[12-year history of radical surgery indications for the treatment of prostate cancer]. / Évolution sur 12 ans des indications de prostatectomie totale pour cancer.

AIM: To analyze the indications of radical prostatectomy and lymph node dissection retained during the last 12 years in an academic surgical center in the Paris region in order to ensure their adequacy in relation to the current clinical guidelines. METHOD: Monocentric retrospective study of prospectively collected data, between 2007 and 2019. Analysis of the clinical and pathological characteristics which were taken into account during multidisciplinary meeting discussion for the treatment decision, and comparison of their evolution over the four 3-year period corresponding to the clinical guideline updates. RESULTS: Two thousand eighty-eight consecutive patients treated by radical prostatectomy between 16/03/2007 and 17/03/2019 were included. The proportion of patients classified as low, intermediate or high risk according to D'Amico system was 13.2%, 80.8% and 6.0% respectively. An increase in the frequency of surgical treatment of high-risk cancers has been observed. At the same time, there has been a decrease in the frequency of prostatectomies to treat low-risk cancers. CONCLUSION: The indications for radical prostatectomy and lymph node dissection have evolved in line with the current clinical guidelines which were taken into consideration in a onco-urological multidisciplinary meeting. LEVEL OF EVIDENCE: 3.

[Materials used in treatment of stress urinary incontinence with suburethral sling]. / Les matériaux utilisables dans le traitement de l'incontinence urinaire d'effort par bandelette sous-uréthro-cervicale.

Suburethral sling is a classical method of surgical repair of female stress urinary incontinence (SUI). Initially reserved for SUI due to sphincter incompetence, this method now appears to be indicated for other types of SUI. A large number of organic and synthetic materials have been used in published series. The long-term functional results reported in the literature vary between 65 and 98%, regardless of the materials used. Some of the complications observed are specific to the type of material. Synthetic slings appear to be associated with a higher complication rate. It is too early, based on data of the literature, to determine the real role of Prolene tape (TVT).

Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations.

PURPOSE: Bacillus Calmette-Guerin (BCG) therapy is considered to be an effective prophylactic and therapeutic agent for high risk superficial transitional cell carcinoma of the bladder. Nevertheless, in a select uncommon population of stage Ta grade 3 superficial lamina-free tumors the results of this treatment have not yet been well established. We evaluated recurrence and progression rates, and the success of BCG therapy in a population with stage Ta grade 3 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Of the 605 patients treated at our institution from 1982 to 1996 for the histopathological diagnosis of primary bladder cancer 32 (5.3%) with stage Ta grade 3 noninvasive primary bladder tumor were treated with intravesical instillations of 75 mg. Pasteur strain BCG in 50 ml. saline weekly for 6 weeks. At a followup of 2 to 13 years (mean 58.4 months) patients were evaluated with urinary cytology, cystoscopy, transurethral resection and random mucosal biopsies. Recurrence, grade and stage progression, death and causality were analyzed. RESULTS: Of the 32 patients 9 (28%) responded positively to BCG without recurrence, while disease recurred as stage Ta in 8 (25%) and T1 in 7 (22%), and progressed to muscle layer infiltration in 8 (25%). Four patients (12%) died of bladder cancer. The number of tumors at primary resection, gross examination, the mitotic index or an association with carcinoma in situ did not appear to be predictive factors of progression to muscle invasion. Urine cytology (I to II versus III to IV) appeared to correlate highly with progression and BCG response (p<0.001) with excellent sensitivity (1) but low specificity (0.67). CONCLUSIONS: Our study demonstrates the high progression potential of stage Ta grade 3 tumors, since nearly 50% recurred and 25% progressed to invasive disease. These results may be closely compared with the results of previous trials of stage T1 grade 3 disease. We suggest that recurrence should be detected at an early stage using long-term followup with strict observance of the surveillance protocols during a minimum 5-year tumor-free period.

[Renal tumor with thrombus involving all of the lumen of the inferior vena cava: surgical indication, technique and results]. / Tumeur rénale avec thrombus s'étendant à la totalité de la lumière de la veine cave inférieure: indication chirurgicale, technique et résultats.

OBJECTIVES: Almost 5% of renal tumours are associated with thrombus of the renal vein or inferior vena cava at the time of diagnosis. Radical nephrectomy with complete resection of the tumour nodule is the reference first-line treatment in this situation. This retrospective series was designed to analyse the surgical strategy according to the extent of the tumour nodule and the morbidity and mortality as a function of the prognostic factors of these renal tumours. MATERIALS AND METHODS: From 1982 to 1995, 51 patients (out of a series of 724 nephrectomies) presented with renal vein invasion involving all of the lumen of the inferior vena cava. The choice of medical imaging varied over time (cavography, Doppler ultrasound, CT, MRI and transoesophageal ultrasonography). Control of the inferior vena cava was always performed below the renal veins and above the thrombus. RESULTS: MRI and transoesophageal ultrasonography were found to be the most reliable diagnostic examinations. The incision and vessel control technique must be selected as a function of the type of thrombus and the emboligenic risk. With a follow-up of 4.3 years, the overall 2-year survival was 46% and the 5-year survival was 31%. All recurrences at 1 year occurred in N+ patients. CONCLUSION: Lymph node status and invasion of the perirenal fat are the most important prognostic factors, while the presence and length of the thrombus do not appear to influence survival. Radical nephrectomy of these tumours, invading all of the lumen of the inferior vena cava, requires complete resection of the thrombus. Adhesion of the thrombus constitutes a major technical problem that must be envisaged before the incision in order to correctly control the vessels.

[Electrovaporization of the prostate (EVP) for the treatment of prostatic adenoma]. / Electro-vaporisation de la prostate (EVP) pour le traitement de l'adénome de prostate.

UNLABELLED: Electrovaporization of the prostate consists of the use of a high energy section current to destroy hyperplastic prostatic tissue. The authors present the preliminary results obtained with this new technique. METHOD: 15 patients presenting indications for transurethral resection of the prostate were included in this prospective study. Three patients were in complete retention. Three patients presented a high operative risk (ASA 3). Electrovaporization of the prostatic tissue was performed according to the plans of resection using a round loop and a pure section current of 250 to 300 W. RESULTS: The mean operating time was 22 min (+/- 13) for a mean prostatic weight of 43 g (+/- 7.7). No immediate postoperative haematuria was observed. The duration of catheterization was 2.2 days, and the mean hospital stay was 2.8 days (range: 2-4 days). With a minimum follow-up of 6 months, all patients were improved with an average flow rate of 22.17 +/- 8.6 mL/s, and a score less than 7. Two patients developed haematuria on D5 and D7, one patient developed resorption hyponatraemia and one patient died on D2 from acute respiratory failure. CONCLUSION: EVP is an effective new resection technique designed to limit postoperative morbidity and the length of hospital stay, which uses inexpensive material. A randomized study versus loop resection should allow identification of the advantages of this technique.