Base bibliographique

Cancer de la prostate : aspects médicoéconomiques
2010
- Réf : Prog Urol, 2010, 2, 20, 85-90


Introduction



Prostate cancer is the first cancer in men. Its incidence is constantly increasing. The significant evolution of diagnostic and therapeutic means during the two last decades contrasts with the scarcity of medicoeconomic studies. The aim of this review is to present a synthesis of the different studies published and to respond to questions about the economic aspects of this disease, with the evaluation of its direct and indirect costs. The cost-effectiveness and the benefits of the prevention and the screening are still being studied. The costs of the surgery and the radiotherapy are roughly similar. The new surgical techniques, especially the laparoscopic and the robotic surgeries, are not necessarily associated with higher costs, in condition of a high-volume laparoscopic surgery program and a faster discharge. The indirect costs of prostate cancer concern the loss of economic production associated with the disease and death and are more difficult to determine.

Mots clés:
Cancer de la prostate / Aspects économiques / Santé publique / Couts
Mots-clés:
prostate cancer / Economic aspects / Public health / Costs
Cancer de la prostate et hormonothérapie : indications thérapeutiques de première ligne
2010
- Réf : Prog Urol, 2010, 2, 20, 109-115


Introduction



The utilization of androgen deprivation therapy in prostate cancer has evolved over time. Unquestionably considered first line treatment in metastatic cancers or in case of lymph node involvement, it is increasingly used in locally advanced and high-risk cancers, combined with radiation therapy. However, the practical modalities of treatment are still controversial (neoadjuvant, concomitant/adjuvant) and should be discussed on a case-by-case basis, taking into account tumor stage and risk level, which depends mainly on Gleason score and PSA levels and kinetics. Hormone therapy is also indicated in case of systemic relapse, especially if PSA doubling time is less than 12 months. LHRH agonists have become the standard care; antiandrogens can be added at the beginning of the LHRH agonist therapy to obtain a complete androgen blockade. Intermittent androgen deprivation therapy has recently proved efficacious and might be more widely used in the future, provided that strict prescription and follow-up recommendations are clearly established.

Mots clés:
Cancer de la prostate / Hormonothérapie / Analogues GnRH / Association hormonothérapie/radiothérapie / Traitement intermittent
Mots-clés:
prostate cancer / Androgen deprivation / LHRH agonists / Combined treatment / Intermittent androgen blockade
Facteurs prédictifs et résultats carcinologiques à long terme des patients n'ayant plus de tumeur résiduelle (stade pT0) sur la pièce de cystectomie totale réalisée pour cancer de vessie
2010
- Réf : Prog Urol, 2010, 2, 20, 130-137


Introduction



Aim

The aim of our study was to evaluate predictive factors and long-term carcinogenic results for patients who had had a total cystectomy for cancer of the bladder and whose final histological results did not show evidence of a residual tumor.


Patients and methods

From 1988 to 2002, 192 patients had a total cystectomy for a bladder tumor. No residual tumor (pT0) was evident in the specimens of cystectomy of 22 patients (11.5%). None of the patients had distant metastasis or ganglions at the time of the initial examination.


Results

Predictive factors for having no residual tumors based on the specimen of cystectomy (pT0) were an antecedent of neo-adjuvant chemotherapy (p =0.0079), an interval between the resection of the bladder and the cystectomy of more than 12 weeks (p =0.0014) and a resection of the initial bladder considered complete (p =0.0036). The average treatment of these 22 patients was 70±46 months. During treatment, two patients (9%) had a recurrence in the pelvis and 10 patients died including one from the development of his cancer of the bladder. Global, specific and non-recurrence survival at five years were 75%, 100% and 94%, respectively. We revealed better specific survival (p =0.0007) and without relapse (p <0.0001) in patients who no longer had a tumor on the specimen of cystectomy (pT0) compared with patients who had a residual tumor (pT+) but with no difference in global survival (p =0.0574).


Conclusion

The absence of residual tumors (pT0) on a specimen of total cystectomy for cancer of the bladder was a good factor for prognosis regarding long-term survival even if tumor development was observed. Complete resection and neo-adjuvant chemotherapy probably played a beneficial role in the future of these patients.

Mots clés:
Cancer / Vessie / PT0 / Survie
Mots-clés:
Cancer / bladder / PT0 / survival
IRM et cancer prostatique : mesure de la cinétique du gadolinium avec un système CAD
2010
- Réf : Prog Urol, 2010, 2, 20, 121-129


Introduction



Objectives

To assess with a CAD in the peripheral (ZP) and transitional (ZT) zones the areas with modifications of the kinetic parameter Kep (ratio of exchanges between vascular compartment and extravascular extracellular spaces) in prostatic cancers with DCE MRI before radical prostatectomy.


Methods

Forty-two consecutive patients (mean age 67 years, mean PSA: 8.9ng/ml) with a prostatic cancer proved after a set of 12 biopsies underwent, before radical prostatectomy, a dynamic MRI (1.5T) with a surface coil after injection of gadolinium. We look with a CAD for foci of voxels with an abnormal Kep in ZP and/or in ZT. Foci of abnormal voxels computerized were compared with histological results of radical prostatectomies: prostates were shared in 12 sectors (six peripheral and six central) and a total of 504 sectors were studied. The links between prostatic capsule and foci of voxels with elevated Kep were systematically evaluated. The location and the local extension of the various cancerous foci were estimated. A comparison with the results of the T2W and T1 DCE MRI sequences without use of the CAD was made.


Results

Eighty-eight percent of investigated patients revealed at least a cancerous focus associated with a group of pathological voxels. Hundred and seventy-eight of the 504 investigated prostatic sectors revealed a cancerous lesion after radical prostatectomy (RP) and 116 a focus of voxels with a pathological Kep being linked to 71 isolated lesions, some of them filling several sectors (47 peripheral and 24 transitional). The automatic research with the software of foci of voxels with a parameter Kep more than 2,2 per minute to detect a cancerous lesion had a sensitivity by sector less than the reading without CAD (69% in ZP and 58% in ZT against respectively, 85 and 66% (p <0.01) but seemed more specific: 98% in PZ and 95% in ZT against respectively, 80 and 82% (p <0.01). After RP, 16 cancers were classified Pt2, 10 Pt2R+ and 16 Pt3. The CAD had a better accuracy (74%) than T2W MRI (60%) to look for an extracapsular extension (EPE) or a risk of positive margins: 86% of extraprostatic extension and 60% of positive margins were near a focus of pathological voxels.


Conclusions

CAD allowed a computerized qualitative and quantitative study of DCE MRI. It identified and localized with a good specificity the significant foci. A focus of voxels with elevated Kep against the capsule increased significantly the risk of an extraprostatic extension or a positive margin after radical prostatectomy.

Mots clés:
IRM / prostate / Cancer / Diagnostic / Quantification
Mots-clés:
MRI / prostate / Cancer / Diagnosis / Quantification
Le kyste hydatique du rein chez l'enfant : étude rétrospective de dix cas
2010
- Réf : Prog Urol, 2010, 2, 20, 144-147


Introduction



Introduction

The hydatid cyst disease of the kidney is rare in children, it ranks third among the liver and the lung.


Material

We report a series of 10 pediatric case of hydatid cyst of the kidney, managed in the department of surgery pediatric of Rabat, betwen 1990 and 2008.


Results

The median age was 9 years (4–15 years). The clinical presentation was pain (7 cases) and/or abdominal mass (6 cases). Diagnostic accuracy has been improved since the wide use of ultrasonography in eight cases. In all cases, the resection of the prominent dome was usually sufficient.


Conclusion

In the light of these 10 observations, the ultrasonography may be sufficient and the surgical conservative treatment is still necessary.

Mots clés:
kyste hydatique / Rein / Enfant
Mots-clés:
hydatid cyst / kidney / child
Physiopathologie et prise en charge de la maladie de La Peyronie
2010
- Réf : Prog Urol, 2010, 2, 20, 91-100


Introduction



Peyronie’s disease (PD) is due to a fibrotic plaque forms in the tunica albuginea layer of the penis. It is responsible of penile pain, angulation, and erectile dysfunction. Even though the aetiology remains unknown, the knowledge of the pathophysiology has evolved in recent years. Recent studies indicate that PD has prevalence of 3 to 9% in adult men. During the initial acute phase (6 to 18months), the condition may progress, stabilize or regress in 20%. Therefore, a conservative treatment approach has been advocated. An initial discussion about evaluation, information, and reassurance is necessary in most cases. The most commonly employed oral therapies include tocopherol (vitamin E), and para-aminobenzoate (Potaba), which have failed to demonstrate efficiency. Intralesional injection therapies with interferon alpha-2B, verapamil are frequently used as a first-line treatment modality, and can provide an improvement in decreasing penile pain and penile curvature. Current literature has shown that extracorporeal shock wave lithotripsy was only active on the pain. Regarding penile curvature, there are discrepancies in the published series. The surgical approach is restricted to men unresponsive to nonoperative therapies (i.e., 10% of patients). In such cases, plication, grafting or even penile prosthesis implantation are conceivable management options.

Mots clés:
maladie de La Peyronie / Injection intralésionnelle / Vérapamil / Excision de plaque / Greffe dermique
Mots-clés:
Peyronie’s disease / Intralesional injection / Vérapamil / Plaque excision / Dermal graft
Prise en charge de la lithiase sur rein transplanté
2010
- Réf : Prog Urol, 2010, 2, 20, 138-143


Introduction



Introduction

Urolithiasis in kidney transplants is rare but not exceptional (0,20–3%). Dealing with it is complex: abstention, lithotripsy or surgery? The aim of this study is to find out what can be done about it.


Method

A retrospective study about 420 kidney transplants performed in our institution between 1990 et 2005 revealed nine cases of lithiasis. Among the factors leading to lithiasis were urinary flow obstruction in six cases and hyperparathyroidy in three cases.


Results

Five grafts with calculi whose diameter do not exceed 5mm were kept under medical supervision. Two of them were in chronic rejection without residual diuresis. Extra shockwawe lithotripsy was performed for a 13mm diameter calical calculi. Two percutaneous extraction were performed: one for a 20mm diameter “pyelic” calculi and one for three kidney stones and among them one was 12mm. A 20mm calculi was extracted by open pyelotomy during the repairing of the ureteral anastomosys on a Bricker diversion.


Conclusion

Consequently, dealing with calculi on kidney transplants is similar to dealing with a unique native kidney.

Mots clés:
Rein / Transplantation / Calcul / Traitement
Mots-clés:
Renal transplantation / Calculi / treatment
Prostatectomie radicale laparoscopique chez la personne âgée (> 75 ans) : résultats carcinologiques et fonctionnels
2010
- Réf : Prog Urol, 2010, 2, 20, 116-120


Introduction



Objective

Prostate cancer incidence increases with age. Radical prostatectomy (RP) seems to be feasible for elderly well-selected patients. We report our experience with patients older than 75 years old who underwent laparoscopic RP.


Methods

From 2000 to 2007, 22 patients older than 75 years old at time of surgery were included in the study. The patient clinical characteristics, the peri- and postoperative data, and the pathological data were collected retrospectively. The overall, specific and PSA-free survival were analysed with Kaplan–Meier method. The functional results such as continence and erectile function were assessed by self-questionnaires.


Results

The mean patient age was 75 years (75–81), the median PSA level was 10.77ng/ml (5–30). The mean American Society of Anesthesiologists score was 2.1 (2–3). Two (9%) perioperative complications occurred but no conversion was necessary. Five patients (23%) had a pT3 disease and the overall positive surgical margins rate was 14%. With a median follow-up of 42months, no patient has died and five had a biochemical recurrence. At 12-month follow-up, 82% of patients were continent (no pad) and potency (erection sufficient for intercourse) rate was 36% with or without the use of phosphodiesterase-5 inhibitors.


Conclusion

Laparoscopic RP is feasible for localized prostate cancer in elderly well-selected patients with satisfactory oncological and functional outcomes although the incontinence rate is increased comparing to younger patients.

Mots clés:
prostatectomie radicale / Âge / / 75 ans / laparoscopie
Mots-clés:
radical prostatectomy / Elderly / Laparoscopy
PSA et spironolactone
2010
- Réf : Prog Urol, 2010, 2, 20, 154-157


Introduction



The spironolactone is a diuretic of potassium savings. It is also used in the treatment of the hirsutism for its antiandrogenic action. Its use and its effects on the patients affected by a prostate cancer are less known. We report the case of a 72-year-old man having a cancer of prostate which normalized its PSA after institution of a treatment by spironolactone for ascites. This patient had a biological recurrence of a prostate cancer, arisen 7 years later after a treatment by hormonal radiotherapy. Nine months after the implementation of the treatment by spironolactone, there were no clinical and biological signs of disease progress.

Mots clés:
Spironolactone / Action anti-androgénique / Cancer prostate / Normalisation PSA
Mots-clés:
Spironolactone / Antiandrogenic effects / prostate cancer / PSA normalization
Recommandations de bonnes pratiques cliniques : l'antibioprophylaxie en chirurgie urologique, par le Comité d'infectiologie de l'association française d'urologie (CIAFU)
2010
- Réf : Prog Urol, 2010, 2, 20, 101-108


Les infections nosocomiales et l’antibioprophylaxie sont un problème majeur de santé publique, notamment en urologie. En 2008, une enquête sur les pratiques de l’antibioprophylaxie chirurgicale en urologie a été réalisée par le Comité d’infectiologie de l’association française d’urologie (CIAFU). Les principaux points de cette enquête ont été les suivants :


The French Association of anesthesiology (SFAR) has published in 1999 the Antibiotic prophylaxis guidelines . Antibiotic resistance has increased and new procedures appeared so new recommendations were needed. We present the antibiotic prophylaxis guidelines from the committee of infectious diseases of the French Association of Urology.

Mots clés:
Infection / Antibioprophylaxis / Chirurgie
Mots-clés:
Infection / Antibiotic prophylaxy / Surgery
Réparation d'un épispadias compliquée d'un diverticule de l'urètre avec calcul
2010
- Réf : Prog Urol, 2010, 2, 20, 158-160


Introduction



Diverticula of the male urethra are rare clinical entities. Congenital and acquired have similar modes of presentation. No case of urethral diverticulum, containing stone, complicating epispadias repair have been reported. We report the case of 8-year-old boy with an urethral diverticulum, containing stone, complicating epispadias repair. Diverticulectomy with removal of the stone by urethroplasty was performed. Through this observation and review of the literature, authors describe pathological and management finding of urethral diverticula.

Mots clés:
Diverticule de l’urètre / Épispadias / Calcul / Enfant
Mots-clés:
Urethral diverticulum / Épispadias / stone / child
Rôle de l'échographie translabiale dans la prise en charge des troubles urinaires du bas appareil compliquant la mise en place d'une bandelette sous-urétrale
2010
- Réf : Prog Urol, 2010, 2, 20, 148-153


Introduction



Objective

To assess the role of the introital ultrasound in the evaluation of patients with low urinary tract symptoms after sling placement.


Material and method

From 2000 till 2007, a total of 31 patients underwent sub-urethral tape placement for a stress urinary incontinence and developed thereafter a low urinary tract symptoms. The urological evaluation consisted of a detailed medical history, a urogynecologic examination, a complete urodynamic exam, a measurement of the postvoiding residue and a introital ultrasound. All patients filled the mesure du handicap urinaire (MHU) questionnaire. These patients had a transvaginal tape lysis under local anesthesia. We correlated the ultrasound findings with postoperative clinical success and failure.


Results

Thirty-one patients with low urinary tract symptoms secondary to sling placement underwent a tape lysis. Median age was 63.1±10.9 years, the median time between the anti-incontinence surgery and the tape lysis was 21.5±16.2 months. Seven patients had only obstructive symptoms, 15 patients had obstructive and bladder overactivity symptoms and nine patients had bladder overactivity symptoms. Introital ultrasound revealed an abnormality of the tape in 26 patients. Ten patients had a position abnormality of the tape, five patients had urethral angulation abnormality and 11 patients had the previous two abnormalities. After tape lysis, the obstructive symptoms disappeared in 19 out of 22 patients (86%), the bladder overactivity symptoms disappeared in 16 out of 24 patients (66%). In case of introital ultrasound abnormalities, the tape lysis was efficient in 23 out of 26 patients (89%), while in the absence of ultrasound abnormalities (five patients), the tape lysis was not useful in treating LUTS in all patients.


Conclusion

Ultrasonography is a useful tool in investigating postoperative low urinary tract symptoms and in the selection of patients who will benefit from tape lysis.

Mots clés:
Bandelette sous-urétrale / TUBA / hyperactivité vésicale / Obstruction sous-vésicale
Mots-clés:
Sub-urethral sling / LUTS / Bladder overactivity / Obstruction