Biomedical subjects

Marc Fourmarier

Publications and source records attributed to Marc Fourmarier.

6 recordsLinked to original sources

PubMed2006

Management of non-complicated BPH: proposition of a renewed decision tree.

Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. The standard medical treatments are represented by three families which are the phytotherapy, the alpha-blockers and the 5-alpha-reductase inhibitors. These treatments were deemed as symptomatic and used only as monotherapy. Recent numerous studies bring new assessments on BPH: the medical treatment is able to modify the natural history of BPH especially by reducing the risk of acute urinary retention. Furthermore the association of two different therapeutic classes seems to be more efficient than the use of a monotherapy in some cases. Similarly the place of two instrumental techniques, the thermotherapy by microwaves or by radiofrequencies, previously proposed as alternatives to the surgical treatment seems to find their way rather as alternatives to the medical treatment. These different elements allow building a renewed decision tree which decisions are shared with the patient at each stage. This decision tree of the management of patients having non-complicated BPH symptoms must include initial clinical characteristics of the patient and its disease and the evolution under treatment which has not been yet considered in the international recommendations. It also considers the possibilities of associations with other therapeutic classes.

Decision Trees↗

PubMed2006

Other therapies for BPH patients: desmopressin, anti-cholinergic, anti-inflammatory drugs, and botulinum toxin.

The usual treatments of benign prostate hyperplasia (BPH) including the alpha-blockers, the inhibitors of the 5-alpha reductase and the phytotherapy drugs allow significant improvements of the lower urinary tracts symptoms (LUTS). However, some patients are not responders or have side effects due to the treatments. Other therapeutic approaches described in the literature are possible in order to alleviate the LUTS. The anti-cholinergic drugs seem to be efficient against the irritating symptoms even if they are supposed to be contra-indicated when there is BPH. Anti-diuretic hormone could be useful to treat nocturia due to diuresis reversal. Inflammation is a part of the underlying mechanisms of BPH and as such the role of the anti-inflammatory drugs has to be revised. Eventually, botulinum toxin is more and more used for patients with neurological bladder and could also have a role in LUTS. If the coming clinical studies on those different treatments confirm the preliminary results, the learning societies in charge of the guidelines would have to update the decision trees by adding these new therapeutic approaches.

Anti-Inflammatory Agents↗

PubMed2006

[Urodynamic changes after transobturator suburethral tape].

INTRODUCTION: Prospective study of urodynamic changes induced by transobturator insertion of suburethral tape a dip-stick under-urethral. MATERIALS AND METHODS: 25 women with pure (12) or mixed (13) stress urinary incontinence were operated by this technique, allowing urodynamic assessment and completion of the MHU urinary disability questionnaire. Three operators performed these 25 tape insertions in 2 centres (Amiens and St Quentin hospitals) according to a standardized technique. Six months after the operation, patients were reviewed by clinical examination, MHU questionnaire and urodynamic assessment. RESULTS: The cure rate at 6 months was 80% (20 patients) and the improvement rate was 20% (5 patients). The maximum flow rate decreased from 23.6 ml/s to 18.9 ml/s (p = 0.02) and the post-voiding residual volume increased from 26.8 ml to 66.8 ml (p = 0.01). Urethral resistance increased from 0.16 to. 0.25 (p = 0.03) and maximum closure pressure increased from 43.8 to 47.5 cm H2O (p = 0.02). These results demonstrate the obstructive nature of this suburethral tape. The results of the MHU questionnaire showed accentuation of dysuria (p = 0.04) and improvement of stress urinary incontinence (p < 0.001). CONCLUSION: This prospective study confirms the efficacy of this technique, but analysis of the urodynamic studies and the MHU questionnaire demonstrates obstruction. Long-term surveillance of these patients by uroflowmetry and residual urine appears to be useful to detect possible progression to chronic urinary retention.

Adult↗

PubMed2006

[Role of prostatic stents and transurethral microwave thermotherapy in the treatment of voiding disorders related to benign prostatic hyperplasia (CTMH-AFU forum 2005)].

Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment of voiding disorders related to benign prostatic hyperplasia. A review of the literature evaluates the place of these treatments in 2006. Permanent prostatic stenting is rarely used, but remains a treatment option for patients with obstructive disorders and a formal anaesthetic contraindication. Temporary stenting can be used to predict the effect of resection in selected patients. Finally, microwave thermotherapy, not widely used in France, has a promising clinical efficacy and occupies a place between medical treatment and surgery.

Humans↗

PubMed2004

[Emphysematous cystitis complicated by bladder perforation: diagnosis and treatment of a rare case].

Emphysematous cystitis is a rare disease mainly encountered in poorly controlled diabetics, immunodepressed patients or patients with infravesical obstruction. The pathophysiology of this disease is characterized by the formation of carbon dioxide (CO2) present in the lumen and/or bladder wall, derived from bacterial fermentation of carbohydrates. The bacteria most frequently responsible are facultative aerobes-anaerobes (Escherichia coli) and more rarely strict anaerobes (Clostridium perfringens). The authors report a case of emphysematous cystitis in a context of pelvic trauma and fracture of the pelvis, complicated by secondary bladder rupture. The diagnostic and therapeutic aspects are discussed.

Aged↗

PubMed2004

[Natural history of a suspicious renal mass in a patient with gastric cancer: how to evaluate the risk of multiple primary tumours (MPT)?].

The coexistence of several tumours in the same patient is a rare phenomenon and corresponds to the multiple primary tumour (MPT) syndrome. The most frequently diagnosed MPT include gastrointestinal tumours associated with urological tumours. Overexpression of the STAG1 gene could explain the development of several solid tumours and could be the origin of the multiple primary tumour syndrome. A suspicious renal mass discovered at the same time as a documented cancer is usually a malignant lesion and may justify combined radical surgical treatment. The authors report the natural history of a suspicious renal mass in a patient with primary gastric tumour corresponding to a MPT syndrome. They recall and discuss the epidemiology, pathophysiology, diagnosis and treatment of MPT.

Adenocarcinoma↗