[Does chewing gum improve postoperative results in patients undergoing radical cystectomy? A systematic review of literature and meta-analysis]. / Le chewing-gum améliore-t-il les résultats postopératoires chez les patients opérés d'une cystectomie radicale ? Revue systématique de la littérature et méta-analyse.

INTRODUCTION: Postoperative ileus occurs in different degrees, in the majority of patients undergoing radical cystectomy, which may increase the length of hospital stay. The use of chewing gum has demonstrated its effectiveness in reducing time-to-bowel function and the length of hospital stay in several surgical procedures. OBJECTIVE: To evaluate the benefit of post-operative chewing gum use in patients undergoing radical cystectomy through a systematic review of the literature and meta-analysis. MATERIAL AND METHODS: We performed a literature search of MedLine, Scopus, CochraneLibrary and ClinicalTrials.Gov in March 2017 according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The studies were evaluated according to the "Oxford Center for Evidence-Based Medicine" criteria. The outcome measures evaluated were time-to-flatus, time-to-defecation, length of the hospital stay, and the rates of general and gastrointestinal postoperative complications. Continuous and dichotomous variables were compared respectively using weighted means differences and odds ratios with 95 % confidence intervals. The presence of publication bias was examined by funnel plots. RESULTS: Three studies (including 274 patients in total) met the inclusion criteria. The pooled results demonstrated a 11.82hour reduction in time-to-flatus (95 % CI : -15.43, -8.22h, P <0.00001), and 19.57hours in time-to-defecation (95 % CI : -29.33, -9.81h, P <0.0001), and a decreasing trend of 2.85 days in the length of the hospital stay (95 % CI : -6.13, -0.43, P=0.09), by the use of chewing gum. There was no significant difference between the "chewing gum" and "control" groups in terms of general and gastrointestinal complications (Peto Odds ratio 1.04 [0.60, 1.79], 95 % CI, P=0.89 and Peto Odds ratio 0.65 [0.26, 1.61], 95 % CI, P=0.35 respectively). CONCLUSION: Chewing gum may be recommended postoperatively in patients undergoing radical cystectomy to improve time-to-bowel function.

Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África / Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men

Antecedentes: Los hombres norteafricanos (NAF) presentan una alta incidencia de cáncer de próstata (CaP) avanzado en el momento del diagnóstico. Varios estudios han demostrado la existencia de diferencias étnicas en la agresividad del CaP y esto ha dado lugar a algunas preocupaciones relacionadas con la inclusión de algunos grupos étnicos en los protocolos de vigilancia activa. Objetivo: Evaluar los resultados patológicos y la agresividad del CaP de bajo riesgo tratado con prostatectomía radical en un grupo étnico NAF. Sujetos y métodos: Los datos de 147 NAF sometidos a prostatectomía radical por CaP de bajo riesgo diagnosticado por medio de una biopsia de 12 núcleos en 2 centros académicos entre 2011 y 2015 se revisaron retrospectivamente para evaluar las tasas de resultados patológicos peores definidas como: actualización de la puntuación de Gleason a por lo menos 3 + 4, eclipse a pT3a o superior o pN1, y márgenes quirúrgicos positivos. Resultados: El eclipse y/o actualización significativa global se produjo en el 20,2% y se produjeron márgenes quirúrgicos positivos en el 18,3%. En el análisis de regresión logística multivariante, las variables independientes que predijeron eclipse y/o actualización o márgenes quirúrgicos positivos en toda la cohorte fueron: grupo de riesgo NCCN (riesgo bajo > riesgo muy bajo), edad avanzada > 60 años, PSA > 6 ng/ml, densidad de PSA ≥ 0,15, más de 2 núcleos positivos en la biopsia, implicación del cáncer de más del 50% en los núcleos positivos, estadio clínico (T2a > T1c) y puntuación UCSF-CAPRA-S > 3. Conclusiones: Nuestro estudio encontró que, al menos patológicamente, los hombres NAF no tienen una enfermedad más agresiva que los caucásicos y afroamericanos, tanto en CaP de bajo como de muy bajo riesgo. Por lo tanto, creemos que la vigilancia activa es un enfoque adecuado para pacientes seleccionados ya que no hay datos definitivos que muestren una historia natural más agresiva de CaP en hombres NAF

Background: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. Objective: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. Subjects and methods: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3 + 4, upstage to pT3a or higher or pN1, and positive surgical margins. Results: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk > very low risk), advanced age > 60 years, PSA > 6 ng/ml, PSA density ≥ 0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a > T1c) and UCSF-CAPRA-S score > 3. Conclusions: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men

Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men. / Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África.

BACKGROUND: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. OBJECTIVE: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. SUBJECTS AND METHODS: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3+4, upstage to pT3a or higher or pN1, and positive surgical margins. RESULTS: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk>very low risk), advanced age>60 years, PSA>6ng/ml, PSA density≥0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a>T1c) and UCSF-CAPRA-S score>3. CONCLUSIONS: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men.

[Primitive neuroectodermal tumor (PNET) of the upper-urinary tract]. / Tumeur neuro-ectodermique primitive (TNEP) de la voie excrétrice supérieure.

Primitive neuroectodermal tumors (PNETs) are rare and aggressive malignant small round cell sarcomas. Primitive urogenital location of PNETs is rare and occurs most frequently in the kidney. PNETs of the upper-urinary tract are exceptional (only one case reported in the literature). Its diagnosis is almost postoperative within pathological study of the operatory specimen, supported by immunohistochemistry and cytogenetics. Treatment is similar in all to that of Ewing's sarcoma and involves surgery, chemotherapy and radiotherapy. We report a new case of upper-urinary tract PNET and discuss the diagnostic and therapeutic problems posed by this particular tumor.

Pseudotumoral malacoplakia of the bladder

Malacoplakia is a rare inflammatory condition most often affecting the genitourinary system. We report the case of a 24-year-old man who presented with gross hematuria; nocturia; frequency; dysuria and considerable weight loss during the preceding three months. Digital rectal examination showed a solid pelvic mass. Ultrasonography and computed tomography showed calyceal dilatation on the right side and a solid bladder mass 10 cm in diameter suspicious of bladder cancer. Transurethral resection of the tumor was incomplete; due to the large volume of the bladder mass. Histological examination of the resected specimen revealed malacoplakia of the bladder. The patient was treated with fluoroquinolone and vitamin C. Follow-up at 3 months showed marked regression of the bladder mass and complete resolution of the calyceal dilatation