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Endocrine cells are a normal constituent of the prostate gland, prostatic urethra and urinary bladder mucosa. Positive results using immunohistochemical technics were obtained only with antiserotonin antibodies. In normal tissues, there was a close similarity between the distribution of argyrophilic cells (Grimelius) and serotonin-storing cells. Some striking features were the patchy distribution of endocrine cells, the presence of slender cytoplasmic processes occasionally reaching the luminal surface and the paucity of specialized cells in bladder mucosa. It is unlikely that endocrine cells participate in conventional neoplasms of prostate and bladder. Exceptions are lobular hyperplasia, certain adenocarcinomas of prostate and inverted papilloma of bladder. An ultrastructural study permitted the distinction of two types of endocrine cells characterized by a different morphology of their granules. Another relevant finding was the presence of serotonin-storing cells in Brenner tumors. The latter observation emphasizes the close similarity between this neoplastic epithelium and urothelium. This implies that endocrine cells may be of mesodermal derivation. [ABSTRACT FROM AUTHOR]

Objective: Perianastomotic stenoses (PAS) complicating native arteriovenous fistulas (AVF) of the forearm can be treated by angioplasty or surgery. The objective of this study was to report primary patency (PP) and primary assisted patency (PAP) rates of surgery and angioplasty of these stenoses. The secondary objective was to identify factors influencing the patency rates of these reoperations., Material and Methods: Seventy-three patients with a mean age, 65 years were treated for PAS between January 1999 and December 2005 in two centres (Tours and Le Mans), which were retrospectively included. PAS were treated by surgery (n=21) or angioplasty (n=52). The two groups were comparable. The mean follow-up was 39 months for the angioplasty group and 49 months for the surgery group (p=0.088)., Results: The PP rate was 71+/-10% for surgery and 41+/-6% for angioplasty (p<0.0175). The PAP rate was not significantly different (p=0.462) between angioplasty (92+/-4%) and surgery (95+/-4%). In the endovascular group, the site of stenosis on the anastomosis was a risk factor for early recurrence (95% CI between 0.006 and 0.392; p=0.047)., Conclusion: These results suggest that anastomotic stenoses should be treated surgically rather than by angioplasty. Angioplasty and surgery give identical patency rates in other types of perianastomotic stenoses at the cost of a higher reoperation rate for angioplasty.

Objectives: To compare pain during prostate biopsy performed in two different positions., Methods: We carried out a prospective, randomized study to compare the pain experienced during biopsy in two different positions: lithotomy (group 1) and lateral (group 2). Pain was evaluated using a visual analog scale (VAS)., Results: 70 patients were randomized to the two positions for biopsy. The median number of samples taken was the same for both groups (n = 10). The median VAS rating after biopsy was 30 in group 1 and 45 in group 2. 96.6% of the men in group 1 were prepared to undergo a repeat examination according to the same modalities, against only 86.7% in group 2. Only 14.3% of the men in group 1 would have preferred more analgesic against 37.1% in group 2. Pain after biopsy was less in group 1. The men with prostate adenocarcinoma tolerated biopsies better than the others., Conclusion: Our results suggest that the lithotomy position induced less pain and less post-biopsy hematuria than did the lateral position during prostate biopsy. Men with prostate adenocarcinoma tolerated the procedures better.

The frequency of vesicourethral anastomotic stricture after prostatectomy is estimated to be 14%, an average of 3 months after the operation. The authors report the cases of a 61-year-old man undergoing radical prostatectomy for localized prostate cancer. The postoperative course was marked by recurrent urinary retention and several urethrotomies failed to restore spontaneous voiding. A clip was finally visualized and removed by endoscopy. The patient has not experienced any further episodes of retention. This is the first published cases of clip migration responsible for anastomotic stricture after radical prostatectomy. This diagnosis must be considered in the case of repeated postoperative retention.

Introduction: The second national ranking test took place in 2005 in the same conditions as the year before. Analysis of the results permits us to assess whether the objectives of this reform have been met so far., Method: Data crossing of the results provided by the national testing center allowed us to rank: 1) the appeal of specializations for each geographic subdivision, 2) the candidates by medical school, and 3) the appeal of each subdivision by candidate rank., Results: 66% of the students were classified high enough to be able to choose any specialization. Trends observed from the first examination, in 2004, were confirmed, with the clear desirability of medical specializations and a certain lack of interest in occupational medicine and public health. All the surgery posts were filled, even though the number of posts had increased enormously since the first examination. After adjustment for the number of posts available, the specializations in decreasing order of popularity were: medical, surgical, pediatrics, anesthesiology, gynecology-obstetrics, general medicine, psychiatry, and biology. Approximately 1000 posts in general medicine were not filled. The medical schools whose students ranked highest were Paris Pitié, Paris V, Paris West, Lyon North, Grenoble, and Aix-Marseille. Some medical schools did less well than previously: Marseille very slightly and Angers substantially. Strasbourg, Nancy Amiens and Bobigny were at the bottom of the list. The cities most desired for internships were Paris, Toulouse, Lyon, and Aix-Marseille, while Brest, Nancy, Limoges and the West Indies were ranked lowest, although each was chosen by highly ranked candidate., Conclusion: Two thirds of the students were ranked high enough to allow them a free choice of specializations. All the specializations except public health and occupational medicine had very highly ranked students. Medical specializations are the most desired, but surgery remains highly demanded, despite a substantial increase in the number of posts. All posts were filled in all specializations, but only 41% of those in general medicine. Medical schools whose students ranked highest had the fewest students choosing general practice.

Laparoscopic cutaneous ureterostomy is an alternative to definitive percutaneous nephrostomy for patients with pelvic malignancies. The surgical technique was initially described by lumbar laparoscopy, requiring a change of position in the case of a bilateral procedure. The authors describe a laparoscopic technique allowing bilateral cutaneous ureterostomy to be performed without a change of position.

Objective: Due to the reduction of the potential number of residents in surgery, a study was conducted to determine the reasons motivating the choice of urology., Material and Methods: A questionnaire was sent to several generations of urologists concerning the criteria which influenced their choice of this surgical subspecialty., Results: More than one half had chosen urology before their residency. Almost none of the urologists in this subgroup hesitated about another surgical subspecialty at the time of their final choice. Hospital medical training is therefore an essential factor in the choice of the future specialty. Almost all urologists who chose their specialty during their residency initially hesitated with another discipline, corresponding to gastrointestinal surgery in 59% of cases. The most attractive feature was the medical and surgical aspect of urology and possibility of group practice with several urologists, limiting the time on call., Conclusions: Hospital medical students therefore constitute a potential reserve for urologists and need to be motivated by means of good quality practical teaching. Residents in other specialties can also modify their initial choice in favour of urology, especially gastrointestinal surgeons.

The results of the 2004 National-Ranking Exams supply interesting but preliminary information. Its intended goal is to rank the students, but it also provides qualitative and quantitative data about students, the success rates of various university teaching and research units (UFR - unité de formation et de recherche), the ranking for each of the 11 possible specialties, student mobility, and the relative desirability of the University Hospital Centres. In these first ranking exams, the medical and surgical specialties appear to be selected by students with the highest ranks, while less good scores lead to public health, occupational medicine. On an individual level, nonetheless, all combinations are seen.

Unlabelled: Prostate cancer is the most frequent cancer and second cause of cancer mortality in men. The objective of this study was to analyse the prostatic biopsy technique and to verify its conformity with the reference technique of the Centre region., Material and Method: This study concerned first-line biopsies performed and analysed between 01/01/2001 and 31/03/2001 by all pathologists of the Centre region. We analysed the anaesthesia used to perform these biopsies, whether or not the patient was hospitalized, the needle diameter, the use of ultrasound or finger guidance, the operator's specialization and whether he/she worked in the private or public sector, the number of biopsies, the histology request form and the antibiotic prophylaxis used., Results: Six hundred and twelve reports were sent by laboratories at the request of the regional health insurance fund. There were 562 first-line biopsies, which represented 93% of all biopsies studied Biopsy was performed as an outpatient procedure, the recommended modality, in only 36% of cases; in 10% of cases, hospitalization was justified by a particular clinical context. 11% of biopsies were not ultrasound-guided, particularly in the private sector. Information about histological type, Gleason grade, tumour volume, number of cores invaded and extension to the periprostatic space was present in 46% of cases., Conclusions: Only 40% of biopsies performed during the first quarter of 2001 complied with recognized quality criteria: ultrasound guidance, as an outpatient procedure or justified hospitalization, without anaesthesia or with local anaesthesia. Improvement of clinical practice probably requires a phase of discussions and negotiations between professionals and authorities to determine a reasonable fee allowing an objective choice adapted to the patient's state of health. The quality of the histological report is not satisfactory at the present time. A standard report was presented by the Réseau Regional de Cancérologie du Centre (Centre Regional Oncology Network) but has not been adopted by all professionals; further discussions are required to develop a simplified grid comprising essential information, especially as the quality of these reports determines treatment decisions.

Since its first description in 1995, treatment of female urinary incontinence by TVT has become a routine procedure. The ascending retropubic approach can lead to a number of complications. Bladder trauma is observed in 2% to 20% of cases depending on the series. They do not have any repercussions if they are diagnosed and repaired intraoperatively, but, when they are detected later, they raise problems of diagnosis and management. The authors report 2 cases in which a combination of cystoscopy and laparoscopy was used to section intravesical TVT.

The authors report the case of a three-month pregnant woman, in whom a bladder tumour was discovered incidentally by ultrasound, raising the question of the possible foetal repercussions of using an electric scalpel in cutting mode. The bladder tumour was resected using a bipolar electric scalpel and irrigation was performed with physiological saline. No intraoperative or postoperative foetal repercussions were observed. Delivery was conducted with no particular problems and the newborn infant was perfectly healthy. The bipolar electric scalpel is not used routinely, but could be useful in pregnant women or patients with a pacemaker.

Most seminal vesicle cysts have an embryological origin and are often associated with homolateral renal agenesis. The diagnosis of seminal vesicle cyst has been greatly improved by progress in medical imaging, particularly ultrasound, which reveals a retrovesical cystic image and homolateral renal agenesis. Transperineal or laparoscopic vesiculectomy is technically difficult and is associated with high morbidity. The authors report a case of laparoscopic vesiculectomy with an uneventful postoperative course.

Von Recklinghausen disease usually involves the large vessels. Involvement of the pelvic vessels has not been previously reported in the literature. The authors report the case of a man presenting with acute pelvic pain secondary to rupture of an aneurysm of the internal obturator artery, in a context of Von Recklinghausen disease.

Objective: Urinary incontinence is a very common disease among women but only few studies have been published in young adult and middle-aged population. We studied urinary incontinence prevalence and risk factors in this young and middle-aged population., Material and Methods: We studied during the year 1998 the prevalence of global incontinence and stress, urge and mixed urinary incontinence in 1700 women working in a French academic hospital (n = 2800). Women received the questionnaire at the same time than their convocation for their yearly visit in occupational medicine. Usual risk factors of constitutional events (increasing âge, obesity defined by a Body Mass Index > or = 25); obstetric events (pregnancy, previous caesarean delivery, previous vaginal delivery, post-partum incontinence) and gynaecological event (hysterectomy) were evaluated., Results: 177 women (mean âge 40.0 years) returned the questionnaire. 467 women (27.5% 95% CI = 25.4-29.7) reported urinary incontinence, 210 (12.4% 95% CI = 10.8-14.0) stress urinary incontinence, 28 (1.6% 95% CI = 1.1-2.4) urge urinary incontinence and 229 (13.5% 995% CI = 11.9-15.2) mixed urinary incontinence. 38 women (8.1%) suffered from frequent urinary leakage corresponding to 1 (0.5%), 4 (14.3%) and 33 (14.4%) stress, urge and mixed urinary incontinence. The prevalence of urinary incontinence increased significantly with âge > or = 40 years (RR = 2.16 95% CI = 1.86-2.57) pregnancy (RR = 2.22 95% CI = 1.71-2.87), previous vaginal delivery (RR = 2.15 95% CI = 1.72-2.69), post-partum incontinence (RR = 2.57 95% CI = 2.22-2.97, hysterectomy (RR = 1.52 95% CI = 1.11-2.08). Obesity (RR = 1.14 95% CI = 0.99-1.32) and previous caesarean delivery (RR = 2.15 95% CI = 1.72-2.69) did not increase the risk of urinary incontinence. The risk factors for stress urinary incontinence were âge > or = 40 years (RR = 2.18 95% CI = 1.66-2.87), pregnancy (RR = 2.36 95% CI = 1.55-3.58), previous vaginal delivery (RR = 2.47 95% CI = 1.70-3.59), post-partum incontinence (RR = 2.78 95% CI = 2.14-3.61) and hysterectomy (RR = 2.83 95% CI = 1.93-4.15). No relationship was found between stress urinary incontinence and obesity (RR = 1.25 95% CI = 0.96-1.64) and previous caesarean delivery (RR = 1.02 95% CI = 0.45-2.32)., Conclusion: A high prevalence of urinary incontinence was observed among young adult and middle-aged female hospital workers with an easy access to medical resources. Gynaecological and obstetric event (pregnancy particularly previous vaginal delivery and hysterectomy) were the most prominent risk factors, especially for stress urinary incontinence.

Objectives: To report and prevent a serious complication of tension-free vaginal tape (TVT) procedure., Case Report: One day after a TVT procedure, an emergency CT scan showed adhesion of intestinal loops with a pneumoperitoneum. The patient had previously had intra- and retroperitoneal surgery with a sacral cervicopexy and a Burch colposuspension., Conclusion: In such a case of previous surgery, a CT scan may be useful before a TVT procedure.

Objective: The prevalence of urinary symptoms, their impact on quality of life and sexuality and the man's attitude in relation to these problem were studied by a self-administered questionnaire (including I-PSS, 6 questions of DAN-PSS-1, BPHQL9 and IIEF)., Material and Methods: This questionnaire was sent by mail to a national representative sample of 3,500 French men aged 50 to 80 years. Of the 2,372 men who returned an interpretable questionnaire, 21%, 33% and 42% belonged to the severe or moderate category for symptoms, tolerance of symptoms, and alteration of quality of life, respectively., Results: 81% of men reported sexual activity during the last 4 weeks. 8.3% of men were treated with "antiprostate" medical treatments, and 8% had been operated (16% of them were treated medically after the operation). Only 29% and 17% of men had talked about their sexual and urinary problems, respectively., Conclusion: Alteration of functional and perceived sexuality was correlated with age and the severity of symptoms in non-operated patients, but the poor correlations between scales evaluating sexuality and symptoms indicate that sexuality is a difficult aspect to investigate.

The authors report two cases of abdominal fibromatosis corresponding to Gardner's syndrome, causing hydronephrosis by extrinsic ureteric compression in young men in whom any form of surgical resection would have been in vain. These cases of ureteric compression were treated endoscopically by placement of a double J ureteric stent associated with treatment by tamoxifen in one case and sulindac in the other, with apparent stabilization of the disease. The two patients are regularly followed in the department with ureteric stent replacement two to three times a year.

We report the case of a young pregnant woman with a malignant tumour of the kidney suggestive of oncocytoma. Because of the pregnancy, preoperative staging consisted of abdominal ultrasound and magnetic resonance imaging. Caesarean section was performed. Several days later, surgical exploration of the kidney was performed with tumourectomy and frozen section analysis: radical nephrectomy was finally performed. The definitive histology was chromophobe renal cell carcinoma. This is a rare tumour of the kidney, with its own characteristics allowing histopathological diagnosis and with a better prognosis than renal cell carcinoma. In the literature, pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.

Ureterocele or congenital pseudocystic dilatation of the terminal portion of the ureter due to persistence of Chwalla's membrane is frequent in female adults (17-35%) in its orthotopic form. It expands the short submucosal segment of the normally situated ureter and may be intravesical or extravesical. The diagnosis is primarily radiological based on intravenous urography (IVU) and endoscopy (urethrocystoscopy). Treatment depends on the site of the ureterocele, the clinical context, associated anomalies and especially the dimensions. Endoscopic treatment has numerous advantages and deserved to be more widely used.

We report on the case of a young pregnant woman who had a malignant tumor of the kidney. The pregnancy did not change the gold standard therapy: radical nephrectomy. Because of the pregnancy the preoperative staging consisted of an abdominal ultrasound and a magnetic resonance imaging for the local extension, and of a chest X-ray looking for pulmonary metastases. According to the literature pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.

Malignant fibrous histiocytoma is the commonest soft tissue sarcoma of adults. The soft tissue of the extremities is the commonest primary site of malignant fibrous histiocytoma. It is much less common in the female retroperitoneum, leading to diagnostic errors. The clinical, radiographic and CT signs are non-specific. This tumor can only be diagnosed by histology. An initial complete resection is essential for successful treatment of the primary tumor. Radiation therapy is limited and chemotherapy has only been successful in a limited number of cases. This tumor has a poor prognosis. These lesions are relatively rare and consequently difficult to study. The authors report three cases and review the literature.

The authors report two cases of retroperitoneal malignant fibrous histiocytoma which is a rare tumour (200 cases reported in the literature). The clinical and radiological signs are nonspecific and the diagnosis is based on histological examination of the specimen. Surgical resection must be as complete as possible to prevent local recurrence. The efficacy of adjuvant therapy has not been demonstrated due to the low incidence of this tumour.

It has been calculated that 7% of the males living in France over the age of 65% will undergo a surgical procedure for benign prostatic hyperplasia within 5 years. Currently approximately 65000 patients are operated every year. The mean age of the patients is 71.8 years with an incidence much lower than that observed in the United states where the mean age is 66 years. According to the reports of the 87th congress of urology, 10 to 20% of the patients are operated because of urine retention.