Base bibliographique

Biopsies prostatiques ciblées guidées par IRM dans le diagnostic du cancer de prostate : revue de la littérature
2012
- Réf : Prog Urol, 2012, 15, 22, 903-912


Introduction



Introduction

Advances in MRI technology for detection of prostate cancer allow targeted biopsies of suspicious areas.


Material and methods

A systematic literature review was performed on Medline® with the keywords “targeted”, “prostate biopsy” and related articles. We studied 65 abstracts and 102 related abstracts, read 38 articles and selected 27 articles.


Results

Mental reconstruction gives way for targeted biopsies by direct MRI guidance inside the MRI, and MRI-TRUS fusion. The first option offers high precision targeting but is limited by the accessibility, cost and duration of the procedure. MRI-TRUS image fusion is a promising compromise. Cancer detection rates vary from 15 to 64 %.


Conclusion

Biopsies targeting suspicious areas on MRI are promising to improve the sensitivity and performance of prostate biopsies.

Mots clés:
Biopsie prostatique / Biopsie ciblée / IRM / Fusion échographie-IRM / Échographie endorectale
Mots-clés:
Prostate biopsy / Targeted biopsy / MRI / MRI-TRUS fusion / TRUS
Commentaire à pose d'implants UroLift ® intraprostatiques pour hyperplasie bénigne de la prostate
2012
- Réf : Prog Urol, 2012, 15, 22, 974-975

Mots clés:
T.
Mots-clés:
Malakoplakia / Michaelis-Gutman / bodies / urinary tract infection
Étiologie et traitements des plaies iatrogènes de l'uretère : analyse de la littérature
2012
- Réf : Prog Urol, 2012, 15, 22, 913-919


Introduction



Objective

Ureteric injuries (IU) are common complications occurring during abdomino-pelvic surgical procedures. Our aim was to review risk factors, treatment and methods of prevention of these iatrogenic UI.


Material and methods

A literature review in English and French by Medline® was performed using the keywords: ureter; iatrogenic; injury; ureteroscopy; morbidity and endoscopy.


Results

The analysis of the epidemiology of IU shows that the first two causes are gynecological and urological surgery. In 80% of cases, the pelvic ureter was concerned. Mechanisms of injury were essentially ligation, section and ischemia by altering the ureteral vasculature. The main risk factors found were pelvic inflammation (endometriosis, radiation…) and the occurrence of bleeding during surgery. In the presence of risk factors, placing a double J stent or a CT may be useful preoperatively. The choice of reparation technique depended on the location of the PU, the circumstances of the occurrence and experience of the surgical team.


Conclusion

Pelvic surgery is a provider of iatrogenic PU. Knowledge of the management of PU once occurred must be mastered before carrying out any risk surgery.

Mots clés:
Uretère / Iatrogène / Plaie / Urétéroscopie / Iléoplastie
Mots-clés:
ureter / Iatrogenic / Injury / ureteroscopy / Ileoplasty
Étude comparant les coûts hospitaliers de la résection monopolaire et de la vaporisation bipolaire de la prostate
2012
- Réf : Prog Urol, 2012, 15, 22, 963-969


Introduction



Objective

To evaluate and compare the hospital costs of the transurethral resection in saline plasma vaporization of the prostate (TURis-PVP) and the standard TUR of the prostate (TURP). Background: their efficiency and short terms outcomes are similar.


Patients and methods

In an observational retrospective and monocentric study, 86 consecutive patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH) were enrolled in two non randomized groups. TURP was performed in 44 cases and TURis-PVP in 42 cases. Patients with prostate cancer, urethral stenosis or bladder neck stenosis were not included. Hospital costs with a 3-month follow-up were measured using the database and hospital cost accounting system of the Medical Information Department.


Results

Patients from both series had similar preoperative characteristics concerning the age, ASA score, urologic history, and antithrombosis treatments. Catheterization period, complications and rehospitalisation rates were similar. With TURis-PVP, prostatic volume was larger (60±24mL vs. 42±16mL; P <0.05), hospital stay was shorter (4.0±2.8days vs. 4.4±2.1days; P <0.05), single-used materials costs were higher (332±64€ vs. 40±18€; P <0.05). The costs of the first hospitalization were 3721±843€ with TURis-PVP and were 3712±880€ with TURP (P =0.14). Global costs with a 3-month follow-up were 3867±1104€ with TURis-PVP and were 4074±1624€ with TURP (P =0.53).


Conclusion

In this study, the costs for the hospital are lightly higher in TURis-PVP, due to single use systems, but there is no significant difference for global costs between TURP and TURis-PVP with a 3-month follow-up difference for the health care system.

Mots clés:
Résection transurétrale de la prostate / Vaporisation bipolaire transurétrale de la prostate / hypertrophie bénigne de la prostate / étude médico-économique
Mots-clés:
Transurethral resection of the prostate / Transurethral resection (TUR) in saline plasma vaporization of the prostate / Benign prostatic enlargement / Economic evaluation
Étude de la composition des calculs urinaires en fonction de l'âge dans la population du centre tunisien
2012
- Réf : Prog Urol, 2012, 15, 22, 938-944


Introduction



Background

Studies that evaluated the effect of age and gender on the stone composition were scarce. The aim of this study was to identify the stone composition in Tunisian patients and to highlight their modification according to patients’ sex and age.


Patients and methods

We studied 1200 urolithiasic patients, from the urologic and the pediatric surgery departments, ranging from six months to 92years old and known as having urinary stones (729 males and 471 females). Stone analysis was performed respectively using a stereomicroscope and infrared spectroscopy to determine, respectively, the morphological type and the molecular composition of each.


Results

Kidney stones were encountered in 48.6% of calculi. Children and old men were more affected by bladder stone. Whewellite was the main component in 51.8% of the stones and 39.6% of the stone core, its frequency fell according to age from 61.4% in young adults to 47.7% in elderly in favor of the increase of uric acid stones, from 16.4% in young adults to 35.6% in elderly (P <0,02). Struvite stones were rare (3.2%) and more frequent in boys.


Conclusion

The analysis of these data shows that urinary stones in Tunisia were tending to evolve in the same direction as in industrialized countries.

Mots clés:
Lithiase urinaire / spectrophotométrie infrarouge / Enfant / adulte / oxalate de calcium
Mots-clés:
Urinary stone / infrared spectroscopy / children / adult / calcium oxalate
Étude qualitative de la continence urinaire après prostatectomie radicale laparoscopique
2012
- Réf : Prog Urol, 2012, 15, 22, 945-953


Introduction



Purpose

The main purpose of this study was to report urinary continence after laparoscopic radical prostatectomy (LRP) for localised prostate cancer and the return to baseline rate for urinary continence. The minor purpose was to determine the risk factors, which influence return to baseline urinary continence after radical prostatectomy.


Methods

Prospective evaluation of urinary continence with self-administered questionnaire in 300 consecutive LRP for localized prostate cancer.


Results

After LRP, at 3, 6 and 12 months, respectively 12.5%, 23% and 33.7% of patients recover baseline urinary continence. Fifty-four percent, 72.3% and 78.4% of patients did not wear pads 3, 6 and 12 months after LRP. In patients without pad, 43 % recovered baseline continence one year after radical prostatectomy. In univariate analysis, age older than 60 years (P =0.003, P =0.003, P =0.02, 3, 6 and 12 months after LRP) and no sparing of neurovascular bundles (P =0.01, P =0.08 at 3 and 6 months after LRP) were risks factors of urinary incontinence. In multivariate analysis, only age older than 60 years (P =0.018, P =0.01 and P =0.01 at 3, 6 and 12 months after LRP) was a risk factor of urinary incontinence.


Conclusion

One year after LRP, 66.3% of patients had urinary incontinence according to our evaluation using stringent criteria, i.e. return to baseline continence status. However, only 21.6% of patients wore pads and less than 2% wore more than two pads per day.

Mots clés:
cancer de prostate / Prostatectomie / C / lioscopie / continence urinaire
Mots-clés:
Prostate neoplasms / Prostatectomy / Laparoscopy / Urinary continence
Le carcinome rénal à translocation Xp11.2 de l'adulte de plus de 50 ans : à propos de quatre cas
2012
- Réf : Prog Urol, 2012, 15, 22, 932-937


Introduction



Objective

To describe demographic, therapeutic and follow-up data of four cases of renal cell carcinoma with Xp11.2 translocation in adults older than 50 years of age.


Patients and methods

Between January 2008 and December 2011, 170 patients underwent surgery for renal cell carcinoma in our center. Systematic histopathologic analysis of specimen removed was performed. Complementary immunohistochemical analysis was performed only in cases with uncertain diagnosis or in patients younger than 40 years of age.


Results

Among these 170 patients with a median age of 59years old (21–89), immunohistochemistry helped find a TFE3 translocation in four cases (2.4%). There were three women and one man of 53, 71, 75 and 86years old respectively. One patient was metastatic at diagnosis. Radical nephrectomy was first performed in all cases. TNM staging was T3aN2R0, T3bN0R0, T2N2R0 and T3aN2R2, with a Furhman grade of 4. Two patients progressed with metastasis 5 and 7months after surgery, and two with lymphatic invasion 2 and 9months after nephrectomy. One patient died during follow-up.


Conclusion

Xp11.2 translocation renal cell carcinoma was uncommon after 50years of age in our series, but probably under estimated. It seemed to be associated with a poor prognosis. Larger studies must be performed to optimize its specific treatment.

Mots clés:
cancer du rein / Carcinome rénal / Translocation / Xp11.2 / TFE3
Mots-clés:
Renal cancer / Renal carcinoma / Translocation / Xp11.2 / TFE3
Malakoplakie rénale, urétérale bilatérale et vésicale : à propos d'un cas et revue de la littérature
2012
- Réf : Prog Urol, 2012, 15, 22, 970-973


Introduction



Malakoplakia is an unusual chronic inflammation characterized macroscopically by pseudotumoral lesions and histologically by the presence of “Michaelis-Gutman” bodies in macrophages. It affects principally the urinary tract and is probably secondary to an unusual macrophagic reaction to recurrent urinary tract infections. If the bladder is the most frequent site of occurrence, the ureters can very rarely be affected resulting in urinary tract obstruction. We presented here a unique presentation of renal, bilateral ureteral and bladder malakoplakia.

Mots clés:
Malakoplakie / Corps de « Michaelis-Gutman » / infection urinaire
Mots-clés:
Malakoplakia / Michaelis-Gutman / bodies / urinary tract infection
Radiohormonothérapie dans le cancer de la prostate à haut risque : quels résultats sur une population Antillaise ?
2012
- Réf : Prog Urol, 2012, 15, 22, 954-962


Introduction



Objective

To analyze in a Caribbean population at 90% of African descent, the results of radiotherapy with androgen deprivation (AD) in high-risk prostate cancer (PCa).


Patients and methods

Fifty-nine consecutive patients with a high-risk PCa as defined by the D’AMICO classification and treated by radiotherapy with AD between January 2003 and April 2009 in our center were analyzed. The median dose of radiation and the median duration of AD were 70Gy and 37months respectively. Biochemical recurrence (BF), as primary outcome was defined according to the PHOENIX criteria (nadir PSA+2ng/mL). Multivariate analysis was performed to identify predictive factors of BF. The median follow-up was 47months.


Results

Eight (13.6%) patients had BF and four (6.8%) developed metastases. Six (10.2%) died during the follow-up. The 5years acturial biochemical disease-free survival was 79.7%. Multivariate analyses have shown that Gleason sum (GS) superior to 7 (P =0.029), AD duration less than 24months (P =0.004) and the rate of Nadir PSA greater or equal to 0.5ng/mL (P =0.011) were independent predictive factors of BF.


Conclusion

This study was the first to our knowledge, to provide that radiotherapy associate with AD for HRPC among Caribbean men is effective as observed in other populations. Patients with GS superior to 7 could be considered for more aggressive treatments in clinical trials.

Mots clés:
Cancer de la prostate / radiothérapie / Hormonothérapie / Survie / Groupe ethnique
Mots-clés:
Prostate neoplasm / radiotherapy / Androgen deprivation / survival / Ethnicity
Recommandations du comité de cancérologie de l'Association française d'urologie (CC-AFU) pour la bonne pratique des instillations endovésicales de BCG et de mytomycine C dans le traitement des tumeurs de la vessie n'envahissant pas le muscle (TVNIM)
2012
- Réf : Prog Urol, 2012, 15, 22, 920-931


Introduction



Introduction

Intravesical BCG immunotherapy and mitomycin C are considered as the standard treatment for non-muscle invasive bladder cancer. These guidelines aim to describe the optimal condition to perform intravesical instillation of BCG or mitomycin C in order to increase its oncologic efficiency and to decrease its morbidity.


Methods

Online systematic literature search was performed on PubMed® until April 2010. Regulation texts, published guidelines and results of recent urologists practice study were taken into consideration. Level of evidence was assigned to each recommendation. A bibliographic research in French and English using Medline® and Embase® with the keywords “BCG”, “mitomycin C”, “bladder”, “complication”, “toxicity”, “adverse reaction”, “prevention” and “treatment” was performed.


Results

Patient information must be prior to the first intravesical instillation and should be given through a medical exam by the physician performing the procedure. The check for formal contra-indication to BCG is systematically mandatory by the physician during the medical exam. Intravesical instillation must be realized in a health center where urologic endoscopic procedures are made frequently. A recent urine culture has to be checked systematically before any instillation done either by the urologist or a specialized nurse. Contingent upon a bladder catheter has been inserted in the bladder without any injury of the lower urinary tract, the instillation can be done. The pharmaceutical agent needs to be kept two hours in the bladder. After instillation, the patient must be seated to void and also has to keep in mind that he needs to drink at least 2 liters of water per day for 2 days.


Conclusion

To improve the oncologic performance and to reduce the risk of complication and adverse event, achievement of intravesical instillations of BCG and/or mitomycin C should follow a standardized procedure.

Mots clés:
carcinome urothélial / TVNIM / Vessie / Complications / instillations endovésicales
Mots-clés:
Urothelial carcinoma / NMIBC / bladder / Complications / prognosis