S. Bart

Mapping of Transrectal Ultrasonographic Prostate Biopsies Quality Control and Learning Curve Assessment by Image Processing

Objective. Mapping of transrectal ultrasonographic (TRUS) prostate biopsies is of fundamental importance for either diagnostic purposes or the management and treatment of prostate cancer, but the localization of the cores seems inaccurate. Our objective was to evaluate the capacities of an operator to plan transrectal prostate biopsies under 2‐dimensional TRUS guidance using a registration algorithm to represent the localization of biopsies in a reference 3‐dimensional ultrasonographic volume. Methods. Thirty‐two patients underwent a series of 12 prostate biopsies under local anesthesia performed by 1 operator using a TRUS probe combined with specific third‐party software to verify that the biopsies were indeed conducted within the planned targets. Results. The operator reached 71% of the planned targets with substantial variability that depended on their localization (100% success rate for targets in the middle and right parasagittal parts versus 53% for targets in the left lateral base). Feedback from this system after each series of biopsies enabled the operator to significantly improve his dexterity over the course of time (first 16 patients: median score, 7 of 10 and cumulated median biopsy length in targets of 90 mm; last 16 patients, median score, 9 of 10 and a cumulated median length of 121 mm; P = .046). Conclusions. In addition to being a useful tool to improve the distribution of prostate biopsies, the potential of this system is above all the preparation of a detailed “map” of each patient showing biopsy zones without substantial changes in routine clinical practices.

Immunohistochemical expression of p63, p53 and MIB-1 in urinary bladder carcinoma. A tissue microarray study of 158 cases

P63 is a member of the p53 family, which plays a role in the differentiation of urothelium and is supposed to play a role in urothelial carcinogenesis. P53 and MIB-1 are recognised in many studies as predictive markers of progression, but few studies in the literature have examined p63. The aims of our study were to explore the expression of p63 in bladder carcinomas and to compare this expression to p53 and MIB-1, as well as to stage and grade. Tissue microarrays were performed on 158 urothelial carcinomas (56 pTa, 45 pT1 and 57≥pT2). Immunohistochemical studies were performed with p63, p53 and MIB-1 antibodies. In our study we observed that p63 immunostaining is present in all cell layers in papillary urothelial neoplasm of low malignant potential (PUNLMP), but partially lost in non-invasive papillary urothelial carcinoma low grade (NILGC) and in pT1/≥pT2 bladder cancers. P53 and MIB-1 displayed lower expression in PUNLMP/NILGC vs non-invasive papillary urothelial carcinoma high grade (NIHGC)/pT1, but there was no correlation between the expression of p63, p53 and MIB-1. Our study demonstrates that p63 expression distinguishes between PUNLMP/NILGC and NIHGC/pT1 (p=4.105). A statistical difference disserving pTa and pT1/≥pT2 with a statistical significance (p<10−6) could also be observed. P63 should be considered as an additional biomarker that might help pathologists to classify their patients.

Management of Stress Urinary Incontinence Following Prostate Surgery With Minimally Invasive Adjustable Continence Balloon Implants: Functional Results From a Single Center Prospective Study

PURPOSE We determined the functional results and morbidity of balloon (ProACT™) implants for the treatment of male stress urinary incontinence after prostate surgery. MATERIALS AND METHODS Between 2002 and 2008 a prospective, noncontrolled study was conducted. The ProACT implant consists of 2 adjustable balloons placed on either side of the native striated sphincter. The implants are adjusted by inflation during followup visits. The primary efficacy end point was postoperative continence as defined by the use of 0 to 1 pad daily. RESULTS A total of 128 consecutive patients underwent implantation. Mean ± SD patient age was 71 ± 42.3 years (range 52 to 87). The severity of incontinence before ProACT was moderate (71), mild (40) and severe (17). Overall 25% of patients previously underwent pelvic radiotherapy. The mean number of daily pads per patient was 1.46 (vs 4.2 at baseline). Mean followup was 56.3 months (range 24 to 95). The functional result was success in 68% of patients with moderate/mild incontinence and the explantation rate was 18%. Among the 30 patients treated with radiotherapy before ProACT the success rate was only 46% and the incidence of urethral erosion was significantly higher (p = 0.005). CONCLUSIONS The ProACT implant appears to be an option for the treatment of moderate male stress urinary incontinence, especially given the minimally invasive modalities of insertion, the capacity to adjust the inflation of the balloons to achieve postoperative continence and the relative reversibility.

Medical Image Computing and Computer-Aided Medical Interventions Applied to Soft Tissues: Work in Progress in Urology

Until recently, computer-aided medical interventions (CAMI) and medical robotics have focused on rigid and nondeformable anatomical structures. Nowadays, special attention is paid to soft tissues, raising complex issues due to their mobility and deformation. Mini-invasive digestive surgery was probably one of the first fields where soft tissues were handled through the development of simulators, tracking of anatomical structures and specific assistance robots. However, other clinical domains, for instance urology, are concerned. Indeed, laparoscopic surgery, new tumour destruction techniques (e.g., HIFU, radiofrequency, or cryoablation), increasingly early detection of cancer, and use of interventional and diagnostic imaging modalities, recently opened new challenges to the urologist and scientists involved in CAMI. This resulted in the last five years in a very significant increase of research and developments of computer-aided urology systems. In this paper, we propose a description of the main problems related to computer-aided diagnostic and therapy of soft tissues and give a survey of the different types of assistance offered to the urologist: robotization, image fusion, surgical navigation. Both research projects and operational industrial systems are discussed

Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men.

Study Type – Therapy (RCT)

Chapitre B-5 B - Dérivation cutanée non continente en neuro-urologie

Resume Les derivations urinaires non continentes peuvent etre proposees chez les patients neurologiques de facon transitoire ou en fin d’ evolution. Elles sont notamment proposees chez les patients en retention chronique pour lesquels un catheterisme intermittent n’est pas envisageable pour des raisons anatomiques ou pratiques (en raison du handicap neurologique). Dans ce travail, nous presentons les differentes derivations urinaires non continentes qui ont ete rapportes dans la litterature. Nous presentons pour chacune d’ entre elles les modalites techniques de realisation, puis leurs principales complications et les resultats a court, moyen et long terme.

Les traitements de recours dans la cystite interstitielle

Interstitial cystitis is the first cause of bladder pain. In case of failure of the usual treatments, several other modalities have been proposed. These therapeutic modalities are posterior sacral root neuromodulation, posterior tibial nerve stimulation, vanilloid agent intravesical instillation, intradetrusor botulinum toxin injections and surgery. A certain efficiency of each of these treatments in the interstitial cystitis has been reported. However, the evaluation of these treatments is limited and the level of evidence is too low to propose these treatments in routine.

Chapitre C - Troubles vésico-sphinctériens et sclérose en plaques

Resume La sclerose en plaques (SEP) est une maladie neurologique caracterisee par l’existence de lesions multiples demyelinisantes disseminees dans le systeme nerveux central (bloc de conduction nerveuse). La prise en charge de ces patients impose de parfaitement connaitre l’histoire naturelle de la maladie. Dans ce travail, nous avons fait une analyse de la litterature pour identifier les troubles mictionnels les plus frequents dans cette pathologie. Nous avons ensuite etudie les particularites diagnostiques et therapeutiques chez ces patients, ainsi que les modalites optimales de suivi du fait des differents risques evolutifs sur le plan urologique.Multiple sclerosis (MS) is a neurological disease characterized by multiple demyelinating lesions disseminated throughout the central nervous system (nerve conduction block). The management of these patients requires a perfect knowledge of the natural history of the disease. In this article, the authors review the literature to identify the most frequent voiding disorders observed in this disease and then study the diagnostic and therapeutic modalities and the optimal modalities of follow-up in these patients, in view of the risk of various urological complications.

Le parcours de l’opéré en neuro-urologie : de la programmation opératoire à la convalescence. L’avis d’expert du Comité de neuro-urologie de l’AFU

The surgical care pathway of neurologic patients has two aims: preventing urinary morbidity and mortality and improving their quality of life. It requires taking into account the specificities of disabilities in domains of body functions: circulatory, ventilation and digestive physiology, motor functions, sensory functions, mental functions, and skin fragility which are responsible of dependencies in this heterogeneous group of patients. This management is necessarily multidisciplinary to be optimal and through specific clinical care pathway, providing guidance to the surgical procedure: preparation of the surgery, its realization, and post-operative rehabilitation. The indication for surgery must be coordinated and validated in neuro-urology multidisciplinary staff. Preoperative stay in a physical and rehabilitation medicine center may be useful to ensure a complete assessment and anticipate problems related to surgery. The patient will be hospitalized in the urology department in a single room suited to their disabilities and handicaps. The chronic treatments should be not modified if possible. The lack of sensitivity does not dispense anesthesia to prevent autonomic hyperreflexia, the most severe complication after high complete spinal cord injury. The laparoscopy and sub-peritoneal surgery, the early removal nasogastric tube and early refeeding make it possible to early resumption of intestinal transit. In many cases, the patients should be transferred to a physical and rehabilitation medicine during post-operative period where the nursing care will be most suitable. A quickly adapted rehabilitation must be able to reduce loss of function and physical dependence.

Sacral neuromodulation and pregnancy: Results of a national survey carried out for the neuro-urology committee of the French Association of Urology (AFU)

To assess the impact of sacral neuromodulation (SNM) on pregnancy and vice‐versa, by identifying women who had received SNM for lower‐urinary tract symptoms (LUTS) and had become pregnant.