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Corporate culture has recently aroused a great deal of interest and debate in several fields, particularly in business management. Imbued with a rigid and static conception of culture, studies have long excluded any impact of TIC on this variable. The presumed relationship between culture, TIC use and performance was a one-way street. Today, a very different image of culture represents it as an open and dynamic system; susceptible to change as a result of TIC adoption. It is in this perspective that this study aims to analyze the complementarity of corporate culture and TIC in the quest for performance. The problematic that arises is to know how the use of TIC acts on the corporate culture in the search for performance. Based on the hypothesis that the adaptation of the corporate culture to the evolution of TIC leads to performance. The analysis of the results of a survey by opinion poll near a sample of 580 Malagasy companies made it possible to affirm that the use of TIC can be adjusted to the corporate culture because a communication of the culture via TIC can lead to better performances.

L’objet du présent article scientifique est d’évaluer la performance des entreprises à Madagascar par rapport à l’atteinte de l’Objectif du Développement Durable (Axe n°3) relatif à la construction d’un monde meilleur à travers le développement de tout l’Homme et de tous les hommes. Il s’agit de la performance liée au bien-être du salarié au travail. Les Ressources Humaines constituent un levier de croissance et sources de compétitivité pour l’entreprise. Le bien-être au travail devient actuellement une source d’investissement et de motivation. Dans ce contexte, cette dernière prend soin de l’environnement physique et psychologique de son personnel. De même, le bien-être du salarié au travail devient stratégique pour maintenir et accroitre sa performance individuelle. Mais la problématique qui se pose est de savoir en quoi le bien-être au travail impacte-t-il sur la performance individuelle du salarié ? En se basant sur l’hypothèse que le bien-être du salarié au travail ait une influence significative sur la performance individuelle, le présent travail, par une démarche hypothético- déductive, analyse les résultats d’une enquête par sondage. La présente étude est réalisée au mois de Mai 2022 auprès de 562 salariés au sein des entreprises publiques et privées de la région d’Analamanga dans l’objectif de connaitre l’impact du bien-être du salarié au travail sur la performance individuelle.

Resume Introduction L’influence de l’allongement du delai entre les biopsies de prostate et le traitement par prostatectomie radicale pour les patients presentant un cancer de prostate localise est controverse. L’objectif de cette etude etait d’etablir un delai limite entre biopsies de prostate et prostatectomie radicale au-dela duquel les risques d’upgradging et de recidive biochimique seraient majores. Materiel et methode Entre janvier 2013 et janvier 2017, une analyse retrospective des donnees cliniques, biologiques et histologiques de 513 patients ayant eu une prostatectomie radicale pour cancer de prostate localise a ete effectuee dans un centre unique. Le critere de jugement principal etait l’evaluation du risque de recidive biochimique par la difference entre les scores post-biopsies USCF-CAPRA et post-chirurgical CAPRA-S. Le critere de jugement secondaire etait l’evaluation de l’upgrading par la difference entre le score de Gleason sur biopsies et sur piece operatoire. Les risques de recidive biochimique et d’upgrading ont ete compares par test de Student en fonction de differents delais entre biopsies prostatiques et prostatectomie radicale. Les delais les plus courts pour lesquels une difference significative etait retrouvee ont ete rapportes. Resultats Dans cette etude, 513 patients ont ete inclus. L’âge median au moment de la biopsie etait de 65 ans (IQR : 60–69). Le PSA median pre-operatoire etait de 7,30 ng/mL (IQR : 5,60–9,94). Le delai median entre les biopsies et la chirurgie etait de 108 jours (IQR : 86–141). Pour la cohorte entiere, le risque de recidive biochimique apres prostatectomie radicale etait significativement plus eleve au-dela d’un seuil de 90 jours (p = 0,039). Aucun seuil n’a ete retrouve pour les patients Gleason 6(3 + 3). Un seuil de 90 jours a ete retrouve pour les patients Gleason 7(3 + 4) (p = 0,038). Les patients Gleason ≥ 8 presentait plus d’upgrading au-dela d’un seuil de 60 jours (p = 0,040). Conclusion Notre etude a montre qu’au-dela d’un delai de 3 mois, le risque de recidive biochimique apres prostatectomie radicale etait significativement plus eleve pour les cancers de prostate localises. Ce delai semblait pouvoir etre allonge chez les patients a faible risque, alors qu’il paraissait devoir etre conserve pour les risques intermediaires, et reduit a 2 mois pour les risques eleves. Niveau de preuve 4.

Objectifs La presence de carcinome in situ (Cis) en association a une tumeur de vessie est un facteur pronostique etabli. Le pronostic associe a la presence de Cis sur les recoupes ureterales lors de la cystectomie totale est en revanche mal defini. L’objectif a ete d’etablir les differences de pronostiques associees au statut des recoupes ureterale vis-a-vis du Cis. Methodes Une etude retrospective cas-temoin monocentrique realisee dans un service hospitalo-universitaire entre 2001 et 2016. Sur une base de donnees de 1450 cystectomies, 122 patients (cas) porteur du Cis dans les recoupes ureterales lors de la cystectomie ont ete apparies selon l’âge, le sexe, le stade pTNM et la methode de derivation urinaire avec un echantillon de population de 122 patients (temoins) qui avaient des recoupes ureterales saines. L’analyse de regression multivariee de Cox a ete utilisee pour tester l’effet des recoupes positives sur la survie sans recidive urotheliale, la survie specifique au cancer et globale. Resultats La moyenne de suivi etait de 55,43 ± 39,6 mois. La mediane de survie globale et specifique etait diminuee dans le groupe cas estime respectivement a 43,3 [35,33 a 56,93], 52,43 [42,16 a 68,93] par rapport au groupe temoin avec une difference significative (p = 0,001, p = 0,0039). La probabilite cumulee de survie sans recidive urotheliale etait diminuee dans le groupe cas (63,9 %, [49,68 a 78,01]) par rapport au groupe temoin (p = 0,0001). En analyse multivariee, une diminution significative de la survie sans recidive urotheliale etait associee a la presence du Cis sur les recoupes ureterales (p = 0,003, odds ratio = 0,42, IC95 % : [0,28–0,64]) ainsi qu’a l’aspect de l’uretere (epaissie, dilate) (p = 0,023, odds ratio = 0,62, IC95 % : [0,31–0,84]) ( Fig. 1 , Fig. 2 et Tableau 1 ). Conclusion La presence de Cis sur les recoupes ureterales et l’aspect epaissi et ou dilate de l’uretere lors de la cystectomie a ete associee a une diminution significative de la survie globale, specifique et sans recidive urotheliale.

Introduction Our objectives were to evaluate the long-term renal function after radical cystectomy (RC) and ileal conduit diversion (ICD) and to analyze year-by-year the estimated glomerular filtration rate (eGFR) and morphologic upper urinary tract changes. Patients and Methods We retrospectively identified 226 patients who had undergone RC and ICD from 1980 to 2008, with regular postoperative follow-up visits. The eGFR was calculated using the Modification of Diet in Renal Disease equation at baseline and during follow-up. A decrease in renal function was defined as > 1 mL/min/1.73 m 2 annually. Results The median follow-up period after RC was 91 months (range, 61-235 months). The median eGFR decreased from 66 mL/min/1.73 m 2 (range, 17-139 mL/min/1.73 m 2 ) to 59 mL/min/1.73 m 2 (range, 33-102 mL/min/1.73 m 2 ). A rapid decline in renal function occurred during the first 2 postoperative years (−9 mL/min/1.73 m 2 and −4 mL/min/1.73 m 2 in the first and second year, respectively), with a moderate to slight decrease in the subsequent years. Urinary obstruction was diagnosed in 51 patients (23%). Among the patients who underwent prompt surgical treatment, we did not find any association with the eGFR decline ( P = .8). Conclusion Patients with urinary ICD have a lifelong risk of chronic kidney disease. Regular monitoring of renal function and the morphologic upper urinary tract will permit early diagnosis and treatment of modifiable factors, avoiding irreversible kidney damage.

Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA). Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan–Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model). The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011–1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011–1.483), p = 0.038]. Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.

To describe the epidemiology, clinical features, and prognostic factors of local recurrence (LR) in a large case series of patients treated by radical cystectomy (RC) for bladder cancer. A retrospective study was conducted on 903 patients treated in a single tertiary reference center. All cases of LR were identified. Descriptive analysis was performed on the clinical features, evolution, and overall mortality of these patients. Prognostic factors of LR were assessed using the Mann–Whitney test for continuous variables and the χ2 test for categorical variables. Fifty-three patients were diagnosed with LR during follow-up (5.9 %). One patient had concomitant distant metastasis. Pain was the most frequent symptom leading to diagnosis. Mean time interval from RC to LR was 14.4 ± 13 months (1–64) with 50 % of cases diagnosed in the first postoperative year. Overall median survival of patients diagnosed with LR was 9 months [95 % confidence interval (6–11)]. Advanced pathological stage (T3 or T4) and lymph-node invasion were associated with increased LR rate in univariate and multivariate analysis. Presence of squamous cell carcinoma (SCC) was associated with a poorer prognosis after LR compared to pure urothelial carcinoma (p = 0.04). None of the parameters tested was associated with time interval between RC and LR diagnosis. LR is not uncommon, favored by high pathological stage (T3/T4), and has a very bad prognosis, particularly when SCC is present. LR must be carefully tracked during follow-up after RC, and optimal management of these cases remains to be determined.

Study Type – Therapy (retrospective cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The more that bladder cancer progresses from the urothelium to the outside of the bladder the worse the prognosis. To date, the use of adjuvant chemotherapy has not been completely defined. The present study clarifies the prognosis and benefits of adjuvant chemotherapy for different stages of bladder cancer that invade perivesical fat. OBJECTIVE • To assess the prognosis of pT2b, pT3a and pT3b bladder cancers after radical cystectomy (RC) in order to define potential situations where chemotherapy may be of benefit. PATIENTS AND METHODS • Between 1985 and 2009, 903 patients underwent a RC and pelvic bilateral lymphadenectomy in an Institutional Referral Centre. • In all, 87 patients (9.6%) had a pT2b tumour, 111 patients (12.3%) a pT3a tumour, and 129 patients (14.3%) a pT3b tumour. • The median (range) overall follow-up was 23 (1–350) months. • Overall (OS), disease-specific (DSS), metastases-free (MFS) and local recurrence-free survival (LRFS) was estimated and compared using Kaplan–Meier plots and log-rank test. RESULTS • The 5-year survivals pT2b and pT3a were similar for LRFS (86% vs 84%), MFS (69% vs 63%), DSS (72% vs 70%) and OS (66% vs 61%), and the prognosis was better than for pT3b stage tumours (69%, 44%, 40%, and 31% respectively). • In pN0 disease, MFS differences between pT2b–pT3a and pT3b tumours were not significant in patients who had received adjuvant chemotherapy (MSF of 87%, 69% and 56%, respectively) while they were significant in patients without adjuvant chemotherapy (MFS of 70%, 68% and 42%, respectively). CONCLUSIONS • Bladder cancers invading perivesical tissue macroscopically have a greater propensity to produce lymph node metastases, local recurrence, and have lower MFS, DSS, and OS. In pN0 disease, pT3b tumours may receive more benefit from adjuvant chemotherapy. • Our results could be a useful for selecting patients for adjuvant chemotherapy.

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the results in terms of functional results and morbidity of Z-shaped ileal neobladder performed in a single center. PATIENTS AND METHODS 329 consecutive male patients who had an orthotopic bladder replacement using the Z-shaped ileal neobladder between May 1990 and January 2009. RESULTS The mean age of the patients was 64.4 ± 9.6 years, with a mean follow-up of 59.4 ± 55 months. Eighty-three early complications in 80/294 patients (27.2%) occurred. The average Clavian rate of these early complications was 2.24. Among these, 12 complications in 12 patients (4.1%) were pouch-related, and 3 reoperations were required. Two patients died from cardiac complications. Sixty-three late complications in 60/294 patients (20.4%) were recorded. The average Clavian rate of these late complications was 2.98. Among these, 47 complications in 45/294 patients (15.3%) were pouch-related, and 18 reoperations were required, essentially for ureteral anastomosis stricture. Satisfactory daytime urinary continence was achieved in 92% of patients. Daytime continence was obtained within, on average, 6.8 ± 16.4 months. The interval between each daytime urination was 2.6 ± 0.8 h (median = 2.5 [1–5] h). Forty-four (15%) patients developed metabolic acidosis which only required oral medication. Satisfactory nocturnal urinary continence was achieved in 87% of patients. Night-time continence was obtained within, on average, 10.8 ± 22.4 months. Hyper-continence with subsequent need for CISC was observed in 4%. CONCLUSION In our series of 329 patients, compared with the other techniques, the Z-shaped ileal neobladder had an ‘expected’ complication rate for this high risk surgery with satisfactory daytime and night-time continence in nine out of ten patients.

Resume But Etudier et evaluer le fonctionnement des neovessies orthotopiques en « Z » a long terme et la qualite de vie des patients ayant ce type de remplacement. Materiel et methode A partir de 162 dossiers de patients ayant eu une cystoprostatectomie totale pour cancer de vessie suivi d’un remplacement orthotopique type Z avec un recul de cinq ans minimum, 40 patients (recul moyen de 113 mois) habitant dans le departement ont ete convoques pour un entretien et ont constitue la population cible de ce travail. Un examen physique, un Pad test et un entretien specifique ont permis d’evaluer la continence tandis que trois questionnaires valides ont permis d’apprecier la qualite de vie. Resultats La continence etait satisfaisante pour 82 % des patients de jour et 55 % la nuit. Il existait une correlation negative significative entre l’âge au moment de la cystoprostatectomie et la continence diurne. Leur qualite de vie etait bonne a long terme. Conclusion Les resultats fonctionnels a long terme de la neovessie ileale detubulee en Z sont satisfaisants. Elle permet, tout en respectant le schema corporel, une bonne qualite mictionnelle ainsi qu’une qualite de vie satisfaisante chez les patients necessitant une cystoprostatectomie totale pour cancer.

Resume Objectif Evaluer l’impact de l’indication imperative sur le taux de complication et les resultats carcinologiques a long terme apres nephrectomie partielle (NP). Patients et methodes Entre 1985 et 2005, tous les patients operes d’une NP pour cancer localise dans deux centres ont ete revus. Les taux de complication global, hemorragique et urinaire ont ete compares entre le groupe I (indication elective) et le groupe II (indication imperative). Les survies sans recidive et specifique a cinq, dix et 20 ans ont ete comparees entre ces deux groupes. Une analyse multivariee selon le modele de Cox a ete realisee pour rechercher les facteurs associes a la recidive et au deces sur l’ensemble de la serie. Resultats Trois cent cinq patients ont ete inclus dans l’etude. Aucune difference significative n’a ete retrouvee entre le groupe I et le groupe II en ce qui concerne le taux de complication global (17 vs 20 %), le taux de complication hemorragique (3,5 vs 3,8 %) et le taux de complication urinaire (3,9 vs 2,5 %). Les patients operes pour une indication imperative avaient des survies sans recidive et specifique significativement plus faibles a cinq, dix et 20 ans. Sur l’ensemble de la serie, l’indication imperative etait le seul facteur independant associe a la recidive et au deces en analyse multivariee. Conclusions Si le taux de complication ne semblait pas significativement associe a l’indication operatoire, les patients a l’indication imperative representaient un groupe heterogene de moins bon pronostic. Ce facteur devrait etre pris en compte dans les etudes portant sur la NP.

Urinary tract involvement is rarely described in APS. We report the case of a 40 year-old man with primitive APS who was diagnosed an arterial and venous unilateral ureteral ischemia, revealed by a hydronephrosis. He had been on oral anticoagulation for six years because of two deep venous thromboses. He developed then a massive splenic infarct and an acute myocardial infarct, which required intensification of his anticoagulation, add of aspirin and high doses of corticosteroids. Three months later, he was explored for a latero-thoracic pain. Biology found an acute renal failure and microscopic haematuria. CT scan showed hypoperfusion of the left kidney, an ostial defect on renal artery and left hydronephrosis. Retrograde pyelography found a proximal ureteral stenosis. A dilatation with stenting failed, leading to a partial left ureteral resection. Histology confirmed ureteral segmental organized arterial thrombosis and venous thrombosis. Evolution was favourable with stabilization of creatinine level.Urinary tract involvement is rarely described in antiphospholipid syndrome (APS). We report the case of a 40 year-old man with primitive APS who developed an arterial and venous unilateral ureteral ischemia revealed by painful unilateral hydronephrosis. The patient was on oral anticoagulation for six years because of two deep venous thromboses. He developed then a massive splenic infarct and an acute myocardial infarct, which required the intensification of his anticoagulation and high doses of corticosteroids. Three months later, he was explored for a latero-thoracic pain. Biology found an acute renal failure and microscopic haematuria. CT scan showed a hypoperfusion of the left kidney, an ostial defect on renal artery and a left hydronephrosis. Retrograde pyelography found a stenosis of the proximal ureter. A dilatation with stenting failed, leading to a partial left ureteral resection. Histology confirmed ureteral segmental organized arterial thrombosis and venous thrombosis. Evolution was favourable with stabilization of creatinine. DOI: http://dx.doi.org/10.3126/jaim.v2i2.7659 Journal of Advances in Internal Medicine 2013;02(02):78-80

Resume De nombreuses lesions benignes de la prostate comme l’atrophie, l’hyperplasie adenomateuse atypique ou des foyers de PIN peuvent simuler un cancer et conduire au diagnostic de foyer suspect (ASAP), incitant a effectuer de nouvelles biopsies. Devant de telles lesions, le pathologiste peut avoir recours a une etude immunohistochimique avec l’anticorps anti cytokeratine de haut poids moleculaire CK903 (34bE12) qui en confirmant l’absence de cellules basales, permet de porter le diagnostic de cancer. But de l’etude Evaluer les nouveaux marqueurs des cellules basales (cytokeratine 5/6 et p63), et un marqueur des cellules prostatiques tumorales (p504s) dirige contre l’alpha methylacyl-CoA racemase (AMACR), dans le diagnostic du cancer de prostate. Materiels et methodes Etude retrospective sur 44 prelevements inclus et fixes en paraffine (36 biopsies, 4 resections, 1 adenomectomie et 3 prostatectomies radicales), interessant 20 adenocarcinomes prostatiques (2 cas de carcinome intraductal ; 12 cas Gleason 6(3+3) ; 4 cas Gleason 7(4+3) ; 2 Gleason 8(4+4)) ; 11 foyers suspects ; 9 neoplasies intra epitheliales : 2 bas grade et 7 haut grade dont 1 isolee ; 10 lesions benignes (8 atrophies, 1 hyperplasie adenomateuse atypique et 1 hyperplasie cribriforme a cellules claires). Pour tous les cas, des coupes de tissu fixe inclus en paraffine ont ete testees avec les anticorps anti CK 5/6 et un cocktail associant p63 et p504s, apres restauration antigenique et utilisation de l’automate Ventana. Resultats CK 5/6 et p63 marquent les cellules basales des glandes normales dans respectivement 91,3 et 100 % des cas, quelque soit le mode de fixation (Bouin, Formol). Les adenocarcinomes ont un profil p63 -/p504s +, les neoplasies intra epitheliales et l’hyperplasie adenomateuse atypique sont p63 +/p504s + et les lesions benignes (atrophie, hyperplasie des cellules basales, hyperplasie cribriforme a cellules claires) sont p63 +/p504s –. L’etude des differents anticorps montre un gain en terme de sensibilite CK5/6 (80 %), p63 (90 %), p504s (95 %) p63/p504s (100 %) et de specificite : CK5/6 (87,5 %), p63 (90,5 %), p504s (90,9 %) p63/p504s (90 %). Conclusion Les resultats de cette etude preliminaire permettent de valider la technique d’utilisation d’un cocktail d’anticorps p63/p504s sur l’automate Ventana, et montrent que devant une lesion ambigue, la realisation d’une etude immunohistochimique avec les anticorps anti CK5/6 et un cocktail p63 + p504s permet de proposer un diagnostic dans 82 % des cas.

Objectifs Evaluer l’indication du curage ganglionnaire dans le cancer de prostate en appreciant le taux de curages positifs (N+) lors de la prostatectomie robot-assistee (PRR). Methodes Serie de 447 patients consecutifs operes de PRR, de fevrier 2010 a mai 2016 par mono-operateur, donnees recueillies de facon prospective en base de donnees portant sur le nombre de curages realises (bilateraux–unilateraux), le nombre de curages positifs, serie selon les donnees du bilan preoperatoire (PSA, Gleason, TR), en univarie et en multivarie (actuellement en cours). Resultats Pas de curage 30,4 % – curage unilateral 6 % et N+ = 0 – curage BILATERAL 63,5 % et N+ = 6,7 %. Les donnees du curage bilateral seules seront donc exploitees (284 pts). Nombre moyen de ganglion par curage : 17 (7–34) ( Tableau 1 ). Conclusion Le curage etendu montre un taux de positivite significatif meme dans les faibles risques presumes en preoperatoire, du fait de l’imprecision relative des criteres de risque qui doivent etre revisites. La rentabilite du curage ganglionnaire etendu justifie sa pratique lors de la prostatectomie radicale.

Purpose: After cystectomy for bladder cancer, when pelvic lymph nodes are positive, bladder replacement remains controversial. The aim of this study was to evaluate the outcome of patients who underwent neobladder replacement despite bladder cancer metastasis to the regional lymph nodes. Materials and Methods: From 1981 to 1997, a total of 504 consecutive cystectomies for bladder cancer were performed at our institution. For 150 patients, pelvic lymphadenectomy were positive, nevertheless 71 patients underwent a neobladder replacement (50 N1 and 21 N2). The distribution of patients by clinical stage, according to the TNM 97 classification, was 4 T1, 14 T2, 32 T3 and 21 T4. No patient showed signs of metastasis on diagnosis. Results: Five-year disease specific survival rate of the entire group (71 patients) was 46%. With a mean follow-up of 8.3 years (3.2–20 years), 25 patients (35%) were alive and free of disease (72% with day continence), five patients were alive with recurrence (three bone metastasis, one chest metastasis and one with local recurrence), 41 patients died, (three non-cystectomy related). Of the 46 patients who recurred, a total of eight patients had local recurrence. For five patients, a severe dysfunction of the plasty appeared: two needed definitive bladder drainage until they died, one patient became totally incontinent, one patient needed a conversion of the plasty to Bricker ileal conduit. For the remaining patient the tumor involvement provoked recto-plasty-cutaneous fistula. All these five patients died in the 6 months after the plasty dysfunction appeared. Conclusions: Although prognosis in bladder cancer metastasis to the regional lymph nodes has been reported to be poor, this study demonstrates that after cystectomy, it is justified to propose a neobladder replacement to well selected patients. Local recurrence only occurred in 11% of patients and there was no damage to enteroplasty function for nearly half of the patients, and considering benefit to the quality of life, orthotopic bladder substitution should be considered as the preferential diversion in this patient population.

Objectives. To assess in a prospective study whether extracorporeal shock wave therapy (ESWT) using a standard radioscopic location lithotriptor is effective in the treatment of Peyronie’s disease. Methods. Fifty-four patients were included in this prospective study. Before and after treatment, the angulation was calculated by auto-photography. Pain severity was assessed by a visual analog pain scale. A self-evaluation questionnaire (International Index of Erectile Function) was used. All patients had symptoms (35 had pain during erection and 51 angulation greater than 20°). The mean disease duration was 16 months. The mean angulation before treatment was 48° (range 10° to 100°). Twenty-four patients had erectile dysfunction (questionnaire score less than 18). The Multiline Siemens lithotriptor was used. The plaque was located by palpation, and 1 mL of contrast agent was injected. Scopic visualization was used. Each patient received a minimum of one session of ESWT (3000 shock waves, 7 kJ) applied to a flaccid penis. Results. All patients completed the protocol. The tolerance and safety were excellent. Of the 35 patients with pain on erection, 31 (91%) noticed relief immediately after ESWT (mean reduction 2.9 on the visual analog pain scale) (P

Objectifs Lorsque les tumeurs de vessie infiltrant le muscle sont localement avancees, ou qu’il existe une atteinte ganglionnaire, une chimiotherapie « d’induction » est recommandee. Elle vise a obtenir l’operabilite du malade mais son benefice potentiel ne peut etre extrapole a partir d’etudes sur la chimiotherapie neoadjuvante, realisee de principe, chez un patient operable. Nous nous sommes interesses aux devenir et pronostic des patients traites par chimiotherapie d’induction pour un cancer de la vessie localement avance ou metastatique ganglionnaire. Methodes Il s’agit d’une etude retrospective monocentrique incluant les patients pris en charge pour une tumeur de vessie cTxN1-3M0 ou cT4NxM0 traites par chimiotherapie d’induction entre 2006 et 2016. L’envahissement ganglionnaire a ete determine soit sur des criteres d’imagerie, soit histologiquement avec la realisation d’un curage premier. Les donnees clinico-bio-pathologiques et du suivi des patients ont ete relevees. Les courbes actuarielles de survie ont ete etablies selon la technique de Kaplan–Meier et comparee par le test du log rank. L’analyse de l’association des differents facteurs supposement pronostiques a la survie ont ete realisees. Resultats Soixante-douze patients ont ete etudies. Leur devenir est rapporte dans la Fig. 1 . Le pronostic des 51 patients repondeurs a la chimiotherapie d’induction etaient significativement plus favorable en termes de survie sans progression et de survie globale (p Conclusion Il semble de meilleur pronostic que les patients repondeurs a la chimiotherapie d’inductions soient operes au decours de ce traitement.

Introduction and Objectives: The aim of this study was to evaluate preliminary results of tension–free vaginal tape (TVT), a new surgical procedure, performed during the learning ph

Objective: The aim of this study was to assess the impact of a 12–month treatment period with alfuzosin, 2.5 mg t.i.d, on symptomatic patients with BPH (n = 355) by means of the Int

Purpose: Proliferation rate is an important determinant of bladder tumor progression. However, this factor has not yet been correlated to bacillus Calmette–Guerin (BCG) therapy resp

The aim of this retrospective study was to evaluate the effects and results of low-dose bacillus Calmette-Guérin (BCG) therapy on a selective high-risk population of stage T1, grade 3 (G3) bladder tumours. Recurrence and progression were also analysed. Thirty-five consecutive patients presenting with T1 G3 tumours were treated with intravesical BCG. All patients underwent complete transurethral tumour resection. A course of BCG 75 mg Pasteur strain was begun 4 weeks after the first resection of the diagnosed tumour and continued for a 6-week period. At the end of treatment, a complete urological evaluation was routinely carried out: urine cytology test, cystoscopy with bladder biopsies randomly performed, and any recurrences were resected. In cases of abnormal cytology and/or recurrence an additional course of BCG was initiated, followed by the same tests. Follow-up examination and cystoscopy or fibroscopy were conducted every 3 months for 1 year, semiannually and annually thereafter. Median follow-up was 45 months (range 10-120); 7 patients (20%) did not respond to BCG instillations. Of these patients, 5 underwent cystectomy and in 2 patients the bladder was left in place in spite of recurrence because of age (+80 years). Twenty-eight patients (80%) responded positively, 24 after one single course of BCG, and 4 patients after two courses. During follow-up, recurrence was observed in 8 cases: stage T1 G3 in 4 patients, T1 CIS (carcinoma in situ) in 2 patients, Ta G2 and Ta G1 in 2 patients. Three of these patients were treated by cystectomy and the remaining patients with transurethral resection alone or combined with additional courses of BCG. Overall, 25 patients (71%) were considered free of tumour occurrence after low-dose BCG therapy. Ten patients underwent cystectomy (29%) or remained in occurrence and 2 patients died of the disease. These results can be closely compared to the results of other trials conducted on stage T1 G3 and BCG treatment, using a different dosage and BCG protocol therapy. BCG is an effective prophylactic and therapeutic agent for T1 G3 carcinoma of the bladder responders. The identification of these responders before beginning instillations still remains a challenge.

Objective: The management of the male urethra after cystectomy for bladder cancer continues to be a dilemma. Patients who undergo a cystectomy require either urinary diversion or bladder substitution. Therefore, the use of the urethra to ensure voiding is important. On the other hand, the probable risk of urethral carcinoma recurrence is generally estimated at approximately 10%. The aim of this study was to assess the predictive value of preoperative urethral biopsies, and of frozen sections during cystoprostatectomy, in patients with invasive bladder cancer. Methods: From 1982 to 1986, 118 male patients underwent a cystoprostatectomy for transitional cell carcinoma of the bladder. All patients underwent endoscopic latero-montanal biopsies 2 weeks preoperatively and urethral frozen cut section during radical prostatocystectomy. Results: Carcinoma was observed in 12 patients on both examinations. All patients underwent en bloc urethrectomy during cystectomy. In the remaining 106 patients, the frozen cut margin was negative (including 9 with positive latero-montanal biopsies), and these patients had the urethra preserved. After a 10-year minimum follow-up, no recurrence was observed in these patients with negative frozen cut section. No significant risk factors for urethral recurrence were found. Latero-montanal biopsies did not reveal a positive specificity, and this procedure was later abandoned in our institution (in 1986). Conclusions: The urethral frozen section was the only guideline used for simultaneously performing the urethrectomy. All male patients with negative frozen cut sections should be considered candidates for bladder substitution. A prophylactic urethrectomy is only indicated in patients with carcinoma (minimum carcinoma in situ) in the frozen urethral margin section during cystectomy.

The purpose of this study was to determine health-related quality of life (HRQoL) among long-term disease-free survivors in women who underwent radical cystectomy (RC) for urothelial carcinoma and orthotopic ileal neobladder (ONB) reconstruction, using validated patient-reported outcome instruments.From 2000 to 2011, a total of 46 women with urothelial bladder carcinoma had RC and ONB at our institution; 31 (67 %) eligible women completed 3 validated questionnaires: the medical outcome study short form 12 (SF-12), the urinary symptom profile, and the Contilife, respectively evaluating general HRQoL, voiding function, and urinary incontinence specific HRQoL. Unadjusted analyses were performed to analyze standardized measures of HRQoL and voiding symptoms; p0.05 was considered significant.The mean follow-up was 5.7 years; 24 women (77 %) considered their health as good, very good, or excellent. The SF-12 physical and mental scores were not significantly different between the population study and the general population (p0.05). A total of 20 women (65 %) declared to be fully continent. Daytime incontinence, nighttime incontinence, and hypercontinence were reported by 26, 29, and 31 % of women, respectively. On unadjusted analysis, incontinence was associated with age65 years at the time of surgery (p0.001). Hypercontinence was not associated with any variable.This study suggests that in the setting of radical cystectomy in women, ileal neobladder reconstruction provides long-term satisfaction with maintained HRQoL. For properly selected women, orthotopic neobladder can be considered an appropriate diversion choice.

To evaluate sexuality and erectile function of candidates for radical prostatectomy in order to assess the place of nerve-sparing surgery in the preoperative discussion.From June 2004 to January 2005, 75 consecutive patients, candidates for radical prostatectomy, were prospectively evaluated. Their erectile function and sexuality were evaluated after announcing the diagnosis. Patients completed the IIEF (International Index of Erectile Function), EQS (Erection Quality Scale) and the sexual satisfaction score (SSS). The mean age of the patients was 65 years and 50% were younger than 65.Erectile dysfunction according to the IIEF-5 scale was observed in 64% of cases (43% of patients younger than 65 and 84% of patients over 65). Erectile dysfunction was considered to be severe in 5% of young patients versus 34% of patients over 65. The majority of patients (69%) had a sexual activity more than twice a month. Only 31% of patients under 65 and 8% of older patients considered their erections to be very satisfactory according to the EQS. Despite this high frequency of erectile dysfunction in men over the age of 65, sexual satisfaction was not influenced by erectile dysfunction. In contrast, patients younger than 65, erectile dysfunction clearly altered the SST sexual satisfaction score.Erectile dysfunction was present in a large proportion of candidates for radical prostatectomy. The presence of erectile dysfunction in patients over the age of 65 did not modify their sexual satisfaction score. A detailed clinical interview concerning sexuality should be conducted to select patients likely to benefit from nerve-sparing surgery. Nerve-sparing surgery would be beneficial in young patients in whom sexual satisfaction is dependent on erectile function. In the older men, erectile dysfunction can be present without affecting sexual satisfaction.

The diagnosis of prostate cancer is based on histological examination of prostatic biopsies using histological criteria identified on standard stains. In certain lesions mimicking prostate cancer, the pathologist must perform immunohistochemical studies looking for loss of basal cells and antibodies directed against cytokeratin CK 903 (34bE12) or CK5/6, which sometimes give inconclusive results leading to a diagnosis of suspicious site. The discovery of overexpression of alpha-méthylacyl CoA racemase in prostate cancer using a microarray technique has allowed the development and marketing of an antibody (P504S /AMACR) which, in combination with a new basal cell marker (p63), is a very valuable tool for the pathologist in the management of suspicious sites and cancers less than 1 mm in diameter detected on prostatic biopsies.

Purpose: Resection of ileal segments may result in malabsorption and a decrease in intestinal uptake of different substances. The use of intestinal segments in the urinary tract may also cause metabolic disorders. We studied long-term metabolic consequences of enterocystoplasty after radical cystoprostatectomy for bladder cancer.Materials and Methods: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectomy. The enterocystoplasty was constructed with a 35 cm. ileal segment resected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultrasonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglycerides, albumin, protein, vitamins B12 and B9, iron, ferritin, calcium, phosphate, vitamin D, parathyroid ho...

Numerous lesions of the prostate, such as atrophy, adenomatous atypical hyperplasia (adenosis) or PIN can be misdiagnosed with prostatic cancer, and confused with ASAP, leading to perform additional biopsies. In such lesions, the pathologist can perform an immunohistochemical study with the anti-high molecular weight cytokeratin antibody CK903 (34bE12), which confirms the absence of basal cells and supports the diagnosis of prostatic cancer.To compare markers of basal cells (cytokeratin 5/6, p63) and the marker of prostatic carcinomatous glands (p504s) or alpha methylacyl-CoA racemase (AMACR).Retrospective study of 44 cases of paraffin-embedded prostatic specimens (36 biopsies, 4 PER, 1 adenomectomy and 3 radical prostatectomies), consisting in 20 cases of prostatic carcinomas (2 intraductal, 12 Gleason 6 (3+3), 4 Gleason 7 (4+3), 2 Gleason 8 (4+4)), 11 ASAP, 9 PIN (2 low grade, 7 high grade (2 isolated)), and 10 benign lesions (8 atrophy, 1 atypical adenomatous hyperplasia and 1 case of clear cell cribriform hyperplasia). All cases were tested with antibodies to CK 5/6, and with a cocktail to p63 and p504s, after heat antigenic retrieval on NEXES Ventana processor.Basal cells of normal prostatic glands stained with CK5/6 and p63 in 91,3% and 100% of cases, independently from the fixation procedure (Bouin or Formalin). Carcinomas had a p63-/p504s+ profile, PIN were p63+/p504s+, and benign lesions were p63+/p504s-. We observed an increase in sensitivity: p63/p504s (100%), CK5/6 (80%), p63 (90%), p504s (95%), and specificity: p53/p504s (90%), CK5/6 (87.5%), p63 (90.5%), p504s (90.9%).Our results show that the use of a cocktail to p63/p504s is more specific than the use of CK5/6 alone this technique supports a diagnosis of prostatic cancer in 40% of cases previously considered as ASAP.

Pelvic arteriovenous malformations (AVM) are rare, and the treatment of this condition presents an interesting challenge. We report the first case of a major AVM in a patient with Down syndrome which was revealed by a massive hematuria. Arteriography showed a bilateral complex iliac artery malformation. The first proximal embolization (unilateral) did not prevent bladder hemorrhage, and the second distal (bilateral) immobilization produced bladder necrosis. However, the patient died despite an emergency cystectomy.

Purpose: The goal of this double-blind, placebo-controlled, three-way crossover, randomized clinical trial was to compare the efficacy and safety of the combination of 6g of L-arginine glutamate and 6mg of yohimbine hydrochloride (AY) with that of 6mg of yohimbine hydrochloride (YP) alone and that of placebo (PP) alone, for the treatment of erectile dysfunction (ED). Materials and Methods: Forty-five patients were included in this study. During each of the 2-week, crossover periods, drug was administered orally, one to two hours before intended sexual intercourse. The primary endpoint was change in the Erectile Function Domain score of the International Index of Erectile Function (IIEF). The secondary endpoints were patient and investigator assessments of treatment success. Results: At the end of each treatment period, the Erectile Function Domain scores for AY, YP and PP were 17.2±7.17, 15.4±6.49 and 14.1±6.56, respectively. The difference between AY and PP was statistically significant ( p =0.006). When stratified according to baseline scores over 14, those patients with mild to moderate MED had a better Erectile Function Domain response to treatment (AY=22.2±4.99, YP=18.2±5.59, PP=16.9±6.91, respectively) than those with scores 14 and below (AY=12.4±5.48, YP=12.7±6.25, PP=11.4±5.02, respectively). Investigators' and patients' assessment of efficacy was significantly improved by YP over PP. Conclusions: This pilot study shows that the on-demand oral administration of the L-arginine glutamate 6g and 6mg yohimbine combination is effective in improving erectile function in patients with mild to moderate ED. It appears to be a promising addition to first-line therapy for ED.

Objectifs La topologie du cancer localise de la prostate conduit a adopter une strategie preetablie de chirurgie de preservation, bilaterale, unilaterale ou non preservative, ainsi que la proximite capsulaire de la dissection. Notre objectif etait d’evaluer les resultats de la strategie chirurgicale pour la recuperation de la spontaneite erectile pour pouvoir ainsi informer les patients sur leurs chances effectives de recuperer une erection spontanee apres prostatectomie radicale. Methodes Analyse des resultats depuis 1/2010 pour 187 patients sexuellement actifs en preoperatoire, recueillis de facon prospective a 1 mois et 1 an, portant d’une part sur le type de preservation des BNV realisee par l’operateur senior, classe en dissection intra-fasciale (IA), inter-fasciale (IR), extra-fasciale (E), et non preservative (non), unilaterale (x1) ou bilaterale (x2), et d’autre part sur l’appreciation de la rigidite penienne par le patient sur une echelle de 0 a 10 (la penetration etant estimee possible a partir de 7), la possibilite d’avoir des rapports sexuels avec penetration, l’utilisation des traitements de recours quels qu’ils soient (Trt R) pour obtenir une erection effective. Resultats Outre la qualite de la preservation chirurgicale, l’âge etait un element essentiel predictif de la recuperation. Les resultats presentes dans les tableaux ci-dessous sont stratifies selon l’âge, le type de dissection [bilaterale (IAx2 + IRx2 + IAIR)–unilaterale (IAx1 + IRx1 + IAE + IRE)], et le delai de recuperation effective (dans le mois postoperatoire : M1, a 1 an : M12). ( Tableau 1 ) Conclusion Par tranches d’âge, la recuperation d’erections effectives etait plus frequente et precoce en cas de preservation bilaterale qu’unilaterale, et l’utilisation de traitements de recours a ete plus frequente en cas de preservation unilaterale. L’information donnee au patient devrait mentionner ce risque chiffre en fonction du type d’exerese et de preservation, eu egard a la tumeur pour laquelle il est traite.

Objectifs L’obesite augmente le risque de cancers de la prostate et est associee a un devenir pejoratif avec une recidive biologique plus frequente apres prostatectomie radicale. Cependant, le mecanisme de cette association n’est pas clairement defini. Cette etude avait pour objectif de comparer les caracteristiques histologiques des cancers de la prostate en fonction de l’IMC et du statut gonadique chez les patients ayant une prostatectomie radicale. Methodes Entre 3/2007 et 9/2013, les donnees cliniques, pathologiques, et biologique des patients traites par prostatectomie radicale dans un centre francais ont ete collectes. La testosterone totale (TT) et bio disponible (bioT) preoperatoire ont ete determinees par radio-immunologie dans un laboratoire centralise (prelevements realises entre 7 h et 10 h). Le seuil definissant l’hypogonadisme etait TT ® v.17, Chicago, IL). Resultats Au total, 937 patients ont ete inclus. Les valeurs moyennes de l’âge, du PSA, d’IMC, de TT et BioT etaient respectivement de 63 ± 6 ans, 8,48 ± 5,49 ng/ml, 26,4 ± 3,6 kg/m 2 , 4,60 ± 1,67 ng/mL et 1,35 ± 0,62 ng/mL. Cent trente-cinq patients etaient obeses (14,4 %), parmi lesquels 42 avaient une TT Conclusion L’obesite hypogonadisme sont tous deux des facteurs de risque independant de pGP4 chez les patients traites par prostatectomie radicale. Ces deux facteurs doit etre pris en compte dans la prise en charge du cancer de la prostate, specialement lorsqu’une approche conservatrice est envisagee ( Fig. 1 ).

Objectifs Les marges positives (R1) apres prostatectomie radicale, facteur reconnu de recidive biologique, posent la question de l’indication d’un traitement adjuvant par radiotherapie ou d’un traitement de rattrapage a la recidive. Afin de guider cette decision therapeutique, notre etude avait pour objectif d’analyser la survie sans recidive biologique des patients R1 sans traitement adjuvant et avec PSA post-operatoire indetectable et d’en determiner les facteurs de risque. Methodes Entre 2005 et 2008, 630 patients ont ete traites par prostatectomie radicale pour adenocarcinome dans notre centre. Une relecture anatomopathologique a ete faite. Les patients R1, Nx ou N0, avec PSA postoperatoire indetectable et n’ayant pas recu de traitement adjuvant par radiotherapie ont ete inclus. La survie sans recidive biologique a ete etudiee avec la methode de Kaplan-Meier. Pour definir les facteurs associes a la recidive, une analyse uni- puis multivariee (modele de Cox) ont ete effectuees. Resultats Parmi les 630 patients, 207 avaient une marge positive (32,8 %) dont 111 repondaient aux criteres d’inclusion. Les tumeurs etaient classees T2 ( n = 71), T3 ( n = 37) ou non statuables ( n = 3), avec score de Gleason 7 dans 68 % des cas. La duree moyenne de suivi etait de 70 mois. Le taux de recidive biologique etait de 33 % avec survie sans recidive a 5 ans de 64,5 %. En analyse univariee, les variables significativement associees a la recidive etaient : predominance et pourcentage de Gleason 4, volume tumoral, engainement peri-nerveux et extension extra-prostatiques, longueur de la marge et predominance de Gleason 4 a la marge. Le PSA preoperatoire n’avait pas d’impact ( p = 0,06). En analyse multivariee, seuls restaient significatifs le volume tumoral (OR = 4,29, IC95 % [1,011–1,483] p = 0,038) et la longueur de la marge (OR = 4,35, IC95 % [1,011–1,421] p = 0,037). ( Tableau 1 ), ( Fig. 1 ) Conclusion Seul un patient sur trois a eu une recidive biologique. On peut donc raisonnablement surseoir au traitement adjuvant par radiotherapie chez les patients ayant une marge positive apres prostatectomie radicale et PSA postoperatoire indetectable. Le volume tumoral et la longueur de la marge sont des facteurs de risque de recidive biologique a prendre en consideration dans la decision therapeutique postoperatoire.

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.

To assess the efficacy and the safety of a new transurethral endoscopic device using bipolar electrocautery, the Gyrus system. This system permits rapid prostate tissue removal by endoscopic vaporization with little bleeding and no pad return using saline irrigation and therefore eliminating TURP syndrome.Forty-two patients (mean age 70; range 49-90 years) with symptomatic benign prostatic hyperplasia (BPH) without suspected cancer, confirmed by digital rectal examination and PSA tests, were treated between October 1998 and February 1999 with the Gyrus and evaluated at 1 and 3 months postoperatively by the International Prostate Symptom Score (IPSS) and maximum urinary flow rate.No postoperative bleeding necessitating catheterization for postoperative retention occurred. The duration of the procedure wasor = 30 minutes in 12 patients, 30 to 60 minutes in 27 patients, and60 minutes in 3 patients. The mean time of postoperative continuous bladder irrigation was 1.2 days (0.5-3 days). The mean catheterization time was 1.4 days (range 0.5-5 days). Urethral stricture requiring treatment occurred in two patients. Dysuria was reported by four patients (mild two, severe two). The postoperative hospitalization was a mean of 2.2 days. The mean peak flow rate increased from 7.9 to 19.7 mL/sec at 3 months, and the IPSS decreased from 16 to 9 at 3 months.Our preliminary results with a bipolar electrode for electrovaporization of the prostate using the Gyrus suggest that it is a useful and safe endoscopic device. It appears to be an effective treatment for BPH; however, long-term results (i.e., 1-year follow-up) should be evaluated. This pilot series permits a comparative study with TURP to assess the benefits for patients and the health care system.

The aim of this study was to determine if p53 status, assessed before intravesical bacillus Calmette-Guerin (BCG) therapy, can predict clinical outcome in a high risk population of patients with stage T1, grade G3 bladder cancer and if it can be used to select patients responsive to therapy.After complete transurethral resection 35 patients with T1G3 bladder carcinoma received 6 weekly instillations of BCG and nonresponsive patients received a second course. After treatment cystoscopy and randomized biopsies of the bladder mucosa were performed. Pathologists had sufficient material to perform immunomarking in 25 cases using the peroxidase-antiperoxidase technique with antiprotein monoclonal antibody p53. The results were expressed in percentage of marked nuclei. We established 5% increment thresholds from 0 to 60%. Contingent tables were established, and chi-square and Fisher's exact test were performed for each 5% threshold.Median followup was 51.3 months (range 25 to 144). Of the 25 patients 8 (32%) did not respond to BCG therapy and 17 (68%) did. Immunomarkings were not statistically different between BCG responsive and nonresponsive patients for 0, 5, 10, 20, 35, 40, 45, 55 and 65 thresholds. Chi-square and Fisher's exact test were 0.91 and 0.83, 0.40 and 0.20, 0.58 and 0.29, 0.96 and 0.81, 0.80 and 0.88, 0.67 and 0.73, 0.91 and 0.83, 0.80 and 0.38, 0.69 and 0.32, respectively.Our results indicate that the percentage of p53 immunomarked cell cannot currently be used to predict clinical response to BCG therapy and, therefore, p53 over expression is not a viable indicator of T1G3 recurrence when using this treatment.

Between January 1987 and January 1991, 110 detubularized U-shaped ileocystoplasties (Camey II) following radical cystectomy were carried out in our Department of Urology (CMC Foch Suresnes, France). Our first evaluation of this procedure was carried out in 1989 and reviewed initial 57 patients operated on. These data were compared with those of the Camey I operation. The improvement in neobladder capacity as well as nighttime urinary control achieved by the detubularization required in the Camey II operation was obvious. In this article we review the first 110 patients treated by Camey II bladder replacement following cystectomy.