Biomedical subjects
Publications and source records attributed to Pierre Plante.
We describe our experience of open partial nephrectomy with a parenchymal clamp, the Reni-Clamp, in 30 patients from January 2002 to May 2005. The mean operative and clamping time was 150 and 27 minutes, respectively, and the blood loss was 150 mL. The Reni-Clamp enabled us to perform partial nephrectomy safely in all cases of polar or external edge renal tumor.
OBJECTIVES: Testicular cancer (TC) is the most common malignancy in young men. A review of all published articles on TC incidence revealed an increased incidence in Northern and Central Europe. We extended the analysis to the whole of Europe by using all data available, notably from registries. METHODS: We performed a PubMed search and selected articles dealing with TC incidence. We obtained additional information from data of European registries through the eight volumes of the Cancer Incidence in Five Continents, IARC Scientific Publications. RESULTS: Since the Second World War, TC incidence has been increasing in nearly all European countries. It has doubled in several countries, including France, since 1970. We observed that the increase followed a gradient: the highest rate is centred in Denmark and Germany, and decreases progressively in a centrifugal manner. CONCLUSIONS: TC incidence is increasing throughout Europe, but wide discrepancies exist between the different countries. The reasons for such a phenomenon are still unclear although environmental factors are strongly suspected, which could have an impact on male fertility. From a public health perspective, further research using cases collected through national and regional population-based registers and case-control studies must be strongly encouraged.
Encoded by the genome of most eukaryotes examined so far, microRNAs (miRNAs) are small approximately 21-nucleotide (nt) noncoding RNAs (ncRNAs) derived from a biosynthetic cascade involving sequential processing steps executed by the ribonucleases (RNases) III Drosha and Dicer. Following their recent identification, miRNAs have rapidly taken the center stage as key regulators of gene expression. In this review, we will summarize our current knowledge of the miRNA biosynthetic pathway and its protein components, as well as the processes it regulates via miRNAs, which are known to exert a variety of biological functions in eukaryotes. Although the relative importance of miRNAs remains to be fully appreciated, deregulated protein expression resulting from either dysfunctional miRNA biogenesis or abnormal miRNA-based gene regulation may represent a key etiologic factor in several, as yet unidentified, diseases. Hence is our need to better understand the complexity of the basic mechanisms underlying miRNA biogenesis and function.
OBJECTIVES: To evaluate the efficacy and safety of a porcine biomaterial (Pelvicol) in the transvaginal surgical treatment of urogenital prolapse. MATERIAL AND METHOD: Prospective study from June 2001 to February 2004 based on 132 patients with a mean age of 67.6 +/- 9.89 years presenting major urogenital prolapse: 132 cystoceles and 84 rectoceles with 100% and 63.4% of grade 2 or 3, respectively. Patients were evaluated by questionnaire and clinical examination at 1 month, 6 months, 12 months and 24 months after the operation. Two hundred and sixteen Pelvicol implants were inserted via a vaginal approach: 132 anterior implants and 84 posterior implants. RESULTS: The mean follow-up was 21 months [range: 6-24]. No intraoperative complication was observed. The postoperative complication rate was 11.3% (15/132) including 1 prosthetic exposure with a favourable outcome. After 6 months, 1 recurrence of cystoceles and 1 recurrence of rectoceles were found in 132 patients. Out of the 117 patients followed up for 12 months, 6 presented with grade 2 cystoceles and 1 grade 2 rectoceles. After 24 months, out of the 107 patients evaluated, 18 cystoceles and 9 rectoceles of grade 2 or 3 were found. Globally, 83.1% of patients did not present with grade 2 or 3 recurrences after 24 months. Safety was considered to be good with 10% of moderate pelvic pain and 6% of de novo dyspareunia at 12 months. The overall satisfaction rate was 94%. CONCLUSION: These preliminary results demonstrate an efficacy of 83.1% at 24 months and the good safety of Pelvicol in the transvaginal surgical treatment of urogenital prolapse.
OBJECTIVES: To determine the results of treatment of chronic urinary retention secondary to bladder outlet obstruction complicating retropubic suburethral insertion of Tension-free Vaginal Tape (TVT) by section of this tape. MATERIAL AND METHODS: Between June 2000 and December 2004, 30 women with a mean age of 63.5 +/- 11.6 years underwent a single lateral urethral section of Tension-free Vaginal Tape to treat bladder outlet obstruction secondary to retropubic suburethral TVT insertion. Success was defined by resolution of the symptoms, a maximum urine flow rate greater than 15 ml/s and a post-voiding residual less than 50 ml and failure was defined by persistence of at least one of these three criteria. RESULTS: The mean interval between TVT placement and tape section was 12.7 +/- 14.7 months. The mean follow-up was 25.8 +/- 7.8 months. The cure rate was 70%. One complication (a bladder wound) was observed. Postoperatively, two patients (70%) developed recurrence of stress urinary incontinence. CONCLUSION: The treatment of chronic bladder outlet obstruction after retropubic TVT placement to treat stress urinary incontinence by single lateral urethral section of this tape is a simple and effective technique with low morbidity, accompanied by a very low urinary incontinence recurrence rate.
UNLABELLED: Application to the study of sexuality in a population of 93 French women. OBJECTIVES: This study was designed to linguistically validate the French version of the BISF-W (Brief Index of Sexual Functioning for Women) which provides a quantitative and qualitative assessment of female sexuality according to 7 dimensions. This version was then used to study the impact of recognized factors of sexual dysfunction on a control population. MATERIAL AND METHOD: The BISF-W a self-administered quality of life questionnaire developed by Rosen, was translated and linguistically validated. This questionnaire comprises 22 questions in 7 dimensions investigating all aspects of female sexuality: D1 (desire), D2 (arousal), D3 (frequency of sexual activity), D4 (receptiveness), 05 (pleasure, orgasm), D6 (relational satisfaction), D7 (problems affecting sexuality), Composite Score (CS) D1+D2+D3+D4+D5+D6+07. The French version was administered to a study population of 93 women: 49 derived from gynaecology or urology departments and 44 derived from the general population. We calculated and compared the scores of the various dimensions of the BISF-W according to factors able to modify sexuality, such as menopause, age or parity. RESULTS: The results of our study show an alteration of the various dimensions of sexuality in elderly patients (D2, D5, D6, CS; p<0.05) or postmenopausal patients (D2, D5, D6, CS, p<0.05) and in multiparous women. CONCLUSION: The French version of the BISF-W gives results in line with the literature and demonstrates changes of sexuality as a function of the above mentioned variables.
OBJECTIVE: Study of the incidence of severe long-term gastrointestinal (GI) and genitourinary (GU) complications of conformal radiotherapy after total prostatectomy for localized prostatic adenocarcinoma. MATERIAL AND METHOD: From 1991 to 2000, 114 patients with a mean age of 62 years (range: 45-82 years) were treated by total prostatectomy followed by adjuvant radiotherapy. The mean dose of radiotherapy was 65 Gy (range: 58-72 Gy). The mean interval between prostatectomy and radiotherapy was 10 months (range: 2-28 months). Patients were reviewed every 6 months. We studied severe complications (RTOG grade 3 or 4) occurring after treatment. The mean follow-up was 74 months (range: 32-132 months). RESULTS: Eight patients (7%) treated by adjuvant radiotherapy with a mean dose of 65.5 Gy (range: 59-70 Gy) developed long-term severe complications. The mean time to onset of complications was 25 months (range: 5-72 months). Three patients developed gastrointestinal complications (2 cases of radiation proctitis and 1 anal stricture). Five patients developed genitourinary complications (4 cases of radiation cystitis and 1 urethral stricture). These eight patients received multiple transfusions and required surgical or endoscopic procedures. Most patients were hospitalized on several occasions for periods ranging between 3 days and 1 month. CONCLUSION: Adjuvant radiotherapy after total prostatectomy is associated with severe long-term complications in 7% of cases. When they occur, these complications generally require repeated major urological and gastrointestinal surgery.
PURPOSE: We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis. MATERIALS AND METHODS: Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia. RESULTS: CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%). CONCLUSIONS: Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.
PURPOSE: We determined the safety and efficacy of each of 2 doses of botulinum toxin type A (BTX-A) (200 or 300 U BOTOX) injected into the detrusor for urinary incontinence caused by neurogenic detrusor overactivity of predominantly spinal cord origin. MATERIALS AND METHODS: A total of 59 patients with urinary incontinence caused by neurogenic detrusor overactivity (due to spinal cord injury in 53 and multiple sclerosis in 6) requiring clean intermittent self-catheterization were randomized to receive a single dose into the detrusor of BTX-A (200 U or 300 U) or placebo. Changes in daily frequency of urinary incontinence episodes were monitored via a patient bladder diary during 24 weeks. Key urodynamic assessments (maximum cystometric capacity, reflex detrusor volume and maximum detrusor pressure during bladder contraction) were used to provide objective measures of the treatment effect on bladder function. The impact of treatment on quality of life was assessed using the Incontinence Quality of Life questionnaire. RESULTS: There were significant posttreatment decreases in incontinence episodes from baseline in the 2 BTX-A groups (p </=0.05) but not in the placebo group. In addition, more patients who received BTX-A reported no incontinence episodes during at least 1 posttreatment evaluation period. Positive treatment effects were also reflected by significant improvements in bladder function in the BTX-A groups, as assessed by urodynamics and in patient quality of life. Benefits were observed from the first evaluation at week 2 to the end of the 24-week study. No safety concerns were raised. CONCLUSIONS: Intramuscular injections of BTX-A into the detrusor can provide rapid, well tolerated, clinically significant decreases in the signs and symptoms of urinary incontinence caused by neurogenic detrusor overactivity during a 24-week study period.
Prostatic biopsy is a routine clinical procedure often wrongly considered to be perfectly harmless. The authors report the first case of epidural abscess after prostatic biopsy, despite properly conducted antibiotic prophylaxis. Although the epidural space is a known site of infection, the relationship with prostatic biopsies has never been previously reported. This clinical case emphasizes the need for complete patient information and the importance of anti-infective prophylaxis guidelines.
BACKGROUND: Patients with testicular cancer have an excellent survival rate, and fertility is one of the main concerns of survivors. The authors investigated fertility status after treatment for testis cancer in long-term survivors. METHODS: Four hundred fifty-one consecutive patients with testicular cancer (1979-1999) from health facilities in the French Midi-Pyrenees region were enrolled. Testis tumors were classified according to the Royal Marsden Hospital Classification. Fertility status was assessed by means of a mailed, standardized questionnaire focused on reproductive events that occurred before and after treatment. Of 451 patients with germ-cell tumors, information concerning fertility was obtained in 446 patients (98.9%). The follow-up was at least 3 years. RESULTS: Before they were diagnosed with testicular cancer, 91.2% of patients who had tried to get their partners pregnant had succeeded, compared with 67.1% of patients after treatment. Radiotherapy had a much more deleterious effect on fertility compared with chemotherapy alone. Furthermore, cumulative conception rates (log-rank test) for patients who received radiotherapy were significantly lower compared with the rates for patients who received chemotherapy. CONCLUSIONS: The outcome of this study, which included the largest series reported to date, showed that fertility in patients with testicular cancer decreased by 30% after treatments and that radiotherapy seemed to have the most deleterious effect on fertility.
OBJECTIVES: To report the long-term impact of two cycles of adjuvant chemotherapy on relapse rates and treatment-related morbidity in high-risk stage I nonseminomatous testicular germ cell tumors (NSGCTT I). MATERIAL AND METHODS: From April 1987 to September 1997, 40 stage I NSGCTT patients with evidence of vascular invasion and/or embryonal carcinoma (EC) in the orchidectomy specimen were treated with two courses of bleomycin, cisplatin, and etoposide (BEP). RESULTS: All patients but one (incidental death) were alive after an extended follow-up (median 113.2 months, range 63-189). No patients relapsed but two patients presented a second cancer in the remaining testis. Short-term toxicity was minimal and no long-term toxicity was observed. CONCLUSION: The present series, with extensive follow-up, demonstrated that the efficacy and toxicity of two cycles of BEP compared well with the results of surveillance strategies or RPLND in high-risk stage I NSGCTT.
OBJECTIVES: To determine the ability, reliability, and accuracy of urinary red blood cell volume distribution curves obtained with the use of an autoanalyzer to identify the origin of isolated microscopic hematuria and compare the results with those obtained with phase-contrast microscopy (PCM). METHODS: A prospective evaluation was performed in 45 patients with glomerular or nonglomerular microhematuria detected by urinalysis, PCM, radiologic evaluation, endoscopy, and, sometimes, renal biopsy. Urine samples were analyzed in an electronic particle-size analyzer, and the tests were repeated to assess reliability. The kappa correlation coefficient was used to assess reliability and to compare the results with the final diagnosis and with those obtained with PCM. RESULTS: Of the 28 patients who had a single definite cause of hematuria, 16 had glomerular bleeding and 12 nonglomerular bleeding. The origin of hematuria was correctly identified by the autoanalyzer in 60.7% of cases. A statistically significant correlation was found with the final diagnosis (kappa = 0.433, P = 0.048). The reliability was excellent (kappa = 0.917, P <0.0001). Of 16 patients with glomerulonephritis, 10 (62.5%) were correctly identified by PCM and 14 (87.5%) by the autoanalyzer. In 12 patients with nonglomerular bleeding, PCM was accurate in 7 (58%) and the autoanalyzer in 3 (25%). The results were statistically correlated with the findings of PCM (kappa = 0.327, P <0.00001). CONCLUSIONS: The use of an autoanalyzer is easy, reproducible, and noninvasive. It provides reliable information to orient the diagnosis toward glomerular or nonglomerular bleeding. It is as accurate as PCM for screening for the source of hematuria.
PURPOSE: We evaluated the morbidity of radical cystectomy for invasive bladder cancer in select patients older than 75 years using recent data from 2 academic hospitals. MATERIALS AND METHODS: We analyzed 73 radical cystectomies performed from January 1995 to June 2000 in patients 75 to 89 years old (median age 79.3). Cases were categorized according to the American Society of Anesthesiologists classification with a score of 2 in 41, 3 in 30 and 4 in 2. External urinary diversion was performed in 51 cases and an ileal neobladder was constructed in 22. We evaluated the incidence and type of complications, clinical outcome, and postoperative care unit and hospital stay. Statistical analysis was done using the chi-square and Student t tests. RESULTS: Median operative time was 263 minutes (range 95 to 451). The perioperative mortality rate was 2.7%. The intraoperative, early and late postoperative complication rates were 38.4%, 46.5% and 16.4%, respectively. Three reoperations (4.1%) were necessary. The most common early complications were pyelonephritis in 12.3% of cases, disorientation in 10.9%, pneumonia in 8.2% and prolonged ileus in 12.3%. The most common late complications were ureteroileal anastomotic stenosis in 5 cases and hernia in 3. Median postoperative care unit and hospital stays were 12 and 34 days, respectively. At a median followup of 14.4 months (range 6 to 74) the overall mortality rate was 31.5%. Hospital stay was significantly higher in patients with complications. The incidence of complications was similar in the 2 groups. CONCLUSIONS: These data support the aggressive surgical management of bladder cancer in select elderly patients. A rigorous multidisciplinary team approach can provide acceptable perioperative morbidity.
OBJECTIVES: Trainee urologists must be helped and guided in order to acquire surgical techniques and professional skills. This methodological trial was designed to define the training objectives based on the needs formulated in terms of basic technical procedures. MATERIALS AND METHODS: Systematic planning based on the training cycle was used in this study. Training needs were identified by a questionnaire sent to 4 groups composed of a limited number (about twelve) of urologists, but representative of the various modes of urological practice in several regions of France. Data were acquired according to the Delphi method. RESULTS: A list of 10 operations to be mastered at the end of urology training was defined consensually based on the replies (79.2%) to the questionnaire. This list was used as the basis for the design of general and specific training objectives for each operation. These objectives were validated by the urologists consulted. Three examples of these objectives are presented. CONCLUSION: A clear determination of the surgical technique training needs and objectives could lead to standardization of the practical training of urology residents. This would subsequently need to be completed by determination of the methods of evaluation of achievement of these objectives for tutors and trainee urologists.
OBJECTIVES: To assess the value of measuring urinary corpuscular volume (UCV) with a haematology automat for determination of the glomerular or non-glomerular origin of isolated microscopic haematuria (MHi). MATERIAL AND METHODS: Forty-five fresh urine samples taken from 45 consecutive patients, with a median age of 59 years, consultant for MHi on urinary dip-sticks were studied with a haematology automat. After each analysis, MHi was classified into one of the following three groups: High MHi (glomerular, UCV < 50 fl), low MHi (non-glomerular, UCV > 50 fl), MHi of unknown origin (mixed UCV). A complete aetiological assessment of MHi was performed in each case. RESULTS: The aetiological diagnosis of MHi was established in 28 cases (62%), with a glomerular origin in 16 cases and a non-glomerular origin in 12 cases. UCV was of the glomerular (19 cases), non-glomerular (3 cases) or mixed type (6 cases). When UCV indicated a glomerular or non-glomerular origin for MHi (22/28 = 78.6%), the result was exact in 77% of cases (17/22). The sensitivity to diagnose glomerular haematuria was 100%, the specificity was 37.5%, the PPV was 73.7% and the NPV waas 100%. CONCLUSION: The study of UCV can suggest the origin of MHi, but cannot confirm this origin due to its poor specificity.
Pudendal nerve trauma is a rare complication of orthopaedic and traumatological surgery, which occurs after traction of the pelvis on an orthopaedic table fitted with a pelvic support. This trauma is generally due to crushing of the nerve against the central part of the table or stretching of the pudendal nerve due to excessive traction during fractures of the femur. the urological consequences of this neurological trauma present in the form of disorders of perineal sensitivity, which usually rapidly resolve spontaneously, or vesicosphincteric and/or erectile disorders, which have a more pejorative course and which can sometimes persist. The prognosis depends on the severity of the symptoms and the results of electrophysiological studies, which are reserved for serious lesions. This investigation identifies the level of the neurological lesion. Surgical decompression, rarely indicated, can be necessary in the case of serious and persistent sensory or motor lesions. Patients must be clearly informed about this possible neurological complication before an operation on the orthopaedic table as part of good surgical practice.