[Prognostic value of markers of aggressiveness of urinary bladder tumours evaluated by immunohistochemistry]

Study the expression of the following immunohistochemical markers in Tumours of the bladder: Proliferating Cell Nuclear Antigen [PCNA], Ki67 antigen [MIB1], the C-erbB2 proto- antigene, the tumor suppressor gene p53, the receptor for epidermal growth factor [EGF-R], the apoptosis suppressor gene bcl2, the carcinoembryonic antigen [CEA] and epithelial membrane antigen [EMA]. Study of retrospective series of 30 patients having tumours of the urinary bladder. The expression of PCNA with a cut-off value of 14% is correlated with recurrence [P = 0.010]. The expression of PCNA with a cut-off value of 1% is correlated with tumour stage [P = 0.003]. The expression of MIB1 with a cut-off value of 47% is correlated with recurrence [P = 0.010]. The expression of MIB1 with a cut-off value of 47% is correlated with the tumour progression in stage and/or in grade [P = 0.007]. The expression of C-erbB2 with a cutoff value of 28% is correlated in the tumour grade [P = 0.007]. The other antibodies didn't demonstrate a prognostic value. MIb1 and PCNA being correlated with recurrence, they can be useful with the decision of the rhythm of the endoscopy. The correlation of C-erbB2 with the tumour grade could serve to better graduating bladder tumours

[Recurrent obstructions after resonance stent placement in the treatment of ureteral compression from malignant disease]

Background: The Resonance ureteral stent is a newly developed all-metallic double-pigtail ureteral stent allowing a palliative diversion on a patient with malignant ureteral obstruction

Aim: To define selection criteria of good candidates for Resonance stent

Case: A 62-year-old woman was admitted to the emergency department with complaining of severe right flank pain and anuria. Twelve days earlier, we had placed retrogradely a ureteral metallic Resonance stent [Resonance: Cook Ireland Ltd, Limerick, Ireland] for the treatment of a ureteral compression from pelvic recurrence of an appendical colloid mucosal carcinoma in a solitary functionning right kidney. A percutaneous nephrostomy catheter was placed, and an antegrade nephrostogram demonstrated complete distal ureter obstruction. The patency of the ureteral stent was restored spontaneously and then, nephrostomy catheter was removed. Two weeks later, she presented with obstructed ureteral stent. Percutaneous nephrostomy was performed and Resonance stent was removed definitively. Ureteroscopy with biopsy confirmed the tumor extension into the ureteral lumen

Conclusion: The risk of subsequent obstruction after Resonance metallic ureteral stent placement is real. Patients with intra-ureteral tumour extension are presumably not good candidates for Resonance stent management

[Ureteral injuries in gynaecologic surgery]

Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the cas of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject