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Analyse monocentrique et rétrospective des complications vasculaires de la transplantation rénale sur cinq années
2010
- Réf : Prog Urol, 2010, 1, 20, 40-48


Introduction



Introduction

The aim of this study was to evaluate frequency and management of vascular complications in renal allograft.


Patients and methods

We performed retrospective analysis of patients who underwent renal allograft from 2001 to 2006 at our university hospital center. In order to access peri- and postoperative vascular complications, data were also obtained from donors and receivers, as well as organ procurement and renal transplant procedure.


Results

One hundred and seventy-nine files were analyzed with a median follow-up of 40 months, mean age of donors was 40.4±11.2 years and 46.01±10.6 years for receivers. Seventy-two allograft patients had at least one vascular complication, with 32 cases of renal arterial stenosis, 28 cases of hematoma with surgical exploration required in seven cases, four cases of arterial thrombosis, two cases of venous thrombosis and one arterial dissection. Our series underlines that tobacco abuse in donors is a risk factor for vascular complication (p =0.043), as well as glomerular nephropathy (p =0.0185), coagulopathy (p =0.0165) and hemodialysis (p =0.02) are risk factors for receivers. Multiple arteries in renal allograft (p =0.03) and calcification on aortic patch (p =0.0274) would present a greater risk of postoperative complications. Our results demonstrate that the following parameters i.e., postoperative transfusion (p =0.011), heparin therapy (p =0.0085), immunosuppression (p =0.0478), and peri-operative aminovasopressive drugs (p =0.086) could also be implicated in vascular complication occurrence.


Conclusion

A careful selection of donors remains a major factor for renal allograft quality, however arterial evaluation and coagulopathy detection in receivers must also be performed prior to transplantation procedure. A multidisciplinary approach (nephrologist, urologist, anesthesist) will optimize vascular ischemia delay and also reduce early and late vascular complications, which could have possible consequences on renal allograft and patient survival.

Mots clés:
Transplantation rénale / Complications vasculaires / facteurs de risque
Mots-clés:
Renal allograft / Vascular complications / Risk factors
Aspects épidémiologiques, étiologiques et thérapeutiques de la fistule obstétricale au Togo
2010
- Réf : Prog Urol, 2010, 1, 20, 71-76


Abréviations



Objective

To appreciate and to analyse the different human and materials capacities available for management in view of its total eradication.


Patients and methods

From January 2001 to December 2005, a census of obstetrical urogenital fistulae was carried out from treatment cases notes in all the hospitals of Togo. It was a retrospective and descriptive study which included the age of the patients, the situation of the sanitary institution, the quality of the physician in charge of the obstetrical fistulae, information about the kind of the fistulae, the way in which the delivery was done and the financial incidence for the repair of the fistulae. The subject of the study, the confidentiality on the contents of the case notes and the results expected were clarified to the responders.


Results

One hundred and sixty-three (163) cases of obstetrical fistulae were studied. The average age was 21 years (extremes: 15 and 45). Forty-four sanitary institutions comprising 93 treatments service were visited. Hospitals were noted to be far away from patients in the north of the country. All the four hospitals able to take care of obstetrical fistulae effectively were located in the south. Eight hundred and forty health personals were questioned and 467 (55.60%) had said to be able to make the diagnosis of obstetrical fistula. A maximum of four surgeons were trained and competent to manage obstetrical fistula. Operating equipment of obstetrical fistula was inexistent in 40 hospitals, that is 90.90%.


Conclusion

Obstetrical fistula is present in Togo and represents a public health problem to eradicate. It is more frequent in young women from rural areas and of low educational level. It constitutes also a handicap for the reproduction of humankind.

Mots clés:
Fistule obstétricale africaine / Épidémiologie / Prévention / Traitement
Mots-clés:
African obstetrical fistula / Prévention / treatment
Aspects urologiques de l'infection à Polyomavirus
2010
- Réf : Prog Urol, 2010, 1, 20, 11-16


Aspects urologiques de l’infection à Polyomavirus



JC virus (JCV) and BK virus (BKV) are human Polyomaviruses of the papovavirus family, which also includes a simian vacuolating virus 40 (SV40). Human Polyomaviruses were first isolated in 1971 from the brain (JCV) and urine (BKV) of two different patients. Human Polyomaviruses have a limited and specific tissue tropism infecting the renal tubular cells, the urothelium, the B cells and the brain cells. The virus infects the majority of the human population with seroconversion occurring during adolescence. The detection of the virus may be cytological, pathological, virological or immunological. Following a typically subclinical primary infection, Polyomavirus establishes a life-long persistent infection, especially in the urinary tract. BKV is known to reactivate and cause severe disease in immunosuppressed patients. The presence of Polyomavirus outside conditions of immunosuppression raises the question of its meaning and its therapeutic management. Given the ubiquitous nature of the virus and its strong association with cancer in animal models, they may play an etiological role in human malignancies. Here, we describe the biology of human Polyomaviruses , review their non-malignant and malignant potentials, and discuss the therapeutic aspect.

Mots clés:
/ , classification / Humains / Virus BK, pathogénicité / Virus JC, pathogénicité
Mots-clés:
/ , classification / Humans / BK Virus, pathogenicity / JC Virus, pathogenicity
Erratum à « Hypertrophie bénigne de la prostate » [Prog Urol 2009;19:670–74]
Erratum to “Benign hypertrophy of the prostate” [Prog Urol 2009;19:670–74]
2010
- Erratum
- Réf : Prog Urol, 2010, 1, 20, 83


Une erreur est intervenue dans le volume 19, numéro 10/2009 de Progrès en urologie . L’ordre et le nom des auteurs de l’abstract O-048 ne sont pas corrects. Nous prions les auteurs et nos lecteurs de bien vouloir nous excuser de cette erreur. O-048 Épure : résultat d’une étude multicentrique prospective évaluant la faisabilité du prostiva en chirurgie ambulatoire

Mots clés:
Mélanome / Urètre / Métastase
Mots-clés:
Melanoma / urethra / metastasis
Évaluation des pratiques des médecins généralistes du Maine et Loire concernant l'hypertrophie bénigne de la prostate
2010
- Réf : Prog Urol, 2010, 1, 20, 65-70


Introduction



Aim

To assess the diagnosis and therapeutic management of the benign prostatic hyperplasia (BPH) by the general practitioners (GPs) in the Maine-et-Loire.


Patient and methods

A questionnaire evaluating the management of BPH was sent to the 686 GPs of the Maine-et-Loire between March and June 2008.


Results

One hundred and seventy-one GPs answered. Among them 24% were women, 35.1% worked in urban areas, 34.5% worked in semi-urban areas and 30.4% worked in rural areas. 17.5 % had been working less than 10 years, 29.2% had been working between 10 and 20 years and 53.2% had been working more than 20 years. The medical interview, the digital rectal examination (DRE) and the assay of the prostatic serum antigen (PSA) were performed by more than 90% of the GPs whereas the ultrasound scan and the international prostatic score symptom (IPSS) were respectively used by only 15,2 and 69,6% of them. Phytotherapy, alphablockers and inhibitors of 5 alpha reductase were respectively prescribed by 85.4, 95.3 and 53.8% of the GPs. 96.5% of the GPs addressed the patient to a urologist after the failure of the first line treatment. There were no differences according to the working environment. Women performed less DRE (p <0.0001) and sent more patients to urologist than men (p =0.0197). Finally, 88.9% of the GPs were interested in having an update on the last recommendations.


Conclusion

The GPs diagnosed BPH and initiated the first line treatment. In case of failure, they sent the patients to a urologist. Their primary treatment management was not really in adequation with the recommendations. The recent therapeutic innovations may explain this discordance between the clinical practice and the recommendations. It is noteworthy that most of the GPs who answered this survey were keen in having an update on the recent advances in the BPH management.

Mots clés:
Hypertrophie bénigne de prostate / dépistage / traitement médical / Médecine générale / Évaluation des pratiques
Mots-clés:
Benign prostatic hyperplasia / treatment / General practitioner / Evaluation of the practices / Maine et Loire
Évaluation fonctionnelle de la néovessie iléale détubulée orthotopique en Z avec cinq ans de recul minimum
2010
- Réf : Prog Urol, 2010, 1, 20, 49-55


Introduction



Objective

Study and evaluate the orthotopic Z-shaped neobladder in the long term and life quality of patients bearing this type of replacement.


Methods

Based on 162 medical records of patients who have undergone total cystoprostatectomy and orthotopic Z-shaped replacement because of bladder cancer with a minimal 5-year follow-up. Forty patients (113-month average follow-up) residing in the region were notified for a clinical consultation and were the basis for the target population of this study. A physical examination, a Pad test and a specific consultation allowed for continence evaluation whereas three validated surveys allowed for life quality appreciation.


Results

Continence was satisfactory for 82% of the patients during the day and 55% during the night. There was a significant negative correlation between a patient’s age at the time of the cystoprostatectomy and diurnal continence. Life quality was estimated as good in the long term.


Conclusion

The functional results of the Z-shaped ileal detubulated neobladder in the long term are satisfactory. It allows for good urination quality and satisfactory quality of life for patients subject to total cystoprostatectomy because of cancer as well as body schema’s conservation.

Mots clés:
Néovessie orthotopique en Z / continence / Qualité de vie / Long terme / Cancer de vessie
Mots-clés:
Orthotopic Z-shaped neobladder / continence / Quality of life / Long term / bladder cancer
Le cancer de la prostate en France en 2001 : état des pratiques et facteurs associés à la réalisation d'une prostatectomie totale
2010
- Réf : Prog Urol, 2010, 1, 20, 56-64


Introduction



Introduction

Prostate cancer was the most common cancer in men in France in 2005, and the second cause of male death from cancer. In this study, we analyzed clinical characteristics of patients with prostate cancer diagnosed in France in 2001 with a focus on therapeutic management of localized prostate cancers.


Patients and methods

A total of 2181 cases of prostate cancer diagnosed in 2001 from 11 French counties covered by a cancer registry were analyzed. A descriptive study of the clinical characteristics of patients was performed. Parameters studied included age, county, TNM stage, PSA value, Gleason score, D’Amico prognostic group, Charlson’s comorbidity index and initial treatment modalities. For localized cancers, multivariate logistic regression analysis identified factors associated with radical prostatectomy.


Results

The proportion of localized prostate cancer (T1 or T2) was 86.6 %. The use of invasive curative treatment (radical prostatectomy and radiotherapy) was 58.4 % for localized cancers. Significant differences in therapeutic management were found between counties. Radical prostatectomy was associated with age at diagnosis, D’Amico prognostic group and the presence of comorbidities.


Conclusions

Most of prostate cancers diagnosed in France in 2001 were clinically localized and were treated by invasive therapy. The consequences of these practices remain to be determined given the limited evolution of many prostate cancers and the frequency of adverse events related to invasive treatments.

Mots clés:
Cancer de la prostate / Cancer de la prostate/traitement / Épidémiologie / Registres / France
Mots-clés:
Prostatic neoplasm / Prostatic Neoplasm/therapy / epidemiology / Registries / France
Le dépistage du cancer de la prostate en 2009 : mise au point du comité de cancérologie de l'Association française d'urologie
2010
- Réf : Prog Urol, 2010, 1, 20, 17-23


Généralités



Objective

To analyze the impact of screening on prostate cancer (PCa) mortality, and to discuss the main points of controversy regarding this screening.


Methods

A bibliographic analysis was made using Medline services (keywords: prostate cancer, screening). Only the randomized studies regarding the impact of PCa screening on specific mortality were taken into account.


Results

Two randomized studies, comparing one group of screened men with another group of nonscreened men, were published this year with conflicting results. The American study PLCO included 76,693 men. After a follow-up of 7 years, it did not report a significant difference in terms of specific mortality between both arms: 2/10,000 deaths in the control group versus 1.7/10,000 in the screened arm (RR=1.13; IC 95%: 0.75–1.7). The European study ERSPC included 182,160 men. After 9 years of follow-up, it showed a significant 20% reduction of specific mortality rate in the screened group (RR=0.80; IC 90%: 0.65–0.98; p =0.04). Methodologically, the European study seems to be superior to the American study, in which the control group was biased by a high percentage of preinclusion screening.


Conclusions

This is the first time that a large randomized study shows a benefit of PCa screening regarding specific mortality. However, this issue remains to be clarified, due to the lack of data regarding the risk of “overdiagnosis” and the economic impact of screening.

Mots clés:
Cancer de la prostate / dépistage / PSA / Diagnostic / Détection
Mots-clés:
prostate cancer / Screening / PSA / Diagnosis / Détection
Le point sur l'utilisation d'estramustine dans le cancer de la prostate métastatique
2010
- Réf : Prog Urol, 2010, 1, 20, 24-29


Introduction



Chemotherapy is indicated in metastatic castration-refractory prostate cancer. It aims at alleviating symptoms and increasing survival, without impairing quality of life. Docetaxel is considered as the reference treatment in this indication. However, several studies demonstrated the relevance of associating estramustin with docetaxel, due to the synergistic effect of the combination and the action of estramustin on resistance mechanisms. Moreover, the addition of estramustin to chemotherapy demonstrated a survival benefit for patients. Thrombotic events are frequent in patients with advanced prostate cancer and estramustine is known to increase the risk. Optimization of treatment requires a thorough assessment of the individual risk in each patient as well as the prescription of an anti-thrombotic prophylaxis, which should be currently based on low molecular weight heparin.

Mots clés:
Cancer de la prostate métastatique / Docétaxel / Estramustine / Chimiotherapie
Mots-clés:
Metastatic prostate cancer / Docétaxel / Estramustin / chemotherapy
Mélanome primitif de l'urètre découvert au stade métastatique : à propos d'un cas
2010
- Réf : Prog Urol, 2010, 1, 20, 80-82


Introduction



Purpose

Primary urethral melanoma is a rare pathology for which treatment strategies are controversial. The aim of this work was to report a case of metastatic primary urethral melanoma, and to discuss recent data available from literature.


Material and method

Case study was summarized from the patient’s medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.


Results

We reported the case of an 89-year-old woman who died from a primary metastatic melanoma of the urethra. This pathology encounters for less than 1% of melanomas and has an adverse prognosis. In case of metastasis, specific survival is only of a few months. When localized to the urethra, treatment relies on radical urethrectomy, followed by adjuvant chemo- and immunotherapy.


Conclusions

The modalities of treatment of primary urethral melanoma rely only on reported case studies. When diagnosed at the metastatic stage, reported specific survival does not exceed a few months.

Mots clés:
Mélanome / Urètre / Métastase
Mots-clés:
Melanoma / urethra / metastasis
Résultats de l'aspiration cytologique à l'aiguille fine dans le diagnostic des tumeurs solides du rein de nature indéterminée
2010
- Réf : Prog Urol, 2010, 1, 20, 30-34


Introduction



Objective

To evaluate the accuracy of fine-needle aspiration cytology for the diagnosis of imaging indeterminate solid renal tumours.


Materials and methods

From February 2003 to February 2009, 60 cytoaspirations have been performed to 20 female and 40 male patients (average age: 62.0±14.2 years) with an indeterminate solid renal mass by imaging. The average tumour size was 3.4±2.8cm. The cytoaspiration was performed through a 22 Gauge needle under CT (n =39) or US (n =21) guidance. Papanicolaou staining was used. All slides were examined by one experienced cytologist without any clinicoradiological information. The results were given as malignant, benign, suspect or non significant. A classification of subtypes of renal cancer might be added by the cytologist.


Results

Twenty-one cytoaspirations (35%) were non significant while 39 (65%) showed cells of interest. Among these 39 cellular cytoaspirations, the specificity for malignancy or benignity was 89.7%. The proportion of non-significant samples was the same in tumors lesser than 2cm (38.4%) as in tumors 2–4cm (38.8%) (p =1.000, Fisher’s exact test). Subtype identification was only reliable for clear cell carcinomas. No complication was observed.


Conclusion

The fine-needle aspiration cytology is an auxiliary technique for the diagnosis of indeterminate solid renal tumours. This simple and mini-invasive technique had a high specificity but a low sensitivity in our experience. Fine-needle aspiration is complementary to core biopsy which remains the gold standard of percutaneous sampling.

Mots clés:
Aspiration / cytologie / Diagnostic / Tumeur rénale
Mots-clés:
Aspiration / cytology / Diagnosis / Renal tumour
Tumeurs des voies excrétrices urinaires supérieures sporadiques : identification de l'interaction entre l'exposition aux carcinogènes environnementaux et la susceptibilité génétique des individus
2010
- Réf : Prog Urol, 2010, 1, 20, 1-10


Introduction



Upper urinary tract urothelial cell carcinomas (UUT UCC) are rare sporadic tumors. Recent epidemiologic and molecular data have shown a singular susceptibility of UUT UCCs for specific risk factors. The main exogenic factors involved in UUT UCCs carcinogenesis remain tobacco and occupational exposure (aromatic amines, polycyclic hydrocarbures and chlored solvents). Enzymatic variants of detoxification system may be responsible of carcinogenesis with these toxics. Tumors induced by phenacetine consumption are decreasing since it was banned in the 1970s. Also, acid aristolochic exposure (Balkan nephropathy, Chinese Herb nephropathy) has been demonstrated to specifically induce UUT UCCs. Familial genic polymorphism of detoxification system would explain geographic distribution in endemic areas. In Taiwan, chronic arsenic exposition would constitute the main risk factor of UUT UCC. However, theses mechanisms of carcinogenesis remain unclear. The knowledge of UUT UCC development mechanisms implying toxic detoxification systems is still incomplete. To date, there is a growing body of evidence supporting that the interaction between individual genetic susceptibilities and environmental toxic exposure is a key to explain carcinogenesis in the majority of sporadic UUT UCC occurrence.

Mots clés:
carcinome urothélial / Bassinet / Uretère / facteur de risque / Polymorphisme génétique
Mots-clés:
MeSH / Urothelial carcinoma / Renal pelvis / ureter / risk factor
Une application de la tomodensitométrie en double énergie dans le traitement d'un calcul coralliforme
2010
- Réf : Prog Urol, 2010, 1, 20, 77-79


Introduction



We report the history of a patient who presented a radiodense large staghorn kidney stone which was investigated by dual energy CT. Dual energy CT showed that this stone consisted of uric and calcic compounds. The patient received a specific treatment combining chemical lysis and lithotripsy active on uric and calcic parts respectively, leading to a complete noninvasive destruction of the stone. It seemed that lithotripsy performed at first step allowed for efficient lysis by chemical agent.

Mots clés:
Tomodensitométrie double énergie / Lithiase coralliforme / Traitement
Mots-clés:
Dual energy CT / Staghorn kidney stone / treatment
Validation externe du modèle pronostique de l'University of Los Angeles Integrated Staging System (UISS) dans le cancer du rein localisé : étude monocentrique
2010
- Réf : Prog Urol, 2010, 1, 20, 35-39


Introduction



Objective

To assess the ability of the University of Los Angeles Integrated Staging System (UISS) to stratify patients with a renal cell carcinoma (RCC) in one single French centre.


Patients and methods

Four hundred and forty-three patients operated for a RCC in the Urological Department of Strasbourg University Hospital between January 1989 and December 2000 were classified according to the UISS, which combines TNM stage, Fuhrman grade and Eastern cooperative oncology group performance status. Two groups were created: 362 patients with localized and 81 patients with metastatic RCC.


Results

The UISS stratified the localized RCC into three different risk groups (p <0.0001). The 5-year survival rates were 75, 61 and 29% for low-, intermediate- and high-risk groups, respectively. For the metastatic RCC, the UISS couldn’t well discriminate (p =0.092), with the 5-year survival rates of 18, 9 and 12% for low-, intermediate- and high-risk groups, respectively.


Conclusion

This study validates the UISS for predicting survival in patients with localised RCC in our centre and, therefore, qualifies us to participate in clinical trials using this model. In metastatic RCC, the UISS was less accurate due to the small number of patients and the heterogeneity of treatments.

Mots clés:
UISS / cancer du rein / Survie / Pronostic
Mots-clés:
UISS / Renal cell carcinoma / survival / prognostic