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Biomedical subjects

H Botto

Publications and source records attributed to H Botto.

At least 37 records · Page 2Linked to original sources
PubMed1998

Urethral recurrence of transitional cell carcinoma of the bladder. Predictive value of preoperative latero-montanal biopsies and urethral frozen sections during prostatocystectomy.

OBJECTIVE: The management of the male urethra after cystectomy for bladder cancer continues to be a dilemma. Patients who undergo a cystectomy require either urinary diversion or bladder substitution. Therefore, the use of the urethra to ensure voiding is important. On the other hand, the probable risk of urethral carcinoma recurrence is generally estimated at approximately 10%. The aim of this study was to assess the predictive value of preoperative urethral biopsies, and of frozen sections during cystoprostatectomy, in patients with invasive bladder cancer. METHODS: From 1982 to 1986, 118 male patients underwent a cystoprostatectomy for transitional cell carcinoma of the bladder. All patients underwent endoscopic latero-montanal biopsies 2 weeks preoperatively and urethral frozen cut section during radical prostatocystectomy. RESULTS: Carcinoma was observed in 12 patients on both examinations. All patients underwent en bloc urethrectomy during cystectomy. In the remaining 106 patients, the frozen cut margin was negative (including 9 with positive latero-montanal biopsies), and these patients had the urethra preserved. After a 10-year minimum follow-up, no recurrence was observed in these patients with negative frozen cut-section. No significant risk factors for urethral recurrence were found. Latero-montanal biopsies did not reveal a positive specificity, and this procedure was later abandoned in our institution (in 1986). CONCLUSIONS: The urethral frozen section was the only guideline used for simultaneously performing the urethrectomy. All male patients with negative frozen cut sections should be considered candidates for bladder substitution. A prophylactic urethrectomy is only indicated in patients with carcinoma (minimum carcinoma in situ) in the frozen urethral margin section during cystectomy.

Adult↗
PubMed1998

Low-dose BCG instillations in the treatment of stage T1 grade 3 bladder tumours: recurrence, progression and success.

The aim of this retrospective study was to evaluate the effects and results of low-dose bacillus Calmette-Guérin (BCG) therapy on a selective high-risk population of stage T1, grade 3 (G3) bladder tumours. Recurrence and progression were also analysed. Thirty-five consecutive patients presenting with T1 G3 tumours were treated with intravesical BCG. All patients underwent complete transurethral tumour resection. A course of BCG 75 mg Pasteur strain was begun 4 weeks after the first resection of the diagnosed tumour and continued for a 6-week period. At the end of treatment, a complete urological evaluation was routinely carried out: urine cytology test, cystoscopy with bladder biopsies randomly performed, and any recurrences were resected. In cases of abnormal cytology and/or recurrence an additional course of BCG was initiated, followed by the same tests. Follow-up examination and cystoscopy or fibroscopy were conducted every 3 months for 1 year, semiannually and annually thereafter. Median follow-up was 45 months (range 10-120); 7 patients (20%) did not respond to BCG instillations. Of these patients, 5 underwent cystectomy and in 2 patients the bladder was left in place in spite of recurrence because of age (+80 years). Twenty-eight patients (80%) responded positively, 24 after one single course of BCG, and 4 patients after two courses. During follow-up, recurrence was observed in 8 cases: stage T1 G3 in 4 patients, T1 CIS (carcinoma in situ) in 2 patients, Ta G2 and Ta G1 in 2 patients. Three of these patients were treated by cystectomy and the remaining patients with transurethral resection alone or combined with additional courses of BCG. Overall, 25 patients (71%) were considered free of tumour occurrence after low-dose BCG therapy. Ten patients underwent cystectomy (29%) or remained in occurrence and 2 patients died of the disease. These results can be closely compared to the results of other trials conducted on stage T1 G3 and BCG treatment, using a different dosage and BCG protocol therapy. BCG is an effective prophylactic and therapeutic agent for T1 G3 carcinoma of the bladder responders. The identification of these responders before beginning instillations still remains a challenge.

Administration, Intravesical↗
PubMed1998

Correlation between p53 over expression and response to bacillus Calmette-Guerin therapy in a high risk select population of patients with T1G3 bladder cancer.

PURPOSE: The aim of this study was to determine if p53 status, assessed before intravesical bacillus Calmette-Guerin (BCG) therapy, can predict clinical outcome in a high risk population of patients with stage T1, grade G3 bladder cancer and if it can be used to select patients responsive to therapy. MATERIAL AND METHODS: After complete transurethral resection 35 patients with T1G3 bladder carcinoma received 6 weekly instillations of BCG and nonresponsive patients received a second course. After treatment cystoscopy and randomized biopsies of the bladder mucosa were performed. Pathologists had sufficient material to perform immunomarking in 25 cases using the peroxidase-antiperoxidase technique with antiprotein monoclonal antibody p53. The results were expressed in percentage of marked nuclei. We established 5% increment thresholds from 0 to 60%. Contingent tables were established, and chi-square and Fisher's exact test were performed for each 5% threshold. RESULTS: Median followup was 51.3 months (range 25 to 144). Of the 25 patients 8 (32%) did not respond to BCG therapy and 17 (68%) did. Immunomarkings were not statistically different between BCG responsive and nonresponsive patients for 0, 5, 10, 20, 35, 40, 45, 55 and 65 thresholds. Chi-square and Fisher's exact test were 0.91 and 0.83, 0.40 and 0.20, 0.58 and 0.29, 0.96 and 0.81, 0.80 and 0.88, 0.67 and 0.73, 0.91 and 0.83, 0.80 and 0.38, 0.69 and 0.32, respectively. CONCLUSIONS: Our results indicate that the percentage of p53 immunomarked cell cannot currently be used to predict clinical response to BCG therapy and, therefore, p53 over expression is not a viable indicator of T1G3 recurrence when using this treatment.

Aged↗
PubMed1998

[The absence of metabolic disorders 8 years after detubulized Z entero-cystoplasty].

Intestinal resection can lead to decreased gastrointestinal absorption of various metabolic substances. The use of these intestinal segments as materials for urinary tract reconstruction can also induce metabolic disorders. The authors studied the long-term metabolic consequences of replacement enterocystoplasty after radical cystectomy for bladder cancer.

Aged↗
PubMed1998

[Renal tumor with thrombus involving all of the lumen of the inferior vena cava: surgical indication, technique and results].

OBJECTIVES: Almost 5% of renal tumours are associated with thrombus of the renal vein or inferior vena cava at the time of diagnosis. Radical nephrectomy with complete resection of the tumour nodule is the reference first-line treatment in this situation. This retrospective series was designed to analyse the surgical strategy according to the extent of the tumour nodule and the morbidity and mortality as a function of the prognostic factors of these renal tumours. MATERIALS AND METHODS: From 1982 to 1995, 51 patients (out of a series of 724 nephrectomies) presented with renal vein invasion involving all of the lumen of the inferior vena cava. The choice of medical imaging varied over time (cavography, Doppler ultrasound, CT, MRI and transoesophageal ultrasonography). Control of the inferior vena cava was always performed below the renal veins and above the thrombus. RESULTS: MRI and transoesophageal ultrasonography were found to be the most reliable diagnostic examinations. The incision and vessel control technique must be selected as a function of the type of thrombus and the emboligenic risk. With a follow-up of 4.3 years, the overall 2-year survival was 46% and the 5-year survival was 31%. All recurrences at 1 year occurred in N+ patients. CONCLUSION: Lymph node status and invasion of the perirenal fat are the most important prognostic factors, while the presence and length of the thrombus do not appear to influence survival. Radical nephrectomy of these tumours, invading all of the lumen of the inferior vena cava, requires complete resection of the thrombus. Adhesion of the thrombus constitutes a major technical problem that must be envisaged before the incision in order to correctly control the vessels.

Adenocarcinoma↗
PubMed1997

Ureteroileal implantation in orthotopic neobladder with the Le Duc-Camey mucosal-through technique: risk of stenosis and long-term follow-up.

PURPOSE: We determined the postoperative risk of nonneoplastic ureteroileal implantation stenosis using the Le Duc-Camey technique, and assessed the extent to which followup is mandatory. MATERIALS AND METHODS: Between October 1980 and October 1989, after a cystoprostatectomy, 158 consecutive men underwent lower urinary tract reconstruction by means of a U-shaped orthotopic ileal neobladder. Of these cases 109 were tubularized and 49 were detubularized. The 313 ureteral implantations were performed according to the Le Duc-Camey mucosal-through technique. Followup studies in all patients consisted of excretory urography or renal sonography carried out before discharge home, at least every 6 months during the first year after surgery and once a year thereafter. Followup was more than 2 years for 123 patients. The study was conducted retrospectively. RESULTS: The rate of anastomotic stenosis was 4.9% among 123 patients who were followed a minimum of 2 years. No obstructions were detected after 2 years. The rates of ureteral reimplantation and nephrectomy for chronic kidney obstruction were 3.7% and 2%, respectively. All strictures were located at the anastomosed site, and retrograde catheterization was uncertain. Surgical reimplantation through an elective extraperitoneal approach was easy to perform and effective. CONCLUSIONS: The anastomotic stenosis rate after Le Duc-Camey ureteroileal implantation in orthotopic U-shaped neobladder was 4.9%. During the first year after surgery, the difference between true stenosis and temporary edema was not easy to assess. The U-shaped neobladder allows for the implantation of a minimally dissected iliac ureter, which could be a factor in minimizing the risk of obstruction.

Adult↗
PubMed1997

No evidence of metabolic disorders 10 to 22 years after Camey type I ileal enterocystoplasty.

PURPOSE: Resection of ileal segments may results in malabsorption and a decrease in intestinal uptake of different substances. The use of intestinal segments in the urinary tract may also cause metabolic disorders. We studied long-term metabolic consequences of enterocystoplasty after radical cystoprostatectomy for bladder cancer. MATERIALS AND METHODS: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectomy. The enterocystoplasty was constructed with a 35 cm. ileal segment resected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultrasonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglycerides, albumin, protein, vitamins B12 and B9, iron, ferritin, calcium, phosphate, vitamin D, parathyroid hormone, urea, creatinine, creatinine clearance and prostate specific antigen. In addition urine calcium, protein, creatinine and pH were measured, and a midstream urine specimen was obtained. RESULTS: There was no evidence of metabolic acidosis, impairment of phosphorus and calcium metabolism, vitamin D deficiency or parathyroid hormone disturbance. All other laboratory tests were within the normal range. Mean creatinine was 106 mumol./l., mean creatinine clearance was 1.5 ml. per second per m.2 and mean prostate specific antigen was 0.2 ng./ml. No patient had post-void residual urine or a dilated upper urinary tract. CONCLUSIONS: This ileal bladder substitute does not induce long-term metabolic anomalies. However, these results may be due to the short ileal length used in the Camey type I technique and the absence of post-void residual urine obtained by good urinary training (that is sustained voiding function).

Adenocarcinoma↗
PubMed1997

[Value of nephron preservation in conservative surgery of renal tumors].

The increasing use of abdominal ultrasonography and computed tomography results in the increasingly early diagnosis of subclinical renal tumours. These asymptomatic tumours can sometimes be treated conservatively. This technique raises the problem of the multifocal nature of renal tumours In order to assess the real benefit of nephron-sparing surgery in relation to the risk of recurrence, this study evaluates the repercussions of exclusive tumour resection on the nephron number. From 1990 to 1995, 28 patients underwent partial nephrectomy for suspected renal cell carcinoma. Computed tomography was use to estimate the volume and therefore the weight of the kidney and the tumour: weight (g) = volume (mL) = length x width x height/2. The mean age of the patients was 59.1 years. The contralateral kidney was normal in 20 patients (group 1) and the tumour affected a solitary kidney in 8 patients (group 2). The initial serum creatinine level was normal (between 78 and 96) in all patients. The mean weight of the tumour was 16.1 g (13.6 g for group 1 and 22.3 g for group 2), and corresponded to 3.84% of the total kidney weight in group 1 and 9.73% in group 2. 1,400,000 nephrons were preserved in group 1 versus 900,000 nephrons in group 2, equivalent to a glomerular filtration rate of 89 mL/min and 58 mL/min, respectively. Partial nephrectomy therefore constitutes a real nephron-sparing technique. It allows sparing of a sufficient number of nephrons to ensure normal renal function and, most importantly, allows the possibility of subsequent partial surgery in view of the potential risk of multifocal tumours.

Adult↗
PubMed1997

[Infectious risks of outpatient cystoscopy in men with sterile urine].

OBJECTIVE: To prospectively assess the inherent risk of infection associated with outpatient cystoscopy performed in men with sterile urine without antibiotic prophylaxis. MATERIAL AND METHODS: 298 cystoscopies were performed in men corresponding to these criteria, with the exclusion of patients at risk of bacterial endocarditis. The equipment consisted of three cystoscopes prepared according to the recommendations of the Société Française d'Hygiène Hospitalière. The disease justifying the examination was specified for each patient. The sterility of the urine was verified during the week preceding the examination and 48 hours later by urine culture. RESULTS: Out of 281 evaluable patients, an infection was observed in 22 cases (7.8%), and was symptomatic in only one case. Escherichia coli was the organism most frequently isolated (50%) and no multiresistant bacteria were detected. A particularly high infection rate was observed in enterocystoplasty patients (21.7%). CONCLUSION: The infectious risk of cystoscopy in the presence of sterile urine, performed according to recommendations, appears to be higher than previously reported. This risk appears to be significantly higher in the case of enterocystoplasty than for other diseases.

Ambulatory Care↗
PubMed1997

[Nosocomial urinary infections].

The concept of nosocomial urinary tract infection now corresponds to a precise definition. It is generally related to bladder catheterization, constitutes the most frequent form of nosocomial infection (30 to 50% of infections), and represents the third most frequent portal of entry of bacteraemia. The organism most frequently isolated is Escherichia coli; but the flora is changing and the ecological distribution is continually modified. Despite their usually benign nature, these nosocomial infections can nevertheless influence hospital mortality; they increase the hospital stay by an average of 2.5 days and their treatment represents a large share of the antibiotic budget. Prevention of these infections is therefore essential, with particular emphasis on simple and universally accessible measures: very precise indications for vesical catheterization, use of closed circuit drainage, maximal asepsis when handling catheters, after washing the hands.

Adult↗
PubMed1996

Update on the Camey II procedure.

Between January 1987 and January 1991, 110 detubularized U-shaped ileocystoplasties (Camey II) following radical cystectomy were carried out in our Department of Urology (CMC Foch Suresnes, France). Our first evaluation of this procedure was carried out in 1989 and reviewed initial 57 patients operated on. These data were compared with those of the Camey I operation. The improvement in neobladder capacity as well as nighttime urinary control achieved by the detubularization required in the Camey II operation was obvious. In this article we review the first 110 patients treated by Camey II bladder replacement following cystectomy.

Cystectomy↗
PubMed1996

The relationship between sexual life and urinary condition in the French community.

As part of a large, nationwide community-based study in France on health and urinary condition, involving 2011 men aged between 50 and 80 years, information was collected on sexual life factors (e.g., frequency of sexual desires and sexual relations, and the frequency of having difficulties with erection and ejaculation) in addition to an assessment of overall sexual life satisfaction. Data on sexual life were obtained by means of a self-administered questionnaire, while information on the frequency of urinary symptoms was obtained by a professional interviewer. The median number of sexual relations decreased with age from "once per week" in those aged 50-59 years to "less than once per week" in those aged 60-69 years to "never" in those aged over 70 years, while the percentage reporting difficulty with erection at least some of the time increased from 20 to 38% between 50-59 and 70-79 years, respectively. The number of sexual relations during the past month was by far the most important factor having an influence on overall sexual life satisfaction, with those men reporting relations less than once per week almost 10 times more likely to be dissatisfied. Severity of overall urinary symptoms (as well as many individual symptoms) was also inversely related to sexual life satisfaction, and the association persisted after taking account of the strong influence of age and the frequency of sexual relations. All other factors being equal (age, number of relations, comorbidities, and previous prostate surgery), the likelihood of men being dissatisfied with sexual life increased twofold in men with moderate symptoms and fourfold in those with severe symptoms. The results obtained in the current study should be considered preliminary, given the complexity of the relationship between these two factors and the lack of previously published evidence. They certainly call for further studies, which should include a detailed assessment of sexual function and a clinical assessment of the urinary condition.

Aged↗
PubMed1995

[Antibiotic prophylaxis in urology].

There is little reason why the organism could benefit from the presence of micro-organisms in the urine. In the case of severe infection, the consequences can be devastating, both for the health of the individual and for the overall effect in terms of health care costs. There is thus a clear need for a reduction in the number and severity of urinary tract infections by a strictly controlled, well-planned, antibiotic prophylaxy. Beyond well-established rules concerning timing, duration, dose and, in certain cases, indications of antibiotics, there remains a number of questions yet to be fully understood. What is the ecologic impact of antibiotic prophylaxy? What is the original source of infection in patients undergoing multiple procedures? What is the relationship between serum concentrations and efficacy? What is the role of in situ germs and nosocomial agents? These and other questions require rigorously conducted research where not only urologists but also bacteriologists, infectiologists and public health specialists all have an important role to play.

Aminoglycosides↗
PubMed1995

Impact of symptoms of prostatism on level of bother and quality of life of men in the French community.

The impact of symptoms of prostatism on level of bother and quality of life of French men was assessed nationwide, in a representative community sample of 2,011 subjects 50 to 84 years old. Bothersome level and quality of life associated with 12 urinary symptoms were assessed by face-to-face interviews, using a previously validated questionnaire for benign prostatic hyperplasia (BPH). The international prostate symptom score and the American Urological Association (AUA) bothersome index were also computed. Urgency was by far the most bothersome symptom in French men. Nocturia and wetting underclothes ranked second in subjects who did not undergo prostate surgery and among symptomatic patients, respectively. Overall, symptom frequency accounted for 72% of the variability of symptom bother but the form and strength of this correlation varied among symptoms from 0.18 to 0.43. Among the symptomatic subjects who had not yet undergone prostate surgery 11%, 10% and 79%, respectively, were dissatisfied, neutral and satisfied with the current urinary condition. Satisfaction with the urinary condition was positively linked to symptom frequency (p < 0.001) and symptom bother level (p < 0.001). Nocturia, dysuria, daytime repeat voiding, wetting clothes and urgency, when severely bothersome, were independent predictors of decreased satisfaction with the urinary condition (p = 0.01). Approximately half of the patients with severe BPH symptoms expressed serious worries and concerns with the urinary condition, and sizable levels of interference by the symptoms with daily activities, which are potentially affected by urinary troubles. The AUA bother index was the best determinant of subject level of worry about the urinary condition and of interference with daily life. This study supported the concomitant use of the international prostate symptom score and the AUA bother index in further research studies of BPH related impairments in quality of life.

Aged↗
PubMed1995

Determinants of treatment-seeking behaviour for urinary symptoms in older men.

OBJECTIVE: To determine the factors associated with seeking treatment for urinary symptoms among older men in a European population. SUBJECTS AND METHODS: A community survey involving a representative nationwide sample of 2011 French men aged between 50 and 80 years was performed and information collected using an interviewer-administered questionnaire. RESULTS: Visiting a doctor for urinary symptoms was associated with the perceived bothersomeness of urinary symptoms, in addition to and independently of the level of symptom severity. It was also associated with higher socio-economic class. Many partners of men with urinary symptoms were unaware of their condition. CONCLUSIONS: This study emphasizes the importance of including the perception of bother associated with urinary symptoms in addition to urinary severity and provides information useful for inclusion in education programmes on urinary symptoms.

Aged↗
PubMed1995

[T1 G3 bladder tumors: the respective role of BCG and cystectomy].

Forty eight patients with T1 G3 bladder cancer were treated between 1975 and 1991. An associated carcinoma in situ in one third of cases. Twenty six patients received intravesical BCG instillations (an average of 2.5 courses of 6 instillations) with no local recurrence or metastases in 50% of cases (mean follow-up: 54 months). Thirteen patients developed recurrence after a mean disease-free interval of 8 months (range: 3 to 18 months: 7 with disease progression, 5 at an identical stage and 1 Ta. Six cystectomies were performed in this group over the following two years: 3 patients were cured with a mean follow-up of 33 months, 2 died from their cancer, 1 patient is alive with an urethral redux. In view of age and/or clinical context, 7 patients were treated by repeated resections and other local treatments: 3 relapsed without progression, 2 died from their cancer and 2 have been lost to follow-up. Twenty one cystectomies were performed as first-line treatment: 20 patients are recurrence-free with a mean follow-up of 47 months and one patient died from cancer within 6 months. T1 G3 bladder cancer should be considered to be a lesion with a poor prognosis, requiring active treatment. First-line BCG therapy is effective in 50% of cases, but cystectomy is required in the absence of response to BCG.

Adult↗
PubMed1994

[Chemotherapy of bladder tumors].

Chemotherapy of bladder cancer is based on the methotrexate-vinblastine-cysplatinum (M-VAC) protocole. The neo-adjuvant therapy sterilizes 20% of the bladders, but the criteria of effectiveness are not precise enough to recognize the patients. Surgical indications have not been modified by this chemotherapy. The effectiveness of adjuvant chemotherapy has not yet been firmly established; it seems therefore reasonable to reserve it for cancers with poor prognosis. Intravesical chemotherapy has been abandoned to be replaced by BCG.

Antineoplastic Combined Chemotherapy Protocols↗