[Active surveillance for prostate cancer: usefulness of endorectal MR at 1.5 Tesla with pelvic phased array coil in detecting significant tumors]. / Cancer de la prostate localisé: l'IRM endorectale à 1,5 Tesla améliore-t-elle la sélection des patients en vue d'une surveillance active?

PURPOSE: To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol. PATIENTS AND METHODS: The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology. RESULTS: 85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score>6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS>1 as a predictor tool of significant tumor. ("T3MRI±NPS>1"=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI±NPS>1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score>6 rates (20%). CONCLUSION: Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR±NSP>1" may represent an exclusion citeria due to its ability to predict significant tumor.

[Nerve-sparing open radical prostatectomy with extracapsular dissection]. / Le respect de l'intégrité capsulaire dans la prostatectomie radicale à ciel ouvert avec préservation nerveuse.

BACKGROUND: Potency recovery after radical prostatectomy (RP) has to be weighed against the risks of nerve-sparing surgery in relation to long-term cancer control. OBJECTIVE: To apply quality control criteria for RP, define the risk of iatrogenic positive margins and evaluate nerve-sparing dissection and sexual outcomes. INTERVENTION: Nerve-sparing retropubic RP with "extracapsular" dissection. METHOD: Histopathology : whole-mount 3-mm serial sections from the prostate apex to base using the Stanford technique. Recovery of erectile function evaluated with the abridged version of the International Index for Erectile Function (IIEF-5). RESULTS: Prospective study about 507 consecutive RP candidates. Bilateral nerve-sparing (n=273, 88.1%), unilateral (n=37, 11.9%). The risk of iatrogenic positive margins was 5%. The positive surgical margin rate was 6.3% (2.2% for pT2 and 14.5% for pT3). The potency recovery rate with or without type 5 phosphodiesterase inhibitor assistance was 83.5% at 1 year and 95.1% at 2 years. CONCLUSION: Nerve-sparing can be performed in a dissection plane outside the boundaries of the capsule, thus ensuring oncological safety whilst providing highly satisfactory potency recovery rates.

[Retroperitoneal laparoscopic treatment of symptomatic caliceal diverticular calculi]. / Traitement par laparoscopie rétropéritonéale d'un amas lithiasique intradiverticulaire caliciel symptomatique.

Treatment of urinary calculi in caliceal diverticular is indicated when they are symptomatic. Minimally invasive techniques, in particularly laparoscopic approach, occupy an increasingly important place in the urological therapeutic armamentarium and have changed from an open surgical approach to endoscopic treatment for the management of symptomatic caliceal diverticular calculi. Herein, we report the case of a woman with symptomatic calculi in an upper caliceal diverticular managed by retroperitoneal laparoscopic approach.

[Vulvar invasive squamous cell carcinoma and hidradenoma papilliferum. Case report]. / Carcinome épidermoïde et hidradénome papillifère vulvaire. A propos d'un cas.

We report a case of a vulvar invasive squamous cell carcinoma associated to a benign tumor with apocrine differenciation, the hidradenoma papilliferum, infiltrated by the carcinoma. Diagnosis was established by clinical and histopathological examination, first on biopsy and then on local vulvar excision. Classical association between hidradenoma papilliferum and Paget's disease is described, but to the best of our knowledge, there have been no previous reports of such case in published literature. A common physiopathological etiology cannot be completely excluded.

[Urethrovesical anastomosis in retropubic radical prostatectomy]. / Anastomose vésico-urétrale dans la prostatectomie radicale rétropubienne.

Urethrovesical anastomosis is the most codified step in radical prostatectomy. Most of the time, the bladder neck diameter makes it possible to carry out a congruent anastomosis. Otherwise one has to resort either to the tennis racket closure or the parachute technique. Stenosis will remain an exceptional complication if the technique is applied with strictness and precision.

Cascading blockages in channel bundles.

Flow in channel networks may involve a redistribution of flux following the blockage or failure of an individual link. Here we consider a simplified model consisting of N(c) parallel channels conveying a particulate flux. Particles enter these channels according to a homogeneous Poisson process and an individual channel blocks if more than N particles are simultaneously present. The behavior of the composite system depends strongly on how the flux of entering particles is redistributed following a blockage. We consider two cases. In the first, the intensity on each open channel remains constant while in the second the total intensity is evenly redistributed over the open channels. We obtain exact results for arbitrary N(c) and N for a system of independent channels and for arbitrary N(c) and N=1 for coupled channels. For N>1 we present approximate analytical as well as numerical results. Independent channels block at a decreasing rate due to a simple combinatorial effect, while for coupled channels the interval between successive blockages remains constant for N=1 but decreases for N>1. This accelerating cascade is due to the nonlinear dependence of the mean blocking time of a single channel on the entering particle flux that more than compensates for the decrease in the number of active channels.

Generalized model of blockage in particulate flow limited by channel carrying capacity.

We investigate stochastic models of particles entering a channel with a random time distribution. When the number of particles present in the channel exceeds a critical value N, a blockage occurs and the particle flux is definitively interrupted. By introducing an integral representation of the n-particle survival probabilities, we obtain exact expressions for the survival probability, the distribution of the number of particles that pass before failure, the instantaneous flux of exiting particles, and their time correlation. We generalize previous results for N=2 to an arbitrary distribution of entry times and obtain exact solutions for N=3 for a Poisson distribution and partial results for N≥4.

Comparison of respirator protection factors measured by two quantitative fit test methods.

A comparison of measured respirator protection factors for a di-2-ethylhexyl phthalate (liquid aerosol challenge) respirator quantitative fit test method is made with a complementary sodium chloride (solid aerosol challenge) method. The United States Army XM-29 chemical warfare defense respirator was used in this evaluation. A subject pool of twelve individuals (two female and ten male) were fitted and tested on both respirator quantitative fit test methods on ten different occasions. An exercise protocol of six different breathing and head movement maneuvers was used in each test. The purpose of the comparison was to determine if there is a difference between the two fit test methods. The di-2-ethylhexyl phthalate method showed a significant order-interaction effect with respect to the exercise sequence and whether it preceded or followed testing with sodium chloride. The sodium chloride method did not show a similar phenomenon, and consistently measured smaller protection factors compared to the di-2-ethylhexyl phthalate method. It appears that the sodium chloride method is more sensitive.

[What can be expected of x-ray computed tomography in the assessment of the loco-regional extension of kidney cancer?]. / Qu'attendre de la tomodensitométrie dans le bilan d'extension loco-régionale des cancers du rein?

The authors assess the role of CT scanning in investigations for the extension of renal tumors with the aid of a series of 40 patients. A complete inventory of the lesions was obtained in 30 patients who had undergone radical surgery. Capsular damage is visualized with a high percentage of uncertainty, and, setting aside a few exceptions, it is impossible to specify the histological nature of adenomegalies. On the other hand, venous exploration can be performed with growing accuracy thanks to series of angioscans. This method of investigation would therefore not seem suitable for staging tumors on Robson's scale, but it is most useful in selecting surgical tactics in the preoperative assessment of the lesions.

[Value of x-ray computed tomography in the study of the inferior vena cava in urologic practice]. / Apport de la tomodensitométrie dans létude de la veine cave inférieure en pratique urologique.

The CT scan provides a reliable evaluation of the inferior vena cava, especially since the development of second and third generation scanners. It can readily detect congenital malformations and obstructive anomalies complicating renal cancer and it is also able to determine the tumoral or thrombotic nature of the venous obstruction. This excellent definition of the vessel reduces the indications for caval angiography to a few exceptional cases.

[Spontaneous regression of regressive pulmonary metastases from kidney cancer. Myth or reality? Apropos of 2 cases]. / Régression spontanée de métastases pulmonaires régressives de cancer du rein. Un mythe ou une réalité? A propos de deux cas.

The authors report two cases of regression of lung metastases from renal cell cancer with cytological and histological proof. They present a complete review of the literature and analyse the theories proposed to explain this phenomenon.

[The value of preoperative perineal rehabilitation in radical prostatectomy and replacement entero-cystoplasty. Preliminary results]. / Intérêt de la rééducation périnéale pré-opératoire dans les prostatectomies radicales et les entérocystoplasties de remplacement. Résultats préliminaires.

Radical surgery of the prostate and replacement entero-cystoplasty are associated with varying degrees of risk of diurnal or nocturnal incontinence, which is always poorly tolerated by the patient. In order to reduce this discomfort, perineal reeducation, commenced before the operation, appears to be a valuable aid. A survey of sphincter function easily detects patients at risk and postoperative sphincter disorders can be prevented to a large degree. The authors analyse their preliminary results in 14 patients undergoing radical prostatectomy and in another 10 patients undergoing replacement entero-cystoplasty.

[Salvage cryotherapy for recurrent prostate cancer after radiotherapy failure: principles, indications, patient selection, oncological results and morbidity]. / Cryothérapie de rattrapage après radiothérapie prostatique : principes, indications, sélection des patients, résultats oncologiques et morbidité

Potentially curative salvage options for biochemical failure after primary prostatic radiotherapy include salvage radical prostatectomy, brachytherapy, high-intensity focused ultrasound and cryotherapy. Salvage cryoablation for recurrent prostate cancer after irradiation failure is currently a well-established therapeutic option, since technical improvements have permitted better oncologic outcomes and lower complications rates over the years. This article reviews surgical technique, oncologic and functional outcomes, as well as morbidity and complications of salvage cryotherapy for local recurrence after external beam radiotherapy or brachytherapy for prostate cancer.

Improving bladder neck division in radical retropubic prostatectomy by prior dissection of the seminal vesicles and vasa deferentia.

OBJECTIVE: To develop a convenient technique for dividing the bladder neck during radical retropubic prostatectomy. METHOD: Before opening the bladder, we created a plane that separates the anterior surface of the seminal vesicles from the posterior wall of the bladder and ran an umbilical tape through the plane. The posterior bladder neck wall was later divided using this tape as a guide mark. RESULTS AND CONCLUSION: The posterior bladder neck was divided in a single, easy, and swift maneuver (less than 2 min) in 350 patients with no subsequent complications.