Metastatic Renal Cell Carcinoma in a Renal Allograft: A Sustained Complete Remission After Stimulated Rejection.

We report the case of a 40-year-old woman who recovered from a diffuse metastatic renal cell carcinoma that developed from a kidney allograft. She was successfully treated by the induction of tumor rejection. Immunosuppression was discontinued, and transplant nephrectomy was deliberately delayed based on the expectation that the tumor mass would trigger the alloimmune response, which was stimulated with pegylated interferon-α-2a. Three years later, the patient remained in complete remission. Despite this severe context, the present case shows that the poor prognosis of allograft metastatic renal cell carcinoma could be dramatically reversed by taking advantage of the donor tumor origin to actively induce a specific alloimmune rejection of the tumor.

[Management of male urinary incontinence after radical prostatectomy (CTMH AFU 2006 - 4/5): place of intraurethral macroplastique injection, artificial urinary sphincter and cell therapy]. / Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006 - 4/5): place de l'injection intra-urétrale de macroplastique, du sphincter urinaire artificiel et des thérapies cellulaires.

The management of moderate urinary incontinence after radical prostatectomy may require the use of an artificial sphincter, which remains the reference technique although it requires implantation of material, sometimes involving redo operations. Submucosal macroplastique injections have been proposed, but the results do not appear to be maintained over time. Cell therapy, consisting of the injection of stem cells into or close to the sphincter, probably represents the approach of the future, but in 2006, studies were still only at the evaluation phase.

[Management of male urinary incontinence after radical prostatectomy (CTMH AFU 2006 - 5/5). Prevention of incontinence and CTMH guidelines]. / Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006 - 5/5) Prévention de l'incontinence et recommandations du CTMH.

Preservation of continence essentially depends on the operator and the quality of the operative procedure. The number of publications on this subject reflects the desire of urologists to provide their patients not only with control of the cancer but also preservation of their sexual and urinary functions. Ideally, surgery should preserve the striated sphincter and levator muscles, the neurovascular pedicles when oncologically acceptable, and the bladder neck and a leak-proof anastomosis must be ensured. The surgeon must satisfy two imperatives to achieve these objectives: a good knowledge of anatomy and meticulous preservation of this anatomy from the beginning to the end of the operation by highly selective dissection in selected patients. Finally, the Comité des Troubles Mictionnels de l'Homme (Male Voiding Disorders Committee) proposes guidelines for the diagnosis and treatment of urinary incontinence after radical prostatectomy.

[Management of male urinary incontinence after radical prostatectomy (CTMH AFU 2006-1/5): incidence and role of urodynamic assessment and electromyography]. / Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006-1/5): incidence et rôle du bilan urodynamique et de l'électromyogramme.

The incidence of postprostatectomy urinary incontinence varies according to the technique used, over time and according to the type of management, with an incidence at one year ranging from just a few percent to more than 60%. Assessment is required in the case of persistent disabling urinary incontinence despite well conducted perineal rehabilitation one year after surgery or earlier in the case of severe incontinence. Urodynamic assessment is the essential examination to quantify urethral closure pressure. A review of the literature of urodynamic assessment and electromyography is presented.

[Management of male urinary incontinence after radical prostatectomy (CTMH AFU 2006-2/5): place of perineal rehabilitation and medical treatment]. / Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006-2/5): place de la rééducation périnéale et du traitement médical.

The treatment of incontinence is changing, but perineal rehabilitation still plays an essential role and is usually able to rapidly and effectively improve urinary incontinence. Medical treatment modalities are fairly limited: anticholinergic drugs have a limited efficacy except in the case of unstable bladder demonstrated by urodynamic assessment and, despite encouraging preliminary results, duloxetine has not obtained scientific recognition or marketing authorization.

[Management of male urinary incontinence after radical prostatectomy (CTMH AFU 2006-3/5): place of periurethral balloon and suburethral tape]. / Prise en charge d'une incontinence urinaire masculine après prostatectomie radicale (CTMH AFU 2006-3/5): place des ballons périurétraux et des bandelettes sous uréthrales.

The treatment of incontinence is changing. Perineal rehabilitation still plays an essential role, but new modalities are now available with promising results, particularly periurethral balloon and suburethral tape, which may be indicated after failure of well-conducted perineal rehabilitation and before artificial sphincter. Periurethral balloons consist of two silicone balloons filled with a mixture of saline and radiopaque agent inserted transperineally on either side of the urethra as close as possible to the bladder neck. Titanium ports connected to each balloon allow adjustment of the volume contained in the balloon at any time after surgery. This technique appears to be promising but further studies are required to clearly define many unresolved issues, including results based on longer follow-up and patient selection according to the severity of incontinence or their treatment history (radiotherapy). Suburethral tape is used to exert permanent static compression of the urethra and was still under development in 2006. Fairly heterogeneous materials are used and no consensus on this issue has yet been reached. Follow-up is still relatively short and few studies have addressed the problem of patient selection. Some authors consider that the best indication is mild-to-moderate incontinence, which has not yet been clearly defined.

[Laparoscopic surgery in urology: current status and trends in 1993]. / Chirurgie laparoscopique en urologie: actualité et perspectives en 1993.

Laparoscopic surgery in Urology is in a testing and development phase. The technique is currently used by some urologists to evaluate nonpalpable testes and to perform varicocelectomy or pelvic lymphadenectomy. Other standard open surgical procedures are experimentally being performed with the laparoscope. Owing to technologic advances laparoscopic surgery might become a part of routine urological care. We review the current impact of laparoscopy on Urology, we emphasize the advantages but also the risks of this new approach, and we discuss the benefit of these surgical procedures..