Biochemical relapse predictive factors in patients with lymph node metastases during radical prostatectomy.

INTRODUCTION: There are no clear recommendations for the management of patients with lymph node invasion discovered during radical prostatectomy for prostate cancer (PCa). Adequate risk stratification could personalize post-surgical adjuvant treatment. Our objective was to identify predictive factors for biochemical relapse (BCR) in patients with lymph node (LN) invasion at the time of radical prostatectomy(RP). MATERIALS AND METHODS: Patients who underwent RP for high-risk PCa with LN invasion in two academic centres between 2008 and 2019 were included. Patients with metastatic disease or extrapelvic LN involvement were excluded. Following data were collected retrospectively: age, preoperative prostate-specific antigen level, Gleason score, clinical and pathological stage, number of metastatic LN and LN density. Outcome was BCR during follow-up. BCR-free survival was assessed by Kaplan-Meier method and its association with relevant variables was determined with log-rank test. RESULTS: Twenty-six patients were included. Median (IQR) age, PSA and follow-up were 64.5 years (55-78), 9.2ng/mL (4.4-20) and 16.1 months (6-27.5), respectively. Twenty patients (77%) had BCR after surgery, accounting for 24-month BCR-free survival of 65%. Patients with LN density > 15% had better survival rates than those with ≤ 15% (40% vs. 0%, respectively, at 24 months; P=0.06) without reaching significance. Cox proportional Hazards analysis could not evidence predictive factors of BCR free-survival. CONCLUSIONS: LN density seemed associated with BCR-free survival within patients with high-risk PCa and positive LN at RP. However, extraprostatic extension, number of positive LN and positive surgical margins were not independent risk factors for BCR. Larger prospective studies with centralized pathological reviews are needed. LEVEL OF PROOF: 3.

The Impact of Rheology on Viscous Oil Displacement by Polymers Analyzed by Pore-Scale Network Modelling.

Several experimental studies have shown significant improvement in heavy oil recovery with polymers displaying different types of rheology, and the effect of rheology has been shown to be important. These experimental studies have been designed to investigate why this is so by applying a constant flow rate and the same polymer effective viscosity at this injection rate. The types of rheology studied vary from Newtonian and shear thinning behavior to complex rheology involving shear thinning and thickening behavior. The core flood experiments show a significantly higher oil recovery with polyacrylamide (HPAM), which exhibits shear thinning/thickening behavior compared to biopolymers like Xanthan, which is purely shear thinning. Various reasons for these observed oil recovery results have been conjectured, but, to date, a clear explanation has not been conclusively established. In this paper, we have investigated the theoretical rationale for these results by using a dynamic pore scale network model (DPNM), which can model imbibition processes (water injection) in porous media and also polymer injection. In the DPNM, the polymer rheology can be shear thinning, shear thinning/thickening, or Newtonian (constant viscosity). Thus, the local effective viscosity in a pore within the DPNM depends on the local shear rate in that pore. The predicted results using this DPNM show that the polymer causes changes in the local flow velocity field, which, as might be expected, are different for different rheological models, and the changes in the velocity profile led to local diversion of flow. This, in turn, led to different oil recovery levels in imbibition. However, the critical result is that the DPNM modelling shows exactly the same trend as was observed in the experiments, viz. that the shear thinning/thickening polymer gave the highest oil recovery, followed by the Newtonian Case and the purely shear thinning polymer gave the lowest recover, but this latter case was still above the waterflood result. The DPNM simulations showed that the shear-thinning/thickening polymer show a stabilized frontal velocity and increased oil mobilization, as observed in the experiments. Simulations for the shear-thinning polymer show that, in high-rate bonds, the average viscosity is greatly reduced, and this causes enhanced water fingering compared to the Newtonian polymer case. No other a priori model of the two-phase fluid physics of imbibition, coupled with the polymer rheology, has achieved this degree of predictive explanation, of these experimental observations, to our knowledge.

Prostate cancer before renal transplantation: A multicentre study.

INTRODUCTION: The surgical issues of renal transplantation (RT) after localized prostate cancer (PC) treatment and oncological outcomes after transplantation in patients on the waiting list with a history of PC were unknown. We conducted a retrospective multicentre study including all patients with PC diagnosed before the kidney transplantation. METHODS: Fifty-two patients were included from December 1993 to December 2015. The median age at diagnosis of PC was 59.8years old. RESULTS: The median PSA rate at diagnosis was 7ng/mL. Twenty-seven, Twenty-four, and one PC were respectively low, intermediate and high risk according to d'Amico classification. Forty-three patients were treated by radical prostatectomy (RP): 28 retropubic, 15 laparoscopic and 3 by a perineal approach. Eighteen patients had a lymph node dissection. Four patients were treated with external radiotherapy and 2 by brachytherapy. Eight patients underwent radiotherapy after surgery. The median time between PC treatment and RT was 35.7 months. The median operating time for the renal transplantation was 180min (IQR 150-190; min 90-max 310) with a median intraoperative bleeding of 200mL (IQR 100-290; min 50-max 2000). A history of lymphadenectomy did not significantly lengthen operative time (P=0.34). No recurrence of PC was observed after a median follow of 36months. CONCLUSION: PC discovered before RT should be treated with RP to assess the risk of recurrence and decrease waiting for a RT. If the PC is at low risk of recurrence, it seems possible to shorten the waiting time before the RT after a multidisciplinary discussion meeting. LEVEL OF EVIDENCE: 4.

Testicular Metastasis of a Upper Urinary Tract High-grade Papillary Urothelial Carcinoma, 2 Years After Nephroureterectomy.

Urothelial carcinomas are the fourth most common tumors in men. Upper tract urinary carcinomas (UTUCs) are uncommon and represent only 5-10% of urothelial carcinomas.(1) Metastatic testicular cancers are rare and primary tumor sources are the prostate, lung, and gastrointestinal tract. We report the first case of testicular metastasis 2 years after initial curative surgery for a high-grade UTUC, all other reported cases weren't proceed by curative surgery.(3).

Prospective evaluation of early postoperative male and female sexual function after radical prostatectomy with erectile nerves preservation.

Prostate cancer screening has led to the diagnosis of localized prostate cancer in increasingly young and sexually active men. Accordingly, the impact of cancer treatment on sexual function is gaining more attention. To prospectively evaluate the impact of radical prostatectomy (RP) on male, female and conjugal sexual function. Patients were prospectively assessed by an urologist and a sexologist before and 6 months after robot-assisted laparoscopic RP (RALP). RALP was performed with uni- or bilateral neurovascular bundle preservation by a single surgeon. Postoperatively, all patients were prescribed tadalafil 20 mg, 3 times a week during 6 months. Male and female sexual functions were evaluated by using the International Index of Erectile Function (IIEF-5), the Female Sexual Function Index (FSFI) and the Lock-Wallace Marital Adjustment Test (MAT). Continuous variables were analyzed with rank-sum and t-tests, as needed, and categorical variables with chi-squared tests. All tests were two-sided, with a P-value ⩽ 0.05 considered significant. Twenty-one couples were included. Mean patient male and female age was 62.4 and 60.7 years, respectively. Bilateral nerve sparing was performed in 12/21 (57%) patients. Median preoperative IIEF-5 was 20/25, corresponding to mild erectile dysfunction (ED). Median preoperative FSFI and MAT were both within normal range (28/36 and 114/158, respectively). Six months following surgery, both IIEF-5 (11/25) and FSFI (25/36) had significantly dropped (P=0.007 and 0.003, respectively). Postoperative decreases in IIEF-5 and FSFI scores were associated within couples. MAT scores (115/158), however, remained unaffected by RALP, showing an unmodified relationship satisfaction postoperatively. Finally, bilateral nerve sparing surgery preserved not only male but also female sexual function. This study shows that the expected short-term post-RALP ED is associated with a worsening of female sexual function, whereas nerve sparing surgery has a protective effect on both the patient's and his partner's sexual function with a significant effect of bilateral over unilateral neurovascular bundle preservation. Furthermore, we found that conjugal complicity remains stable throughout the first semestrial postoperative period despite the decrease in sexual function.

Can Dopamine Depletion at DAT Scan in a Non Parkinson Patient be the Cause a Refractory Overactive Bladder?

We report here the first case of treatment of idiopathic refractory overactive bladder with dopamine. A female patient consulted for urge incontinence. Management included all recommended treatments without success. DAT scan was finally performed showing clear reduction in dopamine secretion without diagnosis of any neurological condition. Patient started dopamine treatment. At 1 month, patient described persistence of mild urgency and frequency but complete resolution of urge incontinence. At 3 months patient was completely dry with only persistence of mild frequency. Functional imaging and central nervous system target might represent new ways of managing idiopathic overactive bladder.

[Robotic-assisted organ transplantation]. / Transplantation d'organes avec assistance robotique.

Advanced surgical procedures have traditionally been a domain of open surgery. However, minimally invasive approaches are evolving with the development of robotic technology which appears capable to overcome technical limitations of conventional laparoscopy. While traditionally perceived as impossible indications for minimally invasive surgery, reports on robotic organ transplantations have surfaced with promising results.

Acute and long term mineral metabolism adaptation in living kidney donors: a prospective study.

BACKGROUND: Living kidney donors (LKDs) experience an abrupt decline in glomerular filtration rate (GFR). Mineral metabolism adaptations in early CKD are still debated and not well studied in LKDs. We prospectively studied acute and long term mineral metabolism adaptation of LKDs. METHODS: From May 2010 to December 2012, we included 27 adult LKDs. Their mineral parameters and renal function were repeatedly measured at days 0, 1, 2, 3, 180 and 360 after donation. We also measured in uninephrectomized rats' Klotho in the remnant kidney and FGF23 circulating levels. RESULTS: In the first days after nephrectomy, LKDs experience transient dilution hypocalcemia and secondary hyperparathyroidism. Urinary phosphate reabsorption decreases in spite of an abrupt decline in circulating FGF23 and Klotho. In a more chronic stage, at days 180 and 360 after donation, LKDs have lower GFR and 1,25(OH)2D compared to pre-donation levels, with unchanged 25(OH)D. PTH levels increase, resulting in decreased plasma phosphate levels and renal tubular reabsorption of phosphate. In comparison to pre-donation, FGF23 levels are not significantly changed whereas circulating Klotho levels are lower than pre-donation but higher than immediately post-donation. In uninephrectomized rats, Klotho kidney expression increases after three weeks, whereas circulating FGF23 levels are unchanged. CONCLUSION: From six months after kidney donation, LKDs develop secondary hyperparathyroidism related to a decrease in 1,25(OH)2D, and decreased plasma phosphate levels. FGF23 levels do not rise in LKDs. Middle term mineral metabolism adaptations to decreased eGFR in donors include decrease in 1,25(OH)2D and increase in PTH and fractional excretion of phosphate resulting in lowered plasma phosphate levels, independently of FGF23. These adaptations differ from those described in CKD patients.

[Renal stone disease: collaborative management between primary care and specialized physicians]. / Approche pratique de la lithiase rénale: duo entre généralistes et spécialistes.

Nephrolithiasis is a highly prevalent pathology with a 10% lifetime risk in the Western population. Although it is often minimized and qualified as "idiopathic" significant comorbidities are frequently observed, e.g. the metabolic syndrome, type 2 diabetes mellitus, hypertension and bone fragility. Therefore nephrolithiasis can be regarded as a systemic disorder. A specialized diagnostic and therapeutic approach should be offered to such patients with active kidney stone disease in order to prevent stone recurrence and favor early diagnosis of said comorbidities.

[Should we prescribe phosphodiesterase inhibitors for the treatment of symptomatic benign prostatic hyperplasia]. / Est-il opportun de prescrire des inhibiteurs de la phosphodiestérase pour traiter le prostatisme?

This October, the FDA has approved the use of phosphodiesterase inhibitors for the treatment of micurition symptoms due to benign prostatic hyperplasia, so as for erectile dysfunction. This decision is essentially based on the results of 2 studies that we discuss in this article. Although methodologically well designed, these works show that phosphodiesterase inhibitors decrease only weakly, but statistically sigificatively the micturition score of patients suffering from prostatism. Besides that, only one of these papers show a limited effect on a single objective micturitionnal parameter. According to the present knowledge, it appears judicious to prescribe tadalafil to treat benign prostatic hyperplasia symptoms of patients suffering simultaneously of a significant erectile dysfunction.

[Testicular torsion: a tricky diagnosis]. / Torsion testiculaire: une urgence piège.

In common urological practice, testicular torsion is one of the most serious emergencies. Consequences can be devastating for the patient, both physically and psychologically. The primary care physician should be able to quickly identify the pathology and refer immediately the patient to a center with surgical facilities. Rapid diagnosis provides the best chances to save the patient's testicle, which may suffer irreversible damage as soon as 6 hours after the onset of the symptoms. History and clinical examination remain the cornerstones of the diagnosis, and are often sufficient to select patients who need surgical exploration. If time allows it, Doppler Ultrasound can often help distinguish torsion from other scrotal conditions, but cannot be considered as a 100% diagnostic tool.

[Robotic partial nephrectomy: development and advantages]. / Développement de la néphrectomie partielle robotisée: avantages.

Surgery is the first line of treatment of renal cell carcinoma. For small tumours confined to the kidney (< or = 4 cm), partial tumour resection has logically become the standard treatment. When technically feasible, partial nephrectomy may be applied to treat tumors less than 7 cm, according to 2010 recommendations of the European Association of Urology. In addition, nephron-sparing surgery has proven to positively impact on quality of life. Robotic-assisted laparoscopy partial kidney resection has recently emerged. Its indications are as yet undergoing validation, while open surgery still remains the gold standard. For the patients, the consequences of this minimally invasive evolution are evident: The comfort and postoperative recovery are respectively greater and faster compared to conventional open surgery.

Female hydrocele: the cyst of Nuck.

The canal of Nuck is the portion of the processus vaginalis within the inguinal canal in women. A hydrocele of the canal of Nuck is equivalent to an encysted hydrocele of the cord in men. The literature reveals very little about this rare condition in the adult female patient. In this paper, we report a case of hydrocele of the canal of Nuck in a young female. The diagnosis was made with ultrasound and magnetic resonance imaging and then confirmed preoperatively and by histopathology. Although rare, a hydrocele of the canal of Nuck has to be included in the differential diagnosis of a groin lump in female patients.

[Prostate cancer screening: an update]. / Dépistage du cancer de la prostate: actualité.

Prostate cancer screening using PSA is controversial because of a low specificity and detection of non clinically relevant cancer. Two important studies have been published recently. One of two studies suggests a 20% lowering in specific prostate cancer mortality due to PSA screening. This benefit is relevant but implies at a high risk of overtreatment and treatment-related complications. Currently PSA screening is only proposed as an individual screening for informed patients.

[Sexual function after radical prostatectomy: update of 2009]. / Fonction sexuelle après prostatectomie radicale: revue et prise en charge en 2009.

Prostate cancer is more frequently diagnosed in young males. It is then of utmost importance to improve preservation and recovery of sexual function. The surgical technique of radical prostatectomy has evolved and erectile nerve sparing allows now to achieve recovery in an important proportion of selected patients. However, rehabilitation and sexual counselling protocols are rare and may not include the partner. This has led us to propose a specific urologic and sexologic associated management.