Search

Resume But Evaluer la faisabilite en chirurgie ambulatoire du traitement de l’hypertrophie benigne de prostate par radiofrequence (TUNA) et sa place en termes d’efficacite parmi les autres techniques chirurgicales mini-invasives. Methodes Cinquante-quatre patients souffrant d’hypertrophie benigne de prostate et en echec du traitement medical ont ete traites par radiofrequence entre septembre 2004 et juin 2007. Parmi eux 28 patients, d’âge moyen 65,8 ans (52–82 ans), ont ete retenus pour un traitement par Transurethral Needle Ablation (TUNA) en chirurgie ambulatoire. Le statut mictionnel a ete evalue avant et apres traitement par TUNA par le score international symptomatique de la prostate (IPSS), le score de qualite de vie (QDV) lie aux symptomes urinaires, la mesure du debit urinaire maximal et du residu postmictionnel. La fonction erectile a ete evaluee par l’index international de la fonction erectile (IIEF-5). Resultats Avec un recul moyen de 12,14 mois, une amelioration significative du statut mictionnel a ete observee avec un score IPSS moyen passant de 22,4 a 9,75 et un score de QDV moyen passant de 4,9 a 1,9. Le debit maximal et le volume urine moyens ont significativement augmente de 8,66 a 14,6 ml/s et de 202 a 248,4 ml, respectivement. Le residu postmictionnel moyen a diminue de 177,4 a 112,2 ml ( p Conclusion La TUNA-therapie est une technique mini-invasive du traitement de l’hypertrophie benigne de prostate realisable en chirurgie ambulatoire et efficace sur la symptomatologie urinaire avec peu de morbidite. Elle est une alternative au traitement medical et ne se substitue pas au traitement chirurgical de reference.

The arterial aneurysm secondary to Candida is a rare but frightening complication of renal transplant. We report the case of a 58-year-old patient who developed an arterial aneurysm secondary to a Candida infection in 3 weeks of a third renal transplant. Candida albicans was isolated from the preservation solution. The treatment consisted of a transplant nephrectomy, aneurysm excision and an iliac bypass with cryopreserved iliac homograft. All of bacteriologic culture was positive for Candida. The positive bacteriologic culture for Candida in preservation solution requires antifongic treatment. In case of arterial aneurysm, a surgical treatment is necessary but majority of kidney transplant had to be removed.

Resume But Evaluer la faisabilite et l’efficacite de la radiofrequence (TUNA™) en chirurgie ambulatoire chez le sujet jeune souffrant d’hypertrophie benigne de prostate. Materiels et methodes Neuf patients, d’âge moyen 59,7 ans (valeurs extremes : 55-68) souffrant d’hypertrophie benigne de prostate, ont ete traites par radiofrequence entre mai 2004 et mai 2005 en chirurgie ambulatoire. Le statut mictionnel des patients a ete evalue par le score international symptomatique de la prostate (IPSS), le score de qualite de vie liee aux symptomes urinaires (QdV), la debitmetrie et le residu post-mictionnel. La fonchtion erectile a ete evaluee par l’Index International de la Fonction Erectile (IIEF-5). Resultats Les scores IPSS moyen et de QdV moyen preoperatoires etaient respectivement de 25,2 et de 5,6. Le debit urinaire maximal moyen preoperatoire etait de 6 ml/s et le residu post-mictionnel moyen etait de 167,1 ml. Le score moyen IIEF-5 etait de 20,2. Les patients traites par radiofrequence ont ete revus tous les trois mois. Avec un recul moyen de 9,5 mois, huit patients ont eu une amelioration de leur statut urinaire, avec des scores moyens IPSS et de QdV respectivement de 9,5 et de 1,6 (p Conclusion A l’issue de cette evaluation initiale, le TUNA™ etait une technique fiable, qui a permis de preserver les fonctions sexuelles des sujets jeunes. Sa faible morbidite pourrait permettre sa pratique en chirurgie ambulatoire.

Transurethral resection of bladder tumour is a common procedure (10,711 new cases of bladder tumour diagnosed in France in 2000), associated with a certain morbidity. Intra- or extraperitoneal perforation of the bladder wall is a possible complication. The diagnosis is generally established intraoperatively and cystography can be performed in the operating room to demonstrate the diameter of the perforation. Most cases of extraperitoneal perforation can be treated conservatively by simple bladder drainage. Intraperitoneal perforations may require surgical repair Laparoscopy is currently tending to replace open surgery for this repair. One of the risks of perforation is also tumour seeding outside of the bladder However metastases related to perforation appear to be rare and occur rapidly requiring close surveillance.

Transurethral resection of bladder tumour is a common procedure (10,711 new cases of bladder tumour diagnosed in France in 2000), associated with a certain morbidity. Intra- or extraperitoneal perforation of the bladder wall is a possible complication. The diagnosis is generally established intraoperatively and cystography can be performed in the operating room to demonstrate the diameter of the perforation. Most cases of extraperitoneal perforation can be treated conservatively by simple bladder drainage. Intraperitoneal perforations may require surgical repair Laparoscopy is currently tending to replace open surgery for this repair. One of the risks of perforation is also tumour seeding outside of the bladder However metastases related to perforation appear to be rare and occur rapidly requiring close surveillance.

Evaluating the effectiveness and feasibility of transurethral needle ablation (TUNA) for young patients with symptomatic benign hyperplasia (BPH) in outpatient care.From 2004 to 2005, 9 patients (mean age: 59.7 years) were treated with the TUNA device. The urinary function using the IPSS (International Prostate Symptom Score), the quality of life score (QOL-UR), the uroflowmetry, and the post-void residue, and the sexual function using the International Index of Erectile Function score (IIEF-5) were assessed.Prior to thermotherapy, the mean IIEF-5 was 20.2. The mean preoperative IPSS and QOL-UR scores were respectively 25.2 and 5,6. Regarding uroflowmetry, the mean pre-treatment maximal urinary flow was 6 ml/s and the mean post-void residue was 167.1 mL. Patients' follow-up was at intervals of 3 months. With a mean follow-up of 9.5 months, 8 patients have achieved a better urinary status with a mean IPSS and QOL-UR score of 9.5 and 1.6 respectively (p0.05). The mean maximal flow rate was improved (14 ml/s, p0,05). The post-void residue decreased but had no statistical significance. The IIEF-5 score remained unchanged. Only 4 complications including 3 urinary retentions and 1 prostatitis were revealed for 3 patients. No failure with radiofrequency thermal therapy was observed.TUNA as a mini-invasive outpatient treatment for symptomatic BPH proved reliable and reproducible for young patients with preserved sexual function.