OBJECTIVE: The aim of the study was to characterize the metabolic changes in non-weight-losing patients with cancer of the bladder and to investigate the effect of tumor stage.METHODS: The kinetics of glucose, glycerol, and urea metabolism were assessed in 22 weight-stable patients with non-metastatic bladder cancer (tumor stage p less than or equal to T2; n = 8; tumor stage p > T2, n = 14) and 10 patients with benign uterine myoma (controls). The kinetics of glucose, glycerol, and urea metabolism were assessed by [6,6-H-2(2)]glucose, [1,1,2,3,3-H-2(5)]glycerol, and [N-15(2)]urea. Plasma concentrations of glucose, glycerol, urea, lactate, free fatty acids, insulin, glucagon, cortisol, epinephrine, and norepinephrine also were determined.RESULTS: Plasma concentrations of glucose, urea, and insulin were higher in cancer patients than in controls (P < 0.05). Whereas glucose production was similar in both groups, glucose clearance was lower in patients with bladder cancer (P < 0.05). Glycerol turnover rate was comparable between groups. Whole-body urea synthesis rate was higher in the cancer group than in the control group (P < 0.05), but there was no difference in urea synthesis when calculated per kilogram of fat-free body mass. Plasma concentrations of glycerol, lactate, free fatty acids, glucagon, cortisol, epinephrine, and norepinephrine were similar in both groups. There was no difference in any parameter between patients with an early tumor stage (p < T2) and patients with a later tumor stage (p > T2).CONCLUSION: Patients with bladder cancer had a lower rate of glucose clearance than did control subjects. Lipid metabolism was not affected, whereas urea synthesis rate was elevated in cancer patients. However, when expressed per kilogram of. fat-free body mass, no difference in protein breakdown could be observed. The tumor stage had no effect on glucose, lipid, or protein metabolism.

External pelvimetry can be used to predict the technical difficulty of retropubic radical prostatectomy and the results should be taken into account in the treatment plan.

OBJECTIVE:Hautmann neobladder is one of the most widely bladder replacement techniques in the two sexes. The uretero-ileal stenosis rate is estimated to be 11% with the initial CAMEY-LE DUC technique. A new anastomosis technique is presented in order to improve this postoperative complication. MATERIALS AND METHODS:Two 5 to 10 cm ileal segments are prepared at the two extremities of the W of the neobladder to receive the largely spatulated ureters. The anastomosis is performed directly on the ileal resection margin, in a strictly retroperitoneal position. Between December 1996 and December 1998, the technique was performed in 89 patients including 19 women. One hundred and sixty six renal units (RU) were analysed by preoperative renal ultrasound, repeated after 1, 3 and 6 months and then every 6 months. Urine culture was performed monthly for 6 months. RESULTS:Thirteen RU were dilated (grade II and III) preoperatively (7.8%). No secondary anastomotic stenosis was observed with a mean follow-up of 5.8 +/- 7.6 months. Of the 166 RU examined, 129 were normal, 13 preoperative dilatations were improved and 24 RU presented minimal postoperative dilatation (grade I). Ileo-ureteric reflux was observed on the postoperative retrograde cystography in two cases. The only complication was acute pyelonephritis (1.1%) at 1 month. 90% of urine cultures were sterile after 6 months. CONCLUSION:Modification of uretero-ileal anastomosis by the "double chimney" technique is performed without tension by placing the two ureters in an anatomical position without plication or torsion. Preservation of the ureteric blood supply contributes to the low complication rate and a decreased risk of stenosis. However, the technique needs to be validated by analysis of the results with a longer follow-up.

Summary Introduction & objectives: For advanced prostatic carcinoma with subvesical obstruction the treatment of choice is ablative hormonal therapy. However, three months after ablative therapy, roughly one-third of patients still have subvesical obstruction serious enough to require treatment. The classical procedure, transurethral resection of the prostate, should not be used without careful considera- tion, especially in high risk patients. Material & methods: From June 1992 to June 1999 we treated 43 patients with advanced prostatic carcinoma and persi- stent subvesical obstruction despite androgen ablation. The mean patient age was 74.3 years (53-89). Because of serious concurrent diseases, 48.7 % of these patients were classified under ASA 3 risk status and 51.3 % under ASA 4, as defined by the criteria of the American Association of Anaesthesiology. The patients were treated by the Memotherm® Stent System, a thermosensitive Nitinol mesh stent. Results: After insertion of the stent 40 (93 %) of the patients were able to void spontaneously. There was statistically significant improvement in micturition parameters. These results remained unchanged over a mean follow up period of 17.2 months (6-58). There were no serious stent associated complications. Conclusions: We conclude that for high risk patients with subvesical obstruction due to a prostatic carcinoma the insertion of a permanent metal stent system offers a useful alternative treatment without the risk of tumour spread.

OBJECTIVE:To evaluate the results obtained using a permanent prostatic stent system (Memotherm, Bard/ Angiomed, Karlsruhe, Germany) in high-risk patients with advanced prostatic carcinoma and subvesical obstruction.PATIENTS AND METHODS:The study included 35 patients (mean age 75.3 years, range 53-89) with advanced prostatic carcinoma and persistent subvesical obstruction despite androgen ablation. Because of serious concurrent diseases, 49% of these patients were classified as American Society of Anesthesiologists (ASA) grade 3 and 51% as ASA grade 4. The patients were treated using the Memotherm stent, a thermosensitive Nitinol mesh stent. The outcome was assessed by measuring voiding variables, a symptom score and as the incidence of complications.RESULTS:After inserting the stent, 33 (94%) of the patients were able to void spontaneously and there was a statistically significant improvement in the voiding variables. These results remained unchanged over a mean (range) follow-up of 15.2 months (3-38). There were no serious complications arising from the insertion of the stent.CONCLUSION:For high-risk patients with subvesical obstruction caused by prostatic carcinoma, the insertion of a permanent metal stent system offers a useful alternative treatment to transurethral resection.

Utilisation de la pelvimetrie externe comme moyen de prediction de la difficulte de realisation d'une prostatectomie radicale retropubienne. Prise en compte dans le schema therapeutique.