Base bibliographique

Sommaire :

Aspects cliniques et thérapeutiques de la torsion du cordon spermatique : étude de 27 cas
2010
- Réf : Prog Urol, 2010, 7, 20, 527-531


Introduction



Objective

To analyze in a retrospective way the clinical and therapeutical aspects of the testicular torsion in our service.


Patients and methods

It is a retrospective survey of 15 years, from June 1st, 1993 to May 31 2008 to the urology – Andrology service of Conakry. We have 27 files of patients with torsion of the spermatic cord confirmed to the intervention. A percentage of 70.30% patients were less than 25 years old.


Results

The scrotal pain was the most frequent functional sign (96.3%). Only 11 patients (40.7%) have been received before the sixth hour. The swelling of the scrotum, ascended testis and the sign of Prehn were the dominant physical signs. All patients have been operated. The number of spire towers varied from 1 to 3. Twenty-two testes (81.5%) have been judged viable and fixed. With a median follow-up of 60 months, the testes volume of these patients was stable in 20 cases (90.9%). The postoperative course was simple in 96.3% of cases. Twenty-three patients (85.2%) were released within a week.


Conclusion

Torsion of the spermatic cord remained a dangerous affection because putting in game the vital prognosis of the testis. The only justifiable attitude is the urgent surgical operation.

Mots clés:
Torsion / cordon spermatique / testicule / orchidopexie / Urgence
Mots-clés:
Torsion / Spermatic cord / Testis / Orchiopexy / Emergency
Carcinome médullaire du rein : rapport d'une rémission sous gemcitabine-cisplatine et revue des perspectives thérapeutiques
2010
- Réf : Prog Urol, 2010, 7, 20, 538-541


Introduction



We report a case of renal medullary carcinoma concerning a 38-year-old woman. Heterozygote sickle cell trait was noticed in her past medical history. The physical examination was unremarkable. The CT-scan revealed a left renal mass of 48mmx20mm, hypovascularised, located in the lower pole of the kidney with extension into the sinus. There were also enlarged lymph nodes laterally to aortic artery and between the aorta and the vena cava. A left radical nephrectomy with lymphadenectomy was performed. The histological examination with immuno-histo-chemical analysis revealed a renal medullary carcinoma T1N2R0 (TNM 2002). An adjuvant chemotherapy consisting of gemcitabine-cisplatin was administered. A regression of the residual lymph nodes was noticed after the six cycles of chemotherapy and the PET-Scan was negative. The patient underwent a second operation and the residual mass was excised. No tumor cell was found at the histological examination of the residual nodes. The patient had no clinical or radiological symptoms of progression eight months after the radical nephrectomy. We discuss the diagnostic criteria and analyse the therapeutic perspectives.

Mots clés:
Rein / Carcinome médullaire / Gemcitabine / Cisplatine / Paclitaxel
Mots-clés:
kidney / Medullary carcinoma / Gemcitabine / Cisplatin / Paclitaxel
Épidémiologie des patients neurologiques dans une population de transplantés rénaux
2010
- Réf : Prog Urol, 2010, 7, 20, 503-507


Introduction



Objectives

The aim of this study was to describe the epidemiology of neuropathic bladder in kidney transplant patients.


Patients and Methods

Patients with terminal chronic kidney disease related to neurogenic bladder were sorted out from a population of 1286 kidney transplant recipients operated between 1993 and 2008.


Results

Thirty-three patients, 26 men and seven women, mean age 46.9±12.4 years old at the transplantation time were found out. Neurological conditions were spinal dysraphism in 39.4% of the cases, brain injury in 18.2%, cerebrovascular accident in 15.2%, spinal cord injury in 12.2%, myelitis in 6%, congenital encephalopathy in 6% and Hinmann’s syndrome in 3%. Mean time between the onset of the neurological disease and the beginning of the dialysis was 21.7±11.9 years.


Conclusion

Prevalence of patients with neuropathic bladder in kidney transplant patients is 2.6%. Most frequent neurological conditions involved are spinal dysraphism and brain injury. The onset of the dialysis occurs 21 years on average after the diagnosis of the neurological disease in patients with mean age of 37.8 years.

Mots clés:
Neuro-Urologie / Transplantation rénale / Insuffisance rénale / vessie neurologique
Mots-clés:
Neuro-urology / Kidney transplantation / Renal impairment / Neurogenic bladder
Erratum à « Spécificités de la prise en charge par chimiothérapie chez le sujet âgé » [Prog Urol 2009;S3:S100–5]
Erratum to “Specificities of chemotherapy in elderly cancer patients” [Prog Urol 2009;S3:S100–5]
2010
- Erratum
- Réf : Prog Urol, 2010, 7, 20, 545


Une erreur s’est glissée dans le volume 19, supplément 3 (novembre 2009) de Progrès en Urologie sur la « Prise en charge des cancers urologiques chez le sujet âgé ». Le nom du premier auteur a été mal orthographié. Il s’agit de C. Delbaldo (et non pas C. Delbado). Nous prions nos lecteurs de nous excuser de cette erreur.

Mots clés:
C. / P. / D. / E. / S.
Mots-clés:
nephrectomy / Mesenteric ischemia / Kayexalate / Dialyzed renal insufficient
Fuites urinaires et sport chez la femme
2010
- Réf : Prog Urol, 2010, 7, 20, 483-490


Définition



A quarter of French women over 25 years old are regular sportswomen. The practice of sport is synonymous with youth and good health. The current health policy also aims at promoting the sport. However, sport may be the cause of various diseases when it is poorly chosen or improperly performed. The High Authority of Health identifies the intensive exercise as a risk factor for urinary incontinence, defined as “the complaint of any involuntary leakage of urine”. It is essentially stress urinary incontinence, occurring because of the phenomenon of intrabdominal hypertension, inherent with certain activities, and excess capacity of sphincters. Some sports are more risk than others, and high-level sportswomen are the most exposed. So, the general practitioner and the doctor of sports play a vital role in informing, screening, prevention, therapeutic orientation and monitoring of sportswomen. Better information is needed for this public health problem because according to the severity of incontinence and its impact, there are simple, effective, more or less invasive treatment options. The aim of this study was to establish an inventory of scientific knowledge on the subject and to assist the practitioner in the care of these patients.

Mots clés:
incontinence urinaire / Sport / Produits absorbants
Mots-clés:
Urinary incontinence / Sport
Infarctus mésentérique dans les suites d'une néphrectomie élargie gauche
2010
- Réf : Prog Urol, 2010, 7, 20, 542-544


Introduction



The nephrectomy of a dialyzed renal insufficient patient is a frequent operation. Nevertheless, the vascular complication risks are increased for these patients. We report the case of a patient who had presented a mesenteric ischemia after a left nephrectomy. The cause of this ischemia was plurifactorial with, on one hand, a splanchnic hypoperfusion due to post-procedure hypovolemia caused by an important depletion during the dialysis as well as the use of vasoactive amines and, on the other hand, the peripheral mesenteric microvascularisation occlusion due to a kayexalate crystal deposit.

Mots clés:
Néphrectomie / Infarctus mésentérique / Kayexalate / Hémodialysé chronique
Mots-clés:
nephrectomy / Mesenteric ischemia / Kayexalate / Dialyzed renal insufficient
La circoncision chez le nouveau-né et le nourrisson au bloc opératoire du CHU de Lomé : technique utilisant le Gomco clamp versus technique utilisant uniquement des pinces
2010
- Réf : Prog Urol, 2010, 7, 20, 532-537


Introduction



Objectives

To describe the various techniques used for the circumcision in newborns and infants in the operating room of the Lomé Teaching Hospital (Togo) and to compare their results.


Patients and methods

It is about a prospective study carried out in the operating room of the Lomé Teaching Hospital from June 15th, 2007 to December 15th, 2008 (18 months). It concerned newborns and infants circumcised according to two techniques: the technique using grips only (group A: n =138; 69%) and the technique using Gomco clamp (group B: n =62; 31%). The Khi2 test with the threshold 5% was used for the statistical analysis.


Results

According to the duration of the intervention, 34 newborns and infants (24.6%) were circumcised within less than 15minutes in the group A and 27 (43.5%) in the group B (p <0.05). According to the importance of the bleeding and to the type of material used, 28 newborns and infants (20.30%) had bled much in the group A and one (1,61%) in the group B (p <0.05). According to the postoperative complications and to the technique used, nine newborns and infants (9.4%) had postoperational complications in the group A and two (3.2%) in the group B. The wound had healed within less than 6 days in one infant (0.7%) in the group A and six (9.7%) in the group B (p <0.05). One hundred penises (72.46%) were considered to be very satisfying in the group A and 55 (88.7%) in the group B (p <0.05).


Conclusion

The technique using Gomco clamp for circumcision had more advantages than that using only the grips. It was much more safe for the child.

Mots clés:
nouveau-né / Nourrisson / Circoncision / Pinces / Gomco clamp
Mots-clés:
Newborn / Infant / Circumcision / Grips / Gomco clamp
La spectroscopie optique : une nouvelle approche pour l'étude des tumeurs urologiques
2010
- Réf : Prog Urol, 2010, 7, 20, 477-482


Introduction : les promesses de la spectroscopie optique dans la prise en charge du cancer



Introduction

Optical spectroscopy refers to a group of novel technologies that uses interaction of light with tissues to analyze their structure and chemical composition. The objective of this article is to describe these technologies and detail their potential for assessing urological tumors.


Material and methods

It has been shown that optical spectroscopy can accurately analyse multiple solid tumors. Several publications specifically aimed at assessing prostate cancers, renal carcinomas and urothelial tumors.


Results

There are three types of spectroscopy that all use light focussed on a tissue and thereafter collect a specific reflected optical signal. Optical spectroscopy can differentiate benign (adenoma or inflammation) and malignant (adenocarcinoma) prostatic tissues. It can also distinguish normal bladder tissue from inflammatory or cancerous cells. Regarding renal tumors, spectroscopy can identify normal and tumoral tissue and differentiate benign and malignant tumors. Its diagnostic accuracy is about 85%. However, reported studies only concentrate on in vitro or ex vivo specimen and the numbers of patients are quite small.


Conclusion

Optical spectroscopy can be envisioned as an “optical biopsy” tool. Potential applications in the clinical field are promising. Larger studies on in vivo specimen need to be undertaken to confirm phase I preliminary reports.

Mots clés:
Spectroscopie / Raman / Réflectance / Tumeurs
Mots-clés:
Spectroscopy / Raman / Réflectance / Tumors
Les ballonnets périurétraux ACT ® chez la femme : suivi à moyen terme et aide au positionnement
2010
- Réf : Prog Urol, 2010, 7, 20, 520-526


Introduction



Objectives

Evaluation of the results of Adjustable Continence Therapy® (ACT®) in women by a retrospective one-center study and exposure of a technique: bladder neck retrovision.


Patients and methods

Between January 2001 and February 2009, 67 women had ACT® implantation by the same surgeon for the indication of urinary incontinence by intrinsic sphincter deficiency, with mean age of 70.2 years. Mean follow-up was 24.8 months (1 to 89 months). Evaluation of functional results was realized with the research of urinary leakage when coughing or during abdominal thrust in the clinical exam, with the Urinary Symptom Profile® (USP®) questionnaire (since 2007), and with an analogical global satisfaction evaluation.


Results

More than 90% of women (n =67) have been improved at least at one medical consultation, and 60% (40/67) at last follow-up with a satisfaction index superior to 80% in 25 patients. Urinary leakage when coughing or doing abdominal thrust disappeared in 58% (36/62). An improvement of USP® score was observed in 76% (19/25). Postoperative complications occurred in 37.3% (25 patients) with a mean period of 10.8 months after surgery.


Conclusion

The ACT®, indicated in stress urinary incontinence, is attractive because of the benefit–risk ratio. It could represent an alternative treatment when the artificial urinary sphincter is not technically possible, not accepted or when a reversibility is required. The bladder neck retrovision would improve the ACT® surgery by precision and safety.

Mots clés:
incontinence urinaire / Ballonnets ajustables / Rétrovision
Mots-clés:
Urinary incontinence / Adjustable continence therapy / / Rétrovision
Les nouvelles perspectives de prise en charge du cancer de la prostate
2010
- Réf : Prog Urol, 2010, 7, 20, 491-497


Introduction



The treatment of prostate cancer is experiencing important innovations. Hormone therapy includes a new class of drugs: LHRH antagonists, which induce a rapid, fast and sustained reduction of testosterone levels. Active surveillance enables to avoid an aggressive treatment without decreasing survival, provided that strict eligibility and follow-up criteria are applied. New imaging techniques and laboratory assays lead to early diagnosis of small size tumors. Lastly, focal therapy has the potential to target localized cancers without deterioration of surrounding structures. These concomitant improvements offer the clinician and the patient attractive options for prostate cancer management. However, they are not devoid of limitations and constraints. Thus, it is crucial to define the most appropriate patient’s profile for each therapeutic option, taking into account the objective characteristics of the tumor and the psychological features of the patient.

Mots clés:
Cancer de la prostate / Antagonistes de la / / Testostéronémie / Surveillance active
Mots-clés:
prostate cancer / Luteinizing hormone / releasing hormone antagonists / Testosterone levels / Active surveillance
Phéochromocytome et défaillance cardiaque : une indication exceptionnelle de surrénalectomie en urgence ou semi-urgence
2010
- Réf : Prog Urol, 2010, 7, 20, 498-502


Introduction



Objective

To identify cardiogenic failure or cardiogenic shock associated with pheochromocytoma diagnosis and emergency adrenalectomy. Update this unusual presentation of pheochromocytoma.


Methods

Between 1998 and 2009, 119 adrenalectomies were performed in our department, among which 19 cases for pheochromocytoma. We reported three cases with cardiogenic failure or cardiogenic shock associated with emergency adrenalectomy.


Results

Patients were 36, 41 and 67 years old. The elapsed time between cardiogenic failure and surgery was 0, 7 and 19 days. The first diagnosis was a viral myocarditis in those three cases. The diagnosis of adrenal pheochromocytoma was done in a second step by the association of adrenal tumour on abdominal CT scan and detection of significantly elevated plasma/urine catecholamine. Severe systolic dysfunction with low ejection fraction was associated in all cases. Cardiac function was quickly restored after adrenalectomy.


Conclusion

Cardiac emergency associated with pheochromocytoma is an unusual clinical presentation. When diagnosis fails to be performed, patients have a very poor prognosis. According to a review of the sparse literature, only early recognition and emergency adrenalectomy can improve the outcome.

Mots clés:
Phéochromocytome / Défaillance cardiaque / Urgence chirurgicale
Mots-clés:
pheochromocytoma / Cardiac failure / Emergency surgery
Sacrospinofixation mini-invasive avec le dispositif CAPIO ® : étude anatomique
2010
- Réf : Prog Urol, 2010, 7, 20, 515-519


Introduction



Objective

To study anatomical risks after posterior sacrospinous ligament fixation using the CAPIO® needle driver.


Subjects and methods

A simplified bilateral posterior sacrospinous ligament fixation was performed on seven fresh female cadavers using the CAPIO® needle driver. Cadavers were installed in gynaecologic position then dissected by the abdominal route. The posterior sacrospinous ligament fixation was performed after a posterior vaginal wall incision on the midline and a simplified dissection of both pararectal fossae. The abdominal dissection was focused on the sacrospinous ligament area. We measured the distance between the neurovascular elements adjacent to the sacrospinous ligament from the suture site.


Results

Thirteen sacrospinous ligaments were available for analysis. The mean length (±SD) of the ligament was 51±9,2mm and the mean width at the level of fixation (±SD) was 23,5±5,7mm. No rectal injury was observed. Fixations were in the deeper (ligament) and medium (muscle) part of the SSL in eight (61%) and five (39%) cases respectively. The ischial spine was 21,6mm (range: 13–30). The mean distances between fixation and pudendal nerve and artery were 16,1mm (range: 4–32) and 20mm (range: 12–37) respectively.


Conclusion

Mini-invasive posterior sacrospinous ligament fixation using the CAPIO® needle driver seemed to be reproducible with low anatomical risks. However, the fixation should be at least at 20mm medially to the ischial spine in order to reduce neurological risks.

Mots clés:
Prolapsus génital / Sacrospinofixation / Mini-invasif
Mots-clés:
Genital prolapse / Sacrospinous fixation / Mini-invasive
Valeur prédictive de l'inflammation prostatique asymptomatique dans la survenue du cancer de la prostate
2010
- Réf : Prog Urol, 2010, 7, 20, 508-514


Introduction



Objective

Several studies have tried to show a link between inflammation and cancer. In prostate cancer (PCa) development, this question is still not completely elucidated. The aim of the study was to investigate, whether the presence of inflammation in the first series of prostate biopsies was a factor of risk.


Patients and methods

In this retrospective study, we examined prostate biopsy specimen of 220 consecutive patients, who had undergone repeat prostate biopsies in our department. The first screening round was performed between 2000 and 2005. These first prostate biopsies were examined by two pathologists blinded to the patient’s follow-up. Inflammation and several histological criterions were evaluated: acute/chronic and focal/diffuse inflammation, atrophy, high grade PIN (HGPIN) and ASAP. We compared PCa incidences rates (IR) for the different histologic markers using χ 2 analysis and estimated the relative risk (RR) of PCa.


Results

Two hundred and one patients were included definitively with a median follow-up of 2.1 years (42 days – 8.9 years, period between the first and the last biopsy). One hundred and twenty-six patients (62.7%) were identified with inflammation in the first biopsies (inflammatory group [IG]). Ninety-seven patients (48.3%) had PCa, 58 from the IG. PCa IR did not differ significantly between patients with or without inflammation (RR: 0.9, p =0.6).


Conclusions

According to these data, the presence and type of histological inflammation on initial prostate biopsies did not seem to be a risk factor for the development of PCa.

Mots clés:
Cancer de la prostate / Inflammation / Asymptomatique / /
Mots-clés:
prostate cancer / Inflammation / Asymptomatic / PIA / High grade PIN
Actualités dans les cancers de prostate non localisés : diagnostic, traitement et voies d'avenir
2010
- Réf : Prog Urol, 2010, 7, 20, S198, suppl. S3


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Incidence of prostate cancer is constantly growing no matter of the stage of the disease. Locally advanced tumours and metastatic stages of the disease are not exception. Nevertheless, management of advanced prostate cancer is still uncertain. Thus, non invasive molecular or imaging techniques have been proposed to optimize the diagnosis of advanced prostate cancer. The debate is still ongoing regarding therapeutic options to offer to the patient to obtain the optimal oncologic control. Radical prostatectomy can now be considered as an option in certain cases of high-risk prostate cancer, on the basis of a multimodal treatment. The field of hormonotherapy is also evolving. New molecules (GnRH Antagonists, anti androgen) or new modalities of prescription (six-month GnRH agonist) appear. The prescription modalities evolve as well (e.g.; intermittent treatment). Lastly, chemotherapy is now proposed for metastatic symptomatic prostate cancer but also for locally advanced disease. Basic research and genetic investigations are still ongoing to explore pathways and factors of progression to the metastatic status and to find the most appropriate treatment for each patient.

Mots clés:
cancer de prostate / PSA / Métastase / Hormonothérapie / Chimiotherapie
Mots-clés:
Keywords Prostate cancer / PSA / metastasis / Hormonotherapy / chemotherapy
Chimiothérapie en phase précoce d'hormonorésistance des cancers de prostate métastatiques : quelles indications ?
2010
- Réf : Prog Urol, 2010, 7, 20, S192, suppl. S3


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Treatment of hormone-refractory prostate cancer remains a source of debate. Since 2004, docétaxel-based chemotherapy has become the standard treatment as it has demonstrated efficacy on overall survival in two randomized studies. In some studies, chemotherapy seems to be also effective on pain relief. The adverse effects occur more frequently than with others chemotherapy (mitoxantrone) but are moderated and aren’t responsible of specific mortality. These facts encourage to begin the chemotherapy as earlier as possible even before metastases appear. Some studies have even raised the issue of an initiation of chemotherapy before the onset of hormone independence. However these arguments might be use with caution. The treated patients have a limited life expectancy and a 2 months gain of survival may be of limited value. Furthermore, even low side effects can generate a morbidity on these fragile patients especially when they are initially asymptomatic. Thus, an early initiation of chemotherapy must be discussed case by case, on an individual basis. The prognosis factors and alternative therapeutic options based on new molecules used in metastatic cancer might also be considered for the therapeutic decision.

Mots clés:
cancer de prostate / Chimiotherapie / hormono-résistance / Docétaxel / Toxicité
Mots-clés:
prostate cancer / chemotherapy / Hormone-refractory / Docétaxel / Toxicity
Hormonothérapie combinée à la radiothérapie externe dans le cancer de prostate localement avancé : les effets secondaires contrecarrent-ils les bénéfices ?
2010
- Réf : Prog Urol, 2010, 7, 20, S186, suppl. S3


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Used for more than 60 years in metastatic prostate cancers, hormone therapy is nowadays also an option for the treatment of locally advanced prostate cancer. Adjuvant androgen deprivation combined with external beam radiotherapy has become the gold standard treatment in locally advanced prostate cancer. Combined therapy has been extensively investigated and has shown to improve oncologic outcomes. However, its toxicity is not negligible. Several side effects can be encountered: cardiovascular, bone depletion, metabolic changes and neuropsychologic effects. They may overlap treatment benefits and be responsible of a specific mortality. Nevertheless, randomized studies have demonstrated that there was no increase of specific mortality from combined treatments compared to patients treated by radiotherapy alone. Therefore, these side effects might not be a barrier to adjuvant androgenic deprivation. However, long-term results are still needed and also accurate morbidity studies. In addition, the debate is still ongoing regarding the appropriate duration of hormone therapy.

Mots clés:
cancer de prostate / Hormonothérapie / agonistes de la LHRH / effets secondaires / Effets cardiovasculaires
Mots-clés:
prostate / Cancer / Androgen deprivation / LHRH agonists / Side effects
Surveillance active du cancer de prostate localisé
2010
- Réf : Prog Urol, 2010, 7, 20, S181, suppl. S3


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The widespread application of PSA screening has led to an important increase of the small and well-differentiated prostate cancer. Despite natural history of prostate cancer has not been completely elucidated; it has been proved that the evolution of low grade tumours was favorable and that some of them remain indolent. In these cases, curative therapies and their associated morbities might be considered as overtreatment. Active surveillance should be an option to limit this overtreatment. It is obvious that the initial risk stratification used for active surveillance wasn’t enough restrictive. From now on, it seems that a PSA<10 ng/ml, a Gleason score<7 and more than 10 prostate biopsies are the good criteria to propose for the selection of eligible patients. However, the debate about adequate and accurate criteria is still ongoing between several teams worldwide involved in active surveillance. International prospective studies are in progress and are necessary to establish selections criteria and modalities of surveillance and predictors of active treatment. We need to wait for conclusion from prospective studies results. However, it appears that active surveillance offers yet the possibility to delay active treatment and its complications in selected cases.

Mots clés:
Cancer / prostate / Surveillance / dépistage
Mots-clés:
prostate / Cancer / Active surveillance / Screening