Robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Peri and postoperative outcomes.

INTRODUCTION: The treatment of urothelial tumours of the upper urinary tract at high risk of specific mortality is based on radical nephroureterectomy (RNU). Robotic-assisted laparoscopic radical nephroureterectomy (RARNU) is still under investigation to definitively establish the safety of this procedure in the management of urothelial tumours of the upper urinary tract. The primary objective is to evaluate the intra- and postoperative safety of RARNU and, subsequently, to evaluate the medium-term oncological results. METHODS: Our study is a retrospective, mono-centric study with a collection of RARNUs conducted between 1st January 2015 and 1st October 2021. The RARNUs were performed with the assistance of the Da Vinci Si® robot, then from 2017 the Da Vinci Xi® robot. Whenever possible, the entire procedure was carried out without re-docking. RESULTS: Between 1st January 2015 and 1st October 2021, 29 RARNUs were carried out at our centre. Complete surgery without re-docking was possible in 80% of cases with the Da Vinci Xi® robot. One patient required conversion to open surgery due to difficult dissection. 50% of tumours were classified as T3 or T4. The 30-day complication rate was 31%. The median length of hospitalisation was 5 days. The disease-free survival at the mean survival time (27.5 months) was of 75.2%. One patient had a recurrence in the nephrectomy compartment and no patient had a peritoneal or trocar orifice recurrence. CONCLUSION: Performing RARNU for the management of tumours of the upper urinary tract appears to meet the criteria of surgical safety and those of oncological safety.

Influence of inguinal hernia repair on male fertility.

Male infertility is a rare but certainly underestimated iatrogenic complication of inguinal hernia repair. The use of polypropylene mesh, recommended by the European Hernia Society, either via the traditional, open or laparoscopic approach, is responsible for surrounding inflammation followed by fibrosis, but there is no proven increase in vas deferens obstruction found in the literature. Prevention is essential to reduce the incidence of this complication including screening for patients at risk and mastery of surgical techniques.

[Bladder cancer in neurogenic patients: A retrospective study of management and follow-up]. / Cancers de vessie chez les patients neurologiques : étude rétrospective de prise en charge et de suivi.

INTRODUCTION: The prevalence of bladder cancer (BC) in neurological patients seems to be similar to that of the general population. However, they are more aggressive with a higher rate of muscle-invasive forms and squamous cells carcinomas. The aim of the current study was to report etiologies, management and outcomes of BC in neurological population. MATERIAL AND METHOD: Were enrolled all neurological patients with a BC diagnosed between 2004 and 2017. The following data were retrospectively reported: age, gender, duration of the disease, mode of discovery, histological type, treatment and outcomes. RESULTS: In total, 27 patients were included: 11 spinal cord injuries, 7 Parkinson's disease, 5 multiple sclerosis, 3 head trauma, 3 brain strokes, 2 cerebral palsies and 1 spina bifida. The histological subtypes were as follows: 22 transitional cells carcinomas, 4 squamous cell carcinomas (SCC), one mucinous adenocarcinoma, one sarcomatoid and one neuroendocrine with 19 high-grade tumors and 15 muscle-invasive bladder cancer. Seven patients (26%) were diagnosed before 15 years history of neurogenic bladder. The mean follow-up was 14 months (1-210 months). Eight deaths were observed, with 5 related to bladder cancer. In our study, smoking habits, voiding mode, lithiasis or infection histories were not related with a more aggressive pattern, such as SCC. CONCLUSION: The high rate of muscle-invasive bladder cancer and aggressive patterns justify neuro-urological follow-up, even before 15 years of neurogenic bladder. LEVEL OF EVIDENCE: 4.

[Long-term outcomes of prostate cancer patients with lymph nodes metastasis after radical prostatectomy and pelvic lymph node dissection]. / Résultats oncologiques à long terme des patients ayant un cancer de la prostate traité par prostatectomie totale et curage ganglionnaire avec atteinte métastatique ganglionnaire infraclinique.

INTRODUCTION: The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection. PATIENTS AND METHODS: This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. RESULTS: Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS. CONCLUSION: Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. LEVEL OF EVIDENCE: 4.

[Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review]. / Analyse des taux de succès des urétroplasties pour sténoses de l'urètre bulbaire chez l'homme adulte : revue systématique de la littérature.

Male urethral stricture disease is prevalent and has an important impact on quality of life. Direct visual urethrotomy and dilatations have high rates of recurrence. OBJECTIVES: The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra. METHODS: We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required. RESULTS: From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft. CONCLUSION: The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

[Renal colic in pregnancy: series of 103 cases]. / Coliques néphrétiques de la femme enceinte: étude d'une série de cent trois cas.

PURPOSE: To evaluate the management of renal colic in pregnant woman in our hospital. MATERIAL AND METHODS: A retrospective study of 103 pregnant patients, hospitalized for back pain of renal colic type, associated or not with a urinary tract infection, between January 2005 and October 2010. Three groups of patients were identified from the initial clinical and paraclinical (ultrasound). Group I involved patients with dilatation of the renal cavities associated with septic syndrome, they received analgesic treatment and empiric antibiotic therapy. Group II involved patients with dilatation of the renal cavities isolated, without fever, they received only analgesic treatment. Group III involved patients without dilatation of the renal cavities, they received analgesic treatment and antibiotics in case of fever, and then another cause of pain was sought. RESULTS: The renal colic was due to a stone in 19.4 % of cases. A urinary infection was associated in 28 % of patients. Ultrasond was sufficient to confirm the diagnosis in 96 % of cases. In 4 % of cases, MRI or low-dose CT were necessary. Therapeutic management based on analgesic treatment, associated with probabilistic antibiotherapy or adapted in case of documented infection, allowed sedation of pain in two-third of cases. In case of failure or signs of severity, the urinary diversion by a double J stent was efficient, without consequences on pregnancy issue. One stone was treated by ureteroscopy during pregnancy without complication. CONCLUSION: The management of renal colic in pregnant woman based on ultrasound diagnosis, symptomatic treatment and urinary diversion by double J stent in case of failure therefore seemed quite sure on mother and fetus.

[Multicentric evaluation of a self-screening questionnaire for occupational bladder cancer]. / Évaluation multicentrique d'un auto-questionnaire de dépistage des cancers de vessie d'origine professionnelle.

OBJECTIVE: Evaluate a self-screening questionnaire for bladder cancer of occupational origin and analyse an influence of exposure to a carcinogen bladder tumor on prognosis. PATIENTS AND METHODS: Five hundred and thirty-one patients followed, between 2005 and 2010, for bladder cancer in two university centers have received a self-screening questionnaire derived from questionnaire KVP 08. Patients who responded positively to at least one of the items were considered to have a self-screening questionnaire "positive". Patients were finally invited to take an appointment for consultation in occupational pathology. RESULTS: The response rate to self-screening questionnaire was 39.9% (212/531). It was "positive" in 82 cases (38.7%). Among the 82 patients with a self-screening questionnaire "positive", 46 patients consulted in occupational pathology (56%). Occupational exposure to a bladder carcinogen was documented in 91.3% of cases. Among the 22 patients who consulted in occupational pathology with a self-screening questionnaire "negative", an occupational exposure to a bladder carcinogen was documented in 13.6% of cases. The sensibility of the self-screening questionnaire was 91.3%, the specificity 86.4% and the accuracy 89.7%. The relative risk to have an occupational exposure if the self-screening questionnaire was "positive" was 6.69. The analysis of groups "positive" versus "negative" does not reveal any statistically significant difference in terms of tumor aggressiveness and disease-free survival. CONCLUSION: The self-screening questionnaire was considered relevant with good reliability for detection of occupational exposure to a bladder carcinogen.

Comparative proteomic analysis coupled with conventional protein assay as a strategy to identify predictors of successful testicular sperm extraction in patients with non-obstructive azoospermia.

Among infertile couples, approximately half have to face with male infertility. In men with non-obstructive azoospermia, surgical retrieval testicular sperm extraction (TESE) of spermatozoa can be attempted, but with low success rates. A specific biomarker that could predict residual spermatogenesis would obviously be of interest before performing TESE. Thus, our aim was to identify biomarkers of residual spermatogenesis in seminal plasma of patients with non-obstructive azoospermia (NOA) using an isotope-coded protein label (ICPL)-based proteomic strategy coupled with conventional protein assay. This retrospective study was conducted in 40 men with NOA at the University Hospital of Nantes and Proteomics Core facility Biogenouest - Inserm U1085 - IRSET, Rennes, France. Comparative ICPL proteomic screening of frozen seminal plasma and correlation with TESE outcome allowed the identification of some differentially expressed proteins. Among them, lectin galactoside-binding, soluble 3 binding protein (LGALS3BP) expression was further confirmed using conventional protein assay, and its interest as a predictor of TESE outcome was then evaluated and compared with conventional clinical and hormonal markers of residual spermatogenesis. Among the 12 differentially expressed proteins identified with comparative ICPL proteomic strategy, seminal LGALS3BP expression was found to be significantly higher in men with successful TESE. Finally, comparative ICPL proteomic screening of seminal plasma appears to be a promising approach for the identification of biomarkers of residual spermatogenesis. LGALS3BP, associated with clinical and hormonal markers, could potentially be used as a predictive marker of successful TESE outcome in patients with NOA.

[Androgen deprivation and cardiovascular risk in prostate cancer treatment]. / Hormonothérapie et risque cardiaque dans le traitement des cancers prostatiques.

Androgen suppression clearly increases the occurrence of cardiovascular risk factors : increased body fat, dyslipidemia and type II diabetes. Thus, several studies (but not all), showed an increase in coronary artery disease but also of sudden death and ventricular arrhythmias in relation to androgen deprivation, even for a short duration. This risk is particularly important in patients with existing cardiovascular risk factors or a history of heart disease. Cardiovascular risk should be balanced with the benefit of androgen deprivation on overall survival, especially when it is proposed in adjuvant setting, combined with radiotherapy in locally advanced prostate tumors. In practice, it is recommended that patients be referred to their physician for an evaluation before starting treatment, then 3 to 6 months after starting treatment, then once a year. The initial assessment should include: a clinical examination (with measurement of blood pressure and body index) and laboratory test with full lipid profile (total cholesterol, HDL and LDL cholesterol, triglycerides) and glucose. It is also important that patients with heart disease, receive lifestyle advice and low- dose aspirin (80 mg/day).

[Prostatic Stromal Tumors of Uncertain Malignant Potential (STUMP): definition, pathology, prognosis and management]. / Tumeur stromale prostatique à potentiel malin incertain (STUMP) : définition, anatomopathologie, pronostic et prise en charge.

Prostatic Stromal Tumors of Uncertain Malignant Potential (STUMP) are rare tumor of the prostate of mesenchymal origin, accounting, with sarcoma for 0.1-0.2% of all malignant prostatic tumours. They however require to be individualized, to differentiate it from a benign prostatic hyperplasia or a sarcoma of the prostate. The therapeutic management should be made keeping in mind the risk of degeneration towards a malignant shape. Although the appropriate treatment is unknown, radical prostatectomy seem to be the treatment of reference, especially for young patient or for extensive lesion.

[Pelvic radiotherapy and artificial urinary sphincter in women]. / Radiothérapie pelvienne et sphincter artificiel urinaire chez la femme.

OBJECTIVES: A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR). POPULATION AND METHODS: From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n=206) and the other group with PR (group 2; n=9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure. RESULTS: Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P<0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4-140) with AUS implantation. CONCLUSION: AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres.

The new Ghent criteria for Marfan syndrome: what do they change?

The diagnosis of Marfan syndrome (MFS) is challenging and international criteria have been proposed. The 1996 Ghent criteria were adopted worldwide, but new diagnostic criteria for MFS were released in 2010, giving more weight to aortic root aneurysm and ectopia lentis. We aimed to compare the diagnosis reached by applying this new nosology vs the Ghent nosology in a well-known series of 1009 probands defined by the presence of an FBN1 mutation. A total of 842 patients could be classified as MFS according to the new nosology (83%) as compared to 894 (89%) according to the 1996 Ghent criteria. The remaining 17% would be classified as ectopia lentis syndrome (ELS), mitral valve prolapse syndrome or mitral valve, aorta, skeleton and skin (MASS) syndrome, or potential MFS in patients aged less than 20 years. Taking into account the median age at last follow-up (29 years), the possibility has to be considered that these patients would go on to develop classic MFS with time. Although the number of patients for a given diagnosis differed only slightly, the new nosology led to a different diagnosis in 15% of cases. Indeed, 10% of MFS patients were reclassified as ELS or MASS in the absence of aortic dilatation; conversely, 5% were reclassified as MFS in the presence of aortic dilatation. The nosology is easier to apply because the systemic score is helpful to reach the diagnosis of MFS only in a minority of patients. Diagnostic criteria should be a flexible and dynamic tool so that reclassification of patients with alternative diagnosis is possible, requiring regular clinical and aortic follow-up.

[Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function outcome in tumors larger than 4 cm]. / Intérêt de la néphrectomie partielle pour la préservation de la fonction rénale des patients ayant une tumeur rénale de plus de 4 cm.

OBJECTIVE: The objective of the present study was to analyse whether nephron-sparing surgery (NSS) was superior to radical nephrectomy (RN) in preserving renal function outcome in tumors larger than 4cm. METHODS: The data from 888 patients who had been operated upon at eight french university hospitals were retrospectively analyzed. Glomerular filtration rate (GFR) pre- and post-surgery was calculated with the abbreviated Modification of Diet in Renal Disease (MDRD) equation. For a fair comparison between the two techniques, all imperative indications for NSS and all GFR<30 mL/min/1.73 m(2) were excluded from analysis. A shift to a less favorable DFG group following surgery was considered clinically significant. RESULTS: Seven hundred and thirty patients were suitable for comparison. Median age at diagnosis was 60 years (19-88). Tumors measuring more than 4cm represented 359 (49.2%) cases. NSS and RN were performed in 384 (52.6%) and 346 (47.4%) patients, respectively. In univariate analysis, patients undergoing NSS had a smaller risk than RN of developing significant GFR change following surgery. This was true for tumors≤4cm (P=0.0001) and for tumors>4cm (P=0.018). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P=0.001), decreased preoperative DFG (P=0.006), increased age at diagnosis (P=0.001) and increased ASA score (P=0.004). CONCLUSION: The renal function benefit offered by elective NSS over RN persists even when expanding NSS indications beyond the traditional 4 cm cut-off.

[Imperative partial nephrectomy for renal cell carcinoma: oncological and functional results]. / Néphrectomie partielle de nécessité pour carcinome à cellules rénales : résultats oncologiques et fonctionnels.

OBJECTIVES: To study oncological results and functional results after partial nephrectomy in imperative indication for the treatment of renal cell carcinoma. PATIENTS AND METHODS: From January 1990 to December 2009, 65 partial nephrectomies in 61 patients were performed in imperative indication for renal cell carcinoma. RESULTS: The mean age of patients was 59.3 years. The mean follow-up was 47.4 months. The tumours were asymptomatic in 87.5%. The average tumour diameter was 4.3 cm. Twenty-nine percent of patients relapsed after a mean time of 27.4 months. The morbidity was 38.5%. Preoperative and endpoint serum creatinine and renal clearance were respectively 119 µmol/L and 63.1 mL/min versus 137 µmol/L and 50.9 mL/min (P=0.0003; 0.0002). Overall survival at one, three, five and ten years was 98.4%, 91.2%, 91.2% and 51.9%. CONCLUSION: Partial nephrectomy in imperative indication for renal cell carcinoma has helped preserve renal function but has a significant morbidity and recurrence rate.

[Surveillance after prostate cancer radiotherapy]. / Suivi après la radiothérapie des cancers de la prostate : bases scientifiques, rapport coût-bénéfice.

Follow-up after prostate cancer radiotherapy aims at detecting local or metastatic relapse, as well as long-term toxicity, requiring adapted treatments. Several scientific societies have published guidelines including clinical, biological and imaging recommendations. More data suggest a role for aggressive salvage therapy in case of local failure following radiotherapy. An adequate follow-up is required for the sake of patients' safety, i.e. to a posteriori validate dose constraints and radiation technique in each radiotherapy department.

[Double spinofixation laparoscopic versus laparoscopic robot-assisted: Morbidity, anatomical and functional short-term results]. / Double promontofixation laparoscopique versus laparoscopique robot-assistée : morbidité, résultats anatomiques et fonctionnels à court terme.

OBJECTIVE: The purpose of our study was to compare the morbidity and the short-term anatomical and functional outcome of the double promontofixation according to the surgical access laparoscopic versus laparoscopic robot-assisted. METHODS: Forty-six patients were operated for anterior and posterior promontofixation with two mesh between March 2008 and February 2010, 19 were robot-assisted (PR) and 27 laparoscopic (PL). All the patients were contacted again by telephone to answer a questionnaire estimating the functional results. RESULTS: Both groups (PR vs PL) were comparable in terms of age, score ASA and of surgical histories. There was no difference in terms of hospital stay nor per- and postoperative complications. The mean operating time was significantly more important in the group PR (P=0.049). With a mean follow-up of 10,7±7,8 months (PL) versus 8,8±5,9 months (PR), the anatomical result was good without recurrence in 93,5% of the cases. The rate of recurrence was similar in both groups with three patients who had a cystocele grade 2, two in the group PR and one in the group PL (P=0.411). The urinary and sexual functional results were comparable between both groups with an improvement of the rate of dyspareunia and dysuria. However we observed more postoperative constipation in the group PR (10/19 vs 6/27, P=0.033). CONCLUSION: The robot-assisted laparoscopic promontofixation is a reproducible technique with a morbidity and anatomical and functional results comparable to the laparoscopic way.

[Laparoscopic sacrocolpopexy results contingent on mesh position]. / Résultats anatomiques et fonctionnels des promontofixations par cœlioscopie en fonction de la position des prothèses.

OBJECTIVES: Do the number and the position of meshes in laparoscopic sacrocolpopexy influence anatomical or functional postoperative results in genital prolapse treatment? PATIENTS AND METHODS: Ninety patients were treated for genital prolapse by laparoscopic sacrocolpopexy between January 1998 and 2007. Eleven had an anterior single mesh, 36 a single posterior mesh and 43 a double mesh. RESULTS: Four patients with late postoperative complications needed a new surgical procedure. Three of them had a double mesh. Thirteen anatomical recurrences (14 %) were found. Eleven recurrences had a single posterior mesh and eight needed a new surgical procedure. Two other recurrences had a double mesh. Only one needed a new surgical procedure. No recurrence was noticed in the anterior single mesh group. The observed pelvic floor dysfunction rates were respectively for the single anterior mesh group, posterior single mesh group and double mesh group: constipation 20 % 64 % 35 %, anal incontinence 0 % 14 %/2 %, urgency 0 %/8 %/12 %, stress urinary incontinence 27 % 14 %/31 %. CONCLUSION: Double mesh reduced anatomical recurrence, but increased surgical complications and postoperative dysfunctions.

[Active surveillance for prostate cancer: usefulness of endorectal MR at 1.5 Tesla with pelvic phased array coil in detecting significant tumors]. / Cancer de la prostate localisé: l'IRM endorectale à 1,5 Tesla améliore-t-elle la sélection des patients en vue d'une surveillance active?

PURPOSE: To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol. PATIENTS AND METHODS: The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology. RESULTS: 85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score>6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS>1 as a predictor tool of significant tumor. ("T3MRI±NPS>1"=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI±NPS>1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score>6 rates (20%). CONCLUSION: Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR±NSP>1" may represent an exclusion citeria due to its ability to predict significant tumor.