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H Botto

Publications and source records attributed to H Botto.

At least 19 recordsLinked to original sources
PubMed2000

Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations.

PURPOSE: Bacillus Calmette-Guerin (BCG) therapy is considered to be an effective prophylactic and therapeutic agent for high risk superficial transitional cell carcinoma of the bladder. Nevertheless, in a select uncommon population of stage Ta grade 3 superficial lamina-free tumors the results of this treatment have not yet been well established. We evaluated recurrence and progression rates, and the success of BCG therapy in a population with stage Ta grade 3 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Of the 605 patients treated at our institution from 1982 to 1996 for the histopathological diagnosis of primary bladder cancer 32 (5.3%) with stage Ta grade 3 noninvasive primary bladder tumor were treated with intravesical instillations of 75 mg. Pasteur strain BCG in 50 ml. saline weekly for 6 weeks. At a followup of 2 to 13 years (mean 58.4 months) patients were evaluated with urinary cytology, cystoscopy, transurethral resection and random mucosal biopsies. Recurrence, grade and stage progression, death and causality were analyzed. RESULTS: Of the 32 patients 9 (28%) responded positively to BCG without recurrence, while disease recurred as stage Ta in 8 (25%) and T1 in 7 (22%), and progressed to muscle layer infiltration in 8 (25%). Four patients (12%) died of bladder cancer. The number of tumors at primary resection, gross examination, the mitotic index or an association with carcinoma in situ did not appear to be predictive factors of progression to muscle invasion. Urine cytology (I to II versus III to IV) appeared to correlate highly with progression and BCG response (p<0.001) with excellent sensitivity (1) but low specificity (0.67). CONCLUSIONS: Our study demonstrates the high progression potential of stage Ta grade 3 tumors, since nearly 50% recurred and 25% progressed to invasive disease. These results may be closely compared with the results of previous trials of stage T1 grade 3 disease. We suggest that recurrence should be detected at an early stage using long-term followup with strict observance of the surveillance protocols during a minimum 5-year tumor-free period.

Adjuvants, Immunologic↗
PubMed1999

[Isolated ureteral metastasis of prostatic adenocarcinoma. Apropos of a case].

A ureteric tumour was discovered in a patient presenting with an episode of renal colic and a history of prostatectomy for prostatic adenocarcinoma. Segmental ureterectomy was performed. Histological examination showed a metastasis from prostatic adenocarcinoma. This is a rare site of secondaries: less than 40 cases have been reported in the literature, essentially based on autopsy series. Metastatic spread occurs via lymphatics or the blood stream, and the secondary tumour develops from the adventitia before invading the ureteric wall. Although this diagnosis may be suggested by the clinical features and imaging, it can only be confirmed by histology. After ureterectomy, treatment can combine all of the recognized treatment modalities against prostatic adenocarcinoma: endocrine therapy and adjuvant radiotherapy.

Adenocarcinoma↗
PubMed1999

[Erectile dysfunction after radical prostatectomy: value of preoperative programming of intracavernous injections].

OBJECTIVES: Vasoactive drugs used for self-administered intracavernous injections are currently the reference treatments for erectile dysfunction after radical prostatectomy. The acceptability of and compliance with this treatment often limit their use. This study analysed these two parameters as a function of the type of andrological management decided before radical prostatectomy. MATERIAL AND METHOD: From January 1996 to January 1997, 45 sexually active patients, aged 52 to 69 years, requiring radical prostatectomy without preservation of the nervi erigentes, for localized prostate cancer, were included in this prospective study. Before the operation all 45 patients were informed about the high risk of erectile dysfunction following radical prostatectomy. Fifteen patients (group 1) did not receive any particular advice concerning the management of erectile dysfunction after radical prostatectomy, but were possibly referred for an andrology consultation depending on their complaints. Fifteen patients (group 2) were systematically referred for an andrology consultation three months after radical prostatectomy for information about the available treatment options. For 15 patients (group 3), the andrology consultation (3 months after the operation) had been planned before radical prostatectomy to perform a test injection of prostaglandin E1. The injections, started before the operation in this group 3, therefore constituted an integral part of the global management of prostate cancer. All these patients were followed for at least 1 year in the urology department. RESULTS: Only 7 of the 15 patients of group 1 consulted an andrologist. Five of these patients received a test intracavernous injection versus 14 in group 2 and 15 in group 3. The 5 patients of group 1 who received an intracavernous injection accepted this modality as treatment versus 8 in group 2 and 12 in group 3. After one year, 4, 5 and 9 patients in groups 1, 2 and 3, respectively, continued intracavernous injections. CONCLUSION: The management of erectile dysfunction after radical prostatectomy must start with the decision to operate. Systematic encouragement to use intracavernous injections after radical prostatectomy helps to improve access to this treatment for impotence. The acceptability, and especially the compliance, appear to be better in patients in whom intracavernous injections were integrated into the global management of their prostate cancer.

Aged↗
PubMed1999

[Study of the Ki-67 antibody immunolabeling of renal adenocarcinomas with or without renal vein thrombosis].

OBJECTIVES: The objective of this study was to compare the proliferation index (immunolabelling by monoclonal antibody Ki67 - MIB-1) of renal cell carcinomas as a function of the presence or absence of renal vein thrombus. Analysis of the numbers of Ki67-positive nuclei can be used to assess the degree of aggressiveness of the cell populations of these various carcinomas (tumour without thrombus, tumour with thrombus and neoplastic thrombus). METHODS: Twenty three renal cell carcinomas with renal vein thrombus were matched for Furhman grade (1st degree), tumour volume (2nd degree) and the patient's age (3rd degree) with 23 renal cell carcinomas not presenting any vascular embolus on histology. Monoclonal antibody MIB-1 immunolabelling was performed on 69 paraffin-embedded specimens: 23 tumours with thrombosis, the 23 corresponding neoplastic thrombi and 23 tumours without vascular embolus. RESULTS: A correlation between Furhman grade and the percentage of immunolabelled nuclei was observed (mean: 2.67% for low-grade tumours and 14.34% for high-grade tumours). No labelling difference was observed between the two populations of primary tumours (with thrombus/without embolus). Primary tumours presented significantly weaker Ki67 labelling than their corresponding neoplastic thrombus (mean of 2.47% versus 10.3%, p < 0.01). CONCLUSION: This study shows that there is no difference of the proliferation index between tumours with neoplastic venous thrombus and those with no histological vascular embolus. However, a difference of proliferation index was observed between the primary tumour and its corresponding thrombus, which presented a statistically higher immunolabelling. This finding suggests that the thrombus possesses more dividing cells than the primary tumour, i.e. has a shorter doubling time.

Adenocarcinoma↗
PubMed1998

Urethral recurrence of transitional cell carcinoma of the bladder. Predictive value of preoperative latero-montanal biopsies and urethral frozen sections during prostatocystectomy.

OBJECTIVE: The management of the male urethra after cystectomy for bladder cancer continues to be a dilemma. Patients who undergo a cystectomy require either urinary diversion or bladder substitution. Therefore, the use of the urethra to ensure voiding is important. On the other hand, the probable risk of urethral carcinoma recurrence is generally estimated at approximately 10%. The aim of this study was to assess the predictive value of preoperative urethral biopsies, and of frozen sections during cystoprostatectomy, in patients with invasive bladder cancer. METHODS: From 1982 to 1986, 118 male patients underwent a cystoprostatectomy for transitional cell carcinoma of the bladder. All patients underwent endoscopic latero-montanal biopsies 2 weeks preoperatively and urethral frozen cut section during radical prostatocystectomy. RESULTS: Carcinoma was observed in 12 patients on both examinations. All patients underwent en bloc urethrectomy during cystectomy. In the remaining 106 patients, the frozen cut margin was negative (including 9 with positive latero-montanal biopsies), and these patients had the urethra preserved. After a 10-year minimum follow-up, no recurrence was observed in these patients with negative frozen cut-section. No significant risk factors for urethral recurrence were found. Latero-montanal biopsies did not reveal a positive specificity, and this procedure was later abandoned in our institution (in 1986). CONCLUSIONS: The urethral frozen section was the only guideline used for simultaneously performing the urethrectomy. All male patients with negative frozen cut sections should be considered candidates for bladder substitution. A prophylactic urethrectomy is only indicated in patients with carcinoma (minimum carcinoma in situ) in the frozen urethral margin section during cystectomy.

Adult↗
PubMed1998

Low-dose BCG instillations in the treatment of stage T1 grade 3 bladder tumours: recurrence, progression and success.

The aim of this retrospective study was to evaluate the effects and results of low-dose bacillus Calmette-Guérin (BCG) therapy on a selective high-risk population of stage T1, grade 3 (G3) bladder tumours. Recurrence and progression were also analysed. Thirty-five consecutive patients presenting with T1 G3 tumours were treated with intravesical BCG. All patients underwent complete transurethral tumour resection. A course of BCG 75 mg Pasteur strain was begun 4 weeks after the first resection of the diagnosed tumour and continued for a 6-week period. At the end of treatment, a complete urological evaluation was routinely carried out: urine cytology test, cystoscopy with bladder biopsies randomly performed, and any recurrences were resected. In cases of abnormal cytology and/or recurrence an additional course of BCG was initiated, followed by the same tests. Follow-up examination and cystoscopy or fibroscopy were conducted every 3 months for 1 year, semiannually and annually thereafter. Median follow-up was 45 months (range 10-120); 7 patients (20%) did not respond to BCG instillations. Of these patients, 5 underwent cystectomy and in 2 patients the bladder was left in place in spite of recurrence because of age (+80 years). Twenty-eight patients (80%) responded positively, 24 after one single course of BCG, and 4 patients after two courses. During follow-up, recurrence was observed in 8 cases: stage T1 G3 in 4 patients, T1 CIS (carcinoma in situ) in 2 patients, Ta G2 and Ta G1 in 2 patients. Three of these patients were treated by cystectomy and the remaining patients with transurethral resection alone or combined with additional courses of BCG. Overall, 25 patients (71%) were considered free of tumour occurrence after low-dose BCG therapy. Ten patients underwent cystectomy (29%) or remained in occurrence and 2 patients died of the disease. These results can be closely compared to the results of other trials conducted on stage T1 G3 and BCG treatment, using a different dosage and BCG protocol therapy. BCG is an effective prophylactic and therapeutic agent for T1 G3 carcinoma of the bladder responders. The identification of these responders before beginning instillations still remains a challenge.

Administration, Intravesical↗
PubMed1998

Correlation between p53 over expression and response to bacillus Calmette-Guerin therapy in a high risk select population of patients with T1G3 bladder cancer.

PURPOSE: The aim of this study was to determine if p53 status, assessed before intravesical bacillus Calmette-Guerin (BCG) therapy, can predict clinical outcome in a high risk population of patients with stage T1, grade G3 bladder cancer and if it can be used to select patients responsive to therapy. MATERIAL AND METHODS: After complete transurethral resection 35 patients with T1G3 bladder carcinoma received 6 weekly instillations of BCG and nonresponsive patients received a second course. After treatment cystoscopy and randomized biopsies of the bladder mucosa were performed. Pathologists had sufficient material to perform immunomarking in 25 cases using the peroxidase-antiperoxidase technique with antiprotein monoclonal antibody p53. The results were expressed in percentage of marked nuclei. We established 5% increment thresholds from 0 to 60%. Contingent tables were established, and chi-square and Fisher's exact test were performed for each 5% threshold. RESULTS: Median followup was 51.3 months (range 25 to 144). Of the 25 patients 8 (32%) did not respond to BCG therapy and 17 (68%) did. Immunomarkings were not statistically different between BCG responsive and nonresponsive patients for 0, 5, 10, 20, 35, 40, 45, 55 and 65 thresholds. Chi-square and Fisher's exact test were 0.91 and 0.83, 0.40 and 0.20, 0.58 and 0.29, 0.96 and 0.81, 0.80 and 0.88, 0.67 and 0.73, 0.91 and 0.83, 0.80 and 0.38, 0.69 and 0.32, respectively. CONCLUSIONS: Our results indicate that the percentage of p53 immunomarked cell cannot currently be used to predict clinical response to BCG therapy and, therefore, p53 over expression is not a viable indicator of T1G3 recurrence when using this treatment.

Aged↗
PubMed1998

[The absence of metabolic disorders 8 years after detubulized Z entero-cystoplasty].

Intestinal resection can lead to decreased gastrointestinal absorption of various metabolic substances. The use of these intestinal segments as materials for urinary tract reconstruction can also induce metabolic disorders. The authors studied the long-term metabolic consequences of replacement enterocystoplasty after radical cystectomy for bladder cancer.

Aged↗
PubMed1998

[Renal tumor with thrombus involving all of the lumen of the inferior vena cava: surgical indication, technique and results].

OBJECTIVES: Almost 5% of renal tumours are associated with thrombus of the renal vein or inferior vena cava at the time of diagnosis. Radical nephrectomy with complete resection of the tumour nodule is the reference first-line treatment in this situation. This retrospective series was designed to analyse the surgical strategy according to the extent of the tumour nodule and the morbidity and mortality as a function of the prognostic factors of these renal tumours. MATERIALS AND METHODS: From 1982 to 1995, 51 patients (out of a series of 724 nephrectomies) presented with renal vein invasion involving all of the lumen of the inferior vena cava. The choice of medical imaging varied over time (cavography, Doppler ultrasound, CT, MRI and transoesophageal ultrasonography). Control of the inferior vena cava was always performed below the renal veins and above the thrombus. RESULTS: MRI and transoesophageal ultrasonography were found to be the most reliable diagnostic examinations. The incision and vessel control technique must be selected as a function of the type of thrombus and the emboligenic risk. With a follow-up of 4.3 years, the overall 2-year survival was 46% and the 5-year survival was 31%. All recurrences at 1 year occurred in N+ patients. CONCLUSION: Lymph node status and invasion of the perirenal fat are the most important prognostic factors, while the presence and length of the thrombus do not appear to influence survival. Radical nephrectomy of these tumours, invading all of the lumen of the inferior vena cava, requires complete resection of the thrombus. Adhesion of the thrombus constitutes a major technical problem that must be envisaged before the incision in order to correctly control the vessels.

Adenocarcinoma↗
PubMed1997

Ureteroileal implantation in orthotopic neobladder with the Le Duc-Camey mucosal-through technique: risk of stenosis and long-term follow-up.

PURPOSE: We determined the postoperative risk of nonneoplastic ureteroileal implantation stenosis using the Le Duc-Camey technique, and assessed the extent to which followup is mandatory. MATERIALS AND METHODS: Between October 1980 and October 1989, after a cystoprostatectomy, 158 consecutive men underwent lower urinary tract reconstruction by means of a U-shaped orthotopic ileal neobladder. Of these cases 109 were tubularized and 49 were detubularized. The 313 ureteral implantations were performed according to the Le Duc-Camey mucosal-through technique. Followup studies in all patients consisted of excretory urography or renal sonography carried out before discharge home, at least every 6 months during the first year after surgery and once a year thereafter. Followup was more than 2 years for 123 patients. The study was conducted retrospectively. RESULTS: The rate of anastomotic stenosis was 4.9% among 123 patients who were followed a minimum of 2 years. No obstructions were detected after 2 years. The rates of ureteral reimplantation and nephrectomy for chronic kidney obstruction were 3.7% and 2%, respectively. All strictures were located at the anastomosed site, and retrograde catheterization was uncertain. Surgical reimplantation through an elective extraperitoneal approach was easy to perform and effective. CONCLUSIONS: The anastomotic stenosis rate after Le Duc-Camey ureteroileal implantation in orthotopic U-shaped neobladder was 4.9%. During the first year after surgery, the difference between true stenosis and temporary edema was not easy to assess. The U-shaped neobladder allows for the implantation of a minimally dissected iliac ureter, which could be a factor in minimizing the risk of obstruction.

Adult↗
PubMed1997

No evidence of metabolic disorders 10 to 22 years after Camey type I ileal enterocystoplasty.

PURPOSE: Resection of ileal segments may results in malabsorption and a decrease in intestinal uptake of different substances. The use of intestinal segments in the urinary tract may also cause metabolic disorders. We studied long-term metabolic consequences of enterocystoplasty after radical cystoprostatectomy for bladder cancer. MATERIALS AND METHODS: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectomy. The enterocystoplasty was constructed with a 35 cm. ileal segment resected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultrasonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglycerides, albumin, protein, vitamins B12 and B9, iron, ferritin, calcium, phosphate, vitamin D, parathyroid hormone, urea, creatinine, creatinine clearance and prostate specific antigen. In addition urine calcium, protein, creatinine and pH were measured, and a midstream urine specimen was obtained. RESULTS: There was no evidence of metabolic acidosis, impairment of phosphorus and calcium metabolism, vitamin D deficiency or parathyroid hormone disturbance. All other laboratory tests were within the normal range. Mean creatinine was 106 mumol./l., mean creatinine clearance was 1.5 ml. per second per m.2 and mean prostate specific antigen was 0.2 ng./ml. No patient had post-void residual urine or a dilated upper urinary tract. CONCLUSIONS: This ileal bladder substitute does not induce long-term metabolic anomalies. However, these results may be due to the short ileal length used in the Camey type I technique and the absence of post-void residual urine obtained by good urinary training (that is sustained voiding function).

Adenocarcinoma↗
PubMed1997

[Value of nephron preservation in conservative surgery of renal tumors].

The increasing use of abdominal ultrasonography and computed tomography results in the increasingly early diagnosis of subclinical renal tumours. These asymptomatic tumours can sometimes be treated conservatively. This technique raises the problem of the multifocal nature of renal tumours In order to assess the real benefit of nephron-sparing surgery in relation to the risk of recurrence, this study evaluates the repercussions of exclusive tumour resection on the nephron number. From 1990 to 1995, 28 patients underwent partial nephrectomy for suspected renal cell carcinoma. Computed tomography was use to estimate the volume and therefore the weight of the kidney and the tumour: weight (g) = volume (mL) = length x width x height/2. The mean age of the patients was 59.1 years. The contralateral kidney was normal in 20 patients (group 1) and the tumour affected a solitary kidney in 8 patients (group 2). The initial serum creatinine level was normal (between 78 and 96) in all patients. The mean weight of the tumour was 16.1 g (13.6 g for group 1 and 22.3 g for group 2), and corresponded to 3.84% of the total kidney weight in group 1 and 9.73% in group 2. 1,400,000 nephrons were preserved in group 1 versus 900,000 nephrons in group 2, equivalent to a glomerular filtration rate of 89 mL/min and 58 mL/min, respectively. Partial nephrectomy therefore constitutes a real nephron-sparing technique. It allows sparing of a sufficient number of nephrons to ensure normal renal function and, most importantly, allows the possibility of subsequent partial surgery in view of the potential risk of multifocal tumours.

Adult↗
PubMed1997

[Infectious risks of outpatient cystoscopy in men with sterile urine].

OBJECTIVE: To prospectively assess the inherent risk of infection associated with outpatient cystoscopy performed in men with sterile urine without antibiotic prophylaxis. MATERIAL AND METHODS: 298 cystoscopies were performed in men corresponding to these criteria, with the exclusion of patients at risk of bacterial endocarditis. The equipment consisted of three cystoscopes prepared according to the recommendations of the Société Française d'Hygiène Hospitalière. The disease justifying the examination was specified for each patient. The sterility of the urine was verified during the week preceding the examination and 48 hours later by urine culture. RESULTS: Out of 281 evaluable patients, an infection was observed in 22 cases (7.8%), and was symptomatic in only one case. Escherichia coli was the organism most frequently isolated (50%) and no multiresistant bacteria were detected. A particularly high infection rate was observed in enterocystoplasty patients (21.7%). CONCLUSION: The infectious risk of cystoscopy in the presence of sterile urine, performed according to recommendations, appears to be higher than previously reported. This risk appears to be significantly higher in the case of enterocystoplasty than for other diseases.

Ambulatory Care↗
PubMed1997

[Nosocomial urinary infections].

The concept of nosocomial urinary tract infection now corresponds to a precise definition. It is generally related to bladder catheterization, constitutes the most frequent form of nosocomial infection (30 to 50% of infections), and represents the third most frequent portal of entry of bacteraemia. The organism most frequently isolated is Escherichia coli; but the flora is changing and the ecological distribution is continually modified. Despite their usually benign nature, these nosocomial infections can nevertheless influence hospital mortality; they increase the hospital stay by an average of 2.5 days and their treatment represents a large share of the antibiotic budget. Prevention of these infections is therefore essential, with particular emphasis on simple and universally accessible measures: very precise indications for vesical catheterization, use of closed circuit drainage, maximal asepsis when handling catheters, after washing the hands.

Adult↗
PubMed1996

Update on the Camey II procedure.

Between January 1987 and January 1991, 110 detubularized U-shaped ileocystoplasties (Camey II) following radical cystectomy were carried out in our Department of Urology (CMC Foch Suresnes, France). Our first evaluation of this procedure was carried out in 1989 and reviewed initial 57 patients operated on. These data were compared with those of the Camey I operation. The improvement in neobladder capacity as well as nighttime urinary control achieved by the detubularization required in the Camey II operation was obvious. In this article we review the first 110 patients treated by Camey II bladder replacement following cystectomy.

Cystectomy↗
PubMed1996

The relationship between sexual life and urinary condition in the French community.

As part of a large, nationwide community-based study in France on health and urinary condition, involving 2011 men aged between 50 and 80 years, information was collected on sexual life factors (e.g., frequency of sexual desires and sexual relations, and the frequency of having difficulties with erection and ejaculation) in addition to an assessment of overall sexual life satisfaction. Data on sexual life were obtained by means of a self-administered questionnaire, while information on the frequency of urinary symptoms was obtained by a professional interviewer. The median number of sexual relations decreased with age from "once per week" in those aged 50-59 years to "less than once per week" in those aged 60-69 years to "never" in those aged over 70 years, while the percentage reporting difficulty with erection at least some of the time increased from 20 to 38% between 50-59 and 70-79 years, respectively. The number of sexual relations during the past month was by far the most important factor having an influence on overall sexual life satisfaction, with those men reporting relations less than once per week almost 10 times more likely to be dissatisfied. Severity of overall urinary symptoms (as well as many individual symptoms) was also inversely related to sexual life satisfaction, and the association persisted after taking account of the strong influence of age and the frequency of sexual relations. All other factors being equal (age, number of relations, comorbidities, and previous prostate surgery), the likelihood of men being dissatisfied with sexual life increased twofold in men with moderate symptoms and fourfold in those with severe symptoms. The results obtained in the current study should be considered preliminary, given the complexity of the relationship between these two factors and the lack of previously published evidence. They certainly call for further studies, which should include a detailed assessment of sexual function and a clinical assessment of the urinary condition.

Aged↗