Base bibliographique

Sommaire :

Bilan initial et suivi de l'hyperplasie bénigne de prostate : revue de littérature du CTMH de l'AFU
2012
- Réf : Prog Urol, 2012, 1, 22, 1-6


Objectif



Purpose

To perform an update on the initial evaluation and follow-up of benign prostatic hyperplasia (BPH).


Method

A systematic review of recent literature was performed. Level of evidence of publications was evaluated.


Results and conclusions

Objectives of the initial evaluation are to assess the link between low urinary tract symptoms (LUTS) and BPH, to evaluate the bother associated to LUTS, assess a complicated bladder outlet obstruction (BOO), diagnose an adenocarcinoma of the prostate if it modifies the therapeutic strategy, and establish an evolutive profile of the disease. Clinical assessment with digital rectal examination, evaluation of symptoms by a dedicated questionnaire and urine analysis are the first steps of BPH evaluation. Bladder diary is useful to objective storage symptoms. Uroflowmetry and post-void residual volume assessment are useful if BOO is suspected. Measure of serum creatinine and ultrasound exam of the urinary tract are second line explorations. Urine cytology, neurological evaluation, urethrocystoscopy, urodynamics with pressure-flow studies are useful if the link between LUTS and BPH is unclear. PSA dosage is used for prostate cancer screening or as a prognostic marker of BPH evolution.

Mots clés:
hyperplasie bénigne de la prostate / Symptômes du bas appareil urinaire / Bilan initial / Suivi / Diagnostic
Mots-clés:
Benign prostatic hyperplasia / Diagnosis / Low urinary tract symptoms / Initial assessment / Follow-up
Complications urinaires après réimplantation urétérovésicale selon la technique du « one-stitch » en transplantation rénale
2012
- Réf : Prog Urol, 2012, 1, 22, 22-29


Introduction



Purpose

To assess urinary complications related to the “one-stitch” technique extravesical ureteroneocystostomy in renal transplantation, and evaluate the impact of such complications on kidney graft and patient survival.


Patients and methods

A single-institution, retrospective study was performed on 202 renal transplant recipients, from January 2004 to December 2008. Two combined kidney and liver transplantations were excluded. The “one-stitch” extravesical ureteroneocystostomy technique, fast and easy to perform, was systematically used. The evaluated urinary complications were urinary fistula, ureteral stenosis, symptomatic ureteral reflux, stone formation and complicated hematuria. We tried to point out factors impacting urinary complications occurrence and studied grafts and patients survival according to the existence of urinary complications.


Results

Fifty-five patients presented urinary complications (27.5%). The most frequent urinary complications were complicated hematuria (36 over 200, 18%), ureteral stenosis (15 over 200, 7.5%). Few cases of stone disease (one over 200, 0.5%), urinary fistula (two over 200, 1%) and symptomatic ureteral reflux (one over 200, 0.5%) were noted. Male gender (100 vs 34, P =0.95), âge (46.78±14.17 vs 48.06±14.19 years, P =0.58), Body mass index (24.14±5.04 vs 24.28±4.83, P =0.86) and past history of renal transplantations (16±3% vs 10±3%, P =0.27) as well as cold ischemia time (17.08±7.07 vs 16.9±8.95hours, P =0.71) were not significantly different in the urinary complications group and the non-urinary complications group. Median hospitalization time was similar in both groups (14 vs 12 days, P =0.37). The existence of urinary complications didn’t affect the 5 years kidney graft survival (91.9% vs 89.9%, HR 1.21, CI 95% [0.37–3.3], P =0.83) neither the 5 years patient survival (94.8% vs 92.15%, HR 0.52 CI 95% [0.13–2.07], P =0.85).


Conclusion

If benign urinary complications in “one-stitch” ureteroneocystostomy were frequent in our study (17% grade II Clavien Dindo), kidney graft and patients survivals were not affected.

Mots clés:
Transplantation rénale / Réimplantation urétérovésicale / Technique du « one-stitch » / Complications urinaires
Mots-clés:
Renal transplantation / Ureteroneocystostomy / One-stitch / Technique / Urinary complications
Détection laparoscopique des ganglions sentinelles dans le cancer localisé de la prostate : résultats obtenus chez 70 premiers patients
2012
- Réf : Prog Urol, 2012, 1, 22, 30-37


Introduction



Objectives

The lymph node metastasis is an important prognostic factor in prostatic cancer. The aim of this prospective study was to evaluate the relevance of the sentinel lymph node biopsy by laparoscopy in staging locoregional patients with clinically localized PC.


Patients and methods

A transrectal ultrasound-guided injection by 0.3mL/100MBq 99mTc-sulfur rhenium colloid in each prostatic lobe was performed the day before surgery. The detection was realized intraoperatively with a laparoscopic probe (Clerad® Gamma Sup) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by hematoxyline-phloxine-safran staining and followed by immunochemistry if SLN is free.


Results

Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 68/70 (97%). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14%). The internal iliac region was the first metastatic site (40.9%). A metastatic sentinel node in common iliac region beyond the ureteral junction was present in 18.2%. A non-negligible sentinel metastatic region was the common iliac area (18.2%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59% of lymph node metastases.


Conclusion

The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limited the risk of surgical extended dissection while maintaining the accuracy of the information.

Mots clés:
cancer de prostate / chirurgie laparoscopique / Ganglion sentinelle / Curage ganglionnaire pelvien étendu
Mots-clés:
prostate cancer / laparoscopic surgery / Sentinel lymph node / Extended pelvic lymph node dissection
Devenir des traumatismes fermés sévères du rein de l'enfant
2012
- Réf : Prog Urol, 2012, 1, 22, 58-62


Introduction



Aims

To analyze the results of treatment of major renal injuries according imaging data in order to determine their function after follow-up.


Patients and methods

This is a retrospective study of 22 cases of fracture of the kidney (grade V) in two pediatric surgical services that were reviewed over a period of 16years. After initial conservative treatment in 19 patients (86.5%), a scan and/or Uro-MRI were realized in all patients in monitoring evolving. Three children with vascular injury were treated by interventional radiology. The morphology and functional evolution of the injured kidney were determined.


Results

A DMSA scan investigation was performed in 21 patients (95.5%) associated with Uro-MRI in two cases; one patient was only explored with Uro-MRI. A complete restitution of the renal parenchyma was confirmed in 10 children (45.5%), we noted an atrophy of the upper pole in 30%, a lower pole atrophy in 4.5%, two complete renal atrophy in 9%. An urinoma was present in six patients (27%) that required drainage in five cases and declined during the surveillance in one case. Normal function of the injured kidney was noticed in half of grade V (11 of 22 patients) with a mean follow-up of 19months. None of our patients did present hypertension.


Conclusion

Non-operative conservative treatment in severe renal trauma was efficient, morphological and functional sequelas were present in 50% on scintigraphy and/or Uro-MRI.

Mots clés:
Fracture rénale / Traitement conservateur / Scintigraphie / Enfant
Mots-clés:
Kidney fracture / Conservative treatment / Scintigraphy / child
Endothéline-1 et récepteur A : valeur pronostique pour la reprise évolutive biologique dans l'adénocarcinome de prostate localement avancé et métastatique ganglionnaire
2012
- Réf : Prog Urol, 2012, 1, 22, 38-44


Introduction



Introduction

Pathological endothelin axis is known to be involved in prostate cancer progression. Our study evaluates immunohistochemical expression of ET-1 and ET-AR on prostate biopsy specimen and the predictive value for biochemical relapse on patients with advanced and metastatic cancer. We also evaluated the impact of ET-1 and ET-AR expression on local progression and metastatic bone progression for these patients.


Patients and method

From 1992 to June 2009, 44 patients with clinical T3 stage and metastatic lymph nodes were included. PSA levels, Gleason score in biopsy cores, number of invaded lymph nodes, the existence of nodular capsule transgression and hormonal treatment given to the patient, were analyzed. Biopsy cores were submitted to immunohistochemical study of the expression of ET-1 and ET-AR. Semi-quantitative ET-1 and ET-AR staining assessment was always realised by the same pathologist.


Results

The average age of the cohort was 65.6 (standard deviation 6.3), median PSA level was 52.8 ng /ml (3–227), median time of follow-up was 70 months (6–144). Biochemical relapse was observed in 62.8%. Statistically significant stronger ET-1 expression was observed in biopsies of patients with a biochemical relapse (p =0.014). Eighty percent of patients with a biochemical relapse had a high level of ET-AR expression, but no statistical significance has been shown (p =0.109). The relative risk for progression under hormonal therapy was 1.9 in case of high level of ET-1 expression and biochemical relapse was confirmed 8 months earlier in average. High level of ET-AR expression on biopsy cores may indicate earlier local progression and metastatic bone progression but there were no statistical proof.


Conclusion

In our study, the strength of ET-1 expression in prostate cancer biopsy cores is a prognostic factor of biochemical relapse for cT3 stage patients with metastatic lymph nodes. We have not been able to prove that ET-1 is an independent prognostic factor. A high level of ET-AR expression on prostate biopsy cores is not, in our study, a prognosis factor for predicting the biochemical relapse.

Mots clés:
Endothéline-1 / cancer de prostate / biopsies de prostate / Pronostic / Métastases
Mots-clés:
Endothelin-1 / prostate cancer / Prostate biopsy cores / prognosis / metastasis
Évolution sur cinq ans des infections à germes produisant une β-lactamase à spectre étendu
2012
- Réf : Prog Urol, 2012, 1, 22, 17-21


Introduction



Introduction

Actually, epidemiology of extended-spectrum β-lactamase (ESBL) producing enterobacteriaceae is increasing worldwide, especially in urinary tract infections (UTI). The objective of the study was to investigate the epidemiology of ESBL producers in a department of urology.


Patients and methods

This was a retrospective, monocentric study, which included all patients with positive culture showing an ESBL producing enterobacteriaceae in a department of urology between 2005 and 2009 included.


Results

The prevalence of ESBL producers in UTI was 2/113 (1.8%) in 2005 and 3/196 (1.5%) in 2009 (P =0.87). Twenty-seven isolates were included: 66.7% of Escherichia coli , 11.1% of Klebsiella pneumoniae , 11.1% of Enterobacter cloacae . ESBL producers were resistant to another antibiotic family in 24 cases (88.8%). The mean age in this study was 70.4 years, 70% of patients had another antibiotherapy in the past 6 months, 87% an hospitalization within 90% had surgery. Among the patients, 56.5% had a material. The infection was community-acquired in three cases only. Thirty-five percent of patients had no symptoms, 26% presented with severe sepsis.


Conclusion

This report was a five-year retrospective study of BLSE-positive bacteria showing the nosocomial infection with ESBL producers and their multiresistance to usual antibiotics without any increase of their prevalence.

Mots clés:
-lactamase à spectre étendu / Épidémiologie / facteurs de risque / Nosocomiale / Bactéries multirésistantes
Mots-clés:
Extended-spectrum / -lactamase-producing / epidemiology / Risk factors / Nosocomial
Fertilité après curiethérapie par implants permanents d'Iode 125 pour cancer localisé de la prostate
2012
- Réf : Prog Urol, 2012, 1, 22, 53-57


Introduction



Objectives

Preservation of fertility in men of middle age is an issue that is experiencing a growing interest. Prostate cancer is the second most common cancer in men and is diagnosed earlier than before. Brachytherapy is a treatment for prostate cancer that preserves ejaculation. Our aim was to study the fertility of men treated with prostate brachytherapy in order to improve patient information.


Patients and methods

In a series of 270 sexually active men with localized prostate cancer treated with brachytherapy (permanent implants of Iode 125) at the Institute Claudius Regaud between 2000 and 2006, mean age 65 years (43–80), four patients spontaneously expressed their interest in the preservation of fertility and had an andrological evaluation.


Results

Four patients were aged 43, 48, 57 and 61years, all working (including two businessmen), their partner was aged respectively 42, 37, 47 and 38years. All four had a post-treatment semen analysis (done over a year after brachytherapy) rich in spermatozoa, with moderate asthenospermia, the main anomaly being severe hypospermia. These spermiograms were nonetheless consistent with the occurrence of spontaneous pregnancy (occurrence of miscarriage in the patient 1).


Conclusion

There is an interest in applying to men with prostate cancer their position on fertility in order to inform them about the morbidity of various treatments, options for fertility preservation, and the need to continue a contraception after brachytherapy if the partner is not menopausal.

Mots clés:
Curiethérapie / prostate / fertilite
Mots-clés:
brachytherapy / prostate / fertility
Information du malade et responsabilité médicale
2012
- Réf : Prog Urol, 2012, 1, 22, 67-69


Introduction



The Court of cassation is the highest court in the French judiciary. In a recent decision on June 3, 2010, the supreme jurisdiction quashed partially a court of appeal judgement. A patient developed erectile dysfunction following open prostatectomy for benign prostatic hyerplasia. The patient was not informed of this risk before the surgery. The judges recall that failure to provide information, including very exceptional risks, asserts in itself the physician’s responsibility and allows financial reparation for patients. In accordance with this decision, a new jurisprudence in medical responsibility is born.

Mots clés:
dysfonction érectile / Consentement éclairé / Responsabilité professionnelle
Mots-clés:
erectile dysfunction / Informed consent / Professional responsibility
Les accidents de la circoncision à Yaoundé, Cameroun : à propos de cinq observations cliniques
2012
- Réf : Prog Urol, 2012, 1, 22, 63-66


Introduction



Material and method

Within a period of twomonths, (from July to August 2007), five accidents resulting from circumcisions were recorded in the pediatric surgical unit of Gynaeco-Obstetric and Paediatric Hospital Yaoundé.


Results

Average age was 7.75 years within a range of 4–10 years. Anatomic/clinical pathologies recorded were: (a) one case of haemorrhage; one case of balanitis; (b) one case of amputation of the glans penis and (d) two cases of urethral fistula.


Conclusion

This study brings out the ritualistic nature of circumcision rather than its therapeutic approach. Knowing fully the impact of accidents arising from the act of circumcision, there is no doubt that circumcision is entirely a surgical procedure requiring primarily the services of a paediatric surgeon. Its practice by other health care personnel like wise tradi-practioners should be under strict control.

Mots clés:
Accidents de circoncision / Enfant / Afrique
Mots-clés:
Circumcision accidents / Infancy / Africa
Prise en charge des nodules testiculaires dans une population de patients infertiles
2012
- Réf : Prog Urol, 2012, 1, 22, 45-52


Introduction


L’infertilité masculine est en progression constante depuis de nombreuses années.



Introduction

Testicular parenchyma abnormalities and testis cancers are more frequent in infertile men, hence the guidelines recommending a systematic scrotal ultrasound.


Methods

A retrospective review of all patients treated with total or partial orchidectomy, from January, 2000 to July, 2010, for a testicular lesion discovered during an infertility evaluation work-up. Physical, examination data, type of surgery and pathological results were reported.


Results

Forty-five patients were treated. The majority of tumors (80%) were non palpable, and incidentally discovered with scrotal ultrasonography. Eight cases were partial orchidectomies, and 37 cases were radical orchidectomies. A frozen section examination was performed in 13 cases, and led to two radical orchidectomies. Standard histological examination revealed 33 (73.3%) benign lesions (11 Leydig cell hyperplasias, 17 Leydig cell tumors, five Sertoli cell tumors) and 10 (22.2%) malignant lesions (nine seminomas and one teratoma). Ten patients had a Klinefelter syndrome, for whom all the lesions were benign.


Conclusion

The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men were benign tumors. Conservative management in this context appears to be an option, to preserve the endocrine function and the fertility of these patients, while being ontologically safe.

Mots clés:
Infertilité masculine / testicule / Cancer du testicule / Tumeur à cellules de Leydig / échographie
Mots-clés:
Male infertility / Testis / Testicular neoplasms / Leydig cell tumor / ultrasonography
Radiochimiothérapie pour le traitement des cancers de vessie infiltrant le muscle : modalités, surveillance et résultats. Mise au point du comité de cancérologie de l'Association française d'urologie
2012
- Réf : Prog Urol, 2012, 1, 22, 13-16


Introduction



Radical cystectomy is the treatment of choice for non-metastatic, muscle infiltrating bladder cancer. However, bladder-sparing approaches can be discussed in carefully selected patients. Bladder-preservation protocols aim to guaranty local control and survival with a functional bladder and a good quality of life. The ideal candidate for bladder-preservation therapy is a patient with a small tumor, stage T2, in whom a complete trans-urethral resection of the bladder tumor is achievable, who has no associated carcinoma in situ or hydronephrosis, and who is medically fit to receive chemotherapy. The 5- and 10-year survival rates for muscle-invasive tumors are approximately 50% and 35%, comparable to the results achievable with cystectomy. Approximately 80% of long-term survivors will preserve a native bladder, and approximately 75% of them will have a normal-functioning bladder.

Mots clés:
Cancer de vessie / Traitement conservateur / radiothérapie / Chimiotherapie / Radiochimiothérapie
Mots-clés:
bladder cancer / Conservative treatment / Radiation therapy / chemotherapy / Radiochemotherapy
Traitement médical de l'hyperplasie bénigne de la prostate : revue de littérature par le CTMH/AFU
2012
- Réf : Prog Urol, 2012, 1, 22, 7-12


Introduction et objectifs



Introduction and objectives

The medical treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS-BPH) has dramatically evolved within the last years: new drugs have been commercialized and others that used to be contra-indicated may now be prescribed. Our objective was to provide with an updated review of the scientific literature on the medical treatment of LUTS-BPH.


Patient and method

A systematic review of the most recent scientific literature was performed. The query was addressed to the PubMed database using the following keywords: “benign prostatic hyperplasia” and “medical treatment”. A very large amount of publications, from year 1990 until 2011, were reviewed to select the publications with level of evidence 1 and 2. These publications were analysed and the 30 most relevant were selected to serve as references for this article.


Results

There are many randomized clinical trials in the field of LUTS-BPH medical treatment. Recently, anti-muscarinic agents have been assessed and have proven their efficacy and tolerance as long as the storage symptoms are predominant over the voiding symptoms. Combination therapies using alpha-blockers and 5-alpha reductase (5-ARI) inhibitors, but also anti-muscarinic agents and PDEF-5 inhibitors may also be prescribed depending on the patient’ complaint.


Conclusion

The publication of recent randomized clinical trials allows the urologists to use new drugs and new combination therapies in the medical treatment of LUTS-BPH. In 2011, the medical treatment decision-making may better integrate the patient’ complaint and medical history.

Mots clés:
Hyperplasie bénigne de prostate / traitement médical
Mots-clés:
Benign prostatic hyperplasia / Medical treatment
Tumeur de Buschke-lowenstein associé à un mélanome scrotal. À propos d'un cas
2012
- Réf : Prog Urol, 2012, 1, 22, 70-72


Introduction



Buschke-Lowenstein tumour (BLT) is a giant condyloma acumina, which is rare entity and represents only 1% of all populace. It is a rare viral disease, essentially transmitted by sexual intercourse, characterized by a potential for malignant transformation, invasion and recurrence after treatment. We report a case of BLT associated with perinea-scrotal melanoma. This association was never described in the literature. The purpose of our case report is to discuss the clinical and pathological appearances of these two entities and to outline the recent studies of molecular biology, which can explain this association.

Mots clés:
Tumeur de Buschke-Lowenstein / Mélanome scrotal / HPV / biologie moléculaire
Mots-clés:
Buschke-Lowenstein tumour / Perinea-scrotal melanoma / HPV / molecular biology