Base bibliographique

Azoospermie : prise en charge et résultats. À propos de 90 cas
2011
- Réf : Prog Urol, 2011, 13, 21, 946-954


Introduction



Objective

To report our 15-year experience in managing azoospermic males at the Brest University Hospital.


Patients and methods

From 1996 to 2010, 90 azoospermic males were followed: 41 with non-obstructive azoospermia (NOA) and 49 with obstructive azoospermia (OA). Surgical methods proposed for retrieving sperm were Microsurgical Epididymal Sperm Aspiration (MESA) for men with OA and microdissection Testicular Sperm Extraction (mTESE) for those with NOA.


Results

Spermatozoa were retrieved in 56.1% of the testicular biopsies for NOA. The embryo transfer rate per cycle for injection intracytoplasmique d’un spermatozoïde (ICSI) with epididymal spermatozoa (OA) was higher to that of ICSI with ejaculated spermatozoa (93.2% vs. 86.6%, P <0.05), but the rate was lower for ICSI with testicular sperm (NOA) (70.2% vs. 86.6%, P <0.01). The rate of clinical pregnancy per embryo transfer was 31.4% following ICSI with epididymal spermatozoa but it was of 24.2% with testicular sperm and 23.1% with ejaculated sperm.


Conclusion

ICSI are usually difficult in NOA because they are done with very few spermatozoa. When spermatozoa are retrieved from surgical techniques, more than 50% of the OA couples and almost 30% of the NOA couples conceived at least one child.

Mots clés:
Azoospermie / Infertilité masculine / mTESE / MESA / ICSI asynchrone
Mots-clés:
Azoospermia / Male infertility / mTESE / MESA / Asynchronous ICSI
Cancer de la prostate à haut risque de progression. Article de revue du comité de cancérologie de l'association française d'urologie
2011
- Réf : Prog Urol, 2011, 13, 21, 901-908


Introduction



Introduction

Localized prostate tumors have various clinical, biological and histopathological characteristics that lead to different progression profiles. High-risk prostate cancer has been classically defined by clinical examination, PSA levels and histopathological data. High-risk prostate cancer has usually a worse outcome, but classic stratification predictive of outcome for prostate cancer is a matter of debate concerning its accuracy.


Methods

A systematic review of the literature on high-risk prostate cancer over the 15 last years was carried out on Medline database. The literature selection was based on evidence and practical considerations.


Results

A great deal of scientific work have been deployed to prove that high-risk prostate cancer should be approached by teamwork including radio-hormone therapy, systemic treatment with long term use of LH-RH and a radical prostatectomy with adequate lymph node dissection. Selection of patients is essential to define individualized therapeutic strategy and timing for every modality should come as a consensus of medical supported evidence.


Conclusion

Accurate patient selection and multimodal treatment offer the best therapeutic option in high-risk prostate cancer.

Mots clés:
Cancer de la prostate à haut risque / radiothérapie / Hormonothérapie / Prostatectomie totale / Lymphadenectomie pelvienne étendue
Mots-clés:
High-risk prostate cancer / Radiation therapy / Androgen deprivation therapy / radical prostatectomy / Combined treatments
Diversité chimique des calculs prostatiques : une investigation par MEB et spectroscopie infrarouge
2011
- Réf : Prog Urol, 2011, 13, 21, 940-945


Introduction



Objective

Revisiting the chemical diversity of the crystalline phases of prostatic calculi by means of SEM and FT-IR analysis.


Methods

A set of 32 prostatic calculi has been studied by FT-IR and SEM.


Results

FT-IR analysis has determined the chemical composition of each prostatic calculus and the SEM observation has described the morphology of the calculi surfaces and layers. Infrared analysis revealed that 90.7% of the stones were mainly composed of calcium phosphates. However, several mineral phases previously not reported in prostatic calculi were observed, as brushite or octocalcium phosphate pentahydrate.


Conclusion

Prostatic calculi exhibited a diversity of crystalline composition and morphology. As previously reported for urinary calculi, relationships between composition and morphology of prostatic stones and étiopathogenic conditions could be of interest in clinical practice.

Mots clés:
Calculs prostatiques / Diversité chimique / MEB / Spectroscopie infrarouge
Mots-clés:
Prostatic calculi / Chemical diversity / SEM / FT-IR
Efficacité et tolérance des dilatations par autosondages après urétrotomie interne pour sténoses urétrales
2011
- Réf : Prog Urol, 2011, 13, 21, 955-960


Introduction



Objective

To retrospectively evaluate efficiency and tolerance of intermittent self-dilatation (ISD) after unicenter internal urethrotomy (IU) on urethral strictures (US).


Patients and methods

From January 2000 to November 2008, ISD have been performed after IU on 54 patients; 44.4% were iatrogenic. ISD median frequency was once a week (0.25–14). ISD was carried out for a median period of 8.4 months (0–97).


Results

IPSS was 21 at diagnosis vs 7 during ISD (P =0.018). QoL score of IPSS was 5 at diagnosis vs 2 during ISD (P =0.03). Maximum flow rate was 4.6mL/s at diagnosis vs 16.6mL/s during ISD (P =0.003). Ten patients had recurrence during ISD period. The follow-up from the beginning of ISD was 35 months (range, 0–164). Urologists’ evaluation of ISD tolerance was excellent or good for 47 patients (87%). Tolerance self-evaluation was excellent or good for seven patients out of 15.


Conclusion

ISD was a well-tolerated and useful option after IU. It had a 81.5% efficiency in our cohort.

Mots clés:
Sténose de l’urètre / Urétrotomie interne / Autosondage
Mots-clés:
Urethral stricture / internal urethrotomy / Intermittent self-dilatation
Élastographie en temps réel pour l'identification du cancer de prostate : comparaison d'imagerie préopératoire avec l'anatomopathologie après prostatectomie totale
2011
- Réf : Prog Urol, 2011, 13, 21, 925-931


Introduction



Introduction

Conventional grey scale ultrasound has only limited sensitivity and specificity in the detection of prostate cancer. Real time elastography is a promising modality to overcome this problem. The goal of the current study was an evaluation of real time elastography for the correct detection of prostate cancer lesions in prostatectomy specimens.


Patients and methods

Between 11/2008 and 05/2009, 28 patients diagnosed with prostate cancer and scheduled for radical prostatectomy underwent real time elastography before radical prostatectomy. Elastography was performed using a Hitachi® EUB 7500 ultrasound machine with a V53W rectal probe at 7,5MHz by one operator. During the exam, each prostate was partitioned into 12 sectors (anterior, posterior, left, right, base, middle gland, apex). Suspect zones were identified and filed depending on their localization. The prostatectomy specimens were processed according to the Stanford protocol in 3–5mm step sections. The preoperative and postoperative results regarding tumor localization were compared.


Results

In total, 88 cancer lesions could be identified in the prostatectomy specimen, where 125 sectors were positive for a total of 336 sectors evaluated. Based on elastography 134 suspicious sectors were identified. For real time elastography, the sensitivity and specificity for correct cancer identification were 73.4 and 79.0 %, respectively. The negative and positive predictive value was 83.4 and 67.4 %, respectively. Accuracy for correct identification of the tumor lesion was 76.5 %.


Conclusion

In this study, real time elastography showed high accuracy in the identification of prostate cancer lesions in the prostate. Routine use of elastography could improve the diagnosis of prostate cancer, as well as the therapeutic management.

Mots clés:
Élastographie / Temps réel / prostate / Cancer / Diagnostic
Mots-clés:
Elastography / Real time / prostate / Cancer / Diagnosis
L'hémangiome caverneux : un incidentalome rare de la surrénale
2011
- Réf : Prog Urol, 2011, 13, 21, 961-964


Introduction



The hemangioma of the adrenal gland is an adrenal gland lesion rare, benign and usually asymptomatic. Discovered incidentally during an abdominal imaging study, it is part of incidentalomas. Imagery is the best to characterise these silent adrenal masses (computed tomography [CT], Magnetic Resonance Imaging [MRI]± Positron Emission Tomography [PET scan] with 18F-FDG). The main risks of the hemangioma are ignorance of malignancy, bleeding and abdominal mass syndrome. The analysis of the literature shows the importance of laparoscopy. A multidisciplinary discussion on this type of lesion appears indispensable both diagnostic and therapeutic.

Mots clés:
Hémangiome / incidentalome / glande surrénale / laparoscopie
Mots-clés:
Hemangioma / incidentaloma / adrenal gland / Laparoscopy
Lithiase urinaire : une alerte à ne pas méconnaître
2011
- Réf : Prog Urol, 2011, 13, 21, 965-966

Mots clés:
G. / M. / O.
Mots-clés:
Hemangioma / incidentaloma / adrenal gland / Laparoscopy
Néphrectomie partielle par chirurgie conventionnelle : définir les critères de la chirurgie mini-invasive
2011
- Réf : Prog Urol, 2011, 13, 21, 917-924


Introduction



Objective

Partial nephrectomy is now recognized as the standard treatment for tumors less than 7cm. The oncological results are comparable to those obtained by total nephrectomy, while preserving kidney function. Our objective was to describe our experience and research factors associated with complications, recurrence and death.


Patients and methods

Partial nephrectomy performed in our center by June 1996 to December 2008 were reviewed retrospectively. Demographic and tumors characteristics, postoperative complications and patient outcomes were identified. Factors associated with complications and survival were investigated by regression tests.


Results

Of the 96 patients enrolled (mean age 61.4 years±12.8), 13 had renal insufficiency (serum creatinine 120 to 212μmol/L). The mean tumor size was 32mm (±13.9) and 57 (79.2%) corresponded to clear cell carcinoma. The overall rate of postoperative complications was 26%, including 8.3% of hemorrhagic complications and 3.1% of urinary complications. None of the analyzed variables were associated with the occurrence of complications. With a mean of 2 years and 9 months follow-up (±28months), eight patients (11.1%) had tumor recurrence. Multifocal tumors as well as postoperative complications were associated with risk of recurrence. Three patients with positive tumor margins were monitored with no evidence of progression (with 71, 42 and 12 months of follow-up).


Conclusion

Our single-center retrospective study of partial nephrectomy for renal tumor showed medium-term oncological results similar to those reported in the total nephrectomy with the advantage of nephron preservation. The results of studies by conventional surgery such as that we report should be a benchmark for laparoscopic surgery.

Mots clés:
cancer du rein / Néphrectomie partielle / Complications
Mots-clés:
Kidney cancer / partial nephrectomy / Complications
Orgasme après curiethérapie de prostate par implants permanents d'iode 125 pour cancer localisé de la prostate
2011
- Réf : Prog Urol, 2011, 13, 21, 932-939


Introduction



Objectives

Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer.


Patients and methods

In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43–80), participated in a mailed survey about sexual function after a mean time of 36 months (9–70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often).


Results

After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P =0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P =0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P =0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P <0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n =31) before implantation (P =0.0001).


Conclusion

Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm.

Mots clés:
Curiethérapie / prostate / Orgasme / sexualité / Éjaculation
Mots-clés:
brachytherapy / prostate / Orgasm / Sexuality / Éjaculation
Prise en charge du cancer du pénis en 2010 : rapport du forum du Comité de cancérologie de l'Association française d'urologie – organes génitaux externes (CCAFU-OGE)
2011
- Réf : Prog Urol, 2011, 13, 21, 909-916


Introduction



Introduction

Treatment of penile carcinoma, even if it is well codified, is not well known because of its rarity. The aim of this article is to report the management of penile carcinoma in 2010.


Patients and methods

This article is a summary of the forum of the Committee of Oncology of the French Association of Urology (AFU-CC), held at the Congress of the AFU.


Results

The role of the urologist is to diagnose precancerous lesions and penile carcinomas beginners to limit the risk of mutilating treatments. In case of doubt, a biopsy with orientation must be performed. The extension of the tumor is mainly based on clinical examination. Penile MRI can help to assess the depth extension. The treatment of penile tumor must be the most conservative either with surgery or brachytherapy. The risk of local recurrence, after conservative treatment, is 20 % but does not influence survival. The management of lymph nodes should be systematic, bilateral and performed at diagnosis. Tumors greater or equal to pT1b and/or grade greater or equal to 2 are at risk of lymph node extension. The staging of lymph node and distance metastase is clinical and radiological (CT and/or PET-CT 18F-FDG). The inguinal lymphadenectomy have a curative role. The type of inguinal lymphadenectomy (modified and/or total) is based on clinical examination, para-clinical and fine needle aspiration of lymph nodes. In some cases, associated pelvic lymph node dissection is recommended. The place and the type of chemotherapy remain to be defined. This treatment is based at least on the administration of cisplatin.


Conclusion

The treatment of penile carcinoma requires a local treatment of the tumor as conservative as possible. The management of inguinal lymph nodes is important because of its prognostic value. It must be made at initial diagnosis and is based on clinical and para-clinical examinations.

Mots clés:
Carcinome épidermoïde du pénis / Ganglions / Chirurgie / Curiethérapie / Chimiotherapie
Mots-clés:
Penile carcinoma / lymph node / Surgery / Brachytherapie / chemotherapy
Quelle place pour la surveillance active des petites tumeurs rénales ?
2011
- Réf : Prog Urol, 2011, 13, 21, 895-900


Introduction



Incidence of small renal masses (SRM) T1a is increasing in every age group. In relation to their characteristics, treatments seem to become less invasive. This article summarizes data about Watchful Waiting. A literature review based on Pubmed and keywords “petites masses rénales ”, “small renal masses”, “rein ”, “kidney”, “tumeur ”, “tumor”, “surveillance ”, “watchful waiting” was done. Fifty-eight english and french articles including cohort-following and meta-analysis were selected. Considering indolence and harmless of the SRM, watchful waiting is nowadays a valid therapeutic option: in most of the series is tumoral growing lower than 0.40cm per year, metastatic evolution approaches 1 to 2% (except in the Kouba et al. study with 5,7%) and disease-free survival is 100%. Nevertheless, this option seems to be appropriate after carefully selection of the patients (age, conciliance, comorbidities, imperative indications…) and the tumors (tumor size, localization, histology…). Watchful waiting is a promising alternative after selection of the SRM. Large-scale and long-term studies will precise the global cost and modalities of this therapeutic option.

Mots clés:
Cancer / Rein / Surveillance active / Petites masses / Comorbidités
Mots-clés:
Cancer / kidney / watchful waiting / Small renal masses / Comorbidities