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1.
Prog Urol ; 22(12): 688-91, 2012 Oct.
Article in French | MEDLINE | ID: mdl-22999114

ABSTRACT

Prostatic Stromal Tumors of Uncertain Malignant Potential (STUMP) are rare tumor of the prostate of mesenchymal origin, accounting, with sarcoma for 0.1-0.2% of all malignant prostatic tumours. They however require to be individualized, to differentiate it from a benign prostatic hyperplasia or a sarcoma of the prostate. The therapeutic management should be made keeping in mind the risk of degeneration towards a malignant shape. Although the appropriate treatment is unknown, radical prostatectomy seem to be the treatment of reference, especially for young patient or for extensive lesion.


Subject(s)
Prostatic Hyperplasia/pathology , Prostatic Neoplasms/pathology , Stromal Cells/pathology , Humans , Male , Prostatectomy , Prostatic Hyperplasia/surgery , Prostatic Neoplasms/surgery , Sarcoma/pathology , Sarcoma/surgery
2.
Prog Urol ; 20(2): 130-7, 2010 Feb.
Article in French | MEDLINE | ID: mdl-20142054

ABSTRACT

AIM: The aim of our study was to evaluate predictive factors and long-term carcinogenic results for patients who had had a total cystectomy for cancer of the bladder and whose final histological results did not show evidence of a residual tumor. PATIENTS AND METHODS: From 1988 to 2002, 192 patients had a total cystectomy for a bladder tumor. No residual tumor (pT0) was evident in the specimens of cystectomy of 22 patients (11.5%). None of the patients had distant metastasis or ganglions at the time of the initial examination. RESULTS: Predictive factors for having no residual tumors based on the specimen of cystectomy (pT0) were an antecedent of neo-adjuvant chemotherapy (p=0.0079), an interval between the resection of the bladder and the cystectomy of more than 12 weeks (p=0.0014) and a resection of the initial bladder considered complete (p=0.0036). The average treatment of these 22 patients was 70+/-46 months. During treatment, two patients (9%) had a recurrence in the pelvis and 10 patients died including one from the development of his cancer of the bladder. Global, specific and non-recurrence survival at five years were 75%, 100% and 94%, respectively. We revealed better specific survival (p=0.0007) and without relapse (p<0.0001) in patients who no longer had a tumor on the specimen of cystectomy (pT0) compared with patients who had a residual tumor (pT+) but with no difference in global survival (p=0.0574). CONCLUSION: The absence of residual tumors (pT0) on a specimen of total cystectomy for cancer of the bladder was a good factor for prognosis regarding long-term survival even if tumor development was observed. Complete resection and neo-adjuvant chemotherapy probably played a beneficial role in the future of these patients.


Subject(s)
Cystectomy , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery , Aged , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Predictive Value of Tests , Survival Rate , Survivors , Time Factors , Treatment Outcome , Urinary Bladder Neoplasms/mortality
3.
Prog Urol ; 18(13): 1062-7, 2008 Dec.
Article in French | MEDLINE | ID: mdl-19041812

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the mortality and morbidity of cystectomy and the functional results of the associated diversions in patients over the age of 75 operated for bladder cancer. MATERIAL AND METHODS: From 1988 to 2002, 37 patients (29 men and 8 women) aged between 75 to 88 years (median: 79 years) underwent radical cystectomy for bladder cancer. All patients had at least one comorbidity factor, 17 patients were classified as ASA II (45.9%) and 20 were classified as ASA III and IV (54.1%). An external urinary diversion was performed in 35 patients and orthotopic bladder replacement was performed in two patients. The mean follow-up was 21.0 months (range: 0.3-88.6). The mortality, early and late morbidity, and functional results were analyzed. RESULTS: There was no intraoperative mortality and the early mortality rate was 5.4% (2/37). The early medical morbidity rate was 24.3%, essentially cardiovascular (pulmonary embolism, myocardial infarction, pulmonary edema), and the early surgical morbidity rate was 2.7%. The late morbidity rate was 27.0%, essentially corresponding to wound complications (peristomal or midline incisional hernias). In terms of functional results, a peristomal incisional hernia with stoma appliance difficulties was observed in 11.4% of patients with an external diversion. One of the two patients treated by bladder replacement performed intermittent self-catheterization and the other was continent during the day and required pads at night. CONCLUSION: This study shows that the acceptable mortality and early and late morbidity results allow radical cystectomy to be proposed in patients over the age of 75.


Subject(s)
Cystectomy/adverse effects , Cystectomy/mortality , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/surgery , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Retrospective Studies
4.
Prog Urol ; 18(6): 351-7, 2008 Jun.
Article in French | MEDLINE | ID: mdl-18558323

ABSTRACT

OBJECTIVE: The objective of this retrospective study was to analyse the impact of lymph node invasion on survival after radical cystectomy for bladder cancer. MATERIAL AND METHODS: From 1988 to 2002, 192 patients underwent radical cystectomy for bladder cancer. Lymph node dissection was performed in 144 patients (75%) with bilateral pelvic lymph node dissection in 130 patients and extension to iliac chains in 14 patients. RESULTS: Lymph node dissection had no impact on medical or surgical morbidity. Lymph node invasion was demonstrated in 35.4% of cases (51/144). Tumour effraction of the lymph node capsule was reported in 70.6% (36/51) of pN+ patients. Lymph node invasion was reported in 16.7% of pT0 patients, 0% of pTa, pTis, pT1 patients and 40, 47 and 48% of pT2, pT3 and pT4 patients, respectively. The mean follow-up was 40.3+/-3.5 months (median: 26.6; range 0-207 months). Overall, specific and recurrence-free survivals were significantly influenced by lymph node invasion (p<0.0001, p<0.0001, p<0.0001, respectively) and capsular effraction (p=0.0021, p=0.0027, p=0.0113, respectively). CONCLUSION: Lymph node invasion and especially capsular effraction were significant prognostic factors of overall specific and recurrence-free survival.


Subject(s)
Cystectomy , Lymph Node Excision , Urinary Bladder Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Cystectomy/methods , Female , Follow-Up Studies , Humans , Lymphatic Metastasis , Male , Middle Aged , Prognosis , Retrospective Studies , Time Factors , Urinary Bladder Neoplasms/mortality
5.
Ann Urol (Paris) ; 41(6): 261-75, 2007 Dec.
Article in French | MEDLINE | ID: mdl-18457318

ABSTRACT

Kidney transplantation has become the treatment of choice for patients with end stage renal disease since it offers an excellent quality of life. Moreover, the economic impact is considerable, particularly beyond the first year. Indeed, the annual cost of a successful renal transplantation is ten fold lower than haemodialysis. But surgical complications remain one of our main concerns. Surgical complications are various. They may be non-specific as haematomas, incision-induced hernias and wound infections. They may also be directly related to the procedure as vascular thrombosis and urinary fistula in the early postoperative period or arterial stenosis and ureteral obstruction in the late post-operative period. The accurate diagnosis and the appropriate management of these complications are the most important tasks for the surgical team. This review is based upon our experience in kidney transplantation and upon the medical published data.


Subject(s)
Intraoperative Complications/etiology , Kidney Transplantation , Postoperative Complications/etiology , Blood Loss, Surgical/prevention & control , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , Intraoperative Complications/epidemiology , Intraoperative Complications/prevention & control , Kidney/blood supply , Kidney Transplantation/adverse effects , Kidney Transplantation/methods , Lymphocele/etiology , Lymphocele/prevention & control , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Surgical Wound Dehiscence/prevention & control , Surgical Wound Infection/prevention & control , Thrombosis/etiology , Thrombosis/prevention & control , Ureteral Obstruction/etiology , Ureteral Obstruction/prevention & control , Urinary Calculi/etiology , Urinary Calculi/prevention & control , Urinary Fistula/diagnosis , Urinary Fistula/etiology , Urinary Fistula/prevention & control , Vascular Diseases/etiology , Vascular Diseases/prevention & control , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/prevention & control
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