[Neoadjuvant chemotherapy in muscular invasive bladder cancer: Complications and consequences with cystectomy]. / Chimiothérapie néoadjuvante dans le cancer de vessie infiltrant le muscle : complications et conséquences sur la réalisation de la cystectomie.

INTRODUCTION: The fear of the deterioration of the patient's condition related to the toxicity of neoadjuvant chemotherapy is a barrier to its development. This multicenter retrospective study aims to present the secondary effects of neoadjuvant chemotherapy and its impact on the achievement of cystectomy. MATERIALS AND METHODS: Patients with urothelial carcinoma classified cT2 to cT4a N0M0 were included. Chemotherapy with 6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) followed by a cysto-prostatectomy or anterior pelvectomy was scheduled. RESULTS: A total 32 patients were included. Six cycles of neoadjuvant chemotherapy were performed in all 11 patients. Shutdown causes were toxicity in 85% of cases. Cystectomy was performed in 86.6% of patients. Surgery was not performed in 6 patients. The reasons were the alteration of the general condition in 2 cases, 2 patients had advanced cancers diagnosed intraoperatively, and 2 refused surgery. Complications of grades 3 and 4 according to the classification of Clavien and Dindo had occurred respectively in 15.3% and 11.5%. DISCUSSION: This study reports results close to what is found in the literature on the effects of neoadjuvant chemotherapy on achieving cystectomy, but it has some limitations: the retrospective analysis of data on surgery and the lack of control group. In addition, the short follow-up does not yet allow to know the long-term oncological results. CONCLUSION: This study supports the fact that the toxicity of neoadjuvant chemotherapy does not seem to cause a significant risk of non-completion of cystectomy. LEVEL OF EVIDENCE: 4.

[Complete rupture of the urethra and bilateral fracture of the corpus cavernosum penis]. / Rupture complète de l'urètre et fracture bilatérale des corps caverneux.

The authors report a case of complete rupture of the urethra with bilateral fracture of the corpora cavernosa caused by a faux pas during coitus and emphasize the importance of early surgical treatment which allows a precise evaluation of the lesions and immediate repair, which are the best guarantees of a good functional prognosis.

[Direct cutaneous ureterostomy with myoplasty using a pedicled flap of the rectus abdominis]. / Urétérostomie cutanée directe avec myoplastie par lambeau pédiculé de muscle grand droit.

Many methods have been reported to prevent the development of stomal stenosis following direct cutaneous ureterostomy, thus avoiding catheterizations with their attendant complications, and improving patient tolerance. Nevertheless, although lessened, the risk of stenosis persists in narrow ureters. In order to improve local trophicity and help maintain a wide, flexible intraparietal segment, the authors have developed a technique of cutaneous ureterostomy using a muscle flap from the rectus abdominis muscle and a V-shaped skin flap. This procedure was used on 20 ureters, including 12 dilated ureters and 8 narrow ureters. Follow-up was 3 months to 2 years. In 18 cases, no catheterization was needed, and no stenoses or complications were observed. In one case, stomal stenosis developed on a dilated, irradiated ureter from a non-functioning kidney. An indwelling catheter was used in one narrow ureter with a stenosis proximal to the abdominal wall. These preliminary results suggest that this technique is beneficial. Further studies with a larger number of patients and longer follow ups are needed.

[Resection-suture of the ureter. A study of 26 cases]. / Résection-suture de l'urètre. Etude de vingt-six cas.

The authors analyze twenty six cases of urethral resection and suture performed for short strictures secondary to trauma of iatrogenic or infectious origin. The results were good or very good in 78 per cent of cases. The main indications are post-traumatic or iatrogenic strictures without infection or prior dilatation. The procedure was performed, in every case, late after the trauma, though other authors have advocated shortening the delay. Postoperative sexual impotence was more often the result of the initial trauma than of the surgical procedure, but the patient must always be warned of this risk.

[Controlled obturator nerve block using electrostimulation: prevention of the stimulation of the obturator nerve during resection of the lateral walls of the bladder]. / Blocage obturateur contrôlé par électrostimulation: prévention de la stimulation du nerf obturateur lors des résections des faces latérales de vessie.

An adductor contraction secondary to obturator nerve stimulation can occur during transurethral resection of a lateral bladder lesion and then can induce bladder perforation or hamper complete resection. Many technique have been advocated but they are ineffective or unreliable. Obturator nerve blockade in the obturator canal by local anesthesia with control by nerve stimulator can prevent these complications. The technique described, has been used in 12 patients it is reliable, fast and easy to perform.

[Rectal stenoses caused by carcinoma of the prostate. Apropos of 9 cases]. / Sténoses rectales des carcinomes prostatiques. A propos de neuf observations.

Rectal strictures are rare complications of prostatic cancer and are considered to be a sign of poor prognosis. The authors report 9 cases. In 5 cases, the cancer was already diagnosed and had been treated by endocrine therapy. All patients died during the months following onset of the intestinal symptoms despite diversion colostomy (4 cases) and high dose oestrogen therapy. Rectal strictures therefore have the same poor prognosis as escape from endocrine therapy. In 3 cases, the stricture was the presenting sign of the cancer in one case, the cancer was already known and treated by radiotherapy; in this case, survival depends on the hormone sensitivity of the cancer and one patient survived for 7 years with subsequent closure of the colostomy.

[Significance of flow cytometry in the prognosis of tumors of the kidney in adults]. / Intérêt de la cytométrie de flux dans le pronostic des tumeurs du rein de l'adulte.

The DNA index was measured by flow cytometry on paraffin-embedded tissue blocks, from a series of 50 renal tumours studied retrospectively. These tumours consisted of 48 renal cell carcinomas and 1 oncocytoma. The mean follow-up was 3 years. TNM classification and Syrjanen's combined histological grading were used. There was a significant correlation between ploidy and nuclear grading (P = 0.02); between ploidy and TNM classification (72% of diploid tumours were T1 and T2, M0, N0, P = 0.01); between ploidy and development of metastases during the follow-up (71% of aneuploid tumours developed metastases, P = 0.04). In contrast, ploidy was not related with tumour differentiation (P = 0.052), and did not influence the overall long-term survival (P = 0.2). The small number of patients studied did not allow a significant survival rate to be established for each stage according to ploidy. The measurement of the DNA index by flow cytometry is prognostically useful for renal tumours, but must be compared with other prognostic parameters. Its therapeutic value will only be able to be assessed in the future; especially in conservative surgery indications, possibly in the choice of complementary therapeutic associations and even in the approach to treatment of metastases.

[Calibrated cicatrization of internal urethrotomies over spiral metal endoprosthesis. Preliminary study]. / Cicatrisation calibrée des uréthrotomies internes sur endoprothèse métallique spiralée. Etude préliminaire.

The authors have developed a new model of flewible metal prosthesis to maintain the urethral calibre throughout the period of healing and epithelial restoration following internal urethrotomy. It consists of a large intravesical spiral, a shaft within the prostatic and sphincteric urethra and a spiral in the bulbar and anterior urethra. This prosthesis, implanted in 7 patients for periods ranging from 2 to 5 months, provides additional calibration following internal urethrotomy, but a longer follow-up is necessary to assess its real efficacy.

[Color doppler echography in the exploration of vasculogenic impotence]. / Echographie-doppler couleur dans l'exploration de l'impuissance d'origine vasculaire.

102 patients with suspected vasculogenic impotence were evaluated with color doppler sonography. Measurement of normal systolic and diastolic velocities were obtained from the cavernosal arteries of patients responding by a full erection after intra-cavernosal injection of 20 mg of Papaverine. A correlation with cavernosometry was obtained in 61 patients and with selective internal pudendal arteriography in 11. The 10 patients with abnormal arteriograms had a systolic velocity < 25 cm/sec. 13 out of the 15 patients with an end diastolic velocity > 5 cm/sec had a venous leak defined by a maintenance flow rate of erection during cavernosometry > 25 ml/mn. End diastolic velocity is an excellent index of the function of the veno-occlusive system, provided the systolic velocity remains at a normal value. In case of arterial insufficiency, a diastolic flow < 5 cm/sec is of no value and cavernometry is mandatory to detect a mixed arterio-venous impotence. The addition of color doppler sonography permitted a more rapid detection of vessels and an easily reproducible measurement of velocities which makes color doppler sonography an excellent screening test for examining patients with potential vasculogenic impotence.

Biochemical exploration of azoospermia: interest of the seminal transferrin assay.

Seminal transferrin is considered a good index of Sertoli cell function. In this study, including 19 control subjects, four vasectomized subjects and 65 non-vasectomized subjects with azoospermia, transferrin was measured concomitantly with other classical biochemical seminal markers such as L-carnitine, fructose and zinc. This parameter should provide additional information for differentiation between obstructive and non-obstructive azoospermia. A threshold value of 85 micrograms/ejaculate for transferrin was defined in the control and the vasectomized groups. The 65 subjects with azoospermia were divided into five groups according to L-carnitine and transferrin threshold values; the nature of azoospermia (obstructive or non-obstructive) was considered in each group. In the biological investigation of sterility, the measurement of transferrin provided information as to the aetiology of azoospermia. However, the determination of L-carnitine and fructose remains important in the localization of any obstruction.