[Urethroplasties for male urethral strictures: Success rates and predictive factors]. / Urétroplasties pour sténoses de l'urètre masculin : taux de succès et facteurs prédictifs.

INTRODUCTION: Urethroplasty has reported success rates ranging from 60 to 98%. Predictive factors for recurrence are rarely studied, postoperative urinary drainage modalities are not investigated. The primary objective was to evaluate the success rate of urethroplasty in our center. Secondary objectives were to identify recurrence predictive factors. METHODS: A single-center retrospective cohort including men treated with urethroplasty for stricture between 2007-2017, followed up for a minimum of 12 months. Recurrence was defined as the necessity of a new procedure (endo-urethral or surgical). Data from penile urethra (SUP) and bulbo-membranous urethra (SUBM) stenosis were analyzed separately. Recurrence-free survival (success) was analyzed according to the Kaplan-Meier model. The characteristics of the patients, the stenosis, the surgical technique, the modalities of postoperative urinary drainage were analyzed in subgroups for the bulbo-membranous urethra looking for a correlation with recurrence. RESULTS: A total of 103 patients included: 25 with SUP, 78 with SUBM. The overall success rate was 69%, CI95% [60-79] with a mean follow-up of 62.85 months. The success was 68%, CI95%[46-82] for SUP, 69.23%, CI95% [58-78] for SUBM. Recurrences occurred during the first 12 months. Only postoperative suprapubic urinary drainage was a predictive factor (HR=0.947, CI95% [0.905-0.992]). A period longer than 14 days reduced recurrence by 37%. CONCLUSION: Urethroplasty had a success rate of 69%, comparable to published series. Suprapubic urinary drainage improved the surgery outcomes. LEVEL OF PROOF: 2, Grade B.

[Erdheim-Chester disease : a case report]. / Cas clinique. Maladie d'Erdheim-Chester.

We report the case of a 47-year-old woman with unexplained inflammatory syndrome and asthenia. Imaging findings show bilateral abnormalities of femurs and tibias, suggesting an Erdheim-Chester disease, which is confirmed by a bone marrow biopsy of the left femur. The BRAF V600E mutation is detected, allowing the administration of targeted therapies such as BRAF and MEK inhibitors that lead to the improvement of symptoms.

Nous rapportons le cas d'une patiente de 47 ans explorée pour un syndrome inflammatoire inexpliqué et une asthénie chronique. Les examens en imagerie démontrent la présence d'importants remaniements osseux au niveau du périoste des deux fémurs et tibias, évoquant une maladie d'Erdheim-Chester. Celle-ci est confirmée par l'analyse d'une biopsie ostéomédullaire réalisée au niveau du fémur gauche. La détection de la mutation V600E du gène BRAF permet à la patiente de bénéficier d'un traitement ciblé anti-BRAF et anti-MEK, améliorant sa symptomatologie.

[Evolution of the number of incident cases, stage and first treatments for prostate cancer in France between 2001 and 2016]. / Évolution du nombre de cas incidents, du stade et des premiers traitements des cancers de la prostate en France entre 2001 et 2016. À partir de données hospitalières de 3 centres.

INTRODUCTION: No studies of French hospital registries for prostate cancer (PCa) have been published since the 2012 USPSTF recommendations. MATERIAL: This is a multicenter cohort study based on hospital data of prostate biopsies (PB) in 3 health centers between 2001 and 2016. The main objective is to describe the evolution of incident cases of PCa. The secondary objectives are to describe the number of cases per stage of PCa and the distribution of the first treatments. RESULTS: In total, 11,491 PB series diagnosed 5927 cases of PCa. The median age was 67 [61-73] years and the median PSA was 7.8 [5.5-13] ng/mL. The number of cases increased until 2006 before decreasing from 2006 to 2013 and then stabilizing from 2013 to 2016. The proportion of incident cases was: (1) for the stable metastatic stage around 8 [7-10]%, (2) for cases with PSA<10 ng/mL increasing from 46% to 75% in 2010 down to 64% in 2016, (3) for the grade 1 group decreasing from 59% to 33 % between 2011 and 2016. The proportion of active surveillance treatment for low-risk cancers increased from 5 to 60% and surgery decreased from 73 to 33%. CONCLUSION: The evolution of the incident cases showed a decrease from 2006 to 2013 and a stability until 2016. The number of cases with PSA<10 ng/mL decreased since 2010 and the proportion of the options of treatment by surveillance increased strongly to the detriment of the surgery for low risks. LEVEL OF EVIDENCE: 3.

Radical prostatectomy for locally advanced and high-risk prostate cancer: A systematic review of the literature.

CONTEXT: The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing. PURPOSE: To review the existing literature and determine the value of RP in high-risk and locally advanced PCa. DOCUMENTARY SOURCE: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines. SELECTION OF STUDIES: Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa. RESULTS: Mortality was approximately 0-1% and Clavien≥3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%. LIMITS: Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments. CONCLUSIONS: The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.