Base bibliographique

Dysfonction érectile et hyperplasie bénigne de la prostate deux pathologies fréquentes de l'homme âgé
2012
- Réf : Prog Urol, 2012, 22, 1-5, suppl. HS6


Introduction. – L’hyperplasie bénigne de prostate (HBP) et la dysfonction érectile (DE) sont deux affections fréquemment rencontrées chez l’homme de plus de 50 ans.


Matériels et méthodes. – Une revue systématique de la littérature a été pratiquée sur Pubmed entre 1998 et 2012 utilisant les mots clés erectile dysfonction, benign prostatic hyperplasia et/ou low urinary tract symptoms.


Résultats. – Dix-huit articles d’intérêts ont été sélectionnés, dont dix études cliniques, quatre articles de science fondamentale, trois articles de pharmacologie et un article de revue. Il s’agit d’études rétrospectives dont le niveau de preuve est principalement 2b. Un lien statistique indépendant est retrouvé dans la plupart des études cliniques, et des hypothèses physiopathologiques communes comme l’athérosclérose, l’hyperactivité autonome sont avancées par les études fondamentales.


Conclusion. – Il existe un lien statistique indépendant entre HBP et DE. L’utilisation d’iPDE-5 présente un intérêt aux regards des mécanismes physiopathologiques communs mis en évidence.

Abstract


Introduction. – Benign prostatic hyperplasia (BPH) end erectile dysfunction (ED) are frequently observed in the aging male.


Materials and methods. – A systematic review of the literature was performed on Pubmed including the keywords “erectile dysfonction”, “benign prostatic hyperplasia” and/or “low urinary tract symptoms”.


Results. – Eighteen manuscripts were selected, including 10 retrospective clinical studies, four of basic science, three of pharmacology and a review article. A significant relationship was found in most of the studies, and physiopathological hypothesis as atherosclerosis and autonomic hyperactivity were enlighten.


Conclusion. – A statistical independent relationship exists between BPH and ED. The use of PDE-5i could be interesting regarding the common pathological process involved.


Mots clés :


Dysfonction érectile ;
,
Hypertrophie bénigne de la prostate ;
,
Symptômes du bas appareil urinaire

Keywords:


Erectile dysfonction;
,
Benign Prostatic Hyperplasia;
,
Low urinary tract symptoms



Plan Masquer le plan Introduction
MSAM-7
Étude américaine du BPH Registry
Autres études
Mécanismes physiopathologiques
Conclusion
Déclarations d’intérêts
Références


1 Publication originale : Ferretti L, et al. Dysfonction érectile et hyperplasie bénigne de la prostate : deux pathologies fréquentes de l’homme âgé. Progrès en Urologie – FMC (2012),

cliquez ici.

Haut de page

© 2012 Elsevier Masson SAS. Tous droits réservés.

Effet biologique du sérum humain recueilli avant et après une administration par voie orale de Pygeum africanum , sur diverses cultures de cellules bénignes de la prostate
2012
- Réf : Prog Urol, 2012, 22, 6-13, suppl. HS6


Pygeum africanum (Tadenan®) est un agent phytothérapeutique auquel on a souvent recours dans le traitement symptomatique de l’hypertrophie bénigne de la prostate. Les composants actifs du médicament n’ont pas été identifiés, il est donc impossible de déterminer la concentration plasmatique de ce dernier. Les résultats des études menées sur son efficacité étant contradictoires, nous avons cherché à déterminer son effet sur la croissance in vitro des cellules de la prostate en ayant recours à du sérum humain recueilli avant et après une administration de Pygeum africanum. Nous avons utilisé des cultures primaires et des cultures organotypiques de lignées cellulaires de myofibroblastes stromales prostatiques humaines WPMY et des lignées cellulaires épithéliales prostatiques PNT2, ainsi que des tissus prostatiques bénins frais. Le sérum d’un patient sous traitement a provoqué une diminution de la prolifération des cellules primaires, des cellules organotypiques et des cellules WPMY, mais pas de celle des cellules PNT2. Nous avons également analysé l’effet du sérum traité sur le profil d’expression génique des cellules WPMY. L’analyse du transcriptome a révélé une régulation à la hausse des gènes impliqués dans de multiples voies de suppression de tumeur et une régulation à la baisse des gènes impliqués dans les voies de l’inflammation et du stress oxydatif. L’administration de Pygeum africanum par voie orale a abouti à des taux sériques de substances actives suffisants pour inhiber la prolifération de cultures cellulaires myofibroblastiques prostatiques. Cette inhibition a été accompagnée de modifications au sein du transcriptome.


Asian Journal of Andrology prépublication en ligne 26 décembre 2011 ; doi : 10.1038/aja.2011.132


Mots clés :


Hyperplasie prostatique bénigne ;
,
Culture organotypique ;
,
Culture primaire ;
,
PNT2 ;
,
Pygeum africanum ;
,
Transcriptome ;
,
WPMY



Plan Masquer le plan Introduction
Matériels et méthodes  (+)
Le sérum Culture cellulaire primaire Cultures organotypiques Analyse statistique Analyse du transcriptome Résultats
Discussion
Contributions des auteurs
Financement
Remerciements
Références


1 Publication originale : Larré S, et al. Biological effect of human serum collected before and after oral intake of Pygeum africanum on various benign prostate cell cultures. Asian Journal of Andrology 2012;14:499-504.

Haut de page

© 2012 Elsevier Masson SAS. Tous droits réservés.

Hyperplasie bénigne de la prostate
2012
- Réf : Prog Urol, 2012, 22, 14-29, suppl. HS6


L’hyperplasie bénigne de la prostate, maladie très fréquente de l’homme âgé, est une atteinte aussi bien stromale qu’épithéliale de la glande prostatique. Elle est due à un déséquilibre entre croissance et apoptose cellulaires dont les mécanismes ne sont pas totalement élucidés. Il en est de même des rapports entre symptomatologie et obstruction urodynamique, sans qu’on puisse bien discerner la part qui revient aux phénomènes statiques (augmentation de volume), dynamiques (⍺1 récepteurs) et aux troubles vésicaux consécutifs à l’obstruction. Cela explique la multiplicité des traitements, et la difficulté de poser les indications thérapeutiques qui s’échelonnent entre abstention-surveillance et chirurgie.


Mots clés :


Hypertrophie bénigne prostatique ;
,
Troubles urinaires du bas appareil urinaire ;
,
TUBA ;
,
Traitement médical ;
,
Traitement chirurgical ;
,
Lasers ;
,
Traitements mini-invasifs



Plan Masquer le plan Introduction
Embryologie
Anatomie
Physiopathologie et étiologie
Mécanismes de l’obstruction sous-vésicale d’origine prostatique
Épidémiologie
Symptomatologie
Examen physique
Examens complémentaires
Évolution. Complications
Méthodes d’évaluation
Traitements  (+)
Méthodes Indications Conclusion
Références


1 Publication originale : Bastien L, Fourcade RO, Makhoul B, Meria P, Desgrandchamps F. Hyperplasie bénigne de la prostate. EMC (Elsevier Masson SAS, Paris), Urologie, 18-550-A-10, 2011.

Haut de page

© 2012 Elsevier Masson SAS. Tous droits réservés.

Cancer de la prostate chez les sujets âgés : comment faire le diagnostic, pourquoi et comment mettre en place une évaluation gériatrique
2012
- Réf : Prog Urol, 2012, 22, S55, suppl. S2




 


Managing an elderly subject with prostate cancer brings into play the notion of likelihood of survival before any diagnostic or therapeutic decision can be made. The diagnostic strategy must be specifi ed for each patient in accordance with the clinical presentation so as to determine whether prostate biopsies are indicated in this elderly population. To estimate the likelihood of survival, one must make use of geriatric assessment techniques comprising medical strategies ranging from screening for frailty to detailed geriatric evaluation for the most complex patients. The many tools available for estimating the likelihood of survival requires a critical review of their advantages and disadvantages in daily clinical practice.

Éditorial
2012
- Réf : Prog Urol, 2012, 22, S29, suppl. S2




 

Hormonothérapie et risque cardiaque dans le traitement des cancers prostatiques
2012
- Réf : Prog Urol, 2012, 22, S48, suppl. S2




 


Androgen suppression clearly increases the occurrence of cardiovascular risk factors : increased body fat, dyslipidemia and type II diabetes. Thus, several studies (but not all), showed an increase in coronary artery disease but also of sudden death and ventricular arrhythmias in relation to androgen deprivation, even for a short duration. This risk is particularly important in patients with existing cardiovascular risk factors or a history of heart disease. Cardiovascular risk should be balanced with the benefit of androgen deprivation on overall survival, especially when it is proposed in adjuvant setting, combined with radiotherapy in locally advanced prostate tumors.

In practice, it is recommended that patients be referred to their physician for an evaluation before starting treatment, then 3 to 6 months after starting treatment, then once a year. The initial assessment should include: a clinical examination (with measurement of blood pressure and body index) and laboratory test with full lipid profile (total cholesterol, HDL and LDL cholesterol, triglycerides) and glucose. It is also important that patients with heart disease, receive lifestyle advice and low- dose aspirin (80mg/day).

Impact métabolique de la suppression androgénique dans le cancer de la prostate
2012
- Réf : Prog Urol, 2012, 22, S39, suppl. S2




 


Because of the low mortality rates associated with prostate cancer, treatments long-term adverse effects constitute an important parameter in the management of patients. In particular, androgen deprivation has been shown to be linked to several metabolic disorders which are already frequent in men after age 60, such as weight and fat gain, insulin resistance likely to evolve into diabetes, and dyslipidemia. So far no consensus guidelines have been published regarding the screening and treatment of metabolic disorders in men with prostate cancer. It is essential to detect and manage these metabolic disorders, all the more so as they seem to be associated with an increased aggressiveness of prostate cancer. Here we report the development of a new questionnaire, which might contribute to the systematic management, and potentially the screening and treatment or the prevention of these metabolic disorders in patients with prostate cancer. In accordance with recent reviews and on the basis of experience, our French board of experts also recommends systematic screening and selective treatment for diabetes, regular follow-up of fasting glucose rates, lipid profile and blood pressure in all patients under long-term androgen deprivation treatment, as well as lifestyle changes (practice of exercise, nutritional habits).

Sexualité et cancer de la prostate
2012
- Réf : Prog Urol, 2012, 22, S72, suppl. S2




 


All treatments of prostate cancer have a negative effect on both sexuality and male fertility. There is a specific profile of changes in the fields of quality of life, sexual, urinary, bowel and vitality according to the treatment modalities chosen.

Maintain a satisfying sex is the main concern of a majority of men facing prostate cancer and its treatment. It is essential to assess the couple’s sexuality before diagnosis of prostate cancer in order to deliver complete information and to consider early and appropriate treatment options at the request of the couple.

Forms of sexuality sexual preference settings stored (orgasm) may, when the erection is not yet recovered, be an alternative to the couple to maintain intimacy and complicity.

In all cases, a specific management and networking will in many cases to find a satisfactory sexuality.

Consequences of the treatment on male fertility should be part of the information of patients with prostate cancer and their partners. The choice of treatment must take into account the desire of paternity of the couple. A semen analysis with sperm cryopreservation before any therapy should be routinely offered in men with prostate cancer, particularly among men under 55, with a partner under 43 years old or without children. If the desire for parenthood among couples, sperm cryopreservation before treatment and medical assisted reproduction are recommended.

Suppression androgénique dans le cancer de la prostate et risque ostéoporotique
2012
- Réf : Prog Urol, 2012, 22, S31, suppl. S2




 


Androgen deprivation therapy represents an important part of the management of prostate cancer. However, epidemiological data have shown that it is a well-established cause of osteoporosis and increased risk of fracture. So far no consensus guidelines have been published regarding the screening and treatment of osteoporosis in men with prostate cancer. Here we report the design of a new questionnaire, derived from the FRAX® (“Fracture Risk Assessment Tool”) algorithm, to evaluate the risk of fracture in those patients. In accordance with recent reviews and on the basis of their experience, our French board of experts recommends systematic screening for osteoporosis with dual energy x- ray absorptiometry scans, practice of exercise and calcium and vitamin D supplementation, and selective treatment with bisphosphonates in men at greatest osteoporotic risk.

Troubles de l'humeur et cognitifs et suppression androgénique
2012
- Réf : Prog Urol, 2012, 22, S64, suppl. S2




 


Prostate cancer has become a chronic disease. In this context, it is important to take into account the quality of life of patients and their family in the therapeutic approach. Recent studies have demonstrated the importance of depression and the risk of suicide in patients with prostate cancer as well as the repercussions of the disease on the spouse and their relationship. The implication of hormonal treatment in the increase in risk of depression is difficult to affirm. Few studies have investigated this subject and they present methodological biases. Some authors report an increased risk of cognitive decline in patients on androgen deprivation. However, even if certain physiopathological hypotheses have been put forward, the imputability of the treatment on the alteration of cognitive functions has not been clearly established.

Urologists are at the forefront of diagnosis and treatment of prostate cancer occurring most often in elderly subjects. Therefore, given the prevalence of depression syndromes and/or the alteration of cognitive functions in this population, the urologist must be aware of these different factors, which are potentially aggravated by the introduction of androgen deprivation.

Based on a review of the recent literature, the authors suggest using a simple depression screening tool: confirmation of the diagnosis and management is within the competence of the general practitioner. As for the risk of cognitive decline, it seems difficult to imagine, and not necessarily relevant, to systematically propose a battery of neuropsychometric screening tests. On the other hand, giving the patient the G8 screening test can allow the urologist to assess whether the patient needs a geriatric consultation or not.

Critères cliniques et biologiques pertinents pour poser un diagnostic de déficit androgénique lié à l'âge (DALA)
2012
- Réf : Prog Urol, 2012, 22, S21, suppl. S1




 


Introduction

The androgen deficiency in the aging male (ADAM) affects 30 % of men after 70. It’s responsible for many minor symptoms but also major complications. The objective of this study was to establish the clinical and biological criteria for the diagnosis of ADAM.


Material and method

Data on clinical and biological criteria for the diagnosis of ADAM have been explored in Medline and Embase using the MeSH keywords : androgen deficiency ; testosterone deficiency ; late-onset hypogonadism ; aging. The articles were selected based on their methodology, relevance, date and language of publication.


Relevant clinical criteria for the diagnosis of ADAM

The prevalence of symptomatic ADAM in the old male ranges from 6 % to 12 %. The main clinical manifestations of ADAM include various sexual disorders associated with many nonspecific symptoms which can even be present without androgen deficiency. ADAM may induce type 2 diabetes or some cardiovascular complications which increase the risk of death. Because of low specificity, the use of diagnostic tools is not recommended to screen ADAM.


Variation in the androgen secretion during aging

The annual decrease rate of testosterone is 1.6 % after 30 leading to androgen deficiency in 50 % of patients after 80. ADAM is due to a concomitant reduction of testosterone and gonadotropin secretion.


Relevant biological criteria for the diagnosis of ADAM

The biological diagnosis of androgen deficit is based on two determinations of total testosterone obtained between 7AM and 11AM. Levels below 8nmol/L are an indication to hormonal substitution while patients with levels above 12nmol/L don’t seem to benefit from this type of treatment. Between 8 and 12nmol/L, it is recommended to assess free testosterone levels. Because of a decrease in gonadotrophin secretion during aging, the LH levels are abnormally normal in ADAM.


Conclusion

ADAM is a biological and clinical syndrome characterized by the association of nonspecific symptoms and decrease testosterone levels. Hormone replacement therapy appears to benefit patients at risk of metabolic, cardiovascular or bone complications.

Dysfonction uro-érectile : une nouvelle entité nosologique
Erectile urogenital dysfunction: a new nosological entity
2012
- Réf : Prog Urol, 2012, 22, S27, suppl. S1


Influence de l'âge sur la santé sexuelle masculine
2012
- Réf : Prog Urol, 2012, 22, S7, suppl. S1




 


Introduction

With the increase in life expectancy, men’s sexual health has become a major concern for elderly couples. Erectile dysfunction (ED) is responsible for a 50 % decrease of sexually active men between 60 and 85. The aim of this study was to identify objective elements to evaluate the influence of age on male sexual health.


Materials and method

Data on the effects of aging on men’s sexual health have been explored in Medline and Embase using the MeSH keywords : prostate ; sexuality and erectile dysfunction ; aging. The articles were selected based on their methodology, relevance, date and language of publication.


Results

ED concerns 64 % of 70 years old patients and up to 77.5 % after 75 years. The screening of this pathology is based on standardized diagnostic tools. The most used of them remains the “International Index of Erectile function” which, in its simplified version with 5 items (IIEF-5 or SHIM), presents at the cutoff score of 21, a sensitivity of 98 %, a specificity of 88 % and a kappa index of 0.82. The ED is often responsible for a decrease in the quality of life for 60 % of elderly couples wishing to pursue sexual activity. Some diagnostic tools, such as the «Self-Esteem And Relationship» (SEAR) questionnaire or the «Sexual Experience Questionnaire» (SEX-Q) assess individual and couple satisfaction. Physiological aging seems to favor erection disorders by the development of an Androgen Deficiency of the Aging Male (ADAM) but pathological aging appears to be primarily responsible. Cardiovascular or neurological diseases and lower urinary tract symptoms (LUTS) are, with the polymedication, modifiable risk factors of ED to systematically screen in elderly subjects.


Conclusion

Many diagnostic tools allow to detect ED and assess the impact on the quality of life of elderly men. The fundamental element of the management of ED is the research of modifiable risk factors including cardiovascular.

La prostate : une glande au carrefour uro-génital
2012
- Réf : Prog Urol, 2012, 22, S2, suppl. S1




 


The prostate’s location at the crossroad between the urethra and ejaculatory ducts could explain her urinary and génital function. The currently anatomical model has been proposed by McNeal et al. in 1968. The prostate gland is divided in 4 zones surrounding the urethra in its vertical path from the bladder to the striated sphincter. Transition, Central and peripheral zones consist of tubulo-alveolar glandular tissue secreting the spermatic fluid while the anterior fibro-muscular zone consists of smooth muscle which may start voiding. The confluence between the urinary and genital tract in the prostate explains the anatomic proximity and the intimate relationship between male genital and urinary organs. Elderly anatomical changes of the prostate may therefore be involved in sexual and urinary symptoms. The development of prostate medications may be effective both on voiding and erectile dysfunction.

La prostate : une glande énigmatique
The prostate: a mysterious gland
2012
- Éditorial
- Réf : Prog Urol, 2012, 22, S1, suppl. S1


Troubles sexuels associés aux maladies de la prostate
2012
- Réf : Prog Urol, 2012, 22, S14, suppl. S1




 


Introduction

The lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) and the treatment of prostate cancer (PCa) are linked to erectile dysfunction (ED). The objective of this work was to evaluate the influence of prostatic diseases on ED.


Materials and method

Data on the influence of BPH and PCa on ED have been explored in Medline and Embase using the MeSH keywords : benign prostatic hyperplasia, prostate cancer, prostatectomy, external beam radiotherapy ; androgen deprivation therapy ; erectile dysfunction. The articles were selected based on their methodology, relevance, date and language of publication.


Results

The rate of ED in patients with BPH ranged from 30 to 70 %. The LUTS were an independent risk factor of ED. The pathophysiology linking BPH to ED has not been elucidated but seems to involve the path of Nitric Oxide - cyclic Guanosine Monophosphate (cGMP-No.), the RhoA - Rho - Kinase (ROCK) signal, the sympathetic autonomic nervous system and pelvic atherosclerosis. The rate of ED after radical prostatectomy (RP) ranged from 60 to 89 %. The bilateral preservation of neurovascular bundels improved these results. Risk factors of ED after RP were age, PSA levels, pretreatment erectile function and surgical technique. The rate of ED after prostate external beam radiotherapy ranged from 6 to 84 %. Risk factors of ED after external beam radiotherapy were age, pretreatment erectile function and association of androgen deprivation therapy. The rate of ED with androgen deprivation therapy was 85 %. Risk factors of ED with androgen deprivation therapy were age > 70 years, diabetes and pretreatment erectile function. Intermittent androgen deprivation therapy was associated with better results on erectile function than continue androgen deprivation therapy.


Conclusion

ED is responsible for a decrease of elderly patients life quality already affected by urinary symptoms and prostate disease progression. The development of drugs effective on both ED and BPH or PCa symptoms is then full of meaning.