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1.
Clin Genitourin Cancer ; 16(6): 453-457, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30072310

RESUMO

BACKGROUND: Partial nephrectomy (PN) is the standard treatment for localized renal tumors. Laparoscopic PN (LPN) after selective embolization of tumor (LPNE) in a hybrid operating room has been developed to make LPN easier and safer. The aim of this study was to compare outcomes of LPNE and robot-assisted PN (RAPN). PATIENTS AND METHODS: All patients who underwent an LPNE at Angers University Hospital between May 2015 and April 2017, and a RAPN at Diaconesses Croix Saint Simon hospital between October 2014 and April 2017 were prospectively included. The functional outcomes were evaluated using the change of estimated glomerular filtration rate (eGFR) at 1 month, and the oncological outcomes were evaluated using the positive surgical margin (PSM) rate. RESULTS: Fifty-seven patients underwent LPNE and 48 underwent RAPN. There was no difference between oncological and functional outcomes, with 2 PSM (4.4%) in the LPNE group and 4 PSM (10.3%) in the RAPN group (P = .32), and a mean change in eGFR at 1 month of -5.5% for LPNE and -8.3% for RAPN (P = .17). The mean surgical time was shorter in the LPNE group (150 vs. 195 minutes; P < .001), and mean estimated blood loss was less in the LPNE group (185 vs. 345 mL; P = .04). CONCLUSION: The short-term oncological and functional outcomes for LPNE were comparable with those for RAPN. A longer follow-up and a larger cohort of patients would be necessary to verify the benefits of LPNE, which appears to be a very interesting alternative to RAPN.


Assuntos
Embolização Terapêutica , Neoplasias Renais/terapia , Laparoscopia/métodos , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/irrigação sanguínea , Rim/fisiopatologia , Rim/cirurgia , Neoplasias Renais/patologia , Laparoscopia/efeitos adversos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
2.
J Laparoendosc Adv Surg Tech A ; 28(9): 1047-1052, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29664692

RESUMO

PURPOSE: To compare the short-term outcomes of robot-assisted partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) when performed by highly experienced surgeons. METHODS: A prospective multicenter study was conducted, including the 50 last patients having undergone LPN and RPN for T1-T2 renal tumors in two institutions between 2013 and 2016, performed by two different surgeons with an experience of over 200 procedures each in LPN and RPN, respectively, at the beginning of the study. Perioperative parameters and functional and oncological outcomes were collected and compared between the LPN and RPN groups. RESULTS: The laparoscopic approach was associated with a longer warm ischemia time (15.7 versus 23 minutes; P < .001) and hospital stay (3.6 versus 4.6 days; P = .01). Conversely, estimated blood loss was significantly higher in the RPN group (381 mL versus 215 mL; P < .001), but transfusion rates were similar between the two groups (8% versus 6%; P = .33). In the RPN group, three patients (6%) required conversion to open partial nephrectomy and three patients (6%) required a conversion to radical nephrectomy (RN), while no conversion was needed in the LPN group. There were no differences in terms of perioperative complications, and change in renal function was comparable in the two groups postoperatively. Positive surgical margin rates were similar in the RPN and LPN groups (2% versus 6%; P = .36). After a median follow-up of 19 and 14 months in the RPN and LPN groups, respectively (P = .38), recurrence-free survivals did not differ significantly (P = .94). CONCLUSION: In this series, perioperative and short-term oncological and functional outcomes appeared broadly comparable between RPN and LPN when performed by highly experienced surgeons.


Assuntos
Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Conversão para Cirurgia Aberta , Intervalo Livre de Doença , Seguimentos , Humanos , Curva de Aprendizado , Tempo de Internação , Pessoa de Meia-Idade , Neoplasia Residual , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Isquemia Quente
3.
BJU Int ; 121(6): 916-922, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29504226

RESUMO

OBJECTIVE: To assess the impact of hospital volume (HV) and surgeon volume (SV) on perioperative outcomes of robot-assisted partial nephrectomy (RAPN). PATIENTS AND METHODS: All consecutive patients who underwent a RAPN from 2009 to 2015, at 11 institutions, were included in a retrospective study. To evaluate the impact of HV, we divided RAPN into four quartiles according to the caseload per year: low HV (<20/year), moderate HV (20-44/year), high HV (45-70/year), and very high HV (>70/year). The SV was also divided into four quartiles: low SV (<7/year), moderate SV (7-14/year), high SV (15-30/year), and very high SV (>30/year). The primary endpoint was the Trifecta defined as the following combination: no complications, warm ischaemia time (WIT) <25 min, and negative surgical margins. RESULTS: In total, 1 222 RAPN were included. The mean (sd) caseload per hospital per year was 44.9 (26.7) RAPNs and the mean (sd) caseload per surgeon per year was 19.2 (14.9) RAPNs. The Trifecta achievement rate increased significantly with SV (69.9% vs 72.8% vs 73% vs 86.1%; P < 0.001) and HV (60.3% vs 72.3% vs 86.2% vs 82.4%; P < 0.001). The positive surgical margins (PSM) rate (P = 0.02), length of hospital stay (LOS; P < 0.001), WIT (P < 0.001), and operative time (P < 0.001), all decreased significantly with increasing SV. The PSM rate (P = 0.02), LOS (P < 0.001), WIT (P < 0.001), operative time (P < 0.001), and major complications rate (P = 0.01), all decreased significantly with increasing HV. In multivariate analysis adjusting for HV and SV (model 3), HV remained the main predictive factor of Trifecta achievement (odds ratio [OR] 3.70 for very high vs low HV; P < 0.001), whereas SV was not associated with Trifecta achievement (OR 1.58 for very high vs low SV; P = 0.34). CONCLUSION: In this multicentre study HV and SV both greatly influenced RAPN perioperative outcomes, but HV appeared to have a greater impact than SV.


Assuntos
Nefrectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Competência Clínica/normas , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Duração da Cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos , Carga de Trabalho/estatística & dados numéricos
4.
Urol Oncol ; 35(1): 35.e15-35.e19, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27692834

RESUMO

OBJECTIVE: To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC). MATERIAL AND METHODS: We performed a multicenter international study involving the French Network for Research on Kidney Cancer (UroCCR) and 5 international teams. Data from 808 patients treated with NSS between 2004 and 2014 for non-clear cell RCCs were analyzed. RESULTS: We included 234 patients with cRCC. There were 123 (52.6%) females. Median age was 61 (23-88) years. Median tumor size was 3 (1-11)cm. A positive surgical margin was identified in 14 specimens (6%). Pathologic stages were T1, T2, and T3a in 202 (86.3%), 9 (3.8%), and 23 (9.8%) cases, respectively. After a mean follow-up of 46.6 ± 36 months, 2 (0.8%) patients experienced a local recurrence. No patient had metastatic progression, and no patient died from cancer. Three-years estimated cancer-free survival and cancer-specific survival were 99.1% and 100%, respectively. CONCLUSION: Oncological results of NSS for localized cRCC are excellent. In this series, only 2 patients had a local recurrence, and no patient had metastatic progression or died from cancer.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia , Néfrons , Tratamentos com Preservação do Órgão , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
5.
J Surg Oncol ; 114(8): 992-996, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27859263

RESUMO

BACKGROUND AND OBJECTIVES: To identify predictive preoperative factors of the presence of teratoma in retroperitoneal lymph node dissection specimens. METHODS: We performed a 20 years multicenter retrospective analysis of all patients who underwent retroperitoneal lymph node dissection for residual masses after chemotherapy (PC-RPLND). Patients had undergone PC-RPLND after chemotherapy for advanced testicular cancer. The histologic components of the primary tumor were compared with those of the residual masses using logistic regression. RESULTS: A total of 469 NSGCT patients underwent PC-RPLND (complete data available for 211). By PC-RPLND, necrosis was found in 84 cases, teratoma in 102 cases, and viable tumor in 25 cases. The univariate and multivariate analyses showed that teratoma (P = 0.001 and P = 0.002, respectively) and yolk sac tumor (P = 0.009 and P = 0.035, respectively) in orchiectomy specimens were statistically significant predictors of the presence of teratoma in retroperitoneal lymph nodes. CONCLUSIONS: PC-RPLND is the standard treatment for any supracentimetric residual lesion. This procedure is associated with a high morbidity, and almost half patients are overtreated. The presence of teratoma and yolk sac tumor in the orchiectomy specimen were independent significant predictors of teratoma in retroperitoneal masses. J. Surg. Oncol. 2016;114:992-996. © 2016 Wiley Periodicals, Inc.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Excisão de Linfonodo , Linfonodos/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Retroperitoneais/patologia , Teratoma/patologia , Neoplasias Testiculares/patologia , Adulto , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Cisplatino/uso terapêutico , Humanos , Modelos Logísticos , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Neoplasias Retroperitoneais/etiologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal , Estudos Retrospectivos , Fatores de Risco , Teratoma/cirurgia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/cirurgia , Resultado do Tratamento
6.
World J Urol ; 34(3): 347-52, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26149352

RESUMO

OBJECTIVES: To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following nephron sparing surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death. MATERIALS AND METHODS: An international multicentre retrospective study involving 19 institutions and the French network for research on kidney cancer was conducted after IRB approval. We analyzed data of all patients with pRCC who were treated by NSS between 2004 and 2014. RESULTS: We included 486 patients. Tumors were type 1 pRCC in 369 (76 %) cases and type 2 pRCC in 117 (24 %) cases. After a mean follow-up of 35 (1-120) months, 8 (1.6 %) patients experienced a local recurrence, 12 (1.5 %) had a metastatic progression, 24 (4.9 %) died, and 7 (1.4 %) died from cancer. Patients with type I pRCC had more grade II (66.3 vs. 46.1 %; p < 0.001) and less grade III (20 vs. 41 %; p < 0.001) tumors. Three-year estimated cancer-free survival (CFS) rate for type 1 pRCC was 96.5 % and for type 2 pRCC was 95.1 % (p = 0.894), respectively. Three-year estimated cancer-specific survival rate for type 1 pRCC was 98.4 % and for type 2 pRCC was 97.3 % (p = 0.947), respectively. Tumor stage superior to pT1 was the only prognostic factor for CFS (HR 3.5; p = 0.03). CONCLUSION: Histological subtyping of pRCC has no impact on oncologic outcomes after nephron sparing surgery. In this selected population of pRCC tumors, we found that tumor stage is the only prognostic factor for cancer-free survival.


Assuntos
Carcinoma de Células Renais/classificação , Neoplasias Renais/classificação , Estadiamento de Neoplasias , Nefrectomia/métodos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Progressão da Doença , Intervalo Livre de Doença , Feminino , França/epidemiologia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Néfrons/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
7.
Acta Oncol ; 53(10): 1413-22, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24874929

RESUMO

UNLABELLED: There is growing evidence that sunitinib plasma levels have an impact on treatment outcome in patients with metastatic renal cell carcinoma (mRCC). We studied the impact of single nucleotide polymorphisms (SNPs) in genes involved in sunitinib pharmacokinetics, and additionally, sunitinib pharmacodynamics on dose reductions of the tyrosine kinase inhibitor. METHODS: We retrospectively analyzed germ-line DNA retrieved from mRCC patients receiving sunitinib as first-line therapy. We genotyped 11 key SNPs, respectively, in ABCB1, NR1/2, NR1/3 and CYP3A5, involved in sunitinib pharmacokinetics as well as VEGFR1 and VEGFR3, which have been suggested as regulators of sunitinib pharmacodynamics. Association between these SNPs and time-to-dose-reduction (TTDR) was studied by Cox regression. RESULTS: We identified 96 patients who were treated with sunitinib and from whom germ-line DNA and data on dose reductions were available. We observed an increased TTDR in patients carrying the TT-genotype in ABCB1 rs1125803 compared to patients with CC- or CT-genotypes (19 vs. 7 cycles; p = 0.031 on univariate analysis and p = 0.012 on multivariate analysis) and an increased TTDR in patients carrying the TT/TA-variant in ABCB1 rs2032582 compared to patients with the GG- or GT/GA-variant (19 vs. 7 cycles; p = 0.046 on univariate analysis and p = 0.024 on multivariate analysis). CONCLUSION: mRCC patients carrying the rs1128503 TT-variant or the TT/TA-variant in rs2032582 in ABCB1, which encodes for an efflux pump, do require less dose reductions due to adverse events compared to patients with the wild type or heterozygote variants in these genes.


Assuntos
Antineoplásicos/farmacocinética , Indóis/farmacocinética , Neoplasias Renais/sangue , Neoplasias Renais/genética , Polimorfismo de Nucleotídeo Único , Pirróis/farmacocinética , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Carcinoma de Células Renais/sangue , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/genética , Citocromo P-450 CYP3A/genética , Feminino , Genótipo , Humanos , Indóis/administração & dosagem , Indóis/efeitos adversos , Neoplasias Renais/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pirróis/administração & dosagem , Pirróis/efeitos adversos , Estudos Retrospectivos , Sunitinibe , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/genética , Receptor 3 de Fatores de Crescimento do Endotélio Vascular/genética
8.
Clin Genitourin Cancer ; 12(4): 292-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24461624

RESUMO

INTRODUCTION: The objective of this study was to conduct a declarative professional practices survey among urologists of the French Association of Urology (AFU) and French pathologists concerning their management of testicular cancer. MATERIALS AND METHODS: A questionnaire was sent to all urologists, members of the AFU, and another questionnaire was sent to French pathologists, members of the International Academy of Pathology, French Division, in June 2010. A total of 289 urologists (29%) and 84 pathologists (19%) returned the questionnaires. RESULTS: Fifty-seven percent of urologists declared that they performed fewer than 5 orchidectomies per year. Pathologists declared that they examined less than 5 orchidectomy specimens per year in 24% of cases. The laboratory work-up (only alpha fetoprotein [AFP], lactate dehydrogenase [LDH], and total human chorionic gonadotropin [hCG]) and the radiological work-up (only testicular ultrasound and chest, abdomen, and pelvis computed tomography [CT] scan) were performed strictly according to guidelines in 15.9% and 65.7% of cases, respectively. A total of 31.8% of urologists declared that they performed the minimum assessment required by guidelines (AFP, LDH, total hCG, testicular ultrasound and chest, abdomen, and pelvis CT scan plus other examinations not recommended). Prognostic factors of stage I tumors, to define the indications for adjuvant therapy, were correctly declared in 7.3% of nonseminomatous germ cell tumors (vascular and/or lymphatic emboli) and in 13.8% of seminomas (tumor size >4 cm and rete testis invasion). CONCLUSION: This survey demonstrated that clinical practice did not comply with guidelines, which raises the question of the measures that can be taken to ensure better application of guidelines or how to develop expert centers for the management of these rare tumors.


Assuntos
Orquiectomia/estatística & dados numéricos , Patologia Clínica , Padrões de Prática Médica , Neoplasias Testiculares/cirurgia , Urologia , Fidelidade a Diretrizes , Inquéritos Epidemiológicos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Prognóstico , Inquéritos e Questionários
9.
J Minim Invasive Gynecol ; 20(1): 49-55, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23131702

RESUMO

STUDY OBJECTIVE: To evaluate urologic complications after colorectal resection for endometriosis. DESIGN: Cohort study (Canadian Task Force classification II-2). SETTING: Tertiary referral university hospital and expert center in endometriosis. PATIENTS: One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging. INTERVENTION: Open or laparoscopic colorectal resection for endometriosis. MEASUREMENTS AND MAIN RESULTS: Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003). CONCLUSION: Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed.


Assuntos
Endometriose/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias , Doenças Urológicas/etiologia , Doenças Vaginais/cirurgia , Adulto , Estudos de Coortes , Endometriose/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Laparoscopia/métodos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia , Doenças Urológicas/terapia , Doenças Vaginais/diagnóstico , Adulto Jovem
11.
Prostate ; 72(12): 1382-8, 2012 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-22228175

RESUMO

BACKGROUND: Circulating tumor cell (CTC) analysis is a potential new biomarker in prostate cancer. We hypothesize that quantitative detection of CTCs in patients pre- and post-radical prostatectomy (RP) using quantitative TaqMan® fluorogenic RT-PCR will improve the accuracy of the Kattan nomogram to predict the probability of recurrence-free survival (RFS) post-RP. METHODS: Ninty-two patients who underwent RP between 2004 and 2009 had venous blood samples taken pre- (Day - 1) and post-operatively (Day + 7). We performed quantitative Taqman® RT-PCR to detect circulating prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) mRNA. We calculated both the logarithmic ratio of Day + 7/Day - 1 for PSA (PSAr) and PSMA (PSMAr) expression (log(Day+7/Day-1) ) and the Kattan nomogram predicted probability of disease recurrence for each patient. We then analyzed how the AUC-ROC analysis for the Kattan nomogram prediction alone (K) compared to the addition of the PSAr and PSMAr in predicting 5-year RFS. RESULTS: The mean age (years), PSA (ng/ml), and follow-up (mo) was 65.1, 9.13, and 72, respectively. The AUCs for K, PSAr + K, and PSMAr + K were 0.752 (95%CI 0.620-0.860), 0.830 (95%CI 0.740-0.911), and 0.837 (95%CI 0.613-0.923), respectively (P = 0.03). The Kattan 5-year PSA RFS was 75%. The actual 5-year PSA RFS survival rate was 77%. CONCLUSIONS: Data from modern quantitative RT-PCR to detect circulating prostate-derived PSA and PSM mRNA pre- and post-RP improves the accuracy of the Kattan nomogram to predict biochemical recurrence.


Assuntos
Antígenos de Superfície/genética , Glutamato Carboxipeptidase II/genética , Células Neoplásicas Circulantes/patologia , Antígeno Prostático Específico/sangue , Antígeno Prostático Específico/genética , Prostatectomia , Neoplasias da Próstata/genética , RNA Mensageiro , Reação em Cadeia da Polimerase em Tempo Real/métodos , Idoso , Antígenos de Superfície/sangue , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/genética , Intervalo Livre de Doença , Seguimentos , Glutamato Carboxipeptidase II/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/mortalidade , Nomogramas , Valor Preditivo dos Testes , Antígeno Prostático Específico/química , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/cirurgia , RNA Mensageiro/sangue , RNA Mensageiro/genética , Recidiva
13.
Mol Med ; 17(5-6): 473-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21308149

RESUMO

Single nucleotide polymorphisms (SNPs) have been associated with prostate cancer (PCa) risk and tumor aggressiveness in retrospective studies. To assess the value of genotyping in a clinical setting, we evaluated the correlation between three genotypes (rs1447295 and rs6983267[8q24] and rs4054823[17p12]) and prostatic biopsy outcome prospectively in a French population of Caucasian men. Five hundred ninety-eight patients with prostatic-specific antigen (PSA) >4 ng/mL or abnormal digital rectal examination (DRE) participated in this prospective, multicenter study. Age, familial history of PCa, body mass index (BMI), data of DRE, International Prostate Symptom Score (I-PSS) score, PSA value and prostatic volume were collected prospectively before prostatic biopsy. Correlation between genotypes and biopsy outcome (positive or negative) and Gleason score (≤6 or >6) were studied by univariate and multivariable analysis. rs1447295 and rs6983267 risk variants were found to be associated with the presence of PCa in univariate analysis. rs6983267 genotype remained significantly linked to a positive biopsy (odds ratio [OR] = 1.66, 95% confidence interval [CI]: 1.06-2.59, P = 0.026) in multivariable analysis, but rs1447295 genotype did not (OR = 1.47, 95% CI: 0.89-2.43, P = 0.13).When biopsy outcome was stratified according to Gleason score, risk variants of rs1447295 were associated with aggressive disease (Gleason score ≥7) in univariate and multivariable analysis (OR = 2.05 95% CI: 1.10-3.79, P = 0.023). rs6983267 GG genotype was not related to aggressiveness. The results did not reach significance concerning rs4054823 for any analysis. This inaugural prospective evaluation thus confirmed potential usefulness of genotyping PCa assessment. Ongoing clinical evaluation of larger panels of SNPs will detail the actual impact of genetic markers on clinical practice.


Assuntos
Biópsia/métodos , Neoplasias da Próstata/genética , Idoso , Genótipo , Humanos , Masculino , Análise Multivariada , Polimorfismo de Nucleotídeo Único/genética , Estudos Prospectivos , Antígeno Prostático Específico/genética , Neoplasias da Próstata/diagnóstico , Fatores de Risco
14.
Eur Urol ; 59(1): 148-54, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21030144

RESUMO

BACKGROUND: Duloxetine is effective in the management of stress urinary incontinence (SUI) in women but has been poorly evaluated in the treatment of SUI following radical prostatectomy (RP). OBJECTIVE: To establish the superiority of duloxetine over placebo in SUI after RP. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective, randomised, placebo-controlled, double-blind, monocentric superiority trial. After a placebo run-in period of 2 wk, patients with SUI after RP were randomised to receive either 80mg of duloxetine daily or matching placebo for 3 mo. MEASUREMENTS: The primary outcome measure was the relative variation in incontinence episodes frequency (IEF) at the end of study compared to baseline. Secondary outcomes included quality of life (QoL) measures (Incontinence Impact Questionnaire Short Form [IIQ-SF], Urogenital Distress Inventory Short Form [UDI-SF], Incontinence Quality of Life [I-QoL]), symptom scores (Urinary Symptom Profile [USP] questionnaire, International Consultation on Incontinence/World Health Organisation Short Form questionnaire [ICIQ-SF], the Beck Depression Inventory [BDI-II] questionnaire), 1-h pad test, and assessment of adverse events. RESULTS AND LIMITATIONS: Thirty-one patients were randomised to either the treatment (n=16) or control group (n=15). Reduction in IEF was significant with duloxetine compared to placebo (mean±standard deviation [SD] variation: -52.2%±38.6 [range: -100 to +46] vs +19.0%±43.5 [range: -53 to +104]; mean difference: 71.2%; 95% confidence interval [CI] for the difference: 41.0-101.4; p<0.0001). IIQ-SF total score, UDI-SF total score, SUI subscore of the USP questionnaire, and question 3 of the ICIQ-SF questionnaire showed improvement in the duloxetine group (p=0.006, p=0.02, p=0.0004, and p=0.003, respectively). Both treatments were well tolerated throughout the study period. CONCLUSIONS: Duloxetine is effective in the treatment of incontinence symptoms and improves QoL in patients with SUI after RP.


Assuntos
Inibidores da Captação Adrenérgica/uso terapêutico , Prostatectomia/efeitos adversos , Inibidores de Captação de Serotonina/uso terapêutico , Tiofenos/uso terapêutico , Incontinência Urinária/prevenção & controle , Inibidores da Captação Adrenérgica/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Método Duplo-Cego , Cloridrato de Duloxetina , Humanos , Masculino , Pessoa de Meia-Idade , Paris , Projetos Piloto , Efeito Placebo , Estudos Prospectivos , Qualidade de Vida , Inibidores de Captação de Serotonina/efeitos adversos , Inquéritos e Questionários , Tiofenos/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/etiologia
15.
Int Urogynecol J ; 22(2): 183-9, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20821309

RESUMO

INTRODUCTION AND HYPOTHESIS: Cell therapy for stress urinary incontinence (SUI) management has been experienced with encouraging results. METHODS: We conducted an open prospective study on 12 women presenting severe SUI with fixed urethra, after previous failed surgical management. Patients underwent intrasphincteric injections of autologous progenitor muscular cells isolated from a biopsy of deltoid muscle. Primary endpoint focused on safety (measurement of Q(max) variation after 3 months). Secondary endpoints assessed side effects and efficacy. RESULTS: No variation was diagnosed on Q(max) measurements. Efficacy data show that three of 12 patients are dry at 12 months, seven other patients are improved on pad test but not on voiding diary, and two patients were slightly worsened by the procedure. Quality of life was improved in half of patients. CONCLUSIONS: Cell therapy for severe multioperated cases of SUI is a mini-invasive, feasible, and safe procedure that can improve urinary condition in as a second line therapy.


Assuntos
Mioblastos/transplante , Incontinência Urinária por Estresse/terapia , Adulto , Idoso , Feminino , Humanos , Injeções , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Transplante Autólogo , Resultado do Tratamento
16.
Eur Urol ; 59(2): 250-7, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21056532

RESUMO

BACKGROUND: Cytogenetic abnormalities occur at an early stage of bladder urothelial carcinomas (BUC), and their frequency increases as the cancer becomes more advanced. OBJECTIVE: To assess the diagnostic performance of a test based on cytogenetic abnormalities to diagnose, stage, and grade BUC from the urine. DESIGN, SETTING, AND PARTICIPANTS: We used a 341 bacterial artificial chromosome (BAC) comparative genomic hybridisation (CGH)-array chip (BCA-1) designed to include loci affected in BUC. The chip was first used on 32 frozen BUC biopsies to design staging (BN0) and grading (BN1 and BN2) prediction models based on Bayesian networks analysis. The models were then validated on external data obtained from 98 tumour samples using a 2464 BAC CGH-array chip. The performance of the test was finally assessed on 44 urine pellets collected, including 22 patients who had BUC and 22 controls. MEASUREMENTS: We measured sensitivity and specificity to diagnose BUC stage and grade from urine pellets. RESULTS AND LIMITATIONS: In the urine, BCA-1 test sensitivity was 95%, specificity was 86%, and accuracy was 91%. The BN0 staging model identified T1-4 tumours in the urine with a sensitivity of 90%, a specificity of 83%, and an accuracy of 87%. The BN1 and BN2 grading models detected high-grade disease with a sensitivity, specificity, and accuracy of 86%, 88%, and 87%, respectively, using BN1 and 100%, 63%, and 82%, respectively, using BN2. BN models performed with similar sensitivity but reduced specificity using the external data. BCA-1 failed to produce results for eight additional samples (failure rate: 9%). The test needed high quantities and quality of DNA, and external validation in larger, prospective, and better-designed studies is necessary to confirm feasibility and performance. CONCLUSIONS: The BCA-1 mini-CGH-array chip detected BUC in urine with a high diagnostic performance. It could also accurately discriminate low-grade from high-grade tumours and, to a lesser extent, lamina propria-invasive tumours from pTa tumours.


Assuntos
Carcinoma , Hibridização Genômica Comparativa/métodos , Estadiamento de Neoplasias/métodos , Neoplasias Urológicas , Urotélio/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/urina , Carcinoma/genética , Carcinoma/patologia , Carcinoma/urina , Cromossomos Artificiais Bacterianos , Hibridização Genômica Comparativa/normas , Testes Genéticos/métodos , Testes Genéticos/normas , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Neoplasias Urológicas/genética , Neoplasias Urológicas/patologia , Neoplasias Urológicas/urina
17.
BJU Int ; 108(2): 236-40, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20955265

RESUMO

OBJECTIVE: • To assess clinical outcomes at mid-term follow-up and determine preoperative factors associated with the failure of the Advance(TM) male sling for post-prostatectomy incontinence (PPI). PATIENTS AND METHODS: • A prospective evaluation was conducted of 136 consecutive patients implanted with the Advance(TM) male sling for mild to moderate stress urinary incontinence after prostatectomy. • Patients were preoperatively evaluated using medical history, ASA score, urodynamics, 24-h pad test and pad usage. • The clinical outcome was evaluated according to pad use and the Patient Global Impression of Improvement scale and by assessment of side effects. 'Cure' was defined as no pad usage and 'improvement' as a decrease in pad use by >50%. • Factors related to functional outcome were studied by univariate and multivariate analysis. RESULTS: • After a mean ± SD (range) follow-up of 21 ± 6 (12-36) months, 62% of patients were cured, 16% improved and 22% not improved. • Failure (no cure or improvement) was associated with previous urethral stricture surgery (P= 0.013) and a 24-h pad-test >200 g/day (P= 0.026), and there was a trend for an association with previous radiation therapy (P= 0.053). • Age, learning curve and type of prostatectomy did not affect the results. • Immediate postoperative complications were limited to two cases of dysuria, one case of perineal haematoma and two cases of perineal paresthesia. During follow-up, 10% of patients had perineal pain and 14% of patients had mild dysuria. None required surgical management. CONCLUSION: • The results of the present study, with a follow-up of up to 3 years, confirm that the Advance(TM) male sling is an efficient treatment for PPI. However, particular attention should be given to the preoperative data associated with failure.


Assuntos
Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Idoso , Idoso de 80 Anos ou mais , Métodos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia
18.
Eur Urol ; 58(1): 157-61, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20434258

RESUMO

BACKGROUND: TVT-Secur has been described as a new minimally invasive sling for women's stress urinary incontinence (SUI) management, showing promising results in short-term studies. OBJECTIVE: Our goal was to evaluate the outcome of this procedure after a midterm follow-up. DESIGN, SETTING, AND PARTICIPANTS: A prospective evaluation involved 45 consecutive patients presenting SUI associated with urethral hypermobility. Fourteen patients preoperatively reported overactive bladder (OAB) symptoms, but none had objective detrusor overactivity. Eight patients had low maximal urethral closure pressure (MUCP). Four patients had pelvic organ prolapse (POP). INTERVENTION: Patients with POP were treated under general anesthesia by Prolift and TVT-Secur procedure. The 41 other patients received TVT-Secur under local anesthesia on an outpatient basis. All interventions were made by the same surgeon. MEASUREMENTS: Postoperative assessment included pad count, bladder diary, clinical examination with stress test, evaluation of satisfaction with the Patient Global Impression of Improvement (PGI-I) scale, and evaluation of side effects. Patients were classified as cured if they used no pads, had no leakage, and had a PGI-I score < or = 2; as improved in case of reduction of SUI symptoms >50% and PGI-I score < or = 3; and as failure otherwise. RESULTS AND LIMITATIONS: Mean postoperative follow-up was 30.2 +/- 9.8 mo (range: 11-40 mo). Short-term evaluation showed a 93.5% success rate, but, at last follow-up, only 18 (40%) patients were cured, while 8 (18%) were improved, and 19 (42%) failed. Twelve patients underwent implantation of TVT or transobturator tape during follow-up. Age, MUCP, or OAB were not associated with failure. Side effects were limited to five cases of de novo OAB and three cases of urinary tract infection. This work is limited by the absence of a comparison group. CONCLUSIONS: Our experience shows that despite its good short-term efficacy, TVT-Secur is associated with a high recurrence rate of SUI. Therefore, TVT-Secur does not seem appropriate for SUI first-line management in women.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais , Bexiga Urinária Hiperativa/cirurgia , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Recidiva , Falha de Tratamento , Resultado do Tratamento , Infecções Urinárias/etiologia
19.
Surg Radiol Anat ; 32(7): 663-7, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20429006

RESUMO

PURPOSE: Nerve-sparing radical prostatectomy (NSRP) is based on anatomical considerations that are still controversial. The aim of this study is to define and describe the anatomy of the fascias surrounding the prostate in a histoembryologic model and during open and laparoscopic approaches to assess their importance in surgical practice. METHODS: An anatomical dissection of three fresh cadavers was conducted to reproduce an open approach. Complementary data under laparoscopic conditions were obtained from images captured from the video feed during a laparoscopic NSRP performed via a transperitoneal approach. A histological study of one fresh 25-week human male fetus, obtained following miscarriage, was also conducted to document the embryologic development of the identified fascias. RESULTS: Three fascias surrounding the prostate can clearly be individualized both in histologic and clinical conditions. The endopelvic fascia (EF), the prostatic fascia (PF) and the Denonvilliers' fascia (DF) recover the prostate gland and structure the periprostatic environment. Neurovascular bundles are situated in a triangle formed by PF, EF and DF. Interfascial dissection (between EF and PF) allows nerve-sparing surgery. CONCLUSION: When performing radical prostatectomy, it is mandatory to locate EF, PF and DF precisely to respect the neurovascular bundles. Nevertheless, cancer extension and anatomic variations can lead to more extensive procedures.


Assuntos
Fáscia/inervação , Próstata/inervação , Próstata/cirurgia , Prostatectomia/métodos , Idoso , Cadáver , Fáscia/embriologia , Feto/anatomia & histologia , Humanos , Laparoscopia , Masculino , Próstata/embriologia
20.
Eur Urol ; 56(6): 923-7, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19748174

RESUMO

BACKGROUND: Transobturator male slings have been proposed to manage stress urinary incontinence (SUI) after prostatic surgery, but data are still lacking. OBJECTIVE: To determine the safety and prospectively evaluate the clinical outcome after management of SUI after prostatic surgery by placement of a transobturator male sling. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective evaluation on 102 patients treated in a single center between 2007 and 2009 for mild to moderate SUI following prostatic surgery. INTERVENTIONS: Placement of a suburethral transobturator sling and clinical follow-up. MEASUREMENTS: Patients were evaluated by medical history, preoperative urodynamics, maximum flow rate measurement, 24-h pad test, and daily pad use. During follow-up, data on patients' pad use, complications, and answers to the Patient Global Impression of Improvement (PGI-I) questionnaire were collected. Cure was defined as no pad usage or one pad for security reasons and improvement as reduction of pads≥50%. Median follow-up was 13 mo (range: 6-26). RESULTS AND LIMITATIONS: Most patients (95%) presented post-radical prostatectomy incontinence (PRPI). Hospital stay was 2 d in 97 cases, and all patients were catheterized for 24h except two (48 h). Of 102 patients, 64 were cured, 18 were improved, and 20 were not improved. According to the PGI-I questionnaire, 85%, 11%, and 4% of patients described a respectively better, unchanged, and worse urinary tract condition, respectively. Previous radiation was associated with higher rate of failure (p=0.039). Neither severe complication nor postoperative urinary obstruction was noted during follow-up. CONCLUSIONS: Placement of a transobturator sling is a safe and effective procedure, giving durable results after >1 yr of follow-up. Further evaluation and high-quality controlled, randomized studies are needed to assess long-term efficacy and precise indications of this procedure for post-prostatic-surgery SUI management.


Assuntos
Complicações Pós-Operatórias/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Tampões Absorventes para a Incontinência Urinária , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Slings Suburetrais/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento
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