PubMed Health⌕ Search

Biomedical subjects

J D Doublet

Publications and source records attributed to J D Doublet.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopic radical prostatectomy: the lessons learned.

PURPOSE: To evaluate the operative, oncologic, and functional results of laparoscopic radical prostatectomy based on an initial series of 350 patients. PATIENTS AND METHODS: Between January 1998 and May 2000, 350 consecutive patients underwent laparoscopic radical prostatectomy according to our technique. The study of operative morbidity was based on all intraoperative and postoperative complications. The oncologic assessment was based on clinical, laboratory, and intraoperative and postoperative pathological data. Postoperative functional results were assessed by the ICS-male self-administered questionnaire. RESULTS: No deaths were observed in this series. Conversion was required in seven cases, exclusively among the first 70 patients. The mean operating time was 217 +/- 59 minutes, including the lymphadenectomy phase that was considered necessary in 21.4% of patients, and 195 +/- 56 minutes for the most recent 200 patients. The mean intraoperative blood loss was 354 +/- 250 mL. The overall transfusion rate was 5.7% and 2.8% in the last 250 patients. Intraoperative complications were reported in 14 patients (4%), and the reoperation rate was 3.7%. The mean postoperative bladder catheterization time was 5.8 +/- 3.3 days, and the catheter could be removed before the 5th day in 41% of patients. The mean hospital stay was 6 +/- 3.9 postoperative days (range 2-33 days). By pathologic stage, the positive surgical margin rate was 3.6% for pT2a specimens (3 patients), 14% for pT2b specimens (29 patients), 33% for pT3a specimens (12 patients), and 43.5% for pT3b specimens (10 patients). In the first 75 patients with pT2N0/Nx negative-margin specimens and a follow-up of >12 months, the PSA concentrations was <0.2 ng/mL in 92% of patients. The continence rate (no protection necessary either during the day or at night) among the first 133 patients was 85.5% and the postoperative erection rate was 59% among 22 selected consecutive patients. CONCLUSIONS: This study confirms the value, in our experience, of the laparoscopic approach to radical prostatectomy, which allows satisfactory cancer control associated with low perioperative morbidity and encouraging functional results in terms both of continence and erectile function.

Aged↗
PubMed2001

Proposal for a "European Scoring System for Laparoscopic Operations in Urology".

PURPOSE: To propose a scoring system of difficulties for the most currently performed laparoscopic procedures in urology. MATERIALS AND METHODS: Each current laparoscopic procedure has been evaluated according to three different criteria: technical difficulty, operative risk and the attention required. Each criterion is scored from 1 (minimal impact of the criteria) to 7 (maximal impact of the criteria). The sum of the 3 criteria is used to classify each operation according to an increasing level of global difficulty, classified into 6 levels: easy (E: sum of criteria between 3 and 5), slightly difficult (SD: sum of criteria between 6 and 8), fairly difficult (FD: sum of criteria between 9 and 11), difficult (D: sum of criteria between 12 and 14), very difficult (VD: sum of criteria between 15 and 17), extremely difficult (ED: sum of criteria greater than 18). RESULTS: Procedures currently performed by laparoscopy have been selected for evaluation according to the above criteria, and retrospectively validated by European experts in laparoscopic urology according to their experience and the international literature. CONCLUSION: This proposal of a scoring scale system is a basis for discussion, teaching and learning of urological laparoscopy. By necessity, this scale is evolving and will be regularly reconsidered and updated every 5 years.

Humans↗
PubMed2001

[Metastasis to trocar site after lymphadenectomy with retroperitoneal laparoscopy].

The authors report a case of trocar site metastasis, one year after laparoscopic retroperitoneal lymphadenectomy. This is the seventh published case of trocar site metastasis in laparoscopic urological surgery. The lymph node resection procedure and the histological type of the tumour appear to be risk factors for the development of wall metastases.

Carcinoma, Squamous Cell↗
PubMed2000

Evaluation of FDG uptake by renal malignancies (primary tumor or metastases) using a coincidence detection gamma camera.

UNLABELLED: The aim of this study was to evaluate the usefulness of FDG scanning using an ordinary gamma camera equipped with coincidence detection (CDET) for 2 renal cancer indications: characterization and staging of renal masses before nephrectomy and search for recurrence after nephrectomy. METHODS: Between September 1997 and June 1998, a whole-body scan and at least 1 tomoscintigram were obtained on 23 occasions in 22 patients (fasting for at least 6 h) using a Prism XP 2000 CDET gamma camera; scanning was begun 45 min after intravenous injection of 150-250 MBq FDG. RESULTS: Postoperative histologic evidence was obtained from 13 of 16 patients who underwent FDG using a CDET gamma camera before renal surgery; 4 renal masses did not accumulate FDG (3 true-negatives, 1 false-negative), whereas 9 renal tumors accumulated FDG (8 true-positives, 1 false-positive). In the other 3 patients, only 1 extrarenal site of FDG uptake was checked and confirmed on histologic examination: a bone metastasis from renal cell carcinoma in 2 cases and lymph node metastasis from a squamous cell carcinoma (3 true-positives). The primary local and regional staging of the malignant renal tumors was accurate in the 9 patients who underwent nephrectomy (8 true-negatives, 1 true-positive). The primary distant staging was positive in 1 case (focus in the chest corresponding to a probable true-positive on follow-up). In the 7 examinations performed because of suspected recurrence of renal cell carcinoma several months after nephrectomy, metastases were visualized by FDG in 4 patients, confirmed by biopsy in 2 patients, and confirmed by conventional imaging or follow-up (or both) in 2 patients. The other 3 patients had negative FDG scans, corresponding to probable true-negative results on follow-up. CONCLUSION: FDG using a CDET gamma camera can be used effectively for the staging and restaging of renal tumors and might be useful for characterization of the primary renal tumor in doubtful cases.

Carcinoma, Renal Cell↗
PubMed2000

[Balloon catheter parieto-renal dilatation in percutaneous kidney surgery].

OBJECTIVE: To compare two techniques of parieto-renal dilatation for percutaneous surgery: Alken dilators and balloon catheter. MATERIAL AND METHODS: This prospective, non-randomized study was conducted between July 1999 and April 2000 in 20 patients undergoing percutaneous renal surgery. 10 patients were dilated with a balloon catheter (NephroMax, Boston Scientific) and the other 10 patients were dilated with Alken metal dilators. Statistical analysis was performed with the Mann-Whitney test. RESULT: The dilatation time and x-ray exposure time were shorter during balloon catheter dilatation (statistically significant difference) and the two techniques were associated with a comparable morbidity. CONCLUSION: Balloon catheter parieto-renal dilatation significantly decrease dilatation and x-ray exposure times and very considerably simplifies this operative step, essential to the success of percutaneous surgery.

Adult↗
PubMed1998

In vivo inaccessibility of somatostatin receptors to 111In-pentreotide in primary renal cell carcinoma.

The presence of somatostatin receptors on human renal cell carcinomas in surgically removed kidneys has been demonstrated by autoradiography. The aim of this study was to detect to in vivo presence of somatostatin receptors in primary renal tumours and their possible metastases before surgery, using 111In-pentreotide scintigraphy. 201Tl was used as a sensitive tumour-seeking agent with blood flow-dependent uptake. Fifteen patients were imaged before surgical removal of the renal tumour. Thirteen tumours were malignant. The large tumours (more than 4 cm in diameter) did not accumulate 111In-pentreotide or 201Tl. In contrast, the single small tumour accumulated both tracers. A scalp skin metastasis was demonstrated in one patient by 201Tl and 111In-pentreotide uptake. In one case, known lung metastases were visualized with both 201Tl and 111In-pentreotide, but the lung metastases of another three patients as well as one case of epidural metastasis were not identified. In one patient with a photopaenic lesion, positive labelling of the surgically removed tumour was demonstrated by in vitro autoradiography. Somatostatin receptor scintigraphy with 111In-pentreotide appears to have little value for the detection of metastases in patients with renal cell carcinoma, as some metastases (especially those of the lungs) were missed. The absence of 111In-pentreotide uptake by large primary tumours is an interesting finding, suggesting inaccessibility of these very large tumours to drugs.

Adult↗
PubMed1997

Retroperitoneal laparoscopic nephrectomy of native kidneys in renal transplant recipients.

BACKGROUND: The purpose of this study was to compare retroperitoneal laparoscopic nephrectomy in transplant recipients and in other patients scheduled for nephrectomy. METHODS: From February 1994 to July 1996, 15 transplant recipients and 17 other patients underwent a total of 36 retroperitoneal laparoscopic nephrectomies for various indications. Operative time, morbidity, and hospital stay were compared between the two groups. RESULTS: The average operating time for the 36 procedures was 95+/-38 min (range, 35-180 min). It was shorter in transplant recipients (81+/-32 min) than in other patients (100+/-39 min, P<0.05). There was one postoperative complication in the transplant recipient group. The average length of the postoperative hospitalization was 3.7+/-1.4 days (range, 2-8 days). CONCLUSIONS: The retroperitoneal laparoscopic approach for nephrectomy is as safe and effective in renal transplant recipients as in other patients. Postoperative stay and delay to resumption of oral immunotherapy are short. This approach has become our first-line approach for native nephrectomy in transplant recipients.

Adolescent↗
PubMed1997

Endothelial and macrophage upregulation of urokinase receptor expression in human renal cell carcinoma.

The binding of urokinase-type plasminogen activator (u-PA) to a specific cell surface receptor (uPA-R) has been shown to enhance plasminogen activation, a process involved in extracellular matrix degradation and cell migration during angiogenesis and tumor growth. We investigated the expression of u-PA and uPA-R in renal cell carcinomas (n = 11). By immunohistochemistry using monoclonal and polyclonal anti-uPA-R antibodies, we found that tumoral capillary endothelial cells (von Willebrand factor and CD31 positive cells) overexpressed uPA-R, whereas vascular endothelial cells of the normal human kidney do not. In addition, tumor-associated macrophages (CD68-positive cells) strongly expressed uPA-R. In contrast, few tumoral cells and stromal fibroblasts expressed uPA-R. By in situ hybridization using a cDNA S35-labeled probe specific for uPA-R, we confirmed the local expression of uPA-R messenger RNA. We also detected the induction of u-PA in tumoral capillary endothelial cells and in tumor-associated macrophages. In two cases, tumoral cells themselves were also stained by anti-u-PA antibodies in focal areas. Finally tissue-type plasminogen activator (t-PA) was also overexpressed by tumoral capillary endothelial cells as compared with endothelial cells of normal human kidney vessels. These findings indicate an active invasive phenotype of endothelial cells in renal cell carcinoma and suggest a role for the plasminogen activation system in tumoral angiogenesis and invasion.

Carcinoma↗
PubMed1997

Renal cell carcinoma of native kidneys: prospective study of 129 renal transplant patients.

PURPOSE: We evaluated the prevalence of renal cell carcinoma of the native kidneys in renal transplant recipients as well as possible risk factors. MATERIALS AND METHODS: A total of 129 consecutive renal transplant recipients underwent ultrasound examination of the native kidneys as part of a routine evaluation. A record was made of acquired cystic kidney disease, defined as 3 cysts or more, and of suspicious masses. When a malignancy was suspected radical nephrectomy was performed. RESULTS: The overall prevalence of renal cell carcinoma of the native kidney was 5 in 129 recipients (3.9%). All cancers were limited to the kidney. No significant relationship was detected between renal cell carcinoma occurrence and patient age, dialysis (when initiated, type and duration), transplantation, drug regimen or incidence of acquired cystic kidney disease. CONCLUSIONS: The risk of renal cell carcinoma, a clinically significant cancer, was approximately 100 times greater in our renal transplant patients than in the general population but no significant risk factor could be identified. Routine ultrasonography for early diagnosis in asymptomatic patients on immunosuppressive therapy is strongly recommended to improve prognosis.

Adult↗
PubMed1997

In situ extracorporeal shock wave lithotripsy for acute renal colic due to obstructing ureteral stones.

The purpose of the present study was to evaluate in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of obstructing ureteral stones causing acute renal colic. In situ ESWL with an EDAP LT-02 piezo-electric lithotriptor was used in a prospective study to treat 67 patients with obstructing ureteral stones causing acute renal colic. Patients were treated without anesthesia on an out-patient basis or during a one-day hospital stay. The overall one month stone-free rate was 94% (94% for proximal stones and 95% for distal stones). The overall success rate after a single ESWL session was 81%. Treatment was well tolerated in 90% (60/67) of patients. There was one case of non-obstructive pyelonephritis and one of ureteral edema. These rates compare well with published reports for delayed treatment in patients without renal colic. Immediate ESWL for cases of acute renal colic due to obstructing ureteral stones is an effective treatment strategy that warrants wider consideration.

Acute Disease↗
PubMed1997

[Feasibility of "Valsalva Leak Point Pressure". Prospective study].

OBJECTIVE: To prospectively evaluate the feasibility of determination of the Valsalva Leak Point Pressure (VLPP). PATIENTS AND METHODS: From 1st January to 31st July 1996, 155 consecutive patients investigated for urinary incontinence with no pelvis static disorder performed Valsalva manoeuvres during cystomanometry in order to determine the VLPP. The examination was performed in the standing position at a filling volume of 200 cc with then without a vesical pressure transducer. The mean age of the patients was 54 +/- 16 years (range: 16-84 years). RESULTS: The mean maximal intensity of abdominal straining pressure measured by the intravesical transducer was 72 +/- 28 cm of water. The VLPP could not be determined in 50.4% of cases, as the abdominal straining pressure during the Valsalva manoeuvre was less than 60 cm of water. No correlation was observed between abdominal straining pressure and patient age (r = 0.13; p > 0.1). CONCLUSION: Leak Point Pressure cannot always be determined by the Valsalva method. Other techniques of progressive increase of intravesical pressure must be investigated.

Adolescent↗
PubMed1995

[The value of PSA density for the diagnosis of prostatic cancer and for the indication of radical prostatectomy].

We evaluated the diagnostic and prognostic value of PSA density (PSAD) in a prospective study of 100 men consulting for various urinary tract disorders. PSAD was calculated by the ratio of serum PSA over the ultrasonographic volume of the prostate gland, and was expressed in ng/ml/ml. The mean PSAD of 31 patients with prostate cancer was significantly higher than that of the 69 patients without prostate cancer (p = 0.0003). The patients were classified into two groups according to the serum PSA value. Forty nine patients had a serum PSA < or = 10 ng/ml, 31 of whom had a PSAD < or = 0.15 ng/ml/ml and 29 of these 31 patients (94%) did not have prostate cancer; 18 patients had a PSAD > 0.15 ng/ml/ml and six of them (33%) had prostate cancer (p = 0.04). Fifty one patients had a serum PSA > 10 ng/ml and 23 of them (45%) has prostate cancer; 14 of these 51 patients had a PSAD < or = 0.30 ng/ml/ml and two of them (14% à had prostate cancer; 37 patients had a PSAD > 0.30 ng/ml/ml, 21 of whom (57%) had prostate cancer (p = 0.016). Twenty one of these 31 patients with prostate cancer were candidates for radical prostatectomy. Four patients were N+ and 17 underwent radical prostatectomy. Capsular invasion was significantly correlated with PSAD. None of the four patients with PSAD < or = 0.30 ng/ml/ml showed capsular invasion, while 11 of the 13 patients (85%) with PSAD > 0.30 ng/ml/ml had capsular invasion. In conclusion, in patients with PSA < or = 10 ng/ml, calculation of the PSAD avoids approximately two-thirds of prostatic biopsies, with a very low risk of missing a clinically significant cancer. On the other hand, PSAD is of more limited value in patients with PSA > 10 ng/ml. In cancers considered to be operable clinically, the cut-off value of 0.30 ng/ml/ml for PSAD is predictive of capsular or lymph node invasion with a diagnostic accuracy of 94%.

Aged↗
PubMed1995

[Kidney surgery using lumbar endoscopy: initial experiences].

OBJECTIVES: To evaluate the feasibility, safety and clinical value of lumboscopy for the treatment of upper urinary tract diseases. METHODS: Six nephrectomies, one renal biopsy and one renal cystectomy were performed by retroperitoneoscopy (lumboscopy) in 7 patients. These cases represent the beginning of our experience. The operating time, incidence of intraoperative or postoperative complications and length of hospital stay were studied. RESULTS: The mean operating time was 134 min for nephrectomy, 180 min for cystectomy and 30 min for renal biopsy. No complications were observed. No conversion into laparotomy was required. The mean postoperative hospital stay was 3 days in the patients who were submitted to a single operation. CONCLUSION: Lumboscopy is a relatively easy, safe and reliable technique, and its use in urology warrants further study and development. Dissection of the retroperitoneal space with low pressure CO2 is possible and simplifies the procedure, without increasing the risks for the patient. The indications, especially for nephrectomy, are currently under evaluation.

Adult↗
PubMed1994

The loss of E-cadherin mRNA transcripts in rat prostatic tumors is accompanied by increased expression of mRNA transcripts encoding fibronectin and its receptor.

We compared the levels of mRNA transcripts encoding E-cadherin, N-cadherin, beta 1 integrin subunit, alpha 5 integrin subunit and fibronectin in the normal rat prostate gland, as well as in tumors derived from three invasive sublines (G, MatLyLu, AT-2) of the Dunning R-3227 rat prostatic adenocarcinoma. E-cadherin mRNA transcripts were only detectable in total RNA extracts prepared from normal rat prostates, whereas N-cadherin mRNA transcripts were only found in normal rat brains. In contrast, the mRNA transcripts encoding the beta 1 integrin subunit, alpha 5 integrin subunit and fibronectin were all elevated in the tumors, as compared to the levels of these transcripts in normal tissues. Our results suggest that there is an inverse correlation between cadherin and integrin mRNA levels in rat prostatic tumors.

Adenocarcinoma↗
PubMed1994

Laparoscopic pelvic lymph node dissection for staging of prostatic cancer.

Assessment of the pelvic lymph node status is a major concern in prostatic cancer staging. In spite of a normal abdominopelvic CT scan examination in patients with organ-confined disease, 7-30% will have lymph node metastases at pathological examination and will not benefit from radical prostatectomy. Laparoscopy enables pelvic lymph node dissection via a minimally invasive approach. Twenty-nine patients underwent laparoscopic pelvic lymph node dissection (LPLND) for prostatic cancer staging. The average duration of the bilateral dissection was 90 +/- 40 min (range 35-180 min). One patient died of a stroke on postoperative day 1, without local complication. The peroperative complications were 1 injury of the external iliac vein, 1 ileal injury, 1 ureteral injury, all 3 (11%) requiring immediate or delayed laparotomy. One patient had a self-resolving bilateral obturator nerve paresis. A previously irradiated patient had perineal lymphedema for 4 weeks. The average number of lymph nodes removed was 8.4 +/- 3.4 (range 4-17) for bilateral LPLND. Five patients had lymph node metastases. The median length of stay for patients undergoing LPLND as a single procedure was 2 days (range 2-11 days). After an operational period, during which the complication rate was relatively high, we now consider LPLND as a safe and effective procedure for the staging of patients with organ-confined prostatic cancer, but considering the increased risk of complications during the application period, we do not encourage the generalization of this technique which should remain restricted to some particular strategies, as in combination with perineal radical prostatectomy.

Aged↗
PubMed1994

[Urethro-vesical stenosis after radical prostatectomy].

Stricture of the urethrovesical anastomosis is an uncommon complication of radical prostatectomy, but it can affect the patient's quality of life. From January 1991 to December 1993, 50 patients underwent radical prostatectomy for clinically localised prostatic cancer (41 via a retropubic incision and 9 via a perineal incision). We retrospectively studied the influence of several factors on the incidence of anastomotic stricture: history of prostatic surgery, surgical incision, blood loss, pathological stage, presence of a contrast agent leak during follow-up urethrocystography, postoperative adjuvant treatment, oncological status at the time of the stricture. Seven patients developed clinically significant anastomotic stricture (14%). The time to onset was 1.5 to 10 months (median: 3 months). We were unable to demonstrate any pre-, intra- or postoperative or histological factors able to predict the development of anastomotic stricture. The transperineal approach appears to be associated with a lower incidence, but this finding must be confirmed in a larger series of patients. The seven patients with an anastomotic stricture were treated by endoscopic scalpel incision of the stricture, followed by insertion of a 22 F Foley catheter for 48 hours. No patient has developed a recurrent stricture with a mean follow-up of 8 months (0 to 13 months). Postoperative continence was normal in every case.

Aged↗