Is recipient's body mass index a determinant of short term complications in early renal transplantation?

OBJECTIVES: Obesity prevalence has increased over the past 20 years in the general population and among kidney transplant recipients. General surgical belief is that obesity increases surgical difficulty. The aim of this study was to assess the impact of Body Mass Index (BMI) on perioperative complications. METHODS: All kidney transplantations performed in adults in our centre from 2006 to 2011 were analysed. Data on patients' characteristics, surgical protocol, intra and postoperative complications and renal function were collected. Patients were divided into 4 groups as follows: underweight (BMI<18.5kg/m2), normal weight (18.5kg/m2≤BMI<25kg/m2), overweight (25kg/m2≤BMI<30kg/m2) and obese (BMI≥30kg/m2). We also studied the impact of BMI on complications using it as a continuous variable to identify potential threshold values. RESULTS: Among 694 patients included, 52% had normal BMI, 7%, 31% and 9% were underweight, overweight and obese, respectively. In multivariate analysis, overweight was significantly associated with longer operative time compared to normal-weight patients (estimated mean difference of 10,4min, 95% confidence interval (CI) [4.0; 16.9]) and obesity was associated with an increased risk of wound dehiscence (odds ratio 3.1, 95%CI [1.3; 7.3] compared with normal-weight patients). Considering BMI as a continuous variable, the risk of parietal dehiscence significantly increased beyond a BMI of 26kg/m2, intraoperative blood loss and the risk of ureteral stenosis beyond 32kg/m2 and the risk of abdominal wall hematoma beyond a BMI of 34kg/m2. CONCLUSIONS: We found BMI thresholds above which intraoperative blood loss and the risk of parietal dehiscence, ureteral stenosis, and parietal hematoma significantly increased. LEVEL OF EVIDENCE: 3.

[Predictive factors of active surveillance interruption for prostate cancer after 5years of follow-up]. / Surveillance active du cancer de prostate : facteurs prédictifs d'échecs après 5 ans de suivi.

INTRODUCTION AND PURPOSE: The objective of this work was to identify the risk factors (RFs) of active surveillance (AS) interruption in a prostate cancer (PCa) single-center retrospective cohort of patients. MATERIAL AND METHOD: All patients in AS between January 2011 and October 2019 were retrospectively included in a computerized database. The group of patients who had an AS interruption was compared to the one still under AS, in order to identify potential risk factors for the interruption of the surveillance protocol. RESULTS: Two hundred and two patients have been included in the AS cohort with a median follow-up of 32months. At the time of analysis, 72 patients (36%) were not under the AS protocol anymore, 118 (58%) were still under AS and 12 (6%) were lost of follow-up. Sixty-six patients (92%) had left SA due to PCa progression, 4 (5%) by personal choice and 2 (3%) switched to watchful waiting. A PSA doubling Time<3years (PSADT<3years) has been identified as the only statistically significant RF for AS interruption, both in the unvaried (P<0.001) and multivariate (OR=5.403, P<0.01) analysis. It was also the only RF of AS interruption in the early analysis in the first three years of AS, in the unvaried analysis (P=0.021) and the multivariate analysis (OR=3.612, P=0.018). CONCLUSION: PSADT was the only RF of AS early and late interruption in our study. It represents a major inclusion criterion in AS protocol during the initial assessment. LEVEL OF EVIDENCE: 3.

Active surveillance in prostate cancer is possible for Afro-Caribbean population: Comparison of oncological outcomes with a Caucasian cohort.

BACKGROUND: Prostate cancer is supposedly more aggressive among Afro-Caribbean men. There is a lack of data in this population for active surveillance. Published series are retrospective or have small samples and results are discordant. The objective was to determinate whether actual active surveillance modalities can be applied for Afro-Caribbean men by comparing their oncological outcomes with Caucasian men. METHODS: A total of 449 consecutive patients who underwent active surveillance for favorable-risk prostate cancer in two French University-Medical-Centers between 2005 and 2018: 261 in Guadeloupe, French West Indies, and 188 in Bordeaux, metropolitan France. Median follow-up was 56 months, (95% CI [32-81]) and 52 months (95% CI [30-75]), respectively (P=0.07). Curative treatment was given in case of histological, biological, or imaging progression, or upon patient demand. Primary endpoints were treatment-free, overall and specific survival. Secondary outcomes were reasons of discontinuating active surveillance, histological poor prognosis factors after prostatectomy, CAPRA-S score, biochemical-recurrence-free after treatment and metastasis-free survival. Kaplan-Meier method was used. RESULTS: Median treatment free survival was 58.4 months (CI 95% [48.6-83.1]) for ACM and not reached at 120 months for CM (P=0.002). Overall survival (P=0.53), and specific survival (P=0.21) were similar in the two groups. CM were likely to have poor prognosis factor on prostatecomy piece (57 vs 30%, P=0.01). No difference for repartition of the CAPRA-S score (P=0.86), biochemical-recurrence-free (P=0.92) and metastasis-free (P=0.44) survival. CONCLUSIONS: Oncological outcomes for active surveillance of Afro-Caribbean and Caucasian men were similar in terms of mortality, recurrence and metastasis in our bicentric study, showing usability of current criteria for Afro-Caribbean. The higher rate of disease progression in the Afro-Caribbean population requires close monitoring. LEVEL OF EVIDENCE: 3.

[The basis of endoscopic stones recognition, a prospective monocentric study]. / Base pédagogique de la reconnaissance endoscopique des calculs, étude prospective monocentrique.

INTRODUCTION: To evaluate by junior urologists the morphology of urinary stone using visual endoscopic recognition after expert teaching. Material From December 2017 to May 2018, surface and section stone pictures extracted from digital ureteroscopy had been submitted to description and recognition. Participants could take benefit from an expert coaching. Each stone was evaluated by a different coherence questionnaire (score 1-5). RESULTS: Nine stones had been analyzed by 15 junior urologists. Mean score was initially 1.94/4 and then from 2.07 to 4.07/5 during the study. A perfect stone recognition and a matching etiological lithiasis research had been observed in 40.7% and 55.6% of cases respectively. CONCLUSION: This first teaching experience of the urinary stone morphological endoscopic typing confirms the possibility to train urologists to gain this specific initial skill. Thereby, they could play a more important role in the etiological and diagnostic lithiasis research.

[Partial nephrectomy for renal masses >7cm: Morbidity, oncological and functional outcomes (UroCCR-7 study)]. / Néphrectomie partielle pour tumeur de plus de 7cm : morbidité, résultats oncologiques et fonctionnels (UroCCR-7 study).

OBJECTIVES: To describe the morbidity, mortality, oncological and functional results of Partial nephrectomy (PN) for the treatment of renal tumors of more than 7cm. MATERIAL AND METHODS: Thirty-seven partial nephrectomies for tumors larger than 7cm operated in a single center between 1987 and 2016 were analyzed retrospectively. The pre, per and postoperative clinico-biological data were collected within the UroCCR database. The GFR was assessed at day 5, 1 month and last follow-up. Intraoperative and postoperative surgical complications, the recurrence rate and the overall and specific mortality were collected. RESULTS: The mean age of the patients was 57 years (44-68). The preoperative GFR and the median tumor size were 80mL/min and 8cm, respectively. The indication for surgery was elective in 21 cases (60%) and 19 tumors (54%) were malignant. Postoperative complications occurred in 24,3 cases (24.3%). The median post-operative GFR was respectively 77mL/min, 80mL/min and 77mL/min at day 5, 1month and at last follow-up. With a median follow up of 31 months [1-168], 5 patients (26,3%) had metastatic progression of whom 1 (5.3%) had a concomitant local recurrence and 3 (15.8%) had died from cancer. CONCLUSION: This study confirms the feasibility of PN for large tumors with acceptable morbidity, limited risk of local recurrence and excellent functional results. LEVEL OF EVIDENCE: 4.

Influence du score de Gleason des marges chirurgicales de prostatectomie totale sur la récidive biologique.

OBJECTIVES: The aim of this study was to assess the impact of the aggressiveness of cancer cells at the level of positive surgical margins (PSM) on the biochemical recurrence rate (BRR) by studying the Gleason score (GS) at this level. METHODS: We included all radical prostatectomy (RP) procedures performed from January 2007 to November 2011. All of the RP specimens with PSM were reviewed to determine the GS at the level of PSM. We compared the GS at PSM with BRR. RESULTS: A total of 658 RP were analysed, among which 16% had PSM. From the 101 patients with PSM included, 32% had biochemical recurrence (BR) with a median follow-up of 38 months. GS at PSM was significantly associated with earlier BR (P=0.008). Univariate analysis showed that GS at PSM (P=0.013), initial PSA (P<0.0001), pathologic GS (P<0.001), length of PSM (P=0.013), and seminal vesicle invasion (P<0.0001) were predictors of BR. Multivariate analysis confirmed that PSA greater than 10ng/mL and length of PSM greater than 3mm were independent prognostic factors for BR, but GS at the level of PSM was not. CONCLUSION: GS at PSM was not confirmed as an independent risk factor for BR. Initial PSA greater than 10ng/mL and length of PSM greater than 3mm were the sole independent predictors for BR. LEVEL OF PROOF: 4.

[Radical cystectomy with orthotopic neobladder replacement: Comparison of robotic assisted and open surgical route]. / Cystectomie totale avec remplacement vésical orthotopique : comparaison des résultats des patients opérés par voie ouverte et par voie cœlioscopique robot-assistée.

INTRODUCTION: Radical cystectomy remains the referent treatment of non-metastatic muscle-invasive bladder cancer (MIBC). The fast development of robotic surgery has led some teams to use it for the surgical treatment of the MIBC, in the hope of reducing postoperative morbidity. Urinary diversion by bladder substitution is a bypass option. The aim of our study was to compare the robot-assisted cystectomy with open cystectomy, with urinary diversion by bladder substitution. PATIENTS AND METHODS: Over a two-year period, all the patients who underwent a robot-assisted laparoscopic or open cystectomy with urinary diversion by bladder substitution have been included. The urinary diversion performed was extra-corporeal. RESULTS: The study concerned were 26 men, 15 of them underwent robot-assisted cystectomy, and 11 open cystectomy. There was no significant difference in the median operating time or duration of stay (300 vs 314min and 14 vs 18 days). However, there were less blood loss and more lymph nodes collected in the cystectomies robot-assisted group (median: 400 vs 800mL, P=0.016; 15 vs 10, P=0.01). Three grade III complications of the Clavien-Dindo classification have been described in the robot-assisted group, and none in the open group. No robot-assisted procedure required a conversion to laparotomy. Within 90 postoperative days, complications are basically low grades and results are consistent with the literature. CONCLUSION: In our series, robot-assisted cystectomies with extracorporeal bladder substitution is technically feasible, with best results on blood loss and the number of lymph nodes removed, without impact on the length of stay. LEVEL OF EVIDENCE: 4.

[Eight years of experience with HIFU for prostate cancer: Oncological and functional results]. / Huit ans d'expérience dans le traitement du cancer de prostate par HIFU, résultats oncologiques et fonctionnels.

OBJECTIVE: To study the oncologic and functional results of HIFU as a first-line treatment for localized prostate cancer. MATERIAL AND METHOD: Enrolment of patients between 2006 and 2011 for the first treatment against localized prostate cancer with HIFU (Integrated Imaging(®), EDAP-TMS, Vaulx-en-Velin, France). The biochemical recurrence-free survival was calculated by using the Phoenix criterion (PSA>nadir+2 ng/mL). The functional complications were assessed clinically and through standardised questionnaires. RESULTS: The condition of 191 patients was assessed at a mean follow-up of 55.5 ± 22.7 months. In 10,1% of the treatments, an incident during the medical procedure was observed with the volume of the prostate (P=0.026) as risk factor. The overall survival, the survival and the metastatic free survival rate were respectively 89.5%, 98.4% and 97.4%. The biochemical free survival rate for 5 years was 87.5%, 69% and 39% respectively for the low, medium and high-risk groups of d'Amico classification. Eighty-six percent of the patients with a PSA nadir ≤ 0.3 ng/mL were relapse free at 5 years. Whereas only 48% of the patients with a nadir>0.3 ng/mL did not. Only 17.8% of the patients had a rescue treatment with an average delay of 31.1 months. The urinary and sexual impairment was significant but 78.1% of the patients were dry at the end of the study. The most common complication found in 18.3% of the patients was the prostatic obstruction. CONCLUSION: The oncologic and functional results of the HIFU seem similar to the other first-line treatments results and reveal that the HIFU is a therapeutic option for the treatment of prostate cancer in men over 70 years. LEVEL OF EVIDENCE: 5.

[Partial nephrectomy on solitary kidney: Renal function outcome and predictive factors of impairment]. / Néphrectomie partielle pour cancer sur rein unique : évolution de la fonction rénale et facteurs prédictifs de son altération.

OBJECTIVES: To assess the postoperative functional outcome of PN in solitary kidney and define some predictive factors of renal change. MATERIAL AND METHODS: A monocentric series of 45 partial nephrectomies on solitary kidneys, performed between 1988 and 2014, was retrospectively analyzed. Pre-, per- and postoperative clinicopathological data were collected in the UroCCR database. The evolution of early, medium and long-term postoperative Glomerular Filtration Rate (GFR) was evaluated. Predictive factors of GFR decline and hemodialysis were assessed in multivariate analysis. RESULTS: Mean age was 61 years old (±10.8). Mean preoperative GFR and tumor size were respectively 59.6 mL/min (±18.7) and 3.9 cm (±2.6). Vascular clamping was performed in 41 cases (91%). Median time of warm ischemia was 20 minutes (2-60). Mean follow-up was 66 months (±47). Mean GFR at day 5, 1 month and last follow-up were respectively 46.4 mL/min, 50.3 mL/min and 53.1 mL/min. At day 5 and at last follow-up, a GFR decrease ≥ 20% was found in 20 patients (44.4%) and in 16 patients (35.5%), respectively. Five patients (11%) required definitive hemodialysis (HD) at last follow-up. At day 5, tumor size>4 cm (0.006) and operative time (P=0.003) were independent predictive factors of GFR decline. At 1 year, RENAL ns ≥ 10 was the only independent predictive factor of GFR alteration (P=0.0007). Preoperative GFR was significantly associated with final hemodialysis (P=0.023). CONCLUSION: Partial nephrectomy allows most of the patients presenting with renal cell carcinoma on solitary kidney to be free of hemodialysis. Tumor complexity, tumor size and preoperative GFR seems to play a determinant role on postoperative functional outcome. These non-modifiable predictive factors should be recognized and taken into account to better select patients with high risk of postoperative renal failure. LEVEL OF EVIDENCE: 5.

Embolization of renal arteries before transplantation in patients with polycystic kidney disease: a single institution long-term experience.

PURPOSE: We aimed to retrospectively assess the long-term safety and efficacy of embolization of renal arteries (ERA) in patients with polycystic kidney disease (PKD) before renal transplantation. MATERIAL AND METHODS: Between January 2008 and November 2013, 82 ERA procedures were performed on 76 kidneys in 73 patients (mean age 53 years, range: 34-72). All patients had terminal-stage PKD and were under dialysis and on the renal transplant waiting list with a temporary contraindication due to excessive renal volume. RESULTS: ERA was considered successful in 89.5% (68/76) of embolized kidneys, meaning that the temporary contraindication for transplantation could be withdrawn for 65 patients (on average 5.6 months, range: 2.8-24.3, after ERA). Mean volume reduction was 40 (range: 2-69) at 3 months and 59% (35-86) thereafter (both p < 0.001). Post-embolization syndrome occurred after 15 of 82 procedures (18.3%). The severe complication rate was 4.9%. Forty-three (67.7%) transplantations were successfully conducted after ERA, with a mean follow-up of 26.2 months (range: 1.8-59.5), and the estimated 5-year graft survival rate was 95.3% [95% CI: 82.7-98.8]. CONCLUSIONS: ERA is a safe and effective alternative to nephrectomy before renal transplantation in patients with PKD. KEY POINTS: • Embolization of non-functioning polycystic kidneys allowed transplantation in 89.5% of cases. • Technical failure rate was 7.9% after embolization, irrespective of the technique used. • Post-embolization syndrome occurred after 18.3% of the procedures. • A low rate of severe complications (4.9%) was observed after renal embolization.

[Multicenter study of Advance ® suburethral sling for treatment of postoperative urinary incontinence of male]. / Évaluation multicentrique de la bandelette sous-urétrale Advance ® dans le traitement de l'incontinence urinaire masculine postopératoire.

OBJECTIVES: To estimate in the medium term, the efficiency and morbidity of Advance(®) for the treatment of postoperative urinary incontinence for male, and determine predictive preoperative factors of success or failure. MATERIAL AND METHODS: Retrospective multicentric clinical study of patients presenting a postoperative urinary incontinence and treated by Advance(®) suburethral sling. The importance of the preoperative incontinence was classified in three groups: light (pad-test<50 g/day or 1 pad/day), moderated (pad-test between 50 and 100 g/day or 2 or 3 pads/day), severe (pad-test>100 g/day or >3 pads/day). The functional results were classified in 4 categories: continence and improvement, defining the criterion of success and unchanged situation and deteriorated situation defining the criterion of failure. RESULTS: Sixty-six patients were included from 2008 till 2013. The radical prostatectomy was responsible in 85.5% of the cases. The incontinence was light, moderated and severe for respectively 43.4%, 35.6% and 21% of the patients. After treatment, 39.4% of the patients were continent and 78.9% in situation of success. The rate of success decreased with the severity of the incontinence (respectively 94%, 74% and 56%). For 9 patients, implantation of artificial urinary sphincter was performed without operative difficulties. Complications were urine retention (n=4), hematoma (n=3) and scrotal pains persistent more than one postoperative month (n=11). CONCLUSION: Advance(®) suburethral sling is a technique in which the efficiency decreases with the severity of the incontinence, but which does not seem to prevent from implanting artificial urinary sphincter. Its main problem is the apparition of scrotal pain.

[Holmium laser enucleation of the prostate as a day case surgery: prospective evaluation of the first 30 patients]. / Énucléation de la prostate au laser Holmium en chirurgie ambulatoire : évaluation prospective des 30 premiers patients.

OBJECTIVES: To evaluate the feasibility of holmium laser enucleation of the prostate (HoLEP) as a day case surgery. MATERIAL AND METHODS: Observational prospective study including 30 consecutive patients after exclusion of unstable diseases and anticoagulant therapy. Patients were discharged before 8PM and the urinary catheter was removed at home the next morning. The monitoring included a phone call after 24hours and clinical evaluations after 1 and 3month follow-up. Clinical data were prospectively collected and complications were classified according to the Clavien-Dindo classification. RESULTS: The mean age of the study population was 63.8, prostate volume was 75.3cc, maximum urinary flow rate was 9.5mL/s, and IPSS was 22.9. The conversion rate to conventional hospitalization was 3.3%. After 3months follow-up, readmission and reoperation rates were respectively 16.6% and 3.3%. The overall complication rate was 66% (Clavien I=57.7%, II=38.5%, III=3.8%). The satisfaction rate was 100% (score=9.2/10). The mean prostate volume at 3months follow-up was 23.3cc, maximum urinary flow was 25.6mL/s, and IPSS was 4.7. CONCLUSION: This study confirmed the feasibility of HoLEP as a day case surgery for selected patients. Conversion rate to conventional hospitalization and complications of grade >2 were less than 5% while the satisfaction rate was high. LEVEL OF EVIDENCE: 3.

Long-term results of preventive embolization of renal angiomyolipomas: evaluation of predictive factors of volume decrease.

OBJECTIVES: To evaluate the efficacy of selective arterial embolization (SAE) of angiomyolipomas based on the percentage volume reduction after embolization and to identify predictive factors of volume decrease. METHODS: Patients receiving prophylactic SAE of renal angiomyolipomas were included retrospectively over 3 years. The volume change after SAE and haemorrhagic or surgical events were recorded. Initial tumour volume, percentage tumour fat content, mean tumour density, embolic agent used, number of angiomyolipomas and tuberous sclerosis disease were evaluated as predictive factors of volume decrease. RESULTS: A total of 19 patients with 39 angiomyolipomas were included with median follow-up of 28 months (interquartile range 21-37 months). All treatments were technically successful (92% primary and 8% secondary). No distal bleeding or any increase in size or surgical nephrectomy after SAE was recorded. Mean volume reduction was 72% (±24%). Volumes before SAE (R(2) = 0.276; p = 0.001), percentage fat content (R(2) = 0.612; p < 0.0001) and mean angiomyolipoma density (R(2) = 0.536; p < 0.0001) were identified as predictive factors of volume decrease. In multivariate regression, only percentage fat content influenced volume decreases. CONCLUSIONS: SAE is an efficient treatment for angiomyolipoma devascularisation and volume reduction. A significant reduction of volume is modulated by the initial volume and tissue composition of the tumour. KEY POINTS: • Selective arterial embolization is effective for angiomyolipoma devascularisation and volume reduction • Volume reduction depends of initial volume and tissue composition of the tumour • Selective arterial embolization is a low radiation treatment.

[ACT device: what place in the treatment of female urinary incontinence?]. / Ballons ACT: quelle place dans le traitement de l'incontinence urinaire de la femme?

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%.

Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients.

OBJECTIVES: To evaluate survival and outcomes after percutaneous radiofrequency ablation (RFA) of malignant renal tumours in high-risk patients with long-term follow-up. METHODS: Between 2002 and 2009, 62 patients (71 tumours), with a median age of 73.5 years (20-87), consecutively treated with RFA under ultrasound or computed tomography guidance for malignant renal tumours were retrospectively selected and prospectively followed until 2012, including 25 patients (40.3 %) with solitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 and 46 mm (median: 23 mm). RESULTS: Radiofrequency ablation was technically possible for all patients. Mean follow-up was 38.8 months (range: 18-78 months). Primary and secondary technique effectiveness was 95.2 % and 98.4 % per patient respectively. The rates of local tumour progression and metastatic evolution were 3.2 % and 9.7 % per patient and were associated with tumour size >4 cm (P = 0.005). The disease-free survival rates were 88.3 % and 61.9 % at 3 and 5 years. No significant difference in glomerular filtration rates before and after the procedure was observed (P = 0.107). The major complications rate was 5.9 % per session with an increased risk in the case of central locations (P = 0.006). CONCLUSIONS: Percutaneous renal RFA appears to be safe and effective with useful nephron-sparing results. KEY POINTS: • Radiofrequency ablation (RFA) is a well-tolerated technique according to mid-term results. • RFA for malignant renal tumours preserved renal function in high-risk patients. • Mid-term efficacy of RFA was close to that of formal conservative surgery. • Tumour size and central location limit the efficacy and safety of RFA.

De novo kidney graft tumors: results from a multicentric retrospective national study.

De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis.

[Primary angiosarcoma of the kidney: case report and literature review]. / Angiosarcome primitif du rein : à propos d'un cas et revue de la littérature.

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).

[Tolerance and effectiveness of Memokath® 051 ureteral stents : a prospective 3 year follow-up study]. / Efficacité et tolérance des endoprothèses urétérales métalliques Memokath® 051 : étude prospective sur trois ans.

OBJECTIVE: To assess the effectiveness and tolerance of the metallic stent Memokath® 051 in the management of patients with chronic ureteral stricture treated by JJ stenting. PATIENTS AND METHODS: A prospective observational study included 16 patients with chronic ureteral stricture managed with JJ stents. They were all treated with Memokath® 051 metallic stents. The primary endpoint was the medium durability of the stent. Adverse events and complications were prospectively collected. The evolution of the irritative urinary symptoms and lumbar pain after stent insertion were also assessed. RESULTS: Sixteen patients (mean age: 62, standard deviation: 11,4) had a total of 20 stents inserted. It was technically impossible to insert the stent in two patients and one stent was removed one day after insertion. The medium durability of the stents was 13 months (standard deviation: 10,9). Eight stents (40%) were still functioning at the end of the study. Complications were: six migrations (30%) and four obstructions (20%) of the stents. Thirteen of the 14 patients with a Memokath® stent experienced significant improvement of their JJ stent-related symptoms. CONCLUSION: The Memokath® 051 stent was an interesting alternative to JJ stents in the management of chronic ureteral strictures. Their tolerance was good and complications were easily managed without threatening the urologic prognosis of the patients. Larger studies are required to identify the risk factors of complications and the best indications for stent insertion.

[Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function outcome in tumors larger than 4 cm]. / Intérêt de la néphrectomie partielle pour la préservation de la fonction rénale des patients ayant une tumeur rénale de plus de 4 cm.

OBJECTIVE: The objective of the present study was to analyse whether nephron-sparing surgery (NSS) was superior to radical nephrectomy (RN) in preserving renal function outcome in tumors larger than 4cm. METHODS: The data from 888 patients who had been operated upon at eight french university hospitals were retrospectively analyzed. Glomerular filtration rate (GFR) pre- and post-surgery was calculated with the abbreviated Modification of Diet in Renal Disease (MDRD) equation. For a fair comparison between the two techniques, all imperative indications for NSS and all GFR<30 mL/min/1.73 m(2) were excluded from analysis. A shift to a less favorable DFG group following surgery was considered clinically significant. RESULTS: Seven hundred and thirty patients were suitable for comparison. Median age at diagnosis was 60 years (19-88). Tumors measuring more than 4cm represented 359 (49.2%) cases. NSS and RN were performed in 384 (52.6%) and 346 (47.4%) patients, respectively. In univariate analysis, patients undergoing NSS had a smaller risk than RN of developing significant GFR change following surgery. This was true for tumors≤4cm (P=0.0001) and for tumors>4cm (P=0.018). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P=0.001), decreased preoperative DFG (P=0.006), increased age at diagnosis (P=0.001) and increased ASA score (P=0.004). CONCLUSION: The renal function benefit offered by elective NSS over RN persists even when expanding NSS indications beyond the traditional 4 cm cut-off.

[Comparative study of periprostatic tissues thickness after retropubic or laparoscopic radical prostatectomy]. / Comparaison de l'épaisseur des tissus périprostatiques après prostatectomie rétropubienne ou laparoscopique.

OBJECTIVE: Analysing periprostatic tissue (PPT) thickness after retropubic (RP) or laparoscopic (LP) prostatectomy. MATERIAL: From January to December 2007, 114 consecutives prostatectomies were performed in our institution (38 RP, 76 LP). Clinical data were prospectively collected in a database. Gardner et al.'s (1988) procedure was used for pathological analysis. PPT thickness was measured on pathological specimens by a single observer on a single microscope. The observer had no knowledge of either clinical data or surgical approach. Four levels were chosen (at the base, the proximal part, the distal part, the apex) and 12 standardized measures were performed on each level, 48 measures: a prostate. We compared PPT thickness and surgical margins according to surgical approach and clinical data. RESULTS: Comparative analysis confirmed that LP and RP groups were similar as far as it concerns preoperative and pathological findings. Positive margin rate was also similar in LP and RP groups (4% versus 5.3%; P=0,37). Overall PPT thickness was thinner after LP than after RP except at the apex and the anterior face. Nevertheless, in the "complete preservation" group, PPT thickness was thinner at the apex in the RP group, thinner at the base in the LP group. CONCLUSION: Measuring PPT thickness was an original objective and reproducible way to compare different techniques and new technologies for radical prostatectomy. PPT sparing was different but not better with the laparoscopic approach.