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See detailNovel surgical technique for the treatment of female urinary incontinence: Transobturator vaginal tape inside-out
de Leval, Jean ULg; Bonnet, Pierre ULg; Reul, Olivier ULg et al

in European Urology Supplements (2004, February), 3(2), 226

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See detailNovel surgical technique for the treatment of female stress urinary incontinence: Transobturator vaginal tape inside-out
de Leval, Jean ULg; Bonnet, Pierre ULg; Reul, Olivier ULg et al

Poster (2004)

Introduction and Objective: To describe a new, simple surgical technique for the treatment of female stress urinary incontinence (SUI) and to evaluate its feasibility. Methods: We have developed a novel ... [more ▼]

Introduction and Objective: To describe a new, simple surgical technique for the treatment of female stress urinary incontinence (SUI) and to evaluate its feasibility. Methods: We have developed a novel surgical treatment of SUI, the transobturator inside-out tension-free urethral suspension, which uses specifically designed surgical tools: a pair of stainless steel helical passers, two plastic tubes with a pointed distal end and one guide. Using these instruments, a synthetic tape is passed from underneath the urethra, through the obturator foramens, towards the thighs, without entering the pelvic region at any time during the procedure. The tubes bear a lateral opening, which allows the insertion of the helical passer into its lumen. The proximal end of each tube is attached to a non-absorbable synthetic tape. The guide acts as a shoe-horn to ease the introduction of the tubes assembled onto the helical passers from the perineal space through the obturator foramen. After perforation of the obturator membrane, a rotational movement of the helical passer around the upper part of ischio-pubic ramus allows the exit of the pointed tip of the tube and, further, of the tape at the level of the thigh on either side. The tape is positioned without tension under the junction between mid and distal urethra. Results: The procedure was carried out in 210 consecutive patients (mean age = 62 years) using the same operative protocol in all case subjects, independently of the patient’s size and weight. Mean operative time was 14 min (range = 6 to 20) in case of isolated SUI treatment. No bladder or urethra injury and no vascular (hematoma or bleeding) or neurological complication were observed. Conclusions: The results of this study indicate that our novel transobturator inside-out surgical technique for treating SUI is feasible, accurate, and quick. This technique avoids damage to the urethra and bladder and, therefore, makes cystoscopy not necessary. Further prospective studies are currently ongoing to determine the efficacy of our new surgical approach for treating SUI. [less ▲]

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See detailInside-out transobturator vaginal tape (TVT-O): Short-term results of a prospective study
Waltregny, David ULg; Reul, Olivier ULg; Bonnet, Pierre ULg et al

in International Urogynecology Journal & Pelvic Floor Dysfunction (2004)

Hypothesis / aims of study The aim of this study was to prospectively evaluate the efficacy of the TVT-O inside-out procedure for the treatment of female stress urinary incontinence (SUI). Study design ... [more ▼]

Hypothesis / aims of study The aim of this study was to prospectively evaluate the efficacy of the TVT-O inside-out procedure for the treatment of female stress urinary incontinence (SUI). Study design, materials and methods From March 2003 through September 2003, 53 patients with clinical evidence of SUI participated in this prospective clinical trial. Preoperative evaluation included complete history, physical examination, multichannel urodynamics, urine analysis, and cystoscopy. None of the patients presented the following exclusion criteria: post-void residual volume (PVR) ≥ 100 cc, detrusor overactivity or acontractility, contraindication to anesthesia, pregnancy, neurological pathology, or active urinary or vaginal infection. All patients met the following inclusion criteria: age > 25 and < 85 years, clinically demonstrated SUI, positive Ulmsten test, and maximum cystometric capacity ≥ 300 mL. In all patients, a sub-urethral tape (Gynecare®) was inserted by one single surgeon via an inside-out transobturator approach (TVT-O), as previously described (1). Evaluation of SUI, urgency/urge incontinence, daytime urinary frequency/nocturia, and lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction/retention was carried out using the Measurement of Urinary Handicap scale questionnaire (2). The importance of urinary incontinence was assessed with a visual analog scale graded from 0 to 10. Quality of life (QoL) assessment was performed using the validated Ditrovie self-administered questionnaire. Outpatient follow-up was perfomed at 1 and 6 months, and every 6 months thereafter. Follow-up evaluation included physical examination with a stress test, uroflowmetry, PVR, and symptom, visual analog, and QoL scales scoring. Cure was defined as no leakage based on both symptom scale scoring and physical examination. Improvement was defined as at least a 50% decrease in symptoms based on the questionnaire’s evaluation. Chart review was conducted by a physician not associated with the surgical procedure. The specific protocol used in this study was approved by the Medical Ethics committee of our Institution. All patients had given their written informed consent. Methods, defintions,and units conform to the standards recommended by the ICS. Results Mean age of the patients was 61.2 years (36 to 80). Of the 53 patients, 20 had undergone previous pelvic surgery. Forty-eight patients suffered from SUI. Five patients did not complain of SUI but had clinical evidence of SUI after reduction of pelvic organ prolapse (POP) during vaginal examination. The TVT-O procedure was associated with POP cure (performed before TVT-O) in 12 patients. Maximal urethral closure pressure was < 30 cm H20 in 6 patients. Follow-up time was ≥ 6 months in all women (max = 12.5; mean = 8). A total of 33 and 20 women received spinal and general anesthesia, respectively. Intraoperative blood loss was < 100 cc in all cases. No vaginal wall, urethral, or bladder perforation was encountered. No hematoma, neurological complication, fistula, vaginal or urethral erosion, or tape rejection was observed. Some patients reported pain symptoms, directly after the procedure, mainly located in the thigh regions (either uni- or bilaterally). Pain was always mild, never requiring opioid antalgics. No patient complained of persistent pain; indeed, pain had completely vanished within the first post-operative month in all cases. At the latest follow-up visit, PVR was < 100 cc and max flow rate was ≥ 10 mL/sec in 49 (92.4%) and 39 (73.6%) patients, respectively. One patient underwent an immediate tape release procedure for complete retention 2 days after TVT-O. Thereafter, the patient had no PVR and was completely dry. The tape was sectioned in 2 patients for chronic retention and/or urgency associated with bladder outlet obstruction, 4 and 7 months after the operation. Based on the SUI questionnaire evaluation and physical examination, 50 (94.3%) patients were cured. SUI symptoms had improved in 1 patient and had not changed in another. One patient with POP not complaining of SUI preoperatively (but with clinically demonstrated SUI following POP reduction) developed SUI after POP cure associated with TVT-O. Analysis of the urgency questionnaire’s results revealed that among the 53 patients, 32 did not complain of any urgency before the operation. Of these 32 patients, 3 patients developed de novo urgency, with one of them requiring tape sectioning because of obstruction-associated urge incontinence. Among the 21 patients with preoperative urge symptoms, 15 of them reported disappearance of urgency after the procedure. Urge symptoms were unchanged in the remaining 6 patients. Daytime frequency/nocturia symptoms scale scoring showed that 4 patients had a worsening of these symptoms while all other patients were either improved or unchanged. LUTS suggestive of bladder outlet obstruction/retention appeared or worsened in 3 patients, amongst which the 2 patients who required tape sectioning. These symptoms were unchanged or decreased (mainly in patients with associated POP cure) in all other patients. Analysis of the urinary incontinence visual analog and QoL scale scores demonstrated that the majority of patients reported disappearance of urinary leakage together with significant improvement of their QoL (Figures 1 and 2). Interpretation of results As already suggested by the results of a recent feasibility study (1), TVT-O appears to be associated with a minimal risk of peri-operative complications. Indeed, in our present prospective study, no injury to the bladder, vagina, or urethra was encountered and we have not observed any vascular, digestive or neurological complication. Our data suggest that TVT-O is associated with high objective and subjective SUI cure rates and a low incidence of post-operative complications. Longer follow-up times are required to determine the long-term efficacy of TVT-O. Concluding message The short term results of this prospective study suggest that TVT-O is a safe and efficient surgical procedure for the treatment of female SUI. References 1. Novel surgical technique for the treatment of female stress urinary incontinence: Transobturator vaginal tape inside-out. Eur Urol 44:724-730, 2003 2. Elaboration and validation of a specific quality of life questionnaire for urination urgency in women. Prog Urol 7:56-63, 1997 [less ▲]

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See detailScreening of histone deacetylases (HDAC) expression in human prostate cancer reveals distinct class IHDAC profiles between epithelial and stromal cells
Waltregny, David ULg; North, Brian; Van Mellaert, Frank et al

in European Journal of Histochemistry (2004), 48(3, Jul-Sep), 273-290

Histone deacetylases (HDACs) represent a large family of enzymes identified as key regulators of nucleosomal histone acetylation, a major epigenetic event that controls eukaryotic gene transcription ... [more ▼]

Histone deacetylases (HDACs) represent a large family of enzymes identified as key regulators of nucleosomal histone acetylation, a major epigenetic event that controls eukaryotic gene transcription. Inappropriate deacetylation mediated by HDACs has been associated with profound alterations in cellular biology. We have thus hypothesized that an altered HDAC expression may favor cancer development/progression. To test this possibility, we have sought to screen the expression profiles of several class I and class 11 HDACs (HDAC1-8) in DU-145, PC-3 and LNCaP human prostate cancer cell lines as well as in matched malignant and nonmalignant prostate tissues by use of real time RT-PCR, immunoblot and immunohistochemistry. All HDAC transcripts tested were detected at various levels in all prostate cancer cell lines and tissue samples analyzed. In prostate tissues, the abundance of HDAC1 protein, which was exclusively expressed in the cell nucleus, was similar in normal and malignant epithelial cells, but was usually lower in stromal cells. Unexpectedly, HDAC8, another class I HDAC, was not detected in epithelial cells but was uniquely expressed in the cytoplasm of stromal cells, HDAC5, a class II HDAC involved in myogenesis, was not detected in the tissues. Altogether, our findings indicate that epithelial and stromal cells exhibit distinct class I HDAC expression profiles, and the abundance of HDAC1 is not altered in human prostate cancer. In addition, our observations are the first to demonstrate the prominently cytosolic distribution of a class I HDAC, HDAC8. [less ▲]

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See detailInside-out transobturator vaginal tape (TVT-O): Short-term results of a prospective study
Waltregny, David ULg; Reul, Olivier ULg; Bonnet, Pierre ULg et al

in Neurourology and Urodynamics (2004), 23(5-6), 428-429

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See detailLa voie transobturatrice de dedans en dehors: Considérations anatomiques
Bonnet, Pierre ULg; Waltregny, David ULg; de Leval, Jean ULg

in Progrès en Urologie (2003), 13(5)(Suppl.), 22

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See detailNovel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out.
de Leval, Jean ULg

in European Urology (2003), 44(6), 724-30

OBJECTIVES: To describe a new, simple surgical technique for the treatment of female stress urinary incontinence (SUI) and to evaluate its feasibility. METHODS: We have developed a novel surgical ... [more ▼]

OBJECTIVES: To describe a new, simple surgical technique for the treatment of female stress urinary incontinence (SUI) and to evaluate its feasibility. METHODS: We have developed a novel surgical treatment of SUI, the transobturator inside-out tension-free urethral suspension, which uses specifically designed surgical tools, and in which a synthetic tape is passed from underneath the urethra, through the obturator foramens, towards the thigh folds, without entering the pelvic region at any time during the procedure. The tape is positioned without tension under the junction between mid and distal urethra. RESULTS: The procedure was carried out in 107 consecutive patients (mean age: 62 years) using the same operative protocol in all case subjects, independently of the patient's size and weight. Mean operative time was 14 min (range: 7-20) in case of isolated SUI treatment. No bladder or urethral injuries and no vascular (hematoma or bleeding) or neurological complications were encountered. CONCLUSIONS: The results of this study indicate that our novel transobturator inside-out surgical technique for treating SUI is feasible, accurate, and quick. This technique avoids damage to the urethra and bladder and, therefore, makes cystoscopy not necessary. Further prospective studies are currently ongoing to determine the efficacy of our new surgical approach for treating SUI. [less ▲]

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See detailLe TVT: traitement revolutionnaire de l'incontinence urinaire
Sanjurjo, Sylvia ULg; Ben Younes, A.; Bonnet, Pierre ULg et al

in Revue Médicale de Liège (2002), 57(12), 765-70

Stress urinary incontinence represents an important, often unknown and, yet, certainly most unpleasant pathology. Over years, several different surgical techniques have been proposed and reported to have ... [more ▼]

Stress urinary incontinence represents an important, often unknown and, yet, certainly most unpleasant pathology. Over years, several different surgical techniques have been proposed and reported to have variable success. TVT, a simple and reproducible technique, aims at stabilizing mid-urethra, and not bladder-neck. Our own clinical experience amounts to 139 cases. All these patients were evaluated by clinical examination and, subjectively, by a questionnaire. 89.2% were cured and 6.5% improved. The most frequent complication was bladder perforation (6.5%), but it had no incidence on the final results. Morbidity was low. This revolutionary technique is very promising and our own results are similar to those reported by others. [less ▲]

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See detailHematurie causee par un "nutcracker syndrome" ou "syndrome du casse-noisettes": confirmation peroperatoire de sa realite
Andrianne, Robert ULg; Limet, Raymond ULg; Waltregny, David ULg et al

in Progrès en Urologie (2002), 12(6), 1323-6

Nutcracker syndrome should be considered in the case of left ureteric haematuria based on computed tomography with vascular reconstruction of the hilar region of the kidney. The best confirmation is ... [more ▼]

Nutcracker syndrome should be considered in the case of left ureteric haematuria based on computed tomography with vascular reconstruction of the hilar region of the kidney. The best confirmation is obtained by studying the pressure gradient between the left renal vein and the inferior vena cava during cavography. Various modalities of surgical treatment have been proposed by a few authors, but have been criticised by some authors who question the clinical reality of this syndrome and the efficacy of treatment. The decision to operate may be difficult and other investigations may be useful to confirm the diagnosis. We report the case of a patient in whom the diagnosis of nutcracker syndrome was confirmed intraoperatively by the immediate appearance of massive, reversible haematuria induced by clamping of the renal vein during vein dissection and augmentation plasty. In the light of this original case, we believe that a preoperative percutaneous haematuria provocation test by temporary obstruction of the left renal vein during venography could allow a more formal diagnosis of nutcracker syndrome when this syndrome is highly suspected. [less ▲]

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See detailIntermittent Versus Continuous Total Androgen Blockade in the Treatment of Patients with Advanced Hormone-Naive Prostate Cancer: Results of a Prospective Randomized Multicenter Trial
De Leval, Jean ULg; Boca, Philippe; Yousef, Enis et al

in Clinical Prostate Cancer (2002), 1(3), 163-71

The aim of this study was to compare the efficacy of total intermittent androgen deprivation (IAD) versus total continuous androgen deprivation (CAD) for treating patients with advanced prostate cancer in ... [more ▼]

The aim of this study was to compare the efficacy of total intermittent androgen deprivation (IAD) versus total continuous androgen deprivation (CAD) for treating patients with advanced prostate cancer in a phase III randomized trial. A total of 68 evaluable patients with hormone-naive advanced or relapsing prostate cancer were randomized to receive combined androgen blockade according to a continuous (n = 33) or intermittent (n = 35) regimen. Therapeutic monitoring was assessed by use of serum prostate-specific antigen (PSA) measurements. Patients in the CAD and IAD groups were equally stratified for age, biopsy Gleason score, and baseline serum PSA levels. The outcome variable was time to androgen-independence of the tumor, which was defined as increasing serum PSA levels despite androgen blockade. Mean follow-up was 30.8 months. The 35 IAD-treated patients completed 91 cycles, and 19 of them (54.3%) completed > or = 3 cycles. Median cycle length and percentage of time off therapy were 9.0 months and 59.5, respectively. The estimated 3-year progression rate was significantly lower in the IAD group (7.0% +/- 4.8%) than in the CAD group (38.9% +/- 11.2%, P = 0.0052). Our data suggest that IAD treatment may maintain the androgen-dependent state of advanced human prostate cancer, as assessed by PSA measurements, at least as long as CAD treatment. Further studies with longer follow-up times and larger patient cohorts are needed to determine the comparative impacts of CAD and IAD on survival. [less ▲]

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See detailEfficacy of upper urinary tract stones treatment by ESWL under local anesthesia, with the use of the Dornier Compact alpha Lithotriptor.
Leduc, frédéric; Ben Younes, Adelin; Andrianne, Robert ULg et al

Poster (2002, September)

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See detailOverexpression of the homeobox gene HOXC8 in human prostate cancer correlates with loss of tumor differentiation
Waltregny, David ULg; Alami, Younes; Clausse, Nathalie et al

in Prostate (2002), 50(3), 162-169

BACKGROUND. Homeobox (HOX)-containing proteins have been identified as regulators controlling the coordinated expression of genes involved in development and differentiation. Recent data also suggest a ... [more ▼]

BACKGROUND. Homeobox (HOX)-containing proteins have been identified as regulators controlling the coordinated expression of genes involved in development and differentiation. Recent data also suggest a possible involvement of HOX genes in malignant transformation and/or progression. We have previously shown that HOXC8 expression was selectively turned on in human cervix cancer cells compared with normal keratinocytes, suggesting that HOXC8 may be involved in the process leading to the transformation of cervix keratinocytes [Alami et al.: Biochem Biophys Res Commun 257:738-745,1999]. METHODS. RT-PCR and in situ hybridization experiments were performed to investigate the expression and cell type localization of HOXC8 transcripts in human prostate cancer cell lines and tissues. In situ hybridization was performed with the use of an HOXC8 anti-sense digoxigenin-labeled probe to investigate HOXC8 mRNA expression in 27 prostate cancer tissue specimens. RESULTS. Out of the three human prostate cancer cell lines tested, DU-145 and PC3 but not LNCaP cells expressed detectable amount of HOXC8 transcripts. Results from in situ hybridization experiments demonstrated that HOXC8 gene was expressed mainly in malignant epithelial cells. Furthermore, the staining intensity in epithelial cells was significantly increased in high Gleason score carcinomas (scores 7-9, n = 12; labeling intensity 2 + to 3 +) compared with the one observed in low and intermediate Gleason score tumors (scores 3-6, n = 15; labeling intensity 0 and 1 +) (ANOVA test, P < 0.0001). CONCLUSIONS. Our data showing that HOXC8 overexpression is associated with the loss of tumor differentiation in human prostate cancer suggests that HOXC8 may play a role in the acquisition of the invasive and metastatic phenotype of this malignancy. (C) 2002 Wiley-Liss, Inc. [less ▲]

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See detailAdult mullerian duct or utricle cyst: clinical significance and therapeutic management of 65 cases.
Coppens, Luc ULg; Bonnet, Pierre ULg; Andrianne, Robert ULg et al

in Journal of Urology (The) (2002), 167(4), 1740-4

PURPOSE: We define guidelines for the exploration and treatment of adult mullerian duct cysts. MATERIALS AND METHODS: From January 1988 through September 1999 a diagnosis of enlarged prostatic utricle was ... [more ▼]

PURPOSE: We define guidelines for the exploration and treatment of adult mullerian duct cysts. MATERIALS AND METHODS: From January 1988 through September 1999 a diagnosis of enlarged prostatic utricle was made in 65 adults based on transrectal ultrasound findings. Echographic criteria to define simple versus complicated cysts were detailed. We reviewed the clinical presentation, diagnostic modalities, indications for invasive procedures and postoperative outcome. RESULTS: The usual clinical presentations were hematospermia in 40% of cases, other ejaculatory disturbances in 20%, recurrent testicular or pelviperineal pain in 33%, lower urinary tract irritation symptoms in 25%, lower urinary tract infection in 18.5%, male infertility in 12% and incidental finding in 18.5%. Cyst dimensions did not influence the indication for invasive procedures, which were performed in only 27 of the 65 patients (41.5%) to treat disabling symptoms in 28% and obstructive infertility in 5%, and investigate complicated cysts on transrectal ultrasound in 6%. These procedures included transperineal or transrectal puncture in 9 patients, simple endoscopic section of the utricle meatus in 12 and large marsupialisation in 6. Complete and sustained cure was noted in half of the patients treated with cyst puncture only, although echographic relapse was the rule. Endoscopic procedures definitely improved or cured 82% of the patients at a mean followup of 51 months, during which neither early nor late complications were noted. CONCLUSIONS: Since almost 60% of adults diagnosed with a mullerian duct cyst did not experience any cyst related symptoms or ejaculatory-fertility impairment, we recommend that investigation and/or treatment should only be done in symptomatic or infertile patients. [less ▲]

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