Base bibliographique

Étude in vitro de l'activité litholytique de quatre plantes médicinales vis-à-vis des calculs urinaires de cystine
2011
- Réf : Prog Urol, 2011, 1, 21, 40-47


Introduction



Introduction

Cystine stones represent 1% of urinary calculi in adults and 10% in children and are especially recurrent and resistant to ESWL. Medical therapy is often efficient but often poorly tolerated. In Morocco, various plants, Herniaria hirsuta , Opuntia ficus-indica , Zea mays and Ammi visnaga are proposed against nephrolithiasis. We assessed the effect of plant extracts on the disolution of cystine stones in vitro.


Material and method

An extract of each plant was prepared by infusion of two grams of powdered plants during 30minutes in100ml of a boiled NaCl 9g/L aqueous solution. Each extract was then filtered and thereafter set in a flask containing a cystine stone. The medium was maintained under stirring during 8 weeks. NaCl 9g/L solution and sodium citrate 3mmol/L solution were used as controls. At the end of each two weeks period, the stone was removed from the experimental medium and weighted after a 16h drying period at 40°C.


Results

After 8 weeks of experiment, stone dissolution was complete for all herbal extracts, and was earlier in the presence of Zea mays (4 weeks) or of Ammi visnaga (6 weeks) by comparison to only 18±8 and 20±1.5 % for citrate and NaCl solutions, respectively.


Conclusion

The studied herbal extracts were efficient for dissolving cystine stones, probably resulting from the formation of complexes between cystine and polyhydroxylated molecules present in the extracts. These results, to be confirmed in vivo, underline the potential interest of the plant extracts to treat cystine stones.

Mots clés:
Lithiase urinaire / Cystine / phytothérapie / /
Mots-clés:
Urolithiasis / Cystine / Herbal extracts / /
Évaluation par l'index international de la fonction érectile (IIEF-15) de la fonction sexuelle des hommes atteints d'une maladie de Parkinson idiopathique
2011
- Réf : Prog Urol, 2011, 1, 21, 67-71


Introduction



Objective

To assess the sexual function in men with idiopathic Parkinson’s disease.


Patients and methods

A cross-sectional study was performed in 35 men, mean age 68±9 years, with idiopathic Parkinson’s disease followed in a single urological department. The 15 questions International Index of the Erectile Function was sent by postal mail.


Results

The answer’s rate was 42.9% (15 patients). The mean age of the responders was 68.7±10.0 years. Mean duration of the disease was 10.4±6.8 years. Sexual dysfunction was the second cause for consultation in urology. Despite a sustained sexual desire, patients had an altered sexual function with low erectile function, orgasmic function, intercourse satisfaction and total satisfaction scores. According to the Cappelleri’s classification, the erectile dysfunction was severe in 54% of the cases and moderate in 26.6%. Age, institutionalization and overactive bladder symptoms were associated with erectile, orgasmic function and intercourse satisfaction alteration, sexual desire alteration, intercourse and global satisfaction alteration, respectively.


Conclusion

Men with idiopathic Parkinson’s disease had a severe sexual dysfunction. The sexual desire was usually maintained but all the other domains were severely altered.

Mots clés:
sexualité / Parkinson / IIEF / dysfonction érectile
Mots-clés:
Sexuality / Parkinson’s disease / IIEF / erectile dysfunction
Évaluation préopératoire du nombre de vaisseaux chez le donneur de rein vivant. La TDM est-elle supérieure à l'IRM ?
2011
- Réf : Prog Urol, 2011, 1, 21, 34-39


Introduction



Background

Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are both used in the preoperative assessment of vascular anatomy before donor nephrectomy. Our objective was to determine retrospectively and to compare the sensitivity of CTA and MRA imaging in preoperative renal vascularisation in living kidney donors.


Patients and methods

Between 1999 and 2007, 42 kidney donors were assessed in our center: 27 by MRA, 10 by CTA, and five by both techniques. Images were interpreted using multiplanar reconstructions. Results were compared retrospectively with peroperative findings; discordant cases were re-examined by an experienced radiologist. Numbers of vessels detected with imaging methods was compared with numbers actually found at the operating time.


Results

MRA showed 35/43 arteries (Se 81.4 %) and 33/34 veins (Se 97.1 %), and CTA showed 18/18 arteries (Se 100 %) and 15/16 veins (Se 93.8 %). The presence of multiple arteries was detected in only one third of cases (3/9) on MRI scans; this difference was statistically significant. The missed arteries were not detected on second examination of the MRI scans with the knowledge of peroperative findings.


Conclusion

MRA is less sensitive than CTA for preoperative vascularisation imaging in living renal donors, especially in the detection of multiple renal arteries.

Mots clés:
Transplantation rénale / Donneur vivant / Anatomie réno-vasculaire / Sensibilité de l’imagerie / Artères multiples
Mots-clés:
Renal transplantation / Donor nephrectomy / Renal vascular anatomy / Imaging accuracy / Multiple arteries
La femme face à la dysfonction érectile de son partenaire. À propos de 137 patients
2011
- Réf : Prog Urol, 2011, 1, 21, 59-66


Introduction



Aim

To assess the behavior of female partners of patients consulting for erectile dysfunction (ED) and the impact of ED on their sex life.


Material

One hundred and thirty seven men (mean age 57.4 years), consulting for the first time because of ED and having a stable relationship with a single woman for more than six months, completed various questionnaires: IIEF, grounds for the possible absence of their partner during the consultation, attitude of the latter confronted with ED. The partners (mean age 54 years) have been invited to complete a questionnaire ISL (Index of Sexual Life) regarding their sexual life during the four last weeks. Seventy-nine (58%) have responded.


Results

Most often, the ED was severe (49%) and has evolved for more than one year (64%). The relationship has lasted for more than ten years for 77% of couples. Moreover, 43% of men declared that their partner had encouraged them to consult but 76% consulted alone the first time. According to the patients, the most frequent grounds for absence of their partner were: “she was occupied” (58%), “we did not think of it” (24%), “we did not know that it was possible” (15%). According to the patients, confronted with ED their partner was disappointed (29%), vexed (27%), frustrated (17%), accepting (15%) but the most often understanding (77%). The ISL scores were impaired in the different categories (sexual drive, sexual life satisfaction, general life satisfaction). According to ISL, 41% of women indicated that sexual intercourse was “a few times, almost never” or never satisfactory for them. Moreover, 45% found sexual intercourse “fairly enjoyable, enjoyable, or very enjoyable” but 41% did not feel an orgasm during vaginal penetration. Additionally, 44% remained “moderately or very satisfied” with their sexual relationship and 54% with their overall sex life.


Conclusion

Few women attended the first consultation of ED because, according to the patients, usually they were not free. According to the patients, confronted with ED their partner was sometimes vexed, disappointed, frustrated but more often remained understanding. The analysis of the questionnaires ISL completed by the female partners shown that ED affected their sexuality but about half of them remained satisfied with their sexual relationship and overall sex life.

Mots clés:
dysfonction érectile / Partenaire sexuelle / Comportement sexuel
Mots-clés:
erectile dysfunction / Sexual partners / Sexual behavior
La néphrectomie laparoscopique par accès ombilical unique : évolution ou révolution chirurgicale ?
2011
- Réf : Prog Urol, 2011, 1, 21, 29-33


Introduction



Objective

To present our initial experience of laparoendoscopic single site (LESS) renal surgery.


Methods

Between May 2009 and March 2010, nine nephrectomies and one cyst decortication were performed in nine patients. Eight of the procedures were done with three 5mm trocars inserted through a unique peri-umbilical incision. In two cases, a specific single-port device was used. All operations were achieved with a 5-mm 30° lens and conventional laparoscopic instruments. The specimens were entrapped in a 10mm endoscopic bag and extracted through the umbilical incision.


Results

Mean age was 56 years old. Mean BMI was 23.5 [19–34]. Mean operative time was 149min [80–240], and estimated blood loss was 90ml [20–250]. None of the patients required blood transfusion. Mean length of stay was 4.1 days [3–5]. Only one major complication occurred (functional occlusion). One conversion to conventional laparoscopy was necessary in a case of inflammatory kidney. Histologic exam showed benign lesions (cyst and non functional kidney) in seven cases, and papillary carcinoma in three cases.


Conclusion

LESS surgery is feasible. Its advantages over conventional laparoscopy are not clear. LESS is a new procedure that should benefit from the improvement of technical instrumentation.

Mots clés:
Néphrectomie / laparoscopie / Accès unique ombilical / Trocar unique
Mots-clés:
nephrectomy / Laparoscopy / LESS surgery / Single-port / Single access
Les biomarqueurs émergents du diagnostic, du staging et du pronostic du cancer de la prostate
2011
- Réf : Prog Urol, 2011, 1, 21, 1-10


Introduction



The introduction and widespread adoption of prostate-specific antigen (PSA) has revolutionized the way prostate cancer is diagnosed and treated. However, the use of PSA has also led to overdiagnosis and overtreatment of prostate cancer resulting in controversy about its use for screening. PSA also has limited predictive accuracy for predicting outcomes after treatment and for making clinical decisions about adjuvant and salvage therapies. Hence, there is an urgent need for novel biomarkers to supplement PSA for detection and management of prostate cancer. A plethora of promising blood- and urine-based biomarkers have shown promise in early studies and are at various stages of development (Human kallikrein 2, Early Prostate Cancer Antigen, Transforming Growth Factor-Beta 1 and Interleukin-6, Endoglin, PCA3, AMACR and ETS Gene Fusions). In this article, we review those biomarkers and then discuss the challenges a biomarker has to undergo before it is approved in a clinical use.

Mots clés:
Cancer de la prostate / / / Biomarqueur / Récidive
Mots-clés:
prostate cancer / Prostate-specific antigen / Biomarker / recurrence / metastasis
Les sarcomes du cordon spermatique de l'adulte : diagnostic et prise en charge
2011
- Réf : Prog Urol, 2011, 1, 21, 53-58


Introduction



Purpose

To clarify the patterns of diagnosis and management of adult spermatic cord sarcoma.


Patients and methods

Between 1996 and 2009, seven patients with spermatic cord sarcoma were treated at Cochin hospital. After updating the pathological diagnosis according to the new classification of sarcoma we found that all patients had well-differentiated or dedifferentiated liposarcoma. We analysed their clinical presentation, management and carcinological outcome.


Results

The patients’ age ranged from 51 to 77 years, and their follow-up from 7 to 68 months. In five patients, the diagnosis of well-differentiated liposarcoma (lipoma-like) with some dedifferentiated sectors was made straightaway. In the two other patients, the initial diagnosis was that of leiomyosarcoma, which was reconsidered as dedifferentiated liposarcoma according to the cytogenetical and immunohistochemical techniques available since 2005. In 6/7 patients, a tumour resection with an orchiectomy at the same time (four patients) or secondarily (two patients) was performed. In one patient, only a tumour resection, without orchiectomy, was made. Multiple recurrences were observed in the two patients who were initially diagnosed as leiomyosarcoma. They needed multiple reintervention. One of them died after 68 months of evolution, the other one was treated with chemotherapy and died after 47 months of evolution. Four patients are out of recurrence. One patient was lost to follow-up.


Conclusion

The diagnosis of liposarcoma must be considered in all adult patients aged of more than 50 with fatty-shaped or containing fibomuscular nodules paratesticular tumours. The surgeon and the pathologist must be well informed and an early and wide resection of fatty masses of the sperm cord with negative margins is advocated. The quality of resection is crucial but its appreciation and carrying out are difficult. The role of complementary treatments, especially radiotherapy, has to be determined.

Mots clés:
sarcome / Liposarcome / cordon spermatique / scrotum / Paratesticulaire
Mots-clés:
Sarcoma / Liposarcoma / Spermatic cord / Scrotum, Paratesticular / Surgical margins
Métastase cutanée d'un séminome testiculaire pur
2011
- Réf : Prog Urol, 2011, 1, 21, 76-78


Introduction



Seminomas are germinal tumors from testicular cells in men. Cutaneous metastasis are very rare. The authors report the case of a 56-year-old male patient admitted for treatment of an enlarged left testicular mass. Physical examination revealed a cutaneous nodule on the right side of the back. Histopathologic examination of both orchiectomy materiel and cutaneous lesion revealed pure seminoma. Chest and abdomen-pelvis CT revealed a pulmonary metastatic nodules, enlarged para-aortic lymph nodes and metastatic lesions in the adrenals glands. The patient died six months after diagnosis due to complications of metastatic disease despite adjuvant chemotherapy. To our knowledge, we report the first case demonstrating that seminoma may spread to skin.

Mots clés:
Métastases cutanées / Tumeur testiculaire / Séminome pur
Mots-clés:
Skin metastasis / Testicular tumour / Pure seminoma
Modification de la libido et de l'orgasme après prostatectomie totale
2011
- Réf : Prog Urol, 2011, 1, 21, 48-52


Introduction



Objectives

To assess the impact of RP on patients’ sexual desire and orgasm.


Material and methods

Prospective, cross-sectional survey using a 16-item self-administered questionnaire. We assessed relevant domains of male sexual function (erectile function, sexual desire, and orgasm), psychological impact and treatment of ED.


Results

A total of 63 consecutive patients after RP were included (mean age: 63.9). Median time between questionnaire and RP was 26.8 months (range 6–67). After RP, 74.6 % of patients used ED treatments. Lower sexual desire and intercourse frequency were reported in respectively 52.4 and 79.4 %. Orgasm was modified in most patients: 39.7 % described loss of orgasm and 38.1 % reported decreased intensity. Involuntary loss of urine at orgasm (climacturia) was reported in 25.4 %. Negative psychological impact was reported in 68.3 % (loss of self-esteem, loss of masculinity, anxiety).


Conclusions

RP adversely affected erectile and orgasmic functions but also sexual desire, self-esteem and masculinity despite treatments. Candidates for RP should be aware of ED but also of other postoperative sexual dysfunctions.

Mots clés:
Orgasme / Perte d’urine à l’orgasme / Libido / Prostatectomie totale / sexualité
Mots-clés:
Libido / Orgasm / Climacturia / radical prostatectomy / Sexuality
Recommandations pour la bonne pratique des biopsies prostatiques
2011
- Réf : Prog Urol, 2011, 1, 21, 18-28


Introduction



Objectives

The aim of these recommendations is to help urologists to optimize prostate biopsy practice in order to improve diagnosis yield and to minimize associated morbidity.


Methods

Online systematic literature search was performed on PubMed® until April2010. Regulation texts, published guidelines and results of recent urologists practice study, were taken into consideration. Level of evidence was assigned to each recommendation.


Results

Patient information must be prior to the procedure and should be given through a medical exam by the physician performing the biopsies. The check for complication risk factors (allergic, infectious, hemorrhagic) had to be done preoperatively by the physician during the medical exam. The use of single systemic antibiotics is recommended and Quinolones are the drugs of choice (level of evidence 2). Biopsies should be performed on outpatient basis to assess the safety of the procedure. Transrectal route and ultrasound guidance are state-of-the-art. Local anaesthesia with peri-prostatic block is recommended (level of evidence 1). On baseline biopsies, extended 12-cores scheme should be performed. Urine retention and severe postbiopsies infections have been reported in less than 1% of cases. Optimal management of severe post-biopsies infections is based first on patient information and require hospital intravenous antibiotic therapy.


Conclusion

To improve the sensitivity and to reduce the risk of complication, achievement of prostate biopsies should follow a standardized procedure.

Mots clés:
cancer de prostate / Diagnostic / Biopsie / Stadification / imagerie
Mots-clés:
Prostatic neoplasm / Diagnosis / Biopsy / Staging / imaging
Rétention vésicale du post-partum
2011
- Réf : Prog Urol, 2011, 1, 21, 11-17


Introduction



Postpartum urinary retention is an uncommon event that occurs in 0.7 to 0.9% of vaginal deliveries. An ignorance of this situation can lead to delayed diagnosis worsening the prognosis and to inadequate treatments. This complication is defined as the absence of spontaneous micturition within 6hours of vaginal delivery with a bladder volume above 400mL. The etiology depends on multiple factors. Because of physiological changes during pregnancy, the bladder is hypotonic with an increased post-void residual volume. The occurrence of a perineal neuropathy during delivery may cause a urinary retention. Risk factors are primiparity, prolonged labour, instrumental delivery and perineal lacerations. Treatment consists on clean intermittent catheterization and recovery occurs generally in 72hours. Persistent urinary retention is the principal short-term complication and should be treated by clean intermittent self-catheterization. Long-term consequences are poorly reported in the literature.

Mots clés:
Extraction instrumentale / Neuropathie périnéale / Post-partum / Rétention vésicale
Mots-clés:
extraction / Obstetrical / Perineal neuropathy / Postpartum / Urinary retention
Urétéro-renoscopie souple chez un nourrisson de 22 mois
2011
- Réf : Prog Urol, 2011, 1, 21, 72-75


Introduction



With the endourological development, the management of urinary tract calculi in children has significantly improved. The miniaturization of endoscopic equipment has allowed the use of flexible ureteroscopic with holmium YAG laser lithotripsy in children. We highlighted the case of a 22-month-old child, with an antecedent of megaureter, who had calculi in the right kidney lower pole. In collaboration with the urologist specialising in adult care, using an adapted technical tray, we underwent a laser intracorporeal lithotripsy using a 8 Charriere (Ch) ureteroscope and an holmium laser. No ureteral dilatation was required. A complete fragmentation of this infectious calculus was performed. This experience with a flexible ureteroscopy confirms that this technique is practicable, efficient and safe for stone treatment in children.

Mots clés:
Nourrisson / Urétéroscopie / Laser / Calcul / Rein
Mots-clés:
child / ureteroscopy / Lithotripsy / stone / kidney