PubMed Health⌕ Search

Biomedical subjects

Emmanuel Chartier-Kastler

Publications and source records attributed to Emmanuel Chartier-Kastler.

At least 19 recordsLinked to original sources
PubMed2007

Late recurrence of a prostatic adenocarcinoma as a solitary splenic metastasis.

Splenic metastases of solid tumors are exceptional. We report the first case of an isolated splenic metastasis from prostate carcinoma, 5 years after radical prostatectomy. The splenic tumor was revealed by a pain and progressive increase in the serum prostate-specific antigen (PSA) level. Histology of the spleen showed an adenocarcinoma immunostained with cytokeratin and PSA markers. The patient remained asymptomatic and his serum PSA level was within normal limits 17 months after the splenectomy. This case suggests that splenic metastasis might be the result of the growth of an early blood-borne micrometastasis within the spleen after a period of clinical latency.

Adenocarcinoma↗
PubMed2006

Topographic anatomy of a new posterior approach to the pudendal nerve for stimulation.

OBJECTIVES: To describe a new approach to the pudendal nerve from a dorsal direction in terms of topographic anatomy and to discuss pudendal nerve neurophysiology in light of the rationale behind pudendal nerve stimulation to treat lower urinary tract disorders. MATERIALS AND METHODS: Cadavers of four women aged 78-87 yr were studied. After placing the cadavers in prone position with a 40 degrees -60 degrees flexion of the hips and determining anatomic landmarks, a 20-G insulated needle was inserted close to the pudendal nerve. Then the topographic relationships of the puncture with the pudendal canal were explored by dissection. RESULTS: The mean points of insertion of the needle were 14 cm inside the great trochanter, 9 cm above the ischiatic tuberosity, and 6 cm outside the gluteal fold. If the needle was inserted 6.5 cm under the previous with an orifice of 60 degrees and this route was followed, the needle could have a contact area with the pudendal nerve larger, leading to a greater stimulation efficacy with less stimulation intensities. The rectum was so far away that a rectal injury with the needle seemed unlikely. No vascular structure was at the contact of the nerve. CONCLUSIONS: The described new puncture technique to reach the pudendal nerve provides easy and safe accessibility of the nerve for stimulation. In light of our increasing understanding of the rationale behind neuromodulative stimulation, the pudendal nerve could be a promising target for continuous lower urinary tract neuromodulation by implant.

Aged↗
PubMed2006

Patient characteristics associated with quality of life in European women seeking treatment for urinary incontinence: results from PURE.

OBJECTIVE: To investigate the association between patient characteristics and disease-specific and generic quality of life (QOL) as well as the degree of bother in women seeking treatment for urinary incontinence (UI). METHODS: The Prospective Urinary Incontinence Research (PURE) was a 6-mo observational study with 1055 physicians from 15 European countries enrolling 9487 women. QOL was assessed at the enrolment visit using the urinary Incontinence Quality of Life questionnaire (I-QOL) and the generic EQ-5D. A single-item instrument was used to measure the degree of bother. UI severity was assessed using the Sandvik Index. UI was categorised into stress (SUI), mixed (MUI), and urge (UUI) urinary incontinence by a patient-administered instrument (Stress and Urge Incontinence Questionnaire [S/UIQ]). Multivariate linear (I-QOL, EQ-5D Visual Analogue Scale) and logistic (bother, EQ-5D health state index) regressions were performed. RESULTS: Mean total I-QOL scores were significantly and independently associated with UI severity, nocturia, age, UI subtype, number of selected concomitant medical conditions, length of suffering from UI before contacting a doctor, smoking status, ongoing use of UI medication, and country. After adjusting for all the covariates, the total I-QOL scores for SUI, MUI, and UUI were 62.7, 53.8 and 60.1, respectively. As with I-QOL, UI severity was also the most important predictor for bother. The number of concomitant medical conditions, together with UI severity, was the variable most strongly associated with EQ-5D. CONCLUSION: In addition to the UI subtypes, severity of UI should be given more importance in treatment algorithms and in treatment decision-making by both the patient and the physician.

Europe↗
PubMed2006

Upper urinary tract transitional cell carcinoma: recurrence rate after percutaneous endoscopic resection.

OBJECTIVES: To assess oncologic outcomes in patients undergoing percutaneous management for upper urinary tract transitional cell carcinoma (UUT-TCC) of the renal cavities. METHODS: We performed a retrospective review of data for patients who underwent percutaneous conservative surgery for a UUT-TCC between 1989 and 2005: sex; age at diagnosis; mode of diagnosis; smoking; history of bladder cancer; type of surgery; complications; tumour site, size, stage and grade, and recurrence and progression. We evaluated recurrence and survival rates. RESULTS: Data were analyzed for 24 patients. Median age was 70 yr. The tumour was located in the renal pelvis in 11 patients and in the caliceal system in 13 patients. Mean tumour size was 1.8 cm (range: 0.8-2.9). Four patients had a history of bladder carcinoma. Three patients experienced perioperative blood loss requiring transfusion, and one experienced colon wound. Median follow-up was 62 mo. Eight (33.3%) patients experienced local recurrence (three in the treated urinary tract, one in the contralateral tract, four in the bladder). Five patients underwent nephroureterectomy (NUT) during follow-up. Five (20.8%) patients have died, four from disease progression and one from cardiovascular causes. The 5-year disease-specific and tumour-free survival rates were 79.5% and 68%, respectively. CONCLUSIONS: Percutaneous management can be recommended as an alternative to NUT or ureteroscopy for low-grade or superficial UUT-TCCs localised in the renal cavities. These patients require long-term postsurgical surveillance. For patients with high-grade or invasive tumours, open NUT remains the gold standard.

Aged↗
PubMed2006

Prevention of urinary tract infection in spinal cord-injured patients: safety and efficacy of a weekly oral cyclic antibiotic (WOCA) programme with a 2 year follow-up--an observational prospective study.

POPULATION: Spinal cord injury (SCI) patients with neurogenic bladder have an increased risk for symptomatic urinary tract infection (UTI). Recurrent UTI requires multiple courses of antibiotic therapy, markedly increasing the incidence of multidrug-resistant (MDR) bacteria. METHODS: During an observational prospective study, we determined the safety and efficacy of a weekly oral cyclic antibiotic (WOCA) regimen to prevent UTI in SCI adult patients with neurogenic bladder undergoing clean intermittent catheterization. The WOCA regimen consisted of the alternate administration of an antibiotic once per week over a period of at least 2 years. The antibiotics chosen were efficient for UTI, well tolerated and with low selection pressure. RESULTS: There was a significant decrease in antimicrobial consumption linked to the dramatic decrease in the incidence of UTI. Before intervention, there were 9.4 symptomatic UTIs per patient-year, including 197 episodes of febrile UTI responsible for 45 hospitalizations. Under the WOCA regimen there were 1.8 symptomatic UTIs per patient-year, including 19 episodes of febrile UTI. No severe adverse events and no new cases of colonization with MDR bacteria were reported. CONCLUSIONS: In this prospective, observational pilot study a novel approach to the prevention and treatment of UTI in SCI was investigated. Our study shows the benefit of WOCA in preventing UTI in SCI patients.

Adult↗
PubMed2006

Histologic features in the urinary bladder wall affected from neurogenic overactivity--a comparison of inflammation, oedema and fibrosis with and without injection of botulinum toxin type A.

OBJECTIVES: To study histological features and morphological differences in bladder wall specimen from patients with and without botulinum toxin A injections and to compare those issues in responders and non-responders to the toxin therapy. MATERIAL AND METHODS: Bladder wall specimen obtained from cystectomy in 45 patients with neurogenic overactive bladders with and without injection of botulinum toxin A into the detrusor muscle for treatment of neurogenic incontinence were evaluated concerning the histological criteria inflammation, oedema and fibrosis of the bladder wall. RESULTS: Bladder wall specimen obtained from patients suffering from neurogenic detrusor overactivity showed important histological alterations. Generally, inflammatory infiltration, oedema and fibrosis of the bladder wall were frequently observed. When comparing specimen from patients who had received botulinum toxin injection to those from patients who had not, there was no difference concerning inflammation and oedema. However, patients who had received botulinum toxin injection showed significantly less fibrosis of the bladder wall than those who had not received the toxin injection (p<0.00073). When comparing specimen from responders and non-responders to the botulinum toxin therapy, there was no difference in inflammation. Although not significant, a trend was observed that responder to the toxin therapy had less fibrosis and oedema of the bladder wall than non-responder. CONCLUSION: In our study injection of botulinum toxin into the detrusor muscle did not lead to increased fibrotic activity within the bladder wall, on the contrary patients with previous botulinum toxin injection revealed significant less fibrosis than patients without toxin injection.

Adult↗
PubMed2006

Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma.

OBJECTIVES: To compare the outcomes in patients who had undergone either open nephroureterectomy or conservative endoscopic surgery (ureteroscopic or percutaneous management) for upper urinary tract transitional cell carcinoma. METHODS: We performed a retrospective review of the data for patients treated surgically for upper urinary tract transitional cell carcinoma from 1990 to 2004. The data included patient sex, age at diagnosis, mode of diagnosis, smoking history, history of bladder cancer, type of surgery, complications, and tumor site, size, stage, grade, recurrence, and progression. We also evaluated the recurrence and survival rates. RESULTS: Data were analyzed for 97 patients. The median patient age was 68 years. Sixteen patients had a history of bladder tumor. The surgical procedure was open nephroureterectomy in 54 patients, ureteroscopy in 27, and percutaneous endoscopic ablation in 16. The tumor stage, grade, and site were independent prognostic factors for survival in a multivariate analysis (P <0.05). The 5-year disease-specific survival rate was 81.9% for low-grade tumors and 47.3% for high-grade tumors (P = 0.0001). A correlation (P = 0.002) was found between low-grade tumors and superficial tumors. In patients with low-grade tumors (n = 46), the 5-year disease-specific survival rate after nephroureterectomy, ureteroscopy, and percutaneous endoscopy was 84%, 80.7%, and 80%, respectively (P = 0.89); the corresponding 5-year tumor-free survival rates were 75.3%, 71.5%, and 72% (P = 0.78). CONCLUSIONS: Conservative surgery can be recommended as an alternative to nephroureterectomy for low-grade or superficial upper urinary tract transitional cell carcinoma. For patients with high-grade or invasive tumors to be candidates for conservative surgery will require the development of additional prognostic factors (eg, molecular markers). These patients require long-term postoperative surveillance.

Aged↗
PubMed2006

L6-S1 spinal nerve stimulation reduces micturition frequency in anaesthetized rats with cyclophosphamide-induced cystitis.

OBJECTIVE: To further investigate the rationale for using spinal nerve stimulation (SNS) for treating bladder overactivity associated with cystitis in a rat model of cyclophosphamide-induced cystitis, as several studies suggested that symptoms associated with chronic cystitis could be treated using stimulation of sacral spinal nerves, but the mechanisms by which it works are unknown. MATERIALS AND METHODS: Cystitis was induced by i.p. injection of cyclophosphamide 48 h before the experiments in anaesthetized male rats. Neurograms were taken by placing a recording electrode onto the pelvic nerve and a stimulating electrode on either the L6 or S1 ipsilateral spinal nerves. Two selected intensities were then evaluated for SNS in control and cyclophosphamide-treated rats during cystometry. RESULTS: Cyclophosphamide resulted in significant bladder overactivity. There was no apparent difference in the neurograms generated in response to SNS of the S1 and L6 spinal nerves, and between cyclophosphamide and control rats. Intensities of 200 microA (Adelta-fibre-specific) and 2 mA (Adelta+ C-fibres) were chosen for SNS. Continuous SNS at 200 microA significantly reduced the frequency of voiding and non-voiding contractions in cyclophosphamide-treated rats. SNS at 2 mA resulted in the abolition of voiding contractions, accompanied by continuous leakage of urine. CONCLUSION: SNS recruiting only Adelta-fibre produced fewer voiding contractions in cyclophosphamide-treated rats, to a level similar to that from the control rats. These results support the ability of SNS to decrease bladder overactivity in a pathophysiological model of chemical irritation of the bladder.

Animals↗
PubMed2006

Improving the global management of the neurogenic bladder patient: part II. Future treatment strategies.

BACKGROUND: Patients with neurogenic bladder represent a small fraction of the total overactive bladder population. As a consequence, development of new therapies in this area has largely focused on idiopathic urinary incontinence. The absence of data for patients with neurological disease has far-reaching implications, affecting reimbursement and physicians' willingness to prescribe therapies, and limiting access of potential valuable treatments to patients whose lives are significantly impaired by inadequately managed bladder symptoms. SCOPE: The range of new therapies is increasing. Although many reviews of the overall safety, efficacy and mode of action of such treatments are available, there is limited information on how these treatments will best be used in clinical practice. We considered the current benefits and limitations of the various new licensed and unlicensed therapies and what role each would have in the future management of neurogenic urinary incontinence. CONCLUSIONS: A wide range of new treatments have been investigated for the management of overactive bladder; few, however, have been evaluated extensively in neurogenic urinary incontinence. Further studies are required to determine the optimal dosing regimes and formulations for individual sub-populations of neurogenic bladder patients and to determine the cost-effectiveness of these interventions. With the current experience available, two treatment algorithms for a subset of patients with neurological disease have also been proposed, which suggest at which stage of management and in which patients individual therapies for neurogenic urinary incontinence could be used.

Algorithms↗
PubMed2006

Improving the global management of the neurogenic bladder patient: part I. The complexity of patients.

BACKGROUND: The management of urinary incontinence in patients with neurological disease is complex. Physicians face a multitude of challenges related to progression of the primary condition, the presence of a diversity of other related and unrelated symptoms, the safety, efficacy and tolerability issues associated with multiple therapies being required and the changing need for collaboration with other specialities. SCOPE: Current guidelines produced by the urological communities, as well as the disease-focused organizations, aim to standardize care in their specific group of patients. A passive approach to implementation, however, means that guidelines produced are all too frequently not readily available to, read by or followed by the wider audience. In addition, each speciality has its own guidelines and a different view of the primary focus of care in neurological patients, which may lead to variations in recommendations and, subsequently, in clinical practice. A review of current urological and disease specific guidelines was made to evaluate differences between the published guidance between the specialities and within urology itself. CONCLUSIONS: Although availability of effective therapies remains a cornerstone of neurogenic bladder treatment, consideration must also be given to the non-pharmacological and surgical issues related to the global management of this population. Improved cross-speciality interactions and development of patient-specific treatment and follow-up plans, which are in keeping with the current guidelines of each speciality involved, may serve to enhance physicians' understanding of the importance of effective urinary incontinence treatment as well as the overall management of the patient.

Europe↗
PubMed2006

[Surgical management of chronic refractory pain after TVT treatment for stress urinary incontinence].

OBJECTIVE: To evaluate the results of surgical treatment of iatrogenic pelviperineal pain following TVT treatment for stress urinary incontinence (SUI). MATERIAL AND METHODS: Eight patients developed chronic pain after TVT that was refractory to symptomatic medical treatment. Pain was characterized by clinical interview and clinical examination and an aetiological assessment demonstrated the role of TVT in pathogenesis of the pain. TVT was removed by open surgery or by laparoscopy. Pain and continence were evaluated postoperatively. RESULTS: TVT was completely (n = 3) or partially (n = 5) removed. With a mean follow-up of 31 months, no patient has experienced pain recurrence. Five patients have remained continent and 3 patients were treated for recurrent urinary incontinence. CONCLUSION: Although medical treatment may be disappointing, surgical resection provides good results on refractory pain, but preservation of continence is inconstant.

Aged↗
PubMed2006

[Role of endoscopy in the management of upper urinary tract tumors].

Transitional cell carcinomas of the upper urinary tract are rare tumours that represent about 5% of all transitional cell carcinomas. The reference treatment is currently open nephroureterectomy. Low-grade or superficial urinary tract tumours have a good prognosis, similar to that of noninvasive bladder tumours (80% 5-year specific survival). The surgical management of upper urinary tract tumours is gradually evolving towards complete preservation of the upper urinary tract and renal parenchyma, when compatible with local conditions. Conservative endoscopic treatments (ureteroscopy, percutaneous treatment) provide good oncological results and constitute a possible alternative to nephroureterectomy for the systematic management of good prognosis tumours. The cost of endoscopy equipment and consumable items is currently a limiting factor to the widespread use of these techniques.

Carcinoma, Transitional Cell↗
PubMed2005

A description of health care provision and access to treatment for women with urinary incontinence in Europe -- a five-country comparison.

BACKGROUND: Female urinary incontinence is a prevalent condition, but only about one-third of women seek treatment. OBJECTIVES: To describe the health care provision for women with urinary incontinence from a European perspective, selecting France, Germany, Spain, Sweden, and the United Kingdom as examples, and to investigate whether specific barriers for treatment exist. METHODS: Available health care system information, a literature review and clinical expert information identified patterns of treatment provision. RESULTS: In Spain, Sweden, and the UK, access to medical care in general is primarily through the general practitioners. However, in Spain and Sweden, women with urinary incontinence can directly visit specialists. In France and Germany, women have equal access to either general practitioners or specialists. Aside from general practitioners, gynaecologists play a major role in urinary incontinence care in all countries except the UK. In Germany, urologists are also involved in initial female urinary incontinence care; however, only in about 16% of women. There are no waiting lists in France and Germany for appointments with physicians or procedures, contrary to Spain, which has long waiting lists. Access to general practitioners in the UK is unrestricted whereas advanced diagnosis and treatment in secondary care requires long waits. A specific Swedish policy mandates that no woman is required to wait longer than 3 months for incontinence visits and related surgery. In Sweden and the UK, specialist nurses and other health care workers provide incontinence services. Almost all treatment options for urinary incontinence are at least in part reimbursed. However, various co-payments and fees in France, Germany, Spain and Sweden exist and constitute out-of-pocket expenses for women if no complementary additional private health insurance is available. In some countries, financial incentives for physicians to provide incontinence services are low, raising concerns about their interest to engage in continued patient care. CONCLUSIONS: Information about service provision in Europe for women with urinary incontinence is limited and makes it difficult to understand barriers to treatment seeking. A broad European perspective may promote optimised treatment access in the future for this widespread and under-recognised condition.

Ambulatory Care↗
PubMed2005

Immunohistochemical expression of p63, p53 and MIB-1 in urinary bladder carcinoma. A tissue microarray study of 158 cases.

P63 is a member of the p53 family, which plays a role in the differentiation of urothelium and is supposed to play a role in urothelial carcinogenesis. P53 and MIB-1 are recognised in many studies as predictive markers of progression, but few studies in the literature have examined p63. The aims of our study were to explore the expression of p63 in bladder carcinomas and to compare this expression to p53 and MIB-1, as well as to stage and grade. Tissue microarrays were performed on 158 urothelial carcinomas (56 pTa, 45 pT1 and 57>or=pT2). Immunohistochemical studies were performed with p63, p53 and MIB-1 antibodies. In our study we observed that p63 immunostaining is present in all cell layers in papillary urothelial neoplasm of low malignant potential (PUNLMP), but partially lost in non-invasive papillary urothelial carcinoma low grade (NILGC) and in pT1/>or=pT2 bladder cancers. P53 and MIB-1 displayed lower expression in PUNLMP/NILGC vs non-invasive papillary urothelial carcinoma high grade (NIHGC)/pT1, but there was no correlation between the expression of p63, p53 and MIB-1. Our study demonstrates that p63 expression distinguishes between PUNLMP/NILGC and NIHGC/pT1 (p=4.10(5)). A statistical difference disserving pTa and pT1/>or=pT2 with a statistical significance (p<10(-6)) could also be observed. P63 should be considered as an additional biomarker that might help pathologists to classify their patients.

Adult↗
PubMed2005

[The choice of a medical career in a population of 600 second-cycle French medical students preparing the national-ranking exam].

OBJECTIVES: To analyse the choice of career of a sample of second-cycle French medical students following the implementation of the recent national-ranking exam (NRE). METHODS: All the medical students registered in a cycle of conferences to prepare for the NRE filled-in a self-administered, anonymous, questionnaire in Paris and the provinces during the university year 2004. The items concerned the choice of career, according to the NRE discipline selected, and the mobility required for the success of the project. RESULTS: Six hundred students were included in the study; 398 were women (66%) and 202 were men (34%), with a mean age of 23.2 +/- 6 years (21-29). Two hundred were at the end of their first cycle (33%) and 400 at the end of their third cycle (67%). Two hundred came from the provinces (33%) and 400 from Paris. Regarding the disciplines selected, medical specialisation predominated (36.2%) followed by surgical specialisation (15.5%) and general medicine (11.3%); psychiatry ranked lowest (4.5%). Psychiatry ranked lowest in Paris (4.8%) and gynaecology-obstetrics in the provinces (3.5%). Regarding geographical mobility, 83.3% of Parisians and 16.8% of provincials refused the idea of completing their third cycle anywhere other than in their area of origin. CONCLUSION: The NRE permitted the integration of general medicine among all the other clinical specialisations. Surgery retained a place of choice among the disciplines selected by the students. However, many Parisian students will be obliged to take on a residency in a hospital other than their original university hospital.

Adult↗
PubMed2005

Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study.

PURPOSE: We determined the safety and efficacy of each of 2 doses of botulinum toxin type A (BTX-A) (200 or 300 U BOTOX) injected into the detrusor for urinary incontinence caused by neurogenic detrusor overactivity of predominantly spinal cord origin. MATERIALS AND METHODS: A total of 59 patients with urinary incontinence caused by neurogenic detrusor overactivity (due to spinal cord injury in 53 and multiple sclerosis in 6) requiring clean intermittent self-catheterization were randomized to receive a single dose into the detrusor of BTX-A (200 U or 300 U) or placebo. Changes in daily frequency of urinary incontinence episodes were monitored via a patient bladder diary during 24 weeks. Key urodynamic assessments (maximum cystometric capacity, reflex detrusor volume and maximum detrusor pressure during bladder contraction) were used to provide objective measures of the treatment effect on bladder function. The impact of treatment on quality of life was assessed using the Incontinence Quality of Life questionnaire. RESULTS: There were significant posttreatment decreases in incontinence episodes from baseline in the 2 BTX-A groups (p </=0.05) but not in the placebo group. In addition, more patients who received BTX-A reported no incontinence episodes during at least 1 posttreatment evaluation period. Positive treatment effects were also reflected by significant improvements in bladder function in the BTX-A groups, as assessed by urodynamics and in patient quality of life. Benefits were observed from the first evaluation at week 2 to the end of the 24-week study. No safety concerns were raised. CONCLUSIONS: Intramuscular injections of BTX-A into the detrusor can provide rapid, well tolerated, clinically significant decreases in the signs and symptoms of urinary incontinence caused by neurogenic detrusor overactivity during a 24-week study period.

Adult↗
PubMed2005

[Artificial urinary sphincters in women: indications, techniques, results].

Artificial urinary sphincter (AUS) is one of the last resort surgical treatments proposed to patients with stress urinary incontinence (SUI) due to severe sphincter incompetence. Despite convincing functional results, AUS implantation in women is a preferred treatment option only for certain teams. An abdominal approach for implantation of the prosthesis is often preferred to the transvaginal approach. The most recent data show that more than 84% of patients are continent at 5 years. The 5-year sphincter revision rate is about 20%. In 2005, AUS is still a valid treatment option in SUI and has a real place in the urologist's therapeutic armamentarium even in the age of synthetic suburethral tape.

Contraindications↗