Base bibliographique

Sommaire :

Actualités sur le cancer de la prostate métastases, IRM et gestion post-opératoire du stade de haut risque
2012
- Réf : Prog Urol, 2012, 5, 22, 15-20
Mots clés:
G. / R. / T.
Mots-clés:
cryptorchidism / Ectopic adrenal cortex / Inguinal canal / Spermatic cord
Actualités sur le carcinome rénal métastatique anticiper l'évolution et éviter l'impasse thérapeutique
2012
- Réf : Prog Urol, 2012, 5, 22, 1-5
Mots clés:
T. / T.
Mots-clés:
cryptorchidism / Ectopic adrenal cortex / Inguinal canal / Spermatic cord
Les spécificités cliniques et thérapeutiques du cancer du pénis avec atteinte ganglionnaire
2012
- Réf : Prog Urol, 2012, 5, 22, 11-14
Mots clés:
R. / T.
Mots-clés:
cryptorchidism / Ectopic adrenal cortex / Inguinal canal / Spermatic cord
Quelles récidives urothéliales peut-on prévenir ou traiter ?
2012
- Réf : Prog Urol, 2012, 5, 22, 6-10
Mots clés:
E. / T.
Mots-clés:
cryptorchidism / Ectopic adrenal cortex / Inguinal canal / Spermatic cord
Atteinte de la Muscularis Mucosae dans les tumeurs urothéliales T1 de vessie : facteur pronostique de progression après immunothérapie par BCG
2012
- Réf : Prog Urol, 2012, 5, 22, 284-290


Introduction



Objectives

To study the prognostic impact of muscularis mucosae (MM) invasion for pT1 bladder cancer treated by transurethral resection (TUR) and adjuvant Bacille Calmette-Guerin (BCG) intravesical immunotherapy.


Methods

Sixty-six patients treated by BCG intravesical instillations were substaged into pT1a and pT1b, regarding Muscularis Mucosae invasion. Tumor grade, associated carcinoma in situ (CIS), multifocality, tumoral size up to 3cm, BCG maintenance were noted. With a mean follow-up of 50.5±38 months, we studied recurrence, progression, overall and specific survival. Cox’s model method was used for multivariate analysis.


Results

Tumor recurrence was observed in 30±7% and 43±10% (P =0.29) and tumor progression in 16.3±5% and 39±10% (P =0.04) for pT1a and pT1b. The rate of progression was higher (P =0.04) and progression free survival was decreased (P =0.04) for pT1b. Specific death rates were 11±5% and 21±9% (P =0.28), median overall survival was 80.9 [1.5–92] and 48.2 [12–93] months for pT1a and pT1b. Overall and specific survival weren’t different between the two populations (P =0.38; P =0.3). Cystectomy rates were 2.3±2% and 30±9% for pT1a and PT1b (P =0.0006). For pT1a patients, recurrence (P =0.8) or progression rates (P =0.64) were no different regarding BCG maintenance immunotherapy but pT1b population had a better progression free survival with BCG maintenance than without (P =0.0051). Only CIS had prognostic value in multivariate analysis.


Conclusions

Tumors with Muscularis Mucosae invasion have a higher risk of progression and BCG failure. Maintenance immunotherapy should be given to improve results with these patients.

Mots clés:
Tumeur de vessie n’infiltrant pas le muscle (TVNIM) / / / Bacille de Calmette et Guérin (BCG) / Immunothérapie intravésicale
Mots-clés:
Urinary bladder neoplasm / / / Bacille Calmette Guerin / Intravesical immunotherapy
Devenir vésicosphinctérien et anorectal des enfants ayant un lipome du cône. Analyse rétrospective sur 114 cas
2012
- Réf : Prog Urol, 2012, 5, 22, 291-300


Introduction



Objective

To clarify bladder and bowel function of children with lipomas of the conus, without, before and after neurosurgery.


Patients and methods

Retrospective analysis of 114 children with a lipomas of the conus, followed in our pediatric neuro-urology department from 1993 to 2010. Several data were collected: bladder and bowel symptoms, bladder and anorectal continence, neurosurgical indication and age, clinical modification after neurosurgery, investigations carried out in pre- and post-surgery treatment, associated bladder and bowel treatment.


Results

Forty-nine of the 77 children (63.6%) operated on had never been seen before surgery in our neuro-urology department. Seventy-seven children (67.5%) underwent a neuro-surgery, 60% indicated due to a neurogenic bladder. Before neurosurgery, 66 children (85.7%) had spontaneous miction. Five children (6.5%) had bladder intermittent catheterization. Forty of these patients (56.3%) were continent. After neurosurgery and a specialized consultation in neuro-urology, 54 children (70.1%) were continent. Thirty-seven children (48%) had spontaneous miction. Thirty-seven children (48%) had bladder intermittent catheterization and drug of overactive detrusor. Fifty-two children (67.5%) were constipated after surgery. Seventy-seven percent of the treatments for bowel symptoms were effective in terms of continence.


Conclusion

The existence of a neurogenic bladder was one of the main indications for neurosurgery. These results suggest that the complexity of care requires neurosurgical, urological surgeon and neuro-urology physician to achieve the explorations and urinary and digestive treatment in order to preserve renal function and both continences.

Mots clés:
Dysraphisme spinal / Lipome du cône / Pédiatrie / Vessie / Constipation
Mots-clés:
Spinal dysraphism / Lipomas of the conus / Pediatry / bladder / Constipation
Efficacité et tolérance des endoprothèses urétérales métalliques Memokath ® 051 : étude prospective sur trois ans
2012
- Réf : Prog Urol, 2012, 5, 22, 266-272


Introduction



Objective

To assess the effectiveness and tolerance of the metallic stent Memokath® 051 in the management of patients with chronic ureteral stricture treated by JJ stenting.


Patients and methods

A prospective observational study included 16 patients with chronic ureteral stricture managed with JJ stents. They were all treated with Memokath® 051 metallic stents. The primary endpoint was the medium durability of the stent. Adverse events and complications were prospectively collected. The evolution of the irritative urinary symptoms and lumbar pain after stent insertion were also assessed.


Results

Sixteen patients (mean age: 62, standard deviation: 11,4) had a total of 20 stents inserted. It was technically impossible to insert the stent in two patients and one stent was removed one day after insertion. The medium durability of the stents was 13 months (standard deviation: 10,9). Eight stents (40%) were still functioning at the end of the study. Complications were: six migrations (30%) and four obstructions (20%) of the stents. Thirteen of the 14 patients with a Memokath® stent experienced significant improvement of their JJ stent-related symptoms.


Conclusion

The Memokath® 051 stent was an interesting alternative to JJ stents in the management of chronic ureteral strictures. Their tolerance was good and complications were easily managed without threatening the urologic prognosis of the patients. Larger studies are required to identify the risk factors of complications and the best indications for stent insertion.

Mots clés:
Sténose urétérale / Endoprothèse urétérale
Mots-clés:
Ureteral stricture / ureteral stent
Épidémiologie des cancers urologiques au Centre national hospitalier universitaire Hubert Koutoukou Maga Cotonou, Bénin. Analyse d'une série hospitalière de 158 cas
2012
- Réf : Prog Urol, 2012, 5, 22, 261-265


Introduction



Objective

To study the epidemiological profile of urologic cancers in the department of urology at the teaching hospital of Cotonou.


Methodology

We analysed the course of all urological cancer data over a 42-month period, from January the 1st 2008 to 30th June 2011.


Results

Urologic cancers were frequent in our hospital practice with a frequency of 17,38 %. They are dominated by prostatic cancer (69 %), the cancer of bladder (28,5 %), the cancer of the kidney (8,5 %) and cancers of the external genitals (testis and scrotum) which are marginal in our review. We did not report any case of penis cancer and urethral cancer. They occured at an advanced age with an average age 62.89±15.51years. Urologic cancers were the prerogative of the subjects of male sex with a sex ratio of 9/10. Specific mortality rate which is attached to them was high.


Conclusion

The epidemiologic profile of urologic cancers in our practice had some essential characteristic for the primary prevention. The improvement of the quality of data, the installation of a cancer register and the improvement of the technical skills will allowed a better approach of urologic cancer in our urology unit.

Mots clés:
Épidémiologie / Cancers urologiques / Cancer de la prostate / Cancer de vessie
Mots-clés:
epidemiology / Urologic cancer / prostate cancer / bladder cancer
Étude prospective chez 100 patients des résultats de la technique d'anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann
2012
- Réf : Prog Urol, 2012, 5, 22, 255-260


Introduction



Purpose

We attempted to determine the results of the ureterointestinal anastomosis in the Hautmann orthotopic ileal neobladder. This study was conducted prospectively and focused on ureteral stricture, which occurs mainly during the 2 years after surgery.


Patients and methods

Between January1999 and June 2009, a total of 100 consecutive patients (five women and 95 men) with bladder cancer underwent cystectomy followed by construction of a Hautmann neobladder. The median age of the patients was 62 (36–78) years. The mean follow-up was 63 (±28) months and included physical examination, serum creatinine values, urine cytology, CT scans and renal ultrasonography.


Results

A total of 197 renal units (RU) were included. In eleven RU, hydronephrosis was present preoperatively and improved postoperatively. In ten others RU, hydronephrosis persisted postoperatively without symptoms. The anastomotic stricture rate was 4%, concerning eight RU by seven patients. Five inflammatory strictures (2.5%) occurred early on the 5th, 6th, 8th and 13th postoperative weeks and were revealed by pyelonephritis. Three strictures were tumors in nature and were revealed by urine cytology and radiology on the 6th, 7th and the 14th month respectively. The five inflammatory strictures were treated with percutaneous nephrostomy, balloon dilatation and ureteral stenting. For three of these four patients, surgical reimplantation was necessary on the 4th, 5th and 7th months, like in the case of the three tumoral strictures.


Conclusion

With a minimal 2 years follow-up, ureterointestinal anastomosis with double chimney had, in this study, a 4% rate of anastomotic stenosis. The surgical modification avoiding tension seemed to preserve ureteral vascularization.

Mots clés:
Néovessie iléale / Sténose urétérale / technique chirurgicale
Mots-clés:
Ileal neobladder / Ureteral stricture / surgical technique
Évaluation de la sexualité chez les patients afro-caribéens drépanocytaires homozygotes SS suivis en Martinique
2012
- Réf : Prog Urol, 2012, 5, 22, 301-306


Introduction



Objectives

To evaluate and compare retrospectively the sexuality of homozygous sickle cell patients from Martinique related to priapismic events using the IIEF-15 questionnary.


Patients and methods

Retrospective survey of 68 patients with sickle cell disease regularly followed up at sickle cell disease’s center of Lamentin’s hospital according to the occurrence and the type of priapism (intermittent or acute). We shared patients in three groups: no priapism (group 1), intermittent priapism (group 2) and acute priapism (group 3). Information regarding specific and preventive treatments to the disease, and events related to priapism have been gathered for all patients. Each patient’s sexuality has been studied with the IIEF-15 questionnary and results have been compared between the groups to show the priapism’s impact on sexual activity of these young men.


Results

In 37.3%, priapism was observed. The group 1 and 2 had better results than the group 3 on the EF score. There was no significative difference between the group 1 and 2. There was also no significative difference between the three groups on the SD, FO, IS and OS score. The increase of the priapism duration and the repetition of the episodes were associated to a decrease of the EF score.


Conclusion

Our study showed the lack of major impairment of erectile function in patients with intermittent priapism in opposition to the patients with acute priapism.

Mots clés:
priapisme / Drépanocytose / dysfonction érectile
Mots-clés:
priapism / Sickle cell disease / erectile dysfunction
Impact de la prise de statines sur les groupes à risques de progression de D'Amico et la survie sans récidive biologique après prostatectomie totale
2012
- Réf : Prog Urol, 2012, 5, 22, 273-278


Introduction



Objective

To examine the association between statin use and prostate cancer (PC) stratified with D’Amico risk groups and biochemical recurrence (BR) in patients undergoing radical prostatectomy (RP).


Patients and methods

All medical charts of patients managed from 2004 to 2008 for PC with RP were reviewed retrospectively. The use and the type of statin were identified. Patients were split according to the use (S+) or not (S−) of statin. The two groups were compared using the Chi2 test. A logistic regression was performed for multivariate analysis.


Results

Overall, 377 patients were included. Mean age was 64 (48–76) (median, range). Ninety-seven patients (27.5%) used statin for at least a year. Groups S− and S+ were comparable in terms of age, obesity, diabetes, preoperative PSA, biopsy Gleason score or clinical stage. The use of statin was statistically associated with D’Amico risk groups (P =0.003). The number of high-risk PC was higher in Group S+ (23.7% vs. 10.7%) with an odds ratio of 2.4 (P =0.009). With a mean follow up of 33±10 months, the overall 2-years-BR was 89%. The 2-years-BR was higher in the S+ (93% vs. 88%, P =0.16). After adjustment, this difference was statistically significant with a hazard ratio of 0.46 (P =0.036).


Conclusion

The use of statin was associated with high risk PC in this study. Surprisingly, the statin use seem also to be associated with better disease-free survival, independently of other risk factors.

Mots clés:
cancer de prostate / Prostatectomie / Statines
Mots-clés:
prostate cancer / radical prostatectomy / survival / Statin
Lymphadénéctomies rétropéritonéales postchimiothérapie des tumeurs germinales testiculaires. Revue de la littérature par le Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes (CCAFU-OGE)
2012
- Réf : Prog Urol, 2012, 5, 22, 245-254


Abréviations



Introduction

Postchemotherapy retroperitoneal lymphadenectomy (PC RPLDN) leads to an overall survival rate for testicular cancer exceeding 75%. Several questions still persist concerning: preoperative assessment of residual masses, reducing templates of dissection, choosing surgical approaches or including RPLND in high-risk patients’ management.


Method

The main series in the literature of the past 20 years were analyzed and selected to address these issues and reach a consensual diagnostic and therapeutic approach.


Results

Forty-eight original articles (1992 to 2011) were selected. They confirm that no preoperative tool can predict the histological nature of residual masses. The unilateral modified template is a valid option for selected patients but the full bilateral dissection remains the standard but more morbid. The laparoscopic approach is being evaluated. The LDNRP PC is indicated in “high risk” situations especially after salvage chemotherapy.


Conclusion

The bilateral lymphadenectomy by laparotomy of any supracentimeter residual mass, 6 weeks after chemotherapy, for germ cell tumors of the testicle is a standard of care.

Mots clés:
Tumeur germinale non séminomateuse / Chimiothérapie BEP / Chirurgie rétropéritonéale
Mots-clés:
Nonseminoma Germ cell tumor / PEB chemotherapy / Retroperitoneal surgery
Maladie d'Erdheim-Chester : à propos d'un cas et revue de la littérature
2012
- Réf : Prog Urol, 2012, 5, 22, 310-312


Introduction



The Erdheim-Chester disease is a rare non-Langerhans hystiocytose acquired in adults. It results from a xanthogranulomatous infiltration, consists of histioccytes foamy and is characterized by heterogeneous systemic manifestations. The most frequent clinical manifestations of the disease are the bone with a long bone uptake on bone scintigraphy99Tc (Dion et al., 2006 [11

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]) and urological damage with an array of pseudo retroperitoneal fibrosis. We report the case of a 64-year-old man in whom was founded in the course of acute obstructive renal disease with Erdheim-Chester pseudofibrose retroperitoneal.

Mots clés:
Maladie d’Erdheim-Chester / Hystiocytose / Fibrose rétropéritonéale
Mots-clés:
Erdheim-Chester disease / Hystiocytose / Retroperitonale fibrosis
Métastase laryngée unique d'un carcinome rénal à cellules claires : cas clinique et revue de la littérature
2012
- Réf : Prog Urol, 2012, 5, 22, 307-309


Introduction



Metastasis from renal cell carcinoma may reach head and neck region in 14–16% of cases. In this region, the most involved areas are thyroid gland, nose, paransal sinuses and parotid gland. Secondary localization to the larynx is a very rare occurrence. We report a case of solitary laryngeal metastasis from clear cell carcinoma of the kidney, occurring several months after removal of the primary tumour.

Mots clés:
Cancer rénal à cellules claires / Métastase laryngée / Métastase solitaire
Mots-clés:
Clear cell carcinoma of the kidney / Laryngeal metastasis / Solitary metastasis
Place du -2proPSA et de l'index phi dans la détection précoce du cancer de prostate : évaluation sur une série de 452 patients
2012
- Réf : Prog Urol, 2012, 5, 22, 279-283


Introduction



Introduction

Early detection of prostate cancer (Pca) is a real challenge to reduce morbidity and mortality while avoiding over-diagnosis and over-treatment. The prostate specific antigen (PSA) is characterized by its imperfections justifying the evaluation of new serum or urinary specific markers allowing a better selection of patients at risk of developing aggressive Pca.


Aim

To compare the value of -2pro PSA and phi index to total and free PSA.


Methods

Serum sampled from 452 patients from two university centers were used to determine levels of PSA before performing biopsies. The patients were included in this study based on the PSA serum concentration between 1.6ng/mL and 8ng/mL according to the WHO international standard. All biopsies were performed according to a standardized protocol consisting of 12 cores or more. Sera were analyzed centrally in one of the two institutions with on a single analyzer. Sera from 243 prostate cancer and 208 negative biopsies patients have been taken into account.


Results

Sera were analyzed blinded for total PSA, free PSA and [-2] proPSA using Access® immunoassay method from Beckman Coulter. The Prostate Health Index (phi) was calculated using the formula phi=([-2] proPSA/fPSA)×sqrt (PSA). The median value of the phi index is significantly (P >0.0001) higher for patients with cancer (phi=65.8) compared to patients with negative biopsies (phi=40.6). At a given sensitivity, the phi index significantly increases the specificity of detection of prostate cancer compared to other markers.


Conclusion

The phi index currently appears as the best predictor of prostate cancer for patients with a total PSA between 1.6 and 8ng/mL according to the WHO standard. The improvement in specificity of the phi index over tPSA could reduce significantly the numbers of unnecessary biopsies. Whether this new biomarker could be an indicator of aggressive prostate cancer remains to be confirmed.

Mots clés:
cancer de prostate / Isoformes du PSA / Index phi
Mots-clés:
prostate cancer / PSA isoform / Phi index