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Marc Zerbib

Publications and source records attributed to Marc Zerbib.

At least 19 recordsLinked to original sources
PubMed2006

Identification of risk factors for voiding dysfunction following TVT placement.

OBJECTIVE: To determine preoperative risk factors of postoperative voiding dysfunction after tension-free vaginal tape (TVT) procedure. METHODS: In 2004, 100 patients with genuine stress urinary incontinence underwent surgery by the TVT procedure. Preoperative and postoperative urodynamic study was performed for each patient. Postoperatively, patients' perception of result and quality of life were assessed on two validated scales, namely, Mesure du Handicap Urinaire (MHU) and Ditrovie. Voiding dysfunction was defined by a postoperative peak flow rate of <15 ml/s at 3 mo. Clinical and urodynamic parameters were compared and analysed. RESULTS: At 3 mo, 20 patients (20%) showed evidence of voiding dysfunction despite the absence of clinical symptoms in 14 of them (70%). Multivariate analysis showed that age (p<0.038) and preoperative peak flow rate (p<0.001) were independent risk factors for voiding dysfunction. Parity, menopausal status, body mass index, and maximal urethral closure pressure were not statistically related to the risk of voiding dysfunction. CONCLUSIONS: This study confirms the existence of an important rate of postoperative voiding dysfunction, mostly asymptomatic, and identifies age and preoperative maximal peak flow rate as independent preoperative risk factors. Identification of voiding dysfunction in patients may lead to better follow-up and early detection of late potential complications of suburethral procedures.

Female↗
PubMed2006

Can pT0 stage of prostate cancer be predicted before radical prostatectomy?

OBJECTIVES: To report our experience with biopsy-proven pT0 prostate cancer over the last 10 yr. METHODS: We retrospectively analysed a series of 1950 consecutive patients treated with radical prostatectomy (RP) for clinically localized prostate cancer between 1996 and 2005 at our institution. The patients without residual tumour on RP specimen were defined as pT0 patients. The group of pT0 patients was compared with a control group of 295 patients operated consecutively during the same period. RESULTS: Overall, 11 (0.5%) patients were classified as pT0 on pathologic examination of the RP specimen. There was no pT0 tumour in the control group. Among the pT0 patients, five characteristics were particularly frequent: T1c clinical stage (90.9%), prostate-specific antigen (PSA) or=60 g (100%). All these characteristics were present in 8 of the 11 (72.7%) pT0 patients, while they were present in only 12 of the 295 (4.1%) controls. These parameters, when combined together, had a sensitivity of 72%, a specificity of 96%, and an accuracy of 99% for the prediction of pT0 stage. With a mean follow-up of 30 months after RP, no pT0 patient had clinical or biologic evidence of prostate cancer. CONCLUSIONS: In our experience, the rate of pT0 tumours after RP is 0.5%. The combination of clinical stage, preoperative PSA, number of positive biopsy cores, Gleason score, and prostate weight could help to predict pT0 stage after RP.

Aged↗
PubMed2006

Management of a malignant urinary fistula by ureteral embolization with coils.

We report the case of a 42-year-old man with a synovial sarcoma of the prostate, metastatic at presentation, who after aggressive chemotherapy followed by extensive surgery developed a complex pelvic fistula involving the lower ureter, bladder, and enteral structures. The patient was a poor candidate for surgery because of his short life expectancy and poor health status. Conservative management with bilateral nephrostomy tubes did not allow sufficient fistulous output for symptomatic relief. Using the percutaneous access already in place, we performed bilateral ureteral embolization with coils. Complete ureteral occlusion was obtained with a minimally invasive procedure and allowed total symptomatic relief.

Adult↗
PubMed2006

[Does transrectal MRI before radical prostatectomy modify the operative technique to decrease the positive margin rate?].

OBJECTIVE: To determine the value of magnetic resonance imaging (MRI) in the surgical management of prostate cancer patients. PATIENTS AND METHODS: 159 patients with prostate cancer underwent transrectal MRI before retropubic radical prostatectomy (RP). Patients operated despite a suspicion of extraprostatic extension on MRI had a modified non-nerve-sparing surgical technique. Postoperative histological findings were compared to MRI data. RESULTS: 34/159 patients (21.4%) had suspected extraprostatic extension in MRI. The pT3 rate on the RP specimen was significantly higher for patients with abnormal MRI than for patients with normal MRI (61% versus 39%, p = 0.02). Among pT3 patients, the positive surgical margin rate was significantly lower in the group with abnormal MRI than in the group with normal MRI (24% versus 51%, p = 0.035). CONCLUSIONS: Among patients with stage pT3 on the RP specimen, those in whom extraprostatic extension was suspected on MRI were treated by a modified surgical technique resulting in a lower positive surgical margin rate.

Aged↗
PubMed2005

Evolution of health-related quality of life two to seven years after retropubic radical prostatectomy: evaluation by UCLA prostate cancer index.

To determine changes in health-related quality of life (HRQOL) in patients treated with retropubic radical prostatectomy (RP) between two and seven years after surgery. A questionnaire from the University of California Los Angeles Prostate Index was sent to 142 patients previously treated with retropubic RP as mono-therapy for clinically localized prostate cancer. Patients were divided into five groups according to time from surgery. Demographics, clinical and pathological characteristics of patients were compared between these groups. Correlation coefficients controlled for age at the time of questionnaire between HRQOL scores and time from RP were assessed. A total of 105 patients (74%) returned the questionnaire. The mean time from surgery was 48 months (range 25-84). Demographics, clinical and pathological characteristics of patients were not statistically different between time groups. Several recoding items were found to decrease significantly with the time from RP including physical functioning, role limitations due to physical health problem, vitality, and general health. In contrary, urinary, bowel and sexual scores were not significantly correlated to time from RP. Although sexual, urinary and bowel scores seem to remain stable from 2 to 7 years following RP, general health appears to significantly deteriorate with time after RP, independent of the patient's age at the time of the questionnaire.

Aged↗
PubMed2005

Outcome of patients with fortuitous prostate cancer after radical cystoprostatectomy for bladder cancer.

OBJECTIVES: To analyze the outcome of patients after fortuitous diagnosis of prostate cancer (PCa) on cystoprostatectomy (CPT) specimen. METHODS: The medical charts of 141 male patients who underwent radical CPT for urothelial cell carcinoma of the bladder between january 1995 and april 2000 were retrospectively reviewed. None of the patients had preoperative clinical or biological suspicion of PCa. RESULTS: Pathological examination of the CPT specimens showed PCa in 20 patients (14.2%). Of these, 6 had a microfocal PCa, 10 had a pT2a tumour, 2 had a pT2b tumour, and 2 had a pT3a tumour. The Gleason score was < or =5 in 5 cases, 6 in 13 cases, and 7 in 2 cases. Two patients were lost to follow-up. Ten patients died of bladder cancer after a median follow-up of 13 months. Eight patients remained free of disease after a median follow-up of 64.5 months. None of the 20 patients experienced PCa recurrence during follow-up. CONCLUSIONS: In our experience, the rate of unsuspected PCa on cystoprostatectomy specimens was 14.2%. The majority of these PCas were organ-confined, and there was no PCa recurrence during follow-up.

Aged↗
PubMed2005

Negative prostatic biopsies in patients with a high risk of prostate cancer. Is the combination of endorectal MRI and magnetic resonance spectroscopy imaging (MRSI) a useful tool? A preliminary study.

OBJECTIVE: Repeated biopsies in patients with a high risk of prostate cancer only allow a small proportion of new cancer diagnosis. The aim of this study was to evaluate the use of combined MRI and magnetic resonance spectroscopy imaging (MRSI) for these patients. METHODS: Between April 2003 and April 2004, 42 patients with negative multiple cores prostatic biopsies and serum PSA>4 ng/ml underwent a combined MRI/MRSI analysis. Suspicious zones on standard MRI included low intensity signals on T2 weighted images. A high choline+creatine-to-citrate ratio defined a MRSI suspicious zone. A 10 cores following peripheral biopsy scheme was done to which were added supplementary biopsies on the MRI/MRSI suspicious zones. RESULTS: The mean age was 62.3 years (51-74), the mean pre-biopsy serum PSA was 12 (3.87-35), the mean free/total PSA ratio was 11% (5-20). The mean number of previous prostate biopsy rounds was 2.04. 15 prostate cancers were diagnosed (35.7%). In 9 cases, abnormal MRI/MRSI findings and positive biopsy sites were located on the same prostatic zones. In 5 cases, MRSI alone located the positive biopsy zones. Sensitivity of combined MRI/MRSI in this study was 73.3%; specificity, positive predictive value, negative predictive value and accuracy were 96.3%, 91.6%, 86.6% and 88% respectively. CONCLUSIONS: This preliminary study shows that the combination of MRI and MRSI might be able to guide and therefore limit the number of iterative biopsies and cores for patients who are at high risk of having a prostate cancer. In some cases, MRSI alone allows identification of neoplasic prostatic zones. Other studies are needed to confirm these data.

Aged↗
PubMed2005

Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: long-term experience.

OBJECTIVES: To analyze the oncologic results of intermittent androgen deprivation (IAD) for biochemical recurrence after radical prostatectomy (RP). METHODS: A total of 57 patients with biochemical recurrence after RP have been treated with IAD at our institution. The 57 patients were divided into two groups: group 1 comprised 29 patients who received salvage radiotherapy after RP; group 2 comprised 28 patients who did not receive salvage radiotherapy. Hormonal therapy during the first treatment phase consisted of an antiandrogen alone. This treatment was maintained for 3 months after the prostate-specific antigen (PSA) level had become undetectable and was then discontinued. Hormonal therapy was resumed when the PSA level exceeded 4 ng/mL; treatment was discontinued when the PSA level dropped to less than 1 ng/mL. RESULTS: The patients in group 1 had less favorable characteristics than those in group 2 in terms of pathologic stage and Gleason score. Overall, the median follow-up after starting hormonal therapy was 92 months (range 36 to 176). The percentage of each cycle that was spent "off" treatment decreased from 60% to 50%. During follow-up, 38.6% of patients required a luteinizing hormone-releasing hormone analog for nonresponse to the antiandrogen alone, and 15.8% experienced metastatic progression. The cancer-specific mortality rate was 12.3%; all patients who died of prostate cancer were from group 1. The median interval between initiation of hormonal therapy and cancer-related death was 86 months. CONCLUSIONS: In our experience, IAD for biochemical recurrence after RP provided satisfactory long-term oncologic results. Our data suggest that IAD can be initiated with an antiandrogen alone.

Aged↗
PubMed2005

[GnRH analogs and prostate cancer treatment].

Prostate cancer is currently the main indication of LH-RH analogs. This class, which in recent years has replaced diethylstilbestrol and surgical castration, now plays a major role at all stages of the disease. Numerous studies with contradictory results have compared total hormonal blockage, an alog combined with an anti-androgen, with analog alone in locally advanced prostate cancer. A recent metaanalysis showed a slight though globally non-significant advantage in favour of total blockage, but with a significant advantage in the case of a nonsteroidal anti-androgen. In stage T3 cancers, adjuvant hormone therapy over three years in combination with radiotherapy versus external radiotherapy alone was more effective in terms of local or metastatic progression and survival. Institution during radiotherapy and a prolonged duration of treatment gives a greater benefit though this was only significant for the subgroup of patients with a Gleason score > or = 8. For localized stages but at high risk (PSA > 15 ng / ml and\or Gleason score > 7), adjuvant hormone therapy after prostatectomy improved recurrence-free survival in comparison with prostatectomy followed-up by simple monitoring. On the other hand, the administration of analogs two or three months before radical prostatectomy did not seem to provide any additional benefit. Medical castration prolonged by LH-RH analogs engenders multiple side effects which become all the more worrying as patient survival is prolonged by this hormone therapy. In phase I-II studies, intermittent treatment is equivalent to continuous treatment for "hormone sensitive" patients (PSA nadir at six months < 0.5 ng). Phase III studies are in progress to confirm this equivalence. This intermittent hormone therapy may be a useful solution for elderly patients (> 78 years old) with a biologically highly active cancer and remains to be evaluated in relatively young subjects after radical prostatectomy or radiotherapy. Combination of analogs with chemotherapy has been used very recently for patients who have reached hormonal escape and may be a useful immediate option for patients with cancers with a high risk of progression.

Antineoplastic Agents, Hormonal↗
PubMed2005

Combination of gemcitabine and oxaliplatin in urothelial cancer patients with severe renal or cardiac comorbidities.

Clinical trials in urothelial cancer exclude a large population of patients. An observational study evaluated the behavior of frail patients not eligible for cisplatin- or carboplatin-based regimens. Urothelial cancer patients requiring chemotherapy with either chronic renal failure (creatinine clearance <60 ml/min), and/or performance status (PS) > or =2 and/or cardiac dysfunction were prospectively observed. The treatment associated gemcitabine 1200 mg/m and oxaliplatin 85 mg/m, bimonthly (GO). Over 2 years, 31 of 45 (69%) patients with urothelial cancer requiring chemotherapy were not eligible for cisplatin- or carboplatin-based chemotherapy. Sixteen (52%) had a PS > or =2, 23 (74%) had creatinine clearance <60 ml/min, and 20 (65%) had an underlying cardiopathy. A total of 178 cycles of GO were administered (median 6 per patient, range 2-12). No aggravation of renal or cardiac status was noted. Acute grade 3 and 4 neutropenia and thrombocytopenia were observed in 16 and 13% of patients, respectively, with one febrile neutropenia. The median progression-free and overall survival values were 4.2 and 9.5 months, respectively. The majority of urothelial cancer patients have severe renal or cardiac comorbidities, and we conclude that in this subset of patients the combination of gemcitabine and oxaliplatin is well tolerated, and its clinical activity warrants further evaluation.

Aged↗
PubMed2005

[Results of open radical nephrectomy in a series of 230 patients].

OBJECTIVE: To analyse the oncological results of open radical nephrectomy for renal cancer PATIENTS AND METHODS: Between December 1989 and June 2003, open radical nephrectomy for renal cancer was performed by the same operator in 230 patients. Cancers treated by partial nephrectomy were excluded from this study. The operation was performed via a lumbar incision in 95.7% of cases. Surveillance consisted of clinical examination and thoracic and abdominopelvic computed tomography twice a year for the first two years, then annually for 3 years, and then at 7 years and at 10 years in the absence of recurrence. RESULTS: With a median follow-up of 63.1 months, the 5-year and 10-year recurrence-free survival rates were 88.4% and 67.2%, respectively. Tumour size, tumour stage (TNM 1997), Fuhrman's nuclear grade, histological type of cancer, and the presence of suggestive signs were correlated with the recurrence-free survival rate. The 10-year recurrence-free survival rate was zero in patients with visceral or lymph node metastases at the time of diagnosis. The patient's age at the time of diagnosis and the presence of a paraneoplastic syndrome did not influence recurrence free survival in this series. CONCLUSIONS: This study confirms the data of the literature: tumour size, tumour stage, nuclear grade, histological type, and suggestive signs are prognostic factors of renal cancer. Radical nephrectomy ensures a global 5-year recurrence-free survival rate higher than 85%.

Adult↗
PubMed2005

[Results of the AMS 800 artificial urinary sphincter in men, based on a series of 47 patients].

INTRODUCTION: Male urinary incontinence due to sphincter incompetence is usually secondary to prostate surgery. After failure of other treatments, severe sphincter incompetence requires placement of an artificial urinary sphincter The authors present the results of the AMS 800 artificial urinary sphincter based on a series of 47 consecutively operated patients. PATIENTS AND METHODS: From 1990 to 2003, 47 AMS 800 were inserted by the same operator and according to the same technique. The aetiologies of urinary incontinence were: radical prostatectomy (45% of cases), transurethral resection of the prostate (36%), open prostatectomy (10.5%), and others (8.5%). RESULTS: The mean age of the patients was 65 years. The mean follow-up was 36 months. The mean time to insertion was 3 years and 10 months (range: 5 months-15 years). 23.4% of patients presented one or several complications (mechanical failure: 19%; infection; 10.6%; erosion: 4%; bladder stones: 2%), 21% of patients required one or several surgical revisions after a mean interval of 25.5 months (range: 2-80 months). The actuarial 5-year revision rate was 25.5%. With a mean follow-up of 36 months, 98% of patients had a functioning artificial urinary sphincter and 83% still had their original artificial urinary sphincter Social continence and patient satisfaction rates were 87% and 95.7%, respectively. CONCLUSION: These results are comparable to those of similar published series. The AMS 800 is associated with high continence and patient satisfaction rates and currently remains the reference treatment for refractory sphincter incompetence in men.

Adult↗
PubMed2005

[Leiomyosarcoma of the renal pelvis].

Leiomyosarcoma of the renal pelvis is an exceptional tumour, as only 3 cases have been reported in the literature. The authors report a new case and discuss the differential diagnoses and prognosis of this lesion.

Aged↗
PubMed2005

[Anaemia and prostatic cancer].

Abnormal laboratory parameters are frequently observed during the course of prostate cancer. Anaemia, often due to multifactorial causes, develops progressively and essentially depends on the stage of the disease and the therapeutic strategy. Androgen deprivation can induce a reduction of haemoglobin that can sometimes be severe, especially in the case of complete hormonal blockade. At a time when the extension of the indications for hormonal blockade in combination with external beam radiotherapy in localized prostate cancers appears to be confirmed, the long-term adverse effects need to be monitored more closely. External beam radiotherapy is also responsible for a fall in haemoglobin, which depends on the dimensions of the irradiation field and the volume of bone marrow included in the field. However progress in irradiation techniques should result in decreased haematological toxicity. Anaemia inevitably affects the patient's quality of life and also appears to have a negative impact on local control of localized prostate cancer treated by external beam radiotherapy. The indications for early and preventive management of anaemia must be defined. Furthermore, as treatment of advanced disease is based on symptomatic treatment and improvement of quality of life, correction of anaemia must also be considered as part of palliative care.

Anemia↗