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Resume La technique de fermeture du parenchyme apres nephrectomie partielle utilisant des clips Hem-o-lok ® pour appuyer la suture est largement utilisee en chirurgie laparoscopique, robotique et parfois en chirurgie ouverte. Nous presentons ici un cas de migration massive des clips apres nephrectomie partielle ouverte. Nous discutons les caracteristiques de ces clips a l’imagerie : non visibles sur les cliches d’AUSP, faible densite au scanner, avant de revoir les cas decrits dans la litterature.

Radiotherapy combined with androgen-deprivation therapy (ADT) is superior to radiotherapy alone in localised prostate cancer; however, data comparing ADT alone are somewhat limited.To compare 3-yr ADT plus radiotherapy with ADT alone in locally advanced prostate cancer patients.A multicentre randomised open controlled phase 3 trial in 264 histologically confirmed T3-4 or pT3N0M0 prostate cancer patients randomised from March 2000 to December 2003.ADT (11.25mg subcutaneous depot injection of leuprorelin every 3 mo for 3 yr) plus external-beam radiotherapy or ADT alone. Flutamide (750 g/d) was administered for 1 mo.The primary objective was 5 yr progression-free survival (PFS) according to clinical or biologic criteria, using the American Society for Therapeutic Radiology and Oncology (ASTRO) and the newer (Phoenix) definition (nadir plus 2 ng/ml), by intention to treat. Secondary objectives included time to locoregional recurrence and distant metastases, and overall and disease-specific survival. Our Analyses: intent-to-treat analysis, multivariate analyses using a Cox model with a 5% threshold from univariate analysis, and Kaplan-Meier estimates.ADT alone was administered to 130 patients and combined therapy to 133. With a median follow-up of 67 mo, 5-yr PFS was 60.9% for combined therapy versus 8.5% with ADT alone (ASTRO; p0.0001), and 64.7% versus 15.4%, respectively, for Phoenix (p0.0011). Locoregional progression was reported in 9.8% of combined-therapy patients versus 29.2% with ADT alone (p0.0001) and metastatic progression in 3.0% versus 10.8%, respectively (p0.018). Overall survival was 71.4% with combined therapy versus 71.5% with ADT alone; disease-specific survival was 93.2% versus 86.2%. Limitations included the relatively small population and a relatively short follow-up period.Combined therapy strongly favoured improved PFS, locoregional control, and metastasis-free survival. Longer follow-up is needed to assess the potential survival impact.

Among the different options recommended for locally advanced prostate cancer (LAPC), radical prostatectomy (RP) is a relatively infrequent option because its role is still controversial. The results of clinical trials combining an external radiotherapy to a long-term androgen deprivation sustain the principle of a multidisciplinary management of LAPC. Impact of surgery on the risk of progression and local recurrence is important in selected patients with low grade and small tumoral volume. Clinical and histological data associated to the MRI assessment remain essential and enhance the preoperative multidisciplinary decision. Oncological results from recent series show 10-year and 15-year specific survival rates around 85 and 75%, respectively. Moreover, approximately 20 to 30% of patients initially presented with cT3 tumours have finally an organ-confined disease on pathological examination. Morbidity of the procedure is similar to RP for organ-confined tumours despite more erectile dysfunction due to non-sparing RP in most of cases. An enlarged RP with an extended pelvic lymphadenectomy can be considered as a viable alternative to radiotherapy and hormonal therapy in patients with long life expectancy presenting cT3 tumour with a high risk of local progression and a low risk of metastatic disease. Comparative and combined treatments including RP have to be prospectively investigated in clinical trials in terms of oncological outcome and quality of life.

Resume Introduction Le priapisme veineux est une erection prolongee, douloureuse et persistante malgre l’absence de desir ou de stimulation sexuelle. Il peut s’agir d’un effet indesirable, rare mais redoutable, de certains neuroleptiques. Materiel et methodes Du premier janvier 2000 au 30 septembre 2007, quatre hommes, âges de 25 a 55 ans, soignes par des neuroleptiques (amisulpride, clozapine, levomepromazine, olanzapine, pipotiazine, risperidone ou zuclopenthixol) ont presente un ou plusieurs episodes de priapisme veineux. Aucun autre facteur etiologique n’a ete mis en evidence et tous les episodes de priapisme ont ete traites par ponction-lavage des corps caverneux et injection intracaverneuse d’une drogue alpha-stimulante completees dans un cas par une anastomose cavernospongieuse chirurgicale. Discussion La litterature medicale mentionne de nombreux cas de priapisme veineux chez des patients traites par des neuroleptiques classiques ou atypiques. Environ 30 % des priapismes veineux pourraient etre rapportes a des medicaments dont environ 50 % aux neuroleptiques. Cet effet secondaire est lie aux proprietes alpha1-adrenergiques bloquantes de ces traitements, plus ou moins importantes selon les medicaments de cette classe. Apres son traitement en urgence, ce priapisme pose le probleme de la poursuite du traitement neuroleptique. La substitution d’une molecule par une autre aux proprietes alpha1-bloquantes moins marquees est conseillee. Conclusion Le priapisme veineux est une urgence uro-andrologique. Il constitue un des effets secondaires des neuroleptiques, a ne pas meconnaitre pour eviter des sequelles erectiles. Le patient doit etre informe de cette complication eventuelle.

1. La PRL doit etre prelevee dans des conditions precises et controlee en cas d’elevation. 2. La prevalence des HPRL, et des tumeurs hypophysaires dans la population des insuffisants erectiles est faible. 3. Le dosage de la PRL est justifle si la libido est emoussee, la testosteronemie totale