Search

OBJECTIVES Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006 and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]). MATERIALS AND METHODS Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004). RESULTS Between 2006 and 2013, the number of penile implants in France doubled (307 to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87 %) (228 to 552) (+142 %). The use of semi-rigid prostheses declined by 26.7 %. The distribution between the private and public sector was close to 1 in 2013. More than half of French penile prostheses were implanted in three regions (Ile-de-France, Languedoc-Roussillon, Rhone-Alpes). Nearly 62 % of surgeons implanted only one or two three-compartment prostheses in 2013. CONCLUSION The number of penile prostheses in France doubled between 2006 and 2013. Three regions were particularly active as far as this surgery is concerned (Ile-de-France, Languedoc-Roussillon, Rhone-Alpes). They were boosted by 5 surgeons with more than 20 prostheses surgeries a year. LEVEL OF EVIDENCE 4.

Objective The varicocele is a venous abnormality frequently found in humans (1/10). Although the recommendations for management of this pathology are clear, two therapeutic options can be discussed: surgery or radiological embolisation. We wanted to study the evolution of the therapeutic management of varicocele using the French national coding database. Methods Analysis of database from the "Agence technique de l'information sur l'hospitalisation" (ATIH) (number of surgical procedures and interventional radiology used in the treatment of varicocele for the period 2006-2014). The common classification of medical procedures (CCAM) was used to extract the codes for surgery and radiological embolisation. Then we recorded the corresponding "Groupes homogenes de malades" (GHM), excluding those with a different primary diagnosis of varicocele cure. Results The number of surgical procedures and radiological embolisation performed for the treatment of varicocele increased from 3626 to 4007 procedures (+10.5%) between 2006 and 2014. While the frequency of interventional radiology (embolization pampiniform plexus) increased by 73.9%, surgery procedures (by direct approach or laparoscopy) decreased by 31.4% throughout the study (2006-2014). Thus in 2006, 60.2% of therapeutic procedures were performed surgically and 39.8% by radiological embolisation. In 2014, 37.4% of therapeutic procedures were performed surgically and 62.6% by embolization. Conclusion The analysis of French national database has confirmed a change in the therapeutic management of varicocele between 2006 and 2014. The minimally invasive treatment by radiological embolisation is currently favored in France and surgery pushed into the background. In 2014, more than one therapeutic management out of two was performed in interventional radiology. Level of evidence 4.

Resume Objectifs Evaluer l’impact de la technique Hexvix ® sur la frequence de detection des tumeurs urotheliales et preciser le profil des tumeurs plus particulierement concernees par le ciblage Hexvix ® . Patients et methodes Entre septembre 2008 et avril 2012, un total de 107 patients (300 prelevements avec une lesion vesicale papillaire typique ou une lesion plane suspecte) ont ete identifies en cystoscopie (lumiere blanche). Une resection endoscopique etait realisee apres identification des lesions vesicales en lumiere blanche puis en lumiere bleue (Hexvix ® ). Pour chaque patient, etaient colliges les elements anatomocliniques, les groupes de risque EORTC pour la recidive et la progression des tumeurs de vessie n’infiltrant pas le muscle vesical (TVNIM). Resultats Parmi les 107 patients etudies, 67 patients avaient une tumeur urotheliale et 328 prelevements avaient une fluorescence positive en Hexvix ® . Treize localisations tumorales supplementaires ont ete diagnostiquees chez 11 patients : six Carcinomes in situ (Cis), trois tumeurs a faible potentiel de malignite (LMP), trois pTa de bas grade et un pT1 de bas grade ( p = 0,003). Le taux de faux positifs en Hexvix ® etait de 53,4 % contre 52 % en lumiere blanche. Parmi les facteurs cliniques et pathologiques etudies, la recidive tumorale, la multifocalite, et les scores EORTC de recidive et de progression superieurs ou egaux a 5 etaient statistiquement associes aux chances d’avoir un diagnostic tumoral supplementaire par Hexvix ® ( p = 0,007 ; p = 0,01 ; p = 0,03 ; p = 0,04). Les diagnostics complementaires n’ont eu aucun impact sur la suite de la prise en charge therapeutique. Conclusion Dans notre experience, le ciblage par Hexvix ® des tumeurs de vessie permettait d’augmenter les prelevements tumoraux de 9 % (13/144) chez 10,2 % des patients etudies (11/107) ( p = 0,003). Cette technique etait associee a de nombreux faux positifs (53,4 %). Les tumeurs multifocales, recidivantes et ayant des scores EORTC de recidive ou de progression superieurs ou egaux a 5 constituent les groupes d’interet du ciblage par Hexvix ® .

Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006 and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]).Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004).Between 2006 and 2013, the number of penile implants in France doubled (307 to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87 %) (228 to 552) (+142 %). The use of semi-rigid prostheses declined by 26.7 %. The distribution between the private and public sector was close to 1 in 2013. More than half of French penile prostheses were implanted in three regions (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). Nearly 62 % of surgeons implanted only one or two three-compartment prostheses in 2013.The number of penile prostheses in France doubled between 2006 and 2013. Three regions were particularly active as far as this surgery is concerned (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). They were boosted by 5 surgeons with more than 20 prostheses surgeries a year.4.

Resume Objectif Decrire l’epidemiologie, le diagnostic et le resultat des nephrectomies pour tumeurs des reins natifs chez les patients transplantes renaux. Patients et methode De juin 1989 a decembre 2007, 824 transplantations renales ont ete realisees et suivies en consultation annuelle par un urologue avec une echographie ou un scanner abdominal. Les lesions renales considerees comme suspectes ont ete traitees par nephrectomie elargie. L’incidence, le diagnostic, le traitement, le type histologique et la survie de tous les patients ont ete analyses. Resultats Trente-trois patients ont eu une nephrectomie pour des lesions renales suspectes. Vingt-deux tumeurs de novo des reins natifs parmi 21 patients ont ete diagnostiquees (15 carcinomes a cellules claires et sept carcinomes papillaires) avec un delai de 25,6 mois (2,3–105,5) apres la transplantation. Toutes etaient classees pT1aN0M0. Seulement un patient est decede de son cancer a huit mois. Tous les autres patients ont eu une survie sans recidive de 34,8 mois (2,8–113,9). Le taux de survie specifique apres cinq ans etait de 93,3 %. Conclusion Le risque accru de cancer parmi les patients transplantes renaux nous a conduit a proposer, en cas des lesions suspectes des reins natifs, une nephrectomie elargie. Dans notre serie, 65 % des patients pris en charge avaient un cancer. Le bon pronostic de ces tumeurs localisees justifie une attitude therapeutique agressive malgre 35 % de patients transplantes indemnes de cancer.

Resume Objectif Evaluer la sensibilite et la specificite de l’IRM pour distinguer les tumeurs urotheliales vesicales superficielles et infiltrantes. Materiel et methodes Soixante patients (52 hommes et huit femmes), d’âge moyen 66,8 ans, ont beneficie entre mai 2002 et novembre 2005, d’une IRM vesicale pour une premiere tumeur de vessie diagnostiquee par endoscopie, suivie d’une resection endoscopique de tumeur de vessie avec examen anatomopathologique. Le suivi des patients pour lesquels il existait une discordance entre IRM et analyse histologique a ete analyse. Resultats La stadification de 49 tumeurs de vessie (40 superficielles et neuf infiltrantes) etait concordante entre imagerie et anatomopathologie. Dix tumeurs vues infiltrantes a l’IRM etaient superficielles a l’analyse histologique et parmi elles, six ont recidive sur la cicatrice de resection a un ou trois mois. La sensibilite de l’IRM etait de 80 % pour une specificite de 90 %. La valeur predictive positive de cet examen etait de 97,5 %. Conclusion L’IRM a ete un examen fiable pour affirmer le caractere superficiel des tumeurs de vessie. Lorsque l’IRM et l’analyse histologique d’une resection de tumeur de vessie etaient discordantes, une resection de second look etait souhaitable pour traiter une maladie residuelle presente dans notre serie dans 60 % des cas.

L’incidence du nombre de blesses medullaires est en constante augmentation et parmi eux 41% ont moins de 30 ans. Les possibilites de procreation sont des preoccupations essentielles chez ces jeunes patients. L’impact deletere du traumatisme medullaire sur la fonction ejaculatoire et sur les principaux parametres spermatiques sont bien documentes: le volume, la numeration et la mobilite sont perturbes. Des congelations de sperme dites « preventives » sont a envisager rapidement apres le traumatisme. La conduite a tenir chez ces patients leses medullaires qui desirent un enfant va dependre de leurs capacites ejaculatoires et du nombre de spermatozoides mobiles obtenus. Si une ejaculation est possible naturellement ou a l’aide de techniques simples (vibromassage) et que le sperme presente des caracteristiques normales une conception pourra etre tentee a domicile. Si les caracteristiques spermatiques sont mauvaises, des techniques d’AMP sont envisageables. En fonction du nombre de spermatozoides mobiles recueillis le couple beneficiera d’une insemination intra-uterine, d’une fecondation in vitro ou d’une injection intracytoplasmique.

Resume Objectif Evaluer en temps et en nombre d’actes, la part de l’activite consacree a la chirurgie de l’insuffisance renale chronique dans un bloc operatoire d’urologie et de transplantation. Materiel et methodes Analyse de l’activite operatoire du bloc d’urologie et de transplantation du CHU d’Amiens au cours d’une annee (2003), en evaluant le nombre d’actes et le temps d’occupation du bloc (temps entre l’entree et la sortie du bloc) recueillis partir des fiches d’ecologies remplies pour chaque intervention. Ces actes regroupent d’une part ceux de la chirurgie urologique classique de l’adulte et d’autre part l’ensemble des actes de I’insuffisance renale chronique (depuis la creation des voies d’abord de l’epuration extra renale jusqu’aux complications de la transplantation renale). Resultats La prise en charge de l’insuffisance renale chronique au bloc operatoire represente 22,6% des actes et 30,1% du temps d’occupation du bloc operatoire. Soixante neuf pour cent du temps operatoire des transplantations renales et 95% de celui des prelevements d’organes sont effectues sur l’astreinte. Conclusion L’activite operatoire liee a l’insuffisance renale chronique represente pres d’un tiers de l’activite operatoire globale d’un Service qui prend en charge cette pathologie. Ces donnees justifient l’attribution de moyens chirurgicaux supplementaires adaptes a cette activite dont l’importance croit parallelement au nombre de patients insuffisants renaux chroniques.

Objective. To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis. Patient and methods. From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment. Results. Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75% (n = 16) for Politano-Leadbetter anastomosis versus 53% (n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P = .1). Conclusion. Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.

Resume Objectif L’hormone gonadotrophique chorionique (HCG) est secretee par 10 a 20 % des seminomes. Nous avons evalue les variations du taux serique de l’HCG totale initialement normal dans la surveillance des seminomes testiculaires traites, afin d’evaluer l’interet du dosage de ce marqueur tumoral dans la surveillance des tumeurs germinales seminomateuses. Patients et methodes Etude retrospective realisee de janvier 1988 a mars 2007, incluant 95 cancers du testicule operes, dont 28 tumeurs germinales seminomateuses ; 25 seminomes etaient non secretants (taux initial de l’HCG totale inferieur a 15 UI/L). Le schema de surveillance etait periodique : tous les trois mois pendant un an, tous les six mois la deuxieme annee, puis une fois par an, associant un examen clinique, un examen tomodensitometrique et le dosage des marqueurs tumoraux (HCG, LDH et AFP). Resultats Le suivi moyen etait de 77,5 mois (6–120). Les 25 patients ont eu un taux d’HCG totale inferieur a 15 UI/L a trois mois de l’orchidectomie. Chez tous les patients ayant un recul de plus de trois ans, le taux de l’HCG est reste stable a moins de 15 UI/L. Deux patients ont eu une recidive ganglionnaire non regionale, sans modification du taux de l’HCG. Conclusion L’ensemble des tumeurs germinales seminomateuses non secretantes, traites avec ou sans recidives, ont eu un taux d’HCG normal et stable durant tout le suivi. Cela fait discuter l’utilite de son dosage de surveillance, apres affirmation histologique du diagnostic.

Prospective evaluation of bladder tumor targeting by Hexvix(®) fluorescence.From September 2008 to April 2012, 107 patients have been evaluated using Hexvix(®) technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected prospectively and patients have been classified using EORTC score.From the 107 patients, 67 have been identified with bladder cancer and 328 samples have shown positive fluorescence in blue light. Compared to white light, 13 additional tumors have been diagnosed by Hexvix(®) for 11 patients: Cis (n=6), LMP (n=3), pTa low grade (n=3), pT1 low grade (n=1) (P=0.003). The false positive rate for Hexvix(®) was 53.4% versus 52% for white light. Previous TCC history, multifocality and EORTC score for recurrence and progression have been associated with better bladder cancer targeting by Hexvix(®) (P=0.007; P=0.01; P=0.03; P=0.04).In our experience, Hexvix(®) targeting was associated with better diagnosis for bladder cancer with 9% (13/144) of new positive samples (P=0.003). In our study, false positive rate is a critical point (53.4%). Multifocality, previous TCC, and EORTC score for recurrence and progression might allow selecting patients to be targeted by Hexvix(®).

Objective To evaluate the epidemiology, diagnosis, and outcome of de novo renal cell carcinoma in renal transplant recipients. Patients and Methods From June 1989 to August 2006, 800 renal transplant recipients were followed up annually by a urologist using abdominal ultrasonography or computed tomography. Renal lesions considered suspect were treated using extended nephrectomy. Incidence, diagnosis, histologic type, treatment, and outcome were analyzed in all patients. Results Thirty-three patients underwent nephrectomy because of suspect renal lesions including 22 de novo tumors in 21 native kidneys (renal clear-cell carcinoma in 15 and papillary carcinoma in 7). All tumors were classified as pT1aN0M0. Mean (range) time after diagnosis was 25.6 (2.3–105.5) months. Only 1 patient died, at 8 months after diagnosis. All other patients were alive at follow-up of 34.8 (2.8–113.9) months. Five-year survival was 92%. Conclusion The increased risk of tumor in renal transplant recipients leads us to propose extended nephrectomy in the case of suspect lesions in the native kidney. In our patients, 65% of patients had malignant lesions. Good prognosis for these localized tumors justified aggressive therapy even though 35% of transplant recipients were tumor-free.

Evaluate epidemiology, diagnosis and outcome of de novo renal cell carcinoma in renal transplanted patients.From June 1989 to December 2007, 824 renal transplantations were carried out and followed in annual consultation by an urologist with abdominal echography or tomodensitometry. The suspect renal lesions were treated by a widened nephrectomy. Incidence, diagnosis, treatment, histological type, and outcome of all patients were analysed.Thirty-three patients had nephrectomy for suspect renal lesions. Twenty-two de novo tumours of native kidneys among 21 patients were diagnosed (15 renal clear cell carcinoma and seven papillary tumours) with mean time after transplantation of 25,6 months (2.3-105.5). All tumours were classified pT1aN0M0. Only one patient died at 8 months of metastatic dissemination of a papillary tumour classified initially pT1aN0M0. All the other patients are alive with mean follow-up of 34.8 months (2.8-113.9). Specific survival to 5 years was 93.3%.The increase risk of tumour at the renal transplanted patient led to propose in the event of suspect lesions of the native kidneys, a widened nephrectomy. In our series, 65% of the operated patients carried a cancer. The good forecast of these localized tumours justifies a regular radiological monitoring and an aggressive therapeutic attitude despite of absence of tumours in 35% of the transplanted patients.

To determine the sensitivity and specificity of MRI to distinguish between superficial and invasive transitional cell bladder cancer.Sixty patients (52 men and eight women) with a mean age of 66.8 years were assessed by bladder MRI between May 2002 and November 2005 for a primary bladder cancer diagnosed by endoscopy, followed by transurethral resection and histological examination of the bladder cancer. Patients presenting a discordance between MRI findings and histological examination were analysed.Imaging and pathology staging was concordant for 49 bladder cancers (40 superficial and nine invasive). Ten tumours considered to be invasive on MRI were superficial on histological examination and six of them relapsed at the resection scar at one or three months. The sensitivity of MRI was 80% for a specificity of 90% and a positive predictive value of 97.5%.MRI is a reliable examination to confirm the superficial nature of bladder cancer. When MRI and histological examination of a bladder cancer resection specimen are discordant, second look surgery is recommended to treat residual disease, which was present in 60% of cases in the present series.

Objectifs La varicocele est une anomalie veineuse frequente retrouvee chez un homme adulte sur dix. Meme si la prise en charge de cette pathologie fait l’objet de recommandations claires, deux attitudes therapeutiques peuvent etre discutees : chirurgie ou radiologie interventionnelle. Nous avons souhaite etudier l’evolution de la prise en charge therapeutique des varicoceles au moyen des donnees nationales du codage. Methodes Nous avons analyse les actes de chirurgie et de radiologie interventionnelle utilises dans le traitement des varicoceles de 2006 a 2013 au moyen des donnees issues de la base de donnees de l’Agence technique de l’information sur l’hospitalisation (ATIH). La classification commune des actes medicaux (CCAM) a ete utilisee pour extraire les codes relatifs a la chirurgie et a la radiologie interventionnelle. Nous avons releve les groupes homogenes de malade (GHM) correspondants en excluant ceux qui relevaient d’un diagnostic principal different de la cure d’une varicocele. Resultats Le nombre d’actes chirurgicaux et de radiologie interventionnelle effectues pour le traitement de varicoceles est passe de 3626 a 3862 procedures de 2006 a 2013 (+6,5 %). Les actes chirurgicaux (par abord direct ou laparoscopique) ont regresse de 23,5 % entre 2006 et 2013. Les actes de radiologie interventionnelle (embolisation du plexus pampiniforme) ont progresse de 51,9 % entre 2006 et 2013. En 2006, les actes chirurgicaux representaient 60,2 % des actes therapeutiques pour la cure de varicoceles contre 39,8 % pour les prises en charge par radiologie interventionnelle. En 2013, les actes chirurgicaux ne representaient plus que 43,2 % des actes therapeutiques contre 56,8 % pour les procedures de radiologie interventionnelle. ( Tableau 1 et Fig. 1 ) Conclusion L’analyse des donnees CCAM confirme une modification de la prise en charge therapeutique de la varicocele entre 2006 et 2013. Le traitement mini-invasif par radiologie interventionnelle est privilegie et la chirurgie est relayee au second rang. En 2013, plus d’une prise en charge sur deux a ete realisee en radiologie interventionnelle.

Uretero-arterial fistulas are exceptional complications: only about forty cases have been reported in the literature. The authors report new two cases of fistula between the common iliac artery and the ureter. One fistula occurred in a context of prolonged ureteric stenting after radiotherapy and pelvic surgery for cancer of the uterus, and the other occurred after an aorto-bifemoral allograft. These fistulas generally occur in a particular clinical context, associating several aetiological factors. The clinical presentation is dominated by often massive and intermittent haematuria. The most useful diagnostic examinations are retrograde ureteropyelography and arteriography. The proposed treatment options (nephrectomy, vascular bypass graft and even embolization) depend on the urgency of the situation and involve both the blood vessel and the urinary tract. The prognosis depends on early diagnosis, but preventive measures can be envisaged to decrease the risk of appearance of these fistulas in high-risk patients.

Complete, isolated trisomy of the short arm of chromosome 18 is very rare. To date, only 24 cases of trisomy 18p have been reported in the literature, making it difficult to define a potentially associated phenotype. However, the available evidence suggests that few clinical features are shared by these patients: only variable intellectual disability, variable facial dysmorphism and epilepsy are reported in a few patients. Although three inherited cases of trisomy 18p have already been reported, all were of maternal origin. We report on a patient carrying an isolated complete trisomy 18p translocated to the short arm of chromosome 14 and presenting with facial dysmorphism, mild intellectual disability and non-obstructive azoospermia. Chromosomal abnormalities are more frequent in infertile men with poor sperm quality than the general population. Both numerical and structural chromosomal aberrations have been already reported within the context of azoospermia. To our knowledge, this is the first patient with trisomy 18p to present a fertility impairment due to totally altered spermatogenesis and azoospermia. Although fertility disorders were not mentioned in the four previous reports of men with trisomy 18p, none of the latter had children. We suggest that azoospermia is a previously uncharacterized feature of trisomy 18p syndrome. We further hypothesize that two mechanisms could be responsible of the fertility impairment: a meiotic synapsis defect due to the additional 18p arm that blocks meiosis, and/or overexpression of a gene located on the 18p chromosome involved in the normal testicular development.