Aurélien Descazeaud

Centre Hospitalier Universitaire de Limoges, Limages, Limousin, France

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Publications (113)153.3 Total impact

  • S Lebdai, A Descazeaud
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    ABSTRACT: Benign prostatic hyperplasia is a frequent pathology in men after 50years old. It is responsible for lower urinary tract symptoms (LUTS). These LUTS might have an important impact on quality of life and might induce complications that might require medical or surgical treatments. The aim of this study was to explain the management of LUTS due to BPH.
    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 perform an update on the conservative treatment of male non-neurologic urinary incontinence.
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 09/2014; 24(10):610-5.
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    ABSTRACT: To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder.
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 07/2014; 24(9):588-94.
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    ABSTRACT: To perform an update on the initial evaluation of male urinary incontinence (MUI).
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 06/2014; 24(7):421-6.
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    ABSTRACT: Intravesical prostatic protrusion (IPP) is a protrusion of the lateral and/or median prostatic lobes into the bladder lumen. IPP can be estimated by suprapubic ultrasound. A literature search was conducted in Pubmed/MEDLINE database using the following keywords: intravesical prostatic protrusion; benign prostatic enlargement; treatment outcome; ultrasonography. There are 3 grades of IPP: grade 1, 2 and 3 respectively if IPP≤5mm, if 5-10mm, and if >10mm. IPP was a better prognosis factor than PSA and prostate volume for bladder outlet obstruction (BOO) with a sensibility of 80% and a sensitivity of 68% for grade 3. The progression risk of BOO increased with IPP (grade 1: OR=5.1 [95%CI: 1.6-16.2] and grade≥2 OR=10.4 [95%CI: 3.3-33.4]). IPP was a predictive marker of failure of trial off catheter in patients with acute urinary retention with a 6 folds higher risk for grades ≥2. IPP was a prognosis factor for tamsulosine efficacy: 78% of patients with grade≤2 had an improvement >35% of the IPSS-score versus 58% for grade >3 (P<0.01). Patients with grade >3 and a PV<40cc had a poorer response to tamsulosine. After TURP, IPSS was more improved for grade≥1 with an OR=3.43 (95%CI: 1.03-11.44, P=0.045). IPP can be a useful marker for the management of LUTS/BPH.
    Progrès en Urologie 04/2014; 24(5):313-8. · 0.80 Impact Factor
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    ABSTRACT: The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice. This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3months. Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2±6.1 to 9.7±5.5, P<0.0001) and USP score (from 10.6±5.1 to 6 0±4.6, P<0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P<0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P<0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3months of treatment silodosin was continued in 86.9% of patients. This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.
    Progrès en Urologie 03/2014; 24(3):196-202. · 0.80 Impact Factor
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    ABSTRACT: Purpose To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder. Method A systematic review was conducted using PubMed/MEDLINE with the following keywords: “overactive bladder”, “male urinary incontinence”, “urgency”, “antimuscarinic”, “onabotulinumtoxinA”, “neurostimulation”, “cystoplasty”. Results Antimuscarinic treatments were the first line option for overactive bladder incontinence (decreased incontinence under tolterodine versus placebo respectively −71% vs. −40%, P < 0.05). Their main side effects were dry mouth (16–29.6%) and constipation (4%), which might decrease the observance. In case of failure, neuromostimulation could be prosed with a 67% efficacy rate. Intra-detrusorian injections of onabotulinumtoxinA were an option, however there were still not validated for this indication and their efficacy decreases with time and after repeated injections. The ultimate option in case of refractory major over-activity was cystoplasty, which involves major morbidity for inconstant efficacy. Conclusions The same treatments are available for non-neurologic urinary incontinence by bladder over-activity for men and women: antimuscarinic drugs, neurostimulation, onabotulinumtoxinA. However, only few data is available for masculine population exclusively.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: Purpose To perform an update on the conservative treatment of male non-neurologic urinary incontinence. Method A systematic review was conducted using PubMed/MEDLINE with the following keywords: “incontinence”, “male stress urinary incontinence”, “pelvic floor training”, “biofeedback”, “absorbant products”, “life style”, “penile clamp”. Results Palliative devices like penile clamps, penile sheaths and absorbent products were transitory options that were poorly evaluated. Life style modifications (scheduled voiding, controlled hydric absorption, decreased caffeine and spice intake) were useful in complement of other treatments especially in case of overactive bladder. Pelvic floor training (PFT) was useful after radical prostatectomy but remained optional for other types of incontinence. It accelerated the continence recovery postoperatively but it results at 1 year were uncertain. These results were maintained 1 year. Conservative treatments were useful postoperatively especially early supervised PFT. The benefit of biofeedback and perineal stimulation was controversial. Balder catheterization was a last resort option. Penile sheaths were better than urethral catheterization if there were no post-voiding residual urines. Conclusions Palliative options have a limited efficacy but are mini-invasive and might be helpful complementary options.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: Introduction Intravesical prostatic protrusion (IPP) is a protrusion of the lateral and/or median prostatic lobes into the bladder lumen. IPP can be estimated by suprapubic ultrasound. Methods A literature search was conducted in Pubmed/MEDLINE database using the following keywords: intravesical prostatic protrusion; benign prostatic enlargement; treatment outcome; ultrasonography. Results There are 3 grades of IPP: grade 1, 2 and 3 respectively if IPP ≤ 5 mm, if 5–10 mm, and if > 10 mm. IPP was a better prognosis factor than PSA and prostate volume for bladder outlet obstruction (BOO) with a sensibility of 80% and a sensitivity of 68% for grade 3. The progression risk of BOO increased with IPP (grade 1: OR = 5.1 [95%CI: 1.6–16.2] and grade ≥ 2 OR = 10.4 [95%CI: 3.3–33.4]). IPP was a predictive marker of failure of trial off catheter in patients with acute urinary retention with a 6 folds higher risk for grades ≥ 2. IPP was a prognosis factor for tamsulosine efficacy: 78% of patients with grade ≤ 2 had an improvement > 35% of the IPSS-score versus 58% for grade > 3 (P < 0.01). Patients with grade > 3 and a PV < 40 cc had a poorer response to tamsulosine. After TURP, IPSS was more improved for grade ≥ 1 with an OR = 3.43 (95%CI: 1.03–11.44, P = 0.045). Conclusion IPP can be a useful marker for the management of LUTS/BPH.
    Progrès en Urologie. 01/2014; 24(5):313–318.
  • S. Lebdai, A. Descazeaud
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    ABSTRACT: Benign prostatic hyperplasia is a frequent pathology in men after 50 years old. It is responsible for lower urinary tract symptoms (LUTS). These LUTS might have an important impact on quality of life and might induce complications that might require medical or surgical treatments. The aim of this study was to explain the management of LUTS due to BPH.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: To describe drugs targeting urethra and prostate to treat dysfunctions such LUTS related to BPH, primary bladder neck obstruction (PBNO), detrusor sphincter dyssynergia (DSD) or sphincter deficiency (SD). Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). To treat LUTS related to BPH alpha-blockers (AB) and 5-alpha reductase inhibitors (5ARIs) have a clearer efficacy than plant extract. Daily Phospdiesterase 5 inhibitors (PDE5Is) alone or in association with AB also demonstrate efficacy in this indication. AB are an option in PBNO and DSD related to multiple sclerosis. Although Botulinum toxin A derived molecules decrease urethral pressure in patient with DSD related to spinal cord injury or multiple sclerosis, efficiency remains to be demonstrated. Duloxetine a serotonin reuptake inhibitor increases urethral sphincter pressure and reduce stress urinary incontinence in women and men. Nevertheless, moderate efficacy combine with frequent side effects lead French regulation agency to reject its agreement. Armamenterium to treat urethral dysfunctions has recently increases. Two new therapeutic classes emerge: PDE5Is to treat LUTS related to BPH and an SRIs (Duloxetine) to treat stress urinary incontinence. Efficacy and safety evaluation of all the possible associations between drugs targeting urethra and/or bladder is needed to a subtler and more efficient pharmacologic modulation of lower urinary tract dysfunction.
    Progrès en Urologie 11/2013; 23(15):1287-98. · 0.80 Impact Factor
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    ABSTRACT: The present study assessed the incidence and histopathological features of incidentally diagnosed prostate cancer (PCa) in specimens from radical cystoprostatectomy (RCP) for bladder cancer. The patient outcomes also were evaluated. We retrospectively reviewed the histopathological features and survival data of 4,299 male patients who underwent a RCP for bladder cancer at 25 French centers between January 1996 and June 2012. No patients had preoperative clinical or biological suspicion of PCa. Among the 4,299 RCP specimens, PCa was diagnosed in 931 patients (21.7 %). Most tumors (90.1 %) were organ-confined (pT2), whereas 9.9 % of them were diagnosed at a locally advanced stage (≥pT3). Gleason score was <6 in 129 cases (13.9 %), 6 in 575 cases (61.7 %), 7 (3 + 4) in 149 cases (16.0 %), 7 (4 + 3) in 38 cases (4.1 %), and >7 in 40 cases (4.3 %). After a median follow-up of 25.5 months (interquartile range 14.2-47.4), 35.4 % of patients had bladder cancer recurrence and 23.8 % died of bladder cancer. Only 16 patients (1.9 %) experienced PCa biochemical recurrence during follow-up, and no preoperative predictive factor was identified. No patients died from PCa. The rate of incidentally diagnosed PCa in RCP specimens was 21.7 %. The majority of these PCas were organ-confined. PCa recurrence occurred in only 1.9 % of cases during follow-up.
    Annals of Surgical Oncology 10/2013; · 4.12 Impact Factor
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    ABSTRACT: OBJECTIVE: To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). EVIDENCE ACQUISITION: We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. EVIDENCE SYNTHESIS: Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. CONCLUSIONS: These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/pdf/12_Male_LUTS.pdf).
    European Urology 03/2013; · 10.48 Impact Factor
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    ABSTRACT: Background. There are no validated markers that predict outcome in metastatic renal cell cancer (mRCC) patients treated with sunitinib. Recently, single nucleotide polymorphism (SNP) rs9582036 in VEGFR1 has been proposed as a predictor of progression-free survival (PFS) and overall survival (OS) to bevacizumab in patients with pancreatic cancer and rs7993418 in VEGFR1 as predictor for PFS in mRCC-patients treated with bevacizumab. Here, we aim to study the impact of these SNPs in mRCC patients treated with sunitinib. Methods. We included patients with mRCC treated in 15 institutions in France and Belgium. Patients received sunitinib as first-line targeted therapy. We assessed response, time-to-tumor progression (TTP), OS, and clinical and biochemical parameters associated with outcome. We genotyped rs9582036 and rs7993418 as well as three other surrounding SNPs in VEGFR1: rs9554320, rs9554316 and rs9513070. Association between SNPs and treatment outcome were studied by univariate analysis and by multivariate Cox regression using relevant clinical factors associated with TTP and OS as covariates. Findings. Ninety-one patients were included. We found that mRCC patients with the CC-variant in rs9582036 in VEGFR1 have a poorer response rate (RR) (0% vs. 46%, p = 0.028), a poorer PFS (10 vs. 18 months, p = 0.033 on univariate and 0.06 on multivariate analysis) and a poorer OS (14 vs. 31 months, p = 0.019 on univariate and 0.008 on multivariate analysis) compared to patients with the AC- and AA-genotypes. mRCC patients with the AA-variant in rs9554320 in VEGFR1 have a poorer PFS (12 vs. 21 months, p = 0.0066 on univariate and 0.005 on multivariate analysis) and a poorer OS (22 vs. 34 months, p = 0.019 on univariate and 0.067 on multivariate analysis) compared to patients with the AC- and CC-genotypes. Interpretation. mRCC patients with the CC-genotype in VEGFR1 SNP rs9582036 have a poorer response rate, PFS and OS when treated with sunitinib. These findings are in agreement with the association of rs9582036 and outcome observed in bevacizumab treated pancreatic cancer patients. Prospective validation of this SNP is warranted.
    Acta oncologica (Stockholm, Sweden) 02/2013; · 2.27 Impact Factor
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    ABSTRACT: OBJECTIVE: The objective of the study was to evaluate the effect of a history of bladder cancer (BC) or synchronous BC on the prognosis and survival of patients who have undergone radical nephroureterectomy(RNU). METHODS AND MATERIALS: Using a multi-institutional, retrospective database, we identified 662 patients with upper urinary tract urothelial carcinoma (UUT-UC) treated by radical nephroureterectomy, between 1995 and 2010. We analyzed clinicopathologic characteristics and outcomes according to the history of BC or concomitant BC or both, at the time of diagnosis. BC was evaluated as a prognostic factor for bladder recurrence and survival. RESULTS: Overall, 83 (12.5%) patients had previous BC, 62 (9.4%) exhibited concomitant BC, and 75 (11.3%) presented with both previous and current BC. A history of BC was less seen in women and nonsmokers (P<0.0001 and P = 0.013, respectively). The patients with associated BC had more tumors located in the ureter (P<0.0001), as well as more multiple locations in the upper tract (P<0.0001). The tumors without concomitant BC were more likely to be associated with locally advanced stages (P = 0.024). At a median follow-up time of 37.3 months, 31.4% of patients experienced BC recurrence and 2.9% developed contralateral upper tract tumor. Using multivariate analyses, the previous or synchronous BC (P = 0.01) and positive surgical margins (P = 0.03) are independent prognostic factors for BC recurrence. The metastasis-free survival and cancer-specific survival rates did not significantly differ according to the associated BC status. CONCLUSIONS: In patients without previous or concomitant BC, the upper tract tumors are more frequently localized in the renal pelvis and are associated with a more invasive status at the time of diagnosis. Nevertheless, the presence of UUT-UC without previous or synchronous BC did not significantly affect the survival rates after nephroureterectomy.
    Urologic Oncology 02/2013; · 3.65 Impact Factor
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    ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Positive surgical margin (PSM) frequency after radical cystectomy has been estimated to be 4-15%. Studies that have not distinguished between the different sites of PSM have failed to show that they are an independent prognostic factor for disease-free survival. Only perivesical soft tissue PSMs have been associated with an increased risk of cancer recurrence and cancer-specific death. This is the first comprehensive published analysis of PSMs occurring during radical cystectomy for pTx pN0 M0 bladder cancer according to their location, comparing their cancer-specific survival (CSS) and other outcomes with those of a control group paired according to TNM status, age, sex and urinary diversion method. Local recurrence-free survival rates were found to be lower in patients with both soft tissue and urethral PSMs. Moreover, soft-tissue PSMs were associated with lower metastatic recurrence-free and CSS rates. OBJECTIVE: To compare the prognoses associated with positive surgical margins (PSMs) according to their urethral, ureteric and/or soft tissue locations in patients with pN0 M0 bladder cancer who have not undergone neoadjuvant chemotherapy. PATIENTS AND METHODS: A retrospective, case-control study was conducted between 1991 and 2011 using data from 17 academic centres in France. A total of 154 patients (cases) with PSMs met the eligibility criteria and were matched according to centre, pT stage, gender, age and urinary diversion method with a population-based sample of 154 patients (controls) from 3651 patients who had undergone cystectomies. The median follow-up period was 23.9 months. Multivariable Cox regression analysis was used to test the effects of PSMs on local recurrence (LR)-free survival, metastatic recurrence (MR)-free survival and cancer-specific survival (CSS). RESULTS: The 5-year LR-free survival and CSS rates of patients with urethral and soft tissue PSMs were lower than those in the control group. A significant decrease in CSS was associated with soft tissue PSMs (P = 0.003, odds ratio = 0.425, 95% confidence interval 0.283-0.647). The prognosis was not affected in cases of ureteric PSMs. CONCLUSIONS: Soft tissue PSMs were associated with poor CSS rates in patients with pN0 M0 bladder cancer. A correlation between urethrectomy and a reduction of the risk of LR in a urethral PSM setting was observed.
    BJU International 01/2013; · 3.05 Impact Factor
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    ABSTRACT: Despite the high prevalence of histological Benign Prostatic Hypeplasia (BPH) in elderly men, little is known regarding the molecular mechanisms and networks underlying the development and progression of the disease. Here, we explored the effects of a phytotherapeutic agent, Lipidosterolic extract of the dwarf palm plant Serenoa repens (LSESr), on the mRNA gene expression profiles of two representative models of BPH, BPH1 cell line and primary stromal cells derived from BPH. Treatment of these cells with LSESr significantly altered gene expression patterns as assessed by comparative gene expression profiling on gene chip arrays. The expression changes were manifested three hours following in vitro administration of LSESr, suggesting a rapid action for this compound. Among the genes most consistently affected by LSESr treatment, we found numerous genes that were categorized as part of proliferative, apoptotic, and inflammatory pathways. Validation studies using quantitative real-time PCR confirmed the deregulation of genes known to exhibit key roles in these biological processes including IL1B, IL1A, CXCL6, IL1R1, PTGS2, ALOX5, GAS1, PHLDA1, IL6, IL8, NFkBIZ, NFKB1, TFRC, JUN, CDKN1B, and ERBB3. Subsequent analyses also indicated that LSESr treatment can impede the stimulatory effects of certain proinflammatory cytokines such as IL6, IL17, and IL15 in these cells. These results suggest that LSESr may be useful to treat BPH that manifest inflammation characteristics. This also supports a role for inflammation in BPH presumably by mediating the balance between apoptosis and proliferation.
    International Journal of Molecular Sciences 01/2013; 14(7):14301-14320. · 2.46 Impact Factor
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    ABSTRACT: Purpose To perform an update on the initial evaluation of male urinary incontinence (MUI). Method A systematic review was conducted using Pubmed/Medline from 1995 to 2013. Results Definition of MUI and its prevalence is variable according its definition and the population. Tools for its evaluation have been mainly studied in female population or only in patients with UI after radical prostatectomy. Objectives of the initial evaluation are to assess the type of incontinence, to evaluate its severity and the bother associated, and define the choice of treatment. Medical history, clinical assessment, and urine analysis are the first steps of the evaluation. Bladder diary, questionnaires and pad test can be useful to evaluate MUI. Post-void residual volume assessment is necessary if lower urinary tract symptoms are associated. Imaging is not routinely used in MUI. A specialist referral and further investigations such as urethrocystoscopy and urodynamics should be considered in case of invasive treatment, recurrent incontinence and specific situations. Conclusions Initial assessment of MUI should be sequential with systematic investigations and optional ones.
    Progrès en Urologie. 01/2013;
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    ABSTRACT: The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice. Method This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3 months. Results Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2 ± 6.1 to 9.7 ± 5.5, P < 0.0001) and USP score (from 10.6 ± 5.1 to 6 0 ± 4.6, P < 0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P < 0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P < 0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3 months of treatment silodosin was continued in 86.9% of patients. Conclusion This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.
    Progrès en Urologie. 01/2013;
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    ABSTRACT: Objectif Établir des recommandations de bonne pratique pour la démarche diagnostique, le suivi et le traitement d’une hyperplasie bénigne de prostate (HBP). Méthode Une revue systématique de la littérature a été réalisée. Le niveau de preuve des publications sélectionnées a été évalué. Des recommandations ont ensuite été établies et gradées par un groupe de travail, puis relues par un groupe de relecteurs selon la technique du consensus formalisé. Résultats La terminologie de l’International Continence Society (ICS) a été adoptée. Les objectifs du bilan initial sont multiples : affirmer que les symptômes du bas appareil urinaire (SBAU) sont liés à l’HBP, évaluer la gêne provoquée par les SBAU et rechercher une obstruction sous-vésicale compliquée. L’interrogatoire avec réalisation d’un score symptomatique, et l’examen physique comprenant un toucher rectal, l’examen d’urine, la débitmétrie et la mesure du résidu post-mictionnel font parti du bilan de première intention recommandé pour explorer des SBAU d’un homme afin de répondre aux questions posées ci-dessus. Le catalogue mictionnel est optionnel dans ce bilan initial, mais recommandé si les symptômes de la phase de remplissage sont prédominants. Le dosage du PSA est utile chez les patients pour lesquels le diagnostic d’un cancer modifierait la prise en charge des SBAU. Lorsqu’un traitement chirurgical est envisagé, un dosage de la créatininémie et du PSA, ainsi qu’une échographie de l’appareil urinaire sont recommandés. L’information du patient sur le caractère bénin mais éventuellement progressif de sa pathologie est recommandée. En l’absence de gène et de complication, une surveillance annuelle est recommandée. Le traitement médical repose sur la phytothérapie, les alpha-bloquants et les inhibiteurs de la 5-alpha-réductase, les deux derniers pouvant être associés. L’association d’un anticholinergique et d’un alpha-bloquant peut être proposée à des patients déjà traités par alpha-bloquant seul ayant des SBAU de la phase de remplissage persistants, et en l’absence d’obstruction sous-vésicale sévère (résidu post-mictionnel supérieur à 200 mL ou débit maximum inférieur à 10 mL/s). Les inhibiteurs de la phosphodiestérase de type 5 peuvent être proposés aux patients présentant une dysfonction érectile associée à des SBAU. En cas d’HBP compliquée, ou lorsque le traitement médical est inefficace ou mal toléré, une solution chirurgicale est discutée. Tout traitement doit être décidé en tenant compte de la symptomatologie et de la gêne du patient, de l’anatomie prostatique, du degré d’obstruction et du retentissement éventuel sur l’appareil urinaire, des co-morbidités du patient, de l’expérience du praticien, et du choix du patient en termes de bénéfice, de risque et d’effets indésirables attendus. Outre la chirurgie classique (adénomectomie sus-pubienne, résection trans-urétrale de prostate, incision cervivo-prostatique), les options chirurgicales ayant le plus haut niveau de preuve quant à leur efficacité sont la résection électrique bipolaire, la photovaporiation laser en longueur d’onde 532 nm, et l’énucléation par laser Holmium. Conclusion Sont ici présentées les premières recommandations de l’Association française d’urologie sur le bilan initial, le suivi et le traitement des troubles mictionnels en rapport avec une HBP.
    Progrès en Urologie. 12/2012; 22(16):977–988.

Publication Stats

529 Citations
153.30 Total Impact Points

Institutions

  • 2008–2014
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France
    • Centre Hospitalier Universitaire de Poitiers
      Poitiers, Poitou-Charentes, France
  • 2011–2013
    • University of Limoges
      Limages, Limousin, France
  • 2010–2012
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2009–2012
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
  • 2008–2011
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2007–2008
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      • Service d’Urologie
      Lutetia Parisorum, Île-de-France, France
  • 2006–2007
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France