But: Demontrer la faisabilite et l'efficacite de la coelioscopie dans le traitement des kyste... more But: Demontrer la faisabilite et l'efficacite de la coelioscopie dans le traitement des kystes simples du rein. Methodes: Nous rapportons une serie de 12 cas de kystes simples du rein symptomatiques traites par voie lomboscopique de Janvier 2000 a Decembre 2004. L'âge moyen est de 57 ans (43-72 ans). Il s'agit de 11 femmes et d'un homme. Le signe revelateur etait une douleur de la fosse lombaire dans tous les cas. Une masse lombaire a ete palpee chez 2 patients (16 %). Une echographie a ete realisee chez tous les patients. Un uroscanner a ete pratique dans 4 cas (33 %). Il s'agissait d'un kyste unique dans 9 cas (75 %), de doubles kystes dans 2 cas (17 %) et de 4 kystes dans 1 cas (8 %). La taille moyenne des kystes est de 7.7 cm (5-16). Un kyste de siege parapyelique a ete retrouve dans un cas. Tous les patients ont ete operes par voie lomboscopique avec resection du dome saillant. Resultats: La duree operatoire moyenne etait de 80 min (50-160). Aucune compl...
Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It c... more Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.
Resume Objectif Etude de la courbe d’apprentissage de la prostatectomie radicale robot-assistee e... more Resume Objectif Etude de la courbe d’apprentissage de la prostatectomie radicale robot-assistee en evaluant les difficultes peroperatoires et les complications postoperatoires selon la classification de Clavien-Dindo. Patients et methodes Etude retrospective de nos 157 premiers patients consecutifs traites par prostatectomie robot-assistee pour cancer localise de la prostate entre septembre 2011 et decembre 2014. Comparaison de l’apprentissage par palier de 50 procedures, puis comparaison entre un groupe de patients operes par un binome de deux chirurgiens seniors formes specifiquement a la chirurgie robotique et un groupe opere par un binome mixte incluant un chirurgien junior encadre d’un des deux seniors du premier groupe. Resultats Seules les complications postoperatoires diminuaient significativement des le 51 e patient ( p = 0,04). Les courbes montrant l’evolution de la duree operatoire diminuaient avec une tendance parallele entre les deux binomes mais avec plus de variabilite dans le binome mixte. Il n’existait pas de difference significative en terme de difficultes peroperatoires ( p = 0,59), ni de complications postoperatoires ( p = 0,56) majoritairement de grade 2. Les pertes sanguines, le taux de transfusion, la duree d’hospitalisation, le taux de readmissions ne differaient pas. La realisation d’un curage n’influencait pas ces resultats. Sur le plan carcinologique, le taux global des marges chirurgicales positives (R+) etait de 30,6 % dans le binome initial contre 24,2 % dans le binome mixte sans difference significative. Neanmoins, l’etude en sous-population objectivait un taux de R+ de 12,86 % pour les pT2 contre 42,85 % pour les pT3. Conclusion L’implication precoce d’un chirurgien junior n’ayant pas suivi d’entrainement specifique, mais beneficiant de l’encadrement d’un chirurgien du binome senior, ne compromettait pas les resultats observes tout en permettant une courbe d’apprentissage plus rapide avec un taux de complications operatoires proche de celui observe par le binome senior. Niveau de preuve 4.
Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It c... more Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.
To state the efficiency and the place of lumboscopy in the treatment of ureteral stones. We repor... more To state the efficiency and the place of lumboscopy in the treatment of ureteral stones. We report 31 cases of patients operated by lumboscopy for ureteral stones from January 2001 to December 2005. In most of cases, the indication is stone which size is higher than 15 mm. The mean operating time is 91 min and the rate of conversion to open surgery is 9.7%. 9 (29%) postoperative complication is noted. The mean hospital stay is 5 days. No ureteral stricture or kidney destruction is noted with a mean follow-up of 34 months. Lumboscopy is a safe and effective technique in the treatment of the ureteral stones with a low rate of complications. It can replace open surgery in most of cases.
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.
The objective of this study was to evaluate the incidence of prostatic carcinoma in patients trea... more The objective of this study was to evaluate the incidence of prostatic carcinoma in patients treated by intravesical BCG-therapy for superficial bladder cancer and presenting granulomatous prostatitis. The authors discuss the problems of interpretation of total PSA and the potential indications for prostatic biopsies in this population. A retrospective study was performed on the cases of symptomatic granulomatous prostatitis observed among patients treated with intravesical BCG instillations between January 1997 and December 2006. A total of 153 men were treated for high-risk or intermediate-risk superficial bladder cancer according to the usual recommendations. The attenuated Connaught strain of BCG was used at a dose of 81 mg. Induction treatment consisted of six weekly instillations and was followed by maintenance treatment for a period of three years. Six patients developed symptomatic granulomatous prostatitis (4% of cases). On average, this complication occurred after about the 10th intravesical instillation (6-13) of maintenance treatment. The mean total PSA at three months was 8 ng/ml (range: 5-11.6). Ultrasound-guided biopsies were indicated in view of the persistently elevated PSA level and confirmed the tuberculoid granulomatous lesion of the prostate in each case and revealed prostatic adenocarcinoma in two patients. Prostatic carcinoma must be systematically excluded by ultrasound-guided biopsies in all patients with clinical granulomatous prostatitis and persistently elevated PSA three months after intravesical BCG instillations.
Arterial hypertension often present after kidney transplantation is of mutifactorial origin. The ... more Arterial hypertension often present after kidney transplantation is of mutifactorial origin. The aim of this study was to determine the role of donor and recipient factors in the development of hypertension after renal transplantation. We retrospectively analyzed the data of 280 patients transplanted between 1985 and 2005, who still had functioning grafts at 1 year after transplantation. We recorded donor and recipient parameters. One hundred eighty-seven patients (66.8%) were hypertensive. Upon multivariate analysis of recipient factors, pretransplant hypertension (odds ratio) [OR]: 8.5, 95% confidence interval [CI]: 4.5 to 16.1); serum creatinine level Ͼ 130 mol/L at 6 months (OR: 2.5, 95% CI: 1.3 to 4,7), male gender (OR: 2.02, 95% CI: 1.2 to 3.4), and chronic rejection (OR: 2.4, 95% CI: 1.2 to 4.7) were independent predisposing factors. Among donor factors, age was significantly associated with arterial hypertension upon univariate analysis. In conclusion, recipient factors, especially pretransplant hypertension, contribute to the disorder in renal transplant patients. Address reprint requests to
Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It c... more Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man
Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadic... more Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. The data of six patients managed for emphysematous pyelitis were collected and analyzed. The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dediffere...
But: Demontrer la faisabilite et l'efficacite de la coelioscopie dans le traitement des kyste... more But: Demontrer la faisabilite et l'efficacite de la coelioscopie dans le traitement des kystes simples du rein. Methodes: Nous rapportons une serie de 12 cas de kystes simples du rein symptomatiques traites par voie lomboscopique de Janvier 2000 a Decembre 2004. L'âge moyen est de 57 ans (43-72 ans). Il s'agit de 11 femmes et d'un homme. Le signe revelateur etait une douleur de la fosse lombaire dans tous les cas. Une masse lombaire a ete palpee chez 2 patients (16 %). Une echographie a ete realisee chez tous les patients. Un uroscanner a ete pratique dans 4 cas (33 %). Il s'agissait d'un kyste unique dans 9 cas (75 %), de doubles kystes dans 2 cas (17 %) et de 4 kystes dans 1 cas (8 %). La taille moyenne des kystes est de 7.7 cm (5-16). Un kyste de siege parapyelique a ete retrouve dans un cas. Tous les patients ont ete operes par voie lomboscopique avec resection du dome saillant. Resultats: La duree operatoire moyenne etait de 80 min (50-160). Aucune compl...
Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It c... more Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.
Resume Objectif Etude de la courbe d’apprentissage de la prostatectomie radicale robot-assistee e... more Resume Objectif Etude de la courbe d’apprentissage de la prostatectomie radicale robot-assistee en evaluant les difficultes peroperatoires et les complications postoperatoires selon la classification de Clavien-Dindo. Patients et methodes Etude retrospective de nos 157 premiers patients consecutifs traites par prostatectomie robot-assistee pour cancer localise de la prostate entre septembre 2011 et decembre 2014. Comparaison de l’apprentissage par palier de 50 procedures, puis comparaison entre un groupe de patients operes par un binome de deux chirurgiens seniors formes specifiquement a la chirurgie robotique et un groupe opere par un binome mixte incluant un chirurgien junior encadre d’un des deux seniors du premier groupe. Resultats Seules les complications postoperatoires diminuaient significativement des le 51 e patient ( p = 0,04). Les courbes montrant l’evolution de la duree operatoire diminuaient avec une tendance parallele entre les deux binomes mais avec plus de variabilite dans le binome mixte. Il n’existait pas de difference significative en terme de difficultes peroperatoires ( p = 0,59), ni de complications postoperatoires ( p = 0,56) majoritairement de grade 2. Les pertes sanguines, le taux de transfusion, la duree d’hospitalisation, le taux de readmissions ne differaient pas. La realisation d’un curage n’influencait pas ces resultats. Sur le plan carcinologique, le taux global des marges chirurgicales positives (R+) etait de 30,6 % dans le binome initial contre 24,2 % dans le binome mixte sans difference significative. Neanmoins, l’etude en sous-population objectivait un taux de R+ de 12,86 % pour les pT2 contre 42,85 % pour les pT3. Conclusion L’implication precoce d’un chirurgien junior n’ayant pas suivi d’entrainement specifique, mais beneficiant de l’encadrement d’un chirurgien du binome senior, ne compromettait pas les resultats observes tout en permettant une courbe d’apprentissage plus rapide avec un taux de complications operatoires proche de celui observe par le binome senior. Niveau de preuve 4.
Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It c... more Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man who had a surgical history of transvesical adenomectomy of the prostate. The diagnosis was done on the retrograde urethrocystography. We performed bilateral herniorrhaphy with herniated bladder reduction. The postoperative history was uneventful.
To state the efficiency and the place of lumboscopy in the treatment of ureteral stones. We repor... more To state the efficiency and the place of lumboscopy in the treatment of ureteral stones. We report 31 cases of patients operated by lumboscopy for ureteral stones from January 2001 to December 2005. In most of cases, the indication is stone which size is higher than 15 mm. The mean operating time is 91 min and the rate of conversion to open surgery is 9.7%. 9 (29%) postoperative complication is noted. The mean hospital stay is 5 days. No ureteral stricture or kidney destruction is noted with a mean follow-up of 34 months. Lumboscopy is a safe and effective technique in the treatment of the ureteral stones with a low rate of complications. It can replace open surgery in most of cases.
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.
The objective of this study was to evaluate the incidence of prostatic carcinoma in patients trea... more The objective of this study was to evaluate the incidence of prostatic carcinoma in patients treated by intravesical BCG-therapy for superficial bladder cancer and presenting granulomatous prostatitis. The authors discuss the problems of interpretation of total PSA and the potential indications for prostatic biopsies in this population. A retrospective study was performed on the cases of symptomatic granulomatous prostatitis observed among patients treated with intravesical BCG instillations between January 1997 and December 2006. A total of 153 men were treated for high-risk or intermediate-risk superficial bladder cancer according to the usual recommendations. The attenuated Connaught strain of BCG was used at a dose of 81 mg. Induction treatment consisted of six weekly instillations and was followed by maintenance treatment for a period of three years. Six patients developed symptomatic granulomatous prostatitis (4% of cases). On average, this complication occurred after about the 10th intravesical instillation (6-13) of maintenance treatment. The mean total PSA at three months was 8 ng/ml (range: 5-11.6). Ultrasound-guided biopsies were indicated in view of the persistently elevated PSA level and confirmed the tuberculoid granulomatous lesion of the prostate in each case and revealed prostatic adenocarcinoma in two patients. Prostatic carcinoma must be systematically excluded by ultrasound-guided biopsies in all patients with clinical granulomatous prostatitis and persistently elevated PSA three months after intravesical BCG instillations.
Arterial hypertension often present after kidney transplantation is of mutifactorial origin. The ... more Arterial hypertension often present after kidney transplantation is of mutifactorial origin. The aim of this study was to determine the role of donor and recipient factors in the development of hypertension after renal transplantation. We retrospectively analyzed the data of 280 patients transplanted between 1985 and 2005, who still had functioning grafts at 1 year after transplantation. We recorded donor and recipient parameters. One hundred eighty-seven patients (66.8%) were hypertensive. Upon multivariate analysis of recipient factors, pretransplant hypertension (odds ratio) [OR]: 8.5, 95% confidence interval [CI]: 4.5 to 16.1); serum creatinine level Ͼ 130 mol/L at 6 months (OR: 2.5, 95% CI: 1.3 to 4,7), male gender (OR: 2.02, 95% CI: 1.2 to 3.4), and chronic rejection (OR: 2.4, 95% CI: 1.2 to 4.7) were independent predisposing factors. Among donor factors, age was significantly associated with arterial hypertension upon univariate analysis. In conclusion, recipient factors, especially pretransplant hypertension, contribute to the disorder in renal transplant patients. Address reprint requests to
Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It c... more Inguinal hernia of the bladder is uncommon. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or computerized tomography confirm the diagnosis. We report a case of bilateral inguinal hernia involving the bladder at the right side in a 87 years old man
Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadic... more Emphysematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. The data of six patients managed for emphysematous pyelitis were collected and analyzed. The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned -- dediffere...
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