Base bibliographique

Analgésie peropératoire en urologie et influence potentielle de l'anesthésie sur les résultats de la chirurgie carcinologique
2012
- Réf : Prog Urol, 2012, 9, 22, 503-509


Introduction



Introduction

The objective of the current article was to present a review concerning current concepts of perioperative analgesia in urology and to assess the potential influence of anesthesia on oncologic outcomes after surgery.


Patients and methods

Data on general anesthesia and perioperative analgesia were explored on Medline using the following MeSH terms: anesthesia; analgesia; pain urology; cancer; morphin; nefopam; tramadol; ketamine; local anesthetics; non-steroid anti-inflammatory treatments; surgery; cancer. Publications were considered on the following criteria: methodology, relevance and date of publication.


Results

The concepts of acute and chronic pain after surgery are discussed, as well as prevention and treatment. Types of available pharmacological substances are listed and the possible routes of administration for these products. The concept of multimodal analgesia and preemptive analgesia are exposed and their role for the prevention of perioperative pain. Recent studies suggest a relationship between the modes of anesthesia and analgesia in cancer surgery, and recurrence of the disease after surgery.


Conclusion

Current concepts of perioperative analgesia offer new perspectives to urologists in the management of pain. Current scientific literature advocates regional anesthesia, the fight against pain and stress, and decreased use of opioids. In addition, the use of a multimodal analgesia seems to be an option for an optimal oncologic management of urologic tumours.

Mots clés:
Douleur / analgésie / Peropératoire / urologie / Chirurgie
Mots-clés:
MeSH / Anesthesia / analgesia / Pain urology / Cancer
Analyse de l'évolution des pratiques chirurgicales pour la prise en charge des tumeurs primitives du rein dans la période 2006–2010 : à propos d'une série de 458 chirurgies consécutives
2012
- Réf : Prog Urol, 2012, 9, 22, 520-528


Abréviations



Objective

Most of small renal masses are accessible to conservative surgery, which has proved to maintain carcinological outcome, with a lower cardiovascular morbidity, hospital stay and mortality. Current international guidelines for the management of renal tumours recommend that partial nephrectomy be the new standard of treatment of T1 tumours. In this study, the authors assessed evolutive trends in the surgical management of renal tumours in the period 2006 to 2010 in a university hospital.


Patients and methods

Retrospective analysis of a cohort of 446 consecutive patients treated for renal tumour between 2006 and 2010.


Results

Overall, 458 surgeries were performed, divided in 184 (40.2%) partial nephrectomy and 274 (49.8%) radical nephrectomy. During the study period, the number of partial nephrectomy increased significantly, with a mean annual increase rate of 10% in T1a tumours (P =0.002). We also observed a non significant increasing trend for conservative surgery in T1b tumours. Furthermore, the number of laparoscopic partial nephrectomy increased significantly, with a mean annual increase rate of 8% (P =0.02). At the end of the study period, one in two patients, whatever the stage, was treated by partial nephrectomy. This change in practice occurred without any increase in per- and postoperative morbidity (P =0.39).


Conclusion

Analysis of this cohort of patients operated for renal tumour between 2006 and 2010 in our university hospital did not highlight underuse of conservative surgery, taking into account the current international guidelines. This trend for more partial nephrectomy did not underscore an increase in surgical morbidity or decrease in carcinological outcome. However, the higher rate of positive surgical margins in the laparoscopic partial nephrectomy group should incite to caution.

Mots clés:
Néphrectomie partielle / Néphrectomie élargie / Carcinome rénal / Recommandations
Mots-clés:
partial nephrectomy / radical nephrectomy / Renal carcinoma / Recommendations
Fistules vésicovaginales avec calculs enclavés
2012
- Réf : Prog Urol, 2012, 9, 22, 549-552


Introduction



Objective

To describe the clinical features and treatment of a large stone associated with vesicovaginal fistula and analyze the contributing factors.


Patients and methods

From January 2000 to July 2011, seven patients were operated on for a large stone wedged in the vesicovaginal at the Urology Andrology department of the University Hospital of Brazzaville. For each case, the epidemiological, clinical, therapeutic aspects were analyzed.


Results

Seven of 89 patients operated on for vesicovaginal in 10years had a large stone. The age of patients ranged from 35 to 63years with an average of 44years. The age of the fistula ranged from 3 to 33years. History were six caesarean sections and one obstructed labor. The urine culture performed in six patients had identified both Escherichia Coli , five times, and Proteus mirabilis , one time. The calculus was extracted five times by the bladder and two times vaginally. The dimensions of the calculi ranged from 3 to 7cm of large diameter. The suture concomitant fistula was performed with four cures and three failures cured by a second course.


Conclusion

Vesicovaginal fistulas may be complicated by calculus. The contributing factors are foreign bodies and infection.

Mots clés:
Volumineux calcul / Fistule vésicovaginal / traitement chirurgical / Brazzaville
Mots-clés:
Large stone / Vesicovaginal fistulas / Surgery / Brazzaville
La cryopréservation ovocytaire va-t-elle relancer l'intérêt du prélèvement chirurgical de spermatozoïdes synchrone du recueil ovocytaire en cas d'azoospermie non obstructive ?
2012
- Réf : Prog Urol, 2012, 9, 22, 553-554


Cher Éditeur,


Mots clés:
Biopsie testiculaire / Azoospermie non obstructive / Infertilité masculine
Mots-clés:
Testicular biopsy / Non obstructive azoospermia / Male infertility
Le curage ganglionnaire dans le cancer de la prostate : une mise au point du comité de cancérologie de l'association française d'urologie
2012
- Réf : Prog Urol, 2012, 9, 22, 510-519


Introduction



Lymph node invasion is the first step of metastatic evolution of prostate cancer. In this case, today, no local treatment should be proposed. Detection of lymph node invasion is performed by CT-scan and RMI, which show hypertrophied nodes. No difference in term of sensibility and specificity is observed between CT-scan and RMI. Invaded nodes are defined by modifications of size, form, and aspect of the architecture of nodes. Sentinel node belongs to expert centers. Surgical lymphadenectomy remains the best way to evaluate lymph node status. Limited to ilio-obturator land, it underestimates the risk of lymph node invasion: Extended lymph node excision defined by the association of bilateral ilio-obturator, internal iliaca and external iliaca lymphadenectomy should be systematically proposed to intermediate and high risk prostate cancer. A “well done” lymphadenectomy is represented by more than 10 nodes removed. Lymph node invasion represents bad prognosis. However, therapeutic value and influence of prognosis of lymphadenectomy in prostate cancer is still not established. Therefore, one or two invade lymph nodes represented a population of patients with better prognosis, specially if no capsular effraction is observed. After radical prostatectomy, in case of lymph node invasion, immediate hormonotherapy is the standard; however, this treatment is discussed in case of low number of invaded nodes (one or two) and if postoperative PSA is equal to zero. In this case, radiotherapy is still in evaluation and chemotherapy has no indication.

Mots clés:
Cancer de la prostate / Envahissement ganglionnaire / Curage ganglionnaire / Prostatectomie totale / radiothérapie
Mots-clés:
prostate cancer / Lymph node invasion / Lymphadenectomy / radical prostatectomy / External radiotherapy
Prise en charge des patients ayant une vessie neurologique en France : une enquête du groupe d'études de neuro-urologie de langue française (GENULF)
2012
- Réf : Prog Urol, 2012, 9, 22, 540-548


Introduction



Objective

To design and run a survey aiming at investigating urologists’ and physiatrists’ clinical practices in France when managing neurogenic bladder patients.


Patients and methods

Three thousand one hundred and eighty questionnaires were sent to the members of four French societies involved in treating neurogenic bladder dysfunction. Questions were focused on consultations, clinical follow-up and patient management.


Results

Two hundred and seventy-four urologists and 109 physiatrists completed the questionnaire. The frequency of systematic follow-up differed between urologists (6months) and physiatrists (12months). Upper urinary tract imaging and systematic urodynamic follow-up were usually performed yearly. The latter was carried out by 56% urologists and 83% physiatrists. Urinary retention was essentially treated by intermittent catheterization. Less than 15% of urologists and physiatrists were treating bacteriuria. Symptomatic urinary infections were treated for 11 to 12days (men) and for 8 to 9days (women). To treat their patients, both specialists used self-catheterization education and botulinumtoxinA injections.


Conclusion

Our survey showed differences in approach between urologists and physiatrists in the management of patients with neurogenic bladder dysfunction. Their clinical practice was most of the time in line with national and international guidelines.

Mots clés:
Vessie / neurologique / questionnaire / Enquête de santé / Pratique clinique
Mots-clés:
Urinary bladder / neurogenic / questionnaire / Healthcare survey / Clinical practice
Radiothérapie pelvienne et sphincter artificiel urinaire chez la femme
2012
- Réf : Prog Urol, 2012, 9, 22, 534-539


Introduction



Objectives

A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR).


Population and methods

From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n =206) and the other group with PR (group 2; n =9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure.


Results

Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P <0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4–140) with AUS implantation.


Conclusion

AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres.

Mots clés:
sphincter artificiel urinaire / Incontinence / radiothérapie / Femme
Mots-clés:
Artificial urinary sphincter / Incontinence / radiotherapy / Women
Résultats périopératoires et postopératoires précoces de la photovaporisation prostatique au laser Greenlight XPS selon l'utilisation d'une fibre 4090 délivrant 120 watts ou d'une fibre MOXY délivrant 180 watts
2012
- Réf : Prog Urol, 2012, 9, 22, 529-533


Introduction



Introduction

Photoselective vaporisation of the prostate (PVP) is a surgical alternative to transurethral resection of the prostate (TURP). The goal of this study was to compare the new AMS MOXY fiber which provide 180 watts power to the 4090 fiber 120 watts power source currently used in benign prostatic hyperplasia. The assessment criteria were peroperative and early postoperative data.


Method

This study was a monocentric prospective trial comparing two parallel groups of treatment: prostatic vaporisation with MOXY fiber (180 watts) against 4090 fiber (120 watts) in patients operated by an experienced surgeon. The urinary catheter was removed the day after the intervention and the patient was allowed to quit after a clinical examination. All the patients had a routine consultation at 1 month: clinical examination, max flow rate, biological results and results of autoquestionnaires.


Results

This study included 50 patients. The two groups were similar at the inclusion: age, urinary catheter, and prostate volume. The operative data show a decrease of vaporization duration (29minutes versus 36minutes, P = 0.009) with an energy delivered increased (281kJoules versus 223kJoules, P = 0.036) and with similar postoperative data: duration of urinary catheterization (3.8 days versus 3.6 days, P = 0.908), length of stay (1.6 days versus 1.8 days, P = 0.371). The 1-month results were similar between the two groups.


Conclusion

The new fiber AMS 180 watts ROXY offer similar postoperative data to the 4090 fiber with improved operative duration and energy delivered.

Mots clés:
Photovaporisation / Puissance / Fibre / HBP
Mots-clés:
Photovaporisation / Power / Fiber / HBP
Tumeurs de vessie intradiverticulaires : revue du Comité de cancérologie de l'Association française d'urologie
2012
- Réf : Prog Urol, 2012, 9, 22, 495-502


Introduction



Introduction

Cancer Committee of the French Association of Urology (CCAFU) conducted a review of the epidemiology, diagnosis and treatment of intradiverticular bladder tumours (TVID) and proposed therapeutic management.


Material and methods

A bibliographic research in French and English using Medline® with the keywords “tumor”, “bladder” and “diverticulum” was performed.


Results

TVID are more frequently of stage T3a and with non urothelial histology than classical bladder tumors. At diagnosis, the risk of underestimation of the extent and multifocality of the tumor was described. Their prognosis, that was more pejorative than conventional tumors, should impelled to limit the indications of conservative treatment. The evidence levels of analyzed publications were low, with C level according to Sackett score.


Conclusion

the specificities of the TVID have lead the CCAFU to propose specific therapeutic guidelines, based on poor evidence level. Ta-T1 low grade TVID can be treated by transurethral resection alone or followed by BCG therapy in cases of associated carcinoma in situ. High-grade TVID, unifocal and without associated carcinoma in situ, can be treated by diverticulectomy associated with pelvic lymphadenectomy. High grade TVID, multiple or associated with carcinoma in situ, warranted total cystectomy.

Mots clés:
Vessie / Diverticule / Cancer / Diverticulectomie / Cystectomie
Mots-clés:
bladder / diverticula / Cancer / Diverticulectomy / Cystectomy