Impact of Transplantation Timing on Renal Graft Survival Outcomes and Perioperative Complications.

Nighttime organ transplantation aims to decrease cold ischemia duration, yet conflicting data exists on its impact on graft function and perioperative complications. This multicenter TRANSPLANT'AFUF study including 2,854 patients, transplanted between 1 January 2011, and 31 December 2022, investigated nighttime kidney transplantation's impact (8:00 p.m.-8:00 a.m.) versus daytime (8:00 a.m.-8:00 p.m.) on surgical complications and graft survival. Overall, 2043 patients (71.6%) underwent daytime graft, while 811 (28.4%) underwent nighttime graft. No impact was observed of timing of graft surgery on graft survival with a median survival of 98 months and 132 months for daytime and nightime grafting, respectively (p = 0.1749). Moreover, no impact was observed on early surgical complications (Clavien I-II = 20.95% for DG and 20.10% for NG; Clavien III-IV-V = 15.42% for DG and 12.94% for NG; p = 0.0889) and late complications (>30 days) (Clavien I-II = 6.80% for DG and 5.67% for NG; Clavien III-IV-V = 12.78% for DG and 12.82% for NG; p = 0.2444). Noteworthy, we found a significant increase in Maastricht 3 donors' rates in nighttime transplantation (5.53% DG vs. 21.45% NG; p < 0.0001). In conclusion, nighttime kidney transplantation did not impact early/late surgical complications nor graft survival.

[Early detection of prostate cancer: Towards a new paradigm?] / Détection précoce du cancer de la prostate : vers un nouveau paradigme ?

Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.

Pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: what we need to know.

Median arcuate ligament (MAL) syndrome is a rare and poorly known cause of abdominal pain. MAL narrows the celiac artery (CA), resulting in true distal aneurysms, including pancreaticoduodenal artery (PDA) aneurysms. These aneurysms often have an aggressive course, as rupture can result in hemorrhagic shock. CT scan appears to be the most effective investigation for the diagnosis of PDA aneurysms and may reveal possible celiac artery compression. In this series, we describe four cases of PDA aneurysm: two ruptured aneurysms treated by an endovascular procedure and two non-ruptured aneurysms treated by surgery. It was also decided to treat CA stenosis in three of the four patients based on the clinical presentation (ruptured or non-ruptured) and the presence of peripancreatic collateral vessels on imaging. This strategy contrasts with the approach commonly reported in the literature, in which MAL section is mandatory due to the high risk of ischemia rather than the potential risk of recurrent aneurysm. Medical teams should be aware of this disease to improve diagnosis and patient management.

[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.

Gangrene of the perineum.

Fournier's gangrene, an anaerobic necrotizing cellulitis of the infradiaphragmatic soft tissues, is a serious pathologic entity with an unpredictable course. From 1978 to 1991, a total of 24 men (mean age, 57 years; range 27 to 90) were treated for this entity at our institution. Diagnosis prompted immediate institution of multimodal treatment combining triple antibiotics, surgical dissection, debridement, and repeated surgical drainage. Fecal diversion (16 patients), hyperbaric oxygenation, and standard intensive care procedures were widely indicated and performed quasi-systematically. The mean interval between initial symptoms and diagnosis was 7.4 days. Lesions were limited to the perineum in 11 patients but extended to the abdomen, thighs, or loins in the remaining 13. The pathogens were identified in 19 patients, and hemoculture results were positive in 5. A coloproctologic origin was identified in 12 patients and a urogenital origin in 4. In 2 patients, perineal gangrene occurred postoperatively, and no etiology was determined for 6. Six patients died, and 18 patients recovered, without any sequelae. The prognosis is better when the patient is young (less than 60 years old), has clinically localized disease, without systemic involvement, and sterile hemocultures and is managed with colostomy. A thorough workup is mandatory to determine the etiology (locoregional lesion, malignancy, hemopathy, arteritis).

[Predictive value of urinary cytology in the diagnosis of urothelial tumors]. / Valeur prédictive de la cytologie urinaire dans le diagnostic des tumeurs urothéliales.

Between November 1991 and June 1993, 315 patients with urethral lesions were divided into two groups: group 1 included 215 patients with urethral tumours and group 2 included 100 patients with non-tumoural lesions. In all patients, urethral smears (performed on 3 consecutive days), pyelography and uretrocystoscopy (with bladder biopsy of observable lesions) were performed in all. The sensitivity of urine cytology examinations in the diagnosis of bladder cancer was found to by 80% with a specificity of 90%. The positive predictive value was 94.5% and the negative predictive value 67.7%. Urine cytology agreed with the diagnosis of urethral tumours especially well in advanced stage ulcerated tumours. These results underline the importance of cytology examinations in the exploration and follow-up of patients with urethral tumours.

[Radical prostatectomy after complete androgen blockade in stage B2 and C cancer]. / Prostatectomie radicale après blocage androgénique complet pour cancer de stade B2 et C.

Despite recent advances in imaging techniques, the staging process is still unsatisfactory in cancer of the prostate. The underestimation for stage B2 and C tumours in about 50%. We present our findings in a retrospective study analyzing the clinical and biological effects of complete androgen blockade before radical prostatectomy in patients with advanced stage localized tumours. We treated 21 patients from 1989 to 1993. All received preoperative homonotherapy by complete androgen block for at least 3 months before node dissection preceding suprapubic radical prostatectomy. Only 20 prostatectomies were performed as metastasis was found in the extemporaneous examination in 1 patient. The volume of the prostate gland had diminished in all patients after the hormonotherapy (27.8%) as did PSA (95%). When evaluated, the tumour stage of the surgical specimen was always more advanced than the needle biopsy. Only 1 tumour was strictly limited to the intracapsule and all the others had either invaded the capsule, reached the margins or had invaded the seminal vessels or lymph nodes. With a mean follow up of 45 months, recurrence rate is 50%, mainly due to tumours with positive margins or seminal invasion in patients who were not given adjuvant treatment. Our results are in agreement with those in the literature showing that although the volume of the prostate is reduced and PSA declines, no improvement in pathology staging is observed.

[Urinary malacoplakia. Anatomoclinical analysis of 3 cases with long-term follow-up. Review of the literature]. / Malakoplakie urinaire. Analyse anatomoclinique de 3 observations suivies à long terme. Revue de la littérature.

Malakoplakia is a granulomatous disease. We report 3 cases of this condition. This disease is characterized by its rarity, the nonspecific revealing signs, histological studies being the only method providing a positive diagnosis, and the possibility of healing with a simple medical treatment.

Piezoelectric lithotripsy monotherapy for partial or total staghorn lithiasis and calculi larger than thirty millimeters.

Thirty patients with partial or total staghorn lithiasis or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had a pelvic stone; the other 11 had partial (nine) or total (two) staghorn lithiasis. All patients first underwent an initial lithotripsy session. No anesthesia or intravenous sedation was required in any case. If stone fracturization was achieved after this first session, a double J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had a sterile urine culture; 12 of 30 presented major distention of the excretory tract. Results were analyzed to determine those factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stone had completely disappeared on abdominal plain films (14/30 = 46%). In seven patients (23.3%), fracturization had occurred but residual fragments remained (1-3 fragments less than or equal to 4 mm). No fracturization was obtained after the first session in nine patients (30.7%) (one total staghorn lithiasis, eight pelvic stones). The mean number of treatment sessions was five (range 1-15). Complications occurred in only 10% of patients (3/30): two steinstrasse and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distention and 55% of patients whose initial urine culture was sterile, achieved a stone-free state.(ABSTRACT TRUNCATED AT 250 WORDS)

[Testicular sarcoidosis]. / Sarcoïdose testiculaire.

The authors report a case of testicular sarcoidosis. This lesion may mimic cancer, but the association of germ cell tumour and systemic sarcoidosis appears to be too frequent to be simply a coincidence. It is important to diagnose combinations of these 2 diseases in the scrotum or in the mediastinum, but their pathogenesis remains hypothetical.

[Urological surgical effect of the repair of inguinal hernia using bilateral subperitoneal prosthetic mesh]. / Incidences urologiques chirurgicales des cures de hernies inguinales par voile prothétique sous-péritonéal bilatéralisé.

In view of the increasing frequency of using subperitoneal bilateral prosthesis for inguinal hernia repairs, urologists should be aware of the genitourinary implications of this procedure: risk of infection due to potentially septic procedures on bladder or prostate, postoperative genitourinary complications, interval before subsequent trans-prosthetic surgical incision, operative tactical outcomes of subperitoneal pelvic fibrosis.

[Infections risk in transrectal prostate biopsy. An experience of antibioprophylaxis at a single dose]. / Le risque infectieux de la biopsie prostatique transrectale. Une expérience d'antibioprophylaxie à dose unique (180 cas).

Prostate biopsy remains the key-test in diagnosing clinically-detected prostatic carcinoma. Easy and efficient, the transrectal approach is credited with major infectious risk. The authors report a conclusive clinical experiment on 180 cases with antibioprophylaxy by injecting a single dose of third generation cephalosporin.

[Exclusive piezo-electric lithotripsy (EDAP LT 01) in the treatment of calculi larger than 30 mm. Pyelic, partial or total staghorn]. / La lithotritie piézo-électrique exclusive (EDAP LT 01) dans le traitement des calculs de plus de 30 mm. Pyéliques, coralliformes partiels ou totaux.

Thirty patients with partial of total staghorn calculi or pyelic calculi greater than 30 mm were treated by extracorporal piezo-electric lithotripsy (PEL) exclusively with an EDAP LT 01 lithotripter equipped with an ultrasound localisation system. Nineteen patients had a pyelic calculus and the others a partial (n = 9) or total (n = 2) staghorn calculus. All patients first underwent extracorporal lithotripsy (ECL). None of the patients received IV sedation or anesthesia. When fragmentation of the calculus was observed after the first session, a double J stent was inserted before the second ELC session. Before the first session, urine samples were sterile in 18 of the 30 patients; 12 of the 30 patients presented major distention of the urinary tract. Results were analysed to identify factors affecting results of this type of treatment. Patients whose calculus had completely disappeared on plain films three months after the first session were considered to be cured clinically and radiologically (14/30 = 46%). Seven patients (23.3%) were clinically cured (absence of pain and sterile urine) but there were residual fragments (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in 9 patients (30.7%) (1 total staghorn, 8 pyelic calculi). The mean number of sessions was 5 (range 1-15). Only 10% of the patients (3/30) presented a complication: 2 steinstrasses and 1 acute pyelonephritis. 83% of the patients without urinary tract distention and 55% of the patients whose urines were initially sterile were cured.(ABSTRACT TRUNCATED AT 250 WORDS)

[Extracorporeal piezoelectric lithotripsy (EDAP LT 01) in the treatment of ureteral calculi. Apropos of a series of 143 cases]. / La lithotritie piézo-électrique extra-corporelle (EDAP LT 01) dans le traitement des calculs de l'uretère. A propos d'une série de 143 cas.

The results for 143 cases of ureteral stones treated by EDAP LT01 were analyzed concerning stone location, ureteral manipulation and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter (PU1 and PU2), mid-ureter (MU), distal ureter (D1 and D2). The overall fracturization rate (FR) was 72%, as detailed below: UPJ (89%, 26/29), PU1 (86%, 13/15), PU2-MU (62%, 15/24), DU1 (59%, 25/42), DU2 (72%, 24/33). Anesthesia or iv sedation were never used for PEL. 24% of the patients underwent retrograde ureteral manipulation (in situ/push back = 108/35). For PU1, the FR was twice as high after retrograde manipulation (in situ/push back = 5/8). For PU2 and MU, the supine position was most common. For UPJ and PU1, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder must be well filled; the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month's follow-up) was 93% (27/29). The stone-free rate for in situ stones at 3 months was 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones. The success rate of in situ PEL improves after the operator becomes skilled with the procedure. The advantages of the EDAP LT01 are the absence of pain, no need for anesthesia, and the mobility of the shock wave unit.

[Clinicopathologic and biological correlations (PSA-PAP) in pathology of the prostate. Apropos of 150 cases]. / Corrélations anatomoclinique et biologique (PSA-PAP) dans la pathologie prostatique. A propos de 150 observations.

On the basis of 150 patients (16 controls with no disease of the prostate, 96 cases of benign prostatic hypertrophy (BPH) and 38 cases of carcinoma of the prostate (CP)), the authors intended to answer 3 questions: How can the borderline values of PSA in BPH be interpreted? Is there a correlation between the Gleason and PSA values in carcinomas? Should the simultaneous measurements of PSA and PAP be continued? All patients were examined with a rectal touch, transrectal echography (TRE) and PAS and PAP assays. All CP were examined with bone radionuclide scanning (BR). The correlation coefficient being 0.391 (p 0.001), the PSA value and prostatic weight can be regarded as linearly correlated in BPH (5 g BPH = 1 ng/ml PSA). This lower value of PSA is linked with the increase produced by TRE in the assessment of prostatic weight. On the other hand, the authors did no observe a correlation between the PSA and the Glisson grade in carcinomas with negative BR. Lastly, the sensitivity of PSA is noticeably higher than that of PAP (75% vs. 50%), and no false negative finding with PSA was corrected by PAP measurements.

[Exclusive piezoelectric lithotripsy in the treatment of calculi larger than 30 mm (partial or complete coralliform, pyelic calculi)]. / La lithotritie piézo-électrique exclusive dans le traitement des calculs de plus de 30 mm (pyéliques, coraliformes partiels ou totaux).

Thirty patients with partial or total staghorn stones or calculi larger than 30 mm were treated by piezoelectric lithotripsy (PEL) monotherapy using an EDAP LT-01 lithotripter with ultrasound guidance. Nineteen of these patients had pelvic stones; the other 11 had partial (9) or total (2) staghorn stones. All patients first underwent an initial lithotripsy session. No anesthesia or IV sedation was required in any case. If stone fragmentation was achieved during this first session, a double-J stent was inserted before the second lithotripsy session. Prior to the first session, 18 of 30 patients had sterile urine cultures; 12 of 30 presented major distension of the excretory tract. Results were analyzed to determine the factors influencing the outcome of this therapy. Three months after the first session, patients were considered cured if their stones had completely disappeared according to plain abdominal films (14 of 30, 46%). In seven patients (23.3%) fragmentation had occurred but residual fragments remained (1 to 3 fragments less than or equal to 4 mm). No fragmentation was obtained after the first session in nine patients (30.7%) (1 total staghorn stone, 8 pelvic stones). The mean number of treatment sessions was five (range, 1 to 15). Complications occurred in only 10% of patients (3 of 30): two steinstrassen and one acute pyelonephritis. Eighty-three percent of patients without major excretory tract distension and 55% of patients whose initial urine culture was sterile achieved a stone-free state. Therefore the best indications for PEL monotherapy for calculi larger than 30 mm are pelvic stones and partial staghorn stones and no major excretory tract dilatation in patients with sterile initial urine cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

[Extracorporeal piezoelectric lithotripsy in the treatment of calculi of the ureter. Apropos of a series of 143 cases]. / La lithotritie piézo-électrique extra-corporelle dans le traitement des calculs de l'uretère. A propos d'une série de 143 cas.

The results obtained in 143 cases or ureteral stones treated by EDAP LT-01 were analysed concerning stone location, ureteral manipulation, and treatment position. The ureter was divided into six segments: ureteropelvic junction (UPJ), proximal ureter higher than the lower pole of the kidney (PU1), proximal ureter between the lower pole and the iliac crest (PU2), mid-ureter between the iliac crest and the lower end of the sacroiliac joint (MU), distal ureter between the lower end of the sacroiliac joint and the ischial spine (DU1), and the distal ureter below the ischial spine to the meatus (DU2). The overall fragmentation rate (FR) was 72%, as detailed below: (table; see text) Anesthesia or iv sedation was never used for EPL. 28% of the patients underwent retrograde ureteral manipulation (29/103). For PU1, the FR was twice as high after retrograde manipulation (push back/in situ = 5/8). For UPJ, the supine position was most common. For PU1 and PU2, it was often better to have the patient lie on his side. For DU1 and DU2, a prone position was necessary. For all stones in DU1, the bladder had to be well filled and the FR was higher in DU2 than in DU1. DU2 stones appeared to adhere to the bladder wall or were intravesical (stone in the meatus). The stone-free rate for successfully manipulated ureteral calculi (3 month follow-up) is 93% (27/29). The stone-free rate for in situ stones at 3 months is 94% (70/74). Extracorporeal piezoelectric lithotripsy combined with stone manipulation is highly efficient in the management of UPJ, PU1 and DU2 stones.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anatomoclinical and biologic correlations in prostatic pathology. Apropos of 150 case reports]. / Corrélations anatomoclinique et biologique dans la pathologie prostatique. A propos de 150 observations.

The authors analyzed 150 patient files (16 controls with no prostatic pathology, 96 patients with benign prostatic hypertrophy (BPH), 38 prostate cancer patients) in an attempt to answer three questions: how should borderline values of PSA be interpreted in patients with BPH; is there a correlation between the Gleason grade and PSA levels in prostate cancer? Should both PSA and PAP concentrations be assayed? All patients underwent digital rectal examination and transrectal ultrasonography (TU), and were assayed for PSA and PAP. All prostate cancer patients had a bone scintigraphy (Bs). In view of the correlation coefficient of 0.391 (p less than 0.001), it can be affirmed that PSA and weight are linearly correlated in BPH (5 g BPH = 1 ng/ml PSA). This lower value of PSA is due to the overevaluation of prostate weight by TU. In contrast, the authors did not find any correlation between the PSA level and the Gleason grade in prostate cancer patients with a negative bone scintiscan. Finally, the sensitivity of PSA was markedly better than that of PAP (75% vs 50%), and no PSA false negative error was corrected by the PAP value.