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Marrakesh, Morocco

Hatzimouratidis K.,Aristotle University of Thessaloniki | Eardley I.,University of Leeds | Giuliano F.,Service durologie | Hatzichristou D.,Aristotle University of Thessaloniki | And 4 more authors.
European Urology | Year: 2012

Context: Penile curvature can be congenital or acquired. Acquired curvature is secondary due to La Peyronie (Peyronie's) disease. Objective: To provide clinical guidelines on the diagnosis and treatment of penile curvature. Evidence acquisition: A systematic literature search on the epidemiology, diagnosis, and treatment of penile curvature was performed. Articles with the highest evidence available were selected and formed the basis for assigning levels of evidence and grades of recommendations. Evidence synthesis: The pathogenesis of congenital penile curvature is unknown. Peyronie's disease is a poorly understood connective tissue disorder most commonly attributed to repetitive microvascular injury or trauma during intercourse. Diagnosis is based on medical and sexual histories, which are sufficient to establish the diagnosis. Physical examination includes assessment of palpable nodules and penile length. Curvature is best documented by a self-photograph or pharmacologically induced erection. The only treatment option for congenital penile curvature is surgery based on plication techniques. Conservative treatment for Peyronie's disease is associated with poor outcomes. Pharmacotherapy includes oral potassium para-aminobenzoate, intralesional treatment with verapamil, clostridial collagenase or interferon, topical verapamil gel, and iontophoresis with verapamil and dexamethasone. They can be efficacious in some patients, but none of these options carry a grade A recommendation. Steroids, vitamin E, and tamoxifen cannot be recommended. Extracorporeal shock wave treatment and penile traction devices may only be used to treat penile pain and reduce penile deformity, respectively. Surgery is indicated when Peyronie's disease is stable for at least 3 mo. Tunical shortening procedures, especially plication techniques, are the first treatment options. Tunical lengthening procedures are preferred in more severe curvatures or in complex deformities. Penile prosthesis implantation is recommended in patients with erectile dysfunction not responding to pharmacotherapy. Conclusions: These European Association of Urology (EAU) guidelines summarise the present information on penile curvature. The extended version of the guidelines is available on the EAU Web site (www.uroweb.org/guidelines/). © 2012 European Association of Urology. Source

Villers A.,Service durologie
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie | Year: 2010

Endothelin-1 (ET-1) is a vasoactive peptide but also mitogenic and pro-angiogenic. ET-1 exerts its actions via two G protein-coupled receptors, ETA and ETB. ET-1 is involved in the progression of prostate cancer. Its actions affect the tumor cell proliferation, inhibition of apoptosis, angiogenesis, migration, invasion, metastasis to the bone growth. Inhibitors of receptors of ET-1 in clinical development are the atrasentan and ZD4054. This article reports on controlled, randomized, phase II and III studies on this new therapeutic class. Source

Prostate cancer incidence has tripled in Luxembourg as in many other western countries. From 1982 to 2006, new cases increased from 80 to 309 per year, while the incidence (world stand.pop.) rose from 29.5 to 85 per 100 000 men. Since 1991 prostate cancer is the most frequent male cancer in Luxembourg, exceeding colo-rectal, lung and stomach cancer. Prostate cancer deaths have diminished from 64 in 1982 to 45 in 2006. This represents less than 10% of male cancer related deaths; it represents the third most frequent cancer death, behind lung and colo-rectal cancers. Annual mortality rate has decreased from 29 to 10 per 100 000 men during the same period, this difference between incidence and mortality is explained on the one hand by the widespread use of PSA since the 1990's and on the other hand by a better local control as well as a multidisciplinary approach of advanced disease. The increase of the incidence is particularly important in the 60 to 70 age group, while for men older than 70, the peak incidence was reached in 2002. A lowering of the age at diagnosis is confirmed by the 5-year age group analysis. The hospital cohort consists of 628 patients from the urological department of the Centre Hospitalier de Luxembourg diagnosed with prostate cancer between 1st January 1982 and 31st December 2006; follow-up ended 31st December 2011. During this period, age at diagnosis decreased from 71.5 to 68.9 years whereas the proportion of localized clinical stages increased from 44 to 70%. Median PSA dropped from 14.5 to 9 ng/ml. Furthermore the analysis of cancer specific mortality confirms the negative effects of an advanced clinical stage (10-year survival: 90% for localized disease, 60% for advanced disease) or a high PSA level at diagnosis (10-year survival: 97% if PSA < 4 ng/nl, 94% if 4 < PSA < 10, and 72% if PSA > 10 ng/ml), as well as a poor differentiation (60% 10-year survival compared to 90% for differentiated tumors). Kaplan-Meier curves show that long term surveillance is necessary as even tumors with a good initial prognosis may relapse after 10-12 years. Source

Local recurrence after external radiotherapy or brachytherapy occurs in 30% of patients treated for prostate cancer. These recurrences can be localised to the prostate and controlled by salvage treatment. Salvage prostatectomy is the gold standard treatment, however, it is associated with a high morbidity rate. Minimally invasive treatments such as cryotherapy and high intensity focused ultrasound (HIFU) can be proposed to treat local recurrences. Indications, complications and oncological results of these salvage treatments are discussed in this article. © 2010 Société française de radiothérapie oncologique (SFRO). Source

Dominique S.,Service durologie
Progres en Urologie | Year: 2014

The medical treatment of uric acid stones is essential to its management. It allows the dissolution of the stones and prevents the formation of new ones. This treatment is based on a large diuresis, an alkanilization of the urines and diet. In most of the cases, the medical treatment avoids the use of surgical procedures. © 2014 Elsevier Masson SAS. All rights reserved. Source

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