Evolution of patients with and without preoperative stress urinary incontinence after surgical cystocele repair by mesh implantation using a vaginal approach.

INTRODUCTION: To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. MATERIAL AND METHODS: Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. RESULTS: Thirty-six women were included (mean age: 72±7years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41±12min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n=6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR=2.0 [95% CI: 0.8175-4.8928]; P=0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. CONCLUSION: Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. LEVEL OF EVIDENCE: 4.

[Long-term follow-up of continent cystostomy with the Mitrofanoff procedure: 5 years later]. / Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l'adulte : résultats à 5 ans.

INTRODUCTION: This study analyzed long-term functional outcome of continent catheterizable channels with the Mitrofanoff procedure, their continence, complications and the satisfaction of the patients. MATERIAL AND METHOD: Data from patients who underwent a Mitrofanoff procedure at our institution from June 1997 to March 2015 were retrospectively collected. All patients were contacted at the end of the study, a survey was submitted to them. RESULTS: Sixty-seven patients underwent a continent cystostomy with the Mirtrofanoff procedure. Forty-five patients had the inclusion criteria: 18 years old or older, no previous urinary diversion with a minimum of 6 months of follow-up. The cohort comprised mainly neurologic bladder (84 %) with spinal cord injuries (54 %) or spina-bifida patients (15 %). Median age was 35 years old [22-49]. Median follow-up was 64months [39-90]. The surgical procedure used an appendicular channel: 30 patients (67 %) or a continent ileal plasty: 15 patients (33 %). At the end of follow-up: 88 % patients have a full cystostomy continence, 89 % full uretral continence. Twenty-nine patients had one (41 %) or more reinterventions. Reasons for the 58 reinterventions were: stomal stenosis (31 %), uretral incontinence (29 %), cystostomy incontinence (15 %), lithiasis (9 %). Those reinterventions were done with a local surgery (31 %) or an endoscopic surgery (35 %). Overall early adverse events (<30days) or delayed (>30days) adverse events were similar (P=0.93) in appendicovesicostomy group or continent ileal plasty group. Ninety-four percent patients described a satisfactory urinary comfort. The cystostomy was considered esthetic by 71 %, its realization allowed an improvement of the quality of life for 89 % of them. CONCLUSION: Continent channels in adults demonstrate favorable long-term outcomes even if reinterventions could be necessary to maintain a continent and catheterizable channel. Despite reinterventions, patients remain satisfied by the Mitrofanoff procedure which facilitate the process of clean intermittent catheterization. LEVEL OF EVIDENCE: 4.

Open prostatectomy versus 180-W XPS GreenLight laser vaporization: Long-term functional outcome for prostatic adenomas>80 g.

INTRODUCTION: GreenLight photoselective vaporisation of the prostate (PVP) offers an endoscopic alternative to open prostatectomy (OP) for treatment of large adenomas. This study compares long-term functional outcome of both techniques in patients with Benign prostatic obstruction (BPO)>80g. MATERIAL AND METHOD: Data from patients who underwent surgical treatment for BPO>80g from January 2010 to February 2015 at our institution were retrospectively collected and compared according to surgical technique. Patient's demographics, surgeon's experience, operative data and long-term functional results were analyzed, using IPSS and International continence society (ICS) male questionnaire associated with Quality of life scores (IPSS-QL and ICS-QL). Predictors of long-term outcome were also assessed. RESULTS: In total, 111 consecutive patients, 57 PVP and 54 OP, were included in the study with a mean follow-up of 24 and 33 month respectively. Patient's age, Charlson score, preoperative IPSS and urinary retention rates were similar. Mean prostatic volume was superior in the OP group (142 versus 103g, P<0.001). Transfusion rate was lower after PVP (P=0.02), despite a more frequent anticoagulant use. Length of hospital stay and urinary catheterization were shorter after PVP (P<0.001), with however a higher rate of recatheterization (RR=4.74) and rehospitalization (RR=10.42). Long-term scores were better after OP for IPSS (1 versus 5, P<0.001), IPSS-QL, ICS, ICS-QL. On multivariate analysis, prostatic residual volume was the only predictor of long-term IPSS but not ICS. CONCLUSION: Long-term functional outcome are better after OP compared to PVP. However, PVP offers good results, allowing to safely operate patients taking anticoagulants, regardless of prostatic volume. Endoscopic enucleation may the compromise between both techniques. LEVEL OF EVIDENCE: 4.

[Management of intraparenchymal pseudoaneurysm after blunt renal trauma: Results from a series of 325 patients]. / Prise en charge des pseudo-anévrismes rénaux intraparenchymateux post-traumatiques : à propos d'une série de 325 patients traumatisés rénaux.

INTRODUCTION: The purpose was to describe the management of intraparenchymal pseudoaneurysm (PA) after blunt renal trauma in our center, and to review the cases published in the literature, in order to propose a management algorithm. MATERIALS AND METHODS: We reviewed the files of 325 patients included in a prospective database, from July, 2004, to May, 2016. A systematic review of the published cases was done with the keywords "blunt renal trauma" and "pseudoaneurysm" in Pubmed (excluding arteriovenous fistulas, open renal traumas and extraparenchymal PA) allowing us to analyze 29 extra cases. Management of these patients in our center is decribed. RESULTS: Among 325 kidney trauma patients, 160 (49.3%) had grade IV and V renal trauma. Conservative management was done in 93.2%. We noted 8 cases of PA, with an incidence of 2.5%. Four patients required angioembolization. Four patients were treated by watchful waiting, with 2 cases of spontaneous occlusion, one case of absence of regression and embolization, and one case of occult hemorrhage. All PA with a favorable outcome were less than 1cm. The mean relative renal scintigraphic function at 6 months of the kidneys requiring embolization was 71.6%. The literature review reported 29 published cases, among whom 26 required embolization, with a success rate of 84.6%. Two cases were just watched, but one was finally embolized in the absence of regression. CONCLUSION: Pseudoneurysm formation after blunt renal trauma is a rare complication (2.5%). In case of clinical symptoms or hemodynamic instability, embolization allows a good renal preservation. Watchful waiting seems to be an option in asymptomatic cases with a PA less than 1cm. LEVEL OF EVIDENCE: 5.

[Renal transplantation using a Maastricht category III non-heartbeating donor: First French experience and review of the literature]. / Transplantation rénale à partir d'un donneur décédé par arrêt circulatoire Maastricht III : première expérience française et revue de la littérature.

In 2015, Annecy Hospital was the first French hospital to perform non-heartbeating organ donation from a Maastricht category III donor (patient awaiting cardiac arrest after withdrawal of treatment). Non-heartbeating organ donation (NHBD), performed in France since 2006, had initially excluded this category, due to ethical questions concerning end of life and treatment withdrawal, as well as technical specificities linked to this procedure. Grenoble University Hospital and Edouard-Herriot Hospital in Lyon then performed the first kidney transplants, with satisfactory outcomes in both recipients. This article presents the details and results of this new experience, challenging both on a deontological and organizational level. Functional outcomes of kidney grafts from NHBD are now well known in the literature and confirm their benefit for patients, with similar results to those from heartbeating donors (HBD). International experiences concerning specifically Maastricht category III NHBD are encouraging and promising.

[Biochemical recurrence after curative treatment for localized prostate cancer: Performance of choline PET/CT in the assessment of local recurrence]. / Récidive biochimique après traitement curatif d'un adénocarcinome prostatique localisé: intérêt de la TEP à la choline dans l'évaluation de la récidive locale.

OBJECTIVE: To establish 18 fluorocholine-positron emission tomography/computed tomography (F-PET/CT) performances for the detection of local recurrence in a population of patients with biochemical failure after primary curative treatment for localized prostate carcinoma. MATERIAL AND METHOD: From February 2011 to February 2014, 55 patients underwent a F-PET/CT for biochemical relapse after primary radical therapy for prostate cancer localized or locally advanced. Primary therapies for prostate cancer were 19 radical prostatectomy, 18 radiotherapy, 13 radiotherapy with hormonal treatment, 3 brachytherapy. The median age was 65 years (50-79). The initial staging was 17 T1, 23 T2 and 15 T3, 52 were N0 and N1 3. The median PSA was 12 (3-127). The Gleason score was less than 7, equal to 7 and greater than 7 at 21, 25 and 9 patients respectively. The average time to recurrence was 69.5 months (8-147) with a median PSA of 2.9 ng/mL (0.48-41). RESULTS: In 42 cases, F-PET/CT showed uptake, suggesting a recurrence, metastatic (6), nodal (26) or local isolated (10). The focal uptake in PET commissioned in 5 cases prostate biopsy, confirming the histological recurrence of prostate cancer in 4 cases. Among the 10 patients with isolated local recurrence, 8 underwent salvage radiotherapy. Of the 13 cases where the (F-PET/CT) showed no recurrence, 7 multiparametric MRI were performed. The MRI showed a local recurrence in 3 patients, the diagnoses were confirmed with prostate biopsy for two of them. CONCLUSION: In our study, for the patients with biochemical relapse of prostate adenocarcinoma localized or locally advanced, (F-PET/CT) was able to detect local recurrence isolated in nearly half the cases but did not show sufficient sensitivity to exclude recurrence local if negative. It does not replace MRI or additional prostate biopsy.

[The urinary bladder is an uncommon site of metastasis from breast cancer]. / La vessie : un site rare de métastase de cancer du sein.

Bladder metastasis of breast origin are rare. Lobular carcinoma is the most frequent histological subtype of the primary tumor. This secondary location can be the only one or can be associated with other locations. The prognosis is poor. The period between primary breast tumor and the development of bladder metastasis is variable. Herein is reported the case of a 68-year-old woman presenting with irritative disorders. Urological examination was performed and made the diagnosis. When having a history of breast cancer, the occurrence of urinary symptoms require radiographics and a cystoscopy.

[Sarcomatoid renal cell carcinoma: follow-up of a series of 23 patients]. / Carcinome rénal à contingent sarcomatoïde: suivi d'une série de 23 patients.

OBJECTIVE: To describe survival data and prognostic factors in a population of renal cell carcinoma with sarcomatoid renal carcinoma. PATIENTS AND METHODS: We reviewed the files of 950 patients treated for malignant renal tumor in two centers between January 2002 and December 2011. Patients with sarcomatoid renal cell carcinoma were extracted. Demographic data, treatments, histopathological and survival data as well as prognostic factors were analyzed. RESULTS: Twenty-three patients (2.4%) with 65% of men were included with a mean age of 62.8 years (41; 82). Median ECOG PS was 1 (0; 3) and median Karnofsky PS was 80% (40-100). Median tumor size was 100mm (30; 190). Eight patients (35%) were metastatic at diagnosis. An initial surgical treatment was performed in 22 patients (95.7%). Tumors were clear cell carcinoma in 19 cases (82.6%). TNM tumor stage was greater than 2 in 81.8% of cases. Median rate of sarcomatoid component was 50% (10; 100). In univariate analysis, the existence of initial metastasis and microvascular invasion were predictors of specific survival. In multivariable analysis, the only predictor was the initial existence of metastasis. A progression was observed in metastatic mode in 78% of patients within a median of 7 months. The median disease-specific survival was 18 months. CONCLUSION: Sarcomatoid renal cell carcinomas were aggressive tumors with a median progression-free survival of 7 months and a median disease-specific survival of 18 months. Prognostic factors were comparable to high-risk renal cell carcinomas. LEVEL OF EVIDENCE: 5.

[Pyelovenous fistula revealed by repeated thromboembolic events after emergency peripartum hysterectomy]. / Fistule pyéloveineuse révélée par des accidents thromboemboliques après hystérectomie d'hémostase.

We report the case of a 51-year old woman presenting pyelovenous fistula revealed by recurrent and serious thromboembolic events after ureteral ligation during emergency peripartum hysterectomy. Imaging reported a complete left ureteral obstruction, a fistula between the upper calix and the left renal vein and a renal function preserved. Uretero-vesical reimplantation was performed. The patient was well doing after 12 months. The authors wonder if pyelovenous fistula is responsible for prothrombotic state and maintaining renal function.

[Sarcomatoid renal cell carcinoma]. / Carcinomes rénaux à contingent sarcomatoïde.

INTRODUCTION: The objective was to perform a systematic review of literature concerning epidemiology, clinical and biological data, prognosis and therapy of sarcomatoid renal cell carcinomas. MATERIAL AND METHODS: Data on sarcomatoid renal cell carcinomas have been sought by querying the server Medline with MeSH terms following or combination of them: "renal carcinoma", "renal cell carcinoma," "renal cancer", "sarcomatoid" "sarcomatoid transformation" and "sarcomatoid differentiation." The articles obtained were selected according to their methodology, the language in English or French, the relevance and the date of publication. Twenty papers were selected. RESULTS: According to the literature, a sarcomatoid contingent can be observed in all subtypes of renal cell carcinomas, with a frequency of 1 to 15% of cases. The median age at diagnosis was 60 years with a majority of symptomatic patients (90%), mainly with abdominal pain and hematuria. These tumors were often found in patients with locally advanced or metastatic (45-77%). The imaging was not specific for the diagnosis and biopsy had a low sensitivity for identifying a sarcomatoid contingent. The treatment was based on a combination of maximal surgical resection whenever possible and systemic therapy for metastastic disease. Pathological data often showed large tumors, Furhman 4 grades, combined biphasic carcinomatous contingent (clear cell carcinoma in most cases) and sarcomatoid. Genetically, there was no specific abnormality but a complex association of chromosomal additions and deletions. The prognosis was pejorative with a specific median survival of 5 to 19 months without any impact of the sarcomatoid contingent rate. CONCLUSION: Sarcomatoid renal cell carcinoma is a form not to ignore despite its rarity. Mainly symptomatic and discovered at an advanced stage, it has a poor prognosis, requiring multidisciplinary management quickly and correctly.

[The use of haemostatic agent: impact on perioperative outcomes of partial nephrectomy]. / Impact de l'utilisation d'un agent hémostatique sur les complications périopératoires de la néphrectomie partielle.

OBJECTIVE: To evaluate impact of the use of haemostatic agent in partial nephrectomy on perioperative outcomes. MATERIAL AND METHODS: We reviewed the files of patients candidates for partial nephrectomy in our center between 2005 and 2010. The use of haemostatic agent and surgical procedure data were noted. Perioperative outcomes in haemostatic agent group were compared with perioperative outcomes in conventional surgical haemostasis group. RESULTS: Among the 131 patients included, haemostatic agent was used in 91 cases (69.5%). There was no statistically difference between the two groups on age, sex, BMI, ASA score, tumor size and RENAL score. The use of haemostatic agent was more frequent for patients operated with laparoscopy (10.7%, P=0.04). Concerning perioperative outcomes, there was no difference between the two groups on surgical complications, transfusions, conversion to radical nephrectomy and hospital stay. Median warm ischaemia time was comparable into the two groups. In multivariate analysis, haemorrhage, complications and transfusions were not predicted by the use of haemostatic agent. CONCLUSION: Use of haemostatic agent in partial nephrectomy had no benefice on perioperative outcomes in our series. Rapport between utility and cost for these agents must be discussed in partial nephrectomy.

[Perioperative outcomes and mid-term results of radiofrequency ablation and partial nephrectomy in indications of renal tumor treatment and imperative nephron-sparing procedure]. / Traitement d'une tumeur rénale et préservation néphronique impérative : étude comparative des données périopératoires et des résultats à moyen terme de la néphrectomie partielle et de la radiofréquence.

OBJECTIVE: To compare morbidity, oncological and functional outcomes of percutaneous radiofrequency ablation (RFA) and partial nephrectomy in indications of renal tumor treatment with imperative nephron-sparing procedure. PATIENTS AND METHODS: Between January 2005 and December 2010, 50 consecutive patients were referred in our center for NP or RFA for a renal tumor with either a renal function impairment defined as estimated glomerular filtration (eGFR) less than 60 mL/min/1.73 m(2), and/or solitary kidney and/or bilateral tumors. Perioperative outcomes were compared. RESULTS: Thirty-six PN and 14 RFA were performed. RFA patients were older (79.2 vs. 62.5 years old), had a higher ASA score (3 vs. 2), a lower RENAL score (6 vs. 7.5) and a lower rate of tumor on solitary kidney or bilateral tumors (P=0.009). Overall complications (29.4% vs. 6.3%), transfusions (20.6% vs. 0) and longer hospital stay (9 vs. 3 days) were more likely to occur in the NP group. During a median follow-up of 22 months (4.3-53.7), eGFR decrease was similar between the two groups (P=0.34). On multivariate analysis, PN was associated with an increased occurrence of overall complications (OR=14.09, P=0.02) but with a similar eGFR decrease. No patient died. CONCLUSION: For patients with an indication of treatment of renal tumor and imperative nephron-sparing procedure, RFA seems to provide low morbidity and comparable functional outcomes as partial nephrectomy. Our limited follow-up does not permit to conclude on oncologic data.

[Renal cell carcinoma: A 12-year retrospective study of epidemiologic, therapeutic and follow-up data]. / Étude rétrospective d'une population de carcinomes à cellules rénales sur 12ans : épidémiologie, prise en charge thérapeutique et impact sur la survie.

OBJECTIVE: To describe the evolution of epidemiology and management of renal cell carcinoma and their impact on overall and progression-free survivals. PATIENTS AND METHODS: We reviewed the files of consecutive patients with renal cell carcinoma in our center between January 2000 and December 2011. Patients with confirmed diagnosis on histology who underwent radical nephrectomy, partial nephrectomy or thermoablation were included. Benign tumors were excluded. Epidemiologic and therapeutic data during the period of study were compared. Overall and progression-free survivals divided in three periods were compared by Kaplan-Meier curves. RESULTS: Four hundred and forty-nine patients were included with a median age of 60 years old [21; 89], and median follow-up of 39 months. Tumor histology was clear cell carcinoma in 75.9% of cases. During the period of study, patients with ASA score upper than 3 increased from 20.4% to 47.8%, tumor size decreased from 58.4mm to 49.5mm and incidental tumor discovery increased from 59.1% to 71.6%. Nephron-sparing surgery increased from 19.7% to 44%. Overall survival and progression-free survival was not different during this period (P=0.071 and P=0.582). CONCLUSION: The increase in early incidental discovery of renal cell carcinoma allowed nephron-sparing surgery in spite of patients with more comorbidities, with stable overall and progression-free survivals in our series.