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The status of surgical margins after radical prostatectomy is a major prognostic factor. The role of several technical aspects of radical prostatectomy, such have surgical access, bladder neck preservation or neurovascular bundle sparing, in generating supplementary positive margins has been controversial for many years. Positive margins along with other poor prognostic factors are important elements in the decision to perform adjuvant therapy after radical prostatectomy. This review of the literature, based on a Medline search, was designed to update these various issues encountered by urologists in their everyday practice.

Objective: This study was designed to evaluate the medium-term results of surgical treatment of penile curvature by tunica albuginea plication of tunica albuginea resection-prosthetic graft., Materials and Methods: A retrospective study of 45 patients operated for penile curvature was performed: 38 were treated by tunica albuginea plication and 7 were treated by tunica albuginea resection-graft. Each patient returned for early (1 month), medium-term (3 months-1 year) and long-term (total mean follow-up of 34 months) postoperative review., Results: Patients operated by plication were satisfied in 88.6% of cases. Significant shortening of the penis was observed in 52% of cases and one in five patients complained of disabling shortening; other complications were rare. The global satisfaction rate among patients operated by resection-graft was 29%, with 57% of residual curvature and 15% of postoperative erectile dysfunction., Conclusion: Tunica albuginea plication is a simple and effective technique with low morbidity for the treatment of penile curvature. Tunica albuginea resection followed by Goretex graft gives unsatisfactory results and is associated with considerable morbidity in the treatment of complex penile curvature.

Suburethral TVT tape has become immensely popular since its invention in 1995. A new transobturator surgical approach was proposed in 2001, resulting in a modification of the quality of the tape available from various suppliers. The authors present 2 cases of obturator foramen abscess related to suburethral Uratape, occurring a long time after the procedure and requiring complete removal of the tape. These infections can be prevented by using good quality tape, which must be made from monofilament large-mesh woven polypropylene. The tape must be completely removed as early as possible in the case of vaginal erosion, even asymptomatic, via a transobturator approach, if necessary.

Objective: To evaluate the risk of progression after conformal radiotherapy combined with 12 months of adjuvant hormone therapy in a series of patients with prostate cancer considered to be at high risk of progression., Material and Methods: Between January 1997 and December 2001, 63 consecutive patients classified at high-risk according to Amico's classification were treated by combined radiotherapy-hormone therapy. All patients presented at least one factor of the high-risk group of Amico's classification: TNM 92 stage T2c, T3 or T4, or Gleason score > or = 8 or baseline PSA > 20 ng/ml. All patients were treated by combined radiotherapy-hormone therapy with concomitant hormone therapy for 2 months and adjuvant hormone therapy for 10 months. Biochemical progression was defined according to the ASTRO criteria. The median follow-up was 36 months., Results: The 3-year and 5-year biochemical recurrence-free survival was 78%. No local recurrence was observed in 94% of cases and no metastases were observed in 93% of patients. On univariate analysis, only a baseline PSA greater than 22 ng/ml was identified as a predictive factor of early biochemical recurrence. The 3-year biochemical recurrence-free survival was 96% for patients with baseline PSA < 22 ng/ml and 56% for patients with baseline PSA > or = 22 ng/ml (p=0.0017)., Conclusion: The early results of 12 months of radiotherapy-hormone therapy in high-risk patients in our series were comparable to those reported in the literature. Only a high baseline PSA was predictive of early biochemical recurrence. Adjuvant hormone therapy (long-term, intermittent hormone therapy) could therefore be modulated as a function of the baseline PSA.

Objective: Use of an isotope sentinel node mapping technique in prostate cancer to study its feasibility, lymphatic prostate drainage and its value in pelvic lymph node staging., Material and Method: The sentinel node mapping technique was performed in 34 patients with clinically localized prostate cancer. A transrectal intraprostatic injection of Technetium 99m-labelled nanocolloidal particles was performed on the day before radical prostatectomy. Sentinel node mapping was performed by intraoperative lymphoscintigraphy and gamma probe. A standard pelvic lymphadenectomy was systematically performed., Results: Preoperative lymphoscintigraphy allowed identification of sentinel nodes in 85.3% of patients. Four of the five failures had a history of pelvic surgery. Sentinel node mapping and biopsy were possible in 23 patients (67.7%). The majority of sentinel nodes were located in the hypogastric region (58.4%). A microscopic lymph node metastasis was identified in 4 patients (11.7%), located in a sentinel node in 3 cases. In 2 cases, the micrometastasis was situated in a sentinel node outside of the pelvic chain. These four patients had a pretreatment PSA > 10 ng/ml and a Gleason score > or = 7 (on the prostatectomy specimen)., Conclusion: This study confirms the feasibility of the sentinel node technique in prostate cancer and the diversity of lymphatic drainage of the prostate. Pelvic lymphadenectomy alone also appears to be insufficient for precise staging in patients with pretreatment PSA > 10 ng/ml and a Gleason score > 6. This isotope technique could therefore improve the yield of lymphadenectomy by limiting its extent.

Epidermoid cyst of the testis is a rare benign tumour. The diagnosis is strongly suggested by ultrasound and MRI. Conservative surgery is possible in the case of a small isolated lesion and requires intraoperative histological confirmation. It is a constantly benign tumour that must be distinguished from testicular teratomas, justifying the search for associated neoplastic contingents requiring orchidectomy.