Evaluation de la toxicite aigue chez 50 patients atteints de cancer de la prostate traites par radiotherapie conformationnelle

Purpose: To report our experience with 3D conformal radiotherapy for prostate cancer material and methods: We reviewed our first 50 patients diagnosed with prostate cancer. Median follow-up was 27 months [16-40 m]. Median age 68 [52-74] T stage was T1c = 12 T2a = 14 T2b = 10 T2c = 2 T3a = 10 T3b = 1 and T3c = 1. Gleason score [GS] 4-6 50% and GS 7-8 50%. Pretreatment PSA.value of < 10 ng/ml 36%, 10-20 ng/ml 32% and >20 ng/ml 32%. Forty patients received androgen ablation therapy 2 to 6 months before radiation. 3D conformal radiotherapy was used to allow a smaller amount of rectum and bladder to be in the high dose volume. An 18 Mv linear accelerator was used. The first 21 patients received 66 Gy, 28 patients received 70 Gy and one 74 Gy.The mean prostate volume was 45 cc for patients who received androgen ablation and 54 for the others [p = 0.02]. The percentage of volume receiving more than 50 Gy [V50] was calculated for the rectum and bladder. The median V50 was 30% [10-55] for the rectum and 36% [5-70] for the bladder. Based on the RTOG grading [gr] for acute toxicity, there was no gr 3 gastrointestinal [GI] toxicity and only 1 gr 3 genitourinary [GU] toxicity. There were 9 gr 1 and 5 gr 2 GI toxicity, 10 gr 1 and 5 gr 2 GU toxicity. With our actual follow-up we have 2 late morbidities: gr 2 GLI and one erectile failure.3D conformal radiotherapy for prostate cancer has a good toxicity profile. Longer follow-up is needed to assess late toxicity and clinical outcome in this series

Cystoplastie d'augmentation et catheterisme intermittent dans les vessies neurogenes

An enterocystoplasty was done on 17 paraplegic adults patients [beit chahab hospital for handicapped] with hyperreflexic neurogenic bladder secondary to an accident of the supra-sacral medulla. These patients were incontinent, had urinary tract infections, vesico-renal reflux or autonomic dysreflexia. Detubularised ileum was used in 16 cases and sigmoid in one. Ureteral reimplantation was performed on one patient; implantation of an artificial urinary sphincter for one patient and an injection of a periurethral teflonpaste was also done for one patient. After 16 months of follow-up all patients are continent on self intermittent catheterization. The upper urinary tract is stable or improved. No antonomic dysreflexia. Thirteen patients have an asymptomatic untreated bacteriuria

Traitement de l'hypospadias par le lambeau pedicule preputial transverse

With a better understanding of the penile vasculature, many one-stage techniques were proposed for mid-shaft and posterior hypospadias repair including the Duckett's technique with the transverse preputial island flap [TPIF]. We performed the Duckett's technique on 25 patients with penile hypospadias with the following no cases of meatal stenosis and three cases of urethrocutaneous fistula [12%]. The three cases of urethrocutaneous fistula were reported in the first 15 patients where the neo-urethra was closed in one layer but no case of fistula was reported in the last 10 patients where the neo-urethra was closed in two layers: the difference is significative [P< 0.05]. in conclusion, the duckett's technique with the two-layer closure technique of the neo-urethra is a good alternative for penile hypospadias repair