Flexible and rigid ureteroscopy in outpatient surgery.

BACKGROUND: Outpatient surgery is critical to improve health care costs. The aim of the study was to prospectively evaluate the results of outpatient treatment of upper tract urinary stones by rigid or flexible ureteroscopy in a routine care setting. METHODS: A database was created at the creation of the outpatient surgery department. 87 patients underwent 100 ureteroscopic procedures for urinary lithiasis from June 2013 to March 2015. RESULTS: Most of our patients were male with 53 men (sex ratio M/F 1.13), with a mean age of 52.9 ± 15 years old (23.4-82.4). 44 % of ureteroscopies performed were flexible ureteroscopies, 31 % rigid ureteroscopies and 25 % associated rigid and flexible ureteroscopies. The average stone load was 10.1 ± 5.7 mm (2-30) The mean operating time was 58.3 ± 21.1 min (20-150). 82.9 % of patients had a single urinary stone and 17.1 % (n = 14) had 2 or more. 114 stones were treated, 57,1 % intrarenal. There were 6 (6 %) postoperative complications: three Clavien stage 2 infections; three Clavien stage 3b complications (two renal colics requiring ureteral stenting 48 h after discharge and 1 symptomatic perirenal urinoma 48 h after discharge). There was one intraoperative complication (1 %): a ureteral wound with contrast leakage. The rate of transfer to conventional hospitalization was 2.2 %. Stone size influenced the stone-free status (p < 0.0001) and the need for more than one session. There was a significant correlation between operative time and stone size above 10 mm (p < 0.0001). CONCLUSIONS: Flexible and rigid ureteroscopy are safe and efficient procedures for upper urinary tract stones and can be carried out in an outpatient department. Stone size had an impact on postoperative stone-free status and operative time.

Efficacy and tolerance of one-third full dose bacillus Calmette-Guérin maintenance therapy every 3 months or 6 months: two-year results of URO-BCG-4 multicenter study.

OBJECTIVES: To assess bacillus Calmette-Guérin maintenance treatment schedule for non-muscle invasive bladder cancer at 2 years, using one-third of the full dose and fewer instillations every 3 months or 6 months. METHODS: This was a prospective, randomized, multicenter study. All patients had an intermediate- or high-risk non-muscle invasive bladder cancer. They received three weekly instillations of one-third dose bacillus Calmette-Guérin every 6 months (group I) and two weekly instillations every 3 months (group II) during 3 years. In the two schedules we assessed efficacy, tolerance, leukocyturia and prostate-specific antigen. RESULTS: No significant difference was observed between the two groups for recurrence at 6, 12 or 18 months. At 2 years, tumor recurrence was observed in 10.9% and muscle invasion in 2.9% of cases. Bacillus Calmette-Guérin tolerance was comparable - the adverse events score was 0.8 in group I and 1 in group II (P = 0.242). No statistical correlation was observed between the adverse events score over 2 years, either for leukocyturia (P = 0.8891) or prostate-specific antigen level (P = 0.7155). Leukocyturia level was not significantly associated with tumor recurrence or progression. CONCLUSION: One-third dose maintenance bacillus Calmette-Guérin is effective with no impact on tumor recurrence or muscle invasion. Furthermore, there seems to be no difference in tumor response or side-effects between patients receiving two or three maintenance instillations every 3 months or 6 months. In clinical practice, the use of leukocyturia or total prostate-specific antigen levels do not appear to be useful in predicting bacillus Calmette-Guérin toxicity.

Intraoperative ultrasound control of surgical margins during partial nephrectomy.

AIMS: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. SUBJECTS AND METHODS: This study was conducted for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. RESULTS: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. CONCLUSIONS: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

Left adrenal tumor extending into the renal vein: surgical management with ipsilateral kidney preservation.

If single adrenal metastasis surgery is well admitted, no recommendation exists about the management of a renal vein tumor thrombus, even though the actual consensual attitude consists in a nephrectomy associated to an adrenalectomy. We report, here, the case of a 74-year-old man with a suspected adrenal metastasis of a lung carcinoma associated with a left adrenal and renal vein tumor thrombus treated by adrenalectomy and renal vein thrombectomy and ipsilateral kidney sparing. The postoperative computed tomography scan showed no thrombus in the left renal vein. Doppler ultrasound performed 1 month after adrenalectomy proved a good left renal vein flux. At 36 months of follow-up, the patient is alive without signs of recurrence.

Prostatectomy for localized prostate cancer to prepare for renal transplantation in end-stage renal disease patients.

BACKGROUND: Surgical difficulties of renal transplantation related to prostate cancer (PC) treatment and the results of renal transplantation after radical prostatectomy are currently poorly known, as well as oncological follow-up before and after renal transplantation. MATERIAL/METHODS: We performed a retrospective study including all patients diagnosed with PC before renal transplantation in our department. RESULTS: Nineteen patients were included between August 2003 and December 2013. The mean age at diagnosis of PC was 61.7 years (range 51.4-71.1). PSA mean level at diagnosis was 8.5 ng/ml (range 4.8-20). Fourteen had a retro-pubic and 5 a laparoscopic prostatectomy. Three patients underwent radiotherapy for positive surgical margins or extra-capsular extension. Fourteen patients were transplanted. The mean time lapse between prostatectomy and kidney transplantation was 32.8 months (range 14-71). Seven recipients (50%) were transplanted less than 24 months after prostatectomy. Post-transplantation surgical complications were not significantly related to dissection difficulties (p=0.2). No recurrence of PC was observed after renal transplantation, with a mean follow-up of 38 months (range 6-77.9). CONCLUSIONS: Prostate cancer discovered before renal transplantation should be treated by radical prostatectomy to assess recurrence risk. If the PC is at low risk of recurrence, it seems possible to shorten the 2-year period of oncologic follow-up before transplantation called for in current recommendations.

Prostate cancer in deceased organ donors: a review.

OBJECTIVE: To estimate the risk of prostate cancer transmission in relation with organ procurement. METHODS: A literature search from the Medline database using the following keywords-transplantation, prostate cancer, organ procurement, donor transmitted malignancies, disease transmission, staging, evaluation, and PSA-was conducted to select 16 articles written in English and French over the last 15 years. RESULTS: The incidence of prostate cancer in deceased organ donors (DOD) has been estimated to be between 3% and 18.5%. There were more than 120 solid-organ transplantations performed with organs coming from DOD with a proven prostate cancer without any case of cancer transmission or death related to malignancy and only 1 case of transmission by the donor after a heart transplant has been described. CONCLUSION: Transmission of prostate cancer by a transplanted organ seems incidental. When PSA is measured, it should be suspected only if the value is beyond 20 ng/ml and in all cases, should be interpreted taking digital rectal examination (DRE) into account. Organs from a DOD with a DRE proving a T3-T4 prostate cancer should not be procured. Suspect iliac lymph nodes during the preparation of the vessels for cannulation must lead to the discontinuation of the procurement or a histological analysis.

Does daily urine output really matter in renal transplantation?

BACKGROUND: Our objective was to clarify the clinical outcome of renal transplantation based on residual daily urine output (RDUO). MATERIAL AND METHODS: We retrospectively analyzed a prospective database of 276 patients who underwent renal transplantation (Tx) between January 2008 and December 2012. Patients had pre-transplantation daily urine output measurement of 24-h proteinuria and were clinically re-evaluated the day before transplantation. We included patients with no daily urine output and those with residual daily urine output. Real bladder capacity was not measured. We excluded patients with a history of lower urinary tract malformation, those treated by trans-ileal conduit or enterocystoplasty, and those with early graft thrombosis or graft primary non-function. RESULTS: Sex ratio, age at Tx, pre-Tx MHC antibodies levels, donor age, and cold ischemia duration were not significantly different between the 2 groups. Dialysis duration was longer in group I (p<0.001). The dialysis duration was correlated with the volume of residual urine output (r=0.12, p<0.0001). We found 14 (19.4%) urological complications in Group I (11 urinary leaks and 3 urethral stenosis) and 13 (6.4%) in Group II (5 urinary leaks and 8 stenosis). This difference was significant (p=0.0013 and relative risk [RR]=2.2). Absence of residual daily urine output was a risk factor of post-transplantation urinary leak (p<0.0001: RR=2.95). At 3 years, graft survival was 74.7% and 94.6%, respectively, in Group I and II (p=0.003). CONCLUSIONS: The absence of residual daily urine output seems to be a major risk factor for urological complications. Taking into account recipient residual daily urine output should modify surgical strategy during renal transplantation.

Bladder metastasis from maxillary sinus undifferentiated carcinoma: a rare case.

We report the rare case of a 72-year-old woman with maxillary sinus undifferentiated carcinoma with metachronous metastasis localized to the bladder. Bladder metastases and maxillary sinus carcinoma are rare tumors. The bladder is not 1 of the usual sites of distant extension for parasinus tumors. To our knowledge, no data have been reported regarding bladder metastasis originating from a maxillary sinus carcinoma.