[What's new in 2009 about urothelial tumors? Live from EAU, AUA and ASCO, ASCO-GU]. / Avancées et synthèse des derniers congrès: ASCO-GU, EAU, AUA, ASCO concernant la prise en charge médicale des cancers urothéliaux.

During the EAU and AUA congress in 2009, major work about the urothelial carcinoma was interested in the classification T1a / b and its therapeutic consequences, the last results of BCG therapy and photodynamic diagnosis. At ASCO congress, the main studies presented focused on the systemic treatment, in adjuvant situation, in first line treatment of metastatic bladder cancer, particularly with the addition of anti-angiogenic to chemotherapy, and in conservative treatment in association with radiotherapy.

Endopyelotomy in the elderly.

Elderly patients with ureteropelvic junction obstruction present higher risks for operative repair than younger patients and may benefit from a less invasive approach. We review 18 patients older than 65 years who underwent endopyelotomy for a primary (8) or secondary (10) ureteropelvic junction obstruction. Average followup was 32 months (range 3 to 80). Average operating time, including cystoscopy and patient positioning, was 85 minutes. Average hospital stay was 6.3 days. No intraoperative complications were encountered. One failure occurred immediately postoperatively and the patient underwent corrective pyeloplasty. One patient has had intermittent pain but a negative Whitaker test with no evidence of obstruction. The success rate is 88%. Endopyelotomy can be considered a safe and satisfactory procedure for initial treatment of significant ureteropelvic junction obstruction in the elderly.

[A case of an ectopic testis in the perineum]. / Un cas de testicule ectopique en position périnéale.

The ectopic position of the testis is defined by a migration differing from the normal descent into the scrotum. This error is due to an anomaly of fixation of the distal extremity of the gubernaculum testis (2), resulting in an abnormal position of the testis. The five major sites of ectopic testis are the superficial inguinal canal (most frequent), femoral canal, suprapubic region (at the base of the penis), contralateral scrotum (rare) (3) and, lastly, the perineal region, which is also rare (8). The authors report a case of perineal testis in a 4 year old boy. The diagnosis was clinical and was confirmed by ultrasonography. Doppler studies visualised the testicular blood supply. The testis was surgically relocated in the scrotum.

MR imaging of adult Wilms' tumor: correlation with US, CT, and pathology.

The magnetic resonance (MR) features of an adult nephroblastoma are presented. The MR appearance is correlated with ultrasound (US), computed tomographic (CT) and pathology. The tumor appeared heterogeneous with calcifications and areas of necrosis and hemorrhage. MR correctly staged the tumor.

[The value of pulsed Doppler for the follow-up of the transplanted kidney in the first 3 months of transplantation]. / Intérêt du Doppler pulsé pour la surveillance du rein transplanté dans les trois premiers mois de la greffe.

This prospective study was conducted in 34 consecutive renal transplant patients. Pulsed doppler was used to evaluate the peripheral resistance (PR) in the transplant vessels. Under normal conditions, the PR of the graft is low, resulting in a continuous diastolic blood flow. The intensity of this blood flow was evaluated by means of a resistance index (RI), Pourcelot's index, calculated as follows: RI = systolic peak - end-diastolic peak/systolic peak This study demonstrated values for RI of 0.71 +/- 0.087 in 14 totally asymptomatic patients. In 10 cases of acute rejection, the RI increased to 0.91 +/- 0.12. The 7 patients with acute tubular necrosis had an RI equal to 1. In patients with cytomegalovirus infection of suffering from cyclosporin overdose, the RI was not modified in relation to asymptomatic subjects. This study demonstrates the existence of a rise in the PR in cases of acute rejection and acute tubular necrosis with a sensitivity of 90% and 100% respectively for these two diagnoses. However, this method cannot be used to distinguish between acute rejection and acute tubular necrosis.

[Fibrous polyps of the urinary tract]. / Polypes fibreux de la voie excrétrice.

The authors report five cases of fibrous polyps of the urinary tract, which is a rare disease, as Mazeman only reported 12 cases in his review in 1972. These cases confirm the polymorphic nature of the clinical presentation and the site of these tumours of mesodermal origin, essentially composed of richly vascular connective tissue covered with surface epithelium. Treatment is surgical and conservative. The authors performed two junctional resections, one ureterotomy, one ureteroscopic resection and one nephro-ureterectomy for a partially destroyed kidney.

[Massive retroperitoneal hematoma caused by rupture of the kidney, secondary to cortical abscess]. / Hématome rétropéritonéal massif par rupture du rein, secondaire à un abcès cortical.

A massive retroperitoneal hemorrhage found to be due to a renal abscess in a previously healthy kidney was treated successfully by nephrectomy. This type of lesion occurs fairly infrequently, but it is quite exceptional to observe presenting signs as in the case reported, and recovery is not mentioned in the published literature. Therapy for renal abscess involves either urgent nephrectomy in cases of associated hemorrhagic or septic shock, or medical treatment under close supervision in the absence of major signs of severity, which may, however, develop at any moment making surgery inevitable.

[Periarteritis nodosa in an addict with a hepatitis B injection (author's transl)]. / Périartérite noueuse chez un toxicomane atteint d'hépatite B.

The authors describe a case of a drug addict with a hepatitis B who was found to have periarteritis nodosa and a nephrotic syndrome. The course was rapidly fatal and autopsy confirmed the diagnosis. This new case questions the hypothesis suggested of possible toxicity of hard drugs (especially the amphetamines) as being an etiological factor for periarteritis nodosa observed in addicts. Hepatitis B virus, which is involved in the etiology of periarteritis nodosa and some nephrotic syndromes (also reported in addicts) is, in fact, very prevalent in users of hard drugs by the parenteral route.