Base bibliographique

Objective

To determine the survival and prognosis criteria of pT3NxM0 prostate tumours (TNM 2002) after radical retropubic prostatectomy (RRP).

Material and methods

Between 1988 and 2000, 606 consecutive RRP were performed for T1-3 tumours, whose 246 (40.6%) specimens were classified pT3, followed in 53 cases by adjuvant radiotherapy and in 71 cases by salvage radiotherapy. Fifty-five patients received postoperative hormonotherapy at the time of biochemical recurrence. Biochemical recurrence was determined by two PSA values greater than 0.2ng/ml.

Results

Mean age of this group was 65 years at surgery. Mean follow-up was 91.4 months. Mean preoperative PSA was 12.8ng/ml. Distribution of cases was 170 pT3a (69.1%) and 76 (30,9%). At 10 years, the biochemical progression-free, metastasis-free, specific and overall survival was 54, 86, 92 and 75% respectively. Worse biochemical prognostic factors were lymph node extension, high Gleason score, high preoperative PSA, seminal vesicles involvement, positive surgical margins and adjuvant radiotherapy absence.

Conclusion

This study shows that pT3 tumours treated with therapeutic associations including RRP presents an excellent specific survival at 10 years. The determination of biochemical recurrence prognostic factors could help to select patients who need complementary treatments after surgery.

The fact that external beam radiotherapy and brachytherapy are now considered to be curative techniques has led to major review of the modalities of follow-up after radiotherapy for prostate cancer. The problem concerns both the diagnosis of recurrence, rapidly announced by elevation of prostatic-specific antigen (PSA), usually at a subclinical stage, and the validity of criteria of biochemical recurrence to allow comparison of various study. Physicians involved in follow-up should be aware of the potential of bounce in PSA follow-up after external beam radiotherapy or brachytherapy. The PSA bounce phenomemon was defined by a rise of PSA values (+0.1 −0.8ng/ml) with a subsequent fall. Biochemical failure after external beam radiotherapy or brachytherapy (with or without hormonotherapy) was defined by Phoenix criteria by a rise of 2ng/ml above an initial PSA nadir. This definition was more correlated to PSA bounce phenomenon.

Introduction and objectives

Preparation for the national entrance examination is a major concern for hospital medical students. Many teaching materials are available to prepare for the urology module: faculty photocopies and general urology texts. The objective of this study was to determine the selection criteria used by medical students to choose their urology teaching materials, in preparation for the national entrance examination.

Material and method

A questionnaire was distributed to 200 medical students (4th and 6th year students) preparing for the national entrance examination. This questionnaire comprised three parts: (1) information about the student (medical school, attendance of lectures, participation in intern conferences); (2) studentʼs level of satisfaction with the teaching material provided;(3) criteria of choice (18 items) of the photocopies used.

Results

Out of the 200 students completing the questionnaire, only 32% used teaching material provided by the university and 22% reported that their medical school did not provide Urology teaching material. Fifty-nine percent of students thought that this teaching material was “moderately” to “not at all adapted” to the national entrance examination programme and 70% considered that they were “moderately” to “not at all” prepared for the national entrance examination. We noted that 83.5% of students thought that intern conferences were “useful” to “very useful” to prepare the urology module of the national entrance examination and 85% thought that photocopies were “useful” to “very useful” to prepare the national entrance examination. The College of urology photocopies were the most widely used teaching material: 38% of students. The four most important criteria of choices were “their peers’ opinion”, “the style of presentation and writing” and “advice from interns”. “The author” and “price” were only rated in 11th and 12th positions.

Conclusion

In this study, students appeared to consider that the material provided by medical schools was insufficient and poorly adapted to prepare for the national entrance examination in Urology. In contrast, College of urology photocopies appeared to be a satisfactory study tool, in terms of presentation and writing.

Closed penile fractures without hematoma and without rupture of the albuginea, though frequent, are not well documented. In most cases, faced with no or few symptoms, the patient makes little case of this painful episode. These fractures are secondarily responsible for a fibrotic response of the corpus cavernosum, which bring patients later on to the clinic. Radiological investigations show the fibrotic reaction. A diagnosis is made retrospectively, based on the patientʼs history.

Objective

The purpose of our study was to demonstrate the prognostic value of morphologic subdivision of papillary renal cell carcinoma and compare MUC1 expression in two types.

Materials and methods

The present retrospective study included 30 cases of papillary renal cell carcinoma based on review of histology slides. The histologic type, Führman grade and stage pTNM were specified. Immunohistochemistry was performed in 22 cases using antibody MUC1.

Results

Patients were 23 men and seven women with a mean age of 59.6 years. Eleven tumors were type 1 and 19 were type 2. Type 2 tumors were significantly associated with a higher Führman grade (p =0.0002). We showed a differential expression of MUC1, which is frequently expressed in the type 1. A local recurrence occurred in one case, lung metastasis in the second one and both tumors were type 2. The survival rate without recurrence and metastasis was 100 % in the type 1. It was 79 % at 12 months and 59 % at 24 months in the type 2. MUC1 expression was correlated with the outcome.

Conclusion

Type 2 tumors are associated with a higher Führman grade than type 1 and MUC1 expression is more frequent in type 1 and correlated with outcome.

Objective

To evaluate the results of one-stage bilateral rigid ureteroscopy for the treatment of bilateral ureteric stones and to identify predictive factors of failure.

Materials and methods

From January 1995 to June 2006, 61 patients were hospitalised for bilateral ureteric stones. Fifty patients, that is, 100 renal units were treated by first-line one-stage bilateral rigid ureteroscopy using an 8 F rigid ureteroscope and a ballistic lithotriptor. A complete statistical analysis (bivariate analysis completed by multivariate analysis) was performed to identify predictive factors of intraoperative failure.

Results

The overall success rate per patient (success on at least one side) was 92% (with bilateral success in 70% of cases). Statistical analysis revealed a statistically significant difference between the two failure/success groups for mean stone diameter (p <0.1%), site (p =0.6%) and degree of cavity dilatation (p =4%). Similarly, a strong statistical correlation was observed between these variables and intraoperative failure. The intraoperative complication rate was 4% (two patients) and the postoperative complication rate was 16%, corresponding to minor complications in every case (low back pain, fever) not requiring a supplementary procedure.

Conclusion

One-stage bilateral rigid ureteroscopy achieved satisfactory results similar to those of unilateral ureteroscopy. Predictive factors of failure were: stone diameter (greater than 15mm), stones in the lumbar ureter and marked cavity dilatation.

Urethral duplication, also called supernumerary urethra, is a rare malformation essentially affecting the boys. It is defined by juxtaposition of two or more muscular channels with urinary tract mucosal lining. Various features may be observed depending on the site of the extra urethra and its incomplete or complete nature. In this study, the authors examined a particular aspect of this malformation, the epispadiac form.

The prospect for a treatment by chemical lysis and the effective disease prevention appropriateness are the purposes of the early recognition of the uric acid stones, which counts up to 10% of all kidney stones. Until now, this characterization was possible only afterwards by the chemical analysis of an expelled stone. Neither biology nor radiology contributed as a valid share on this subject. CT with “dual energy” mode seems to fill this gap. This concept, known since the seventies, reaches the clinical routine now thanks for the use of a “dual source CT”.

Mucinous tumors of the kidney are rare. The pathogenesis of these lesions is controversial. We report the observation of a 31-year-old woman presented with right-flank pain and hematuria. Abdominal ultrasonography and computed tomography revealed a multicystic mass of the right kidney. A total nephrectomy was performed. The pathological exam concluded on a mucinous cystadenoma of the right kidney. Mucinous cystadenoma of the kidney with a multicystic presentation has not been previously reported. In this work, we present the different pathogenic hypothesis and the means of treatment of this rare entity.

Introduction

The knowledge of professional practices is necessary for defining educational needs. The topic to explore was testosterone deficiency syndrome.

Material and methods

An opinion survey on testosterone deficiency syndrome was conducted on the internet among urologists members of the French Urological Association. Two hundred and thirty-six urologists filled in a questionnaire exploring the perception of the concept, the clinical and biological components of diagnosis, and finally the means and aim of management.

Results

The variety of denominations for a single disease and the predominance of sexual and functional symptoms were highlighted. Difficulties in biochemical diagnosis seemed to be linked to the different circulating fractions of serum testosterone, with bioavailable testosterone being too much prescribed as a first line test. Decision to treat, after contraindications have been ruled out, was mainly based on a decreased quality of life, on sexual dysfunction and patient request. Three urologists out of four gave recommendations for life hygiene and eight out of ten managed themselves testosterone replacement treatment.

Conclusion

Overall, French urologists showed a fairly good knowledge of testosterone deficiency syndrome and a strong will for a treatment tailored to patients requirements and symptomatic efficiency.

Purpose

To study prevalence and severity of erectile dysfunction (ED) in a population of men treated in emergency for a coronaropathy.

Material

The files of 200 patients who underwent a coronarography in urgency before the 1st of January 2007 were reviewed retrospectively. The following data were collated: epidemiological data and detailed breakdown of affected coronary arteries. The following patients were excluded from the current study: age over 65, past history of prostate surgery or pelvic external beam radiation therapy. The international index of erectile function (IIEF-5) questionnaire was sent by regular mail. Patients were classified according to the severity of ED: “no ED” between 21 and 25 inclusive, “mild ED” less than 21, “moderate ED” less than 17 and “strong ED” less than 10.

Results

Overall, 78 patients were included with a median age of 58 years. Prevalence of DE was 0.82 and median length of evolution was 9 months before coronary syndrome. Forty-nine patients (62.8%) had an ED classified between moderate and strong. ED was significantly associated with the group of patients smoking more than 20 cigarettes a day for at least 10 years (N =44; P =0.01) and with the group of patients older than 60 years (N =38; P =0.02). There was an association between the severity of the coronary disease and an ED classified between moderate and strong (P =0.03).

Conclusion

This study corroborates the existence of a strong link between ED and coronary disease, notably in patients under 65 years of age. In addition, it seems that the severity of ED is directly related with the anatomical severity of coronary disease.

Premature ejaculation is a very frequent form of sexual dysfunction characterized by loss of control of ejaculation, inducing performance anxiety and, consequently, impaired quality of life of patients and their partners. The pathophysiology of this symptom is often both psychogenic and organic. The various organic causes must be systematically investigated. Several drug treatments are used with varying degrees of efficacy and their adverse effects must be taken into account when choosing a molecule. Psychological management is an essential complement to drug treatment.

In 2007, prostate cancer was the subject of a large number of communications in international conferences. The most innovating studies that are likely to modify patient management were selected. The topics included cancer detection, active surveillance, surgery and treatment of urinary incontinence after prostatectomy, radiotherapy, and high-intensity focalized ultrasound (HIFU). Current hormone treatment modalities as well as the new therapies for hormone-resistant prostate cancer management were also evaluated in detail.

In 2007, urothelial cancers were the subject of a large number of varied communications in international conferences. Some of the most innovating studies likely to modify patient management were selected. Regarding non muscle-invading tumors, maintenance treatments using intravesical instillations were emphasized. Laser and laparoscopy were assessed in urothelial tumors of the upper urinary tract. Finally, new radiochemotherapy protocols have appeared for infiltrating bladder tumors. Extended lymphadenectomy and laparoscopy were also evaluated in detail.

The most innovating studies presented at the 2007 international conferences in the field of kidney cancer were selected. The notable topics presented covered diagnostic biopsies and the growing place of conservative surgery and laparoscopy in kidney cancer management. For cases with poor prognosis, the new anti-angiogenic therapies were thoroughly evaluated.

In the 2007 international conferences, a certain number of communications were devoted to the cancers of the male external genital organs. The most innovating studies were selected. In the pure testicular seminomas, radiotherapy was compared to carboplatin in adjuvant treatment. Active surveillance of stage la germinal tumors was evaluated. In penis cancer management, curietherapy in early-stage treatment was reported, and sentinel lymph node detection was covered in many studies.