Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2011
Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to rea... more Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer. In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often). After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P=0.0001). More than 50% of the patients had an altered orgasm (weak, d...
To present 2 cases with polyorchidism, to review the literature about polyorchidism, and to propo... more To present 2 cases with polyorchidism, to review the literature about polyorchidism, and to propose a rational therapeutic algorithm. In our institution, we encountered 2 patients with polyorchidism: The 1st patient had bilateral double testis with testicular torsion, and the 2nd patient presented with an indolent scrotal mass. We also performed a literature search (PubMed) for other reports of polyorchidism. Polyorchidism is a rare congenital anomaly that is not well known by most urologists. So far, as illustrated by our 2 cases, the management of polyorchidism is rarely conservative, and usually the supernumerary testis is removed without any evidence supporting this attitude. Rare cases are complicated by torsion (case 1), cryptorchidism, or testicular neoplasm. In case of torsion, the conservative approach depends on the viability of the twisted testis. In case of cryptorchidism, notably in children or young adults, conservative management should be proposed, if technically feasible. In case of signs of malignancy, orchiectomy must be performed. Conservative treatment is advised in all uncomplicated cases. Complicated cases need a careful management, but several situations can be managed conservatively. Based on the literature, we propose a simple, rational therapeutic algorithm.
ABSTRACT Objective To study the morbidity and haemodynamic parameters on a consecutive series of ... more ABSTRACT Objective To study the morbidity and haemodynamic parameters on a consecutive series of adrenalectomies performed for phaeochromocytoma by retroperitoneal laparoscopy. Material and Methods The study population comprised 23 phaeochromocytomas in 20 patients treated by controlled retroperitoneal laparoscopic surgery. The following parameters were studied: intraoperatively : operating time, blood loss, blood pressure, heart rate, and postoperatively : infectious, haemorrhagic and thromboembolic complications. Results The mean operating time was 156 minutes (range : 105-224). Mean blood loss was 58 ml (range : 0-300). Intraoperatively, 15% of patients presented a peak SBP > 220 mmHg and 70% presented a peak SBP > 200 mmHg. In contrast, 20% of patients presented a nadir SBP < 60 mmHg, but no patient presented a nadir SBP less than 40 mmHg. One case of intraoperative haemorrhage was observed (4.3%). Three postoperative complications (1 case of respiratory distress, 1 case of haemorrhagic shock, and 1 abscess) were observed (13%). Conclusion Laparoscopic surgery for phaeochromocytoma is associated with a risk of haemodynamic instability. Phaeochromocytoma surgery should therefore continue to be performed in specialized centres (surgical, anaesthetic and endocrinological).
We describe here the first case of a synchronous epidermoid cyst and mature teratoma of the testi... more We describe here the first case of a synchronous epidermoid cyst and mature teratoma of the testis occurring in a young man presenting a with bilateral testicular tumor. After a clinical, biological and ultrasound evaluation, testis-sparing surgery was performed on the left testis and a total orchiectomy on the right side in accordance with oncological principles. Histopathological examination revealed a simple epidermoid cyst on the left side and a mature teratoma on the right side, following Price's criteria. No metastasis was detected, and the patient was closely followed. The patient remains disease-free and has normal postoperative testosterone levels 3 years after the surgery.
Cryptorchidism is the most frequent abnormality of male sexual differentiation. Recently, numerou... more Cryptorchidism is the most frequent abnormality of male sexual differentiation. Recently, numerous reports have increased concerns that exposure to certain types of chemicals in the environment, including in utero exposure to compounds with estrogenic or antiandrogenic activities, may be linked with recently observed deleterious effects on male reproductive health, especially cryptorchidism and also decrease in sperm production and increased in
Testicular cancer (TC) is the most common malignancy in 20 to 34-year-old men. Numerous publicati... more Testicular cancer (TC) is the most common malignancy in 20 to 34-year-old men. Numerous publications have shown an increase in the incidence of testis cancer in the last 40 years with substantial differences among countries. We evaluated worldwide variations in testicular cancer incidence and compared trends in different regions in the world. We reviewed 441 studies provided by a MEDLINE search using the key words testis/testicular, cancer/tumor and incidence that were published between 1980 and 2002. From these articles we selected only those devoted to testis cancer incidence and of them only the most recent studies from each country or region. Nevertheless, articles using the same data base but providing new and additional information, for example differences among ethnic groups or controversial explanations for trends, were also retained. We selected 30 articles and analyzed their methodological approach and main results. Worldwide we observed a clear trend toward an increased TC incidence in the last 30 years in the majority of industrialized countries in North America, Europe and Oceania. Nevertheless, surprising differences in incidence rates were seen between neighboring countries (Finland 2.5/100,000 cases versus Denmark 9.2/100,000) as well as among regions of the same country (2.8 to 7.9/100,000 according to various regional French registers). In addition, substantial differences in the TC incidence and trends were observed among ethnic groups. The increase in the TC incidence was significantly associated with a birth cohort effect in the United States and in European countries. To date except for cryptorchidism no evident TC risk factor has been clearly demonstrated, although the environmental hypothesis with a key role of endocrine disrupters has been put forward by several groups. Such a recent increase in the TC rate in most industrialized countries should lead urologists and andrologists to give more attention to testicular cancer symptoms in adolescents and young adults. In a public health perspective further research using cases collected through national and regional population based registers and case-control studies must be strongly encouraged if we wish to be able to assess future trends in TC incidence rates and also identify risk factors.
We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for ger... more We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis. Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia. CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%). Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.
Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie, 2011
Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to rea... more Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer. In a series of 270 sexually active men treated by prostate brachytherapy (125I permanent implantation), 241 (89%), mean age of 65 (43-80), participated in a mailed survey about sexual function after a mean time of 36 months (9-70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often). After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P=0.0001). More than 50% of the patients had an altered orgasm (weak, d...
To present 2 cases with polyorchidism, to review the literature about polyorchidism, and to propo... more To present 2 cases with polyorchidism, to review the literature about polyorchidism, and to propose a rational therapeutic algorithm. In our institution, we encountered 2 patients with polyorchidism: The 1st patient had bilateral double testis with testicular torsion, and the 2nd patient presented with an indolent scrotal mass. We also performed a literature search (PubMed) for other reports of polyorchidism. Polyorchidism is a rare congenital anomaly that is not well known by most urologists. So far, as illustrated by our 2 cases, the management of polyorchidism is rarely conservative, and usually the supernumerary testis is removed without any evidence supporting this attitude. Rare cases are complicated by torsion (case 1), cryptorchidism, or testicular neoplasm. In case of torsion, the conservative approach depends on the viability of the twisted testis. In case of cryptorchidism, notably in children or young adults, conservative management should be proposed, if technically feasible. In case of signs of malignancy, orchiectomy must be performed. Conservative treatment is advised in all uncomplicated cases. Complicated cases need a careful management, but several situations can be managed conservatively. Based on the literature, we propose a simple, rational therapeutic algorithm.
ABSTRACT Objective To study the morbidity and haemodynamic parameters on a consecutive series of ... more ABSTRACT Objective To study the morbidity and haemodynamic parameters on a consecutive series of adrenalectomies performed for phaeochromocytoma by retroperitoneal laparoscopy. Material and Methods The study population comprised 23 phaeochromocytomas in 20 patients treated by controlled retroperitoneal laparoscopic surgery. The following parameters were studied: intraoperatively : operating time, blood loss, blood pressure, heart rate, and postoperatively : infectious, haemorrhagic and thromboembolic complications. Results The mean operating time was 156 minutes (range : 105-224). Mean blood loss was 58 ml (range : 0-300). Intraoperatively, 15% of patients presented a peak SBP > 220 mmHg and 70% presented a peak SBP > 200 mmHg. In contrast, 20% of patients presented a nadir SBP < 60 mmHg, but no patient presented a nadir SBP less than 40 mmHg. One case of intraoperative haemorrhage was observed (4.3%). Three postoperative complications (1 case of respiratory distress, 1 case of haemorrhagic shock, and 1 abscess) were observed (13%). Conclusion Laparoscopic surgery for phaeochromocytoma is associated with a risk of haemodynamic instability. Phaeochromocytoma surgery should therefore continue to be performed in specialized centres (surgical, anaesthetic and endocrinological).
We describe here the first case of a synchronous epidermoid cyst and mature teratoma of the testi... more We describe here the first case of a synchronous epidermoid cyst and mature teratoma of the testis occurring in a young man presenting a with bilateral testicular tumor. After a clinical, biological and ultrasound evaluation, testis-sparing surgery was performed on the left testis and a total orchiectomy on the right side in accordance with oncological principles. Histopathological examination revealed a simple epidermoid cyst on the left side and a mature teratoma on the right side, following Price's criteria. No metastasis was detected, and the patient was closely followed. The patient remains disease-free and has normal postoperative testosterone levels 3 years after the surgery.
Cryptorchidism is the most frequent abnormality of male sexual differentiation. Recently, numerou... more Cryptorchidism is the most frequent abnormality of male sexual differentiation. Recently, numerous reports have increased concerns that exposure to certain types of chemicals in the environment, including in utero exposure to compounds with estrogenic or antiandrogenic activities, may be linked with recently observed deleterious effects on male reproductive health, especially cryptorchidism and also decrease in sperm production and increased in
Testicular cancer (TC) is the most common malignancy in 20 to 34-year-old men. Numerous publicati... more Testicular cancer (TC) is the most common malignancy in 20 to 34-year-old men. Numerous publications have shown an increase in the incidence of testis cancer in the last 40 years with substantial differences among countries. We evaluated worldwide variations in testicular cancer incidence and compared trends in different regions in the world. We reviewed 441 studies provided by a MEDLINE search using the key words testis/testicular, cancer/tumor and incidence that were published between 1980 and 2002. From these articles we selected only those devoted to testis cancer incidence and of them only the most recent studies from each country or region. Nevertheless, articles using the same data base but providing new and additional information, for example differences among ethnic groups or controversial explanations for trends, were also retained. We selected 30 articles and analyzed their methodological approach and main results. Worldwide we observed a clear trend toward an increased TC incidence in the last 30 years in the majority of industrialized countries in North America, Europe and Oceania. Nevertheless, surprising differences in incidence rates were seen between neighboring countries (Finland 2.5/100,000 cases versus Denmark 9.2/100,000) as well as among regions of the same country (2.8 to 7.9/100,000 according to various regional French registers). In addition, substantial differences in the TC incidence and trends were observed among ethnic groups. The increase in the TC incidence was significantly associated with a birth cohort effect in the United States and in European countries. To date except for cryptorchidism no evident TC risk factor has been clearly demonstrated, although the environmental hypothesis with a key role of endocrine disrupters has been put forward by several groups. Such a recent increase in the TC rate in most industrialized countries should lead urologists and andrologists to give more attention to testicular cancer symptoms in adolescents and young adults. In a public health perspective further research using cases collected through national and regional population based registers and case-control studies must be strongly encouraged if we wish to be able to assess future trends in TC incidence rates and also identify risk factors.
We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for ger... more We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis. Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia. CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%). Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.
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Papers by Eric Huyghe