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1.
Prog Urol ; 33(3): 103-109, 2023 Mar.
Article in French | MEDLINE | ID: mdl-36581504

ABSTRACT

OBJECTIVES: To evaluate the feasibility, efficiency, and predictive factors of therapeutic success of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones. METHODS: It is a retrospective, single-center study at the CHU - La Conception, Marseille, France including all patients treated with VDI from 2013 to 2018. VDI was indicated for stones <6mm in first-line treatment or for residual fragments <6mm after ureteroscopy, PCNL, microPCNL. The protocol included 4 sessions in outpatient care from 2013 to 2015 then 6 sessions from 2015 to 2018 and a final radiological evaluation. RESULTS: In total, 109 patients or 489 sessions are reported: median age was 55 years [14-84], median BMI 25kg/m2 [15-37], average cumulative size of kidney stones 3mm ±4. VDI was performed after flexible ureteroscopy (62%), SWL (20%), percutaneous treatment (9%) or as a first-line treatment (9%). Compliance was 87 %. The median VAS during the session was 0[0-8]. The incidence of post-session renal colic was 4% (all Clavien I). The postoperative fragment-free and microfragment rates were respectively 39% and 21%, i.e. an overall success of 60% for kidney stones, and 43% and 21%, i.e. an overall success of 64% for lower pole kidney stones. CONCLUSION: VDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment.


Subject(s)
Kidney Calculi , Lithotripsy , Humans , Middle Aged , Retrospective Studies , Vibration , Feasibility Studies , Kidney Calculi/surgery , Ureteroscopy/adverse effects , Diuresis , Treatment Outcome , Lithotripsy/methods
2.
Prog Urol ; 31(6): 316-323, 2021 May.
Article in English | MEDLINE | ID: mdl-33663939

ABSTRACT

OBJECTIVES: To evaluate the efficacy of Continuous Saline Bladder Irrigation (CSBI) after blue light transurethral resection of bladder tumor (TURBT) to prevent recurrence of low- to intermediate-risk Non-Muscle Invasive Bladder Cancer (NMIBC). PATIENTS AND METHODS: We conducted a retrospective study including patients with low- to intermediate-risk NMIBC who underwent TURBT in two urological centers between January 2017 and December 2018. Each TURBT was performed using blue light after intravesical instillation of hexaminolaevulinic acid. The experimental group included patients who received CSBI while the control group included patients without CSBI. When practice, CSBI was started immediately after the surgery and was interrupted 24 hours thereafter. Low-risk NMIBC had a surveillance while intermediate NMIBC had 8 adjuvant endovesical instillations of Mitomycin. The primary endpoint was bladder tumor recurrence free-survival which was defined as the time between the initial TURBT and the date of TURBT for bladder recurrence. RESULTS: A total of 167 patients (median age: 71 years) were included: 20% female, 15% low-risk, 85% intermediate-risk NMIBC. CSBI was performed in 95 cases (57%). No complication related to irrigation was reported. Bladder recurrence was observed in 55 cases (32.9%): 22 (23.1%) in the CSBI group vs. 33 (45.8%) in the control group (P=0.002). Multivariate stepwise logistic regression analysis with backward selection revealed that CSBI (HR 0.47 [0.27-0.81]; P=0.006) and MMC (HR 0.55 [0.31-0.95]; P=0.034) were significantly associated with reduced risk of bladder recurrence. CONCLUSIONS: Continuous saline bladder irrigation reduced the risk of bladder recurrence after blue light TURBT in patients with low- to intermediate-risk NMIBC while being safe. Prospective randomized study is needed to confirm these results. LEVEL OF EVIDENCE: 3.


Subject(s)
Cystectomy/methods , Saline Solution , Therapeutic Irrigation/methods , Urinary Bladder Neoplasms/therapy , Aged , Combined Modality Therapy , Disease-Free Survival , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/prevention & control , Retrospective Studies , Risk Assessment , Urinary Bladder Neoplasms/pathology
3.
Prog Urol ; 31(6): 368-373, 2021 May.
Article in English | MEDLINE | ID: mdl-33461865

ABSTRACT

OBJECTIVE: To compare the perioperative complications of patients who underwent flexible ureteroscopy (fURS) for the treatment of urinary stones according to the type of ureteroscope used, single-use (suURS) or reusable (rURS) flexible ureteroscope. PATIENTS AND METHODS: A retrospective and single-center study was conducted between January 2017 and May 2019, including all fURS performed for nephrolithiasis management. During the study period, 5rURS and 1suURS (UscopePU3022™) were available. The primary endpoint was the occurrence of 30-days postoperative complications, especially infectious complications, classified according to Clavien-Dindo grading system. RESULTS: Overall, 322 consecutive fURS were included corresponding to 186 rURS (57.8%) and 136 suURS (42.2%). Respectively in rURS and suURS groups, the median (IQR) age was 57 (45-65) vs. 57 (44-66) years (P=0.75), 83 (44.6%) vs. 63 (46.3%) female were included (P=0.82), and median (IQR) Charlson score was 2 (1-3) vs. 2 (0-3) (P=0.15). Fifty-one patients (15.8%) developed postoperative complications, 28 patients (15%) in rURS group and 23 patients (17.6%) in suURS group (P=0.64). Most of them (n=47, 92.1% of overall complications) were minor (Clavien I-II). Occurrence of urinary tract infection in suURS group (n=13; 9.5%) was equally comparable with rURS group (n=10; 5.4%), P=0.15. CONCLUSIONS: Our data suggests that suURS represents a safe alternative to rURS. Compared to reusable devices, UscopePU3022™ use was associated with a similar complication rates, however, did not decrease the occurrence of infectious events. LEVEL OF EVIDENCE: 3.


Subject(s)
Disposable Equipment , Equipment Reuse , Postoperative Complications/epidemiology , Ureteroscopes , Urinary Calculi/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies
5.
Prog Urol ; 29(3): 138-146, 2019 Mar.
Article in French | MEDLINE | ID: mdl-30846356

ABSTRACT

OBJECTIVE: The objective of our study was to evaluate, in a review of the literature, the impact of diagnostic ureteroscopy before total nephroureterectomy (NUT) on the risk of bladder recurrence. METHODS: We conducted a literature review in the Pubmed database in March 2018. Initial research identified 45 publications. Following full text screening, 9 studies were finally included, with a total of 1041 NUT with URS prior versus 2909 NUT alone. The primary endpoint was bladder recurrence. Secondary objectives were specific survival and overall survival. RESULTS: Bladder recurrence was reported in the 9 studies included. Diagnostic ureteroscopy was significantly associated with an increased risk of post-NUT bladder recurrence (HZ 1.42 [1.29-1.56], P<0.01). The specific survival and overall survival at 5 years, were reported in respectively 4 and 2 studies. There was no impact of the pre-NUT diagnostic URS on the specific survival (HZ 0.75 [0.54-1.03], P=0.08) or post-NUT overall survival (HZ 1.15 [0.68-1.96], P=0.59). CONCLUSION: The URS diagnostic before NUT for TVEUS is associated with a significant increase in the risk of postoperative bladder recurrence.


Subject(s)
Nephroureterectomy/methods , Ureteroscopy/methods , Urinary Bladder Neoplasms/surgery , Humans , Neoplasm Recurrence, Local , Risk Factors , Survival Rate , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/pathology
6.
World J Urol ; 36(1): 105-109, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29058024

ABSTRACT

PURPOSE: Urolithiasis is rare among renal transplant recipients and its management has not been clearly defined. METHODS: This multicentre retrospective study was organised by the Comité de Transplantation de l'Association Française d'Urologie (French Urology Association transplantation committee). Statistical analysis was performed with SPSS 19 software. RESULTS: Ninety-five patients were included in this study. Renal transplant urolithiasis was an incidental finding in 55% of cases, mostly on a routine follow-up ultrasound examination. One half of symptomatic stones were due to urinary tract infection and the other half were due to an episode of acute renal failure. The initial management following diagnosis of urolithiasis was double J stenting (27%), nephrostomy tube placement (21%), or watchful waiting (52%). Definitive management consisted of: watchful waiting (48%), extracorporeal lithotripsy (13%), rigid or flexible ureteroscopy (26%), percutaneous nephrolithotomy (11%) and surgical pyelotomy (2%). All transplants remained functional following treatment of the stone. The main limitation is the retrospective design. CONCLUSIONS: The incidence of lithiasis could be higher in kidney transplanted patients due to a possible anatomical or metabolical abnormalities. The therapeutic management of renal transplant urolithiasis appears to be comparable to that of native kidney urolithiasis.


Subject(s)
Kidney Transplantation/adverse effects , Urolithiasis/etiology , Urolithiasis/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies
8.
Prog Urol ; 24(17): 1132-8, 2014 Dec.
Article in French | MEDLINE | ID: mdl-25217479

ABSTRACT

OBJECTIVE: To report efficacy and morbidity of periurethral adjustable balloons (PUAB) in the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). PATIENTS AND METHODS: Retrospective descriptive and analytic patients cohort study was performed from July 2010 to June 2012. We reviewed data from 43 patients (19 women and 24 men). The patients were categorized into 3 groups: i) women, ii) men after prostatectomy, iii) men with neurogenic SUI (prostate in position). Sandvick score and the average of 3 days 24 h Pad test evaluated the efficacy of the device. The patients impression of improvement was assessed in three degrees: completely improved, partially improved, not improved. RESULTS: After a median follow-up of 67 weeks (min. 40, max. 91) a significant improvement of the score of Sandvik was observed (8 to 4, P<0.005). The proportion of dry patients or with one security protection in the three groups was 57.9%, 64.3% and 50% respectively for women, men after prostatectomy, and men with neurological SUI. About 27.9% (12/43) of the patients had post-operative complications. These complications required an explantation of the PUAB in 11/12 patients among whom 7/11 (63.6%) had a delayed re-implantation of the device. CONCLUSION: In this series, the overall efficacy observed was 67.4% with a post-operative complication rate of 27.9%. The device adjustment was done in consultation as well as the complications management and the explantation when necessary. LEVEL OF EVIDENCE: 4.


Subject(s)
Prostheses and Implants , Urethra/physiopathology , Urinary Incontinence, Stress/therapy , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Muscle Weakness/physiopathology , Muscle, Smooth/physiopathology , Retrospective Studies , Urinary Incontinence, Stress/physiopathology
9.
Prog Urol ; 23(10): 861-8, 2013 Sep.
Article in French | MEDLINE | ID: mdl-24034798

ABSTRACT

INTRODUCTION: Thirty-three percent of the localized cancers belongs initially to the group of intermediate risk of D'Amico. The standard treatments validated by the French Association of Urology are the radical prostatectomy and the external beam radiotherapy. OBJECTIVES: We retrospectively compared the carcinologic results of the radical prostatectomy±adjuvant treatment (RP) and the external beam radiotherapy combining high dose (75.6 Gy) and short hormonotherapy (RH), in the treatment of intermediate risk prostate cancer. The series consisted of 143 patients treated between 2000 and 2006 in the department of Urology and Kidney transplantation of the Conception Hospital, Marseilles. The main assessment criteria was the survival without biological recurrence (SBR). RESULTS: The median follow-up was 90 months [59-51]. The 5 years and 8 years SBR were 85% and 73% in the RH group, versus 74% and 65% with RP (P=0.196). There was a significant difference between the series: on the age of diagnosis (63.9 versus 73.3 years, P<0.001), the Charlson score of comorbidity (2 versus 3, P<0.001) and the number of intermediate criteria per patients (one intermediate criteria: RP 74% versus 57%, P<0.01). CONCLUSION: According to our study, there was no superiority of the radical prostatectomy±adjuvant treatment or the external radiotherapy combining high dose and concomitant short hormonotherapy on the survival without biological recurrence at 5 and 8 years. Many studies confirm that a concomitant hormonotherapy increases the carcinologic control, even with a high rate external beam radiotherapy.


Subject(s)
Antineoplastic Agents, Hormonal/therapeutic use , Prostatectomy , Prostatic Neoplasms/mortality , Prostatic Neoplasms/therapy , Aged , Chemotherapy, Adjuvant , Comorbidity , Follow-Up Studies , Humans , Male , Middle Aged , Neoadjuvant Therapy , Prostate-Specific Antigen/blood , Prostatic Neoplasms/pathology , Radiotherapy, Adjuvant , Retrospective Studies
10.
Prog Urol ; 23(5): 356-63, 2013 Apr.
Article in French | MEDLINE | ID: mdl-23545011

ABSTRACT

PURPOSE: To assess both economical and organizational impact as well as bacteriologic safety of a flexible cystoscope with sterile disposable sheath (FCSDS) compared to standard flexible cystoscopy (SFC) in two French urologic academic units. PATIENTS: Two-center prospective study, comparing the use of the FCSDS to the SFC on two consecutive periods of time. Two hundred and five patients were included and divided into each group. Duration procedures and costs were analysed in the two techniques. The urinary tract infection rate was also described. A dedicated sheaths leaks test after use was performed systematically. RESULTS: The preparation time of the fibroscope was longer for the sheathed cystoscopy group: 16.2 minutes versus 10.9 minutes for the standard group. The mean duration of disinfection was significantly shorter for the sheathed cystoscopy group: 53.8 minutes saved compared to the standard group; 99.01% of the tested sheaths, after their use, had no breaches. Urinary tract infections rate were similar in the two groups. The average cost of a sheathed cystoscopy compared to the standard was significantly cheaper in Lyon and almost equivalent in Marseille. CONCLUSION: The FCSDS allows significant saving over the disinfection duration, consumable costs and staff costs, while ensuring patient bacteriologic safety similar to SFC.


Subject(s)
Cystoscopes/economics , Disinfection/economics , Disinfection/organization & administration , Disposable Equipment , Adult , Aged , Aged, 80 and over , Costs and Cost Analysis , Equipment Design , Female , Humans , Male , Middle Aged , Prospective Studies
11.
Prog Urol ; 22(14): 886-91, 2012 Nov.
Article in French | MEDLINE | ID: mdl-23101961

ABSTRACT

Female stress incontinence is often the consequences of obstetrical traumatisms. They are responsible of a weakness of perineal musculoaponevrotic structures. Until 1996, the reference treatment of this pathology was the "Burch" colposuspension, by laparotomy, then laparoscopic way. After 1996, a new procedure was developped by Ulmten, reproducible, easy, safe and mini-invasive: the tension free-vaginal-tape (TVT) followed by the trans-obturator-tape (TOT). This therapeutic tool has become the reference for the treatment of the female stress incontinence. There are now 15 years from the beginning of this procedure and still 80% of the patients are improved.


Subject(s)
Suburethral Slings , Urinary Incontinence, Stress/surgery , Female , Humans , Prosthesis Design , Suburethral Slings/adverse effects , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/methods
12.
Prog Urol ; 21(11): 789-92, 2011 Nov.
Article in French | MEDLINE | ID: mdl-22032602

ABSTRACT

Overall success for living donor kidney transplantation is better than conventional cadaver transplant without imposing a high level of risk to the donor. The kidney can be removed by laparoscopic surgery or by traditional open surgery.


Subject(s)
Kidney Transplantation , Living Donors , Donor Selection , Humans , Nephrectomy/methods
13.
Prog Urol ; 21(3): 177-83, 2011 Mar.
Article in French | MEDLINE | ID: mdl-21354035

ABSTRACT

OBJECTIVES: To evaluate the results of partial nephrectomy (NP) for cancer in 60 patients selected by the biopsy of the tumor by analyzing the information, oncologic follow-up. PATIENTS: It was a cohort study unicenter retrospective from 1994 to 2006. The biopsy was systematically done for patients who were candidates for elective NP. The criteria for elective indications NP tumors were less than 4cm, low grade Fuhrman (I and II). The tubulopapillary tumors (TBP) on biopsy were excluded from the elective indications. The parameters studied were the biopsy data, overall survival, disease-free survival. RESULTS: The median age was 59 years (32-79 years) and 69% of tumor were fortuitous discovery. Indications of need accounted for 30% of cases (single kidney, bilateral tumors and chronic renal failure [CRF]). Biopsy allowed a diagnosis in 89% of cases. There was one death in specific postoperative immediately. A final histology was 75% of clear cell carcinoma, 13.3% of chromophobe and 11.7% of TBP, 96.6% of T1a including 86.6% of low grade and no surgical margin. The median follow-up was 49 months with 98.5% of specific survival at 5 years, one local recurrence and no general recurrence. CONCLUSION: The study has shown that the selection of patients by biopsy gives satisfactory carcinologic results with 98.5% specific survival at the end of follow-up; it is between 89 and 100% in the literature.


Subject(s)
Kidney Neoplasms/surgery , Nephrectomy/methods , Adult , Aged , Biopsy/methods , Cohort Studies , Female , Humans , Kidney Neoplasms/mortality , Male , Middle Aged , Retrospective Studies , Survival Rate , Treatment Outcome
14.
Prog Urol ; 20(8): 598-600, 2010 Sep.
Article in French | MEDLINE | ID: mdl-20832039

ABSTRACT

We report the case of an early local recurrence after a laparoscopic partial nephrectomy (LPN) for a Furhman grade 1-2 clear cell renal carcinoma (CCRC). CT scan at 6 months revealed a local recurrence. An open total nephrectomy was performed. There were six nodules in the perirenal fat from a grade 3 CCRC. Twenty-six months after the LPN, the patient had a wound recurrence, which was surgically removed. Four months after the wound recurrence, the patient had pulmonary, liver and adrenal glands metastasis. He received an oral treatment with sunitinib. At 4 months after the initiation of the sunitinib, he had a total response.


Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Neoplasm Recurrence, Local , Nephrectomy/methods , Humans , Male , Middle Aged
15.
Prog Urol ; 20(2): 154-7, 2010 Feb.
Article in French | MEDLINE | ID: mdl-20142058

ABSTRACT

The spironolactone is a diuretic of potassium savings. It is also used in the treatment of the hirsutism for its antiandrogenic action. Its use and its effects on the patients affected by a prostate cancer are less known. We report the case of a 72-year-old man having a cancer of prostate which normalized its PSA after institution of a treatment by spironolactone for ascites. This patient had a biological recurrence of a prostate cancer, arisen 7 years later after a treatment by hormonal radiotherapy. Nine months after the implementation of the treatment by spironolactone, there were no clinical and biological signs of disease progress.


Subject(s)
Prostatic Neoplasms/radiotherapy , Spironolactone/therapeutic use , Aged , Androgen Antagonists/therapeutic use , Humans , Male , Neoplasm Recurrence, Local/drug therapy , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology
16.
Prog Urol ; 19(1): 27-32, 2009 Jan.
Article in French | MEDLINE | ID: mdl-19135639

ABSTRACT

OBJECTIVE: To evaluate our results of retrograde laser endopyelotomy for uretero-pelvic junction obstruction. MATERIAL AND METHODS: Retrospective study of 27 consecutive retrograde laser endopyelotomies performed on 24 patients over a six years period (June 1999 to July 2005). Sixteen stenoses were primary. The level of obstruction was severe in 13 patients and moderate in 14 patients. A polar pedicle was diagnosed by pre-operative CT-angiography in seven cases. Balloon dilatation was performed in 17 procedures. A double J ureteral stent remained in place for six weeks mean. We evaluated results by a clinical examination and an excretory urography (at 1 and 6 months then annually). Mean follow-up was 35+/-22.7 months. RESULTS: Mean operating time and mean length of hospital stay were 49.8+/-17.9min and four days (range: 2-10 days). Two cases of pyelonephritis were observed. The overall success was 70%. In the eight unresolved cases, the failure appeared at 2.7+/-1 month mean. Success criteria were moderate level of obstruction and primary junction. Here, patients so selected have 100% of success. CONCLUSION: Study confirmed retrograde laser endopyelotomy was safety with a short length of hospital stay. This minimally invasive procedure should be reserved to primary moderate stenoses without polar pedicle.


Subject(s)
Kidney Pelvis/surgery , Lasers, Solid-State/therapeutic use , Ureteral Obstruction/surgery , Adult , Female , Humans , Male , Retrospective Studies
17.
Prog Urol ; 18(5): 304-10, 2008 May.
Article in French | MEDLINE | ID: mdl-18538276

ABSTRACT

OBJECTIVE: To evaluate the functional and cancer results of radical prostatectomy with bladder neck preservation in the treatment of localized prostate cancer. MATERIAL AND METHOD: From January 2000 to March 2006, 194 consecutive patients underwent open retropubic radical prostatectomy for localized prostate cancer. The bladder neck was technically preserved in 180 patients (93%). The mean age of these 180 patients was 63.2+/-6.1 years. The mean preoperative PSA was 9.38+/-6 ng/ml. The 180 patients were classified according to the Amico prognostic classification as low risk: 52.2%, intermediate risk: 37.8% and high risk: 10%. Operative specimens were examined by the same pathologist according to the Stanford technique. Positive surgical margin was defined as tumour tissue in contact with the ink of the operative specimen. For analysis of the functional results, patients were classified into three categories: continent without protection, stress incontinent, totally incontinent. Continence was evaluated at D10, one month, six months, one, two, three, four and five years. The mean follow-up was 44+/-25 months. RESULTS: This series of 180 operative specimens comprised 64 (35.6%) cases of positive surgical margins and 112 (62.2%) pT3 cancers. No positive margins were observed in the bladder neck, either alone or associated with another positive margin. Seventy-one percent of patients were continent on D10 and at one month, 85% were continent at six months and 89% were continent at one year. Two cases of anastomotic stenosis were observed (1.2%). CONCLUSION: Bladder neck preservation during open retropubic radical prostatectomy allows early continence in more than 70% of cases without increasing the risk of positive surgical margins.


Subject(s)
Prostatectomy/methods , Urinary Incontinence/prevention & control , Follow-Up Studies , Humans , Male , Middle Aged , Prostatic Neoplasms/surgery , Retrospective Studies
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