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Background: Overdiagnosis and subsequent overtreatment are important side effects of screening for, and early detection of, prostate cancer (PCa). Active surveillance (AS) is of growing interest as an alternative to radical treatment of low-risk PCa., Objective: To update our experience in the largest worldwide prospective AS cohort., Design, Setting, and Participants: Eligible patients had clinical stage T1/T2 PCa, prostate-specific antigen (PSA) ≤ 10 ng/ml, PSA density <0.2 ng/ml per milliliter, one or two positive biopsy cores, and Gleason score ≤ 6. PSA was measured every 3-6 mo, and volume-based repeat biopsies were scheduled after 1, 4, and 7 yr. Reclassification was defined as more than two positive cores or Gleason >6 at repeat biopsy. Recommendation for treatment was triggered in case of PSA doubling time <3 yr or reclassification., Outcome Measurements and Statistical Analysis: Multivariate regression analysis was used to evaluate predictors for reclassification at repeat biopsy. Active therapy-free survival (ATFS) was assessed with a Kaplan-Meier analysis, and Cox regression was used to evaluate the association of clinical characteristics with active therapy over time., Results and Limitations: In total, 2494 patients were included and followed for a median of 1.6 yr. One or more repeat biopsies were performed in 1480 men, of whom 415 men (28%) showed reclassification. Compliance with the first repeat biopsy was estimated to be 81%. During follow-up, 527 patients (21.1%) underwent active therapy. ATFS at 2 yr was 77.3%. The strongest predictors for reclassification and switching to deferred treatment were the number of positive cores (two cores compared with one core) and PSA density. The disease-specific survival rate was 100%. Follow-up was too short to draw definitive conclusions about the safety of AS., Conclusions: Our short-term data support AS as a feasible strategy to reduce overtreatment. Clinical characteristics and PSA kinetics during follow-up can be used for risk stratification. Strict monitoring is even more essential in men with high-risk features to enable timely recognition of potentially aggressive disease and offer curative intervention. Limitations of using surrogate end points and markers in AS should be recognized., Trial Registration: The current program is registered at the Dutch Trial Register with ID NTR1718 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1718)., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Little is known about the outcome of radical prostatectomy (RP) in men initially followed on active surveillance (AS) for low-risk prostate cancer (PCa)., Objective: Evaluate pathology findings after RP in our prospective AS cohort., Design, Setting, and Participants: All men participated in the Prostate Cancer Research International: Active Surveillance (PRIAS) study. Eligible men were initially diagnosed with low-risk PCa (clinical stage ≤ T2, prostate-specific antigen [PSA] ≤ 10 ng/ml, PSA density <0.2 ng/ml per ml, one or two positive biopsy cores, and Gleason score ≤ 6) and underwent RP between December 2006 and July 2011. The study protocol recommends RP in case of risk reclassification on repeat biopsy (Gleason score >6 and/or more than two positive cores) or a PSA doubling time ≤ 3 yr., Measurements: Descriptive statistics were used to report on pathology findings for staging and grading., Results and Limitations: Pathology results were available in 167 out of 189 RP cases (88.4%). Median time to RP was 1.3 yr (range: 1.1-1.9). Protocol-based recommendations led to deferred RP in 143 men (75.7%); 24 men (12.7%) switched because of anxiety, and 22 (11.6%) had other reasons. Pathology results showed 134 (80.8%) organ-confined cases and 32 (19.2%) cases with extracapsular extension. Gleason scores ≤ 6, 3+4, 4+3, and 8 were found in 79 (47.3%), 64 (38.3%), 21 (12.6%), and 3 (1.8%) cases, respectively. Unfavourable RP results (pT3-4 and/or Gleason score ≥ 4+3) were found in 49 patients (29%), of whom 33 (67%) had a biopsy-related reason for deferred RP., Conclusions: RP results in men initially followed on AS show organ-confined disease and favourable Gleason grading in a majority of cases. Most men in our cohort had a protocol-based reason to switch to deferred RP. A main focus for AS protocols should be to improve the selection of patients at the time of inclusion to minimise reclassification of risk and preserve the chance for curative treatment, if indicated., (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours., Objective: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population., Design, Setting, and Participants: Twenty-four French university departments of urology participated in this retrospective study., Intervention: All patients were treated according to current European Association of Urology guidelines., Measurements: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods., Results and Limitations: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design., Conclusions: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population., (Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: Repair of large incisional lumbar hernias or muscular bulges is a challenge to the surgeon as reflected by the high recurrence rate. We evaluated a surgical procedure using a running strip of autogenous skin graft as a retention suture., Methods: Eight patients with large incisional lumbar hernias (> or = 20 cm, n = 6) or muscular bulges (n = 2) underwent a parietal reconstruction with this procedure. Two patients had previously been treated with synthetic meshes without success, and one had a colocutaneous fistula., Results: No recurrence was observed in 6 patients (75%) with a mean follow-up of 14 months. After significant weight gain, 2 repairs failed at 6 months and 1 year (partially in 1 case). No recurrence was noted for muscular bulges., Conclusion: The use of a running strip of autogenous skin graft is a simple and reliable procedure for the repair of large lumbar hernias or muscular bulges for patients with stable weight conditions.

With the ongoing evaluation of laparoscopic techniques in urology, the transperitoneal access used initially has been progressively replaced by the much simpler retroperitoneal route. The applicability of these new techniques has now been proven though their application still requires a delicate procedure. A long training period is usually required to be able to perform safe operations of reasonable duration. We present a different technique using a modified vaginal speculum and a laparoscopic optic positioned between the valves of the speculum to give a good visualization and expose the operative field. Several retroperitoneal procedures can be performed with this technique using the video-assisted pelviscope, including nephrectomy, pyeloplasty, lymphadenectomy in the pelvis... This video-assisted surgical technique is an interesting compromise between classical surgery and laparoscopic surgery. It is both simple and safe causing little tissue damage and has the advantage of a short postoperative recovery period.

The erythrocyte polyamines, spermidine and spermine, are known proliferation markers. The authors present their experience with polyamines and prostatic carcinoma. 229 patients with prostatic carcinoma had polyamine erythrocyte determination at diagnosis. Previous results confirmed a tendency to spermidine increase with tumor stage and a significant increase in spermine in metastatic and hormonal escape patients. No correlation was found between polyamine erythrocyte levels and hemoglobin, prostate-specific antigen or tumor grade. 148 prostatic carcinoma patients were followed up. Their pretreatment erythrocyte polyamine levels were correlated to progression. Patients (whatever stage) with rapid progression present significantly enhanced pretreatment erythrocyte spermine levels compared to patients with a favorable outcome. Polyamines are not only proliferation markers but are also necessary for cell division. The authors present their results on polyamine deprivation, combining a polyamine-free diet, polyamine synthesis inhibitors and intestinal tract decontamination, on in vivo tumor growth inhibition of the murine prostatic carcinoma Dunning Mat LyLu tumor model.

We have selected 38 patients (55 ureters) with primary vesicoureteric reflux successfully treated by endoscopic subureteric injection of Teflon. The success rate after 1 injection was 83.6%. Nine ureters required a 2nd or even a 3rd injection of Teflon to achieve success. The follow-up time for these successfully treated patients was 2-5 years, and results remained stable in 94.5% of cases. Endoscopic injection of Teflon seems to be a reliable alternative to open surgery in the treatment of primary vesicoureteric reflux.