M. Thoulouzan

Ejaculatory function after permanent 125I prostate brachytherapy for localized prostate cancer.

PURPOSE Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent (125)I prostate brachytherapy for localized prostate cancer. PATIENTS AND METHODS Of 270 sexually active men with localized prostate cancer treated with permanent (125)I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain. RESULTS Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001). CONCLUSION Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.

Orgasme après curiethérapie de prostate par implants permanents d’iode 125 pour cancer localisé de la prostate

OBJECTIVES Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer. PATIENTS AND METHODS In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often). RESULTS After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P=0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P=0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P=0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P<0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n=31) before implantation (P=0.0001). CONCLUSION Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm.

Conventional Versus Automated Implantation of Loose Seeds in Prostate Brachytherapy: Analysis of Dosimetric and Clinical Results

PURPOSE To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. METHODS AND MATERIALS 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. RESULTS 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. CONCLUSION Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis<3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.

Assessing the extirpative quality of a radical prostatectomy technique: categorisation and mapping of technical errors

To examine the extirpative quality of an open radical prostatectomy (RP) technique by first categorising and mapping all intraprostatic incisions into benign tissue and then determining a cumulative technical error rate given by all intraprostatic incisions into benign and malignant tissue.

Retroperitoneoscopic Adrenalectomy: Comparison of Retrograde and Antegrade Approach Among a Series of 279 Cases

OBJECTIVE To compare the results of retroperitoneal laparoscopic adrenalectomy using the antegrade and retrograde approach. MATERIALS AND METHODS We performed an analysis of a single-center series of 279 retroperitoneal laparoscopic adrenalectomies from 1996 to 2010. We compared 172 cases performed with an antegrade approach and 107 with a retrograde approach without dissection of the renal hilum and initial control of the adrenal vein in comparable populations. RESULTS The operative time was shorter in the group treated with the retrograde technique, 101±51 vs 140±40 minutes, respectively (Students t test, P<.001). Blood loss was similar in both groups, 85±224 vs 80±126 mL, respectively (P=NS). Hemodynamic instability was defined as the maximal systolic blood pressure minus the minimal systolic blood pressure divided the maximal systolic blood pressure. It was lower in the group who underwent the retrograde technique (32.7 vs 37.6 mL; Students t test, P=.005) with a lower perioperative consumption of ephedrine (2.2 vs 5.1 mg, P=.004) and atropine (0.09 vs 0.22 mg, P=.026). No difference was found between the 2 groups in the frequency of perioperative complications or postoperative mortality (1 death in each group of causes unrelated to the surgery). CONCLUSION Retroperitoneal laparoscopic adrenalectomy using a retrograde approach is a safe and reproducible technique. It makes it possible to perform adrenalectomy without dissection of the renal hilum, with a reduction in the operative time. The good hemodynamic stability observed with this technique makes it very attractive for the treatment of pheochromocytoma.

Prise en charge du tératome pur testiculaire postpubertaire à propos d’une série multicentrique sur 15 ans☆

OBJECTIVE To analyze cases of pure teratoma of the testis (PTT) of a large population-based study, as such tumors are rare, and to make an update on the topic. PATIENTS AND METHODS We retrospectively reviewed the records of patients treated for PTT from 1987 to 2003 in the French Midi-Pyrenees region (southwestern France) and in the Val-de-Grâce military hospital, Paris. Among more than 1000 cases of testis cancer, we identified 20 cases of PTT (4% of the whole population). For each patient, the orchiectomy specimen was reviewed and a clinical and imaging re-evaluation was performed. RESULTS The pathological re-evaluation revealed non-teratomatous components in three patients (excluded from a following analysis). For the localized PTT patients, four out of eight out of 8 were on surveillance only after the orchiectomy, and the remaining four received adjuvant chemotherapy. None of them received any lymphadenectomy for staging. All patients with the metastatic disease were treated by chemotherapy followed by surgical removal of residual tumor masses. With a mean of 125 months follow-up, 85% of the population did not relapse after treatment. At the last contact, all were alive, without the disease. CONCLUSION We confirm that PTT is a malignant disease with a good prognosis. As its management differs from the other non-seminomatous germ cell tumors, the diagnosis of PTT must be with certainty. The retrospective analysis of a series over two decades highlights the deviations from current guidelines. We propose that this rare tumor of young man should be treated in specialized centers to get the optimal management.

Fertilité après curiethérapie par implants permanents d'Iode 125 pour cancer localisé de la prostate

OBJECTIVES Preservation of fertility in men of middle age is an issue that is experiencing a growing interest. Prostate cancer is the second most common cancer in men and is diagnosed earlier than before. Brachytherapy is a treatment for prostate cancer that preserves ejaculation. Our aim was to study the fertility of men treated with prostate brachytherapy in order to improve patient information. PATIENTS AND METHODS In a series of 270 sexually active men with localized prostate cancer treated with brachytherapy (permanent implants of Iode 125) at the Institute Claudius Regaud between 2000 and 2006, mean age 65 years (43-80), four patients spontaneously expressed their interest in the preservation of fertility and had an andrological evaluation. RESULTS Four patients were aged 43, 48, 57 and 61 years, all working (including two businessmen), their partner was aged respectively 42, 37, 47 and 38 years. All four had a post-treatment semen analysis (done over a year after brachytherapy) rich in spermatozoa, with moderate asthenospermia, the main anomaly being severe hypospermia. These spermiograms were nonetheless consistent with the occurrence of spontaneous pregnancy (occurrence of miscarriage in the patient 1). CONCLUSION There is an interest in applying to men with prostate cancer their position on fertility in order to inform them about the morbidity of various treatments, options for fertility preservation, and the need to continue a contraception after brachytherapy if the partner is not menopausal.

Faut-il envisager un traitement complémentaire après une colique néphrétique drainée par une sonde JJ ?

PURPOSE The aim of the study was to evaluate if only ureteral stent removing after complicated renal colic (RC) could prevent from complementary treatment (shock-wawe lithortripsy or ureteroscopy). PATIENTS AND METHODS Data from 95 patients, 39 women and 56 men, who had an ureteral stent for complicated RC from 2005 to 2010 were retrospectively collected. Mean age was 46.4 ± 17.2 years. After the initial management, another hospitalization was organized where patients had ureteral stent removing under local anesthesia, then an abdominal CT-scan without injection and complementary treatment of ureteral stones (none or ESWL or ureteroscopy). Parameters studied were age, sex, stone size, location of calcul. Quantitative values were compared with Students t test. Qualitative values were compared with the Chi(2). P<0.05 was considered statistically significant. RESULTS Mean duration between the two hospitalizations were 1.58 ± 1.84 months. Sixty-one patients (64.2%) had no more urolithiasis. In these patients, mean size of urolithiasis was 5.85 ± 2.33 mm. Location of urolithiasis in distal, mild and proximal ureter was 77%, 3% and 20% respectively. Thirty-four patients (35.8%) had persistant lithiasis after CT-scan. Location of stone in distal, mild and proximal ureter was 17.5%, 5.8% and 76.7% respectively. CONCLUSION After management of complicated renal colic by ureteral stent, 64% of patients had spontaneous elimination of stones after removing of ureteral stent, especially in women and pelvic ureter.

Impact du délai diagnostique sur la survie du cancer du testicule

RésuméObjectifsLe cancer du testicule est le premier cancer de l’adulte jeune et son incidence augmente dans la quasi-totalité des pays industrialisés. Le taux de survie après cancer du testicule est de 95%, tous stades confondus, cependant un groupe de patients à mauvais pronostic continue à échapper aux thérapeutiques. Le délai diagnostique est défini comme le temps en mois entre la perception du premier symptôme de cancer du testicule par le patient et le diagnostic par le médecin de la maladie. L’objectif de cette étude est de déterminer si le délai diagnostique a une valuer pronostique, en particulier s’il est corrélé avec le stade de la maladie et la survie.Matériel et méthodesLe délai diagnostique a été étudié chez 542 patients ayant eu un diagnostic de cancer du testicule entre 1983 et 2002 dans la région Midi-Pyrénées. L’information concernant la maladie et les traitements contenus dans les dossiers médicaux a été colligée sur un document synthétique. Le délai diagnostique a été corrélé avec les paramètres pronostiques, dont le stade et la survie.RésultatsLe délai diagnostique était de 3,7±5,1 mois et était plus long pour les séminomes (4,9±6,1 mois) que pour les tumeurs germinales non séminomateuses (TGNS) (2,8±4,0 mois). La durée du délai diagnostique était corrélée avec le stade de la maladie et la survie à 5 ans, sur l’ensemble de la population et dans le groupe des TGNS, mais non dans le groupe des séminomes.ConclusionsLa précocité du diagnostic conserve une valeur pronostique (corrélation avec le stade de la maladie et le taux de survie à 5 ans). Les mesures de sensibilisation et d’information du cancer du testicule sont donc à considérer.AbstractObjectivesTesticular cancer is the leading cancer of young adults and its incidence is increasing in almost all industrialized countries. The survival rate after testicular cancer is 95%, all stages combined, but a group of patients with poor prognosis still fails to respond to treatment. The time to diagnosis is defined as the time in months between perception of the first symptoms of testicular cancer by the patient and the diagnosis of the disease by the doctor. The objective of this study is to determine whether the time to diagnosis has a prognostic value, particularly whether it is correlated with the stage of the disease and survival.Material and MethodsThe time to diagnosis was studied in 542 patients with a diagnosis of testicular cancer between 1983 and 2002 in the Midi-Pyrenées region. Information concerning the disease and treatments contained in medical files was collected on a summary document. The time to diagnosis was correlated with prognostic parameters, including stage and survival.ResultsThe mean time to diagnosis was 3.7±5.1 months and was longer for seminomas (4.9±6.1 months) than for non-seminomatous germ cell tumours (NSGCT) (2.8 ±4.0 months). The time to diagnosis was correlated with the stage of the disease and the 5-year survival on the overall population and in the NSGCT group, but not in the seminoma group.ConclusionsEarly diagnosis has a prognostic value (correlation with stage of the disease and 5-year survival rate). Testicular cancer information campaigns should therefore be envisaged.