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Long JA, Fiard G, Giai J, Teyssier Y, Fontanell A, Overs C, Poncet D, Descotes JL, Rambeaud JJ, Moreau-Gaudry A, Ittobane T, Bouzit A, Bosson JL, Lanchon C. Superselective Ischemia in Robotic Partial Nephrectomy Does Not Provide Better Long-term Renal Function than Renal Artery Clamping in a Randomized Controlled Trial (EMERALD): Should We Take the Risk? Eur Urol Focus 2021; 8:769-776. [PMID: 33931361 DOI: 10.1016/j.euf.2021.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/14/2021] [Accepted: 04/13/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Superselective clamping of tumor-targeted arteries aims to eliminate ischemia of the remnant kidney while keeping tumor bed bloodless during excision. OBJECTIVE To evaluate the impact of superselective clamping on long-term renal function, compared with renal artery early unclamping. DESIGN, SETTING, AND PARTICIPANTS A randomized monocentric single-blind trial (1:1) was conducted from February 2018 to August 2019. Patients with a single renal tumor were candidates for a robot-assisted partial nephrectomy (RAPN) in a referral center. EMERALD (NCT03679572) was powered to include 50 patients with an interim analysis after 30 cases. INTERVENTION Superselective RAPN (SS-RAPN) with near-infrared fluorescence (NIRF) or conventional RAPN with renal artery early unclamping. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the percent change of estimated glomerular filtration rate (eGFR) in the operated kidney after 6 mo (combination of eGFR and relative function on 99mTc-DMSA scintigraphy). Secondary endpoints assessed feasibility and safety of the technique. RESULTS AND LIMITATIONS Relative eGFR reduction in the operated kidney at 6 mo did not differ significantly (-21.4% vs -23.4%, p=0.66). This absence of difference remained after adjusting on percentage of kidney volume preserved, which was an independent predictor of functional preservation. There were no significant differences in terms of blood loss, change in hemoglobin, postoperative complications, transfusion, and conversion to radical nephrectomy (two vs zero) or to open surgery (one vs zero). Despite a good accrual, the steering committee interrupted the trial after the interim analysis for futility given the absence of trend in favor of SS-RAPN. CONCLUSIONS SS-RAPN using NIRF does not provide better renal function preservation than renal artery clamping, questioning the interest of this technique at a higher risk of bleeding. PATIENT SUMMARY In this randomized controlled trial, superselective clamping of tumor feeding arteries did not show any advantage in terms of long-term renal function compared with conventional artery clamping.
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Affiliation(s)
- Jean-Alexandre Long
- Urology Department, Grenoble University Hospital, Grenoble, France; TIMC-IMAG UMR CNRS 5525, Domaine de la Merci, La Tronche, France.
| | - Gaëlle Fiard
- Urology Department, Grenoble University Hospital, Grenoble, France; TIMC-IMAG UMR CNRS 5525, Domaine de la Merci, La Tronche, France
| | - Joris Giai
- Clinical Investigation Center, Grenoble University Hospital, Grenoble, France
| | - Yann Teyssier
- Radiology Department, Grenoble University Hospital, Grenoble, France
| | - Amina Fontanell
- Urology Department, Grenoble University Hospital, Grenoble, France
| | - Camille Overs
- Urology Department, Grenoble University Hospital, Grenoble, France
| | - Delphine Poncet
- Urology Department, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Urology Department, Grenoble University Hospital, Grenoble, France; TIMC-IMAG UMR CNRS 5525, Domaine de la Merci, La Tronche, France
| | | | - Alexandre Moreau-Gaudry
- TIMC-IMAG UMR CNRS 5525, Domaine de la Merci, La Tronche, France; Clinical Investigation Center, Grenoble University Hospital, Grenoble, France
| | - Tarek Ittobane
- Clinical Investigation Center, Grenoble University Hospital, Grenoble, France
| | - Assilah Bouzit
- Urology Department, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Bosson
- Clinical Investigation Center, Grenoble University Hospital, Grenoble, France
| | - Cecilia Lanchon
- Urology Department, Grenoble University Hospital, Grenoble, France
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Franquet Q, Matillon X, Terrier N, Rambeaud JJ, Crouzet S, Long JA, Fassi-Fehri H, Codas-Duarte R, Poncet D, Jouve T, Noble J, Malvezzi P, Rostaing L, Descotes JL, Badet L, Fiard G. The Mayo Adhesive Probability score can help predict intra- and postoperative complications in patients undergoing laparoscopic donor nephrectomy. World J Urol 2020; 39:2775-2781. [PMID: 33175210 DOI: 10.1007/s00345-020-03513-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Living donor nephrectomy is a high-stake procedure involving healthy individuals, therefore every effort should be made to define each patient's individualized risk and improve potential donors' information. The aim of this study was to evaluate the interest of the Mayo adhesive probability (MAP) score, an imaging-based score initially designed to estimate the risk of adherent perinephric fat in partial nephrectomy, to predict intra- and postoperative complications of living donor nephrectomy. MATERIALS AND METHODS We retrospectively reviewed the imaging, clinical, and follow-up data of 452 kidney donors who underwent laparoscopic donor nephrectomy in two academic centers. RESULTS Imaging and follow-up data were available for 307 kidney donors, among which 44 (14%) had a high MAP score (≥ 3). Intraoperative difficulties were encountered in 50 patients (16%), including difficult dissection (n = 35) and bleeding (n = 17). Conversion to open surgery was required for 13 patients (4.2%). On multivariate analysis, a MAP score ≥ 3 was significantly associated with the risk of intraoperative difficulty [OR 14.12 (5.58-35.7), p < 0.001] or conversion to open surgery [OR 18.96 (3.42-105.14), p = 0.0042]. Postoperative complications were noted in 99 patients (32%), including 12 patients (3.9%) with Clavien-Dindo grade III-IV complications. On multivariate analysis, a high MAP score was also associated with the risk of postoperative complications [OR 2.55 (1.20-5.40), p = 0.01]. CONCLUSIONS In this retrospective bicentric study, a high MAP score was associated with the risk of intra- and postoperative complications of laparoscopic donor nephrectomy. The MAP score appears of interest in the living donor evaluation process to help improve donors' information and outcomes.
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Affiliation(s)
- Quentin Franquet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Xavier Matillon
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Terrier
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Jean-Jacques Rambeaud
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas-Duarte
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Poncet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Lionel Badet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France. .,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France.
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Peilleron N, Seigneurin A, Herault C, Verry C, Bolla M, Rambeaud JJ, Descotes JL, Long JA, Fiard G. External evaluation of the Briganti nomogram to predict lymph node metastases in intermediate-risk prostate cancer patients. World J Urol 2020; 39:1489-1497. [PMID: 32583038 DOI: 10.1007/s00345-020-03322-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The Briganti nomogram can be used with a threshold of 5% to decide when to offer lymph node dissection during radical prostatectomy. The objective of the study was to assess the accuracy of the Briganti nomogram on intermediate-risk prostate cancer patients managed in a single academic department. METHODS We retrospectively reviewed the files of all patients managed by radical prostatectomy (RP) and bilateral pelvic lymph node dissection (BPLND) in our center between 2005 and 2017. The overall accuracy of the model in predicting metastatic lymph node disease was quantified by the construction of a receiver-operator characteristic (ROC) curve. A calibration plot was drawn to represent the relationship between the predicted and observed frequencies. RESULTS We included 285 patients, among whom 175 (61.4%) were classified as intermediate risk as defined by D'Amico. The median follow-up was 60 (34-93) months. Twenty-seven patients (9.5%) were diagnosed with lymph node metastases. The median number of lymph nodes removed was 10 (7-14). The mean Briganti score was 19.3% in patients with lymph node involvement (LNI) and 6.3% in patients without LNI. Focusing on intermediate-risk patients, 91(52%) and 84 (48%) had a Briganti score < 5% and ≥ 5%, respectively, among whom 6 (6.6%) and 7(8.3%) had lymph node metastases. The accuracy of the score was low for intermediate risk patients with an area under the curve (AUC) of 53.1% (95% CI 0.45-0.61). CONCLUSION The Briganti nomogram in our retrospective cohort showed low accuracy for the prediction of lymph node involvement in an intermediate-risk prostate cancer population.
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Affiliation(s)
- Nicolas Peilleron
- Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France
| | - Arnaud Seigneurin
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC IMAG, Grenoble, France
- Department of Medical Assessment, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Herault
- Department of Medical Assessment, Grenoble Alpes University Hospital, Grenoble, France
| | - Camille Verry
- Department of Radiotherapy, Grenoble Alpes University Hospital, Grenoble, France
| | - Michel Bolla
- Department of Radiotherapy, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Jacques Rambeaud
- Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC IMAG, Grenoble, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC IMAG, Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, CS10217 Cedex 9, 38043, Grenoble, France.
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC IMAG, Grenoble, France.
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Lanchon C, Arnoux V, Fiard G, Descotes JL, Rambeaud JJ, Lefrancq JB, Poncet D, Terrier N, Overs C, Franquet Q, Long JA. Super-selective robot-assisted partial nephrectomy using near-infrared flurorescence versus early-unclamping of the renal artery: results of a prospective matched-pair analysis. Int Braz J Urol 2018; 44:53-62. [PMID: 29144626 PMCID: PMC5815532 DOI: 10.1590/s1677-5538.ibju.2017.0311] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Super-selective clamping of tumor-specific segmental arteries was developed to eliminate ischemia of the remnant kidney while limiting hemorrhage during partial nephrectomy. The objective is to evaluate the benefice of super-selective clamping on renal functional outcome, compared to early-unclamping of the renal artery. Materials and Methods From March 2015 to July 2016, data from 30 patients undergoing super-selective robot-assisted PN (RAPN) for a solitary tumor by a single surgeon were prospectively collected. Tumor devascularization was assessed using indocyanine green near-infrared fluorescence. A matched-pair analysis with a retrospective cohort undergoing early-unclamping was conducted, adjusting on tumor complexity and preoperative eGFR. Perioperative, oncologic and functional outcomes using DMSA-renal scintigraphy were assessed. Multivariate analysis was performed to identify predictors of postoperative renal function and de novo chronic kidney disease (CKD). Results Super-selective RAPN was successful in 23/30 patients (76.7%), 5 requiring secondary main artery clamping due to persistent tumor fluorescence. Matched-pair analysis showed similar operating time, blood loss, positives margins and complication rates. Super-selective clamping was associated with an improved eGFR variation at discharge (p=0.002), 1-month (p=0.01) and 6-month post-op (-2%vs-16% p=0.001). It also led to a better relative function on scintigraphy (46%vs40% p=0.04) and homolateral eGFR (p=0.04), and fewer upstaging to CKD stage ≥3 (p=0.03). On multivariate analysis, super-selective clamping was a predictor of postoperative renal function. Conclusion Super-selective RAPN leads to an improved preservation of renal function and a reduced risk of de novo CKD stage≥3, while keeping the benefit of main artery clamping on perioperative outcomes.
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Affiliation(s)
- Cecilia Lanchon
- Department of Urology, Grenoble University Hospital, Grenoble, France.,UJF-Grenoble 1, CNRS, INSERM, TIMC-IMAG UMR 5525, 38041 Grenoble, France
| | - Valentin Arnoux
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Gaëlle Fiard
- Department of Urology, Grenoble University Hospital, Grenoble, France.,UJF-Grenoble 1, CNRS, INSERM, TIMC-IMAG UMR 5525, 38041 Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, Grenoble, France.,UJF-Grenoble 1, CNRS, INSERM, TIMC-IMAG UMR 5525, 38041 Grenoble, France
| | | | | | - Delphine Poncet
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Nicolas Terrier
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Camille Overs
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Quentin Franquet
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital, Grenoble, France.,UJF-Grenoble 1, CNRS, INSERM, TIMC-IMAG UMR 5525, 38041 Grenoble, France
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Franquet Q, Terrier N, Pirvu A, Rambeaud JJ, Long JA, Janbon B, Tetaz R, Malvezzi P, Jouve T, Descotes JL, Fiard G. Aortic bypass surgery for asymptomatic patients awaiting a kidney transplant: A word of caution. Clin Transplant 2018; 32:e13218. [DOI: 10.1111/ctr.13218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Quentin Franquet
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Nicolas Terrier
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Augustin Pirvu
- Department of Vascular Surgery; Grenoble University Hospital; Grenoble France
| | - Jean-Jacques Rambeaud
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
- TIMC-IMAG Laboratory; CNRS; UMR 5525; Grenoble France
| | - Benedicte Janbon
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Rachel Tetaz
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation; Grenoble University Hospital; Grenoble France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
- TIMC-IMAG Laboratory; CNRS; UMR 5525; Grenoble France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation; Grenoble University Hospital; Grenoble France
- TIMC-IMAG Laboratory; CNRS; UMR 5525; Grenoble France
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Bey E, Gaget O, Descotes JL, Franquet Q, Rambeaud JJ, Long JA, Fiard G. Transrectal ultrasound-guided prostate biopsies vs. magnetic resonance imaging ultrasound fusion targeted biopsies: Who are the best candidates? Can Urol Assoc J 2018; 12:E10-E14. [PMID: 29173269 PMCID: PMC5783701 DOI: 10.5489/cuaj.4571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to compare the results of ultrasound-guided prostate biopsies (US-PB) and magnetic resonance imaging-ultrasound fusion biopsies (MRI-PB) in two contemporary cohorts and to describe the parameters orienting the choice of technique. METHODS Two contemporary cohorts of patients undergoing US-PB or MR-PB using the Urostation® (Koelis, Grenoble, France) between November 2010 and July 2015 were analyzed retrospectively. Patients with metastatic cancer or recurrence after treatment, saturation biopsies, and US-PB performed after a negative MRI were excluded. Comparison of populations, biopsy results, and clinical and biological parameters guiding the choice of technique were studied on multivariate analysis (logistic regression) taking into account the following confounding factors: age, prostate-specific antigen (PSA) rate, prostatic volume, number of previous biopsies, and abnormal digital rectal examination. RESULTS One hundred fourteen patients were included in the US-PB group and 118 in the MR-PB group. Prostate cancer was diagnosed among 65 patients in the US-PB group (detection rate 57.0%) and 70 patients in the MR-PB group (detection rate 59.3%) (odds ratio [OR] 3.00; 95% confidence interval [CI] 1.52-6.17; p=0.002). Among the cancers diagnosed in the MR-PB group, 21 were diagnosed by the two targeted biopsy cores only (15.5%). Patients undergoing MR-PB were significantly younger (p=0.0005), with a higher number of previous biopsy sessions (p<10-7) and larger prostate volume (p=0.001). PSA rate alone (p=0.23) and digital rectal examination (p=0.48) did not significantly interfere with the choice of a technique. CONCLUSIONS Younger patients with larger prostates and prior negative biopsy were more likely to be offered the MR-PB technique. On multivariate analysis, the detection rate was higher in the MR-PB group.
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Affiliation(s)
- Elsa Bey
- Department of Urology, Grenoble University Hospital, France
| | - Olivier Gaget
- Department of Public Health, Grenoble University Hospital, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
| | | | - Jean-Jacques Rambeaud
- Department of Urology, Grenoble University Hospital, France
- Université Grenoble Alpes; Grenoble, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
- Université Grenoble Alpes; Grenoble, France
| | - Gaelle Fiard
- Department of Urology, Grenoble University Hospital, France
- CNRS, TIMC-IMAG, France
- Université Grenoble Alpes; Grenoble, France
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Roche Y, Pasquier D, Rambeaud JJ, Seigneurin D, Duperray A. Fibrinogen mediates bladder cancer cell migration in an ICAM-1-dependent pathway. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryFibrinogen (fg), present in tumor matrices, has been demonstrated to be determinant in metastatic potential. We have recently shown that fg/ICAM-1 interactions are involved in leukocyte migration across endothelial cell monolayers. Using bladder transitional cell carcinoma as a model, we will show in this study that bladder high grade tumor cell lines express ICAM-1, and that this expression induces an fg-mediated migration. This phenomenon was dependent on ICAM-1/fg interaction as well as RhoA activity. ICAM-1 was concentrated in focal adhesion plaques when tumor cells were allowed to adhere on immobilized fg, suggesting a role in cell migration. The addition of fg induced a 3- to 6-fold enhancement of bladder tumor cell migration through HUVEC monolayers. This process was inhibited by an anti-ICAM-1 antibody blocking fg binding, demonstrating that ICAM-1/fg interaction was involved in the extravasation process. Finally, immunohistological studies revealed that the expression of ICAM-1 was closely associated with an infiltrative histological phenotype.Part of this paper was originally presented as part of the joint meetings of the 16th International Congress of the International Society of Fibrinolysis and Proteolysis (ISFP) and the 17th International Fibrinogen Workshop of the International Fibrinogen Research Society (IFRS) held in Munich, Germany, September, 2002.
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Lanchon C, Fiard G, Arnoux V, Descotes JL, Rambeaud JJ, Terrier N, Boillot B, Thuillier C, Poncet D, Long JA. High Grade Blunt Renal Trauma: Predictors of Surgery and Long-Term Outcomes of Conservative Management. A Prospective Single Center Study. J Urol 2016; 195:106-11. [DOI: 10.1016/j.juro.2015.07.100] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Cecilia Lanchon
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Gaëlle Fiard
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Valentin Arnoux
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | | | - Nicolas Terrier
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Bernard Boillot
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | | | - Delphine Poncet
- Department of Urology, Grenoble University Hospital, Grenoble, France
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Pignot G, Salomon L, Neuzillet Y, Masson-Lecomte A, Lebacle C, Patard JJ, Lunardi P, Rischmann P, Pasticier G, Bernhard JC, Cohen J, Timsit MO, Verkarre V, Peyronnet B, Verhoest G, Le Goux C, Zerbib M, Brecheteau F, Bigot P, Larre S, Murez T, Thuret R, Lacarriere E, Champy C, Roupret M, Comperat E, Berger J, Descazeaud A, Toledano H, Bastide C, Lavilledieu S, Avances C, Delage F, Valeri A, Molimard B, Houlgatte A, Gres P, Donnaint A, Kleinclauss F, Legal S, Doerfler A, Koutlidis N, Cormier L, Hetet JF, Colls P, Arvin-Berod A, Rambeaud JJ, Quintens H, Soulie M, Pfister C. Clinicopathological Characteristics of Incidental Prostate Cancer Discovered from Radical Cystoprostatectomy Specimen: A Multicenter French Study. Ann Surg Oncol 2014; 21:684-690. [DOI: 10.1245/s10434-013-3340-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Sauvanaud C, Boillot B, Sergent F, Long JA, Pernod G, Rambeaud JJ. [Pyelovenous fistula revealed by repeated thromboembolic events after emergency peripartum hysterectomy]. ACTA ACUST UNITED AC 2014; 42:258-60. [PMID: 24394325 DOI: 10.1016/j.gyobfe.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/14/2013] [Indexed: 11/15/2022]
Abstract
We report the case of a 51-year old woman presenting pyelovenous fistula revealed by recurrent and serious thromboembolic events after ureteral ligation during emergency peripartum hysterectomy. Imaging reported a complete left ureteral obstruction, a fistula between the upper calix and the left renal vein and a renal function preserved. Uretero-vesical reimplantation was performed. The patient was well doing after 12 months. The authors wonder if pyelovenous fistula is responsible for prothrombotic state and maintaining renal function.
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Affiliation(s)
- C Sauvanaud
- Service d'urologie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - B Boillot
- Service d'urologie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France.
| | - J A Long
- Service d'urologie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France
| | - G Pernod
- Service de médecine vasculaire, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France
| | - J J Rambeaud
- Service d'urologie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France
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Arnoux V, Descotes JL, Fiard G, Terrier N, Boillot B, Thuillier C, Rambeaud JJ, Long JA. [The use of haemostatic agent: impact on perioperative outcomes of partial nephrectomy]. Prog Urol 2013; 23:317-22. [PMID: 23545006 DOI: 10.1016/j.purol.2012.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 06/29/2012] [Accepted: 10/22/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate impact of the use of haemostatic agent in partial nephrectomy on perioperative outcomes. MATERIAL AND METHODS We reviewed the files of patients candidates for partial nephrectomy in our center between 2005 and 2010. The use of haemostatic agent and surgical procedure data were noted. Perioperative outcomes in haemostatic agent group were compared with perioperative outcomes in conventional surgical haemostasis group. RESULTS Among the 131 patients included, haemostatic agent was used in 91 cases (69.5%). There was no statistically difference between the two groups on age, sex, BMI, ASA score, tumor size and RENAL score. The use of haemostatic agent was more frequent for patients operated with laparoscopy (10.7%, P=0.04). Concerning perioperative outcomes, there was no difference between the two groups on surgical complications, transfusions, conversion to radical nephrectomy and hospital stay. Median warm ischaemia time was comparable into the two groups. In multivariate analysis, haemorrhage, complications and transfusions were not predicted by the use of haemostatic agent. CONCLUSION Use of haemostatic agent in partial nephrectomy had no benefice on perioperative outcomes in our series. Rapport between utility and cost for these agents must be discussed in partial nephrectomy.
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Affiliation(s)
- V Arnoux
- Service d'urologie et transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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Long JA, Fiard G, Descotes JL, Skowron O, Arnoux V, Rambeaud JJ. 13 HIGH GRADE RENAL INJURY: NON OPERATIVE MANAGEMENT OF URINARY EXTRAVASATION AND PREDICTION OF LONG-TERM OUTCOMES. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fiard G, Hohn N, Descotes JL, Rambeaud JJ, Troccaz J, Long JA. Targeted MRI-guided prostate biopsies for the detection of prostate cancer: initial clinical experience with real-time 3-dimensional transrectal ultrasound guidance and magnetic resonance/transrectal ultrasound image fusion. Urology 2013; 81:1372-8. [PMID: 23540865 DOI: 10.1016/j.urology.2013.02.022] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/29/2013] [Accepted: 02/15/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To prove the feasibility and evaluate the initial clinical results of targeted prostate biopsies using the Urostation novel platform using magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) registration to help steer the biopsy needle to suspicious areas. METHODS We prospectively included 30 patients for suspicion of prostate cancer from November 2011 to August 2012. All patients were previously evaluated by a multiparametric MRI, interpreted by a single radiologist who attributed a Prostate Imaging-Reporting and Data System (PI-RADS) score to each lesion. A conventional 12-core randomized biopsy protocol was performed and 2 additional targeted biopsies were performed on suspicious area(s). The results of randomized and targeted biopsies were compared. RESULTS Among the 30 patients, suspicious area(s) were found on MRI in 20 cases (67%). Median procedure time was 23 minutes. Targeting success rate (biopsy visualized inside the target) was 83%, with at least 1 biopsy reaching the target in all cases. Prostate cancer was detected in 14 cases (47%), including 11 cases with an abnormal MRI. Targeted biopsies detected cancer in all 11 cases and all but 1 were clinically significant. Randomized biopsies detected 10 of these 11 cases, and 3 more cases that MRI considered normal. Sensitivity to detect a significant cancer was 91% in both modalities. CONCLUSION This initial clinical study showed encouraging results for targeted MRI-guided prostate biopsies using MRI-TRUS fusion. Although further studies are needed to determine the role of prostate MRI before biopsy and the relevance of targeted biopsies, the Urostation is an MRI-TRUS fusion device that has good accuracy for targeting suspicious areas on MRI.
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Affiliation(s)
- Gaelle Fiard
- Urology Department, Grenoble University Hospital, Grenoble, France
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Long JA, Tostain J, Lanchon C, Voros S, Medici M, Descotes JL, Troccaz J, Cinquin P, Rambeaud JJ, Moreau-Gaudry A. First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder. J Endourol 2013; 27:58-63. [DOI: 10.1089/end.2012.0357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Jacques Tostain
- Department of Urology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Cecilia Lanchon
- Urology Department, Grenoble University Hospital, Grenoble, France
| | | | - Maud Medici
- Clinical Investigation Center, Grenoble University Hospital, Grenoble, France
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Long JA, Fiard G, Descotes JL, Arnoux V, Arvin-Berod A, Terrier N, Boillot B, Skowron O, Thuillier C, Rambeaud JJ. High-grade renal injury: non-operative management of urinary extravasation and prediction of long-term outcomes. BJU Int 2012; 111:E249-55. [DOI: 10.1111/j.1464-410x.2012.11578.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Long JA, Hungr N, Baumann M, Descotes JL, Bolla M, Giraud JY, Rambeaud JJ, Troccaz J. Development of a novel robot for transperineal needle based interventions: focal therapy, brachytherapy and prostate biopsies. J Urol 2012; 188:1369-74. [PMID: 22906671 DOI: 10.1016/j.juro.2012.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Indexed: 01/25/2023]
Abstract
PURPOSE We report what is to our knowledge the initial experience with a new 3-dimensional ultrasound robotic system for prostate brachytherapy assistance, focal therapy and prostate biopsies. Its ability to track prostate motion intraoperatively allows it to manage motions and guide needles to predefined targets. MATERIALS AND METHODS A robotic system was created for transrectal ultrasound guided needle implantation combined with intraoperative prostate tracking. Experiments were done on 90 targets embedded in a total of 9 mobile, deformable, synthetic prostate phantoms. Experiments involved trying to insert glass beads as close as possible to targets in multimodal anthropomorphic imaging phantoms. Results were measured by segmenting the inserted beads in computerized tomography volumes of the phantoms. RESULTS The robot reached the chosen targets in phantoms with a median accuracy of 2.73 mm and a median prostate motion of 5.46 mm. Accuracy was better at the apex than at the base (2.28 vs 3.83 mm, p <0.001), and similar for horizontal and angled needle inclinations (2.7 vs 2.82 mm, p = 0.18). CONCLUSIONS To our knowledge this robot for prostate focal therapy, brachytherapy and targeted prostate biopsies is the first system to use intraoperative prostate motion tracking to guide needles into the prostate. Preliminary experiments show its ability to reach targets despite prostate motion.
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Long JA, Arnoux V, Fiard G, Autorino R, Descotes JL, Rambeaud JJ, Boillot B, Terrier N, Arvin-Berod A, Moreau-Gaudry A. External validation of the RENAL nephrometry score in renal tumours treated by partial nephrectomy. BJU Int 2012; 111:233-9. [PMID: 22788546 DOI: 10.1111/j.1464-410x.2012.11339.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Valentin Arnoux
- Urology Department; Grenoble University Hospital; Grenoble; France
| | - Gaelle Fiard
- Urology Department; Grenoble University Hospital; Grenoble; France
| | | | | | | | - Bernard Boillot
- Urology Department; Grenoble University Hospital; Grenoble; France
| | - Nicolas Terrier
- Urology Department; Grenoble University Hospital; Grenoble; France
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Fiard G, Rambeaud JJ, Descotes JL, Boillot B, Terrier N, Thuillier C, Chodez M, Skowron O, Berod AA, Arnoux V, Long JA. Long-term renal function assessment with dimercapto-succinic acid scintigraphy after conservative treatment of major renal trauma. J Urol 2012; 187:1306-9. [PMID: 22341289 DOI: 10.1016/j.juro.2011.11.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE The management of high grade blunt renal injury has evolved with time to become increasingly conservative with the ultimate objective of renal preservation. We evaluated relative renal function with dimercapto-succinic acid renal scintigraphy 6 months after major renal trauma (grade IV or V). MATERIALS AND METHODS This prospective observational study was done between January 2004 and April 2010. All patients who presented with grade IV or V renal trauma and were treated conservatively were included in analysis. Patient and trauma characteristics, and initial management were recorded. Relative renal function was evaluated by dimercapto-succinic acid renal scintigraphy 6 months after trauma. RESULTS A total of 88 patients were included in the study. Conservative management was possible in 79 patients (90%), including 69 and 10 with grade IV and V trauma, respectively. Dimercapto-succinic acid renal scintigraphy was done at 6 months for 22 patients (28%). Mean relative renal function for grade IV and V injuries was 39% and 11%, respectively (p=0.0041). The percent of devascularized parenchyma (p=0.0033) and the vascular subtype of grade IV injuries (p=0.0194) also correlated with decreased renal function. No complication or de novo arterial hypertension was noted. CONCLUSIONS Conservative treatment achieves the objective of renal function preservation for grade IV lesions. Grade V and specific subtypes of grade IV injury have a poor functional outcome. Further study must be performed to determine which patients will benefit from conservative treatment vs early nephrectomy to avoid a longer hospital stay and useless procedures.
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Affiliation(s)
- Gaelle Fiard
- Department of Urology, Grenoble University Hospital, Grenoble, France
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Seigneurin D, Rambeaud JJ, Louis J. PROGNOSIS SIGNIFICANCE OF IMAGE CYTOMETRY IN NON INVASIVE BLADDER CANCER. Biol Cell 2012. [DOI: 10.1016/0248-4900(93)90204-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fiard G, Long JA, Terrier N, Thuillier C, Chodez M, Arvin-Berod A, Arnoux V, Descotes JL, Rambeaud JJ. 100 RESULTS AND RENAL FUNCTION SIX MONTHS AFTER CONSERVATIVE TREATMENT OF SEVERE GRADE IV AND V BLUNT RENAL TRAUMA: A PROSPECTIVE EVALUATION. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jeldres C, Bensalah K, Capitanio U, Zini L, Perrotte P, Suardi N, Tostain J, Valeri A, Descotes JL, Rambeaud JJ, de La Taille A, Salomon L, Abbou C, Patard JJ, Karakiewicz PI. Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy. BJU Int 2009; 103:1632-5. [DOI: 10.1111/j.1464-410x.2008.08258.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karakiewicz PI, Suardi N, Capitanio U, Jeldres C, Ficarra V, Cindolo L, de la Taille A, Tostain J, Mulders PFA, Bensalah K, Artibani W, Salomon L, Zigeuner R, Valéri A, Descotes JL, Rambeaud JJ, Méjean A, Montorsi F, Bertini R, Patard JJ. A preoperative prognostic model for patients treated with nephrectomy for renal cell carcinoma. Eur Urol 2008; 55:287-95. [PMID: 18715700 DOI: 10.1016/j.eururo.2008.07.037] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Currently two pretreatment prognostic models with limited accuracy (65-67%) can be used to predict survival in patients with localized renal cell carcinoma (RCC). OBJECTIVE We set out to develop a more accurate pretreatment model for predicting RCC-specific mortality after nephrectomy for all stages of RCC. DESIGN, SETTING, AND PARTICIPANTS The data originated from a series of prospectively recorded contemporary cases of patients treated with radical or partial nephrectomy between 1984 and 2006. Model development was performed using data from 2474 patients from five centers and external validation was performed using data from 1972 patients from seven centers. MEASUREMENTS The probability of RCC-specific mortality was modeled using Cox regression. The significance of the predictors was confirmed using competing risks analyses, which account for mortality from other causes. RESULTS AND LIMITATIONS Median follow-up in patients who did not die of RCC-specific causes was 4.2 yr and 3.5 yr in the development and validation cohorts, respectively. The freedom from cancer-specific mortality rates in the nomogram development cohort were 75.4% at 5 yr after nephrectomy and 68.3% at 10 yr after nephrectomy. All variables except gender achieved independent predictor status. In the external validation cohort the nomogram predictions were 88.1% accurate at 1 yr, 86.8% accurate at 2 yr, 86.8% accurate at 5 yr, and 84.2% accurate at 10 yr. CONCLUSIONS Our model substantially exceeds the accuracy of the existing pretreatment models. Consequently, the proposed nomogram-based predictions may be used as benchmark data for pretreatment decision making in patients with various stages of RCC.
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Affiliation(s)
- Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
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Long JA, Cinquin P, Troccaz J, Voros S, Berkelman P, Descotes JL, Letoublon C, Rambeaud JJ. Development of miniaturized light endoscope-holder robot for laparoscopic surgery. J Endourol 2007; 21:911-4. [PMID: 17867952 DOI: 10.1089/end.2006.0328] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We have conducted experiments with an innovatively designed robot endoscope holder for laparoscopic surgery that is small and low cost. MATERIALS AND METHODS A compact light endoscope robot (LER) that is placed on the patient's skin and can be used with the patient in the lateral or dorsal supine position was tested on cadavers and laboratory pigs in order to allow successive modifications. The current control system is based on voice recognition. The range of vision is 360 degrees with an angle of 160 degrees . Twenty-three procedures were performed. RESULTS The tests made it possible to advance the prototype on a variety of aspects, including reliability, steadiness, ergonomics, and dimensions. The ease of installation of the robot, which takes only 5 minutes, and the easy handling made it possible for 21 of the 23 procedures to be performed without an assistant. CONCLUSION The LER is a camera holder guided by the surgeon's voice that can eliminate the need for an assistant during laparoscopic surgery. The ease of installation and manufacture should make it an effective and inexpensive system for use on patients in the lateral and dorsal supine positions. Randomized clinical trials will soon validate a new version of this robot prior to marketing.
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Hutterer GC, Patard JJ, Perrotte P, Ionescu C, de La Taille A, Salomon L, Verhoest G, Tostain J, Cindolo L, Ficarra V, Artibani W, Schips L, Zigeuner R, Mulders PF, Valeri A, Chautard D, Descotes JL, Rambeaud JJ, Mejean A, Karakiewicz PI. Patients with renal cell carcinoma nodal metastases can be accurately identified: external validation of a new nomogram. Int J Cancer 2007; 121:2556-61. [PMID: 17691107 DOI: 10.1002/ijc.23010] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Outcome of patients with renal cell carcinoma nodal metastases (NM) is substantially worse than that of patients with localized disease. This justifies more thorough staging and possibly more aggressive treatment in those at risk of or with established NM. We developed and externally validated a nomogram capable of highly accurately predicting renal cell carcinoma NM in patients without radiographic evidence of distant metastases. Age, symptom classification, tumour size and the pathological nodal stage were available for 4,658 individuals. The data of 2,522 (54.1%) individuals from 7 centers were used to develop a multivariable logistic regression model-based nomogram predicting the individual probability of NM. The remaining data from 2,136 (45.9%) patients from 5 institutions were used for external validation. In the development cohort, 107/2,522 (4.2%) had lymph node metastases vs. 100/2,136 (4.7%) in the external validation cohort. Symptom classification and tumour size were independent predictors of NM in the development cohort. Age failed to reach independent predictor status, but added to discriminant properties of the model. A nomogram based on age, symptom classification and tumour size was 78.4% accurate in predicting the individual probability of NM in the external validation cohort. Our nomogram can contribute to the identification of patients at low risk of NM. This tool can help to risk adjust the need and the extent of nodal staging in patients without known distant metastases. More thorough staging can hopefully better select those in whom adjuvant treatment is necessary. (c) 2007 Wiley-Liss, Inc.
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Affiliation(s)
- Georg C Hutterer
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
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Long JA, Daanen V, Moreau-Gaudry A, Troccaz J, Rambeaud JJ, Descotes JL. Biopsies prostatiques sous guidage échographique 3 dimensions et temps réel (4D) sur fantôme. Etude comparative contre guidage 2D. Prog Urol 2007; 17:1337-42. [DOI: 10.1016/s1166-7087(07)78573-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Terrier N, Long JA, Cadi P, Thuillez C, Bayle F, Descotes JL, Rambeaud JJ. Prélèvement d’organe en vue de la transplantation : évaluation de la charge de travail. A propos de 390 prélèvements. Prog Urol 2007; 17:973-7. [DOI: 10.1016/s1166-7087(07)92400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yves B, de la Taille A, Chartier-Kastler E, Moreau JL, Davin JL, Mignard JP, Coulange C, Allegre JP, Averous M, Botto H, Coloby P, Conort P, Delmas V, Desgrandchamps F, Fourcade RO, Grall J, Grise P, Kouri G, Le Doze H, Piechaud T, Prunet D, Rambeaud JJ, Rebillard X, Soulie M, Vignes B, Villers A. [The prostate: how to treat this symbol of male vulnerability? An Association Française d'Urologie (AFU)-IPSOS qualitative survey]. Prog Urol 2007; 17:199-202. [PMID: 17489318 DOI: 10.1016/s1166-7087(07)92263-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Information on prostate diseases, including prostate cancer, has been promoted by the Association Française d'Urologie (AFU) for several years, but is developing slowly in France. In 2005, a first communication was targeted to the male public and identified the reasons for the fatalistic attitude of men, and paradoxically, why the prostate incarnates the vulnerability of their sexual capital. As part of a second phase, this article presents the results of a complementary study conducted among general practitioners to identify their expectations and the most appropriate levers to promote screening. MATERIAL AND METHOD The Ipsos survey company developed a Krisis qualitative protocol in October 2005 (after the first French prostate day on 15 September 2005). Three groups of general practitioners were defined: doctors who are very active in terms of screening, doctors who are uncomfortable with this problem and doctors who systematically refer their patients to urologists. RESULTS The management of prostate diseases often highlights the ageing process for the patient. The ability to discuss these problems during the consultation depended on the doctor's degree of comfort with this subject, which is related to his/her training and relationships with urologists. To initiate the question of screening, general practitioners involved in this process asked simple questions about everyday practices without being afraid of making jokes or basing their approach on mediatization of the disease. Digital rectal examination is one of the important clinical elements but is not always easy to perform. PSA was found to be an examination that is not always appropriate, characterized by a lack of information on the conditions for ordering this test, its usefulness and its relevance for screening. Ultrasound could be a way of alerting the patient without dramatizing the situation, letting the urologist perform digital rectal examination. Female general practitioners preferred PSA and ultrasound. The doctors surveyed relied on mediatization of prostate diseases, a high level of interactivity with urologists and documents and brochures to be placed in waiting rooms to relay screening messages. CONCLUSION General practitioners need their authorities, specialists and public health institutions to develop and mediatize andrology in the same way as gynaecology. Urologists play a major supportive role by means of conferences, postgraduate training or AFU invitations.
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Taccoen X, Valeri A, Descotes JL, Morin V, Stindel E, Doucet L, Joulin V, Bocqueraz F, Coulange C, Rambeaud JJ, Fournier G, Mejean A. Renal Cell Carcinoma in Adults 40 Years Old or Less: Young Age is an Independent Prognostic Factor for Cancer-Specific Survival. Eur Urol 2007; 51:980-7. [PMID: 17092632 DOI: 10.1016/j.eururo.2006.10.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 10/16/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as </=40 yr old, compared to RCC in older patients. METHODS Between 1988 and 2000, 1233 patients, 93 under 40 yr old and 1140 older (mean ages, 34.2 and 61.9 years, respectively) underwent surgery for RCC in four teaching hospitals. Clinical and biologic parameters at diagnosis were compared and subjected to univariate and multivariate analyses to study survival. Mean follow-up was 4.5 yr for young and 4.1 yr for older patients. RESULTS When comparing younger to older patients, respectively, they had a lower male-to-female ratio (1.2 vs. 2.5), lower stage (84.9% vs. 67.4% pT1-pT2N0M0; p=0.001), and fewer clear-cell carcinomas (73.1% vs. 82%), but more papillary carcinomas (20.4% vs. 11.4%; p=0.01) and better 5-yr cancer-specific survival rates (90.8% vs. 78.3%; p=0.005). Independent prognostic factors for survival, in the order of decreasing impact, were tumor stage (p<0.0001), Fuhrman nuclear grade (p<0.0001), and age </=40 yr at diagnosis (risk ratio 0.4, p<0.047). Young patients tended to have a better 5-yr progression-free survival (80.5% vs. 70.7%; p=0.05). CONCLUSIONS RCC in young adults was more often localised at diagnosis and had a better prognosis than the disease in older subjects. Age under 40 yr old was an independent prognostic factor for survival.
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Affiliation(s)
- Xavier Taccoen
- Service d'Urologie, Centre Hospitalier et Universitaire, 29609 Brest Cedex, France
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Long JA, Descotes JL, Rambeaud JJ. [Kidney cancer diagnosis]. Rev Prat 2007; 57:603-12. [PMID: 17593784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Currently, kidney cancer is in most cases fortuitously diagnosed by ultrasound or abdominal computed tomography, performed for non-specific clinical signs. The late-developing clinical signs are suggestive of an advanced tumour stage. Abdominal computed tomography is the key examination; it enables to establish the diagnosis and assess tumour extension. Performing a tumour biopsy is useful in patients with small tumours, when diagnostic certainty is required or when metastases or a lymphoma are suspected.
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Affiliation(s)
- Jean-Alexandre Long
- Service d'urologie et de la transplantation rénale, CHU Michallon, 38043 Grenoble 9.
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Descotes JL, Legeais D, Gauchez AS, Long JA, Rambeaud JJ. PSA measurement following prostatectomy: an unexpected error. Anticancer Res 2007; 27:1149-50. [PMID: 17465255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
An unexpected and exceptional observation was made during the biological follow-up of a patient who had undergone a radical prostatectomy for a prostate adenocarcinoma. A residual PSA level was first considered as a reliable marker of relapse. Certain limits are highlighted concerning the reliability of the PSA assay, which must be interpreted along with all the other prognostic information on the tumor and possibly verified using other biological techniques.
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Affiliation(s)
- Jean-Luc Descotes
- Service de Chirurgie Urologique et de Transplantation Rénale, CHU de Grenoble, 38043 Grenoble 9, France
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Karakiewicz PI, Trinh QD, Rioux-Leclercq N, de la Taille A, Novara G, Tostain J, Cindolo L, Ficarra V, Artibani W, Schips L, Zigeuner R, Mulders PF, Lechevallier E, Coulange C, Valeri A, Descotes JL, Rambeaud JJ, Abbou CC, Lang H, Jacqmin D, Mejean A, Patard JJ. Collecting duct renal cell carcinoma: a matched analysis of 41 cases. Eur Urol 2007; 52:1140-5. [PMID: 17336449 DOI: 10.1016/j.eururo.2007.01.070] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 01/22/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Collecting duct renal cell carcinoma (CDRCC) is a rare but reportedly aggressive histologic subtype. We assessed the stage and histologic features of patients with CDRCC and compared cancer-specific mortality in CDRCC and matched patients with clear-cell renal cell carcinoma (CRCC). METHODS Forty-one (0.6%) patients with CDRCC and 5246 CRCC patients were identified within a cohort of 6608 patients treated with either radical or partial nephrectomy for renal cancer. Within the 5246 CRCC cases, 105 were matched with CDRCC cases for grade, tumour size, and T, N, and M stages. Kaplan-Meier and life table analyses addressed RCC-specific survival. RESULTS Of all CDRCC patients, 76% had pT3 disease at nephrectomy versus 37% for those with CRCC. The predominant Fuhrman grades were III (56%) and IV (22%) in CDRCC versus II (42%) and III (28%) for CRCC. Moreover, 49% of CDRCC patients were pN1-2 versus 8% for CRCC. Of CDRCC patients 19% had distant metastases at nephrectomy versus 14% for CRCC. Finally, 73% of CDRCC patients had either local or systemic symptoms versus 56% for CRCC. After matching, the RCC-specific mortality of CDRCC patients was no different from that for CRCC patients (RR=1.1; p=0.8). One- and 5-yr CDRCC-specific survival rates were 86% and 48%, respectively, versus 86% and 57% for matched CRCC controls. CONCLUSIONS CDRCC patients present with more advanced stage and with more aggressive disease compared with CRCC patients. After nephrectomy, when CDRCC cases were matched with CRCC, the same cause-specific survival was seen.
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Affiliation(s)
- Pierre I Karakiewicz
- Cancer Prognostics and Health Outcome Unit, University of Montreal Health Centre, Montreal, QC, Canada.
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Long JA, Daanen V, Moreau-Gaudry A, Troccaz J, Rambeaud JJ, Descotes JL. Prostate biopsies guided by three-dimensional real-time (4-D) transrectal ultrasonography on a phantom: comparative study versus two-dimensional transrectal ultrasound-guided biopsies. Eur Urol 2006; 52:1097-104. [PMID: 17141944 DOI: 10.1016/j.eururo.2006.11.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/14/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the accuracy in localisation and distribution of real-time three-dimensional (4-D) ultrasound-guided biopsies on a prostate phantom. METHODS A prostate phantom was created. A three-dimensional real-time ultrasound system with a 5.9MHz probe was used, making it possible to see several reconstructed orthogonal viewing planes in real time. Fourteen operators performed biopsies first under 2-D then 4-D transurethral ultrasound (TRUS) guidance (336 biopsies). The biopsy path was modelled using segmentation in a 3-D ultrasonographic volume. Special software was used to visualise the biopsy paths in a reference prostate and assess the sampled area. A comparative study was performed to examine the accuracy of the entry points and target of the needle. Distribution was assessed by measuring the volume sampled and a redundancy ratio of the sampled prostate. RESULTS A significant increase in accuracy in hitting the target zone was identified using 4-D ultrasonography as compared to 2-D. There was no increase in the sampled volume or improvement in the biopsy distribution with 4-D ultrasonography as compared to 2-D. CONCLUSION The 4-D TRUS guidance appears to show, on a synthetic model, an improvement in location accuracy and in the ability to reproduce a protocol. The biopsy distribution does not seem improved.
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Affiliation(s)
- Jean-Alexandre Long
- Urological Surgery and Renal Transplantation Unit, Grenoble University Hospital Centre, Grenoble, France.
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Long JA, Cinquin P, Troccaz J, Rambeaud JJ, Skowron O, Berkelman P, Letoublon C, Cadi P, Bocqueraz F, Voros S, Descotes JL. [Preclinical development of the TIMC LER (light endoscope robot)]. Prog Urol 2006; 16:45-51. [PMID: 16526539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION The authors participated in the development of an innovative endoscope robot in laparoscopic surgery designed by TIMC-GMCAO, providing a solution to the disadvantages of currently available systems, i.e. their cost and large dimensions. MATERIAL AND METHODS A compact robot (LER) placed on the patient's skin that can be used in the lateral and dorsal supine position was tested on cadavres and laboratory pigs in order to allow successive modifications. The current control system is based on voice recognition. The amplitude of vision is 360 degrees with an angle of 160 degrees. Twenty three procedures were performed (2 radical prostatectomies, 4 pelvic lymph node dissections, 6 nephrectomies, 2 adrenalectomies, 3 cholecystectomies, 1 small bowel resection-anastomosis, 1 cystectomy, 1 splenectomy, and 3 appendicectomies). RESULTS Among the various control systems tested, we adopted voice recognition on the basis of its intuitive nature and the fact that it leaves one hand free. In the light of these studies, several aspects of the prototype were modified: reliability, fixation, ergonomy and dimensions. The ease of installation, which takes only 5 minutes, and the easy handling of the robot allowed 21 out of 23 laparoscopic procedures to be performed without the need for an assistant. CONCLUSION The LER robot is an endoscope robot guided by the surgeon's voice that can eliminate the need for an assistant to hold the camera during laparoscopic surgery in the lateral and dorsal supine positions. The ease of installation and manufacture should make this an effective and inexpensive system. The gain in operating time was not evaluated during these trials on cadavres and pigs, as various prototypes were tested and several problems of reliability were successively resolved. Ongoing randomized, prospective clinical trials should soon validate this robot prior to marketing.
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Affiliation(s)
- Jean-Alexandre Long
- Service de Chirurgie Urologique et de la Transplantation rénale, CHU de Grenoble, France.
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Long JA, Descotes JL, Skowron O, Troccaz J, Cinquin P, Boillot B, Terrier N, Rambeaud JJ. [Use of robotics in laparoscopic urological surgery: state of the art]. Prog Urol 2006; 16:3-11. [PMID: 16526532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To evaluate the current place of robotics in laparoscopic urological surgery. MATERIAL AND METHODS A review of the international literature was conducted to evaluate the various available endoscope robot systems and telemanipulator robots and to establish their practical limitations and their contribution to surgery. RESULTS Robotic systems are based on various structures, which each present specific disadvantages. Two types of systems can be distinguished: endoscope robots and telemanipulator robots (complete robotic systems) with different degrees of complexity, dimensions and costs. Each system is different in terms of service rendered. Endoscope robot systems (EndoAssist, AESOP, LapMan) are reliable and eliminate the need for an assistant to hold the camera. Man-machine interfaces can be manual, by pedal or by voice recognition. They are relatively large and expensive, limiting their diffusion at the present time. Complete instrument-handling robots (master-slave manipulators) are currently represented by 2 robots (Zeus and Da Vinci) which have demonstrated their efficacy in many difficult operations. Their very high cost and their large dimensions also constitute limitations to their diffusion, making them inaccessible to the majority of centres. The urological community has largely contributed to the evaluation of robots in laparoscopic operations, as reflected by the large number of publications. CONCLUSION Considerable technological progress has been made over recent years to make laparoscopic surgery more accessible. Current robotized tools are still imperfect systems, but, in the future, may possibly facilitate difficult laparoscopic operations, particularly in urology.
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Affiliation(s)
- Jean-Alexandre Long
- Service de Chirurgie urologique et de la Transplantation rénale, CHU de Grenoble, France.
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Terrier N, Long JA, Bocqueraz F, Cadi P, Boillot B, Bayle F, Descotes JL, Rambeaud JJ. [Surgical complications of renal transplantations: incidence and prognostic factors]. Prog Urol 2005; 15:1271-85. [PMID: 16734217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Nicolas Terrier
- Service de chirurgie urologique et de la transplantation rénale, CHU Grenoble, France
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Saidi A, Bocqueraz F, Descotes JL, Cadi P, Terrier N, Boillot B, Rambeaud JJ. [Blunt kidney trauma: a ten-year experience]. Prog Urol 2004; 14:1125-31. [PMID: 15751405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE The objective of this study is to assess the results of our therapeutic management of blunt kidney trauma in patients hospitalised over the last 10 years. MATERIALS AND METHODS From January 1993 to January 2003, 105 patients were hospitalised in our department for blunt kidney trauma. We retrospectively studied age, gender, injured side, mechanism of trauma (direct, indirect or deceleration), aetiology, presence of associated lesions (visceral, orthopaedic), and clinical and laboratory signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine). The grade of the lesions was defined by radiological assessment, specifying the presence or absence of devascularized fragments and urine extravasation. All complications were noted and studied according to the initial therapeutic management and grade. Follow-up was clinical (BP and search for renal pain) and radiological (CT and/or DMSA scan). RESULTS 105 cases of blunt trauma of the kidney were hospitalised between January 1993 and January 2003 in our department. The mean age of the patients was 28.7 years (range: 7-75 years). Trauma was classified into 5 grades on the basis of the radiological assessment according to the ASST (American Society of Surgery of Trauma): 51 (49%) cases of grade 1 (n = 26) and grade 2 (n = 25) trauma, and 54 (51%) cases of major grade 3 to 5 trauma: 17 grade 3 (16%), 28 grade 4 (27%) and 9 grade 5 (8%) were diagnosed. Among the cases of major trauma, 7 (13%) were operated urgently during the first 24 hours: 4 cases of grade 5 trauma with renal artery dissection and 3 cases of grade 4 trauma with immediate uncontrolled bleeding. The nephrectomy rate (partial and total), when major renal trauma (grade 3, 4 and 5) (n = 47) was managed conservatively was 23% (11 nephrectomies) with the loss of 9.5 renal units (20%); this rate was 57% for grade 4 trauma presenting urine extravasation and devascularized fragments (n = 14). Twelve patients (7 with grade 4 trauma and 5 with grade 3 trauma) were reviewed by DMSA scintigraphy with a mean follow-up of 63 months (range: 26-108 months). Traumatized kidneys presented a mean function of 41.8% (range: 26.4-50%). CONCLUSION Blunt kidney trauma is usually managed conservatively. The development of interventional radiology, endourological drainage techniques and medical intensive care helps to maintain this attitude by decreasing the need for surgery, even in the most severe trauma.
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Affiliation(s)
- Abdelkader Saidi
- Service d'Urologie et de la Transplantation rénale, Centre Hospitalier et Universitaire de Grenoble, France.
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Long JA, Manel A, Moalic R, Pellat JM, Boillot B, Descotes JL, Rambeaud JJ. [Use of MEOPA (nitrogen monoxide-oxygen mixture) as analgesic for prostate biopsies]. Prog Urol 2004; 14:1167-70. [PMID: 15751411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine the tolerance of prostate biopsies in the case of co-administration of an analgesic gas composed of a ready for use mixture of nitrogen monoxide and oxygen (MEOPA) (marketed under the trade name of Kalinox), and intrarectal instillation of xylocaine gel by comparing the results with those obtained in a control group only receiving intrarectal xylocaine instillation. MATERIAL AND METHODS Non-randomized, prospective study conducted on 100 cases, with a control group composed of the first 22 patients (before availability of MEOPA in the department), followed by 78 patients treated with MEOPA. A questionnaire was completed by the patient and by the outpatient nurse caring for the patient. RESULTS A very significant reduction (p=0.003) of the VAS pain score (from 3.86 to 2.38) and a highly significant improvement (p<0.001) of global tolerance of the procedure based on the nurse's estimation of pain (VAS scale) were observed. The MEOPA group also presented a significant improvement of pain in patients who had previously undergone a series of prostate biopsies (p=0.043). The satisfaction rate was higher in patients receiving MEOPA, although 28.2% of patients experienced adverse effects, all minor and bothersome in only 3.81% of cases. CONCLUSION The MEOPA analgesic method as a complement to intrarectal xylocaine instillation considerably improved tolerance of the procedure with no major adverse effects and without prolonging the procedure or the surveillance. It is simple to use, safe and effective.
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Affiliation(s)
- Jean-Alexandre Long
- Service de Chirurgie Urologique et de la Transplantation rénale, CHU de Grenoble, France.
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Coulange C, Rambeaud JJ, Jacqmin D, Cohen E, Amiel J. [Kidney cancer in adults]. Rev Med Suisse Romande 2004; 124:669-74. [PMID: 15631161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Saidi A, Descotes JL, Sengel C, Terrier N, Manel A, Moalic R, Boillot B, Rambeaud JJ. [Management of blunt trauma of the kidney]. Prog Urol 2004; 14:461-71. [PMID: 15776893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The current management of blunt trauma of the kidney is based on the 5-grade classification of lesions established by the ASST (American Society of the Surgery of Trauma). The indications for imaging are now clearly defined and spiral CT represents the reference examination. Over the last decade, the debate concerning the management of severe trauma has divided the supporters of surgical treatment from those who recommended conservative management. The contribution of interventional radiology and endourological treatments and the efficacy of intensive care now limit the complications related to trauma and reduce the need for surgery. However, the morbidity related to trauma is considerable in the presence of fragments of devascularized renal parenchyma, urine extravasation and associated lesions. These complications can be anticipated by a better definition of the traumatic lesions. The American classification presents certain limitations in relation to these combinations of poor prognostic factors. This review was designed to define the most recent biomechanical considerations, the place of imaging and finally the indications and results of management of blunt trauma of the kidney, in the light of the data of the literature.
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Affiliation(s)
- Abdelkader Saidi
- Service d'Urologie et de la Transplantation renale, Centre Hospitalierm Universitaire de Grenoble, France
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Teillac P, Rozet F, Terrier N, Mongiat-Artus P, Rambeaud JJ. [Value of a visual analogue scale for evaluation of the severity of symptoms of benign prostatic hyperplasia (BPH). Pilot study in two urology centres]. Prog Urol 2004; 14:493-500; discussion 499. [PMID: 15776898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE One half of French patients over the age of 50 with BPH are not diagnosed. Real difficulties are also currently encountered in the use of the I-PSS in general practice. In this context, the objective of this pilot study was to evaluate the concordance between the I-PSS score and a visual analogue scale (VAS), proposed as a new, precise and easy to use aid to the diagnosis of BPH. PATIENTS AND METHODS Sixty five patients (mean age: 66 +/- 9 years, mean I-PSS: 13.6 +/- 7.0) recruited by two urology departments quantified their urinary symptoms by answering the question "How much difficulty do you have problems to urinate?": 7 patients used a 10 cm and a 35 cm VAS, 30 patients used a 15 cm VAS and 28 patients used a 20 cm VAS. All patients also completed the self-administered I-PSS questionnaire. RESULTS The VAS scores were independent the patient's age. The 4 classes of I-PSS severity were also represented in the VAS groups (p=0.999). The strongest correlation with the I-PSS score was observed with the 20 cm VAS (R=0.91, p<0.0001). This coefficient was 0.26, 0.67 and 0.72 for the 10 cm, 15 cm and 35 cm VAS, respectively. A very close correlation was observed between the evaluation on the 20 cm VAS and the classes of the I-PSS score. Finally, the relationship between the I-PSS subscores and the 20 cm VAS was statistically significant (p<0.0001) with high correlation coefficients (R=0.75 and R=0.87 for irritative and obstructive symptoms, respectively). This VAS did not appear to favour one type of symptoms over another. CONCLUSION This pilot study on a small number of patients showed that a 20 cm VAS can constitute a simple and precise aid to the detection of BPH. These results must now be validated by a large-scale study, under real general practice conditions.
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Long JA, Manel A, Penillon S, Badet L, Sessa C, Descotes JL, Sengel C, Rambeaud JJ. [Traumatic dissection of the renal pedicle. Modalities of management in adults and children]. Prog Urol 2004; 14:302-9; discussion 308. [PMID: 15373170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To evaluate the medium-term results of treatment for traumatic dissection of the renal arteries in a series of 12 cases and to propose emergency management based on recent endovascular revascularization techniques. MATERIAL AND METHODS Between January 1999 and July 2003, 12 patients were admitted for closed trauma of the renal artery. There were 11 dissections with thrombosis and 1 intimal flap without distal thrombosis. Six patients were revascularized surgically (3 reno-renal bypass grafts, 3 auto-transplantations), 4 patients were treated by an endovascular procedure and 2 patients were treated conservatively with simple surveillance. Renal function, renal artery patency and blood pressure were evaluated immediately and at 3 months by clinical examination, Doppler ultrasound of the renal artery or CT angiography, and renal scintigraphy. RESULTS In the group of 6 patients undergoing surgical revascularization (mean warm ischaemia time: 8 hours 30 minutes), 2 nephrectomies were performed (1 failure of revascularization, 1 sepsis in a non-functioning kidney). The other 4 patients presented negligible renal function on scintigraphy at 3 months despite patent renal arteries. Among the 4 patients undergoing endovascular revascularization (mean warm ischaemia time: 8 hours 50 minutes), 2 died from associated lesions and 2 had a non-functioning kidney (1 stent thrombosis, 1 silent kidney despite a patent renal artery). No cases of hypertension were observed regardless of the type of management. CONCLUSION Renal revascularization after thrombosis due to traumatic dissection of the renal artery must not be performed systematically after a warm ischaemia time of more than 4 hours in view of the poor recovery of renal function and the absence of morbidity associated with simple surveillance. When a procedure is performed, evaluation of the results must be based on morphological as well as functional parameters (scintigraphy).
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Affiliation(s)
- Jean-Alexandre Long
- Service de Chirurgie Urologique et de la Transplantation, CHU de Grenoble, France
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Long JA, Descotes JL, Terrier N, Faucheron JL, Pecher M, Francony G, Sengel C, Rambeaud JJ. [Endovascular aortic balloon catheter occlusion for severe renal trauma]. Prog Urol 2004; 14:394-7; discussion 397. [PMID: 15373184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Control of the renal vascular pedicle in a context of severe renal trauma in a haemodynamically unstable patient is difficult due to the large retroperitoneal haematoma. Laparotomy in these exsanguinated patients is associated with a risk of cardiac arrest due to hypovolaemia. The authors describe an endovascular aortic balloon catheter occlusion technique prior to laparotomy for haemostasis nephrectomy in a haemodynamically unstable patient presenting an abdominal compartment syndrome. In the light of this case, the authors discuss vascular control in the context of surgical management of severe renal trauma.
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Roche Y, Pasquier D, Rambeaud JJ, Seigneurin D, Duperray A. Fibrinogen mediates bladder cancer cell migration in an ICAM-1-dependent pathway. Thromb Haemost 2003; 89:1089-97. [PMID: 12783123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Fibrinogen (fg), present in tumor matrices, has been demonstrated to be determinant in metastatic potential. We have recently shown that fg/ICAM-1 interactions are involved in leukocyte migration across endothelial cell monolayers. Using bladder transitional cell carcinoma as a model, we will show in this study that bladder high grade tumor cell lines express ICAM-1, and that this expression induces an fg-mediated migration. This phenomenon was dependent on ICAM-1/fg interaction as well as RhoA activity. ICAM-1 was concentrated in focal adhesion plaques when tumor cells were allowed to adhere on immobilized fg, suggesting a role in cell migration. The addition of fg induced a 3- to 6-fold enhancement of bladder tumor cell migration through HUVEC monolayers. This process was inhibited by an anti-ICAM-1 antibody blocking fg binding, demonstrating that ICAM-1/fg interaction was involved in the extravasation process. Finally, immunohistological studies revealed that the expression of ICAM-1 was closely associated with an infiltrative histological phenotype.
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Affiliation(s)
- Yann Roche
- Unité INSERM 578, Institut Albert Bonniot, Grenoble, France
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Pfister C, Chautard D, Devonec M, Perrin P, Chopin D, Rischmann P, Bouchot O, Beurton D, Coulange C, Rambeaud JJ. Immunocyt test improves the diagnostic accuracy of urinary cytology: results of a French multicenter study. J Urol 2003; 169:921-4. [PMID: 12576813 DOI: 10.1097/01.ju.0000048983.83079.4c] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The limitations of urinary cytology and the invasiveness of cystoscopy generate an increasing interest in noninvasive diagnostic tools for the management of transitional cell carcinoma. We assess the clinical performance of ImmunoCyt (DiagnoCure, Inc., Saint-Foy, Canada) in the detection of bladder cancer in a 10-center French trial. MATERIALS AND METHODS From October 2000 to April 2001, 694 patients undergoing cystoscopy were prospectively included in the study. Of the patients 458 (66%) had been previously treated for superficial transitional cell carcinoma and 236 (34%) were referred for symptoms suggestive of bladder cancer. All patients underwent ImmunoCyt test and standard urinary cytology from voided urine as well as a complete evaluation including cystoscopy and transurethral resection or biopsy of suspicious lesions. Sensitivity and specificity values of urinary cytology and ImmunoCyt whether or not combined were calculated using cystoscopy as the gold standard and histopathology when available. RESULTS A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologicaly confirmed. Overall sensitivity of urinary cytology was 17.9%, 46.3% and 63.8% respectively, for G1, G2 and G3 transitional cell carcinoma, whereas that of ImmunoCyt was 60.7%, 75.6% and 76.8%. Sensitivity of the combined tests was 66.7%, 78% and 87%, respectively. Moreover, 10 of 55 (18.2%) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone. Specificity of urinary cytology was 94.5%, whereas that of ImmunoCyt was 84.2%. Specificity of the combined tests was 80.7%. Marked variations in urinary cytology sensitivity were observed among the different centers (27.3% to 66.7%), whereas combined assays (urinary cytology and ImmunoCyt) enhanced the overall sensitivity in the 80% range at most centers. CONCLUSIONS This prospective multicenter series confirmed a marked increase in sensitivity without significant loss in specificity when including ImmunoCyt in standard urinary cytology protocol. This increased sensitivity was observed in high grade lesions (with 100% sensitivity for carcinoma in situ) as well in low grade, low stage tumors.
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Affiliation(s)
- Christian Pfister
- Urology Department, Charles Nicolle University Hospital, Rouen, France
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Saidi A, Bocqueraz F, Sengel C, Descotes JL, Boillot B, Rambeaud JJ. [Early revascularization by stent in renal pedicle trauma]. Prog Urol 2003; 13:123-7. [PMID: 12703368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVES Lesions of the renal pedicle after blunt trauma of the abdomen are rare, and the results of the various therapeutic approaches are unpredictable and usually disappointing. We therefore decided to evaluate an endovascular approach with stent placement in this indication. CASE A 50-year-old woman, after jumping out of a window, arrived in coma with multiple organ lesions, haemorrhagic shock and initial haemodynamic instability. Renal arteriography, performed 2 hours after the fall, showed complete dissection of the right renal artery. A stent was inserted. Revascularization was satisfactory on follow-up CT. The macroscopic haematuria initially present rapidly resolved. With a follow-up of 1 month, the kidney presented a normal morphology with a normal nephrogram and a normal excretion time. CONCLUSION In renal pedicle trauma, urgent elective nephrectomy in patients with a functional contralateral kidney now appears to be the most widely used treatment option, regardless of the interval since trauma. Treatment by vascular stent can be performed even in the context of serious multiple injuries, and the first attempts show encouraging results.
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Riquet H, Fabre-Bocquentin B, Skowron O, Boillot B, Descotes JL, Rambeaud JJ. [Report of a case of leiomyoma of the kidney]. Prog Urol 2002; 12:92-5. [PMID: 11980022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The authors report a case of leiomyoma of the renal capsule. Although leiomyoma is a frequent tumour in the uterus, leiomyomas of the urinary tract are very rarely reported in the literature. This tumour has an excellent prognosis. In rare cases, the diagnosis may be suggested by CT scan, but histological examination confirms the diagnosis of benign tumour.
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Descotes JL, Pasquier D, Bayle F, Teil E, Rambeaud JJ. [Management of oncocytoma in transplanted kidney]. Prog Urol 2001; 11:91-4. [PMID: 11296656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The authors report a case of oncocytoma arising in a transplanted kidney. The diagnostic and therapeutic management is discussed and compared to the limited data reported in the literature on this subject. Immunosuppression of renal transplant recipients does not appear to increase the incidence of graft tumours, but, in the authors' opinion, modifies the conservative attitude generally proposed for this type of tumour.
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Affiliation(s)
- J L Descotes
- Service de Chirurgie Urologique, CHU de Grenoble, France
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Rambeaud JJ. Intermittent complete androgen blockade in metastatic prostate cancer. Eur Urol 2000; 35 Suppl 1:32-6. [PMID: 10081701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Intermittent hormonal treatment of prostate cancer was first developed based upon experimental study results. Using the Shionogi mouse breast cancer model, it was shown that the tumor grows rapidly in the presence of androgens, then undergoes apoptotic regression when androgens are removed. This apoptotic potential can be reinduced several times by cyclic replacement and withdrawal of androgens. These results led to the concept being evaluated in clinical trials. METHOD In most of the clinical studies a protocol is used in which the patient receives 36 weeks of androgen deprivation. For those patients whose prostate-specific antigen (PSA) drops to less than 4 ng/ml within 32 weeks of therapy, the androgen withdrawal is stopped at 36 weeks, and not reintroduced until PSA increases to 20 ng/ml. This cycle is then repeated until the patient's tumor becomes hormone-sensitive. RESULTS Akakura et al. in 1993, reported on 7 patients who had a total of 12 episodes off-hormone therapy after achieving PSA complex remission, with further response after each re-exposure. Bruchovsky et al. in 1997, reported on 47 patients who entered a study of intermittent hormone therapy to evaluate the effect of cyclic withdrawal and replacement therapy in 14 D2, 10 D, 19 C, 2 B2, 2 A2 patients. Treatment was initiated with combined androgen blockade and continued for at least 6 months until a serum PSA nadir was observed. The first two treatment cycles lasted 73 and 75 weeks, with a mean time-off therapy of 30 and 33 weeks and an overall mean percentage time-off therapy of 41 and 45%. Serum testosterone returned to the normal range within 8 weeks (range: 1-26 weeks) of stopping treatment. The off-treatment period in both cycles was associated with an improvement in sense of well-being, and the recovery of libido and potency in the men who reported normal or near-normal sexual function before the start of therapy. In 7 patients with stage D2 disease, the cancer progressed to an androgen-independent state. The mean and median times to progression were 128 and 108 weeks. Seven patients died, one from a non-cancer-related illness, with mean and median overall survival times of 210 and 166 weeks. CONCLUSION These studies demonstrated that the androgen-dependent state of prostate cancer can be maintained during a course of intermittent androgen suppression, supporting the possibility of multiple apoptotic regressions under well-regulated conditions. Oliver et al. in 1997, conducted a retrospective study of 20 patients and concluded that intermittent androgen deprivation reduced induction of hormone-resistant prostate cancer, with no acute or major risk associated with the use of intermittent androgen suppression. More clinical studies are required to clarify the indication for intermittent hormone therapy and evaluate improvement in quality of life and survival. In the future, approaches to the improvement of therapeutic apoptosis could include intermittent hormone therapy, associated with additive cytotoxic therapeutic strategies.
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Affiliation(s)
- J J Rambeaud
- Department of Urology, University Hospital of Grenoble, France
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Sappey O, Mollier S, Skowron O, Equy V, Ranchoup Y, Descotes JL, Boillot B, Rambeaud JJ. [Puerperal thrombophlebitis of the ovarian vein revealed by renal colic]. Prog Urol 1999; 9:313-8. [PMID: 10370958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The authors report the clinical case of a young woman with thrombophlebitis of the right ovarian vein following delivery by caesarean section, initially presenting in the form of renal colic. In the light of a review of the literature, they recall the pathophysiological mechanisms of ovarian thrombophlebitis and the various features observed on imaging examinations. The most frequent clinical features are also described. The authors emphasize the potential, but rare severity of this disease, characterized by the risk of pulmonary embolism, and its treatment, which is usually medical.
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Affiliation(s)
- O Sappey
- Service de Chirurgie Urologique et de la Transplantation Rénale, CHU de Grenoble, France
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