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 leiomyosarcoma of the epididymis: a case report with review of the literature]. / Léiomyosarcome de l'épididyme : à propos d'un cas avec revue de la littérature.

Primary epididymal leiomyosarcoma is uncommon: only 16 cases has been reported in the literature. We present an additionnal case in a 78-year-old man, treated for a prostatic adenocarcinoma by gonadorelin (LH-RH) analogue, who had an epididymal tumor. A right orchidectomy with high ligation of the spermatic cord was performed. The diagnostic of primary leiomyosarcoma of the epididymis was made. The patient is dead 2 years later with no recurrence of disease. A review of reported cases is made.

[Study on the quality of life of patients suffering from localized prostate cancer treated with HIFU]. / Etude de la qualité de vie des patients ayant un cancer de prostate localisé traité par HIFU.

AIM: The treatment of prostate cancer using high intensity focused ultrasound (HIFU) is considered to be mini-invasive and normally has a low rate of morbidity. The aim of this study was to evaluate the quality of life of patients treated with HIFU. PATIENTS AND METHOD: Fifty consecutive patients whose first-line treatment was with HIFU for localized cancer of the prostate between 2003 and 2005 received the "UCLA/RAND PCI" quality of life questionnaire at preoperative stage and one year after treatment. The scores for postoperative quality of life were compared to preoperative scores and to a test population who did not have prostate cancer. RESULTS: Eighty percent of patients answered both questionnaires. 72.5% of the patients were "satisfied" or "very satisfied", 2.5% were "very dissatisfied" and 25% had no opinion. The general quality of life scores (SF-36) did not show any significant differences before and after treatment. Alterations and discomfort concerning sexual and urinary functions were statistically significant. For the digestive function, there was no difference before and after treatment; however, an increase in discomfort felt was statistically significant. CONCLUSION: The treatment of prostate cancer using HIFU is accepted well by the patient, quality of life is preserved one year later. There is significant degradation of the sexual function and more moderately of the urinary function.

Laparoscopic computer-assisted pyeloplasty: the results of experimental surgery in pigs.

OBJECTIVE: To evaluate the experimental feasibility of laparoscopic computer-assisted pyeloplasty for pelvi-ureteric junction obstruction. MATERIALS AND METHODS: Fourteen pyeloplasties were undertaken in pigs using a laparoscopic transperitoneal approach and the robotic surgical system (da Vinci, Intuitive Surgical Inc., Sunnyvale, CA, USA). RESULTS: The robotic surgical system provides real-time three-dimensional stereoscopic vision. Manipulating the intracorporeal endo-wristed instruments from a remote console allows laparoscopic manoeuvres that are as easy as those during open surgery. Surgeons with no particular experience in laparoscopic surgery could learn complex surgery easily and quickly. CONCLUSION: This technique provides faster training and the possibility of undertaking complex laparoscopic procedures, especially reconstructive, with less fatigue for the surgeon.

[Kidney cooling during multi-organ harvesting. Descriptive study]. / Le refroidissement des reins pendant le prélèvement multi-organe. Etude descriptive.

OBJECTIVE: To describe kidney cooling during multi-organ harvesting (MOH) from brain-dead donors and to evaluate harvesting practices. MATERIAL AND METHOD: The temperature of 12 kidneys (6 left and 6 right kidneys) was monitored continuously during MOH from brain-dead donors. After in situ cooling, the kidneys were separated on the table and washed for several minutes with UW preservation solution. The kidney temperature was studied as a function of the main phases of the operative procedure. RESULTS: The mean minimum kidney temperature of 10.8 degrees C (3.7 degrees C to 16.6 degrees C) was reached at the beginning of mobilization of the liver, i.e. an average of 20 minutes (13 to 37 min) after cannulation. The mean cooling rate was 1.37 degrees C/min (0.73 to 2.19 degrees C/min). The mean temperature of the UW cooling solution was 9.4 degrees C (3.8 degrees C to 14 degrees C). For hepatic followed by renal dissection, the kidneys slowly reheated at a mean rate of 0.20 degree C/min (0.12 to 0.37 degree C/min) to reach a mean temperature of 21 degrees C (13.5 degrees C to 26.3 degrees C) at the time of resection. The mean kidney temperature at the time of placement in the container was 17.5 degrees C (13.2 degrees C to 22 degrees C). CONCLUSION: The course of kidney temperature during MOH has not been previously described. This study, performed under usual harvesting conditions, demonstrated sometimes imperfect cooling that could be harmful to he kidneys, but which could be improved by simple measures: rapid dissection of the liver and kidneys and correct application of contact cooling.