Annales D Urologie最新文献

The contribution of LHRH analogs is enormous in prostate cancer management at nearly all stages of the disease, the leading cancer in males over 50 years of age. They make it possible to use hormone therapy reliably, with little morbidity, and can be reversed. Their use can be immediate or delayed, continuous or intermittent, whether or not they are associated with an antiandrogen, and can be associated with chemotherapy for patients who have reached the stage of hormone-refractory prostate cancer.

Based on a systematized literature analysis, laparoscopic radical prostatectomy is associated with less peroperative blood loss than open surgery. Operative time is shorter using an open approach. In terms of cancer control and functional results, no difference was found between both approaches. © 2007 Elsevier Masson SAS. Tous droits réservés.

The quality of a therapeutic trial depends on several parameters. The ideal trial in prostate cancer should be a high-quality trial on a well-defined and significant population. The method used to calculate the number of subjects necessary should appear in the study. There should be a single and significant evaluation criterion and follow-up should be long given the natural history of the disease. Intention to treat is also a quality criterion. Finally, the therapeutic class effect does not exist; therefore, the efficacy of any new drug, must be proven.

Urachal diseases are infrequent. Congenital affections include cysts, fistula, diverticulum, external sinus, and alternating drainage sinus. Ultrasonography and fistulography are useful for the diagnosis. Treatment of malformations is rarely conservative; it consists in urachal resection. Urachal tumours are frequently malignant and adenocarcinomas are the main histological form. CT scanning is useful for staging. Treatment of urachal carcinomas consists in urachal, umbilicus and bladder removal. Prognosis is poor.

This article is an extensive review on open surgery techniques for urethral strictures from the membranous urethra after pelvic fracture up to the meatus urethrae. It is based on more than 10 year personal experience with nearly all mentioned techniques and a PubMed review on the subject from 1992 to 2005. Most of the studies published are descriptive and retrospective and deliver only a level 3 of evidence. General principles applicable to urethral surgery and tissue transfer are discussed. The different techniques are described in detail. Their indications, limitations, advantages, disadvantages and results are discussed. Especially re-interventions need experience to make the best choice among the different techniques.

Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.

MRI spectroscopy is a non invasive method for detecting active metabolites used as markers. Chorine and citrate are used for analyzing prostate cancer. MRI spectroscopy combines morphologic imaging and metabolic cartography. This combination allows a new approach for the diagnosis of prostate cancer in patients with negative biopsy and high levels of PSA. With MRI spectroscopy the local staging of prostate cancer has a better accuracy than with MRI alone. It can also be used for the diagnosis of residual disease and recurrence in patients treated with conservative therapy.

The indications and techniques of retroperitoneal lymphadenectomy in stage I non seminomatous germ cell tumours have markedly evolved over the past ten years. A literature review allows noticing that historical radical retroperitoneal dissection has been replaced by more limited techniques, known as nerve sparing and nerve preserving lymph node dissection. Stage I non seminomatous germ cell tumours are classified according to the risk of retroperitoneal lymph node involvement; they constitute three groups: low, intermediate and high risk tumours. Retroperitoneal lymph node dissection is considered for low risk patients in case of non compliance or difficult follow-up, and for intermediate risk patients (vascular invasion with presence of high percentage of teratomatous component).