[Laparoscopic spermatic vessel ligation in the treatment of varicocele: report of 129 procedures]

With the improvement of laparoscopic techniques in the hands of urologists, a minimally invasive therapy can be offered to patients. We report retrospectively our experience in the laparoscopic treatment of varicoceles. A total of 93 patients with 129 varicoceles were treated by a laparoscopic approach, the mean age was 29 years (12-47), with 57 left varicoceles and 36 bilateral varicoceles. Indications for treatment were infertility in 51 patients and pain in 42 cases. The mean duration of the operation was 40 min (25-85) for bilateral varicoceles, and 24 min (15-65) for left varicoceles. All our patients were operated the day of their admission and 52 patients left the hospital 8 h after the intervention. We report 2 incidents with conversion to open surgery in one case. The pregnancy rate after surgery in patients with infertility was 21%, the recurrence rate was 4%. Laparoscopic spermatic vein ligation in the treatment of varicocele is a minimally invasive procedure, simple, fast and is not a contraindication for other procedures in case of recurrence.

Megapenis associated to corpus spongiosum agenesis with scrotal and pelvic hemangiomas

An exceptional case of megapenis associated with corpus spongiosum agenesis and multiple hemangiomas of the scrotum, perineum and pelvis is reported. This is the first case in which three exceptional malformations are associated.

[Management of percutaneous nephrolithotomy complications by shock wave lithotripsy. A report of 82 consecutive cases]

In this paper, authors assessed the complication rate of percutaneous nephrolithotomy (PCNL) through a consecutive series of 82 PCNL performed on 80 patients with renal calculi (48 men and 32 women). Patients' mean age was 42 years. Stones were located in the pelvis or lower calyx in 75% of cases with a diameter exceeding 20 mm in 56%. 11 Patients had intraoperative problems: one ureteral false passage, one renal perforation by a ureteral stent, three cases of hemorrhage, three cases of punctate perforations of excretory cavities. In one case, nephrostomy tube fell and could not be replaced. 6 patients had post operative complications: three patients had postoperative fever, one patient developed acute pyelonephritis and two patients had transient urinary leakage after nephrostomy tube removal. After reviewing the literature, authors conclude to the low complication rates of PCNL.

Hydatid cyst of the kidney. A report of 147 controlled cases

OBJECTIVES

We report our experience in the management of 147 hydatid cysts of the kidney over an 11-year period.

MATERIAL AND METHODS

The records of 147 patients operated for hydatid cysts of the kidney between 1985 and 1996 were reviewed in order to address patient's symptoms at presentation, radiological findings, diagnostic tests and surgical outcome. All patients were managed with open surgery. No preoperative or postoperative antiparasitic medication was used.

RESULTS

Lumbar or lumbo-abdominal pain was the most frequent symptom (84%). Hydaturia was observed in 28% of the cases. Preoperative diagnosis was based upon intravenous pyelography (IVP), ultrasound and serology tests. CT scan was performed only in litigating cases (15%). In 20 cases, damage to the renal parenchyma was so extensive as to justify nephrectomy. Abstention concerned 5 involutive type V cysts. The remaining patients had an excision of the prominent part of the cyst (partial cystopericystectomy). Postoperative course was smooth in all cases. Postoperative IVP (3-6 months) showed a restituo ad integrum in 80% of the cases and residual pelvicaliceal distortions in 20%.

CONCLUSIONS

Diagnosis of hydatid cyst of the kidney is based mainly on ultrasonography and IVP. Open surgery is the treatment of choice with excellent results.

[Ambulatory urological surgery]

Ambulatory surgery offers to patients to be treated on an outpatient basis. Strict criterious, social, surgical and medical must be associated to authorize this type of hospitalisation. From January 1998 to December 1999, 1882 patients (46% of our operative activity) were treated on an outpatient basis, to undergo an endoscopic surgery (66%), conventional surgery (20%) or other (14%). 9 patients remain a supplementary night because of post-operative fever in 5 patients and an incomplete recovery in 4 patients. No patient was rehospitalized for complication. In this series, ambulatory surgery has proved its advantages, without loss of patients' security, if selection criterious were respected.

[Bladder pheochromocytoma]

OBJECTIVE

Report of a new case of a rare bladder tumour: bladder phaeochromocytoma.

MATERIAL AND METHODS

A 45-year-old patient presented with paroxysmal symptoms consisting of headaches, palpitations, tinnitus and excessive sweating after each micturition. Complementary investigations: ultrasonography, intravenous urography and magnetic resonance imaging, suggested a circumscribed tumour with a 2 cm long axis in the bladder dome, and the diagnosis of bladder phaeochromocytoma was proposed. Partial cystectomy was performed.

RESULTS

The postoperative course was uneventful and the subsequent outcome was favourable with resolution of all symptoms with a follow-up of 28 months. Histological examination of the operative specimen confirmed the diagnosis of bladder phaeochromocytoma.

CONCLUSION

Bladder phaeochromocytoma is a rare tumour. Treatment of this lesion requires the same preparation as for any other site of phaeochromocytoma. Partial cystectomy ensures radical and effective treatment. Long-term surveillance is necessary, as recurrences or metastases have been described 20 and 40 years after treatment.

[Testicular non-Hodgkin's lymphoma. Report of 2 cases]

We report two cases of non Hodgkin malignant lymphoma of the testis observed in two patients 36 and 32 years old. Diagnosis was made on pathological examination after orchiectomy. One patient had an involvement of the lung and Waldeyer's ring and the other presented cerebral involvement. Despite combination chemotherapy and external beam radiation therapy, the disease progression was rapid and fatal in the first patient (19 months) while the second had multiple cerebral relapses and died by disease progression 21 months after orchiectomy.