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Port-Saint-Louis-du-Rhône, France

Benoit G.,Urologie
Bulletin de l'Academie Nationale de Medecine | Year: 2011

This article reviews a series of 3 000 consecutive kidney transplantations. Vascular and urinary complications occurred in respectively 7.4% and 9.8% of recipients. Arterial and venous thrombosis and urinary fistulas were the most serious complications. The frequency of arterial stenosis fell from 18.8% to 8.9% when the artery was implanted in the external rather than the internal iliac artery. The frequency of artery stenosis fell from 15.9% to 9.5% when the right renal vein was extended by using the transected cadaver vena cava. Urinary fistulas were an early complication, but their incidence fell from 6.6% to 2.8% with the use of JJstents. Urinary stenosis remainedfrequent (5.4%) despite the use of JJstents. Surgical and endoscopic treatment of renal artery stenosis gave very similar success rates (82%), indicating that dilation of a stenosed artery is a good option when medical treatment fails. Endourological treatment of urinary complications was successful on 64% of fistulas and 46% of stenoses. The results of this series and an analysis of the literature show the importance of improving the organ harvest technique and reducing the cold ischemia time, which is the main reason for delayed recovery of graft function. Source


Goepel M.,Urologie | Kirschner-Hermanns R.,Universitatsklinikum Aachen | Welz-Barth A.,Klinik fur Geriatrische Rehabilitation | Steinwachs K.-C.,Neuropsychiatrische Praxis | Rubben H.,Universitatsklinikum Essen
Deutsches Arzteblatt | Year: 2010

Background: Urinary incontinence is a common and distressing complaint in the elderly. Its causes include structural changes in vesical muscle as well as impaired neural control and age-related changes of the lower urinary tract. Incontinence can also be a side effect of medication. Methods: The PubMed database was selectively searched for publications containing the terms "urinary incontinence" and "elderly." Studies with a high level of evidence were chosen as the main basis for this review. Results: The individualized diagnostic evaluation of the incontinent elderly patient should generally be non-invasive. The evaluation may reveal urinary incontinence of several different types: stress incontinence, overactive bladder, and mixed incontinence. The treatment generally involves medication, such as anti-muscarinic agents, alpha-receptor blockers, and/or serotonin/noradrenalin reuptake inhibitors, combined with modifications of personal behavior, such as bladder training, altered fluid intake, and pelvic floor contraction. A number of minimally invasive surgical techniques can be useful for patients in operable condition, whenever such an operation seems reasonable in view of the patient's overall situation. Conclusion: Urinary incontinence in the elderly can be readily evaluated, and the currently available forms of treatment often bring satisfactory relief with an economical use of medical resources and with little or no additional discomfort for the patient. Source


Lotan Y.,University of Texas Southwestern Medical Center | Shariat S.F.,Sloan Kettering Cancer Center | Schmitz-Drager B.J.,Urologie | Sanchez-Carbayo M.,CSIC - National Center for Metallurgical Research | And 6 more authors.
Urologic Oncology: Seminars and Original Investigations | Year: 2010

Bladder cancer is a common disease that is often detected late and has a high rate of recurrence and progression. Cystoscopy is the main tool in detection and surveillance of bladder cancer but is invasive and can miss some cancers. Cytology is frequently utilized but suffers from a poor sensitivity. There are several commercially available urine-based tumor markers currently available but their use is not recommended by guideline panels. Markers such as the Urovysion FISH assay and the NMP22 BladderChek test are approved for surveillance and detection in patients with hematuria. The added benefit of these markers and other commercially available markers (e.g. Ucyt+, BTA stat) has not been well investigated though it appears these markers are insufficiently sensitive to replace cystoscopy. Additional studies are needed to determine the clinical scenarios where bladder markers are best utilized (screening, surveillance, early detection, evaluating cytologic atypia) and what impact they should have on clinical decision making. Furthermore, a variety of issues and barriers can affect the movement of clinical tests from research to clinical practice. This article addresses some of the challenges facing research and medical communities in the delivery and integration of markers for bladder cancer diagnosis. Moreover, we attempt to outline criteria for the clinical utility of new bladder cancer diagnostic markers. © 2010 Elsevier Inc. All rights reserved. Source


Schmitz-Drager B.J.,Urologie | Weiss C.,Novartis | Ebert T.,Urologie | Dorsam J.,Urologie | Bismarck E.,Urologie
Urologia Internationalis | Year: 2013

Purpose: With stage migration induced by early diagnosis of prostate-specific antigen, the course of disease for prostate cancer (PCa) patients has changed. Increasingly, patients undergo long-term androgen ablation with consecutive risks including osteoporosis and pathologic fractures. A recent randomized trial found that the RANK ligand inhibitor denosumab was more effective preventing skeletal-related events in patients with metastatic PCa as compared to treatment with the bisphosphonate zoledronic acid. This improved efficacy was linked to an increase of side effects. Methods: The present analysis compares results reported for both substances using a number needed to treat analysis approach. Based upon these findings, risk-benefit calculations were performed. Results: The results demonstrate that for patients with bone metastatic castration-resistant PCa, decision for or against treatment with either denosumab or zoledronic acid must not only consider efficacy but needs to balance the desired effects versus potential side effects. This is of specific relevance since life expectancy is limited in this patient cohort with end-stage disease. Conclusions: Further scientific efforts are necessary to identify optimal dosing and application intervals for denosumab and zoledronic acid as well as to answer the question of optimal duration of treatment. These findings will directly impact the risk versus benefit relations for both therapeutic options. Copyright © 2013 S. Karger AG, Basel. Source


Kamat A.M.,University of Houston | Hegarty P.K.,Guys Hospital | Gee J.R.,University of Wisconsin - Madison | Clark P.E.,Vanderbilt University | And 10 more authors.
European Urology | Year: 2013

Context and objective: To present a summary of the 2nd International Consultation on Bladder Cancer recommendations on the screening, diagnosis, and markers of bladder cancer using an evidence-based strategy. Evidence acquisition: A detailed Medline analysis was performed for original articles addressing bladder cancer with regard to screening, diagnosis, markers, and pathology. Proceedings from the last 5 yr of major conferences were also searched. Evidence synthesis: The major findings are presented in an evidence-based fashion. Large retrospective and prospective data were analyzed. Conclusions: Cystoscopy alone is the most cost-effective method to detect recurrence of bladder cancer. White-light cystoscopy is the gold standard for evaluation of the lower urinary tract; however, technology like fluorescence-aided cystoscopy and narrow-band imaging can aid in improving evaluations. Urine cytology is useful for the diagnosis of high-grade tumor recurrence. Molecular medicine holds the promise that clinical outcomes will be improved by directing therapy toward the mechanisms and targets associated with the growth of an individual patient's tumor. The challenge remains to optimize measurement of these targets, evaluate the impact of such targets for therapeutic drug development, and translate molecular markers into the improved clinical management of bladder cancer patients. Physicians and researchers eventually will have a robust set of molecular markers to guide prevention, diagnosis, and treatment decisions for bladder cancer. © 2012 European Association of Urology. Source

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