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La lésion iatrogène des voies urinaires chez les femmes soumises à la chirurgie pelvienne Introduction. La lésion iatrogène des voies urinaires chez les femmes subissant des interventions pelviennes est l'une des complications les plus redoutées et une source importante de morbidité significative. En outre, elles provoquent beaucoup d'anxiété en égale mesure pour le patient et le chirurgien et elles créent également de nombreuses préoccupations juridiques. Les organes les plus fréquemment touchés sont l'uretère, la vessie et l'urètre. Les lésions urologiques en obstétrique et en chirurgie gynécologique devraient toujours être une question de prévention, mais il y a des situations où la ABSTRACT Introduction. Iatrogenic injury of the urinary tract in women undergoing pelvic surgeries is one of the most feared complications and an important source of significant morbidity. Moreover, they cause a lot of anxiety to both patient and surgeon and they also create many legal concerns. The most commonly affected organs are the ureter, bladder and urethra. Urologic injury during obstetrics and gynecologic surgery should always be a matter of prevention, but there are situations in which prevention fails. With this article we intend to raise the awareness on potential situations leading to iatrogenic urinary tract lesions during obstetrics and gynecology surgery.

Malpractice is a relatively new term in terms of litigation. Prior to the early 18 th century, medical malpractice lawsuits were mainly limited to cases that resulted in severe injury and death. At the beginning of the 19 th century, things started to change for the medical practitioners, unfortunately not in a good way. What seemed to have started in the USA, spread like fi re throughout the Western Europe. This state of affair prompted physicians to practice the socalled "defensive medicine". It is well known that surgery in general and urologic surgery in particular is associated with iatrogenic injury and high-risk procedures that do not always have a positive outcome. Moreover, offi ce urology seems to also imply a high degree of litigation risk. The aim of this paper was to determine the fi elds in Urology that are most prone to litigation and malpractice lawsuits.

Benign prostatic hyperplasia (BPH) is induced by a persistent local inflammatory process that leads to cell proliferation. Viral infections associated with immune deficiencies can trigger the chronic inflammation of the prostate. Therefore, we have investigated several viral expressions in BPH patients and tried to establish a link with the diagnosed hyperplasia. 50 patients with BPH without urinary tract infection were tested for the presence of the following viruses: human papilloma virus (HPV), cytomegalovirus (CMV) and Epstein-Barr virus (EBV). These viruses are the most common cause of asymptomatic viral infections. HPV-specific DNA detection by polymerase chain reaction (PCR) was used for freshly surgical removed tissue sample. Both anti-CMV (IgG, IgM) and anti-EBV (IgG, IgM) antibodies were detected in the patients� serum with standard enzyme-Linked Immunosorbent Assay technique (ELISA). Specific HPV-DNA in prostate tissue was found only in 4% of patients, while 98% and 100% patients were positive for serum anti-CMV IgG or anti-EBV, proving intense earlier contact with the virus. IgM anti-CMV evaluation was found in around 10% of the cases which were also negative for EBV, sustaining that this was a non-acute infection. The findings showed that BPH may be associated with a chronic inflammation due to the post-viral infection with CMV or EBV, or secondary to the presence of these viruses in the prostate, while the involvement of HPV infection in BPH development is comparably lower. Our data suggests that viral investigation in BPH should be considered in the screening protocol of BPH as an indicator of possible inflammatory-mediated tumorigenesis of urinary tract.

Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.

The retroperitoneum can host a wide variety of pathologies, including benign and malignant tumors. Primary retroperitoneal tumors are rare, usually large in size, more than half of them being larger than 20 cm at the time of diagnosis, due to their silent growth. They often present several therapeutic challenges because of their rarity, relatively late presentation and anatomical location, often in close relationship with several important structures in the retroperitoneal space. Extensive surgery is often required because of the intimate relationships with vital organs in the retroperitoneum. Retroperitoneal sarcomas frequently involve major vessels, originating from them or secondarily encase or invade them, requiring major vascular resections, with increasing morbidity. The main intervention that can increase the survival of patients with retroperitoneal tumors is radical resection. The involvement of large retroperitoneal vessels often makes impossible a radical intervention, usually because of the lack of an adequate material for ample and laborious vascular reconstruction. In this paper, a thorough search of the PubMed database was performed, to bring into the light the implications of vascular involvement in primary retroperitoneal tumors and the need of a strong cooperation between the urological or general surgeon and the vascular surgeon.

Retroperitoneal tumors, once considered uncommon, have been reported in the last years in such numbers that they cannot be considered anymore a rare condition. Tumor recurrence following surgical excision is quite common and a tumor that was considered originally as benign in many cases can recur as a malignant tumor. The purpose of this paper is to underline the difficulties in terms of establishing a correct diagnosis and a proper therapeutic protocol when facing a retroperitoneal mass of unknown origin, as well as to present the available data regarding prognosis, treatment options and tumor recurrence. Retroperitoneal tumors can be classified as benign or malignant; solid, cystic or both; single or multiple, and of varied histological types. A high percentage of patients with retroperitoneal tumors are discovered in advanced stages, usually seeking medical help for symptoms related to nearby organ compression/invasion. This pathology requires a prompt and adequate multidisciplinary management, in order to achieve disease control and to reduce the recurrence rate. Complete surgical resection is the potential curative treatment for retroperitoneal tumors and it is best managed in high-volume centers, by a multidisciplinary team. Complete oncological tumor resection and tumor grade remain the most important predictors for local recurrence and disease-specific survival. Further research is required in order to define the role of radiotherapy, as well as to discover new biological therapies that target various molecular pathways involved in retroperitoneal cancers.

The role of beta-adrenergic receptor antagonists in cardiovascular therapy has been the subject of various studies over time, these agents representing one of the oldest class of drugs used for the treatment of cardiovascular diseases. Although beta-blockers have been excluded from guidelines as the first-line therapy in essential hypertension, they remain the first choice in patients with heart failure, coronary artery disease, and atrial fibrillation. In this article, we review the major clinical evidence for the use of beta-blockers in cardiovascular diseases. Several trials have demonstrated that beta-blockers reduce mortality in patients with heart failure with a reduced ejection fraction. Also, beta-blockers have beneficial properties in patients with heart failure with preserved ejection fraction. Guidelines recommend beta-blockers for the relief of symptoms in cases of angina pectoris and for the control of the ventricular rate in cases of atrial fibrillation. Also, beta-blockers have numerous benefits in hypertensive patients with diabetes mellitus. In conclusion, betablockers are an important class of cardiovascular drugs, reducing the mortality and morbidity rates in patients with cardiovascular diseases.