Base bibliographique

Sommaire :

Attitudes des médecins généralistes et endocrinologues face à la dysfonction érectile du patient diabétique : enquête auprès de 130 patients
2011
- Réf : Prog Urol, 2011, 2, 21, 126-133


Introduction



Objectives

To assess the prevalence, the severity and expectations regarding erectile dysfunction (ED) in diabetic patients, then to investigate how general practitioners (GP) and endocrinologists manage this disorder.


Patients and methods

A questionnaire was given during 5 weeks to every diabetic patient addressed to the endocrinology department in order to assess erectile function (IIEF5), patient’s bother and expectations to be treated, and the management of ED by GP and endocrinologists and differences in management between male and female doctors.


Results

One hundred and thirty questionnaires were available. Mean age was 57.5 and the mean IIEF5 score was 13.6. Twenty-two patients (16.9%) reported an IIEF5 score less than 5 and 75 patients (57,6%) reported an IIEF5 between 5 and 20. Eighty-six patients declared ED (66.2%). In these patients, 76 (88.4%) sought for a medical treatment and 11 (12.8%) received a treatment for ED. Endocrinologists were more active than GP in the screening of ED (59.5% vs 19.4%, P =0.001) but prescribed a treatment less often (14.3% vs 45.2%, P =0.008). Female doctors seemed less active in ED management (29.3% vs 13.3%, NS).


Conclusions

This study highlighted the lack of ED management by GT and endocrinologists in diabetic patients in spite of ED’s frequency and patients’ expectations.

Mots clés:
dysfonction érectile / diabète / IIEF5 / Médecin traitant
Mots-clés:
erectile dysfunction / Diabetes / IIEF5 / General practitioner doctor
Calculs urinaires et rein en fer à cheval : place de l'urétérorénoscopie souple-laser
2011
- Réf : Prog Urol, 2011, 2, 21, 109-113


Introduction



Objectives

We aim to assess the outcome of the flexible ureterorenoscopy (F-URS) with holmium laser in treating horseshoe kidney (HSK) stones.


Patients and methods

We reviewed retrospectively the records of 18 patients with HSK stone (18 renal units) who underwent F-URS using holmium laser from December 2004 to October 2009. The mean age was 37.7±6.9 years. The F-URS used after the extracorporeal shock wave lithotripsy (ESWL) failure in eight patients (44.4%) and four patients (22.2%) had PCNL failure. The follow up visit range were between 4 and 6 weeks with plain radiograph (KUB) and renal ultrasound or non contrast computed tomography scan (NCCT). Success rate was defined as stone free or residual fragment less than 3mm. Use of auxiliary procedures like ESWL were considered as treatment failure.


Results

Eighteen patients, three females and 15 males with mean age was 37.7±6.9 years with HSK calculi underwent ureteroscopic management. The presenting symptoms were renal colic, urinary tract infection or hematuria. We found different HSK stone location (11 mixed calyceal, three mixed pelvic and calyceal and four pelvic). The average stone burden was 15.5±7.3mm and the mean operative time was 112±9.4 minutes. All over procedures were 27, with mean average of 1.5 procedures per patient. The success rate was 89%.


Conclusion

The F-URS with holmium laser is an efficient minimal invasive procedure in treating HSK stones.

Mots clés:
Rein / Anomalie / Endoscopie / Laser
Mots-clés:
kidney / Anomaly / endoscopy / Laser
Cancer de la prostate localisé : l'IRM endorectale à 1,5 Tesla améliore-t-elle la sélection des patients en vue d'une surveillance active ?
2011
- Réf : Prog Urol, 2011, 2, 21, 114-120


Introduction



Purpose

To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French “SurAcaP” protocol.


Patients and methods

The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled “SurAcaP” protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology.


Results

85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score>6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS>1 as a predictor tool of significant tumor. (“T3MRI±NPS>1”=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion “T3MRI±NPS>1” in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the “SurAcaP” protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score>6 rates (20%).


Conclusion

Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called “T3MR±NSP>1” may represent an exclusion citeria due to its ability to predict significant tumor.

Mots clés:
Cancer / prostate / Surveillance active / IRM / Tumeur latente
Mots-clés:
prostate cancer / Active surveillance / MRI / Indolent tumor / Significant tumor
Chirurgie cancérologique et développement : refuser la fatalité, rechercher la prévention
Oncological surgery and development: To refuse fate and search for prevention
2011
- Articles originaux
- Réf : Prog Urol, 2011, 2, 21, 125


L’article de Niang et al. montre la faisabilité de la cystectomie pour tumeur de vessie localement avancée dans un pays en développement. Bien que modeste, cette série conforte l’intérêt de l’acte, pourtant difficile, faute de vraie alternative thérapeutique disponible et malgré les difficultés d’accès à des standards de soins, en l’absence de socialisation des dépenses de santé.

Mots clés:
G.
Mots-clés:
Bladder cancer locally advanced / Cystectom
Cystectomies totales pour cancers localement avancés de vessie au service d'urologie de l'hôpital général de Grand-Yoff
2011
- Réf : Prog Urol, 2011, 2, 21, 121-124


Introduction



Objective

The goals of the study is to evaluate the feasability of the total cystectomy for cancer infiltrating locally advanced of bladder and to evaluate perioperatitive morbidity and short-term results.


Patients and methods

We made a retrospective study concerning 12 first patients having profited from a total cystectomy for cancer infiltrating of the bladder in our hospital over one period of 1 year. The parameters of study were: the age at the time of the diagnosis, circumstances of the diagnosis, antecedents of the patient, the histological type and stage TNM before and after intervention, the type of derivation associated, duration of the intervention, the anesthesia, complications and morbidity per- and postoperational. We carried out calculations of average and frequency for the data analysis.


Results

The mean age was 51 years (extreme: 32; 83). They were nine men and three women. The circumstances of diagnosis were dominated by the total hematuria and in less frequency by the bladder irritative symptoms. The antecedents of the patients were dominated by the schistosomia (five cases) and the tobacco addiction (two cases). The histological type obtained in preoperative after biopsy or trans urethral resection of bladder found, seven cases of squamous cell carcinoma, four cases of transitional cell carcinoma and one case of adenocarcinoma. Into preoperative, three patients were at the stage pT2, eight patients pT3, one pT4. Four patients had a replacement of bladder: three by a bladder in Z and a patient had Camey II. They were the three patients pT2 preoperative and a patient pT3. Two patients had a standard ureterosigmoidostomy type coffey: the patient pT4 and a patient pT3. The six other patients had Bricker. All the patients profited from a blood transfusion peroperational (two units on average). We did not record any operational mortality. The complications and morbidity are represented by the suppurations of wall (three cases), the vesicocutaneous fistula (one case), the infections urinary and the anemia which was constant.


Conclusion

The management of bladder cancer poses a real problem in our countries because of the diagnosis at advanced stage.

Mots clés:
Cancer localement avancé de vessie / Cystectomie
Mots-clés:
Bladder cancer locally advanced / Cystectom
Formation et avenir des internes et chefs de clinique d'urologie en France : résultats d'une enquête nationale auprès de 154 urologues en formation
2011
- Réf : Prog Urol, 2011, 2, 21, 139-145


Introduction



Purpose

To raise an appraisal of French urologist resident and chief resident’s demographic characteristics, activity, post-residency project, career desires and factors associated with obtaining a fellowship.


Methods

An electronic questionnaire was sent by email between June 2009 and January 2010 to the 288 French urologists currently in training. Items analysed included demographics, achievement of academic works and post-residency projects.


Results

Overall, we obtained 156 answers (response rate of 54%). Our population was composed by 47 (27%) fellows and 114 (73%) residents. They work 68.1hours per week and 31 (20%) leave the hospital after an on-call night. Thirty-two (20.5%) have validated a master 2. Among the resident, 54 (47.3%) are certain to have the opportunity to be a chief resident. Regarding residents, factors significantly associated with the fact to obtain a fellowship in multivariate analysis were: to gain a master 2, working more than 65hours per week and achieving academics works. Installation in a general hospital, a university hospital and a private clinic was considered by respectively 21.7%, 41.6% and 67.3% of young urologists.


Conclusion

French urologist resident and chief resident’s work an average 68hours per week. The determining factors in obtaining a fellowship are the realization of a master 2, a workweek exceeding 68hours and the achievement of academic work. After completing their academic training, a majority of young urologists are attracted by private practice.

Mots clés:
urologie / Internat / Chef de clinique / Formation universitaire / Activité professionnelle
Mots-clés:
Urology / Residency / Fellow / Academic training / Professional activity
Lithiase urinaire et sclérose en plaques
2011
- Réf : Prog Urol, 2011, 2, 21, 102-108


Introduction



Objective

The aim of our study was to determine the nature of urinary stones and the main lithogenic process in patients with multiple sclerosis who developed secondary urolithiasis.


Patients and method

This is a retrospective study of 60 urinary stones from 49 patients with lithiasis including 30 women and 19 men. The stones have been analyzed by optical microscopy and infrared spectroscopy.


Results

Our study clearly showed the net preponderance of phosphatic stones. Urinary stones were mainly located in the upper urinary tract (2/3 of cases). A particularly high frequency of struvite was observed among these stones (65% of cases in women and 45% of cases in men), thus suggesting the main lithogenic mechanism in multiple sclerosis patients was a urinary tract infection by urea splitting-bacteria. The second lithogenic process among these patients was metabolic. The high frequency of weddellite and brushite, especially in men, suggested that mainly hypercalciuria was involved in these metabolic stones.


Conclusion

Urolithiasis in multiple sclerosis was mainly due to urinary tract infection, especially in women. Urinary tract infection related to bladder and sphincter disorders is extremely frequent and polymorphic in multiple sclerosis. Hence the importance of providing appropriate care to prevent complications of urinary tract infections and, especially, the ascending migration of microorganisms and the risk of pyelonephritis and of infectious kidney stones.

Mots clés:
sclérose en plaques / Lithiase urinaire / Calculs phosphatiques / infection urinaire
Mots-clés:
Multiple sclerosis / Urolithiasis / Phosphate stones / urinary tract infection
Nécrose vésicale dans les suites d'une instillation postopératoire précoce (Ipop) de mitomycine C
2011
- Réf : Prog Urol, 2011, 2, 21, 151-153


Introduction



Administration of intravesical chemotherapy by mitomycin C decreases the risk of recurrence in non-muscle-invasive bladder tumours. We report the case of a man, who presented a full bladder necrosis after an immediate adjuvant mitomycin C instillation. The failure of resection of the necrotic area led us to perform a total cystectomy with an intestinal reconstruction. A review of the literature showed four other cases of necrosis of the bladder or of lower urinary tract. In all cases the rules of early instillation were observed.

Mots clés:
Instillation postopératoire précoce / Ipop / Mitomycine / Nécrose vésicale / Cancer de vessie
Mots-clés:
Immediate post-operative instillation / Mitomycine / Bladder necrosis / bladder cancer
Prolapsus vaginal. Comment l'IRM pelvienne dynamique vient-elle compléter l'examen clinique ?
2011
- Réf : Prog Urol, 2011, 2, 21, 93-101


Introduction



Objective

We wanted to study the role of dynamic pelvic MRI (D-MRI) in the surgical management of patients with genito-urinary prolapse.


Patients

A routine D-MRI examination before and after laparoscopic double promontofixation was performed in 15 cases with symptomatic vaginal prolapse in need of surgical treatment. The review included also three self-administered questionnaires of symptoms and quality of life. We compared the preoperative clinical evaluation of the studied cases with D-MRI data. Changes after the surgical treatment were also studied.


Results

The D-MRI provides an accurate diagnostic evaluation of the pelvis, which is both objective and reproducible. The correlation between clinical scores and radiological magnetic resonance was 53.3% only. In cases with absence of previous pelvic surgery, there was a radio-clinical discrepancy of 40% of cases, while in cases with history of a previous pelvic surgery we found a discrepancy of 60% of cases. This was due to clinical difficulty in differentiating between peritoneocele and rectocele, or due to under-diagnosis of complex prolapse. The sensitivity of MRI in the diagnosis of cystocele, hysterocele and rectocele were respectively 100, 100 and 83%. The gain in sensitivity provided by the MRI was significant for the diagnosis of peritoneocele: 100% against 33%. The specificity was 100%. Static images allowed a detailed study of damaged connective tissues and pelvic muscles.


Conclusion

The D-MRI seems an appropriate tool in pre-operative assessment of cases with vaginal prolapse. It will help in focusing our surgical strategy, especially in cases that present post-hysterectomy and in cases with residual or recurrent prolapse.

Mots clés:
prolapsus vaginal / IRM pelvienne dynamique / Promontofixation laparoscopique
Mots-clés:
vaginal prolapse / Dynamic MRI / Laparoscopic sacrocolpopexy
Résultats préliminaires d'une nouvelle technique de recueil du sperme vésical en présence d'éjaculation rétrograde réfractaire au traitement médical
2011
- Réf : Prog Urol, 2011, 2, 21, 134-138


Introduction



Aims

To describe and evaluate a novel technique of spermatozoa retrieval from patients suffering from infertility secondary to refractory retrograde ejaculation.


Method

Prospective study to compare mobility and vitality of spermatozoa obtained from urine (U) after oral modification of chemical parameter (PH, Osmolarity) versus from endovesical instillation of sterile spermatozoa culture medium before ejaculation (F). Patients were their own controls. Twelve month prospective follow-up was achieved to document the results of assisted procreation.


Results

Eight patients were included and mobility and vitality were improved in all patients after F technique was compared to U technique. With U technique, eight patients on eight had negative defrost test; after F technique, seven patients on eight had a positive defrost test and could therefore have access to assisted reproduction techniques. Four couples had five ICSI and obtained three pregnancies leading to five births.


Conclusion

Endovesical instillation of sterile spermatozoa culture medium before ejaculation was a safe and effective technique to improve spermatozoa quality in male infertility related to refractory retrograde ejaculation.

Mots clés:
Infertilité masculine / éjaculation rétrograde / Anejaculation / sperme / Vessie
Mots-clés:
Infertility / retrograde ejaculation / Anejaculation / Sperm / bladder
Thérapie photodynamique et cancer de la prostate
2011
- Réf : Prog Urol, 2011, 2, 21, 85-92


Introduction



Purpose

Photodynamic therapy (PDT) is an innovative therapeutic modality in urologic oncology.


Material and methods

We reviewed the current literature on principles and modalities of PDT in prostatic oncology.


Results

Focal therapy of prostate cancer is an application field of PDT. Clinical phase II studies are ongoing to determine PDT efficacy and safety in this indication. PDT as salvage treatment after prostatic radiotherapy has been tested. Carcinologic results were promising but important side effects were reported. Individual dosimetric planification is necessary to avoid this toxicity.


Conclusion

PDT first clinical experience for prostate cancer has showed its technical feasibility. Several research ways are currently in study to improve carcinologic efficacy and to limit potential side effects.

Mots clés:
Thérapie photodynamique / urologie / prostate / Cancer
Mots-clés:
Photodynamic therapy / prostate / Cancer
Urétéroscopie souple et mini néphrolithotomie percutanée dans le traitement des calculs pyélo-caliciels inférieurs ou égaux à 2 cm
2011
- Réf : Prog Urol, 2011, 2, 21, 79-84


Introduction



Purpose

Compare, in a retrospective study, the indications, the efficiency and the morbidity of the flexible ureteroscopy (URS) and the mini percutaneous nephrolithotomy (mini-perc) for the treatment of the renal lithiasis less or equal to 2cm.


Materials and methods

One hundred and forty-four operated patients: 101 by “mini-perc” and 43 by URS. Pre-, per- and post-operative data prospectively entered in a computerized database.


Results

URS and “mini-perc” groups were comparable in terms of age (49.2±14 years versus 51.7±16 years; P =0.37) and of size of the lithiasis (8.5±3.2mm versus 8.9±2.7mm, P =0.4). However, the number of lithiasis was more important in URS group (2.7±141.6 versus 1.3±0.38; P <0.05). The operating time was 59±32.6min in URS and 48±28.3min “mini-perc” group (P =0.05). The peroperating complication rate was 2% for URS (a false passage during the introduction of the access girdle) and null in the “mini-perc” group. The hospitalization was 1.49±11.4 days after URS and of 4.1±1.2 days after “mini-perc” (P <0.05). The duration of ureter drainage by stent was respectively 13.8±11.5 and 2.6±1.2 days (P <0.05). One month later, the treatment was effective in 88% of cases in the URS group whereas 93% in “mini-perc” group (P =0.17). Six patients (14%) need complementary treatment for residual lithiasis in the URS group and four (3.9%) in the “mini-perc” group.


Conclusion

The “mini-perc” and the URS are two effective techniques for the treatment of the renal lithiasies less or equal to 2cm. For the two groups, the complication rates were low and the length of hospital stay was short.

Mots clés:
Calculs pyélo-calicielles / Calculs / Mini-perc / néphrolithotomie percutanée / Urétéro-rénoscopie souple
Mots-clés:
Nephrolitiasis / stone / Mini-perc / percutaneous nephrolithotomy / Flexible ureteroscopy
Urothorax : complication rare d'une valve de l'urètre postérieur sectionnée en période néonatale
2011
- Réf : Prog Urol, 2011, 2, 21, 146-150


Introduction



We report a newborn aged 19 days, carrying a posterior urethral valve antenatal screening in which developed 7 days after the entire section of the valve, a compressive urinothorax in connection with a perirenal urinoma. Pleural and bladder drainage has a surrender of effusions and a healing of the renal parenchyma. The thoracic urine effusion is a very rare complication of a posterior urethral valve with perirenal urinoma. This probably results from a rupture of a fornix dysplastic by hypertension of the urinary tract. The authors emphasize the unusual discovery of this disease by breathing problems and his delayed character after resection of the obstruction in the neonatal period.

Mots clés:
Valve de l’urètre postérieur / nouveau-né / complication / Urothorax
Mots-clés:
Posterior urethral valve / Newborn / complication / Urinothorax
Vers une nouvelle frontière ?
2011
- Réf : Prog Urol, 2011, 2, 21, 154-155


L’urologie tire pour une bonne part son caractère attractif des frontières multiples avec d’autres spécialités, telles que la néphrologie, l’immunologie, la génétique, la gynécologie, l’endocrinologie et la neurologie, pour n’en citer que quelques-unes.


Mots clés:
cancer de prostate / recherche fondamentale / Santé publique / dépistage
Mots-clés:
prostate cancer / basic research / Public health / Screening
Comment améliorer les résultats de la chirurgie du cancer de prostate ?
2011
- Réf : Prog Urol, 2011, 2, 21, S7, suppl. S1


Le dilemme du T3



This work summarizes the highlights of the satellite symposium of the seventh edition of the European Robotic Urology Symposium. Treatment options of T3 prostate cancer were discussed, including the results of the Tap 032 study. In this phase III study, 264 patients with locally advanced prostate cancer were randomized to be treated by leuproreline 11,25 mg for 3 years alone or radiotherapy plus leuproreline 11,25 mg for 3 years. The median of disease free survival (Phoenix definition : PSA nadir + 2 ng/ml) was significantly longer in the group of patients treated with the combined treatment (6,96 years vs 3,46 years, p = 0,0005). No statistical difference was observed in specific survival (93,2% vs 86,1%, p = 0,11). In the second part of the satellite symposium, perioperative, oncological, and functional outcomes of laparoscopic robotic-assisted radical prostatectomy were presented, as well as today and future developments of robotic surgery.

Mots clés:
Leuproreline / Cancer de prostate localement avancé / radiothérapie / Robotique / Prostatectomie
Mots-clés:
Leuproreline / locally advanced prostate cancer / radiotherapy / Robotic / Prostatectomy
L'essentiel du congrès de l'ERUS 2010
2011
- Réf : Prog Urol, 2011, 2, 21, S1, suppl. S1


Introduction



This work summarizes the highlights of what was presented at the seventh edition of the European Robotic Urology Symposium meeting which took place in Bordeaux, France, from September 29 to October 1, 2010. Future developments of robotic surgery and training in robotic were discussed. Robotic assisted laparoscopic radical prostatectomy was largely discussed. The use of robotic in renal and bladder surgery was also developed. The congress contained update lectures, debates, live cases transmission of robotic surgery, and poster and video communications.

Mots clés:
cancer de prostate / Prostatectomie / Cancer de vessie / Néphrectomie / Robotique
Mots-clés:
prostate cancer / Prostatectomy / bladder cancer / nephrectomy / Robotic