Annales D Urologie最新文献

The Repair study included 535 French urologists. All of them answered to a general information questionnaire. Then, they had to complete a questionnaire for each of the 10 first radical prostatectomy patients they saw in consultation and who were operated in the last 12 months. Overall, 2445 patient questionnaires were completed by the urologists. In addition, 2644 self-questionnaires were completed by the patients at home and sent to the TNS SOFRES Company. All questionnaires contained information regarding the incidence and the management of urinary and sexual disorders following radical prostatectomy.

The Repair study contains many data regarding the incidence of erectile dysfunction following radical prostatectomy, and the point of view of patients who undergo sexual disorders. First, it appears that 80% of patients are given information by their urologist before surgery about sexual consequences of radical prostatectomy. During the three months before surgery, 92% and 75% of patients who completed the questionnaires have had erections and sexual intercourse, respectively. Using the laparoscopic approach or the open technique for radical prostatectomy appears not to influence the incidence of erectile dysfunction following surgery that is 92%. Contrary to what the urologists report in the questionnaires, the patients consider erectile dysfunction more important than urinary disorders. In addition, 61% of patients report that they would like to be treated for erectile dysfunction during the first three months following surgery, which is earlier than the urologists consider. Finally, it appears in the Repair study that erectile function recovery is easier when patients are managed early after surgery for their sexual disorders.

Here is reported the main data contained in the Repair study regarding the management of sexual disorders following radical prostatectomy by French urologists. 20% of urologists do not evaluate the sexual function of their patient prior surgery. All urologists who participated to the study report that they take care of erectile dysfunction following radical prostatectomy. 38% of them have a systematical approach for the management of erectile dysfunction following surgery. 80% of urologists start their management of sexual disorders during the first 3 months following surgery, and 88% of them always use the same protocol. In 76% of cases, this protocol consists in the administration of intracavernous injections. The early administration of erectile dysfunction treatments is frequently used by the urologists. Finally, it appears in the Repair study that erectile dysfunction treatment is better accepted by patients when given early and systematically after surgery.

Although the objective of the urologist is to correct the factors of male infertility and to favour natural procreation, the strategy must consider also the couple and the female aspects of infertility. Some types of male infertility require specific treatment. In severe cases, recent advances in medical assistance to procreation have changed the prognosis of male infertility. Pregnancy can be obtained by the means of gamet manipulation and spermatozoid selection. Nevertheless, such techniques expose to genetic disorders transmission. Subsequently, genetic assessment is required during male infertility management, especially for difficult cases.

Transabdominal sacrocolpopexy offers an excellent definitive treatment option for patients with high grade vaginal vault prolapse with long-term success rates ranging from 93-99 %. However, because it is a transabdominal procedure it is associated with increased morbidity compared with vaginal repairs. We describe a novel minimally invasive technique of vaginal vault prolapse repair and present out initial experience. The surgical technique involves placement of five laparoscopic ports: three for the Da Vinci ^® robot and two for the assistant. A polypropylene mesh is then attached to the sacral promontory and to the vaginal apex using Gortex sutures. At the end of the case, the mesh material is the covered by the peritoneum. We also present our initial experience with this technique in 18 consecutive patients. The analysis focused on complications, urinary continence, patient satisfaction, and morbidity. Follow-up was conducted by provider-patient interview. Twenty-five patients underwent a robotic-assisted laparoscopic sacrocolpopexy at our institution in the past 24 months for severe symptomatic vaginal vault prolapse. 10/25 (40 %) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5. (1-12) months and mean age was 66 (47-82) years. Mean total operative time was 3.2 (2.25-4.75) hours. One patient had to be converted to an open procedure secondary to unfavorable anatomy. All but one patient were discharged from the hospital after an overnight stay; one patient left on postoperative day #2. Complications were limited to mild port site infections in two patients, which resolved with oral antibiotic therapy. One patient developed recurrent grade 3 rectocele, but had no evidence of cystocele or enterocele. We present a novel technique for vaginal vault prolapse repair that combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high patient satisfaction. While our early experience is encouraging, long-term data is needed to confirm these findings and establish longevity of the repair.

Lymphomas of the genitourinary tract represent rare tumours for which the diagnosis is crucial regarding the specificity of the treatment. The most frequent localisations are the kidney (solitary tumour or multiple nodules) and the testis; other sites of the genitourinary tract are uncommon. One of the main challenges is to obtain an appropriate immuno-histochemical diagnosis with a good staging which is necessary to adapt the therapeutic options. These are mostly based on chemotherapy (with immunotherapy in B-cell lymphomas), of which the intensity and number of cycles depend on initial prognosis factors.

The conservative management of kidney cancer is widely accepted as a therapeutic option for tumours measuring less than 4 cm or in case of underlying renal disease and solitary kidney. The functional and carcinologic success of this conservative treatment results from a radical resection of the tumour and a careful repair of the collecting system and selective ligature of the vessels. Kidney artery clamping is a key to reach these objectives. The cooling of the kidney preserves from warm ischemia and reperfusion lesions. In this review, we explain the physiological basis of warm ischemia induced kidney lesions due to the kidney artery clamping and the advantage of hypothermia. The surgical technique as described by Novick is detailed. This well standardized technique has the advantage of being reproducible and adaptable to all situations.

Retropubic radical prostatectomy is the most commonly used therapeutic option for the treatment of clinically localized prostate cancer. An ongoing stage migration towards organ-confined cancers allows performing a nerve-sparing procedure in a growing number of patients. Key elements for achieving convincing functional results are a sphincter preserving ligation of the distal part of Santorini's plexus and the subtle preparation of the neurovascular bundle. This article gives a detailed description of the operative technique. Furthermore, a strategy for patient selection and tumour selection for the indication of nerve-sparing radical prostatectomy (NSRP) is suggested.

The histological appearance and the clinical behaviour of upper urinary tract urothelial tumours are almost identical to those of the bladder. Superficial papillary tumours rarely progress and turn to invasive disease despite a high frequency of recurrence. Technical developments in the endourology field have allowed full endoscopic access to upper tract tumours. Endoscopic resection or ablation of the tumour can be undertaken safely and effectively through ureteroscopy or percutaneous nephroscopy with low risk of extra-renal tumour seeding. For superficial (Ta, T1), low grade (I, II) tumours, a conservative approach can be selected without compromising survival and prognosis. For muscle invasive > T2 or high grade (III) tumours, nephroureterectomy remains the treatment of choice. Intracavitary BCG used after percutaneous resection reduces the risk of recurrence of upper tract urothelial tumours regardless of the grade. Finally, the world literature and our personal experience have shown that the tumour grade and stage are the two independent factors that affect survival of patients with upper urinary tract tumours.