Thirty patients with partial or total staghorn stones or calculi larger than 30 mm were treated b... more Thirty patients with partial or total staghorn stones or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had pelvic stones; the other 11 had partial (9) or total (2) staghorn stones. All patients first underwent an initial lithotripsy session. No anesthesia or IV sedation was required in any case. If stone fragmentation was achieved during this first session, a double-J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had sterile urine cultures; 12 of 30 presented major distension of the excretory tract. Results were analyzed to determine the factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stones had completely disappeared according to plain abdominal films (14 of 30, 46%). In seven patients (23.3%) fragmentation had occurred but...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 1992
Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance ... more Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance of a pelvic nodule positive on biopsy and/or the presence of bone metastases confirmed by bone scan, was studied in a series of patients with prostatic cancer with a follow-up of between 6 months and 5 years. The progression-free survival rate was 86% at 1 year and 60% at 5 years. A progression-free survival rate and the relative risk of progression were established on the basis of the morphological characteristics (anatomical stage, tumour volume, seminal vesicle invasion, condition of the prostatic capsule and lymph nodes, positive resection margins at the apex) and histological features (Gleason's score) of the cancer, allowing determination of the influence of prognostic criteria on the outcome. The positive resection margins at the apex were due to preservation of the nervi erigentes. The preservation of the neurovascular pedicles may not be justified in the case of a tumour con...
Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed ... more Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed in adults because of a complication. Renal colic and dysuria were the clinical symptoms that led to discovery in the two patients reported here. These two women (aged 80 and 32 years) underwent transurethral meatotomy for complicated ureterocele. This procedure was sufficient for cure, with spontaneous evacuation of all stones in patient 2. There were no clinical or bacteriological (urine analyses) signs of reflux during the follow-up period (24 and 12 months). Endoscopic treatment of adult complicated ureterocele can thus be proposed as a first line procedure. Development of symptomatic secondary reflux is an indication for surgery.
To study high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (micro‐US) for the detectio... more To study high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (micro‐US) for the detection of clinically significant prostate cancer (csPCa) on prostate biopsy, and validate an image interpretation protocol for micro‐US imaging of the prostate.
e16015 Background: Partial nephrectomy (PN) is now the gold standard for small renal mass of less... more e16015 Background: Partial nephrectomy (PN) is now the gold standard for small renal mass of less than 4 cm since it prevents renal insufficiency that may occur with radical nephrectomy. The impact of warm ischemis time (WIT) on the operated kidney's renal differential function (RDF) have been poorly studied in the litterature, especially when WIT is less than 30 minutes. We evaluated the effect of WIT and other perioperative factors on RDF function assessed by pre- and post-operative renal scintigraphy. Methods: Between 2003 and 2008, 182 laparoscopic PN were performed by a single surgeon on patients with two kidneys. Among those, 56 had a MAG3-lasix renal scintigraphy pre- and post-operatively between 7 and 14 days. Data were collected prospectively. Loss in RDF is calculated as follow: Loss in RDF=(RDF preoperatively-RDF postoperatively/RDF preoperatively) × 100. Results: Medians for age, pre- op creatinine, pre-op GFR (Cockroft formula) and tumor CT-size were 61 years, 83 μM...
This video shows the feasibility of early ligature of the renal artery performed during laparosco... more This video shows the feasibility of early ligature of the renal artery performed during laparoscopic radical nephrectomy, in order to achieve oncological asepsis. MATERIAL & METHODS: Four patients underwent radical laparoscopic nephrectomy for treatment of RCC (4-6 cm in size) with early ligature of the renal artery. 1 st case: the sovramesocolic posterior peritoneum was incised; the descending portion of the duodenum was exposed and displaced medially. The right renal artery was isolated where it emerges from the lateral margin of the inferior vena cava and treated by means of Hemo-lock. The renal vein was closed with Hemo-lock and sectioned. 2 na case: the vena cava, the left renal vein and inter aorto cavaI space were exposed by Kocherizing the duodenum. The right renal artery was revealed at its origin. After the artery was isolated and secured with Hemo-lock the surgical procedure continued in the usual manner. The renal artery, previously tied, was secured at the branch intersection with Hemolock and sectioned. The renal vein was isolated and secured with Hemo-Iock and sectioned. 3 ra case the early access to the left renal vascular pediele included: incision of left Toldt line and medial mobilization of the left colic flexure. Spleen and pancreatic tail were progressively separated from the anterior Gerota's fascia. The Toldt fascia was incised and two renal arteries are isolated and secured with Hemo-tock and sectioned. The renal vein was isolated, secured with a vascular Endo-GIA stapler. Then the adrenal pedicle was secured with Hemo-lock and sectioned. 4 th case: early ligature was at the level of the Treitz ligament. The Treitz ligament and the inferior mesenteric vein were identified, the Treitz ligament and the posterior peritoneum were sectioned.. A blunt dissection was performed to the aortic wail to free it of lymphatic tissue. The small renal lumbar artery and gonadal artery were identified, clipped and sectioned. The left renal vein was retracted upwards and the renal artery was identified. The renal artery was isolated carefully and secured with an extra-corporeal knot. RESULTS: Operating times were between 120-160 minutes. No intra-operative complications were recorded. Blood loss was between 200-400ml. Post operative stay 4-6 days. Histological examination revealed RCC in all cases. CONCLUSIONS: Early ligature of the renal artery is feasible and safe in laparoscopic procedures. It also permits the procedure to be performed in total oncological asepsis, accurately reproducing the radical principles that have driven open surgical techniques for years and have contributed significantly to improving therapeutic successes.
Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed ... more Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed in adults because of a complication. Renal colic and dysuria were the clinical symptoms that led to discovery in the two patients reported here. These two women (aged 80 and 32 years) underwent transurethral meatotomy for complicated ureterocele. This procedure was sufficient for cure, with spontaneous evacuation of all stones in patient 2. There were no clinical or bacteriological (urine analyses) signs of reflux during the follow-up period (24 and 12 months). Endoscopic treatment of adult complicated ureterocele can thus be proposed as a first line procedure. Development of symptomatic secondary reflux is an indication for surgery.
Thirty patients with partial or total staghorn stones or calculi larger than 30 mm were treated b... more Thirty patients with partial or total staghorn stones or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had pelvic stones; the other 11 had partial (9) or total (2) staghorn stones. All patients first underwent an initial lithotripsy session. No anesthesia or IV sedation was required in any case. If stone fragmentation was achieved during this first session, a double-J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had sterile urine cultures; 12 of 30 presented major distension of the excretory tract. Results were analyzed to determine the factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stones had completely disappeared according to plain abdominal films (14 of 30, 46%). In seven patients (23.3%) fragmentation had occurred but...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 1992
Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance ... more Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance of a pelvic nodule positive on biopsy and/or the presence of bone metastases confirmed by bone scan, was studied in a series of patients with prostatic cancer with a follow-up of between 6 months and 5 years. The progression-free survival rate was 86% at 1 year and 60% at 5 years. A progression-free survival rate and the relative risk of progression were established on the basis of the morphological characteristics (anatomical stage, tumour volume, seminal vesicle invasion, condition of the prostatic capsule and lymph nodes, positive resection margins at the apex) and histological features (Gleason's score) of the cancer, allowing determination of the influence of prognostic criteria on the outcome. The positive resection margins at the apex were due to preservation of the nervi erigentes. The preservation of the neurovascular pedicles may not be justified in the case of a tumour con...
Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed ... more Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed in adults because of a complication. Renal colic and dysuria were the clinical symptoms that led to discovery in the two patients reported here. These two women (aged 80 and 32 years) underwent transurethral meatotomy for complicated ureterocele. This procedure was sufficient for cure, with spontaneous evacuation of all stones in patient 2. There were no clinical or bacteriological (urine analyses) signs of reflux during the follow-up period (24 and 12 months). Endoscopic treatment of adult complicated ureterocele can thus be proposed as a first line procedure. Development of symptomatic secondary reflux is an indication for surgery.
To study high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (micro‐US) for the detectio... more To study high‐frequency 29 MHz transrectal side‐fire micro‐ultrasound (micro‐US) for the detection of clinically significant prostate cancer (csPCa) on prostate biopsy, and validate an image interpretation protocol for micro‐US imaging of the prostate.
e16015 Background: Partial nephrectomy (PN) is now the gold standard for small renal mass of less... more e16015 Background: Partial nephrectomy (PN) is now the gold standard for small renal mass of less than 4 cm since it prevents renal insufficiency that may occur with radical nephrectomy. The impact of warm ischemis time (WIT) on the operated kidney's renal differential function (RDF) have been poorly studied in the litterature, especially when WIT is less than 30 minutes. We evaluated the effect of WIT and other perioperative factors on RDF function assessed by pre- and post-operative renal scintigraphy. Methods: Between 2003 and 2008, 182 laparoscopic PN were performed by a single surgeon on patients with two kidneys. Among those, 56 had a MAG3-lasix renal scintigraphy pre- and post-operatively between 7 and 14 days. Data were collected prospectively. Loss in RDF is calculated as follow: Loss in RDF=(RDF preoperatively-RDF postoperatively/RDF preoperatively) × 100. Results: Medians for age, pre- op creatinine, pre-op GFR (Cockroft formula) and tumor CT-size were 61 years, 83 μM...
This video shows the feasibility of early ligature of the renal artery performed during laparosco... more This video shows the feasibility of early ligature of the renal artery performed during laparoscopic radical nephrectomy, in order to achieve oncological asepsis. MATERIAL & METHODS: Four patients underwent radical laparoscopic nephrectomy for treatment of RCC (4-6 cm in size) with early ligature of the renal artery. 1 st case: the sovramesocolic posterior peritoneum was incised; the descending portion of the duodenum was exposed and displaced medially. The right renal artery was isolated where it emerges from the lateral margin of the inferior vena cava and treated by means of Hemo-lock. The renal vein was closed with Hemo-lock and sectioned. 2 na case: the vena cava, the left renal vein and inter aorto cavaI space were exposed by Kocherizing the duodenum. The right renal artery was revealed at its origin. After the artery was isolated and secured with Hemo-lock the surgical procedure continued in the usual manner. The renal artery, previously tied, was secured at the branch intersection with Hemolock and sectioned. The renal vein was isolated and secured with Hemo-Iock and sectioned. 3 ra case the early access to the left renal vascular pediele included: incision of left Toldt line and medial mobilization of the left colic flexure. Spleen and pancreatic tail were progressively separated from the anterior Gerota's fascia. The Toldt fascia was incised and two renal arteries are isolated and secured with Hemo-tock and sectioned. The renal vein was isolated, secured with a vascular Endo-GIA stapler. Then the adrenal pedicle was secured with Hemo-lock and sectioned. 4 th case: early ligature was at the level of the Treitz ligament. The Treitz ligament and the inferior mesenteric vein were identified, the Treitz ligament and the posterior peritoneum were sectioned.. A blunt dissection was performed to the aortic wail to free it of lymphatic tissue. The small renal lumbar artery and gonadal artery were identified, clipped and sectioned. The left renal vein was retracted upwards and the renal artery was identified. The renal artery was isolated carefully and secured with an extra-corporeal knot. RESULTS: Operating times were between 120-160 minutes. No intra-operative complications were recorded. Blood loss was between 200-400ml. Post operative stay 4-6 days. Histological examination revealed RCC in all cases. CONCLUSIONS: Early ligature of the renal artery is feasible and safe in laparoscopic procedures. It also permits the procedure to be performed in total oncological asepsis, accurately reproducing the radical principles that have driven open surgical techniques for years and have contributed significantly to improving therapeutic successes.
Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed ... more Usually diagnosed in childhood, ureterocele is a congenital malformation which is often revealed in adults because of a complication. Renal colic and dysuria were the clinical symptoms that led to discovery in the two patients reported here. These two women (aged 80 and 32 years) underwent transurethral meatotomy for complicated ureterocele. This procedure was sufficient for cure, with spontaneous evacuation of all stones in patient 2. There were no clinical or bacteriological (urine analyses) signs of reflux during the follow-up period (24 and 12 months). Endoscopic treatment of adult complicated ureterocele can thus be proposed as a first line procedure. Development of symptomatic secondary reflux is an indication for surgery.
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