Proposal for a predictive model of erectile function after permanent (125)I prostate brachytherapy for localized prostate cancer.

To determine the risk factors for EDin men treated by prostate brachytherapy (PB) for localized prostate cancer and to propose a model to predict post-implant erectile function. Out of a series of 270 sexually active men treated by PB, 241 (89%) (mean age=66 years (range, 43-80)) accepted to participate in a mail-based study on erectile function. The risk factors for erectile dysfunction were determined by regression analysis and a predictive model was proposed. The performance of the model was determined in this population and subsequently verified in a population of 50 men treated by PB in another treatment center. The risk factors for ED after PB were age, the pre-implant IIEF score and prostate volume. In the studied population, the final model to predict a post-treatment IIEF-5 score, using these factors, had a sensitivity of 69% and a specificity of 68% associated to an area under the ROC curve (AUC) of 0.75. The same performance was obtained in another treatment center. Age, pre-implant IIEF-5 score and prostate volume may be used to predict post-implant erectile function in patients treated by PB.

[Analysis of the evolution of surgery for the treatment of primary renal tumors during the period 2006-2010: report of 458 consecutive surgeries]. / Analyse de l'évolution des pratiques chirurgicales pour la prise en charge des tumeurs primitives du rein dans la période 2006-2010: à propos d'une série de 458 chirurgies consécutives.

OBJECTIVE: Most of small renal masses are accessible to conservative surgery, which has proved to maintain carcinological outcome, with a lower cardiovascular morbidity, hospital stay and mortality. Current international guidelines for the management of renal tumours recommend that partial nephrectomy be the new standard of treatment of T1 tumours. In this study, the authors assessed evolutive trends in the surgical management of renal tumours in the period 2006 to 2010 in a university hospital. PATIENTS AND METHODS: Retrospective analysis of a cohort of 446 consecutive patients treated for renal tumour between 2006 and 2010. RESULTS: Overall, 458 surgeries were performed, divided in 184 (40.2%) partial nephrectomy and 274 (49.8%) radical nephrectomy. During the study period, the number of partial nephrectomy increased significantly, with a mean annual increase rate of 10% in T1a tumours (P=0.002). We also observed a non significant increasing trend for conservative surgery in T1b tumours. Furthermore, the number of laparoscopic partial nephrectomy increased significantly, with a mean annual increase rate of 8% (P=0.02). At the end of the study period, one in two patients, whatever the stage, was treated by partial nephrectomy. This change in practice occurred without any increase in per- and postoperative morbidity (P=0.39). CONCLUSION: Analysis of this cohort of patients operated for renal tumour between 2006 and 2010 in our university hospital did not highlight underuse of conservative surgery, taking into account the current international guidelines. This trend for more partial nephrectomy did not underscore an increase in surgical morbidity or decrease in carcinological outcome. However, the higher rate of positive surgical margins in the laparoscopic partial nephrectomy group should incite to caution.

[Fertility after prostate brachytherapy with Iode 125 permanent implants for localized prostate cancer]. / Fertilité après curiethérapie par implants permanents d'Iode 125 pour cancer localisé de la prostate.

OBJECTIVES: Preservation of fertility in men of middle age is an issue that is experiencing a growing interest. Prostate cancer is the second most common cancer in men and is diagnosed earlier than before. Brachytherapy is a treatment for prostate cancer that preserves ejaculation. Our aim was to study the fertility of men treated with prostate brachytherapy in order to improve patient information. PATIENTS AND METHODS: In a series of 270 sexually active men with localized prostate cancer treated with brachytherapy (permanent implants of Iode 125) at the Institute Claudius Regaud between 2000 and 2006, mean age 65 years (43-80), four patients spontaneously expressed their interest in the preservation of fertility and had an andrological evaluation. RESULTS: Four patients were aged 43, 48, 57 and 61 years, all working (including two businessmen), their partner was aged respectively 42, 37, 47 and 38 years. All four had a post-treatment semen analysis (done over a year after brachytherapy) rich in spermatozoa, with moderate asthenospermia, the main anomaly being severe hypospermia. These spermiograms were nonetheless consistent with the occurrence of spontaneous pregnancy (occurrence of miscarriage in the patient 1). CONCLUSION: There is an interest in applying to men with prostate cancer their position on fertility in order to inform them about the morbidity of various treatments, options for fertility preservation, and the need to continue a contraception after brachytherapy if the partner is not menopausal.

[Orgasm after curietherapy with permanent iodine-125 radioimplants for localized prostate cancer]. / Orgasme après curiethérapie de prostate par implants permanents d'iode 125 pour cancer localisé de la prostate.

OBJECTIVES: Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer. PATIENTS AND METHODS: In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often). RESULTS: After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P=0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P=0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P=0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P<0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n=31) before implantation (P=0.0001). CONCLUSION: Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm.

[Carcinological results of laparoscopic adrenalectomy for adrenal metastasis]. / Résultats de la chirurgie des métastases surrénaliennes par voie laparoscopique.

INTRODUCTION AND OBJECTIVES: Indication of laparoscopic adrenalectomy for adrenal metastasis remains debated. Our aim was to analyze its carcinological results. MATERIAL AND METHODS: In a series of 332 laparoscopic adrenalectomies, 13 were for adrenal metastasis (kidney=5, lung=3, melanoma=3, breast=1, eye=1). The indication was curative (single metastasis) in nine cases (69%), the four other patients (31%) having a polymetastatic disease. All alive patients were interviewed in August 2010. Survival was estimated using the Kaplan-Meyer method, with comparisons using the log rank test. RESULTS: Mean operative time was 174.2 ± 102 minutes. Blood loss was 351 ± 136 mL. Three conversions (23%) were necessary, for gastric perforation, wound of vena cava and inability to dissect the adrenal. Surgical margins were positive in six cases (46%). The risk of positive margin was lower in case of metastasis of renal cell carcinoma (Fischer, p=0.02). The median of overall survival was 14 months (3-45). Survival was significantly higher in metastases of renal cell carcinoma (p=0.035) than in metastases of other tumors, 24 months (11-36) vs six months (3-45), respectively. There was no difference according to the laparoscopic technique used, neither according to the age, nor according to the tumoral size. CONCLUSIONS: Laparoscopic surgery did not offer sufficient guarantee to be considered as the standard treatment in case of adrenal metastasis. However, with a survival rate of 60%, a lower rate of surgical margins, metastases of renal cell carcinoma seem to be the better candidates for laparoscopic adrenalectomy.

[Preprosthetic periodontal examination. Clinical observations]. / L'examen parodontal préprothétique. Réflexions cliniques.

A detailed and comprehensive clinical examination is an important and fundamental basis for establishing a proper diagnosis for prosthetic treatment. It is important to make an accurate diagnosis, a rational treatment plan and establishing a prognosis. A careful examination of teeth and periodontium must be done and the prosthetic plan must consider the periodontal status of the teeth. The prosthetic treatment plan must take into consideration problems of appliance retention, iatrogenic tooth injuries and other factors. A classification based on 6 different clinical situations suggested and their therapeutic solution proposed.