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


Introduction



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.

Mots clés:
cancer de prostate / Radiothérapie externe exclusive / Ultrasons focalisés de haute intensité
Mots-clés:
prostate cancer / External beam radiotherapy / High intensity focused ultrasound
Caractéristiques des incrustations des endoprothèses urétérales chez les patients lithiasiques
2008
- Réf : Prog Urol, 2008, 4, 18, 230-237


Introduction



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.

Mots clés:
Endoprothèses urétérales / Lithiase / Incrustations / Prévention
Mots-clés:
Double JJ stents / Urolithiasis / Encrustations / Prévention
Editorial Board
2008
- Réf : Prog Urol, 2008, 4, 18, iii
Mots clés:
C.C.
Mots-clés:
Health economic / Politic / Law / Public health / Costs
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


Introduction



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.

Mots clés:
Carcinome / Cellule rénale / Néphrectomie / morbidité
Mots-clés:
Carcinoma / renal cell / nephrectomy / Morbidity
Facteurs génétiques déterminant les variations anatomiques de la prostate
2008
- Réf : Prog Urol, 2008, 4, 18, 214-222


Introduction



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.

Mots clés:
Facteurs génétiques / Variation anatomique / prostate
Mots-clés:
Genetic factors / Anatomical variant / prostate
Faut-il passer au prélèvement de 20 carottes lors d'une première biopsie prostatique ?
2008
- Réf : Prog Urol, 2008, 4, 18, 251-252



Contexte


Mots clés:
prélèvement / Biopsie prostatique
Mots-clés:
Protocol / Prostate biopsy
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


La circoncision est l’ablation du prépuce en partie ou en totalité pour une raison thérapeutique ou rituelle [1 Sylla C., Diao B., Diallo A.B., Fall P.A., Sankale A.A., Mamadou B.A. Les complications de la circoncision. À propos de 63 cas Prog Urol 2003 ;  13 : 266-272

Mots clés:
F.A. / A.F. / H.N. / M.L. / N.
Mots-clés:
bladder cancer / Grade
Les « tumeurs superficielles de vessie » n'existent plus
2008
- Réf : Prog Urol, 2008, 4, 18, 204-205


Pourquoi faut-il abandonner les TVS ?



“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.

Mots clés:
Tumeur de vessie / Stade
Mots-clés:
bladder cancer / Grade
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


Introduction



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.

Mots clés:
Bandelette sous-urétrale / Qualité de vie / Incontinence urinaire à l’effort
Mots-clés:
Suburethral sling / Quality of life / Stress urinary incontinence
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


Introduction



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.

Mots clés:
Carcinome à cellule rénal / Chirurgie / Délai / Surveillance
Mots-clés:
Renal cell carcinoma / Surgery / Waiting time / watchful waiting
Traitement néoadjuvant du cancer du rein
2008
- Réf : Prog Urol, 2008, 4, 18, 256-258


Introduction



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.

Mots clés:
Cancer du rein métastatique / Traitement neoadjuvant / Antiangiogéniques / Sunitinib
Mots-clés:
metastatic renal cancer / Neoadjuvant therapy / Antiangiogenic / Sunitinib
Transplantation foie–rein combinée : indications et résultats
2008
- Réf : Prog Urol, 2008, 4, 18, 245-250


Introduction



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.

Mots clés:
greffe / Foie / Rein
Mots-clés:
transplant / Liver / kidney
Une tumeur rénale à connaître : le carcinome tubulomucineux et fusiforme
2008
- Réf : Prog Urol, 2008, 4, 18, 253-255


Introduction



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.

Mots clés:
Carcinome rénal / Carcinome tubulomucineux fusiforme de bas grade / Immunohistochimie
Mots-clés:
Renal cell carcinoma / Mucinous tubular and spindle cell carcinoma / Immunohistochemical markers
Cystites aiguës
2008
- Réf : Prog Urol, 2008, 4, 18, 9-13


La prise en charge de la cystite aiguë recherche des facteurs de gravité, de risque ou de complications. La cystite aigue simple ne nécessite aucun examen complémentaire, un traitement court est recommandé. La cystite aiguë compliquée nécessite parfois une évaluation clinique, bactériologique et radiologique, un traitement plus long est recommandé. La définition de la cystite récidivante est précisée dans ces recommandations.


The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.

Mots clés:
cystite / cystite interstitielle / antibiotique / Culture bactérienne / Cystitis
Mots-clés:
F. / G. / J.-P. / A. / J.-P.
Cystites aiguës
2008
- Réf : Prog Urol, 2008, 4, 18, 9-13


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The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.

Mots clés:
cystite / cystite interstitielle / antibiotique / Culture bactérienne / Cystitis
Mots-clés:
F. / G. / J.-P. / A. / J.-P.
Généralités
2008
- Réf : Prog Urol, 2008, 4, 18, 4-8


Les infections bactériennes urinaires de l’adulte sont fréquentes. Le but de ces recommandations vise à améliorer les pratiques. La prescription abusive d’antibiotiques provoque des résistances bactériennes. Les définitions de colonisation, bactériurie, leucocyturie sont précisées ainsi que la valeur d’un examen cytobactériologique ou d’une bandelette urinaire. Les principes de bon usage des antibiotiques dépendent de données bactériologiques, pharmacologiques, individuels et économiques qui sont discutées dans ces recommandations.


Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.

Mots clés:
bactériurie / Culture bactérienne / Résistance / au traitement / Bactérien
Mots-clés:
F. / G. / J.-P. / A. / J.-P.
Généralités
2008
- Réf : Prog Urol, 2008, 4, 18, 4-8


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Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.

Mots clés:
bactériurie / Culture bactérienne / Résistance / au traitement / Bactérien
Mots-clés:
F. / G. / J.-P. / A. / J.-P.
Méthodologie
2008
- Réf : Prog Urol, 2008, 4, 18, 1-3


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Mots clés:
F. / G. / J.-P. / A. / J.-P.
Mots-clés:
prostatitis / Bacterial culture / Antibiotic / guidelines
Méthodologie
2008
- Réf : Prog Urol, 2008, 4, 18, 1-3


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Mots clés:
F. / G. / J.-P. / A. / J.-P.
Mots-clés:
Cancer / prostate / PSA / bladder / kidney
Prostatites aiguës
2008
- Réf : Prog Urol, 2008, 4, 18, 19-23


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A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.

Mots clés:
Prostatites / Culture bactérienne / antibiotique / Recommandations
Mots-clés:
prostatitis / Bacterial culture / Antibiotic / guidelines
Prostatites aiguës
2008
- Réf : Prog Urol, 2008, 4, 18, 19-23


Un tableau d’infection urinaire fébrile de l’homme doit faire évoquer a priori une prostatite aiguë. Les examens complémentaires rechercheront des signes de gravité et un résidu post-mictionnel qui nécessitera un drainage. Un traitement antibiotique probabiliste par C3G ou fluoroquinolone de 3 à 6 semaines est recommandé.


A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.

Mots clés:
Prostatites / Culture bactérienne / antibiotique / Recommandations
Mots-clés:
prostatitis / Bacterial culture / Antibiotic / guidelines
Pyélonéphrites aiguës
2008
- Réf : Prog Urol, 2008, 4, 18, 14-18


La première phase d’évaluation d’une pyélonéphrite aiguë vise a rechercher des signes de gravité ou de complication. Une échographie rénale et une radiographie de l’abdomen sans préparation permet de montrer une dilatation des cavités pyélocalicielles ou un calcul obstructif, le drainage urgent alors s’impose. En présence de signes de gravité ou de complication un scanner remplacera l’échographie. En l’absence de signe de gravité un traitement ambulatoire de 2 semaines par fluoroquinolone ou céphalosporine de 3e génération avec relais en fonction des résultats de l’antibiogramme sera suffisant. En revanche en présence de signes de gravité une hospitalisation s’impose avec une antibiothérapie initialement double pour un total de 3 à 6 semaines.


The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.

Mots clés:
pyélonéphrite / Culture bactérienne / antibiotique / Recommandations
Mots-clés:
pyelonephritis / Bacterial culture / Antibiotic / guidelines
Pyélonéphrites aiguës
2008
- Réf : Prog Urol, 2008, 4, 18, 14-18


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The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.

Mots clés:
pyélonéphrite / Culture bactérienne / antibiotique / Recommandations
Mots-clés:
pyelonephritis / Bacterial culture / Antibiotic / guidelines
Résumé des communications d'onco-urologie présentées au 101 e Congrès de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 4, 18, 31-37


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Regarding renal cell carcinoma, most recent advances concern metastatic cases in which antiangiogenic agent seem to be efficient for specific survival and outcome without progression of the disease. In prostate cancer, new urinary molecular markers, more specific than PSA, are currently under development to allow an early and non invasive diagnosis of the disease. Robot-assisted radical prostatectomy is a growing surgical approach in the treatment of localized prostate cancer, at the expense of the laparoscopic approach, with satisfactory oncologic preliminary results. Whether or not a cystectomy should be done after the resection of a pT1G3 bladder tumour, remains a moot point. However the risk of progression is far from being negligible. Regarding upper urinary tract tumors, the outcome is different from bladder tumors and several teams are working on specific molecular markers, dedicated to be useful in prognosis and specific survival.

Mots clés:
Cancer / prostate / PSA / Vessie / testicule
Mots-clés:
Cancer / prostate / PSA / bladder / kidney
Résumé des communications d'onco-urologie présentées au 101 e Congrès de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 4, 18, 31-37


Dans le cancer du rein, l’avancée thérapeutique la plus récente concerne les formes métastatiques où les traitements antiangiogéniques trouvent une place pour prolonger la survie sans progression et la survie spécifique. Dans le cancer de la prostate, les marqueurs moléculaires urinaires, plus spécifiques de la maladie que le PSA, sont développés pour permettre un diagnostic non invasif et précoce de la maladie. La prostatectomie totale par voie d’abord robot assistée prend une place de plus en plus importante dans le traitement du cancer de prostate localisé, aux dépends de la laparoscopie, avec des résultats carcinologiques satisfaisants. Après résection d’une tumeur de vessie pT1G3, l’intérêt de réaliser une cystectomie précoce est encore extrêmement débattu, mais le risque de progression est important. Concernant les tumeurs de la voie excrétrice supérieure, dont l’évolution est distincte de celles des tumeurs de la vessie, plusieurs équipes cherchent à identifier des marqueurs moléculaires spécifiques, capables d’être utiles au pronostic et à la survie spécifique.


Regarding renal cell carcinoma, most recent advances concern metastatic cases in which antiangiogenic agent seem to be efficient for specific survival and outcome without progression of the disease. In prostate cancer, new urinary molecular markers, more specific than PSA, are currently under development to allow an early and non invasive diagnosis of the disease. Robot-assisted radical prostatectomy is a growing surgical approach in the treatment of localized prostate cancer, at the expense of the laparoscopic approach, with satisfactory oncologic preliminary results. Whether or not a cystectomy should be done after the resection of a pT1G3 bladder tumour, remains a moot point. However the risk of progression is far from being negligible. Regarding upper urinary tract tumors, the outcome is different from bladder tumors and several teams are working on specific molecular markers, dedicated to be useful in prognosis and specific survival.

Mots clés:
Cancer / prostate / PSA / Vessie / testicule
Mots-clés:
Cancer / prostate / PSA / bladder / kidney
Résumé des communications d'urologie fonctionnelle présentées au 101 e Congrès de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 4, 18, 25-30


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Functional urology knows more and more a marked development. Regarding benign prostatic hypertrophia, combined treatments are used often and new molecules such as inhibitor of phosphodiesterase of type 5 are appearing. The gold standard treatment of urinary incontinence with sphincteric deficiency remains the artificial urinary sphincter, in men and in women, where the rate of success is nearly of 95 %. The use of botulic toxin in neurogenic bladder and especially in overactive bladder is growing remarkably, notably in patients of whom quality of life is improve against a very low toxicity. However, the effect of the molecules becomes blurred within a few months. The CT diagnosis of urinary lithiasis is about to provide nowadays the main component of each calculi. Peyronie’s disease remains scarce in which verapamil’s injections are strongly suggested to amend pain but not the curve during erection.

Mots clés:
incontinence urinaire / Lithiase / hypertrophie bénigne de la prostate / Neuro-Urologie / Rein
Mots-clés:
Urinary incontinence / Lithiasis / Benign prostatic hyperplasia / Neuro-urology
Résumé des communications d'urologie fonctionnelle présentées au 101 e Congrès de l'Association française d'urologie
2008
- Réf : Prog Urol, 2008, 4, 18, 25-30


L’urologie fonctionnelle connaît un essor de plus en plus marqué. Dans l’hypertrophie bénigne de la prostate, la place des traitements combinés se précisent et l’implication de nouvelles molécules comme les inhibiteurs de la phosphodiestérase de type 5 font leur apparition. Le traitement de référence de l’incontinence urinaire par insuffisance sphinctérienne reste le sphincter artificiel, y compris chez la femme, où le succès escompté est de l’ordre de 95 %. L’utilisation de la toxine botulique ne cesse de croître dans le domaine de la neuro-urologie et notamment de la vessie hyperactive où la qualité de vie des patients est améliorée dans la plupart des cas au prix d’une toxicité négligeable, mais d’un effet qui s’estompe dans le temps. Le diagnostic scannographique des lithiases urinaires permet dorénavant d’en préjuger la nature et la composition à partir de leur densité à l’imagerie. La maladie de la Peyronie est une pathologie de l’érection dans laquelle les injections de Verapamil sont recommandées pour diminuer les douleurs dans plus de 80 % des cas mais pas les courbures de verge.


Functional urology knows more and more a marked development. Regarding benign prostatic hypertrophia, combined treatments are used often and new molecules such as inhibitor of phosphodiesterase of type 5 are appearing. The gold standard treatment of urinary incontinence with sphincteric deficiency remains the artificial urinary sphincter, in men and in women, where the rate of success is nearly of 95 %. The use of botulic toxin in neurogenic bladder and especially in overactive bladder is growing remarkably, notably in patients of whom quality of life is improve against a very low toxicity. However, the effect of the molecules becomes blurred within a few months. The CT diagnosis of urinary lithiasis is about to provide nowadays the main component of each calculi. Peyronieʼs disease remains scarce in which verapamilʼs injections are strongly suggested to amend pain but not the curve during erection.

Mots clés:
incontinence urinaire / Lithiase / hypertrophie bénigne de la prostate / Neuro-Urologie / Rein
Mots-clés:
Urinary incontinence / Lithiasis / Benign prostatic hyperplasia / Neuro-urology