Biomedical subjects

A Joual

Publications and source records attributed to A Joual.

At least 55 records · Page 3Linked to original sources

PubMed1998

[Contralateral aneurysm-like adrenal gland metastasis of a renal adenocarcinoma].

The authors report a case of adrenal metastasis contralateral to a renal cell carcinoma in a 74-year-old patient who had undergone right radical nephrectomy for renal cell carcinoma. Nine months later, computed tomography revealed a hypervascular mass considered to be an aneurysm of the splenic artery. Arteriography led to the diagnosis of hypervascular adrenal tumour. Left adrenalectomy was performed. Histological examination showed a metastasis from renal cell carcinoma. This is an unusual form of renal cancer metastasis. Its treatment and prognosis are discussed.

Adrenal Gland Neoplasms↗

PubMed1998

[Laparoscopic adrenalectomy. A general review of a current technic].

The anatomical situation of the adrenal gland explains the diversity of the surgical incisions used for adrenalectomy. Laparoscopic adrenalectomy was first performed in 1992. It allows eradication of small adrenal lesions, which are often incidental findings. There are two routes of laparoscopic access to the adrenal gland: transperitoneal and retroperitoneal. Laparoscopy allows excellent operative exposure, reduction of postoperative pain and hospital stay and rapid convalescence. Retroperitoneoscopy, by allowing direct access to the retroperitoneum, is more rapid than the transperitoneal route.

Adrenal Gland Diseases↗

PubMed1998

[Tumors of the bladder in women. Epidemiologic and therapeutic aspects. Apropos of 40 cases].

Bladder tumours in women. Epidemiological aspects and treatments, based on a series of 48 cases. Bladder tumours are more frequent in men than in women, in whom they present certain epidemiological, clinical and therapeutic characteristics. The authors report a retrospective study of 48 cases of bladder tumour in women, observed in the urology department over a 20-year period. These tumours represented 4.2% of all bladder tumours. The patients had a mean age of 59 years (range: 29 to 77). Only one patient was a smoker (2%). Haematuria was present in 93% of cases, and signs of bladder irritation were present in 60% of cases. All tumours were transitional cell carcinomas. The tumour was classified as stage 0 in 10 cases (20.9%), stage A in 15 patients (31.2%), stage B in 22 patients (45.8%) and stage C in 1 case (2.1%); no patients (0%) were classified as stage D. Our therapeutic protocol was established as a function of the stage of tumour invasion. For example, superficial tumours were treated conservatively by transurethral resection, either alone or combined with intravesical instillation. Radical surgery was performed whenever possible for invasive tumours. External urinary diversion was performed in 11 cases, ureterosigmoidostomy in 3 cases and enterocystoplasty in 5 cases. The clinical course of the 15 superficial tumours was marked by recurrence in 5 cases, while that of the 23 invasive tumours was marked by local recurrence (3 cases), renal failure (1 case) and 3 deaths.

Administration, Intravesical↗

PubMed1997

[Epidemiology of urinary lithiasis].

The objective of this study was to analyse the epidemiological profile of urinary stones based on one thousand cases observed in our institution over a 10-year period. The mean age of the patients was 45 years and two-thirds of patients were males. The kidney was the commonest site of stones, in 57.8% of cases. The stone was radiopaque in 86.4% of cases and was a staghorn calculus in 12.2% of cases. An associated renal malformation was observed in 10.4% of cases. Urinary stones is therefore a common disease, essentially observed in a young population and characterized by recurrence. It therefore constitutes a public health problem and prevention consists of detecting recurrences and treating stone-inducing factors.

Adolescent↗

PubMed1997

[Seminal vesicle cyst associated with homolateral renal agenesis and megaureter. Apropos of a case].

We report a case of a 24-year-old male patient with cystic dilatation of the seminal vesicle associated with renal agenesis and megaureter. This patient complained of left renal colic with pollakiuria. We performed intravenous urography and ultrasound showed a cyst in the seminal vesicle associated with left megaureter and right renal agenesis. Treatment consisted of resection of the cyst and reimplantation of the left ureter into the bladder. No postoperative complications were observed. This association is rare and can be explained by the common embryological origin of the seminal vesicle and kidney and ureter. Its diagnosis is now facilitated by ultrasound and CT. The treatment of this tumor is surgical only when the lesions are responsible for clinical symptoms.

Adult↗

PubMed1997

[Calculus-induced anuria. Apropos of 25 cases].

The objective of this study was to analyse the clinical and therapeutic aspects of stone-induced anuria based on the analysis of 25 cases. The mean age of the patients was 51 years. The stones were bilateral in 54% of cases, and consisted of uric acid stones in 52% of cases. The diagnosis was based on laboratory and radiological findings. Dialysis was indicated in eight patients because of major metabolic disorders. Urinary diversion was performed by insertion of a ureteric catheter or percutaneous nephrostomy. The medium- to long-term prognosis was favourable in two-thirds of cases, but 3 immediate deaths were observed due to delayed diagnosis.

Acidosis↗

PubMed1997

[Hemospermia].

Haemospermia is a relatively frequent symptom in urology, especially in young subjects. It is often benign, but is important because of the anxiety it can cause to the patient. The predominant aetiology of haemospermia is prostatic and seminal vesicle disease. Iatrogenic aetiologies, generally without severity, are due to the development of instrumental diagnosis and treatment in urology. Recent progress in the field of medical imaging, particularly transrectal ultrasonography and magnetic resonance imaging, has greatly contributed to the diagnostic and therapeutic approach to haemospermia.

Blood↗

PubMed1996

[Detubularized U-shaped enterocystoplasty after cystoprostatectomy].

We reviewed the charts of 58 patients who underwent orthotopic bladder replacement after total cystoprostatectomy for muscle invasive bladder cancer. Mean age was 56 years. As described by Camey, 60 centimetres of small bowel, are isolated, detubularised then folded upon itself to form a U shaped reservoir, which is anastomosed to the urethra. Death occurred in 5%. Urologic complications observed were: urinary leakage (15%), ureteral reflux (6.8%), ureteral stenosis (8.6%) and stones of the neobladder (5.1%). 64.2% of the patients were immediately continent during the day. Nocturnal continence was obtained for 50% immediately and for 80% three months postoperatively. Detubularised and U shaped cystoplasty achieve a low pressure reservoir, with protection of the upper urinary tract, and a diurnal continence. Nocturnal continence is achieved later.

Adult↗

PubMed1996

[Ureterovaginal fistulas. A report of 17 cases].

OBJECTIVE: Our purpose was to study aetiopathogenic, diagnostic and therapeutic aspects of ureterovaginal fistulas. STUDY DESIGN: A retrospective study concerned 17 ureterovaginal fistulas in 16 patients. The main causes were gyneacological and obstetrical procedures. The diagnosis was based on clinical considerations and intravenous pyelography in all cases. Three vesicovaginal fistulas were associated with iatrogenic ureteral lesions. Various therapeutic methods were used: psoas-bladder hitch procedure (11 cases) and Boari-Küss flap (4 cases). In two patients, fistulae healed by drainage after ureterolysis. RESULTS: Late radiology showed success of the procedure in 14 patients and persistance of ureteral dilatation in 2 cases treated by Boari-Küss procedure. CONCLUSION: Ureterovaginal fistulae are a relatively frequent complication of pelvic surgery. Psoas-bladder hitch is the procedure of choice in such fistulae cure and prevention is the most efficient treatment.

Adult↗

PubMed1996

[Ureteropelvic junction syndrome in adults. 108 cases in 102 adults].

We report 108 cases of ureteropelvic junction obstruction corresponding 54 males and 48 females, with a mean age of 33 years. Pain was the commonest symptom. Delay in diagnosis was 3 and a half years. The diagnosis was made by IVP allowing our patients to be in different stages : Stage I (12 cases), stage II (39 cases), stage III (25 cases), stage IV (32 cases). We did not operate on 10 patients presenting with allow stage. 61 patients were operated by a conservative procedure : dismembered pyeloplasty (58 cases), YV pyeloplasty (3 cases). Nephrectomy was performed in 37 patients (34%). This high nephrectomy rate was due to be delayed in diagnosis.

Adolescent↗

PubMed1996

[Ureteral reimplantation].

Various techniques of ureteral reimplantation have been described for different indications. After a retrospective study concerning 109 cases and 178 ureteral reimplantations, the authors propose the selective indications for each technique noting the most important results. The indications for reimplantations are numerous and varied: enterocystoplasty (60 cases), iatrogenic lesion of the pelvic ureter (11 cases), inflammatory stenosis (13 cases), renal transplantation (20 cases), primary megaureter (4 cases), stenosis of reimplantation (2 cases). 5 techniques were used in this study: Leduc-Camey, Leadbetter-Politano, Direct, Manchette, Lich-Gregoir. We conclude that in ureterodigestive reimplantation, Leduc-Camey modified method is indicated. In renal transplantation, Lich-Gregoir is the ideal technique. In primary megaureter, the Leadbetter-Politano procedure possibly with ureter modelling improves the results. In iatrogenic lesions of the pelvic ureter, Leadbetter-Politano technique and possibly a hitch-bladder gives a good result.

Adult↗

PubMed1996

[Complications of urinary calculi].

Urinary stones is a frequent disease whose renal complications can engage both functional and vital prognosis. We report 769 complicated cases observed 10 years. The diagnosis was made by intravenous urography and ultrasonography. 607 cases were mechanical complications, 582 hydronephrosis, 25 anuria, 262 were infectious complications, 82 chronic pyelonephritis, 60 pyonephrosis, 10 perinephric abscess. Treatment included adapted antibiotic therapy, ureteral catheter in case of anuria ; surgical extraction of the stone nephrectomy was performed in 100 patients. Results were generally good. 9 patients had endstage chronic renal failure. The high frequency of urinary stone complications is due to the fact that most patients consult late. The diagnosis must obviously be made.

Adult↗

PubMed1996

[An unusual presentation of prostate cancer].

The authors report an uncommon case of a 74-year old man with prostatic cancer revealed by pelvic mass. Ultrasound exam and CT-scan showed a bilateral laterorectal mass with high density. Presence of such a mass in an old patient is very suggestive of lymph nodes than retroperitoneal tumor. Serum prostate specific antigen (PSA) is rather helpful in such conditions. Biopsy of the mass allows confirmation of the prostatic cancer diagnosis. Bilateral Surgical pulpectomy is performed in combination with oral hormonal therapy. Follow-up after 6 months showed a good course or ultrasound exam and PSA level.

Aged↗

PubMed1996

[Lithiasis and ectopic pelvic kidney. Therapeutic aspects].

Kidney in ectopic position is dysplasic, and associated to other malformations. The advent of a lithiasis in these conditions rises questions about therapeutic options. We report on five observations of pelvic ectopic kidney with urinary lithiasis. Patients were aged from 16 to 42 years. Kidney was non functional in two cases, or with normal appearance sized 10 to 12 cm. We performed total nephrectomy in two cases, pyelolithotomy in the other cases. Surgical approach was subperitoneal via iliac route. A dismembered pyeloplasty was associated in one case. All patients did well. Radiologic control at 6 and 12 months showed no recurrence in a well functioning kidney. Surgical lithotomy is advocated as a treatment in urinary lithiasis affecting ectopic kidney. It is an easy procedure which permits correction of other associated malformations.

Adolescent↗

PubMed1995

[Obstructive anuria. Thirty cases].

The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology.

Adult↗

PubMed1995

[Percutaneous alcoholization of simple serous cysts of the kidney].

Benign renal cysts are usually asymptomatic: They require a minimally invasive treatment if they cause complaints such as flank pain or other compressive complications. During a 6 month period, 14 patients were treated for benign renal cyst using an ultrasound guided puncture. Presenting complaints were flank pain (12 cases), hypertension (1 case), polycythaemia (1 case). Only cyst of 5 centimeters diameter or more were assigned to this treatment. After needle puncture, the cyst was evacuated and then filled with sterile 95% alcohol. Clinical and anatomical results, after 6 months, were good in 9 cases, 2 cases showed good anatomical results with persistence of initial symptoms, and there were 3 failures corresponding to large cysts of 10 cm diameter or more. Percutaneous alcoholization of moderate benign cysts is a safe, simple and reliable method.

Adult↗

PubMed1995

[Pseudocystic ureteritis. Apropos of a case].

The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.

Adult↗

PubMed1995

[Two-stage surgical treatment of urethral stenosis].

We analysed the results of two-operation procedures for cutaneous urethroplasty performed over a 10 year period. From 1983 to 1993, 44 patients had a Leadbetter urethroplasty. The indication in all cases was stenosis of the bulbal or bulbomenbranous urethra complicated by urethro-cutaneous fistula. After the first operation, 10 patients (22.7%) had a stenosis of one or both of the urethrostomy orifices, requiring one or more further procedures. The second operation concerned 18 patients (40.9%) and gave goods results in 10 (55.5%). Poor results were due to recurrence of the stenosis in 3 cases (16.6%), perineal suppuration in 1 (5.5%), failure of the skin plasty in 1 (5.5%) and formation of a stenosis by a tuft of hair in 1 (5.5%). Finally, 2 patients were lost to follow-up. Mean interval between operations was 8 months. It appears, despite the drawbacks and uncertain results, that sequential operations for cutaneous urethroplasty are indicated when stenosis of the urethra is complicated by fistulization or perineal infection.

Adolescent↗