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B Guillonneau

Publications and source records attributed to B Guillonneau.

At least 37 records · Page 2Linked to original sources
PubMed2000

Laparoscopic radical prostatectomy: the Montsouris experience.

PURPOSE: We evaluate our experience with laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between February 1, 1998 and May 1, 1999, 120 consecutive patients underwent laparoscopic radical prostatectomy. Morbidity of the first 40 (group 1), next 40 (group 2) and last 40 (group 3) procedures was compared. Oncological data were assessed by pathological examination and postoperative prostate specific antigen (PSA). Functional results were assessed by a self-administered questionnaire for the first 60 patients and potency was assessed in the last 40. RESULTS: Mean operating time plus or minus standard deviation was 239+/-59 minutes (range 150 to 450) for the series, and 282, 247 and 231, respectively, for groups 1, 2 and 3. Surgical conversion was necessary in 7 cases (5.8%) overall, including 10% (4) in group 1, 7.5% (3) in group 2 and 0% in group 3. Mean intraoperative bleeding was 402+/-293 ml. (range 50 to 1,500) in the series, and 534, 517 and 277, respectively, for groups 1, 2 and 3. The transfusion rate was 10% overall, and 15%, 12.5% and 2.5%, respectively, in groups 1, 2 and 3. The reoperation rate was 1.7%. Mean postoperative bladder catheterization time was 6.6+/-2.4 days. The positive and questionable surgical margin rate was 15%. Pathological tumor stage was pT2a in 4 specimens (11%), pT2b in 11 (16%), pT3a in 0 and pT3b in 3 (50%) with positive surgical margins. PSA assays were available in 94 patients with a mean postoperative followup of 2.2 months (range 1 to 12). Serum PSA was 0.1 ng./ml. or less in 89 men (94.7%). The continence rate at 6 months postoperatively was 72% among the first 60 patients. Of 20 group 3 patients who were sexually active preoperatively 9 (45%) reported postoperative spontaneous erections. The overall cost of retropubic radical prostatectomy was about $1,237 more than that for laparoscopy. CONCLUSIONS: Laparoscopic radical prostatectomy is feasible and perioperative morbidity is low. Based on our postoperative followup, oncological results are identical to those of conventional surgery and functional results are encouraging.

Aged↗
PubMed1999

Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations.

BACKGROUND: Our purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy. METHODS: We describe an original technique of laparoscopic radical prostatectomy performed in 65 successive patients during 11 months. RESULTS: Radical prostatectomy was performed entirely by laparoscopy in 59 patients (91%). The median operating time was 265 min, including times for lymphadenectomy performed in 33% of patients. Preoperative complications included one rectal injury, sutured laparoscopically with an uneventful postoperative course, and one epigastric artery injury which needed secondary open procedure. The transfusion rate was 15.4% (10 patients). Median postoperative vesical catheterization lasted 7 days. The reduction of postoperative pain allowed rapid discharge of patients, by the fourth postoperative day in 60% of consenting patients. As regards oncological results, resection margins were negative in 57 patients (87.7%). The last prostate-specific antigen (PSA) assay was undetectable (<0.1 ng/ml) in 85.7% of the 42 patients in whom PSA was available more than 1 month after the operation. CONCLUSIONS: Radical prostatectomy can be routinely performed by laparoscopy by an experienced team. Short-term oncological data were identical to the results of conventional retropubic surgery, and morbidity was low. The laparoscopic approach could constitute in the future a technical improvement over radical prostatectomy if long-term oncological results are confirmed and if improvement of intraoperative vision improves the functional results of this operation.

Aged↗
PubMed1999

Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations.

OBJECTIVE: To evaluate the technical feasibility, oncological efficacy and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy. METHOD: We describe an original technique of laparoscopic radical prostatectomy performed in 40 patients between 26th January and 12th October, 1998. RESULTS: Radical prostatectomy was performed entirely by laparoscopy in 35 patients (87.5%) and only one conversion was performed in the last 26 patients (4%). Pelvic lymphadenectomy was performed in the light of preoperative staging data in 14 patients (35%). The median total operating time was 270 min. The only major complication was a rectal injury (patient 8), sutured laparoscopically with an uneventful postoperative course. Postoperative vesical catheterization lasted an average of 7.65 days. Seven patients were transfused (17.5%) with an average of 2.8 units of packed cells (range: 2-3). The reduction of postoperative pain is an element allowing for a rapid discharge of the patients by the 3rd postoperative day. The oncological results were as follows: 36 patients had a pT2 tumor (90%); prostate tumor was staged as N0 in 14 cases and NX in 26 cases. Surgical margins were negative in 33 patients (82.5%). Two patients had a doubtful resection margin (1 at the apex and 1 at the bladder neck) and 5 patients had positive margins. The last PSA level was undetectable (<0.1 ng/ml) in 26 (89.7%) of the 29 patients in whom PSA level was available more than 1 month after the operation. Functional results are not yet available and will be published later. CONCLUSIONS: Radical prostatectomy is an operation which can be routinely performed by laparoscopy by a team experienced with this technique. Operative and postoperative morbidity was low. Short-term oncological data appear identical to the results of conventional retropubic surgery. The improvement of operative visibility was considerable allowing a much more precise dissection. The laparoscopic approach appears to represent a technical improvement of the radical prostatectomy if the functional results of this operation improve parallel to the quality of dissection. A long-term follow-up is needed to define definitively the place of this new approach to radical prostatectomy.

Adenocarcinoma↗
PubMed1999

[Update of the morbidity of radical retropubic prostatectomy: retrospective analysis of 100 consecutive operations during the period 1996-1997].

OBJECTIVE: To retrospectively evaluate the morbidity of radical prostatectomy, with the exception of sexual complications, based on a recent single-centre series. MATERIAL AND METHOD: From January 1996 to January 1998, the morbidity of 100 consecutive patients undergoing radical retropubic prostatectomy was compared to the morbidity of the first 150 patients operated by the same technique in our department for the period 1983-1993. The perioperative morbidity was studied retrospectively on case files, while continence was evaluated in the last 50 patients by a self-administered questionnaire. Sexual complications could not be evaluated objectively for methodological reasons and were not addressed in this study. RESULTS: The single operative complication was a rectal injury (1%). The transfusion rate was 31%. The early complication rate was 23% with a major complication rate of 5% (four thromboembolic complications and one gastrointestinal haemorrhage). The most frequent minor complications (18%) were wound abscess (5%). The reoperation rate was 3%. The mean duration of vesical catheterization was 7 days (range: 4-30) and the mean hospital stay was 8 days (range: 5-30). With a mean follow-up of 14 months, 73% of patients are perfectly continent, with no incontinence pads, while 15% of the patients required incontinence pads "as a precaution". Incontinence required implantation of an artificial sphincter in 2 patients (2%). Only one patient developed stenosis of the anastomosis requiring internal urethrotomy. The reduction of morbidity in these 100 recently operated patients compared to the first 150 operated patients concerned the transfusion rate (31% versus 65%), the reoperation rate (3% versus 8%) and the minor complication rate (18% versus 32%). The reduction of operative morbidity partly explains the reduction of mean duration of vesical catheterization (7 days versus 15 days), and hospital stay (8 days versus 18 days); the anastomotic stenosis rate was also decreased from 17.3% to 1%. CONCLUSION: This study confirms the reduction of overall morbidity of retropubic radical prostatectomy. This improvement is probably multifactorial: increased operative experience and better postoperative management. These retrospective data must be taken into account in the diagnostic and therapeutic decisions concerning localized prostate cancer.

Aged↗
PubMed1998

[Laparoscopic radical prostatectomy. Preliminary evaluation after 28 interventions].

OBJECTIVE: Evaluate the technical feasibility of laparoscopic radical prostatectomy, its carcinological efficacy and per- and post-operative morbidity. PATIENTS AND METHODS: We performed radical prostatectomy using a new laparoscopic technique in 28 patients between February 1 and August 31, 1998. RESULTS: Radical prostatectomy was achieved totally by a laparoscopic approach in 24 patients (86%). No conversion was required in the last 14 patients. In 9 patients (32%) ilio-obturator node resection was also performed as indicated by preoperative extension work-up. Mean operative time was 270 minutes. The only major complication was one rectal wound (patient n degree 8) which had a benign course after suturing under laparoscopy. The bladder catheter was removed a mean 7.7 days after the procedure. Five patients (18%) required transfusions (mean 2.7 units, range 2-3). Rapid discharge on day 3 was possible due to rapid pain relief postoperatively. Tumor classes were pT2 in 26 patients, NO in 9, NX in 17. The surgical border was doubtful at the apex in one case. The last prostate specific antigen assay was below detectable levels (< 0.1 ng/ml) in 16 patients (89%) among the 18 with levels know prior to the procedure. Continence was assessable in 20 patients after a 1 to 6 month follow-up. Continence was perfect in 18 patients and becoming so in 12. Sexual activity was not assessed in this series due to the short follow-up. CONCLUSION: Radical prostatectomy can be reasonably performed as a routine laparoscopic procedure by a well-trained team. The cancerological results in this series were equivalent to those with conventional retropubic surgery and morbidity was very low. Improved operative vision was considerable, allowing much more precise dissection. The laparoscopic technique appears to be an important improvement for radical prostatectomy and should help improve functional outcome.

Adenocarcinoma↗
PubMed1998

Prognostic significance of seminal vesicle invasion on the radical prostatectomy specimen. Rationale for seminal vesicle biopsies.

OBJECTIVE: The prognostic significance of seminal vesicle invasion on the radical prostatectomy specimen was evaluated according to the proximal or distal site of this invasion. MATERIALS AND METHODS: 52 consecutive patients undergoing radical prostatectomy for stage pT3b N0 M0 prostatic cancer were classified into two groups: group A (18 patients): patients with invasion limited to the proximal part of the seminal vesicles (stage T3b limited); group B (34 patients): patients with invasion extending to the free part of the seminal vesicles (stage T3b extensive). The PSA progression-free curves were compared between the two groups. A multivariable regression model was performed to determine independent prognostic factors. RESULTS: Overall, the 5-year PSA progression free rate of the 52 patients was 14.4%. The 5-year PSA progression-free rate of the patients in group A was 45.4 vs. 4.2% at 4 years in group B (p = 0.0004). The stage of seminal vesicle invasion and the Gleason score were the only independent predictive factors of PSA progression (p = 0.02 and p = 0.04, respectively). CONCLUSIONS: The prognostic significance of seminal vesicle invasion is not constant and depends on the site of invasion. Preoperative seminal vesicles biopsies can select patients with invasion extending to the free part of seminal vesicles and who have a poor prognosis in terms of PSA progression after radical prostatectomy.

Adenocarcinoma↗
PubMed1997

[Biopsy of the seminal vesicles in the staging of localized cancer of the prostate: technic and results].

OBJECTIVE: To allow the diagnosis of pathological stage C prostatic cancer before deciding on treatment. METHOD: Seminal vesicle biopsy was performed as an outpatient procedure without anaesthesia. An identical antibiotic prophylaxis to that used for prostatic biopsy was performed. Biopsies were performed by longitudinal vision using a transrectal probe. A seminal vesicle needle biopsy was performed lateral to the prostate in the medial third of the seminal vesicle. RESULT: When seminal vesicle biopsies are positive, the final pathology report after radical prostatectomy confirmed the diagnosis in 100% of cases. When seminal vesicle biopsies were negative, seminal vesicle invasion was detected on the final pathology examination in one third of cases, mostly corresponding to exclusively intraprostatic involvement of the seminal vesicle. Biopsies are useful when at least one of the two prostatic bases is involved. In the series of the last 42 radical prostatectomies performed because of negative seminal vesicle biopsies, we detected only 11% of capsular lesions, almost always less than 1 mm, and 0% of ilio-obturator lymph node invasion. CONCLUSION: Although the digital rectal examination findings, the PSA level, the Gleason score, and the number of positive biopsies and their length, allow an approach to preoperative staging, only seminal vesicle biopsies can provide a better preoperative staging of prostatic cancer for a given patient and no longer just statistically.

Ambulatory Care↗
PubMed1997

Indications for preoperative seminal vesicle biopsies in staging of clinically localized prostatic cancer.

OBJECTIVE: To identify patients at high risk of extraprostatic seminal vesicle infiltration, in whom preoperative seminal vesicle biopsies should be performed. MATERIALS AND METHODS: We studied the relationship between extraprostatic seminal vesicle infiltration and the available preoperative data [age, clinical stage, prostate-specific antigen (PSA) level, number and site of positive prostatic sextant biopsies, Gleason score] in a total of 75 patients suffering from clinically localized prostatic adenocarcinoma who were candidates for radical prostatectomy. RESULTS: The chi 2 test showed that the preoperative data most significantly correlated with extraprostatic seminal vesicle infiltration were the presence of positive basal biopsies (p < 0.001). The PSA level did not have any predictive value. The most discriminant preoperative parameter of the state of the seminal vesicles (analysis of variance on a univariate model) was the state of the basal prostatic biopsies. The importance of this parameter was confirmed by cluster analysis. Overall, the risk of extraprostatic seminal vesicle invasion was 0 (0/21 patients) when the 2 basal prostatic biopsies were negative, 10.25% (4/39 patients) when 1 of the 2 basal prostatic biopsies was positive and 73.33% (11/15 patients) when both basal prostatic biopsies were positive. CONCLUSIONS: In a patient with clinically localized prostatic adenocarcinoma who is a candidate for radical prostatectomy, seminal vesicle biopsies are useless when basal prostatic biopsies are negative, regardless of the state of other preoperative parameters. When 1 or 2 basal prostatic biopsies are positive, seminal vesicle biopsies can improve the pretreatment pathological staging.

Adenocarcinoma↗
PubMed1996

Ablation of superficial bladder tumors with focused extracorporeal pyrotherapy.

OBJECTIVES: We report the first experimental studies of focused extracorporeal pyrotherapy. METHODS: Focused extracorporeal pyrotherapy has been used to treat superficial bladder tumors in a Phase II protocol in 25 patients. In 5 cases, for technical reasons, pyrotherapy was not used. In 20 patients (10 under general anesthesia and 10 under spinal anesthesia), the mean treated volume was 3 cm3 with an average of 300 shots and a mean skin focused length of 90 mm. Treatment time was 44 minutes; hospital stay was 2 days. Postoperatively, two skin burns and one acute retention were observed. RESULTS: Of 20 patients, 15 (75%) had a normal urinary cytology bladder ultrasonography and cystoscopy at 1 month. In 67% of patients with primary tumor, there was no recurrence at 1 year; 33% had recurrent tumors. No infiltrative tumor or metastases have been observed during this follow-up (3 to 21 months). CONCLUSIONS: These encouraging results show that ablation of superficial bladder tumor is feasible. The technique must be improved to allow treatment of larger tumor volume in a shorter time.

Adult↗
PubMed1996

Laparoscopic versus lumboscopic nephrectomy.

OBJECTIVES: The aim of this study is to compare the initial experience at two different urologic centers of the 20 first laparoscopic nephrectomies performed either by transperitoneal laparoscopy (10 cases) in one center or by retroperitoneal laparoscopy (lumboscopy, 10 cases) in the other center. METHODS: 5 males and 15 females with a mean age of 36 years (range 3-74) were operated on the right side in 8 cases and on the left side in 12 cases. Nephrectomies were indicated in 18 cases for benign renal disease, and in 2 cases for ureteric tumor (1 patient in each group). The techniques of these two approaches are described. RESULTS: The mean operating time was shorter with lumboscopy (173 min) than with laparoscopy (210 min), probably due to the direct approach to the renal compartment without intraperitoneal dissection with lumboscopy. There were no severe intraoperative or postoperative complications, but one hematoma of the renal area in the laparoscopic group. The mean postoperative hospital stay was identical following lumboscopy and laparoscopy (4.3 and 4.2 days, respectively). CONCLUSION: These two approaches can be used to perform nephrectomy. In this initial experience, the results appear to be equivalent in terms of morbidity and postoperative hospital stay, but the operating time appears to be shorter with lumboscopy. Larger studies comparing respective nephrectomy conversion rates would provide other arguments in favor of one or other of these techniques.

Adolescent↗
PubMed1995

[Extracorporeal lithotripsy in the treatment of upper urinary tract lithiasis].

The advent of extra-corporal shock-wave lithotripsy in the eighties totally changed management strategies for renal and ureteral lithiasis of the upper urinary tract. Currently, approximately 80% of all patients can benefit from lithotripsy with an overall success rate of about 75%. Although classical surgery has a higher success rate of about 90%, extra-corporal shock-wave lithotripsy has many advantages. First there is a very low risk of morbidity (pain, immobilization, complications) for this outpatient treatment. Second, the overall cost, including that of preventive treatment, is low as illustrated by the major reduction in the number of cases of pyonephritis on stones and of corraliform lithiasis. The apparent safety of shock-wave therapy should not mask the risk of unacceptable indications: small stones which may resolve spontaneously or inversely very large stones carrying the risk of residual fragments and renal damage. Long-term morbidity remains to be evaluated, but the management of upper urinary tract lithiasis now relies heavily on shock-wave therapy alongside conventional surgery and percutaneous or endoscopic methods.

Female↗
PubMed1995

Retroperitoneal laparoscopic nephrectomy: animal and human anatomic studies.

Retroperitoneal laparoscopic nephrectomy with CO2 insufflation was performed in 11 goats. The hemodynamic and blood gas repercussions of retroperitoneal laparoscopy were compared during the first 30 minutes with those induced by intraperitoneal laparoscopy. With the animal placed in the left lateral supine position, the hemodynamic and blood gas changes were similar with the two techniques and had a similar time course. The technical feasibility of retroperitoneal laparoscopy in animals was confirmed in the fresh human cadaver. The technical feasibility of retroperitoneal laparoscopy and the absence of any particular hemodynamic and blood gas repercussions encourage us to develop this approach for clinical upper urinary tract surgery.

Animals↗
PubMed1995

[Lumbar endoscopy: analysis and evaluation of 10 primary operations].

The authors report their experience of the first 10 patients operated by upper urinary tract lumboscopic surgery. Lumboscopy is performed in the lateral supine position and a simple technique for creation of retropneumoritoneum is described. In 4 patients, the planned nephrectomy could be performed because of poor anatomical conditions (peripyelitis and/or perinephritis). Lumboscopy allowed complete renal exploration, two nephrectomies, two resections of the roofs of compressive parapelvic cysts and one lumbar ureterolithotomy. The ease and rapidity of lumboscopic dissection makes it a valuable alternative to laparoscopy.

Cysts↗
PubMed1995

[Urodynamic study of obstruction induced by vesicoureteral reflux surgery with submucosal advance in beagle female dogs].

The treatment of veslcoureteric reflux by submucosal advancement is effective in human clinical practice on nondilated refluxing ureters, with a low morbidity. In contrast, the results of this technique in the presence of concomitant disease such as megaureter appear to be less favourable and could be due to obstruction induced by the reflux surgery. The objective of this study was to evaluate the urodynamic modifications of ureterovesical reimplantation in 10 female Beagle dogs. Left ureterovesical reimplantation by submucosal ureteric advancement was performed in each animal which constituted its own control. The morphological results were assessed by intravenous urography and retrograde cystography. The urodynamic study was conducted during another surgical operation performed, on average, around the 18th postoperative week. A 6F two-channel probe was inserted on each ureter: while a pump delivered a constant infusion (2 then 5 ml/min) into one channel, the ureteric pressure was measured by the other channel. The bladder pressure was recorded by a bladder catheter. For each infusion rate, the increased pressure in the reimplanted ureter was compared to that measured in the control ureter, as a function of the bladder pressure. The subsequent morphological evaluation demonstrated the absence of any repercussions on the upper urinary tract and the absence of vesicoureteric reflux and paraureteric diverticulum. An initial increase in the basal ureteric pressure was observed at the beginning of the infusion and was significantly higher in the operated ureter than in the control ureter (for an infusion rate of 2 then 5 ml/min, p = 0.0008 and 0.00029, respectively). The mean ureteric pressures increased in parallel, but those recorded in the reimplanted ureter were significantly higher than those recorded in the control ureter (p < 0.01). Ureteric pressure peaks were only recorded on the reimplanted left ureter at an infusion rate of 2 ml/min. These results suggest that, in this experimental model, the resistance to passive flow was higher in the reimplanted ureterovesical junction than in the control ureterovesical junction.

Animals↗