M. Roumiguié

Œstrogénothérapie locale en urologie et pelvi-périnéologie. Revue de littérature

OBJECTIVE To conduct a literature review of the efficiency of vaginal local estrogenotherapy (LE) on genitourinary disorders related to menopause and those side effects. MATERIALS A literature review was conducted using Pubmed database using the keywords vaginal estrogen, urinary incontinence, urgency, urinary tract infection, vulvar and vaginal atrophy, dyspareunia, breast cancer, endometrial cancer, thrombosis. The most relevant articles were selected and analyzed. RESULTS The LE demonstrates its efficiency on preventing urinary tract infections, treatment of overactive bladder and vaginal disorders of postmenopausal women in controlled studies or meta-analysis level of evidence 1. Local side effects (discharge, erythema, vaginal bleeding, etc.) are rare. The systemic diffusion of low dose LE is limited and allowed to prescribe it to postmenopausal women without special supervision. However, using LE might be avoided in women with a history of oncological breast due to the lack of controlled studies evaluating the risk of developing breast cancer under LE. Except for high-risk women, LE does not increase the risk of thrombosis. CONCLUSION Vaginal administration of low dose of estrogen is an effective and safe treatment in the management of postmenopausal genitourinary disorders. However, using LE for women with history of breast cancer or high risk of thrombisis should be avoided.

Oncocytose rénale unilatérale : à propos d’un cas

The renal oncocytoma tumors are rare (5% of renal tumors). These benign tumors are incidentally diagnosed most often in an asymptomatic form. Sometimes it is multiple bilateral tumors affecting the renal parenchyma and forming a renal oncocytosis. We report the case of a unilateral right renal oncocytosis, very rare situation, characterized by a right renal parenchymal nodules with oncocytoma and a normal left kidney.

Article originalLe traitement des petites tumeurs du rein : efficacité et comparaison des coûtsTreatment of small renal masses: Effectiveness and cost-comparison analysis

OBJECTIVE The stage of discovery and treatment of kidney cancer have changed. Partial nephrectomy is the standard treatment for small renal masses (SRM). Also are recommended the thermal ablative techniques. The cost of these treatments for the establishment and society is often unclear. The purpose of this study was to calculate the cost of treatment of SRM in order to assess the profitability for a health institution that invests in innovation. MATERIALS AND METHODS A retrospective single-center study was conducted with 124 patients treated for SMR (T1a) by open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (LRPN), radio frequency (RF) and cryotherapy (CT) between 2009 and 2011. We calculated the price of stay of each patient, searched the amount billed to health insurance and calculated the profitability of treatment for the establishment. RESULTS The OPN cost on average 7884±1201€ and reported 451±1861€, the LPN cost on average 6973±3503€ and reported 2271±3370€, the cost of the LRPN was on average 9600±4595€ and resulted in a deficit of 838±3007€. The radiofrequency cost on average 2724±813€ and caused a deficit of 954±684€, cryotherapy cost on average 6702±857€ and resulted in a deficit of 4723±941€. CONCLUSION According to current repayment terms, the LPN was the treatment of SRM that offered the best profitability.

Le traitement des petites tumeurs du rein : efficacité et comparaison des coûts

OBJECTIVE The stage of discovery and treatment of kidney cancer have changed. Partial nephrectomy is the standard treatment for small renal masses (SRM). Also are recommended the thermal ablative techniques. The cost of these treatments for the establishment and society is often unclear. The purpose of this study was to calculate the cost of treatment of SRM in order to assess the profitability for a health institution that invests in innovation. MATERIALS AND METHODS A retrospective single-center study was conducted with 124 patients treated for SMR (T1a) by open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (LRPN), radio frequency (RF) and cryotherapy (CT) between 2009 and 2011. We calculated the price of stay of each patient, searched the amount billed to health insurance and calculated the profitability of treatment for the establishment. RESULTS The OPN cost on average 7884±1201€ and reported 451±1861€, the LPN cost on average 6973±3503€ and reported 2271±3370€, the cost of the LRPN was on average 9600±4595€ and resulted in a deficit of 838±3007€. The radiofrequency cost on average 2724±813€ and caused a deficit of 954±684€, cryotherapy cost on average 6702±857€ and resulted in a deficit of 4723±941€. CONCLUSION According to current repayment terms, the LPN was the treatment of SRM that offered the best profitability.

Revue de la littératureŒstrogénothérapie locale en urologie et pelvi-périnéologie. Revue de littératureUse of local estrogenotherapy in urology and pelviperineology: A systematic review

OBJECTIVE To conduct a literature review of the efficiency of vaginal local estrogenotherapy (LE) on genitourinary disorders related to menopause and those side effects. MATERIALS A literature review was conducted using Pubmed database using the keywords vaginal estrogen, urinary incontinence, urgency, urinary tract infection, vulvar and vaginal atrophy, dyspareunia, breast cancer, endometrial cancer, thrombosis. The most relevant articles were selected and analyzed. RESULTS The LE demonstrates its efficiency on preventing urinary tract infections, treatment of overactive bladder and vaginal disorders of postmenopausal women in controlled studies or meta-analysis level of evidence 1. Local side effects (discharge, erythema, vaginal bleeding, etc.) are rare. The systemic diffusion of low dose LE is limited and allowed to prescribe it to postmenopausal women without special supervision. However, using LE might be avoided in women with a history of oncological breast due to the lack of controlled studies evaluating the risk of developing breast cancer under LE. Except for high-risk women, LE does not increase the risk of thrombosis. CONCLUSION Vaginal administration of low dose of estrogen is an effective and safe treatment in the management of postmenopausal genitourinary disorders. However, using LE for women with history of breast cancer or high risk of thrombisis should be avoided.

Épidémiologie des consultations aux urgences pour une retention aiguë d’urine

INTRODUCTION Acute urinary retention (AUR) is a common reason for emergency consultation. It may be spontaneous or precipitated and affects both men and women. The purpose of this study was to determine the profile of men visiting emergency departments for an AUR. MATERIEL AND METHODS A retrospective monocentric study including all men who consulted the emergency department between January 2014 and December 2016 for AUR was conducted. RESULTS In 3 years, 731 patients were admitted for AUR (611 men and 120 women). The mean age was 71.6±14 years with a mean retention volume of 948±668mL drained for 96% of patients (n=584) through a bladder catheter and 4% (n=27) with a suprapubic catheter. Most patients had an urological (66%, n=104) or neurologic (40%, n=242) history and 23% (n=136) already had an episode of AUR. In 28% of cases (n=173), the globe was not painful. A majority of AUR were spontaneous, 53% (n=326) versus 46% (n=279) who were precipitated, secondary to a recent surgical procedure (<1 month) (15%, n=89), hematuria (9%, n=54), or male urinary tract infections (7%, n=42). Patients were treated externally in 71% (n=436), 25% (n=153) were hospitalized with significantly more comorbidities. CONCLUSION Men consulting emergency for AUR are 72 years old, with a globe volume of 942mL. Thirty-three percent have a history of BPH, with a prostate treatment like alpha-blockers type. Almost all patients were treated with a bladder catheter and the majority was treated externally. LEVEL OF EVIDENCE 4.

Comparison of intradetrusor injections of botulinum toxin A in adult patients with spina bifida and in patients with spinal cord injury: A multicenter study

Hypothesis / aims of study Botulinum toxin injections have become the gold standard treatment of neurogenic detrusor overactivity (NDO) refractory to anticholinergic therapy. Spina bifida is a common cause of neurogenic bladder but patients with spinal dysraphism were not included in the large randomized trials that have evaluated the safety and efficacy of intradetrusor injections of botulinum toxin in NDO. Only a few studies have aimed to assess the outcomes of botulinum toxin injections in spina bifida patients and all of them were conducted in children. The aim of the present study was to evaluate the outcomes of intradetrusor botulinum toxin injections in adult patients with spina bifida and to compare them to those observed in patients with spinal cord injury (SCI).

Mécanismes de résistance à la castration : l’hypoxie intratumorale stimule l’expression du récepteur aux androgènes

PURPOSE Tumor hypoxia and its biological consequence lead to microenvironment adaptation of tumor initiation, promotion and progression. The aim of the study was to observe the influence of hypoxia on the expression of the androgen receptor (AR), using an original model of multicellular spheroids obtained from castration-resistant prostate tumor cells. MATERIAL Two human castration-resistant prostate cancer cell lines have been used to generate multicellular tumor spheroids (MTS). The conditions and duration of incubation modulated the final size of the MTS and the intrinsic hypoxia gradient. The expression of AR was studied by immunohistochemistry (IHC) and secretion of PSA measured in the culture medium. RESULTS The IHC expression of AR was characterized by a decreasing gradient from the periphery to the center of MTS (less intense in central hypoxic zone), corresponding to a nuclear translocation of activated AR. This result was proportionally correlated with the duration of hypoxic incubation period. Hypoxia caused significant increase in AR expression at 6h of oxygen deprivation. This activation of AR was correlated with transcriptional activity increase of target genes, including increased secretion of PSA. CONCLUSION This demonstration of activation, increased expression and increased transcriptional activity of AR by hypoxia is the first to have been made with an original model of hypoxia, closer to reality than previous models, i.e. close to tissue hypoxia observed in primary prostate cancer. LEVEL OF EVIDENCE 4.

Optimisation de l’utilisation du 4e bras lors de la prostatectomie totale laparoscopique robot-assistée

Objectifs Le nombre de systemes robotiques Da-Vinci (Intuitive Surgical ® ) est en constante augmentation. La majorite de ces robots sont des systemes 4 bras. Le 4 e bras presente en effet de nombreux avantages sous couvert d’une bonne maitrise de son utilisation. Nous presentons une video focalisee sur le role du 4 e bras dans la prostatectomie totale laparoscopique robot-assistee. Methodes Le 4 e bras est positionne du cote droit du patient dans cette video. Lors du decollement de la vessie, le 4 e bras vient tracter le peritoine vers le bas de maniere a permettre de trouver le plan de l’espace de Retzius dans de bonnes conditions. Apres avoir sectionne les arteres ombilicales, le 4 e bras va tracter le peritoine et ainsi guider la section de ce peritoine jusqu’aux orifices inguinaux externes. Ce 4 e bras va ensuite mettre en tension les aponevroses pelviennes droite et gauche facilitant ainsi la progression dans l’espace latero-prostatique. Resultats A gauche, il tractera en fascia endo-pelvien visceral permettant une progression facile vers l’apex. L’abord du col se fera apres traction de la vessie par le 4 e bras. Une fois visualisee, la sonde sera suspendue en avant de la symphyse pubienne par le 4 e bras. La dissection du bloc vesiculo-deferentiel se fera par tractions successives du deferent et des vesicules seminales selon la technique decrite dans la video par ce 4 e bras. La conservation nerveuse sera facilitee par l’orientation et la suspension de la prostate par ce 4 e bras. La dissection de l’apex se fera egalement par traction prudente de la prostate en reajustant au fur et a mesure cette traction. L’organisation des fils de suture lors de la reconstruction posterieure et de l’anastomose sera facilitee par ce 4 e bras. Conclusion L’optimisation de l’utilisation du 4 e bras lors de la prostatectomie totale laparoscopique robot-assistee permet une diminution progressive de la duree operatoire et une amelioration de la qualite des resultats fonctionnels et oncologiques obtenus. La courbe d’apprentissage de la prostatectomie totale robotisee est etroitement liee a l’optimisation de la gestion de ce 4 e bras.