Jean-Pierre Sarramon

High prevalence of erectile dysfunction after renal transplantation.

BACKGROUND AND METHODS A cross-sectional study of multifaceted male sexual function in 323 consecutive kidney transplant recipients was conducted by mail by means of the validated International Index of Erectile Function (IIEF). All five IIEF domains (IIEF-5), i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, were scored for each responder. IIEF-5 scoring that conformed to the National Institutes of Health definition of erectile dysfunction (ED) was computed for all patients sexually active within the past 4 weeks. RESULTS Two hundred and seventy-one patients replied. Compared to the controls used for IIEF psychometric validation, kidney transplant recipients gave lower erectile function (P<0.01) and intercourse satisfaction (P<0.05) scores, despite their being younger. ED, according to the IIEF-5 method, was demonstrated in 55.7% of the sexually active patients (n=212). Age, time on dialysis, and iterative transplants were significantly and negatively related to erectile dysfunction. CONCLUSION IIEF proved to be a valuable means of unveiling highly prevalent erectile dysfunction in male kidney transplant recipients. The negative impact of the time on dialysis was emphasized in the results.

Sacral neuromodulation for treating neurogenic bladder dysfunction: clinical and urodynamic study.

The efficacy of sacral neuromodulation for treating refractory idiopathic lower urinary tract dysfunction is now well established. Nevertheless, results of this technique in neurological patients are still controversial. The aim of this retrospective study was to assess the results of sacral neuromodulation in neurogenic bladder dysfunction.

Influence of digital rectal massage on urinary prostate-specific antigen: Interest for the detection of local recurrence after radical prostatectomy

Following radical prostatectomy, urinary prostate‐specific antigen (uPSA) may originate from periurethral glands or from recurrent carcinomatous prostatic cells. We evaluated massage of the urethro‐vesical anastomosis as a uPSA‐releasing method for the detection of local recurrence.

Bladder cancer arising in a spina bifida patient

We report the case of a 52-year-old patient with spina bifida, neurologic bladder, and a history of recurrent urinary tract infections (UTIs) in whom a bladder cancer was incidentally discovered. Cytology, cystoscopy, and cystography showed nonspecific, extensive inflammatory lesions. Cystography demonstrated a complex of diverticulae and cellules. Pathologic examination of a diverticulectomy specimen revealed a grade III pT3b transitional and squamous cell carcinoma. Because of the similar disease causation (recurrent UTIs, stones, and indwelling catheterization), we suggest extension of the guidelines proposed for patients with spinal cord injuries (ie, annual serial bladder biopsies) to patients with nontraumatic neurogenic bladder.

Prostate‐specific antigen in acute hepatitis and hepatocellular carcinoma

Prostate‐specific antigen (PSA) is the most important tumor marker in prostate cancer diagnosis and follow‐up. Its catabolism by the liver has not influenced its use as a prostate marker until the recent report of a significant increase in a man and a woman with acute hepatitis. In addition, PSA was detected in liver tumor extracts, which warranted its evaluation in liver cytolysis and hepatocellular carcinoma. In this study, PSA was evaluated in a cohort of both sexes presenting either acute hepatitis or hepatocellular carcinoima.

Flow cytometry analysis of urothelial cell DNA content according to pathological and clinical data on 100 bladder tumors.

DNA content of 100 bladder tumors (34 grade I, 42 grade II and 24 grade III, WHO classification) were studied by flow cytometry. Ten normal bladder samples were used as control. The 100 bladder tumors could then be separated into two groups. A first group of 60 tumors (60%) had a unimodal distribution with a diploid peak and a DNA index close to 1.0, 32 grade I, 22 grade II and 6 grade III tumors displayed this pattern as did the 10 normal bladders. The second group (40%) had a bimodal distribution with two peaks, the first one (diploid peak) with a DNA index of 1.0, the second (aneuploid peak) with a DNA index greater than 1.0. Two grade I, 20 grade II and 18 grade III tumors belonged to this group. Frequency of the aneuploid peak increased with tumor grade and infiltration progression. Hence 6% of grade I, 48% of grade II and 75% of grade III tumors showed an aneuploid peak as well as 8% of Pa, 46% of P1, 73% of P2 and 87.5% of P3 stage tumors. This study showed that a good correlation exists between flow-cytometric, pathological and clinical data.

Antibodies to bladder-tumor-associated antigens as prognosis probes in the flow-cytometric analysis.

Monoclonal antibodies directed against bladder tumor cells (10D1, 7C12, 6D1, 3C6, G4 and E7) and human leukocyte antigen (HLe1) were tested by flow cytometry on 68 bladder tumors involving 10 grade I, 29 grade II and 29 grade III tumors (WHO classification). According to their evolution stage, these tumors can be subdivided into 17 stage Pa, 34 stage P1, 7 stage P2 and 10 stage P3. Fifteen normal bladder samples were used as a control. Analysis of DNA content revealed a first group of 31 tumors with a unimodal DNA profile. In the second groups of 37 tumors, the DNA profile was bimodal. Cells from grade I tumors were labelled with 10D1 and 6D1 antibodies; all these cells showed a unimodal DNA profile. Grade III tumor cells were labelled with antibodies G4 and E7; most of these cells showed a bimodal DNA profile. The percentage of HLe1-positive cells decreased with the pathological grade and stage of tumor. The composition of infiltrating leukocytes was different in unimodal and bimodal tumors. In conclusion, cells of low-grade tumors can be identified with 10D1 and 6D1 antibodies, and antigens recognized by G4 and E7 antibodies are mostly expressed by aneuploid cells. HLe1 antibody demonstrates the importance of the inflammatory reaction in bladder tumors. Moreover, in flow cytometry, leukocytes within a tumor could be used as internal reference for precise measurement of the DNA content of tumor cells.

Re: Effect of α1-Adrenoreceptor Antagonist Exposure on Prostate Cancer Incidence: An Observational Cohort Study

Expert’s summary: Quinazoline a1adrenoreceptor antagonists (doxazosin and terazosin) (a1AA) are widely used in the treatment of benign prostate hypertrophy and systemic hypertension. They induce apoptosis in prostate epithelial cells and stromal smooth muscle cells in benign prostate hypertrophy (BPH) and in prostate cells prostate cancer (PC) [1,2]. In addition, Quinazolin can suppress tissue angiogenesis by targeting vascular endothelial growth factor. A retrospective observational study at the Lexington Veterans Affairs Medical Center (VA) and the Kentucky Cancer Registry (KCR) between 1998–2003 has compared the incidence of PC in men unexposed and exposed to a1AA. In the first group of 23 068 patients, 556 (2.4%) were diagnosed with PC. In the second group of 4070 patients treated with a1AA, the figures were respectively 4003 without PC and 67 (1.6%) with PC. The a1AA group had a PC cumulative incidence of 1.6% compared to 2.41% in the unexposed group. On the whole, men treated with a1AA had 31.7% lower risk for PC than unexposed men ( p < 0005).