[Follow-up of urothelial carcinoma: Review of the Cancer Committee of the French Association of Urology]. / Surveillance des carcinomes urothéliaux : revue du Comité de cancérologie de l'Association française d'urologie.

INTRODUCTION: Cancer Committee of the French Association of Urology (CCAFU) conducted a literature review concerning the follow-up of urothelial carcinomas and provides recommendations for monitoring. MATERIAL AND METHODS: A bibliographic research in French and English using PubMed was carried out from 1990 to 2014 using the keywords "urothelial carcinoma", "follow-up", "prognosis", and "recurrence". RESULTS: Rhythm and tools of follow-up (cytology, endoscopy, CT-urography) for non muscle invasive bladder cancer (NMIBC) have to be adjusted to the recurrence and progression risk defined by the EORTC tables. After radical treatment of muscle invasive bladder cancer (MIBC), follow-up is based on endoscopy, cytology and CT-urography. Monitoring of the urethra must be adapted to the recurrence factors and continued for at least 5 years. The monitoring of upper tract should be continued for life. In case of conservative treatment for MIBC, early endoscopy and imaging reassessment is required. After radical treatment of upper urinary tract tumour (UTUC), cystoscopy and cytology are essential because of the frequency of bladder recurrence in the first three years. Conservative management of UTUC requires strict monitoring including flexible ureteroscopy. CONCLUSION: Oncologic follow-up of urothelial carcinomas is adapted according to tumour stage and grade, location and treatment modality thus defining the risk of recurrence over time.

[RALP: comparison of the oncological and functional outcomes of the intrafascial and the interfascial approaches]. / Résultats carcinologiques et fonctionnels de l'abord interfascial de la prostatectomie robotique comparé avec l'abord intrafascial.

INTRODUCTION: Due to its technical ease and greater precision Robotic Assisted Laparoscopic radical Prostatectomy (RALP) allows a better preservation of the neurovascular bundles, thereby improving functional outcomes. The intrafascial dissection has been proposed to allow a more complete preservation of these bundles. However, this technique harbors a high rate of positive surgical margins, justifying another trend: the interfascial approach. To date, there are still few publications directly comparing these 2 techniques and our study is the first to offer a 2-year follow-up. MATERIALS AND METHODS: Our study focused on a two-hundred patients population divided into two consecutive groups. All the patients were continent preoperatively and had a satisfactory IIEF5 score: (1) Group 1 consisted of 100 patients who underwent RALP with the intrafascial approach. They had a mean age of 60.3 years (45-70). The majority of cancers were of the low or moderate risk group of d'Amico. The mean PSA was 7.43ng/ml. Seventy-five patients had a pT2, 24 a pT3 and one patient had a pT4. (2) Group 2 included 100 patients who underwent RALP with the interfascial technique. Patients had a mean age of 61.6±5.96 years (45-72), and their cancers were mostly of the low or moderate risk groups of d'Amico. The mean PSA was 6.3ng/ml. Seventy-four patients had a pT2, 22 a pT3a, and 4 had a pT3b. All patients were evaluated after one and two years of follow-up. RESULT: Rates of positive surgical margins were 45% and 19% respectively for groups 1 and 2 (P<0.0001). The rates of biochemical failure (PSA>0.2ng/ml) at 2 years were 10% and 3%, respectively for groups 1 and 2 (P=0.0447). At 2 years, 2 patients in group 1 and one patient in group 2 were using 2 or more urinary pads. Erection with or without oral medication was maintained in 65 (65%) and 31 (31%) patients respectively for groups 1 and 2 at one year. At 2 years 86 and 65 patients were having spontaneous erection, respectively in groups 1 and 2 (P=0.0006). In addition, 65 and 55 patients were also capable of sexual penetration, respectively in groups 1 and 2 (P=0.0045). CONCLUSION: The intrafascial approach exposed to a very high rate of positive surgical margins while offering only a little benefit in the erectile function preservation at 2 years compared to the interfascial variant. In our series, we did not notice any significant difference between the two techniques concerning the urinary continence. LEVEL OF EVIDENCE: 5.

[Ipsilateral dual kidney transplantation: a monocentric experience about 15 cases and literature review]. / Bi-transplantation rénale par abord ipsilatéral: expérience d'un centre à propos de 15 patients opérés consécutivement et revue de la littérature.

OBJECTIVE: Our study aimed to support the viability of the concept of Ipsilateral Dual Kidney Transplantation (DKT) by presenting our initial experience and proposing a review of the literature in this subject. METHODS: Fifteen ipsilateral DKT were performed at Nice University Hospital between August 2010 and March 2012. We have described our skin incision preferences, the vascular anastomoses, and the uretero-vesical reimplantation. We have analyzed the operative duration, the cold ischemia time (CIT) of both transplants, the blood transfusion volume, the intraoperative and postoperative complications, the time to diuresis recovery, the hospital stay, and the kinetics of the creatinine clearance until the third postoperative month. We have compared our results with those of the literature. RESULTS: The average CIT of the first transplant (T1) was 17.5 ± 3.3 hours, and that of the second (T2) was 18.4 ± 3.3 hours. The mean operating time was 234 ± 67 minutes. Patients received an average of 2 units of blood during surgery [0-4] and 1.8 units in the postoperative period [0-15]. The complications rate was 26.7% and included an intraoperative T2 artery thrombosis and 3 postoperative complications consistent with a hematoma, a T2 ureteric necrosis and a T2 venous thrombosis. Two transplants were lost (6.7%) and one death (6.7%) was reported on day 40. The average length of hospital stay was 20.9 ± 7.8 days. The mean creatinine clearance values were 12.6 mL/min at D2, 35.6 mL/min at D7, 44.9 mL/min on discharge, and 48.2 mL/min at D90. CONCLUSION: Our results supported the viability of the dual kidney transplantation concept. Furthermore the ipsilateral approach shortened the procedure and limited the surgical trauma by preserving the contralateral iliac fossa, without compromising renal function recovery or increasing morbidity.

[Management of the bladder cuff removal by open excision versus transurethral resection of the ureteral orifice after laparoscopic radical nephroureterectomy in upper urinary tract--urothelial carcinoma]. / Évaluation des différentes techniques d'excision de la collerette vésicale lors des néphro-urétérectomies laparoscopiques pour la prise en charge des carcinomes urothéliaux de la voie excrétrice supérieure.

OBJECTIVES: To assess treatment-related complication outcomes in the management of the bladder cuff removal by open excision (OE) or transurethral resection of the ureteral orifice (TURUO) after laparoscopic radical nephroureterectomy (LNU) in upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS: We did a retrospective study involving patients having UUT-UC who underwent LNU from 2004 to 2012 in two references center. Flexible ureteroscopy was carried out for multiple biopsies. Patients were assigned to one of two different surgical groups consisting of LNU with OE versus TURUO for the bladder cuff removal. Perioperative characteristics, complication related treatment and oncological outcomes were collected during the follow-up. RESULTS: Overall, 29 patients underwent LNU over-time including 16 using LNU with OE and 13 LNU with TURUO. LNU+OE were older (66.5 years [48-87] [P<0.01]). Operative time was shorter (180 min vs. 240 min [P=0.01]) with a longer hospital stay (7 days vs. 5 days [P<0.01]) than TURUO technic. No difference in the complication rate was reported. LNU +OE was associated with higher grade (81.3% vs. 38.5% [P=0.026]) and more invasive tumor (37.5% vs. 24.1% [P=0.03]). Regardless the technic, the cancer-specific survival rate was 63.7 years without significant differences between technics. CONCLUSION: TURUO was shorter in hospital stay but had a longer operative time with no impact on the treatment-related complication. Oncological control not highlighted any difference between technics however longer follow up is expected for recommendations.

[Surgical treatment of metastatic urothelial carcinoma of the bladder: Review of the Cancer Committee of the French Association of Urology]. / Traitement chirurgical du carcinome urothélial de vessie métastatique : revue du Comité de cancérologie de l'Association française d'urologie.

INTRODUCTION: The role of surgery in the treatment of patients with metastatic urothelial bladder cancer is controversial. The aim was to review situations where surgical resection of the bladder tumor and/or metastatic urothelial carcinoma has been reported and analyze its results. MATERIALS AND METHODS: A bibliographic research in French and English using the keywords BCG, bladder cancer, metastases, cystectomy, metastasectomy, radiotherapy, curative treatment and palliative treatment was performed, 177 articles have been reviewed, and 18 have been selected. RESULTS: Synchronous or metachronous urothelial carcinoma metastases were diagnosed in 4 and 50% of the cases, respectively. The surgical treatment of metastatic urothelial carcinoma of the bladder has been proposed to achieve oncologic resection of all detectable lesions after a first-line chemotherapy or to treat symptoms, which were refractory to other treatment modalities. In achieving complete resection of the primary tumor and metastases after MVAC chemotherapies, the 5years overall survival was 28%. CONCLUSION: There was no evidence in favouring surgical treatment of metastatic urothelial carcinoma. Considering the high perioperative mortality rate of cystectomy in imperative indications, particularly in the case of hematuria, all therapeutic alternatives must have been exhausted and urine derived in the simplest way.

[Urothelial carcinoma in patients under 40 years. Review of the cancer committee of the French Association of Urology]. / Le carcinome urothélial des patients de moins de 40 ans. Revue du comité de cancérologie de l'Association française d'urologie.

INTRODUCTION: Urothelial carcinoma in young patients (<40 years) is rare. The only known risk factor is exposure to tobacco smoking and/or early active tobacco intoxication. No genetic predisposing factor seems to exist. MATERIAL AND METHODS: A review of the literature was performed using PubMed database with a combination of the following keywords: urothelial carcinoma, young patients/adults, children, pediatrics, urothelium and neoplasm prognosis. DISCUSSION: Urothelial carcinomas before the age of 20 years are non-invasive papillary lesions (papillary urothelial neoplasm of low malignant potential and non-invasive papillary urothelial carcinoma low grade or high grade) of excellent prognosis. Rare cases of infiltrating carcinomas have been described between 20 to 40 years; their histological and clinical aspects are close to those observed in usual urothelial carcinomas. CONCLUSION: The management of urothelial carcinomas of patients under 40 years relies on the tumor grade and stage. Treatment of aggressive cases has to be curative from a clinical point of view, nevertheless conserving vital and reproducing functions.

[CCAFU Recommendations 2013: Bladder carcinoma]. / Recommandations en onco-urologie 2013 du CCAFU : Tumeurs de la vessie.

INTRODUCTION: The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC). METHODS: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. RESULTS: Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS<1) and renal function (creatinine clearance > 60 ml/min) permits (only in 50% of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC.

[CCAFU Recommendations 2013: Upper urinary tract carcinoma]. / Recommandations en onco-urologie 2013 du CCAFU : Tumeurs de la voie excrétrice urinaire supérieure.

INTRODUCTION: The objective was to update the guidelines of the French Urological Association Cancer Committee for upper tract urothelial carcinoma (UTUC). METHODS: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS: The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Total nephro-urectomy remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed : unifocal tumour and diameter < 1 cm and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. CONCLUSION: These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for UTUC.

[Sexuality and prostate cancer]. / Sexualité et cancer de la prostate.

All treatments of prostate cancer have a negative effect on both sexuality and male fertility. There is a specific profile of changes in the fields of quality of life, sexual, urinary, bowel and vitality according to the treatment modalities chosen. Maintain a satisfying sex is the main concern of a majority of men facing prostate cancer and its treatment. It is essential to assess the couple's sexuality before diagnosis of prostate cancer in order to deliver complete information and to consider early and appropriate treatment options at the request of the couple. Forms of sexuality sexual preference settings stored (orgasm) may, when the erection is not yet recovered, be an alternative to the couple to maintain intimacy and complicity. In all cases, a specific management and networking will in many cases to find a satisfactory sexuality. Consequences of the treatment on male fertility should be part of the information of patients with prostate cancer and their partners. The choice of treatment must take into account the desire of paternity of the couple. A semen analysis with sperm cryopreservation before any therapy should be routinely offered in men with prostate cancer, particularly among men under 55, with a partner under 43 years old or without children. If the desire for parenthood among couples, sperm cryopreservation before treatment and medical assisted reproduction are recommended.

[Intradiverticular bladder tumours: review of the Cancer Committee of the French Association of Urology]. / Tumeurs de vessie intradiverticulaires: revue du Comité de cancérologie de l'Association française d'urologie.

INTRODUCTION: Cancer Committee of the French Association of Urology (CCAFU) conducted a review of the epidemiology, diagnosis and treatment of intradiverticular bladder tumours (TVID) and proposed therapeutic management. MATERIAL AND METHODS: A bibliographic research in French and English using Medline(®) with the keywords "tumor", "bladder" and "diverticulum" was performed. RESULTS: TVID are more frequently of stage T ≥ 3a and with non urothelial histology than classical bladder tumors. At diagnosis, the risk of underestimation of the extent and multifocality of the tumor was described. Their prognosis, that was more pejorative than conventional tumors, should impelled to limit the indications of conservative treatment. The evidence levels of analyzed publications were low, with C level according to Sackett score. CONCLUSION: the specificities of the TVID have lead the CCAFU to propose specific therapeutic guidelines, based on poor evidence level. Ta-T1 low grade TVID can be treated by transurethral resection alone or followed by BCG therapy in cases of associated carcinoma in situ. High-grade TVID, unifocal and without associated carcinoma in situ, can be treated by diverticulectomy associated with pelvic lymphadenectomy. High grade TVID, multiple or associated with carcinoma in situ, warranted total cystectomy.

[Benefit of bladder and upper urinary tract urothelial tumors lymph node dissection: review from the Bladder Cancer Committee of the French National Association of Urology ("CC-AFU Vessie")]. / Intérêt du curage ganglionnaire dans les tumeurs urothéliales infiltrantes de la vessie (TVIM) et de la voie excrétrice supérieure (TVES) : article de revue du Comité de cancérologie de l'Association française d'urologie.

INTRODUCTION: Lymph node dissection during radical cystectomy or nephroureterectomy confers improved prognosis and eventually therapeutic advantage. The aim of this update is to clarify the anatomical limits of the lymph node dissection, imaging related techniques, possible difficulties related to pathological analysis, its prognostic value and adjuvant treatments. METHOD: A literature review was performed using PubMed database with a combination of the following keywords: "urothelial carcinoma", "lymph node excision", "imaging", "pathology analysis", "prognosis", "chemotherapy" and "radiotherapy". RESULTS: Regarding bladder tumours, extended lymph node dissection is usually performed up to the division of the iliac vessels and the crossing of the ureters. The CT scan is the recommended imaging technique for lymph node staging but its sensitivity is low. Pathological examination should include perivesicle lymph nodes analysis and report the number of normal and metastatic lymph nodes separately. The prognosis is correlated to the total number of lymph nodes removed and to the extent of the excision. The lymph node density (number of metastatic nodes/normal nodes) is the most important prognosis factor. Adjuvant chemotherapy has not demonstrated a clear advantage. Its most efficient modality is a combination including cisplatin. For upper urinary tract tumours, lymph node dissection may have an impact on survival but definitive conclusion is limited by the lack of surgical technique and indications standardisation. CONCLUSION: Extended lymph node dissection improves survival of bladder cancer and prognosis assessment that could eventually be used to stratify patient requiring adjuvant treatment (level of evidence 3). Improvement on survival was also suggested for upper urinary tract tumors (level of evidence 4).

[Chemoradiotherapy for muscle-invasive cancer: methods, surveillance and results. An update from the cancer committee of the French National Association of Urology]. / Radiochimiothérapie pour le traitement des cancers de vessie infiltrant le muscle: modalités, surveillance et résultats. Mise au point du comité de cancérologie de l'Association française d'urologie.

Radical cystectomy is the treatment of choice for non-metastatic, muscle infiltrating bladder cancer. However, bladder-sparing approaches can be discussed in carefully selected patients. Bladder-preservation protocols aim to guaranty local control and survival with a functional bladder and a good quality of life. The ideal candidate for bladder-preservation therapy is a patient with a small tumor, stage T2, in whom a complete trans-urethral resection of the bladder tumor is achievable, who has no associated carcinoma in situ or hydronephrosis, and who is medically fit to receive chemotherapy. The 5- and 10-year survival rates for muscle-invasive tumors are approximately 50% and 35%, comparable to the results achievable with cystectomy. Approximately 80% of long-term survivors will preserve a native bladder, and approximately 75% of them will have a normal-functioning bladder.

[The role and method of fluorescence-guided cystoscopy in 2011 for management of bladder cancer: Review of the Oncology Committee of the French Urology Association]. / Intérêt et modalités pratiques de la cystoscopie de fluorescence en 2011 pour la prise en charge des carcinomes urothéliaux de la vessie : une revue du Comité de cancérologie de l'Association française d'urologie.

AIM: Fluorescence-guided cystoscopy is a useful tool for bladder tumour detection in association with white-light cystoscopy and decreases the residual tumour rate. The aim of the study was to provide an overview of the pertinent literature on this subject. MATERIALS AND METHODS: The data were provide from a Medline(®) research by using the follow keywords: urinary bladder neoplasms; cystoscopy; fluorescence; prognosis; intraepithelial neoplasm. RESULTS: No evidence 1 level data was available. The fluorescence-guided cystoscopy improves the bladder cancer detection rate, especially the flat lesions, and improve the recurrence-free survival by decreasing the residual tumour rate. The specific indications for fluorescence-guided cystoscopy in the diagnosis and management of non-muscle invasive bladder cancer (NMIBC) should benefit the patients. CONCLUSION: The fluorescence-guided cystoscopy is a benefical tool in association with white-light cystoscopy in NMIBC diagnosis. It has been shown to have a positive impact on recurrence-free survival but not on progression-free survival. More investigations with significant follow-up should be lead in the future to accurately assess its therapeutic impact on patients.

[Diagnostic test for bladder cancer: the NMP22®]. / Actualités urologiques concernant les tests diagnostiques utilisés pour les tumeurs de vessie: le NMP22.

INTRODUCTION: Diagnosis and follow-up of bladder cancer is based on cytology and cystoscopic exams. Cytology is highly specific but remains with a highly variable sensitivity. Cystoscopy is an invasive exam and has shown specific limits. Urinary test, highly specific and highly sensitive, might be ideal to replace the couple cytology-cystoscopy. MATERIAL AND METHODS: Through a literature review, using MeSH system and Pubmed system (keywords: NMP22 and bladder cancer), authors pointed to the value of NMP22 to replace cystoscopy and cytology. RESULTS: Between 1996 and 2010, 193 publications were identified with these keywords. Seventeen original articles have been selected based on their quality and methodology. NMP22 was more sensitive than cytology for follow-up and screening of bladder cancer. As screening test, NMP22 has shown positive predictive value between 0 and 70%. As follow-up test, NMP22 has shown more stable positive predictive value close to 70%. Coupled to cytology, NMP22 has shown predictive positive value up to 90%. CONCLUSION: For screening test, NMP22 should be the referent test for best selection cases (tobacco, hematuria) and for systemic elimination of false positive cases (ureteral stent, lithiasis). For follow-up test, NMP22-cytology should be the new reference. Moreover, when NMP22 is positive with negative cystoscopy, follow-up may be carefully proposed (recurrence risk×10).

[Checkup and management of upper urinary tract tumours in 2010: An update from the committee of cancer from the French National Association of Urology]. / Bilan et prise en charge d'une tumeur de la voie excrétrice urinaire supérieure en 2010 : mise au point du comité de cancérologie de l'Association francaise d'urologie.

Urothelial carcinoma of the upper urinary tract (UUT-UCC) are rare tumours and represent about 5 % of urothelial tumours. There is a history of bladder cancer in 30 % of patients with UUT-UCC but less than 2 % of patients with bladder cancer have a location in the upper urinary tract. The main prognostic factors are age, grade and tumour stage. A High-MSI status is predictive of improved survival, especially in patients under 70years with invasive tumour. During the preoperative assessment, improved staging of UUT-UCC is now essential. The couple urine cytology and uro-CT is an element of staging that underestimates or overestimates some UUT-UCC. The diagnostic ureteroscopy has become a fundamental step in the preoperative evaluation of the tumour. Ureteroscopy allows to explore visually at least 95 % of the upper urinary tract and to perform biopsies of the tumour that help to determine the grade cell. It can also detect a possible secondary location unnoticed with imaging. An exhaustive preoperative assessment, including a systematic diagnostic ureteroscopy, should allow to explore UUT-UCC in a better manner and to increase the number of potential candidates for conservative treatment. The treatment of choice is currently nephroureterectomy with open approach. Superficial and/or low-grade UUT-UCCs have favourable outcomes similar to noninvasive tumours of the bladder (80 % specific survival at five years). Their surgical management is gradually evolving towards the maximum preservation of the upper urinary tract and of the renal parenchyma. The good oncologic results obtained after conservative endoscopic treatment (ureteroscopy, percutaneous treatment) make it a credible alternative to the radical surgery for the management of tumours with non-aggressive behaviour. However, the high cost of endoscopy equipment and supplies currently remains a factor limiting their distribution in France.

[Iodine 125 prostate brachytherapy: prognostic factors for long-term urinary, digestive and sexual toxicities]. / Curiethérapie de prostate par iode 125 : facteurs pronostiques de longue durée de toxicité urinaire, digestive et sexuelle.

PURPOSE: For patients with good urinary function and presenting with a low risk prostate cancer, prostate brachytherapy using iodine implants represents one of the techniques of reference. This retrospective analysis investigates urinary (U), digestive (D) and sexual (S) toxicities and their prognostic factors of duration. MATERIAL AND METHODS: From August 2000 to November 2007, 176 patients presenting with prostate adenocarcinoma underwent interstitial brachytherapy. Urinary, digestive and sexual toxicities were classified according to Common toxicities criteria for adverse events, version 3.0 (CTCAE V3.0). For each toxicity (U, D, S), the number of complications U (dysuria, nicturia...), D (proctitis, diarrhea...) and S (sexual dysfunction, loss of libido, ...) was listed and analyzed according to criteria related to the patient, implant, dosimetric data and characteristics of the toxicity. Prognostic factors identified in univariate analysis (UVA) (Log Rank) were further analyzed in multivariate analysis (MVA) (Cox model). RESULTS: With a median follow-up of 26 months (1-87), 147 patients (83.5 %) presented urinary toxicities. Among them, 29.5 % (86 patients) and 2.4 % (seven patients) presented grade 2 and 3 U toxicity respectively. In UVA, urinary grade toxicity greater than or equal to 2 (p=0.037), the presence of initial U symptoms (p=0.027) and more than two urinary toxicities (p=0.00032) were recognized as prognostic factors. The number of U toxicities was the only prognostic factor in MVA (p=0.04). D toxicity accounted for 40.6 % (71 patients). Among them, 3 % (six patients) were grade 2. None were grade 3. Two factors were identified as prognostic factors either in UVA and MVA: the number of D toxicities greater than or equal to 2 (univariate analysis: p=0,00129, multivariate analysis: p=0,002) and age less than or equal to 65 years (univariate analysis: p=0,004, multivariate analysis: p=0,007). Eighty-three patients (47.4 %) presented a sexual toxicity; 26.9 % (49 patients) and 5 % (nine patients) were scored as grade 2 and 3 respectively. A number of seeds greater than 75 (p=0.032) and S grade greater than or equal to 2 (p<0.0001) were recognized as prognostic factors in UVA. S grade was the only prognostic factor in MVA (p=0.0015). CONCLUSION: The duration of U, D and S toxicity is strongly correlated with a high number of toxicities and the grade of toxicity. This analysis allows for better information given to the patient regarding the duration of the post-treatment complications.

[Treatment of infiltrating nonmetastatic bladder cancers in elderly patients]. / Traitement des cancers infiltrants non métastatiques de la vessie chez les patients âgés.

Total cystectomy is the reference treatment for infiltrating nonmetastatic bladder cancers. With the progress in anesthesia and postoperative intensive care, this treatment can be applied to a population of elderly subjects provided there is a strict oncological and geriatric evaluation of the patient. Recent series reporting total cystectomies in subjects over 75 years of age report comparable morbidity and mortality rates to the general population. Strategies to preserve the vesical reservoir can be indicated in selected cases. Their objectives are to guarantee local control and follow-up identical to radical cystectomy, while preserving a functional bladder and good quality of life. The strategies including transurethral resection with radiochemotherapy are analyzed. Thus, with multidisciplinary consensus and adapted management, elderly patients with significant comorbidities should not be automatically excluded from access to effective treatment of these cancers.