J. Rigaud

University of Nantes, Naoned, Pays de la Loire, France

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Publications (306)285.32 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this article was to make a focus on pathological, clinical and therapeutic of different forms of adult testicular teratoma.
    Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 09/2014;
  • J Rigaud
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    ABSTRACT: The role of the nurse in the management of penile cancer sometimes used to make the diagnosis when the discovery of a suspicious lesion but also participates in the patient information on the therapeutic orientation and support for care. The purpose of this article is to make a focus of the management of penile cancer for nurses.
    Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 09/2014;
  • Source
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    ABSTRACT: To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication.
    Urologic oncology. 07/2014;
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    ABSTRACT: To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE).
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 06/2014; 24(7):414-20.
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    ABSTRACT: We report the case of a patient affected by a voluminous prostatic tumor for which the histological analysis conclude in a stromal tumor of uncertain malignant potential. This type of tumor is rare, but requires to be individualized to differentiate it from a benign prostatic hyperplasia or a sarcoma of the prostate. The therapeutic care must be made keeping in mind the risk of degeneration towards a malignant shape.
    Annales de Pathologie 06/2014; 34(3):233-6. · 0.24 Impact Factor
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    ABSTRACT: To evaluate the feasibility and morbidity of laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPK).
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 06/2014; 24(7):463-9.
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    ABSTRACT: To evaluate the management of renal colic in pregnant woman in our hospital. A retrospective study of 103 pregnant patients, hospitalized for back pain of renal colic type, associated or not with a urinary tract infection, between January 2005 and October 2010. Three groups of patients were identified from the initial clinical and paraclinical (ultrasound). Group I involved patients with dilatation of the renal cavities associated with septic syndrome, they received analgesic treatment and empiric antibiotic therapy. Group II involved patients with dilatation of the renal cavities isolated, without fever, they received only analgesic treatment. Group III involved patients without dilatation of the renal cavities, they received analgesic treatment and antibiotics in case of fever, and then another cause of pain was sought. The renal colic was due to a stone in 19.4 % of cases. A urinary infection was associated in 28 % of patients. Ultrasond was sufficient to confirm the diagnosis in 96 % of cases. In 4 % of cases, MRI or low-dose CT were necessary. Therapeutic management based on analgesic treatment, associated with probabilistic antibiotherapy or adapted in case of documented infection, allowed sedation of pain in two-third of cases. In case of failure or signs of severity, the urinary diversion by a double J stent was efficient, without consequences on pregnancy issue. One stone was treated by ureteroscopy during pregnancy without complication. The management of renal colic in pregnant woman based on ultrasound diagnosis, symptomatic treatment and urinary diversion by double J stent in case of failure therefore seemed quite sure on mother and fetus.
    Progrès en Urologie 04/2014; 24(5):294-300. · 0.80 Impact Factor
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    ABSTRACT: Despite benefits in functional renal outcome and favorable oncological efficacy, previous studies show marked underuse of partial nephrectomy (PN). We investigated national utilization of partial and radical nephrectomy (RN) using a contemporary, prospective population-based cohort. Between June and December 2010, 1,237 patients were treated by PN or RN for renal cell carcinoma in 56 French centers. Data were prospectively collected, and statistical analyses were performed. Overall, 667 (53.9 %) and 570 patients (46.1 %) underwent RN and PN, respectively. In case of PN, surgical approach was an open PN in 63.3 % of cases, a laparoscopic PN in 21.0 % of cases and a robot-assisted PN in 15.7 % of cases. PN was used in T1a, T1b, T2 and T3 tumors in 395 (76.7 %), 131 (38.2 %), 29 (14.7 %) and 7 (4.6 %), respectively. Median ischemia time was 16 min [0-60], and mean blood loss was 280.4 ml (±339.9). Tumor characteristics and operative features were significantly different according to the surgical approach. Warm ischemia time was significantly higher in case of laparoscopic or robot-assisted procedure (p < 0.001). There was no statistical significant difference in blood loss and transfusion rate according to surgical approach. Postoperative medical and surgical complications occurred in 8.2 and 10.0 % of PN, respectively, with no significant difference according to surgical approach. Partial nephrectomy for renal cell carcinoma is commonly used in this French centers sample. Mini-invasive approaches represent also a significant part of all partial nephrectomies with no difference in terms of complication rates.
    World Journal of Urology 03/2014; · 2.89 Impact Factor
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    ABSTRACT: Robotic-assisted surgery for pelvic floor disorders (PFD) meets the accepted standards for laparoscopic surgery. The aim of this study was to describe the technique and the impact of this standardized surgical technique and dedicated operating teams on the operative time for robotic-assisted laparoscopic ventral mesh rectopexy (RALVMR). Data from a prospective database were extracted for all patients who underwent RALVMR between January 2008 and May 2012 for multi-compartment PFD. Patient pre-, intra- and early postoperative data were analysed. To evaluate the impact of both the surgical technique and operating room team on operative time over successive years, we divided the total operation time (TOT) into robot set-up time (RST) and surgeon console time (SCT) including disembarking robotic arms and closure of wounds. A total of 51 patients (3 male) with a mean age of 61.1 [±11, standard deviation (SD)] years were included for analysis. There were no major complications or deaths. Median TOT fell significantly by 23 % from 2008 (270 min) to 2012 (179 min) (p < 0.0001). The largest reduction (>60 %) was seen in RST, from 55 (SD ±3) to 21 (SD ±2) min (p < 0.0001). Similarly, SCT was reduced by 36 % from 216 (SD ±12) to 138 (SD ±8) min (p < 0.0001). Decreased operative time and efficiency were facilitated by a devoted, well-trained and consistent team. A standardized surgical technique for PFD helps to reduce the duration of the surgical procedure.
    Journal of Robotic Surgery 03/2014;
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    ABSTRACT: We report the case of a patient affected by a voluminous prostatic tumor for which the histological analysis conclude in a stromal tumor of uncertain malignant potential. This type of tumor is rare, but requires to be individualized to differentiate it from a benign prostatic hyperplasia or a sarcoma of the prostate. The therapeutic care must be made keeping in mind the risk of degeneration towards a malignant shape.
    Annales de Pathologie 01/2014; · 0.24 Impact Factor
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    ABSTRACT: Objectives To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication. Methods and materials Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant. Results Median age at diagnosis was 60 years (19–91). Tumor size was smaller than 4 cm in 665 (68.3%) cases and larger than 4 cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4 cm (P = 0.0001) and for tumors>4 cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR<60 ml/min (P = 0.0001), tumor size≥4 cm (P = 0.0001), and older age at diagnosis (P = 0.0001). Conclusions The renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff.
    Urologic Oncology: Seminars and Original Investigations. 01/2014;
  • European Urology Supplements 01/2014; 13(1):e7. · 2.16 Impact Factor
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    ABSTRACT: Introduction The objective of this article was to make a focus on pathological, clinical and therapeutic of different forms of adult testicular teratoma. Material and methods The multidisciplinary working group has conducted a literature search on Pubmed with keywords: adult teratoma; malignant transformation; growing teratoma; chemotherapy; surgery to make a focus on the different forms of adult testicular teratoma. Results Teratomas of the adults are malignant and subdivided into localized and metastatic forms that may be distinguished under exclusive teratoma form, growing teratoma or teratoma with malignant transformation. The management is based on an enlarged surgical excision (testis and metastasis) with, in metastatic forms, a chemotherapy adjusted with histology. Extended follow-up beyond 10 years is necessary because of the risk of late relapse. Conclusions Testicular teratoma is a rare tumor, which is considered malignant with a potential of metastasis. The treatment is based mainly on surgical management.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: Purpose To evaluate the management of renal colic in pregnant woman in our hospital. Material and methods A retrospective study of 103 pregnant patients, hospitalized for back pain of renal colic type, associated or not with a urinary tract infection, between January 2005 and October 2010. Three groups of patients were identified from the initial clinical and paraclinical (ultrasound). Group I involved patients with dilatation of the renal cavities associated with septic syndrome, they received analgesic treatment and empiric antibiotic therapy. Group II involved patients with dilatation of the renal cavities isolated, without fever, they received only analgesic treatment. Group III involved patients without dilatation of the renal cavities, they received analgesic treatment and antibiotics in case of fever, and then another cause of pain was sought. Results The renal colic was due to a stone in 19.4 % of cases. A urinary infection was associated in 28 % of patients. Ultrasond was sufficient to confirm the diagnosis in 96 % of cases. In 4 % of cases, MRI or low-dose CT were necessary. Therapeutic management based on analgesic treatment, associated with probabilistic antibiotherapy or adapted in case of documented infection, allowed sedation of pain in two-third of cases. In case of failure or signs of severity, the urinary diversion by a double J stent was efficient, without consequences on pregnancy issue. One stone was treated by ureteroscopy during pregnancy without complication. Conclusion The management of renal colic in pregnant woman based on ultrasound diagnosis, symptomatic treatment and urinary diversion by double J stent in case of failure therefore seemed quite sure on mother and fetus.
    Progrès en Urologie. 01/2014; 24(5):294–300.
  • J. Rigaud
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    ABSTRACT: Introduction The role of the nurse in the management of penile cancer sometimes used to make the diagnosis when the discovery of a suspicious lesion but also participates in the patient information on the therapeutic orientation and support for care. The purpose of this article is to make a focus of the management of penile cancer for nurses. Materials and methods A literature search on Pubmed was performed to make a focus on the management of penile cancer. Results Penile cancer is a rare tumor that occurs in mostly older people (over 60 years). The diagnosis of penile precancerous lesions is essential and can be made fortuitously by the nurse during care or catheterization. The staging of the penile tumor is based on clinical examination could be aided by MRI with a penile erection test. The treatment of penile tumor is conservative whenever possible. The first lymph node involvement is inguinal. Lymph node invasion is the most important prognostic value. Supported of the Lymph nodes must be systematic, bilateral and performed at diagnosis. The assessment is based on clinical examination, sentinel lymph node biopsy and 18F-FDG PET-CT. Inguinal lymphadenectomy alone has a curative role and type of lymph node dissections is based on physical examination and staging. In some cases it may be associated with adjuvant or neoadjuvant chemotherapy. Conclusion The problem is that penile cancer is a rare tumor for which the urological team is little confronted which can lead to defects in support care while national or international recommendations exist.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: To assess oncologic outcomes after salvage radiotherapy (SRT) without androgen deprivation therapy (ADT) in patients with persistently detectable PSA after radical prostatectomy (RT). Two hundred and one patients who failed to achieve an undetectable PSA received SRT without ADT. The primary endpoint was failure to SRT that was defined by clinical progression or use of second-line ADT. Clinicopathological parameters, 6-week PSA level, PSAV and pre-SRT PSA levels were assessed using time-dependent analyses. Median postoperative 6-week PSA and pre-SRT PSA levels were 0.25 and 0.48 ng/mL, respectively. Median time between surgery and SRT was 7 months. Failure to SRT was reported in 42.8 % of cases with the need for second-line ADT in 26.9 % of cases. Pre-SRT PSA was strongly correlated with postoperative 6-week PSA (p < 0.001) but not with PSAV. The risk of SRT failure was increased by threefold in case of Gleason score 8-10 (p = 0.036) or pT3b cancer (p = 0.006). Risk group classification based on these prognostic factors improved SRT failure prediction. Survival curves confirmed that 5-year ADT-free survival rates were significantly influenced by PSAV (p = 0.002) and pre-SRT PSA (p = 0.030). In patients with persistently detectable PSA after RP and selected for local salvage treatment, SRT offers good oncologic clinical outcomes. The most powerful pathologic predictive factors of SRT failure include a pT3b stage, a Gleason score 8 or more cancer and high PSAV and pre-SRT PSA levels. Patients having a high PSAV >0.04 ng/mL/mo would be potentially better candidates for a systemic therapy due to a high SRT failure rate.
    World Journal of Urology 11/2013; · 2.89 Impact Factor
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    ABSTRACT: To investigate the impact of hospital volume on partial nephrectomy indications and outcomes. Data were extracted from the National Observational Registry on the Practice and Hemostasis in Partial Nephrectomy registry. Four groups were created according to the number of partial nephrectomy (PN) performed: very high (VH, ≥19 PN), high (H, 10-18 PN), moderate (M, 4-9 PN) and low (L, <4 PN) PN activity. Indications and surgical outcomes were compared among all groups. The effect of hospital volume on postoperative complications and positive margin rate was examined by a multivariable analysis. Fifty-three centers included a total of 570 PN. There were 9 VH, 13 H, 12 M and 19 L volume centers which performed 270 (47.4 %), 179 (31.4 %), 74 (13 %) and 47 (8.2 %) PN, respectively. Patients in higher volume centers were significantly younger (p = 0.008), had a lower BMI (p = 0.002) and decreased ASA score (p < 0.001). PN was more frequently performed in higher volume centers (p = 0.006) particularly in case of renal masses <4 cm (p = 0.005). Open surgery was the most common approach in all groups, but laparoscopic PN was more frequent in M volume hospitals (p < 0.001). Positive margin (p = 0.06) and complications (p = 0.022) rates were higher in M group. In multivariable analysis, renal chronic disease was an independent predictor of positive margin rate (p < 0.001, OR 3.91). PN is more frequently performed in high volume institutions particularly for small renal masses. We observed increase positive margin and complication rates in moderate volume centers that might be explained by an increased use of laparoscopy.
    World Journal of Urology 11/2013; · 2.89 Impact Factor
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    ABSTRACT: The objective of this article is to establish guidelines proposed by the external genital organ group of the CCAFU for the diagnosis, treatment and follow-up of the germ cell tumours of the testis. The multidisciplinary working party studied previous guidelines, exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommendation. The initial work-up of testicular cancer is based on clinical, laboratory (AFP, total hCG, LDH) and imaging assessment (scrotal ultrasound and chest, abdomen and pelvis computed tomography). Inguinal orchidectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. The management of stage I tumours must be adapted to the risk by explaining to the patient the benefits/disadvantages of active treatment or watchful waiting as a function of the risk of relapse. Treatment options for stage 1 seminomas comprise : watchful waiting, chemotherapy (1 cycle of carboplatin) or para-aortic radiotherapy. Treatment options for stage 1 nonseminomatous germ cell tumours comprise : watchful waiting, chemotherapy (2 cycles of BEP) or staging retroperitoneal lymphadenectomy. The management of metastatic tumours essentially comprises chemotherapy with 3 or 4 cycles of BEP according to the prognostic group. Radiotherapy may be indicated in seminomas with lymph node metastasis < 3cm. Review 3 to 4 weeks post-chemotherapy is essentially based on tumour marker assays and chest, abdomen and pelvis computed tomography. Surgical retroperitoneal lymph node dissection is indicated for all residual NSGCT masses > 1cm and for persistent residual seminoma masses > 3cm with (18)F-FDG PET-CT uptake. Germ cell tumours have an excellent survival rate based on precise initial staging, adapted and strictly defined treatment and close surveillance.
    Progrès en Urologie 11/2013; 23 Suppl 2:S145-60. · 0.80 Impact Factor
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    ABSTRACT: Retroperitoneal sarcomas are rare tumours. The objective of this article is to propose management guidelines. A review of the literature was performed using the PubMed search engine (1985-2013) with the key words: retroperitoneal sarcoma, prognosis, recurrence, surgery, radiation therapy, chemotherapy. Chest, abdomen and pelvis computed tomography is the reference examination. Other examinations are optional. PET scan is not indicated for the primary diagnosis. CT-guided retroperitoneal biopsy is recommended and must be systematically performed before any management of a suspicious retroperitoneal mass. All retroperitoneal sarcomas must be registered and presented to a multidisciplinary consultation meeting devoted to the management of sarcomas (regional meetings) prior to any therapeutic intervention. Treatment is essentially surgical and is primarily designed to achieve negative surgical margins (R0). Neoadjuvant or adjuvant radiotherapy and chemotherapy can be proposed depending on the risk of progression and the resectability. The recurrence rate is related to tumour grade and surgical margins. The final prognosis is intimately related to the quality of initial management and the number of cases treated by each centre. Retroperitoneal sarcomas have a poor prognosis. The quality of initial management directly impacts recurrence-free survival and overall survival. The prognosis is improved by multidisciplinary management conducted in a reference centre.
    Progrès en Urologie 11/2013; 23 Suppl 2:S161-6. · 0.80 Impact Factor
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    ABSTRACT: Malignant tumours of the penis are rare tumours. The objective of this article is to propose guidelines for the management of these tumours. A review of the literature was performed by selecting articles on penile cancer published in PUBMED. The most common histological type is squamous cell carcinoma. Clinical examination of the penis is usually sufficient to assess local extension of the primary tumour, but it can be completed by MRI to assess deeper extension. Inguinal lymph nodes must be systematically palpated on both sides to assess regional extension. In the presence of palpable lymph nodes, aspiration cytology is recommended in combination with abdomen and pelvis computed tomography and (18)F-FDG PET-CT. Sentinel lymph node biopsy is recommended in the case of penile cancer at high risk of lymph node extension with no palpable lymph nodes. Treatment of the primary tumour is usually surgical. It must be as conservative as possible while ensuring negative surgical margins. Brachytherapy or local treatment (laser, cytotoxic cream, etc.) can be proposed in some cases. Bilateral lymph node chains must be systematically treated at the time of diagnosis of the disease. Inguinal lymphadenectomy alone has a curative role in patients with metastatic invasion of a single lymph node (stage pN1). In the case of more extensive lymph node involvement, multimodal management combining chemotherapy, surgery and possibly radiotherapy, must be considered. The treatment of penile cancer is usually surgical possibly in combination with chemotherapy in the presence of lymph node extension. The main prognostic factor is lymph node involvement, requiring appropriate management right from the time of diagnosis.
    Progrès en Urologie 11/2013; 23 Suppl 2:S135-44. · 0.80 Impact Factor

Publication Stats

797 Citations
285.32 Total Impact Points

Institutions

  • 2013–2014
    • University of Nantes
      Naoned, Pays de la Loire, France
    • University of Angers
      Angers, Pays de la Loire, France
  • 2003–2014
    • Centre Hospitalier Universitaire de Nantes
      • • Clinique de chirurgie digestive et endocrinienne
      • • Service d'urologie
      Naoned, Pays de la Loire, France
  • 2010–2012
    • Centre Catherine de Sienne
      Naoned, Pays de la Loire, France
    • Centre Hospitalier Régional d'Orléans
      Orléans, Centre, France
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia
  • 2011
    • Hôpital Foch
      Lutetia Parisorum, Île-de-France, France
  • 2008–2010
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, TX, United States
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 2004–2009
    • Centre Hospitalier Universitaire de Québec (CHUQ)
      Québec, Quebec, Canada
  • 2005
    • CHRU de Strasbourg
      Strasburg, Alsace, France