[Open partial nephrectomy: standard of minimal invasive surgery]. / Néphrectomie partielle par chirurgie conventionnelle : définir les critères de la chirurgie mini-invasive.

OBJECTIVE: Partial nephrectomy is now recognized as the standard treatment for tumors less than 7cm. The oncological results are comparable to those obtained by total nephrectomy, while preserving kidney function. Our objective was to describe our experience and research factors associated with complications, recurrence and death. PATIENTS AND METHODS: Partial nephrectomy performed in our center by June 1996 to December 2008 were reviewed retrospectively. Demographic and tumors characteristics, postoperative complications and patient outcomes were identified. Factors associated with complications and survival were investigated by regression tests. RESULTS: Of the 96 patients enrolled (mean age 61.4 years±12.8), 13 had renal insufficiency (serum creatinine 120 to 212µmol/L). The mean tumor size was 32mm (±13.9) and 57 (79.2%) corresponded to clear cell carcinoma. The overall rate of postoperative complications was 26%, including 8.3% of hemorrhagic complications and 3.1% of urinary complications. None of the analyzed variables were associated with the occurrence of complications. With a mean of 2 years and 9 months follow-up (±28months), eight patients (11.1%) had tumor recurrence. Multifocal tumors as well as postoperative complications were associated with risk of recurrence. Three patients with positive tumor margins were monitored with no evidence of progression (with 71, 42 and 12 months of follow-up). CONCLUSION: Our single-center retrospective study of partial nephrectomy for renal tumor showed medium-term oncological results similar to those reported in the total nephrectomy with the advantage of nephron preservation. The results of studies by conventional surgery such as that we report should be a benchmark for laparoscopic surgery.

[Efficiency and tolerance of intermittent self-dilatation after internal urethrotomy for urethral strictures]. / Efficacité et tolérance des dilatations par autosondages après urétrotomie interne pour sténoses urétrales.

OBJECTIVE: To retrospectively evaluate efficiency and tolerance of intermittent self-dilatation (ISD) after unicenter internal urethrotomy (IU) on urethral strictures (US). PATIENTS AND METHODS: From January 2000 to November 2008, ISD have been performed after IU on 54 patients; 44.4% were iatrogenic. ISD median frequency was once a week (0.25-14). ISD was carried out for a median period of 8.4 months (0-97). RESULTS: IPSS was 21 at diagnosis vs 7 during ISD (P=0.018). QoL score of IPSS was 5 at diagnosis vs 2 during ISD (P=0.03). Maximum flow rate was 4.6mL/s at diagnosis vs 16.6mL/s during ISD (P=0.003). Ten patients had recurrence during ISD period. The follow-up from the beginning of ISD was 35 months (range, 0-164). Urologists' evaluation of ISD tolerance was excellent or good for 47 patients (87%). Tolerance self-evaluation was excellent or good for seven patients out of 15. CONCLUSION: ISD was a well-tolerated and useful option after IU. It had a 81.5% efficiency in our cohort.

[The French linguistic validation of the Ureteric Stent Symptom Questionnaire (USSQ)]. / Validation en langue française du questionnaire << Ureteric Stent Symptom Questionnaire >> (USSQ).

PURPOSE: Translation and linguistic validation of the French version of the Ureteral Stent Symptom Questionnaire (USSQ). MATERIALS AND METHODS: A double-back translation of the original Ureteral Stent Symptom Questionnaire was performed. First, two urologists translated the English version in French. Then a first consensus meeting between the translators and a group composed with three urologists, one general practitioner and two nurses was achieved. Back-translation of this version was then done by professional translators (Nagpal, Paris) to ensure that no distortion was detected between the two questionnaires. Finally, a pilot test followed by an interview was carried out among two men and two women who had an indwelling ureteral stent. RESULTS: The consensus version is attached to the article. No difficulties were reported by the pilot population to comprehend or to complete this USSQ French version. CONCLUSION: This USSQ version - attached to the article - makes it possible for researchers among a French population to use this validated and internationally recognized tool that provides reproducible and measurable endpoints on tolerance of ureteral stents.

[Surgical management of urinary tract endometriosis: 12 cases]. / Prise en charge chirurgicale de l'endométriose de l'appareil urinaire : à propos de 12 cas.

OBJECTIVES: Our study aimed at evaluating, retrospectively, the outcome of the surgical management of urinary tract endometriosis. PATIENTS AND METHODS: Twelve women with a mean age of 36,4 were recruited between 1994 and 2007. They all had a histologically-proven and surgically-treated endometriosis of the urinary tract. RESULTS: Seven of them had a unilateral ureteric localization, two had a bilateral ureteric localization and three had a vesical localization. One patient with bladder nodules underwent a partial cystectomy and the two other patients with bladder localization underwent a transurethral resection. Out of the nine patients who had a ureteric localization of endometriosis, seven had a ureterectomy and re-implantation with bladder psoas hitching and had no recurrence. CONCLUSIONS: Our experience showed that ureterectomy and re-implantation with bladder psoas hitching is probably the best way of preventing recurrences in the case of urethral endometriosis. In the case of bladder endometriosis, transurethral resection did not appear as the most effective treatment although it remains an acceptable alternative, especially as far as premenopausal women or young women wishing to conceive are concerned.

[Percentage of positive biopsy cores at the onset of hormone therapy for prostate cancer: prognostic significance]. / Pourcentage de biopsies positives chez les patients traités par hormonothérapie pour cancer de la prostate : valeur pronostique.

INTRODUCTION: We hypothesized that it would predict time to hormonal independence and survival in prostate cancer patients treated by androgen deprivation therapy (ADT). MATERIAL AND METHODS: We used clinical data from 403 men treated with ADT between 1980 and 1999 and focused on a subgroup of 220 patients treated with GnRH analogue. Percentage PBC was defined as the number of positive biopsy cores multiplied by 100 and divided by the total number of biopsy cores. RESULTS: Median percentage PBC was 83.3% (16.7-100%). Mean follow-up was 57.4 months. Survival at 5 years in men with 83.3% PBC or less was 62.3, 89.1 and 82.6% for recurrence-free, specific and overall survival respectively, significantly better than that of men with a percentage PBC of more than 83.3% (32.2, 74.7 and 67.7%, respectively; p<0.004). Among the factors available in the pretreatment setting, namely age, clinical stage, PSA, Gleason score, bone scan and percentage PBC, the latter was independently associated with survival in multivariate analysis. CONCLUSIONS: Percentage PBC may improve the ability to predict time to hormonal resistance and survival in patients treated with ADT for prostate cancer. This finding warrants further investigation.

[Short or long schemes of antibiotic prophylaxis for prostate biopsy. A multicentre prospective randomised study]. / Antibioprophylaxie courte versus longue pour les biopsies prostatiques. Etude prospective randomisée multicentrique.

OBJECTIVE: We compared the incidence of the Urinary Tract Infection between a single preoperative dose and a three-day antibiotic prophylaxis regimen for transrectal ultrasound guided biopsy in randomized multicenter trial. MATERIAL AND METHODS: Between February 2006 and December 2007, 322 men who underwent transrectal ultrasound-guided prostate biopsy were included in a multicentre prospective randomised study. Patients received antibiotic prophylaxis by ciprofloxacin orally, either 1g single dose two hours before the biopsy (Group 1: n=139) or a prolonged prophylaxis for three days (Group 2: n=149). Assessment five days before and five days following the biopsy included a clinical examination, biological tests and a self-questionnaire. RESULTS: Two patients developed prostatitis, one in each group: 0.75% of the first group, 0.69% of the second. Twelve developed asymptomatic bacteriuria, six in each group: 4.51% of the first group and 4.19% of the second. There was no significant difference between the two groups (Fisher test; p>0.9). CONCLUSIONS: There was no significant difference between the two antibiotic prophylaxis regimen (one single dose or three days) for patients undergoing TRUS guided biopsies. Therefore, the single preoperative dose should be the preferred option.