[Minimally invasive radical prostatectomy: Contribution of robotic support, functional and oncological outcomes]. / Prostatectomie radicale mini-invasive : apport de l'assistance robotisée, résultats fonctionnels et oncologiques.

OBJECTIVES: Radical prostatectomy (RP) remains a standard for localized prostate cancer treatment. The objective of this study is to present this operating technique of the robot-assisted radical prostatectomy (PR-RA) and to evaluate oncological and functional results as well as on the surgical safety. METHODS: A first series of 1679 patients consecutively operated in our institution with this technique from 2005 to 2010 and with a 5-year follow-up evaluated in 2014. The oncology monitoring is ensured with a PSA test every six months during the first three years and once a year the years after if the level remains undetectable. RESULTS: The oncologic outcomes show 17.4% for pT2 stages and 36.9% for pT3 stages positive margins. The level of biological recurrence is 21.27% with an average delay of 88 months as the time needed for the recurrence to occur. At 12 months, urinary continence (0-1pad/day) returned at 94% of all patients and potency with successful penetration for all men is 61.1% and 88.8% for men with sexual activity before surgery. CONCLUSIONS: The technique PRRA seems to be a reliable technique whose functional results studied from meta-analysis seem to be superior in terms of rapidity of recovery of the continence and erection in comparison with classical surgical or laparoscopic approach.

The first case of robotic pudendal nerve decompression in pudendal nerve entrapment syndrome.

OBJECTIVE: To report the first case of robotic pudendal nerve (PN) decompression for bilateral PN entrapment (PNE). PN decompression is a safe and effective treatment for PNE and can be accomplished laparoscopically with a better exploration of the sacral roots and of the PN. MATERIALS AND METHODS: We describe in detail all the steps of our surgery, performed on a 38-year-old female patient suffering from PNE. All the anatomic landmarks are clearly shown. RESULTS: Our technique was successful, and the patient's postoperative course was uneventful. Six months after surgery, the pain had completely resolved, and the patient was drug-free. CONCLUSIONS: We showed the feasibility and effectiveness of robotic PN decompression, with surgical advantages that could potentially extend the indications of robot-assisted surgery.

Laparoscopic and robot-assisted continent urinary diversions (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 15 adult patients: the Saint Augustin technique.

OBJECTIVE: To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches. PATIENTS AND METHODS: Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4). The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire. RESULTS: All surgeries were successfully completed with no conversions. Operating time was always <5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months. Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure. Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient. Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery. CONCLUSIONS: While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.

Feasibility of robotic double Yang-Monti ileal conduit with bladder augmentation: surgical technique.

OBJECTIVE: To report the feasibility of a novel robotic technique for intracorporeal construction of a double Yang-Monti ileal conduit with bladder augmentation in an adult patient. METHODS: The Yang-Monti procedure can be considered as an alternative to Mitrofanoff appendicovesicostomy when the appendix is not available or in obese patients. To date, the robotic approach has not been described. We have described all the steps of our surgery, performed on a 35-year-old obese patient with post-traumatic paraplegia and a neurogenic bladder. We focused on the technical tips and highlighted all the differences with the standard open technique. RESULTS: Our technique provided satisfactory results. No intraoperative complications occurred. The operative time was 250 minutes, and the intraoperative blood loss was 200 mL. The clinical course was uneventful. CONCLUSION: We have shown that robotic intracorporeal realization of a double Yang-Monti ileal conduit with bladder augmentation is feasible, extending the potential indications of robot-assisted surgery. The evaluation of more cases is advised.

[Paraneoplastic urticarial vasculitis and renal carcinoma]. / Vasculite urticarienne paranéoplasique et carcinome rénal.

Paraneoplastic syndromes have been described in various types of tumours, but are rarely associated with renal cancer. Paraneoplastic cutaneous manifestations, consisting of urticarial vasculitis are exceptional and can sometimes constitute the presenting sign of a completely asymptomatic renal cancer. This vasculitis resolves after curative treatment of the tumour, confirming its paraneoplastic nature. The authors report a case of a paraneoplastic urticarial vasculitis associated with the discovery of an asymptomatic renal carcinoma in a 37-year-old man and discuss paraneoplastic cutaneous syndromes that must be recognised to allow earlier diagnosis of renal tumours.

[Study of the prognostic value of DNA ploidy and proliferation index (Ki-67) in renal cell carcinoma with venous thrombus]. / Etude de la valeur pronostique de l'ADN-ploïdie et de l'index de prolifération (Ki-67) dans la tumorogenèse du cancer du rein avec thrombus veineux.

INTRODUCTION: Malignant tumours of the renal parenchyma are accompanied by extension to the inferior vena cava in 4% to 10% of cases. The objective of this study was to compare DNA ploidy and proliferation index of renal cell carcinoma (RCC) with renal vein (RV) thrombus and RCC with inferior vena cava (IVC) thrombus and to investigate a correlation between these markers and Fuhrman grade and patient survival. MATERIAL AND METHODS: A retrospective study was conducted in 58 patients with RCC and venous thrombus (40 in the RV and 18 in the IVC). Flow cytometry (FCM) and MiBI antibody immunolabelling (Ki-67 index) were performed on the healthy parenchyma, the renal tumour and the venous thrombus. Eighteen tumours with inferior vena cava thrombus were compared to 40 tumours with renal vein thrombus. Fuhrman grade, the presence of capsular rupture, invasion of the perirenal fat, and the presence of sarcomatoid transformation were investigated for a possible correlation with survival. RESULTS: No difference of expression of Ki-67 antigen expression was observed between the two populations of renal tumours with thrombus (RV/IVC), but a significant difference was observed for the two types of thrombus (RV/IVC). A difference in ploidy index was observed was also observed between tumours with RV and IVC thrombus (p<0.005). The tumours had less intense MiB1 immunolabelling and a lower DNA ploidy than their corresponding renal vein and inferior vena cava thrombi (Ki-67: 1.07% vs 5.12%, p<0.01: DNA index: 1.61 vs 1.87, p<0.01). A correlation between Fuhrman grade and tumour DNA index was demonstrated (1.149 for low grade tumours and 1.857 for high grade tumours, p<0.05). Sarcomatoid transformation, capsular effraction and capsular rupture were significantly correlated with Fuhrman grade (p<0.01) and patient survival (p<0.05). CONCLUSION: The proliferation index is not a prognostic factor, but DNA ploidy appears to be more useful because of its correlation with Fuhrman grade and the level of extension of the thrombus (RV/IVC). The proliferation index and ploidy appear to be involved in the process of carcinogenesis and venous thrombus.

[Testicular microlithiasis and cancer of the testis]. / Micro-lithiases testiculaires et cancer du testicule.

The authors report the case of a patient with a history of testicular cryptorchidism followed for 4 years for infertility and who developed seminoma. Bilateral testicular microlithiasis was initially detected on ultrasonography. On the basis of this case and a review of the literature, the authors discuss the aetiopathogenesis and management of these microscopic stones in a context of cancer.