1
|
Lambert E, Chartier-Kastler E, Vaessen C, Beaugerie A, Cotte J, Rouprêt M, Mozer P, Parra J, Seisen T, Lenfant L. Reply to Carmen Gravina, Matteo Romagnoli, Antonio Nacchia, et al.'s Letter to the Editor re: Edward Lambert, Emmanuel Chartier-Kastler, Christophe Vaessen, et al. Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach. Eur Urol. 2024;85:139-145. Eur Urol 2024; 85:e140-e141. [PMID: 38267281 DOI: 10.1016/j.eururo.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Edward Lambert
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
| | | | - Christophe Vaessen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Juliette Cotte
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Morgan Rouprêt
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Pierre Mozer
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jérôme Parra
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Thomas Seisen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Louis Lenfant
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| |
Collapse
|
2
|
Lambert E, Chartier-Kastler E, Vaessen C, Beaugerie A, Cotte J, Roupret M, Mozer P, Parra J, Seisen T, Lenfant L. Robot-assisted Periprostatic Artificial Urinary Sphincter Implantation in Men with Neurogenic Stress Urinary Incontinence: Description of the Surgical Technique and Comparison of Long-term Functional Outcomes with the Open Approach. Eur Urol 2024; 85:139-145. [PMID: 37914580 DOI: 10.1016/j.eururo.2023.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Periprostatic artificial urinary sphincter implantation (pAUSi) is a rare yet relevant indication for male neurogenic stress urinary incontinence (SUI). OBJECTIVE To describe the surgical technique of robot-assisted pAUSi (RApAUSi) and compare the long-term functional results with the open pAUSi (OpAUSi). DESIGN, SETTING, AND PARTICIPANTS Data of 65 consecutive men with neurogenic SUI undergoing pAUSi between 2000 and 2022 in a tertiary centre were collected retrospectively. SURGICAL PROCEDURE Thirty-three patients underwent OpAUSi and 32 underwent RApAUSi. OpAUSi cases were performed by a single surgeon, experienced in functional urology and prosthetic surgery. RApAUSi cases were performed by the same surgeon together with a second surgeon, experienced in robotic surgery. MEASUREMENTS Outcome measures were achievement of complete urinary continence, intra- and postoperative complications, and surgical revision-free survival (SRFS). RESULTS AND LIMITATIONS RApAUSi showed superior results to OpAUSi in terms of median (interquartile range) operative time (RApAUSi: 170 [150-210] min vs OpAUSi: 245 [228-300] min; p < 0.001), estimated blood loss (RApAUSi: 20 [0-50] ml vs OpAUSi: 500 [350-700] ml; p < 0.001), and median length of hospital stay (LOS; RApAUSi: 5 [4-6] d vs OpAUSi: 11 [10-14] d; p < 0.001). Clavien-Dindo grade ≥3a complications occurred more frequently after OpAUSi (RApAUSi: 1/32 [3%] vs OpAUSi: 10/33 [30%]; p = 0.014). Achievement of complete urinary continence (zero pads) was comparable between the groups (RApAUSi: 24/32 [75%] vs OpAUSi: 24/33 [73%]; p = 0.500). The median follow-up periods were 118 (50-183) and 56 (25-84) mo for OpAUSi and RApAUSi, respectively (p < 0.001). A tendency towards longer SRFS was observed in the RApAUSi group (p = 0.076). The main study limitation was its retrospective nature. CONCLUSIONS RApAUSi is an efficient alternative to OpAUSi, resulting in shorter operative times, less blood loss, fewer severe complications, and a shorter LOS with similar functional results and need for revision surgery. PATIENT SUMMARY Compared with open periprostatic artificial urinary sphincter implantation (pAUSi), robot-assisted pAUSi leads to faster recovery and similar functional results, with fewer postoperative complications.
Collapse
Affiliation(s)
- Edward Lambert
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; J-ERUS/YAU Academic Urologists Working Group on Robot-Assisted Surgery, Paris, France.
| | - Emmanuel Chartier-Kastler
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Christophe Vaessen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Aurélien Beaugerie
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Juliette Cotte
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Morgan Roupret
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Pierre Mozer
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Jérôme Parra
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Thomas Seisen
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| | - Louis Lenfant
- Department of Urology, University Hospital Pitié-Salpêtrière, Paris, France; Faculty of Medicine Sorbonne University, Paris, France
| |
Collapse
|
3
|
Grobet-Jeandin E, Lenfant L, Pinar U, Parra J, Mozer P, Renard-Penna R, Thibault C, Rouprêt M, Seisen T. Management of patients with muscle-invasive bladder cancer with clinical evidence of pelvic lymph node metastases. Nat Rev Urol 2024:10.1038/s41585-023-00842-y. [PMID: 38297079 DOI: 10.1038/s41585-023-00842-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 02/02/2024]
Abstract
Identification of clinically positive pelvic lymph node metastases (cN+) in patients with muscle-invasive bladder cancer is currently challenging, as the diagnostic accuracy of available imaging modalities is limited. Conventional CT is still considered the gold-standard approach to diagnose lymph node metastases in these patients. The development of innovative diagnostic methods including radiomics, artificial intelligence-based models and molecular biomarkers might offer new perspectives for the diagnosis of cN+ disease. With regard to the treatment of these patients, multimodal strategies are likely to provide the best oncological outcomes, especially using induction chemotherapy followed by radical cystectomy and pelvic lymph node dissection in responders to chemotherapy. Additionally, the use of adjuvant nivolumab has been shown to decrease the risk of recurrence in patients who still harbour ypT2-T4a and/or ypN+ disease after surgery. Alternatively, the use of avelumab maintenance therapy can be offered to patients with unresectable cN+ tumours who have at least stable disease after induction chemotherapy alone. Lastly, patients with cN+ tumours who are not responding to induction chemotherapy are potential candidates for receiving second-line treatment with pembrolizumab.
Collapse
Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Louis Lenfant
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Jérôme Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Pierre Mozer
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Raphaele Renard-Penna
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Radiology, 75013, Paris, France
| | - Constance Thibault
- Department of medical oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP centre, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, 75013, Paris, France.
| |
Collapse
|
4
|
Gabriel PE, Pinar U, Lenfant L, Parra J, Vaessen C, Mozer P, Chartier-Kastler E, Rouprêt M, Seisen T. Perioperative, renal function and oncological outcomes of robot-assisted radical nephroureterectomy for patients with upper tract urothelial carcinoma. World J Urol 2023; 41:3001-3007. [PMID: 37676283 DOI: 10.1007/s00345-023-04590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE To report perioperative, renal function and oncological outcomes of robot-assisted radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). METHODS This was a retrospective single-arm monocentric study including all consecutive UTUC patients treated with robot-assisted RNU at our institution between 2014 and 2022. Descriptive statistics with median and interquartile range (IQR) for continuous variables and numbers with frequencies for categorical variables were used to report perioperative and renal function outcomes while Kaplan-Meier curves were computed to present extravesical and intravesical recurrence-free survival(RFS) as well as cancer-specific (CSS) and overall survival (OS) with the corresponding 95% confidence intervals(CIs). RESULTS Overall, 70 patients with a median age of 69.6 [63.3-74.9] years were included in our study. With regards to perioperative outcomes, the median operative time was 157 [130-182] min with a median blood loss of 200 [100-300] cc. Intraoperative complications occurred in 4 (5.7%) patients but no conversion to open or laparoscopic surgery was required. Postoperative complications occurred in 9 (12.9%) patients, including 5 (7.1%) with grade ≥ 3 complications according to the Clavien-Dindo classification. The median length of stay was 4 [3-6] days. With regards to renal function outcomes, the median postoperative loss in estimated glomerular filtration rate at discharge was 16 [10.25-26] mL/min/1.73 m2. With regards to oncological outcomes, the 3-year extravesical and intravesical RFS, CSS and OS rates were 73.6 [62.8-86.2]%, 68.1 [54.6-85]%, 82.5 [72-94.4]% and 75.3 [63.4-89.5]%, respectively. CONCLUSION We report favorable perioperative and oncological outcomes with expected decrease in renal function after robot-assisted RNU for patients with UTUC.
Collapse
Affiliation(s)
- Pierre-Etienne Gabriel
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Ugo Pinar
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Louis Lenfant
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Jérôme Parra
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Christophe Vaessen
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Pierre Mozer
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Thomas Seisen
- Department of Urology, Pitié Salpêtrière Hospital, APHP, GRC 5, Predictive Onco-Urology, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| |
Collapse
|
5
|
Gabriel PE, Pinar U, Parra J, Vaessen C, Mozer P, Chartier-Kastler E, Rouprêt M, Seisen T. [Pathological pelvic lymph node involvement in muscle-invasive bladder cancer patients treated with radical cystectomy: A narrative review]. Prog Urol 2023; 33:145-154. [PMID: 36604248 DOI: 10.1016/j.purol.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To perform a narrative review of the contemporary literature on the diagnosis, prognosis and adjuvant management of muscle-invasive bladder cancer (MIBC) patients with pathological pelvic lymph node involvement (pN+) at radical cystectomy. METHOD A narrative review of the contemporary literature available on Medline was conducted to report studies evaluating the diagnosis, prognosis and/or adjuvant treatments for MIBC patients with pN+ disease at radical cystectomy. RESULTS Open or robotic extended pelvic lymph node dissection up to the crossing of the ureter with common iliac vessels can enhance the diagnosis of pN+ MIBC, especially using separate packages for the submission of a maximum number of lymph nodes. The main prognosis factors for pN+ patients are the number of positive and retrieved lymph nodes, lymph node density, extranodal extension as well as lymph node metastasis diameter. Adjuvant chemotherapy is likely to prolong overall survival in pN+ patients treated with radical cystectomy alone while adjuvant immunotherapy using nivolumab has been shown to decrease the risk of recurrence in all pN+ patients, especially those with ypN+ disease after neoadjuvant chemotherapy followed by radical cystectomy. However, few data are currently available on the role of adjuvant radiation therapy, which remains currently experimental for these patients. CONCLUSION Multiple parameters have been reported to impact the diagnosis and prognosis of patients with pN+ MIBC at radical cystectomy. Adjuvant management is currently based on chemotherapy and immunotherapy with preliminary data on radiation therapy.
Collapse
Affiliation(s)
- P-E Gabriel
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France.
| | - U Pinar
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - J Parra
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - C Vaessen
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - P Mozer
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - E Chartier-Kastler
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - M Rouprêt
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| | - T Seisen
- Sorbonne université, GRC n(o) 5, onco-urologie prédictive, AP-HP, hôpital de la Pitié-Salpêtrière, service d'urologie, 75013 Paris, France
| |
Collapse
|
6
|
Krings G, Ayoub E, Campi R, Rouprêt M, Vaessen C, Parra J, Mozer P. Ureteropelvic junction obstruction and renal calculi: Simultaneous treatment by robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy. Technique description and early outcomes. Prog Urol 2023; 33:279-284. [PMID: 36792487 DOI: 10.1016/j.purol.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) and renal calculi are associated in 20 to 30% of cases and treatment is mandatory. The simultaneous surgical management is a therapeutic challenge that is still a source of controversy. We describe our technique combining robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy (fURS), assessing the feasibility of simultaneous treatment through an original technique. METHODS This single centre series reports our initial experience with 12 patients. From January 2014 to September 2018, 12 patients underwent robot-assisted laparoscopic pyeloplasty with simultaneous fURS for UPJO and renal calculi. Mean age was 46 years (24-68). 92% had multiple renal stones and the mean cumulative stone diameter was 31,3mm. Robot-assisted pyeloplasty was performed with peroperative transcutaneous retrograde fURS through a ureteral access sheath introduced in an incision on the bassinet through a subcostal trocar. Stone extraction was performed using a basket. RESULTS All patients underwent surgery successfully, achieving UPJ repair and complete stone extraction. Mean operating time was 92,5min (85-110). All reported Clavien-Dindo complications were grade 1. Non-contrast enhanced abdominal CT performed 1 month after surgery confirmed the absence of residual stones in all patients. Mean follow-up time was 10 months with no recurrence of UPJO. CONCLUSION This small series confirms the feasibility with good surgical results of concomitant robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde fURS stone extraction. No major complications were observed. This technique is easily reproducible but requires 2 experienced urologists to be achieved in a contained operative time.
Collapse
Affiliation(s)
- G Krings
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Urology Department, CHU UCL Namur, 1 Av Gaston Therasse, 5530 Yvoir, Belgium.
| | - E Ayoub
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - R Campi
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Department of Urology, University of Florence, Careggi Hospital, Urology, Florence, Italy..
| | - M Rouprêt
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013 Paris, France.
| | - C Vaessen
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - J Parra
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France.
| | - P Mozer
- Academic Department of Urology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France; Sorbonne Université, Institut des Systèmes Intelligents et de Robotique (ISIR) UPMC - CNRS/UMR 7222, 75005 Paris, France.
| |
Collapse
|
7
|
Grobet-Jeandin E, Pinar U, Parra J, Rouprêt M, Seisen T. Health-related quality of life after curative treatment for muscle-invasive bladder cancer. Nat Rev Urol 2023; 20:279-293. [PMID: 36653671 DOI: 10.1038/s41585-022-00693-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/19/2023]
Abstract
Muscle-invasive bladder cancer (MIBC) is an aggressive disease for which the gold-standard treatment is radical cystectomy (RC) in combination with cisplatin-based neoadjuvant chemotherapy. Bladder-sparing strategies such as trimodal therapy (TMT) have also emerged to improve health-related quality of life (HRQoL) of patients. However, an improved understanding of the effect of all these treatment modalities on HRQoL is essential to provide personalized patient care. Different combinations of generic, cancer-specific and bladder cancer-specific questionnaires can be used as instruments for HRQoL evaluation in patients with MIBC before and after curative treatments, which can largely affect multiple domains of HRQoL including general health as well as physical, functional, social and emotional well-being. However, diagnosis of MIBC per se is also likely to affect HRQoL, and the perspective of cure after RC or TMT could induce a return to baseline HRQoL values for most of these domains. A considerable amount of data on HRQoL after RC is available, but conflicting results have been reported regarding the effect of urinary diversion (ileal conduit or orthotopic neobladder) and surgical approach (open or robotic surgery) on patient quality of life. Data on HRQoL after TMT are scarce, and additional comparative studies including patients receiving RC (especially using ileal orthotopic neobladder) are needed.
Collapse
Affiliation(s)
- Elisabeth Grobet-Jeandin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France. .,Division of Urology, Geneva University Hospitals, Geneva, Switzerland.
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| | - Jérôme Parra
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France
| |
Collapse
|
8
|
Joyeux L, van der Merwe J, Aertsen M, Patel PA, Khatoun A, Mori da Cunha MGMC, De Vleeschauwer S, Parra J, Danzer E, McLaughlin M, Stoyanov D, Vercauteren T, Ourselin S, Radaelli E, de Coppi P, Van Calenbergh F, Deprest J. Neuroprotection is improved by watertightness of fetal spina bifida repair in the sheep model. Ultrasound Obstet Gynecol 2023; 61:81-92. [PMID: 35353933 DOI: 10.1002/uog.24907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES A contributing factor to unsuccessful prenatal spina bifida aperta (SBA) repair via an open approach may be incomplete neurosurgical repair causing persistent in-utero leakage of cerebrospinal fluid (CSF) and exposure of the fetal spinal cord to amniotic fluid. We aimed to investigate the neurostructural and neurofunctional efficacy of watertight prenatal SBA repair in a validated SBA fetal lamb model. METHODS A well-powered superiority study was conducted in the validated SBA fetal lamb model (n = 7 per group). The outcomes of lambs which underwent watertight or non-watertight multilayer repair through an open approach were compared to those of unrepaired SBA lambs (historical controls) at delivery (term = 145 days). At ∼75 days, fetal lambs underwent standardized induction of lumbar SBA. At ∼100 days, they were assigned to an either watertight or non-watertight layered repair group based on an intraoperative watertightness test using subcutaneous fluorescein injection. At 1-2 days postnatally, as primary outcome, we assessed reversal of hindbrain herniation using magnetic resonance imaging (MRI). Secondary proxies of neuroprotection were: absence of CSF leakage at the repair site; hindlimb motor function based on joint-movement score, locomotor grade and Motor Evoked Potential (MEP); four-score neuroprotection scale, encompassing live birth, complete hindbrain herniation reversal, absence of CSF leakage and joint-movement score ≥ 9/15; and brain and spinal cord histology and immunohistochemistry. As the watertightness test cannot be used clinically due to its invasiveness, we developed a potential surrogate intraoperative three-score skin-repair-quality scale based on visual assessment of the quality of the skin repair (suture inter-run distance ≤ 3 mm, absence of tear and absence of ischemia), with high quality defined by a score ≥ 2/3 and low quality by a score < 2/3, and assessed its relationship with improved outcome. RESULTS Compared with unrepaired lambs, lambs with watertight repair achieved a high level of neuroprotection (neuroprotection score of 4/4 in 5/7 vs 0/7 lambs) as evidenced by: a significant 100% (vs 14%) reversal of hindbrain herniation on MRI; low CSF leakage (14% vs 100%); better hindlimb motor function, with higher joint-movement score, locomotor grade and MEP area under the curve and peak-to-peak amplitude; higher neuronal density in the hippocampus and corpus callosum; and higher reactive astrogliosis at the SBA lesion epicenter. Conversely, lambs with non-watertight SBA repair did not achieve the same level of neuroprotection (score of 4/4 in 1/7 lambs) compared with unrepaired lambs, with: a non-significant 86% (vs 14%) reversal of hindbrain herniation; high CSF leakage (43% vs 100%); no improvement in motor function; low brain neuron count in both the hippocampus and corpus callosum; and small spinal astroglial cell area at the epicenter. Both watertight layered repair and high (≥ 2/3) intraoperative skin-repair-quality score were associated with improved outcome, but the watertightness test and skin-repair-quality scale could not be used interchangeably due to result discrepancies. CONCLUSIONS Watertight layered fetal SBA repair is neuroprotective since it improves brain and spinal-cord structure and function in the fetal lamb model. This translational research has important clinical implications. A neurosurgical technique that achieves watertightness should be adopted in all fetal centers to improve neuroprotection. Future clinical studies could assess whether a high skin-repair-quality score (≥ 2/3) correlates with neuroprotection. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- L Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - J van der Merwe
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - M Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - P A Patel
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - A Khatoun
- Exp ORL, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - M G M C Mori da Cunha
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - S De Vleeschauwer
- Animal Research Center, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - J Parra
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- BCNatal, Fetal Medicine Research Center, Hospital Clinic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - E Danzer
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - M McLaughlin
- Radiology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - D Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - T Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - E Radaelli
- Department of Pathobiology, Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - P de Coppi
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Pediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals, NHS Foundation Trust, London, UK
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - J Deprest
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division of Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
| |
Collapse
|
9
|
Diamant E, Roumiguié M, Ingels A, Parra J, Vordos D, Bajeot AS, Chartier-Kastler E, Soulié M, de la Taille A, Rouprêt M, Seisen T. Correction: Diamant et al. Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer. Cancers 2022, 14, 3797. Cancers (Basel) 2022; 14:cancers14236001. [PMID: 36497499 PMCID: PMC9737656 DOI: 10.3390/cancers14236001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
In the original article [...].
Collapse
Affiliation(s)
- Elliott Diamant
- Sorbonne Université, Department of Urology, GRC n°5 Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
- Correspondence:
| | - Mathieu Roumiguié
- Department of Urology, CHU-Institut Universitaire du Cancer-Oncopôle, 31000 Toulouse, France
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, APHP, UPEC, 94000 Créteil, France
| | - Jérôme Parra
- Sorbonne Université, Department of Urology, GRC n°5 Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Dimitri Vordos
- Department of Urology, University Hospital Henri Mondor, APHP, UPEC, 94000 Créteil, France
| | - Anne-Sophie Bajeot
- Department of Urology, CHU-Institut Universitaire du Cancer-Oncopôle, 31000 Toulouse, France
| | - Emmanuel Chartier-Kastler
- Sorbonne Université, Department of Urology, GRC n°5 Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Michel Soulié
- Department of Urology, CHU-Institut Universitaire du Cancer-Oncopôle, 31000 Toulouse, France
| | - Alexandre de la Taille
- Department of Urology, University Hospital Henri Mondor, APHP, UPEC, 94000 Créteil, France
| | - Morgan Rouprêt
- Sorbonne Université, Department of Urology, GRC n°5 Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - Thomas Seisen
- Sorbonne Université, Department of Urology, GRC n°5 Predictive Onco-Urology, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France
| |
Collapse
|
10
|
Grobet‐Jeandin E, Pinar U, Parra J, Vaessen C, Chartier‐Kastler E, Seisen T, Rouprêt M. Medico‐economic impact of onco‐urological robot‐assisted minimally invasive surgery in a high‐volume centre. Int J Med Robot 2022; 18:e2462. [DOI: 10.1002/rcs.2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Elisabeth Grobet‐Jeandin
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
- Division of Urology Geneva University Hospitals Geneva Switzerland
| | - Ugo Pinar
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Jérôme Parra
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Christophe Vaessen
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Emmanuel Chartier‐Kastler
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Thomas Seisen
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Morgan Rouprêt
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| |
Collapse
|
11
|
Grobet-Jeandin E, Benamran D, Pinar U, Beirnaert J, Parra J, Vaessen C, Seisen T, Rouprêt M, Phé V. Urodynamic assessment and quality of life outcomes of robot-assisted totally intracorporeal radical cystectomy and orthotopic neobladder for bladder cancer: a preliminary study. World J Urol 2022; 40:2535-2541. [PMID: 35994092 DOI: 10.1007/s00345-022-04126-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Few data exist regarding the functional outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder. The aim of this study was to evaluate the urodynamic and functional outcomes in patients undergoing RARC and totally intracorporeal orthotopic neobladder for bladder cancer. METHODS In this monocentric, observational study carried out between 2016 and 2020, consecutive patients undergoing RARC and intracorporeal orthotopic neobladder in the Department of Urology, Pitié-Salpêtrière Hospital, were included. Reconstruction was totally intracorporeal Y-shaped neobladder. Main outcomes were urodynamic findings 6 months post-surgery, continence and quality of life (QoL). Continence was defined by no pad or one safety pad. International Consultation on Incontinence Questionnaire (ICIQ), International Index of Erectile Function questionnaire (IIEF-5) and Bladder Cancer Index (BCI) scores were recorded. RESULTS Fourteen male patients were included (median age: 64 years [IQR 54-67]. Median maximal neobladder cystometric capacity was 495 ml [IQR 410-606] and median compliance was 35.5 ml/cm H2O [IQR 28-62]. All patients had post-void residual volume < 30 ml, except for three (22%) who required clean intermittent-self catheterisation. Daytime continence was achieved in 10 patients (71%) and night-time continence in two (14.3%). Median ICIQ score was 7 [IQR 5-11]. Postoperative erectile function was present in 7% of patients (mean IIEF-5 = 5 [IQR 2-7]). Thirteen patients (93%) were satisfied with their choice of neobladder. CONCLUSION RARC with totally intracorporeal orthotopic neobladder for bladder cancer provides satisfactory urodynamic results and good QoL. These findings should be confirmed long-term.
Collapse
Affiliation(s)
- Elisabeth Grobet-Jeandin
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland.,Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland.,Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Ugo Pinar
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeanne Beirnaert
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.,Service d'Urologie, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Jérôme Parra
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Christophe Vaessen
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Thomas Seisen
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université, GRC n°5, Predictive Oncology, Assistance Publique-Hôpitaux de Paris, AP-HP Sorbonne Université, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France.
| |
Collapse
|
12
|
Lluís N, Parra J, Villodre C, Zapater P, Jalali A, Cantó M, Mena L, Ramia JM, Lluís F. Prediction of peritoneal soiling in acute appendicitis with simple clinical and laboratory data. Prospective, multicenter, cohort study of 2,645 adult patients nationwide. Int J Surg 2022; 104:106741. [PMID: 35772594 DOI: 10.1016/j.ijsu.2022.106741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS In order to facilitate the preoperative prediction of complicated appendicitis, we propose a complementary approach by selecting an endpoint defined by the intraoperative finding of peritoneal soiling (PS). METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending emergency general surgery patients on a 24-hour, 7-days a week basis, enrolled consecutive adult patients requiring appendectomy. Patients were stratified according to the absence or the finding of PS during the surgical procedure. RESULTS A total of 2645 patients were included; median age (IQR) was 35 (22-51) years, 44.3% were female. The laparoscopic approach was used in 70.8% of appendectomies. In a third of patients (31.7%), there was PS with pus around the appendix, or bowel contents, free pus, or blood in the peritoneal cavity. To develop the prediction model, 1764 patients were randomly selected for the derivation cohort and the remaining 881 patients were assigned to the validation cohort. On multivariable logistic regression analysis of all patients, two clinical variables (age, and pulse) and three laboratory variables (serum urea, serum sodium, and white blood cell count) were individually associated (P < .05) with a greater probability of having PS (Hosmer-Lemeshow chi, 1.63; P = .99; C-statistic, 0.7). Based on the multivariable regression model, both static and dynamic nomograms were developed for the prediction of PS in patients with acute appendicitis. CONCLUSIONS The entry of simple clinical and laboratory variables in the dynamic nomogram may be useful in guiding the initial management of patients with acute appendicitis in resource-limited settings.
Collapse
Affiliation(s)
- N Lluís
- Hepatobiliary and Pancreas Surgery, Department of Surgical Oncology, Miami Cancer Institute, Miami, FL, USA
| | - J Parra
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - C Villodre
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
| | - P Zapater
- Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - A Jalali
- School of Mathematical Sciences, University College Cork, Cork, Ireland
| | - M Cantó
- Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - L Mena
- Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - J M Ramia
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - F Lluís
- Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | | |
Collapse
|
13
|
Chmielak B, Suckow S, Parra J, Duarte VC, Mengual T, Piqueras MA, Giesecke AL, Lemme MC, Sanchis P. High-efficiency grating coupler for an ultralow-loss Si 3N 4-based platform. Opt Lett 2022; 47:2498-2501. [PMID: 35561384 DOI: 10.1364/ol.455078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
Integrated silicon nitride waveguides of 100 nm height can achieve ultralow propagation losses below 0.1 dB/cm at the 1550 nm wavelength band but lack the scattering strength to form efficient grating couplers. An enhanced grating coupler design based on an amorphous silicon layer on top of silicon nitride is proposed and demonstrated to improve the directionality of the coupler. The fabrication process is optimized for a self-alignment process between the amorphous silicon and silicon nitride layers without increasing waveguide losses. Experimental coupling losses of 5 dB and a 3 dB bandwidth of 75 nm are achieved with both regular and focusing designs.
Collapse
|
14
|
Benamran D, Grobet-Jeandin E, Msika J, Vaessen C, Parra J, Seisen T, Rouprêt M. Preliminary Outcomes after Same Day Discharge Protocol for Robot-Assisted Partial Nephrectomy: A Single Centre Experience. Urology 2022; 164:145-150. [DOI: 10.1016/j.urology.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
|
15
|
Pattou M, Baboudjian M, Pinar U, Parra J, Rouprêt M, Karsenty G, Phe V. Continent cutaneous urinary diversion with an ileal pouch with the Mitrofanoff principle versus a Miami pouch in patients undergoing cystectomy for bladder cancer: results of a comparative study. World J Urol 2022; 40:1159-1165. [DOI: 10.1007/s00345-022-03954-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
|
16
|
Benarroche D, Paladini A, Grobet-Jeandin E, Vaessen C, Parra J, Seisen T, Pinar U, Roupret M. Robotic vs. open simple prostatectomy for benign prostatic hyperplasia in large glands: Single-centre study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F, Afonso N, Aguilella V, Aguiló J, Alados JC, Alberich M, Apio AB, Balongo R, Bra E, Bravo-Gutiérrez A, Briceño FJ, Cabañas J, Cánovas G, Caravaca I, Carbonell S, Carrera-Dacosta E, Castro EE, Caula C, Choolani-Bhojwani E, Codina A, Corral S, Cuenca C, Curbelo-Peña Y, Delgado-Morales MM, Delgado-Plasencia L, Doménech E, Estévez AM, Feria AM, Gascón-Domínguez MA, Gianchandani R, González C, Hevia RJ, González MA, Hidalgo JM, Lainez M, Lluís N, López F, López-Fernández J, López-Ruíz JA, Lora-Cumplido P, Madrazo Z, Marchena J, de la Cuadra MB, Martín S, Casas MI, Martínez P, Mena-Mateos A, Morales-García D, Mulas C, Muñoz-Forner E, Naranjo A, Navarro-Sánchez A, Oliver I, Ortega I, Ortega-Higueruelo R, Ortega-Ruiz S, Osorio J, Padín MH, Pamies JJ, Paredes M, Pareja-Ciuró F, Parra J, Pérez-Guarinós CV, Pérez-Saborido B, Pintor-Tortolero J, Plua-Muñiz K, Rey M, Rodríguez I, Ruiz C, Ruíz R, Ruiz S, Sánchez A, Sánchez D, Sánchez R, Sánchez-Cabezudo F, Sánchez-Santos R, Santos J, Serrano-Paz MP, Soria-Aledo V, Tallón-Aguilar L, Valdivia-Risco JH, Vallverdú-Cartié H, Varela C, Villar-Del-Moral J, Zambudio N. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg 2022; 97:106168. [PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
Collapse
Affiliation(s)
- C Villodre
- Hospital Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain Hospital Universitario de Badajoz, Badajoz, Spain Hospital Universitario de Bellvitge, Barcelona, Spain Hospital Marina Baixa, Alicante, Spain Hospital Juan Ramón Jiménez, Infanta Elena, Huelva, Spain Hospital Infanta Cristina, Parla, Madrid, Spain Hospital Universitario de Canarias, Tenerife, Spain Hospital Reina Sofía de Córdoba, Córdoba, Spain H. Ramón y Cajal, Madrid, Spain Hospital Parc Taulí de Sabadell, Barcelona, Spain Hospital General Universitario de Alicante, Alicante, Spain Complejo Hospitalario Universitario de Vigo, Hospital Pontevedra, Spain Hospital Trueta de Girona, Girona, Spain Hospital Universitario Rio Hortega, Valladolid, Spain Hospital Mutua Terrassa, Barcelona, Spain Consorci Hospitalari de Vic, Barcelona, Spain POVISA, Pontevedra, Spain Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain Hospital Universitario Basurto, Bizkaia, Spain Hospital Universitario Marqués de Valdecilla, Santander, Spain Hospital de Viladecans, Barcelona, Spain Hospital Clínico de Valencia, Valencia, Spain Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain Hospital Vírgen de la Macarena, Sevilla, Spain Hospital Cabueñes, Gijón, Spain Complejo Hospitalario de Jaén, Jaén, Spain Hospital Universitari Sant Joan de Reus, Tarragona, Spain Hospital Universitario Infanta Sofía, Madrid, Spain Complejo Hospitalario Torrecárdenas, Almería, Spain Hospital Sant Pau i Santa Tecla, Tarragona, Spain Hospital General Rafael Méndez de Lorca, Murcia, Spain Hospital Vírgen del Rocío, Sevilla, Spain Hospital Morales Meseguer, Murcia, Spain Hospital del Vinalopó, Alicante, Spain Hospital Universitario del Vinalopó, Alicante, Spain Hospital Universitario Virgen de las Nieves, Granada, Spain Department of Surgery, General University Hospital of Alicante, Alicante, Spain Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain Computing, BomhardIP, Alicante, Spain Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Benarroche D, Rouprêt M, Chartier-Kastler E, Pinar U, Vaessen C, Seisen T, Parra J. Résultats de l’adénomectomie voie haute par voie laparoscopique robot-assistée : analyse monocentrique. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Petri E, Virto R, Mottura M, Parra J. Comparison of Peracetic Acid and Chlorine Effectiveness during Fresh-Cut Vegetable Processing at Industrial Scale. J Food Prot 2021; 84:1592-1602. [PMID: 34015109 DOI: 10.4315/jfp-20-448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/16/2021] [Indexed: 11/11/2022]
Abstract
ABSTRACT This study was conducted to compare the efficacy of two sanitizing agents, chlorine and peracetic acid (PAA), in reducing spoilage and pathogenic microorganisms and disinfection by-products in the washing stage of three types of minimally processed vegetables: iceberg lettuce, carrots, and baby leaves. These fresh-cut products are consumed uncooked; thus, proper sanitation is essential in preventing foodborne illness outbreaks. The comparison was done at industrial scale with equipment already used in the fresh-cut industry and with washers designed and manufactured for this purpose. Results showed that for washing water hygiene and final product microbial quality, the use of PAA or chlorine had similar efficacy. Different scenarios combining PAA, chlorine, and water were tested, simulating the current industrial processes for each of the tested vegetables. Overall, results confirmed that the use of a sanitizer, PAA or chlorine, in the washing water is effective for the prevention of cross-contamination during the washing process and hence for produce food safety. For final product microbiological quality and shelf life, the use of chlorine or PAA showed no significant differences in lettuce or baby leaves. Chlorinated disinfection by-products in processing water were not formed in significant amounts when washing water was treated with PAA in all scenarios and for all tested vegetables, whereas washing with chlorine (80 mg/L) generated important amounts of trihalomethanes, chlorates, and chlorites. Although chlorates and chlorites were always below the recommended levels or legal limits established for drinking water, trihalomethanes exceeded the legal limits. For perchlorates, values were below the quantification limit in all scenarios. Our results show that PAA is a reliable alternative to chlorine disinfection strategies in the fresh-cut industry. HIGHLIGHTS
Collapse
Affiliation(s)
- E Petri
- R&D&I Area, Centro Nacional de Tecnología y Seguridad Alimentaria (CNTA), Carretera NA-134, Km. 53, 31570 Navarra, Spain
| | - R Virto
- R&D&I Area, Centro Nacional de Tecnología y Seguridad Alimentaria (CNTA), Carretera NA-134, Km. 53, 31570 Navarra, Spain
| | - M Mottura
- Productos Citrosol S.A., Partida Alameda, Parcela C, 46721 Potries, Valencia, Spain
| | - J Parra
- Productos Citrosol S.A., Partida Alameda, Parcela C, 46721 Potries, Valencia, Spain
| |
Collapse
|
20
|
Filfilan A, Anract J, Chartier-Kastler E, Parra J, Vaessen C, de La Taille A, Roupret M, Pinar U. Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area. Prog Urol 2021; 31:1133-1138. [PMID: 34454847 PMCID: PMC8387203 DOI: 10.1016/j.purol.2021.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/24/2021] [Accepted: 08/07/2021] [Indexed: 11/19/2022]
Abstract
Introduction Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. Materials and methods Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions–total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. Results Eighty patients were included. Face-to-face consultations would have resulted in 6699 km (4162 miles) of travel (83.7 km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1 kg CO2e while face-to-face consultation emitted 0.5 kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141 kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112 h (1.4 h/patient). Conclusions Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000 km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. Level of evidence 3.
Collapse
Affiliation(s)
- A Filfilan
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - J Anract
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - E Chartier-Kastler
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - J Parra
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - C Vaessen
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| | - A de La Taille
- Henri Mondor hôpital, urology, hôpitaux universitaires Henri Mondor, AP-HP, 94010 Créteil, France
| | - M Roupret
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France.
| | - U Pinar
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013 Paris, France
| |
Collapse
|
21
|
Vives-Rego J, Vaque MD, Sanchez Leal J, Parra J. Surfactants Biodegradation in Sea Water / Biologischer Tensidabbau in Meerwasser. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1987-240110] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
22
|
Pinar U, Clerget A, Perrot O, Beaud N, Akakpo W, Ruggiero M, Parra J, Vaessen C, Guillot-Tantay C, Conort P, Campedel L, Girault J, Simon J, Maingon P, Renard-Penna R, Mozer P, Chartier-Kastler E, Roupret M, Seisen T. Assessment of physicians’ satisfaction with a virtual tumour board in a French academic centre during the COVID-19 pandemic. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
|
24
|
Pinar U, Anract J, Chartier-Kastler E, Parra J, Vaessen C, De La Taille A, Roupret M. Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Abdessater M, Alechinsky L, Parra J, Malaquin G, Huot O, Bastien O, Barrou B, Drouin SJ. Anatomical variations of the renal artery based on the surgeon's direct observation: A French perspective. Morphologie 2021; 106:15-22. [PMID: 33745846 DOI: 10.1016/j.morpho.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Renal arterial vasculature presents a great anatomical variation. A good knowledge of this anatomy is essential in the field of kidney transplantation. The aim of this study is to describe the anatomical variations of the renal arterial vasculature based on the retrieved but not transplanted kidneys (RNTK) and their contralateral grafted kidneys (CGK), which anatomy is described by surgeons themselves after aortic dissection during multi-organ procurement (MOP). MATERIAL AND METHODS Using the "Crystal" database of the French "Agence de la biomédecine" (ABM), all RNTK were retrospectively selected over one year. Then, the arterial anatomy of each RNTK and their CGK was studied using the surgical and the histopathological reports. The surgical report was completed by the surgeon at the end of the MOP from deceased donors. The qualitative variables were expressed in numbers (percentage of the population) and were compared by a Chi2 test or an exact Fisher test depending on the sample size. A P-value of less than 0.05 was considered statistically significant. RESULTS In total, 356 kidneys were studied (241 RNTK - 115 CGK), 69% had a single artery and 31% had multiple arteries (26% with two arteries and 5% with three or more). The incidence of multiple arteries was similar between the right and left kidneys (32% vs. 30% respectively). A modal arrangement with 1 artery on each side was present in 51% of cases. Thus, 1 in 2 donors had at least 2 arteries on one side. Multiple arteries were bilateral in 12% of cases. The RNTK group presented more kidneys with multiple arteries than the CGK group (35% vs. 22%). CONCLUSION Our study shows a higher incidence of multiple renal arteries than the literature (31% vs. 25%). Thus, MOP can be considered as an accurate and reliable method of describing renal arterial anatomy, especially that some small arteries may be missed when using radiological or cadaveric dissection techniques.
Collapse
Affiliation(s)
- M Abdessater
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France.
| | - L Alechinsky
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France
| | - J Parra
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France
| | - G Malaquin
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis-la-Plaine cedex, France
| | - O Huot
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis-la-Plaine cedex, France
| | - O Bastien
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis-la-Plaine cedex, France
| | - B Barrou
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France.
| | - S J Drouin
- Department of urology and renal transplantation, Sorbonne University, Pitié Salpêtrière University Hospital, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France
| |
Collapse
|
26
|
Pinar U, Anract J, Perrot O, Tabourin T, Chartier-Kastler E, Parra J, Vaessen C, De La Taille A, Roupret M. Évaluation préliminaire de la satisfaction des patients et des médecins concernant l’utilisation de la téléconsultation en urologie pendant la pandémie COVID-19. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
27
|
Abdessater M, Akakpo W, Kanbar A, Parra J, Chartier-Kastler E, Roupret M. Traitement de la maladie de Lapeyronie par les ondes de choc de faible intensité : expérience monocentrique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Bentellis I, Chartier-Kastler E, Guillot-Tantay C, Parra J, Phé V. Cystectomie robot-assistée avec dérivation urinaire non continente trans-iléale intracorporelle chez les patients neuro-urologiques. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
29
|
Tabourin T, Sarfati J, Pinar U, Beaud N, Parra J, Vaessen C, Gomez F, Benamran D, Canlorbe G, Belghiti J, Chartier-Kastler E, Cussenot O, Seisen T, Roupret M. Évaluation du risque de contamination par le coronavirus après chirurgie robotique durant la pandémie COVID-19. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
30
|
Benamran D, Phé V, Drouin SJ, Perrot O, Grégoris A, Parra J, Vaessen C, Seisen T, Rouprêt M. Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review. J Robot Surg 2020; 14:813-820. [DOI: 10.1007/s11701-020-01070-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
|
31
|
Hessler D, Fisher L, Polonsky W, Strycker L, Parra J, Bowyer V, Dedhia M, Masharani U. There is value in treating elevated levels of diabetes distress: the clinical impact of targeted interventions in adults with Type 1 diabetes. Diabet Med 2020; 37:71-74. [PMID: 31314907 DOI: 10.1111/dme.14082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of targeted interventions to reduce high diabetes distress among adults with Type 1 diabetes with a comparison sample of similar but untreated individuals, and to document the stability of untreated diabetes distress over time. METHODS A total of 51 adults with Type 1 diabetes with elevated baseline diabetes distress (distress score ≥ 2.0) and HbA1c levels (≥ 58 mmol/mol) were identified from a longitudinal, non-intervention study, and compared with a similar sample of 51 participants in an intervention study. Both groups completed the T1-DDS diabetes distress questionnaire at baseline and 9 months. RESULTS Large and significant reductions in diabetes distress scores were recorded in the intervention group (mean ± sd change = -0.6 ± 0.6), while minimal change was found in the non-intervention group (-0.2 ± 0.6, group effect P = 0.002; effect size d = 0.67). Additional analyses using the established minimal clinically important difference for the T1-DDS showed that diabetes distress increased significantly (minimal clinically important difference ≥ 1) or persisted at high levels for 51% of participants in the non-intervention group, compared with 23.5% in the intervention group. CONCLUSION Our results showed that targeted interventions led to dramatic reductions in diabetes distress compared with a lack of treatment. We also conclude that elevated diabetes distress, when left unaddressed, does not resolve over time and often remains chronic. (Clinical Trials Registry no.: NCT02175732).
Collapse
Affiliation(s)
- D Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - L Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - W Polonsky
- Behavioural Diabetes Institute, Department of Psychiatry, University of California, San Diego, CA, USA
| | - L Strycker
- Oregon Research Institute, Eugene, OR, USA
| | - J Parra
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - V Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Dedhia
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - U Masharani
- Department of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
32
|
Lenfant L, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, de La Taille A, Roumiguie M, Lesourd M, Taksin L, Misraï V, Granger B, Ploussard G, Vaessen C, Verhoest G, Rouprêt M. Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study. World J Urol 2019; 38:1951-1958. [PMID: 31720765 DOI: 10.1007/s00345-019-02998-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted radical cystectomy (RARC) has been shown to be non-inferior to open radical cystectomy (ORC) for the treatment of bladder cancer (BC). However, most data on RARC come from high-volume surgeons at high-volume centers. The objective of the study was to compare perioperative and mid-term oncologic outcomes of RARC versus ORC in a real-life cohort of patients treated by surgeons starting their experience with RARC. MATERIALS AND METHODS Data were prospectively collected from consecutive patients undergoing RARC and ORC at five referral Centers between 2010 and 2016 by five surgeons (one per center) with no prior experience in RARC. Patients with high-risk non-muscle-invasive or organ-confined muscle-invasive (T2N0M0) bladder cancer were considered for RARC. The main study endpoints were perioperative outcomes, postoperative surgical complications, and mid-term oncologic outcomes. RESULTS Overall, 124 and 118 patients underwent RARC and ORC, respectively. Baseline patients' and tumors' characteristics were comparable between the two groups. Yet, the proportion of patients receiving neoadjuvant chemotherapy was significantly higher in the RARC cohort. Median operative time was significantly higher, while median EBL, LOH, and transfusion rates were significantly lower after RARC. Median number of lymph nodes removed was significantly higher after RARC. All other histopathological outcomes, as well as the rate of early (< 30 days) and late postoperative complications, were comparable to ORC. At a median follow-up of 2 years, 29 (23%) and 41 (35%) patients developed disease recurrence (p = 0.05), while 20 (16%) and 37 (31%) died of bladder cancer (p = 0.005) after RARC and ORC, respectively. CONCLUSIONS With proper patient selection, RARC was non-inferior to ORC throughout the surgeons' learning phase. Yet, the observed differences in oncologic outcomes suggest selection bias toward adoption of RARC for patients with more favorable disease characteristics.
Collapse
Affiliation(s)
- Louis Lenfant
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Riccardo Campi
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Jérôme Parra
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Vivien Graffeille
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Dimitri Vordos
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Alexandre de La Taille
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Mathieu Roumiguie
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Marine Lesourd
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Lionel Taksin
- Hôpital privé d'Antony, 1 rue Velpeau, 92160, Antony, France
| | - Vincent Misraï
- Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France
| | - Benjamin Granger
- Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Sorbonne, Paris, France
| | | | - Christophe Vaessen
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gregory Verhoest
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Morgan Rouprêt
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| |
Collapse
|
33
|
Msika J, Seisen T, Vaessen C, Parra J, Cohen J, Chartier Kastler E, Bitker M, Roupret M. Faisabilité de la prostatectomie totale laparoscopique robot-assistée en unité de chirurgie ambulatoire pour la prise en charge du cancer de prostate. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
34
|
Kaulanjan K, Drouin S, Vaessen C, Parra J, Arzouk N, Tourret J, Ourahma S, Cazenave M, Barrou B. Prélèvement robot assisté du rein de donneur vivant : expérience monocentrique. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
35
|
Lenfant L, Verhoest G, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, De La Taille A, Roumiguie M, Lesourd M, Taksin L, Vaessen C, Ploussard G, Granger B, Rouprêt M. Comparaison des résultats périopératoires entre la reconstruction urinaire intracorporelle et extracorporelle après cystectomie robot-assistée pour cancer de vessie : une étude multicentrique française. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Lenfant L, Verhoest G, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, de La Taille A, Roumiguie M, Lesourd M, Taksin L, Misraï V, Grande P, Vaessen C, Ploussard G, Granger B, Rouprêt M. Perioperative outcomes and complications of intracorporeal vs extracorporeal urinary diversion after robot-assisted radical cystectomy for bladder cancer: a real-life, multi-institutional french study. World J Urol 2018; 36:1711-1718. [PMID: 29744571 DOI: 10.1007/s00345-018-2313-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/26/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To compare perioperative outcomes and complications of extracorporeal (ECUD) vs intracorporeal urinary diversion (ICUD) in patients after undergoing robot-assisted radical cystectomy (RARC) at five referral centers in France. METHODS We retrospectively reviewed our multi-institutional, prospectively-collected database to select patients undergoing RARC between 2010 and 2016 with at least 3 months of follow-up. At each center, the surgery was performed by one surgeon with extensive experience in robotic surgery and radical cystectomy but no prior experience in RARC. RESULTS Overall, 108 patients were included. ECUD and ICUD were performed in 34 (31.5%) and 74 (68.5%) patients, respectively. Patient characteristics were comparable among the two groups, except for a higher proportion of patients with high surgical risk (ASA score ≥ 3) in the ECUD group. Ileal conduit and ileal neobladder were performed in 63/108 (58%) and 45/108 (42%) cases, respectively. Ileal conduit was performed more often with an extracorporeal approach while ileal neobladder with an intracorporeal approach. Overall, operative time, length of hospital stay, positive margin rate, and number of lymph nodes removed did not significantly differ among the two cohorts. Estimated blood loss and transfusion rates were significantly higher in the ECUD group. Rate of early (38.2 vs 47.3%, p = 0.4) and late (29.4 vs 18.9%, p = 0.2) surgical complications did not significantly differ between the ECUD and ICUD groups. Results were comparable in the subgroup analysis in the ileal conduit subpopulation. CONCLUSION In our real-life, multi-institutional study, RARC with ICUD achieved perioperative outcomes and complication rates comparable to those of RARC with ECUD.
Collapse
Affiliation(s)
- Louis Lenfant
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Gregory Verhoest
- Department of Urology, Pontchaillou Hospital, CHU Rennes, Rennes, France
| | - Riccardo Campi
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Jérôme Parra
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Vivien Graffeille
- Department of Urology, Pontchaillou Hospital, CHU Rennes, Rennes, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Dimitri Vordos
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Alexandre de La Taille
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Mathieu Roumiguie
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1 Avenue J Pouilhès, 31059, Toulouse Cedex, France
| | - Marine Lesourd
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1 Avenue J Pouilhès, 31059, Toulouse Cedex, France
| | - Lionel Taksin
- Hôpital privé d'Antony, 1 rue Velpeau, 92160, Antony, France
| | - Vincent Misraï
- Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France
| | - Pietro Grande
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Department of Obstetric and Gynaecological Sciences and Urological Sciences, 'Sapienza' University, Rome, Italy
| | - Christophe Vaessen
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Benjamin Granger
- Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Pitié-Salpétrière Hospital, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.
| |
Collapse
|
37
|
Wafi A, Faron G, Parra J, Gucciardo L. Influence of cervical cerclage interventions upon the incidence of neonatal death: a retrospective study comparing prophylactic versus rescue cerclages. Facts Views Vis Obgyn 2018; 10:29-36. [PMID: 30510665 PMCID: PMC6260668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of prophylactic and rescue cervical cerclages for pregnant patients with an incompetent cervix, and to assess the neonatal outcomes of both clinical conditions. METHODS This was a retrospective observational study of all women who had an elective or rescue cerclage between January 2008 and December 2016 in our institution. Prophylactic cerclage was defined as a cerclage before 16 weeks of gestation, while rescue cerclages were performed between 16 and 23 weeks of gestation. RESULTS In total, we analyzed the outcomes of 212 cervical interventions; 71% of the recruited patients experienced prophylactic cerclage, while 29% underwent rescue cerclage. Most of the patients delivered vaginally (70%) and were able to leave the hospital with a healthy newborn (78%). The mean pregnancy prolongation time after cerclage in the prophylactic and rescue groups were 21 weeks and 10 weeks, respectively. CONCLUSION Prophylactic cerclage interventions are most likely to be associated with a reduction of fetal demise because of the correlation between fetal prognosis and the gestational age at which cerclage is performed. Once the diagnosis of cervical insufficiency is confirmed, cerclage should be recommended as this will help to prolong the pregnancy.
Collapse
Affiliation(s)
- A Wafi
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G Faron
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Parra
- Faculty of Medicine and Pharmacy, Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - L Gucciardo
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
38
|
Tur R, De Grado C, Martin MR, De Castro J, Filipovich E, Segovia B, Ceballos J, Parra J, Revestido R, Alés-Martínez JE. Abstract P3-01-19: Relationship of axillary total tumor load (TTL) by OSNA (one step nucleic acid amplification) in early breast cancer and clinical outcomes using strict Z0011 study criteria for axilla management. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-01-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The study of sentinel lymph node (SNL) assessed by OSNA provides a new variable, Total Tumoral Load (TTL).This variable is defined as the amount of CK19 mRNA copies number in all positives SLN. TTL has been showed to predict the axillary node status and has been analysed to determine its usefulness in the axillary surgical management. Based on TTL values different cut-off points have been proposed (last 25.000 copies) to establish a new tool to practice axillary lymph node dissection (ALND). We present the follow-up data of at least 5 years of breast cancer patients who underwent ALND according, strictly, to Z0011 trial criteria. We hypothesized that there will be no correlation between TTL and locoregional relapse if Z0011 are followed.
Methods: Clinicopathological and follow up data were obtained from patients with invasive breast cancer and SLN assessed by OSNA between 2011 and 2012 at Complejo Asistencial de Ávila, Spain. ALND was decided based on Z0011 study criteria independently of TTL. All patients have been followed for a minimun of 5 years.
Results: A total of 106 patients underwent SN assessed by OSNA, age range 27-85 years (mean 58,96). Of them 90% were ductal, 7,5% lobular and 2% others. By inmunophenotype: Luminal A 55%, Luminal B 28%, Triple Negative 9,4%, Her2 positive 3,7% and Luminal B-Her2 positive 2,8%. TTL was equal to zero in 58 cases and greater than zero in 48 cases with a range of 280-2.700.000 copies. Only 5 cases met ALND criteria (average TTL 68.164). Average TTL in cases without ALND was 111.000. For the time being, none of them has had locoregional relapse (median follow up 65 months). 3 patients have died one metastatic desease (Negative SN), one uterine cervix cancer and one neutropenic fever.
Baseline and outcomes dataVARIABLE N%Age, years (median, range) 59 (27-85) Tumour TypeDuctal9690,5 Lobular87,5 Others21,8InmunophenotypeLuminal A5955,6 Luminal B3028,3 Luminal B-Her232,8 Her243,7 Triple Negative109,4Total Tumoral Load (TTL)=05854,7 >04845,2Axillary Lymph Node Dissection (ALND) 254,7TTL >25.000 2321,7Locoregional relapse 00Overall Survival 95,2
Conclusions:
-Using Z0011 criteria and OSNA no locoregional recurrence has been observed so far.
-TTL did not predict risk of recurrence
-If we had based axillary management only on TTL values (i.e higher than 25.000 copies) we would have unnecessarily increased the number of lymphadenectomies in a 22%.
This is an ongoing study that designed to increased the sample size and obtain longer follow-up data.
Citation Format: Tur R, De Grado C, Martin MR, De Castro J, Filipovich E, Segovia B, Ceballos J, Parra J, Revestido R, Alés-Martínez JE. Relationship of axillary total tumor load (TTL) by OSNA (one step nucleic acid amplification) in early breast cancer and clinical outcomes using strict Z0011 study criteria for axilla management [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-19.
Collapse
Affiliation(s)
- R Tur
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - C De Grado
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - MR Martin
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - J De Castro
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - E Filipovich
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - B Segovia
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - J Ceballos
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - J Parra
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - R Revestido
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| | - JE Alés-Martínez
- Complejo Asistencial de Ávila, Ávila, Spain; Complejo Asistencial de Ävila, Ávila, Spain; Biomedical Investigation Center (CIBER-BBN. ISCIII), Ávila, Spain
| |
Collapse
|
39
|
Lenfant L, Parra J, Verhoest G, Graffeille V, Masson-Lecomte A, Vordos D, Roumiguie M, Lesourd M, Taksin L, Granger B, Ploussard G, Rouprêt M. Comparaison périopératoire de la voie d’abord robotique et de la voie incisionnelle pour le traitement des tumeurs de la vessie infiltrant le muscle : analyse d’une série française multicentrique. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
40
|
Unuane D, Velkeniers B, Bravenboer B, Drakopoulos P, Tournaye H, Parra J, De Brucker M. Impact of thyroid autoimmunity in euthyroid women on live birth rate after IUI. Hum Reprod 2017; 32:915-922. [PMID: 28333271 DOI: 10.1093/humrep/dex033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022] Open
Abstract
Study question Does thyroid autoimmunity (TAI) predict live birth rate in euthyroid women after one treatment cycle in IUI patients? Summary answer TAI as such does not influence pregnancy outcome after IUI treatment. What is known already The role of TAI on pregnancy outcome in the case of IVF/ICSI is largely debated in the literature. This is the first study to address this issue in the case of IUI. Study design, size, duration This was a retrospective cohort study. A two-armed study design was performed: patients anti-thyroid peroxidase (TPO)+ and patients anti-TPO-. All patients who started their first IUI cycle in our fertility center between 1 January 2010 and 31 December 2014 were included. After exclusion of those patients with or being treated for thyroid dysfunction, 3143 patients were finally included in the study. Participants/materials, setting, methods After approval by the institutional review board we retrospectively included all patients who started their first IUI cycle in our center between 1 January 2010 and 31 December 2014 with follow-up of outcome until 31 December 2015. Patients with clinical thyroid dysfunction were excluded (thyroid-stimulating hormone (TSH) <0.01 mIU/l; TSH >5 mIU/l) as were patients under treatment with levothyroxine or anti-thyroid drugs. These patients were then divided into two main groups: patients anti-TPO+ and patients anti-TPO- (= control group). Live birth delivery after 25 weeks of gestation was taken as the primary endpoint of our study. As a secondary endpoint, we evaluated differences in live birth delivery after IUI according to different upper limits of preconception TSH thresholds (<2.5 and <5.0 mIU/l). Furthermore, the influence of thyroid function (TSH, free thyroxine (fT4)), anti-TPO status, age, smoking, BMI, parity, ovarian reserve (anti-mullerian hormone (AMH) and FSH), IUI indication and IUI stimulation on live birth rate was analyzed. Main results and the role of chance Between-group comparison did not show any significant difference between the anti-TPO+ and anti-TPO- group with respect to live birth delivery-, pregnancy- or miscarriage rate with odds ratio at 1.04 (95% CI: 0.63; 1.69), 0.98 (95% CI: 0.62; 1.55) and 0.74 (95% CI: 0.23; 2.39), respectively. In addition, there were no significant differences in live birth delivery-, pregnancy- or miscarriage rate when comparing subgroups according to TSH level (TSH ≥2.5 mIU/l vs. TSH <2.5 mIU/l) with an odds ratio at 1.05 (95% CI: 0.76; 1.47), 1.04 (95% CI: 0.77; 1.41) and 0.95 (95% CI: 0.47; 1.94), respectively. Limitations, reasons for caution This study was powered for the primary aim, live birth rate. The limitations of this study are the absence of region-specific reference ranges for thyroid hormones and the absence of follow-up of TSH values during ART and subsequent pregnancy. Moreover, there was a time difference of 5 months between thyroid assessment and the start of stimulation. The area where the study was conducted corresponds to a mild iodine deficient area and data should be translated with caution to areas with different iodine backgrounds. Wider implications of the findings Our findings indicate comparable pregnancy-, abortion- and delivery rates in women with and without TAI undergoing IUI. Moreover, we were unable to confirm a negative effect of TSH level above 2.5 mIU/l on live birth delivery rate. We therefore believe that advocating Levothyroxine treatment at TSH levels between 2.5 and 4 mIU/l needs to be considered with caution and requires further analysis in a prospective cohort study. Study funding/competing interest(s) No external funding was used for this study. No conflicts of interest are declared.
Collapse
Affiliation(s)
- D Unuane
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - B Velkeniers
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - B Bravenboer
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - P Drakopoulos
- Department of Gynaecology and Fertility, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - H Tournaye
- Department of Gynaecology and Fertility, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - J Parra
- Department of Statistics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium
| | - M De Brucker
- Department of Gynaecology and Fertility, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium.,Department of Obstetrics and Gynaecology, CHU Tivoli, Avenue Max Buset, La Louvière, Belgium
| |
Collapse
|
41
|
Drakopoulos P, van de Vijver A, Parra J, Anckaert E, Schiettecatte J, Smitz J, Blockeel C, Hund M, Verhagen-Kamerbeek W, He Y, Polyzos N, Tournaye H. Effect of GnRH agonist downregulation on serum AMH levels: a prospective cohort study with repeated measurements. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
42
|
Flippot R, Mouawad R, Spano JP, Rouprêt M, Compérat E, Bitker MO, Parra J, Vaessen C, Allanic F, Manach Q, Tannir N, Khayat D, Su X, Malouf G. Expression of long non-coding RNA MFI2-AS1 is a strong predictor of recurrence in sporadic localized clear-cell renal cell carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
43
|
Su X, Zhang J, Mouawad R, Compérat E, Rouprêt M, Allanic F, Parra J, Bitker MO, Thompson EJ, Gowrishankar B, Houldsworth J, Weinstein JN, Tost J, Broom BM, Khayat D, Spano JP, Tannir NM, Malouf GG. NSD1 Inactivation and SETD2 Mutation Drive a Convergence toward Loss of Function of H3K36 Writers in Clear Cell Renal Cell Carcinomas. Cancer Res 2017; 77:4835-4845. [PMID: 28754676 DOI: 10.1158/0008-5472.can-17-0143] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/21/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022]
Abstract
Extensive dysregulation of chromatin-modifying genes in clear cell renal cell carcinoma (ccRCC) has been uncovered through next-generation sequencing. However, a scientific understanding of the cross-talk between epigenetic and genomic aberrations remains limited. Here we identify three ccRCC epigenetic clusters, including a clear cell CpG island methylator phenotype (C-CIMP) subgroup associated with promoter methylation of VEGF genes (FLT4, FLT1, and KDR). C-CIMP was furthermore characterized by silencing of genes related to vasculature development. Through an integrative analysis, we discovered frequent silencing of the histone H3 K36 methyltransferase NSD1 as the sole chromatin-modifying gene silenced by DNA methylation in ccRCC. Notably, tumors harboring NSD1 methylation were of higher grade and stage in different ccRCC datasets. NSD1 promoter methylation correlated with SETD2 somatic mutations across and within spatially distinct regions of primary ccRCC tumors. ccRCC harboring epigenetic silencing of NSD1 displayed a specific genome-wide methylome signature consistent with the NSD1 mutation methylome signature observed in Sotos syndrome. Thus, we concluded that epigenetic silencing of genes involved in angiogenesis is a hallmark of the methylator phenotype in ccRCC, implying a convergence toward loss of function of epigenetic writers of the H3K36 histone mark as a root feature of aggressive ccRCC. Cancer Res; 77(18); 4835-45. ©2017 AACR.
Collapse
Affiliation(s)
- Xiaoping Su
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Jianping Zhang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roger Mouawad
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France.,Fondation AVEC Laboratory, Paris, France
| | - Eva Compérat
- Department of Pathology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France
| | - Frederick Allanic
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France.,Fondation AVEC Laboratory, Paris, France
| | - Jérôme Parra
- Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France
| | - Marc-Olivier Bitker
- Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France
| | - Erika J Thompson
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - John N Weinstein
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorg Tost
- Laboratory for Epigenetics and Environment, Centre National de Recherche en Genomique Humaine, CEA - Institut de Biologie Francois Jacob, Evry, France
| | - Bradley M Broom
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Khayat
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriel G Malouf
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancérologie, AP-HP, Paris, France.
| |
Collapse
|
44
|
Goñi I, Rodríguez R, García-Arnáez I, Parra J, Gurruchaga M. Preparation and characterization of injectable PMMA-strontium-substituted bioactive glass bone cement composites. J Biomed Mater Res B Appl Biomater 2017; 106:1245-1257. [PMID: 28580716 DOI: 10.1002/jbm.b.33935] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022]
Abstract
In most minimally-invasive procedures used to address severe pain arising from compression fractures of the vertebral bodies, such as percutaneous vertebroplasty (PVP), a poly(methyl methacrylate) (PMMA) bone cement is used. Shortcomings of this type of cement, such as high exotherm temperature and lack of bioactivity, are well known. We prepared different formulations of a composite bone cement, whose solid constituents consisted of PMMA beads and particles of a bioactive glass (BG), where 0-20%(w/w) of the calcium component was substituted by strontium. The difference between the formulations was in the relative amounts of the solid phase constituents and in the Sr-content of BG. We determined the influence of the mixture of solid phase constituents of the cement formulation on a collection of properties, such as maximum exotherm temperature (Tmax ), setting time (tset ), and injectability (I). The selection of the PMMA beads was crucial to obtain cement composite formulations capable to be efficiently injected. Results allowed to select nine solid phase mixtures to be further tested. Then, we determined the influence of the composition of these composite bone cements on Tmax , tset , I, and cell proliferation. The results showed that the performance of various of the selected composite cements was better than that of PMMA cement reference, with lower Tmax , lower tset , and higher I. We found that incorporation of Sr-substituted BGs into these materials bestows bioactivity properties associated with the role of Sr in bone formation, leading to some composite cement formulations that may be suitable for use in PVP. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1245-1257, 2018.
Collapse
Affiliation(s)
- I Goñi
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - R Rodríguez
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - I García-Arnáez
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| | - J Parra
- Unidad Asociada CAA-CSIC. Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Complejo Asistencial de Ávila. Hospital Provincial., 05071, Ávila, Spain
| | - M Gurruchaga
- Department of Science and Technology of Polymers, POLYMAT (Institute of Polymeric Materials), Faculty of Chemistry, University of The Basque Country (UPV/EHU), P°Manuel de Lardizabal, 3., 20018, San Sebastián, Spain
| |
Collapse
|
45
|
Pascual A, Guerriero S, Rams N, Juez L, Ajossa S, Graupera B, Hereter L, Cappai A, Pero M, Perniciano M, Errasti T, Parra J, Solis M, Alcázar JL. Clinical and ultrasound features of benign, borderline, and malignant invasive mucinous ovarian tumors. EUR J GYNAECOL ONCOL 2017. [PMID: 29693878 DOI: 10.1002/uog.14971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To compare clinical and sonographic features of benign, borderline, and malignant invasive mucinous ovarian tumors (MOTs). MATERIALS AND METHODS Retrospective observational multicenter study comprising 365 women (mean age: 46.1 years) with a histologically confirmed benign, borderline or malignant invasive MOT. Clinical data (patient's age, patient's complaints), tumor markers (CA-125 and CA-1 9.9), and sonographic data (tumor size, bilaterality, morphology -unilocular, multilocular, unilocular-solid, multilocular-solid and solid-, and IOTA color score) were reviewed and compared among these three groups. Women with ultrasound evidence on intra-abdominal disease spread were excluded. RESULTS Three hundred seventy-eight MOTs (14 women had bilateral lesions) were analyzed. Histologically, 287 tumors were benign, 51 were borderline, and 40 were malignant. No difference in patient's mean age was observed. Women with borderline or invasive tumors were less frequently asymptomatic. Tumors were larger in case of invasive lesions. Borderline and invasive tumors showed solid components and exhibited IOTA color score 3 or 4, more frequently than benign lesions (p < 0.001). However, the authors discovered that 16 out of 51 (31.4%) of borderline tumors and six out of 40 (15.0%) of invasive cancers had no solid components and a color score 1 or 2, and were considered as a benign lesion by the sonolo- gist. On the other hand, 96 out of 287 (33.4%) benign mucinous cystadenoma exhibited solid components and/or a color score of 3 or 4. CONCLUSIONS In spite of statistical differences, the authors observed significant overlapping in ultrasound features among benign, borderline, and invasive ovarian mucinous tumors that renders a difficult accurate preoperative discrimination among these lesions.
Collapse
|
46
|
Drouin S, Raux M, Tourret J, Lebreton G, Coffin G, Cohen J, Arzouk N, Ourahma S, Parra J, Riou B, Leprince P, Barrou B. Transplantation rénale issue de donneurs décédés d’arrêt cardiaque de la catégorie III de Maastricht. Résultats après un an d’expérience. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
Bastard C, Rouprêt M, Kerever S, Bitker M, Parra J, Zorn K, Misrai V. Évaluation comparative des courbes d’apprentissage de la photovaporisation prostatique au laser Greenlight® : résultats d’une étude multicentrique. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Drouin S, Tourret J, Arzouk N, Cohen J, Coffin G, Parra J, Barrou B. L’emploi de la solution de préservation SCOT 15® pourrait réduire l’incidence des rejets aigus en transplantation rénale. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Herrera FV, Ciro J, Parra J. La adición de Enterococcus faecium aumenta la respuesta inmune intestinal en cerdos en crecimiento. ARCH ZOOTEC 2016. [DOI: 10.21071/az.v65i251.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
El destete produce un periodo breve de ayuno y adaptación a una nueva ración sólida, la cual provoca disminución de la supervivencia de los lechones y proliferación de la microbiota patógena. Se ha propuesto la utilización de probióticos, evitando que los seres humanos consuman alimentados tratados con antibióticos. El objetivo de este trabajo fue determinar el efecto de la adición de cepas de probióticos en cerdos en crecimiento sobre las poblaciones celulares del sistema inmune (eosinófilos, basófilos, neutrófilos, monocitos y linfocitos) en intestino delgado. Se sacrificaron 35 lechones escalonadamente los días 1 (21 días de edad), 15 y 30 posdetete, y se extrajo completamente el intestino. Los animales fueron alimentados con dos dietas: dieta comercial con y sin la adición de antibiótico; a esta última se adicionaron los diferentes probióticos (Lactobacillus casei, Lactobacillus acidophilus o Enterococcus faecium) en el agua de bebida. Se utilizó un diseño de bloques al azar en un arreglo de parcelas divididas. Los aislamientos realizados a partir de las muestras intestinales de E. faecium presentaron un mayor número de poblaciones celulares del sistema inmune a nivel intestinal (p<0.01). Además, se realizó medición del pH intestinal, el cual presentó una disminución estadística significativa (p<0.01), donde los animales que consumieron E. faecium presentaron los valores más bajos de pH intestinal, frente a aquellos que consumieron la dieta con adición de antibiótico. La adición de la cepa E. faecium en el alimento de lechones recién destetados, estimula el aumento en el número de poblaciones celulares intestinales del sistema inmune y alcanzan una mayor disminución del pH intestinal.
Collapse
|
50
|
Vuichoud C, Perrouin-Verbe MA, Phe V, Bitker MO, Parra J, Chartier-Kastler E. La dérivation cutanée continente après cystectomie pour cancer, une alternative fiable ? Étude rétrospective monocentrique. Prog Urol 2016; 26:642-650. [DOI: 10.1016/j.purol.2016.09.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/29/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
|