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Computer-assisted pathology is one of the biggest challenges in the medicine of the future. However, artificial intelligence is struggling to gain acceptance in the broader medical community due to data security issues, lack of trust in the machine, and poor data availability. Here, we develop a tumor delineation algorithm with only eight whole slide images of ovarian cancer to demonstrate the feasibility of an artificial intelligence application created from only a few data, finely annotated and with optimal processing. We test the model on seventeen other slides from the same hospital. The predictions are similar to the ground truth annotations made by an expert pathologist, with a mean DICE score of 0.90 [0.85 - 0.93]. The results on slides from another hospital are consistent, suggesting that the model is generalizable and that its performance does not suffer from different data acquisition. This study demonstrates the feasibility of a contouring algorithm based on a reduced dataset well optimized, going against the commonly accepted idea that a phenomenal amount of data is paramount. This study paves the way for other medical applications, especially for rare pathologies with limited available data.

To update the French guidelines on kidney cancer.- A systematic review of the literature between 2015 and 2020 was performed. The most relevant articles regarding the diagnosis, the classification, surgical treatment, medical treatment and follow-up of kidney cancer were retrieved and included in the new guidelines. The guidelines were updated with corresponding levels of evidence.- Thoraco-abdominal CT scan with injection is the best radiological exam for the diagnosis of kidney cancer. MRI and contrast ultra-sound can be useful in some cases. Percutaneous biopsy is recommended when histological results will affect clinical decision. Renal tumours must be classified according to pTNM 2017 classification and ISUP grade. Metastatic kidney cancers must be classified according to IMDC criteria. Partial nephrectomy is the recommended treatment for T1a tumours and can be done through an open, laparoscopic or robotic access. T1b tumours can be treated by partial or total nephrectomy according to tumour complexity. Radical nephrectomy is the recommended treatment of advanced localized tumours. There is no recommended adjuvant treatment. In metastatic patients: cyto-reductive nephrectomy can be offered in case of good prognosis; medical treatment must be counseled first in case of intermediate or bad prognosis. Surgical or local treatment of metastases should be considered in case of solitary lesion or oligo-metastases. First line recommended drugs in metastatic patients include the associations axitinib/pembrolizumab and nivolumab/ipilimumab. Cystic tumours must be classified according to Bosniak Classification. Surgical excision should be offered to patients with Bosniak III and IV lesions. It is recommended to follow patients clinically and with imaging according to tumour aggressiveness.- These updated recommendations should assist French speaking urologists for their management of kidney cancers.

International audience; Renal cell carcinoma is the third type of urologic cancer and has a poor prognosis with 30% of metastatic patients at diagnosis. The antiangiogenics and targeted immunotherapies led to treatment remodeling emphasizing the role of the tumour microenvironment. However, long-term responses are rare with a high rate of resistance. New strategies are emerging to improve the efficacy and the emerging drugs are under evaluation in ongoing trials. With the different treatment options, there is an urgent need to identify biomarkers in order to predict the efficacy of drugs and to better stratify patients. Owing to the limitations of programmed death-ligand 1 (PD-L1), the most studied immunohistochemistry biomarkers, and of the tumor mutational burden, the identification of more reliable markers is an unmet need. New technologies could help in this purpose.

Depuis la dernière classification OMS des tumeurs urogénitales en 2004, les progrès en pathologie moléculaire ont permis de démembrer un certain nombre de sous-types histologiques des tumeurs du rein avec des profils histologiques, phénotypiques et moléculaires différents. Cette revue a pour objectif de rappeler les dernières nouveautés concernant l’évolution de la classification OMS des tumeurs du rein et les facteurs pronostiques requis pour ces cancers.

Tubulocystic renal cell carcinoma is a rare tumor with an indolent behavior in the majority of cases. In contrast, tubulocystic renal cell carcinoma with poorly differentiated foci has a bad prognosis with an aggressive and metastatic behavior. We present the case of a patient diagnosed with tubulocystic renal cell carcinoma with poorly differentiated foci.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004. C’est cette nouvelle version qui doit être utilisée pour citer l’article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the DOI:10.1016/j.purol.2019.01.004. That newer version of the text should be used when citing the article.

Hereditary apolipoprotein A-I (apoA-I) amyloidosis (AApoAI) is a life-threatening incurable genetic disorder whose molecular underpinnings and the full spectrum of afflicted organs are unclear. We report a new form of AApoAI with amyloid deposition in multiple organs, including an unprecedented retinal amyloidosis. Genetic and proteomic analyses identified Glu34Lys apoA-I as the fibrillar protein causing the clinical manifestations. A life-saving combined hepatorenal transplantation was performed for one Glu34Lys carrier. To elucidate structural underpinnings for amyloidogenic properties of Glu34Lys, we generated its recombinant globular domain and compared the conformation and dynamics of its lipid-free form with those of two other naturally occurring apoA-I variants, Phe71Tyr (amyloidogenic) and Leu159Arg (non-amyloidogenic). All variants showed reduced stability and altered aromatic residue packing. Molecular dynamics simulations revealed local helical unfolding and suggested that transient opening of Trp72 induced mutation-dependent structural perturbations in a sensitive region, including the major amyloid hotspot residues 14-22. We posit that a shift from the “closed” to an “open” orientation of Trp72 modulates structural protection of amyloid hotspots, suggesting a previously unknown early step in protein misfolding.

Tubulocystic renal cell carcinoma is a rare tumor with an indolent behavior in the majority of cases. In contrast, tubulocystic renal cell carcinoma with poorly differentiated foci has a bad prognosis with an aggressive and metastatic behavior. We present the case of a patient diagnosed with tubulocystic renal cell carcinoma with poorly differentiated foci.

Renal carcinomas are histologically and prognostically heterogeneous. Genomic as well as chromosomal studies of these tumors have permitted a better comprehension of molecular mechanisms implicated in their development and progression. The most frequent histological subtypes are characterized by recurrent cytogenetic abnormalities, such as the loss of the chromosome 3 short arm involving a VHL gene copy in clear cell renal carcinomas, or trisomies 7 and 17 in papillary renal cell carcinomas. New histological subtypes like renal carcinomas associated with Xp11.2 translocations have also been individualized. Besides diagnosis, some chromosomal aberrations like the loss of a short arm of chromosome 9 in different renal carcinoma histological subtypes have a worse prognostic impact. The identification of chromosomal shuffles contributes in backing histological diagnosis and in precising the individual prognosis of patients. This review describes chromosomal abnormalities associated to renal carcinomas and their impact for an accurate classification of these tumors and the evaluation of their prognosis.

The previous guidelines from the Cancer Committee of the Association Française d'Urologie were published in 2013. We wanted this new version to be simple, clear and straightforward. All significant recent publications on kidney cancer have been included. The main changes compared to 2013 are the following: © 2016 Elsevier Masson SAS. All rights reserved.

The aim of this study was to report perioperative and oncological outcomes of robot-assisted radical cystectomy (RARC) in a single-center series and to evaluate the impact of the experience on perioperative outcomes.Between March 2012 and January 2016, 41 patients underwent RARC associated with extended pelvic lymphadenectomy for muscle-invasive bladder cancer. All RARC included were performed by a single-surgeon in one center. Perioperative and oncological datas were collected prospectively. Recurrence-free (RFS), overall (OS) and cancer-specific survivals (CSS) were estimated using the Kaplan-Meier Method. The impact of the experience on perioperative data was estimated using Spearman's correlation test.Mean age was 67,7years (±10.6). Most patients underwent neoadjuvant chemotherapy (73.2%). Mean operative time and mean estimated blood loss were respectively 319.5minutes (±85.3) and 662.5mL (±360.9). Eight patients needed perioperative blood transfusion (19.5%). Conversion to open surgery was necessary in 3 cases (7.3%). Ileal neobladder was performed in 26.8% of the cases (54.5% being performed intracorporeal), and non-continent urinary diversion in 73.2%. Mean nodal yield was 17.7 (±9.3). Positive surgical margins were observed in 1 patient (2.3%). Mean length of stay was 13.2 days (±9.8). Postoperative complication rate was 46,3%. After a median follow-up of 16months, estimated 2 year-OS and CSS were respectively 62 and 76.1%. Estimated 2-year RFS was 67.6%. Perioperative outcomes improved with experience with a significant decrease in operative time (P=0.04) and a significant increase of nodal yield (P=0.05).In this single-center prospective study, satisfactory perioperative and oncological outcomes after RARC were observed despite the learning curve. Perioperative outcomes improved with surgeon's experience. Further studies are needed to confirm these findings.4.

Resume Le traitement du CRM chez les sujets âges est identique a celui des patients plus jeunes. Alors que les cytokines etaient classiquement contrindiquees chez les patients de plus de 70 ou 75 ans (notamment l’IL2), les nouvelles therapeutiques ciblees ont ete evaluees sans limitation d’âge et l’ensemble des etudes de phase III a inclus des patients de plus de 80 ans. Globalement, il ne semble pas y avoir de difference d’efficacite en fonction de l’âge (sauf peut-etre pour le temsirolimus). Concernant la tolerance, elle est satisfaisante avec l’ensemble des therapeutiques. La diminution de doses est un peu plus frequente, ce qui doit rendre prudent, notamment avec le sunitinib pour lequel une correlation directe entre la dose administree et l’efficacite a ete rapportee. Compte-tenu des donnees disponibles, aucune adaptation de dose en fonction de l’âge n’est recommandee dans le CRM.

Les carcinomes a cellules renales (CCR) representent un groupe heterogene de tumeurs dont les aspects anatomopathologiques, les voies moleculaires impliquees et les bases genetiques different. L’etude des syndromes de predisposition familiale aux CCR a permis une meilleure connaissance des voies moleculaires activees. Cinq voies de signalisation se degagent: la voie de l’hypoxie ou voie VHL/HIF/VEGF et la voie mTOR dans les CCR a cellules claires, la voie C-MET et la voie de la fumarate hydratase (FH) dans les carcinomes tubulopapillaires du rein de types 1 et 2, et la voie BHD (Birt-Hogg-Dube) dans le CCR chromophobe. La comprehension de ces mecanismes a deja permis le developpement de therapies ciblees pour ces tumeurs resistantes aux traitements conventionnels. La poursuite des investigations de transfert est essentielle pour la recherche de nouvelles cibles therapeutiques et pour l’evaluation de marqueurs predictifs de reponse aux differents traitements.

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

The aim of this study was to assess the impact of the acquisition of a Da VinciIt was a single center retrospective study including 280 patients who underwent PN from January 2006 to May 2013. The number of PN, tumors and patients' characteristics and perioperative outcomes have been assessed over 3 periods defined according to the main surgical approach: 2006-2008 (open PN), 2008-2010 (laparoscopic PN) and 2010-2013 (robotic PN).Over the study period, the surgical approach has changed significantly in favor of minimally-invasive surgery and especially robotic approach. The PN/nephrectomy rate has also evolved to a higher proportion of PN over radical nephrectomy (P=0.002). No significant difference was noted between the three periods in terms of tumor size but there was a higher rate of highly complex tumors (RENAL score≥10) during the last period (10.7%; 18.6% and 33.2%; P=0.04). Warm ischemia time increased from 2006-2008 to 2008-2010 (26 vs. 23minutes) but decreased thereafter during the robotic era (14.5minutes; P0.001). Regarding postoperative outcomes, the only change was a decreased length of stay over time (P=0.003).In this single center series, the robotic approach was associated with a spread of PN and with an improvement of nephron-sparing surgery outcomes.4.

Resume Introduction L’epidermolyse bulleuse dystrophique recessive d’Hallopeau-Siemens (EBDR-HS) est une dermatose bulleuse hereditaire severe, due a un deficit en collagene VII. Les infections cutanees a repetition observees dans cette affection sont responsables d’un syndrome inflammatoire chronique, et peuvent se compliquer d’amylose AA avec insuffisance renale chronique engageant le pronostic vital. Moins souvent dans l’EBDR-HS, l’insuffisance renale peut etre due a une autre nephropathie : la glomerulonephrite a depots mesangiaux d’IgA ou maladie de Berger. Seulement deux cas ont ete decrits dans la litterature. Nous en rapportons quatre nouvelles observations. Observations Nous rapportons quatre cas d’EBDR-HS associee a une glomerulonephrite a depots mesangiaux d’IgA. Une ponction-biopsie renale a confirme le diagnostic chez les 4 malades. Deux malades ont eu ulterieurement une deuxieme ponction-biopsie renale pour aggravation de la fonction renale. L’une de ces 2 malades avait sur la deuxieme ponction-biopsie renale une nephropathie amylosique de type AA. Aucune des 6 ponctions-biopsies renales pratiquees chez nos 4 malades n’a ete suivie de complications cutanees locales. Trois malades ont eu une insuffisance renale terminale. L’hemodialyse sur fistule arterioveineuse a ete alors realisee avec une bonne tolerance et a entraine une amelioration de l’etat general et de la qualite de vie. Discussion La presence d’une hematurie au cours d’une EBDR-HS doit faire evoquer une glomerulonephrite a depots mesangiaux d’IgA. La ponction-biopsie renale n’est pas contre-indiquee. Elle confirme le diagnostic et precise le pronostic, different de celui d’une amylose. Au stade d’insuffisance renale terminale, l’hemodialyse est possible et bien toleree. Il n’y a pas d’argument suffisant pour un lien genetique entre l’EBDR-HS et la glomerulonephrite a IgA. Une physiopathologie immuno-infectieuse est possible.

Objectifs La realisation systematique d’un examen extemporane des recoupes uretrale et ureterales lors de la cystectomie pour cancer n’est pas consensuelle. L’objective de cette etude etait d’evaluer la fiabilite de l’examen extemporane des recoupes uretrale et ureterales et son impact sur les resultats oncologiques apres cystectomie pour cancer. Methodes Tous les patients traites par cystectomie radicale pour cancer vesical ont ete inclus dans une etude retrospective monocentrique. L’utilisation de l’extemporane des recoupes uretrales ou ureterales variait en fonction des preferences de l’operateur (systematique pour certains chirurgiens, jamais pour d’autres) mais pas en fonction des donnees peroperatoires. Les patients etaient divises en 2 groupes selon qu’un examen extemporane des recoupes avait ete realise ou non. Le taux de marges positives lors de l’examen anatomopathologique final a ete compare entre les 2 groupes. Les facteurs pronostics associes a la survie specifique et a la survie sans recidive (SSR) ont ete recherches en analyse univariee et multivariee. Resultats Parmi les 329 patients inclus dans l’etude, un examen extemporane des recoupes ureterales a ete realise chez 132 (40 %) et un examen extemporane de la recoupe uretrale chez 183 (56 %) respectivement. Treize recoupes uretrales etaient positives (7,1 %) entrainant 10 uretrectomies complementaires. Quatorze recoupes ureterales etaient envahies entrainant 8 resections ureterales complementaires et une nephro-ureterectomie. L’utilisation de l’extemporane uretrale a une diminution du taux de marges positives (6 % vs. 23 % ; p p = 0,85). L’utilisation de l’extemporane ureterale n’avait pas d’impact sur la survie tandis que l’extemporane uretrale etait associe a la SSR en analyse univariee (SSR a 5 ans : 51,5 % vs. 32 % ; p p = 0,003).( Fig. 1 ) Conclusion Dans cette etude, l’utilisation systematique de l’examen extemporane de la recoupe uretrale diminuait le taux de marges positives et ameliorait la survie sans recidive apres cystectomie pour cancer. A l’inverse l’examen extemporane systematique des recoupes ureterales n’avait pas d’impact sur les resultats oncologiques.

Laparoscopy has become the gold-standard approach for excision of benign adrenal tumors but the question of its safety for malignant lesions is still controversial. Our aim was to evaluate the oncologic outcome of laparoscopic adrenalectomy for adrenal metastasis and to look for predictors of a negative surgical outcome.We retrospectively reviewed the charts of all patients who underwent laparoscopic adrenalectomy for suspicion of adrenal metastasis between 2007 and 2013 at a single academic institution. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Univariate analysis was performed to determine risk factors of negative surgical outcome (positive surgical margins, complications, conversion, significant blood loss) and predictors of RFS and CSS.Thirteen patients underwent 14 laparoscopic adrenalectomies. All patients were operated by a single highly experienced surgeon. Complications occurred in 2 patients (15%): 2 blood transfusions (Clavien-score=2). There were 3 positive surgical margins (21%). Mean length of hospital stay was 4.3 days. Unadjusted RFS and CSS were respectively 48.4% and 83.3% at 1 year, 39.5% and 66.7% at 5 years. In univariate analysis, tumor size was the only risk factor of complication (P=.009) and conversion (P=0.009). Capsule invasion and tumor size were risk factors of positive surgical margins (P=0.01 and P0.0001). One hundred percent of complications, conversion and positive surgical margins occurred in tumor7.5 cm on preoperative CT-scan. No predictors of RFS and CSS was found in univariate analysis.Laparoscopic adrenalectomy for adrenal metastasis achieves good surgical and oncologic outcomes. When performed by highly experienced surgeon, complications and positive surgical margins occur only in tumors7.5 cm. These patients may benefit from an open surgical approach.

International audience; OBJECTIVES: To identify the predictive factors of hemorrhagic complications (HC) in a contemporary cohort of patients who underwent partial nephrectomy (PN). MATERIALS AND METHODS: Records of 199 consecutive patients who underwent PN between 2008 and 2012 at our institution were retrospectively analyzed. HC was defined as a hematoma requiring transfusion, an arterio-veinous fistula, a false aneurysm or a post-operative decrease of hemoglobin \textgreater3 g/dl. Patients with or without HC were compared using Wilcoxon and Fisher exact tests for continuous and categorical variables, respectively. We performed a univariate and multivariate analysis with a logistic regression model using the occurrence of an HC as the dependent variable. RESULTS: 54% of the patients were male with a median age of 61 (22-86) years. Median BMI was 26 (18-47) kg/m(2). Surgery was done open, laparoscopically or with robotic assistance in 106, 54 and 39 cases, respectively. Global complication rate was 40% including 21.6% HC. There were more complex tumors (75.6% vs. 66.5%, p = 0.04) and median length of stay was increased (11 days compared to 7 days, p \textless 0.0001) in case of a HC. In univariate analysis, imperative indication (p = 0.08), RENAL score (p = 0.07), operating time (p = 0.07) and operative blood loss \textgreater 250 ml (p = 0.002) were statistically relevant. In multivariate analysis, only operative blood loss \textgreater250 ml was identified as a predictive factor of HC (p = 0.0007). CONCLUSION: Patients who underwent a procedure with estimated blood loss \textgreater250 ml should be carefully monitored in the postoperative course.

A controversy animates the literature on the potential role of the renin-angiotensin system (RAS) in tumorogenesis. The objective of this review was to determine the involvement of this pathway in cancer, and more specifically in urological cancers.We made a systematic review of articles referenced in Pubmed, using the following keywords alone or combined: cancer, renin, angiotensin, VEGF, AT1R, antagonists of angiotensin-2 receptors, inhibitors of angiotensinogen converting.Many types of cancers overexpress AT1-R in their tumoral tissues (breast, stomach, bladder, astrocytoma, glioblastoma, ovary, uterus, pancreas, kidney, prostate, adrenal gland). Ang-II can induce VEGF-A expression and promote neoangiogenesis, but also can trigger different molecular pathways involved in cell proliferation or inhibit apoptosis. Several xenograft murin models demonstrated anti-tumoral efficacy of RAS blockers, alone or using combined therapies, targeting angiogenesis and slowing down tumor growth. Retrospective studies in patients have also revealed a better progression-free survival and a better response to therapies in those treated with RAS blockers.Many data seem to demonstrate the involvement of the RAS in carcinogenesis, as well as anti-tumoral effect of RAS blockers in addition to anti-cancer treatments. Clinical data are now expected to confirm these experimental findings.

Renal carcinomas are histologically and prognostically heterogeneous. Genomic as well as chromosomal studies of these tumors have permitted a better comprehension of molecular mechanisms implicated in their development and progression. The most frequent histological subtypes are characterized by recurrent cytogenetic abnormalities, such as the loss of the chromosome 3 short arm involving a VHL gene copy in clear cell renal carcinomas, or trisomies 7 and 17 in papillary renal cell carcinomas. New histological subtypes like renal carcinomas associated with Xp11.2 translocations have also been individualized. Besides diagnosis, some chromosomal aberrations like the loss of a short arm of chromosome 9 in different renal carcinoma histological subtypes have a worse prognostic impact. The identification of chromosomal shuffles contributes in backing histological diagnosis and in precising the individual prognosis of patients. This review describes chromosomal abnormalities associated to renal carcinomas and their impact for an accurate classification of these tumors and the evaluation of their prognosis.

To evaluate the histological correlation between transuretral resection chips and biopsy cores within a population of patients who underwent resection of prostate (TURP) and prostate biopsies (BPx).Clinical and tumoral data of 77 patients who had both procedures simultaneously or with a slight delay were collected. According to the presence of prostate cancer (Pca), 4 groups were defined: group 1 (TURP and BPx negative), group 2 (TURP positive, BPx negative), group 3 (TURP negative, BPx positive), group 4 (TURP and BPx positive). Means and proportions were compared using Anova and χ(2) test, respectively.The patients were older in groups 3 and 4 (79 and 76 respectively, P=0.65). The PSA was higher in the groups 3 and 4 (64 and 55 ng/mL) than the groups 1 and 2 (10.6 et 16 respectively, P=0.23). The number of positive biopsy was higher in the group 4 than the group 3 (5.6 vs. 4.6, P0.0001), the chips were more invaded in the group 4 than the group 2 (41% vs. 11% P0.0001), the Gleason score at TURP was higher in the group 4 than the group 2 (7.5 vs. 6.2 P0.0001).Our study underlines that the Pca of transition and peripheral zones seems to have distinct characteristics. When chips of TURP and BPx were both invaded, it was due to an aggressive cancer. The decision to explore the peripheral zone in the case of positive TURP must take clinical context into consideration.

International audience; OBJECTIVE: Partial Nephrectomy (PN) in a solitary kidney is at risk of chronic kidney disease (CKD) stage V and/or haemodialysis (HD). Our objective was to determine predictive factors of CKD stage V in this population. MATERIAL & METHODS: Data from 300 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics and renal function before surgery were analyzed. Patients with and without CKD stage V (defined as MDRD\textless1 5 ml/min) were compared using χ2 and Student-t tests for qualitative and quantitative variables, respectively. Predictive factors of CKD stage V were evaluated with a multivariable analysis using a Cox regression model. RESULTS: Median age and BMI were 63 years old and 26 kg/m², respectively. Most of the patients (65%) were male with an anatomic solitary kidney (88.3%). Median tumor size was 4 cm and 98% were malignant tumors. Median operative time, blood loss and clamping time were 180 min, 350 ml and 20 min respectively. Renal cooling was used in 19.3% and clamping of the pedicle was performed in 61.6%. Twenty five patients (8.5%) presented post operative CKD stage V at last follow-up and 18 underwent HD (6%) post-operatively because of acute renal insufficiency. There was no difference between CKD stage V and non CKD stage V patients concerning Charlson index, operative time (180 min vs 179 min, p = 0.39), blood loss (475 ml vs 350 ml, p = 0.51), use of renal cooling and type of clamping. Patients with CKD stage V were older (70 vs 63 years old, p = 0.005), had a lower baseline renal function (clearance MDRD 41 vs. 62 ml/min, p\textless0.0001) and an increased tumor size (p = 0.02). Complications occurred in 91 patients (30%) with 16% of minor (Clavien 1-2) and 14% of major (Clavien \textgreater 2) complications, respectively. In multivariable analysis, baseline MDRD, BMI, and the occurrence of a minor complication were independent predictive factors of post operative CKD stage V. CONCLUSION: PN in a solitary kidney is at risk of post-operative CKD stage V and HD. Pre-operative altered renal function and post operative complications are the main predictive factors of permanent CKD stage V.

The aim of our study was to report our experience of laparoscopic nephrectomy in patients with polycystic kidney disease.Between December 2007 and February 2012, we performed 39 consecutive laparoscopic nephrectomies in patients with polycystic kidneys. All patients were operated by a transperitoneal approach.Patients had a mean age of 55 with an average BMI of 25 kg/m(2). Eighty-seven percent were ASA III and 77% were on dialysis. In most of the cases, the indication concerned patients who were candidates to a renal transplantation to make space for graft implantation. Operative time was 167 minutes with a mean blood loss of 200 mL. Two open conversions were necessary (splenic injury and difficulty of dissection of the renal pedicle). Fifteen percent of patients were transfused. There were 11 complications (28%) among which five were major (Clavien ≥ 3). Mean length of stay was 5.2 days.Our study showed that laparoscopic nephrectomy for polycystic kidney is feasible and reproducible. We systematically offer it when indicated.

To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) in a single French institution.Between February 2008 and April 2012, 98 patients underwent RAPN (n=54) or NPL (n=44) for a kidney tumor. Demographic data, perioperative and pathological outcomes were compared using Student's test and χ2 for continuous and categorical variables, respectively.Both groups were comparable for age, BMI, American Society of Anesthesiologists classification (ASA) and preoperative renal function (MDRD clearance). Tumor complexity was increased in the RAPN group (55.5 % vs. 29.5 % RENAL score≥2, P=0.05). There was no significant difference in terms of operative time (191 vs. 202 min, P=0.2), tumor size (35 vs. 30mm, P=0.1) or positive margins (2 vs. 5, P=0.14). However, there was a significant decrease in warm ischemia time (18 vs. 25.6 min, P=0.004) and hospital stay (5.1 vs. 6.9 days, P=0.003) for RAPN. Estimated blood loss was greater in the RAPN group (490 vs. 280mL, P=0.003), but the numbers of transfusions were similar (5 vs. 4 patients, P=0.96). Urinary tract was more frequently entered in the RAPN group (28 vs. 12, P=0.009). The complication rate was similar in both groups (28 % vs. 32 %, P=0.66).RAPN is feasible and reproducible. As in previous publications, our study confirms a potential benefit of RAPN concerning warm ischemia.