Base bibliographique

Astuce technique cœlioscopique : porte optique à moindre coût
2008
- Réf : Prog Urol, 2008, 5, 18, 323-326




 


The authors have created a reproducible laparoscope holder that is 150 euros less expensive, which can be used to perform laparoscopic radical prostatectomy and sacral colpopexy with a single assistant and four free hands. One hundred and sixteen procedures were performed with this original, compact and easy to use apparatus. The characteristics of this scope holder allow mobilization of the camera in three dimensions and maintenance of a fixed image after positioning. This laparoscope holder provides an economic solution that can be used in all laparoscopy units and which liberates the assistant’s two hands.

Cancer de l'urètre féminin, à propos de trois cas et revue de la littérature
2008
- Réf : Prog Urol, 2008, 5, 18, 318-322




 


Objective

To review the various clinical forms of female urethral cancer in the light of three clinical cases with a review of the corresponding treatment guidelines.


Method

The authors report three cases of female urethral cancer. Case 1 consisted of squamous cell carcinoma in a 56-year-old woman with no particular history. Case 2 was a urothelial tumour arising in a urethral diverticulum in a 60-year-old smoker. Case 3 was a 69-year-old woman patient with invasive urothelial carcinoma.


Results

Case 1 was treated by segmental urethrectomy with no adjuvant therapy and a favourable course. Case 2 was treated by anterior pelvic exenteration with no adjuvant therapy. This patient relapsed in the form of peritoneal carcinomatosis two years later and died. Case 3 was initially treated by anterior pelvic exenteration followed by a chemoradiotherapy combination after local recurrence with a favourable course.


Conclusion

There are many clinical presentations and histological forms of female urethral cancer. Localized distal lesions can be treated by simple circumferential resection. The treatment of other lesions comprises anterior pelvic exenteration and platinum- or M-VAC-based chemoradiotherapy. The main prognostic factors for these tumours are their size, histological type, site and the presence of pelvic lymph node extension.

Carcinome rénal associé à une translocation MiTF/TFE : présentation de six cas chez l'adulte jeune
2008
- Réf : Prog Urol, 2008, 5, 18, 275-280




 


Objective

The authors present six cases of renal carcinoma associated with MiTF/TFE translocation in young adults. This tumour is one of the newly identified entities of the WHO 2004 classification.


Materials

Six patients with MiTF/TFE translocation were identified in a series of 636 adults operated between 2001 and 2005. The diagnosis was based on cytogenetic analysis and immunohistochemistry (IHC) in three patients and IHC alone in the other three patients.


Results

Four women and two men between the ages of 28 and 42 years presented a tumour with a mean diameter of 6cm (range: 3–15cm). The TNM classification of these tumours was pT1N0 (n =2), pT2N0 (n =1), pT3aN+M0 (n =1), and pT3aN+M+ (n =2). The mean follow-up was 32 months. One M+ patient died six months after the operation, another two pT3 patients developed metastatic disease and pT1 or pT2 patients were alive without recurrence. The histological features comprised a typical papillary architecture with large eosinophil and/or clear cells. IHC showed TFE3 (n =5) or TFEB (n =1) expression. Cytogenetic analysis demonstrated a t (X;1)(p11.2;p34) or t (X;17)(p11.2;q25) translocation in two patients expressing TFE3 and a t (6;11)(p21; q13) translocation in the patient expressing TFEB.


Conclusion

Renal carcinoma associated with MiTF/TFE translocation can be diagnosed by IHC. However, cytogenetic analysis on fresh or frozen material allows characterization of the translocation and should be performed on all renal tumours in young adults. Prognosis is related to stage. In the future, the diagnosis of more cases of this type of carcinoma will allow more precise definition of the clinicopathological profile and the most appropriate management.

Description et résultat d'une étude prospective portant sur une nouvelle méthode de kinésithérapie dans la prise en charge de l'incontinence urinaire postprostatectomie
2008
- Réf : Prog Urol, 2008, 5, 18, 311-317




 


Objective

Prospective evaluation of the short-, medium- and long-term efficacy of the “ABDO-MG® concept” technique in the rehabilitation of urinary incontinence following radical prostatectomy (abdominal or laparoscopic approach).


Methodology

Fifty-three patients suffering from clinical urinary stress or triple incontinence (pure stress incontinence, incontinence due to bladder instability or sphincteric insufficiency) took part in the study. Rehabilitation treatment, begun six weeks before the operation, continued during the immediate postoperative period, at home and at the physiotherapist’s office for three to 12 months until the urinary incontinence had disappeared or was considered to be minimal and acceptable, therefore tolerated. The exercises were performed according to a strict protocol defined by the inventor of the concept, involving expiration into a specific end-piece (called “sound end-piece”) and connection with an abdominal neurostimulator for which the current is triggered and maintained by the sound of the patient’s breathing into the sound end-piece. The efficacy of this concept was confirmed by a comparative trial before and during rehabilitation and then at the end of treatment. There was triple monitoring: evaluation by LFT noting, for each breath, the flowrate/volume curve and FEV1/s, clinical abdominal testing with monitoring of abdominal movement both vertically and horizontally during coughing and a “pad test” at home, assessing the quantity of nocturnal and diurnal urinary leakage relative to each patient’s activity.


Results

The results were meaningful and significant. The improvement of the flowrate/volume curve and FEV1/s varied between 1.4436 and 1.1209L. Abdominal testing showed constant positive evolution in the correction of abdominal incompetence under stress (test improved by one point on a negative graduation of −1 to −3). The home “pad test” confirmed a highly significant result with leakage virtually disappearing, sometimes falling from nearly 800 cc to just a few drops at the end of treatment. The subjective results were marked by the improvement in various dysfunctions within the context of abdominal incompetence increased by the abdominal surgery.


Conclusion

This prospective study was the first to provide an evaluation of the abdominal motor score and the relationship between expiration thrust and pelviperitoneal protection.

L'approche lomboscopique dans le traitement des calculs urétéraux lombaires
2008
- Réf : Prog Urol, 2008, 5, 18, 281-287




 


Introduction

Retroperitoneal laparoscopy is a recent alternative to conventional surgical treatment of ureterolithiasis. The objective of this study was to evaluate the place of retroperitoneal laparoscopic ureterolithotomy.


Material and methods

The authors report 50 cases of retroperitoneal laparoscopy for lumbar ureter stones performed in 49 patients between January 2001 and December 2006. The indications were a very large (>15mm) obstructive stone in the lumbar ureter in 88% of cases, failure of extracorporeal shock wave lithotripsy (ESWL) in 6% of cases and refusal of ESWL in 6% of cases.


Results

The mean stone diameter was 17mm (range: 10–35mm). The stone was removed by retroperitoneal laparoscopy in 46 out of 50 cases (92%). The mean operating time was 97min. (range: 35–170min.). The surgical conversion rate was 8%. Ten patients (20%) developed a urinary fistula requiring secondary drainage by double J ureteric stent. The mean hospital stay was 6.8 days. No cases of ureteric stenosis or kidney destruction was observed with a mean follow-up of 32 months.


Conclusion

Retroperitoneal laparoscopic lumbar ureterolithotomy is a safe, effective and minimally invasive technique which could constitute an alternative to open ureterolithotomy in the majority of its current indications.

La pyélonéphrite xanthogranulomateuse : principaux aspects en imagerie
2008
- Réf : Prog Urol, 2008, 5, 18, 266-274




 


Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis, which frequently has a pseudotumoral appearance, as a result of which differential diagnosis with malignant renal neoplasia is difficult, especially as there are no specific signs of this lesion. The aim of this article is to notice the various histological, clinical and radiological characteristics, and the different modalities of diagnostic and treatment of this affection.

Localisation vulvaire de la bilharziose
2008
- Réf : Prog Urol, 2008, 5, 18, 327-329




 


Vulvar localisation of schistosomiasis is a rare presentation. We report a case of a woman of 20years old hospitalised for a vulvar mass of six months. That mass progressively increased in volume and was tender. It was accompanied by frequency and dysuria. The patient had a history of swimming in fresh water and hematuria when she was eight years old.

Initial clinical examination found a good general state, there was a mass involving the clitoris and the small lips. This painless mass had a cauliflower appearance and was soft with a large implantation. Pathology exam of the mass revealed a vulvar schistosomiasis with an important amount of living eggs.

A tumour removal with a plasty of small lips was performed. Additionally, praziquantel was administered orally.

Vulvar localisation of schistosomiasis might suggest a malignant tumour. Only pathological examination can assess the diagnosis.

Place du test urinaire PCA3 pour le diagnostic du cancer de la prostate
2008
- Réf : Prog Urol, 2008, 5, 18, 259-265




 


PCA3 gene has been discovered in 1999 because of its differential expression between prostate cancer and nonneoplastic tissue. Several studies evaluated its value for prostate cancer diagnosis. These papers are consistent with significant statistical accuracy of measure of the urinary number of PCA3 copies (PCA3 test). While sensitivity is slightly weaker than that of seric PSA, specificity as well as positive and negative predictive values are quite better. PCA3 test seems therefore to be a good indicator of prostate biopsy results. As a commercial kit is available, large studies will be conducted to confirm these results, precise when to perform the test and evaluate the benefit/cost ratio. One of the aims is better selection of those patients who will really benefit from prostate biopsies.

Prostatectomie radicale avec conservation du col vésical : marges chirurgicales et continence urinaire
2008
- Réf : Prog Urol, 2008, 5, 18, 304-310




 


Objective

To evaluate the functional and cancer results of radical prostatectomy with bladder neck preservation in the treatment of localized prostate cancer.


Material and method

From January 2000 to March 2006, 194 consecutive patients underwent open retropubic radical prostatectomy for localized prostate cancer. The bladder neck was technically preserved in 180 patients (93%). The mean age of these 180 patients was 63.2±6.1 years. The mean preoperative PSA was 9.38±6ng/ml. The 180 patients were classified according to the Amico prognostic classification as low risk: 52.2%, intermediate risk: 37.8% and high risk: 10%. Operative specimens were examined by the same pathologist according to the Stanford technique. Positive surgical margin was defined as tumour tissue in contact with the ink of the operative specimen. For analysis of the functional results, patients were classified into three categories: continent without protection, stress incontinent, totally incontinent. Continence was evaluated at D10, one month, six months, one, two, three, four and five years. The mean follow-up was 44±25 months.


Results

This series of 180 operative specimens comprised 64 (35.6%) cases of positive surgical margins and 112 (62.2%) pT3 cancers. No positive margins were observed in the bladder neck, either alone or associated with another positive margin. Seventy-one percent of patients were continent on D10 and at one month, 85% were continent at six months and 89% were continent at one year. Two cases of anastomotic stenosis were observed (1.2%).


Conclusion

Bladder neck preservation during open retropubic radical prostatectomy allows early continence in more than 70% of cases without increasing the risk of positive surgical margins.

Qualité de vie après cystectomie : enquête nationale de l'Association française d'urologie (AFU), la Fédération des stomisés de France (FSF) et de l'Association française des entérostomathérapeutes (AFET) chez des patients ayant eu une dériv...
2008
- Réf : Prog Urol, 2008, 5, 18, 292-298




 


Objective

National multicentre study based on specific self-administered quality of life questionnaires in patients with Bricker ileal conduit urinary diversion or orthotopic neobladder.


Material and method

Questionnaires were distributed by three associations (FSF, AFU, AFET) and comprised general questions and questions specific to the type of diversion. A disability score was also included.


Results

Between September 2003 and March 2004, out of a total of 5739 questionnaires, 909 were returned and 877 were analysed: 738 patients with Bricker ileal conduit and 139 with orthotopic neobladder. The two populations differed at the time of the study (Bricker: 69% of men with a mean age of 70 years, orthotopic neobladder: 95.7% of men with a mean age of 64 years). The mean interval since the operation was seven years. Ninety-four percent of patients with Bricker ileal conduit and 93% of patients with orthotopic neobladder were satisfied or very satisfied with the diversion, despite mean disability scores of 5.2±3.7 and 3.1±3.6, respectively. A correlation between this score and patient satisfaction (Wilcoxon: p <0.0001) was only observed for patients with a Bricker ileal conduit. This score was significantly related to the presence of urinary incontinence with the two types of diversion. Incontinence was frequent (16.1% with Bricker ileal conduit) and 78% of patients feared episodes of incontinence, mainly due to the appliance. Daytime incontinence was frequent for 18.1% of patients with orthotopic neobladder and 40% of patients used at least one protection per day. Out of the patients with neobladder, 82.6% experienced nocturnal incontinence, interfering with sleep in 31.9% of cases. Sexual disorders and altered bowel habit (40%) were very frequent. Stoma-therapy management was insufficient for Bricker ileal conduit and exceptional after bladder replacement.


Conclusion

Cystectomy with either ileal conduit urinary diversion or orthotopic neobladder alters many aspects of the patient’s life, but patients finally accept and adapt to their new way of life.

Risque cardiovasculaire chez les lithiasiques
2008
- Réf : Prog Urol, 2008, 5, 18, 288-291




 


Objective

Urolithiasis appears to be associated with several cardiovascular risk factors (excess salt and animal proteins, hypertension, metabolic syndrome) and, more recently, the development of stroke. The authors describe the frequency of cardiovascular risk factors and cardiovascular events before and after management of urolithiasis.


Method

The authors retrospectively collected data from patients born before 1956 and managed surgically or instrumentally for urolithiasis in our establishment in 1994 concerning the frequency of cardiovascular risk factors and the incidence of acute coronary syndrome, stroke or acute lower limb ischaemia before or after treatment of urolithiasis.


Results

Data were obtained for 33 patients, revealing 12 events including five previous events (four cases of acute coronary syndrome, one ischaemic stroke) and seven subsequent events (five cases of acute coronary syndrome with one death, one ischaemic stroke, one case of acute lower limb ischaemia) an average of 5.7 years after management. These 33 patients had an average of more than two risk factors.


Conclusion

This retrospective study based on a small sample size demonstrated a high frequency of risk factors and cardiovascular events. This correlation needs to be studied in more detail. Urolithiasis could constitute an indirect cardiovascular risk factor dependent on “classical” risk factors, suggesting the need for integrated management of stone patients, in the same way as for patients with erectile dysfunction.

« Big PSA » et prostatectomie totale : survie spécifique et globale à dix ans
2008
- Réf : Prog Urol, 2008, 5, 18, 299-303




 


Introduction

Radical prostatectomy is not currently a recommended treatment modality for patients with preoperative PSA greater than 40ng/ml.


Objectives

To evaluate the specific and overall long-term survival of patients operated despite a PSA greater than 40ng/ml and to describe the adjuvant treatments associated with the surgical procedure.


Materials

From 1988 to 1998, 32 consecutive patients with a mean age of 65 years (range: 46–73) underwent retropubic radical prostatectomy. The preoperative work-up (abdominopelvic CT scan, bone scintigraphy) were all interpreted as being normal. All patients had lymph node dissection. Progression was defined by PSA greater than or equal to 0.2ng/ml or the appearance of metastases.


Results

The mean follow-up was 117 months (range: 2–177). Six patients were alive without progression, and five of them had received adjuvant radiotherapy. Twelve patients were alive with biological progression after second- or third-line treatment. Three patients had died from their cancer and 12 had died from another cause. With a mean follow-up of 10 years, the specific survival of patients operated for high PSA was 80% and the overall survival was 56% with a progression-free survival of 18.7%.


Conclusion

In rigorously selected patients, radical prostatectomy for high PSA possibly associated with adjuvant radiotherapy can achieve satisfactory prostate cancer control at 10 years for almost 20% of N0M0 patients.