Biomedical subjects
Publications and source records attributed to H Bittard.
The authors present a distal urethroplasty technique (or urethromeatoplasty) which consists of reconstruction of the floor of the distal urethral (glandular urethra) by inversion of a pedicled ventral penile skin patch graft raised transversely. This technique allows treatment of recurrent stricture of the glandular urethra in circumcised patients with good aesthetic and functional results.
OBJECTIVE: The objective of this study was to evaluate the management and current treatment options for ureteric complications after vascular surgery based on a series of 6 cases. PATIENTS AND METHOD: 6 patients were treated between 1990 and 1998 (mean age: 64.7 years) for ureteric complications after aortic bifurcation surgery. The mean interval between vascular surgery and urological management was 11.6 years (+/- 4.04). All patients were assessed by intravenous urography (IVU), and 4 patients were assessed by abdominal computed tomography (CT). These complications consisted of: 2 cases of ureteric stenosis, 1 case of inflammatory peri-ureteritis, 2 cases of chronic peri-ureteritis and 1 case of compression by a false aneurysm. The lesion was situated in the iliac ureter in every case. RESULTS: Treatment consisted of temporary double J stenting (n = 1), ureter release (n = 1), endoscopic dilatation (n = 1), psoas bladder reconstruction (n = 1) and corticosteroid therapy (n = 2), with 4 successes, 1 failure (corticosteroid therapy), and 1 death from another cause. CONCLUSION: Ureteric lesion after vascular surgery is a rare complication, often discovered incidentally. The iliac ureter is predominantly affected. IVU and CT are the reference examinations. Treatment options primarily depend on the patient's general state.
PURPOSE: Mutations of p53 tumor suppressor gene and nuclear accumulation of p53 protein are common in bladder tumors. The prognostic significance of p53 alterations in bladder tumors has not been established. The aim of the present study was to evaluate an immunohistochemical (IHC) method for the routine determination of p53 protein overexpression in human bladder tumors and to determine the relation between nuclear accumulation of p53 with the traditional prognostic indicators and patient survival. MATERIALS AND METHODS: 104 transitional cell carcinomas of the bladder were analyzed simultaneously by immunohistochemistry for p53 protein overexpression and direct DNA sequencing for p53 gene mutations. RESULTS: The overexpression of p53 protein was reported in 30.8% of the cases and mutations of p53 gene in 23.0%. A significant association was observed between p53 alterations established either by IHC or direct DNA sequencing and stage (p<0.0001), grade (p<0.001), vascular invasion (p = 0.0005), DNA ploidy (p = 0.0002) and carcinoma in situ (p<0.0001). The correlation between the p53 gene mutations and p53 nuclear reactivity as detected by IHC was highly significant (p<0.0001). Univariate statistical analysis showed that the expression of p53 was significantly correlated to poor prognosis (p<0.0001). However, in multivariate analysis, only stage was significantly correlated to prognosis (p<0.0001). CONCLUSIONS: The IHC method was highly sensitive and specific and simple to apply for the routine examination of p53 overexpression in bladder tumors. However, overexpression of p53 as determined immunohistochemically, does not appear to have a better predictive prognostic value than stage in bladder tumors.
Nephrolithiasis is uncommon after kidney transplantation. However, calcium (Ca) supplementation, which has been proposed as a treatment of post-transplant osteopenia, might increase calciuria and bolster Ca stone formation. Therefore, in 24-hour urine of 82 normocalcemic long-term renal transplant recipients (RT) and in 82 healthy subjects (HS), we assessed some Ca nephrolithiasis risk factors and the Ca-salt saturation estimated by the ion-activity product index (AP) and relative supersaturation (RS). In RT, calciuria was lower (mean +/- SD, 3.20 +/- 2.25 vs. 4.61 +/- 1.71 mmol/day; P < 0.001), urinary volume higher (2.41 +/- 0.83 vs. 1.39 +/- 0.53 liter/day; P < 0.001), oxaluria higher (419 +/- 191 vs. 311 +/- 79 mumol/day; P < 0.001) and citraturia lower (1.40 +/- 1.36 vs. 3.77 +/- 1.36 mmol/day; P < 0.001) than in HS. As a result, Ca-oxalate supersaturation was lower in RT than HS (AP, 1.07 +/- 0.69 vs. 2.07 +/- 1.13, P < 0.001; and RS, 0.62 +/- 0.26 vs. 0.94 +/- 0.21, P < 0.001), and was similar in subgroups of RT (N = 37) and HS (N = 37) matched for urinary volume, demonstrating that even without any larger urinary volume, Ca-oxalate saturation was not higher in RT than HS, and suggesting that opposite changes in Ca and oxalate in RT likely canceled their effects on lithogenic risk. In RT which had similar urinary pH and phosphate (P) than HS, Ca-P supersaturation was lower than in HS for brushite (AP, 3.25 +/- 6.67 vs. 6.01 +/- 4.85, P < 0.001; RS, -0.33 +/- 0.76 vs. 0.48 +/- 0.53, P < 0.001) and octacalcium phosphate (RS, -0.95 +/- 0.72 vs. 0.21 +/- 0.85, P < 0.001), and similar for apatite. Finally, fasting calciuria and calciuric response to a single oral Ca load were similar in RT (N = 19) and HS (N = 8). Together, these results argue strongly against a higher risk of Ca stone formation in RT than HS, even in case of Ca supplementation.
Pheochromocytoma rarely occurs in the bladder. We report a fortuitously observed case and review the main clinical, biological and radiological features.
PURPOSE: To clarify the role of the c-Ha-ras-1 gene in bladder cancer predisposition and prognosis. MATERIALS AND METHODS: The c-Ha-ras-1 locus was studied by Southern blotting in white blood cells and tumor samples obtained from 126 patients with bladder cancer (74 Ta-T1 and 52 T2-T4). A comparison with 84 unaffected patients and a survival analysis were performed. RESULTS: The patients with bladder cancer presented 7 different c-Ha-ras-1 alleles, 12 different genotypes, heterozygosity in 49% of cases and a loss of heterozygosity (in the tumor) in 13 cases. The most frequent allele (a1, 6.6 kb) was present in 83% of patients. Heterozygosity correlated with vascular invasion in the tumor (p < 0.0001). In the small subgroup of 11 patients with rare alleles and genotypes, these alleles and genotypes occurred more often in patients with T2-T4 tumors (p < 0.01 for alleles and genotypes), aneuploid tumors (p < 0.001, p < 0.005) and tumors with vascular invasion (p < 0.01, p < 0.005). However, in this study, the majority of patients with high risk tumors possessed common alleles and genotypes. Survival analysis showed that neither the c-Ha-ras-1 genotype nor allelomorphism was an independent prognostic factor. Elsewhere, no rare allele occurred more frequently in bladder cancer affected patients than in unaffected patients. CONCLUSION: This study confirms c-Ha-ras-1 gene polymorphism in a bladder cancer affected population and, in some cases, a loss of genetic material in the vicinity of this locus. No specific genotype can be implicated in the predisposition to bladder carcinoma, and c-Ha-ras-1 genotyping appears of limited value in the clinical management of these patients.
PURPOSE: We evaluated the clinical value of flow cytometry in bladder cancer. MATERIALS AND METHODS: Deoxyribonucleic acid (DNA) content was measured by flow cytometry in 275 untreated patients with bladder tumor followed for 1 to 8 years. Four pathological parameters (stage, grade, observed vascular invasion and associated carcinoma in situ) and 3 flow cytometric parameters (ploidy, number of aneuploid cell lines and DNA index) were defined. RESULTS: Univariate survival analysis showed that every parameter, when considered separately, was a significant prognostic factor (p < 0.0001 in call cases). Multivariate analysis showed that stage (p < 0.0001), DNA index (p < 0.01) and associated carcinoma in situ (p < 0.05) were independent, significant prognostic factors. However, ploidy and DNA index enhanced prognostic information above the traditional stage and grade only in patients with a stage pT1, grade 3 tumor (p < 0.05). Retrospectively, different therapeutic decisions could have been made using DNA content only in 4% of cases. CONCLUSIONS: In patients with bladder cancer DNA content is an independent predictor of survival but its clinical usefulness is limited.
A cystic dilatation of the right seminal vesicle due to an ectopic implantation of the right ureter was observed in a patient with ipsilateral renal agenesia. The embryology, symptomatology and radiological diagnosis, including magnetic resonance imaging, and treatment of this malformation are reported.
Traumatic fracture of the pelvis led to the rare combination of urethra and bladder rupture and fistulization into the vagina. This unusual lesion can go undiagnosed initially and must be properly identified during the emergency gynaecology and urology examination. Tissue damage involved nearly the entire length of the urethra including both the smooth and striated sphincters. Reconstructive surgery produced good anatomic and functional results.
We report our recent experience in the surgical treatment of severe closed renal trauma, describing the value of the initial tomography scan, the problems encountered with indications for surgery, and use of a resorbable peri-renal prosthesis made of polyglactine 910. During the last 4 years, 41 patients were hospitalized for renal trauma. Eleven of these patients were operated for severe lesions (Chatelain stage 3 and 4). Surgical treatment was as conservative as possible: total organ repair was possible in 5 cases and partial repair in 3, the kidney was lost in 3 cases.
The authors report the results of a 5-year experience with flow cytometry (FCM) in the diagnosis and evaluation of bladder tumors. FCM was applied to 400 patients (225 without a urinary tumor and 175 with a past or recent bladder tumor). For the patients without a tumor, bladder-irrigation-fluid FCM was positive in 22% of samples vs 1% of those tested with conventional cytology. The high rate of false-positive results may have been due to an imperfect quality of the samples, to the staining procedure and to the high amount of squamous cells. For 72 selected tumors in which the bladder washing was performed under specific requirements, the detection rate of FCM was lower than that of conventional cytology, including G1-grade tumors. A comparison between bladder-irrigation-fluid FCM and disaggregated-biopsy FCM revealed a 22% rate of discordant results. From these data it does not seem desirable tu use bladder-irrigation FCM instead of conventional cytology in routine urologic examinations. The use of this technique must be more selective in bladder tumor evaluation.
The c-Ha-ras-1 polymorphism was studied in 92 bladder tumor samples (newly diagnosed and/or recurrent) obtained from 73 patients and in the paired white blood cells (WBC). A heterozygous state was detected in WBC DNA of 38 patients (52%). The statistical analysis (univariate and multivariate) demonstrated an association between the heterozygous state of the patients and a lymphatic invasion. In patients with a pTa tumor, there was a relation between the heterozygous state and a younger age at diagnosis. A loss of heterozygosity for c-Ha-ras-1 locus was detected in seven out of the 38 informative tumors (18.4%). No significant correlation was observed with the prognostic factors. These results address the relation between the heterozygous genomic state and the risk of lymphatic invasion in the patients with a bladder tumor.
To find whether the liver can be procured after exclusive aortic perfusion, three organ perfusion models were used in three groups of donor rats. Group 1 underwent liver wash-out via the portal vein; in group 2, the kidneys alone were perfused via the aorta; and group 3 underwent simultaneous aortic perfusion of liver and kidneys. All perfusion flow rates in the three groups were adjusted to physiological values. Harvested organs were transplanted and recipient animals were killed 4 h after transplantation to study liver and kidney viability by using intracellular ATP measurement. Liver ATP was lower (P < 0.005) in the portal perfusion group (group 1: 1.396 +/- 0.412) than in the aortic perfusion group (group 3: 2.181 +/- 0.061). Kidney ATP was comparable in groups 2 and 3:1.066 +/- 0.09 vs 1.059 +/- 0.273 (mumol/g) tissue). Liver cooling was quicker with portal perfusion than with the aortic flush (20 degrees C in 20 s vs 15 degrees C in 60 s). Aortic perfusion at a physiologic flow rate has no detrimental effect on renal viability studied by intracellular ATP measurement. We conclude that liver cooling via the aortic route only is a good alternative to portal perfusion and seems to give good preservation. Application of this observation to emergency procurement in humans is still the subject of controversy.
An urethral lesion due to coital faux pas is usually associated with a lesion of the corpora cavernosa, but may occasionally be isolated. Suspected clinically due to the presence of urethral bleeding, the diagnosis of ruptured urethra is based on urethrography and, more importantly, urethroscopy, which appears to be more reliable for defining the complete or partial nature and the site of the rupture. Even in incomplete forms, surgical suture of the lesion appears to give better results than urinary diversion alone.
The authors report a case of prolactinoma discovered during assessment of a case of ejaculation failure attributed for more than eight years to a psychogenic cause. Because of the size of the tumour, surgical resection of the lesion left a persistent hyperprolactinaemia, which only returned to normal after treatment with bromocriptine. The persistence of sexual disorders justified adjuvant treatment with exogenous testosterone. Despite the unusual mode of presentation of hyperprolactinaemia, these data correspond to those reported in the literature. Prolactin assay should therefore be performed in any case of male sexual dysfunction to allow the early diagnosis of prolactinoma and to improve the functional prognosis.
Female urethra ruptures associated with pelvic ring fractures are exceptionally observed. The authors compared these 2 cases (Besançon and Toulon) to already published cases. This diagnosis must be contemplated and established by the surgeon or in his/her presence using urethral catheterization. The surgical approach (most of time abdominoperineal) allows an accurate injury repair and prevents from fearsome complications due to late diagnosis and treatment. An active attitude following this urological act is highly required, in case of osteoarticular injuries, whose instability and rules are currently known.
During the transplantation of a kidney, we have discovered an undetected recent thrombosis of the renal artery of the graft, which was revealed after clamp removal by infarction of the kidney. We performed an immediate arterial desobstruction and a secondary high flow rate washing of the kidney, which allowed properly restoring the vascularity of the graft and successfully grafting it.
We report 2 cases of decompensation of a pelviureteric obstruction in a transplanted kidney. In one case, the pyeloureteral obstruction was discovered intraoperatively during grafting (cadaver kidney) and was corrected at that time. In the other case, the obstruction was decompensated one month after grafting (kidney taken from a living donor with a very discrete bilateral junction syndrome) and required surgical treatment. The procedure used in both cases was a pyelopyelic anastomosis after nephrectomy of the recipient's kidney.