Marc-olivier Bitker - Academia.edu (original) (raw)
Papers by Marc-olivier Bitker
Journal of Cancer Therapy, 2011
The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of ... more The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of the thighs. The diagnosis of acquired haemophilia A associated to renal cancer was retained. She received anti CD 20 monoclonal antibody treatment allowing her to undergo partial nephrectomy 4 months later without major complication. One year after surgery there is no sign of tumour recurrence.
Journal of Cancer Therapy, 2011
The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of ... more The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of the thighs. The diagnosis of acquired haemophilia A associated to renal cancer was retained. She received anti CD 20 monoclonal antibody treatment allowing her to undergo partial nephrectomy 4 months later without major complication. One year after surgery there is no sign of tumour recurrence.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2011
The aim of our work was to present a review of technical features and complications of general an... more The aim of our work was to present a review of technical features and complications of general anesthesia during robot-assisted laparoscopic radical prostatectomy (RALRP). Data on RALRP and general anesthesia were explored on Medline using the following MeSH terms: radical prostatectomy; morbidity; anesthesia complications; laparoscopy; robotics; Trendeleburg. Publications were considered on the following criteria: methodology, relevance and date of publication. There was no data of level of evidence 1 available. The first RALRP was reported in 2000. Technological innovation brought by the robot with its 3-D vision, the acquisition of degrees of mobility and a more ergonomic position for the surgeon, have led to a growing interest from new teams in the western world. However, the RALRP generates constraints for the anesthesia team who need to incorporate the rules of laparoscopy and the patient's specific installation to guarantee maximum safety. There are inherent complications...
Nephrology Dialysis Transplantation, Feb 1, 2001
Archives des maladies du coeur et des vaisseaux, 1981
Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. ... more Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excludi...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1998
Organ recipients are at a high risk of posttransplant lymphoproliferative disorders (PTLD) as a r... more Organ recipients are at a high risk of posttransplant lymphoproliferative disorders (PTLD) as a result of immunosuppressive therapy. Most B-cell lymphomas are associated with Epstein-Barr virus (EBV) infection. We describe a morphologically and clinically distinct group of PTLD in 11 patients that occurred late after organ transplantation and were not associated with EBV. There were seven kidney, three heart, and one liver transplant recipients (group I). The clinical manifestations, pathologic findings, treatment, and outcome were compared with those in 21 patients with EBV-associated PTLD treated in our institution (group II). EBV was detected with at least two techniques: Epstein-Barr-encoded RNA (EBER) in situ hybridization with EBER 1 + 2 probes, Southern blotting, and detection of latent membrane protein 1 (LMP1) expression by immunohistochemistry. The time between transplantation and the diagnosis of lymphoma ranged from 180 to 10,220 days in group I (mean, 2,234; median, 1,8...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2002
To evaluate the quality of the postoperative course after conventional organ donation nephrectomy... more To evaluate the quality of the postoperative course after conventional organ donation nephrectomy. Over the last 29 months, 29 organ donation nephrectomies were performed in our hospital. Thirteen donors were non-residents. This series consisted of twenty organ donations between siblings, two organ donations from children to parents and seven organ donations from parents to children. The mean age of the donors was 42 years (range: 21 to 53). Ten pairs were HLA identical, 18 were semi-identical and one pair had only one A identity in common. The mean plasma creatinine on admission was 81 +/- 23 mumol/l. Twenty three left kidneys and 3 right kidneys were harvested, with the last two right kidneys removed via a right anterior subcostal incision. Among the 23 left lumbotomies, the 11th rib was preserved in 21 cases in order to decrease postoperative pain. The mean operating time for patients operated by lumbotomy was 90 +/- 11 minutes. The mean postoperative stay (MPS) was 4.56 days (ra...
The Journal of Urology, Apr 1, 2015
(p¼0.0016) and had fewer symptomatic UTI's (3.6 vs 0.73 episodes, p<0.0001); courses of treatment... more (p¼0.0016) and had fewer symptomatic UTI's (3.6 vs 0.73 episodes, p<0.0001); courses of treatment oral antibiotics (3.8 vs 0.91, p<0.0001); and telephone encounters for UTI's (2.3 vs 0.45, p¼0.0011). CONCLUSIONS: Gentamicin bladder instillations significantly decrease symptomatic UTI episodes and oral antibiotic use in patients with NGB. Prospective, placebo-controlled, longer-term trials are needed to determine if this effect is generalizable.
Radiology, 2013
To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targe... more To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy (TB) with that of extended systematic biopsy (SB) in prostate cancer (PCa) detection. Materials and Methods: This institutional review board-approved multicenter prospective study (May 2009 to January 2011) included 95 patients with informed consent who were suspected of having PCa, with a suspicious abnormality (target) at prebiopsy MR. Patients underwent 12-core SB and four-core TB with transrectal ultrasonographic (US) guidance, with two cores aimed visually (cognitive TB [TB-COG]) and two cores aimed using transrectal US-MR fusion software (fusionguided TB [TB-FUS]). SB and TB positivity for cancer and sampling quality (mean longest core cancer length, Gleason score) were compared. Clinically significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB. Statistical analysis included t test, paired x 2 test, and k statistic. Primary end point (core cancer length) was calculated (paired t test).
World Journal of Urology, 2016
To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cance... more To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cancer aggressiveness as defined by pathological Gleason score or molecular markers in a cohort of patients defined with a Gleason score of 6 at biopsy. Sixty-seven men treated by radical prostatectomy (RP) for a low grade (Gleason 6) on biopsy and mp MRI before biopsy were selected. The cycle cell proliferation (CCP) score assessed by the Prolaris test and Ki-67/PTEN expression assessed by immunohistochemistry were quantified on the RP specimens. 49.25 % of the cancers were undergraded on biopsy compared to the RP specimens. Apparent diffusion coefficient (ADC) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.80 × 10(-3) mm(2)/s (P value 0.003), Likert score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 (P value 0.003) and PSA density &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.15 ng/ml/cc (P value 0.035) were significantly associated with a higher RP Gleason score. Regarding molecular markers of aggressiveness, ADC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.80 × 10(-3) mm(2)/s and Likert score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 were also significantly associated with a positive staining for Ki-67 (P value 0.039 and 0.01, respectively). No association was found between any analyzed MRI or clinical parameter and the CCP score. Decreasing ADC value is a stronger indicator of aggressive prostate cancer as defined by molecular markers or postsurgical histology than biopsy characteristics.
Morphologie, 2006
la connaissance de l'anatomie des fascias de la prostate est indispensable lors des prostatectomi... more la connaissance de l'anatomie des fascias de la prostate est indispensable lors des prostatectomies radicales : ils sont les plans de dissection et des repères pour la préservation des nerfs caverneux. Mais les descriptions en sont multiples. Le but de cette étude a été de définir et confronter l'anatomie chirurgicale et l'anatomie coelioscopique des fascias de la prostate. Matériel et méthodes : 4 sujets anatomiques, ayant fait don de leur corps pour l'enseignement et la recherche, de sexe masculin d'âge moyen 78 ans, sans cicatrice abdominale. 2 sujets ont eu une dissection par voie abdominale, 2 par voie coelioscopique sous-péritonéale. Des photos et un film video ont été réalisés pour illustrer les fascias mis en évidence. Résultats : après ouverture de l'espace rétropubien, la face antérieure de la prostate était recouverte par le fascia endopelvien allant d'un muscle levator ani à l'autre ; la veine vésicale antérieure était en avant de lui. Après incision du fascia endopelvien aux bords latéraux de la prostate, un espace se créait entre le muscle levator ani et la face latérale de la prostate, jusqu'au rectum en arrière. La prostate était recouverte par un fascia prostatique ; ce fascia était séparé de la capsule prostatique par une fine lame graisseuse : l'incision de ce fascia, quelque soit le niveau, permettait de trouver un plan passant en avant du pédicule contenant les nerfs caverneux. À l'angle postéro-latéral de la prostate, se trouvait le fascia prostato-rectal que l'on pouvait désinsérer du fascia prostatique pour passer devant le rectum. Conclusion : les deux voies d'abord permettaient un isolement des différents fascias et donc une dissection isolant les nerfs caverneux dans leur pédicule latéro-prostatique. Chronologie de l'ossification de l'arc vertébral lombo-sacré : bases anatomiques de l'anesthésie rachidienne basse en période néonatale
The Journal of Urology, 2011
The Journal of Urology, 2010
INTRODUCTION AND OBJECTIVES: In urothelial carcinoma of the bladder, concomitant carcinoma in sit... more INTRODUCTION AND OBJECTIVES: In urothelial carcinoma of the bladder, concomitant carcinoma in situ (CIS) has been shown to be associated with poor clinical outcomes. To date, the prognostic value of concomitant carcinoma in situ in upper tract urothelial carcinoma (UTUC) has not been evaluated. The aim of the present study was to assess the association of concomitant CIS with clinico-pathologic features, disease recurrence, and cancer-specific death in a large international cohort of patients with UTUC treated by radical nephroureterectomy (RNU). METHODS: We retrospectively collected the data of 583 patients treated with RNU for UTUC at 9 centres in Asia, Canada and Europe. RESULTS: 75 patients had concomitant CIS (13%). Presence of concomitant CIS was not associated with age, gender, location of UTUC or pathologic stage (all p values Ͼ0.05). However, concomitant CIS was significant more common in high grade tumours (pϭ0.009), tumor necrosis (pϭ0.002) and sessile architecture (pϭ0.04). Within a median follow-up of 38 months (IQR: 16-67), 164 patients experienced disease recurrence and 140 died of UTUC. On univariable Cox regression analyses, patients with concomitant CIS were at increased risk for disease recurrence [HR 1.93, pϽ0.001; 3-year RFS: 52% (SE 6%) vs. 74% (SE 2%)] and death [HR 1.74, pϭ0.01; 3-year CSS: 63% (SE 6%) vs. 78% (SE 2%)]. On multivariable Cox regression analyses that a adjusted for the effects of stage, grade, lymph node status, lymphovascular invasion, tumor location, tumor architecture and adjuvant chemotherapy, concomitant CIS was an independent predictor of disease recurrence (HR 2.2, pϽ0.001) and death (HR 1.8, pϭ0.01),. Concomitant CIS retained its independent prognostic value for both RFS (HR 2.28, pϭ0.001) and CSS (HR 2.3, pϭ0.002), after exclusion of patients treated with adjuvant chemotherapy. CONCLUSIONS: In the present international, multicentre series of patients treated with RNU for UTUC, concomitant CIS was associated with features of biologically aggressive UTUC and cancerspecific outcomes after RNU. Concomitant CIS should be systematically assessed in RNU specimens and presence/absence should be reported. After confirmation of other studies, concomitant CIS should be included in predictive models for patient counselling and management decision.
The Journal of Urology, 2011
Academic Radiology, 2010
Rationale and Objectives-We conducted a prospective study to investigate using multiparametric an... more Rationale and Objectives-We conducted a prospective study to investigate using multiparametric and multinuclear magnetic resonance imaging(MRI) during preoperative systemic treatment(PST) for locally advanced breast cancer. Methods-Women with operable stage II or III breast cancer who received PST were studied using dynamic-contrast-enhanced(DCE)-MRI, spectroscopy(MRS), and (23 Na)sodium MR. Quantitative metrics of choline peak signal-to-noise ratios(SNR), total sodium concentration(TSC;mM), tumor volumes and Response Evaluation Criteria In Solid Tumors (RECIST) were determined and compared to final pathological result with ROC analysis. Hormonal markers were investigated. Statistical significance was set at p<0.05. Results-Eighteen(n=18) eligible women were studied. Fifteen(n=15) responded to therapy, four(22%) with pathological-complete-response(pCR) and eleven(61%) with a pathologicalpartial-response(pPR). Three patients(17%) had no response(pNR). Among ER+, HER2+, and Triple Negative(TN) phenotypes, observed frequencies of pCR, pPR, and pNR were 2/5/0, 1/4/0, and 1/1/3, respectively. Responders(pCR and pPR) had the largest reduction in choline SNR (35%:7.2±2.3 to 4.6±2;p<0.01) compared to pNR(11%:8.4±2.7 to 7.5±3.6;p=0.13) after the first cycle. TSC significantly decreased in responders(27%:66±18 to 48.4±8mM;p=0.01), while there was little change in non-responders(51.7±7.6 to 56.5±1.6;p=0.50). Lesion volume decreased in responders(40%:78±78 to 46±51mm 3 ;p=0.01) and nonresponders(21%:100±104 to 79.2±87 mm 3 ;p=0.23) after the first cycle. The largest reduction in RECIST occurred after the first treatment in responders(18%:24.5±20 to 20.2±18mm;p=0.01) with a slight decrease in tumor diameter noted in nonresponders(17%;23±19 to 19.2±19.1mm;p=0.80).
Progres En Urologie, Sep 1, 2016
INTRODUCTION Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is n... more INTRODUCTION Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is not frequently used after cystectomy for malignancy. The aim of our work was to assess mid-term oncological and functional outcomes of CCUD in case of malignancies. PATIENTS AND METHODS We retrospectively included all patients who underwent CCUD after radical cystectomy for cancer (according Mitrofanoff or Monti's principle) between July 2001 and November 2015 in our department. Perioperative data, oncological and functional outcomes were reported. To measure disease specific quality of life, we used the French version of Bladder Cancer Index. RESULTS Overall 12 patients were involved in the study. With a median follow-up of 32 months, we noticed one death due to cancer recurrence. Early postoperative complications occurred in 8 patients, with one requiring reoperation. The late postoperative complication rate was 66%, whose 4 patients (33%) presented cutaneous stenosis. Overall satisfaction rate was scored 8.9/10 and body image was preserved for 75% of patients. At last follow-up, continence (no urinary leakage) was achieved for 62.5% of patient. Sexual impairment was significant for 5 patients. CONCLUSION The CCUD is a valid alternative to other urinary diversions with similar oncological results and with a similar rate of complications. The high satisfaction rate was related to the preservation of body image and the high rate of continence. LEVEL OF EVIDENCE 5.
Springer eBooks, Feb 24, 2006
L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale... more L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale (HU) et/ou a une insuffisance sphincterienne (IS). De tres nombreuses techniques chirurgicales ont ete decrites pour le traitement de l’IUE. Dans l’HU, les soutenements, les suspensions ou les frondes qui utilisent des materiaux autologues ou synthetiques ont pour but de positionner le col vesical dans l’enceinte manometrique abdominale. Ils repondent a la theorie de defaut de transmission des pressions abdominales a l’uretre (1), et a l’ecrasement du col vesical et de l’uretre sur les structures de suspension (2). Une nouvelle technique, le Tension-free Vaginal Tape, consiste a soutenir la partie moyenne de l’uretre et non plus le col vesical. Elle resulte de la theorie integrale des mecanismes de cloture uretrale chez la femme (3, 4). Dans le cas de l’IS isolee avec uretre fixe, l’approche chirurgicale est polymorphe avec trois techniques chirurgicales validees : les frondes sous-uretrales, les injections para-uretrales, et le sphincter urinaire artificiel. Les deux premieres techniques sont passives et tendent a retablir la continence en creant une dysurie par obstruction uretrale. Le sphincter urinaire artificiel vise a retablir un cycle continence-miction quasi physiologique en obtenant une continence complete entre des mictions qui s’effectuent sans obstacle au niveau de l’uretre. Les techniques chirurgicales les plus utilisees actuellement pour le traitement de l’IUE, se resument aux colposuspensions, aux frondes, au TVT, aux injections para-uretrales et au sphincter urinaire artificiel. Les troubles de la statique pelvienne sont souvent associes a l’IUE. Ils concernent les etages anterieur (cystocele), moyen (colpocele, hysterocele et ptose du dome vaginal), et posterieur (rectocele et elytrocele). Les modalites chirurgicales sont multiples. Toutes visent a retablir une anatomie normale.
Progres En Urologie, Mar 1, 2010
Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erec... more Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erectile dysfunction (ED) in selected series is still reported as high as 80% after this surgery. Patient selection and surgical technique (i.e., preservation of neurovascular bundles) are the major determinants of postoperative ED. Pharmacological treatment of postoperative ED, using either oral or local approaches, is effective and safe. Thus, most men need adjuvant treatments to be sexually active following RP. These include intracorporeal injections of vasoactive drugs, vacuum constriction devices and transurethral dilators, all of which have reported response rates of 50 to 70%. Unfortunately, long-term compliance is sub-optimal, with a discontinuation rate of nearly 50% at 1 year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy (IPDE5) since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections is the gold standard for partients over 60 years old and those who underwent non-sparing surgery. In younger patients and/or when preservation of nerve tissue was feasible, oral IPDE5 may be effective in promoting an earlier return of erectile function. Recent studies have shown that pharmacological prophylaxis early after RP can significantly improve the rate of erectile function recovery after surgery. Use of on-demand treatments for treatment of ED in patients subjected to RP has been shown to be highly effective, especially in cases of properly selected young patients treated with a bilateral nerve-sparing approach by experienced urologists.
Journal of Cancer Therapy, 2011
The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of ... more The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of the thighs. The diagnosis of acquired haemophilia A associated to renal cancer was retained. She received anti CD 20 monoclonal antibody treatment allowing her to undergo partial nephrectomy 4 months later without major complication. One year after surgery there is no sign of tumour recurrence.
Journal of Cancer Therapy, 2011
The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of ... more The case of a forty-five year old woman is presented who consulted for spontaneous haematomas of the thighs. The diagnosis of acquired haemophilia A associated to renal cancer was retained. She received anti CD 20 monoclonal antibody treatment allowing her to undergo partial nephrectomy 4 months later without major complication. One year after surgery there is no sign of tumour recurrence.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2011
The aim of our work was to present a review of technical features and complications of general an... more The aim of our work was to present a review of technical features and complications of general anesthesia during robot-assisted laparoscopic radical prostatectomy (RALRP). Data on RALRP and general anesthesia were explored on Medline using the following MeSH terms: radical prostatectomy; morbidity; anesthesia complications; laparoscopy; robotics; Trendeleburg. Publications were considered on the following criteria: methodology, relevance and date of publication. There was no data of level of evidence 1 available. The first RALRP was reported in 2000. Technological innovation brought by the robot with its 3-D vision, the acquisition of degrees of mobility and a more ergonomic position for the surgeon, have led to a growing interest from new teams in the western world. However, the RALRP generates constraints for the anesthesia team who need to incorporate the rules of laparoscopy and the patient's specific installation to guarantee maximum safety. There are inherent complications...
Nephrology Dialysis Transplantation, Feb 1, 2001
Archives des maladies du coeur et des vaisseaux, 1981
Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. ... more Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excludi...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1998
Organ recipients are at a high risk of posttransplant lymphoproliferative disorders (PTLD) as a r... more Organ recipients are at a high risk of posttransplant lymphoproliferative disorders (PTLD) as a result of immunosuppressive therapy. Most B-cell lymphomas are associated with Epstein-Barr virus (EBV) infection. We describe a morphologically and clinically distinct group of PTLD in 11 patients that occurred late after organ transplantation and were not associated with EBV. There were seven kidney, three heart, and one liver transplant recipients (group I). The clinical manifestations, pathologic findings, treatment, and outcome were compared with those in 21 patients with EBV-associated PTLD treated in our institution (group II). EBV was detected with at least two techniques: Epstein-Barr-encoded RNA (EBER) in situ hybridization with EBER 1 + 2 probes, Southern blotting, and detection of latent membrane protein 1 (LMP1) expression by immunohistochemistry. The time between transplantation and the diagnosis of lymphoma ranged from 180 to 10,220 days in group I (mean, 2,234; median, 1,8...
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2002
To evaluate the quality of the postoperative course after conventional organ donation nephrectomy... more To evaluate the quality of the postoperative course after conventional organ donation nephrectomy. Over the last 29 months, 29 organ donation nephrectomies were performed in our hospital. Thirteen donors were non-residents. This series consisted of twenty organ donations between siblings, two organ donations from children to parents and seven organ donations from parents to children. The mean age of the donors was 42 years (range: 21 to 53). Ten pairs were HLA identical, 18 were semi-identical and one pair had only one A identity in common. The mean plasma creatinine on admission was 81 +/- 23 mumol/l. Twenty three left kidneys and 3 right kidneys were harvested, with the last two right kidneys removed via a right anterior subcostal incision. Among the 23 left lumbotomies, the 11th rib was preserved in 21 cases in order to decrease postoperative pain. The mean operating time for patients operated by lumbotomy was 90 +/- 11 minutes. The mean postoperative stay (MPS) was 4.56 days (ra...
The Journal of Urology, Apr 1, 2015
(p¼0.0016) and had fewer symptomatic UTI's (3.6 vs 0.73 episodes, p<0.0001); courses of treatment... more (p¼0.0016) and had fewer symptomatic UTI's (3.6 vs 0.73 episodes, p<0.0001); courses of treatment oral antibiotics (3.8 vs 0.91, p<0.0001); and telephone encounters for UTI's (2.3 vs 0.45, p¼0.0011). CONCLUSIONS: Gentamicin bladder instillations significantly decrease symptomatic UTI episodes and oral antibiotic use in patients with NGB. Prospective, placebo-controlled, longer-term trials are needed to determine if this effect is generalizable.
Radiology, 2013
To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targe... more To compare biopsy performance of two approaches for multiparametric magnetic resonance (MR)-targeted biopsy (TB) with that of extended systematic biopsy (SB) in prostate cancer (PCa) detection. Materials and Methods: This institutional review board-approved multicenter prospective study (May 2009 to January 2011) included 95 patients with informed consent who were suspected of having PCa, with a suspicious abnormality (target) at prebiopsy MR. Patients underwent 12-core SB and four-core TB with transrectal ultrasonographic (US) guidance, with two cores aimed visually (cognitive TB [TB-COG]) and two cores aimed using transrectal US-MR fusion software (fusionguided TB [TB-FUS]). SB and TB positivity for cancer and sampling quality (mean longest core cancer length, Gleason score) were compared. Clinically significant PCa was any 3 mm or greater core cancer length or any greater than 3 Gleason pattern for SB or any cancer length for TB. Statistical analysis included t test, paired x 2 test, and k statistic. Primary end point (core cancer length) was calculated (paired t test).
World Journal of Urology, 2016
To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cance... more To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cancer aggressiveness as defined by pathological Gleason score or molecular markers in a cohort of patients defined with a Gleason score of 6 at biopsy. Sixty-seven men treated by radical prostatectomy (RP) for a low grade (Gleason 6) on biopsy and mp MRI before biopsy were selected. The cycle cell proliferation (CCP) score assessed by the Prolaris test and Ki-67/PTEN expression assessed by immunohistochemistry were quantified on the RP specimens. 49.25 % of the cancers were undergraded on biopsy compared to the RP specimens. Apparent diffusion coefficient (ADC) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.80 × 10(-3) mm(2)/s (P value 0.003), Likert score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 (P value 0.003) and PSA density &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.15 ng/ml/cc (P value 0.035) were significantly associated with a higher RP Gleason score. Regarding molecular markers of aggressiveness, ADC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.80 × 10(-3) mm(2)/s and Likert score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4 were also significantly associated with a positive staining for Ki-67 (P value 0.039 and 0.01, respectively). No association was found between any analyzed MRI or clinical parameter and the CCP score. Decreasing ADC value is a stronger indicator of aggressive prostate cancer as defined by molecular markers or postsurgical histology than biopsy characteristics.
Morphologie, 2006
la connaissance de l'anatomie des fascias de la prostate est indispensable lors des prostatectomi... more la connaissance de l'anatomie des fascias de la prostate est indispensable lors des prostatectomies radicales : ils sont les plans de dissection et des repères pour la préservation des nerfs caverneux. Mais les descriptions en sont multiples. Le but de cette étude a été de définir et confronter l'anatomie chirurgicale et l'anatomie coelioscopique des fascias de la prostate. Matériel et méthodes : 4 sujets anatomiques, ayant fait don de leur corps pour l'enseignement et la recherche, de sexe masculin d'âge moyen 78 ans, sans cicatrice abdominale. 2 sujets ont eu une dissection par voie abdominale, 2 par voie coelioscopique sous-péritonéale. Des photos et un film video ont été réalisés pour illustrer les fascias mis en évidence. Résultats : après ouverture de l'espace rétropubien, la face antérieure de la prostate était recouverte par le fascia endopelvien allant d'un muscle levator ani à l'autre ; la veine vésicale antérieure était en avant de lui. Après incision du fascia endopelvien aux bords latéraux de la prostate, un espace se créait entre le muscle levator ani et la face latérale de la prostate, jusqu'au rectum en arrière. La prostate était recouverte par un fascia prostatique ; ce fascia était séparé de la capsule prostatique par une fine lame graisseuse : l'incision de ce fascia, quelque soit le niveau, permettait de trouver un plan passant en avant du pédicule contenant les nerfs caverneux. À l'angle postéro-latéral de la prostate, se trouvait le fascia prostato-rectal que l'on pouvait désinsérer du fascia prostatique pour passer devant le rectum. Conclusion : les deux voies d'abord permettaient un isolement des différents fascias et donc une dissection isolant les nerfs caverneux dans leur pédicule latéro-prostatique. Chronologie de l'ossification de l'arc vertébral lombo-sacré : bases anatomiques de l'anesthésie rachidienne basse en période néonatale
The Journal of Urology, 2011
The Journal of Urology, 2010
INTRODUCTION AND OBJECTIVES: In urothelial carcinoma of the bladder, concomitant carcinoma in sit... more INTRODUCTION AND OBJECTIVES: In urothelial carcinoma of the bladder, concomitant carcinoma in situ (CIS) has been shown to be associated with poor clinical outcomes. To date, the prognostic value of concomitant carcinoma in situ in upper tract urothelial carcinoma (UTUC) has not been evaluated. The aim of the present study was to assess the association of concomitant CIS with clinico-pathologic features, disease recurrence, and cancer-specific death in a large international cohort of patients with UTUC treated by radical nephroureterectomy (RNU). METHODS: We retrospectively collected the data of 583 patients treated with RNU for UTUC at 9 centres in Asia, Canada and Europe. RESULTS: 75 patients had concomitant CIS (13%). Presence of concomitant CIS was not associated with age, gender, location of UTUC or pathologic stage (all p values Ͼ0.05). However, concomitant CIS was significant more common in high grade tumours (pϭ0.009), tumor necrosis (pϭ0.002) and sessile architecture (pϭ0.04). Within a median follow-up of 38 months (IQR: 16-67), 164 patients experienced disease recurrence and 140 died of UTUC. On univariable Cox regression analyses, patients with concomitant CIS were at increased risk for disease recurrence [HR 1.93, pϽ0.001; 3-year RFS: 52% (SE 6%) vs. 74% (SE 2%)] and death [HR 1.74, pϭ0.01; 3-year CSS: 63% (SE 6%) vs. 78% (SE 2%)]. On multivariable Cox regression analyses that a adjusted for the effects of stage, grade, lymph node status, lymphovascular invasion, tumor location, tumor architecture and adjuvant chemotherapy, concomitant CIS was an independent predictor of disease recurrence (HR 2.2, pϽ0.001) and death (HR 1.8, pϭ0.01),. Concomitant CIS retained its independent prognostic value for both RFS (HR 2.28, pϭ0.001) and CSS (HR 2.3, pϭ0.002), after exclusion of patients treated with adjuvant chemotherapy. CONCLUSIONS: In the present international, multicentre series of patients treated with RNU for UTUC, concomitant CIS was associated with features of biologically aggressive UTUC and cancerspecific outcomes after RNU. Concomitant CIS should be systematically assessed in RNU specimens and presence/absence should be reported. After confirmation of other studies, concomitant CIS should be included in predictive models for patient counselling and management decision.
The Journal of Urology, 2011
Academic Radiology, 2010
Rationale and Objectives-We conducted a prospective study to investigate using multiparametric an... more Rationale and Objectives-We conducted a prospective study to investigate using multiparametric and multinuclear magnetic resonance imaging(MRI) during preoperative systemic treatment(PST) for locally advanced breast cancer. Methods-Women with operable stage II or III breast cancer who received PST were studied using dynamic-contrast-enhanced(DCE)-MRI, spectroscopy(MRS), and (23 Na)sodium MR. Quantitative metrics of choline peak signal-to-noise ratios(SNR), total sodium concentration(TSC;mM), tumor volumes and Response Evaluation Criteria In Solid Tumors (RECIST) were determined and compared to final pathological result with ROC analysis. Hormonal markers were investigated. Statistical significance was set at p<0.05. Results-Eighteen(n=18) eligible women were studied. Fifteen(n=15) responded to therapy, four(22%) with pathological-complete-response(pCR) and eleven(61%) with a pathologicalpartial-response(pPR). Three patients(17%) had no response(pNR). Among ER+, HER2+, and Triple Negative(TN) phenotypes, observed frequencies of pCR, pPR, and pNR were 2/5/0, 1/4/0, and 1/1/3, respectively. Responders(pCR and pPR) had the largest reduction in choline SNR (35%:7.2±2.3 to 4.6±2;p<0.01) compared to pNR(11%:8.4±2.7 to 7.5±3.6;p=0.13) after the first cycle. TSC significantly decreased in responders(27%:66±18 to 48.4±8mM;p=0.01), while there was little change in non-responders(51.7±7.6 to 56.5±1.6;p=0.50). Lesion volume decreased in responders(40%:78±78 to 46±51mm 3 ;p=0.01) and nonresponders(21%:100±104 to 79.2±87 mm 3 ;p=0.23) after the first cycle. The largest reduction in RECIST occurred after the first treatment in responders(18%:24.5±20 to 20.2±18mm;p=0.01) with a slight decrease in tumor diameter noted in nonresponders(17%;23±19 to 19.2±19.1mm;p=0.80).
Progres En Urologie, Sep 1, 2016
INTRODUCTION Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is n... more INTRODUCTION Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is not frequently used after cystectomy for malignancy. The aim of our work was to assess mid-term oncological and functional outcomes of CCUD in case of malignancies. PATIENTS AND METHODS We retrospectively included all patients who underwent CCUD after radical cystectomy for cancer (according Mitrofanoff or Monti's principle) between July 2001 and November 2015 in our department. Perioperative data, oncological and functional outcomes were reported. To measure disease specific quality of life, we used the French version of Bladder Cancer Index. RESULTS Overall 12 patients were involved in the study. With a median follow-up of 32 months, we noticed one death due to cancer recurrence. Early postoperative complications occurred in 8 patients, with one requiring reoperation. The late postoperative complication rate was 66%, whose 4 patients (33%) presented cutaneous stenosis. Overall satisfaction rate was scored 8.9/10 and body image was preserved for 75% of patients. At last follow-up, continence (no urinary leakage) was achieved for 62.5% of patient. Sexual impairment was significant for 5 patients. CONCLUSION The CCUD is a valid alternative to other urinary diversions with similar oncological results and with a similar rate of complications. The high satisfaction rate was related to the preservation of body image and the high rate of continence. LEVEL OF EVIDENCE 5.
Springer eBooks, Feb 24, 2006
L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale... more L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale (HU) et/ou a une insuffisance sphincterienne (IS). De tres nombreuses techniques chirurgicales ont ete decrites pour le traitement de l’IUE. Dans l’HU, les soutenements, les suspensions ou les frondes qui utilisent des materiaux autologues ou synthetiques ont pour but de positionner le col vesical dans l’enceinte manometrique abdominale. Ils repondent a la theorie de defaut de transmission des pressions abdominales a l’uretre (1), et a l’ecrasement du col vesical et de l’uretre sur les structures de suspension (2). Une nouvelle technique, le Tension-free Vaginal Tape, consiste a soutenir la partie moyenne de l’uretre et non plus le col vesical. Elle resulte de la theorie integrale des mecanismes de cloture uretrale chez la femme (3, 4). Dans le cas de l’IS isolee avec uretre fixe, l’approche chirurgicale est polymorphe avec trois techniques chirurgicales validees : les frondes sous-uretrales, les injections para-uretrales, et le sphincter urinaire artificiel. Les deux premieres techniques sont passives et tendent a retablir la continence en creant une dysurie par obstruction uretrale. Le sphincter urinaire artificiel vise a retablir un cycle continence-miction quasi physiologique en obtenant une continence complete entre des mictions qui s’effectuent sans obstacle au niveau de l’uretre. Les techniques chirurgicales les plus utilisees actuellement pour le traitement de l’IUE, se resument aux colposuspensions, aux frondes, au TVT, aux injections para-uretrales et au sphincter urinaire artificiel. Les troubles de la statique pelvienne sont souvent associes a l’IUE. Ils concernent les etages anterieur (cystocele), moyen (colpocele, hysterocele et ptose du dome vaginal), et posterieur (rectocele et elytrocele). Les modalites chirurgicales sont multiples. Toutes visent a retablir une anatomie normale.
Progres En Urologie, Mar 1, 2010
Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erec... more Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erectile dysfunction (ED) in selected series is still reported as high as 80% after this surgery. Patient selection and surgical technique (i.e., preservation of neurovascular bundles) are the major determinants of postoperative ED. Pharmacological treatment of postoperative ED, using either oral or local approaches, is effective and safe. Thus, most men need adjuvant treatments to be sexually active following RP. These include intracorporeal injections of vasoactive drugs, vacuum constriction devices and transurethral dilators, all of which have reported response rates of 50 to 70%. Unfortunately, long-term compliance is sub-optimal, with a discontinuation rate of nearly 50% at 1 year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy (IPDE5) since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections is the gold standard for partients over 60 years old and those who underwent non-sparing surgery. In younger patients and/or when preservation of nerve tissue was feasible, oral IPDE5 may be effective in promoting an earlier return of erectile function. Recent studies have shown that pharmacological prophylaxis early after RP can significantly improve the rate of erectile function recovery after surgery. Use of on-demand treatments for treatment of ED in patients subjected to RP has been shown to be highly effective, especially in cases of properly selected young patients treated with a bilateral nerve-sparing approach by experienced urologists.