[Surgical and pathological consequences of preoperative immunotherapy in onco-urology]. / Conséquences chirurgicales et anatomopathologiques de l'immunothérapie préopératoire en onco-urologie.

INTRODUCTION: Patients treated with immunotherapy might need surgical procedures in addition to the medical treatment. The main indications are cytoreductive nephrectomy, cystectomy (as part of clinical trials) and metastasis removal in some oligometastatic patients. This study aims to assess the feasibility of surgery for patients treated by immunotherapy and describes the histological modifications found in the pathological analysis. MATERIAL AND METHODS: We conducted a retrospective, monocentric study. We included all patients operated for a urologic cancer and previously treated with systemic immunotherapy between February 2018 and June 2022. We compared this population with a control group of patients treated with surgery without having previous immunotherapy. Patients were compared according to the cancer type, age and sex. We compared perioperative complications. We performed an analysis for evaluation of the peri-tumoral inflammatory infiltration. RESULTS: We included 50 patients in this study. The two groups were comparable in age (63.7 vs. 63.3years old, P=0.95) and sex (4 and 6 women in the first and second group). The peroperatory complication rate was comparable (20% vs. 16%, P=1). The mean bleeding volume was comparable (664 vs. 629mL; P=0.89). The postoperative complication rate (48% vs. 56%; P=0.78) and their grade (Clavien III-IV 8% vs. 24%; P=0.24) were comparable. The anatomopathological analysis described the same rate and intensity of peri-tumoral inflammatory infiltrate (96% vs. 96%; P=1). CONCLUSIONS: Preoperative immunotherapy does not appear to be associated with increased surgical difficulty and perioperative complications. Blind histological analysis of the surgical specimens did not reveal any specific features related to pre operative immunotherapy. LEVEL OF EVIDENCE: Grade 3 HAS.

Testicular Radiotherapy: A Challenging Irradiation Site.

Testicular radiation therapy is a crucial component of the overall treatment of certain neoplasms. Yet, it remains challenging due to the unique anatomic location of the testicles, their specific radiation tolerance, and the lack of a standardized treatment workflow. In this article, we present the case of a 78-year-old patient with primary testicular lymphoma and describe the technical aspects of his radiation therapy. The challenge was to achieve a comfortable, reproducible, and effective treatment position while protecting the penis and covering the superficial layers of the scrotum. We used a total body restraint system and performed a second simulated CT scan with a bolus. The entire scrotum was delineated as the clinical target volume, with an additional 1 cm margin to obtain the planning target volume. This case highlights the importance of careful planning and personalized treatment approaches in testicular irradiation and underscores the need for further research and standardization in this complex irradiation site.

Intervene to Improve: Awareness of Testicular Self-Examination and Testicular Cancer Among Male Patients at a Tertiary Care Hospital in Lahore, Pakistan.

Background and objective Testicular cancer is the commonest of all types of cancer males are affected with. Testicular cancer, when diagnosed early, has one of the best prognoses. However, in Pakistan, early detection is hindered by religious and sociocultural norms, lack of education, and awareness deficit. Testicular self-examination (TSE) can significantly facilitate early detection of the condition and decrease associated mortality rate. This study aimed to acquire the frame of mind regarding testicular cancer (TC) and testicular self-examination (TSE) among the male outdoor patients of Lahore General Hospital, Lahore. Materials and methods After ethical considerations, elaborated literature review and consequent pilot study were done to develop a bilingual questionnaire. Following patient consent, answers to a set of questions were noted down by the authors. A 90-second bilingual, motivational video was displayed and an educational pamphlet on the same topic was also handed over. Afterward, another survey was conducted to grasp the comprehension, satisfaction, and willingness to spread the message. Results About 92% of the subjects had not heard of or performed TSE and 58.3% mentioned lack of education as the reason for not knowing the method. Eighty-two percent patients had never heard of TC. Post-education, 100% patients claimed that their knowledge of the subject improved and 97% were ready to teach other male relatives. Conclusion The results indicate that the population's lack of awareness regarding testicular self-examination and testicular cancer is alarming. Most subjects did not know the age group, risk factors, presentation, and early prevention of testicular cancer.

Hereditary Leiomyomatosis and Renal Cell Carcinoma: A Case Report and Review of the Literature.

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare genetic disorder, and individuals tend to develop multiple cutaneous leiomyomas, uterine leiomyomas, and renal cell cancer (RCC). In our study, we report the first case in Saudi Arabia, to our knowledge - a 28-year-old male with a history of right leg leiomyosarcoma post excision two years back who was referred to us with incidental finding of right kidney mass measuring 1.8x2x2.2 cm who underwent right laparoscopic radical nephrectomy, and histopathology reported it as HLRCC and RCC.

Medico-economic impact of onco-urological robot-assisted minimally invasive surgery in a high-volume centre.

BACKGROUND: We lack data regarding the economic cost of robot-assisted surgical procedures in urology. We aimed to assess the medico-economic impact of onco-urological robot-assisted surgery. METHODS: All patients who underwent robot-assisted radical prostatectomy (RARP) or robot-assisted partial nephrectomy (RAPN) in 2019 were included. Cost assessment included the costs of surgery, hospital stay, and complications. Global cost was calculated and compared with open and laparoscopic procedures. RESULTS: Overall, 126 (48%) RAPN and 135 (52%) RARP were included. Total cost per patient was 6857€ for RARP and 6034€ for RAPN. Costs of surgery, hospital stay, and complications represented 76.2%, 21.5%, and 2.3%, respectively, of the total cost per patient for RAPN, and 74.1%, 25.9%, and 0% for RARP. Compared to the open approach, RAPN was 6% cheaper and RARP was 10% more expensive per patient. Standard laparoscopic procedures were cheaper. CONCLUSIONS: Robotic procedures were associated with increased costs of surgical procedures, but with reduction in morbidity and hospital stay costs.

[CCAFU Recommendations 2013: Diagnosis, treatment, follow up of urological cancers]. / Recommandations de bonnes pratiques cliniques 2013 du CCAFU: Diagnostic, traitement et suivi des cancers urologiques chez l'homme et la femme.

INTRODUCTION: The objective of the 2013 recommendations performed by the different committees of CCAFU is to improve the management of urological cancers regarding diagnosis, clinical assessment and treatments in men and women. MATERIAL AND METHODS: 2010 clinical guidelines were updated based on international AUA and EAU guidelines and on systematic literature search performed by each sub-Committee in Medline and PubMed databases to evaluate references, levels of evidence and grade of recommendation. RESULTS: CCAFU clinical guidelines reply to the main clinical questions on management of urological cancers. CONCLUSION: French clinical guidelines are updated every three years by CCAFU in accordance with the main international guidelines in onco-urology.