[Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation]. / Évaluation urodynamique de patients guéris d'incontinence urinaire d'effort post-prostatectomie radicale après implantation d'une bandelette sous-urétrale transobturatrice.

INTRODUCTION: The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence. PATIENTS AND METHODS: In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®). RESULTS: Urodynamic studies were performed after a median time of 9months (min 4 - max 34) following sling implantation. Postoperatively, a rise of 11cm H2O in median MUCP (P=0.09) and an increase of 14mm in median FUL (P=0.13) were observed. None of the urodynamic changes was statistically significant. CONCLUSIONS: Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies. LEVEL OF EVIDENCE: 4.

[Spasmolytics indication in renal colic: a literature review]. / La place des spasmolytiques dans la colique néphrétique.

UNLABELLED: Spasmolytics are often prescribed by general practitioners or by emergency services as soon as renal colic is diagnosed. This practice has however been widely contested. This article presents a literature review on the efficiency of spasmolytics for the treatment of renal colic. Furthermore, it draws a comparison with daily practice, and finally summarizes side effects of this treatment. CONCLUSION: Based on the EBM review, it cannot be concluded that spasmolytics are effective in renal colic. A better practice is to use diclofenac as a unique drug, and to complement the treatment with tramadol and antalgics for uncontrolled patients. Furthermore, the use of tamsulosin is proved to be efficient for lithiasis in the lower part of the ureter.

[Charles Phillips (1811-1870), a famous urologist, born in Liege, and yet unknown in that city]. / Charles Phillips (1811-1870): un célèbre urologue liégeois, pourtant inconnu chez nous.

Charles Phillips was born in Liege at the beginning of the XIXth century. In that city, he studied medicine and, later, lectured, during a few years, initially, at the School of Medicine, and, later, at the School of Veterinary Medicine. Having trained in several European centres, he settled in Paris where he soon became a well-known urologist. Remarkably intelligent and inventive, he was also a great medical artist; he produced some wonderful books and invented several devices that are still in use to-day in basic urology. Surprisingly, his name is almost unknown nowadays in his city of origin.

[TVT-O, a novel minimally invasive technique for the treatment of female stress urinary incontinence from development to clinical experience]. / Actualités thérapeutiques en urologie. Le TVT-O, nouvelle technique mini-invasive pour le traitement de l'incontinence urinaire d'effort féminine, développements et expérience clinique.

Tension-free sub-urethral tapes have revolutionized the surgical treatment of female stress urinary incontinence for the past decade. The inside-out transobturator approach, developed in our Institution 5 years ago, is currently being utilized worldwide. The technique is simple and reproducible and the incidence of complications is minimized. Stress urinary incontinence cure rates of almost 90% are achieved after a 3-year minimum follow up. These good results have been confirmed in the international literature.

Prognostic value of bone sialoprotein expression in clinically localized human prostate cancer.

BACKGROUND: Bone sialoprotein (BSP), a bone matrix protein, was recently found to be expressed ectopically in breast cancer and to have a statistically significant association with poor prognosis and the development of bone metastases in that disease. These data prompted us to investigate whether BSP might also be expressed in human prostate cancer, which often metastasizes to bone, and be predictive for progression risk. METHODS: Tissue sections from 180 patients who had undergone a radical prostatectomy for localized prostate cancer were analyzed immunohistochemically for BSP expression. Biochemical progression was defined as an increasing serum prostate-specific antigen level of 0.5 ng/mL or more. Statistical analysis was used to assess associations between pathologic findings and level of BSP expression, and a Cox proportional hazards model was used to determine which clinical and histologic parameters, including stage, Gleason score, and BSP expression (immunostaining intensity and extent), were independently associated with biochemical progression. All P values were two-sided. RESULTS: Most of the prostate cancer lesions examined (78.9%) expressed detectable levels of BSP, compared with no or low expression in the adjacent normal glandular tissue. A statistically significant association was found between BSP expression and biochemical progression in both univariate and multivariate analyses. After a follow-up interval of 3 years, the biochemical relapse rate was 36.7% (95% confidence interval [CI] = 23.4%-47.7%) in patients whose tumors expressed high levels of BSP compared with 12.1% (95% CI = 2.3%-20.8%) in patients whose tumors expressed no or a low detectable level of the protein (logrank test, P = .0014). BSP expression status could identify those patients at higher risk of biochemical progression (logrank test, P<.05) among patients with moderately differentiated tumors or with pathologically confined tumors. CONCLUSIONS: To our knowledge, this study is the first to demonstrate BSP expression in human prostate cancer and to highlight the protein's statistically significant prognostic value in patients with clinically confined prostate adenocarcinomas.

Benign prostatic hyperplasia and normal prostate aging: differences in types I and II 5 alpha-reductase and steroid hormone receptor messenger ribonucleic acid (mRNA) levels, but not in insulin-like growth factor mRNA levels.

Benign prostatic hyperplasia (BPH) is so common in elderly men that the development of adenomatous nodules in this organ can be seen as a normal age-dependent process. In this work, we used Northern blotting to compare the levels of androgen, estrogen, and insulin-like growth factor-I (IGF-I) receptor in young (age range, 23-33; n = 3), old normal (age range, 52-80; n = 3), and BPH-affected subjects (age range, 66-87; n = 15). We have also investigated in these groups the expression of genes coding for the two 5 alpha-reductases (types I and II), aromatase, IGF-I, and IGF-II. Our results show significantly increased levels of IGF mRNA in old healthy and BPH-affected subjects; the respective rises for IGF-I, IGF-II, and IGF-I receptor mRNAs were 3.0-, 2.9-, and 1.5-fold (BPH) and 2.7-, 2.4-, and 1.8-fold (old normal controls). For estrogen receptor, androgen receptor, and type I and II 5 alpha-reductase mRNAs, a marked but opposite effect was observed in adenomatous tissues only; the respective levels were 2.2-, 1.8-, 3.9-, and 1.7-fold lower than those in young adult subjects, whereas no significant differences were recorded between the two normal groups. Morphometric analysis of each tissue specimen confirmed the significantly lower epithelium/stroma ratio in adenomas compared to young or old healthy tissues. Together, these observations suggest that prostatic adenomas may result from at least two conjugate processes: one characterized by a drop in the mRNA levels of steroid hormone receptors, which might be associated with a lower epithelium/stroma ratio, and another characterized by normal aging phenomena, of which the increased production of IGFs and IGF-I receptor transcripts could be biochemical markers.

Feasibility study combining low dose rate (192)Ir brachytherapy and external beam radiotherapy aiming at delivering 80-85 Gy to prostatic adenocarcinoma.

BACKGROUND: Increasing the radiation dose to prostatic adenocarcinoma has provided higher local control rates. A total of 80 Gy seem necessary to achieve this goal but patient set-up and prostate motion remain difficult problems to solve in conformal radiotherapy. Brachytherapy which overcomes these points could be an alternative way to external beam boost fields. We wanted to transpose the irradiation models largely used in cervix cancer treatment combining external beam radiotherapy and low dose rate brachytherapy. MATERIALS AND METHODS: In 71 patients with 19.5 and 13 ng/ml mean and median PSA levels, respectively, a dose escalation from 74 to 85 Gy was performed in four groups. RESULTS: Shifting from intraoperative placement of sources vectors (Group I) to positioning under ultrasound controls (groups II-IV), improving the implantation shape and optimizing radiation delivery to urethral bed have reduced the total dose to rectal wall under 65 Gy and to urethra under 100 Gy. Rectal/prostate dose ratio was lowered from 0.7 (Groups I-II) to 0.58 (Groups III-IV) while avoiding problems resulting from pelvic bone arch interference, prostate volume or seminal vesicles location. The mean and median follow-up periods are 28 and 18 months. In Groups III and IV 85% of patients without hormonotherapy treated with 80-85 Gy normalized PSA under 1 ng/ml within 6 months. No severe late effect has been noted for patients implanted under echographic control. CONCLUSIONS: The method described allows to deliver 85 Gy. Longer follow-up is however needed but the levels of dose delivered are not expected to induce prohibitive side effects.

Growth hormone and prolactin stimulate androgen receptor, insulin-like growth factor-I (IGF-I) and IGF-I receptor levels in the prostate of immature rats.

In this study we investigated the involvement of several different pituitary hormones on rat prostate development. 22-day-old Wistar rats, hypophysectomized (hypox) at 19 days of age were supplemented with highly purified human prolactin (hPRL), human luteinizing hormone (hLH), porcine follicle-stimulating hormone (pFSH), and bovine growth hormone (bGH) or with saline. Quantitative analysis of RNAs shows that treatment with either PRL or GH increases significantly steady-state mRNAs levels of the following genes in the prostate: androgen receptor (AR) (respectively 3.5- and 4.8-fold above hypox controls), IGF-I (5- and 2.7-fold), and IGF-I receptor (2.9- and 2.3-fold). LH and FSH, by contrast, have negative effects on these parameters. To test whether the enhancing effect of PRL and GH on AR-mRNA abundance was followed by increased content in the protein itself, binding assays were performed with the androgen agonist [3H]R1881 (131 and 153 fmol/mg protein while hypox controls contained 110 fmol/mg protein). In addition to the well-documented presence of prolactin receptors in prostatic tissues, we have further demonstrated, by means of nuclease S1 protection assays plus dot- and Northern-blot analyses, that a GH receptor mRNA is produced in the immature rat prostate. Moreover, we observed not only strong lactogenic but also purely somatogenic binding to be occurring in the immature prostates. Finally, we have studied IGF-I mRNA content in separated epithelial/stromal cell fractions and have concluded that IGF-I expression is principally located in the prostatic stroma. Taken together, these results suggest that PRL and GH are involved in regulating AR synthesis, at least partially by direct action on the organ. In this context IGF-I appears as a paracrine factor playing a role in epithelium/stroma interactions during prostatic development.

Screening of histone deacetylases (HDAC) expression in human prostate cancer reveals distinct class I HDAC profiles between epithelial and stromal cells.

Histone deacetylases (HDACs) represent a large family of enzymes identified as key regulators of nucleosomal histone acetylation, a major epigenetic event that controls eukaryotic gene transcription. Inappropriate deacetylation mediated by HDACs has been associated with profound alterations in cellular biology. We have thus hypothesized that an altered HDAC expression may favor cancer development/progression. To test this possibility, we have sought to screen the expression profiles of several class I and class II HDACs (HDAC1-8) in DU-145, PC-3 and LNCaP human prostate cancer cell lines as well as in matched malignant and non-malignant prostate tissues by use of real time RT-PCR, immunoblot and immunohistochemistry. All HDAC transcripts tested were detected at various levels in all prostate cancer cell lines and tissue samples analyzed. In prostate tissues, the abundance of HDAC1 protein, which was exclusively expressed in the cell nucleus, was similar in normal and malignant epithelial cells, but was usually lower in stromal cells. Unexpectedly, HDAC8, another class I HDAC, was not detected in epithelial cells but was uniquely expressed in the cytoplasm of stromal cells. HDAC5, a class II HDAC involved in myogenesis, was not detected in the tissues. Altogether, our findings indicate that epithelial and stromal cells exhibit distinct class I HDAC expression profiles, and the abundance of HDAC1 is not altered in human prostate cancer. In addition, our observations are the first to demonstrate the prominently cytosolic distribution of a class I HDAC, HDAC8.

[Treatment of male incontinence]. / Traitement de l'incontinence masculine.

Male urinary incontinence may be due to a variety of pathophysiological mechanisms: detrusor hyper- or hypoactivity, lower obstruction and, most frequently, sphincter incompetence, generally secondary to surgery. As far as possible, treatment should be aetiopathogenic, with the use of drugs for detrusor dysfunction. The treatment of sphincter incompetence primarily consists of prophylaxis and education of urologists. When a lesion does not resolve with time, i.e. after more than one year of physiotherapy or drugs, the artificial sphincter may be indicated with good results in more than 90% of cases.

[Techniques of urodynamic diagnosis. Measurement--pressure--flow]. / Techniques d'urodynamique diagnostiques. Mesure--pression--débit.

The urodynamic techniques useful for the diagnostic assessment of vesicosphincteric disorders are uroflowmetry, measurement of abdominal, urethral and vesical pressure and electromyography. Uroflowmetry is a very widely used screening examination, as it is atraumatic. Other techniques are more invasive, but provide more pathophysiological information. The methodology is recalled for each of these examinations. The parameters to be analysed are described in detail. The value and limitations of these modalities are emphasised. Combined examinations allow a better understanding of vesicosphincteric equilibria and disequilibria and reveal the concepts of compliance, detrusor pressure, isometric detrusor contractions, hyper and hypoactivity, and pressure transmission.

[Infravesical obstruction]. / Obstruction infravésicale.

Infravesical obstruction presents clinically in the form of dysuria. Urodynamic studies play an important role to distinguish between a disorder of detrusor contractility and a functional or organic obstruction. The value of uroflowmetry, static and voiding urethral pressure profiles, cystometry and electromyography is discussed. The instantaneous voiding profile appears to be the most useful test: it allows calculation of urethral resistance, which is the ratio between bladder voiding pressure and the square of flow. Bladder neck obstruction is present in more than 80% of cases with a value greater than 0.5. Obstacles are more easily identified clinically in women, but the same tests can be applied with a poorer reliability for urethral resistance.

[Urinary incontinence in elderly women]. / L'incontinence urinaire chez la femme âgée.

Physical, psychological and economical consequences of urinary incontinence of the elderly woman are underestimated. It often results in depression, social isolation and early institutionalisation. It is often the key factor that determines the decision of institutionalisation, which represent the most important part of the total cost of urinary incontinence. This problem is too often neglected and deserves considerable attention.

[Clinical case of the month. Acute focal bacterial nephritis]. / Le cas clinique du mois. La néphrite focale bactérienne aiguë.

Focal acute bacterial nephritis (lobar nephronia) is a localized bacterial infection of the kidney that has rarely been described in childhood. It is frequently associated to urinary tract anomalies and malformations and its diagnosis is based upon renal ultrasonography and computed tomography. In this article, we report a case in an 8 year old boy admitted to hospital in a septic state.

[Clinical case of the month. Von Hippel-Lindau disease]. / Le cas clinique du mois. Maladie de Von Hippel-Lindau.

VHL disease is a rare genetical disease with a poor long-term prognosis. Clinical features include retineous angiomas, CNS hemangioblastomas, pheochromocytomas and renal cysts. Renal cysts are bilateral and frequently lead to malignant transformation. Surgical treatment of renal cysts is preferably delayed until a minimum of 3 cm diameter has been reached. Treatment has to be as conservative as possible, knowing that uni- or bilateral nephrectomy often has to be carried out later.

[Results of artificial sphincter for the treatment of sphincter incontinence]. / Résultat du sphincter artificiel en cas d'incontinence sphinctérienne.

47 patients were treated since 1987 by implantation of an artificial sphincter. The majority of female patients were operated for bladder neck hypermotility. In the male population, incontinence was mostly a complication of prostatic surgery. The indication, preoperatory assessment, surgical techniques and results are discussed. During a mean follow-up of 38 months, 92.9% of females remained perfectly continent and results were good in 76.7% of males. The results are similar to those reported in the literature.

[TVT: Revolutionary treatment of urinary incontinence]. / Le TVT: traitement révolutionnaire de l'incontinence urinaire.

Stress urinary incontinence represents an important, often unknown and, yet, certainly most unpleasant pathology. Over years, several different surgical techniques have been proposed and reported to have variable success. TVT, a simple and reproducible technique, aims at stabilizing mid-urethra, and not bladder-neck. Our own clinical experience amounts to 139 cases. All these patients were evaluated by clinical examination and, subjectively, by a questionnaire. 89.2% were cured and 6.5% improved. The most frequent complication was bladder perforation (6.5%), but it had no incidence on the final results. Morbidity was low. This revolutionary technique is very promising and our own results are similar to those reported by others.

[Surgery, radiotherapy or hormonal therapy in the treatment of prostate cancer]. / Chirurgie, radiothérapie ou hormonothérapie dans le traitement du cancer de la prostate.

Prostatic cancer (PC) became the first diagnosed cancer in western men and is the second leading cause of cancer death in men. Wide utilisation of serum PSA and free PSA measurements, identifies patients requiring transrectalultrasonography (TRUS) and TRUS guided biopsies. Most prostatic cancers diagnosed today are locally limited and may be treated by radical surgery or radiotherapy. In case of disseminated disease, hormonal manipulations remain the treatment of choice. In that field, many new drugs have been designed to allow medical castration with less complications, especially regarding sexual potency.

[Periurethral injection of silicone microparticles in the treatment of sphincter deficiency urinary incontinence]. / Injection périurétrale de microparticules de silicone dans le traitement de l'incontinence urinaire par insuffisance sphinctérienne.

OBJECTIVE: To assess the mid-term efficacy of periurethral injection of silicone micro-implants in women with urinary incontinence due to intrinsic sphincter deficiency. MATERIAL AND METHODS: Between July 1992 and March 1999, 25 women (mean age 65.17 +/- 13.5 years) with intrinsic sphincter deficiency underwent periurethral injection of silicone micro-implants. Urodynamic investigations were performed prior to and after surgery. The subjective degree of continence was also assessed for 3 years. RESULTS: Subjective success rate were 80%, 72%, 65%, 60%, and 60% at 6 weeks, 3 months, 6 months, 1 year and 3 years, respectively. Post-operative maximum urethral closure pressure was significantly increased (post-op 32.35 +/- 18.04 cm H2O versus pre-op 23.68 +/- 9.4 cm H2O; P < 0.01) No serious operative or postoperative complication occurred. CONCLUSION: In spite of time-dependent decrease in success rate periurethral silicone micro-implants injection remains an effective and safe procedure for women with urinary incontinence due to intrinsic sphincter deficiency.