ABSTRACT
OBJECTIVE: The apex is a particular region of the prostate in its surgical dissection and pathological analysis. We sought to evaluate the prognostic value of the apical localization of prostate tumors. METHOD: From 1988 to 2010, data pre- (age, clinical stage, preoperative PSA, biopsy Gleason score) and postoperative (prostate weight, pathologic stage TNM 2010, Gleason score, margin status) of 2765 total prostatectomies were collected prospectively. These data were compared according to existence or absence of tumor at the apex. The prognostic impact of tumor at the apex on biochemical recurrence-free survival (PSA>0.2 ng/mL) has been studied in univariate and multivariate models. RESULTS: One thousand eight hundred seventeen tumors had a location at the apex (65.7%). In univariate analysis, there was a significant difference in the clinical stage, the biopsy and pathological Gleason score, the result of curage, the pathological stage and the margin status between apical tumors and others. With a mean decline of 34.6 months, 502 patients had a biochemical recurrence (18.1%). Disease-free survival at 10 years was 60.7% for tumor at the apex versus 65.9% in other cases. The location at the apex was significantly associated with biochemical recurrence on univariate analysis (P=0.01). After adjustment for clinical and pathological stage, PSA level, Gleason score and surgical margins, the apex was not anymore a pejorative independent predictor (P=0.0087). CONCLUSION: The existence of tumor in the prostatic apex was associated with more aggressive tumoral criteria and was an independent and pejorative predictor of biochemical recurrence-free survival at 10 years in univariate analysis. The apical localization could be an additional argument in the decision of adjuvant therapy after prostatectomy.
Subject(s)
Prostatectomy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Prostatic Neoplasms/mortality , Survival RateABSTRACT
OBJECTIVES: Assessment of the adjustable continence therapy device (ACT) in the treatment of female stress or mixed urinary incontinence in terms of efficacy and complications. MATERIAL: Between April 2005 and September 2011, the device ACT was put by two different operators to treat a stress and/or mixed urinary incontinence at women. The results were studied under two shutters: complications and efficacy. RESULTS: Seventy-seven women were operated. Mean age of the patients was of 68 years (34-87). Mean follow-up was of 22 months (1-72). Over the 77 patients, eight peroperative complications (10%) were noted. Twenty-five explantations were required in 22 patients (28%). In terms of efficacy, after an average follow-up of 22 months, the results were: 19 patients (25%) were continents, 25 (33%) very improved and five (6%) improved regards to the initial stage preceding the implantation. Fifteen patients (19%) were in failure. Seven patients (9%) were unchanged and in the course of adjustment (recent implantation) and six others (8%) explanted waiting for another implantation. CONCLUSION: The ACT procedure was feasible on a population of multi-operated women with 64% of improvement in our hands. Complications were rare, easily detected and repaired. The risk of explantation was reported to be 28%.
Subject(s)
Urinary Incontinence/surgery , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Follow-Up Studies , Humans , Middle Aged , Urologic Surgical Procedures/instrumentationABSTRACT
The primary angiosarcoma of the kidney is a rare tumor. We report a case of angiosarcoma of the right kidney in a man of 60 years. The CT-scan appearance is the one of a solid tumor compatible with renal cell carcinoma. Histological examination of the piece of nephrectomy straightens diagnosis and reveals the angiosarcomatous nature. In this patient with bone and lung synchronous metastasis, evolution has been a lightning death in less than three months. The literature review confirms the high potential of malignancy of these tumors (metastases almost constant and very short survival in spite of local and systemic treatment).
