Management of testicular cancer: Practice survey in localized stage.

INTRODUCTION: Management of testicular cancer requires a complete evaluation to confirm the localized stage and effective treatment according to guidelines to ensure the best outcome. The primary objective of this study was to evaluate practices at each stage of care in patients with a localized testicular tumor. The secondary objective was to evaluate the oncological prognosis of these patients according to the modalities of care. METHODS: We conducted a multicenter practice evaluation study with retrospective collection and evaluation of patient records. The study was conducted in two French departments (population pool of 2 million inhabitants) between January 1, 2010, and January 31, 2015, enabling a five-year followup of patients. Patients presenting with stage I testicular tumor according to the American Joint Committee on Cancer classification were included in the analysis. RESULTS: A total of 226 records were analyzed; 93% of patients underwent bilateral scrotal ultrasound and 93.25% had a chest-abdomen-pelvis computed tomography scan. A total of 29.65% of patients had a preoperative tumor marker assay in accordance with guidelines; 94% of patients had a total orchiectomy, with a median time of 15 days. At the end of the followup period, 17 patients had suffered a recurrence of their disease. Providing adjuvant care in accordance with guidelines reduced the risk of recurrence in patients with a seminomatous tumor. CONCLUSIONS: Our study showed heterogeneity in compliance with guidelines for evaluation and effective treatment of patients with a localized testicular tumor. Some essential practices, such as assays of tumor markers and fertility preservation for patients over 40 years, were not well carried out. Adjuvant management of localized tumors appears to be an important predictor of recurrence.

[Study of the efficacy and medium-term complications of 41 sacral nerve neurostimulators (Interstim, Medtronic, U.S.A.) in refractory urinary disorders]. / Etude sur l'efficacité et les complications à moyen terme de 41 implantations de neuromodulateur des racines sacrées (Interstim, Medtronic, U..S.A.) dans les troubles urinaires réfractaires.

OBJECTIVE: Single-centre retrospective follow-up study (short-term and medium-term efficacy, complications, revisions) of patients treated for refractory urinary disorders by sacral nerve neurostimulation (Interstim, Medtronic, U.S.A.). MATERIAL AND METHOD: A sacral nerve neurostimulation screening test was performed in 79 patients with refractory urinary disorders between 1999 and 2005 and a neurostimulator was implanted in 41 of these patients. Patients were evaluated by bladder diary, MHU urinary disability score, and urodynamic assessment. RESULTS: The mean follow-up was 20.5 months. A significant improvement of bladder diary parameters and MHU urinary disability score was observed at 6, 12, and 24 months of follow-up. At 20.5 months, 22 (54%) patients were considered to be failures and 3 were explanted. Five patients were considered to be a success, and 14 were improved, i.e. 19 (46%) success/improvement at 20.5 months of follow-up. The only predictive factor of success was a history of symptoms lasting less than 5 years before neurostimulator implantation. A complication was observed in 70% of patients. More than one half of patients reported pain at some time during follow-up. Four infections were observed, one of which required explantation. Ten technical problems due to accidental deactivation or interference with a magnetic field were observed. Seven patients (17%) required revision: repositioning of the leads due to inefficacy in 3 cases, and change of position of the device in 4 cases. CONCLUSION: Sacral nerve neurostimulation is an effective treatment in refractory urinary disorders in more than 45% of implanted patients, although this effect tends to wane over time. Our results are less favourable than those described in the literature, but were based on stricter endpoints. A high complication rate, mainly pain, was observed, but most required only symptomatic management. This technique nevertheless remains a good alternative to invasive surgical management of functional disorders.

[Predisposing factors for ureteric strictures in renal transplantation]. / Facteurs favorisant les sténoses urétérales en transplantation rénale.

OBJECTIVE: Renal transplantation is a well defined surgical procedure, but it nevertheless remains associated with a risk of medical and surgical complications. Ureteric strictures, with an incidence ranging from 2% to 7.5% according to the series, are the most frequent urological complication. The objective of this study was to determine the incidence of ureteric strictures and the existence of risk factors predisposing to the development of ureteric strictures and to evaluate their consequences on patient and graft survival, based on a single-centre retrospective series of renal transplantations. PATIENTS AND METHODS: From January 1990 to December 2002, 1787 renal transplantations were performed consecutively in our centre. Graft, donor and recipient characteristics were extracted from a computerized database and validated by an independent observer. The parameters studied included donor's age and recipient's age, donor's haemodynamic status and serum creatinine at the time of harvesting, cause of death, graft weight and number of graft arteries, cold ischaemia and reperfusion times, number of HLA incompatibilities and percentage anti-HLA immunization, time to return of graft function, acute rejection, presence or absence of a double J stent, episodes of acute pyelonephritis, CMV infection and patient and graft survival according to the Kaplan-Meier method. RESULTS: Ureteric stricture was observed in 74 patients (4.1% of cases) and a donor age greater than 65 years (p < 0.0001), the presence of more than 2 arteries on the graft (p = 0.03) and recipients with an anti-HLA immunization less than 25% (p = 0.037) were identified as independent risk factors. Furthermore, grafts complicated by ureteric stricture resumed function later (p = 0.001). The development of ureteric stricture did not have an unfavourable impact on the 10-year recipient and graft survival rates.