49 results on '"M, Audouin"'
Search Results
2. Évaluation des résultats opératoires et des coûts liés à la mise en place d’une activité d’urétéroscopie souple au sein d’un centre hospitalo-universitaire
- Author
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Olivier Traxer, Vincent Ravery, K. del Santo, I. Ouzaid, and M. Audouin
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Urology ,030232 urology & nephrology ,Medicine ,business ,Humanities - Abstract
Resume Introduction L’usage croissant de l’ureteroscopie souple (URSS) expose aux problemes de couts inevitablement associes a la fragilite de ces endoscopes. Le but de ce travail est de degager a partir d’un exemple recent les resultats et couts lors de la mise en place de cette technique. Materiel et methodes Il s’agit d’une etude retrospective menee de decembre 2012 (date de mise en place de l’activite) a mars 2015 concernant les URSS realisees dans un CHU francais pour pathologie lithiasique. Dans cette analyse, le cout des consommables n’etait pas evalue, ni les frais de fonctionnement du bloc operatoire ou d’hospitalisation. Resultats Cent quarante et une URSS sur cent treize patients ont ete realisees par sept chirurgiens. Dix-sept casses et pannes ont ete repertoriees et ont mene a l’envoi de l’endoscope en reparation. Le taux de casses et pannes etait de 12 %. L’ensemble des pannes ont ete traitees par un echange standard de l’appareil (dont 4 echanges standards pris sous garantie). Le cout moyen estime des pannes etait de 3600 euros. Cela represente donc un cout moyen par procedure d’environ 625 euros (acquisition plus cout des pannes) sans compter les couts lies a la sterilisation ou a la desinfection de haut niveau. L’impossibilite de relocaliser les calculs du calice inferieur est associee a un sur-risque de casse ( odd ratio : 2,92 IC95 : [1,02 ; 8,37]). Conclusion Cette etude est originale car elle s’interesse au cout de mise en place d’une technique dans un centre hospitalo-universitaire francais. L’usage d’ureteroscope souple a usages uniques pourrait etre une source interessante d’economies lors de la mise en place de cette technique. Ceci reste cependant a evaluer. Niveau de preuve 5.
- Published
- 2017
3. Électroporation irréversible du cancer de la prostate localisé : résultats oncologiques et fonctionnels
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M. Audouin, O. Cussenot, and D. Grinholtz
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Gynecology ,medicine.medical_specialty ,business.industry ,Urology ,Medicine ,business - Abstract
Objectifs Les therapies focales sont des techniques recentes permettant de traiter le cancer de la prostate (CaP) localise de risque faible et intermediaire tout en limitant les effets secondaires. L’electroporation irreversible (IRE) est une technique basee sur la destruction cellulaire par application d’un courant de haut voltage et faible intensite sans variation thermique. Nous presentons ici les resultats oncologiques et fonctionnels d’une serie de patients ayant ete traite par d’IRE. Methodes Des hommes presentant un CaP localise ≤ Gleason 7 (3 + 4), ≤ 20 mm, avec un PSA ≤ 20 ng/mL et naifs de tout traitement ont ete traites par IRE. Une ou deux cibles etaient reperees a l’IRM. Des electrodes etaient introduites par voie transperineale sous echo guidage afin d’appliquer des impulsions electriques. Une IRM etait realisee 6 a 9 mois apres l’intervention puis annuellement en cas de normalite. En cas de suspicion de recidive, des biopsies ciblees etaient realisees. Le suivi fonctionnel etait base sur les scores IPSS, QoL et IIEF. Resultats Entre mai 2015 et janvier 2019, 63 patients ont ete traites. Le suivi median etait de 19,6 mois. Dix-huit (28,6 %) ont recidive avec un delai median de 15,1 mois. Treize (20,6 %) patients ont necessite un traitement de rattrapage. Aucune evolution metastatique et aucun deces n’ont ete constates. Les scores IPSS et QoL etaient ameliores respectivement de −2,74 et −0,79 points (p Conclusion L’IRE apparait comme une therapie efficace, intermediaire entre la surveillance active et les traitements radicaux, avec un retentissement fonctionnel modere. En cas de recidive, toutes les therapies habituelles sont realisables en tant que traitement de rattrapage. Elle peut s’inscrire dans le cadre d’une surveillance active amelioree, dite « super surveillance active ». Des essais randomises devraient apporter prochainement un niveau de preuve suffisant afin d’inclure cette technique encore experimentale dans l’arsenal therapeutique du CaP localise.
- Published
- 2020
4. [Correlation of genetic and cytogenetic alterations in pathological aggressiveness urothelial carcinoma of the bladder: Performance of BCA-1, a mini-array comparative genomic hybridisation-based test]
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P, Léon, G, Cancel Tassin, K, Sighar, E, Compérat, C, Gaffory, V, Ondet, S, Hugonin, M, Audouin, S, Doizi, O, Traxer, C, Ciofu, M, Rouprêt, R, Lacave, and O, Cussenot
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Adult ,Aged, 80 and over ,Chromosome Aberrations ,Male ,Morpholines ,Carcinoma ,Nucleic Acid Hybridization ,DNA ,Genomics ,Middle Aged ,Ethylenediamines ,Prognosis ,Sensitivity and Specificity ,Urinary Bladder Neoplasms ,Predictive Value of Tests ,Risk Factors ,Biomarkers, Tumor ,Humans ,Female ,Neoplasm Invasiveness ,Prospective Studies ,Urothelium ,Aged ,Neoplasm Staging - Abstract
Urothelial carcinomas are the fourth leading cause of cancer in humans. Their incidence is increasing by more than 50% in 25 years. The superficial forms (70% cases) require a close active surveillance to identify frequent recurrences and progression to invasive stage. Our main goal was to identify prognostic molecular markers for bladder cancer that could be used alone or in combination in routine clinical practice. In this aim, we evaluated the capability of the BCA-oligo test based on a CGH array to correctly classify tumoral grade/stage.Urinary DNA was extracted from 81 patients with superficial bladder cancer and has been hybridized on the BCA-oligo array. The results from the molecular analysis were correlated with the tumoral grade and stage.Several chromosomal alterations were significantly more frequent in tumors of higher grade and more advanced stage. A significant association was observed between a high grade and the presence of one of these alterations: loss on 6p, gain on 8q or 13q, loss or gain on 9q or 11q, with an odds ratio of 6.91 (95% CI=2.20-21.64; P=0.0009). Moreover, a significant association was found between a more advanced stage (pT1) and the presence of one of these alterations: loss on 6p, gain on 8q, loss or gain on 5p, with an odds ratio of 15.2 (95% CI=3.71-62.58; P=0.0002).Our results showed that molecular analyses of superficial bladder cancers based on urinary DNA and the BCA-oligo test could be used as prognostic factor for the tumor evolution, allowing then a more adapted clinical management.
- Published
- 2017
5. Uretra femenina normal y patológica
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M. Audouin and P. Sèbe
- Abstract
Aunque la uretra es facilmente accesible a la exploracion fisica, sus afecciones son infrecuentes y, por tanto, a menudo no se diagnostican. Desde el punto de vista anatomico, se trata de un conducto musculomembranoso donde desembocan las glandulas parauretrales. En cuanto a su embriologia, se relaciona con la del resto del aparato urogenital. La resonancia magnetica (RM) pelvica, la fibroendoscopia uretrovesical y la uretrocistografia son las exploraciones complementarias que permiten estudiar la morfologia uretral. La mayoria de las malformaciones forman parte de un cuadro polimalformativo. El tratamiento del diverticulo uretral es quirurgico. Las enfermedades infecciosas uretrales rara vez son aisladas. En cambio, pueden afectar de forma especifica a las glandulas parauretrales. Los traumatismos de la uretra son esencialmente iatrogenicos y obstetricos.
- Published
- 2014
6. [Evaluation of the operating results and costs associated with the implementation of a flexible ureteroscopy activity within a university hospital center]
- Author
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K, Del Santo, M, Audouin, I, Ouzaid, V, Ravery, and O, Traxer
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Adult ,Hospitals, University ,Treatment Outcome ,Costs and Cost Analysis ,Ureteroscopes ,Ureteroscopy ,Humans ,Child ,Retrospective Studies - Abstract
The increasing use of flexible ureteroscopy (USSR) sets the cost problems inevitably associated with the fragility of these endoscopes. The aim of this work is to clear from a recent example (universitary hospital) results, costs during the implementation of this technique.This is a retrospective study conducted from December 2012 (date of introduction of the activity) in March 2015 concerning the USSR made in a French universitary hospital for stone disease. In this analysis, the cost of consumables was not evaluated, nor the costs of the operating theater or hospitalization.One hundred forty-one hundred and thirteen patients USSR were conducted by seven surgeons. Seventeen breakages and failures have been identified and have led to the sending of the endoscope for repair. Breakage rate and failure was 12%. All failures were treated with a standard exchange of the device (including 4 standard exchanges made under warranty). The estimated average cost of outages was 3600 euros. This represents an average cost per procedure of about 625 euros (acquisition plus cost of failures) without counting the costs of sterilization or high-level disinfection. The impossibility of relocating the lower calyx stones is associated with an excess risk of breakage (odd ratio: 2.92 CI95: [1.02; 8.37]).This study is novel because it focuses on the cost of implementing a technique in a French university hospital. The use of flexible ureteroscope to unique uses might be an interesting source of savings in the implementation of this technique. This remains to be evaluated.5.
- Published
- 2016
7. [Not Available]
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V, Frydman, J, Cornu, S, Benbouzid, M, Audouin, J, Terrasa, L, Peyrat, C, Ciofu, and F, Haab
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- 2015
8. [Not Available]
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M, Najdawi, S, Benbouzid, M, Audouin, J, Terrasa, L, Peyrat, C, Ciofu, F, Haab, and J, Cornu
- Published
- 2015
9. [Evaluation of postoperative symptoms after Greenlight™ photovaporization of the prostate through a dedicated questionnaire]
- Author
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M, Audouin, S, Benbouzid, J B, Terrasa, S, Proietti, O, Cussenot, B, Lukacs, and J N, Cornu
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Male ,Prostatectomy ,Early Diagnosis ,Postoperative Complications ,Surveys and Questionnaires ,Humans ,Laser Therapy ,Aged ,Retrospective Studies - Abstract
To evaluate postoperative symptoms after Greenlight™ photovaporisation of the prostate (PVP), through a dedicated questionnaire.A retrospective study has been conducted between 2008 and 2014. The questionnaire had 5 sections about pain while voiding, hematuria, urgency, incontinence and urinary stream, and was filled at one-month postoperative. The main outcome criterion was pain while voiding. Descriptive statistical analyses were done to identify predictive factors for pain while voiding.Out of 169 patients, 22% had no pain while voiding, 37% had moderate pain, 30% acceptable pain and 11% intense pain. Patients with pain were significantly older, (P=0.012), had more urgency (P=0.01) and more often hematuria (P=0.0001). Only 7% of patients had no symptoms of urgency, and urgency was painful or bothering in 57% of cases. Hematuria was frequent, with clots in 21% of cases. Ninety three percent felt improvement of urinary stream.Systematic evaluation of symptoms through a dedicated questionnaire one month after PVP has shown that 41% of patients felt pain while voiding, 57% had urgency and 39% significant hematuria. These results should encourage a more accurate patient information and further studies to better understand postoperative healing after PVP.
- Published
- 2015
10. [Erectile dysfunction after radical prostatectomy: pathophysiology, evaluation and treatment]
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M, Audouin, S, Beley, F, Cour, C, Vaessen, E, Chartier-Kastler, M-O, Bitker, F, Richard, and M, Rouprêt
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Male ,Prostatectomy ,Erectile Dysfunction ,Surveys and Questionnaires ,Humans - Abstract
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 1year. 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 60years 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.
- Published
- 2009
11. [Primary upper urinary tract tumors and subsequent location in the bladder]
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M-D, Azémar, M, Audouin, A, Revaux, V, Misraï, E, Comperat, M-O, Bitker, E, Chartier-Kastler, F, Richard, O, Cussenot, and M, Rouprêt
- Subjects
Carcinoma, Transitional Cell ,Urinary Bladder Neoplasms ,Risk Factors ,Ureteral Neoplasms ,Humans ,Neoplasms, Second Primary ,Kidney Neoplasms - Abstract
The urothelium is the epithelium that lines the upper and lower urinary tract. Over 95% of urothelial carcinomas are derived from urothelium. They can be located in the lower tract (bladder, urethra) or upper tract (pyelocaliceal cavities, ureter). Urothelial carcinomas are the fourth most common tumours after prostate (or breast) cancer, lung cancer and colorectal cancer. On one hand, bladder tumours account for 90-95% of urothelial carcinomas. It is the most common malignancy of the urinary tract and the second most common malignancy of the urogenital tract after prostate cancer. It accounts for 5-10% of all cancers diagnosed each year in Europe. On the other hand, upper urinary tract urothelial cell carcinomas (UUT-UCC) are scarce and account for only 5-10% of urothelial carcinomas. Recurrence in the bladder after primary UUT-UCC occurs in 15-50% of UUT-UCC. Differences in treatment modalities of the primary UUT-UCC do not play a key role in the subsequent appearance of a bladder recurrence. However, others factors have been described such as stage and location in the upper tract of the primary tumour or upper tract tumour multifocality. Previous history of bladder tumour is also associated with the risk that another tumour arises in the bladder subsequently. However, it becomes difficult to distinguish between natural history of bladder tumour and evolution of UUT-UCC in these cases. In most cases, bladder cancer occurs in the first two years after UUT-UCC management. Surveillance protocol is based on cystoscopy and on urinary cytology during at least every three months for two years. Current surveillance regimen have a low level of evidence considering the paucity of UUT-UCC.
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- 2009
12. Enceinte de radioprotection en fer construite avec des rails comme matériau de base
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P. Bonét-Maury and M. Audouin
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Nuclear Energy and Engineering ,Renewable Energy, Sustainability and the Environment ,Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,Safety, Risk, Reliability and Quality ,Waste Management and Disposal - Abstract
Les auteurs proposent l'utilisation de rails usages pour construire des enceintes de radioprotection en fer, autour des sources importantes de rayonnements ionisants. Ils decrivent la facon dont, avec ces rails, ils ont realise, pour un betatron de 20 MeV, une protection biologique qui s’est montre satisfaisante du point de vue technique et economique.
- Published
- 1971
13. ChemInform Abstract: Stereochemistry. Part 61. Fluorinated Steroids. Part 12. Spinal Rearrangement of 17β-Hydroxy-9,11α-epoxy-4-androstene-3-one
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M. Audouin and J. Levisalles
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Chemistry ,Stereochemistry ,visual_art ,visual_art.visual_art_medium ,Organic chemistry ,General Medicine ,Epoxy ,Fluorinated steroids - Published
- 1986
14. Associations of Postural Activities and Knowledge for Voice with Breathing Issues and Voice-Physical-Disorders Among Lyric Singers.
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Somme L, Audouin M, Chau N, Beyaert C, and Perrin P
- Abstract
Objectives/hypothesis: The purpose of this research was to study the associations of postural activities and knowledge of the voice of opera singers, recognized in the literature for the specificity of their posture. Additionally, the link between vocal pathologies and body pains on one hand, and posture control on the other hand was investigated., Methods: A questionnaire including 90 questions was distributed to singers in France and overseas during 6 months. Ninety-eight opera singers participated in the survey. Data were analyzed using Excel and Stata software., Results: The results showed that the singers who paid more attention to posture, postural work while singing, had knowledge of anatomy and postural role in singing voice, healthy lifestyle, and good body habits, had less vocal discomfort and pathologies, a better vocal preservation, and used more costo-abdominal breathing. On the other hand, knowledge of postural role and postural work was linked with pain and vocal fatigue. Furthermore, a preventive need was revealed concerning the providing of knowledge and skills to singers, but also to singing teachers, speech therapists, and stage workers., Conclusion: Our study shows that benefits were found in the voice quality of opera singers with anatomical and postural knowledge and who work on posture as part of their vocal work compared to others. Postural work and knowledge increase attention to body pain and vocal fatigue. These results can inform health care providers, opera singers, and their teachers and performers of the benefits of posture on operatic voice quality. Accordingly, this study sparks new ideas for postural work and therapy in lyric voice., Competing Interests: Declaration of Competing Interest The research was conducted without funding. None of the authors reported any conflict of interest in connection with this article., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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15. Valorization of Vegetal Fibers (Hemp, Flax, Miscanthus and Bamboo) in a Fiber Reinforced Screed (FRS) Formulation.
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Pons Ribera S, Hamzaoui R, Colin J, Bessette L, and Audouin M
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A persistent rise in the costs of construction materials has led to the need to address this problem in line with the Sustainable Development Goals. This research employed vegetal soft and rigid fibers in a screed mortar to produce a sustainable fabric-cement matrix. Four different vegetal-dried fibers (hemp, flax, miscanthus, and bamboo) with dosages of 0.4, 0.6, 0.8, 1.2, 2, and 4 kg/m
3 were used. Laboratory investigations were slump test, bulk density, air occluded, shrinkage, and mechanical strength. Scanning Electron Microscope (SEM) assessments were performed and analyzed on the natural fibers and the screed formulation. The results highlight that fiber dosages significantly influence the above-mentioned properties.- Published
- 2023
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16. Testicular sperm extraction (TESE) outcomes in the context of malignant disease: a systematic review.
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Ogouma L, Berthaut I, Lévy R, Hamid RH, Prades M, Audouin M, Sermondade N, and Dupont C
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- Child, Humans, Male, Quality of Life, Spermatozoa, Testis, Syndrome, Sperm Retrieval, Retrospective Studies, Azoospermia etiology, Azoospermia therapy, Testicular Neoplasms therapy
- Abstract
Advances in the oncology field have led to improved survival rates. Consequently, quality of life after remission is anticipated, which includes the possibility to conceive children. Since cancer treatments are potentially gonadotoxic, fertility preservation must be proposed. Male fertility preservation is mainly based on ejaculated sperm cryopreservation. When this is not possible, testicular sperm extraction (TESE) may be planned. To identify situations in which TESE has been beneficial, a systematic review was conducted. The search was carried out on the PubMed, Scopus, Google Scholar, and CISMeF databases from 1 January 2000 to 19 March 2020. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed in selecting items of interest. Thirty-four articles were included in the systematic review, including 15 articles on oncological testicular sperm extraction (oncoTESE), 18 articles on postgonadotoxic treatment TESE and 1 article on both oncoTESE and postgonadotoxic treatment TESE. Testicular sperm freezing was possible for 42.9% to 57.7% of patients before gonadotoxic treatment and for 32.4% to 75.5% of patients after gonadotoxic treatment, depending on the type of malignant disease. Although no formal conclusion could be drawn about the chances to obtain sperm in specific situations, our results suggest that TESE can be proposed before and after gonadotoxic treatment. Before treatment, TESE is more often proposed for men with testicular cancer presenting with azoospermia since TESE can be performed simultaneously with tumor removal or orchiectomy. After chemotherapy, TESE may be planned if the patient presents with persistent azoospermia., Competing Interests: None
- Published
- 2022
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17. Postural Control in Lyric Singers.
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Peultier-Celli L, Audouin M, Beyaert C, and Perrin P
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- Disability Evaluation, Humans, Postural Balance, Surveys and Questionnaires, Voice Quality, Singing, Voice Disorders
- Abstract
Background: Singers are unique musicians because they use their whole body as a musical instrument. Posture and proprioception are key components for a robust and healthy voice., Objective: This study aimed to analyze the postural control of lyric singers in different sensorimotor conditions., Methods: Seventeen lyric singers were compared to a control group of 12 participants in static postural control test in eyes open (C1) and eyes closed (C2) conditions. Postural control of singers was also assessed in four specific singing conditions: singing posture eyes open (C3) and eyes closed (C4), vocalization (C5) and free aria (C6), low values being representative of good postural control. Singers also completed the Singing Voice Handicap Index (SVHI) French version, low scores reflecting a good SVHI result., Results: No significant difference was observed between the two groups in C1 and C2. Postural control of singers was more accurate in C3 than in C1. Increased values in all postural parameters were seen in the singing conditions. Scores obtained at the SVHI were correlated to the area covered by the center of foot pressure in C5, low scores at the SVHI being correlated with low area values in this postural condition., Conclusions: Singing is a multitask situation which involves several movements including breathing, and management of factors such as stress. This can affect balance and so rigorous work on posture and proprioception is required as soon as a singer begins to perform in order to take care of the voice., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2022
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18. Long-term outcomes after penile prosthesis placement for the Management of Erectile Dysfunction: a single-Centre experience.
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Frydman V, Pinar U, Abdessater M, Akakpo W, Grande P, Audouin M, Mozer P, Chartier-Kastler E, Seisen T, and Roupret M
- Abstract
Background: Penile prothesis (PP) is the gold-standard treatment of drug-refractory erectile dysfunction (ED). While postoperative outcomes have been widely described in the literature, there are few data about patient satisfaction and intraoperative events. We aimed to assess long-term patient satisfaction and perioperative outcomes after PP implantation in a single-centre cohort of unselected patients using validated scales., Results: A total of 130 patients received a PP (median age: 62.5 years [IQR: 58-69]; median International Index of Erectile Function (IEEF-5) score: 6 [IQR: 5-7]). Median follow-up was 6.3 years [IQR: 4-9.4]. Thirty-two (24.6%) patients underwent surgical revision, of which 20 were PP removals (15.4%). Global PP survival rate was 84.6% and previous PP placement was a risk factor for PP removal (p = 0.02). There were six (4.6%) non-life-threatening intraoperative events including two which resulted in non-placement of a PP (1.5%). EAUiaic grade was 0 for 124 procedures (95.4%), 1 for four procedures (3.1%) and 2 for two procedures (1.5%). Of patients who still had their PP at the end of the study, 91 (80.5%) expressed satisfaction., Conclusions: PP implantation is a last-resort treatment for ED with a satisfactory outcome. PPs are well accepted by patients.
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- 2021
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19. Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer.
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Lenfant L, Leon P, Cancel-Tassin G, Audouin M, Staerman F, Rouprêt M, and Cussenot O
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- Humans, Male, Testosterone therapeutic use, Hormone Replacement Therapy adverse effects, Prostatic Neoplasms chemically induced, Testosterone adverse effects
- Abstract
Often contraindicated because of the theoretical risk of progression based on the dogma of hormone dependent prostate cancer (CaP), testosterone replacement therapy (TRT) is increasingly discussed and proposed for hypogonadal patients with localized CaP. To perform a systematic literature review to determine the relationship between TRT and the risk of CaP with a focus on the impact of TRT in the setting of previous or active localized CaP. As of October 15, 2019, systematic review was performed via Medline Embase and Cochrane databases in accordance with the PRISMA guidelines. All full text articles in English published from January 1994 to February 2018 were included. Articles were considered if they reported about the relationship between total testosterone or bioavailable testosterone and CaP. Emphasis was given to prospective studies, series with observational data and randomized controlled trials. Articles about the safety of the testosterone therapy were categorized by type of CaP management (active surveillance or curative treatment by radical prostatectomy, external radiotherapy or brachytherapy). Until more definitive data becomes available, clinicians wishing to treat their hypogonadal patients with localized CaP with TRT should inform them of the lack of evidence regarding the safety of long-term treatment for the risk of CaP progression. However, in patients without known CaP, the evidence seems sufficient to think that androgen therapy does not increase the risk of subsequent discovery of CaP., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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20. The eye of the endourologist: what are the risks? A review of the literature.
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Doizi S, Audouin M, Villa L, Rodríguez-Monsalve Herrero M, De Coninck V, Keller EX, and Traxer O
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- Eye Injuries epidemiology, Humans, Occupational Injuries epidemiology, Risk Assessment, Endoscopy, Eye Diseases etiology, Eye Injuries etiology, Occupational Diseases etiology, Occupational Exposure adverse effects, Occupational Injuries etiology, Urology
- Abstract
Purpose: During endourological procedures, the eye of the urologist is exposed to hazards such as contact with body fluids and irrigation solutions as well as laser injury, and X-ray radiation absorption. The resulting potential injuries and damages to the eye have not been summarily reviewed to date. The objective was to review the different risks of exposure to the eyes of urologists during endourological procedures., Methods: The Medline database was searched for identification of studies on hazards to the eye of the endourologist. All articles published in English until September 2018 were considered., Results: Twenty-three publications were included in this analysis. The incidence of eye contact with patient body fluids or irrigation solutions during endoscopic procedures ranged between 37.50 and 100%. Laser-induced eye injuries were reported in 37.9% of all kind of adverse events related to laser use in urology. The eye lens dose of radiation ranged from 0.04 to 1600 µSv per endourological procedures., Conclusions: While the risks of infection, laser injury, lens opacity and cataract are generally low, the wear of protective glasses is recommended. Lead glasses may protect against all these risks in case of Ho:YAG laser use with concomitant X-ray radiation. If Ho:YAG laser is used without any concomitant X-ray radiation, proper laser safety glasses or at least conventional eyeglasses should be recommended. When other types of laser are used, we recommend wearing laser eye protection glasses covering the adequate range of wavelength. For endourological procedures without laser use and X-ray radiation, specific protection devices such as goggles or face shields are recommended.
- Published
- 2019
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21. Stone composition independently predicts stone size in 18,029 spontaneously passed stones.
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Keller EX, De Coninck V, Audouin M, Doizi S, Daudon M, and Traxer O
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- Adult, Aged, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Remission, Spontaneous, Kidney Calculi chemistry, Kidney Calculi pathology, Ureteral Calculi chemistry, Ureteral Calculi pathology
- Abstract
Purpose: To evaluate whether the size of spontaneously passed stones (SPS) may be associated with clinical parameters., Methods: A search for SPS was conducted in our electronic stone database, comprising data on stones analyzed over the last 33 years at our institution. Adults with upper urinary tract stones were included. Cases with stenotic urinary tract disease or past history of anastomotic urinary tract surgery were excluded. Stone size expressed as maximal stone diameter (MSD) and stone volume (SV) was compared between groups by one-way ANOVA. Logistic regression analyses were performed to identify predictors of MSD ≥ 6 mm., Results: Overall mean MSD and SV for 18,029 SPS was 4.1 mm and 11.5 mm
3 , respectively, and significantly differed between stone composition groups (p < 0.001). The lowest mean MSD and SV were found for calcium oxalate monohydrate (3.6 mm and 9.0 mm3 , respectively) and the highest mean MSD and SV were found for struvite (7.9 mm and 61.0 mm3 , respectively). Stone composition and increasing age were found to be independent predictors of MSD ≥ 6 mm (both p < 0.001). Sex differentiation did not contribute as a predictor of MSD ≥ 6 mm., Conclusions: Stone composition and-to a lesser extent-age serve as independent predictors of size of spontaneously passed stones. Of particular importance, large spontaneously passed stones of ≥ 6 mm may be frequently found in cystine, brushite or struvite stone formers, whereas a minority of all calcium oxalate stones exceed that cutoff. Future studies shall evaluate these parameters as possible predictors of spontaneous stone passage.- Published
- 2019
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22. Markers of graft microvascular endothelial injury may identify harmful donor-specific anti-HLA antibodies and predict kidney allograft loss.
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Louis K, Hertig A, Taupin JL, Buob D, Jamme M, Brocheriou I, Luque Y, Jouanneau C, Ouali N, Audouin M, Rondeau E, and Xu-Dubois YC
- Subjects
- Adult, Aged, Allografts immunology, Antilymphocyte Serum immunology, Biomarkers metabolism, Biopsy, Carrier Proteins, Complement C4b immunology, Endothelium, Vascular immunology, Female, Follow-Up Studies, HLA Antigens immunology, HSP47 Heat-Shock Proteins, Histocompatibility Testing, Humans, Kidney immunology, Male, Microfilament Proteins, Middle Aged, Peptide Fragments immunology, Reoperation statistics & numerical data, Retrospective Studies, Tissue Donors, Vimentin, Antibodies chemistry, Graft Rejection immunology, Kidney blood supply, Kidney Transplantation, Microcirculation, Renal Insufficiency surgery
- Abstract
Graft microvasculature is a major target of donor-specific antibodies (DSA) and endothelial damage is direct evidence of antibody-mediated rejection (ABMR). Using immunohistochemistry, we analyzed the expression of three microvascular endothelial activation markers (fascin, vimentin, and hsp47), suggestive of endothelial-to-mesenchymal transition (EndMT) in 351 graft biopsies from 248 kidney recipients, with concomitant screening of circulating antihuman leukocyte antigen (HLA) DSA at the time of the biopsy. The factors associated with EndMT marker expression were DSA and the presence of microvascular inflammation (MI). EndMT expressing grafts had significantly more allograft loss compared to EndMT negative grafts (P < .0001). The expression of EndMT markers positively correlated with anti-HLA DSA class II mean fluorescence intensity (MFI) levels and especially identified DQ and DR antibodies as being more closely associated with microvascular injury. Moreover, only DSA linked to positive EndMT score affected allograft survival, regardless of DSA MFI levels or presence of C4d deposition. Thus, EndMT markers could represent a clinically relevant tool for early identification of ongoing endothelial injury, harmful DSA, and patients at high risk for allograft failure., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2019
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23. Fragments and dust after Holmium laser lithotripsy with or without "Moses technology": How are they different?
- Author
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Keller EX, de Coninck V, Audouin M, Doizi S, Bazin D, Daudon M, and Traxer O
- Subjects
- Adult, Aged, Child, Female, Humans, Male, Middle Aged, Dust, Lasers, Solid-State, Lithotripsy, Laser instrumentation, Urinary Calculi surgery
- Abstract
Urinary stones can be readily disintegrated by Holmium:YAG laser (Holmium laser lithotripsy), resulting in a mixture of small stone dust particles, which will spontaneously evacuate with urine and larger residual fragments (RF) requiring mechanical retrieval. Differences between fragments and dust have not been well characterized. Also, it remains unknown how the recently introduced "Moses technology" may alter stone disintegration products. Three complementary analytical techniques have been used in this study to offer an in-depth characterization of disintegration products after in vitro Holmium laser lithotripsy: stereoscopic microscopy, scanning electron microscopy and Fourier-transform infrared spectroscopy. Dust was separated from fragments based on its floating ability in saline irrigation. Depending on initial crystalline constituents, stone dust either conserved attributes found in larger RFs or showed changes in crystalline organization. These included conversion of calcium oxalate dihydrate towards calcium oxalate monohydrate, changes in carbapatite spectra towards an amorphous phase, changes of magnesium ammonium phosphate towards a differing amorphous and crystalline phase and the appearance of hydroxyapatite on brushite fragments. Comparatively, "Moses technology" produced more pronounced changes. These findings provide new insights suggesting a photothermal effect occurring in Holmium laser lithotripsy. Figure: Appearance of hydroxyapatite hexagons on stone dust collected after Holmium laser lithotripsy of a brushite stone using "Moses technology.", (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)
- Published
- 2019
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24. Systematic review of ureteral access sheaths: facts and myths.
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De Coninck V, Keller EX, Rodríguez-Monsalve M, Audouin M, Doizi S, and Traxer O
- Subjects
- Equipment Design, Humans, Practice Guidelines as Topic, Ureteroscopy methods, Dilatation instrumentation, Kidney Calculi pathology, Ureteroscopy instrumentation
- Abstract
The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used., (© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)
- Published
- 2018
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25. Comparison of cell cycle progression score with two immunohistochemical markers (PTEN and Ki-67) for predicting outcome in prostate cancer after radical prostatectomy.
- Author
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Léon P, Cancel-Tassin G, Drouin S, Audouin M, Varinot J, Comperat E, Cathelineau X, Rozet F, Vaessens C, Stone S, Reid J, Sangale Z, Korman P, Rouprêt M, Fromond-Hankard G, and Cussenot O
- Subjects
- Aged, Humans, Male, Middle Aged, Neoplasm Grading, Prostate-Specific Antigen, Retrospective Studies, Treatment Outcome, Cell Cycle physiology, Ki-67 Antigen analysis, Neoplasm Recurrence, Local chemistry, PTEN Phosphohydrolase analysis, Prostatectomy, Prostatic Neoplasms chemistry, Prostatic Neoplasms surgery
- Abstract
Purpose: Previous studies of the cell cycle progression (CCP) score in surgical specimens of prostate cancer (PCa) in patients treated by radical prostatectomy (RP) demonstrated significant association with time to biochemical recurrence (BCR). In this study, we compared the ability of the CCP score and the expression of PTEN or Ki-67 to predict BCR in a cohort of patients treated by RP. Finally, we constructed the best predictive model for BCR, incorporating biomarkers and relevant clinical variables., Materials and Methods: The study population consisted of 652 PCa patients enrolled in a retrospective cohort and who had RP surgery in French urological centers from 2000 to 2007., Results: Among the 652 patients with CCP scores and complete clinical data, BCR events occurred in 41%, and the median time from surgery to the last follow-up among BCR-free patients was 72 months. In univariate Cox analysis, the continuous CCP score and positive Ki-67 predicted recurrence with a HR of 1.44 (95% CI 1.17-1.75; p = 5.3 × 10
-4 ) and 1.89 (95% CI 1.38-2.57; p = 1.6 × 10-4 ), respectively. In contrast, PTEN expression was not associated with BCR risk. Of the three biomarkers, only the CCP score remained significantly associated in a multivariable Cox model (p = 0.026). The best model incorporated CAPRA-S and CCP scores as predictors, with HRs of 1.32 and 1.24, respectively., Conclusion: The CCP score was superior to the two IHC markers (PTEN and Ki-67) for predicting outcome in PCa after RP.- Published
- 2018
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26. Evaluation of a Portable Urinary pH Meter and Reagent Strips.
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De Coninck V, Keller EX, Rodríguez-Monsalve M, Doizi S, Audouin M, Haymann JP, and Traxer O
- Subjects
- Humans, Urinary Tract, Hydrogen-Ion Concentration, Monitoring, Physiologic instrumentation, Point-of-Care Systems, Reagent Strips, Urinalysis instrumentation
- Abstract
Objective: To evaluate a portable electronic pH meter and to put its accuracy in perspective with reagent strips read by a layperson, a healthcare professional, and an electronic reading device., Materials and Methods: Based on a preanalysis on 20 patients, a sample size of 77 urine aliquots from healthy volunteers was necessary to obtain sufficient study power. Measurements of urinary pH were obtained by use of reagent strips, a portable pH meter and a laboratory pH meter (gold standard). Reagents strips were read by a professional experienced in interpreting strips, a layperson, and an electronic strip reader. The mean matched pair difference between measurement methods was analyzed by the paired t-test. The degree of correlation and agreement were evaluated by the Pearson's correlation coefficient and Bland-Altman plots, respectively., Results: The mean matched pair difference between the gold standard and all other pH measurement methods was the smallest with the portable electronic pH meter (bias 0.01, 95% confidence interval [CI] -0.07 to 0.08; p = 0.89), followed by strips read by a professional (bias -0.09, 95% CI -0.21 to 0.02; p = 0.10), layperson (bias -0.17, 95% CI -0.31 to -0.04; p = 0.015), and electronic strip reader (bias -0.29, 95% CI -0.41 to -0.16; p < 0.001). The portable electronic pH meter achieved the highest Pearson's correlation coefficient and narrowest 95% limits of agreement, followed by strip interpretation by a professional, electronic strip reader, and layperson. To quantify the ability of pH measurement methods to correctly classify values within a predefined urinary pH target range, we performed classification tests for several stones. The portable electronic pH meter outperformed all other measurement methods for negative predictive values., Conclusions: Findings of this study support that the portable electronic pH meter is a reliable pH measuring device. It appears to be more accurate compared to reagent strips readings.
- Published
- 2018
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27. Typology of intravesical prostatic protrusions, or so-called median lobes, in middle-aged and older men.
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Audouin M, Girshovich A, Cussenot O, and Renard-Penna R
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Anatomic Variation, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Organ Size, Prostate diagnostic imaging, Prostate anatomy & histology
- Abstract
Purpose: Changes related to prostatic ageing include an increase of prostate volume and morphologic distortions of the prostatic edges in middle-aged and older men. These changes of the prostate exhibit a certain level of heterogeneity, which is clinically obvious for surgeons, radiologists, and anatomists, and which can be explained by the complex nature of the embryologic/anatomic development of the prostate. While the etiology of the median lobe has typically been attributed to a growth and protrusion of the prostatic area at the top of the utricle, we argue that this is not necessarily the case as intravesical protrusions of the prostate have also been observed laterally and anteriorly to the bladder neck, suggesting the involvement of other prostatic zones, thereby highlighting the need to refine the concept of the median lobe., Material: The current study examined a large series of 478 prostate magnetic resonance imaging scans (MRIs). Intravesical prostatic protrusions were classified, based on their topography: anterior (A), posterolateral (P), and dual (D). Data were analyzed using MedCalc
® 11.6.1.1.0 software. Pearson's correlations with coefficients (r) and P values were calculated for the patient's age, prostate volume, and IVPP size., Results: An intravesical prostatic protrusion was observed in 27% of cases, with type A occurring in 18% (3% isolated), type P in 96% (81% isolated), and type D in 15%., Conclusion: The new insights regarding the variability in prostate anatomy will contribute to the improved management of prostate hypertrophy by radiologists and surgeons.- Published
- 2018
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28. Pelvi-ureteric junction obstruction related to crossing vessels: vascular anatomic variations and implication for surgical approaches.
- Author
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Panthier F, Lareyre F, Audouin M, and Raffort J
- Subjects
- Humans, Kidney Pelvis anatomy & histology, Ureter anatomy & histology, Ureteral Obstruction etiology, Vascular Malformations complications, Vascular Malformations surgery, Anatomic Variation, Kidney Pelvis surgery, Renal Artery anatomy & histology, Ureter surgery, Ureteral Obstruction surgery
- Abstract
Pelvi-ureteric junction obstruction corresponds to an impairment of urinary transport that can lead to renal dysfunction if not treated. Several mechanisms can cause the obstruction of the ureter including intrinsic factors or extrinsic factors such as the presence of crossing vessels. The treatment of the disease relies on surgical approaches, pyeloplasty being the standard reference. The technique consists in removing the pathologic ureteric segment and renal pelvis and transposing associated crossing vessels if present. The vascular anatomy of the pelvi-ureteric junction is complex and varies among individuals, and this can impact on the disease development and its surgical treatment. In this review, we summarize current knowledge on vascular anatomic variations in the pelvi-ureteric junction. Based on anatomic characteristics, we discuss implications for surgical approaches during pyeloplasty and vessel transposition.
- Published
- 2018
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29. The True Ablation Effect of Holmium YAG Laser on Soft Tissue.
- Author
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Emiliani E, Talso M, Haddad M, Pouliquen C, Derman J, Côté JF, Doizi S, Millán F, Berthe L, Audouin M, and Traxer O
- Subjects
- Animals, Cattle, Holmium, Models, Animal, Kidney surgery, Laser Therapy methods, Lasers, Solid-State therapeutic use
- Abstract
Purpose: The holmium YAG (Ho:YAG) laser penetration depth (PD) of 0.4 mm has been widely described. Nonetheless, in physics, this concept refers to the tissue thickness at which 90% of the energy has been absorbed and not to the incision depth (ID) that the laser can achieve in tissue. The aim of this study is to evaluate the ablation efficiency of Ho:YAG laser on soft tissue., Materials and Methods: With an automated robotic arm, systematic fissures were performed on flat veal kidney specimens. Broad setting spectrums from 2.5 to 80 W, short and long pulse, were tested with 272 and 365 μm laser fibers. Experiments were repeated three times. Two pathologists in a blinded manner measured the width, depth, and coagulation area with electronic microscopy., Results: The overall mean ID was 2 mm (0.25-4.39) and the mean width was 1 mm (0.3-3.1). The mean coagulation thickness was 0.48 mm (0.25-1.73). The higher the frequency and energy, the deeper and wider was the incision p < 0.001. No differences were observed regarding the fiber diameter. The pulse length did not affect the ID, although the mean width was greater with short pulse p = 0.04. The outer mean coagulation was increased by increasing energy but not by increasing frequency p > 0.119., Conclusions: The overall mean ID was significantly higher than the theoretical 0.4 mm PD described for Ho:YAG laser. The energy, frequency, and pulse length had individual effects regarding ID, incision width, and coagulation. The ID should be specified in accordance with the laser's power output and should not be confused with the physics of PD concept.
- Published
- 2018
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30. [Correlation of genetic and cytogenetic alterations in pathological aggressiveness urothelial carcinoma of the bladder: Performance of BCA-1, a mini-array comparative genomic hybridisation-based test].
- Author
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Léon P, Cancel Tassin G, Sighar K, Compérat E, Gaffory C, Ondet V, Hugonin S, Audouin M, Doizi S, Traxer O, Ciofu C, Rouprêt M, Lacave R, and Cussenot O
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma urine, Female, Genomics, Humans, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Nucleic Acid Hybridization methods, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Sensitivity and Specificity, Urinary Bladder Neoplasms urine, Urothelium pathology, Biomarkers, Tumor urine, Carcinoma genetics, Carcinoma pathology, Chromosome Aberrations, DNA urine, Ethylenediamines, Morpholines, Urinary Bladder Neoplasms genetics, Urinary Bladder Neoplasms pathology
- Abstract
Introduction: Urothelial carcinomas are the fourth leading cause of cancer in humans. Their incidence is increasing by more than 50% in 25 years. The superficial forms (70% cases) require a close active surveillance to identify frequent recurrences and progression to invasive stage. Our main goal was to identify prognostic molecular markers for bladder cancer that could be used alone or in combination in routine clinical practice. In this aim, we evaluated the capability of the BCA-oligo test based on a CGH array to correctly classify tumoral grade/stage., Method: Urinary DNA was extracted from 81 patients with superficial bladder cancer and has been hybridized on the BCA-oligo array. The results from the molecular analysis were correlated with the tumoral grade and stage., Results: Several chromosomal alterations were significantly more frequent in tumors of higher grade and more advanced stage. A significant association was observed between a high grade and the presence of one of these alterations: loss on 6p, gain on 8q or 13q, loss or gain on 9q or 11q, with an odds ratio of 6.91 (95% CI=2.20-21.64; P=0.0009). Moreover, a significant association was found between a more advanced stage (pT1) and the presence of one of these alterations: loss on 6p, gain on 8q, loss or gain on 5p, with an odds ratio of 15.2 (95% CI=3.71-62.58; P=0.0002)., Conclusion: Our results showed that molecular analyses of superficial bladder cancers based on urinary DNA and the BCA-oligo test could be used as prognostic factor for the tumor evolution, allowing then a more adapted clinical management., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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31. Modern flexible ureteroscopy in Cohen cross-trigonal ureteral reimplantations.
- Author
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Emiliani E, Talso M, Audouin M, and Traxer O
- Subjects
- Adolescent, Adult, Humans, Male, Patient Positioning, Replantation methods, Ureteral Calculi surgery, Ureteroscopy methods
- Abstract
Purpose: We describe a feasible flexible ureteroscopy (fURS) technique with the latest instruments to and to discuss their advantages., Methods: Three patients underwent a fURS for stone treatment. A 7F angled orifice catheter and a hydrophilic angled tip stiff wire is used to guide the wire in the proper ureteral direction sighting the ureter allowing the use of a 10/12 ureteral access sheath. A single use ureteroscope was used., Results: All of them had successful ureteral access and laser lithotripsy being stone free endoscopically. No complications reported., Conclusion: The modern fURS technique was found feasible and safe in patients with cross-trigonal ureteroneocystostomy., (Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2017
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32. [Evaluation of the operating results and costs associated with the implementation of a flexible ureteroscopy activity within a university hospital center].
- Author
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Del Santo K, Audouin M, Ouzaid I, Ravery V, and Traxer O
- Subjects
- Adult, Child, Humans, Retrospective Studies, Treatment Outcome, Costs and Cost Analysis, Hospitals, University economics, Hospitals, University organization & administration, Ureteroscopes economics, Ureteroscopy economics, Ureteroscopy instrumentation
- Abstract
Introduction: The increasing use of flexible ureteroscopy (USSR) sets the cost problems inevitably associated with the fragility of these endoscopes. The aim of this work is to clear from a recent example (universitary hospital) results, costs during the implementation of this technique., Material and Methods: This is a retrospective study conducted from December 2012 (date of introduction of the activity) in March 2015 concerning the USSR made in a French universitary hospital for stone disease. In this analysis, the cost of consumables was not evaluated, nor the costs of the operating theater or hospitalization., Results: One hundred forty-one hundred and thirteen patients USSR were conducted by seven surgeons. Seventeen breakages and failures have been identified and have led to the sending of the endoscope for repair. Breakage rate and failure was 12%. All failures were treated with a standard exchange of the device (including 4 standard exchanges made under warranty). The estimated average cost of outages was 3600 euros. This represents an average cost per procedure of about 625 euros (acquisition plus cost of failures) without counting the costs of sterilization or high-level disinfection. The impossibility of relocating the lower calyx stones is associated with an excess risk of breakage (odd ratio: 2.92 CI95: [1.02; 8.37])., Conclusion: This study is novel because it focuses on the cost of implementing a technique in a French university hospital. The use of flexible ureteroscope to unique uses might be an interesting source of savings in the implementation of this technique. This remains to be evaluated., Level of Evidence: 5., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
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33. [Evaluation of postoperative symptoms after Greenlight™ photovaporization of the prostate through a dedicated questionnaire].
- Author
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Audouin M, Benbouzid S, Terrasa JB, Proietti S, Cussenot O, Lukacs B, and Cornu JN
- Subjects
- Aged, Early Diagnosis, Humans, Male, Postoperative Complications diagnosis, Retrospective Studies, Laser Therapy adverse effects, Prostatectomy methods, Surveys and Questionnaires
- Abstract
Aims: To evaluate postoperative symptoms after Greenlight™ photovaporisation of the prostate (PVP), through a dedicated questionnaire., Methods: A retrospective study has been conducted between 2008 and 2014. The questionnaire had 5 sections about pain while voiding, hematuria, urgency, incontinence and urinary stream, and was filled at one-month postoperative. The main outcome criterion was pain while voiding. Descriptive statistical analyses were done to identify predictive factors for pain while voiding., Results: Out of 169 patients, 22% had no pain while voiding, 37% had moderate pain, 30% acceptable pain and 11% intense pain. Patients with pain were significantly older, (P=0.012), had more urgency (P=0.01) and more often hematuria (P=0.0001). Only 7% of patients had no symptoms of urgency, and urgency was painful or bothering in 57% of cases. Hematuria was frequent, with clots in 21% of cases. Ninety three percent felt improvement of urinary stream., Conclusions: Systematic evaluation of symptoms through a dedicated questionnaire one month after PVP has shown that 41% of patients felt pain while voiding, 57% had urgency and 39% significant hematuria. These results should encourage a more accurate patient information and further studies to better understand postoperative healing after PVP., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Published
- 2016
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34. [Not Available].
- Author
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Najdawi M, Benbouzid S, Audouin M, Terrasa J, Peyrat L, Ciofu C, Haab F, and Cornu J
- Published
- 2015
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35. [Not Available].
- Author
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Frydman V, Cornu J, Benbouzid S, Audouin M, Terrasa J, Peyrat L, Ciofu C, and Haab F
- Published
- 2015
- Full Text
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36. A 20-Year Epidemiological Review of Testis Cancer at a French Military Hospital.
- Author
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Dusaud M, Durand X, Desfemmes FR, Molimard B, Bayoud Y, Audouin M, and Houlgatte A
- Subjects
- Adolescent, Adult, Aged, Disease Progression, Follow-Up Studies, France epidemiology, Humans, Male, Middle Aged, Morbidity trends, Retrospective Studies, Survival Rate trends, Testicular Neoplasms diagnosis, Young Adult, Forecasting, Hospitals, Military statistics & numerical data, Neoplasm Staging methods, Testicular Neoplasms epidemiology
- Abstract
Objectives: To determine if the epidemiology of testis cancer in military service has followed worldwide trends and if the end of conscription in 2000 in France marked an epidemiologic turn., Methods: All of the patients who had an orchiectomy for a testis germ tumor from January 1990 to January 2011 were studied. The patients were divided into two groups: orchiectomy before 2000 and after 2000., Results: 289 patients were included, with a mean age of 30.8. The mean age at diagnosis increased significantly as well as the proportion of stage 1 seminomas, whereas stage 1 nonseminomatous germ cell tumors (NSGCT) slightly decreased. For stage 1 seminomas, there was an increase in the surveillance (10% vs. 31%) and in the number of chemotherapies (19% vs. 22%); for stage 1 NSGCT, surveillance also increased (53% vs. 64%). The specific 5-year survival was 98.3%., Conclusions: We noted an increase in the number of stage 1 seminomas, the surveillance of located germ tumors, and an excellent survival rate. However, the population was younger with regard to national data, and the number of stage 1 NSGCT decreased in favor of advanced metastatic tumors., (Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.)
- Published
- 2015
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37. Immediate Nephroureterectomy or After Attempting Conservative Treatment, on Elective Indications, for Upper Urinary Tract Urothelial Carcinoma: Comparison of the Pathology Reports on a Retrospective Monocentric Study.
- Author
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Haddad M, Cloutier J, Cornu JN, Villa L, Terrasa JB, Benbouzid S, Audouin M, Cussenot O, and Traxer O
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Transitional Cell pathology, Elective Surgical Procedures, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Retrospective Studies, Survival Analysis, Urologic Neoplasms pathology, Carcinoma, Transitional Cell surgery, Laser Therapy methods, Nephrectomy methods, Ureter surgery, Urinary Tract surgery, Urologic Neoplasms surgery
- Abstract
Objective: Conservative treatment (CT) with flexible ureteroscopy and laser ablation is an alternative to radical nephroureterectomy (RNU) for the treatment of the upper urinary tract urothelial carcinoma (UTUC). The purpose of this study was to compare the pathology results obtained after immediate RNU or after attempt of CT for elective indication., Patients and Methods: A retrospective study was conducted in a single tertiary center. All patients who had an RNU for urothelial carcinoma between 2007 and 2012 have been included. The patients were classified into two groups: group 1 is immediate RNU, and group 2 is RNU after CT (only elective indications). Preoperative data collected were as follows: age, sex, chronic kidney failure, radiological classification for cancer staging (TNM), tumor size, localization, and multifocal indication of CT. The pathological RNU data collected were tumor stage and grade. The T stage was divided into two groups (primary endpoint): pTa-T1-T2 and pT3-T4. The χ(2) test and Mann-Whitney was performed to compare the independent qualitative and quantitative variables, respectively., Results: A total of 51 patients were included (40 patients in the immediate RNU group and 11 patients in the delayed RNU group after CT). Patients in both groups had comparable characteristics regarding age, sex, location, T stage, and preoperative tumor grade. On final pathology, 23 tumors were classified as pTa-T1-T2 in the immediate RNU group compared with 6 in the delayed RNU group. Seventeen and five tumors were classified as T3 in group 1 and group 2, respectively. These results were not significantly different between both groups (p=0.866). The pathological RNU grade was not significantly different between the groups., Conclusion: Within the limits of this retrospective study, the pathological RNU data showed no significant difference when RNU was done immediately or after CT for UTUC.
- Published
- 2015
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38. A guidewire introducer as a ureteral foreign body: A case report.
- Author
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Sener TE, Cloutier J, Audouin M, Villa L, and Traxer O
- Abstract
A 63-year-old male, previously treated for a ureteral tumour by a right-sided segmental ureterectomy and end-to-end anastomosis of ureteral segments, was referred to our clinic for endoscopic follow-up. During his follow-up, he was diagnosed with partial right-sided ureteral stricture which eventually progressed to complete obstruction. During the ureteroscopy, as the stenotic segment did not allow passage of an hydrophilic guidewire, an antegrade-retrograde approach was decided. On the antegrade endoscopic view, a near-complete stenosis was diagnosed and a nephrostomy catheter (12 Fr) was placed. A second intervention was planned and from the nephrostomy tract, the ureteroscope was placed into the right pyelocaliceal system. The diagnostic ureteroscopy revealed a foreign object proximal to the stenotic area. Right-sided segmental ureterectomy of the stenotic segment with ureteroneocystostomy and removal of the foreign object was performed. This is the only case in literature to reveal a guidewire introducer as a ureteral foreign body. This case also highlights the importance of the fragility of the ureter, the importance of the equipment, of always being watchful during a surgery, and the importance of checking the integrity of the equipment at the end of each procedure.
- Published
- 2015
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39. Charlson score as a single pertinent criterion to select candidates for active surveillance among patients with small renal masses.
- Author
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Audenet F, Audouin M, Drouin SJ, Comperat E, Mozer P, Chartier-Kastler E, Méjean A, Cussenot O, Shariat SF, and Rouprêt M
- Subjects
- Adenoma pathology, Adenoma, Chromophobe pathology, Adenoma, Chromophobe surgery, Adenoma, Oxyphilic pathology, Adenoma, Oxyphilic surgery, Aged, Aged, 80 and over, Angiomyolipoma pathology, Carcinoma, Renal Cell pathology, Cohort Studies, Disease Management, Disease Progression, Disease-Free Survival, Female, Humans, Kidney Neoplasms pathology, Male, Neoplasm Grading, Nephrons, Organ Sparing Treatments methods, Retrospective Studies, Risk Factors, Treatment Outcome, Adenoma surgery, Angiomyolipoma surgery, Carcinoma, Renal Cell surgery, Comorbidity, Kidney Neoplasms surgery, Nephrectomy methods, Patient Selection, Watchful Waiting
- Abstract
Purpose: The aim of the study was to assess the outcome after nephron-sparing surgery (NSS) of patients with small renal masses (SRMs) who would have been eligible for active surveillance (AS)., Methods: Data were collected retrospectively for 758 patients who underwent NSS over a 5-year period. Outcomes were assessed in two groups of patients who were eligible for AS according to different criteria. Group 1 criteria were as follows: age >75 years, renal mass ≤4 cm, significant comorbidities [Charlson Comorbidity Index (CCI) >2]. Group 2 criteria were as follows: any SRM ≤ 4 cm regardless of age, severe comorbidities with a 10-year mortality risk >50 % (CCI > 4). The two groups were not compared statistically because some patients were included in both., Results: Fifty-five patients (7.3 %) were included in Group 1 and 62 (8.2 %) in Group 2. There was a significant proportion of benign tumours in Group 1 (N = 6; 11 %) and Group 2 (N = 6; 10 %). Six (11 %) positive margins were observed in Group 1 and 8 (13 %) in Group 2. The 2- and 5-year recurrence-free survival rates were 100 and 77.4 %, respectively, in Group 1, and 88.5 and 79.6 % in Group 2. The 2- and 5-year overall survival rates were 100 and 74.7 % in Group 1, and 96.7 and 78.1 % in Group 2., Conclusions: The majority of patients with SRMs who would have been eligible for AS had no recurrence after initial tumour removal. In these patients, a CCI > 4 appeared to be a pertinent criterion to identify those patients less likely to benefit from immediate surgery.
- Published
- 2014
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40. Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy.
- Author
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Colin P, Ghoneim TP, Nison L, Seisen T, Lechevallier E, Cathelineau X, Ouzzane A, Zerbib M, Long JA, Ruffion A, Crouzet S, Cussenot O, Audouin M, Irani J, Gardic S, Gres P, Audenet F, Roumiguié M, Valeri A, and Rouprêt M
- Subjects
- Aged, Carcinoma, Transitional Cell pathology, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Kidney Neoplasms pathology, Kidney Pelvis pathology, Lymph Node Excision, Male, Middle Aged, Multivariate Analysis, Neoplasm Metastasis, Neoplasm Staging, Neoplasm, Residual, Neoplasms, Multiple Primary pathology, Prognosis, Retrospective Studies, Risk Assessment, Ureteral Neoplasms pathology, Carcinoma, Transitional Cell surgery, Kidney Neoplasms surgery, Kidney Pelvis surgery, Neoplasm Recurrence, Local, Neoplasms, Multiple Primary surgery, Nephrectomy methods, Ureter surgery, Ureteral Neoplasms surgery
- Abstract
Purpose: To assess the risk factors of metastasis relapse in pT2-3 upper tract urothelial carcinomas (UTUCs) treated by radical nephroureterectomy (RNU) without lymphadenectomy (LN)., Methods: A multicentric retrospective study was performed for pT2-3 pNx UTUCs treated by RNU between 1995 and 2010. The following criteria were retrieved: age, gender, American Society of Anaesthesiologists physical status, surgical approach, preoperative hydronephrosis, stage, grade, tumor location, surgical margin, lymphovascular invasion (LVI) status and outcomes. Metastasis-free survival (MFS) was measured by Kaplan-Meier method with the log-rank test., Results: Overall, 151 patients were included. The median follow-up was 18.5 months (IQR 9.5-37.9). The 2- and 5-year MFS were 69 % ± 4.5 and 54.1 % ± 5.8, respectively. In univariate analysis, ureteral location, pT3 stage, positive LVI status and positive surgical margin were significantly associated with worse MFS (p = 0.03; 0.02; 0.01 and 0.006, respectively). In the multivariate analysis of ureteral location and pT3 stage were independent prognostic factors (p = 0.03 and 0.03, respectively). Based on the results of the univariate analysis, we proposed a risk model predicting MFS, which classifies patients into 3 categories with different overall survival (p < 0.001)., Conclusion: In view of our data, tumor location, T stage, LVI and surgical margin status are mandatory to predict survival in case of RN without LN. Contingent upon external validation, our risk model based on these variables could be useful to provide relevant information concerning metastasis relapse probability and necessity of close follow-up for these patients.
- Published
- 2014
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41. Germline genetic variations at 11q13 and 12p11 locus modulate age at onset for renal cell carcinoma.
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Audenet F, Cancel-Tassin G, Bigot P, Audouin M, Gaffory C, Ondet V, Thibault F, Auribault K, Gazut S, Benhabiles N, Azzouzi AR, Méjean A, Rouprêt M, and Cussenot O
- Subjects
- Aged, Body Mass Index, Case-Control Studies, Female, Humans, Male, Middle Aged, Multivariate Analysis, Risk Factors, White People genetics, Age of Onset, Carcinoma, Renal Cell epidemiology, Carcinoma, Renal Cell genetics, Chromosomes, Human, Pair 11 genetics, Genetic Predisposition to Disease genetics, Genetic Variation, Kidney Neoplasms epidemiology, Kidney Neoplasms genetics, Polymorphism, Single Nucleotide genetics
- Abstract
Purpose: Few risk factors have been identified for renal cell carcinoma. We performed a validation study in a population with a European background to identify the most significant variants previously identified in association with renal cell carcinoma risk., Materials and Methods: We performed a case-control validation study after recruiting 463 controls and 463 patients with a histologically confirmed diagnosis of clear cell renal cell carcinoma. For each patient and matched control we genotyped 8 single nucleotide polymorphisms selected from previous studies to evaluate the association between candidate single nucleotide polymorphisms and renal cell carcinoma susceptibility., Results: After adjusting for patient age, gender, smoking status and body mass index the AG + AA genotypes from rs7105934 (11q13) were associated with a decreased risk of renal cell carcinoma (OR 0.50, 95% CI 0.33-0.75, p = 0.001) and the AC + CC genotypes from rs1049380 (ITPR2) were associated with an increased risk (OR 1.66, 95% CI 1.28-2.16, p <0.001). Kidney cancer developed at an older age in patients carrying the dominant risk allele A for rs7105934 (mean age at diagnosis 73.1 vs 68.9 years, p = 0.002) and at a younger age in those carrying the dominant allele C for rs1049380 (mean 68.1 vs 70.8 years, p = 0.005)., Conclusions: In what is to our knowledge the first validation study of the main 8 single nucleotide polymorphism variants associated with renal cell carcinoma susceptibility we confirmed the association of 2 single nucleotide polymorphisms with the risk of renal cell carcinoma. Each variant influenced patient age at disease diagnosis., (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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42. Genetic polymorphisms on 8q24.1 and 4p16.3 are not linked with urothelial carcinoma of the bladder in contrast to their association with aggressive upper urinary tract tumours.
- Author
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Yates DR, Rouprêt M, Drouin SJ, Audouin M, Cancel-Tassin G, Comperat E, Bitker MO, and Cussenot O
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Transitional Cell pathology, Case-Control Studies, Cohort Studies, Female, Gene Frequency, Genetic Predisposition to Disease, Genotype, Humans, Kidney Neoplasms genetics, Kidney Pelvis, Logistic Models, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Odds Ratio, Polymorphism, Single Nucleotide, Prospective Studies, Ureteral Neoplasms genetics, Urinary Bladder Neoplasms pathology, Carcinoma, Transitional Cell genetics, Chromosomes, Human, Pair 4 genetics, Chromosomes, Human, Pair 8 genetics, Urinary Bladder Neoplasms genetics
- Abstract
Purpose: Bladder urothelial carcinoma (bladder-UC) displays distinct genotypic differences compared to upper tract UC (UTUC). We recently reported specific 8q24 SNP variants confer susceptibility to UTUC and aggressive disease features. Herein, we evaluate a bladder-UC cohort to see whether similar polymorphisms are linked similarly same way with disease risk and aggressiveness., Methods: 231 bladder-UC patients and 261 benign controls were matched for gender, age, ethnicity and smoking habits. We retrospectively retrieved information on tumour stage, grade, size, multiplicity, carcinoma in situ and tumour number. DNA was extracted from paraffin-embedded primary bladder-UC samples and blood of benign controls. Genotyping of rs9642880[T] (8q24.1) and rs798766[T] (4p16.3) was performed using commercially available Taqman(®) assays and the ABI™ 7000 Sequence Detector., Results: Using a case-control analysis, bladder-UC risk was increased in individuals carrying the T/T genotype of rs9642880 [OR = 1.72 (95 % CI 1.1-2.8); p = 0.028] and rs798766 [OR = 1.84 (95 % CI 0.9-2.3); p = 0.01]. When analysing parameters of bladder-UC aggressiveness, the T/T genotypes for rs9642880 and rs798766 were not found to be associated with either grade [OR = 0.89 (95 % CI 0.52-1.32; p = 0.68) and OR = 0.95 (95 % CI 0.58-1.48; p = 0.61), respectively] or pathological stage [OR = 0.79 (95 % CI 0.42-1.48; p = 0.46) and OR = 0.90 (95 % CI 0.49-1.61; p = 0.72), respectively]. SNP variability of rs9642880[T] and rs798766[T] is associated with an increased risk of bladder-UC but we did not find an association with disease aggressiveness as we did previously for UTUC., Conclusions: This is further evidence of the distinct genetic differences that exist between bladder-UC and UTUC, and it is not possible to extrapolate results of genetic studies between these two urothelial disease entities.
- Published
- 2013
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43. The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi-institutional collaborative study.
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Berod AA, Colin P, Yates DR, Ouzzane A, Audouin M, Adam E, Arroua F, Marchand C, Bigot P, Soulié M, Roumiguié M, Polguer T, Gardic S, Grès P, Ravier E, Neuzillet Y, Delage F, Bodin T, Pignot G, and Rouprêt M
- Subjects
- Aged, Carcinoma, Transitional Cell diagnosis, Female, France epidemiology, Humans, Incidence, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Survival Rate trends, United States, Ureteral Neoplasms diagnosis, Ureteral Neoplasms etiology, Anesthesiology, Carcinoma, Transitional Cell epidemiology, Carcinoma, Transitional Cell etiology, Nephrectomy adverse effects, Societies, Medical, Ureteral Neoplasms epidemiology
- Abstract
Unlabelled: Study Type--Prognosis (cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT-UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT-UC. Using a multi-institutional French database, we have shown that the 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P = 0.01). ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P = 0.04)., Objective: • To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC)., Patients and Methods: • A retrospective multi-institutional cohort study of the French collaborative national database of UUT-UC treated by RNU in 20 centres from 1995 to 2010. • The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables., Results: • Overall, 554 patients were included. The median follow-up was 26 months (10-48 months), and the median age was 69.5 years (61-76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. • The 5-year recurrence-free survival (P = 0.21) and metastasis-free survival (P = 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). • The 5-year cancer-specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P = 0.01). • ASA status had a significant impact on cancer-specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients (P = 0.04)., Conclusions: • ASA classification correlates significantly with cancer-specific survival after RNU for UUT-UC. • It is a further pre-operative clinical variable that can be incorporated into future risk prediction tools for UUT-UC to improve their accuracy., (© 2012 BJU INTERNATIONAL.)
- Published
- 2012
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44. Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: results from a large French multicentre study.
- Author
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Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, Audouin M, Neuzillet Y, Albouy B, Hurel S, Saint F, Guillotreau J, Guy L, Bigot P, De La Taille A, Arroua F, Marchand C, Matte A, Fais PO, and Rouprêt M
- Subjects
- Aged, Carcinoma, Transitional Cell mortality, Carcinoma, Transitional Cell pathology, Carcinoma, Transitional Cell secondary, Female, Humans, Kidney Neoplasms mortality, Kidney Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local, Survival Rate, Ureteral Neoplasms mortality, Ureteral Neoplasms pathology, Carcinoma, Transitional Cell surgery, Kidney Neoplasms surgery, Nephrectomy, Ureter surgery, Ureteral Neoplasms surgery
- Abstract
Unlabelled: What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinomas (UUT-UCs) are rare tumours. Because of the aggressive pattern of UC, radical nephroureterectomy (RNU) with bladder cuff removal remains the 'gold-standard' treatment. However, conservative strategies, such as segmental ureterectomy (SU) or endourological management, have also been developed in patients with imperative indications. Some teams are now advocating the use of conservative management more commonly in cases of elective indications of UUT-UCs. Due to the paucity of cases of UUT-UC, only limited data are available on the oncological outcomes afforded by conservative management. We retrospectively investigated the oncological outcomes after SU and RNU in a large multi-institutional database. Overall, 52 patients were treated with SU and 416 with RNU. There was no statistical difference between the RNU and SU groups for the 5-year probability of cancer-specific survival, recurrence-free survival and metastasis-free survival. The type of surgery was not a significant prognostic factor in univariate analysis. The results were the same in a subgroup analysis of only unifocal tumours of the distal ureter with a diameter of <2 cm and of low stage (≤T2). Our results suggest that oncological outcomes after conservative treatment with SU are comparable to RNU for the management of UUT-UC in select cases., Objective: To compare recurrence-free survival (RFS), metastasis-free survival (MFS) and cancer-specific survival (CSS) after segmental ureterectomy (SU) vs radical nephroureterectomy (RNU) for urothelial carcinoma (UC) of the upper urinary tract (UUT-UC) located in the ureter., Patients and Methods: We performed a multi-institutional retrospective review of patients with UUT-UC who had undergone RNU or SU between 1995 and 2010. Type of surgery, Tumour-Node-Metastasis status, tumour grade, lymphovascular invasion and positive surgical margin were tested as prognostic factors for survival., Results: In all, 52 patients were treated with SU and 416 with RNU. The median (range) follow-up was 26 (10-48) months. The 5-year probability of CSS, RFS and MFS for SU and RNU were 87.9% and 86.3%, respectively (P = 0.99); 37% and 47.9%, respectively (P = 0.48); 81.9% and 85.4%, respectively (P = 0.51). In univariable analysis, type of surgery (SU vs RNU) failed to affect CSS, RFS and MFS (P = 0.94, 0.42 and 0.53, respectively). In multivariable analyses, pT stage and pN stage achieved independent predictor status for CSS (P = 0.005 and 0.007, respectively); the positive surgical margin and pT stage were independent prognostic factors of RFS and MFS (P = 0.001, 0.04, 0.009 and 0.001, respectively). The main limitation of the study is its retrospective design, which is due to the rarity of the disease., Conclusions: Short-term oncological outcomes after conservative treatment with SU are comparable to RNU for the management of UUT-UC in select cases and should be considered an option. In every other case, RNU still represents the 'gold standard' for the treatment of UUT-UC., (© 2012 BJU INTERNATIONAL.)
- Published
- 2012
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45. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs): results from a large French multicenter collaborative study.
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Ariane MM, Colin P, Ouzzane A, Pignot G, Audouin M, Cornu JN, Albouy B, Guillotreau J, Neuzillet Y, Crouzet S, Hurel S, Arroua F, Bigot P, Marchand C, Fais PO, de la Taille A, Saint F, Ravier E, Matte A, Guy L, Bruyère F, and Rouprêt M
- Subjects
- Aged, Carcinoma, Transitional Cell mortality, Carcinoma, Transitional Cell pathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures mortality, Neoplasm Grading, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Retrospective Studies, Survival Rate, Treatment Outcome, Ureteral Neoplasms mortality, Ureteral Neoplasms pathology, Carcinoma, Transitional Cell surgery, Laparoscopy mortality, Neoplasm Recurrence, Local surgery, Nephrectomy mortality, Postoperative Complications, Ureteral Neoplasms surgery
- Abstract
Background: The purpose of this study was to compare the postsurgical survival of UUT-UC patients treated with ONU and LNU., Methods: Using a multi-institutional, national, retrospective database, we identified patients with UUT-UC who underwent radical nephroureterectomy by open access (ONU) or by the minimally invasive alternative (LNU). Survival curves were estimated using Kaplan-Meier method. A multivariate Cox model was used to evaluate the association between surgical approach and disease recurrence., Results: Overall, 609 patients were included (ONU = 459 and LNU = 150). The median age was 69.8 years (range 61.9-76), and the male-to-female ratio was 2:1. Postoperative complications occurred in 80 patients, with no significant difference between ONU and LNU on the whole (P = 0.64). The median follow-up was 27 months. There was no difference between the 2 procedures in the 5-year CSS or 5-year RFS. Moreover, the 5-year CSS (P = 0.053) and 5-year RFS (P = 0.9) for cases with locally advanced disease (pT3/pT4) were similar between ONU and LNU. In the multivariate analysis, the surgical procedure used was not found to be associated with survival. The main limitation of the study is its retrospective design, which is the result of the rarity of the disease., Conclusions: There is no evidence that oncological outcomes for LNU are inferior to those for open surgery, provided that the appropriate precautionary measures are taken.
- Published
- 2012
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46. [Erectile dysfunction after radical prostatectomy: pathophysiology, evaluation and treatment].
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Audouin M, Beley S, Cour F, Vaessen C, Chartier-Kastler E, Bitker MO, Richard F, and Rouprêt M
- Subjects
- Erectile Dysfunction diagnosis, Erectile Dysfunction physiopathology, Erectile Dysfunction therapy, Humans, Male, Surveys and Questionnaires, Erectile Dysfunction etiology, Prostatectomy adverse effects
- Abstract
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 1year. 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 60years 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., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)
- Published
- 2010
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47. [Primary upper urinary tract tumors and subsequent location in the bladder].
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Azémar MD, Audouin M, Revaux A, Misraï V, Comperat E, Bitker MO, Chartier-Kastler E, Richard F, Cussenot O, and Rouprêt M
- Subjects
- Humans, Risk Factors, Carcinoma, Transitional Cell therapy, Kidney Neoplasms therapy, Neoplasms, Second Primary diagnosis, Neoplasms, Second Primary therapy, Ureteral Neoplasms therapy, Urinary Bladder Neoplasms diagnosis, Urinary Bladder Neoplasms therapy
- Abstract
The urothelium is the epithelium that lines the upper and lower urinary tract. Over 95% of urothelial carcinomas are derived from urothelium. They can be located in the lower tract (bladder, urethra) or upper tract (pyelocaliceal cavities, ureter). Urothelial carcinomas are the fourth most common tumours after prostate (or breast) cancer, lung cancer and colorectal cancer. On one hand, bladder tumours account for 90-95% of urothelial carcinomas. It is the most common malignancy of the urinary tract and the second most common malignancy of the urogenital tract after prostate cancer. It accounts for 5-10% of all cancers diagnosed each year in Europe. On the other hand, upper urinary tract urothelial cell carcinomas (UUT-UCC) are scarce and account for only 5-10% of urothelial carcinomas. Recurrence in the bladder after primary UUT-UCC occurs in 15-50% of UUT-UCC. Differences in treatment modalities of the primary UUT-UCC do not play a key role in the subsequent appearance of a bladder recurrence. However, others factors have been described such as stage and location in the upper tract of the primary tumour or upper tract tumour multifocality. Previous history of bladder tumour is also associated with the risk that another tumour arises in the bladder subsequently. However, it becomes difficult to distinguish between natural history of bladder tumour and evolution of UUT-UCC in these cases. In most cases, bladder cancer occurs in the first two years after UUT-UCC management. Surveillance protocol is based on cystoscopy and on urinary cytology during at least every three months for two years. Current surveillance regimen have a low level of evidence considering the paucity of UUT-UCC.
- Published
- 2009
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48. Influence of HMPA on the stereochemical outcome of the addition of a racemic allenylzinc onto enantiopure N-tert-butanesulfinimines: stereoselective access to enantiopure cis-ethynylaziridines.
- Author
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Ferreira F, Audouin M, and Chemla F
- Abstract
In the presence of 60 equivalents of HMPA, the condensation of the racemic allenylzinc derived from 1-chloro-3-trimethylsilylpropyne onto enantiopure non-alpha-branched N-tert-butanesulfinimines was proven to give access to the corresponding cis-ethynylaziridines as the major products. The good cis selectivity observed presumably resulted from a high kinetic resolution with the allenylzinc being partially configurationally labile with respect to the time scale defined by the rate of the reaction. Both single crystal X-ray analysis and semiempirical calculations conducted at the MM2 and AM1 levels of theory proved that the reaction certainly occurred through a preferred synclinal transition state in a supra- or antarafacial S(E)2' process. In all cases, chromatographic purification over silica gel allowed the cis-ethynyl-N-tert-butanesulfinylaziridines to be obtained as diastereo- and enantiomerically pure compounds (dr >98:2 and ee >99%).
- Published
- 2005
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49. N-tritylprolinal: an efficient building block for the stereoselective synthesis of proline-derived amino alcohols.
- Author
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Bejjani J, Chemla F, and Audouin M
- Subjects
- Models, Chemical, Stereoisomerism, Amino Alcohols chemical synthesis, Proline analogs & derivatives, Proline chemical synthesis, Proline chemistry, Trityl Compounds chemical synthesis, Trityl Compounds chemistry
- Abstract
N-Tritylprolinal (prepared in four steps from l-proline) shows a very high Felkin diastereoselectivity in its reaction with various nucleophiles, leading to a straightforward and highly stereoselective access to syn-proline-derived amino alcohols.
- Published
- 2003
- Full Text
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