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Marian Devonec

Publications and source records attributed to Marian Devonec.

16 recordsLinked to original sources
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

TNF-alpha-related apoptosis-inducing ligand decoy receptor DcR2 is targeted by androgen action in the rat ventral prostate.

The apoptotic cell death process in the prostate is known to be under the control of androgens. Tumor necrosis factor-alpha (TNF-alpha)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF-alpha family of cytokines, known to induce apoptosis upon binding to its death domain-containing receptors, DR4/TRAIL-R1 and DR5/TRAIL-R2. Two additional TRAIL receptors, DcR1/TRAIL-R3 and DcR2/TRAIL-R4, lack functional death domains and act as decoy receptors for TRAIL. In this study, we examined whether TRAIL and cellular receptors expression was targeted by androgens during the apoptotic cell death process in the hormone sensitive ventral prostate. The role of androgens was investigated using two sets of experiment. (1) Androgen deprivation associated with an apoptotic process resulted in a decrease in DcR2 mRNA and protein expression in the ventral prostate 3 days after castration. Testosterone administration to castrated adult rats prevented the decrease in DcR2 mRNA and protein levels in the ventral prostate. In contrast, DcR2 expression was modified, neither in the dorsolateral nor in the anterior prostate following castration. No changes were observed in DR4, DR5, DcR1, and TRAIL mRNA and protein levels in prostate after castration. (2) A specific decrease in DcR2 expression was observed in the ventral prostate after treatment of rats with the anti-androgen flutamide. Together, the present results suggest that testosterone specifically controls DcR2 expression in the adult rat ventral prostate. Androgen withdrawal, by reducing DcR2 expression, might leave the cells vulnerable to cell death signals generated by TRAIL via its functional receptors.

Androgen Antagonists↗
PubMed2006

[Management of corpus cavernosum trauma].

Rupture of the tunica albuginea of the corpus cavernosum of the penis is a rare disease, usually occurring in young adults during sexual intercourse. In Western countries, the most frequent causes is coital injuries. Ultrasound, cavernography or magnetic resonance imaging of the penis can be performed to determine the exact site of the fracture. Treatment is usually elective surgery and consists of evacuating the subcutaneous haematoma and suturing the tear of the tunica albuginea. An associated rupture of the urethra must be excluded. Complications of these fractures of the tunica albuginea especially comprise erectile dysfunction, deviation of the erect penis, development of plaques resembling those of La Peyronie disease, urethro-cavernous or urethro-cutaneous fistula or dysuria secondary to urethral stricture.

Adolescent↗
PubMed2006

[REMEEX: A possible treatment option in selected cases of sphincter incompetence].

OBJECTIVE: To evaluate the functional results and morbidity of adjustable tension suburethral tape (REMEEX) in the treatment of urinary incontinence due to severe sphincter incompetence (MUCP < 40 cm H2O) in patients presenting a contraindication to artificial sphincter operated between December 2001 and May 2004. Twelve patients (66.7%) had already undergone incontinence surgery. Ten patients (55.5%) had mixed urinary incontinence. The efficacy of the tape was considered to be good when incontinence resolved completely, partial when incontinence was decreased by > 50% and/or PVR > 100 ml. All other cases were considered to be failures. In April 2005, after a mean follow-up of 26.3 months, retrospective evaluation of the functional results was performed by means of a pad-test and a questionnaire comprising an MHU (urinary disability) score and a Ditrovie score. Complications after each intercurrent event were recorded. RESULTS: The initial efficacy of the tape was considered to be good in 13 patients (72.2%) and partial in 4 patients (22.2%) with only one initial failure. Eight patients (44.4%) required secondary adjustment after a mean interval of 5.2 months, with a failure rate of 62.5%. In April 2005, 10 patients (55.5%) had a good result, 2 patients (11.1%) required self-catheterization (partial efficacy) and 6 patients (33.4%) were considered to be failures. In terms of morbidity, we observed 2 bladder injuries (11.1%), 6 superinfections of the device (33.3%), 2 (11.1%) of which required removal of the material. Fifteen patients (83.3%) answered the questionnaire: 6 patients (40%) had an MHU score greater than 3. The mean Ditrovie score was 2.1. 9 patients (60%) had a score less than 2 and 4 patients (26.6%) had a score greater than 3. CONCLUSION: The results of this series, in patients in whom artificial sphincter was contraindicated, are satisfactory at the price of acceptable morbidity. Before defining the place of this device in the range of treatment options for sphincter incompetence, our results must be confirmed by a longer series.

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↗
PubMed2005

[Well differentiated paratesticular liposarcoma in adults].

The authors report a case of well differentiated paratesticular liposarcoma in a 41-year-old patient. This is a rare tumour (about one hundred cases have been reported in the literature), which essentially arises from the spermatic cord. Clinical and radiological signs are nonspecific and the diagnosis is generally based on histological examination of the operative specimen. Due to the histological similarities, all specimens of benign lipoma must be examined for the presence of well differentiated liposarcoma. Treatment consists of transinguinal radical orchidectomy, sometimes with resection of adjacent structures. The prognosis is generally better than that of other paratesticular sarcomas. Adjuvant radiotherapy may be indicated in locally advanced masses or in the case of incomplete resection.

Adult↗
PubMed2004

Activation of caspases-3, -6, and -9 during finasteride treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) results from an increase in both epithelial and stromal compartments of the human prostate. Although inhibitors of 5alpha-reductase such as finasteride have been shown to reduce the size of BPH tissues by inducing apoptosis, their mechanisms of action still remain unknown. The present study supports that such a process triggered by finasteride is caspase dependent with a possible involvement of two effector caspases (caspase-3 and 6) and two initiator caspases (caspase-8 and 9). Indeed, by using tissues from patients affected by BPH and treated by finasteride (5 mg/d) for 2-3, 6-8, or 27-32 d, we observed that the 5alpha-reductase inhibitor induced apoptosis in epithelial cells (evaluated through cell number positive for terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) as early as 2-3 d of treatment, with a maximal activity (250-fold increase, P < 0.0001) at 6-8 d of treatment. However, after 27-32 d of treatment, the number of apoptotic cells was reduced and was close to control. Caspases-3, -6, -8, and -9 were immunolocalized to (basal and secretory) epithelial cells and to a lesser extent to stromal cells. Activated caspase-3 immunoexpression was restricted to epithelial secretory cells, and its immunostaining intensity appeared to be higher in BPH tissues from patients treated for 2-3 or 6-8 d. Consistently, in Western blotting analyses, activated caspases-3 and -6 were detected as early as 2-3 d of treatment in BPH tissues, and their levels were increased after 6-8 d of treatment. In real time quantitative PCR experiments, caspase-3 and -6 mRNA levels were found to be unchanged after finasteride treatment. Activated caspase-8 was not detected in the different conditions tested, whereas activated caspase-9 protein levels were maximally enhanced after 2-3 d of finasteride treatment. In conclusion, we report here that finasteride treatment of BPH tissues induced a caspase-dependent apoptotic process restricted to epithelial cells by activating effector caspases-3 and -6 and exhibited a transient action because the apoptotic process was no longer observed after 27-32 d of treatment.

Aged↗
PubMed2004

[Contribution of fluorescence immunocytochemistry (uCyt+TM) in the postoperative surveillance of bladder cancer].

OBJECTIVE: To assess 1) the value of fluorescence immunocytochemistry (uCyt+ test, DiagnoCure Inc., Quebec) in the detection of recurrent bladder tumour after transurethral resection (TUR) and 2) the predictive value of a positive uCyt+ test in patients with negative cystoscopy. MATERIAL AND METHODS: This study was based on 132 patients with a mean follow-up of 21.9 weeks after TUR. The initial tumours were pTa G1-2 in 66.7% of cases, and G3 in 28.8% of cases. Cystoscopy, urine cytology (UC) and uCyt+ test data were collected on the day of the first control visit (D0), and the patients were then reviewed at 6 and 12 months. All lesions detected on cystoscopy were biopsed. RESULTS: The mean sensitivity of UC was 47.4% and the mean sensitivity of uCyt+ was 73.7% (84.2% in combination). In patients with negative cystoscopy on D0, a positive uCyt+ test has no predictive value at 6 months. At 12 months, 20.0% of patients with positive UC had relapsed, versus 16.7% of patients with negative UC (p = ns). On the other hand, at 12 months, 50.0% of patients with negative cystoscopy but positive uCyt+ test had relapsed, versus 16.4% of patients with a negative uCyt+ test (p < 0.01). CONCLUSIONS: The uCyt+ test allows assessment of the risk of recurrence at I year, while UC alone only has a diagnostic value. These results raise the possibility of combining the tests in order to decrease the frequency of follow-up cystoscopy.

Adult↗
PubMed2003

Immunocyt test improves the diagnostic accuracy of urinary cytology: results of a French multicenter study.

PURPOSE: The limitations of urinary cytology and the invasiveness of cystoscopy generate an increasing interest in noninvasive diagnostic tools for the management of transitional cell carcinoma. We assess the clinical performance of ImmunoCyt (DiagnoCure, Inc., Saint-Foy, Canada) in the detection of bladder cancer in a 10-center French trial. MATERIALS AND METHODS: From October 2000 to April 2001, 694 patients undergoing cystoscopy were prospectively included in the study. Of the patients 458 (66%) had been previously treated for superficial transitional cell carcinoma and 236 (34%) were referred for symptoms suggestive of bladder cancer. All patients underwent ImmunoCyt test and standard urinary cytology from voided urine as well as a complete evaluation including cystoscopy and transurethral resection or biopsy of suspicious lesions. Sensitivity and specificity values of urinary cytology and ImmunoCyt whether or not combined were calculated using cystoscopy as the gold standard and histopathology when available. RESULTS: A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologicaly confirmed. Overall sensitivity of urinary cytology was 17.9%, 46.3% and 63.8% respectively, for G1, G2 and G3 transitional cell carcinoma, whereas that of ImmunoCyt was 60.7%, 75.6% and 76.8%. Sensitivity of the combined tests was 66.7%, 78% and 87%, respectively. Moreover, 10 of 55 (18.2%) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone. Specificity of urinary cytology was 94.5%, whereas that of ImmunoCyt was 84.2%. Specificity of the combined tests was 80.7%. Marked variations in urinary cytology sensitivity were observed among the different centers (27.3% to 66.7%), whereas combined assays (urinary cytology and ImmunoCyt) enhanced the overall sensitivity in the 80% range at most centers. CONCLUSIONS: This prospective multicenter series confirmed a marked increase in sensitivity without significant loss in specificity when including ImmunoCyt in standard urinary cytology protocol. This increased sensitivity was observed in high grade lesions (with 100% sensitivity for carcinoma in situ) as well in low grade, low stage tumors.

Adult↗
PubMed2003

[Evaluation of the accuracy of four-channel multidetector CT for investigation of the renal arterial blood supply].

OBJECTIVE: To evaluate the accuracy of four-channel multidetector CT for investigation of the proximal and distal renal arterial blood supply. MATERIAL AND METHOD: Four-channel multidetector CT was performed in 51 patients prior to nephrectomy (3 bilateral nephrectomies). The anatomy of the renal pedicle was described intraoperatively and arteriography of the nephrectomy specimen was performed immediately postoperative. Preoperative CT data were compared to intraoperative anatomical findings and arteriography findings on 54 nephrectomy specimens. Concordance analysis (determination of the kappa coefficient) was based on 4 criteria: number of renal arteries, position of the artery with respect to the vein, the intra-sinus or extra-sinus situation of the division of the artery and the number of first order branches. RESULTS: The concordance between CT and intraoperative anatomical findings was good for number of renal arteries (kappa = 0.78) and moderate for the position of the artery with respect to the vein (kappa = 0.65). The concordance between CT and arteriography was poor for the intra-sinus or extra-sinus situation of the division of the renal artery (kappa = 0.5) and for the number of first order branches of the renal artery (kappa = 0.41). CONCLUSION: Four-channel multidetector CT precisely visualizes the proximal renal arterial blood supply, but remains less accurate than arteriography for investigation of the distal arterial blood supply.

Adult↗
PubMed2002

Identification of tumor necrosis factor-alpha-related apoptosis-inducing ligand (TRAIL) and its receptors in adult rat ventral prostate.

Tumor necrosis factor-alpha-related apoptosis-inducing ligand (TRAIL) is a member of the tumor necrosis factor-alpha (TNF-alpha) family of cytokines that is known to induce apoptosis upon binding to its death domain-containing receptors, DR4/TRAIL-R1 and DR5/TRAIL-R2. Two additional TRAIL receptors, DcR1/TRAIL-R3 and DcR2/TRAIL-R4, lack functional death domains and act as decoy receptors for TRAIL. In this study, the presence of TRAIL and its receptors was investigated in adult rat hormonosensitive ventral prostate. TRAIL and its receptors were identified in the rat ventral prostate in terms of protein and mRNA. TRAIL and its receptors were immunolocalized in prostatic epithelial cells.

Animals↗
PubMed2002

[Prostate tumors].

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Age of Onset↗
PubMed2002

[Rigid ureteroscopy in the case of suspected tumor of the upper urinary tract: report of 63 cases].

OBJECTIVE: This retrospective study was designed to determine the place of rigid ureteroscopy in the diagnosis of upper urinary tract tumours. MATERIAL AND METHODS: 63 patients (45 males and 18 females) with a mean age of 60 years, were investigated by rigid ureteroscopy for suspected upper urinary tract tumour. The Wolf 8-9.8 F ureteroscope was used in the case of suspected upper urinary tract tumour in a context of ureteric obstruction on the IVU in 29 cases, haematuria in 23 cases, a defect on retrograde ureteropyelography in 5 cases, suspicious CT scan in 5 cases and positive cytology with normal cystoscopy in 2 cases. RESULTS: The ureteroscope was able to be advanced as far as the suspicious zone in 89% of cases. The mean operating time was 48 minutes and the mean hospital stay was 3.2 days. Diagnostic rigid ureteroscopy has a Sensitivity of 58% (95% confidence interval CI95: +/- 28), a Specificity of 100%, a Positive Predictive Value of 100%, a Negative Predictive Value of 91% (+/- 7) and a low morbidity (3%). CONCLUSION: Rigid ureteroscopy does not appear to be the examination of choice for the diagnosis of upper urinary tract tumours, as it cannot investigate the renal pelvis or calices and the ureteroscope cannot always be advanced to the suspicious zone. The flexible ureteroscope now appears to be a more reliable diagnostic tool.

Female↗
PubMed2002

[Trans-urethral micro-wave thermotherapy of prostatic benign hypertrophy].

Transurethral microwave thermotherapy is designed to destroy non-malignant tissue by exposure to a cytotoxic temperature ranging from 45 degrees C to more than 70 degrees C. The combination of microwave-induced heat administered transurethrally and protection of the urethra by a cooling circuit allows delivery of sufficient power to induce coagulation of the periurethral prostatic tissues without any form of anaesthesia part from instillation of anaesthetic jelly into the urethra. Treatment takes only 30 minutes. Strict security limits (urethral temperature and rectal temperature) ensure a low complication rate. The therapeutic efficacy of thermotherapy is situated between that of drugs and endoscopic surgery. The effect is lasting. The development of a tailor-made treatment for each patient should increase the response rate of this technique.

Diathermy↗