Julien Van Damme1, Bertrand Tombal1, Marco Gizzi2,3, Sandy Van Nieuwenhove4, Vassiliki Pasoglou4, Guillaume Grisay2,5, Emmanuel Seront2Published in the journal : February 2025Category : Urology
The standard treatment for non-metastatic muscle-invasive bladder cancer is neoadjuvant systemic chemotherapy followed by cystectomy or radiochemotherapy, regardless of the extent of tumor response. Recent studies have questioned the relevance of local treatment in cases of complete clinical response after systemic therapy. De-escalation strategies are limited by the poor correlation between clinical assessment of tumor response and the final pathology results from radical cystectomy specimens. Therefore, there is significant interest in developing and validating a multimodal signature to improve the prediction of response to systemic treatment using several available tools: cystoscopy with biopsies, multiparametric bladder MRI, quantification of circulating and urinary tumor DNA, and evaluation of urinary biomarkers. A more accurate assessment of tumor response to initial systemic treatment could help inform patients when choosing between standard treatment and a risk-adapted strategy: bladder-sparing procedures (clinical surveillance or intravesical treatments) for responders and immediate escalation of systemic therapy without local treatment for non-responders
Michel Bailly, Vincent Scavée, Christian Van Ruyssevelt, Olivier Rahier, Jean-Luc Jorion, Emmanuel DardennePublished in the journal : May 2021Category : Urology
Uretero-arterial fistulas (UAFs) are the consequence of a chronic inflammatory process that leads to the weakening of ureteral and arterial walls at the crossing level. In recent years, the number of cases described in the literature has continuously increased. Most UAFs are accounted for by the exposure to several typical risk factors. Clinical suspicion is the key for a rapid diagnosis and appropriate treatment. Management of UAFs has evolved over time, being currently based on an endovascular approach. Despite an improvement in diagnostic and therapeutic techniques, morbidity and mortality remain high.
This work, which is based on two clinical cases with different presentation and management, illustrates the heterogeneity of this pathology, which is often barely understood. In addition, the article proposes a review of the current recommendations on the subject.
Emilie Delchambre, Marie-Camille Guerin, François HervéPublished in the journal : February 2020Category : Urology
Patients with lower urinary tract symptoms often report a decrease in quality of life, with a diminished self-confidence leading to social isolation and depression. Their symptoms are related to the dysfunction of the lower urinary tract, including the detrusor or urinary sphincter, and concern the storage, emptying phase, or both.
The year 2019 has been characterized by scientific findings demonstrating the central effect of botulinum toxin after its injection in the detrusor of patients suffering from overactive bladder. New therapeutic targets have also been evaluated. The past year has emphasized the relevant role of psychological comorbidities in non-obstructive voiding disorders, and our treatment armamentarium has thus been improved. Finally, several multidisciplinary guidelines concerning the workout and treatment of nocturia have been established.
Félix Kwizera (1), Stéphanie Hublet (1), Antoine Bufkens (1), Jean-Pierre Chami (2), Stéphane Rysselinck (1)Published in the journal : January 2017Category : Urology
Genito-urinary tuberculosis (GUTB) is a severe form of extra-pulmonary tuberculosis (EPTB). The most commonly affected organs are the epididymis and testis. GUTB diagnosis may prove difficult and is often delayed given that symptoms are non-specific. We have here reported the case of a patient with no history of pulmonary TB, who presented with acute right scrotal pain mimicking an epididymo-orchitis. After failure of antibacterial therapy, we completed the patient's work-up by means of a CT scan that showed progressive retro-peritoneal lymph nodes. Correct diagnosis was made using laparoscopic lymphadenectomy (histology: granulomatous necrotizing lymphadenitis, culture: M. Turberculosis). A tuberculosis treatment was initiated after diagnosis.