Pouch conservation during Studer enterocystoplasty in ileal nondetubularized segmental stenosis.
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Aged↗
Biomedical subjects
C C Abbou
Publications and source records attributed to C C Abbou.
[Studer's bladder: functional results and morbidity in 33 patients].
OBJECTIVE: Several types of enterocystoplasty can be performed after cystoprostatectomy for cancer. The objective of this study was to evaluate our 8-year experience with Studer's technique. PATIENTS AND METHODS: The medical files of 33 patients were studied retrospectively. The median age was 60 years. Bladder replacement was performed when frozen section histological examination of urethral biopsies was negative. The median follow-up was 41 months. Continence was evaluated by means of a questionnaire. Patients not using any pads or only using pads as a precaution were considered to be diurnally continent, and those using no more than one pad per night were considered to be nocturnally continent. RESULTS: Postoperative surgical morbidity consisted of two pelvic abscesses, two cases of obstructive acute pyelonephritis, one occlusion, and three wound complications. Eight patients developed urethroneovesical stenosis and seven ureters were reimplanted because of stenosis (two right ureters and five left ureters). Diurnal and nocturnal continence rates were 67% and 74% at 12 months, and 80% and 94% at 24 months, respectively. Seven patients developed acute pyelonephritis, renal function deteriorated in one patient (preoperative renal failure) and one patient developed acidosis. CONCLUSION: Studer's technique is a simple technique providing satisfactory functional results while preserving the upper tract by means of a simple and original antireflux system (ileal ureter) with a median follow-up of 41 months, although it was associated with a considerable stenosis and pyelonephritis rate.
Adult↗
[Detection of circulating prostatic cells with RT-PCR PSA in prostatic cancer].
OBJECTIVES: The detection of circulating prostatic cells by molecular biology techniques (RT-PCR) can be useful in the staging of localized prostate cancer prior to radical prostatectomy in some institutions. After describing their technique, the authors report their results. PATIENTS: 80 RT-PCR were performed: 32 in a control group (including 11 women free of any neoplastic disease, 11 healthy men, and 10 men with benign prostatic hyperplasia before resection), and 48 in patients with prostate cancer (43 with clinically localized cancer and 5 with metastatic cancer). RESULTS: In the control group, none of 11 women had a positive RT-PCR, 1 of the healthy men was positive (orchidopexy) and 3 of the 11 patients with benign prostatic hyperplasia were positive, but none of them had tumour on the resection chips. None of the 5 metastatic patients were positive. In the patients treated by radical prostatectomy, no correlation was observed between RT-PCR results, pathological stage, positive resection margin status and laboratory progression after radical prostatectomy. CONCLUSION: This PSA RT-PCR technique developed in this institution does not appear to be useful for the molecular staging of prostate cancer. This study demonstrates the difficulty of standardization of this technique which limits its routine use.
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Retroperitoneoscopic nephroureterectomy for renal pelvic tumors with a single iliac incision.
PURPOSE: Retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is a useful approach to urological surgery. We applied this technique to nephroureterectomy in patients with tumors of the renal pelvis. MATERIALS AND METHODS: Between January 1995 and March 1997 we performed 4 retroperitoneal laparoscopic nephroureterectomies in patients with tumors of the renal pelvis. The patients were placed in the lateral decubitus position. Five trocars were used. Balloon dilation was not contributory. Radical nephrectomy was performed and the kidney was left in the retroperitoneal space. Via an iliac incision ureterectomy with a bladder cuff was performed and the specimen was removed (kidney and ureter) en bloc via this incision without opening the urinary tract. RESULTS: One right and 3 left nephroureterectomies were performed with an average operating time of 220 minutes (range 160 to 300). Average kidney size was 110 mm. (range 100 to 120). Average hospital stay was 5.7 days (range 5 to 7). Blood loss was minimal and postoperative analgesic requirements were moderate. Conversion to open surgery was never necessary. The morbidity rate was zero. The pathological stages were pT2 G2, pT3 G2, pT3G3 and pT3 G2-G3 N+. A local recurrence was observed in a patient with a pT3 G3 tumor. CONCLUSIONS: Nephroureterectomy can be performed by retroperitoneal laparoscopy. The perioperative morbidity and hospital stay are reduced. Further followup is required to evaluate long-term results in terms of cancer outcome.
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[Benign prostatic hypertrophy: criteria and results].
UNLABELLED: CLINICAL AND ECONOMICAL SETTING: Benign prostatic adenoma, a commonly observed tumor in older men, is a major public health problem. The economic implications and the multiplicity of therapeutic alternatives require the development of criteria for assessing the effects of proposed treatments. PROSTATE EXPLORATIONS: Two categories of criteria should be determined. Firstly, objective data should be obtained on urine flow rate, post-mictional residue, prostate morphometrics and prostate specific antigen (PSA) levels. Secondly, subjective assessment is needed to determine the extent of the mictional disorder; the international prostatic symptomatic score (IPSS) is an accepted tool used world-wide. CLINICAL TRIALS: Rigorous methodology is indispensable to improve the diagnostic and therapeutic armamentarium and achieve a better cost/benefit ratio for the management of benign prostatic hyperplasia.
Adult↗
Immune response following intravesical bacillus Calmette-Guerin instillations in superficial bladder cancer: a review.
Local immunotherapy with bacillus Calmette-Guerin (BCG) can prevent recurrences and progression of superficial bladder cancer, but the antitumoral mechanism of BCG is still unclear. The first event seems to be binding of BCG to urothelial cells via fibronectin, and processing of mycobacterial antigens by antigen-presenting cells. Experimental data suggest that bacterial antigens can also be processed by urothelial cells. CD4 lymphocytes subsequently recognize antigenic peptides presented by HLA class II molecules. The most common profile of urinary cytokines is interleukin-2 and interferon-gamma, suggesting the predominant involvement of the Th1 lymphocyte subpopulation. Natural killer cells, lymphocyte-activated killer cells, BCG-activated killer cells and macrophages are able to kill bladder tumor cells in vitro, but there is no evidence that a major histocompatibility complex (MHC)-restricted specific T cytotoxic response is involved in BCG antitumor activity.
Antigen Presentation↗
Laparoscopic adrenalectomy: the retroperitoneal approach.
PURPOSE: Retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is an interesting approach to urological surgery. We report our initial experience with retroperitoneal laparoscopic adrenalectomy. MATERIALS AND METHODS: Between January 1995 and April 1997, 23 adrenalectomies were performed by retroperitoneal laparoscopy in 10 men and 12 women. The patients were placed in the lateral decubitus position and 5 trocars were used. The retroperitoneal working space was created by digital dissection and was completed by insufflation without balloon dissection. The surgical indications were Conn's adenoma in 12 cases, Cushing's adenoma in 4, bilateral adrenal hyperplasia (Cushing's disease) in 1 (treated in a single procedure), a nonfunctioning adenoma in 2, pheochromocytoma in 2 and adrenal metastasis in 1. RESULTS: We removed 7 right and 16 left adrenal glands in an average operating time of 97 minutes (range 45 to 160). Average tumor size was 26 mm. (range 10 to 40). Average hospital stay was 3.3 days (range 1 to 10). Blood loss was minimal. Postoperative analgesic requirements were moderate. Conversion to open surgery was not necessary. The morbidity rate was low, with 1 postoperative hematoma and 1 case of persistent fever (greater than 38.5C). CONCLUSIONS: Retroperitoneal adrenalectomy is a reliable and effective technique. At our institution retroperitoneal laparoscopy is now the standard adrenal surgery procedure for tumors less than 5 cm.
Adenoma↗
Modulation of cytokeratin subtype, EGF receptor, and androgen receptor expression during progression of prostate cancer.
After initial regression in response to androgen deprivation, most prostate cancers develop resistance to endocrine therapy. Identification of cellular and molecular changes occurring during endocrine therapy-induced regression and subsequent hormone insensitivity may point to mechanisms underlying the transition to hormone-independent prostate cancer. A series of untreated (n = 24), regressed (n = 15), and endocrine therapy-resistant (n = 10) prostatic adenocarcinomas were analyzed using immunohistochemistry with regard to cytokeratin 5 and 18, androgen receptor (AR), and epidermal growth factor receptor (EGF-R) expression in tumor cells. Using semiquantitative reverse transcription-polymerase chain reaction, the amount of AR mRNA also was determined. In regressed and therapy-resistant prostate cancers, an increase in cytokeratin 5-positive tumor cells was noted when compared with untreated carcinomas. Similarly, the proportion of EGF-R-positive tumor cells increased in the treated cases, whereas the proportion of AR-positive tumor cells dropped in regressed carcinomas and increased in hormone-refractory cancers. In the latter group, an eightfold higher level of AR mRNA was observed when compared with the other cases. Changes in the proportion of cytokeratin 5 and EGF-R-positive tumor cells suggests that during androgen deprivation an enlarged subpopulation of tumor cells with combined features of basal and secretory phenotypes arises. The increased proportion of AR-positive tumor cells during the transition from the regression phase to the hormone escape phase points to an important role of AR overexpression in this process.
Adenocarcinoma↗
Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group.
OBJECTIVE: To examine the safety and efficacy of transurethral pharmacotherapy for erectile dysfunction, involving the use of a novel therapeutic system to administer alprostadil (prostaglandin E1) to the urethral mucosa in a double-blind, randomized, parallel, placebo-controlled study conducted in five countries in Europe. PATIENTS AND METHODS: In an outpatient setting, patients with primarily organic erectile dysfunction of at least 3 months' duration were treated with transurethral alprostadil, in an open-label, dose-escalating study. Testing stopped when the dose provided an erection sufficient for intercourse, as assessed by the patient and the investigator. Patients who achieved a sufficient response were then randomized to either active medication at the selected dose or to placebo for use at home for 3 months. After each home administration, patients recorded in diaries whether or not sexual intercourse occurred and any adverse reactions to the drug. RESULTS: A total of 249 patients were treated in an outpatient setting; of these patients, 159 (64%) achieved an erection sufficient for intercourse and were randomized (1:1) to either active medication or placebo for home treatment. Of the patients randomized to alprostadil for home treatment, 69% reported intercourse at least once, compared with 11% of patients randomized to placebo (P < 0.001). The most common adverse reaction, urethral pain/burning, was reported by 7% of patients in the clinic. Most patients (83%) graded transurethral alprostadil as causing minimal or no discomfort in the clinic. No patient reported priapism or developed penile fibrosis. CONCLUSION: Alprostadil delivered transurethrally by this system was well tolerated and effective in treating erectile dysfunction.
Adult↗
The effect of transurethral alprostadil on the quality of life of men with erectile dysfunction, and their partners. MUSE Study Group.
OBJECTIVE: To evaluate the impact of treatment for erectile dysfunction on the quality of life of men and their partners. PATIENTS AND METHODS: The study included 249 men with organic erectile dysfunction of more than 3 months' duration who self-administered transurethral alprostadil in an open-label, dose-escalating manner in an outpatient medical setting. Patients with a sufficient response (159) were randomly assigned in a double-blind protocol to either active medication or placebo for 3 months at home. Patients and partners each completed quality-of-life questionnaires before and after treatment. RESULTS: In the clinic 159 of the 249 men (64%) had an erection sufficient for intercourse when using transurethral alprostadil. At home, 46 of 67 men (69%) reported intercourse at least once on transurethral alprostadil, compared with eight of 73 (11%) on placebo (P < 0.001). Patients on alprostadil showed a 34% improvement in their 'relationship with partner', a 5% improvement in 'personal wellness', and a 71% improvement in 'quality of erection' domains, compared with a decline of 11%, 8% and 1%, respectively, in patients on placebo (P < 0.005 for each comparison). Partners of patients on alprostadil showed a 35% improvement in the 'relationship with partner' domain, compared with a 12% improvement in the placebo group (P = 0.028). There was a trend toward improvement in other partner domains. Urogenital pain was reported by 14% of patients during home treatment. CONCLUSION: The resumption of sexual intercourse with the use of transurethral alprostadil was accompanied by an improvement in several important quality-of-life domains in patients and their partners.
Adult↗
Use of three additional mid biopsies to improve local assessment of prostate cancer in patients with one positive sextant biopsy.
OBJECTIVES: Routine sextant biopsies have proven useful in the diagnosis and local staging of prostate cancer. A single positive biopsy is more frequently associated with a smaller tumor and a low risk of positive margins. Nevertheless, the risk of positive margins in patients with 1 positive sextant biopsy remains high (20%). A better assessment of local invasion is therefore needed. In addition to standard sextant biopsies, we routinely obtain 3 additional mid biopsies from the apex to the base of the prostate. The aim of this study is to analyze the contribution of these 3 additional mid biopsies to local staging. METHODS: From 1988 to 1996, 177 men underwent sextant biopsies plus 3 additional mid biopsies prior to radical prostatectomy; 59 men had 1 positive sextant biopsy, and 13 also had 1-3 positive mid biopsies. The pathological results of the prostatectomy specimens from these 13 men (group A) were compared with those of the 46 men with only 1 positive sextant biopsy (group B), by means of the Fisher and Mann-Whitney tests. RESULTS: The two groups were similar in terms of age, preoperative prostate-specific antigen, the Gleason score of positive biopsies, the weight of the specimen, the Gleason specimen score, tumor volume and pathological stage. Positive surgical margins were found in 53.8% of group A and 19.4% of group B patients (p = 0.002). The location of the positive additional biopsies matched that of the positive surgical margins. CONCLUSIONS: Additional mid biopsies improve the local assessment of prostate cancer in patients with a single positive sextant biopsy, identifying significantly more positive margins when these additional mid biopsies are positive and indicating the location of the positive surgical margins. These informations could be helpful to avoid positive surgical margins during radical prostatectomy.
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Biopsy-based diagnosis of prostate cancer in 1290 patients referred for prostate examination: results according to the PSA level, digital rectal examination and ultrasonography.
Authors present their retrospective study of 1290 patients referred for prostate evaluation. The risk of cancer was analysed according to PSA, rectal palpation and ultrasound examination. Among the 1290 patients, 54.8% had cancer. The risk of cancer was multiplied by 2.8 when the PSA was between the normal limit and 10 ng/ml, by 7.5 when it exceeded 10 ng/ml, by 4.0 when rectal palpation was abnormal and by 1.6 when a hypoechogenic zone was present. Although a hypoechogenic zone does not improve the detection of cancer compared to PSA and rectal palpation, an increased PSA level even lower than 10 ng/ml indicates biopsies.
Adult↗
[Contralateral aneurysm-like adrenal gland metastasis of a renal adenocarcinoma].
The authors report a case of adrenal metastasis contralateral to a renal cell carcinoma in a 74-year-old patient who had undergone right radical nephrectomy for renal cell carcinoma. Nine months later, computed tomography revealed a hypervascular mass considered to be an aneurysm of the splenic artery. Arteriography led to the diagnosis of hypervascular adrenal tumour. Left adrenalectomy was performed. Histological examination showed a metastasis from renal cell carcinoma. This is an unusual form of renal cancer metastasis. Its treatment and prognosis are discussed.
Adrenal Gland Neoplasms↗
[Prostatic specific antigen in practice in 1997].
PSA (Prostate Specific Antigen) has modified the management of prostatic disease. Changes of PSA levels can be observed in many clinical circumstances other than cancer (endoscopic procedures, prostatitis, medications, etc.). Various methods have been proposed to increase the specificity of PSA in prostatic cancer, particularly when the PSA level is between 4 and 10 ng/ml: age-related PSA, PSA density, PSA velocity, freePSA. These methods allow more refined indications for transrectal biopsies of the prostate which provide the histological evidence essential for the diagnosis of cancer.
Adult↗
[The value of prostatic biopsy in tumor mapping].
OBJECTIVES: Prostatic biopsies, a diagnostic tool, are also used as prognostic elements before radical prostatectomy. Their sites within the prostatic gland constitute one of these prognostic criteria. The authors compared the site of positive prostatic biopsies with that of the tumour after radical prostatectomy in order to study the value of this prognostic factor and the way in which it can be improved. MATERIAL AND METHODS: From 1988 to 1996, 166 localized prostatic tumours treated by radical prostatectomy were diagnosed by 6 systematized ultrasound-guided transrectal biopsies and 3 supplementary median biopsies performed from the base to the prostatic apex. The site of positive biopsies was compared to that of the tumour within the prostatic gland. RESULTS: Of the 996 sextant biopsies performed, 331 (33%) were positive, i.e. 1.99 biopsies per prostate. 92 (19%) median biopsies were positive. 331 positive sextant biopsies corresponded to a tumour within the prostate with a specificity of 81.5%, a sensitivity of 39.4%, a positive predictive value (PPV) of 83.3%, a negative predictive value (NPV) of 36.4% and an accuracy of 52%. For 3 median biopsies, the sensitivity was 70.3%, the specificity was 91.6%, the PPV was 61.9%, the NPV was 94%, and the accuracy was 82%. The weight of the prostate (prostates less than and greater than 45 g), influenced these results, as PPV decreased from 90.8% to 76.1% while NPV increased from 32.9% to 37.8%. CONCLUSION: Negative biopsies in a prostatic zone after 6 randomized biopsies do not exclude the presence of tumour in this zone and cannot be used as a prognostic element before radical prostatectomy for the therapeutic management. The presence of negative biopsies in a prostatic zone must be interpreted by taking the prostatic weight into account. 3 median biopsies are more accurate and less influenced by prostatic weight.
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Symptomatic caliceal diverticula treated with extraperitoneal laparoscopic marsupialization fulguration and gelatin resorcinol formaldehyde glue obliteration.
PURPOSE: The treatment of symptomatic stone filled caliceal diverticula has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy, percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. We describe a laparoscopic technique for the management of symptomatic caliceal diverticula. MATERIALS AND METHODS: An extraperitoneal laparoscopic procedure was done in 3 women with symptomatic caliceal diverticula. Watertight obliteration of the diverticular cavity was achieved without suturing, using gelatin resorcinol formaldehyde glue. RESULTS: Average operating time was 80 minutes, including ureteral catheterization. All patients became stone-free, there were no complications and average hospital stay was 6.6 days. At 6-month followup the patients remained asymptomatic with no diverticula or stone recurrence. CONCLUSIONS: Retroperitoneoscopy allows safe access to caliceal diverticula regardless of location, and permits complete removal of stone and fulguration of the diverticular neck. Gelatin resorcinol formaldehyde glue minimizes the risk of urinoma formation, and provides a simple, quick and safe alternative for nephrotomy closure.
Adolescent↗
[Improvement over time of oncological results after radical prostatectomy: what are the responsible factors?].
OBJECTIVES: The histological results after radical prostatectomy constitute one of the main prognostic factors. We studied the course of these results over time in order to assess their improvement and to identify the factors responsible. MATERIAL AND METHODS: 175 radical prostatectomies were performed between 1989 and 1996. The preoperative assessment for each patient comprised clinical examination, PSA assay, and histological examination of 6 ultrasound-guided transrectal biopsies. All radical prostatectomy specimens were analysed according to the Stanford technique by the same pathologist: the weight of the prostatectomy specimen, the Gleason score, existence of capsular effraction, seminal vesicle invasion, positive lymph node dissection and the presence of positive surgical margins were studied. The results were studied and compared year by year using Student's test and the Chi-square test. RESULTS: From 1989 to 1996, stages pT1-pT2 increased from 40 to 81.8%, while the positive resection margin rate decreased from 80 to 18.1%. No difference was observed over time for weight and Gleason score. Among the preoperative factors, no difference was observed for age of the patients, number of positive biopsies and Gleason score of these biopsies. Only the mean preoperative PSA level decreased from 52.2 to 12.2 ng/ml (t = 0.0001) and the number of stage T1c tumours increased from 13.3 to 59%. CONCLUSION: The preoperative PSA level is the main factor explaining improvement of the oncological results, especially as the tumours operated between 1988 and 1996 were identical in terms of aggressiveness (Gleason score). This improvement of the results reflects better patient selection, although this selection is performed case by case without exclusive factors.
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[Current state of knowledge concerning the mechanisms of action of BCG].
The better understanding of antitumour immunity has improved our knowledge concerning the mechanisms of action of BCG. There are three phases in the immune response to BCG: first of all, BCG adheres and is then phagocytosed by antigen-presenting cells, but also by urothelial cells. This phase corresponds to the early release of so-called inflammatory cytokines (IL-1, IL-6, IL-8). These cytokines may be responsible for certain adverse effects, but may also participate in the cytotoxic phenomenon. The second phase consists of recognition of bacterial antigens by CD4 lymphocytes, which release mainly IL-2 and IFN-gamma(TH1 response). This cell activation leads to the third phase, which consists of amplification of cytotoxic-populations: CD8, gamma delta lymphocytes, macrophages, NK, LAK, BAK. All these cells also release cytokines which then regulate the response. The identification of these modulations allows rationalization of BCG instillation protocols, but identification of the truly cytotoxic elements would allow the proposal of more effective immunization protocols.
Adjuvants, Immunologic↗