Base bibliographique

Assistance médicale à la procréation avec don de spermatozoïdes
2012
- Réf : Prog Urol, 2012, 10, 22, 561-567


Introduction



Introduction

The purpose of this review is to relate to the operating rules of CECOS in France and the legal, medical and ethical issues raised by sperm donation.


Material and methods

Review of articles and consensus conferences on this subject published in Medline (PubMed) selected from 1973 and 2011 according to their relevance and Acts recorded on official legislative French websites.


Results

The operating rules of CECOS were established by the Act of July 29, 2004, revised 6 August 2004 and July 7, 2011. Of the 21,759 children born of ART in France in 2009, 5.1% are from a sperm donation. From 1973 to 2006, 44,045 children are born after a sperm donation. Between 1973 and 2006, 16,971 donors are presented in the CECOS and only 10,347 donors have completely made their donation process. The main indication for use of donor sperm (75% of applications) is represented by men of infertile couples with nonobstructive azoospermia, the second indication is infertile men with oligospermia. In azoospermia, the application is usually performed after failure of testicular or epididymal surgical specimen. In oligozoospermia, claims made most often after several failures of intraconjugal ART.


Conclusion

Many questions are still present around the conception of children by sperm donation. The legitimacy of maintaining anonymity in the gift remains widely debated.

Mots clés:
Assistance médicale à la procréation / Don de spermatozoïdes / Infertilité masculine
Mots-clés:
Assisted reproductive technologies / Sperm donation / Male infertility
Bilharziose urinaire : une série française
2012
- Réf : Prog Urol, 2012, 10, 22, 598-601


Introduction



Urinary schistosomiasis is very frequent, but there are few data upon its epidemiology in western countries. We wanted to describe the cohort from Tenon hospital, in Paris, France, near a big subsaharian community.


Methods

We searched in our clinical files database for “urinary schistosomiasis” encoding.


Results

The cohort comprised 207 men and 34 women seen for the first time at the mean age of 34, mainly for haematuria or LUTS. Patients were mainly native from subsaharian Africa. The lost to follow up rate was 54%. Diagnosis was made on sole endoscopic finding in half of the cases. For non-tumor pathology, were made seven cystoplasties et 12 ureteral dilations. Tumoral pathology was frequent and severe (15/81 from the same age range), mainly represented by urothelial histology (8/14). Imported cases were rare (five cases).


Conclusion

Despite its limitations, different characteristics from this cohort seemed noticeable: frequency of sole lower urinary tract symptoms, frequency and severity of tumoral diseases, mainly with urothelial carcinoma as histology.

Mots clés:
Bilharziose urinaire / Épidémiologie descriptive
Mots-clés:
Urinary schistosomiasis / Descriptive epidemiology
Effet des extraits de plantes médicinales sur la dissolution des calculs rénaux de cystine in vitro : étude à l'échelle mésoscopique
2012
- Réf : Prog Urol, 2012, 10, 22, 577-582


Aim

Assessing the efficacy to dissolve cystine stones in vitro of plant extracts used in traditional medicine to treat or prevent urolithiasis.


Material and method

Pure cystine stones were incubated during 8 weeks under magnetic stirring in the presence of four plant extracts or of NaCl 9g/l solution used as control. Plants under examination were Arenaria ammophila (leaves and stems), Parietaria officinalis (leaves and flowers studied separately), Paronychia argentea (flowers). Each experiment was performed in triplicate. The mass loss of the stones and the pH of the solution were measured after each two weeks period. Possible changes in the cystine crystals at the stone surface were assessed at the mesoscopic scale using a scanning electron microscope.


Results

None of the plant extracts has revealed a significant effect to dissolve cystine stones by comparison to the control during the time of the experiment. The best result was a mass loss of 99mg at the end of experiment in the presence of A. ammophila vs. 43.7mg for the NaCl solution (P =0.051). Considering the slopes of the dissolution, only that extract could have an actual efficacy on a more prolonged period.


Conclusion

Our study failed to demonstrate a significant effect of the tested plant extracts to dissolve cystine stones in vitro. However, the examination of the dissolution curves suggests that a more prolonged test period could allow an efficacy of some extracts, especially A. ammophila . Further studies are needed to verify such hypothesis. However, we cannot recommend the use of the tested plants to treat cystine stones in vivo.

Mots clés:
Cystine / Plantes médicinales / Calculs / Dissolution in vitro /
Mots-clés:
Cystine / Medicinal plants / Urinary calculi / In vitro dissolution /
Étude anatomoclinique et de l'expression immuno-histochimique de CA9 dans les carcinomes kystiques multiloculaires du rein
2012
- Réf : Prog Urol, 2012, 10, 22, 572-576


Introduction



Objective

Multilocular cystic renal cell carcinoma has been considered as a distinct subtype of clear cell renal cell carcinoma according to 2004 WHO classification. CA9 has proven to be a diagnostic and prognostic marker for clear cell renal cell carcinoma, but the study has been limited to solid tumors. The aim of this article was to analyse the clinical features of multilocular cystic renal cell carcinoma with focus on CA9 expression.


Patients and methods

Nine multilocular cystic renal cell carcinomas were found. Their age was from 33 to 74years old with a median of 54years. There were five men and four women. The computerized tomography was analyzed. There were three total nephrectomies and six partial nephrectomies. The follow-up ranged from five to 102months with a median 56months. Immunohistochemical staining was performed on surgical samples to detect CA9 expression.


Results

There were seven pT1a, one pT1b and one pT2; four grade 1 and five grade 2. The Bosniak classification was: one B2F, six B3 and two B4. In CT examination, all tumors showed a hypodense mass. Seven out of nine showed multiple intern septa, more or less thick and vascularized with an enhancement after injection of contrast. No metastasis or relapse was found during follow-up. Eight out of nine multilocular cystic renal cell carcinomas expressed strongly CA9.


Conclusion

Multilocular cystic renal cell carcinoma was a low malignant tumor with a good prognosis. The diagnostic criteria based on the WHO classification 2004 should be adopted in routine. CA9 could be a new diagnostic marker for this tumor.

Mots clés:
Carcinome kystique multiloculaire du rein / Étude clinique / Marqueur / CA9
Mots-clés:
Multilocular cystic renal cell carcinoma / Clinical study: Marker / CA9
Évaluation du positionnement de la bandelette rétro-urétrale transobturatrice par IRM pelvienne statique et dynamique
2012
- Réf : Prog Urol, 2012, 10, 22, 602-609


Introduction



Purpose

To evaluate the usefulness of MRI to assess the anatomical and functional relationships between the transobturator male sling Advance® and the uretral sphincter, in patients treated for postprostatectomy urinary incontinence.


Patients

For 12 patients treated for postprostatectomy urinary incontinence using the transobturator male sling Advance®, a pelvic real-time MRI was performed between 1 and 3 months postoperatively. A comparison between pre- and postoperative MRI was performed in eight patients. The static sequences studied the anatomical relationships between the sling and the uretral sphincter, as well as the impact on the location of the vesico-uretral anastomosis. The dynamic sequences by coughing looked for the existence of an uretral sphincter mobility. Finally, the voiding sequences studied the impact of the sling on the uretral lumen during the micturition.


Results

The position of the sling was always visible, located at a median distance of 5mm from the posterior wall of the uretra. On transverse sections, the angles between the transobturator arms and the horizontal line between the ischial tuberosities varied from 28 to 59 degrees. The vesico-uretral anastomosis location was not modificated between pre and postoperative MRI. On the preop sequences by coughing, four patients had uretral mobility, which didn’t exist on postop sequences. To finish, the seven patients who were able to void during MRI, had micturition without uretral stenosis.


Conclusion

Pelvic MRI was a useful tool to assess the positioning of the sling and the relationships with the uretral sphincter. When correctly positioned, the sling was retro-uretrally and no urethral stenosis was visible during the micturition.

Mots clés:
incontinence urinaire / Bandelette transobturatrice / IRM / prostatectomie radicale
Mots-clés:
Urinary incontinence / Transobturator male sling / MRI / radical prostatectomy
Inhibiteurs des 5 alpha-réductases et cancer de la prostate : une mise au point du Comité de cancérologie de l'Association française d'urologie
2012
- Réf : Prog Urol, 2012, 10, 22, 555-560


Introduction



Introduction

Two randomised trials and negative conclusion of the FDA about inhibitors of 5 alpha-reductase in prevention of prostate cancer need a revision of the indications of these drugs.


Methods

After description of fundamentals data, review of the literature in PubMed library was performed to analyse the indications of these drugs according to the different stages of prostate cancer.


Results

Even if PCPT and REDUCE studies showed a decrease of cancers with the use of 5 alpha-reductase (5ARI) but with side effects, there is no indication for prostate cancer prevention by these drugs. In the same way, despite the results of REEDEM study, there is no indication of these drugs in active surveillance.


Conclusion

Despite the large interest of these drugs, no recommendation can be given for indications of 5ARI in prevention or treatment of prostate cancer.

Mots clés:
Cancer de la prostate, Chimioprévention / Dunastéride, Finastéride, Inhibiteurs de la 5 alpha-réductase
Mots-clés:
prostate cancer / Chemoprevention / Dutastéride / Finastéride / 5 alpha-reductase inhibitors
IRM mutiparamétrique de la prostate avant biopsies : la fin des biopsies systématisées ?
2012
- Réf : Prog Urol, 2012, 10, 22, 583-589


Introduction



Objective

To evaluate the value of multiparametric MRI-targeted prostate biopsies in patients with suspected low-risk prostate cancer.


Patients and method

Patients with normal digital rectal examination and a PSA level between 4 and 10ng/mL were prospectively included. A multiparametric MRI of the prostate was performed prospectively before the biopsies. 12-core randomized biopsies were performed, with additional targeted samples in each suspicious area identified on MRI. Detected cancers and their histological characteristics were compared between those two biopsy protocols. A micro focal cancer (MFC) was defined by the presence of less than 4mm of Gleason score 3+3 cancer on a single core.


Results

Seventy-one consecutive patients were included. The overall detection rate was of 53% (38/71). It was of 70% (26/37) in the presence of suspicious area on MRI versus 35% (12/34) in the absence of any suspicious area (P =0.004). MRI-targeted biopsies alone detected three cancers, none of which was a MFC. 12-core biopsies alone detected 14 cancers, including ten MFC (71%). In 21 patients, prostate cancer was detected by both the MRI-targeted and 12-core biopsies. The Gleason score in the MRI-targeted area was the highest Gleason score in 90% of the cases. It was high (>6) in 76% (16/21) of the patients.


Conclusions

MRI-targeted biopsies detected less micro focal cancers than randomized 12-core biopsies. They did not seem however to decrease the detection of clinically significant cancers.

Mots clés:
Cancer de la prostate / IRM multiparamétrique / Biopsies ciblées
Mots-clés:
prostate cancer / Multiparametric MRI / Targeted biopsies
L'acétate de goséréline pourrait-il induire des hépatites d'allure auto-immune ?
2012
- Réf : Prog Urol, 2012, 10, 22, 610-612


Introduction



We report a case of acute icteric hepatitis attributed to goserelin acetate, occurred during prostate cancer treatment. Gosereline acetate could induce acute hepatitis, which characteristics are close to autoimmune hepatitis type I and may require hepatic monitoring.

Mots clés:
Acétate de goséréline / Hépatite auto-immune
Mots-clés:
Gosereline acetate / Autoimmune hepatitis
Le growing teratoma syndrome
2012
- Réf : Prog Urol, 2012, 10, 22, 568-571


Introduction



Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that’s why the treatment must not be delayed.

Mots clés:
Syndrome de / / Tumeur germinale non séminomateuse / Masses résiduelles / Chimiotherapie
Mots-clés:
Growing teratoma syndrome / Non-seminomatous germ cell of the testis / Residual masses / chemotherapy
Pose d'implants UroLift ® intra-prostatiques pour hyperplasie bénigne de la prostate : résultats préliminaires des quatre premiers cas réalisés en France
2012
- Réf : Prog Urol, 2012, 10, 22, 590-597


Introduction



Objectives

To evaluate the feasibility, tolerance and short-term efficacy of intra-prostatic UroLift® implants in four patients with symptomatic benign prostatic hyperplasia.


Patients and method

Four patients with symptomatic BPH, already treated with alpha-blockers, were consecutively treated with intra-prostatic UroLift® implants under general anaesthesia. A bladder catheter was placed postoperatively. Alpha-blocker therapy was withdrawn 7 days postoperatively. The clinical and morphological characteristics of the patients were noted. Low urinary tract (IPSS) and sexual symptoms (IIEF5, MSHQ-EjD), maximum urinary flow rate and post voiding residual volume were evaluated preoperatively and at 1 month.


Results

Median age was of 69 [52–74] years old and median prostatic volume of 50cm3 [40–80]. Median procedure time was of 11minutes [6–15]. Intra- and postoperative outcomes were uneventful. At 1 month, the mean IPSS and IPSS-QOL improvement were of 46 % and 58 %, respectively. One patient reported no improvement in his urinary and sexual symptoms. In the other three patients, the maximum urinary flow rate was improved, the post voiding residual improved in two patients and similar in one. No alteration in erection or ejaculation functions was reported.


Conclusions

In our initial experience, intra-prostatic UroLift® implant procedure seemed feasible, efficacious for LUTS and well tolerated, especially concerning sexual outcomes. Further study of the UroLift® implant in France is currently being planned.

Mots clés:
hyperplasie bénigne de la prostate / Urolift / / Mini-invasif
Mots-clés:
Benign prostate hyperplasia / Urolift / / Mini-invasive