PubMed Health⌕ Search

Biomedical subjects

Thierry Roumeguere

Publications and source records attributed to Thierry Roumeguere.

6 recordsLinked to original sources
PubMed2006

Presence of LDL modified by myeloperoxidase in the penis in patients with vascular erectile dysfunction: a preliminary study.

OBJECTIVE: Erectile dysfunction (ED) is a major vascular disorder. Atherosclerosis is closely related to lipoprotein metabolism and especially, oxidative modifications of low-density lipoproteins (LDLs), which are involved in early development of the atherosclerotic lesions. Current major questions include how LDLs are oxidised (OxLDL) in vivo. Myeloperoxidase (MPO) is an enzyme present in the azurophile granules of neutrophils and monocytes that can contribute to LDL oxidation in the presence of H(2)O(2). We have developed a new monoclonal antibody against LDL modified by MPO (Mox-LDL) and have used it on penile biopsies from patients operated on for penile implant. METHODS: Seven patients with vascular ED and one impotent patient after radical prostatectomy (RP) underwent biopsy of the cavernous body during penile implant procedures. An immunohistochemical study with a monoclonal antibody against Mox-LDL and an antibody against apoprotein B (ApoB), the protein moiety of LDL, to confirm the presence of LDL was performed. RESULTS: The staining was positive for Mox-LDL and ApoB and was present between the endothelial cells of the sinusoid spaces and the smooth muscle cells in the seven patients with vascular ED. The patient with RP was negative for Mox-LDL. DISCUSSION: Because it is known that modified LDL could decrease nitric oxide production, Mox-LDL could be one of the agents responsible for ED. Further studies are needed to confirm this hypothesis.

Aged↗
PubMed2005

Laparoscopic radical prostatectomy: the learning curve.

PURPOSE OF REVIEW: Laparoscopic radical prostatectomy is now an accepted treatment option for the management of localized prostate cancer. Numerous studies have demonstrated the feasibility and the reproducibility of this procedure. Expert teams in high-volume centres routinely carry out laparoscopic radical prostatectomy but for the novice the obstacle to success is how to learn and gain proficiency in this procedure. In this review, we will present our views on how this can be done. RECENT FINDINGS: A learning curve includes the necessity for continuous self-evaluation in terms of cancer control, continence and potency. Many different methods can be used to acquire the technique: dry lab, animal live lab, cadaveric laparoscopic dissection or mentoring with an expert. All of these steps may not be essential as laparoscopic radical prostatectomy is not too dissimilar to open prostatectomy. However, one must understand that the physiological consequences of anaesthesia during laparoscopy and basic laparoscopic suturing technique should be perfected prior to taking on laparoscopic radical prostatectomy. The training then must continue under the supervision of a mentor. The opportunity for discussion with an expert allows the novice to learn the pitfalls and the tips and tricks of laparoscopic radical prostatectomy, thus reducing the length of the learning curve and negating the need to reinvent the wheel. SUMMARY: Laparoscopic radical prostatectomy is similar to any other new surgical procedure and as with open surgery we learn and gain experience with each procedure; the learning curve is never completely finished.

Animals↗
PubMed2003

Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches.

We prospectively compared, within the same center and during the same period of time, the perioperative parameters as well as the oncological and functional results of both open retropubic (ORP) and laparoscopic radical prostatectomy (LRP). From September 1999 to September 2001, 162 patients with prostate cancer were treated with radical prostatectomy, 77 using an open retropubic technique, and 85 by the laparoscopic extraperitoneal approach. We prospectively recorded pre-, per- and postoperative parameters and complications, and evaluated the carcinological and functional results, comparing both approaches. There were no significant differences in the preoperative characteristics of the two groups. Mean operative time was statistically longer with LRP than with ORP (288 vs 168 min, P<0.0001) but median blood loss was decreased (400 vs 1,300 ml, P<0.0001). Major complications occurred in a similar number of cases (5% vs 2.4%, NS) while minor complications occurred more frequently with ORP (24.6 vs 11.8%, P=0.003). Pathological examination revealed a similar distribution of Gleason scores and stages in each group. Positive surgical margins in pT2 cases occurred in 7.8% of LRP and 7.3% of ORP. Continence rates (no pad and no leakage at all) were similar (83.9% in ORP vs 80.7% in LRP, NS). Potency rates were similar after 1 year in patients undergoing bilateral nerve sparing (55% in ORP vs 65% in LRP, NS). However, patients operated by LRP had more spontaneous erections. We conclude that this prospective, comparative study shows that LRP, when performed in specialized centers, gives oncological and functional results comparable to open surgery.

Aged↗
PubMed2003

The place of surgery for vascular impotence in the third millennium.

PURPOSE: With the arrival of new oral therapies the question arises about the role of surgery in patients with vascular impotence. We compared the sexual satisfaction rate in patients with arterial and/or venous impotence treated with 4 surgical techniques with long-term followup. MATERIALS AND METHODS: Surgery was performed in 130 patients with vascular erectile dysfunction by 1 surgeon. Two young patients (2%) with traumatic arterial lesions underwent penile revascularization (group 1), while 128 with arterial and/or venous impotence were also treated with surgery, including 11 of 130 (8%) with deep dorsal penile vein resection (group 2), 39 (30%) with arterialization of the deep dorsal penile vein (group 3) and 78 (60%) with penile implants (group 4). Sexual satisfaction, defined as the possibility of satisfactory sexual intercourse without any additional treatment or pain, was evaluated by patient interview. RESULTS: Of the 130 patients 111 (85%) participated in the sexual life events interview, including 2 of 2 (100%) in group 1, 7 of 11 (63.6%) in group 2, 33 of 39 (85%) in group 3 and 69 of 78 (88%) in group 4. Mean followup was 50, 48, 46 and 54 months for groups 1 to 4, respectively. The sexual satisfaction rate was 2 of 2 (100%) for penile revascularization, 1 of 7 (14%) for venous resection, 4 of 33 (12%) for arterialization and 64 of 69 (93%) for penile implantation. Complications occurred in 9.5%, 12.5% and 20.5% of the patients in groups 2 to 4, respectively. CONCLUSIONS: Except for young patients with traumatic arterial lesions this study demonstrated the poor sexual satisfaction rate in impotent patients treated with the vasculogenic approach and the high rate of satisfaction in those treated with penile implants. Better selection criteria must be applied for vascular surgical treatment for impotence.

Adult↗
PubMed2002

Comparison of laparoscopic radical prostatectomy techniques.

Over the past years, laparoscopic radical prostatectomy has emerged as an attractive, exciting, and new approach for the surgical treatment of localized prostate cancer. Several centers in Europe and the United States have developed their own technique and have already published their first results. Two main routes have been used, namely, the transperitoneal and extraperitoneal approaches. Data from the literature and available experience demonstrate that this laparoscopic procedure is feasible and teachable and that oncologic and functional results seem comparable to those of classic open radical prostatectomy. Minimal bleeding, reduced blood transfusion rates, shorter hospitalization, and shorter recovery time are unquestionable advantages for laparoscopic procedures. Laparoscopic radical prostatectomy remains a difficult intervention and should be performed in selected centers with experienced teams who already have extensive laparoscopic experience and who recruit enough patients to grant them the proper amount of expertise. This is the only way to achieve excellence in terms of oncologic and functional results.

Humans↗