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J J Patard

Publications and source records attributed to J J Patard.

At least 55 records · Page 3Linked to original sources
PubMed1999

Perineal approach to radical prostatectomy in kidney transplant recipients with localized prostate cancer.

Close urologic follow-up of renal transplant candidates and recipients often reveals prostate carcinoma at an early stage. Two patients who underwent renal transplantation for end-stage disease also underwent radical perineal prostatectomy for localized prostate carcinoma, 3 years after grafting in 1 patient and 4 years before grafting in the other. The perineal approach to prostatectomy may facilitate later renal transplantation and avoid allograft damage.

Adenocarcinoma↗
PubMed1999

Results of pyeloureterostomy after ureterovesical anastomosis complications in renal transplantation.

OBJECTIVES: The most frequent urologic complications after renal transplantation involve the ureterovesical anastomosis (ie, leakage, stenosis, and reflux), with a frequency of 1% to 30% in different series. We present the results of pyeloureterostomy using the recipient's ureter. METHODS: From 1988 to 1996, 570 cadaveric renal grafts were performed at our institution. A Lich Gregoir ureterovesical anastomosis was used in every case. Complications involving the anastomosis occurred in 19 cases (3.3%), with 10 stenoses (1.7%), 6 cases of leakage (1.1%), and 3 of reflux (0.5%). The mean donor age was 36.2 years, and the mean duration of cold ischemia was 29.4 hours. The mean recipient age was 41.3 years. Corrective surgery was performed 0.09 years (range 0.01 to 0.22) after transplantation for leakage, 1.13 years (range 0.14 to 5.11) for stenosis, and 5.55 years (range 0.51 to 9.71) for reflux. The recipient's ureter was stented with a ureteral catheter before median laparotomy, except in 3 cases of early leakage (less than 3 days). The recipient's ureter was cut, without the need for ipsilateral nephrectomy, and sutured to the graft pelvis. A nephroureterostomia stent (Gil Vernet stent) (12 cases) or a double J ureteral stent (7 cases) was used for urinary drainage. RESULTS: One graft was lost on day 1 through renal vein thrombosis. Percutaneous nephrostomy was performed on day 2 to clear an obstruction of the double J ureteral stent in one case, and a double J ureteral stent was inserted on day 2 because the nephrouretrostomia stent was incorrectly positioned in another case. Pyelographic controls on day 15 were normal in every case. The mean follow-up was 2.25 years (range 0.24 to 6.1) (2.9 years for leakage, 2.08 years for stenosis, and 1.44 years for reflux). One patient died with a functional graft 3 years after surgery. One graft was lost 4 years after surgery through chronic rejection. There were no complications affecting the ipsilateral kidney. No further ureteral complications occurred after surgery. The mean creatinine level 3 years after surgery was 1.59 mg/dL. CONCLUSIONS: Pyeloureterostomy is a safe and permanent treatment for complications of ureterovesical anastomosis and gives excellent results. The technique requires stenting of the recipient's ureter and graft drainage with a nephroureterostomia stent or a double J ureteral stent.

Adult↗
PubMed1999

Prostate specific antigen levels in the follow up of localised prostate cancer: how does radiotherapy compare to radical prostatectomy?

This study aimed to evaluate tumor progression as assessed by PSA level of curative treatment for localised prostate cancer by either radiotherapy or prostatectomy. From 1987 to 1993, 180 patients were treated for clinically localised prostate cancer either by radiotherapy or prostatectomy. One hundred and five patients with clinical T1T2N0M0 were eligible for this study. Forty five underwent external beam radiotherapy and 60 had a radical prostatectomy. After radiotherapy PSA slowly decreased to reach a nadir 18 months after treatment. Any subsequent increase from this lowest post treatment level is associated with tumor progression. After radical prostatectomy PSA becomes undetectable and any increase will be regarded as evidence of tumor progression. The median PSA level before treatment and the median length of follow-up were comparable for the two groups. There was no statistically significant difference in overall survival and biological evidence of disease progression at 5 y. Analysis of the evolution of median PSA level shows a progressive decline during the 4 y after radiotherapy. After radical prostatectomy PSA become undetectable, 4 y after treatment PSA levels become comparable in the two groups. The biochemical free survival was 60% for the prostatectomy group and 62% for the radiotherapy group. PSA is an effective marker of tumour progression after surgery or radiotherapy for localised prostate cancer. In our retrospective study recurrence rates at 5 y were not significant but direct comparisons are limited due to the Gleason score of the two groups. PSA levels can take up to 4 y to reach a nadir after radiotherapy.

Journal Article↗
PubMed1999

Value of ultrasound-guided systematic sextant biopsies in prostate tumor mapping.

OBJECTIVE: To determine the value of positive sextant biopsies in assessing the location of prostate tumors within radical prostatectomy specimens and to determine if prostate weight influences the results. METHODS: From 1988 to 1996, 166 radical prostatectomies were performed for localized prostate cancer diagnosed by means of ultrasound-guided sextant biopsies. The location of the biopsies was compared with that of tumor tissue within the radical prostatectomy specimen. RESULTS: Of the 996 biopsies, 331 (33%) were positive. The correspondence between the location of the biopsies and that of tumor tissue in the surgical specimen was found to have a sensitivity of 39.4%, a specificity of 81.5%, a positive predictive value of 83.3%, negative predictive value of 36.4% and an accuracy of 52%. For prostates weighing < and >/= 45 g, the sensitivity was 39.9 and 38.9%, the specificity was 88 and 77.2%, the positive predictive value was 90.8 and 76.1%, the negative predictive value was 34.9 and 39.8%, and the accuracy was 52 and 52%, respectively. CONCLUSION: Negative biopsies do not predict a lack of tumor tissue in the corresponding prostate site after radical prostatectomy, and had less value than positive biopsies for prognostic staging before radical prostatectomy. Results of sextant biopsies are more significant for prognosis before radical prostatectomy when positive. Prostate weight influences the interpretation of the results of sextant biopsies.

Aged↗
PubMed1999

[Results of pyeloureteral anastomoses onto the native ureter after complication of ureterovesical anastomosis in kidney transplantation].

OBJECTIVES: Complications of the ureterovesical anastomosis after renal transplantation are the most frequent surgical complications, estimated to occur in 3 to 20% of cases, depending on the series. Various techniques have been used to treat anastomotic leaks, stenoses or reflux. We present the results of pyeloureterostomy using the recipient's own ureter. MATERIAL AND METHODS: 520 cadaver kidney renal transplantations were performed between 1988 and 1996. The ureterovesical anastomosis was performed according to the Lich Gregoir technique. Sixteen recipients (3%) developed an anastomotic complication: 9 stenoses (1.7%), 6 leaks (1.1%), 1 reflux (0.2%). The mean age of the donor was 37 years and the mean cold ischaemia time was 30 hours. There were 8 right kidneys and 8 left kidneys, transplanted in the right iliac fossa in 11 cases and left iliac fossa in 5 cases. The mean age of the recipients was 42 years, and they were transplanted for nephropathy in 15 cases and uropathy in 1 case. Surgical revision was performed 1 month after transplantation for anastomotic leaks and after 14 months for stenoses. In every case, the native ureter was identified by a ureteric catheter via a midline incision except for 3 cases of early anastomotic leak (< 3 days). The native ureter was sectioned without associated ipsilateral nephrectomy then anastomosed to the renal pelvis of the transplant, which was then drained by a Gil-Vernet catheter (10 cases) or ureteric stent (6 cases). RESULTS: One transplant was lost on D1 due to renal vein thrombosis. One nephrostomy was inserted on D2 due to obstruction of the ureteric stent. Follow-up pyelography on D15 was normal in every case. The mean follow-up was 2.5 years (2.9 years for anastomotic leaks, 2.2 for stenoses, 3.6 for reflux). One patient died with a functional renal transplant 3 years after the operation and one transplant was lost due to chronic rejection 4 years later. No complications involving the native kidney ipsilateral to the anastomosis were observed and there were no repeated ureteric complications. Mean creatinine 3 years after the operation was 141 mumol/l. CONCLUSION: Pyeloureterostomy is a reliable technique in the case of complications of the ureterovesical anastomosis. Pyeloureterostomy via a midline incision allowed one-stage definitive treatment of all anastomotic complications of the ureterovesical anastomosis with a low morbidity.

Adult↗
PubMed1999

[Bologna procedure in stress urinary incontinence with stage III cystocele (with or without vaginal hysterectomy)].

OBJECTIVES: The vaginal approach constitutes a solution for all types of urinary stress incontinence (USI). The type of surgery depends on the position of the bladder neck and urethra, the quality of the sphincter and the severity of genital prolapse. The objective of this study was to evaluate the efficacy of the Bologna procedure in the treatment of urinary stress incontinence (USI) with stage III cystocele. MATERIAL AND METHODS: This procedure can repair genital prolapse and USI via a 2 cm suprapubic incision, with vaginal hysterectomy, and intraoperative cystoscopy. The patient is placed in the lithotomy position and a Crossen T-shaped vaginal incision is made releasing the anterior wall and allowing the creation of 2 pedicled vaginal flaps posterior to the urethral meatus. The flaps, passed through the suprapubic pelvic fascia, support the bladder neck by means of 2 nonresorbable sutures to the rectus abdominis muscles. Fifty-four patients were treated by the Bologna procedure with or without vaginal hysterectomy from 1990 to 1996 and were reviewed with a mean follow-up of 30 months (16 to 46 months). All women (mean age: 63.4 years) underwent a preoperative clinical examination, renal ultrasound, cystoscopy and urodynamic assessment (37 cases). RESULTS: Twelve patients developed postoperative complications (9 local infections, 3 cases of deep vein thrombosis with one pulmonary embolism). All complications were treated by local drainage and/or removal of the suspension sutures. Continence was excellent in 45 women (83.3%), improved in 4 (7.4%), and unchanged in 5 (9.3%). The anatomical results were excellent with correction of prolapse in 48 patients (89%). Six patients subsequently developed prolapse of the vaginal dome and 5 complained of voiding discomfort. CONCLUSION: USI and genital prolapse must be treated simultaneously. The vaginal approach is minimally invasive and can treat both diseases during the same operation.

Aged↗
PubMed1999

[Studer's bladder: functional results and morbidity in 33 patients].

OBJECTIVE: Several types of enterocystoplasty can be performed after cystoprostatectomy for cancer. The objective of this study was to evaluate our 8-year experience with Studer's technique. PATIENTS AND METHODS: The medical files of 33 patients were studied retrospectively. The median age was 60 years. Bladder replacement was performed when frozen section histological examination of urethral biopsies was negative. The median follow-up was 41 months. Continence was evaluated by means of a questionnaire. Patients not using any pads or only using pads as a precaution were considered to be diurnally continent, and those using no more than one pad per night were considered to be nocturnally continent. RESULTS: Postoperative surgical morbidity consisted of two pelvic abscesses, two cases of obstructive acute pyelonephritis, one occlusion, and three wound complications. Eight patients developed urethroneovesical stenosis and seven ureters were reimplanted because of stenosis (two right ureters and five left ureters). Diurnal and nocturnal continence rates were 67% and 74% at 12 months, and 80% and 94% at 24 months, respectively. Seven patients developed acute pyelonephritis, renal function deteriorated in one patient (preoperative renal failure) and one patient developed acidosis. CONCLUSION: Studer's technique is a simple technique providing satisfactory functional results while preserving the upper tract by means of a simple and original antireflux system (ileal ureter) with a median follow-up of 41 months, although it was associated with a considerable stenosis and pyelonephritis rate.

Adult↗
PubMed1998

An antigen recognized by autologous CTLs on a human bladder carcinoma.

By stimulating blood lymphocytes with autologous bladder carcinoma cells that had been transfected with B7-1, we obtained a panel of CTL clones which lyse specifically the bladder tumor cells in an MHC class I-restricted fashion. Based on inhibition with anti-HLA Abs and the recognition of allogeneic tumor cells, we could distribute our clones in three groups that recognized three distinct Ags. We characterized one of these Ags by screening a cDNA library prepared with the RNA from this bladder tumor line. This new tumor Ag is a peptide presented by HLA-B4403 molecules. It is produced by a point mutation in a gene that is recorded in databases under the name KIAA0205, is ubiquitously expressed, and whose function is unknown. We also found this mutation in the tumor sample that was originally resected from this patient, but the mutation was not found in the 100 or more independent tumors of various histologic types that were tested. This report is the first to describe the isolation of CTL clones directed against human bladder cancer and the molecular characterization of a bladder tumor Ag.

Antigens, Neoplasm↗
PubMed1998

Immune response following intravesical bacillus Calmette-Guerin instillations in superficial bladder cancer: a review.

Local immunotherapy with bacillus Calmette-Guerin (BCG) can prevent recurrences and progression of superficial bladder cancer, but the antitumoral mechanism of BCG is still unclear. The first event seems to be binding of BCG to urothelial cells via fibronectin, and processing of mycobacterial antigens by antigen-presenting cells. Experimental data suggest that bacterial antigens can also be processed by urothelial cells. CD4 lymphocytes subsequently recognize antigenic peptides presented by HLA class II molecules. The most common profile of urinary cytokines is interleukin-2 and interferon-gamma, suggesting the predominant involvement of the Th1 lymphocyte subpopulation. Natural killer cells, lymphocyte-activated killer cells, BCG-activated killer cells and macrophages are able to kill bladder tumor cells in vitro, but there is no evidence that a major histocompatibility complex (MHC)-restricted specific T cytotoxic response is involved in BCG antitumor activity.

Antigen Presentation↗
PubMed1998

Use of three additional mid biopsies to improve local assessment of prostate cancer in patients with one positive sextant biopsy.

OBJECTIVES: Routine sextant biopsies have proven useful in the diagnosis and local staging of prostate cancer. A single positive biopsy is more frequently associated with a smaller tumor and a low risk of positive margins. Nevertheless, the risk of positive margins in patients with 1 positive sextant biopsy remains high (20%). A better assessment of local invasion is therefore needed. In addition to standard sextant biopsies, we routinely obtain 3 additional mid biopsies from the apex to the base of the prostate. The aim of this study is to analyze the contribution of these 3 additional mid biopsies to local staging. METHODS: From 1988 to 1996, 177 men underwent sextant biopsies plus 3 additional mid biopsies prior to radical prostatectomy; 59 men had 1 positive sextant biopsy, and 13 also had 1-3 positive mid biopsies. The pathological results of the prostatectomy specimens from these 13 men (group A) were compared with those of the 46 men with only 1 positive sextant biopsy (group B), by means of the Fisher and Mann-Whitney tests. RESULTS: The two groups were similar in terms of age, preoperative prostate-specific antigen, the Gleason score of positive biopsies, the weight of the specimen, the Gleason specimen score, tumor volume and pathological stage. Positive surgical margins were found in 53.8% of group A and 19.4% of group B patients (p = 0.002). The location of the positive additional biopsies matched that of the positive surgical margins. CONCLUSIONS: Additional mid biopsies improve the local assessment of prostate cancer in patients with a single positive sextant biopsy, identifying significantly more positive margins when these additional mid biopsies are positive and indicating the location of the positive surgical margins. These informations could be helpful to avoid positive surgical margins during radical prostatectomy.

Aged↗
PubMed1998

[Ureteral reimplantation on psoas bladder: long-term results].

OBJECTIVE: To evaluate indications and long-term results of ureteral reimplantation with psoas hitch bladder. MATERIALS AND METHODS: Between January 1985 and December 1997, we performed psoas-hitch ureteral reimplantation in 18 patients (13 females and 5 males). Mean age was 48 years old. All ureteral injuries involved a pelvic portion of the ureter. The indication was: ureteral injury during gynecological procedures in 5 cases, stricture following open uretero-lithotomy in 3 cases, avulsion of the ureter during ureteroscopy in 1 case, stricture following prior ureteral reimplantation in 3 cases, prostate cancer involving the distal ureter in 1 case, megaureter in 1 case, radiation therapy in 1 case, pelvic and ureteral endometriosis in 3 cases. Treatment consisted to adequate mobilization of the bladder, fixation of the posterolateral corner of the bladder to psoas and ureteral reimplantation with anti-reflux system. In all cases, psoas-hitch ureteral reimplantation has been performed because of an inability to perform end-to-end uretero-ureterostomy or direct uretero-neocystostomy. RESULTS: No complications were observed. At follow-up of 7 months to 12 years (mean 5.7 years) we noticed 13 success (72.4%), 4 improvements (22.2%) and one patient (5.4%) was lost at follow-up. No nephrectomy was done. CONCLUSION: Psoas-hitch bladder ureteral reimplantation is simple, effective and a first-line procedure for the replacement of the long defects of the lower ureter.

Adult↗
PubMed1998

[Conservative treatment of stage III kidney injuries].

OBJECTIVE: The aim of this study is to evaluate the safety and effectiveness of conservative management in stage III renal trauma. MATERIAL AND METHODS: We reviewed the records of 150 patients who presented in our institution with renal trauma between 1986 and 1995. RESULTS: Minor injuries (stage I and II: 100 cases) were treated with expectant management. Only 3 patients required nephrectomy in this group. Stage III injuries were seen in 40 patients. The great majority (85%) were treated conservatively with renal sparing procedures such as endourologic techniques (14 cases), nephrorraphy or partial nephrectomy (20 cases). Total nephrectomy was performed in 15% of the cases and only for severely injured kidney or major associated intraabdominal injuries. In this group, none of the patients suffered from hypertension at follow-up. All patients (10 cases) with pedicle injury (stage IV) required total nephrectomy. CONCLUSION: Stage III renal trauma with urinary extravasation can safely be treated conservatively.

Adolescent↗
PubMed1998

[Contralateral aneurysm-like adrenal gland metastasis of a renal adenocarcinoma].

The authors report a case of adrenal metastasis contralateral to a renal cell carcinoma in a 74-year-old patient who had undergone right radical nephrectomy for renal cell carcinoma. Nine months later, computed tomography revealed a hypervascular mass considered to be an aneurysm of the splenic artery. Arteriography led to the diagnosis of hypervascular adrenal tumour. Left adrenalectomy was performed. Histological examination showed a metastasis from renal cell carcinoma. This is an unusual form of renal cancer metastasis. Its treatment and prognosis are discussed.

Adrenal Gland Neoplasms↗
PubMed1998

[Prostatic specific antigen in practice in 1997].

PSA (Prostate Specific Antigen) has modified the management of prostatic disease. Changes of PSA levels can be observed in many clinical circumstances other than cancer (endoscopic procedures, prostatitis, medications, etc.). Various methods have been proposed to increase the specificity of PSA in prostatic cancer, particularly when the PSA level is between 4 and 10 ng/ml: age-related PSA, PSA density, PSA velocity, freePSA. These methods allow more refined indications for transrectal biopsies of the prostate which provide the histological evidence essential for the diagnosis of cancer.

Adult↗
PubMed1998

[The value of prostatic biopsy in tumor mapping].

OBJECTIVES: Prostatic biopsies, a diagnostic tool, are also used as prognostic elements before radical prostatectomy. Their sites within the prostatic gland constitute one of these prognostic criteria. The authors compared the site of positive prostatic biopsies with that of the tumour after radical prostatectomy in order to study the value of this prognostic factor and the way in which it can be improved. MATERIAL AND METHODS: From 1988 to 1996, 166 localized prostatic tumours treated by radical prostatectomy were diagnosed by 6 systematized ultrasound-guided transrectal biopsies and 3 supplementary median biopsies performed from the base to the prostatic apex. The site of positive biopsies was compared to that of the tumour within the prostatic gland. RESULTS: Of the 996 sextant biopsies performed, 331 (33%) were positive, i.e. 1.99 biopsies per prostate. 92 (19%) median biopsies were positive. 331 positive sextant biopsies corresponded to a tumour within the prostate with a specificity of 81.5%, a sensitivity of 39.4%, a positive predictive value (PPV) of 83.3%, a negative predictive value (NPV) of 36.4% and an accuracy of 52%. For 3 median biopsies, the sensitivity was 70.3%, the specificity was 91.6%, the PPV was 61.9%, the NPV was 94%, and the accuracy was 82%. The weight of the prostate (prostates less than and greater than 45 g), influenced these results, as PPV decreased from 90.8% to 76.1% while NPV increased from 32.9% to 37.8%. CONCLUSION: Negative biopsies in a prostatic zone after 6 randomized biopsies do not exclude the presence of tumour in this zone and cannot be used as a prognostic element before radical prostatectomy for the therapeutic management. The presence of negative biopsies in a prostatic zone must be interpreted by taking the prostatic weight into account. 3 median biopsies are more accurate and less influenced by prostatic weight.

Aged↗
PubMed1998

[Outcome of renal function in 114 patients who underwent uninephrectomy for renal cancer].

OBJECTIVE: To evaluate the medium-term and long-term impact of radical nephrectomy on renal function and to identify prognostic factors able to help predict deterioration of renal function in patients treated for renal cancer by radical nephrectomy, with a functionally and morphologically healthy remaining kidney. MATERIAL AND METHODS: Between January 1992 and June 1996, 114 patients (72 males, 42 females) with renal cancer were treated by radical nephrectomy. The contralateral kidney was healthy. The mean age of the patients was 64 years (31-85 years). Pre- and postoperative renal function was assessed by serum creatinine assay, in micromol/l. RESULTS: 105 patients were alive (16 with metastases) and 9 had died. The mean follow-up of the survivors was 19.6 months (3-53 months). A slight elevation of mean serum creatinine was observed in this group after nephrectomy compared to preoperative figures (117.9 micromol/l versus 95.6 micromol/l). 37 patients (35.2%) had a postoperative serum creatinine greater than or equal to 121 micromol/l, most of them were elderly, male (81%) and/or hypertensive (43%) and/or diabetic (11%). 6 (5.7%) of these 37 patients had a serum creatinine greater than or equal to 170 micromol/l and all were hypertensive and/or diabetic. CONCLUSION: This study shows that HT, diabetes, advanced age and male sex constitute risk factors for deterioration of renal function. The indication for conservative surgery for T1 T2 N0 M0 tumours should be discussed in the presence of these factors. In their absence and provided the remaining kidney is healthy, renal function remains relatively stable after radical nephrectomy for cancer.

Adult↗
PubMed1998

[Improvement over time of oncological results after radical prostatectomy: what are the responsible factors?].

OBJECTIVES: The histological results after radical prostatectomy constitute one of the main prognostic factors. We studied the course of these results over time in order to assess their improvement and to identify the factors responsible. MATERIAL AND METHODS: 175 radical prostatectomies were performed between 1989 and 1996. The preoperative assessment for each patient comprised clinical examination, PSA assay, and histological examination of 6 ultrasound-guided transrectal biopsies. All radical prostatectomy specimens were analysed according to the Stanford technique by the same pathologist: the weight of the prostatectomy specimen, the Gleason score, existence of capsular effraction, seminal vesicle invasion, positive lymph node dissection and the presence of positive surgical margins were studied. The results were studied and compared year by year using Student's test and the Chi-square test. RESULTS: From 1989 to 1996, stages pT1-pT2 increased from 40 to 81.8%, while the positive resection margin rate decreased from 80 to 18.1%. No difference was observed over time for weight and Gleason score. Among the preoperative factors, no difference was observed for age of the patients, number of positive biopsies and Gleason score of these biopsies. Only the mean preoperative PSA level decreased from 52.2 to 12.2 ng/ml (t = 0.0001) and the number of stage T1c tumours increased from 13.3 to 59%. CONCLUSION: The preoperative PSA level is the main factor explaining improvement of the oncological results, especially as the tumours operated between 1988 and 1996 were identical in terms of aggressiveness (Gleason score). This improvement of the results reflects better patient selection, although this selection is performed case by case without exclusive factors.

Aged↗