Introduction > Infertility in men may be associated with on elevated risk of testicular cancer. The authors report a case of testicular seminoma discovered fortuitously during a workup for infertilityCase > A 30 year-old mole was seen for infertility Physical examination and testicular ultrasonography were normal. The sperm count found oligoasthenospermia related to the excretory ducts. The patient underwent testicular biopsies for infertility which showed on intratubular germ cell tumor Tumor markers (beta HCG, alpha FP LDH) were normal. Computed tomography was normal for the thorax, abdomen, and pelvis. We performed on inguinal orchiectomy The pathology examination found seminoma, at a pT1 stage. one course of chemotherapy followed.Discussion > The incidence of testicular cancer is increasing throughout the world, Recent studies show a strong relation between infertility and on increased risk of testicular cancer and some authors even suggest a causal relation.

Evaluer les résultats à moyen terme des cures de cystocèle de grade 3 et 4 (classification de Baden-Walker), traitée par voie basse à l’aide de plaque de xénogreffe porcine (Pelvicol™). Entre février 2002 et octobre 2005, cinquante patientes présentant une cystocèle de grade 3 ou 4 ont été traitées par plaque de Pelvicol. En préopératoire, le grade du prolapsus et la symptomatologie (urinaire et pesanteur pelvienne) ont été notés et un questionnaire d’étude de sexualité a été rempli de façon rétrospective (questionnaire BISF-W). Toutes les patientes ont été revues en consultation à 1 mois et à la date du dernier suivi. La réussite du geste chirurgical est définie par les grades 0 et 1 postopératoire. La symptomatologie et la sexualité ont été comparées en pré et post opératoire. La morbidité suite a l’intervention a été relevée. La réussite du geste chirurgical a été comparée chez les patientes opérées pour la première fois et chez les patientes en récidive. Résultats: L’âge moyen était de 69,4 ans. Vingt neuf patientes présentaient une cystocèle de grade 3 (58%), et 21 patientes une cystocèle de grade 4 (42%). La symptomatologie pré opératoire était une dysurie (32%), des signes d’hyperactivité vésicale (22%) et était accompagnée d’une incontinence urinaire d’effort symptomatique (36%) ou masquée (20%). La pesanteur pelvienne était présente dans 100% des cas. Un geste associé a été nécessaire dans 70% des cas (29 bandelettes sous urétrales, 6 cures de rectocèle, 3 hystérectomies vaginales).Le suivi moyen était de 27.2 mois (IC95% [23.3-31.l]).Aucune complication per et post opératoire n’a été observée. Pendant le suivi, aucun rejet du matériel, érosion vaginale ou problème de cicatrisation n’ont été relevés. Le taux de réussite chirurgicale était de 94% (37 grades 0 et 10 grades 1). La dysurie et la pesanteur pelvienne ont été améliorées significativement. Sur 10 femmes ayant une sexualité pré opératoire, aucune ne signalait de gêne en post opératoire. Parmi les 50 patientes opérées, 35 (70%) ont été traitées en première intention par Pelvicol™ et 15 étaient des récidives (30%), aucune différence significative de réussite chirurgicale n’a été retrouvée (94,3% versus 93,4%). L’utilisation d’une plaque de xénogreffe porcine (Pelvicol™) semble être une technique sûre et efficace à moyen terme dans le traitement de première intention des cystocèles grades 3 et 4. To evaluate the medium-term results of grade 3 and 4 (Baden-Walker classification) cystocele repair by transvaginal porcine xenograft matrix (Pelvicol). Between February 2002 and October 2005, fifty patients with grade 3 or 4 cystocele were treated by Pelvicol matrix. The preoperative grade of prolapse and symptoms (urinary and pelvic heaviness) were recorded and a sexuality questionnaire was completed retrospectively (BISF-W questionnaire). All patients were reviewed in the outpatients department at 1 month and at the date of last follow-up. The success of the surgical procedure was defined by postoperative grades 0 and 1. Preoperative and postoperative symptoms and sexuality were compared. The operative morbidity was recorded. The success of the surgical procedure was compared in patients operated for the first time and in redo patients. The mean age was 69.4 years ; 29 patients had a grade 3 cystocele (58%), and 21 had a grade 4 cystocele (42%). Preoperative symptoms consisted of dysuria (32%) and symptoms of overactive bladder (22%), accompanied by symptomatic (36%) or asymptomatic (20%) stress urinary incontinence. Pelvic heaviness was present in 100% of cases. An associated procedure was necessary in 70% of cases (29 suburethral tapes, 6 rectocele repairs, 3 vaginal hysterectomies). Mean follow-up was 27.2 months (95%CI [23.3-31.1]). No intraoperative or postoperative complications were observed. During follow-up, no cases of rejection of material, vaginal erosion or delayed healing were observed. The surgical success rate was 94% (37 grade 0 and 10 grade 1). Dysuria and pelvic heaviness were significantly improved. None of the 10 women who were sexually active preoperatively reported postoperative discomfort. Among the 50 operated patients, 35 (70%) were treated by Pelvicol as first-line procedure and 15 were redo procedures (30%); no significant difference in surgical success rate was observed between these two groups (94.3% versus 93.4%). The use of a porcine xenograft matrix (Pelvicol) appears to be a safe and effective technique in the medium term for first-line treatment of grade 3 and 4 cystocele.

In prostate cancer, use of FDG, the radiopharmaceutical currently most widely used in oncology, is limited to the most aggressive cancers and, in the absence of another tracer, to attempting to localise occult recurrences detected biochemically (elevated PSA serum levels).

INTRODUCTION:Infertility in men may be associated with an elevated risk of testicular cancer. The authors report a case of testicular seminoma discovered fortuitously during a workup for infertility. CASE:A 30 year-old male was seen for infertility. Physical examination and testicular ultrasonography were normal. The sperm count found oligoasthenospermia related to the excretory ducts. The patient underwent testicular biopsies for infertility, which showed an intratubular germ cell tumor. Tumor markers (beta HCG, alpha FP, LDH) were normal. Computed tomography was normal for the thorax, abdomen, and pelvis. We performed an inguinal orchiectomy. The pathology examination found seminoma, at a pT1 stage. One course of chemotherapy followed. DISCUSSION:The incidence of testicular cancer is increasing throughout the world. Recent studies show a strong relation between infertility and an increased risk of testicular cancer, and some authors even suggest a causal relation.

In prostate cancer, use of FDG, the radiopharmaceutical currently most widely used in oncology is limited to the most aggressive cancers and, in the absence of another tracer to attempting to localise occult recurrences detected biochemically (elevated PSA serum levels). Four other PET tracers ore currently suggested in various situations of prostate cancer development: for guiding biopsies, for diagnosis and staging of the primary cancer and of local or metastatic recurrences, especially in bone, and for localizing occult biochemical recurrence. This article is illustrated by cases summonsing our experience with fluoromethylcholine-(18F) and PET/CT. They cover a wide spectrum of clinical settings: localisation of intraprostatic neoplastic lesions, initial staging, monitoring treatment by ultrasound, detection of occult recurrences and characterisation of images on conventional imaging modalities, which ore questionable or difficult to interpret.

OBJECTIVE:To evaluate the medium-term results of grade 3 and 4 (Baden-Walker classification) cystocele repair by transvaginal porcine xenograft matrix (Pelvicol).MATERIALS:Between February 2002 and October 2005, fifty patients with grade 3 or 4 cystocele were treated by Pelvicol matrix. The preoperative grade of prolapse and symptoms (urinary and pelvic heaviness) were recorded and a sexuality questionnaire was completed retrospectively (BISF-W questionnaire). All patients were reviewed in the outpatients department at 1 month and at the date of last follow-up. The success of the surgical procedure was defined by postoperative grades 0 and 1. Preoperative and postoperative symptoms and sexuality were compared. The operative morbidity was recorded. The success of the surgical procedure was compared in patients operated for the first time and in redo patients.RESULTS:The mean age was 69.4 years; 29 patients had a grade 3 cystocele (58%), and 21 had a grade 4 cystocele (42%). Preoperative symptoms consisted of dysuria (32%) and symptoms of overactive bladder (22%), accompanied by symptomatic (36%) or asymptomatic (20%) stress urinary incontinence. Pelvic heaviness was present in 100% of cases. An associated procedure was necessary in 70% of cases (29 suburethral tapes, 6 rectocele repairs, 3 vaginal hysterectomies). Mean follow-up was 27.2 months (95%CI [23.3-31.1]). No intraoperative or postoperative complications were observed. During follow-up, no cases of rejection of material, vaginal erosion or delayed healing were observed. The surgical success rate was 94% (37 grade 0 and 10 grade 1). Dysuria and pelvic heaviness were significantly improved. None of the 10 women who were sexually active preoperatively reported postoperative discomfort. Among the 50 operated patients, 35 (70%) were treated by Pelvicol as first-line procedure and 15 were redo procedures (30%); no significant difference in surgical success rate was observed between these two groups (94.3% versus 93.4%).CONCLUSION:The use of a porcine xenograft matrix (Pelvicol) appears to be a safe and effective technique in the medium term for first-line treatment of grade 3 and 4 cystocele.

The incidence of stones after urinary diversion is variable but considerable. The authors report the case of a patient with a stone of the uretero-sigmoid junction of a Mainz II pouch occurring three years after radical cystectomy for recurrent carcinoma in situ refractory to conservative treatment. The patient was treated by anterograde Holmium:YAG laser flexible ureteroscopy. This clinical case illustrates the role of anterograde flexible ureteroscopy combined with Holmium:YAG laser as a minimally invasive, sale and effective technique for the management of stones in a urinary diversion.

Multiple endocrine neoplasia (MEN) is defined by the presence of at least two functionally unrelated endocrine gland tumours in the same subject. There are three types of MEN. MEN type 1 (or Wermer syndrome) is an autosomal dominant cancer syndrome. In the light of a case report, the authors recall the characteristics of MEN type 1 responsible for severe and recurrent urolithiasis and emphasize the need for systematic aetiological work-up for all patients presenting a first episode of urolithiasis according to the guidelines of the Association Française d'Urologie Stone Committee (CLAFU).

Objective To evaluate the prevalence, prognosis and possible risk factors of renal cell carcinoma (RCC) of the native kidney in renal transplant recipients.Patients and Methods We retrospectively re-examined the follow-up data of 373 consecutive renal transplant recipients at our institution between August 1993 and September 2004. We collected the data of all de novo RCC of the native kidney in the current analysis.Results Of the 373 patients examined, 12 tumours of the native kidney were diagnosed in 10 individuals. The mean ages at transplantation and diagnosis were 33 and 45.8 years, respectively. Thirteen malignancies were discovered fortuitously. Among the renal ultrasonograms there were two false-negative results. The mean tumour size was 21 mm. Nephrectomy was performed in all cases. Among the 12 kidney malignancies, there were five conventional RCCs and seven papillary RCCs. Half of all tumours were Furhman Grade 3 lesions, and pT1aN0M0 tumours also accounted for all malignancies in the current cohort. One of the 10 patients died, from progression of metastases 6 years after diagnosis. One patient had a local recurrence 2 years after diagnosis. The other eight patients were alive with no evidence of disease at the time of the current report. No significant relationship was detected between RCC occurrence and clinical patient characteristics.Conclusions There appears to be a greater risk of RCC of the native kidney in patients with end-stage renal disease. The present results suggest that an annual examination of the native kidney before and after renal transplantation is essential.

Transitional cell carcinomas of the upper urinary tract are rare tumours that represent about 5% of all transitional cell carcinomas. The reference treatment is currently); open nephroureterectomy. Low-grade or superficial urinary tract tumours have a good prognosis, similar to that of noninvasive bladder tumours (80% 5-year specific survival). The surgical management of upper urinary tract tumours is gradually evolving towards complete preservation of the tipper urinary tract and renal parenchyma, when compatible with local conditions. Conservative endoscopic treatments (ureteroscopy, percutaneous treatment) provide good oncological results and constitute a possible alternative to nephroureterectomy for the systematic management of good prognosis tumours. The cost of endoscopy equipment and consumable items is currently a limiting factor to the widespread use of these techniques.

Introduction: Endoscopic placement of ureteric stents was first described in 1967 by Zimskind. Few studies have evaluated the impact of double J ureteric stents on the patient's quality of life. This prospective study was designed to evaluate the safety and morbidity associated with ureteric stents.Patients and Methods: From February 2001 to June 2003, 115 patients (64 men and 51 women; mean age: 49.5 years [range: 19-90]) were included in this study. Ureteric stents were placed under general anaesthesiafor urolithiasis (80 cases), ureteroplasty (25 cases) and extrinsic ureteric compression (10 cases). 28 cm 7F polyurethane stents were used in every case. Patients with double J stent for renal transplantation or pregnancy were excluded. The safety of stents was evaluated on the day of removal by a questionnaire based on a 100 mm visual analogue scale (VAS).Results: The mean duration of stenting was 91.8 days (range: 10-287). Macroscopic haematuria was reported in 56% of cases, dysuria was reported in 36% of cases and urgency was reported in 78% of cases. The mean score on the VAS was 44 (0-100) for global impression, 41 (0-100) for bladder pain, 41 (0100)for low back pain, 62 (2-100) for low back pain during micturition and 32 (0-100) for straining on the stent.Conclusions: Double J stents are associated with high morbidity, which is sometimes underestimated by operators. Our study confirms that the duration of stenting must be as short as possible in order to improve patient comfort, which implies rapid organization of the aetiological management of these patients.

Renal cell carcinomas account for 4.6% of post-transplant cancers, 10% of which occur in allograft kidneys. We report three such cases among kidney grafts that were performed or followed from 1970 to 2004. In all patients, we performed a partial allograft nephrectomy after consideration of the tumor size, location, and absence of metastases and local extension. Renal function has remained stable, and there has been no sign of graft rejection, tumor recurrence or metastases. The surgery was technically feasible without exposing the patients to increased postoperative risks. The lateral, peripherally located tumor allowed excision without renal hilar dissection or entry into the collecting system. In agreement with data emerging from the literature, the present cases confirm that even in the setting of long-standing immunosuppression, de novo RCC of the kidney graft warrants a minimally invasive approach to spare patients graft loss and return to hemodialysis.

OBJECTIVE Spontaneous renal haematomas are rare. The authors discuss the aetiological diagnosis and management of these haematomas. MATERIAL AND METHODS Seven cases (3 females and 4 males) of spontaneous renal haematoma were managed between July 1999 and December 2002 and the case files were studied retrospectively. RESULTS The circumstances of discovery were nonspecific. One patient presented with haemorrhagic shock. Radiological work-up comprised abdominal ultrasound and CT scan in almost every case. Ultrasound failed to demonstrate the aetiological diagnosis. CT revealed the cause of bleeding in 7 cases. MRI was performed in 4 cases, but urgent angiography was not performed. Four total nephrectomies were necessary, while two patients were treated by conservative surgery. One patient was simply followed by repeat CT scan. The short-term course was favourable with a mean follow-up of 23 months. CONCLUSION Spontaneous renal haematomas raise 2 problems, that of their aetiology: tumours are the commonest causes (angiomyolipoma and renal cell carcinoma), and that of their management. Three therapeutic approaches are possible: radical surgery in the case of uncontrollable bleeding, conservative surgery or surveillance in the absence of a life-threatening emergency and when the aetiological diagnosis has not been established. Rigorous and repeated radiological surveillance can identify the cause of the bleeding allowing conservative surgery to be performed when indicated.

Animal bites to the scrotum are rare, but potentially serious. In the light of a personal case, the authors discuss the management of these lesions. An animal bite comprises a triple infectious risk: bacterial, tetanus and rabies. Surgical exploration is indicated for assessment of the structures involved and debridement. The morbidity is related to the severity of the bite and the waiting time before consultation, and complications are rare. Orchidectomy is sometimes necessary, as in the case reported here, and the patient must be warned about this possibility. Antibiotic therapy is empirical: tetracycline and anti-anaerobe antibiotic. Rabies and tetanus prophylaxis must be performed according to vaccine guidelines.

Primary hyperparathyroidism (PHPT) is not a rare disease. Renal stones are the most frequent complication of PHPT The authors report the case of a patient with giant parathyroid adenoma responsible for early recurrence of renal stones. Ultrasound examination of the neck, parathyroid MRI and Technetium99m-Sestamibi scintigraphy confirmed the parathyroid adenoma. Surgical exploration allowed resection of a giant adenoma (6.5 x 2.5 x 1.5 cm weighing 17 g). In the light of this case, the authors describe the characteristics of HPT define the place of preoperative imaging and emphasize the need for systematic aetiological work-up looking for HPT in all patients with a first episode of renal stones.

Objective: Flexible ureteroscopy is nowadays an alternative effective option for treatment of upper urinary tract stones, especially in the lower renal pole. Access in this case is often limited by active deflection capabilities of the instrument which is always deteriorated by the passage of different tools through the working channel. Insertion of them limits also the irrigation flow and so that the visibility. These deteriorations vary largely following the tool inserted. We performed an in vitro evaluation of deterioration of active deflection, possibility of tool insertion in maximal active deflection and irrigation flow in 6 different flexible ureteroscopes with almost all of tools available.

spontane du rein. Depuis cette date de nombreux cas ont ete rapportes mais cet evenement clinique reste rare puisque ZHANG ne retrouve que 165 cas dans la litterature anglosaxone entre 1985 et 1999 [17]. Il revele le plus souvent une pathologie renale (93,3%) mais peut survenir sur un rein normal (6,7%) [9]. Il peut s’agir d’un hematome sous capsulaire ou d'un hematome peri-renal. Le but de ce travail a ete de discuter a partir de 7 observations le diagnostic etiologique des hematomes spontanes du rein, la place de l’imagerie et leur prise en charge therapeutique.