Base bibliographique

Approche mini-invasive de l'autotransplantation rénale dans la prise en charge du loin pain hematuria syndrome
2013
- Réf : Prog Urol, 2013, 6, 23, 389-393




 


Objective

To review retrospectively our experience with laparoscopic approach to renal autotransplantation in four patients using a single iliac incision in the management of loin pain hematuria (LPH) syndrome.


Methods

Four patients with LPH (all women, mean age 29.5 years, range 23–36 years) underwent four technically successful laparoscopic nephrectomies with renal autotransplantation, using a single iliac incision to both harvest and transplant the kidney. Hand assistance was used in two patients immediately before clamping the renal pedicle. All patients required narcotic analgesics preoperatively.


Results

Mean total surgical time was 4.1hours. For laparoscopic donor nephrectomy phase, mean operative time was 1.9hours. The warm ischemia time was 5minutes. The cold ischemia time was 58minutes. The hospital stay was 6 days. None of the patients had abnormal renal function postoperatively. Three of four patients had episodes of iliac fossa pain with effort at the level of the transplantation incision. Two of four patients became Morphine-free. The other two required a significantly reduced dose of oral narcotics. None of these patients required nephrectomy. (Median follow-up 9 months).


Conclusion

Laparoscopic approach to renal autotransplantaion using a single extended iliac incision in the management of LPH syndrome can be considered as a less invasive treatment compared to open renal autotransplantation in selected patients. This technique may be extended to patients having other conditions requiring autotransplantation.

Commentaire à la néphrectomie laparoscopique pour rein polykystique est faisable et reproductible
2013
- Réf : Prog Urol, 2013, 6, 23, 425-426




 

Curiethérapie exclusive du cancer de la prostate par implants permanents : indications et résultats. Revue du CC-AFU
2013
- Réf : Prog Urol, 2013, 6, 23, 378-385




 


Introduction

To summarize the indications and outcomes of low dose-rate prostate brachytherapy with permanent implants.


Methods

Bibliographic database PubMed was searched with prostate cancer and brachytherapy as keywords from 1995 to 2012.


Results

The main indication of prostate brachytherapy is the favorable group, but it could be proposed to patients with an intermediate prognostic group if the PSA is15ng/mL or if the Gleason score is 7 (3+4), under cover of a prostate MRI without any extra-capsular extension. Oncologic results are similar to those of surgery or external beam irradiation (EBRT), with a 10-yr biochemical control rate approaching 90%. Urinary toxicity is common during the year following the implant, mainly irritative symptoms; 5 to 15% of patients experienced acute urinary retention. A prostate volume higher than 50 cc or an initial high international prostatic symptom score (IPSS) are predictive of toxicity and are recognized as relative contraindications of the technique. Sexual activity is maintained in 60% of patients.


Conclusion

Brachytherapy must be proposed as a validated option beside active surveillance, surgery and EBRT.

Désobstruction prostatique a la phase avancée du cancer de prostate
2013
- Réf : Prog Urol, 2013, 6, 23, 386-388




 


Bladder outlet obstruction (BOO) is one of the major complication of the locally advanced prostate cancer. Its impact on prostate cancer prognosis is low and remains controversial but its impact on patient quality of life is real. We performed a systematic search to find relevant publications from Medline and wrote a mini-review on the different therapeutic approaches to relieve obstructive symptoms.

Impact pronostique de la localisation urétérale dans les tumeurs de la voie excrétrice supérieure
2013
- Réf : Prog Urol, 2013, 6, 23, 399-404




 


Objectives

The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC).


Patients and methods

Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161).


Results

In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P =0.009 and P =0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P =0.002 and P =0.0008 respectively for ureteral location).


Conclusion

Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis.

Impact pronostique des tumeurs localisées à l'apex prostatique
2013
- Réf : Prog Urol, 2013, 6, 23, 405-409




 


Objective

The apex is a particular region of the prostate in its surgical dissection and pathological analysis. We sought to evaluate the prognostic value of the apical localization of prostate tumors.


Method

From 1988 to 2010, data pre- (age, clinical stage, preoperative PSA, biopsy Gleason score) and postoperative (prostate weight, pathologic stage TNM 2010, Gleason score, margin status) of 2765 total prostatectomies were collected prospectively. These data were compared according to existence or absence of tumor at the apex. The prognostic impact of tumor at the apex on biochemical recurrence-free survival (PSA>0.2ng/mL) has been studied in univariate and multivariate models.


Results

One thousand eight hundred seventeen tumors had a location at the apex (65.7%). In univariate analysis, there was a significant difference in the clinical stage, the biopsy and pathological Gleason score, the result of curage, the pathological stage and the margin status between apical tumors and others. With a mean decline of 34.6 months, 502 patients had a biochemical recurrence (18.1%). Disease-free survival at 10 years was 60.7% for tumor at the apex versus 65.9% in other cases. The location at the apex was significantly associated with biochemical recurrence on univariate analysis (P =0.01). After adjustment for clinical and pathological stage, PSA level, Gleason score and surgical margins, the apex was not anymore a pejorative independent predictor (P =0.0087).


Conclusion

The existence of tumor in the prostatic apex was associated with more aggressive tumoral criteria and was an independent and pejorative predictor of biochemical recurrence-free survival at 10 years in univariate analysis. The apical localization could be an additional argument in the decision of adjuvant therapy after prostatectomy.

La néphrectomie laparoscopique pour rein polykystique est faisable et reproductible
2013
- Réf : Prog Urol, 2013, 6, 23, 394-398




 


Purpose

The aim of our study was to report our experience of laparoscopic nephrectomy in patients with polycystic kidney disease.


Material

Between December 2007 and February 2012, we performed 39 consecutive laparoscopic nephrectomies in patients with polycystic kidneys. All patients were operated by a transperitoneal approach.


Results

Patients had a mean age of 55 with an average BMI of 25kg/m2. Eighty-seven percent were ASA III and 77% were on dialysis. In most of the cases, the indication concerned patients who were candidates to a renal transplantation to make space for graft implantation. Operative time was 167minutes with a mean blood loss of 200mL. Two open conversions were necessary (splenic injury and difficulty of dissection of the renal pedicle). Fifteen percent of patients were transfused. There were 11 complications (28%) among which five were major (Clavien3). Mean length of stay was 5.2 days.


Conclusion

Our study showed that laparoscopic nephrectomy for polycystic kidney is feasible and reproducible. We systematically offer it when indicated.

Léiomyosarcome primitif de la surrénale chez une noire africaine : aspects diagnostiques et thérapeutiques
2013
- Réf : Prog Urol, 2013, 6, 23, 421-424




 


We report a bulky adrenal gland in black woman of 52 years old. This patient was submitted to surgery for resection of the mass. The histopathologic exam found primary leiomyosarcoma of adrenal gland. Beyond twelve month after adrenalectomy, the patient was alive without metastasis.

Mise au point sur la prise en charge des traumatismes de l'urètre antérieur de l'enfant
2013
- Réf : Prog Urol, 2013, 6, 23, 410-414




 


Introduction

Anterior urethral injuries are a rare entity in the pediatric age group. Data of the literature are limited to the injuries of the posterior urethra. The aim of this study was to take stock of the initial management of this disease, from our experience and data of the literature.


Patients and methods

A literature review and a retrospective study were conducted. We used our department database to find all the patients treated for anterior urethral injuries at the Children’s Hospital of Toulouse between 2000 and 2011. Data on patients with trauma of the anterior urethra were analysed.


Results

Among the 13 patients treated for urethral injuries, seven patients had trauma to the anterior urethra. The initial symptom was an acute retention of urine in three cases (43%) and urethral bleeding in six cases (85%). All patients with acute retention of urine had emergency management consisting in endoscopic realignment and urinary diversion by suprapubic catheter. Patients with hematuria were treated with paracetamol and non-steroidal anti-inflammatory. After a mean follow-up of 507 days (332–893), none had dysuria and no posttraumatic stenosis has been demonstrated in uroflowmetry.


Conclusion

In our experience, the trauma of the anterior urethra of the child had a satisfactory development through appropriate management. Clinical and uroflometry follow-up is necessary.

Stratégies thérapeutiques innovantes pour l'administration médicamenteuse intravésicale
2013
- Réf : Prog Urol, 2013, 6, 23, 369-377




 


Introduction

Perspectives for innovative pharmaceutical molecules and intravesical administration of pharmacological agents are presented in the present review carried out from a recent literature.


Materials and methods

This review of the literature was built by using the PubMed and ScienceDirect databases running 20keywords revealing 34publications between 1983 and 2012. The number of referenced articles on ScienceDirect has increased in recent years, highlighting the interest of scientists for intravesical drug administration and the relevance of innovating drug delivery systems.


Results

Different modalities of intravesical administration using physical (e.g., iontophoresis, electroporation) or chemical techniques (e.g., enzyme, solvent, nanoparticles, liposomes, hydrogels) based on novel formulation methods are reported. Finally, the development of biopharmaceuticals (e.g., bacillus Calmette-Guérin, interferon ⍺) and gene therapies is also presented and analyzed in this review.


Conclusion

The present review exhibits new development in the pipeline for emerging intravesical drug administration strategies. Knowledge of all these therapies allows practitioners to propose a specific and tailored treatment to each patient with limiting systemic side effects.

Traitement de l'incontinence urinaire par sphincters urinaires artificiels chez la femme : efficacité, complications et survie
2013
- Réf : Prog Urol, 2013, 6, 23, 415-420




 


Objective

To analyze long-term results and mechanical survival of the artificial urinary sphincter (AUS) AMS 800™ (American Medical Systems, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD).


Patients and methods

Data were collected prospectively from women treated for SUI at one university hospital between 1987 and 2007. Inclusion criteria was SUI with severe ISD defined by low urodynamic closure pressure and negative continence tests. Endpoints were survival, complications and continence.


Results

A total of 376 AUS were implanted in 344 patients with a median age of 57 years (18–93 years). The median follow-up was 9 years (3–20 years). The 3, 5, and 10 years global device survival were 92, 88.6, and 69.2% respectively. The mean mechanical survival was 176 months (14.7 years). The two main risk factors for decreased AUS survival were the number of previous incontinence surgeries and the presence of neurogenic bladder. The continence rates assessed as full (no leakage) in 85.64% patients, social (some drops but no pad) in 8.78% and incontinence (1 pad or more) in 5.58%.


Conclusions

The study has shown that in patients with ISD, the AUS represents an effective process, durable with an acceptable rate of complication.