Decrease in mortality from benign prostatic hyperplasia: a major unheralded health triumph.

PURPOSE: A systematic examination of all available mortality data from benign prostatic hyperplasia (BPH) between 1950 and 1990 was done to estimate the changing international mortality pattern of this condition. MATERIALS AND METHODS: Mortality data in which BPH was the underlying cause of death were abstracted from the World Health Organization mortality data base. These data were available from a variety of international countries (in many since 1950). RESULTS: Mortality rates have decreased with considerable magnitude in developed western countries between the early 1950s and late 1980s. This fact could reasonably be attributed to the improved management of the most severe complications of BPH and to improvements in surgery and anesthesia, which have made surgical interventions of the prostate possible in a greater proportion of men, and safer in the immediate and subsequent postoperative period. CONCLUSIONS: The decreases noted in western countries, such as the United Kingdom (where 8,700 fewer men die each year presently than would be expected if the BPH mortality rates from the early 1950s still applied), United States (13,681 fewer deaths) and France (2,884 fewer deaths), indicate a considerable but unheralded achievement for modern medicine. Unfortunately, these decreases have not been observed to the same extent in central and eastern Europe and South America, where the residual high mortality rates could be lowered by education, and the widespread availability of modern surgical and anesthetic equipment.

[Treatment of stress urinary incontinence in women using the Goebell-Stoeckel surgical method. Study of 59 operated patients. Long-term review]. / Le traitement de l'incontinence d'effort de la femme par l'opération de Goebell-Stoeckel. Etude de 59 opérées. Revue à long terme.

Stress urinary incontinence may be treated by different techniques. This study is based on a retrospective analysis of 59 patients treated between 1985 and 1993, by the Goebell-Stoeckel technique. 48 patients were questionned by phone in March 1995 to estimate the long term results. Two groups were defined; group A: follow-up between 15-60 months and group B: follow-up between 72-120 months (Total average follow-up: 68 months). The majority of patients were elderly, menopaused (88%) and had had one or more surgical procedure for incontinence (60%). Among 59 patients, 8 developped minor early complications. The mean length of hospital stay was 14 days and the mean duration of indwelling catheterization was 6.5 days. 60% of patients have had urinary retention after catheter ablation and have required intermittent catheterization at home for a mean duration of 14 days. Continence was achieved in 84% of cases at 3 months and had persisted in 96% of cases for group A and 91.5% of cases for group B. With a mean follow-up of 68 months, 37.5% of cases had irritative symptoms, 12.5% had minor urethral obstruction. 52% of patients obtained a very excellent result (normal continence, no urgency, no dysuria), 9% obtained an excellent result (normal continence, urgency with no leaked, and/or minor dysuria); 12 obtained a moderate result (normal continence, urgency with minor leakage without toilet set, and/or minor dysuria) and 27% obtained a poor result (incontinence, urgency with leakage necessitating toilet set, and/or dysuria).

[Restructuring of emergency services: a safety imperative]. / La restructuration des urgences: un impératif de sécurité.

More than 7,000,000 cases have been treated each year in the emergency care units of the french Hospitals. The majority of them have been properly treated. However complaints of unsatisfactory treatment were noted and in some cases very serious complications were reported. The main cause of the weakness of some care units rests in the qualitative and quantitative "under medicalisation". First care is often administered by students without control by the staff. Frequently also, the senior members of these units have an insufficient medical curriculum. A National Commission to reform the emergency care units (Commission Nationale de Restructuration des Urgences on CNRU) has been set up by the Government in order to define ways to reorganize these units. The Commission has established 3 conditions which are required for an emergency care unit: high medical skill which implies that the patients have to be treated by a senior physician; permanent reception: which requires a sufficient number of physicians to allow the presence of seniors 24h/24; responsibility: the function of every member of the team has to be clearly defined. The Commission has suggested the reception of emergency patients to be organised in two structures of different level: 1) the Department of Emergency (Service d'Accueil des Urgences or SAU) in which all the medical and technical requirements allow the reception and treatment of all types of emergency cases; 2) the reception and orientation units (Antennes d'Accueil et d'Orientation or ANACOR) which is a light structure assigned for the patients whose troubles are not surgical and who do not require major treatments. Such an organisation in a double structure requires a clear information of the population, an improvement of the medical regulation of the emergency cases and an the adaptation of the medical studies. Finally the aim of the reform is to improve the quality of care, to increase the safety of patients and to limit the inequality of patients facing an emergency situation.

[TULIP: transurethral ultrasound-guided laser-induced prostatectomy. One-year clinical results]. / TULIP: transurethral ultrasound-guided laser-induced prostatectomy. Résultats cliniques à un an.

The TULIP (transurethral ultrasound-guided laser-induced prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 microns wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.

[Retrospective comparative study of three surgical procedures in the treatment of urinary stress incontinence in women. Apropos of 119 patients treated from 1985 to 1990]. / Etude comparative rétrospective de trois interventions chirurgicales dans le traitement de l'incontinence urinaire d'effort de la femme. A propos de 119 patientes traitées entre 1985 et 1990.

From 1985 to 1990, 119 female patients underwent a cure for urinary incontinence on exertion according to a technique that varied according to the period and to the data of the literature. From 1985 to 1988, 42 patients were operated with the Goebbel-Stoeckel technique; from 1986 to 1988, 32 patients were operated with Stamey's procedure, and 47 patients with Gittes' procedure from 1988 to 1990. These three groups of patients with comparable ages, previous history and degree of urinary incontinence on exertion were analyzed by the same surgeon for functional results and morbidity, both in the immediate three months after surgery and in July, 1991, with an average distance in time of 29 months. The patients with no leakage of urine were regarded as healed, those presenting with occasional leakages on violent exertion but requiring no napkins were regarded as improved. All other patients were regarded as failures. The percentage of failure is similar for the three technical procedures when analyzing long-term results and according to our criteria, 66% of patients only are healed or improved. These figures are noticeably higher if surgery has been performed in a patient with normal preoperative closing pressure. The analysis of this series and comparison with series in the literature seem to allow outlining a therapeutic pattern for urinary incontinence on exertion, whether recurrent or not, with or without sphincter hypotonia.

[Urodynamic study of the behavior of detubulated ileocystoplasties according to feeding]. / Etude urodynamique du comportement des iléocystoplasties détubulées en fonction de l'alimentation.

Twenty-three patients having undergone enterocystoplasty with a detubulated graft has an urodynamic study on an empty stomach and after a standardized meal. All patients (average age 62.9 years) had been operated more than 6 months earlier, and 30% still presented with urine leakages at night. The urodynamic study included a cystomanometric measurement with rapid water filling, an urethral profile and a micturating cystography. It was repeated 60 to 90 minutes after a meal composed of glucids, lipids and protids. Feeding had variable effects on the intestinal graft: increase in peristaltic intensity and/or earlier onset of contractions (10/23); apparently paradoxical decrease in contractions (6/23); sometimes no modification (7/23). This short work without any obvious physiopathological explanation has led us to advocating breaking up feeding for patients who were improved by the meals.

[Urinary diversion by ureteral endoprosthesis during pregnancy]. / Dérivation urinaire par endoprothèse urétérale au cours de la grossesse.

Dilatation of the renoureteral cavities during pregnancy is a common occurrence, especially on the right side. Though generally asymptomatic, this dilatation can be unfrequently complicated by pain and/or urinary infections that may cause severe infectious and obstetrical complications. In such cases, drainage of the renal cavities may be indicated in very selected cases. The authors review their experience with renal bypass through an endoureteral prosthesis during pregnancy, and specify the technical aspects and the indications of this type of bypass.

[TULIP: transurethral ultrasound-guided laser-induced prostatectomy. Clinical results after on year]. / TULIP: transurethral ultrasound-guided laser-induced prostatectomy. Résultats cliniques à un an.

The TULIP (Transurethral Ultrasound-guided Laser-Induced Prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 micron wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.

[Renal oncocytoma. Retrospective study of 38 cases]. / Oncocytome rénal. Etude rétrospective de 38 cas.

38 cases of renal oncocytoma were recognized at Cochin's hospital from 1982 to 1991. Accurate diagnosis was not possible before performing surgery. However, a benign tumor appearance on the preoperative morphologic investigations and an evocative peroperative macroscopic aspect of renal oncocytoma, allowed us to realize a conservative surgery in 4 cases. Follow-up of 27 patients (11 lost to follow-up) showed a benign clinical behaviour in all cases, de spite of invasion of the perirenal fat in 2 cases, and tumoral thrombosis of a proximal branch of the renal vein in 1 case. No metastases occurred after a mean follow-up of 32.5 months, within range from 11 to 101. Our experience as well as the literature leads us to believe that renal oncocytoma is a benign tumor. We conclude that conservative surgery must be systematically considered when peroperative histological examination assert the diagnosis of renal oncocytoma, especially when the tumoral diameter is less than 5 cm.

Complete ureteral transection associated with percutaneous lumbar disk nucleotomy.

A case of complete ureteral transection complicating percutaneous nucleotomy for disk herniation is reported. The ureteral lesion was contralateral to the percutaneous approach and was treated by intubated ureteroureterostomy, since complete section precluded endourological management.

Localized hyperthermia versus the sham procedure in obstructive benign hyperplasia of the prostate: a prospective randomized study.

Hyperthermia was shown to cause improvement in 50 to 60% of the patients with benign prostatic hyperplasia (BPH) without considering placebo effects. We studied 68 patients randomly assigned to a treatment group (38) and a sham group (30) who underwent the same manipulation but without applying radio frequency power. The Biodan Prostathermer was used. Criteria for inclusion were based on objective and subjective symptoms. Treatment was performed 6 times at 43 +/- 0.5C for the treatment group. Followup evaluation was performed at 3 months, and the same objective and subjective symptoms were recorded. We observed a statistically significant subjective improvement in the sham group (33%) that was not accompanied by any significant objective improvement. In the treatment group the subjective response was significantly better regarding number of patients (68%) and response rate, and was substantiated by a significant improvement in all objective symptoms (53% of the patients) except voided volume. Therefore, hyperthermia treatment had a definite therapeutic effect on BPH in excess of placebo.

Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer.

Intravesical therapy with bacillus Calmette-Guerin (BCG) has proved to be more effective in the prophylaxis and treatment of superficial bladder tumors and carcinoma in situ than most chemotherapeutic agents. Compared to intravesical chemotherapy, instillations with BCG provoke more local and systemic reactions. In addition to the commonly induced granulomatous inflammatory changes in the bladder, which produce irritative symptoms, this therapy may cause systemic side effects varying from mild malaise and fever to, in rare instances, life-threatening or fatal sepsis. We report the incidence and varieties of toxicities in 2,602 patients treated with intravesical BCG. Side effects are classified according to local and systemic toxicity. Treatment options vary according to the severity of toxicity from delaying or withholding instillations to treatment with antituberculous drugs for up to 6 months. In general, 95% of the patients have no serious side effects. Recognition of risk factors, particularly traumatic catheterization or concurrent cystitis, that result in systemic BCG absorption, as well as the prompt and appropriate treatment of early side effects should significantly decrease the incidence of severe toxicity.

[Morbidity of radical prostatectomy for localized cancer of the prostate. Apropos of 100 cases]. / Morbidité de la prostatectomie radicale pour cancer localisé de la prostate. A propos de 100 cas.

Adenocarcinoma of the prostate is the most frequent cancer of male over 60 years of age. Radical prostatectomy is one of the preferred modes of treatment for localized stages. Surgical morbidity decreases with experience and consists mainly in bleeding and rectal injury. Delayed morbidity comprises loss of erection, anastomosis stricture, incontinence. A retrospective study of 100 patients is reported.

[Localized transrectal hyperthermia in the treatment of obstructive manifestations of prostatic adenoma. Review of the literature and personal experience]. / Hyperthermie transrectale localisée dans le traitement des manifestations obstructives de l'adénome prostatique. Revue de la littérature et expérience personnelle.

For about the last 10 years, transrectal hyperthermia has been used to treat obstructive manifestations of adenoma of prostate. This procedure induces interstitial edema and acts preferentially on the fibrous elements of the prostate. Several therapeutic regimens have been used successively by different teams, after objective and subjective inclusion screening programmes. Results published up to the present show about 45% of objective responders (against 3% in a placebo group) with improvement sustained in 3 out of 4 cases. Morbidity rate (infection and urinary retention) was 3%. Data from a retrospective study of a series of personally treated patients was w used to determine those with the greatest chance of a successful outcome, even though this is never comparable with that of surgical treatment.

BCG therapy in superficial bladder tumours--complications and precautions.

Bacillus Calmette-Guérin (BCG) immunotherapy represents a valuable treatment in the management of superficial bladder cancer, but the therapy is not without its risks. A total of 220 patients have been included in a review of local and systemic side effects associated with BCG immunotherapy. The majority of side effects are mild and self limiting, but potentially life threatening complications can arise with BCG immunotherapy. These systemic side effects include pneumonitis/hepatitis and systemic BCG infection. Recommendations are given for the use and administration of BCG, and if these rules are correctly applied, BCG may be administered safely, and with confidence.

[The treatment of patients with ureteral calculi by ureteroscopy and intracorporeal lithotripsy]. / Lechenie bol'nykh s kamniami mochetochnika ureteroskopiei s intrakorporal'noi litotripsiei.

Ureteroscopy with endocorporeal urinary stone lithotripsy (EUSL) implies an "in situ" stone fragmentation including or not a basket extraction of the fragments. EUSL needs three conditions: ureteronephroscopy (antegrade or retrograde), sources of energy (ultrasonic, electrohydraulic, laser), extraction devices (basket, grasping forceps). The paper reports the data on 120 ureteral stones treated by ureteroscopy and laser lithotripsy with an overall effect of 84%.