Laparoscopic tumorectomy of renal carcinoma recurred in remaining kidney.

Nephron sparing surgery is the standard treatment for small, peripherally located renal cell carcinoma. To reduce the morbidity of nephron sparing surgery laparoscopy was proposed. A case of renal carcinoma recurred in the remaining kidney successfully treated by laparoscopic approach is reported.

Iatrogenic bladder stone formation on absorbable suture 3-years after radical prostatectomy.

Vesical calculi formation on absorbable sutures is rare. The case of a 68-year-old white man, who had formed a large bladder stone on absorbable suture 3 years after radical prostatectomy, is reported. Endoscopic lithotripsy of the bladder calculi was performed and the suture was removed.

Successful transarterial embolization of idiopathic renal arteriovenous fistula.

A case of idiopathic renal arteriovenous fistula in a 46-year-old woman presenting intensive right renal colic associated to massive hematuria is reported. The renal arteriography confirmed the diagnosis and embolization of the fistula was performed. The transarterial embolization was successful no recurrence is observed after one year follow-up.

[Apropos of 1 case of paratesticular papillary serous cystadenocarcinoma]. / A propos d'un cas de cystadénocarcinome papillaire séreux paratesticulaire.

The occurrence within the testis or paratesticular tissue of serous tumors, similar to ovarian tumors, is rare. This article reports a primary serous paratesticular cystadenocarcinoma in a 39 year-old man. From data of the literature, we offer guidelines for diagnosis, histogenesis and treatment of this rare tumor.

[Radiotherapy of localized prostatic cancer: follow-up of 48 patients. G.C.C.P. (Cooperative Group for the Study of Prostatic Cancer)]. / Radiothérapie des cancers de prostate localisés: 48 malades suivis plus de dix ans. G.C.C.P. (Groupe Coopératif d'Etude du Cancer de la Prostate).

OBJECTIVE: To evaluate the safety and long-term efficacy of curative-intent radiation therapy in patients with apparently localized prostate cancer. METHOD: 48 patients with T < 3 M0 prostate cancer recruited between 1981 and 1985 received regular clinical follow-up for at least ten years or until their death. Radiation therapy was given according to the protocols established by Ray and Bagshaw. RESULTS: Radiation therapy was safe and effective in most patients. The rate of escape phenomenon was less than 10% after two years. Tumor control rates were greater than 80% after five years and 50% after ten years. Unfortunately, local remission, even when prolonged, did not necessarily indicate a complete cure: 20% of local recurrences developed five to 11 years after radiation therapy. CONCLUSION: Radiation therapy may be the best first-line treatment in men older than 75 years of age and in those whose life expectancy seems shorter than ten years, but should probably not be considered curative.

[Results of long-term treatment of inoperable cancer of the bladder with cisplatin and concurrent irradiation: prognostic factors of local control and survival]. / Résultats à long terme du traitement des cancers de vessie inopérables par cisplatine et irradiation concomitante: facteurs pronostiques du contrôle local et de la survie.

PURPOSE: Therapeutic strategies for muscle invasive bladder cancer are currently evolving. A recent European randomized study has shown that neoadjuvant chemotherapy does not improve the chance of cure or and radiotherapy would provide better results but there is a need to identify by prognostic factors patients who may benefit from such a conservative strategy. MATERIAL AND METHODS: One hundred and nine patients with localized muscle-invasive bladder cancer, who were not candidates for radical cystectomy, were treated with concomitant cisplatin and radiation therapy. Their mean age was 71. Thirty-six percent of the patients had T3B-4 tumors, and 37% had benefited from prior macroscopically complete transurethral resection (TUR). Pelvic irradiation consisted of 40 to 45 Gy and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg/m2/d for 5 days) was delivered during the second and fifth weeks of radiation therapy. RESULTS: Median follow-up was 73 months. The projected 5-year locoregional control rate was 43% for the 109 patients and 55% for the 86 patients with complete response. The projected overall 5-year survival rate was 36% for all patients and 44% for complete responders. Univariate analysis of prognostic factors was carried out for local control, and survival. The local control was statistically better in patients with good performance status, T2-3A, complete initial TUR, and in patients without hydronephrosis. In terms of overall survival, four factors were significant: the performance status, T-stage, absence of hydronephrosis, and complete response. By multivariate analysis, performance status, hydronephrosis and T-stage were significant factors for local control, while T-stage and complete response were the strongest determinants for survival. CONCLUSION: Concurrent cisplatin and radiation therapy is a potentially locally curative treatment for 43% of patients with muscle-invasive bladder cancer not candidates for radical surgery. Clinical T-stage and hydronephrosis have a significant and independent prognostic value on local control but appears not discriminant enough to select patients for conservative treatment.

DNA ploidy by image cytometry in urothelial carcinomas. Comparison of touch imprints and paraffin-embedded biopsies from 31 patients.

OBJECTIVE: To compare DNA content measured by image cytometry from touch imprints and formalinfixed, paraffin-embedded samples in bladder carcinomas. STUDY DESIGN: Thirty-one biopsies of urothelial carcinomas were selected for a prospective study. Imprints of fresh specimens were performed. Cell suspensions were obtained from dewaxed samples by the procedure of Hedley. Sections 7 microns thick were used for carcinoma in situ and small biopsies. The DNA ploidy index was measured on Feulgen-stained slides using an image cytometer. RESULTS: From imprint analysis, seven grade 1 carcinomas (n = 9) were found to be diploid (78%). Nine grade 2 carcinomas (n = 12) exhibited aneuploidy (75%), as did all grade 3 and in situ carcinomas (n = 10). Multiploidy was demonstrated from imprints in four cases instead of the two detected from dewaxed tissue. In 27 cases (87%), G0/G1 peaks obtained from paraffin blocks showed a shift to the left. In five cases (16%), variations in the DNA index were responsible for discrepancies in the DNA ploidy evaluation between fresh imprints and dewaxed samples of the same tumors. CONCLUSION: Image cytometry on Feulgen-stained imprints of bladder biopsies is a simple and reliable procedure for assessing DNA ploidy in urothelial carcinomas, providing great sensitivity for detecting small aneuploid peaks and multiploid tumors. DNA image analysis of touch preparations is especially useful for carcinoma in situ and small biopsies unsuitable for Hedley's technique.

[Xanthine urinary calculus in a patient with Lesch-Nyhan syndrome. Apropos of a case]. / Calcul urinaire de xanthine chez un patient porteur d'un syndrome de Lesh Nyhan. A propos d'un cas.

The authors report a case of xanthine stones in a 12-year-old child with Lesh Nyhan syndrome treated by allopurinol at the dose of 10 mg/kg/24 hours. This type of urinary stone is unusual and its structure was confirmed by spectrophotometric analysis. This type of stone, in the context of Lesh Nyhan syndrome, suggests the presence of allopurinol treatment. Discontinuation of this treatment prevents recurrence of xanthine stones.

Concurrent cisplatin and radiotherapy for patients with muscle invasive bladder cancer who are not candidates for radical cystectomy.

PURPOSE: We assessed the results and prognostic factors in patients with bladder cancer treated conservatively with concurrent cisplatin and radiotherapy. MATERIALS AND METHODS: A total of 109 patients with localized muscle invasive bladder cancer who were not candidates for radical cystectomy underwent concomitant chemotherapy and radiation. Median patient age was 70 years. Of the patients 36% had stages T3B and 4 tumors, and 37% had benefited from prior macroscopically complete transurethral resection. Pelvic irradiation consisted of 40 to 45 Gy., and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg./m.2 daily for 5 days) was delivered during weeks 2 and 5 of radiation therapy. RESULTS: Median followup was 54.8 months. The projected 4-year locoregional control rate was 47.6% for the 109 patients and 61.2% for 76 with a complete response. Projected overall 4-year survival was 41.9% for all patients and 51.4% for complete responders. Univariate analysis of prognostic factors was done for local control and survival. Local control was statistically better in patients with a good performance status, stages T2 and 3A disease, complete initial transurethral resection and without hydronephrosis. In terms of overall survival 4 factors were significant: 1) performance status, 2) T stage, 3) absence of hydronephrosis and 4) complete response. By multivariate analysis performance status, hydronephrosis and T stage were significant factors for local control, while T stage and complete response were the strongest determinants for survival. CONCLUSIONS: Concurrent cisplatin and radiation therapy is a potentially curative and conservative treatment for patients with localized muscle invasive bladder cancer who are not candidates for radical surgery, particularly those with intravesical stages T2 and T3A tumors.

[Unusual tumors of the testis. Apropos of 22 cases]. / Les tumeurs rares du testicule. A propos de vingt-deux cas.

The authors report their experience of rare non-germ-cell tumours of the testis over a period of 10 years. The criteria of benign disease, justifying testicular preservation in 5 out of 7 cases of epidermoid cysts, are defined. Four cases of Leydig cell tumours, including 3 with gynaecomastia, are described. Three cases of adenomatoid tumours with conservative surgery, 3 lymphomas, 2 mature teratomas and 2 cysts of the rete testis are also reported. The place of ultrasonography is defined and the possibility of conservative surgery is discussed in relation to a review of the recent literature.

[Endoscopic transvesicoparietal exteriorization of ureteral catheters]. / Extériorisation transvésicopariétale endoscopique des sondes urétérales.

Endoscopic introduction of catheter into the ureter for drainage has long been a common procedure, and recent advances in endoscopic urology have widened its indications. The ureteral catheter is usually exteriorized through the urethra and attached to the urethral catheter, but with this technique it tends to descend spontaneously and to create infections which are a possible cause of ureteral stenosis. A technique of endoscopic transvesicoparietal exteriorization of ureteral catheters without incision has been developed in 1982. The problems encountered in exteriorizing the ureteral catheter through the lumen of a suprapubic trocar have now been solved by using a bipodal forceps introduced into the trocar.

[Tumor grafts in the upper urinary tract secondary to tumors of the bladder epithelium]. / Greffe de tumeur dans la voie excrétrice supérieure à partir des tumeurs de l'épithelium vésical.

A retrospective study of cases seen between 1975 and 1985 showed 24 tumors of upper urinary tract secondary to primary bladder localizations. These secondary localizations developed during evolution of multi-resected recurring bladder tumors, within a mean period of 15 months after discovery of a secondary vesicorenal reflux. This reflux is acquired constantly during the course of these tumors and it is undoubtedly responsible for the onset of these upper tract tumoral grafts. These findings suggest the need for urographic surveillance combined with regular endoscopic examinations of patients with bladder tumors, for prevention of reflux during endoscopic resections and for treatment of any reflux detected.

[Recurrence of a urothelial carcinoma in an ileal neo-bladder. Apropos of a case]. / Récidive sur une néo-vessie iléale d'un carcinome urothélial. A propos d'un cas.

Recurrences of bladder carcinoma on ileal loop are rare (8 cases reported). We report herein the first case of recurrence after enterocystoplasty (Camey procedure).

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

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

[Benign prostatic hypertrophy. Surgical treatment. Value of surgery by a high approach]. / Hypertrophie prostatique bénigne. Traitement chirurgical. Valeur de l'intervention par voie haute.

Transurethral resection of the prostate is not a new procedure for the treatment of adenoma of the prostate but is being increasingly used. This fact is incontrovertible and all urologists perform transurethral resection for small adenomas. For large adenomas we still believe surgical removal is the best method. The results of resections of the prostate reported in the literature are not good enough to cause us to change our mind (80% good results after one or several procedures with an 8% incontinence rate!). To allow a more accurate evaluation we compared our personal results with surgical removal to the results of resections performed in our unit and reported in the literature.

[Extensive nephrectomy in severe forms of cancer of the kidney in the adult]. / Néphrectomie élargie dans les formes graves du cancer du rein de l'adulte.

Resection of renal tumours may be useless when the staging procedures reveal that the disease is too far advanced. A retrospective study of 100 radical nephrectomies for renal cell carcinoma distinguished the following groups: advanced cancers in young patients; cancers in patients over the age of 70 years. Despite the limited follow-up of this series, the study of survival demonstrates the following points: the difficulty of predicting the degree of lymph node involvement on pre-operative staging, the value of an anterior sub-costal and abdominal approach which facilitates radical nephrectomy in elderly and fragile patients, the poor prognosis of lymph node invasion and metastases, although some patients have survived for 12 months after resection of metastatic tumours.

[Urologic complications in adult kidney recipients]. / Complications urologiques chez les transplantés rénaux adultes.

In this article, the authors study the complications following all the kidney transplantations performed in their hospital between 1969 and 1980. During this period, 580 patients underwent 637 transplantations, including 120 (19%) with urological complications: urinary fistulae (49%), stenoses (28%), vesicorenal refluxes (13%), and calculi (10%). The postoperative mortality rate was 2.7%. Some patients presented with two or more complications. The circumstances of the discovery of the sequelae and the treatment prescribed are described in each case and a comparative study is made with other transplantation centers.

[Encysted renal tumor in adults. Apropos of an unusual ultrasonographic and anatomo-pathological case]. / Tumeur rénale kystisée de l'adulte. A propos d'un cas inhabituel échographique et anatomo-pathologique.

Ultrasound imaging in a 45 years old man with a one year history of bladder stone colic treated medically detected a partly encysted tumoral mass in the corticomedullary zone of upper pole of right kidney. Extemporaneous examination, requested because of the original macroscopic appearance of this tumor, prevented excision of right kidney. The atypical microscopic appearances, not found during a literature review, justify reporting of this case.