Base bibliographique

Sommaire :

Angiomyolipome renal à extension veineuse cave inférieure
2010
- Réf : Prog Urol, 2010, 5, 20, 382-384


Introduction



Angiomyolipoma is generally a benign and noninvasive tumor. We report a case of angiomyolipoma with tumor thrombus from the renal vein into the inferior vena cava suggesting a malignant disease.

Mots clés:
Angiomyolipome / Rein / Veine cave inférieur
Mots-clés:
Angiomyolipoma / kidney / Inferior vena cava
Ascite chyleuse post-surrénalectomie laparoscopique transpéritonéale : distribution anatomique des lymphonœuds et prise en charge thérapeutique
2010
- Réf : Prog Urol, 2010, 5, 20, 385-388


Introduction



We report the case of a chylous ascites after transperitoneal laparoscopic adrenalectomy. This complication is known after surgery in urology but remains rare and was not described after laparoscopic adrenalectomy. Anatomy for lymph nodes distribution was described to understand the occurrence of this complication. The diagnosis of chylous ascites is referred to clinical signs of peritoneal irritation and confirmed by puncture, the treatment is initially conservative.

Mots clés:
Ascite chyleuse / Chylopéritoine / Surrénalectomie / Traitement
Mots-clés:
Chylous ascites / Chyloperitoneum / adrenalectomy / Management
Comment se comparent néphrectomies partielles et élargies pour le traitement des carcinomes papillaires pT1aN0M0 ? Étude comparative rétrospective de 277 cas
2010
- Réf : Prog Urol, 2010, 5, 20, 350-355


Introduction



Purpose

Our objective was to compare oncologic results of nephron sparing surgery (NSS) versus radical nephrectomy (RN) in T1aN0-x M0 papillary renal cell carcinoma (PRCC).


Patients and methods

We retrospectively reviewed 277 patients treated for a pT1aN0M0 PRCC selected from an academic database from 12 centres. We compared the clinico-pathological features by using Chi-square and Student statistical analyses. Survivals analyses using Kaplan-Meier and Log-rank models were performed.


Results

The two groups were composed by 186 patients treated by NSS and 91 by RN. The TNM stage was fixed and the two groups were, in terms of age and Fuhrman grade, comparable. Median age at diagnosis was 59 years (27–85). Median tumor size was 2.7cm (0.4–4). The average follow-up was 49 months (1–246). Very few events arose in both groups: two local recurrences were observed in the NSS group (1.07%), three patients died of cancer in the NSS treated group (1.6%) and five in the RN treated group (5.5%). The five and 10 cancer-specific survival rate were comparable in the two groups (98% vs. 100% and 98% vs. 97%). The specific survival curves were perfectly similar for both groups (log rank test , p =0.25).


Conclusion

NSS is equivalent to RN as far as oncologic control of pT1aN0M0 PRCC is concerned.

Mots clés:
cancer du rein / Néphrectomie partielle / Carcinome tubulopapillaire
Mots-clés:
Renal cell carcinoma / Nephron-sparing surgery / Papillary carcinoma
Enseignement et perception de l'urologie à la fin du deuxième cycle des études médicales : état des lieux
2010
- Réf : Prog Urol, 2010, 5, 20, 375-381


Introduction



Objectives

Our purpose was to determine how the medical students from the second cycle perceived urology and what their learning methods were.


Material and methods

An e-questionnaire was sent to 1600 students in 16 teaching faculties during the last year of their second cycle.


Results

Overall, we obtained 590 answers (36.8%). In our population, 70.2% of the students were women. Of them, 24.1% had been already enrolled in an academic urology unit. Urology was defined as a medical, surgical and medico-surgical discipline by 3.7%, 37.8% and 58% of the students, respectively. Urology was considered as very important, important, not very important and not important at all by 5.1%, 54.4%, 37.5% and 2.4% of the students. The teaching methods used to learn urology were duplicated-notes for ENC preparation (45.3%), conferences for ENC (French national ranking exam) preparation (43.7%), courses of the national urology college (38.6%) and courses of the faculty (32%). The best mastered items were lithiasis disease (86.3%), voiding dysfunction (76.3%) and urological cancers (56.7%). On the contrary, only 34.7% and 28% considered their knowledge sufficient on the erectile dysfunctions and on renal transplantation. Lastly, 7.3% intended to become urologists. Having a work experience in a urology unit was significantly associated to the feeling of being prepared to become an intern (p <0.001) and to the project of becoming a urologist (p <0.001).


Conclusion

Urology was considered like an important discipline by half of the students at the end of the second cycle even though it is under-represented in the national teaching programme for ENC. A third of the students used courses from the faculty to learn urology and a quarter of them had a work experience in a urology unit during their second cycle.

Mots clés:
Étudiants en médecine / Étude médicale / urologie
Mots-clés:
Medical student / Medical study / Urology
Énurésie nocturne primaire isolée : diagnostic et prise en charge. Recommandations par consensus formalisé d'experts
2010
- Réf : Prog Urol, 2010, 5, 20, 343-349


Introduction



Objective

The causes and treatment of isolated primary nocturnal enuresis (PNE) are the subject of ongoing controversy. We are proposing consensus practical recommendations, based on a formalised analysis of the literature and validated by a large panel of experts.


Methodology

A task force of six experts based its work on the guide for literature analysis and recommendations and recommendation grading of the French Haute Autorité de Santé (formalized consensus process methodological guidelines) to evaluate the level of scientific proof (grade of 1 to 4) and the strength of the recommendations (grade A, B, C) of the publications on PNE. As a result of this, 223 articles from 2003 on were identified, of which only 127 (57 %) have an evaluable level of proof. This evaluation was then reviewed by a 19-member rating group. Several recommendations, poorly defined by the literature, had to be proposed by a professional agreement resulting from a consultation between the members of the task force and those of the rating group. For its final validation, the document was submitted to a reading group of 21 members working in a wide range of specialist areas and practices but all involved in PNE.


Results

The definition of PNE is very specific: intermittent incontinence during sleep, from the age of 5, with no continuous period of continence longer than 6 months, with no other associated symptom, particularly during the day. Its diagnosis is clinical by the exclusion of all other urinary pathologies. Two factors must be identified during the consultation: nocturnal polyuria promoted by excessive fluid intake, inverse secretion of vasopressin, snoring and sleep apnoea. It is sensitive to desmopressin; small bladder capacity evaluated according to a voiding diary and the ICCS formula. It may be associated with diurnal hyperactivity of the detrusor (30 %). It is resistant to desmopressin. Problems associated with PNE are: abnormal arousal threshold, attention deficit hyperactivity disorder (ADHD) (10 %), low self-esteem. The psychological component is not very significant.


Conclusion

PNE is not psychological in origin. The management of this condition includes: evaluating the intrafamilial tolerance and the child’s motivation, evaluating the rate, the volume of urine and wet nights using a diurnal and nocturnal diary; education (sufficient fluid intake at the start of the day, decrease in hyperosmolar intake in the evening, regular and complete urination); specific treatments: desmopressin for polyuric forms (expected success rate of 60–70 %), alarms for forms involving small bladder capacity (expected success rate of 60–80 %); alternative treatments and/or treatments combined with the preceding ones, for refractory forms: oxybutinin, tricyclic antidepressants (risk). Results obtained with hypnosis, psychotherapy, acupuncture, homoeopathy or chiropractic are not currently validated (insufficient level of proof).

Mots clés:
urologie / Pédiatrie / Incontinence / Énurésie
Mots-clés:
Urology / paediatrics / Incontinence / enuresis
Erratum à « Traitement chirurgical du prolapsus par promontofixation cœlioscopique. Techniques et résultats » [Prog Urol 2009;19:994–1005]
Erratum to “Surgical treatment of prolapse using coelioscopic promontofixation: Techniques and results” [Prog Urol 2009;19:994–1005]
2010
- Erratum
- Réf : Prog Urol, 2010, 5, 20, 392

Mots clés:
L. / L. / V. / F. / P.
Mots-clés:
Biopsy / prostate / Rectal bleeding / Anticoagulant
Expression immunohistochimique de l'endothéline-1 sur biopsies prostatiques : marqueur pronostique d'adénocarcinome localement avancé ?
2010
- Réf : Prog Urol, 2010, 5, 20, 364-368


Introduction



Aim

The study evaluated the immunohistochemistry expression of endothelin-1 (ET-1) by prostate cancer (PCa) in prostate biopsies as an extracapsular stage (pT3a) prognostic factor.


Material and method

Sixty-eight radical prostatectomies (RP) were performed for clinically localised PCa (35 pT2 and 33 pT3a according to the 2002 pTNM classification). Age, digital rectal examination, initial PSA, biopsy Gleason score, positive biopsies ratio, specimen Gleason score, biopsy and RP specimen perineural neoplasic invasion, PCa DNA ploidy, PCa Ki-67 DNA image cytometry and biopsy and RP specimen ET-1 immunohistochemistry expression for both group were compared. Semi-quantitative ET-1 staining assessment was realised by the same pathologist.


Results

pT3a group initial PSA was higher (p =0.032). No statistically difference was noticed between pT2 and pT3a groups for positive biopsies ratio, biopsy perineural neoplastic invasion and biopsy DNA ploidy determination. Biopsy Gleason score ≥7 was predictive of a pT3a stage (p =0.03). Statistically higher intensity of ET-1 PCa expression was observed in biopsies and specimens in pT3a group than in pT2 group (p <0.001 and p =0.01). In multivariate analysis, biopsy ET-1 PCa expression was an independent risk factor of pT3a stage with specificity 79 %, sensibility 69 %, predictive positive value 77 % and negative positive value 72 %. Combined with initial PSA ≥7, values were respectively 100 %, 76.9 %, 100 % and 57.1 %.


Conclusion

Endothelin-1 (ET-1) prostate cancer biopsy expression in our study was an independent prognostic factor of extracapsular stage (pT3a). Further studies will assess the relevance of ET-1 expression study in clinically localised PCa for active surveillance, curative treatment or targeted adjuvant therapy management.

Mots clés:
cancer de prostate / Stade tumoral / Endothéline-1 / Biopsie / prostatectomie radicale
Mots-clés:
prostate cancer / Staging / Endothelin-1 / Biopsy / radical prostatectomy
Prise en charge ganglionnaire dans le carcinome épidermoïde du pénis : revue de la littérature par le comité de cancérologie de l'Association française d'urologie – groupe organes génitaux externes (CCAFU–OGE)
2010
- Réf : Prog Urol, 2010, 5, 20, 332-342


Introduction



Introduction

Invasive lymph nodes are an independent factor of prognosis and essential for the survival of patients with cancer of the penis. The aim of this article is to analyse published research results on the diagnosis and treatment of lymph nodes in cancer of the penis.


Material and method

Bibliographic research on Medline was carried out using the terms penile carcinoma, lymph node dissection, lymphadenectomy, survival, chemotherapy and radiotherapy.


Results

The risk of lymph node metastasis depends on the stage of the primitive tumour, its histological grade, the presence of venous and lymphatic embolus and the presence of palpable lymph nodes (classification into risk groups by the European Association of Urology [EAU]). A diagnosis of suspected adenopathy based on clinical examination associated with FNA biopsy is essential. No medical imaging (tomodensitometry, NMR, PET-scan) has proven to be superior to clinical examination. The search for the sentinel lymph node although interesting remains to be defined, especially in patients who have no palpated adenopathy but are at risk of metastasis. Not only is surgery on inguinal lymph nodes the only reliable way of confirming an invasive metastatic lymph node, it also plays a therapeutic and prognositic role for patients who have a tumour of the penis which risks spreading to lymph nodes (intermediate or high risk according to EAU). The act should always be two-fold. The type of dissection is in function with the clinical examination: a radical inguinal dissection is recommended in the case of palpated adenopathy and a modified inguinal dissection is recommended if there is no palpated adenopathy, this should be radicalised in the case of metastatic adenopathy on histological examination. Neo-adjuvant or adjuvant chemotherapy would appear to play a interesting role when combined with surgery for certain patients without there being currently being precise consensus because of the lack of documented cases. The same goes for external radiotherapy on inguinal lymph nodes which seems to play a role in local controls of the lymph node disease though increases morbidity risks of surgical intervention.


Conclusion

Lymph node dissection alone has a therapeutic role in patients who have reached metastasis of lymph nodes (stage pN1). However, it remains insufficient for patients who have metastatic infiltration of more than 2 lymph nodes (stagepN2). Consequently, it would seem important to develop multimodal approaches in the treatment of these patients in order to increase the rate of response to treatment.

Mots clés:
Carcinome épidermoïde du pénis / Métastase ganglionnaire / Lymphadénectomie / Ganglion sentinelle / Chimiotherapie
Mots-clés:
Penile carcinoma / lymph node metastasis / Lymphadenectomy / Sentinel lymph node / chemotherapy
Prostatectomie de rattrapage après échec de radiothérapie externe pour cancer de la prostate localisé : enquête de pratique, indications, morbidité et résultats. Travail du CCAFU sous-comité prostate
2010
- Réf : Prog Urol, 2010, 5, 20, 317-326


Abréviations



Local recurrence after external radiotherapy for prostate cancer occurs in 30 to 50 % and is often diagnosed by a rising PSA. The absence of local control after radiotherapy is a risk factor of metastases and specific mortality. There are several therapeutic options to treat these patients: surveillance, hormonotherapy and salvage therapies (radical prostatectomy, cystoprostatectomy, brachytherapy, high intensity focused ultrasound [HIFU] and cryotherapy). Hormonotherapy is not a curative treatment and after a couple of years, the disease will progress again. Local salvage therapies are the only treatment to have the potential to cure these patients with the condition of very strict inclusion criteria. Among these therapies, only radical prostatectomy demonstrated his efficacity with a follow-up of 10 years on specific survival and survival without biological progession respectively from 70 to 77 % and from 30 to 43 %. During last decade, morbidity of RP has strongly decreased with a percentage of rectal and ureteral injury at 3 %. Netherless, percentage of urinary incontinence remains high from 29 to 50 %. Salvage mini-invasive therapies (cryotherapy, HIFU and cryotherapy) are under constant evolution due to progress of technology. Functional and oncological results are better with last generation devices but need to be evaluated and compared with radical prostatectomy.

Mots clés:
Prostatectomie de rattrapage / Récidive locale / cancer de prostate / Cryothérapie / HIFU
Mots-clés:
Salvage radical prostatectomy / Local recurrence / prostate cancer / cryotherapy / HIFU
Rectorragie abondante tardive après biopsies de prostate : à propos d'un cas
2010
- Réf : Prog Urol, 2010, 5, 20, 389-391


Introduction



The biopsy of the prostate is a common medical act, which is little invasive and can easily be practiced in external care. Some cases of early rectal or urinary bleedings, which mainly stopped spontaneously, have been described in the literature. The case reported here is that of a patient whose hemorrhagic syndrome arose more than two weeks after the biopsy and required an endoscopic haemostatic treatment.

Mots clés:
Biopsie / prostate / Rectorragie / Anticoagulant
Mots-clés:
Biopsy / prostate / Rectal bleeding / Anticoagulant
Répercussions cliniques et urodynamiques du traitement de l'incontinence urinaire d'effort par bandelettes sous-urétrales transobturatrice
2010
- Réf : Prog Urol, 2010, 5, 20, 369-374


Introduction



Aims

Analyse changes in voiding patterns after the treatment of female urodynamic stress incontinence (USI) with suburethral transobturator tape (TOT).


Patients and methods

Prospective study of 50 women with pure stress urinary incontinence treated between March 2004 and February 2006; mean age was 53±13 (34–87); parity was 2±0.75; mean follow-up was of 15months (7–43). Each patient did a complete urodynamic examination and filled in two questionnaires (MHU and Contilife), before and three months after surgery.


Results

Cure rate was 94% (47/50). Three of 50 patients remained incontinent after surgery (6%). No peroperative complications occurred. Analysis of questionnaires showed that two clinical symptoms predominated postoperatively: dysuria (14%; n =7) and urgency (6%; n =3). Urodynamic profiles showed the following: a decrease in maximum flow rate from 23.6 to 18.9ml/s (p <0.01), and an increase in urethral resistance from 0.12 to 0.23 (p <0.01). The number of patients with at least two Massey Abrams criteria defining obstruction rose from six to 19, while only seven patients had symptomatic dysuria. Quality of life improved significantly, from 2.32 to 4.63 (p <0.05).


Conclusions

TOT is a safe, effective procedure with few complications. While urodynamic data show some obstruction, this has little impact upon clinical results or mid-term complications; it only mildly affects voiding and does not compromise patient satisfaction.

Mots clés:
incontinence urinaire / Obstruction / dysurie / Urodynamique / Bandelettes
Mots-clés:
Urinary incontinence / Obstruction / Dysuria / Urodynamic / Suburetral tapes
Résultats carcinologiques de la prostatectomie totale chez 81 patients à haut risque
2010
- Réf : Prog Urol, 2010, 5, 20, 356-363


Introduction



Objectives

To evaluate carcinologic outcomes and biologic recurrence (BR) factor after radical prostatectomy (RP) for high-risk (HR) prostate cancer.


Material and methods

Between 1996 and 2006, 81 consecutives RP (65 with standard lymphadenectomy) have been done by a single surgeon for HR cancer according to d’Amico classification. No patient received neo-adjuvant therapy. Minimum follow-up required was 2 years. The BR was defined by two consecutives PSA greater than 0.2ng/ml. Forty patients required immediate adjuvant therapy. Thirty for patients required secondary therapy. A multivariate analysis have been done for the following factors: age at RP, TNM stage, pre- and postoperative PSA, Gleason score, number of positive core biopsy, number of HR factor, positive surgical margin and immediate adjuvant therapy.


Results

Mean age was 64 years. Median follow-up was 71 month. Forty-nine patients was pT3 (60.5 %), seven was pN+(8.7 %) and 40 had positive surgical margin (49.4 %). The 5 years biological recurrence free survival rate was 42 %. The Gleason score (p =0.003, RR=1.688, IC=1.193–2.387), the preoperative PSA (p =0.001, RR=1.06, IC=1.032–1.089) and the number of positive core biopsy (p =0.006, RR=5.316, IC=1.605–17.607) were significant independent prognostic factors for the BR. The number of HR factor, positive surgical margin and immediate adjuvant therapy were not significant independent prognostic factors for the BR.


Conclusions

At 5 years, RP in HR prostate cancer allowed carcinologic control without BR in 34 patients (42 %). This result was not influenced by the number of HR factor, surgical positive margin and immediate adjuvant therapy.

Mots clés:
cancer de prostate / Prostatectomie / Récidive / facteur de risque / Pronostique
Mots-clés:
prostate cancer / Prostatectomy / recurrence / Risk factors / prognosis
Sclérose de l'anastomose urétrovésicale après prostatectomie totale pour cancer
2010
- Réf : Prog Urol, 2010, 5, 20, 327-331


Introduction



The present paper intends to review diagnosis and treatment issues of bladder neck anastomosis stricture after radical prostatectomy for localised prostate cancer. Even though cancer control is not necessarily a concern, quality of life may be greatly altered. Patients may suffer from dysuria, urgency and the feeling of incomplete bladder emptying. Flowmetry, cystoscopy and cystography contribute to its diagnosis. Treatment should be graded according to the severity of the disease and the quality of life of the patient. Cold-Knife incisions and pneumatic dilatation are the first line treatments. Holmium laser shows good results on the stricture in a second line treatment. A two-stage strategy with an endoluminal stent followed by artificial urinary sphincter implant is the ultimate option to manage severe strictures, while maintaining acceptable quality of life. Continence sparing is the challenge of the treatment of this type of stricture.

Mots clés:
Cancer prostate / Sclérose de l’anastomose urétrovésicale / Urétrotomie / Sphincter artificiel / Sténose urétrale
Mots-clés:
prostate cancer / Bladder-neck contracture / Artificial urinary sphincter / Urethral stricture