Base bibliographique

Sommaire :

Bifidité pyélo-urétérale et sténose de la jonction pyélo-urétérale
Pyelo-ureteral bifidity and stenosis of pyelo-ureteral junction
2010
- Cas cliniques
- Réf : Prog Urol, 2010, 3, 20, 238


Cystectomie radicale cœlioscopique pour cancer de vessie, chez les sujets de plus de 70 ans : faisabilité et étude de la morbidité
2010
- Réf : Prog Urol, 2010, 3, 20, 204-209




 


Objectives

To evaluate the feasibility and morbidity and mortality of laparoscopic radical cystectomy for bladder cancer in elderly patients.


Methods

Prospective study conducted between January 2003 and May 2009 in 22 patients, one woman and 21 men, who underwent laparoscopic radical cystectomy for bladder cancer. Mean patient age was 76.2±4.3 years. The median preoperative ASA score was 2 (1–3). The indication for surgery was an invasive muscle bladder tumour in 18 cases and noninvasive muscle bladder cancer refractory to conservative treatment (chemotherapy, immunotherapy) in four cases. Ileal conduit was carried out in 15 cases. An ileal neobladder was fashioned in six cases using Camey’s technique. One bilateral cutaneous ureterostomy was performed.


Results

There was one conversion to open surgery. One intraoperative complication was noted (left obturator nerve injury). Mean blood loss was 377.5±341.2ml. No perioperative death was observed. Mean time to resumption of oral fluids was 2.4±1.6 days and mean time to resumption of solids was 4.5±1.6 days. Mean time to resumption of bowel movements was 3.9±1.9 days. Mean critical care unit was 4.2±1.4 days. Five patients (22.7 %) had postoperative complications. Postoperative narcotic analgesics were necessary in 60 % of cases. Mean hospital stay was 11.0±3.0 days. Mean patient follow-up was 46.4±20.8 months.


Conclusions

Laparoscopic radical cystectomy for bladder cancer in elderly patients is associated with low morbidity, and a limited hospital stay.

Dysfonction érectile après prostatectomie totale : controverses et consensus
2010
- Réf : Prog Urol, 2010, 3, 20, 182-183




 

Dysfonction érectile après prostatectomie totale : physiopathologie, évaluation et traitement
2010
- Réf : Prog Urol, 2010, 3, 20, 172-182




 


Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erectile dysfunction (ED) in selected series is still reported as high as 80% after this surgery. Patient selection and surgical technique (i.e., preservation of neurovascular bundles) are the major determinants of postoperative ED. Pharmacological treatment of postoperative ED, using either oral or local approaches, is effective and safe. Thus, most men need adjuvant treatments to be sexually active following RP. These include intracorporeal injections of vasoactive drugs, vacuum constriction devices and transurethral dilators, all of which have reported response rates of 50 to 70%. Unfortunately, long-term compliance is sub-optimal, with a discontinuation rate of nearly 50% at 1year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy (IPDE5) since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections is the gold standard for partients over 60years old and those who underwent non-sparing surgery. In younger patients and/or when preservation of nerve tissue was feasible, oral IPDE5 may be effective in promoting an earlier return of erectile function. Recent studies have shown that pharmacological prophylaxis early after RP can significantly improve the rate of erectile function recovery after surgery. Use of on-demand treatments for treatment of ED in patients subjected to RP has been shown to be highly effective, especially in cases of properly selected young patients treated with a bilateral nerve-sparing approach by experienced urologists.

Dysfonction érectile et cellules endothéliales caverneuses
2010
- Réf : Prog Urol, 2010, 3, 20, 188-193




 


The physiopathology of erectile dysfunction (ED) is multifactorial. The recent discovery of the precise role of cavernosal endothelium in the functional regulation of the smooth muscle cells allowed to understand the physiological bases of erection. The purpose of this article is to make a synthesis of the current knowledge on the endothelial function and to allow a better understanding of the pathological responsible mechanisms of ED. Endothelium provides cavernosal smooth muscle cells relaxation by two main pathways: the NO/cGMP pathway induced by production of neural nitric oxide (NO) in cavernosal nerve terminals, and the AC/cAMP pathway which by-passes the NO route by using other mediators. This action allows the initiation and maintenance of erection. Risk factor-associated cavernosal endothelial alterations (diabetes mellitus, hypertension, hypercholesterolemia) are mostly induced by unifying mechanisms, including oxidative stress and accumulation of reactive oxygen species, alteration of NO production, or decrease of VEGF expression. The same cellular mechanisms can also be observed during aging. To a comprehensive appraisal of physiological bases of viable endothelium in erectile function, it is crucial to understand its biological activities. The hemodynamic evaluation of endothelial function and the current therapeutic implications will be later approached.

La sténose du pyélon supérieur : complication rare d'une bifidité urétérale. Enquête embryologique
2010
- Réf : Prog Urol, 2010, 3, 20, 233-237




 


A stenosis of the upper pole of an incomplete renal duplication is presented. The prenatal diagnosis of a right renal ureteropyelic junction syndrome, isolated, with a normal amniotic liquid was confirmed at birth. Intravenous pyelogram 8 days after birth showed three right dilated calical groups with a dilated renal ureteropyelic junction, but an normal inferior calical group suspected a renal bifidity. Renal MagIII scintigraphy evaluated the anatomical and functional stenosis and indicated surgery. Postoperative followings were simple and results good 3 years after. From this rare case, embryogenesis is discussed.

Le profil des urgences urologiques au CHU de Conakry, Guinée
2010
- Réf : Prog Urol, 2010, 3, 20, 214-218




 


Objective

To stick out the profil urological emergencies at the Conakry University Teaching Hospital, Guinea.


Patients and methods

This retrospective study, carried out over a period of 3 years (January 2005–December 2007), included 757 urological emergencies admitted to the urology department of the university hospital of Conakry, Guinea.


Results

The mean age of patients was 56 years. These patients had an age equal to or higher than 60 years in 58% of the cases. The sex ratio (M/F) was 16.6. According to the social profession, the farmer (40,6%) and workers (21%) were the dominant patients. The most frequent illness was vesical urinary retention (73.9%), hematuria (9.6%) and genito-urinary system trauma (7%). The most performed procedures were the installation of a urethral catheter (55.25%) and the installation of a suprapubic catheter (24.14%).


Conclusion

The most frequent urological emergency in our country was vesical urinary retention, the hematuria and genito-urinary system trauma are not rare there.

Les fistules rénocoliques post-traumatiques : à propos d'une observation
2010
- Réf : Prog Urol, 2010, 3, 20, 230-232




 


The renocolic fistula is a rare entity, which has occurred exceptionally in a traumatic not iatrogenic context, we report a case of renocolic fistula complicating penetrating abdominal trauma from a gunshot.

Place de l'embolisation artérielle percutanée en pathologie rénale
2010
- Réf : Prog Urol, 2010, 3, 20, 161-171




 


Therapeutic embolization in renal pathology is used for various conditions in cancerology, traumatology, urology, nephrology and for iatrogenic complications of percutaneous manoeuvers. Any department of vascular radiology may be requested to use this technique, especially in emergent traumatology or palliative cancerology. The authors study the various conditions that may benefit from these procedures and give the highlights of the main indications and the main types of embolic agents used. Complications, side effects and the major precautions are also reviewed.

Place de l'urétéroscopie dans le traitement de la lithiase chez l'enfant
2010
- Réf : Prog Urol, 2010, 3, 20, 224-229




 


Objective

To determine the efficiency and the role of ureteroscopy in the treatment of urolithiasis in children.


Methods

A multicenter retrospective study was conducted between January 2006 and March 2008 in the department of pediatric surgery and urology of Besançon, Lyon and Grenoble. The clinical data of 17 children having benefited from one or more ureteroscopy procedures for urolithiasis were analyzed. These data concerned age, sex, antecedents of metabolic diseases, existence of a malformed uropathy, how the urolithiasis was discovered, therapeutic indications, endoscopic procedures, type of endoscopic treatment for urolithiasis, results and complications.


Results

Twenty-six ureteroscopies were carried out for 17 children (eight girls and nine boys) aged between 9 months and 12 years (mean: 5 ½ years old) as a first-line treatment or after extracorporeal shock wave lithotripsy. A 6/7,5 Fr semi-rigid ureteroscope was used in all case. Only once, the operator chose a flexible ureteroscope. Lithotripsy was carried out 15 times with YAG Holmium laser, four times with Swiss Lithoclast® and six times by simple extraction with a Dormia® type basket .A stent probe was left in place after endoscopy for 14 children. The “stone free” rate was 88% with an average hindsight of 11 months. Two incidents without major complication were recorded: a section of the guide by the laser beam and a perforation with extravasation of the contrast agent.


Conclusion

Ureteroscopy is the first-line treatment in isolated ureteral urolithiasis. On the other hand, LEC remains the treatment of choice for Starghon calculi, since LIC should be offered only in the event of failure of LEC.

Pyéloplastie pour syndrome de la jonction pyélo-urétérale chez l'enfant : voie lombo-assistée versus lombotomie
2010
- Réf : Prog Urol, 2010, 3, 20, 219-223




 


Surgical treatment of pyelo-ureteric junction syndromes was classically at the child’s, a pyeloplasty by posterior way or by lombotomy. For several years, assisted video techniques are proposed for this gesture. The purpose of our study was to compare the lombo-assisted pyeloplasty procedure with the lombotomy procedure, within the framework of this coverage. We made a retrospective study of procedures performed from January 2000 to December 2005, based on a file review of children operated for pyelo-ureteric junction syndrome. Children under the age of 2 years were excluded. Fifty-two children were divided in 2 groups: group 1: 24 children, 7 girls and 17 boys, average age of 86 months (extremes: 27–172) benefited from a lombo-assisted pyeloplasty. Group 2: 28 children, 12 girls and 16 boys, average age of 69 months (extremes: 24–129) benefited from a pyeloplasty by lombotomy. Operating times were significantly shorter in opened surgery than with the lombo-assisted procedure. There was no significant difference in terms of per- or post-operating complication, use of analgesic and hospitalization duration. On the other hand, the lombo-assisted procedure provided the same undisputable aesthetic benefit and the same muscular preservation than pure lomboscopy procedure. As a consequence, this procedure could be set up at no risk for the patient, even if it had lead to longer operating times. However, operating times stayed shorter than with the pure lomboscopy or the celioscopy procedures, compared to the literature.

Recommandations de bonnes pratiques cliniques : diagnostic et traitement des uréthrites aiguës non compliquées de l'homme, par le comité d'infectiologie de l'Association française d'urologie (CIAFU)
2010
- Réf : Prog Urol, 2010, 3, 20, 184-187




 


Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.

Tumeurs rénales complexes sur rein unique : résultats de la chirurgie partielle ex vivo avec autotransplantation
2010
- Réf : Prog Urol, 2010, 3, 20, 194-203




 


Objective

To analyze the complications and the oncologic and functional results after ex vivo surgery and autotransplantation for the treatment of complex renal tumors.


Material and method

From 1996 to 2009, 11 patients, mean age 54.8 years, underwent ex vivo nephron-sparing surgery and autotransplantation for malignant complex renal tumors (centrorenal or hilar topography) on an anatomic or functional solitary kidney. Three patients (27.2 %) were treated for a metastatic disease.


Results

Mean operative time was 340minutes (240–440) and mean ischemia time was 162minutes (110–231). Five patients (45.4 %) needed peroperative blood transfusion. Mean hospital stay was 21.5 days (8–50). Eight patients (72.7 %) suffered complications: two urinary fistulas, two early vascular thrombosis leading to nephrectomy and permanent dialysis, two pneumopathies and four acute tubular necrosis leading to temporary dialysis. There was no death among patients in early postoperative period. Tumors TNM staging ranged from pT1 to pT3aN0. Surgical positive margins were observed in three cases (27.2 %). With a mean follow-up of 37.8 months (3–144), the mean MDRD creatinine clearance was of 45.4ml/min/1.73m2 and four patients (36.4 %) were presenting a complete remission. We observed two local recurrences (18.2 %) and five metastatic evolutions (45.4 %) leading to two deaths (18.2 %).


Conclusion

Ex vivo nephron-sparing surgery was an acceptable option in the treatment of complex renal tumors for imperative indications, when in situ surgery appeared to be technically unfeasible. Despite a significative morbidity, long-term functional results were satisfying.

Validation en langue française du questionnaire « Ureteric Stent Symptom Questionnaire » (USSQ)
2010
- Réf : Prog Urol, 2010, 3, 20, 210-213




 


Purpose

Translation and linguistic validation of the French version of the Ureteral Stent Symptom Questionnaire (USSQ).


Materials and methods

A double-back translation of the original Ureteral Stent Symptom Questionnaire was performed. First, two urologists translated the English version in French. Then a first consensus meeting between the translators and a group composed with three urologists, one general practitioner and two nurses was achieved. Back-translation of this version was then done by professional translators (Nagpal, Paris) to ensure that no distortion was detected between the two questionnaires. Finally, a pilot test followed by an interview was carried out among two men and two women who had an indwelling ureteral stent.


Results

The consensus version is attached to the article. No difficulties were reported by the pilot population to comprehend or to complete this USSQ French version.


Conclusion

This USSQ version – attached to the article – makes it possible for researchers among a French population to use this validated and internationally recognized tool that provides reproducible and measurable endpoints on tolerance of ureteral stents.