J. Rigaud

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

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Publications (313)309.32 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the influence of vascular clamping and ischemia time on long-term post-operative renal function following partial nephrectomy (PN) for cancer in a solitary kidney. This is a retrospective study including 259 patients managed by PN between 1979 and 2010 in 13 centers. Clamping use, technique choice (pedicular or parenchymal clamping), ischemia time, and peri-operative data were collected. Pre-operative and last follow-up glomerular filtration rates were compared. A multivariate analysis using a Cox model was performed to assess the impact of ischemia on post-operative chronic renal failure risk. Mean tumor size was 4.0±2.3cm and mean pre-operative glomerular filtration rate was 60.8±18.9mL/min. One hundred and six patients were managed with warm ischemia (40.9%) and 53 patients with cold ischemia (20.5%). Thirty patients (11.6%) have had a chronic kidney disease. In multivariate analysis, neither vascular clamping (P=0.44) nor warm ischemia time (P=0.1) were associated with a pejorative evolution of renal function. Pre-operative glomerular filtration rate (P<0.0001) and blood loss volume (P=0.02) were significant independent predictive factors of long-term renal failure. Renal function following PN in a solitary kidney seems to depend on non-reversible factors such as pre-operative glomerular filtration rate. Our findings minimize the role of vascular clamping and ischemia time, which were not significantly associated with chronic renal failure risk in our study. 5. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 10/2014;
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    ABSTRACT: To assess bacillus Calmette-Guérin maintenance treatment schedule for non-muscle invasive bladder cancer at 2 years, using one-third of the full dose and fewer instillations every 3 months or 6 months.
    International journal of urology : official journal of the Japanese Urological Association. 09/2014;
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    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;
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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
  • European Urology Supplements 04/2014; 13(1):e7. · 3.37 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;
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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;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To assess the influence of vascular clamping and ischemia time on long-term post-operative renal function following partial nephrectomy (PN) for cancer in a solitary kidney. Patients and methods This is a retrospective study including 259 patients managed by PN between 1979 and 2010 in 13 centers. Clamping use, technique choice (pedicular or parenchymal clamping), ischemia time, and peri-operative data were collected. Pre-operative and last follow-up glomerular filtration rates were compared. A multivariate analysis using a Cox model was performed to assess the impact of ischemia on post-operative chronic renal failure risk. Results Mean tumor size was 4.0 ± 2.3 cm and mean pre-operative glomerular filtration rate was 60.8 ± 18.9 mL/min. One hundred and six patients were managed with warm ischemia (40.9%) and 53 patients with cold ischemia (20.5%). Thirty patients (11.6%) have had a chronic kidney disease. In multivariate analysis, neither vascular clamping (P = 0.44) nor warm ischemia time (P = 0.1) were associated with a pejorative evolution of renal function. Pre-operative glomerular filtration rate (P < 0.0001) and blood loss volume (P = 0.02) were significant independent predictive factors of long-term renal failure. Conclusion Renal function following PN in a solitary kidney seems to depend on non-reversible factors such as pre-operative glomerular filtration rate. Our findings minimize the role of vascular clamping and ischemia time, which were not significantly associated with chronic renal failure risk in our study. Level of evidence 5.
    Progrès en Urologie. 01/2014;
  • [Show abstract] [Hide abstract]
    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
    [Show abstract] [Hide abstract]
    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: Los dolores pelviperineales crónicos presentan una evolución superior a 6 meses y se asimilan completamente a síndromes; asocian varios síntomas, sobre todo urinarios o sexuales, y fenómenos psicológicos, orgánicos y psicosomáticos. Fuente de discapacidad, estos síndromes alteran la calidad de vida del paciente y su personalidad e influyen en su comportamiento y su vida sexual, familiar, social y laboral. El conjunto de los síndromes dolorosos pelviperineales crónicos incluye la prostatitis bacteriana, el síndrome doloroso pélvico (antigua prostatitis crónica no bacteriana), el síndrome doloroso vesical, los dolores uretrales, escrotales, epidídimo-testiculares, peneanos, los dolores con la eyaculación, los dolores neuropáticos somáticos (incluida la neuralgia pudenda), los dolores musculoesqueléticos, los dolores irradiados y los dolores postoperatorios. En ausencia de etiología orgánica, tisular o iatrogénica, un síndrome doloroso pelviperineal crónico podría corresponder a una forma de hipersensibilización urogenital, posiblemente secundaria a antecedentes nociceptivos locales repetidos, como por ejemplo infecciosos o traumáticos, y reflejar una disfunción de la transmisión nociceptiva y la regulación de los mensajes dolorosos pelviperineales. Debido a su complejidad y a sus múltiples implicaciones, los síndromes dolorosos pelviperineales crónicos requieren un enfoque global y transdisciplinario. Existe un amplio arsenal terapéutico (tratamientos farmacológicos orales o locales, principalmente mediante infiltraciones, fitoterapia, fisioterapia, psicoterapia, neuromodulación, acupuntura, cirugía), pero su eficacia es con frecuencia limitada y carece de validación. Son indispensables estudios de investigación fundamental o clínica de alto nivel de evidencia científica para progresar en la comprensión, la valoración y el manejo de los dolores pelviperineales crónicos.
    EMC - Urología. 12/2013; 45(4):1–15.
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    ABSTRACT: Objective To review epididymo-testicular referred pain and posterior ramus syndrome. Material and methods Review of the literature performed by searching the Medline database using keywords, abdominal pain, epididymis, low back pain, pelvic pain, referred pain, testis. Results Referred pain is perceived in zones situated away from the causal lesion. In urology, pain referred to the epididymo-testicular zone can be due to vertebral disease during the posterior ramus or thoraco-lumbar junction syndrome described by Robert Maigne. In this syndrome, pain is not perceived at the thoraco-lumbar junction, but more distally in the lumbosacral or sacroiliac region. This syndrome can also be responsible for pseudovisceral lower abdominal pain and painful bands in a given dermatome. The usual cause of posterior ramus syndrome is minor intervertebral dysfunction involving a posterior facet joint, usually at T12-L1. Only a thorough physical examination can demonstrate the painful vertebral segment. Conclusion The site of the pain is not always a reliable indicator of the organ or region responsible for the pain. In chronic epididymo-testicular pain, clinical interview and thorough physical examination can allow the diagnosis of referred pain and, especially in posterior ramus syndrome, guide the physician to the origin of the pain in the thoraco-lumbar junction.
    Progrès en Urologie - FMC 12/2013; 23(4):F119–F123.

Publication Stats

851 Citations
309.32 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
  • 2009–2012
    • Centre Catherine de Sienne
      Naoned, Pays de la Loire, France
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, TX, United States
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 2011
    • Hôpital Foch
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Centre Hospitalier Régional d'Orléans
      Orléans, Centre, France
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia
  • 2008–2010
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
  • 2004–2009
    • Centre Hospitalier Universitaire de Québec (CHUQ)
      Québec, Quebec, Canada
  • 2005
    • CHRU de Strasbourg
      Strasburg, Alsace, France