Base bibliographique

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Agenda
2008
- Réf : Prog Urol, 2008, 1, 18, 74-75


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Mots clés:
Hydrocèle abdominoscrotale / Obstruction urétérale / Enfant
Mots-clés:
Abdominoscrotal hydrocele / Hydroureteronephrosis / child
Cancer de prostate et coagulation intravasculaire disséminée : une revue de la littérature
2008
- Réf : Prog Urol, 2008, 1, 18, 9-13


Introduction



Disseminated intravascular coagulation is a rare complication of prostatic cancer evolution. Occurring on hormonorefractory phase, it remains most often infraclinic. Cases of acute, severe intravascular disseminated coagulation at first presentation are life-threatening because of hemorragic and thrombotic complications, justifying emergency medical treatment. In the light of a review of literature, we insist on epidemiological features, physiopathology and therapeutics of intravascular disseminated coagulation. In spite of a pejorative prognosis, this could help to achieve a period of remission.

Mots clés:
cancer de prostate / Coagulation intravasculaire disséminée / Diagnostic / Traitement
Mots-clés:
Prostatic cancer / Intravascular disseminated coagulation / Diagnosis / treatment
Du bon usage de l'antigène spécifique prostatique en pratique de ville
2008
- Réf : Prog Urol, 2008, 1, 18, 41-45


Introduction



Objective

To standardize interpretation and comments of prostate-specific antigen (PSA) assay results by clinical pathology laboratories in office practice.


Material

From September 2004 to May 2006, interpretation and comments of PSA assay results performed by 100 different laboratories were analysed retrospectively.


Results

Nineteen different PSA assay kits were used. The so-called “normal” value for total PSA was less than 4ng/ml for two-thirds of kits. Determination of the free PSA/total PSA ratio (91 cases) was based on a cut-off value ranging from 10 to 25% and the frequent laboratory comments (89 cases) more often referred to benign prostatic hyperplasia (51 case) than prostate cancer (nine cases).


Conclusion

The marked diversity of PSA assay techniques currently used and the divergent interpretations by various laboratories lead to problems of interpretation for both practitioners and patients.

Mots clés:
PSA / Laboratoire d’analyse médicale
Mots-clés:
PSA / Clinical pathology laboratory
Enquête observationnelle sur les variations d'incidence par stade des cancers de la prostate dans la région Nord-Pas-de-Calais entre 1998 et 2004
2008
- Réf : Prog Urol, 2008, 1, 18, 53-59


Introduction



Objective

The aim of this work is to study variations of prostate cancer incidence by stage as a function of time and place in a region of France.


Material and methods

Retrospective observational survey conducted in five private and public urology centres representative of the various demographic features of the Nord-Pas-de-Calais region. In each centre, the medical records of the first 25 cases of prostate cancer diagnosed in 1998, 2002 and 2004, identified from histology laboratory data, were studied by means of a case report form evaluating the circumstances of diagnosis, PSA level, grade, stage (TNM 97, classification) and initial management.


Results

This analysis was based on 123, 124 and 125 patients in five centres in 1998, 2002 and 2004, respectively. The age at diagnosis ranged from 71.14 to 68.9 years between 1998 and 2004 (p =0.054). Median PSA decreased over this six-year period from 18 to 10.8ng/ml. Between 1998 and 2004, the percentage of patients with localized cancer (PSA<20ng/ml) increased from 44.8 to 66.4% (p <0.05), the percentage of patients with locally advanced cancer (PSA between 20 and 50ng/ml) decreased from 17 to 9.6% (p <0.05), the percentage of patients with regional or distant metastatic disease (N1and/or M1and/or PSA>50ng/ml) decreased from 29.4 to 22.4% (p <0.05) and the percentage of patients receiving curative treatment increased from 30 to 54.4% (p <0.005).


Conclusion

The prostate cancer incidence by stage varied between 1998 and 2004, with a significantly higher proportion of localized stages, which can be explained by the increased use of screening and diagnostic tests. Routine surveys can measure trends and the amplitude of incidence variations in the population of a region. A representative survey conducted in centres throughout France would allow evaluation of national trends between two publications of incidence by stage results in French registries.

Mots clés:
Épidémiologie du cancer de prostate / PSA / / /
Mots-clés:
Cancer prostate epidemiology / PSA / Screening / Staging
Étude de pratique des médecins généralistes concernant le dépistage individuel du cancer de la prostate
2008
- Réf : Prog Urol, 2008, 1, 18, 46-52


Introduction



Objective

To assess the practices of general practitioners in the Auvergne region concerning individual prostate cancer screening, to compare these practices with published guidelines and to identify those points that are most difficult to perform.


Material

An anonymous postal survey using a predefined questionnaire was conducted among 1339 general practitioners in the Auvergne region identified by the URSSAF file on 1st January 2006. This was a declarative survey with no individual financial reward. The questionnaire comprised three aspects: general practitioner identification criteria, screening practices and the doctors’ opinion concerning guidelines.


Results

The participation rate was 49.1: 98.3% of general practitioners declared that they proposed screening and 89.5% declared that they proposed screening to all men within certain age limits, from 50 to 75 years in 80.8% of cases. Only 4.6% of doctors provided complete preliminary information to their patients. Among the doctors,75.6% combined digital rectal examination and total PSA assay, but in the presence of an abnormality, only 10.5% referred their patients directly to an urologist without prescribing other complementary investigations (first- or second-line). Finally, 53.5% of doctors considered that published guidelines were adapted to their clinical practice.


Conclusion

Individual prostate cancer screening is massively proposed, but differences are observed between the doctors’ reported practices and official guidelines. This study emphasizes the need to provide patients with clear and complete information and to improve the general practitioners’ knowledge on screening tests and patient referral in the case of positive screening tests.

Mots clés:
/ / / /
Mots-clés:
Prostatic neoplasms / Prostate-specific antigen / Family practice / Mass screening
Évolution de la testostéronémie chez les patients traités par hormonothérapie pour un cancer prostatique
2008
- Réf : Prog Urol, 2008, 1, 18, 2-8


Introduction



Objective

To assess the time-course of plasma testosterone in patients with prostate cancer treated by endocrine therapy.


Methods

A PubMed review of the literature on plasma testosterone and the various endocrine therapies for prostate cancer was performed.


Results

The time-course of plasma testosterone varies according to the type of endocrine therapy. The effective castration level, classically considered to be 50ng/dl, is currently tending to be replaced by 20ng/dl. Following surgical castration, plasma testosterone reaches effective castration levels within several hours, while with LH–RH agonist therapy, plasma testosterone reaches its trough value after three to four weeks, and remains low for six months after stopping treatment. However, about 15% of patients treated with LH–RH agonists do not achieve effective castration levels. Plasma testosterone remains unchanged or even increases in response to anti-androgens. Plasma testosterone assay is of limited value in routine clinical practice in patients receiving endocrine therapy for prostate cancer, but should be performed in the case of elevation of PSA to ensure that the patient has achieved effective castration levels.


Conclusion

The correlation between plasma testosterone and progression of prostate cancer is unclear. Other studies are therefore necessary to define the value of plasma testosterone assay in patients treated for prostate cancer.

Mots clés:
cancer de prostate / traitement hormonal / Testostérone
Mots-clés:
prostate cancer / endocrine therapy / Testostérone
http://ees.elsevier.com/purol : changement, nouveaute ou evolution
2008
- Éditorial
- Réf : Prog Urol, 2008, 1, 18, 1
Mots clés:
Hypertonie sphinctérienne / Toxine botulique de type A / Transplantation rénale
Mots-clés:
Botulinum Toxin Type A / Kidney transplantation / Sphincter hypertonia
Hydrocèle abdominoscrotrale de l'enfant compliquée par une urétérohydronéphrose
2008
- Réf : Prog Urol, 2008, 1, 18, 71-73


Introduction



Abdominoscrotal hydrocele is a very rare clinical entity especially in childhood with less than 100 paediatric cases reported in the literature. It is associated with various complications and its pathogenesis is still a matter for debate. The authors report a case of abdominoscrotal hydrocele in the child. The methods of the diagnosis as well as the specific treatment are pointed out.

Mots clés:
Hydrocèle abdominoscrotale / Obstruction urétérale / Enfant
Mots-clés:
Abdominoscrotal hydrocele / Hydroureteronephrosis / child
Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006 – 1/5) : incidence et rôle du bilan urodynamique et de l'électromyogramme
2008
- Réf : Prog Urol, 2008, 1, 18, 14-18


Introduction et incidence



The incidence of postprostatectomy urinary incontinence varies according to the technique used, over time and according to the type of management, with an incidence at one year ranging from just a few percent to more than 60%. Assessment is required in the case of persistent disabling urinary incontinence despite well conducted perineal rehabilitation one year after surgery or earlier in the case of severe incontinence. Urodynamic assessment is the essential examination to quantify urethral closure pressure. A review of the literature of urodynamic assessment and electromyography is presented.

Mots clés:
Incontinence / prostatectomie radicale / Incidence / bilan urodynamique
Mots-clés:
Incontinence / radical prostatectomy / Incidence / urodynamic assessment
Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006 – 2/5) : place de la rééducation périnéale et du traitement médical
2008
- Réf : Prog Urol, 2008, 1, 18, 19-22


Introduction



The treatment of incontinence is changing, but perineal rehabilitation still plays an essential role and is usually able to rapidly and effectively improve urinary incontinence. Medical treatment modalities are fairly limited: anticholinergic drugs have a limited efficacy except in the case of unstable bladder demonstrated by urodynamic assessment and, despite encouraging preliminary results, duloxetine has not obtained scientific recognition or marketing authorization.

Mots clés:
Incontinence / prostatectomie radicale / Incidence / Duloxétine / Rééducation périnéale
Mots-clés:
Incontinence / radical prostatectomy / Incidence / Duloxétine / Perineal rehabilitation
Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006 – 3/5) : place des ballons périurétraux et des bandelettes sous uréthrales
2008
- Réf : Prog Urol, 2008, 1, 18, 23-28


Introduction



The treatment of incontinence is changing. Perineal rehabilitation still plays an essential role, but new modalities are now available with promising results, particularly periurethral balloon and suburethral tape, which may be indicated after failure of well-conducted perineal rehabilitation and before artificial sphincter. Periurethral balloons consist of two silicone balloons filled with a mixture of saline and radiopaque agent inserted transperineally on either side of the urethra as close as possible to the bladder neck. Titanium ports connected to each balloon allow adjustment of the volume contained in the balloon at any time after surgery. This technique appears to be promising but further studies are required to clearly define many unresolved issues, including results based on longer follow-up and patient selection according to the severity of incontinence or their treatment history (radiotherapy). Suburethral tape is used to exert permanent static compression of the urethra and was still under development in 2006. Fairly heterogeneous materials are used and no consensus on this issue has yet been reached. Follow-up is still relatively short and few studies have addressed the problem of patient selection. Some authors consider that the best indication is mild-to-moderate incontinence, which has not yet been clearly defined.

Mots clés:
Incontinence / prostatectomie radicale / Incidence / Ballon / Bandelette
Mots-clés:
Incontinence / radical prostatectomy / Incidence / Incidence / Balloon
Prise en charge de la colique néphrétique chez la femme enceinte : à propos de 48 cas
2008
- Réf : Prog Urol, 2008, 1, 18, 29-34


Introduction



Introduction

Urinary stones are relatively frequent in pregnant women and raise specific diagnostic and therapeutic problems. The authors conducted a retrospective review of the management of this disease in their establishment.


Patients and methods

Between January 1999 and December 2003, out of a total of 10,398 parturients, 48 pregnant women were hospitalised for renal colic, that is, incidence of 0.04%. The medical records of these patients were retrospectively reviewed and clinical, laboratory, treatment and outcome data were analysed.


Results

Standard analgesic treatment, comprising paracetamol and an antispasmodic, achieved pain relief in 84% of cases. A concomitant short course of corticosteroid therapy in cases of renal colic refractory to standard treatment was effective in 71% of patients and allowed deferral of surgical management in five out of seven cases. A double J stent was placed in all patients requiring urinary diversion, followed by closer ultrasound and bacteriological monitoring throughout pregnancy. Only two patients required surgical management of their stone after delivery. The only obstetric event related to renal colic was induction of labour at term in two cases because of fœtal distress.


Conclusion

The authors propose a two-stage management plan for renal colic in pregnant women resulting in a low maternal and fœtal complication rate.

Mots clés:
Coliques néphrétiques / Lithiases / grossesse
Mots-clés:
Renal colic / stones / pregnancy
Prostatectomies totales rétropubiennes, laparoscopiques et robot-assistées : comparaison des suites postopératoires, des résultats anatomopathologiques et fonctionnels : à propos de 86 prostatectomies
2008
- Réf : Prog Urol, 2008, 1, 18, 60-67


Objective

Compare three surgical approach procedures of total prostatectomy (retropubic, transperitoneal laparoscopic and robot-assisted laparoscopic), about technical, oncological and fonctional results.


Methods

Eighty-six patients had a total prostatectomy for localized cancer, in a unique center, performed by two expert surgeons, on a 16-months-period. Twenty nine had a retropubic, 23 a transperitoneal laparoscopic and 34 a robot-assisted (Da Vinci) surgical approach. Retrospectively, operative time, blood loss, per- and postoperative complications, duration of catheterization, length of hospital stay, in each group had been compared. The positive margin rates, the PSA levels at one and six months postoperative had been compared. The continence has also been evaluated at six months.


Results

The three groups are comparable even if the median age is significatively lower in the retropubic group (p =0.018). Duration of catheter (p <2.2×10−16), blood loss (p <3.12×10−5) and operative times support significatively the laparscopic approachs, clearlier the conventional than the robot-assisted one. No significative difference has been shwown about positive margin rates, even if it’s higher in the robot-assisted group (p =0.37). Finally, the continence rate is quite higher in the laparoscopic groups without statistic signficativity (76 % retropubic versus 96.8 % laparoscopic and 85.3 % robot-assisted).


Conclusions

The conventional laparoscopic and robot-assisted approachs seem to present technical advantages. Nevertheless, pathologic results are shader: the positive margin rate in the robot-assisted group is higher, in particular regarding to pT2. These results are concordant with the available datas of the literature.

Mots clés:
prostate / cancer de prostate / Prostatectomie / laparoscopie / Robotique chirurgicale
Mots-clés:
prostate / prostate cancer / Prostatectomy / Laparoscopy / Surgical robot
Traitement par laparoscopie extrapéritonéale itérative d'un adénome corticosurrénalien ectopique responsable d'un syndrome de Cushing
2008
- Réf : Prog Urol, 2008, 1, 18, 68-70


Introduction



We report a case of a Cushing syndrome, enduring after retroperitoneal laparoscopic bilateral adrenalectomy whose aetiology was an ectopic adenoma. This lesion had then been treated by a secondary retroperitoneal laparoscopic procedure.

Mots clés:
Adénome surrénalien / Syndrome de Cushing / Laparoscopie extrapéritonéale / Adénome ectopique
Mots-clés:
Adrenal adenoma / Cushing syndrome / Retroperitoneal laparoscopic adrenalectomy / Ectopic adenoma
Tumeurs de vessie pTa : facteurs de récidive et de progression
2008
- Réf : Prog Urol, 2008, 1, 18, 35-40


Introduction



Objective

The aim of this work has been to study the prognostic factors of recurrence and progression of stage pTa bladder tumours.


Patients and methods

The case files of 193patients, consecutively undergoing transurethral resection for primary pTa bladder tumour between 1980 and 2003, were retrospectively reviewed. Recurrence, progression and specific survival rates were studied. Prognostic factors associated with this type of tumour were then investigated.


Results

After a mean follow-up of 58 months, the recurrence rate was 56.5% and the rate of progression to stage T1 was 9.3%. The 10-year specific survival was 95.8%, but the 10-year recurrence-free survival rate was only 22.5%. Two risk factors for recurrence were identified on univariate analysis: haematuria at the time of diagnosis (p =0.009) and tumour size (p =0.01). Two factors were associated with a risk of progression: tumour size (p =0.03) and relapse during the first year after initial resection (p =0.003). None of these factors were independent prognostic factors on multivariate analysis.


Conclusion

pTa bladder tumours present a high risk of recurrence. However, with attentive follow-up, the risk of progression is low and their 10-year specific survival rate is greater than 95 %. Tumour size at the initial diagnosis and early relapse increase the risk of progression to more aggressive disease.

Mots clés:
Tumeurs de vessie / Stade pathologique / Récidive / Progression / Pronostic
Mots-clés:
Bladder tumours / Pathological stage / recurrence / Progression / prognosis