[Congenital undescended testis: Should open processus vaginalis have any impact on the elected surgical approach?] / Cryptorchidie : la présence d'un canal péritonéo-vaginal perméable devrait-elle influer dans le choix de la technique chirurgicale ?

PURPOSE: Compare the position of the undescended testis at clinical examination and under general anesthesia with the patency of an open processus vaginalis. PATIENTS AND METHODS: We included children from 2 to 18 years of age operated for a unilateral or bilateral undescended testis between January 2006 and April 2014 at the Annecy Genevois hospital, France. The analysis was conducted considering that the individual was the testis. Testicular position before surgery, under general anesthesia and patency of open processus vaginalis as a surgical finding were prospectively recorded. RESULTS: Three hundred and six children were included. The analysis was conducted over 401 testes. The position at clinical examination was significantly linked to a persistent open processus vaginalis (P=0.0045). Over the 282 testes considered as candidate for Bianchi's procedure, as to say intra- or supra-scrotal under general anesthesia, 154 had a persistent processus vaginalis (55%). CONCLUSION: There is a link between a persistent processus vaginalis and the location of the undescended testis which should encourage us not to neglect the inguinal approach, and eventually to question the relevance of Bianchi's procedure. LEVEL OF EVIDENCE: 4.

[Renal cell carcinoma: A 12-year retrospective study of epidemiologic, therapeutic and follow-up data]. / Étude rétrospective d'une population de carcinomes à cellules rénales sur 12ans : épidémiologie, prise en charge thérapeutique et impact sur la survie.

OBJECTIVE: To describe the evolution of epidemiology and management of renal cell carcinoma and their impact on overall and progression-free survivals. PATIENTS AND METHODS: We reviewed the files of consecutive patients with renal cell carcinoma in our center between January 2000 and December 2011. Patients with confirmed diagnosis on histology who underwent radical nephrectomy, partial nephrectomy or thermoablation were included. Benign tumors were excluded. Epidemiologic and therapeutic data during the period of study were compared. Overall and progression-free survivals divided in three periods were compared by Kaplan-Meier curves. RESULTS: Four hundred and forty-nine patients were included with a median age of 60 years old [21; 89], and median follow-up of 39 months. Tumor histology was clear cell carcinoma in 75.9% of cases. During the period of study, patients with ASA score upper than 3 increased from 20.4% to 47.8%, tumor size decreased from 58.4mm to 49.5mm and incidental tumor discovery increased from 59.1% to 71.6%. Nephron-sparing surgery increased from 19.7% to 44%. Overall survival and progression-free survival was not different during this period (P=0.071 and P=0.582). CONCLUSION: The increase in early incidental discovery of renal cell carcinoma allowed nephron-sparing surgery in spite of patients with more comorbidities, with stable overall and progression-free survivals in our series.