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Purpose: Robotic partial nephrectomy (RPN) is a minimally-invasive technique used to treat renal tumors. A clinical pathway and prospective research protocol (AMBU-REIN) were specifically set up to establish and assess the routine use of day-case RPN., Methods: The AMBU-REIN study was conducted in the framework of the French research network on kidney cancer UroCCR (NCT03293563). We present our initial experience of patients treated using day-case RPN and released from our hospital on the same day, focusing on patient selection, safety and patient satisfaction using the EVAN-G validated questionnaire., Results: Between September 2016 and September 2019, 429 RPN were performed and 82 patients were consecutively selected for day-case RPN. Patients were managed using transperitoneal RPN with off-clamp tumorectomy for 66/82 cases. Mean tumor size was 2.7 ± 1.2 cm. There were no immediate severe postoperative complications; 7/82 patients were kept under observation overnight and discharged the following day. The follow-up at day 30 indicated postoperative complications, readmissions, and mortality rates of 1.2, 1.2, and 0%, respectively. Next-day patient satisfaction questionnaires indicated that patients were generally highly satisfied, with a mean ± standard deviation global score of 83.6 ± 10.3%. "Attention" was rated the highest overall (mean 94.8 ± 10.5%), while "pain management" scored the lowest (61.2 ± 20.5%)., Conclusions: This prospective case series is the first to demonstrate the safety and feasibility of day-case RPN. For selected patients and through a dedicated, nurse-led clinical pathway, it provided a high level of patient satisfaction. Expected benefits on healthcare cost savings warrant further investigation., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Prostate cancer is supposedly more aggressive among Afro-Caribbean men. There is a lack of data in this population for active surveillance. Published series are retrospective or have small samples and results are discordant. The objective was to determinate whether actual active surveillance modalities can be applied for Afro-Caribbean men by comparing their oncological outcomes with Caucasian men., Methods: A total of 449 consecutive patients who underwent active surveillance for favorable-risk prostate cancer in two French University-Medical-Centers between 2005 and 2018: 261 in Guadeloupe, French West Indies, and 188 in Bordeaux, metropolitan France. Median follow-up was 56 months, (95% CI [32-81]) and 52 months (95% CI [30-75]), respectively (P=0.07). Curative treatment was given in case of histological, biological, or imaging progression, or upon patient demand. Primary endpoints were treatment-free, overall and specific survival. Secondary outcomes were reasons of discontinuating active surveillance, histological poor prognosis factors after prostatectomy, CAPRA-S score, biochemical-recurrence-free after treatment and metastasis-free survival. Kaplan-Meier method was used., Results: Median treatment free survival was 58.4 months (CI 95% [48.6-83.1]) for ACM and not reached at 120 months for CM (P=0.002). Overall survival (P=0.53), and specific survival (P=0.21) were similar in the two groups. CM were likely to have poor prognosis factor on prostatecomy piece (57 vs 30%, P=0.01). No difference for repartition of the CAPRA-S score (P=0.86), biochemical-recurrence-free (P=0.92) and metastasis-free (P=0.44) survival., Conclusions: Oncological outcomes for active surveillance of Afro-Caribbean and Caucasian men were similar in terms of mortality, recurrence and metastasis in our bicentric study, showing usability of current criteria for Afro-Caribbean. The higher rate of disease progression in the Afro-Caribbean population requires close monitoring., Level of Evidence: 3., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction and Purpose: The objective of this work was to identify the risk factors (RFs) of active surveillance (AS) interruption in a prostate cancer (PCa) single-center retrospective cohort of patients., Material and Method: All patients in AS between January 2011 and October 2019 were retrospectively included in a computerized database. The group of patients who had an AS interruption was compared to the one still under AS, in order to identify potential risk factors for the interruption of the surveillance protocol., Results: Two hundred and two patients have been included in the AS cohort with a median follow-up of 32months. At the time of analysis, 72 patients (36%) were not under the AS protocol anymore, 118 (58%) were still under AS and 12 (6%) were lost of follow-up. Sixty-six patients (92%) had left SA due to PCa progression, 4 (5%) by personal choice and 2 (3%) switched to watchful waiting. A PSA doubling Time<3years (PSADT<3years) has been identified as the only statistically significant RF for AS interruption, both in the unvaried (P<0.001) and multivariate (OR=5.403, P<0.01) analysis. It was also the only RF of AS interruption in the early analysis in the first three years of AS, in the unvaried analysis (P=0.021) and the multivariate analysis (OR=3.612, P=0.018)., Conclusion: PSADT was the only RF of AS early and late interruption in our study. It represents a major inclusion criterion in AS protocol during the initial assessment., Level of Evidence: 3., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: To evaluate by junior urologists the morphology of urinary stone using visual endoscopic recognition after expert teaching. Material From December 2017 to May 2018, surface and section stone pictures extracted from digital ureteroscopy had been submitted to description and recognition. Participants could take benefit from an expert coaching. Each stone was evaluated by a different coherence questionnaire (score 1-5)., Results: Nine stones had been analyzed by 15 junior urologists. Mean score was initially 1.94/4 and then from 2.07 to 4.07/5 during the study. A perfect stone recognition and a matching etiological lithiasis research had been observed in 40.7% and 55.6% of cases respectively., Conclusion: This first teaching experience of the urinary stone morphological endoscopic typing confirms the possibility to train urologists to gain this specific initial skill. Thereby, they could play a more important role in the etiological and diagnostic lithiasis research., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: To describe the morbidity, mortality, oncological and functional results of Partial nephrectomy (PN) for the treatment of renal tumors of more than 7cm., Material and Methods: Thirty-seven partial nephrectomies for tumors larger than 7cm operated in a single center between 1987 and 2016 were analyzed retrospectively. The pre, per and postoperative clinico-biological data were collected within the UroCCR database. The GFR was assessed at day 5, 1 month and last follow-up. Intraoperative and postoperative surgical complications, the recurrence rate and the overall and specific mortality were collected., Results: The mean age of the patients was 57 years (44-68). The preoperative GFR and the median tumor size were 80mL/min and 8cm, respectively. The indication for surgery was elective in 21 cases (60%) and 19 tumors (54%) were malignant. Postoperative complications occurred in 24,3 cases (24.3%). The median post-operative GFR was respectively 77mL/min, 80mL/min and 77mL/min at day 5, 1month and at last follow-up. With a median follow up of 31 months [1-168], 5 patients (26,3%) had metastatic progression of whom 1 (5.3%) had a concomitant local recurrence and 3 (15.8%) had died from cancer., Conclusion: This study confirms the feasibility of PN for large tumors with acceptable morbidity, limited risk of local recurrence and excellent functional results., Level of Evidence: 4., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: To investigate sunitinib in the real-life first-line treatment of metastatic renal cell carcinoma (mRCC)., Methods: SANTORIN is a French observational multicentre cohort. Patients initiating sunitinib in first-line mRCC therapy were included (January 2008 to April 2010) and followed for 24 months. Data were collected from medical files. The outcomes were 24-month overall survival (OS) and progression-free survival (PFS), response and safety., Results: Three hundred two patients were included: median age, 64.8 years; male, 73.2%; clear cell mRCC, 83.1%; prior nephrectomy, 85.4%; >1 metastatic sites, 64.2%; brain metastases, 6.3%; ECOG-PS ≥ 2, 9.9%. Median duration of first-line therapy with sunitinib was 10.7 months. Initial sunitinib dose was 50 mg/day for 83.4% of patients; dose reduction occurred in 65.2%. Sunitinib was discontinued in 73.2% of the patients: for progression (61.1%), death (31.2%) or adverse events (6.8%). More than half (58.3%) had grade ≥3 adverse events, mainly hypertension (12.6%) and hand-foot syndrome (12.3%). The 24-month OS and PFS rates [95%CI] were 49.5% [43.7;55.0] and 16.4% [12.5;20.9], respectively. Median OS was 23.6 months [20.2;-] and median PFS 8.4 months [7.6;9.9]. Overall best response rate was 31.1%., Conclusions: Results from this large observational study suggest that effectiveness of sunitinib in first-line mRCC as predicted by clinical trials is maintained in real-life clinical practice. The expected benefit in poor-prognosis patients that were not evaluated in the pivotal clinical trial remains; however, questionable and long-term safety monitoring is still warranted. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

Objectives: The aim of this study was to assess the impact of the aggressiveness of cancer cells at the level of positive surgical margins (PSM) on the biochemical recurrence rate (BRR) by studying the Gleason score (GS) at this level., Methods: We included all radical prostatectomy (RP) procedures performed from January 2007 to November 2011. All of the RP specimens with PSM were reviewed to determine the GS at the level of PSM. We compared the GS at PSM with BRR., Results: A total of 658 RP were analysed, among which 16% had PSM. From the 101 patients with PSM included, 32% had biochemical recurrence (BR) with a median follow-up of 38 months. GS at PSM was significantly associated with earlier BR (P=0.008). Univariate analysis showed that GS at PSM (P=0.013), initial PSA (P<0.0001), pathologic GS (P<0.001), length of PSM (P=0.013), and seminal vesicle invasion (P<0.0001) were predictors of BR. Multivariate analysis confirmed that PSA greater than 10ng/mL and length of PSM greater than 3mm were independent prognostic factors for BR, but GS at the level of PSM was not., Conclusion: GS at PSM was not confirmed as an independent risk factor for BR. Initial PSA greater than 10ng/mL and length of PSM greater than 3mm were the sole independent predictors for BR., Level of Proof: 4., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Purpose: To prospectively assess the feasibility and safety of holmium laser enucleation of the prostate (HoLEP) as day-case surgery for the treatment of benign prostatic hyperplasia., Materials and Methods: A prospective observational study was conducted by a single surgeon between June 2012 and October 2015. Except for patients ineligible for day-case surgery due to unstable cardiovascular disease, all patients with lower urinary tract symptoms presumably due to benign prostatic hyperplasia were consecutively included. HoLEP procedures were performed at 8AM, and patients were discharged before 8PM. The urinary catheter was removed at home the following morning. The monitoring of complications related with surgery included systematic assessment of perioperative complications, phone call within 48 hours after surgery, and follow-up visits after 1 and 3 months. Intent-to-treat univariate and multivariate analysis was performed to identify risk factors for day-case surgery failure., Results: Ninety among 211 HoLEP performed by the surgeon were selected for day-case surgery (43%). Hospital stay was <12 hours in 83.4% of them. Prolonged hospitalization was necessary in 15 patients mainly due to gross hematuria requiring continuous bladder irrigation (n = 13). Day-case surgery failure rate (including prolonged hospitalization and readmissions within 48 hours) was 20.0% (18/90). The overall complication rate was 36.7%, with a Clavien III complication rate of only 3.3%. Monocentric design and limited number of patients are the main limitations of this work., Conclusions: This prospective evaluation shows that day-case HoLEP may be performed by a trained surgeon with an appropriate patient selection.

Introduction: Radical cystectomy remains the referent treatment of non-metastatic muscle-invasive bladder cancer (MIBC). The fast development of robotic surgery has led some teams to use it for the surgical treatment of the MIBC, in the hope of reducing postoperative morbidity. Urinary diversion by bladder substitution is a bypass option. The aim of our study was to compare the robot-assisted cystectomy with open cystectomy, with urinary diversion by bladder substitution., Patients and Methods: Over a two-year period, all the patients who underwent a robot-assisted laparoscopic or open cystectomy with urinary diversion by bladder substitution have been included. The urinary diversion performed was extra-corporeal., Results: The study concerned were 26 men, 15 of them underwent robot-assisted cystectomy, and 11 open cystectomy. There was no significant difference in the median operating time or duration of stay (300 vs 314min and 14 vs 18 days). However, there were less blood loss and more lymph nodes collected in the cystectomies robot-assisted group (median: 400 vs 800mL, P=0.016; 15 vs 10, P=0.01). Three grade III complications of the Clavien-Dindo classification have been described in the robot-assisted group, and none in the open group. No robot-assisted procedure required a conversion to laparotomy. Within 90 postoperative days, complications are basically low grades and results are consistent with the literature., Conclusion: In our series, robot-assisted cystectomies with extracorporeal bladder substitution is technically feasible, with best results on blood loss and the number of lymph nodes removed, without impact on the length of stay., Level of Evidence: 4., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To study the oncologic and functional results of HIFU as a first-line treatment for localized prostate cancer., Material and Method: Enrolment of patients between 2006 and 2011 for the first treatment against localized prostate cancer with HIFU (Integrated Imaging(®), EDAP-TMS, Vaulx-en-Velin, France). The biochemical recurrence-free survival was calculated by using the Phoenix criterion (PSA>nadir+2 ng/mL). The functional complications were assessed clinically and through standardised questionnaires., Results: The condition of 191 patients was assessed at a mean follow-up of 55.5 ± 22.7 months. In 10,1% of the treatments, an incident during the medical procedure was observed with the volume of the prostate (P=0.026) as risk factor. The overall survival, the survival and the metastatic free survival rate were respectively 89.5%, 98.4% and 97.4%. The biochemical free survival rate for 5 years was 87.5%, 69% and 39% respectively for the low, medium and high-risk groups of d'Amico classification. Eighty-six percent of the patients with a PSA nadir ≤ 0.3 ng/mL were relapse free at 5 years. Whereas only 48% of the patients with a nadir>0.3 ng/mL did not. Only 17.8% of the patients had a rescue treatment with an average delay of 31.1 months. The urinary and sexual impairment was significant but 78.1% of the patients were dry at the end of the study. The most common complication found in 18.3% of the patients was the prostatic obstruction., Conclusion: The oncologic and functional results of the HIFU seem similar to the other first-line treatments results and reveal that the HIFU is a therapeutic option for the treatment of prostate cancer in men over 70 years., Level of Evidence: 5., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objectives: To estimate in the medium term, the efficiency and morbidity of Advance(®) for the treatment of postoperative urinary incontinence for male, and determine predictive preoperative factors of success or failure., Material and Methods: Retrospective multicentric clinical study of patients presenting a postoperative urinary incontinence and treated by Advance(®) suburethral sling. The importance of the preoperative incontinence was classified in three groups: light (pad-test<50 g/day or 1 pad/day), moderated (pad-test between 50 and 100 g/day or 2 or 3 pads/day), severe (pad-test>100 g/day or >3 pads/day). The functional results were classified in 4 categories: continence and improvement, defining the criterion of success and unchanged situation and deteriorated situation defining the criterion of failure., Results: Sixty-six patients were included from 2008 till 2013. The radical prostatectomy was responsible in 85.5% of the cases. The incontinence was light, moderated and severe for respectively 43.4%, 35.6% and 21% of the patients. After treatment, 39.4% of the patients were continent and 78.9% in situation of success. The rate of success decreased with the severity of the incontinence (respectively 94%, 74% and 56%). For 9 patients, implantation of artificial urinary sphincter was performed without operative difficulties. Complications were urine retention (n=4), hematoma (n=3) and scrotal pains persistent more than one postoperative month (n=11)., Conclusion: Advance(®) suburethral sling is a technique in which the efficiency decreases with the severity of the incontinence, but which does not seem to prevent from implanting artificial urinary sphincter. Its main problem is the apparition of scrotal pain., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate renal function and to identify factors associated with renal dysfunction in the elective indications setting of nephron-sparing surgery (NSS)., Methods: We retrospectively reviewed operative data and glomerular filtration rate (GFR) of 519 patients treated by NSS in an elective indications setting between 1984 and 2006 in eight academic institutions. A GFR decrease under the thresholds of 60 or 45 ml/min at last follow-up was considered a significant renal dysfunction. Univariate and multivariate regression models were used to assess multiple factors of renal function., Results: Median age, tumor size, preoperative, and final GFR were 59.5 years (27-84), 2.7 cm (0.9-11), 79 (45-137), and 69 ml/min (p < 0.0001), respectively, with a median follow-up of 23 months (1-416). Hilar clamping was performed in 375 procedures (72.3 %). Significant GFR decrease was observed in 89 patients (17.1 %). Median operating time, hilar clamping duration, and blood loss were 137 min (55-350), 22 min (0-90), and 150 ml (0-4150), respectively. At univariate analysis, age (p = 0.002), preoperative GFR (p = 0.001), pedicular clamping (p = 0.01), and ischemia time (p = 0.0001) were associated with renal dysfunction. Age (p = 0.004; HR 1.2), pedicular clamping (p = 0.04; HR 1.3), and ischemia time (p = 0.0001; HR 1.8) remained independent risk factors for renal function deterioration in multivariate analysis., Conclusion: Non- or time-limited clamping techniques are associated with preservation of renal function in the elective indications setting of NSS.

Objectives: To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication., Methods and Materials: Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant., Results: Median age at diagnosis was 60 years (19-91). Tumor size was smaller than 4 cm in 665 (68.3%) cases and larger than 4 cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4 cm (P = 0.0001) and for tumors>4 cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR<60 ml/min (P = 0.0001), tumor size≥4 cm (P = 0.0001), and older age at diagnosis (P = 0.0001)., Conclusions: The renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the efficacy of selective arterial embolization (SAE) of angiomyolipomas based on the percentage volume reduction after embolization and to identify predictive factors of volume decrease., Methods: Patients receiving prophylactic SAE of renal angiomyolipomas were included retrospectively over 3 years. The volume change after SAE and haemorrhagic or surgical events were recorded. Initial tumour volume, percentage tumour fat content, mean tumour density, embolic agent used, number of angiomyolipomas and tuberous sclerosis disease were evaluated as predictive factors of volume decrease., Results: A total of 19 patients with 39 angiomyolipomas were included with median follow-up of 28 months (interquartile range 21-37 months). All treatments were technically successful (92% primary and 8% secondary). No distal bleeding or any increase in size or surgical nephrectomy after SAE was recorded. Mean volume reduction was 72% (±24%). Volumes before SAE (R(2) = 0.276; p = 0.001), percentage fat content (R(2) = 0.612; p < 0.0001) and mean angiomyolipoma density (R(2) = 0.536; p < 0.0001) were identified as predictive factors of volume decrease. In multivariate regression, only percentage fat content influenced volume decreases., Conclusions: SAE is an efficient treatment for angiomyolipoma devascularisation and volume reduction. A significant reduction of volume is modulated by the initial volume and tissue composition of the tumour., Key Points: • Selective arterial embolization is effective for angiomyolipoma devascularisation and volume reduction • Volume reduction depends of initial volume and tissue composition of the tumour • Selective arterial embolization is a low radiation treatment.

Purpose: With the emergence of targeted therapies, the indications of cytoreductive nephrectomy have to be redefined. This review article presents the evidence data guiding our current indications of surgery in the management of metastatic renal cell carcinoma (mRCC) in the era of targeted therapies., Methods: A nonsystematic review of the electronic databases PubMed and MEDLINE from 1980 to 2012 was performed and limited to English language., Results: Two studies based on immunotherapy (EORTC 30947 and SWOG 8949) were at the origins of the recommendations on initial nephrectomy for patients with mRCC. Since the introduction of angiogenesis inhibitors, there is still no high-level evidence from prospective studies assessing the indication of surgery for mRCC. However, surgery still has its importance in the management of primary tumors and metastasis with the objective of an optimal balance between morbidity, quality of life, and survival. The treatment sequence between surgery and targeted therapies is still to be established and two randomized prospective studies were then specifically designed and are currently recruiting., Conclusions: Preliminary evidence data from retrospective series seem to be in favor of a benefit of surgery for patients with good and intermediate prognosis. However, patients' inclusions in current prospective studies are highly recommended to clearly precise nephrectomy's indications.

Objectives: To evaluate survival and outcomes after percutaneous radiofrequency ablation (RFA) of malignant renal tumours in high-risk patients with long-term follow-up., Methods: Between 2002 and 2009, 62 patients (71 tumours), with a median age of 73.5 years (20-87), consecutively treated with RFA under ultrasound or computed tomography guidance for malignant renal tumours were retrospectively selected and prospectively followed until 2012, including 25 patients (40.3 %) with solitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 and 46 mm (median: 23 mm)., Results: Radiofrequency ablation was technically possible for all patients. Mean follow-up was 38.8 months (range: 18-78 months). Primary and secondary technique effectiveness was 95.2 % and 98.4 % per patient respectively. The rates of local tumour progression and metastatic evolution were 3.2 % and 9.7 % per patient and were associated with tumour size >4 cm (P = 0.005). The disease-free survival rates were 88.3 % and 61.9 % at 3 and 5 years. No significant difference in glomerular filtration rates before and after the procedure was observed (P = 0.107). The major complications rate was 5.9 % per session with an increased risk in the case of central locations (P = 0.006)., Conclusions: Percutaneous renal RFA appears to be safe and effective with useful nephron-sparing results., Key Points: • Radiofrequency ablation (RFA) is a well-tolerated technique according to mid-term results. • RFA for malignant renal tumours preserved renal function in high-risk patients. • Mid-term efficacy of RFA was close to that of formal conservative surgery. • Tumour size and central location limit the efficacy and safety of RFA.

Objective: The purpose of our study was to evaluate the combination of dynamic contrast-enhanced T1-weighted and double-echo gradient-echo MR imaging to distinguish renal oncocytoma with high T2 signal intensity centrally from renal cell carcinoma (RCC)., Materials and Methods: Between 2006 and 2011, 63 renal tumors (59 patients) presenting with a high signal intensity (SI) central area on T2-weighted sequences were imaged with dynamic contrast-enhanced sequences, including phases later than 5 minutes after contrast injection, and double-echo chemical-shift sequences were selected from our institutional database. Two experienced radiologists visually assessed presence and distribution of signal enhancement of central areas after injection and measured SI changes on opposed-phase images for calculation of the SI index and tumor-to-spleen ratio. Cutoff values were derived from the receiver operating characteristic (ROC) curve., Results: There were 19 oncocytomas (16 patients), 43 RCCs (42 patients), and one leiomyoma. Complete late enhancement of the central area was observed in 14 oncocytomas (74%) and in five RCCs (12%) (p = 0.05). The combination of complete enhancement and SI index lower than 2% (p = 0.02) or tumor-to-spleen ratio higher than -6% (p = 0.001) provided sensitivity of 36% and 55%, specificity of 95% and 97%, positive predictive value of 67% and 86%, and negative predictive value of 84% and 88%, respectively, for diagnosis of oncocytomas., Conclusion: Absence of central area SI inversion or presence of a signal drop on chemical-shift imaging may rule out the diagnosis of oncocytoma.

The clear cell subtype of renal carcinoma (CCRCC) is highly vascularized and despite a slow progression rate, it is potentially a highly aggressive tumor. Although a doubling of median progression-free survival in CCRCC patients treated by targeted therapies has been observed, the fact that tumors escape after anti-VEGF treatment suggests alternative pathways. The chick chorioallantoic membrane (CAM) is a well-established model, which allows in vivo studies of tumor angiogenesis and the testing of anti-angiogenic molecules. However, only a few data exist on CCRCC grafted onto CAM. We aimed to validate herein the CAM as a suitable model for studying the development of CCRCC and the interactions with the surrounding stroma. Our study uses both CCRCC cell lines and fresh tumor samples after surgical resection. We demonstrate that in both cases CCRCC can be grafted onto the CAM, to survive and to induce an angiogenic process. We further provide insights into the transcriptional regulation of the model by performing a differential analysis of tumor-derived and stroma-derived transcripts.

De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis., (© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.)

The primary angiosarcoma of the kidney is a rare tumor. We report a case of angiosarcoma of the right kidney in a man of 60 years. The CT-scan appearance is the one of a solid tumor compatible with renal cell carcinoma. Histological examination of the piece of nephrectomy straightens diagnosis and reveals the angiosarcomatous nature. In this patient with bone and lung synchronous metastasis, evolution has been a lightning death in less than three months. The literature review confirms the high potential of malignancy of these tumors (metastases almost constant and very short survival in spite of local and systemic treatment)., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: To assess the effectiveness and tolerance of the metallic stent Memokath® 051 in the management of patients with chronic ureteral stricture treated by JJ stenting., Patients and Methods: A prospective observational study included 16 patients with chronic ureteral stricture managed with JJ stents. They were all treated with Memokath® 051 metallic stents. The primary endpoint was the medium durability of the stent. Adverse events and complications were prospectively collected. The evolution of the irritative urinary symptoms and lumbar pain after stent insertion were also assessed., Results: Sixteen patients (mean age: 62, standard deviation: 11,4) had a total of 20 stents inserted. It was technically impossible to insert the stent in two patients and one stent was removed one day after insertion. The medium durability of the stents was 13 months (standard deviation: 10,9). Eight stents (40%) were still functioning at the end of the study. Complications were: six migrations (30%) and four obstructions (20%) of the stents. Thirteen of the 14 patients with a Memokath® stent experienced significant improvement of their JJ stent-related symptoms., Conclusion: The Memokath® 051 stent was an interesting alternative to JJ stents in the management of chronic ureteral strictures. Their tolerance was good and complications were easily managed without threatening the urologic prognosis of the patients. Larger studies are required to identify the risk factors of complications and the best indications for stent insertion., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: The objective of the present study was to analyse whether nephron-sparing surgery (NSS) was superior to radical nephrectomy (RN) in preserving renal function outcome in tumors larger than 4cm., Methods: The data from 888 patients who had been operated upon at eight french university hospitals were retrospectively analyzed. Glomerular filtration rate (GFR) pre- and post-surgery was calculated with the abbreviated Modification of Diet in Renal Disease (MDRD) equation. For a fair comparison between the two techniques, all imperative indications for NSS and all GFR<30 mL/min/1.73 m(2) were excluded from analysis. A shift to a less favorable DFG group following surgery was considered clinically significant., Results: Seven hundred and thirty patients were suitable for comparison. Median age at diagnosis was 60 years (19-88). Tumors measuring more than 4cm represented 359 (49.2%) cases. NSS and RN were performed in 384 (52.6%) and 346 (47.4%) patients, respectively. In univariate analysis, patients undergoing NSS had a smaller risk than RN of developing significant GFR change following surgery. This was true for tumors≤4cm (P=0.0001) and for tumors>4cm (P=0.018). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P=0.001), decreased preoperative DFG (P=0.006), increased age at diagnosis (P=0.001) and increased ASA score (P=0.004)., Conclusion: The renal function benefit offered by elective NSS over RN persists even when expanding NSS indications beyond the traditional 4 cm cut-off., (Copyright © 2011. Published by Elsevier Masson SAS.)

Objective: Analysing periprostatic tissue (PPT) thickness after retropubic (RP) or laparoscopic (LP) prostatectomy., Material: From January to December 2007, 114 consecutives prostatectomies were performed in our institution (38 RP, 76 LP). Clinical data were prospectively collected in a database. Gardner et al.'s (1988) procedure was used for pathological analysis. PPT thickness was measured on pathological specimens by a single observer on a single microscope. The observer had no knowledge of either clinical data or surgical approach. Four levels were chosen (at the base, the proximal part, the distal part, the apex) and 12 standardized measures were performed on each level, 48 measures: a prostate. We compared PPT thickness and surgical margins according to surgical approach and clinical data., Results: Comparative analysis confirmed that LP and RP groups were similar as far as it concerns preoperative and pathological findings. Positive margin rate was also similar in LP and RP groups (4% versus 5.3%; P=0,37). Overall PPT thickness was thinner after LP than after RP except at the apex and the anterior face. Nevertheless, in the "complete preservation" group, PPT thickness was thinner at the apex in the RP group, thinner at the base in the LP group., Conclusion: Measuring PPT thickness was an original objective and reproducible way to compare different techniques and new technologies for radical prostatectomy. PPT sparing was different but not better with the laparoscopic approach., (Copyright © 2011. Published by Elsevier Masson SAS.)

With 300,000 annually new cases worldwide, urothelial-cell carcinoma of the bladder (UCCB) is the second most common urologic neoplasm after prostate carcinoma. Non-muscle-invasive bladder cancer (NMIBC), which is not immediately life-threatening, represents 70% to 80% of these initial cases. Despite optimal treatment (transurethral resection with intravesical chemo- or immunotherapy), 70% of these NMIBC will recur, and 10% to 20% will progress, highlighting the need for a new therapeutic approach. Indeed, the identification of patients at high risk of disease recurrence and progression would be beneficial in predicting which patients with NMIBC would benefit from strict follow-up and which would benefit from a more aggressive therapy. To date, conventional treatment remains disappointing in terms of oncologic results and morbidity. The growing understanding in tumor biology has enabled the signaling pathways involved in bladder tumorigenesis and progression to be identified, but few molecular targets have been available until now. The encouraging results seen in various human carcinomas suggests that these new agents should become part of the arsenal of drugs available in the treatment of NMIBC, alone or in combination with already known agents. In this article, we have tried to highlight the main molecular signaling pathways involved in NMIBC tumorigenesis and progression, and the potential targets useful for improving the treatment of NMIBC., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation., (©2010 The Authors Journal compilation©2010 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Purpose of Review: Bladder cancer development in organ transplant recipients remains a complex problem to manage as it has been demonstrated that the clinical course seems worse than in the general population. Most of the reports on bladder cancer after organ transplantation were done for kidney transplantation. Both virally and nonvirally are involved in bladder tumor development. The immunosuppressed status of the transplant recipients renders the screening, the therapeutic management, and the post-treatment surveillance very difficult., Recent Findings: With the increase of organ transplantation, especially renal transplantation, graft survival, and age of donor and recipient, urological cancer, including bladder cancer, become a critical problem affecting the survival. The advent of the new immunosuppressed drugs, mTOR inhibitors, leads to the hope of improving both survivals of the graft and of the recipients., Summary: The molecular pathway P13K/Akt/mTOR is frequently activated during human solid tumor development and progression. However, mTOR inhibitors are also used in order to avoid renal allograft rejection. The combination of both actions could significantly improve graft and organ recipient survival and could provide progresses in targeted therapy management of bladder cancer.

Purpose: Metastasis remains the main cause of death in both bladder (BCa) and prostate (PCa) cancers. The results of chemotherapy did not show any significant improvement of the survival the past years. Cancer research has led to the identification of signaling pathways involved and molecular targets that could change the natural history. The epithelial-mesenchymal transition (EMT), critical during embryonic development, becomes potentially destructive in many epithelial tumors progression where it is inappropriately activated. The cell-cell and cell-extracellular matrix interactions are altered to release cancer cells, which are able to migrate toward metastatic sites. Hallmarks of EMT include the down-regulation of E-cadherin expression, which is the main component of the adherens junctions. The protein TWIST is a transcriptional repressor of E-cadherin, tumor progression, and metastasis, and could be used as a molecular target to restore the chemosensitivity in BCa and PCa., Materials and Methods: We selected the last 5-year basic research literature on EMT and TWIST but also clinical studies on BCa and PCa in which TWIST is overexpressed and could be considered as an efficient prognostic marker and molecular target., Results: TWIST is considered as a potential oncogene promoting the proliferation and inhibiting the apoptosis. TWIST promotes the synthesis of the pro-angiogenic factor, vascular endothelial growth factor (VEGF) involved in tumor progression and metastasis. Apoptosis and angiogenesis are two essential cancer progression steps in many epithelial tumors, including BCa and PCa., Conclusions: With the targeted therapy, oncology has entered into a new era, which is going to be critical in cancer treatment in combination with traditional anticancer drugs., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Background: Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants., Objective: To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC)., Design, Setting, and Participants: We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively., Measurements: Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model., Results and Limitations: Among 809 NSS procedures with a median follow-up of 27 (1-252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5-38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p=0.0489), imperative indication (p<0.01), tumour bilaterality (p<0.01), tumour size >4cm (p<0.01), Fuhrman grade III or IV (p=0.0185), and PSM (p<0.01). In multivariate analysis, tumour bilaterality, tumour size >4cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size >4cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up., Conclusions: RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics., (Copyright © 2010 European Association of Urology. All rights reserved.)

Purpose: Our objective was to compare oncologic results of nephron sparing surgery (NSS) versus radical nephrectomy (RN) in T1aN0-x M0 papillary renal cell carcinoma (PRCC)., Patients and Methods: We retrospectively reviewed 277 patients treated for a pT1aN0M0 PRCC selected from an academic database from 12 centres. We compared the clinico-pathological features by using Chi-square and Student statistical analyses. Survivals analyses using Kaplan-Meier and Log-rank models were performed., Results: The two groups were composed by 186 patients treated by NSS and 91 by RN. The TNM stage was fixed and the two groups were, in terms of age and Fuhrman grade, comparable. Median age at diagnosis was 59 years (27-85). Median tumor size was 2.7 cm (0.4-4). The average follow-up was 49 months (1-246). Very few events arose in both groups: two local recurrences were observed in the NSS group (1.07%), three patients died of cancer in the NSS treated group (1.6%) and five in the RN treated group (5.5%). The five and 10 cancer-specific survival rate were comparable in the two groups (98% vs. 100% and 98% vs. 97%). The specific survival curves were perfectly similar for both groups (log rank test, p=0.25)., Conclusion: NSS is equivalent to RN as far as oncologic control of pT1aN0M0 PRCC is concerned., (Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.)

Objectives: To determine and analyze the incidence, prognosis, and therapeutic strategy of de novo urological malignancies in a series of renal transplant recipients (RTRs)., Methods: A retrospective study of 1350 recipients between January 1998 and January 2008 was carried out; we reviewed the data of 42 de novo urological malignancies in 39 recipients., Results: There were 21 cases of prostate cancer, 13 cases of renal cell carcinoma in 10 patients, 3 cases of renal graft tumors, and 5 cases of transitional cell carcinoma of the bladder. The overall incidence of urological neoplasms was 3.1%. The mean age of cancer diagnosis was 60 +/- 8.3 years. The mean duration of dialysis before cancer diagnosis was 35 +/- 37.5 months. About 92% of patients underwent hemodialysis (34/39) and the remaining underwent peritoneal dialysis (5/39). All the 39 recipients received cadaveric kidneys. The mean follow-up period for this study was 33 +/- 34.4 months (range 2-160 months). There appears to be a greater risk of urological neoplasm in RTRs. Prostate cancer and renal carcinoma can be treated in a similar manner than in general population with encouraging oncological results and low morbidity. However, the transitional cell carcinoma of the bladder remains particularly aggressive requiring optimal treatment despite the morbidity concerning the intravesical therapy., Conclusions: We can apply the standard medical and surgical treatment in RTRs, with encouraging oncological results if a strict screening program is established and followed by the patients., (2010 Elsevier Inc. All rights reserved.)

Objectives: To report our experience with 9 consecutive laparoscopic radical prostatectomy (LRP) on renal transplant recipients (RTR) and to compare it with other LRPs performed during the same period by the same surgeons. Retropubic radical prostatectomy has widely been described in RTR, whereas LRP has rarely been studied., Methods: Between January 2007 and December 2008, all clinical data from patients undergoing radical prostatectomy were prospectively collected in a database. The database was searched to find information of LRP on RTR. We compared RTR and other patients for all relevant clinical data and for surgical complications., Results: A total of 9 LRP on RTR (5.8%) and other 164 LRP were performed. LRP on RTR were compared with other LRP. No statistically relevant difference was observed in patient characteristics, biopsy core pathologic analysis, prostate specimen pathologic analysis, and oncologic outcomes. Surgical procedure was also achieved under the same conditions in RTR than in other patients (surgical time, blood loss, transfusion rate, bladder injury). Rectal injury rate was significantly higher in RTR than in other patients (22.2% vs 1.8%, P = .022)., Conclusions: LRP in RTR is feasible. The procedure can be managed the same way as LRP on other patients, but special care must be taken to avoid rectal injury. In our experience, the dissection of the posterior side of the prostate was more difficult on RTR than on other patients.

Objectives: To assess cancer-specific survival of partial nephrectomy (PN) patients with >or= 7-cm lesions or unfavorable pathology (stage T3a or Fuhrman grades III-IV)., Material and Methods: At 13 participation centers, 4072 partial or radical nephrectomies (RN) were performed for RCC between 1984 and 2001. Of all procedures, 925 (22.7%) were for tumors > 7 cm, 973 (23.9%) had Fuhrman grades III or IV, and 861 (21.1%) had stage pT3a. None had nodal or distant metastases. Matched (age, gender, tumor size, T stage, histologic subtype, and Fuhrman grade [FG]) survival analyses addressed the effect of nephrectomy type (partial vs radical) on cancer-specific mortality., Results: Partial nephrectomy for tumors > 7 cm was associated with higher mortality than RN (HR = 5.3; P = .025). No significant cancer-specific survival differences were recorded after PN for FG III-IV (HR = 0.7, P = .5) or for pT3a lesions (HR = 2.5, P = .9)., Conclusions: Partial nephrectomy may undermine cancer control in patients with tumors > 7 cm. Conversely, after PN, the same cancer control rates as after RN may be expected in patients with Fuhrman grades III-IV or with pT3a histology.

Background: Although urachal remnants are very rare, dermatologists must be aware of them in order to ensure suitable treatment by urologists. Lack of appropriate treatment exposes patients to the risks of recurrent infectious complications or degeneration to vesical adenocarcinoma., Case Report: A 32-year-old man consulted for mild and recurring umbilical weeping for approximately 1 year. He had previously undergone unsuccessful treatment, comprising application of liquid nitrogen and of silver nitrate to an umbilical lesion measuring several millimetres regarded as pyogenic granuloma. The diagnosis of urachal sinus was suspected clinically (umbilical weeping or inflammation) and confirmed by urological scan., Discussion: A defect involving partial or total obliteration of the urachal canal after the fifth month of gestation can result in four types of benign abnormalities. Patent urachus (50%) is diagnosed during the neonatal period, while in adults, the most frequent form is a urachal cyst (30%), with sinuses (15%) and the diverticula (5%) being very rare. The urachus and its implantation base on the bladder must be removed surgically. Laparoscopic surgery offers a valuable alternative to open-surgery and probably leads to less morbidity and shorter convalescence in active young subjects.

Objective: To examine cancer-specific and non-cancer-related mortality rates in 451 patients with T1a-bN0M0 renal cell carcinoma (RCC) treated with either radical or partial nephrectomy (RN or PN) in Europe., Patients and Methods: Between 1987 and 2007, 451 patients with T1a-bN0M0 RCC were treated for histologically confirmed RCC with RN or PN at one of seven participating European institutions. The preoperative American Society of Anesthesiology (ASA) score was available for all patients and was used to control for baseline comorbidities. The preoperative glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease study group equation. We used univariate and multivariate competing-risks regression analyses to test the effect of the ASA score, GFR, T stage (T1a vs T1b) and nephrectomy type (RN or PN) on RCC-specific mortality and non-RCC-related mortality., Results: In patients with T1a-b RCC cancer- specific mortality was unaffected by stage, nephrectomy type or GFR. Conversely, non-RCC-related mortality was strongly affected by the ASA score and GFR. Unlike in a previous report, nephrectomy type did not affect non-RCC-related mortality. This lack of significance relative to RN may stem from the relatively high rate of PN use in the present series., Conclusion: PN or RN virtually eliminate the risk of cancer-specific mortality in patients with T1a-b RCC. Poor preoperative ASA score and impaired renal function appear to represent relative contra-indications to surgical management of T1a-b lesions.

The efficacy of radiofrequency ablation of large renal tumors can be increased by modulating their size and vascularity with antiangiogenic drugs, which may limit the sink effect related to high blood flow. We present an observation with 3 recurrent tumor locations, the largest being 3.7 cm in diameter. Pretreatment with antiangiogenics provided a significant reduction of tumor size and perfusion, allowing efficient ablation under favorable conditions.

Objective: To identify, in a large multicentre series of incidental renal tumours, the key factors that could predict cancer-related deaths, as such tumours have a better outcome than symptomatic tumours and selected patients are increasingly being included in watchful-waiting protocols., Patients and Methods: Data from 3912 patients were extracted from three international kidney-cancer databases. Age, gender, Eastern Cooperative Oncology Group (ECOG) performance status (PS), Tumour-Node-Metastasis (TNM) stage, tumour size, Fuhrman grade, and final pathology were recorded. Benign tumours and malignant lesions with incomplete information were excluded from final analysis., Results: The mean (SD) age of the patients was 60.6 (12.2) years and the mean tumour size 5.5 (3.5) cm. Most tumours were malignant (90.2%) and of low stage (T1-T2, 71.7%) and low grade (G1-G2, 72.4%). There were nodal and distant metastases in 5.7% and 13% of the patients. In all, 525 (14.4%) patients died from cancer; in this group, tumours were >4 cm in 88.2% and had nodal or distant metastases in 20.2% and 49.3%, respectively. Multivariable analysis showed that tumour size >4 cm, ECOG PS >or=1, TNM stage and Fuhrman grade were independent predictors of cancer-related death., Conclusion: A significant proportion of incidental renal tumours can lead to the death of the patient. Standard prognostic variables for renal cell carcinoma appear to remain valid for this subset of patients. A watchful-waiting strategy should not be recommended if the tumour diameter is >4 cm, if biopsy confirms high-grade tumours, or if there is an impaired ECOG PS, or computed tomography findings suggest the presence of advanced T stage.

Urachus pathologies are very rare but require to be known by urologists. Lack of appropriate treatment exposes the patients to the risks of symptoms recurrence, infectious complications or adenocarcinomatous degeneration. A partial or total defect of obliteration of the urachus channel after the fifth month of gestation can be at the origin of four benign pathologies. The ombilicovesical fistula (47.6%) is diagnosed at the native period. In the adult, the most frequent form is the cyst (30.7%) whereas the external (16.4%) and internal sinus (3.2%) are rarer. Diagnosis depends on the clinical examination and the association of sonography and TDM. The risk of complications must systematically result in proposing a surgical treatment for these benign pathologies. The umbilicus resection is not recommended, but the surgeon has to remove the urachus and its implantation base on the bladder. Laparoscopic surgery seems to be an interesting route for this intervention.

Anti-angiogenic treatments have recently been incorporated as a milestone in the management of metastatic renal cell carcinoma. This retrospective study explores this new practice in 94 patients treated by sorafenib, bevacizumab or sunitinib in the department of oncology of CHU of Bordeaux in a 32 months period. The adverse effects reported are similar than those from prospective trials but for some different in frequency or severity. Efficacy of these drugs appeared more modest than expected from phase III trials. An objective response rate or stabilisation longer than six month was seen in 35% of the patients. Median overall survival was 14.1 months (IC 95%: 8.3-18.7 months). Nevertheless, the population considered in this study had a worse prognosis with more patients with an altered general status (OMS 2 or 3: 13.8%).

New antiangiogenic molecules have proven an advantage in term of survival in metastatic renal cell carcinoma. We describe herein two clinical cases showing the efficacy of antiangiogenic agent in locally advanced or metastatic renal cell carcinoma. In this cases the surgical management has been altered in front of an important tumor necrosis provided by this treatment. The role of antiangiogenic agents as adjuvant or neo adjuvant therapy has not yet been defined precisely. However, these new molecules open new perspectives in the therapeutic field of metastatic renal cell carcinoma notably in case of bulky tumors which appeared difficult to remove surgically at first look or in case of early recurrence after radical nephrectomy.

Cancer is a complex disease characterized by a multitude of molecular and genetic abnormalities affecting cell proliferation and differentiation, apoptosis, and mobility (invasion). Each of these alterations represents a potential target for the development of targeted therapy. These new therapies inhibit cell growth and are said to be "cytostatic" in contrast with conventional "cytotoxic" chemotherapy. As a result of a better understanding of the molecular biology of bladder cancers, various signalling pathways involved in both carcinogenesis and tumour progression have been defined, and some of the key molecules in these pathways have been isolated and can be used as prognostic markers and as potential therapeutic targets. Locally advanced, and/or metastatic bladder cancer, is characterized by mutations of the p53 and retinoblastoma (Rb) genes, regulators of the cell cycle, which interact with the Ras-mitogen activated protein kinase (MPAK) transduction pathway. Overexpression of tyrosine kinase receptors, including EGFR, VEFGR and HER2/neu, is correlated with tumour progression and activation of the phosphatidyl-inositol-3 kinase (PI-3K) pathway is involved in tumour invasion and inhibition of apoptosis. Due to their molecular heterogeneity, optimal targeted therapy of bladder cancers will require the combined use of several molecules. Modulation of signalling pathways by these new molecules can restore chemosensitivity to cytotoxic drugs, which can then be associated with targeted therapy.

Objective: To evaluate the morbidity of partial nephrectomy (PN) according to tumour size and the type of indication based on a multicentre retrospective study., Materials and Methods: Seven French teaching hospitals participated in this study. Data concerning tumour size, indication for PN (elective or necessity), age, gender, TNM stage, histological type, Fuhrman grade, ASA score and performance status (ECOG) were analysed. Medical and surgical complications, intraoperative blood loss, blood transfusion rate and length of hospital stay were also studied. Statistical analysis of qualitative and quantitative variables was performed with Chi-square test (Fisher's test) and Student t-test., Results: Six hundred and ninety one patients were included. The median tumour diameter was 3cm (0.4-18). Tumours measuring less or equal to 4cm and incidental tumours represented 77.7 and 80.7% of cases, respectively. Clear cell carcinomas represented 75.1% of malignant tumours. Some 89.1% of tumours were T1, 1.6% were N+ and 2.3% were M+. In the 486 elective indications: the operating time (p = 0.03), mean blood loss (p = 0.04), and urinary fistula rate (p = 0.01) were significantly higher in tumours greater than 4cm. These differences were not associated with an increase in the medical (p = 0.7) or surgical complication rate (p = 0.2), or the length of hospital stay (p = 0.4)., Conclusion: Broader indications for elective PN is associated with an increased morbidity but which remains acceptable. This is an important point for patient information and to guide the choice of surgical strategy, particularly in elderly, frail patients or patients with major comorbidities.

Introduction: The objective of this study was to evaluate the risk factors of biochemical recurrence in patients with prostate cancer treated by retropubic prostatectomy., Material and Methods: Retrospective analysis of 121 consecutive retropubic radical prostatectomies performed between January 1994 and December 1997. Biochemical recurrence was defined by PSA > or = 0.2 ng/ml. Biochemical recurrence-free survival rates were calculated by the actuarial method. Univariate and multivariate analysis of prognostic factors of biochemical recurrence was performed., Results: The actuarial biochemical recurrence-free survival was 71% at 5 year and 63% at 7.5 years. Kaplan-Meier analysis did not reveal any difference for the risk of biochemical recurrence between patients with doubtful margins and those with positive margins. These two groups were therefore combined. Significant risk factors on univariate analysis were: pathological stage, grade of the predominant cell contingent on the specimen, margins, highest cell grade on biopsies, clinical stage, PSA level, perineural invasion and Gleason score. Significant risk factors for biochemical recurrence on multivariate analysis were: pathological stage, PSA > 10 ng/ml, the highest grade on biopsies, positive margins and perineural invasion., Conclusion: Doubtful margins and positive margins appear to be associated with the same risk of biochemical recurrence. The prognostic value of Gleason grade on the specimen is higher than that of the Gleason score. A high Gleason grade on biopsies is associated with a particularly poor prognosis.

Introduction: Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70 is considered to be associated with a higher risk than extracorporeal shock-wave lithotripsy (ESWL). However this technique is sometimes necessary for very large or complex stones in patients with several comorbidities., Study Objective: To evaluate the predictive factors of success and operative risks likely to influence the results of PCNL in a population of patients over the age of 70., Material and Method: Retrospective study of 203 patients (110 males, 97 females) over the age of 70, in whom a total of 210 PCNL were performed over a 12-year period in ten referral centres for the treatment of stones. 68.5% of cases presented a comorbidity and the median ASA score was 2. The median stone dimensions were 24 x 15 mm. There were 67 solitary pelvic stones, 7 infrapelvic ureteric stones, 31 solitary inferior caliceal stones, 40 complex stones and 13 staghorn calculi. A standard one-stage operative technique was performed in 92% of cases; the nephrostomy tract was easily performed by the urologists themselves in 71.8% of cases., Results: The overall stone-free (SF) rate was 70.8%. The patient's weight and height (p=0.03 and p=0.01), stone dimensions and their solitary nature were significant factors of success (p<0.00001 and p=0.01) with SF rates of 81.1% for pelvic stones and 90.3%for solitary inferior caliceal stones (p<0.003); the SF rate for complete staghorn calculi was only 30.8%. A history of stones (p=0.04) and diabetes (p=0.03) influenced the stone-free rate, but the other comorbidities, body mass index, and age did not influence the stone-free rate. There were two deaths (0.9% and haemostasis nephrectomy was performed in 2 ASA 3 subjects in renal failure. In the other patients, there was no difference between preoperative and postoperative serum creatinine and haemoglobin levels. The ease of nephrostomy, the rapidity of PCNL, the day of removal of the drainage nephrostomy, the mean hospital stay (median stay: 6 days), sterility of postoperative urine and at the 1-month visit were significantly correlated with the SF rate., Conclusions: PCNL in subjects over the age of 70 years is a safe and reliable technique that achieved a stone-free rate of 70.8% for all types of stones combined. The best results were obtained for solitary stones larger than 20 mm in the renal pelvis or inferior calyx. Apart from diabetes, which remains a risk factor, well controlled comorbidities do not increase the operative risk. PCNL did not affect haemodynamic parameters or renal function.

Objective: To describe the circumstances of development, diagnostic approach and treatment of iatrogenic ureteric lesions after laparoscopic surgery., Material and Methods: From 1992 to 2003, nine patients with iatrogenic trauma of the ureter after laparoscopic surgery were managed by our team., Results: The time to diagnosis ranged from 0 to 640 days. These injuries were related to gynaecological surgery in 56% of cases, gastrointestinal surgery in 22% of cases, vascular surgery in 11% of cases, and spinal surgery in 11% of cases. The two lesions identified intraoperatively were treated immediately with success. In the case of lesions identified secondarily, first-line endourological treatment was performed in 57% of cases with a good result without reoperation in only 25% of cases. Three patients required reoperation with 66% of satisfactory results and two patients were treated by nephrectomy., Conclusion: Intraoperative difficulties and limited experience of laparoscopic surgery are the factors most frequently identified in iatrogenic ureteric lesions. The time to diagnosis has a considerable impact on the modalities and results of management.

The association of interleukin-2 (IL-2), interferon alpha-2a (IFNalpha), 5-fluorouracil (5-FU) has been reported to induce response in metastatic renal cell carcinoma (MRCC). This study evaluated IL-2, IFNalpha and 5FU as second-line treatment after failure under immunotherapy. A total of 35 patients received IL-2, at 9 x 10(6) IU m(-2), once or t.i.d, 5 days a week, every other week. Interferon alpha was administered at 6 MUI, TIW along with IL-2 every week. 5-Fluorouracil was given at 750 mg m(-2) day(-1) on days 1-5 every 4 weeks. One cycle lasted 8 weeks. All patients were evaluable for response and toxicity. There were two objective responses (5.7%) and 14 stable diseases (40%). Survival was 14 months. In all, 17 patients experienced grade 3 toxicity. The predictive factor for progression to second-line immunotherapy was the results of first-line immunotherapy, and performance status, delay from primary tumour to metastases and response or stabilisation to chemo-immunotherapy for survival. IL-2, IFNalpha and 5-FU induce low objective response but stabilisation in patients with MRCC having failed with immunotherapy, and may be considered only in selected patients on performance status, stabilisation or response after first-line immunotherapy and interval from their primary tumour to metastases.