A comparison of perioperative outcomes of transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review.

RAPN can be carried out via a transperitoneal or retroperitoneal approach. The choice between the two approaches is open to debate and usually based on surgeon preference. The perioperative outcomes of transperitoneal robot-assisted partial nephrectomy versus retroperitoneal robot-assisted partial nephrectomy were compared. A systematic review of the literature was performed up to May 2020, using PubMed, Cochrane, Scopus and Ovid databases. Articles were selected according to a search strategy based on PRISMA criteria. Only studies comparing TRAPN with RRAPN were eligible for inclusion. Eleven studies were included in the quantitative synthesis. Baseline demographics (age, BMI, ASA, tumour size, and RENAL nephrometry score), intraoperative data (operative time, estimated blood loss, and warm ischaemia time) and postoperative outcomes (major complications according to Clavien-Dindo, length of hospital stay (LOS) and positive surgical margin rate) were recorded. A total of 3139 patients were included (2052 TRAPN vs. 1087 RRAPN). There was no significant difference in demographic variables (age, BMI), tumour size (p = 0.06) nor the nephrometry score (p = 0.20) between the two groups. Operative time (p = 0.02), estimated blood loss (p < 0.00001) and LOS (p < 0.00001) were significantly lower in the RRAPN group. No differences were found in major postoperative complications (Clavien-Dindo > 3; p = 0.37), warm ischaemia time (p = 0.37) or positive surgical margins (p = 0.13). Future researchers must attempt to achieve adequately powered, expertise based, multi-surgeon and multi-centric studies comparing TRAPN and RRAPN. RRAPN gives similar outcomes to TRAPN. RRAPN is associated with reduced operative time and LOS. Ideally, surgeons should be familiar and competent in both RAPN approaches and adopt a risk-stratified and patient-centred individualised approach, dependent on the tumour and patient characteristics. RAPN is feasible via two approaches. The retroperitoneal approach seems to be associated with a shorter operation time and hospital stay.

[Tolerance of adjuvant radiotherapy in the treatment of stage I seminoma]. / Tolérance de la radiothérapie dans le traitement adjuvant des séminomes testiculaires stade I.

OBJECTIVE: To assess the tolerance of adjuvant radiotherapy in the treatment of stage I seminoma post-orchiectomy. MATERIAL AND METHODS: Between 2001 and 2006, 21 men with stage I seminoma underwent 3D conformal radiotherapy 3 to 4 weeks post-orchiectomy. The total radiation dose was 2490 cGy divided into 15 sessions. Radiation was delivered by 2 antero-posterior fields using X-ray photons of 18 MV. Two types of radiation fields were used : para-aortic and ipsilateral iliac (dog leg) or para-aortic only. The average followup was 2 years 4 months with an interval of 4 to 58 months. Tolerance of treatment was evaluated according to criteria of the RTOG. RESULTS: Median follow-up time is 30 months. Disease-free survival was 100%. The most frequently encountered acute toxicity was gastrointestinal; mainly nausea and vomiting. Tolerance to treatment was better in the group receiving para-aortic radiotherapy alone (37% of grade II gastrointestinal toxicity vs 62%) CONCLUSION: The para-aortic irradiation for stage I seminoma gave satisfactory results with a better toxicity profile than the dogleg irradiation.

Fluoroless endourological surgery for high burden renal and proximal ureteric stones: A safe technique for experienced surgeons.

Objective: To describe the feasibility of treating proximal ureteric and renal stones using flexible ureteroscopy (fURS) or a double approach (mini-percutaneous nephrolithotomy [PCNL] + fURS) without any use of radiation. Patients and methods: We retrospectively reviewed the data of all patients operated by one surgeon for retrograde endoscopic removal of renal and ureteric lithiasis performed between June 2015 and January 2019 in our institution. Patients with anatomical complexities, high-burden stone disease (diameter >20 mm), and medical comorbidities (anti-platelet drug administration) were included in our study. Outcomes analysed included complication rate, stone-free rate (SFR, defined as no residual stone >1 mm), and repeat procedure rate. Results: In all, 183 consecutive URS for proximal ureteric and renal lithiasis were conducted. C-arm fluoroscope guidance was not required, not even in the complex cases. Simultaneous ultrasonography and fURS guidance was used in patients where the mini-PCNL approach was indicated. Lead aprons were not needed by the operating room staff in any of the operations. The SFR was 91.8% after the first procedure, with no Clavien-Dindo Grade III or IV complications. Conclusion: Our present series shows clearly that the fURS and mini-PCNL approach under fURS control is a feasible and safe technique for experienced surgeons. Patients had a high SFR and no technique-related complications, with no additional risk of X-ray exposure. However, a prospective study is required to test the reproducibility of this technique. Abbreviations: GMSV: Galdakao-modified supine Valdivia; ICRP: International Commission on Radiological Protection; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; OR: operating room; PCNL: percutaneous nephrolithotomy; SFR: stone-free rate; UAS: ureteric access sheath; (f)URS: (flexible) ureteroscopy; US: ultrasonography.

[Partial nephrectomy for renal cancers larger than 4 cm]. / Néphrectomie partielle pour les cancers du rein de plus de 4 cm.

OBJECTIVE: To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (RN) for renal cancers < 4 cm, between 4 and 7 cm and > 7 cm. MATERIALS AND METHODS: Retrospective study including 107 patients operated for renal cancer between 1998 and 2004. Demographic characteristics, TNM stage, tumour diameter and type of surgery (PN vs RN) were recorded. The patients' current status was determined and a survival curve was constructed by the Kaplan-Meier method. RESULTS: 35.2% patients were operated by PN and 64.8% were operated by RN. The mean follow-up was 45 months. No significant difference in recurrence-free survival rate was observed between patients operated by PN and RN for tumours < 4 cm (93.3% vs 92.3%, respectively, p = 0.243), or for tumours between 4 and 7 cm (100% vs 89.3%, respectively, p = 0.564) or for tumours > 7 cm (100% vs 85.5%, respectively, p = 0.218). CONCLUSION: Partial nephrectomy is the standard treatment for tumours < 4 cm, but this study suggests that it is just as effective for tumours up to 7 cm in diameter. Although partial nephrectomy also appears to be a safe treatment for tumours > 7 cm, further studies based on a greater number of tumours in this size category with a longer follow-up are necessary.

Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution.

Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured.

[Paratesticular fibrous pseudotumours]. / Pseudotumeurs fibreuses paratesticulaires.

Paratesticular fibrous pseudotumours are a rare form of benign tumour with a slow course and a difficult preoperative diagnosis. The objective of treatment is to ensure optimal testis conservation, which is possible when the diagnosis is made on intraoperative frozen section examination. The authors report a case of diffuse fibrous pseudotumour in a 23-year-old man. In the light of this case and a review of the literature, they discuss the diagnostic and therapeutic aspects of these tumours.

[A five-year experience in conformational radiotherapy in the treatment of prostate cancer. Evaluation of acute toxicity in 131 patients]. / Radiothérapie conformationnelle dans le traitement du cancer de la prostate. Evaluation de la toxicité aiguë chez 131 patients.

PURPOSE: To evaluate the urinary and rectal toxicity secondary to 3D conformal radiotherapy for prostate cancer. MATERIAL AND METHODS: Between 1998 and 2003, 131 men with prostate cancer underwent 3D conformal radiotherapy with or without androgen deprivation. The different stages were: 2 T1b ; 40 T1c; 19 T2a; 16 T2b; 18 T2c; 33 T3a; 1 T3b and 2 T3c with Gleason score: 4-6 = 47%, 7 = 36% and 8-9 in 17% of the cases. The median patient age was 66 (48-87). Pretreatment PSA level was respectively < 10 ng/ml (41%). 10-20 ng/ml (30%) and > 20 ng/ml (29%). Of the 131 patients, 98 received androgen ablation therapy before radiation. The total radiation dose varied between 66 and 74 Gy, delivered with 18MV photons of the linear accelerator, the median follow up was 33 months (5-67). RESULTS: According to the RTOG grading (gr) for acute toxicity, we noticed 3gr 3 genitourinary (GU) toxicity and no gr3 gastro intestinal (GI) toxicity. There were 36 gr 1 and 12 gr 2 GI toxicity, 41 gr 1 and 22 gr 2 GU toxicity. The mean prostate volume was 41 cc for patients who received androgen ablation and 56 cc for the others (p < 0.002). The percentage of volume receiving more than 50 Gy (V50) was calculated, the median V50 was 32% (5-67) for the rectum and 35% (5-79) for the bladder CONCLUSION: The toxicity profile in this study is in the same range than those of the literature and of our previous study concerning our first 50 patients with prostate cancer treated with 3D conformal radiotherapy.

Etiology and medical management of urinary stone disease.

Urinary lithiasis is a worldwide very frequent disease, but its etiology is most frequently unclear. Calcium stones are predominant. The metabolic evaluation of urinary lithiasis may be difficult and inconclusive, but it can guide a specific treatment. Medical treatment depends on the nature of stone and the metabolic disease that might be found. The goal of this article is to simplify and summarize the etiopathology, metabolic evaluation and medical treatment of urinary stone disease.

[von Hippel-Lindau syndrome: molecular diagnosis of two Lebanese families and analysis of the genotype-phenotype correlation]. / La maladie de von Hippel-Lindau: Etude moléculaire de deux families libanaises et analyse de la corrélation génotype-phénotype.

The von Hippel-Lindau syndrome (VHL) is a dominantly transmitted hereditary disorder associating multisystemic tumors affecting mainly the central nervous system, the kidneys, the pancreas, as well as pheochromocytomas. Mutations of the tumor suppressor gene VHL on chromosome 3 are responsible for the disease. This article reports for the first time the study of two Lebanese VHL affected families, presenting particularly hemangioblastomas of the central nervous system. Two different mutations of the VHL gene, S65W and F76S, respectively identified in the two families, confirmed the clinical diagnosis of the patients. Molecular diagnosis was then performed for at risk members of these families. This article reveals the importance of molecular diagnosis for suspected patients and of presymptomatic diagnosis for at risk members, especially that a close follow-up of carriers allows an early detection of tumors and prevents the metastasis stage, the most common cause of death of these patients.