Prostate-specific antigen density: a means to enhance detection of prostate cancer.

The ability of serum prostate-specific antigen (PSA) and PSA density (PSAD) to distinguish patients with prostate cancer from those with benign diseases of the prostate was assessed in 495 men. All men were evaluated with PSA determination, digital rectal examination (DRE), transrectal ultrasonography (TRUS) and ultrasound-guided prostatic biopsies. PSA was analysed by the polyclonal (Yang) assay.

[Intravesical instillations of BCG and bladder carcinoma in situ].

32 patients with bladder carcinoma in situ (CIS) were treated by intravesical instillations of BCG immun F Pasteur between 1988 and 1991. The CIS was isolated (13 cases, 40.6%) or associated with a pTa papillary tumour (10 cases, 31.

[Treatment of sexual impotency by intra-cavernous injections of prostaglandin E1. Report of 180 patients].

As already reported, PGE1 induces a valid erection, when administered intracavernously, without causing prolonged erection or general side effects. We have tested PGE1 (< 20 micrograms) in 180 patients suffering from organic erectile impotence, a complete erection was observed in 130 (72.2%), while incomplete erection was noted in 37 (20.

[Urinary lithiasis and pregnancy].

The incidence of renal stones in pregnant women is 1 in 1500. The diagnosis may be made more difficult by the particular anatomo-physiological conditions of pregnancy. Ultrasonography is not always sufficient to localise the stone and can be completed by intravenous urography, which is not contraindicated in pregnant women.

Panlobar nephroblastomatosis with cystic dysplasia: an unusual case with diffuse renal involvement studied by immunohistochemistry.

A unilateral cystic renal process discovered prenatally was removed in a neonate. Dysplastic cysts were associated with diffuse (both intra- and perilobar) nephroblastomatosis. We describe a comprehensive immunohistological study confirming the transition observed on simple histology between the different structures: nephrogenic rests (CD9+, CD24+/-, CD56+/-), glomeruloid bodies (CD10++, CD35++), ducts lined by columnar epithelium (CD9+, CD24+, CD56++), cysts lined by cuboidal or thin epithelium (some cells CD10+, CD26+, others EMA+, CD24+).

[Sub-urethral diverticulum in women. Apropos of 6 cases].

Six female patients with a mean age of 40 years presenting with a suburethral diverticulum were treated between August 1990 and October 1992. The commonest functional symptoms were recurrent urinary tract infections (2/3 of cases) and post-voiding urethral discharge (1/2 of cases). Clinical examination revealed a tender anterior vaginal mass in only one half of cases.

Pulmonary sarcoidosis in children: serial evaluation of bronchoalveolar lavage cells during corticosteroid treatment.

The clinical course of sarcoidosis in children has not been well defined. Eight children with symptomatic sarcoidosis included in this study underwent pulmonary function tests and bronchoscopy with bronchoalveolar lavage (BAL) before treatment and during steroid therapy. At the start of therapy, functional parameters, mostly dynamic lung compliance and lung transfer factor for CO, were impaired.

[Is the urodynamic assessment of enuresis in young adults justified?].

Primary or secondary nocturnal enuresis in adults (over the age of 15 years) is rare, but is associated with considerable psychosocial repercussions. The aim of this retrospective study was to determine whether urodynamic studies have any predictive value for the efficacy of the treatments proposed in these patients. This study was based on 20 patients (8 females and 12 males) between the ages of 15 and 33 years (mean: 23.

[Posterior vertical lumbar approach in the treatment of pyelo-ureteral junction syndromes in the adult].

Posterior vertical lumbar incision is an alternative incision for the treatment of hydronephrosis due to ureteropelvic junction anomaly in adults. The authors have performed 18 pyeloplasties via this incision in adults between the ages of 19 and 72 years (mean 36 years). The results of pyeloplasty (88% success rate) were comparable to those obtained via other incisions.

Occupational risks of bladder cancer in France: a multicentre case-control study.

The relationships between occupational risk factors in France and bladder cancer were assessed from a hospital-based case-control study conducted between 1984 and 1987 in five regions representing various industries, including mining, textile manufacture, metallurgy and the production of rubber and chemicals. The study concerned 765 cases (658 men and 107 women) and the same number of controls. Odds ratios (OR) adjusted for matching variables (age, place of residence and hospital), and tobacco smoking were estimated by unconditional logistic regression.

Extraperitoneal endosurgical lymphadenectomy with insufflation in the staging of bladder and prostate cancer.

A new technique of endosurgical pelvic lymph node dissection was performed for the staging of 10 prostate and 8 bladder cancers. The technique, involving an exclusive extraperitoneal space development with CO2 insufflation, is described in detail. Using the standard endosurgical (laparoscopic) equipment, we performed a complete bilateral ilio-obturator lymph node dissection in 15 patients (83%).

[Computerization in private urologic practice with multiple practice locations: the use of medical software and a portable microcomputer].

The authors have used a medical programme, Medistory, since June 1990 to computerize a private urological practice. This programme allows personalization of data collection adapted to urology: interview sheets related to the disease, standard report forms, edition of letters, creation of a multi-entry file and entering of accounts. The consultation was always held without a paper support with real-time data acquisition and the accounting was performed at the end of the visit.

Invasion of Denonvilliers' fascia in radical prostatectomy specimens.

Denonvilliers' fascia consists of a single fibromuscular structure covering the posterior aspect of the prostate and surrounding the seminal vesicles. This structure has multiple layers that are fused together, and to the stroma of the prostate and seminal vesicles. A separate posterior layer of Denonvilliers' fascia was not seen during radical prostatectomy.

[Urodynamic ultrasonography in the management of urinary disorders in women].

The authors report the preliminary results of a study on the use of perineal sonography with a vaginal probe as a complement to urodynamic investigation, in patients with stress urinary incontinence or other urinary symptoms. This technique seems useful especially in stress urinary incontinence to precise the existence and the importance of bladder neck hypermobility, and in the evaluation of post-opérative outcome after surgical suspension of the bladder neck.

[Color echo-doppler of the ureterovesical stream. Normal aspects. Application to the acute ureteral obstruction].

A colour Doppler ultrasound study of the ureterovesical was performed to define the normal features, variants and abnormalities of the ureteric stream by comparing 50 normal subjects and 19 subjects with renal colic due to ureteric stones. The examination included assessment of the frequency, intensity, morphology and symmetry of the ureterovesical stream. In normal subjects, the stream was either absent, especially in the case of fluid restriction (36%), present and symmetrical (34%) or asymmetrical (30%).

Mechanisms of action of bacillus Calmette-Guérin in the treatment of superficial bladder cancer.

Local immunotherapy with bacillus Calmette-Guérin (BCG) is an effective treatment to prevent recurrence and progression of superficial bladder cancer, but the antitumor mechanism of action of BCG remains unclear. There are some experimental and clinical data suggesting that BCG antigens are processed not only by immunocompetent cells but also by urothelial cells and tumor cells. The foreign antigen may be presented at the cell surface by major histocompatibility complex (MHC) class II molecules and recognized by CD4 cells.

Nonsteroidal antiandrogen monotherapy of metastatic cancer of the prostate.

The use of nonsteroidal antiandrogens as first-line therapy for the treatment of cancer of the prostate is discussed. The results of studies using flutamide as monotherapy are reviewed and show flutamide to be an effective agent in the treatment of metastatic prostate cancer. Comparative studies have shown that flutamide monotherapy is as effective as standard hormonal treatment, with no difference in the two treatments.

[Penile endoscopy: technique, results].

The authors report their experience based on 200 consecutive examinations. Peniscopy is an outpatient examination of the penis using a magnification system: commercial magnifying glass or colposcope. It consists of examining the whole penis in detail with the naked eue and then with a magnitification system after application of 5% acetic acid to the glans and prepuce in order to identify subclinical lesions.

Nucleolar organizer regions in congenital mesoblastic nephroma.

A review of 78 renal tumors in patients under 6 months of age revealed 35 congenital mesoblastic nephromas (CMNs). Based on cellular criteria, 14 were classified as classical, 4 as partly cellular, and 17 as cellular CMN. The mean ages were 24, 11, and 70 days, respectively.

[Extraperitoneal endoscopic lymph node dissection with insufflation in the staging of bladder and prostate cancer].

Endoscopic pelvic lymph node dissection was performed in 30 patients as part of the staging of prostate (19) or bladder (11) cancers. The technique, using a procedure of detachment of the retroperitoneal space with CO2 insufflation, is described. Complete bilateral dissection of the ilio-obturator lymph nodes was performed in 24 patients (80%) using conventional laparoscopic surgical equipment.