[Short version of recommendations for enhanced recovery program (ERP) for cystectomy: Technical measures]. / Version courte des recommandations de la récupération ameliorée après chirurgie (RAAC) pour la cystectomie : mesures techniques.

INTRODUCTION: The enhanced recovery program (ERP) is a management mode whose objective is to reduce the risk of complications and allow the patient to recover more quickly all its functional capacities and to reintegrate at most quickly and safely in his usual environment. This intentionally synthetic document aims to disseminate in the urological community the main points of the ERP recommendations for cystectomy. This work, coordinated by AFU, involves several other partners. The full document is available on the "Urofrance" website. Another article will follow on organizational measures. METHOD: The development of the recommendations is based on the method "formalized consensus of experts" proposed by the HAS. The report is based on a systematic review of the literature (January 2006-May 2017), two rounds of iterative quotations and a national proofreading. Levels of proof of conclusions and gradation of recommendations are based on the HAS grid. RESULTS: The bibliographic strategy made it possible to retain 298 articles. Only the recommendations that obtained a strong agreement after the two rounds of iterative listing were retained. The recommendations presented here are in chronological form (before, during, after hospitalization). Twenty-six key points on the technical and organizational measures of ERP have been identified. CONCLUSION: The result of the literature review, supplemented by expert opinion, suggests a significant clinical interest in the application and dissemination of ERP for cystectomy, despite the limited data available for this indication.

[A case of pyeloureteritis cystica: a diagnosis to keep in mind]. / La pyélo-urétérite kystique : un diagnostic à ne pas méconnaître.

The diagnosis of pyeloureteritis cystica is rare. Data from the literature about this disease are limited. Pyeloureteritis cystica is described as a benign inflammatory disease of the urinary tract, resulting from chronic inflammation of the urothelium. Radiologically, it is characterized by multiple rounded incomplete images of the urinary tract. The histology can confirm the diagnosis or eliminate differential diagnosis. We report the case of a pyeloureteritis cystica in a 64-year-old man, who had a chronic haematuria since ten years.

[Renal cell carcinoma: antiangiogenic therapies and management of the complications. A case report]. / Cancer du rein: traitements anti-angiogéniques et gestion des complications. A propos d'un cas.

Direct side effects of the inhibition of activation of VEGF receptors are well known and could be easily explained (HTA). The indirect toxicity of the inhibitors of tyrosinekinases is much less known and several hypotheses appear. Usually, the common side effects of the inhibitors of tyrosine-kinases can be easily managed and are reversible when the treatment is stopped. Their management is essentially based on prevention measures. It is necessary to stop definitively or temporarily the treatment in case of intensification of pre-existing comorbidities or side effects of rank 3 or 4. There is no predictive factor of treatment toxicity and, at the moment, there is thus no indication in a previous dose adaptation.

[Renal and adrenal involvement in von Hippel-Lindau disease: clinical features and therapeutic strategies]. / Atteintes rénales et surrénaliennes dans la maladie de von Hippel-Lindau: aspects cliniques et stratégies thérapeutiques.

OBJECTIVES: We report our experience of renal and/or adrenal manifestations of von Hippel-Lindau disease and propose a practical approach. METHODS: Eight patients (mean age: 43 years) presented with predominant renal and adrenal lesions in 6 cases and 2 cases, respectively. RESULTS: All patients are alive with a mean follow-up of 8.1 years. A local recurrence after partial nephrectomy was observed in two cases. Two patients are in renal failure and are treated by dialysis and two patients require hormone replacement therapy for adrenal insufficiency. CONCLUSIONS: The predegenerative nature of simple renal was not observed. Conservative renal surgery is adapted to small renal tumours, with a low cytological grade and without any distant lesions in the same kidney. Radical nephrectomy is reserved for large lesions (greater than 5 cm) with a high cytological grade. The presence of pheochromocytoma must be systematically excluded. Preservation of the adrenal gland in the case of homolateral renal surgery for cancer is recommended. The reliability of the genetic test allows early diagnosis of this disease.

[Urinary infections in pregnant women]. / L'infection urinaire chez la femme enceinte.

Urinary tract infection is frequent during pregnancy with a high potential risk for mother and child. Based on a review of the literature and a retrospective survey conducted in 20 representative French university hospitals during 1993, the authors propose a practical review designed to standardize the therapeutic approach to this disease. They define a high-risk group which requires systematic screening and close surveillance during pregnancy. They evaluate the need for complementary investigations in relation to the 3 clinical presentations encountered (asymptomatic bacteriuria, cystitis and acute pyelonephritis) taking into account their respective adverse effects. The therapeutic modalities of the three clinical forms are then described, including drainage of the urinary tract.

[Prognostic factors of survival in infiltrating urothelial bladder carcinoma. A retrospective study of 158 patients treated by radical cystectomy]. / Facteurs pronostiques de survie dans les carcinomes urothéliaux infiltrants de vessie. Etude rétrospective de 158 cas traités par cystectomie radicale.

The clinical files of 158 patients who were treated by radical cystectomy for infiltrating bladder carcinoma were retrospectively reviewed to define prognostic factors. PATIENTS AND METHODS.--All patients had a radical cystectomy with bilateral pelvic lymph node dissection for an infiltrating operable bladder urothelial tumor. Each tumor was classified according the pTNM staging system and were analysed for the presence of vascular invasion, carcinoma in situ and tumor grade. Twenty-three patients (14.5%) had an irradiation. Sixty-seven patients (42%) received chemotherapy (neoadjuvant in 31, adjuvant in 30, both in 6). RESULTS.--The median overall survival of the whole group was 19 months. The 5 years disease free survival (DFS) and overall survival (OS) were 44% and 31%, respectively. In the univariate analysis, the factors with significant prognostic value were: pT stage and the tumor size for OS, age and lymph node involvement for DFS, presence of carcinoma in situ (CIS) and tumor size for local recurrence free survival (LRFS) and sex and lymph node involvement for metastatic free survival (MFS). The following variables attained significant prognostic value in the multivariate analysis: pT stage and an interaction between lymph node involvement and vascular invasion for OS, pT stage and presence of CIS for LRFS, pT stage for MFS. CONCLUSION.--The pT stage, lymph node involvement and vascular invasion are the most important prognostic factors of survival in infiltrating bladder cancer.

[Early diagnosis and screening of cancer of the prostate]. / Diagnostic précoce et dépistage du cancer de la prostate.

It is obvious that digital rectal examination and assay of prostate specific antigen are required for all patients presenting signs of prostatism, but the true benefit of such an attitude for all patients is a matter of much controversy. We do know that the incidence of prostate cancer is rising faster than any other cancer and that the cause of death in approximately 3% of the male population over 50 years will be cancer of the prostate. Yet despite this risk, and due to the lack of satisfactory registries, the prevalence of the disease still remains unknown. A well-conducted mass screening programme could be expected to uncover prostate cancer in approximately 6% of the population, which would mean that in the French male population in the 55-70 year range, 348,000 cases would be diagnosed. Assuming that 70% of them would have a localized form theoretically accessible to curative treatment (radical prostatectomy or radiotherapy), the current mortality for prostatectomy (1 to 2%) would mean that at least 2,500 persons would die during the perioperative period. The question of psychological impact of a general screening programme and its cost are other considerations of importance. Under these conditions, can a mass screening programme be proposed? In France, the answer today appears to be no. The arguments in favour of early diagnosis are insufficient for mass screening and will remain so until a certain number of basic questions concerning the efficacy of treatment, the cost-benefit ratio of screening, and the psychological impact of early diagnosis are resolved.

Clinical value of fine-needle aspiration cytology and biopsy in the evaluation of male infertility. A comparative study of 48 infertile patients.

OBJECTIVE: To evaluate whether fine-needle aspiration cytology of the testis can be considered as a diagnostic parameter in the evaluation of male infertility. PATIENTS AND METHODS: We studied 30 oligospermic and 18 azoospermic patients using 63 fine-needle aspiration samples and 57 biopsy samples obtained surgically (10 cases) or with a spring-loaded biopsy device (47 cases). Cytologic evaluation of spermatogenesis was performed by studying longitudinal segments of seminiferous tubules and cytocentrifuged dissociated cells. RESULTS: Comparison between fine-needle aspiration and the biopsy methods gave concordant results in 72.2% of cases. Discordant findings were recorded in 10 cases (27.8%). In eight cases, significant maturation into spermatozoa was recognized in samples obtained by fine-needle aspiration only, whereas moderate to severe hypospermatogenesis or germ cell aplasia were demonstrated in samples obtained by the spring-loaded biopsy device or by open surgical biopsy. Germ cell aplasia was recognized in samples obtained by both methods in 75.0% of cases. Insufficient specimens were obtained by fine-needle aspiration and the spring-loaded biopsy device in 15.9% and 12.3% of cases, respectively, whereas all surgical biopsy specimens were of good quality. Four bleeding episodes and one case of epididymitis were observed after use of the spring-loaded biopsy device, but no complication was related to either surgical biopsy or fine-needle aspiration. CONCLUSION: The findings show that fine-needle aspiration cytology could represent a more reliable means of identifying significant numbers of the most mature germ cells.

Pheochromocytoma as the first manifestation of von Hippel-Lindau disease.

BACKGROUND: von Hippel-Lindau disease is an autosomal dominant disorder characterized by the development of hemangioblastomas in the cerebellum, spinal cord, and retina, renal cell carcinoma and cysts, pancreatic cysts, and pheochromocytoma. METHODS: We have studied a series of 36 French patients affected with von Hippel-Lindau disease pheochromocytoma. Thirty (83%) of them were diagnosed as having von Hippel-Lindau disease because the disease occurred in a familial von Hippel-Lindau disease setting; six (17%) were diagnosed as having von Hippel-Lindau disease because they displayed another characteristic manifestation of that disease. RESULTS: The mean age at pheochromocytoma diagnosis was 29 +/- 14 years (5 to 62 years). Bilateral tumors were documented in 15 (42%) cases, paraganglioma was associated with adrenal pheochromocytoma in four cases, and malignant pheochromocytoma occurred in three cases. Prevalence of pheochromocytoma revealing von Hippel-Lindau disease was 20 (53%) out of 36. In six cases pheochromocytoma was the only manifestation of the disease. CONCLUSIONS: In the interest of the patients themselves and of family members who are at risk, search for von Hippel-Lindau disease must be systematic in the presence of pheochromocytoma. Basic checkup may be completed with familial inquiry, ophthalmoscopy, cerebral magnetic resonance imaging, abdominal ultrasonography, and computed tomography-scan for detection of latent lesions. In the future, after characterization of von Hippel-Lindau disease gene mutations, molecular diagnosis is going to be possible in individual patients.

Metastatic malignant melanoma: an unusual case presentation.

Secondary involvement of the genitourinary tract with malignant melanoma is a common autopsy finding, but rarely evident clinically. We report a rare case involving a previously asymptomatic patient presenting with gross hematuria and a large renal mass, which was found to be metastatic melanoma. We propose that metastatic melanoma to the kidney, although rare, be considered in the differential diagnosis of disease processes causing hematuria.

[Diagnosis and evaluation of spread of prostate cancer]. / Diagnostic et bilan d'extension du cancer de la prostate.

In more than 50% of the cases, the diagnosis of prostate cancer is made at the time of extra-prostatic or distant disease involving poor prognosis for cure. Small tumours for which curative treatment is possible are asymptomatic. Thus, useful early diagnosis of prostatic cancer is based on digital rectal examination and PSA concentration. PSA levels are also indicative of tumour volume. Thus, determining dissemination becomes significant only in the case of elevated PSA, indicating a large tumour.

[Viewpoints of the urologist on acute pyelonephritis]. / Points de vue de l'urologue sur les pyélonéphrites aiguës.

For the urologist acute pyelonephritis is a relatively common disease when it is uncomplicated and occurs in otherwise healthy patients. In such cases, admission to hospital is not always required. On the other hand, there are situations in which the disease is more difficult to manage. A poor general condition, the existence of a congenital malformation, the presence of a foreign body in the urinary tract, the occurrence of the disease after a surgical or instrumental procedure may transform acute pyelonephritis into a dangerous condition which sometimes follows a dramatic course.

Thermoregulation during transurethral microwave thermotherapy: experimental and clinical fundamentals.

Transurethral microwave thermotherapy of 340 patients treated at our center for benign prostatic hypertrophy shows the importance of the role played by two thermoregulation processes during the procedure. The first one is artificial and automatically driven by the machine (the power output and cooling rate are adjusted to the urethral and rectal temperature safety thresholds). The second one is natural thermoregulation; the latter is species specific, organ specific, zone specific and even cell specific. Thermoregulation variability is linked to the geometry of the gland, vessel distribution, histology and tissue conductivity. This variability has been demonstrated by interstitial thermometry and histological study. Interstitial thermometry was performed during treatment in 30 dogs and 35 patients; a histological study of prostate specimens was performed 1-12 weeks after treatment in 30 dogs and 15 patients. The human prostate is more resistant to heat than the dog prostate of a comparable volume and treated with the same thermal dose. The prostate of a young patient requires a higher thermal dose than that of an old patient with the same prostate volume in order to achieve a comparable intraprostatic temperature, probably due to a more viable blood supply. The transition zone is more sensitive to heat than the peripheral zone, as demonstrated by temperatures recorded at the same distance from the antenna of up to 60 versus 42 degrees C, respectively. Acinar cells seem to be more resistant to heat than smooth muscle cells when exposed to the same temperature level, as demonstrated by microscopic examination at the periphery of the treated area.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pheochromocytoma, first manifestation of Von Hippel-Lindau disease: a possibility to be considered]. / Phéochromocytome, première manifestation de la maladie de von Hippel-Lindau: une éventualité à connaître.

Von Hippel-Lindau (VHL) disorder is an autosomal dominant disease characterized by the almost constant development of hemangioblastomas in the central nervous system (cerebellum, spinal cord and retina). In addition, various types of tumors including renal cell carcinomas, pancreatic cysts and pheochromocytomas are frequently observed in VHL gene carriers. Linkage of the VHL locus to the RAF-1 oncogene on the short arm of chromosome 3 (3p25-26) has been recently reported. Pheochromocytoma is of particular interest because of the risk of inaugural malignant hypertensive crisis but especially because of a great degree of interfamily variability (from 0 to 92% of affected members in previously reported large kindreds). We have studied a French series of 25 pheochromocytoma (11 males, 14 females) in VHL affected patients. Twenty pheochromocytoma (80%) occurred in a familial context, whereas 5 (20%) were consistent with "apparent sporadic cases". The mean age at pheochromocytoma diagnosis was 27 years (5-55 years). Bilateral tumours have been documented in 13 cases (52%). The prevalence of pheochromocytoma revealing VHL was 14 out 25 (56%). In these cases, VHL diagnosis was considered up to 25 years later. In 6 cases (2 deceased) pheochromocytoma was the only manifestation of VHL. Thus, search for VHL must be systematic in the presence of pheochromocytoma, in the interest of the patients themselves and of potential at-risk family members (prevention of hypertensive crisis linked to latent tumours). Basic check-up (neurological and somatic examination, ophthalmoscopy, familial inquiry) may be completed with cerebral CT scan or MRI and abdominal ultrasonography followed, if positive or doubtful, by abdominal MRI or selective angiography.

[Deep venous thromboses in erysipelas of the leg. A prospective study of 40 cases]. / Thromboses veineuses profondes au cours des érysipèles de jambe. Etude prospective de 40 observations.

The treatment of lover limb erysipelas rests on antibiotic therapy directed against streptococci, but the necessity of prescribing a concomitant anticoagulant treatment has not yet been established. The incidence of deep vein thrombosis in patients with erysipelas of the leg in unknown. In a prospective study of 40 patients presenting with this type of skin disease, we looked for deep vein thrombosis, using systematically pulsed Doppler vein exploration combined with ultrasonography and, if necessary, a second Doppler examination and a phlebography. Six cases of deep vein thrombosis were diagnosed. This complication was observed in 5 patients at high risk for deep venous thrombosis; it had never been foreseen at clinical examination.

[Progression after radical prostatectomy of cancer of the prostate: prognostic criteria and the role of PSA in monitoring]. / Progression après prostatectomie radicale pour cancer de la prostate: critères pronostiques et place du PSA dans la surveillance.

Progression after radical prostatectomy, evaluated by a rise in plasma PSA and/or the appearance of a pelvic nodule positive on biopsy and/or the presence of bone metastases confirmed by bone scan, was studied in a series of patients with prostatic cancer with a follow-up of between 6 months and 5 years. The progression-free survival rate was 86% at 1 year and 60% at 5 years. A progression-free survival rate and the relative risk of progression were established on the basis of the morphological characteristics (anatomical stage, tumour volume, seminal vesicle invasion, condition of the prostatic capsule and lymph nodes, positive resection margins at the apex) and histological features (Gleason's score) of the cancer, allowing determination of the influence of prognostic criteria on the outcome. The positive resection margins at the apex were due to preservation of the nervi erigentes. The preservation of the neurovascular pedicles may not be justified in the case of a tumour confined to the prostatic apex.

Minimal focal dermal hypoplasia in a man: a case of father-to-daughter transmission.

Focal dermal hypoplasia is a rare genetic disorder characterized by diffuse and specific cutaneous lesions. Multiple visceral abnormalities are frequently associated. A minimal form of the disease (only cutaneous and localized to one thigh) is reported in the father of a woman who had typical focal dermal hypoplasia.