Robert Andrianne

Adult Müllerian Duct Or Utricle Cyst: Clinical Significance And Therapeutic Management Of 65 Cases

PURPOSEnWe define guidelines for the exploration and treatment of adult müllerian duct cysts.nnnMATERIALS AND METHODSnFrom January 1988 through September 1999 a diagnosis of enlarged prostatic utricle was made in 65 adults based on transrectal ultrasound findings. Echographic criteria to define simple versus complicated cysts were detailed. We reviewed the clinical presentation, diagnostic modalities, indications for invasive procedures and postoperative outcome.nnnRESULTSnThe usual clinical presentations were hematospermia in 40% of cases, other ejaculatory disturbances in 20%, recurrent testicular or pelviperineal pain in 33%, lower urinary tract irritation symptoms in 25%, lower urinary tract infection in 18.5%, male infertility in 12% and incidental finding in 18.5%. Cyst dimensions did not influence the indication for invasive procedures, which were performed in only 27 of the 65 patients (41.5%) to treat disabling symptoms in 28% and obstructive infertility in 5%, and investigate complicated cysts on transrectal ultrasound in 6%. These procedures included transperineal or transrectal puncture in 9 patients, simple endoscopic section of the utricle meatus in 12 and large marsupialisation in 6. Complete and sustained cure was noted in half of the patients treated with cyst puncture only, although echographic relapse was the rule. Endoscopic procedures definitely improved or cured 82% of the patients at a mean followup of 51 months, during which neither early nor late complications were noted.nnnCONCLUSIONSnSince almost 60% of adults diagnosed with a müllerian duct cyst did not experience any cyst related symptoms or ejaculatory-fertility impairment, we recommend that investigation and/or treatment should only be done in symptomatic or infertile patients.

Characteristics and expectations of patients with erectile dysfunction: results of the SCORED study

In an observational study in men with erectile dysfunction (ED) consulting a general practitioner (GP) or urologist in Belgium, demographics, ED characteristics (including erection hardness score), co-morbidities and treatment expectations were evaluated using a structured questionnaire. In total, 341 GPs and 41 urologists recruited 1492 patients. Most (74%) were untreated and 25% had ED for >3 years. Considering PDE5 inhibitors, erection hardness (89%) and maintenance (92%) were considered ‘very important’ by most patients. Only 18% of physicians initiated discussion about ED, despite 41% of patients having ⩾3 known risk factors. The questionnaire was considered helpful by 81% of GPs and 83% of their patients. Overall, patients are under-diagnosed, and physicians are reluctant to ask about ED. A questionnaire including erection hardness score is useful to facilitate discussion about ED in general practice. Erection hardness and maintenance are more important to patients as compared to fast onset or long duration of action.

Penile prosthesis, sexual satisfaction and representation of male erotic value

A follow-up study conducted among 39 implanted patients and 30 partners shows that subjects satisfaction towards prosthetic-sexuality depends on their representation of male erotic value. The less satisfied patients are sensitive to a normative representation that associates erotic value to criteria of spontaneity, naturalness, tall and non-assisted erections. Their main dissatisfaction likely derives from the insufficiency of a prosthetic solution to restore a male self-image based on such criteria. This induces a more important impact on satisfaction rates than do functional problems (e.g. difficulties in manipulating the device, unwanted deflations, uncomfortable sensations). These patients also show an attribution bias consisting in attributing erroneously the same dissatisfaction and negative attitude towards prosthetic sexuality to their partner. Therefore, in addition to surgery, a psychosexual support is necessary to modify erotic representations and to improve the communication between the partners in order to increase sexual satisfaction with prosthesis-assisted sexuality.

Repérage scintigraphique peropératoire d’une métastase costale unique d’un adénocarcinome prostatique opéré

We present a case of a lonely bone lesion after a prostatic adenocarcinoma with recurrent increased PSA. The localization of the metastasis at the level of a rib is infrequent. The precise localization of the lesion was made possible by intraoperative scintigraphy. Histology confirmed the complete resection of the lesion with safe margins.

PD25-05 ′ANDRIANNE MINI-JUPETTE′ GRAFT AT THE TIME OF INFLATABLE PENILE PROSTHESIS PLACEMENT FOR THE MANAGEMENT OF POST-PROSTATECTOMY CLIMACTURIA AND MINIMAL URINARY INCONTINENCE

[Yafi, Faysal A.] Univ Calif Irvine, Irvine, CA USA. [Andrianne, Robert] Univ Hosp Liege, Liege, Belgium. [Alzweri, Laith; Hellstrom, Wayne J. G.] Tulane Univ, New Orleans, LA 70118 USA. [Brady, Jeffrey] Florida Urol Associates, Orlando, FL USA. [Butcher, Michael] Pk Nicollet Sexual Hlth Clin, St Louis Pk, MN USA. [Chevalier, Daniel] CHU Nice, Nice, France. [DeLay, Kenneth J.] Adv Urol Inst, Tallahassee, FL USA. [Faix, Antoine] Clin Beau Soleil, Montpellier, France. [Hatzichristodoulou, Georgios] Julius Maximilians Univ Wurzburg, Wurzburg, Germany. [Jenkins, Lawrence] Ohio State Univ, Columbus, OH 43210 USA. [Kohler, Tobias S.] Mayo Clin, Rochester, MN USA. [Osmonov, Daniar] Univ Hosp Schleswig Holstein, Kiel, Germany. [Park, Sun Hung] Sewum Prosthet Urol Ctr Excellence, Seoul, South Korea. [Schwabb, M. David] Lincoln Med Ctr, Bronx, NY USA. [Valenzuela, Robert] Mt Sinai Hosp, New York, NY 10029 USA. [van Renterghem, Koenraad] Jessa Hosp, Hasselt, Belgium. [Wilson, Steven K.] Inst Urol Excellence, La Quinta, CA USA.

Notre Experience du Lithotripteur Direx (Tripter X1) pour le Traitement Extracorporel des Calculs du Haut Appareil Urinaire [Unsere Erfahrung mit dem Direx-Lithotriptor (Tripter X1) bei der Behandlung von Steinen der oberen Harnwege]

Von Dezember 1987 bis August 1988 wurden 200 vorher nicht ausgesuchte Patienten, bei denen Harnsteine diagnostiziert wurden, mit extrakorporalen Stoswellen behandelt. Zur Steinzertrummerung benutzten wir den Tripter X1 von Direx, der am besten den von uns gestellten Anspruchen entsprach. Ende des Jahres 1987 waren bereits funfzehn Gerate in dem 10 Millionen Einwohner zahlenden Belgien in Betrieb. Von den 4000 Personen, die jahrlich an Harnsteinen in unserem Land erkranken, werden ungefahr 400 an der Lutticher Universitatsklinik behandelt.