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Resume Introduction Le Comite de cancerologie de l’Association francaise d’urologie (CCAFU) a realise une revue de la litterature concernant la surveillance des carcinomes urotheliaux et propose des recommandations de suivi. Materiel et methode Une recherche bibliographique en langue francaise et anglaise a partir de PubMed » a ete effectuee de 1990 a 2014 en utilisant les mots cles « carcinome urothelial », « suivi », « pronostic », et « recidive ». Resultats Le rythme et les moyens de surveillance (cytologie, fibroscopie, uro-TDM) des tumeurs de la vessie non infiltrant le muscle (TVNIM) doivent etre adaptes aux risques de recidive et de progression definis selon les tables de l’EORTC. Apres traitement radical d’une tumeur de la vessie infiltrant le muscle (TVIM), la surveillance est basee sur la fibroscopie, la cytologie et la realisation d’une imagerie de coupe avec temps tardifs. La surveillance de l’uretre doit etre adaptee aux facteurs de recidive et poursuivie au moins 5 ans. La surveillance du haut appareil est a poursuivre a vie. En cas de traitement conservateur d’une TVIM, une reevaluation precoce par imagerie et fibroscopie est necessaire. Apres traitement radical d’une tumeur des voies excretrices superieures (TVES), la surveillance par cystoscopie et cytologie est essentielle en raison de la frequence des recidives vesicales au cours des trois premieres annees. Le traitement conservateur des TVES necessite une surveillance stricte notamment par uretero-renoscopie. Conclusion La surveillance des carcinomes urotheliaux est a adapter en fonction des stades et grades tumoraux, de la localisation et de la modalite de traitement definissant ainsi le risque de recidive dans le temps.

Current literature supports the efficacy of anti-PD-1 and anti-PD-L1 immune checkpoint inhibitors for the treatment of urothelial carcinomas. While the prognostic value of PD-1 and PD-L1 levels has been comprehensively analyzed for urothelial carcinoma of the bladder, less is known for upper tract urothelial carcinoma. In addition, available data on the prognostic value of PD-1 and/or PD-L1 level in the tumor and/or peritumoral microenvironment are heterogeneous and even sometimes contradictory. In this article, we compared the methodologies of the various available studies in order to highlight the factors that can explain these discordant results.

The epidemiology of kidney cancer is evolving with a net increase in the incidence of renal tumors, globally, and in young people in particular.To evaluate the incidence and clinical and pathological characteristics of sporadic renal tumors in young subjects and their risk factors.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.Our study showed a very significant increase in the incidence of renal tumors in our 11 years of decline (P=6.10Our 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.4.

Resume Introduction Le Comite de cancerologie de l’Association francaise d’urologie (CCAFU) a realise une revue de la litterature sur l’epidemiologie, le diagnostic et les traitements des tumeurs de vessie intradiverticulaires (TVID) et a propose des propositions therapeutiques. Materiel et methode Une recherche bibliographique en langue francaise et anglaise par Medline ® en utilisant les mots cles « tumeurs », « vessie » et « diverticule » a ete effectuee. Resultats Les TVID etaient plus frequemment de stade T ≥ 3a et de types histologiques non urotheliaux que les tumeurs de vessie classiques. Lors de leur diagnostic, un risque de sous-evaluation de l’extension et de la multifocalite tumorale a ete constate. Leur pronostic a ete plus pejoratif que celui des tumeurs classiques qui incite a une limitation de l’indication des traitements conservateurs. Les niveaux de preuves de publications analysees etaient faibles, avec un niveau C selon le score de Sackett. Conclusion Les specificites des TVID a conduit le CCAFU a proposer des prise en charge therapeutiques specifiques, se basant sur de faible niveaux de preuves. Les TVID Ta-T1 et de bas grade peuvent etre traitees par une resection endoscopique seule ou suivi d’une BCG therapie en cas de carcinome in situ associe. Les TVID de haut grade, unique et sans carcinome in situ associe, peuvent etre traitees par diverticulectomie associee a un curage ganglionnaire pelvien. Les TVID de haut grade, multiples ou associees a du carcinome in situ, justifient une cystectomie totale.

The ISUP (International Society of Urological Pathology) Consensus Conferences between 2012 and 2015 made recommendations regarding the classification, staging, prognostic factors of adult tumors from kidney, prostate, bladder and testis. The main points of these recommendations are highlighted in this article.This article is based on a systematic literature search by using different keywords "cancer, kidney, prostate, bladder, testis, pathology, classification" from Pubmed database. Only publications between 2012 and 2015 were retained.The different Consensus conferences since 2012 in uropathology have provided international guidelines for the classification, grading and staging of tumors in kidney, bladder, prostate and testis. We identified in this article the main points of these new guidelines that are about to be published in the new 2016 WHO classification of urogenital tract tumors in adult.New pathological guidelines in urogenital tumors have to be taken into account for a better diagnosis and therapy.

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).Internet-based observational survey evaluating indications and practical modalities of IPOP in NMIBC treatment using questionnaire sent in May 2014 to 915 urologists.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 declared24h 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.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.3.

Upper tract urothelial carcinomas (UTUC) are rare tumors. Pathologist have a crucial role in establishing the diagnosis and the evaluation of the prognosis of these tumors.A systematic review of the scientific literature was performed in the Medline database (PubMed) using different associations of the following key words alone or concomittantly: ureter; renal pelvis; urothelial carcinoma; specimen; pathology; histology; classification; grade; stage; prognosis. A particular search was done on the characteristics of the specimen management provided by urologists to pathologists and main prognostic specificities expected in UTUCs.Urinary cytology and biopsies are useful to provide the grade of the tumor according to the WHO classification 2004. The urologist needs to depict the clinical context to the pathologist in order to eliminate differential diagnosis. The main prognostic informations provided by the pathologist from the specimen analysis are the following: stage (TNM 2009), grade (WHO 2004), carcinoma in situ, location within upper tract, multifocality, necrosis, tumor size, lymphovascular invasion, margins and potentially microsatellite status when a HNPCC case is suspected.The pathologic analysis of a UTUC specimen needs nowadays to fulfill standardised international criteria of quality. However, specific additional aspects reported in the literature (e.g., lymphovascular invasion) are not systematically depicted.

The role of surgery in the treatment of patients with metastatic urothelial bladder cancer is controversial. The aim was to review situations where surgical resection of the bladder tumor and/or metastatic urothelial carcinoma has been reported and analyze its results.A bibliographic research in French and English using the keywords BCG, bladder cancer, metastases, cystectomy, metastasectomy, radiotherapy, curative treatment and palliative treatment was performed, 177 articles have been reviewed, and 18 have been selected.Synchronous or metachronous urothelial carcinoma metastases were diagnosed in 4 and 50% of the cases, respectively. The surgical treatment of metastatic urothelial carcinoma of the bladder has been proposed to achieve oncologic resection of all detectable lesions after a first-line chemotherapy or to treat symptoms, which were refractory to other treatment modalities. In achieving complete resection of the primary tumor and metastases after MVAC chemotherapies, the 5years overall survival was 28%.There was no evidence in favouring surgical treatment of metastatic urothelial carcinoma. Considering the high perioperative mortality rate of cystectomy in imperative indications, particularly in the case of hematuria, all therapeutic alternatives must have been exhausted and urine derived in the simplest way.

Cystoprostatectomy (CPT) is the gold standard surgical treatment for muscle invasive bladder cancer (MIBC). In certain cases, MIBC can invade the prostate gland and/or a prostate cancer (PCa) can be discovered fortuitously on the pathologic specimen. The aim of the current study was to report the prognostic influence of PCa in patients who underwent a CPT for MIBC.A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: prostatic neoplasm; urinary bladder neoplasm; cystectomy; surgery; recurrence; prognosis; survival. Clinical cases and series of less than five cases were deliberately excluded herein.Overall, ten studies published between 2004 and 2011 and involving 2196 patients were selected. Only retrospective studies of low level of evidence (NP 4) were available. The incidence of neoplastic invasion of the prostate gland by MIBC ranged from 25 to 48%. Preoperative predictors were multiple BC, recurrent, location in the trigone and existence of CIS. Overall survival at 3 years was significantly affected by the invasion of the prostate gland (pT4a) in these patients. The incidence of PCa discovered incidentally pathologic specimen CPT ranged from 14 to 49%. Only age was found as a positive predictor. The diagnosis of PCa did not influence survival of patients with MIBC and no specific PCa adjuvant treatment was systematically advocated.Fortuitous diagnosis of PCa and/or neoplastic invasion of the prostatic gland by BC on CPT specimen is not uncommon but this is variable across studies, depending on the quality of the pathological analysis. The invasion of the prostate gland by MIBC is a serious situation (pT4a) and linked with a poor prognosis. In case of concomitant PCa and MIBC, the prognosis is much more related to the natural history of the bladder tumour.

Cancer Committee of the French Association of Urology (CCAFU) conducted a review of the epidemiology, diagnosis and treatment of intradiverticular bladder tumours (TVID) and proposed therapeutic management.A bibliographic research in French and English using Medline(®) with the keywords "tumor", "bladder" and "diverticulum" was performed.TVID are more frequently of stage T ≥ 3a and with non urothelial histology than classical bladder tumors. At diagnosis, the risk of underestimation of the extent and multifocality of the tumor was described. Their prognosis, that was more pejorative than conventional tumors, should impelled to limit the indications of conservative treatment. The evidence levels of analyzed publications were low, with C level according to Sackett score.the specificities of the TVID have lead the CCAFU to propose specific therapeutic guidelines, based on poor evidence level. Ta-T1 low grade TVID can be treated by transurethral resection alone or followed by BCG therapy in cases of associated carcinoma in situ. High-grade TVID, unifocal and without associated carcinoma in situ, can be treated by diverticulectomy associated with pelvic lymphadenectomy. High grade TVID, multiple or associated with carcinoma in situ, warranted total cystectomy.

The urothelium is the epithelium that lines the upper and lower urinary tract. Over 95% of urothelial carcinomas are derived from urothelium. They can be located in the lower tract (bladder, urethra) or upper tract (pyelocaliceal cavities, ureter). Urothelial carcinomas are the fourth most common tumours after prostate (or breast) cancer, lung cancer and colorectal cancer. On one hand, bladder tumours account for 90-95% of urothelial carcinomas. It is the most common malignancy of the urinary tract and the second most common malignancy of the urogenital tract after prostate cancer. It accounts for 5-10% of all cancers diagnosed each year in Europe. On the other hand, upper urinary tract urothelial cell carcinomas (UUT-UCC) are scarce and account for only 5-10% of urothelial carcinomas. Recurrence in the bladder after primary UUT-UCC occurs in 15-50% of UUT-UCC. Differences in treatment modalities of the primary UUT-UCC do not play a key role in the subsequent appearance of a bladder recurrence. However, others factors have been described such as stage and location in the upper tract of the primary tumour or upper tract tumour multifocality. Previous history of bladder tumour is also associated with the risk that another tumour arises in the bladder subsequently. However, it becomes difficult to distinguish between natural history of bladder tumour and evolution of UUT-UCC in these cases. In most cases, bladder cancer occurs in the first two years after UUT-UCC management. Surveillance protocol is based on cystoscopy and on urinary cytology during at least every three months for two years. Current surveillance regimen have a low level of evidence considering the paucity of UUT-UCC.

To date, radical nephrectomy (RN) remains the gold standard treatment for renal cell carcinoma (RCC) larger than 4 cm. However, from the early 1990's, improvements in surgical techniques have lead to the development of nephron-sparing surgery (NSS) for small renal tumours of less than 4 cm in diameter. This surgical procedure avoids nephronic waste with an acceptable morbidity and similar oncological outcomes compared to radical surgery. Recent large published series did not show any difference between NSS and RN in terms of oncological safety. Specific and disease-free five-year survival rates (82% to 97.3% and 81% to 97.3%, respectively) have confirmed the safety of NSS. Regarding laparoscopic NSS, the technique is still under evaluation and only mid-term outcomes are available so far. However, these studies are still limited and longer follow-up is needed before any definitive statement can be made. Current guidelines recommend NSS only in case of RCC of less than 4 cm in diameter in elective indications. In daily practice however, surgical teams are pushing back the limit above the threshold of 4 cm. More and more surgeons are either considering anatomical location or technical expected difficulties rather than just the tumour size. NSS leads to higher risk of bleeding, especially in case of tumours larger than 4 cm. Therefore, it is absolutely necessary to investigate thoroughly the vascularization of the tumour to avoid such complications with exhaustive and accurate preoperative imaging.

Ductal adenocarcinoma of the prostate (DAP) is an unusual form of prostatic cancer rising in the light of the acini and prostatic ducts with preservation of their architecture. We report the case of a 78-year-old patient presenting a pure ductal adenocarcinoma of the prostate locally advanced, with a four years' follow-up. With this case, we report the principal aspects of the literature.

The authors report the case of a 44-year-old man in whom a poorly differentiated primary carcinoma of the head of the epididymis was discovered incidentally. Due to the rarity of this diagnosis, a comprehensive assessment was performed looking for a primary tumour, but without success. Despite early surgical resection, the patient developed lymph-node metastases. This exceptional tumour showed low sensitivity to chemotherapy. Malignant tumours of the epididymis are exceptional and require investigations to detect a primary tumour. Treatment is based on surgical resection, ideally via an inguinal incision, combined with chemotherapy adapted to the histological type.

Crohn's disease is responsible for 20% of uroenteric fistulas and is the first aetiology of colovesical fistula in young patients. The authors report an unusual case of rectovesical fistula and discuss diagnosis and treatment of Crohn's urodigestive fistulas.A young patient, 38 years old, non smoker, was operated of a suspected bladder tumor by a transuretral approach. Postoperatively appeared a pneumaturia, later on related to a rectovesical fistula. Histology was unclear reporting inflammatory pseudotumor of the bladder. A laparotomy was then performed as the patient was in incomplete bowel occlusion. Peroperative findings and pathological analysis were in favor of a Crohn's disease which was confirmed by secondary study of pathology samples. Resection of terminal ileum and cure of rectovesical fistula protected by a colostomy were performed. The patient completely recovered with an adjuvant medical treatment by infliximab (Remicade).The authors discuss diagnosis management of a pneumaturia and the occurrence of various Crohn's disease related urodigestive fistulas. A review of recently published papers emphasises the interest of using monoclonal antibodies in the medical treatment of Crohn's fistulas after discarding abdominal tuberculosis. In every cases anyway, surgery remains indicated when diagnosis work up reveals presence of an abscess or a bowel stenosis.Crohn's disease should be evocated when histology is not relevant in front of a bladder pseudotumor or a rectovesical fistula.

A 73-year-old man presented with renal cell carcinoma of the left kidney. Despite the absence of metastases, primary nephrectomy was not performed immediately due to the large tumour volume and the presence of large lymph node extension. The patient was treated with sunitinib for 10 months. Computed tomography at the end of treatment showed a significant reduction of the size of the tumour and the volume of lymph node extension. Radical nephrectomy was then performed. On histological evaluation, the primary renal tumour and, to a lesser degree, the lymph nodes were predominantly necrotic.

In 2006, the risk of developing bladder tumour remains an important aspect of the management and surveillance of spinal cord injury patients. Based on a review of the literature, the authors show that these patients present a particularly high risk of squamous cell carcinoma of the bladder Risk factors remain controversial, but the duration of neurogenic bladder and the voiding mode appear to be the main risk factors. The authors discuss the optimal diagnostic modalities in this setting and the particular case of bladder augmentation.

Bladder compliance is defined as the relationship between change in bladder volume and change in detrusor pressure (DV/DP). The pathophysiology of neurogenic disorders of bladder compliance is still poorly understood. Experimental reduction of blood flow in the bladder wall, bilateral hypogastric nerve section in rats, the study of spinalized rat bladders, and reduction of oestrogen impregnation show that these conditions induce loss of the viscoelastic properties of the bladder. With the arrival of new treatments active on afferent and/or efferent pathways or on the central nervous system, it is very important to improve our understanding of the pathophysiology of neurogenic disorders of bladder compliance. The reversibility of these disorders constitutes a major therapeutic challenge and their functional consequences constitute a crucial prognostic element of neurogenic bladder. Disorders of bladder compliance can be assessed clinically from two points of view: 1) The natural history of onset of these disorders in neurogenic bladder. Clinical experience demonstrates certain risk factors for the development of these disorders, such as the voiding mode (intermittent self-catheterization or by a carer versus indwelling catheter), the level of the spinal cord lesion (suprasacral versus sacral, incomplete versus complete, and cauda equina lesions), and the presence of myelomeningocele. 2) Data derived from conservative management of these disorders in patients with neurogenic bladder: urethral dilatation, various types of sphincterotomy, vesical denervation, alpha-blockers, sympatholytics, vanilloids (resiniferatoxin and capsaicin), intra-detrusor botulinum toxin and intrathecal baclofen have been shown to improve disorders of compliance of neurogenic bladder.

Objectifs Connaitre l’apport de l’echographie haute frequence dans un essai therapeutique tumoral. Connaitre la technique d’imagerie fonctionnelle de contraste. Reconnaitre en ultrasonographie de contraste les modifications fonctionnelles associees a l’angiogenese. Points cles Les mesures fonctionnelles peuvent permettre une detection plus precoce de la reponse anti-angiogenique que les mesures morphologiques conventionnelles. Ces techniques peuvent contribuer a la comparaison des associations therapeutiques et a l’acceleration des essais pre-cliniques. L’application clinique de l’imagerie ultrasonore fonctionnelle pourrait contribuer a une meilleure optimisation therapeutique en tenant compte de la reponse individuelle du patient. Resume L’echographie haute-resolution (24 MHz) a permis de suivre des tumeurs renales chez la souris de diametre > 5 mm pour l’initiation du traitement (placebo/anti-angiogenique). L’echographie de contraste a ete realisee ensuite tous les 4 - 5 jours (systeme clinique). Dans le plan presentant la plus grande surface tumorale les evaluations morphologiques (dimensions) et fonctionnelle (l’intensite du contraste et la vitesse de remplissage suite a sa destruction acoustique - toujours dans la meme zone de profondeur) ont ete effectuees. L’echographie haute-resolution permet d’initier le traitement apres detection. Des reponses therapeutiques ont ete detectees plus precocement sur les mesures fonctionnelles que sur les mesures morphologiques.

Resume Devant une tumeur de la surrenale, les problemes diagnostiques sont essentiellement de trois orders : distinguer une tumeur primitive d’une lesion metastatique ; en cas de tumeur primitive, distinguer les tumeurs du cortex des tumeurs de la medullaire et d’autres entites tumorales plus rares ; enfin dans le cas d’une tumeur surrenalienne corticale ou medullaire primitive, reconnaitre les elements en faveur d’une lesion benigne ou au contraire maligne. En dehors des origines renales qui constituent un piege classique, le diagnostic differentiel entre lesion surrenalienne primitive et metastatique est facilite par la connaissance du contexte clinique. L’analyse immunohistochimique permet habituellement de confirmer l’origine d’une lesion secondaire au sein de la surrenale. Devant une lesion corticale unique, bien limitee, de couleur chamois ou jaunâtre, accompagnee de manifestations cliniques a type d’hypercorticisme ou un syndrome de Cushing, le premier diagnostic a evoquer est celui d’un adenome surrenalien. Mais l’hyperplasie surrenalienne peut parfois prendre un aspect nodulaire ou diffus meme si elle atteint le plus souvent l’ensemble de la glande ou est bilaterale. Les kystes, epitheliaux, endotheliaux ou parasitaires (hydatidose, echinoccocose) et les autres neoplasies mesenchymateuses, notamment le myelolipome, sont generalement d’aspect radiologique evocateur. Les pheochromocytomes constituent les principales lesions de la medullaire. Parmi les autres tumeurs dans cette localisation, on observe des proliferations neurogenes comme les neuroblastomes. L’hyperplasie est egalement decrite. La distinction entre tumeur primitive benigne et maligne peut etre delicate en l’absence de metastase d’emblee. Les tumeurs malignes presentent souvent des zones de necrose, mais une tumeur benigne de grande taille peut etre siege de remaniements kystiques et hemorragiques. La distinction histologique se fonde sur l’analyse de criteres (dits de Weiss ou Weiss modifie). Des recidives tardives, meme 5 a 10 ans apres la tumeur initiale, ont ete rapportees. Chez l’enfant, des pheochromocytomes malins multiples ont ete rapportes soulignant l’importance des donnees de l’analyse moleculaire dans ces lesions pouvant entrer dans des syndromes complexes. Les donnees de l’imagerie et de l’anatomie pathologique apparaissent donc complementaires dans la prise en charge diagnostique et therapeutique de ces lesions dont l’incidence des decouvertes fortuites est en augmentation.

Resume Le RP peut heberger pratiquement tous les types de proliferations tumorales. L’imagerie ne permet pas toujours d’apporter le diagnostic differentiel entre une lesion primitive ou secondaire (lymphome primitif versus metastase ganglionnaire, extension d’un carcinome de haut grade du rein, du pancreas, de la surrenale), ni entre une lesion benigne ou maligne (ex fibrose retroperitoneale idiopathique ou carcinose). La semiologie radiologique (mode developpement, contenu) compte tenu de la frequence des differentes tumeurs permet d’envisager un diagnostic de tumeur benigne tel que lymphangiome kystique, neurofibrome ou paragangliome ou de tumeur maligne (liposarcome le plus frequent). Mais il peut s’agir de tout autre type de sarcome (leiomyosarcome, angiosarcome, synovialosarcome.), ou d’une proliferation conjonctive de pronostic incertain (tumeur fibreuse solitaire, angiomyolipome epithelioide.). Une biopsie percutanee peut etre tres utile a condition qu’elle soit faite en concertation avec le pathologiste pour prevoir sur un materiel limite les etudes complementaires utiles : immunohistochimie (marqueurs lymphoi-des, musculaires, neuroides.,), une etude genomique (recherche d’anomalies cytogenetiques ou de transcrit de fusion). Ceci necessite que des prelevements soient congeles ou communiques frais au laboratoire de biologie moleculaire dans un milieu de transport (RPMI).