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Stereotactic body radiation therapy (SBRT) has become a new therapeutic option for primary renal cell carcinoma. However, treatment doses lack consistency in the literature. The primary objective of this study was to determine the maximum tolerated dose for renal cancer SBRT.This phase 1 multicentric dose-escalation study assessed 4 dose levels: 8 Gy × 4, 8 Gy × 5, 10 Gy × 4, and 12 Gy × 4. The primary objective of this study was to determine the maximal tolerated dose, defined by the occurrence of dose-limiting toxicity was defined as any acute side effect of grade ≥4 based on the Common Terminology Criteria for Averse Events, version 4.0.From October 2010 to September 2017, 13 patients were enrolled. The median follow-up was 23 months. There was no dose-limiting toxicity in our study, and the highest dose was reached successfully. No acute or late toxic effects above grade 2 were seen. There was no significant alteration of renal function after treatment. At 24 months, 2 patients had partial response and the others had stable disease.After 24 months of follow-up, no dose-limiting toxicity was seen at any of the prescribed dose levels in our study. The findings suggest that our last dose level of 48 Gy in 4 12-Gy fractions can be considered safe and can be used in further studies.

To evaluate the surgical and functional outcomes of urethral reconstruction associated with phalloplasty, depending on the surgical techniques and patient history.We conducted a single-centre retrospective study including 89 patients who underwent phalloplasty with urethral reconstruction between 2007 and 2018. Patients included were trans-male patients undergoing gender-affirming surgery and cis-male patients undergoing penile reconstruction after trauma, congenital malformation, or cancer. Urethral reconstructions were performed by free flap or skin graft (total or thin). Secondary urethroplasty may include direct vision urethrotomy, excision-anastomosis, or augmentation urethroplasty (skin graft, buccal mucosa graft). Patient demographics, medical history, peri- and postoperative data were collected from patient files. Functional results were evaluated using individual questionnaires.The mean (±sd) follow-up duration was 5.5 (±3.7) years. No significant difference was found for total urethral complication rate (fistula and/or stricture) according to type of urethral construction (70.9% for free flap urethra vs 73.5% for skin graft urethra; P = 0.911), nor according to the patient's grounds for surgery (72.7% for cis-male vs 71.8% for trans-male patients; P = 1). A total of 36 patients (40.5%) answered the functional questionnaire, of whom 80.5% reported usually voiding while standing and 47.5% were comfortable with urinating in public.Urethral construction in phalloplasty is associated with a high complication and revision rate regardless of the type of urethral reconstruction. Voiding in a standing position is generally possible but should not conceal feeble functional results.

The prognostic impact of renal cell carcinoma (RCC) morphotype remains unclear in patients who undergo partial nephrectomy (PN). Our objective was to determine the risk factors for recurrence after PN, including RCC morphotype.Patients with RCC who had undergone PN were extracted from the prospective, national French database, UroCCR. Patients with genetic predisposition, bilateral or multiple tumours, and those who had undergone secondary totalization were excluded. Primary endpoint was 5-year, recurrence-free survival (RFS), and secondary endpoint was overall survival (OS). Risk factors for recurrence were assessed by multivariable Cox regression analysis.Overall, 2,767 patients were included (70% male; median age: 61 years [interquartile range (IQR) 51-69]). Most (71.5%) of the PN procedures were robot-assisted. Overall, 2,573 (93.0%) patients were recurrence free, and 74 died (2.7%). Five-year RFS was 84.9% (IQR 82.4-87.4). A significant difference in RFS was observed between RCC morphotypes (p0.001). Surgical margins (hazard ratio [HR] = 2.0 [95% confidence interval (CI): 1.3-3.2], p0.01), pT stage1 (HR = 2.6 [95% CI: 1.8-3.7], p0.01]) and Fuhrmann grade2 (HR = 1.9 [95% CI: 1.4-2.6], p0.001) were risk factors for recurrence, whereas chromophobe subtype was a protective factor (HR = 0.08 [95% CI: 0.01-0.6], p = 0.02). Five-year OS was 94.0% [92.4-95.7], and there were no significant differences between RCC subgroups (p = 0.06). The main study limitation was its design (multicentre national database), which may be responsible for declarative bias.Chromophobe morphotype was significantly associated with better RFS in RCC patients who underwent PN. Conversely, pT stage, Fuhrman group and positive surgical margins were risk factors for recurrence.

The management of solitary kidney tumors is a surgical challenge, requiring irreproachable results on both oncological and functional outcomes. The goal of our study was to compare the perioperative results of robotic-assisted partial nephrectomy (RAPN) to open surgery in this indication.We led a multicentric study based on the prospectively maintained French national database UroCCR. Patients who underwent partial nephrectomy on a solitary kidney between 1988 and 2020 were included. Clinical and pathological data were retrospectively analyzed. The main outcome of the study was the analysis of the variation of the estimated glomerular filtration rate (eGFR) calculated according to MDRD at 3, 6, 12, and 24 months depending on the chosen surgical approach. The secondary outcomes were the comparison of Trifecta success, perioperative complications, and length of hospital stay.In total, 150 patients were included; 68 (45%) in the RAPN group and 82 (55%) in the open surgery group. The two groups were comparable for all data. The variation of eGFR at 3, 6, 12, or 24 months was comparable without any significant difference between the 2 groups (p = 0.45). Trifecta was achieved in 40% of the patients in the RAPN group and 33% in the open group (p = 0.42). A significant difference was observed for the length of stay, 5 days for the robot group versus 9 days for the open surgery group (p 0.0001).In our study, the surgical approach did not modify functional results and we noted a significant decrease in hospital stay and complications in the RAPN group. RAPN is a safe and efficient method for management of kidney tumors in solitary kidneys.

International audience; Background: We previously reported a 35-gene expression classifier identifying four clear-cell renal cell carcinoma groups (ccrcc1 to ccrcc4) with different tumour microenvironments and sensitivities to sunitinib in metastatic clear-cell renal cell carcinoma. Efficacy profiles might differ with nivolumab and nivolumab-ipilimumab. We therefore aimed to evaluate treatment efficacy and tolerability of nivolumab, nivolumab-ipilimumab, and VEGFR-tyrosine kinase inhibitors (VEGFR-TKIs) in patients according to tumour molecular groups.Methods: This biomarker-driven, open-label, non-comparative, randomised, phase 2 trial included patients from 15 university hospitals or expert cancer centres in France. Eligible patients were aged 18 years or older, had an Eastern Cooperative Oncology Group performance status of 0-2, and had previously untreated metastatic clear-cell renal cell carcinoma. Patients were randomly assigned (1:1) using permuted blocks of varying sizes to receive either nivolumab or nivolumab-ipilimumab (ccrcc1 and ccrcc4 groups), or either a VEGFR-TKI or nivolumab-ipilimumab (ccrcc2 and ccrcc3 groups). Patients assigned to nivolumab-ipilimumab received intravenous nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for four doses followed by intravenous nivolumab 240 mg every 2 weeks. Patients assigned to nivolumab received intravenous nivolumab 240 mg every 2 weeks. Patients assigned to VEGFR-TKIs received oral sunitinib (50 mg/day for 4 weeks every 6 weeks) or oral pazopanib (800 mg daily continuously). The primary endpoint was the objective response rate by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1. The primary endpoint and safety were assessed in the population who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT02960906, and with the EU Clinical Trials Register, EudraCT 2016-003099-28, and is closed to enrolment.Findings: Between June 28, 2017, and July 18, 2019, 303 patients were screened for eligibility, 202 of whom were randomly assigned to treatment (61 to nivolumab, 101 to nivolumab-ipilimumab, 40 to a VEGFR-TKI). In the nivolumab group, two patients were excluded due to a serious adverse event before the first study dose and one patient was excluded from analyses due to incorrect diagnosis. Median follow-up was 18·0 months (IQR 17·6-18·4). In the ccrcc1 group, objective responses were seen in 12 (29%; 95% CI 16-45) of 42 patients with nivolumab and 16 (39%; 24-55) of 41 patients with nivolumab-ipilimumab (odds ratio [OR] 0·63 [95% CI 0·25-1·56]). In the ccrcc4 group, objective responses were seen in seven (44%; 95% CI 20-70) of 16 patients with nivolumab and nine (50% 26-74) of 18 patients with nivolumab-ipilimumab (OR 0·78 [95% CI 0·20-3·01]). In the ccrcc2 group, objective responses were seen in 18 (50%; 95% CI 33-67) of 36 patients with a VEGFR-TKI and 19 (51%; 34-68) of 37 patients with nivolumab-ipilimumab (OR 0·95 [95% CI 0·38-2·37]). In the ccrcc3 group, no objective responses were seen in the four patients who received a VEGFR-TKI, and in one (20%; 95% CI 1-72) of five patients who received nivolumab-ipilimumab. The most common treatment-related grade 3-4 adverse events were hepatic failure and lipase increase (two [3%] of 58 for both) with nivolumab, lipase increase and hepatobiliary disorders (six [6%] of 101 for both) with nivolumab-ipilimumab, and hypertension (six [15%] of 40) with a VEGFR-TKI. Serious treatment-related adverse events occurred in two (3%) patients in the nivolumab group, 38 (38%) in the nivolumab-ipilimumab group, and ten (25%) patients in the VEGFR-TKI group. Three deaths were treatment-related: one due to fulminant hepatitis with nivolumab-ipilimumab, one death from heart failure with sunitinib, and one due to thrombotic microangiopathy with sunitinib.Interpretation: We demonstrate the feasibility and positive effect of a prospective patient selection based on tumour molecular phenotype to choose the most efficacious treatment between nivolumab with or without ipilimumab and a VEGFR-TKI in the first-line treatment of metastatic clear-cell renal cell carcinoma.

BACKGROUND AND AIMS Partial nephrectomy (PN) has progressively replaced radical nephrectomy (RN) whenever feasible for renal tumors. However, its effects on renal outcomes are less known in patients with pre-existing chronic kidney disease (CKD) or with solitary kidney (SK). We aimed to assess renal and major clinical outcomes after PN or RN in patients with moderate to severe CKD or SK. METHOD We included all surgical procedures conducted between 2013 and 2018 in the Hospices Civils de Lyon, in patients with last pre-operative estimated glomerular filtration rate (eGFR) RESULTS We included 173 procedures (67 RN and 79 PN on CKD patients, 27 PN on SK patients). Patients undergoing RN were older, had bigger tumors and higher T stages on TNM classification. Preoperative estimated glomerular filtration rate (eGFR) and CKD stages were not different between the groups. One year after surgery, PN was associated with less occurrence of the main composite outcome compared to RN (42.9% versus 70.7%, P < 0.01). On multivariate analysis, independent risk factors for the main outcome were postoperative AKI (no AKI as reference; AKI stage 1 odds ratio (OR) = 8.68, 95% confidence interval (CI) 3.23–23.33; AKI stage 2 OR = 23.50, 95% CI 2.33–236.51; AKI stage 3 OR = 28.87, 95% CI 4.77–167.61) and bigger tumor size (OR = 1.21/cm, 95% CI 1.02–1.45), while preoperative eGFR was not (Table 1). Compared to pre-operative values, eGFR significantly decreased both after RN or PN 1 month after surgery (eGFR loss -12mL/min 1.73m² after RN P < 0.001, −3mL/min/1.73m² after PN, P < 0.05) and this decrease remained stable 1 year after surgery (eGFR loss -11mL/min/1.73m² after RN, P < 0.001, −3mL/min/1.73m² after PN, P < 0.05), but renal function was better preserved after PN than after RN at 1 month (P < 0.05) or 1 year (P < 0.01) (Figure 1). CONCLUSION In moderate to severe CKD patients, PN was associated with less risk of CKD progression or major cardio-vascular event or death 1 year after surgery, compared to RN. Postoperative AKI was the major determinant of clinical and renal outcomes.

Objectives: The aim of the study was to assess the efficacy and safety of an enhanced recovery program (ERP) after robot-assisted partial nephrectomy (RAPN) for cancer. Methods: It was a monocentric, retrospective, comparative study. An ERP after RAPN was introduced at our institution in 2015 and proposed to all consecutive patients admitted for RAPN. The control group for this study was composed of patients managed immediately before the introduction of the ERP. We collected information on patient characteristics, tumor sizes, ischemia times, biology, hospital length of stays, postoperative (≤30 days) complications, and readmission rates. Group comparisons were made using the Pearson χ2 test for qualitative data and the Student t test for quantitative data. Results: Between 2015 and 2017, 112 patients were included in the ERP group. Fifty patients were included in the control group. Ninety patients in the ERP group (80.4%) were discharged at or before postoperative day (POD) 2 versus 10 patients (20%) in the control group (p < 0.001). There was no significant difference between the ERP and control groups for the urinary retention rate (respectively 3.6 vs. 2%; p = 0.593). Resumption of normal bowel function was significantly shorter in the ERP group (94.6% at POD1 vs. 69.6% in the control group, p < 0.001). There were no significant differences for postoperative complications (15.2% in the ERP group vs. 20% in the control group, p = 0.447) or readmissions within 30 days (8.04 vs. 0.2%, p = 0.140). Conclusions: ERP after RAPN seems to reduce postoperative length of stay without increasing postoperative complications or readmissions.

Resume Introduction L’information preoperatoire est determinante a l’adhesion du patient au traitement mais peut etre insuffisamment assimilee par le patient du fait de sa densite et de sa complexite. L’objectif de cette etude etait d’evaluer la comprehension et la satisfaction des patients de l’information preoperatoire de chirurgie de l’hypertrophie benigne de prostate (HBP). Les facteurs influencant la comprehension etaient egalement etudies. Methodes Il s’agissait d’une etude monocentrique sur questionnaire incluant tous les patients devant se faire operer d’une HBP quelle que soit la technique chirurgicale. Un questionnaire etait envoye a chaque patient, a domicile, apres la consultation urologique preoperatoire. Resultats Deux cent dix questionnaires ont ete envoyes et 106 patients (50,5 %) ont renvoye le questionnaire. L’information etait jugee excellente (cotee 9/10 et 10/10 sur l’echelle numerique) par 38,68 % (41/106) des patients et « tres bonne » (cotee 7–8) par 45,28 % des patients (48/106). Les complications postoperatoire les plus frequemment citees par les patients etaient l’ejaculation retrograde (39,6 % des patients, n = 42/106) et le saignement (29,2 %, n = 31/106). 57,6 % des patients (n = 61) se rappelaient avoir recu la fiche d’information ecrite. Apres rappel des complications eventuelles, 5,7 % des patients (n = 6/106) hesitaient a se faire operer. Seul l’âge des patients etait significativement associe a une difference de comprehension (p Conclusion L’information dispensee aux patients avant chirurgie d’HBP paraissait satisfaisante bien qu’elle semble mal comprise, notamment concernant les complications. Cette etude pourrait permettre de modifier notre vision de l’information du patient, en passant d’un modele paternaliste a un modele de « partenariat » avec le patient. Niveau de preuve 3.

Summary Aims The objective of this study was to assess the effectiveness and the complications rate following continent cutaneous channels (CCC) procedures, at short and medium term follow-up (FU). Materials & Methods A continuous retrospective case series (2008–2018): all patients who have undergone a CCC for neurogenic bladder were included in our department. The primary outcome was the effectiveness of CCC defined by the status of catheterizability (by the patient or a care-giver), continence of the tube, and absence of reintervention at 3 and 12 months FU. The secondary outcome was the prevalence of postoperative complications at 3 and 12 months FU. Results Fifty-three patients were included during the study period in our department. Median follow up was 3,3 years (1.5–6.1). The overall effectiveness of CCC was 67.9% (n = 36/53) at 3 months FU and 45,3% (n = 24) at 12 months FU. The global rate of complications was 60.4% (n = 32/53) at 3 months, and 73.6% (n = 39/73) at 12 months FU. The statistical analysis showed no statistical differences on efficacy and complications in the different subgroups of CCC. Conclusions In the current series, the effectiveness and the complications rates following CCC were comparable across the procedure types. Level of evidence 4.

Resume Introduction Plusieurs programmes de rehabilitation avancee apres chirurgie (RAAC) ont montre une amelioration des suites postoperatoires pour les patients permettant des durees d’hospitalisation diminuees. Tres peu d’etudes a notre connaissance ont evalue la satisfaction des patients sur ces protocoles. L’objectif de cette etude etait d’evaluer la satisfaction des patients ayant beneficie du protocole de RAAC pour nephrectomie partielle robot-assistee (NPRA). Materiels et methodes Un questionnaire valide EORTC IN-PATSAT32 associe a un questionnaire specifique sur la RAAC ont ete envoye aux 42 premiers patients inclus dans le protocole RAAC de RAPN apres leur consultation postoperatoire. Les reponses etaient anonymes. Les calculs des scores de satisfaction du questionnaire EORTC ont ete effectues pour chaque dimension par la methode de Likert. Les scores ont ensuite ete transformes lineairement en une echelle variant de 0 a 100, ou 100 represente le meilleur niveau de satisfaction sur les soins (methode EORTC). Resultats Au total, 21 patients ont renvoye les questionnaires (50 %). Le score moyen de satisfaction globale etait de 75,1 % (37,3 ; 100) dans le questionnaire EORTC. Au total, 71,4 % des patients (n = 15) trouvaient la sortie a j2 postoperatoire satisfaisante et 5 patients (23,8 %) trouvaient cela prematuree. Aucun des patients n’avait d’impression negative sur le protocole de RAAC. L’evaluation globale moyenne du protocole par les patients sur une echelle de satisfaction de 1 a 10 etait de 8,9/10. Conclusion Dans notre etude, les patients ayant beneficie du protocole de RAAC apres NPRA semblaient tres satisfaits de leur prise en charge pre-, per- et postoperatoire. Etant donnee la satisfaction des patients, la reduction des durees d’hospitalisation, la securite du patient et l’avantage medico-economique, ces protocoles de RAAC sont a developper et evaluer. Des etudes de plus grands effectifs sont necessaires pour evaluer le vecu des patients sur ces protocoles de RAAC. Niveau de preuve 4.

To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications.

Background Transperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects. Objective To assess surgical and functional outcomes of this treatment of RUF. Design, setting, and participants A retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020. Surgical procedure The standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures. Measurements Fistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark’s score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality. Results and limitations The median (interquartile range) follow-up was 27 (8–47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark’s score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations. Conclusions The present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate. Patient summary We performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes. Take Home Message Transperineal repair of rectourethral fistula with gracilis muscle flap interposition is a safe surgery with a high success rate. Urinary continence is a serious issue, but patients may be reassured as to the impact on digestive continence, lower extremity functionality, and scar aesthetics.

Introduction The ZSI 475FtM is a new prosthesis that has recently been specifically designed for phalloplasty. It has several functions that have been conceived to answer the challenges of implantation after phalloplasty: a large base for pubic bone fixation, realistically shaped hard glans, and a pump shaped like a testicle. Aim To assess the safety, feasibility, and patient satisfaction of the ZSI 475 FtM. Methods Surgical outcomes were analyzed after implantation of the prosthesis between June 2016 and September 2017 (single institution, single surgeon). Patients were then asked to answer a satisfaction questionnaire that included the International Index of Erectile Function–5, Erectile Dysfunction Inventory of Treatment Satisfaction, and Self-Esteem and Relationship, as well as other non-validated questions. Main Outcome Measure Complication rates and the scores of the different questionnaires were reviewed. Results 20 patients who had gender dysphoria and underwent operation for a female-to-male procedure were included. The mean age was 37.9 years. Complications after 21 implantations included 2 (9.5%) infections that were medically treated (Clavien II), 1 (4.7%) infection treated by explantation (Clavien IIIb), 2 (9.5%) mechanical failures (Clavien IIIb), and 1 (4.7%) malpositioning (Clavien IIIb). The mean follow-up was 8.9 months (SD 4.0), with 50% of the implanted patients having >12 months of follow-up. 14 patients (70%) answered the satisfaction questionnaire. 12 patients (85.7%) had regular penetrative sexual intercourse. The mean International Index of Erectile Function–5 score was 20.2 of 25 (standard deviation [SD] 7.9), the mean Self-Esteem and Relationship score was 84.5 of 100 (SD 9.9), and the mean Erectile Dysfunction Inventory of Treatment Satisfaction score was 82 of 100 (SD 17.5). 13 patients (92.8%) were satisfied or very satisfied with the prosthesis. Clinical Implications This new innovative prosthesis could better answer the challenges faced by the implantation of an erectile device by phalloplasty. Strength & Limitations Our study is the first to report data on this new prosthesis. The main limitation is the small number of patients and the short follow-up. Conclusion Preliminary results for the ZSI 475 FtM are encouraging. Safety seems to be satisfactory, and patient satisfaction is high. Long-term studies are needed for further analysis.

Resume Objectif Les complexites diagnostiques et therapeutiques de l’endometriose justifient la discussion des decisions therapeutiques en reunion de concertation pluridisciplinaire (RCP). Le deploiement de centres experts regionaux en endometriose requiert une evaluation de la qualite et de l’interet des RCP endometriose. Methodes Etude retrospective qualitative des dossiers presentes en RCP endometriose au centre hospitalier Lyon-Sud entre juin 2013 et decembre 2017. Resultats Parmi 376 patientes presentees, 309 (82,2 %) etaient des patientes algiques et 184 (59,5 %) presentaient une endometriose complexe. Une evaluation clinique complete a ete realisee chez 120 (38,8 %) patientes. Une IRM a ete realisee chez 370 (98,4 %) patientes dont 303 (81,9 %) relues par un radiologue expert. Ces relectures ont permis un diagnostic de rattrapage chez 88 (60,7 %) patientes presentant une endometriose complexe. L’entero-IRM (27,8 %) et l’echoendoscopie rectale (14,4 %) etaient les examens de troisieme ligne les plus frequemment utilises pour completer le bilan des lesions digestives chez les patientes presentant une endometriose rectale. Une prise en charge chirurgicale a ete proposee pour 199 (52,9 %) patientes dont 108 (58,7 %) presentant une endometriose complexe. Conclusion Un des interets majeurs de la RCP endometriose est la relecture des IRM qui, en identifiant des endometrioses complexes initialement non diagnostiquees ou sous-evaluees, a permis de mieux discuter les benefices/risques des choix therapeutiques, et d’organiser les chirurgies complexes lorsque celles-ci etaient retenues. Le developpement des RCP au sein de centres experts regionaux participera a l’optimisation de la pertinence des soins des patientes atteintes d’endometriose.

Purpose The purpose of this study was to retrospectively evaluate the performance of magnetic resonance imaging (MRI) in locating endometriosis implants within the bladder wall with assessment of ureteral orifice extension using surgical findings as standard of reference. Materials and methods MRI examinations of 39 consecutive women (mean age: 31.2 ± 5.5 [SD] years; age range: 22–42 years) operated in 3 university hospitals for bladder endometriosis over a 6-year period were reviewed by 2 independent readers. Interobserver agreement was assessed using Kappa tests. Results of consensus reading were used to calculate sensitivity, specificity and accuracy of MRI for the diagnosis, location and extent of endometriosis implants using surgical findings as the standard of reference. Results Mean bladder repletion volume was 134 ± 110 [SD] mL (range: 21–479 mL). The mean largest endometriosis implant diameter was 30 ± 7 [SD] mm (range: 19–41 mm). On MR images, 34/39 (87%) endometriosis implants were present in the two anterior thirds of the dome (k = 0.45), 31/39 (79%) extended or were present in the posterior third pouch (k = 0.92) and 25/39 (64%) extended into the bladder base (k = 0.84) with sensitivities of 100% (31/31; 95% confidence interval [CI]: 89–100%), 100% (30/30; 95% CI: 88–100%) and 90% (19/21; 95% CI: 69–98%), respectively, specificities of 83% (5/6, 95% CI: 36–100), 88% (7/8, 95% CI: 47–100%), 87% (13/15; 95% CI: 52–96), respectively and accuracies of 97% (36/37, 95% CI: 86–100%), 97% (37/38; 95% CI: 86–100%), and 89% (32/36; 95% CI: 74–97%), respectively. In 9 (9/25; 36%) patients with bladder base involvement, a zero distance was reported between endometriosis implants and ureteral orifices, all but one presenting with low-to-moderate bladder volumes. In the two patients who needed ureteral resection-reimplantation, ureteral dilation was associated with a zero distance. External adenomyosis was reported in 26/39 (66%) patients (k = 0.94). Conclusion A dedicated preoperative MRI work-up for bladder endometriosis helps accurately depict and locate endometriosis implants. Adequate bladder filling is needed to improve appropriate estimate of the distance between endometriosis implants and ureteral orifices to better predict requirement of ureteral resection-reimplantation.

INTRODUCTION AND OBJECTIVE:Obesity is a public health problem in industrialized countries and is a known risk factor for kidney cancer.At the same time, partial nephrectomy has become the gold stan...

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

Objectifs Les tumeurs malignes du rein ont une incidence croissante et l’obesite en est l’un des facteurs de risque connus. L’obesite serait associee a des types histologiques differents qui pourraient egalement impacter le pronostic voire la prise en charge des patients. Methodes L’objectif principal de l’etude etait d’evaluer l’influence de l’obesite sur le type histologique des tumeurs renales. L’objectif secondaire etait d’evaluer l’impact de l’obesite sur la survie sans recidive apres chirurgie d’une tumeur renale. Une etude descriptive comparative multicentrique a ete realisee au sein du reseau Uro-CCR. Les caracteristiques histologiques des tumeurs renales operees chez les patient inclus entre 2007 et 2020 ont ete comparees selon leur statut obese ou non, defini par un IMC > = 30 kg/m2, a l’aide du test de Chi2 et admettant pour significativite p Resultats Un total de 6749 tumeurs renales ont ete inclues, dont 1687 (25 %) etaient obeses. Ces derniers etaient plus souvent diabetiques et hypertendus (respectivement 27,2 % versus 11,4 % et 61,2 % versus 41,2 %, tous deux p 30 kg/m2: 50,9 % de grades 1–2 versus 43,4 % (p Conclusion A notre connaissance, nous rapportons les Resultats de la plus importante cohorte sur ce sujet. L’obesite serait associee a un taux plus eleve de carcinomes a cellules claires et des caracteristiques tumorales moins agressives. Bien que ces donnees histologiques suggerent des lesions moins agressives chez les patients obeses, cela ne semble pas confirme par une meilleure survie sans recidive.

Objectifs Les plasties peniennes pour defect cutane du fourreau de la verge, toutes etiologies confondues restent actuellement des procedures delicates et peu communes, qui doivent repondre a des attentes esthetiques et fonctionnelles. La technique la plus communement pratiquee est la greffe de peau, avec des resultats imparfaits. Notre objectif est de rapporter les resultats de la plastie penienne par rotation de lambeaux scrotaux pedicules, une technique encore largement sous-utilisee. Methodes L’ensemble des patients ayant beneficie d’une plastie penienne par lambeaux scrotaux ( Fig. 1 ) dans notre centre entre 2009 et 2016 ont ete inclus. Nous avons collecte dans les dossiers de chaque patient les donnees demographiques, comorbidites, indications de plastie penienne, donnees perioperatoires et complications chirurgicales. Les resultats fonctionnels et esthetiques ont ete recueillis par l’administration d’un questionnaire [Annexe 1] comprenant des items cotes de 1 a 10 evaluant l’impact de l’intervention sur l’aspect, la fonctionnalite et la satisfaction des patients, ainsi que deux questionnaires traduits et valides sur la rigidite des erection (EHS) et sur l’aspect des cicatrices (POSAS). Resultats Vingt-deux patients ont ete inclus avec un suivi median de 10,5 mois. Les indications etaient iatrogenes, verges enfouies, lesions tumorales et dermatosiques ou injections de produits sclerosants. Les complications precoces comprenaient 36,4 % de desunions cicatricielles, 9,5 % d’infections et 9,1 % d’hematomes, sans aucune reprise chirurgicale. Plus tardivement, 27,3 % des patients ont presente une ascension testiculaire, 31,8 % une retraction cutanee, 9,1 % un aspect pyramidal de la verge et 13,6 % un raccourcissement, avec au total 36,4 % de reinterventions ( Tableau 1 ). Douze patients ont finalement repondu aux questionnaires. La satisfaction globale de l’intervention etait cotee en moyenne a 8,3/10, avec un impact psychologique positif sur l’image corporelle et le regard exterieur. L’aspect global des organes genitaux, la pilosite, la coloration, l’elasticite et l’epaisseur cutanees etaient les items les moins bien notes. L’EHS et le POSAS postoperatoires etaient respectivement cotes a 3,3/4 et 17,3/60 en moyenne ( Tableau 2 ). Conclusion Dans notre serie, la plastie penienne par rotation de lambeaux scrotaux pedicules parait etre une bonne alternative a la greffe de peau libre pour la reconstruction de defects cutanes du fourreau, avec une morbidite acceptable et des resultats fonctionnels, esthetiques et psychologiques satisfaisants. Ces resultats appellent confirmation par une etude de plus grande envergure, idealement avec comparaison a la greffe de peau libre.

Objectifs La prise en charge d’une tumeur sur rein unique anatomique est un defi chirurgical avec un objectif de resultat imperatif a la fois oncologique et fonctionnel. L’objectif de notre etude etait de comparer les resultats perioperatoires de la chirurgie robot-assiste a ceux de la chirurgie a ciel ouvert dans cette indication. Methodes Nous avons mene une etude multicentrique sur la base de donnees uro-CCR, 150 patients ont ete inclus entre 1988 et 2020. Les donnees clinicopathologique, pre-, per- et postoperatoires ont ete analysees de maniere retrospective. L’objectif principal de l’etude etait l’etude de la variation du debit de filtration glomerulaire (DFG) calcule selon MDRD a 3, 6, 12 et 24 mois en fonction de la voie d’abord choisie. L’objectif secondaire etait la comparaison de l’accomplissement du Trifecta (marges negatives, absence de complications et clampage Resultats Soixante-huit patients (45 %) ont ete inclus dans le groupe robot et 82 patients (55 %) dans le groupe chirurgie ouverte. Les deux groupes etaient comparables pour toutes les donnees pre-, per- ou postoperatoire. Une difference significative etait observee sur la duree d’hospitalisation qui etait de 5 jours pour le groupe robot versus 9 jours pour le groupe chirurgie ouverte (p Tableau 1 , Tableau 2 ). Conclusion Dans notre etude, la voie d’abord ne modifiait ni les resultats oncologiques ni les resultats fonctionnels et permettait une diminution significative de la duree de sejour. La chirurgie laparoscopique robot-assistee est une technique sure et efficace pour la prise en charge des tumeurs renales sur rein unique anatomique.

Resume Objectif Evaluer les complications et l’efficacite sur le plan de la douleur et des symptomes fonctionnels urinaires de la chirurgie pour atteinte endometriosique profonde vesicale ou ureterale. Methode Etude retrospective des complications postoperatoires (Clavien-Dindo), de la douleur (echelle visuelle analogique [EVA]) et du retentissement fonctionnel (Urinary Symptom Profile [USP]) des patientes operees pour une endometriose vesicale ou ureterale entre 2007 et 2015 au CHU de Lyon. Resultats Parmi les 31 patientes presentant une atteinte vesicale, 83,9 % ont beneficie d’une cystectomie partielle et 16,1 % d’une resection extra-muqueuse. En cas d’atteinte ureterale (20 patientes), 85 % des patientes ont eu une resection ureterale avec reimplantation vesicale et 15 % une ureterolyse seule. Le taux de complications de grade III etait respectivement de 6 % et 0 % apres chirurgie pour atteinte vesicale et ureterale. Aucune complication de grade IV ou V n’a ete observee. L’EVA moyenne de douleur vesicale a 42 mois de suivi diminuait de 5,3 ± 4,2 a 0,3 ± 0,9 (p Conclusion La prise en charge chirurgicale multidisciplinaire de l’endometriose des voies urinaires est associee a un faible taux de complications severes et a une amelioration significative a long terme de tous les symptomes douloureux sans sequelles fonctionnelles.

To evaluate predictive radiological elements for adherent perinephric fat (APF) and the Mayo adhesive probability (MAP) score in the setting of open partial nephrectomy, and to assess their reproducibility.We performed a retrospective case-control study involving 86 patients who had open partial nephrectomies performed by a single surgeon between January 1, 2009 and April 1, 2015. Radiological elements were assessed by 4 readers blinded to patient APF status. Univariate and multivariate analyses were performed for all radiological and clinical factors. Reproducibility was analyzed using agreement coefficients.On univariate analysis for radiological findings, lateral and posterior fat thickness (odds ratio [OR]: 1.084 [1.033, 1.138], P .001), stranding (OR: 2.179 [1.431, 3.318], P .001), -80 HU fat area, and the MAP score (OR: 1.797 [1.332, 2.424], P .001) were predictive of APF. On multivariate analysis, only age and the MAP score remained statistically significant (OR: 1.060 [1.005, 1.118], P = .03; and OR: 1.560 [1.137, 2.139], P = .0058, respectively). The reproducibility of the MAP score was fair (AC1 = 0.367 and kappa F = 0.353), as was that of stranding (AC1 = 0.499, kappa F = 0.376). The agreement was important if we defined a "low" (0 to 3) or "high" (4 or 5) score (AC1 = 0.706 and kappa F = 0.681).The MAP score was the element that best predicted APF in our study, although its reproducibility among our readers was only fair. The agreement becomes important if we defined "low or high" score.

Renal epithelioid angiomyolipoma (E-AML) is a rare mesenchymal tumor of the kidney included in the family of tumor with perivascular epithelioid cell differentiation (PEComas) and is frequently associated with tuberous sclerosis complex. Since its clinical and radiological features are not specific, the diagnosis remained mostly pathological. Microscopically, E-AML demonstrate proliferation of more than 80% of epithelioid cells with atypia, often associated with necrosis, hemorrhage, mitotic activity and vascular invasion. Tumor's cells are immunohistochemically positive for melanocytic and smooth muscle markers. The pathologic prognostic predictors are not well known and the malignancy remained based on the identification of distant metastasis. We herein report a case of E-AML diagnosed in a 58-year-old woman and review analysis in the literature to discuss the prognostic indicators of malignancy useful for risk stratification of E-AML and to manage the patients.

Resume Introduction Les lesions ureterales post-traumatiques sont majoritairement traitees par sonde double J. Une minorite necessite des prises en charges complementaires. Les stents ureteraux presentent une alternative chirurgicale. Pour evaluer les resultats de la mise en place des protheses Allium ® ureterales dans la prise en charge des patients porteurs de sonde double J au long cours pour des stenoses ureterales. Materiels et methodes Etude de cohorte retrospective, multicentrique, de 36 patients ayant beneficies de la pose de 37 stents ureteraux Allium ® (metallique 24 Ch) de septembre 2011 a janvier 2015 dans trois centres hospitalo-universitaire francais. La moyenne d’âge des patients operes etait de 63,8 ans (33 a 88 ans). La majorite des patients etaient des femmes (70 %). Un pourcentage de 5,6 presentaient une fistule ureterale et 94,4 % une stenose. La longueur moyenne de la stenose etait de 4,15 cm (0,5 a 12 cm). Toutes les analyses ont ete realisees en formulation bilaterale pour un risque d’erreur de premiere espece de 5 %. Une difference a ete consideree comme statistiquement significative quand le degre de signification ( p ) etait inferieur a 0,05 (risque α = 5 %). Les resultats sont exprimes en termes d’hasard-ratios (HR), intervalles de confiance a 95 % associes et p -values. Resultats Trente-sept pour cent des stents ont ete retire au decours du suivi pour des complications a type de migration (18,9 %), d’infection (10,8 %) et d’intolerance (8,1 %). Les autres stents ont ete retires au bout d’un an. L’efficacite de la mise en place du stent, definie comme l’absence de recidive de la stenose ou de la fistule, etait de 52,8 % avec un suivi moyen de 7,1 mois. Conclusions La mise en place des stents Allium ureteraux offre une alternative chez les patients en sonde double J a demeure avec une efficacite de plus de 50 %. Niveau de preuve 4.

Introduction The creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques. Aim To report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. Methods This is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis. Main Outcome Measures Early-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction. Results Sixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft. Conclusion This study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.

Objectifs Evaluer la morbidite, les resultats carcinologiques et fonctionnels de la voie d’abord robotique pour la nephrectomie partielle (NP) chez le patient obese (IMC > 30 kg/m2). Methodes Analyse retrospective portant sur les patients avec IMC > 30 et operes par NP entre 2009 a 2017 et inclus prospectivement apres consentement dans la base de donnees francaise UroCCR (CNIL DR 2013-206 ; NCT03293563 ). Analyse descriptive de la population et comparaison du groupe experimental « NPR » avec un groupe controle nephrectomie partielle ouverte (NPO). Les variables qualitatives ont ete decrites par les effectifs et pourcentages. Comparaisons par les tests du Chi2, de Fischer et le test de Student pour les variables qualitatives et quantitatives. Analyse de survie par un modele de survie d’Aalen–Johansen pour prendre en compte le risque competitif (Rstudio version 1.1.463). Resultats Au total, 669 patients (480 NPR vs 189 NPO) presentaient un IMC > 30 kg/m2, mediane : 32,4 kg/m2 dont 9,2 % en obesite morbide (IMC > 40) avec un suivi median de 36 mois. Parmi les patients, 62,2 % avaient un ASA 2 et 72,9 % un ECOG 0. Aucune difference statistique n’etait retrouvee sur les variables de complexite et de taille tumorale. Les taux de complications per-, postoperatoires medicales et chirurgicales etaient significativement moins importants apres NPR (5,5 vs 11 %, 13,2 vs 20 % et 3,8 vs 15 %, respectivement). La duree d’hospitalisation et les pertes sanguines etaient inferieures apres NPR (3,8 vs 8,1 j et 305 vs 426 mL). Le Trifecta et la duree de clampage n’etait pas statistiquement differents. Les variations de fonction renale etaient comparables entre les 2 groupes. Les survies sans recidives etaient identiques dans les 2 groupes. Conclusion (1) La voie d’abord robotique permet de diminuer la morbidite de la NP et les durees d’hospitalisation chez les patients obeses (IMC > 30 kg/m2) tout en garantissant des resultats oncologiques et fonctionnels equivalents a la voie ouverte. (2) Effectifs trop faibles pour conclure sur les patients en obesite severe (IMC > 35).

Objectifs La rehabilitation amelioree apres chirurgie (RAAC) a montre de nombreux avantages notamment en chirurgie digestive et actuellement pour la cystectomie en urologie. L’objectif de notre etude etait d’evaluer l’interet et la securite d’un programme de RAAC pour la nephrectomie partielle robot-assistee (NPRA) pour cancer. Methodes Il s’agissait d’une etude monocentrique retrospective comparative dans un centre ou un programme de RAAC apres NPRA a ete introduit depuis 2015 et propose a tous les patients operes de NPRA apres consentement signe. Le groupe controle incluait les patients operes d’une NPRA immediatement avant la mise en place du protocole. Les parametres etudies incluaient les caracteristiques des patients, des tumeurs, les parametres peroperatoires (saignement, temps d’ischemie), biologiques, les durees d’hospitalisation, les complications postoperatoires et le taux de rehospitalisation. Les comparaisons etaient calculees en utilisant le test Pearson Chi2 pour les donnees qualitatives et le test de Student pour les donnees quantitatives. Resultats Entre 2015 et 2017, 112 patients ont ete inclus dans le groupe RAAC ( Tableau 1 ) et 50 patients ont ete inclus dans le groupe controle. La duree d’hospitalisation etait significativement plus courte dans le groupe RAAC que dans le groupe controle (90 patients [80,4 %] sortis a j2 postoperatoire ou avant vs. 10 patients [20 %] ; p Tableau 2 . Il n’etait pas retrouve de difference significative en termes de complications postoperatoires (15,2 % dans le groupe RAAC vs. 20 % dans le groupe controle, p = 0,447) ni de taux de rehospitalisations dans les 30 jours postoperatoires (9 patients [8,04 %] dans le groupe RAAC vs. 1 patient [0,2 %] dans le groupe controle, p = 0,140). Conclusion La RAAC apres NPRA semble diminuer les durees d’hospitalisation postoperatoires sans augmenter les complications postoperatoires ou les taux de rehospitalisations. La mise en place d’un protocole de RAAC necessite une prise en charge multidisciplinaire et une formation des equipes medicales et paramedicales pour une application optimale en securite pour le patient.

Objectifs Les protocoles de rehabilitation amelioree apres chirurgie (RAAC) en chirurgie robot-assistee renale ont permis d’optimiser la prise en charge des patients. L’appel du lendemain par l’infirmiere de coordination sert a verifier que le retour a domicile s’est effectue dans de bonnes conditions et detecter precocement des complications postoperatoires. L’objectif de cette etude est d’evaluer l’interet de l’appel et ses consequences dans le suivi du patient. Methodes Il s’agit d’une etude preliminaire et retrospective. Tous les patients consecutifs operes d’une nephrectomie (partielle ou totale) ou d’une nephro-ureterectomie robot-assistee depuis septembre 2018 ont ete inclus. Les patients ont tous beneficie du protocole RAAC en vigueur dans le service incluant un appel a j1 de la sortie. Les principaux criteres de jugement etaient le taux d’appel du medecin a l’issue de l’entretien telephonique, le taux d’appel du medecin a 1 mois de la sortie et le taux de rehospitalisation a 1 mois. Resultats Soixante patients ont ete inclus. L’âge median etait de 61 ans (29–80). Quarante-sept (78 %) patients ont ete opere d’une tumorectomie, 12 (20 %) d’une nephrectomie elargie et 1 (2 %) d’une nephro-ureterectomie. La duree moyenne de sejour etait de 2 jours. Cinquante-huit (97 %) des patients ont repondu a l’appel. Parmi les repondants, tous avaient repris une alimentation, 55 (95 %) un transit, 44 (76 %) n’avaient pas ou peu de douleurs, 10 (18 %) presentaient des nausees et aucun n’avait de la fievre. Seuls 5 patients (8 %) ont necessite une mise en relation avec un medecin et il ne s’agissait dans ces situations que de complications mineures Clavien 1. Parmi les 58 repondants, 3 (5 %) ont rappele un medecin et 5 (8 %) ont ete re-hospitalises dans les 30 jours postoperatoires, a distance de l’appel infirmier. Conclusion L’appel du lendemain par l’infirmiere de coordination, peut etre en raison de la precocite de cet appel, n’a pas abouti au diagnostic de complications graves apres chirurgie du rein robot-assistee. Sa suppression pourrait etre discutee pour concentrer ce temps sur la phase preoperatoire determinante dans la prise en charge des patients en protocole RAAC.

Objectifs L’incontinence urinaire d’effort (IUE) est un facteur de degradation de la qualite de vie dans les suites d’une prostatectomie radicale. Le sphincter urinaire artificiel (SAU) est le traitement de reference. Le depistage et le traitement preoperatoire d’une stenose de l’anastomose uretrovesicale (SAUV) est une etape essentielle pour la reussite de l’intervention. L’objectif de l’etude etait d’evaluer l’impact des SAUV sur les resultats du SAU. Methodes Nous avons etudie retrospectivement 147 implantations de SAU de 2005 a 2013 dans le service d’urologie du centre hospitalier de Lyon par 3 operateurs. Les caracteristiques demographiques, l’antecedent d’irradiation, la severite de l’incontinence, les complications ainsi que les taux de continence et de satisfaction postoperatoire du SAU ont ete recueillis. Des tests statistiques de Wilcoxon et Fischer et une courbe de Kaplan–Meier ont ete utilises pour comparer les 2 groupes temoin et SAUV. Une analyse en regression logistique a recherche des facteurs predictifs de reintervention chirurgicale. Resultats Parmi les 147 patients inclus, 24 (16,3 %) presentaient un antecedent de SAUV. Parmi eux, 21 (87,5 %) avaient ete traites par uretrotomie endoscopique. Les patients dans le groupe SAUV avaient une incontinence plus severe (p Conclusion Bien que les resultats apparaissent globalement moins bons, l’antecedent de SAUV ne semble pas etre predictif de mauvaise evolution apres mise en place d’un SAU. Des etudes sur de plus larges cohortes sont necessaires pour confirmer ces resultats.

Resume Objectif principal Recenser les hospitalisations directement liees a une complication survenant dans les 30 jours suivants une ponction biopsie de prostate par voie transrectale (PBP). Objectifs secondaires Definir le taux d’hospitalisation global, le taux de mortalite, les facteurs favorisants eventuels de complications. Patients et methodes Etude monocentrique incluant tous les patients ayant eu une PBP entre janvier 2005 et janvier 2012. Toute hospitalisation survenant dans les 30 jours suivant la PBP pour un motif urgent etait consideree comme potentiellement imputable a la biopsie. On identifiait dans le motif d’hospitalisation les complications directes (infection urinaire ou fievre, rectorragies, caillotage vesical, retention) ou indirectes (decompensation de comorbidites sous-jacentes) de la biopsie. Les facteurs favorisants recherches etaient la prise d’anticoagulant ou d’antiagregant ainsi que les facteurs de baisse de l’immunite. Resultats Sur 2715 hommes ayant eu une PBP 120 (4,4 %) hospitalisations dont 28 (1,03 %) etaient imputables a la biopsie. Vingt-cinq (0,92 %) etaient en rapport avec une complication directe de la biopsie : 14 (56 %) pour infection urinaire ou fievre dont une hospitalisation en reanimation, 5 (20 %) pour rectorragies dont une a necessite plusieurs transfusions, 10 (40 %) pour retention urinaire et 3 (0,11 %) pour une complication indirecte (2 syndromes coronariens et 1 decompensation respiratoire). Plusieurs complications directes etaient associees dans 3 cas. Seules deux hospitalisations pour rectorragie etaient associees a la prise d’un antiagregant ou d’un anticoagulant. Il n’existait pas d’association entre les hospitalisations pour infections urinaires et un statut immunologique diminue. Le premier deces constate dans notre serie est survenu a j31 par embolie pulmonaire (patient multi-metastatique d’un cancer de vessie). Vingt (60,6 %) patients hospitalises en urgence n’avaient pas de cancer de prostate. Conclusions Dans ce large echantillon de patient, le taux global d’hospitalisation imputable a la realisation d’une PBP etait de 1 %. Il n’a pas ete retrouve de facteur predictif de complications amenant a une hospitalisation. Niveau de preuve 4.

Resume Introduction L’utilisation de transplants issus de donneurs a criteres etendus entraine une augmentation du nombre de complications urologiques apres transplantation renale. Deux techniques differentes d’anastomose utilisees afin de retablir la continuite urinaire sont comparees dans cette etude. Patients et methodes Etude retrospective, bicentrique sur une periode de 5 ans. Cent soixante-seize patients operes aux hospices civils de Lyon ont beneficie d’une anastomose uretero-vesicale selon De Campos-Freire (groupe 1) et 167 patients operes a l’hopital Necker a Paris ont eu une anastomose pyelo-ureterale (groupe 2). Les differentes complications urologiques (fistules, stenoses, lymphoceles, hematomes et reflux vesico-ureteraux) et leur prise en charge ont ete comparees. Les facteurs de risque ont ete recherches. Resultats Les delais d’attente avant la transplantation etaient plus longs dans le groupe 2 que dans le groupe 1 (51.0 et 33.8 mois) ainsi que le pourcentage de patients anuriques. (52,9 % contre 32,9 %) (p Conclusion Cette etude ne permet pas de mettre en evidence la superiorite d’une technique d’anastomose urinaire. La mise en place d’une sonde JJ limite le risque de complication. L’analyse des facteurs de risque permet de proposer un arbre decisionnel afin de guider la strategie chirurgicale, en particulier dans la population de receveurs anuriques. Niveau de preuve 5.

Resume Objectif Evaluer les resultats oncologiques et fonctionnels apres un traitement par cryoablation pour des tumeurs renales dans notre centre. Patients et methode Etude retrospective concernant 28 tumeurs pour 26 patients chez qui une cryoablation a ete realisee de novembre 2006 a juin 2011. Les caracteristiques des patients et des tumeurs ainsi que les donnees peri- et postprocedure ont ete repertoriees. Une biopsie a ete realisee systematiquement avant chaque procedure. Le protocole de suivi comprenait une imagerie de controle a 1 mois, puis tous les 3 mois pendant 1 an, puis tous les 6 mois pendant 2 ans, puis annuellement. Le succes a ete defini par l’absence de rehaussement dans la zone traitee, apres injection de produit de contraste, lors des differents controles d’imagerie. Resultats Les patients avaient un âge, un indice de comorbidite selon Charlson et un BMI moyens de 70,1 ans, 6 et 29 kg/m2 respectivement. Ont ete inclus onze reins uniques dont quatre transplants. Les tumeurs avaient une taille moyenne de 29,5 (± 9,8) mm et etaient representees majoritairement par des carcinomes renaux a cellules claires (16/28), endophytiques (17/28) et mediorenales (14/28). Vingt-cinq cryoablations ont ete realisees par voie percutanee, deux par lombotomie, parmi les complications nous avons note deux pneumothorax perprocedures et six complications mineures postprocedure (≤ Clavien 2). Il n’y a eu aucune complication majeure. Le suivi moyen etait de 27,5 mois (± 15,7). Il n’y a pas eu de modification significative de la fonction renale. La survie globale et la survie specifique etaient de 100 % tandis que la survie sans recidive etait de 78,6 % (5 recidives et un 1 echec de traitement). Conclusion La cryoablation percutanee offre une alternative mini-invasive, avec un controle oncologique satisfaisant, pour les patients porteurs de petites tumeurs renales qui ne peuvent pas beneficier d’une chirurgie d’exerese. Niveau de preuve 5.

Resume But Evaluer la capacite du test urinaire PCA3 a predire le resultat des biopsies prostatiques dans une large cohorte issue du centre hospitalier Lyon-Sud. Patients et methodes Le score PCA3 a ete determine prospectivement chez 1015 patients adresses pour biopsies prostatiques. La capacite predictive du score PCA3 a ete evaluee par la comparaison des aires sous les courbes ROC, de modeles de regression logistique et une analyse par decision curve analysis (DCA). Resultats Le score PCA3 median etait significativement plus eleve chez les patients avec biopsies positives. L’AUC etait de 0,76, significativement plus elevee que celle du PSA a 0,55. Au seuil de 35, la sensibilite etait de 68 %, la specificite de 71 %, les valeurs predictives positive et negative de 67 % et 71 %, et l’efficience de 69 %. En analyse multivariee, le score PCA3 etait predicteur independant du resultat des biopsies et son addition a un modele de base comportant les donnees clinico-biologiques classiques apportait un gain diagnostique significatif. Au seuil de 20, pres de la moitie des biopsies a posteriori inutiles auraient ete evitees, tout en ayant ignore 7 % des cancers avec score de Gleason ≥ 7. Le score PCA3 n’apparaissait pas correle au score de Gleason, mais etait bien correle au volume tumoral (evalue par la proportion de carottes envahies). Conclusion Le test urinaire PCA3 presente des performances diagnostiques elevees pour le diagnostic precoce du CaP. Sa correlation avec l’agressivite du cancer s’exprime a travers le volume tumoral plus que par le score de Gleason. Niveau de preuve 5.