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Sommaire :

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


Cet article est particulièrement intéressant et à plus d’un titre. Tout d’abord, c’est la première étude réalisée simultanément dans un même centre et qui compare deux techniques opératoires rigoureusement similaires, comportant la même dissection rétrograde commençant par l’apex et conduites parallèlement, l’une par voie chirurgicale classique à ciel ouvert, éprouvée depuis de nombreuses années et l’autre, plus récente et innovante, par voie laparoscopique extrapéritonéale et rétrograde.

Mots clés:
P.
Mots-clés:
radical prostatectomy / Laparoscopy / Cancer / continence / Quality of life
Circoncision et VIH
2008
- Réf : Prog Urol, 2008, 6, 18, 331-336


Introduction



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.

Mots clés:
Circoncision masculine / Infection par le VIH/prévention et contrôle
Mots-clés:
Male circumcision / HIV infection/prevention and control
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



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.

Mots clés:
Connaissance / Perception / Attitude / Fistule obstétricale / Maroua
Mots-clés:
Knowledge / Perception attitude / Obstetric fistula / Maroua / Cameroon
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



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.

Mots clés:
prostatectomie radicale / C / lioscopie / Cancer / continence
Mots-clés:
radical prostatectomy / Laparoscopy / Cancer / continence / Quality of life
Évaluation des pratiques professionnelles : audit portant sur l'antibioprophylaxie en urologie
2008
- Réf : Prog Urol, 2008, 6, 18, 395-401


Introduction



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.

Mots clés:
Antibioprophylaxies / Évaluation des pratiques professionnelles / Chirurgie urologique
Mots-clés:
Prophylactic antibiotics / Clinical practice evaluation / Urological surgery
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.

Mots clés:
analgésie / biopsies de prostate / Protoxyde d’azote / Meopa / Anxiété
Mots-clés:
analgesia / Prostate biopsy / Nitrous oxide / Meopa / Anxiety
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


Introduction



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.

Mots clés:
Biopsies rénales / Tumeurs rénales inférieures ou égales à 4 / cm
Mots-clés:
Renal biopsies / Renal tumours less or equal to 4 / cm
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


Introduction



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.

Mots clés:
Bandelette sous-urétrale / incontinence urinaire / Prostatectomie totale
Mots-clés:
Male sling / Stress urinary incontinence / radical prostatectomy
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



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.

Mots clés:
Néphrectomie partielle / Laparoscopique / Courbe d’apprentissage / Modèle porcin
Mots-clés:
partial nephrectomy / Laparoscopic / Learning curve / Porcine model
Repérage scintigraphique peropératoire d'une métastase costale unique d'un adénocarcinome prostatique opéré
2008
- Réf : Prog Urol, 2008, 6, 18, 402-405


Introduction



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.

Mots clés:
Cancer prostate / Métastase osseuse / Scintigraphie peropératoire
Mots-clés:
Prostatic cancer / bone metastasis / Intraoperative scintigraphy
Résultats des néphrostomies à ballonnet dans le traitement des fistules urinaires basses
2008
- Réf : Prog Urol, 2008, 6, 18, 372-378


Introduction



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.

Mots clés:
MeSH / Fistule / néphrostomie / Ballonnet / Obstruction urétérale
Mots-clés:
MeSH / Fistula / néphrostomy / Balloon / Ureteral obstruction
Valeur pronostique du curage ganglionnaire lors des cystectomies totales pour cancer de la vessie
2008
- Réf : Prog Urol, 2008, 6, 18, 351-357


Introduction



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.

Mots clés:
Cancer de vessie / Cystectomie / Ganglion / curage / Envahissement
Mots-clés:
bladder cancer / Urothelial tumor / Cystectomy / lymph node dissection
Éditorial
2008
- Réf : Prog Urol, 2008, 6, 18, 93-93


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Mots clés:
Pascal
Mots-clés:
Prostatic cancer / bone metastasis / Intraoperative scintigraphy
Immunothérapie par Bacille de Calmette-Guérin : quel protocole ?
2008
- Réf : Prog Urol, 2008, 6, 18, 99-104


Plusieurs méta-analyses ont fait le point sur l’efficacité de l’immunothérapie par Bacille de Calmette-Guérin (BCG) dans le traitement des tumeurs de vessie n’infiltrant pas le muscle (TVNIM). Tout d’abord, il a été montré que la BCG-thérapie était supérieure à la résection endoscopique seule pour la réduction du taux de progression tumorale, à condition d’utiliser un protocole d’entretien. En outre, le BCG parait être supérieur à la Mitomycine C dans la prévention des récidives. Le BCG a également prouvé sa supériorité sur la Mitomycine C en ce qui concerne le risque de progression tumorale, à la condition d’être utilisé avec un traitement d’entretien. Le traitement d’entretien par BCG semble donc être l’option de choix pour diminuer à la fois le risque de récidive et de progression tumorale. Les modalités de ce traitement ne sont pas clairement définies. Divers protocoles ont été testés. Parce qu’il a fait la preuve de son efficacité sur une large cohorte et dans une analyse randomisée, le protocole du SWOG est actuellement le plus utilisé. Il consiste en 6 instillations hebdomadaires pour le traitement d’induction, suivies de 3 instillations hebdomadaires à 3, 6, 12, 18, 24, 30 et 36 mois. Il a été montré que la toxicité de la BCG-thérapie était fréquemment responsable d’un arrêt du traitement d’entretien. Chez les patients ayant une mauvaise tolérance à la dose standard de BCG, une réduction de dose semble être une option intéressante pour améliorer la tolérance du BCG tout en préservant a priori son efficacité. Enfin, des travaux récents ont montré qu’il serait préférable d’adapter à chaque patient la dose et la fréquence des instillations d’entretien de BCG. Cette approche individualisée constitue probablement l’avenir de la BCG-thérapie.


Several meta-analyses have reviewed the efficacy of bacille Calmette-Guérin (BCG) immunotherapy in treating nonmuscle-invasive bladder cancer (NMIBC). First, it was shown that BCG therapy was better than endoscopic resection alone in reducing the tumor progression rate, as long as a maintenance protocol was used. Moreover, BCG seems to be superior to mitomycin C in preventing recurrence. BCG has also proven its superiority over mitomycin C in terms of the risk for tumor progression when maintenance treatment is used. BCG maintenance treatment therefore seems to be the choice option to reduce the risk of both recurrence and tumor progression. The modalities for this treatment have not been clearly defined. Several protocols have been tested. Since its efficacy has been proven on a large cohort with randomized analysis, the SWOG protocol is currently the most widely used. It comprises six weekly instillations for the induction treatment, followed by three weekly instillations at 3, 6, 12, 18, 24, 30 and 36 months. It has been shown that BCG therapy toxicity was frequently the reason for interrupting maintenance therapy. In these patients with poor tolerance to the standard BCG dose, reducing the dose seems to be a useful option to improve BCG tolerance while preserving it efficacy. Finally, recent studies have shown that it would be preferable to adapt the dose and frequency of instillations of maintenance BCG to each patient. This individualized approach is undoubtedly BCG therapyʼs future.

Mots clés:
Tumeurs de vessie n’infiltrant pas le muscle / TVNIM / BCG / Immunothérapie / Mitomycine C
Mots-clés:
Nonmuscle-invasive bladder cancer / NMIBC / Superficial bladder cancer / BCG / immunotherapy
Prévention des complications du Bacille de Calmette-Guérin
2008
- Réf : Prog Urol, 2008, 6, 18, 105-110


Le Bacille de Calmette-Guérin (BCG) en instillations intravésicales est le traitement de référence du carcinome urothélial à haut risque de progression. L’observance de ce traitement est altérée par ses effets secondaires loco-régionaux ou généraux potentiellement graves. La prévention de ces complications impose des règles de bonne pratique des instillations. Les effets indésirables doivent être reconnus précocement. Leur traitement doit être rapide et adapté. Les résultats de l’étude française randomisée et contrôlée par placebo ITB01 ont montré que les effets secondaires de classe II du BCG étaient significativement diminués par l’administration orale d’ofloxacine après chaque instillation de BCG. Le nombre d’effets secondaires de classe III nécessitant un recours à un traitement antituberculeux était aussi diminué chez les patients de cette étude ayant reçu de l’ofloxacine.


Bacille Calmette-Guérin (BCG) in intravesical instillations is the reference treatment for urothelial carcinoma with a high risk of progression. Compliance with this treatment is altered by its potentially serious locoregional or general side effects. Prevention of these complications requires implementing rules of good practice for the instillations. The undesirable side effects should be recognized early. Their treatment should be rapid and adapted to the patient. The results of the French randomized, placebo-controlled ITB01 study showed that the class II side effects of BCG were significantly reduced by administration of ofloxacin after each instillation of BCG. The number of class III side effects requiring antitubercular treatment was also reduced in the patients in this study who had received ofloxacin.

Mots clés:
Tumeur de vessie n’infiltrant pas le muscle / TVNIM / BCG / Immunothérapie / Ofloxacine
Mots-clés:
Nonmuscle-invasive bladder cancer / NMIBC / Superficial bladder cancer / BCG / immunotherapy
Prise en charge des carcinomes Ta, T1, et in situ de vessie : quoi de neuf ?
2008
- Réf : Prog Urol, 2008, 6, 18, 94-98


Des évolutions récentes ont modifié la prise en charge des tumeurs de vessie n’infiltrant pas le muscle (TVNIM). La re-résection tumorale a un intérêt prouvé dans les tumeurs à haut risque. L’apport de la cystoscopie à fluorescence est encore en évaluation. La nouvelle classification des tumeurs en haut et bas grade remplace progressivement la classification G1-G2-G3. Des facteurs pronostiques connus mais peu utilisés en pratique tels que l’envahissement prostatique et de la lamina propria méritent d’être rappelés. Les instillations postopératoires précoces font aujourd’hui consensus pour diminuer le risque de récidive des tumeurs Ta et T1. La Mitomycine C peut être optimisée selon des critères précis pour en améliorer l’efficacité. Enfin, il apparaît que le Bacille de Calmette-Guérin (BCG) est le traitement de choix du carcinome in situ , et est supérieur à la Mitomycine C pour les tumeurs à haut risque. Le BCG administré en traitement d’induction suivi d’un entretien diminuerait également le risque de progression.


Since a recent time, some changes were made in the management of nonmuscle-invasive bladder cancer. Second-look resection is efficient in patients with high risk superficial tumors. The interest of resection under fluorescence is still discussed. The new classification in high grade and low grade tumors is progressively replacing the G1-G2-G3 grade classification. New prognosis markers appear such as lamina propria invasion microstaging and prostatic urethra involvement. Immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer. Intravesical Mitomycin C can be optimized to significantly enhance its efficacy. Intravesical Bacillus Calmette-Guérin (BCG) appears to be the treatment of choice for the management of carcinoma in situ, and is superior to Mitomycin C in reducing tumor recurrence in high-risk nonmuscle-invasive bladder cancer. In addition, intravesial BCG significantly reduces the risk of progression after transurethral resection in patients with nonmuscle-invasive bladder cancer who receive maintenance treatment.

Mots clés:
Tumeurs de vessie n’infiltrant pas le muscle / TVNIM / BCG / Pronostic / Mitomycine C
Mots-clés:
Nonmuscle-invasive bladder cancer / NMIBC / Superficial bladder cancer / BCG / prognosis
Tumeurs de vessie n'infiltrant pas le muscle de haut grade (TVNIM): quand cystectomiser ?
2008
- Réf : Prog Urol, 2008, 6, 18, 111-114


Le traitement de référence recommandé pour les patients chez qui a été diagnostiquée une tumeur de vessie n’infiltrant pas le muscle (TVNIM) à haut risque est le Bacille de Calmette-Guérin (BCG) par instillations endovésicales. Néanmoins, la cystectomie peut parfois être indiquée. En effet, certains critères de mauvais pronostics cliniques, endoscopiques et histologiques peuvent permettre d’identifier des patients à très haut risque pour lesquels la cystectomie totale d’emblée doit être discutée. Par ailleurs, en cas d’échec avéré du BCG, la cystectomie reste le traitement de référence. Dans les deux cas (précoce avant BCG ou après échec du BCG), cette chirurgie d’exérèse doit être réalisée sans délai car le risque de progression est majeur et la réalisation de la cystectomie ne souffre aucun délai lorsque son indication est posée.


The reference treatment recommended for patients who have been diagnosed with a high-risk nonmuscle-invasive bladder cancer (NMIBC) is bacille Calmette-Guérin (BCG) therapy through intravesical instillations. Nevertheless, cystectomy can sometimes be indicated. Some of the clinical, endoscopic, and histological criteria indicating poor prognosis can identify very high-risk patients for whom immediate total cystectomy should be discussed. In addition, in cases of clear BCG treatment failure, cystectomy remains the reference treatment. In both cases (early, before BCG treatment, or after BCG treatment failure), this excision therapy should be practiced rapidly because the risk of progression is high and cystectomy tolerates no delay when indicated.

Mots clés:
Cystectomie / Tumeur superficielle de vessie / Haut grade / BCG / Tumeur de vessie n’infiltrant pas le muscle
Mots-clés:
Cystectomy / Nonmuscle-invasive bladder cancer / NMIBC / Superficial bladder cancer / BCG