Biomedical subjects
Publications and source records attributed to H Leremboure.
Long-term outcome in 142 patients after endoscopic or surgical treatment or urethral stenosis were evaluated. Results seem disappointing. Development of new therapeutic methods is desirable: the principle of use of an endoprosthetic material for stenoses of the bulbar urethra is described, and the operative technique and preliminary results are reported.
Two patients with disorders of bladder emptying (dysuria, pollakiuria) were treated by endourethral resection after being investigated by ultrasonography without intravenous pyelography. Intravenous pyelography performed subsequently due to persistence and even deterioration of the bladder emptying disorders revealed the diagnosis and allowed treatment of renal tuberculosis. Intravenous pyelography is therefore an essential part of the assessment of patients with prostatic symptoms.
The authors analyse and compare the clinical and urodynamic results of 16 tubed caecocystoplasties and 5 detubed ileocaecocystoplasties. The urodynamic assessments were performed between 2 months and up to 4 years after the operation. After a period of about 6 months, there was a functional difference between these two types of reservoir. The loss of pressure peaks in detubed reservoirs is not sufficient to ensure complete nocturnal continence. Neovesico-sphincteric synergy is responsible for real sphincteric self-re-education. Rationally, a detubing procedure in bladder replacement is only desirable in the case of a "deficient" sphincter.
Five hundred and twenty six extracorporeal lithotripsies have been performed for renal and ureteric stones. Using low frequencies (1.25 to 2.5 cycles per second), extracorporeal lithotripsy was performed without anaesthesia and without premedication in 85% of cases. 91.9% of patients treated were followed and reviewed after one and three months: 292 (55%) were successes, 124 (22.5%) obtained partial results, 122 (22.5%) were failures. The best results were obtained in stones less than 20 mm in diameter. The results could only be improved by a second session of extracorporeal lithotripsy. Scintigraphic scars observed after high frequency lithotripsy and not observed after low frequency lithotripsy were again seen after renewal of the firing head.
The reserved prognosis of stage T1 (A) bladder tumours is emphasised in relation to a series of 41 cases: 95% of tumours recurred, one third of these recurrent tumours posed a therapeutic problem because of their diffuse nature (15%) or tumour progression (24%). The risk of allowing a limited tumour to progress towards and extensively infiltrating carcinoma justifies the search for a prognostic factor allowing the early recognition of the more aggressive lesions. At the present time, no one prognostic element can indicate with certainty the course of the T1 tumour. All of the data obtained from detailed histological examination of the tumour and the adjacent urothelium and from the early course of the tumour allow a better evaluation of the prognosis. The search for surface antigens (ABO) and, more recently, chromosome analysis and study of the DNA content of the tumour by flow cytometry, may complete this prognostic evaluation.
The authors report their experience concerning 25 cases of ureterectomy by stripping, introduced by Dell'Ami. The technique carried out in the department is described. Cases of failures and possible complications are also discussed.
Three hundred and sixty nine extracorporeal lithotripsies for renal stones have been performed using the EDAP apparatus (ultrasound detection, piezoelectric destruction). In 7.1% of cases, the stone could not be located. By using low frequencies (1.25 to 5 cycles per second), extracorporeal lithotripsy was able to be performed in 82% of cases without anaesthesia and without premedication. 96.5% of patients treated have been followed and reviewed at one and three months: 169 (61%) cases were successful, 59 (21.3%) were partial results and 49 (17.7%) were failures. The best results were obtained in stones less than 20 mm in diameter. A poor result can only be improved by a second session of extracorporeal lithotripsy. The scintigraphic scars observed after high frequency extracorporeal lithotripsy were not observed when low frequencies were used. This new outpatient extracorporeal lithotripsy procedure without anaesthesia currently represents 79% of our primary indications in renal stones.
45 patients underwent urinary diversion by caecocystoplasty following simple or radical cystectomy with or without prostatectomy. The immediate postoperative course of such a major operation was surprisingly simple both in terms of the gastrointestinal tract (due to the use of automatic sutures) and in terms of the urinary tract. Micturition and diurnal continence were perfect. The few cases of incontinence related to high caecal pressure were controlled by perineal reeducation and/or the prescription of oxybutynin. A Peniflow apparatus controls the inevitable enuresis of these neobladders when the trigone has not been preserved. The upper tract is perfectly protected. The authors consider that the caecal reservoir warrants a place of choice in bladder replacement after cystectomy.
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