[Do postoperative drainage types modify outcomes after retrograde intrarenal surgery?]. / Le type de drainage postopératoire modifie-t-il les résultats de l'urétérorénoscopie souple pour la fragmentation laser des calculs rénaux?

INTRODUCTION: The aim of the current study was to evaluate if the postoperative drainage type modified the outcomes after retrograde flexible ureteroscopy (f-URS) and intracorporeal lithotripsy f-URS for intrarenal stones. MATERIAL AND METHODS: We retrospectively analyzed 162 procedures of f-URS for intrarenal stones between January 2010 and January 2013 at a single institute. Independent-sample t-tests and chi-square tests were used for comparisons of means and proportions between patients with ureteral stent or double pigtail stents. RESULTS: There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8 ± 17 years. Double pigtail stents and ureteral stents were used in 117 (72.2%) and 45 (27.8%) cases, respectively. Cases with postoperative double pigtail stents had a longer operative time (96.2 ± 35 min vs 81.2 ± 5 min; P = 0.018) and were less often operated by an experienced surgeon (P = 0.001). Length of hospital staying (P = 0.804), postoperative complication (P = 0.148) and stone free status (P = 0.116) were not different between postoperative drainage by double pigtail and ureteral stents. CONCLUSION: Postoperative drainage by double pigtail stent was used more often by surgeons in the beginning of their RIRS experience and was associated with longer operation time. Nevertheless, the postoperative drainage type did not modify the outcomes regarding the postoperative complication rate, the length of hospital staying and the stones free rate.

CT and MR imaging of retroperitoneal schwannoma.

The purpose of this presentation is to allow the radiologist to discuss the diagnosis of retroperitoneal schwannoma, involving mostly a fortuitous discovery and a misleading clinical presentation. We present 4 cases of retroperitoneal schwannoma, two having benefited from a surgery and two others of a therapeutic abstention. The retropritoneal localization and the imaging are good indicator elements of this pathology. The constant improvement of the CT and MR imaging allows a better approach of this entity also by specifying its localization and its anatomical relationships to guide the therapeutic attitude which must be remain mutidisciplinary.

[Evaluation of the management of metastatic renal cell carcinoma in the era of targeted therapies. retrospective clinical study over six years]. / Évaluation de la prise en charge du cancer du rein métastatique à l'ère des thérapies ciblées. Étude clinique rétrospective sur six ans.

OBJECTIVE: To evaluate the outcomes following targeted therapies in the management of metastatic renal cell carcinoma (mRCC), through the study of overall survival (OS) and progression-free (PFS). PATIENTS AND METHODS: We retrospectively included 78 patients treated with targeted therapies for mRCC at the Paul Papin Cancer Institute from 2004 to 2009. Overall survival (OS), progression free survival (PFS), response to treatment, occurrence of grade III and IV side effects, were analyzed following first and second line treatments. RESULTS: Median follow-up was 33 months [5-236], and 41 patients died (52.6%). Median OS was 36 months [95% CI 29-43]. The median PFS was 14 months [95% CI 6.71-21.29] for sunitinib, 38 months [95% CI 11.41-64.59] for bevacizumab with interferon (IFN), and 8 months [95% CI 0-17.03] for IFN alone. A partial reduction, stabilization or increase in tumor size was observed for 19.2%, 47.4% and 25.6% of cases. A second line treatment was given for 53 patients. They received either sunitinib (n=20, 37.8%), bevacizumab with IFN (n=7, 13.2%), sorafenib (n=17, 32.2%), temsirolimus (n=3, 5.6%) or other molecules (n=6 11.2%). Grade III or IV side effects were observed for 14.1%, 28.3% and 18.2% of the patients following first, second and third line treatment, respectively. CONCLUSION: Outcomes of targeted therapies in our center upheld the literature data. These therapies allow a benefit survival versus immunotherapy, with sometimes large side-effect.

[Postpartum urinary retention]. / Rétention vésicale du post-partum.

Postpartum urinary retention is an uncommon event that occurs in 0.7 to 0.9% of vaginal deliveries. An ignorance of this situation can lead to delayed diagnosis worsening the prognosis and to inadequate treatments. This complication is defined as the absence of spontaneous micturition within 6hours of vaginal delivery with a bladder volume above 400mL. The etiology depends on multiple factors. Because of physiological changes during pregnancy, the bladder is hypotonic with an increased post-void residual volume. The occurrence of a perineal neuropathy during delivery may cause a urinary retention. Risk factors are primiparity, prolonged labour, instrumental delivery and perineal lacerations. Treatment consists on clean intermittent catheterization and recovery occurs generally in 72hours. Persistent urinary retention is the principal short-term complication and should be treated by clean intermittent self-catheterization. Long-term consequences are poorly reported in the literature.