Annales D Urologie最新文献

Chemotherapy is one the therapeutic options in prostate cancer. Docetaxel once every three weeks is the current standard for castration-refractory disease with cancer-related symptoms. The docetaxel plus estramustine association is likely more active than docetaxel alone. Docetaxel is currently tested in early stages: first results of phase III trials are expected by 2009–2010.

Urinary diversion, pouches and orthotopic bladder replacement have been made possible by the use of bowel segments in urologic surgery. The most important complications at short and long term are metabolic disorders due to the permanent contact of urine with the bowel segment or the exclusion of this segment from bowel continuity. Metabolic acid-base problems occur immediately after the derivation beginning and depend on the renal capacity to compensating. The metabolic disorder due to the exclusion of a bowel segment appears generally years later, after complete depletion of physiologic reserves (vitamin B₁₂). Perfect knowledge of early and late metabolic complications of urinary diversion allows a more accurate indication, a more adequate selection of the derivation type, an improved patient follow-up, and better long term results. Metabolic complications constitute the best selection criteria for urinary diversion; subsequently, only a few techniques are likely to persist in the future.

Prostate cancer, particularly advanced prostate cancer, should be considered as a chronic disease that requires multidisciplinary management. Each health professional involved the urologist of course, but also the other therapists, especially the general practitioner and nurse, should place their activities within a therapeutic synergy. The onco-psychological dimension should not be underestimated. In particular, information about the disease, its course and the therapeutic solutions proposed should be given gradually and, above all, should be regularly recapitulated. Patients are more accepting of treatments when they know about them. The point of view of the patient with prostate cancer is approached here in two ways; firstly through the comments of a psychologist on the history of a patient with prostate cancer and the dialogue with an experienced urologist. The treatment should not only be understood, but also accepted and requested by the patient. In this chronic disease, the patient often feels the treatment to be a bond between the therapist and himself. A survey based on an auto-questionnaire was also conducted among 275 patients and 50 urologists in order to investigate these relationships. From the results of this survey, in the case of hormone treatment, a quarterly rhythm for LHRH agonist injections appears to be perfectly matched to patient requirements. Monthly injections involve too great an intrusion by the treatment into the life of a cancer patient, in contrast injections which are spaced at greater than quarterly intervals could be seen to much as desertion and also lead to forgetfulness and neglect.

Several adjuvant treatments are used after radical prostatectomy. In case of local risk of recurrence, adjuvant radiotherapy decreases the risk of biochemical recurrence but does not improve the overall survival. In case of metastasis risk, adjuvant hormone therapy should be discussed. For positive lymph node patients, LHRH agonists after radical prostatectomy improve overall survival. For pT3 patients with positive surgical margins, non steroid anti androgens improve disease free survival. © 2007 Elsevier Masson SAS. Tous droits réservés.

Ureteral stenosis is the most frequent complication after kidney transplantation. The diagnosis is based on an elevated creatinine level and a dilatation of the urinary cavity. The first step of the management is a urinary diversion with endo-ureteral prosthesis or a nephrostomy placement. The surgical gold standard is the pyelo-ureterostomy. This is a safe and efficient technique in the treatment of this complication. We describe the different surgical alternatives and the endo-urologic management of the stenosis.

High-intensity focused ultrasound (HIFU) is a minimally invasive alternative for patients with localized prostate cancer, not suitable for radical prostatectomy because of a life expectancy less than 10 years or because of major co-morbidities precluding surgery. HIFU can be performed in patients with LUTS (associated TURP) or with a previous history of BPH surgery. HIFU is repeatable after the initial procedure if a recurrent cancer is diagnosed on control biopsies. Furthermore, this therapy is a viable option for patients with a local relapse after external beam radiation therapy: oncologic efficacy is conversely related to the initial prostate cancer stage before radiation therapy.

Five hundred and twenty one abstracts (26.51 %) were dedicated to prostate cancer during the 2007 annual meeting of the American Urological Association (AUA) which took place in Anaheim from 19-24th of May. The aim of the current article was to provide a summary of the most debated topics and to highlight the most original subjects in this specific field of urology. This year, the main topics of prostate cancer were diversified and concern notably : statin treatment, PSA kinetic, surgical margins, robotic surgery, molecular markers from bodily fluids and adjuvant therapy after surgery.

Before prostatectomy, imaging has a dual role: detecting cancer and staging it. During prostatectomy, imaging can guide the surgeon by localizing a probable zone of prostate extension that therefore contraindicates vessel and nerve preservation. After la prostatectomy, imaging can be useful to differentiate local recurrence and distant metastasis. New techniques such as dynamic MRI and MRI spectroscopy are very promising.

Rising PSA after radical prostatectomy corresponds to a biochemical recurrence, i.e., a new rise in PSA levels. Several definitions of biochemical recurrence exist. Predictive factors can differentiate local recurrence and distant metastasis. Depending on the case, the therapeutic options for managing these recurrences are radiotherapy, hormone therapy, and chemotherapy.