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Jichlinski P.,Service durologie
Revue Medicale Suisse | Year: 2017

This article summarizes recent advances in the field of urinary infections, bladder function, minimal invasive surgery and genitourinary cancers.


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.


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.


Bruyere F.,Service durologie
Progres en Urologie | Year: 2011

Photoselective vaporization of the prostate is a minimal invasive endoscopic treatment of benign prostatic hyperplasia (BPH) obstruction. It uses the light energy produced by a laser source to destroy and remove urethral obstruction due to BPH. Its main advantage over transurethral resection of prostate is the minimal bleeding allowing a short urethral catheterization and hospital stay. It is useful in patients with bleeding disorders. © 2011 Elsevier Masson SAS.


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.


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.


The indication for artificial urinary sphincter implantation in women is based on several para meters: severity of incontinence, sphincter deficiency with negative urethral support maneuvers, the notion of postsurgery recurrence of incontinence, and absence of contraindication. Quality preoperative clinical and urodynamic assessment is indispensable. The factors for success depend on: implantation on tissue that has not been damaged by repeated interventions; well-codified technique based on regular surgical experience; sufficiently long deactivation; long-term monitoring with expertise in managing breakdowns and revisions. © 2010 Elsevier Masson SAS. All rights reserved.


The physiopathology of urinary incontinence in women is complex. It must be thoroughly understood to orient the therapeutic choices available to patients. In urge incontinence, the initial management is above all conservatory, based on medical treatments and rehabilitation. In stress urinary incontinence, the quality of the urethra guides the indications for support techniques, with suburethral slings taking the lead and a preference for the retropubic approach in cases of sphincter deficiency with mobility of the urethrovesical junction preserved. In mixed urinary incontinence, the choices are always difficult and generally one begins with treating the component that is the most uncomfortable for the patient. Whatever choice is made, one must be aware that the first treatment often influences future treatments. © 2010 Elsevier Masson SAS. All rights reserved.


Translation and linguistic validation of the French version of Bladder Cancer Index (BCI). A double-back translation of the original Bladder Cancer Index was performed. First, two urologists translated the English version in French. Then, a first consensus meeting between the translators and a group composed of urologists and nurses was achieved. Back-translation of this version was then done by professional translators (Nagpal, Paris) to ensure that no distortion was detected between the two questionnaires. Finally, a pilot study followed by an interview was carried out among one woman and five men having bladder cancer. The consensus version is attached to the article. No difficulties were reported by the pilot population to comprehend or to complete this BCI French version. This BCI French version-attached to the article-makes it possible for researchers among a French population to use this validated and internationally recognized tool among a French population. The impact of various bladder cancer treatment on quality of life could hence be assessed and compared. Copyright © 2011 Elsevier Masson SAS. All rights reserved.


Several clinical trials on cell therapy have recently been conducted in the treatment of urinary incontinence. The cell preparation procedures and the inclusion criteria were different for each study. The feasibility of this technology, however, seems acquired. The indications for treatment and the long-term effects have yet to be specified. Cell therapy for urinary incontinence is only conceivable within the context of a clinical trial at this time. We encourage all investigator-urologists involved in a clinical trial on cell therapy to make themselves known on the website http://clinicaltrials.gov so as to inform the community and encourage the technique's development. © 2010 Elsevier Masson SAS. All rights reserved.

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