Laparoscopic artificial urinary sphincter in women for type III incontinence: preliminary results.

PURPOSE: To evaluate the feasibility by laparoscopy of the AMS 800 (American Medical Systems, Inc., Minnetonka, Minnesota) artificial urinary sphincter in women with type III incontinence. MATERIALS AND METHODS: Four women with genuine stress incontinence due to intrinsic sphincter deficiency were operated by laparoscopy. Primary criterion was negative Marshall test. One patient had not undergone surgery, and we performed laparoscopic promonto-fixation in the same procedure. Two of the three remaining patients had previous TVT (tension-free vaginal tape) with complications regarding the perforation and erosion of bladder mucosa and urethra. Laparoscopic explantation of TVT was performed 3 months previously. In the last case, previous urethropexy and laparoscopic promonto-fixation in association with TVT were performed 10 years and 1 year ago respectively. A modified surgical procedure was used to implant the AMS 800 through laparoscopic transperitoneal approach, with placement of the cuff around the bladder neck between the periurethral fascia and the vagina. RESULTS: Mean age was 68.5 (50-79) years. Mean closure pressure was 24.5 (20-28) cm. Water. There was no erosion or extrusion. The only significant risk factor was previous surgery. The operative time was less than 3 hours. The hospital stay was 8 days. The mean follow-up was 6 (3-13) months. Activation was done 6 to 8 weeks after implantation. Social continence (1 pad use with moderate leakage) and improvement of quality of life was reported in one patient. In this case the balloon was changed in order to obtain more pressure in the cuff. Resolution of incontinence was achieved in 3 patients. CONCLUSIONS: The AMS 800 can be successfully implanted by laparoscopy to treat women with genuine stress incontinence, a low urethral closure pressure and negative Marshall test indicating severe intrinsic sphincter deficiency. A long term follow-up is warranted to determine the efficacy and durability of this procedure

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Laparoscopic splenectomy was performed on eight patients with idiopathic thrombocytopenic purpura refractory to medical treatment. Preoperative infusion of immunoglobulin G gamma-globulin was used to boost the platelet count. Accessory spleens were sought by preoperative computed tomography and peroperative examination of the usual anatomical locations. Seven patients underwent successful laparoscopic splenectomy, with a mean postoperative stay of 3.6 days. One patient with an accessory spleen detected before operation but not during laparoscopy required conversion to open surgery for control of haemorrhage from the splenic hilum. Another patient had a transient pancreatic fistula. Laparoscopic splenectomy is feasible and sfe in patients with idiopathic thrombocytopenic purpura. Long-term results require evaluation as detection of accessory spleens can prove difficult during laparoscopy

Testicular torsion after previous orchidopexy for undescended testis.

We report one case of acute testicular torsion following orchidopexy for an undescended testis. A review of the literature reveals only ten similar cases. History of a previous testicular surgery should not preclude the possibility of a torsion in that testicle. We conclude that at orchidopexy for an undescended testis, eversion of the tunica vaginalis is an essential step to avoid any future torsion

Traitement endoscopique des urétérocèles de l’adulte à Douala

L’urétérocèle est une malformation congénitale caractérisée par une dilatation pseudo-kystique de la portion terminale de l’uretère. Le but de ce travail était de décrire notre démarche diagnostique dans la prise en charge des urétérocèles de l’adulte au centre médico-chirurgical d’urologie de Douala. Il s’est agi d’une étude observationnelle, descriptive, rétrospective, de janvier 2011 à décembre 2014, soit une période de 4 ans. Ont été inclus les seuls dossiers complets de patients porteurs d’urétérocèles recensés pendant la période d’étude. Les variables étudiés étaient l’âge, le sexe, le motif de consultation, le côté, les malformations associées, les données paracliniques. Pour tous les patients, la perforation endoscopique a été de mise sous anesthésie générale laissant en place une sonde double J pour une durée de 10 jours. L’âge moyen des patients était de 37,2 ans. Le sex ratio était de 2. Les motifs de consultation étaient représentés par les lombalgies (n=5), hématurie (n=4), dysurie (n=2). L’urétérocèle était à droite (n=3), à gauche (n=2), bilatéral (n=1). L’urétérocèle était associé à une duplication uretérale et intéressait le pyélon supérieur dans 2 cas. Elle était compliquée de lithiase dans deux cas. Le diagnostic paraclinique était dominé par la tomodensitométrie (n=4), suivie de l’échographie abdominale (n=2) et la cystoscopie (n=6). La durée moyenne du temps opératoire était de 56,6 min. Les suites opératoires immédiates étaient simples. Avec un recul moyen de 7 mois, aucune complication n’a été enregistrée. La perforation endoscopique des urétérocèles est une procédure mini-invasive qui est fiable, reproductive avec une faible morbidité dans notre pratique..Mots clés: Urétérocèle, lithiase, incision endoscopiqueEnglish AbstractUreterocele is a congenital malformation characterized by a pseudocystic dilatation of the terminal submusous portion of the ureter. The objective of this study was to describe the diagnostic and therapeutic approach for ureteroceles. This was a retrospective study on 6 cases diagnosed and treated from January 2011 to December 2014. The patients were consulted at the Medico- Surgical Centre of Urology in Douala. Clinical and paraclinical workup helped to establish the diagnosis. Patients underwent endoscopic treatment, and were followed up in the same centre. Variables studied were clinical, paraclinical, therapeutic and evolution. The mean age was 31.8 years. The sex ratio was 4 males and 2 females. The major complaints were: gross or macroscopic hematuria (n = 4), dysuria (n =2), and lumbar pains (n=5). The diagnosis was made on the basis of ultrasound scan images (n=2) and by computed tomography (n=4). The location of ureterocele was on the right (n=3), the left (n=2) and bilateral (n=1). Ureterocele was associated with ureteral duplication (n=1) and involved the superior renal pelvis. Ureterocele was complicated by lithiasis (n=2), and in 1 , there were multiple lithiases. Under spinal anesthesia, all patients underwent endoscopic incision of the urererocele taking away the stones, followed by verification of ureteral permeability by ureteroscopy; then placement of a double J stent for a duration of 10 days. The mean duration of operation was 56.6 minutes. Postoperative course was uneventful. After 7 months of follow-up, no complication was reported. Endoscopic incision of ureterocele is a miniinvasive technic of choice for the treatment of ureteroceles, when the technical platform is available. This technic is reliable, and reproducible with low morbidity.Keywords: ureterocele, lithiasis, endoscopic incisio

Is adrenalectomy part of radical nephrectomy?

Standard radical nephrectomy entails en bloc removal of the kidney together with Gerota's fascia and the ipsilateral adrenal. Thanks to the refinement of imaging techniques (ultrasound, CT and MRI), smaller tumors are being diagnosed. In addition, direct extension to the adrenal gland or adrenal metastasis can be detected in most cases. This is why several authors reserve adrenalectomy for large and/or upper pole tumors or abnormal appearing glands on preoperative CT-scan. However, preoperative diagnosis is not always accurate. Furthermore, micrometastatic adrenal invasion at the time of nephrectomy and late recurrences in the persistent adrenal have been documented, so that partisans of adrenalectomy only spare the adrenal in exceptional cases. The authors have reviewed several series in the litterature as well as there own, and conclude that ipsilateral adrenalectomy can be omitted for small middle- or lower pole tumors when the adrenal appears normal on CT and during the surgical intervention