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Biopsies prostatiques itératives suite à une première biopsie négative dans un contexte d'élévation de l'antigène spécifique de la prostate
2012
- Réf : Prog Urol, 2012, 12, 22, 718-724


Introduction



Introduction

An elevated PSA and a negative prostate biopsy (PB) can be a false negative PB that ignores a prostate cancer (PCa) or a false positive PSA not related to PCa. The objective of this study was to analyze a group of patients who had a negative first BP for a PSA superior to 4ng/mL and at least one additional PB and to compare these cases with controls who had the diagnosis PCa from the first PB.


Methods

Retrospective single-center study comparing patients with an elevated PSA and repeat biopsy following a first negative PB and patients with PCa diagnosed from the first PB.


Results

The 63 cases were younger than the 75 controls and had more often a normal digital rectal examination. Their prostate volume was larger and their number of PSA before the first PB lower: this corresponded to a lower PSA in the second (7/64), third (6/31), fourth (3/9) and sixth (1/1) PB. Among these cases with PCa, the length of core invaded by cancer and the total length of cancer of the entire PB were smaller than controls. In 76% of cases, the Gleason score among cases was 6 or less.


Conclusion

PCa discovered on repeat biopsy had features of better prognosis than those of controls. We propose an algorithm for management of patients with elevated PSA and negative first PB.

Mots clés:
Adénocarcinome prostatique / Antigène spécifique de la prostate / Biopsie prostatique
Mots-clés:
prostate cancer / prostate specific antigen / Prostate biopsy
Cancer du rein de moins de 4 cm : traitement dans un centre de référence régional en cancérologie
2012
- Réf : Prog Urol, 2012, 12, 22, 692-700


Introduction



Objectives

To analyze the impact of preoperative clinical data that could influence the undertaking of small renal masses (size<4cm) and to direct patients towards surgery or observance or radiofrequency.


Patients and methods

From January 2000 to December 2010, 253 small renal masses were included in a retrospective study. Renal masses less than 3cm were compared to the 3 to 4cm masses. Clinical data, pathological data and follow-up was noted prospectively on the database and we analyzed it according to the treatment done (surgery, radiofrequency or observation).


Results

Surgical treatment, radiofrequency and observation were performed for 214 (86.4%), 15 (5.9%), and 24 (9.5%) patients respectively. The treatments of the patients differed in the two groups (<3cm vs. 3–4cm) and the appeal to radiofrequency and observation was more frequent for elder patients (>65years old) and for those whom performance status (ECOG status) greater or equal to 1. Cancer specific survival was not statistically different for the two groups (average: 87.5% after 5years, mean 33months follow-up, P =0.7). Independent risk factors of recurrence were Fuhrman grade, synchronous tumors, noddles invasion and metastatic progression. Positive surgical margins were not a risk factor of recurrence (P =0.6).


Conclusion

Age and performance status are the two main clinical data, which influence the treatment for patients with small renal masses. Radiofrequency and observation were undertaken more regularly for elder and altered ones. The use of scales as Charlson Index or Lee scale could help to choose more easily according to global morbidity and mortality.

Mots clés:
cancer du rein / Traitement / Tumorectomie / Radiofréquence / Surveillance
Mots-clés:
Renal cell carcinoma / treatment / Nephron-sparing surgery / Radiofrequency / Surveillance
Cystectomie totale pour cancer urothélial : impact pronostique de l'atteinte ganglionnaire et des marges chirurgicales positives
2012
- Réf : Prog Urol, 2012, 12, 22, 705-710


Introduction



Purpose

To assess the association of soft tissue surgical margins (STSM) and/or lymph node metatstasis (pN+) with characteristics and outcomes of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).


Materials and methods

We retrospectively collected the data of 242 patients treated with RC and pelvic lymphadenectomy for UCB between January 2005 and June 2009. Different parameters were studied: age, PSAt, pathological stage of cystectomy specimen (pT and pN), tumor grade, number (nb) of nodes (N) in lymphadenectomy, nb of metastatic nodes (nb N+), bigger diameter of N+, ganglionic density, nb of N with capsular ruptur, associated CIS, associated prostate cancer, follow-up, global and specific survival, date and etiology of death.


Results

Positive STSM were identified in 22 patients (9.1%) and lymph node metastasis in 59 (24.4%). pN+ status was significantly associated with lower global (GS) and specific survival (SS) (P <0.003). So was it for patients with positive STSM R+ with actuarial 3-year GS and SS respectively of 5% and 25% versus 35% and 43.9% no STSM (P <0.001).


Conclusions

Positive soft tissue surgical margin and/or lymph node metatstasis on cystectomy specimen is a strong predictor of GS and SS from urothelial carcinoma of the bladder. So it is for capsular rupture, ganglionic density greater or equal to 0.10 and nb of N in lymphadenectomy less than 14 for pN+ patients.

Mots clés:
Cystectomie / Pronostic / Tumeurs de vessie / carcinome urothélial / Survie
Mots-clés:
Cystectomy / prognosis / Urinary bladder neoplasms / Carcinoma / transitional cell
Cystoscopes souples : pratiques de désinfection et de surveillance microbiologique parmi les urologues français. Une enquête du comité d'infectiologie de l'AFU
2012
- Réf : Prog Urol, 2012, 12, 22, 731-735


Introduction



Introduction

According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing.


Material and methods

The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists.


Results

Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance.


Conclusion

Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.

Mots clés:
Cystoscopes souples / Désinfection / Gaines stériles / Stérilisation / Surveillance microbiologique
Mots-clés:
Flexible cystoscopes / Disinfection / Sterilization / Sterile disposable sheaths / Microbiological surveillance
Évolution de la prise en charge chirurgicale des pathologies prostatiques : analyse nationale du codage
2012
- Réf : Prog Urol, 2012, 12, 22, 711-717


Introduction



Introduction

Prostatic diseases are very important in urologist’s practice. We wanted to study evolution of prostatic procedures using French national coding database.


Methods

We searched the Agence Technique d’Information sur l’Hospitalisation (ATIH) web server for prostatic procedures between 1997 and 2011 for both private and public sectors.


Results

The procedures were more often performed in private sector (up to 70%). There was a sustained increase (+332%) of the number of prostatectomies between 1997 and 2007 (more than 27,000 procedures), followed by a slight decrease. There is a rising use of laparoscopic approach from 35% in 2006 up to 58% in 2011. The use of brachytherapy and HIFU was marginal. Transurethral resection of the prostate number was stable between 56,000 and 60,000 procedures a year (for cancer for less than 7%). Adenomectomies number decreased from 9832 to 7963 procedures a year.


Conclusion

The most noticeable data were upon prostatectomies number, with a peak effect in 2007. Laparoscopic procedures were more and more frequent. TURP number was stable, whereas adenomectomies number decreased.

Mots clés:
prostate / Prostatectomie / Economie de santé
Mots-clés:
prostate / Prostatectomy / Health economics
Faut-il envisager un traitement complémentaire après une colique néphrétique drainée par une sonde JJ ?
2012
- Réf : Prog Urol, 2012, 12, 22, 701-704


Introduction



Purpose

The aim of the study was to evaluate if only ureteral stent removing after complicated renal colic (RC) could prevent from complementary treatment (shock-wawe lithortripsy or ureteroscopy).


Patients and methods

Data from 95 patients, 39 women and 56 men, who had an ureteral stent for complicated RC from 2005 to 2010 were retrospectively collected. Mean age was 46.4±17.2 years. After the initial management, another hospitalization was organized where patients had ureteral stent removing under local anesthesia, then an abdominal CT-scan without injection and complementary treatment of ureteral stones (none or ESWL or ureteroscopy). Parameters studied were age, sex, stone size, location of calcul. Quantitative values were compared with Student’s t test. Qualitative values were compared with the Chi2. P <0.05 was considered statistically significant.


Results

Mean duration between the two hospitalizations were 1.58±1.84 months. Sixty-one patients (64.2%) had no more urolithiasis. In these patients, mean size of urolithiasis was 5.85±2.33mm. Location of urolithiasis in distal, mild and proximal ureter was 77%, 3% and 20% respectively. Thirty-four patients (35.8%) had persistant lithiasis after CT-scan. Location of stone in distal, mild and proximal ureter was 17.5%, 5.8% and 76.7% respectively.


Conclusion

After management of complicated renal colic by ureteral stent, 64% of patients had spontaneous elimination of stones after removing of ureteral stent, especially in women and pelvic ureter.

Mots clés:
calcul urétéral / Sonde JJ / Élimination spontanée / Traitement
Mots-clés:
Ureteral stone / JJ stent / Spontaneous elimination / Management and treatment
Intérêt du lambeau de Martius (LM) dans l'incontinence urinaire d'effort (IUE) traitée par bandelettes sous-urétrales (BSU)
2012
- Réf : Prog Urol, 2012, 12, 22, 725-730


Introduction



Objective

Study of a series of patients treated with suburethral tapes using the Martius flap technique, for complications or in a preventive way, in order to determine its interest and morbidity.


Patients

Eleven female patients treated by suburethral tapes for stress urinary incontinence, for which we described the type of tapes used, their complications, the procedure including Martius flap and the outcomes.


Results

Indications of the Martius flap were: three tapes through bladder neck, one through urethra, one uro-vaginal fistula, four loss of substance of the vaginal wall, one peri-urethral fibrosis and one preventive use on irradiated pelvis. Complications were transient postoperative pain and one abscess of the greater lip. In our series, the Martius flap never cured stress urinary incontinence. The placement of a suburethral tape on a Martius flap is feasible but the adjustment is more difficult.


Conclusion

The Martius flap is efficient in the treatment or prevention of suburethral tapes complications with low morbidity. It allows secondary placement of a suburethral tape with difficult adjustment.

Mots clés:
Lambeau de Martius / Bandelettes sous-urétrales
Mots-clés:
Martius flap / Suburethral tapes complications
Mélanome métastatique aux voies excrétrices supérieures. À propos de trois cas et revue de la littérature
2012
- Réf : Prog Urol, 2012, 12, 22, 736-739


Le mélanome malin est un cancer cutané dont la dissémination se fait principalement par voie lymphatique [1 Xiaowei X., et al. Lymphatic invasion is independently prognostic of metastasis in primary cutaneous melanoma Clin Cancer Res 2012 ;  18 (1) : 229-237


Melanoma is a slowly growing malignancy, with potential distant metastasis at various sites. In this article, we reported three original cases of melanoma metastases in the upper urinary tract, and we achieved a literature review. Symptoms are inconstant and non-specific (pain or haematuria). Nephroureterectomy is performed in the majority of cases. Even if this metastatic location remains uncommon, it should be timely detected in order to allow an appropriate management and to improve the prognostic of melanoma.

Mots clés:
Mélanome / Métastase / hématurie / Voies excrétrices supérieures
Mots-clés:
Melanoma / metastasis / haematuria / upper urinary tract
Place de l'hypofractionnement dans la radiothérapie des cancers de la prostate : revue de la littérature
2012
- Réf : Prog Urol, 2012, 12, 22, 671-677


Introduction



Background

Radiotherapy of prostate cancers, over the last few years, has been an alternative choice to radical prostatectomy in the case of localised cancers as well as being the preferred treatment in both advanced localised cancers and those of the elderly. A conventional course of prostate radiotherapy consisting of four to five sessions a week, lasts between 7 and 8 weeks plus about one week of preparation.


Materials and methods

A systematic review of the scientific literature based on Pubmed, along with an exhaustive review of randomised studies presented at international congresses, have made it possible to analyse the numerous therapeutic regimens available other than the conventional normofractioned one (i.e. with doses per session ranging between 1.8 and 2.2 grays).


Results

Five randomised trials reported since 2005, plus several thousand patients treated by stereotaxic radiotherapy, have given rise to numerous scientific questions; these alternative hypofractioned courses (dose per fraction higher than 2.2 grays) have a potentially enhanced antitumoral efficacity along with the practical advantages of a shortened duration of radiotherapy.


Conclusion

The aim of this analysis of the scientific literature on hypofractioning in prostate cancer radiotherapy is to gather all the scientific evidence we currently have at our disposal. Further mature results of future randomised trials will have to be examined before modifying current practice.

Mots clés:
radiothérapie / Cancer de la prostate / Hypofractionnement / PSA / Survie
Mots-clés:
prostate cancer / radiotherapy / Hypofractionnation / PSA / survival
Transplantation rénale et receveurs obèses : revue du comité de transplantation de l'Association française d'urologie
2012
- Réf : Prog Urol, 2012, 12, 22, 678-687


Introduction



Introduction

Transplantation Committee of the French Association of Urology (CTAFU) conducted a review of the complication of kidney transplantation in obese recipients.


Material and methods

A bibliographic research in French and English using Medline with the keywords “obesity”, “body mass index”, “kidney transplantation”, “graft function”, “survival”, “wound complications”, “graft rejection” and “graft survival” was performed. We limited the review for the last fifteen years because of the change in immunosuppressive treatment area. Only studies with more than 20 obese patients were selected.


Results

Wound or infectious postoperative complications and delayed graft function are more frequent in obese patients than in non-obese recipients. Similarly, transplant survival at 5 years is lower in obese patients. On the other hand, patient survival and acute rejection are the same between the two groups if recipient selection is carefully made, particularly with regard to heart complication.


Conclusion

Kidney transplantation in obese patients is not an easy surgery with known complication. Obese patients will take time before transplantation to explain all the risk and a regular heart follow-up is crucial if we don’t want to reduce patient survival. But obese survival is better if we proceed to kidney transplantation than if they stay on dialysis, arguing for a non-exclusion of the waiting list. So there is the need for a national study concerning obese patients on waiting list to enact future guidelines.

Mots clés:
Obésité / Index de masse corporelle / Transplantation rénale / Survie / Survie du transplant
Mots-clés:
Obesity / body mass index / Kidney transplantation / survival / Graft survival
Tumeur stromale prostatique à potentiel malin incertain (STUMP) : définition, anatomopathologie, pronostic et prise en charge
2012
- Réf : Prog Urol, 2012, 12, 22, 688-691


Introduction



Prostatic Stromal Tumors of Uncertain Malignant Potential (STUMP) are rare tumor of the prostate of mesenchymal origin, accounting, with sarcoma for 0.1–0.2% of all malignant prostatic tumours. They however require to be individualized, to differentiate it from a benign prostatic hyperplasia or a sarcoma of the prostate. The therapeutic management should be made keeping in mind the risk of degeneration towards a malignant shape. Although the appropriate treatment is unknown, radical prostatectomy seem to be the treatment of reference, especially for young patient or for extensive lesion.

Mots clés:
prostate / Cancer / sarcome / Stromale / STUMP
Mots-clés:
prostate / Cancer / Sarcoma / stromal / STUMP