Base bibliographique

Editorial Board
2008
- Réf : Prog Urol, 2008, 4, 18, iii


Adénocarcinome prostatique en récidive locale après radiothérapie exclusive : résultats du traitement par ultrasons focalisés
2008
- Réf : Prog Urol, 2008, 4, 18, 223-229




 


Objectives

To determine the efficacy and adverse effects of high intensity focused ultrasound (HIFU) for the treatment of local recurrence of prostate cancer after exclusive external beam radiotherapy.


Material and methods

Seventy-two patients with histologically and biologically documented local recurrence after radiotherapy were treated by HIFU. The mean age was 68.27±5.93 years, and mean PSA was 6.64±7.26ng/ml. Thirty patients were treated according to standard parameters and 42 according to specific parameters. ASTRO 2005 criteria, specific for salvage therapy (Phoenix consensus), were used to define recurrence. Progression-free survival was calculated by the Kaplan-Meier method.


Results

Mean follow-up was 39±28 months. The negative biopsy rate was 80% and the median nadir PSA was 0.10ng/ml. Specific survival was 94% at three years and 90% at five years, and progression-free survival was 50% at three years and 44% at five years. The urinary incontinence rate was 44% (grade 1 : 12%, grade 2/3 : 32%) and the urethral stricture or bladder neck stenosis rate was 30%. The use of specific parameters reduced the incidence of severe incontinence (19% versus 50, P =0.005) and stenosis (24% versus 40).


Conclusions

Treatment with HIFU achieved a five-year progression-free survival of 44%, but patients must be clearly informed about the high rate of adverse effects.

Caractéristiques des incrustations des endoprothèses urétérales chez les patients lithiasiques
2008
- Réf : Prog Urol, 2008, 4, 18, 230-237




 


Introduction

The goal of this prospective study was to characterize ureteral stents encrustation in stone formers.


Material and methods

We report the results of a study based on 658 double-J stents (412 men and 246 women) collected from patients with in situ urinary calculi. The mean age was 48.2±16.0 years without differences between genders. Ureteral stent encrustation was analysed by infrared spectroscopy. Results are expressed according to the main component.


Results

The mean indwelling time was 73.5±73.2 days. The main component in stent encrustations was calcium oxalate (43.8%), essentially the monohydrate form (27.1%), followed by proteins (27.4%), calcium phosphates (16.4% with 8.4% brushite), and uric acid (5.2%). Struvite, detected on 49 stents, was the main component in 2.4% of cases. Significant differences according to gender and age were found: calcium oxalate monohydrate, which represented 24.5% in 20 to 29 years old men class increased to 37.0% in 50 to 59 years class and then decreased in older patients. Calcium oxalate dihydrate increased with age up to 70 years in women while it felt dramatically in man beyond 50 years old. Brushite was more abundant in young men (20.4% in patients aged 20–29 years) and was decreasing beyond this age while it remained in stable proportion for all age classes in women. Increasing prevalence of uric acid encrustations with age was observed, especially in men beyond the age of 70 years. Mineral encrustations increased with the indwelling time, the part of mineral being preponderant after 15 days: 7,3% of the stents had become massively encrusted within 113 days mean period. The comparison between biomaterials showed that silicone stents were significantly less encrusted than polyurethane stents.


Conclusion

Stent encrustation constitutes a serious complication of ureteral stent use in stone formers. Lithogenic factors should be considered for the prevention of stent encrustation in these patients.

Élargir les indications de la néphrectomie partielle induit-il un surcroît de morbidité ? : Une étude multicentrique française
2008
- Réf : Prog Urol, 2008, 4, 18, 207-213




 


Objective

To evaluate the morbidity of partial nephrectomy (PN) according to tumour size and the type of indication based on a multicentre retrospective study.


Materials and methods

Seven French teaching hospitals participated in this study. Data concerning tumour size, indication for PN (elective or necessity), age, gender, TNM stage, histological type, Fuhrman grade, ASA score and performance status (ECOG) were analysed. Medical and surgical complications, intraoperative blood loss, blood transfusion rate and length of hospital stay were also studied. Statistical analysis of qualitative and quantitative variables was performed with Chi-square test (Fisher’s test) and Student t -test.


Results

Six hundred and ninety one patients were included. The median tumour diameter was 3cm (0.4–18). Tumours measuring less or equal to 4cm and incidental tumours represented 77.7 and 80.7% of cases, respectively. Clear cell carcinomas represented 75.1% of malignant tumours. Some 89.1% of tumours were T1, 1.6% were N+ and 2.3% were M+. In the 486 elective indications: the operating time (p  = 0.03), mean blood loss (p  = 0.04), and urinary fistula rate (p  = 0.01) were significantly higher in tumours greater than 4cm. These differences were not associated with an increase in the medical (p  = 0.7) or surgical complication rate (p  = 0.2), or the length of hospital stay (p  = 0.4).


Conclusion

Broader indications for elective PN is associated with an increased morbidity but which remains acceptable. This is an important point for patient information and to guide the choice of surgical strategy, particularly in elderly, frail patients or patients with major comorbidities.

Facteurs génétiques déterminant les variations anatomiques de la prostate
2008
- Réf : Prog Urol, 2008, 4, 18, 214-222




 


Introduction

The determinants of macroscopic and microscopic anatomical variants of the prostate during ageing are poorly defined. The authors evaluated the correlation between specific gene polymorphisms involved in androgen and oestrogen synthesis and gross (prostatic weight) and microscopic anatomy (stroma/epithelium ratio) of the prostate during ageing.


Methods

The prostatic weight and stromal surface area of an autopsy series of 85 men over the age of 50 were measured, then compared as a function of gene polymorphisms involved in androgen or oestrogen regulation. The following polymorphisms were studied: number of CAG repeats of the androgen receptor (AR), number of TA repeats and the V89L variant of the 5-alpha-reductase gene (SRD5A2 ) for androgens, and the A1A2 variant of 17-alpha-hydroxylase (CYP17 ) and number of TTTA repeats of the aromatase (CYP19 ) for oestrogens.


Results

No correlation was observed between the number of TA repeats of the SRD5A2 gene or TTTA repeats of the CYP19 gene and anatomical parameters of the prostate. A statistically significant positive correlation was observed between age and prostate weight (r =0.21, p =0.05) and a statistically significant negative correlation was observed between prostate weight and number of CAG repeats (r =−0.32, p =0.003). The group with less than 20 CAG repeats was associated with a higher prostate weight than the other group. The stromal surface area was greater in the [20–23] CAG repeat group (p =0.02), and in the A2A2 group of CYP17 (p =0.016) than in the other groups.


Conclusion

A small number of CAG repeats is associated with a higher prostate weight. The mean number of CAG repeats of the androgen receptor and the A2A2 variant of the CYP17 gene are associated with a larger stromal surface area.

Faut-il passer au prélèvement de 20 carottes lors d'une première biopsie prostatique ?
2008
- Réf : Prog Urol, 2008, 4, 18, 251-252




 

La posthéphagie rituelle et l'infection à l'hépatite virale B
The ritual posthephagia and viral B hepatitis infectious
2008
- Lettre à la rédaction
- Réf : Prog Urol, 2008, 4, 18, 206


Les « tumeurs superficielles de vessie » n'existent plus
2008
- Réf : Prog Urol, 2008, 4, 18, 204-205




 


“Superficial bladder tumours” term is progressively abandoned in the urological community because of its ambiguity leading possibly to harmful confusions. The Comité de cancérologie de l’Association française d’urologie proposes to designate by tumeur de vessie n’infiltrant pas le muscle Ta, T1 and Tis tumours.

Peut-on déterminer en peropératoire les candidates à une réimplantation immédiate d'une bandelette sous-urétrale après résection d'une première bandelette pour obstruction chronique ?
2008
- Réf : Prog Urol, 2008, 4, 18, 238-244




 


Objective

To intraoperatively identify candidates for immediate reimplantation of a suburethral sling after sling removal due to chronic obstruction.


Material and method

Clinical study of 22 women, operated by suburethral sling for stress urinary incontinence between 2000 and 2007, who subsequently developed lower urinary tract obstructive symptoms. The suburethral sling was removed in all patients under local anaesthesia and fentanyl/midazolam sedation. Immediate replacement of the suburethral sling was performed in patients with cough incontinence demonstrated intraoperatively after sling removal. The mesure du handicap urinaire (MHU) questionnaire, UDI-6/IIQ-7 score and uroflowmetry with determination of the postvoiding residual volume were performed before and three months after the operation.


Result

Twelve patients (group 1) underwent removal and reimplantation of a new sling and 10 patients (group 2) underwent simple sling removal. The two groups were comparable. In each group, a significant difference was observed between preoperative and postoperative postvoiding residual volume, peak flow rate and MHU score and a non-significant difference was observed for the UDI-6/IIQ-7 score in group 2, in contrast to group 1. The urinary continence rate was 100% in both groups. The success rate, defined urodynamically, was 75% in group 1 and 80% in group 2. The success rate, defined by resolution of the initial urinary symptoms and improvement of the questionnaire score, was 75% in group 1 and 90% in group 2.


Conclusion

Candidates for immediate replacement of suburethral sling after sling removal due to obstructive symptoms can be identified intraoperatively. The cough test under local anaesthesia and fentanyl/midazolam sedation allows selection of these patients. Immediate sling replacement is accompanied by good results on continence without inducing a new obstruction.

Quelle peut être la durée du délai entre le diagnostic et le traitement chirurgical du cancer du rein ?
2008
- Réf : Prog Urol, 2008, 4, 18, 197-203




 


When announcing the diagnosis of renal cell carcinoma, the urologist and the patient can wonder about the waiting time for surgically treating the cancer. This review aimed to investigate the scientific facts to determine the time between the diagnosis of kidney cancer and the achievement of surgically. The natural history of kidney cancer has been the fundament of the therapeutic management. The time between diagnosis and surgical treatment depends on the conditions under which the diagnosis was established. Patients with symptomatic cancer or discovered at metastatic stage had to be treated quickly. In case of incidental diagnosis, evaluation of tumors has resulted in the selection of patients who can wait several months between diagnosis and surgical treatment of kidney cancer on the condition watchful waiting. The modalities of this assessment, radiological and anatomopathological, must be validated by further studies.

Traitement néoadjuvant du cancer du rein
2008
- Réf : Prog Urol, 2008, 4, 18, 256-258




 


A 73-year-old man presented with renal cell carcinoma of the left kidney. Despite the absence of metastases, primary nephrectomy was not performed immediately due to the large tumour volume and the presence of large lymph node extension. The patient was treated with sunitinib for 10 months. Computed tomography at the end of treatment showed a significant reduction of the size of the tumour and the volume of lymph node extension. Radical nephrectomy was then performed. On histological evaluation, the primary renal tumour and, to a lesser degree, the lymph nodes were predominantly necrotic.

Transplantation foie–rein combinée : indications et résultats
2008
- Réf : Prog Urol, 2008, 4, 18, 245-250




 


Purpose

The purpose of this article is to report our experience concerning the indications and results for combined liver–kidney transplantation in our centre.


Material and method

From July 1991 to October 2006, 26 patients underwent combined liver–kidney transplantation in our establishment. This group comprised 16 men and 10 women with a mean age of 50.1 years (range: 19 to 68 years). The main indications were as follows: hepatorenal polycystic disease, type I hyperoxaluria, cirrhosis associated with end-stage renal failure.


Result

The median follow-up was 62.73 (±50.9) months. Only two patients of this series died, one at 70 months from gastric cancer, and the other at 89 months from cerebral metastases. Nine patients developed surgical complications (29%). Liver function was normal in the 24 surviving patients. Only one case of loss of renal graft was observed at 12 years and this patient is currently on dialysis. The mean creatinine level in these patients (apart from the dialysed patient) at the last follow-up visit was 120.3 (±30.43)μmol/l.


Conclusion

Combined liver–kidney transplantation can be performed with acceptable morbidity and mortality and excellent long-term results.

Une tumeur rénale à connaître : le carcinome tubulomucineux et fusiforme
2008
- Réf : Prog Urol, 2008, 4, 18, 253-255




 


Mucinous tubular and spindle cell carcinoma is a rare and newly described type of renal cell carcinoma (RCC) with a relatively indolent behaviour. We report a case of 53-year-old woman who had macroscopic hematuria and flank pain. A right radical nephrectomy was performed showing a well circumscribed tumour confined to the kidney and measuring 17cm. The histologics findings consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumour cells were cuboidal to spindled with eosinophilic cytoplasm and lower nuclear grade. Tumour was immunoreactive for cytokeratin CK 7, CK19 and epithelial membrane antigene (EMA). The morphological and immunohistochemical features were consistent with mucinous tubular and spindle cell carcinoma of kidney.