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Bitransplantation rénale : expérience du protocole lyonnais de l'hôpital E.-Herriot
2008
- Réf : Prog Urol, 2008, 10, 18, 678-684


Introduction



Introduction

In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be “borderline” represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant.


Materials and methods

Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient’s weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol.


Results

Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon’s discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4mol/l at six months (creatinine clearance according to MDRD formula: 57.3ml/min per 1.73m2), 118.8mol/l at 12 months (creatinine clearance: 55.8) and 132.4mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5ml/min per 1.73m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function.


Conclusion

In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.

Mots clés:
Bitransplantation rénale / Créatinémie / Fosses iliaques / DGF /
Mots-clés:
Dual kidney transplant / Serum creatinine / Iliac fossa
Cancer du penis : recommandations du comité de cancérologie de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 10, 18, 685-686


Monsieur le rédacteur en chef Nous avons lu l’article de J.-N. Cornu (Progrès en Urologie, novembre 2007;17(7):1347–1350) rapportant l’expérience d’un centre sur la prise en charge des tumeurs du pénis. Il est indiqué avec insistance qu’aucune recommandation n’existe tant dans la prise en charge que pour la prescription d’éventuels examens complémentaires et que la variété des traitements possibles compliquait encore cette prise en charge.

Mots clés:
Nicolas
Mots-clés:
Dual kidney transplant / Serum creatinine / Iliac fossa
Comparaison des taux d'estradiol et de testostérone dans le sang périphérique et dans le sang spermatique chez les patients avec azoospermie sécrétoire
2008
- Réf : Prog Urol, 2008, 10, 18, 663-668


Introduction



Objective

Comparison of testosterone and oestradiol levels in spermatic cord blood and peripheral blood as a function of the results of testicular sperm extraction by surgical biopsy in a population of patients with nonobstructive azoospermia (NOA).


Material and methods

Prospective, comparative, teaching hospital-sponsored, ethics committee-approved study of 30 patients with NOA. Plasma testosterone and oestradiol assays in peripheral blood and blood taken from the spermatic vein during testicular biopsy were performed simultaneously for each patient. Statistical analyses were performed with Mann-Whitney test and Spearman’s correlation coefficient by univariate and multivariate analysis of variance (p <0.05).


Results

No significant correlation was demonstrated between spermatic and peripheral blood levels of testosterone and oestradiol, regardless of the biopsy results. The spermatic oestradiol/testosterone ratio was significantly increased when testicular sperm extraction was negative (p =0.018).


Conclusion

The increase of the oestradiol/testosterone ratio in spermatic cord blood in the case of negative testicular sperm extraction suggests the hypothesis of greater conversion of testosterone to oestradiol in the testes. This could reflect increased aromatase activity in the absence of germ cells. Further studies using tissue markers of spermatogenesis should provide a better understanding of the physiological role of oestrogens in spermatogenesis and to refine the indications for testicular biopsy in patients with NOA.

Mots clés:
Estrogène / Testostérone / Azoospermie non obstructive / Biopsie testiculaire
Mots-clés:
Estrogen / Testostérone / Non obstructive azoospermia / Testis biopsy
Editorial Board
2008
- Réf : Prog Urol, 2008, 10, 18, iii
Mots clés:
Oncology / Cancérologie / Literature / Valeur p / Statistiques
Mots-clés:
Oncology / Literature / p / value / Statistical
Imagerie par résonance magnétique et cancer de la prostate
2008
- Réf : Prog Urol, 2008, 10, 18, 621-633


Introduction



Prostate magnetic resonance imaging (MRI) has taken advantage of recent technological developments that increase the field of its indications. Available improvements concern functional MRI based on dynamic MRI (after intravenous injection of gadolinium), diffusion-weighted imaging and, possibly, spectroscopy to localise an undiagnosed prostate cancer on a first series of biopsies and differentiate tumors of significant volume from indolent or latent tumors. The combination of dynamic MRI and diffusion-weighted imaging seems to be the most accurate for the time being. An optimal accuracy to assess local tumor staging can only be obtained with the surface endorectal coil. Future advances concern lymph node extension following an intravenous injection of iron particles and detection of bone metastases by whole-body MRI.

Mots clés:
Imagerie par résonance magnétique / Cancer de la prostate / Détection / Volume tumoral / Extension
Mots-clés:
magnetic resonance imaging / prostate cancer / Détection / Tumor volume / Extension
La cure de prolapsus antérieur par prothèse fixée par voie transobturatrice expose à une lésion urétérale
2008
- Réf : Prog Urol, 2008, 10, 18, 687-690


Introduction



The lower third ureteral injuries are not rare during pelvic surgeries. We report for the first time a case of ureteral injury during a transvaginal cure of an anterior vaginal wall prolapse with a synthetic mesh, whose the four arms are fixed by transobturator way. This lesion is itself included in the lesions of the low urinary tract during vaginal surgery with transobturator tape. The difficult diagnosis of these iatrogenic injuries must be carried early in order to decrease their morbidity and in the case of ureteral injury to preserve the nephrogenic capital.

Mots clés:
prolapsus / Lésion urétérale et vésicale / Iatrogène / Voie transobturatrice
Mots-clés:
Prolapse / Bladder and ureteral injury / Iatrogenic / Transobturator tape
Les urgences urologiques en milieu hospitalier universitaire à Dakar : aspects épidémiologiques, cliniques et thérapeutiques
2008
- Réf : Prog Urol, 2008, 10, 18, 650-653


Introduction



Objective

To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa.


Material and methods

The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar).


Results

There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month–94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier’s gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%).


Conclusion

The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier’s gangrene) and priapism are not rare there.

Mots clés:
Urgences urologiques / Épidémiologie / Clinique / Traitement
Mots-clés:
Urological emergencies / epidemiology / Clinical / treatment
Pathologies bénignes de l'ouraque chez l'adulte : origine embryologique, présentation clinique et traitements
2008
- Réf : Prog Urol, 2008, 10, 18, 634-641


Introduction



Urachus pathologies are very rare but require to be known by urologists. Lack of appropriate treatment exposes the patients to the risks of symptoms recurrence, infectious complications or adenocarcinomatous degeneration. A partial or total defect of obliteration of the urachus channel after the fifth month of gestation can be at the origin of four benign pathologies. The ombilicovesical fistula (47.6%) is diagnosed at the native period. In the adult, the most frequent form is the cyst (30.7%) whereas the external (16.4%) and internal sinus (3.2%) are rarer. Diagnosis depends on the clinical examination and the association of sonography and TDM. The risk of complications must systematically result in proposing a surgical treatment for these benign pathologies. The umbilicus resection is not recommended, but the surgeon has to remove the urachus and its implantation base on the bladder. Laparoscopic surgery seems to be an interesting route for this intervention.

Mots clés:
ouraque / embryologie / Pathologie bénigne / Diagnostic / laparoscopie
Mots-clés:
urachus / embryology / Benign abnormalities / Diagnosis / Laparoscopy
Place de la néphrectomie chez les patients atteints de polykystose rénale autosomique dominante de l'adulte en attente de transplantation rénale
2008
- Réf : Prog Urol, 2008, 10, 18, 642-649


Objective

To define the indications, results and place of nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) in relation to renal transplantation.


Material and methods

Between October 1998 and February 2006, 145 patients with ADPKD were followed in our institution; 38 of them underwent nephrectomy via a subcostal incision, mainly in preparation for renal transplantation. The decision to perform nephrectomy in preparation for renal transplantation was based on clinical examination and CT findings.


Results

Indications for nephrectomy were preparation for renal transplantation (n =28, 68%), severe urological complications (n =12) and malignant tumour (n =1). Forty-one nephrectomies were performed, pretransplantation in 36 cases (88%) and five post-transplantation nephrectomies in three patients. The nephrectomy rate was 26%. The median kidney weight was 2800grams. The mean operating time was 100minutes and mean blood loss was 76ml. The overall morbidity was 36.6% with 7.3% of serious complications. The mean hospital stay was 14.5 days. No patient nephrectomized before transplantation (n =13) developed any complications of the contralateral native kidney with a mean follow-up of 33 months. The mean interval between initiation of dialysis and transplantation and between nephrectomy and transplantation was 30 and 16 months, respectively.


Conclusions

The optimal timing and incision for nephrectomy for ADPKD are still a subject of debate. In the absence of urological complications, nephrectomy, associated with considerable morbidity, should only be performed when very large kidneys truly interfere with graft implantation. Systematic unilateral or bilateral nephrectomy must therefore no longer be proposed. To avoid the complications of the anephric state, it is preferable to wait, whenever possible, until the patient is placed on dialysis, but the development of pre-emptive transplantation raises the issue of concomitant nephrectomy and transplantation, which may be a feasible option.

Mots clés:
Néphrectomie / Polykystose rénale autosomique dominante
Mots-clés:
nephrectomy / Autosomal dominant polycystic kidney disease
Place du dosage sérique de l'HCG dans la surveillance des tumeurs testiculaires séminomateuses non sécrétantes
2008
- Réf : Prog Urol, 2008, 10, 18, 654-656


Introduction



Objective

Human chorionic gonadotrophin (HCG) is secreted by 10 to 20% of seminomas. The authors evaluated variations of serum total HCG levels in patients with normal baseline levels for the surveillance of treated testicular seminomas in order to determine the value of assay of this tumour marker in the follow-up of testicular seminoma.


Patients and methods

Retrospective study from January 1988 to March 2007, including 95 cases of operated testicular cancer, including 28 seminomas, 25 of which did not secrete HCG (baseline total HCG less than 15IU/L). Patients were reviewed periodically: every three months for one year, every six months during the second year, then annually, comprising of clinical examination, CT examination and assay of tumour markers (HCG, LDH and AFP).


Results

Mean follow-up was 77.5 months (range: 6–120). Twenty-five patients had a total HCG level less than 15IU/L three months after orchidectomy. Serum HCG remained stable at less than 15IU/L in all patients with a follow-up of more than three years. Two patients developed non-regional lymph node recurrence with no modification of the serum HCG level.


Conclusion

All treated non-HCG-secreting seminomas with or without recurrence had stable and normal HCG levels throughout follow-up, which raises the question of the value of HCG assay in the follow-up of these patients following histological confirmation of the diagnosis.

Mots clés:
séminome testiculaire / Hormone chorionique gonadotrope (HCG) / Surveillance
Mots-clés:
testicular seminoma / Human chorionic gonadotrophin (HCG) / Surveillance
Priapisme sous neuroleptiques. À propos de quatre patients
2008
- Réf : Prog Urol, 2008, 10, 18, 669-673


Introduction



Introduction

Ischemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications.


Material

Between 1st January 2000 and 30th September 2007, four men (range 25/55 years), treated with antipsychotic agents (amisulpride, clozapine, levomepromazine, olanzapine, pipotiazine, risperidone or zuclopenthixol), presented one or several episodes of ischemic priapism. No other etiological factor was diagnosed. The patients were treated with aspiration and irrigation of the corpa cavernosa with intracavernous injection of sympathomimetic drugs followed in one case by a surgical distal cavernoglanular shunt.


Discussion

Many conventional or atypical antipsychotic agents have been reported to cause priapism. Drug-induced priapism comprised of about 30% of the cases and an estimated 50% of them occurred with antipsychotic agents. The mecanism of priapism associated with antipsychotics agents thought to be related to alpha-adrenergic blocking properties. The decision of whether to restart a patient on a specific antipsychotic agent after an episode of priapism is a difficult clinical decision. An agent with low peripheral alpha-adrenergic blocking affinity would be preferred.


Conclusion

Ischemic priapism is an urologic emergency. Clinicians should be familiar with this rare but serious adverse event of antipsychotic agents to avoid long-term sequelae including erectile dysfunction.

Mots clés:
érection / priapisme / Neuroleptiques
Mots-clés:
Penile erection / priapism / Antipsychotic agents
Résultats des extractions chirurgicales testiculaires de spermatozoïdes (TESE) dans une population de patients azoospermiques avec antécédent de cryptorchidie : à propos d'une expérience sur dix ans auprès de 142 patients
2008
- Réf : Prog Urol, 2008, 10, 18, 657-662


Introduction



Introduction

Cryptorchidism is a common and possible etiology of male infertility.


Objectives

This is a retrospective study of 142 azoospermic men with history of cryptorchidism. A testicular sperm extraction (TESE) was performed for each of them, between 1995 and 2005, to realize in vitro fecundation with intracytoplasmic sperm injection (ICSI).


Material and methods

We studied the clinical pattern (age at the treatment, unilateral or bilateral cryptorchidism), hormonal levels (total testosterone and FSH) and ultrasound examinations in this population. Then, we studied the rates of successful TESE according to these various characteristics.


Results

The main origin of azoospermia is non obstructive (secretory). A great majority of the patients (71.8%) has benefited of an orchidopexy before the age of 10 years which does not seem to represent a factor of better forecast of surgical extraction of sperm cells. In the subgroup of the bilateral cryptorchidy, the rate of extraction was 63% (55/87). In the subgroup of the one-sided cryptorchidy, it was 61.9% (36/42).


Conclusion

For us, history of cryptorchidism is an etiology of good prognosis for azoospermia, since the rate of TESE with positive sperm retrieval is 65%. In our population, the subgroups of patients whose FSH is normal and/or whose testicular volume is higher than 10cm3 are those whose forecast is still better, because the rate of TESE with positive sperm retrieval is 75%.

Mots clés:
Azoospermie / cryptorchidie / Testicules non descendus / Infertilité masculine / Extraction chirurgicale de spermatozoïdes
Mots-clés:
Azoospermia / cryptorchidism / Undescended testis / Male sterility / Testicular sperm extraction (TESE)
Utilisation des nouveaux critères diagnostiques de la cystite interstitielle dans la pratique quotidienne : à propos de 156 cas
2008
- Réf : Prog Urol, 2008, 10, 18, 674-677


Introduction



Objectives

To describe the characteristics of patients with interstitial cystitis and to determine what proportion of those patients met the European Society for the Study of interstitial cystitis/painful bladder syndrome 2005 (ESSIC IC/PBS) definition and how those who met the definition differed from those who did not.


Material and method

A total of 156 patients diagnosed as having an interstitial cystitis were followed in our institution between 1997 and 2007. The diagnosis was suggested by the clinical history and confirmed on the basis of clinical symptoms, voiding diary findings, Pearson’s test, O’Leary-Sant questionnaire, cystoscopy and hydrodistension and by the exclusion of other significant pathologies. The patients were evaluated in a prospective manner. We studied the demographics of our patients, described the common clinical presentation. We applied the ESSIC 2005 definition of CI/PBS on this population and found the proportion that meets this definition.


Results

The sex ratio F/M was 8:1. The patients were symptomatic for a median of 7.3 years before IC is diagnosed. The most common symptom was pain which was found in 100% of patients, frequency was found in 82% and nocturia in 62%. The common sites where pain was localized were suprapubic in 80%, perineal in 70% and genital in 40%. A burning sensation was found in 55% of patients. Hunner’s lesion was found in three patients. The cystoscopy and hydrodistension revealed glomerulations in 88.4% of patients. The ESSIC 2005 definition identified only 74% of the 156 patients diagnosed as having IC/PBS.


Conclusion

The symptoms in interstitial cystitis are variable. The ESSIC 2005 definition may not be sufficiently sensitive excluding over 26% of patients diagnosed as having IC. Minor modifications (pain type and location) of the definition appeared to increase its sensitivity.

Mots clés:
cystite interstitielle / Syndrome de la vessie douloureuse / Glomérulations
Mots-clés:
interstitial cystitis / Painful bladder syndrome / Glomérulations