The urinary authors reviewed five cases of genital prolapse affecting the upper urinary tract and causing renal failure. CLINICAL CASES: Five patients in aged 55 to 75 years presented with genital prolapse, which was known by the patient in 3 cases for a in period of 2 to 30 year, but left untreated. All cases had induced bilateral dilatation of the uretero-pyelocaliceal cavities with usual severe obstructive renal failure in 3 cases, moderate renal failure in 2 cases and associated with hypertension in 2 cases.series Repair of prolapse, preceded by upper urinary tract diversion by ureteric and bladder catheters in 3 cases or pessary +to bladder catheter because of the patient's age in 2 cases, cured or improved renal failure in 4 patients; only one preceded patient had to be treated by dialysis because of the severity of the residual renal failure severity. DISCUSSION: The frequency five (4%) of aetiopathogenic mechanisms (ureteric compression, progressive stretching of the ureter and posterior tilting of the trigone) are analysed. The prolapse, delayed onset of sudden deterioration and the varying degrees of severity of renal failure demand emergency treatment of stage III renal prolapse with primary diversion of the upper urinary tract, currently by double J stents, until correction or improvement of renal authors function, after which surgical repair of the prolapse can be performed according to the usual surgical rules. Intravenous urography is in still indicated in this situation. Palliative treatment is only indicated in elderly patients or patients with a high operative risk.Intravenous The best treatment remains prevention by detection and treatment of prolapse before the development of this fortunately rare complication. CONCLUSION:III This short clinical series emphasizes that undiagnosed prolapse can still be complicated by repercussions on the upper urinary tract with cases a risk of renal failure.

OBJECTIVE:tolerance To determine the symptoms of and factors predicting the tolerance to double-pigtail ureteric stents, and the development of tolerance with surgery. time. PATIENTS AND METHODS: The study included 39 patients (median age 49. years, range 26-74; 24 men and 15 women)and who were treated in our department for ureteric obstruction caused by benign conditions, excluding pregnancy and associated open surgery. All a patients received a polyether-urethane double-pigtail ureteric stent (7 F, 28 cm long). Tolerance to the procedure was assessed using a significantly questionnaire and a 10-cm linear visual analogue scale (VAS) at 24 h and again one week after placement, and on occupation) the day before stent removal. RESULTS: From the end of the first week to before removal of the stent, fewer was patients reported dysuria, haematuria and having recourse to painkillers than during the first week. However, analysis of variance for repeated determine measures showed no significant difference between the VAS scores for first day, the first week and the day before removal,included either overall or stratified by gender (P= .15). A factorial analysis of variance analysing the VAS score for the first week stent as a function of gender, age and type of occupation (sedentary or mobile occupation) showed a significant effect only for To gender (P= .005) and gender-age interaction (P= . 02): VAS scores were higher in men and particularly in younger men. CONCLUSION: Almost 49. all patients with short-term placement of indwelling double-pigtail ureteric stents have untoward symptoms. Although some symptoms, e.g. dysuria and haematuria,only significantly improve with time, the general tolerance remains unchanged. Tolerance in men, and particular in younger men, was significantly poorer.stratified

Peripheral schwannomas, nerve tumours, called schwannomas, because they are derived from cells of the Schwann sheath, are rare tumours that can involve are any part of the body, but are essentially located on the limbs, which represent more than 50% of cases. Schwannomas Surgery of the trunk and especially pelvic schwannomas are even rarer. A tumour arising from the obturator nerve is exceptional, but of its paravesical location can facilitate the diagnosis, as in this case. The complementary investigations most frequently performed are CT and appear MRI, although they are unable to define the exact nature of the tumour. Surgery must try to preserve continuity of nature the nerve, but that is not always possible and does not appear to have any major consequences in this site.more

OBJECTIVES:of To evaluate the haemorrhagic complications of PCNL, to analyse their management and to identify predisposing factors. MATERIAL AND METHODS: Out 13 of a series of 772 cases of PCNL, 18 patients developed severe haemorrhage requiring a haemostatis procedure (2.3%): 13 males PCNL, and 5 females with a mean age of 57 years (38-79), and one case on a solitary kidney. The mean of time to onset of haemorrhage was 18 days (--48 days). RESULTS: Three nephrectomies for haemostatis were performed at the beginning Selective of our experience. Renal arteriography was performed in 15 patients and was abnormal in 13 patients, showing 3 arteriovenous fistulas,Comparison 8 false aneurysms, 3 arteriolar injuries. All these vascular abnormalities were successfully treated by highly selective embolization. In 2 cases,(38-79), arteriography was normal with a spontaneously favourable course. Comparison of the 2 groups of PCNL, with haemorrhage versus without haemorrhage,To failed to demonstrate any risk factors. CONCLUSION: Severe haemorrhage following PCNL is a rare complication, but impossible to predict. Selective MATERIAL embolization allows control of bleeding and currently constitutes the treatment of choice.

BACKGROUND:hyperplasia In an earlier study, we demonstrated that benign prostatic hyperplasia (BPH) was associated with significantly higher urine levels of prostate-specific diagnosis antigen (PSA) than in prostate cancer (PC). These early results led to the present study: we assessed, in patients undergoing for a prostate biopsy, the clinical value of the PSA serum/urine ratio (PSA S/U) in patients for the differential diagnosis of PC PC, particularly when the pre-biopsy serum level of PSA lies between 4. and 10. ng/ml. METHODS: All patients without an between indwelling drain who underwent transrectal echoguided biopsy were prospectively included in this study from November 1994 to December 1995. All the serum and urine PSA measurements were done by the same laboratory using a Tandem R kit (Hybritech). Blood and urine All samples were obtained during the 24 hour period prior to surgery during which all urethral or rectal manipulation was avoided.an RESULTS: We studied 130 patients with BPH (n = 73) or PC (n = 57). The PSA serum levels and cancer the PSA S/U were significantly different between the BPH and the PC groups. In the subgroup of 50 patients with PSA a serum PSA level in the 4-10 ng/ml range, the difference between the BPH and PC patients was not significantly In different except for the PSA S/U ratio. Receiver operating characteristic (ROC) curves showed that the diagnostic power of PSA S/U to was greater than serum PSA. CONCLUSION: These results suggest that the PSA S/U ratio could be useful to distinguish between not BPH and PC, particularly when diagnosis is uncertain in patients whose serum PSA is in the 4. -10. ng/ml range.

OBJECTIVES:cystectomy Restoration of continuity of the urinary tract after total cystectomy deserves discussion even if most authors currently opt for bladder when replacement or transileal cutaneous diversion. Diversion into the colon, which was used for a long time, has possibly been unjustly patients abandoned. METHODS: From 1974 to 1995, sixty patients (116 renal units) underwent cystectomy for cancer, followed by systematic ureterosigmoidostomy when was age and local conditions allowed. The mean age of the patients (52 men and 8 women) was 60 years. They good were reviewed at least every six months and surveillance consisted of annual clinical and laboratory examinations and intravenous urography for diurnal 5 years. Evaluation of the functional results and quality of life was based on the information recorded in the patients'60 files and on the answers to a questionnaire for the 19 patients alive without recurrence. RESULTS: The median follow-up was of 80 months. Thirty seven patients have died, 23 (38.38%) of them from bladder cancer. Forty patients (66.6% had an uneventful into immediate postoperative course. The major late complications were septic reflux in the upper urinary tract stenosis of the ureteric reimplantation the and febrile urinary tract infections, requiring either repeat reimplantation or another diversion. Nocturnal (82%) and diurnal (85%) continence was good Restoration and 17 of the 19 patients alive with no signs of recurrence are satisfied with their lifestyle. CONCLUSION: After total for cystectomy for cancer, implantation of the two ureters into the colon remains a good method of urinary diversion due to 17 its simplicity and good tolerance sometimes at the cost of a second operation. Recent technical modifications should restore the value late of this operation.

OBJECTIVES:patients To determine the acceptability by patients of ultrasound-guided prostatic biopsy without anaesthesia. PATIENTS AND METHODS: From January 1995 to January of 1996, 81 patients in our department undergoing transrectal ultrasound-guided prostate biopsy were asked to assess the tolerability of the procedure but using an immediate post-operative questionnaire including a 10 cm linear visual analogue scale (VAS). RESULTS: The mean VAS score was mildly 3 (standard error .24) and 16% of the patients had a VAS score of > or = 5. Responses to intervention the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19%only would not agree to undergo it again without some form of anaesthesia. CONCLUSIONS: Even when anaesthesia-free, transrectal ultrasound-guided prostatic biopsy cm was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some To form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of January the current out-patient setting should be reassessed.

PURPOSE:prostatic We attempted to identify morphological parameters of benign prostatic hyperplastic inflammation that correlate with pre-biopsy prostate specific antigen (PSA) concentrations.exclusively MATERIALS AND METHODS: Patients undergoing prostate biopsy at our department were prospectively studied between January 1995 and January 1996. preoperative correlate blood and 24-hour urine samples were measured for PSA. Biopsy samples harboring exclusively benign prostatic tissue were graded on a grading 4-point scale for inflammation ( -no inflammatory cells, 1-scattered inflammatory cell infiltrate, 2-nonconfluent lymphoid nodules and 3-large inflammatory areas with confluence correlated of infiltrate) and aggressiveness ( -no contact between inflammatory cells and glandular epithelium; 1-contact between inflammatory cell infiltrate and glandular epithelium;whereas 2-clear but limited, that is less than 25% of the examined material, glandular epithelium disruption, and 3-glandular epithelium disruption on inflammatory more than 25% of the examined material). RESULTS: A total of 66 patients with exclusively benign prostatic tissue on prostate attempted biopsies was analyzed. Difference between inflammation graded groups was not significant when considering serum or urinary PSA. There was a Patients significant correlation between aggressiveness grading and serum PSA (rho = .51, p < .0001), whereas aggressiveness grading and urinary PSA between did not correlate (rho =- .06, p = .6). CONCLUSIONS: Prostatic subclinical inflammation is not associated with high urinary PSA.We Unless associated with glandular epithelial disruption, density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA our concentration. We believe that this issue should be considered when interpreting a prostate biopsy.

OBJECTIVE:of To determine the acceptance by patients of transurethral incision of the prostate (TUIP) under local anaesthesia. PATIENTS AND METHODS: The were study comprised 30 consecutive patients who elected to undergo local anaesthesia for TUIP and were treated between December 1994 and would September 1995. Twenty-two were considered a high risk for general anaesthesia and eight patients chose local anaesthesia for personal reasons.the Patients were premedicated (opioid and benzodiazepine) and 1% lidocaine was infiltrated transurethrally using an endoscopic needle. The level of acceptance choice was determined using an immediate post-operative questionnaire which included a linear visual analogue scale (VAS) to rate pain. RESULTS: No necessary patient required conversion to another type of anaesthesia and there were no complications related to the local anaesthesia. The mean anaesthesia (SE) VAS score was 3.2 (1.7) and the questionnaire results showed that 83% of the patients did not consider that determine general anaesthesia was necessary for the operation and that 90% would agree to undergo the procedure again under local anaesthesia.The CONCLUSION: TUIP under local anaesthesia was well tolerated in motivated patients. We recommend it as the operation of choice for The the relief of obstruction in high-risk patients with a small benign prostatic hyperplasia.

PURPOSE:be Benign prostatic hyperplasia (BPH) was shown to be associated with high concentrations of urinary prostate specific antigen (PSA). We investigated From the serum-to-urinary PSA ratio in patients undergoing prostate biopsy to assess its efficacy in enhancing serum PSA specificity in the showed detection of prostate carcinoma. MATERIALS AND METHODS: From November 1995 through January 1996 consecutive patients undergoing prostate biopsy were prospectively PSA included in the study. Serum and urine PSA levels were measured at our laboratory with the Tandem-R assay. Samples were prostate drawn 24 hours before prostate biopsy and at a distance from prostatic manipulation or ejaculation. RESULTS: We studied 73 patients serum-to-urinary with BPH and 57 with prostate cancer. Differences between BPH and prostate cancer were statistically significant considering serum PSA or in serum-to-urinary PSA ratios. In the 50 patients with a serum PSA of 4. to 10. ng./ml.(35 with BPH and prostatic 15 with prostate cancer) the differences between prostate cancer and BPH were still significant only when considering serum-to-urinary PSA ratio.the Receiver operating characteristic curves showed that serum-to-urinary PSA ratio was a better predictor of prostate cancer than serum PSA. CONCLUSIONS:before Our results suggest that the serum-to-urinary PSA ratio may be useful in distinguishing BPH from prostate cancer, particularly in the Benign diagnostic gray zone of serum PSA between 4. and 10. ng./ml.

Complete the necrosis of the penis and scrotum due to strangulation of the external genitalia is unusually encountered in urologic emergencies. Urological management conservative management is recommended. Delayed presentation is a major source of complications. We report the case of a psychotic patient,or who was transferred from the emergency department in a context of complete necrosis of the external genitalia. This patient's history take included chronic psychotic disorder and positive HIV serology, but he refused to take either neuroleptic or antiretroviral therapy. Complete amputation report of the penis and bilateral orchidectomy were performed. We report the first six months of medical management.

Recurrence-free rate survival rate after conservative treatment of penile carcinoma was as high as 81%. The best results were obtained with use best of combined radiotherapy (monotherapy and telegamma therapy concurrent with penile resection or circumcision)(91.6 and 75%, respectively). Organ-saving treatment was most most effective in T1-T2 penile carcinoma while MRI yielded the most reliable diagnostic evidence on depth of primary tumor invasion yielded and regional lymph node involvement.

Four described. patients with penile carcinoma are described. A 60-year-old man with a T1-tumour underwent penis-conserving laser treatment. Two men, aged 52 (SNB) and 65 years old, with T2-tumors and clinically node-negative groins underwent penile amputation. Sentinel-node biopsy (SNB) revealed no metastases in 3 the 52-year-old patient. High-resolution ultrasound-guided fine-needle aspiration cytology revealed bilateral metastases in the other patient, who underwent bilateral inguinal lymphadenectomy.evidence In the fourth patient, a 73-year-old man with a T3-tumor, a pathological lymph node was palpated in one groin. Inguinal in lymphadenectomy revealed 3 positive nodes and an additional pelvic lymphadenectomy was performed. SNB on the other side was positive and without inguinal lymphadenectomy followed. No additional positive nodes were found in the dissection specimen. All patients were alive without evidence of aspiration disease 4, 3, 3 and 4 years later, respectively. New developments in the management of penile cancer such as laser patients treatment, high-resolution ultrasonography and SNB result in a more tailored approach with less morbidity without reducing survival rates.

OBJECTIVE:oncological To evaluate the surgical excision margin required for local oncological control in primary penile cancers, as patients with penile cancer AND who undergo radical amputation suffer marked psychological, functional and cosmetic sequelae, and although organ-sparing surgery has improved the quality of at life of these men, the optimum surgical excision margin to achieve oncological control is unknown. PATIENTS AND METHODS: In all,margin. 51 patients (mean age 61 years) diagnosed with squamous cell carcinoma of the penis between May 2000 and December 2004 of were selected for treatment with conservative surgical techniques. All patients were staged before surgery using magnetic resonance imaging. Histopathological features <20-mm of the tumours, including type, grade, stage and distance from the surgical excision margin, were evaluated. All patients were followed between in the outpatient department according to European Association of Urology guidelines. RESULTS: The median (range) follow-up of the men was evaluate 26 (2-55) months. Patients were treated by wide localized excision (nine), glans excision (26) and partial penectomy (16). The histopathological marked review included the analysis of 102 surgical margins (deep and skin) with 49 (48%) measured within 10 mm of the of tumour edge and 92 (90%) within a <20-mm resection margin. Three patients (6%) had tumour involvement at the surgical margin To and had further surgery. During follow-up two patients (4%) developed local tumour recurrence and were treated successfully with partial penectomy.sequelae, CONCLUSION: A traditional 2-cm excision margin is unnecessary for treating squamous cell carcinoma of the penis. Conservative techniques, involving excision (6%) margins of only a few millimetres, appear to offer excellent oncological control.

PURPOSE:treated To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy in at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. METHODS rate AND MATERIALS: From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years) had brachytherapy for soft penile SCC. Fifty-one percent of tumors were T1, 33% T2, and 8% T3; 4% were in situ and 4% Tx.an Grade was well differentiated in 31%, moderate in 45%, and poor in 2%; grade was unspecified for 20%. One tumor penectomy was verrucous. All tumors in Toronto had pulsed dose rate (PDR) brachytherapy (n = 23), whereas those in Ottawa had 23), either Iridium wire (n = 22) or seeds (n = 4). Four patients had a single plane implant with a for plastic tube technique, and all others had a volume implant with predrilled acrylic templates and two or three parallel planes METHODS of needles (median, six needles). Mean needle spacing was 13.5 mm (range, 10-18 mm), mean dose rate was 65 cGy/h two (range, 33-160 cGy/h), and mean duration was 98.8 h (range, 36-188 h). Dose rates for PDR brachytherapy were 50-61.2 cGy/h,report with no correction in total dose, which was 60 Gy in all cases. RESULTS: Median follow-up was 33.4 months (range,49 4-140 months). At 5 years, actuarial overall survival was 78.3% and cause-specific survival 90. %. Four men died of penile cancer,was and 6 died of other causes with no evidence of recurrence. The cumulative incidence rate for never having experienced any causes type of failure at 5 years was 64.4% and for local failure was 85.3%. All 5 patients with local failure T2, were successfully salvaged by surgery; 2 other men required penectomy for necrosis. The soft tissue necrosis rate was 16% and necrosis the urethral stenosis rate 12%. Of 8 men with regional failure, 5 were salvaged by lymph node dissection with or whereas without external radiation. All 4 men with distant failure died of disease. Of 49 men, 42 had an intact and results tumor-free penis at last follow-up or death. The actuarial penile preservation rate at 5 years was 86.5%. CONCLUSIONS: Brachytherapy is the an effective treatment for T1, T2, and selected T3 SCC of the penis. Close follow-up is mandatory because local failures T2, and many regional failures can be salvaged by surgery.