[Hypothyroidism and immunotherapy using interferon or interleukin for metastatic renal adenocarcinoma]. / Hypothyroïdie et immunothérapie par interféron ou interleukine pour adénocarcinome rénal métastasé.

The authors report a case of hypothyroidism occurring during cytokine treatment of metastatic renal cancer. This is a relatively rare complication of immunotherapy, whose aetiopathogenesis remains unclear. Possible hypotheses include an autoimmune process or direct toxicity. Thyroid function tests at the start of immunotherapy and regular monitoring are therefore recommended during treatment with interferon and/or interleukin. If hypothyroidism is not recognised, its clinical symptoms and signs could be attributed to cytokine toxicity, leading to unwarranted discontinuation of treatment when L-thyroxin replacement therapy would have been sufficient.

[Laparoscopic drainage of a lymphocele after radical prostatectomy]. / Drainage laparoscopique d'une lymphocèle après prostatectomie radicale.

A laparoscopic procedure used to achieve transperitoneal drainage of a lymphocele that developed three months after radical prostatectomy for prostate cancer is described. The lymphocele wall was resected through a peritoneal opening. After drainage of the lymphocele, a corner of the omentum was inserted into the cavity. Preoperative aspiration of the lymphocele and computed tomography allowed accurate evaluation of the relationships of the lymphocele with the blood vessels, urinary tract, and digestive tract. These investigations also ruled out an infection and established the diagnosis of lymphocele. Laparoscopic drainage has the same indications as conventional internal drainage and readily allows to perform the same procedures. As a conventional internal drainage and readily allows to perform the same procedures. As a simple procedure associated with low morbidity, laparoscopic drainage could be used as the first-line treatment for large, symptomatic, recurrent lymphoceles developing after pelvic surgery, in particular after extraperitoneal procedures such as radical prostatectomy, provided there is no infection, the lymphocele is readily accessible, and the surgeon is experienced in the use of laparoscopic techniques.

[Drainage of a lymphocele after kidney transplantation, using laparoscopy]. / Drainage d'une lymphocèle après transplantation rénale, par laparoscopie.

The authors report a case of transperitoneal laparoscopic drainage of a recurrent, compressive lymphocele occurring 3 months after cadaver renal transplantation. The technique consists of creating a transperitoneal breach and resecting the walls of the lymphocele to ensure internal drainage followed by suture of a slip of greater omentum over the opened lymphatic cavity. Preoperative aspiration and computed tomography precisely defined the site of the lymphocele in relation to urinary and vascular structures, confirmed the lymphatic nature of the collection and excluded the presence of infection. This technique has the same indications as classical surgical internal drainage and can be used to easily perform the same procedures. Because of its simplicity and low morbidity, laparoscopic drainage can be proposed as first-line treatment for large, symptomatic and recurrent posttransplantation lymphoceles, in the absence of infection and provided the lymphocele is in an accessible site and the operator has a sufficient experience of laparoscopic techniques.

Continent urinary diversion using an artificial urinary sphincter.

We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra-prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure-regulating balloon is implanted within the area of abdominal pressure, retroperitoneally. After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow-up of 20 months. These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir. Although long-term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.