Base bibliographique

Avantages fonctionnels de la prostatectomie totale laparoscopique
Functional advantages of laparoscopic total prostatectomy
2008
- Articles originaux
- Réf : Prog Urol, 2008, 6, 18, 371


Circoncision et VIH
2008
- Réf : Prog Urol, 2008, 6, 18, 331-336




 


The idea that circumcision decreases the risk of sexual transmission of HIV was first proposed in the 1980s, at the time of the worldwide emergence of HIV infection. Many descriptive studies have subsequently been conducted to confirm this effect. Over the last two years, three experimental studies have provided scientific proof of the protective effect of circumcision, evaluated to be about 60%. These studies were recently validated by the WHO. The underlying mechanism of this protective effect remains unclear, but appears to be related more to the number of CD4+ lymphocytes on the mucosal surface of the prepuce in uncircumcised men than to keratinisation of the glans in circumcised men. Paradoxically, the practical implications are unclear, as large-scale prophylactic circumcision, depending on the country, would raise problems of acceptability, material feasibility and even efficacy if the population, considering itself to be protected, abandons conventional safe sex precautions which remain essential.

Connaissance, attitude et perception vis-à-vis des fistules obstétricales par les femmes camerounaises : Une enquête clinique conduite à Maroua, capitale de la province de l'extrême Nord du Cameroun
2008
- Réf : Prog Urol, 2008, 6, 18, 379-389




 


Introduction

This study seeks to identify what the women who live in Maroua Cameroon know and think about obstetric fistula.


Population and method

It is a single hospital, cross-sectional, descriptive and comparative study. Ninety-nine women in the maternity service of the Maroua Provincial Hospital were interrogated on obstetric fistula between May and July 2005, by enquirers who were trained health agents using a questionnaire which required both closed and open answers.


Results

The women who had no previous knowledge of it were generally the illiterate (41.7% compared to 18.8%). More than a third of the women who had an idea of the fistula do not know that there is a surgical treatment for it. Whether they had the previous information on fistula or received it from us, one-tenth of the women suggested that suicide was the solution to fistula where as one-third of the women suggested that a patient suffering from fistula should be isolated.


Conclusion and interpretation

Illiteracy contributes significantly to the lack of knowledge of this affection. The population has a poor perception and a strong negative attitude towards obstetric fistula as they see isolation or suicide as the solution to it.

Étude de la continence urinaire après prostatectomie radicale. Comparaison entre prostatectomie rétropubienne et cœlioscopique à propos de 251 cas
2008
- Réf : Prog Urol, 2008, 6, 18, 364-371




 


Introduction

The objective of this study was to compare the results in terms of continence and quality of life between retropubic radical prostatectomy and laparoscopic radical prostatectomy, performed according to the same principle of retrograde dissection from the apex.


Material and method

The series was composed of 120 patients undergoing retropubic radical prostatectomy and 131 patients undergoing laparoscopic radical prostatectomy performed in the Limoges hospital, urology and andrology department, between January 2002 and September 2005. Continence was evaluated by anonymous self-administered questionnaire sent to the patient’s home. Pain was evaluated by visual analogue scale and narcotic consumption. Predictive factors of continence were analysed.


Results

The two groups were comparable in terms of pathological stage, Gleason score and age. The laparoscopy group comprised more patients with a history of transurethral resection of the prostate and more obese patients. No significant difference was observed between laparoscopy and laparotomy for degree of continence (71% versus 76%; p >0.05), time to return of continence (13 weeks versus nine weeks; p >0.05) and rate of mild (14% versus 13%), moderate (7% versus 6%) and severe (7% versus 5%) urinary incontinence. The anastomosis secondary stenosis rate was also identical in the two groups. Age was found to be a predictive factor for continence, especially for the mean time to return periods of continence. The patient’s weight, prostate weight and TNM stage were not predictive factors for incontinence. The incontinence rate was 40% for salvage prostatectomies after radiotherapy. The mean duration of bladder catheterization was 6.9 days in the laparoscopy group and 7.2 days in the laparotomy group. Narcotic consumption was significantly lower in the laparoscopy group (21mg versus 36mg; p <0.05).


Conclusion

Laparoscopic radical prostatectomy appears to give the same results in terms of continence as retropubic radical prostatectomy. However, these procedures were the first laparoscopic prostatectomies performed in the department, suggesting that, with greater experience, the results of laparoscopy could become superior to those of laparotomy. The laparoscopic technique also appeared to provide better patient comfort by decreasing postoperative pain.

Évaluation des pratiques professionnelles : audit portant sur l'antibioprophylaxie en urologie
2008
- Réf : Prog Urol, 2008, 6, 18, 395-401




 


Objective

To evaluate compliance with clinical practice guidelines concerning prophylactic antibiotics in urological surgery.


Material and methods

Thirty per cent of the medical charts for the first 288 patients operated in 2005 and requiring prophylactic antibiotics were selected at random. On this sample of 84 patients, compliance with the CHU de Toulouse (Toulouse teaching hospital) and société française d’anesthésie et de réanimation (SFAR) (French Society of Anaesthesia and Intensive Care), prophylactic antibiotic guidelines were investigated according to the method recommended by the Centre de coordination de da lutte dontre des infections nosocomiales (CCLIN) Ouest (Nosocomial Infection Control Coordination Centre) which analyses the indication, type of antibiotic, time of administration and duration of treatment.


Results

The compliance rate with the indication was 88.1%. When prophylactic antibiotics were effectively administered, compliance with guidelines were 91.9% for type of antibiotic and 72.9% for time of administration. The duration was excessive in one case. The overall compliance rate was 58.3%.


Conclusion

Prophylactic antibiotic guidelines were inadequately applied, especially concerning the time of administration. Further progress must be made in terms of compliance with guidelines and recording of administration, which must be repeatedly evaluated.

Intérêt du mélange équimolaire d'oxygène et de protoxyde d'azote (Meopa) dans les biopsies transrectales de prostate
2008
- Réf : Prog Urol, 2008, 6, 18, 358-363




 


Objective

The objective of this study was to evaluate the analgesic and anxiolytic properties of an equimolar nitrous oxide-oxygen mixture (Entonox) for transrectal prostate biopsies compared with the use of intrarectal lidocaine gel. The authors evaluated the pain experienced by patients during the procedure and the correlation between pain and anxiety.


Material and methods

One hundred and two patients were included in the study and were divided into two groups. Patients of group 1 (47 patients) received 15ml of intrarectal 2% lidocaine gel and patients of group 2 (55 patients) inhaled Entonox for three minutes before the procedure. A visual analogue scale (VAS), graduated from 0 to 10, was used to evaluate pain intensity. Patients completed the Spielberger State-Trait Anxiety Inventory (forms Y and A), scored from 20 to 80, before the procedure.


Results

No significant difference in anxiety scores was observed between the two groups (p =0.85). In contrast, pain intensity evaluated by the patient tended to be lower in the Entonox group (mean VAS: 2.9 versus 3.5; p =0.10). A linear correlation was observed between the anxiety score and pain intensity in the lidocaine group (p =0.01), but not in the Entonox group (p =0.92).


Conclusion

The use of Entonox tended to improve the tolerability of prostate biopsies, which can be explained by attenuation of the anxiogenic component of pain.

Intérêts des ponctions biopsies rénales percutanées dans la prise en charge des tumeurs solides du rein inférieures ou égales à 4 cm
2008
- Réf : Prog Urol, 2008, 6, 18, 337-343




 


Objective

To assess the value of diagnostic percutaneous kidney biopsy of solid renal tumours less or equal to 4cm and its impact on management.


Materials and method

From January 2001 to October 2006, all solid renal tumours less or equal to 4cm were systematically assessed by CT-guided percutaneous biopsy: 66 tumours were biopsied in 65 patients (one bilateral tumour) and four patients had a second biopsy. A total of 70 biopsies were performed.


Results

Among the biopsies, 18% (12/66) were not contributive. Four were repeated and provided a diagnosis in 50% of cases. Two patients with non contributive biopsies were lost to follow-up. Seven benign tumours (10.9%) and 54 malignant tumours were diagnosed. The kidney biopsy diagnosed 91% (52/57) of malignant tumours and 57% (4/7) of benign tumours. The concordance between biopsy results and pathology results was 90.7% for histological type of tumour and 64% for Fuhrman nuclear grade. Histological type and tumour grade had no impact on the type of surgery performed (51 patients operated, 29 kidney-preserving procedures, by necessity in seven cases). Four patients (6.3%) in whom a benign tumour was diagnosed on biopsy were simply followed, thereby avoiding surgery.


Conclusion

This series revealed 10.9% of benign tumours, only 57% of which were diagnosed by biopsy. Management was modified for only four patients (6.3%). Kidney biopsy remains an option in the pretreatment assessment of renal tumours less or equal to 4cm, but cannot be proposed systematically.

Le traitement de l'incontinence urinaire postopératoire de l'homme par la bandelette sous-urétrale à ancrage osseux
2008
- Réf : Prog Urol, 2008, 6, 18, 390-394




 


Objective

To evaluate the results of treatment of postoperative male stress urinary incontinence by placement of an AMS Invance® bone-anchored male sling (BAMS).


Material and method

Between February 2005 and May 2007, 29 patients with stress urinary incontinence secondary to prostatic surgery were treated by Invance® bone-anchored male sling. This BAMS consists of a silicone-coated polyester sling placed around the bulbar urethra and anchored to the ischiopubic rami by six titanium screws. According to the number of protections used per 24hour, patients were considered to present mild (one to two), moderate (three to four) or severe (five or more, or penile sheath) incontinence. The number of protections, the continence rate and early and late complications were reported. Success or continence was defined by the absence of urine leaks and protections.


Results

The mean age of the patients of this series was 67.5 years. Incontinence was mild for 12 patients (41.4%), moderate for six patients (20.7%) and severe for 11 patients (37.9%). The mean interval between prostatic surgery and BAMS placement was 47.9 months. The mean operating time was 65.8minutes. There were no intraoperative complications. Two cases (7%) of spontaneously resolving acute urinary retention were observed. Explantation of the BAMS for chronic perineal pain or operative site infection was performed in five patients (17%) after a mean interval of 4.1 months (range: 1–8.5 months). The revision rate for repositioning of the screws was 10.3% (three patients). The continence rate at three months was 62.5%. After a mean follow-up of 11.5 months, this rate was 37.5%, corresponding to 77.8% of patients with initially mild or moderate incontinence and 22.2% with severe incontinence. Residual incontinence was mild in 41.7%, moderate in 8.3% and severe in 12.5%. Four patients with persistent urinary incontinence after BAMS placement were treated by artificial urinary sphincter.


Conclusion

Bone-anchored male sling is a minimally invasive treatment for postoperative male urinary incontinence, but is associated with significant morbidity (five explantations in a series of 29 patients). Better results were obtained for mild to moderate incontinence.

Néphrectomie partielle laparoscopique : courbe d'apprentissage d'un interne en urologie sur un modèle porcin
2008
- Réf : Prog Urol, 2008, 6, 18, 344-350




 


Introduction

Several teams have recently confirmed the technical feasibility of laparoscopic partial nephrectomy (LPN). However, this procedure is not widely performed because it is technically difficult and associated with a high rate of bleeding complications, even for experienced teams. The authors studied the LPN learning curve for urology residents using a porcine model based on analysis of the following criteria: operating time, warm ischaemia time and intraoperative and postoperative bleeding.


Materials and methods

Forty LPN were performed by the same operator. All operations were performed after arterial clamping and heparinisation of the animal. The renal section was always the same, removing 40 % of the kidney and always comprised the excretory tract. A continuous running suture on the excretory tract and interrupted sutures on the parenchyma were performed. Operating time and warm ischaemia time were recorded. Animals were monitored for ten days. Intraoperative and postoperative bleeding via drains was recorded and retrograde urography was performed on the 10th day to confirm the absence of excretory tract leaks. Linear regression statistical tests investigated a correlation between these various criteria and the number of cases performed.


Results

The mean total operating time, warm ischaemia time and total bleeding (intraoperative and postoperative) were 108minutes (70–140minutes), 38minutes (22–50minutes) and 95ml (10–300ml), respectively. Linear regression analysis revealed a direct correlation between the number of cases performed and intraoperative bleeding (p <0.001) and warm ischaemia time (p <0.001). These parameters became stable after the 10th operated case. Two cases of urine leaks were observed on D10 out of a series of 40 operations, with no correlation with the number of cases performed.


Conclusion

The operating time and warm ischaemia time are directly correlated with the number of cases performed. Training on a porcine model appears to be a good way to reduce the learning curve in man. Ten operations are necessary to acquire the various steps of the procedure.

Repérage scintigraphique peropératoire d'une métastase costale unique d'un adénocarcinome prostatique opéré
2008
- Réf : Prog Urol, 2008, 6, 18, 402-405




 


We present a case of a lonely bone lesion after a prostatic adenocarcinoma with recurrent increased PSA. The localization of the metastasis at the level of a rib is unfrequent. The precise localization of the lesion was made possible by intraoperative scintigraphy. Histology confirmed the complete resection of the lesion with safe margins.

Résultats des néphrostomies à ballonnet dans le traitement des fistules urinaires basses
2008
- Réf : Prog Urol, 2008, 6, 18, 372-378




 


Objective

To study the results of balloon nephrostomy urine drainage in the treatment of lower urinary tract fistula.


Material and methods

A series of 10 patients with lower urinary tract fistula was treated by balloon nephrostomy for tumour in eight cases and trauma in two cases with a palliative indication in two patients.


Results

The duration of diversion ranged from seven to 210 days (mean: 55 days). The only incidents observed were three cases of urinary sepsis and four cases of nephrostomy tube or balloon migration. On removal of the nephrostomy, there were no signs of stenosis or other ureteric lesion. Balloon nephrostomy drainage achieved cure of the fistula in four cases, and allowed successful surgical repair in the other cases.


Conclusion

Balloon nephrostomy placement appears to constitute an alternative to surgical repair for lower urinary tract fistula. In the case of failure, it appears to allow surgical repair to be performed under better conditions than in the case of immediate surgery. However, these preliminary results need to be confirmed on larger series.

Valeur pronostique du curage ganglionnaire lors des cystectomies totales pour cancer de la vessie
2008
- Réf : Prog Urol, 2008, 6, 18, 351-357




 


Objective

The objective of this retrospective study was to analyse the impact of lymph node invasion on survival after radical cystectomy for bladder cancer.


Material and methods

From 1988 to 2002, 192 patients underwent radical cystectomy for bladder cancer. Lymph node dissection was performed in 144 patients (75%) with bilateral pelvic lymph node dissection in 130 patients and extension to iliac chains in 14 patients.


Results

Lymph node dissection had no impact on medical or surgical morbidity. Lymph node invasion was demonstrated in 35.4% of cases (51/144). Tumour effraction of the lymph node capsule was reported in 70.6% (36/51) of pN+ patients. Lymph node invasion was reported in 16.7 % of pT0 patients, 0% of pTa, pTis, pT1 patients and 40, 47 and 48% of pT2, pT3 and pT4 patients, respectively. The mean follow-up was 40,3±3,5 months (median: 26,6; range 0–207 months). Overall, specific and recurrence-free survivals were significantly influenced by lymph node invasion (p <0,0001, p <0,0001, p <0,0001, respectively) and capsular effraction (p =0,0021, p =0,0027, p =0,0113, respectively).


Conclusion

Lymph node invasion and especially capsular effraction were significant prognostic factors of overall specific and recurrence-free survival.