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Tauzin-Fin P, Sesay M, Ryman A, Ballanger P, Combe C. Postoperative Thrombotic Microangiopathy following Radical Cystectomy for Bladder Cancer. Anaesth Intensive Care 2019; 34:672-5. [PMID: 17061648 DOI: 10.1177/0310057x0603400515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/16/2022]
Abstract
This report describes the perioperative management of disseminated intravascular coagulation occurring abruptly during a planned cystectomy for non-metastatic bladder papillary carcinoma. Peroperatively, profuse bleeding and an acute decrease in blood pressure were effectively treated by blood transfusions and fresh frozen plasma. Haematological tests indicated the presence of disseminated intravascular coagulation. On the following three days, acute renal failure, peripheral disseminated intravascular coagulation-related thrombocytopenia and haemolytic anemia with schistocytes were suggestive of thrombotic microangiopathy. Treatment by plasma exchange along with haemodialysis was commenced. An aetiological work-up remained negative. After 21 days of treatment, haemodialysis and plasma exchange were stopped. Urological outcome was favourable. The one-year follow-up did not show any residual renal insufficiency and laboratory parameters returned to normal. In the absence of evidence in favour of an infectious, drug-related or immunological aetiology, we postulated that this thrombotic microangiopathy was caused by disseminated intravascular coagulation and that the tumour manipulation during the surgical procedure was the triggering factor.
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Affiliation(s)
- P Tauzin-Fin
- Departement d'Anesthésie-Réanimation III and Service d'Urologie, Hôpital Pellegrin-Tondu, Bordeaux, France
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Susperregui J, Pierry C, Bonhomme B, Pasticier G, Bernhard JC, Capon G, Bensadoun H, Ballanger P, Ferrière JM, Robert G. Influence du score de Gleason des marges chirurgicales de prostatectomie totale sur la récidive biologique. Prog Urol 2017; 27:632-639. [PMID: 28869168 DOI: 10.1016/j.purol.2017.07.239] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/10/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of the aggressiveness of cancer cells at the level of positive surgical margins (PSM) on the biochemical recurrence rate (BRR) by studying the Gleason score (GS) at this level. METHODS We included all radical prostatectomy (RP) procedures performed from January 2007 to November 2011. All of the RP specimens with PSM were reviewed to determine the GS at the level of PSM. We compared the GS at PSM with BRR. RESULTS A total of 658 RP were analysed, among which 16% had PSM. From the 101 patients with PSM included, 32% had biochemical recurrence (BR) with a median follow-up of 38 months. GS at PSM was significantly associated with earlier BR (P=0.008). Univariate analysis showed that GS at PSM (P=0.013), initial PSA (P<0.0001), pathologic GS (P<0.001), length of PSM (P=0.013), and seminal vesicle invasion (P<0.0001) were predictors of BR. Multivariate analysis confirmed that PSA greater than 10ng/mL and length of PSM greater than 3mm were independent prognostic factors for BR, but GS at the level of PSM was not. CONCLUSION GS at PSM was not confirmed as an independent risk factor for BR. Initial PSA greater than 10ng/mL and length of PSM greater than 3mm were the sole independent predictors for BR. LEVEL OF PROOF 4.
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Affiliation(s)
- J Susperregui
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - C Pierry
- Service d'anatomopathologie, centre hospitalier universitaire de Bordeaux, France
| | - B Bonhomme
- Service d'anatomopathologie, centre hospitalier universitaire de Bordeaux, France
| | - G Pasticier
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-C Bernhard
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
| | - G Capon
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - H Bensadoun
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - P Ballanger
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
| | - J-M Ferrière
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
| | - G Robert
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
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Rouget B, Capon G, Bernhard J, Robert G, Ballanger P, Pierquet G, Bensadoun H, Ferrière JM, Pasticier G. Huit ans d’expérience dans le traitement du cancer de prostate par HIFU, résultats oncologiques et fonctionnels. Prog Urol 2016; 26:50-7. [DOI: 10.1016/j.purol.2015.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/25/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
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Pierquet G, Zongo D, Robert G, Pasticier G, Maurice-Tison S, Bensadoun H, Ballanger P, Rouget B, Ferriere JM, Bernhard JC. [Partial nephrectomy on solitary kidney: Renal function outcome and predictive factors of impairment]. Prog Urol 2015; 26:34-40. [PMID: 26654468 DOI: 10.1016/j.purol.2015.09.018] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/10/2015] [Accepted: 09/29/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess the postoperative functional outcome of PN in solitary kidney and define some predictive factors of renal change. MATERIAL AND METHODS A monocentric series of 45 partial nephrectomies on solitary kidneys, performed between 1988 and 2014, was retrospectively analyzed. Pre-, per- and postoperative clinicopathological data were collected in the UroCCR database. The evolution of early, medium and long-term postoperative Glomerular Filtration Rate (GFR) was evaluated. Predictive factors of GFR decline and hemodialysis were assessed in multivariate analysis. RESULTS Mean age was 61 years old (±10.8). Mean preoperative GFR and tumor size were respectively 59.6 mL/min (±18.7) and 3.9 cm (±2.6). Vascular clamping was performed in 41 cases (91%). Median time of warm ischemia was 20 minutes (2-60). Mean follow-up was 66 months (±47). Mean GFR at day 5, 1 month and last follow-up were respectively 46.4 mL/min, 50.3 mL/min and 53.1 mL/min. At day 5 and at last follow-up, a GFR decrease ≥ 20% was found in 20 patients (44.4%) and in 16 patients (35.5%), respectively. Five patients (11%) required definitive hemodialysis (HD) at last follow-up. At day 5, tumor size>4 cm (0.006) and operative time (P=0.003) were independent predictive factors of GFR decline. At 1 year, RENAL ns ≥ 10 was the only independent predictive factor of GFR alteration (P=0.0007). Preoperative GFR was significantly associated with final hemodialysis (P=0.023). CONCLUSION Partial nephrectomy allows most of the patients presenting with renal cell carcinoma on solitary kidney to be free of hemodialysis. Tumor complexity, tumor size and preoperative GFR seems to play a determinant role on postoperative functional outcome. These non-modifiable predictive factors should be recognized and taken into account to better select patients with high risk of postoperative renal failure. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- G Pierquet
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - D Zongo
- ISPED, 33076 Bordeaux, France
| | - G Robert
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - G Pasticier
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | | | - H Bensadoun
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - P Ballanger
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - B Rouget
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - J-M Ferriere
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - J-C Bernhard
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Réseau français de recherche sur le cancer du rein, 33076 Bordeaux, France
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Comat V, Pierquet G, Pierquet G, Capon G, Bernhard J, Pasticier G, Bensadoun H, Ballanger P, Ferriere J, Robert G. Énucléation de la prostate au laser Holmium (HoLEP) : expérience monocentrique après 400 procédures avec 1 an de recul. Prog Urol 2015; 25:779-80. [DOI: 10.1016/j.purol.2015.08.131] [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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Vuong N, Michiels C, Grassano Y, Cornelis F, Dupitout L, Siméon H, Yacoub M, Pasticier G, Robert G, Bensadoun H, Ballanger P, Grenier N, Ferriere J, Bernhard J. Néphrectomie partielle laparoscopique robot assistée : réalisation de tumorectomies multiples sous clampages supra-sélectifs. Prog Urol 2015; 25:861-2. [DOI: 10.1016/j.purol.2015.08.296] [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: 11/30/2022]
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Robert G, Coma V, Ferrière J, Ballanger P. Énucléation laser de la prostate au laser Holmium : technique d’énucléation en bloc. Prog Urol 2015; 25:865. [DOI: 10.1016/j.purol.2015.08.305] [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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Quiboeuf E, Nidecker S, Ballanger P, Hocké C. [Vaginal mesh exposure after prolapse surgery. A descriptive study of 43 cases: Epidemiology and therapeutic management]. Prog Urol 2015; 25:1232-40. [PMID: 26321358 DOI: 10.1016/j.purol.2015.07.003] [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: 10/01/2014] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence and time of occurrence of vaginal mesh exposure based on the initial surgical approach of prolaps. To describe their therapeutic management. MATERIAL Descriptive retrospective study of 43 women followed for vaginal mesh exposure diagnosed during a follow-up visit or motivated by symptoms. The initial surgery was performed abdominally (promontofixation) or vaginally. The therapeutic management was carried out by medical and/or surgical (prosthetic resection partial or complete). RESULTS The prevalence of vaginal exposure was 7.3% in case of vaginal initial surgery and 2.8% in case of promontofixation initial (P=0.02). Mesh exposure have appeared earlier in case of vaginal initial surgery compared to promontofixation (14.9 months vs. 45.2 months). After vaginal initial surgery, vaginal mesh exposure appeared to third within 6 months postoperatively (9/29). The success rate of medical treatment was 21.4%. In total, 31% of women initially made vaginally and 64.9% of women initially made abdominally required at least two surgeries to get a cure. CONCLUSION Vaginal mesh exposure may be away from the initial surgery, especially when the first initial surgery was abdominal. The medical treatment of vaginal mesh exposure led to poor results. The overall rate of healing in our experience was good but at the cost of considerable morbidity as a significant proportion of patients required two or more surgical interventions.
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Affiliation(s)
- E Quiboeuf
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - S Nidecker
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - P Ballanger
- Service d'urologie, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
| | - C Hocké
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, université de Bordeaux 2, place Amélie Raba-Léon, 33076 Bordeaux, France.
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Mascle L, Descazeaud A, Robert G, Bernhard JC, Bensadoun H, Ferrière JM, Ballanger P, Pasticier G. [Multicenter study of Advance ® suburethral sling for treatment of postoperative urinary incontinence of male]. Prog Urol 2015; 25:249-55. [PMID: 25748789 DOI: 10.1016/j.purol.2015.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 03/19/2014] [Revised: 01/01/2015] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate in the medium term, the efficiency and morbidity of Advance(®) for the treatment of postoperative urinary incontinence for male, and determine predictive preoperative factors of success or failure. MATERIAL AND METHODS Retrospective multicentric clinical study of patients presenting a postoperative urinary incontinence and treated by Advance(®) suburethral sling. The importance of the preoperative incontinence was classified in three groups: light (pad-test<50 g/day or 1 pad/day), moderated (pad-test between 50 and 100 g/day or 2 or 3 pads/day), severe (pad-test>100 g/day or >3 pads/day). The functional results were classified in 4 categories: continence and improvement, defining the criterion of success and unchanged situation and deteriorated situation defining the criterion of failure. RESULTS Sixty-six patients were included from 2008 till 2013. The radical prostatectomy was responsible in 85.5% of the cases. The incontinence was light, moderated and severe for respectively 43.4%, 35.6% and 21% of the patients. After treatment, 39.4% of the patients were continent and 78.9% in situation of success. The rate of success decreased with the severity of the incontinence (respectively 94%, 74% and 56%). For 9 patients, implantation of artificial urinary sphincter was performed without operative difficulties. Complications were urine retention (n=4), hematoma (n=3) and scrotal pains persistent more than one postoperative month (n=11). CONCLUSION Advance(®) suburethral sling is a technique in which the efficiency decreases with the severity of the incontinence, but which does not seem to prevent from implanting artificial urinary sphincter. Its main problem is the apparition of scrotal pain.
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Affiliation(s)
- L Mascle
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France; Service d'urologie, CHU de Pellegrin, place Amélie-Raba-Leon, 33000 Bordeaux, France.
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France.
| | - J-C Bernhard
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France.
| | - H Bensadoun
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France.
| | - J-M Ferrière
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France.
| | - P Ballanger
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France.
| | - G Pasticier
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Leon, 33000 Bordeaux, France.
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Pasticier G, Chicart M, Gross-Goupil M, Donon L, Robert G, Ferriere JM, Ballanger P, Bernhard JC, Cornelis F, Lebras Y, Grenier N, Ravaud A, Haaser T, Fernandez P, De Clermont-Gallerande H. Impact of the 18F- PET/CT scan in the management of patients with high-risk or intermediate-risk prostate cancer at initial diagnosis or at recurrence. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
87 Background: It is reported that a Fcholine Positron Emission Tomography (PET/CT) scan can change the management of the patients with prostate cancer up to 20% of the cases. The aim of this study was to evaluate the impact of 18FCholine PET/CT when its indication was taken by a multi-disciplinary staff in case of initial diagnosis or in case of recurrence. Methods: This retrospective study involved 84 patients between May 2013 and July 2014. After a selective approach 86 18F-PET/CT were performed consecutively: 37 (43%) for the initial staging and 49 (57%) in biochemical failure. The acquisition protocol included a pelvic dynamic scan after injection of 4 MBq/kg of 18FCholine followed by a whole-body scan. Mean age, PSA level and Gleason score were respectively in relapse and initial staging: 71 years (59-82), 4.9 (0.12-32.8), 7 (6-9) and 63 years (48-76), 16 (2.42-55) and 8 (6-10). Results: In initial diagnosis, prostate cancer was identified in all the patients on PET/CT. Local disease was seen in 23/37 scans (62.2%); loco-regional node involvement in 8 (21.6%) and metastatic disease in 6 (16.2%). PET/CT confirmed the therapeutic decision in 48.6% of cases and led to a therapeutic modification in 43.2% of cases,avoiding radical prostatectomy and lymphadenectomy in 25% of cases or modifying the extend of radiotherapy (25%) . In biochemical recurrence, PET/CT showed relapse in the prostatic area in 14 patients (28.6%); abnormal pelvic lymph nodes in 10 cases (20.4%) and distant metastases in 18 patients (36.7%). It failed to identify the cause of relapse in 7 cases (14.3%). PET/CT confirmed the therapeutic approach in 24.5% and led to a therapeutic change in 61.2% of cases The diagnostic performance of the FCholine PET/CT scan on nodes, according to the pathological results were: sensitivity 80 %, specificity 84.6%, positive predictive value 66.7% and negative predictive value 91.7 % Conclusions: A rigorous selection of the patients before the realization of a FCholine PET/CT scan in the management of a prostate cancer can increase the diagnostic performance and provide a better impact. In this study the treatment modification affected 54.8% of the patients.
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Affiliation(s)
- Gilles Pasticier
- Urology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | | | - Laurence Donon
- Urology Departement, University Hospital Bordeaux, Bordeaux, France
| | - Gregoire Robert
- Urology Departement, University Hospital Bordeaux, Bordeaux, France
| | | | | | | | - Francois Cornelis
- Radiology Department, University Hospital Bordeaux, Bordeaux, France
| | - Yann Lebras
- Radiology Department, University Hospital Bordeaux, Bordeaux, France
| | - Nicolas Grenier
- Radiology Department, University Hospital Bordeaux, Bordeaux, France
| | | | - Thibaut Haaser
- Radiation Therapy Department, University Hospital Bordeaux, Bordeaux, France
| | - Philippe Fernandez
- Nuclear Medicine Department, University Hospital Bordeaux, Bordeaux, France
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Gamé X, Karsenty G, Ruffion A, Amarenco G, Ballanger P, Chartier-Kastler E, Cosson M, Costa P, Fatton B, Deffieux X, Haab F, Hermieu JF, Le Normand L, Saussine C, Denys P. [Idiopathic overactive bladder and BOTOX(®): Literature review]. Prog Urol 2015; 25:461-73. [PMID: 25662706 DOI: 10.1016/j.purol.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/11/2014] [Accepted: 01/12/2015] [Indexed: 11/29/2022]
Abstract
AIM Systematically review literature on the efficacy and tolerability of botulinum toxin A (onabotulinumtoxineA, BOTOX(®), Allergan, CA, USA) in refractory idiopathic overactive bladder (iOAB) METHODS: Pubmed search on the efficacy, toxicity and adverse events of onabotulinumtoxinA in clinical trials only with level 1 and 2 evidence. RESULTS Eleven controlled randomised trials have been selected, of which 3 phase III trials. The studies published data of 1008 patients with refractory iOAB treated with onabotulinumtoxineA. In the phase II and III trials, doses from 50 U to 300 U have been evaluated; more than half of the patients (n = 676) with 100 U. In the 2 main phase III trials, onabotulinumtoxinA has demonstrated to be more efficient compared to placebo on continence, symptoms and quality of live (QoL). Urodynamic results, reported in the phase II trials, demonstrated higher changes compared to placebo only from dose 100 U on, although not always significant. Adverse events (urinary retention, dysuria, urinary tract infection) were easily treated and did not influence patient's QoL. CONCLUSION Intradetrusor injections of onabotulinumtoxinA (BOTOX(®)), a minimally-invasive procedure, seem to be efficient and well tolerated in the treatment of refractory iOAB.
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Affiliation(s)
- X Gamé
- Service d'urologie, hôpital de Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - G Karsenty
- Service de chirurgie urologique et transplantation rénale, CHU de la Conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France
| | - A Ruffion
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - G Amarenco
- Service de rééducation neuro-urologique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - P Ballanger
- Service d'urologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital de la Pitié-Salpétrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Cosson
- Service de gynécologie, CHRU de Lille, rue Eugène-Avinée, 59037 Lille cedex, France
| | - P Costa
- Service d'urologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - B Fatton
- Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-Trivaux, 92140 Clamart, France
| | - F Haab
- Service d'urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - L Le Normand
- Service d'urologie, Hôtel Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Saussine
- Service d'urologie, CHU, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - P Denys
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
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Gabbay G, Bernhard JC, Renard O, Ballanger P, Ferriere JM, Fallot J, Comat V, Robert G. Énucléation de la prostate au laser Holmium en chirurgie ambulatoire : évaluation prospective des 30 premiers patients. Prog Urol 2015; 25:34-9. [DOI: 10.1016/j.purol.2014.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/17/2014] [Accepted: 09/24/2014] [Indexed: 02/02/2023]
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Donon L, Robert G, Ballanger P. Neuromodulation sacrée : résultats d’une série monocentrique de 93 cas. Prog Urol 2014; 24:1120-31. [DOI: 10.1016/j.purol.2014.09.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/15/2022]
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Bernhard J, Mascle L, Grassano Y, Pierquet G, Capon G, Vuong N, Fallot B, Robert G, Pasticier G, Bensadoun H, Gabbay G, Donon L, Ballanger P, Ferriere J. Néphrectomie partielle laparoscopique robot-assistée : s’appuyer sur l’imagerie préopératoire pour planifier la réalisation d’un clampage artériel suprasélectif. Prog Urol 2014; 24:893-4. [DOI: 10.1016/j.purol.2014.09.009] [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: 11/28/2022]
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Bernhard J, Capon G, Pierquet G, Mascle L, Grassano Y, Fallot J, Donon L, Gabbay G, Robert G, Pasticier G, Ballanger P, Ferriere J. Néphrectomie partielle laparoscopique robot-assistée d’indication élective pour tumeur>7cm : à quoi s’attendre ? Prog Urol 2014; 24:893. [DOI: 10.1016/j.purol.2014.09.008] [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: 10/24/2022]
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Bernhard J, Capon G, Mascle L, Grassano Y, Queruel V, Pierquet G, Fallot J, Robert G, Donon L, Bensadoun H, Ballanger P, Gabbay G, Pasticier G, Ferriere J. Néphrectomie partielle laparoscopique robot-assistée avec clampage artériel suprasélectif pour tumeur hilaire complexe. Prog Urol 2014; 24:892. [DOI: 10.1016/j.purol.2014.09.006] [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: 10/24/2022]
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Deffieux X, Fatton B, Denys P, Chartier-Kastler E, Amarenco G, Haab F, Costa P, Game X, Karsenty G, Saussine C, Ballanger P, Le Normand L, Ruffion A, Hermieu JF, Cosson M. [Intra-detrusor injection of botulinum toxin for female refractory idiopathic overactive bladder syndrome]. J Gynecol Obstet Hum Reprod 2014; 43:572-580. [PMID: 25087018 DOI: 10.1016/j.jgyn.2014.06.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Botulinum toxin-A detrusor injections are now approved for use (extension of marketing authorization) in the management of refractory idiopathic overactive bladder. The goal of the current study was to study the value and efficacy of this therapy. PATIENTS AND METHODS A literature review was performed on Medline, Embase and Cochrane databases, using the following keywords: botulinum toxin; overactive bladder syndrome; urinary incontinence; detrusor injection. RESULTS The recommended first step dose is 50 units of BOTOX(©) (dose selected for tolerance assessment). However, the cure rates for urge incontinence are greater with 100 units. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by the patient, because of the risk of urinary retention (6%). The administration of BOTOX(©) comprises an intra-detrusor injection using a cystoscope, performed under local anesthesia. Clinical improvement is generally observed in the first two weeks after the injection. Patients should be considered for reinjection when the clinical effect of the previous injection has diminished, approximately 6-9 months after the first injection. An injection of 100 units may be considered when the clinical benefit of the 50-unit injection is not satisfactory concerning incontinence symptoms. CONCLUSION Botulinum toxin detrusor injections may be offered to women who develop refractory OAB.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, groupe hospitalier universitaire Sud, Assistance publique-Hôpitaux de Paris (AP-HP), 157, rue de La-Porte-de-Trivaux, 92414 Clamart, France.
| | - B Fatton
- Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - P Denys
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital de la Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Amarenco
- Service de rééducation neuro-urologique, hôpital Tenon, 4, rue de La-Chine, 75020 Paris, France
| | - F Haab
- Service d'urologie, hôpital Tenon, 4, rue de La-Chine, 75020 Paris, France
| | - P Costa
- Service d'urologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - X Game
- Service d'urologie, hôpital de Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - G Karsenty
- Service d'urologie, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - C Saussine
- Service d'urologie, centre hospitalier universitaire, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - P Ballanger
- Service d'urologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - L Le Normand
- Service d'urologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - A Ruffion
- Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - M Cosson
- Service de gynécologie, CHRU de Lille, rue Eugène-Avinée, 59037 Lille cedex, France
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Hermieu JF, Ballanger P, Amarenco G, Chartier-Kastler É, Cosson M, Costa P, Fatton B, Saussine C, Denys P, Gamé X, Haab F, Karsenty G, Le Normand L, Ruffion A, Deffieux X. Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management: Translation of French recommendations. Prog Urol 2014; 24:e1-7. [DOI: 10.1016/j.purol.2014.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/12/2014] [Indexed: 11/16/2022]
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Hermieu JF, Ballanger P, Amarenco G, Chartier-Kastler É, Cosson M, Costa P, Fatton B, Deffieux X, Denys P, Gamé X, Haab F, Karsenty G, Le Normand L, Ruffion A, Saussine C. Recommandations pour l’utilisation de la toxine botulinique de type A (Botox®) dans l’hyperactivité vésicale réfractaire idiopathique. Prog Urol 2013; 23:1457-63. [DOI: 10.1016/j.purol.2013.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 10/13/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
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Capon G, Donon L, Soulet F, Deminiere C, Merlio JP, Doussau A, De Pommerol MJ, Drutel G, Ravaud A, Quemener C, Robert G, Pasticier G, Ballanger P, Bikfalvi A, Ferrière JM, Bernhard JC. 604 PREDICTIVE FACTORS OF IMPAIRED FROZEN KIDNEY TISSUE SAMPLES QUALITY IN THE SETTING OF ROUTINE SURGICAL ACTIVITY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.155] [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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Nacir M, Ballanger P, Donon L, Bernhard JC, Douard A, Marit-Ducamp E, Ferriere JM, Pasticier G. Ballons ACT® : quelle place dans le traitement de l’incontinence urinaire de la femme ? Prog Urol 2013; 23:276-82. [DOI: 10.1016/j.purol.2013.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 02/05/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Donon L, Bernhard JC, Soulet F, Drutel G, Leste-lasserre T, Yacoub M, Le Bail B, Ballanger P, Ferrière JM, Bikfalvi A. Expression et valeur pronostique de cxcl4, cxcl4l1, et cxcr3b dans le carcinome à cellules rénales claires (CCRc). Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.025] [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: 10/27/2022]
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Vergnolles M, Robert G, Ballanger P, Ferriere JM, Pasticier G, Ravaud A, Houede N, Bernhard JC, Wallerand H. 1776 E-CADHERIN, N-CADHERIN AND TWIST EXPRESSION IN HIGH RISK BLADDER CANCER. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1793] [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: 10/28/2022]
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Forgues A, Junes F, Gateau T, Geissman A, Merignargues F, Ballanger P, Robert G. [Right obstructive pyelonephritis due to supra-piriform herniation of the pelvic ureter: a clinical case]. Prog Urol 2011; 21:887-90. [PMID: 22035916 DOI: 10.1016/j.purol.2011.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 11/14/2010] [Accepted: 02/15/2011] [Indexed: 11/19/2022]
Abstract
Ureteric herniations are extremely rare. We are reporting the case of a 57-year-old female presenting with an upper urinary tract sepsis due to a pelvic ureteral herniation into the supra-piriform sciatic foramen. The diagnosis was made by the CT scan and the treatment was performed in two steps: first the upper urinary tract was drained, and then the hernia was surgically treated. Although ureteral hernias are exceptional causes for nephritic colic, urologists must be aware of the specificity of the diagnosis and of the treatment in order to avoid complications.
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Affiliation(s)
- A Forgues
- Service d'urologie, université Bordeaux 2 Victor-Segalen, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Chartier-Kastler E, Ballanger P, Belas M, Biserte J, Corbel L, Gamé X, Grise P, Karsenty G, Le Normand L, Mauroy B, Pasquale J, Ruffion A, Rousseau T, Saussine C, Suberville M, Tollon C. Neuromodulation sacrée avec le système InterStim™ : résultats du registre national français. Prog Urol 2011; 21:209-17. [DOI: 10.1016/j.purol.2010.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 05/04/2010] [Accepted: 05/09/2010] [Indexed: 11/29/2022]
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Chartier-Kastler E, Ballanger P, Petit J, Fourmarier M, Bart S, Ragni-Ghazarossian E, Ruffion A, Le Normand L, Costa P. Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men. BJU Int 2010; 108:241-7. [DOI: 10.1111/j.1464-410x.2010.09736.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bernhard J, Quemener C, Soulet F, Deminière C, Pineau R, Merlio J, Ballanger P, Ravaud A, Ferrière J, Bikfalvi A. R78: Niveau d’expression et valeur pronostique de CXCL4, CXCL4L1 et CXCR3B dans le carcinome à cellules rénales claires. Bull Cancer 2010. [DOI: 10.1016/s0007-4551(15)30996-6] [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: 11/26/2022]
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Bernhard JC, Soulet F, Quemener C, Deminiere C, Fergelot P, Sire M, Pineau R, Wallerand H, Pasticier G, Merlio JP, Ballanger P, Ravaud A, Ferriere JM, Bikfalvi A. 211 LEVEL OF EXPRESSION AND PROGNOSTIC VALUE OF CXCL4, CXCL4L1 AND CXCR3B IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.268] [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: 10/19/2022]
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Elkentaoui H, Robert G, Pasticier G, Bernhard JC, Couzi L, Merville P, Ravaud A, Ballanger P, Ferrière JM, Wallerand H. Therapeutic Management of De Novo Urological Malignancy in Renal Transplant Recipients: The Experience of the French Department of Urology and Kidney Transplantation from Bordeaux. Urology 2010; 75:126-32. [PMID: 19864001 DOI: 10.1016/j.urology.2009.06.106] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/10/2009] [Accepted: 06/26/2009] [Indexed: 12/11/2022]
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Vergnolles M, Wallerand H, Gadrat F, Maurice-Tison S, Deti E, Ballanger P, Ferriere JM, Robert G. Predictive Risk Factors for Pain During Extracorporeal Shockwave Lithotripsy. J Endourol 2009; 23:2021-7. [PMID: 19821695 DOI: 10.1089/end.2009.0111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marc Vergnolles
- Department of Urology, Pellegrin University Hospital, Bordeaux, France
| | - Hervé Wallerand
- Department of Urology, Pellegrin University Hospital, Bordeaux, France
- Bordeaux 2 University, Victor Segalen, Bordeaux, France
| | - Francis Gadrat
- Department of Anaesthesiology, Pellegrin University Hospital, Bordeaux, France
| | - Sylvie Maurice-Tison
- Department of Medical Information, Pellegrin University Hospital, Bordeaux, France
| | - Edouard Deti
- Department of Medical Information, Pellegrin University Hospital, Bordeaux, France
| | - Philippe Ballanger
- Department of Urology, Pellegrin University Hospital, Bordeaux, France
- Bordeaux 2 University, Victor Segalen, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Pellegrin University Hospital, Bordeaux, France
- Bordeaux 2 University, Victor Segalen, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Pellegrin University Hospital, Bordeaux, France
- Bordeaux 2 University, Victor Segalen, Bordeaux, France
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Wallerand H, Bernhard JC, Culine S, Ballanger P, Robert G, Reiter RE, Ferrière JM, Ravaud A. Targeted therapies in non-muscle-invasive bladder cancer according to the signaling pathways. Urol Oncol 2009; 29:4-11. [PMID: 19914099 DOI: 10.1016/j.urolonc.2009.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
With 300,000 annually new cases worldwide, urothelial-cell carcinoma of the bladder (UCCB) is the second most common urologic neoplasm after prostate carcinoma. Non-muscle-invasive bladder cancer (NMIBC), which is not immediately life-threatening, represents 70% to 80% of these initial cases. Despite optimal treatment (transurethral resection with intravesical chemo- or immunotherapy), 70% of these NMIBC will recur, and 10% to 20% will progress, highlighting the need for a new therapeutic approach. Indeed, the identification of patients at high risk of disease recurrence and progression would be beneficial in predicting which patients with NMIBC would benefit from strict follow-up and which would benefit from a more aggressive therapy. To date, conventional treatment remains disappointing in terms of oncologic results and morbidity. The growing understanding in tumor biology has enabled the signaling pathways involved in bladder tumorigenesis and progression to be identified, but few molecular targets have been available until now. The encouraging results seen in various human carcinomas suggests that these new agents should become part of the arsenal of drugs available in the treatment of NMIBC, alone or in combination with already known agents. In this article, we have tried to highlight the main molecular signaling pathways involved in NMIBC tumorigenesis and progression, and the potential targets useful for improving the treatment of NMIBC.
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Affiliation(s)
- Hervé Wallerand
- Department of Urology, Centre Hospitalo-Universitaire Pellegrin, Victor Segalen School of Medicine, Bordeaux, France.
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Robert G, Elkentaoui H, Pasticier G, Couzi L, Merville P, Ravaud A, Ballanger P, Ferrière JM, Wallerand H. Laparoscopic Radical Prostatectomy in Renal Transplant Recipients. Urology 2009; 74:683-7. [DOI: 10.1016/j.urology.2009.04.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/09/2009] [Accepted: 04/05/2009] [Indexed: 11/28/2022]
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Callier C, Tauzin-Fin P, Bram R, Ballanger P. [Effect of sublingual oxybutynin in postoperative pain after radical retropubic prostatectomy]. Prog Urol 2009; 19:558-62. [PMID: 19699454 DOI: 10.1016/j.purol.2009.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 11/06/2008] [Accepted: 01/05/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Total prostatectomy (TP) is one of the referential treatments of localized cancer of the prostate gland. Urethrovesical anastomosis and urinary catheterization may be sources of strong contractions of the detrusor muscle responsible for intense pain which is added to parietal pain. This study evaluates the efficiency of oxybutynin in the treatment of this postoperative pain (POP). MATERIAL AND METHOD Forty-five patients due to benefit from a TP by laparotomy were included in this prospective study. A urinary catheter was put in place during the operation. Patients were randomly split into two groups in the postoperative care room. Group P (n = 23) received a placebo in tablet form and group O (n = 22) received 5mg of oxybutynin in sublingual form. The POP was evaluated every 2 hours using the Visual Analogue pain Scale (VAS 0:10). RESULTS The accumulated dose of tramadol after 8 hours was 110.8 mg in group P and 39.7 mg in group O (p < 0.05). For group P, 15/23 of the patients (65%) were in pain versus 4/22 (18%) in group O. The VAS scores of group P were higher (4.1 +/- 1) than those of group O (1.2 +/- 0.9). For group P, when the PCA dose of tramadol was inefficient, a tablet of oxybutynin 5 mg brought the VAS scores down to the same level of those of group O within 2 hours. No side effects linked to the antimuscarinic action were observed. CONCLUSION Oxybutynin given in sublingual form reduced, at postoperative stage, the frequency and intensity of pain linked to the bladder wound and to the catheter after TP. Its use for the POP of the bladder section reduced the consumption of postoperative analgesia.
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Affiliation(s)
- C Callier
- Service d'urologie, groupe hospitalier Pellegrin, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Robert G, Gabbay G, Bram R, Wallerand H, Deminière C, Cornelis F, Bernhard JC, Ravaud A, Ballanger P. Complete Histologic Remission after Sunitinib Neoadjuvant Therapy in T3b Renal Cell Carcinoma. Eur Urol 2009; 55:1477-80. [DOI: 10.1016/j.eururo.2008.12.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 12/25/2008] [Indexed: 10/21/2022]
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Lapouge O, Bram R, Hocke C, Ballanger P. [Management of erosive complications after tension-free vaginal tape procedure]. Prog Urol 2009; 19:193-201. [PMID: 19268258 DOI: 10.1016/j.purol.2008.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 10/16/2008] [Accepted: 11/26/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the management of patients with an erosive complication after tension free vaginal tape. To establish a diagnostic approach, describe the results on symptoms and continence after a conservative surgery. METHODS Retrospective descriptive study of 38 patients supported for complications after suburethral synthetic sling. We have diagnosed 12 erosions vaginal and five bladder erosions. Patients have been treated from a recovery surgery according to a conservative approach (partial resection or endoscopic section). RESULTS Of the 12 patients with a vaginal erosion, 10 expressed symptoms in relation with their erosion. After partial resection, eight patients (80% of patients with symptomatic erosion) did not have more complain. Of these, 50% were continent, the other with mostly a slight recurrence accessible to a second suburethral sling. First endoscopic section was a minimally invasive option for bladder erosion. However, an only cystoscopic approach seemed to be not sufficient to cut the sling as far as possible. After section, two patients have been treated from a laparotomy with bladder dissection, one for immediate outcome unsatisfactory, the other for reccurent symptoms. The results for continence were excellent as the suburethral portion was not resected. CONCLUSION Our study showed the importance of regular clinical surveillance, feasibility and the relative success of this conservative approach. The technical feasability and the increasing number of patients must not forget to respect good indication and rigorous technique. These complications invite us to moderate our indications especially for young patients.
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Affiliation(s)
- O Lapouge
- Service de chirurgie urologique, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Wallerand H, Robert G, Pasticier G, Ravaud A, Ballanger P, Reiter RE, Ferrière JM. The epithelial-mesenchymal transition-inducing factor TWIST is an attractive target in advanced and/or metastatic bladder and prostate cancers. Urol Oncol 2009; 28:473-9. [PMID: 19272800 DOI: 10.1016/j.urolonc.2008.12.018] [Citation(s) in RCA: 84] [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: 11/13/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE Metastasis remains the main cause of death in both bladder (BCa) and prostate (PCa) cancers. The results of chemotherapy did not show any significant improvement of the survival the past years. Cancer research has led to the identification of signaling pathways involved and molecular targets that could change the natural history. The epithelial-mesenchymal transition (EMT), critical during embryonic development, becomes potentially destructive in many epithelial tumors progression where it is inappropriately activated. The cell-cell and cell-extracellular matrix interactions are altered to release cancer cells, which are able to migrate toward metastatic sites. Hallmarks of EMT include the down-regulation of E-cadherin expression, which is the main component of the adherens junctions. The protein TWIST is a transcriptional repressor of E-cadherin, tumor progression, and metastasis, and could be used as a molecular target to restore the chemosensitivity in BCa and PCa. MATERIALS AND METHODS We selected the last 5-year basic research literature on EMT and TWIST but also clinical studies on BCa and PCa in which TWIST is overexpressed and could be considered as an efficient prognostic marker and molecular target. RESULTS TWIST is considered as a potential oncogene promoting the proliferation and inhibiting the apoptosis. TWIST promotes the synthesis of the pro-angiogenic factor, vascular endothelial growth factor (VEGF) involved in tumor progression and metastasis. Apoptosis and angiogenesis are two essential cancer progression steps in many epithelial tumors, including BCa and PCa. CONCLUSIONS With the targeted therapy, oncology has entered into a new era, which is going to be critical in cancer treatment in combination with traditional anticancer drugs.
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Affiliation(s)
- Hervé Wallerand
- Department of Urology, Centre Hospitalo-Universitaire Pellegrin-Tripode, Victor Segalen School of Medicine, Bordeaux, France.
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Gosse P, Tauzin-Fin P, Sesay MB, Sautereau A, Ballanger P. Preparation for surgery of phaeochromocytoma by blockade of α-adrenergic receptors with urapidil: what dose? J Hum Hypertens 2009; 23:605-9. [DOI: 10.1038/jhh.2008.172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sesay M, Tauzin-Fin P, Gosse P, Ballanger P, Maurette P. Real-Time Heart Rate Variability and Its Correlation with Plasma Catecholamines During Laparoscopic Adrenal Pheochromocytoma Surgery. Anesth Analg 2008; 106:164-70, table of contents. [DOI: 10.1213/01.ane.0000289531.18937.0a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lapray JF, Ballanger P. [Recommendations for imaging in the investigation of non-neurological female urinary incontinence]. Prog Urol 2007; 17:1285-1296. [PMID: 18214139] [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: 05/25/2023]
Abstract
INDICATIONS FOR IMAGING: Apart from ultrasound assessment of post-voiding residual urine, radiological examinations are not recommended for the initial work-up of non-neurological female urinary incontinence. CYSTOGRAPHY: Cystography is not recommended as a first-line examination to evaluate uncomplicated stress, urge or mixed urinary incontinence. Cystography may be recommended in the case of complex, complicated or relapsing urinary incontinence, discordance between clinical findings and urodynamic assessment or in the presence of associated prolapse, in which case colpocystodefecography or even dynamic MRI should be preferred. URINARY TRACT ULTRASOUND: Ultrasound is not recommended for the initial work-up of pure stress urinary incontinence or genital prolapse Ultrasound without forced diuresis and after a spontaneous void, is recommended for the assessment of post-voiding residual urine and to assess complicated suburethral tape. Ultrasound is an optional examination in the case of complex or relapsing urinary incontinence, discordance between clinical findings and urodynamic assessment or in the presence of prolapse. PELVIC MRI: Dynamic MRI is not currently recommended for the initial work-up of urinary incontinence.
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Hermieu JF, Cortesse A, Cardot V, Le Normand L, Lapray JF, Ballanger P, Monneins F. [Summary of recommendations for the clinical evaluation of non-neurological female urinary incontinence]. Prog Urol 2007; 17:1239-1241. [PMID: 18214135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Delmas V, Ballanger P, Grise P, Ortuno C. MP-07.13: Transobturator suburethral tape ARIS in the treatment of stress urinary incontinence: one year evaluation. Urology 2007. [DOI: 10.1016/j.urology.2007.06.297] [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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Leroux S, Desgrandchamps F, Ravery V, Bochereau G, Menut P, Teillac P, Ballanger P. [Prospective study of the quality of life after palliative urinary diversion by subcutaneous pyelovesical bypass (Detour ureteric prosthesis)]. Prog Urol 2007; 17:60-4. [PMID: 17373239 DOI: 10.1016/s1166-7087(07)92227-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 01/22/2023]
Abstract
OBJECTIVE To prospectively evaluate the quality of life of cancer patients at the palliative stage after implantation of an extra-anatomical ureteric prosthesis as an alternative to permanent percutaneous nephrostomy (PCN). MATERIAL AND METHODS A series of 27 prostheses in 19 patients with PCN was prospectively evaluated. The ureteric prosthesis (Detour) consists of two concentric tubes glued to each other. The inner tube is made of silicone and the outer tube is made of polyester. This prosthesis is introduced percutaneously into the renal pelvis as an alternative to nephrostomy. It is tunnelled subcutaneously and is introduced into the bladder via a short incision. Patients were reviewed every three months for 18 months or until death. The EORTC QLQ-C30 self-administered questionnaire was used to evaluate the patients' quality of life. The functioning and position of the prostheses were verified by ultrasound and/or intravenous urography (IVU). RESULTS There were no failures of prosthesis placement and no intraoperative or early postoperative complications. Injection of the suprapubic incision was observed in 3 cases, in patients with pre-existing bladder disease (radiation cystitis or bladder tumour). The mean follow-up was 7.8 months: 6.6 months for the group of patients who died (15) and 12 months for the 4 patients still alive at the end of the study. Functional scores improved due to elimination of the external nephrostomy tube. In parallel, physical score deteriorated due to disease progression. Overall quality of life and index of satisfaction were improved by elimination of the external diversion. CONCLUSION Subcutaneous pyelovesical diversion ensures a better quality of life than classical percutaneous nephrostomy in cancer patients at the palliative stage.
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Desgrandchamps F, Leroux S, Ravery V, Bochereau G, Menut P, Meria P, Ballanger P, Teillac P. Subcutaneous pyelovesical bypass as replacement for standard percutaneous nephrostomy for palliative urinary diversion: prospective evaluation of patient's quality of life. J Endourol 2007; 21:173-6. [PMID: 17338616 DOI: 10.1089/end.2006.0194] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 11/13/2022] Open
Abstract
PURPOSE To improve the quality of life of patients with palliative definitive percutaneous nephrostomy, we prospectively evaluated a subcutaneous ureteral bypass using a newly designed ureteral prosthesis. PATIENTS AND METHODS A series of 19 patients receiving 27 subcutaneous tubes in replacement for percutaneous nephrostomy were evaluated. The ureteral prosthesis (Detour), a silicone tube glued inside a polyester tube, is inserted percutaneously into the renal pelvis to replace an established nephrostomy, tunneled subcutaneously, and introduced into the bladder through a small incision. All patients were followed every 3 months for 18 months or until death from tumor. Quality of life was assessed using the EORTC QLC-30 questionnaire; ultrasonography, intravenous urography, or both were used to assess the position and patency of the tubes. RESULTS There was no failure of insertion and no operative or immediate complication. The mean follow-up was 7.8 months, 6.6 months for the 15 patients who died from their tumors and 1 year for the 4 patients still alive at the end of the study. Suprapubic parietal infection occurred in three patients with altered bladders (radiation cystitis or tumor progression). There was an improvement of the function scale as a result of the elimination of the external percutaneous tube and a parallel worsening of the symptom scale secondary to the progression of disease. Patient ratings of the global quality of life and satisfaction with the urinary diversion were improved because of the absence of the percutaneous tube. CONCLUSION The subcutaneous pyelovesical bypass provides a better quality of life than a standard percutaneous nephrostomy tube in terminally ill patients by making them external-tube free.
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Grise P, Droupy S, Saussine C, Ballanger P, Monneins F, Hermieu JF, Serment G, Costa P. Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: Prospective study with 1 year of minimal follow-up and review of transobturator tape sling. Urology 2006; 68:759-63. [PMID: 17070348 DOI: 10.1016/j.urology.2006.04.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Revised: 03/12/2006] [Accepted: 04/21/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of a minimally invasive surgical procedure using a polypropylene transobturator tape to treat female stress urinary incontinence during a minimal follow-up of 1 year and to present a review of this technique. METHODS A total of 206 women with stress urinary incontinence who underwent the transobturator tape procedure in a French multicenter prospective open tracker study, with a minimal follow-up of 1 year (range 12 to 33 months), were assessed. A nonelastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique used a vaginal and transobturator percutaneous approach. Postoperative assessments included clinical examination, cough-stress test (full bladder), uroflowmetry, and postvoid residual urine volume performed after 1, 6, 12, 18, and 24 months. RESULTS The mean follow-up was 16 months (range 12 to 33). Of the 206 patients, 79.1% were completely cured, 13% improved, and 7% failed. No vascular, nervous system, or digestive perioperative complications were observed; however, 2.4% of the patients had postoperative urinary retention. CONCLUSIONS The results of the present study have confirmed the optimal results in stress incontinence previously reported in short-term studies. These results suggest that the transobturator tape procedure is a valuable alternative to the transvaginal tape procedure, with a low rate of complications.
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Affiliation(s)
- Philippe Grise
- Department of Urology, Rouen University Hospital, Rouen, France
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Robert G, Calvet C, Lapouge O, Vallee V, Emeriau D, Ballanger P. [Development and validation of a model of training at home to the laparoscopy]. Prog Urol 2006; 16:352-5. [PMID: 16821350] [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: 05/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Practice on a Pelvitrainer training is an essential part of the training of surgeons in laparoscopy. Most university departments are equipped with this type of model, but this equipment is expensive, cumbersome and often poorly accessible. The authors propose a new laparoscopy home training model and compare its performances with those of the reference training model. MATERIAL AND METHOD The laparoscopy home training model is composed of a laptop computer; a Web Cam and a translucent plastic box. Ten operators with various levels of training were timed during 4 simple exercises performed on the home training model and were then timed when performing 6 interrupted sutures with this model and with a Pelvitrainer RESULTS All operators successfully performed the proposed exercises. The mean operating time was correlated with the level of training (35 minutes versus 15 minutes for the 3 most experienced operators). The suture time was comparable with the home trainer (14 minutes) and the Pelvitrainer (13 minutes). The home training model is less expensive (75 euros), more accessible and easier to install (3 minutes) than the Pelvitrainer and can be used outside of medicalized structures. CONCLUSION Trainee operators can practice laparoscopy at home. The manufacture of a Home-trainer requires simple material. The training capacities of this model are similar to those of a Pelvitrainer, but it is less cumbersome, less expensive and more readily available. This type of model could be used by each operator at home to improve his/her performances and to accelerate training.
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Ballanger P. [Epidemiology of urinary incontinence in women]. Prog Urol 2005; 15:1322-33. [PMID: 16734224] [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]
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Ballanger P. [Surgery for genitourinary prolapse: prosthesis or no prosthesis?]. Ann Urol (Paris) 2005; 39 Suppl 5:S132-6. [PMID: 16425731] [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: 05/06/2023]
Abstract
In view of the limits of traditional surgery in the restoration of a normal vaginal anatomy and function in genitourinary prolapse, the use of either of synthetic, or more recently biological prosthetic materials, appears to be a necessity. Among synthetic materials, a macroporous net made of a wide mesh of knitted polypropylene monofilaments is currently the reference product for prosthetic surgery of urogenital prolapsus, laparoscopic promontofixation, but also, for the treatment of the cystoceles by the endovaginal route. Materials of human origin are apparently more flexible and the first results seem to show reduced erosion rate, but longer follow-up is required to specify their role in routine practice.
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Affiliation(s)
- P Ballanger
- Service d'urologie, CHU hôpital Pellegrin Tondu, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Martin X, Claude A, Colombel M, Sarramon JP, Ballanger P, Lobel B, Richard F, Saussine C, Cavillon C, Buzelin JM, Baron JC, Lambert D, Haillot O. [Treatment of benign prostatic hyperplasia (BPH) by transurethral needle ablation (TUNA) and 36-month follow-up of the retreatment rate]. Prog Urol 2005; 15:674-80. [PMID: 16459684] [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: 05/06/2023]
Abstract
OBJECTIVE Benign prostatic hyperplasia (BPH) is a disease affecting about 25% of men over the age of 40. One half of these men report symptoms that interfere with their daily activities. MATERIAL AND METHODS In this multicentre study, 102 patients with BPH were treated by transurethral needle ablation (TUNA). The efficacy of treatment was evaluated for 12 months after the operation by means of Madsen and IPSS (International Prostate Symptom Score) scores. The course of uroflowmetry and quality of life (International Score) and sexual function were also assessed for one year. The safety of treatment was evaluated according to the type and frequency of complications. The results show an immediate and significant improvement of symptoms (p < 0.0001 for Madsen and IPSS scores and maximum flow rate between M0 and M12) demonstrating the efficacy of the TUNA system. A very positive impact of TUNA was demonstrated on quality of life. No negative impact was reported on sexual function and the operation had very few repercussions with a low adverse event rate. The retreatment rate (surgical and/or drug) was evaluated 36 months after the operation by means of an optional follow-up questionnaire subsequently completed by the investigators. RESULTS After 3 years, based on the 80 questionnaires returned, 43 patients (53.8%) were stable and did not need any other medical or surgical treatment for BPH. Thirty-seven (37) patients (46.3%) required retreatment: 21 were treated with drugs (26%), 17 were treated surgically (21.25%) including 1 patient who was also retreated with drugs. This study demonstrates the significant and lasting improvement of BPH symptoms by TUNA, which constitutes an alternative attractive to surgery in young patients and/or patients worried about their sexuality.
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Affiliation(s)
- Xavier Martin
- Service d'Urologie, Hôpital Edouard Herriot, Lyon, France.
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Emeriau D, Vallee V, Tauzin-Fin P, Ballanger P. [Morbidity of unilateral and bilateral laparoscopic adrenalectomy according to the indication. Report of a series of 100 consecutive cases]. Prog Urol 2005; 15:626-31. [PMID: 16459675] [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: 05/06/2023]
Abstract
INTRODUCTION Laparoscopic adrenalectomy is the reference technique for the treatment of adrenal tumours. This retrospective study reports the experience of 100 consecutive laparoscopic adrenalectomies, in order to assess its indications, the incision, the morbidity and to determine the limitations of this procedure. MATERIAL AND METHODS Between April 1994 and June 2004, 100 laparoscopic adrenalectomies were performed in 92 patients via a transperitoneal (n = 93) or retroperitoneal (n = 7) approach, with 84 unilateral and 8 bilateral adrenalectomies. The mean age was 52 years. The operative and postoperative characteristics and the functional results were evaluated. RESULTS The mean operating time was 112 min [70-175] via the retroperitoneal approach, 101 min [40-215] via the transperitoneal approach, and 135 min [120-270] for bilateral adrenalectomies. The mean tumour diameter was 44 mm [10-120 mm]. The mean blood loss was 215 ml [0-1210 ml]. Ten patients were transfused. The mean hospital stay was 3 days. Histology revealed 25 Conn adenomas, 20 cortisol-secreting adenomas and Cushing syndrome, 22 phaeochromocytomas, 20 metastases, 2 adrenal cortical adenomas, and 11 incidentalomas. Conversion to "open" surgery were necessary for technical difficulties in 6% of cases. There were 7 minor postoperative complications (7%) and 4 late complications (4%) (deep vein thrombosis, effusion, 2 local recurrences). Four patients in the group with secondary adrenal tumours were alive without recurrence 18, 20, 44 and 48 months after adrenalectomy. Antihypertensive treatment was stopped in 16 of the 25 patients operated for Conn adenoma. The mean follow-up was 31 months [5-98 months]. CONCLUSION This technique has a low morbidity, requires minimal postoperative analgesia and a short hospitalisation. The retroperitoneal or transperitoneal approach must be chosen as a function of the patient's history and the surgeon's habits. Tumours larger than 8 cm can be resected, but with a higher morbidity. Laparoscopic adrenalectomy for malignant tumours is associated with higher morbidity.
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Affiliation(s)
- Damien Emeriau
- Service d 'Urologie, Hôpital Pellegrin, Bordeaux, France.
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Rocha MF, Tauzin-Fin P, Vasconcelos PL, Ballanger P. Assessment of serum catecholamine concentrations in patients with pheochromocytoma undergoing videolaparoscopic adrenalectomy. Int Braz J Urol 2005; 31:299-307; discussion 307-8. [PMID: 16137397 DOI: 10.1590/s1677-55382005000400002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 02/02/2005] [Accepted: 06/10/2005] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We analyzed the changes in serum catecholamine concentrations, i.e. adrenaline and noradrenaline, in response to surgical stress in patients with pheochromocytoma who undergone videolaparoscopic adrenalectomy. MATERIALS AND METHODS Between January 1998 and March 2002, 11 patients underwent 12 videolaparoscopic adrenalectomies. In one case, the adrenalectomy was bilateral. Serum catecholamines were measured at 6 surgical times: T0: control before induction; T1: following the induction, laryngoscopy and intubation sequence; T2: after installing the pneumoperitoneum; T3: during manipulation-exeresis of the pheochromocytoma; T4: following ablation of the pheochromocytoma; T5: in the recovery room following intervention when the patient was extubated and was hemodynamically stable. RESULTS Mean concentrations of serum noradrenaline were significantly different when the T0 and T2 surgical times were compared (T0: 3161 pg/mL; T2: 40440 pg/mL; p < 0.01), T0 and T3 (T0: 3161 pg/mL; T3: 46021 pg/mL; p < 0.001), T1 and T3 (T1: 5531 pg/mL; T3: 46021 pg/mL; p < 0.01), T2 and T4 (T2: 40440 pg/mL; T4: 10773 pg/mL; p < 0.01) and T3 and T5 (T3: 46021 pg/mL; T5: 2549 pg/mL; p < 0.001). Mean concentrations of serum adrenaline were significantly different when the T0 and T3 surgical times were compared (T0: 738 pg/mL; T3: 27561 pg/mL; p < 0.01). CONCLUSION The pneumoperitoneum significantly increases serum noradrenaline concentrations, manipulation of the adrenal gland significantly increases the serum concentrations of noradrenaline and adrenaline, and the pheochromocytoma ablation significantly decreases serum noradrenaline concentrations.
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Affiliation(s)
- Marcos F Rocha
- Department of Urology, Hospital Pellegrin-Tondu, Pellegrin University Hospital Center, Bordeaux, France.
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