6,9 j en cœlioscopie et 7,2 jours en laparotomie. La consommation morphinique etait statistiquement inferieure en cœlioscopie (21 mg versus 36 mg ; p Conclusion La prostatectomie radicale sous cœlioscopie a semble avoir les memes resultats en terme de continence que la prostatectomie retropubienne. Cependant, il s’agissait des premieres prostatectomies sous cœlioscopie realisees dans le service. On peut esperer obtenir, avec plus d’experience, des resultats superieurs a la laparotomie. Par ailleurs, la technique cœlioscopique a semble apporter un meilleur confort au malade en diminuant la douleur postoperatoire.

The objective of this study was to evaluate the Feasibility, the morbidity and the carcinologic results of laparoscopic partial nephrectomy.Between August 2001 and December 2005, 17 partial nephrectomies were performed by laparoscopy in patients with a mean age of 59.2 years. Postoperative complications, the conversion rate, operating time, arterial clamping time, length of hospital stay and oncological results were studied for each patient.The mean operating time was 190 min, the mean arterial clamping time was 30 min and the mean hospital stay was 6.3 days. There were 2 complications including one postoperative haematoma requiring surgical revision for drainage and repositioning of a stent for urine leak. Two conversions had to be performed early in our experience. A tumour recurrence 2 years after the initial operation was treated by total nephrectomy.Our results in terms of morbidity are similar to those reported for open surgery, but the recurrence rate appears to be slightly higher than that observed with open partial nephrectomy. Laparoscopic partial nephrectomy remains a difficult operation requiring a learning curve even for a department that regularly performs laparoscopic surgery.

FREDDY laser technology was developed for endocorporeal lithotripsy. The purpose of this study was to evaluate, based on our initial experience, the efficacy and place of this technology in the treatment of urinary calculi by ureterorenoscopy. (World of Medicine) to treat 26 patients (29 stones) by ureterorenoscopy. This was the second procedure for 25 stones: after ESWL (23 cases) or percutaneous nephrolithotomy (2 cases) and the first procedure for 4 stones. The mean stone diameter was 9 mm (range: 6-15 mm). Thirteen stones were situated in the kidney and 16 were in the ureter. Success of treatment was defined by the absence of residual fragments immediately after the operation or at one month on plain abdominal x-ray.Twenty-six stones were satisfactorily fragmented. At three months, 21 out of 26 (80.7%) patients were stone-free corresponding to 21 out of 29 (72.4%) stones). Failures concerned 8 stones (5 patients). For five stones, measuring more than 10 mm, residual fragments persisted at three months. For three other stones, two cystine stones and one calcium oxalate monohydrate stone, fragmentation was insufficient or even nonexistent for the cystine stones. The mean length of hospital stay was 1.5 days (range: 1-3 days). A ureteric perforation due to a stone impacted in the ureteric wall was observed.FREDDY laser endoscopic lithotripsy is a safe and effective method due to the wavelength used. This laser could constitute an alternative treatment option in view of its moderate cost and the fact that it is adapted to flexible ureterorenoscopy. However, it presents certain limitations in terms of fragmentation, particularly in the case of cystine stones, and cannot be used to treat solid lesions (urinary tract strictures and tumours).

There is only one published case of arteriovenous fistula discovered 20 years after firearm trauma. The authors report the case of a 47-year-old man injured by firearm 28 years ago presenting with a highflow aneurysm of the right renal artery secondary to arteriovenous fistula and associated with lower pole renal tumour and describe the radiological work-up and surgical management.

We describe the unusual case of a 78-year-old woman consulting for extensive and painful wound leg ulcerations and calcifications secondary to CREST syndrome that was treated by extracorporeal shock wave lithotripsy. This treatment was considered because of the severity of our patient's symptoms and her failure to respond to various medical and surgical treatment.