Search

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.

Usual treatments combining surgery, radiation therapy, chemotherapy and hormonotherapy are poorly effective. The immunotherapy gave and objective response rate of 25% but is associated with many side effects. Multidrug resistance (MDR) can be explained, in part, by an mdr1 gene overexpression in renal carcinoma. The MDR is related to expression of a 170 Kda membrane glycoprotein, the so-called P glycoprotein (Pgp). This protein is able to extrude from cytoplasm drugs with various structures and mechanisms. Reversal compounds capable of inhibiting Pgp, given with antineoplastic drugs, could be able to increase their intracellular concentrations. Nevertheless, renal cell carcinomas are characterized by their multifactorial resistance and a better knowledge in this field will allow to design new circumvention resistance to chemotherapy.

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.

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.

Nearly 2,500 new cases of metastatic renal cell carcinoma are diagnosed in France every year. Only immunotherapy has demonstrated some therapeutic responses, owing to antitumoral activity of T lymphocytes, CDS and also CD4. This review illustrates results from different therapeutic regimen with interferon alpha, interleukin-2 (intravenous or subcutaneous), alone or in association, and adoptive immunotherapy with in vitro activated lymphocytes. Response rates ranged from 15 to 30%, with a 10% complete response rate. High level of serum interleukin-6 and C-reactive protein predicted unfavorable evolution and lack of response to immunotherapy. Improvement in the response rate needs the selection of patients who are potentially responder and new therapeutic association, especially interleukin-2, interferon alpha and 5-fluoro-uracil.

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)

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.

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.

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.

Primary malignant lymphoma of the bladder is infrequent and usually has a low malignancy, with a possibility of long-lasting remission. Our case is that of a 73-year-old woman who presented with a tumor of the bladder revealed by hematuria. She was treated with incomplete endoscopic resection, which showed that the lesion was a B cell lymphoma. After a complementary 60-Gy radiation therapy, remission was complete at 6 months. The histological and immunological study showed the lymphomatous proliferation infiltrating the chorion and the expression of the usual B-lymphocytic markers by the tumoral cells. Lymphoma of the bladder was described for the first time in 1885, and only a few small series of vesical lymphomas have been published since then. The prognosis is usually favorable owing to long-lasting remission. Complete surgical resection does not improve the results, and radiation therapy is the treatment of choice.

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.

Intracavernous injections have been used for about 10 years for the diagnosis and treatment of erectile insufficiencies. This development has been justified by a better knowledge of the physiology of erection and by the recent use of prostaglandin E1. We have reviewed the information provided by the literature (major journals of urology, medicine and physiology), as well as our experience of erectile insufficiency. Diagnostic intracavernous injections allows ruling out vascular or cavernous causes when the injection is followed by a stiff erection within 10 minutes and for more than 20 minutes, whatever the vasoactive agent used. All the causes of erectile insufficiency can be treated with intracavernous injections if the induced erection allows penetration. Prostaglandin E1 provides the highest response rate with fewer adverse effects, but it is not commonly available at present.