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Angiomyolipomes rénaux sans composante graisseuse : caractéristiques tomodensitométriques, histologiques et évolutives
2011
- Réf : Prog Urol, 2011, 12, 21, 837-841


Introduction



Introduction

Angiomyolipoma is the most frequent benign renal solid tumor. Because of the lack of fat component on the CT scan, diagnosis of this tumor is hard and can require percutaneous biopsy of unknown renal tumor. The follow-up of the poor fat CT scan component AML (PFCT AML) is uncertain.


Methods

Five hundred percutaneous renal biopsy under tomodenstitometry have been realised between 1998 and 2008. There was 41 PFCT AML on the 500 biopsy. By definition, a PFCT AML is an AML where the diagnosis is done on a percutaneous biopsy but where there was no fat component on the first CT scan. We studied and compared clinical, tomodensitometric and histologic parameters of these 41 patients (mean age: 56, 9±11.04; sexe rate M/F: 6/35) where renal AML was diagnosed on percutaneous renal biopsy but without fat component on CT scan. Average size was 26.44±14.68mm. We phone-called 16 patients for the long-term follow-up. Average follow-up was 41±28.3 months. For four patients on 16, initial diagnosis was done in front of local symptoms, for one of the 16 diagnosis was done in front of general symptoms, for one of the diagnosis was done during Bourneville tuberous sclerosis evolution and 10 of the 16 was done fortuitously.


Results

After review of the initial CT scan, fat density was found on 24% of them. Ten percent was epithelioid angiomyolipoma. Four renal biopsy on 41 (10%) was epithelioid AML. No epithelioid AML had fat component after the second look of the CT scan. Among the 16 patients who were phone-called, three (19%) underwent a complication. Two had abdominal pain and was treated medically. Initial sizes were 26 and 30mm. Only one patient must be operated by radical nephrectomy for acute hemorrhage. Initial size was 45mm. No neoplasic degeneration was identified for those 16 patients.


Conclusion

In our study, the PFCT AML rate was 8.2%. In 25% cases, CT scan read-through shown a fat component and could help for the diagnosis. PFCT AML evolution seems to be the same as a classic AML. Conservative treatment had a good covering because there was no death and no malignant evolution. However, we found 10% of epithelioid angiomyolipoma in which malignant risk is high. PFCT AML diagnosed on renal percutaneous biopsy of unknown renal tumor requires the same management than the classic AML.

Mots clés:
Rein / Angiomyolipome / Diagnostic / Évolution / Complications
Mots-clés:
kidney / Angiomyolipoma / Diagnosis / Follow-up / Complications
Complications de l'anesthésie générale inhérentes à la voie laparoscopique et à la prostatectomie totale robot-assistée
2011
- Réf : Prog Urol, 2011, 12, 21, 829-834


Introduction



Introduction

The aim of our work was to present a review of technical features and complications of general anesthesia during robot-assisted laparoscopic radical prostatectomy (RALRP).


Materials and methods

Data on RALRP and general anesthesia were explored on Medline using the following MeSH terms: radical prostatectomy; morbidity; anesthesia complications; laparoscopy; robotics; Trendeleburg. Publications were considered on the following criteria: methodology, relevance and date of publication.


Results

There was no data of level of evidence 1 available. The first RALRP was reported in 2000. Technological innovation brought by the robot with its 3-D vision, the acquisition of degrees of mobility and a more ergonomic position for the surgeon, have led to a growing interest from new teams in the western world. However, the RALRP generates constraints for the anesthesia team who need to incorporate the rules of laparoscopy and the patient’s specific installation to guarantee maximum safety. There are inherent complications with the installation of the patient himself in the Trendelenburg position (ocular, neurological, hemodynamic, respiratory) and respiratory complications related to the specific procedure in gaseous atmosphere due to pneumoperitoneum. One of the criteria of the quality of publications in the field of surgery is related to the objective evaluation of complications by appropriate scale systems and the complications of general anesthesia must also be absolutely recorded.


Conclusion

RALRP had deeply modified the anatomical landmarks of the surgical removal of prostate cancer. However, the perioperative environment has also been completely altered and the installation of RALRP in the daily routine of a service requires from the anesthesia team to adapt their behavior to this sophisticated surgical access.

Mots clés:
Prostatectomie / morbidité / Anesthésie / Complications / laparoscopie
Mots-clés:
radical prostatectomy / Morbidity / Anethesiology / Complications / Laparoscopy
Évaluation prospective du traitement de l'incontinence urinaire post-prostatectomie par injections intrasphinctériennes de cellules musculaires autologues
2011
- Réf : Prog Urol, 2011, 12, 21, 859-865


Introduction



Purpose

Cell therapy for urinary incontinence management has been experienced in animals with encouraging results, but studies in human beings are lacking. Our primary objective was to assess the safety of intrasphincteric injections of autologous muscular cells in patients with postprostatectomy incontinence (PPI). Secondary objectives focused on complications efficacy.


Methods

We conducted an open, prospective study in a single center on 12 patients presenting PPI. Patients underwent intrasphincteric injections of autologous muscular cells isolated from a biopsy of deltoid muscle. The primary endpoint was the Qmax variation at the three month visit in order to assess potential bladder outlet obstruction. Secondary endpoints assessed side effects and efficacy parameters based on symptoms, quality of life score, voiding diary, pad-test, and urethral pressure profile at one, two, three, six and 12 months after injection.


Results

No immediate complication occurred and no significant variation was noted on Qmax . The only side effects possibly product-related were three cases of urinary tract infection treated by antibiotics. An acceptable safety and tolerability of the procedure whatever the injected dose of muscular cells was demonstrated. Results on efficacy after one year were heterogeneous, with 4/12 patients describing reduced urine leakage episodes, 1/12 patient presenting increased maximal closure pressure, and 8/12 patients showing improvement on pad-test.


Conclusions

Cell therapy consisting of intrasphincteric injections of autologous muscular cells in patients with PPI was a feasible and safe procedure. The results point out that some subjects may positively respond to this procedure, but clinical efficacy remains to be confirmed.

Mots clés:
Thérapie cellulaire / Incontinence urinaire d’effort / Myoblastes / Prostatectomie
Mots-clés:
Urinary incontinence, Stress / Cell therapy / Myoblast / Prostatectomy
Exhaustivité et qualité des réunions de concertation pluridisciplinaire ; l'exemple des cancers prostatiques en Midi-Pyrénées
2011
- Réf : Prog Urol, 2011, 12, 21, 879-886


Introduction



Objectives

To determine the completeness of the examination of cancer patient cases in a multidisciplinary team meeting (MDTM), to study the factors that can affect this examination and to assess the quality of the MDTM concerning prostate cancer in Tarn.


Methods

Completeness was estimated by comparing the database of the Tarn cancer registry containing all the inhabitants of this department for whom prostate cancer was diagnosed in 2007 with the list of patients living in Tarn whose cases were discussed during a Midi-Pyrénées MDTM. Determinants of the case discussion in MDTM were studied from data collected in medical records (age, stage at diagnosis, PSA level, Gleason score, treatment). The MDTM quality study (delay in management, whether the case was seen before or after treatment, required elements for MDTM, clinical data, conformity between suggested treatment and guidelines, adequacy between suggested and performed treatments) was based on the MDTM forms retrieved from the DCO and from medical records.


Results

Four hundred and fifty-nine patients were re-examined. The pretherapeutic passage rate within three months after diagnosis was 56.2%. The probability of a discussion in MDTM decreased for people over 85 years of age (OR=0.10) compared with the 70–74 year-old people and it increased for the N+M+ (OR=4.23) compared with the T1–T2. Patients for whom radiotherapy was considered were presented more frequently than the others. The MDTM quality was studied based on 220 DCO forms. The patient’s physician attended the MDTM in 65% of the cases, 97% of the suggested treatments were consistent with the guidelines and 90% of the performed treatments complied with the suggested treatment.


Conclusion

The discussion rate in MDTM has not reached the 100% planned by the first “plan cancer” yet, but when a MDTM was carried out, its compliance and adequacy were high. While seniors’ cases require interdisciplinarity because of a complicated management, they were less discussed in MDTM.

Mots clés:
prostate / Cancer / Concertation pluridisciplinaire / Épidémiologie / Registre
Mots-clés:
prostate / Cancer / Interdisciplinary communication / epidemiology / Registries
Intérêt d'une forme semestrielle d'hormonothérapie pour le traitement du cancer de la prostate hormono-dépendant à un stade avancé : résultats d'ELIRE, enquête observationnelle française
2011
- Réf : Prog Urol, 2011, 12, 21, 866-874


Introduction



Objectives

Androgen-deprivation therapy modalities are on continuing evolution. Leuprolide Acetate (LA) Eligard®45mg was the first 6-monthly LHRH agonist (agoniste luteinizing hormone-releasing hormone [LHRHa]) treatment available for use in prostate cancer. The objective of this study was to assess the use of the 3-monthly and the 6-monthly LHRHa in patients with prostate cancer.


Patients and methods

A two-step survey (registration and follow-up) was held between July 2008 and January 2009. One hundred and sixty doctors included patients treated with LHRHa for prostate cancer. Then, a follow-up registry was implemented for patients who had been prescribed a 3- or 6-monthly LHRHa.


Results

Data analysis showed that the 1853 registered patients had a mean age of 75 years old. Time to diagnosis was 7 months. Among them, 26.4% had an N+ and/or M+ cancer. The most tumor node metastasis (TNM) stage represented was T3N0M0 with Gleason score 7. High prostate specific antigen (PSA) level and metastatic stage were the main motives for LHRHa prescription. Choice criteria for a 3 or a 6-monthly LHRHa were patient autonomy (3.2 vs 18.4%), age (27.2 vs 44%) and anxiety (28 vs 16.8%). Patients for 6-monthly LHRHa were likely to be with low urinary symptoms, older, less autonomous and less anxious. The reported advantage of the 3-monthly LHRHa was the high satisfying quality of medical follow-up. For the 6-monthly form, the advantages were the flexibility and the freedom to stop worrying about their cancer for up to 6 months.


Conclusion

The 6-monthly LHRHa provides more flexibility in the management and follow-up of patients with locally advanced or metastatic prostate cancer.

Mots clés:
cancer de prostate / Hormonothérapie / Qualité de vie / Analogues de la LHRH
Mots-clés:
prostate cancer / Hormonotherapy / Quality of life / GHRH agonists
Intérêt de la néphrectomie partielle pour la préservation de la fonction rénale des patients ayant une tumeur rénale de plus de 4 cm
2011
- Réf : Prog Urol, 2011, 12, 21, 842-850


Introduction



Objective

The objective of the present study was to analyse whether nephron-sparing surgery (NSS) was superior to radical nephrectomy (RN) in preserving renal function outcome in tumors larger than 4cm.


Methods

The data from 888 patients who had been operated upon at eight french university hospitals were retrospectively analyzed. Glomerular filtration rate (GFR) pre- and post-surgery was calculated with the abbreviated Modification of Diet in Renal Disease (MDRD) equation. For a fair comparison between the two techniques, all imperative indications for NSS and all GFR<30mL/min/1.73m2 were excluded from analysis. A shift to a less favorable DFG group following surgery was considered clinically significant.


Results

Seven hundred and thirty patients were suitable for comparison. Median age at diagnosis was 60 years (19–88). Tumors measuring more than 4cm represented 359 (49.2%) cases. NSS and RN were performed in 384 (52.6%) and 346 (47.4%) patients, respectively. In univariate analysis, patients undergoing NSS had a smaller risk than RN of developing significant GFR change following surgery. This was true for tumors4cm (P =0.0001) and for tumors>4cm (P =0.018). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P =0.001), decreased preoperative DFG (P =0.006), increased age at diagnosis (P =0.001) and increased ASA score (P =0.004).


Conclusion

The renal function benefit offered by elective NSS over RN persists even when expanding NSS indications beyond the traditional 4cm cut-off.

Mots clés:
cancer du rein / Néphrectomie partielle / Fonction rénale / Débit de filtration glomérulaire / Insuffisance rénale chronique
Mots-clés:
Renal cell carcinoma / partial nephrectomy / Renal function / Glomerular filtration rate / End stage renal disease
Intérêt et modalités pratiques de la cystoscopie de fluorescence en 2011 pour la prise en charge des carcinomes urothéliaux de la vessie : une revue du Comité de cancérologie de l'Association française d'urologie
2011
- Réf : Prog Urol, 2011, 12, 21, 823-828


Introduction



Aim

Fluorescence-guided cystoscopy is a useful tool for bladder tumour detection in association with white-light cystoscopy and decreases the residual tumour rate. The aim of the study was to provide an overview of the pertinent literature on this subject.


Materials and methods

The data were provide from a Medline® research by using the follow keywords: urinary bladder neoplasms; cystoscopy; fluorescence; prognosis; intraepithelial neoplasm.


Results

No evidence 1 level data was available. The fluorescence-guided cystoscopy improves the bladder cancer detection rate, especially the flat lesions, and improve the recurrence-free survival by decreasing the residual tumour rate. The specific indications for fluorescence-guided cystoscopy in the diagnosis and management of non-muscle invasive bladder cancer (NMIBC) should benefit the patients.


Conclusion

The fluorescence-guided cystoscopy is a benefical tool in association with white-light cystoscopy in NMIBC diagnosis. It has been shown to have a positive impact on recurrence-free survival but not on progression-free survival. More investigations with significant follow-up should be lead in the future to accurately assess its therapeutic impact on patients.

Mots clés:
Tumeurs de la vessie / cystoscopie / Fluorescence / Pronostic / Carcinome in situ
Mots-clés:
Urinary bladder neoplasms / Cystoscopy / Fluorescence / prognosis / Intraepithelial neoplasm
La neutrophil gelatinase-associated lipocalin , ou LCN 2, facteur d'agressivité dans le carcinome rénal à cellules claires (CRCC)
2011
- Réf : Prog Urol, 2011, 12, 21, 851-858


Introduction



Objective

To determine the prognostic significance of the neutrophil gelatinase-associated lipocalin (NGAL) and the matrix metalloproteinase 9 (MMP-9) in clear cell renal cell carcinoma (CCRCC).


Patients and methods

NGAL and MMP-9 expression were quantified by immunohistochemistry in clear renal cell carcinoma tissues and in sera by Enzyme Linked Immunosorbent Assay (Elisa). Results were associated with clinicopathologic data.


Results

Seventy-four patients operated for CCRCC in Rennes between 2003 and 2009 were included. High concentrations of NGAL–MMP-9 complex in serum were associated with short progression free survival (PFS) (33.3months versus 47.3months, P =0.016) and poor overall survival (42.5months versus 51.9months, P <0.047). High NGAL concentrations in serum were also associated with shorter PFS (13.6months versus 41.6months, P =0.04). However, no NGAL expression was observed in renal tumor cells. Interestingly, NGAL was expressed by neutrophils infiltrating CCRCC and we showed that the density of NGAL expressing neutrophils was associated with pejorative PFS and survival (36.9months versus 56.1months, P <0.006).


Conclusion

In this study, we showed the pejorative significance of NGAL–MMP-9 complex and NGAL rates in serum of CCRCC. We also confirmed that density of NGAL expressing neutrophils in CCRCC was associated with poor outcome.

Mots clés:
carcinome à cellules rénales / Pronostic / Protéine LCN2 / Matrix métalloprotéinase 9 /
Mots-clés:
Renal cell carcinoma / prognosis / LCN2 protein / Matrix métalloprotéinase 9 / Vascular endothelial growth factor
Les complications urologiques de la chirurgie gynécologique
2011
- Réf : Prog Urol, 2011, 12, 21, 875-878


Introduction



Objective

To analyze the epidemiological, anatomoclinical, surgical and evolutionary aspects of the urological complications of gynecological surgery.


Material and methods

It was about a retrospective survey, concerning 81 patients hospitalized in the department of urology of the university hospital, Brazzaville from 2000 to 2008 for urological complications of the gynecological surgery. The epidemiological, diagnostic, surgical and evolutionary parameters have been analyzed.


Results

The urological complication of the gynecological surgery has been recovered in 3% of patients hospitalized in urology. The middle age was 37±14.52 years (17 and 74 years). The median was about 36 years. The middle delay of diagnosis was 15 days (0 and 350 days). The revealing clinical signs were: the oligoanuria (n =12), the urinary incontinence (n =57), the lumbar pain (n =9) and the cyclic hematuria (n =2). The surgical interventions in reason were: the Caesarean (n =50), the hysterectomy for fibroma (n =26), the myomectomy (n =3) and the hysterectomy for cancer (n =2). Anatomical lesion were 55 (67.9%) vesicovaginal fistulas, 12 (14.8%) ureteral ligatures, eight (10%) uretero-vaginal fistulas, three (3.7%) vesico-uterine fistulas, two (2.4%) wounds ureteral and one (1.2%) vaginal vesico-fistulas and uretero-vaginal fistulas. The treatment consisted in one termino-terminal ureterorraphia, 20 uretero-vesical reimplantation, 57 cures of vesico-vaginal fistulas and one nephrectomy. The recovery was obtained at 96% of the ureteral lesions and 90% of the vesico-vaginal fistulas.


Conclusion

The lesions of the ureteral and the bladder were often met during the gynecological surgery. The treatment requires knowledge of the anatomy of pelvis.

Mots clés:
Complications urologiques / Chirurgie gynécologique / Congo
Mots-clés:
Urologics / Complications gynecological surgery / Congo
Pyélonéphrite obstructive droite par étranglement herniaire supra-piriforme de l'uretère pelvien : cas clinique
2011
- Réf : Prog Urol, 2011, 12, 21, 887-890


Introduction



Ureteric herniations are extremely rare. We are reporting the case of a 57-year-old female presenting with an upper urinary tract sepsis due to a pelvic ureteral herniation into the supra-piriform sciatic foramen. The diagnosis was made by the CT scan and the treatment was performed in two steps: first the upper urinary tract was drained, and then the hernia was surgically treated. Although ureteral hernias are exceptional causes for nephritic colic, urologists must be aware of the specificity of the diagnosis and of the treatment in order to avoid complications.

Mots clés:
Colique néphrétique / Hernie abdominale / anatomie / Foramen supra-piriforme
Mots-clés:
Nephritic colic / Abdominal hernia / anatomy / Supra-piriform foramen
Thérapie cellulaire et incontinence urinaire : si loin, si proche
2011
- Réf : Prog Urol, 2011, 12, 21, 835-836

Mots clés:
G.
Mots-clés:
radical prostatectomy / Morbidity / Anethesiology / Complications / Laparoscopy
Variante plasmacytoïde de carcinome urothélial vésical et cancer prostatique : à propos de deux cas
2011
- Réf : Prog Urol, 2011, 12, 21, 891-894


Introduction



Plasmacytoid urothelial carcinoma (PUC) is a rare variant of urothelial carcinoma with aggressive clinicopathological behaviours. We experienced two cases of PUC of urinary bladder. Both cases were advanced cancer with extravesical invasion and lymph node metastases. They also had coexisting prostatic carcinoma, one was preoperatively diagnosed and the other was incidentally discovered after surgery. As these cases were the first report of PUC simultaneously associated with prostatic carcinoma, clinicopathological features and the treatment options were discussed.

Mots clés:
Adénocarcinome prostatique / carcinome urothélial / prostate / Variante plasmacytoïde / Vessie
Mots-clés:
Plasmacytoid carcinoma / prostate / Prostatic adenocarcinoma / Urinary bladder / Urothelial carcinoma