Base bibliographique

Sommaire :

Effet de l'infiltration pariétale d'anesthésique local (ropivacaïne) sur la douleur postoperatoire après prostatectomie radicale laparoscopique sous-péritonéale
2010
- Réf : Prog Urol, 2010, 6, 20, 435-439


Introduction



Purpose

Evaluation of the efficiency of wound infiltration of ropivacaine in postoperative pain after extraperitoneal laparoscopic radical prostatectomy.


Material and methods

Prospective single institution study included 130 patients treated by extraperitoneal laparoscopic radical prostatectomy from January to March 2007. One hundred and two patients were included and randomised in two groups according to the year of birth (pair or impair). Only patients from the first group (year pair) had wound infiltration at the end of the procedure. The second group (year impair) was the control group. An analogic visual scale (EVA) permitted evaluation of pain at 30 minutes, 1, 6 and 12hours after the procedure. Use of analgesics after procedure were noted for each patient.


Results

In the first group, the median of EVA was 1.44, 1.34, 1.72 and 1.51 respectively at 30 minutes, 1, 6 and 12hours. In the second group, the median of EVA was 1.28, 1.36, 1.46 and 1.44. We found no statistically significant difference for pain and use of analgesic between the two groups (p =0.71, 0.96, 0.47 and 0.86 respectively at 30 minutes, 1, 6 and 12hours).


Conclusion

Ropivacaine in wound infiltration did not decrease significantly the postoperative pain and must not be used systematically.

Mots clés:
Prostatectomie / laparoscopie / Douleur / Anesthésie locale / Ropivacaïne
Mots-clés:
Prostatectomy / Laparoscopy / Pain / Local anesthesia / Ropivacaïne
Faut-il monitorer la température pendant la phase de préservation en transplantation rénale ?
2010
- Réf : Prog Urol, 2010, 6, 20, 430-434


Introduction



Goal

It is generally considered that kidney grafts should be preserved at 4°C during cold storage. However, actual temperature conditions are not known. We decided to study the temperature levels during preservation with the Biotainer® storage can and Vitalpack® transport pack.


Material

Temperature was monitored using the Thermobouton® probe during preservation of pig kidneys, in the same conditions used with human grafts. The probe recorded the temperature level every 10minutes during four days. We compared the results found with the new storage can with results obtained in the same conditions with the storage can formerly used by our team. We also studied the best position of the probe for temperature monitoring and the influence of the amount of ice within the transport pack on the temperature level. We then monitored the temperature during the conservation of actual human kidney grafts harvested at our institution from August 2007 to May 2008.


Results

The temperature levels were the same regardless of the position of the probe within the transport pack. The lowest temperature was maintained during 15hours, and the temperature level stayed below 5°C for 57hours with the new storage can. The former storage can maintained the lowest temperature level for 80minutes, and temperature reached 5°C after 10hours 40minutes. Temperature levels were similar when 2 or 4 kg of crushed ice were used. We observed similar results when monitoring the conservation of human grafts.


Conclusion

The new storage can affords more stable temperature levels when compared to the formerly used can. Since temperature is stable during conservation, continuous monitoring in everyday practice does not seem warranted.

Mots clés:
Rein / Transplantation / Conservation / Transport
Mots-clés:
kidney / Transplantation / Organ preservation / Transportation
Faux anévrisme rénal après chirurgie conservatrice du rein pour cancer : à propos d'un cas et revue de la littérature
2010
- Réf : Prog Urol, 2010, 6, 20, 472-475


Introduction



Renal artery pseudoaneurysm (RAP) is a well-documented complication of percutaneous urologic procedures (biopsy, nephrostomy, nephrolithotomy) and renal trauma. Only few cases occurring after partial nephrectomy for cancer have been reported in the literature. We describe the case of one patient who presented with postoperative haemorrhage due to a RAP after partial nephrectomy. He has been successfully treated by angiographic selective embolization. This complication is rare but potentially life threatening. We describe its clinical and radiological diagnosis, and its management along with the current medical literature.

Mots clés:
Chirurgie rénale conservatrice / Néphrectomie partielle / Faux anévrisme rénal / Embolisation sélective
Mots-clés:
Nephron-sparing surgery / partial nephrectomy / Renal artery pseudoaneurysm / Selective embolization
Hématomes surrénaliens potentialisés par le Synacthène ® (HSS)
2010
- Réf : Prog Urol, 2010, 6, 20, 425-429


Introduction



Objective

Many spontaneous adrenal hematomas have been observed in patients being treated by Synacthène®. The purpose of this study is to define how to take those patients in charge on a short-, mid- and long-term.


Patients and methods

From January 2000 to December 2008, five patients (four males and one female), mean age 47, were taken in charge in our service for spontaneous adrenal hematomas. All those patients had been treated with Synacthène® for a mid-sciatic pain for 72hours. We associated a clinical, endocrine and radiologic staging to treat those patients.


Results

Four patients underwent a watchful waiting, only one patient needed surgery. No adrenal tumor was ever found during the mean two years follow-up (one to four). Two patients suffered of the condition of the antiphospholipid syndrome.


Conclusion

Spontaneous adrenal hematomas are a most uncommon pathology. The clinical attitude has thus to be defined clearly. The patient must be under close clinical evaluation. Biological and morphological parameters have to be often repeated. An adrenal tumor has to be excluded by the evaluation, as that tumor could be secreting or could not be secreting. Antiphospholipid syndrome must also be excluded.

Mots clés:
Hématome surrénalien / Synacthène / / Antiphospholipides
Mots-clés:
Adrenal hematoma / Adrenocorticotropin hormone / Antiphospholipid syndrome
Hyperméthylation et cancer de la prostate
2010
- Réf : Prog Urol, 2010, 6, 20, 408-415


Introduction



The diagnosis of localized prostate cancer is in constant modification. Recent studies on early diagnosis and prognosis analysis have demonstrated the limits of using PSA. The challenge for the upcoming years will be to adapt therapeutic strategies for each patient according to more reliable tests. These objectives apply for DNA methylation analysis. Hypermethylation of the promoter of gene implicated in the carcinogenesis of prostate cancer has been shown as an interesting filed for new tests. So far, DNA methylation tests were assessed on small cohorts of localized prostate cancer patients with promising results when applied on primary tumours and in urine, particularly for patients at high risk of progression after radical prostatectomy. Since the last phase of development for DNA methylation tests will be the industrialization and evaluation on large scale, it is important to have a synthesis on current knowledge of DNA methylation tests in the diagnosis of prostate cancer.

Mots clés:
Cancer de la prostate / Diagnostic / Méthylation de l’ADN / Marqueurs moléculaires
Mots-clés:
prostate cancer / Diagnosis / DNA methylation / Molecular markers
Inflammation et hyperplasie bénigne de la prostate : cause ou conséquence ?
2010
- Réf : Prog Urol, 2010, 6, 20, 402-407


Introduction et objectifs



Introduction and objectives

Although benign prostatic hyperplasia (BPH) is the most frequent disease in elderly men, only a few predictive factors have been clearly identified. Recently, chronic prostatic inflammation has emerged as one of them. This review aims at describing the scientific proof of a relationship between chronic prostatic inflammation and BPH.


Material and method

Searching in the PubMed database identified clinical studies and basic research experiments in relation with the role of inflammation in BPH.


Results

Large clinical studies recently highlighted a relationship between chronic prostatic inflammation and prostate volume or urinary symptoms. Microscopic studies also found numerous inflammatory cells infiltrating BPH tissues. Immune cells are releasing cytokines and growth factors to modulate the immune response but evidences are also showing that they are promoting the epithelial and stromal prostatic cells growth. Moreover, prostatic cells by themselves are able to secrete inflammatory mediators and finally to stimulate their own growth. Once the vicious circle has started, it appears that feedback controls can be overwhelmed and that prostate volume progressively increases.


Conclusion

BPH is a complex disease but chronic prostatic inflammation is one of the mechanisms leading to prostatic enlargement and urinary symptoms.

Mots clés:
hyperplasie bénigne de la prostate / Cancer de la prostate / Inflammation / facteur de risque
Mots-clés:
Benign prostatic hyperplasia / prostate cancer / Inflammation / risk factor
La neuro-urologie : une sur-spécialité en perpétuelle évolution
2010
- Réf : Prog Urol, 2010, 6, 20, 463-464


L’article de Caremel et al. sur l’intérêt porté à la neuro-urologie par les urologues en formation soulève deux questions. Une question sur le fond et une autre sur la forme.


Sur le fond


Mots clés:
P.
Mots-clés:
Neuro-urology / Medical education / questionnaire / Urology residents
Particularités pronostiques, histopathologiques, génétiques et thérapeutiques du carcinome à cellules rénales tubulopapillaire
2010
- Réf : Prog Urol, 2010, 6, 20, 393-401


Introduction



Purpose

We reviewed papillary renal cell carcinoma (PRCC) epidemiology, radiological and clinical presentations, and specific features of morphological subtypes focusing on genetic defects, risk of local and metastatic recurrence and frequency of multifocality.


Materials and methods

The MEDLINE database of the US National Library of Medicine was searched for pertinent studies.


Results

According to multivariate analyses, PRCC histology was not retained as a prognostic factor. Reported rates of multifocality in PRCC are 22 to 41% but distinction between histological subtype or hereditary forms are barely detailed. Multifocality frequency is independent of size, stage or grade and is not associated with ipsilateral or controlateral recurrence or death from RCC. Thus, PRCC multifocality is not an argument against nephron-sparing surgery. Antiangionenic therapies are being evaluated for the Metastatic PRCC.


Conclusion

According to the literature, specific prognostic features of PRCC remain controversial due to the lack of distinction between different PRCC subtypes. Genomic and cytogenetic characterizations have been used to establish an evolving classification of PRCC subtypes and may be a source of new markers that will eventually enable us to precise prognosis and identify targets for new adjuvant therapies.

Mots clés:
carcinome à cellules rénales / Tubulopapillaire / Épidémiologie / Morphologie / Anomalies génétiques
Mots-clés:
Renal cell carcinoma / Tubulopapillary / epidemiology / Morphology / Genetic abnormalities
Pilomatricome scrotal : à propos d'un cas et revue de la littérature
2010
- Réf : Prog Urol, 2010, 6, 20, 469-471


Introduction



Pilomatrixoma, calcifying epithelioma of Malherbe, is a cutaneous tumor, originating from the hair matrix, mostly affecting pediatric population. We report a particularly uncommon location of pilomatrixoma: the scrotal skin. A 46-year-old man, without history, has developed a scrotal, multinodular firm tumor, measuring 10cm. Most often, its preoperative diagnosis is not possible, because of its clinical polymorphism. The precise diagnosis is histological, by the revealing of mummified cells. The treatment is surgical, with only purpose to perform complete removal of pathologic tissue, allowing to decrease the rate of local relapse.

Mots clés:
Épithélioma calcifié de Malherbe / Pilomatricome / Tumeur scrotale
Mots-clés:
Calcifying epithelioma of Malherbe / Pilomatrixoma / Scrotal tumor
Récidives tardives des tumeurs germinales du testicule
2010
- Réf : Prog Urol, 2010, 6, 20, 416-424


Introduction



The late relapses (LR) of germinal cells tumors occur by definition more than two years after a succesful initial care. These rare situations have a poor prognosis with a median survival of 23.9 months after chemotherapy. The LR arise as a general rule at the patient’s suffering from an advanced initial stage NSGCT. The risk is increased by the arising of a first relapse in the first two years which follow the initial treatment. The diagnosis is mostly mentioned in front of symptoms, CT scan or rising markers in 40% of the cases. The LR group includes two very different clinical situations: the LR of the initially watched GCT, treatment of which bases on the standards of first-line stage II tumor treatment; and the LR of NSGCT after a first line chemotherapy, treatment of which bases mainly on surgery which allows a long-term complete remission in more than 50%. Other situations (multifocal, non extirpable tumors) require therapeutic associations and impact the prognosis. The knowledge of particular genetic profiles could allow in the future to identify the germinal tumors at risk of RT and to propose adapted watching.

Mots clés:
Cancer du testicule / Tumeurs germinales non séminomateuses / Récidives tardives / Lymphadénectomies rétropéritonéales
Mots-clés:
Testicular cancer / Non seminomatous germ cell tumor / Late realpses / retroperitoneal lymph node dissection
Résultat d'une enquête par questionnaire sur l'intérêt porté à la neuro-urologie par les urologues en formation
2010
- Réf : Prog Urol, 2010, 6, 20, 458-463


Abréviations



Objectives

To evaluate the interest borne towards neuro-urology within the community of the urology residents.


Materials and methods

Between January and May 2009, all urology residents received an anonymous questionnaire by e-mail estimating their interest for neuro-urology. The analyzed data were: epidemiologic data; participation in theoretical learning and training courses practices; interest and investment in the speciality; opinion on the current formation. The qualitative variables were compared by the chi-2 test. P values <0,05 were considered significant.


Results

The rate of answer was 45,3 %. The middle age was 28,7±2,3 years. Ninety-two (70,7 %) of the 130 urologist residents questioned wished to exert full-time or divided in a hospital structure. They were 40 % to have a multidisciplinary neuro-urology staff, and 80 % were in a service which dealt with suffering patients of neurological bladder. The percentage of urologist residents interested by neuro-urology was 69,2 %, and 61,5 % of them wished to practice this activity in their future exercise. This wish was significantly higher for those resulting from the ENC (p <0,05), for those wishing to exert at the hospital (p <0,01) and for those who practice urology at a level of expertise in neuro-urology (p <0,01). The theoretical and practical teaching of neuro-urology were considered as being insufficient for respectively 73,9 % and 64,2 % of the urologist residents. In contrast, the average note allotted to the neuro-urology module of the ECU was of 7,47 out of 10.


Conclusion

Neuro-urology seems to be particularly attractive for the urologist residents, and many wished to integrate it in their future exercise. The motivation was more important for those who wished to carry out a career in hospital. Even if the quality of the teaching was very noted, their modalities were considered to be insufficient by most of them.

Mots clés:
Formation médicale / Neuro-Urologie / questionnaire / Urologue en formation
Mots-clés:
Neuro-urology / Medical education / questionnaire / Urology residents
Sarcome à cellules claires du rein : à propos d'un cas pédiatrique
2010
- Réf : Prog Urol, 2010, 6, 20, 465-468


Introduction



Clear-cell sarcoma of the kidney (CCSK) is a rare malignant tumor of childhood, known for its aggressiveness, its tendency to recurrence and to metastasis to bone. We report an observation of a child of 48 months carrying a large abdominal mass. The diagnosis of the SCCR was made on biopsy, since imaging remained uncertain as to the renal origin of the mass. Indeed, our observation underlines the difficulty of its diagnosis. Excepting the morphological aspect, there is no criterion for its recognition. Its prognosis has been improved by the new treatments.

Mots clés:
Tumeur / Rein / Enfant / sarcome / Cellules claires
Mots-clés:
tumor / kidney / child / Sarcoma / Clear-cell
Signes de lutte dans les vessies neurologiques des lésions de la queue de cheval et du cône terminal
2010
- Réf : Prog Urol, 2010, 6, 20, 450-457


Introduction



Introduction

The bladder deformations observed in the neurogenic bladders are frequent, particularly in the “upper motor neuron” bladder type (paraplegia, multiple sclerosis). We wanted to verify the predictive factors of such damage and particularly, if the urodynamic typology intervened in their genesis by using the model of cauda equina syndrome and conus medullaris lesions.


Patients and methods

We have studied retrospectively the presence of cystographic bladder deformations at patients with neurogenic bladder due to cauda equina syndrome or conus medullaris lesion according to their urodynamic status: either overactive or acontractile detrusor.


Results

Of 68 patients, (mean age 47.2 years), 34 had an overactive and 34 an acontractile detrusor. The presence of bladder deformations was associated with an overactive detrusor (p =0.04). However, 50% of the patients with acontractile detrusor had bladder deformations, and those deformations were associated with male sex, and this excluding urologic obstruction.


Conclusion

This study demonstrates the existence of bladder deformations in the hypoactive lower motor neuron neurogenic bladder type. If the bladder deformations seem more frequent in the overactive neurogenic bladder type, their specific and repeated search is also necessary during the follow-up of the lower motor neuron neurogenic bladder type.

Mots clés:
vessie neurologique / Syndrome de la queue de cheval / cystographie / Diverticules / Trabéculations
Mots-clés:
Neurogenic bladder / diverticulum / Acontractile detrusor / Cauda equina syndrome / Cystography
Tumeur urothéliale de vessie T1 : valeur pronostique du franchissement de la muscularis mucosae (T1a/T1b). Étude multicentrique du Comité de cancérologie de l'Association française d'urologie (CCAFU)
2010
- Réf : Prog Urol, 2010, 6, 20, 440-449


Introduction



Objective

The aim of this multicenter study was to determine the prognostic value of the depth of invasion of lamina propria and more specifically the influence of the invasion of the muscularis mucosae on survival parameters in T1 bladder carcinoma.


Patients

Six urological centers included patients between 1994 and 2004 who had an initial T1 bladder tumor. All T1 tumors were substaged according to the muscularis mucosae (MM) invasion into T1a (no invasion beyond the MM) and T1b (invasion beyond MM but preserving the muscle). Among the 387 patients included, 269 (69.5%) were found T1a and 118 (30.5%) T1b. Mean follow-up was 45.4 months. T1a and T1b groups were comparable except for tumor grade that was higher in T1b (p <0.001).


Results

Survival without recurrence was not significantly different between T1a and T1b groups (p <0.3) but T1a stage was found as an independent factor for survival without progression (RR=0.49; IC 95%=[0.71–0.90]), specific survival (RR=0.33; IC 95%=[0.16–0.67]) and global survival (RR=0.52; IC 95%=[0.32–0.85]).


Conclusion

This study, the largest on the subject to our knowledge, have shown that muscularis mucosae invasion was a prognostic factor for survival without progression, specific survival, and global survival. We support that routine pathological assessment of the level of MM invasion in patients with stage T1 bladder cancer should be included in the histopathological report.

Mots clés:
Cancer / Muscularis mucosae / Survie / Vessie / Chorion
Mots-clés:
Cancer / Muscularis mucosae / survival / bladder / Lamina propria