[Androgen deprivation and cardiovascular risk in prostate cancer treatment]. / Hormonothérapie et risque cardiaque dans le traitement des cancers prostatiques.

Androgen suppression clearly increases the occurrence of cardiovascular risk factors : increased body fat, dyslipidemia and type II diabetes. Thus, several studies (but not all), showed an increase in coronary artery disease but also of sudden death and ventricular arrhythmias in relation to androgen deprivation, even for a short duration. This risk is particularly important in patients with existing cardiovascular risk factors or a history of heart disease. Cardiovascular risk should be balanced with the benefit of androgen deprivation on overall survival, especially when it is proposed in adjuvant setting, combined with radiotherapy in locally advanced prostate tumors. In practice, it is recommended that patients be referred to their physician for an evaluation before starting treatment, then 3 to 6 months after starting treatment, then once a year. The initial assessment should include: a clinical examination (with measurement of blood pressure and body index) and laboratory test with full lipid profile (total cholesterol, HDL and LDL cholesterol, triglycerides) and glucose. It is also important that patients with heart disease, receive lifestyle advice and low- dose aspirin (80 mg/day).

[Results of sacral posterior neuromodulation on voiding disorders and impact on sexuality based on a single-center study]. / Résultats de la neuromodulation des racines sacrées postérieures sur les troubles mictionnels et impact sur la sexualité à partir d'une étude monocentrique.

OBJECTIVE: The objective of this study was to evaluate the results of S3 sacral neuromodulation on certain voiding disorders (overactive bladder and chronic retention) and its impact on the sexuality of these patients. MATERIAL AND METHOD: A S3 sacral root neuromodulator was implanted in 41 patients with a mean of age of 53 years between January 1999 and March 2004. This study comprised two groups: one group composed of patients with overactive bladder (32 subjects) and the other composed of patients with chronic retention without obstruction (nine subjects). RESULTS: The mean follow-up of this study was 34 months (range: 12 to 72 months). In the group of patients with overactive bladder, after the operation, the daily voiding frequency decreased from 20.8 to 7.8 (p<0.0001), episodes of incontinence decreased from 3.7 to 1.4 per day (p<0.0001), the number of pads decreased from 2.5 to 1 per day (p<0.001) and 72% of these patients reported an improvement of their continence time. In the group with chronic retention, the number of intermittent self-catheterizations decreased from 4.77 to 0.44 per day (p=0.0169) and 72% of these patients resumed spontaneous voiding (7/9). Among this patient population, 41.5% reported sexual problems, which were improved after implantation of the neurostimulator in 41.2% of cases. CONCLUSION: In the light of these results, sacral neuromodulation appears to be an effective treatment for certain refractory chronic voiding disorders such as overactive bladder and chronic retention without obstructive syndrome. This study showed that improvement of clinical signs could have a positive impact on the sexuality of these patients, especially for patients with chronic retention without obstruction.

[Comparison of ultrasonographic and hysteroscopic results in perimenopausal metrorrhagias]. / Confrontation des résultats échographiques et hystéroscopiques dans les métrorragies périménopausiques.

84 perimenopausal women with uterine bleeding underwent transvaginal ultrasonography and hysteroscopy. Sonographic and hysteroscopic findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. Sensitivity, specificity, positive and negative predictive value of hysteroscopy and transvaginal ultrasonography were calculated. Hysteroscopy had 91.6% sensitivity, 83.3% specificity, 93.2% positive predictive value and 80% negative predictive value in the diagnosis of intrauterine abnormality, whereas transvaginal ultrasonography had only 67.3% sensitivity, 87.5% specificity, 89.7% positive predictive value and 62.2% negative predictive value. In consequence hysteroscopy is better than transvaginal sonography concerning only the sensitivity (p < 0.01). Transvaginal ultrasonography seems to be an excellent initial diagnostic method, but hysteroscopy is a highly accurate means of diagnosing the cause of excessive uterine bleeding.