Quality of life in adults with bladder exstrophy-epispadias complex.

PURPOSE: We evaluated quality of life in adults with bladder exstrophy-epispadias complex to improve patient and parent counseling. MATERIALS AND METHODS: We evaluated quality of life in a multicenter study using the SF-36® Medical Outcome Study questionnaire and a local questionnaire. A total of 47 patients born in 1957 to 1990 were followed due to bladder exstrophy-epispadias complex at the 4 participating hospitals. RESULTS: Nine women and 16 men were included in analysis, including 15 who underwent staged reconstruction for bladder exstrophy-epispadias complex and 10 who underwent primary or secondary urinary diversion. Nine patients were married and 2 were in a long-term partnership. A total of 22 patients achieved a high school degree with examination success and 17 worked full time. Six women and 12 men achieved penetrative intercourse. A total of 13 children were born to 3 women and 7 men. Quality of life scores in our patients were less than the norm based scores on 2 of the 8 health concepts, including limitations in physical activity due to health problems and general health perception. Results were statistically different among patients depending on dryness, voiding and urinary reconstruction/diversion. Patient scores did not differ in regard to gender, number of interventions, sexual life, cosmesis or renal function. CONCLUSIONS: Patient scores were less than norm based scores on only 2 health concepts and patients were generally well integrated into society. Urinary diversion was usually well tolerated. It remains a therapeutic option when incontinence interferes with social life or renal function is compromised.

Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract.

Primary cancers of the ureter and renal pelvis are rare tumours, > 90% of which are transitional cell carcinomas. Only approximately 5% of urothelial tumours arise in the upper urinary tract (UUT). Many environmental factors contribute to the development of these cancers. Some are similar to bladder cancer-associated factors (tobacco, occupational exposure), while others are more specific to carcinogenesis of the UUT (phenacetine, Balkan endemic nephropathy [BEN], Chinese herb nephropathy or association with Blackfoot disease [BFD]). This review discusses the environmental factors involved in UUT carcinoma. Tobacco and occupational exposure remain the principal exogenous risk factors for developing these tumours. Conversely, carcinogenesis of UUT tumours resulting from phenacetine consumption has almost disappeared. Although the incidence of BEN is also on the decline, roles for aristolochic acid and the consumption of Chinese herbs in the physiopathology and induction of this nephropathy, respectively, have proposed. In Taiwan, the association of this tumour type with BFD and arsenic exposure remains unclear to date. As some genetic polymorphisms are associated with an increased risk of cancer or faster disease progression, there is variability in interindividual susceptibility to the development of UUT carcinoma when exposed to the aforementioned risk factors Cytosolic sulfotransferases (SULTs) catalyse the detoxification of many environmental chemicals but also in the bioactivation of dietary and other mutagens. Polymorphism of the SULT gene, is thought to confer susceptibility to upper tract tumours.

Dynamic contrast-enhanced MRI of anterior prostate cancer: morphometric assessment and correlation with radical prostatectomy findings.

The purpose of the study was to relate morphometric features of prostate cancers in the anterior compartment of the prostate by dynamic contrast-enhanced (DCE) MRI to subsequent histopathologic findings. We prospectively performed DCE-MRI before biopsy in patients with suspected prostate cancer and selected those showing both a suspicious lesion at MRI and positive biopsies in the anterior compartment of the gland. Tumor contours, margins, largest surface areas and volumes were assessed at MRI and histopathology, when available. Anterior compartment tumors were classified according to transition zone (TZ) boundaries with the peripheral zone (PZ) or with the anterior fibromuscular stroma (SFMA). Forty-three patients were included in this study [median PSA 12.7 ng/ml (3.6-72)]. Whole-mount radical prostatectomy specimens were available in 27 cases. Of the anterior cancers, 89% had ill-defined margins at T2-weighted MRI. Cancer location and contour established at MRI agreed well with histopathology in the 27 cases. Median largest surface area and volume were 1.38 cm(2) (0.35-5.82) and 1.01 cc (0.15-7.4) for MRI versus 1.86 cm(2) (0.2-14) and 2.84 cc (0.33-28.92) for histopathology with respective correlation coefficients (r(2)) of 0.73 and 0.69. The site of origin could be accurately determined for the 15 tumors of less than 3 cc. We found a good relationship between DCE-MRI and histopathology for localization, morphologic description and volume assessment of anterior prostate cancers.

Prognostic value of combined p53 and survivin in pT1G3 urothelial carcinoma of the bladder.

pT1G3 bladder tumors have a high tendency to recur and progress. We evaluated the prognostic values of the depth of submucosal invasion and immunostaining with survivin and p53 in 30 pT1G3 urothelial carcinomas at the first endoscopic resection. The depth of invasion was evaluated toward the muscularis mucosa and measured using a micrometer. Survivin and p53 immunostaining were performed using an automated immunostainer. Of the patients, 19 (63%) had tumor recurrence, 11 (37%) had tumor progression, 10 (33%) had metastatic spread, and 10 (33%) died of the disease. Infiltration of deep lamina propria (pT1b) and a micrometric measure of 1.5 mm or more were associated with an increased risk of tumor local and/or metastatic progression (P = .03 and P = .02, respectively). A combined high expression of survivin (

Retroperitoneal infiltration as the first sign of Erdheim-Chester disease.

We report a case of an elderly man with bladder cancer, in whom the first manifestation of Erdheim-Chester disease was retroperitoneal infiltration detected during routine follow-up. The disease was diagnosed on the basis of histology and immunochemistry findings (presence of histiocytes) and of imaging findings (plain radiography, computed tomography, magnetic resonance imaging, and bone scintigraphy). The differential diagnosis with respect to other causes of retroperitoneal infiltration is discussed.

[Gastric or duodenal metastases from clear cell renal cell carcinoma. Report of two cases and review of the literature]. / Métastases gastriques et duodénales de cancer du rein à cellules conventionnelles.

INTRODUCTION: Gastric or duodenal metastases from clear cell renal cell carcinoma are exceptional. According to autopsy series, the incidence of gastrointestinal metastases is 0.06 to 4% for all cancers and 0.2 and 0.7% for renal cancers. OBJECTIVE: To define the diagnostic and therapeutic management of these rare sites in the light of 2 cases of gastric metastases from renal cancer seen in our institution and a review of the literature. RESULTS: These two patients with gastric or duodenal metastases from renal cancer can be added to the 15 cases found in the literature. These 17 cases consisted of 5 cases of duodenal metastases and 12 cases of gastric metastases and were described in 14 articles (2 articles comprised 2 and 3 cases, respectively). Metastases were the presenting sign of the cancer in 3 cases or occurred during follow-up after nephrectomy in 14 cases after a mean of 6.6 years (range: 2 years-14 years). The mean number of metastatic sites was 2.5 (range: 1-5). Presenting symptoms were mainly upper or lower gastrointestinal bleeding (14 out of 17 cases) or anaemia (2 cases). Gastroscopy established the diagnosis and allowed biopsies and control of acute bleeding. For patients with a solitary metastasis and in good general condition, gastrectomy was performed as complementary treatment. For patients with multiple or inoperable metastases, treatment consisted of either endoscopic resection, embolization of the metastasis, or immunotherapy. The benefit of surgery in terms of survival could not be demonstrated due to the short follow-up (mean: 8.6 months; range: 1 to 36 months). The median overall survival of this group has not been reached, but is greater than 6 months. CONCLUSION: Surgical resection of the metastasis is the preferred treatment in the case of a solitary metastasis and absence of contraindication related to the general state. In the other cases, endoscopic resection or embolization of the metastasis can be proposed, with or without systemic immunotherapy. None of these treatments has been shown to be superior in terms of survival in this indication. The place of targeted anti-tumour treatments such as anti-angiogenic drugs has not been evaluated

[The female urogenital system and high level sports]. / Appareil génital féminin et sport de haut niveau.

High-level competition sports can have a variety of negative effects on the female urogenital apparatus. Perineal trauma is rare and is usually associated with certain sports (impalement or hydrotubation during water-skiing, indurated perineal nodules in racing cyclists, and horse-riders' perineum). Effort incontinence is seen in all sports involving abrupt repeated increases in intra-abdominal pressure that may exceed perineal floor resistance. Sportswomen should be questioned about possible incontinence and be informed of preventive and therapeutic measures.

[Urethral duplication in an adult. A case report]. / A propos d'un cas de duplication urétrale chez un adulte.

Urethral duplication is a rare congenital anomaly, essentially diagnosed during adulthood. There are many anatomical variants and many, different classifications. This case report presents an uncommon form of incomplete sagittal urethral duplication with a blind intraprostatic proximal extremity. The authors discuss the value of pelvic and prostatic NMR in the work-up of this anomaly.

[Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management]. / Atteinte urétérale et vésicale de l'endométriose pelvienne profonde. Interet de la prise en charge chirurgicale multidisciplinaire.

OBJECTIVES: To evaluate the clinical features, staging by medical imaging, treatment strategy and results of surgical management of deep pelvic endometriosis with bladder and/or ureteric involvement. MATERIALS AND METHODS: Eighteen cases of ureteric and/or bladder deep pelvic endometriosis (DPE) were treated in our centre between 1996 and 2004. Preoperative data (clinical symptoms, MR imaging), intraoperative data (resection and urinary tract diversion procedures, associated procedures on the genital and gastrointestinal tracts), and postoperative data (histological results, complications, anatomical follow-up by imaging and functional assessment) were reviewed. RESULTS: Urinary symptoms were present in 55% of cases, genital symptoms were present in 83% of cases and gastrointestinal symptoms were present in 46% of cases. A combination of gynaecological and gastrointestinal lesions was demonstrated on imaging in 82% of cases. The mean postoperative follow-up was 16 months (range: 6-36 months). Six patients presented anterior vesical endometriosis. In these cases, the sensitivity and specificity of MRI were 100%. Six partial cystectomies were performed. All corresponded to endometriotic lesions on histological examination. No cases of recurrence of vesical endometriosis were observed. Posterior endometriosis with ureteric involvement was observed in 13 patients (including one with vesical endometriosis). The ureteric lesion was asymptomatic in 8 out of 13 cases (61%). The diagnostic sensitivity of MRI was 92% for posterior nodules, identifying 4 lateral parametrial nodules and 8 median retrocervical nodules. Ureterohydronephrosis was observed in 3 patients with lateral parametrial nodules and 8 patients with median retrocervical nodules, and was bilateral for 3 patients, i.e. 14 dilated renal units. Surgical management consisted of 2 ureteric resections with end-to-end anastomosis, 3 psoas bladder reimplantations, and 9 ureterolyses (8 patients). Two out of 13 patients (15%) with ureteric lesions treated by ureterolysis developed recurrence of the ureteric stricture with upper tract dilatation related to recurrence of the lateral nodule. In 14 patients, genital and/or gastrointestinal resections were associated with the urinary tract procedure. CONCLUSION: Preoperative evaluation of all DPE lesions is based on MRI with reconstruction images of the ureter in the presence of urinary tract lesions. Systematic ureteric stenting prior to surgical dissection of the pelvic wall is recommended in patients with posterior nodules and in the case of partial cystectomy for anterior nodules when the ureteric meati are adjacent to the lesion. Ureteric reimplantation onto a psoas hitch bladder must be performed when the DPE lesions are extensive and partly resected or invade the ureteric wall. The frequency of associated lesions (urinary, gynaecological gastrointestinal) justifies a multidisciplinary surgical approach.

[Infertility and testicular tumour based on a series of 25 patients]. / Infertilité et tumeur du testicule: a propos de 25 patients.

OBJECTIVES: To evaluate the frequency of testicular tumours in infertile men and to specify their clinical, ultrasound and histological characteristics. MATERIAL AND METHODS: Retrospective study of all partial or total orchidectomies performed between January 1995 and April 2004. During this period, 3,000 new patients consulted for assessment of infertility. The clinical, laboratory and ultrasound assessment was identical for each patient. RESULTS: Twenty-six testicular tumours were operated in 25 patients, i.e. 0.83% of the infertile men who consulted our department. Six tumours were clinically palpable (23%) and 20 (77%) were discovered on ultrasonography. The size of nodules ranged between 4 and 49 mm. Twenty-three radical orchidectomies and only 3 partial orchidectomies were performed, as 96% of testes presenting a nodule were hypotrophic. Histological examination demonstrated 15 Leydig cell tumours (58%), 8 seminomas (30%), mature teratoma,1 Sertoli cell tumour, and 1 burnt-out tumour. Nine (36%) patients had a history of cryptorchidism. Tumour markers were normal in 24 of the 25 patients (96%). All nodules were hypoechoic. All tumours were classified as pT1 N0 M0 and no recurrence has been observed to date. CONCLUSION: The incidence of testicular tumours in infertile men is much higher than in the general population. This incidence ranges between 0.35% and 0.83% according to various studies. A urological and andrological assessment should therefore be performed in all men presenting with infertility.

Microcystic transitional cell carcinoma: a report of 2 cases arising in the renal pelvis.

Microcystic transitional cell carcinoma is a rare variant of urothelial carcinoma; to date, it has been described only in the urinary bladder. We report 2 cases of microcystic transitional cell carcinoma arising in the renal pelvis. The first case occurred in a 73-year-old man with a history of superficially invasive transitional cell carcinoma who presented with macroscopic hematuria and anemia. The second case occurred in a 62-year-old woman who had no relevant medical history and presented with hematuria. Computed tomographic scan revealed a tumor of the renal pelvis. In both cases, microscopic examination showed invasive transitional cell carcinoma with prominent cystic features. The cysts were irregular in size and were deeply infiltrative. The cysts were lined by single or multiple layers of cuboidal or flattened cells with minimal cytological atypia. The first patient died of his disease 18 months after presentation. The second patient remained well at her 6-month follow-up examination. Microcystic transitional cell carcinoma is an unusual, deceptively bland variant of urothelial carcinoma, which can mimic benign lesions.

[Auto-reeducation of female stress urinary incontinence]. / Auto-rééducation de l'incontinence urinaire d'effort de la femme.

The Pelvia device is the fruit of the latest anatomic, functional and physiotherapeutic research into the pelvic floor. Thanks to its sophisticated technology, Pelvia is a user-friendly device fully suited to today's lifestyle of women, allowing them to do self-retraining exercises of the perineal muscles as an adjunct to the other therapies available. It is a reliable method to make patients aware of the strength and improvement of th perineal muscles contraction. It has nothing to do with "vaginal weight cones". This method is based on feedback, but the weight of the device itself does not only increase awareness but allows patients to increase their muscular strength. 30 women with stress urinary incontinence followed the protocol of self-retraining. All of them presented the following symptoms: urinary leakage, urethral urinary incontinence due to urethral hypermobility or sphincteral insufficiency, a perineum muscular testing below 4. After retraining the results were as follows: 17 cases of cure (57%); 9 cases (30%) were improved without full disappearance of incontinence; 4 cases failed (13%). The average follow-up period is 10 months (2-22). The results observed in 30 women seem promising. Of course this is only a small series and results need confirming by studying a larger series with a longer follow-up.

[Schwannoma of the penis: a rare and unusual tumor of the external genital organs]. / Schwannome du pénis: une tumeur rare et inhabituelle des organes génitaux externes.

The authors report an isolated case of schwannoma of the penis in a 34-year-old man. The diagnosis was based on precise histological and immunohistochemical criteria and treatment consisted of simple surgical excision followed by clinical follow-up.

[Cell therapy for urethral sphincter incompetence by muscle precursor cell autograft]. / Thérapie cellulaire de l'insuffisance sphinctérienne urétrale par autogreffe de cellules précurseur musculaire.

This article reviews cell therapy for muscle diseases and describes the development of a treatment for urethral sphincter insufficiency by muscle precursor cell (MPC) autograft. These studies were conducted in several successive steps, comprising: 1) comparative study of the cellular mechanisms of regeneration of skeletal striated muscle and urethral striated sphincter and development of a method of extraction of MPC; 2) creation of an animal model of sphincter injury reproducing chronic denervation lesions and fibrosis responsible for sphincter insufficiency in human; 3) study of the biology of intrasphincteric transplantation of MPC extracted from peripheral muscle, taking into account the interactions between these cells and the peripheral nervous system.

[Should scrotal ultrasound be discouraged in cases of suspected spermatic cord torsion?]. / Faut-il déconseiller l'échographie scrotale en cas de suspicion de torsion du cordon spermatique?

OBJECTIVE: To assess the value of scrotal ultrasound to guide the diagnosis of torsion of the spermatic cord. MATERIAL AND METHODS: Retrospective study from January 1995 to June 2001. One hundred and sixty eight patients were admitted to the emergency department with an empirical diagnosis of torsion of the spermatic cord. Scrotal ultrasound was performed when there was a doubt about the diagnosis or in the presence of atypical clinical features. All patients underwent surgical exploration of the scrotum. Two groups were distinguished: torsion and no torsion. We evaluated the contribution of ultrasound signs. RESULTS: Scrotal ultrasound was performed in 66 cases (39%) and suggested the diagnosis of torsion in 30 cases and showed no signs of torsion in 36 cases. Seven of these 36 cases actually presented torsions confirmed by surgical exploration (false-negative), corresponding to a sensitivity of 79% and a specificity of 88%. The interval between arrival of the patient in the emergency department and scrotal exploration was 2.6-fold longer when scrotal ultrasound was performed (p < 0.001). Surgical exploration identified 99 torsions (59%). Orchidectomy had to be performed in 15 cases (15% of torsions). However, the need for orchidectomy was not significantly different according to whether or not scrotal ultrasound was performed (p = 0.08). CONCLUSION: As scrotal ultrasound gave false-negative results in 10% of cases and delayed surgery, we do not recommend this examination as an emergency investigation. Systematic surgical exploration of the scrotum in all cases of painful testis must be performed urgently without preoperative morphological assessment.

[Long-term oncological results after conservative surgery for unifocal renal cancer]. / Résultats carcinologiques à long terme après chirurgie conservatrice pour cancer rénal unifocal.

OBJECTIVE: To evaluate the risk of local recurrence and metastatic spread of renal cancer treated by conservative surgery with a minimum follow-up of 5 years. MATERIAL AND METHODS: All patients operated for renal cancer by conservative surgery in our department between November 1989 and March 1997 were included in this retrospective study and were submitted to annual follow-up. These patients presented conventional indications (solitary T1N0M0 tumours < 4 cm) or indications of necessity (all stages). RESULTS: The minimum follow-up was 5 years (range: 63-143 months; median: 90 months). This series comprised 30 partial nephrectomies, 15 performed for solitary T1N0M0 tumours < 4 cm, and conservative surgery was performed by necessity in 15 patients (10 patients with T1N0M0 tumours, 5 patients with T2 or M+ tumours). All tumours less than 4 cm on imaging were less than 4 cm on the operative specimen. In stage T1N0M0 tumours, the prediction of pathological stage by preoperative imaging was accurate in 24 out of 25 cases, with 24 pT1N0M0 and 1 pT3aN0M0 on final histology. The resection margins were negative in 29 out of 30 patients. One patients with a stage T2N0M+ tumour (7.5 cm in diameter) had a positive resection margin. Two out of 30 patients developed impaired renal function after surgery to a solitary kidney. Renal function at 3 months remained identical to preoperative renal function in all other patients. For 24 patients with pT1N0M0 tumours < 4 cm, the specific recurrence-free survival was 100% (median follow-up: 90 months; range: 63 to 143 months). Among the 6 patients with T2 or M+ tumours, 5 patients (84%) died from metastatic disease at 18, 22, 24, 28 and 54 months, while 1 patient (16%) was still alive without recurrence at 119 months. CONCLUSION: The indication for conservative surgery for T1N0M0 renal tumours < 4 cm is a validated treatment option for unifocal renal cancer. This series confirms the data reported in the literature with a minimum follow-up of 5 years. Stage pT3a tumours on postoperative diagnosis have a high risk of recurrence and metastatic spread, which may constitute an indication for secondary radical nephrectomy. Annual surveillance by imaging is essential.

[Bladder tumor in young patients: a series of 26 cases. Comparison with a review of the literature]. / Tumeurs de vessie du sujet jeune: à propos de 26 cas. Comparaison aux données de la littérature.

OBJECTIVE: Urothelial bladder tumours are rare before the age of 40 and represent only 1% to 4% of all bladder tumours. This study reviews the histological features of these tumours and tries to more clearly define their natural history. MATERIAL AND METHOD: From 1980 to 2000, we observed 2,600 cases of primary bladder tumours; 34 subjects were younger than 40. We studied the course of 26 subjects with a urothelial tumour. Their mean age was 30 years (range: 16 to 40 years) and 8 patients were younger than 30. RESULTS: 22 of the 26 patients presented a superficial tumour, including 21 cases of stage Ta tumour. The majority of tumours were well differentiated. Two patients had a multifocal tumour and 4 patients had a tumour larger than 3 cm in diameter. The overall recurrence rate was 55% with progression of the tumour stage in 9% of cases. A better prognosis was observed before the age of 30, with a recurrence rate of 38% versus 62% in patients between the age of 30 and 40. Four patients had an invasive tumour, which was metastatic at the time of diagnosis in 3 cases. CONCLUSION: The natural history of superficial bladder tumours appears to differ according to age. Before the age of 30 years, tumours are frequently stage Ta, well differentiated, with a low recurrence rate. Between the ages of 30 and 40 years, the course of superficial bladder tumours is similar to that observed in older subjects. However, the prognosis of invasive tumours is usually very poor, indicating a particularly aggressive potential.

[Cystic prostate cancer: a clinical entity of ductal carcinoma]. / Cancer de prostate de forme kystique: une entité clinique de carcinome ductal.

Cystic prostate cancer is a rare entity. Ductal adenocarcinoma, formerly known as endometrioid adenocarcinoma, is a clinical and histological variant of prostatic carcinoma. The authors report two cases of cystic prostate cancer, in which histological examination demonstrated the predominance of a ductal carcinoma contingent. A review of the literature revealed 8 cases of cystic prostate cancer, including 3 cases that also presented a ductal contingent. The cystic appearance of the peripheral prostatic zone appears to be a distinct clinical and morphological entity of ductal carcinomas. This entity has never been previously reported.

[Primary neuroectodermal tumour of the kidney invading the wall of the inferior vena cava. Surgical strategy]. / Tumeur neuro-ectodermique primitive du rein envahissant la paroi de la veine cave inférieure: stratégie chirurgicale.

Primary neuroectodermal tumours (PNET) are very aggressive malignant tumours, rapidly progressing to metastasis and death. They rarely involve the kidney, as only 23 cases have been described in the literature. Renal tumours, regardless of their histology, spread to the inferior vena cava (IVC) in 4% to 10% of cases. Invasion of the inferior vena cava wall by tumour thrombus is rare and, when it occurs, is often limited to the ostium of the renal vein. The authors report a case of primary neuroectodermal tumour of the kidney with thrombus in the inferior vena cava ascending to the right atrium (level IV), invading the wall of the IVC and associated with a non-infiltrating papillary urothelial tumour of the ureter. They describe the surgical management of this tumour and present a review of the literature.