Female urinary incontinence. An overview of a report presented to the French Urological Association.
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Adult↗
Biomedical subjects
P Rischmann
Publications and source records attributed to P Rischmann.
[Place of chemotherapy in the treatment of invasive bladder tumors].
Urothelial bladder tumours are chemosensitive. Chemotherapy is indicated in the case of metastatic bladder cancer. The M-VAC protocol remains the reference treatment. The efficacy of this protocol is estimated to be about 18% in terms of complete responses and 20% of these responding patients achieve long-term survival. New combinations, comprising drugs such as ifosfamide, gallium nitrate, paclitaxel or gemcitabine, appear to be promising. Neoadjuvant and adjuvant chemotherapy cannot be considered to be standard treatment at the present time.
Antineoplastic Combined Chemotherapy Protocols↗
[Changing indications and histological and biological results of radical prostatectomy].
OBJECTIVES: To compare: 1) the incidence of positive resection margins after radical prostatectomy, 2) the incidence of secondary elevation of PSA, in two groups of patients operated before and after May 1994. METHODS: We collected and compared preoperative (PSA, Gleason score on biopsies, positive apical biopsies) and postoperative variables (number and site of positive margins, secondary elevation of PSA) in two historical cohorts of 115 and 67 patients undergoing retropubic radical prostatectomy. RESULTS: We currently operate on tumours characterized by lower PSA values with a smaller proportion of positive apical biopsies. Inversely, the proportion of high Gleason scores appears to be greater, although the difference is not statistically significant. The decreased incidence of positive resection margins and PSA failure rate compared to our initial series reflects the improvement of the oncological results. The respective place of improvement of techniques and changing indications has yet to be defined. CONCLUSION: This study demonstrates the changing operative indications and histological and laboratory results over time. The documented improvement of oncological results is partly related to the progress in surgical indications.
Biopsy↗
[Risk of second non-germ cell cancer after treatment of stage I-II testicular seminoma].
OBJECTIVE: To determine the incidence of second non-germ-cell cancers (SNGC) in patients treated for stage I-II testicular seminoma. MATERIAL AND METHODS: This study is based on 131 evaluable patients treated at the Institut Claudius Regaud between 1970 and 1990. Treatment modalities, including salvage therapy for 6 patients developing recurrence, were as follows: infradiaphragmatic irradiation (infraDI) only in 55 cases, infra- and supradiaphragmatic irradiation (infraDI + supraDI) in 64 cases, and irradiation and chemotherapy (IC) in 12 cases. Five patients were lost to follow-up 4 months to 14 years after primary treatment (mean follow-up: 11 years). The cumulative incidence of SNGC was compared to the overall cancer incidence in the age-matched male population reported in the Tarn Cancer Registry. The relative risk was expressed as the Standardized Incidence Ratio (SIR). RESULTS: The cumulative incidence of SNGC was 10.7% (14/131 patients). SIR was equal to 2.81 (p < 0.001) and increased with the duration of follow-up. SIR was significantly increased in 64 patients treated with infraDI + supraDI (SIR) = 3.25; p = 0.002), but not in the 55 patients treated with infraDI only (SIR = 0.62; p = 0.8). The 12 treated patients with IC had an SIR of 26.2 (p < 0.001). Three of the 4 patients who developed a haematological malignancy belonged to the IC group. CONCLUSIONS: The risk of SNGC is increased after infraDI + supraDI. The risk of SNGC after infraDI only is not increased with a median follow-up of 6 years, but this follow-up is too short to allow any definitive conclusions. The risk of SNGC and particularly haematological malignancy appears to be increased by the combination of radiotherapy and chemotherapy.
Adult↗
[Vascular microsurgery in the treatment of vasculogenic erectile dysfunction: clinical experience apropos of 115 operations performed according to 2 different surgical techniques].
OBJECTIVES: The treatment of vascular erectile insufficiency may require surgery because of the high failure rate of intracavernous injections. Implantation of penile prostheses is a last resort which can be avoided in certain selected patients in whom vascular surgery can be proposed. However, the modalities and results of this type of treatment remain controversial. We therefore evaluated the results of two different techniques. MATERIAL AND METHODS: From 1st January, 1985 to 31st December, 1995, 114 patients were operated for impotence due to pure veno-cavernous incompetence in 23 cases (20%), associated with arterial disease in 38 cases (46%) or purely arterial insufficiency in 39 cases (34%). The mean age was 47.5 +/- 11 years (range: 20 to 74). These patients had suffered from erectile insufficiency for an average of 33.3 +/- 3 years. Pharmacological erection tests achieved rigid erection in only 6 cases. Two surgical techniques were used: end-to-end bypass graft between the epigastric artery and the dorsal artery of the penis (DAP) in 44 cases and arterialisation of the deep dorsal vein of the penis (DVP) in 71 cases. RESULTS: Overall, there were 54 good results (48%), defined by return of normal erections allowing satisfactory sexual intercourse without any complementary treatment, 15 improvements (14%) and 45 failures (38%) with a mean follow-up of 18 months (range: 3 to 120). These results were equivalent in the case of pure veno-cavernous incompetence (65%) of good results) or associated arterial disease (52%) of good results), but poorer results (31% of good results) were obtained in the case of pure arterial disease. The results were not statistically influenced by age or the presence of graft in all 3 types of erectile insufficiency, arterial, veno-cavernous or mixed. However, this difference was only statistically significant for pure veno-cavernous incompetence. The morbidity of arterialisation of the DVP was marked by high-flow syndrome in 21% of cases (n = 15), requiring surgical revision in 77% of cases (n = 11). Interestingly, 85% of good results on erectile function were obtained in this subgroup. CONCLUSION: The results obtained in this series of vascular erectile impotence, regardless of the aetiology of erectile insufficiency, are in favour of the better efficacy of arterialisation of the DVP compared to arterial bypass graft. The biological mechanisms underlying this better result need to be elucidated.
Adult↗
Influence of digital rectal massage on urinary prostate-specific antigen: interest for the detection of local recurrence after radical prostatectomy.
BACKGROUND: Following radical prostatectomy, urinary prostate-specific antigen (uPSA) may originate from periurethral glands or from recurrent carcinomatous prostatic cells. We evaluated massage of the urethro-vesical anastomosis as a uPSA-releasing method for the detection of local recurrence. METHODS: PSA was assessed (PSA IMx, Abbott Diagnostic, Rungis, France) in serum and in the first voided urine before and after massage in 59 patients: 7 after cystoprostatectomy for bladder cancer, 22 with prostate in situ, and 30 after radical prostatectomy for prostate cancer. RESULTS: No significant changes of uPSA were induced by the massage in cystoprostatectomy patients and in 4 radical prostatectomy patients with a negative biopsy of the anastomosis. In contrast, a significant increase of uPSA was observed after massage in the patients with prostate in situ and in 6 radical prostatectomy patients with biopsy-proven local relapse. CONCLUSIONS: uPSA before and after massage of the prostatic fossa may constitute a new and efficient tool for the detection of local recurrence, if these preliminary results are confirmed on a larger scale.
Adult↗
[Surgical treatments of erectile impotence].
Impotence affects 10 to 15% of the male population. Organic factors are recognized in 80% of cases. Intracavernosal injections of vasoactive agents (Virag) have provided advances in the physiopathologic understanding of impotence and provide new ways of treating this incapacity. However this option is inaffective in most organic cases: arteriogenic, venogenic or disorders of smooth cavernous muscle. Vasoactive injections for many reasons are abandoned in about 40% of the cases. Two kinds of surgical management can be performed: microrevascularization in order to restore the arterial penile flow or to reduce penile venous flow during erection; implantation of penile prosthesis when other therapeutic possibilities are exhausted. Arterialization of the deep dorsal vein (DDV) appears to be the best procedure in arteriogenic and principally venous impotence. Erectile function in theses case is restored in 60% of our patients. Two types of prostheses can be implanted: semi-rigid with an axial permanent rigidity and inflatable or hydraulic devices with a flaccid aspect after intercourse. These prostheses are technically successful in 75 to 90% of cases, but partner satisfaction does not match surgical success rates.
Arteriovenous Shunt, Surgical↗
Microrevascularisation of the penis in vascular impotence.
PURPOSE: We evaluated the results of microvascular penile revascularization in impotent men and carefully selected those whose vasculogenic impotence was defined as arteriogenic impotence, veno-cavernous leakage or mixed vasculogenic impotence. MATERIALS AND METHODS: Over a period of 11 y, 114 patients were treated for vasculogenic impotence with two surgical procedures: Michal II arterial bypass (44 patients) and modified Furlow-Fisher technique of deep dorsal vein arterialization (DDVA) (70 patients). Initial evaluation included history, physical and neurological examination, hormonal level determination, pharmacological erection test, Rigiscan, duplex ultrasonography, selective pudendal arteriograpy, dynamic cavernosometry and cavernosography. The patients were followed up for a mean period of 17 months and the results were clinically evaluated. RESULTS: The results at the end of one month were considered as good in 69.5% and improved in 12.2% and failed in 18.3%. Follow-up results are good in 47.8%, improved in 14.6% and failed in 37.4%. The best success rate was obtained with patients with pure venogenic impotence treated with DDVA, whereas the worst was observed in patients with pure arteriogenic impotence treated with the Michal II procedure. DDVA seems to provide better results than arterial bypass regardless of the etiology of impotence. CONCLUSIONS: Penile microvascular revascularization is not the best cure for all impotent men but appears to have a place in the treatment for selected patients with vasculogenic impotence. Further studies will be necessary to define parameters able to permit a better understanding and selection of candidates. DDVA is the most effective procedure to treat surgically vasculogenic impotence although the hemodynamic and biologic consequences of this operation are unknown.
Adult↗
[Examination of the female perineum].
Examination of the female perineum consists of evaluation of the constituent musculo-aponeurotic and sphincteric structures and global assessment of any abnormalities of pelvic and perineal tone. This examination is primarily clinical, starting with guided clinical interview designed to investigate urinary, genital and rectal disorders, based on precise signs followed by detailed examination evaluating trophicity, sensitivity, mobility and tone of support structures and pelvic organs. Complementary investigations (radiological, urodynamic, electrophysiological) are not performed routinely. They should be performed selectively to support or confirm a difficult diagnosis and to objectively assess the results of treatment.
Diagnostic Imaging↗
Results of 51 renal transplants with the use of bowel conduits in patients with impaired bladder function: a retrospective multicenter study.
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Adolescent↗
Microsurgical arterio-arterial and arterio-venous penile revascularization in patients with pure arteriogenic impotence.
OBJECTIVE: To restore physiological erection by performing microsurgical penile revascularization. PATIENTS AND METHODS: The records of 21 patients with pure arteriogenic impotence were reviewed. Thirteen patients with localized obstruction of the internal pudendal or common penile artery underwent a Michal II arterio-arterial penile revascularization. Eight patients with a more distal arterial obstruction underwent a penile deep dorsal vein arterialization (DDVA). The mean follow-up period was 22 months. Surgery was considered successful when the patients had a permeable anastomosis and were able to achieve satisfactory erections resulting in normal intercourse. RESULTS: Potency was restored in eight of the 13 patients who had a Michal II procedure and in five of the eight patients who had a DDVA. Under antithrombotic therapy graft occlusion occurred in four patients. CONCLUSION: Microsurgical penile revascularization restored erectile function in two-thirds of patients in this study. However, further research must be performed to reach a greater understanding of the revascularization process.
Adult↗
Deep dorsal vein arterialization in vascular impotence.
33 patients underwent a penile deep dorsal vein arterialization (DDVA) (11 venous leak, 8 pure arteriogenic impotence, 14 mixed arterial and venous impotence). The mean follow-up was 12 months. Surgery was considered successful when the patients had permeable anastomosis and were able to achieve satisfactory erections resulting in normal intercourse. 92% of the patients with venous leak, 62.5% of those with arteriogenic impotence and 58% with mixed lesions had a successful results. Due to antithrombotic therapy, there was no graft occlusion. Glans hypervascularity occurred in 3 patients and was treated by arterial banding. The role of DDVA in vascular impotence and its functional mechanism are discussed.
Adult↗
Antibodies to bladder-tumor-associated antigens as prognosis probes in the flow-cytometric analysis.
Monoclonal antibodies directed against bladder tumor cells (10D1, 7C12, 6D1, 3C6, G4 and E7) and human leukocyte antigen (HLe1) were tested by flow cytometry on 68 bladder tumors involving 10 grade I, 29 grade II and 29 grade III tumors (WHO classification). According to their evolution stage, these tumors can be subdivided into 17 stage Pa, 34 stage P1, 7 stage P2 and 10 stage P3. Fifteen normal bladder samples were used as a control. Analysis of DNA content revealed a first group of 31 tumors with a unimodal DNA profile. In the second groups of 37 tumors, the DNA profile was bimodal. Cells from grade I tumors were labelled with 10D1 and 6D1 antibodies; all these cells showed a unimodal DNA profile. Grade III tumor cells were labelled with antibodies G4 and E7; most of these cells showed a bimodal DNA profile. The percentage of HLe1-positive cells decreased with the pathological grade and stage of tumor. The composition of infiltrating leukocytes was different in unimodal and bimodal tumors. In conclusion, cells of low-grade tumors can be identified with 10D1 and 6D1 antibodies, and antigens recognized by G4 and E7 antibodies are mostly expressed by aneuploid cells. HLe1 antibody demonstrates the importance of the inflammatory reaction in bladder tumors. Moreover, in flow cytometry, leukocytes within a tumor could be used as internal reference for precise measurement of the DNA content of tumor cells.
Antibodies, Monoclonal↗
[Recurrent urethral stenosis: (technique and indications for the "urolume" Wallstent prosthesis in recurrent urethral stenosis and in obstruction due to benign prostatic hypertrophy)].
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Endoscopy↗
[Microsurgical treatment of impotence of vascular origin].
Impotence of vascular origin may be due to a defect of the arterial blood supply, a cavernous venous leak or a combination of the two phenomena. Several microsurgical techniques have been proposed to restore physiological erectile function, without the use of intracavernous injections of vasoactive drugs or implantation of penile prostheses. We have used this type of surgery in motivated and selected patients for more than 15 years (72 patients treated, 57 patients evaluated after surgery). In patients with impotence of arterial origin, we perform a Michal II arterio-arterial revascularisation in the case of limited proximal or distal lesions with preservation of one of the two dorsal arteries, (13 patients) and arterialisation of the deep dorsal vein of the penis in the case of diffuse distal lesions (8 patients). 62% of positive results were obtained with both forms of revascularisation with a mean follow-up of 22 months. In patients with impotence of venous origin (11 patients), we perform arterialisation of the deep dorsal vein of the penis, with 92% of positive results with a mean follow-up of 12 months. In patients with impotence of arterial and venous origin (25 patients), we carry out a Michal II revascularisation and ligation of the dorsal vein or arterialisation of the dorsal vein achieves 64% and 58% of positive results with a mean follow-up of 12 months and 5 months, respectively. In the light of these results, the authors try to define the place of vascular microsurgery in the treatment of impotence.
Adult↗
[Carcinoma in situ on ureteric stump after cystectomy treated by BCG].
Intravesical BCG is the reference adjuvant therapy for superficial urothelial tumours. Its adverse effects and the modalities of follow-up are now clearly established. We treated a female patient by antegrade BCG instillation for a carcinoma in situ discovered in a ureteric stump following cystectomy for generalised CIS. Treatment was well tolerated and no recurrence was observed with a follow-up of 3 years.
Administration, Intravesical↗
[Cancer of the prostate: curative radiotherapy preceded by lymphadenectomy in 20 patients. Follow-up over 10 years].
Twenty patients with prostatic cancer were treated by external beam radiotherapy after ilioobturator lymphadenectomy. The patients could be divided into two groups: Group I: no lymph node invasion and Group II: presence of lymph node metastases. In Group I, only one death was due to cancer and the 6-year survival was 90%. In Group II, 7 deaths were due to cancer and the 6-year survival was 20%. Secondary endocrine treated administered at the time of recurrence appeared to significantly prolong survival in comparison with the stage D1 cancers treated immediately by endocrine therapy.
Aged↗
Flow cytometry analysis of urothelial cell DNA content according to pathological and clinical data on 100 bladder tumors.
DNA content of 100 bladder tumors (34 grade I, 42 grade II and 24 grade III, WHO classification) were studied by flow cytometry. Ten normal bladder samples were used as control. The 100 bladder tumors could then be separated into two groups. A first group of 60 tumors (60%) had a unimodal distribution with a diploid peak and a DNA index close to 1.0, 32 grade I, 22 grade II and 6 grade III tumors displayed this pattern as did the 10 normal bladders. The second group (40%) had a bimodal distribution with two peaks, the first one (diploid peak) with a DNA index of 1.0, the second (aneuploid peak) with a DNA index greater than 1.0. Two grade I, 20 grade II and 18 grade III tumors belonged to this group. Frequency of the aneuploid peak increased with tumor grade and infiltration progression. Hence 6% of grade I, 48% of grade II and 75% of grade III tumors showed an aneuploid peak as well as 8% of Pa, 46% of P1, 73% of P2 and 87.5% of P3 stage tumors. This study showed that a good correlation exists between flow-cytometric, pathological and clinical data.
Cell Division↗