Base bibliographique

Sommaire :

Actualités en transplantation, dysfonction érectile et cancérologie prostatique au congrès de l'AFU 2011
2012
- Réf : Prog Urol, 2012, 2, 22, 1-7
Mots clés:
T.
Mots-clés:
Vaginal apical prolapse / Rectocèle / Tension-free Vaginal Tape / Trans-ischio-anal / Biologic implant
Le cancer de la prostate résistant à la castration (CPRC) métastatique au congrès de l'AFU 2011
2012
- Réf : Prog Urol, 2012, 2, 22, 8-12
Mots clés:
T. / B. / S. / M.
Mots-clés:
Vaginal apical prolapse / Rectocèle / Tension-free Vaginal Tape / Trans-ischio-anal / Biologic implant
Cancer de la prostate de stade pT3N0 traité par prostatectomie radicale en monothérapie : résultats carcinologiques et facteurs prédictifs de récidive
2012
- Réf : Prog Urol, 2012, 2, 22, 100-105


Introduction



Objectives

To evaluate biological free survival in patients with locally advanced prostate cancer treated with radical prostatectomy (RP) as sole treatment, and to analyse predictive factors of recurrence.


Patients and method

We retrospectively studied patients treated between 1996 and 2006 for a pT3N0 prostate cancer with RP without any adjuvant treatment. The main endpoint was PSA relapse, defined as two successive elevations of PSA>0.2 ng/mL. An association between PSA free survival and PSA, Gleason score, pathological stage and surgical margins status was statistically assessed.


Results

A total of 147 patients were included. Median preoperative PSA was of 10 ng/mL. Pathological stage was pT3b in 30% of the cases and surgical margins showed cancer involvement in 63% of the cases. Gleason score was3+4 in 74% of the cases. Postoperative PSA was undetectable in 121 (82%) patients. Median follow up following RP was of 5 years. The 5-year-PSA free survival was of 48%. Multivariate analysis showed that preoperative and postoperative PSA, as well as Gleason score were predictors of PSA relapse (P <0.05). In patients with undetectable postoperative PSA, 5-year-PSA free survival was of 56%. Seminal vesicle involvement and Gleason score3+4 were the only independent predictors of PSA relapse.


Conclusions

After RP for pT3N0 prostate cancer, the only predictive factors of recurrence were postoperative PSA and Gleason score. In case of undetectable postoperative PSA, surveillance seems acceptable if Gleason score is <3+4 and in the absence of seminal vesicle involvement.

Mots clés:
Cancer de la prostate / Localement avancé / prostatectomie radicale / Survie sans récidive biologique
Mots-clés:
prostate cancer / Locally advanced / radical prostatectomy / Biological free survival
Commentaire sur article : prise en charge des patients avec sonde vésicale à demeure au long cours : enquête auprès des médecins généralistes du Limousin : E. Valgueblasse, J. Berger, A. Roux, X. Plainard, J.-P. Dumas et A. Descazeaud
2012
- Réf : Prog Urol, 2012, 2, 22, 136-137

Mots clés:
E.
Mots-clés:
Proteus syndrome / vascular malformation / bladder
Enquête CAPURO sur la qualité de vie des urologues en 2009
2012
- Réf : Prog Urol, 2012, 2, 22, 120-126


Introduction



Background

The physician’s well-being at work is more and more evaluated, but so far few studies have concerned the specialty of urology. The objective of this survey CAPURO was to explore the quality of the professional life of French urologists, to get their position about on going reforms and information about their extra professional activities.


Methods

The duration of this survey conducted in 2009 was one month with a questionnaire of 25 questions available at the AFU congress and on the Internet site www.cap-uro.com/.


Results

Two hundred and ninety-six urologists have answered the questionnaire. More than two of three urologists declared being satisfied of their work, especially private urologists. The mean duration of weekly work was 57hours with much time spent for activities not directly related to the care of patients, but judged useful to develop quality of care and evaluation of practices. Ninety percent of urologists declared not to have an easy access to the new techniques and 60% of them were interested by clinical research, but most of them didn’t have the necessary resources. They declared to be satisfied by the continuous medical training, but they affirmed lacking of help to get accreditation. Oncology, benign hyperplasias of prostate, lithiasis and endourology were the main urological specialities exercised by urologists. A majority of French urologists seemed to be very anxious about the future, mainly because of on going reforms. A few numbers of urologists had extra professional activities.


Conclusion

In 2009, French urologists who participated in the survey CAPURO were mostly satisfied or very satisfied with their conditions of practice, but with some dissatisfaction justifying a real dialogue between health authorities and professionals.

Mots clés:
Enquête / urologue / Pratique professionnelle / Formation médicale continue / Bien-être au travail
Mots-clés:
Survey / Urologist / Professional practices / Medical training / Well-being at work
Évaluation clinique et paraclinique de la maladie de Lapeyronie : place des questionnaires et du pharmaco-doppler pénien
2012
- Réf : Prog Urol, 2012, 2, 22, 113-119


Introduction



Purpose

Assessment of the Peyronie’s disease (PD) is clinical in absence of validated questionnaire or of para-clinical standardized test. The international index of erectile function (IIEF) and Lue’s score are used for the clinical evaluation. Penile dynamic duplex ultrasound (PDU) was considered in the 2010 recommendations as “useful but not necessary test”. The objective of this study was to estimate the utility of the scores and of the PDU in the diagnostic and in the therapeutic decision at the patients suffering from a PD.


Patients

Twenty-one patients were included in this forward-looking single-center study over 12 months. All the patients had a clinical examination with photos, an evaluation using the IIEF-5 and the Lue’s score and a PDU.


Results

The average age was of 57.7 years (34–77) with an average evolution duration of 38.9 months. IIEF-5 was not adapted to the assessment of the preoperative erectile function of the PD because the questions 3 to 5 were modified by the penil deformity. The result of Lue’s score did not seem to us to have interest in the therapeutic decision because it is not recommended to operate a patient in evolution. Plaques were classified according to ultrasonographic patterns : presence of hyperechoic or/and calcified lesion. The application of relevant differential ultrasound criteria turned out delicate. The PDU found abnormalities of the vascular flows for 61.9 % of the patients. Nine patients were operated and PDU modified the surgical gesture for two of them.


Conclusion

The search for objective criteria of evaluation of the PD is essential, but those currently proposed, clinical or ultrasound seemed to us a little adapted or difficult to apply.

Mots clés:
Maladie de Lapeyronie / Pharmaco-doppler pénien / Plaque fibreuse / Insuffisance érectile
Mots-clés:
Peyronie’s disease / Penile duplex ultrasonography / Erectil dysfunction / Penile induration
Hémorragie récidivante secondaire à des varices péristomiales compliquant une dérivation urinaire selon Bricker et traitée efficacement par voie endoscopique
2012
- Réf : Prog Urol, 2012, 2, 22, 127-131


Introduction



Stomal varices developed in patients with cirrhosis and enterostomy can be source of important haemorrhages. It is a rare event but often recurrent and difficult enough to treat efficiently. In certain cases, consequences can be severe. We report the case of a 63-years-old patient with medical history of hepatic cirrhosis who underwent a radical cystoprostatectomy with urinary derivation type Bricker. Five years afterwards, he developed stomal varices very haemorrhagic treated efficiently by endoscopic way, without any recurrence 12 months later. This observation shows that stomal haemorrhages can be treated by endoscopic way.

Mots clés:
Varices iléales / hémorragie / Bricker / Cirrhose / Endoscopie
Mots-clés:
Ileal varices / Bleeding / Bricker / Cirrhosis / endoscopy
Le carcinome à cellules rénales du sujet de moins de 40 ans
2012
- Réf : Prog Urol, 2012, 2, 22, 93-99


Introduction



Context

Clinical and pathological characteristics of renal cell carcinoma (RCC) of patients younger than 40 years old are not well known. The objective of this study was to analyze these characteristics by comparison to a group of patients aged 58 to 62.


Methods

Retrospective study of a group of patients aged less than 40 years old (group 1, n =44) and a group of patients aged 58 to 62 years old (group 2; n =106) treated surgically for a renal mass from January 2000 to July 2009. A comparative analysis of clinical, pathological characteristics and of cancer-specific survival was performed. Specific survival was calculated with the Kaplan-Meier method and compared with the Log-Rank test. Univariate and multivariable analysis were performed to assess and quantify the effect of age on cancer-specific survival. Covariates were gender, age group, tumor size, pT stage, histological sub-type and Fuhrman grade.


Results

Clinical and pathological characteristics were similar in both groups (P >0.05) except for histological sub-type (56% of clear cell RCC for group 1 versus 82% for group 2). In the group of patients younger than 40 years, translocation RCC represented 23% of all RCCs. Cancer-specific survival at five years was similar in both groups (80% and 76% for group 1 and 2 respectively, P >0.58). Fuhrman grade was the only independent prognostic factor of cancer-specific survival (P =0.001).


Conclusion

Patients younger than 40 years were more likely to have a translocation RCC than their older counterparts for who clear cell RCC represented the main histological sub-type. Cancer-specific survival was similar between both groups. Only a systematic specific immunostaining for TFE3 or TFEB will allow to assess the exact incidence and prognosis of this entity.

Mots clés:
Rein / Carcinome / Groupe d’âge / Translocation / TFE3
Mots-clés:
kidney / Carcinoma / Age group / Translocation / TFE3
Prise en charge des patients avec sonde vesicale à demeure au long cours : enquête auprès des médecins généralistes du Limousin
2012
- Réf : Prog Urol, 2012, 2, 22, 106-112


Introduction



Objective

To evaluate the management of patients with long-term (>1month) indwelling catheter by general practitioners (GP).


Patients and methods

A self-questionnaire was sent to 603 regional GP, between March and May 2010. It was composed of 12 multiple-choice questions and one open question, about management of their patients with indwelling catheter.


Results

Two hundred and twenty-eight self-questionnaires were analyzed: 126 (55%) from urban GP and 102 (45%) from rural GP. On average, each GP managed 1.3 patients with long term indwelling catheter (>1month). The catheters were changed by the GP, urologists, and nurses in 23.2, 23.7, and 53.1%, respectively. In a majority of cases, catheters were changed every 4weeks (59%). Nursing cares were prescribed by 64.5% of GP. Prescribed drainage bags were sterile in 42.5%. Most of GP reported to prescribe a daily change of drainage bag (56.1%). Urine analysis as performed only in case of symptomatic urine infection by 58% of respondents. Fifty percent of GP required guidelines for the management of patients with long term indwelling catheter. Rural GP managed significantly more patients with indwelling catheter, prescribed fewer sterile drainage bags, made change the drainage bag less often, and required the help of urologist less frequently.


Conclusion

Management of long term indwelling catheter was heterogeneous among GP, and varied according to rural or urban practice. Some used significantly differed from available practice guidelines. This survey could be a basis for the preparation of an informative document aimed at GP.

Mots clés:
Sonde vésicale / Long cours / Prise en charge / Médecine générale
Mots-clés:
Indwelling catheter / Long term / Management / general medicine
Traitement chirurgical de l'hyperplasie bénigne de la prostate par laser : revue de littérature du CTMH de l'AFU
2012
- Réf : Prog Urol, 2012, 2, 22, 80-86


Objectifs



Purpose

To perform an update on the surgical treatment of benign prostatic hyperplasia (BPH) by laser.


Method

A systematic review of recent literature was performed. The level of evidence of each report was evaluated, and only recent publications of high level of evidence were included.


Results and conclusions

Monopolar transurethral resection of the prostate (TURP) and open prostatectomy remain the gold standards. Alternative endoscopic options are laser photoselective vaporisation, holmium enucleation and thulium resection. These techniques seem to show functional results similar to those obtained after TURP and open prostatectomy, as well as an advantage in terms of bleeding.

Mots clés:
hypertrophie bénigne de la prostate / Résection / Vaporisation / Laser
Mots-clés:
Benign prostatic hyperplasia / Résection / Vaporisation / Laser
Traitement chirurgical de l'hyperplasie bénigne de la prostate par thermothérapie et autres techniques émergentes : revue de littérature du CTMH de l'AFU
2012
- Réf : Prog Urol, 2012, 2, 22, 87-92


Objectifs



Purpose

To perform an update on mini-invasive surgical treatment of benign prostatic hyperplasia (BPH) by thermotherapy and other emerging techniques.


Method

A systematic review of literature was performed in Pubmed database for the period running from 1980 to 2011. The level of evidence of each report was evaluated, and only recent publications of high level of evidence were included.


Results and conclusions

Monopolar transurethral resection of the prostate (TURP) and open prostatectomy remain the gold standards. Thermotherapy using transurethral microwaves or needle ablation is an alternative to medical management. Urethral stents should only be proposed in exceptional cases of surgical contra-indication, because of their related complications. Botulinium toxin and ethanol intra-prostatic injections are currently under evaluation.

Mots clés:
hypertrophie bénigne de la prostate / Radiofréquence / Toxine botulique / Éthanol / Prothèse intra-urétrale
Mots-clés:
Benign prostatic hyperplasia / Radiofrequency / Botulinium toxin / Ethanol injections / urethral stent
Traitement de l'hyperplasie bénigne de prostate par techniques endoscopiques électriques et adénomectomie voie haute : revue de littérature du CTMH de l'AFU
2012
- Réf : Prog Urol, 2012, 2, 22, 73-79


Objectif



Purpose

To perform an update on the surgical treatment of benign prostatic hyperplasia (BPH) by endoscopic electric resection and vaporization, and by open prostatectomy.


Method

A systematic review of recent literature was performed. The level of evidence of each report was evaluated, and only recent publications of high level of evidence were included.


Results and conclusions

Both monopolar transurethral resection of the prostate (TURP) and open prostatectomy remain the gold standards. Endoscopic electric alternatives are monopolar and bipolar prostate vaporisation as well as bipolar resection. These techniques seem to show similar functional results than TURP and open prostatectomy, as well as an advantage in terms of bleeding.

Mots clés:
hypertrophie bénigne de la prostate / Résection / Vaporisation / Adénomectomie
Mots-clés:
Benign prostatic hyperplasia / Résection / Vaporisation / Open prostatectomy
Une malformation vasculaire vésicale rare dans le cadre du syndrome de Protée
2012
- Réf : Prog Urol, 2012, 2, 22, 132-135


Introduction



Proteus syndrome is a rare, sporadic disorder consisting of disproportionate overgrowth of multiple tissues, vascular malformations, and connective tissue or epidermal nevi. Due to mosaic pattern of distribution, the phenotypes are variable and diverse. Vascular malformations are part of the major criteria used to define and diagnose this syndrome. It can involve the gastrointestinal tract, spleen, or the urinary tract but bladder malformations are rare. We report here a case of bladder vascular malformation in a 12-year-old boy known to have Proteus syndrome and review the literature on bladder malformations or tumors in this syndrome.

Mots clés:
Syndrome de Protée / malformation vasculaire / Vessie
Mots-clés:
Proteus syndrome / vascular malformation / bladder