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Graffeille V, Verhoest G, Gryn A, Kammerer-Jacquet SF, Alimi Q, Beauval JB, Beuzit L, Pradère B, Thoulouzan M, Khene ZE, Guille F, Rioux-Leclercq N, Mathieu R, Gamé X, Bensalah K, Soulié M, Roumiguié M, Peyronnet B. Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes. Urol Int 2021; 106:122-129. [PMID: 33626547 DOI: 10.1159/000512053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study was to assess the impact of complete transurethral resection of bladder tumors (TURBTs) before radical cystectomy on pathological and oncological outcomes of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC. MATERIALS AND METHODS The charts of all patients who underwent radical cystectomy for bladder cancer in 2 academic departments of urology between 1996 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the completeness of the last endoscopic resection before radical cystectomy: macroscopically complete transurethral resection (complete) or macroscopically incomplete transurethral resection (incomplete). The primary end point was the recurrence-free survival (RFS). Secondary end points included cancer-specific survival (CSS) and rates of pT0 and downstaging. RESULTS Out of 486 patients included for analysis, the TURBT immediately preceding radical cystectomy was considered macroscopically complete in 253 patients (52.1%) and incomplete in 233 patients (47.9%). In multivariate analysis, macroscopically complete TURBT was the strongest predictor of both pT0 disease (OR = 3.1; p = 0.02) and downstaging (OR = 7.1; p < 0.0001). After a median follow-up of 41 months, macroscopically complete TURBT was associated with better RFS (5-year RFS: 57 vs. 37%; p < 0.0001) and CSS (5-year CSS: 70.8 vs. 54.5%; p = 0.002). In multivariate analysis adjusting for multifocality, weight of endoscopic resection specimen, cT4 stage on preoperative imaging, interval between endoscopic resection and radical cystectomy, neoadjuvant chemotherapy, pT stage, and associated carcinoma in situ, macroscopically complete endoscopic resection remained the main predictor of better RFS (HR = 0.4; p = 0.0003) and the only preoperative factor associated with CSS (HR = 0.5; p = 0.01). CONCLUSION A macroscopically complete TURBT immediately preceding radical cystectomy may improve pathological and oncological outcomes in patients with MIBC and high-risk MIBC.
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Affiliation(s)
- Vivien Graffeille
- Department of Urology, University Hospital of Rennes, Rennes, France,
| | - Grégory Verhoest
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Alexandre Gryn
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | | | - Quentin Alimi
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Luc Beuzit
- Department of Radiology, University Hospital of Rennes, Rennes, France
| | - Benjamin Pradère
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Zine Eddine Khene
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - François Guille
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Romain Mathieu
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Xavier Gamé
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Michel Soulié
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France
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Nouhaud FX, Chakroun M, Lenormand C, Ouzaid I, Peyronnet B, Gryn A, Prudhomme T, Grafeille V, Soulié M, Roumiguié M, Verhoest G, Xylinas E, Bouzouita A, Chebil M, Pfister C. Comparison of the prognosis of primary vs. progressive muscle invasive bladder cancer after radical cystectomy: Results from a large multicenter study. Urol Oncol 2020; 39:195.e1-195.e6. [PMID: 33214030 DOI: 10.1016/j.urolonc.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/18/2020] [Revised: 08/03/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess whether progressive and primary muscle invasive bladder cancer (MIBC) have different prognosis after radical cystectomy or not. To date only a few data are available on this topic with conflicting results. Further studies on large cohort are needed to clarify these outcomes that may influence bladder cancer management for these patients. MATERIAL AND METHODS A multicentre retrospective study was conducted on patient treated for MIBC at 5 centres between 2005 and 2015 by radical cystectomy. Patients' outcomes were compared between patients with primary MIBC vs. progressive MIBC subsequent to a history of non-muscle invasive bladder cancer (NMIBC). RESULTS A total of 1197 patients were included. Median (IQ) age was 65 (58-72) years and median follow-up was 65 months. Baseline characteristics were similar between the groups as well as the Tumour pT stage, N status and positive surgical margins. Patients with progressive MIBC had worse overall survival (OS) (hazard ratio [HR] 1.36, [95%CI 1.10-1.76]; P = 0.004), cancer specific survival (CSS) (HR 1.41 [1.13-1.78]; P = 0.002), and recurrence-free survival (RFS) (HR 1.21 [1.01-1.49]; P = 0.05). Pathological stage ≥pT3, positive surgical margins, and positive lymph nodes status (pN+) were also found as predictors of OS, CSS, and RFS. CONCLUSIONS Our results suggest that patient having a progressive BC have a worse prognosis in terms of OS, PFS, and CSS than patient with primary disease. These 2 groups may require different management and patients with high risk NMIBC should be assessed properly to avoid progression and be offered early cystectomy.
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Affiliation(s)
| | | | | | - Idir Ouzaid
- Department of Urology, Bichat University Hospital, Paris, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Alexandre Gryn
- Department, of Urology, Toulouse University Hospital, Toulouse, France
| | - Thomas Prudhomme
- Department, of Urology, Toulouse University Hospital, Toulouse, France
| | - Vivien Grafeille
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Michel Soulié
- Department, of Urology, Toulouse University Hospital, Toulouse, France
| | - Mathieu Roumiguié
- Department, of Urology, Toulouse University Hospital, Toulouse, France
| | - Grégory Verhoest
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | | | - Mohamed Chebil
- Department of Urology, Tunis University Hospital, Tunis, Tunisia
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Prudhomme T, Roumiguié M, Gas J, Gryn A, Crenn G, Gamé X, Soulié M, Thoulouzan M, Huyghe E. Comparaison de la surrénalectomie cœlioscopique rétropéritonéale et de la surrénalectomie cœlioscopique transpéritonéale : sont-elles toutes les deux aussi sûres ? Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.213] [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]
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Goujon A, Schoentgen N, Betari R, Gryn A, Vanalderwerelt V, Oumakhlouf S, Toulouzan M, Brichart N, Pradere B, Soulie M, Fournier G, Saint F, Bensalah K, Bruyere F, Joulin V, Nouhaud F, Huygue E, Manunta A, Peyronnet B. Laparoscopic adrenalectomy for adrenal metastasis: Comparison of the transperitoneal vs. retroperitoneal approaches. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33188-8] [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] Open
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Prudhomme T, Roumiguié M, Crenn G, Gryn A, Gas J, Bouhanick B, Amar J, Chamontin B, Vezzosi D, Bennet A, Caron P, Soulié M, Thoulouzan M, Huyghe E. Comparison of retroperitoneoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy: Are they both equally safe? A university center experience. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33187-6] [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] Open
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Chebbi A, Peyronnet B, Giwerc A, Freton L, Hutin M, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Matillon X, Caes T, Patard PM, Szabla N, Brichart N, Boehm A, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Rod X, Fiard G, Pradere B, Pfister C, Nouhaud FX. Observation vs. early drainage for grade IV blunt renal trauma: a multicenter study. World J Urol 2020; 39:963-969. [PMID: 32447442 DOI: 10.1007/s00345-020-03255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/22/2020] [Accepted: 05/11/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The aim of this study was to compare observation and early drainage by ureteral stenting in patients with blunt renal trauma and urinary extravasation. MATERIALS AND METHODS A retrospective national multicenter study was performed including all patients admitted for renal trauma at 17 hospitals between 2005 and 2015. Patients presenting with a urinary extravasation on initial imaging were considered for inclusion. Patients were divided in two groups according to the initial approach: observation vs. early drainage by ureteral stent (within 48 h after admission). The primary endpoint was the persistence of urinary extravasation on follow-up imaging. RESULTS Out of 1799 patients with renal trauma, 238 were included in the analysis (57 in the early drainage and 181 in the observation group). In the early drainage group, 29 patients had persistent urinary extravasation vs. 77 in the observation group (50.9% vs. 42.5%; p value = 0.27). The rates of secondary upper urinary tract drainage did not differ significantly between the early drainage group (26.4%) and the observation group (16%) (p = 0.14). There were no statistically significant differences between the two groups in terms of secondary nephrectomy (0% vs. 2.8%; p = 0.34), and death from trauma (0% vs. 1.8%; p = 0.99). In multivariate analysis, early drainage remained not statistically associated with persistence of urinary extravasation on follow-up imaging (OR = 1.35; p = 0.36) CONCLUSION: In this multicenter cohort, observation was not different from early drainage in terms of persistent urinary extravasation after grade IV blunt renal trauma. Further randomized controlled prospective trials are needed to confirm these findings.
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Affiliation(s)
- Ala Chebbi
- Urology, University of Rouen, Rouen, France.
- Service d'urologie, Hopital Charles Nicolle, 37 boulevard Gambetta, 76000, Rouen, France.
| | | | | | | | - Marine Hutin
- Urology, University of Montpellier, Montpellier, France
| | | | | | - Marina Ruggiero
- Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | | | | | - Reem Betari
- Urology, University of Amiens, Amiens, France
| | | | | | | | | | | | | | - Laura Sabourin
- Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Cédric Lebacle
- Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | | | - Xavier Rod
- Urology, University of Nantes, Nantes, France
| | - Gaelle Fiard
- Urology, University of Grenoble, Grenoble, France
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Freton L, Pradere B, Fiard G, Chebbi A, Caes T, Hutin M, Olivier J, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Patard PM, Szabla N, Brichart N, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Rod X, Nouhaud FX, Matillon X, Peyronnet B. [Renal Trauma]. Prog Urol 2019; 29:936-942. [PMID: 31668829 DOI: 10.1016/j.purol.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Renal traumas are common, observed in 10% of patients with abdominal trauma. Most renal traumas are blunt, resulting from a direct hit or from an abrupt deceleration. MATERIAL AND METHODS We realized a synthesis of renal trauma management for nurses. RESULTS Clinical presentation often encompasses gross hematuria and lumbar pain. The best diagnostic tool is computed tomography (CT) urogram. Based on CT urogram images, renal traumas are classified according to the American Association for the Surgery of Trauma (AAST) classification in five grades of increasing severity. The management is conservative in the vast majority of cases and has been largely simplified over the past few years, being now mostly based on observation. Radiological interventional and endoscopic procedures are used only in very selected cases and surgical exploration has become extremely rare. CONCLUSION The prognosis has also considerably improved and renal trauma rarely result in death or loss of the kidney nowadays.
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Affiliation(s)
- L Freton
- Service d'urologie, université de Rennes, 35000 Rennes, France.
| | - B Pradere
- Service d'urologie, PRES Centre Val-de-Loire, CHRU de Tours et université François-Rabelais de Tours, 37000 Tours, France
| | - G Fiard
- Service d'urologie, université de Grenoble, 38700 Grenoble, France
| | - A Chebbi
- Service d'urologie, université de Rouen, 76000 Rouen, France
| | - T Caes
- Service d'urologie, université de Lille, 59000 Lille, France
| | - M Hutin
- Service d'urologie, université de Montpellier, 34000 Montpellier, France
| | - J Olivier
- Service d'urologie, université de Lille, 59000 Lille, France
| | - M Ruggiero
- Service d'urologie, université de Paris Sud, CHU de Bicêtre, 94270 Paris, France
| | - I Dominique
- Service d'urologie, université de Lyon, 69002 Lyon, France
| | - C Millet
- Service d'urologie, université de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - S Bergerat
- Service d'urologie, université de Strasbourg, 67000 Strasbourg, France
| | | | - R Betari
- Service d'urologie, université de Brest, 29200 Brest, France
| | - P-M Patard
- Service d'urologie, université de Toulouse, 31300 Toulouse, France
| | - N Szabla
- Service d'urologie, université de Caen, 14033 Caen, France
| | - N Brichart
- Service d'urologie, CHR d'Orléans, 45100 Orléans, France
| | - L Sabourin
- Service d'urologie, université de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - K Guleryuz
- Service d'urologie, université de Caen, 14033 Caen, France
| | - C Dariane
- Service d'urologie, université de Paris-Descartes, 75006 Paris, France
| | - C Lebacle
- Service d'urologie, université de Paris Sud, CHU de Bicêtre, 94270 Paris, France
| | - J Rizk
- Service d'urologie, université de Lille, 59000 Lille, France
| | - A Gryn
- Service d'urologie, université de Toulouse, 31300 Toulouse, France
| | - F-X Madec
- Service d'urologie, hôpital Saint-Joseph, 75014 Paris, France
| | - X Rod
- Service d'urologie, université de Nantes, 44000 Nantes, France
| | - F-X Nouhaud
- Service d'urologie, université de Rouen, 76000 Rouen, France
| | - X Matillon
- Service d'urologie, université de Lyon, 69002 Lyon, France
| | - B Peyronnet
- Service d'urologie, université de Rennes, 35000 Rennes, France
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Misraï V, Pasquie M, Bordier B, Guillotreau J, Gryn A, Palasse J, Bruguière E, Pradere B, Rouprêt M, Zorn KC. Accuracy of the preoperative PSA level for predicting clinically significant incidental transitional zone-prostate cancer before endoscopic enucleation of very large adenoma. World J Urol 2019; 38:993-1000. [PMID: 31139906 DOI: 10.1007/s00345-019-02823-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/17/2019] [Accepted: 05/24/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To analyse the accuracy of high preoperative PSA levels for predicting transitional zone incidental PCa (TZ-PCa) in men with very large prostates. MATERIALS AND METHODS Perioperative data from 375 consecutive patients who underwent endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction between July 2013 and December 2018 were retrospectively reviewed. Patients were stratified into three groups according to the preoperative PSA level: low-PSA (< 4 ng/mL), intermediate-PSA (4 ≤ PSA < 10 ng/mL) and high-PSA (≥ 10 ng/mL). Men in each group were propensity score matched by age, 5α-reductase inhibitor (5-ARI) use, prostate volume and mpMRI. The TZ-PCa incidence rate was retrospectively compared by preoperative PSA level in a propensity score model including all predetermined variables. RESULTS Age, prostate volume, 5-ARI use were similar between patient groups. The median PSA levels in the low-, intermediate- and high-PSA groups were 3 [2.3; 3.4], 6.6 [5.3; 8.1] and 12.7 [11; 16.7] ng/mL, respectively. The median prostate volume was > 100 grams in all groups (108, 105 and 120 cc, respectively). The T1a-Gleason 6 incidental TZ-PCa rate was statistically comparable between the three groups (3.4, 5.1 and 8.6% in the low-, intermediate- and high-PSA groups, respectively). The detection rate of clinically significant TZ-PCa was low for preoperative PSA levels > 4 ng/mL (1.7%); with no difference between the intermediate- and high-PSA groups. CONCLUSION In men with large glands, the clinically significant incidental TZ-PCa detection rate was similar regardless of the preoperative PSA level stratum. Such details may help with patient counselling during BPH surgical management.
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Affiliation(s)
- Vincent Misraï
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France.
| | - Marie Pasquie
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Benoit Bordier
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | | | - Alexandre Gryn
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | | | - Eric Bruguière
- Department of Radiology, Clinique Pasteur, Toulouse, France
| | | | - Morgan Rouprêt
- Urology Department, Hôpital Pitié-Salpêtrière, Sorbonne Université, GRC N°5, ONCOTYPE-URO, AP-HP, 75013, Paris, France
| | - Kevin C Zorn
- Brunswick Science and Technology, Montreal, QC, Canada
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Peyronnet B, Schoentgen N, Betari R, Gryn A, Goujon A, Vanalderwerelt V, Oumakhlouf S, Thoulouzan M, Brichart N, Pradère B, Rammal A, Soulié M, Fournier G, Saint F, Bensalah K, Bruyère F, Joulin V, Nouhaud F, Huyghe E, Manunta A. L’origine de la tumeur primitive et la taille tumorale sont les deux facteurs pronostiques associés aux résultats oncologiques après surrénalectomie pour métastase surrénalienne. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.038] [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]
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Freton L, Scailteux L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Lebacle C, Rizk J, Matillon X, Gryn A, Madec F, Nouhaud F, Rod X, Hutin M, Fiard G, Pradere B, Peyronnet B. Traumatisme rénal de bas grade et durée de séjour : vers une prise en charge ambulatoire ? Résultats de l’étude multicentrique traumAFUf avec analyse par score de propension. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.150] [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: 10/27/2022]
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Panayotopoulos P, Pradere B, Olivier J, Hutin M, Ruggiero M, Dominique I, Freton L, Millet C, Bergerat S, Betari R, Chebbi A, Caes T, Patard PM, Szabla N, Brichart N, Boehm A, Sabourin L, Guleryuz K, Prudhomme T, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Nouhaud FX, Rod X, Fiard G, Peyronnet B. PD02-10 WHICH IS THE PLACE FOR IMMEDIATE RADIO-EMBOLIZATION IN THE MANAGEMENT OF HEMODYNAMICALLY INSTABLE PATIENTS WITH KIDNEY TRAUMA ? RESULTS OF THE MULTICENTRIC NATIONAL FRENCH STUDY TRAUMAFUF. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.235] [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] [Indexed: 10/17/2022]
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Caës T, Rizk J, Olivier J, Hutin M, Bergerat S, Betari R, Freton L, Ruggiero M, Panayatopoulos P, Patard P, Dariane C, Fiard G, Peyronnet B, Pradere B, Nouhaud FX, Langouet Q, Dominique I, Matillon X, Chebbi A, Szabla N, Brichart N, Sabourin L, Guleryuz K, Bohem A, Millet C, Rod X, Lebacle C, Gryn A, Madec FX. Facteurs de risque d’échec du traitement conservateur des traumatismes du rein : une étude multicentrique (TRAUMAFUF). Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Prudhomme T, Becquart N, Gryn A, Gas J, Cordonnier C, Thoulouzan M, Duly Bouhanick B, Bennet A, Soulié M, Saint F, Huyghe E. Facteurs prédictifs de persistance de l’hypertension artérielle après surrénalectomie dans l’adénome de Conn. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.229] [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]
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Prudhomme T, Gas J, Gryn A, Thoulouzan M, Mazelolles M, Atalalh F, Duly B, Bennet A, Soulié M, Huyghe E. Évolution de la procédure peropératoire de la surrénalectomie laparoscopique pour phéochromocytome sur une période de 21 ans et comparaison de la voie d’abord : transpéritonéale vs rétropéritonéale. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.230] [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: 11/24/2022]
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Patard P, Abbo O, Gryn A, Bergerat S, Matillon X, Betari R, Ruggiero M, Dominique I, Freton L, Rod X, Dariane C, Lebacle C, Pradere B, Fiard G, Peyronnet B, Panayatopoulos P, Olivier J, Langouet Q, Millet C, Hutin M, Chebbi A, Caes T, Szabla N, Brichart N, Sabourin L, Guleryuz K, Rizk J, Madec FX, Nouhaud FX. Comparaison des caractéristiques et de la prise en charge des traumatismes rénaux entre la population adulte et pédiatrique. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.056] [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]
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Freton L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec F, Nouhaud F, Pradere B, Bensalah K, Fiard G, Peyronnet B. Traumatismes du rein de bas grade : vers une prise en charge en ambulatoire ? Résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.256] [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]
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Pradere B, Freton L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Boehm A, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Lebacle C, Rizk J, Gryn A, Nouhaud F, Madec F, Dariane C, Bensalah K, Fiard G, Peyronnet B. Incidence et facteur prédictifs des pseudo-anévrysmes au cours des traumatismes du rein : résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.259] [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]
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Peyronnet B, Schoentgen N, Betari R, Gryn A, Goujon A, Grevez T, Oumakhlouf S, Thoulouzan M, Brichart N, Pradère B, Beauval J, Rammal A, Soulié M, Fournier G, Bruyère F, Grise P, Joulin V, Nouhaud F, Manunta A, Huyghe E, Bensalah K. Résultats de la surrénalectomie pour métastase surrénalienne de cancer du rein à l’ère de la néphrectomie totale avec préservation surrénalienne : une étude multicentrique. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.100] [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]
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Peyronnet B, Bergerat S, Betari R, Freton L, Olivier J, Ruggiero M, Panayatopoulos P, Langouet Q, Dominique I, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N, Bohem A, Sabourin L, Guleryuz K, Millet C, Dariane C, Lebacle C, Rizk J, Gryn A, Madec F, Nouhaud F, Pradère B, Bensalah K, Fiard G. Faut-il maintenir les patients en décubitus dorsal après un traumatisme du rein ? Résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Madec FX, Dariane C, Pradere B, Amadane N, Bergerat S, Gryn A, Lebacle C, Matillon X, Olivier J, Nouhaud FX, Panayotopoulos P, Peyronnet B, Rizk J, Sanson S, Seisen T, Salomon L, Fiard G. [French resident's performance on laparoscopic surgery box trainer: 7-year results of pelvitrainer contests]. Prog Urol 2016; 26:1171-1177. [PMID: 28279367 DOI: 10.1016/j.purol.2016.09.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/24/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The study objectives were to analyze the resident's laparoscopic surgery performance in order to build a self-assessment data set, to identify discriminatory exercises and to investigate the suturing time changes. METHODS From 2007 to 2014, the French Association of Urologist in Training (AFUF) organized 7 pelvitrainer contests. Participant scores on 11 laparoscopic surgery exercises were evaluated. RESULTS Sixty-six residents participated to these contests and performed 11 exercises each. Twenty-two (33.3 %) participants were beginners, 26 (39.4 %) intermediates et 18 (27.3 %) experienced. The participant scores were gathered into a data set including the average time per exercise. We found a time scoring improvement related to the resident experience for all exercises. A significant decline in time was noted for exercise 8 and 9 between beginners and intermediates (139s [±71]), (173.9s [±118.3]) and between beginners and experienced (80.6s [±26.7]), (94,1s [±42.7]) with a P<0.05. The correlation coefficient for the exercise 11 duration (vesico-uretral anastomosis) was 0.04 over a 7-year period (P=0.44). CONCLUSION The study provided a data set on 11 laparoscopic surgery tasks which can be consulted by all residents as a reference in a self-assessment process. Two exercises (8 and 9) discriminated beginners from intermediates and experienced groups and could be used as a benchmark ahead of an operating room procedure. The vesico-uretral anastomosis duration (exercise 11) did not improve significantly between 2006 and 2014. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F-X Madec
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - C Dariane
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - B Pradere
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - N Amadane
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France
| | - S Bergerat
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Gryn
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Département d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex, France
| | - C Lebacle
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Henri-Mondor, CHU Paris-Est, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - X Matillon
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et chirurgie de la transplantation, hôpital Édouard-Herriot, centre hospitalier universitaire de Lyon, 3, place d'Arsonval, 69003 Lyon, France
| | - J Olivier
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - F-X Nouhaud
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Rouen Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - P Panayotopoulos
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - B Peyronnet
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - J Rizk
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - S Sanson
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Département d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex, France
| | - T Seisen
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, université Pierre-and-Marie-Curie, 75013 Paris, France
| | - L Salomon
- Service d'urologie, hôpital Henri-Mondor, CHU Paris-Est, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - G Fiard
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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Gryn A, Peyronnet B, Manunta A, Beauval JB, Bounasr E, Nouhaud FX, Rioux-Leclercq N, Caron P, Thoulouzan M, Verhoest G, Soulie M, Bensalah K, Huyghe E. Patient selection for laparoscopic excision of adrenal metastases: A multicenter cohort study. Int J Surg 2015; 24:75-80. [PMID: 26542988 DOI: 10.1016/j.ijsu.2015.10.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/07/2015] [Revised: 10/11/2015] [Accepted: 10/25/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The use of laparoscopy for the excision of adrenal metastasis remains controversial. We aimed to report oncological and perioperative outcomes of laparoscopic excision of adrenal metastases and to seek for predictive factors of unfavorable oncological outcomes. METHODS A retrospective chart review was conducted and all consecutive patients who underwent laparoscopic adrenalectomy (LA) in the setting of metastatic cancer in two academic urology departments from November 2006 through January 2014 were included. Primary tumors were categorized as pulmonary, renal or "other primary" tumors to allow statistical comparison. Unfavorable surgical outcomes were defined as the occurrence of either postoperative complications and/or positive surgical margins. RESULTS Forty-three patients who underwent a total of 45 LA were included for analysis. There were 8 complications (17.8%). Positive surgical margins were found in 12 specimens (26.7%). After a median follow-up of 37 months, estimated overall survival rates were 89.5% and 51.5% at 1 year and 5 years, respectively. In multivariable analysis the only predictor of unfavorable surgical outcomes was a tumor size >5 cm (OR = 20.5; p = 0.001). In multivariate analysis the pulmonary (OR = 0.3; p = 0.008) or "other" (OR = 0.1; p = 0.0006) origin of the primary tumor was the only prognostic factor of shorter cancer specific survival. CONCLUSION Laparoscopic resection of adrenal metastasis can be safely performed in most patients but is associated with an increased risk of positive surgical margins and postoperative complications in larger tumors (>5 cm). Adrenalectomy provides better oncological outcomes in metastases from renal cell carcinoma compared to other primary tumors.
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Affiliation(s)
| | | | | | | | - Elie Bounasr
- Department of Urology, CHU Toulouse, Toulouse, France
| | | | | | - Philippe Caron
- Department of Endocrinology, CHU Toulouse, Toulouse, France
| | | | | | - Michel Soulie
- Department of Urology, CHU Toulouse, Toulouse, France
| | | | - Eric Huyghe
- Department of Urology, CHU Toulouse, Toulouse, France
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Gryn A, Duly-Bouhanick B, Bennet A, Almont T, Beauval J, Gas J, Roumiguié M, Thoulouzan M, Vezzosi D, Caron P, Amar J, Chamontin B, Gamé X, Malavaud B, Soulié M, Rischmann P, Huyghe E. Comparaison de la stabilité hémodynamique peropératoire lors d’une surrénalectomie pour phéochromocytome entre une préparation anti-hypertensive préopératoire courte vs longue. Prog Urol 2015; 25:857-8. [DOI: 10.1016/j.purol.2015.08.286] [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]
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Peyronnet B, Gryn A, Tanguy L, Gas J, Thoulouzan M, Bensalah K, Soulié M, Huyghe E, Manunta A. Surrénalectomie pour métastases surrénaliennes : la voie d’abord laparoscopique est-elle bénéfique pour tous les patients ? Prog Urol 2014; 24:883-4. [DOI: 10.1016/j.purol.2014.08.216] [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: 10/24/2022]
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nasr EB, Gryn A, Gas J, Crenn G, Thoulouzan M, Almont T, Roumiguie M, Beauval J, Bennet A, Vezzosi D, Carron P, Rischmann P, Soulie M, Huyghe E. Impact pronostique de la prise en charge chirurgicale dans le corticosurrénalome malin à propos d’une série de 23 cas. Prog Urol 2014; 24:884-5. [DOI: 10.1016/j.purol.2014.08.219] [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]
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Gryn A, Gas J, Thoulouzan M, Roumiguié M, Beauval J, Crenn G, Duly-Bouhanick B, Amar J, Chamontin B, Bennet A, Vezzosi D, Caron P, Game X, Malavaud B, Soulié M, Rischmann P, Huyghe E. Évaluation des complications majeures de la surrénalectomie laparoscopique : à propos de 469 cas. Prog Urol 2014; 24:884. [DOI: 10.1016/j.purol.2014.08.218] [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: 10/24/2022]
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Gryn A, Peyronnet B, Tanguy L, Galland F, Manunta A, Gas J, Thoulouzan M, Soulie M, Rischmann P, Bensalah K, Huyghe E. Résultats carcinologiques et morbidité de la surrénalectomie laparoscopique pour métastase surrénalienne : données d’une étude multicentrique. Prog Urol 2014; 24:885. [DOI: 10.1016/j.purol.2014.08.220] [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: 10/24/2022]
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Gryn A, Gas J, Thoulouzan M, Almont T, Beauval J, Roumiguié M, Crenn G, Bennet A, Vezzosi D, Caron P, Duly-bouhanick B, Amar J, Chamontin B, Atallah F, Mazerolles M, Rischmann P, Soulié M, Huyghe E. Étude de l’amélioration du contrôle de la stabilité hémodynamique peropératoire de la surrénalectomie laparoscopique pour phéochromocytome. Prog Urol 2014; 24:886. [DOI: 10.1016/j.purol.2014.08.222] [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]
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Ballouhey Q, Galinier P, Gryn A, Grimaudo A, Pienkowski C, Fourcade L. Benefits of primary surgical resection for symptomatic urethral prolapse in children. J Pediatr Urol 2014; 10:94-7. [PMID: 23916576 DOI: 10.1016/j.jpurol.2013.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Urethral prolapse (UP) is a complete eversion of the distal urethral mucosa through the external meatus. UP must be distinguished by examination from trauma, prolapsed ureterocele, tumors or sexual abuse. Its management remains controversial. The aim of the study was to promote the benefits of primary surgical management for UP. METHODS A retrospective multicenter review of children who received surgery for UP between 1991 and 2011 was carried out. Non-complicated UP was primarily treated conservatively. A total of 19 patients were referred for complicated UP and underwent resection of the prolapsed urethral mucosa. RESULTS The mean delay in diagnosis was 2.2 days (range 1-6) and the most common symptoms were vaginal spotting and bleeding. No predisposing factor was found, but most patients had a mean weight, height and BMI greater than the 50th percentile. All patients underwent surgery successfully. One patient experienced a complication, i.e., dysuria. There was no case of recurrence after a mean 28 months of follow-up. CONCLUSION Early detection is based on bedside examination. The first-line treatment strategy for uncomplicated UP should be conservative management. Surgical resection is safe and effective for patients with significant symptoms.
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Affiliation(s)
- Q Ballouhey
- Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 avenue Dominique Larrey, 87042 Limoges Cedex, France.
| | - P Galinier
- Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, France
| | - A Gryn
- Service d'Urologie et de Transplantation, 1 avenue Jean Poulhes, Hôpital Rangueil, 31059 Toulouse cedex 9, France
| | - A Grimaudo
- Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 avenue Dominique Larrey, 87042 Limoges Cedex, France
| | - C Pienkowski
- Service d'endocrinologie et de gynécologie pédiatrique, Hôpital des Enfants, 330 avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, France
| | - L Fourcade
- Service de chirurgie viscérale pédiatrique, Hôpital des Enfants, 8 avenue Dominique Larrey, 87042 Limoges Cedex, France
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Gryn A, Bennet A, Vezzosi D, Crenn G, Thoulouzan M, Soulié M, Rischmann P, Caron P, Huyghe E. Résultats de la surrénalectomie unilatérale pour hyperplasie macronodulaire bilatérale des surrénales. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.105] [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: 11/30/2022]
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