The aims of this study are to describe the implantation technique of an artificial urinary sphinc... more The aims of this study are to describe the implantation technique of an artificial urinary sphincter (AUS) with intracavernous cuff, define the indications and report the preliminary results of this technique. A single-centre retrospective study was carried out in 10 patients with a median age of 66 years. The aetiology of urinary incontinence was radical prostatectomy alone in four cases, combined with radiotherapy in four cases and transurethral resection of the prostate in two cases. The initial treatment consisted of AUS in seven cases and suburethral tape in two cases and the last patient had not been previously treated. Failure of AUS was due to atrophy in three cases and urethral erosion in four cases. Six patients needed to use more than three pads per day. Erections were absent in all patients. All patients were treated by insertion of an intracavernous cuff according to the same technique: perineoscrotal incision on the median raphe, dissection of the bulbar urethra and inferior aspect of the corpora cavernosa, vertical incision of the tunica albuginea on either side of the urethra, passage of the cuff from one incision to the other behind the tunica albuginea and leaving the tunica albuginea against the urethra, and closure of the tunica albuginea by interrupted sutures leaving a passage for the cuff. The median follow-up was 15.5 months. The median operating time was 90 min. No intraoperative complication was observed. Two patients had to be explanted because of infection of the material. Seven of the remaining eight patients were satisfied and six of them needed less than one pad per day. A history pelvic irradiation did not appear to have any impact on the results. The treatment of male urinary incontinence by artificial urinary sphincter with intracavernous cuff is a simple technique that improves the trophicity and calibre of the urethra underneath the cuff. This technique achieved good results in patients with a history of pelvic irradiation.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2001
Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demo... more Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma. Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed. 300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize th...
Idiopathic retroperitoneal fibrosis is a rare disease and a delay in diagnosis may cause renal fa... more Idiopathic retroperitoneal fibrosis is a rare disease and a delay in diagnosis may cause renal failure. Medical treatment i.e. corticotherapy or more recently, tamoxifene has been used successfully. This approach is recommended in patients either with moderate obstruction of the upper urinary, risk of major surgery or in cases of recurrence after surgical treatment. Ureterolysis using conventional surgery or laparoscopy remains the treatment of choice. This procedure should be considered in patients with neoplasic fibrosis, corticoresistant fibrosis or in cases of peri-aneurysm fibrosis.
Objective: Consultation activity is an important aspect of urological practice, but the specific ... more Objective: Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology.
Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which ca... more Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which can also occur in a large number of other sites. The authors report a case of solitary fibrous tumour involving the kidney and present a brief review of the main sites currently described in the urogenital tract and the most characteristic elements of the diagnosis based on histological and immunohistochemical examination designed to improve their subsequent recognition within the wide range of spindle cell tumours.
Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma whic... more Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma which is difficult to diagnose due to its resemblance to other benign bladder lesions, such as hyperplasia of Von Brünn nests. The authors present three clinical cases of this variant of urothelial carcinoma and emphasize the importance of clinical, cytological, histological and immunohistochemical criteria for the diagnosis and the need for early and adapted therapeutic management, as this type of bladder tumour, wrongly considered to be benign up until the early 1990s, is just as invasive as high-grade urothelial carcinoma.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2012
According to the French regulatory authorities, the highest level of disinfection must be achieve... more According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing. The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists. Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance. Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2001
Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demo... more Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma. Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed. 300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize th...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2001
Consultation activity is an important aspect of urological practice, but the specific teaching of... more Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology. Two-step qualitative protocol: 1) Establishment of an initial list of skills based on data of the literature; 2) Submission of this list to a series of "focus groups" (urologists, interns, referring physicians) in order to validate and progressively refine the model. The items identified were classified into 3 distinct lists: 1) theoretical knowledge; 2) technical skills specific to urology, predominantly performed in the consulting setting, 3) interpersonal skills exclusively concerning the consultant-referring physician relationship. The consensual specification of these skills can be used to objectively define teaching and evaluation strategies for urology cons...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2000
Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. Retrospectiv... more Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. Retrospective study of 25 consecutive lumboscopic retroperitoneal pyeloplasties performed over 3 years in 14 women and 11 men with symptomatic ureteropelvic junction syndrome. The mean operating time was 200 minutes (range: 120-360 minutes) and mean blood loss was 60 ml. Surgical conversion was necessary in three cases due to the difficulty of dissection and in one case because of rupture of the ureter. Analgesic prescription was generally only necessary for the first 2 postoperative days. The mean hospital stay was six days (range: 2-16 days). Patients were able to return to work an average of 10 days after the operation. With a mean follow-up of 9 months (range: 6 to 18 months), all patients were asymptomatic except for one patient who reported pain at a trocar site. Follow-up urography at 3 months showed marked improvement in 18 patients (85.7%), moderate pyelocaliceal dilatation in 2 cases and o...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 1999
To evaluate the results and the place of a minimally invasive intraurethral injection technique d... more To evaluate the results and the place of a minimally invasive intraurethral injection technique designed to improve the efficacy of the urethral sphincter in urinary incontinence after prostatic surgery. A prospective study of 26 Macroplastique injections performed in 15 patients with a mean age of 66.4 years (range: 54 to 78 years) was conducted over an 18-month period. Eleven patients received 2 injections. Prostatic surgery consisted of retropubic radical prostatectomy (9 cases), transurethral resection (4 cases) or open prostatectomy (2 cases). Three patients received pelvic irradiation. Evaluation at 1, 3 and 12 months consisted of clinical questionnaire and urodynamic assessment. Rapid deterioration of the initial improvement was observed (40% success at 1 month; 71% at 3 months; 33% at 6 months; 26% at 12 months). No significant influence was demonstrated for post-prostatectomy radiotherapy, the patient's age, more proximal bladder dysfunction, severity of incontinence or...
Résumé La prise en charge de la cystite aiguë recherche des facteurs de gravité, de risque ou de... more Résumé La prise en charge de la cystite aiguë recherche des facteurs de gravité, de risque ou de complication. La cystite aiguë simple ne nécessite aucun examen complémentaire, un traitement court est recommandé. La cystite aiguë compliquée nécessite parfois une évaluation clinique, bactériologique et radiologique, un traitement plus long est recommandé. La définition de la cystite récidivante est précisée dans ces
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2003
Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which ca... more Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which can also occur in a large number of other sites. The authors report a case of solitary fibrous tumour involving the kidney and present a brief review of the main sites currently described in the urogenital tract and the most characteristic elements of the diagnosis based on histological and immunohistochemical examination designed to improve their subsequent recognition within the wide range of spindle cell tumours.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2005
Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma whic... more Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma which is difficult to diagnose due to its resemblance to other benign bladder lesions, such as hyperplasia of Von Brünn nests. The authors present three clinical cases of this variant of urothelial carcinoma and emphasize the importance of clinical, cytological, histological and immunohistochemical criteria for the diagnosis and the need for early and adapted therapeutic management, as this type of bladder tumour, wrongly considered to be benign up until the early 1990s, is just as invasive as high-grade urothelial carcinoma.
The aims of this study are to describe the implantation technique of an artificial urinary sphinc... more The aims of this study are to describe the implantation technique of an artificial urinary sphincter (AUS) with intracavernous cuff, define the indications and report the preliminary results of this technique. A single-centre retrospective study was carried out in 10 patients with a median age of 66 years. The aetiology of urinary incontinence was radical prostatectomy alone in four cases, combined with radiotherapy in four cases and transurethral resection of the prostate in two cases. The initial treatment consisted of AUS in seven cases and suburethral tape in two cases and the last patient had not been previously treated. Failure of AUS was due to atrophy in three cases and urethral erosion in four cases. Six patients needed to use more than three pads per day. Erections were absent in all patients. All patients were treated by insertion of an intracavernous cuff according to the same technique: perineoscrotal incision on the median raphe, dissection of the bulbar urethra and inferior aspect of the corpora cavernosa, vertical incision of the tunica albuginea on either side of the urethra, passage of the cuff from one incision to the other behind the tunica albuginea and leaving the tunica albuginea against the urethra, and closure of the tunica albuginea by interrupted sutures leaving a passage for the cuff. The median follow-up was 15.5 months. The median operating time was 90 min. No intraoperative complication was observed. Two patients had to be explanted because of infection of the material. Seven of the remaining eight patients were satisfied and six of them needed less than one pad per day. A history pelvic irradiation did not appear to have any impact on the results. The treatment of male urinary incontinence by artificial urinary sphincter with intracavernous cuff is a simple technique that improves the trophicity and calibre of the urethra underneath the cuff. This technique achieved good results in patients with a history of pelvic irradiation.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2001
Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demo... more Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma. Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed. 300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize th...
Idiopathic retroperitoneal fibrosis is a rare disease and a delay in diagnosis may cause renal fa... more Idiopathic retroperitoneal fibrosis is a rare disease and a delay in diagnosis may cause renal failure. Medical treatment i.e. corticotherapy or more recently, tamoxifene has been used successfully. This approach is recommended in patients either with moderate obstruction of the upper urinary, risk of major surgery or in cases of recurrence after surgical treatment. Ureterolysis using conventional surgery or laparoscopy remains the treatment of choice. This procedure should be considered in patients with neoplasic fibrosis, corticoresistant fibrosis or in cases of peri-aneurysm fibrosis.
Objective: Consultation activity is an important aspect of urological practice, but the specific ... more Objective: Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology.
Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which ca... more Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which can also occur in a large number of other sites. The authors report a case of solitary fibrous tumour involving the kidney and present a brief review of the main sites currently described in the urogenital tract and the most characteristic elements of the diagnosis based on histological and immunohistochemical examination designed to improve their subsequent recognition within the wide range of spindle cell tumours.
Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma whic... more Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma which is difficult to diagnose due to its resemblance to other benign bladder lesions, such as hyperplasia of Von Brünn nests. The authors present three clinical cases of this variant of urothelial carcinoma and emphasize the importance of clinical, cytological, histological and immunohistochemical criteria for the diagnosis and the need for early and adapted therapeutic management, as this type of bladder tumour, wrongly considered to be benign up until the early 1990s, is just as invasive as high-grade urothelial carcinoma.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2012
According to the French regulatory authorities, the highest level of disinfection must be achieve... more According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing. The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists. Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance. Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2001
Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demo... more Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma. Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed. 300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize th...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2001
Consultation activity is an important aspect of urological practice, but the specific teaching of... more Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology. Two-step qualitative protocol: 1) Establishment of an initial list of skills based on data of the literature; 2) Submission of this list to a series of "focus groups" (urologists, interns, referring physicians) in order to validate and progressively refine the model. The items identified were classified into 3 distinct lists: 1) theoretical knowledge; 2) technical skills specific to urology, predominantly performed in the consulting setting, 3) interpersonal skills exclusively concerning the consultant-referring physician relationship. The consensual specification of these skills can be used to objectively define teaching and evaluation strategies for urology cons...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2000
Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. Retrospectiv... more Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. Retrospective study of 25 consecutive lumboscopic retroperitoneal pyeloplasties performed over 3 years in 14 women and 11 men with symptomatic ureteropelvic junction syndrome. The mean operating time was 200 minutes (range: 120-360 minutes) and mean blood loss was 60 ml. Surgical conversion was necessary in three cases due to the difficulty of dissection and in one case because of rupture of the ureter. Analgesic prescription was generally only necessary for the first 2 postoperative days. The mean hospital stay was six days (range: 2-16 days). Patients were able to return to work an average of 10 days after the operation. With a mean follow-up of 9 months (range: 6 to 18 months), all patients were asymptomatic except for one patient who reported pain at a trocar site. Follow-up urography at 3 months showed marked improvement in 18 patients (85.7%), moderate pyelocaliceal dilatation in 2 cases and o...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 1999
To evaluate the results and the place of a minimally invasive intraurethral injection technique d... more To evaluate the results and the place of a minimally invasive intraurethral injection technique designed to improve the efficacy of the urethral sphincter in urinary incontinence after prostatic surgery. A prospective study of 26 Macroplastique injections performed in 15 patients with a mean age of 66.4 years (range: 54 to 78 years) was conducted over an 18-month period. Eleven patients received 2 injections. Prostatic surgery consisted of retropubic radical prostatectomy (9 cases), transurethral resection (4 cases) or open prostatectomy (2 cases). Three patients received pelvic irradiation. Evaluation at 1, 3 and 12 months consisted of clinical questionnaire and urodynamic assessment. Rapid deterioration of the initial improvement was observed (40% success at 1 month; 71% at 3 months; 33% at 6 months; 26% at 12 months). No significant influence was demonstrated for post-prostatectomy radiotherapy, the patient's age, more proximal bladder dysfunction, severity of incontinence or...
Résumé La prise en charge de la cystite aiguë recherche des facteurs de gravité, de risque ou de... more Résumé La prise en charge de la cystite aiguë recherche des facteurs de gravité, de risque ou de complication. La cystite aiguë simple ne nécessite aucun examen complémentaire, un traitement court est recommandé. La cystite aiguë compliquée nécessite parfois une évaluation clinique, bactériologique et radiologique, un traitement plus long est recommandé. La définition de la cystite récidivante est précisée dans ces
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2003
Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which ca... more Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which can also occur in a large number of other sites. The authors report a case of solitary fibrous tumour involving the kidney and present a brief review of the main sites currently described in the urogenital tract and the most characteristic elements of the diagnosis based on histological and immunohistochemical examination designed to improve their subsequent recognition within the wide range of spindle cell tumours.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2005
Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma whic... more Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma which is difficult to diagnose due to its resemblance to other benign bladder lesions, such as hyperplasia of Von Brünn nests. The authors present three clinical cases of this variant of urothelial carcinoma and emphasize the importance of clinical, cytological, histological and immunohistochemical criteria for the diagnosis and the need for early and adapted therapeutic management, as this type of bladder tumour, wrongly considered to be benign up until the early 1990s, is just as invasive as high-grade urothelial carcinoma.
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Papers by Hubert Bugel