Annales D Urologie最新文献

Except for segmental parenchymal atrophies, partial nephrectomy is more and more often indicated when treating isolated small renal tumours. During the last few years this technique has been increasingly accepted for the excision of tumours less than 4 centimetres. In order to diminish the operative morbidity, the laparoscopic approach has been proposed. During the last decade, laparoscopic partial nephrectomy “has come to maturity” and this technique is now well standardized. Knowledge and operative skills are required for both trans-peritoneal and extra-peritoneal route. Extra-peritoneal approach is more suitable for posterior lesions or at the level of the lower pole while the trans-peritoneal route is preferred in case of tumours near the renal hilum or on the anterior surface. Different methods offering temporary arrest of renal perfusion have been elaborated. There is a clear tendency for renal parenchyma sectioning without the use of any kind of thermal energy. This allows a better identification of renal lesions. Sectioned collecting system, blood vessels and renal parenchyma are systematically sutured. Despite its complexity, this technique has become reproducible and reliable in specialized laparoscopic centres.

This chapter presents a detailed introduction regarding Artificial Neural Networks (ANNs) and their contribution to modern Urologic Oncology. It includes a description of ANNs methodology and points out the differences between Artifical Intelligence and traditional statistic models in terms of usefulness for patients and clinicians, and its advantages over current statistical analysis.

Male infertility is present in 50% of couple infertility. Diagnosis of infertility requires methodical and rigorous approach based upon knowledge of the pathophysiology and the causes of infertility.

Hysterectomy remains a usual procedure in vaginal reconstructive pelvic surgery. However, it may seem illogical, given our improved knowledge of the pathologic pelvic anatomy, to begin pelvic repair by a removal procedure. The question about uterine preservation during vaginal reconstructive surgery is crucial. Although some authors have proposed some arguments on this topic, we don't have, at present, any rigorous prospective and randomized studies able to prove the superiority of hysterectomy or uterine preservation, on long-term anatomic results. Nevertheless, in reconstructive surgery with synthetic mesh, hysterectomy exposes to an increased risk of mesh exposure. Consequently, it increases blood lost, surgical duration and hospitalisation stay. On the other hand, uterine preservation imposes constant gynaecologic follow-up. Subsequently, if a hysterectomy is needed for benign or malignant diseases, the surgery is often difficult because of prior uterine fixation. Subtotal hysterectomy which prevents endometrial cancer can be a possible alternative but, at the moment, no study was able to demonstrate that uterine cervix has a role in pelvic static. Functional results, influenced by biological individual characteristics and by the number of associated procedures, are even more difficult to analyse. Sexual life after hysterectomy has been the subject of numerous publications of unequal scientific quality. Among correctly evaluated and informed patients, hysterectomy do not seem to produce negative consequences on sexuality; it can even improve, in some circumstances, the sexual life. We can admit that cervical conservation in some women may have a role in terms of pleasure, more from sexual fantasies and ballistic reasons than in relation with organic and physiologic reasons. Since no rigorous and specifically oriented works on that topic have been published until now, it seems justified today to promote prospective and randomized studies, advice against systematic attitudes, favour uterine conservation in young women and when doing surgery with mesh, realize a complete gynaecologic work-up before all uterine conservation decisions, correctly inform the patient and respect her preference.

Germ cell tumours of the testis are curable disease. Two different pathological subtypes are observed: seminoma and non-seminoma. Two tumour stages have been defined: the disease limited to the testis and the advanced disease. In the latter group, the prognosis is established by a specific classification based on the level of serum tumour marker and the location of the metastases. The most active first line chemotherapy is a combination of bleomycine, etoposide and cisplatine. Patients with good prognostic factors receive three cycles of this regimen; patients with poor-risk characteristics receive four cycles of the same regimen. The strategy in non-seminoma patients is to give a first-line chemotherapy adapted to the risk factors, then to complete surgical exeresis of all residual disease. Patients with stage I disease may receive two cycles of the same regimen. The strategy for advanced seminoma is to give first-line good-risk chemotherapy followed by a close observation and in several selected cases a surgical removal of all residual disease. Patients with stage I disease may receive one cycle of carboplatin. Salvage chemotherapy is based on the combination of ifosfamide, cisplatine and either vinblastine or paclitaxel.

Today, hysterectomy is, after caesarean section, the most frequent surgical intervention performed in fertile women. Introduced in 1989, laparoscopic hysterectomy remains poorly diffused: today, less than 5% of all hysterectomies remain done by laparoscopy. Nevertheless after a correct learning curve, laparoscopic hysterectomy finds perfect indications in benign and even some malignant indications. In these conditions, the complication rate is similar to those of the other surgical routes. Currently the limitations of this technique are the very bulky uterus, contraindicated uterine morcellation, the lengthening of the operative time potentially generated by this technique, and the lack of experienced instructors.

Hormone-refractory prostate cancer is an advanced stage of the metastatic disease; it has a poor prognosis and a short median survival, about 9 to 18 months. The current article is based on a literature review regarding the prognostic factors and medical treatments, with a focus on recent advances in chemotherapy. With the use of docetaxel that increases the median survival of this disease and improves the symptoms, new clinical protocols have been developed, with promising results; these protocols propose a combination with calcitriol or antiangiogenic agents. Supportive care is also an important part of the treatment due to the high level of bone involvement and its consequences. Such recent advances constitute a real progress in the management of prostate cancer, namely the pharmacological combinations with a promising efficacy and little toxicity.

Permanent seed brachytherapy as a monotherapy is an appropriate treatment in patients with low risk localized prostate cancer such as intraprostatic cancer, T1-2 stage, PSA less than 10 ng/mL, low tumour volume, well differentiated cancer (Gleason score less than 7), gland size less than 50 mL, no micturition symptoms that could decompensate after implantation. A brachytherapy program needs a specialized multidisciplinary team with the collaboration of urologists, radiotherapists (authorized person to manipulate radioactive elements), and physicists. The 10-year oncologic and morbidity results have been published in the literature and are comparable to those of other standard treatments of localized prostate cancer such as radical prostatectomy and external beam radiation therapy.

Radical prostatectomy is a curative option for the treatment of clinically localized prostate cancer. The neurovascular bundles preservation technique increases the chance of sexual activity recovery following surgery. Nevertheless, erectile dysfunction after radical prostatectomy has been reported to occur in up to 80% of patients. Urinary dysfunction is the other main complication of radical prostatectomy. In the literature, conflicting results have been reported regarding the incidence of sexual and urinary disorders following radical prostatectomy. In addition, data regarding urologists' habits for the care of patients following this surgery are sparse. In Repair study, extensive data were collected from both urologists and their patients to analyze the incidence, the consequences, and the way to take care of sexual and urinary disorders following radical prostatectomy.

In the Repair study, 55% of radical prostatectomy patients present urinary disorders following surgery. No difference was observed between the laparoscopic and the open approaches in term of continence scores. One third of patients operated at least eight months earlier, have moderate urinary disorders (30%) to serious urinary disorders (5%). After eight months following surgery, 33% still wear urinary protections during daytime. In general, urologists start to take care of urinary disorders in the first four weeks following surgery. 90% of patients with urinary disorders are managed by kinesitherapy. Finally, it appears in Repair study that urinary incontinence is much well accepted by the patients when discussed preoperatively with the surgeon.