Search

Objectives: To assess the efficacy and safety of a minimally invasive surgical procedure using a polypropylene transobturator tape to treat female stress urinary incontinence during a minimal follow-up of 1 year and to present a review of this technique., Methods: A total of 206 women with stress urinary incontinence who underwent the transobturator tape procedure in a French multicenter prospective open tracker study, with a minimal follow-up of 1 year (range 12 to 33 months), were assessed. A nonelastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique used a vaginal and transobturator percutaneous approach. Postoperative assessments included clinical examination, cough-stress test (full bladder), uroflowmetry, and postvoid residual urine volume performed after 1, 6, 12, 18, and 24 months., Results: The mean follow-up was 16 months (range 12 to 33). Of the 206 patients, 79.1% were completely cured, 13% improved, and 7% failed. No vascular, nervous system, or digestive perioperative complications were observed; however, 2.4% of the patients had postoperative urinary retention., Conclusions: The results of the present study have confirmed the optimal results in stress incontinence previously reported in short-term studies. These results suggest that the transobturator tape procedure is a valuable alternative to the transvaginal tape procedure, with a low rate of complications.

Objective: To establish a multi-centre database of a large number of patients treated with brachytherapy across Europe., Methods: A total of 1175 patient files were registered in the database and the completeness of the data on these patients resulted in the majority being included in the analysis., Results: The database of patients treated with brachytherapy across Europe indicates that optimal patient selection for this procedure has been made, both in terms of outcome and side-effects, which will be subject of future analyses. This should enable refinement of the treatment choice and administration as well as provide useful guidance to other centres that want to establish this procedure for their patients. It will also set the ground for prospective studies., Conclusions: The established database indicates that brachytherapy as a treatment option for prostate cancer is well established in many centres.

Objectives: To describe the outcome of patients with muscle-invasive bladder carcinoma treated with multimodality therapy in our institution from 1993 to 2002., Methods: The charts of 60 patients with Stage T2-T4N0-N1M0 treated with transurethral resection of bladder tumor followed by a chemoradiotherapy combination were retrospectively reviewed. Of the 60 patients, 22 had received neoadjuvant chemotherapy (methotrexate, cisplatin, and vinblastine or methotrexate, adriamycin, cisplatin, and vinblastine) followed by concomitant chemoradiotherapy (weekly cisplatin/carboplatin or a cisplatin and 5-fluorouracil combination), and 38 had received concomitant chemoradiotherapy alone. Radiotherapy delivered a median dose of 45 Gy to the pelvis and 65 Gy to the bladder in a once-daily or twice-daily fractionation scheme. Follow-up evaluations included cystoscopy with biopsies at regular intervals. Salvage cystectomy was recommended in the case of local persistent tumor or bladder relapse., Results: The median follow-up was 48.5 months (range 10 to 126). Of the 22 patients who received neoadjuvant chemotherapy, 18 (82%) had received two or more cycles; 51 (85%) of the 60 patients received the concomitant chemotherapy as planned. Radiotherapy was completed in 56 patients. Twenty-eight patients developed relapse either locally (14 did not achieve a complete local response after chemoradiotherapy and 6 had true local relapse during follow-up) or at distant sites. The actuarial 5-year disease-specific survival and freedom from local and distant relapse rate was 54% and 42%, respectively. The actuarial local control rate with an intact bladder was 56% at 5 years. When stratified according to stage and grade, patients with Stage T2-T3, grade 2 tumors had a statistically significantly better chance of remaining relapse free than did the others (P = 0.045). Salvage cystectomy (n = 11) for isolated local failure in this population achieved limited results., Conclusions: Transurethral resection of bladder tumor with this chemoradiotherapy combination achieved satisfactory results in this unfavorable population with invasive bladder carcinoma.

Objectives: Prosthetic surgery for impotence has been transformed by the use of inflatable prostheses, superseding the old semi-rigid designs. Our objective is to report the functional results and the complications of this type of surgery., Methods: 80 inflatable prostheses were implanted between October 1987 and October 1994. The mean follow-up was 3 years and assessment of the objective (mechanical functioning of the prosthesis and complications) and subjective results (sexuality of the patients) was made in 68 patients., Results: There were: 54.5% functional disturbances, 7% infections, and 27.5% prosthesis removals. Most of the patients were satisfied, although only 65% returned to regular sexual activity., Conclusions: The choice between an inflatable and a semi-rigid prosthesis should be carefully discussed because of the frequent mechanical complications that have been reported for the sophisticated designs. Inflatable penile prostheses nevertheless remain the design of choice. Their reliability has been increasing since the manufacture of monobloc designs. Such a device is costly, and should be compared with that of intracavernous injections.

The authors report an exceptional case of subcutaneous metastatic dissemination, located at the puncture points of a coelioscopic lymphadenectomy for a vesical urothelial carcinoma. Few cases of parietal metastasis have been described after coelioscopic check-up for gynaecological and digestive tumours. The onset of this new type of serious complication suggests a need to reassess the benefits of this technique in tumours with lymphatic invasion.

A series of 35 patients who were treated surgically by pericavernoplasty using a prosthetic band is presented. At the 1-year follow-up visit, 57% still had improved erectile capability. At the present time, it is difficult to determine whether or not surgical treatment will result in failure. However, according to recent histological studies, prognostic insight in the future might be provided through the analysis of erectile tissue, but for the present moderation must be used in deciding upon surgical treatment since there is a lack of precise physiopathologic understanding of erectile dysfunction.

To examine the mechanism of bromocriptine effects in patients suffering from benign prostatic hypertrophy (BPH), urinary prostaglandin E2 (PGE2) contents were investigated before and during treatment. An active PGE2 synthesis was detected within the BPH area. Yet, PGE2 concentration in urine could be related neither to the severity of disease nor to the clinical response observed in patients under bromocriptine therapy. Under treatment, a considerable urodynamic improvement was observed in 75% of patients suffering from BPH. In these cases, the prostatic hypertrophy was not markedly reduced. PGE2 urinary contents lowered under treatment provided a beneficial clinical response in patients. The results are discussed with respect to PGE2 involvement in the mechanism of action of prolactin. It is suggested that a direct role of PGE2 and a local effect of bromocriptine in BPH urinary dysfunctioning of the lower urinary tract could not be excluded.