Search

Analysis of nine cases of bladder tumors in patients under 40 years of age leads to the following conclusions: the tumors are invariably urothelial papillary lesions, which do not affect the muscularis. Multiple locations with a high recurrence potential are by no means an exception. Laser therapy may well prove the decisive weapon against recurrence.

Eleven selected patients participated in a programme of intracavernous auto-injections for erectile impotence. This treatment provided these patients with an erection allowing sexual relations which were considered to be satisfactory at the beginning, but more than one half of them progressively abandoned the technique after six months; as the majority of partners expressed feelings of frustration. Auto-injections represent a valid alternative in the treatment of erectile impotence of essentially neurological origin.

Since October 1984, 39 patients have been treated with cisplatin based chemotherapy for advanced bladder tumour of for pelvic recurrence or metastasis after total cystectomy. Cisplatin-methotrexate protocol (23 cases): 2 cases died during the first two cycles and 21 were evaluated after three cycles: only 39% of objective responses (2 CR-5 PR-2 MR) were observed with a mean survival not exceeding 12.6 months (7 deaths, 2 patients alive at the present time). All of the non-responders died within 4 to 16 months following the start of treatment (mean survival: 8.7 months). These particularly disappointing results led to the suspension of this protocol. Cisplatin-methotrexate-vinblastine protocol: 16 cases since September 1986. Eleven patients have been evaluated after three cycles: 3 CR-3 PR-5 PROG. The C.M.V. protocol appears to have a superior efficacy, principally on bladder, lymph node or lung lesions, at the cost of a higher but acceptable toxicity. Hepatic and central nervous system metastases were observed secondarily in this case.

The analysis of a series of 248 cases led to the following conclusions: intravenous pyelography, together with nephrotomography and ultrasonography represent, the pillars of emergency assessment; computed tomography, performed systematically since 1985, is the most appropriate examination for the precise assessment of the lesions in a functioning kidney; arteriography is still essential in cases of urographically silent kidneys. The choice of therapeutic approach essentially depends on the type of the lesion: severe parenchymal lesions (type III) (58 cases) and certain cases of type II trauma (25 cases) underwent a deferred emergency operation which was as conservative as possible; pedicle lesions (type IV) and serious haemorrhagic lesions required emergency surgery (11 cases); type I or type II lesions with moderate hematomas were usually treated by simple observation (145 cases); cases of trauma seen at the stage of sequelae (8 cases) sometimes required a surgical solution (arteriovenous fistula, segmental ischaemia of the parenchyma with hypertension, encysted urinoma).

The authors report three cases of adrenal cancer in pregnant women. The diagnostic, pathogenic and therapeutic problems are discussed with particular emphasis on the considerable interest of ultrasound scanning. The surgical indications are always difficult and depend on the stage of evolution of the cancer, and the term of the pregnancy.

The analysis of a series of 31 cases of bilateral renal cancers and cancers of solitary kidneys revealed the following findings: 1) conservative in situ surgery with clamping of the renal pedicle and dopamine, when it is possible, appears to be by far the most logical and simplest solution (17 cases); 2) ex-vivo surgery with auto-grafting represents an extreme solution (2 cases); 3) cases of technical impossibility, in the absence of distant metastases, require radical nephrectomy followed by dialysis (3 cases); 4) in advanced forms, surgical abstention followed by hormone therapy (8 cases) or highly selective embolisation (1 case) sometimes provides surprising survivals.

Nine patients with symptomatic intradiverticular stones have been treated, 3 by open surgery (excluded cavity and abscess formation) and 6 by endoscopy. When possible (4 cases), direct puncture of the diverticular cavity seems to be much simpler and more effective than indirect intrarenal access. The percutaneous approach constitutes a valuable alternative to open surgery in the treatment of symptomatic intra-diverticular stones, although secondary obliteration of the cavity is not always obtained, which leaves a potential risk of long term recurrent stones.

The extracorporeal lithotripter has radically changed the treatment of urinary stones. Three-hundred and seventy-four stones in 356 patients were treated over an eight-month period. Extracorporeal lithotripsy (262 cases) is mainly indicated in pelvic and calyceal stones measuring less than 2.5 cm, stones located in the lumbar ureter and previously flushed, and some stones of the pelvic ureter. Analysis of results showed that extracorporeal lithotripsy achieved fragmentation in 80% of cases and complete elimination 3 months after the procedure in 70% of cases. Repeat procedures were needed in 23% of patients. Complementary procedures were required to relieve obstruction in 4% of patients. Percutaneous nephrolithotomy now has very few indications but remains useful in large pelvic stones, failures of EDAP (7 cases), and some staghorn stones with few ramifications. Open surgery (24 cases) is still useful for complex staghorn stones, soft stones in febrile patients, calyceal stones with destruction of the neighboring renal parenchyma, incarcerated lumbar stones, and stones associated with an obstructive malformation of the urinary tract. Ureteroscopy (69 cases) proved highly reliable in stones located in the pelvic ureter. An improvement, therefore, but no miracle.