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Purpose: Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort., Methods: We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain., Results: 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87)., Conclusions: Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To assess the oncological outcomes of renal cell carcinoma (RCC) associated with tumor thrombus and identify predictive factors of recurrence., Methods: Multi-institutional study that included patients with cT3-4N0-1M0 RCC with tumoral thrombus identified in the prospective UroCCR database (CNIL DR 2013-206; NCT03293563). pT3a without involvement of the renal vein were excluded. All patients underwent radical nephrectomy and a thrombectomy of the renal vein ± inferior vena cava ± right atrium. The primary endpoint was recurrence-free survival (RFS). Thirty-two patients who had adjuvant therapies (tyrosine kinase inhibitors or mTOR inhibitor) were compared to control group (surveillance) in a propensity score-matched 1:1 sub-analysis RESULTS: A total of 432 patients were included: 70.4% pT3a, 20.1% pT3b, 4.2% pT3c and 5.3% pT4. Tumor characteristics were: 90.7% clear cell RCC, 13.9% pN1, and 87.1% high Fuhrman grade. 173 patients (40%) had disease recurrence, and median RFS was 37.3 months (95% CI, 26.4-46.7). In a multivariate analysis (Cox model), predictive factors of recurrence were: pT4 (HR 2.66; 95% CI, 1.42-4.99; p = 0.002), pN1 (HR 2.53; 95% CI, 1.46-4.39; p < 0.001), tumor necrosis (HR 2.92; 95% CI, 1.85-4.62; p < 0.001), tumor size > 10 cm (HR 1.56; 95% CI, 1.08-2.24; p = 0.018). Adjuvant therapy was a protective factor of cancer recurrence (HR 0.33; 95% CI, 0.17-0.66; p = 0.002). Propensity score-matched sub-analysis of adjuvant vs control (surveillance) confirmed adjuvant treatment as a protective factor of cancer recurrence (Log rank p = 0.015)., Conclusions: In this contemporary multi-institutional cohort of RCC + tumor thrombus, we reported higher recurrence rate shortly after surgical excision and demonstrated an oncological benefit of adjuvant treatment., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To perform an external validation of this RC-pentafecta., Method: Between January 2014 and December 2019, 104 consecutive patients who underwent RARC with ICUD within 6 urological centers were analyzed retrospectively. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), a lymph node (LN) yield ≥ 16, absence of major (Clavien-Dindo grade III-V) 90-day postoperative complications, absence of UD-related long-term sequelae, and absence of 12-month clinical recurrence were considered to have achieved RC-pentafecta. A multivariable logistic regression model was used to measure predictors for achieving RC-pentafecta. We analyzed the influence of this RC-pentafecta on survival, and the impact ofthe surgical experience., Results: Since 2014, 104 patients who had completed at least 12 months of follow-up were included. Over a mean follow-up of 18 months, a LN yield ≥ 16, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤ 12 months were observed in 56%, 96%, 85%, 81%, and 91% of patients, respectively, resulting in a RC-pentafecta rate of 39.4%. Multivariate analysis showed that age was an independent predictor of pentafecta achievement (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.90. 0.99; p = 0.04). The surgeon experience had an impact on the validation of the criteria., Conclusion: This study confirmed that the RC-pentafecta is reproducible and could be externally used for the outcome assessment after RARC with ICUD. Therefore, the RC-pentafecta could be a useful tool to assess surgical success and its impact on different outcomes., (© 2021. The Author(s).)

Hormone deprivation therapies play a key role in the treatment of prostate cancer. These treatments require standardized care and regular monitoring. The objective of this work was to review the different hormonal therapies available, their side effects and the role of a coordinating nurse in the management of these therapies. First generation hormone therapy is the standard treatment for metastatic prostate cancer. In the past years, second generation hormone therapies have been indicated in combination with first-generation hormone therapies at different stages of the disease. These molecules are responsible for several side effects that should be monitored and prevented. Thus, after an initial assessment, clinical and paraclinical follow-up are essential. Our center has set up monitoring by a coordinating nurse (IDEC) to optimize the education and follow-up of the patient, but also to provide psychosocial support adapted throughout the patient's care path under hormone therapy. This monitoring and information function by IDEC can be facilitated by new digital solutions., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objective: We aimed to explore biological predictive factors of progression after surgery in nonmetastatic renal cell carcinoma (RCC) using the collected tumors in the French cohort of the randomized S-TRAC trial patients. Patients and Methods: We analyzed the tumors of the French cohort of STRAC that included 44 cases of clear cell RCC (ccRCC) that were collected from six centers. The main objective was to explore biological predictive factors of progression (defined as PFS) to sunitinib. Broad-spectrum analysis including immunohistochemistry, fluorescent in situ hybridization (FISH), comparative genomic hybridization (CGH) array, and transcriptomic analyses were performed on the tumors. Results: Analysis of vascular density showed type 1 vascular stroma corresponding to high vascular density was associated with progression ( p < 0.034). Loss of poly bromo-1 expression showed a distinct profile: a highly histopathological aggressive tumor with a marked angiogenic profile (vascular endothelial growth factor overexpression and immature vascular stroma type 2), no PD1 or PDL1 expression, and wild-type (WT) status of the VHL gene. There were 27 chromosome regions gained in patients with progression (on chromosomes 7 and 16, and to a lesser extent 8, 12, 17, 17, 19, 20 corresponding to 605 associated genes) and 10 regions lost in these same patients on chromosomes 8 and 9, and to a lesser extent 2 and 21 corresponding to 25 associated genes. Conclusion: We found that an angiogenic phenotype defined by a high vascular density with a vascular type 2 stroma was a predictive factor of sunitinib resistance. Regardless of adjuvant treatment, chromosomal gains and losses and genomic alterations including PBRM1 loss were associated with worse outcomes. Clinical Trial Registration : ClinicalTrials.gov number, NCT00375674., (Copyright © 2020 Ouzaid, Kammerer-Jacquet, Khene, Ravaud, Patard, Bensalah and Rioux-Leclercq.)

Objectives: To evaluate the prognostic role of the Bosniak classification on the long-term oncological outcomes of cystic renal cell carcinomas., Material and Method: In a national multicentric retrospective study, we included patients treated surgically for localized cystic RCC from 2000 to 2010. Patients with a follow-up of less than 4 years, benign tumors, and ablative treatments were excluded. The primary outcome was disease-free survival., Results: 152 patients met the inclusion criteria: Bosniak II (6%), III (53%), IV (41%), with a median follow-up of 61 (12-179) months. Characteristics of the population and the tumors were [median, (min-max)] age 57 (25-84) years old, tumor size 43 mm (20-280), RENAL score 7 (4-12), PADUA score 8 (5-14). Treatments were 55% partial nephrectomy, 45% radical nephrectomy, 74% open surgery, and 26% laparoscopy. In pathological report, cystic RCC were mainly of low grade (1-2, 77%) and low stage (pT1, 81%). The two main histological subtypes were conventional (56%) and papillary (23%) RCC. Staging at presentation and histological characteristics were similar between Bosniak III and IV, except for high grade which was more common in Bosniak IV (12 vs 36%, p < 0.01). The Bosniak classification was not predictive of the recurrence, as 5- and 10-year disease-free survival were similar in Bosniak III and IV (92% vs 92% and 84% vs 83%, p = 0.60)., Conclusion: The Bosniak classification is predictive of the risk of malignancy but not of the oncological prognosis. Regardless of the initial Bosniak categories, almost all cystic RCCs were of low stage/grade and had low long-term recurrence rate.

Objective: To evaluate the impact of anticoagulant (AC) or antiplatelet (AP) therapy on the morbidity of robot-assisted partial nephrectomy (RAPN)., Materials and Methods: From 2011 to 2015, we retrospectively analyzed a prospectively maintained institutional review board-approved database of RAPN from 2 academic departments of urology. We evaluated the occurrence of overall complications and hemorrhagic complications (pseudoaneurysm, arteriovenous fistula, hematoma, transfusion). Patients with therapeutic AC or AP, stopped or not before surgery, were compared with patients without therapeutic AC or AP. A logistic regression model was used to identify predictors of complications., Results: Out of 533 patients who underwent RAPN, 70 had AC or AP (50% aspirin, 25% clopidogrel, 28% AC, 8% direct oral AC). Clopidogrel, AC, and direct oral AC were always stopped preoperatively. Aspirin was continued in 25% of the cases. In univariate analysis, overall complications (39.2% vs 17.4%; P = .001) and hemorrhagic complications (32.7% vs 9.6%; P <.001) were higher in patients on AC or AP. Hospital stay was longer in the group with therapeutic AC or AP treatment (5.1 vs 3.9 days; P <.001). In multivariate analysis, predictors of complications were intake of therapeutic AC (odds ratio [OR] = 4.3, IC95% [1.2-15.9], P = .03) and tumor size (OR = 1.8, IC95% [1.3-7.2], P = .03). Patients on aspirin tended to have more complications (OR = 2.4; IC95% [0.4-9.3]; P = .15)., Conclusion: AP and therapeutic AC increase the morbidity of RAPN. These treatments should be taken into account in treatment decision-making algorithm of small renal masses., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Genital prolapse is usually seen as a benign condition warranting treatment only when bothersome. We report the case of a 77-year-old woman who presented with massive incarcerated pelvic organ prolapse, which led to bladder necrosis, cystectomy with bilateral cutaneous ureterostomy, and death from medical complications 5 weeks after the initial presentation. This first case report of death from bladder necrosis after incarcerated genital prolapse could warrant treatment of massive prolapse even when apparently well tolerated., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Only a few studies have compared the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). This study aimed to compare perioperative and oncologic outcomes of RPN and OPN., Methods: The data of all patients who underwent partial nephrectomy from 2006 to 2014 in six academic departments of urology were retrospectively collected. Perioperative outcomes were compared between OPN and RPN patients. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method and compared using the log-rank test., Results: The study included 1800 patients: 937 who underwent RPN and 863 who underwent OPN. The patients in the robotic group had smaller tumors (33.1 vs. 39.9 mm; p < 0.001) but comparable RENAL scores (6.8 vs. 6.7; p = 0.37). The complication rate was higher in the OPN group (28.6 vs. 18 %; p < 0.001). The OPN patients had greater estimated blood loss (359.5 vs. 275 ml; p < 0.001) and more frequent hemorrhagic complications (12.1 vs. 6.9 %; p < 0.001). The robotic approach was associated with a shorter warm ischemia time (WIT 15.7 vs. 18.6 min; p < 0.001) and a shorter hospital of stay (4.7 vs. 10.1 days; p < 0.001). In the propensity score-weighted analysis, the inverse probability of treatment weighting adjusted odds ratio for the risk of complication after OPN versus RPN was 2.11 (95 % confidence interval, 1.53-2.91; p < 0.001). After a median postoperative follow-up period of 13 months for OPN and 39 months for RPN (p < 0.001), CSS and RFS were similar in the two groups. In the multivariate analysis, RPN showed an impact on the occurrence of a complication but had no effect on WIT or RFS., Conclusion: In this study, RPN was less morbid than OPN, with lower complications, less blood loss, and a shorter hospital of stay. The intermediate-term oncologic outcomes were similar in the two groups.

Introduction: The aim of this study was to assess the impact of the acquisition of a Da Vinci ® robot on the use and outcomes of partial nephrectomy (PN)., Patients and Methods: It 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)., Results: 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; P<0.001). Regarding postoperative outcomes, the only change was a decreased length of stay over time (P=0.003)., Conclusion: In this single center series, the robotic approach was associated with a spread of PN and with an improvement of nephron-sparing surgery outcomes., Level of Evidence: 4., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the impact of HA on robotic PN (RPN) outcomes., Methods: We retrospectively analyzed data from patients who underwent RPN in eight centers between 2009 and 2013. Hemorrhagic complications were defined as the occurrence of a pseudoaneurysm, arteriovenous fistula or hematoma requiring transfusion. Patients were first divided into two groups: group A (use of at least one HA) and group B (no HA used), and then into five groups to assess the impact of each HA: group 1 (no HA), group 2 (Floseal(®) only), group 3 (Surgicel(®) only), group 4 (Tachosil(®) only) and group 5 (Surgicel(®) + Floseal(®)). The impact of HA was evaluated by univariate and multivariate analysis., Results: Out of 515 RPN, 315 (61 %) were done using at least one HA (group A) and 200 (39 %) were done without any HA (group B). Patients in both groups had similar hemorrhagic complication rates (13 % vs. 15 %, p = 0.42) and postoperative complication rates (19 % vs. 23 %, p = 0.32). In multivariate analysis, the absence of HA was not a risk factor for hemorrhagic complications (OR 0.77, p = 0.54). When each type of HA was considered individually, none was associated with the occurrence of hemorrhagic complication either in univariate or in multivariate analysis., Conclusion: In this multicenter study, the use of HA was not associated with a lower risk of hemorrhagic or global complications.