Learning curve in flexible ureteroscopy for renal stones: A propensity score-matched study.

OBJECTIVE: To assess the learning curve and evaluate the impact of surgical experience related to the outcomes of flexible ureteroscopy (fURS) for upper urinary tract stones. METHOD: We evaluated retrospectively lithiasis fURS performed in our institution between January 2004 and December 2020. Patients were divided into two groups by the number of procedures performed by surgeon. Group 1 (G1) included the first 50 procedures, and group 2 (G2) the next cases. These groups were matched on baseline characteristics by a propensity score. Stones free rate (SFR) and complication rate (CR) were compared. Learning curves were realized using logistic curve with 95% confidence interval. RESULTS: After criteria exclusion and propensity score matching, 1548 procedures were analyzed (1:1, G1 and G2, n=774 procedures). A total of 29 surgeons were evaluated. The overall SFR was 68.4% without statistical difference between the two groups (G1=67.9% vs. G2=68.8%, P=0.72). The surgeon's experience was not associated with SFR (OR=1.15, 95% CI: 0.90-1.47), except in subgroup stones>2cm (OR=2.89, 95% CI: 1.29-6.46). The overall CR was 12.5%, mainly Clavien-Dindo grade I-II complications (96.2%). Surgical experience was not associated with CR (OR=1.06, 95% CI: 0.77-1.45). The overall logistic curves for probability of stone clearance and complication tended to be a flat slope. CONCLUSION: Impact of surgical experience on fURS for UUTS was not associated with SFR and CR. However, for stones larger than 2cm, surgeon's experience tended to be associated with SFR, but without impact on overall complications.

[Sacral neuromodulation as treatment of non-neurological vesical emptying disorders]. / Neuromodulation sacree dans le traitement des troubles non neurologiques de la vidange vesicale.

GOAL: The goal was to evaluate the results of sacral neuromodulation (SNM) in non-neurological vesical emptying disorders. PATIENTS AND METHODS: From February 2010 to October 2017, 28 patients presenting voiding symptoms or a non-obstructive chronic urine retention without neurological cause have been operated for an SNM (test phase). The test was positive in case of decreased number of proper intermittent self-catheterization (SC) or post-voiding residual urine (PVR) of at least 50 %. A 100 % positive result meant the return to a spontaneous voiding without SC with a non-significative PVR (<100ml). RESULTS: The median follow-up was of 53.2±21.2 months. Twenty-four (85.7%) tests were positive, from which twenty-two (78.6%) were 100% positive. 16 (84.2%) out of 19 patients with SC had spontaneous voiding without PVR. The number of daily SC decreased from 4.6±1.5 to 0.4±1.2 in post-operative (P<0.001). The PVR was of 287.1±170.4ml vs. 30.4±48.6ml in post-operative (P<0.001). Fourteen patients (58.3%) underwent at least one chirurgical revision or a removal of material ; mainly for loss of efficiency, end of battery, electrode migration and pain on material. At the end of the follow-up, 70.8% of the responding patients had their device still efficient. CONCLUSION: Results showed that SNM appears to be an efficient treatment of non-neurological emptying vesical troubles. Nevertheless, the re-operation rate was still significant. LEVEL OF EVIDENCE: 3.

Impact of blood transfusion on survival after nephrectomy for localized or locally advanced renal cancer.

OBJECTIVE: Several studies have reported blood transfusion were associated with a decrease of survival after oncological surgery. For kidney cancer, the effect of blood transfusion is still debated. The objective of this study was to determine the effect of blood transfusion after oncological nephrectomy on overall, specific and recurrence-free survival in a retrospective cohort of localized or locally advanced kidney cancer. MATERIAL AND METHODS: We performed a monocentric retrospective analysis of all patients managed by surgery for localized or locally advanced renal cancer between January 2000 and December 2016. We compared overall and specific survival and recurrence-free survival between two groups: patients transfused and not transfused. Demographic, surgical and tumor characteristics were compared. Survival analyses were performed using univariate Cox regression and multivariate Cox proportional regression test. RESULTS: We included 382 patients in this study: 320 (83.8%) were not transfused and 62 (16.2%) were transfused. Transfused patients were significantly older (P=0.001) and had a lower pre-operative hemoglobin level (P=0.008). Operative and oncological characteristics were also different between both groups. In univariate analysis, we showed that blood transfusion was associated with lower overall survival (P<0.001), specific survival (P<0.001), and recurrence-free survival (P<0.001). In multivariate analysis, we found that blood transfusion was not associated with overall survival, or specific survival, but it was associated with lower recurrence-free survival (HR: 1.967, CI95% [1.024-3.780], P=0.042). CONCLUSIONS: Perioperative blood transfusion is an independent risk factor that increases tumor recurrence among patients treated with nephrectomy for renal cancer.

[Postoperative complications and long-term outcomes of transplantation with expended criteria donors transplants]. / Complications chirurgicales et résultats à long terme des transplantations rénales avec transplants à critères élargis.

OBJECTIVE: The objective of this study was to analyze early, late complications and outcomes following expended criteria donors (ECD) kidney transplantation compared to standard donors. MATERIALS AND METHODS: We performed a retrospective study including 470 patients who received a kidney transplant between 2005 and 2016. Expended criteria donors were defined following the United Network of Organ Sharing criteria. In each group, length of stay, delayed graft function, surgical site infection, acute rejection, surgical complications by type and according to Clavien and Dindo classification were analyzed in univariate and multivariate analysis. The impact of ECD transplant on transplant and patient survival was assessed using a Cox proportional regression model. RESULTS: One hundred and ninety seven (41.9%) patients received ECD kidney. The mean follow-up was 61,4 months (22.4-93.89). Patients with ECD transplant presented more delayed graft function (HR=2.1 (1.1-3.68), P=0.008) but the rate of complications including surgical complications was not different. Patients and transplant survival were decreased in ECD transplant group (P=0.005 et 0.001 respectively). In multivariate analysis ECD kidney was an independent factor only associated with decreased transplant survival (HR=1.81 (1.1-2.98), P=0.029) but not with patient survival. CONCLUSION: ECD kidney transplantation was not associated with increased postoperative complications but a higher rate of delayed graft function. Nevertheless, it was associated with a decreased transplant survival. The use of pulsatile perfusion machine for explanted criteria transplant should be evaluated to improve these results.

[Concordances and predictors of biopsies in renal tumors]. / Concordances et facteurs prédictifs des biopsies dans les tumeurs rénales.

AIM: Evaluate the concordance between the renal lesions biopsy's histology and the final histology of the surgical specimen according to histological subtype, and search for predictive factors of non-concordance. MATERIAL: We performed a monocentric retrospective study that included 156 patients suffering from a renal tumor that benefited a lesion biopsy before surgical treatment. Sensibility and specificity of the renal lesion's biopsy for histological diagnostic of the different renal tumors where calculated. RESULTS: One hundred and fifty-eight renal tumor biopsies were realized between 2001 and 2016. One hundred and forty-three renal cell carcinoma were found on the surgical piece, 135 were diagnosed on prior biopsy. Global concordance rate was 88%. For the establishment of the nuclear Fuhrmann grade, the concordance rate (low vs. high grade) was 72.9%. The cohort was divided into 2 groups according to the existence (group 1, n=139) or the absence (group 2, n=19) of concordance. Group 1 and 2 differed by the predominance of men in group 1 (66% vs. 37%, P=0.013), distance between the sinus and the tumor above 4mm (65% vs. 42%, P=0.05). CONCLUSION: In renal tumor care, renal biopsy is a reliable testing. However, some factors most likely linked to the tumor anatomy (intra-sinusal tumor) and their histological composition were involved in the lack of non-contribution to the diagnosis. LEVEL OF EVIDENCE: 4.

[Flexible ureterorenoscopy vs percutaneous nephrolithotomy for renal stone management: Retrospective study]. / Étude rétrospective comparant la néphrolithotomie percutanée et l'uréterorénoscopie souple pour le traitement des calculs intrarénaux.

PURPOSE: The aim of this study was to evaluate the efficacy and tolerance of renal stone fragmentation by flexible ureterorenoscopy (URS), compared to percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: Patients treated between 1998 and 2010 by URS and PCNL for intrarenal stone were reviewed. Patients' and stones' characteristics were analyzed. The preoperative parameters were reported as well as the procedure's efficiency and its complications. Success was defined by the absence of residual lithiasis visualized on renal imaging at 6 months of follow-up. RESULTS: Among 531 patients included, there were 159 PCNL and 372 URS. The mean duration of hospitalization after PCNL was 8±4.6 days and 3±1.7 days after URS. The mean stones' size was higher in the PCNL group (19.9±7.5mm) than for the URS group (9.7±5.6mm; P<0.0001). The stone-free rate was significantly better in the PCNL group for stones measuring between 10 and 20mm (P<0.0001) and for stones of more than 20mm (P=0.017). Postoperative complications were significantly more frequent (27 %) and more severe (8.8 % vs Clavien III and IV) in the PCNL, than in the URS group, respectively (P=0.0001). CONCLUSION: PCNL is a successful technique for renal stone fragmentation. However, URS seemed more tolerated despite a lower stone-free rate. LEVEL OF EVIDENCE: 4.

[Impact of obesity on pathologic outcomes and biochemical reccurence after radical prostatectomy]. / Effets de l'obesité sur les résultats anatomopathologiques de la prostatectomie totale et sur la survie sans recidive biologique.

OBJECTIVE: To determine whether obesity is associated with adverse pathologic characteristics, positive surgical margins and the biochemical recurrence free survival (bRFS) after primary treatment with radical prostatectomy (RP). PATIENTS AND METHODS: Medical charts of patients managed with RP between 1999 and 2011 for localized prostate cancer (PCa) were retrospectively reviewed. Population study was split into two groups according to the body mass index (BMI): non obese (BMI< 30 kg/m(2)) and obese (BMI ≥ 30 kg/m(2)). Correlations between obesity and adverse pathological features or bRFS were assessed using univariable and multivariable analyses. RESULTS: Overall, 328 patients were included in the present study: 278 (84.8%) obese and 50 (15.2%) non obese. In multivariable analysis, obesity was associated with positive surgical margins (P=0.014), extracapsular extension (P=0.004) and pathologic Gleason score ≥ 7 (P=0.048). Obesity was not associated with seminal vesicle invasion (P=0.636) and lymph node metastasis (P=0.132). After a mean follow-up of 60.51 ± 28.82 months, no statistical difference in terms of bRFS was observed between the two groups (P=0.186). Furthermore, obesity was not an independent predictor of bFS in multivariable analysis. CONCLUSION: Obesity was associated with adverse pathologic characteristics and positive surgical margins but no statistical correlation was found with bRFS. LEVEL OF EVIDENCE: 5.

[Evaluation of the activity of a urological emergency unit in university hospital]. / Évaluation de l'activité d'une unité d'urgences urologiques en centre hospitalier universitaire.

AIM OF THE STUDY: To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. PATIENTS AND METHODS: In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. RESULTS: During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. CONCLUSION: The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount.

[Update for the management of kidney stones in 2013. Lithiasis Committee of the French Association of Urology]. / Mise au point sur la prise en charge des calculs du rein en 2013. Comité Lithiase de l'Association française d'urologie.

Since the publication of the latest recommendations of the Lithiasis Comity of the French Association of Urology (CLAFU) on the management of ureteral and renal stones, practices have evolved. This text provides an update for the treatment of kidney stones. It is especially the important advances in the field of laser-ureterorenoscopy that changed practices. Percutaneous nephrolithotomy has been enriched by technical modifications and extracorporeal shockwave lithotripsy confirmed its predominant place in the first line of treatment. For stones less than 20mm, extracorporeal lithotripsy remains the standard, but in some cases the possibility of recommending a flexible ureterorenoscopy is possible in first line. For stones more than 20mm, percutaneous nephrolithotomy is the standard treatment, but optional flexible ureteroscopy and extracorporeal lithotripsy are possible. The treatment carried out, collect the stone fragments for a morpho-constitutional analysis and achieve a metabolic evaluation is necessary, to investigate etiologic and give dietary advices to prevent recurrence.

[Flexible ureterorenoscopy in obese patients: results from a large monocenter cohort]. / Urétérorénoscopie souple avec laser Holmium-YAG dans la prise en charge des lithiases urinaires chez le patient obèse: résultats d'une cohorte monocentrique.

OBJECTIVE: To analyze results and morbidity after flexible ureterorenoscopy (fURS) in patients with a body mass index (BMI)>30 kg/m² and to compare with results obtained in a large cohort of non-obese patients. METHODS: We conducted a retrospective monocenter study including all fURS for urinary lithiasis performed in our institution between January 2004 and December 2010. During the study period, 497 procedures were performed. Twenty-three had to be excluded because of missing data on BMI. Thus, a total of 474 procedures were included in the final analysis, 93 for obese patients (OP) and 381 for non-obese patients (NOP). Characteristics of the patients, stones and procedures were analyzed. Success was defined as clear imaging (completely stone-free) on renal tomography and ultrasonography. RESULTS: Mean BMI was 33.5 ± 0.3 in OP vs 23.9 ± 0.1 kg/m² in NOP (P<0.0001). Mean stone size, location, and composition were not significantly different between groups. Technical aspects (operative time, ureteral dilatation, access sheath, monobloc extraction) were also similar in OP and NOP. The immediate (63.5% for OP vs 66.1% in NOP, P=0.62) and follow-up (65.1% for OP vs 71% in NOP, P=0.26) stone-free rate were not significantly different between the groups. For stone size<1cm, SFR raised to 77% in OP vs 83% in NOP (P=0.28). The rate of minor complications Clavien II was similar in OP (7.5%) and NOP (12%). No major complication (Clavien III or IV) was observed. CONCLUSION: fURS is a safe and efficient option for the management of urinary lithiasis in obese patients.

[Existence of pattern 5 on radical prostatectomy: poor prognostic factor associated with a lower biochemical recurrence-free survival]. / Existence de grade 5 sur pièce de prostatectomie totale: facteur de mauvais pronostic associé à une moindre survie sans récidive biologique.

OBJECTIVES: To analyze the impact of the existence of Gleason grade 5 on the adverse pathology and biochemical recurrence-free survival of patients. PATIENTS: Three hundred and seventy-two prostatectomies were performed between 1999 and 2011 in our institution for localised prostate adenocarcinoma. We examined the existence of grade 5 of the specimen to determine the reliability of prostate biopsies in the diagnosis of grade 5 and the association of grade 5 with other histoprognostic factors. Biochemical recurrence-free survival was analyzed according to the presence of grade 5 in the final specimen. RESULTS: In total, all histological data and biochemical recurrence-free survival were available for 321 patients who were included in the study. Sixty-eight had Gleason grade 5 (majority or third minority pattern) on the specimen while 253 had not. Grade 5, rarely diagnosed on biopsy (sensitivity=26.47 %) was correlated independently with the extracapsular extension (OR=2.1; CI 95 [1.1-3.9]), the seminal vesicle invasion (OR=3.8; CI 95 [1.7-8.7]) and positive surgical margins (OR=2.0; CI 95 [1.1-3.6]). Overall survival was similar in both groups but the biochemical recurrence-free survival was statistically lower in the presence of grade 5 (HR=3.7; CI 95 [1.8-7.6]). Biochemical recurrence-free survival was not different than grade 5 is predominant or third minority pattern (HR=1.01; CI 95 [0.3-2.8]). On multivariate analysis, grade 5 was an independent risk factor for biochemical recurrence (P=0.005) as well as seminal vesicle invasion (P=0.047). CONCLUSION: The existence of grade 5 in the surgical specimen whatever the percentage was a poor prognostic factor associated with increased tumor aggressiveness and reduced biochemical recurrence-free survival. LEVEL OF EVIDENCE: 5.

[Management of adult's renal and ureteral stones. Update of the Lithiasis Committee of the French Association of Urology (CLAFU). General considerations]. / Prise en charge urologique des calculs rénaux et urétéraux de l'adulte. Mise au point du Comité Lithiase de l'Association Française d'Urologie (CLAFU). Aspects généraux.

The Lithiasis Committee of the French Association of Urology (CLAFU) aimed to update the current knowledge about urolithiasis. This update will be divided into four parts: 1) general considerations; 2) the management of ureteral stones; 3) the management of kidney stones; 4) metabolic assessment and medical treatment of urolithiasis. Recent technicals advances helped the urologists to improve stones management: new extracorporeal shockwave lithotripsy (ESWL) devices, new flexible ureterorenoscopes, development of laser fragmentation. ESWL, semi-rigid and flexible ureteroscopy and the percutaneous nephrolithotomy (PCNL) remain currently the main therapeutic options. The first part of this update deals with the description and classification of stones, preoperative assessment, post-operative management and clinical follow-up. Main criteria of therapeutic choices are stone location, stone composition and stone size. Stone composition is assessed with infrared spectrophotometry analysis and its hardness is correlated with U.H. density on CT scan assessment. Preoperative assessment consists in urinary cytobacteriological examine, urinary PH, blood creatininemia, hemostasis. Low-dose CT scan is recommended before urological treatment. The result of the treatment must be done 1 or 3 months later with plain abdominal film and ultrasonography. Medical management of urolithiasis will be based on stone composition, metabolic and nutritional evaluation. Treatment success is definited by absence of residual fragments. Annual follow-up is recommended and based either on plain abdominal film and ultrasonography or low-dose CT scan.

[Place of the flexible ureterorenoscopy first choice for the treatment of kidney stones. Survey results practice committee of the AFU lithiasis completed in 2011]. / Place de l'urétérorénoscopie souple en première intention pour le traitement des calculs du rein. Résultats de l'enquête de pratique du comité lithiase de l'AFU réalisée en 2011.

UNLABELLED: The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation. METHODS: Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney. RESULTS: Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient. CONCLUSION: The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL).

[Accuracy of prostate biopsies to evaluate tumor location in prostate cancer]. / Fiabilité des biopsies prostatiques pour l'étude de la topographie tumorale dans le cancer de prostate.

INTRODUCTION: The therapeutic approach of prostate cancer depends mainly on pathological criteria obtained through prostate biopsy. The low accuracy of prostate biopsy for Gleason grade determination is well known but its accuracy for bilateral or multifocal tumor has not been evaluated. The goal of this study was to assess the concordance between prostate biopsy and whole prostate specimen obtained after radical prostatectomy especially for bilateral and/or multifocal tumor. METHODS: We retrospectively compared the pathological results of prostate biopsy cores to the prostate specimen in patients who underwent radical prostatectomy in our department between the 01/01/1999 and the 31/12/2008. The criteria analyzed were the Gleason score, tumor bilaterality or multifocality. The impact of the number of prostate biopsy cores was also analyzed. RESULTS: Two hundred and five complete histological records were studied. Regarding the Gleason score overall concordance was 55%. In 38%, prostate biopsies downgraded the Gleason score. This concordance decreased with tumor differentiation (90.6% for Gleason 6 vs. 31% for Gleason greater than 7). For the tumor bilaterality, 78% of cancers affected both lobes at the definitive specimen analysis while only 49% were bilateral at prostate biopsies, achieving a concordance of 61%. Multifocal disease was observed in 36% at definitive pathology analysis with low concordance with prostate biopsies (36%). The number of biopsies increased the concordance for the Gleason score (60 to 81% for Gleason 7 and from 28 to 50% for Gleason greater than 7) and tumor location (44 to 70%). CONCLUSION: Pathological criteria and tumor mapping obtained from prostate biopsies were not very reliable especially when the tumor was poorly differentiated. An increased number of prostate biopsy core improved the sensitivity and specificity for the Gleason score diagnostic and of the tumor mapping.

[Urinary complications of one-stitch ureteroneocystostomy in renal transplantation]. / Complications urinaires après réimplantation urétérovésicale selon la technique du "one-stitch" en transplantation rénale.

PURPOSE: To assess urinary complications related to the "one-stitch" technique extravesical ureteroneocystostomy in renal transplantation, and evaluate the impact of such complications on kidney graft and patient survival. PATIENTS AND METHODS: A single-institution, retrospective study was performed on 202 renal transplant recipients, from January 2004 to December 2008. Two combined kidney and liver transplantations were excluded. The "one-stitch" extravesical ureteroneocystostomy technique, fast and easy to perform, was systematically used. The evaluated urinary complications were urinary fistula, ureteral stenosis, symptomatic ureteral reflux, stone formation and complicated hematuria. We tried to point out factors impacting urinary complications occurrence and studied grafts and patients survival according to the existence of urinary complications. RESULTS: Fifty-five patients presented urinary complications (27.5%). The most frequent urinary complications were complicated hematuria (36 over 200, 18%), ureteral stenosis (15 over 200, 7.5%). Few cases of stone disease (one over 200, 0.5%), urinary fistula (two over 200, 1%) and symptomatic ureteral reflux (one over 200, 0.5%) were noted. Male gender (100 vs 34, P=0.95), age (46.78 ± 14.17 vs 48.06 ± 14.19 years, P=0.58), Body mass index (24.14 ± 5.04 vs 24.28 ± 4.83, P=0.86) and past history of renal transplantations (16 ± 3% vs 10 ± 3%, P=0.27) as well as cold ischemia time (17.08 ± 7.07 vs 16.9 ± 8.95 hours, P=0.71) were not significantly different in the urinary complications group and the non-urinary complications group. Median hospitalization time was similar in both groups (14 vs 12 days, P=0.37). The existence of urinary complications didn't affect the 5 years kidney graft survival (91.9% vs 89.9%, HR 1.21, CI 95% [0.37-3.3], P=0.83) neither the 5 years patient survival (94.8% vs 92.15%, HR 0.52 CI 95% [0.13-2.07], P=0.85). CONCLUSION: If benign urinary complications in "one-stitch" ureteroneocystostomy were frequent in our study (17% grade II Clavien Dindo), kidney graft and patients survivals were not affected.

[Muscularis mucosae invasion: prognostic factor for intravesical BCG immunotherapy failure for T1 bladder carcinoma]. / Atteinte de la Muscularis Mucosae dans les tumeurs urothéliales T1 de vessie : facteur pronostique de progression après immunothérapie par BCG.

OBJECTIVES: To study the prognostic impact of muscularis mucosae (MM) invasion for pT1 bladder cancer treated by transurethral resection (TUR) and adjuvant Bacille Calmette-Guerin (BCG) intravesical immunotherapy. METHODS: Sixty-six patients treated by BCG intravesical instillations were substaged into pT1a and pT1b, regarding Muscularis Mucosae invasion. Tumor grade, associated carcinoma in situ (CIS), multifocality, tumoral size up to 3cm, BCG maintenance were noted. With a mean follow-up of 50.5±38 months, we studied recurrence, progression, overall and specific survival. Cox's model method was used for multivariate analysis. RESULTS: Tumor recurrence was observed in 30±7% and 43±10% (P=0.29) and tumor progression in 16.3±5% and 39±10% (P=0.04) for pT1a and pT1b. The rate of progression was higher (P=0.04) and progression free survival was decreased (P=0.04) for pT1b. Specific death rates were 11±5% and 21±9% (P=0.28), median overall survival was 80.9 [1.5-92] and 48.2 [12-93] months for pT1a and pT1b. Overall and specific survival weren't different between the two populations (P=0.38; P=0.3). Cystectomy rates were 2.3±2% and 30±9% for pT1a and PT1b (P=0.0006). For pT1a patients, recurrence (P=0.8) or progression rates (P=0.64) were no different regarding BCG maintenance immunotherapy but pT1b population had a better progression free survival with BCG maintenance than without (P=0.0051). Only CIS had prognostic value in multivariate analysis. CONCLUSIONS: Tumors with Muscularis Mucosae invasion have a higher risk of progression and BCG failure. Maintenance immunotherapy should be given to improve results with these patients.

[Management of renal colic in pregnant women, based on a series of 48 cases]. / Prise en charge de la colique néphrétique chez la femme enceinte: à propos de 48 cas.

INTRODUCTION: Urinary stones are relatively frequent in pregnant women and raise specific diagnostic and therapeutic problems. The authors conducted a retrospective review of the management of this disease in their establishment. PATIENTS AND METHODS: Between January 1999 and December 2003, out of a total of 10,398 parturients, 48 pregnant women were hospitalised for renal colic, that is, incidence of 0.04%. The medical records of these patients were retrospectively reviewed and clinical, laboratory, treatment and outcome data were analysed. RESULTS: Standard analgesic treatment, comprising paracetamol and an antispasmodic, achieved pain relief in 84% of cases. A concomitant short course of corticosteroid therapy in cases of renal colic refractory to standard treatment was effective in 71% of patients and allowed deferral of surgical management in five out of seven cases. A double J stent was placed in all patients requiring urinary diversion, followed by closer ultrasound and bacteriological monitoring throughout pregnancy. Only two patients required surgical management of their stone after delivery. The only obstetric event related to renal colic was induction of labour at term in two cases because of foetal distress. CONCLUSION: The authors propose a two-stage management plan for renal colic in pregnant women resulting in a low maternal and foetal complication rate.

Protein kinase C signalling pathway is involved in the regulation of vascular endothelial growth factor expression in human bladder transitional carcinoma cells.

Vascular endothelial growth factor (VEGF) is a potent angiogenic factor associated with the growth and metastasis of various cancers and plays a prominent role in vesical angiogenesis regulation. In this study, we investigated the effect of the phorbol 12-myristate 13-acetate (PMA) on the expression of VEGF in human bladder transitional carcinoma cells (RT4). RT4 cells expressed three VEGF isoforms (VEGF(189), VEGF(165), VEGF(121)). PMA increased VEGF mRNA expression time-dependently with a peak at 4 h. PMA increased the half-life of VEGF mRNA. The amount of VEGF protein in conditioned media was increased by PMA in a dose-dependent manner with a maximal effect at 10(-7) M. Staurosporine and calphostin C (PKC inhibitors) decreased PMA-induced VEGF mRNA expression as opposed to protein kinase A or cyclic nucleotide-dependent protein kinase inhibitors. Thus, in RT4 cells, VEGF expression is up-regulated by PMA via the PKC signalling pathway and according to a posttranscriptional mechanism.

Relationship between expansion of the CAG repeat in exon 1 of the androgen receptor gene and idiopathic male infertility.

OBJECTIVE: To determine whether expansion of CAG repeats in exon 1 of the androgen receptor is correlated with impaired spermatogenesis in patients with male idiopathic infertility. DESIGN: A retrospective study. SETTING: Medical school in Besançon, France. PARTICIPANT(S): Thirty-seven infertile patients with azoospermia or oligospermia and 50 fertile controls. INTERVENTION(S): History, physical, hormonal assays, semen analysis, and collection of blood samples in order to study the androgen receptor's gene. MAIN OUTCOME MEASURE(S): Blood samples were collected from each infertile patient and control. The length of the CAG repeat segment was evaluated by using polymerase chain reaction (PCR) electrophoresis in exon 1 and PCR single-strand conformation polymorphism in exons 2-8. RESULT(S): The mean length of the CAG repeats was significantly different between infertile and fertile patients (23.91 +/- 0.5 vs. 22.20 +/- 0.4). No mutation was detected in exons 2-8 of the androgen receptor gene in infertile patients. CONCLUSION(S): Expansion of the CAG repeat segment of the androgen receptor is correlated with male idiopathic infertility. The number of CAG repeats may therefore have a modulatory effect on normal androgen receptor function.

[Idiopathic male infertility and androgen receptors]. / Infertilité masculine idiopathique et récepteur aux androgènes.

In France, 12 to 15% of couples experience procreation difficulties. A disorder of spermatogenesis (oligospermia, azoospermia) is responsible in 1/3 of cases. These forms of infertility, labelled idiopathic, probably have a genetic component, like microdeletions of the Y chromosome. The normal rate of circulating androgens suggests the implication, in some cases, of an abnormality from the receptor to the androgens (RA) of these male infertilities, whose number remains to be defined. Point mutations on exons of the gene encoding the AR cannot account for all cases of infertility due to idiopathic disorders of spermatogenesis. Expansion of the number of CAG triplets of exon 1 of the AR gene, already demonstrated in a fatal degenerative neuropathy (Kennedy's disease, in which more than 50% of patients are infertile), has been detected in these cases of idiopathic infertility and would be responsible for AR dysfunction. The number of these triplets is also decreased in patients with androgen-dependent prostate cancer. The polymorphism of repetition of CAG triplets would therefore be responsible for fine adjustment of the AR between excessive and insufficient function. ICSI. (Intra-Cytoplasmic Sperm Injection) is currently proposed in these cases of infertility, but the consequences of transmission of these abnormalities to the offspring are unknown.