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Analyse critique d'une méta-analyse comparative sur la morbidité, les résultats fonctionnels et carcinologiques de la prostatectomie totale en fonction de la voie d'abord utilisée. Travail du comité de cancérologie de l'AFU
2010
- Réf : Prog Urol, 2010, 8, 20, 547-552


Introduction



Surgical approach for radical prostatectomy is even today a subject of debate in the urologic community. Many comparative studies between retropubic and laparoscopic approach (robotic assisted or not) were reported since 10 years without being able to decide between the supporters of retropubic or laparoscopic approach. The committee of cancer research of the French urological association took hold this question after a recent meta-analysis publication on this subject. Although imperfect, this meta-analysis exists and permits to conclude partially on the advantages and the inconveniences supposed for each surgical approach. Regarding morbidity after radical prostatectomy, the only significant difference reported concerns the hemorrhagic risk in favour of the laparoscopic approach. Regarding oncologic results, the only exploitable data concern positive surgical margins rate, which is identical whatever surgical approach. Concerning the functional results, no difference was reported in the literature between different surgical approaches.

Mots clés:
Prostatectomie / Voie d’abord / Méta-analyse / cancer de prostate
Mots-clés:
Prostatectomy / Prostate neoplams / Meta-analysis / Surgical approach
Apports d'une consultation infirmière spécialisée dans la prise en charge de l'hyperactivité détrusorienne traitée par injections intradétrusoriennes de toxine botulique dans un service d'urologie. Expérience pilote
2010
- Réf : Prog Urol, 2010, 8, 20, 584-589


Introduction



Objectives

To adapt in daily practice, in a urology department, recommendations for good clinical practice for follow-up of neurological patients with neurogenic detrusor overactivity treated with injections of botulinum toxin type A by involving a referent nurse in neuro-urology.


Method

A nurse consultation in neuro-urology has been created in June2007 to intervene at each follow-up consultation at D0, D8, D45, then by phone until reappearance of functional signs to organize a new injection of botulinum toxin. This pilot study evaluated the faisability, the input on clinical workload, and the benefit on relationship between the patient and the caregiver.


Results

An improvement of the quality of care has been given to the patient since first contact to follow-up. The number of neurological patient transfers and waiting time between the recurrence of functional signs and new therapeutic care were reduced. The number of medical consultations has been reduced saving time to redistribute on other activities. Knowledge improvement and privileged relationship with the patient and the doctor were reported by the referent nurse.


Conclusion

The participation of a referent nurse in neuro-urology has improved the quality of care of these patients from first contact to follow-up and has allowed adaptation of the recommendations in the practice of caring of an urology department.

Mots clés:
incontinence urinaire / vessie neurologique / Toxine botulique
Mots-clés:
Urinary incontinence / Neurogenic bladder / Botulinum toxin
Caractéristiques cliniques, histologiques et évolutives des cancers du rein de taille inférieure ou égale à 4 cm traités chirurgicalement
2010
- Réf : Prog Urol, 2010, 8, 20, 572-577


Introduction



Purpose

In a retrospective study, we described the characteristics and the outcome of renal cancers less than or equal to 4cm treated by surgical excision.


Material

Two hundred and eighty four cancers less than or equal to 4cm on preoperative CT scan (T1a) were extracted from our database. We studied, the presence of symptoms, the ECOG and ASA scores, the size, the histological type and the Fuhrman grade. The follow up was clinical, biological and radiological.


Results

The mean age was 60.8 years. 21% of patients were symptomatic. The renal capsule was intact in 182 cases (64.08%), the urinary tract in 267 cases (94.01%). Seven patients (2.46%) were metastatic with tumors greater than or equal to pT3a. The most common histological types were the conventional renal cell carcinoma (78.52%) and the papillary renal cell carcinoma (16.55%). 76.06%. of the tumors were low grade. With a median of 66.9 months, 33 patients died (11.61%) . For N0M0 patients, with a median of 59.3 months, three specific deaths (1.19%) and 17 deaths from other causes (6.77%) were observed. The average survival of N0M0 group was 227.2 months.


Conclusion

The renal cell carcinoma less than or equal to 4cm was a heterogeneous group including locally advanced and aggressive or metastatic tumors. For localized forms, surgical excision provided an effective long-term treatment regardless the histological type or the tumor grade.

Mots clés:
cancer du rein / Néphrectomie / Analyse de survie / Anatomopathologie chirurgicale
Mots-clés:
Kidney neoplasms / nephrectomy / Survival analysis / Surgical pathology
La prostatectomie totale robot-assistée : complications périopératoires, résultats anatomopathologiques et fonctionnels pendant la période d'initiation
2010
- Réf : Prog Urol, 2010, 8, 20, 590-596


Introduction



Objective

We report our experiences regarding the peri- and postoperative complications as well as pathological and functional results of robot-assisted radical prostatectomy during the implementation phase and the learning curve of the technique.


Material

All clinical, paraclinical, as well as peri- and postoperative events of the first 102 patients were filed. Postoperative complications were classified according to the Clavien classification. Regarding functional results, continence was defined as the use of 0 pads or one pad for security reasons. Erectile function was classified into absence of spontaneous erections, erections insufficient for sexual intercourse and erections sufficient for sexual intercourse.


Results

Median procedure time was 240min, blood-loss 400mL and transfusion rate 2%. Overall, 7.8% of all patients had perioperative complications, 13.7% had minor and 4.9% had mayor post operative complications. The overall positive surgical margin rate was 16.0%. At 12month, 87% of all patients were continent and 21.1% had spontaneous erections and 47.4% had sexual intercourse.


Conclusion

Patients treated during the implementation phase of robot-assisted radical prostatectomy show rates of peri- and postoperative complications, as well as pathological and functional results comparable to the results of centers of excellence published in the literature.

Mots clés:
Prostatectomie / Chirurgie robotique / Marge chirurgicale / continence / fonction érectile
Mots-clés:
Prostatectomy / Robotic / Surgical margin / continence / Potency
Le désordre primaire de la relaxation sphinctérienne ou syndrome de Fowler
2010
- Réf : Prog Urol, 2010, 8, 20, 553-559


Introduction



The primary disorder of sphincter relaxation or Fowler’s syndrome constitutes the first cause of urinary retention in young women after ruling neurological, iatrogenic and local origins out. It includes painless urinary retention, polycystic ovaries in more than 50% of the cases, high maximum urethral closure pressure, increase in sphincter volume and striated urethral sphincter electromyography abnormalities. So far, the only treatment restoring micturation in this condition is sacral neuromodulation.

Mots clés:
Syndrome de Fowler / rétention d’urine / Femme / sphincter
Mots-clés:
Fowler’s syndrome / Urinary retention / Woman / sphincter
Les règles de la médecine fondée sur les preuves sont-elles strictement respectées dans le domaine de la prostatectomie totale laparoscopique robot-assistée ?
2010
- Réf : Prog Urol, 2010, 8, 20, 596-597

Mots clés:
M.
Mots-clés:
Prostatectomy / Robotic / Surgical margin / continence / Potency
Nutrition, suppléments alimentaires et cancer de la prostate
2010
- Réf : Prog Urol, 2010, 8, 20, 560-565


Prostate cancer is becoming the most common cancer in men. In parallel, role of diet as contributing or protector factor of prostate cancer is supported by experimental studies, clinical observations and intervention studies. Among the prostate cancer risk factor, role of energy intake, especially saturated fat, has been demonstrated. Similarly, omega-3, lycopene, pomegranate juice and vitamin D protective role have been shown. Informed and educated population is necessary to limit energy intake and promote consumption of foods potentially protective.

Mots clés:
Cancer de la prostate / nutrition / Prévention
Mots-clés:
prostate cancer / nutrition / Prévention
Que peut cacher une hydrocèle ?
2010
- Réf : Prog Urol, 2010, 8, 20, 601-603


Introduction



The catheter migration after ventriculoperitoneal shunt (VPS) for hydrocephalus is a very rare complication. It is caused by a disconnection or rupture of the catheter. Then, this one can be exteriorized through the anus or the mouth. We report here the case of catheter exteriorization after VPS through the peritoneovaginal duct diagnosed during the hydrocele surgical cure, two years after VPS insertion. The children with VPS require a regular clinical surveillance and a radiographic control of the hydrocephalus valve track, once per year.

Mots clés:
Cathéter ventriculopéritonéal / complication / migration / Canal péritonéovaginal
Mots-clés:
Ventriculoperitoneal catheter / complication / migration / Peritoneovaginal duct
Récidive locale après néphrectomie partielle laparoscopique (NPL) pour cancer du rein
2010
- Réf : Prog Urol, 2010, 8, 20, 598-600


Introduction



We report the case of an early local recurrence after a laparoscopic partial nephrectomy (LPN) for a Furhman grade 1–2 clear cell renal carcinoma (CCRC). CT scan at 6 months revealed a local recurrence. An open total nephrectomy was performed. There were six nodules in the perirenal fat from a grade 3 CCRC. Twenty-six months after the LPN, the patient had a wound recurrence, which was surgically removed. Four months after the wound recurrence, the patient had pulmonary, liver and adrenal glands metastasis. He received an oral treatment with sunitinib. At 4 months after the initiation of the sunitinib, he had a total response.

Mots clés:
Rein / Cancer / Néphrectomie partielle / laparoscopie / Récidive
Mots-clés:
kidney / Cancer / partial nephrectomy / Laparoscopy / recurrence
Syndrome d'Antopol Goldman bilatéral associé à un déficit congénital sévère en facteur V
2010
- Réf : Prog Urol, 2010, 8, 20, 604-607


Introduction



Antopol-Goldman lesions are extremely rare. This kind of lesion is a subepithelial pelvic hematoma. This syndrome is certainly of rare occurrence and that is why a differential diagnosis of urothelial cancer in young patients who had problems with clotting must be raised. We reported a case of a 43-year-old haemophiliac with a severe congenital factor V deficit and presenting a bilateral and asynchronous Antopol Goldman syndrome. The diagnosis has been based on CT scans. The subepithelial aetiology bleeding has been shown on selective renal arteriography that allowed to cover a micro-aneurysm through the setting up of a vascular stent and a selective embolization.

Mots clés:
hématurie / Antopol Goldman / Hémophilie / Facteur V / Embolisation
Mots-clés:
hematuria / Antopol Goldman / Haemophilia / Factor V / embolization
Traitement de l'hyperplasie bénigne de la prostate par radiofréquence monopolaire type Prostiva ®
2010
- Réf : Prog Urol, 2010, 8, 20, 566-571


Introduction



Benign prostatic hyperplasia (BPH) is a common disease affecting a large proportion of men older than 50 years. There are multiple treatment options for BPH including medications, minimally invasive options such as transurethral needle ablation (Tuna®) and transurethral microwave therapy (TUMT), and more invasive options such as transurethral laser vaporization and transurethral resection of the prostate (TURP). The minimally invasive options induce thermal injury to the BPH adenoma with a lower risk of permanent side effects than TURP. Tuna® treatment is a minimally invasive technique of BPH which can be carried out in ambulatory surgery and which is effective for urinary symptoms with little risk of morbidity. It is an alternative to medical treatment and does not replace planned surgical treatment. Available evidence suggests that Tuna® is a relatively effective and safe technique. It significantly improves BPH parameters but it does not reach the same level efficacy and long-lasting success as TURP. Also the Tuna® procedure compares favourably to combination medical therapy for the treatment of BPH on a cost basis. ⍺-Blocker monotherapy is less costly than Tuna® for 5 years, while the cost of 5⍺-reductase inhibitor monotherapy is approximately equivalent to that of Tuna® for 5 years. From the payer’s perspective, the break-even point between the Tuna® procedure and combination medical management occurs after approximately 2 years 7 months of treatment.

Mots clés:
hyperplasie bénigne de la prostate / Traitement / Radiofréquence
Mots-clés:
Symptomatic benign prostatic hyperplasia / treatment / Transurethral needle ablation
Traitement du prolapsus génital par renfort transvaginal Prolift ® : une étude prospective
2010
- Réf : Prog Urol, 2010, 8, 20, 578-583


Introduction



Objective

To evaluate the efficacy and to report the follow-up of transvaginal repair of genital prolapse using a tension free vaginal mesh.


Patients and methods

Twenty-eight women were treated for genital prolapse with the Prolift® technique and followed prospectively. Preoperative prolapse treatment, associated treatment, complications were reported. Postoperatively, efficacy and complications were reported. Patients were examined at one, three, six and 12 months then yearly. Treatment failure defined as Pelvic Organ Prolapse Quantification (POP-Q) stage II or more.


Results

The mean age was 68 years. The median follow-up was 12 months. Ten (35%) and 14 (50%) patients had a stage II and III/IV cystocele respectively. Nineteen (67%) patients had stage II/III rectocele. We reported one bladder injury (3.5%) sutured during surgery and one haematoma (3.5%) requiring secondary management. Important buttock pain appeared in two patients (7%) treated with a total mesh on day 1 and 6 weeks after surgery respectively. They were both relieved after cutting one posterior arm of the mesh. De novo stress incontinence appeared in one (3.5%) patient and urgency in two (7%) patients. Mesh exposure occurred in one (3.5%) patient requiring a minimal surgical management. One patient (3.5%) declared dyspareunia. Success was reached in 96.5% patients.


Conclusion

The transvaginal mesh was a safe and efficient technique to treat genital prolapse.

Mots clés:
cystocèle / Rectocèle / Prolapsus génital / Voie vaginale / Mèche vaginale
Mots-clés:
cystocèle / Rectocèle / Genital prolapse / Vaginal route / Transvaginal mesh