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Intracorporeal lithotripsy of urinary calculi by pulsed dye laser has recently enriched the urologist's therapeutic arsenal. We recall the in vitro studies and animal experimentations which demonstrated the feasibility of laser lithotripsy and the absence of harmful tissue damage. The ideal indications for intracorporeal lithotripsy are ureteral stones accessible by rigid and, more especially, flexible ureteroscopy. The results of the first published series using this technique are very encouraging.

Extracorporeal shock wave lithotripsy (ESWL) as primary treatment for large renal stones has been evaluated in this clinical study of 55 patients. Patients were treated using the Dornier HM-3 lithotripter. Twenty-one (38%) patients presented with a stone burden greater than 4 centimeters. Nineteen patients had "steinstrasse", of which 8 had to undergo a secondary procedure. Sixteen (29%) patients had no residual stone, 5 had clinically non significant stones and 34 had clinically significant stones. Out of the 15 patients who underwent a second ESWL, only 2 were rendered stone-free. In this study, ESWL was not found to be a satisfactory treatment for large renal stones.

Among one hundred consecutive patients submitted to radical cysto-prostatectomy for invasive transitional cell carcinoma of the bladder, 26 also exhibited adenocarcinoma of the prostate on histological specimens: 17 microscopic foci and 9 larger prostate carcinomas. In 3 cases, the tumor was found in the apex of the prostate gland. Pelvic lymphadenectomy was positive in 4 cases but always corresponded to a urothelial metastasis. Follow-up was never marked by a metastatic development of this adenocarcinoma. This frequency of latent prostatic adenocarcinoma is not different from its observed incidence in the general population on autopsy studies. The high incidence of this association makes removal of the whole prostatic tissue during total cystectomy necessary.

Malakoplakia is a fairly rare disease, normally found in women (four out of every five cases). It mainly attacks the urinary system, but may spread to the other viscera. The symptoms are not clinically specific. The main interest of the disease is its pathogenesis, from which its treatment is derived. It is in fact an immunological dysfunction of the phagocytes, leading to chemical disorders in the macrophages. Its treatment is based on the use of cholinergic agonists and vitamin C therapy.

Forty-one patients with prostatic cancer were treated with DTrp6 LH-RH, a luteinizing hormone releasing hormone agonist. Thirty-eight of them had advanced cancer with either metastases or major local spread. In all cases with plasma testosterone levels were normal before treatment, the LH-RH agonist brought them down to values observed after surgical castration. An objective response ("improvement" or "stabilization") was obtained in 68% of the patients, but virtually all "improved" patients were those without previous hormonal treatment. As with all LH-RH agonists, the pharmacological castration produced by DTrp6 LH-RH is of considerable value in the treatment of prostatic cancer, especially since this compound, unlike estrogens, does not seem to cause cardiovascular accidents. However, transient hyperandrogenism may occur during the first days of treatment (as it did in 9 of our patients) and may be responsable for an acute flare-up of the tumoral process, as suggested by 2 of our cases. The concomitant administration of an anti-androgenic drug should perhaps be considered.

Pelvic lipomatosis is a rare disease characterized by an abnormal accumulation of adipose tissues around the pelvic organs. The symptoms are vague and non-specific. The diagnosis is facilitated by typical radiological features. CT scanning is extremely useful and typical. The course of the disease is usually benign in older men, but may be dangerous in the young; it may require diversion.

It has now been clearly demonstrated that cryptorchidism is accompanied by a very marked increase in malignancy of the ectopic testis as well as in that in place. Amongst 80 patients undergoing surgery for carcinoma of the testis 14 (17.5%) had a past history of unilateral undescended. The risk of malignancy developing in an ectopic testis is 12 to 48 times greater than that of a testis which has descended normally. It would appear that the higher the position of the testis, the greater is the risk. Orchidopexy may decreased the risk if performed before the age of 11. When the tumour is situated in an ectopic testis, the clinical picture is often misleading. When the ectopic testis has been brought down the special feature of these tumours is the frequency of spread to inguinal lymph nodes. In terms of its basic principles the treatment of these tumours does not differ from that of those affecting normal testis. The aetiology of these tumours remains uncertain. There would seem to be a consensus in favour of a disgenetic origin, possible secondary to hormonal deficiency.

Thirty patients with advanced prostatic cancers (8 stage C, and 22 stage D) were treated for at least three months with D Trp6 LH-RH, a powerful LH-RH agonist. In all the cases in which the testosterone levels had been normal before treatment, the treatment led to a decline to the levels observed after castration. In seven cases, the drop was preceded by a rise in the first few days of treatment. Twenty two patients reacted favorably to the "medical castration" resulting from LH-RH agonists (11 improved and 11 remained stable). The improvements were mainly noted in patients who had not undergone previous treatment. Four deaths were registered in patients already at an advanced stage. Two of these patients presented with visceral metastases in circumstances such that a sudden deterioration due to the agonists cannot be excluded.

Owing to the wider use of ultrasonography, renal angiomyolipoma is now diagnosed with increasing frequency. Within a few months, 10 female patients were explored by ultrasounds, computerized tomography and nuclear magnetic resonance (Magniscan 5,000, 0.5 Tesla). At ultrasonography the lesion was hyperechogenic in 9 cases and heterogenic in 1 case. At computerized tomography 7 patients had a strongly hypodense lesion and 3 had a lesion of slightly positive density. At magnetic resonance imaging the lesion produced a characteristically loud signal similar to that of fatty tissues. In practice, ultrasonography and computerized tomography combined provide the diagnosis in most cases. In case of doubt, especially since the tumour may be small and asymptomatic and the lesions multiple and/or bilateral, magnetic resonance imaging with its fat-like loud signal confirms the diagnosis and leads to partial resection. When no complications are present, it may even suggest that surgery is unnecessary.

Twenty one patients with advanced bladder cancer (metastases and/or loco-regional recurrences) were treated by cisplatin-based chemotherapy (cisplatin, adriamycin, cyclo-phosphamide (8 patients), cisplatin, methotrexate (8 patients) and cisplatin and radiotherapy (5 patients). The results with pure chemotherapy were, on the whole, disappointing, with a remission rate of 25% and a response rate of 50%. Only the combination of cisplatin-based chemotherapy and radiotherapy gave spectacular results with 50% complete response, but even then at the price of a high morbidity rate.

The association between chronic lymphocytic leukemia and a solid tumor is well known. When the leukemia appears before the tumor a question may be asked : is the tumor a cancer or a localisation of the leukemia ? When the cancer is diagnosed before the leukemia, an other question may be asked : is it a true leukemia or is it a paraneoplasic leukemoid reaction ?

Results of a retrospective study of 72 patients with urogenital tuberculosis admitted to Hôpital Cochin Paris, from 1970 to 1980, were compared with those of studies conducted since 1945. Though there has been a marked reduction in the number of cases of tuberculosis in absolute terms, morbidity has not altered as a nephrectomy was performed in 44 p. cent of cases both in the period 1970 to 1980, and the year 1950. There has, however, been a noticeable increase in the use of plastic surgery. Future perspectives involve both the medical and surgical fields, in the former leading to a shorter period (9 months) of treatment, and in the latter by the development of new endoscopic procedures: modelling ureteral sounds, and hydrostatic bladder distention. It is reasonable to assume that surgery will be required less often in the future, medical treatment involving endoscopic procedures being sufficient to treat the majority of urogenital tuberculosis cases.

Four patients with solid genito-urinary tumors and HIV 1 infection have been treated in our institution over the last 2 years, including 2 with seminoma, 1 with renal adenocarcinoma and 1 with renal angiosarcoma. All had severely impaired immunity with a low CD4 level. Three had or developed a true AIDS syndrome according to the WHO and CDC criteria (1988). The remaining patient was seropositive and died less than 3 months following the diagnosis of renal angiosarcoma, he is the first reported case of renal sarcoma in a patient infected with HIV 1. Two patients were homosexuals and the other 2 were drug addicts. Along with other reported cases, our cases may underline the association between depression of immunity due to HIV and onset of solid genito-urinary tumors.

In order to define the prognosis of pure squamous carcinomas of the bladder, on the one hand (group I), and the possible aggravating role of the presence of squamous tissue in an invasive renal cell tumour, on the other hand (group II), 46 cases files of patients treated between 1975 and 1984 were analysed retrospectively. Group I consisted of 18 cases of pure squamous carcinoma (11 men with a mean age of 71 years and 7 women with a mean age of 74 years). 66% of cases presented with haematuria, but urinary cytology was of little help. The diagnosis was established by transurethral resection with 18 grade 3 tumours: stage A in 4 cases and stage B in 14 cases. 10 patients had unilateral (8 cases) or bilateral (2 cases) complications of the upper urinary tract. The presence of lymph node and/or haematogenous metastases was investigated by bone scan, hepatic ultrasonography, pulmonary tomography and, most importantly, by bipedal lymphography combined with percutaneous cyto-aspiration of suspicious nodes. 4 patients presented with invasion of the obturator lymph nodes (2 cases) and iliac lymph nodes (2 cases). 9 patients were treated by total cysto-prostatectomy, 6 patients by radiotherapy (60 Grays) and 3 patients did not receive any treatment. The overall survival was 12.5% after 2 years. None of the patients treated by radiotherapy were alive after 2 years. 29% of the patients treated by surgery survived for 2 years, but none of them were alive after 5 years, essentially as a result of local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Among 169 patients treated for superficial bladder tumors with intravesical instillations of 150 mg BCG-Pasteur, five developed BCG-itis--a severe systemic infection with bronchopulmonary lesions and granulomatous hepatitis. In four cases, the complication appeared early during treatment (after three, six, six and eight instillations respectively). In one case, BCG-itis appeared 6 months after completion of 2 years monthly maintenance therapy. In addition to pulmonary basal infiltration and granulomatous hepatitis, intramedullary granulomatosis was observed. In three patients, the role of trauma has to be considered, as BCG-itis appeared after a traumatic instillation with bleeding. All patients were cured by combined treatment with Rifampicin, Isoniazid and Prednisolone.

One case of intra-abdominal seminoma with persistent müllerian duct syndrome is reported. Literature is reviewed and guidelines for management of such are suggested.

Prostatic specific antigen has become an essential laboratory parameter in prostatic cancer; it may rise transiently after various manipulations of prostatic tissue. We decided to investigate a possible modification in PSA after rectal examination. The PSA level, studied before and after rectal examination in 40 patients, confirmed the almost constant rise in PSA after thorough rectal examination. The biokinetic features of PSA are also discussed as they are important to determine the time of PSA assay after a transient rise.

Two cases of epididymotesticular metastases are reported: one epididymal from a carcinoma of the kidney by retrograde venous spread and the other testicular secondary to a carcinoma of the prostate and apparently by arterial spread. Epididymotesticular metastases of carcinomas are rare. When the initial carcinoma is known, or even treated, the development of a large testis should lead to consideration of the possibility. Treatment should consist of inguinal orchidectomy with ligation of the spermatic cord as high as possible.