Base bibliographique

Apport de l'embolisation curative et préventive pour la prise en charge des angiomyolipomes rénaux
2010
- Réf : Prog Urol, 2010, 9, 20, 627-632


Introduction



Objective

The purpose of this study was to present the role of embolization in the treatment of kidney angiomyolipomas (AML), for preventive care or in case of bleeding.


Methods

From March 1995 to March 2007, 22 AML in 21 patients (16 women and five men, mean age 38years) were embolized: five AML were treated for hemorrhagic shock emergency and 16 were preventive embolization. Eight AML were discovered incidentally and nine patients had pain or hematuria. The average size of AML was 70mm (20 to 130mm). The embolization was performed with coils or embospheres.


Results

Three patients have not been embolized because of renal failure catheterization. The embolization was effective in 100% of patients treated in emergency. The six patients cared for gross hematuria and pain were asymptomatic after embolization. The average tumor size reduction was 32% with a mean time of 53.2months (five to 101months). Three patients (14%) have benefited from surgery remotely.


Conclusion

Embolization is the best technique for treating bleeding secondary to AML. In preventive treatment or symptomatic, AML embolization is a treatment to offer before considering surgery.

Mots clés:
Angiomyolipome / Embolisation
Mots-clés:
Angiomyolipomas / embolization
Évaluation des réunions de concertation pluridisciplinaire (RCP) en cancérologie dans la région Rhône-Alpes : une enquête de terrain
2010
- Réf : Prog Urol, 2010, 9, 20, 651-656


Introduction : le contexte légal des RCP



The results of a local survey sent to urologists, oncologists and radiotherapeutists working in Rhône-Alpes have been reported to assess the value of multidisciplinary oncological meetings (RCP) in Urology. The results of this short study have been analyzed and compared to the national results published by the Inspection Générale des Affaires Sociales report. Meanwhile, we have created a professional electronic directory collecting all RCP of Rhône-Alpes, which will be accessible soon.

Mots clés:
Reunion concertation multidisciplinaire / Enquête / Annuaire / Rhône-Alpes
Mots-clés:
RCP / Survey / Directory / Rhône-Alpes
Évaluation prospective monocentrique du ciblage diagnostique par hexaminolevulinate (Hexvix ® ) des tumeurs urothéliales de vessie : étude préliminaire
2010
- Réf : Prog Urol, 2010, 9, 20, 644-650


Introduction



Purpose

Prospective evaluation of bladder tumor targeting by Hexvix® fluorescence.


Patient and methods

From September 2008 to September 2009, 28 patients have been evaluated using Hexvix® technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected and patients have been classified using EORTC score.


Results

From the 28 patients, 14 have been identified with bladder cancer (31 tumors) and 90 samples have shown positive fluorescence in blue light. Compared to white light, four additional tumors have been diagnosed by Hexvix® for three patients (p =NS): two cis, one LMP, one pTa low grade. The false positive rate for Hexvix® was 65.5 versus 58.5 % for white light. EORTC score for bladder cancer was associated with better bladder cancer targeting by Hexvix® (p <0.05).


Conclusion

In our experience, Hexvix® targeting was associated with better diagnosis for bladder cancer. Thirteen percent of new positive samples have been found for 10,7 % of patients. In our study false positive rate is a critical point (65.5 %). EORTC score for recurrence and progression might allow to select patients to be targeted by Hexvix®.

Mots clés:
Tumeur de vessie / Hexvix / / Ciblage diagnostique
Mots-clés:
bladder cancer / Hexvix / / Diagnosis / Targeting
Impact de la tomodensitométrie faible dose sur le diagnostic et la prise en charge des coliques néphrétiques aux urgences
2010
- Réf : Prog Urol, 2010, 9, 20, 633-637


Introduction



Objective

To evaluate the diagnostic performance and the benefit in terms of management of low-dose CT for the imaging assessment of renal colic (CN) emergencies.


Patients and methods

Two hundred and ninety-one patients admitted to emergency for CN were included in this study. Eighty-seven had a low-dose CT and 40 an ASP and an ultrasound (ASPE). Different parameters evaluating the diagnostic performance and efficiency of care were compared between the two groups. The quantitative and qualitative variables were compared by Student t test and χ 2 test, respectively.


Results

CT and ASPE confirmed the diagnosis of CN in 76% and 54% of patients, respectively (p =0.013). The average lengths of stay were 408minutes versus 520 (p =0.013) in group scanner and ASPE, respectively. The scan was obtained more rapidly (139min versus 224, p =0.002). There were more requests for expert advice (30% versus 20%, p =0.18) and gestures endo-urology (9.5% versus 5%, p =0.31) in the CT group compared to the group ASPE. Finally, the patients in the scanner have less painful recurrences (6% versus 12.5%, p =0.18) and fewer imaging examinations of second-line (0% versus 30%, p <0.001).


Conclusion

The low dose CT has been more efficient than the couple ASPE for a CN diagnosis. It optimizes the management of emergency patients by reducing their length of stay, waiting time and the rate of second consultation.

Mots clés:
Colique néphrétique / Urgence / TDM faible dose / Prise en charge
Mots-clés:
Renal colic / Emergency / Low dose computed tomography / Patient management
Le robot améliore-t-il la prostatectomie totale laparoscopique dans les cas complexes ?
2010
- Réf : Prog Urol, 2010, 9, 20, 638-643


Introduction



The radical prostatectomy is the main treatment prostate cancer in young men. However in difficult cases, another therapeutic option is often suggested.


Objective

Evaluation of the quality of the anastomosis in complex surgical cases by comparing laparoscopic radical prostatectomy (LRP) to robotic assisted radical prostatectomy (RLRP).


Material

From March 2004 to August 2009, 397 patients underwent radical prostatectomy: 176 LRP and 221 RLRP consecutively by the same surgeon. Antecedents that might have complicated dissection were analyzed: prostatic volume over 80cc, previous inguinal hernia repair with mesh, previous pelvic surgery, body mass index over 30 and previous trans-uretral resection of prostate.


Results

In a preoperative mode, there was no significant difference between the two groups. A multivariable analysis of the quality of the anastomosis turned to the advantage of the robot (OR=2.56 [95 %CI: 1.28–5.25]), specifically for difficult cases (Odd Ratio=7.736 [95 %CI: 2.689–22.254]).


Conclusion

The use of the robot improved the quality of the anastomosis for patients that might have raised technical issues.

Mots clés:
cancer de prostate / Prostatectomie / Robotique chirurgicale / Anastomose / Difficultés techniques
Mots-clés:
prostate cancer / Prostatectomy / Surgical robotic / Anastomosis
Schwannome kystique pelvien évoquant une tumeur de la vésicule séminale droite
2010
- Réf : Prog Urol, 2010, 9, 20, 660-664


Introduction



We present the case of a pelvic schwannoma in a 36 years old man. It was discovered by chance during the medical assessment of a prostatitis. A computed tomography scan and magnetic resonance imaging revealed a 8 centimeters cystic pelvic tumor, closed to the right seminal vesicle. The patient underwent a transrectal ultrasound-guided biopsy, which showed a proliferation of neural peripheric cells with nuclear abnormalities. A tumorectomy was performed by laparotomy. The histological study diagnosed a benign cystic schwannoma. The patient was free of disease 12 months postoperatively.

Mots clés:
Neurilemmoma / vésicule séminale / Tumeurs pelviennes
Mots-clés:
Neurilemmoma / seminal vesicle / Pelvic neoplasms
Single-port en urologie
2010
- Réf : Prog Urol, 2010, 9, 20, 609-615


Introduction



Single-port transumbilical laparoscopy has emerged as an attempt to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Within a short span, several clinical reports have emerged in the urologic literature. As this field is poised to move forward, a complete understanding of its evolution and current status seems imperative. We have summarized and reviewed the history of Single-Port across surgical disciplines. This review emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes.


Evidence acquisition

Using the National Library of Medicine database, the English language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, laparoendoscopic single site surgery intraumbilical, and transumbilical. Within the bibliography of selected references, additional sources were retrieved.


Evidence synthesis

The major findings and surgical techniques described in these papers, are summarized in a chronological and subject-grouped manner.


Conclusions

Single-port has made its initial forays into laparoscopic surgery. Ongoing refinement in technique and instrumentation is likely to expand its future role.

Mots clés:
laparoscopie / / / NOTES / Trans-ombilical
Mots-clés:
Laparoscopy / Single-port / NOTES / Transumbilical / Laparoendoscopic single site surgery
Torsion du cordon spermatique : faut-il faire confiance à un antécédent d'orchidopexie ? À propos d'un cas ayant entraîné la perte d'un testicule unique avec conséquences médicolégales
2010
- Réf : Prog Urol, 2010, 9, 20, 657-659


Introduction



The authors report the case of a patient aged of 27 years who presented in the past a testicular torsion with loss of the ipsilateral testis and fixation of the contralateral one. Ten years later, he presented with pain on the remaining testis, which evolved to necrosis, and led to a second orchidectomy. In retrospective, it appears that the assumption that the testis had been adequately fixed ten years earlier led to the loss of the remaining testis. We thus recommend an urgent surgical exploration when facing a suspicion of spermatic cord torsion, regardless of previous history of orchidopexy.

Mots clés:
torsion du testicule / orchidopexie / Médicolégal
Mots-clés:
Torsion testis / Orchidopexy / médico-légal
Traitement des troubles du bas appareil urinaire liés à une hyperplasie bénigne de prostate par inhibiteur de la phosphodiestérase de type 5
2010
- Réf : Prog Urol, 2010, 9, 20, 616-626


Abréviations



Context

In aging males, there is an increased prevalence of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) whose affect significantly their quality of life. LUTS would represent for ED an independent risk factor. Some treatment of LUTS have indesirable effects on the erectile function. The phosphodiesterase type 5 inhibitors (IPDE 5) revolutionized the treatment of ED. Several recent clinical studies evaluated the effect daily treatment by IPDE 5 on the LUTS secondary to BPH among patients with or without ED.


Materials and methods

we searched Medline for the peer-reviewed articles in English published, pertraining to findings of potential interest supporting a role of IPDE5 in LUTS due to BHP. The keywords used were: benign prostatic hyperplasia; cyclic nucleotide phosphodiesterase type 5; lower urinray tract symptoms; erectile dysfunction.


Results

Generally, daily treatment with IPDE 5 improves the LUTS secondary to BPH as well as in both the storage and voiding domains of the international prostate symptom score (IPPS) and in quality of life questionnaire. It was not observed adverse events.


Conclusion

The first results of the use of IPDE 5 in the LUTS treatment secondary to the HBP seem promising. However, a direct comparison of efficacy of IPDE 5 and alpha-blockers or 5-alpha-reductase inhibitors is not yet available. The mechanism(s) of action(s) of these compounds in this indication remain difficult to affirm even if new hypotheses can be formulated.

Mots clés:
Revue de la littérature / Troubles du bas appareil urinaire / Hyperplasie bénigne de prostate / Inhibiteur de phosphodiestérase de type 5 / NO/cGMP
Mots-clés:
Benign prostatic hyperplasia / Phosphodiesterase type 5 inhibitor / Lower urinray tract symptoms / erectile dysfunction