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Introduction: Indication for percutaneous-ablation (PA) is gradually expanding to renal tumors T1b (4-7cm). Few data exist on the alteration of renal functional volume (RFV) post-PA. Yet, it is a surrogate marker of post partial-nephrectomy (PN) glomerular filtration rate (GFR) impairment. The objective was to compare RFV and GFR at 1-year post-PN or PA, in this T1b population., Methods: Patients with unifocal renal tumor≥4cm treated between 2014 and 2019 were included. Tumor, homolateral (RFVh), contralateral RFV, and total volumes were assessed by manual segmentation (3D Slicer) before and at 1 year of treatment, as was GFR. The loss of RFV, contralateral hypertrophy, and preservation of GFR were compared between both groups (PN vs. PA)., Results: 144 patients were included (87PN, 57PA). Preoperatively, PA group was older (74 vs. 59 years; P<0.0001), had more impaired GFR (73 vs. 85mL/min; P=0.0026) and smaller tumor volume(31.1 vs. 55.9cm 3 ; P=0.0007) compared to PN group. At 1 year, the PN group had significantly more homolateral RFV loss (-19 vs. -14%; P=0.002), and contralateral compensatory hypertrophy (+4% vs. +1,8%; P=0.02, respectively). Total-RFV loss was similar between both (-21.7 vs. -19cm 3 ; P=0.07). GFR preservation was better in the PN group (95.9 vs. 90.7%; P=0.03). In multivariate analysis, age and tumor size were associated with loss of RFVh., Conclusion: For renal tumors T1b, PN is associated with superior compensatory hypertrophy compared with PA, compensating for the higher RFVh loss, resulting in similar ΔRFV-total between both groups. The superior post-PN GFR preservation suggests that the preserved quantitative RFV factor is insufficient. Therefore, the underlying quality of the parenchyma would play a major role in postoperative GFR., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: Neoadjuvant chemotherapy (NAC) is now recommended to treat muscle-invasive bladder cancer (MIBC) but is not always executed in real life. This study aims to evaluate the proportion of patients with MIBC who receive an optimal NAC, and to present the predictive factors of its achievement., Methods: This monocenter retrospective study included all the patients who underwent radical cystectomy for≥pT2NxM0 MIBC between 2013, January and 2018, December. NAC consisted in 4-6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) or 4 cycles of GC (gemcitabin, and carboplatin). Demographic (sex, age, ECOG-PS, glomerular filtration rate [GFR], and cN stage), surgical (urinary derivation, time of surgery, blood loss, and complications), and oncological characteristics were analyzed. Multivariate analysis are made to find predictors of administration of NAC., Results: One hundred and twenty-seven patients were included. Thirty received CNA (24%). Patients who underwent CNA were younger, with better ECOG and better GFR. Multivariate analysis showed that cN+ stage and better GFR were significantly associated to administration of NAC. Eight patients (27%) couldn't receive an optimal treatment due to toxicity. Perioperative complication rates were similar, with or without NAC. Patients who underwent NAC had a worse GFR after treatment (-17 versus +5mL/min, P<0.01)., Conclusion: Due to the risks of toxicity, NAC can only be proposed to selected population, which is not the current patients. Immunotherapy could allow to treat more patients because of better tolerance., Level of Evidence: 3., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Infrarenal abdominal aortic aneurysm (AAA) repair can lead to ejaculation and erection troubles in men. There are few studies on sexual dysfunction after endovascular repair (EVAR) but they suggest less retrograde ejaculation than after open repair. We assessed the sexual dysfunction and ejaculation troubles after elective laparoscopic repair or EVAR., Methods: We conducted a monocentric prospective study on 124 patients undergoing AAA repair between 2013 and 2015. Sexual function was evaluated using the IIEF-15 questionnaire and questions on ejaculation., Results: Only 45 patients (36.3%) accepted to complete the IIEF preoperatively with 20-37.8% having preoperative sexual dysfunction. Among them, 21 (46.7%) accepted to complete the questionnaire at 3, 6 and 12 months. Mean age at inclusion was 65±5.6 years in the laparoscopic group and 77±10.5 years in the EVAR group (P=0.003). Erectile and sexual function were slightly improved at 12 months in the laparoscopic group (+1.4 for erectile score and +4.6 for IIEF score) with no significant difference (P=0.83 and 0.74) whereas 8 patients (61.5%) had persistent ejaculation troubles at 3 months. In the EVAR group, patients had moderate sexual dysfunction at baseline without improvement at 12 months, but only one patient reported ejaculation troubles., Conclusions: Most patients eligible for AAA repair present with baseline erectile and sexual dysfunction. Laparoscopic AAA repair provides no onset of erectile or sexual dysfunction but a global improvement after surgery. Ejaculation troubles are frequent and persistent at 1 year. However, EVAR treatment, doesn't allow recovering of sexual function at 1 year., Level of Evidence: 4., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: Partial nephrectomy (PN) is the gold standard treatment for renal cell carcinomas under 4cm. No robust data exists to recommend PN for tumours>7cm (cT2). The objective of this work is to evaluate the results of PN for cT2 tumours., Patients and Methods: All patients who underwent PN or radical nephrectomy (RN) for cT2 tumours between 2000 and 2013 at our institution have been included. Patient demographics, postoperative data including renal function, morbidity, mortality and oncologic outcomes were reviewed retrospectively and compared using χ 2 test, Mann-Whitney test, Kaplan-Meier method and log rank test., Results: We included 130 patients, 49 (38%) in the PN group and 81 (62%) in the RN group, with a median follow-up of 42 months [19-69]. Variation of postoperative renal function at day 5 and last recorded value was significantly different between the groups (P=0.03 and P<0.001). The PN group had a significantly higher complication rate as compared with RN group (37% versus 14%, P=0.002). There were no significant differences between the two groups for overall, recurrence free and specific survival (P=0.55, P=0.55, P=0.24, respectively). In univariate analysis, the type of surgery (PN versus RN) was not associated with a significant difference of oncologic outcome (margins, survival)., Conclusion: PN can be offered for cT2 tumours with oncological outcomes similar to RN. Despite an increased morbidity, it remains acceptable with the demonstrated advantage of preservation of renal function., Level of Evidence: 4., (Copyright © 2018. Published by Elsevier Masson SAS.)

Introduction: The epidemiology of kidney cancer is evolving with a net increase in the incidence of renal tumors, globally, and in young people in particular., Objective: To evaluate the incidence and clinical and pathological characteristics of sporadic renal tumors in young subjects and their risk factors., Material and Methods: A retrospective study aimed at collecting clinical, epidemiological and anatomopathological information from the 118 patients aged 18 to 40 treated for a sporadic kidney tumor in two Parisian university hospital centers between 2003 and 2013., Results: Our study showed a very significant increase in the incidence of renal tumors in our 11 years of decline (P=6.10 -15 ). The mode of discovery also seems to have evolved with a majority of tumors (67 %), due to the considerable growth of imaging in recent decades. We also showed a different pathological distribution compared to the literature with a significant increase in the number of papillary tumors (16.9 %) and chromophobes (15.2 %), in addition to a decrease in the number of carcinomas (43.2 %) as well as the appearance of a new pathological entity of particular clinical severity: renal carcinoma related to translocation Xp11.2 (15.3 %) (P<10 -5 ). Among the risk factors, hypertension seems to be a definite risk factor while tobacco and obesity do not have a significant influence., Conclusion: Our study showed a marked increase in the incidence of renal tumors with specific clinical and epidemiological features in a population of young subjects. The role and importance of oncogenetic management as well as the study of environmental factors could lead to the identification of new risk factors and corollary to their prevention., Level of Evidence: 4., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Elderly patients represent a growing part of our society for who treatment strategy for localized renal tumors has to be chosen knowing iatrogen effects and renal function morbidity. The aim was to analyze oncological and functional results of nephron sparing surgery (PN) versus radiofrequency ablation (RFA)., Materials and Methods: All patients aged more than 75 treated by partial nephrectomy or radiofrequency ablation between 2007 and 2014 in our centre were included. Patient and tumors data were compared and these criteria were analyzed: survival (overall and without recurrence) and loss of renal function (pre- and postoperative MDRD)., Results: In total, 100 patients were included (26 partial nephrectomies, group 1 and 74 radiofrequency ablation, group 2) with a 32-months medium follow-up. Medium age and tumor size were significantly different (respectively, 78 versus 81 years old, P=0.001, 38mm versus 29mm, P=0.003). Perioperative results showed no differences in complications. Transfusion rate and duration of hospital stay were significantly higher in the PN group. Median overall survival were 45 vs. 27 months (P=0.23) for PN and RFA and median recurrence-free survival were 28 vs. 10 months (P=0.34). On a multivariate analysis, operative technique (PN or RFA) were not significantly linked to survival (HR 2.37 [95% CI: 0.66-8.5]), P=0.19. Loss of renal function were 1.5±14mL/min/1.73m 2 for PN and 3±14mL/min/1.73m 2 for RFA (P=0.69)., Conclusion: Our study showed better perioperative results for RFA than for PN, without significant different survival. Loss of renal function were little and similar., Level of Evidence: 4., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Compare three morphometrics scores of the kidney on the reproductibility and the predictability of complications per- and post-partial nephrectomy., Materials and Methods: This comparative study analyzed a monocentric retrospective cohort of 47 patients affected by a unique renal tumor and operated by partial nephrectomy by lumbotomy excluding the genetic diseases from January till December, 2014. The preoperative scanners were reviewed in double-blind by a radiologist and an internal surgeon who classified each tumor according to the three classifications: R.E.N.A.L. score, score in 12 segments and the University Paris Renal Cancer Classification (UPRCC). The judging criteria were the operative and ischemic duration, the blood loss, the preoperative injuries, the length of the hospital stay, the postoperative complications according to the Clavien-Dindo classification. The Cohen's kappa coefficient and the one-way analysis of variance were used respectively to compare the inter-observer reproducibility and the predictability of the complications for each classification., Results: Forty-four tumors of which 30 (64%) were on the left kidney, with an average size of 55.19mm with 17 (39%) on the upper pole, 12 (27%) on the lower pole and 15 (34%) medio-renal. The UPRCC was the most reproductible classification with 90% inter-observer concordance against 84% for the R.E.N.A.L. score and 72% for the score in 12 segments. The most predictable classification of complications was the score in 12 segments in particular thanks to the subgroup including the number of segments reached which allows to predict significantly the risk of a duration of intervention, prolonged ischemia and the risk of blood loss (P=0.03, 0.06 and <0.001)., Conclusion: The main result of this study is that, as in the majority of the previous studies on morphometrics scores, no score allows to predict the postoperative complications., Level of Evidence: 4., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objectives: Ureteral stents and ureteral catheters externalized through the urethra are not ideal solutions to manage complicated upper urinary tract fistulae. We sought an effective method of drainage, minimally invasive, reproducible allowing a rapid patient's discharge., Patients and Methods: Between November 2013 and February 2015, an ureteral stent was exteriorized in trans-vesico-parietal by an endoscopic and percutaneous access in patients with complicated upper urinary tract fistulae. Monitoring of tolerance, complications and urinary fistula healing was performed., Results: Nine consecutive patients had an ureteral stent exteriorized in trans-vesico-parietal to manage complicated upper urinary tract fistulae. There was no failure in introducing the catheter, or postoperative complication. Catheters were left in place on average 36.1days (24-55). The patients were able to return home with the catheter in place in 77.8% of cases. The tolerance of the catheter was good. All fistulae were able to be treated conservatively at the end of the drainage period., Conclusion: Trans-vesico-parietal ureteral catheters enable efficient and reproducible conservative treatment of upper tract urinary fistulae regardless of their cause., Level of Evidence: 5., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the practice of immediate postoperative instillation (IPOP) using mitomycin C for non-muscle invasive bladder cancer (NMIBC) treatment by urologists members of the French Association of Urology (AFU)., Material and Method: Internet-based observational survey evaluating indications and practical modalities of IPOP in NMIBC treatment using questionnaire sent in May 2014 to 915 urologists., Results: Two hundred ninety-eight urologists participated in the survey (response rate: 32.6%) and 57% prescribed the IPOP. The median frequency of IPOP prescription was 3.3%, and was higher in the academic public sector. The CASE recommendations were self-assessed as known or well-known in 67% of cases. The selections criteria for IPOP were adequately identified by 62% of urologists, without differences according to sectors of activity. The IPOP prescription modalities were declared as an obstacle to the completion for 41.9% of urologists, and especially in the private sector. Completion times of IPOP were declared <24h in 91% of cases. We see that 28.5% of urologists prescribed an urinary alkalization. The average frequency of complications of IPOP was 0.91 per urologist., Conclusions: The IPOP prescription frequency was higher among urologists practicing in the academic sector. Neither the level of knowledge of the recommendations nor the frequency of complications of IPOP had explained this difference. However, the prescription modalities were more frequently reported as an obstacle to their completion in the private sector., Level of Evidence: 3., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To review the differences between the BCG strains used for the treatment of non-muscle invasive bladder cancer (NMIBC) at the molecular level, regarding cytotoxicity, immunogenicity, clinical efficiency, and safety., Material and Method: A systematic review of the literature search was performed from the database MedLine, focused on the following keywords: BCG; bladder; strain; genome; cytotoxicity; immune response; efficiency; safety., Results: Genetic differences between BCG strains have been identified and correlated to their time to differentiation from their initial cultures start, assuming a lower resistance to the host immune defenses of Tice and Danish strains compared to the Connaught strain. Preclinical comparative data showed superior cytotoxic effect and immunogenicity of the Connaught strain compared to Tice and Danish strains. The phase III trials have shown superior efficiency of BCG Connaught compared to BCG Tice and BCG Danish compared to BCG Tice regarding recurrence-free survival., Conclusions: Among BCG strains used in France in NMIBC treatment, preclinical and clinical efficiency of Connaught strain was higher than that of the Tice strain. The limits of the currently available studies lie primarily in the lack of use of maintenance therapy., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: One of the priorities of the "Plan against the Cancer" in France is to ensure the discussion of all cancer cases in a multidisciplinary meeting staff (RCP). The multidisciplinary collaboration is proposed to guarantee a discussion between specialists in every cases, particularly in complex cases. The aim of this study was to compare the therapeutic decision taken in four RCP in Paris Île-de-France academic centres for three identical cases., Material: Three cases of urological oncology (prostate cancer [PCa], renal cell carcinoma [RCC] and bladder tumour) were selected by a single urologist, not involved in further discussion. These cases were blindly presented in four academic urology department from Paris: Pitié-Salpêtrière Hospital, Mondor Hospital, the Georges-Pompidou European Hospital and Foch Hospital., Results: The four centres met the criteria of quality of RCP in terms of multidisciplinarity, frequency and standardization. The therapeutic suggestions were similar in the RCC cases, there were differences in the surgical approaches and preoperative work-up in the PCa case and, lastly, the proposals were different for the bladder cancer case., Conclusion: The decisions relies on clinical data and preoperative work-up but also on the experience and habits of the centre of excellence. For complex cases that does not fit with current guidelines, the panel discussion can lead to different therapeutic options from a centre to another and is largely influenced by the local organisation of the RCP., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Radiofrequency is a minimally invasive therapy allowing tumor destruction by applying physical means to the core of the lesion. There is a particular indication for the hereditary already surgically treated renal carcinomas like Von Hippel-Lindau's disease. We present a case of renal-pleural fistula developed after a percutaneous radiofrequency ablation under computed tomography (CT) guidance of a renal tumor in a VHL female patient with a renal cell carcinoma of the upper pole of the left kidney. The kidney manifestations begin at 20-year-old with the appearance of cystic lesion at the lower pole of the left kidney. At 30-year-old, a computed tomography study revealed a solid lesion arising from a cyst. The patient underwent a partial nephrectomy by flank incision. Follow-up studies discovered three solid lesions of the upper pole of the left kidney. The patient undertook a radiofrequency ablation of these lesions. Follow-up control showed a contrast enhancement of one of the three lesions treated. Under this condition another course of RF was performed, complicated by a renal-pleural fistula. A conservative management of this iatrogenic fistula was attempted combining a water restriction and the insertion of a ureteral catheter. Three weeks were necessary until the fistula completely regress., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Kidney transplantation in rats is a classic experimental model used in transplant research. As several methods have been previously reported without definition of a gold standard, we describe herein a simple institutional technique that has been used in more than 500 procedures and taught to medical students or surgeons without previous microsurgical experience. Our step-by-step illustrated report would allow French-speaking trainees to learn how to perform kidney transplantation in rats in a reproducible manner and add this valuable tool to their research protocols., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Three clinical cases have shown the superiority of sunitinib in first line therapy intermediate risk metastatic clear cell renal carcinoma and a best safety of bevacizumab plus interferon, the current lack of high level of evidence arguments for the neo-adjuvant treatment of kidney cancer, the importance to prevent mucositis during a mTOR inhibitors treatment and the diagnostic pitfalls of its pulmonary complications., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: We reviewed papillary renal cell carcinoma (PRCC) epidemiology, radiological and clinical presentations, and specific features of morphological subtypes focusing on genetic defects, risk of local and metastatic recurrence and frequency of multifocality., Materials and Methods: The MEDLINE database of the US National Library of Medicine was searched for pertinent studies., Results: According to multivariate analyses, PRCC histology was not retained as a prognostic factor. Reported rates of multifocality in PRCC are 22 to 41% but distinction between histological subtype or hereditary forms are barely detailed. Multifocality frequency is independent of size, stage or grade and is not associated with ipsilateral or controlateral recurrence or death from RCC. Thus, PRCC multifocality is not an argument against nephron-sparing surgery. Antiangionenic therapies are being evaluated for the Metastatic PRCC., Conclusion: According to the literature, specific prognostic features of PRCC remain controversial due to the lack of distinction between different PRCC subtypes. Genomic and cytogenetic characterizations have been used to establish an evolving classification of PRCC subtypes and may be a source of new markers that will eventually enable us to precise prognosis and identify targets for new adjuvant therapies., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Treatment of metastatic kidney cancer in elderly subjects is identical to treatment of younger subjects. Whereas cytokines were classically contraindicated in patients over 70 or 75 years (notably IL2), new targeted therapies have been evaluated and found to be usable with no age limit, and all of the phase III studies have included patients 80 years old and older. Overall, there seems to be no difference in efficacy based on age (except perhaps for temsirolimus). As for tolerance, it is satisfactory for all therapies. Dose reduction is slightly more frequent, which calls for caution, notably with sunitinib, for which a direct correlation between the dose administered and efficacy has been reported. Given the data available today, no dose adaptation in relation to age is recommended in metastatic renal cancer., ((c) 2009 Elsevier Masson SAS. All rights reserved.)

The development of ablative techniques in renal oncology has profoundly changed treatment of small renal tumors. The objective of this review of the literature was to assess the arguments for treating localized kidney tumors with these techniques in the elderly patient. The two techniques retained because of their recognized use, for all approaches, are radiofrequency and cryotherapy. The data in the literature report more frequent local recurrence with these techniques than with surgical excision and an advantage to cryotherapy over radiofrequency. There seems to be no difference in terms of metastatic progression. Morbidity is not insignificant, with major complications in slightly less than 10% of cases. Given the need to consider small tumors (<4 cm), the advantage in terms of life expectancy is challenged by series studying active monitoring of the oldest patients who present co-morbidities. At present, the indications should therefore be measured and based on a general assessment of the patient, with particular consideration of the existing co-morbidities so as not to treat a patient while imposing undue complications., ((c) 2009 Elsevier Masson SAS. All rights reserved.)

The concomitant increase in life expectancy and the incidence of kidney cancers will result in an increase in kidney cancers in subjects over 75 years of age in the coming years. A wait-and-see attitude in cases of voluminous tumors, particularly symptomatic tumors, may well alter the quality of life of these patients through chronic abdominal pain, macroscopic hematuria, or alteration of the general condition due to metastatic progression. Curative or palliative surgical management can be envisioned and should be discussed in the multidisciplinary consensus meeting. Before validating the indication for nephrectomy in the elderly patient, a preoperative geriatric assessment should be made. Moreover, preoperative renal function should be carefully evaluated to measure the risk of terminal renal failure. The reduction in the mean duration of the hospital stay provided by laparoscopic surgery allows patients to return home or to their institution more quickly, an important consideration in the rehabilitation of these patients, who are very sensitive to such changes. Laparoscopic nephrectomy, with evidence in the literature of reduced morbidity and satisfactory oncological results, could therefore be superior to open surgery when indicated and technically feasible., ((c) 2009 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the impact of imperative indication on the rate of complications and long term carcinological results after partial nephrectomy (PN)., Patients and Method: Between 1985 and 2005, all patients who had a PN for localized cancer in two centers were reviewed. The rates of global, hemorrhagic and urinary complications were compared between group I (elective indication) and group II (imperative indication). Rates of survival without recurrence and specific at 5, 10 and 20 years were compared between these two groups. A multivariate analysis using the Cox model was carried out to research factors associated with recurrence and death on the whole of the series., Results: Three hundred and five patients were included in the study. No significant difference was found between group I and group II as far as global complications were concerned (17 vs 20%), the rate of hemorrhagic complications (3.5 vs 3.8%) and the rate of urinary complications (3.9 vs 2.5%). The patients who had been operated on for an imperative indication had survived specifically and without recurrence which was significantly lower at 5, 10 and 20 years. On the whole of the series, the imperative indication was the only independent factor associated with recurrence and death in a multivariate analysis., Conclusions: Even if the rate of complication does not appear to be significantly associated with the indication for operating, patients of imperative indication represented a heterogeneous group with a poorer prognosis. This factor should be taken into account in studies on the subject of PN.

Malignant tumours may have a cystic appearance. They are dominated by multilocular cystic renal cell carcinoma, usually low-grade, which rarely metastasize. The Bosniak classification distinguishes non suspicious lesions (type I and II) from suspicious lesions (type III and IV) requiring resection and lesions requiring follow-up (type IIF). The main feature suggestive of malignancy is the enhancement of the septa and the walls of the cyst. Renal cysts classified as IIF require surveillance by contrast-enhanced imaging (CT, MRI or ultrasound). The treatment of cystic tumours is based on surgery. Partial nephrectomy is recommended in this type of tumour regardless of the size. Laparoscopy is a validated technique in experienced hands. Aspiration is not very effective for the treatment of benign cysts, but may be useful for diagnosis. Surgical resection of the roof of the cyst is the most effective technique.

When announcing the diagnosis of renal cell carcinoma, the urologist and the patient can wonder about the waiting time for surgically treating the cancer. This review aimed to investigate the scientific facts to determine the time between the diagnosis of kidney cancer and the achievement of surgically. The natural history of kidney cancer has been the fundamental of the therapeutic management. The time between diagnosis and surgical treatment depends on the conditions under which the diagnosis was established. Patients with symptomatic cancer or discovered at metastatic stage had to be treated quickly. In case of incidental diagnosis, evaluation of tumors has resulted in the selection of patients who can wait several months between diagnosis and surgical treatment of kidney cancer on the condition watchful waiting. The modalities of this assessment, radiological and anatomopathological, must be validated by further studies.

Objective: To study the specific features of the sporadic form of bilateral renal cell carcinoma (RCC)., Material and Method: Twenty-six patients presented bilateral RCC among a total of 759 patients operated for RCC in our institution between 1985 and 1998. The mean follow-up for 23 patients (3 were lost to follow-up) was 56.5 months. Actuarial survival was estimated by the Kaplan-Meier method and comparisons between the various groups were performed with a Mann-Whitney test., Results: This series comprised 10 asynchronous tumours and 16 synchronous tumours. The mean diameter of synchronous tumours was significantly greater than that of asynchronous tumours (61 vs 33.5 mm). Histology revealed 16 clear cell carcinomas (CCC), 7 tubulopapillary carcinomas (TPC), 2 cases with CCC and TPC, and one bilateral oncocytoma. Malignant tumours were classified as stage T1-T2 (n=23) or T3 (n=2). TPC was more frequently bilateral than CCC (7.9% vs. 2.8%). Forty-four surgical operations (19 radical nephrectomies and 24 partial nephrectomies) were performed. The mean interval between two operations for asynchronous tumours was 85.2 months. Follow-up demonstrated 15 remissions and 6 deaths, including 5 deaths due to RCC, one local recurrence and one local recurrence with metastases. One-year specific survival was 96% and 5-year survival was 74%. Age, gender, histological type and the asynchronous or synchronous mode did not induce any significant difference on survival., Conclusion: The surgical approach must therefore be resolutely conservative in view of the good 5-year survival rate and the low local recurrence and metastasis rates.

Cryoablation and radiofrequency are minimally invasive techniques allowing resection of the tumour by application of physical means (cold or heat) to the centre of the lesion, rather than strictly surgical resection. The incision is usually percutaneous but can be laparoscopic in certain indications. Indications are currently limited to exophytic renal tumours < 40 mm, situated away from structures of the hilum (vessels and renal pelvis) and gastrointestinal structures in patients > 70 years or in the context of previously operated hereditary renal carcinoma (von Hippel Lindau disease). The results of the first series are encouraging, although more contradictory for radiofrequency probably due to the heterogeneous equipment (electrodes, generator, frequency, etc.). The complication rate is low. A PHRC national multicentre randomized study is currently underway to compare the functional and oncological results of radiofrequency and conservative surgery.

The follow-up of renal cancer is essentially based on thoracoabdominal computed tomography (CT). The duration of this follow-up and the frequency of examinations depend on the patient's level of risk. Early detection of metastases has a limited therapeutic value at the present time, apart from tumours with a good prognosis or for the management of complications. Recent publications on targeted treatments raise new hopes and may lead to a modification of follow-up guidelines.

The Bellini collecting duct carcinoma is a very rare form of renal cell carcinoma (1%). It presents at the stage of metastases in the very great majority of cases. The diagnosis should be considered in patients presenting with marked deterioration of the general status and/or the presence of a very large invasive renal tumour on abdominal CT scan. The overall 2-year survival rate of Bellini carcinoma is about 20%. As the prognosis is very poor, even despite radical nephrectomy, biopsy may be performed as the first-line procedure when the diagnosis is suspected. In the case of primary metastatic Bellini carcinoma, radical nephrectomy alone appears to be useless and dangerous except for analgesic purposes or in the context of new multicentre chemotherapy protocols, combining gemcitabine and cisplatin, currently under evaluation.

Objectives: To report the results of conservative surgery for the treatment of hereditary renal cell carcinoma (RCC) and to define its place with respect to new less invasive treatment options., Material and Method: Over a period of 14 years, 30 women and 26 men were operated for one or several hereditary RCC, either by radical nephrectomy or nephron-sparing excision, via a lumbar or subcostal incision, when the diameter of at least one RCC was greater than 2.5 cm., Results: 92 operations were performed: 62 local excisions and 30 nephrectomies. The TNM stage was: 75 pT1, 14 pT2, 3 pT3b; 4 N+; 3 M+. 26 patients (46%) were operated at least twice. Two or more RCC were resected in 43 cases (47%). In the case of nephron-sparing surgery, mean blood loss was 175 +/- 231.7 cc (range: 50-1300 cc); mean pedicle clamping time (97% of cases) was 32 +/- 10.4 min (range: 10-50 min); mean preoperative serum creatinine was 85 +/- 18 micromol/L (range: 52-150 micromol/L) and mean postoperative serum creatinine was 105 +/- 80 micromol/L (range: 59-576 micromol/L); the calculated tumour recurrence rate was 24% at 5 years and 80% at 8 years; overall 5-year survival was 100% and overall 10-year survival was 67%. The median follow-up was 55.9 months., Conclusion: When hereditary RCCs are situated between 2.5 cm and 6 cm in diameter, nephron-sparing surgery is the reference treatment. Modern imaging and genetic screening should allow early detection of increasingly smaller RCCs. In the future, less invasive treatment options could replace surveillance for RCCs less than 2 cm and eventually reduce the indications for local excision.

Prostate cancer has become the most frequent cancer and the second cause of cancer mortality in men. This public health problem is becoming increasingly important due to the increasing life expectancy. At the present time, prostate cancer will be discovered in one in every eight men during their lifetime. Prostate cancer represents 25% of all new cases of male cancers. Prostate cancer screening is designed to detect early stage, asymptomatic prostate cancer, as the patient's chances of cure are higher when the cancer is diagnosed at an early stage. The conclusions of the ANAES evaluation in 1998 did not recommend mass screening for prostate cancer. Several international prospective randomized studies based on serum PSA assay, sometimes associated with digital rectal examination, are currently underway. France is participating in the European ERSPC study (European Randomized Study of Screening for Cancer Prostate) and is organizing a national study on high-risk populations. While waiting for the final results of these studies, a recommendation needs to be proposed to inform general practitioners and specialists about optimal use of the currently available tests. Based on the conclusions of its oncology committee (composed of urologists, medical oncologists, radiotherapists, pathologists and radiologists), the Association Française d'Urologie proposes a recommendation concerning prostate cancer screening and defines its modalities, especially concerning the target population, screening tests and the information given to men before screening. The Association Française d'Urologie recommends prostate cancer screening by PSA assay (prostate specific antigen) and digital rectal examination annually between the ages of 50 and 75 years, and from the age of 45 years in men with a family or ethnic risk. If total PSA is above the normal value of the test or if digital rectal examination is abnormal, referral to a urologist is recommended. Information concerning the limits, benefits and risks of screening and the available treatment options must be given before performing these examinations.

Several promising approaches to the treatment of renal cancer have been developed over recent years. Two independent North American and European studies have demonstrated the value of nephrectomy in patients with metastatic disease: the overall survival of patients treated with interferon was improved by nephrectomy, essentially in patients with a good general status. Several publications have also emphasized the value of surgery for metastases. New experimental approaches have also been developed. Dendritic cells fused with tumour cells induced 4 complete remissions and 2 partial remissions in a series of 17 patients. Allogeneic haematopoietic stem cell transplantation induced lasting remissions in 10 out of 17 patients. The National Cancer Institute team, in the United States, has developed this approach for patients with an HLA-compatible relative. Finally, various molecules with promising antiangiogenic properties are currently under development in renal cancer.

Objective: To try to define when and what type of operation should be performed in von Hippel-Lindau disease (VHL) with renal involvement., Material and Methods: Between 1985 and July 1996, 43 patients with renal involvement of VHL disease were followed in our department. We decided to operate on patients with one or several solid or complex tumours greater than 2.5 cm in diameter, by means of conservative surgery (tumour excision removing a layer of healthy parenchyma) when the kidney did not contain more than 5 or 6 tumours or radical nephrectomy in the other cases. Subsequent follow-up consisted of CT, chest x-ray and renal function tests every 6 months., Results: Twenty-nine patients with a mean age of 33.6 years were operated. 21 patients (29 kidneys) were treated by conservative surgery: in situ in 20 cases and ex vivo in 9 cases; 3 cases were treated by bilateral radical nephrectomy, 4 by unilateral radical nephrectomy and 1 by resection of the prominent dome for urinary tract obstruction. Four cases of acute arterial thrombosis were observed following ex vivo surgery, requiring nephrectomy in every case. No serious complications were observed with in situ conservative surgery. A new lesion in the renal parenchyma remaining after conservative surgery was observed in 5 cases during follow-up (mean: 29 months). No local recurrence was observed after radical nephrectomy. Two nonoperated patients developed metastatic disease., Conclusion: Conservative treatment is usually possible: either simple surveillance, in the absence of any solid or complex tumours larger than 2.5 cm in diameter, or conservative surgery for tumours larger than 2.5 cm in diameter, with no more than 6 tumours per kidney; this attitude requires six-monthly follow-up by CT of the renal parenchyma.