Robotic-Assisted Partial Nephrectomy: Techniques to Improve Clinical Outcomes.

PURPOSE OF REVIEW: To summarize current options available for robot-assisted partial nephrectomy RECENT FINDINGS: Partial nephrectomy (PN) is a standard treatment option for management of cT1 renal masses. It may be carried out by multiple approaches. Robot-assisted (RA) PN is one such option. The goal of treatment is both correct oncological (negative surgical margins) and functional (preservation of sufficient amount of renal parenchyma of the operated kidney) outcome. Appropriate outcomes depend on multiple factors. There are many, but among others tumor characteristics (size, location, i.e., tumor complexity), patient baseline renal function, patient comorbidities, and performance status etc. Based on all these, the surgeon adapts the intervention for each mass/patient by preoperative planning, absence/use/duration of warm or cold ischemia, perioperative imaging, resection technique adapted to tumor location and depth of invasion, use of hemostatics, type and degree of renal parenchymal closure and others details. Nephroprotective agents have not shown efficacy so far. It should not be forgotten that surgeon's experience plays a key role in the achievement of good results. Although multiple factors have a role in the RA partial nephrectomy, surgeon experience and adaptation of technique of intervention have the crucial role in the achievement of both functional and oncological results.

[Pregnancy and purulent retention of urine in the upper urinary tract. Apropos of 4 cases]. / Grossesse et rétention purulente d'urines dans la voie excrétrice supérieure. A propos de quatre cas.

The authors report their diagnostic and therapeutic approach to four recent cases. While ultrasound is an excellent diagnostic aid, only simplified intravenous urography can establish the nature and localization of the obstacle. As regards management, surgery, when it is possible, allows removal of the obstacle and the repair of the excretory tract. In pregnant women, as in other cases when surgery is not feasable, the drainage of the infected and retained urine is achieved endoscopically. The J ureteral catheter offers a sure and comfortable method. When retrograde catheterization is unsuccessful, percutaneous nephrostomy can be used as a temporary measure to tide over the pregnancy.

[Renal cancers and caval thrombus, prognostic study. Apropos of 25 cases]. / Cancers du rein et thrombus cave, étude pronostique. A propos de vingt-cinq cas.

Of the 235 renal cancers treated between 1975 and 1984, twenty five cases were complicated by thrombus of the vena cava. Analysis by Kaplan-Meier's method shows a satisfactory survival rate for isolated thrombus of the vena cava (80 per cent at two years, and 45 per cent at five years). But associated lesions to the perirenal fat or lymph nodes considerably diminishes the survival rate, so that the overall survival rate in this series was only 37 per cent at two years and 20 per cent at five years. 57 per cent of the patients who seemed free of distant metastases during the preoperative investigations, nonetheless died within two years postoperatively, from a lung, liver or bone metastasis. CT scan at present allows diagnosis of renal cancer and assessment of the extension to the fatty capsule and the vena cava. It is to be hoped that nuclear spin electronic resonance will provide a better assessment of the prognostic factors, and, in particular, the lymph node extension.

[Vesico-renal reflux and pregnancy]. / Reflux vésico-rénal et grossesse.

By modifying the anatomical location of the bladder and ureter, and by favoring urinary stasis and pyuria, pregnancy may reveal or aggravate an existing vesico-renal reflux. In reporting six cases of vesico-renal reflux in pregnant women, revealed by attacks of feverish lombalgia, or mictional disorders associated with pyuria, and confirmed postpartum by intravenous urography, retrograde cystography and cystoscopy, the authors recall the factors associated with pregnancy which favor the appearance of a reflux, mechanical, hormonal and metabolic action. Surgical correction of refluxes associated with pyuria and detected during pregnancy would seem indicated.

[Vesico-renal reflux in adults. Study of 57 ureters reimplanted by the submucosal advancement method]. / Reflux vésico-rénal de l'adulte. Etude de cinquante-sept uretères réimplantés par avancement sous-muqueux.

Vesicorenal reflux raises specific problems in adults, as regards both the surgical indications and the operative technique. The operative results are discussed in relation to fifty seven ureters reimplanted in thirty six patients, and the indications for surgical management are outlined. Refluxes clinically associated with lumbalgia, fever and pyuria, always require surgery. The most difficult problems arise from "asymptomatic" refluxes revealed by checkups for renal insufficiency, proteinuria or arterial hypertension. In these cases, the characteristics of the ureter (e.g. wide or narrow) and the existence or absence of renal scars must be taken into consideration. Refluxes in narrow ureters should be followed closely, and the advisability of surgery should be carefully weighed in patients with a wide ureter with no visible damage to the parenchyma.