Base bibliographique

Sommaire :

Actualisation 2008 de la 8 e Conférence de consensus de la Société francophone d'urgences médicales de 1999. Prise en charge des coliques néphrétiques de l'adulte dans les services d'accueil et d'urgences
2009
- Réf : Prog Urol, 2009, 7, 19, 462-473


Introduction



The care in the emergencies of the renal colic at the adult was the object in 1999 of a conference of consensus of the French Society of Emergency (SFMU) in association with the French Association of Urology and the Society of Nephrology. This already former text was the object of an update in 2008 by the subcommittee of scientific monitoring of the SFMU and was presented to the congress 2008. This public presentation in the presence of an expert urologist allowed to confront this new text with the practices and to publish an updating of the conference of consensus of 1999. A survey of practice was led with the emergency physicians, whose results are presented.

Mots clés:
Lithiase urinaire / calcul urinaire / calcul rénal / Étiologie / Diagnostic
Mots-clés:
Urolithiasis / Urinary calculi / Kidney calculi / Etiology / Diagnosis
Angiomyolipome épithélioïde rénal
2009
- Réf : Prog Urol, 2009, 7, 19, 457-461


Introduction



Renal epithelioid angiomyolipomas (ReAML) are rare tumors (identified in less than 0,1‰ in general population) and represent 8% of operated angiomolipomas (AML). The diagnostic is histological, with an epithelioid cell component among the typical AML cells. ReAML are tumors derived from perivascular epithelioid cells (PEComa). There are benign PEComas, potentially agressive PEComas and malignant PEComas. Most malignant PEComas are ReAML. There are two ReAML clinical entities, sporadic or associated to Tuberous Sclerosis Complex (TSC). ReAML are unique, localized and sporadic solid tumors of the kidney of variable size that can be revealed as classical AML with local symptoms or a complication (hemorrhage). Revelation mode is mostly radiologic. ReAML are fat-poor on CT-scan. They can be misdiagnosed with renal cell carcinoma (RCC). (One third of ReAML are malignant with a locoregional, nodal or metastatic evolution that can lead to death. ReAML treatments are multimodal depending of histology, clinical-radiological entity, evolution and the patient. Partial nephrectomy or follow-up are the benign entity treatment. Radical nephrectomy eventually followed by doxorubicine or rapamycine treatments are recommended for potentially agressive and malignant entities.

Mots clés:
Angiomyolipome épithélioïde / Tumeur / Rein / mTOR
Mots-clés:
Epithelioïd angiomyolipoma / tumor / kidney / mTOR
Cure d'hypospadias. La forme de la plaque urétrale a-t-elle une influence sur le résultat de l'intervention de Duplay-Snodgrass ?
2009
- Réf : Prog Urol, 2009, 7, 19, 507-510


Introduction



Objectives

A number of factors potentially influence the outcome of hypospadias surgery. We evaluate the effect of catheter-size used during urethroplasty (a detail related to the depth of the urethral groove and width/elasticity of the urethral plate) on the complication rate following Duplay-Snodgrass repair.


Methods

The data of 113 patients undergoing primary hypospadias repair was retrospectively reviewed. Patients were divided into two groups based on the urethral plate width evaluated by the catheter-size used during urethral reconstruction, and the rate of complications was compared in the two groups. Other factors evaluated included age of patients and severity of the defect.


Results

Complications (urethro-cutaneous fistula and meatal stenosis) were more common in the narrow urethral plate 8F catheter group (three fistulae among 18 patients) compared to the wide urethral plate 10F catheter group (six fistulae and one meatal stenosis in 95 patients) (p =0.08).


Conclusion

The width of the urethral plate during a modified Duplay urethroplasty has a significant impact on outcome. A smaller-sized catheter for neo-urethral reconstruction, implying a shallow urethral groove and a narrow or inelastic urethral plate, is associated with a higher rate of urethrocutaneous fistula and meatal stenosis.

Mots clés:
Complications / Hypospadias / Chirurgie
Mots-clés:
Complications / Hypospadias / Surgery
Dépistage du cancer de la prostate : les données du premier tour de dépistage de la population française participant à l'essai européen ERSPC
2009
- Réf : Prog Urol, 2009, 7, 19, 499-500

Mots clés:
F.
Mots-clés:
Prostatic neoplasm / Mass screening / Prostatic neoplasm / /
Endopyélotomie rétrograde pour sténose de la jonction pyélo-urétérale
Retrograde endopyelotomy for uretero-pelvic junction
2009
- Commentaire à...
- Réf : Prog Urol, 2009, 7, 19, 512

Mots clés:
M.
Mots-clés:
Complications / Hypospadias / Surgery
État des lieux et facteurs de participation à l'étude européenne ERSPC de dépistage randomisé du cancer de la prostate par dosage sérique de l'antigène prostatique spécifique : départements français du Tarn et de l'Hérault
2009
- Réf : Prog Urol, 2009, 7, 19, 487-498


Introduction



Introduction

Mass screening modalities remained controversial and made necessary large studies. The European Randomized study of Screening for Prostate cancer (ERSPC) was initiated in 1994. Eight countries including France are participating.


Methods

ERSPC is a multicentric randomised study and started with the aim to determine whether a 20% reduction in prostate cancer mortality can be achieved with PSA-based screening. Men aged 50–74 and living in the Tarn or Hérault were included. After randomization and exclusion of men who died or had a prostate cancer were invited to participate by giving their consent and had a PSA test. In case of PSA greater than or equal to 3ng/ml, biopsy was recommended. Included men in both screening and control group were followed through cancer registries. Objective was to present first round results of French participation to ERSPC, to determine factors of participation and to compare detected cancers cases between both groups.


Results

Population of men included was 84,781 and were randomized in screening (n =42,590) or control (n =42,191) group. Participation rate was 36.9% in Tarn and 24.3% in Hérault. PSA was greater than or equal to 3ng/ml in 15,4% of cases (n =1812) and 45.9% of men (n =832) who were biopsied. Age, previous PSA performed within two years prior to invitation, health insurance and department of residence were significantly associated to participation rate. Cumulated incidence with a four years follow-up was 2.48% (n =1053) in screening and 1.99% (n =840) in control group, with a relative risk (RR) of 1.242. Corresponding RR for Tarn and Hérault were 1.37 and 1.20 respectively. Clinical parameters and treatments modalities were similar between both screening and control groups (radical prostatectomy 68% and radiation therapy 20%).


Conclusion

Participation rate at first round was modest. Profile of men who participated compared to men who did not were different. The control group was probably contaminated by PSA testing outside study protocol. Consequences at ERSPC level of this low participation rate on final analysis remain to be determined.

Mots clés:
Cancer de la prostate / dépistage de masse / Cancer de la prostate / /
Mots-clés:
Prostatic neoplasm / Mass screening / Prostatic neoplasm / /
Impact de l'indication impérative sur la morbidité et les résultats carcinologiques à long terme après néphrectomie partielle
2009
- Réf : Prog Urol, 2009, 7, 19, 481-486


Introduction



Objective

To evaluate the impact of imperative indication on the rate of complications and long term carcinological results after partial nephrectomy (PN).


Patients and method

Between 1985 and 2005, all patients who had a PN for localized cancer in two centers were reviewed. The rates of global, hemorrhagic and urinary complications were compared between group I (elective indication) and group II (imperative indication). Rates of survival without recurrence and specific at 5, 10 and 20 years were compared between these two groups. A multivariate analysis using the Cox model was carried out to research factors associated with recurrence and death on the whole of the series.


Results

Three hundred and five patients were included in the study. No significant difference was found between group I and group II as far as global complications were concerned (17 vs 20%), the rate of hemorrhagic complications (3.5 vs 3.8%) and the rate of urinary complications (3.9 vs 2.5%). The patients who had been operated on for an imperative indication had survived specifically and without recurrence which was significantly lower at 5, 10 and 20 years. On the whole of the series, the imperative indication was the only independent factor associated with recurrence and death in a multivariate analysis.


Conclusions

Even if the rate of complication does not appear to be significantly associated with the indication for operating, patients of imperative indication represented a heterogeneous group with a poorer prognosis. This factor should be taken into account in studies on the subject of PN.

Mots clés:
cancer du rein / Néphrectomie partielle / Indication impérative
Mots-clés:
Kidney cancer / partial nephrectomy / Imprative indication
Les tumeurs rares du rein et le rôle de la biologie moléculaire
2009
- Réf : Prog Urol, 2009, 7, 19, 479-480


À l’instar de la cancérologie moderne, la pathologie tumorale rénale subit une double mutation, diagnostique et thérapeutique. La série rapportée dans ce numéro par l’équipe de Long et al. illustre cette transformation et est intéressante à plus d’un titre.

Mots clés:
E.M. / P.
Mots-clés:
Sarcoma / Synovial sarcoma / kidney / Synovialosarcoma / Renal cancer
Radiothérapie chez les patients à haut risque après prostatectomie radicale : postopératoire ou de rattrapage ?
2009
- Réf : Prog Urol, 2009, 7, 19, 447-456


Introduction



The use of immediate postoperative and salvage radiotherapy in high-risk patients after radical prostatectomy for prostate cancer remains controversial. Immediate postoperative radiotherapy improves biochemical and clinical progression-free survival in randomised trials. Metastasis-free survival and overall survival were seen to be improved in a recently updated randomised trial. On the basis of retrospective data only, salvage radiotherapy is effective against biochemical relapse after prostatectomy. The adjunction of androgen deprivation therapy to immediate postoperative or salvage radiotherapy is only supported by retrospective data. The results of the ongoing, prospective, randomized trials will hopefully enable accurate comparison of immediate postoperative radiotherapy with salvage radiotherapy and assessment of the value of androgen deprivation therapy.

Mots clés:
Cancer prostatique / Prostatectomie / radiothérapie / radiothérapie adjuvante / Radiothérapie de rattrapage
Mots-clés:
prostate cancer / Prostatectomy / radiotherapy / adjuvant radiotherapy / Salvage radiotherapy
Résultat à deux ans de la thermothérapie prostatique par radiofréquence pour troubles mictionnels liés à l'HBP
2009
- Réf : Prog Urol, 2009, 7, 19, 501-506


Introduction



Aim

To describe medium-term functional results of Transuretral Needle Ablation (TUNA) to treat symptomatic benign prostatic hyperplasia (BPH) refractory to medical treatment.


Materials and method

Patients who completed at least 2 years follow-up after TUNA were systematically offered a reevaluation including: Flowmetry, PSA, symptom score (IPSS), satisfaction index visual analogic scale (VAS) and a treatment impact evaluation with a Likert scale (ranging from much worse to much improved).


Results

From December 2002 to January 2007, 45 patients were treated with TUNA under local regional anaesthesia (prostatic block). Twenty-seven of them were followed-up longer than 24 months (median follow-up 44 months [26–52]). Changes in the selected outcomes were: increase in Q max from 9.5mL/s preoperatively to 9mL/s at 6 month and 11.5mL/s after 2 years; increase in IPSS from 19.3 before TUNA to 16.3 at 6 month and 16.5 after 2 years.

About subjective evaluation, 58% of patient gave a satisfaction VAS ≥6, and the improvement index was greater or equal to +1 in 67% of case.


Conclusion

In this initial monocentric experiment, despite a modest improvement of objective parameters and a 20% of retreatment rate, TUNA give contentment and improvement sensation for 60% of patients who were treated for non-efficiency of medical treatment for benign prostatic hyperplasia.

Mots clés:
hypertrophie bénigne de la prostate / TUNA / thermothérapie / Radiofréquence / Chirurgie mini-invasive
Mots-clés:
Benign prostatic hyperplasia / TUNA / thermotherapy / Radiofrequency / Minimaly invasive surgery
Synovialosarcome primitif rénal : une tumeur kystique chez des patients jeunes
2009
- Réf : Prog Urol, 2009, 7, 19, 474-478


Introduction



Introduction

The study of the clinical, histological and immunohistochemical aspects of three kidney tumors corresponding to synovial sarcomas operated on in our center over three years.


Patients and method

Three patients aged between 27 and 33 had an enlarged nephrectomy for kidney tumors corresponding to a histological examination of a synovial sarcoma. The tumors were symptomatic in 100% of cases with back pain and spontaneous rupture. Size varied from 5 to 13cm. The radiological aspect was a cystic tumor (BosniakIV) in two cases and in the other a spontaneous perirenal hematoma. Two were in the right kidney and one in the left kidney. The parts were analyzed after fixation. Immunohistochemical coloration and an analysis in molecular biology by RT-PCR of fusion transcripts were carried out.


Results

One patient died because of local development and metastasis 24 months after an enlarged nephrectomy associated with radio chemotherapy (Maidprotocol). Two patients were in total remission after an average of 25 months following the same treatment. The histology found a mesenchymal fusocellular monotone proliferation corresponding to a sarcoma. In all three cases, it was a biphasic form with plaques of fusiform cells and epithelial cells. The immunohistochemical study shows a positivity of the contingent epithelial and fusiform. The muscular markers were negative. A study in molecular biology of the fusion transcript allowed for the finding of a translocation (X;18) in all three cases.


Conclusion

Primitive synovial sarcoma of the kidney occured in young patients. The translocation (X;18) is pathognomonic of the diagnosis. The prognosis is bleak despite complete excision, radiotherapy and chemotherapy.

Mots clés:
sarcome / Sarcome synovial / Rein / Synovialosarcome / cancer du rein
Mots-clés:
Sarcoma / Synovial sarcoma / kidney / Synovialosarcoma / Renal cancer
Transplantation domino à partir d'un donneur vivant d'un rein greffé atteint d'une micro-angiopathie thrombotique : aspects chirurgicaux
2009
- Réf : Prog Urol, 2009, 7, 19, 513-516


Introduction



We report surgical aspects of the first case of retransplantation of a kidney initially retrieved from a cadaveric donor, then on a first recipient which developed a recurrent severe and intractable thrombotic microangiopathy on the allograft.

Mots clés:
Transplantation domino / Retransplantation rénale / Transplantation donneur vivant
Mots-clés:
Domino transplantation / Kidney retransplantation / Living-donor transplantation
Urétroplastie pour hypospadias : évaluation de la plaque urétrale
2009
- Réf : Prog Urol, 2009, 7, 19, 510-511

Mots clés:
D.
Mots-clés:
Complications / Hypospadias / Surgery