Saint-Pierre-du-Chemin, France
Saint-Pierre-du-Chemin, France

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Evrard P.-L.,Service urologie | Mongiat-Artus P.,Service urologie | Desgrandchamps F.,Service urologie
Progres en Urologie | Year: 2017

Introduction: Monopolar transurethral resection of the prostate is one of standard surgical treatment of benign prostatic hyperplasia. The objective of this study was to evaluate early postoperative complications in patients aged 75 years old and more using a standardized classification. Material and methods: We included all patients aged at least 75 on the day of surgery between 1 January 2008 and 31 December 2013. The reporting of complications was carried from the Clavien-Dindo classification. Results: One hundred and seventy-six patients were included in this study. A total of 47.2% of patients experienced at least one complication. The majority of patients (79.5%) had complications grade 1 or 2 according to Clavien-Dindo classification. One patient died postoperatively at day 27. Most complications were urological (55%). A high Charlson score and low plasma hemoglobin levels have been identified as a risk factor for complications. Conclusion: Monopolar transurethral resection of the prostate is followed by significant morbidity in older patients, higher than in the general population. Level of evidence: 4. © 2017 Elsevier Masson SAS.


PubMed | Service de Nephrologie et Hemodialyse, University Pierre and Marie Curie, French Institute of Health and Medical Research, University Paris - Sud and Service Urologie
Type: Journal Article | Journal: Urology | Year: 2015

To underline peculiar composition of kidney stones and to propose an epidemiologic study of urinary stones in West African countries, where epidemiologic studies are scarce. Only few data are available regarding stone composition in sub-Saharan countries. Recently, a set of 100 stones consecutively removed by surgery in the Department of Urology of the University Hospital of Ouagadougou in Burkina Faso were collected for physical analysis, which provided the opportunity to obtain an epidemiologic profile of stone composition in this country.A total of 100 stones from 64 men, 22 women, 10 boys, and four girls were analyzed by morphologic examination, infrared spectroscopy, and electron microscopy in our laboratory. The results were considered by sex and separately for adults and children.Sixty-five percent of the 100 stones contained calcium oxalate as the main component. Interestingly, the second main component was opaline silica (18%). Furthermore, opaline silica was identified in any proportion in 48% of the stones. The prevalence was sex and age dependent. Opaline silica was detected as the main component in 42% of the nuclei, which underlines its role as one of the main components involved in the initiation of calculi in this country.For the first time, a dramatically high occurrence of a scarce urinary stone component, namely opaline silica, was reported in a series of consecutive calculi from a single country. We propose that a regular consumption of clay could be the origin of this phenomenon in these populations.


Boccon-Gibod L.,University Paris Diderot | Davin J.-L.,Service urologie | Coulange C.,Aix - Marseille University | Culine S.,University Paris Est Creteil | And 4 more authors.
Progres en Urologie | Year: 2010

The treatment of prostate cancer is experiencing important innovations. Hormone therapy includes a new class of drugs: LHRH antagonists, which induce a rapid, fast and sustained reduction of testosterone levels. Active surveillance enables to avoid an aggressive treatment without decreasing survival, provided that strict eligibility and follow-up criteria are applied. New imaging techniques and laboratory assays lead to early diagnosis of small size tumors. Lastly, focal therapy has the potential to target localized cancers without deterioration of surrounding structures. These concomitant improvements offer the clinician and the patient attractive options for prostate cancer management. However, they are not devoid of limitations and constraints. Thus, it is crucial to define the most appropriate patient's profile for each therapeutic option, taking into account the objective characteristics of the tumor and the psychological features of the patient. © 2010 Elsevier Masson SAS.


The diagnostic for prostate cancer is changing. To improve the detection of this cancer, urologists expect a lot from the contribution of magnetic resonance imaging (MRI). What is the role of this imaging in prostate cancer detection? This is a retrospective study, from 2011 to 2013, mono-centric and single-operator. Of the 464 needle biopsy of the prostate (BP), we excluded those with PSA > 20 ng/mL or digital rectal examination (DRE) > T3. The remaining 430 BP were submitted or not to a 1.5 tesla MRI with pelvic antenna. The primary aim is the overall detection of prostate cancer. Secondary aim was the detection rate during the first series of BP and repeat BP, between the two groups in the MRI group. MRI and MRI without populations are comparable for age (63.3 vs 64.6), PSA (6.10 vs 6.13), DRE > T1c, prostate volume (55.4 cm3 vs 51.7 cm3). There is no significant difference in overall detection between the two groups (P = 0.12). There is no significant difference in cancer detection between the first BP (P = 0.13) and the repeat BP (P = 0.07). There is a significant difference in the early detection of BP MRI group (P = 0.03) but not for the BP repeat MRI group (P = 0.07). For 108 BP iterative MRI group, there were 67 BP targeted "mentally" with MRI: 18 cancers were detected, making a 25% detection rate. This study helps to highlight the value of MRI in the early rounds of BP but we can ask the value of this imaging during repeat biopsies. Targeted biopsies "mentally" do not have the expected detection sensitivity and seems to require a three-dimensional reconstruction to be more effective. © 2015 Elsevier Masson SAS.


PubMed | Hopital prive Ste Marie and Service urologie
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2015

The diagnostic for prostate cancer is changing. To improve the detection of this cancer, urologists expect a lot from the contribution of magnetic resonance imaging (MRI). What is the role of this imaging in prostate cancer detection? This is a retrospective study, from 2011 to 2013, mono-centric and single-operator. Of the 464 needle biopsy of the prostate (BP), we excluded those with PSA>20 ng/mL or digital rectal examination (DRE)>T3. The remaining 430 BP were submitted or not to a 1.5 tesla MRI with pelvic antenna. The primary aim is the overall detection of prostate cancer. Secondary aim was the detection rate during the first series of BP and repeat BP, between the two groups in the MRI group. MRI and MRI without populations are comparable for age (63.3 vs 64.6), PSA (6.10 vs 6.13), DRE>T1c, prostate volume (55.4 cm(3) vs 51.7 cm(3)). There is no significant difference in overall detection between the two groups (P=0.12). There is no significant difference in cancer detection between the first BP (P=0.13) and the repeat BP (P=0.07). There is a significant difference in the early detection of BP MRI group (P=0.03) but not for the BP repeat MRI group (P=0.07). For 108 BP iterative MRI group, there were 67 BP targeted mentally with MRI: 18 cancers were detected, making a 25% detection rate. This study helps to highlight the value of MRI in the early rounds of BP but we can ask the value of this imaging during repeat biopsies. Targeted biopsies mentally do not have the expected detection sensitivity and seems to require a three-dimensional reconstruction to be more effective.5.


Luyckx F.,Roche Holding AG | Hallouin P.,Service Radiologie | Barre C.,Service Urologie | Aillet G.,Institute dHistopathologie | And 4 more authors.
Clinical Genitourinary Cancer | Year: 2013

Background: The objective of this study was to assess the possibility of improving the reliability of preoperative detection of extracapsular extension (ECE) in each prostate lobe by using a new sign called sum of positive sextants per lobe (SPS-L), combining interpretation of MRI and prostate biopsy results. Patients and Methods: We reviewed the charts of 590 patients undergoing radical prostatectomy between 2002 and 2007. All patients were assessed by preoperative 1.5 Tesla MRI using an integrated endorectal and pelvic phased array coil. A sextant was defined as "positive" when tumor infiltration was observed on a biopsy sample or a pathologic image was observed on MRI (0 = absent, 1 = present). A score, called sum of positive sextants per lobe (SPS-L), was defined as the sum of positive sextants on biopsy samples and positive sextants on MRI (MRI-L) for each lobe. A second score taking into account the presence or absence of ECE visualized on MRI (T3 MRI-L + SPS-L) was also tested for the detection of ECE per lobe. Results: On multivariate analysis, the SPS-L and T3 MRI-L + SPS-L scores were significantly higher in the presence of ECE and extensive ECE (P <.0001). The areas under receiver operating characteristic (ROC) curves were significantly greater for the T3 MRI-L + SPS-L score than for the positive biopsy result per lobe (PB+/L) rate (P < .0001). Conclusion: The use of indirect signs (SPS-L) associated with direct signs (T3 MRI) allows the preoperative detection of ECE per lobe by endorectal 1.5 Tesla MRI with high sensitivity.


Andres E.,Service Medecine Interne | Eschwege P.,Nancy University Hospital Center | Lang H.,Service Urologie | Moreau J.-L.,Center dUrologie | And 3 more authors.
Progres en Urologie | Year: 2012

Because of the low mortality rates associated with prostate cancer, treatments long-term adverse effects constitute an important parameter in the management of patients. In particular, androgen deprivation has been shown to be linked to several metabolic disorders which are already frequent in men after age 60, such as weight and fat gain, insulin resistance likely to evolve into diabetes, and dyslipidemia. So far no consensus guidelines have been published regarding the screening and treatment of metabolic disorders in men with prostate cancer. It is essential to detect and manage these metabolic disorders, all the more so as they seem to be associated with an increased aggressiveness of prostate cancer. Here we report the development of a new questionnaire, which might contribute to the systematic management, and potentially the screening and treatment or the prevention of these metabolic disorders in patients with prostate cancer. In accordance with recent reviews and on the basis of experience, our French board of experts also recommends systematic screening and selective treatment for diabetes, regular follow-up of fasting glucose rates, lipid profile and blood pressure in all patients under long-term androgen deprivation treatment, as well as lifestyle changes (practice of exercise, nutritional habits). © 2012 Elsevier Masson SAS.


Faure J.P.,University of Poitiers | Breque C.,University of Poitiers | Danion J.,University of Poitiers | Delpech P.O.,Service Urologie | And 2 more authors.
Surgical and Radiologic Anatomy | Year: 2016

Purpose: In primary and continuing medical education, simulation is becoming a mandatory technique. In surgery, simulation spreading is slowed down by the distance which exists between the devices currently available on the market and the reality, in particular anatomical, of an operating room. We propose a new model for surgical simulation with the use of cadavers in a circulation model mimicking pulse and artificial respiration available for both open and laparoscopic surgery. Methods: The model was a task trainer designed by four experts in our simulation laboratory combining plastic, electronic, and biologic material. The cost of supplies needed for the construction was evaluated. The model was used and tested over 24 months on 35 participants, of whom 20 were surveyed regarding the realism of the model. Results: The model involved a cadaver, connected to a specific device that permits beating circulation and artificial respiration. The demonstration contributed to teaching small groups of up to four participants and was reproducible over 24 months of courses. Anatomic correlation, realism, and learning experience were highly rated by users Conclusion: This model for surgical simulation in both open and laparoscopic surgery was found to be realistic, available to assessed objectively performance in a pedagogic program. © 2016 Springer-Verlag France


Roupret M.,Service Urologie | Guillotreau J.,Toulouse University Hospital Center | Irani J.,Service Urologie | Zerbibd M.,Service dUrologie
Progres en Urologie | Year: 2010

Immediate intravesical chemotherapy after transurethral resection decrease recurrences in non-muscle-invasive bladder cancer. Guidelines recommend immediate, intravesical instillation for all patients with Ta/T1 tumours. Instillation has to be avoided when there is a bladder perforation, a large resection (≥3cm) or gross haematuria. Tolerance is good and morbidity is low. © 2010 Published by Elsevier Masson SAS.


Baka K.H.,Service Urologie | Guedira H.,Service Urologie | Lakmichi M.A.,Service Urologie | Dahami Z.,Service Urologie | And 2 more authors.
African Journal of Urology | Year: 2016

Mucinous tumors of the kidney are rare and little reported in the literature. We report the observation of a 63 year old man who consulted for abdominal mass gradually increasing in size. Ultrasonography and CT showed a significant hydronephrosis of the left kidney. Total nephroureterectomy was performed. Pathological examination found a mucinous cystadenoma of kidney and ureter. The mucinous cystadenoma in this presentation has not been reported before. © 2016 Pan African Urological Surgeons' Association.

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