One of the priorities of the "Plan against the Cancer" in France is to ensure t... more One of the priorities of the "Plan against the Cancer" in France is to ensure the discussion of all cancer cases in a multidisciplinary meeting staff (RCP). The multidisciplinary collaboration is proposed to guarantee a discussion between specialists in every cases, particularly in complex cases. The aim of this study was to compare the therapeutic decision taken in four RCP in Paris Île-de-France academic centres for three identical cases. Three cases of urological oncology (prostate cancer [PCa], renal cell carcinoma [RCC] and bladder tumour) were selected by a single urologist, not involved in further discussion. These cases were blindly presented in four academic urology department from Paris: Pitié-Salpêtrière Hospital, Mondor Hospital, the Georges-Pompidou European Hospital and Foch Hospital. The four centres met the criteria of quality of RCP in terms of multidisciplinarity, frequency and standardization. The therapeutic suggestions were similar in the RCC cases, there were differences in the surgical approaches and preoperative work-up in the PCa case and, lastly, the proposals were different for the bladder cancer case. The decisions relies on clinical data and preoperative work-up but also on the experience and habits of the centre of excellence. For complex cases that does not fit with current guidelines, the panel discussion can lead to different therapeutic options from a centre to another and is largely influenced by the local organisation of the RCP.
Purpose: Resection of ileal segments may result in malabsorption and a decrease in intestinal upt... more Purpose: Resection of ileal segments may result in malabsorption and a decrease in intestinal uptake of different substances. The use of intestinal segments in the urinary tract may also cause metabolic disorders. We studied long-term metabolic consequences of enterocystoplasty after radical cystoprostatectomy for bladder cancer. Materials and Methods: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectomy. The enterocystoplasty was constructed with a 35 cm. ileal segment resected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultrasonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglycerides, albumin, protein, vitamins B12 and B9, iron, fenitin, calcium, phosphate, vitamin D, parathyroid hormone, urea, creatinine, creatinine clearance and prostate specific antigen. In addition urine calcium, protein, creatinine and pH were measured, and a midstream urine specimen was obtained. Results: There was no evidence of metabolic acidosis, impairment of phosphorus and calcium metabolism, vitamin D deficiency or parathyroid hormone disturbance. All other laboratory tests were within the normal range. Mean creatinine was 106 gmol.A., mean creatinine clearance was 1.5 ml. per second per m.2 and mean prostate specific antigen was 0.2 ng./ml. No patient had post-void residual urine or a dilated upper urinary tract. Conclusions: This ileal bladder substitute does not induce long-term metabolic anomalies. However, these results may be due to the short ileal length used in the Camey type I technique and the absence of post-void residual urine obtained by good urinary training (that is sustained voiding function).
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2003
Several studies have reported the important role played by telomerase, an enzyme which maintains ... more Several studies have reported the important role played by telomerase, an enzyme which maintains the length of telomeres, during carcinogenesis. The objective of this study was to detect telomerase activity by semiquantitative in situ methods and to quantify expression of the hTERT subunit in a group of bladder cancers in order to assess its diagnostic and prognostic value. Telomerase activity (TA) was detected by the TRAP method ("telomeric repeat amplification protocol") on a series of 29 bladder cancers and 3 samples of healthy mucosa. Levels of expression of the hTERT gene were studied by real-time quantitative RT-PCR. In situ detection of TA was performed by using the same kit as the TRAP method, applied to frozen tissue sections exclusively for cases with discordant results between TA detection and hTERT mRNA. TA was detected by TRAP in 15 of the 29 bladder cancers. hTERT mRNA was detected and quantified in all tumour samples. A significant correlation was observed b...
La semaine des hôpitaux : organe fondé par l'Association d'enseignement médical des hôpitaux de Paris, Jan 9, 1982
The authors discuss nine cases of anuria by local recurrence after abdominoperineal resection for... more The authors discuss nine cases of anuria by local recurrence after abdominoperineal resection for cancer of the rectosigmoid, with particular emphasis on the frequency, diagnosis, prognosis, and the different methods of treating this type of anuria. The placing of a Gibbons catheter between the renal pelvis and the bladder seems to be the most suitable.
Material & Methods: We carried out two internet based prevalence studies as one-day studies in No... more Material & Methods: We carried out two internet based prevalence studies as one-day studies in November 2003 and 2004, respectively. 152 hospitals took part in the studies and 6033 hospitalised urology patients were screened for NAUTI. Local investigators identified all patients with NAUTI and reported data anonymously to a central study database. The study application was developed by Trent, a company owned by the EAU and both studies were fully sponsored by the EAU. Detailed information on 727 cases of NAUTI were provided. All data were analysed in the statistical application SPSS R . The most common pathogen was E coli accounting for 33% followed by Pseudomonas sp. 14% and Enterococcus for 11% of cases. In 65% of patients a second pathogen was also reported and Candida sp. was the most common second pathogen seen in 14%. There were significant regional variation in the distribution of pathogens with for example Enterococcus varying from 3% in Russia to 15% in Europe. The principal pathogen turned out to be resistant to many of the most commonly used antibiotics in 70-80% of cases. Enterococcus and Proteus had resistance rates to the most commonly used antibiotics between 60-90%. There was great variation between hospitals in the number of culture tests taken varying from 0-5.9 per patient admission. While the prevalence of asymptomatic bacteriuria was fairly constant around 30%, the prevalence of urosepsis varied between 2-27% in the regions studied. The susceptibility of pathogens causing NAUTI is a cause of concern in many regions and the basis for empirical treatment is very uncertain. In order to be able to tailor empirical treatment to more effective antibiotic regimens the number of culture tests need to be increased in many hospitals and urology sections should be encouraged to keep records of pathogens causing NAUTI and their susceptibility data. In order to obtain a more uniform reporting on the prevalence of asymptomaic bacteriuria and urosepsis among nations and regions, guidelines need to be worked out on when to take urine and blood culture tests after transurethral surgery.
One of the priorities of the "Plan against the Cancer" in France is to ensure t... more One of the priorities of the "Plan against the Cancer" in France is to ensure the discussion of all cancer cases in a multidisciplinary meeting staff (RCP). The multidisciplinary collaboration is proposed to guarantee a discussion between specialists in every cases, particularly in complex cases. The aim of this study was to compare the therapeutic decision taken in four RCP in Paris Île-de-France academic centres for three identical cases. Three cases of urological oncology (prostate cancer [PCa], renal cell carcinoma [RCC] and bladder tumour) were selected by a single urologist, not involved in further discussion. These cases were blindly presented in four academic urology department from Paris: Pitié-Salpêtrière Hospital, Mondor Hospital, the Georges-Pompidou European Hospital and Foch Hospital. The four centres met the criteria of quality of RCP in terms of multidisciplinarity, frequency and standardization. The therapeutic suggestions were similar in the RCC cases, there were differences in the surgical approaches and preoperative work-up in the PCa case and, lastly, the proposals were different for the bladder cancer case. The decisions relies on clinical data and preoperative work-up but also on the experience and habits of the centre of excellence. For complex cases that does not fit with current guidelines, the panel discussion can lead to different therapeutic options from a centre to another and is largely influenced by the local organisation of the RCP.
Purpose: Resection of ileal segments may result in malabsorption and a decrease in intestinal upt... more Purpose: Resection of ileal segments may result in malabsorption and a decrease in intestinal uptake of different substances. The use of intestinal segments in the urinary tract may also cause metabolic disorders. We studied long-term metabolic consequences of enterocystoplasty after radical cystoprostatectomy for bladder cancer. Materials and Methods: We reviewed 17 patients with a Camey type I enterocystoplasty for a mean of 12.9 years (range 10 to 22) after radical cystoprostatectomy. The enterocystoplasty was constructed with a 35 cm. ileal segment resected 20 cm. proximal to the ileocecal valve. All patients underwent complete physical and radiological examinations, including renal ultrasonography and excretory urography. Laboratory studies included blood count with mean corpuscular volume and packed cell volume. Serum was analyzed for electrolytes, hepatic function, cholesterol, triglycerides, albumin, protein, vitamins B12 and B9, iron, fenitin, calcium, phosphate, vitamin D, parathyroid hormone, urea, creatinine, creatinine clearance and prostate specific antigen. In addition urine calcium, protein, creatinine and pH were measured, and a midstream urine specimen was obtained. Results: There was no evidence of metabolic acidosis, impairment of phosphorus and calcium metabolism, vitamin D deficiency or parathyroid hormone disturbance. All other laboratory tests were within the normal range. Mean creatinine was 106 gmol.A., mean creatinine clearance was 1.5 ml. per second per m.2 and mean prostate specific antigen was 0.2 ng./ml. No patient had post-void residual urine or a dilated upper urinary tract. Conclusions: This ileal bladder substitute does not induce long-term metabolic anomalies. However, these results may be due to the short ileal length used in the Camey type I technique and the absence of post-void residual urine obtained by good urinary training (that is sustained voiding function).
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2003
Several studies have reported the important role played by telomerase, an enzyme which maintains ... more Several studies have reported the important role played by telomerase, an enzyme which maintains the length of telomeres, during carcinogenesis. The objective of this study was to detect telomerase activity by semiquantitative in situ methods and to quantify expression of the hTERT subunit in a group of bladder cancers in order to assess its diagnostic and prognostic value. Telomerase activity (TA) was detected by the TRAP method ("telomeric repeat amplification protocol") on a series of 29 bladder cancers and 3 samples of healthy mucosa. Levels of expression of the hTERT gene were studied by real-time quantitative RT-PCR. In situ detection of TA was performed by using the same kit as the TRAP method, applied to frozen tissue sections exclusively for cases with discordant results between TA detection and hTERT mRNA. TA was detected by TRAP in 15 of the 29 bladder cancers. hTERT mRNA was detected and quantified in all tumour samples. A significant correlation was observed b...
La semaine des hôpitaux : organe fondé par l'Association d'enseignement médical des hôpitaux de Paris, Jan 9, 1982
The authors discuss nine cases of anuria by local recurrence after abdominoperineal resection for... more The authors discuss nine cases of anuria by local recurrence after abdominoperineal resection for cancer of the rectosigmoid, with particular emphasis on the frequency, diagnosis, prognosis, and the different methods of treating this type of anuria. The placing of a Gibbons catheter between the renal pelvis and the bladder seems to be the most suitable.
Material & Methods: We carried out two internet based prevalence studies as one-day studies in No... more Material & Methods: We carried out two internet based prevalence studies as one-day studies in November 2003 and 2004, respectively. 152 hospitals took part in the studies and 6033 hospitalised urology patients were screened for NAUTI. Local investigators identified all patients with NAUTI and reported data anonymously to a central study database. The study application was developed by Trent, a company owned by the EAU and both studies were fully sponsored by the EAU. Detailed information on 727 cases of NAUTI were provided. All data were analysed in the statistical application SPSS R . The most common pathogen was E coli accounting for 33% followed by Pseudomonas sp. 14% and Enterococcus for 11% of cases. In 65% of patients a second pathogen was also reported and Candida sp. was the most common second pathogen seen in 14%. There were significant regional variation in the distribution of pathogens with for example Enterococcus varying from 3% in Russia to 15% in Europe. The principal pathogen turned out to be resistant to many of the most commonly used antibiotics in 70-80% of cases. Enterococcus and Proteus had resistance rates to the most commonly used antibiotics between 60-90%. There was great variation between hospitals in the number of culture tests taken varying from 0-5.9 per patient admission. While the prevalence of asymptomatic bacteriuria was fairly constant around 30%, the prevalence of urosepsis varied between 2-27% in the regions studied. The susceptibility of pathogens causing NAUTI is a cause of concern in many regions and the basis for empirical treatment is very uncertain. In order to be able to tailor empirical treatment to more effective antibiotic regimens the number of culture tests need to be increased in many hospitals and urology sections should be encouraged to keep records of pathogens causing NAUTI and their susceptibility data. In order to obtain a more uniform reporting on the prevalence of asymptomaic bacteriuria and urosepsis among nations and regions, guidelines need to be worked out on when to take urine and blood culture tests after transurethral surgery.
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Papers by Henry Botto