Annales D Urologie最新文献

{"title":"Renal imaging and biopsy for diagnosis of renal masses","authors":"Jean-Luc Descotes ,&nbsp;Jean-Dominique Doublet","doi":"10.1016/S0003-4401(06)80030-6","DOIUrl":"10.1016/S0003-4401(06)80030-6","url":null,"abstract":"<div><p>Incidental diagnosis of renal tumors is more and more common. Imaging is of paramount importance for the caracterization of these tumors. Ultrasound allows the diagnosis of solid tumors, thereby excluding cysts. The gold standard is the CT-scan, the realisation of which must obey to precise quality criteria. MRI yields further informations in selected cases. Renal cancer is the main etiology, but benign tumors can be suspected in small tumors less than 4 cm. Angiomyolipoma and oncocytoma are the more frequent benign tumors. Angiolipoma can be diagnosed with CT-scan, but there are no radiological criteria for the diagnosis of oncocytoma. Renal percutaneous biopsy can be helpful in selected cases. It is recommended for bilateral tumors, or when a renal metastasis is suspected. For small lesions with radiological features consistent with the diagnosis of benign tumor, renal biopsy can confirm this diagnosis and lead surgical abstention. Nevertheless, few centers have a regular practise of renal biopsy. Its contribution is still to be evaluated.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 ","pages":"Pages S86-S90"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0003-4401(06)80030-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26610872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostatectomie périnéale","authors":"H. Villavicencio,&nbsp;J. Segarra","doi":"10.1016/j.anuro.2006.06.001","DOIUrl":"10.1016/j.anuro.2006.06.001","url":null,"abstract":"<div><p>There is a lack of prospective randomised trials comparing the efficacy of the different techniques for treating localised prostate cancer. Consequently, selecting one rather than the other appears very difficult. Even radical prostatectomy is controversial regarding its best approach – perineal, retropubic or laparoscopic. The perineal route was the first to be undertaken, and it was dropped out due to the need of performing obturator lymphadenectomy by a separate approach. Widespread use of prostate-specific antigen as a screening method has enabled to diagnose prostate cancer at its early stages, when the potential for lymphatic dissemination is low, which enables to obviate lymphadenectomy in most patients. This was a promoting circumstance to use the perineal route in radical prostatectomies. In this article we discuss the perineal radical prostatectomy surgical technique, its indications, and its advantages and disadvantages as compared to other approaches.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 5","pages":"Pages 317-327"},"PeriodicalIF":0.0,"publicationDate":"2006-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26418877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Place de la néphrectomie dans la prise en charge des cancers du rein métastatiques","authors":"N. Mottet","doi":"10.1016/j.anuro.2006.07.001","DOIUrl":"10.1016/j.anuro.2006.07.001","url":null,"abstract":"<div><p>Metastatic kidney cancer is still a devastating disease but it represents a very heterogeneous situation. Some patients will have a median survival limited to some months, while others will live several years. If the initial diagnosis of kidney cancer at metastatic stage is quite uncommon, it raises the question of whether or not performing initial nephrectomy. The point was long debated as it was suggested that initial nephrectomy could result in a spontaneous metastase regression and protect against local complications (hematuria, local pain,…). Today, nephrectomy must not be systematic, as effective alternative treatments are often available. Furthermore spontaneous postoperative metastasis regression is unusual. Two recent prospective randomized trials clarified the impact of initial nephrectomy. It is now accepted that initial surgery prior to systemic immunotherapy results in 30% survival benefit. However this procedure should only be considered for highly selected cases: patients in otherwise good condition (ECOG 0-1), macroscopically complete local resection, no supra-hepatic caval thrombus, and patients suitable for systemic immunotherapy treatment. Several questions remain unanswered, such as lymph node dissection to be performed, and its real survival impact. Furthermore the definition of “suitable” patients for immunotherapy has to be clarified, based on the recent results from the Percy Quatro study. It would probably be more effective to consider only patients with an expected good survival benefit using immunotherapy, such as those classified as “good prognosis” based on the CRECY criteria. Finally the development of new drugs, targeting mainly the angiogenic pathway may lead to different future indications in this setting.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 5","pages":"Pages 273-279"},"PeriodicalIF":0.0,"publicationDate":"2006-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26418873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic et traitement des ruptures de l'urètre postérieur","authors":"K. Bensalah,&nbsp;A. Manunta,&nbsp;F. Guillé,&nbsp;J.-J. Patard","doi":"10.1016/j.anuro.2006.06.003","DOIUrl":"10.1016/j.anuro.2006.06.003","url":null,"abstract":"<div><p>Rupture of posterior urethra is usually seen in major traumas with associated pelvic fractures. Clinical presentation classically associates blood at the uretral meatus and urinary retention. Urinary diversion should be achieved by suprapubic puncture and major associated traumatic injuries (abdominal, orthopaedic, and neurological lesions) must be treated prior to urological management. Retrograde uretrocystography is performed a few days later in order to localize and classify the urethral lesion. Treatment of posterior urethral ruptures has evolved over the years. Immediate open repair is no longer recommended. The supra-pubic catheter can be left in place until Resorption of the pelvic hematoma. Obliteration occurs in 100% of the cases and is treated by open surgery at 3 months. More and more patients are treated by early endoscopic realignment which has diminished by half the incidence of urethral strictures. Impotence and incontinence secondary to trauma or surgery occur in 20% and 10% of the patients respectively. Long term follow-up should be achieved in every patient.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 5","pages":"Pages 309-316"},"PeriodicalIF":0.0,"publicationDate":"2006-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26418875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhabdomyosarcomes du sinus urogénital de l'enfant","authors":"P. Philippe-Chomette (Chirurgien pédiatre praticien hospitalier) ,&nbsp;D. Orbach (Oncologue pédiatre) ,&nbsp;H. Brisse (Radiologue) ,&nbsp;Y. Aigrain (Professeur des Universités, chirurgien pédiatre) ,&nbsp;D. Berrebi ,&nbsp;A. El Ghoneimi (Professeur des Universités, chirurgien pédiatre)","doi":"10.1016/j.anuro.2006.08.002","DOIUrl":"10.1016/j.anuro.2006.08.002","url":null,"abstract":"<div><p>Genitourinary rhabdomyosarcoma (RMS) accounts for approximately 25% of all rhabdomyosarcomas. Management of RMS at this site has changed during the last 5 consecutive Intergroup Rhabdomyosarcoma (IRS) trials, with increasing emphasis of bladder and vaginal conservation. As more effective treatment regimens has improved survival, surgical approaches have evolved to less aggressive management of the primary tumour to improve conservation. Various combinations of chemotherapy, irradiation and surgery have resulted in a decreased late sequelae in the group of patients with sarcoma arising in the genitourinary tract.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 5","pages":"Pages 280-296"},"PeriodicalIF":0.0,"publicationDate":"2006-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26418876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Évaluation et traitement des plaies pénétrantes du rein","authors":"P.-M. Cabrera Castillo,&nbsp;L. Martínez-Piñeiro,&nbsp;M. Álvarez Maestro,&nbsp;J.-J. De la Peña","doi":"10.1016/j.anuro.2006.06.002","DOIUrl":"10.1016/j.anuro.2006.06.002","url":null,"abstract":"<div><p>Penetrating lesions of the kidney are less frequent than closed wounds. However, their incidence has increased these past decades, in relation with the augmentation of urban violence. The main causes of penetrating wounds are knives and firearms, with a related rate of renal lesions more important in the second case. The treatment of renal traumas has evolved these past years. Previously, surgical investigations were systematically indicated in most cases, which was associated with an elevated number of nephrectomies. Today, the development of new diagnostic imaging techniques available in most emergency units allows in certain cases the replacement of therapy by a strict follow-up of the patient, the objective being to preserve the kidney. The principal diagnostic investigation is CT scanning with injection of a contrast product, which is useful to adequately classify renal lesions and to make decision regarding the best first-line therapeutic management. In case of penetrating lesion, the first step is the evaluation of the haemodynamic condition of the patient. In case of haemodynamic instability, immediate surgical investigation is necessary. Conversely, if the patient is stable, CT with delayed imaging must be carried out. For grade I and II renal lesions, therapeutic abstention is recommended. Grade III and IV lesions associated with other intraperitoneal lesions that require emergency laparotomy must be surgically investigated and in these cases, reconstructive surgery or nephrectomy must be considered. Most grade IV lesions associated with a lesion of the renal hilus and grade V lesions must be referred to surgery. Minor renal lesions may not be treated; such cases necessitate a follow-up of the patient that should include successive assessments of the haemoglobin and the haematocrite, together with CT and ultrasonographic investigations aimed at the follow-up of lesion evolution and detection of potential urinomas or prolonged bleedings. The progressive decrease of the haematocrite and arteriovenous fistulae must be treated first by an embolization. Untreated patients with persistent urinary fistulae will undergo, if necessary, ureteral catheterization and percutaneous drainage of the urinoma.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 5","pages":"Pages 297-308"},"PeriodicalIF":0.0,"publicationDate":"2006-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26418874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rupture des corps caverneux : aspects techniques de la prise en charge","authors":"P. Paparel,&nbsp;A. Ruffion","doi":"10.1016/j.anuro.2006.05.004","DOIUrl":"https://doi.org/10.1016/j.anuro.2006.05.004","url":null,"abstract":"<div><p>Rupture of corpora cavernosa is a rare disease in young adults. In western countries, the most frequent cause is the so-called “faux pas du coït”. In the Middle East, masturbation and penis manipulations aimed at stopping morning erection are the most frequent causes. The fracture which is audible by the patient is accompanied by a rapid detumescence with progressive onset of a haematoma. Diagnosis is based on clinical findings but radiological investigations such as MRI, ultrasonography or cavernography may help localizing the exact fracture site. The treatment of albugineal ruptures is surgery, in an elective manner whenever possible; it consists in the eviction of the subcutaneous haematoma, the suture of the albuginea and treatment of a potentially associated urethral rupture. Conservative treatment is exceptional and limited to patients who reject surgery, since it generates more complications: painful erections, persistent haematoma with a risk of infection, arteriovenous fistula, impotence, and unrecognized urethral rupture. Patients must be clearly informed on all these complications.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 4","pages":"Pages 267-272"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.05.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72274336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiothérapie conformationnelle du cancer de la prostate : technique et résultats","authors":"C. Hennequin,&nbsp;L. Quero,&nbsp;H. Soudi,&nbsp;G. Sergent,&nbsp;C. Maylin","doi":"10.1016/j.anuro.2006.03.003","DOIUrl":"10.1016/j.anuro.2006.03.003","url":null,"abstract":"<div><p>A number of retrospective and prospective studies have demonstrated that radiotherapy of prostate cancer must be actually conformal. Three-dimensional (3D) treatment planning consists in an as accurate as possible definition of target-volume, usually by CT-scan, and design of radiation fields shaped to this target-volume. Several steps are required, each step being important for the overall quality of the treatment. Conformal radiotherapy is better tolerated than conventional irradiation, with significantly less rectal toxicity. It allows dose-escalation up to 80 Gy. It is now possible to go beyond this dose with intensity-modulated radiotherapy. The benefit of these high doses was demonstrated by some large retrospective studies and some prospective dose-escalation trials. Several randomized trials are in progress, preliminary results of two of them have been published, both showing an improvement in disease control with the higher doses. The advantage of higher doses is clearly evident for patients in the intermediate prognostic group, but is still discussed for patients with a low risk tumour or treated in combination with hormone therapy. Late proctitis is the main toxicity of these high doses. Some volume constraints have been defined during the last years and will allow a decrease of the rate of rectal toxicity. Because of these technological improvements, results of radiation therapy are now similar to those of surgery: no direct comparison with a randomized trial is available, but large comparative studies show that long-term disease control are identical with both techniques. Radiation therapy must be proposed to all patients with a prostate carcinoma as an alternative to surgery.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 4","pages":"Pages 233-240"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26309152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faut-il mettre une sonde double J de façon systématique lors d'une transplantation rénale ?","authors":"J.-F. Hétet (Chef de clinique-assistant des Hôpitaux),&nbsp;J. Rigaud (Chef de clinique-assistant des Hôpitaux),&nbsp;G. Karam (Professeur des Universités - Praticien hospitalier)","doi":"10.1016/j.anuro.2006.05.001","DOIUrl":"https://doi.org/10.1016/j.anuro.2006.05.001","url":null,"abstract":"<div><p>Protection of urinary anastomoses using a ureteral sound is a frequent option in urology but such use in a systematic manner remains debated in renal transplantation. Some consider that systematic insertion of a double J sound decreases the incidence of ureteral complications (fistula and stenosis). Others who prefer a selective use in some situations with a related risk consider that the implementation of a double J sound cannot compensate a technical defect. It is even responsible for specific complications (infections, incrustations, haemorrhages); it increases implantation costs and is useless in more than 90% of the cases. This article analyses the risks related to systematic implementation of a double J sound in Lich-Gregoir ureterovesical anastomoses for renal transplantation, together with the related costs and the infectious risk. The benefits in terms of prevention of ureteral complications are evaluated.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 4","pages":"Pages 241-246"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72274335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anastomose vésico-urétrale dans la prostatectomie radicale rétropubienne","authors":"C. Barré (chirurgien urologue, ancien chef de clinique-assistant des hôpitaux)","doi":"10.1016/j.anuro.2006.03.002","DOIUrl":"10.1016/j.anuro.2006.03.002","url":null,"abstract":"<div><p>Urethrovesical anastomosis is the most codified step in radical prostatectomy. Most of the time, the bladder neck diameter makes it possible to carry out a congruent anastomosis. Otherwise one has to resort either to the tennis racket closure or the parachute technique. Stenosis will remain an exceptional complication if the technique is applied with strictness and precision.</p></div>","PeriodicalId":50783,"journal":{"name":"Annales D Urologie","volume":"40 4","pages":"Pages 247-254"},"PeriodicalIF":0.0,"publicationDate":"2006-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.anuro.2006.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26309068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}