Prostatic arterial embolization versus holmium laser enucleation of the prostate: 1-year outcomes.

PURPOSE: Holmium Laser Enucleation of the Prostate (HoLEP) and Prostatic Artery Embolization (PAE) are novel techniques for the treatment of benign prostatic hyperplasia lower urinary tract symptoms (BPH-LUTS). The objective of this study was to describe and compare the functional results and complications of these two techniques at one year follow-up. MATERIALS AND METHODS: We performed a retrospective, monocentric study of all patients consecutively treated in our center with HoLEP or PAE for symptomatic or complicated BPH between January 2016 and December 2019. Data regarding patient and perioperative characteristics, follow-up biological results, functional questionnaires and uroflowmetry were collected from medical records. RESULTS: A total of 490 and 57 patients were treated with HoLEP and PAE, respectively. The demographic and clinical characteristics of the two groups were similar. The operative time was significantly higher for PAE (p < 0.001) and hospitalization time longer after HoLEP (p = 0.0006). The urinary catheterization time was longer after PAE (p < 0.001). The prostatic volume treated was higher with HoLEP than with PAE (56% versus 26%, p < 0.001). The mean difference in IPSS from baseline to 12 months was significantly higher after HoLEP than after PAE: - 17.58 versus - 8 (p < 0.001). The mean difference in QoL-IPSS from baseline to 12 months was significantly higher after HoLEP: - 4.09 versus - 2.27 (p < 0.001). The rate of postoperative adverse events in the first three months was similar between the two groups:35% after HoLEP and 33% after PAE (p = 0.88). CONCLUSIONS: HoLEP and PAE both significantly improved BPH-LUTS, with HoLEP having an advantage over PAE.

The Mayo Adhesive Probability score can help predict intra- and postoperative complications in patients undergoing laparoscopic donor nephrectomy.

PURPOSE: Living donor nephrectomy is a high-stake procedure involving healthy individuals, therefore every effort should be made to define each patient's individualized risk and improve potential donors' information. The aim of this study was to evaluate the interest of the Mayo adhesive probability (MAP) score, an imaging-based score initially designed to estimate the risk of adherent perinephric fat in partial nephrectomy, to predict intra- and postoperative complications of living donor nephrectomy. MATERIALS AND METHODS: We retrospectively reviewed the imaging, clinical, and follow-up data of 452 kidney donors who underwent laparoscopic donor nephrectomy in two academic centers. RESULTS: Imaging and follow-up data were available for 307 kidney donors, among which 44 (14%) had a high MAP score (≥ 3). Intraoperative difficulties were encountered in 50 patients (16%), including difficult dissection (n = 35) and bleeding (n = 17). Conversion to open surgery was required for 13 patients (4.2%). On multivariate analysis, a MAP score ≥ 3 was significantly associated with the risk of intraoperative difficulty [OR 14.12 (5.58-35.7), p < 0.001] or conversion to open surgery [OR 18.96 (3.42-105.14), p = 0.0042]. Postoperative complications were noted in 99 patients (32%), including 12 patients (3.9%) with Clavien-Dindo grade III-IV complications. On multivariate analysis, a high MAP score was also associated with the risk of postoperative complications [OR 2.55 (1.20-5.40), p = 0.01]. CONCLUSIONS: In this retrospective bicentric study, a high MAP score was associated with the risk of intra- and postoperative complications of laparoscopic donor nephrectomy. The MAP score appears of interest in the living donor evaluation process to help improve donors' information and outcomes.

Long-term kidney transplant survival in patients with continent urinary diversion.

OBJECTIVES: To report the long-term survival of transplanted kidneys in patients with a continent urinary diversion. METHODS: Between January 1987 and July 2015, 16 patients with a median age of 37 years (range 21-63 years) underwent kidney transplantation on a continent urinary diversion. A total of 14 patients presented irreversible dysfunction of the lower urinary tract, and two patients had required radical cystectomy because of bladder cancer. All continent urinary diversions were carried out before the transplantation. There were nine Kock pouches, five Mainz pouches, one Mainz neobladder and one Hautmann neobladder. A total of 11 patients had a previous non-continent urinary diversion. Of the transplants, 14 came from brain-dead donors and two from related living donors. RESULTS: The median post-transplantation follow up was 171 months (range 30-298 months). Two patients died, while six patients lost their transplant and resumed hemodialysis. Nine patients (56.2%) were alive with a functional transplant at the end of follow up. The most common allograft complication was acute pyelonephritis, but no graft was lost as a result of urinary diversion complications. The kidney transplant survival rate was 73.3% after 10 years, and 66.6% after 15 years. Among patients who still had a functional transplant at the time of the study, creatinine clearance was >30 mL/min for seven patients and <30 mL/min for two patients. CONCLUSIONS: The present study is the longest series to date of renal transplantation on continent urinary diversions. The long-term outcome shows that the presence of a continent urinary diversion does not reduce transplant survival.

Complications after artificial urinary sphincter implantation in patients with or without prior radiotherapy.

OBJECTIVE: To compare complications after implantation of an artificial urinary sphincter (AUS) in patients with or without prior radiotherapy (RT). PATIENTS AND METHODS: Between January 2000 and December 2011, 160 patients underwent AMS 800 AUS implantation in our institution. We excluded neurological and traumatic causes, implantation on ileal conduit diversion, penoscrotal urethral cuff position and those lost to follow-up. In all, 122 patients were included in the study, 61 with prior RT and 61 without prior RT. All patients underwent the same surgical technique by two different surgeons. All AUS were implanted with a bulbar urethral cuff position. The mean (range) follow-up was 37.25 (1-126) months. RESULTS: In the patients without prior RT and those with prior RT, revision rates were 32.8% vs 29.5%, respectively (P = 0.59). The median time to first revision was 11.7 months. Early complications were similar in the two groups (4.9% vs 6.5%, P = 1). Erosion rates were not significantly different (4.9% vs 13.1%, P = 0.13). However, infection and explantation were more prevalent in patients with prior RT [two (3.2%) vs 10 (16.3%), P = 0.018 and three (4.9%) vs 12 (19.6%), P = 0.016, respectively]. Finally, continence rates were not significantly different [75.4% (without prior RT) vs 63.9% (with prior RT), P = 0.23]. CONCLUSION: AUS is the 'gold standard' treatment of male urinary incontinence after re-education failure in patients with or without prior RT. Our experience showed similar functional outcomes in both groups but a higher rate of major complications in the group with prior RT.

Three-dimensional ultrasound in the management of bladder endometriosis.

STUDY OBJECTIVE: To assess the performance of three-dimensional (3D) ultrasound with color Doppler in the diagnosis of bladder endometriosis compared with magnetic resonance imaging (MRI) and cystoscopy. DESIGN: Canadian Task Force classification II-3. SETTING: Department of gynecology and obstetrics of a university hospital. PATIENTS: Eight women who reported urinary tract symptoms suggestive of bladder endometriosis between May 2012 and November 2013. INTERVENTIONS: For all cases, we assessed the size of the endometriotic nodule, its location on the bladder wall, and the distance between the lesion and the ureteral meatus, with pelvic 3D ultrasound (full bladder), uro-MRI, and cystoscopy. The results were compared with the postoperative histopathologic findings. MEASUREMENTS AND MAIN RESULTS: The pathology results differed from those produced by imaging by a mean ± SD of -3.5 ± 6.4 mm on transvaginal ultrasound (TVUS) and -5.75 ± 11.9 mm) for MRI. There was no significant difference between imaging and pathology findings (p = .20) or between the 2 imaging findings (TVUS and MRI) (p = .73). Results showed a trend toward better accuracy for 3D ultrasound than MRI with smaller SDs (p = .08). Cystoscopy and ultrasound were compared; however, without any tools to assess the distance in cystoscopy, no statistical result was possible. CONCLUSION: Ultrasound seems to be superior to cystoscopy and is at least as effective as MRI in diagnosing and planning the surgery for bladder endometriosis.

Prognostic Implications of Treatment Delays for Patients with Non-muscle-invasive Bladder Cancer.

BACKGROUND: Delay in treatment is a prognostic factor in muscle-invasive bladder cancer. OBJECTIVE: To evaluate clinical outcomes associated with delays in diagnosis and treatment for patients with non-muscle invasive bladder cancer (NMIBC). DESIGN, SETTING, AND PARTICIPANTS: In this retrospective study we analyzed data for patients treated at our center between November 2008 and December 2016 for intermediate risk (IR) or high risk (HR) NMIBC with an additional intravesical treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time delays from diagnosis to first transurethral resection (TT-TUR), from resection to restaging resection (TT-reTUR), and from the last resection to first instillation (TT-INST) of bacillus Calmette-Guérin (BCG) or mitomycin C (MMC) were documented. To identify the interval of time from which recurrence rates significantly increased, we used nonparametric series regression. Recurrence-free survival (RFS) and progression-free survival for patients in each time delay category were compared using the Kaplan-Meier method. Factors associated with tumor recurrence were analyzed in a multivariable model. RESULTS AND LIMITATIONS: A total of 434 patients were included, of whom 168 (38.7%) had IR and 266 (61.3%) had HR NMIBC. Among the patients, 34.6% had reTUR, 63.6% received BCG, and 36.4% received MMC. The median TT-TUR, TT-reTUR, and TT-INST was 4.0 wk, 6.5 wk, and 7.0 wk, respectively. At 40 mo the rate of recurrence was 28.4% and the rate of progression was 7.3%. Nonparametric analysis revealed that each week in delay increased the risk of recurrence, starting from week 6 for TT-TUR for IR and HR cases, and starting from week 7 for TT-INST for IR cases. RFS was significantly lower with TT-TUR > 6 wk among patients in the IR (p < 0.001) and HR (p = 0.04) groups, and with TT-INST >7 wk for patients in the IR group (p = 0.001). TT-reTUR >7 wk had a significant negative impact on progression (p < 0.017). Multivariable analysis revealed that for IR and HR cases, multifocality (p = 0.02 and p = 0.007) and TT-TUR >6 wk (p = 0.001 and p = 0.03) were independent predictors of recurrence, while TT-INST >7 wk predicted recurrence (p = 0.04) for IR NMIBC. CONCLUSIONS: Our results suggest that delays of >6 wk to first TUR in IR and HR NMIBC, and >7 wk to first instillation in IR cases are associated with increases in the risk of recurrence. TT-reTUR of >7 wk is also associated with higher risk of progression. PATIENT SUMMARY: We evaluated the impact of treatment delays on outcomes for patients with intermediate- and high-risk bladder cancer not invading the bladder wall muscle. We found that delays from diagnosis to first bladder resection, from first resection to repeat resection, and from last resection to bladder instillation treatment increase the rates of cancer recurrence and progression. The medical team should avoid delays in treatment, even for low-grade bladder cancer.

Recurrence Rate and Cost Consequence of the Shortage of Bacillus Calmette-Guérin Connaught Strain for Bladder Cancer Patients.

BACKGROUND: Between 2013 and 2016, global production of bacillus Calmette-Guérin (BCG) was dramatically reduced due to the collapse of the factory producing BCG Connaught. OBJECTIVE: To evaluate the clinical and economic impact of BCG shortage on a cohort of non-muscle-invasive bladder cancer (NMIBC) patients treated during the period of restricted supply. DESIGN, SETTING AND PARTICIPANTS: This retrospective, before and after, cost-consequence study included patients with intermediate- and high-risk NMIBC. Those resected between November 2011 and September 2013 (control group) were compared with those resected between October 2013 and December 2016 (study group). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was the rate of tumor recurrence from 30 d after transurethral resection to the end of follow-up at 24 mo; the secondary endpoints included the average cost of primary treatment, average cost of treatment of recurrence, and excess cost due to BCG shortage per patient. RESULTS AND LIMITATIONS: A total of 402 patients were included: 191 in the control group and 211 in the study group. The rate of recurrence at 24 mo was significantly higher in the study group than in the control group (46.9% vs 16.2%; relative risk: 0.7, 95% confidence interval [0.60; 0.82]; p < 0.001). The increased cost due to the decrease in BCG production was estimated to be €783 per patient with a new diagnosis of NMIBC during the period of restricted supply. This is a retrospective analysis at the level of our unit. A more precise evaluation would require a study of a larger cohort of patients. CONCLUSIONS: The shortage of BCG between October 2013 and December 2016 had a significant medical and economic impact; there was an increased rate of bladder cancer recurrence, and the total cost of care for intermediate- and high-risk NMIBC was higher. PATIENT SUMMARY: In this report, we analyzed the medical and economic impact of bacillus Calmette-Guérin (BCG) shortage that occurred between 2013 and 2016. We found a significant increase of bladder cancer recurrence and progression, and an increase in the number of patients who had to be treated by cystectomy. BCG shortage also had a significant impact on the total cost. Since there are no alternatives to BCG for high-risk non-muscle-invasive bladder cancer patients, BCG production has to be maintained by any means.

Effectiveness and Complications of the AMS AdVance™ Male Sling System for the Treatment of Stress Urinary Incontinence: A Prospective Multicenter Study.

OBJECTIVE: To evaluate the effectiveness and tolerance of the AdVance Male Sling System for the treatment of male stress urinary incontinence in patients after prostatic surgery. METHODS: An international, observational, prospective, multicenter study was conducted on male patients with urinary incontinence after prostatic surgery. Patients underwent a 24-hour pad test with a threshold at 250 g. All patients were operated with the same AdVance implant procedure. They were seen 6 weeks later, and examined again at 3, 6, 12, and 24 months. Incontinence was measured using 1-hour and 24-hour pad tests, the number of protective pads used, ICIQ-SF and IQoL questionnaires. Success was defined as no urinary leakage and no pad use. Patient improvement was defined as a reduction of more than 50% in leakage and no more than one pad used per day. Any perioperative and late complications were documented. RESULTS: From January 2007 to November 2012, 113 patients were successfully operated on. At 24 months after surgery, the mean weight of the 1-hour pad test had decreased from 48.7 g to 6.6 g (P < 0.001) while that of the 24-hour pad test decreased to 45.0 g from 113.9 g (P < 0.001). Success and improvement occurred in 22.6% and 58.0% of the patients, respectively. Seventy-five patients (80.6%) used none or one protective pad daily, and the IQoL and ICIQ-SF scores were both significantly improved. Fourteen patients (12.4%) required a second intervention. Three patients (2.7%) had a Clavien IIIb complication. CONCLUSION: The AdVance Male Sling System is an effective treatment for mild to moderate male stress urinary incontinence. Complications from its use are rare and 24-month results are satisfactory.

Holmium laser versus thulium laser enucleation of the prostate: a matched-pair analysis from two centers.

BACKGROUND: The aim of our study was to compare perioperative and functional outcomes of two different prostatic laser enucleation techniques performed in two high-volume centers: 100 W holmium laser enucleation of the prostate (HoLEP) (Lyon, France) and 110 W thulium laser enucleation of the prostate (ThuLEP) (Varese, Italy). MATERIALS AND METHODS: A nonrandomized, observational, retrospective and matched-pair analysis was performed on two homogeneous groups of 117 patients that underwent prostate laser enucleation in the HoLEP or ThuLEP centers between January 2015 and April 2017, following the classical 'three lobes' enucleation technique. The American Society of Anesthesiologists (ASA) score and prostate volume were the main parameters considered for matching the patients between the two groups. Patients on anticoagulant therapy, with documented detrusor hypoactivity or hyperactivity or with the finding of concurrent prostate cancer were excluded from the study. Follow up was assessed at 3, 6 and 12 months after surgery. RESULTS: Median enucleation and morcellation time was 75.5 and 11.5 min, respectively, in the HoLEP group versus 70.5 and 12 min, respectively, in the ThuLEP group (p = 0.001 and 0.49, respectively). Enucleated adenoma weight was comparable (44 g versus 45.6 g, p = 0.60). Energy index (3884.63 versus 4137.35 J/g, p = 0.30) and enucleation index (0.57 versus 0.6 g/min, p = 0.81) were similar in the two groups. Catheterization time was comparable (1 versus 1 day; p = 0.14). The International Prostate Symptom Score and Quality of Life score significantly decreased, as well as maximal urinary flow rate. Median prostate-specific antigen (PSA) drop 1 year after surgery was 2.1 ng/ml in the HoLEP group (-52.83%) versus 1.75 ng/ml in the ThuLEP group (-47.85%) (p = 0.013). CONCLUSION: Both HoLEP (100 W) and ThuLEP (110 W) relieve lower urinary tract symptoms in a comparable way with high efficacy and safety, with negligible clinical differences.

[Left radical nephrectomy in two patients with portal hypertension and splenorenal venous shunt]. / Néphrectomie elargie gauche chez deux patients atteints d'hypertension portale porteurs d'un shunt veineux spléno-rénal.

The authors report two cases of hepatic cirrhosis complicated by portal hypertension with splenorenal venous shunt presenting with left renal tumour that was treated by left radical nephrectomy with preservation of the shunt.

Holmium Laser Enucleation of the Prostate versus Laparoscopic Transcapsular Prostatectomy: Perioperative Results and Three-Month Follow-Up.

PURPOSE: Symptomatic benign prostatic hypertrophy greater than 70 cc used to be treated by invasive procedures. Holmium laser enucleation of prostate (HoLEP) and laparoscopic transcapsular prostatectomy (LTP) are two techniques whose efficacy has been demonstrated compared to standard onesmore invasive standard procedures. The objective was to evaluate and compare perioperative results from these two techniques for the treatment of benign prostatic hypertrophy greater than 70 cc. METHODS: This was a non-randomized retrospective study comparing the HoLEP technique with LTP. From January 2012 to January 2015, 39 patients had HoLEP and 28 had LTP. Perioperative outcomes, complications, and functional results at 3 months were compared. A chi-2 squared test and Student's t test were used for statistical analysis. RESULTS: In multivariate analysis, there was a statistically significant difference in favor of HoLEP for the duration of catheterization (1.9 vs. 3.7 days; p = 0.004) and the average length of stay (2.8 vs. 4.0 days, p = 0.010). There was a trend towards a greater decrease in postoperative hemoglobin levels in LTP (138 vs. 218 g/l; p = 0.082), which was statistically significant in univariate analysis (p = 0.033). Other endpoints were not significant, particularly the enucleated prostate volume compared to the total prostate volume (61.8 vs. 68.4%; p = 0.319) and postoperative complications. CONCLUSION: There was no increased morbidity for LTP compared to the HoLEP technique. However, the HoLEP technique appeared to be a less invasive technique, reducing the duration of catheterization, blood loss, and the average length of stay while maintaining good efficacy for the enucleated prostate volume.

[Complications and functional results of Hautmann ileal bladder in a series of 87 patients]. / Complications et résultats fonctionnels de la vessie iléale de Hautmann: a propos de 87 patients.

OBJECTIVES: To retrospectively evaluate the complications, urinary reservoir function and quality of life of patients with Hautmann ileal bladder after cystectomy for bladder urothelial carcinoma. METHODS: From 1994 to 2004, 87 patients with a mean age of 61.1 years underwent total cystoprostatectomy (n = 85 men) or radical cystectomy (n = 2 women) with Hautmann replacement enterocystoplasty. The mean follow-up was 40.7 months. Continence, quality of voiding, and quality of life were evaluated by self-administered questionnaires (continence questionnaire, DITROVIE score, I-PSS score). RESULTS: The early complication rate was 30.1%, including 6.9% related to the ileal bladder. The late complication rate was 33.6%, including 20.9% related to the ileal bladder. Four patients died during the perioperative period, 14 patients (17%) died from progression of their cancer and 7 patients (8%) died from an independent cause. One patient was lost to follow-up. Questionnaires were sent to 56 patients and 52 replies were received: 96.2% of patients were continent during the day, 53.8% were continent at night. 4.9% of patients performed self-catheterization for chronic urine retention, 90.4% of patients were satisfied with their replacement bladder and only 5.8% of patients had an altered quality of life. CONCLUSION: Despite a considerable morbidity rate and a significant nocturnal incontinence rate, the orthotopic Hautmann W-shaped ileal bladder does not appear to alter the patients' quality of life.

[Renal transplantation techniques in children with impaired patency of the inferior vena cava or iliac vein]. / Techniques de transplantation rénale chez des enfants présentant un trouble de la perméabilité de la veine cave inférieure ou des veines iliaques.

INTRODUCTION: Congenital or acquired disorders of patency of the inferior vena cava (IVC) or iliac veins have been considered for a long time to be an almost insurmountable technical obstacle in paediatric renal transplantation. The authors report their experience based on 7 transplantations performed in children with a disorder of venous patency, in whom renal transplantation was able to be performed. More generally, they also discuss the available technical options based on a review of the literature. MATERIAL AND METHOD: From April 1987 to January 2002, renal transplantation was performed in 7 children with congenital or acquired abnormality of the iliac veins or IVC in our unit. All children underwent radiological assessment by venous Doppler ultrasound before transplantation. The contribution of radiological examinations to the diagnosis, the surgical technique performed, postoperative complications, patient survival and graft survival as well as long-term renal function were studied retrospectively. RESULTS: Four of the 7 transplanted children presented a congenital anomaly of the IVC and 3 had acquired thrombosis. In 5 out of 7 cases, the diagnosis was established before transplantation by Doppler ultrasound (completed by cavography in one case). The transplant renal vein was anastomosed to the iliocaval system in the majority of cases and the portal system had to be used in one case. With a mean follow-up of 94 months, all children have a functioning graft with a mean serum creatinine of 88 micromol/l. CONCLUSIONS: Disorders of patency of the IVC or iliac veins in children waiting for renal transplantation are rare, but these abnormalities can cause problems for the surgical team and compromise graft survival. Radiological assessment of patency of the venous network must help to demonstrated these abnormalities in order to optimally adapt the transplantation technique, which ensures very acceptable graft survival rates.

[Treatment of postoperative male urinary incontinence by INVANCE prosthesis: preliminary results]. / Traitement de l'incontinence urinaire post-opératoire de l'homme par la prothèse INVANCE: résultats préliminaires.

PURPOSE: To evaluate the preliminary results of treatment of postoperative male stress urinary incontinence (SUI) by the INVANCE (AMS) suburethral sling. MATERIAL AND METHODS: From June 2003 to May 2004, 22 patients with stress urinary incontinence secondary to prostatic surgery (13 radical prostatectomies, 7 Ablatherm, 2 transurethral resections of the prostate) were treated by INVANCE sling. The patients presented either grade 1 incontinence (1 to 2 pads per day), or grade 2 incontinence (3 to 4 pads per day), or grade 3 incontinence (5 or more pads per day). The INVANCE process uses a rectangular polyester sling positioned under the bulbar urethra via a perineal incision. It is attached to the 2 ischiopubic rami by 3 titanium screws using a disposable electric screwdriver. Patients were reviewed every 3 months to evaluate the results (continence, Qmax, post-voiding residual volume, IPSS score, quality of life) RESULTS: The mean duration of the procedure was 79 minutes (range: 60-120). No intraoperative incidents were observed. The bladder catheter was removed on D1 (n=20) or D2 (n=2). The mean length of stay was 3.3 days (range: 2-8). Complications consisted of perineal haematoma (n=1), acute urinary retention after catheter removal (n=4), sling infection requiring removal (n=1), and prolonged perineal pain (n=5). No de novo irritative or obstructive urinary tract disorders were observed. With a median follow-up of 12 weeks (range: 3-44), 11 patients were completely continent (50%), 5 patients were significantly improved (22.7%) and 6 patients were considered to be failures (27.3%), 3 of whom had previously received external beam radiotherapy. CONCLUSION: The INVANCE process appears to be a simple and effective option for the treatment of grade 1 and 2 postoperative male stress urinary incontinence.

[Torsion of the renal pedicle after kidney luxation after simultaneous double kidney and pancreas transplantation]. / Torsion du pédicule rénal après luxation du rein dans les suites d'une double transplantation simultanée de rein et de pancréas.

Torsion of a renal transplant around its pedicle is a rare complication, which has been described in renal transplant children with Prune Belly syndrome, but also exceptionally in adults undergoing kidney-pancreas transplantation. One of the diagnostic difficulties is due to the lack of specificity of the clinical features in some cases, which may lead to delayed diagnosis and loss of the kidney due to renal pedicle thrombosis. The authors report a case of a 31-year-old woman undergoing simultaneously kidney-pancreas transplantation, who developed torsion of the renal pedicle following intraperitoneal rotation of the renal transplant several months after transplantation. They discuss the diagnosis and prevention of this exceptional complication.

[Comparative analysis of conservative surgery versus radical nephrectomy for renal cancer]. / Chirurgie conservatrice contre néphrectomie élargie pour cancer du rein: analyse comparative.

OBJECTIVES: To compare the results of conservative surgery (CS) and radical nephrectomy (RN) for the treatment of renal cancer. MATERIAL AND METHOD: Between 1988 and 1999, more than 900 patients were operated for renal cancer in our department. We compared results of CS (partial nephrectomy and/or lumpectomy) to those of RN on 2 groups of matched patients with a similar sample size (n=62) in terms of morbidity, course of renal function, oncological efficacy and survival. RESULTS: The mean follow-up was more than 5 years for the two groups. This series comprised a predominance of localized (pT1 and pT2) low-grade (1 and 2) tumours: 80%. In our experience, CS was responsible for greater morbidity than RN, essentially because of indications of necessity compared to elective indications. Although the local recurrence rate was significantly higher after CS, analysis of overall and specific survival did not reveal any significant difference between the two groups. CONCLUSIONS: Conservative surgery appears to be a reasonable alternative to radical nephrectomy for the treatment of renal cancer in some indications and allows nephron sparing. This option appears to be all the more justified in view of the increasingly frequent discovery of small tumours in increasingly young patients. The development of minimally invasive techniques, particularly laparoscopy, is another aspect of this "minimal" trauma approach, but must be shown to ensure an equivalent oncological efficacy.

Efficacy of the InVance male sling in men with stress urinary incontinence.

OBJECTIVES: To evaluate the efficacy and safety of the InVance bulbourethral sling in male stress urinary incontinence. MATERIALS AND METHODS: Between June 2003 and April 2005, the InVance bulbourethral sling was implanted into 50 patients with urinary incontinence after prostate surgery in 49 cases and pelvic trauma in 1 case. The patients were monitored and evaluated in a prospective manner (continence, tolerance, and satisfaction). The treatment was considered to be successful if the patient stopped wearing any kind of continence pad (patient cured) or only one pad per day (patient improved), with no de novo urinary disorders and without significant postvoid residual urine. Patient satisfaction with the procedure was assessed. RESULTS: After a median follow-up of 6 mo, 50% of patients were dry, 26% had improved, and 24% suffered treatment failure. The success rates for the patients with severe incontinence and those who had undergone radiation therapy were 50% and 25%, respectively. All patients who were dry or had improved were satisfied and presented no obstructive or irritative de novo urinary disorders. The overall success rate for the 51 procedures conducted was 74.5%. Six cases of transitory acute urine retention and six cases of persistent perineal pain were reported. Explantation was necessary because of suppuration of the sling in three patients and of a de novo irritative urinary disorder in one patient. No cases of pubic osteitis or urethral erosion were reported. CONCLUSIONS: The InVance bulbourethral sling procedure makes it possible to treat stress urinary incontinence after prostate surgery with satisfactory and lasting short-term results. Severe incontinence and a past history of pelvic radiation therapy seem to be factors contributing to the failure of this procedure.

Treatment of uretero-intestinal and ureterovesical strictures by Acucise balloon catheter.

OBJECTIVE: Acucise balloon catheter has been proposed as an alternative to open surgery for the treatment of strictures of the ureteropelvic junction because of its low morbidity and the short hospital stay following the endoscopic procedure. The objective of this study was to evaluate the results of this technique applied to patients developing strictures after surgical reimplantation of the ureterovesical (UV) or uretero-intestinal (UI) junction. MATERIAL AND METHODS: Between March 1997 and January 2000, 12 strictures (11 patients) were treated by Acucise balloon catheter via an antegrade and/or retrograde approach with double J stenting for an average of 6 weeks (range: 4-12 weeks): six uretero-ileal strictures (three Bricker, one uretero-ileoplasty, one enterocystoplasty and one Kock pouch) and six ureterovesical strictures (Lich-Grégoir or Paquin UV reimplantations after gynaecological, vascular or endoscopic surgery). The median postoperative follow-up was 16 months (range: 10-36 months). A good result was defined by the absence of recurrence of the stricture evaluated both clinically and radiologically (regression of stasis measured by IVU and/or ultrasonography). RESULTS: The mean operating time was 70 minutes and the mean hospital stay was 4.8 days (range: 3-14 days). Only one intraoperative complication was observed (migration of the double J stent to the kidney). The operation was successful in eight patients (75%). The success rate was 83% for ureterovesical strictures and 50% for uretero-ileal strictures. A history of previous irradiation appeared to be a factor of failure. CONCLUSION: The Acucise procedure is a minimally invasive and effective (75% success rate) treatment option for the treatment of postoperative stricture after ureteric reimplantations. In our department, this option is considered to be first-line treatment, as surgical reimplantation is reserved for failures of the endoscopic technique.