Base bibliographique

Adénocarcinome de l'ouraque : à propos d'un cas clinique et revue de la littérature
2011
- Réf : Prog Urol, 2011, 5, 21, 364-366


Introduction



This article describes the case of a 38-year-old patient with a urachus tumor treated surgically by resection and chemotherapy. When the chemotherapy was stopped, a peritoneal carcinomatosis appeared. We are conducting a review of the literature regarding the diagnosis and treatment of urachus tumors.

Mots clés:
Tumeur / ouraque / Vessie / adénocarcinome
Mots-clés:
tumor / urachus / bladder / adenocarcinoma
Cas clinique et revue de la littérature : un schwannome périnéal
2011
- Réf : Prog Urol, 2011, 5, 21, 360-363


Introduction



Schwannoma is a rare and benign peripheral nerve sheath tumor arising from Schwann cells. Perineal localisation is exceptional. It is most frequently isolated but can be associated with neurofibromatosis 2 or schwannomatosis. This article describes a case of perineal schwannoma, its management and update diagnosis modality and treatment of this tumor.

Mots clés:
Schwannome / Tumeur du périnée / Neurofibromatose 2
Mots-clés:
Schwannoma / Perineal tumor / Neurofibromatosis 2
Chirurgie combinée par bandelette transobturatrice Advance et prothèse pénienne après prostatectomie totale : une première expérience
2011
- Réf : Prog Urol, 2011, 5, 21, 349-353


Introduction



Purpose

Stress urinary incontinence (SUI) and erectile dysfunction (ED) are two major complications following radical prostatectomy (RP). In case of failure of medical treatment, Advance™ retrourethral male sling and penile implant are validated options to manage respectively SUI and ED. Our goal was to assess the feasibility and results of the combination of these two devices.


Patients and methods

Four patients were treated for SUI and DE following RP in our institution by retrourethral sling and penile prosthesis, after failure of medical management. Each patient was preoperatively evaluated by age, complete medical history, ASA score, endoscopy, pad-test, and urodynamics. The first two patients were implanted with the two devices in a two-stage procedure: retrourethral sling then penile prosthesis for one, and penile prosthesis then retrourethral sling for the other. The two other patients underwent a one-stage procedure: one received the two devices, and the other had retrourethral sling implantation and replacement of a penile prosthesis. Post-operative follow-up was focused on complications and efficacy (evaluated by pad use and PGI-I questionnaire for continence, and patient auto-evaluation for sexual function).


Results

No perioperative complication occurred. After a minimum of 6 months follow-up, all the four patients were pad-free with no leakage reported, feeling very much better after the procedure according to the PGI-I. The four patients were fully satisfied of the penile implant device.


Conclusions

According to our initial experience, surgery combining the transobturator Advance male sling and a penile prosthesis is feasible, successively or simultaneously, and leads to excellent functional results with no complications.

Mots clés:
Prothèse pénienne / Bandelette transobturatrice Advance™ / Prostatectomie
Mots-clés:
penile prosthesis / Transobturator / Advance™ sling / Prostatectomy
Évaluation de la pratique de la chirurgie ambulatoire en urologie : expérience d'un centre
2011
- Réf : Prog Urol, 2011, 5, 21, 354-359


Introduction



Objective

Ambulatory surgery is an alternative to traditional hospitalisation and an opportunity for savings for the healthcare system. Here, we analyze our experience in outpatient surgery in urology over a year.


Material

A prospective database concerning outpatient activity was established in 2009, gathering age, ASA score, type of intervention, discharge and recovery for each patient. An individual questionnaire was sent retrospectively in February 2010, to collect data about history of outpatient surgery, overall satisfaction, preference for traditional hospitalization and emergency department visits within 48hours after surgery.


Results

In 2009, 465 patients aged of 52±16 years (15–98) underwent urologic surgery on an outpatient basis. Median ASA score was 2 (1–3). Types of intervention were mainly endo-urology (44.5%), surgery for urinary incontinence (32.5%), and circumcision (12.3%). The postoperative hospitalization rate was 4.5%. The questionnaire response rate was 28%. Forty-six percent of the patients had already been supported in ambulatory, overall satisfaction was 3.3 out of 4 (±1.06) and 24% of patients would have preferred a traditional hospitalization. 11% of patients required emergency department care within 48hours whatever the surgery undergone.


Conclusion

An important part of urological procedures has been done on an outpatient basis without compromising quality of care and patient satisfaction.

Mots clés:
Chirurgie ambulatoire / Hôpital de jour / Activité / urologie
Mots-clés:
Ambulatory surgery / Outpatient / Surgical activity / Urology
La radiothérapie conformationnelle associée à l'hormonothérapie du cancer de prostate localisé : l'âge est-il un facteur limitant ?
2011
- Réf : Prog Urol, 2011, 5, 21, 333-340


Introduction



No study on side effects had showed that conformal radiation therapy for prostate cancer is more harmful in patients older than 70 years to patients younger. The aim of this study was to evaluate acute and late toxicities of conformal radiotherapy, with high dose for localized prostate cancer in patients older than 70 years and compared to patients younger than 70 years. Between 1996 and 2009, 104 patients were treated with radiation therapy and hormonal therapy for localized cancer prostate. Median follow-up was 105 months (9–300). Acute (occurred atthree months) and late side effects of 55 patients older than 70 years (median age: 75 [71–92]) were graded according to the CTCAE 3.0 criteria and compared to the younger population. Median dose to the prostate was 75.6Gy (67–80) in both groups. There were no significant differences in acute and late side effects between age groups. For patients above 70 years, the incidence of grade II or higher acute and late side effects were respectively 27 and 22% for urologic symptoms and 13 and 16% for rectal symptoms. The frequency of grade III late symptoms was low and ranged between 0 and 6% for the evaluated symptoms, irrespective of age group. Older patients had a better biochemical recurrence-free survival than younger patients (86 versus 77% at four years, P =ns). High dose 3D conformal radiotherapy for localized prostate cancer was well tolerated in patients older than 70 years. Age is not a limiting factor for conformal radiation therapy and hormonotherapy for older patients.

Mots clés:
radiothérapie conformationnelle / personne âgée / cancer de prostate / Âge / Toxicité
Mots-clés:
Conformal radiation therapy / Older patient / Localized prostate cancer / Âge / Toxicity
La survie est associée au délai d'atteinte du PSA nadir (DAN) et au ratio DAN/valeur nadir après suppression androgénique pour cancer de prostate
2011
- Réf : Prog Urol, 2011, 5, 21, 341-348


Introduction



Objective

The objective of this study was to assess the prognostic decrease rate of PSA in patients treated with androgen suppression (AS) for prostate cancer (PCa).


Methods

We identified in our database CaP patients with histologically documented, treated with SA alone and for whom vital status with a minimum follow-up of 6 months (except death beforehand) was established. Patient characteristics and CaP and PSA at baseline, PSA nadir, time of reaching the nadir PSA (DAN) and the ratio of the DAN/nadir value (ratio DAN / Nadir) were analyzed in relation to progression-free survival, specific and overall survival.


Results

One hundred ninety eight patients met the inclusion criteria and the median was 61.5 months (range 4.8 to 233). The median PSA at the start of the SA were 37.1ng/mL and the median nadir PSA was 0.48ng/mL. The median time to progression was 23.6 months. The median specific and overall survivals were 94 and 78 months, respectively. In univariate analysis, predictors of progression-free survival were PSA before SA, PSA nadir, DAN, DAN ratio/nadir, Gleason score, the percentage of core positive prostate biopsy and the status of bone scintigraphy. Except for PSA before SA which was no longer significant, predictors of specific and overall survival were similar and added the biochemical response (decrease of more than 50% of PSA) to a second hormonal manipulation during the biological progression. In multivariate analysis, the nadir PSA and the ratio DAN/Nadir remained significant predictors.


Conclusion

These results have confirmed in one hand the predictive value of survival in patients DAN SA for CaP: achieving faster nadir PSA was associated with shorter survival. They have introduced in the other hand the new concept of DAN/Nadir PSA which provides independent prognostic information.

Mots clés:
cancer de prostate / Suppression androgénique / Cancer de prostate métastatique hormonosensible / Antigène spécifique de la prostate / Cinétique de l’antigène spécifique de la prostate
Mots-clés:
prostate cancer / Prostate-specific antigen kinetics / Time to prostate-specific antigen nadir
Le traitement endoscopique conservateur par urétéroscopie souple est-il sur le point de remplacer la néphro-urétérectomie ?
2011
- Réf : Prog Urol, 2011, 5, 21, 367-368

Mots clés:
Tumeur de la voie excrétrice supérieure / carcinome urothélial / Surveillance / Urétéroscopie souple / Uretère
Mots-clés:
Urinary tract cancer / Surveillance / prognosis / Urothelial carcinoma / Renal pelvis
Physiopathologie et nouvelles stratégies thérapeutiques dans la prise en charge des métastases osseuses du cancer de la prostate
2011
- Réf : Prog Urol, 2011, 5, 21, 301-307


Introduction



Prostate cancer (PCa) is one of the most common human malignancies that have a strong propensity to spread in the bones. Despite the progress in the diagnosis and the treatment of prostate cancer, bone metastases are present in nearly 95% of men with metastatic PCa at autopsy. Bone metastases are a major cause of skeletal complications which may negatively affect the quality of life and increase morbidity and mortality in men with advanced PCa. Bisphosphonates are potent inhibitors of bone resorption that have demonstrated clinical benefit for the treatment of bone metastases. They are standard of care for the prevention of skeletal complications such as pain and pathological fractures in patients with bone metastases from PCa. More recently, the discovery of the OPG/RANK/RANKL system has permitted to better understand the role of OPG and RANKL as key regulators of osteoclast-mediate bone destruction in both normal bone remodelling and pathologic conditions. RANKL has been shown to contribute to the vicious cycle of bone destruction and tumour growth in PCa. Therefore, the development of new emerging treatment that inhibits RANKL using RANKL antibodies, as denosumab, resulted in a better control and treatment of skeletal complications, with the hope in a near future to prevent bone metastases.

Mots clés:
Cancer de la prostate / Métastase osseuse / RANK/RANKL/OPG / Biphosphonates / Dénosumab
Mots-clés:
prostate cancer / Bone metastases / RANK/RANKL/OPG / Biphosphonates / Dénosumab
Prise en charge des séminomes sécrétants de l'hormone chorionique gonadotrope
2011
- Réf : Prog Urol, 2011, 5, 21, 308-313


Introduction



Introduction

The human chorionic gonadotropin (HCG)-producing seminoma is an uncommon entity and belongs to the overall category of pure seminoma.


Method

The literature search was conducted on Medline® using the words: seminoma, human chorionic gonadotropin, HCG combined with radiotherapy, chemotherapy, surveillance, management and prognosis. We extended our search of similar references by related articles function, reading the bibliography of identified articles and publications available on Medline® from the same authors. This research was limited to English or French publications. Articles were eligible if they were randomized trials, prospective, retrospective or systematic reviews of the literature.


Results

Few articles were found on this subject. We selected the most relevant series while summarizing various parameters (epidemiological, clinical, therapeutic and prognostic).


Conclusions

Clinical presentation, behaviour and work-up for HCG-producing seminoma should be the same as for non-secreting seminoma. HCG-producing seminoma tumours are not more resistant to radiation therapy or chemotherapy than non-secreting seminoma tumours. Radiotherapy remains an excellent option in stage I and IIA disease with chemotherapy as an alternative; overall prognosis is excellent. Surveillance in early stage HCG-producing seminoma is followed by a higher relapse than in early stage non-secreting seminoma.

Mots clés:
séminome / Hormone chorionique gonadotrope (HCG) / Traitement / radiothérapie / Chimiotherapie
Mots-clés:
seminoma / Human chorionic gonadotropin (HCG) / treatment / radiotherapy / chemotherapy
Recommandations du comité d'infectiologie de l'AFU. Diagnostic, traitement et suivi des candiduries
2011
- Réf : Prog Urol, 2011, 5, 21, 314-321


Méthode



The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60 % of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4–14 % of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400mg on day 1 and 200mg daily for 7 to 14days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3–6mg/kg/day) for 14days or amphotericin B at a dose of 0.5 to 0.7mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata ).

Mots clés:
Infections urinaires / / / Traitement / Antifongiques
Mots-clés:
Urinary infection / / / treatment / Antifungal agents
Résultats des néphrectomies pour tumeurs des reins natifs chez les patients transplantés rénaux
2011
- Réf : Prog Urol, 2011, 5, 21, 322-326


Introduction



Objective

Evaluate epidemiology, diagnosis and outcome of de novo renal cell carcinoma in renal transplanted patients.


Patients and method

From June 1989 to December 2007, 824 renal transplantations were carried out and followed in annual consultation by an urologist with abdominal echography or tomodensitometry. The suspect renal lesions were treated by a widened nephrectomy. Incidence, diagnosis, treatment, histological type, and outcome of all patients were analysed.


Results

Thirty-three patients had nephrectomy for suspect renal lesions. Twenty-two de novo tumours of native kidneys among 21 patients were diagnosed (15 renal clear cell carcinoma and seven papillary tumours) with mean time after transplantation of 25,6 months (2.3–105.5). All tumours were classified pT1aN0M0. Only one patient died at 8 months of metastatic dissemination of a papillary tumour classified initially pT1aN0M0. All the other patients are alive with mean follow-up of 34.8 months (2.8–113.9). Specific survival to 5 years was 93.3%.


Conclusion

The increase risk of tumour at the renal transplanted patient led to propose in the event of suspect lesions of the native kidneys, a widened nephrectomy. In our series, 65% of the operated patients carried a cancer. The good forecast of these localized tumours justifies a regular radiological monitoring and an aggressive therapeutic attitude despite of absence of tumours in 35% of the transplanted patients.

Mots clés:
Transplantation rénale / cancer du rein
Mots-clés:
Kidney transplantation / Renal carcinoma
Urétéroscopie souple dans le traitement des calculs du rein de 2 à 3 cm
2011
- Réf : Prog Urol, 2011, 5, 21, 327-332


Introduction



Purpose

Our aim was to evaluate the outcome of flexible ureteroscopy (F-URS) with Holmium Laser as a minimal invasive procedure for kidney stone between 2 and 3cm in diameter.


Material

We prospectively evaluated 101 patients (103 kidney units) with kidney stone between 2 and 3cm, who underwent flexible ureteroscopy (F-URS) with Holmium Laser. Patient age, sex, body mass index (BMI), stone size, stone composition, associated lower calyx stone, prestenting, congenital abnormalities, urological history, operating time and complications were evaluated. The outcome was determined at 4 weeks on plain radiograph (KUB) and noncontrast CT scan (NCCT) or by endoscopic second look if needed. Ureteroscopy success rate was defined as stone free (SF) or remaining fragments (RF) less than 3mm.


Results

After F-URS session we obtained a stone free status in 35 kidney units (34%), residual fragment less than 3mm in 30 kidney units (29.1%) and 38 kidney units (36.9%) with significant residual fragment. F-URS success rate was 89.3% and 97.1% after second and third session, respectively.


Conclusions

F-URS with Holmium Laser is a very effective and safe technique in treating kidney stone. This technique should be proposed to patient with kidney stone between 2 and 3cm as one of the treatment modalities, F-URS offers excellent results, low rate of complications and short hospital stay. Patients should be informed about staged therapy.

Mots clés:
Endoscopie / Calcul / Laser
Mots-clés:
endoscopy / stone / Laser