Forced diuresis improves the diagnostic accuracy of 18F-FDG PET in abdominopelvic malignancies.

UNLABELLED: Our aim was to evaluate the role of forced diuresis in improving the diagnostic accuracy of abdominopelvic (18)F-FDG PET. METHODS: Thirty-two patients were enrolled. Besides the presence of known intravesical tumors or undefined renal lesions on the initial PET scan, the inclusion criterion was the appearance of indeterminate or equivocal (18)F-FDG foci that extended along the course of the urinary tract and could not confidently be separated from urinary activity. For each patient, a second abdominopelvic PET study was performed after intravenous injection of 0.5 mg of furosemide per kilogram of body weight (maximum, 40 mg) coupled with parenteral infusion of physiologic saline. RESULTS: Forced diuresis coupled with parenteral hydration eliminated any significant (18)F-FDG activity from the lower urinary tract in 31 (97%) of 32 patients after the bladder had been voided 3 successive times. Twelve intravesical lesions were visualized with outstanding clarity, whereas radiologic suspicion of locally recurrent bladder tumors was ruled out in 3 patients. Among 14 indeterminate or equivocal extravesical foci, 7 were deemed of no clinical value because they disappeared after furosemide challenge, whereas 7 persisting foci were proven to be true-positive PET findings. The performance of (18)F-FDG PET in characterizing 3 renal-space-occupying lesions could not be improved by our protocol. CONCLUSION: Furosemide challenge has the potential to noninvasively resolve the inherent (18)F-FDG contrast handicap in the lower urinary tract.

[Urologic treatment of lithiasis]. / Traitement urologique de la lithiase.

The urological treatment of urolithiasis has completely changed during the last 20 years with a huge technical development. Many eclectic fields as aeronautical, micromechanic, Laser and optical research as well as computerised radiology have contributed to this evolution. We discuss here, the several therapeutic modalities, with there applications, combinations and various indications.

[Localized cancer of the prostate: which treatment should be chosen?]. / Cancer localisé de la prostate: quel traitement choisir?

Prostate cancer is a frequent tumor. Nowadays, its diagnosis is often established when the tumor is localized, and curative treatment can be proposed to the patients. Systematic screening studies are under way. Although their conclusions are not yet known, some clues seem to show that early diagnosis and treatment may increase specific prostate cancer survival. Every patient over 50 years old and with a life expectancy of at least 10 years should benefit from a prostate specific antigen (PSA) blood testing and from a prostate rectal palpation every year. This paper reviews oncological and functional results of the established curative treatments of localized prostate cancer, namely radical prostatectomy, external beam radiation, and brachytherapy.