Base bibliographique

À la recherche du spermatozoïde chirurgical : doit-on effectuer une biopsie testiculaire systématique ?
2013
- Réf : Prog Urol, 2013, 1, 23, 58-65


Introduction



Introduction

Testicular biopsies are diagnostic and therapeutic tools involved in male infertility care. However, this surgery is invasive and not systematically successful. We studied the preoperative clinical and hormonal factors allowing to predict the obtaining of sperm cells.


Patients and methods

A retrospective study was conducted on 209 patients who all had a testicular biopsy for procreation medically assisted (PMA). The studied criteria were: the age at the time of the surgery, the male cause of the infertility, the testicular volume, the tobacco smoking exposure, the concentrations of estradiol, FSH, LH, prolactin, and testosterone. The comparison of both groups (successful biopsy versus failed biopsy) was made in bivariate analysis then in multivariate analysis.


Results

The testicular volume average and the cause were the two only factors which had a real influence on the negativity of the biopsy. In it was added in bivariate analysis a statistically significant correlation of the smoking exposure and the FSH with the failed biopsy.


Discussion

The existence of these factors, and their accumulation, was strongly predictive of a failure of the biopsy. However, we found germ cells in patients exposed to the studied factors, letting think that it is systematically necessary to propose the surgery at the risk of a limited profit.

Mots clés:
Biopsie testiculaire / AMP / Azoospermie / Volume testiculaire
Mots-clés:
Testicular biopsy / PMA / Azoospermia / Testicular volume
Cancer de la prostate : quelle prise en charge au Sénégal ?
2013
- Réf : Prog Urol, 2013, 1, 23, 36-41


Introduction



Objective

To evaluate the management of patients with prostate cancer in Senegal.


Materials and methods

We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities.


Results

We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen.


Conclusion

The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

Mots clés:
Cancer / prostate / Prostatectomie / Sénégal
Mots-clés:
Cancer / prostate / Prostatectomy / Sénégal
Étude préliminaire des mutations des gènes p53 et FGFR3 sur le culot urinaire des tumeurs de la vessie
2013
- Réf : Prog Urol, 2013, 1, 23, 29-35


Introduction



Introduction

Two major pathways are described in bladder carcinogenesis: one for invasive or high grade tumors characterized by alteration of the p53 tumor suppressor gene and the other for non-invasive tumors or low grade involving mutations FGFR3 . The objective of our study was to validate the research in the urine of mutations in these two genes in patients with a bladder tumor.


Patients and methods

In our preliminary study, we investigated 36 patients the FGFR3 and p53 mutations in tumors and urine collected during endoscopic resection. The p53 mutations were sought in FASAY, which allows a functional analysis of the protein P53. The FGFR3 mutations were sought in SNaPshot that searches the eight most frequent mutation points of this gene.


Results

For 24 patients (66% of cases), we found at least one of the two mutations in the tumor. This mutation was present in the urine in 15 patients (sensitivity=62.5%). In only one patient, we found a mutation in the urinary sediment that did not exist in the tumor (specificity=91.7%).


Conclusion

The search for mutations of p53 and FGFR3 in the urine was a simple and non-invasive assay, which seems superior to urinary cytology for the detection of bladder tumors, raising hopes of an interest in this bio-assay for surveillance of bladder tumors and screening risk populations.

Mots clés:
Tumeur de vessie / Urine / / /
Mots-clés:
Bladder tumor / Urine / / /
Étude rétrospective d'une population de carcinomes à cellules rénales sur 12 ans : épidémiologie, prise en charge thérapeutique et impact sur la survie
2013
- Réf : Prog Urol, 2013, 1, 23, 15-21


Introduction



Objective

To describe the evolution of epidemiology and management of renal cell carcinoma and their impact on overall and progression-free survivals.


Patients and methods

We reviewed the files of consecutive patients with renal cell carcinoma in our center between January 2000 and December 2011. Patients with confirmed diagnosis on histology who underwent radical nephrectomy, partial nephrectomy or thermoablation were included. Benign tumors were excluded. Epidemiologic and therapeutic data during the period of study were compared. Overall and progression-free survivals divided in three periods were compared by Kaplan-Meier curves.


Results

Four hundred and forty-nine patients were included with a median age of 60 years old [21; 89], and median follow-up of 39 months. Tumor histology was clear cell carcinoma in 75.9% of cases. During the period of study, patients with ASA score upper than 3 increased from 20.4% to 47.8%, tumor size decreased from 58.4mm to 49.5mm and incidental tumor discovery increased from 59.1% to 71.6%. Nephron-sparing surgery increased from 19.7% to 44%. Overall survival and progression-free survival was not different during this period (P =0.071 and P =0.582).


Conclusion

The increase in early incidental discovery of renal cell carcinoma allowed nephron-sparing surgery in spite of patients with more comorbidities, with stable overall and progression-free survivals in our series.

Mots clés:
cancer du rein / Carcinome rénal / Épidémiologie / Traitement / Survie
Mots-clés:
Renal cancer / Renal cell carcinoma / epidemiology / treatment / survival
Fonction érectile et sexualité des partenaires après prostatectomie totale robot-assistée versus laparoscopique manuelle : évaluation à long terme
2013
- Réf : Prog Urol, 2013, 1, 23, 42-49


Introduction



Objective

To compare the long-term sexual outcome of laparoscopic radical prostatectomy (LRP) vs robot-assisted laparoscopic prostatectomy (RALP).


Patients and methods

A questionnaire was sent to the 412 patients treated by the same surgeon by LRP or RALP from March 2004 to July 2009. Ninety-six patients were evaluated preoperatively with a good erectile function before surgery and a follow-up more than 24 months. Erectile function was evaluated by the IIEF-5, the QLQ-C30 PR25 questionnaires. Partner’s sexuality was evaluated with a FSFI’s based questionnaire.


Results

There was no significant difference before surgery between two groups LRP and RALP. After surgery, the IIEF-5 without any treatment was better in RALP group than in LRP group (P =0.025). When a bilateral nerve sparing was performed, the IIEF-5 maximum was better in RALP group (P =0.002). For the partners, there was no difference between the two techniques and it appeared that communication about sexuality is the less altered, long time after a radical prostatectomy.


Conclusions

In case of bilateral nerve sparing prostatectomy, an experimented operator in laparoscopic surgery should have better long-term erectile function results with RALP than LRP. Partner’s sexuality modifications need more prospective studies to know its influence on erectile rehabilitation.

Mots clés:
dysfonction érectile / Prostatectomie totale / Robot / sexualité
Mots-clés:
impotence / Sexual dysfunction / radical prostatectomy / Robotic surgery / Neurovascular bundles
Localisation iléale d'un carcinome à cellules rénales révélée par une invagination iléo-cæcale
2013
- Réf : Prog Urol, 2013, 1, 23, 73-75


Introduction



The lung, the liver, the bone tissue and the brain are the most frequent sites for renal cell carcinoma metastasis. Small bowel metastasis from renal cell carcinoma is rare, with only few cases published. We report the case of ileal metastasis from operated kidney cancer revealed by ileocolic intussusception and causing intestinal obstruction in a 32-year-old woman.

Mots clés:
carcinome à cellules rénales / Métastase / Intestin grêle / Invagination intestinale
Mots-clés:
Renal cell carcinoma / metastasis / Small intestine / Intussusception
Nouvelles thérapeutiques dans le cancer de la prostate résistant à la castration : panorama des études pivotales et nouveaux schémas thérapeutiques à venir
2013
- Réf : Prog Urol, 2013, 1, 23, 1-7


Introduction



Objective

Recently, new agents have been developed in the treatment of prostate cancer. Our aim was to review phase III studies that involved novel agents in the treatment of castration resistant prostate cancer.


Methods

PubMed databases were searched for original articles published with the search terms: prostate cancer, castration resistant, metastatic, targeted therapy, biologic agents, immunotherapy and clinical trials. Proceedings from 2008 of conferences of the American Society of Clinical Oncology, American Urological Association, and the European Association of Urology were also searched. We included phase III studies that involved: abiraterone, MDV 3100, cabazitaxel, sipuleucel-T, radium-223, and denosumab.


Results

Abiraterone and MDV 3100 are two new hormotherapies that showed an increased overall survival of 15 and 18 months respectively before after docetaxel based chemotherapy in randomized trials. Cabazitaxel became the standard second line chemotherapy after docetaxel. Sipuleucel-T has emerged as the first approved vaccine in prostate cancer. It showed a 22 % reduction of mortality and a prolonged survival time of 4.1 months compared to placebo. A radium-223 based metabolic radiotherapy has showed a better overall survival, delayed and reduced skeletal-related events in placebo controlled randomized trials. Denosumab also delayed the first skeletal-related event in a zoledronic acid controlled trial (20.7 versus 17.1 months, P =0.0002). Moreover, Denosumab delays bone metastases by 4.1 months compared to placebo.


Conclusion

The novel agents that emerged in the treatment of prostate cancer showed an efficacy in placebo controlled trials. They added new tools in the armamentarium of therapies of castration resistant prostate cancer.

Mots clés:
Cancer de la prostate / Résistance à la castration / Métastases / Survie globale / Essais randomisés
Mots-clés:
prostate cancer / Castration-resistant / metastasis / overall survival / Randomized trials
Perceptions de l'hypertrophie bénigne de la prostate par le patient et le médecin généraliste – étude Trophée
2013
- Réf : Prog Urol, 2013, 1, 23, 50-57


Introduction



Objective

To compare the perception of benign prostatic hypertrophy (BPH) between patients and general practitioners (GPs) in terms of severity and evolution of symptoms and medication adherence.


Methodology

A cross-sectional observational study was performed in France in a sample of GPs who included patients for whom a BPH treatment was prescribed. Data were collected on patient and GP characteristics, diagnosis, BPH management, severity and evolution of symptoms and medication adherence.


Results

One thousand and ninety-eight patients were recruited by 247 GPs. In 87.4% of cases, diagnosis was performed by GPs. Among them, 82.7% of patients were treated by monotherapy. The choice of a treatment was mainly based on treatment efficacy and the patient’s opinion was taken into account by 5% of GPs. The patient’s evaluation of symptoms severity was consistent with the GP’s in 53.9% of cases. A worsening of symptoms was reported significantly more frequently by patients (18.5%) than by GPs (8.8%). Among 94 patients who reported poor adherence, GPs estimated that the level of medication adherence was good for 72 of these (77%).


Conclusion

There was discordance between the evaluation made by GPs and by patients on the perception of BPH symptoms and medication adherence. The patient’s opinion was rarely taken into account in the therapeutic decision, reflecting a lack of shared medical decision-making, which would be helpful for the physician in order to optimize BPH management.

Mots clés:
hypertrophie bénigne de la prostate / Médecine générale / Observance / Qualité de vie / IPSS
Mots-clés:
Benign prostatic hyperplasia / General practitioner / adhérence / Quality of life / International Prostate Symptom Score
Place de l'urétérorénoscopie souple en première intention pour le traitement des calculs du rein. Résultats de l'enquête de pratique du comité lithiase de l'AFU réalisée en 2011
2013
- Réf : Prog Urol, 2013, 1, 23, 22-28


Introduction



The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation.


Methods

Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient’s supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney.


Results

Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient.


Conclusion

The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL).

Mots clés:
Urétéroscopie souple / Calculs urinaires / Laser Ho YAG / Obésité/complications / Indice masse corporelle
Mots-clés:
Flexible ureteroscopy / urinary stones / Laser Ho YAG / Obesity/complications / body mass index
Problématique de la prise en charge des anomalies de la différenciation sexuelle dans le service d'urologie : CHU Point G
2013
- Réf : Prog Urol, 2013, 1, 23, 66-72


Introduction



Abnormal sexual development causes unconformity between gender identity and gender role. In countries with low socio-economic level, the optimal management is difficult. The aim of this study was to evaluate the frequency, the genital anatomy appearance, the diagnostic and the surgical management of disorders of sex development (DSD) discovered during the adolescence. Between January 2005 and November 2006 (23 months), five patients with abnormal sexual development were identified in Point G Hospital. First-line testing included biology measurement and imaging. A surgical management was systematically offered. Median age was 19.5±11.8 years (6–31). All patients were initially assigned male. Sexual dimorphic with genital ambiguity was the first reason of consultation (three children to five). One patient had male breast development and one had pelvic pain. All clinical evaluation suggested genital ambiguity. The diagnostic was female pseudohermaphrodism in three cases, true hermaphrodism in one case and hypogonadism for one patient. A masculinizing genital surgery was performed in three cases. The other patients refused the treatment or were out of sight. Intersex disorders are relatively rare in Mali with a prevalence of 2.30‰ in our hospital. This study highlighted the lack of financial means and local resources for optimal clinical management of individuals with DSD.

Mots clés:
Anomalies de la différenciation sexuelle / Adolescent
Mots-clés:
Disorders of sex development / Adolescent
Syringomyélie post-traumatique : ce que doit savoir l'urologue ?
2013
- Réf : Prog Urol, 2013, 1, 23, 8-14


Introduction



The incidence of post-traumatic syringomyelia (PTS) is estimated according to recent studies at 25 to 30% of patients with traumatic spinal cord injuries in magnetic resonance imaging (MRI), which remains the gold standard exam for syringomyelia diagnosis and monitoring. Syringomyelia is translated by an increased cord signal (similar to CSF) with low-density T1-weighted image and high-density T2-weighted image, which extends beyond site of initial lesion at least to two vertebral segments. Two conditions are required for development of PTS: traumatic spinal cord injury and blocked the flow of CSF epidural. The mean interval from spinal cord injury to diagnosis SPT was 2.8years (range, 3months to 34years). The commonest symptoms are pain and sensory loss. PTS should be suspected if the patient has new neurological symptoms above level of injury, such as dissociated sensory injuries, reflexes abolition, and motor deficit, after the neural function becomes stable for certain time. In urologic practice, new neurological symptoms could be bladder and/or erectile dysfunction. The medical management based on prevention efforts with closed-glottis pushing, which could aggravate the syrinx cavity. In urology, extracorporeal shockwave lithotripsy, and laparoscopic or robotic surgery could extend the syrinx cavity for the same reason (increase abdominal pressure). The indications for surgical intervention and optimal surgical treatment technique for patients with PTS are not consensual. The literature demonstrated that surgery PTS is effective at arresting or improving motor deterioration, but not sensory dysfunction or pain syndromes.

Mots clés:
Syringomyélie post-traumatique / troubles vésico-sphinctériens / Chirurgie urologique
Mots-clés:
Post-traumatic syringomyelia / Bladder dysfunction / epidemiology / Physiopathology