[Massive migration of Hem-o-lok® clips following open partial nephrectomy: a case report and literature review]. / Migration massive de clips Hem-o-lok® après néphrectomie partielle ouverte : cas clinique et revue de la littérature.

The sliding-clip renorraphy technique using Hem-o-lok(®) clips for parenchymal closure in partial nephrectomy is largely used in laparoscopic, robotic and sometimes open surgery. We present here a case of massive migration of the clips after open partial nephrectomy. We discuss the imaging characteristics of those clips: not visible on plain X-ray, low density on computed tomography, before reviewing previously published cases.

[Surgery of locally advanced prostate cancer]. / La chirurgie du cancer de la prostate au stade localement avancé. Revue du comité de cancérologie de l'AFU (sous-comité "Prostate").

Among the different options recommended for locally advanced prostate cancer (LAPC), radical prostatectomy (RP) is a relatively infrequent option because its role is still controversial. The results of clinical trials combining an external radiotherapy to a long-term androgen deprivation sustain the principle of a multidisciplinary management of LAPC. Impact of surgery on the risk of progression and local recurrence is important in selected patients with low grade and small tumoral volume. Clinical and histological data associated to the MRI assessment remain essential and enhance the preoperative multidisciplinary decision. Oncological results from recent series show 10-year and 15-year specific survival rates around 85 and 75%, respectively. Moreover, approximately 20 to 30% of patients initially presented with cT3 tumours have finally an organ-confined disease on pathological examination. Morbidity of the procedure is similar to RP for organ-confined tumours despite more erectile dysfunction due to non-sparing RP in most of cases. An enlarged RP with an extended pelvic lymphadenectomy can be considered as a viable alternative to radiotherapy and hormonal therapy in patients with long life expectancy presenting cT3 tumour with a high risk of local progression and a low risk of metastatic disease. Comparative and combined treatments including RP have to be prospectively investigated in clinical trials in terms of oncological outcome and quality of life.

[Priapism associated with antipsychotic medications: a series of four patients]. / Priapisme sous neuroleptiques. A propos de quatre patients.

INTRODUCTION: Ischemic (veno-occlusive, low flow) priapism is a painful and persistent penile erection unrelated to sexual desire or stimulation. In some cases, it is an adverse event of antipsychotic medications. MATERIAL: Between 1st January 2000 and 30th September 2007, four men (range 25/55 years), treated with antipsychotic agents (amisulpride, clozapine, levomepromazine, olanzapine, pipotiazine, risperidone or zuclopenthixol), presented one or several episodes of ischemic priapism. No other etiological factor was diagnosed. The patients were treated with aspiration and irrigation of the corpa cavernosa with intracavernous injection of sympathomimetic drugs followed in one case by a surgical distal cavernoglanular shunt. DISCUSSION: Many conventional or atypical antipsychotic agents have been reported to cause priapism. Drug-induced priapism comprised of about 30% of the cases and an estimated 50% of them occurred with antipsychotic agents. The mechanism of priapism associated with antipsychotics agents thought to be related to alpha-adrenergic blocking properties. The decision of whether to restart a patient on a specific antipsychotic agent after an episode of priapism is a difficult clinical decision. An agent with low peripheral alpha-adrenergic blocking affinity would be preferred. CONCLUSION: Ischemic priapism is an urologic emergency. Clinicians should be familiar with this rare but serious adverse event of antipsychotic agents to avoid long-term sequelae including erectile dysfunction.

[Standards, options, and recommendation for external radiotherapy of prostatic cancer: evaluation of the effect of dosage]. / Standards, Options et Recommandations pour la radiothérapie externe des patients atteints de cancer de la prostate: évaluation de l'effet dose.

CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical speciality societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for the radiotherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Association (AFU) designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. RESULTS: The main recommendations are: 1/ a minimal dose of 70 Gy must be used, whatever the prognostic factors; 2/ it appeared that patients with favourable prognostic indicators (stage T1-2, PSA < or = 10 micrograms/L and Gleason score < or = 6) do not benefit from a dose escalation effect for doses over 70-74 Gy; 3/ patients with intermediate prognosis are the ones who benefit most from the dose escalation effect over 74 Gy, provided they receive exclusive radiation therapy; 4/ whenever possible, patients should be included in controlled trials designed to assess the effects of dose escalation and hormonotherapy.

[Standards, Options, and Recommendations for brachytherapy in patients with prostate cancer: efficacy and toxicity]. / Standards, Options et Recommandations pour la curiethérapie des patients atteints de cancer de la prostate: efficacité et toxicité.

CONTEXT: The "Standards, Options and Recommendations" (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by a critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. OBJECTIVES: Produce clinical practice guidelines for the brachytherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. METHODS: The FNCLCC and the French Urology Association (AFU) first designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. RESULTS: The main recommendations are: 1/Brachytherapy with permanent seeds alone is a possible curative treatment for prostate cancer patients with the following prognosis factors: tumour stage T1 or T2a (TNM 1992), Gleason score < or = 6 and PSA < 10 micrograms/L. 2/Combined treatment with brachytherapy and hormonal therapy could be more efficient than brachytherapy alone for prostate cancer patients with Gleason score > 7 and/or PSA > 10.3/Combination of brachytherapy and external beam radiation therapy can be proposed to prostate cancer patients with intermediate prognosis. 4/Before and after seed implantation, risks of infection must be prevented by appropriate antibiotic therapy (recommendation). 5/Brachytherapy must not be performed within 2 months of transurethral prostate resection. 6/The height of the urethra receiving more than 200% of the prescribed dose must be reported. The portion of the rectum receiving 100 and 120% of the prescribed dose must be limited to 10 and 5 mm length, respectively.

[Interstitial radiotherapy and prostate cancer. Analysis of the literature. Subcommittee of Prostate Cancer of C.C.A.F.U]. / Radiothérapie interstitielle et cancer prostatique. Analyse de la littérature. Sous-Comité Cancer de Prostate du C.C.A.F.U.

The C.C.A.F.U. reviewed the role of interstitial radiotherapy by analysing 66 references published over the last 10 years, obtained from the Medline database. RESULTS IN TERMS OF PSA MONITORING: Various modalities of analysis of the laboratory follow-up after radiotherapy have been reported in the literature. The American Society of Therapeutic Radiation Oncology (ASTRO) defines biochemical progression after irradiation by the existence of three consecutive elevations of PSA above the nadir without taking into account the value of this nadir, but the risk of progression appears to continually increase as a function of the PSA nadir; this definition also makes it difficult to compare radiotherapy and surgery. Consequently, we only analysed series reporting results according to strict laboratory criteria (PSAn < or = 1 ng/ml, PSAn < or = 0.5 ng/ml) more than 4 years after treatment. For stage T1-T2 and well differentiated tumours, the 5-year results of interstitial radiotherapy were comparable to those of surgery, and superior to those of external radiotherapy for poorly differentiated tumours. For stage T3 tumours, only 192Ir and, to a lesser extent, 103Pd associated with external irradiation gave slightly better results than those of external irradiation. RESULTS IN TERMS OF FOLLOW-UP BIOPSIES: Post-treatment biopsies may become negative after a considerable period of time, which justifies follow-up biopsies beyond the 24th month. The significance of persistence of tumour cells on the follow-up biopsy is unclear. A correlation between the follow-up biopsy and PSA monitoring has been demonstrated. RESULTS IN TERMS OF MORBIDITY: Frequency of early irritating symptoms (45% of cases). Dysuria and retention are frequent late complications, and there is a high risk of incontinence after associated endoscopic resection. The impotence rate is low (25%), but sexual potency decreases with time. CONCLUSION: Interstitial radiotherapy can be rightfully considered to be a curative treatment for localized prostate cancer. However, this treatment modality requires further evaluation due to the insufficient follow-up of recent series and the absence of comparative studies.

[Should plasma prolactin assay be routinely performed in the assessment of erectile dysfunction? Report of a series of 445 patients. Review of the literature]. / Faut-il doser la prolactinémie dans le bilan d'une insuffisance érectile? A propos d'une série de 445 patients. Revue de la littérature.

OBJECTIVE: To define the value of plasma prolactin assay in the assessment of erectile insufficiency. MATERIAL AND METHODS: Plasma prolactin assay (radioimmunoassay) was performed in 445 patients presenting with erectile insufficiency (mean age 52.5 years). RESULTS: 9 patients (2%) presented plasma prolactin levels greater than 25 ng/ml and 4 (0.9%) of them had levels higher than 35 ng/ml. Eight of these 9 patients were taking hyperprolactinaemic drugs. The aetiology remained unclear in 1 patient, but the pituitary gland was normal on CT scan. REVIEW OF THE LITERATURE: In the population of men with erectile insufficiency, 2.7% of subjects have plasma prolactin levels greater than 20 or 25 ng/ml. 1.3% have levels greater than 35 or 40 ng/ml and 0.6% present pituitary tumours. In the case of pituitary tumours responsible hyperprolactinaemia and erectile insufficiency: 1) plasma prolactin is greater than 30 ng/ml in 90% of cases and greater than 50 ng/ml in 83% of cases; 2) total plasma testosterone is less than 3 ng/ml in 88% of cases and less than 4 ng/ml in 96% of cases; 3) libido is decreased in 90% of cases. CONCLUSION: The prevalence of hyperprolactinemia and pituitary tumours in the population of men with erectile insufficiency is low. Moreover, certain criteria are suggestive of hyperprolactinemia, especially when it is secondary to a pituitary tumour. Consequently, routine plasma prolactin assay is not justified. This assay should only be performed when libido is impaired, total plasma testosterone is decreased or when the patient presents certain signs such as headache, gynaecomastia or visual disturbances.

[Clinical stage T3 prostate cancer: natural history, therapeutic choices and their results]. / Cancer de prostate de stade T3 clinique: histoire naturelle, les choix thérapeutiques et leurs résultats.

Clinical stage T3 prostate cancer is ambiguous both in terms of its definition and its place in the natural history of the disease, and there is no consensus concerning its treatment. In a review of the literature, 148 articles were selected and analysed from the Medline database over a 14-year period (1983-1997). Single-agent therapy: Radiotherapy and radical prostatectomy: it is unlikely that these treatments can cure clinical stage T3 prostatic cancer, except perhaps for a small minority of patients actually presenting with overstaged pT2 disease or certain forms of low-grade pT3. Neither treatment appears to have any advantage over the other-Endocrine therapy: it has been proposed as exclusive treatment at this stage. Few studies have been reported. However, many authors consider this choice to be legitimate, because one-half of patients already have lymph node involvement. Combination therapy: Radiotherapy and endocrine therapy: recent studies comparing exclusive external beram radiotherapy with endocrine therapy show an advantage in favour of combination therapy. Total prostatectomy and endocrine therapy: neoadjuvant endocrine therapy does not provide any advantage. Adjuvant endocrine therapy improves local control and progression-free survival. Adjuvant radiotherapy and radical prostatectomy provides no advantage for T3. The choice of treatment for stage T3, N0, M0 obviously depends on the patient's general state and life expectancy. If the option of a curative treatment in a young subject can be reasonably considered, combination therapy should be preferred.

[Nondilated obstructive anuria complicating urethrocystopexy]. / Anuries obstructives à cavités non dilatées après urétro-cervico-cystopexie.

Anuria complicating urethrocystopexy is generally an obstructive uropathy. No urinary tract dilatation had been observed in these two following cases. The rupture of the collecting system, with urinary extravasation, is due to acute ureteral obstruction and furosemide associated. The first exam to be done is the ultrasonography. However, this exploration can fail to demonstrate obstruction. Urgent percutaneous nephrostomy appears to be the best curative method. Surgical liberation of the trapped ureters is almost necessary.

[Difficulties of radiologic diagnosis of renal masses. A case of hemangioma of the kidney]. / Difficultés du diagnostic radiologique des masses rénales. Une observation d'hémangiome du rein.

One case of renal hemangioma is reported. Exact diagnosis was dependent on histopathologic findings. This hemangioma had a calcified mass feature, so, several radiological diagnosis are debated. The relevant literature is reviewed.

[Tentative classification of the ultrasound symptomatology of the prostate by an anatomo-ultrasonic comparison of 34 cases]. / Tentative de classification de la sémiologie échographique de la prostate par confrontation anatomo-ultrasonique de trente-quatre cas.

Ultrasound and histological sections were taken of 34 prostate units removed from fresh cadavers. Ultrasonography seems to raise more problems than it solves; only 73% of the normal prostates were homogeneous under ultrasound. Ultrasonography visualized nodular structures requiring biopsy in 71% of the cases of prostatic adenoma. There were too few cases of malignant tumors in the sample to warrant a conclusion. They were highly evolved. Ultrasonography gave strong grounds for suspicion, but they could be easily diagnosed clinically.

[Bladder exstrophy and pregnancy. Apropos of 2 cases]. / Exstrophie vésicale et grossesse. A propos de deux observations.

The authors report two cases of pregnant women suffering from exstrophy of the bladder. One of the patients had been operated on in childhood for reconstruction of the bladder, and the other had undergone Coffey's operation, so that both were able to lead practically normal lives in adulthood. Three children were born by prophylactic cesarean. Exstrophy of the bladder is often associated with other urological, genital or, on occasion, orthopedic, malformations. This article analyzes the consequences of these malformations on the course of pregnancy and delivery, and the consequences of pregnancy on the urinary tract or on the different types of surgical reconstruction. The indications for the type of delivery (natural passages or cesarean section) are discussed in the light of the author's personal experience and a review of the literature.

[Transcutaneous measurement of blood flow in arteriovenous fistulae caused by hemodialysis using Doppler ultrasound]. / Mesure transcutanée du débit dans les fistules artério-veineuses d'hémodialyse par échographie-Doppler.

Blood flow measurement in arterio-venous fistulae can be performed with a duplex ultrasound system which combines echography and C. W. Doppler. This method is very useful to follow up the patency of the fistulae and his consequence on the cardiac function. The exploration consists in two steps: a qualitative study of the Doppler spectrum to detect a possible decrease of the arterial diastole flow which traduce a severe stenosis; the evaluation of the blood flow in ml/min. The blood flow in ml/mn is a good parameter for the follow-up of the fistulae; moreover in case of high blood flow values, it is very useful to guide the surgical therapy.

[Organ donors: survey of 1000 persons]. / Les dons d'organes: enquête sur 1 000 personnes.

According to the french law, organs may be removed from all persons who have not, prior to their death, notified their opposition. The survey shows that 56% had not heard of the law, although 77% were willing to donate. There were marked differences in the answers of the different social groups, the lower groups being less informed and more reserved towards the idea of organ donation. The women asked were less willing than the men to donate their own organs or those of their families, and yet they said they had given more thought to this problem. Finally, although this survey was carried out in an area where there been widespread information on the subject, 94% considered that the public were not sufficiently informed. It is true that, of the 20% against donation, only 1 in 10 knew the practical possibilities for refusal. Could we not envisage a system, as exists in other countries, whereby the acceptance or refusal is mentioned on the identity card? We know in advance that 77% would be willing to donate.