[Intravesical microwave thermo-chemotherapy for the treatment of non-invasive bladder cancer]. / Thermo-chimiothérapie intravésicale par radiofréquence pour le traitement du cancer non invasif de la vessie.

Non-invasive urothelial carcinoma of the bladder is known for its significant rate of recurrence after transurethral resection (TURB) even after adjuvant intravesical chemotherapy or immunoprophylaxis. Therefore, new and more effective approaches for the management of non-invasive bladder tumors have been developed and are progressively introduced in clinical practice. Recently, the endovesical administration of a combined regimen using a cytostatic agent and microwave-induced hyperthermia appears to be highly efficient and possibly superior to intravesical chemotherapy alone for none invasive bladder cancer.

Le carcinome urothélial non invasif de la vessie (n'envahissant pas le détrusor) est grevé d'un risque de récidive significatif malgré les instillations endovésicales adjuvantes avec des agents chimio- ou immunothérapeutiques suite à la résection endoscopique de la tumeur vésicale. Dans ce contexte, de nouvelles approches thérapeutiques potentiellement plus efficaces ont été récemment développées et sont progressivement introduites dans la pratique clinique courante. L'une de ces dernières est la combinaison d'une hyperthermie endovésicale à l'instillation intravésicale d'agents chimiothérapeutiques classiquement administrés lors de la prise en charge des cancers non invasifs. Ce nouveau traitement apparaît être d'une efficacité supérieure à celle de l'instillation simple d'agents chimiothérapeutiques endovésicaux.

Post-kidney Transplant Robot-assisted Laparoscopic Ureteral (Donor-receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease.

OBJECTIVE: To report our experience with robot-assisted ureteral anastomosis for kidney graft. Kidney graft complex ureteral strictures or symptomatic vesicoureteral reflux may require complex reconstruction. This is classically done through an open surgical access, which adds to the morbidity of kidney transplantation. The da Vinci robot enables performance of complex laparoscopic procedures and may hence be used for such reconstructions. PATIENTS AND METHODS: We retrospectively reviewed all patients undergoing robotic surgical revision for stricture or reflux disease over a 3-year period. Contemporary patients who underwent open surgery were used as a control group. RESULTS: Ten patients underwent a robotic attempt, of whom 4 needed conversion to open surgery. Seven patients underwent an open surgery. Preoperative demographics were similar in both groups. The median operative time was 293 minutes, with a shorter operative time in the open group. The group of patients who could be completed robotically had a significantly lower postoperative length of stay (5 vs 9 days), quicker return to normal food intake (postoperative day 1 vs 3), and quicker control of pain without opiates (postoperative day 1 vs 4) than the converted or open group. Morbidity was comparable with 1 late Clavien IIIb complication in each subgroup (open, converted, and robotic group). After a median follow-up of 43 months, renal function was stable and there were no recurrent graft infections. CONCLUSION: Robotic ureteral reconstruction for kidney graft patients is feasible and efficient, and offers the classical advantages of minimally invasive surgery with outcomes comparable with open series.

[New approaches for the treatment of superficial bladder cancer]. / Nouvelles approches dans le traitement des tumeurs non invasives de la vessie.

Extending up to the submucosa, superficial bladder tumours (pTis, pTa et pTi) are initially treated by transurethral resection. According to their risk of recurrence and progression, this frequent cancer subsequently benefits from intra-vesical instillations of cytotoxic agents and immunomodulators. Several new treatments are currently being evaluated, namely new genetically modified BCG strains, so as novel means to administrate intravesical chemotherapy, which seam to improve prognosis. Owing to the significant prevalence of superficial bladder cancer and its morbidity, these new therapeutic means will probably be increasingly used.

Histologic confirmation of a biochemical recurrence after radical prostatectomy by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance imaging.

OBJECTIVE: To obtain a histologic confirmation of biochemical recurrence after radical prostatectomy, which still remains a challenge. Historically, biopsy protocols have been designed but have provided rather unsatisfactory results. We report the first case of histologic confirmation of a biochemical recurrence in the prostatectomy bed by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance images. MATERIALS AND METHODS: A 66-year-old man who underwent laparoscopic prostatectomy for a localized prostate cancer of Gleason sum 3+3=6 and preoperative prostate-specific antigen (PSA) level of 8.9 ng/L was followed up yearly. Postoperative serum PSA value was <0.04 ng/L. Nine years later, the patient developed a biochemical recurrence with an elevation of serum PSA level to 1.27 ng/mL. A 3-T endorectal positron emission tomography-magnetic resonance imaging (MRI) scan showed a 5 × 3 mm nodule in the prostatectomy bed in contact with the vesicourethral anastomosis without hypermetabolism. Two biopsies of this nodule were performed by using a 3-dimensional endorectal ultrasonography probe connected to the Koelis navigation system (Urostation; Koelis, Grenoble, France) with fusion to MRI images. RESULTS: Histologic findings confirmed the presence of a recurrence of the prostate cancer of Gleason sum 4+3=7 in both biopsies, and the patient was addressed to the radio-oncologist for salvage therapy. CONCLUSION: The use of a transrectal approach with 3-dimensional guidance and MRI fusion allows correct sampling of prostate cancer recurrence nodules in the prostate bed. This procedure is easily performed in the outpatient clinic but still has to be validated in a larger series.

[Primary care management of hematuria: is it obvious?]. / Prise en charge de l'hématuri par le praticien généraliste Une démarche diagnostique qui coule de source?

Hematuria is frequent and its diagnostic array is wide, ranging from benign pathologies such as infections or stones to neoplasia, sometimes also including some nephropathies. Twenty per cent of patients presenting with macro-hematuria harbour a urologic tumor. This validates an in-depth evaluation, classicaly associating contrast studies and cystoscopy. The occurrence of hematuria in patients on anticoagulants and/or antithrombotics should never be overlooked, since post work-up etiologies are as significant as these outlined in patients not under such prescriptions. Microhematuria also requires a distinct work-up, especially when there are risk factors for a urothelial neoplasia.