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Etude prospective de traitement des sténoses urétérales localisées par endoprothèse grillagée métallique
2007
- Réf : Prog Urol, 2007, 2, 17, 219-224


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Aims

To assess efficacy of Mémotherm® BARD® ureteral metallic stent in the treatment of non-operable ureteral stenoses.


Material and Method

Prospective evaluation of ureteral stenoses consecutively treated using Mémotherm® BARD® ureteral metallic stent. Assessment criteria (recurrence frequency, permeability, tolerance, complications) were measured by clinical examination, Intra Veinous Pyelography, renal sonography, urine culture at 1, and every 3 months.


Results

Thirteen stents were inserted in 12 patients (mean age: 68yrs) presenting with subsequent ureteral stenosis (9 neoplastic, 3 following radiotherapy) over a 3 year period. No technical difficulty was observed. Mean follow-up was 19 months. Stenosis recurrence was observed in 5 patients, due to tumoural progression, but with no tumour ingrowth. There was non incrustation or migration, pain, hematuria, infection due to the stent. All stent remained permeable and functional in surviving patients.


Conclusions

In our experience, Mémotherm® BARD® ureteral metallic stent could be considered a useful cost-effective alternative to double J stent or traditional surgery in non-operable or end-of-life patients. The high ureteral stenosis recurrence rate was linked to the patient initial pathology. Considering these encouraging results, this study could represent the first stage of a multicenter tracker-study, which would permit to take into account further technological development of this type of material.

Mots clés:
sténose / endoprothèse / uretère
Mots-clés:
ureteral stenosis / ureteral stent / Metallic stent
Etude randomisée multicentrique comparant la castration médicale par triptoréline à la castration chirurgicale dans le traitement du cancer de la prostate localement avancé ou métastatique
2007
- Réf : Prog Urol, 2007, 2, 17, 235-239


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Objective

To report the results of a trial comparing the efficacy of triptorelin and surgical castration in the treatment of locally advanced or metastatic prostate cancer.


Materials and methods

80 patients with previously untreated locally advanced or metastatic prostate cancer prostate cancer were included in a one-year multicentre, randomized, prospective, open-label therapeutic trial. Patients either received a monthly injection of triptorelin (group 1; n = 40), or were treated by pulpectomy (group 2; n = 40). Patients were reviewed every 3 months, then every 6 months.


Results

The mean age of the patients was 71.22 ± 8.25 years. At 1 month, 38patients were castrated (plasma testosterone < 0.5 mg/ml) in the pulpectomy group versus 35 in the triptorelin group. The mean follow-up was 38.8 ± 26 months in the triptorelin group and 36.3 ± 25 months in the pulpectomy group. On multivariate analysis, age, impaired performance status and PAP level (> 3.2 ng/ml) were predictive factors of a poor outcome. The median survival was 37,5 ± 9 months in the triptorelin group and 33 ± 3 months in the pulpectomy group. At 3 years, no significant difference in specifie survival was observed between the 2 groups. At 8 years of follow-up, 63 patients had died.


Conclusion

This study demonstrates an equivalent specifie survival between patients treated by triptorelin or surgical castration. Castration is rapidly obtained with triptorelin (< 2 months) and is maintained over time throughout the duration of treatment.

Mots clés:
cancer de prostate / essai thérapeutique / Triptoréline / effets secondaires / taux de testostérone
Mots-clés:
prostate cancer / Clinical trials / Triptorelin / adverse events / testoterone levels
Evaluation de la stimulation visuelle combinée aux injections intra-caverneuses pour le traitement de la dysfonction érectile sévère
2007
- Réf : Prog Urol, 2007, 2, 17, 225-228


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Mots clés:
dysfonction érectile / stimulation sexuelle visuelle / érection / image fonctionnelle / éveil sexuel
Mots-clés:
erectile dysjimction / visual sexual stimulation / Penile erection / functional imaging / Sexual arousal
Évaluation prospective des effets du stage d'initiation pratique sur le recrutement des internes d'urologie à Paris : résultats définitifs
2007
- Réf : Prog Urol, 2007, 2, 17, 240-244


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Objectives

To evaluate the effects of a practical introduction to urology session on the recruitment of Parisian interns since introduction of the National Classljjing Examination.


Materials and methods

Since 2004, all surgery interns appointed in Paris have participated in a practical introduction to urology session before starting work in hospital. They were asked to complete a questionnaire. The prospective survey studied: age, gender, urology training as a medical student and the intern’s preferences in relation to 11 surgical specialties. Interns were recontacted annually to determine their choice of specialization.


Results

Population. 255 interns participated, including 145 females (56.9%) and 110 maies (43.1%). The mean age was 24.6 ± 5 years (range: 22-31). 173 interns were attached to a Parisian teaching hospital (67.8%) and 82 (32.2%) were attached to a provincial teaching hospital. 52 interns (21.2%) had completed at least one attachment in a urology department during their medical training. Surgical specialties. Orthopaedics was most frequently listed (n = 48 ; 28.9%). Urology was chosen by 32 interns (12.5%), 28 of whom had completed an urology attachment during their medical training. At the end of the introductory training sessions, 18 interns were tempted by urology. At one year, 31/34 interns (91.2%) confirmed their choice in favour of urology.


Conclusion

A practical training sessions very early in the training of young surgeons is a good solution to introduce them to urology. Based on a more informed choice, the most motivated interns are encouraged to preferentially choose this discipline.

Mots clés:
Urology / enseignement / Formation
Mots-clés:
Internship / surgery / Urology / Motivation
Fistule vésico-vaginale après bandelette transobturatrice
2007
- Réf : Prog Urol, 2007, 2, 17, 253-255


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The transobturator approach is gradually replacing the retropubic approach for the treatment of female stress urinary incontinence and suburethral tape. The major argument in favour of this approach is the decreased risk of bladder injury during insertion of the needles, which nevertheless remains a minor complication. Provided another more median approach is used in closer contact with the bone, followed by prolonged bladder catheterization for 24 to 48 hours, this complication has no consequences.

However; the authors report a case of bladder injury during insertion of transobturator tape (TOT) in a patient with no particular history, attributable to the technique itself, as it occurred during finger dissection towards the obturator membrane. This complication led to secondary formation of a vesicovaginal fistula after insertion of the tape, despite satisfactory repair of the bladder.

This case illustrates that TOT is not devoid of risks to the bladder; with sometimes even serious consequences. TOT should not be inserted when bladder suture is required. If a fistula is observed after insertion of TOT, the tape should be completely removed as soon as possible, but correction of urinary incontinence may persist.

Mots clés:
complication / fistule vésico-vaginale / incontinence urinaire / Femme / TOT
Mots-clés:
Female urinary incontinence / transobturator tape, vesicovaginal fistula
Index
2007
- AFU - Formation medicale intiale et continue progres en urologie - Avril 2007
- Réf : Prog Urol, 2007, 2, 17, 264


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Mots clés:
Baptiste / Christian
Mots-clés:
intra uterine device / trans utero vesical migration / cystoscopic removal
Index
2007
- Réf : Prog Urol, 2007, 2, 17, 265-266


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Mots clés:
Baptiste / Christian
Mots-clés:
intra uterine device / trans utero vesical migration / cystoscopic removal
L'expression tumorale de VEGF est-elle associée à l'envahissement veineux et à la survie dans les carcinomes du rein pT3 ?
2007
- Réf : Prog Urol, 2007, 2, 17, 189-193


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Study objective

To determine whether there is a relationship between VEGF expression and renal vein and vena cava invasion in stage pT3 renal cell carcinoma and to evaluate the impact of VEGF expression on survival in pT3 renal cell carcinoma.


Material and methods

78 patients with a pT3a or pT3b tumour without vena cava invasion or pT3b tumour with vena cava invasion were comparedfor age, gender, Fuhrman grade and immunohistochemical expression of VEGF. All these variables were submitted to univa-riate and multivariate analysis to establish their impact on survival.


Results

Only tumour size appeared to be significantly different between the 3 groups. On univariate analysis, invasion of the perirenalfat, lymph node involvement, distant metastases and VEGF expression were significantly associated with survival (p<0.01). On multivariate analysis, lymph node involvement, distant metastases and VEGF expression (OR 6.07) were identified as independent predictive factors of survival.


Conclusion

Progression of a pT3 tumour into the renal vein and vena cava is not associated with increased tumour expression of VEGF. However, VEGF is an independent prognostic factor in this group of poor prognosis renal tumours.

Mots clés:
carcinome à cellules rénales / VEGF, pronostic / Survie
Mots-clés:
Renal cell carcinoma / VEGF / prognosis / survival
La prostate : Identification des attentes du médecin généraliste. Une enquête qualitative. Association Française d'Urologie (AFU) - IPSOS
2007
- Réf : Prog Urol, 2007, 2, 17, 199-202


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Introduction

Information on prostate diseases, including prostate cancer, has been promoted by the Association Française d’Urologie (AFU) for several years, but is developing slowly in France. In 2005, a first communication was targeted to the male public and identifled the reasons for the fatalistic attitude of men, and paradoxically, why the prostate incarnates the vulnerability oftheir sexual capital. As part of a second phase, this article presents the results of a complementary study conducted among general practitioners to identify their expectations and the most appropriate levers to promote screening.


Material and Method

The Ipsos survey company developed a KrisisTM qualitative protocol in October 2005 (after the first French prostate day on 15 September 2005). Three groups of general practitioners were defined: doctors who are very active in terms of screening, doctors who are uncomfortable with this problem and doctors who systematically refer their patients to urologists.


Results

The management of prostate diseases often highlights the ageing process for the patient. The ability to discuss these problems during the consultation depended on the doctor’s degree of comfort with this subject, which is related to his/her training and relationships with urologists. To initiate the question of screening, general practitioners involved in this process asked simple questions about everyday practices without being afraid of making jokes or basing their approach on mediatization ofthe disease.

Digital rectal examination is one of the important clinical elements but is not always easy to perform. PSA was found to be an examination that is not always appropriate, characterized by a lack of information on the conditions for ordering this test, its usefulness and Us relevance for screening. Ultrasound could be a way of alerting the patient without dramatizing the situation, letting the urologist perform digital rectal examination. Female general practitioners preferred PSA and ultrasound. The doctors surveyed relied on mediatization of prostate diseases, a high level of interactivity with urologists and documents and brochures to be placed in waiting rooms to relay screening messages.


Conclusion

General practitioners need their authorities, specialists and public health institutions to develop and mediatize andrology in the same way as gynaecology. Urologists play a major supportive role by means of conferences, postgraduate training or AFU invitations.

Mots clés:
prostate / HBP / prostate / Cancer de la prostate / Qualité de vie
Mots-clés:
prostate / BPH / prostatitis / prostate cancer / Quality of life
Le faible poids de la prostate est un facteur de risque indépendant de marges chirurgicales positives sur pièce de prostatectomie radicale
2007
- Réf : Prog Urol, 2007, 2, 17, 203-207


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Objective

The presence of positive surgical margins (PSM) on radical prostatectomy specimen is predictive of biological recurrence. Our objective was to analyze the influence of prostate weight on surgical margins status after radical prostatectomy.


Patients and methods

A cohort of 295 patients operated consecutively between 1998 and 2004 at our institution was prospectively studied. The variables significantly associated with the surgical margins status in univariate analysis were used for multivariate analysis.


Results

The overall rate of PSM was 23% (9% for pT2 patients). Parameters significantly associated with surgical margins status were preoperative PSA (p=0.02), number of positive biopsy cores (p=0.04), pathological stage (p< 0.001), and Gleason score on radical prostatectomy specimen (p<0.001). In addition, patient age and surgical specimen weight were conversely associated with surgical margins status (p= 0.008 and p= 0.001, respectively). In multivariate analysis, only three parameters were found to be independent factors of PSM: the pathological stage (p<0.001), the patient age (p=0.02), and the surgical specimen weight (p= 0.02). PSM rates were 6% and 25% in patients with prostate ≥ 70g and < 70g, respectively (p= 0.008), and 15% and 28% in those with prostate weight ≥ 50g and < 50g, respectively (p=0.015).


Conclusion

Low prostate weight is an independent risk factor of PSM. Patients with prostate weight ≥ 70g should be considered at low risk of PSM, while those with prostate weight <50g are at high risk of PSM.

Mots clés:
cancer de prostate / prostatectomie radicale / Marges chirurgicales / Pronostic
Mots-clés:
prostate cancer / radical prostatectomy / Surgical margins / Predictive factors
Les formes moléculaires du PSA
2007
- Réf : Prog Urol, 2007, 2, 17, 165-171


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Molecular forms of serum PSA (prostate specifie antigen) have been developped to improve total PSA sensitivity and specificity in prostate cancer diagnosis and staging. Total PSA is measured in bound (complexed PSA) and unbound (free PSA) molecular forms. Their levels in absolute values and in relation to total PSA (f/t PSA and c/t PSA) have been evaluated. The percentage of free PSA is more specific but less sensitive than tPSA and it is not recommended as a first line diagnostic test, it may be useful as a second-line test, prescribed by the urologist after a first series of negative biopsies. There is general agreement that at high sensitivity, cPSA provides higher specificity compared with tPSA in the gray zone (2-10 ng/ml). Nevertheless the widespread use of tPSA an the small benefit in terms of specificity explains why cPSA is not generally recommanded. Molecular derivates of free PSA have been identified : proPSA (precursor inactive form of PSA), intact PSA (an additionnal form of proPSA that is found intact and inactive), human Kallikrein 2 and BPSA (for benign PSA wich is associated to BPH) have been evaluated. Preliminary studies did not have demonstrate their ability to discriminate between cancer and BPH, and did not define cutoff values.

Mots clés:
Antigène spécifique prostatique / Cancer de la prostate / PSA complexé / proPSA / PSA libre
Mots-clés:
prostate specifie antigen / prostate cancer / complexed PSA / proPSA / free PSA
Marges après prostatectomie totale : aspects techniques et valeur pronostique
2007
- Réf : Prog Urol, 2007, 2, 17, 182-188


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The status of surgical margins after radical prostatectomy is a major prognostic factor. The role of several technical aspects of radical prostatectomy, such have surgical access, bladder neck preservation or neurovascular bundle sparing, in generating. supplementary positive margins has been controversial for many years. Positive margins along with other poor prognostic factors are important elements in the decision to perform adjuvant therapy after radical prostatectomy. This review of the literature, based on a Medline search, was designed to update these various issues encountered by urologists in their everyday practice.

Mots clés:
marges / Prostatectomie / Facteur pronostique / prostate / Cancer
Mots-clés:
margin status / Prostatectomy / Prognostic factor
Métastase testiculaire d'un adénocarcinome prostatique : à propos d'un cas
2007
- Réf : Prog Urol, 2007, 2, 17, 251-252


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Metastasis of prostate adenocarcinoma to testis is an extremely rare occurrence. Orchiectomy is necessary to confirm histopathological diagnosis. Metastatic carcinoma of the prostate to the testis is a commonly accepted as a sign of disseminated disease. Systemic treatment are therefore required. We report a case of a 62-year-old patient who presented a prostatic carcinoma with a testicular metastasis.

Mots clés:
métastase testiculaire / Cancer / prostate
Mots-clés:
testicular metastasis / adenocarcinoma / prostate
Migration intravésicale d'un dispositif intra-utérin. Stratégies d'exploration et modalités thérapeutiques
2007
- Réf : Prog Urol, 2007, 2, 17, 256-259


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The migration of an intra uterine device (IUCD) into the bladder is a rare complication. The authors report a case of IUCD migrated into the bladder. The patient was asymptomatic. Diagnosis was made on abdominal X-ray performed for another reason. It was confirmed by ultra-sound and cystoscopy. As the IUCD was only partially intra vesical, it’s removal was made by laparoscopy and cystoscopy. The authors then discussed the frequency, the physiopathology, the diagnosis and the treatment with arguments from the literature.

Mots clés:
Dispositif intra-utérin / ablation cystoscopique / Fistule / Vessie
Mots-clés:
intra uterine device / trans utero vesical migration / cystoscopic removal
Mortalité prématurée par cancer urologique : le rein en première ligne
2007
- Réf : Prog Urol, 2007, 2, 17, 260-261


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Mots clés:
Gauthier / Jean-Christophie
Mots-clés:
intra uterine device / trans utero vesical migration / cystoscopic removal
Paul Sauvage, Penis surgery atlas of infancy and childhood, Editions Chirurgicales Pédiatriques, Strasbourg.
2007
- Commentaire d'un livre
- Réf : Prog Urol, 2007, 2, 17, 262


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Mots clés:
Éric
Mots-clés:
intra uterine device / trans utero vesical migration / cystoscopic removal
Pourquoi écrire un article en 2007 ?
2007
- Éditorial
- Réf : Prog Urol, 2007, 2, 17, 155


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Mots clés:
Éric
Mots-clés:
Polyorchidism / testis abnormalities / children
Prélèvement rénal chez le donneur vivant : morbidité et suivi à long terme
2007
- Réf : Prog Urol, 2007, 2, 17, 194-198


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Objective

To evaluate the morbidity of living donor kidney harvesting and the long-term medical consequences and impact on quality oflife (QoL).


Material and methods

Retrospective analysis of medical and surgical data for 114 living kidney donors in a single teaching hospital between 1977 and 2005. Complications were evaluated in relation to the surgical approach and body mass index (BMI) using a Chi-square test or Fisher’s exact test. Changes in renal function (serum creatinine, crea-tinine clearance), proteinuria and blood pressure (BP) were studied by Student’s t test or a Mann-Whitney U or Wilcoxon nonparametric test. Long-term QoL was evaluated by the MOS SF-36 questionnaire and a local questionnaire and was then compared to that ofthe French general population.


Results

The median follow-up was 63 months. The morbidity of kidney harvesting was significantly correlated with the surgical approach (p=0.018) and a BMI ≥ 25kg/m2 (p=0.014). No mortality was observed in this series. A moderate elevation of serum creatinine was obser-ved during follow-up (mean serum creatinine increased from 82.2μmol/l [± 16.3] to 104.5μmol/l [± 19.9]), and mean creatinine clearance decreased from 113.4ml/min [±27.6] to 76ml/min [±29.9]. Little impact was observed on proteinuria and BP and QoL was not altered by kidney harvesting.


Conclusion

The perioperative complication rate is correlated with BMI and a flank incision. Kidney harvesting lowers glomerular filtration, but clearance remained stable during follow-up. Macroalbuminuria or hypertension may be observed, but their frequency is not higher than in the general population. The QoL of living donors is not altered. Clear information for the general public would allow promotion of living donor transplantation.

Mots clés:
Donneur vivant / prélèvement / Qualité de vie / Transplantation rénale / morbidité
Mots-clés:
living donor / harvesting / Quality of life / renal transplantation / Morbidity
Proth&#x00065;ses péniennes: évaluation multicentrique des pratiques : résultats d'une série de 282 implantations
2007
- Réf : Prog Urol, 2007, 2, 17, 229-234


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Objectives

Multicentre practice evaluation in the field of penile prostheses based on the Club des Implanteurs de Prostheses Peniennes (CIPP) database.


Method

282 penile prostheses, including 276 inflatable prostheses (97.8%), were implanted in 254 patients between 1996 and 2005 in three centres (1 public and 2 private). Preoperative data (patient’s age, aetiology and duration of erectile dysfunction, preliminary treatments) and intraoperative data (type of implant used, surgical approach) were recorded. Postoperative complications were studied and postoperative erectile function was evaluated by a self-admi-nistered questionnaire (IIEF). The mean follow-up was 27.7 months.


Results

Penile prostheses were implanted after an average of 39.2 months of erectile dysfunction in patients with a mean age of ’58.6 years. The main aetiologies were arterial disease (35.3%), diabetes (22.8%) and radical prostatectomy (16.5%). The postoperative sepsis rate was 2.2% and the mechanical dysfunction rate was 7.5% at the beginning of the operators’ experience. The rate of other complications requiring repeat surgery (erosion, migration, self-inflation) was 1.8% at the beginning of the operators’ experience. The septic risk was increased (7.6%) in the presence of diabetes (p=0.01). The postoperative overall satisfaction was 86.7% and the IIEF score increased from 20.5±11.8 preoperatively to 68.9±5.4 postoperatively.


Conclusion

Penile prostheses achieve a high postoperative satisfaction score with a low complication rate. However, they are only indicated after failure of less invasive treatments and must be implanted by experienced operators. These results are comparable to those of large international single-centre series.

Mots clés:
prothèse pénis / impuissance / diabète / infection
Mots-clés:
penile prosthesis / impotence / Diabetes / infection
Severi G., Morris H.A., MacInnis R.J., English D.R., Tilley W., Hopper J.L., Boyle P., Giles G.G. Circulating steroid hormones and the risk of prostate cancer. Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
2007
- andrologie
- Réf : Prog Urol, 2007, 2, 17, 267


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Mots clés:
J.
Mots-clés:
intra uterine device / trans utero vesical migration / cystoscopic removal
Sonde JJ après urétéroscopie non compliquée
2007
- Une image à retenir
- Réf : Prog Urol, 2007, 2, 17, 250


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Mots clés:
Jacques
Mots-clés:
continent vesicostomy / Neurogenic bladder / intermittent catheterization / renal failure
Synthèse de veille 2006 Recommandations pour la pratique clinique : utilisation de la TEP-FDG dans les cancers du rein, de la prostate, du testicule et de la vessie
2007
- Réf : Prog Urol, 2007, 2, 17, 172-175


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Mots clés:
Diagnostic / Cancer / TEP-FDG / rein / prostate
Mots-clés:
Patrick / François / Françoise / Sébastien /
Transplantation rénale et transmission tumorale
2007
- Réf : Prog Urol, 2007, 2, 17, 178-181


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The transplanted kidney can be a vector of various diseases including tumours. These tumours, arising from donor cells, can be benign or malignant renal tumours or extrarenal tumours transmitted to the recipient in theform ofoccult metastases in the transplant. The authors review the statistical risks, prevention and therapeutic management of these tumours transmitted during renal transplantation

Mots clés:
transplantation, pathologie transmise, cancer, immunologie
Mots-clés:
transplantation, transmitted disease, cancer, immunology