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To evaluate the medium-term results of grade 3 and 4 (Baden-Walker classification) cystocele repair by transvaginal porcine xenograft matrix (Pelvicol).Between February 2002 and October 2005, fifty patients with grade 3 or 4 cystocele were treated by Pelvicol matrix. The preoperative grade of prolapse and symptoms (urinary and pelvic heaviness) were recorded and a sexuality questionnaire was completed retrospectively (BISF-W questionnaire). All patients were reviewed in the outpatients department at 1 month and at the date of last follow-up. The success of the surgical procedure was defined by postoperative grades 0 and 1. Preoperative and postoperative symptoms and sexuality were compared. The operative morbidity was recorded. The success of the surgical procedure was compared in patients operated for the first time and in redo patients.The mean age was 69.4 years; 29 patients had a grade 3 cystocele (58%), and 21 had a grade 4 cystocele (42%). Preoperative symptoms consisted of dysuria (32%) and symptoms of overactive bladder (22%), accompanied by symptomatic (36%) or asymptomatic (20%) stress urinary incontinence. Pelvic heaviness was present in 100% of cases. An associated procedure was necessary in 70% of cases (29 suburethral tapes, 6 rectocele repairs, 3 vaginal hysterectomies). Mean follow-up was 27.2 months (95%CI [23.3-31.1]). No intraoperative or postoperative complications were observed. During follow-up, no cases of rejection of material, vaginal erosion or delayed healing were observed. The surgical success rate was 94% (37 grade 0 and 10 grade 1). Dysuria and pelvic heaviness were significantly improved. None of the 10 women who were sexually active preoperatively reported postoperative discomfort. Among the 50 operated patients, 35 (70%) were treated by Pelvicol as first-line procedure and 15 were redo procedures (30%); no significant difference in surgical success rate was observed between these two groups (94.3% versus 93.4%).The use of a porcine xenograft matrix (Pelvicol) appears to be a safe and effective technique in the medium term for first-line treatment of grade 3 and 4 cystocele.

In prostate cancer, use of FDG, the radiopharmaceutical currently most widely used in oncology, is limited to the most aggressive cancers and, in the absence of another tracer, to attempting to localise occult recurrences detected biochemically (elevated PSA serum levels). Four other PET tracers are currently suggested in various situations of prostate cancer development: for guiding biopsies, for diagnosis and staging of the primary cancer and of local or metastatic recurrences, especially in bone, and for localizing occult biochemical recurrence. This article is illustrated by cases summarising our experience with fluoromethylcholine-(18F) and PET/CT. They cover a wide spectrum of clinical settings: localisation of intraprostatic neoplastic lesions, initial staging, monitoring treatment by ultrasound, detection of occult recurrences and characterisation of images on conventional imaging modalities, which are questionable or difficult to interpret.

Transitional cell carcinomas of the upper urinary tract are rare tumours that represent about 5% of all transitional cell carcinomas. The reference treatment is currently open nephroureterectomy. Low-grade or superficial urinary tract tumours have a good prognosis, similar to that of noninvasive bladder tumours (80% 5-year specific survival). The surgical management of upper urinary tract tumours is gradually evolving towards complete preservation of the upper urinary tract and renal parenchyma, when compatible with local conditions. Conservative endoscopic treatments (ureteroscopy, percutaneous treatment) provide good oncological results and constitute a possible alternative to nephroureterectomy for the systematic management of good prognosis tumours. The cost of endoscopy equipment and consumable items is currently a limiting factor to the widespread use of these techniques.

The incidence of stones after urinary diversion is variable but considerable. The authors report the case of a patient with a stone of the uretero-sigmoid junction of a Mainz II pouch occurring three years after radical cystectomy for recurrent carcinoma in situ refractory to conservative treatment. The patient was treated by anterograde Holmium:YAG laser flexible ureteroscopy. This clinical case illustrates the role of anterograde flexible ureteroscopy combined with Holmium:YAG laser as a minimally invasive, sale and effective technique for the management of stones in a urinary diversion.

Endoscopic placement of ureteric stents was first described in 1967 by Zimskind. Few studies have evaluated the impact of double J ureteric stents on the patient's quality of life. This prospective study was designed to evaluate the safety and morbidity associated with ureteric stents.From February 2001 to June 2003, 115 patients (64 men and 51 women; mean age: 49.5 years [range: 19-90]) were included in this study. Ureteric stents were placed under general anaesthesia for urolithiasis (80 cases), ureteroplasty (25 cases) and extrinsic ureteric compression (10 cases). 28 cm 7F polyurethane stents were used in every case. Patients with double J stent for renal transplantation or pregnancy were excluded. The safety of stents was evaluated on the day of removal by a questionnaire based on a 100 mm visual analogue scale (VAS).The mean duration of stenting was 91.8 days (range: 10-287). Macroscopic haematuria was reported in 56% of cases, dysuria was reported in 36% of cases and urgency was reported in 78% of cases. The mean score on the VAS was 44 (0-100) for global impression, 41 (0-100) for bladder pain, 41 (0100) for low back pain, 62 (2-100) for low back pain during micturition and 32 (0-100) for straining on the stent.Double J stents are associated with high morbidity, which is sometimes underestimated by operators. Our study confirms that the duration of stenting must be as short as possible in order to improve patient comfort, which implies rapid organization of the aetiological management of these patients.

Multiple endocrine neoplasia (MEN) is defined by the presence of at least two functionally unrelated endocrine gland tumours in the same subject. There are three types of MEN. MEN type 1 (or Wermer syndrome) is an autosomal dominant cancer syndrome. In the light of a case report, the authors recall the characteristics of MEN type 1 responsible for severe and recurrent urolithiasis and emphasize the need for systematic aetiological work-up for all patients presenting a first episode of urolithiasis according to the guidelines of the Association Française d'Urologie Stone Committee (CLAFU).

Flexible ureterorenoscopy is recommended for the treatment of inferior calyx stones, 10 to 15 mm in diameter, particularly after failure of extracorporeal lithotripsy. It is recommended to mobilize an inferior calyx stone towards the renal pelvis or superior calyx before starting fragmentation. This manoeuvre is essential to preserve the ureterorenoscope. The objective of this technical note is to explain the stone "relocalization" manoeuvre and describe how in situ treatment of an inferior calyx stone can be dangerous for the flexible ureterorenoscope.

Infertility in men may be associated with an elevated risk of testicular cancer. The authors report a case of testicular seminoma discovered fortuitously during a workup for infertility.A 30 year-old male was seen for infertility. Physical examination and testicular ultrasonography were normal. The sperm count found oligoasthenospermia related to the excretory ducts. The patient underwent testicular biopsies for infertility, which showed an intratubular germ cell tumor. Tumor markers (beta HCG, alpha FP, LDH) were normal. Computed tomography was normal for the thorax, abdomen, and pelvis. We performed an inguinal orchiectomy. The pathology examination found seminoma, at a pT1 stage. One course of chemotherapy followed.The incidence of testicular cancer is increasing throughout the world. Recent studies show a strong relation between infertility and an increased risk of testicular cancer, and some authors even suggest a causal relation.

Miniaturization and development of flexible instruments have led to the development of flexible ureterorenoscopy. The objective of this study was to compare the capacities of active deflection of two latest generation flexible ureterorenoscopes and to evaluate alteration of deflection and flow of irrigating fluid in the presence of instruments in the operating channel.Two ureterorenoscopes were evaluated in this study. The Karl STORZ Flex-X and the ACMI DUR-8 Elite. Comparison of deflection movements was performed ex situ by super-imposing all active movements of the two ureterorenoscopes. Alteration of deflection was performed by alternately placing an extraction or fragmentation instrument of variable dimensions in the operating channel. Alteration of flow was also assessed in the presence of the same instruments.The ex situ deflection capacities of the DUR-8 Elite flexible ureterorenoscope were more extensive than those of the Flex-X, but it was more complicated to manipulate. Alterations of deflection and flow of irrigation fluid were comparable for the two ureterorenoscopes.On the basis of these data, we can confirm that the two latest generation ureterorenoscopes present comparable capacities, but different functioning modalities. We therefore recommend that each operator test the two ureterorenoscopes to become familiar with their manipulation. Other studies are necessary to evaluate the optical properties, ease of use in clinical practice and fragility of these new ureterorenoscopes.

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).

National audience; La modélisation et l'animation des vêtements est un élément fondamental pour la création de personnages virtuels. Pour renforcer leur réalisme, il est important de tenir compte des propriétés géométriques des vêtements réels et en particulier du fait que ces derniers sont obtenus en cousant entre elles des pièces de tissus, développables dans un plan. Les logiciels standard (MAYA, 3DS) exploitent cette propriété en demandant à l'utilisateur de spécifier ces patrons 2D ainsi que leurs coutures, de les positionner autour du corps du personnage puis de lancer une simulation physique pour déterminer la position au repos du vêtement. Cependant, outre le fait que l'utilisateur n'a pas forcément les compétences d'une couturière, cette approche est longue et fastidieuse, en particulier en ce qui concerne le rêglage des paramêtres physiques. Le but de ce projet est de modéliser un vêtement plausible, directement à partir d'un dessin 2D rapidement esquissé par l'utilisateur. La surface du vêtement, constituée du raccordement de pièces développables, sera inférée à partir des contours et éventuellement des directions principales de plis spécifiés par l'utilisateur (une surface est dite développable si elle peut être mise à plat sans déchirement, étirement ni plis; ce sont des surfaces rêglées - engendrées par des familes de droites - comme par exemple les cylindres et les cônes). Outre le modèle 3D, la méthode calculera en sortie les pièces de patron nécessaires à la réalisation du vêtement virtuel, utiles par exemple pour plaquer la texture du tissus sur ce dernier, ou pour spécifier les paramètres physiques qui serviront à son animation. Ce projet fait suite à un sujet posé en 2004, qui engendrait un vêtement virtuel à partir d'un dessin, sans se préoccuper du caractère développable souhaité pour les surfaces. Une première étude sur les plis des vêtements et la génération de patrons a également été réalisée au sein de l'équipe.

A single stone analysis is necessary during the patient's clinical history in order to institute specific drug treatment and health and dietary measures to prevent stone recurrence. In practice, only one in every two stones is recovered for morpho-constitutional analysis. The objective of this study was to determine the place of double J stent encrustation analysis for indirect determination of stone composition.Double J stents and stones from all patients treated in the same centre over 24 months were consecutively analysed by infrared spectrophotometry. The correlation coefficient 1, evaluating the concordance between the composition of stones and double J stent encrustation was estimated statistically by SPSS 12.0 software (011; 1=0: no concordance; 1=1: perfect concordance).45 males and 27 females with a mean age of 45.3 years (range: 29-70) were included Double J stents were placed for: febrile obstruction (N=52; 72%), acute renal colic (N=15; 21%) and impaired renal function (N=5; 7%). Calculated values for 1 were: 0.78 for the concordance between the predominant constituent of the stone and the encrustation (N=72; p0.0005); 0.91 for the concordance between the nature of the encrustation of the upper loop and that of the lower loop of the stent (N=30, p0.0005).The composition of mineral encrustation of double J stents is a good marker of stone formation. This constitutes an alternative method that can be used by urologists when no stone is available for spectrophotometric analysis.

Flexible ureterorenoscopy combined with Holmium:YAG laser is an emerging technology that already has its place among the urologist's treatment options for the management of urinary stones. The main indication for the technique is renal stones, particularly lower caliceal stones. After mobilization of the stone in the renal pelvis or upper caliceal group, fragmentation is achieved by Holmium:YAG laser and the largest fragments are removed. When small fragments persist that are difficult to extract, the patient's blood is injected into the lower caliceal group to obtain a blood clot This clot then fills the lower caliceal group and prevents secondary accumulation of residual stone fragments, facilitating elimination of fragments towards the ureter. This article describes this technique.

A caliceal diverticulum corresponds to a cavity communicating with the renal excretory tract via a neck. Surgical treatment is required when the caliceal diverticulum is symptomatic with repercussions on the patient's quality of life. A retrograde approach via holmium:YAG laser ureterorenoscopy has been recently used to treat the stone and externalize the caliceal diverticulum into the pyelocaliceal cavities. The problem raised by this approach is identification of the diverticular neck. The objective of this technical note is to describe a technique to facilitate identification of the diverticular neck.

The main objective of the ACCORD project was to propose to Information System architects an analysis and design framework based on explicit contracts and addressing the description and assembly of business components. Project motivations are first presented, then the framework elements are detailed in conjunction with contracts hierarchy description. Focus is put on contract concept to solve components assembly and integration problems. Last part shows how model transformations are used to translate an ACCORD framework based design into a component-based specific platform design (here, EJB and CCM as examples). This transformation process is compared to the MDA approach proposed by the OMG., Le projet ACCORD avait pour objectif de proposer aux architectes et intégrateurs de systèmes d'information un cadre d'analyse et de conception fondé sur l'explicitation de la sémantique de contrats pour décrire et assembler des composants métiers. Les motivations du projet sont d'abord présentées, puis les concepts ACCORD pour l'analyse et la conception sont détaillés en conjonction avec une description hiérarchique des contrats. L'accent est mis sur le rôle des contrats pour résoudre les problèmes d'assemblage et d'intégration de composants. La dernière partie montre comment les transformations de modèle sont utilisées pour traduire une conception basée sur les concepts ACCORD en une conception spécifique à une plate-forme à base de composants (ici EJB et CCM sont pris comme exemples). Ce processus de transformation est comparé à l'approche MDA proposée par l'OMG.

Spontaneous renal haematomas are rare. The authors discuss the aetiological diagnosis and management of these haematomas.Seven cases (3 females and 4 males) of spontaneous renal haematoma were managed between July 1999 and December 2002 and the case files were studied retrospectively.The circumstances of discovery were nonspecific. One patient presented with haemorrhagic shock. Radiological work-up comprised abdominal ultrasound and CT scan in almost every case. Ultrasound failed to demonstrate the aetiological diagnosis. CT revealed the cause of bleeding in 7 cases. MRI was performed in 4 cases, but urgent angiography was not performed. Four total nephrectomies were necessary, while two patients were treated by conservative surgery. One patient was simply followed by repeat CT scan. The short-term course was favourable with a mean follow-up of 23 months.Spontaneous renal haematomas raise 2 problems, that of their aetiology: tumours are the commonest causes (angiomyolipoma and renal cell carcinoma), and that of their management. Three therapeutic approaches are possible: radical surgery in the case of uncontrollable bleeding, conservative surgery or surveillance in the absence of a life-threatening emergency and when the aetiological diagnosis has not been established. Rigorous and repeated radiological surveillance can identify the cause of the bleeding allowing conservative surgery to be performed when indicated.

Primary hyperparathyroidism (PHPT) is not a rare disease. Renal stones are the most frequent complication of PHPT The authors report the case of a patient with giant parathyroid adenoma responsible for early recurrence of renal stones. Ultrasound examination of the neck, parathyroid MRI and Technetium99m-Sestamibi scintigraphy confirmed the parathyroid adenoma. Surgical exploration allowed resection of a giant adenoma (6.5 x 2.5 x 1.5 cm weighing 17 g). In the light of this case, the authors describe the characteristics of HPT define the place of preoperative imaging and emphasize the need for systematic aetiological work-up looking for HPT in all patients with a first episode of renal stones.

Based on 12 years of experience, laparoscopic nephrectomy has become the reference approach to benign kidney disease. This technique is effective, safe and reproducible. The complication rate is comparable or even lower than that of open nephrectomy and the postoperative course is more favourable. Based on a review of the literature, this paper reviews the technique, indications and results of laparoscopic nephrectomy for benign kidney disease.

Animal bites to the scrotum are rare, but potentially serious. In the light of a personal case, the authors discuss the management of these lesions. An animal bite comprises a triple infectious risk: bacterial, tetanus and rabies. Surgical exploration is indicated for assessment of the structures involved and debridement. The morbidity is related to the severity of the bite and the waiting time before consultation, and complications are rare. Orchidectomy is sometimes necessary, as in the case reported here, and the patient must be warned about this possibility. Antibiotic therapy is empirical: tetracycline and anti-anaerobe antibiotic. Rabies and tetanus prophylaxis must be performed according to vaccine guidelines.

The popularity of vitamin C can be attributed to Linus Pauling who, in the 1970s, recommended the use of vitamin C for the prevention of influenza. Vitamin C has subsequently been used extensively in a wide range of diseases. Ascorbic acid (vitamin C) has been incriminated as a possible risk factor for calcium oxalate stones due to its enzymatic conversion into oxalate. However, this lithogenic role has never been clearly established. Studies evaluating the effect of ascorbic acid on lithogenesis have reported contradictory results. Ascorbic acid has also been extensively used as an urine acidifier for the treatment of chronic or recurrent urinary tract infection. Once again, the data of the literature are contradictory. The purpose of this article was to review the effects of ascorbic acid on lithogenesis and urinary pH based on a review of the literature.

To evaluate cystectomy with preservation of the prostate in the treatment of bladder tumours.A review of the literature (Medline, key words: cancer, bladder, cystectomy, prostate, urinary incontinence, sexual impotence) was performed. Three cystectomy techniques with preservation of the prostate were recently described; their anatomical basis, surgical techniques and indications are reported. Their morbidity and oncological and functional results were then studied and compared to contemporary total cystectomy series.The morbidity is not worsened. The functional results were globally improved, especially in terms of erectile function. In terms of cancer control, local recurrences were not more frequent, but metastatic recurrence rates appeared to be higher.Compared to total cystectomy, cystectomy with preservation of the prostate is not associated with increased morbidity, improves functional results, but does not appear to ensure an equivalent level of cancer control.

Secondary deflection of a flexible ureterorenoscope (FUR) is a passive mechanism, which can only be performed under certain anatomical conditions. The objective of this study was to present a new double active deflection FUR and to assess its value based on our initial experience.From October 2002 to February 2003, we performed flexible retrograde ureterorenoscopy in 30 consecutive patients (34 renal units) using a double active deflection FUR (ACMI DUR 8 Elite). Bilateral ureterorenoscopy was performed during the same operating time in four patients. Ureterorenoscopy was diagnostic for 9 patients (macroscopic haematuria, urinary tract tumour), and therapeutic for 21 patients (stones, urinary tract tumour, ureteropelvic junction stenosis with stone). The value of double deflection as well as the efficacy and morbidity of the technique were evaluated.The main indication for flexible ureterorenoscopy was the treatment of urinary stones (73.6%), followed by the diagnosis of macroscopic haematuria and urinary tract tumours (26.4%). Ureteric dilatation was necessary in 38.3% of cases. The use of active secondary deflection was essential in 20% of cases (7/34) for complete investigation of the pyelocaliceal cavities. Access to the lower calices was not possible in one patient with a left pelvic kidney. 19 patients with urinary stones had no fragments (79.2%) at the end of the operation, while 4 had residual fragments in the lower calices. The global success rate for all operations was 85% (29/34). Two patients developed acute pyelonephritis during the 48 hours after the procedure and another two patients experienced acute renal colic.Our study confirms the data of the literature on flexible ureterorenoscopy in terms of indications and efficacy. The URS DUR 8 Elite allowed complete exploration of the pyelocaliceal cavities in more than 97% of cases. The use of active secondary deflection was unnecessary for the majority of patients (80%), but it represents a major technical progress which should be taken into account in the design of future flexible ureterorenoscopes.

The bladder is a rare site of scleroderma. The frequency of bladder involvement is difficult to estimate, as only about thirty cases have been reported in the literature. Scleroderma bladder involvement usually presents in the form of frequency and burning, but may sometimes cause urgency or recurrent urinary tract infections. The authors report a case of bladder scleroderma responsible for severe haematuria in a 56-year-old woman and discuss this rare cause of macroscopic haematuria in the light of the histological findings and a review of the literature.