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Debard C, Margue G, Klein C, Rompré-Brodeur A, Marcq G, Bensadoun H, Robert G, Anidjar M, Bladou F. [Oncological and functional results of focal treatment of localized prostate cancer with HIFU]. Prog Urol 2023; 33:966-973. [PMID: 37770359 DOI: 10.1016/j.purol.2023.09.012] [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: 05/19/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION In recent years, improved diagnosis of prostate cancer has allowed the development of focal therapy, in order to reduce the morbidity of treatments. Our study assesses the medium-term oncological and functional results of FocalOne® HIFU treatment in localized prostate cancer. METHODS This is a retrospective, multicentre study including patients with low- or intermediate-risk localized prostate cancer treated with Focal one HIFU between November 2014 and December 2019. The primary endpoint was the retreatment rate and subgroup analyses were performed to identify predictive factors of retreatment. RESULTS One hundred and thirty-seven patients were included with a median follow-up of 25.5 months. Seventy percent of patients had clinical stage T2, 64% had an ISUP score of 2 or 3 on initial biopsies and 38% were treated with hemi-ablation. Follow-up biopsies were performed in 76.6% of patients during follow-up with 21.8% having clinically significant cancers. The retreatment rate at 24 months was 37.2%, with positive biopsies being the primary criterion for retreatment. Patients with a PSA>8ng/mL had a significantly higher retreatment rate. Finally, morbidity remained acceptable with 5.8% of patients requiring reoperation for complications and 21% for de novo erectile dysfunction. CONCLUSION Our results are in agreement with those of the literature, seeming to indicate a lower morbidity of the focal treatment by HIFU compared to the radical treatments while offering an acceptable oncological control. Prospective randomized trials are ongoing. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Debard
- Service d'urologie, CHU de Pellegrin, Bordeaux, France.
| | - G Margue
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - C Klein
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - A Rompré-Brodeur
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - G Marcq
- Service d'urologie, hôpital Claude-Huriez, CHU de Lille, Lille, France
| | - H Bensadoun
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - G Robert
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
| | - M Anidjar
- Department of Surgery (Division of Urology), Mc Gill University Health Center, Montreal, Canada
| | - F Bladou
- Service d'urologie, CHU de Pellegrin, Bordeaux, France
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Margue G, Ferrer L, Etchepare G, Bensalah K, Mejean A, Roupret M, Doumerc N, Ingels A, Boissier R, Pignot G, Parier B, Paparel P, Waeckel T, Bigot P, Colin T, Bernhard JC. Development of an individual postoperative prediction model for kidney cancer recurrence using machine learning (UroCCR study 120). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00519-5] [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: 02/12/2023]
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Margue G, Allenet C, Michiels C, Estrade V, Alezra E, Capon G, Bladou F, Robert G, Bernhard JC. Technical tips of 3D Image Guided Robotic Assisted Partial Nephrectomy (3D-IGRAPN) for the management of a hilar tumor. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02234-0] [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: 11/06/2022] Open
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Margue G, Callede E, Ricard S, Picard F, Dubernet C, Robert G, Bladou F, Bernhard JC. [Digital transformation of perioperative nurse-coordinated protocols in renal surgery for enhanced recovery and outpatient surgery using UroConnect® application]. Prog Urol 2022; 32:888-892. [PMID: 36055902 DOI: 10.1016/j.purol.2022.08.015] [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] [Received: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
Robot Assisted Partial Nephrectomy (RAPN) is a standard of care for localized renal tumors. It allows a good carcinological control while limiting complications. Despite numerous benefits, the economic sustainability of robotic assistance remains a challenge in the French health care system. The introduction in our institution of two perioperative nurse-coordinated protocols for patients undergoing RAPN (Enhanced Recovery After Surgery: NP-RAAC in 2015 and Outpatient: Ambu-Rein in 2016) is associated with a shortening of the average length of hospital stay, thus reducing the cost of robotic assisted procedures. With the aim of improving efficiency of nursing support within these protocols, we have introduced digitalized nursing coordination by developing a urological perioperative application: UroConnect®. This device is offered to patients by the coordinating nurses during a preoperative visit. It provides information on the pathology and its surgical management. Self-completed questionnaires sent at key moments collect data from the first month after surgery and detect patients presenting difficulties or complications, allowing the nurses to respond with appropriate care. The application allows a secure discharge, a personalised follow-up and an increase in the patient's autonomy and compliance with care.
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Affiliation(s)
- G Margue
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France.
| | - E Callede
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
| | - S Ricard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
| | - F Picard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - C Dubernet
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - G Robert
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - F Bladou
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - J C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
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Ali Benali N, Pradère B, Lannes F, Thi Dang V, Mauger de Varennes A, Gaillard C, Berchiche W, Margue G, Bardet F, Manuguerra A, Pinar U, Duquesne I, Plassais C, Wandoren W, Hulin M, Khene ZE, Vallée M, Michiels C, Chabenes M, Gaillard V, Felber M, Kaulanjan K, Dominique I, Sbizerra M, Seizilles de Mazancourt E, Freton L, Gondran-Tellier B, Matillon X. TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients. Prog Urol 2021; 32:92-100. [PMID: 34920923 DOI: 10.1016/j.purol.2021.10.011] [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: 07/10/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUNDS Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration. METHODS We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not. RESULTS In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28). CONCLUSION Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.
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Affiliation(s)
- N Ali Benali
- Department of Urology, Poitiers University Hospital, Poitiers, France.
| | - B Pradère
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - F Lannes
- Department of Urology, Nord University Hospital, Marseille, France
| | - V Thi Dang
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - C Gaillard
- Department of Urology, Tours University Hospital, Tours, France
| | - W Berchiche
- Department of Urology, Nord University Hospital, Marseille, France
| | - G Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - F Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - A Manuguerra
- Department of Urology, Nancy University Hospital, Nancy, France
| | - U Pinar
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - I Duquesne
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - W Wandoren
- Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe
| | - M Hulin
- Department of Urology, Reims University Hospital, Reims, France
| | - Z-E Khene
- Department of Urology, Rennes University Hospital, Rennes, France
| | - M Vallée
- Department of Urology, Poitiers University Hospital, Poitiers, France; Poitiers University, INSERM U1070, "Pharmacologie des Anti-Infectieux", UFR Médecine-Pharmacie, Pôle Biologie Santé, Poitiers, France
| | | | - C Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - M Chabenes
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - V Gaillard
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - M Felber
- Department of Urology, Nancy University Hospital, Nancy, France
| | - K Kaulanjan
- Department of Urology, Pointe-à-Pitre University Hospital, Pointe-à-Pitre, Guadeloupe
| | - I Dominique
- Department of Urology, Lyon Sud University Hospital, Lyon, France
| | - M Sbizerra
- Department of Urology, Lyon Sud University Hospital, Lyon, France
| | | | - L Freton
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - X Matillon
- Department of Urology, Lyon Sud University Hospital, Lyon, France
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Margue G, Debard C, Michiels C, Dupitout L, Alezra E, Estrade V, Blanc P, Capon G, Robert G, Bladou F, Bernhard J. Tumorectomies rénales multiples, robot-assistées sans clampage et guidées par modélisation 3D. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.009] [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]
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Margue G, Michiels C, Allenet C, Dupitout L, Ricard S, Blanc P, Alerzra E, Estrade V, Capon G, Bladou F, Robert G, Grenier N, Bernhard J. Faisabilité des néphrectomies partielles robot-assistées de rattrapage après échec de traitement ablatif (Étude UROCCR–62). Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.125] [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: 10/19/2022]
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Berchiche W, Sbizzera M, Lannes F, Pinar U, Duquesne I, Felber M, Plassais C, Dang V, Ali Benali N, Gaillard C, Mauger De Varennes A, Margue G, Bardet F, Hulin M, Manuguerra A, Wandoren W, Chabennes M, Gaillard V, Matillon X, Khene Z, Pradere B. Impact of testicular torsion on fertility and erectile dysfunction: A multicenter national retrospective studyTORSAFUF. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00899-x] [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: 12/01/2022]
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Margue G, Percot M, Dupitout L, Michiels C, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Robert G, Grenier N, Bernhard J. Feasibility of salvage robotic partial nephrectomy after ablative treatment failure (UroCCR-62 study). Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00944-1] [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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Seizilles de Mazancourt E, Pradere B, Duquesne I, Pinar U, Felber M, Plassais C, Dang V, Ali Benali N, Berchiche W, Gaillard C, Mauger de Varennes A, Margue G, Bardet F, Hulin M, Manuguerra A, Wandoren W, Chabenes M, Sbizzera M, Khene Z, Matillon X. Heure limite de prise en charge opératoire pour torsion du cordon spermatique : résultats d’une série rétrospective multicentrique de 2986 patients sur 15 ans. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.206] [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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Mauger de Varennes A, Khene Z, Pradere B, Lannes F, Freton L, Dang V, Berchiche W, Ortier E, Michiels C, Margue G, Gaillard C, Ali Benali N, Bardet F, Hulin M, Gaillard V, Manuguerra A, Pinar U, Duquesne I, Felber M, Plassais C. Marqueurs biologiques préopératoires prédictifs de la viabilité testiculaire suite à une torsion du cordon spermatique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.058] [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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