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Objectives: The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC)., Patients and Methods: Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161)., Results: In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P=0.009 and P=0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P=0.002 and P=0.0008 respectively for ureteral location)., Conclusion: Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Purpose: to clarify the patterns of diagnosis and management of adult spermatic cord sarcoma., Patients and Methods: between 1996 and 2009, seven patients with spermatic cord sarcoma were treated at Cochin hospital. After updating the pathological diagnosis according to the new classification of sarcoma we found that all patients had well-differentiated or dedifferentiated liposarcoma. We analysed their clinical presentation, management and carcinological outcome., Results: the patients' age ranged from 51 to 77 years, and their follow-up from 7 to 68 months. In five patients, the diagnosis of well-differentiated liposarcoma (lipoma-like) with some dedifferentiated sectors was made straightaway. In the two other patients, the initial diagnosis was that of leiomyosarcoma, which was reconsidered as dedifferentiated liposarcoma according to the cytogenetical and immunohistochemical techniques available since 2005. In 6/7 patients, a tumour resection with an orchiectomy at the same time (four patients) or secondarily (two patients) was performed. In one patient, only a tumour resection, without orchiectomy, was made. Multiple recurrences were observed in the two patients who were initially diagnosed as leiomyosarcoma. They needed multiple reintervention. One of them died after 68 months of evolution, the other one was treated with chemotherapy and died after 47 months of evolution. Four patients are out of recurrence. One patient was lost to follow-up., Conclusion: the diagnosis of liposarcoma must be considered in all adult patients aged of more than 50 with fatty-shaped or containing fibomuscular nodules paratesticular tumours. The surgeon and the pathologist must be well informed and an early and wide resection of fatty masses of the sperm cord with negative margins is advocated. The quality of resection is crucial but its appreciation and carrying out are difficult. The role of complementary treatments, especially radiotherapy, has to be determined., (2010 Elsevier Masson SAS. All rights reserved.)

Purpose: Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature., Patient and Method: Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database., Results: Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma., Conclusions: HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Prostate cancer is the first cancer in men. Its incidence is constantly increasing. The significant evolution of diagnostic and therapeutic means during the two last decades contrasts with the scarcity of medicoeconomic studies. The aim of this review is to present a synthesis of the different studies published and to respond to questions about the economic aspects of this disease, with the evaluation of its direct and indirect costs. The cost-effectiveness and the benefits of the prevention and the screening are still being studied. The costs of the surgery and the radiotherapy are roughly similar. The new surgical techniques, especially the laparoscopic and the robotic surgeries, are not necessarily associated with higher costs, in condition of a high-volume laparoscopic surgery program and a faster discharge. The indirect costs of prostate cancer concern the loss of economic production associated with the disease and death and are more difficult to determine., ((c) 2009 Elsevier Masson SAS. All rights reserved.)

Purpose: Primary urethral melanoma is a rare pathology for which treatment strategies are controversial. The aim of this work was to report a case of metastatic primary urethral melanoma, and to discuss recent data available from literature., Material and Method: Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database., Results: We reported the case of an 89-year-old woman who died from a primary metastatic melanoma of the urethra. This pathology encounters for less than 1% of melanomas and has an adverse prognosis. In case of metastasis, specific survival is only of a few months. When localized to the urethra, treatment relies on radical urethrectomy, followed by adjuvant chemo- and immunotherapy., Conclusions: The modalities of treatment of primary urethral melanoma rely only on reported case studies. When diagnosed at the metastatic stage, reported specific survival does not exceed a few months., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Objective: The aim of the study was to compare ureteroileal anastomosis strictures rates in patients receiving either double J stent or open-ended ureteral stent, after bladder replacement for cancer., Methods: Medical charts from 75 patients who underwent cystectomy and Z pouch bladder substitution for bladder cancer, between 2001 and 2005, were retrospectively reviewed. Ureteroileal anastomosis was direct, spatulated end-to-side fashioned in all patients. Double J stents were used in 39 patients (group A) and open-ended ureteral stent were used in 36 patients (group B). Mean hospital stay, early and late complications were also observed., Results: Seventeen anastomotic strictures have been documented during the follow-up: 5.2% in group A versus 18.3% in group B (p=0.012). Mean catheterization period was six weeks in group A and 12 days in group B. No significant differences were found in mean hospital stay, early and late complications., Conclusion: The use of internal double J ureteral stent is now a feasible option and can decrease the rate of anastomotic stricture. The fact that the double J stent is removed after the anastomosis healing period may be a possible explanation.

Objective: To assess the satisfaction of men and of their partner towards their testicular implants after undergoing orchidectomy., Materials and Methods: Hundred and twenty-four consecutive patients, who had undergone orchidectomy, and their partner were sent an anonymous questionnaire. The follow-up after the implantation was at least one year. The testicular implants used were all Perthèse., Results: Seventy-two patients answered to the questionnaire, among whom 63 had a testicular implant. Fifty-eight partners answered. From the patients with implant, 5% thought their body image was worse than before the operation and 80% thought their sexual activity was unchanged. Ninety-six percent thought the implantation was worthwhile and would do it again if they had to do the choice again. The reasons for dissatisfaction were: for the shape (n=8), for the size (n=3), for the position (n=2) and one patient thought the implant was too cold. Forty percent of the partners did not care about the implants and 58% thought the implant was essential. The dissatisfaction rate for the partners was 26% and reasons for were: for the shape (n=5), for the size (n=2), and one partner thought the implant was too cold. From the patients without implant, only one is thinking about having one., Conclusion: Testicular implants are well accepted, but some reasons of dissatisfaction appeared in our study. It was the first evaluation of the partner's satisfaction.

Purpose: To describe therapeutic modalities for localized prostate cancer treated by conformal radiation to 76Gy with or without androgen ablation. To evaluate the preliminary results in terms of survival, biological control and toxicity., Patients and Method: Between January 1998 and June 2001, 321 patients with localized prostate cancer were irradiated at institut Curie. Tumors were stratified into the three Memorial Sloan-Kettering Cancer Center prognostic groups (1998) for analysis: favorable risk group (FG) 23%, intermediate risk group (IG) 36.5%, unfavorable risk group (UG) 40.5%. Androgen deprivation, mainly neoadjuvant, less or equal to one year was prescribed to 93.8% of patients (72.6% less or equal to six months). Planning target volume prescription doses were: prostate: 76Gy, seminal vesicles: 56 to 76Gy, and pelvic lymph nodes: 44Gy to 16.8% of patients., Results: The five-year actuarial overall survival was 94% (95% IC: 90-97%). The median post-therapeutic follow-up was 36 months (nine to 60 months). The 48-month actuarial rates of biochemical control for the three prognostic groups were statistically different according to both the American Society for Therapeutic Radiology and Oncology consensus (ASTRO 1997) and the Fox Chase Cancer Center definitions of biochemical failure (FCCC 2000) with respectively 87 and 94% for FG, 78 and 84% for IG, 54 and 58% for UG (P<10(-6) and P<10(-8)). At time of our analysis, late post-treatment rectal and bladder bleedings were 17,4 and 13,6%, respectively. According to a 1-4 scale adapted from M.D. Anderson Cancer Center criteria: rectal bleedings were grade 1 (9.6%), grade 2 (6.2%) and grade 3 (1.6%). Bladder bleedings were grade 2 (13%) and grade 3 (0.6%). Analysis of rectal bleeding risk factors showed significant correlations with pelvic lymph nodes irradiation for grade 2 and 3, (P=0.02), and for all grades, a correlation with smaller rectal wall volumes (P=0.03), and greater percentages of rectal wall irradiated to higher doses: 65, 70, 72 and 75Gy (P=0.02, P=0.01, P=0.0007 and P=0.003, respectively)., Conclusions: These results are comparable to those previously reported with the same follow-up. Impact of dose escalation with short androgen deprivation on local control, survival and complications needs longer follow-up and further analysis.

Objective: The aim of this work has been to study the prognostic factors of recurrence and progression of stage pTa bladder tumours., Patients and Methods: The case files of 193 patients, consecutively undergoing transurethral resection for primary pTa bladder tumour between 1980 and 2003, were retrospectively reviewed. Recurrence, progression and specific survival rates were studied. Prognostic factors associated with this type of tumour were then investigated., Results: After a mean follow-up of 58 months, the recurrence rate was 56.5% and the rate of progression to stage T1 was 9.3%. The 10-year specific survival was 95.8%, but the 10-year recurrence-free survival rate was only 22.5%. Two risk factors for recurrence were identified on univariate analysis: haematuria at the time of diagnosis (p=0.009) and tumour size (p=0.01). Two factors were associated with a risk of progression: tumour size (p=0.03) and relapse during the first year after initial resection (p=0.003). None of these factors were independent prognostic factors on multivariate analysis., Conclusion: pTa bladder tumours present a high risk of recurrence. However, with attentive follow-up, the risk of progression is low and their 10-year specific survival rate is greater than 95 %. Tumour size at the initial diagnosis and early relapse increase the risk of progression to more aggressive disease.

Objective: The presence of positive surgical margins (PSM) on radical prostatectomy specimen is predictive of biological recurrence. Our objective was to analyze the influence of prostate weight on surgical margins status after radical prostatectomy., Patients and Methods: A cohort of 295 patients operated consecutively between 1998 and 2004 at our institution was prospectively studied. The variables significantly associated with the surgical margins status in univariate analysis were used for multivariate analysis., Results: The overall rate of PSM was 23% (9% for pT2 patients). Parameters significantly associated with surgical margins status were preoperative PSA (p = 0.02), number of positive biopsy cores (p = 0.04), pathological stage (p < 0. 001), and Gleason score on radical prostatectomy specimen (p < 0. 001). In addition, patient age and surgical specimen weight were conversely associated with surgical margins status (p = 0.008 and p = 0.001, respectively). In multivariate analysis, only three parameters were found to be independent factors of PSM: the pathological stage (p < 0. 001), the patient age (p = 0. 02), and the surgical specimen weight (p = 0.02). PSM rates were 6% and 25% in patients with prostate > 70g and < 70g, respectively (p = 0.008), and 15% and 28% in those with prostate weight > or = 50g and < 50g, respectively (p = 0.015)., Conclusion: Low prostate weight is an independent risk factor of PSM. Patients with prostate weight > or = 70g should be considered at low risk of PSM, while those with prostate weight < 50g are at high risk of PSM.

The authors report the case of a patient hospitalized for bilateral pyelonephritis and emphysematous cystitis requiring bilateral nephrostomy. This rare disease occurs in diabetic patients and is essentially due to Escherichia coli and Klebsiella pneumoniae. Treatment consists of antibiotics and renal drainage or nephrectomy. The prognosis is poor with a mortality rate greater than 50%.

Sarcomatoid carcinomas of the bladder with heterologous osteoid differentiation are exceptional, aggressive tumors with a poor prognosis. We report a new case, and discuss the clinical and pathological characteristics of this tumor.

Introduction: Male urinary incontinence due to sphincter incompetence is usually secondary to prostate surgery. After failure of other treatments, severe sphincter incompetence requires placement of an artificial urinary sphincter The authors present the results of the AMS 800 artificial urinary sphincter based on a series of 47 consecutively operated patients., Patients and Methods: From 1990 to 2003, 47 AMS 800 were inserted by the same operator and according to the same technique. The aetiologies of urinary incontinence were: radical prostatectomy (45% of cases), transurethral resection of the prostate (36%), open prostatectomy (10.5%), and others (8.5%)., Results: The mean age of the patients was 65 years. The mean follow-up was 36 months. The mean time to insertion was 3 years and 10 months (range: 5 months-15 years). 23.4% of patients presented one or several complications (mechanical failure: 19%; infection; 10.6%; erosion: 4%; bladder stones: 2%), 21% of patients required one or several surgical revisions after a mean interval of 25.5 months (range: 2-80 months). The actuarial 5-year revision rate was 25.5%. With a mean follow-up of 36 months, 98% of patients had a functioning artificial urinary sphincter and 83% still had their original artificial urinary sphincter Social continence and patient satisfaction rates were 87% and 95.7%, respectively., Conclusion: These results are comparable to those of similar published series. The AMS 800 is associated with high continence and patient satisfaction rates and currently remains the reference treatment for refractory sphincter incompetence in men.

Objective: To analyse the oncological results of open radical nephrectomy for renal cancer, Patients and Methods: Between December 1989 and June 2003, open radical nephrectomy for renal cancer was performed by the same operator in 230 patients. Cancers treated by partial nephrectomy were excluded from this study. The operation was performed via a lumbar incision in 95.7% of cases. Surveillance consisted of clinical examination and thoracic and abdominopelvic computed tomography twice a year for the first two years, then annually for 3 years, and then at 7 years and at 10 years in the absence of recurrence., Results: With a median follow-up of 63.1 months, the 5-year and 10-year recurrence-free survival rates were 88.4% and 67.2%, respectively. Tumour size, tumour stage (TNM 1997), Fuhrman's nuclear grade, histological type of cancer, and the presence of suggestive signs were correlated with the recurrence-free survival rate. The 10-year recurrence-free survival rate was zero in patients with visceral or lymph node metastases at the time of diagnosis. The patient's age at the time of diagnosis and the presence of a paraneoplastic syndrome did not influence recurrence free survival in this series., Conclusions: This study confirms the data of the literature: tumour size, tumour stage, nuclear grade, histological type, and suggestive signs are prognostic factors of renal cancer. Radical nephrectomy ensures a global 5-year recurrence-free survival rate higher than 85%.

Radical cystectomy is the standard treatment for muscle-invasive bladder cancer. Today, most patients can undergo substitution enteroplasty following cystectomy. Recto-colic urinary diversions and cutaneous ureterostomy are now uncommon. An ileal conduit (Bricker) may be proposed to patients with urethral involvement, as well as to elderly patients and to women who are at a high risk of severe urine leakage following enteroplasty. Thanks to progress in anesthesia, surgical techniques and intensive care, cystectomy with substitution enteroplasty is now a routine procedure. For localized bladder cancer (pT2N0M0 stage), this intervention is associated with a 10-year survival rate of about 80%. The mean length of stay in the intensive care unit varies between 1 and 7 days, and the mean total hospital stay ranges from 10 to 13 days. Early complications, which occur in less than 30% of cases, are mainly medical; the most common are cardiovascular complications, pulmonary embolism, disorientation and urinary tract and pulmonary infections. Late complications are less common and are mainly surgical; they include uretero-ileal stenoses (-10% of cases), uretero-ileal stenosis (4%), and intestinal obstruction (4%). Urinary and sexual disorders are frequent after radical cystectomy and substitution enteroplasty. Early postoperative incontinence occurs in more than 50% of cases but often responds to physiotherapy. In contrast, most male patients remain impotent. Simple transurethral resection of the prostate with cystectomy may be used instead of radical cystoprostatectomy in order to reduce the risks of incontinence and impotence, but this approach is controversial, as some authors have reported an increased risk of recurrence and metastasis.

Objectives: To evaluate the quality of life after retropubic radical prostatectomy (RP) and its impact on global patient satisfaction concerning the treatment received., Patients and Methods: 142 questionnaires were sent to patients treated for a localized prostate cancer by RP alone, with a minimum follow-up of 2 years. The questionnaire was the validated French version of the "UCLA-Prostate Cancer Index". A question concerning global patient satisfaction with treatment was added., Results: 102 questionnaires were returned and analysed. The mean age of the patients at the time of RP was 63.8 years and the mean follow-up was 48 months. Evaluation of global satisfaction showed that 35/102 (343%) patients were very satisfied, 45/102 (44.1%) were satisfied, 15/102 had no opinion, 4/102 (3.9%) were dissatisfied and 3/102 (29%) were very dissatisfied. General quality of life scores ranged from 72 to 87 on a scale from 1 to 100 (where 100 corresponds to the best quality of life). For specific quality of life, the mean scores for sexual function and dysfunction were 27.5 and 25.1, respectively. The mean scores for urinary function and dysfunction were 72.5 and 67.8, respectively. Urinary function scores and seven of the nine general quality of life items were significantly correlated with better global patient satisfaction, but sexual function was not related to global satisfaction., Conclusions: Although sexual function is markedly altered after RP, it does not affect global patient satisfaction with the treatment received. Urinary function and general quality of life are significantly correlated with global satisfaction.

The authors report 5 cases of polycythaemia associated with renal cancer. This paraneoplastic syndrome is present in less than 5% of all renal cancers. It is considered to be a factor of poor prognosis, as it is often associated with metastatic and/or high-grade cancer Polycythaemia, secondary to secretion of erythropoietin (EPO) by the tumour, is reversible after nephrectomy. The persistence or recurrence of polycythaemia after nephrectomy may indicate incomplete local resection or the presence of EPO-secreting metastases.

Over the last two decades, several improvements have been made in the diagnosis and treatment of renal carcinoma. In the past, renal cancer was usually discovered after hematuria, pain, or palpation of a lumbar mass, and required total nephrectomy. Today, about 40% of renal tumors are discovered incidentally by ultrasonography or computed tomography. Therefore, the majority of renal carcinomas are discovered at an early stage. Partial nephrectomy has been developed for polar and small tumors. This surgery can now be performed using a laparoscopic approach, thereby decreasing morbidity and shortening the hospital stay.

Introduction: This study was designed to evaluate the quality of life after external beam radiotherapy for localized prostate cancer using the UCLA/RAND Cancer Prostate Index questionnaire., Material and Methods: An accurate translation of the questionnaire was retrospectively sent to 108 patients treated for localized prostate cancer by exclusive external beam radiotherapy between 1989 and 1999. The reference values adopted for comparison were those observed by Litwin in a control population without prostate cancer. Patient subgroups were constituted according to the presence or absence of neoadjuvant endocrine therapy and laboratory signs of progression (ASTRO)., Results: The response rate was 61.1%, the mean age of the patients was 71.9 years and the mean follow-up was 46.5 months. The percentage of patients "living in a couple" or with "a serious relationship" was 93.4% Three quarters of the population declared that they were "satisfied" or "very satisfied" with the treatment performed. General quality of life scores were comparable to those of Litwin's control population. A functional alteration and decreased tolerance of impairment were observed, in decreasing order, for the sexual, gastrointestinal and urinary factors., Conclusion: External beam radiotherapy essentially alters quality of life related to gastrointestinal and sexual functions, while the only aspect of urinary function studied by this questionnaire is continence.

Introduction: Study of the efficacy of intermittent endocrine therapy after failure of local treatment., Material and Methods: 74 patients were treated for biochemical recurrence after radical prostatectomy (n = 30), radiotherapy (n = 28) or radical prostatectomy followed by radiotherapy (n = 16). Treatment (63 patients were treated by antiandrogens alone, 8 by LHRH analogue and 3 by complete androgen suppression) was continued for 6 months after obtaining undetectable PSA levels for patients after radical prostatectomy (and restarted when PSA > 4 ng/ml) or a PSA nadir < 4 ng/ml for the other patients (and restarted for PSA > 10 ng/ml)., Results: The duration of periods without treatment represented 50% of the total treatment cycle. With a mean follow-up of 43.8 months, the overall 5-year biochemical progression-free survival rate was 54.6%. On multivariate analysis, factors predictive of biochemical progression were age less than 70 years (p = 0.05), Gleason score greater than or equal to 8 (p = 0.038) and the presence of lymph node metastases (p = 0.05)., Conclusion: Intermittent endocrine therapy is a treatment option for patients with recurrence after local treatment. Candidates for intermittent endocrine therapy must be over the age of 70, with localized adenocarcinoma and a Gleason score less than or equal to 7.

Introduction: This study analyses the results of external beam radiotherapy in stage T1 T2 Nx M0 prostate cancer, with reference to the nadir PSA and the kinetics of PSA decline., Material and Methods: 65 patients with T1 T2 Nx M0 localized prostate cancer were treated by external beam radiotherapy (conventional or conformal) between 1990 and 1999. Two populations of 22 and 25 patients were distinguished according to the nadir PSA: population A with a nadir < or = 0.5 ng/ml or not yet reached, but with PSA < or = 0.5 ng/ml and population B with a nadir > 0.5 ng/ml. The various clinical and laboratory parameters and the kinetics of PSA decline (calculation based on the course of PSA between the first 3 and 6 months after irradiation) were compared by statistical tests (Chi-square, Student t test). According to the ASTRO criteria, the results in terms of absence of biochemical progression were evaluated by non-parametric Kaplan-Meier estimate., Results: No biochemical progression was observed in population A with a mean follow-up of 29.5 months. The absence of biochemical progression in population B at 42 months was 52.77%. The baseline PSA (p = 0.009), the dose delivered (p = 0.027), and the kinetics of PSA decline (p = 0.0069) were identified as predictive factors. The patient with a zero kinetic developed biochemical progression, while 91.3% of patients with a kinetic < 0.35 ng/ml/month remained free of biochemical progression. A group of patients (median nadir: 0.8 ng/ml, baseline PSA < 10 ng/ml and kinetic < 0.35 ng/ml/month) was distinguished by its good prognosis., Conclusion: In stage T1-T2 prostate cancer, the value of the nadir PSA is an essential prognostic factor. The kinetics of PSA decline appear to have an early predictive role.

Fibromyxoid tumours are rare inflammatory bladder tumours. These benign tumours are responsible for minimal symptoms. The diagnosis is based on histological examination showing spindle cells infiltrating the detrusor associated with more or less abundant inflammatory infiltrates. It is important to demonstrate the myofibroblastic nature of these cells, which constantly express specific muscle actin and smooth muscle actin on immunohistochemistry. The differential diagnoses are high-grade sarcomatoid spindle cell urothelial carcinoma, leiomyosarcoma and embryonal rhabdomyosarcoma in children. Treatment is surgical, comprising complete endoscopic resection or partial or total cystectomy. The authors report 3 new cases of fibromyxoid tumours treated conservatively by complete endoscopic resection or partial cystectomy. No recurrence was observed. The authors present a review of the literature and a discussion of the differential diagnoses.

Objective: The natural history of stage T1a prostate cancer is generally favourable, but is nevertheless associated with a considerable progression rate of 7% to 27% depending on the study. The objective of this study was to identify possible predictive criteria of tumour progression to improve patient surveillance and early treatment., Material and Methods: 27 patients with stage T1a prostate cancer according to the TNM 97 classification, were followed for a mean duration of 79 months (range: 24-132, median: 68). A complementary assessment was performed in patients under the age of 70 years, and a strict clinical (DRE) and laboratory (PSA) surveillance protocol was performed in all patients. The initial mean PSA was 7 ng/ml and the mean Gleason score was 4.8., Results: 20 patients (75%) did not present any clinical and/or laboratory signs of progression and were therefore not treated. Seven patients (25%) received treatment with a mean follow-up of 63 months (radical prostatectomy in 2 cases, external beam radiotherapy in 1 case, endocrine therapy in 4 cases). All patients are alive and in complete remission at last follow-up., Conclusion: Based on our results and a review of the literature, conservative management based on strict, long-term surveillance, is a frequent approach to stage T1a prostate cancer confirmed by negative biopsies of the residual capsule. The PSA velocity is the key to surveillance, and the only factor of predictive of tumour progression that can be really used in routine clinical practice. However, our study showed tumour progression in 25% of cases, raising the question of curative treatment, especially in young patients.

Objective: To describe the clinical and histological characteristics and natural history of clear cell renal carcinoma., Patients and Methods: The case files of 35 patients (22 men and 13 women, with a mean age of 58 +/- 13.8 years) operated for clear cell renal carcinoma were reviewed. The circumstances of diagnosis and the histological features of the tumour were analysed. The outcome of the patients was studied with a mean follow-up of 70 +/- 20.2 months., Results: The diagnosis was incidental in 66% of cases. The macroscopic appearance of the tumour was characteristic: homogeneous and beige or white colour. On light microscopy, tumours were composed of variable proportions of clear cells and eosinophilic cells. The were classified as 15 predominantly eosinophilic tumours (43%), 9 predominantly clear cell tumours (26%) and 11 tumours composed of equal number of clear cells and eosinophilic cells (31%). Nuclei were irregular and indented. Hale stain was positive in every case. The majority of tumours were confined to the kidney (T1: 65% and T2: 29%) with a low nuclear grade (91% of grades 1 and 2). No patient developed local recurrence or metastasis during follow-up. The overall 5-year survival rate was 92%. No death related to the disease was reported., Conclusion: The histological diagnosis of clear cell renal cancer is now easy and can be suggested even on macroscopic examination of the operative specimen. This tumour appears to have a good prognosis, as it is usually confined to the kidney with a low nuclear grade.

Aim of the Study: To assess the role of nitric oxide (NO) and its second messenger, cGMP, on the mechanisms underlying human ureteral smooth muscle relaxation., Methods: Proximal segments of ureter were dissected from nephrectomy, then cut into rings and suspended in organ chambers. Isometric tone was recorded at baseline and after preincubation with KCl (120 mumol). The Increasing concentration (10-8-10-4 M) of NO donors, Sodium nitroprusside, (SNP) and molsidomine (SIN-1) and a type V phosphodiesterase inhibitor, Zaprinast were added to the organ chambers and a dose response curve was constructed from each experiment., Results: Dose-dependent relaxation was seen with all compounds. This was, however, more pronounced with SNP as compared with SIN-1. Zaprinast alone had marginal relaxant effect but markedly potentiated the relaxing effect of the NO donor SNP (p < 0.05). Inhibition of NO synthesis by the arginine analogue L-NA increased electrical-induced contraction (98 +/- 4% vs 122 +/- 3%, p < 0.001)., Conclusion: Activation of the soluble guanylate cyclase by NO donors markedly relaxed significantly human ureteral smooth muscle but inhibition of phosphodiesterase did not affect the in vitro relaxation. Our results suggest that cGMP is an important second messenger in the transduction signalling pathway leading to relaxation of human ureteral smooth muscle. By contrast, basal activity of phosphodiesterase seems to be marginal under physiological condition.

Introduction: Cystine stones is a rare disease, related to a genetic metabolic disease. Its management must treat both the stones and their complications, and prevent recurrences by controlling cystinuria., Objective: The objective of this study was to define the natural history of cystine stones, identify reliable diagnostic criteria and propose a simple treatment regimen., Material and Method: The authors studied the clinical, biochemical and radiological data of a retrospective series of 116 cases, treated by the same urologist between 1953 and 1999., Results: Cystinuria is often diagnosed in young adults on the basis of urine biochemistry (Brand's reaction, urinary cystine assay) or spectrophotometric analysis of the stones or urinary crystals. This assessment, not performed routinely, must be guided by a family history, recurrent stones or following failure of lithotripsy. The appearance of the stones, macroscopically a waxy yellow, radiologically only slightly opaque with a large component in the renal pelvis associated with a small round caliceal stones, is highly suggestive. Radiological assessment by IVU is generally sufficient. Treatment of the disease is medical and surgical: dietary measures, alkalinization of the urine and possibly drug treatments, are associated with extracorporeal lithotripsy or surgical treatment. These modalities eliminate cystine stones in 70% of cases. Recurrent stones are observed in 42% of cases followed for more than 5 years, mainly due to the presence of residual fragments (60% of recurrences). Surveillance and dietary measures must be maintained for life. Surveillance is based on biannual radiographic follow-up (plain x-rays +/- ultrasound) to detect and consequently treat small stones. A test for cystinuria must be proposed to all relatives of affected patients., Conclusion: This disease presents very polymorphic clinical features and clinical course. It can be responsible for impaired renal function and must therefore be investigated in the presence of suggestive clinical signs or history to avoid a delayed diagnosis, as treatment modalities are available to decrease the frequency of recurrence and which can potentiate treatment by surgical or lithotripsy. However, there are no predictive factors of deterioration of the disease, and biannual surveillance, for life, is essential to detect and treat small stones.