Base bibliographique

Implantation du sphincter urinaire artificiel AMS 800 : la voie péno-scrotale est-elle une alternative à la voie périnéale ?
2008
- Réf : Prog Urol, 2008, 3, 18, 177-182


Introduction



Objective

To compare the short-term results of penoscrotal and perineal artificial urinary sphincter implantation.


Patients and methods

From May 2005 to February 2007, 37 artificial urinary sphincters were implanted successively, via a penoscrotal approach in 16 cases and via a perineal approach in 21 cases. Incontinence was secondary to prostate surgery (n =36) and pelvic trauma (n =1). Seventeen patients had a history of external beam radiotherapy. The times and modalities of activation of the sphincter were identical in the two groups.


Results

The mean age of the patients, the mean operating time, the mean catheterization duration, the mean hospital stay and the mean postoperative follow-up were equivalent in the two groups. Six urethral erosions (37.5%) and one scrotal erosion due to the pump (6.6%) were observed in the penoscrotal group and infection of the sphincter in two patients (9.5%) and pump migration in another two patients (9.5%), but no urethral erosions were observed in the perineal group. The success rate without revision was 56% in the penoscrotal group and 71.5% in the perineal group.


Conclusion

The perineal approach is the reference incision, as the penoscrotal approach is associated with a high rate of erosion. The penoscrotal urethral approach can constitute an alternative when the bulbar urethra cannot be used.

Mots clés:
incontinence urinaire / Sphincter urinaire artificiel / Urètre / prostatectomie radicale
Mots-clés:
Urinary incontinence / Artificial urinary sphincter / urethra / radical prostatectomy
Indications et résultats des injections intradétrusoriennes de toxine botulique type A chez l'enfant
2008
- Réf : Prog Urol, 2008, 3, 18, 168-171


Introduction



Objective

The authors report their experience of intradetrusor injections of botulinum toxin type A (TBA) in children. This treatment was deliberately limited to patients with acquired neurogenic bladder, high detrusor pressures and urinary incontinence despite anticholinergic therapy.


Material

Six children with a mean age of 11.6 years (range: five to 18 years) treated by intermittent catheterization presented an indication for intradetrusor injection of TBA. One half of these patients presented recurrent urinary tract infections. Their leak point pressure was greater than or equal to 40cmH2 O (mean: 67±33.6) and the bladder capacity of these children was less than the capacity predicted for age (mean: 68%±32.8). TBA was injected into 20 to 30 sites by cystoscopy at a dose of 12IU/kg of body weight (maximum dose: 300IU).


Results

No adverse effects were observed. Only one child still presented incontinence, but only during urinary tract infections. Four children were able to stop their anticholinergic treatment. Two months after the injection, all children had normal detrusor pressures (mean: 24.2±7.4cmH2 O). The maximum cystomanometric capacity then exceeded the predicted capacity (113%±22).


Conclusion

In acquired neurogenic bladder with detrusor hyperactivity, TBA protects the upper urinary tract (by decreasing detrusor pressures) and controls urinary incontinence (by increasing the functional bladder capacity), without preventing subsequent bladder augmentation.

Mots clés:
Adolescent / Vessie, neurogène / Toxine botulique type A / Enfant / Hypertonie musculaire
Mots-clés:
Adolescent / Bladder, neurogenic / Botulinum Toxin Type A / child / Muscle hypertonia
Les fistules vésico-utérines : une expérience de 17 ans
2008
- Réf : Prog Urol, 2008, 3, 18, 173-176


Introduction



Objective

To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment.


Materials and methods

The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects.


Results

The patients were young (29–40years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair.


Conclusion

Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.

Mots clés:
Fistule vésico-uterine / césarienne / Traitement / Prévention
Mots-clés:
Vesicouterine fistula / cesarian section / treatment / Prévention
Les médicaments de l'uretère
2008
- Réf : Prog Urol, 2008, 3, 18, 152-159


La meilleure compréhension de la physiologie du haut-appareil urinaire s’accompagne de progrès dans la connaissance des effets élémentaires sur l’uretère de différentes classes pharmacologiques. Cela aboutit à de nouvelles applications cliniques notamment dans le domaine du calcul urétéral.



Many improvements have been made recently in the field of the ureteral smooth muscle pharmacology. After a brief summary on physiological basis, we review what is known about effects on ureter of different drugs class. In a second part, we review clinical applications for renal colic analgesia, calculi expulsive medical therapy, ESWL adjuvant treatment and preoperative treatment before retrograde access. There are now sufficient data on NSAID and ⍺-blockers. β-agonists, especially for β3 selective ones, and topical drugs before retrograde access are interesting and should be further evaluated.

Mots clés:
Uretère / Calculs urétéraux / Effets des médicaments
Mots-clés:
ureter / Ureteral calculi / Drug effects
Lymphome primitif de la vessie. À propos d'un cas
2008
- Réf : Prog Urol, 2008, 3, 18, 186-189


Introduction



Lymphoma is an uncommon tumor of bladder. We report herein one case in a 58 year-old man aiming to show diagnosis and treatment difficulties in our practice. This patient had medical history of nephritic colic, haematuria and cystitis. Imagery revealed tissular mass with orange-like dimension in the right bladder corn. There was no kidney function alteration. Complete mass excision was performed and histological examination diagnosed low grade lymphoma with lymphoplasmocytary type. After chemotherapy, complete remission was obtained after 10 months follow-up.

Mots clés:
Diagnostic / lymphome / Traitement / Vessie
Mots-clés:
bladder / Diagnosis / Lymphoma / treatment
Neuromodulation des racines sacrées et sexualité
Sacral neuromodulation and sexuality
2008
- Articles originaux
- Réf : Prog Urol, 2008, 3, 18, 167

Mots clés:
X.
Mots-clés:
neuromodulation / Sacral nerve roots / urgency / Frequency / Rétention
Place de la cystectomie radicale par voie laparoscopique dans le traitement des carcinomes urothéliaux infiltrants de vessie
2008
- Réf : Prog Urol, 2008, 3, 18, 145-151


Le traitement de référence des tumeurs de vessie infiltrantes est la cystectomie radicale par laparotomie. La cystectomie permet d’obtenir un meilleur contrôle carcinologique que les traitements conservateurs [1 Zerbib M., Bouchot O. Résultats des cystectomies totales. B. Résultats carcinologiques Prog Urol 2002 ;  12 : 913-922


Radical cystectomy is the reference treatment for recurrent superficial or invasive bladder tumours. The most standardized incision is midline infra-umbilical laparotomy. The first laparoscopic cystectomy was performed in 1992 in a patient with neurogenic bladder and several teams have subsequently described this incision for the treatment of bladder tumours. The advantages of laparoscopy have been reported in terms of morbidity and earlier return to daily activities. The current oncological results of this incision are difficult to compare with those of conventional open surgery due to the insufficient follow-up. However, published series have not reported any significant difference in the intermediate term. Until convincing results become available, it therefore appears legitimate to allow teams skilled in laparoscopy to demonstrate the oncological efficacy of this approach. At the present time, the reference treatment for invasive bladder cancer remains open cystectomy.

Mots clés:
carcinome urothélial / Cystectomie / chirurgie laparoscopique / Survie
Mots-clés:
(MeSH) Urothelial cell carcinoma / Cystectomy / Laparoscopy / survival
Prise en charge d'un séminome testiculaire avec élévation de l'alpha-fœtoprotéine. À propos d'un cas
2008
- Réf : Prog Urol, 2008, 3, 18, 190-192


Introduction



The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels.

Mots clés:
séminome testiculaire / Élévation de l’alpha-f / toprotéine / AFP /
Mots-clés:
testicular seminoma / Elevation of alphafoetoprotein
Prise en charge des neurovessies de l'enfant
Management of neurogenic bladder in children
2008
- Articles originaux
- Réf : Prog Urol, 2008, 3, 18, 172


Dans cette étude clinique, portant sur six patients, âgés de cinq à 18 ans, les auteurs confirment les bons résultats chez l’enfant de l’injection intradétrusorienne de la toxine botulique A (TBA), pour améliorer significativement la compliance d’une neurovessie hyperactive, ainsi que la continence intersondage. Si les auteurs ont sélectionnés seulement les cas de neurovessies acquises, l’indication peut parfaitement s’étendre aux neurovessies congénitales comme l’ont montré différentes études référencées dans l’article.

Mots clés:
D.
Mots-clés:
Adolescent / Bladder, neurogenic / Botulinum Toxin Type A / child / Muscle hypertonia
Prostatectomie totale laparoscopique chez le greffé rénal : à propos d'un cas
2008
- Réf : Prog Urol, 2008, 3, 18, 183-185


Introduction



Despite increased screening in renal transplant recipients, the prostate cancer-renal transplantation association is not well-known. Treatment of localized forms must be curative. Total prostatectomy is performed according to the classically described incisions, either retropubic or perineal. The authors describe the technique and results of laparoscopic total prostatectomy in a renal transplant recipient.

Mots clés:
Transplantation / prostate / Cancer / prostatectomie radicale / laparoscopie
Mots-clés:
Transplantation / prostate / Cancer / radical prostatectomy / Laparoscopy
PSA et suivi après traitement du cancer de la prostate
2008
- Réf : Prog Urol, 2008, 3, 18, 137-144


Introduction



A first serum total PSA assay is recommended during the first three months after treatment. When PSA is detectable, PSA assay should be repeated three months later to confirm this elevation and to estimate the PSA doubling time (PSADT). In the absence of residual cancer, PSA becomes undetectable by the first month after total prostatectomy: less than 0.1ng/ml (or less than 0.07ng/ml) for the ultrasensitive assay method and less than 0.2ng/ml for the other methods. In the presence of residual cancer, PSA either does not become undetectable or increases after an initial undetectable period. A consensus has been reached to define recurrence as PSA greater than 0.2ng/ml confirmed on two successive assays. After external beam radiotherapy, PSA can decrease after a mean interval of one to two years to a value less than 1ng/ml (predictive of recurrence-free survival). Biochemical recurrence after radiotherapy is defined by an increase of PSA by 2ng or more above the PSA nadir, whether or not it is associated with endocrine therapy. After endocrine therapy, the PSA nadir is correlated with recurrence-free survival. PSA is decreased for a mean of 18 to 24 months followed by a rise in PSA, corresponding to hormone-independence. The time to recurrence or the time to reach the nadir and the PSA doubling time after local therapy with surgery or radiotherapy have a diagnostic value in terms of the site of recurrence, local or metastatic and a prognostic value for survival and response to complementary radiotherapy or endocrine therapy. A PSADT less than eight to 12 months is correlated with a high risk of metastatic recurrence and 10-year mortality. The histological and biochemical characteristics in favour of local recurrence are Gleason score less or equal to seven (3+4), elevation of PSA after a period greater than 12 months and PSADT greater than 10 months. In other cases, recurrence is predominantly metastatic. The risk of demonstrating metastasis in the case of biochemical recurrence after total prostatectomy and before endocrine therapy depends on the PSA level and the PSADT. No consensus has been reached concerning the indication for complementary investigations by bone scan and abdominopelvic CT in patients with biochemical recurrence after treatment of localized cancer without endocrine therapy. However, when PSADT greater than six months, the risk of metastasis is less than 3% even for PSA greater than 30ng/ml. When PSADT less than six months and PSA greater than 10ng/ml, the risk of metastasis is close to 50%.

Mots clés:
Abaissement du PSA / Définition de la récidive biologique / Modalités et rythme du dosage de PSA
Mots-clés:
Lowering of PSA / Definition of biochemical recurrence / Modalities and frequency of PSA assay
Résultats de la neuromodulation des racines sacrées postérieures sur les troubles mictionnels et impact sur la sexualité à partir d'une étude monocentrique
2008
- Réf : Prog Urol, 2008, 3, 18, 160-166


Introduction



Objective

The objective of this study was to evaluate the results of S3 sacral neuromodulation on certain voiding disorders (overactive bladder and chronic retention) and its impact on the sexuality of these patients.


Material and method

A S3 sacral root neuromodulator was implanted in 41 patients with a mean of age of 53 years between January 1999 and March 2004. This study comprised two groups: one group composed of patients with overactive bladder (32 subjects) and the other composed of patients with chronic retention without obstruction (nine subjects).


Results

The mean follow-up of this study was 34 months (range: 12 to 72 months). In the group of patients with overactive bladder, after the operation, the daily voiding frequency decreased from 20.8 to 7.8 (p <0.0001), episodes of incontinence decreased from 3.7 to 1.4 per day (p <0.0001), the number of pads decreased from 2.5 to 1 per day (p <0.001) and 72% of these patients reported an improvement of their continence time. In the group with chronic retention, the number of intermittent self-catheterizations decreased from 4.77 to 0.44 per day (p =0.0169) and 72% of these patients resumed spontaneous voiding (7/9).Among this patient population, 41.5% reported sexual problems, which were improved after implantation of the neurostimulator in 41.2% of cases.


Conclusion

In the light of these results, sacral neuromodulation appears to be an effective treatment for certain refractory chronic voiding disorders such as overactive bladder and chronic retention without obstructive syndrome. This study showed that improvement of clinical signs could have a positive impact on the sexuality of these patients, especially for patients with chronic retention without obstruction.

Mots clés:
neuromodulation / racines sacrées / impériosité / pollakiurie / Rétention
Mots-clés:
neuromodulation / Sacral nerve roots / urgency / Frequency / Rétention
Une fistule rectovésicale révélatrice d'une maladie de Crohn
2008
- Réf : Prog Urol, 2008, 3, 18, 193-195


Introduction



Introduction

Crohn’s disease is responsable of 20% of uroenteric fistulas and is the first aetiology of colovesical fistula in young patients. The authors report an unusual case of rectovesical fistula and discuss diagnosis and treatment of Crohn’s urodigestive fistulas.


Observation

A young patient, 38 years old, non smoker, was operated of a suspected bladder tumor by a transuretral approach. Postoperatively appeared a pneumaturia, later on related to a rectovesical fistula. Histology was unclear reporting inflammatory pseudotumor of the bladder. A laparotomy was then performed as the patient was in incomplete bowel occlusion. Peroperative findings and pathological analysis were in favor of a Crohn’s disease which was confirmed by secondary study of pathology samples. Resection of terminal ileum and cure of rectovesical fistula protected by a colostomy were performed. The patient completely recovered with an adjuvant medical treatment by infliximab (Remicade®).


Discussion

The authors discuss diagnosis management of a pneumaturia and the occurrence of various Crohn’s disease related urodigestive fistulas. A review of recently published papers emphasises the interest of using monoclonal antibodies in the medical treatment of Crohn’s fistulas after discarding abdominal tuberculosis. In every cases anyway, surgery remains indicated when diagnosis work up reveals presence of an abscess or a bowel stenosis.


Conclusion

Crohn’s disease should be evocated when histology is not relevant in front of a bladder pseudotumor or a rectovesical fistula.

Mots clés:
Pseudotumeur de vessie / Fistule rectovésicale / Maladie de Crohn
Mots-clés:
Bladder tumor / Rectovesical fistula / Crohn disease