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Marc-Olivier Bitker

Publications and source records attributed to Marc-Olivier Bitker.

7 recordsLinked to original sources
PubMed2006

Outcome after radical prostatectomy in young men with or without a family history of prostate cancer.

OBJECTIVES: To establish the cancer control afforded by radical prostatectomy in patients aged 50 years or younger with sporadic, familial, or hereditary prostate cancer. METHODS: We collected data on all patients 50 years old or younger among 5880 patients treated for prostate cancer between 1994 and 2004. We recorded age, ethnic origin, clinical presentation, family history of prostate cancer, preoperative prostate-specific antigen (PSA) level, treatment, Gleason score, 2002 TNM stage, surgical margin status, and disease progression. Radical prostatectomy was offered as first-line treatment to all patients with localized prostate cancer (T1-T2N0M0) and negative lymph nodes. PSA-free survival was calculated. RESULTS: We analyzed the data from 110 patients (1.9%), of whom 37 had familial cancer (33.6%) and 15 hereditary cancer (13.6%). A total of 85 patients (77.3%) had undergone radical prostatectomy, 39 (45.9%) by open retropubic surgery and 46 (54.1%) laparoscopically. The surgical margins were positive in 11 patients (12.9%). The mean follow-up after prostatectomy was 39.1 +/- 36.8 months (range 4 to 125). Nine patients (10.6%) experienced biochemical recurrence (PSA level greater than 0.2 ng/mL). Longer PSA-free survival after surgery was significantly associated with high-risk and intermediate-risk patients (P = 0.01 and P = 0.02, respectively) but not with the surgical procedure (P = 0.6) or family history of cancer (P = 0.46). CONCLUSIONS: Radical prostatectomy is an effective treatment of localized cancer in patients younger than 50 years old. Nearly one half of our cases of prostate cancer in younger men were forms of familial cancer. Detecting familial forms is a key objective in early screening and in the timely identification of candidates for prostatectomy.

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↗
PubMed2003

Spontaneous rupture of non-tumoral kidneys in patients with end stage renal failure: risks and management.

OBJECTIVES: To determine the risks and treatment modalities of spontaneous subcapsular or perinephric bleeding in end stage renal patients. METHODS: 8 patients with end stage renal failure developed a spontaneous hemorrhage of one of their native kidneys and were referred to our institution. They were all men. Six of them presented an acquired renal cystic disease. Symptoms included sudden abdominal pain in 7 patients, vomiting in 2 and hematuria in 1. Symptoms were always associated with a hemoglobin decrease. Four patients were receiving oral anticoagulants for various reasons and one had thrombopenia. Bleeding was confirmed by computerized tomography and nephrectomy undertaken in all cases. RESULTS: 3 patients died in the immediate post-operative period. Histologic findings confirmed bleeding and did not find any other abnormality than those related to renal insufficiency (cysts and atrophy). CONCLUSION: Renal rupture should be considered in case of unexplained distress or sudden fall of the hemoglobin especially when patients are on anticoagulants. Surgery is our preferred treatment because of the frequency of unrevealed tumours and the potential mortality of massive hematomas.

Adult↗
PubMed2003

[Value of preserved saphenous vein graft for the creation of access ports in hemodialyzed patients: report of 309 cases].

INTRODUCTION: Biological grafts are rarely used for the creation of vascular access, despite their many advantages. Our group prefers to use distal vascular accesses with interposition of a biological graft when direct access cannot be achieved. The objective of this study was to determine the long-term patency and the complication rate of a series of 309 vascular access procedures using a preserved saphenous (PS) vein homograft. MATERIALS AND METHODS: 410 (27%) of the 1,500 vascular access procedures performed by our group required the use of a graft, including 376 PS vein homografts (25%). This retrospective study comprised complete data collection for 309 arteriovenous fistulas (AVF) using preserved saphenous (PS) vein graft in the forearm performed in 267 patients between 1985 and 2000. Primary patency was defined as the interval between creation of the vascular access and the first complication requiring surgical or radiological correction; secondary patency was defined as the interval between creation and loss of the graft, with or without revision of the fistula. Survival rates were calculated according to the Kaplan-Meier method. Inter-group comparison was performed by the Logrank test and analysis of variance was performed by logistic regression. RESULTS: Primary patency rates were 77%, 40% and 27% at 1,2 and 5 years, respectively. Secondary patency rates were 79% and 47% at 1 year and 5 years, respectively. The thrombosis rate was 42%. Two episodes of thrombosis occurred in 25% of grafts and 3 episodes were observed in 10% of cases. Infection rates were 1.9% postoperatively and 5% after dialysis, respectively. An aneurysm occurred on 10% of grafts. The operator's experience (RR = 1.58; p < 0.05) and diabetic nephropathy (RR = 1.89; p = 0.059) significantly influenced graft patency. In contrast, the position of the graft, the fact that it crossed the elbow joint, and the site of the arterial anastomosis did not have any negative impact on graft patency. DISCUSSION: Preservation of the patient's vascular capital is an essential objective in patients with chronic renal insufficiency, which is sometimes difficult to reconcile with the need to create vascular accesses with a long life span. The strategic choice between a distal access requiring a graft and a direct proximal access depends on the clinical context: cardiac function, waiting list for renal transplantation. Our preferred material in the case of bypass graft is the PS graft, as it presents the same resistance and the same patency rates as synthetic grafts, without the associated septic complications. CONCLUSION: The PS vein graft is a good material for the creation of vascular accesses with similar patency rates to those of prosthetic grafts. Vein grafts present a number of advantages, particularly a greater ease of use facilitating distal implantation of the graft and a low infection rate.

Adolescent↗
PubMed2003

[Cavernosal metastases from bladder tumour after cystoprostatectomy].

OBJECTIVE: To evaluate the predictive factors for cavernosal metastases after cystoprostatectomy for transitional cell bladder cancer. MATERIAL AND METHOD: Between February 1998 and January 2002, 61 men were treated by cystectomy for transitional cell bladder cancer (56 total cystoprostatectomies and 5 partial cystectomies). Five patients (8%) subsequently developed cavernosal metastases. The assessment criteria were classified into three categories: clinical history, histological findings on the operative specimen and follow-up data. RESULTS: The metastasis was observed an average of 8.4 months (range: 3-17) after cystoprostatectomy. Three of the 5 patients had a history of transurethral procedure at the same time as resection of a high-grade invasive bladder tumour: a urethral recurrence concomitant with the penile metastasis was observed in these cases. In 4 out of 5 cases, the bladder tumour was multifocal, involving the bladder neck, extensive and high-grade (> or = pT3 G3). Vascular tumour emboli were detected on the cystoprostatectomy specimen in 4 cases. All urethral sections performed during cystectomy were negative. All 5 patients died with a mean survival of 7 months (range: 1 to 21 months). CONCLUSION: The development of penile metastases after cystectomy appears to be frequently associated with the presence of extensive tumour (> or = pT3) on the operative specimen, involving the bladder neck, with a high histoprognostic grade and with the presence of tumour embolus. No transurethral procedures should be performed at the same time as resection of an obviously invasive bladder tumour. Health urethral sections do not exclude the risk of penile metastases.

Carcinoma, Transitional Cell↗
PubMed2002

[Postoperative course after open nephrectomy for organ donation].

OBJECTIVE: To evaluate the quality of the postoperative course after conventional organ donation nephrectomy. PATIENTS AND METHODS: Over the last 29 months, 29 organ donation nephrectomies were performed in our hospital. Thirteen donors were non-residents. This series consisted of twenty organ donations between siblings, two organ donations from children to parents and seven organ donations from parents to children. The mean age of the donors was 42 years (range: 21 to 53). Ten pairs were HLA identical, 18 were semi-identical and one pair had only one A identity in common. The mean plasma creatinine on admission was 81 +/- 23 mumol/l. RESULTS: Twenty three left kidneys and 3 right kidneys were harvested, with the last two right kidneys removed via a right anterior subcostal incision. Among the 23 left lumbotomies, the 11th rib was preserved in 21 cases in order to decrease postoperative pain. The mean operating time for patients operated by lumbotomy was 90 +/- 11 minutes. The mean postoperative stay (MPS) was 4.56 days (range: 3 to 8 days). The mean morphine consumption during hospitalisation was 40 mg per patient (range: 0 to 105 mg). Only one complication was observed: pneumothorax requiring postoperative drainage for 48 hours with no subsequent sequelae. No donor was transfused intraoperatively or postoperatively and no wound sequelae were observed. The mean plasma creatinine on discharge was 113 +/- 23 mumol/l. CONCLUSION: These results in terms of analgesic consumption, complications, and mean postoperative stay appear to compare favourably with those obtained by other teams, particularly when organ harvesting is performed laparoscopically (MPS: 4.5 days vs 3 days).

Adult↗