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Objective: To assess the learning curve and evaluate the impact of surgical experience related to the outcomes of flexible ureteroscopy (fURS) for upper urinary tract stones., Method: We evaluated retrospectively lithiasis fURS performed in our institution between January 2004 and December 2020. Patients were divided into two groups by the number of procedures performed by surgeon. Group 1 (G1) included the first 50 procedures, and group 2 (G2) the next cases. These groups were matched on baseline characteristics by a propensity score. Stones free rate (SFR) and complication rate (CR) were compared. Learning curves were realized using logistic curve with 95% confidence interval., Results: After criteria exclusion and propensity score matching, 1548 procedures were analyzed (1:1, G1 and G2, n=774 procedures). A total of 29 surgeons were evaluated. The overall SFR was 68.4% without statistical difference between the two groups (G1=67.9% vs. G2=68.8%, P=0.72). The surgeon's experience was not associated with SFR (OR=1.15, 95% CI: 0.90-1.47), except in subgroup stones>2cm (OR=2.89, 95% CI: 1.29-6.46). The overall CR was 12.5%, mainly Clavien-Dindo grade I-II complications (96.2%). Surgical experience was not associated with CR (OR=1.06, 95% CI: 0.77-1.45). The overall logistic curves for probability of stone clearance and complication tended to be a flat slope., Conclusion: Impact of surgical experience on fURS for UUTS was not associated with SFR and CR. However, for stones larger than 2cm, surgeon's experience tended to be associated with SFR, but without impact on overall complications., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: Several studies have reported blood transfusion were associated with a decrease of survival after oncological surgery. For kidney cancer, the effect of blood transfusion is still debated. The objective of this study was to determine the effect of blood transfusion after oncological nephrectomy on overall, specific and recurrence-free survival in a retrospective cohort of localized or locally advanced kidney cancer., Material and Methods: We performed a monocentric retrospective analysis of all patients managed by surgery for localized or locally advanced renal cancer between January 2000 and December 2016. We compared overall and specific survival and recurrence-free survival between two groups: patients transfused and not transfused. Demographic, surgical and tumor characteristics were compared. Survival analyses were performed using univariate Cox regression and multivariate Cox proportional regression test., Results: We included 382 patients in this study: 320 (83.8%) were not transfused and 62 (16.2%) were transfused. Transfused patients were significantly older (P=0.001) and had a lower pre-operative hemoglobin level (P=0.008). Operative and oncological characteristics were also different between both groups. In univariate analysis, we showed that blood transfusion was associated with lower overall survival (P<0.001), specific survival (P<0.001), and recurrence-free survival (P<0.001). In multivariate analysis, we found that blood transfusion was not associated with overall survival, or specific survival, but it was associated with lower recurrence-free survival (HR: 1.967, CI95% [1.024-3.780], P=0.042)., Conclusions: Perioperative blood transfusion is an independent risk factor that increases tumor recurrence among patients treated with nephrectomy for renal cancer., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Aim: Evaluate the concordance between the renal lesions biopsy's histology and the final histology of the surgical specimen according to histological subtype, and search for predictive factors of non-concordance., Material: We performed a monocentric retrospective study that included 156 patients suffering from a renal tumor that benefited a lesion biopsy before surgical treatment. Sensibility and specificity of the renal lesion's biopsy for histological diagnostic of the different renal tumors where calculated., Results: One hundred and fifty-eight renal tumor biopsies were realized between 2001 and 2016. One hundred and forty-three renal cell carcinoma were found on the surgical piece, 135 were diagnosed on prior biopsy. Global concordance rate was 88%. For the establishment of the nuclear Fuhrmann grade, the concordance rate (low vs. high grade) was 72.9%. The cohort was divided into 2 groups according to the existence (group 1, n=139) or the absence (group 2, n=19) of concordance. Group 1 and 2 differed by the predominance of men in group 1 (66% vs. 37%, P=0.013), distance between the sinus and the tumor above 4mm (65% vs. 42%, P=0.05)., Conclusion: In renal tumor care, renal biopsy is a reliable testing. However, some factors most likely linked to the tumor anatomy (intra-sinusal tumor) and their histological composition were involved in the lack of non-contribution to the diagnosis., Level of Evidence: 4., (Copyright © 2019. Published by Elsevier Masson SAS.)

Purpose: The aim of this study was to evaluate the efficacy and tolerance of renal stone fragmentation by flexible ureterorenoscopy (URS), compared to percutaneous nephrolithotomy (PCNL)., Material and Methods: Patients treated between 1998 and 2010 by URS and PCNL for intrarenal stone were reviewed. Patients' and stones' characteristics were analyzed. The preoperative parameters were reported as well as the procedure's efficiency and its complications. Success was defined by the absence of residual lithiasis visualized on renal imaging at 6 months of follow-up., Results: Among 531 patients included, there were 159 PCNL and 372 URS. The mean duration of hospitalization after PCNL was 8±4.6 days and 3±1.7 days after URS. The mean stones' size was higher in the PCNL group (19.9±7.5mm) than for the URS group (9.7±5.6mm; P<0.0001). The stone-free rate was significantly better in the PCNL group for stones measuring between 10 and 20mm (P<0.0001) and for stones of more than 20mm (P=0.017). Postoperative complications were significantly more frequent (27 %) and more severe (8.8 % vs Clavien III and IV) in the PCNL, than in the URS group, respectively (P=0.0001)., Conclusion: PCNL is a successful technique for renal stone fragmentation. However, URS seemed more tolerated despite a lower stone-free rate., Level of Evidence: 4., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To determine whether obesity is associated with adverse pathologic characteristics, positive surgical margins and the biochemical recurrence free survival (bRFS) after primary treatment with radical prostatectomy (RP)., Patients and Methods: Medical charts of patients managed with RP between 1999 and 2011 for localized prostate cancer (PCa) were retrospectively reviewed. Population study was split into two groups according to the body mass index (BMI): non obese (BMI< 30 kg/m(2)) and obese (BMI ≥ 30 kg/m(2)). Correlations between obesity and adverse pathological features or bRFS were assessed using univariable and multivariable analyses., Results: Overall, 328 patients were included in the present study: 278 (84.8%) obese and 50 (15.2%) non obese. In multivariable analysis, obesity was associated with positive surgical margins (P=0.014), extracapsular extension (P=0.004) and pathologic Gleason score ≥ 7 (P=0.048). Obesity was not associated with seminal vesicle invasion (P=0.636) and lymph node metastasis (P=0.132). After a mean follow-up of 60.51 ± 28.82 months, no statistical difference in terms of bRFS was observed between the two groups (P=0.186). Furthermore, obesity was not an independent predictor of bFS in multivariable analysis., Conclusion: Obesity was associated with adverse pathologic characteristics and positive surgical margins but no statistical correlation was found with bRFS., Level of Evidence: 5., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To analyze results and morbidity after flexible ureterorenoscopy (fURS) in patients with a body mass index (BMI)>30 kg/m² and to compare with results obtained in a large cohort of non-obese patients., Methods: We conducted a retrospective monocenter study including all fURS for urinary lithiasis performed in our institution between January 2004 and December 2010. During the study period, 497 procedures were performed. Twenty-three had to be excluded because of missing data on BMI. Thus, a total of 474 procedures were included in the final analysis, 93 for obese patients (OP) and 381 for non-obese patients (NOP). Characteristics of the patients, stones and procedures were analyzed. Success was defined as clear imaging (completely stone-free) on renal tomography and ultrasonography., Results: Mean BMI was 33.5 ± 0.3 in OP vs 23.9 ± 0.1 kg/m² in NOP (P<0.0001). Mean stone size, location, and composition were not significantly different between groups. Technical aspects (operative time, ureteral dilatation, access sheath, monobloc extraction) were also similar in OP and NOP. The immediate (63.5% for OP vs 66.1% in NOP, P=0.62) and follow-up (65.1% for OP vs 71% in NOP, P=0.26) stone-free rate were not significantly different between the groups. For stone size<1cm, SFR raised to 77% in OP vs 83% in NOP (P=0.28). The rate of minor complications Clavien II was similar in OP (7.5%) and NOP (12%). No major complication (Clavien III or IV) was observed., Conclusion: fURS is a safe and efficient option for the management of urinary lithiasis in obese patients., (Copyright © 2014. Published by Elsevier Masson SAS.)

Objectives: To analyze the impact of the existence of Gleason grade 5 on the adverse pathology and biochemical recurrence-free survival of patients., Patients: Three hundred and seventy-two prostatectomies were performed between 1999 and 2011 in our institution for localised prostate adenocarcinoma. We examined the existence of grade 5 of the specimen to determine the reliability of prostate biopsies in the diagnosis of grade 5 and the association of grade 5 with other histoprognostic factors. Biochemical recurrence-free survival was analyzed according to the presence of grade 5 in the final specimen., Results: In total, all histological data and biochemical recurrence-free survival were available for 321 patients who were included in the study. Sixty-eight had Gleason grade 5 (majority or third minority pattern) on the specimen while 253 had not. Grade 5, rarely diagnosed on biopsy (sensitivity=26.47 %) was correlated independently with the extracapsular extension (OR=2.1; CI 95 [1.1-3.9]), the seminal vesicle invasion (OR=3.8; CI 95 [1.7-8.7]) and positive surgical margins (OR=2.0; CI 95 [1.1-3.6]). Overall survival was similar in both groups but the biochemical recurrence-free survival was statistically lower in the presence of grade 5 (HR=3.7; CI 95 [1.8-7.6]). Biochemical recurrence-free survival was not different than grade 5 is predominant or third minority pattern (HR=1.01; CI 95 [0.3-2.8]). On multivariate analysis, grade 5 was an independent risk factor for biochemical recurrence (P=0.005) as well as seminal vesicle invasion (P=0.047)., Conclusion: The existence of grade 5 in the surgical specimen whatever the percentage was a poor prognostic factor associated with increased tumor aggressiveness and reduced biochemical recurrence-free survival., Level of Evidence: 5., (Copyright © 2014. Published by Elsevier Masson SAS.)

Since the publication of the latest recommendations of the Lithiasis Comity of the French Association of Urology (CLAFU) on the management of ureteral and renal stones, practices have evolved. This text provides an update for the treatment of kidney stones. It is especially the important advances in the field of laser-ureterorenoscopy that changed practices. Percutaneous nephrolithotomy has been enriched by technical modifications and extracorporeal shockwave lithotripsy confirmed its predominant place in the first line of treatment. For stones less than 20mm, extracorporeal lithotripsy remains the standard, but in some cases the possibility of recommending a flexible ureterorenoscopy is possible in first line. For stones more than 20mm, percutaneous nephrolithotomy is the standard treatment, but optional flexible ureteroscopy and extracorporeal lithotripsy are possible. The treatment carried out, collect the stone fragments for a morpho-constitutional analysis and achieve a metabolic evaluation is necessary, to investigate etiologic and give dietary advices to prevent recurrence., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Aim of the Study: To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit., Patients and Methods: In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data., Results: During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization., Conclusion: The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount., (Copyright © 2013. Published by Elsevier Masson SAS.)

Unlabelled: The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation., Methods: Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney., Results: Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient., Conclusion: The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL)., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: The therapeutic approach of prostate cancer depends mainly on pathological criteria obtained through prostate biopsy. The low accuracy of prostate biopsy for Gleason grade determination is well known but its accuracy for bilateral or multifocal tumor has not been evaluated. The goal of this study was to assess the concordance between prostate biopsy and whole prostate specimen obtained after radical prostatectomy especially for bilateral and/or multifocal tumor., Methods: We retrospectively compared the pathological results of prostate biopsy cores to the prostate specimen in patients who underwent radical prostatectomy in our department between the 01/01/1999 and the 31/12/2008. The criteria analyzed were the Gleason score, tumor bilaterality or multifocality. The impact of the number of prostate biopsy cores was also analyzed., Results: Two hundred and five complete histological records were studied. Regarding the Gleason score overall concordance was 55%. In 38%, prostate biopsies downgraded the Gleason score. This concordance decreased with tumor differentiation (90.6% for Gleason 6 vs. 31% for Gleason greater than 7). For the tumor bilaterality, 78% of cancers affected both lobes at the definitive specimen analysis while only 49% were bilateral at prostate biopsies, achieving a concordance of 61%. Multifocal disease was observed in 36% at definitive pathology analysis with low concordance with prostate biopsies (36%). The number of biopsies increased the concordance for the Gleason score (60 to 81% for Gleason 7 and from 28 to 50% for Gleason greater than 7) and tumor location (44 to 70%)., Conclusion: Pathological criteria and tumor mapping obtained from prostate biopsies were not very reliable especially when the tumor was poorly differentiated. An increased number of prostate biopsy core improved the sensitivity and specificity for the Gleason score diagnostic and of the tumor mapping., (Copyright © 2012. Published by Elsevier Masson SAS.)

Objectives: To study the prognostic impact of muscularis mucosae (MM) invasion for pT1 bladder cancer treated by transurethral resection (TUR) and adjuvant Bacille Calmette-Guerin (BCG) intravesical immunotherapy., Methods: Sixty-six patients treated by BCG intravesical instillations were substaged into pT1a and pT1b, regarding Muscularis Mucosae invasion. Tumor grade, associated carcinoma in situ (CIS), multifocality, tumoral size up to 3cm, BCG maintenance were noted. With a mean follow-up of 50.5±38 months, we studied recurrence, progression, overall and specific survival. Cox's model method was used for multivariate analysis., Results: Tumor recurrence was observed in 30±7% and 43±10% (P=0.29) and tumor progression in 16.3±5% and 39±10% (P=0.04) for pT1a and pT1b. The rate of progression was higher (P=0.04) and progression free survival was decreased (P=0.04) for pT1b. Specific death rates were 11±5% and 21±9% (P=0.28), median overall survival was 80.9 [1.5-92] and 48.2 [12-93] months for pT1a and pT1b. Overall and specific survival weren't different between the two populations (P=0.38; P=0.3). Cystectomy rates were 2.3±2% and 30±9% for pT1a and PT1b (P=0.0006). For pT1a patients, recurrence (P=0.8) or progression rates (P=0.64) were no different regarding BCG maintenance immunotherapy but pT1b population had a better progression free survival with BCG maintenance than without (P=0.0051). Only CIS had prognostic value in multivariate analysis., Conclusions: Tumors with Muscularis Mucosae invasion have a higher risk of progression and BCG failure. Maintenance immunotherapy should be given to improve results with these patients., (Copyright © 2011. Published by Elsevier Masson SAS.)

Purpose: To assess urinary complications related to the "one-stitch" technique extravesical ureteroneocystostomy in renal transplantation, and evaluate the impact of such complications on kidney graft and patient survival., Patients and Methods: A single-institution, retrospective study was performed on 202 renal transplant recipients, from January 2004 to December 2008. Two combined kidney and liver transplantations were excluded. The "one-stitch" extravesical ureteroneocystostomy technique, fast and easy to perform, was systematically used. The evaluated urinary complications were urinary fistula, ureteral stenosis, symptomatic ureteral reflux, stone formation and complicated hematuria. We tried to point out factors impacting urinary complications occurrence and studied grafts and patients survival according to the existence of urinary complications., Results: Fifty-five patients presented urinary complications (27.5%). The most frequent urinary complications were complicated hematuria (36 over 200, 18%), ureteral stenosis (15 over 200, 7.5%). Few cases of stone disease (one over 200, 0.5%), urinary fistula (two over 200, 1%) and symptomatic ureteral reflux (one over 200, 0.5%) were noted. Male gender (100 vs 34, P=0.95), age (46.78 ± 14.17 vs 48.06 ± 14.19 years, P=0.58), Body mass index (24.14 ± 5.04 vs 24.28 ± 4.83, P=0.86) and past history of renal transplantations (16 ± 3% vs 10 ± 3%, P=0.27) as well as cold ischemia time (17.08 ± 7.07 vs 16.9 ± 8.95 hours, P=0.71) were not significantly different in the urinary complications group and the non-urinary complications group. Median hospitalization time was similar in both groups (14 vs 12 days, P=0.37). The existence of urinary complications didn't affect the 5 years kidney graft survival (91.9% vs 89.9%, HR 1.21, CI 95% [0.37-3.3], P=0.83) neither the 5 years patient survival (94.8% vs 92.15%, HR 0.52 CI 95% [0.13-2.07], P=0.85)., Conclusion: If benign urinary complications in "one-stitch" ureteroneocystostomy were frequent in our study (17% grade II Clavien Dindo), kidney graft and patients survivals were not affected., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Urinary stones are relatively frequent in pregnant women and raise specific diagnostic and therapeutic problems. The authors conducted a retrospective review of the management of this disease in their establishment., Patients and Methods: Between January 1999 and December 2003, out of a total of 10,398 parturients, 48 pregnant women were hospitalised for renal colic, that is, incidence of 0.04%. The medical records of these patients were retrospectively reviewed and clinical, laboratory, treatment and outcome data were analysed., Results: Standard analgesic treatment, comprising paracetamol and an antispasmodic, achieved pain relief in 84% of cases. A concomitant short course of corticosteroid therapy in cases of renal colic refractory to standard treatment was effective in 71% of patients and allowed deferral of surgical management in five out of seven cases. A double J stent was placed in all patients requiring urinary diversion, followed by closer ultrasound and bacteriological monitoring throughout pregnancy. Only two patients required surgical management of their stone after delivery. The only obstetric event related to renal colic was induction of labour at term in two cases because of foetal distress., Conclusion: The authors propose a two-stage management plan for renal colic in pregnant women resulting in a low maternal and foetal complication rate.

Objective: To evaluate the complications, the morbidity and mortality of renal transplantation in patients with a vascular prosthesis inserted either prior to or at the same time as renal transplantation., Patients and Method: Between January 2001 and January 2006, six renal transplantations were performed in patients with arterial vascular prostheses or requiring concomitant insertion of a vascular prosthesis during renal transplantation. The mean age was 58 years [range: 47-69 years]. In each case, we evaluated operative difficulties, complications and postoperative course (morbidity, mortality) and the renal functional result., Results: The mean operating time was 230 minutes [range: 130-380 minutes] with a mean blood loss of 390 ml [175-750 ml]. Three patients required another surgical operation for femoral thrombosis, iliofemoral thrombosis and compressive haematoma. The median length of hospital stay was 21 days [range: 9-78 days]. Graft function was restored immediately in all six patients, and one case of graft loss was observed. The morbidity was higher than that usually observed after renal transplantation. With a mean follow-up of 26 months, the vascular and renal results are satisfactory., Conclusion: Renal transplantation in patients with a history of vascular prosthesis or requiring replacement of the vascular prosthesis at the same time as renal transplantation can be performed with satisfactory results but with an increased morbidity. The vascular treatment must be part of a multidisciplinary strategy in the context of transplantation.

At the present time, 15% of couples experience reproduction difficulties. Surgical collection of spermatozoa associated with the intracytoplasmic sperm injection technique (ICSI) resolves the problems of male infertility formerly considered to be irreversible, regardless of its aetiology. Molecular biology now allows evaluation of the genetic dimension of male infertility. Although it demonstrates the multiple aetiologies of male infertility, it also reveals the gaps in our knowledge and the extent of the task that has yet to be accomplished. Microdeletion of the Y chromosome, detected in 2% to 20% of infertile patients with a disorder of spermatogenesis, has already been well documented. All of the genes involved on the Y chromosome (DAZ, RBMY, etc.) in infertile patients have been shown to be involved in spermatogenesis. Testing for other genes of the genome would also be useful. However, the unknown outcome of these abnormalities with successive generations raises a number of questions. In this article, the authors describe the main genes involved in spermatogenesis as demonstrated by molecular biology.

Objective: To analyse the progress in the management of severe renal trauma (Chatelain stage 3 and 4) over a period of 11 years., Patients and Methods: From December 1989 to June 2001, 21 patients were treated for severe renal trauma. Up until 1995, all patients were operated urgently or on the 7th day (n = 12). After 1995, patients were operated (n = 3) or managed nonoperatively (n = 6). We retrospectively studied the age, gender, type of trauma (open, closed), associated lesions, radiological assessment performed, treatment and complications., Results: 20 males and 1 female with a mean age of 30.3 years were managed for severe renal trauma (17 stage 3 and 4 stage 4; 20 cases of closed trauma, 1 case of open trauma). The radiological assessment comprised ultrasound (13 cases), abdominopelvic CT (19 cases) and IVU (4 cases). Thirteen patients presented with multiple injuries with associated visceral (8 cases), bone (7 cases), or mixed (3 cases) lesions. Six patients were managed nonoperatively and 15 patients were operated: 6 urgently (4 total nephrectomies), 9 on the average of the 7th day (conservative treatment). Five patients developed long-term complications (4 cases of renal atrophy, 1 urohaematic pseudocyst). The median follow-up was 13.5 months., Conclusion: The current approach to stage 3 renal trauma tends to be surveillance and nonsurgical management (carefully selected, haemodynamically stable patients). Vascular repair before the 5th hour is recommended for stage 4 trauma. Cases of delayed diagnosis of arterial thromboses are monitored.

In France, 12 to 15% of couples experience procreation difficulties. A disorder of spermatogenesis (oligospermia, azoospermia) is responsible in 1/3 of cases. These forms of infertility, labelled idiopathic, probably have a genetic component, like microdeletions of the Y chromosome. The normal rate of circulating androgens suggests the implication, in some cases, of an abnormality from the receptor to the androgens (RA) of these male infertilities, whose number remains to be defined. Point mutations on exons of the gene encoding the AR cannot account for all cases of infertility due to idiopathic disorders of spermatogenesis. Expansion of the number of CAG triplets of exon 1 of the AR gene, already demonstrated in a fatal degenerative neuropathy (Kennedy's disease, in which more than 50% of patients are infertile), has been detected in these cases of idiopathic infertility and would be responsible for AR dysfunction. The number of these triplets is also decreased in patients with androgen-dependent prostate cancer. The polymorphism of repetition of CAG triplets would therefore be responsible for fine adjustment of the AR between excessive and insufficient function. ICSI. (Intra-Cytoplasmic Sperm Injection) is currently proposed in these cases of infertility, but the consequences of transmission of these abnormalities to the offspring are unknown.

Angiogenesis is a complex, multi-step process which leads to the formation of new blood capillaries (neovessels) from preexisting vessels. It is essential top the growth of solid tumours and tumour metastasis (tumour angiogenesis). This process is initiated by the synthesis, by tumour cells and non-malignant tumour-associated cells, of growth factors called antigenic factors or inducers. bFGF (basic Fibroblast Growth Factor) and VEGF (Vascular Endothelial Growth Factor) are the two angiogenic factors involved in bladder tumour angiogenesis. The angiogenic activity of a bladder tumour can be measured by the microvascular density (MVD), considered by some authors to be an independent prognostic indicator of recurrence and survival in the group of invasive bladder tumours. VEGF expression in bladder tumours and biological fluids (serum, urine) appears to be a predictive marker of the risk of progression of superficial bladder tumours. Urinary bFGF assay reveals high levels in patients with bladder tumour, but this elevation is not specific to bladder tumours. Inhibition of tumour angiogenesis has become a therapeutic target. Intravesical suramine and a fumagillin analogue (TNP-470) have given promising results in terms of efficacy and safety in the treatment of bladder tumours.

Objectives: To assess the diagnostic value of clinical examination and ultrasound in testicular trauma and to analyse the complications of the various treatments proposed (surgical and medical treatments), in order to more clearly define the place of medical treatment in this form of trauma in young adults., Patients and Methods: 56 cases of testicular trauma in 50 patients were managed between January 1990 and January 2000. In the absence of clinical and ultrasonographic criteria of severity (haematocele, very large intratesticular haematoma, rupture of the tunica albuginea), medical treatment consisting of rest, anti-inflammatory drugs, and testicular support was instituted. Surgical exploration was performed when serious lesions of the testis were suspected. Three subgroup were defined: the medical treatment subgroup, the early surgical treatment subgroup, and the deferred surgical treatment subgroup (more than 3 days after trauma). The immediate morbidity and long-term sequelae were analysed in each of these three subgroups., Results: The clinical features of pain and scrotal swelling make assessment of the lesions difficult. Testicular ultrasound can help the clinician, but it has a low sensitivity for the diagnosis of testicular rupture. No significant difference was observed between the three subgroups in terms of morbidity, orchidectomy, and long-term sequelae rates., Conclusion: In the absence of signs of severity, medical treatment with regular surveillance remains justified. However, in the case of doubtful clinical or ultrasound findings, surgical exploration must be performed as soon as possible.

The antioncogene p53 has been the subject of many studies in the field of bladder cancer, for many years and there appears to be a good correlation between p53 protein overexpression and pejorative clinicopathological factors, but contradictory results have been reported concerning its prognostic value. These discordances can be partly explained by the various immunohistochemical methods used in published series. Standardization of a highly sensitive and specific immunohistochemical method for the detection of p53 alterations now appears to be essential in order to accurately determine the value of p53 in the clinical management of bladder cancer.

Objective: The objective of this study was to evaluate the management and current treatment options for ureteric complications after vascular surgery based on a series of 6 cases., Patients and Method: 6 patients were treated between 1990 and 1998 (mean age: 64.7 years) for ureteric complications after aortic bifurcation surgery. The mean interval between vascular surgery and urological management was 11.6 years (+/- 4.04). All patients were assessed by intravenous urography (IVU), and 4 patients were assessed by abdominal computed tomography (CT). These complications consisted of: 2 cases of ureteric stenosis, 1 case of inflammatory peri-ureteritis, 2 cases of chronic peri-ureteritis and 1 case of compression by a false aneurysm. The lesion was situated in the iliac ureter in every case., Results: Treatment consisted of temporary double J stenting (n = 1), ureter release (n = 1), endoscopic dilatation (n = 1), psoas bladder reconstruction (n = 1) and corticosteroid therapy (n = 2), with 4 successes, 1 failure (corticosteroid therapy), and 1 death from another cause., Conclusion: Ureteric lesion after vascular surgery is a rare complication, often discovered incidentally. The iliac ureter is predominantly affected. IVU and CT are the reference examinations. Treatment options primarily depend on the patient's general state.

The authors present a distal urethroplasty technique (or urethromeatoplasty) which consists of reconstruction of the floor of the distal urethral (glandular urethra) by inversion of a pedicled ventral penile skin patch graft raised transversely. This technique allows treatment of recurrent stricture of the glandular urethra in circumcised patients with good aesthetic and functional results.

The authors report the case of a very large, obstructive malignant melanoma (MM.) of the prepuce, encasing all of the distal extremity of the penis, and discovered at a late metastatic stage (regional lymph node metastasis). Palliative treatment, consisting of partial penectomy associated with a complementary induction and maintenance chemotherapy did not achieve any objective response at one year. MM. of the penis are rare urological tumours, including MM of the penis and MM of the male urethra (exclusively mucosal involvement). The diagnosis of MM of the penis must be considered in any case of black or brown lesion of the glans, which is the most frequent site. The prognosis is determined by the clinical stage (BRACKEN and DIOKNO classification) and by the depth and level of tumour invasion (BRESLOW index and CLARK's degree of dermal invasion). The 5-year survival is inversely proportional to the tumour thickness. The treatment of MM of the penis is surgical; the extent of resection and the indication for lymph node dissection depend on the patient's age, sexuality, and the stage of the disease and depth of tumour invasion.

The occurrence of upper urinary tract tumors has been studied in 479 patients followed for bladder cancer: The incidence rate is low (2.9%) but increases with time (mean: 58 months). Some patients are more exposed: those who underwent repeated transurethral resections of Ta-T1 multifocal bladder carcinoma. Retrograde and voiding cystourethrogram seems to be useful to select a group "at risk" during the follow-up of patients with bladder tumors treated by endoscopic resection: a yearly excretory urography for upper urinary tract survey should then be performed.