No ischemia technique, parenchymal preservation and age are the most important determinants of renal function after partial nephrectomy.

OBJECTIVE: The aim of the present study was to compare the outcomes of Off-Clamp to On -Clamp approach during robot-assisted partial nephrectomy (RAPN). MATERIEL AND METHODS: Retrospective study of 940 patients who underwent a RAPN between 2007 and 2015 for cT1a tumors using On-Clamp or Off-Clamp approaches. Patient with solitary kidney or multifocal were excluded. Overall, 103 patients underwent Off-Clamp approach and 37 patients On-Clamp approach. We matched the patients in terms of tumor size, Charlson comorbidity index and R.E.N.A.L. score. At all, 309 patients from the On-Clamp were matched to the Off-Clamp group. We compared the clinic-pathological characteristics, perioperative morbidity and late functional outcomes between the 2 propensity score matched groups. Limitation included retrospective analysis. RESULTS: After matching, there were no difference in clinic-pathological characteristics in terms of gender, age, race, body mass index, Charlson comorbidity index, American Society of Anesthesiologists score, baseline estimated glomerular filtration rate (e-GFR), tumor size, R.E.N.A.L. score complexity, hilar (H) location between the 2 groups. Regarding perioperative outcomes; while operative time (P=0,4), estimated blood loss (P=0,28), Clavien grade III-IV complications (P=0,8) surgical reoperation (P=1), 30-day readmission (P=1), positive surgical margin (5,5% vs. 5,8%, P=0,9) were comparable between the 2 groups, there were significant difference in excisional volume loss (median, 7,08 vs. 3,51cm3, P<0,01), e-GFR decline (median, -9,7 vs. -2,2ml/min/1,73 m2, P<0,01), percent of e-GFR preservation (median, 87% vs. 97%, P<0,01), and CKD upstaging (36,5% vs. 23,3%, P=0,01), Off-Clamp approach (P=0,01), and age (P=0,02) were predictors of renal function preservation, whereas excisional volume loss (OR=1,035, CI 95% (1,015-1,06), P<0,01) predicted upstaging. CONCLUSION: RAPN for selected renal mass using Off-Clamp approach offered renal functional advantage over On-Clamp, without adding morbidities. While no ischemia technique was associated with less excisional volume loss, Off-Clamp approach, and age were independent predictors of renal function preservation. Clinical significance of these findings in various clinical settings will require further investigation.

[The dimethyl sulfoxide under general anesthesia: An alternative after failure without anesthesia in the painful bladder syndrome/interstitial cystitis?] / Le diméthyl sulfoxide (DMSO) sous anesthésie générale : une alternative après échec du DMSO sans anesthésie dans le syndrome de la douleur vésicale ?

INTRODUCTION: The intravesical instillation of dimethyl sulfoxide (iDMSO), performed without anesthestic, is a therapeutic option for the painful bladder syndrome/interstial cystitis (PBS/IC). Some patients are against those iDMSO because of bad tolerance. Our study evaluates the tolerance and the outcome of the iDMSO under general anesthetic (GA) after the failure of the iDMSO without anesthetic. PATIENTS AND METHODS: From May 2013 to April 2016, 11 patients with a PBS, 9 women (81.8 %), have been treated by iDMSO without anesthetic, without improvement because of bad tolerance and no possibility to have a one hour contact between the bladder and the DMSO. The 11 patients were evaluated by mictional calendar and Sant O'Leary score. All the patients had a hydrodistension and a per os treatment without improvement. OUTCOMES: Six new iDMSO were performed under general anesthetic in ambulatory surgery with good tolerance for the 11 patients. The frequency and the nocturia before iDMSO without anesthetic and after iDMSO under general anesthetic were 32.2minutes [15; 60] and 6.3 per night [3; 10] and 126.9minutes [25; 240] and 3 per night [2; 6], so a variation respectively of 96.4minutes [0; 180] and of 3.75 per night [2; 6]. The symptom score and the problem index were 17.5 [13; 20] and 15.5 [13; 16] before and 13.5 [4; 20] and 12 [1; 16] after iDMSO under general anesthetic; a variation of 3.2 [0; 9] and 4 [0; 12]. CONCLUSION: The iDMSO under general anesthetic seems to improve objectively and subjectively the patients who are not improved by the instillations without anesthetic because of bad tolerance. LEVEL OF EVIDENCE: 4.

[Key concepts of survival analysis: Checking appropriateness]. / Le concept de l'analyse de survie : vérifier l'applicabilité.

Analysis of cancer survival data and related outcomes is necessary to assess cancer treatment. The survival analysis, although considered a cornerstone of oncology papers, is the weak point for the interpretation of results when used without robust data, without verifying the conditions of usage, and without defining the terminology we are using; leading to missing the real message. Unfortunately, a lot of scientific papers dealing with oncology violates the assumptions necessary for the usage of these tests, consequently, the conclusions in these papers cannot be assumed by the methodology used.

[Ablative therapy in kidney cancer: Oncological, functional, perioperative outcomes and cost]. / Thérapies ablatives dans le cancer du rein : résultats oncologiques, périopératoires, fonctionnels et médico-économiques.

INTRODUCTION: The incidence of kidney cancer has increased significantly over the past few decades presumably due to the increased use of imaging. The aim of this article is to describe contemporary outcomes of ablative therapy and to compare them to other therapeutic options in terms of oncological, functional, perioperative outcomes and cost. MATERIAL AND METHODS: We searched MEDLINE®, Embase®, using (MeSH) words; from January 2005 through May 2017, and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS: Ninety-one articles were analyzed. We described the outcomes of ablative therapy in relation to the energy used and the approach, and compared these outcomes to the other therapeutic options in terms of oncological, functional and perioperative outcomes. We analyzed these studies in order to search for predictive factors influencing the results of ablative therapy. We also analyzed the economic burden of small renal tumor management. CONCLUSION: The strength of evidence is based almost entirely on retrospective studies and is susceptible to the inherent limitations of this study design. Although, the evidence was low among studies, our revue showed that, in elderly patients treated with ablative therapy for cT1a tumors, the cancer-specific survival was comparable to partial nephrectomy with differences in overall survival that are explained by competing risks of death in the old population. Considering the functional results, the renal function preservation seems to be comparable between the 2 groups while the perioperative morbidity is higher in the partial nephrectomy group. The evidence base medicine at this time cannot support the extension of the indications of ablative therapy beyond the actual implementations.

[Long-term results and satisfaction of the mid-urethral slings among women]. / Résultats et satisfaction à long terme de la bandelette sous-urétrale trans-obturatrice chez la femme.

OBJECTIVE: The mid urethral sling (MUS) has become as the gold standard treatment for stress urinary incontinence (SUI) in female. The aim of this study was to assess the outcome of the SUI Transobturator Tape after 10 years follow-up. METHODS: Retrospective study of 73 patients who underwent a mid urethral sling-transoburator tape (MUS-TOT) between November 2002 and November 2004. These patients were followed up by phone call and by mail, 10 years after the surgery. The indication of the MUS-TOT was a stress urinary incontinence, yet 26 patients (35.6 %) had a mixed urinary incontinence. RESULTS: Out of 73 patients, 5 patients were excluded. Sixty-eight patients were contacted. The rate of responders was 72 %. Thirty-four patients (69.3 %) described episodes of urinary incontinence (52.9 % SUI, 47.1 % urgency). Fifteen patients (30.7 %) were continent. Among the patients who had incontinence, 26 (76.5 %) needed protections during the day and 18 (52.9 %) had to change them at least once. Twelve patients (35.3 %) needed protections at night and 3 (8.8 %) had to change it at least once. Thirty-nine patients (79.6 %) were satisfied. Twenty-nine patients filled up the Ditrovie questionnaire (42.6 %). The mean score of Ditrovie questionnaire after 10 years was 1.6±0.7, with a real improvement in comparison with the preoperative score (P<0.05). CONCLUSION: Ten years after MUS-TOT treatment, the continence rate was low, even though the patients included in this study had high satisfaction rate. Several limitations should be taken into consideration in this study. LEVEL OF EVIDENCE: 4.

[The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]. / Le retentissement du diabète sur le bas appareil urinaire : une revue du comité de neuro-urologie de l'Association française d'urologie.

OBJECTIVES: Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients. METHODS: A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia". RESULTS: LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients. CONCLUSION: Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.

[Benefit of clean intermittent self-catheterization in the management of urethral strictures]. / Apport des auto-dilatations dans le traitement des sténoses de l'urètre.

OBJECTIVES: Urethral stenosis has a recurrent character. The urethroplasty is often proposed for repeat stenosis. This study seeks to explore the interest of clean intermittent self-catheterization in the evolution of urethral stenosis after urethrotomy. METHODS: Single-center retrospective study from 2008 to 2013, concerning patients who received urethrotomy to treat urethral stenosis which was confirmed by endoscopy and a flow chart. Some accomplished self-catheterization in addition to urethrotomy to prevent recurrence. The monitoring was provided during consultation by a subjective assessment (patient and surgeon) and a flow chart. The restenosis were confirmed by endoscopy and flow chart. RESULTS: Ninety-three patients treated with urethrotomy alone (50 patients) or associated with self-catheterization (43) was included. Urethral stenosis were mostly iatrogenic (75%), short <10mm (84%), single (74%) and primary (50.5%). Mean follow-up was 99.3±72.8 weeks. Eighteen patients (19%) had symptomatic recurrence suspected by flow chart with a mean Qmax at recurrence was 6.25±2.8mL/s (P<0.001), 8 in urethrotomy group and 10 in the urethrotomy+self-catheterization group. Recurrence rates were comparable in the 2 groups, urethrotomy (16%) urethrotomy+self-catheterization (23%) (P=0.46). The mean time to recurrence was 81.1±87 weeks and was different in the 2 groups: 76.8±76.3 weeks in urethrotomy group, 83.3±93.9 in urethrotomy+self-catheterization group (P=0.014). An analysis recurrence for the primitive urethral stenosis showed that the recurrence rate was not statistically different: 18% for urethrotomy+self-catheterization group vs 14% for urethrotomy group. An analysis of recurrent relapses for urethral stenosis showed a rate of 26%, comparable in the 2 groups (P=1). CONCLUSION: After urethrotomy, urethral stenosis recurs in 1 patient over 5, after 18 months especially if they were complicated (multiple, recurrent, extended). Self-catheterization do not provide benefit in terms of recurrence (for the general population and for primitive urethral stenosis) compared to only urethrotomy but seem to extend the time without recurrence (76.8 weeks vs 83.3 weeks). LEVEL OF EVIDENCE: 5.

[Surveillance of stage I testicular seminoma: 20 years oncological results]. / Surveillance des séminomes testiculaires de stade I: résultats oncologiques sur 20ans.

INTRODUCTION AND OBJECTIVE: The objective of this study was to assess the oncological results of a population of patients which undergo surveillance after diagnosis of stage I testicular seminoma (2, 5 and 8 years overall, specific and recurrence free survival). We also research recurrence risk factors. PATIENTS AND METHODS: We have looked at the data of all patients treated in our center since 1993 for a grade I testicular seminoma. We focused on age at diagnosis, biological (tumoral markers) and pathological (tumor size, rete testis, lymphovascular, tunica albuginea or spermatic cord invasion) data. During surveillance, we noted the number, the localization and the interval until recurrence and death. We calculated 2, 5 and 8 years overall, specific and recurrence-free survival and searched recurrence risk factors. RESULTS: Sixty-nine patients (mean age: 37) were followed during a mean time of 97 months. Sixty-three per cent of the tumours were less than 4 cm (50 lesions). Lymphovascular, rete testis, spermatic cord and tunica albuginea invasion were present in respectively 21%, 33%, 4% and 29% of the cases. LDH and HCG were above normal rate in respectively 44 and 27% of the cases. Eighteen patients (23%) relapsed at a mean time of 12 months. Recurrence-free survival was respectively 81%, 77% and 77% at 2, 5 and 8 years. Tumor size<4 cm (P = 0.002), rete testis invasion (P = 0.03) and stage ≥ pT2 (P = 0.012) were associated with recurrence in univariate analysis. Using multivariate analysis, only tumor size >4 cm was a recurrence risk factor (risk multiplied by 3). At the end of the study, 77 patients are alive (97.5%). Overall and specific survival was 97.5% at 2, 5 and 8 years. CONCLUSION: We show here the interest of surveillance in case of stage 1 testicular seminoma. The overall and specific survivals are the same as after chemotherapy or radiotherapy. Furthermore, we confirm the role of tumor size to stratify recurrence risk.

[Definition of botulinum toxin failure in neurogenic detrusor overactivity: Preliminary results of the DETOX survey]. / Définition et prise en charge de l'échec d'une première injection de toxine botulique Botox ® 200 U pour hyperactivité détrusorienne neurogène: résultats de l'enquête DETOX.

OBJECTIVE: There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin. METHODS: A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions. RESULTS: Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%). CONCLUSION: This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.

[Flexible ureteroscopy and laser lithotripsy for kidney and ureter stone: indications, morbidity and outcome]. / L'urétéroscopie souple-laser dans le traitement des calculs du rein et de l'uretère: indications, morbidité et résultats.

PURPOSE: To report our experience with Flexible Ureteroscopy-laser (FU-L) in the treatment of renal and/or ureteric stones. PATIENTS AND METHODS: We conducted a retrospective study of 191 kidney and/or ureteric stones treated in the urology department of New Civil Hospital (Strasbourg) over a period of 2 years. Two hundred and nineteen FU-L were performed. We were interested in the indications of FU-L, its complications, treatment outcomes and predictors of obtaining a stone-free outcome. Postoperative complications were reported according to the Clavien-Dindo classification. RESULTS: The indications were first line in 62.3% of cases, failures of shock wave lithotripsy in 26.2% of cases and failure of alkalinization of urine in 5.2% of cases. As intraoperative complications, we had one case of ureteropelvic avulsion and one case of bronchospasm leading to stop ureteroscopy. Postoperative complications occurred after 38 FU-L (17.3%). All grades combined these postoperative complications were infectious in 50% of cases. They were grade I, II, III, IV and V respectively in 5.9; 7.3; 2.7; 1.3 et 0% of cases. Their occurrence was not significantly correlated to the size of the stones or the unilateral or bilateral nature of the FU-L. The overall rate of stone-free was 71.7%. The factors determining significantly a stone-free outcome were the size of kidney stone and experience of the operator. CONCLUSION: In our center, the FU-L is increasingly used as first-line option due to its low morbidity and excellent results especially for the treatment of kidney stones less than 20mm and ureteric stones. It is a quality alternative to PCNL in kidney stones over 20mm.

[Postoperative male stress urinary incontinence: outcomes of treatment by I-STOP TOMS® transobturator sling]. / Incontinence urinaire d'effort postopératoire chez l'homme: résultats du traitement par bandelette transobturatrice I-STOP TOMS®.

OBJECTIVE: To evaluate the outcome of postoperative male stress urinary incontinence surgery using the I-STOP TOMS(®) sub-urethral sling. MATERIAL AND METHOD: Between April 2007 and August 2012, 29 patients had been treated by sub-urethral sling. Stress urinary incontinence was classified as mild, moderate or severe according to the number of pads per day. Patients were also assessed thanks to IQOL, MHU and Ditrovie self-administered questionnaires. RESULTS: Before surgery, 16 patients (55.2%) had mild incontinence, 12 (41.4%) had moderate incontinence and one (3.4%) had severe incontinence. Preoperative median MHU was 9 (5-12); median IQOL was 73 (58-88); and median Ditrovie was 2.7 (2.1-3.3). Three months after surgery, median MHU was 7 (4-9); median IQOL was 85 (75-99); and median Ditrovie was 2.1 (1.6-2.4). Pre- and postoperative questionnaires scores show a significant improvement for IQOL (P=0.014) and Ditrovie (P<0.001). After 3 months, six patients were dry (20.7%), 19 patients had mild incontinence (65.5%) and four had moderate incontinence (13.8%); in résumé 17 patients (58.6%) showed a significant improvement in the number of pads (20.7% dry, 37.9% improved). After a mean follow-up of 24 ± 19.9 months, five patients were dry (17.2%), 20 patients (69%) had mild incontinence and four had moderate incontinence (13.8%). CONCLUSION: I-STOP TOMS(®) sub-urethral sling improved the level of postoperative stress urinary incontinence. However, the continence rate was weak.

[Inflatable penile prosthesis: satisfaction rate, result, prognostic factors. Prospective study on 50 primooperated patients in CHU of Nice between 2000 and 2009]. / Implants péniens hydrauliques: enquête de satisfaction, résultats et complications. Étude rétrospective portant sur 50 patients consécutifs primo implantés au CHU de Nice entre 2000 et 2009.

OBJECTIVE: To evaluate satisfaction rates and results in patients with penile prosthesis (5 PP). MATERIALS AND METHODS: From January 2000 till 2009, 50 patients with organic erectile dysfunction (ED) were implanted with hydraulics penile prosthesis by the same surgeon. Medical records were collected retrospectively. We analysed demographic characteristics, type of prosthesis used, per- and postoperative complications, prosthesis explantations and satisfaction rate measured by EDITS modified. RESULTS: Mean age of patients was 60.2 ± 8.46 years (35-75). Thirty implanted patients (60%) were diabetics. We used a peno-scrotal incision in all patients. Three types of prosthesis were used; AMS Ambicor, AMS 700, Titan OTR. A bi-compartment and three-compartment prosthesis were implanted respectively in 24 and 26 patients. The prosthesis was retrieved in two patients secondary to a mechanical failure, in three patients for prosthesis erosion, in two patients for prosthesis infection. In four out of the seven explanted patients, a second prosthesis was implanted. The EDITS questionnary was realized by telephonic interview in 47 patients after a mean follow-up of 45 months (5-114). The response rate was of 83%. The satisfaction rate was of 81%. CONCLUSION: In our series, the satisfaction rate was better for the three-compartment prosthesis. After 45 months of follow-up, 73% (31/42) of patients had a functional prosthesis. The non-satisfaction most frequently found were patients who have complications as sepsis; mechanical failure, and prosthesis erosion, and subjective feeling of penile length reduction.

[Vaginal prolapse. What dynamic pelvic MRI adds to clinical examination?]. / Prolapsus vaginal. Comment l'IRM pelvienne dynamique vient-elle compléter l'examen clinique ?

OBJECTIVE: We wanted to study the role of dynamic pelvic MRI (D-MRI) in the surgical management of patients with genito-urinary prolapse. PATIENTS: A routine D-MRI examination before and after laparoscopic double promontofixation was performed in 15 cases with symptomatic vaginal prolapse in need of surgical treatment. The review included also three self-administered questionnaires of symptoms and quality of life. We compared the preoperative clinical evaluation of the studied cases with D-MRI data. Changes after the surgical treatment were also studied. RESULTS: The D-MRI provides an accurate diagnostic evaluation of the pelvis, which is both objective and reproducible. The correlation between clinical scores and radiological magnetic resonance was 53.3% only. In cases with absence of previous pelvic surgery, there was a radio-clinical discrepancy of 40% of cases, while in cases with history of a previous pelvic surgery we found a discrepancy of 60% of cases. This was due to clinical difficulty in differentiating between peritoneocele and rectocele, or due to under-diagnosis of complex prolapse. The sensitivity of MRI in the diagnosis of cystocele, hysterocele and rectocele were respectively 100, 100 and 83%. The gain in sensitivity provided by the MRI was significant for the diagnosis of peritoneocele: 100% against 33%. The specificity was 100%. Static images allowed a detailed study of damaged connective tissues and pelvic muscles. CONCLUSION: The D-MRI seems an appropriate tool in pre-operative assessment of cases with vaginal prolapse. It will help in focusing our surgical strategy, especially in cases that present post-hysterectomy and in cases with residual or recurrent prolapse.

[Renal-pleural fistula after radiofrequency ablation of renal tumor in VHL patient]. / Fistule réno-pleurale après radiofréquence d'une tumeur rénale chez une patiente avec un VHL.

Radiofrequency is a minimally invasive therapy allowing tumor destruction by applying physical means to the core of the lesion. There is a particular indication for the hereditary already surgically treated renal carcinomas like Von Hippel-Lindau's disease. We present a case of renal-pleural fistula developed after a percutaneous radiofrequency ablation under computed tomography (CT) guidance of a renal tumor in a VHL female patient with a renal cell carcinoma of the upper pole of the left kidney. The kidney manifestations begin at 20-year-old with the appearance of cystic lesion at the lower pole of the left kidney. At 30-year-old, a computed tomography study revealed a solid lesion arising from a cyst. The patient underwent a partial nephrectomy by flank incision. Follow-up studies discovered three solid lesions of the upper pole of the left kidney. The patient undertook a radiofrequency ablation of these lesions. Follow-up control showed a contrast enhancement of one of the three lesions treated. Under this condition another course of RF was performed, complicated by a renal-pleural fistula. A conservative management of this iatrogenic fistula was attempted combining a water restriction and the insertion of a ureteral catheter. Three weeks were necessary until the fistula completely regress.

[The role of introital ultrasonography in treating low urinary tract symptoms complicating sub-urethral tape placement]. / Rôle de l'échographie translabiale dans la prise en charge des troubles urinaires du bas appareil compliquant la mise en place d'une bandelette sous-urétrale.

OBJECTIVE: To assess the role of the introital ultrasound in the evaluation of patients with low urinary tract symptoms after sling placement. MATERIAL AND METHOD: From 2000 till 2007, a total of 31 patients underwent sub-urethral tape placement for a stress urinary incontinence and developed thereafter a low urinary tract symptoms. The urological evaluation consisted of a detailed medical history, a urogynecologic examination, a complete urodynamic exam, a measurement of the postvoiding residue and a introital ultrasound. All patients filled the mesure du handicap urinaire (MHU) questionnaire. These patients had a transvaginal tape lysis under local anesthesia. We correlated the ultrasound findings with postoperative clinical success and failure. RESULTS: Thirty-one patients with low urinary tract symptoms secondary to sling placement underwent a tape lysis. Median age was 63.1+/-10.9 years, the median time between the anti-incontinence surgery and the tape lysis was 21.5+/-16.2 months. Seven patients had only obstructive symptoms, 15 patients had obstructive and bladder overactivity symptoms and nine patients had bladder overactivity symptoms. Introital ultrasound revealed an abnormality of the tape in 26 patients. Ten patients had a position abnormality of the tape, five patients had urethral angulation abnormality and 11 patients had the previous two abnormalities. After tape lysis, the obstructive symptoms disappeared in 19 out of 22 patients (86%), the bladder overactivity symptoms disappeared in 16 out of 24 patients (66%). In case of introital ultrasound abnormalities, the tape lysis was efficient in 23 out of 26 patients (89%), while in the absence of ultrasound abnormalities (five patients), the tape lysis was not useful in treating LUTS in all patients. CONCLUSION: Ultrasonography is a useful tool in investigating postoperative low urinary tract symptoms and in the selection of patients who will benefit from tape lysis.

[External validation of the University of Los Angeles Integrated Staging System (UISS) in localized renal cell carcinoma: single center study]. / Validation externe du modèle pronostique de l'University of Los Angeles Integrated Staging System (UISS) dans le cancer du rein localisé: étude monocentrique.

OBJECTIVE: To assess the ability of the University of Los Angeles Integrated Staging System (UISS) to stratify patients with a renal cell carcinoma (RCC) in one single French centre. PATIENTS AND METHODS: Four hundred and forty-three patients operated for a RCC in the Urological Department of Strasbourg University Hospital between January 1989 and December 2000 were classified according to the UISS, which combines TNM stage, Fuhrman grade and Eastern cooperative oncology group performance status. Two groups were created: 362 patients with localized and 81 patients with metastatic RCC. RESULTS: The UISS stratified the localized RCC into three different risk groups (p<0.0001). The 5-year survival rates were 75, 61 and 29% for low-, intermediate- and high-risk groups, respectively. For the metastatic RCC, the UISS couldn't well discriminate (p=0.092), with the 5-year survival rates of 18, 9 and 12% for low-, intermediate- and high-risk groups, respectively. CONCLUSION: This study validates the UISS for predicting survival in patients with localised RCC in our centre and, therefore, qualifies us to participate in clinical trials using this model. In metastatic RCC, the UISS was less accurate due to the small number of patients and the heterogeneity of treatments.