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Naim Yarak, Skander Zouari, Omar Karray, Walid Sleiman, Alaa Abdelwahab, Stéphane Bart, Maher Abdessater Urology Department, Centre Hospitalier Régional René DUBOS, Pontoise, 95300, FranceCorrespondence: Maher Abdessater, Email maher.abdessater@gmail.comObjective: To describe our new endoscopic approach in treating iatrogenic ureteral stenosis using the “cut-to-The-light” technique.Methods: Case of a 54 year-old female patient who underwent a right percutaneous nephrolithotomy to treat a staghorn calculus with two subsequent complimentary ureteroscopies complicated by a severe proximal ureteral obstruction. An antegrade flexible uretereroscope and a retrograde rigid ureteroscope were used to locate the stenosis. With the aid of a 365-μm Ho: YAG laser fiber (settings 0.4 J, 12 Hz), we managed to successfully create a small incision in the stenotic lesion, the rigid ureterscopy light was clearly seen by the antegrade flexible ureteroscope and a through-and-through guidewire was then placed, securing the ureter. Ureteral dilatation was then performed followed by a full thickness incision of the ureteral stenosis. A single 8Fr, 28 cm double J ureteral stent was finally placed after stone fragmentation.Results: The operating time was 200 mins. No blood loss. No fever or signs of UTI were seen shortly after the operation. The Foley catheter was successfully removed at day one post-op. The hospital stay was short of only 2 days.Conclusion: The “cut-to-the-light” technique is a new application in the arsenal of ureteral stricture treatment that has been scarcely described in the literature before. The use of this method seems to offer excellent outcomes thus demonstrating the importance of this minimally invasive technique as an alternative to conventional invasive methods used. We believe that studies with larger samples and longer follow up are needed in order to fully determine the benefits of this method and to assess and reveal its suitable application and its drawbacks.Keywords: ureteral stenosis, ureteroscopy, “cut-to-the-light” technique, laser endoureterotomy

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Copyright of Proges en Urologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and Objectives: Bladder cancer (BC) represents the seventh cancer in male patients. The majority of bladder cancers are low-grade (LG) andnon-muscle-invasive cancers (NMIBC). 10 to 20% of patients are initially diagnosed with high-grade (HG NMIBC), and muscle - invasive tumors (MIBC), exhibiting aggressive clinical behavior. Despite significant advances in surgical techniques and adjuvant therapies, bladder cancer remains a lethal malignancy with high rates of recurrence and therapeutic resistance. Therefore, innovative therapeutic strategies based on new molecular markers are required to improve prognosis. Many human cancers have proven the let-7 expression deregulation. Their implication is agreed in the regulation of the expression levels of oncogenes like HMGA2, RAS and Mycalong, in association with genes involved in cell cycle and division control. Therapeutic strategies are developed targeting let-7, using either lenti-or adenoviral-encoded overexpression of let-7 or transient transfection of double-stranded precursors of let-7. Thus, let-7 seems to be promising as a molecular marker in certain cancers with a potential therapeutic impact. We discuss the role of let-7c in normal and bladder tissues, in order to confirm the causality between deregulated let-7 expression, tumorogenesis and BC prognosis. Methods: The expression levels of let-7c was measured using quantitative Real-time polymerase chain reaction (qRT-PCR) analysis for 90 cases with different stages and grade. The association between let-7c expression and epidemiological and clinicopathological factors was analyzed. Results and Conclusions: Mean age at diagnosis was 70.04 (±12.15). 83 were male (99, 2%) and 7 were female patients (7,8%).23 tumors were LG NMIBC, 44 were HG NMIBC and 23 were MIBC. The Let-7cmiR was down regulated in BC samples in comparison with non tumoral ones (p value < 0.05). The expression levels distribution was similar in the three groups (p=0,34). There wasn't a correlation in the expression of Let 7C in LG NMIBC and NMIBC HG (p=0, 22). There wasn't a statistical association between the down regulation of Let-7C and epidemiological parameters such as tobacco smoke exposure (p=0, 87), alcohol consumption (p=0,77) and exposure to professional cancer-causing substances (p=0,09). Finally, oncelet-7C expression was correlated to clinical features, down regulation was not associated to progression (p=0,07) or recurrence (p=0,18). These results suggest that deregulation of Let-7C expression is associated with the initiation of tumorigenesis in bladder cancer but was not implicated in the further evolutive course. [ABSTRACT FROM AUTHOR]

Background: According to the European guidelines, any urological surgery breaching the mucosa requires preoperative screening and antibiotic treatment of any asymptomatic bacteriuria (ABU)., Methods: The aim of this study was to determine whether the preoperative antibiotic treatment duration of ABU in urological surgery impact postoperative infectious complications. National multicenter, retrospective study including all consecutive patients screened for ABU before urologic surgery in 10 centers from 1 st April 2019 to April 2023. The primary endpoint was all postoperative infectious complications occurring within 30 days after surgery. Short antibiotic treatment (SAT) of ABU was defined by 5- day regimen or less. Long antibiotic treatment (LAT) was defined by duration longer than 5 days., Results: Among the 2389 patients included, 839 (35.1%) patients had positive urine culture (UC), of whom 546 (65%) had positive mono or bimicrobial UC and 292 (34.8%) polymicrobial UC. There were 106 (4.4%) postoperative infectious complications occurring within 30 days including 62 (58.5%) in the positive UC group. In the positive UC group, 336 (40%) had received SAT, 261 (31.1%) LAT and 231 (27.5%) had not received any treatment. The 30-day surgery-related infection rates were 8.3%, 6.1% and 7.36% respectively. There was no statistical difference between SAT versus LAT in the univariate analysis (P=0.6) or in the multivariate analysis OR 1.97 [0.37, 1.86] (P=0.06)., Conclusions: Our results found no association between antibiotic treatment duration and urinary infectious complication among patients with preoperative ABU who undergo urological surgery. These results need a RCT to be confirmed.

Purpose: Current guidelines recommend screening and treatment of asymptomatic bacteriuria prior to all urological surgeries breaching the mucosa. But little evidence supports this recommendation. At the least, risk stratification for postoperative UTI to support this strategy is lacking. The aim of this study was to define the associated factors for postoperative febrile infectious complications (UTI or surgical site infection) in urological surgery., Materials and Methods: We conducted a retrospective, multicentric study including all consecutive patients undergoing any urological surgery with preoperative urine culture. The primary outcome was the occurrence of a UTI or surgical site infection occurring within 30 days after surgery., Results: From 2016 to 2023, in 10 centers, 2389 patients were included with 838 (35%) positive urine cultures (mono-/bi-/polymicrobial). Postoperative infections occurred in 106 cases (4.4%), of which 44 had negative urine cultures (41%), 42 had positive mono-/bimicrobial urine cultures (40%), and 20 had polymicrobial urine cultures (19%). In multivariable analysis, UTI during the previous 12 months of surgery (odds ratio [OR] 3.43; 95% CI 2.07-5.66; P < .001), monomicrobial/bimicrobial preoperative urine culture (OR 3.68; 95% CI 1.57-8.42; P = .002), polymicrobial preoperative urine culture (OR 2.85; 95% CI 1.52-5.14; P < .001), and operative time (OR 1.09; 95% CI 1.04-1.15; P < .001) were independent associated factors for postoperative febrile infections., Conclusions: Positive urine culture, including preoperative polymicrobial urine culture, prior to urological surgery was associated with postoperative infection. Additionally, patients experiencing infectious complications also had a higher incidence of other complications. The effectiveness of systematic preventive antibiotic therapy for a positive urine culture has not been conclusively established.

Introduction: In the era of increased bacterial resistance, the main strategy is to reduce the prescription of antibiotics when possible. Nowadays, it is highly recommended to screen for asymptomatic bacteriuria (ABU), prior to urological surgery with potential mucosal breach or urine exposure. Screening and treating urinary colonization is a strategy widely adopted before radical and partial nephrectomy but without any evidence. Our main end point in this study is to analyze the relationship between preoperative urine culture and the risk of postoperative febrile urinary tract infection (UTI) or surgical-site infection (SSI) in partial or radical nephrectomy patients., Methods: We conducted a multicenter retrospective cohort study between January 2016 and January 2023 in 11 French tertiary referral hospitals (TOCUS database). We collected the data for 269 patients including several pre-, intra-, and post-operative variables that could potentially increase the risk of postoperative UTI and SSI including preoperative urinary culture results., Results: The incidence rate of postoperative UTI and SSI was 8.9% in our study. After conducting a logistic multivariate analysis, a propensity score matching analysis, and a subgroup analysis, we found no significant correlation between the urine culture and the postoperative UTI risk [OR = 1.2 (0.5-2.7) (p = 0.7)]. Only the postoperative non-infectious complications were related to a higher risk of postoperative UTI [OR = 12 (4-37), p < 0.001)]., Conclusion: Our research shows that screening and treating for ABU prior to radical or partial nephrectomy seems to be unnecessary to prevent postoperative UTI and SSI., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Limbic encephalitis is an autoimmune neurologic disorder, often of paraneoplastic origin, that seldom complicates prostatic tumors. The nonspecificity of symptoms makes the diagnosis sometimes difficult to establish. Prognosis is essentially determined by comorbidities and sensorineural and cognitive sequelae., Clinical Case: A 66-year-old Caucasian patient known to have prostatic small-cell neuroendocrine adenocarcinoma under hormonal therapy developed complex partial epileptic seizures associated with rapidly aggravating severe memory impairment. The tripod of autoimmune limbic encephalitis diagnosis was based on the clinical aspect of brain's functional deterioration, electroencephalography aspect, and γ-aminobutyric acid type B anti-receptor antibody positivity. Clinical, diagnostic, and therapeutic management as well as evolutionary risks were further analyzed., Conclusion: Limbic encephalitis is an extremely rare presentation of neurologic paraneoplastic syndromes. A better knowledge of this entity would help better manage diagnostic and therapeutic difficulties and reduce the risk of possible sequelae., (© 2021. The Author(s).)

Background: Primitive neuroendocrine prostate neoplasms are rarely reported. This entity comprises carcinoïd tumors and poorly differentiated neuroendocrine tumors, mainly those of the small-cell type. Large-cell-type primitive tumors are exceptional, and only nine cases are reported in the literature. Similar to neuroendocrine tumors of the prostate, large-cell-type primitive tumors may be observed in the context of conventional adenocarcinoma during androgen deprivation therapy or as prostatic metastasis of a distant neuroendocrine tumor, mainly pulmonary neoplasms., Case Presentation: We report a Caucasian case of a mixed prostatic carcinoma, with the largest component being the large-cell neuroendocine carcinoma, in a patient who underwent a total prostatectomy for a localized cancer. Diagnostic, histological, therapeutic and evolutive aspects are reported and discussed., Conclusions: Large-cell primitive prostate neuroendocrine carcinoma is a rare but aggressive histological entity, which can be associated or not with an adenocarcinomatous component. Mixed forms have a better outcome, mainly when diagnosed at an early stage.

Among extramedullary manifestations of multiple myeloma, testicular localization is exceptional. A scrotal mass in this context poses diagnostic and therapeutic challenges given the aesthetic, psychological and reproductive impact of surgery. Authors report a case of testicular plasmocytoma seven years after remission from multiple myeloma. The treatment consisted of left inguinal orchidectomy. Diagnosis needed the recourse to immunohistochemistry. Diagnostic modalities, therapeutic options and evolutive eventualities will be discussed. Extra-medullar localization is exceptionally reported in extramedullary multiple melanoma. Management depends on the concomitant or distant character of hemopathy diagnosis and the disease evolutive history., (© 2020 The Authors. Published by Elsevier Inc.)

Hsa-mir-143 and hsa-let-7c have been reported to be deregulated in multiple neoplasms. The main purpose of this study was to investigate the expression of these miRNAs in bladder cancer (BCa) and to analyze the association between their expression profiles and clinical and epidemiological parameters. Ninety BCa specimens were included. Expression patterns of miR-143 and let-7c were assessed by qRT-PCR using Taqman specific probes. Validated and predicted targets of these miRNA's were identified using CSmiRTar and DAVID tools, respectively. miR-143 was downregulated in tumors compared to controls (mean fold-change (FC) = 0.076). Its expression was significantly higher in MIBC compared to NMIBC (p = 0,001). Its value as a potential biomarker discriminating non invasive tumors from the invasive ones was confirmed by ROC curve (AUC = 0.768; p = 0.0001). Also, this down-regulation positively correlates with frequency of tobacco use (p = 0,04) and chronic alcohol consumption (p = 0,04). Let-7c was overexpressed in BCa samples (mean (FC = 9.92) compared to non tumoral ones but was not associated to clinical and epidemiological parameters. A comprehensive overview of miR-143 targets and pathways implicated in BCa initiation, diagnosis or prognosis using bioinformatical analysis, was conducted. While both deregulated miRNAs may contribute to urothelial tumorigenesis, the deregulation of miR-143 was significantly correlated to epidemiological and clinical parameters.

Introduction: The subdivision into two entities of papillary renal cell carcinoma (PRCC) was established on histological criteria. It's in fact possible to distinguish the two subtypes by the means of radiological and progressive data. The subtype 1 is associated with the favorable profile. The ultrasound and especially CT urography ensure an accurate diagnostic approach with substantial therapeutic and prognostic involvement. The aim of the study is to define the radiological features that distinguish the two subtypes of renal papillary carcinoma, and to study the radiological predictive factors of locoregional recurrence, metastases free survival and specific survival., Methods: It's about a monocentric, retrospective study led between January 2005 and June 2017, gathering 49 cases of operated PRCC. The study concerned patients over the age of 18, who were diagnosed after anatomopathological examination of the operative specimen (enlarged nephrectomy or conservative surgery). Cases in which diagnosis was made by renal biopsy were excluded. The comparative study concerned ultrasound and CT scan data. Univariate and multivariate analysis were performed to determine factors having a prognostic value in terms of locoregional recurrence, metastases-free and specific survival., Results: On the ultrasound, the subtype 1 tumors were significantly homogenous with regular contours. Tumors were globally spontaneously hypodense and hypo vascular in 97,8% of cases. Enhancement was significantly more heterogonous for subtype 2 (p=0,01). Intratumoral necrosis and adenomegalies were associated with subtype 2 (p=0,0001 and 0,005). The predictive factors of locoregional recurrence, metastases-free survival and specific survival in univariate analysis were the contours' aspect, moderate enhancement and the presence of adenomegalies. On multivariate analysis, only the irregular contours were retained for locoregional recurrence-free survival and specific survival., Conclusions: Significant differences between the PRCC subtypes were observed when studying the radiological data. Irregular contours, adenomegalies and enhancement degree seemed to predict the progression of PRCC after curative surgery.

Background: Stratification and risk-evaluation of bladder cancer (BCa) patients are far-reached issues, especially for those with non muscle invasive disease. Thus, setting-up biomarkers, especially after resection of the primary tumor, is crucial. Specifically, Neutrophil to lymphocyte ratio NLR and let-7 deregulation which have been preliminarily but not consistently described to be associated to unfavorable prognosis., Objective: To explore the clinical value of pre-treatment Neutrophil to Lymphocyte Ratio (NLR), let-7c and let-7g's deregulation., Methods: Data were extracted from ninety BCa samples. Pre-treatment NLR was estimated as the absolute neutrophil count divided by the absolute lymphocyte count. Expression patterns of let-7c and let-7g were assessed by qRT-PCR. Correlation with clinical characteristics was performed by descriptive statistics., Results: Both let-7 miRs were upregulated. Interestingly, let-7g was associated to pathological stage (p= 0.001) and tumor multiplicity (p= 0.003). NLR was associated to histological grade (p= 0.005) and clinical stage (p= 0.006). They were both associated to more aggressive phenotype and their worth as potential stratification biomarkers was confirmed by ROC curve., Conclusions: Our data demonstrated the potential clinical value of all markers, especially pretreatment NLR and let-7g. Further studies are recommended to confirm their utility in improving the clinical decision-making regarding treatment and follow-up scheduling.

There is a major need for the identification of biomarkers, which are able to guide personalized therapy for bladder cancer, in particular after resection of the primary tumor. Specifically, miR-9 upregulation has been preliminarily associated with a more aggressive phenotype of bladder cancer, namely muscle-invasive bladder cancer (MIBC) or high-grade non-muscle-invasive bladder cancer (HG NMIBC). In order to explore the potential utility of miR-9 as a biomarker in bladder cancer, we have investigated its expression pattern in a sample of Tunisian patients who have undergone primary resection. This is a retrospective study performed on BCa samples from 90 patients (44 specimens of HG NMIBC, 23 specimens of LG NMIBC, and 23 specimens of MIBC). Ten samples from the non-tumoral zone of cystectomy specimens were used as controls. For each specimen, we measured miR-9 expression and correlated it with the clinical characteristics of the patients. Overall, miR-9 was overexpressed in MIBC compared to NMIBC specimens (median fold change [FC]: - 8.89 vs 1.41, p = 0.001). Similarly, miR-9 expression was significantly different in LG NMIBC, HG NMIBC and MIBC subgroups (median FC: 0.68, 2.14 and 8.89, respectively; p = 0.001). ROC analysis showed that miR-9 expression pattern could be used as potential biomarker for distinguishing NMIBC subgroups: indeed miR-9 expression is relatively low in LG NMIBC and high in HG NMIBC. The thresholds are estimated at 0.063 and 21.597, respectively. Moreover, miR-9 was associated with a higher risk of progression. This study suggests the clinical value of miR-9 as a prognostic factor in bladder cancer after tumor resection. Should the prognostic ability of miR-9 be confirmed in larger studies, also on different ethnic groups, it would be useful to investigate whether urine sampling-which is easier to perform, less invasive and less costly-can provide the same results as analysis on surgical specimens.

Introduction: Ureteral ectopia is a rarely observed anomaly. It may be totally asymptomatic. An association with a duplex system is exceptional. Diagnostic and therapeutic approaches are challenging. Carcinologic surgery must consider the anatomic variant, mainly related to the ectopic site of the ureteral orifice., Observation: We report a case of a ureteral urothelial carcinoma in a North African 52-year-old male patient, in a right duplex system. Radiological explorations concluded a non-functional upper right kidney. A suspect mass was observed in the lumbar part of the ureter of the right upper system. The meatus of the tumorous ureter ended in the right lobe of the prostate. A right hemi-nephro-ureterectomy was performed. A histological examination concluded a pT2G2 urothelial carcinoma., Conclusion: Even if malignancy is rarely observed in ureteral ectopia, it should be evoked mainly in cases of hematuria with risk factors for urothelial tumors.

Introduction: Paratesticular tumors are rarely observed among scrotal neoplasm. Various types of benign lesions are described. Cavernous hemangioma belongs to uncommon epididymal benign tumors. Clinical and sonographic features are not conclusive and diagnosis requires histological confirmation., Case Presentation: Authors report a case of an epididymal hemangioma in a 56-year-old patient, consulting for a painful scrotal swelling. As malignancy was suspected, he underwent inguinal orchiectomy. Histological examination confirmed the diagnosis of cavernous epididymal hemangioma. Clinical and therapeutic aspects of this rare entity are discussed., Conclusion: Epididymis is an infrequent location of cavernous hemangioma. Diagnosis is rarely made preoperatively as symptoms and radiological aspects are not specific. Conservative surgery must be attempted once feasible for aesthetic and functional purposes.

Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma and peri-renal tissues, characterized by the presence of air within the parenchyma of the urinary tract and peri-renal space. This is a severe complication, which involves the functional prognosis of the kidney and the patient's prognosis. The emphysematous pyelonephritis is a rare complication of renal transplantation. Its gravity is linked particularly to the fragility of immunosuppressed patients. The authors report the case of an emphysematous pyelonephritis having occurred 9 months after transplantation in a patient 58 years. The evolving risks and therapeutic modalities will be outlined and discussed., (Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Background: Rupture of the common bile duct is a life-threatening condition, usually observed after a trauma or in association with choledocholithiasis or an obstructive tumor of the bile duct. However, a spontaneous rupture of the common bile duct is a rare entity., Case Presentation: We report a new observation of a spontaneous rupture of the common bile duct, associated with biliary peritonitis and pancreatitis, in a 15-year-old North African girl. Etiological aspects, specificities of clinical presentation, means of diagnosis, as well as surgical and perioperative management are discussed., Conclusions: The diagnosis of spontaneous rupture of the common bile duct is a challenge for both radiologist and surgeon. Beyond the difficulty of diagnosis, which requires radiological exploration, management of the subsequent biliary peritonitis involves urgent surgery, life-supporting measures, and close monitoring.

Cystic lymphangioma is a rare, benign malformation of the lymphatic vessels which may be observed on various locations. Retroperitoneal location is less common than mesenteric location. Cystic lymphangioma has a polymorphic clinical presentation. Diagnosis is based on imaging but requires histological confirmation. Surgery is the treatment of choice. The aim of our study is to analyze the clinical manifestations, complications, diagnostic and therapeutic aspects of this tumor. We report a case series of 5 patients with retroperitoneal cystic lymphangioma (4 women and 1 man) operated in our department between the years 2004 and 2014. Their medical records were reviewed retrospectively. Follow-up was based on clinical examination and abdominal CT scan. The average age was 45 years. The mean follow-up was 32.6 months. The most common symptoms indicative of retroperitoneal cystic lymphangioma were pains and/or an abdominal mass. Abdominal CT scan was the most useful diagnostic test. Total resection was immediately achieved in 4 patients and it was deferred for up to 5 years in one patient. He underwent annual ultrasound monitoring. One patient underwent nephrectomy. No recurrence or complications were noted in 5 patients. Retroperitoneal cystic lymphangioma is a rare condition. Its therapeutic management is based on complete resection in patients with symptomatic lesions or complications, in order to limit the risk of recurrence. Complete resection may be deferred in asymptomatic patients., Competing Interests: Les auteurs déclarent ne pas avoir de conflits d'intérêts en relation avec cet article.