[Prostatic sarcoma: Report of two cases]. / Les tumeurs sarcomateuses de prostate: à propos de deux cas.

Prostatic sarcomas are very rare tumours with a very poor prognosis. They may coexist with prostatic adenocarcinoma, in which case they are only diagnosed on histological examination of the operative specimen with identification of sarcoma on immunohistochemical analysis. Due to their rapidly invasive potential, they must be detect early in the course, particularly in young subjects. Certain clinical signs, such as obstructive urinary symptoms in a young man or rectal symptoms in an elderly man are suggestive of sarcoma. In this article, the authors report two cases of prostatic sarcoma surgically treated and present a review of the literature on this disease.

[Laparoscopic partial nephrectomy: A series of 17 cases]. / Néphrectomies partielles laparoscopiques à propos de 17 cas.

OBJECTIVE: The objective of this study was to evaluate the Feasibility, the morbidity and the carcinologic results of laparoscopic partial nephrectomy. MATERIAL AND METHODS: Between August 2001 and December 2005, 17 partial nephrectomies were performed by laparoscopy in patients with a mean age of 59.2 years. Postoperative complications, the conversion rate, operating time, arterial clamping time, length of hospital stay and oncological results were studied for each patient. RESULTS: The mean operating time was 190 min, the mean arterial clamping time was 30 min and the mean hospital stay was 6.3 days. There were 2 complications including one postoperative haematoma requiring surgical revision for drainage and repositioning of a stent for urine leak. Two conversions had to be performed early in our experience. A tumour recurrence 2 years after the initial operation was treated by total nephrectomy. CONCLUSION: Our results in terms of morbidity are similar to those reported for open surgery, but the recurrence rate appears to be slightly higher than that observed with open partial nephrectomy. Laparoscopic partial nephrectomy remains a difficult operation requiring a learning curve even for a department that regularly performs laparoscopic surgery.

Treatment of cutaneous calcinosis in CREST syndrome by extracorporeal shock wave lithotripsy.

We describe the unusual case of a 78-year-old woman consulting for extensive and painful wound leg ulcerations and calcifications secondary to CREST syndrome that was treated by extracorporeal shock wave lithotripsy. This treatment was considered because of the severity of our patient's symptoms and her failure to respond to various medical and surgical treatment.

[Post-traumatic renal arteriovenous fistula discovered after 28 years]. / Fistule artério-veineuse rénale post-traumatique découverte après 28 ans.

There is only one published case of arteriovenous fistula discovered 20 years after firearm trauma. The authors report the case of a 47-year-old man injured by firearm 28 years ago presenting with a highflow aneurysm of the right renal artery secondary to arteriovenous fistula and associated with lower pole renal tumour and describe the radiological work-up and surgical management.

Genotype-phenotype correlation in von Hippel-Lindau families with renal lesions.

von Hippel-Lindau (VHL) disease arises from mutations in the VHL gene and predisposes patients to develop a variety of tumors in different organs. In the kidney, single or multiple cysts and renal cell carcinomas (RCC) may occur. Both inter- and intrafamilial heterogeneity in clinical expression are well recognized. To identify VHL-dependent genetic factors, we investigated the renal phenotype in 274 individuals from 126 unrelated VHL families in whom 92 different VHL mutations were characterized. The incidence of renal involvement was increased in families with mutations leading to truncated protein (MLTP) or large rearrangement, as compared to families with missense changes (81 vs. 63%, respectively; P=0.03). In the latter group, we identified two mutation cluster regions (MCRs) associated with a high risk of harboring renal lesions: MCR-1 (codons 74-90) and MCR-2 (codons 130-136). In addition, the incidence of RCC was higher in families with MLTP than in families with missense changes (75 vs. 57%; P=0.04). Furthermore, mutations within MCR-1 but not MCR-2 conferred genetic susceptibility to develop RCC. Overall, our data argued for a substantial contribution of the genetic change in the VHL gene to susceptibility to renal phenotype in VHL patients.

[Effect of bicalutamide 150 mg, after 3 years of median follow-up, in non-metastatic prostatic cancer]. / Effet du bicalutamide 150 mg, à trois ans de suivi médian, dans le cancer de la prostate non métastatique.

OBJECTIVE: To determine the efficacy and safety of bicalutamide, at the dose of 150 mg per day, as first-line monotherapy or as curative adjuvant therapy in patients with non-metastatic prostate cancer, and to investigate the possibility of a greater benefit for certain patient subgroups. MATERIAL AND METHODS: This article recalls the preliminary results of an international endocrine therapy programme comprising three double-blind placebo-controlled clinical trials in patients with non-metastatic prostate cancer (T1-T4. Nx/N0/N1, M0). Patients were randomized to receive either 150 mg/day of bicalutamide, or placebo, as an adjuvant to radical prostatectomy, external beam radiotherapy or in the context of watchful waiting. The main endpoints were the time to objective clinical progression and overall survival. The combined data of the three trials were submitted to intent-to-treat analysis. The authors also report the results of exploratory studies performed as a function of the type of treatment and prognostic factors. RESULTS: After a median follow-up of 3 years of a sample size of 8,113 patients, objective clinical progression was observed in 9% of patients of the bicalutamide group (4,052 patients) and in 13.8% of patients of the placebo group (4,061 patients), corresponding to a 42% relative risk reduction (RR: 0.58; p << 0.0001). Reduction of the risk of disease progression was observed for the entire study population regardless of primary treatment, stage of disease or usual prognostic factors. This reduction was more marked for patients presenting poor prognostic factors. Data concerning overall survival are not available due to insufficient follow-up. Treatment was well tolerated. The adverse effects most frequently reported in the bicalutamide group were gynaecomastia and breast pain. CONCLUSION: After a median follow-up of three years, bicalutamide, as first-line monotherapy or as curative adjuvant therapy, significantly reduced the risk of objective clinical disease progression in patients with non-metastatic prostate cancer. Exploratory analyses demonstrate that the benefit of bicalutamide appeared to be greater for patient with poor prognostic factors. Survival data are not yet available.

[Epidemiology of prostate cancer in the Limousin area]. / Epidémiologie des cancers de la prostate en Limousin.

OBJECTIVE: Prostate cancer is the commonest cancer in men in France, and its incidence increases with age. It occupies 4th place in terms of mortality. The Limousin region, with the oldest population in France, established a regional registry of new cases of cancers in 1998. The objective of this study was to analyse the prostate cancer incidence and mortality data in the Limousin region for 1998. MATERIAL AND METHODS: Based on the cancer registry data and martality data of the department of information on medical causes of death, a registry was established for all new of prostate cancer and all cases of prostate cancer death in patients living in the Limousin region in 1998. Standardized incidence and mortality rates were compared with French data. RESULTS: The crude incidence rate detected in the Limousin region was 149.5 per 100,000 inhabitants and the standardized rate compared to the French population was 124. These rates were significantly higher than those reported in France. The mortality rate from prostate cancer in the Limousin region was 29.2 deaths per 100,000 inhabitants and was higher than that reported for France as a whole. CONCLUSION: In view of the data for 1998, prostate cancer is a major public health problem in the Limousin region. This excess incidence could be related to the methodology used, the increased awareness of general practitioners of the problems of prostate cancer, who do not hesitate to request individual screening by prostatic-specific antigen (PSA) or the presence of specific risk factors in the Limousin region. Further studies must be conducted in the Limousin region.

[Role of uropontin in calcium oxalate lithogenesis]. / Rôle de l'uropontine dans la lithogénèse des calculs oxalocalciques.

The formation of calcium oxalate stones involves four phases: nucleation, growth, aggregation and retention. Stone formation is a complex, multifactorial phenomenon involving, among other factors, proteins, some of which play an inhibitory role, while others play a promoting role. The authors studied the role of uropontin. Uropontin is the urinary form of osteopontin. Osteopontin is essentially involved in the mineralisation of bone tissue. Uropontin is secreted in the kidney by epithelial cells of the distal convoluted tubule and loop of Henle. Uropontin has an inhibitory action on the four phases of calcium oxalate crystal formation and is also one of the main constituents of the calcium oxalate stone matrix. A reduction of uropontin expression in epithelial cells induces a reduction of calcium oxalate stone formation. Uropontin is a protein largely involved in the lithogenesis of urinary stones, but its mechanism of action has not yet been fully elucidated.

[Pseudoneoplastic form of Chlamydia trachomatis epididymo-orchitis: a case report]. / Forme pseudo-tumorale de l'orchi-épididymite à chlamydiae trachomatis.

Pseudoneoplastic Chlamydia trachomatis epididymo-orchitis is a rare clinical entity. The differential diagnosis with malignant tumour of the testis remains difficult and surgical exploration with orchidectomy is often difficult to avoid. Urgent testing for Chlamydia trachomatis by PCR in urine, semen and a urethral swab confirms the diagnosis and allows introduction of antibiotic therapy rather than surgical exploration.

[Cystocele]. / Cystocèle.

A cystocele is a bladder hernia through the anterior wall of the vagina. It is common in elderly women. There is no clinico-anatomical correlation, but the functional disturbance, although both variable and variably experienced, remains a major factor in the indication of eventual surgery. Methodologic clinical examination should be made to seek anomalies of pelvic stasis associated with a more or less hidden urinary incontinence. The surgical technique should be chosen according to the age and the classification of the patient, determined by complementary examinations that range from simple to highly technical (echography, cystography and sometimes study of urinary dynamics and MRI). The surgeon should chose the technique of perineal support and clearly explain the possibility of failure or recurrence. Confidence between the patient and the surgeon remains the best guarantee of a good result of management. Such surgery can be proposed to women to request it for physical comfort, whereas the surgeon should be very cautious with regard to those who do not want to undergo surgery (but also with those who strongly insist on surgery).

[Urinary continence following radical prostatectomy: comparison of open, laparoscopic, and robotic approaches]. / Continence urinaire après prostatectomie radicale: comparaison des voies rétropubienne, laparoscopique et robot-assistée.

AIM: To compare urinary continence following radical prostatectomy (RP) between open (Op), laparoscopic (Lap), and robotic (Ro) approaches. METHOD: Urinary continence of the first 59 patients operated by Ro RP between May 2008 and August 2009 was evaluated by self-questionnaires. Results were compared to those obtained in 2006 using the same questionnaire from patients operated by Lap RP or Op RP in the same institution. Patients treated by radiotherapy were excluded from the analysis. RESULTS: Fifty-one of the 59 operated by RP Ro answered the questionnaire. Op and Lap groups included 82 and 100 patients respectively. No significant difference was observed between the three groups in terms of age, body mass index, preoperative PSA, prostate gland weight, and TNM stage on pathology. Overall incontinence rate was 8%, 32%, and 21% for Ro, Lap, and Op RP, respectively. Median duration to recover continence after surgery was three weeks in the Ro group, versus eight weeks in the two other groups. CONCLUSION: In our experience, patients operated by a Ro approach had a lower risk of incontinence and a shorter duration to recover continence compared to those operated by Op and Lap RP. Our previous experience of laparoscopy might explain these findings. Evaluation of overall functional and oncological results is necessary before concluding to a possible superiority of Ro RP.