Base bibliographique

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Carcinosarcome du bassinet sur rein en fer à cheval : à propos d'un cas
2012
- Réf : Prog Urol, 2012, 6, 22, 360-362


Introduction



Carcinosarcoma of the renal pelvis is a rare tumor, and its development in a horseshoe kidney makes it even more special. This is the first case reported in the literature of a renal pelvis carcinosarcoma developed in a horseshoe kidney and diagnosed on macroscopic hematuria.

Mots clés:
Carcinosarcome / Rein en fer à cheval / Pronostic
Mots-clés:
Carcinosarcoma / Horseshoe kidney / prognosis
Implantation asynchrone d'une prothèse pénienne (AMS 700) chez des patients avec un sphincter urinaire artificiel (AMS 800) : quels sont les résultats fonctionnels de l'AMS 1500 ?
2012
- Réf : Prog Urol, 2012, 6, 22, 354-359


Introduction



Objective

To report the functional results and morbidity after metachronous implantation of an AMS 800 artificial urinary sphincter (AUS) and an AMS 700 inflatable penile prosthesis (IPP).


Patients and methods

From the 250 patients treated in our department between 2000 and 2011 for the insertion of an AUS, we retrospectively selected patients who also underwent implantation of an IPP. The following data were recorded: age, aetiology of urinary incontinence (UI) and erectile dysfunction (ED), treatment history of UI/ED, date of insertion of the AUS and the IPP and time gap between the two implants. We evaluated both the pad-test and the number of protective pads used per day, before and after AUS insertion. We also analysed the IIEF5 score before and after IPP. Patients were reviewed at 3, 6 and 12 months and annually thereafter.


Results

In total, five patients were included. The median age was 69 years. The median follow-up after IPP was 22.6 months and the time gap between the two implants was 50 months. The aetiology of UI and ED was prostate surgery in four cases. Complete continence without leakage was observed in three patients and the IIEF5 score increased from 6.6 preoperatively to 22.2 for four patients. One patient developed a urethral erosion of the AUS cuff 6 months after implantation of the IPP. The AUS cuff has been explanted but the patient remains continent with the IPP cylinders semi-inflated.


Conclusion

From our small study, it appears that the combined use of an AMS 800 AUS and an AMS 700 IPP was a feasible and efficacious option in patients with concomitant refractory UI and ED.

Mots clés:
Prostatectomie / incontinence urinaire / impuissance / Chirurgie / urologie
Mots-clés:
Prostatectomy / Urinary incontinence / impotence / Surgery / Urology
L'existence d'emboles vasculaires tumoraux doit être mentionnée sur le compte rendu anatomopathologique après exérèse d'une tumeur de la voie excrétrice urinaire supérieure
2012
- Réf : Prog Urol, 2012, 6, 22, 363-364

Mots clés:
M.
Mots-clés:
Carcinosarcoma / Horseshoe kidney / prognosis
La chirurgie prothétique combinée est-elle une alternative thérapeutique de dernière ligne raisonnable pour le traitement de l'incontinence urinaire associée à une impuissance chez l'homme ?
2012
- Réf : Prog Urol, 2012, 6, 22, 365-366


Les auteurs abordent la question des séquelles génito-sphinctériennes de la prostatectomie radicale sous un angle original et pragmatique. Ils rapportent leur expérience des deux traitements « de dernière ligne » de l’incontinence urinaire associée à une impuissance : la pose de prothèse pénienne gonflable après la pose d’un sphincter artificiel urinaire.


Mots clés:
A.
Mots-clés:
Carcinosarcoma / Horseshoe kidney / prognosis
La neuromodulation des racines sacrées dans le traitement de la double incontinence : revue comparée de la littérature
2012
- Réf : Prog Urol, 2012, 6, 22, 318-325


Abréviations



Urinary and fecal incontinence are common conditions which are frequently associated and defining double incontinence. When conservative treatments fail, sacral nerve modulation (SNM) is considered to be a first-line treatment for patients with urge urinary incontinence and for patients with fecal incontinence. The present article aims to determine the effect of SNM on the treatment of double incontinence. A medline search for clinical studies with SNM and double incontinence was carried out, extracted data were reviewed and analysed. The results of SNM in patients with double incontinence has been reported in seven studies (120 patients). The percentage of patients suffering from double incontinence improved on the urinary and fecal incontinence varied between 32% to 75%. This review reports the effectiveness of the SNM on the urinary and fecal incontinence in this population of double incontinence patients. Its main advantage would be to treat two incontinence by a single treatment. The search of predictive factors of success must be given.

Mots clés:
Neuromodulation des racines sacrées / Double incontinence / incontinence urinaire / Incontinence fécale / Épidémiologie
Mots-clés:
Sacral neuromodulation / Double incontinence / Urinary incontinence / Fecal incontinence, Epidemiology
La radiothérapie hypofractionnée dans le traitement du cancer de prostate : irradier moins pour traiter plus
2012
- Réf : Prog Urol, 2012, 6, 22, 326-330


Introduction



The principle of the hypofractionation in radiotherapy is to deliver a higher dose by session and to reduce the duration of treatment. In the particular case of the cancer of prostate, a hypofractionned protocol allows to deliver an equivalent radiobiological dose identical even higher than a standard plan of irradiation. The hypofractionation is presented as a solution to improve the access to the care (fewer processing times by patient, more patients treated by machine) while increasing the quality of the care: better carcinologic control, less radiotoxicity. The objective of this article is to make a clarification on the hypofractionned radiotherapy in first intention in the treatment of the localized prostate cancer. We count three studies on large cohorts, comparing standard plans to 1.8–2Gy/session and hypofractionned plans (2.5–3Gy/session). The inferior carcinologic results of the two first comparative studies with regard to the study of phase I/II of the Cleveland clinic were owed to a sub-dosage of hypofractionned plans. The administered equivalent biological doses were lower than the at present recommended total doses and lower than the theoretical doses, calculated on the bases of an erroneous evaluation of the radiosensibility of the prostate cancer. In the comparative study of Arcangeli, the rate of survival without biological recurrence in 4 years (82%) was significantly to the advantage of the hypofractionned group, while reducing the duration of treatment of 3 weeks. Four comparative studies reported aigues/late toxicity, gastrointestinal (GI)/genito-urinary acceptable (GU) even lower with a hypofractionned plan. The hypofractionation is potentially the future of the radiotherapy in the treatment of the localized prostate cancer thanks to the technological innovation, but for all that does not constitute at present a standard.

Mots clés:
Hypofractionnement / Radiothérapie hypofractionnée / cancer de prostate / Radiobiologie / Ratio ⍺/
Mots-clés:
Hypofractionation / Hypofractionated radiotherapy / prostate cancer / Radiobiology / ⍺/
Place de la pulpectomie bilatérale dans la suppression androgénique pour cancer de la prostate
2012
- Réf : Prog Urol, 2012, 6, 22, 344-349


Introduction



Purpose

To report the oncologic results and morbidity of bilateral pulpectomy and to identify factors that make this method of androgen suppression therapy the most used in our country.


Patients and methods

We conducted a prospective study in the urology department of Aristide Le-Dantec hospital (Dakar) between January 2008 and June 2010 (30 months). It included 84 cases of prostate cancer treated by bilateral pulpectomy under local anesthesia.


Results

The mean age of patients was 72.17±12.48 years (53–91). The median PSA level was 101ng/mL (12.18–9990). Metastasis have been detected in 75% of cases. The Gleason score was higher than 7 in 40 patients (47.6%). Three months after pulpectomy, an improvement of performance status was seen in 76 patients (90.4%). The back pain significantly decreased in intensity or disappeared in 65.3% (32/49) of cases. A complete recovery of lower limbs motor deficit was observed in 50% of cases (7/14). The PSA levels decreased in 57 of the 76 patients alive and the mean PSA level was then 72±11.7ng/mL (3.8–2433). At six months, of the 53 patients in urinary retention, 18 had recovered spontaneous and complete urination. The PSA level was below 4ng/mL in 33.8% (22/65) of cases and between 4 and 10ng/mL in 52.3% (34/65) of cases. At 12 months, the median PSA nadir was 0.76ng/mL (0,002–8,17) and 57.4% of the 54 patients alive had a PSA nadir less than 2ng/mL. The mean follow-up was 11.08±10.34months (1–30). A rising PSA occurred in 17 patients (20.2%) after an mean progression-free survival of 10.5months (6–25). The overall survival at 6, 12 and 24months were respectively 77.3, 64.3 and 52.3%. The overall cost of pulpectomy was 50 000 FCFA (76€). The specific morbidity of pulpectomy was two cases (2.4%) of infection of the operative site.


Conclusion

The bilateral pulpectomy was a method of androgen suppression immediately effective, efficacious with a low morbidity. Its very low cost is the main reason why it is still the most used method in our country.

Mots clés:
Cancer de la prostate / Suppression androgénique / Pulpectomie bilatérale
Mots-clés:
prostate cancer / Androgen suppression therapy / Bilateral pulpectomy
Place du curage ganglionnaire dans la prise en charge des cancers du rein : revue de la littérature par le sous-comité rein du Comité de cancérologie de l'Association française d'urologie (CCAFU-rein)
2012
- Réf : Prog Urol, 2012, 6, 22, 313-317


Introduction



Nowadays, most of renal cancers are incidental tumors less than 4cm. Prevalence of lymph node involvement is low and does not require a systematic lymphadenectomy as described by Robson in the 1960s. Radiologic progress and particularly CT scan describe with high precision lymph node involvement in the initial work-up. In renal cancer with a high risk of recurrence, lymphadenectomy has a pronostic interest and therapeutic role in rare situations where lymph node involvement is isolated. In metastatic patients, the role of cytoreductive nephrectomy has to be assessed.

Mots clés:
Curage ganglionnaire / cancer du rein / Pronostic
Mots-clés:
lymph node dissection / Renal cell carcinoma / prognosis
Rôle pronostique des emboles vasculaires tumoraux dans les tumeurs des voies excrétrices urinaires supérieures : analyse rétrospective monocentrique
2012
- Réf : Prog Urol, 2012, 6, 22, 331-338


Introduction



Objective

To analyze the prognostic impact of lymphovascular invasion (LVI) in case of urothelial carcinoma of upper urinary tract (UUT-UC).


Patients and methods

Retrospective study of 83 consecutive patients treated surgically for UUT-UC between January 1998 and October 2008. Prognostic interest of histopathological factors (stage, grade, LVI, CIS, tumor architecture, location, nodal status and surgical margins) was assessed in univariate and multivariate Cox regression model. Specific survival (SS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using Kaplan-Meier method and Log-Rank test.


Results

LVI was observed in 26.5% of patients after histopathologic reviewing. The SS, RFS and MFS at 2 years were 93%, 76% and 96% respectively in group without LVI compared to 40%, 13% and 38% in group with LVI (P <0.001). In univariate analysis, pathological stage, LVI and margin status were predictive of SS (P <0.05). Pathological stage, LVI and surgical margin status were predictive of RFS (P <0.05). LVI, tumor architecture and status of surgical margins were predictive of MFS (P <0.05). LVI was the only independent predictive factor in multivariate analysis for all survival (P =0.002, 0.002 and 0.001 respectively for the SS, RFS and MFS).


Conclusion

LVI was a poor prognostic factor in cases of UUT-UC. This criteria should be routinely sought and included in the pathology report.

Mots clés:
Uretère / Pyélon / carcinome urothélial / Emboles vasculaires tumoraux
Mots-clés:
ureter / Renal pelvis / Urothelial carcinoma / Lymphovascular invasion
Suivi au long terme des patients transplantés rénaux ayant un dysraphisme spinal
2012
- Réf : Prog Urol, 2012, 6, 22, 339-343


Introduction



Purpose

To evaluate the long term outcome of renal transplant in patients with a neural tube defect causing voiding dysfunctions.


Patient and methods

Between 1993 and 2010, 18 cadaveric renal transplants were performed in 16 patients (5 females and 11 males) older than 15 years with a neural tube defect and voiding dysfunction.


Results

The patients had dialysis since the mean age of 27.4 and have been transplanted at the mean age of 32.2. The survival rate of the first kidney transplant was 93.75% at 1year and 63.3% at 5 and 10years respectively. With a mean follow-up of 6.67 years, 11 out of 16 first transplants remained functional (68.75%) The median survival of the first transplants was 13.52 years. At the end of the follow-up, 13 out of 18 transplants were still functional (72.2%). The mean serum creatinine level was 123.9micromol/l with a mean glomerular filtration rate estimated by the simplified MDRD formula of 67ml/min for the 13 still functional transplants. Before transplantation, 66% of patients had a neuro-urologic assessment versus 100% thereafter.


Conclusion

Renal transplantation in patients with neural tube defect is feasible without surgical particularities to those of other renal failure causes. These type of patients represented less than 1% of the followed cohort with an average graft survival rate of 63.3% at five and 10years. The median survival time of the first graft was 13.52 years.

Mots clés:
Neuro-Urologie / Transplantation rénale / Insuffisance rénale / vessie neurologique / spina bifida
Mots-clés:
neurourology / Renal transplantation / Chronic renal disease / Neurological bladder / spina bifida
Traduction en langue française et validation linguistique de l'auto-questionnaire Bladder Cancer Index évaluant la qualité de vie dans les tumeurs de vessie
2012
- Réf : Prog Urol, 2012, 6, 22, 350-353


Introduction



Objective

Translation and linguistic validation of the French version of Bladder Cancer Index (BCI).


Material and methods

A double-back translation of the original Bladder Cancer Index was performed. First, two urologists translated the English version in French. Then, a first consensus meeting between the translators and a group composed of urologists and nurses was achieved. Back-translation of this version was then done by professional translators (Nagpal, Paris) to ensure that no distortion was detected between the two questionnaires. Finally, a pilot study followed by an interview was carried out among one woman and five men having bladder cancer.


Results

The consensus version is attached to the article. No difficulties were reported by the pilot population to comprehend or to complete this BCI French version.


Conclusion

This BCI French version–attached to the article–makes it possible for researchers among a French population to use this validated and internationally recognized tool among a French population. The impact of various bladder cancer treatment on quality of life could hence be assessed and compared.

Mots clés:
Tumeurs de vessie / Tolérance traitement / questionnaire / Qualité de vie / France
Mots-clés:
bladder cancer / questionnaire / Quality of life / France