[Renal cell carcinoma mimicking a renal abscess]. / Carcinome rénal se présentant sous forme d'un abcès rénal.

With the development of modern imaging, incidental findings of renal neoplasia are increasingly frequent. However, renal cell carcinoma can also rarely present as an atypical form and can be confused with benign pathologies such as renal abscess or pyelonephritis. We present the case of a renal neoplasia largely mimicking a renal abscess.

Avec le développement de l'imagerie moderne, la découverte fortuite des néoplasies rénales est de plus en plus fréquente. Néanmoins, le carcinome rénal peut également rarement se présenter sous une forme atypique et peut alors être confondu avec des pathologies bénignes comme un abcès rénal ou une pyélonéphrite. Nous présentons le cas d'une néoplasie rénale se manifestant trompeusement sous la forme d'un abcès rénal.

[Management of metastatic hormone-naive prostate cancer at diagnosis]. / Prise en charge d'un cancer de la prostate métastatique au diagnostic.

In Belgium, 12 % of patients present with upfront metastatic hormone-naive prostate cancer. Surgical or medical castration has been the only approved treatment for decades. Since 2014, several randomized trials have demonstrated that survival could be significantly improved in patients who are deemed fit enough to cope with the potential added side-effects. Docetaxel chemotherapy and androgen receptor axis-targeted next generation hormonal agents such as abiraterone, enzalutamide and apalutamide have been shown to improve overall survival when given within 12 weeks after castration initiation. Similarly, prostate radiotherapy, in the absence of urological contraindications, might also improve overall survival in patients presenting with less than 5 bone metastases. How these strategies can be combined remains a matter of debate and is currently under investigation.

En Belgique, le cancer de la prostate se présente sous une forme métastatique d'emblée chez 12 % des patients. Depuis des décennies, le traitement repose sur la castration, chirurgicale ou médicamenteuse. Depuis 2014, plusieurs études randomisées ont démontré le bénéfice de compléter cette castration chez les patients aptes à tolérer les effets secondaires éventuels des traitements complémentaires proposés. La chimiothérapie par docétaxel et les hormonothérapies de nouvelle génération visant l'axe androgènes/récepteurs aux androgènes, telles que l'abiratérone, l'enzalutamide et l'apalutamide, permettent d'augmenter significativement la survie des patients lorsqu'elles sont instaurées dans les 3 mois qui suivent la mise en oeuvre de la castration. De même, l'irradiation de la prostate, lorsque la situation urologique le permet, pourrait augmenter la survie des patients ayant moins de 5 métastases osseuses. Le bénéfice éventuel de combiner ces stratégies reste débattu et en cours d'investigation.

[Management of strictures of the male urethra]. / Comment je traite Une sténose de l'urètre masculine.

Male urethral stricture is a well-known pathology responsible for symptomatology of an infravesical obstacle. Its management is essentially surgical. The different treatment options range from simple ambulatory dilation to urethroplasty, sometimes involving an enlargement graft.

ose de l'urètre masculin est une pathologie urologique bien connue, responsable d'une symptomatologie d'obstacle infravésical. Sa prise en charge est essentiellement chirurgicale. Les différentes options thérapeutiques vont de la simple dilatation ambulatoire, à l'urétroplastie, faisant parfois intervenir un greffon d'agrandissement.

[What the last 10 years have brought in the treatment of benign prostatic hyperplasia]. / L'évolution des traitements de l'adénome prostatique au cours des 10 dernières années.

Benign prostatic hyperplasia (BPH) is a very frequent condition, most of the times related to age, and with initial manifestations and long term development that may vary widely. Treatment is necessary only if the patient is symptomatic or if he has complications related to the BPH. During the last 10 years, the various BPH treatment means have evolved significantly. Regarding medical treatment, new drugs have been introduced and new combinations of drugs have shown their efficacy in BPH treatment. The surgical treatment of BPH has seen the development of minimally invasive surgical techniques, with broader indications and better results compared to classical surgical techniques. Among these techniques, the better studied and developed is the endoscopic Holmium Laser Enucleation of the Prostate (HoLEP). The continuous development of medical lasers and minimally invasive surgical techniques for the treatment of BPH will, in our opinion, lead the way towards a rich and innovative future decade with regard to the surgical treatment of BPH.

L'hyperplasie bénigne de la prostate (HBP) est une pathologie extrêmement fréquente, favorisée par le vieillissement et dont les manifestations cliniques peuvent être très variées. Un traitement n'est nécessaire que lorsque le patient se plaint de symptômes secondaires à l'HBP ou souffre de ses complications. Ces 10 dernières années, les traitements de l'adénome prostatique ont évolué de manière importante. De nouvelles molécules ainsi que de nouvelles associations (de molécules connues ayant déjà prouvé leur efficacité) se sont ajoutées au traitement médical. Le traitement chirurgical, quant à lui, a été significativement marqué par le développement des techniques mini-invasives, aux indications plus larges et aux meilleurs résultats. Parmi ces techniques, la plus développée et étudiée, est la technique d'énucléation endoscopique de la prostate à l'aide du laser Holmium (HoLEP). Le développement des lasers à usage médical ainsi que la recherche de nouvelles techniques chirurgicales mini-invasives ouvrent la voie à une prochaine décennie riche en innovations thérapeutiques pour la prise en charge chirurgicale des adénomes prostatiques.

[Exploration of urethral strictures : place of urethrocystography]. / Comment j'explore les sténoses urétrales : intérêt de l'urétrocystographie.

Stricture of the male urethra is a frequent and regularly iatrogenic pathology in industrialized countries. The urologist's surgical arsenal is wide and the choice of an operative technique is made at the end of an assessment where urethrocystography is the main radiological examination. The conditions to achieve the examination, its different stages, the normal aspects and anatomical variants as well as the limitations to its interpretation, should therefore be known by the urologist and the radiologist, in order to assess correctly this pathology.

La sténose de l'urètre masculin est une pathologie fréquente, régulièrement iatrogène dans les pays industrialisés. L'arsenal chirurgical de l'urologue face à celle-ci est large et le choix d'une technique opératoire est posé au terme d'un bilan dont l'urétrocystographie occupe une place centrale. Les conditions de réalisation de l'examen, ses étapes, les aspects normaux et les quelques variantes anatomiques ainsi que ses limites d'interprétation, doivent donc être connus de l'urologue et du radiologue, de manière à ne pas méconnaître ou, au contraire, surestimer une sténose urétrale.

[Metastase from lobular breast carcinoma on the ileal patch of augmentation]. / Métastase de carcinome lobulaire mammaire sur un patch iléal d'entérocystoplastie.

Patients treated with bladder augmentation have a higher risk of developing bladder cancer than the general population. In these patients, tumours are most frequently primary bladder cancers. Metastasis in an augmentation cystoplasty is extremely rare and here we describe the first case of metastasis from lobular breast carcinoma in an ileal patch. A 52-year-old woman, with a medical history of invasive lobular breast cancer, presented with gross hematuria seven years after an ileal augmentation cystoplasty. A large bladder mass was found exclusively on the enteric patch, with lymphadenopathies from iliac vessels to right kidney hilum. Asurgical resection of the ileal segment with trigonal preservation was performed, associated with a complete cytoreduction. The bladder was reconstructed with a new ileal segment. Pathology confirmed the diagnosis of metastatic lobular breast carcinoma. Patients treated with augmentation cystoplasty need a close and long follow-up to detect the warning signs of tumor development. We herein report our experience of a metastatic lesion on the enteric part of a cystoplasty. Unusual characteristics of the bladder tumor and personal oncologic history of the patient may be suggestive of a secondary lesion.

Les patients traités par entérocystoplastie d'agrandissement présentent un risque plus important que la population générale de développer un cancer de vessie. Chez ceux-ci, les masses vésicales sont le plus souvent des cancers primitifs de la vessie. Les métastases au niveau d'iléocystoplasties sont très rares et nous décrivons le premier cas de métastase d'un carcinome lobulaire du sein sur patch iléal. Il s'agit d'une patiente de 52 ans, se présentant pour hématurie macroscopique survenue sept ans après une iléocystoplastie d'agrandissement. Elle a également été traitée antérieurement pour un carcinome lobulaire du sein. Une large masse vésicale est visualisée sur le patch intestinal uniquement, avec des adénopathies s'étendant des vaisseaux iliaques au hile rénal droit. Nous réalisons une exérèse du segment iléal avec préservation du trigone, associée à une cytoréduction tumorale complète. La vessie est reconstruite avec un nouveau segment d'iléon. L'analyse pathologique confirme le diagnostic de carcinome lobulaire métastatique. Les patients porteurs d'entérocystoplastie d'agrandissement nécessitent un suivi à long terme pour détecter les signes évocateurs d'une tumeur vésicale. Nous rapportons notre expérience d'une lésion métastatique exceptionnelle sur patch iléal d'agrandissement vésical. Des caractéristiques inhabituelles de la tumeur vésicale ainsi que l'historique oncologique du patient pouvaient suggérer une lésion métastatique.

[Favorable impact of left antegrade sclerotherapy of clinical left varicocele on spermogram]. / Impact de la sclérothérapie antégrade de varicocèle gauche clinique sur le spermogramme.

OBJECTIVES: Study the early postoperative course of sperm parameters after antegrade sclerotherapy (AS) of clinical left varicocele (CLV) in men consulting for infertility with sperm disruption, and to validate the efficacy and safety of treatment. MATERIALS AND METHODS: Monocentric retrospective observational study of men with CLV, consultant in medically assisted procreation center for primary or secondary infertility of the couple. All patients were operated by SA via scrotal approach. After clinical and ultrasound checks at 6 weeks, a control spermogram was performed at 3-6 months of surgery. The following parameters were analyzed: sperm count, motility, percent of normal form, and total number of motile sperm ("total motile sperm count" [TMSC]). RESULTS: The study involved 138 men (median age 33 years) with sperm alteration. All patients benefited from AS of their CLV. No Clavian complication > 1 was observed. Postoperative control demonstrated a significant improvement in all spermogram parameters, with a median progression of 40% of the count (55 vs 32×106), 80% of the concentration (20.3 vs 11.1×106/ml), 30% of the motility (34.7% vs 26.5%), 60% of the normal form percentage (4.0 vs 2.5%) and the 75% TMSC (41.5 vs 23%), 7×106) (p<0.005). CONCLUSIONS: SA is an effective and safe technique for treating CLV and improving sperm parameters fertility indicators. Our results suggest that this treatment may be recommended to infertile men with CLV in the management of infertility of the couple. LEVEL OF EVIDENCE: 3.

Urological evaluation before kidney transplantation : recommendations for practice / Comment j'expore. Evaluation urologique des candidats à une transplantation rénale : recommandations pour la pratique.

Candidates for a kidney transplantation must undergo a complete evaluation, including a urological evaluation. This urological assessment should first of all exclude any pathology of the urinary tract likely to contraindicate a transplantation or to evolve under immunosuppression. Moreover, this assessment should evaluate the lower urinary tract that is to receive a kidney graft. It is therefore necessary to detect and possibly treat uro-genital cancers, benign uropathies of the native kidneys or abnormalities of the lower urinary tract. The basic evaluation is rather simple and non-invasive and includes a complete history, general and urogenital physical examination, urinalysis, total serum PSA measurement, urinary tract ultrasound, and uroflowmetry. If necessary, other explorations and testings will be carried out, such as CT scan, MRI, retrograde uretero-pyelography, uretero-renoscopy, cystoscopy, urethro-cystography or urodynamic examination. This article reviews the various pathologies involved, and sets out practical recommendations for explorations to be performed.

Les candidats à une transplantation rénale doivent faire l'objet d'une évaluation complète, y compris urologique. Ce bilan urologique permet, tout d'abord, d'exclure toute pathologie de l'arbre urinaire susceptible de contre-indiquer une greffe rénale ou susceptible de s'aggraver sous immunosuppression. Par ailleurs, ce bilan permet d'évaluer l'aptitude du bas appareil urinaire à recevoir un greffon. Il convient donc de dépister et, éventuellement, de traiter les cancers uro-génitaux, les uropathies bénignes des reins natifs ou les anomalies du bas appareil urinaire. L'évaluation de base est simple et non invasive et comprend une anamnèse complète, un examen clinique général et uro-génital, une analyse d'urine, un dosage de PSA sérique total, une échographie des voies urinaires, et une débitmétrie. Elle sera complétée par d'autres explorations si nécessaire, telles que le scanner, l'IRM, l'urétéro-pyélographie rétrograde, l'urétéro-rénoscopie, la cystoscopie, l'urétro-cystographie rétograde et permictionnelle, ou l'examen urodynamique. Cet article revoit les différentes pathologies urologiques concernées, et définit des recommandations pratiques concernant les explorations à envisager.

[Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation]. / Évaluation urodynamique de patients guéris d'incontinence urinaire d'effort post-prostatectomie radicale après implantation d'une bandelette sous-urétrale transobturatrice.

INTRODUCTION: The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence. PATIENTS AND METHODS: In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®). RESULTS: Urodynamic studies were performed after a median time of 9months (min 4 - max 34) following sling implantation. Postoperatively, a rise of 11cm H2O in median MUCP (P=0.09) and an increase of 14mm in median FUL (P=0.13) were observed. None of the urodynamic changes was statistically significant. CONCLUSIONS: Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies. LEVEL OF EVIDENCE: 4.

Efficacy of a hypnosis-based intervention to improve well-being during cancer: a comparison between prostate and breast cancer patients.

BACKGROUND: Prostate and breast cancer can have a lot of negative consequences such as fatigue, sleep difficulties and emotional distress, which decrease quality of life. Group interventions showed benefits to emotional distress and fatigue, but most of these studies focus on breast cancer patients. However, it is important to test if an effective intervention for breast cancer patients could also have benefits for prostate cancer patients. METHODS: Our controlled study aimed to compare the efficacy of a self-hypnosis/self-care group intervention to improve emotional distress, sleep difficulties, fatigue and quality of life of breast and prostate cancer patients. 25 men with prostate cancer and 68 women with breast cancer participated and were evaluated before (T0) and after (T1) the intervention. RESULTS: After the intervention, the breast cancer group showed positive effects for anxiety, depression, fatigue, sleep difficulties, and global health status, whereas there was no effect in the prostate cancer group. We showed that women suffered from higher difficulties prior to the intervention and that their oncological treatments were different in comparison to men. CONCLUSION: The differences in the efficacy of the intervention could be explained by the baseline differences. As men in our sample reported few distress, fatigue or sleep problems, it is likely that they did not improve on these dimensions. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02569294 and NCT03423927 ). Retrospectively registered in October 2015 and February 2018 respectively.

[Early implantation of a penile prosthesis as an optimal treatment of retractory low flow priapism]. / Implantation précoce d'une prothèse pénienne comme traitement optimal du Priapisme réfractaire à bas débit.

Low flow priapism is a urologic emergency because it leads to erectile dysfunction due to cavernosal fibrosis. Several treatments exist, including cavernosal aspiration, washing with or without alpha-mimetic agent or shunting surgery. In case of failure of these methods or prolonged priapism (superior to 36 hours), the option of early penile prostheses implantation should be discussed with a motivated patient in order to improve sexual satisfaction.

Le priapisme à bas débit est une urgence urologique car il conduit inévitablement à la fibrose des corps caverneux et donc à une dysfonction érectile totale. Différentes méthodes de détumescence existent allant de la ponction évacuatrice, le lavage avec ou sans agent vasoconstricteur à la chirurgie de «shunting¼. En cas d'échec de ces manoeuvres ou en cas de priapisme de plus de 36 heures, les recommandations actuelles sont de proposer au patient motivé l'implantation précoce d'une prothèse pénienne pour optimiser la satisfaction sexuelle ultérieure.

[Post-obstructive diuresis : diagnosis and management]. / Le cas clinique du mois. Obstruction urinaire basse : attention à la levée d'obstacle !

The syndrome of "post-obstructive diuresis" corresponds to a massive polyuria and natriuresis occurring after the drainage of an obstructive acute kidney injury. Such a complication needs to be readily detected and managed because of the significant risk for haemodynamic disorders. On the basis of a clinical observation, we describe the pathophysiology of post-obstructive diuresis, as well as its diagnostic and therapeutic management.

Le syndrome de levée d'obstacle urinaire correspond à une polyurie et une natriurèse massives survenant lors du drainage des voies urinaires dans le cadre d'une insuffisance rénale obstructive. Cette complication doit être rapidement détectée vu les risques de répercussions hémodynamiques sévères. A partir d'une observation clinique, nous décrivons la physiopathologie et la prise en charge diagnostique et thérapeutique du syndrome de levée d'obstacle.

[Highflow priapism : diagnostic evaluation, contribution of ultrasound and recommendations]. / Priapisme à haut débit d'origine traumatique : mise au point diagnostique, apport de l'échographie et recommandations.

The high flow priapism (HFP) is a very rare pathology. It must be distinguished from the low flow which is a real urologic emergency. The diagnosis of HFP (most often post-trauma) remains clinical, but penile color Doppler ultrasound can confirm, identify and track the evolution of the lesion. Conservative treatment is effective and remains the first line treatment. However the different therapeutic modalities (selective embolisation, surgery) should be explained to the patient and be considered case by case.

Le priapisme à haut débit (PHD) est une pathologie très rare et il faut le différencier de celui à bas débit qui est une véritable urgence urologique. Le diagnostic de PHD, souvent d'origine post-traumatique, reste clinique, mais l'échographie Doppler couleur pénienne permet de le confirmer, d'identifier et de suivre l'évolution de la lésion. Le traitement conservateur est efficace et reste celui de première intention. Cependant les différentes modalités thérapeutiques (embolisation sélective, chirurgie) doivent être expliquées au patient et être envisagées au cas par cas.

[How I TREAT... A RENAL COLIC]. / COMMENT JE TRAITE ... une colique néphrétique.

Renal colic (RC) represents nearly 2% of emergency department admissions. RC is defined by the occurrence of back pain which may radiate towards the abdomen and external genitals. In adults, the obstruction is caused by a urinary stone in 80% of cases. The 20 % of non-stone related RCs are due either to an intrinsic obstruction (pyeloureteral junction stenosis, ureteral tumor, ...) or an extrinsic compression (pelvic tumor, lymphadenopathy ...). In over 90% of cases, an RC does not require hospitalization and is treated with medication. In contrast, complicated renal colic (CRC) requires hospitalization with specialized care. Obstructive pyelonephritis (OPN) is a form of CRC and the diagnosis should be considered in a clinical presentation of "renal colic" with acute pyelonephritis. This is a true emergency requiring surgical drainage of the upper urinary tract upstream of the obstacle, as well as antibiotic therapy. It must be kept in mind that some clinical presentations may be atypical, especially in the elderly, which can delay the diagnosis and, thus, the management. The gold standard for diagnosis is CT urography.

Repair of parastomal hernia after Bricker procedure: retrospective consecutive experience of a tertiary center.

BACKGROUND: Ileal conduit parastomal hernias (ICPHs) are frequent after radical cystectomy with ileal conduit urinary diversion, but their management is debated. This study aimed to review the results of ICPH repair according to Sugarbaker or Sandwich techniques, with special interest in ICPH recurrence and urological complications. METHODS: The authors reviewed a consecutive series of patients undergoing ICPH repair between January 2014 and December 2020. Primary endpoints were ICPH recurrences at clinical exam and cross-sectional abdominal computed tomography (CT) scans. Secondary endpoints were any other complications possibly related to the ICPH repair. RESULTS: Twenty-three patients underwent ICPH repair surgery (16 Sugarbaker and 7 Sandwich techniques) during the study period. Sixteen patients underwent a primary laparoscopic approach. All but one patient underwent at least one abdominal CT during the follow-up. Median clinical and CT scan follow-up times were 57 and 50.5 months, respectively. Clinical and CT ICPH recurrence rates were 4.5% and 13% at 5 years, respectively. Eighteen patients (78%) suffered no urological complications during the follow-up period, but three patients (13%) needed redo surgery on the urinary ileal conduit. CONCLUSION: The modified Sugarbaker or Sandwich techniques might be considered as promising techniques for ICPH repair with a low rate of recurrence. The urological complications, and particularly the ileal conduit-related issues, need to be evaluated in further studies. Controlled and prospective data are required to compare the Sugarbaker and Sandwich techniques to the Keyhole approach for ICPH repairs.

[Surgical treatment of female stress urinary incontinence: where are we in 2011?]. / Les traitements chirurgicaux de l'incontinence urinaire d'effort féminine: où en sommes-nous en 2011?

Female stress urinary incontinence (SUI) is mainly due to an excessive mobility of the cervico-urethral complex. Synthetic tapes placed without tension underneath the urethra to correct this hypermobility have revolutionized the surgical treatment of female SUI for the past fifteen years. The retropubic approach, namely the "tension-free vaginal tape" (TVT), was designed in 1996. It generates high SUI cure rates but is associated with a risk of intrapelvic bleeding and bladder and intestine perforation. The inside-out transobturator approach, which was developed eight years ago in our Institution, has since been used worldwide. The surgical technique is simple and reproducible and the incidence of peri- and post-operative complications is reduced. SUI cure rates are +/- 90% after a 3-5 years follow-up, similar to those obtained after the retropubic route. We have recently improved our original technique by using a shorter tape while, at the same time, minimizing the dissection required for its insertion. After a one year minimum follow-up, this new technique appears as safe and efficient as the traditional transobturator technique but is associated with reduced post-operative groin pain. We introduce for the first time the concept of the transobturator "midi sling".

[Detection of bladder cancer in voided urine samples]. / Détecter le cancer de la vessie à partir d'échantillons d'urine.

Bladder cancer mainly affects patients aged 50 years or more and requires close and repeated surveillance. Flexible cystoscopy associated with urinary cytology are the currently recommended diagnostic and follow-up methods. Because medical imaging techniques remain rather unsatisfying for bladder carcinoma detection, research efforts have focused on urinary markers of the disease. Various approaches were tested with results generally too unconsistant to replace cystoscopy. Recently, the department of Urology at the University of Liège together with the Biotechnology Company OncoMethylome Sciences have been interested in testing whether the detection of hypermethylated genes in voided urine samples would be of value for the detection of bladder cancer. The method is based on the Methylation-Specific PCR technology (MSP). This approach has the theoretical advantage of being non invasive, reproducible and based on DNA, whose stability, in urine, is higher than that of proteins. The results of a large prospective study, recently publised in European Urology, have shown that the identification by MSP of 2 methylated genes, TWIST1 and NID2, in voided urine samples, is a sensitive (+/- 90%) and specific (+/- 93%) test for the detection of bladder cancer. The test is largely more sensitive than cytology while both techniques have similar specificity. Based on these promising results, we are currently evaluating this novel, non invasive MSP approach for the follow-up of patients with non-muscle invasive bladder cancer.

[Targeted therapy: toward a clean and effective war against cancer]. / Le ciblage thérapeutique: vers une guerre propre et efficace contre le cancer.

One promising avenue towards the development of more selective, better anticancer drugs consists in the targeted delivery of bioactive compounds to the tumor environment by means of binding molecules specific for tumor-associated biomarkers. Eligibility of such markers for therapeutic use implies ideally three criteria : (i) accessibility from the bloodstream, (ii) expression at sufficient level and (iii) no (or much lower) expression in normal tissues. Most current discovery strategies (such as biomarker searching into body fluids) provide no clue as to whether proteins of interest are accessible, in human tissues, to suitable high-affinity ligands, such as systemically delivered monoclonal antibodies. Innovative proteomic technologies are able to identify such accessible biomarkers and represent a key step in the clinical development of such target therapies.