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Eric Lechevallier

Publications and source records attributed to Eric Lechevallier.

34 records · Page 2Linked to original sources
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↗
PubMed2004

[Limited prognostic value of surgical biopsy before transplantation of good quality renal transplants].

OBJECTIVE: The purpose of this study was to assess the correlations between histological examination of surgical biopsies before transplantation of good quality donor kidneys and delayed return of renal function and renal function at 1 year in order to determine whether histology could explain the various, sometimes surprising outcomes observed with these good quality transplants. MATERIAL AND METHOD: From November 1999 to March 2002, 110 consecutive renal transplantations were performed in our centre from 79 different donors, not including any "borderline" donors. During preparation of each transplant, a surgical wedge biopsy of the mid-renal cortex was performed. Biopsies were paraffin-embedded then stained with P.A.S. (Periodic Acid Shiff). Histological examination was performed by a single pathologist and focused on the glomeruli (number, morphology), and the morphology of the interstitial space and vessels. Delayed return of transplant renal function was defined by the need for dialysis during the first week after renal transplantation. Immunosuppression and surveillance protocols were standardized and uniform. Transplant function at 1 year was evaluated by serum creatinine and creatinine clearance calculated according to Cockcroft's formula. RESULTS: The mean number of glomeruli per biopsy was 15.0 +/- 10.8. 42 renal biopsies (39.2%). Histological examination did not reveal any vascular, interstitial or glomerular lesions. Among these 42 transplants with normal biopsies, 30 (71.4%) did not develop delayed return of renal function (vs 69% of the transplants with abnormal biopsies, p > 0.05). Mean serum creatinine at 1 year (168.5 +/- 63 micromol/l vs 166.9 +/- 40.5 micromol/l, p > 0.05) and mean creatinine clearance at 1 year (53.4 +/- 17.4 ml/min. vs 48.3 +/- 14.3 ml/min, p > 0.05) were not significantly different between the normal biopsy group and the abnormal biopsy group. CONCLUSION: Histological abnormalities are frequently observed in renal transplants derived from good quality donors. The biopsy result before renal transplantation from "non-borderline" donors was not significantly correlated with the risk of delayed return of transplant function or the renal function at 1 year Biopsy alone cannot constitute a reliable criterion for the selection of renal transplants from "non-borderline" donors.

Adolescent↗
PubMed2004

[De novo cancer in a kidney transplant].

Development of cancer on a kidney transplant is a rare complication of renal transplantation. In the light of a case of cancer on a kidney transplant, in a series of 729 consecutive renal transplantations performed between January 1987 and December 2000, the authors discuss the epidemiology, pathophysiology, prognosis, treatment and prevention of this disease and emphasize the importance of regular and prolonged periodic ultrasound surveillance of kidney transplants. The reference treatment is transplantectomy with discontinuation of immunosuppression and resumption of haemodialysis. Under certain conditions, partial transplantectomy could appear be an alternative to the reference treatment.

Adenocarcinoma↗
PubMed2004

[Prostate-sparing cystectomy: long-term functional and oncological results in a series of 25 cases].

OBJECTIVE: To decrease the risk of erectile dysfunction and incontinence by performing prostate-sparing cystectomy for bladder cancer; and to evaluate the oncological results by comparing them to those of radical cystectomy. MATERIALS AND METHODS: Since 1994, 141 men have undergone cystectomy for bladder cancer. Twenty five patients with a mean age of 57 years (range: 47-75 years) underwent prostate-sparing cystectomy. The exclusion criteria were: contraindication to bladder replacement, invasion of the prostatic urethra, and associated prostatic adenocarcinoma. TURP was performed preoperatively to evaluate the prostatic urethra. All patients had a PSA < 4 ng/ml or negative prostatic needle biopsies. The Ditrovie and IIEF scores were used to evaluate the quality of voiding and erectile function. RESULTS: The mean follow-up was 53.4 months (median: 46 months). The overall 5-year survival regardless of stage was 66%. Seven patients (28%) died, all from their cancer. Six patients (24%) developed a pelvic recurrence, 2 patients (8%) developed an urethral recurrence (1 had a multifocal lesion, and 1 had CIS) treated by TURP and 6 patients (24%) developed distant metastases. Among the patients with pelvic recurrence, 4 (66%) presented a multifocal tumour. One patient developed prostatic adenocarcinoma after 36 months, which was treated by external beam radiotherapy. At 1 year, 100% of patients reported normal daytime continence and 19 out of 22 patients (86.4%) were continent at night and had to get up 1 to 3 times per night. At 1 year, 10 out of 22 patients (45.4%) had normal erections, 9 (40.9%) reported impaired erectile function but allowing sexual intercourse, and 3 had major erectile dysfunction (13.6%). At 3 years, 93.7% of patients had normal daytime continence; 75% of patients were continent at night, 37.5% of patients reported normal erections, 37.5% of patients reported partial erections and 25% of patients reported major erectile dysfunction. CONCLUSION: Prostate-sparing cystectomy for the treatment of invasive bladder cancer improves continence, sexual function and quality of life of patients, with poorer oncological results to those of radical cystectomy in terms of pelvic recurrence. Rigorous patient selection should improve these results.

Aged↗
PubMed2004

[Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70: a multicentre retrospective study of 210 cases].

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70 is considered to be associated with a higher risk than extracorporeal shock-wave lithotripsy (ESWL). However this technique is sometimes necessary for very large or complex stones in patients with several comorbidities. STUDY OBJECTIVE: To evaluate the predictive factors of success and operative risks likely to influence the results of PCNL in a population of patients over the age of 70. MATERIAL AND METHOD: Retrospective study of 203 patients (110 males, 97 females) over the age of 70, in whom a total of 210 PCNL were performed over a 12-year period in ten referral centres for the treatment of stones. 68.5% of cases presented a comorbidity and the median ASA score was 2. The median stone dimensions were 24 x 15 mm. There were 67 solitary pelvic stones, 7 infrapelvic ureteric stones, 31 solitary inferior caliceal stones, 40 complex stones and 13 staghorn calculi. A standard one-stage operative technique was performed in 92% of cases; the nephrostomy tract was easily performed by the urologists themselves in 71.8% of cases. RESULTS: The overall stone-free (SF) rate was 70.8%. The patient's weight and height (p=0.03 and p=0.01), stone dimensions and their solitary nature were significant factors of success (p<0.00001 and p=0.01) with SF rates of 81.1% for pelvic stones and 90.3%for solitary inferior caliceal stones (p<0.003); the SF rate for complete staghorn calculi was only 30.8%. A history of stones (p=0.04) and diabetes (p=0.03) influenced the stone-free rate, but the other comorbidities, body mass index, and age did not influence the stone-free rate. There were two deaths (0.9% and haemostasis nephrectomy was performed in 2 ASA 3 subjects in renal failure. In the other patients, there was no difference between preoperative and postoperative serum creatinine and haemoglobin levels. The ease of nephrostomy, the rapidity of PCNL, the day of removal of the drainage nephrostomy, the mean hospital stay (median stay: 6 days), sterility of postoperative urine and at the 1-month visit were significantly correlated with the SF rate. CONCLUSIONS: PCNL in subjects over the age of 70 years is a safe and reliable technique that achieved a stone-free rate of 70.8% for all types of stones combined. The best results were obtained for solitary stones larger than 20 mm in the renal pelvis or inferior calyx. Apart from diabetes, which remains a risk factor, well controlled comorbidities do not increase the operative risk. PCNL did not affect haemodynamic parameters or renal function.

Age Factors↗
PubMed2004

[Urinary stones in subjects over the age of sixty].

OBJECTIVE: Urinary stones, affecting 10% of the French population, is a frequent disease. Data of the literature on this disease in subjects over the age of 60 years reveal age-related changes of risk factors, especially affecting urine composition, but very few data have been reported concerning the clinical characteristics of the disease. Due to the absence of recent data on urinary stones in subjects over the age of 60 in France, we decided to study the epidemiology and urological treatment of urinary stones in the elderly in France. MATERIAL AND METHOD: From November 2001 to August 2002, a survey concerning urinary stones in subjects over the age of 60 was performed by the Association Française d'Urologie Stone Committee among urologist members of the AFU. The parameters studied were epidemiological, clinical, metabolic and therapeutic. The results were analysed on the overall patient population and on the subgroup of patients over the age of 70. RESULTS: The study included 176 patients over the age of 60, 110 of whom were over the age of 70. These patients presented their first episode of urinary stones in 41% of cases. Renal colic was the most frequent presenting symptom. Signs of severity were frequently associated, with urinary tract infection in 24% of cases, associated with sepsis in 49% of cases after the age of 70 years. The incidence of uric acid stones was higher than in the general population. CONCLUSION: Urinary stones can often occur for the first time after the age of 60. This disease appears to be more serious than in the general population due to the high incidence of infectious complications. Uric stones also appear to be more frequent. A multidisciplinary study based on a larger population is necessary to confirm these results.

Age Distribution↗
PubMed2003

Diagnosis and treatment of prostate cancers in renal-transplant recipients.

BACKGROUND: There is no consensus regarding prostate cancer in renal-transplant recipients (RTR). A questionnaire evaluating prostate cancer screening after transplantation and assessing the number, diagnostic modalities, treatment, and outcome of prostate cancer cases was mailed to 22 French renal-transplant centers. RESULTS: Among 1,680 RTR in 1998, 11 (0.65%) cases of prostate cancer were diagnosed, and among the 2,338 recipients followed up, 28 (1%) cases of prostate cancer have been diagnosed and treated. Median ages at diagnosis and at transplantation were 63 and 58, respectively. Clinical stages were T1 50% and T2 25%. Eighteen patients had a Gleason score under 7. At 18 months of mean follow-up, 2 men had died from prostate cancer, and in the curative treatment group, 16 of 17 men were alive with no evidence of disease. CONCLUSIONS: The incidence of prostate cancer in RTR appeared to be higher than expected. Prostate specific antigen (PSA) testing should be performed routinely each year in renal transplantation centers.

Adult↗
PubMed2003

Neural cell adhesion molecule expression in renal cell carcinomas: relation to metastatic behavior.

Neural cell adhesion molecule (NCAM), a member of the immunoglobulin superfamily, is expressed by a subgroup of renal cell carcinomas (RCCs) and by a limited number of adult organs, including the central nervous system (CNS) and adrenal gland. Because the major function of NCAM is homophilic adhesion between homotypic and heterotypic cells, we hypothesized that NCAM-expressing RCCs should preferentially metastasize to the CNS and adrenal gland. We did a retrospective immunohistochemical analysis of NCAM expression both in 338 primary renal tumors, including 249 conventional RCCs and 31 metastases of conventional RCCs. In primary renal tumors, NCAM was expressed by only 38 (15.2%) conventional RCCs and by no other histological subtypes of renal tumor. This expression correlated with a higher risk of adrenal and CNS metastases (P <0.001). NCAM expression also correlated with tumor size (P <0.001), renal vein involvement (P = 0.02), perirenal invasion (P = 0.02), and Fuhrman grading (P < 0.001). Finally, patients with NCAM-expressing RCCs had a lower survival rate (P = 0.006), especially in the first 2 years after surgery. NCAM expression is of interest both for evaluating the prognosis of patients with conventional RCCs and for determining a subgroup of patients at high risk for adrenal and CNS metastases.

Adolescent↗
PubMed2003

Transurethral ureterorenolithotripsy using new automated irrigation/suction system controlling pressure and flow compared with standard irrigation: a randomized pilot study.

PURPOSE: To compare in a random fashion an automated irrigation/suction pump system with the standard pressurized technique during transurethral ureterorenolithotripsy. PATIENTS AND METHODS: Between July 2001 and December 2001, 47 patients were prospectively included. Prior to randomization, rigid instruments were allocated to 25 patients (group R) and flexible instruments to 22 patients (group F) according to stone location. The groups R and F were then randomized separately, and the pressurized technique was employed in groups R1 and F1, while the automated system was employed in groups R2 and F2. Operative time, amount of liquid consumed, and stone-free rate at the end of the procedure were analyzed. RESULTS: For the entire series, ureteroscopy time using the automated system (mean 42 +/- 17[SD] minutes; range 15-90 minutes) was 35% less than with the pressurized technique (mean 65 +/- 25 minutes; range 20-135 minutes) (P = 0.04 Wilcoxon score). The stone-free rate was significantly higher in groups R2 + F2 (92%) than in groups R1 + F1 (69%) (P = 0.048). CONCLUSION: With the ENDO FMS UROLOGY system, there was a significant reduction in the mean ureteroscopy time: 32% less with the rigid instrument and 53% less with the flexible instrument. This seems to be attributable to a wider working space and highly improved visibility. The integrated suction at constant flow allows efficient evacuation of stone fragments while limiting cavity pressure. These results, obtained on 47 patients, should be confirmed by larger randomized studies.

Humans↗
PubMed2003

Attempted isolation of Nanobacterium sp. microorganisms from upper urinary tract stones.

A single team has reported isolation of nanobacteria in human and bovine blood products, as well as, more recently, kidney stones. This has raised controversy. To confirm the data, we searched for nanobacteria from 10 aseptically removed upper urinary tract (UUT) stones. We used scanning electronic microscopy (SEM) with four stones and culture of stones on either 3T6 fibroblast monolayers or liquid RPMI medium. Detection of nanobacteria was made with a commercially available monoclonal antibody, 16S ribosomal DNA amplification with specific primers, and transmission electronic microscopy (TEM) of inoculated cells. SEM showed nanoparticles in four of four UUT stones similar to those recently described. TEM of inoculated 3T6 cell monolayers has shown transient intracytoplasmic vacuolar formations containing 200- to 500-nm particles in 3 of 10 cell cultures. Gimenez staining, Hoechst staining, and specific monoclonal immunofluorescence failed to reveal nanobacteria. Finally, we could not grow Nanobacterium sp. microorganisms by the techniques described. Although with SEM, we observed nanoparticles morphologically similar to nanobacteria, we failed to isolate Nanobacterium sp. microorganisms in culture and to prove the bacterial nature of these nanoparticles in stones.

Bacteria↗
PubMed2003

[Complications of "Acucise" balloon endopyelotomy].

OBJECTIVES: Although the results of endopyelotomy for ureteropelvic junction (UPJ) stenosis are well known, our objective was to study the specific complications of treatment of UPJ stenoses by Acucise balloon. MATERIAL AND METHODS: The specific complications of 50 patients (40 women, 10 men) treated consecutively by Acucise balloon endopyelotomy for UPJ stenosis from January 1994 to February 1999 were reviewed. The mean age was 47 years (range: 19-84 years). Thirty-five stenoses (70%) were primary. A polar pedicle was diagnosed by preoperative CT angiography in 5 cases. The endopyelotomy technique was that described by Chandhokf except in 3 cases in which section with strict external lateral orientation was performed. RESULTS: Mean operating time and mean length of hospital stay were 70 min (range: 35-180 min) and 5.4 days (range: 2-27 days), respectively. Six (12%) technical incidents were observed intraoperatively (3 cases of rupture of balloon) and 7 (14%) haemorrhagic incidents were observed perioperatively (5 polar pedicles). There were no conversions to open surgery. There were 4 (8%) major perioperative complications, all haemorrhagic, which required 2 radiological embolizations and one lumbotomy. Only these patients required transfusion (3.25 units/patient). Fourteen urinary tract infections were observed, including 2 cases of pyelonephritis (4%) and one case of septicaemia (2%). Nine patients experienced severe discomfort due to the double J stent. With a mean follow-up of 47 months, the overall success rate was 74%, not influenced by the development of a complication. Seven (58%) of the 12 patients with failure of endopyelotomy had a lower pole pedicle. CONCLUSION: Acucise endopyelotomy is a simple and effective technique. However, rigorous indications and technique are essential due to the possibility of haemorrhagic complications, often related to a lower pole vessel.

Catheterization↗
PubMed2003

[Flexible ureteroscopy in upper urinary tract diseases].

STUDY OBJECTIVE: Evaluation of active deflection flexible miniureterorenoscopes for diagnostic or therapeutic applications in the management of upper urinary tract diseases. MATERIAL AND METHOD: The authors report a series of 111 consecutive patients undergoing a total of 137 flexible ureteroscopies for upper urinary tract disease between November 1997 and April 2001. The procedures were performed for diagnostic purposes (54 cases: 39%) or therapeutic purposes (83 cases; 61%). A successful procedure was defined as achievement of the objective defined when establishing the indication for ureteroscopy. The mean age of the patients was 51 +/- 15 years. The main diseases investigated or treated were stones (66%) and urothelial tumours (25%). RESULTS: The mean operating time was 42 +/- 22 min. The median length of postoperative hospital stay was 2 days (range: 0-27 days). 8% of patients did not require any postoperative ureteric drainage. 78% of the flexible ureteroscopies performed were successful. Complications were observed in 8% of cases, mainly macroscopic haematuria, including 3 major complications in the form of ureteric perforation. Serious intraoperative equipment damage was observed in 4% of cases. CONCLUSION: Ureteroscopy with a flexible mini-ureteroscope is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique for lesions situated above the iliac vessels. The use of various instruments, including the Holmium:Yag laser, should increase the range of possibilities of endoscopic techniques. The major limitation of active deflection flexible mini-ureterorenoscopes remains their fragility.

Equipment Design↗
PubMed2003

[Contribution of laparoscopy to vesico-ureteral reimplantation on vesico-psoas].

Laparoscopy is now a recognized and widely performed treatment modality for certain ureteric diseases (stones, ureteropelvic junction syndrome, etc.). Vesicopsoas hitch is a reference technique for the treatment of defects of the pelvic ureter larger than 5 cm. The authors report 2 cases of fibrous stenosis of the pelvic ureter effectively treated by laparoscopic vesicopsoas hitch after failure of endourological treatment. The details of the technique and its advantages are described and discussed. The authors believe that laparoscopic vesicopsoas hitch is feasible and reproducible. Larger series of patients treated by laparoscopy are required to allow comparison with conventional open surgery.

Adult↗