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Summary: Despite the organ shortage, a significant number of deceased donor kidneys are retrieved but not transplanted (RNTK). This study aims to describe and analyze the main causes of potential grafts discard and to propose adequate solutions. We collected data from the Cristal database of the French Biomedicine Agency about RNTK over one year. Expert opinion was taken from urologists with extensive expertise in renal transplantation. They retrospectively analyzed each record to assess the appropriateness of each graft refusal and subsequent kidney discard. Of 252 kidneys were retrieved but not transplanted in France over one year. The main reasons for discard were vascular abnormalities in 43.7% (n = 110), suspicion of malignant tumor in 18.7% (n = 47), and severe histological lesions on preimplantation biopsy in 12.3% (n = 31). The reason for kidney refusal was undetermined in 4.8% (n = 12). Iatrogenic lesions were responsible for 26.2% (n = 66). Overall, 46.0% (n = 16) and 25.0% (n = 63) of the grafts were, respectively, properly and improperly denied, and the analysis was not possible in 29.0% (n = 73). In total, 36.9% of RNTK could have been transplanted. Reduction of iatrogenic lesions, improvement of microsurgical repair skills, and proper histological examination are necessary to reduce the number of RNTK. A prospective study applying the proposed principles is undoubtedly essential to complete this work. [ABSTRACT FROM AUTHOR]

Robot-assisted radical cystectomy with intracorporeal urinary diversion is one of the most challenging procedures in urological surgery. Over the past 15 years, this procedure has gained in popularity and the number of procedures performed has increased significantly. While ileal conduit remains the most common diversion, orthotopic neobladders are also formed in a few expert centres that have developed their technique for totally intracorporeal neobladder. The objective of this review is to summarise the techniques currently used to perform totally intracorporeal neobladder with a special focus on their functional outcomes, such as continence or sexual function. The techniques described are the Karolinska-modified Studer neobladder, the USC-modified Studer neobladder, the pyramid pouch, the Y-pouch, and the vesica Ileale Padovana, some trying to totally reproduce the steps of open surgery and others trying to simplify them. Functional outcomes vary depending on the technique performed. Standardisation in assessing outcomes is lacking, as well as objective outcome measurements with questionnaires or urodynamic assessments. Current evidence shows acceptable functional outcomes after totally intracorporeal neobladder construction, but larger prospective randomised series with longer follow-up, better defined outcomes, and more objective measurements are needed in the future. [ABSTRACT FROM AUTHOR]

Objectives To describe the most recent data from phase I and II clinical trials of stereotactic body radiation therapy ( SBRT) using image-guided robotic radiosurgery, specifically the Cyberknife® ( Accuracy Incorporated, Sunnyvale, CA, USA)., To better determine thecurrent role of this type of radiosurgery in prostate cancer ( PCa) management., Materials and Methods Current clinical trials and relevant retrospective studies were identified from the literature, clinical trial databases, websites and conference abstracts., The indications, technical aspects, efficacy and toxicity of SBRT using the Cyberknife® system were summarized., Results The Cyberknife® system is an experimental treatment mostly used for localized PCa in stage cT1/ T2a-b N0 M0 with a Gleason score ≤7 and PSA level ≤20 ng/ mL. Hypofractionated radiation therapy was delivered in five fractions of 7-7.25 Gy for a total dose of 35-36.25 Gy., After treatment, the median PSA levelfell from 4.9-8.3 ng/ mL to 0.1-1.6 ng/m L at a median follow-up of 4-60 months., The biochemical progression-free survival rates ranged from 78.3 to 100%., Acute and late toxicities were mostly grade 1/2 rectal or urinary complications. Few grade 3 and no grade 4 toxicities occurred during follow-up; however, erectile dysfunction and testes toxicity were also reported., Conclusions The use of the Cyberknife® system is limited mainly by its pretreatment and maintenance costs., Despite encouraging preliminary results, longer-term follow-up and randomized controlled phase III clinical trials are necessary before the Cyberknife® system becomes a standard treatment method. [ABSTRACT FROM AUTHOR]

OBJECTIVE To establish the predictive accuracy of the Kattan preoperative nomogram by comparing predictions at 5 years with actual progression in patients who had a radical prostatectomy (RP). MATERIALS AND METHODS We reviewed the data for 928 patients treated by RP as a first-line treatment for localized prostate cancer, between 1994 and 2005. Recurrence was defined as one prostate-specific antigen (PSA) level of >0.4 ng/mL. The 5-year progression-free probability (PFP) rate was evaluated on censured data using the Kaplan-Meier method. Relationships between all predictor variables included in the Kattan nomogram (PSA level, biopsy Gleason scores and clinical stage) and survival were evaluated by Cox proportional-hazards regression analysis. The discriminating ability of the nomogram was assessed by the concordance index ( c-index). Bootstrapping was used to assess confidence intervals (CIs), and then the calibration was assessed. RESULTS The median follow-up was 60 months. Overall, 177 (19%) patients had a recurrence; the 5-year PFP rate (95% CI) was 80.9 (78–83)%. Of the three variables included in the nomogram, all were associated with recurrence in a multivariate analysis ( P < 0.001). The c-index (95% CI) was only 0.664 (0.584–0.744). In general, the nomogram was not well calibrated. CONCLUSIONS There was a discrepancy between the predicted PFP as estimated by the Kattan nomogram and actual relapse in this group of patients. Clinicians should be aware that the nomogram is less accurate when used outside the population used to formulate the nomogram. Although more accurate tools are needed, the Kattan nomogram is still the best choice for urologists so far. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine the effectiveness of cancer control afforded by radical prostatectomy (RP) in patients with clinical stage T3 prostate cancer. PATIENTS AND METHODS We retrospectively reviewed data for patients treated by RP for clinical stage T3 prostate cancer between 1995 and 2005. The following case characteristics were analysed: patient age, clinical presentation, preoperative prostate-specific antigen (PSA) level, Gleason score, tumour stage (2002 Tumour-Node-Metastasis), surgical procedure, pathological data, margin and lymph node status, and recurrence. Biochemical recurrence was defined as an increase in PSA level of >0.2 ng/mL after surgery. Kaplan-Meier survival curves were generated, and prognostic factors were evaluated. RESULTS Overall, 100 patients were included; only 79% of them had pT3 disease based on the pathological specimen. The median follow-up after RP was 69 months. The RP was open in 77 and laparoscopic in 23, with no significant difference between these approaches ( P = 0.38). The 5-year PSA-free survival after surgery was 45%, and 5-year cancer-specific survival was 90%. On univariable analysis, Gleason score >7 ( P = 0.01), pathological stage (pT2-T3a vs T3b) ( P < 0.001), positive lymph node ( P < 0.001), and positive margin ( P < 0.001) were associated with recurrence. On multivariable analysis, lymph node, margin status and Gleason score were also significant ( P < 0.05). CONCLUSIONS RP can be recommended as an alternative primary treatment that results in acceptable cancer control for clinical stage T3 prostate cancer in selected cases. However, the patient should be warned that surgery alone might not be sufficient to control the cancer, and that adjuvant therapy might be needed during the course of the disease. [ABSTRACT FROM AUTHOR]