Surgical Outcomes of Urinary Tract Deep Infiltrating Endometriosis.

OBJECTIVE: To report the outcomes of surgical management of urinary tract endometriosis. DESIGN: Retrospective study based on prospectively recorded data (NCT02294825) (Canadian Task Force classification II-3). SETTING: University tertiary referral center. PATIENTS: Eighty-one women treated for urinary tract endometriosis between July 2009 and December 2015 were included, including 39 with bladder endometriosis, 31 with ureteral endometriosis, and 11 with both ureteral and bladder endometriosis. Owing to bilateral ureteral localization in 8 women, 50 different ureteral procedures were recorded. INTERVENTION: Procedures performed included resection of bladder endometriosis nodules, advanced ureterolysis, ureteral resection followed by end-to-end anastomosis, and ureteroneocystostomy. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was the outcome of the surgical management of urinary tract endometriosis. Fifty women presented with deep infiltrating endometriosis (DIE) of the bladder and underwent either full-thickness excision of the nodule (70%) or excision of the bladder wall without opening of the bladder (30%). Ureteral lesions were treated by ureterolysis in 78% of the patients and by primary segmental resection in 22%. No patient required nephrectomy. Histological analysis revealed intrinsic ureteral endometriosis in 54.5% of cases. Clavien-Dindo grade III complications were present in 16% of the patients who underwent surgery for ureteral nodules and in 8% of those who underwent surgery for bladder endometriosis. Overall delayed postoperative outcomes were favorable regarding urinary symptoms and fertility. Patients were followed up for a minimum of 12 months and a maximum of 7 years postoperatively, with no recorded recurrences. CONCLUSION: Surgical outcomes of urinary tract endometriosis are generally satisfactory; however, the risk of postoperative complications should be taken into consideration. Therefore, all such procedures should be managed by an experienced multidisciplinary team.

Outcomes of surgical management of deep infiltrating endometriosis of the ureter and urinary bladder.

OBJECTIVES: To report the outcomes of surgical management of urinary tract endometriosis and discuss the choice between conservative and radical surgery. MATERIALS AND METHODS: We reviewed data concerning women managed for ureteral or bladder deep infiltrating endometriosis in 5 surgical departments participating in the CIRENDO prospective database. Preoperative data, surgical procedure data, and postoperative outcomes were analyzed. RESULTS: Data from 30 women pooled in the database showed 15 women presenting with ureteral endometriosis, 14 women with bladder nodules, and 1 with both types of lesions. Ureterolysis was performed in 14 cases; the ureter was satisfactorily freed in 10 of these. In 4 women over 40 years old, who were undergoing definitive amenorrhea, moderate postoperative ureteral stenosis was tolerated and later improved in 3 cases, while the fourth underwent secondary ureteral resection and ureterocystoneostomy. Primary ureterectomy was carried out in 4 women. Two cases of intrinsic ureteral endometriosis were found in 5 ureter specimens. Four complications were related to surgical procedures on ureteral nodules, and 2 complications followed the removal of bladder endometriosis. Delayed postoperative outcomes were favorable with a significant improvement in painful symptoms and an absence of unpleasant urinary complaints, except for one patient with prolonged bladder denervation. CONCLUSION: Conservative surgery, in association with postoperative amenorrhea, can be proposed in a majority of cases of urinary tract endometriosis. Although the outcomes are generally favorable, the risk of postoperative complications should not be overlooked, as surgery tends to be performed in conjunction with other complex procedures such as colorectal surgery.

[Disseminated tuberculosis revealed by obstructive and prerenal acute kidney failure]. / Tuberculose disséminée révélée par une insuffisance rénale aiguë obstructive et fonctionnelle.

A 56-year-old Philippine seaman without any medical history presented an obstructive and prerenal acute kidney failure near the coasts of Normandy. He was hospitalized in intensive care units because of the seriousness of kidney failure and because of impaired consciousness. Abdominal computed tomography showed a destroyed left kidney, a right hydronephrosis and ureteral strictures, which is typical of urinary tuberculosis. Koch bacillus was positive in urine sample, confirming the diagnosis. Thoracic computed tomography, brain magnetic resonance imaging revealed a tuberculosis miliary with concomitant tuberculous meningitis and intracranial tuberculoma. Intravenous hydration and a double J ureteral catheter improved renal function. Stage 4 chronic kidney disease persisted. A four antituberculous therapy associated with corticotherapy for the meningitis was initiated. We discuss of urinary tuberculosis based on literature data about epidemiology, physiopathology, diagnosis and treatment.

[Haemospermia due to seminal vesicle amyloidosis. Treatment by laparoscopic vesiculectomy. A case report]. / L'hémospermie par amylose des vésicules séminales. Traitement par vésiculectomie coelioscopique. A propos d'un cas.

Amyloidosis of the seminal vesicles is a rare cause of haemospermia. The authors report the case of a 42-year-old patient with recurrent haemospermia over a period of 2 years and abnormalities of one seminal vesicle on ultrasonography and MRI, justifying laparoscopic resection. Histological examination demonstrated localized amyloidosis, secondary to inflammation. No recurrence was observed with a follow-up of one.

[Endoscopic incision of uretero-vesical junction after renal transplantation]. / Incision endoscopique des sténoses de la jonction urétéro-vésicale après transplantation rénale.

Stenosis of the ureterovesical reimplantation is one of the most frequent urological complications after renal transplantation. It can be treated surgically or endoscopically (dilatation, ureteric stent or Acucise). The authors present the results of a new endoscopic electrode-scalpel incision technique used as first-line treatment in 9 patients with stenosis of the distal centimetre of the ureter.

[Mixed epithelial and stromal tumour of the kidney]. / Tumeur mixte epithéliale et stromale du rein.

The authors report the case of a patient with mixed epithelial and stromal tumour, a rare, recently described entity, as only 40 cases have been reported, mixed epithelial and stromal tumours are essentially observed in women during the perimenopausal period with a history of treatment with oestrogen-progestogens or gynaecological surgery. No clinical or radiological arguments can differentiate these tumours from other renal tumours. Histological examination reveals a tumour with an epithelial component and a stromal component presenting the characteristics of ovarian stroma and expressing oestrogen and progesterone receptors. The prognosis of these tumours is usually very favourable, although caution is advised in view of the limited number of published cases and a recent report of a malignant case.

Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population.

BACKGROUND: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. OBJECTIVE: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. DESIGN, SETTING, AND PARTICIPANTS: Twenty-four French university departments of urology participated in this retrospective study. INTERVENTION: All patients were treated according to current European Association of Urology guidelines. MEASUREMENTS: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods. RESULTS AND LIMITATIONS: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design. CONCLUSIONS: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population.

Testicular metastasis of prostatic cancer.

Secondary testicular tumors are rare, we report a case of a solitary testicular metastasis of prostate cancer in 58-year-old man treated using hormonal therapy associated with radiotherapy. Ultrasound is the imaging modality of choice, but metastasis might be difficult to differentiate from primary tumors. The diagnosis confirmed by histologic examination includes routine microscopic and immunohistochemical findings, and therefore systemic treatment was required.

[The surgical management of recurrent urological malignancies after primary ablative therapy]. / Récidives locorégionales des cancers urologiques: place de la chirurgie.

This literature review highlights the surgical management of recurrent urological malignancies after primary ablative therapy. In particular, recurrent nonseminomatous germ cell tumours (NSGCT) post-chemotherapy, recurrent bladder cancer post-cystectomy, loco-regional recurrence of prostate cancer after radiotherapy, and loco-regional recurrence of renal cell carcinoma after radical nephrectomy. The indications, operative technique, complications and outcomes of each malignancy are discussed.