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B Doré

Publications and source records attributed to B Doré.

At least 19 recordsLinked to original sources
PubMed2006

[Complications of percutaneous nephrolithotomy: risk factors and management].

Extra corporeal shock wave lithotripsy (ESWL) has significantly modified the management of urinary lithiasis. It constitutes usually the first line treatment of urinary calculi sized less than 30 mm. Complex and staghorn calculi may be treated either with percutaneous nephrolithotomy (PCNL) or by flexible uteroscopy (URS) with Holmium laser. PCNL is a minimal invasive technique but it carries a potential risk of complications: infection, bleeding, urinary fistulas and perforations of adjacent organs. PCNL complications may be prevented by the strict respect of technical recommendations; their therapeutic management has been properly codified. In order to reduce the risk of their occurrence, the so-called "mini-perc" (mini-percutaneous technique) has been developed for children and can be applied to adults. Technical details of the two techniques and the treatment of PCNL complications had been described before 1985; the current chapter proposes an update on their prevention and management.

Fistula↗
PubMed2003

Obesity in relation to prostate cancer risk: comparison with a population having benign prostatic hyperplasia.

OBJECTIVE: To analyse the relationship between obesity and prostate cancer, when compared with men with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The records were reviewed of consecutive patients with histologically confirmed prostate cancer admitted for prostate surgery between January 1993 and February 1999. Controls were selected from patients who were hospitalized at the same time for the surgical treatment of BPH. One control was matched to each case by age. Obesity was defined as a body mass index (BMI) of> 29 kg/m2. RESULTS: The study included 194 cases and 194 controls; their median (range) age at operation was 69.5 (50-88) years in both groups, and the BMI 26.1 (16.6-38.1) kg/m2 in the cancer and 25.7 (15.1-36.8) kg/m2 in the BPH group. The difference between the groups was not significant (P = 0.06). Obesity was significantly associated with prostate cancer, with an odds ratio (95% confidence interval) of 2.47 (1.41-4.34). Cases with advanced disease had a higher BMI than those with localized disease, but when age was considered the difference was not significant. CONCLUSION: In general the BMI was not significantly associated with prostate cancer when compared with men having BPH. However, obese men had 2.5 times the risk of having prostate cancer.

Aged↗
PubMed2001

Renal tumor size: comparison between computed tomography and surgical measurements.

OBJECTIVE: We studied the agreement between renal tumor size as assessed on computed tomography (CT) before surgery and that measured during histopathological examination on the radical nephrectomy specimen. METHODS: We retrospectively analyzed the records of 100 consecutive patients treated with radical nephrectomy for a renal tumor. The tumor size was determined in all patients by the largest diameter shown within the month before surgery on contrast-enhanced CT and as measured postoperatively by the pathologist. A possible influence of the clinical and pathological parameters was assessed in a multivariate analysis. RESULTS: CT estimate and surgical measurement of tumor size were highly correlated (r = 0.9; p<0.001). Median (range) tumor size was 70.0 mm (13-180) and 60.0 mm (10-180) as measured, respectively, on CT and in the specimen, with a significant difference (p = 0.005). Multiple regression did not reveal any significant influence of tumor side, location, type, nuclear grade as well as patient gender, body mass index and radiological center (p>0.3 in all cases). The extent of difference between CT and surgical measurements was significantly influenced by the surgical size of the tumor (p = 0.03): the smaller the tumor, the more the CT overestimated the tumor size. If nephron-sparing surgery had been planned for tumors equal to or less than 40 mm, 24 patients would have been selected following the CT estimate, while 27 patients would have met this criterion on the surgical measurement. CONCLUSION: Renal tumors were statistically smaller than the estimate from CT, although this was not systematically the case. This should be kept in mind when issuing recommendations on the optimal cutoff size value under which nephron-sparing surgery is considered equivalent to radical nephrectomy.

Adult↗
PubMed2000

[Impact of genital prolapse on the upper urinary tract].

UNLABELLED: The authors reviewed five cases of genital prolapse affecting the upper urinary tract and causing renal failure. CLINICAL CASES: Five patients aged 55 to 75 years presented with genital prolapse, which was known by the patient in 3 cases for a period of 2 to 30 year, but left untreated. All cases had induced bilateral dilatation of the uretero-pyelocaliceal cavities with severe obstructive renal failure in 3 cases, moderate renal failure in 2 cases and associated with hypertension in 2 cases. Repair of prolapse, preceded by upper urinary tract diversion by ureteric and bladder catheters in 3 cases or pessary + bladder catheter because of the patient's age in 2 cases, cured or improved renal failure in 4 patients; only one patient had to be treated by dialysis because of the severity of the residual renal failure severity. DISCUSSION: The frequency (4%) of aetiopathogenic mechanisms (ureteric compression, progressive stretching of the ureter and posterior tilting of the trigone) are analysed. The delayed onset of sudden deterioration and the varying degrees of severity of renal failure demand emergency treatment of stage III prolapse with primary diversion of the upper urinary tract, currently by double J stents, until correction or improvement of renal function, after which surgical repair of the prolapse can be performed according to the usual surgical rules. Intravenous urography is still indicated in this situation. Palliative treatment is only indicated in elderly patients or patients with a high operative risk. The best treatment remains prevention by detection and treatment of prolapse before the development of this fortunately rare complication. CONCLUSION: This short clinical series emphasizes that undiagnosed prolapse can still be complicated by repercussions on the upper urinary tract with a risk of renal failure.

Aged↗
PubMed1999

[Management of renal calix calculosis].

A FREQUENT PROBLEM: Lithiases in the urinary tract form first in the calices, raising complex problems of lithogenesis. As described by Randall, in males caliceal lithiases are often composed of calcium oxalate, generally as a monohydrate. In females, calcium phosphate stones are common, stones related to urease-producing germs are less frequent, and the bi-hydrated form of calcium oxalate predominates. UNPREDICTABLE NATURAL HISTORY: Caliceal lithiases can remain asymptomatic and are often discovered fortuitously. Symptoms include chronic lower back pain or urinary tract infections. Regular surveillance is required due to the risk of local growth into a more or less voluminous complex lithiasis. Misleading digestive tract or rhumatatism-like recurrent pain may result from local migration. Other stones descend spontaneously creating the specific problems of ureteral lithiasis. CLASSIFICATION: Consensus is still lacking on renal mapping, predominant chemical make-up, and measurement of caliceal lithiases. These three criteria must be carefully studied to achieve a rigorous widely-accepted classification scheme allowing comparisons between proposed management protocols. The classification should use simple and low-cost imaging techniques: plain x-rays remain the gold standard although spiral computed tomography provides a more complete, though more costly, analysis. ADAPTED MANAGEMENT: Regular surveillance is indicated for asymptomatic caliceal lithases measuring less than 5 mm whatever the localization within the kidney. Symptomatic caliceal lithiases measuring less than 20 mm should be treated with first intention extracorporeal lithotripsy. Certain stones with known composition (cystine) resist external shock waves and certain lower or intradiverticular caliceal stones may require a more aggressive approach with percutaneous surgery or ureterorenoscopic endocorporeal lithotripsy. Combination treatment using percutaneous and extracorporeal techniques should be used for large stones (> 20 mm) or for stones lying in an abnormal urinary tract. The goal of all treatments for caliceal stones is to eliminate all residual fragments and collect all eliminated or extracted fragments for physical (intrared spectrophotometry) and non-chemical analysis of the different constituents to establish an adapted management scheme aimed at preventing recurrence.

Humans↗
PubMed1999

Symptom characteristics and the development of tolerance with time in patients with indwelling double-pigtail ureteric stents.

OBJECTIVE: To determine the symptoms of and factors predicting the tolerance to double-pigtail ureteric stents, and the development of tolerance with time. PATIENTS AND METHODS: The study included 39 patients (median age 49.0 years, range 26-74; 24 men and 15 women) who were treated in our department for ureteric obstruction caused by benign conditions, excluding pregnancy and associated open surgery. All patients received a polyether-urethane double-pigtail ureteric stent (7 F, 28 cm long). Tolerance to the procedure was assessed using a questionnaire and a 10-cm linear visual analogue scale (VAS) at 24 h and again one week after placement, and on the day before stent removal. RESULTS: From the end of the first week to before removal of the stent, fewer patients reported dysuria, haematuria and having recourse to painkillers than during the first week. However, analysis of variance for repeated measures showed no significant difference between the VAS scores for first day, the first week and the day before removal, either overall or stratified by gender (P=0.15). A factorial analysis of variance analysing the VAS score for the first week as a function of gender, age and type of occupation (sedentary or mobile occupation) showed a significant effect only for gender (P=0.005) and gender-age interaction (P=0. 02): VAS scores were higher in men and particularly in younger men. CONCLUSION: Almost all patients with short-term placement of indwelling double-pigtail ureteric stents have untoward symptoms. Although some symptoms, e.g. dysuria and haematuria, significantly improve with time, the general tolerance remains unchanged. Tolerance in men, and particular in younger men, was significantly poorer.

Adaptation, Physiological↗
PubMed1999

[Hemorrhagic complications during percutaneous nephrolithotomy. Retrospective studies of 772 cases].

OBJECTIVES: To evaluate the haemorrhagic complications of PCNL, to analyse their management and to identify predisposing factors. MATERIAL AND METHODS: Out of a series of 772 cases of PCNL, 18 patients developed severe haemorrhage requiring a haemostatis procedure (2.3%): 13 males and 5 females with a mean age of 57 years (38-79), and one case on a solitary kidney. The mean time to onset of haemorrhage was 18 days (--48 days). RESULTS: Three nephrectomies for haemostatis were performed at the beginning of our experience. Renal arteriography was performed in 15 patients and was abnormal in 13 patients, showing 3 arteriovenous fistulas, 8 false aneurysms, 3 arteriolar injuries. All these vascular abnormalities were successfully treated by highly selective embolization. In 2 cases, arteriography was normal with a spontaneously favourable course. Comparison of the 2 groups of PCNL, with haemorrhage versus without haemorrhage, failed to demonstrate any risk factors. CONCLUSION: Severe haemorrhage following PCNL is a rare complication, but impossible to predict. Selective embolization allows control of bleeding and currently constitutes the treatment of choice.

Adult↗
PubMed1999

[Schwannoma and the urinary tract. Concerning a tumor of the obdurator nerve].

Peripheral nerve tumours, called schwannomas, because they are derived from cells of the Schwann sheath, are rare tumours that can involve any part of the body, but are essentially located on the limbs, which represent more than 50% of cases. Schwannomas of the trunk and especially pelvic schwannomas are even rarer. A tumour arising from the obturator nerve is exceptional, but its paravesical location can facilitate the diagnosis, as in this case. The complementary investigations most frequently performed are CT and MRI, although they are unable to define the exact nature of the tumour. Surgery must try to preserve continuity of the nerve, but that is not always possible and does not appear to have any major consequences in this site.

Humans↗
PubMed1997

Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value.

PURPOSE: We attempted to identify morphological parameters of benign prostatic hyperplastic inflammation that correlate with pre-biopsy prostate specific antigen (PSA) concentrations. MATERIALS AND METHODS: Patients undergoing prostate biopsy at our department were prospectively studied between January 1995 and January 1996. preoperative blood and 24-hour urine samples were measured for PSA. Biopsy samples harboring exclusively benign prostatic tissue were graded on a 4-point scale for inflammation (0-no inflammatory cells, 1-scattered inflammatory cell infiltrate, 2-nonconfluent lymphoid nodules and 3-large inflammatory areas with confluence of infiltrate) and aggressiveness (0-no contact between inflammatory cells and glandular epithelium; 1-contact between inflammatory cell infiltrate and glandular epithelium; 2-clear but limited, that is less than 25% of the examined material, glandular epithelium disruption, and 3-glandular epithelium disruption on more than 25% of the examined material). RESULTS: A total of 66 patients with exclusively benign prostatic tissue on prostate biopsies was analyzed. Difference between inflammation graded groups was not significant when considering serum or urinary PSA. There was a significant correlation between aggressiveness grading and serum PSA (rho = 0.51, p < 0.0001), whereas aggressiveness grading and urinary PSA did not correlate (rho = -0.06, p = 0.6). CONCLUSIONS: Prostatic subclinical inflammation is not associated with high urinary PSA. Unless associated with glandular epithelial disruption, density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA concentration. We believe that this issue should be considered when interpreting a prostate biopsy.

Aged↗
PubMed1997

Serum-to-urinary prostate specific antigen ratio: its impact in distinguishing prostate cancer when serum prostate specific antigen level is 4 to 10 ng./ml.

PURPOSE: Benign prostatic hyperplasia (BPH) was shown to be associated with high concentrations of urinary prostate specific antigen (PSA). We investigated the serum-to-urinary PSA ratio in patients undergoing prostate biopsy to assess its efficacy in enhancing serum PSA specificity in the detection of prostate carcinoma. MATERIALS AND METHODS: From November 1995 through January 1996 consecutive patients undergoing prostate biopsy were prospectively included in the study. Serum and urine PSA levels were measured at our laboratory with the Tandem-R assay. Samples were drawn 24 hours before prostate biopsy and at a distance from prostatic manipulation or ejaculation. RESULTS: We studied 73 patients with BPH and 57 with prostate cancer. Differences between BPH and prostate cancer were statistically significant considering serum PSA or serum-to-urinary PSA ratios. In the 50 patients with a serum PSA of 4.0 to 10.0 ng./ml. (35 with BPH and 15 with prostate cancer) the differences between prostate cancer and BPH were still significant only when considering serum-to-urinary PSA ratio. Receiver operating characteristic curves showed that serum-to-urinary PSA ratio was a better predictor of prostate cancer than serum PSA. CONCLUSIONS: Our results suggest that the serum-to-urinary PSA ratio may be useful in distinguishing BPH from prostate cancer, particularly in the diagnostic gray zone of serum PSA between 4.0 and 10.0 ng./ml.

Aged↗
PubMed1997

Patient tolerance of transrectal ultrasound-guided biopsy of the prostate.

OBJECTIVES: To determine the acceptability by patients of ultrasound-guided prostatic biopsy without anaesthesia. PATIENTS AND METHODS: From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound-guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post-operative questionnaire including a 10 cm linear visual analogue scale (VAS). RESULTS: The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of > or = 5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia. CONCLUSIONS: Even when anaesthesia-free, transrectal ultrasound-guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out-patient setting should be reassessed.

Aged↗
PubMed1997

[Ureterosigmoidostomy after total cystectomy in cancer. Long-term results. Apropos of 60 cases].

OBJECTIVES: Restoration of continuity of the urinary tract after total cystectomy deserves discussion even if most authors currently opt for bladder replacement or transileal cutaneous diversion. Diversion into the colon, which was used for a long time, has possibly been unjustly abandoned. METHODS: From 1974 to 1995, sixty patients (116 renal units) underwent cystectomy for cancer, followed by systematic ureterosigmoidostomy when age and local conditions allowed. The mean age of the patients (52 men and 8 women) was 60 years. They were reviewed at least every six months and surveillance consisted of annual clinical and laboratory examinations and intravenous urography for 5 years. Evaluation of the functional results and quality of life was based on the information recorded in the patients' files and on the answers to a questionnaire for the 19 patients alive without recurrence. RESULTS: The median follow-up was 80 months. Thirty seven patients have died, 23 (38.38%) of them from bladder cancer. Forty patients (66.6% had an uneventful immediate postoperative course. The major late complications were septic reflux in the upper urinary tract stenosis of the ureteric reimplantation and febrile urinary tract infections, requiring either repeat reimplantation or another diversion. Nocturnal (82%) and diurnal (85%) continence was good and 17 of the 19 patients alive with no signs of recurrence are satisfied with their lifestyle. CONCLUSION: After total cystectomy for cancer, implantation of the two ureters into the colon remains a good method of urinary diversion due to its simplicity and good tolerance sometimes at the cost of a second operation. Recent technical modifications should restore the value of this operation.

Adult↗
PubMed1997

[Serum and urine prostate-specific antigen ratio: its value in the distinction between prostate cancer and adenoma when serum prostate-specific antigen level is between 4 and 10 ng/ml].

BACKGROUND: In an earlier study, we demonstrated that benign prostatic hyperplasia (BPH) was associated with significantly higher urine levels of prostate-specific antigen (PSA) than in prostate cancer (PC). These early results led to the present study: we assessed, in patients undergoing a prostate biopsy, the clinical value of the PSA serum/urine ratio (PSA S/U) in patients for the differential diagnosis of PC, particularly when the pre-biopsy serum level of PSA lies between 4.0 and 10.0 ng/ml. METHODS: All patients without an indwelling drain who underwent transrectal echoguided biopsy were prospectively included in this study from November 1994 to December 1995. All serum and urine PSA measurements were done by the same laboratory using a Tandem R kit (Hybritech). Blood and urine samples were obtained during the 24 hour period prior to surgery during which all urethral or rectal manipulation was avoided. RESULTS: We studied 130 patients with BPH (n = 73) or PC (n = 57). The PSA serum levels and the PSA S/U were significantly different between the BPH and the PC groups. In the subgroup of 50 patients with a serum PSA level in the 4-10 ng/ml range, the difference between the BPH and PC patients was not significantly different except for the PSA S/U ratio. Receiver operating characteristic (ROC) curves showed that the diagnostic power of PSA S/U was greater than serum PSA. CONCLUSION: These results suggest that the PSA S/U ratio could be useful to distinguish between BPH and PC, particularly when diagnosis is uncertain in patients whose serum PSA is in the 4.0-10.0 ng/ml range.

Aged↗
PubMed1996

Patient acceptability of transurethral incision of the prostate under local anaesthesia.

OBJECTIVE: To determine the acceptance by patients of transurethral incision of the prostate (TUIP) under local anaesthesia. PATIENTS AND METHODS: The study comprised 30 consecutive patients who elected to undergo local anaesthesia for TUIP and were treated between December 1994 and September 1995. Twenty-two were considered a high risk for general anaesthesia and eight patients chose local anaesthesia for personal reasons. Patients were premedicated (opioid and benzodiazepine) and 1% lidocaine was infiltrated transurethrally using an endoscopic needle. The level of acceptance was determined using an immediate post-operative questionnaire which included a linear visual analogue scale (VAS) to rate pain. RESULTS: No patient required conversion to another type of anaesthesia and there were no complications related to the local anaesthesia. The mean (SE) VAS score was 3.2 (1.7) and the questionnaire results showed that 83% of the patients did not consider that general anaesthesia was necessary for the operation and that 90% would agree to undergo the procedure again under local anaesthesia. CONCLUSION: TUIP under local anaesthesia was well tolerated in motivated patients. We recommend it as the operation of choice for the relief of obstruction in high-risk patients with a small benign prostatic hyperplasia.

Aged↗
PubMed1996

Serum-to-urinary prostate-specific antigen ratio: a potential means of distinguishing benign prostatic hyperplasia from prostate cancer.

OBJECTIVE: High concentrations of serum prostate-specific antigen (PSA) may be associated with the presence of benign prostatic hyperplasia or prostatitis. We investigated the serum-to-urinary PSA ratio in patients with or without prostate cancer to assess its efficacy in enhancing serum PSA specificity. METHODS: Patients presenting abnormal findings in digital rectal examination or documented prostate carcinoma were prospectively included in the study. A control group, with no evidence of prostate disease, hospitalized in the same time interval was included. Serum and urine PSA levels were measured in our laboratory with the Tandem R assay (Hybritech). Samples were drawn twice at 2-month intervals (M1 and M3). RESULTS: Sixty-eight patients were included in the study divided into 27 cases of benign prostatic hyperplasia, 20 of prostate carcinoma, 10 of prostatitis and 11 patients in the control group. Serum and urine PSA levels were not correlated (r < or = 0.1). There was no significant difference in any group from M1 to M3 as regards urinary PSA (p > or = 0.15). Intergroup comparison showed significantly (p < or = 0.004) high urinary PSA (mean level +/- SEM 28.3 +/- 3.4 micrograms/mmol creatinine) only in the benign prostatic hyperplasia group, mean levels in the prostate carcinoma, prostatitis and control groups being 3.7 +/- 1.1, 11 +/- 2.9 and 5.2 +/- 0.9 micrograms/mmol creatinine, respectively. Differences in urinary PSA levels between the confined prostate carcinoma and benign prostatic hyperplasia groups (p = 0.0008) were further increased when considering the serum-to-urinary PSA ratio (p = 0.0003). CONCLUSION: Our results suggest that the serum-to-urinary PSA ratio may be useful in distinguishing benign prostatic hyperplasia from prostate cancer.

Aged↗
PubMed1996

[Genito-urinary injuries. Sequelae. Medico-legal aspects].

Traumatisms of the genito-urinary apparatus may be due to road or work accidents as well as mishaps occurring in surgery. Whatever be their cause, such after-effects may quite possibly not only perturb genital functioning, but also be detrimental to everyday life, if not survival itself. Such sequels are then open to legal redress, when making an estimate of the attendant damage, it behooves one to take into account the initial lesions, the gesture carried out in surgery, the evolution of such lesions as regards each particular organ and, last but not least, the way after-effects effectively impact upon the subject's everyday life. Such widespread considerations are integrally linked to equally widespread medical knowledge, to which one must necessarily add legal notions pertaining to juridical compensation for the type of corporeal injury which any surgeon, whatever be his degree of expertise, has got to know.

France↗