Base bibliographique

Cystinurie
Cystinuria
2012
- Le point sur...
- Réf : Progrès FMC, 2012, 4, 22, F119


Introduction



Cystinuria is an autosomal recessive inherited aminoaciduria leading to nephrolithiasis. Although its prevalence is lower than other renal stone diseases, cystinuria requires an appropriate and specific support. Extracorporeal lithotripsy is relatively inefficient against cystine stones, thus limiting treatment options. The high risk of recurrence and the frequent evolution toward chronic kidney disease need stringent preventive measures based upon an abundant alkaline diuresis and sometimes therapeutic agents forming soluble mixed disulphides with cystine moieties. A close monitoring of diuresis volume, urinary pH and crystalluria prevents recurrence.

Mots clés:
Cystine / Cystinurie / Lithiase
Mots-clés:
Cystine / Cystinuria / Urolithiasis
Évaluation du risque de confusion postopératoire chez le sujet âgé. Le point de vue du gériatre
Risk assessment of perioperative confusion
2012
- Avis d'expert
- Réf : Progrès FMC, 2012, 4, 22, F131


Justifications



Perioperative confusion in old patient of 80 years old is a frequent condition. The onset of confusion after a surgery can negatively impact on global result of the intervention. Ageing and sub-clinical cognitive impairments (that are overlooked in up to 50% of patients) are the two mains risk factors of confusion. Patients’ characteristics (e.g. multi-morbidity), type of surgery itself (e.g. planed or unplanned) and early postoperative complications have been listed in a clinical model as strong predictors of incidental confusion.

Mots clés:
Chirurgie / Troubles cognitifs / Confusion / facteurs de risque
Mots-clés:
Surgery / Cognitive impairment / Confusion / Risk factors
L'urologie en 2012 : médecine et chirurgie, cancérologie et gériatrie
Urology 2012: Medicine and surgery, oncology and geriatric
2012
- Éditorial
- Réf : Progrès FMC, 2012, 4, 22, F109


Notre spécialité continue à couvrir des domaines aussi variés qu’intéressants comme en témoigne ce numéro de FMC où les articles d’urologie quotidienne côtoient ceux de la biologie et de la chirurgie.


Mots clés:
G.
Mots-clés:
Acute renal failure / Obstructive nephropathy / hemodialysis / Post-obstructive diuresis
Les instillations pour le traitement des tumeurs de la voie excrétrice urinaire supérieure : pour qui, comment ?
Instillations for the treatment of upper urinary tract urothelial carcinomas: For which patients and how to do it?
2012
- Le point sur...
- Réf : Progrès FMC, 2012, 4, 22, F115


Introduction



Urothelial carcinoma of the upper urinary tract (UUT-UC) can be treated with a nephron-sparing strategy, for elective or imperative indications. To reduce the risk of recurrence and progression, this treatment can be supplemented by intracavitary instillation, mainly mitomycin C and BCG as it can be done in non-muscle-invasive bladder cancer (NMIBC). Two techniques have been described in the literature: antegrade perfusion through a nephrostomy tube or retrograde perfusion using vesicoureteral reflux created by a double J stent. Adjuvant topical therapy seems to be safe. The few literature data report an efficacy of BCG with nearly 50% of complete cure after treatment for cis lesions, whereas the effects on recurrence for Ta/T1 lesions are less obvious. However the level of evidence is low, as we deal mainly with retrospective case series.

Mots clés:
carcinome urothélial / Bassinet / Uretère / Traitement adjuvant / instillation
Mots-clés:
Urothelial carcinoma / upper urinary tract / Renal pelvis / ureter / Adjuvant therapy
Modification de la technique d'anastomose urétérovésicale de type Taguchi ( one stitch ) en transplantation rénale
Modification of the technique of anastomosis ureterovesical type Taguchi (one stitch) in renal transplantation
2012
- technique chirurgicale
- Réf : Progrès FMC, 2012, 4, 22, F124


Introduction



Introduction

The ureterovesical anastomosis according to Taguchi (one stitch) in renal transplantation is described since 1968. The rate of urological complications seems higher on the particular gross hematuria in studies comparing one stitch anastomosis according to Lich Gregoir. We propose a modification of surgical technique.


Methods

During the anastomosis we realize two anchoring U points of the ureter of the graft on the bladder to prevent the twisting of it and to achieve better hemostasis. The ureter of the graft is spatulated on a short, 5 to 10mm, to avoid bleeding from the cut surface. This also will have a length of ureter as short as possible and avoid stenosis. Finally we set up a JJ catheter to reduce the systematic risk of urinary fistula.


Discussion

In the literature, most studies found no significant difference in terms of urological complications between the Lich Gregoir anastomosis and the one stitch. Only two studies show a difference between the two groups to the detriment of the anastomosis according to Taguchi. The urological complications range from 4 to 19.8% for the anastomosis Lich Gregoir and 5 to 23.3% for the anastomosis one stitch. Regarding the gross hematuria, most studies comparing both techniques find a difference, significant or not, to the detriment of the anastomosis one stitch.


Conclusion

The changes to the original technique according to Taguchi could reduce the risk of gross hematuria complicated. Randomized studies comparing the anastomosis according Lich Gregoir and changed one stitch is required. A study is underway at Rouen University Hospital.

Mots clés:
Anastomose urétérovésicale / / / Taguchi / Modification
Mots-clés:
Ureterovesical anastomosis / One stitch / Taguchi / Change
Nouvelles hormonothérapies dans le cancer de la prostate
New hormone therapies in prostate cancer
2012
- Le point sur...
- Réf : Progrès FMC, 2012, 4, 22, F110


Au cours des dernières années, la meilleure compréhension des mécanismes de résistance à la castration développés par la cellule cancéreuse prostatique a permis l’émergence de nouvelles classes d’hormonothérapie. Un premier antagoniste de LHRH, le dégarelix, a obtenu une AMM dans le cancer de la prostate avancé sensible à la castration. Plus récemment, l’acétate d’abiratérone, un inhibiteur du cytochrome CYP17, a montré une augmentation de la survie globale des patients métastatiques en phase réfractaire à la castration après docétaxel. Avant chimiothérapie, cette molécule conduit, dans des résultats précoces, à une augmentation de la survie sans progression radiologique. Une tendance au gain de survie globale semble se dessiner. Enfin, l’enzalutamide (MDV3100), antiandrogène de nouvelle génération, a également conduit à un bénéfice de survie des patients métastatiques prétraités par docétaxel. L’évaluation de ces nouveaux médicaments se poursuit à des stades plus précoces, ainsi que le développement d’autres molécules des mêmes classes thérapeutiques.


In recent years, the best understanding of castration resistance mechanisms developed by prostate cancer cells led to the emergence of new hormone therapies. A first GnRH antagonist, degarelix, was approved for clinical use in advanced prostate cancer. More recently, abiraterone, an inhibitor of cytochrome CYP17, showed an increase in overall survival in patients with metastatic castration-resistant prostate cancer progressing after docétaxel use. In chemotherapy-naïve patients, abiraterone showed an increase in radiologic progression free survival in early results. Finally enzalutamide (MDV3100), a new nonsteroidal androgen androgen receptor antagonist, has also led to a survival benefit for metastatic patients previously treated with docetaxel. These new drugs evaluation is in progress in randomized trials at earlier stages disease. Moreover other molecules of the same pharmacotherapeutic group are in development.

Mots clés:
Cancer de la prostate / Nouvelles hormonothérapies / Inhibiteurs des enzymes de la stéroïdogenèse
Mots-clés:
prostate cancer / New hormone therapies / Steroidogenic pathway inhibitors