Base bibliographique

Sommaire :

L'essentiel du Congrès de l'AFU 2012
2013
- Réf : Prog Urol, 2013, 2, 23, 1-5
Mots clés:
J. / A.
Mots-clés:
Female urinary incontinence / Sphincter insufficiency / ACT / device
Quelles nouveautés dans la prise en charge de l'hyperplasie bénigne de la prostate ?
2013
- Réf : Prog Urol, 2013, 2, 23, 6-12
Mots clés:
J. / G. / F. / P. / A.
Mots-clés:
Female urinary incontinence / Sphincter insufficiency / ACT / device
Cicatrice de radiofréquence rénale : corrélations anatomopathologiques-tomodensitométriques chez le porc. Applications pratiques pour le suivi en imagerie
2013
- Réf : Prog Urol, 2013, 2, 23, 105-112


Introduction



Purpose

To analyze the changes in vicinal kidney parenchyma after percutaneous RFA.


Materials et methods

Twenty-four CT-guided RFA procedures were performed on six pigs using 2cm LeVeen coaxial needles. We studied volume, morphology, cavitation and enhancement of the ablation zones (AZ) before and after the procedure on contrast-injected CT-scans. The kidneys were removed four weeks later and studied in the path lab.


Results

All the procedures were successfully completed. Four weeks later, the CT-scans showed AZ that were either clearly circumscribed or with unclear borders, heterogenous areas associating necrosis and infarct tissue and mesenchyma showing a process of apoptosis around the edges. A treatment considered as incomplete on the CT-scan (presenting as an enhancement) was always associated with necrosis on the histology slides, although the necrotic areas behaved in various different ways on the CT-scan after injection of contrast medium: an enhancement of more than 10HU did not mean that no necrotic tissue was present.


Conclusion

RFA causes heterogenous tissue changes, associating necrotic and ischemic zones and an apoptotic reaction. The mechanisms of these changes and their therapeutic significance should be studied. CT-scans performed immediately after RFA procedure and one month later are not predictive of the efficacy of the treatment because an enhancement of the AZ does not mean that it is not necrotic. The value of a CT-scan performed one month after the procedure is debatable, because the tissue remodeling that occurs in the kidneys is not definitive at this time-point.

Mots clés:
Radiofréquence / scanner / Anatomopathologie / Traitement ablatif
Mots-clés:
Radiofrequency / CT-scans / pathology / Ablation techniques
Impact à long terme des complications chirurgicales sur la survie du transplant rénal
2013
- Réf : Prog Urol, 2013, 2, 23, 113-120


Introduction



Objective

To determine the incidence of surgical complications of renal transplantation at one institution, relate this to donor and recipient factors and to long-term graft survival.


Patients and methods

A consecutive series of 145 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Barry-Sarramon anastomosis was the most used method of ureteric reimplantation. Lich-Gregoir anastomosis was used in 28.9% of cases. The mean follow-up time was 14.4±6.23 years.


Results

There were 67 surgical complications including ten vascular, 39 urological and 18 parietal complications. Among urological complications, 13 were urinary leaks, four distal ureteric necrosis, 13 symptomatic ureteric reflux, six primary ureteric obstructions, and one ureteric stone at some time after transplantation. The overall incidence of urological complications was 26.2%. There was no association with recipient or donor age, cold ischaemic times before organ reimplantation, dialysis duration before transplantation, operating times, or ureteric stenting. Overall surgical complications had a significant pejorative impact on graft survival (Hazard Ratio [HR]=1.805; P =0.32), but as we studied them separately, we highlighted that in fact only vascular complications had an impact on long-term graft survival (HR=17.442, P <5E-10). There was no association between urological (P =0.566) or parietal (P =0.797) complications and long-term graft outcome.


Conclusion

The onset of a urological or a parietal complication had no impact in this series on long-term graft survival. Vascular complications dramatically increase the rate of graft loss.

Mots clés:
Transplantation rénale / Complications chirurgicales / Survie du transplant
Mots-clés:
Renal transplantation / Surgical complications / Graft survival
Impact de l'âge au diagnostic sur le devenir à long terme des patients opérés de valves de l'urètre postérieur
2013
- Réf : Prog Urol, 2013, 2, 23, 144-149


Introduction



Purpose

Posterior urethral valves (PUV) diagnosed during childhood have classically been associated with a better outcome than antenatally diagnosed PUV. The aim of our study was to compare long-term outcome of these two patients’ groups.


Material and methods

We retrospectively reviewed the medical records of boys with PUV managed between 1990 and 2010. Patient demographics, clinical background, radiographic data (including prenatal ultrasonography data when available), renal and bladder functional outcomes, surgical procedures and urinary tract infections (UTI) were abstracted. Impaired renal function (IRF) was defined as glomerular filtration rate less than 90mL/min/1.73m2 at last follow-up.


Results

We identified 69 patients with confirmed PUV. Thirty-eight were diagnosed prenatally (group 1) at 30.5weeks of gestation and 31 had a delayed diagnosis (group 2) at a median age of 6.31years. At diagnosis, 20 patients in group 1 had renal insufficiency versus two in group 2 (P <0.05). At the end of mean follow-up of 7.2±0.5years, in group 1, 26.3% developed IRF versus 6.3% in group 2 (mean follow-up 2.3years). Mean age at last follow-up was 7.3years in group 1 versus 8.3 in group 2 (P >0.05). In group 1, 27% had voiding dysfunction versus 30% in group 2 (NS). In group 1, 35% had UTI during follow-up versus 10% (P =0.01).


Conclusion

During the follow-up, the patients with delayed diagnosis VUP have developed fewer complications related to the initial obstruction than the population who was detected antenatally and managed from the early hours of life. However, the rate of IRF and voiding disorders in our study, associated with the data of the literature, highlights the potential persistence and worsening of these conditions. That is why, whatever the age at diagnosis, VUP patients require a close monitoring.

Mots clés:
Valves de l’urètre postérieur / Maladie rénale chronique / Diagnostic anténatal
Mots-clés:
Posterior urethral valves / Chronic renal disease / Antenatal diagnosis
Le score PCA3 et l'IRM prostatique permettent-ils de sélectionner les patients candidats a une première série de biopsies prostatiques ?
2013
- Réf : Prog Urol, 2013, 2, 23, 121-127


Introduction

Determinate if the adjunction of PCA3 score and/or prostatic MRI can improve the selection of the patients who have an indication of first prostate biopsy.


Patients and methods

Multiparametric prostatic MRI and PCA3 score were made before biopsy to men scheduled for initial prostate biopsy for abnormal digital rectal examination and/or PSA superior to 4ng/mL. T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced imaging looked for suspect target classified on a scale of four. It was a prospective, single centre study. The diagnostic accuracy of PCA3 score and MRI was to evaluate in comparison with biopsy results.


Results

Sixty-eight patients were included, median PSA was 5.2ng/mL (3.2–28). Negative predictive value (NPV) of MRI score 0, 1 and 2 were respectively 80%, 43% and 69%. Positive predictive value (PPV) of MRI score 3 and 4 were 50% and 81%. The PCA3 cutoff with best accuracy was 21 (Se: 0.91; Sp: 0.50). Only one patient with positive biopsy (0.5mm of Gleason score 3+3) had negative MRI and PCA3 inferior to 21.


Conclusion

MRI and PCA3 score in association allowed, in this study, to consider reduction of unnecessary initial biopsy without ignoring potential aggressive tumor.

Mots clés:
Biopsie / cancer de prostate / PCA3 / IRM / Diagnostic initial
Mots-clés:
Biopsy / prostate cancer / PCA3 / MRI / Initial diagnosis
Mise au point sur la mutation FGFR3 et le phénotype épigénétique MRES dans la carcinogenèse vésicale
2013
- Réf : Prog Urol, 2013, 2, 23, 96-98


Introduction



FGFR3 mutation leads to a constitutive activation of the receptor 3 to Fibroblast Growth Factor. This mutation is early in urothelial carcinogenesis and is strongly associated to low grade papillary tumors. MRES epigenetic phenotype corresponds to the transcriptional inactivation of chromosomal regions in muscle invasive bladder cancer, and is strongly associated to the molecular signature of carcinoma in situ. These alterations could be targeted by new specific therapies.

Mots clés:
carcinome urothélial / Mutation / / Épigénétique /
Mots-clés:
Urothelial carcinoma of the bladder / / Mutation / Epigenetic /
Photovaporisation prostatique avec le laser KTP chez les patients sous traitement antithrombotique. À propos d'une étude rétrospective sur 120 cas
2013
- Réf : Prog Urol, 2013, 2, 23, 137-143


Introduction



Antithrombotic (AT) medications are more and more prescribed, so complicating the surgery of benign prostatic hyperplasia (BPH). KTP laser is an alternative to the transurethral resection of the prostate thanks to its haemostatic properties.


Objectives

To study the functional outcomes and complications of KTP 80W laser treatment in patients taking AT, comparing with patients without AT (nAT).


Patients and methods

A single-center retrospective study has been conducted in the department of Urology of Nice Teaching Hospital, in patients with uncomplicated symptomatic BPH, treated with the KTP 80W laser treatment, between November 2005 and October 2009. The cohort was divided into two matched groups AT/nAT. In the AT group patients, treatment with aspirin and vitamin K antagonist (VKA) were maintained, whereas clopidogrel was discontinued. The urinary flowmetry, measurement of residual urine, International Prostate Symptom Score (IPSS) and question 8 of the IPSS score were analyzed. The duration of intervention, the amount of laser energy delivered, duration of catheterization and postoperative hospitalization, and the rate of blood transfusion have been evaluated. Clavien classification was used to characterize the postoperative complications.


Results

A total of 120 patients were included in two groups (50 AT/70 nAT), with a median follow-up of 24months. The two study groups were comparable except for age which was significantly higher in patients on AT (P =0.001). The average duration of operation, of catheterization and hospital stay were significantly longer in patients receiving AT. Seven complications were reported in the AT group versus three complications in the nAT. No significant difference was reported on the evaluation of voiding parameters and IPSS score.


Conclusion

Photovaporisation of the prostate using KTP 80W laser treatment provided functional outcomes comparable in patients on AT and untreated patients, with minimal risk of complication.

Mots clés:
hyperplasie bénigne de la prostate / Traitement antithrombotique / Antiagrégant plaquettaire / Antivitamine K / Laser KTP
Mots-clés:
Benign prostatic hyperplasia / Antithrombotic medications / Antiplatelet / Antivitamin K / KTP laser
Résultats de la radiothérapie de rattrapage pour récidive biologique après prostatectomie radicale dans la population africaine-caribéene de la Guadeloupe
2013
- Réf : Prog Urol, 2013, 2, 23, 128-136


Introduction



Objectives

To make the first analysis of the salvage radiotherapy outcomes for biochemical recurrence of prostate cancer after radical prostatectomy in African descendant people, witch has no healthcare access difficulties: the French West-Indies African-Caribbean people of Guadeloupe.


Patients and method

Ninety successive patients, with biological failure after radical prostatectomies were treated in the University Hospital of Pointe-à-Pitre with salvage radiotherapy between April 2003 and December 2008. The retrospective study analysed the biochemical disease free survival (bDFs) after irradiation with Kaplan-Meier method, and the independent predictors of bDFs using the Cox model, with P <0.05. The treatment failure was defined for PSA superior or equal to nadir +0.1ng/mL.


Results

The median dose was 64Gy. At the median follow-up of 24.63months, 35 (38.9%) patients had biochemical recurrence. The median bDFs was 55.3months, the bDFs probabilities at months 12, 24, 36 and 48 were 8.1%, 70.3%, 61.9% and 56.1%. Multivariate analysis determined that the independents predictors of treatment failure were the seminals vesicles invasion (P =0.0094, Hazard ratio=2.63 CI 95%: [1.28–5.55]), the PSA velocity superior or equal to 0.75ng/mL per year (P =0.0002, Hazard ratio=3.88 CI95%: [1.86–7.75]) and the pre-irradiation PSA level superior or equal to 1.5ng/mL (P =0.0093, Hazard ratio=2.89 CI95%: [1.30–6.45]).


Conclusion

Salvage radiotherapy for African descendent people with no healthcare difficulty access was an efficient treatment for the biochemical recurrence and had the same outcomes than others Caucasian people.

Mots clés:
Cancer prostate / Récidive biologique / Radiothérapie de rattrapage / Africain-américain / Guadeloupe
Mots-clés:
prostate cancer / Biochemical recurrence / Salvage radiotherapy / Race / African-American
Rupture traumatique du col vésical chez l'enfant
2013
- Réf : Prog Urol, 2013, 2, 23, 150-152


Introduction



Transverse rupture of the bladder neck injury is rare in children. We report a new case in a 10-month boy with urinary peritonitis. Diagnosis was intraoperative. Surgical treatment in emergency with urethrovesical anastomosis protected by a perivesical drain and a large-bore urinary catheter was performed without urogenital complication.

Mots clés:
Anastomose vésico-urétrale / Rupture traumatique du col vésical
Mots-clés:
Rupture bladder neck injury / Urethrovesical anastomosis
Syndrome métabolique et insulinorésistance chez les patients atteints de cancer de la prostate traités par suppression androgénique hormonale
2013
- Réf : Prog Urol, 2013, 2, 23, 88-95


Introduction



Introduction and objectives

Androgen suppression in prostate cancer is responsible for many side effects. Many studies, mostly retrospective, have found an association between androgen deprivation and increased cardiovascular morbidity. If the cardiovascular impact was chosen, an etiological explanation would be the occurrence of metabolic disorders, particularly insulin resistance. The objective of our work was to conduct a review of the literature assessing the impact of androgen deprivation on the onset of insulin resistance, the metabolic syndrome and changes in key markers of insulin resistance.


Materials and methods

A systematic review of literature from the Pubmed database search was performed using the following keywords: androgen deprivation therapy, metabolic syndrome, insulin resistance, hyperglycemia, cardiovascular diseases, cardiovascular risk, abdominal obesity.


Results

Twelve studies were included, bringing into focus a 55% prevalence of metabolic syndrome in patients treated for more than 12months, an increase in fat mass and decreased lean body mass, an increase in abdominal subcutaneous fat and in visceral adiposity. The insulin was increased in four studies (25 to 60% three months dice). The increased insulin resistance was assessed by the Homeostasis Model Assessment (HOMA) was postponed three times (12% in two prospective cohort studies of type). The increase in triglycerides (20 to 40% at 12months) and total cholesterol (7 to 11%) was observed in five studies, and increased LDL cholesterol and HDL in three studies (9 to 22%).


Conclusion

All studies of this analysis appeared to converge towards the development of insulin resistance and metabolic disorders, however, no prospective cohort study of good methodological quality were identified. It would be necessary to conduct a prospective multicenter study in order to have a causal quality.

Mots clés:
Suppression androgénique / Insulinorésistance / Syndrome métabolique / Hormonothérapie / Risque cardiovasculaire
Mots-clés:
Androgen deprivation therapy / Metabolic syndrome / Insulin resistance / prostate cancer / Hyperglycemia
Traitement d'une tumeur rénale et préservation néphronique impérative : étude comparative des données périopératoires et des résultats à moyen terme de la néphrectomie partielle et de la radiofréquence
2013
- Réf : Prog Urol, 2013, 2, 23, 99-104


Introduction



Objective

To compare morbidity, oncological and functional outcomes of percutaneous radiofrequency ablation (RFA) and partial nephrectomy in indications of renal tumor treatment with imperative nephron-sparing procedure.


Patients and methods

Between January 2005 and December 2010, 50 consecutive patients were referred in our center for NP or RFA for a renal tumor with either a renal function impairment defined as estimated glomerular filtration (eGFR) less than 60mL/min/1.73m2, and/or solitary kidney and/or bilateral tumors. Perioperative outcomes were compared.


Results

Thirty-six PN and 14 RFA were performed. RFA patients were older (79.2 vs. 62.5years old), had a higher ASA score (3 vs. 2), a lower RENAL score (6 vs. 7.5) and a lower rate of tumor on solitary kidney or bilateral tumors (P =0.009). Overall complications (29.4% vs. 6.3%), transfusions (20.6% vs. 0) and longer hospital stay (9 vs. 3days) were more likely to occur in the NP group. During a median follow-up of 22months (4.3–53.7), eGFR decrease was similar between the two groups (P =0.34). On multivariate analysis, PN was associated with an increased occurrence of overall complications (OR=14.09, P =0.02) but with a similar eGFR decrease. No patient died.


Conclusion

For patients with an indication of treatment of renal tumor and imperative nephron-sparing procedure, RFA seems to provide low morbidity and comparable functional outcomes as partial nephrectomy. Our limited follow-up does not permit to conclude on oncologic data.

Mots clés:
cancer du rein / Néphrectomie partielle / Radiofréquence / Complications
Mots-clés:
Renal cancer / partial nephrectomy / radiofrequency ablation / Complications
Traitement de l'hyperplasie bénigne de prostate par photovaporisation au laser Greenlight ® : analyse de la littérature
2013
- Réf : Prog Urol, 2013, 2, 23, 77-87


Introduction



Introduction

Transurethral resection of the prostate (TURP) is the most common surgical procedure in urology and remains the gold standard treatment of complicated benign prostatic hyperplasia or refractory to medical treatment. Routinely used since the 2000s, prostate photoselective vaporization (PVP) with Greenlight® laser has been developed to improve the safety of hemostasis in elderly patients and/or with high surgical risk. The purpose of this study was to review the results of PVP from the international literature.


Materiel and methods

A systematic review of the literature on the research base Pubmed (www.ncbi.nlm.nih.gov/) was performed using the keywords benign prostatic hyperplasia; greenlight; photovaporisation; Laser; IPSS score; endoscopicsurgery; morbidity; complication. Prospective and retrospective studies in English and French were selected from its first use in 1998. Finally, we looked for studies that reported at least one of the following items: surgical technique; operative data; complications; anatomical and functional results and/or direct comparison between PVP and TURP.


Results

Regardless the PVP technique used to treat adenoma and identify the limits of the prostatic capsule, some parameters are well defined (sweepspeed, angle and distance of the fiber with the tissue) but others are still debated (number of joules per volume, when do we have to stop the PVP) and are reported in a heterogeneous manner due to the different generators. Versus TURP, PVP would offer the same functional results in the medium term but with a lower risk of per- and postoperative bleeding. The study of the risk of erectile dysfunction (ED) after PVP is made difficult due to the heterogeneity of DE assessment and study populations. However, PVP does not seem associated with an increased risk of ED versus TURP. The lack of histological material should lead to preoperative individual screening of prostate. The economy generated by PVP regarding the decrease in average length of stay has been clearly identified in Australia, Canada, Switzerland and USA. Studies will be published soon on French economic model.


Conclusion

PVP with Greenlight® laser appears to be a safe and effective technique. With the new generator XPS, the PVP technique reaches maturity. Its development will certainly lead to a long-term evaluation with high levels of evidence based.

Mots clés:
Hypertrophie de la prostate / Laser / score IPSS / chirurgie endoscopique / morbidité
Mots-clés:
Benign prostate hypertrophy / Laser / IPSS score / endoscopic surgery / Morbidity