[Oncological results of 117 consecutive radical prostatectomies]. / Résultats carcinologiques de 117 prostatectomies radicales consécutives.

INTRODUCTION: The objective of this study was to evaluate the risk factors of biochemical recurrence in patients with prostate cancer treated by retropubic prostatectomy. MATERIAL AND METHODS: Retrospective analysis of 121 consecutive retropubic radical prostatectomies performed between January 1994 and December 1997. Biochemical recurrence was defined by PSA > or = 0.2 ng/ml. Biochemical recurrence-free survival rates were calculated by the actuarial method. Univariate and multivariate analysis of prognostic factors of biochemical recurrence was performed. RESULTS: The actuarial biochemical recurrence-free survival was 71% at 5 year and 63% at 7.5 years. Kaplan-Meier analysis did not reveal any difference for the risk of biochemical recurrence between patients with doubtful margins and those with positive margins. These two groups were therefore combined. Significant risk factors on univariate analysis were: pathological stage, grade of the predominant cell contingent on the specimen, margins, highest cell grade on biopsies, clinical stage, PSA level, perineural invasion and Gleason score. Significant risk factors for biochemical recurrence on multivariate analysis were: pathological stage, PSA > 10 ng/ml, the highest grade on biopsies, positive margins and perineural invasion. CONCLUSION: Doubtful margins and positive margins appear to be associated with the same risk of biochemical recurrence. The prognostic value of Gleason grade on the specimen is higher than that of the Gleason score. A high Gleason grade on biopsies is associated with a particularly poor prognosis.

[Mechanical evaluation of various suburethral tapes used for the treatment of stress urinary incontinence]. / Evaluation mécanique de différentes bandelettes sous-urétrales utilisées pour le traitement de l'incontinence urinaire d'effort.

OBJECTIVE: The objective of this study is to compare the mechanical characteristics of a series of suburethral tapes marketed for the treatment of stress urinary incontinence, often considered to be identical in the clinical practice. MATERIAL AND METHOD: Six suburethral tapes were studied: TVT (Gynecare-Ethicon, USA), IVS (Tyco Healthcare, USA), Sparc (AMS, USA), Uretex (Sofradim, France distributed by BARD), I-stop (CL médical, France), and Uratape (Porgès, France). The surface was studied by scanning electron microscopy. Mechanical properties were evaluated on an Instron traction apparatus equipped with a 500 Newton transducer and elongation was performed at a rate of 10 mm/min. Deformation curves, Young's elastic modulus, and maximum load were calculated. Possible release of particles was investigated by weighing each sample before and after gentle 0.01 kN traction. RESULTS: From a purely mechanical point of view, completely opposite properties were observed. The maximum load ranged from 0.012 +/- 0.002 to 0.047 +/- 0.013 kN. Young's elastic modulus ranged from 4.31 +/- 1.1 to 41.99 +/- 14.3 Mpa. Maximum deformity ranged from 31% to 108%. Release of particles was estimated, according to the tape, to represent a variation of the initial weight of between 0.01% and 8.5%. CONCLUSION: It is difficult to compare tapes that are theoretically marketed for the same application, suggesting that the same tape should probably not be used for the same application. Clinicians must more extensively evaluate the required properties. The authors believe that tapes with a high elastic modulus should be proposed for transobturator procedures to provide real perineal support, while tapes with a lower elastic modulus should be used for retropubic techniques.

[Use of transvaginal polypropylene mesh (Gynemesh) for the treatment of pelvic floor disorders in women. Prospective study in 52 patients]. / Utilisation d'un treillis de Polypropylène (Gynemesh) par voie vaginale dans le traitement des troubles de la statique pelvienne de la femme: etude prospective chez 52 patientes.

OBJECTIVES: To evaluate the efficacy and safety of strict transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of female genital prolapse. MATERIALS AND METHODS: The anatomical and functional results of 52 women operated between September 1999 and December 2002 were evaluated prospectively. The mean age of the patients was 62 years. All patients presented a cystocele, associated with a hysterocele, an elytrocele or a rectocele in 28%, 9.5% and 38% of cases, respectively. Urinary incontinence was reported in 65% of patients, and 30% of women had a history of previous pelvic surgery. Depending on the components of the prolapse, the operation comprised anterior or posterior mesh implantation, hysterectomy and TVT insertion. Patients were reviewed by a different surgeon from the operator at 3 months, 6 months and then annually. RESULTS: With a mean follow-up of 27 months, the anatomical success rate was 95% for correction of cystocele, and 100% for correction of rectocele. Vaginal erosion by the mesh occurred in two cases after cystocele repair (3.8%). CONCLUSION: Transvaginal implantation of a polypropylene prosthesis is a safe and reproducible technique, which is effective in the medium term for the treatment of prolapse, but further studies are required to confirm this technique as a valid alternative to existing techniques.

[Post-traumatic high-flow priapism in an adolescent]. / Priapisme post-traumatique a haut débit chez un adolescent.

The authors report a case of high-flow priapism in an adolescent due to rupture of the deep penile artery after falling astride, confirmed by Doppler ultrasound on the third day after the accident, and treated successfully by highly selective embolization with no harmful effects on erectile function.