Base bibliographique

Sommaire :

Erratum à « Intérêt du mélange équimolaire d'oxygène et de protoxyde d'azote (Meopa) dans les biopsies transrectales de prostate » [Prog Urol 2008;18:358–63]
Erratum to “Value of nitrous oxide-oxygen mixture (Emono) in transrectal prostate biopsies” [Prog Urol 2008;18:358–63]
2009
- Erratum
- Réf : Prog Urol, 2009, 11, 19, 861


Facteurs prédictifs d'échec de cure d'incontinence urinaire d'effort masculine par bandelette sous-urétrale à ancrage osseux type InVance™ : étude multicentrique du comité des troubles mictionnels de l'homme de l'Association française d'urologie
2009
- Réf : Prog Urol, 2009, 11, 19, 839-844




 


Aim

To define predictive factors of treatment failure in a multicentric study for the treatment of stress male urinary incontinence by InVance™ (American Medical System, USA) bone anchored sub-urethral sling.


Method

Cases treated by InVance™ between January 2005 and December 2007 in four French academic centers were collected.


Results

Eighty-four patients were evaluated. Mean age was 68 years old. With a mean follow-up of 20 months, 38 patients (45%) were dry, 22 (26%) were improved, and 24 (29%) suffered treatment failure. In univariate analysis, three parameters were significantly associated with treatment failure, including severe urinary incontinence (P =0.005), urodynamic instability (P =0.043), and incontinence due to a bitherapy including external radiotherapy (P =0.031). If zero or one versus two or three risk factors were present, treatment failure rate was 25 and 67%, respectively (P =0.013). In multivariate analysis, bitherapy including radiotherapy was the sole independent treatment failure risk factor (P =0.017).


Conclusion

Two patient groups were defined, allowing to determine preoperatively good candidates and bad candidates for stress urinary incontinence treatment by InVance™ sling.

Gènes de fusion et cancer de la prostate. De la découverte à la valeur pronostique et aux perspectives thérapeutiques
2009
- Réf : Prog Urol, 2009, 11, 19, 819-824




 


The identification of fusion genes provides new insights into the initial mechanisms of molecular events implicated in the prostate cancer tumorigenesis. The presence of TEMPRSS2–ETS fusion in up to half of all human prostate cancer makes it perhaps the most common genetic rearrangement in human epithelial tumors. Some data suggest that TMPRSS2–ERG fusion prostate cancers have a more aggressive phenotype, which may affect cancer progression and outcome in localized tumors treated with prostatectomy. This discovery should pave the way towards future targeted therapies.

La mention systématique d'un indice de qualité dans les comptes rendus de biopsies prostatiques influence les pratiques professionnelles
2009
- Réf : Prog Urol, 2009, 11, 19, 825-829




 


Objective

Evaluate the influence on professional practices of a systematic indication of a quality score (IGap) in the conclusion of the pathologic reports (CRFS) of prostatic biopsies (PB).


Materials and method

Prospective study carried over 339 consecutive 10 core extended standardized PB performed by two urologists over a period of 22 months. The CRFS were computerized. The conclusion included an IGap ranking from 0 to 1, automatically computed from three criteria: the average length of the PB, the number of PB with identified capsules or periprostatic tissues and the average number of fragments per PB. The quality was best when the index is close to 1. A quarterly monitoring of the average of IGap was performed for the two urologists. The student t test was used to compare the averages.


Results

The average of IGap of the urologists A and B was, respectively, of 0.57 (s =0.1; n =184) and 0.66 (s =0.1; n =155): p <0.001. At quarter 1, the averages of IGap of the urologists A and B are, wads of respectively, of 0.47 (s =0.14; n =25) and 0.7 (s =0.12; n =14) (p <0.001). The significant difference of the average of IGap of the urologists A and B observed on quarter 1 progressively decline to disappear from the quarter 4.


Conclusions

At equivalent protocols, the urologists do not necessarily perform PB of comparable quality. A systematic indication of an IGap in the pathological reports of PB seems to prompt the urologists to modify their practices toward an improvement of the score.

Oncologie prostatique du sujet âgé
Prostatic oncology in elderly
2009
- Recommandation
- Réf : Prog Urol, 2009, 11, 19, 818


Prévalence de la dysfonction érectile chez les patients consultant en urologie : l'enquête ENJEU (Enquête nationale de type 1 Jour sur la prévalence de la dysfonction Érectile chez des patients consultant en urologie)
2009
- Réf : Prog Urol, 2009, 11, 19, 830-838




 


Objective

The objective of this survey was to describe medical reasons disclosed by men over 18 years old when visiting an urologist, to estimate the prevalence of male sexual dysfunction (MSD) including erectile dysfunction (ED) and to describe treatment options for ED.


Methods

This survey was performed, with Urology French Association (AFU) partnership, in 150 urological clinics, sample representative of urologists in France regarding age, geographical distribution and practice. The survey was proposed to all adults’ men consulting a participating urologist the defined day (Tuesday the 19th of June 2007 or an imminent day). A total of 1848 (92.5%) patients agreed to participate; analysis was performed on 1740 patients. Information related to urological disorders, sexual dysfunctions, their treatment and their impact on the patient’s life were gathered by a patient auto-questionnaire. Erectile dysfunction was assessed through the single question of John B. McKinlay.


Results

Among patients (mean age 63±14 years), 68% (IC95%=[65.2%; 70.7%]) had ED (44% severe); 25% were treated (of which 2/3 with IPDE5 alone or in association). Male sexual dysfunction was the first reason for visiting urologists (14%) following prostatic diseases (62%). About 60% of the patients had already talked about their ED to a physician, who was an urologist in 44.6% of cases. The perspective of living the rest of their life with this trouble was “unacceptable” for 21.1% of patients with ED and “fairly acceptable” for 34.4%.


Conclusions

This first survey in French urologists’ community emphasizes the high prevalence male sexual dysfunctions for inpatients visiting their urologists. Despite declared urologists’ interest for male sexual dysfunction, the discrepancy between the high prevalence of ED and the low rate of patients consulting for this condition probably explains the low rate of patients using treatments.

Prise en charge chirurgicale de l'endométriose de l'appareil urinaire : à propos de 12 cas
2009
- Réf : Prog Urol, 2009, 11, 19, 850-857




 


Objectives

Our study aimed at evaluating, retrospectively, the outcome of the surgical management of urinary tract endometriosis.


Patients and methods

Twelve women with a mean age of 36,4 were recruited between 1994 and 2007. They all had a histologically-proven and surgically-treated endometriosis of the urinary tract.


Results

Seven of them had a unilateral ureteric localization, two had a bilateral ureteric localization and three had a vesical localization. One patient with bladder nodules underwent a partial cystectomy and the two other patients with bladder localization underwent a transurethral resection. Out of the nine patients who had a ureteric localization of endometriosis, seven had a ureterectomy and re-implantation with bladder psoas hitching and had no recurrence.


Conclusions

Our experience showed that ureterectomy and re-implantation with bladder psoas hitching is probably the best way of preventing recurrences in the case of urethral endometriosis. In the case of bladder endometriosis, transurethral resection did not appear as the most effective treatment although it remains an acceptable alternative, especially as far as premenopausal women or young women wishing to conceive are concerned.

Recommandations pour la prise en charge du cancer de la prostate chez l'homme âgé : un travail du comité de cancérologie de l'association française d'urologie
2009
- Réf : Prog Urol, 2009, 11, 19, 810-817




 


The increase in life expectancy combined with the increase in the global incidence of cancers will probably results in an increase in the number of cancers observed in the elderly. The increase in the incidence of prostate cancers in geriatric patients (45% of prostate cancers are diagnosed after 75 years old) is in sharp contrast with the lack of strong scientific data on the topic. By the meantime, oncogeriatrics has been developing for some years now under the guidance of the International Society of Oncogeriatrics. Such an approach aims at palliating the low quality of care of cancers in geriatric patients. The reasons for the low quality of care come from the characteristics of these patients and from the training of the care providers. The authors recall the principles of oncogeriatric evaluation and the classification of patients as it is actually proposed. They describe the main treatments and their results in the geriatric population and they describe the decision process concerning the choice of the treatment. They also suggest some guidelines on the diagnosis of prostate cancer, evaluation of the patients and the treatments of the disease in the elderly. Prostate cancer is almost the perfect model for oncogeriatrics. Urologists should remain the corner stone of its management, whatever the age of their patient.

Résection transuréthrale de prostate ou incision cervicoprostatique dans les suites immédiates d'une transplantation rénale
2009
- Réf : Prog Urol, 2009, 11, 19, 845-849




 


Aim

The objective of the study was to analyse the results of a transurethral resection of the prostate (TURP) or a transurethral incision of the prostate (TUIP) performed immediately after kidney transplantation.


Material

For the patients who had undergone a transurethral surgical procedure immediately following a renal transplantation, their files were systematically reviewed. Depending on prostate volume, TURP or TUIP was performed. The preoperative assessment included past medical history, clinical examination, retrograde cystography and PSA.


Results

Among the 256 patients having had a renal transplantation between 2001 and 2006, 12 TURP and eight TUIP were done. The procedure was performed 15.2 days (10–30) after the transplantation. The average day of urethral catheter removal was 3.1 days (2–15) after the transurethral procedure. Mean postoperative maximum flow rate was 22.1 ml/s (18–33) and postvoiding residual urine volume was not significant. One patient suffered from two acute urinary retentions that were treated by temporary intermittent self-catherization. Four patients were diagnosed with acute prostatitis. The procedure for benign prostatic hyperplasia did not alter renal function. With a follow-up of 34.2 months (12–73), 18 patients had no urologic symptoms with a mean IPSS score of 4 (3–6).


Conclusion

TURP or TUIP gives good results immediately following a renal transplantation.

Spécificités du cancer de la prostate avant l'âge de 50 ans
2009
- Réf : Prog Urol, 2009, 11, 19, 803-809




 


Objective

To report the characteristics of prostate cancer (PCa) in men less than 50-year-old and the results of different treatments of PCa in this population.


Method

A bibliographic research was performed using Pubmed database. The keywords that we used were: prostate cancer, age, young, radical prostatectomy, brachytherapy, radiotherapy, active surveillance. The studies which included a significant number of patients were selected. A total of 38 articles were used as bibliographic references.


Results

PCa in young men does not seem to have different characteristics than in older men. Nevertheless, young men seem to have a lower risk of severe urinary and sexual sequelae, particularly following radical prostatectomy.


Conclusions

There is no recommendation regarding management of PCa in men less than 50-year-old. In case of localized cancer, two options may be considered. First option consists in decreasing the urinary and sexual complications of radical prostatectomy. A minimally-invasive treatment, such as brachytherapy or even active surveillance, may reach this objective. Second option consists in being more aggressive. To propose a radical prostatectomy offers to the patient the possibility of salvage radiation therapy in case of locally-advanced tumor or local recurrence.

Technique de dérivation urinaire non continente transcutanée comme traitement d'un prolapsus de vésicostomie
2009
- Réf : Prog Urol, 2009, 11, 19, 858-860




 


Vesicostomy prolapse is a frequent complication of an unusual surgical technique in adult patients. We have described a surgical technique to repair a vesicostomy prolapse using subcutaneous tubulisation of thick cutaneous flap taken off the abdominal wall. This technique could help surgeons to cure prolapse of vesicostomy in case of impossible intraperitoneal approach.