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Body mass index (BMI) has been associated with worse outcomes in several solid malignancies. We aimed to evaluate the association between BMI and oncological outcomes in patients treated with radical cystectomy (RC) for muscle-invasive urothelial carcinoma of the bladder (UCB). We retrospectively reviewed 701 consecutive patients treated with RC and pelvic lymphadenectomy for UCB at our institution between 1995 and 2011. Univariable and multivariable Cox regression models investigated the association of BMI with disease recurrence and cancer-specific mortality. BMI was analyzed as both continuous and categorical variable (

Resume But Nous avons voulu evaluer l’impact pronostique du sexe feminin sur le devenir oncologique des patients ayant une tumeur de vessie infiltrant le muscle traites par cystectomie totale. Materiel Les donnees de 701 patients traites par cystectomie totale associee a une lymphadenectomie pelvienne pour une tumeur de vessie infiltrant le muscle ont ete collectees. L’impact du genre sur la recidive tumorale, la mortalite specifique et globale ont ete analyses a l’aide de modeles uni- et multivaries de regression de Cox. Resultats Parmi les 701 patients, il y avait 553 hommes (78,9 %) et 148 femmes (21,1 %). Avec un suivi moyen de 45 mois (ecart interquartile 23–73), 163 patients (23,3 %) ont presente une recidive tumorale et 127 (18,1 %) sont decedes du fait de la tumeur de vessie. En analyses multivariees, apres ajustement sur les facteurs pronostiques cliniques et anatomopathologiques classiques (âge, stade tumoral, grade tumoral, presence d’emboles tumoraux, presence de CIS concomitant, statut ganglionnaire), le sexe feminin etait un facteur pronostique independant associe a la survenue d’une recidive tumorale (RR : 1,73 ; IC 95 % 1,22–2,47 ; p = 0,02) et d’une mortalite specifique (RR = 2,50, IC 95 % = 1,71−3,68 ; p Conclusion Le sexe feminin apparait etre un facteur pronostique independant du devenir oncologique des patients apres cystectomie totale. Il semble pertinent de s’y interesser pour proposer a l’avenir des traitements plus adaptes au pronostic de chaque patient et notamment une prise en charge plus agressive des tumeurs survenant chez les femmes. Niveau de preuve 5.

Objectifs L’objectif de cette etude etait de tester la faisabilite, la precision et la securite d’un traitement transrectal de la tumeur index par micro-onde, guidee par fusion d’image elastique IRM-echographie, chez 10 patients ayant un cancer de la prostate de risque faible ou intermediaire. Methodes Les patients eligibles devaient avoir un PSA Resultats Les caracteristiques cliniques et carcinologiques sont resumees dans les Tableau 1 , Tableau 2 . La totalite des patients ont pu etre traites selon le protocole. La duree moyenne de l’anesthesie generale etait de 82 (44–170) minutes. Aucune douleur ni aucun autre effet indesirable n’a ete observe en postoperatoire immediat et pendant la duree de l’etude. Les mictions ont repris de maniere spontanee dans les deux heures suivant l’intervention. A j7, le volume de necrose recouvrait totalement le volume cible chez 8 (80 %) patients. Apres un suivi de 6 mois, aucune modification des scores IPSS et IIEF5 n’a ete observee ( Tableau 3 ). Les biopsies realisees dans la zone presumee traitee montraient la persistance de cancer de Gleason 3 + 3 et 3 + 4 chez 3 (30 %) et 2 (20 %) patients, respectivement. Conclusion Ces resultats suggerent que le traitement transrectal par micro-onde guide par fusion d’image IRM-echographie est faisable, precis et bien tolere. Plus de patients sont necessaires pour mieux evaluer le resultat carcinologique a long terme.

Resume Introduction Les tumeurs de la voie excretrice urinaire superieure (TVEUS) sont une entite rare. Peu de donnees probantes sont disponibles pour guider la prise en charge des patients. Le but de ce travail etait de decrire les principaux facteurs impactant le pronostic des patients apres traitement d’une TVEUS. Materiel et methodes Une revue de la litterature a ete realisee en utilisant le moteur de recherche PubMed sans restriction de periode mais en limitant la recherche aux travaux en anglais ou en francais. Resultats Les facteurs pronostiques des TVEUS ont ete divisees en quatre groupes : les facteurs liees au patient, preoperatoires, operatoires et anatomopathologiques. Les facteurs pronostiques decrits pour les TVEUS etaient par ordre d’importance : le stade et le grade tumoral, l’envahissement ganglionnaire, l’existence de carcinome in situ concomitant, l’âge, l’invasion lymphovasculaire, l’architecture tumorale, la necrose tumorale etendue, la localisation tumorale et le genre. Le role pronostique de l’obesite, de la consommation tabagique et des autres comorbidites (ECOG, ASA), recemment rapportes, necessite confirmation. Concernant les facteurs perioperatoires, l’approche endoscopique du bas uretere pendant la nephro-ureterectomie serait a plus haut risque de recidive vesicale. Conclusion L’incorporation de ces facteurs dans des modeles de prediction clinique peut aider a guider la prise en charge des patients (surveillance, type de traitement, lymphadenectomie, chimiotherapie).

Objectives To identify predictive factors of bladder recurrence after radical nephroureterectomy and to evaluate the impact of this event on oncological outcomes. Methods We carried out a retrospective analysis of 237 patients treated with radical nephroureterectomy for urothelial carcinoma of the upper tract at our institution from 1998 to 2011. Univariable and multivariable models evaluated the prognostic factors of bladder recurrence, and its impact on recurrence-free survival and cancer-specific survival. Results The median age was 69.3 years (interquartile range 60–76). With a median follow up of 44 months (interquartile range 24–79), bladder recurrence occurred in 85 patients (35.9%). A previous history of bladder cancer (P = 0.01) and the presence of concomitant carcinoma in situ (P = 0.005) remained independent predictors of bladder recurrence. The presence of bladder recurrence was not correlated with worse oncological outcomes in terms of disease recurrence (P = 0.075) and cancer-specific mortality (P = 0.06). However, the patients who experienced muscle-invasive bladder cancer recurrence had worse outcomes in terms of cancer-specific mortality (P = 0.01). Standard pathological features of aggressiveness, such as higher tumor stage (P = 0.05), higher grade (P = 0.01) and carcinoma in situ (P = 0.03), were independent predictors of muscle-invasive bladder cancer recurrence. Conclusions Previous history of bladder cancer, tumor location and concomitant carcinoma in situ are independent predictors of bladder recurrence in patients undergoing radical nephroureterectomy. Bladder recurrence overall does not impact the oncological outcomes, but a muscle-invasive bladder recurrence is associated with a worse cancer-specific mortality. Standard pathological features of urothelial carcinoma of the upper tract aggressiveness (pT-stage, grade) are independent predictors of muscle-invasive bladder cancer recurrence.

To evaluate and compare scar-related satisfaction in patients treated with open (ORP) versus laparoscopic radical prostatectomy (LRP). We prospectively included all patients treated with ORP and LRP in our department between March and June 2010. Scar-related outcomes were collected at 1 and 3 months postoperatively. Three months after surgery, all patients filled up a questionnaire concerning their scar-related symptoms, scar self-consciousness and satisfaction. These variables were statistically compared between the two groups. A total of 101 patients were included for analysis. Of them, 48, 49 and 4 were treated with LRP, ORP and LRP converted to ORP, respectively. Age distribution was not statistically different between groups. Postoperatively, 5 patients experienced skin infection on their scar site, 2 in the ORP and 3 in the LRP group. The most frequently reported symptom was scar itching, that was more frequent after LRP, although difference was not significant (33 vs. 19 %, p = 0.2). According to patient scar-related consciousness, satisfaction and impact on quality of life, no differences were reported between groups. Impact on quality of life was insignificant in 27 (55 %) versus 21 (44 %) patients after ORP and LRP, respectively (p = 0.3). With an overall low impact on satisfaction and quality of life, scars gendered by LRP and ORP were not different from patients’ point of view. In patients undergoing radical prostatectomy, the cosmetic aspect of scars does not seem to be a concern.

Resume Introduction A l’ere des nouvelles therapies ciblees et des strategies neo-adjuvantes, cet article se propose de faire une mise au point sur le role de l’angiogenese dans le processus de cicatrisation physiologique avec une revue de la litterature concernant les complications parietales sous therapies anti-angiogeniques. Methodes Une recherche bibliographique sur Medline a ete realisee en utilisant les termes renal cell carcinoma , angiogenesis , wound healing , targeted therapies , et complications . Resultats La frequence des complications parietales varie de 5 et 50 % selon les etudes. La survenue de ces complications depend de la demi-vie de la molecule et des precautions en periode perioperatoire (delai d’arret avant chirurgie et delai de reprise apres chirurgie). Conclusion En l’absence de recommandations actuelles, il est conseille d’arreter le bevacizumab au minimum cinq semaines avant l’acte chirurgical et de le reprendre quatre semaines apres. Pour les inhibiteurs de tyrosine kinases, le traitement peut etre arrete 24 a 48 heures avant l’acte et repris trois a quatre semaines apres. Enfin, pour les inhibiteurs de mTOR, il est conseille d’arreter le traitement sept a dix jours avant et de le reprendre au minimum trois semaines apres chirurgie.

Resume But Rappeler la coexistence possible chez un meme patient de tumeurs renales a type d’oncocytome, de carcinome chromophobe et de tumeur hybride « oncocytome-chromophobe » (TH). Resumer les donnees recentes de la litterature sur la tumorigenese supposee de ces tumeurs et leur association au syndrome de Birt-Hogg-Dube (BHD). Patient et methode Deux cas cliniques ont ete decrits a partir de l’etude des dossiers medicaux. Une revue de la litterature medicale recente a ete realisee en effectuant une recherche ciblee sur la base de donnees du National Center for Biotechnology Information (NCBI). Resultats Il s’agissait de deux patients ayant de multiples tumeurs du rein, de petite taille, et traitees par tumorectomie. Histologiquement, ces tumeurs avaient les caracteristiques morphologiques de TH. Un syndrome de BHD a ete suppose chez ces deux patients mais non documente. Conclusions Il existe histologiquement un spectre tumoral allant de l’oncocytome au carcinome chromophobe, avec des formes intermediaires hybrides. Les TH n’ayant pas de specificite anatomoclinique, il parait prudent de les considerer comme des carcinomes chromophobes. En cas de TH, une enquete genetique familiale a la recherche d’un BHD peut etre proposee pour permettre la surveillance et le traitement precoce des lesions.

Resume But Analyser les donnees anatomopathologiques sur les pieces de prostatectomie radicale des patients operes d’un cancer prostatique cliniquement localise et repondant aux criteres stricts de la surveillance active (SA). Patients et methodes Les dossiers des patients ayant eu une prostatectomie radicale par un seul chirurgien entre 2002 et 2007 ont ete revus. Les patients inclus dans notre etude etaient ceux qui repondaient aux criteres habituels de la SA : stade clinique inferieur ou egal a T2a, PSA ≤ 10 ng/ml, score de Gleason biopsique inferieur ou egal a 6 sans composante de grade 4 ou 5, inferieur ou egal a deux biopsies positives, inferieur a 50 % de tissu malin par biopsie positive et densite du PSA inferieure ou egale a 0,15 ng/ml par centimetre cube. Resultats Deux cent soixante-treize patients ont ete operes durant cette periode. Parmi eux, 25 (9,2 %) avaient tous les criteres de la SA. L’âge moyen des patients etait de 61 ans (55–68). La valeur moyenne du PSA preoperatoire etait de 6,6 ng/ml (2,5–10). Le stade clinique des tumeurs etait T1c dans 84 % des cas et T2a dans 16 % des cas. Sur les biopsies, 92 % des patients avaient un score de Gleason 3 + 3, 4 % un score de Gleason 2 + 3,= et 4 % un score de Gleason 2 + 2. Apres etude anatomopathologique des pieces operatoires, 28 % des tumeurs etaient classees pT2a, 8 % pT2b, 40 % pT2c et 20 % pT3a. Une tumeur etait classee pT0. Le score de Gleason sur les pieces operatoires etait de 3 + 3 chez 68 % des patients et de 3 + 4 chez 28 %. Il existait une majoration du score de Gleason chez 44 % des patients, mais aucune tumeur n’avait de grade 4 majoritaire. Apres un suivi moyen de 19,2 mois, aucun patient n’a eu de recidive clinique ou biologique. Conclusion Dans notre experience, 20 % des patients ayant les criteres de la SA ont une tumeur extracapsulaire sur la piece de prostatectomie radicale. La SA est en cours d’evaluation. Son risque principal est de sous-estimer l’agressivite du cancer lors du diagnostic.

Resume But Comparer l’utilisation de sondes double J ou de sondes ureterales comme moyen de drainage ureteral apres cystectomie-enterocystoplastie. Patients et methodes Soixante-quinze patients, operes entre 2001 et 2005, ont ete retrospectivement inclus. Le drainage ureteral a ete assure par sondes double J chez 39 patients (groupe 1) et par sondes ureterales chez les 36 autres (groupe 2). L’anastomose uretero-ileale etait realisee par implantation directe, sans procede antireflux. La duree moyenne d’intubation etait de six semaines dans le groupe 1 et de 12 jours dans le groupe 2. Nous avons retrospectivement compare les taux de stenoses uretero-ileales et les autres complications entre les deux groupes de patients. Resultats Dix-sept stenoses de l’anastomose uretero-ileale ont ete recensees durant le suivi : 5,2 % dans le groupe 1 contre 18,3 % dans le groupe 2 ( p = 0,0012). Aucune difference significative n’etait retrouvee concernant les autres complications postoperatoires. Conclusions L’utilisation de sondes double J durant plusieurs semaines est une alternative a l’utilisation de sondes ureterales qui, dans notre experience, a diminue le taux de stenoses uretero-ileales.

Resume But Realiser une enquete aupres de patients ayant une prothese testiculaire (PT) apres orchidectomie et de leur partenaire. Materiel Des auto-questionnaires ont ete adresses a124 patients traites consecutivement par orchidectomie et a leurs partenaires. Les patients avaient au moins un an de recul postoperatoire. Les PT utilisees etaient toutes du modele Perthese ® . Resultats Soixante-douze reponses de patients ont ete recues, dont 63 porteurs de PT et 58 reponses de partenaires. Parmi ceux ayant une PT, 5 % consideraient leur image corporelle deterioree par la PT et 80 % se disaient non genes dans leur vie sexuelle par la PT. Au total, 96 % se disaient pret a se faire a nouveau poser une prothese si le choix etait a refaire. Les critiques formulees concernant la PT etaient la durete ( n = 8) et la taille trop petite ( n = 3), la mauvaise position ( n = 2), la froideur a la palpation ( n = 1). Les partenaires se disaient indifferentes a la PT pour 40 % d’entre elles et la consideraient indispensable pour 58 % d’entre elles. Pour 26 % d’entre elles, la PT n’avait pas toutes les qualites requises, les critiques formulees etant la durete ( n = 5), la taille trop petite ( n = 2) et la froideur ( n = 1). Parmi ceux n’ayant pas de PT, seul un patient envisageait de se faire poser une PT. Conclusion Malgre une bonne tolerance globale de la PT Perthese ® , plusieurs reproches etaient formules par les patients. Il s’agissait de la premiere etude evaluant le point de vue des partenaires des patients orchidectomises.

To confirm gender specific differences in pathologic factors and survival rates of urothelial bladder cancer patients treated with radical cystectomy.We conducted a retrospective monocentric study on 701 patients treated with radical cystectomy and pelvic lymphadenectomy for muscle invasive bladder cancer. Impact of gender on recurrence rate, specific and non-specific mortality rate were evaluated using Cox regression models in univariate and multivariate analysis.We collected data on 553 males (78.9%) and 148 females (21.1%) between 1998 and 2011. Both groups were comparable at inclusion regarding age, pathologic stage, nodal status and lymphovascular invasion. Mean follow-up time was 45 months (interquartile 23-73) and by that time, 163 patients (23.3%) had recurrence of their tumor and 127 (18.1%) died from their disease. In multivariable Cox regression analyses, female gender was independently associated with disease recurrence (RR: 1.73; 95% CI 1.22-2.47; P=0.02) and cancer-specific mortality (RR=2.50, 95% CI=1.71-3.68; P0.001).We confirmed female gender to be an independent negative prognosis factor for patients following a radical cystectomy and lymphadenectomy for an invasive muscle bladder cancer.

Objective To assess the efficacy of salvage/adjuvant radiation therapy (RT) for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). Patients and methods Between 1997 and 2001, 52 patients were treated in our institution with RT for PSA recurrence after RP. The mean (range) delay between RP and RT was 30.5 (0.16–105.6) months. Eighteen patients received no hormonal therapy before RT. The failure of RT was defined as three consecutive increases in PSA levels with intervals of ≥ 6 weeks. Results Within a mean (range) follow-up of 27.7 (6–69) months, 18 patients presented with biochemical progression. The 3-year biochemical progression-free survival was 51%. Using univariate analysis, an age

Resume But Le melanome primitif de l’uretre est une pathologie rare dont les modalites de traitement sont sujettes a controverse. Ce travail decrit un cas de melanome uretral decouvert au stade metastatique et resume les donnees recentes de la litterature. Materiel et methode Ce cas clinique a ete ecrit a partir de l’etude du dossier medical. Une revue de la litterature medicale recente a ete realisee en effectuant une recherche ciblee sur la base de donnees du National Center for Biotechnology Information (NCBI). Resultats Il s’agissait d’une patiente de 89 ans decedee d’un melanome primitif de l’uretre decouvert au stade metastatique. Cette pathologie de mauvais pronostic represente moins de 1 % de l’ensemble des melanomes. La survie specifique est de quelques mois en cas de metastases. Au stade localise, une chirurgie extensive doit etre realisee, suivie d’une immuno-chimiotherapie adjuvante dont les modalites restent a preciser. Conclusions Les modalites de traitement du melanome de l’uretre reposent sur des cas rapportes car il s’agit d’une pathologie rare. Au stade metastatique, la survie n’est que de quelques mois.

Objectifs La recidive vesicale est un evenement frequent chez les patients traites par nephro-ureterectomie totale. Les recommandations de l’EAU suggerent qu’une ureteroscopie diagnostique doit etre effectuee dans l’evaluation de toute TVES. Nous avons cherche a evaluer l’impact de l’ureteroscopie diagnostique sur la survenue d’une recidive vesicale. Methodes Nous avons inclus 237 patients consecutifs presentant une TVES non metastatique traites par nephro-ureterectomie. Les patients ont ete divises en deux groupes, l’un avec ureteroscopie diagnostique effectuee et un sans ureteroscopie avec la TVES diagnostiquee par la cytologie et l’imagerie. Des analyses univariees et multivariee de regression de Cox ont evalue l’association de l’ureteroscopie diagnostique et la survenue d’une recidive vesicale. Resultats Des 237 patients inclus, 74 patients (31,2 %) avaient eu une ureteroscopie diagnostique. Les patients sans ureteroscopie preoperatoire presentaient des caracteristiques de maladie plus agressive telles que des taux plus eleves de stades pT3-pT4 (38 % vs 18,9 % ; p = 0,02) et des taux plus eleves de pN + (12,9 % vs 4,1 % ; p = 0,01). Avec un suivi moyen de 48 mois (EIQ : 25–84), 85 patients (36,9 %) ont eu une recidive vesicale. En analyses univariees, une ureteroscopie diagnostique etait associee a la recidive vesicale ( p = 0,01), mais pas a la mortalite specifique ( p = 0,33). En analyse multivariee, une ureteroscopie diagnostique etait un facteur predictif independant de recidive vesicale (RR : 2,1 ; IC 95 % : 1,31–3,37 ; p = 0,01). Conclusion L’ureteroscopie diagnostique etait un facteur predictif independant de recidive vesicale chez les patients traites par nephro-ureterectomie totale pour TVES. Dans le cas d’une imagerie explicite, l’ureteroscopie diagnostique pourrait etre evitee afin de reduire le risque de recidive vesicale.

Upper urinary tract urothelial carcinoma (UTUC) is a rare disease. Thus, little evidence-based data are available to guide clinical decision-making. The aim of the study was to provide an overview of the currently available prognostic factors for UTUC.A systematic literature search was conducted using the PubMed databases to identify original articles regarding prognostic factors in patients with UTUC.We divided the prognostic factors for UTUC in four different categories: clinical factors, preoperative characteristics, intraoperative/surgical factors and postoperative/pathologic factors. Prognostic factors described in order of importance are: tumor stage and grade, lymph node involvement, a concomitant cis, age at the diagnostic, lymphovascular invasion, tumor architecture and necrosis, tumor location and multifocality, gender. The impact of obesity, smoking and other comorbidities (ECOG, ASA) on outcomes has been recently reported but needs to be validated. The endoscopic approach of distal ureter management during radical nephroureterectomy has been shown to be at higher risk of bladder recurrence.The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.

Objectifs L’objectif de cette etude etait d’evaluer la morbidite, la survie globale ainsi que la survie specifique apres cystectomie chez les patients de la huitieme decade. Methodes Entre 1995 et 2012, 701 patients ayant une cystectomie totale pour une tumeur de vessie infiltrante ou une tumeur de vessie n’infiltrant pas le muscle a haut risque de progression, etaient inclus dans l’etude. Trente-six patients (5 %) avait 80 ans et plus. Resultats L’âge moyen des patients octogenaires etait de 83,2 ans avec un sex-ratio de 3H/1F. La classification du risque preoperatoire selon le score ASA etait : ASA2(33 %), ASA3(54 %), ASA4(13 %). Trente-six pour cent patients ont eu une ureterostomie cutanee, 55 % un bricker, 9 % une entero-cystoplastie. 0,7 % des patients etaient pT0, 15 % Tis + Ta–T1, 50,3 % T2, et 34 %pT3-T4 avec 90 % de G3 et 10 % de G2 ; 21 % etaient pN+. Le taux de mortalite perioperatoire etait de 5,6 %. La duree moyenne d’hospitalisation etait de 13,5 jours(7–32 jours). Le taux de complications a 30 et 90 jours postoperatoires etait de 30 % et 42 %. Le suivi moyen etait de 44,5 mois(21–118 mois). La survie globale etait de 63 %, 44 %, 40 % a 1, 2 et 3 ans, respectivement. La survie specifique etait de 65 %, 52 %, 50 % a 1, 2 et 3 ans, respectivement. Conclusion La cystectomie totale est une option therapeutique efficace et presente une morbidite acceptable chez les patients octogenaires.

In the era of new-targeted therapies and neoadjuvant strategies, this article highlights the role of angiogenesis in the process of physiological wound healing with a review of literature about parietal complications under anti-angiogenic therapies.Research on Medline was carried out using the terms renal cell carcinoma, angiogenesis, wound healing, targeted therapies, and complications.The frequency of these complications varies between 5 and 50% in recent series. These results depend on half-lives of each drug and perioperative management (before and after surgical procedure).In the absence of current recommendations, it is advised to stop bevacizumab at least five weeks before a surgical intervention and to take it back 4 weeks later. For the tyrosine kinase inhibitors, the treatment can be stopped 24-48 hours before the surgery and taken back 3-4 weeks later. Finally, for the mTOR inhibitors, it is advised to stop the treatment 7-10 days before and to take back it at least 3 weeks later.

Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature.Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma.HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives.

Primary urethral melanoma is a rare pathology for which treatment strategies are controversial. The aim of this work was to report a case of metastatic primary urethral melanoma, and to discuss recent data available from literature.Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.We reported the case of an 89-year-old woman who died from a primary metastatic melanoma of the urethra. This pathology encounters for less than 1% of melanomas and has an adverse prognosis. In case of metastasis, specific survival is only of a few months. When localized to the urethra, treatment relies on radical urethrectomy, followed by adjuvant chemo- and immunotherapy.The modalities of treatment of primary urethral melanoma rely only on reported case studies. When diagnosed at the metastatic stage, reported specific survival does not exceed a few months.

To analyze pathological data of the radical prostatectomy specimen in patients operated for clinically-localized prostate cancer and who meet strict criteria for active surveillance.The data of patients who underwent a radical prostatectomy by a single surgeon between 2002 and 2007 were reviewed. We only included the patients that met the usual criteria for active surveillance: clinical stage T1-2a tumor, PSAor =10 ng/mL, biopsy Gleason sum inferior or equal to 6 with no pattern of grade 4 or 5, cancer involvement inferior or equal to two biopsy cores, inferior to 50% of malignant tissue in each positive biopsy core and a PSA density inferior or equal to 0.15 ng/ml/cc.Two hundred and seventy-three patients were operated, including 25 (9.2%) who met all the criteria for active surveillance. Mean age was 61 years (55-68). The mean preoperative PSA was 6.6 ng/mL (2.5-10). Clinical stage of the tumor was T1c in 84% of patients and T2a in 16%. Biopsy Gleason score was 3+3 in 92%, 2+3 in 4% and 2+2 in 4%. Pathological study of the surgical specimen showed that 28% of the tumors were pT2a, 8% pT2b, 40% pT2c and 20% pT3a. One tumor was pT0. The pathological Gleason score was 3+3 in 68% of patients and 3+4 in 28%. Surgical specimen showed a higher Gleason score in 44% of cases, but there were no cases of predominant grade 4. After a mean follow-up of 19.2 months, there was no clinical or biological recurrence.In our experience, 20% of patients who meet the criteria for active surveillance show an extracapsular extent of the tumor on pathological analysis. Active surveillance is still under evaluation. Its main risk is to underestimate the aggressiveness of the tumor at the time of diagnosis.

To assess the satisfaction of men and of their partner towards their testicular implants after undergoing orchidectomy.Hundred and twenty-four consecutive patients, who had undergone orchidectomy, and their partner were sent an anonymous questionnaire. The follow-up after the implantation was at least one year. The testicular implants used were all Perthèse.Seventy-two patients answered to the questionnaire, among whom 63 had a testicular implant. Fifty-eight partners answered. From the patients with implant, 5% thought their body image was worse than before the operation and 80% thought their sexual activity was unchanged. Ninety-six percent thought the implantation was worthwhile and would do it again if they had to do the choice again. The reasons for dissatisfaction were: for the shape (n=8), for the size (n=3), for the position (n=2) and one patient thought the implant was too cold. Forty percent of the partners did not care about the implants and 58% thought the implant was essential. The dissatisfaction rate for the partners was 26% and reasons for were: for the shape (n=5), for the size (n=2), and one partner thought the implant was too cold. From the patients without implant, only one is thinking about having one.Testicular implants are well accepted, but some reasons of dissatisfaction appeared in our study. It was the first evaluation of the partner's satisfaction.

The aim of the study was to compare ureteroileal anastomosis strictures rates in patients receiving either double J stent or open-ended ureteral stent, after bladder replacement for cancer.Medical charts from 75 patients who underwent cystectomy and Z pouch bladder substitution for bladder cancer, between 2001 and 2005, were retrospectively reviewed. Ureteroileal anastomosis was direct, spatulated end-to-side fashioned in all patients. Double J stents were used in 39 patients (group A) and open-ended ureteral stent were used in 36 patients (group B). Mean hospital stay, early and late complications were also observed.Seventeen anastomotic strictures have been documented during the follow-up: 5.2% in group A versus 18.3% in group B (p=0.012). Mean catheterization period was six weeks in group A and 12 days in group B. No significant differences were found in mean hospital stay, early and late complications.The use of internal double J ureteral stent is now a feasible option and can decrease the rate of anastomotic stricture. The fact that the double J stent is removed after the anastomosis healing period may be a possible explanation.

Objectifs Le pronostic des tumeurs de vessie n’infiltrant pas le muscle est heterogene. De nombreux facteurs predictifs de recidive et de progression ont ete proposes y compris la sous-stadification du stade pT1 (T1a/b et T1m/e). Nous avons voulu mener une etude monocentrique de validation externe de ces sous-stadifications dans une cohorte francaise. Methodes Les lames de 174 patients atteints de tumeurs de vessie n’infiltrant pas le muscle pT1 ont ete relues par deux anatomopathologistes independants. Les deux sous-stadifications T1 ont ete rapportees, en fonction de l’invasion de la lamina propria (T1a/T1b) et en utilisant la nouvelle classification distinguant T1micro (T1m) et T1etendu (T1e). Des analyses uni- et multivariees ont permis d’evaluer l’association entre l’une et l’autre des classifications et la survenue d’une recidive et/ou d’une progression tumorale. Resultats Le suivi moyen etait de cinq ans. Cent onze tumeurs etaient classees T1a (64 %) et 11 tumeurs etaient classees T1m (6 %). Cinquante-huit patients (33 %) ont presente une recidive tumorale et 26 (15 %) ont progresse vers une tumeur de vessie infiltrant le muscle. En analyse multivariee, les stades T1b et T1e etaient predictifs de recidive tumorale et de progression ( p Conclusion Cette etudie confirme que l’utilisation de ces sous-classifications est fiable pour la prediction du devenir oncologique des tumeurs de vessie n’infiltrant pas le muscle T1.

The natural history of stage T1a prostate cancer is generally favourable, but is nevertheless associated with a considerable progression rate of 7% to 27% depending on the study. The objective of this study was to identify possible predictive criteria of tumour progression to improve patient surveillance and early treatment.27 patients with stage T1a prostate cancer according to the TNM 97 classification, were followed for a mean duration of 79 months (range: 24-132, median: 68). A complementary assessment was performed in patients under the age of 70 years, and a strict clinical (DRE) and laboratory (PSA) surveillance protocol was performed in all patients. The initial mean PSA was 7 ng/ml and the mean Gleason score was 4.8.20 patients (75%) did not present any clinical and/or laboratory signs of progression and were therefore not treated. Seven patients (25%) received treatment with a mean follow-up of 63 months (radical prostatectomy in 2 cases, external beam radiotherapy in 1 case, endocrine therapy in 4 cases). All patients are alive and in complete remission at last follow-up.Based on our results and a review of the literature, conservative management based on strict, long-term surveillance, is a frequent approach to stage T1a prostate cancer confirmed by negative biopsies of the residual capsule. The PSA velocity is the key to surveillance, and the only factor of predictive of tumour progression that can be really used in routine clinical practice. However, our study showed tumour progression in 25% of cases, raising the question of curative treatment, especially in young patients.

Objectifs L’objectif de notre etude etait de confirmer le caractere pejoratif sur la survie sans recidive et specifique de la presence de marges chirurgicales positives apres cystectomie totale pour une tumeur de vessie infiltrant le muscle. De plus, nous avons voulu evaluer l’impact de la localisation des marges sur le devenir des patients. Methodes Nous avons inclus dans l’etude 701 patients ayant beneficie d’une cystectomie totale pour tumeur de vessie n’infiltrant pas le muscle entre 1995 et 2012. Les marges chirurgicales positives etaient definies comme la presence de cellules cancereuses au niveau de la limite de resection de la piece operatoire. Des modeles de regression de Cox uni- et multivariees ont permis d’evaluer l’impact de la presence de marges chirurgicales positives et de leur localisation sur la survenue d’une recidive tumorale et d’une mortalite specifique. Resultats Parmi 701 patients, 29 avaient des marges chirurgicales positives (4,1 %) de localisation d’abord posterieure ( n = 12, 41 %) puis laterale ( n = 9, 31 %), anterieure ( n = 8, 28 %). Sept patients (24 %) presentaient des marges multifocales. En analyse univariee, la presence de marges etait associee a un stade tumoral plus eleve (pT4) et un envahissement ganglionnaire ( p p p Conclusion Notre etude a confirme l’impact pronostique pejoratif de la presence de marges chirurgicales positives sur la survie sans recidive et la survie specifique des patients traites par cystectomie totale pour une tumeur de vessie n’infiltrant pas le muscle.

Objectifs Nous avons voulu evaluer l’impact pronostic du sexe feminin sur le devenir oncologique des patients ayant une tumeur de vessie infiltrant le muscle traites par cystectomie totale. Methodes Les donnees etaient collectees a partir de donnees de 701 patients traites par cystectomie totale associee a une lymphadenectomie pelvienne pour une tumeur de vessie infiltrant le muscle. L’impact du sexe sur la recidive tumorale, la mortalite specifique et globale ont ete analyses a l’aide de modeles uni- et multivaries de regression de Cox. Resultats Parmi les 701 patients, il y avait 553 hommes (78,9 %) et 148 femmes (21,1 %). Avec un suivi moyen de 44 mois (ecart interquartile 23–73), 163 patients (23,3 %) ont presente une recidive tumorale et 127 (18,1 %) sont decedes lies a la tumeur de vessie. En analyse multivariee, apres ajustement sur les facteurs pronostiques cliniques et anatomo-pathologiques classiques (âge, stade tumoral, grade tumoral, presence d’embols tumoraux, presence de CIS concomitant, statut ganglionnaire), le genre feminin etait un facteur pronostique independant associe a la survenue d’une recidive tumorale ( p = 0,01 ; RR = 1,80 ; IC 95 % = 1,26–2,56) et d’une mortalite specifique ( p = 0,01 ; RR = 2,60 ; IC 95 % = 1,76–3,82). Conclusion Le sexe feminin apparait etre un facteur pronostic independant du devenir oncologique des patients apres cystectomie totale. Il semble pertinent de s’y interesser pour proposer a l’avenir des traitements plus adaptes au pronostic de chaque patient.

Objectifs L’âge avance est correle a un risque plus important de developper une tumeur de vessie et a une evolution plus pejorative chez les patients porteurs de TVNIM. Pour ces derniers, une IPOP permet de reduire le risque de survenue d’une recidive tumorale. Nous avons voulu evaluer si l’âge avait un impact sur le benefice associe a l’IPOP chez les patients porteurs d’une TVNIM. Methodes Nous avons mene une etude multicentrique incluant 4258 patients presentant une TVNIM traites par RTUV. Parmi ces patients, 2605 (61 %) ont eu une instillation unique de mitomycine C. Aucun patient n’a recu d’instillation adjuvante. Un modele multivarie de regression de Cox a permis de tester les facteurs influant sur la survenue d’une recidive tumorale (y compris l’âge et l’administration d’une IPOP). Resultats Avec un suivi moyen de 48 mois, 2063 (48 %) patients ont presente une recidive tumorale. En analyse multivariee ajustant pour les facteurs pronostiques reconnus, l’IPOP (risque relatif : 0,62 ; 95 % IC : 0,56–0,68 ; p

To assess the role of nitric oxide (NO) and its second messenger, cGMP, on the mechanisms underlying human ureteral smooth muscle relaxation.Proximal segments of ureter were dissected from nephrectomy, then cut into rings and suspended in organ chambers. Isometric tone was recorded at baseline and after preincubation with KCl (120 mumol). The Increasing concentration (10-8-10-4 M) of NO donors, Sodium nitroprusside, (SNP) and molsidomine (SIN-1) and a type V phosphodiesterase inhibitor, Zaprinast were added to the organ chambers and a dose response curve was constructed from each experiment.Dose-dependent relaxation was seen with all compounds. This was, however, more pronounced with SNP as compared with SIN-1. Zaprinast alone had marginal relaxant effect but markedly potentiated the relaxing effect of the NO donor SNP (p0.05). Inhibition of NO synthesis by the arginine analogue L-NA increased electrical-induced contraction (98 +/- 4% vs 122 +/- 3%, p0.001).Activation of the soluble guanylate cyclase by NO donors markedly relaxed significantly human ureteral smooth muscle but inhibition of phosphodiesterase did not affect the in vitro relaxation. Our results suggest that cGMP is an important second messenger in the transduction signalling pathway leading to relaxation of human ureteral smooth muscle. By contrast, basal activity of phosphodiesterase seems to be marginal under physiological condition.

Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter.Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization.25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering.Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.

The authors report an uncommon case of renal adenoma, a metanephric adenoma in a 21 year-old man. Treatment consisted in a tumorectomy. The review of the literature, shows it to be a benign tumor with no malignant potential.

Electroconductive lithotripsy uses a highly conductive liquid to bathe the electrodes rather than water. The effect is to channel energy between the electrodes and force it to pass directly from the anode to the cathode, exactly at F1. The Sonolith 4000 (Technomed Medical Systems) uses this new generation of "electroconductive" shock waves. Experimental and clinical results are presented. The typical electroconductive technique creates a linear relationship between energy level, in kilovolts, and the amplitude of the acoustic shock at F2 over a wide range of power. There is also a linear relationship between power and effectiveness of desintegration. More than 800 patients have been treated to date. Follow-up has reached 3 months in the 166 treatments reported here. Overall success rate without residual stone was 82%. The percentage of patients with residual stones smaller than 5mm was 5%. The rate of clinical success was 87%. The rate of retreatment in patients without residual stone was 10%. For 11 to 20 mm stones, the success rate (0 fragments), the rate of retreatment and the rate of auxiliary procedures were 83%, 4% and 2% respectively for stonesor = 10 mm and 78% for 11 to 20 mm stones. The electroconductive generator used in this study provided very satisfactory results, better than those generally obtained with classical generators. Tolerance was excellent.