EAU guidelines on chronic pelvic pain.

OBJECTIVES: On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of chronic pelvic pain patients were established. METHOD: Guidelines were compiled by a working group and based on current literature following a systematic review using MEDLINE. References were weighted by the panel of experts. RESULTS: The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article is a short version of this text and summarises the main conclusions from the guidelines on management of chronic pelvic pain. CONCLUSION: A guidelines text is presented including chapters on prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecological practice, role of the pelvic floor and pudendal nerve, general treatment of chronic pelvic pain and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from chronic pelvic pain.

[Flow cytometry in cancer of the bladder]. / Cytométrie en flux dans les cancers de la vessie.

We reassessed the use of DNA flow cytometry in bladder cancers on the basis of our research and already published findings. We discuss technical aspects underlying the validity of the results. Currently, the validity of DNA flow cytometry is established by parametric analysis of the DNA content of tumor cells found in the course of multiple biopsies of the tumor. In addition, we examine the results obtained with bladder washings and, in some cases, the results of biopsies of the bladder mucosa which may appear normal under cystoscopy. The complementarity of these examinations appears to be essential. Our experience confirms the results already published, suggesting that the frequency of DNA aneuploidy increases significantly according to the grade and the tumor stage. However, clinical interpretation of DNA flow cytometry results calls for some caution. There is a general consensus not to use these results in the screening of bladder cancers. However, DNA flow cytometry is particularly useful in the follow-up of carcinoma in situ since DNA aneuploidy is almost always present. DNA flow cytometry is also useful in the stratification of superficial grade 2 tumors. Finally, during the follow-up of invasive tumors, the persistence or appearance of DNA aneuploidy may be attributed to therapeutic resistance.

[Interstitial cystitis]. / La cystite interstitielle.

Interstitial cystitis is a particular type of cystitis with clear urine, essentially observed in women. Persistent painful urinary frequency and bladder heaviness are suggestive of the diagnosis. Two different forms have been distinguished according to severity: Hunner's ulcer and small capacity bladder;-bladder distension to 800 ml, followed by haemorrhagic petechiae; with a whole series of intermediate forms. The bladder wall undergoes inflammatory reorganization, without infection, leading to fibrosis. The disease is improved by hydrocortisone instillations. Hunner's ulcer can be treated by partial resection. If the cystitis deteriorates, bladder replacement by detubulized intestinal graft may be required.

[Prostate cancer: anatomo-pathological correlation and MRI]. / Cancer prostatique: corrélation anatomo-pathologique et IRM.

In our study, 50 patients had a prostatic carcinoma stade B. Before the radical prostatectomy we have realised a MRImaging of the prostate. After a precise histopathologic correlation we tried to appreciate the MRI performance for the detection of neoplasic nodes in the peripheral zone and for the loco-regional staging of the carcinoma. In detection of the pathologic nodes, MRImaging is more sensitive from the apex (22.5%) to the base of the prostate (91%), but it is at the same time specificless (apex: 90%, base: 40%). The accurate diagnostic for loco-regional staging in our study is 70%. Extracapsular extension is often underestimated because of the very small size of the invasion. On the other hand the specificity of MRI in seminal vesicles extension is satisfactory (87.5%).

[Neuroendocrine cancers of the prostate]. / Les cancers neuro-endocrines de la prostate.

This article is a transcription of several papers on neuroendocrine cancers of the prostate presented to the Uropathology Club in Angers in 1990. It consists of three parts: Firstly, a study of neuroendocrine cells in various organs of the human body, followed by the demonstration of these cells in the normal and pathological prostate. The second part reports 3 cases of neuroendocrine cancers as they are observed in routine practice. A total of 66 cases of pure neuroendocrine cancers have been reported to date in the English language literature. This type of cancer is characterised by a rapid, hormone-resistant course with the development of multiple metastases, frequently visceral. Periods of remission in response to chemotherapy may be observed in some cases. The third part concerns the systematic demonstration of neuroendocrine cells in prostatic adenocarcinoma. The percentage of neuroendocrine cells demonstrated by various histological techniques is directly correlated to an increasingly severe prognosis of the cancer.

[Interstitial cystitis]. / Cystite interstitielle.

Interstitial cystitis, described for many years, remains a mystery for several reasons. Although the clinical and therapeutic understanding of this disease have improved, the histological features are non-specific and the pathogenesis is still unclear. The aim of this article is to briefly review the current state of knowledge and to remind the reader that this disease must not be underestimated or ignored.

[Place of partial nephrectomy in surgery of tumors of the kidney]. / Place de la néphrectomie partielle dans la chirurgie des tumeurs du rein.

Partial nephrectomy for a small renal tumor is usually technically possible, especially in the case of polar tumors, but it does not ensure the same degree of therapeutic safety as radical nephrectomy. At the present time, it is preferable to restrict this technique to tumors in a solitary kidney, when possible, and to benign tumors and tumors less than 3 cm in subjects over the age of 50 years, when the contralateral kidney is healthy.

[Prognostic value of cytofluorometry in bladder tumors]. / Intérêt pronostique de la cytofluorométrie dans les tumeurs vésicales.

Bladder lavage fluid was examined using flow-cytometry (FCM) in 112 patients with transitional cell carcinoma seen over 30 months. FCM investigates the entire mucosa, furnishes indications as to the possible existence of dysplasia or carcinoma in situ, and thus provides for a more accurate evaluation of the evolutive potential of the "bladder disease". FCM consists in the automated assay of the DNA content of epithelial cells. The test is positive when "tumorous" diploid or aneuploid cells are demonstrated. The diagnostic sensitivity of FCM is comparable to that of cytologic diagnosis on bladder lavage specimens, but FCM has the additional advantage of detecting those patients at high risk for disease progression by measurement of the DNA index. Grade 1 and 2 tumors are diploid in 70% of patients, against only 14% for grade 3 tumors and carcinomas in situ. Follow up of 25 grade 2 patients and determination of the recurrence index clearly establishes the prognostic significance of the degree of tumorous ploidy. Furthermore, the effectiveness of endovesical chemotherapy can be monitored using FCM measurement of the aneuploidy index.

[Interstitial cystitis. Current aspects]. / La cystite interstitielle. Aspects actuels.

Fifty-five cases of interstitial cystitis are reported, symptomatology in these 43 women and 12 men being of a severe nature: diurnal and nocturnal pollakiuria, supra-pubic pain. Disorders were always permanent and had been present for at least 6 months, diagnosis being confirmed by endoscopy. Initial bladder filling demonstrated the most important lesions (Hunner's ulcer) and allowed determination of bladder capacity. Decompression and a repeat vesical repletion showed mucosal hemorrhagic spots, establishing the diagnosis of interstitial cystitis. Biopsy forceps were used to obtain fragments of bladder wall for optical microscopy in all cases and electron microscopy in several patients. Histologic findings were compared with two control groups: a group of 30 patients with pollakiuria and dysuria but absence of hemorrhage during bladder distention; a group of 9 patients operated upon for other lesions and with normal bladders. Extracellular deposits were searched for in freshly frozen fragments (liquid nitrogen) in 10 patients, while 24 patients underwent immunologic tests. Finally electron microscopy was used to study vesical epithelium to detect epithelial cell junction. In contrary, optical microscopy by immuno-histochemistry was used to study cytoskeletal keratin filaments. Two groups in this series were distinguished: one with major forms (18 cases) and one with minor forms (37 cases) of the affection. In major forms, affecting elderly patients with reduced bladder capacity, lesions on endoscopy and first distention were apparent as Hunner's ulcer and hemorrhage covering the non-ulcerated mucosa with petechiae. Initial distention in minor forms showed normal mucosa with, on decompression and repeat distention, the appearance of hemorrhagic sub-mucosal spots in the mobile bladder structures.

[Interstitial cystitis. Apropos of 11 cases]. / La cystite interstitielle. A propos de onze observations.

The authors report eleven cases of interstitial cystitis, and discuss two different aspects of the disease: the classic form, with reduced bladder capacity and Hunner's ulcer, and the early form, which is diagnosed by cystoscopy under general anesthesia, and bladder biopsy. The hallmark of this early form is the discovery of multiple petichiae in the bladder mucosa during the second distension of the bladder.

[Computed tomography in renal trauma (author's transl)]. / Apport de la tomodensitométrie dans l'étude des traumatismes fermés et récents du rein.

On the basis of a series of 25 cases of closed recent trauma of the kidney examined by scanner, the authors analyzed the information provided by the method and its correspondence with the various lesions encountered. In the course of this study, the scanner appeared to be the method of investigation which, at the present time, offers the best information concerning the severity of parenchymatous damage, as well as the size, nature and course of the perirenal blood or urine collections. Such data being fundamental to therapeutic decisions, the place of the scanner is essential in the evaluation of renal trauma, and, in severe forms, should be performed immediately after the irreplaceable I.V. urography performed as an emergency.