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Christian Coulange

Publications and source records attributed to Christian Coulange.

At least 19 recordsLinked to original sources
PubMed2006

Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival.

OBJECTIVES: Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as </=40 yr old, compared to RCC in older patients. METHODS: Between 1988 and 2000, 1233 patients, 93 under 40 yr old and 1140 older (mean ages, 34.2 and 61.9 years, respectively) underwent surgery for RCC in four teaching hospitals. Clinical and biologic parameters at diagnosis were compared and subjected to univariate and multivariate analyses to study survival. Mean follow-up was 4.5 yr for young and 4.1 yr for older patients. RESULTS: When comparing younger to older patients, respectively, they had a lower male-to-female ratio (1.2 vs. 2.5), lower stage (84.9% vs. 67.4% pT1-pT2N0M0; p=0.001), and fewer clear-cell carcinomas (73.1% vs. 82%), but more papillary carcinomas (20.4% vs. 11.4%; p=0.01) and better 5-yr cancer-specific survival rates (90.8% vs. 78.3%; p=0.005). Independent prognostic factors for survival, in the order of decreasing impact, were tumor stage (p<0.0001), Fuhrman nuclear grade (p<0.0001), and age </=40 yr at diagnosis (risk ratio 0.4, p<0.047). Young patients tended to have a better 5-yr progression-free survival (80.5% vs. 70.7%; p=0.05). CONCLUSIONS: RCC in young adults was more often localised at diagnosis and had a better prognosis than the disease in older subjects. Age under 40 yr old was an independent prognostic factor for survival.

Adult↗
PubMed2006

[Endoscopic management of urothelial tumours of the upper urinary tract].

OBJECTIVE: The reference treatment for filling defects of the upper urinary tract is nephroureterectomy with excision of a perimeatal bladder segment. The authors evaluated the role of endoscopy and laser in the management of filling defects of the upper urinary tract. MATERIAL AND METHODS: Filling defects of the upper urinary tract were evaluated by biopsies performed during ureteroscopy followed by 10 Watt Holmium-YAG laser vaporisation. High-grade or incompletely vaporised tumours or multifocal tumours or tumours more than 2 cm in diameter received complementary treatment. Low-grade and completely vaporised tumours were followed by ureteroscopy at 3 months and then every 6 months. The authors conducted a prospective study from March 2002 to September 2004. Fifteen consecutive patients were managed according to this protocol. The mean age was 70 years (range: 53 to 85 years). Thirty nine tumours were treated. The mean tumour diameter was 1.05 cm (range: 0.3 to 2.5 cm). RESULTS: In this series of 15 patients treated according to this protocol, 39 tumours were diagnosed and treated. The grade was determined by biopsy in 66% of cases. Seven patients have a median recurrence-free survival of 18 months (range: 12 to 34 months). Overall, conservative management was able to be performed in twelve patients, corresponding to a 22-month kidney preservation rate of 80%. Two patients died during follow-up, one from prostatic cancer and the other from invasive urothelial bladder tumour. One patient who had had recurrence ans had been re-treated was lost for report. CONCLUSION: Filling defects of the upper urinary tract can be investigated by ureteroscopy to obtain a histological diagnosis and to perform treatment by laser vaporisation. Complementary treatment is then performed depending on the histological results, either by complementary vaporisation or by nephroureterectomy. Laser treatment ensures a high kidney preservation rate but with a recurrence risk. Conservative endoscopic treatment, which is considered to be acceptable in cases of necessity, may also be useful in the context of small, unifocal, minimally invasive tumours with a normal contralateral kidney.

Aged↗
PubMed2006

[Management of positive margins after total prostatectomy for localized prostate cancer].

Positive margins after total prostatectomy are frequently observed (10% to 40% of cases) in the everyday practice of urologists treating prostate cancer The presence of positive margins is correlated with the presence of residual tumour in about 50% of cases. It is difficult to clearly define optimal management in view of the marked heterogeneity of the published data concerning the significance and prognosis of positive margins. The objective of this review article was to analyse the various aspects of this situation and to propose practical management guidelines. This analysis was based on data of the literature derived from Medline. In practice, it is essential to more precisely define the concept of positive margins in histological terms by specifying the unifocal or multfocal nature, the total length of positive margins and their site. The decision to perform adjuvant or deferred therapy is based on these histopathological elements together with other prognostic criteria determined after total prostatectomy: pathological stage and Gleason score, tumour volume and postoperative PSA.

Humans↗
PubMed2006

[Outcome of oncocytomas diagnosed by percutaneous renal biopsy].

OBJECTIVE: Renal oncocytoma is a benign tumour that is usually diagnosed postoperatively. Its natural history is poorly defined. We studied the outcome of patients with renal oncocytoma diagnosed by percutaneous biopsy and not operated. MATERIAL: From January 1998 to April 2004, on a series of 148 renal tumour biopsies performed in our centre, 15 showed oncocytoma. The initial treatment was non-surgical. We report the follow-up of these patients and the course of these oncocytomas. The mean follow-up was 404 +/- 20.9 months. RESULTS: The mean age of these patients at diagnosis was 57.6 +/- 14.4 years and the mean tumour diameter was 3.49 +/- 2.43 cm with a mean volume of 62.3 +/- 135.4 cm3. Six of these 15 patients were operated: 4 total nephrectomies and 2 partial nephrectomies. The indications for surgery were the initial tumour volume (n = 1), tumour growth > 0.5 cm/year (n = 4) and the patient's preference (n = 1). Operated patients were younger (45.5 +/- 11.1 years vs 65.6 +/- 10.3 years) and had larger tumours at diagnosis (50 +/- 30.1 mm vs 27.3 +/- 10.5 mm). All 9 patients treated by watchful waiting were asymptomatic. CONCLUSION: The natural history of oncocytomas appears to be a more or less rapid increase in size. Treatment can be conservative. The initial tumour volume or rapid tumour growth are indications for resection. Partial nephrectomy, when allowed by the size and site of the tumour is currently the technique of choice.

Adenoma, Oxyphilic↗
PubMed2006

[Treatment of precalyceal stones of Cacchi-Ricci disease by flexible ureterorenoscopy and Holmium-YAG laser].

Flexible ureterorenoscopy combined with Holmium-YAG laser is an effective and reliable technique for the management of renal stones. Cacchi-Ricci disease is a frequent urological malformation characterized by precalyceal stone formation, for which no preventive treatment is available at the present time. Some complicated forms are difficult to manage because of the technical impossibility of treating these precalyceal stones. The objective of this article is to describe a technique allowing management of these precalyceal stones by flexible ureterorenoscopy combined with Holmium-YAG laser.

Combined Modality Therapy↗
PubMed2005

[High intensity focused ultrasound in localized prostate cancer].

Despite a follow-up too short to allow a relevant assessment of the HIFU efficacy in terms of definitive cure of localized prostate cancer, the last published results from the European multicentric study and from Gelet may consider the HIFU treatment as a valuable alternative option for well differentiated tumors, with an initial PSA<15 ng/ml, in men with a life expectancy more than 5 years. The main advantages of the HIFU treatment are its low morbidity, the option for repeated HIFU treatment, the possible treatment of patients who previously underwent prostate resection, the early local control with biopsies and, if needed, radiotherapy may be performed after HIFU, without increased morbidity.

Biopsy↗
PubMed2005

De novo renal cell carcinoma of native kidney in renal transplant recipients.

BACKGROUND: The 10-year risk of developing a solid malignancy is 20% for kidney transplant recipients. The goal of the current study was to investigate the epidemiology and the diagnostic and prognostic parameters associated with de novo malignancies of the native kidney among transplant recipients at the authors' institution (Department of Urology and Renal Transplantation, Hôpital Salvator, Marseille, France). METHODS: The authors reexamined the follow-up of 933 consecutive transplant recipients at their institution between 1987 and 2003. Immunossupressive therapy was not modified in the event of malignant disease, nor was systematic radiologic monitoring of native kidneys performed. All de novo malignancies of the native kidney were included in the current analysis. RESULTS: Among the 933 patients examined, a combined total of 12 malignancies of the native kidney were diagnosed in 11 individuals. For these 11 individuals, the average ages at transplantation and diagnosis were 42.5 and 49.1 years, respectively. Ten malignancies were discovered fortuitously, whereas two were symptomatic. Among the 10 renal echographies performed, there was 1 false-negative result. Tomodensitometry was performed in 11 cases and yielded no false-negative results. The average tumor size was 37 mm. Nephrectomy was performed in 10 cases, and biopsy was performed in 1. Among the 12 kidney malignancies encountered in the current study, there were 7 conventional cell carcinomas, 3 basophilic papillary carcinomas, and 2 chromophobic renal cell carcinomas. Half of all tumors were Furhman Grade 3 lesions, and pT1aN0M0 tumors (2003 TNM staging system) also accounted for half of all malignancies in the current cohort. Two affected transplant recipients died (one due to disease), and the remaining nine are alive without recurrence and with normal renal functioning (median follow-up, 39 months). CONCLUSIONS: There appears to be an increased risk of malignancy of the native kidney in renal transplant recipients, with high-grade and papillary tumors being particularly common. Consequently, systematic radiologic follow-up of native kidneys must be performed for individuals who undergo kidney transplantation.

Adenoma↗
PubMed2005

Follow-up of renal oncocytoma diagnosed by percutaneous tumor biopsy.

OBJECTIVES: To evaluate the outcome of patients with oncocytoma of the kidney diagnosed in our center by percutaneous biopsy and treated with watchful waiting. METHODS: From January 1998 to April 2004, of 148 solid renal tumors biopsied in our center, 15 were renal oncocytomas. The mean (+/- standard deviation) follow-up was 30 +/- 19.8 months. We report on the outcome of these patients. RESULTS: The mean age at diagnosis was 57.6 +/- 14.4 years, and mean tumor size was 3.49 +/- 2.43 cm, corresponding to a mean tumor volume of 62.3 +/- 135.4 cm3. During follow-up, 6 of 15 patients needed surgery: two partial and four total nephrectomies. Indications for surgery were initial tumor burden, greater than 0.5 cm/yr tumor growth, and patient's preference in 1 case, 4 cases, and 1 case, respectively. The patients who received surgical treatment were significantly younger (45.5 +/- 11.1 years versus 65.6 +/- 10.3 years) and had more bulky tumors at diagnosis (50 +/- 30.1 mm versus 27.3 +/- 10.5 mm). In 1 patient, a chromophobic renal cell carcinoma was associated with the oncocytoma. All 9 patients who did not receive surgical treatment remained asymptomatic. CONCLUSIONS: The evolution of renal oncocytoma seems to be increase of tumor size with variable velocity. Treatment must be conservative. Initial management might be nonsurgical with close follow-up. Monitoring should not miss the time of conservative surgery. Initial tumor volume or fast tumor growth are indications for surgery. Partial nephrectomy, if the tumor size and localization are reasonable, is currently the technique of choice.

Adenoma, Oxyphilic↗
PubMed2005

[Prostate cancer at high risk of recurrence: results of 12 months of radiotherapy-hormone therapy].

OBJECTIVE: To evaluate the risk of progression after conformal radiotherapy combined with 12 months of adjuvant hormone therapy in a series of patients with prostate cancer considered to be at high risk of progression. MATERIAL AND METHODS: Between January 1997 and December 2001, 63 consecutive patients classified at high-risk according to Amico's classification were treated by combined radiotherapy-hormone therapy. All patients presented at least one factor of the high-risk group of Amico's classification: TNM 92 stage T2c, T3 or T4, or Gleason score > or = 8 or baseline PSA > 20 ng/ml. All patients were treated by combined radiotherapy-hormone therapy with concomitant hormone therapy for 2 months and adjuvant hormone therapy for 10 months. Biochemical progression was defined according to the ASTRO criteria. The median follow-up was 36 months. RESULTS: The 3-year and 5-year biochemical recurrence-free survival was 78%. No local recurrence was observed in 94% of cases and no metastases were observed in 93% of patients. On univariate analysis, only a baseline PSA greater than 22 ng/ml was identified as a predictive factor of early biochemical recurrence. The 3-year biochemical recurrence-free survival was 96% for patients with baseline PSA < 22 ng/ml and 56% for patients with baseline PSA > or = 22 ng/ml (p=0.0017). CONCLUSION: The early results of 12 months of radiotherapy-hormone therapy in high-risk patients in our series were comparable to those reported in the literature. Only a high baseline PSA was predictive of early biochemical recurrence. Adjuvant hormone therapy (long-term, intermittent hormone therapy) could therefore be modulated as a function of the baseline PSA.

Adenocarcinoma↗
PubMed2005

[Renal oncocytoma associated with renal cell carcinoma].

Renal oncocytoma is a benign tumour that can be associated with renal cell carcinoma in rare genetic syndromes. The authors report the case of a 62-year-old patient with no medical history, in whom assessment of low back pain in 1999 demonstrated a 40 mm tumour of the lower pole of the left kidney. Percutaneous needle biopsy of the tumour demonstrated oncocytoma confirmed by Hale's stain. Follow-up ultrasound demonstrated an increase in size (88 mm) and a nine-fold increase in volume over four years (210 cm3 in April 2003). Surgery was indicated in view of the rapid increase of the tumour volume. Histological examination of the operative specimen demonstrated a combination of oncocytoma and Fuhrman grade III renal cell carcinoma.

Adenoma, Oxyphilic↗
PubMed2005

[Current place of chemotherapy in the treatment of hormone-refractory metastatic prostate cancer].

The current management of hormone-refractory metastatic prostate cancer is purely palliative. The use of chemotherapy in this indication was revised in 1996, based on the results of studies with a combination of mitoxantrone and prednisone. This combination demonstrated a significant improvement of quality of life (+48%) and pain (+30%), but without any overall survival benefit. Two studies using taxols, TAX_327 and SWOG_9916, were published in the New England Journal of Medicine on 7 October 2004, with, for the first time, a median overall survival benefit of 2 months. However, the encouraging results of these 2 studies, which will probably modify the management of hormone-refractory prostate cancer, need to be interpreted cautiously. First of all, they were conducted in selected study populations (mean age less than 70 years, Kamofsky index greater than 80% in more than 85% of cases, local disease control in more than 70% of cases). They also comprise many methodological imprecisions and biases with especially, in the TAX 327 study, a change of treatment arm in 1/3 of patients without exclusion of these patients from the final analysis. The results obtained are also at the limit of statistical significance. The target improvement of overall survival, +25% and +33%, respectively, was not achieved at the end of these studies. Finally, from a palliative point of view, only one of these 2 studies (TAX_327) demonstrated a palliative benefit compared to mitoxantrone: 9% for pain, for a sixfold higher cost. Adverse effects were significantly more frequent than with mitoxantrone. Patient selection and details about the indications are necessary. Taxols should not be used systematically in this indication. Furthermore, although several studies are underway, the benefit of taxols at earlier stages of the disease are unknown. Urologists must be aware of the place of chemotherapy in the treatment of prostate cancer in order to remain at the centre of the treatment decision.

Adrenal Cortex Hormones↗
PubMed2005

[Reduction of the renal transplantation cold ischaemia time by the use of a timesheet].

OBJECTIVE: Reduction of the cold ischaemia time is one of the major objectives designed to improve the quality and cost of renal transplantation. Based on the experience of other centres, we report the impact of using a renal transplantation timesheet on the cold ischaemia time in our centre. MATERIAL AND METHOD: Since March 2004, we have used a renal transplantation timesheet with the collaboration of all personnel involved in transplantation (coordination, nephrologists, clinical pathologists). For each kidney harvested, the name of the personnel and the start and end times of their interventions were recorded. The authors report the results for the first 7 months. Cold ischaemia times and the incidence of delayed graft function were studied. RESULTS: 47 kidneys were harvested between 01/03/2004 and 30/9/2004 in our centre and 46 transplantations were performed. The mean cold ischaemia time was 14 h 51 min, i.e. a reduction of 8 hours 58 minutes compared to that observed in 2003 (23 h 50 min) (p < 0.01). Delayed graft function (DGF) was observed in 10/46 (21.74%) recipients. This DGF rate was significantly lower than that observed in 2003 (DGF 2003 = 30%), while the mean donor serum creatinine was higher (155 +/- 177 micromol/l vs 98 +/- 71 micromol/l in 2003, p < 0.05). The longest delays were those related to availability of an operating room (n=2: 10 h and 14 h). CONCLUSION: The use of a renal transplantation timesheet allowed a significant reduction of the cold ischaemia time and DGF rate. It requires the collaboration of all renal transplantation personnel and is an indicator of motivation. This timesheet allowed the correction of certain habits that can still be improved. These results should lead to an improvement of the results and cost of renal transplantation.

Creatinine↗
PubMed2005

[Tubulopapillary tumours of the kidney: prognostic value and therapeutic implications of the distinction between type 1 and type 2 based on a series of 58 cases].

OBJECTIVE: The purpose of this study was to demonstrate the prognostic value of subdivision of tubulopapillary tumours into 2 histological subtypes and to discuss the therapeutic implications. MATERIALS AND METHODS: This was a single-centre retrospective study of 58 cases from a series of 414 patients operated for renal cancer between 1988 and 2001 based on review of histology slides (biopsies and operative specimens). The radiological assessment was based on ultrasound reports and review of CT scans. Karyotypes were described by cytogenetic analysis. RESULTS AND DISCUSSION: Tubulopapillary tumours represented 14% of all kidney tumours with a male prevalence of 77% and a mean age of 56.5 years. The overall mean follow-up was 62.6 months. Treatment consisted of 25 right radical nephrectomies, 29 left radical nephrectomies and 4 partial nephrectomies. 84% of tumours were low-grade and 80% were low stage T1 or T2. Multifocal lesions were observed in 31% of cases. Synchronous bilateral lesions were observed in 12% of cases. The 5-year survival was 95% and the 10-year survival was 87%, correlated with stage, grade, tumour diameter, presence of necrosis and low enhancement. According to the data reported by Delahunt, 2 subtypes can be distinguished: Type I tumours (75%) with low grade and low stage were correlated with a high rate of multifocal lesions (30%) with a genetic predisposition. Type 2 tumours (25%), usually unifocal, were correlated with a higher grade and stage, confirmed by their poorer prognosis. Biopsy allows a distinction of the type and grade of the tumour. CONCLUSIONS: In our series, for equivalent mean tumour diameters (55 mm), tubulopapillary tumours treated by radical nephrectomy had a good prognosis regardless of their subtype. Classification of the tumour by biopsy prior to surgery could have implications for therapeutic management. For type 1 tubulopapillary tumours identified on preoperative biopsy, we propose radical nephrectomy due to the high risk of multifocal lesions (30%). Although partial nephrectomy may be indicated for type 1 tubulopapillary tumours less than 4 cm, the patient must be informed about the risk of recurrence and the importance of long-term follow-up. Studies including a larger number of patients must be conducted to compare the survival associated with type 2 tumours compared to that of the classical histological subtype.

Carcinoma, Papillary↗
PubMed2005

[Treatment of inferior caliceal stones by flexible ureteroscopy].

OBJECTIVE: Evaluation of the treatment of inferior caliceal stones by flexible ureterorenoscopy and Holinium-YAG laser on a series of 69 operations. MATERIAL AND METHOD: Between April 1998 and December 2003, 69 flexible ureteroscopies were performed for 55 stones in 49 patients. The mean age of the patients was 51.6 years (range: 18-78). The mean stone diameter was 12.8 mm (range: 5-3 1). 46% of stones had been pretreated by ESWL, PCNL or surgery. Endocorporeal lithotripsy was performed by Holmium-YAG laser in 45 cases, Lithoclast in 5 cases and en bloc extraction in 3 cases. Technical features, efficacy and morbidity were studied. The results were classified into fragment-free (FS), residual fragments (RF) < or = 4 mm, RF > 4 mm and failures. The results were evaluated on D0-D1 and at 3 months on a plain abdominal x-ray and ultrasound. RESULTS: The mean operating time was 61 minutes (range: 25-120). Nine stones required several procedures. 20% of stones were cystine stones. A ureteric stent was placed in 67 cases. The mean length of stay was 2.5 days (D0-D8). At 3 months, after one or several ureteroscopies, the results were: 22% FS, 40% RF < or = 4 mm, 13% RF > 4 mm and 25% failures. One half of failures occurred during the first 14 ureteroscopy procedures. There were 13 minor complications and no major complications. CONCLUSIONS: The results of flexible ureteroscopy in the treatment of inferior caliceal stones are encouraging, especially with standardization of the technique. It appears to be a good compromise between ESWL and PCNL, particularly for stones between 10 and 20 mm, cystine stones and after failure of reference techniques.

Adolescent↗
PubMed2004

Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses.

PURPOSE: We evaluated the accuracy and clinical role of fine needle percutaneous biopsy of solid renal masses 4.0 cm or smaller with helical computerized tomography (CT) guidance. MATERIALS AND METHODS: In 88 consecutive patients (mean age 61 years) 88 biopsies were performed. Median tumor size was 2.8 cm. Tumor biopsy was performed with an 18 gauge needle using helical CT guidance in an outpatient setting. At least 2 whole cores per tumor were obtained. RESULTS: Biopsy material was insufficient for analysis in 3 (3.4%) procedures. Median tumor size of failed biopsies was 3.0 cm. There were 5 (5.6%) biopsies which revealed fibrosis and were considered inconclusive. A benign lesion was found in 14 (15.9%) biopsies. In the 66 biopsies positive for malignancy there were 65 cases of renal cell carcinoma and 1 lymphoma. A total of 62 patients underwent surgery. Biopsy changed tumor management in 42 (47.8%) patients who avoided radical nephrectomy, 13 of whom had a lesion which did not require surgery, 1 with a lymphoma and 28 who were treated with partial nephrectomy. Biopsy accuracy for histopathological tumor type and Fuhrman nuclear grade was 92% and 69.8%, respectively. No substantial morbidity occurred. CONCLUSIONS: Fine needle biopsy of small renal masses could select benign lesions for which observation might be an alternative to surgery. The accuracy of fine needle biopsy in identifying histological tumor type was high. However, biopsy was less accurate in evaluating Furhman grade. Biopsy with helical CT guidance could be a key point in tailored management of small solid renal masses and provide important information to those patients harboring renal masses.

Aged↗