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Unlabelled: The value of intracavernosal corticosteroid infiltration remains controversial or may even be contraindicated in Peyronie's disease, as it is considered to be ineffective and a source of morbidity., Objective: To retrospectively analyse the efficacy and safety of intracavernosal corticosteroid infiltration in a selected population only presenting clinical criteria of the acute phase of Peyronie's disease (pain and/or recent onset < 6 months)., Material and Method: Intracavernosal corticosteroid infiltration (weekly or twice-weekly) was performed in or around the plaque. Evaluation was based on clinical criteria according to the course of pain, the nodule and curvature and the rates of improvement, resolution, stabilization and deterioration of these criteria were studied., Results: In a series of 271 patients, 123 presented criteria of the acute phase of Peyronie's disease. Forty five of these patients were treated exclusively by intracavernosal corticosteroid infiltration. The mean age was 52 +/- 8 years. The number of intracavernosal infiltrations was usually less than 10 (n = 40) with less than 8 injections in the majority of patients (n = 36). Follow-up was 6 months. There were no cases of clinical deterioration. The best results were observed on pain, which decreased (13.6%) or totally resolved (61.4%). Curvature was decreased (20.5%), the plaque decreased (25%) or disappeared (9%). When intracavernosal corticosteroid infiltration is ineffective, it appears useless to administer more than 3 injections. No morbidity was observed., Conclusion: In our population, the reputation of inefficacy and morbidity of local corticosteroid therapy appears to be unjustified. There were no cases of deterioration, but, on the contrary, stabilization and especially very marked and rapid efficacy on pain, but a lesser efficacy on curvature and plaque. Local steroid therapy appears justified during the acute phase, as the injection allows corticosteroids to exert their anti-inflammatory action in situ in line with the pathophysiology of the disease. A standardized, multicentre, prospective, randomized, placebo-controlled study could confirm our impressions.

In this article, an updated review of the potential consequences of treatment of benign prostatic hyperplasia (BPH) on sexual function is proposed in the light of recent data. Differences exist between the different therapeutic options available for the treatment of lower urinary tract symptoms (LUTS) when we want to analyze the impact on sexuality. Surgical procedures including minimally invasive techniques are associated with ejaculation and also erection disorders. Drug treatments also have repercussions on sexuality though there are significant differences between the various classes of these drugs. In daily practice, the relation between the prostate and sexuality must be assessed during any medical examination for one of these diseases and before any decision on treatment.

Introduction: This study was designed to evaluate the efficacy of ESWL in the management of acute renal colic., Material and Method: From January 2003 to August 2003, 102 patients were hospitalised for renal colic. We treated 57 patients by ESWL using an EDAP LT 02 apparatus. Successful treatment was defined by stone fragmentation on the plain abdominal x-ray at 24 hours associated with resolution of pain after only one ESWL session., Results: The overall complete success rate after only one ESWL session was 49%. Results according to site: UPJ stones: 46% of success, lumbar ureter: 14%, iliac ureter: 33%, pelvic ureter: 66%. According to size: < 5 mm: 57% of success, 6 to 10 mm: 70%, 11 to 15 mm: 27%, > 15 mm: 0%. No difference in success rate was observed according to the cumulative energy delivered or according to the duration of ESWL sessions., Conclusion: ESWL can be considered to be a first-line treatment for acute renal colic. Its best indications correspond to pelvic or UPJ stones less than 10 mm in diameter. We believe that it is useless to exceed a duration of 30 min per ESWL session at a frequency of to 2 Hz.

The aim of this paper was to assess long-term results of transperitoneal laparoscopic fenestration in the treatment of symptomatic simple renal cysts. Fifteen consecutive patients (7 men, 8 women), with a mean age of 51 years (range, 36-79 years), underwent transperitoneal fenestration of simple renal cysts (SRC) at our institution from 1994 to 2001. Data were collected by reviewing patients' clinical files, conducting telephone interviews regarding symptoms, and followup renal ultrasonography (US). There were 15 symptomatic cysts (10 parenchymal, 5 peripelvic) ranging in diameter from 3.5 to 20 cm (mean, 8 cm). All patients had lumbar pain and in four (26.6%) the collecting system was compressed by the cysts. Fenestration was carried out laparoscopically in all patients. There was no mortality and no postoperative complications were recorded. No malignancies were detected at final histopathology. Mean length of stay was 2.5 days. All patients were available for long-term followup. At a mean of 60 months (range, 22-93 months) from surgery, three patients (20%) complained of slight discomfort in the lumbar area not requiring any analgesic. No recurrence of the cysts was seen on US. Two asymptomatic patients (13.3%) developed additional cysts originating from sites different than the one operated on. Laparoscopic fenestration of SRC is safe and effective in the long term to relieve patients from symptoms.

Percutaneous nephrolithotomy is associated with a high risk of complications, particularly bleeding, which makes it a potentially invasive technique. Management of haemorrhagic complications sometimes requires the use of embolization. Recurrence after embolization can occur as a result of revascularization or recanalization of vessels, but post-embolization infarction can also lead to persistent haematuria. The authors report the clinical case of a 36-year-old patient presenting with recurrence of severe haematuria after two successive highly selective embolizations. Analysis of the mean corpuscular volume of red cells in the urine confirmed the parenchymal and non-vascular origin of the bleeding, corresponding to a post-embolization syndrome. This analysis therefore constitutes a simple way to avoid repeated embolization or surgical exploration.

Introduction: This prospective study on TVT compared preoperative and postoperative urodynamic in order to evaluate the effects of TVT on the detrusor-sphincter synergy, and quality of life criteria by means of a validated questionnaire., Material and Method: From August 2000 to March 2002, the authors conducted a prospective study on two sites, Nice and Marseille, on 37 patients. The inclusion criteria were clinical and urodynamic. A questionnaire evaluating the severity of incontinence and its impact on daily life was completed preoperatively and postoperatively. Thirty TVTs were placed under local anaesthesia and seven TVTs were placed under general anaesthesia. Patients were reviewed at least 6 months (mean: 9 months; range: 6 to 19 months) after the operation. Statistical analysis was based on a test for paired series, patient by patient, with an a risk of 5%., Results: Eight cases of unilateral bladder perforation (21.6%) were treated by catheterization for 48 hours and 6 cases of transient acute urinary retention (16.2%) were also treated by catheterization. No haemorrhagic or infectious complications were observed. Thirty one (83.7%) patients were completely cured of their incontinence, 5 (13.5%) were improved and there was one failure. Six (75%) of the 8 patients with a urethral closing pressure less than 30 cm H2O, 6 were cured and 2 (25%) obtained a marked improvement. All criteria were compared in the same patient preoperatively and postoperatively. The maximum flow rate on uroflowmetry was significantly lower postoperatively, but no difference was observed for preoperative and postoperative detrusor sensitivity, urodynamic bladder capacity or urethral closing pressure. No de novo detrusor instability was observed. Mean severity scores and impact of incontinence scores were much lower postoperatively., Conclusion: The efficacy of TVT does not appear to be correlated with the severity of sphincter incompetence and did not modify the detrusor-sphincter synergy of the patients of our study. The use of a questionnaire appears to be useful and should be recommended in order to more accurately evaluate the efficacy of the surgical procedure and the improvement of the patient's quality of life.

Objective: To evaluate the value of retrograde ureteroscopy in the treatment of stones less than 2 cm situated above the iliac artery., Material and Method: Between September 1989 and December 1998, 460 consecutive patients, aged 14 to 86 years, presenting with stones situated above the iliac vessels and measuring less than 2 cm were initially managed by fine (7.5 F) semi-rigid ureteroscopy with CANDELA laser fragmentation in the majority of cases. All operations were performed under general anaesthesia with continuous muscle relaxation. The operation was performed by the same operator in every case. In 50 cases (10.65%), a complementary extracorporeal lithotripsy session was performed following the operation and in 13 cases (2.82%) a second ureteroscopy was necessary., Results: 352 patients (76.5%) were free of any residual fragments after a single laser ureteroscopy session. 415 patients (90.21%) were free of any stone fragments at the 3rd postoperative month. Complications consisted of 28 cases of ureteric perforations, which were all cured by double J stenting, and 7 cases of minor haematuria during the operation. No long-term complication was observed., Conclusion: Ureteroscopy with laser lithotripsy using a fine, semi-rigid instrument, is a reliable technique to treat stones situated above the iliac vessels, provided appropriate anaesthesia and continuous muscle relaxation are ensured. This procedure is associated with a low morbidity and therefore constitutes an effective alternative in the case of failure of ESWL for the treatment of stones less than 2 cm situated above the iliac vessels.

Objective: To compare ambulatory ultrasound-guided transrectal biopsy and finger-guided transperineal biopsy., Material and Methods: From June 1997 to October 1999, 51 patients were simultaneously biopsied by the two techniques and by the same operator, 30 min after antibiotic prophylaxis with 200 mg of Ciprofloxacin by intravenous injection. Transperineal biopsies were performed first, followed by ultrasound-guided transrectal biopsies. Six cores were obtained with each technique, from the apex, the middle and the base of each lobe., Results: For a PSA level between 4 and 10 ng/ml, 6 cancers were detected in 23 patients (26%) and one cancer was only detected via the transrectal route. For a PSA level greater than 10 ng/ml, 17 cancers were detected in 28 patients (60%), 15 (53%) by transperineal biopsy and 11 (39%) by transrectal biopsy. Six cancers were only detected by transperineal biopsy and two were only detected by transrectal biopsy. No statistically significant difference was observed between the numbers of positive biopsies obtained with the two techniques., Conclusion: The use of ultrasonography is not essential to perform systematic biopsies. Rather than the technique used, the detection of prostate cancer is improved by performing 12 cores instead of 6.

The occurrence of aortoiliac lesions with renal transplantation is an increasingly common combination that causes problems regarding operative strategy and indications for aortoiliac reconstruction and renal transplantation. To gain greater insight into these problems we undertook a retrospective multicenter study based on data from 24 kidney transplantation centers in France. A total of 83 patients who underwent both aortoiliac reconstruction and kidney transplantation were enrolled. Patients were divided into two groups according to the order in which the two procedures were performed. Group I included 36 patients in whom aortoiliac reconstruction was performed before kidney transplantation-either during the same procedure (6 patients) or as separate procedures (30 patients). Group II included 47 patients in whom aortoiliac reconstruction was performed after kidney transplantation. The mean age was 49.9 years. There were 43 abdominal aortic aneurysms (51.8%), 36 occlusive aortoiliac lesions (43.4%), and 4 aortoiliac dissections (4.8%). Prosthetic bypass grafting was performed in 72 cases (86.8%), transluminal angioplasty in 6 cases (7.2%), endarterectomy in 3 cases (3.6%), and arterial autograft bypass in 1 case. Renal transplant protection was used during aortoiliac clamping in only 3 patients in group II (7.3%). One month after the second procedure (i.e., kidney transplantation in group I and aortoiliac reconstruction in group II), creatinemia was <200 micromol/L in 27 patients (87.1%) in group I and in 37 patients (88.1%) in group II. The graft survival rate was 86.1% in group I and 89.3% in group II. The overall postoperative morbidity rate was 36.1% (13 cases) in group I and 36.1% (17 cases) in group II. One year after the second procedure creatinemia was <200 micromol/L in 29 patients (93.5%) in group I and 36 patients (93%) in group II. The graft survival rate was 86.1% in group I and 85.1% in group II. The outcome of kidney transplantation is comparable regardless of whether the procedure is performed alone or in association with aortoiliac reconstruction. This finding indicates that kidney transplantation should be performed in patients presenting indications for prior aortoiliac reconstruction. The outcome of aortoiliac reconstruction without graft protection in kidney transplant patients is comparable to the outcome of conventional aortoiliac reconstruction in patients with native kidneys.

The origin of Peyronie's disease remains obscure although the first description dates back to 1743. The prevalence of the disease is 388.6 per 100,000 population. Little physiopathologic data is available. Repeated microtrauma to the tunica albuginea appears to favor the onset of inflammatory phenomena, in turn the source of fibrosis. Clinical examination remains the ideal method for diagnosis and follow-up: it can be completed by ultrasonography of the corpora cavernosa. Magnetic resonance imaging does not appear to provide any significant benefits. The inflammation and pain encountered in early stages of the disease can be managed medically. Numerous treatments have been tested (oral route or local injections); results are in the course of evaluation. In the absence of well-controlled clinical trials, there is no standard medical therapy. Radiotherapy today appears inadvisable. The sequels of Peyronie's disease can be treated surgically, especially in patients who can maintain and adequate erection but suffer from a deformation incompatible with sexual activity. Numerous technical artifices have been proposed; correction of deformations is generally satisfactory but perfections need to be made concerning the quality of erection. Patients with advanced disease and severe erectile insufficiency can be offered reconstructive surgery using penile implants: results of the various procedures are analyzed.

Between November 1991 and June 1993, 315 patients with urethral lesions were divided into two groups: group 1 included 215 patients with urethral tumours and group 2 included 100 patients with non-tumoural lesions. In all patients, urethral smears (performed on 3 consecutive days), pyelography and uretrocystoscopy (with bladder biopsy of observable lesions) were performed in all. The sensitivity of urine cytology examinations in the diagnosis of bladder cancer was found to by 80% with a specificity of 90%. The positive predictive value was 94.5% and the negative predictive value 67.7%. Urine cytology agreed with the diagnosis of urethral tumours especially well in advanced stage ulcerated tumours. These results underline the importance of cytology examinations in the exploration and follow-up of patients with urethral tumours.

Acute perineal gangrene due to anaerobic Gram negative bacilli or streptococci rapidly leads to tissue necrosis and death in 50% of the cases despite progress in intensive care. Emergency treatment requires adapted antibiotics, hyperbaric oxygen therapy and repeated surgery. Factors of poor prognosis include age over 60 years, lomboabdominal or crural extension, septic shock, positive blood cultures and lack of fecal derivation. Surgery is performed under general anaesthesia since loco-regional anaesthesia is contraindicated during the septic phase. Repeated operations are needed to make large incisions, evacuate pus, search for foreign bodies and resect damaged tissue in order to expose all the infected areas to air and hyperbaric oxygen. A colostomy must be performed in order to avoid fistulization and contamination of the infected areas. An indwelling urine catheter is usually sufficient although a suprapubic catheter may be needed at the risk of further extension of the gangrene. Surgical treatment is associated with intensive care and hyperbaric oxygen therapy. Three effective antibiotics are recommended. Using this aggressive surgical protocol, we have been able to reduce mortality to 20% in patients under 60 years of age.

Despite recent advances in imaging techniques, the staging process is still unsatisfactory in cancer of the prostate. The underestimation for stage B2 and C tumours in about 50%. We present our findings in a retrospective study analyzing the clinical and biological effects of complete androgen blockade before radical prostatectomy in patients with advanced stage localized tumours. We treated 21 patients from 1989 to 1993. All received preoperative homonotherapy by complete androgen block for at least 3 months before node dissection preceding suprapubic radical prostatectomy. Only 20 prostatectomies were performed as metastasis was found in the extemporaneous examination in 1 patient. The volume of the prostate gland had diminished in all patients after the hormonotherapy (27.8%) as did PSA (95%). When evaluated, the tumour stage of the surgical specimen was always more advanced than the needle biopsy. Only 1 tumour was strictly limited to the intracapsule and all the others had either invaded the capsule, reached the margins or had invaded the seminal vessels or lymph nodes. With a mean follow up of 45 months, recurrence rate is 50%, mainly due to tumours with positive margins or seminal invasion in patients who were not given adjuvant treatment. Our results are in agreement with those in the literature showing that although the volume of the prostate is reduced and PSA declines, no improvement in pathology staging is observed.

Endoscopic resection of the prostate is a well defined surgical procedure. Nevertheless, certain coagulation disorders (hypercoagulability with risk of deep vein thrombosis, haemorrhage) can raise special problems. In patients not given heparin prophylaxis, the incidence of deep vein thrombosis is 10% in transurethral resections of the prostate (TURP). The risk is higher for cancer. Among the diagnostic tools (D-dimer assay, continuous Doppler, pulsed echo-Doppler, thermography, plethysmography, ...) ascending phlebography or pulmonary angiography in case of suspected pulmonary emboli remains the gold standard. Haemorrhage is rarely related to defribination but frequently to dilution coagulopathy favoured by high blood pressure, resorption of irrigation fluid, deficient haemostasis with loss of coagulation factors or massive transfusions. Only clinically patent coagulation disorders leading to haemorrhage should be treated. For dilution coagulopathies and diffuse intravascular coagulation, treatment is based on viro-inactive fresh plasma infusion. Aprotinine is the first choice in case of fibrinolysis.

Fournier's syndrome, characterised by anaerobic necrotising cellulitis of the soft tissues situated below the diaphragm, is a serous disease with an unpredictable course. From 1978 to 1991, we treated 24 men with a mean age of 57 years (27 to 90 years). Following the diagnosis of this disease, rigorous treatment was instituted immediately, consisting of a triple antibiotic combination, repeated surgical exposure, debridement and drainage with a frequent, almost systematic indication for faecal diversion (n = 16), hyperbaric oxygen therapy and classical intensive care measures. The mean interval between the first clinical signs and the diagnosis was 7.4 days. The lesions were limited to the perineum in 11 cases and extended to the abdomen, thighs and/or loins in 13 cases. The microorganisms responsible for the infection were identified in 19 cases and blood cultures were positive in 5 cases. This infection was of coloproctological origin in 12 cases, urogenital origin in 4 cases and postoperative in 2 cases, while no aetiology could be identified in 6 patients. There were 6 deaths and 18 cures without sequelae. 1. The prognosis of this disease is better in younger subjects (under the age of 60 years) with a localised clinical form, with no deterioration in the general status, sterile blood cultures and treated by a diversion colostomy. 2. A detailed aetiological work-up must be performed, looking for local or regional infection, cancer, haematological malignancy or arterial disease.

The authors report a series of 132 patients with urethral stricture all treated by the same surgical technique between 1979 and 1984: direct vision internal urethrotomy. 62% of good results were obtained after a single operation with a follow-up ranging between 18 months and 5 years. There was no mortality and the morbidity was considered to be 5%. The authors indicate that the results were more favourable when the operation was performed in a solitary, short (less than 2 cm) non-infected stricture of the proximal urethra. The duration of postoperative catheterization was 10 days; catheterization for a longer period did not provide any significant advantage. The poor results (38%) were reported in cases of extensive strictures situated in the distal urethra or in patients with a history of urethral surgery. These cases were treated by repeated internal urethrotomy; 32% were cured after a second urethrotomy, while the others required maintenance sessions of urethral dilatation or even a urethroplasty procedure.

Thirty patients with partial or total staghorn lithiasis or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had a pelvic stone; the other 11 had partial (nine) or total (two) staghorn lithiasis. All patients first underwent an initial lithotripsy session. No anesthesia or intravenous sedation was required in any case. If stone fracturization was achieved after this first session, a double J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had a sterile urine culture; 12 of 30 presented major distention of the excretory tract. Results were analyzed to determine those factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stone had completely disappeared on abdominal plain films (14/30 = 46%). In seven patients (23.3%), fracturization had occurred but residual fragments remained (1-3 fragments less than or equal to 4 mm). No fracturization was obtained after the first session in nine patients (30.7%) (one total staghorn lithiasis, eight pelvic stones). The mean number of treatment sessions was five (range 1-15). Complications occurred in only 10% of patients (3/30): two steinstrasse and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distention and 55% of patients whose initial urine culture was sterile, achieved a stone-free state.(ABSTRACT TRUNCATED AT 250 WORDS)

Thirty patients with partial of total staghorn calculi or pyelic calculi greater than 30 mm were treated by extracorporal piezo-electric lithotripsy (PEL) exclusively with an EDAP LT 01 lithotripter equipped with an ultrasound localisation system. Nineteen patients had a pyelic calculus and the others a partial (n = 9) or total (n = 2) staghorn calculus. All patients first underwent extracorporal lithotripsy (ECL). None of the patients received IV sedation or anesthesia. When fragmentation of the calculus was observed after the first session, a double J stent was inserted before the second ELC session. Before the first session, urine samples were sterile in 18 of the 30 patients; 12 of the 30 patients presented major distention of the urinary tract. Results were analysed to identify factors affecting results of this type of treatment. Patients whose calculus had completely disappeared on plain films three months after the first session were considered to be cured clinically and radiologically (14/30 = 46%). Seven patients (23.3%) were clinically cured (absence of pain and sterile urine) but there were residual fragments (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in 9 patients (30.7%) (1 total staghorn, 8 pyelic calculi). The mean number of sessions was 5 (range 1-15). Only 10% of the patients (3/30) presented a complication: 2 steinstrasses and 1 acute pyelonephritis. 83% of the patients without urinary tract distention and 55% of the patients whose urines were initially sterile were cured.(ABSTRACT TRUNCATED AT 250 WORDS)

The treatment of subvesical obstruction with a spiral endoprostatic prosthesis is now well-known since Fabian's initial work (1980). A new method of insertion of the spiral with a releasable catheter and under sonographic monitoring has been proposed recently. This article is a report of a series of 35 patients. These patients presented with an adenoma of the prostate and were fitted with a permanent urethral catheter due to an absolute contraindication for anesthesia. The spiral was inserted with US monitoring in 25 patients. In 5 patients, the spiral had to be inserted under classical endoscopic control. The average follow-up period is 7.2 months. In 25 patients (75%), the spiral remained in place; the maximum flow rate of urine after the insertion averages 12.8 ml/s and 76% of these patients report an improvement of their comfort during urination. The position of the spiral had to be changed in 8 cases. No infectious complication was noted. Hematuric complications are reported in 2 cases. The spiral endoprostatic prosthesis seems to be an elegant alternative to the permanent catheter in patients at high anesthetic risk.

The stage of the tumor is commonly underestimated prior to radical prostatectomy for carcinoma. Can the growth of clinically localized carcinomas beyond their capsule be predicted with the modern medical imaging techniques (MRI and CT)? On the basis of 30 successive prostatectomies, we conclude that CT is ineffective. On the contrary, MRI seems to be an effective technique for this indication. However, no examination yet is better than clinical assessment.

On the basis of 150 patients (16 controls with no disease of the prostate, 96 cases of benign prostatic hypertrophy (BPH) and 38 cases of carcinoma of the prostate (CP)), the authors intended to answer 3 questions: How can the borderline values of PSA in BPH be interpreted? Is there a correlation between the Gleason and PSA values in carcinomas? Should the simultaneous measurements of PSA and PAP be continued? All patients were examined with a rectal touch, transrectal echography (TRE) and PAS and PAP assays. All CP were examined with bone radionuclide scanning (BR). The correlation coefficient being 0.391 (p 0.001), the PSA value and prostatic weight can be regarded as linearly correlated in BPH (5 g BPH = 1 ng/ml PSA). This lower value of PSA is linked with the increase produced by TRE in the assessment of prostatic weight. On the other hand, the authors did no observe a correlation between the PSA and the Glisson grade in carcinomas with negative BR. Lastly, the sensitivity of PSA is noticeably higher than that of PAP (75% vs. 50%), and no false negative finding with PSA was corrected by PAP measurements.