British Journal of UrologyVolume 81, Issue 5 p. 760-761 Benign teratoma of the urachus Defabiani, Defabiani Urology Clinic, Department of Surgery,Search for more papers by this author Iselin, Iselin Urology Clinic, Department of Surgery,Search for more papers by this author Khan, Khan Radiology,Search for more papers by this author Pache, Pache Division of Clinical Pathology, Department of Pathology, Geneva University Hospital, Geneva, SwitzerlandSearch for more papers by this author Rohner, Rohner Urology Clinic, Department of Surgery,Search for more papers by this author Defabiani, Defabiani Urology Clinic, Department of Surgery,Search for more papers by this author Iselin, Iselin Urology Clinic, Department of Surgery,Search for more papers by this author Khan, Khan Radiology,Search for more papers by this author Pache, Pache Division of Clinical Pathology, Department of Pathology, Geneva University Hospital, Geneva, SwitzerlandSearch for more papers by this author Rohner, Rohner Urology Clinic, Department of Surgery,Search for more papers by this author First published: 25 December 2001 https://doi.org/10.1046/j.1464-410x.1998.00456.xCitations: 13 Dr Defabiani Urology Clinic, Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume81, Issue5May 1998Pages 760-761 RelatedInformation

Objective: To investigate the vulnerability of abnormal kidneys in blunt trauma, and to determine clinical features which enable identification of patients at risk of renal abnormality, hence modifying their management.Material and Methods: The medical records of 120 patients with blunt renal trauma were reviewed. Presence of pre-existing renal abnormalities, clinical symptoms, contrast study findings, associated injuries and the estimated impact velocity were recorded.Results: Pre-existing renal abnormalities were found in 23 patients (19%). Patients with renal abnormalities had a lower rate of associated trauma to other abdominal organs, a lower Injury Severity Score (ISS) and their kidneys were more frequently injured by low velocity impacts. Of the patients with normal kidneys requiring surgery, hemodynamics and/or severity of the renal lesions triggered the operative indications in all cases, whereas most (57%) of the abnormal kidneys were operated because of their underlying renal pathology.Conclusion: Patients at risk for harbouring renal pathology are characterized by the association of monotrauma, macroscopic hematuria and low impact velocity. In this clinical setting, contrast studies should be generously indicated, since the management of abnormal kidneys unmasked by trauma is, to a large extent, dependent on the type of pathology.

Nous avons traite au Laser KTP 16 patients presentant 20 stenoses de l'uretre anterieur. L'etiologie etait iatrogene dans 50 %, infectieuse dans 20 %, traumatique dans 20 % et inconnue dans 10 % des cas. La stenose siegeait dans l'uretre bulbaire (80 %), dans l'uretre membraneux (10 %) ou dans l'uretre penien (10 %). La vaporisation de la stenose uretrale par le laser a ete effectuee sur toute la circonference de l'uretre si necessaire, suivi d'un drainage vesical par sonde uretrale pendant 24 heures. Tous les patients ont ete revus prospectivement a 3 semaines, 3 mois et a 6 mois (symptomes cliniques, debitmetrie, cystouretrographie). Un succes symptomatique et urodynamique complet aete obtenu chez 13 patients (81 %) a 3 et 6 mois. La stenose a recidive chez 4 patients, mais seulement trois d'entre eux (19 %) ont necessite un traitement (reoperation ou dilatations iteratives). La moyenne de la debitmetrie maximale a passee de 6 cc/s a 20 cc/s a 3 mois et s'est maintenue a 19 cc/s a 6 mois. Nous n'avons a deplorer aucune complication operatoire et postoperatoire. En conclusion, nos resultats confirment que la vaporisation d'une stenose uretrale au laser KTP532 est une methode sure et efficace a moyen terme. Ces bons resultats suggerent egalement un avantage en terme de taux de recidive par comparaison a l'uretrotomie interne. Notre collectif necessite neanmoins d'etre evalue a plus long terme et des etudes prospectives et randomisees comparant les deux methodes devront etre realisees.

The incidence of impotence following transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) was investigated, as well as its correlation with the localization of peroperative capsular perforations and the amount of prostate tissue resected. Patients underwent an interview questioning their potency before and after TURP. For each patient, the TURP technique was reviewed: the localization of eventual capsular perforations was noted and the amount of tissue resected was recorded. Of the 100 patients assessed, 83 were anamnestically potent prior to TURP. Of these, 27 (##%) reported complete loss of erections after operation. Peroperative capsular perforations adjacent to the neurovascular bundles and small-size adenomas correlated significantly with postoperative impotence. The results suggest that capsular perforations adjacent to the neurovascular bundles may be a cause of impotence after TURP, and that patients with small-size adenomas bear a higher risk of post-TURP erectile dysfunction.

The choice of treatment (surgical or conservative) for major renal trauma still remains controversial. The objective of this study was to compare the results of patients with major renal trauma (grade III and IV) primarily treated by surgical intervention (1980-1992) with those in patients mainly treated conservatively (1992-1995). Between 1980 and 1995, 83 patients with major renal trauma were hospitalized at our institution. Our results show a higher nephrectomy rate of 44% in the case of primary surgical intervention compared to conservative management (27%). The outcome of twenty-two patients treated conservatively was analyzed prospectively with repeated radiological imaging, blood pressure profiles, and renal function assessment by means of MAG 3 renal scintigraphy. No patient developed renovascular hypertension and the relative function of the traumatized kidney was greater than 40% in 95% of patients. In conclusion, our results confirm a lower nephrectomy rate in the case of conservative management without any increase of the immediate or long-term morbidity. Major renal trauma (grade III, IV) can therefore be effectively treated by conservative management and primary surgical repair is only indicated in patients with hemodynamic instability, persistent hematuria and associated visceral injuries.

The authors treated 16 patients presenting with a total of 20 anterior urethral strictures using the KTP 16 Laser. The aetiology was iatrogenic in 50% of cases, infectious in 20% of cases, traumatic in 20% of cases and unknown in 10% of cases. The stricture was situated in the bulbous urethra (80%), membranous urethra (10%) or penil urethra (10%). Laser vaporization of the urethral stricture was performed over the entire circumference of the urethra when necessary, followed by bladder drainage by urethral catheter for 24 hours. All patients were prospectively reviewed at 3 weeks, 3 months and 6 months (clinical symptoms, uroflowmetry, cystourethrography). A complete symptom and urodynamic success was obtained in 13 patients (81%) at 3 and 6 months. The stricture recurred in 4 patients, but only three of them (19%) required treatment (reoperation of repeat dilatations). The mean maximum flow rate increased from 6 mL/s to 20 mL/s at 3 months and was maintained at 19 mL/s at 6 months. No intraoperative or postoperative complications were observed. In conclusion, our results confirm that KTP 532 laser urethral strictures is a reliable and effective method in the medium term. These good results also suggest an advantage in terms of the recurrence rate in comparison with internal urethrotomy. However, our series needs to be evaluated with a longer follow-up and prospective, randomized trials comparing the two methods need to be conducted.

The purpose of this study is to report the safety and efficiency of laparoscopic varicocelectomy in 100 consecutive patients operated at a single teaching institution. There were three indications: (1) infertility associated with oligo-astheno-teratospermia (n = 52); (2) chronic dragging sensation of the left testicle (n = 42), and (3) incidental finding of a large varicocele in young adolescents (n = 6). In group 1 the postoperative pregnancy rate was 47% and sperm quantity, concentration and mobility were significantly increased. The efficiency in pain control and clinical outcome amounted to 80 and 100% in groups 2 and 3, respectively. Complications were few and minor. There was no intraperitoneal organ or major vessel injury. The mean length of hospital stay (0.9 days) and median total recovery time (5 days) were remarkably short. In conclusion, laparoscopic varicocelectomy is a safe procedure. It is as efficient as open spermatic vein ligation, and provides the patient with a short hospital stay and quick full recovery.

The choice of treatment (surgical or conservative) for major renal trauma still remains controversial. The objective of this study was to compare the results of patients with major renal trauma (grade III and IV) primarily treated by surgical intervention (1980-1992) with those in patients mainly treated conservatively (1992-1995). Between 1980 and 1995, 83 patients with major renal trauma were hospitalized at our institution. Our results show a higher nephrectomy rate of 44% in the case of primary surgical intervention compared to conservative management (27%). The outcome of twenty-two patients treated conservatively was analyzed prospectively with repeated radiological imaging, blood pressure profiles, and renal function assessment by means of MAG 3 renal scintigraphy. No patient developed renovascular hypertension and the relative function of the traumatized kidney was greater than 40% in 95% of patients. In conclusion, our results confirm a lower nephrectomy rate in the case of conservative management without any increase of the immediate or long-term morbidity. Major renal trauma (grade III, IV) can therefore be effectively treated by conservative management and primary surgical repair is only indicated in patients with hemodynamic instability, persistent hematuria and associated visceral injuries.

The authors treated 16 patients presenting with a total of 20 anterior urethral strictures using the KTP 16 Laser. The aetiology was iatrogenic in 50 % of cases, infectious in 20 % of cases, traumatic in 20 % of cases and unknown in 10 % of cases. The stricture was situated in the bulbous urethra (80 %), membranous urethra (10 %) or penil urethra (10 %). Laser vaporization of the urethral stricture was performed over the entire circumference of the urethra when necessary, followed by bladder drainage by urethral catheter for 24 hours. All patients were prospectively reviewed at 3 weeks, 3 months and 6 months (clinical symptoms, uroflowmetry, cystourethrography). A complete symptom and urodynamic success was obtained in 13 patients (81 %) at 3 and 6 months. The stricture recurred in 4 patients, but only three of them (19 %) required treatment (reoperation or repeated dilatations). The mean maximum flow rate increased from 6 mL/s to 20 mL/s at 3 months and was maintained at 19 mL/s at 6 months. No intraoperative or postoperative complications were observed. In conclusion, our results confirm that KTP 532 laser urethral strictures is a reliable and effective method in the medium term. These good results also suggest an advantage in terms of the recurrence rate in comparison with internal urethrotomy. However, our series needs to be evaluated with a longer follow-up and prospective, randomized trials comparing the two methods need to be conducted.

OBJECTIVE To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Fifty-three patients (median age 67 years, interquartile range 62-72) were included prospectively in a double-blind placebo-controlled study. Pre-operatively, uroflowmetry and cystometrography (CMG) were performed, and the post-void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post-operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day. CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed. RESULTS In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre-operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively. CONCLUSION Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.

The Nd:YAG/KTP laser offers to the surgeon two wavelengths that can be used to coagulate and vaporize. Our objective was to investigate the combined effect of both wavelengths and to determine the irradiation parameters allowing the largest lesion volume. Chicken breast was irradiated ex vivo. 1064 nm and 532 nm Nd:YAG/KTP laser irradiations were performed sequentially at different combinations with variable fluence and compared to isofluent single wavelengths 40 W irradiation. Although the mean total lesion volume showed no difference between the different wavelengths combinations a significant enhancement of the maximum lesion depth was found under combined irradiation in the 20W/20W conditions. Dual wavelengths irradiation with the Nd:YAG/KTP laser thus induces a specific denaturation process which is more directional and results in an increased total lesion depth. This may represent a ne approach to increase the depth of coagulation necrosis and thus the total lesion volume, thereby improving long term results.

L'indication a une cure chirurgicale de varicocele peut etre posee pour trois raisons : sterilite masculine avec oligo-astheno-teratospermie, douleur testiculaire chronique et importante varicocele asymptomatique decouverte fortuitement chez un adolescent. Nous avons analyse les resultats et les complications de la cure de varicocele par laparoscopie pratiquee dans notre institution chez 100 patients consecutifs. En conclusion, il apparait que la chirurgie mini-invasive de la varicocele est aussi efficace et sure que la chirurgie ouverte, et que le duree d'hospitalisation et de convalescence qu'elle occasionne est remarquablement courte.