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Schirmann A, Boutin E, Faix A, Yiou R. Tolerance and efficacy of platelet-rich plasma injections in Peyronie's disease: Pilot study. Prog Urol 2022; 32:856-861. [PMID: 35778315 DOI: 10.1016/j.purol.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/02/2022] [Revised: 04/05/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Platelet-rich plasma (PRP) injections are increasingly proposed for the treatment of Peyronie's disease since the discontinuation of Xiapex® despite poorly understood results. OBJECTIVES Evaluation of the tolerance and efficacy of intra-plate PRP injections in patients with Peyronie's disease. METHODS Three intra-plate injections of PRP were performed 15 days apart in 17 patients with Peyronie's disease. The Peyronie's Disease Questionnaire (PDQ) and the measurement of the angle of curvature of the erect penis were assessed before treatment and then 1, 3 and 6 months after treatment. Erectile function was assessed by different questionnaires (IIEF-EF, EHS, SEP, sexual discomfort score). RESULTS No side effects were noted during the study period. Three months after treatment, all three PDQ domains were significantly improved (P=0.002; P=0.015; P=0.017 respectively). The angle of curvature of the penis was significantly decreased by 11.8° with a mean angle of 40.4° before treatment and 28.6° after (P=0.007). The IIEF-EF score was significantly improved after treatment (mean preoperative value: 10.67) with a gain of 5 points at months 1 and 6 (P=0.01 and P=0.036 respectively) and 7 points at month 3 (P=0.04). CONCLUSION Our initial experience suggests that PRP injections for Peyronie's disease are safe. Although the limited data is suggestive of efficacy, a placebo control will be required for confirmation.
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Affiliation(s)
- A Schirmann
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre- de- Tassigny, 94010 Créteil, France.
| | - E Boutin
- Université Paris Est Créteil, Inserm, IMRB, CEpiA Team, 94010 Créteil, France; Unité de Recherche Clinique (URC Mondor), AP-HP, Hôpital Henri Mondor, 94010 Créteil, France
| | - A Faix
- Clinique mutualiste St-Roch, Montpellier, France
| | - R Yiou
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre- de- Tassigny, 94010 Créteil, France
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Madec FX, Akakpo W, Ferretti L, Carnicelli D, Terrier JÉ, Methorst C, Beley S, Graziana JP, Hupertan V, Yiou R, Morel Journel N, Marcelli F, Faix A, Huyghe É. [Congenital penile curvature: Guidelines from the Andrology and Sexual Medicine Committee of the French Association of Urology (CAMS-AFU)]. Prog Urol 2022; 32:656-663. [PMID: 35676191 DOI: 10.1016/j.purol.2022.04.010] [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: 01/10/2022] [Revised: 03/14/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Guidelines regarding congenital penile curvature (CPC) are lacking, and this pathology has not been the subject of French recommendations to date. The Andrology and Sexual Medicine Committee (CAMS) of the French Association of Urology (AFU) propose a series of clinical practice recommendations (CPR) by answering five clinical questions concerning the diagnosis and treatment of this pathology. MATERIALS AND METHODS After a bibliographic research between 2000 and 2021, followed by a critical reading according to the CRP method. These recommendations were written to answer five questions: (1) What are the different types of CPC? (2) What are the reasons for consultation? (3) What are the assessment methods for CPCs and their consequences? (4) What are the indications for CPCs treatment? (5) What are the corrective modalities for the treatment of CPC? RESULTS There are two main phenotypes: CPC type 4 (the most common) and chordee without hypospadias. The diagnosis of CPC is clinical and established through enquiry and clinical examination associated with photos of the erect penis. Support can be offered if the curvature is responsible for a disability and/or sexual dissatisfaction linked to a deformation making penetration difficult and/or in the event of significant psychological impact. Only surgical treatments have demonstrated their effectiveness. For type 4 CPCs, corporoplasty (excisional, incisional, or incisionless techniques) is the gold standard. CONCLUSION These recommendations provide support for the management of patients consulting with CPC.
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Affiliation(s)
- F-X Madec
- Service d'urologie, hôpital Foch, Suresnes, France.
| | - W Akakpo
- Service d'urologie, centre médicochirurgical Ambroise-Paré, Neuilly-sur-Seine, France
| | - L Ferretti
- Service d'urologie, maison de santé protestante de Bordeaux, Talence, France
| | - D Carnicelli
- Service d'urologie, CH Lyon Sud, Pierre-Bénite, France
| | - J-É Terrier
- Hôpital privé de La Châtaignerie, Beaumont, France
| | - C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - S Beley
- Cabinet d'urologie Paris Opéra, Paris, France
| | - J-P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - R Yiou
- Service d'urologie, CHU Henri-Mondor, Créteil, France
| | | | - F Marcelli
- Service d'urologie, CHRU de Lille, Lille, France
| | - A Faix
- Service d'urologie polyclinique Saint-Roch, Montpellier, France
| | - É Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France
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Schirmann A, Boutin E, Faix A, Yiou R. Pilot study of intra-cavernous injections of platelet-rich plasma (P-shot®) in the treatment of vascular erectile dysfunction. Prog Urol 2022; 32:1440-1445. [PMID: 35697553 DOI: 10.1016/j.purol.2022.05.002] [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: 02/07/2022] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intracavernosal injections of platelet-rich plasma (PRP) or P-shot® are increasingly proposed as a curative treatment for organic sexual dysfunction despite the lack of evidence of effectiveness. OBJECTIVES We conducted a pilot study to evaluate the safety and efficacy of intracavernous PRP injections in patients with vascular erectile dysfunction (ED). METHODS Three intracavernosal injections of PRP were performed 15days apart in 15 patients with vascular ED unresponsive to medical treatment with 5-phosphodiesterase inhibitors and/or prostaglandin E instillations or injections. Questionnaires assessing erectile function (IIEF-EF, EHS, SEP, Sexual discomfort score) were completed prior to treatment and 1, 3 and 6 months after the last injection. RESULTS No side effects were noted during the study period. The IIEF-EF score was significantly improved after treatment (P<0.001) with a gain of 5 points at 1month, 4 points at 3months and 3 points at 6months (respectively P=0.001, P=0.003 and P=0.022). The other questionnaires did not change significantly. In total, 20% of patients considered that the erection lasted long enough to have a sexual intercourse (SEP score) before P-shot® versus 26.7% after the treatment (P=1). CONCLUSION This study suggests that the effect of P-Shot® remains moderate in cases of ED with vascular origin. Larger clinical studies are needed to determine the real effectiveness of this therapeutic strategy. LEVEL OF PROOF 2.
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Affiliation(s)
- A Schirmann
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre- de- Tassigny, 94010 Créteil, France
| | - E Boutin
- Université Paris Est Créteil, Inserm, IMRB, CEpiA Team, 94010 Créteil, France; AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC Mondor), 94010 Créteil, France
| | - A Faix
- Clinique mutualiste St-Roch, Montpellier, France
| | - R Yiou
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre- de- Tassigny, 94010 Créteil, France.
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Schirmann A, Faix A, Boutin E, De la Taille A, Yiou R. Efficacité des injections intra-caverneuses et intra-plaques de plasma riche en plaquettes dans la dysfonction érectile d’origine vasculaire et la maladie de Lapeyronie : études pilotes. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.103] [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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Madec FX, Karsenty G, Yiou R, Robert G, Huyghe E, Boillot B, Marcelli F, Journel NM. [Which management for anterior urethral stricture in male? 2021 guidelines from the uro-genital reconstruction urologist group (GURU) under the aegis of CAMS-AFU (Committee of Andrology and Sexual Medicine of the French Association of Urology)]. Prog Urol 2021; 31:1055-1071. [PMID: 34620544 DOI: 10.1016/j.purol.2021.07.012] [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: 03/20/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology). MATERIAL AND METHODS These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables. RESULTS Anterior urethral strictures are a common condition (0,1 à 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (<2cm) may benefit from endourethral treatment (direct visual internal urethrotomy or dilation). In case of recurrence or when the stenosis measures more than 2 cm, a urethroplasty will be proposed. Repeated endourethral treatment management are no longer recommended except in case of palliative option. Urethroplasty is usually done with oral mucosa graft as the primary option, in one or two stages approach depending on the extent of the stenosis and the quality of the tissues. Excision and primary anastomosis or non-transecting techniques are discussed for bulbar urethra strictures. Follow-up by clinical monitoring with urethroscopy, or retrograde urethrography with voiding cystourethrography, is performed at least the first year and then on demand according to symptoms. CONCLUSION Anterior urethral strictures need an open surgical approach and should be treated by urethroplasty in most cases. This statement requires a major paradigm shift in practices. Training urologist through reconstructive surgery is the next challenge in order to meet the demand.
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Affiliation(s)
- F-X Madec
- Service d'urologie, hôpital Foch, 40, rue de Worth, 92150 Suresnes, France.
| | - G Karsenty
- Service d'urologie, hôpitaux universitaires de Marseille Conception, 147, boulevard Baille, 13005 Marseille, France
| | - R Yiou
- Service d'urologie, hôpital Henri-Mondor, CHU Paris est, 51, avenue du Marechal de Lattre de Tassigny, 94010 Créteil Cedex, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux GH Pellegrin, 30000 Bordeaux, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 1, avenue du Professeur Jean-Poulhès, 31400 Toulouse, France
| | - B Boillot
- Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - F Marcelli
- Service d'urologie, CHRU-hopital huriez, rue Michel Polonowski, 59037 Lille, France
| | - N M Journel
- Service d'urologie, Centre Hospitalier Lyon Sud (HCL), chemin du Grand Revoyet, 69310 Pierre Benite, France
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Ferretti L, Madec FX, Akakpo W, Methorst C, Carnicelli D, Terrier JE, Morel Journel N, Beley S, Graziana JP, Marcelli F, Hupertan V, Yiou R, Ben-Naoum K, Savareux L, Huyghe E, Faix A. [French Urological Association (AFU) guidelines for Peyronie's disease assessment and treatment]. Prog Urol 2021; 31:477-494. [PMID: 33941460 DOI: 10.1016/j.purol.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/20/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations. MATERIALS AND METHODS These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography. RESULTS The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered. CONCLUSION The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.
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Affiliation(s)
- L Ferretti
- Service d'urologie, MSP Bordeaux Bagatelle, Talence.
| | - F-X Madec
- Service d'urologie, hôpital Foch, Suresnes
| | - W Akakpo
- Département d'urologie, Hôpital Pitié-Salpétrière, Paris
| | - C Methorst
- Service d'urologie, hôpital des 4 Villes, Saint-Cloud
| | - D Carnicelli
- Service d'urologie, hôpital Privé Jean Mermoz, Lyon
| | - J-E Terrier
- Service d'urologie, Hôpital Lyon Sud, Pierre-Bénite
| | | | | | - J-P Graziana
- Clinique Mutualiste de la Porte de l'Orient, Lorient
| | - F Marcelli
- Service d'urologie, andrologie et transplantation rénale, hôpital Huriez CHU Lille, France
| | | | - R Yiou
- Département d'urologie, CHU Henri Mondor, Créteil
| | | | - L Savareux
- Service d'urologie, Hôpital Privé la Chataigneraie, Beaumont
| | - E Huyghe
- Département d'urologie, CHU Rangueil, Toulouse
| | - A Faix
- Centre d'urologie du Polygone, Montpellier
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Methorst C, Akakpo W, Graziana JP, Ferretti L, Yiou R, Morel-Journel N, Terrier JE, Beley S, Carnicelli D, Hupertan V, Madec FX, Faix A, Marcelli F, Huyghe E. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Varicocele]. Prog Urol 2020; 31:119-130. [PMID: 33308982 DOI: 10.1016/j.purol.2020.11.006] [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: 08/15/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Abstract
The diagnosis of varicocele is clinical, carried out in supine and standing position and in Valsalva maneuver. Only clinical varicoceles have to be treated. A scrotal ultrasound with Doppler is generally performed as part of the infertile man's evaluation or in case of examination difficulties. The main indication for varicocele treatment is the adult man with clinical varicocele and abnormalities of sperm parameters, in a context of infertility of couple, with a partner having a satisfactory ovarian reserve and no cause of female infertility or a curable infertility cause. The decision to treat varicocele must therefore be taken after evaluation of the two partners of the couple. Adults with symptomatic varicocele and those with spermogram abnormalities may also be offered a cure for their varicocele even in the absence of a paternity plan, as well as adolescents with reduced testicular growth, an ipsilateral decrease testicular volume, or a size gradient between the 2 testes. The cure of varicocele can be carried out by surgery or by percutaneous embolization. Microsurgery (inguinal or subinguinal) offers lower rates of recurrence and complications than high surgical approaches (laparoscopic or not) and surgeries without magnification. It is therefore the reference surgical technique. Percutaneous retrograde embolization is a minimally invasive alternative to microsurgery offering satisfactory outcomes with rare and often benign complications. The cure for varicocele results in an improvement in sperm parameters and recent data seem to confirm that it increases the natural pregnancy rate. These results appear after a delay of 3 to 9 months (at least 1 to 2 cycles of spermatogenesis). When the sperm involvement was severe (azoospermia, severe oligospermia), the improvement of the spermogram allow (1) to avoid surgery testicular sperm extraction or (2) perform intrauterine insemination rather than ICSI.
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Affiliation(s)
- C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - W Akakpo
- Service d'urologie, Hôpital universitaire de la Pitié Salpêtrière, Paris, France
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - L Ferretti
- Service d'urologie, Hôpital d'instruction des armées Robert Picqué, Villenave-d'Ornon, France
| | - R Yiou
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | | | - J E Terrier
- Hôpital privé de La Châtaignerie, Beaumont, France
| | - S Beley
- Service d'urologie, Hôpital américain, Paris, France
| | - D Carnicelli
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - F X Madec
- Service d'urologie, Hôpital Foch, Suresnes, France
| | - A Faix
- 265, avenue des États du Languedoc, Montpellier
| | - F Marcelli
- Service d'urologie, CHRU de Lille, France
| | - E Huyghe
- Département d'urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France.
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Akakpo W, Schirmann A, Ferretti L, Ben-Naoum K, Carnicelli D, Graziana JP, Hupertan V, Madec FX, Marcelli F, Methorst C, Morel-Journel N, Savareux L, Terrier JE, Faix A, Huyghe E, Yiou R. [Biotherapies for erectile dysfunction and Peyronie's disease: Where are we now?]. Prog Urol 2020; 30:1000-1013. [PMID: 32826194 DOI: 10.1016/j.purol.2020.05.002] [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: 02/18/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies. AIMS The aims of this study are to give an update on biotherapy for ED and PD and to describe the regulatory framework for these therapies. MATERIALS AND METHODS A literature review was performed through PubMed and Clinical.trials.gov addressing cell therapy for ED and PD and using following keywords "erectile dysfunction", "Peyronie's disease", "stem cell", and "platelet-rich plasma". RESULTS Preclinical studies in rodent models have shown the potential benefit of cell therapy for ED after radical prostatectomy or caused by metabolic diseases, and PD. The tissues used to obtain the therapeutic product were bone marrow, adipose tissue and blood (PRP, platelet-rich plasma). Mechanism of action was shown to be temporary and mainly paracrine. Four clinical trials were published concerning ED after radical prostatectomy and in diabetic patients and one for PD. Eleven clinical trials including three randomized trials are currently going on. Preclinical and preliminary clinical results suggested the possibility to improve spontaneous erectile function and response to pharmaceutical treatment in initially non-responder patients. This effect is mediated by an improvement of penile vascularization. A reduction of penile curvature without side effect was noted after injections into the plaque of PD patients. Most of these therapeutic strategies using autologous cells were considered as "Advanced Therapy Medicinal Products" with strict regulatory frameworks imposing heavy constraints, in particular in case of "substantial" modification of the cells. The regulatory framework remains unclear and more permissive for PRP and cell therapy processes with extemporaneous preparation/injection and no "substantial" modifications. CONCLUSIONS First results on cell therapy for ED and PD are promising. The regulatory framework can significantly change according to cell preparations and origins leading to various constraints. This regulatory framework is crucial to consider for the choice of the procedure.
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Affiliation(s)
- W Akakpo
- Service d'urologie, université Pierre et Marie Curie, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - A Schirmann
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - L Ferretti
- Service d'urologie, hôpital d'instruction des armées Robert-Picqué, Villenave-d'Ornon, France
| | - K Ben-Naoum
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - D Carnicelli
- Service d'urologie, CH de Chambery, Chambery, France
| | - J-P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - F X Madec
- Service d'urologie, CHU de Nantes, Nantes, France
| | - F Marcelli
- Service d'urologie, CHRU de Lille, Lille, France
| | - C Methorst
- Service d'urologie, CH des Quatre Villes, Saint-Cloud, France
| | | | - L Savareux
- Hôpital privé de La Châtaignerie, Beaumont, France
| | | | - A Faix
- Clinique mutualiste Beau-Soleil, Montpellier, France
| | - E Huyghe
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - R Yiou
- Service d'urologie, hôpitaux universitaires Henri-Mondor, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Huyghe E, Graziana JP, Methorst C, Morel Journel N, Terrier JE, Marcelli F, Madec FX, Yiou R, Akakpo W, Hupertan V, Carnicelli D, Beley S, Ferretti L, Faix A. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of andrological and sexual medicine pathologies during the COVID-19 crisis]. Prog Urol 2020; 31:495-502. [PMID: 33941462 PMCID: PMC7434359 DOI: 10.1016/j.purol.2020.08.001] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assist urologists in the management of andrological and sexual medicine pathologies during the COVID-19 crisis. MATERIAL AND METHOD Use of the formalized consensus method. RESULTS The medical and surgical management of patients in andrology and sexual medicine must be adapted. Consultations should, as far as possible, be carried out by tele-consultation. For operative procedures, the delay between the operative decision and the date of (re)scheduling of the procedure will depend on: (1) the level of criticality of the clinical situation; (2) the type of intervention; (3) the functional and psychological repercussions, including quality of life while waiting for the procedure; (4) the notion of losing the chance of having an optimal outcome; (5) the risk of potential complications from delaying a procedure for too long; and (6) taking into account the patient's risk factors for severe forms of COVID-19. The protection of urologists from COVID-19 should be considered. Each urologist must make the best decision for the patient, taking into account the acceptable time frame and quality of life impact before surgical management, the COVID risk parameters, the technical and anesthetic feasibility and the structural possibility of the health care institution to ensure a specific dedicated pathway during the COVID-19 health crisis. CONCLUSION The management of andrological and sexual medicine pathologies must be adapted to the COVID-19 crisis context. Some patients may require surgery, including in emergency. These recommendations are transitional and will end with the COVID-19 crisis.
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Affiliation(s)
- E Huyghe
- Département d'urologie, transplantation rénale et andrologie, site de Rangueil, CHU de Toulouse, Toulouse, France.
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - C Methorst
- Service d'urologie, centre hospitalier des quatre villes, Saint-Cloud, France
| | - N Morel Journel
- Service d'urologie, centre hospitalier Lyon Sud, Lyon, France
| | - J E Terrier
- Hôpital privé de La Châtaignerie, Beaumont, France
| | - F Marcelli
- Service d'urologie, CHRU de Lille, Lille, France
| | - F X Madec
- Service d'urologie, hôpital Foch, Suresnes, France
| | - R Yiou
- Service d'urologie, CHU Henri-Mondor, Créteil, France
| | - W Akakpo
- Service d'urologie, hôpital universitaire de la Pitié-Salpêtrière, Paris, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - D Carnicelli
- Service d'urologie, centre hospitalier Lyon Sud, Lyon, France
| | - S Beley
- Service d'urologie, hôpital Américain, Paris, France
| | - L Ferretti
- Service d'urologie, hôpital d'instruction des armées Robert-Picqué, Villenave-d'Ornon, France
| | - A Faix
- 265, avenue des États-du-Languedoc, Montpellier, 34000, France
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Wagner L, Roumeguere T, Yiou R, Costa P, Hegarty P, Ryckebusch H, Chartier Kastler E. Essai européen virtue© pour le traitemnet de l’incontinence urinaire après prostatectomie radicale : résultats intermédiaires à 1 an. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.057] [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: 12/01/2022]
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Denormandie AC, de la Taille A, Salomon L, Abbou C, Yiou R. [Is transition from pure laparoscopic to robotic-assisted radical prostatectomy associated with increase of surgical procedures for urinary incontinence and erectile dysfunction?]. Prog Urol 2018; 28:921-926. [PMID: 30219647 DOI: 10.1016/j.purol.2018.08.008] [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: 03/18/2018] [Revised: 08/01/2018] [Accepted: 08/09/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the impact of changing the technique of radical prostatectomy [pure laparoscopic radical (PR-Lap) to robot-assisted radical prostatectomy (RP-Rob)] on the rate of secondary procedures for urinary incontinence (UI) and erectile dysfunction (ED). MATERIAL Retrospective study evaluating the number and type of surgical procedures for post-RP UI and DE between 2008 and 2015, according to the technique of (RP-Lap or RP-Rob). RESULTS Between 2008 et 2015, 2046 RP were performed in our department including 372 RP-Lap and 1674 RP-Rob. Among these patients, 84 (4%) had a surgical procedure for post-RP UI (18 AMS800, 9 balloons Pro-Act, and 57 male slings) and 15 (0.7%) had implantation of penile prosthesis for post-RP ED; 16 (0.7%) patients had both procedures. The mean delay between RP and UI surgery decrease from 3.2 years in 2008 to 1 year in 2015 and remain stable for penile prosthesis implantation (mean delay: 3.4 years). The overall rates of secondary procedures for UI and DE remained stable and below 5% and 1.7%, respectively, even during the transition period. For each year of PR studied, the rates of secondary procedure were higher in the RP-Lap group. CONCLUSION Changing the technique of RP from RP-Lap to PR-Rob has a favorable impact on the rate of secondary procedures for UI and ED from the outset.
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Affiliation(s)
- A C Denormandie
- Service d'urologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - A de la Taille
- Service d'urologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - L Salomon
- Service d'urologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - C Abbou
- Service d'urologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - R Yiou
- Service d'urologie, CHU Henri-Mondor, AP-HP, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
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Abstract
Stem cell-based therapies have been recently investigated in the field of organic erectile dysfunctions, such as those associated with diabetes or the treatment of prostate cancer. The overall aim is to repair the repair the underlying penile cellular damage. Here, we review the rationale behind the use of stem cells injection in post-radical prostatectomy erectile dysfunction (pRP-ED).Radical prostatectomy for prostate cancer induces complex neurologic and vascular injuries that cause one of the most difficult-to-treat forms of erectile dysfunction. Evidence from animal models replicating pRP-ED suggests that intracavernous injection of autologous bone marrow mononuclear cells (BM-MNCs) may represent the first curative approach. Several clinical trials are ongoing and two of them have been completed with encouraging results.
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Affiliation(s)
- R Yiou
- APHP, Urology Department, Henri Mondor Teaching Hospital, 51 av du Maréchal de Lattre de Tassigny, 94010 Créteil, France. Tel.: +33 (0)1.49.81.25.59; E-mail:
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Beurrier S, Vordos D, Allory Y, Chiarradia M, Yiou R, Hoznek A, De la Taille A, Salomon L, Masson-Lecomte A. Résultats oncologiques de la cystectomie totale pour tumeurs de vessie invasive chez les patients oligo-métastatiques ganglionnaires. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.012] [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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Yiou R, De la taille A, Hoznek A, Salomon L, Vordos D. Pose de bandelette Virtue 4 bras pour incontinence urinaire masculine : bases anatomiques. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.09.008] [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: 10/20/2022]
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Amandine N, Masson-lecomte A, Mordoch J, Allory Y, Vordos D, Yiou R, Hoznek A, De la taille A, Salomon L. Le score de Gleason après prostatectomie totale de l’ISUP 2005 à l’ISUP 2014 : impact sur la survie sans récidive biologique : proposition d’un nouveau groupe pronostic. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.210] [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: 10/20/2022]
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Salomon L, Droupy S, Yiou R, Soulié M. [Functional results and treatment of functional dysfunctions after radical prostatectomy]. Prog Urol 2016; 25:1028-66. [PMID: 26519966 DOI: 10.1016/j.purol.2015.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 07/24/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. MATERIAL AND METHOD Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. RESULTS Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. CONCLUSION Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
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Affiliation(s)
- L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - S Droupy
- Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - R Yiou
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
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Champy C, Salomon L, Cholley I, Hoznek A, Yiou R, Vordos D, Grimbert P, Lang P, De La Taille A. Prélèvement rénal de donneur vivant par laparoscopie robot-assistée avec extraction vaginale : mise à jour d’une série monocentrique. Prog Urol 2015; 25:723. [DOI: 10.1016/j.purol.2015.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cour F, Le Normand L, Lapray JF, Hermieu JF, Peyrat L, Yiou R, Donon L, Wagner L, Vidart A. [Intrinsic sphincter deficiency and female urinary incontinence]. Prog Urol 2015; 25:437-54. [PMID: 25864653 DOI: 10.1016/j.purol.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 10/20/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Stress urinary female incontinence (SUI) is primary due to intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite a lack of standardised international definition, ISD needs to be clearly diagnosed in order to be correctly treated. This work is an update about the female ISD produced from a review of a published article. MATERIAL AND METHODS This review of article published on this subject in the Medline (Pubmed database), selected according to their scientific relevants, of consensus conferences and published guidelines, has been performed by the committee for women pelvic floor surgery of the French Urological Association. RESULTS Although there is no international consensus definition, we can consider that the ISD is a composite concept combining urodynamic data (MUCP < 20 or 30 cmH20) and one or more clinical information (no urethral mobility, negative urethral support test, failure of a first surgery, leakage during abdominal straining, high stress incontinence scores). Imaging can provide additional evidence for intrinsic sphincter deficiency diagnosis, but the correlation between imaging and function remains low. By standardizing methodology and interpretations to better diagnose women with ISD, it may be possible to improve preoperative planning and outcomes for these patients. A retropubic midurethral sling can be performed as a first surgery. In case of a lack of urethral mobility, the artificial urinary sphincter (AUS) remains the gold standard. Adjustable continence therapy (ACT(®)) can be proposed as an alternative option. The efficacy and safety of muscle-derived cell therapy in ISD needs more studies. Injection of bulking agents may be an option according to the severity and the expectations of the patient. Bladder overactivity needs to be treated as first-line in case of mixed urinary incontinence. In elderly women, a careful evaluation of the bladder contractility and comorbidity must be performed. A geriatric evaluation can be necessary. CONCLUSION Clinical and paraclinical assessment allow to confirm the diagnosis of female ISD, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment.
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Affiliation(s)
- F Cour
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles-Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78035 Versailles cedex, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France.
| | - J-F Lapray
- Centre de radiologie, 151, avenue de Saxe, 69003 Lyon, France
| | - J-F Hermieu
- Service d'urologie, CHU Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - L Peyrat
- Service d'urologie, CHU Tenon, 4, rue de la Chine, 75020 Paris, France
| | - R Yiou
- Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - L Donon
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Debré, 30065 Nîmes cedex 09, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles-Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78035 Versailles cedex, France
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Bütow Z, Audureau E, Salomon L, De la Taille A, Yiou R. Les résultats à deux ans du transobturator bulbar male sling (TOMS) après prostatectomie radicale. Prog Urol 2014; 24:890. [DOI: 10.1016/j.purol.2014.08.234] [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: 11/25/2022]
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Yiou R, Loche C, Lingombet O, Coulomb Y, Billebaud T. Évaluation de l’appréhension, de la gêne et la douleur ressenties lors des différentes phases d’un examen urodynamique. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.126] [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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Champy C, Salomon L, Campeggi A, De Fourmestraux A, Hoznek A, Yiou R, Vordos D, Grimbert P, Lang P, De La Taille A. Laparoscopie robot-assistée et néphrectomie chez le donneur vivant : une évolution naturelle de la technique de prélèvement. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.228] [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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Yiou R, Khoddari M, Trébeau C, Souktani R, Rodriguez A. Restauration des fonctions urinaires et sexuelles après injection bifocale de cellules hMADS dans un modèle animal reproduisant les séquelles de la prostatectomie radicale. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.186] [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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Yiou R, Bittari D, Khoddari M, Abbou C, De La Taille A, Contremoulins I, Lhermigny J, Fall P, Rouard H. Thérapie cellulaire pour la dysfonction érectile après prostatectomie radicale : résultats de la première phase de l’essai clinique instin. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.098] [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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Douard A, de la Taille A, Yiou R, Allory Y, Radulescu C, Vordos D, Hoznek A, Abbou CC, Salomon L. [Prognostic impact of tumors localized at the prostatic apex]. Prog Urol 2013; 23:405-9. [PMID: 23628099 DOI: 10.1016/j.purol.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 01/31/2013] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The apex is a particular region of the prostate in its surgical dissection and pathological analysis. We sought to evaluate the prognostic value of the apical localization of prostate tumors. METHOD From 1988 to 2010, data pre- (age, clinical stage, preoperative PSA, biopsy Gleason score) and postoperative (prostate weight, pathologic stage TNM 2010, Gleason score, margin status) of 2765 total prostatectomies were collected prospectively. These data were compared according to existence or absence of tumor at the apex. The prognostic impact of tumor at the apex on biochemical recurrence-free survival (PSA>0.2 ng/mL) has been studied in univariate and multivariate models. RESULTS One thousand eight hundred seventeen tumors had a location at the apex (65.7%). In univariate analysis, there was a significant difference in the clinical stage, the biopsy and pathological Gleason score, the result of curage, the pathological stage and the margin status between apical tumors and others. With a mean decline of 34.6 months, 502 patients had a biochemical recurrence (18.1%). Disease-free survival at 10 years was 60.7% for tumor at the apex versus 65.9% in other cases. The location at the apex was significantly associated with biochemical recurrence on univariate analysis (P=0.01). After adjustment for clinical and pathological stage, PSA level, Gleason score and surgical margins, the apex was not anymore a pejorative independent predictor (P=0.0087). CONCLUSION The existence of tumor in the prostatic apex was associated with more aggressive tumoral criteria and was an independent and pejorative predictor of biochemical recurrence-free survival at 10 years in univariate analysis. The apical localization could be an additional argument in the decision of adjuvant therapy after prostatectomy.
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Affiliation(s)
- A Douard
- Service d'urologie, centre hospitalier de la Côte Basque, 64100 Bayonne, France.
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El Hajj A, Defourmestraux A, Yiou R, Vordos D, Hoznek A, Salomon L, Abbou C, De La Taille A. Prostatectomie radicale robotique de rattrapage après radiothérapie. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.263] [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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Masson-Lecomte A, Vordos D, Hoznek A, Yiou R, Abbou C, De La Taille A, Salomon L. Impact de l’invasion musculaire sur les résultats oncologiques de la cystectomie pour tumeur résistante au BCG. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.047] [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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Masson-Lecomte A, Vordos D, Gillion N, Hoznek A, Yiou R, Allory Y, Abbou C, De La Taille A, Salomon L. Résultats oncologiques à long terme de la pelvectomie antérieure versus cystectomie seule pour carcinome urothélial chez la femme. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.051] [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: 11/29/2022]
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Basset V, De Fourmestraux A, Campeggi A, Allory Y, Vordos D, Yiou R, Hoznec A, Abbou C, De La Taille A, Salomon L. Rôle de la longueur totale d’effraction capsulaire sur la survie sans récidive biologique en cas tumeur de stade pt3a n0 après prostatectomie totale. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.133] [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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Yiou R, Ebrahimina V, Bedretdinova D, Mouracade P, Taille ADL, Salomon L, Vordos D, Hoznek A, Abbou C. Déterminants de la vie sexuelle des partenaires des patients prostatectomisés utilisant des injections intracaverneuses de prostaglandine. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.150] [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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Yiou R, Hogrel JY, Loche C, Zini L, Lefaucheur JP, Abbou C. Résultats électromyographiques et fonctionnels à un an de l’implantation péri-uretrale de myofibres pour le traitement de l’insuffisance sphinctérienne urétrale. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.08.096] [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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Yiou R, Khodari M, Lingombet O, Rudy M, Mine V, de la Taille A, Salomon L, Abbou C. Évaluation d’un programme infirmier d’éducation thérapeutique pour les injections intra-caverneuses d’alprostadil après prostatectomie radicale. Prog Urol 2011; 21:283-7. [DOI: 10.1016/j.purol.2010.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 05/10/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
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Rodriguez-Covarrubias F, Larré S, Dahan M, De La Taille A, Allory Y, Yiou R, Vordos D, Hoznek A, Abbou CC, Salomon L. Invasion of bladder neck after radical prostatectomy: one definition for different outcomes. Prostate Cancer Prostatic Dis 2007; 11:294-7. [PMID: 17876340 DOI: 10.1038/sj.pcan.4501009] [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] [Indexed: 11/09/2022]
Abstract
The aim of the study was to evaluate factors of progression after radical prostatectomy in patients with bladder neck invasion (BNI). From 1988 to 2006, 1395 patients underwent radical prostatectomy, 120 (8.6%) had microscopic BNI (pT4 N0, TNM 2002). Group 1 was defined as BNI alone, group 2 as BNI plus extracapsular extension and group 3 as BNI plus seminal vesicle invasion (SVI). Postoperative follow-up data were obtained through routine serum prostate-specific antigen (PSA) and digital rectal examination. Biochemical progression was defined as a single detectable PSA level postoperatively (>0.2 ng ml(-1)). Groups 1, 2 and 3 included 38 (31%), 35 (30%) and 47 (39%) patients, respectively. Preoperative PSA (11.1 vs 24.7 and 23.3 ng ml(-1), P=0.01), biopsy Gleason score (5 vs 6 and 6, P=0.003) and specimen Gleason score (6 vs 7 and 7, P=0.02) were statistically different between three groups. None of the patients had a specimen Gleason score >or=8 in group 1. After a mean follow-up of 27 months, 51 (42.5%) patients had biochemical progression. The 5-year progression-free survival was 87, 53 and 17% for groups 1, 2 and 3, respectively (P<0.001). Within pT4 prostate cancer, those tumors with isolated microscopic BNI appear to have better prognosis than those with associated extracapsular extension and/or seminal vesicle invasion, and should be distinguished in TNM classification.
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Goeman L, Salomon L, La De Taille A, Vordos D, Hoznek A, Yiou R, Abbou CC. Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol 2006; 24:281-8. [PMID: 16508788 DOI: 10.1007/s00345-006-0054-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [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: 01/04/2006] [Accepted: 01/26/2006] [Indexed: 11/26/2022] Open
Abstract
The objective of the study was to evaluate the long-term results of retroperitoneal laparoscopic radical prostatectomy (LRP). From 2001 to 2005, 550 consecutive patients underwent a laparoscopic extraperitoneal prostatectomy in our department. Continence and erectile function were analysed prospectively by a self-administrated questionnaire. Mean operating time was 188 min, mean bladder catheterisation time 5.9 days, mean hospital stay 4.6 days Pathological stage was pT2 in 55.8%, pT3a in 29.6%, pT3b in 9.1% and pT4a in 5.4% tumours. Positive surgical margins were 17.9% for pT2, 44.8% for pT3 tumours and 71.4% for pT4a tumours. Five years survival without biochemical progression was 78.8%. After 24 months of follow-up, diurnal continence rate was 91%, and potency rate was 64% when both neurovascular bundles were preserved, 78.6% when the patients were younger than 60 years. LRP is now a standardised procedure. An extraperitoneal approach combines the advantages of a laparoscopic procedure with those of an extraperitoneal approach.
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Affiliation(s)
- L Goeman
- Department of Urology, Henri Mondor Hospital, 51 Avenue du Ml. De Lattre de Tassigny, 94010, Créteil, France
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Abstract
Tissue engineering refers to the techniques that are aimed at regeneration of human tissues and organs. Two elements are necessary for these techniques: matrix and cells. Matrix is the scaffold where tissues may organise. Cells are either autologous cells stimulated to regenerate in vivo, aided by implantation of matrix ("guided tissue regeneration"), or autologous cells cultured outside the body (in vitro) and later returned as auto-transplants. All types of conventional tissue reconstructive surgery need tissue engineering. These techniques have been introduced recently into the clinical practice. One of the main limitations of reconstructive surgery in genitourinary tract is the lack of autologous tissue. Two autotransplants could be distinguished: coherent tissue structure or cell suspensions. The great number of studies published in this area emphasizes the importance of the future clinical implication in urology.
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Affiliation(s)
- L Zini
- Service d'urologie, hôpital Claude Huriez, CHRU de Lille, 59037 Lille cedex, France.
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Antiphon P, Elard S, Benyoussef A, Fofana M, Yiou R, Gettman M, Hoznek A, Vordos D, Chopin DK, Abbou CC. Laparoscopic promontory sacral colpopexy: is the posterior, recto-vaginal, mesh mandatory? Eur Urol 2004; 45:655-61. [PMID: 15082210 DOI: 10.1016/j.eururo.2004.01.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2004] [Indexed: 01/03/2023]
Abstract
OBJECTIVE(S) The aim of our retrospective study was to determine if systematic placement of a posterior mesh, in addition to an anterior vesico-vaginal mesh, is necessary for laparoscopic treatment of pelvic organ prolapse. METHODS A laparoscopic promontory sacral colpopexy was performed in 108 patients, including 55 patients with a concurrent laparoscopic Burch procedure (50.9%). We compared 33 patients treated with a single anterior mesh (SAM) and 71 treated with a double, anterior and posterior, mesh (DM). RESULTS The difference between the SAM and DM groups was statistically significant in terms of posterior compartment failure (rectocele and/or enterocele): 31.3% and 5.9%, respectively (p=0.0006). This significant difference persisted in the Burch (B) group (p=0.001), but not in the non-Burch (NB) group (p=0.98). Among the SAM group, this difference between the B and NB groups, was significant (57.1% versus 0%; p=0.0015) and above all not a single posterior failure was observed in the NB group. CONCLUSION(S) The placement of a posterior mesh, if highly effective, appeared unnecessary in the absence of an associated Burch procedure or a patent posterior prolapse. The posterior mesh also increased risk of postoperative complications and side effects.
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Affiliation(s)
- P Antiphon
- Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
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Makhoul B, De La Taille A, Vordos D, Salomon L, Sebe P, Audet JF, Ruiz L, Hoznek A, Antiphon P, Cicco A, Yiou R, Chopin D, Abbou CC. Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy. BJU Int 2004; 93:67-70. [PMID: 14678371 DOI: 10.1111/j.1464-410x.2004.04558.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [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: 11/30/2022]
Abstract
OBJECTIVE To evaluate the complication rate and clinical follow-up of patients treated for T1 renal cancer by open or laparoscopic nephrectomy at the same institution, as this approach appears to be attractive for treating small renal cancers. PATIENTS AND METHODS Between 1995 and 2002, 39 patients underwent retroperitoneal laparoscopic and 26 transperitoneal open radical nephrectomy for T1 renal cancer (TNM 1997). Variables before during and after surgery, e.g. cancer recurrence, were compared between the groups. RESULTS There were no differences between the laparoscopic and open groups in age, sex ratio, weight, height, fitness score, operative duration (134 vs 133 min), minor or major complications, tumour diameter, Fuhrman grade or length of follow-up. Patients who underwent laparoscopic surgery had less blood loss (133 vs 357 mL, P < 0.001), less need for transfusion (none vs 150 mL, P = 0.04), a lower consumption of analgesia drugs, and shorter hospitalization (5.5 vs 8.8 days, P < 0.001). With a mean follow-up of 20.4 months there was no recurrence or tumour progression. CONCLUSION Laparoscopic radical nephrectomy for patients with T1 renal cancer is a safe, reliable procedure that decreases hospitalization time and bleeding, and ensures the same cancer control as open nephrectomy.
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Affiliation(s)
- B Makhoul
- Department of Urology, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
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Abstract
OBJECTIVE To examine whether the outcome of cystectomy for invasive transitional cell carcinoma (TCC) of the bladder was influenced by the type of disease at initial presentation. PATIENTS AND METHODS The charts of 76 patients treated for TCC by radical cystectomy from 1987 to 1997 in our unit were reviewed. The patients were divided into three groups: group 1 comprised 43 patients with primary invasive disease; group 2 included 12 patients with progression of an initial superficial bladder tumour after failure of conservative treatment; and group 3 comprised 21 patients who had a radical cystectomy for superficial TCC, with a high risk of progression after attempts at conservative treatment. The pathological findings on transurethral resection and cystectomy specimens, cancer-specific survival and the time to progression were compared among the three groups. RESULTS The rate of pT0 in cystectomy specimens was 16%, 41% and 24% in groups 1, 2 and 3, respectively. Under-staging occurred in 24% of cases in group 3. The 10-year cancer-specific survival rates were 48%, 47% and 82% in groups 1, 2 and 3, respectively. The cancer-specific survival rate and progression rate were not significantly different between groups 1 and 2, but were significantly lower/higher in these patients than in group 3 (P < 0.01). CONCLUSIONS These data suggest that the prognosis of superficial TCC which progresses despite conservative management is no better than that of invasive TCC at initial presentation, despite the closer follow-up received by the former patients. Early identification of this group of patients may improve the cancer-specific survival, as early cystectomy for high-risk superficial TCC yields better results.
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Affiliation(s)
- R Yiou
- Service d'Urologie, CHU Henri Mondor, EMI INSERM 99-09, Créteil, France
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Abstract
OBJECTIVE To determine whether muscle precursor cells (MPCs) harvested from limb skeletal muscle can enhance the regeneration process of the striated urethral sphincter after injury. MATERIAL AND METHODS Striated urethral sphincters of male mice were injured by an injection of a myotoxic substance (notexin). In the experimental group, 2 days after injury, MPCs were enzymatically harvested from striated muscles of the lower limbs and labelled with PKH 26, then immediately re-injected into the injured urethral sphincter of the same animal. In the control group, saline buffer was injected instead of MPCs. Animals were killed 7 days or 1 month after injury and the sphincters removed for histological study (the presence of PKH 26-labelled myofibres, measurement of myofibre diameter and total number of myofibres). RESULTS MPC autografting accelerated sphincter muscle repair, as shown by a higher myofibre diameter (P = 0.03) and number (P = 0.01) in the experimental group than in the controls at 7 days. One month after their injection MPCs were still detectable in the regenerating sphincters and participated in the formation of new myofibres. CONCLUSION This study provides the experimental basis for a new therapeutic approach to urethral sphincter insufficiency after surgical or obstetrical injury, based on MPC autografting.
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Affiliation(s)
- R Yiou
- Groupe de Recherche Nerf-Muscle INSERM E 00-11, Centre de Recherches Chirurgicales, INSERM U492, Service de Physiologie, Service d'Urologie, Faculté de Médecine de Créteil et CHU Henri-Mondor, Créteil, France
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Abstract
A case of transverse testicular ectopia with supernumerary vas deferens and cyst of the ejaculatory duct is reported. The reports relevant to these malformations were reviewed and their embryologic etiology discussed.
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Affiliation(s)
- R Yiou
- Service d'Urologie Hopital Henri Mondor, Créteil, France
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Abstract
Lumboscopy provides an approach to the retroperitoneum for the majority of upper urinary tract operations. The technique involves a knowledge of specific anatomical landmarks that differ from those in classical open surgery, because of the inferior approach to the renal pedicle with the kidney initially mobilized in a ventral and cranial position. An anatomical study was conducted on five cadavers, using images from surgical operations, in order to describe the vascular elements of the retroperitoneal spaces as they are approached during lumboscopy, as well as to define specific anatomical landmarks. Identification of psoas major is crucial as it is then possible to locate the renal pedicle opposite and the area of the great vessels medially. During dissection of the renal pedicle the renal vein and its branches are the first elements to be approached. On the left side the distal portion of the renal vein can be confused with a reno-hemi-azygo-lumbar trunk, due to the initial ventral mobilization of the kidney stretching it. Because of the inferior view of the renal pedicle the reno-hemi-azygo-lumbar trunk can obscure part of the renal artery and may be confused with the renal vein. On the right side initial identification of the inferior vena cava on the medial aspect of psoas major facilitates identification of the gonadal, renal and suprarenal veins all located in the same plane.
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Affiliation(s)
- R Yiou
- Service d'Urologie, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, F-94010 Créteil, France.
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Abstract
OBJECTIVES The measurement of the pudendal nerve terminal motor latency (PNTML) is used to assess anal sphincter innervation. In healthy subjects, we studied the influence of age on PNTML and the advantage of a new intra-rectal stimulator. METHODS PNTML was determined in a first series of 40 normal subjects, aged 21-75 years, using a standard St. Mark's electrode, and in a second series of 20 normal subjects over 50 years, using a new intra-rectal monopolar stimulator that did not require finger insertion through the anal canal. RESULTS In the first series, PNTML ranged from 1.8 to 5.6 ms (mean+/-SD 2.94+/-0.8 ms) and correlated positively with the age of the subjects (P=0.01, Spearman test). In the second series, PNTML ranged from 2.2 to 5.4 ms (3.7+/-0.9 ms) and was similar to that of the subjects over 50 years of the first series (3.5+/-0.4 ms) (P=0.35, Mann-Whitney U test). CONCLUSIONS This study showed significant effects of age on PNTML. This should encourage every examiner to establish age-stratified reference values of PNTML for older age groups. In addition, we showed the advantage of using a new type of intra-rectal stimulator to reduce the patient's discomfort by avoiding finger insertion to stimulate the pudendal nerve.
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Affiliation(s)
- J Lefaucheur
- Service de Physiologie - Explorations Fonctionnelles, Hopital Henri Mondor, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France.
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Lefaucheur JP, Yiou R, Colombel M, Chopin DK, Abbou CC. Relationship between penile thermal sensory threshold measurement and electrophysiologic tests to assess neurogenic impotence. Urology 2001; 57:306-9. [PMID: 11182342 DOI: 10.1016/s0090-4295(00)00906-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [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: 11/18/2022]
Abstract
OBJECTIVES Erectile function is usually assessed by neurophysiologic tests such as the bulbocavernosus reflex or pudendal nerve somatosensory evoked potentials. These tests investigate only large nerve fibers, although erection depends on autonomic nerve fibers, which are of small diameter. Warm and cold sensory fibers have similar calibers as the autonomic nerve fibers, and their integrity can be reliably evaluated by the measurement of thermal sensory thresholds. We studied penile thermal sensory testing in parallel with standard electrophysiologic tests to assess their sensitivity in the diagnosis of penile neuropathy. METHODS Twenty-five normal male subjects without erectile dysfunction or evidence of diffuse neuropathy (group 1) and 35 diabetic patients who complained of impotence (group 2) were studied. Erectile function was quantitated using the erectile dysfunction symptom score. Warm, cold, and vibratory sensory thresholds were assessed on the dorsal aspect of the penis. In addition, penile sympathetic skin responses and pudendal nerve somatosensory evoked potentials were recorded. RESULTS We found a significant difference between the two groups in the erectile dysfunction symptom score (P <0.0001), cold threshold (P = 0.0007), and warm threshold (P = 0.0025), but not for the other parameters. The erectile dysfunction symptom score correlated with the penile warm and cold thresholds (P = 0.0006 and 0.002, respectively). CONCLUSIONS Thermal thresholds assess small nerve fiber damage, which can indirectly reflect autonomic disturbances, particularly in the context of a diffuse neuropathy such as diabetic polyneuropathy. Penile thermal sensory testing correlated strongly with the clinical evaluation of erectile function and is a new and promising tool for the diagnosis of neurogenic impotence.
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Affiliation(s)
- J P Lefaucheur
- Service de Physiologie-Explorations Fonctionnelles, CHU Henri-Mondor, Creteil, France
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Lefaucheur JP, Yiou R, Salomon L, Chopin DK, Abbou CC. Assessment of penile small nerve fiber damage after transurethral resection of the prostate by measurement of penile thermal sensation. J Urol 2000; 164:1416-9. [PMID: 10992425] [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: 02/17/2023]
Abstract
PURPOSE To determine the occurrence of penile small nerve fiber damage following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). MATERIALS AND METHODS Penile nerve function was evaluated in 18 consecutive patients prior to and one month after TURP for BPH. To test nerve fibers of small diameter, the penile warm and cold sensory thresholds were measured by means of a Peltier-based device, as well as the penile sympathetic skin potentials obtained following electrical stimulation at the wrist. To test nerve fibers of large diameter, the pudendal nerve somatosensory evoked potentials (pSEPs) and the penile vibratory thresholds were recorded. Clinical erectile function was quantified using a standardized questionnaire (erectile dysfunction symptom score, EDSS). Urinary handicap was assessed by the measurement of maximum flow rate (MFR) at uroflowmetry and by a standardized questionnaire (AUA symptom score, AUASS). RESULTS Penile warm threshold (+7.8 vs +6.3C, p = 0.005), cold threshold (-8.5 vs -5.7C, p = 0.003) and vibratory threshold (9.3 vs 7.9 microm., p = 0.03) were significantly higher after than prior to TURP. The amplitude of pSEPs tended to decrease (1.7 versus 2.3 microV, p = 0.06), whereas the remaining neurophysiological parameters were unchanged. Clinical assessment by EDSS demonstrated a significant postoperative erectile function impairment (20.2 vs 17.5, p = 0.04), whereas mictional function improved (MFR: 19 vs 8.8 ml./s and AUASS: 4.9 versus 15.1, p < 0.0001). CONCLUSIONS This study highlights the occurrence of penile small nerve fiber damage following TURP and supports the hypothesis of neurogenic damage as the primary cause of post-operative erectile dysfunction.
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Affiliation(s)
- J P Lefaucheur
- Service de Physiologie-Explorations Fonctionnelles and the Service d'Urologie, CHU Henri-Mondor, Creteil, France
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Yiou R, Salomon L, Colombel M, Patard JJ, Chopin D, Abbou CC. Perineal approach to radical prostatectomy in kidney transplant recipients with localized prostate cancer. Urology 1999; 53:822-4. [PMID: 10197867 DOI: 10.1016/s0090-4295(98)00365-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [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: 11/22/2022]
Abstract
Close urologic follow-up of renal transplant candidates and recipients often reveals prostate carcinoma at an early stage. Two patients who underwent renal transplantation for end-stage disease also underwent radical perineal prostatectomy for localized prostate carcinoma, 3 years after grafting in 1 patient and 4 years before grafting in the other. The perineal approach to prostatectomy may facilitate later renal transplantation and avoid allograft damage.
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Affiliation(s)
- R Yiou
- Service d'Urologie, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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Yiou R, Fuhrer K, Meeker LD, Jouzel J, Johnsen S, Mayewski PA. Paleoclimatic variability inferred from the spectral analysis of Greenland and Antarctic ice-core data. ACTA ACUST UNITED AC 1997. [DOI: 10.1029/97jc00158] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Yiou R, Franco D, Vons C. [Treatment of refractory hydrothorax in liver cirrhosis by pleuro-peritoneal shunting]. Gastroenterol Clin Biol 1996; 20:1135. [PMID: 9033860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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