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We report on 4 cases of urinary stone observed in patients treated with the drug Crixivan (Indinavir Sulfate) and review the literature. Comments include stone composition, clinical aspects, treatment and prevention.

We report two cases of grade 1 papillary transitional cell carcinoma which have a distinct pathological. The tumor was infiltrating the lamina propria in the first case (pT1) and the superficial muscle in the second case (pT2). These tumors were composed by nests and tubules with few cytological atypias, making the diagnosis of cancer difficult. The prognosis of these tumors is not well defined.

Endorectal surface coil magnetic resonance imaging (MRI) was used in the local staging of prostate cancer in 47 patients. We used an 1.5 Tesla General Electric magnet. Fast spin echo sequences were acquired in all cases. All pathological specimen were reviewed by one pathologist. Pathological study showed that 19 patients had a locally confined cancer of the prostate (pT2), and 28 had an extraglandular extension (pT3). MRI correctly predicted a pT3 tumor in 15 of 28 cases, and a pT2 tumor in 18 of 19 patients. MRI was 70% accurate in the differenciation of stage pT2 from stage pT3 cancer. One case was overestimated and 13 cases were underestimated. The latter 13 patients had microscopic extracapsular invasion only.

Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.

The authors report an uncommon case of renal adenoma, a metanephric adenoma in a 21 year-old man. Treatment consisted in a tumorectomy. The review of the literature, shows it to be a benign tumor with no malignant potential.

Eighteen patients with stress urinary incontinence and normal maximal closure pressure underwent Burch procedure with pelvioscopy. A small (3 cm) incision is necessary to introduce the pelvioscope which allowed suture under visual control. Six month clinical results were 93% success and 7% improvement.

Introduction: Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter., Methods: Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization., Results: 25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering., Conclusions: Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.

Twenty five patients with symptomatic BPH and normal PSA underwent electrovaporization. The mean IPSS was 21.5 before and 7.8 three months after treatment while the mean peakflow was 7.1 ml/s and became 16.9. With a short hospital stay (3 days) and a very low morbidity, electrovaporization seems to be a good alternative to TURP. A longer follow-up is necessary.

The authors report 1 case of particularly severe reflex neurovascular dystrophy whose clinical course was marked by the discovery of a carcinoma of the prostate. There was improvement in the reflex neurovascular dystrophy despite hormonal therapy of the cancer. Reflex neurovascular dystrophy cannot be considered as a form of a paraneoplastic syndrome.

A Sertoli cell mesenchymal tumour was observed in a 19-year-old male. The prognosis of this rare tumour is good.

Renal ultrasound seems to be more difficult on the left than on the right side. In a retrospective analysis of 343 patients in whom a radical nephrectomy for renal tumor diagnosed by abdominal ultrasonography had been carried out, we analyzed the characteristics of these tumors. TNM classification was used. Right kidney tumors (n = 170) were smaller than the left ones (n = 172), 58 +/- 31.7 mm and 66.8 +/- 31.5 mm respectively, the difference being statistically significant (p = 0.01). Right kidney tumors of a less advanced stage (p < 0.05). Asymptomatic renal tumors were found more frequently on the right side (58.7%) than on the left (41.3%) (p = 0.03) and were smaller on the right (44 mm +/- 19.6 vs 54.5 mm +/- 27.2) (p = 0.04). In conclusion, Ultrasound exploration of the left kidney seems to be more difficult, mostly because the exploration of the right kidney is facilitated by the acoustic window of the liver.

Seventeen cases of urinary calculi analyzed by infrared spectrophotometry were found to be composed entirely or nearly entirely of bihydrated calcium hydrophosphate. The observations are summarized here. This type of stone occurs with a frequency of about 1% (0.85% in our experience) of all urinary calculi, predominantly in men (14 of our 17 cases). Diagnosis is based on the physical and chemical analysis of the stone and on infrared spectrophotometry. Most of these stones are pure or nearly pure compounds. The macroscopic aspect of the stones or fragments of stones can guide diagnosis. These stones are cream coloured stones with a smooth regular outer surface. Broken fragments show the same cream colour, sometimes with strips radiating from the centre of the fracture surface. Radiologically, these stones are homogeneously radio-opaque, often oval-shaped with a regular outline. Blood tests can demonstrate suspected or proven hyperparathyroidism (4 out of 10 cases in our 17 observations) with hypercalcemia, hypophosphatemia and hypercalciuria. Complementary examinations may be needed to search for a parathyroid adenoma. With or without hyperparathyroidism, 24-h urinalysis usually shows hypercalciuria up to ro over 500 to 600 mg/24 h. Crystallization usually occurs in the upper urinary tract, in the bladder or in indwelling catheters. These stones are extremely hard and are difficult to break in vitro. To be successful, lithotripsy requires prolonged treatment: up to 3000 to 6000 shockwaves at 22-23 kv with the Dornier apparatus. Despite the notion of hypercalciuria, the pathogenesis of bihydrated calcium hydrophosphate calculi remains to be elucidated.

To better determine the role of endovesical BCG treatment for superficial tumours of the bladder, it is necessary to understand the natural history of these tumours and the prognostic factors; The goal is to better manage BCG as a preventive measure for relapse of superficial tumours of the bladder and to prevent possible progression by infiltration. It is also important to emphasize the possible complications of this therapy and the currently recommended precautions in order to carefully use this very effective method with the least possible morbidity.

Urinary fistulization to the skin is a rare complication of cystoprostatectomy with replacement enterocystoplasty. In two cases, fistulization did not respond to continuous drainage of the urine and was treated with a muscle flap using the abdominus rectus. This method offers rapid parietal repair giving a reliable rapid cicatrization since the interpositioned flap is well vascularized in an area of poor tissue quality.

Stress urinary incontinence may be treated by different techniques. This study is based on a retrospective analysis of 59 patients treated between 1985 and 1993, by the Goebell-Stoeckel technique. 48 patients were questionned by phone in March 1995 to estimate the long term results. Two groups were defined; group A: follow-up between 15-60 months and group B: follow-up between 72-120 months (Total average follow-up: 68 months). The majority of patients were elderly, menopaused (88%) and had had one or more surgical procedure for incontinence (60%). Among 59 patients, 8 developped minor early complications. The mean length of hospital stay was 14 days and the mean duration of indwelling catheterization was 6.5 days. 60% of patients have had urinary retention after catheter ablation and have required intermittent catheterization at home for a mean duration of 14 days. Continence was achieved in 84% of cases at 3 months and had persisted in 96% of cases for group A and 91.5% of cases for group B. With a mean follow-up of 68 months, 37.5% of cases had irritative symptoms, 12.5% had minor urethral obstruction. 52% of patients obtained a very excellent result (normal continence, no urgency, no dysuria), 9% obtained an excellent result (normal continence, urgency with no leaked, and/or minor dysuria); 12 obtained a moderate result (normal continence, urgency with minor leakage without toilet set, and/or minor dysuria) and 27% obtained a poor result (incontinence, urgency with leakage necessitating toilet set, and/or dysuria).

Electroconductive lithotripsy uses a highly conductive liquid to bathe the electrodes rather than water. The effect is to channel energy between the electrodes and force it to pass directly from the anode to the cathode, exactly at F1. The Sonolith 4000 (Technomed Medical Systems) uses this new generation of "electroconductive" shock waves. Experimental and clinical results are presented. The typical electroconductive technique creates a linear relationship between energy level, in kilovolts, and the amplitude of the acoustic shock at F2 over a wide range of power. There is also a linear relationship between power and effectiveness of desintegration. More than 800 patients have been treated to date. Follow-up has reached 3 months in the 166 treatments reported here. Overall success rate without residual stone was 82%. The percentage of patients with residual stones smaller than 5mm was 5%. The rate of clinical success was 87%. The rate of retreatment in patients without residual stone was 10%. For 11 to 20 mm stones, the success rate (0 fragments), the rate of retreatment and the rate of auxiliary procedures were 83%, 4% and 2% respectively for stones < or = 10 mm and 78% for 11 to 20 mm stones. The electroconductive generator used in this study provided very satisfactory results, better than those generally obtained with classical generators. Tolerance was excellent.

Kidney cancer accounts for 3% of all cancers, with approximately 85% of tumors arising in the renal parenchyma (renal cell carcinoma). To evaluate the part of the incidental detection of the renal carcinoma, we performed a retrospective review of the 302 patients treated for this reason in our department between April 1981 and October 1992. For the purpose of a historical comparison, 2 periods of 6 years were compared: 1981-1986 and 1987-1992. During 1981 to 1992, 71 patients (25.8%) were totally asymptomatic, with a significant improvement of the incidentally detected tumors from 1981-1986 (15%) to 1987-1992 (33.7%) (p < 0.001). Renal ultrasonography, which is responsible for 97% of the incidental diagnosis, allow for a better detection in the right kidney (60.3% vs. 39.7% in the left kidney) (p < 0.05). Primary tumor size and clinical stage (with Robson or the TNM 1992 classification) were significantly smaller (47.3 +/- 19.9 mm for the asymptomatic group vs. 71.6 +/- 34.1 mm for the symptomatic tumors) and lower respectively, in the asymptomatic group than in the symptomatic group (p < 0.001). The five-year survival rate (actuarial method) of the incidental cases tended to the better for the asymptomatic cases (87.5% vs. 39% for the symptomatic tumors) (p < 0.05). Most of the authors agree that incidental diagnosis has led to lower tumor size and stage and possibly better survival rate compared to cases where the diagnosis was suspected clinically. However, prospective studies on a large scale are needed to evaluate the role of nephron sparing surgery for incidental cancer of the kidney. Nowadays, the treatment remains radical nephectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Distortion of the penis can be an obstacle to normal sexual intercourse and can lead to psychological problems. Nesbit first described an operation for the correction of three cases of congenital incurvation of the penis. Several authors later proposed modifications of the original procedure, but the principle technique relies on folding the corpus cavernosum on the side opposite the deviation. We have treated 26 cases with distorted penis: 14 congenital, 3 postsurgical, 1 post-trauma and 8 due to la Peyronie's disease. Our functional results have been excellent. The risk of postoperative retraction is considerably reduced when the fold is created without removing the albugin patches. The quality of the results is directly related to rigorous patient selection.

While it is known that radical prostatectomy is not a curative procedure, would be logical to propose a possible adjuvant treatment. Unfortunately it does not appear that adjuvant radiotherapy significantly improves total survival.

This study analyzed clinical response induced by TIL in patients with renal cell carcinoma previously treated by interleukin-2. Six patients (4 men, 2 women, mean age 44.3 years) with measurable metastatic localizations have been treated by TIL reinjection (0.02 to 7.6 x 10(10) cells). TIL phenotype was a combination of CD4 and CD8 in 3 patients, predominantly CD4 in two patients and predominantly CD8 in one patient. Previous treatment by interleukin-2 induced one partial response, 2 stabilizations of the disease and 3 tumoral progressions. TIL led to an amelioration for 4 patients: 2 were in complete response, 2 were stabilized and 2 had tumoral progression and decreased. This study shows that CD4 TIL may improve an initially response induced by IL-2 therapy.

24 men (mean age 71.2 years) with micturition disorders and parkinson disease have been studied: irritative symptoms are present in 62.5%. Urodynamics were specially usefull when obstructive symptoms (37.5%). In these cases, 3/4 had a mechanical obstruction to be treated by surgery. 3 men had a neurologic bladder and needed a pharmacological treatment. In this high risk population, urodynamics seemed to be necessary.

The epidermoid cyst of the testis, a rare and benign tumour, continues to create problems. Its definitive diagnosis remains a histopathological one and alters the prognosis and therapy. Based on their case report and a literature review, the authors discuss the different diagnostic, prognostic and therapeutic aspects of this lesion.

The association of an oncocytoma and of an angiomyolipoma within the same renal tumor is infrequent. The authors review the literature on the basis of two cases. Histogenesis and the clinicopathological analysis show that such an association is accidental. It makes up 0.5% of kidney tumors, and 1% of oncocytomas are associated with an angiomyolipoma. The risk to encounter a malignant tumor is of 25% in such cases.

Twenty-three patients having undergone enterocystoplasty with a detubulated graft has an urodynamic study on an empty stomach and after a standardized meal. All patients (average age 62.9 years) had been operated more than 6 months earlier, and 30% still presented with urine leakages at night. The urodynamic study included a cystomanometric measurement with rapid water filling, an urethral profile and a micturating cystography. It was repeated 60 to 90 minutes after a meal composed of glucids, lipids and protids. Feeding had variable effects on the intestinal graft: increase in peristaltic intensity and/or earlier onset of contractions (10/23); apparently paradoxical decrease in contractions (6/23); sometimes no modification (7/23). This short work without any obvious physiopathological explanation has led us to advocating breaking up feeding for patients who were improved by the meals.

The TULIP (Transurethral Ultrasound-guided Laser-Induced Prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 micron wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.

Dilatation of the renoureteral cavities during pregnancy is a common occurrence, especially on the right side. Though generally asymptomatic, this dilatation can be unfrequently complicated by pain and/or urinary infections that may cause severe infectious and obstetrical complications. In such cases, drainage of the renal cavities may be indicated in very selected cases. The authors review their experience with renal bypass through an endoureteral prosthesis during pregnancy, and specify the technical aspects and the indications of this type of bypass.

This work is a report on our preliminary experience with the treatment of iterative stenosis of the pyeloureteral junction (JPU) through a retrograde endoscopic approach. From June, 1991, to June, 1992, we used this method to operate 6 cases of failed surgical pyeloplasty due to abnormalities of the JPU. The success of this operation depends, on one hand, on the systematic dilatation of the intramural portion of the ureter, and on the other hand, on the possible installation of a double pigtail stent a few weeks before endopyelotomy. We have noted no complication. The stay in hospital lasted 3 days in average (2 to 5 days). Clinical and radiological results include: 4 successes, 1 improvement and 1 failure. The average time elapsed is of 9 months (6 to 18 months). This technique, which has a proven feasibility, is a good alternative for this indication, in the absence of associated calculi and particularly in women. Its efficacy remains to be demonstrated by larger series with a longer follow-up.

From 1985 to 1990, 119 female patients underwent a cure for urinary incontinence on exertion according to a technique that varied according to the period and to the data of the literature. From 1985 to 1988, 42 patients were operated with the Goebbel-Stoeckel technique; from 1986 to 1988, 32 patients were operated with Stamey's procedure, and 47 patients with Gittes' procedure from 1988 to 1990. These three groups of patients with comparable ages, previous history and degree of urinary incontinence on exertion were analyzed by the same surgeon for functional results and morbidity, both in the immediate three months after surgery and in July, 1991, with an average distance in time of 29 months. The patients with no leakage of urine were regarded as healed, those presenting with occasional leakages on violent exertion but requiring no napkins were regarded as improved. All other patients were regarded as failures. The percentage of failure is similar for the three technical procedures when analyzing long-term results and according to our criteria, 66% of patients only are healed or improved. These figures are noticeably higher if surgery has been performed in a patient with normal preoperative closing pressure. The analysis of this series and comparison with series in the literature seem to allow outlining a therapeutic pattern for urinary incontinence on exertion, whether recurrent or not, with or without sphincter hypotonia.

The effectiveness of intracavernous PGE1 injections for spontaneous erections has been assessed in this study. Patients with disorders of erection were treated with 6 intracavernous PGE1 injections (10 to 25 micrograms) at 15-day intervals. An exploration was undertaken in these patients to establish the cause of the disorders of erection. Spontaneous erections were compared before and after the six PGE1 injections. Thirty-five patients were studied. Their average age was 58.8 years. The cause of the disorders of erection was organic [22] or psychogenic [13]. Thirty-one patients (88%) had an erection allowing sexual intercourse after the first PGE1 injection, two had a weak erection and two had no erection. After more than one year, 24 (73%) of the 33 patients treated reported improvement of spontaneous erections, allowing intercourse; 11 (33%) occasionally received a PGE1 injection. Nine (27%) were not improved, including two psychogenic cases. The number of patients who occasionally resorted to PGE1 injections raised from 6 to 11 (33%). This study shows the effectiveness--at least temporarily--of repeated PGE1 on spontaneous erections, owing to an action on the psychogenic component of disorders of erection, but maybe also to a local, long-lasting action of PGE1 on the cavernous tissue.

38 cases of renal oncocytoma were recognized at Cochin's hospital from 1982 to 1991. Accurate diagnosis was not possible before performing surgery. However, a benign tumor appearance on the preoperative morphologic investigations and an evocative peroperative macroscopic aspect of renal oncocytoma, allowed us to realize a conservative surgery in 4 cases. Follow-up of 27 patients (11 lost to follow-up) showed a benign clinical behaviour in all cases, de spite of invasion of the perirenal fat in 2 cases, and tumoral thrombosis of a proximal branch of the renal vein in 1 case. No metastases occurred after a mean follow-up of 32.5 months, within range from 11 to 101. Our experience as well as the literature leads us to believe that renal oncocytoma is a benign tumor. We conclude that conservative surgery must be systematically considered when peroperative histological examination assert the diagnosis of renal oncocytoma, especially when the tumoral diameter is less than 5 cm.

The authors report about one case of retroperitoneal benign schwannoma located near the right kidney and causing renovascular arterial hypertension. The diagnosis of benign schwannoma, which is unfrequent in the absence of Recklinghausen's disease, was established after the pathological study of the complete specimen including the right kidney.

Adenocarcinoma of the prostate is the most frequent cancer of male over 60 years of age. Radical prostatectomy is one of the preferred modes of treatment for localized stages. Surgical morbidity decreases with experience and consists mainly in bleeding and rectal injury. Delayed morbidity comprises loss of erection, anastomosis stricture, incontinence. A retrospective study of 100 patients is reported.

For about the last 10 years, transrectal hyperthermia has been used to treat obstructive manifestations of adenoma of prostate. This procedure induces interstitial edema and acts preferentially on the fibrous elements of the prostate. Several therapeutic regimens have been used successively by different teams, after objective and subjective inclusion screening programmes. Results published up to the present show about 45% of objective responders (against 3% in a placebo group) with improvement sustained in 3 out of 4 cases. Morbidity rate (infection and urinary retention) was 3%. Data from a retrospective study of a series of personally treated patients was w used to determine those with the greatest chance of a successful outcome, even though this is never comparable with that of surgical treatment.

Between March 1988 and February 1991, 47 patients with urinary stress incontinence (USI) were treated by Gittes' operation, suspension thread traction being determined by perioperative ultrasonography in 31 of these cases. All patients were re-examined on February 1992 after a mean follow-up of 26 months (range 12 to 24 mths). The global success rate (recovery and improvement) was assessed as 72% at 3 months and 56% at follow-up. Rated as a function of closure pressure (CP), the success rate at evaluation was 62% with normal CP, 42% with CP low for age, and 33% with CP < 30 cm H20. For the 31 patients with perioperative ultrasonography examination the success rate was 80% at 3 months and 70% at follow up. As a function of CP the rate was 83% at follow up with a normal CP, 50% with a CP low for age, 37.5% with a CP < 30 cm H20. Although Gittes' operation is a simple, fairly non-aggressive intervention, results diverge widely from those obtained with "classical" techniques. Optimization of indications is essential, therefore, only patients with pure USI without hypotonia of the sphincter obtaining maximum benefit from the intervention, carried out preferably under perioperative by control ultrasonography.

The authors report about the exeresis of a pyelonephrictic left small kidney with laparoscopic surgery. First a ureteral tube was inserted to facilitate detection of the ureter by laparoscopy possible after reclining the colon. Dissection of the ureter was taken up to the hilum and pedicle, which was severed between rows of clamps by means of the endoscopic GIA stafler. The operation lasted 4 hours and 30 minutes. The blood loss was minimal and the stay in hospital was of three days.

118 patients suffering from a calculus in the lumbar ureter were treated from January, 1987 to January, 1990. The treatment of 91 patients combined an initial internal ureteral drainage, followed by extracorporeal lithotrity (ECL): 40 calculi were driven back into the kidney and 51 were treated within the ureter. 69 patients (76%) no longer have any calculus; 17 (19%) retain residual fragments smaller than or equal to 3 mm in the lower calyces. We therefore count 5 failures, including 3 in which a second-intention surgical ureterotomy was performed. The ascent of the probe failed in 9 cases at the beginning of the series (6 ureterotomies and 3 percutaneous nephrostomies + ECL). 11 patients were treated with probeless in situ ECL. The others were treated with ureteroscopy (4), percutaneous nephrostomy + ECL (1) and nephrectomy (2). There is not one single treatment for the calculi of the lumbar ureter, and they require associating several therapeutic procedures.

A prospective study was carried out in 100 consecutive male patients coming to consultation in the department. These men, whose average age was 65 years (32-82), and who had come for various reasons, answered a questionnaire on the quality of their urine flow, which was rated on a scale ranging from 1 to 4. The results of flow rate measurements were classified in 4 categories according to the maximum flow rate and to the volume of micturation, which always was greater than 150 ml. The comparison of the subjective appreciation and of the objective value showed frequent discrepancies (over- or under-evaluation). These results were analysed according to various parameters, and in particular to the patients' age. It thus appears that one third of the patients only have an accurate appreciation of the quality of their micturation.

The results of 40 consecutive patients who underwent bladder replacement following cystoprostatectomy for invasive bladder cancer are reported. A 30 cm detubularized ileal segment was used to make the neobladder. Mean follow-up was 19 months (over 2 years in 17 patients). All patients achieved diurnal continence. Nocturnal continence was obtained in 70.5% of patients: 41% had no leakage and nocturia less than 2, while 29.5% had some occasional leakage. Urodynamic evaluation showed the average peak flow to be at 18.3 ml/s and an average neobladder capacity of 410 ml. Six patients had spontaneous contractions of the enteric bladder of greater than 40 cm H20, always associated with elevated urethral pressure. Post-void residue was smaller than 100 cc in all cases. This procedure is simple to do, and led to an excellent diurnal continence, although it cannot assure nocturnal continence in every single patient.

The discovery of a pathological stage C after radical prostatectomy with a curative aim for a clinically localized cancer of the prostate raises the question of a possible adjuvant therapy. The indications and modalities of such a therapy still remain controversial. Our review sums up our knowledge and uncertainties on this point.

We report about the case of a patient who, over 27 years, presented with seven local recurrences of a retroperitoneal liposarcoma. This evolution seems to characterize differentiated (adult and myxoid) forms of liposarcoma, for which metastatic expansion is less frequent that in the undifferentiated, pleiomorphic or round-cell forms. The treatment of these tumors is mainly surgical. Adjuvant radiation therapy might reduce the frequency of local recurrence.

An improved technic for exposure of urethrovesicovaginal fistula during operation by a low approach involves placing the patient in ventral decubitus with the thighs abducted and the buttocks separated. Successful results have been obtained in 7 of the 10 patients operated upon during the last two years. One of the 3 patients treated unsuccessfully had recovery surgery with a positive outcome, the 2 others presenting pronounced breaking down of urethra.