Base bibliographique

Sommaire :

Absence de preuve clinique et disparité des pratiques dans la prévention de la thrombose veineuse du transplant rénal
2009
- Réf : Prog Urol, 2009, 3, 19, 191-192

Mots clés:
G.
Mots-clés:
Renal allograft / Kidney transplantation / Prophylaxis / Anticoagulants / Complications
Evidence-based medicine et étudiants en médecine français : état des lieux
2009
- Réf : Prog Urol, 2009, 3, 19, 215-220


Introduction



Introduction

Nowadays, evidence-based medicine (EBM) is essential to learn and to practice medicine. The aim of the current study was to investigate the baseline level of knowledge of French students regarding EBM.


Materials and Methods

Between April and May2008, a questionnaire was sent by e-mail to 900students in their last year of medical study.


Results

On 327 answers, 297 (91%), 94 (29%) and 85 (26%) students declared they read, write and speak medical English. Ninety (28%) read an article of a French medical review once a month and 43 (13%) read an article of an international medical review once a month. Three hundred and eleven (95%) knew the bases of medical research on the Internet and 219 (67%) used them. Twenty-four (7%) had already participated in a editorial staff of a medical article, 7 (2%) had been co-authors. Two hundred and seventy-two (83%) had made an oral presentation during a medical staff and 3 (1%) during a congress. Finally, 237 (73%) understood the interest of the critical analysis of an article at the ECN and 70 (21%) thought they were prepared.


Conclusion

The incapacity of learning EBM is one of the limits of the French medical training system. The introduction of the reading critical of an article at the ECN is the concrete beginning of an answer to this problem.

Mots clés:
Médecine fondée sur les preuves / Lecture critique d’article / Études médicales / Examen national classant
Mots-clés:
Evidence-based medicine / Medical study / National ranking exam
Faux-pas du coït et rupture urétrale complète
2009
- Réf : Prog Urol, 2009, 3, 19, 226-228


Introduction



The authors report the case of a bilateral rupture of the corpora cavernosa associated to a total disruption of the urethra resulting from blunt trauma during sexual intercourse. This association is a rare urologic case of emergency which most often take place during sexual intercourse (0.4% of the urologic cases of emergency). When both corpora cavernosa and urethra are fully disrupted, an internal penis amputation appears, compromising the vascularization and the erectional and micturitional prognosis. The rupture of the urethra is the first complication to search. Early diagnosis and surgical treatment allow a precise assessment of the lesions and a good functional result.

Mots clés:
Fracture du pénis / Traumatisme urétral / Urètre
Mots-clés:
Fracture of penis / Urethral trauma / urethra
La bourse aiguë de l'enfant : corrélations radiocliniques
2009
- Réf : Prog Urol, 2009, 3, 19, 176-185


Introduction



Paediatric surgeons and urologists are often asked to evaluate boys with acute scrotal pain and inflammation. Although, there is much aetiology for this syndrome: testicular torsion, appendicular testicular torsion, epididymo-orchitis, hernia, hydrocele, trauma, Henoch-Schonlein purpura, idiopathic scrotal edema. However, testicular torsion should be at the top of the list because of the medico legal aspects. It is the one diagnosis that must be made accurately and rapidly, if there is any hope for testicular salvage. Color Doppler ultrasound scan can reliably identify those children, who required exploration and spare medical causes. The purpose of this article is to update/review the appropriate evaluation and management of the acute scrotum and to guide the clinician in distinguishing testicular torsion from the other conditions that commonly mimic this surgical emergency.

Mots clés:
testicule / Torsion / Bourse aiguë / épididymite / Orchite
Mots-clés:
Testis / Torsion / Acute scrotum / epididymitis / Orchitis
Le schéma thérapeutique habituel de la dysfonction érectile est-il adapté après 65 ans ?
2009
- Réf : Prog Urol, 2009, 3, 19, 202-207


Introduction



Objectives

To evaluate the recommended erectile dysfunction treatment algorithm for men over age 65.


Patients and methods

Between 2004 and 2006, 334 men were treated for ED at our institution, of whom 64 were greater than 65 years old (19.2%). Medical history, ED treatments and patients’ satisfaction were reported. The first line therapy was PDE 5 inhibitors except after radical prostatectomy, followed by intracavernous injections (ICI). When conservative treatments failed, penile prosthesis was proposed. Mean follow up was 23.7 months.


Results

Mean age was 69.2 years (65–81). Aetiology of ED was organic in 85.9% (39.1% after radical pelvic surgery) and partially drug induced in 45.8%. With PDE 5 inhibitors, the mean success rate was 26.5 and 7.1% after radical pelvic surgery. Because of cost, 30.8 % of satisfied patients stopped PDE 5 inhibitors. Mean ICI success rate was 60.4% but 34.5% of satisfied men interrupted them. Finally, 14% of patients were successfully treated by PDE 5 inhibitors and 29.7% by ICI. Penile prosthesis was implanted in 12 patients (18.7%) with a mean success rate of 83.3%. No successful ED treatment was found in a third of patients.


Conclusion

PDE 5 inhibitors after 65 were found to be less successful as envisaged. This study points out the probable inadequacy between the patients’ expectations and the therapeutic options, including socioeconomic terms.

Mots clés:
dysfonction érectile / Satisfaction / Âge
Mots-clés:
impotence / erectile dysfunction / Satisfaction / Elderly / Âge
Lymphomes non hodgkiniens primitifs du testicule : pronostic à long terme associé au traitement combinant chimiothérapie systémique et intrathécale
2009
- Réf : Prog Urol, 2009, 3, 19, 209-214


Introduction



Objectives

To evaluate the long-term prognosis of a retrospective series of primitive malignant non-Hodgkin’s lymphoma (MNHL) of the testicle treated by orchidectomy and combined systemic and intrathecal chemotherapy.


Patients and methods

From 1992 to 2006, eight consecutive patients were treated for a primitive MNHL of the testicle (stages : IA [n =1], IEA [n =5], IIEA [n =1], IVEA [n =1]) and retrospectively analyzed. All of these tumors were highly malignant. The average age of the patients at the time of diagnosis was 64 years old (46–78). All the patients benefited from an enlarged orchidectomy and received a combination of systemic and intrathecal CHOP and VACP chemotherapy. Six patients finished with some locoregional radiotherapy and three had cerebral radiotherapy.


Results

Patients were treated over an average period of 90.5 months (12 to 168 months). Five patients (62.5%) responded successfully, one patient had a cerebral relapse stabilized by a second course of chemotherapy. Three patients died, one from septic shock during chemotherapy (IVEA stage), another from mesenteric infarction (IAE stage) and the third from acute coronary thrombosis while in complete remission.


Conclusion

In spite of a reputedly bleak prognosis, primitive MNHL of the testicle treated with a combination of systemic and intrathecal chemotherapy would seem to be associated with a good specific long-term survival. Unfortunately, the rate of mortality linked to chemotherapy is significant (close to 12.5% in our series) and would not appear to entirely protect against cerebral recurrence.

Mots clés:
LMNH primitif / testicule / lymphome
Mots-clés:
primitive MNHL / Testicle / Lymphoma
Ostéomyélite secondaire aux bandelettes bulbo-urétrales à ancrage osseux
2009
- Réf : Prog Urol, 2009, 3, 19, 229-230


L’article publié par l’équipe lyonnaise concernant deux cas d’ostéomyélite pubienne secondaire à l’implantation de bandelette sous-urétrale à ancrage osseux chez l’homme soulève une question sur le caractère « mini-invasif » du procédé InVance™. Il faut comprendre par « mini-invasif », une voie visant à limiter le traumatisme chirurgical, mais tout acte chirurgical, qu’il soit considéré comme « mini-invasif » ou non, présente un risque de complications et en particulier les traitements chirurgicaux de l’incontinence urinaire.

Mots clés:
P.
Mots-clés:
Fracture of penis / Urethral trauma / urethra
Parution du premier livre en français sur la cystite interstitielle
First book published in French on IC/PBS
2009
- Revue de livres
- Réf : Prog Urol, 2009, 3, 19, 231

Mots clés:
F.
Mots-clés:
Fracture of penis / Urethral trauma / urethra
Prise en charge des complications érosives après mise en place d'une bandelette sous-urétrale
2009
- Réf : Prog Urol, 2009, 3, 19, 193-201


Introduction



Objective

To describe the management of patients with an erosive complication after tension free vaginal tape. To establish a diagnostic approach, describe the results on symptoms and continence after a conservative surgery.


Methods

Retrospective descriptive study of 38 patients supported for complications after suburethral synthetic sling. We have diagnosed 12 erosions vaginal and five bladder erosions. Patients have been treated from a recovery surgery according to a conservative approach (partial resection or endoscopic section).


Results

Of the 12 patients with a vaginal erosion, 10 expressed symptoms in relation with their erosion. After partial resection, eight patients (80% of patients with symptomatic erosion) did not have more complain. Of these, 50% were continent, the other with mostly a slight recurrence accessible to a second suburethral sling. First endoscopic section was a minimally invasive option for bladder erosion. However, an only cystoscopic approach seemed to be not sufficient to cut the sling as far as possible. After section, two patients have been treated from a laparotomy with bladder dissection, one for immediate outcome unsatisfactory, the other for reccurent symptoms. The results for continence were excellent as the suburethral portion was not resected.


Conclusion

Our study showed the importance of regular clinical surveillance, feasibility and the relative success of this conservative approach. The technical feasability and the increasing number of patients must not forget to respect good indication and rigorous technique. These complications invite us to moderate our indications especially for young patients.

Mots clés:
Incontinence urinaire d’effort / Bandelette sous-urétrale / Complications / Érosion / Chirurgie
Mots-clés:
Stress urinary incontinence / Suburethral sling / Complications / Érosion / Surgery
Prise en charge thérapeutique des tumeurs de l'urètre. Recommandations du comité de cancérologie de l'Association française d'urologie
2009
- Recommandations
- Réf : Prog Urol, 2009, 3, 19, 170-175

The litterature dealing with the treatment of primary uretral carcinoma is very limited. Most of it is based on small series, case report or expert opinions. These guidelines are level IV. The treatment modality is mainly based on the lesion topography and not on the histology. For anterior T1 or 2 lesions, surgery is the most often used modality. In women, radiotherapy might be an attractive option. For more advanced lesions, the combination of radiotherapy and chemotherapy is the standard of care. The optimal protocol remains to be defined. Intradiverticular lesions in women are mainly adenocarcimoma. Surgery only is often inadequate.

Mots clés:
Urètre / Cancer / Traitement
Mots-clés:
Urethra / tumor / treatment
Quelle thromboprophylaxie après transplantation rénale ? Enquête sur la prévention des thromboses du greffon en France
2009
- Réf : Prog Urol, 2009, 3, 19, 186-191


Introduction



Objectives

Graft thrombosis is a major complication of transplantation. However, there are no recommendation on immediate postoperative thromboprophylaxis after kidney transplantation. We recorded clinical practices in France.


Material and Methods

In 29 transplantation centres, four case studies were submitted to the medical kidney transplantation referent (compatible graft from cadaveric donor, without perioperative complication). No 1: Man, 27-years-old, IgA glomerulonephritis, without history of hypercoagulability or cardiovascular risk factor. Hemodialysis since 12months. No 2: Man, 53-years-old, with history of deep venous thrombosis after cholecystectomy 15years before. Membranous nephropathy. Hemodialysis since 10months. No 3: Man, 58-years-old, with history of myocardial infarction. On aspirin therapy. Nephroangiosclerosis and diabetic nephropathy. Peritoneal dialysis since 6months. No 4: Woman, 63-years-old. Atrial fibrillation on vitamin K antagonists therapy. Lupus nephritis without antiphospholipid syndrome. Hemodialysis since 12months.


Results

No 1: No anticoagulation therapy (62%), calcium heparin at prophylactic doses (34.5%). No 2: No anticoagulation therapy (38%), calcium heparin at prophylactic doses (44.8%). No 3: 62% interrupted aspirin of whom 22% without any immediate anticoagulation and 55% replaced aspirin with calcium heparin at prophylactic doses. Thirty-eight percent carried on with aspirin of whom 63.6% without other prophylaxis and 27.3% in association with calcium heparin at prophylactic doses. No 4: Unfractionned heparin at curative dose (62%), unfractionned heparin at prophylactic doses (17.2%), calcium heparin at prophylactic doses (13.8%).


Conclusion

Postoperative anticoagulation after renal transplantation is established as a local dogma rather than evidence-based medicine. Guideline recommendations and standardized protocols for the use of anticoagulation after kidney transplantation should be developed.

Mots clés:
Transplantation rénale / greffe rénale / Thromboprophylaxie / Anticoagulation / Complications
Mots-clés:
Renal allograft / Kidney transplantation / Prophylaxis / Anticoagulants / Complications
Résultats carcinologiques et fonctionnels de la prostatectomie totale laparoscopique robot-assistée
2009
- Réf : Prog Urol, 2009, 3, 19, 158-164


Introduction



The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques.

Mots clés:
Prostatectomie totale / Chirurgie robotique / laparoscopie / Marges chirurgicales / PSA
Mots-clés:
radical prostatectomy / Robotic surgery / Laparoscopy / Surgical margins / PSA
Revue de la littérature sur l'utilisation des lasers pour le traitement de l'HBP symptomatique
2009
- Réf : Prog Urol, 2009, 3, 19, 153-157


Introduction



Even if transurethral resection of the prostate (TURP) today remains the referential surgery in the treatment of symptomatic benign prostatic hyperplasia (BPH), the last decade has seen the emergence of considerable improvements in light amplification by stimulated emission of radiation (LASER) technology. Better understanding of the interaction between the different wavelengths of these lasers and tissue has enabled the development of new and promising types of treatment. This article, through a review of published literature, attempts first of all to retrace the history of this technique in the treatment of symptomatic BPH and then goes on to give an update on results and new aspects of the different types of laser used.

Mots clés:
HBP / Laser / Chirurgie
Mots-clés:
BPH / Laser / Surgery
Spécificité de la prise en charge de la dysfonction érectile chez les sujets de plus de 65 ans
2009
- Réf : Prog Urol, 2009, 3, 19, 207-208


La dysfonction érectile (DE) est définie comme l’impossibilité d’avoir ou de maintenir une érection suffisante pour avoir un rapport satisfaisant [1 NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA, 1993;270:83–90.

Mots clés:
M.
Mots-clés:
impotence / erectile dysfunction / Satisfaction / Elderly / Âge
Traitement par laparoscopie rétropéritonéale d'un amas lithiasique intradiverticulaire caliciel symptomatique
2009
- Réf : Prog Urol, 2009, 3, 19, 221-225


Introduction



Treatment of urinary calculi in caliceal diverticular is indicated when they are symptomatic. Minimally invasive techniques, in particularly laparoscopic approach, occupy an increasingly important place in the urological therapeutic armamentarium and have changed from an open surgical approach to endoscopic treatment for the management of symptomatic caliceal diverticular calculi. Herein, we report the case of a woman with symptomatic calculi in an upper caliceal diverticular managed by retroperitoneal laparoscopic approach.

Mots clés:
Calcul / diverticule caliciel / laparoscopie / Lithiase urinaire
Mots-clés:
Caliceal diverticular / Laparoscopy / stone / Urinary lithiasis
Tumeurs primitives de l'urètre. Épidémiologie, diagnostic et anatomopathologie. Recommandations du comité de cancérologie de l'Association française d'urologie
2009
- Recommandations
- Réf : Prog Urol, 2009, 3, 19, 165-169

Primary urethral carcinomas are unusual. The most frequent histology is the epidermoid carcinoma in both sex, followed by the urothelial carcinoma in men and adenocarcinoma in women. The diagnosis is often late. It is based on a clinical examination under anesthesia and biopsies. MRI is the best imaging modality for the local stadification.

Mots clés:
Urètre / Cancer / Anatomopathologie
Mots-clés:
Urethra / Tumors / Pathology