Base bibliographique

Angiosarcome primitif du rein : à propos d'un cas et revue de la littérature
2012
- Réf : Prog Urol, 2012, 7, 22, 438-441


Introduction



The primary angiosarcoma of the kidney is a rare tumor. We report a case of angiosarcoma of the right kidney in a man of 60years. The CT-scan appearance is the one of a solid tumor compatible with renal cell carcinoma. Histological examination of the piece of nephrectomy straightens diagnosis and reveals the angiosarcomatous nature. In this patient with bone and lung synchronous metastasis, evolution has been a lightning death in less than three months. The literature review confirms the high potential of malignancy of these tumors (metastases almost constant and very short survival in spite of local and systemic treatment).

Mots clés:
Cancer / Rein / Angiosarcome
Mots-clés:
Cancer / kidney / Angiosarcoma
Atteintes rénales de la sclérose tubéreuse de Bourneville : recommandations de prise en charge
2012
- Réf : Prog Urol, 2012, 7, 22, 367-379


Introduction



Purpose

To review existing literature and deduce guidelines for the management of renal disease in patients with tuberous sclerosis complex (TSC).


Patients

After review of literature, a core panel of five physicians wrote a draft that was evaluated by 14 reviewers who used a 9-level scale (1: total disagreement; 9: total agreement). The guidelines were then reformulated until each item received a median score superior or equal to 8.


Results

Forty-eight to 80 % of TSC patients have significant renal involvement including angiomyolipomas (AMLs), cysts, malignant tumors and renal insufficiency. It is recommended to perform an abdominal ultrasound (and serum creatinine if abnormal ultrasound) when TSC is diagnosed. This work-up will be repeated every 3–5years if normal. Associated autosomal dominant polycystic kidney disease must be suspected in case of numerous and large cysts. After the age of 20, follow-up should use computed tomography (CT) or MRI that are more precise than ultrasound for the measurement of AMLs. Biopsy of a renal mass should be discussed in case of calcifications, necrosis or rapid growth. Females with TSC should undergo screening for pulmonary lymphangioleiomyomatosis by CT at the age of 18, and, if negative at the age of 30–40. Acute bleeding should be treated with percutaneous embolization. Asymptomatic angiomyolipomas with several risk factors (size>80mm, predominant vascular component, micro-aneurysms) should undergo prophylactic treatment, if possible using embolization. The role of mTOR inhibitors in the management of angiomyolipomas needs to be defined.


Conclusion

Standardization of follow-up and treatment is necessary to improve the management of TSC renal involvement.

Mots clés:
Sclérose tubéreuse de Bourneville / Rein / Angiomyolipome / Kyste / Embolisation
Mots-clés:
Tuberous sclerosis complex / kidney / Angiomyolipoma / cyst / embolization
Caractéristiques des pyélonéphrites aiguës chez les patients transplantés rénaux
2012
- Réf : Prog Urol, 2012, 7, 22, 397-401


Introduction



Introduction

Renal transplantation is an attractive alternative to haemodialysis for patients with renal failure. Preserving renal function after renal transplantation depends on rejection episodes and infections of the graft.


Purpose

To clarify the characteristics of acute pyelonephritis encountered in a population of kidney transplant patients and to discern risk factors occurring during the first year after transplantation.


Method

Data for all renal transplantations between January 1, 2006, and December 31, 2007 came from a database. Patients were at least 18 years old. A retrospective analysis was done.


Results

One hundred and eighty-four patients were included in the study. The incidence of acute pyelonephritis was 10.9%. In our sample, there were significantly more women who experienced pyelonephritis (P =0.012). Patients who had grafts with at least one episode of acute pyelonephritis were significantly younger (P =0.013) than transplanted patients without a history of acute pyelonephritis (44.4±10.5 and 52.2±13.4 years, respectively).


Conclusion

Our study shows a lower incidence of pyelonephritis compared with the literature. Moreover, we found that young age and female gender were risk factors for developing this infection.

Mots clés:
Pyélonéphrite aiguë / Transplantation rénale / facteur de risque
Mots-clés:
pyelonephritis / Kidney transplantation / Risk factors
Cystostomies continentes : expérience monocentrique
2012
- Réf : Prog Urol, 2012, 7, 22, 415-423


Introduction



Aims

To evaluate the feasibility, the efficiency, the results of continent cystostomy in adult population.


Material and methods

Retrospective study of patients who underwent a continent cystostomy between 1987 and 2011.


Results

Forty-three patients underwent a continent cystostomy (13 men and 30 women). The mean age at surgery was 53.4±14.6years. The mean BMI was 25kg/m2. No death in relation with the cystostomy was reported. Thirty-two patients had a neurological pathology (74.4%), 11 a pathology other than neurological (25.6%). A retention bladder was reported for 12 patients (27.9%), 17 (39.5%) were incontinent, and 14 (32.6%) had a mixed symptomatology. All patients had urodynamics and an evaluation of the urinary tract. Nineteen appendicovesicostomy were made, 15 double Monti-procedure, six simple Monti-procedure, three channels were made of an association of ileon and appendix. Seventeen patients underwent an augmentation cystoplasty in combination with the continent catheterizable conduit. The mean follow-up was 47.6±29months. Continence was achieved in 37 patients (86%), two patients underwent a Bricker. Stomal stenosis occurred in eight patients (18.6%), with a median time of 16.1±20.4 months. Leakage occurred after bladder neck closure for two patients (4.6%). Clean intermittent catheterization were performed by 30 patients, catheterization by a care giver for four patients, seven did not use their stomy because of the evolution of their causal pathology, or because of an intercurrent pathology. No difference between the channels (Mitrofanoff versus Monti) was reported.


Conclusion

Continent catherizable cystostomy were a feasible method of continent urinary diversion in an adult population. This study demonstrated their feasibility in an adult population and their long-term efficiency with a mean follow-up of 47.6months and 127months for one of them. With a rate of continence upper than 80%, it was an effective technique of urinary diversion associated with intermittent catheterization.

Mots clés:
dérivation urinaire continente / Cystostomie / Mitrofanoff / Monti / Incontinence
Mots-clés:
appendicovesicostomy / continent urinary diversion / Mitrofanoff / Monti-procedure / Incontinence
Fiabilité des biopsies prostatiques pour l'étude de la topographie tumorale dans le cancer de prostate
2012
- Réf : Prog Urol, 2012, 7, 22, 408-414


Introduction



Introduction

The therapeutic approach of prostate cancer depends mainly on pathological criteria obtained through prostate biopsy. The low accuracy of prostate biopsy for Gleason grade determination is well known but its accuracy for bilateral or multifocal tumor has not been evaluated. The goal of this study was to assess the concordance between prostate biopsy and whole prostate specimen obtained after radical prostatectomy especially for bilateral and/or multifocal tumor.


Methods

We retrospectively compared the pathological results of prostate biopsy cores to the prostate specimen in patients who underwent radical prostatectomy in our department between the 01/01/1999 and the 31/12/2008. The criteria analyzed were the Gleason score, tumor bilaterality or multifocality. The impact of the number of prostate biopsy cores was also analyzed.


Results

Two hundred and five complete histological records were studied. Regarding the Gleason score overall concordance was 55%. In 38%, prostate biopsies downgraded the Gleason score. This concordance decreased with tumor differentiation (90.6% for Gleason 6 vs. 31% for Gleason greater than 7). For the tumor bilaterality, 78% of cancers affected both lobes at the definitive specimen analysis while only 49% were bilateral at prostate biopsies, achieving a concordance of 61%. Multifocal disease was observed in 36% at definitive pathology analysis with low concordance with prostate biopsies (36%). The number of biopsies increased the concordance for the Gleason score (60 to 81% for Gleason 7 and from 28 to 50% for Gleason greater than 7) and tumor location (44 to 70%).


Conclusion

Pathological criteria and tumor mapping obtained from prostate biopsies were not very reliable especially when the tumor was poorly differentiated. An increased number of prostate biopsy core improved the sensitivity and specificity for the Gleason score diagnostic and of the tumor mapping.

Mots clés:
cancer de prostate / Biopsie de prostate / score de Gleason / Localisation tumorale
Mots-clés:
prostate cancer / Prostate biopsy / Gleason score / Tumor location
Intérêt du curage ganglionnaire dans les tumeurs urothéliales infiltrantes de la vessie (TVIM) et de la voie excrétrice supérieure (TVES) : article de revue du Comité de cancérologie de l'Association française d'urologie
2012
- Réf : Prog Urol, 2012, 7, 22, 380-387


Introduction



Introduction

Lymph node dissection during radical cystectomy or nephroureterectomy confers improved prognosis and eventually therapeutic advantage. The aim of this update is to clarify the anatomical limits of the lymph node dissection, imaging related techniques, possible difficulties related to pathological analysis, its prognostic value and adjuvant treatments.


Method

A literature review was performed using PubMed database with a combination of the following keywords: “urothelial carcinoma”, “lymph node excision”, “imaging”, “pathology analysis”, “prognosis”, “chemotherapy” and “radiotherapy”.


Results

Regarding bladder tumours, extended lymph node dissection is usually performed up to the division of the iliac vessels and the crossing of the ureters. The CT scan is the recommended imaging technique for lymph node staging but its sensitivity is low. Pathological examination should include perivesicle lymph nodes analysis and report the number of normal and metastatic lymph nodes separately. The prognosis is correlated to the total number of lymph nodes removed and to the extent of the excision. The lymph node density (number of metastatic nodes/normal nodes) is the most important prognosis factor. Adjuvant chemotherapy has not demonstrated a clear advantage. Its most efficient modality is a combination including cisplatin. For upper urinary tract tumours, lymph node dissection may have an impact on survival but definitive conclusion is limited by the lack of surgical technique and indications standardisation.


Conclusion

Extended lymph node dissection improves survival of bladder cancer and prognosis assessment that could eventually be used to stratify patient requiring adjuvant treatment (level of evidence 3). Improvement on survival was also suggested for upper urinary tract tumors (level of evidence 4).

Mots clés:
Curage ganglionnaire / Pronostic / Chimiothérapie adjuvante / Tumeur de vessie / Tumeur de l’uretère
Mots-clés:
Lymph node excision / prognosis / adjuvant chemotherapy / Urinary bladder neoplasm / Ureteral neoplasm
Les décisions sont-elles homogènes en réunion de concertation pluridisciplinaire (RCP) en onco-urologie ? Comparaison des choix thérapeutiques dans quatre RCP parisiennes
2012
- Réf : Prog Urol, 2012, 7, 22, 433-437


Introduction



Objective

One of the priorities of the “Plan against the Cancer” in France is to ensure the discussion of all cancer cases in a multidisciplinary meeting staff (RCP). The multidisciplinary collaboration is proposed to guarantee a discussion between specialists in every cases, particularly in complex cases. The aim of this study was to compare the therapeutic decision taken in four RCP in Paris Île-de-France academic centres for three identical cases.


Material

Three cases of urological oncology (prostate cancer [PCa], renal cell carcinoma [RCC] and bladder tumour) were selected by a single urologist, not involved in further discussion. These cases were blindly presented in four academic urology department from Paris: Pitié-Salpêtrière Hospital, Mondor Hospital, the Georges-Pompidou European Hospital and Foch Hospital.


Results

The four centres met the criteria of quality of RCP in terms of multidisciplinarity, frequency and standardization. The therapeutic suggestions were similar in the RCC cases, there were differences in the surgical approaches and preoperative work-up in the PCa case and, lastly, the proposals were different for the bladder cancer case.


Conclusion

The decisions relies on clinical data and preoperative work-up but also on the experience and habits of the centre of excellence. For complex cases that does not fit with current guidelines, the panel discussion can lead to different therapeutic options from a centre to another and is largely influenced by the local organisation of the RCP.

Mots clés:
Réunion de concertation pluridisciplinaire / Cancer / Oncologie / Tumeur / Décision
Mots-clés:
Multidisciplinary meeting / Cancer / Oncology / tumor / Décision
Néphrectomie partielle versus élargie en cas d'envahissement de la graisse périrénale. Résultats oncologiques et fonctionnels
2012
- Réf : Prog Urol, 2012, 7, 22, 388-396


Introduction



Purpose

In the latest guidelines of the European Association of Urology, partial nephrectomy was a reference standard in tumors less than 7cm confined to the kidney. The invasion of the perirenal fat and therefore dissection in a potentially tumor tissue with an increased risk of recurrence.


Material

From 1995 to 2009, we retrospectively evaluated the oncological outcomes of partial versus radical nephrectomy in tumors with local extension beyond the boundaries of the kidney, without adrenal involvement or metastatic lymph node extension. We evaluated the histological factors influencing the prognostic.


Results

A total of 43patients have been included (ten partial and 33radical nephrectomy). We did not found any significant difference in terms of specific and recurrence-free survival between partial and radical nephrectomy in tumor invading the perirenal fat (P =0.739 and P =0.683 respectively). Factors influencing the prognosis were the Fuhrman grade (P =0.010), the invasion of the urinary tract (P =0.017) and the presence of a positive surgical margin (P =0.041). The renal function was better after partial nephrectomy. The complication rate was similar between partial and radical nephrectomy.


Conclusion

The perirenal fat invasion by kidney tumor did not impact the oncological outcomes of partial versus radical nephrectomy with better functional outcomes for partial nephrectomy.

Mots clés:
Néphrectomie / Néphrectomie partielle / cancer du rein
Mots-clés:
nephrectomy / partial nephrectomy / Renal cell carcinoma
Résultats de la neuromodulation des racines sacrées sur la continence et la sexualité dans une cohorte de 20 patientes ayant une double incontinence
2012
- Réf : Prog Urol, 2012, 7, 22, 424-432


Introduction



Context

Urinary and faecal incontinence (defining double incontinence) are common conditions, which are frequently associated and can altered sexuality. The effectiveness of the sacral nerve modulation (NMS) in the treatment of the urge urinary incontinence, faecal incontinence and double incontinence was shown.


Objective

The present article aims to determine the impact of SNM on female sexual function in twenty women suffering from a double incontinence.


Methods

All patients who received sacral neuromodulation for urge urinary and/or faecal incontinence between 2005 and 2010 and who still had the implant were included. Only 20 sexually active patients suffering from double incontinence were considered eligible. They completed a questionnaire on follow-up examinations.


Results

The initial indication of NMS was the urge urinary incontinence for 15 patients and the faecal incontinence for five patients. Ten patients (50%) were improved on two incontinence. All patients preserved sexual activity after the treatment of NMS. NMS improves the quality of sexual activity in 45% patients. The numbers of urinary and faecal episodes of incontinence are decreased respectively for 50% and 15% patients during sexual activity. The quality of sexual’s life and orgasm score are significantly increased in the group of patients improved on the DI.


Conclusion

This study confirms the effectiveness of NMS in the treatment of double incontinence which half patients are improved on the two incontinence. This study shows that improvement of urinary or faecal incontinence could have a positive impact on sexuality of these patients, especially for patients improved double incontinence. It is difficult to know if these results are related to its direct action on the neurological ways of sexual function or on its benefit on the continence.

Mots clés:
Neuromodulation des racines sacrées / Double incontinence / Sexualité féminine / incontinence urinaire / Incontinence fécale
Mots-clés:
Sacral neuromodulation / Double incontinence / Urinary incontinence / Fecal incontinence / Sexual function
Transplantation pancréatique et thrombose veineuse : analyse multivariée des facteurs de risque
2012
- Réf : Prog Urol, 2012, 7, 22, 402-407


Introduction



Objective

Portal veinous thrombosis (VT) in the pancreatic transplant (6 to 20% of the cases) is the first cause of early loss of the transplant. Our objective was to identify the risk factors of VT in our experiment.


Method

The sample group includes 106 patients who underwent pancreas transplantation (portal venous drainage, enteric-drained pancreas) within our institute of transplantation from 2004 until 2010. We completed a portal vein extension graft in 25% of the cases. First of all, risk factors were selected from preoperative and operative data with an univariate analysis. We then carried out a multivariate analysis of these factors (binary logistic regression). The threshold P was 0.05.


Results

Sixteen patients (15%) showed a VT. Eight of them developed a total thrombosis and required a transplantectomy. Three risk factors of VT were isolated by the multivariate analysis: a BMI of the receiver>25kg/m2 (Odds Ratio [OR]=6.977), a portal vein extension graft (OR=4.1) and an age of the donor>45 years (OR=4.432).


Conclusions

The knowledge of these risk factors of thrombosis allows the implementation of preventive measures (selection of the donor, nutritional support of the receiver in the registration if BMI>25kg/m2). The portal lengthening should be avoided by an attentive retrieval of the transplant (without shorter section of the portal vein). Nevertheless, the presence of one of these risk factors in a transplant patient should lead to start an antithrombotic treatment.

Mots clés:
Transplantation / Pancréas / Thrombose veineuse
Mots-clés:
Transplantation / Pancréas / Venous thrombosis