In 65 patients (pts) (130 renal units) with invasive bladder cancer treated at our institution from 1971 to 1992, ureterosigmoidostomy was performed. Early complications (< 3 month) occurred in 25 patients: 9 pts had a pyelonephritis, 3 pts underwent surgery for revision of the ureteral anastomosis because of leakage and 3 had abdominal wall revisions. 4 pts had a severe hyperchloremic metabolic acidosis, 2 pts had respiratory problems. Late complications observed were: 12 pts with pyelonephritis, 4 pts with ureteral stenosis and 9 pts with hyperchloremic metabolic acidosis. 5 patients were incontinent and 3 pts had a anastomotic colon cancer after 10, 12 and 17 years respectively. In 26/65 (40%) of patients with survival over 5 years continence and quality of life were evaluated by means of a questionnaire. 23/26 pts (88%) were continent during daytime and complete continence during the night was reported by 14/26 pts (54%). Quality of life was assessed in a global manner (family and social life, sexuality, comfort, travel and sport) and was rated as satisfactory in 24/26 pts (92%). 2 pts were unsatisfied due to diarrhea. In conclusion, good long-term functional results can be obtained with ureterosigmoidostomy with a careful follow-up. Our long-term results may serve as a basis for comparison with other more recently developed continent urinary diversions such as low pressure systems.

De janvier 1991 a juillet 1995, 90 patients ont ete traites pour des strictures du haut appareil urinaire par endopyelotomie ou endo-ureterotomie. Des 60/72 patients ayant subi une endopyelotomie a la lame froide sous vision directe, 88% (53/60) sont gueris avec un temps d'observation median de 13 mois (2-24). Des 12/72 patients ayant subi une endopyelotomie par Acucise®, 75% (9/12) sont sans recidive pour un suivi median de 21 mois (9-32). Pour les stenoses de l'uretere proximal le taux de succes de l'endo-ureterotomie par Acucise® est de 86% (6/7) et pour les stenoses de l'uretere distal de 67% (8/12) pour un suivi median de 30 mois (12-42). De ce fait, et moyennant une selection correcte des patients, l'endopyelotomie et l'endo-ureterotomie sont a considerer comme les methodes de premier choix pour le traitement des stenoses de la jonction pyeloureterale et de l'uretere, la chirurgie a ciel ouvert etant limitee a des cas exceptionnels.

Nous rapportons 10 ans d'experience chez 100 patients ayant recu apres cystectomie radicale pour cancer invasif de la vessie, une vessie ileale de substitution basse pression. Durant un temps d'observation median de 30 mois (3-108), 42 patients sont decedes dont 33 d'une progression du cancer de la vessie. Le taux de complications postoperatoire fut de 11%. La capacite fonctionnelle mediane du reservoir fut de 500 ml a 12 mois, la continence diurne de 92% apres 1 an et la continence nocturne de 80% a 2 ans. Cette technique chirurgicale est simple, et presente peu de complications avec d'excellents resultats fonctionnels et sur la qualite de vie des patients.

Les auteurs presentent une observation de kyste de la vesicule seminale associe a un abouchement ectopique de l'uretere et une agenesie renale ipsilaterale. La discussion porte sur l'etiologie de ces malformations, leur polymorphisme clinique, les modalites de diagnostic et de traitement ainsi que sur la contribution possible de cette pathologie au diagnostic differentiel des algies pelvi-perineales.

L'indication a une nephrectomie partielle a ete posee chez 18 patients avec un carcinome du rein en vue de preserver la fonction renale. Il s'agissait de patients avec rein unique, anatomique ou fonctionnel, mais egalement de patients avec fonction renale diminuee ou tumeur renale bilaterale. Cette approche preservant le parenchyme renal a permis d'eviter la dialyse chez 15/18 patients. Treize patients sur dix-huit ont presente une absence de recidive tumorale durant une periode d'observation moyenne de 57 mois. Cette chirurgie tumorale, au vu de ces resultats, semble devoir etre recommandee a condition d'etre effectuee dans les regles de l'art, surtout si l'on considere la morbidite, la mortalite et la diminution de la qualite de vie inherentes a une transplantation renale ou a une hemodialyse chronique.

Des traitements alternatifs non medicamenteux de l'hyperplasie benigne de la prostate, nous presentons trois differentes methodes qui semblent presenter un interet grandissant dans le traitement du prostatisme. Les methodes sont la thermotherapie transuretrale (T3® Urologix), la thermotherapie transrectale (Sonablate®) et le laser de contact. Nous avons traite 36 patients dont 8 par thermotherapie transuretrale, 18 par laser de contact et 10 par thermotherapie transrectale. Nos resultats montrent une nette amelioration des symptomes urinaires de l'ensemble de nos patients. Le succes de ces nouvelles techniques reste a etre evalue a long terme et il est encore trop tot pour tirer des conclusions definitives, mais au vu de ces premiers resultats, il semble probable qu'elles vont peu a peu s'integrer dans l'arsenal therapeutique de l'urologue.

An internal urinary diversion after radical cystoprostatectomy has been performed in 70 male patients. The bladder substitute was made from an ileal segment, opened along its antimesenteric border and folded twice, according to Goodwin's "cup-patch technique". After an observation time of 6 months to 6 years, the results are in general good: The initial capacity of the pouch made from only 40 cm of ileum (in order to avoid metabolic disturbances) increases to a functional capacity of 500 ml within the first postoperative weeks. The increase of the bladder substitute's capacity is parallel to the improvement of urinary continence. In general, the latter is achieved after 1-3 months during the day, and after 3-6 months during the night. However, loss of a few drops of urine may occur, reason why half of our patients wear a safety pad later than 6 months after surgery, at least during the night. There was no significant difference between those patients with an antireflux nipple and those patients having an ileal tubular afferent segment.

An internal urinary diversion after radical cystoprostatectomy has been performed in 70 male patients. The bladder substitute was made from an ileal segment, opened along its antimesenteric border and folded twice, according to Goodwin's "cup-patch technique". After an observation time of 6 months to 6 years, the results are in general good: The initial capacity of the pouch made from only 40 cm of ileum (in order to avoid metabolic disturbances) increases to a functional capacity of 500 ml within the first postoperative weeks. The increase of the bladder substitute's capacity is parallel to the improvement of urinary continence. In general, the latter is achieved after 1-3 months during the day, and after 3-6 months during the night. However, loss of a few drops of urine may occur, reason why half of our patients wear a safety pad later than 6 months after surgery, at least during the night. There was no significant difference between those patients with an antireflux nipple and those patients having an ileal tubular afferent segment.