Biomedical subjects
Publications and source records attributed to B Lobel.
Regard to a new case of renal hemangiopericytoma, the authors have reviewed the literature, in order to specify the main features of this uncommon entity. Because of the lack of correlation between the clinical behavior and the histologic pattern, hemangiopericytomas should be treated as potential low grade malignancies and followed carefully. Surgery seems to be actually the only form of treatment to propose.
The authors use the intracavernous injection of papaverine (ICP) as a diagnostic test in order to differentiate between organic and psychogenic erectile impotence. Comparison of the results of this test with those of nocturnal penile plethysmography and Doppler studies of the penile vessels demonstrated a good correlation. However, the ICP test cannot be used alone to confirm the organic or psychogenic nature of erectile impotence.
The authors report their experience of the treatment of Peyronie's disease on the basis of 27 cases. In the light of their results and the data reported in the literature, they study the place of infiltrations, plication of the corpora cavernosa and implants in the treatment of this disease.
Over the period of one year, 356 extracorporeal lithotripsies were performed in 303 patients with the EDAP piezoelectric lithotripter. The success rate, depending on the frequency (1.2 to 40 Hz) was between 75 and 80%. The treatment was repeated for 13 to 22% of the patients and 15% underwent an auxiliary manoeuvre preoperatively. Morbidity remains low with less than 5% of ureteral obstruction. For simple or small calculi (less than 1 cm), the use of low frequencies (1.2 to 5 Hz) is preferred, making it possible to carry out the treatment without anaesthesia and without hospitalization. For complex or bigger calculi, the use of higher frequencies (10-20 Hz), under neuroleptic analgesia, seems to be more efficient with a shorter time of treatment and a lower complication rate.
The problem raised is that of the legitimacy of palliative urinary derivation in the malignant tumours of the pelvis beyond any therapeutic possibility. Between 1980 and 1985, 49 patients were referred to the department of Urology of Rennes for cutaneous ureterostomy type. 39 records were suitable for review. Bilateral ureteric obstruction in the course of carcinomas of the pelvis, regardless of the origin, is uncommon bearing in mind the prevalence of such pathology and notably in women. Recent techniques (J catheter, per-cutaneous nephrostomy) have simplified the surgical procedure of urinary bypass. They do not fundamentally change the incisions and are not always applicable. Use of the J catheter may be prevented by the impossibility of intubating the ureter or when the bladder is unusable as a reservoir, whilst the use of percutaneous nephrostomy is hazardous or possibly even insufficient to dry the perineum when there is a malignant vesicovaginal fistula. This study involved evaluation of 39 patients who underwent uni or bilateral terminal cutaneous ureterostomy, any other technique having proved to be undesirable. The mean survival of the patients was 225 days and its quality as good or satisfactory in only 25% of cases. The implantation of epidural morphine reservoirs may improve the quality of survival of these patients by suppressing pain which up to now has been an absolute contraindication to an upper cutaneous derivation procedure.
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Puigvert's operation for male urinary incontinence was performed in 9 patients. In 8 cases the incontinence was secondary to prostate surgery. Results on continence were evaluated at follow-up during the immediate postoperative period and after 6 weeks, 3 and 6 months and two years. (Table: see text). Results indicate that this technique is simple and safe but unsatisfactory.
The results of 134 patients who underwent 150 treatments with the EDAP lithotriptor are reported. The first patients were treated with a frequency of 150 Hz under general anesthesia, with a success rate of 64%. In order to decrease the pain induced by the shocks waves, the frequency was lowered (20 Hz and 10 Hz), so that treatment could be performed under neuroleptic analgesia. The success rate was respectively 84% and 90%. A second treatment was required in 11% of the patients and 9% have undergone auxiliary endoscopic manoeuvres preoperatively. Morbidity was extremely low with only 3% of ureteral obstruction. The gradual reduction of anesthesia constitutes an advance in lowered morbidity and costs; in addition, the possibility to repeat the treatments makes the management of complex lithiasis easier.
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The authors report their diagnostic and therapeutic approach to four recent cases. While ultrasound is an excellent diagnostic aid, only simplified intravenous urography can establish the nature and localization of the obstacle. As regards management, surgery, when it is possible, allows removal of the obstacle and the repair of the excretory tract. In pregnant women, as in other cases when surgery is not feasable, the drainage of the infected and retained urine is achieved endoscopically. The J ureteral catheter offers a sure and comfortable method. When retrograde catheterization is unsuccessful, percutaneous nephrostomy can be used as a temporary measure to tide over the pregnancy.
By modifying the anatomical location of the bladder and ureter, and by favoring urinary stasis and pyuria, pregnancy may reveal or aggravate an existing vesico-renal reflux. In reporting six cases of vesico-renal reflux in pregnant women, revealed by attacks of feverish lombalgia, or mictional disorders associated with pyuria, and confirmed postpartum by intravenous urography, retrograde cystography and cystoscopy, the authors recall the factors associated with pregnancy which favor the appearance of a reflux, mechanical, hormonal and metabolic action. Surgical correction of refluxes associated with pyuria and detected during pregnancy would seem indicated.
Of the 235 renal cancers treated between 1975 and 1984, twenty five cases were complicated by thrombus of the vena cava. Analysis by Kaplan-Meier's method shows a satisfactory survival rate for isolated thrombus of the vena cava (80 per cent at two years, and 45 per cent at five years). But associated lesions to the perirenal fat or lymph nodes considerably diminishes the survival rate, so that the overall survival rate in this series was only 37 per cent at two years and 20 per cent at five years. 57 per cent of the patients who seemed free of distant metastases during the preoperative investigations, nonetheless died within two years postoperatively, from a lung, liver or bone metastasis. CT scan at present allows diagnosis of renal cancer and assessment of the extension to the fatty capsule and the vena cava. It is to be hoped that nuclear spin electronic resonance will provide a better assessment of the prognostic factors, and, in particular, the lymph node extension.
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Vesicorenal reflux raises specific problems in adults, as regards both the surgical indications and the operative technique. The operative results are discussed in relation to fifty seven ureters reimplanted in thirty six patients, and the indications for surgical management are outlined. Refluxes clinically associated with lumbalgia, fever and pyuria, always require surgery. The most difficult problems arise from "asymptomatic" refluxes revealed by checkups for renal insufficiency, proteinuria or arterial hypertension. In these cases, the characteristics of the ureter (e.g. wide or narrow) and the existence or absence of renal scars must be taken into consideration. Refluxes in narrow ureters should be followed closely, and the advisability of surgery should be carefully weighed in patients with a wide ureter with no visible damage to the parenchyma.
The authors report a series of 47 patients suffering from disseminated sclerosis who required neuro-urological management because of micturition disturbances. They were in general young (mean age 43 years) and had been suffering from disseminated sclerosis for 10 years (on average). The neurological disease was in general severe since it was progressive in 32 cases and pure remittent in 13 only. Two-thirds of the patients were autonomous from a locomotor standpoint. Micturition disturbances developed in the first five years of the disease in 2/ 3rds of the patients and became really troublesome only after disseminated sclerosis had been progressive for five years. Dysuria, frequency and incontinence with urgency were the commonest symptoms. Persistent or transient retention of urine remained relatively common. Nocturnal urine loss was rarer. Sphincter incompetence was marked in half of the patients but this did not necessarily go hand in hand with locomotor incapacity. Symptoms and signs were grouped as irritative, obstructive and mixed syndromes. From a urodynamic standpoint, the detrusor was sometimes normal but more often behaved pathologically, being either hyperactive or hypoactive. Hypoactivity of the detrusor was accompanied in 9 cases out of 10 by spasticity of the striate sphincter. Spasticity of the striate sphincter was the commonest type of behaviour, although normal striate sphincter electromyography was possible and; rarely, results were of peripheral neurogenic type. There was no evidence of any correlation between the type of micturition syndrome, detrusor function and striate sphincter function. Similarly, no correlation could be established between the type of detrusor dysfunction and the period for which disseminated sclerosis had been present.(ABSTRACT TRUNCATED AT 250 WORDS)
An isolated aneurysm of the right hypogastric artery provoked ureteral compression responsible for renal colic and evidence of uretero-pyelo-caliceal dilatation on I.V.U. Diagnostic features are reviewed and emphasis laid on the severe course of this affection which justifies urgent surgery associating vascular reconstruction, ureterolysis and ureteral reimplantation.
Two cases of thrombosis of the dorsal vein of the penis are reported and the clinical features and course of this benign lesion outlined. Diagnosis follows observation of edema of the foreskin with an indurated cord-like dorsal vein on palpation. Recovery usually occurs spontaneously or after anti-inflammatory treatment.