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Resumen El objetivo de este articulo es ofrecer una vision actualizada sobre el lugar del autotrasplante renal en el tratamiento de las afecciones renales complejas como los aneurismas de la arteria renal, las estenosis extensas del ureter y algunos tumores renales bilaterales o que se desarrollan en un rinon unico anatomico o funcional. Estas intervenciones se realizaban inicialmente por una doble via de acceso, lumbar e iliaca, o por una incision medial xifopubica. Las tecnicas quirurgicas han evolucionado mucho con la utilizacion de la laparoscopia y mas recientemente con la asistencia robotica. Han permitido que se recobre el interes por este procedimiento al disminuir la morbilidad y la mortalidad a la vez que se mantiene el mismo nivel de seguridad que con la cirugia abierta. Sin embargo, esta cirugia debe quedar limitada a centros expertos que cuenten con cirujanos experimentados tanto en el trasplante renal como en la laparoscopia robotica.

Resume Objectif Proposer des recommandations pour la prise en charge des symptomes du bas appareil urinaire (SBAU) et de l’incontinence urinaire du patient transplante renal et du candidat a la transplantation renale. Methode Une revue de la litterature (Medline) avec approche systematique a ete conduite par le CTAFU concernant les modalites therapeutiques des SBAU et des troubles de la continence du patient transplante renal et du candidat a la transplantation renale, en evaluant les references et leur niveau de preuve. Resultats La capacite vesicale fonctionnelle et la compliance vesicale sont alterees lors de la dialyse. Les SBAU, lies aux alterations pre-transplantation renale, s’ameliorent le plus frequemment spontanement apres transplantation renale. Les SBAU lies a une hyperplasie benigne de prostate (HBP) peuvent etre masques en pre-transplantation en raison de l’oligurie, des troubles de la compliance et de la capacite vesicale. En cas de SBAU lies a une HBP, seuls les anticholinergiques necessitent une adaptation de la posologie en fonction de la clairance de la creatinine. Si indiquee, la chirurgie de l’HBP peut etre realisee precocement apres transplantation renale. Concernant la prise en charge chirurgicale de l’incontinence urinaire, il ne semble pas exister d’augmentation des complications infectieuses chez le patient transplante renal. Une attention particuliere doit etre portee a la prise en charge du residu post mictionnel et des pressions vesicales en cas de vessie neurologique. La prise en charge adaptee d’un patient presentant une vessie neurologique permet une transplantation renale sans augmentation du risque de perte du transplant renal, au prix d’une augmentation de l’incidence des infections urinaires febriles. Conclusion Ces recommandations francaises doivent contribuer a ameliorer la prise en charge des symptomes du bas appareil urinaire et de l’incontinence urinaire du patient transplante renal et du candidat a la transplantation renale.

Pancreas transplantation exposes to high rates of complications, either vascular (thrombosis, stenosis, pseudoaneurysm, arteriovenous fistula) or nonvascular (fluid collection, graft rejection). With advances in percutaneous and endovascular techniques, interventional radiologists are increasingly involved in the management of these complications. In this article, we review the anatomical considerations relevant to pancreas transplantation, the techniques used for image-guided interventions for vascular and nonvascular complications, and the expected outcomes of these interventions.

In 2015, the French Association of Urology, by the male lower urinary tract symptoms Committee, published a practices guideline for the management of prostatic hyperplasia in general practice. Five years after the publication of these recommendation, our objective is to assess their dissemination and their impact in general practice.A specially designed questionnaire was distributed online via the departmental councils of the order and to all regional unions of liberal doctors. The distribution to general practitioners was at the discretion of each organisation depending on local policies.Two hundred and eighty responses were collected. Fifty-five percent of the population was female. 83 % of the general practitioners did not report having knowledge of the practice guideline. 77 % of doctors stated that they had not received training or information on prostatic hyperplasia in the past 5 years. Among the notable results, 51 % of general practitioners declared performing a digital rectal examination. 44 % prescribed an endorectal ultrasound. Only 7 % of doctors were aware of the existence of minimally invasive surgical techniques.The practices guideline for the management of prostatic hyperplasia in general practice proposed in 2015 by the male lower urinary tract symptoms Committee seems to be little known by general practitioners. Dissemination of these recommendations solely through publication in Progrès en Urologie seems ill-suited to consideration by general practitioners, and it seems necessary to consider other modes of dissemination.4, grade C.

International audience; Background. Kidney and pancreatic transplants from controlled donation after circulatory death donors are vulnerable to ischemia-reperfusion injuries. In this context of transplant shortage, there is a need to optimize the function of these transplants and to develop novel perfusion and preservation strategies in controlled donation after circulatory death in kidney and pancreatic transplants. In Situ Perfusion and Preservation Strategies. In situ regional normothermic perfusion improves the outcome of kidney transplants from controlled donation after circulatory death and provides equivalent results for the kidney from brain-dead donors. In situ regional normothermic perfusion is under investigation for pancreatic transplants. Ex Situ Perfusion and Preservation Strategies. Perfusion on hypothermic machine perfusion is highly recommended for the kidney from controlled donation after cardiac death. Hypothermic oxygenated perfusion machine decreases the rate of graft rejection and graft failure in kidney transplantation. Ex situ normothermic perfusion is an easy way to assess renal function. In the future, kidney transplants could benefit from drug therapy during ex situ normothermic perfusion. In pancreas transplantation, hypothermic machine perfusion and ex situ normothermic perfusion present encouraging results in preclinical studies.

To assess the efficacy and morbidity of percutaneous nephrolithotomy (PNLT) in the treatment of renal stones in patients with neurogenic lower urinary tract dysfunction (NLUTD).Retrospective, monocentric study including all patients with NLUTD who had undergone PNLT between 2005 and 2017. Pre-operative clinical data (neurological condition, voiding mode, preoperative urine culture…), peri-operative and post-operative data (success and morbidity) were collected from the patients' charts. Success was defined by the absence of residual fragment (RF), on imaging or intraoperative endoscopy. Partial efficacy was defined by the presence of RF lower than 4mm. Early complications were reported according to the Clavien-Dindo classification.In all, 53 PNLTs were performed, in 35 patients, mostly with spinal cord injury. The success and partial efficacy rates were 66.0% and 71.7% respectively. The failure rate was correlated with increased stone burden (P=0.03), increased size of the largest stone (P=0.02), and the presence of complex stones (P0.02). The rate of early complications was 41.5%, with 27.3% major, mostly septic, and bleeding. The retreatment rate within 3 years was 41.5%.In patients with NLUTD, PNLT allows a high success rate, but with a significant rate of retreatment and infectious complications. However, NLPC remains the gold standard in this population, especially for renal stones larger 20mm, allowing a higher success rate than ureteroscopy and a lower retreatment rate.

The main objective of static cold storage is to reduce cellular metabolic demands to extend the period of ischaemia prior to transplantation. Hypothermia does not halt metabolism and the absence of oxygen causes a cellular shift toward anaerobic respiratory pathways. There is emerging evidence that the introduction of oxygenation during organ preservation may help ameliorate the degree of ischaemia reperfusion injury and improve post-transplantation outcomes. This review aims to appraise and summarise all published literature that utilises oxygenation to improve kidney preservation for purposes of transplantation.We performed a scoping review of the literature using the bibliographic databases Embase and MEDLINE. The final date for searches was 20 March 2021. All research studies included were those that reported oxygen delivery during kidney preservation as well as providing a description of the oxygenation technique.17 human and 48 animal studies met the inclusion criteria. The oxygen delivery methods investigated included hypothermic oxygenated machine perfusion (HOPE), oxygen carriers, two-layer method, venous systemic persufflation, hyperbaric oxygenation, normothermic machine perfusion and sub-normothermic machine perfusion. The COMPARE trial was the only study carried out with the most methodological robustness being a randomised, double blind, controlled, phase III trial that investigated the efficacy of HOPE versus HMP.A variety of studies reflect the evolution of oxygenation with useful lessons and encouraging outcomes. The first in human studies investigating HOPE and oxygen carriers are most robustly investigated strategies for oxygenation during kidney preservation and are, therefore, the best clinical references.

Additional file 1.

The recent SARS-CoV-2 (COVID-19) pandemic has led to significant disruptions to healthcare delivery, including organ transplantation. In the UK, of 6136 patients on an active transplant list 3.8 per cent tested positive for COVID-19 and 11.0 per cent of these have died. Of 2084 transplants performed in the UK during 2020, 3.4 per cent of patients tested positive but only 0.5 per cent have died1. Most would agree that, for certain groups, risk is higher whilst on a waiting list rather than after a successful transplant. We accept that figures may vary because of the frequency and density of testing. Although the impact of COVID-19 on liver2,3 and renal4 transplant activity is reported, it remains less clear for pancreas transplantation. Of 1757 simultaneous pancreas–kidney recipients in the UK with a functioning graft 23 (1.3 per cent) have developed COVID-19 and only five have died1. An online survey covering key areas for pancreas transplant services was developed and disseminated via the World Pancreas Transplant Guidelines Group between May and July 2020. A total of 28 respondents from 28 centres and 16 countries spanning four continents completed the online survey. One further respondent from the USA was unable to complete the questionnaire as during the COVID-19 pandemic his centre had temporarily ceased transplantation altogether. Most respondents were transplant surgeons (15, 54 per cent), followed by hepatobiliary, pancreatic and transplant surgeons (8, 29 per cent), and general surgeons (5, 18 per cent). The majority worked in an academic centre (26, 93 per cent), with 50 per cent having between 501 and 1000 hospital beds. Eleven of the 28 centres (39 per cent) had between 51 and 100 hospital ICU beds. Patients with COVID-19 were already in 25 (89 per cent) of all hospitals, with four centres (14 per cent) having more than 100 inpatients with COVID-19. The majority of centres were at CRITCON level 0, ‘business as usual’ (10 centres, 36 per cent), followed by CRITCON level 1, ‘normal winter’ (8 centres, 29 per cent), and CRITCON level 2, ‘unprecedented’ (7 centres, 25 per cent)5. This survey highlights the significant reduction in pancreas transplant referrals, which was in excess of 75 per cent in nearly 40 per cent of the 28 centres. There had been a decrease in utilization of both donation after circulatory death (DCD) and donation after brain death (DBD) donors, from 46.4 to 7.1 per cent. In the UK during the months of March and April 2020, total organ retrievals were down by over 95 per cent. Both donors and recipients were screened for COVID-19, with 26 of the 28 centres (93 per cent) opting for polymerase chain reaction (PCR) swab testing, and nine centres (33 per cent) also using CT. For donors testing positive, 10 centres (36 per cent) never used the pancreas, and remaining 18 centres waited to use a donor pancreas either 14 days (1 centre, 4 per cent), 14–28 days (2 centres, 7 per cent), or more than 28 days (15 centres, 54 per cent) after a positive test. The median number of annual pancreas transplants performed in responding centres was 20 (range 2–70). There was a reduction in transplants between March and April 2020 compared with the same period during 2019, from a median of 4 (1–12) to 2 (0–8) respectively. The majority of centres (21, 75 per cent) were still performing pancreas transplants in their usual hospital theatre, but seven centres (25 per cent) performed transplants in the same hospital but a different theatre. Prioritization of patients was still based on waiting time and need for dialysis. After surgery, 16 (57 per cent) of the 28 centres sent transplant patients to a clean ICU, followed by transplant wards or suitable alternatives to ICU (7 centres, 25 per cent), or to a dirty/contaminated ICU (1 centre, 4 per cent). With respect to induction therapy, there were reductions in standard-dose antithymocyte globulin (ATG) (from 18 (64 per cent) to 12 (43 per cent) of the 28 centres) and standard-dose alemtuzumab (from 6 (21 per cent) to 3 (11 per cent) centres), and an increase in dose-reduced ATG (from 4 (14 per cent) to 5 (18 per cent) centres) and basiliximab (from 4 (14 per cent) to 7 (25 per cent) centres). There were no changes to maintenance therapy, which largely included tacrolimus, mycophenolate mofetil, prednisolone and sirolimus. Finally, of surgeons who tested positive for COVID-19, 29 per cent (8/28) were symptomatic and 61 per cent (17/28) were asymptomatic. Furthermore, 23 surgeons (82 per cent) were not redeployed but remained working either at home (4, 14 per cent), transferred to medical wards (2, 7 per cent) or HDU/ICU (1, 4 per cent), or into management (1, 4 per cent). This international survey demonstrates a high level of variation in availability of pancreas transplant services during the COVID-19 pandemic. Given the fall in activity and the added risk of COVID-19, waiting list mortality will inevitably increase. These data highlight the management challenges and practice variations in caring for these complex patients. Dissemination of data from this survey will improve our understanding of current international clinical practice during the pandemic. This study has identified the need for clear and consistent national or international recommendations to ensure a standard level of care for all patients awaiting pancreas transplant. Unfortunately, agreement on recommendations could prove challenging given the variation in how governments have decided to deal with the pandemic in their individual countries. Fil: Kamarajah, S. K.. Freeman Hospital; Reino Unido Fil: Arbogast, H.. Freeman Hospital; Reino Unido Fil: Berney, T.. Freeman Hospital; Reino Unido Fil: Boggi, U.. Freeman Hospital; Reino Unido Fil: Branchereau, J.. Freeman Hospital; Reino Unido Fil: Socci, C.. Freeman Hospital; Reino Unido Fil: Casanova, D.. Freeman Hospital; Reino Unido Fil: Cooper, M.. Freeman Hospital; Reino Unido Fil: Drage, M.. Freeman Hospital; Reino Unido Fil: Elker, D.. Freeman Hospital; Reino Unido Fil: Ferrer, J.. Freeman Hospital; Reino Unido Fil: Furian, L.. Freeman Hospital; Reino Unido Fil: Gruessner, R.. Freeman Hospital; Reino Unido Fil: Harper, S.. Freeman Hospital; Reino Unido Fil: Kwiatkowski, A.. Freeman Hospital; Reino Unido Fil: Kenmochi, T.. Freeman Hospital; Reino Unido Fil: Manas, D.. Freeman Hospital; Reino Unido Fil: Morelon, E.. Freeman Hospital; Reino Unido Fil: Odorico, J.. Freeman Hospital; Reino Unido Fil: Oellinger, R.. Freeman Hospital; Reino Unido Fil: Oniscu, G.. Freeman Hospital; Reino Unido Fil: Perosa, M.. Freeman Hospital; Reino Unido Fil: Saudek, F.. Freeman Hospital; Reino Unido Fil: Scalea, J.. Freeman Hospital; Reino Unido Fil: Schenker, P.. Freeman Hospital; Reino Unido Fil: Stratta, Ricardo Ruben. Freeman Hospital; Reino Unido Fil: Vistulo, F.. Freeman Hospital; Reino Unido Fil: Uva, Pablo Daniel. Freeman Hospital; Reino Unido. Instituto de Nefrología de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: White, S.A.. Freeman Hospital; Reino Unido

The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation.All of the transplants performed in two university hospitals between 2010 and 2017 were analyzed retrospectively. All patients who underwent single kidney transplant from a brain-dead donor with acute renal failure (ARF) were included in this study. ARI was defined here by a decrease over 50 % of glomerular filtration rate (GFR) to a threshold below 45mL/min/1.73 mOne hundred and sixty four patients were transplanted with a kidney from donor with ARF during the selected period. At the admission in ICU the average GFR was 67,7±19mL/min/1,73m

BackgroundWhilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort.MethodsIn this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-event measures. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function.ResultsAmong the 4691 included patients, 747 patients were considered obese with a BMI level greater than 30 kg/m2. We observed a higher mortality for obese recipients (HR = 1.37,p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24,p = 0.0006) and cardiac complications (HR = 1.45,p p = 0.0666) and no significant increased risk of early surgical complications.ConclusionsWe showed that obesity increased the risk of death and serious bacterial infections and cardiac complications in obese French kidney transplant recipients. Further epidemiologic studies aiming to compare obese recipients versus obese candidates remaining on dialysis are needed to improve the guidelines for obese patient transplant allocation.

To define guidelines for the management of renal cell carcinoma of the native kidney (NKRCC) in kidney transplant (KTx) recipients and renal cell carcinoma (RCC) in end-stage renal disease (ESRD) patients candidates for renal transplantation.A review of the literature following a systematic approach (Medline) was conducted by the CTAFU to report renal cell carcinoma epidemiology, screening, diagnosis and management in KTx candidates and recipients. References were assessed according to a predefined process to propose recommendations with the corresponding levels of evidence.ESRD patients are at higher risk of RCC with a standardized incidence ratio of approximately 4,5 as compared with general population. NKRCC tumors occur in 1 to 3 % of KTx recipients with a 10 to 15-fold increased risk as compared with general population, especially in patients with acquired multicystic kidney disease. Most authors suggest yearly monitoring of the native kidneys using ultrasound imaging. Radical nephrectomy (either open or laparoscopic approach) is the preferred treatment of NKRCC in KTx recipients and RCC in ESRD. Surveillance in a valid option in small or cystic renal masses. In the localized setting, change in immunosuppressive therapy is not recommended besides perioperative avoidance of mTOR inhibitor to limit morbidity. CTAFU does not recommend a mandatory waiting time after nephrectomy for RCC in ESRD patients candidates for renal tranplantation when tumor stageT3 and low ISUP grade. Follow-up modalities should follow recommendations in general population.The French recommendations should contribute to improve management of NKRCC in KTx recipients and RCC in ESRD candidates for KTx, integrating oncological objectives in the context of kidney transplantation.

To define guidelines for the management of localized prostate cancer (PCa) in kidney transplant (KTx) candidates and recipients.A systematic review (Medline) of the literature was conducted by the CTAFU to report prostate cancer epidemiology, screening, diagnosis and management in KTx candidates and recipients with the corresponding level of evidence.KTx recipients are at similar risk for PCa as general population. Thus, PCa screening in this setting is defined according to global French guidelines from CCAFU. Systematic screening is proposed in candidates for renal transplant over 50 y-o. PCa diagnosis is based on prostate biopsies performed after multiparametric MRI and preventive antibiotics. CCAFU guidelines remain applicable for PCa treatment in KTx recipients with some specificities, especially regarding lymph nodes management. Treatment options in candidates for KTx need to integrate waiting time and access to transplantation. Current data allows the CTAFU to propose mandatory waiting times after PCa treatment in KTx candidates with a weak level of evidence.These French recommendations should contribute to improve PCa management in KTx recipients and candidates, integrating oncological objectives with access to transplantation.

To propose surgical recommendations for the management of lower urinary tract symptoms (LUTS) and urinary incontinence in kidney transplant recipients and candidates.Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU focusing on medical and surgical treatment of LUTS and urinary incontinence in kidney transplant recipients and candidates. References were assessed according to a predefined process to propose recommendations with levels of evidence.Functional bladder capacity and bladder compliance are impaired during dialysis. LUTS, related to pre-kidney transplantion alterations, frequently improve spontaneously after kidney transplantation. LUTS secondary to benign prostatic hyperplasia (BPH) may be underestimated before kidney transplantation due to oliguria, low bladder compliance and low bladder capacity. In LUTS associated with BPH, anticholinergics require dosage adjustment with creatinine clearance. If surgery is indicated after kidney transplantation, procedure can be safely performed in the early post-transplant course after removal of ureteral stent. Surgical management of urinary incontinence does not seem to be associated with an icreased risk for infectious complications in kidney transplant recipients. Particular attention should be paid to the management of postvoid residual and bladder pressures in case of neurological bladder disease. Optimal care of neurological bladder should be provided prior to transplantation: with a cautious management, and despite an increased occurrence of febrile urinary tract infections, transplant survival is not compromised.These recommendations must contribute to improve the management of lower urinary tract symptoms and urinary incontinence in kidney transplant patients and kidney transplant candidates.

To define guidelines for the management of kidney stones in kidney transplant (KTx) donor or recipients.Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to report kidney stone epidemiology, diagnosis and management in KTx donors and recipients with the corresponding level of evidence.Prevalence of kidney stones in deceased donor is unknown but reaches 9.3% in living donors in industrialized countries. Except in Maastrich 2 donors, diagnosis is done on systematic pre-donation CT scan according to standard french procedure. No prospective study has compared therapeutic strategies available for the management of kidney stones in KTx donor: ureteroscopy or an extra corporeal lithotripsy in case of living donor prior to donation, ex vivo approach (pyelotomy or ureteroscopy), ureterocopy in the KTx recipient or surveillance. De novo kidney stones result from a lithogenesis process to be identified and treated in order to avoid recurrences. The context of solitary functional kidney renders the prevention of recurrence of great importance. Diagnosis is suspected when identification of a renal graft dysfunction, hematuria or urinary tract infection with renal pelvis dilatation. Stone size and location are determined by computed tomography. There are no prospective, controlled studies on kidney stone management in the KTx. The therapeutic strategies are similar to standard management in general population.These French recommendations should contribute to improve kidney stones management in KTx donor and recipients.

To propose surgical recommendations for living donor nephrectomy.Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU regarding functional and anatomical assessment of kidney donors, including which side the kidney should be harvested from. Distinct surgical techniques and approaches were evaluated. References were considered with a predefined process to propose recommendations with the corresponding levels of evidence.The recommendations clarify the legal and regulatory framework for kidney donation in France. A rigorous assessment of the donor is one of the essential prerequisites for donor safety. The impact of nephrectomy on kidney function needs to be anticipated. In case of modal vascularization of both kidneys without a relative difference in function or urologic abnormality, removal of the left kidney is the preferred choice to favor a longer vein. Mini-invasive approaches for nephrectomy provide faster donor recovery, less donor pain and shorter hospital stay than open surgery.These French recommendations must contribute to improving surgical management of candidates for kidney donation.

Resume L’infertilite masculine est une complication iatrogene peu frequente, mais certainement sous-estimee du traitement chirurgical de la hernie inguinale. L’utilisation de prothese de polypropylene, recommandee par la Societe europeenne de la hernie, par voie ouverte ou cœlioscopique, est responsable d’une reaction inflammatoire de proximite, puis d’une fibrose, mais sans majoration evidente du pourcentage d’obstruction du canal deferent dans la litterature. Les progres, pour minimiser cette complication, passent par la prevention : depistage des patients a risque, maintien d’une courbe d’apprentissage de la technique chirurgicale.

Resume Introduction Apres le developpement de la nephrectomie laparoscopique de donneur vivant en 1995, puis l’evolution vers la laparoscopie robot-assistee en 1999, certaines equipes ont evalue l’apport de ces techniques en transplantation renale. Methodes Une revue de la litterature a ete menee colligeant les etudes cliniques evaluant la chirurgie laporoscopique robot-assistee pour le prelevement renal a donneur vivant et pour la transplantation renale. Resultats Le prelevement renal donneur vivant robot-assiste a une tres faible morbidite et de bons resultats a long terme concernant donneurs et receveurs. Elle permet notamment une amelioration des douleurs postoperatoire. L’apport de la chirurgie robotique en transplantation renale semble plus limite. Les differentes series semblent mettre en lumiere un interet chez les patients obeses et/ou sous anticoagulants en diminuant la morbidite parietale.

Male infertility is a rare but certainly underestimated iatrogenic complication of inguinal hernia repair. The use of polypropylene mesh, recommended by the European Hernia Society, either via the traditional, open or laparoscopic approach, is responsible for surrounding inflammation followed by fibrosis, but there is no proven increase in vas deferens obstruction found in the literature. Prevention is essential to reduce the incidence of this complication including screening for patients at risk and mastery of surgical techniques.

The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection.This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients.Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS.Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS.4.

Solitary Pancreas (SPT) and simultaneous kidney-pancreas (SPKT) transplants carry a high risk of surgical complications that may lead to the loss of the pancreas graft and impact later kidney function. The purpose of this study was to investigate the role of MDCT in the diagnosis of early complications and its impact on kidney function.All patients receiving SPT or SPKT over 5 years were retrospectively included. Complications that occurred within the first 15 days were registered and MDCT data analyzed. Data regarding donor, transplant, and recipient characteristics as well as transplantation procedures were analyzed according to the occurrence of early complications. Kidney function at day 3 following MDCT was evaluated.One hundred and forty-one patients were included (85 men, 56 women; mean age 40.1 years, SD 7.7) with 119 SPKT and 22 SPT. Sixty-four complications were registered in 50 patients. Partial (P-) or complete venous thrombosis (C-VT) occurred in 12.1 % (n = 17), arterial thrombosis (AT) in 1.4 % (n = 2), and hemorrhage in 8.5 % (n = 12) of all patients. For venous thrombosis, the predominant risk factor was body mass index (BMI) for either recipients (P 0.05) or donors (P 0.01). Median time for venous thrombosis diagnosis with MDCT was 4 days. Kidney function was not altered following MDCT. Fourteen pancreatectomies were necessary. All patients with C-VT and AT had to undergo graftectomy.Vascular complications occurred early following grafting. Systematic early-enhanced MDCT at day 2-3 should be adequate to detect early thrombosis, especially if risk factors have been identified, without induced kidney function alteration.

International audience; OBJECTIVES:To report major findings that may build the future of kidney transplantation.MATERIAL AND METHODS:Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) database from 1960 to 2016 using the following keywords, in association, "bio-engineering; heterotransplantation; immunomodulation; kidney; regenerative medicine; xenotransplantation". Articles were selected according to methods, language of publication and relevance. A total of 5621 articles were identified including 2264 for xenotransplantation, 1058 for regenerative medicine and 2299 for immunomodulation; after careful selection, 86 publications were eligible for our review.RESULTS:Despite genetic constructs, xenotransplantation faces the inevitable obstacle of species barrier. Uncertainty regarding xenograft acceptance by recipients as well as ethical considerations due to the debatable utilization of animal lives, are major limits for its future. Regenerative medicine and tridimensional bioprinting allow successful implantation of organs. Bioengineering, using decellularized tissue matrices or synthetic scaffold, seeded with pluripotent cells and assembled using bioreactors, provide exciting results but remain far for reconstituting renal complexity and vascular patency. Immune tolerance may be achieved through a tough initial T-cell depletion or a combined haplo-identical bone marrow transplant leading to lymphohematopoietic chimerism.CONCLUSION:Current researches aim to increase the pool of organs available for transplantation (xenotransplants and bio-artificial kidneys) and to increase allograft survival through the induction of immune tolerance. Reported results suggest the onset of a thrilling new era for renal transplantation providing end-stage renal disease-patients with an improved survival and quality of life.

Male urethral stricture disease is prevalent and has an important impact on quality of life. Direct visual urethrotomy and dilatations have high rates of recurrence.The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra.We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required.From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft.The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability.Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system.Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20mm stones. No major complication (Clavien-Dindo2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases.Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted.5.

Corticosteroids are commonly used in the treatment of prostate cancer resistant to castration (PCRC), partly due to the inhibitory effects on adrenal androgen production acting as a pituitary suppressant.A literature search was conducted in PubMed/MEDLINE database using the following key words: prostate cancer; castration resistance; metastasis; corticotherapy.Corticosteroids exert direct anti-tumoral activities mediated by the glucocorticoids receptor and involving cellular/tissue functions as growth, apoptosis, inflammation, metastasis, differentiation and angiogenesis. As a pain relieving agents, corticosteroids significantly relieve PCRC clinical symptoms, especially those due to bone metastasis. In the comparative arm of phase II-III trials, corticosteroids administered daily produce a PSA decline. Among the adverse effects due to corticosteroids, bone loss and cardiovascular risk should be carefully monitored. In association with abiraterone acetate, corticosteroids increase overall survival in PCRC patients, and reduce the mineralocorticoid side effects of abiraterone.Corticosteroids in monotherapy for PCRC have a limited efficacy. In association with abiraterone acetate it reduces the mineralocorticoid toxicity and enhances the androgenic suppression.