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Suivi pratique d'un patient traité par finastéride pour le dépistage de cancer de prostate
2008
- Réf : Prog Urol, 2008, 18, 58-62, suppl. S3




 


The following conclusions can be made on the practical follow up of a patient receiving finasteride in screening for prostate cancer from an analysis of the literature and, particularly, the Prostate Cancer Prevention Trial (PCPT). Prostate volume fells by an average of 17 to 19%. The average fall in PSA after one year of finastéride treatment was 50%. This fall continued over time, at an average of 5% per year. An adjustment factor of × 2 at 1 year was used to return to a PSA value of a group of untreated men. The ratios of free PSA/total PSA and complexed PSA/total PSA remained unchanged and were interpreted as usual. The risk of cancer was low if the PSA fell by ≥ 50% and raised if it fell by < 33%. Prostate cancer was associated with an average 15% rise in PSA on finasteride. This change still needs to be validated. The sensitivity of PSA and rectal examination was greater in detecting all grades of cancer in people receiving finasteride than on placebo. These findings have the benefit of reducing the indications for biopsy during follow up. Finasteride does not appear to cause high grade cancers. Despite the 25% reduction in the risk of cancer on finasteride there was insufficient information, particularly on the impact on mortality to allow chemoprevention to be proposed. Patients started on finasteride to treat BPH must be informed of the possible benefits, side effects and follow up arrangements to screen for prostate cancer.

Cystites aiguës
2008
- Réf : Prog Urol, 2008, 18, 9-13, suppl. S1




 


The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.

Généralités
2008
- Réf : Prog Urol, 2008, 18, 4-8, suppl. S1




 


Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.

Méthodologie
2008
- Réf : Prog Urol, 2008, 18, 1-3, suppl. S1




 

Prostatites aiguës
2008
- Réf : Prog Urol, 2008, 18, 19-23, suppl. S1




 


A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.

Pyélonéphrites aiguës
2008
- Réf : Prog Urol, 2008, 18, 14-18, suppl. S1




 


The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.

Résumé des communications d'onco-urologie présentées au 101 e Congrès de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 18, 31-37, suppl. S2




 


Regarding renal cell carcinoma, most recent advances concern metastatic cases in which antiangiogenic agent seem to be efficient for specific survival and outcome without progression of the disease. In prostate cancer, new urinary molecular markers, more specific than PSA, are currently under development to allow an early and non invasive diagnosis of the disease. Robot-assisted radical prostatectomy is a growing surgical approach in the treatment of localized prostate cancer, at the expense of the laparoscopic approach, with satisfactory oncologic preliminary results. Whether or not a cystectomy should be done after the resection of a pT1G3 bladder tumour, remains a moot point. However the risk of progression is far from being negligible. Regarding upper urinary tract tumors, the outcome is different from bladder tumors and several teams are working on specific molecular markers, dedicated to be useful in prognosis and specific survival.

Résumé des communications d'urologie fonctionnelle présentées au 101 e Congrès de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 18, 25-30, suppl. S2




 


Functional urology knows more and more a marked development. Regarding benign prostatic hypertrophia, combined treatments are used often and new molecules such as inhibitor of phosphodiesterase of type 5 are appearing. The gold standard treatment of urinary incontinence with sphincteric deficiency remains the artificial urinary sphincter, in men and in women, where the rate of success is nearly of 95 %. The use of botulic toxin in neurogenic bladder and especially in overactive bladder is growing remarkably, notably in patients of whom quality of life is improve against a very low toxicity. However, the effect of the molecules becomes blurred within a few months. The CT diagnosis of urinary lithiasis is about to provide nowadays the main component of each calculi. Peyronie’s disease remains scarce in which verapamil’s injections are strongly suggested to amend pain but not the curve during erection.