Bertrand Lukacs - Academia.edu (original) (raw)
Papers by Bertrand Lukacs
Urology, 2009
to determine the long term result and the impact of residual incontinence. Results: By 6 th month... more to determine the long term result and the impact of residual incontinence. Results: By 6 th month, 58.4% (nϭ145) of patients attended PFE programme. At 6 th month PFE could modestly improve incontinence of 29.6% patients (Group II) and cured another ϳ34.2% of patients. Overall ϳ70.2% patients (Group I) were very satisfied with their continence. There was 85% of patients who responded to the survey. Fifty-two percent of Group I patients continued to practice PFE and so did 54% Group II. Twenty percent of Group IϩII patients were totally cured, 70% became pad-free and 72% leaked no more than once a week. There was 92% who claimed the amount of leakage was small only. No statistical significant difference could be found between those continuing to perform regular PFE and those stopped doing it with respect to the bother related to the residual incontinence, interference with daily life, spoilage of social life and global quality of life. However, patients who continued to do regular PFE were more satisfied with their improvement of leakage (score 6.84 vs. 5.27 out of 10). Conclusion: PFE appeared useful in treating female SUI. Its prolonged practice may not diminish the bother due to SUI and its frequency of leakage further but may decrease the pad usage.
European urology, Jan 31, 2015
BJU international, Jan 17, 2015
To describe the step-by-step learning curve of Holmium Laser Enucleation (HoLEP) surgical techniq... more To describe the step-by-step learning curve of Holmium Laser Enucleation (HoLEP) surgical technique. A prospective, multicentrer observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy, never having performed HoLEP were included. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation, within less than 90 minutes, without any conversion to standard TURP, with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Of nine centers, three abandoned the procedure before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful procedures. Overall, the procedures were successfully performed in 43.6% of cas...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2007
New therapeutic approaches have recently been investigated in order to improve the voiding disord... more New therapeutic approaches have recently been investigated in order to improve the voiding disorders of patient with lower urinary tract symptoms related to benign prostatic hyperplasia. The purpose of this article is to provide a review of these treatments: anti-inflammatory, antidiuretic, anticholinergic and botulinum toxin. Anticholinergic drugs associated with a risk of urinary retention, appear to be effective for irritative disorders in combination with an alpha-blocker. Antidiuretics can be proposed in patients younger than 65 with disabling polyuria confirmed by a voiding diary, related to BPH and refractory to conventional treatment of BPH. The interaction between inflammation and BPH has not yet been clarified, but anti-inflammatory drugs appear to improve symptoms and may have a place in short-term treatment of BPH, as their long-term use is not recommended and COX-2 inhibitors have been withdrawn from the market. Finally, botulinum toxin could have a place in the treatme...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2006
Evaluation of a patient with voiding disorders related to benign prostatic hyperplasia is theoret... more Evaluation of a patient with voiding disorders related to benign prostatic hyperplasia is theoretically performed by means of the IPSS score, which comprises only one global quality of life question. This study used a questionnaire to evaluate the frequency of disability induced by each of the symptoms of the IPSS in a representative sample of the French population and then proposed a weighting of the IPSS score by the statistical weight of disability of each symptom without having to increase the number of questions. A survey on the voiding behaviour of French men was performed by TNS Sofres Healthcare by questionnaire between 18/4/03 and 27/5/03 in a panel of 3877 men aged 50 to 80 years representative of the French population. This survey comprised demographic and sociological questions as well as the IPSS score. A specific question concerning the disability induced by each of the 7 symptoms ("Does it bother you enormously, a lot, slightly, not at all? ") was added. Eac...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2006
Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment ... more Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment of voiding disorders related to benign prostatic hyperplasia. A review of the literature evaluates the place of these treatments in 2006. Permanent prostatic stenting is rarely used, but remains a treatment option for patients with obstructive disorders and a formal anaesthetic contraindication. Temporary stenting can be used to predict the effect of resection in selected patients. Finally, microwave thermotherapy, not widely used in France, has a promising clinical efficacy and occupies a place between medical treatment and surgery.
Urologia internationalis, 2012
To assess the results of transurethral needle ablation (TUNA) (Prostiva®, Medtronic, France) perf... more To assess the results of transurethral needle ablation (TUNA) (Prostiva®, Medtronic, France) performed in an ambulatory setting in men with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). A multicenter open-label study was conducted. Short-term success was defined by ability to leave the hospital on the evening of the intervention, and absence of rehospitalization due to complications during the first postoperative month. Sexual and urinary functions were evaluated by validated questionnaires. The procedure was successful in 44/49 patients. Sexual and ejaculatory function was not affected or slightly improved in the majority of patients. Urinary parameters improved with a 32% decrease in the International Prostate Symptom Score. At 1 month postoperation, more than 80% of patients were satisfied, and 36/41 patients were prepared to undergo the procedure again if needed. Our study was limited by the short follow-up duration. TUNA can be successfully performed i...
Presse médicale (Paris, France : 1983), 2007
Management of benign prostatic hyperplasia (BPH) is currently undergoing profound changes. Medica... more Management of benign prostatic hyperplasia (BPH) is currently undergoing profound changes. Medical treatment is not only symptomatic, but may also seek to modify the natural history of the disease, especially by reducing the risk of acute urinary retention. Medical treatment is no longer limited to a single drug: the combination of 2 different drugs from different treatment categories appears superior to single-drug treatment in some patients. Two instrumental techniques - microwave or radiofrequency thermotherapy, previously proposed as alternatives to surgery - are more appropriate as alternatives to medical treatment. These various items make it possible to construct a decision algorithm that is based at each stage on a decision shared with the patient. This algorithm to provide decision aid in management of uncomplicated symptomatic HBP takes initial disease indicators and other patient indicators into account together with its course under treatment, which has not previously be...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2004
In an attempt to standardize clinical practice, a number of authorities (American, European, inte... more In an attempt to standardize clinical practice, a number of authorities (American, European, international) have published guidelines for the assessment and treatment of men with lower urinary tract symptoms (LUTS) related to BPH. In order to determine the impact of these guidelines on daily practice, we conducted a survey of the initial management of BPH by French Urologists. A clear and simple clinical situation was defined and sent to the 796 urologists members of the Association Française d'Urologie: a 65-year-old man presenting with moderate and bothersome lower urinary tract symptoms (LUTS) suggestive of BPH. Various items concerning the choice of complementary investigations were proposed. The last question evaluated the first-line drug prescription. The replies were then analysed as a function of the type of practice and the urologist's age. 184 urologists answered the questionnaire. The mean age of the responding urologists was 47.5 years. 31.6% of responses were de...
The Canadian journal of urology, 2011
To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transuret... more To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP). Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers. Types of OA and perioperative management were collected. Postoperative outcomes were statistically compared between the two groups. A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively. Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group. Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both. PAI was withdrawn preoperatively in 50 patients. All treatments with warfarin were switched for heparin. Comparison of the two gr...
Progrès en Urologie, 2007
Intérêts des antidiurétiques, des anticholinergiques, des anti-inflammatoires et de la toxine bot... more Intérêts des antidiurétiques, des anticholinergiques, des anti-inflammatoires et de la toxine botulinique pour le traitement des troubles mictionnels liés à I'HBP (Forum CTMH-AFU 2005) Alexandre DE LA TAILLE (I), Marc FOURMARIER (2), Francois DESGRANDCHAMPS (3), Charles BALLEREAU (4), Christian SAUSSINE (5), Olivier HAILLOT (6), Abdel-Rahmène AZZOUZI (7), Bertrand LUKACS (E), Marian DEVONEC (9) et le Comité des Troubles Mictionnels de l'Homme (CTMH-AFU)
La Presse Médicale, 2007
... au traitement chirurgical trouvent mieux leur place en alternatives au traitement médical. Ce... more ... au traitement chirurgical trouvent mieux leur place en alternatives au traitement médical. Ces différents éléments permettent de bâtir un algorithme décisionnel, qui à chaque étape s'appuie sur une décision partagée avec le patient. Cet algorithme décisionnel d'aide à la prise ...
Clinical Nutrition, 2014
a Acute Medicine Department, R. Poincar e Hospital, APHP, Garches, Versailles Saint-Quentin-en-Yv... more a Acute Medicine Department, R. Poincar e Hospital, APHP, Garches, Versailles Saint-Quentin-en-Yvelines University, Medical School, EA 4497, France b Patient Reported Outcomes and Value Insight and Communication, Mapi Values, Lyon, France c JNB-D eveloppement, 11, rue Tronchet, 75008 Paris, France d Technical Agency for Information about Hospitalization, Paris, France e Cyklad Group, Rilleux la Pape, France f Joseph Fourier University, University Hospital Center of Grenoble, France g Gastroenterology and Clinical Nutrition in CHU of Nice, University of Nice Sophia Antipolis, France h Urology, Tenon Hospital, Paris, France i Anesthesia and Intensive Care, Antoine-B ecl ere Hospital, AP-HP Clamart, France j Colorectal Department, Beaujon Hospital, APHP, Clichy, Paris, France k Medical Counselor, 6 rue Leclerc, 75014 Paris, France
BMC Urology, 2014
Background: This very large population-based study investigated outcomes after a diagnosis of pro... more Background: This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects.
Urologia Internationalis, 2010
Background/Aims: There are only a few surveys on the prevalence of lower urinary tract symptoms (... more Background/Aims: There are only a few surveys on the prevalence of lower urinary tract symptoms (LUTS) among the general population. The aim of this survey was to assess the prevalence of LUTS and their impact on discomfort in men. Methods: A questionnaire was mailed to 3,877 men aged 50–80 years, which included questions on their medical history, demographic and sociological status, and also the International Prostate Symptom Score (IPSS) with additional questions on discomfort related to urinary symptoms. Results: The response rate was 81.5%. Prevalence of mild and severe IPSS was 89.2%. Specific bother for each urinary symptom depended on symptom frequency: urgency, frequency, weak stream, nocturia, incomplete emptying, intermittency and straining 1 time out of 5 were responsible for discomfort in respectively 4.9, 6.1, 7.1, 7.5, 8.7 and 9.9%; the same symptoms more than half of the time were responsible for discomfort in respectively 32.8, 38, 45.3, 45.6, 53.2 and 58.7%. Urgency...
World Journal of Urology, 2006
Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. Th... more Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. The standard medical treatments are represented by three families which are the phytotherapy, the alpha-blockers and the 5-alpha-reductase inhibitors. These treatments were deemed as symptomatic and used only as monotherapy. Recent numerous studies bring new assessments on BPH: the medical treatment is able to modify the natural history of BPH especially by reducing the risk of acute urinary retention. Furthermore the association of two different therapeutic classes seems to be more efficient than the use of a monotherapy in some cases. Similarly the place of two instrumental techniques, the thermotherapy by microwaves or by radiofrequencies, previously proposed as alternatives to the surgical treatment seems to find their way rather as alternatives to the medical treatment. These different elements allow building a renewed decision tree which decisions are shared with the patient at each stage. This decision tree of the management of patients having non-complicated BPH symptoms must include initial clinical characteristics of the patient and its disease and the evolution under treatment which has not been yet considered in the international recommendations. It also considers the possibilities of associations with other therapeutic classes.
World Journal of Urology, 2006
The usual treatments of benign prostate hyperplasia (BPH) including the alpha-blockers, the inhib... more The usual treatments of benign prostate hyperplasia (BPH) including the alpha-blockers, the inhibitors of the 5-alpha reductase and the phytotherapy drugs allow significant improvements of the lower urinary tracts symptoms (LUTS). However, some patients are not responders or have side effects due to the treatments. Other therapeutic approaches described in the literature are possible in order to alleviate the LUTS. The anti-cholinergic drugs seem to be efficient against the irritating symptoms even if they are supposed to be contra-indicated when there is BPH. Anti-diuretic hormone could be useful to treat nocturia due to diuresis reversal. Inflammation is a part of the underlying mechanisms of BPH and as such the role of the anti-inflammatory drugs has to be revised. Eventually, botulinum toxin is more and more used for patients with neurological bladder and could also have a role in LUTS. If the coming clinical studies on those different treatments confirm the preliminary results, the learning societies in charge of the guidelines would have to update the decision trees by adding these new therapeutic approaches.
The Journal of Urology, 2011
The Journal of Urology, 2011
ied. Data was collected on patient demographics, International Prostate Symptom Score (IPSS), pro... more ied. Data was collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), and perioperative parameters. Maximum flow rate (Qmax), postvoid residual (PVR), and prostate volume as determined by transrectal ultrasound were recorded. Statistical analyses were carried out utilizing the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and unpaired t tests (SPSS 15.0, SPSS Inc., Chicago, IL, USA). RESULTS: Baseline parameters were similar between the PVP and TLEP groups, although prostate volume was greater in the TLEP group (83 vs. 63cc, pϭ0.04) (See Table). Median laser time was commensurately longer in the TLEP group (90 vs. 50 minutes, pϽ0.001) with a higher median energy utilized (308 vs. 165kJ, pϽ0.001). The volume lased per unit time was shorter however for TLEP (0.92cc/minute) than for PVP (1.26cc/minute). A greater median number of fibers was used in TLEP (2.5 vs. 2.0, pϭ0.001). Median duration of follow-up was slightly longer in the PVP group (26.3 vs. 24.7 months, pϽ0.001). Data was available at 12 months and beyond for 59 and 103 patients, respectively (See Table). Improvements in median IPSS and PVR were seen in the TLEP group (5.0, pϽ0.001; 55.5, pϭ0.02 respectively) but not in the PVP group (pϭ0.40 and 0.30). Median Qmax and PSA however improved similarly in both groups. Final IPSS was lower for the TLEP group (pϽ0.001), but other final parameters were statistically equivalent between the two groups. CONCLUSIONS: In our series, both PVP and TLEP techniques were safe and effective. Although changes in Qmax and PSA were similar between the two techniques, durable improvement in urinary symptoms and PVR was superior with the TLEP technique. The TLEP technique was also a more efficient method for laser prostatectomy. * denotes pϽ 0.05 between pre-and postoperative values; ** denotes pϽ 0.05 between PVP and TLEP groups for the same pre-or post-operative parameter
The Journal of Urology, 2012
Urology, 2009
to determine the long term result and the impact of residual incontinence. Results: By 6 th month... more to determine the long term result and the impact of residual incontinence. Results: By 6 th month, 58.4% (nϭ145) of patients attended PFE programme. At 6 th month PFE could modestly improve incontinence of 29.6% patients (Group II) and cured another ϳ34.2% of patients. Overall ϳ70.2% patients (Group I) were very satisfied with their continence. There was 85% of patients who responded to the survey. Fifty-two percent of Group I patients continued to practice PFE and so did 54% Group II. Twenty percent of Group IϩII patients were totally cured, 70% became pad-free and 72% leaked no more than once a week. There was 92% who claimed the amount of leakage was small only. No statistical significant difference could be found between those continuing to perform regular PFE and those stopped doing it with respect to the bother related to the residual incontinence, interference with daily life, spoilage of social life and global quality of life. However, patients who continued to do regular PFE were more satisfied with their improvement of leakage (score 6.84 vs. 5.27 out of 10). Conclusion: PFE appeared useful in treating female SUI. Its prolonged practice may not diminish the bother due to SUI and its frequency of leakage further but may decrease the pad usage.
European urology, Jan 31, 2015
BJU international, Jan 17, 2015
To describe the step-by-step learning curve of Holmium Laser Enucleation (HoLEP) surgical techniq... more To describe the step-by-step learning curve of Holmium Laser Enucleation (HoLEP) surgical technique. A prospective, multicentrer observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy, never having performed HoLEP were included. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation, within less than 90 minutes, without any conversion to standard TURP, with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Of nine centers, three abandoned the procedure before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful procedures. Overall, the procedures were successfully performed in 43.6% of cas...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2007
New therapeutic approaches have recently been investigated in order to improve the voiding disord... more New therapeutic approaches have recently been investigated in order to improve the voiding disorders of patient with lower urinary tract symptoms related to benign prostatic hyperplasia. The purpose of this article is to provide a review of these treatments: anti-inflammatory, antidiuretic, anticholinergic and botulinum toxin. Anticholinergic drugs associated with a risk of urinary retention, appear to be effective for irritative disorders in combination with an alpha-blocker. Antidiuretics can be proposed in patients younger than 65 with disabling polyuria confirmed by a voiding diary, related to BPH and refractory to conventional treatment of BPH. The interaction between inflammation and BPH has not yet been clarified, but anti-inflammatory drugs appear to improve symptoms and may have a place in short-term treatment of BPH, as their long-term use is not recommended and COX-2 inhibitors have been withdrawn from the market. Finally, botulinum toxin could have a place in the treatme...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2006
Evaluation of a patient with voiding disorders related to benign prostatic hyperplasia is theoret... more Evaluation of a patient with voiding disorders related to benign prostatic hyperplasia is theoretically performed by means of the IPSS score, which comprises only one global quality of life question. This study used a questionnaire to evaluate the frequency of disability induced by each of the symptoms of the IPSS in a representative sample of the French population and then proposed a weighting of the IPSS score by the statistical weight of disability of each symptom without having to increase the number of questions. A survey on the voiding behaviour of French men was performed by TNS Sofres Healthcare by questionnaire between 18/4/03 and 27/5/03 in a panel of 3877 men aged 50 to 80 years representative of the French population. This survey comprised demographic and sociological questions as well as the IPSS score. A specific question concerning the disability induced by each of the 7 symptoms ("Does it bother you enormously, a lot, slightly, not at all? ") was added. Eac...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2006
Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment ... more Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment of voiding disorders related to benign prostatic hyperplasia. A review of the literature evaluates the place of these treatments in 2006. Permanent prostatic stenting is rarely used, but remains a treatment option for patients with obstructive disorders and a formal anaesthetic contraindication. Temporary stenting can be used to predict the effect of resection in selected patients. Finally, microwave thermotherapy, not widely used in France, has a promising clinical efficacy and occupies a place between medical treatment and surgery.
Urologia internationalis, 2012
To assess the results of transurethral needle ablation (TUNA) (Prostiva®, Medtronic, France) perf... more To assess the results of transurethral needle ablation (TUNA) (Prostiva®, Medtronic, France) performed in an ambulatory setting in men with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). A multicenter open-label study was conducted. Short-term success was defined by ability to leave the hospital on the evening of the intervention, and absence of rehospitalization due to complications during the first postoperative month. Sexual and urinary functions were evaluated by validated questionnaires. The procedure was successful in 44/49 patients. Sexual and ejaculatory function was not affected or slightly improved in the majority of patients. Urinary parameters improved with a 32% decrease in the International Prostate Symptom Score. At 1 month postoperation, more than 80% of patients were satisfied, and 36/41 patients were prepared to undergo the procedure again if needed. Our study was limited by the short follow-up duration. TUNA can be successfully performed i...
Presse médicale (Paris, France : 1983), 2007
Management of benign prostatic hyperplasia (BPH) is currently undergoing profound changes. Medica... more Management of benign prostatic hyperplasia (BPH) is currently undergoing profound changes. Medical treatment is not only symptomatic, but may also seek to modify the natural history of the disease, especially by reducing the risk of acute urinary retention. Medical treatment is no longer limited to a single drug: the combination of 2 different drugs from different treatment categories appears superior to single-drug treatment in some patients. Two instrumental techniques - microwave or radiofrequency thermotherapy, previously proposed as alternatives to surgery - are more appropriate as alternatives to medical treatment. These various items make it possible to construct a decision algorithm that is based at each stage on a decision shared with the patient. This algorithm to provide decision aid in management of uncomplicated symptomatic HBP takes initial disease indicators and other patient indicators into account together with its course under treatment, which has not previously be...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2004
In an attempt to standardize clinical practice, a number of authorities (American, European, inte... more In an attempt to standardize clinical practice, a number of authorities (American, European, international) have published guidelines for the assessment and treatment of men with lower urinary tract symptoms (LUTS) related to BPH. In order to determine the impact of these guidelines on daily practice, we conducted a survey of the initial management of BPH by French Urologists. A clear and simple clinical situation was defined and sent to the 796 urologists members of the Association Française d'Urologie: a 65-year-old man presenting with moderate and bothersome lower urinary tract symptoms (LUTS) suggestive of BPH. Various items concerning the choice of complementary investigations were proposed. The last question evaluated the first-line drug prescription. The replies were then analysed as a function of the type of practice and the urologist's age. 184 urologists answered the questionnaire. The mean age of the responding urologists was 47.5 years. 31.6% of responses were de...
The Canadian journal of urology, 2011
To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transuret... more To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP). Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers. Types of OA and perioperative management were collected. Postoperative outcomes were statistically compared between the two groups. A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively. Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group. Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both. PAI was withdrawn preoperatively in 50 patients. All treatments with warfarin were switched for heparin. Comparison of the two gr...
Progrès en Urologie, 2007
Intérêts des antidiurétiques, des anticholinergiques, des anti-inflammatoires et de la toxine bot... more Intérêts des antidiurétiques, des anticholinergiques, des anti-inflammatoires et de la toxine botulinique pour le traitement des troubles mictionnels liés à I'HBP (Forum CTMH-AFU 2005) Alexandre DE LA TAILLE (I), Marc FOURMARIER (2), Francois DESGRANDCHAMPS (3), Charles BALLEREAU (4), Christian SAUSSINE (5), Olivier HAILLOT (6), Abdel-Rahmène AZZOUZI (7), Bertrand LUKACS (E), Marian DEVONEC (9) et le Comité des Troubles Mictionnels de l'Homme (CTMH-AFU)
La Presse Médicale, 2007
... au traitement chirurgical trouvent mieux leur place en alternatives au traitement médical. Ce... more ... au traitement chirurgical trouvent mieux leur place en alternatives au traitement médical. Ces différents éléments permettent de bâtir un algorithme décisionnel, qui à chaque étape s'appuie sur une décision partagée avec le patient. Cet algorithme décisionnel d'aide à la prise ...
Clinical Nutrition, 2014
a Acute Medicine Department, R. Poincar e Hospital, APHP, Garches, Versailles Saint-Quentin-en-Yv... more a Acute Medicine Department, R. Poincar e Hospital, APHP, Garches, Versailles Saint-Quentin-en-Yvelines University, Medical School, EA 4497, France b Patient Reported Outcomes and Value Insight and Communication, Mapi Values, Lyon, France c JNB-D eveloppement, 11, rue Tronchet, 75008 Paris, France d Technical Agency for Information about Hospitalization, Paris, France e Cyklad Group, Rilleux la Pape, France f Joseph Fourier University, University Hospital Center of Grenoble, France g Gastroenterology and Clinical Nutrition in CHU of Nice, University of Nice Sophia Antipolis, France h Urology, Tenon Hospital, Paris, France i Anesthesia and Intensive Care, Antoine-B ecl ere Hospital, AP-HP Clamart, France j Colorectal Department, Beaujon Hospital, APHP, Clichy, Paris, France k Medical Counselor, 6 rue Leclerc, 75014 Paris, France
BMC Urology, 2014
Background: This very large population-based study investigated outcomes after a diagnosis of pro... more Background: This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects.
Urologia Internationalis, 2010
Background/Aims: There are only a few surveys on the prevalence of lower urinary tract symptoms (... more Background/Aims: There are only a few surveys on the prevalence of lower urinary tract symptoms (LUTS) among the general population. The aim of this survey was to assess the prevalence of LUTS and their impact on discomfort in men. Methods: A questionnaire was mailed to 3,877 men aged 50–80 years, which included questions on their medical history, demographic and sociological status, and also the International Prostate Symptom Score (IPSS) with additional questions on discomfort related to urinary symptoms. Results: The response rate was 81.5%. Prevalence of mild and severe IPSS was 89.2%. Specific bother for each urinary symptom depended on symptom frequency: urgency, frequency, weak stream, nocturia, incomplete emptying, intermittency and straining 1 time out of 5 were responsible for discomfort in respectively 4.9, 6.1, 7.1, 7.5, 8.7 and 9.9%; the same symptoms more than half of the time were responsible for discomfort in respectively 32.8, 38, 45.3, 45.6, 53.2 and 58.7%. Urgency...
World Journal of Urology, 2006
Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. Th... more Nowadays the management of benign prostatic hypertrophia (BPH) is undergoing striking changes. The standard medical treatments are represented by three families which are the phytotherapy, the alpha-blockers and the 5-alpha-reductase inhibitors. These treatments were deemed as symptomatic and used only as monotherapy. Recent numerous studies bring new assessments on BPH: the medical treatment is able to modify the natural history of BPH especially by reducing the risk of acute urinary retention. Furthermore the association of two different therapeutic classes seems to be more efficient than the use of a monotherapy in some cases. Similarly the place of two instrumental techniques, the thermotherapy by microwaves or by radiofrequencies, previously proposed as alternatives to the surgical treatment seems to find their way rather as alternatives to the medical treatment. These different elements allow building a renewed decision tree which decisions are shared with the patient at each stage. This decision tree of the management of patients having non-complicated BPH symptoms must include initial clinical characteristics of the patient and its disease and the evolution under treatment which has not been yet considered in the international recommendations. It also considers the possibilities of associations with other therapeutic classes.
World Journal of Urology, 2006
The usual treatments of benign prostate hyperplasia (BPH) including the alpha-blockers, the inhib... more The usual treatments of benign prostate hyperplasia (BPH) including the alpha-blockers, the inhibitors of the 5-alpha reductase and the phytotherapy drugs allow significant improvements of the lower urinary tracts symptoms (LUTS). However, some patients are not responders or have side effects due to the treatments. Other therapeutic approaches described in the literature are possible in order to alleviate the LUTS. The anti-cholinergic drugs seem to be efficient against the irritating symptoms even if they are supposed to be contra-indicated when there is BPH. Anti-diuretic hormone could be useful to treat nocturia due to diuresis reversal. Inflammation is a part of the underlying mechanisms of BPH and as such the role of the anti-inflammatory drugs has to be revised. Eventually, botulinum toxin is more and more used for patients with neurological bladder and could also have a role in LUTS. If the coming clinical studies on those different treatments confirm the preliminary results, the learning societies in charge of the guidelines would have to update the decision trees by adding these new therapeutic approaches.
The Journal of Urology, 2011
The Journal of Urology, 2011
ied. Data was collected on patient demographics, International Prostate Symptom Score (IPSS), pro... more ied. Data was collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), and perioperative parameters. Maximum flow rate (Qmax), postvoid residual (PVR), and prostate volume as determined by transrectal ultrasound were recorded. Statistical analyses were carried out utilizing the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and unpaired t tests (SPSS 15.0, SPSS Inc., Chicago, IL, USA). RESULTS: Baseline parameters were similar between the PVP and TLEP groups, although prostate volume was greater in the TLEP group (83 vs. 63cc, pϭ0.04) (See Table). Median laser time was commensurately longer in the TLEP group (90 vs. 50 minutes, pϽ0.001) with a higher median energy utilized (308 vs. 165kJ, pϽ0.001). The volume lased per unit time was shorter however for TLEP (0.92cc/minute) than for PVP (1.26cc/minute). A greater median number of fibers was used in TLEP (2.5 vs. 2.0, pϭ0.001). Median duration of follow-up was slightly longer in the PVP group (26.3 vs. 24.7 months, pϽ0.001). Data was available at 12 months and beyond for 59 and 103 patients, respectively (See Table). Improvements in median IPSS and PVR were seen in the TLEP group (5.0, pϽ0.001; 55.5, pϭ0.02 respectively) but not in the PVP group (pϭ0.40 and 0.30). Median Qmax and PSA however improved similarly in both groups. Final IPSS was lower for the TLEP group (pϽ0.001), but other final parameters were statistically equivalent between the two groups. CONCLUSIONS: In our series, both PVP and TLEP techniques were safe and effective. Although changes in Qmax and PSA were similar between the two techniques, durable improvement in urinary symptoms and PVR was superior with the TLEP technique. The TLEP technique was also a more efficient method for laser prostatectomy. * denotes pϽ 0.05 between pre-and postoperative values; ** denotes pϽ 0.05 between PVP and TLEP groups for the same pre-or post-operative parameter
The Journal of Urology, 2012