[Ambulatory prostate photoselective vaporisation with GreenLight laser (180W): prospective evaluation from 115 patients]. / Vaporisation laser prostatique par GreenLight (180 W) en ambulatoire: évaluation prospective sur 115 patients.

OBJECTIVE: The goal of this prospective study was the evaluation of ambulatory (less than 12h) prostate photoselective vaporisation (PVP) with GreenLight laser XPS. MATERIEL AND METHODS: One hundred and fifteen consecutive patients eligible for ambulatory procedure according to selective criteria (age less than 80, no anticoagulation treatment, no diabetes, patient not alone at home) who underwent ambulatory PVP from 1st May 2012 to 30th June 2013 have been evaluated. The principal criterion was the success rate of ambulatory. Secondary criteria were 3 months functional results and complication rate and satisfaction rate on ambulatory procedure. RESULTS: Around 93.1% patients were successfully treated in ambulatory procedure. The main reason of failure was organizational. There were 2 conversions in monopolar resection and one operative complication. At 3 months, there were 11.5% grade 2 complications with 3.48% rehospitalizations and no reintervention. CONCLUSION: This study demonstrates the feasibility of ambulatory PVP. This procedure should be proposed to selected patients.

[Magnetic resonance imaging and preoperative evaluation of cancer of the kidney. The results apropos of 60 cases]. / Imagerie par résonance magnétique et bilan pré-opératoire des cancers du rein. Résultats à propos de soixante cas.

Sixty renal carcinomas confirmed at surgery or autopsy were studied. Capsular effraction, present in 17 cases, was well assessed in 8 cases, under staged in 8 cases and over staged in 5 cases (sensitivity 47%, specificity 88%). Renal vein involvement was present in 11 cases. In 8 of these 11 cases, a thrombus was present in the inferior vena cava. MRI detected a thrombus in the renal veins in 10/11 cases and in 7/8 cases of caval invasion. The false negative case was due to a huge right upper pole tumor laminating the inferior vena cava. The false positive case was due to an enlarged lymph node compressing the inferior vena cava. Cranial extension of the thrombus was well assessed in 6 of the 7 cases. One thrombus in the right atrium was missed. Lymph node involvement was present in 10 cases and correctly diagnosed by MRI in 7 cases. Three false negative cases were noted, because of microscopic invasion in non enlarged lymph nodes. Adjacent organ invasion, present in 2 cases, was detected in 1 case of liver invasion. Initial results of MRI seem very promising and at present, the best indications of MRI in pre-operative evaluation of a renal carcinoma are assessment of caval extension and spread to adjacent organs in patients with large tumors.

[Cancer of the kidney: venous staging using magnetic resonance imaging]. / Cancers du rein: bilan d'extension veineuse en imagerie par résonance magnétique.

Venous tumor invasion in 42 renal cell carcinomas was evaluated by MRI. A correct diagnosis of renal vein and inferior vena cava (IVC) involvement was made in 14 of 17 tumors: 1 false negative diagnosis of right renal vein invasion was due to a double renal vein in which the inferior vein (identified by MRI) was not involved; 2 cases of IVC involvement were understaged (1 case of suprahepatic extension) or not identified (the false negative of renal vein invasion previously described). One false positive (among 31 tumors without venous invasion) was reported in a case of a large tumor in which the compressed but free right renal vein was overevaluated by MRI.

[[Neoadjuvant chemotherapy (cisplatin, doxorubicin, cyclophosphamide) in the treatment of invasive urothelial tumors of the bladder. Preliminary results of a prospective study concerning 22 patients]. / Chimiothérapie néoadjuvante (cisplatine, doxorubicine, cyclophosphamide) dans le traitement des tumeurs urothéliales infiltrantes de vessie. Résultats préliminaires d'une étude prospective portant sur vingt-deux patients.

Twenty two patients with transitional cell bladder carcinoma (T greater than or equal to 2 Mo) received 2 or 3 courses of systemic chemotherapy (cyclophosphamide 600 mg/m2, doxorubicin 60 mg/m2, cisplatinum 100 mg/m2) prior to total (18) or partial (18) cystectomy. Response rate was appreciated on the pathologic findings of the surgically removed bladders (pTNM): 5 tumor progression (23%); 8 tumor stability (36%); 3 partial remission (14%); 4 complete remission (18%), 2 pTo after complete transurethral resection (9%). These results lead us to conclude that: the rate of tumor progression and stability was too high. Further experience will require a more effective preoperative treatment; clinical staging dramatically underestimates tumor spread; prognosis of non responders is quite poor: 7 deaths with a maximum follow-up of 6 months.

[Treatment and course of advanced bladder cancers. Retrospective study of 29 cases]. / Traitement et évolution des cancers de vessie évolués. Etude rétrospective de vingt-neuf cas.

A retrospective study of 29 patients with extensive but non metastatic bladder cancer (T234N+ M0) demonstrated once more the dreadful prognosis of advanced bladder cancer. Only 4 patients are alive without evidence of recurrence with a follow up of 12 to 64 months. The 11 patients whose tumor was too extended for radical cystectomy had a similar survival rate and better quality of survival than the 18 patients who underwent total cystectomy. Recurrence appears quickly (mean time : 11 months) and is mostly metastatic. This study led us to change our therapeutic attitude. We now use systemic preoperative polychemotherapy and we no longer perform radical cystectomy in bulky nodal metastasis.