[Treatment of precalyceal stones of Cacchi-Ricci disease by flexible ureterorenoscopy and Holmium-YAG laser]. / Traitement des calculs précaliciels de la maladie de Cacchi et Ricci par urétérorénoscopie souple et laser.

Flexible ureterorenoscopy combined with Holmium-YAG laser is an effective and reliable technique for the management of renal stones. Cacchi-Ricci disease is a frequent urological malformation characterized by precalyceal stone formation, for which no preventive treatment is available at the present time. Some complicated forms are difficult to manage because of the technical impossibility of treating these precalyceal stones. The objective of this article is to describe a technique allowing management of these precalyceal stones by flexible ureterorenoscopy combined with Holmium-YAG laser.

[Flexible ureteroscopy and holmium-Yag laser: material and technique]. / Urétéroscopie souple et laser holmium-Yag : matériel et technique.

Flexible ureteroscopy combined with Holmium-YAG laser is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique perfectly adapted to diseases of the upper urinary tract. This technology must be part of the therapeutic armamentarium of any centre involved in the management of urinary stones. The technical facilities must be complete and adapted. Flexible ureteroscopy is a technique with a rapid learning curve once the operator is familiar with all of the equipment. This article describes the material and technique of flexible ureteroscopy combined with Holmium-YAG laser.

[Does the initial or secondary status of T1G3 bladder tumours have a prognostic impact?]. / Le statut initial ou secondaire des tumeurs de vessie T1G3 a-t-il un impact pronostique?

OBJECTIVE: This retrospective study evaluated the prognostic value of the initial or secondary status of pT1G3 bladder tumours. MATERIALS AND METHODS: Between 1990 and 2000, 93 patients presented with T1G3 bladder tumour. Seventy-five patients, 54 with initial T1G3 and 21 with secondary T1G3, with no history of invasive bladder tumour, were included in the study. Seventy-two per cent were treated by intravesical BCG. No patient received maintenance therapy. The median follow-up was 53 months (range: 2 to 285 months). RESULTS: On univariate analysis, a significant difference of overall survival was observed in favour of secondary T1G3 tumours compared to initial T1G3 tumours (p < 0.003), while no difference was observed for recurrence, progression and specific survival. This difference was no longer significant on multivariate analysis, but BCG therapy and smoking were significantly correlated with overall and specific mortality. BCG was also correlated with risk of progression. CONCLUSION: Patients with a secondary T1G3 tumour had a better overall survival. This difference was no longer significant when other prognostic factors were taken into account.

[Current place of chemotherapy in the treatment of hormone-refractory metastatic prostate cancer]. / Place actuelle de la chimiothérapie dans le traitement du cancer de la prostate métastatique hormonorésistant.

The current management of hormone-refractory metastatic prostate cancer is purely palliative. The use of chemotherapy in this indication was revised in 1996, based on the results of studies with a combination of mitoxantrone and prednisone. This combination demonstrated a significant improvement of quality of life (+48%) and pain (+30%), but without any overall survival benefit. Two studies using taxols, TAX_327 and SWOG_9916, were published in the New England Journal of Medicine on 7 October 2004, with, for the first time, a median overall survival benefit of 2 months. However, the encouraging results of these 2 studies, which will probably modify the management of hormone-refractory prostate cancer, need to be interpreted cautiously. First of all, they were conducted in selected study populations (mean age less than 70 years, Kamofsky index greater than 80% in more than 85% of cases, local disease control in more than 70% of cases). They also comprise many methodological imprecisions and biases with especially, in the TAX 327 study, a change of treatment arm in 1/3 of patients without exclusion of these patients from the final analysis. The results obtained are also at the limit of statistical significance. The target improvement of overall survival, +25% and +33%, respectively, was not achieved at the end of these studies. Finally, from a palliative point of view, only one of these 2 studies (TAX_327) demonstrated a palliative benefit compared to mitoxantrone: 9% for pain, for a sixfold higher cost. Adverse effects were significantly more frequent than with mitoxantrone. Patient selection and details about the indications are necessary. Taxols should not be used systematically in this indication. Furthermore, although several studies are underway, the benefit of taxols at earlier stages of the disease are unknown. Urologists must be aware of the place of chemotherapy in the treatment of prostate cancer in order to remain at the centre of the treatment decision.

[Neuroendocrine cancer of the prostate. A series of 6 cases]. / Cancer neuroendocrine de la prostate. A propos de 6 cas.

INTRODUCTION: Neuroendocrine cancer of the prostate (NECP) is a rare entity. Screening for this tumour, although not systematic, may have therapeutic implications. The authors retrospectively evaluated 6 cases of NECP observed in the department between September 1998 and May 2002. MATERIAL AND METHODS: The diagnosis was based on immunohistochemical analysis of biopsy fragments with the presence of marked neuroendocrine differentiation (minimum 50%). Positive staining for anti-Neuron-Specific Enolase (NSE) and anti-Chromogranin A antibodies was observed in 5 and 6 cases, respectively, while anti-PSA antibody labelling was always negative. RESULTS: NECP represented 2.1% of all prostate cancers diagnosed in the department over the same period. Digital rectal examination was abnormal in every case with a median PSA of 9.75 ng/ml (range: 0.25-19.6). Three patients presented metastatic disease at the time of the diagnosis. Four of the 6 patients were urgently admitted to hospital because of acute clinical features. Paroxysmal abdominal pain occurred during the course of the disease in every case with a median of 52 days (range: 22-198) and was initially present in 2 cases. Chemotherapy was performed in 3 cases and palliative therapy was administered in the other cases. A survival difference was observed for patients treated by chemotherapy (13 months versus 4.7). The median survival was 9 months and 14 days. Death occurred in a context of rapid alteration of the general state and renal function. CONCLUSION: NECP has a poor prognosis. Clinical and complementary features guide the diagnosis, which can be confirmed by immunohistochemical analysis, allowing early management based on chemotherapy.