Base bibliographique

Sommaire :

Analyse critique des classifications pronostiques du cancer du rein métastatique
2009
- Réf : Prog Urol, 2009, 6, 19, 383-388


Introduction



A prognostic factor is a statistically associated variable with an event in a certain context. In the case of metastatic renal cell carcinoma, the variables are the clinical, biological and histological features of the cancer and its host, the event is the deaths linked to the cancer and context is the treatment suffered by the patient. Several prognostic classifications have permitted to predict the response to the different treatment of metastatic renal cell carcinoma. This review has aimed to put the main prognostic classifications in context of applicability so that the clinician uses them wisely. The classification of the French Group of Immunotherapy allows the clinician to determine the indications of treatment with IL-2 and IFN and Motzer classification of 2002 must be reviewed to determine the indications targeted therapies.

Mots clés:
carcinome à cellules rénales / Métastase / Pronostic / Thérapeutiques ciblées / Immunothérapie
Mots-clés:
Renal cell carcinoma / metastasis / prognosis / Targeted therapy / immunotherapy
Critères de décision et recommandations de bonne pratique clinique pour la première injection intradétrusorienne de toxine botulique A dans le traitement de l'hyperactivité neurogène du détrusor
2009
- Réf : Prog Urol, 2009, 6, 19, 372-382


Introduction



Botulinum toxin A intradetrusor injections have revolutionised the treatment of neurogenic detrusor overactivity. Based on a systematic literature review, the french speaking group of neuro-urology (Genulf) propose clinical guidelines concerning the indications of the first injection.

Mots clés:
Vessies neurologiques / Hyperactivité du détrusor / Toxine botulique / Injection intradétrusorienne
Mots-clés:
Neurogenic bladder / Neurogenic detrusor overactivity / Botulinum toxin / Intradetrusor injection
Découverte histologique fortuite d'une orchiépididymite à microsporidie chez un patient atteint de Sida
2009
- Réf : Prog Urol, 2009, 6, 19, 439-441


Introduction



Incidences of opportunistic infections of the epididymus and the testicule have already been reported in patients suffering from AIDS for over 10 years. Here we have reported the first description of microsporadic orchiepididymitis diagnosed at the university hospital (CHU) of Nice in 2005. We look at the epidemiology, the physiology and the treatment of this extremely rare infection.

Mots clés:
Orchiépididymite / Microsporidie / VIH
Mots-clés:
Orchiepididymitis / Microsporidia / HIV
Editorial Board
2009
- Réf : Prog Urol, 2009, 6, 19, iii
Mots clés:
Transplantation domino / Retransplantation rénale / Transplantation donneur vivant
Mots-clés:
Domino transplantation / Kidney retransplantation / Living-donor transplantation
Étiologie et prise en charge de la dysfonction érectile chez le patient diabétique
2009
- Réf : Prog Urol, 2009, 6, 19, 364-371


Introduction



Prevalence of erectile dysfunction (ED) has a higher incidence in patients treated for diabetes mellitus as it concerns more than 30% of them. ED’s physiopathology is complex and multifactorial, involving a combination of classical risk factors (endothelial dysfunction), specific factors (e.g., diabetic neuropathy) and psychological factors. ED is most often forewarning a cardiovascular disease. Therefore, it needs to be detected by the physician who is taking care of the diabetic patient. ED is responsible for a deterioration of the quality of life. Therapeutic management relies, on one hand, on specific measures such as prevention of diabetic complications and, on the other hand, on psychological accompaniment of the patient. Phosphodiesterase-5 inhibitors have become the first-line treatment as they are efficient and safe in most cases. As a second line, intracavernous injections remain a gold-standard treatment but the vacuum can be proposed as well. In case of failure, penile prosthesis can even be considered. The psychological dimension of ED has to be considered as much as organic matters.

Mots clés:
diabète / Dysfonction sexuelle / Dysfonction endothéliale / érection / dysfonction érectile
Mots-clés:
Diabetes mellitus / Endothelial dysfunction / Sexual dysfunction / érection / erectile dysfunction
Évaluation prospective de l'intérêt des urologues en formation pour l'andrologie
2009
- Réf : Prog Urol, 2009, 6, 19, 427-433


Introduction



Objective

To evaluate the interest carried in andrology within the community of the urology residents.


Material and methods

Between June and October 2008, all urology residents received an anonymous questionnaire by e-mail estimating their interest for andrology. The following elements were reported: age, sex, current status, future activity, participation in theoretical learning and training courses practices, interest for the speciality and the opinion on the current formation. The statistical analysis was performed with the SEM software.


Results

Seventy-seven of the 238 urology residents (32.4%) answered the sent questionnaire. The mean age was 29.2 years (25–36). Thirty-two of them were from a Parisian center (41.6%) and 45 (58.4%) from another city. There are 40.3% of urology residents who wished work on the hospital, 27.3% wished develop an exclusive liberal activity. There are 81.8% of the urology residents who declared to be interested in andrology and 29.9% were registered or wished to join the diplôme d’études spécialisées complémentaires (DESC) of Andrology. Concerning the current formation, only 4% of the participants considered that the theoretical education of the andrology was sufficient and only 6.6% of them considered to have acquired a sufficient practical training in andrology during the cursus.


Conclusion

The andrology is a particularly attractive speciality for the urology residents and the current modalities of formation are considered insufficient by most of them.

Mots clés:
urologie / andrologie / Motivation / apprentissage / Enseignement médical
Mots-clés:
Urology / andrology / Motivation / learning / Medical education
Fistule recto-urétrale après prostatectomie : cure chirurgicale par double voie d'abord cœlioscopique et périnéale. Technique et résultats à propos de deux cas
2009
- Réf : Prog Urol, 2009, 6, 19, 434-437


Introduction



Purpose

RUF is a rare occurrence usually following radical prostatectomy. We report our short experience and outcomes with the repair of Iatrogenic Recto-urinary fistula using a combined laparoscopic and perineal approach.


Patients and methods

We retrospectively reviewed the medical records of our patients who underwent lately a combined approach using laparoscopic and perineal procedure. Two patients in our unit underwent a RUF repair associating a laparoscopic mobilization of the omentum and a perineal closure. A temporary colostomy was performed at the time of RUF diagnosis and closed few weeks after the RUF repair procedure. Procedure time was 255mn. Blood loss was short and no transfusion was required.


Results

All fistulae were closed within a short hospitalization time and an easy outcome. The delay between the diagnosis and the final closure of the colostomy was reduced to 3 months in our short experience.


Conclusion

The procedure is safe and provides nice exposure and a thick and very well vascularized flap. Shortening the management of this complication after reduces the anxiety of the patients and his medical team.

Mots clés:
Fistule recto-urétrale / Technique chirurgicale urologique / cancer de prostate
Mots-clés:
Recto-urethral fistula / Urological surgical procedures
IRM dynamique quantitative et localisation du cancer de prostate non palpable
2009
- Réf : Prog Urol, 2009, 6, 19, 401-413


Introduction



Purpose

To determine whether quantitative dynamic contrast-enhanced MRI improves the performance of T2W–MRI for the localisation of non-palpable prostate cancer (PCa) and for the estimation of tumor volume.


Materials and methods

Twenty-three patients (PSA: 8.91±6.2ng/m) with a non-palpable cancer underwent endorectal MRI with T2W and dynamic contrast enhanced (DCE) imaging before radical prostatectomy. Each level of evaluation (apex, mid-portion, base) was divided in eight areas (24 areas per prostate and 552 areas for the 23 patients). Localisation and volume of tumor foci greater than 0,2cc present on the radical prostatectmoy specimens were retrospectively correlated to their MR appearance on the 552 evaluated areas. The dynamic parameters included capillary permeability (K trans), maximum concentration of gadolinium after 60s of perfusion ([Gd]) and wash-out (K ep ). Uni- and multivariate analysis were performed to determine which parameters were predictive of PCa.


Results

Mean values of K trans, K ep and [Gd] were significantly higher in the 58 tumor foci greater than 0,2 cm3 of the PZ and the TZ (all p <0.05). Logistic regression for each zone provides provided a value of the area under the ROC curve of 0.83 for the PZ and 0.81 for the TZ (0.7 and 0.75, respectively, for the T2W imaging), only significant for the PZ (p <0.002). Sensitivity and specificity were 79 and 77% for the PZ, 62.5 and 94% for the TZ. Above 0,2 cm3, tumor volume on dynamic MR showed a mean difference of 51±100% (range: −145 to +248%).


Conclusions

Quantitative dynamic MRI is more accurate than T2W imaging for tumor localisation of non-palpable cancer greater than 0,2 cm3, but the difference is only significant for the PZ. Above this volume, correlation between tumor volume measured on dynamic MRI and that on the specimen is poor.

Mots clés:
cancer de prostate / Localisation / Volume tumoral / IRM dynamique quantitative
Mots-clés:
prostate cancer / Localisation / Tumor volume / Quantitative dynamic contrast
Kyste hydatique rétropéritonéal géant
2009
- Réf : Prog Urol, 2009, 6, 19, 442-445


Cas clinique



Hydatidosis is an endemic, widely distributed anthropozoonosis, which involves the liver, lung and other organs [Int J Urol 13 (2006) 76–9]. We reported the case of a large retroperitoneal hydatid cyst, which is a rare situation [Hepatogastroenterology 48 (2001) 1037–9; Int Urol Nephrol 32 (2000) 41–6; J Urol (Paris) 94 (1988) 445–8]. Diagnosis was suspected with blood tests and radiological examinations. A wide incision in the right iliac fossa (such in renal graft) was performed. The cyst wall was excised partially. Before, during and following the operation, the patient was given albendazole tablets (15mg/kg per day) for 3 weeks (1 week before and 2 weeks after the surgery) with blood count and liver enzyme monitorization. Especially in the endemic areas, hydatid cyst should be remembered when evaluating cystic masses in the retroperitoneum. It can be treated successfully with surgery.

Mots clés:
Rétropéritoine / kyste hydatique / Scolicide
Mots-clés:
retroperitoneum / hydatid cyst / Scolicid
La longueur des biopsies prostatiques conditionne l'identification des éléments capsulaires et périprostatiques
2009
- Réf : Prog Urol, 2009, 6, 19, 414-418


Introduction



Objective

To evaluate the influence of the length of prostate biopsies (PB) on identification of prostatic capsule and periprostatic tissue.


Materials and method

A prospective study was carried out in one center by two urologists during 22 months on 339 consecutive protocols of standardized ten-needle PB (PSA<10ng/ml regardless of digital rectal examination). Pathologic reports were standardized. The conclusion of the pathologic report included the average length of the ten-needle PB (Lm) and the number of prostatic core biopsies on which pathologist identified prostatic capsule and periprostatic tissue (BCI). Protocols of PB were spread in 16 groups depending on the value of Lm in millimeter: [0–1], [1–2], [2–3]… [15–16]. Relationship between Lm’s and BCI’s was evaluated using the linear regression and the correlation coefficient (r ).


Results

Average Lm=10.7 (2.1–15.7; s=2.3) (n =339). Average BCI=6.6 (0–10; s=2.3) (n =339). The value of IGap increased when the value of Lm increased (r =0.89).


Conclusions

The pathologists better identify the capsule of the prostate and the periprostatic tissue when the PB’s are of large size. PB’s of small size are of poor quality either for samplings of the prostatic gland or samplings of the capsule and the periprostatic tissues.

Mots clés:
Biopsie / prostate / Cancer / Diagnostic
Mots-clés:
Biopsy / prostate / Cancer / Diagnosis
Les traitements de recours dans la cystite interstitielle
2009
- Réf : Prog Urol, 2009, 6, 19, 357-363


Introduction



Interstitial cystitis is the first cause of bladder pain. In case of failure of the usual treatments, several other modalities have been proposed. These therapeutic modalities are posterior sacral root neuromodulation, posterior tibial nerve stimulation, vanilloid agent intravesical instillation, intradetrusor botulinum toxin injections and surgery. A certain efficiency of each of these treatments in the interstitial cystitis has been reported. However, the evaluation of these treatments is limited and the level of evidence is too low to propose these treatments in routine.

Mots clés:
cystite interstitielle / neuromodulation / Toxine botulique / Agents vanilloïdes / Chirurgie
Mots-clés:
interstitial cystitis / neuromodulation / Botulinum toxin / Vanilloid agents / Surgery
Névralgies obturatrices : prise en charge et résultats préliminaires de la neurolyse laparoscopique
2009
- Réf : Prog Urol, 2009, 6, 19, 420-426


Introduction



Aims

Obturator neuralgia is a pain which is ill-defined and particularly less well-known to practitioners. Here we report on the etiologies, the treatment and the results of conservative laparoscopic treatment by neurolysis of the obturator nerve in cases of obturator neuralgia.


Patients and method

Thirteen patients (15 nerves) who had obturator neuralgia have been treated in our service since 2005. The etiologies were idiopathic (four cases), following surgery for an inguinal hernia (two cases), trauma of the pelvis (one case), a TVT strip (three cases) and a TOT strip (three cases). The diagnosis was based on the pain, which was neuropathic, of the antero-internal side of the thigh. It was confirmed under block anesthetic by tomodensitometry using a posterior approach. The treatment consisted of laparoscopic neurolysis.


Results

The patients suffered pain measured at a rate of 8/10 on the visual analogical scale before the operation. In each case, neurolysis was carried out by transperitoneal laparoscopy by dissecting the nerve and sectionning the scarring fibrosis where the prothesis was in contact. In the idiopathic cases, the liberation of the nerve was carried out by a section of the internal obturator muscle and of the obtured membrane, allowing for the blocked canal to be widened. Seventeen months later, a rate of improvement of at least 50% of pain was found in 77% of cases (10/13), of whom pain had totally disappeared in 54% of cases (7/13). There was no improvement at all for 23% of cases (3/13).


Conclusion

The mini-invasive conservative treatment of obturator neuralgia by laparascopic neurolysis of the obturator nerve, after confirmed diagnosis by selective infiltration allowed for a rate of 75% of improvement to be obtained after a period of 17 months.

Mots clés:
Nerf obturateur / Douleur / Pelvienne / Neuropathie / TVT
Mots-clés:
Obturator nerve / Pain / Pelvic / Neuropathy / TVT
Prévalence et composition de la lithiase urinaire dans une population pédiatrique tunisienne
2009
- Réf : Prog Urol, 2009, 6, 19, 395-400


Introduction



Objectives

The epidemiologic characteristics are significant to take into account in order to determine the etiology of the paediatric urinary calculi. In this study we studied the composition of stones according to the sex and the age.


Patients and methods

Our study focuses on 205 tunisian children aged between three months and 16 years, admitted in our service between 1993–2007. A first urinary metabolic balance was conducted among 126 patients. The physical and chemical stones analysis was performed respectively by a stereomicroscope and infrared spectroscopy. Statistical analysis of the results was made using the software SPSS11.0.


Results

Bladder stone was present in 30.7%. It was more frequent in infants than children over 10 years (p <0.02). The Whewellite was present in 72.7% and predominant in older children stones (59.3% vs 42.9% in infants) (p <0.05). Purines stones were more common among infants. Struvite has been the major compound in only 7.8% of cases where it was more common in infants (p <0.05) male (p <0001).


Conclusion

The higher prevalence of calcium oxalate stones and weaker purin ones in old children suggested the presence of different lithogenous factors of risk according to the age. A modification of the food practices is probably in question.

Mots clés:
Calculs urinaires / Enfants / Âge / Sexe / Tunisie
Mots-clés:
urinary stones / child / Âge / Sex / Tunisia
Prise en charge des fistules uréthrorectales iatrogènes après prostatectomie totale
2009
- Réf : Prog Urol, 2009, 6, 19, 437-438

Mots clés:
M.
Mots-clés:
Recto-urethral fistula / Urological surgical procedures
Qualité des biopsies prostatiques et taille des biopsies
2009
- Réf : Prog Urol, 2009, 6, 19, 418-419


Les auteurs se sont intéressés à la question importante et de pratique quotidienne des biopsies prostatiques. La valeur moyenne de la longueur des biopsies augmentait avec celle des éléments extracapsulaires et la relation qui existait entre ces deux variables était linéaire. Ce travail a démontré la forte corrélation entre ces deux critères de qualité des biopsies.

Mots clés:
E. / G.
Mots-clés:
Biopsy / prostate / Cancer / Diagnosis
Résultats et complications chirurgicales de la néphrectomie donneur vivant : lombotomie vs laparoscopie manuellement assistée
2009
- Réf : Prog Urol, 2009, 6, 19, 389-394


Introduction



Purpose

Hand-assisted laparoscopic nephrectomy in living donors is a minimally invasive surgical modality. Laparoscopic nephrectomy is now a routine procedure. This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor. Donor morbidity and graft function in the laparoscopic group were compared with those in the open group.


Materials and methods

We retrospectively reviewed the medical records of 53 consecutive laparoscopic nephrectomy and compared them with 60 consecutive open donor nephrectomies.


Results

Demographic data of donors and recipients were similar in the two groups. No conversion to open surgery was necessary. Laparoscopic group patients had a shorter hospital stay compared to those undergoing open surgery. Long-term follow-up of serum creatinine levels revealed no significant differences among the two groups: at 3.6 and 12months: 112 (±27) versus 122 (±11), 111 (±25) versus 119 (±19), 114 (±23) versus 122 (±25). There was no difference between hand-assisted laparoscopic nephrectomy (two vesico ureteral leak, three hematoma (one needed a surgical revision) and lombotomy (one vesico ureteral leak, one hematoma needed a surgical revision, two arteries stenosis). The rate of recipient ureteral stenosis in the laparoscopic and open nephrectomy groups was 0 of 39 cases and two of 60, respectively. Two vesico ureteral leak versus none appear in the lapararoscopic group.


Conclusion

Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure which presented low morbidity after surgery. This provides equal graft function equal urological complications compared to open live donor nephrectomy. This is our reference method.

Mots clés:
Néphrectomie / Transplantation / Donneur vivant / laparoscopie / Assistance manuelle
Mots-clés:
nephrectomy / Transplanatation / living donor / Hand-assited laparoscopic nephrectomy
Oncoforum Urology 2008
2009
- Réf : Prog Urol, 2009, 6, 19, S27, suppl. S2


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Mots clés:
Tumeur de la voie excrétrice supérieure / carcinome urothélial / Cancer du testicule / Surveillance / Pronostic
Mots-clés:
Urinary tract cancer / Renal cell carcinoma / prostate cancer / Urothelial carcinoma / testis cancer
Quelles nouveautés en 2008 dans le cancer de la prostate en recherche clinique et en recherche fondamentale ?
2009
- Réf : Prog Urol, 2009, 6, 19, S29, suppl. S2


En 2008, le cancer de la prostate a fait l’objet de nombreuses communications dans les congrès internationaux. Les études les plus marquantes et les plus innovantes, susceptibles de modifier la prise en charge des patients et l’attitude thérapeutique des cliniciens ont été sélectionnées. L’impact du dépistage du cancer de la prostate et l’intérêt de marqueurs urinaires comme le PCA3 ont été évalués. La surveillance active nécessite d’être évaluée et ses modalités restent à définir. Actuellement, il est recommandé d’inclure les patients dans des protocoles. La place de la prostatectomie totale dans la prise en charge du cancer de prostate à haut risque ou localement avancé a été discutée. Le curage étendu divise par deux le risque de récidive biochimique, mais il pose encore des problèmes quant à sa faisabilité technique. Les modalités de la radiothérapie, de l’hormonothérapie et le bénéfice des traitements intermittents ont été abordés. L’hormonothérapie a montré son intérêt en traitement prolongé. Un traitement d’une durée de trois ans a plus de bénéfice qu’un traitement de six mois. Dans une situation de résistance à l’hormonothérapie, il faut effectuer un dosage de la testostéronémie afin de vérifier le seuil de castration. L’intérêt d’un traitement hormonal à l’origine d’une castration efficace (seuil de testostérone < 20 ng/dl) a été souligné pour réduire la mortalité spécifique.

Mots clés:
Cancer de la prostate / dépistage / Prostatectomie totale / radiothérapie / Hormonothérapie
Mots-clés:
prostate cancer / Screening / radical prostatectomy / radiotherapy / Hormonotherapy
Quelles nouveautes en 2008 dans le cancer de la vessie en recherche clinique et en recherché fondamentale ?
2009
- Réf : Prog Urol, 2009, 6, 19, S43, suppl. S2


La cytologie urinaire a fait l’objet de plusieurs communications, sa rentabilité a été mise en cause. L’intérêt de la cystoscopie en fluorescence a été montré tant pour le diagnostic que pour la thérapeutique, mais il reste à définir ses indications précises. Pour les tumeurs de vessie n’envahissant pas le muscle, le traitement d’entretien et l’instillation postopératoire précoce ont été évaluées. Le traitement d’entretien par mitomycine C ou BCG, lorsqu’il est indiqué, devrait être instauré pour une durée minimale d’un an. Pour les tumeurs de vessie infiltrant le muscle, la laparoscopie a été comparée à la voie ouverte, le curage ganglionnaire a été évalué ainsi que la chimiothérapie néo-adjuvante. La cystectomie totale était recommandée à l’issue d’une chimiothérapie néo-adjuvante, même pour les patients cT0 après chimiothérapie. Pour les carcinomes du haut appareil, il n’existe pas de différence carcinologique entre la chirurgie par voie ouverte ou laparoscopique.

Mots clés:
Cancer de vessie / Cystectomie / BCG / Épirubicine / Mitomycine
Mots-clés:
bladder cancer / Cystectomy / BCG / Epirubicin / Mitomycin
Quelles nouveautes en 2008 dans le cancer du rein ?
2009
- Réf : Prog Urol, 2009, 6, 19, S56, suppl. S2


Les travaux les plus innovants présentés lors des congrès internationaux 2008 dans le domaine du cancer du rein ont été sélectionnés. Pour le cancer du rein localisé, l’une des innovations diagnostiques est représentée par l’échographie de contraste. De nombreuses communications ont porté sur les marges positives chirurgicales et leur impact ainsi que les éléments conduisant à une altération de la fonction rénale après néphrectomie. La néphrectomie laparoscopique assistée par robot semble être une technique sûre et efficace. Les traitements mini-invasifs peuvent être intéressants. Pour le cancer du rein métastatique, le sunitinib a été comparé à l’IFN-⍺ en première ligne et des données de survie sont disponibles. L’everolimus pourrait devenir un traitement de seconde ligne de référence après echec d’inhibiteur de tyrosine kinase.


The most innovating studies presented at the 2008 international conferences in the field of kidney cancer were selected. In localized kidney cancer, contrast-enhanced ultrasonography could be a new diagnostic tool. Many communications dealed with positive surgical margins and their consequences, and predictive factors of chronic kidney disease after nephrectomy. Robot-assisted laparoscopic nephrectomy seems to be a safe and effective technique. Mini-invasive treatments are promising. In metastatic kidney cancer, sunitinib was compared to IFN-⍺ in first line treatment and survival data are now available. Everolimus could become the new standard after tyrosine kinase inhibitor failure.

Mots clés:
cancer du rein / Néphrectomie partielle / Insuffisance rénale / Marges chirurgicales positives / Radiofréquence
Mots-clés:
Kidney cancer / partial nephrectomy / Chronic kidney disease / Positive surgical margins / Radiofrequency
Quelles nouveautes en 2008 dans le cancer du testicule et du pénis en recherche clinique et en recherche fondamentale ?
2009
- Réf : Prog Urol, 2009, 6, 19, S51, suppl. S2


Peu de communications ont été dédiées cette année aux cancers des organes génitaux externes de l’homme. Dans les séminomes testiculaires de stade I, les données comparant la chimiothérapie par 1 cure de carboplatine à la radiothérapie rétropéritonéale en traitement adjuvant ont été mises à jour. Les localisations des récidives différaient selon le type de traitement. Pour les tumeurs germinales non séminomateuses de stade I, la surveillance active semblait une option possible en l’absence d’emboles vasculaires. De même la chimiothérapie par 1 cure de BEP était supérieure au curage ganglionnaire rétropéritonéal à long terme. Pour les tumeurs à cellules à Leydig, la chirurgie partielle était possible. Dans la prise en charge du cancer du pénis, la lymphoscintigraphie semblait être intéressante. Pour les tumeurs T1, la microchirurgie au laser CO2 pourrait avoir un intérêt.μ

Mots clés:
Cancer du testicule ;Carboplatine ;Radiothérapie ;Surveillance active ;Cancer du pénis ;Ganglion sentinelle
Mots-clés:
Testis cancer ;Carboplatin ;Radiotherapy ;Active surveillance ;Penile cancer ;Sentinal lymph node