Vincent Joulin

Comparaison de la morbidité entre curage étendu et curage limité au cours de la prostatectomie radicale laparoscopique

OBJECTIVE To compare the morbidity of limited pelvic lymphadenectomy to extended lymphadenectomy in patients undergoing LRP (Laparoscopic Radical Prostatectomy) for clinically localized prostate cancer. PATIENTS AND METHODS We performed a prospective monocentric study focused on 303 consecutive patients having a pelvic lymphadenectomy during LRP from June 2000 to April 2010. One hundred and seventy six patients had a limited pelvic lymphadenectomy (June 2000-June 2006, group 1). One hundred and twenty seven patients had an extended pelvis lymphadenectomy (June 2006-April 2010, group 2) including two sub-groups according to the lateral limit of the procedure i.e. with (group 2a, 60 patients) or without dissection of the lateral side of the iliac artery (group 2b, 67 patients). RESULTS Preoperative data (age, BMI, cTNM, Gleason score and PSA) were comparable between the groups. The number of lymph nodes and the incidence of metastatic lymph nodes were lower in group 1 (6,7 lymph nodes and 5,7%) compared to group 2 (a+b) (15.6 lymph nodes and 18.9%) (P=0.001 and P=0.0004). However, there was no difference between groups 2a and 2b (15.4 and 16.7% vs 15,8 and 20.8% P=0.65 respectively). There were more complications in the extended lymphadenectomy group compared to the limited procedure (35.4% vs 14.2%, P=0.0001), in particular more lymphatic complications (27.5% vs 10.2% P=0.0001) and lymphoedema (LO) (15.7% vs 0.6% P=0.00001). However the lymphorhea (LR) and lymphocele (LC) rate was not different (P=0.11 and P=0.17). All complications were mainly of low Claviens classification grade (1+2) whatever the group of lymphadenectomy. The hospital stay was not increased in group 2a or 2b in regard to group 1. The rate of LR and LC was higher in group 2a than in group 1 (P=0.02 and P=0.05) but not between group 2b and 1 (P=0.81 and P=0.47). CONCLUSION Our study showed a higher rate of complications after extended pelvic lymphadenectomy but of low grade in most cases. Moreover the lateral dissection sparing the lateral side of the iliac artery reduced the risk of lymphatic complications without decreasing the number of lymph nodes removed and the rate of metastasis.

The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer

Abstract Objective: Compared with standard systematic transrectal ultrasound (TRUS)-guided biopsies (SBx), targeted biopsies (TBx) using magnetic resonance imaging (MRI)/TRUS fusion could increase the detection of clinically significant prostate cancer (PCa-s) and reduce non-significant PCa (PCa-ns). This study aimed to compare the performance of the two approaches. Materials and methods: A prospective, single-center study was conducted on all consecutive patients with PCa suspicion who underwent prebiopsy multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS). All patients underwent mpMRI/TRUS fusion TBx (two to four cores/target) using UroStation™ (Koelis, Grenoble, France) and SBx (10–12 cores) during the same session. PCa-s was defined as a maximal positive core length ≥4 mm or Gleason score ≥7. Results: The study included 191 patients (at least one suspicious lesion: PI-RADS ≥3). PCa was detected in 55.5% (106/191) of the cases. The overall PCa detection rate and the PCa-s detection rate were not significantly higher in TBx alone versus SBx (44.5% vs 46.1%, p = .7, and 38.2% vs 33.5%, p = .2, respectively). Combined TBx and SBx diagnosed significantly more PCa-s than SBx alone (45% vs 33.5%, p = .02). PCa-s was detected only by TBx in 12% of cases (23/191) and only by SBx in 7.3% (14/191). Gleason score was upgraded by TBx in 16.8% (32/191) and by SBx in 13.6% (26/191) of patients (p = .4). Conclusions: The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.

MP37-13 OUTCOMES OF ADRENALECTOMY FOR ADRENAL METASTASIS OF RENAL CELL CARCINOMA IN THE ERA OF ADRENAL-SPARING RADICAL NEPHRECTOMY : A MULTICENTER STUDY

benoit peyronnet*, rennes, France; nadja schoentgen, brest, France; andrea manunta, rennes, France; jean-baptiste beauval, toulouse, France; franck bruyere, tours, France; francois-xavier nouhaud, toulouse, France; philippe grise, Rouen, France; georges fournier, brest, France; reem betari, amiens, France; nicolas brichart, orl eans, France; alexandre gryn, toulouse, France; tristan grevez, tours, France; benjamin prad ere, rennes, France; samy oumakhlouf, rouen, France; mathieu thoulouzan, toulouse, France; adham rammal, orleans, France; anna goujon, rennes, France; michel souli e, toulouse, France; fabien saint, amiens, France; vincent joulin, brest, France; eric huyghe, toulouse, France; karim bensalah, rennes, France

Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser

OBJECTIVE To evaluate the long-term reported clinical outcomes after photovaporization of the prostate (PVP) with the XPS-GreenLight laser in patients with symptomatic benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS A prospective longitudinal study was performed for all consecutive patients with BPE who underwent PVP at our institution between 2010 and 2012. Patient-reported clinical outcomes were assessed at 1 mo, 3 mo, 12 mo, and 57 mo using International Prostate Symptoms Score, International Continence Society, and International Index of Erectile Function short-form questionnaires. Maximum flow rate (Qmax), postvoid residual urine measurements were assessed at 3 mo and 12 mo. Long-term satisfaction, complications, and reoperation rates were assessed by questionnaires. Prostate-specific antigen was measured at 3 mo, 12 mo, and 57 mo. INTERVENTION A single surgeon (GF) has practiced photovaporization with a Moxy fiber, under transrectal ultrasonography monitoring. Long-term clinical outcomes were evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary measurement was the reoperation. RESULTS AND LIMITATIONS Eighty-four patients of 102 answered the long-term questionnaire. The mean age was 68±7.2 yr. The mean follow-up was 57.4±6.8 mo. The mean prostate volume was 73±38ml. After treatment, the mean International Prostate Symptoms Score decreased significantly from 19.9±6.4 to 6.1±5.6, 3.9±3.4, and 5.9±5.8, respectively, at 3 mo, 12 mo, and 57 mo. The mean prostate-specific antigen level decreased significantly (-56%) from 4.5±4.3ng/ml preoperatively to 2.0±2.0ng/ml and 2.6±2.2ng/ml, respectively, at 12 mo and 57 mo. The mean Qmax increased from 9.6±3.8ml/s preoperatively to 23.9±11.5ml/s and 25.2±9.2ml/s, respectively, at 3 mo and 12 mo. Overall reoperation rate was 4.8%(4/84). Limitations include the single surgeon single center design study and the lack of long-term objectives data such as urodynamic parameters (postvoid residual urine and Qmax). CONCLUSIONS Photovaporization of the prostate with the XPS-GreenLight laser is an effective technique able to durably improve reported clinical outcomes in patients with BPE. PATIENT SUMMARY In this study we looked at the long-term outcomes after laser therapy with XPS-GreenLight laser for benign prostatic enlargement. We found a few reoperation rates and good stable reported clinical outcomes after a mean follow-up of 57 mo. We conclude that this laser technique can offer durably good reported clinical outcomes.

V21 Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: Usefulness of the fourth arm

The EAU Video Library is supported by an unrestricted educational grant from ASTELLAS 18.2 2012 12 EAU 65 n 180201 Robotic enterocystoplasty after prostatocystectomy for urothelial cancer: Description of the technique A. El Hajj, D. Vordos, A. Defourmestraux, N. Gillion, L. Salomon, A. Hoznek, R. Yiou, C.C. Abbou, A. De La Taille n 180202 Nerveand seminal vesicle sparing radical cystectomy: A new technique R.E. Hautmann n 180203 Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: Usefulness of the fourth arm G. Fournier, M.A. Perrouin Verbe, G. Papin, V. Joulin, C. Deruelle, A. Valeri n 180204 Robotic radical cystectomy with neoadjuvant chemotherapy R.J. Valero, E. Barret, R.S. Sanchez Salas, N. Miranda, F. Rozet, A. Ouzzane, M. Galiano, H. Davila, M. Sanchez Encinas, M. Saad, X. Cathelineau n 180205 Robot assisted laparoscopic cystectomy with bladder replacement F. Girard, W. Massoud, R. Thani-Gasalam, M. Fourati, A. El Hajj, M. Fenouri, O. Dumonceau, M. Ceddaha, H. Baumert n 180206 Robot-assisted intracorporeal ileal conduit urinary diversion J. Sammon, J. Jhaveri, S. Sukumar, C. Fitzgerald, M. Ehlert, A. Friedman, P.K. Agarwal, J.O. Peabody