The authors have created a reproducible laparoscope holder that is 150 euros less expensive, which can be used to perform laparoscopic radical prostatectomy and sacral colpopexy with a single assistant and four free hands. One hundred and sixteen procedures were performed with this original, compact and easy to use apparatus. The characteristics of this scope holder allow mobilization of the camera in three dimensions and maintenance of a fixed image after positioning. This laparoscope holder provides an economic solution that can be used in all laparoscopy units and which liberates the assistant's two hands.

Objective. - To evaluate the correlation between tumour diameter and intraoperative haemodynamic variations during adrenatectomy based on a series of 15 operated cases of adrenal phaeochromocytoma.Material and methods. - Seventeen adrenatectomies for adrenal phaeochromocytomas were performed between January 1997 and March 2007. Two laparoscopic adrenalectomies were excluded to ensure a homogeneous series. The mean age of the patients was 39 years (range: 29-75). The hypertensive peak was defined according to the recommendations of the European Society of Hypertension (blood pressure greater than 140/90 mmHg). Intraoperative blood pressure was measured and recorded every 10 minutes during the operation.Results. - The median diameter of unilateral tumours was 6 cm (range: 3-11) and the median diameter of bilateral tumours (two cases) was less than 6 cm. The mean operating time was 135 minutes (range: 120-170) for tumours greater than or equal to 6 cm versus 105 minutes (range: 90-145) for tumours less than 6cm. Operating time was increased by an average of 30 minutes for tumours greater than or equal to 6 cm. Hypertensive peaks were recorded in seven out of eight cases (87.5%) for adrenal phaeochromocytomas greater than or equal to 6cm, and in three out of seven cases (29%) for adrenal phaeochromocytomas less than 6cm (P = 0.04).Conclusion. - Tumour diameter is a decisive predictive factor of intraoperative haemodynamic variations in adrenal phaeochromocytoma surgery. (C) 2008 Elsevier Masson SAS. Tous droits reserves.

There are six described complications of sickle cell trait or disease : gross hematuria, renal infarction, papillary necrosis, nephrotic syndrome and urine concentration defects.Because of a high frequency of sickle cell trait patients among patients suffering from medullary kidney carcinoma, it has been called the seventh complication. We briefly review physiopatholgy and diagnosis of these complications.

La drépanocytose dans sa forme homo ou hétérozygote peut être responsable de six complications rénales “classiques” : hématurie macroscopique, infarctus rénal, nécrose papillaire, pyélonéphrite aiguë, syndrome néphrotique et troubles de la concentration des urines. Le carcinome médullaire du rein est considéré comme la septième complication. II est en effet statistiquement lié à la forme hétérozygote de la drépanocytose. Nous avons fait le point sur les éléments physiopathologiques et diagnostiques de ces différentes complications.

INTRODUCTION:Prospective study of urodynamic changes induced by transobturator insertion of suburethral tape a dip-stick under-urethral.MATERIALS AND METHODS:25 women with pure (12) or mixed (13) stress urinary incontinence were operated by this technique, allowing urodynamic assessment and completion of the MHU urinary disability questionnaire. Three operators performed these 25 tape insertions in 2 centres (Amiens and St Quentin hospitals) according to a standardized technique. Six months after the operation, patients were reviewed by clinical examination, MHU questionnaire and urodynamic assessment.RESULTS:The cure rate at 6 months was 80% (20 patients) and the improvement rate was 20% (5 patients). The maximum flow rate decreased from 23.6 ml/s to 18.9 ml/s (p = 0.02) and the post-voiding residual volume increased from 26.8 ml to 66.8 ml (p = 0.01). Urethral resistance increased from 0.16 to. 0.25 (p = 0.03) and maximum closure pressure increased from 43.8 to 47.5 cm H2O (p = 0.02). These results demonstrate the obstructive nature of this suburethral tape. The results of the MHU questionnaire showed accentuation of dysuria (p = 0.04) and improvement of stress urinary incontinence (p < 0.001).CONCLUSION:This prospective study confirms the efficacy of this technique, but analysis of the urodynamic studies and the MHU questionnaire demonstrates obstruction. Long-term surveillance of these patients by uroflowmetry and residual urine appears to be useful to detect possible progression to chronic urinary retention.

The coexistence of several tumours in the same patient is a rare phenomenon and corresponds to the multiple primary tumour (MPT) syndrome. The most frequently diagnosed MPT include gastrointestinal tumours associated with urological tumours. Overexpression of the STAG1 gene could explain the development of several solid tumours and could be the origin of the multiple primary tumour syndrome. A suspicious renal mass discovered at the same time as a documented cancer is usually a malignant lesion and may justify combined radical surgical treatment. The authors report the natural history of a suspicious renal mass in a patient with primary gastric tumour corresponding to a MPT syndrome. They recall and discuss the epidemiology, pathophysiology, diagnosis and treatment of MPT.

Emphysematous cystitis is a rare disease mainly encountered in poorly controlled diabetics, immunodepressed patients or patients with infravesical obstruction. The pathophysiology of this disease is characterized by the formation of carbon dioxide (CO2) present in the lumen and/or bladder wall, derived from bacterial fermentation of carbohydrates. The bacteria most frequently responsible are facultative aerobes-anaerobes (Escherichia coli) and more rarely strict anaerobes (Clostridium perfringens). The authors report a case of emphysematous cystitis in a context of pelvic trauma and fracture of the pelvis, complicated by secondary bladder rupture. The diagnostic and therapeutic aspects are discussed.