RESUMO
PURPOSE: To assess the benefits of magnetic resonance imaging (MRI) in the dosimetric treatment planning for prostate radiotherapy. PATIENTS AND METHODS: Ten consecutive patients have been enrolled. They were treated for a low risk prostate adenocarcinoma. A rigid superimposition was performed between MRI and scan slides obtained at time of virtual simulation, then prostate volume was delineated by four to five physicians, on TDM slides and on MRI/TDM superimposition. For each treatment plan, we assessed the impact of MRI in terms of planned treatment volume (PTV) position, individual variability of prostate delineation and doses delivered to the critical organs. The prescribed dose was 74 Gy in 37 fractions to the PTV. RESULTS: PTV delineated on TDM (V(TDM)) were 1.15 (SD 3.71) larger than volumes delineated on MRI. Prostate apex was 4.6 mm (SD 2.87) lower on TDM than on MRI. Posterior limit of the prostate was in mean 4 mm more posterior on TDM. The variability between physicians in terms of prostate delineation was lower using MRI. For apex, these variations were 6.8 mm using TDM, versus 3.3 mm using MRI. Mean rectal dose was 8 % lower with MRI, compared to delineation using TDM. CONCLUSION: Superimposition TDM/MRI improves accuracy, decreases delineation variability, and allows to spare anterior part of the rectum from irradiation. It remains unknown whether this strategy translates into clinical benefit.
Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Imageamento por Ressonância Magnética , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Humanos , Masculino , Planejamento da Radioterapia Assistida por ComputadorRESUMO
INTRODUCTION: The objective of this study was to compare the results in terms of continence and quality of life between retropubic radical prostatectomy and laparoscopic radical prostatectomy, performed according to the same principle of retrograde dissection from the apex. MATERIAL AND METHOD: The series was composed of 120 patients undergoing retropubic radical prostatectomy and 131 patients undergoing laparoscopic radical prostatectomy performed in the Limoges hospital, urology and andrology department, between January 2002 and September 2005. Continence was evaluated by anonymous self-administered questionnaire sent to the patient's home. Pain was evaluated by visual analogue scale and narcotic consumption. Predictive factors of continence were analysed. RESULTS: The two groups were comparable in terms of pathological stage, Gleason score and age. The laparoscopy group comprised more patients with a history of transurethral resection of the prostate and more obese patients. No significant difference was observed between laparoscopy and laparotomy for degree of continence (71% versus 76%; p>0.05), time to return of continence (13 weeks versus nine weeks; p>0.05) and rate of mild (14% versus 13%), moderate (7% versus 6%) and severe (7% versus 5%) urinary incontinence. The anastomosis secondary stenosis rate was also identical in the two groups. Age was found to be a predictive factor for continence, especially for the mean time to return periods of continence. The patient's weight, prostate weight and TNM stage were not predictive factors for incontinence. The incontinence rate was 40% for salvage prostatectomies after radiotherapy. The mean duration of bladder catheterization was 6.9 days in the laparoscopy group and 7.2 days in the laparotomy group. Narcotic consumption was significantly lower in the laparoscopy group (21 mg versus 36 mg; p<0.05). CONCLUSION: Laparoscopic radical prostatectomy appears to give the same results in terms of continence as retropubic radical prostatectomy. However, these procedures were the first laparoscopic prostatectomies performed in the department, suggesting that, with greater experience, the results of laparoscopy could become superior to those of laparotomy. The laparoscopic technique also appeared to provide better patient comfort by decreasing postoperative pain.
Assuntos
Laparoscopia , Complicações Pós-Operatórias , Prostatectomia/métodos , Incontinência Urinária/etiologia , Fatores Etários , Idoso , Interpretação Estatística de Dados , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Prognóstico , Inquéritos e Questionários , Ressecção Transuretral da PróstataAssuntos
Síndrome Metabólica/complicações , Hiperplasia Prostática/complicações , Índice de Massa Corporal , Peso Corporal , Estudos de Coortes , França/epidemiologia , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/patologia , Próstata/patologia , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/patologia , Fatores de Risco , Estados Unidos/epidemiologia , Transtornos Urinários/etiologiaRESUMO
OBJECTIVE: To assess the efficacy and tolerability of localised radiotherapy for the treatment of bicalutamide ('Casodex''Casodex' is a trademark of the AstraZeneca group of companies.)-induced gynaecomastia and/or breast pain. METHODS: This open-label, non-comparative, multicentre study included 51 patients receiving bicalutamide 150 mg for the treatment of non-metastatic prostate cancer (T1b-T4, Nx, M0). Patients who developed symptomatic gynaecomastia and/or breast pain received two 6-Gy fractions of external-beam radiation to the breasts and were then assessed at two 3-monthly follow-up visits. RESULTS: 37/51 (72.5%) patients experienced gynaecomastia and 41/51 (80.4%) experienced breast pain, typically within the first 6 months. Twenty seven and 38 patients, respectively, went on to receive breast irradiation. Following radiotherapy, gynaecomastia improved or resolved in 7/27 (25.9%) and 2/27 (7.4%) cases, respectively, and breast pain improved or resolved in 12/38 (31.6%) and 3/38 (7.9%) cases, respectively. No change was observed in 7 patients (25.9%) with gynaecomastia and 12 patients (31.6%) with breast pain, while 9 patients (33.3%) and 8 patients (21.1%), respectively, worsened. Radiotherapy-related adverse events, reported by 18/41 (43.9%) patients, were generally mild and short lived (median duration approximately 5 weeks). CONCLUSIONS: Therapeutic radiotherapy, using two fractions of 6 Gy external-beam radiation to the male breast, improves the intensity of bicalutamide-induced gynaecomastia and/or breast pain in approximately one-third of patients. Adverse events were often mild and short lived.
Assuntos
Adenocarcinoma/tratamento farmacológico , Anilidas/efeitos adversos , Antineoplásicos/efeitos adversos , Mama/efeitos da radiação , Ginecomastia/radioterapia , Dor/radioterapia , Neoplasias da Próstata/tratamento farmacológico , Adenocarcinoma/patologia , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Anilidas/uso terapêutico , Antineoplásicos/uso terapêutico , Seguimentos , Ginecomastia/induzido quimicamente , Ginecomastia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nitrilas , Dor/induzido quimicamente , Dor/epidemiologia , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Compostos de Tosil , Resultado do TratamentoRESUMO
Obstructive lesions of the anterior urethra (valves, diverticula) are rare and can be difficult to diagnose. One recent case led us to review existing international reports; there are case histories for 260 patients over a 20-year period. The anatomical interpretation of these lesions is far from being unequivocal but many authors clearly distinguish between valves and diverticula, the basic difference being in the contiguity between the anomaly and the corpus spongiosum. Where the clinical presentation depends on age, the diagnosis depends essentially on voiding cysto-urethrography, which must image the whole urethra. Generally, the treatment for valves is simple, consisting of endoscopic resection. For diverticula it is not always necessary or desirable to remove the diverticulum; if there is a well-formed distal obstructing lip, removing it may be enough to cure the obstruction.
Assuntos
Divertículo/etiologia , Uretra/anormalidades , Obstrução Uretral/etiologia , Criança , Dilatação Patológica/etiologia , Dilatação Patológica/patologia , Dilatação Patológica/cirurgia , Divertículo/patologia , Divertículo/cirurgia , Endoscopia/métodos , Humanos , Masculino , Obstrução Uretral/patologia , Obstrução Uretral/cirurgia , Retenção Urinária/etiologia , Retenção Urinária/cirurgiaRESUMO
Discovery of a mass in the spleno-reno-pancreatic region requires complementary investigations to exclude a false diagnosis of renal tumour. While resembling a renal tumour, such masses can actually correspond to splenic lobulation, a cyst of the tail of the pancreas or a splenic entity (accessory spleen or splenosis).
Assuntos
Neoplasias Renais/diagnóstico , Esplenopatias/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , HumanosAssuntos
Adenocarcinoma/secundário , Neoplasias da Próstata/patologia , Neoplasias da Coluna Vertebral/secundário , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Antígeno Carcinoembrionário/análise , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Laminectomia , Masculino , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
We report 2 cases of cancerous transformation in an exstrophic bladder. The histology of these tumors, methods of surveillance, and treatment are discussed in conjunction with a review of published reports. These rare tumors are almost entirely adenocarcinomas. Their treatment is surgical (radical cystectomy) with or without associated radiation therapy. Surveillance for patients with bladder exstrophy, whether surgically corrected or not, is indispensable and rests on cystoscopy and urine cytology.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Bexiga Urinária/anormalidades , Adenocarcinoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
OBJECTIVES: To describe the features and treatment of renal lesions in von Hippel-Lindau disease (VHL) from a series of patients, to highlight important issues in the management of these lesions. MATERIALS AND METHODS: We performed a retrospective study in 7 patients with VHL who underwent surgery for renal lesions between January 1990 and July 1996. The initial evaluation consisted of an abdominal CT scan and renal arteriography. RESULTS: The mean age of patients at the time of discovery was 38 (+/- 12.01 years). All cases were of type 1. Radiology assessment underestimated the gravity of the lesions in 5 patients. In all patients, unilateral surgery was performed with the kidney being conserved in 4 cases. Of the 44 lesions removed, 23 had signs of progressiveness (atypical or malignant cyst, renal cell carcinoma), most of the cancers were of low grade. 84% of the lesions did not exceed 3 cm and 48% were =1 cm. During follow-up (42 months), 2 patients relapsed. CONCLUSION: The clinical and pathological features of renal lesions in VHL require strict and early follow-up (from the age of 15). Only under these circumstances should primary conservative surgery be performed, however, recurrences are frequent. This conservative approach remains to be validated by multicentric prospective studies.
Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Doença de von Hippel-Lindau/diagnóstico por imagem , Doença de von Hippel-Lindau/patologia , Adulto , Angiografia , Carcinoma de Células Renais/cirurgia , Diagnóstico Diferencial , Feminino , Seguimentos , Heterozigoto , Humanos , Rim/patologia , Rim/cirurgia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Linhagem , Prognóstico , Recidiva , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Doença de von Hippel-Lindau/genética , Doença de von Hippel-Lindau/cirurgiaRESUMO
Endoscopic resection is the "gold standard" to treat benign prostatic hyperplasia refractory to medical treatments, because it is effective and only relatively aggressive. In young patients or debilitated elderly patients, there is a place for so-called minimally invasive surgical treatments, consisting of three possibilities: interstitial laser, TUNA (transurethral needle ablation), and thermotherapy. The results of these last two techniques are very similar o those obtained by endoscopic resection, with virtually no complications. These treatments are performed on an outpatient basis and have no consequences for sexuality. Thermotherapy has also been approved by the FDA in the USA. In France, these treatments can only be used in the context of a clinical trial.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Ambulatórios , Ablação por Cateter , França , Humanos , Hipertermia Induzida , Terapia a Laser , Masculino , Resultado do TratamentoRESUMO
OBJECTIVE: Description of the Indiana pouch, a continent urinary diversion after cystectomy for urogenital tumours, and for the sequelae of neurogenic and traumatic bladders. MATERIAL AND METHOD: This was a retrospective study of 16 patients undergoing, between June 1991 and March 1995, cutaneous urinary diversion by ileocaecal graft, detubularized in the colonic segment, with continence ensured by the ileocaecal valve. The postoperative follow-up (4 to 36 months) was performed at 3, 6 and 12 months (abdominal ultrasonography alternating with abdominopelvic CT scan), then annually (CT scan). Finally, a urodynamic assessment was performed in 7 patients. RESULTS: No early complications related to the reservoir were observed. Late complications of the diversion were related to the uretero-colonic anastomosis with 3 dilated renal subunits. Continence was achieved in 12 out of 15 patients, while one patient finally refused self-catheterization. In the patients in whom a urodynamic assessment was performed, the mean capacity of the reservoir was 671.4 +/- 273.9 mL for a filling pressure of between 3.7 +/- 1.6 and 11 +/- 2.5 cm H2O and an ileocaecal valve closure pressure of 97.9 +/- 117.1 cm H2O (full reservoir). CONCLUSION: The Indiana pouch is a useful urinary diversion as it is simple to perform and is associated with a low revision rate, while ensuring low-pressure continence.
Assuntos
Coletores de Urina/métodos , Abdome/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Ceco/transplante , Colo/cirurgia , Cistectomia/reabilitação , Feminino , Seguimentos , Humanos , Valva Ileocecal/cirurgia , Íleo/transplante , Masculino , Pessoa de Meia-Idade , Pressão , Radiografia Abdominal , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia , Ureter/cirurgia , Bexiga Urinária/lesões , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/cirurgia , Cateterismo Urinário , Coletores de Urina/efeitos adversos , Urina , Urodinâmica , Neoplasias Urogenitais/cirurgiaRESUMO
Urinary tract infection is frequent during pregnancy with a high potential risk for mother and child. Based on a review of the literature and a retrospective survey conducted in 20 representative French university hospitals during 1993, the authors propose a practical review designed to standardize the therapeutic approach to this disease. They define a high-risk group which requires systematic screening and close surveillance during pregnancy. They evaluate the need for complementary investigations in relation to the 3 clinical presentations encountered (asymptomatic bacteriuria, cystitis and acute pyelonephritis) taking into account their respective adverse effects. The therapeutic modalities of the three clinical forms are then described, including drainage of the urinary tract.
Assuntos
Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Urinárias/prevenção & controle , Doença Aguda , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Bacteriúria/tratamento farmacológico , Cistite/diagnóstico , Cistite/tratamento farmacológico , Feminino , França , Hospitais Universitários , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológicoRESUMO
The incidence of impotence increases with age. Its etiology is always complex and often multifactorial. The hidden organic causes of impotence are as follows in decreasing order of frequency: arterial, venous, neurological and endocrine. Paraclinical investigation of erection dysfunction plays an important role: hormone levels, arterial Doppler, digitalised rigidimetry, the intracavernous test, cavernometry-cavernography and internal iliac angiography, are used to define the diagnosis and determine appropriate management. It is stressed that supportive sex therapy is often indispensable and that penile prostheses are the final recourse, when treatment based upon etiology has failed.
Assuntos
Disfunção Erétil/diagnóstico , Disfunção Erétil/terapia , Doenças do Sistema Endócrino/complicações , Doenças do Sistema Endócrino/terapia , Disfunção Erétil/etiologia , Humanos , Masculino , Ereção Peniana/fisiologia , Pênis/irrigação sanguínea , Pênis/inervação , Pênis/fisiologia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/terapia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/terapia , Vasoconstritores , VasodilatadoresRESUMO
Prostatic abscess is a rare complication of urinary tract infection, whose symptoms and signs are not often specific. Prostatic abscess can now be easily diagnosed by transrectal ultrasonography. The authors report six cases of prostatic abscess diagnosed by ultrasonography. These abscess were successfully drained by ultrasound-guided transrectal aspiration, which may constitute a useful solution, as the classical treatments to date consist of transurethral resection or rectotomy.
Assuntos
Abscesso/diagnóstico por imagem , Abscesso/terapia , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/terapia , Punções , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Doenças Prostáticas/microbiologia , Punções/instrumentação , RetoRESUMO
The results of perineal rehabilitation in 101 women with urinary incontinence are evaluated with a follow-up of 18 months (9-37 months). The authors try to precise the clinicals and urodynamicals initials factors of a bad pronostic.
Assuntos
Educação de Pacientes como Assunto/normas , Incontinência Urinária/reabilitação , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia , UrodinâmicaRESUMO
We report 2 cases of retroperitoneal tumors in adults: a lipomyxosarcoma and a schwannoma. Computed tomography and ultrasonography help to establish a positive diagnosis. Treatment consists essentially of complete surgical excision. Their subsequent course is often uncertain.