Franck Lay

Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Cote d'Azur, France

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Publications (10)11.62 Total impact

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    ABSTRACT: The reference treatment for filling defects of the upper urinary tract is nephroureterectomy with excision of a perimeatal bladder segment. The authors evaluated the role of endoscopy and laser in the management of filling defects of the upper urinary tract. Filling defects of the upper urinary tract were evaluated by biopsies performed during ureteroscopy followed by 10 Watt Holmium-YAG laser vaporisation. High-grade or incompletely vaporised tumours or multifocal tumours or tumours more than 2 cm in diameter received complementary treatment. Low-grade and completely vaporised tumours were followed by ureteroscopy at 3 months and then every 6 months. The authors conducted a prospective study from March 2002 to September 2004. Fifteen consecutive patients were managed according to this protocol. The mean age was 70 years (range: 53 to 85 years). Thirty nine tumours were treated. The mean tumour diameter was 1.05 cm (range: 0.3 to 2.5 cm). In this series of 15 patients treated according to this protocol, 39 tumours were diagnosed and treated. The grade was determined by biopsy in 66% of cases. Seven patients have a median recurrence-free survival of 18 months (range: 12 to 34 months). Overall, conservative management was able to be performed in twelve patients, corresponding to a 22-month kidney preservation rate of 80%. Two patients died during follow-up, one from prostatic cancer and the other from invasive urothelial bladder tumour. One patient who had had recurrence ans had been re-treated was lost for report. Filling defects of the upper urinary tract can be investigated by ureteroscopy to obtain a histological diagnosis and to perform treatment by laser vaporisation. Complementary treatment is then performed depending on the histological results, either by complementary vaporisation or by nephroureterectomy. Laser treatment ensures a high kidney preservation rate but with a recurrence risk. Conservative endoscopic treatment, which is considered to be acceptable in cases of necessity, may also be useful in the context of small, unifocal, minimally invasive tumours with a normal contralateral kidney.
    Progrès en Urologie 05/2006; 16(2):151-4. · 0.77 Impact Factor
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    ABSTRACT: The 10-year risk of developing a solid malignancy is 20% for kidney transplant recipients. The goal of the current study was to investigate the epidemiology and the diagnostic and prognostic parameters associated with de novo malignancies of the native kidney among transplant recipients at the authors' institution (Department of Urology and Renal Transplantation, Hôpital Salvator, Marseille, France). The authors reexamined the follow-up of 933 consecutive transplant recipients at their institution between 1987 and 2003. Immunossupressive therapy was not modified in the event of malignant disease, nor was systematic radiologic monitoring of native kidneys performed. All de novo malignancies of the native kidney were included in the current analysis. Among the 933 patients examined, a combined total of 12 malignancies of the native kidney were diagnosed in 11 individuals. For these 11 individuals, the average ages at transplantation and diagnosis were 42.5 and 49.1 years, respectively. Ten malignancies were discovered fortuitously, whereas two were symptomatic. Among the 10 renal echographies performed, there was 1 false-negative result. Tomodensitometry was performed in 11 cases and yielded no false-negative results. The average tumor size was 37 mm. Nephrectomy was performed in 10 cases, and biopsy was performed in 1. Among the 12 kidney malignancies encountered in the current study, there were 7 conventional cell carcinomas, 3 basophilic papillary carcinomas, and 2 chromophobic renal cell carcinomas. Half of all tumors were Furhman Grade 3 lesions, and pT1aN0M0 tumors (2003 TNM staging system) also accounted for half of all malignancies in the current cohort. Two affected transplant recipients died (one due to disease), and the remaining nine are alive without recurrence and with normal renal functioning (median follow-up, 39 months). There appears to be an increased risk of malignancy of the native kidney in renal transplant recipients, with high-grade and papillary tumors being particularly common. Consequently, systematic radiologic follow-up of native kidneys must be performed for individuals who undergo kidney transplantation.
    Cancer 01/2005; 103(2):251-7. DOI:10.1002/cncr.20745 · 4.90 Impact Factor
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    ABSTRACT: To decrease the risk of erectile dysfunction and incontinence by performing prostate-sparing cystectomy for bladder cancer; and to evaluate the oncological results by comparing them to those of radical cystectomy. Since 1994, 141 men have undergone cystectomy for bladder cancer. Twenty five patients with a mean age of 57 years (range: 47-75 years) underwent prostate-sparing cystectomy. The exclusion criteria were: contraindication to bladder replacement, invasion of the prostatic urethra, and associated prostatic adenocarcinoma. TURP was performed preoperatively to evaluate the prostatic urethra. All patients had a PSA < 4 ng/ml or negative prostatic needle biopsies. The Ditrovie and IIEF scores were used to evaluate the quality of voiding and erectile function. The mean follow-up was 53.4 months (median: 46 months). The overall 5-year survival regardless of stage was 66%. Seven patients (28%) died, all from their cancer. Six patients (24%) developed a pelvic recurrence, 2 patients (8%) developed an urethral recurrence (1 had a multifocal lesion, and 1 had CIS) treated by TURP and 6 patients (24%) developed distant metastases. Among the patients with pelvic recurrence, 4 (66%) presented a multifocal tumour. One patient developed prostatic adenocarcinoma after 36 months, which was treated by external beam radiotherapy. At 1 year, 100% of patients reported normal daytime continence and 19 out of 22 patients (86.4%) were continent at night and had to get up 1 to 3 times per night. At 1 year, 10 out of 22 patients (45.4%) had normal erections, 9 (40.9%) reported impaired erectile function but allowing sexual intercourse, and 3 had major erectile dysfunction (13.6%). At 3 years, 93.7% of patients had normal daytime continence; 75% of patients were continent at night, 37.5% of patients reported normal erections, 37.5% of patients reported partial erections and 25% of patients reported major erectile dysfunction. Prostate-sparing cystectomy for the treatment of invasive bladder cancer improves continence, sexual function and quality of life of patients, with poorer oncological results to those of radical cystectomy in terms of pelvic recurrence. Rigorous patient selection should improve these results.
    Progrès en Urologie 05/2004; 14(2):172-7; discussion 176. · 0.77 Impact Factor
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    ABSTRACT: Development of cancer on a kidney transplant is a rare complication of renal transplantation. In the light of a case of cancer on a kidney transplant, in a series of 729 consecutive renal transplantations performed between January 1987 and December 2000, the authors discuss the epidemiology, pathophysiology, prognosis, treatment and prevention of this disease and emphasize the importance of regular and prolonged periodic ultrasound surveillance of kidney transplants. The reference treatment is transplantectomy with discontinuation of immunosuppression and resumption of haemodialysis. Under certain conditions, partial transplantectomy could appear be an alternative to the reference treatment.
    Progrès en Urologie 03/2004; 14(1):59-61. · 0.77 Impact Factor
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    ABSTRACT: The purpose of this study was to assess the correlations between histological examination of surgical biopsies before transplantation of good quality donor kidneys and delayed return of renal function and renal function at 1 year in order to determine whether histology could explain the various, sometimes surprising outcomes observed with these good quality transplants. From November 1999 to March 2002, 110 consecutive renal transplantations were performed in our centre from 79 different donors, not including any "borderline" donors. During preparation of each transplant, a surgical wedge biopsy of the mid-renal cortex was performed. Biopsies were paraffin-embedded then stained with P.A.S. (Periodic Acid Shiff). Histological examination was performed by a single pathologist and focused on the glomeruli (number, morphology), and the morphology of the interstitial space and vessels. Delayed return of transplant renal function was defined by the need for dialysis during the first week after renal transplantation. Immunosuppression and surveillance protocols were standardized and uniform. Transplant function at 1 year was evaluated by serum creatinine and creatinine clearance calculated according to Cockcroft's formula. The mean number of glomeruli per biopsy was 15.0 +/- 10.8. 42 renal biopsies (39.2%). Histological examination did not reveal any vascular, interstitial or glomerular lesions. Among these 42 transplants with normal biopsies, 30 (71.4%) did not develop delayed return of renal function (vs 69% of the transplants with abnormal biopsies, p > 0.05). Mean serum creatinine at 1 year (168.5 +/- 63 micromol/l vs 166.9 +/- 40.5 micromol/l, p > 0.05) and mean creatinine clearance at 1 year (53.4 +/- 17.4 ml/min. vs 48.3 +/- 14.3 ml/min, p > 0.05) were not significantly different between the normal biopsy group and the abnormal biopsy group. Histological abnormalities are frequently observed in renal transplants derived from good quality donors. The biopsy result before renal transplantation from "non-borderline" donors was not significantly correlated with the risk of delayed return of transplant function or the renal function at 1 year Biopsy alone cannot constitute a reliable criterion for the selection of renal transplants from "non-borderline" donors.
    Progrès en Urologie 02/2004; 14(1):24-8. · 0.77 Impact Factor
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    ABSTRACT: Laparoscopy is now a recognized and widely performed treatment modality for certain ureteric diseases (stones, ureteropelvic junction syndrome, etc.). Vesicopsoas hitch is a reference technique for the treatment of defects of the pelvic ureter larger than 5 cm. The authors report 2 cases of fibrous stenosis of the pelvic ureter effectively treated by laparoscopic vesicopsoas hitch after failure of endourological treatment. The details of the technique and its advantages are described and discussed. The authors believe that laparoscopic vesicopsoas hitch is feasible and reproducible. Larger series of patients treated by laparoscopy are required to allow comparison with conventional open surgery.
    Progrès en Urologie 07/2003; 13(3):518-22. · 0.77 Impact Factor
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    ABSTRACT: Evaluation of active deflection flexible miniureterorenoscopes for diagnostic or therapeutic applications in the management of upper urinary tract diseases. The authors report a series of 111 consecutive patients undergoing a total of 137 flexible ureteroscopies for upper urinary tract disease between November 1997 and April 2001. The procedures were performed for diagnostic purposes (54 cases: 39%) or therapeutic purposes (83 cases; 61%). A successful procedure was defined as achievement of the objective defined when establishing the indication for ureteroscopy. The mean age of the patients was 51 +/- 15 years. The main diseases investigated or treated were stones (66%) and urothelial tumours (25%). The mean operating time was 42 +/- 22 min. The median length of postoperative hospital stay was 2 days (range: 0-27 days). 8% of patients did not require any postoperative ureteric drainage. 78% of the flexible ureteroscopies performed were successful. Complications were observed in 8% of cases, mainly macroscopic haematuria, including 3 major complications in the form of ureteric perforation. Serious intraoperative equipment damage was observed in 4% of cases. Ureteroscopy with a flexible mini-ureteroscope is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique for lesions situated above the iliac vessels. The use of various instruments, including the Holmium:Yag laser, should increase the range of possibilities of endoscopic techniques. The major limitation of active deflection flexible mini-ureterorenoscopes remains their fragility.
    Progrès en Urologie 07/2003; 13(3):404-15. · 0.77 Impact Factor
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    ABSTRACT: To compare in a random fashion an automated irrigation/suction pump system with the standard pressurized technique during transurethral ureterorenolithotripsy. Between July 2001 and December 2001, 47 patients were prospectively included. Prior to randomization, rigid instruments were allocated to 25 patients (group R) and flexible instruments to 22 patients (group F) according to stone location. The groups R and F were then randomized separately, and the pressurized technique was employed in groups R1 and F1, while the automated system was employed in groups R2 and F2. Operative time, amount of liquid consumed, and stone-free rate at the end of the procedure were analyzed. For the entire series, ureteroscopy time using the automated system (mean 42 +/- 17[SD] minutes; range 15-90 minutes) was 35% less than with the pressurized technique (mean 65 +/- 25 minutes; range 20-135 minutes) (P = 0.04 Wilcoxon score). The stone-free rate was significantly higher in groups R2 + F2 (92%) than in groups R1 + F1 (69%) (P = 0.048). With the ENDO FMS UROLOGY system, there was a significant reduction in the mean ureteroscopy time: 32% less with the rigid instrument and 53% less with the flexible instrument. This seems to be attributable to a wider working space and highly improved visibility. The integrated suction at constant flow allows efficient evacuation of stone fragments while limiting cavity pressure. These results, obtained on 47 patients, should be confirmed by larger randomized studies.
    Journal of Endourology 04/2003; 17(2):97-101. DOI:10.1089/08927790360587423 · 2.10 Impact Factor
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    ABSTRACT: Le cancer de novo sur un rein transplanté est une complication rare [6]. Nous rapportons le cas d'un carcinome rénal de novo sur un rein transplanté diagnostiqué 8 ans après la transplantation. Il s'agit d'un cas unique parmi les 729 transplantés de notre centre de janvier 1987 à décembre 2000. CAS CLINIQUE Il s'agissait d'un patient insuffisant rénal chronique par glomérulo-néphrite chronique. Le patient a été transplanté dans notre service en Octobre 1991, à l'âge de 27 ans, après 3 mois d'hémodialyse. L'immunosuppression était conventionnelle, quadruple et séquentielle (sérum antilympho-cytaire, anticalcineurines, azathioprine et corticoïdes à 1 mg/kg à l'induction puis anticalcineurines, azathioprine et corticoïdes en maintenance à posologie conventionnelle). Le patient a présenté 2 épisodes de rejet aigu résolutifs après flash de corticoïdes IV. Il n'y a jamais eu de virémie positive à CMV chez ce patient. Après 3 ans, on notait une altération progressive de la fonction rénale aboutissant à une reprise de l'hémodialyse en août 1998. Le patient n'a jamais eu de surveillance radiologique systématique du transplant et des reins propres. En septembre 1999 (8 ans de recul), le patient est pris en charge en urgence en urologie pour un syndrome douloureux suraigu fébrile du transplant résistant au traitement symptomatique et antibiotique. Il a été réalisé une transplantectomie conventionnelle par voie sous péritonéale. A l'examen macroscopique du transplant (Figure 1), il existait un syndrome tumoral multifocal (plus de 10 tumeurs) et diffus. La lésion la plus volumineuse était mesurée à 1,5 cm. Microscopique-ment, il existait des lésions multifocales avec un contingent de car-cinome rénal tubulo-papillaire et un contingent de carcinome rénal à cellules conventionnelles. Il s'agissait de carcinomes de grade 2 de Fürhman. Le bilan d'extension était normal. Selon la classification TNM 1997, il s'agissait d'un carcinome rénal T1aN0M0. Après bilan, il n'a pas été retrouvé de tumeur sur les autres organes (rein controlatéral et foie) qui avaient été prélevés et transplantés en 1991. Avec un recul de 3ans, le patient est vivant sans signe d'évolution de la maladie. DISCUSSION Epidémiologie Le développement d'un carcinome à cellules rénales sur un rein transplanté est une complication rare. PENN (Cincinnati Tumor Transplant Register) a recensé 24 carcinomes à cellules rénales du transplant parmi 8091 tumeurs de novo chez 7596 patients [10]. 9% des tumeurs rénales après transplantation se développent sur le transplant lui-même [6]. RESUME Le développement d'un cancer sur un rein transplanté est une complication rare de la transplantation. Au travers d'un cas de cancer sur un rein transplanté, parmi 729 transplantations rénales consécutives de Jan-vier 1987 à Décembre 2000, nous abordons l'épidémiologie, la physiopathologie, le pronostic, le traitement et la prévention de cette pathologie. Il en ressort l'importance d'une surveillance échographique périodique régulière et prolongée des reins transplantés. Le traitement de référence est la transplantectomie avec interruption de l'immunosuppression et reprise de l'hé-modialyse. Dans certaines conditions, la transplantectomie partielle semblerait être une alternative au traite-ment de référence. Organ Procurment Agency) de 1991 à 1997 retrouve 5 cas (0,9%) de cancers du rein au moment du prélèvement rénal. Mais, il s'agit le plus souvent de cancers de novo du transplant [2]. Concernant notre cas, le délai de 8 ans séparant la transplantation du diagnostic de cancer est en faveur de l'hypothèse de carcinome de novo. CLAUDON [2] et HEINZ-PEER [4] ont publié des cas de can-cer du transplant, respectivement 7 et 19 ans après la transplantation et dont le caractère de novo a été confirmé par des techniques d'hy-bridation. Enfin, la taille tumorale, rapportée à la vitesse de crois-sance de ces tumeurs (0,5 cm par an),est également en faveur de leur caractère de novo [3]. La transplantation est un facteur de risque de cancer du rein mais aucun élément favorisant n'a été rapporté (aucune influence de la duré de prise en charge en dialyse, date de la transplantation ou type d'immunosuppression). Par contre l'immunosuppression semble accroître l'agressivité des tumeurs chez le transplanté.
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    ABSTRACT: La réimplantation urétéro-vésicale sur vessie psoïque est une technique de remplacement de l'uretère pelvien. La perte de substance urétérale peut être traumatique, inflam-matoire, tumorale, radique, endométriosique ou par com-pression extrinsèque. Lorsque le sacrifice urétéral excède 5 cm, les techniques de réimplantation urétéro-vésicale directe ou une anastomose urétéro-urétérale ne sont pas recommandées (tension excessive et/ou absence d'anti-reflux). Dans ce cas le rétablissement urétéro-vésical est assuré par la mobilisation de la vessie vers l'uretère iliaque selon la technique de vessie psoïque [5]. La laparoscopie présente des avantages indiscutables pour les patients (durée d'hospitalisation plus courte, morbidité plus basse et convalescence plus rapide) [4]. De plus, de nombreuses pathologies urétérales bénéfi-cient déjà d'un traitement par voie laparoscopique (fibrose rétropéritonéale, calculs, obstruction de la jonction pyélo-urétérale …) [11] dont 1 cas de vessie psoïque par voie laparoscopique [15]. Nous rapportons 2 cas de réimplantation vésico-urété-rale sur vessie psoïque coelio-assistée.

Publication Stats

78 Citations
11.62 Total Impact Points


  • 2003–2006
    • Assistance Publique Hôpitaux de Marseille
      • • Service de neurologie
      • • Service de chirurgie urologique
      Marseille, Provence-Alpes-Cote d'Azur, France