[Non palpable testicular tumors. Retrospective series]. / Tumeurs testiculaires non palpables. Série rétrospective.

OBJECTIVE: To report our experience in 13 cases with nonpalpable testicular tumors and review the literature. MATERIAL AND METHODS: From 1998 to 2012, 13 patients were diagnosed with nonpalpable testicular tumors. The data base was performed prospectively, and analyzed retrospectively. We evaluated demographic data, clinical presentation, ultrasound tumor features, tumor markers, frozen and final histopathological findings. All patients were also evaluated with serum tumor markers and the surgical approach was inguinal. RESULTS: The mean age was 46.4 years and the most frequent clinical presentation were orchialgia in six patients (46.1%) and infertility in three (23%). All masses were hypoechoic with an average tumor size of 8.9 mm. The serum tumor markers were negative in all patients and the final histopathological findings were six seminomas, two embryonal carcinomas, one seminiferous tubules atrophy, a segmental testicular infarction, a Sertoli cell tumor and a Leydig cell tumor. CONCLUSIONS: Nonpalpable testicular masses were benign in almost half of the cases; therefore, we recommend using the frozen section pathology as a tool to perform conservative surgery in selective cases.

[Giant renal angiomyolipoma with right heart failure]. / Angiomyolipome rénal géant compliqué d'insuffisance cardiaque droite.

We report the case of a 63-year-old woman presenting a 26cm right renal angiomyolipoma with intratumoral arteriovenous fistula responsible for a high-output right heart failure. A radical surgical treatment after preoperative embolization allowed rapid improvement of cardiac symptoms with an uneventful postoperative course.

[Treatment by radiofrequency ablation for a renin-secreting juxtaglomerular tumour: a case report]. / Traitement par radiofréquence d'une tumeur de l'appareil juxta-glomérulaire sécrétant de la rénine. À propos d'un cas.

Juxtaglomerular cell tumors are rare and benign tumors, occurring in young patients. The standard treatment is partial nephrectomy. We report the case of a young 22-year-old patient with a renin-secreting tumor diagnosed during an exploration of severe hypertension associated with hypokalemia that we treated by radiofrequency ablation.

[Predictable access to the fellowship of urology in France till 2016: an update of the AFUF]. / Accessibilité prévisible au post-internat d'urologie en France jusqu'en 2016: une mise à jour de l'AFUF.

PURPOSE: To evaluate the predictable accessibility to the fellowship of urology for residents expecting to accomplish their residentship from November 2013 to November 2016. MATERIAL: Between September and November 2013, the representants of the residents ongoing for the residentship of urology in each region of France were reached to participate to the study. A questionnaire was given in aim at reporting all the local residents expecting to accomplish their residentship between November 2013 and 2016, and the number and the expected availability of fellow and specialist assistant posts in the region during the same period. RESULTS: In November 2013, our study listed 334 junior urologists (197 residents, 81 fellows, 56 assistants). Fifty-five residents were ending their internship by November 2013, whereas 67, 50, 77 residents were expecting to accomplish their residentship from November 2014 to 2016 respectively. The predictable accessibility to the fellowship of urology was 96.4%, 82.1%, 90.0%, 74.0% respectively for the residents accomplishing their residentship from November 2013 to November 2016. The predictable deficit of fellow and assistant posts were -2, -12, -5, -20 posts from November 2013 to November 2016 respectively. CONCLUSION: The predictable number of fellow and assistant post in Urology remains insufficiently available for the 2013-2016 period. By reason of the unstable number of residents accomplishing their residentship from 2014 to 2016, the fellowship accessibility was measured at 82.1%, 90.0%, 74.0% from 2014 to 2016 respectively.

[Head to head comparison of two currently used nomograms predicting the risk of side specific extra capsular extension to indicate nerve sparing during radical prostatectomy for treatment of prostate cancer]. / Validation externe des nomogrammes de prédiction de l'extension extra-prostatique spécifiquement au côté pour des patients atteints de cancer de prostate traités par prostatectomie totale.

OBJECTIVE: To perform a head to head comparison of these two nomograms by an external validation combined with an identification of probability cut-offs when to indicate NS. METHODS: The full models of the nomograms of Ohori et al. and Steuber et al. were used to calculate the risk of ECE based on PSA and side specific information on clinical stage, biopsy Gleason score, % positive cores, and % cancer in cores. A dataset of 968 prostate half lobes was used retrospectively for analysis. All patients underwent laparoscopic robot-assisted or open radical prostatectomy for localized prostate cancer. RESULTS: The predictive accuracy of the Ohori nomogram was at 0.80 and for the Steuber Nomogram at 0.78 (comparison P > 0.05). In the calibration plot, the Ohori nomogram showed less departures from ideal predictions than the Steuber nomogram. The best probability cut-off to allow NS for the Ohori nomogram seemed to be ≤ 10%, permitting NS in 59.7% of all cases and being associated with a false negative rate of 10%. The best cut-off for the Steuber nomogram seemed to be ≤ 8%, permitting NS in 44% and associated with a false negative rate 12.5%. CONCLUSIONS: The Ohori et al. and the Steuber et al. nomograms allow highly accurate and comparable predictions of the risk of side specific ECE. LEVEL OF EVIDENCE: 4.

[Current state of compensation of on-duty and on-call urologists in France: a study from AFUF]. / État des lieux des rémunérations des gardes et astreintes d'urologie en France: une étude de l'AFUF.

INTRODUCTION: The French Association of Urologists-in-training (AFUF) aimed to assess the current state of remunerations of on-call and on-duty residents, assistants and lecturers in urology in France. MATERIAL AND METHODS: Data were collected from February to May 2013 through a questionnaire sent to all members of the AFUF (327 members). Remunerations were given in gross values. RESULTS: Forty-three residents took part in the study, 16 assistants and 16 lecturers, representing 62 % of the whole centers (54 hospitals out of the 92 centers practicing urology in France). Most of responders were on security or operational on-call. Twenty hospitals were practicing multi-organ removal. Median remunerations of residents were about 59.51€ per on-call when moving at hospital for work and about 119.02€ per onsite duty. Assistants and lecturers were paid a flat fee rate for 37.5 % of them (140€ for assistants [with variability from 40 to 195€] and 130€ for lecturers [42.5-180]) or an hourly rate depending on the hours spent at hospital for the others (62.5 %): first, second move or move<3h were paid 100€ for assistants and 65€ for lecturers, 233.5€ and 236€ respectively for the third one or above 3h, 365€ and 473€ respectively above 8h. Multi-organ removals were paid a flat fee rate (60 %) or an hourly rate (40 %) as well. Beyond a threshold of 2-3hours, the hourly rate was more interesting than the flat fee rate. CONCLUSION: There were disparities in remuneration of on-call and on-duty urologists. Greater variability affected on-call flat fee rate remuneration beyond a certain threshold of hours and remuneration of multi-organ removal. These disparities should be considered in order to get a national harmonization.

[Research fellowship in the curriculum of French urologists-in-training: a study by the French Association of Urologists-in-training (AFUF)]. / Place du Master 2 recherche dans la formation des jeunes urologues français : une étude de l'AFUF.

OBJECTIVES: To assess motivations, the practical organization and the funding of a research fellowship in the training curriculum of French urologists-in-training. MATERIALS AND METHODS: An online questionnaire was sent to members of the AFUF and to participants of a research training seminar "Graines et Sol" organised by the AFU, between July and September 2013. Results are presented as the median (interquartile range). RESULTS: Sixty answers out of 115 research fellows (response rate 52%) were computed. Median age was 29 years (28-30) during the research year and male proportion 75%. The AFU grant was obtained by 57.4% of applicants, 56.4% for various grants and 47.6% for the research fellowship university grant. The annual gross amount was 29,870€ (22,710-30,195), without any significant difference between residency subdivisions. Financial supplements were obtained by being on-duty (26.2%), on-call (28.6%) and replacements (25%). The research fellowship year was done between 4th and 5th years of residency (53%), for a one-year length (96.7%) and in France (86.6%). Urologic cancerology was the thematic the most studied (60%). The research fellowship was done in view of an academic career (31.7%) or was done to wait for a post-residency position (20.8%). About a quarter was being proposed a chief-residency position before the beginning of the research year. During this year, 76.7% published. About 63% were interested in pursuing with a PhD. CONCLUSION: This study confirmed the interest for a research fellowship by French urologists-in-training. Financial support thanks to grants facilitated the conduct of a research fellowship in the aim of an academic career for most of them.

[The role of simulation in the curriculum of French urologists-in-training: a study by the French Association of Urologists-in-Training (AFUF)]. / Évaluation de l'utilisation de la simulation dans la formation des jeunes urologues français : une enquête de l'association française des urologues en formation (AFUF).

OBJECTIVES: To study the place of simulation in the training curriculum of French urologists-in-training. MATERIALS AND METHODS: An online questionnaire was sent to all residents and fellows members of the AFUF between February and May, 2013. Results are presented as the median (interquartile range). RESULTS: The answers of 125 urologists-in-training were computed (response rate 38%). They were residents in 90 cases (72%), and fellows in 35 cases (28%). Median age was 29 (27-30), male proportion 77%. All French academic urology departments were represented. Ninety of them (72%) had access to a pelvi-trainer and 66 (53%) to animal or cadaveric models, although they never used them or less than once a month in 83 and 97% of cases, respectively. Seventy-two (58%) had used a virtual-reality based simulator at least once and 38 (30%) had regular access to one, but without supervision in 64% of cases. Factors limiting simulation-based training were the lack of available simulators (70%), the lack of time (58%), the absence of incitement (34%) and supervision (20%). If these conditions were met, 86% of urologists-in-training would be ready to spend more than one hour a-week training on a simulator. CONCLUSION: This study revealed among the sample of respondents a limited use of simulation tools for skills aquisition. This was explained by a limited availability of these tools but also by an insufficient use of the tools when available.

[Renal cancer and hereditary diseases]. / Tumeurs rénales des maladies héréditaires.

Renal tumors associated with hereditary diseases are a rare entity characterized by many renal tumors and other manifestations such as pulmonary, neurological and dermatological expressions. The management requires a close collaboration between surgical specialties and geneticists. Precocious, bilateral and/or multifocal tumors call to mind a hereditary disease. Early diagnosis and screening are essential to optimize a strict observation and a most conservative treatment.

[Comparative study of radical prostatectomy versus external beam radiotherapy (75.6 Gy) combined with hormone therapy for prostate cancer of intermediate D'Amico risk classification]. / Étude comparative des résultats carcinologiques après prostatectomie et radiothérapie externe (75,6Gy) avec hormonothérapie concomitante pour cancer de prostate à risque intermédiaire de D'Amico.

INTRODUCTION: Thirty-three percent of the localized cancers belongs initially to the group of intermediate risk of D'Amico. The standard treatments validated by the French Association of Urology are the radical prostatectomy and the external beam radiotherapy. OBJECTIVES: We retrospectively compared the carcinologic results of the radical prostatectomy±adjuvant treatment (RP) and the external beam radiotherapy combining high dose (75.6 Gy) and short hormonotherapy (RH), in the treatment of intermediate risk prostate cancer. The series consisted of 143 patients treated between 2000 and 2006 in the department of Urology and Kidney transplantation of the Conception Hospital, Marseilles. The main assessment criteria was the survival without biological recurrence (SBR). RESULTS: The median follow-up was 90 months [59-51]. The 5 years and 8 years SBR were 85% and 73% in the RH group, versus 74% and 65% with RP (P=0.196). There was a significant difference between the series: on the age of diagnosis (63.9 versus 73.3 years, P<0.001), the Charlson score of comorbidity (2 versus 3, P<0.001) and the number of intermediate criteria per patients (one intermediate criteria: RP 74% versus 57%, P<0.01). CONCLUSION: According to our study, there was no superiority of the radical prostatectomy±adjuvant treatment or the external radiotherapy combining high dose and concomitant short hormonotherapy on the survival without biological recurrence at 5 and 8 years. Many studies confirm that a concomitant hormonotherapy increases the carcinologic control, even with a high rate external beam radiotherapy.

[Cryptorchidism associated with ectopic adrenal cortical tissue in the spermatic cord in a 51-year-old male]. / Un cas de cryptochidie associée à un îlot surrénalien ectopique du cordon spermatique chez un homme de 51ans.

This case report describes an exceptional case of ectopic adrenal cortex tissue (EACT) in the spermatic cord associated with ipsilateral cryptorchidism in an adult. While both EACT and cryptorchidism are fairly common congenital anomalies in boys, adult cases are uncommon. Although the spermatic cord is a known site of EACT, the reports of its association with cryptorchidism have been limited to child cases. During surgery, undescended testis was discovered and incidentally ectopic adrenal tissue along the spermatic cord was also identified. This combination of developmental aberrations in the adult has not been described, and the clinicopathological findings are reported with a brief literature review.

[What is the role of active surveillance for small renal masses?]. / Quelle place pour la surveillance active des petites tumeurs rénales ?

Incidence of small renal masses (SRM) T1a is increasing in every age group. In relation to their characteristics, treatments seem to become less invasive. This article summarizes data about Watchful Waiting. A literature review based on Pubmed and keywords "petites masses rénales", "small renal masses", "rein", "kidney", "tumeur", "tumor", "surveillance", "watchful waiting" was done. Fifty-eight english and french articles including cohort-following and meta-analysis were selected. Considering indolence and harmless of the SRM, watchful waiting is nowadays a valid therapeutic option: in most of the series is tumoral growing lower than 0.40cm per year, metastatic evolution approaches 1 to 2% (except in the Kouba et al. study with 5,7%) and disease-free survival is 100%. Nevertheless, this option seems to be appropriate after carefully selection of the patients (age, conciliance, comorbidities, imperative indications…) and the tumors (tumor size, localization, histology…). Watchful waiting is a promising alternative after selection of the SRM. Large-scale and long-term studies will precise the global cost and modalities of this therapeutic option.

[Plasmacytoid urothelial carcinoma of the bladder with prostate cancer: report of two cases]. / Variante plasmacytoïde de carcinome urothélial vésical et cancer prostatique : à propos de deux cas.

Plasmacytoid urothelial carcinoma (PUC) is a rare variant of urothelial carcinoma with aggressive clinicopathological behaviours. We experienced two cases of PUC of urinary bladder. Both cases were advanced cancer with extravesical invasion and lymph node metastases. They also had coexisting prostatic carcinoma, one was preoperatively diagnosed and the other was incidentally discovered after surgery. As these cases were the first report of PUC simultaneously associated with prostatic carcinoma, clinicopathological features and the treatment options were discussed.

[Treatment of metastatic renal cell carcinoma]. / Traitement du carcinome rénal métastatique.

The median survival of patients with metastatic renal cell carcinoma (mRCC) increased from 10 to more than 40 months since the advent of targeted therapy. The transformation of mRCC from an initially lethal disease to a more favorable entity, albeit incurable, occurred with the transition from best supportive care, to cytokines, to finally sequential targeted therapies. Sunitinib and bevacizumab (level 1b) represent the first-line standard of care for patients with clear-cell mRCC vs temsirolimus (level 2) for those with high-risk features. Additionally, exploratory analyses of the temsirolimus data indicate important benefits for those with nonclear-cell mRCC histological subtypes. In second-line, everolimus proved its efficacy (level 1b). Nonetheless, sunitinib and sorafenib are also effective for nonclear-cell histological subtypes and after failure of other first-line treatment. The PFS benefits of first- and subsequent treatment-lines were confirmed in virtually all subgroup analyses. Potential survival benefits can be derived from cytoreductive nephrectomy (CNT), as was shown for cytokines in the general population, in sunitinib and bevacizumab-exposed patients. Phase III studies are ongoing to address the importance of CNT. This information is crucial to ensure timely delivery of a combination of medical and surgical therapies in this patient population.

[Role of surgery (cytoreductive nephrectomy and metastasectomy) in the management of metastatic renal cell carcinoma: a literature review]. / Place de la chirurgie (néphrectomie cytoréductrice et métastasectomie) dans la prise en charge du cancer du rein métastatique: revue de la littérature.

Cytoreductive nephrectomy is an established treatment option prior immunotherapy in well-selected patients with metastatic renal cell carcinoma. With the recent introduction of new targeted agents, the role of surgery has been source of controversy. This review examines the role of cytoreductive nephrectomy during the immunotherapy era, then in the new targeted therapies era. This review also summarizes the optimal timing of these treatments, the prognostic factors predicting outcome following cytoreductive nephrectomy, the role of metastasectomy, partial and laparoscopic cytoreductive nephrectomy.

[Carcinosarcoma of the renal pelvis in a horseshoe kidney: about a case]. / Carcinosarcome du bassinet sur rein en fer à cheval : à propos d'un cas.

Carcinosarcoma of the renal pelvis is a rare tumor, and its development in a horseshoe kidney makes it even more special. This is the first case reported in the literature of a renal pelvis carcinosarcoma developed in a horseshoe kidney and diagnosed on macroscopic hematuria.

[PSA and spironolactone]. / PSA et spironolactone.

The spironolactone is a diuretic of potassium savings. It is also used in the treatment of the hirsutism for its antiandrogenic action. Its use and its effects on the patients affected by a prostate cancer are less known. We report the case of a 72-year-old man having a cancer of prostate which normalized its PSA after institution of a treatment by spironolactone for ascites. This patient had a biological recurrence of a prostate cancer, arisen 7 years later after a treatment by hormonal radiotherapy. Nine months after the implementation of the treatment by spironolactone, there were no clinical and biological signs of disease progress.

[Epidemiological analysis of drug self-poisonings treated by a mobile intensive care unit]. / Analyse epidémiologique des intoxications médicamenteuses volontaires aiguës: prise en charge par un service mobile d'urgence et de réanimation.

PURPOSE: Study the epidemiology, prehospital emergency care and short-term evolution of the drug self poisonings. METHODS: Retrospective analysis from January 1999 to December 2000 of drug self poisonings requiring Grenoble (France) intensive care unit action and patient follow up. RESULTS: 325 patients, 39.3 years old +/- 14.5 have been treated. The drug self poisonings are representing 4.6% of Grenoble mobile intensive care unit activity. The sex-ratio was, for the 15 to 24 years old population, 2.3 females for 1 male. Mobile intensive care unit has been decided in first intention on 56.3%. 556 toxic substances have been reported, psychotropics are prevailing (79.4% of all drug self poisonings). Intubation has been necessary in 24%. 64.4% of the treated population has been hospitalized into intensive care units. The main exit step of the first admission unit was returning home. Death rate was 0.9%. CONCLUSION: Drug self poisoning is an important part of mobile intensive care unit activity. The very low death rate could be related to several criteria: a high efficient rescue unit setting up a symptomatic based medical treatment and the current decreased toxicity of the ingested drugs.