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La Presse Médicale 11/2011; 41(4):427-33. · 0.67 Impact Factor
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ABSTRACT: BACKGROUND: The robot-assisted laparoscopic approach for radical prostatectomy (RARP) is being performed increasingly worldwide to treat localized prostate cancer (PCa). The aim of this study was to compare the learning curves of two surgeons with different surgical experiences. METHODS: A prospective collection of peri-operative data was made: age, body mass index, PSA, clinical stage, biopsy Gleason score, operative time (OT), blood loss (BL), pathological stages, final Gleason scores, and complications. Patients were included, in two groups. The first group comprised the first 100 patients undergoing RARP by an expert laparoscopic surgeon. The second group of 100 patients was operated on by a junior surgeon without robotic console experience. Post-operative complications were defined according to the Clavien grading system for surgical morbidity RESULTS: For groups 1 and 2 median age was 63 and 62 years, respectively; median pre-operative PSA level was 10 and 8, respectively; the median BMI was 24 and 25, respectively. The median operative time (OT) was 179 and 160 min, respectively (p > 0.05); and median blood loss was 217 and 346 ml, respectively (p = 0.04). The overall transfusion rate was 1.5% and two major complications were recorded in group 1 and four in group 2. CONCLUSIONS: RARP is safe and reproducible even during the initial learning curve. Overcoming the learning curve is multifactorial and is necessarily dependent on the surgeon. However, joining a well-trained team probably affects positively the performance of the surgeon. The value of expert centers to train new surgeons to RARP needs to be evaluated. Copyright © 2011 John Wiley & Sons, Ltd.
International Journal of Medical Robotics and Computer Assisted Surgery 10/2011; · 1.59 Impact Factor
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ABSTRACT: Artificial urinary sphincter (AUS) implantation is one of several surgical options for the treatment of female stress urinary incontinence. It is indicated for women with both clinically and urodynamically defined intrinsic sphincter deficiency that significantly affects quality of life. The erosion/revision risk increases after several previous surgical interventions. Therefore, women believed to be candidates for AUS implantation should be rapidly (after the failure of a maximum of two previous surgical procedures) referred to specialized centres, where the knowledge and experience concerning the diagnosis, surgery and management of female stress urinary incontinence is concentrated. To refer correctly, non-academic urologists/gynaecologists should also be well informed about AUS implantation. Only in this way can the patient weigh the high long-term success rate and high quality of life improvement of AUS implantation against the greater complication/revision risk and take a well-considered decision.
BJU International 05/2011; 107(10):1618-26. · 2.84 Impact Factor
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ABSTRACT: To review the indications and to assess the functional outcomes after placement of a new temporary urethral stent (TUS) in men with lower urinary tract dysfunction.
We retrospectively reviewed the data of men with prostate obstruction and concomitant high-risk surgical status or neurological diseases between 2006 and 2008. TUS placement was performed with Urospiral 2™ which is a temporary, non-expanding, transprostatic stent. Success was defined as follows: when TUS placement allowed patients to void spontaneously and/or when surgery was made feasible after the period of relative contraindication (therapeutic group) or when TUS placement allowed physicians to define the role of prostate obstruction in the patients' voiding disorders and therefore to make an appropriate therapeutic decision (diagnosis group).
We included 94 men with a mean age of 73.3 ± 9 years (48-99) and 5 of them were lost to follow-up. The mean follow-up was 148 ± 100 days (2-1,046) and the mean duration of TUS placement was 155 ± 90 days (2-1,045). After a mean hospital stay of 4.8 ± 3 days (1-31), 84 patients (89%) had recovered spontaneous micturition. In the therapeutic group and the diagnosis group, 23 patients (92%) and 45 patients (70%) voided spontaneously, respectively.
TUS placement may be proposed temporarily in selected patients with static bladder outlet obstruction due to an enlarged prostate as it allows patients to avoid the use of an indwelling catheter.
Neurourology and Urodynamics 03/2011; 30(3):374-9. · 2.96 Impact Factor
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ABSTRACT: A robot-assisted laparoscopic approach for radical prostatectomy (RALRP) is being adopted increasingly worldwide for the treatment of localized prostate cancer (CaP). Complications assessment is essential to the objective evaluation of any new procedure. This study aimed to assess the perioperative complications encountered during the implementation of a robot-assisted urologic surgery program.
A prospective data collection for all men with a diagnosis of CaP who underwent RALRP between 2005 and 2009 in our department was achieved. Together with perioperative data, all the perioperative complications encountered were specifically recorded, including robot dysfunctions. The RALRP was performed with the three-arm Da Vinci system using a transperitoneal approach with six ports. To assess the perioperative complications, the validated Clavien-Dindo classification of surgical procedures was used. Two surgeons were involved in these procedures. A modified Clavien-Dindo classification also was used to account for intraoperative complications.
According to the Clavien-Dindo classification, 16 complications (6.7% complication rate) were recorded during the first 240 procedures. Besides postoperative complications, five procedures (2.1%) were directly affected by robot malfunctions without notable consequences for the patients. Considering these five additional complications, an 8.8% complication rate was recorded using a modified Clavien-Dindo classification. The main limitation of the study was its design restricted to RALRP procedures alone. The second limitation was that the authors' modified classification needs to be validated with a larger series and for different surgical procedures.
The findings show that RALRP is a safe alternative to classical surgery and that the robotic approach is reliable. The authors believe that the reliability of technological devices should be systematically discussed when outcome analysis of a new procedure is performed.
Surgical Endoscopy 02/2011; 25(2):536-42. · 4.01 Impact Factor
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ABSTRACT: The management of ureteropelvic junction (UPJ) obstruction has evolved over the past 20 years in response to the development of new technology. Open surgery is still the reference standard against which all other surgical interventions must be measured. The surgical approach has, however, gone through rapid changes, and the open procedure initially described has evolved considerably. Endoscopic and laparoscopic approaches have largely supplanted open pyeloplasty for the majority of primary ureteropelvic junction obstruction cases. Laparoscopic approaches provide a balance between a highly successful technique in all patients and improved postoperative recovery. It has been shown to improve postoperative outcomes with shorter recovery times and hospital stays, and to provide equivalent functional results with a success rate of 95%. Nevertheless, laparoscopic pyeloplasty is not a simple procedure. There are a certain number of disadvantages, such as the limited range of laparoscopic instrument movement, the two dimensional image, the unfamiliar hand-eye coordination and the relatively inefficient ergonomic position. Since 2000, however, robots have provided a magnified three-dimensional view giving a greater degree of freedom. This system has simplified suturing and has improved precision of the operating technique. However, the system is very expensive and, providing it is available in their institution, it seems easier for beginners to learn the robotic technique. Additionally, it has similar success rates (both radiological and clinical) to those obtained with open techniques.
Actas urologicas españolas 11/2009; 33(10):1103-7. · 0.46 Impact Factor
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ABSTRACT: To assess the oncologic control afforded by radical prostatectomy (RP) in high-risk prostate cancers with a Gleason score ≥ 8.
We performed a retrospective review of prostate cancer patients who underwent RP between 1995 and 2005 for prostate cancer and who had a pathologic Gleason score ≥ 8. Biochemical recurrence was defined as a single rise in PSA levels over 0.2 ng/ml after surgery.
Overall, 64 patients were included and followed for a median time of 84.3 months. The mean age was 63 ± 5.2 years. The mean preoperative PSA was 11.9 ± 7.3 ng/ml (1.9-31), and 29 patients (46%) had a PSA > 10 ng/ml. The biopsy Gleason score was ≤ 7 for 49 patients (76.6%). After pathologic analysis, there were 25 (39%) stage pT2, 37 (58%) stage pT3, and 2 (3%) stage pT4 patients. Nine patients had lymph node involvement (14%). The surgical margins were positive in 25 patients (39%). In 51 patients, (80%) the Gleason score was underestimated by biopsies: 40 patients with a definitive score of Gleason 8 had a Gleason score of 6 or 7 on biopsies, while 11 patients with a Gleason score of 9 initially, had a Gleason score of 7 or 8. Twenty-seven patients underwent adjuvant treatment: external radiation therapy (n = 19), HRT (n = 3), or both (n = 5). During follow-up, 41 patients (64%) presented with a biochemical recurrence, and 11 (17%) died. The PSA-free survival rate at five year was 44%.
RP remains a possible therapeutic option in certain cases of the high-risk cohort of patients with a Gleason score ≥ 8. However, patients should be warned that surgery might only be the first step of a multi-modal treatment approach. The modalities of adjuvant treatments and the right schedule to deliver it following RP still need to be defined.
Urologic Oncology 11/2009; 29(6):602-7. · 3.22 Impact Factor
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ABSTRACT: To highlight the main risk factors for metachronous bladder recurrence after treatment of an upper urinary tract urothelial cell carcinomas (UUT-UCCs) based on the recent literature.
Data on urothelial malignancies after UUT-UCCs management in the literature were searched using MEDLINE and by matching the following key words: urinary tract cancer; bladder carcinomas, urothelial carcinomas, upper urinary tract, renal pelvis, ureter prognosis, carcinoma, transitional cell, renal pelvis, ureter, bladder cancer, cystectomy, nephroureterectomy, minimally invasive surgery, recurrence, and survival.
No evidence level 1 information from prospective randomized trials was available. A range of 15% to 50% of patients with a UUT-UCC will subsequently develop a metachronous bladder UCC. Intraluminal tumor seeding and pan-urothelial field change effect have both been proposed to explain intravesical recurrences. In most cases, bladder cancer arises in the first 2 years after UUT-UCC management. However the risk is lifelong and repeat episodes are common. The identification of variables that allow accurate risk stratification of UUT-UCC patients with regards to future bladder relapse is disappointing. No factors have been identified to date that can reliably predict bladder recurrences. A history of bladder cancer prior to UUT-UCC management and upper tract tumor multifocality are the only frequently reported clinical risk factors among current literature.
Prior histories of bladder cancer and upper tract tumor multifocality are the most frequently reported risk factors for bladder tumors following UUT-UCCs. Surveillance regimen is based on cystoscopy and on urinary cytology for at least 5 years.
Urologic Oncology 09/2009; 29(2):130-6. · 3.22 Impact Factor
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Karim Ferhi,
Morgan Rouprêt,
Julie Rode,
Vincent Misrai,
Raphaële Renard-Penna,
Pierre Conort,
Marc-Olivier Bitker,
Alain Haertig,
Emmanuel Chartier-Kastler, François Richard,
Christophe Vaessen
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ABSTRACT: To assess the effectiveness of robot-assisted pyeloplasty in patients with clinically symptomatic ureteropelvic junction obstruction (UPJO).
We retrospectively reviewed our database for all patients who were treated for UPJO by a single surgeon using a robot-assisted procedure between 2005 and 2007. We collected the following: Patient age, clinical presentation, perioperative data, complications, length of hospital stay, and outcome. Preoperative evaluation of UPJO always included an injected renal CT scan and furosemide-mercaptoacetyltriglycine (MAG-3) renal scintigraphy. Patients were seen at 3 and 6 months after surgery and once a year thereafter. Postoperative success was defined as symptomatic response and radiographic evidence of no further obstruction.
Twenty patients with a mean age of 36.8 +/- 16 years (range 15-69 yr) were included. Six (30%) patients had previously undergone endoscopic treatment. The mean operative time was 150.3 +/- 36.22 minutes (range 150-240 min). The mean follow-up was 19.9 +/- 10.03 months (range 3-37 mos). Two (10%) procedures necessitated conversion to laparoscopic procedures, and there was no conversion to laparotomy. Four (20%) patients experienced minor complications: Two urinary tract infections and two urinomas. Repeated early surgery was needed in one patient for temporary (ie, 8 days) stent placement in the case of urinoma. There was no recurrence of the UPJO, and no repeated surgery was deemed necessary during the follow-up period. The success rate was estimated to be 95%.
Functional outcomes after robot-assisted procedures for alleviation of UPJO are very promising. Our data showed that the robot-assisted procedure was safe and featured negligible morbidity. Therefore, we conclude that our approach is a viable alternative to open surgery.
Journal of endourology / Endourological Society 07/2009; 23(6):959-63. · 1.75 Impact Factor
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ABSTRACT: To determine the cancer control afforded by radical prostatectomy in patients who underwent either an open, laparoscopic, or robotic procedure for localized prostate cancer.
We collected data on all patients treated between 2000 and 2004. We recorded age, BMI, PSA, Gleason score and 2002 TNM stage, type of surgery, perioperative parameters, postoperative complications, pathological data, recurrence and outcome.
Data were analyzed for 239 patients. Overall, the mean follow-up was 49.7 (18-103) months. Surgical procedures were open in 83 patients, laparoscopic in 85, and robot-assisted in 71. The transfusion rate was 5.6% for robotic cases, 5.9% for laparoscopic cases and 9.6% for open prostatectomy (p = 0.03). The positive margin rates in open, laparoscopic, and robotic cases were 18.1, 18.8, and 16.9% (p = 0.52), respectively. Only margin status, PSA level (>10), and Gleason score (>7) were associated with recurrence in univariate analysis (p < 0.05), and only the margin status and the Gleason score were significant in multivariate analysis. The statistical power was 0.7. Overall, the 5-year PSA-free survival rate was 88%. The 5-year PSA-free survival rates for the specific surgical approaches were 87.8% in open cases, 88.1% in laparoscopic cases, and 89.6% in robot-assisted prostatectomies, and there was no statistical difference between the approaches (p = 0.93).
Although open radical prostatectomy remains the gold standard procedure, we found no differences between these three techniques regarding early oncologic outcomes. These results are still preliminary, however, and further studies of larger populations with a longer follow-up are needed to make any statement regarding surgical strategy.
World Journal of Urology 05/2009; 27(5):599-605. · 2.41 Impact Factor
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Kien Nguyen,
Stephanie Eltz,
Sarah J Drouin,
Eva Comperat,
François Audenet,
Raphaele Renard-Penna,
Marc-Olivier Bitker,
Emmanuel Chartier-Kastler, François Richard,
Olivier Cussenot,
Morgan Rouprêt
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ABSTRACT: To assess the cancer control afforded by radical prostatectomy (RP) in patients with prostate-specific antigen (PSA) values above 20 ng/ml.
We performed a retrospective review of prostate cancer patients who had initial PSA values above 20 ng/ml and were treated with surgery between 1995 and 2006. Biochemical recurrence was defined as a single rise in PSA levels over 0.2 ng/ml after surgery.
Overall, 41 patients were included. The mean age was 62 +/- 6.43 years. The mean PSA was 27.39 +/- 13.57 ng/ml (range 20.3-80). After pathological analysis, prostate cancer was organ-confined in 21 cases (51.2%) and locally advanced in 20 cases (48.8%). Positive surgical margins were detected in 36.5% of cases (n = 15). Five patients had lymph node involvement (12%). The mean prostate volume was 58 +/- 28.9 cc. The mean length of follow-up after surgery was 94 +/- 37 months. Median time to biochemical recurrence was 44.6 +/- 22 months. The 5-year PSA-free survival rate was 53%. Through univariate analysis, the pathologic stage (p = 0.016), biopsy and pathological Gleason scores (p = 0.013; p = 0.02) and positive margin (p = 0.04) were associated with recurrence. Overall, 24 patients (58.5%) experienced a biochemical recurrence. Only margin status and pathological Gleason were significant in multivariate analysis (p < 0.05).
RP can be recommended as a viable primary treatment option in selected cases of the high-risk cohort of patients with pre-operative PSA values above 20 ng/ml. However, the modalities of adjuvant treatments following RP remain to be defined in patients who are likely to evolve unfavourably.
World Journal of Urology 05/2009; 27(5):653-8. · 2.41 Impact Factor
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Karim Bensalah,
Allan J Pantuck,
Nathalie Rioux-Leclercq,
Rodolphe Thuret,
Francesco Montorsi,
Pierre I Karakiewicz,
Nicolas Mottet,
Laurent Zini,
Roberto Bertini,
Laurent Salomon, [......],
Ofer Nativ,
Roy Farfara, François Richard,
Morgan Roupret,
Christian Doehn,
Patrick J Bastian,
Stefan C Muller,
Jacques Tostain,
Arie S Belldegrun,
Jean-Jacques Patard
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ABSTRACT: The occurrence of positive surgical margins (PSMs) after partial nephrectomy (PN) is rare, and little is known about their natural history.
To identify predictive factors of cancer recurrence and related death in patients having a PSM following PN.
Some 111 patients with a PSM were identified from a multicentre retrospective survey and were compared with 664 negative surgical margin (NSM) patients. A second cohort of NSM patients was created by matching NSM to PSM for indication, tumour size, and tumour grade.
PSM and NSM patients were compared using student t tests and chi-square tests on independent samples. A Cox proportional hazards regression model was used to test the independent effects of clinical and pathologic variables on survival.
Mean age at diagnosis was 61+/-12.5 yr. Mean tumour size was 3.5+/-2 cm. Imperative indications accounted for 39% (43 of 111) of the cases. Some 18 patients (16%) underwent a second surgery (partial or total nephrectomy). With a mean follow-up of 37 mo, 11 patients (10%) had recurrences and 12 patients (11%) died, including 6 patients (5.4%) who died of cancer progression. Some 91% (10 of 11) of the patients who had recurrences and 83% of the patients (10 of 12) who died belonged to the group with imperative surgical indications. Rates of recurrence-free survival, of cancer-specific survival, and of overall survival were the same among NSM patients and PSM patients. The multivariable Cox model showed that the two variables that could predict recurrence were the indication (p=0.017) and tumour location (p=0.02). No other variable, including PSM status, had any effect on recurrence. None of the studied parameters had any effect on the rate of cancer-specific survival.
PSM status occurs more frequently in cases in which surgery is imperative and is associated with an increased risk of recurrence, but PSM status does not appear to influence cancer-specific survival. Additional follow-up is needed.
European urology 04/2009; 57(3):466-71. · 7.67 Impact Factor
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ABSTRACT: Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI).
To assess the early functional outcome after laparoscopic placement of an AUS in women.
Twelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures.
The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina.
Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter.
The mean age of subjects was 56.7+/-12 yr (33-78). The mean body mass index was 24+/-2.3 (20-25). The mean preoperative closure pressure was 22+/-10.9 cmH(2)O (4-35). The mean operative time was 181+/-39 min [110-240]. Intraoperative complications occurred in three women (25%), with bladder (n=2) and vaginal (n=2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7+/-2.3 d (3-11). The bladder catheter was removed after a mean time of 10+/-8 d (2-30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4-14 wk after implantation. Mean follow-up was 12.1+/-8 mo (5.2-27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up.
AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy.
European urology 04/2009; 57(3):499-504. · 7.67 Impact Factor
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ABSTRACT: Suburethral tapes have been widely adopted to treat stress urinary incontinence. Further resection of such tapes may be necessary in certain cases. We review our experience and assess urinary functional outcomes.
We retrospectively reviewed the data on all women referred to our institution between 2001 and 2007 for suburethral tape related complications and on those who had the tape surgically removed. Complete or partial resection was achieved after assessment, including endoscopic and urodynamic assessment.
A total of 75 women with a mean age of 60.7 years (range 28 to 78) were included in the study. The tape used was transvaginal in 58 cases (77.3%) and transobturator in 17 (22.7%). There were different complications, such as erosion in 16% of cases, vaginal extrusion in 24%, bladder outlet obstruction in 45%, chronic pelvic pain in 21%, and de novo urinary incontinence and urgency in 12%. Resection was done a mean +/- SD of 33 +/- 22 months (range 6 to 80) after tape placement. Of the 58 women with transvaginal tape the tape was completely removed by laparoscopy in 30 (51%). Four of the 17 transobturator slings (23%) were completely removed by laparoscopy (1) and via a low gynecological approach (3). The remaining slings were partially resected via a gynecological approach. At a mean followup of 38.4 months (range 12 to 72) incontinence recurred in 39 women (52%) after partial (18) and complete (21) resection.
In rare women who experience crippling symptoms after suburethral sling implantation urologists must be aware that the decision to completely or partially resect the tape can help resolve symptoms.
The Journal of urology 04/2009; 181(5):2198-202; discussion 2203. · 4.02 Impact Factor
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ABSTRACT: Micropapillary carcinoma (MPC) of the bladder is a rare and aggressive histologic variant of urothelial carcinoma (UC). At the time of presentation, most MPC are muscle invasive with frequent vascular invasion (VI). Our series explores protein expression of markers known to be indicators of poor clinical outcome and progression, trying to explain aggressiveness of MPC.
18 patients with MPC were reviewed. We explored protein expression of p53, MIB-1, Aurora-A and survivin in MPC and compared their expression to conventional urothelial carcinoma (CUC) of the same grade and stage.
Patients, aged 46-85 years, underwent transurethral resection or cystoprostatectomy for UC. MPC was either pure (39%) or only partially present (61%). 55% of the patients died. VI was seen in 95%. MPC displayed overexpression of p53 and MIB-1, Aurora-A and survivin. No statistically significant difference could be made with CUC except for Aurora-A (p = 0.03).
This is the first study to explore different markers of bad clinical outcome in MPC. We suggest that Aurora-A via mechanisms implied into early steps of mitosis might play a role in aggressive clinical behavior of MPC.
Urologia Internationalis 02/2009; 82(3):312-7. · 0.99 Impact Factor
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Evanguelos Xylinas,
Sarah J Drouin,
Eva Comperat,
Christophe Vaessen,
Raphaële Renard-Penna,
Vincent Misrai,
Marc-Olivier Bitker,
Emmanuel Chartier-Kastler, François Richard,
Olivier Cussenot,
Morgan Roupret
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ABSTRACT: To determine the effectiveness of cancer control afforded by radical prostatectomy (RP) in patients with clinical stage T3 prostate cancer.
We retrospectively reviewed data for patients treated by RP for clinical stage T3 prostate cancer between 1995 and 2005. The following case characteristics were analysed: patient age, clinical presentation, preoperative prostate-specific antigen (PSA) level, Gleason score, tumour stage (2002 Tumour-Node-Metastasis), surgical procedure, pathological data, margin and lymph node status, and recurrence. Biochemical recurrence was defined as an increase in PSA level of >0.2 ng/mL after surgery. Kaplan-Meier survival curves were generated, and prognostic factors were evaluated.
Overall, 100 patients were included; only 79% of them had pT3 disease based on the pathological specimen. The median follow-up after RP was 69 months. The RP was open in 77 and laparoscopic in 23, with no significant difference between these approaches (P = 0.38). The 5-year PSA-free survival after surgery was 45%, and 5-year cancer-specific survival was 90%. On univariable analysis, Gleason score >7 (P = 0.01), pathological stage (pT2-T3a vs T3b) (P < 0.001), positive lymph node (P < 0.001), and positive margin (P < 0.001) were associated with recurrence. On multivariable analysis, lymph node, margin status and Gleason score were also significant (P < 0.05).
RP can be recommended as an alternative primary treatment that results in acceptable cancer control for clinical stage T3 prostate cancer in selected cases. However, the patient should be warned that surgery alone might not be sufficient to control the cancer, and that adjuvant therapy might be needed during the course of the disease.
BJU International 12/2008; 103(9):1173-8; discussion 1178. · 2.84 Impact Factor
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ABSTRACT: We determined the cancer control provided by nephron sparing surgery for renal cell carcinoma greater than 4 cm.
We performed a retrospective review of data on patients treated between 1980 and 2005. The case characteristics analyzed were patient age, surgical procedure, intraoperative parameters, complications, tumor size, Fuhrman grade, TNM stage, pathological data and outcome. Kaplan-Meier survival curves were generated.
Median age of the 61 patients was 64 years (range 40 to 83). Mean +/- SD intraoperative blood loss was 622 ml +/- 691 (range 50 to 4,800) and mean operative time was 155.7 +/- 82 minutes (range 52 to 360). Mean creatinine preoperatively and immediately postoperatively was 1.16 and 1.25 mg/dl, respectively. Mean renal cell carcinoma size was 56.3 +/- 18 mm (range 41 to 100). Margin status was positive in 11 cases (18%). Median followup was 70.7 months. The 5 and 10-year cancer specific survival rate was 81% and 78%, respectively. The tumor-free survival rate was 92% at 5 years and 88% at 10 years. On univariate analysis tumor size more than 7 cm (p = 0.002), pathological stage (p = 0.001) and Fuhrman grade (p = 0.004) were associated with survival. On multivariate analysis only pathological stage and Fuhrman grade were significant (p <0.0001 and 0.007, respectively).
Our results support the fact that nephron sparing surgery is a useful and acceptable approach to renal cell carcinoma greater than 4 cm. When technically possible, nephron sparing surgery provides acceptable long-term cancer specific survival rates. However, oncological safety is less evident in cases of renal cell carcinoma greater than 7 cm. To date in such cases nephron sparing surgery should only be considered for absolute indications.
The Journal of urology 11/2008; 181(1):35-41. · 4.02 Impact Factor
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Morgan Rouprêt,
Vincent Hupertan,
David R Yates,
Eva Comperat,
James W F Catto,
Mark Meuth,
Amine Lackmichi,
Sylvie Ricci,
Roger Lacave,
Bernard Gattegno, François Richard,
Freddie C Hamdy,
Olivier Cussenot
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ABSTRACT: To compare the potential of two diagnostic methods for detecting recurrence of urothelial cell carcinoma (UCC) of the bladder, by (i) detecting alterations in microsatellite DNA markers and loss of heterozygosity (LOH), and (ii) detecting aberrant gene hypermethylation, as UCC has a high recurrence rate in the urinary tract and the disease can invade muscle if new tumours are overlooked.
Over 1 year, urine samples were retrieved from 40 patients already diagnosed with bladder UCC (30 pTa, two pTis, eight pT1). Samples were collected 6 months after bladder tumour resection, during the follow-up schedule. We used samples to analyse nine microsatellite markers and the methylation status of 11 gene promoters. Receiver operating characteristic curves were generated and Bayesian statistics used to create an interaction network between recurrence and the biomarkers.
During the study, 15 of the 40 patients (38%) had a tumour recurrence and 14 were identified by cystoscopy (reference method). Overall, microsatellite markers (area under curve, AUC 0.819, 95% confidence interval, CI, 0.677-0.961) had better performance characteristics than promoter hypermethylation (AUC 0.448, 0.259-0.637) for detecting recurrence. A marker panel of IFNA, MBP, ACTBP2, D9S162 and of RASSF1A, and WIF1 generated a higher diagnostic accuracy of 86% (AUC 0.92, 0.772-0.981).
Microsatellite markers have better performance characteristics than promoter hypermethylation for detecting UCC recurrence. These data support the further development of a combination of only six markers from both methods in urinary DNA. Once validated, it could be used routinely during the follow-up for the early detection and surveillance of UCC from the lower and upper urinary tract.
BJU International 07/2008; 101(11):1448-53. · 2.84 Impact Factor
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ABSTRACT: To assess the long term oncologic results of high-intensity focused ultrasound therapy (HIFU) as a primary and single treatment for clinically localized prostate cancer.
A total of 119 patients with clinically localized prostate cancer underwent HIFU (Ablatherm((R)), EDAP, France) as first-line treatment and were retrospectively reviewed. They were stratified according to risk groups proposed by D'Amico. No patient had undergone previous hormonal therapy. PSA level was monitored at 3, 6, 12, 18, 24 months and then yearly. According to the latest ASTRO criteria, failure was defined by a PSA rise of 2 ng/ml or more above the PSA nadir. The biochemical-free survival rate (BFSR) was calculated.
Mean patient age was 68 +/- 7.8 years (46-83). Mean follow-up was 3.9 years (1-6.8). Overall 52 patients (43.7%) experienced a biochemical recurrence which included 26, 23 and 3 patients in the low, intermediate and high-risk groups, respectively. In univariate and multivariate analyses, there was a statistical association between preoperative PSA value > 10, a nadir PSA value > 1 and the risk of biochemical recurrence (P < 0.05). The 5-year BFSR rate was 30% with no statistical difference between low- and intermediate-risk patients. None of the 119 patients died of prostate cancer.
High-intensity focused ultrasound therapy provides efficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy.
World Journal of Urology 06/2008; 26(5):481-5. · 2.41 Impact Factor
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ABSTRACT: To develop and validate a standardized tool assessing urinary symptoms among men and women with stress, urge, frequency, or urinary obstructive symptoms for use in clinical practice to complement clinical measures and diagnosis.
After development by an advisory committee and comprehension testing with patients, the Urinary Symptoms Profile (USP) item content and validity were evaluated by clinicians. Patients with urinary symptoms (n = 253) and without symptoms (n = 75) completed the final questionnaire at day 0 and day 7. Psychometric properties were assessed, including construct and clinical validity, reliability, and predictive ability for detection of and differentiation between urinary disorders.
Principal Component Analysis with Varimax Rotation confirmed the final USP structure of 13 items in 3 dimensions: stress urinary incontinence (SUI), overactive bladder (OAB), and low stream (LS). Internal consistency reliability (Cronbach's alpha ranging from 0.69 to 0.94) and concurrent validity (Spearman correlation coefficients between International Consultation on Incontinence Questionnaire and SUI and OAB dimensions of 0.73 and 0.62, respectively) were good. Test-retest reproducibility over 7 days was excellent in stable patients (Intraclass Correlation Coefficients from 0.84 to 0.91). USP clinical validity was demonstrated by comparing micturition diary with USP scores. USP dimension scores were excellent predictors of urinary disorder presence and identification.
USP is the first valid and reliable questionnaire providing comprehensive evaluation of all urinary disorders and their severity in both men and women with SUI, OAB, and LS. It allows the screening and contributes to the differential diagnosis of these symptoms. The USP is a valuable tool for use in clinical practice.
Urology 05/2008; 71(4):646-56. · 2.43 Impact Factor
