Sclérothérapie percutanée à l’éthanol des kystes rénaux symptomatiques : résultats à 4 ans

Aspiration-sclerotherapy versus laparoscopic de-roofing in the treatment of renal cysts: which is better?

BACKGROUND

To compare the clinical efficiency between aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) in the management of renal cysts through meta-analysis of comparative studies.

METHOD

A comprehensive literature search was performed by PubMed, MEDLINE, Ovid and Web of Science for relevant studies published up to January 2020. The statistical analyses were conducted with Review Manager 5.3.0 and Stata 15.1. The sensitivity analysis was also carried out to confirm the reliability of this Meta-analysis.

RESULTS

Our searches of literature generated 6 studies (1547 patients incorporated) comparing AS with LD in the impacts of renal cyst therapy. Of these, 6 studies contained 1106 and 441 patients who were treated with AS and LD, respectively. The outcome of this meta-analysis indicated that LD group was superior in symptomatic successful rate [Odds Ratio (OR): 0.28; 95%Confidence Interval (CI): 0.09 to 0.86; P = 0.03), radiological successful rate (OR: 0.06; 95%CI: 0.02 to 0.15; P < 0.01) and recurrence rate (OR: 6.08; 95%CI: 2.81 to 13.15; p < 0.01). Nevertheless, AS group had shorter treatment time [Mean Difference (MD):-51.10; 95% CI:-73.01 to - 29.20; p < 0.01]. No statistically significant difference was showed in the rate of complications (OR: 3.19; 95% CI: 0.39 to 25.88; P = 0.28).

CONCLUSIONS

In our meta-analysis, LD had higher symptomatic successful rate, radiological successful rate as well as lower recurrence rate than AS, while the treatment time was longer.

In-hospital management of acute complicated urinary tract infections

Upper tract urinary tract infections that require hospitalization have been the focus of national recommendations in 2018 by the French society of infectious diseases (Spilf). We here propose to discuss several complex-challenging situations: severe infection with sepsis, pyelonephritis in the pregnant woman, management of infections involving multiresistant bacteria and infection in polycystic kidney disease.

Intraprostatic ethanol injection as an alternative therapy in patients with benign prostatic hyperplasia

INTRODUCTION

Benign prostatic hyperplasia is a high prevalence worldwide pathology. Amongst its therapeutic options, there are minimally invasive techniques that use locally injected substances (such as ethanol), which produce a chemoablation of this organ.

OBJECTIVE

The present work aims to evaluate the efficacy of intraprostatic ethanol injection in the treatment of benign prostatic hyperplasia.

MATERIAL AND METHODS

A prospective study was carried out, consisting of patients with symptomatic benign prostatic hyperplasia, who were injected with 95% ethanol transrectally, in a 25% prostate volume dose, divided into 3punctures per each lobe. Follow-up time was 12 months.

RESULTS

The procedure was well tolerated. The mean urethrovesical catheter stay time was 10.68 days (CI 8.61-13.75, Range 3-30). The score on the international scale of prostatic symptoms improved by 47.58% (p<0.05) and quality of life by 43.94% (p>0.05); prostatic volume was reduced by 35.03% (p<0.05) as well as the post-voiding residual by 58.61% (p>0.05) The maximum urinary flow was increased by 84.83% (p<0.05). The most frequent side effects were hematuria, irritative symptoms and infection.

CONCLUSIONS

Intraprostatic ethanol injection can be an effective, non-surgical alternative in the treatment of patients with benign prostatic hyperplasia.

Ultrasound-Guided Aspiration With and Without Ethanol Sclerotherapy in the Management of Simple Adnexal Cysts: A Single-Center Experience

STUDY OBJECTIVES

To compare the efficacy of ultrasound-guided aspiration versus aspiration with ethanol sclerotherapy in the management of simple adnexal cysts measuring 3 to 10 cm, and to explore the risk factors for recurrence associated with each approach.

DESIGN

A prospective follow-up of patients after cyst aspiration with and without ethanol sclerotherapy in simple adnexal cysts in a single-center trial (Canadian Task Force classification II-1).

SETTING

Bellvitge Teaching Hospital, Barcelona, Spain.

PATIENTS

Cyst aspiration and ethanol sclerotherapy were performed in 66 and 75 patients, respectively, between 2002 and 2014. Women enrolled before March 2009 underwent simple aspiration (group 1), and those enrolled after March 2009 underwent ethanol sclerotherapy (group 2).

INTERVENTIONS

Ultrasound-guided fine-needle aspiration with and without ethanol sclerotherapy.

MEASUREMENTS AND MAIN RESULTS

Potential risk factors for recurrence-age, menopausal status, symptoms, cyst diameter, laterality, aspirated volume, simple US-guided aspiration or alcohol sclerotherapy, and complications-were analyzed by logistic regression. The recurrence rates were analyzed by the Kaplan-Meier and Mantel-Haenszel methods. The overall recurrence rates were 72.7% (48 of 66) in group 1 and 22.7% (17 of 75) in group 2 (p < .0001). Risk factors significantly associated with recurrence were simple aspiration without ethanol sclerotherapy (odds ratio [OR], 19.7; 95% confidence interval [CI], 6.756-57.714), postmenopausal status (OR, 9.3; 95% CI, 1.720-50.956), and cyst size (OR, 1.04; 95% CI, 1.005-1.093).

CONCLUSION

Based on the lower recurrence rate, ethanol sclerotherapy was more efficacious than simple aspiration in the management of simple adnexal cysts measuring <10 cm.