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To analyze, in patients with prostate cancer (PC) potentially eligible for active surveillance (AS), whether multiparametric-MRI (mp-MRI) predicts presence of clinically significant cancer on radical prostatectomy (RP) specimen.We identified 77 men with PC eligible for AS (PSA≤15ng/mL, stage≤T2a, Gleason score≤6, up to 3 positive cores, maximal cancer core length≤5mm) who underwent RP between 01/2008 and 08/2015. All patients had prebiopsy mp-MRI followed by systematic±targeted biopsies. For each patient, the likelihood of the presence of cancer on mp-MRI was assigned using Likert scale (1 to 5). The predictive factors for the presence of significant cancer on RP specimen (Gleason score≥7 and/or tumoral maximal diameter10mm) were evaluated using logistic regression.Median age was 61 and median PSA was 6.7ng/mL. Overall, 49 (64%) patients had a positive mp-MRI (score≥3). Clinically significant cancer on RP specimen was found in 45 (58%) patients (69% in MRI-positive patients vs 39% in MRI-negative patients). In multivariate analysis, a positive MRI was a predictive factor for the presence of significant cancer on the surgical specimen (OR=3.0; CI95% [1.01-8.88]; P=0.04), as was age (OR=1.17; CI95% [1.05-1.31]; P=0.004) and PSAD (OR=1.10; CI95% [1.01-1.20]; P=0.02).Mp-MRI is a useful exam for selecting patients eligible for AS even if the situation remains unclear after prostate biopsies including targeted biopsies. Upon confirmation by further studies, mp-MRI should be considered as an independent criterion before entering an AS program.4.

To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS).A single-center, retrospective cohort study on 131 patients in AS, with following criteria:≤cT2 stage, PSA≤15ng/mL, Gleason score≤6,≤3 positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score6 and/or a maximum tumor length5mm.Overall, 29 patients (22.1 %) were reclassified. Reclassification free survival rate was 93 % and 70 % at 1 year and 4 years respectively. Reclassification independent risk factors were: PSA density0.15ng/mL/cmFor patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification.4.

Resume Introduction Les instillations endovesicales de BCG constituent le traitement de reference des TVNIM de risque intermediaire et eleve. Un traitement d’entretien est fortement recommande, neanmoins la frequence des effets secondaire responsable de l’arret du traitement d’entretien chez plus de quatre patients sur cinq avant la troisieme annee pourrait justifier une diminution voire un espacement des instillations. L’objectif de l’etude URO-BCG-4 etait l’evaluation d’un nouveau schema d’entretien par instillations endovesicales de BCG associant une diminution de dose (un tiers de dose) mais aussi une diminution du nombre d’instillation par cycle (deux ou trois). Patients et methodes Etude multicentrique du CCAFU (12 centres hospitalo-universitaires), randomisee, prospective, comparant le schema de reference de BCG-therapie d’entretien au un tiers de dose usuelle (groupe I) a un schema associant un tiers de dose et diminution du nombre d’instillations par cycle (deux au lieu de trois) (groupe II). Nous presentons les resultats preliminaires a un an de ce programme hospitalier de recherche clinique (2003-081 CHU de Rouen Promoteur). Resultats Le taux de recidive tumorale etait respectivement de 9 et 7 % ( p = 0,678) dans les groupes I et II. Le taux de progression tumorale etait de 3 et 2,8 % dans les groupes I et II ( p = 1). La tolerance des instillations endovesicales de BCG evaluee selon la classification OMS (Geneve 1979) etait comparable dans les deux groupes. Conclusion La diminution de la dose de BCG (un tiers de dose) et la modification du nombre et du rythme des instillations n’a pas modifie le taux de survie sans recidive tumorale. La toxicite des instillations endovesicales de BCG etait identique dans les deux groupes. L’utilisation de la classification OMS a montre ses limites dans l’etude des effets secondaires du BCG car trop complexe et souvent non exhaustive. Le taux de progression musculaire etait comparable dans les deux groupes neanmoins un recul clinique plus important est necessaire.

Salvage radical prostatectomy (sRP) for radiorecurrent prostate cancer (PCa) is a challenging procedure. To report our experience with sRP for selected patients with local recurrence after primary treatment for localised PCa.From 2005 to 2015, 24 patients underwent sRP for recurrent PCa in our center and were included in this retrospective study. Local recurrence was suspected by PSA increasenadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed.Overall, 24 patients with a median age of 59 years (IQR: 55-60) were included. Median follow-up was 25 months (IQR: 9-26). Procedures were performed with open-retropubic approach in 50 % and robot-assisted laparoscopic approach in 50 %. Overall, 5 (21 %) and 2 (8 %) patients experienced grade≤IIIa and grade≥IIIb postoperative complication, respectively. Surgical margins were positive in 46 % of cases. Three out of 4 patients with postoperatively detectable PSA (0.2ng/mL) had positive surgical margins. Seven patients experienced biochemical recurrence in a median delay of 19 months (9-62). Seventy-one percent (5) of these patients experienced clinical recurrence in a median delay of 24 months (10-113). Severe urinary incontinence (≥3 pads/day) and erectile dysfunction were reported in 25 % and 63 %, respectively.sRP for patients is a feasible procedure with encouraging local control rate and acceptable morbidity. This technique should be discussed as a treatment option for locally recurrent PCa in well-selected patients.4.

Resume Contexte Le carcinome a cellules renales (CCR) du sujet de moins de 40 ans est une entite dont les caracteristiques clinicopathologiques sont peu connues. Le but de cette etude etait d’evaluer ces caracteristiques en comparaison avec celles d’une cohorte de patients âges de 58 et 62 ans. Methode Etude retrospective des patients âges de moins de 40 ans (groupe 1, n = 44) et des patients âges de 58 a 62 ans (groupe 2, n = 106) traites chirurgicalement pour masse renale de janvier 2000 a juillet 2009. Une analyse comparative des caracteristiques clinicopathologiques et de la survie specifique a ete realisee. La survie specifique etait calculee selon la methode de Kaplan-Meier et comparee entre les groupes par le test de Log-Rank. Des analyses uni- et multivariees, selon le modele de Cox, ont ete realisees pour evaluer et quantifier l’amplitude de l’effet de l’âge sur la survie specifique du CCR. Resultats Les caracteristiques cliniques et pathologiques etaient comparables ( p > 0,05) dans les deux groupes hormis le type histologique (56 % de CCR a cellules claires et 23 % de CCR a translocation, pour le groupe 1 versus 82 % et 0 % respectivement, pour le groupe 2, p p = 0,58). Seul le grade de Fuhrman etait un facteur pronostique independant de survie specifique ( p = 0,001). Conclusion Dans cette etude, les patients de moins de 40 ans avaient des proportions de types histologiques de CCR differentes des patients de 58 a 62 ans, notamment le CCR a translocation. La survie specifique liee au cancer etait similaire dans les deux groupes. Seule la recherche systematique de la translocation par immuno-histochimie specifique chez les patients de 40 ans ou moins permettra d’evaluer l’incidence reelle et le pronostic de cette entite.

Resume Le cancer de vessie est une affection frequente dans les pays industrialises. Si le tabac demeure le facteur de risque principal de ce cancer, les expositions professionnelles cancerigenes ne doivent pas etre sous-estimees. But L’importante surmortalite du cancer de vessie dans la region nord, riche en industries susceptibles d’avoir exposes les salaries a des cancerigenes vesicaux, nous a conduit a etudier l’influence de ces expositions dans l’histoire naturelle de ce cancer. Patients et methode A partir d’un questionnaire elabore par le service de maladie professionnelle et d’une base de donnees, permettant l’enregistrement des donnees cliniques, radiologiques, histologiques, therapeutiques des cancers de vessie pris en charge au CHRU de Lille, nous avons realise une etude de cohorte, prospective a partir d’octobre 2005, comparant un groupe d’exposes a des cancerigenes d’origine professionnelle a un groupe temoin. Resultats De octobre 2005 a fevrier 2009, 69 patients ont ete inclus dans l’etude, 37 exposes professionnels contre 32 temoins. L’âge moyen dans les deux groupes etait 61,6 ans vs 61,8 ans et le sex-ratio d’une femme pour 7,33 hommes vs une femme pour trois hommes. L’âge moyen des patients exposes aux HAP etait de 59,7 ans. Parmi les patients, 86,5 % etaient fumeurs chez les exposes et 87,5 % dans le groupe non expose. La duree du suivi etait respectivement de 38,4 et de 32,9 mois. Les tumeurs n’infiltrant pas le muscle detrusor (TVNIM) etaient plus frequentes ( p = 0,019) dans le groupe expose (84,4 %) que dans le groupe non expose (67,8 %) y compris apres ajustement au tabac ( p = 0,0142). Le type histologique, le grade, la presence du Cis, la recidive precoce a trois mois, le nombre de lesions au diagnostic ne differaient pas dans les deux groupes meme apres ajustement au tabac ou apres analyse par sous-groupe d’exposition, les plus frequentes. Les exposition aux HAP (62 %) et aux amines aromatiques (37,8 %) etaient les plus representees. Sur 37 patients, 13 (35 %) ont fait une declaration en maladie professionnelle (huit selon le Tableau 15 ter, deux selon le Tableau 16 bis et deux presentes devant le CRRMP). Un seul patient a ce jour est reconnu en maladie professionnelle. Conclusion Nous n’avons pas constate d’aggravation du pronostic des cancers de vessie suite a une exposition cancerigene professionnelle excepte pour l’âge moyen au diagnostic. Le faible effectif de la population etudiee, l’importance du tabagisme associe, ont rendu difficile l’analyse de ces expositions professionnelles, dont l’etude ne peut etre separee de la notion de polymorphisme genetique.

Las pruebas de imagen del cancer de prostata se han desarrollado ampliamente, con dos avances principales: el perfeccionamiento y la estandarizacion de los protocolos para las biopsias ecoguiadas de la prostata. Los adelantos de la resonancia magnetica (RM) han proporcionado a esta tecnica un nuevo lugar en el tratamiento del cancer de prostata. Las correlaciones entre las piezas de prostatectomia radical y la RM permiten comprender la historia natural, las formas de progresion y las caracteristicas del cancer de prostata en las pruebas de imagen, ampliando los estudios de McNeal basados en la cartografia tumoral de las piezas de prostatectomia radical para la deteccion de focos tumorales mediante RM. El lugar de la RM, que durante mucho tiempo se mantuvo confinada a la evaluacion de la extension del cancer de prostata, se extendio a la deteccion, al pronostico y a la valoracion preterapeutica; ofrece a los urologos una cartografia tumoral cuya precision ha de seguir aumentando con los progresos de las pruebas de imagen.

RADIOLOGIE ET IMAGERIE MEDICALE : Genito-urinaire - Gyneco-obstetricale - Mammaire - 34-421-A-10

Infecciones del tracto urinario: en este articulo se analiza la contribucion de las tecnicas por imagen al diagnostico, control y tratamiento de las infecciones urinarias. Las infecciones urinarias son frecuentes y el estudio por imagenes participa sobre todo en la evaluacion de las infecciones parenquimatosas. En las infecciones altas revela sobre todo dilatacion y obstruccion de la via excretora, mientras que en pacientes en los que las infecciones se acompanan de factores de riesgo, el diagnostico por imagen cumple una funcion clave, al evaluar la extension y la difusion del proceso infeccioso y orientar el tratamiento y los metodos intervencionistas.

This review analyzes the role of imaging in the diagnosis, follow-up and management of urinary tract infections. Uncomplicated infection of the urinary tract is frequent and usually resolves rapidly with treatment; in such cases imaging is unnecessary except to exclude dilatation or the existence of an obstacle. Progression towards complex infection often occurs in patients with predisposing factors. Imaging helps in evaluating the extent of the disease; it has a role in the selection of therapy and interventional procedures.

Objectifs L’objectif de cette etude etait d’evaluer l’apport de l’IRM multiparametrique comme parametre a part entiere pour predire la presence de cancer significatif sur piece de prostatectomie, et donc pour influencer la decision de traitement chez les patients presentant un cancer de prostate potentiellement eligible a une surveillance active (SA) apres realisation de biopsies systematisees + -ciblees. Methodes Etude retrospective de 77 patients potentiellement eligibles a une SA pour un cancer de prostate localise (PSA ≤15 ng/mL, stade ≤ T2a, score de Gleason = 6, 1 a 3 biopsies positives et une longueur tumorale maximale ≤ 5 mm) et traites par prostatectomie totale (PT) entre 01/2008 et 08/2015. Tous les patients ont eu une IRM et des biopsies systematisees ± ciblees. Pour chaque patient, un score de suspicion IRM etait attribue selon une echelle 1 a 5. Les facteurs predictifs de la presence de cancer significatif sur les pieces de PT (score de Gleason ≥ 7 et/ou diametre tumoral maximal >10 mm) etaient evalues par une regression logistique. Resultats L’âge median etait de 61 ans et le PSA median de 6,7 ng/mL. Au total, 49 (64 %) patients presentaient une IRM positive (score ≥ 3). Un cancer significatif etait retrouve dans 45 (58 %) cas. Le taux de cancer significatif etait plus eleve chez les patients presentant une IRM positive (76 % vs 46 % ; p = 0,009). En analyse multivariee, une IRM positive etait un facteur predictif de la presence d’un cancer significatif sur la piece operatoire (OR = 3,0 ; p = 0,04), tout comme l’âge (OR = 1,17 ; p = 0,004) et la densite du PSA (OR = 1,10 ; p = 0,02).( Fig. 1 ) Conclusion Notre etude a montre que l’IRM est un examen fiable pour selectionner les patients eligibles a une SA meme en cas de doute apres realisation de biopsies prostatiques comprenant des biopsies ciblees. Cet examen pourrait constituer un critere a part entiere en vue d’une inclusion en SA.

To assess long term biochemical recurrence free survival after radical prostatectomy according to open, laparoscopic and robot-assisted surgical approach and clinicopathological stage.A cohort study of 1313 consecutive patients treated by radical prostatectomy for localized or locally advanced prostate cancer between 2000 and 2013. Open surgery (63.7%), laparoscopy (10%) and robot-assisted laparoscopy (26.4%) were performed. Biochemical recurrence was defined by PSA0,1ng/mL. The biochemical recurrence free survival was described by Kaplan Meier method and prognostic factors were analysed by multivariable Cox regression.Median follow-up was 57 months (IQR: 31-90). Ten years biochemical recurrence free survival was 88.5%, 71.6% and 53.5% respectively for low, intermediate and high-risk D'Amico groups. On multivariable analysis, the worse prognostic factor was Gleason score (P0.001). Positive surgical margins rate was 53% in pT3 tumours and 24% in pT2 tumours (P0.001). Biochemical recurrence free survival (P=0.06) and positive surgical margins rate (P=0.87) were not statistically different between the three surgical approaches.Biochemical recurrence free survival in our study does not differ according to surgical approach and is similar to published series. Ten years biochemical recurrence free survival for high-risk tumours without hormone therapy is 54% justifying the role of surgery in the therapeutic conversations in this group of tumours.3.

Intravesical instillations of BCG remains the gold standard for intermediate and high risk NMIBC management. Maintenance treatment is recommended, however, the frequency of side effects responsible for the discontinuation of maintenance therapy over four out of five patients before the third year suggest a reduction or even spacing instillations. The objective of the study URO-BCG-4 was the evaluation of a new maintenance schedule by intravesical instillations of BCG combined reduced dose (third dose) and a decrease number of instillations per cycle (two or three).Multicenter study of the French Association Oncologic Committee (12 university hospital centers), randomized, prospective, comparing reference diagram of BCG maintenance therapy one third of usual dose (group I) to a regimen combining third dose and decrease the number of instillations per cycle (two instead of three) (group II). We present the preliminary results at 1year of this Program of Clinical Research (CHU Rouen Promoter 2003-081).The rate of recurrence was respectively 9 and 7% (P=0.678) in groups I and II. The rate of tumor progression are 3 and 2.8% in groups I and II (P=1). Tolerance of intravesical instillations of BCG scored according to the WHO classification (Geneva 1979) was similar in the two groups.The decrease in the BCG dose (third dose) and the changes in the number and rate of instillations did not alter free tumor recurrence survival. The toxicity of intravesical instillations of BCG was identical in both groups. The use of the WHO classification has shown its limitations in the study of side effects of BCG as too complex and often not exhaustive. The rate of increase muscle was comparable in the two groups; however, a larger clinical experience is required.

To analyze the prognostic impact of lymphovascular invasion (LVI) in case of urothelial carcinoma of upper urinary tract (UUT-UC).Retrospective study of 83 consecutive patients treated surgically for UUT-UC between January 1998 and October 2008. Prognostic interest of histopathological factors (stage, grade, LVI, CIS, tumor architecture, location, nodal status and surgical margins) was assessed in univariate and multivariate Cox regression model. Specific survival (SS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using Kaplan-Meier method and Log-Rank test.LVI was observed in 26.5% of patients after histopathologic reviewing. The SS, RFS and MFS at 2 years were 93%, 76% and 96% respectively in group without LVI compared to 40%, 13% and 38% in group with LVI (P0.001). In univariate analysis, pathological stage, LVI and margin status were predictive of SS (P0.05). Pathological stage, LVI and surgical margin status were predictive of RFS (P0.05). LVI, tumor architecture and status of surgical margins were predictive of MFS (P0.05). LVI was the only independent predictive factor in multivariate analysis for all survival (P=0.002, 0.002 and 0.001 respectively for the SS, RFS and MFS).LVI was a poor prognostic factor in cases of UUT-UC. This criteria should be routinely sought and included in the pathology report.

Clinical and pathological characteristics of renal cell carcinoma (RCC) of patients younger than 40 years old are not well known. The objective of this study was to analyze these characteristics by comparison to a group of patients aged 58 to 62.Retrospective study of a group of patients aged less than 40 years old (group 1, n=44) and a group of patients aged 58 to 62 years old (group 2; n=106) treated surgically for a renal mass from January 2000 to July 2009. A comparative analysis of clinical, pathological characteristics and of cancer-specific survival was performed. Specific survival was calculated with the Kaplan-Meier method and compared with the Log-Rank test. Univariate and multivariable analysis were performed to assess and quantify the effect of age on cancer-specific survival. Covariates were gender, age group, tumor size, pT stage, histological sub-type and Fuhrman grade.Clinical and pathological characteristics were similar in both groups (P0.05) except for histological sub-type (56% of clear cell RCC for group 1 versus 82% for group 2). In the group of patients younger than 40 years, translocation RCC represented 23% of all RCCs. Cancer-specific survival at five years was similar in both groups (80% and 76% for group 1 and 2 respectively, P0.58). Fuhrman grade was the only independent prognostic factor of cancer-specific survival (P=0.001).Patients younger than 40 years were more likely to have a translocation RCC than their older counterparts for who clear cell RCC represented the main histological sub-type. Cancer-specific survival was similar between both groups. Only a systematic specific immunostaining for TFE3 or TFEB will allow to assess the exact incidence and prognosis of this entity.

Extramedullary hematopoiesis (EMH) refers to the location of hematopoietic elements in locations other than the bone marrow medullary space. EMH is an uncommonly isolated disease and it usually occurs during chronic hematologic disorders due to hematopoiesis hyperstimulation. Reticuloendothelial system is the most common site of EMH whereas the kidney is an extremely rare location. EMH lesions are frequently asymptomatic, nevertheless hemorrhagic manifestations can be observed. Patient history can help for making a diagnosis, which can be established by CT scan and/or MRI. Surveillance is recommended for asymptomatic cases while local therapies such as low dose radiation or surgery can be used to treat bleeding lesions. Systemic therapies using iron supplementation or blood transfusion are helpful to avoid disease recurrence. We report a case of pyelocaliceal EMH managed with laser vaporization during ureteroscopy procedures.

Bladder cancer is a common condition in industrialized countries. If tobacco is still the main risk factor in lung cancer, occupational exposures carcinogens should not be underestimated.The significant excess of bladder cancer in the north part of France, with high manufacture concentration likely to have employees exposed to bladder carcinogens, has led us to study the influence of these exposures in the natural history of bladder cancer.We prospectively conducted a descriptive case-control study. A questionnaire was developed by the department of occupational disease and clinical, radiological, histological, therapeutic data were registered at the University Hospital of Lille. From October 2005 to February 2009, 69 patients were included in the study, 37 exposed to occupational carcinogens and 32 in the control group.Mean age was 61.6 years vs. 61.8 years and the sex ratio of 7.33 men to one woman vs. one woman for three men respectively in the two groups. The average age of patients exposed to polycyclic aromatic hydrocarbons was 59.7 years. Smokers were 86.5% and 87.5% respectively. Follow-up was 38.4 and 32.9 months respectively. Nonmuscle invasive bladder cancer were more frequent (P=0.019) in the exposed group (84.4%) than in the unexposed group (67.8%) even after adjustment for smoking (P=0.0142). The histological type, grade, presence of CIS, the early recurrence at 3 months, the number of lesions at diagnosis does not differ in the two groups even after adjustment for smoking or after subgroup analysis of the most frequent exposure. The exposure to polycyclic aromatic hydrocarbons (62%) and aromatic amines (37.8%) were the most represented. Of 37 patients, 13 (35%) were making a statement as an occupational disease (eight according to Table 15 ter, two according to Table 16 bis and two presented to IRB). To date one single patient is recognized as an occupational disease.We did not observe any worsening of the prognosis of bladder cancer following occupational carcinogen exposure except for the mean age at diagnosis. The small size of the population studied and the importance of smoking partner have hampered the analysis of occupational exposures.

To validate the D'Amico risk group classification in French consecutive series and to analyse recurrence risk factor after radical prostatectomy (RP) for prostate cancer.We retrospectively analyzed data collected from 10/2000 to 05/2009 for 730 consecutive patients who underwent RP for clinically localized or locally advanced prostate cancer (cT1-cT3) in our institution. Biochemical recurrence (BCR) was defined by prostate-specific antigen (PSA) of greater than 0.1 ng/ml, with rising PSA at two consecutive dosages. Postoperative survival was estimated using the Kaplan-Meier method after D'Amico's group stratification. The accuracy of the model was evaluated using the Harrell's concordance index. The impact on outcomes of preoperative PSA and pathological features was evaluated using a monovariate and multivariate Cox analysis.Median follow-up was 30 months [interquartile range: 13-51]. The overall 3-year and 5-year probability of freedom from BCR was 85% (95% Confidence Interval (CI), 81-88%) and 78% (95% CI, 74-83%), respectively. For low, intermediate, and high-risk group, the 5-year freedom from BCR was 92% (95% CI, 88-97%), 73% (95% CI, 65-81%) and 44% (95% CI, 28-59%), respectively (p0.001). Harrell's concordance index was 0.71. Surgical margins were positive in 31% of all cases. In a multivariate analysis, preoperative PSA, pathological tumor stage, Gleason score and surgical margins status predicted BCR after RP.We externally validated the ability of the D'Amico's risk group stratification to predict disease progression following RP in European patients. Preoperative PSA, pathological stage, Gleason score and surgical margins status predicted BCR after RP in our series through a multivariate analysis.

To verify the effectiveness and safetiness of artificial urinary sphincter (SUA) AMS 800™ in the management of urinary incontinence by sphincter incompetence.Retrospective study of patients who received SUA by the same operator between 1992 and 2006. Fifty-seven men and 27 women whose average age was 61 years (22-82) suffered from incontinence by sphincter incompetence: after radical prostatectomy (46%), primary stress or mixed incontinence (21.4%), transurethral resection of prostate (9.5%), injury and neurological malformations (9.5%), pelvic or urethral trauma (7.1%), rectal surgery (3.6%), adenomectomy (2.4%). Functional assessment was made by telephone based on a 23-item questionnaire (Appendix 2).The mean follow-up was 52.6 months (5.3-187.1): 64% had their original SUA, 50 re-interventions were necessary for 30 patients with 13.1% mechanical complications, 6.6% urethral atrophy, and 13.9% infectious complications, 2.5% failures and 9% definitive explant. The half-time survival without revision was 8.3 years. Sixty-seven percent of patients were contacted for the functional assessment: 77% success rate (≤1 protection), 85% of patients improved, 87% satisfied or very satisfied and 94% would go again through the same operation.The artificial urinary sphincter AMS 800™ remains still the reference in the management of urinary incontinence by sphincter incompetence in improving the quality of life of patients implanted at the cost of a significant revision rate and frequent residual leaks.

The aim of this work is to study variations of prostate cancer incidence by stage as a function of time and place in a region of France.Retrospective observational survey conducted in five private and public urology centres representative of the various demographic features of the Nord-Pas-de-Calais region. In each centre, the medical records of the first 25 cases of prostate cancer diagnosed in 1998, 2002 and 2004, identified from histology laboratory data, were studied by means of a case report form evaluating the circumstances of diagnosis, PSA level, grade, stage (TNM 97, classification) and initial management.This analysis was based on 123, 124 and 125 patients in five centres in 1998, 2002 and 2004, respectively. The age at diagnosis ranged from 71.14 to 68.9 years between 1998 and 2004 (p=0.054). Median PSA decreased over this six-year period from 18 to 10.8 ng/ml. Between 1998 and 2004, the percentage of patients with localized cancer (PSA20 ng/ml) increased from 44.8 to 66.4% (p0.05), the percentage of patients with locally advanced cancer (PSA between 20 and 50 ng/ml) decreased from 17 to 9.6% (p0.05), the percentage of patients with regional or distant metastatic disease (N1 and/or M1 and/or PSA50 ng/ml) decreased from 29.4 to 22.4% (p0.05) and the percentage of patients receiving curative treatment increased from 30 to 54.4% (p0.005).The prostate cancer incidence by stage varied between 1998 and 2004, with a significantly higher proportion of localized stages, which can be explained by the increased use of screening and diagnostic tests. Routine surveys can measure trends and the amplitude of incidence variations in the population of a region. A representative survey conducted in centres throughout France would allow evaluation of national trends between two publications of incidence by stage results in French registries.

This review analyzes the role of imaging in the diagnosis, follow-up and management of urinary tract infections. Uncomplicated infection of the urinary tract is frequent and usually resolves rapidly with treatment; in such cases imaging is unnecessary except to exclude dilatation or the existence of an obstacle. Progression towards complex infection often occurs in patients with predisposing factors. Imaging helps in evaluating the extent of the disease; it has a role in the selection of therapy and interventional procedures.

Clean intermittent catheterization has become a usual procedure in urologic practice. Self lubrificated catheters are nowadays accepted as the most efficient. This randomised and prospective study compared tolerance and efficiency in a group of 27 patients of three well known catheters (12 charriere, straight): Flocath (Ruschcare), Lofric (Astratech) and Easycath (Coloplast). The systematic comparison of this three catheters did not allow to put in a prominent position one of these. The three catheters are extremely close in terms of tolerance and performance.