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Summary Aim Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. Methods Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords “arterio-ureteral fistula”, “arterio iliac fistula” and “ilio-ureteral fistula”. We excluded uretero-arterial fistula following vascular surgery. Results Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. Conclusion SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. Level of proof 3.

OBJECTIVE To propose recommendations for the management of renal cell carcinomas (RCC) of the renal transplant. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to evaluate prevalence, diagnosis and management of RCC arousing in the renal transplant. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS Renal cell carcinomas of the renal transplant affect approximately 0.2% of recipients. Mostly asymptomatic, these tumors are mainly diagnosed on a routine imaging of the renal transplant. Predominant pathology is clear cell carcinomas but papillary carcinomas are more frequent than in general population (up to 40-50%). RCC of the renal transplant is often localized, of low stage and low grade. According to tumor characteristics and renal function, preferred treatment is radical (transplantectomy) or nephron sparing through partial nephrectomy (open or minimally invasive approach) or thermoablation after percutaneous biopsy. Although no robust data support a switch of immunosuppressive regimen, some authors suggest to favor the use of mTOR inhibitors. CTAFU does not recommend a mandatory waiting time after transplantectomy for RCC in candidates for a subsequent renal tranplantation when tumor stage

Resume Objectif Le but du Comite de transplantation de l’Association francaise d’urologie est de proposer des recommandations pour la prise en charge du cancer de la prostate localise (CaP) chez le candidat ou le receveur d’un transplant renal. Methode Une revue de la litterature d’approche systematique (Medline) a ete conduite par le CTAFU concernant l’epidemiologie, le depistage, le diagnostic et le traitement du CaP chez le candidat ou le receveur d’un transplant renal en evaluant les references et leurs niveaux de preuve. Resultats L’incidence du CaP chez le transplante renal est similaire a la population generale. Le depistage dans cette population doit suivre les recommandations du CCAFU. Le depistage est systematique chez le candidat a un transplant renal de plus de 50 ans. Le diagnostic repose sur les biopsies de la prostate realisees apres IRM multiparametrique et sans specificite de l’antibioprophylaxie. Les recommandations therapeutiques du CaP proposees par le CCAFU restent applicables a la population des patients transplantes avec certaines specificites en particulier pour le traitement des aires ganglionnaires. Pour les candidats a la transplantation renale, la problematique de l’acces a la transplantation doit etre prise en compte. Les donnees actuelles permettent de proposer des delais de carence apres traitement du CaP avec un faible niveau de preuve. Conclusion Ces recommandations francaises doivent contribuer a ameliorer la prise en charge du CaP chez le patient candidat ou receveur d’un transplant renal en integrant objectifs oncologiques et acces a la transplantation.

Resume Objectif Proposer des recommandations pour la prise en charge des calculs urinaires chez le donneur ou le receveur d’un transplant renal. Methode Une revue d’approche systematique de la litterature (Medline) a ete conduite par le CTAFU concernant l’epidemiologie, le diagnostic et le traitement des calculs urinaires chez le donneur ou le receveur d’un transplant renal. Resultats La prevalence des calculs urinaires est inconnue chez les donneurs decedes mais peut atteindre 9,3 % chez les donneurs vivants dans les pays industrialises. Chez tous types de donneurs de reins, hormis ceux de la categorie 2 de Maastricht, le diagnostic repose sur la tomodensitometrie faisant partie du bilan avant tout prelevement d’organes en France. Aucune etude n’a compare les strategies de traitements envisageables en cas de calcul detecte chez le donneur : l’ureteroscopie ou la lithotripsie extracorporelle chez le donneur vivant avant prelevement, un traitement ex vivo (pyelotomie ou ureteroscopie), une ureteroscopie chez le receveur apres transplantation, une surveillance en cas de petit calcul. Les calculs de novo chez le receveur impliquent un processus de lithogenese a identifier et traiter pour eviter les recidives. Le contexte de rein unique fonctionnel fait toute la gravite de la pathologie lithiasique. Le diagnostic est en general fait au decours d’un bilan pour alteration de la fonction renale, d’une hematurie ou d’un sepsis. L’echographie detecte la dilatation des cavites pyelocalicielles, le scanner precise la topographie et la taille du calcul. Il n’existe aucune etude prospective comparative evaluant les techniques de traitement d’un calcul chez un transplante renal qui sont identiques a celles de la population generale. Conclusion Ces recommandations francaises doivent contribuer a ameliorer la prise en charge des calculs urinaires chez le patient donneur ou receveur d’un transplant renal.

To assess the influence of renal transplantation on sexual function. Prospective study including all patients who underwent a kidney transplantation between January 2013 and February 2015. Sexual f...

Characteristics of renal carcinoma arising in non-functional graft in renal transplant recipients (RTR) are unknown. We studied a large national retrospective cohort to analyze circumstances of diagnosis, treatment and outcome compared to the literature. Study included all RTR presenting with kidney graft tumors irrespective of the histology, except those with lymphoma and including those tumors arising in non-functional renal graft. Between January 1988 and December 2018, 56,806 patients had renal transplantation in the 32 centers participating in this study. Among this cohort, 18 renal graft tumors were diagnosed in non-functional grafts. The median patient age at the time of diagnosis was 42.1 years (31.7–51.3). Median age of kidney grafts at the time of diagnosis was 56.4 (23.2–63.4). Eight (44.4%) tumors were discovered fortuitously on renal graft histologic analysis. Fourteen tumors (77.8%) were papillary carcinomas. Two patients had clear cell carcinomas and one patient had a pTa high-grade multifocal urothelial carcinoma in the graft of the upper tract with an in situ carcinoma. Renal carcinomas in non-functional grafts are rare entities and most of them are diagnosed fortuitously. Despite the fact that these tumors are small, low grade and with a good prognosis, regular monitoring of non-functional grafts should be performed with at least an annual ultrasonography.

Objective To calculate the incidence of renal graft urothelial carcinoma in renal transplant recipients (RTR) in a national large retrospective cohort, and to analyze circumstances of diagnosis, treatment and outcome. Material and Methods We conducted a national retrospective, multicenter study. 32 transplant centers were asked to report its cases of kidney graft tumors and the number of kidney transplantations performed since the beginning of their transplantation activity. Results Between January 1988 and December 2018, 56806 patients were transplanted in the 32 centers participating in this study. Among this cohort, 107 renal graft tumors (excluding lymphoma) were diagnosed among them 11 RTR were diagnosed with an urothelial carcinoma in the kidney graft. The calculated incidence was 0.019%. The median patient age at the time of diagnosis was 56.7 years (49.8-60.9) and 51.4 years (47-55.7) at the time of transplantation. The median time between transplantation and diagnosis was 66.6 months (14.3-97). Before treatment, 3 patients had graft tumor biopsies revealing urothelial carcinomas, 3 patients had endoscopic retrograde uretero-pyelography showing lacunary images. Two patients had a diagnostic flexible ureteroscopy with biopsies. Total nephrectomy was performed in all cases Conclusion Even though occurring in the context of immune suppression, most of these tumors seemed to have a relatively good prognosis. With regards to functional outcomes histological diagnosis should always be sought for before radical treatment of these tumors. Treatment should be a transplant nephrectomy including all the ureter with a bladder cuff to ensure optimal carcinologic control.

To evaluate the residual cancer rate after cystoprostatectomy (CPT) in patients with a history of radiation therapy for prostate cancer and the postoperative complication rates. We conducted a retrospective study involving 21 patients who had a CPT over 7 years and who had a history of radiotherapy for prostate cancer. To compare results, two additional groups were created: a group of patients without a history of radiotherapy in whom a CPT was performed, and a group without a history of radiotherapy and in whom was accidentally discovered a prostate cancer after CPT on histology specimens. The median age at the time of radiotherapy was 69 years. The median age at the time of cystoprostatectomy was 78 years. The median PSA at the time of the intervention was 0.6 ng/ml in the group with a history of radiotherapy. The residual cancer rate was 24%. No patients had criteria for biological recurrence. There were no additional surgical complications in the radiotherapy group (p = 0.2). The rate of cutaneous ureterostomy was higher (p = 0.0006) due to increased surgical difficulties (p = 0.0009). The residual cancer rate was 24% after radiotherapy for prostate cancer. PSA alone does not appear to be sufficient to detect the persistence of residual prostate cancer after radiotherapy. There were no more surgical complications after prostate radiotherapy.

Objectives To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter. Design Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017. Settings and participants A total of 305 patients (three groups: younger than 70, 70-80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia. Results A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality-of-life (QoL) score was worse for patients older than 80 years (P = .04). For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups. Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference. Conclusion PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups. J Am Geriatr Soc 67:1888-1894, 2019.

Introduction: The benefit of adjuvant radiotherapy (AR) or salvage radiotherapy (SR) after prostatectomy is still unclear. We wanted to compare both types of radiotherapy after prostatectomy in terms of oncological and functional results. Methods: We included 173 patients treated at a single center between January 2005 and December 2008. All patients were treated with the same radiotherapy protocol (3D conformal radiotherapy accelerator 6 mV, 66 GY). AR was defined as radiotherapy initiated in a patient with a PSA level 10%. Both groups were compared in terms of biological progression-free, metastasis-free, and overall survival (OS) using log-rank tests. Moreover, acute and late urinary and gastrointestinal toxicity were also compared. Results: One hundred and fifty-seven patients underwent an open retropubic prostatectomy whereas 16 underwent a laparoscopy (6 subperitoneal and 10 transperitoneal). Eighty-six patients had AR with a median time of 6.7 months after surgery and 87 had SR with a median time of 21.4 months after surgery. Median follow-up was 6.7 years. Metastasis-free survival (MFS) was better in the AR than in the SR group (p = 0.01, 6-year MFS 95 and 89%, respectively). OS was also better in the AR than in the SR group (p = 0.02, 6-year OS 100 vs. 95%, respectively). AR was associated with better survival with no biochemical recurrence (85 vs. 63%, p < 0.00001). There was no significant difference between groups for acute or late urinary or gastrointestinal toxicity. Conclusion: Our study suggests that patients treated by AR have better results in terms of OS, disease-specific survival, survival without metastatic recurrence, and survival without biochemical recurrence compared with SR. Toxicity was comparable between both groups.

Objectifs L’obesite pourrait avoir un impact sur la periode peri-operatoire des tumeurs du rein, en termes de morbidite, de resultats operatoires, mais egalement une influence sur les choix therapeutiques notamment chirurgicaux. Les modifications morphologiques liees a l’obesite, la morbidite propre s’y rapportant et les comorbidites liees a celle-ci pourraient impacter les resultats peri-operatoires d’une chirurgie renale et influencer le choix de la strategie therapeutique. Methodes Une etude multicentrique a ete realisee au sein de la base Uro-CCR chez les patients traites pour une tumeur du rein entre 2007 et 2020. L’obesite a ete definie par un indice de masse corporel (IMC) ≥ 30. L’objectif principal de l’etude etait de comparer la prise en charge des lesions renales selon le statut obese ou non du patient : biopsies, type de traitement, voie d’abord. Les Objectifs Secondaires etaient les donnees peri-operatoires. Les caracteristiques des groupes et les variables etudiees de patients obeses (PO) vs. non obeses (PNO) ont ete comparees par les tests de Student ou du Chi2. Resultats Un total de 8893 patients ont ete inclus avec 26,1 % de PO. Selon le RENAL score, les lesions apparaissaient comme plus complexes chez les PO (p = 0,023). La prise en charge differait avec un taux superieur de biopsies (4,6 % vs 3,4 % p = 0,0019) chez les PO tout comme la proportion de nephrectomies partielles (NP) (66,9 %vs 62,1 % p Tableau 1 , Tableau 2 ). Conclusion Les resultats de cette etude mettent en avant que si l’obesite ne semble pas influencer de facon significative le type de traitement propose pour une tumeur du rein mais une potentielle meilleure selection des patients. La chirurgie etait cependant impactee avec une duree operatoire superieure, une duree de clampage allongee, un saignement plus important et un risque de conversion superieur.

Prostate cancer (PC) is the most common neoplasia in men. With aging of solid organ transplant recipients (SOTR), its incidence is likely to increase. The aim of this study was to analyze PC screening results retrospectively in renal transplant recipients (RTR), hepatic transplant recipients (HTR) and cardiac transplant recipients (CTR). A retrospective monocentric study of PC diagnosed in renal, hepatic or cardiac transplanted patients since 1989 was performed. All the patients were followed annually by digital rectal examination and prostate serum antigen (PSA) dosage. 57 PC were diagnosed in 1565 SOTR male patients (3.6%): 35 RTR, 15 HTR, and 7 CTR. Standard incidence ratio (SIR) was 41.9. Mean age at the time of diagnosis was 64.5 (60.5–69.2). Mean time between transplantation and PC diagnosis was 95.7 (39.0–139.5) months. Median PSA rate was 7.0 (6.2–13) ng/mL. Clinical stages were T1, T2, and T3, respectively, for 29, 22 and 6 patients. Diagnosis was done by screening in 52 patients, after prostatitis in 1 and bone pain in another. Three PC were discovered on prostate chips after transurethral resection. Two patients were treated by active surveillance. 39 (68%) patients (25 RTR, 11 HTR and 3 CTR) were treated by radical prostatectomy. Histological results were 30 pT2 and 9 pT3 tumors, with 7 positive surgical margins. Gleason score was 5, 6, 7, 8 and 9 in, respectively, in 2, 24, 11, 1 and 1 patients. One patient with positive pelvic nodes was treated with hormonal therapy (HT). One had a biochemical relapse at 10 months and underwent salvage radiotherapy. Median follow-up was 85.2 months (46.1–115.0). 23 (40.4%) patients died. Two (3.6%) RTR and 1 (1.8%) CTR died from their PC. Standard incidence ratio were, respectively, 42.4, 48.2 and 39 in RTR, HTR and CTR. Systematic screening in male SOTR after 50 years old could not be recommended. In the last 3 decades, we diagnosed too many low-risk prostate cancers strongly increasing the SIR but failing to decrease prostate cancer related mortality. SOTR should undergo individual screening with prior MRI when PSA rates are high. Management should not be different from that of the general population.

Resume Plusieurs modalites de traitement de l’insuffisance renale chronique terminale sont aujourd’hui disponibles. La transplantation renale a partir de donneurs vivants est la plus avantageuse pour les receveurs en termes de survie et de qualite de vie, en plus d’etre la plus economiquement viable pour la societe. Cette option souleve la question du devenir des donneurs vivants, sujets sains qui se soumettent a une procedure chirurgicale lourde. Plusieurs travaux ont ete menes comparant le devenir de donneurs de rein a celui de sujets controles. Les criteres d’evaluation etaient les potentielles complications de la nephrectomie a court comme a long termes : survenue d’une insuffisance renale, d’une hypertension arterielle, d’une proteinurie, possibilite de grossesse ulterieure, qualite de vie, survie du patient. Les resultats des premieres etudes ne mettaient pas en evidence de risque lie au don par rapport a celui existant dans la population generale. Mais depuis 2013, des publications ont rapporte l’existence d’un risque plus eleve d’insuffisance renale chronique, voire de mortalite, chez les donneurs de rein compares a des sujets controles selectionnes comme des candidats au don. Le risque lie au don est estime acceptable et minime, aux seules conditions d’une evaluation et d’une selection rigoureuse des candidats et d’un suivi regulier des donneurs indispensable.

Resume Malgre la revolution observee dans la prise en charge multidisciplinaire du cancer du rectum, l’evaluation des sequelles genito-urinaires reste une preoccupation importante. L’evaluation precise preoperatoire a l’aide de scores valides permet de depister des troubles urinaires dans pres de 16 a 23 % des cas et des troubles sexuels chez pres de 35 % des hommes et 50 % des femmes. Quelle que soit la voie d’abord, le respect de l’innervation autonome lors de l’exerese extrafasciale du mesorectum est fondamental dans la prevention de ces sequelles. Cette identification peut etre facilitee par la stimulation nerveuse peroperatoire. Malgre ces precautions, des sequelles urinaires peuvent apparaitre de novo que ce soit une incontinence urinaire dans pres de 33 % des cas ou des troubles de la vidange vesicale dans 25 % des cas. Un âge avance, des troubles urinaires preoperatoires, le sexe feminin et la realisation d’une amputation abdomino-perineale sont des facteurs de risque independants de ces sequelles. Des anomalies postoperatoires precoces du bilan urodynamique seraient predictives de sequelles et justifieraient une reeducation precoce. De la meme maniere, des sequelles sexuelles sont observees que ce soit des troubles de l’erection et/ou de l’ejaculation, des dyspareunies et un defaut de lubrification, aboutissant a une absence d’activite sexuelle de novo chez 28 % des hommes et 18 % des femmes. L’âge avance, une radiotherapie neoadjuvante et la realisation d’une amputation abdomino-perineale en sont des facteurs de risque independants. Le sidenafil semble efficace pour traiter les troubles de l’erection. Des sequelles genito-urinaires et ano-rectales apparaissent chez plus d’un malade sur 10, suggerant une possible physiopathologie commune.

Few studies have established that obesity promotes all types of urinary incontinence and disorders of the pelvic floor. The role of bariatric surgery in urinary incontinence remains poorly studied.To determine the effect of bariatric surgery on urinary incontinence, dysuria, and fecal incontinence before and 1 year after bariatric surgery.University hospital expert in bariatric surgery METHODS: This was an observational cohort study of 140 patients who underwent bariatric surgery between September 2013 and September 2014. Patients prospectively completed 4 questionnaires, 2 for urinary symptoms and 2 for fecal incontinence. Eighty-three women and 33 men completed 4 questionnaires the day before surgery when arriving in the department and 1 year after surgery.Of the 140 patients, 116 completely responded to the 4 questionnaires. The rate of urinary incontinence was 50.9% before surgery and 19% at 1-year follow-up (P.0001). After bariatric surgery, there was improvement in the rate of stress urinary incontinence: 39.7% before surgery versus 15.5% at 1 year (P.0001). In addition, there was an improvement in urinary urge incontinence: 36.8% versus 7.9% at 1 year (P.0001). The dysuria rate was 19.8% before surgery versus 3.4% at 1 year (P.0001). Bariatric surgery improved the quality of life related to urinary symptoms (P.0001). One year after surgery, there was no significant difference in terms of prevalence and severity of fecal incontinence.We confirmed with our study that weight loss after bariatric surgery improves stress urinary incontinence, urge incontinence, dysuria, and quality of life. However, we did not find any positive effect on fecal incontinence.

Objectifs La RAPN est une procedure dont les performances a court terme sont evaluees par le trifecta : temps d’ischemie chaude (TIC), complication Clavien–Dindo (CD) et marges chirurgicales positives (MCP). L’objectif principal de cette etude etait de comparer les vitesses d’apprentissage entre deux chirurgiens pionniers et trois chirurgiens de seconde generation, pour la RAPN en termes de TIC, CD et MCP. Methodes Les donnees de 810 RAPN de deux chirurgiens pionniers (groupe 1) et trois chirurgiens de seconde generation (groupe 2) ont ete incluses. Il s’agissait de toutes les procedures consecutives par voie transperitoneale robot-assistee, sur deux plateformes robotiques DaVinci® Si puis X. Des donnees demographiques, operatoires et postoperatoires ont ete extraites du reseau UroCCR. L’influence de l’experience etait ajustee sur l’âge et le score RENAL. L’influence de l’experience a aussi ete analysee sur trois sequences consecutives de 50, 50 et 60 procedures. Enfin, la vitesse d’apprentissage pour le TIC a ete exploree graphiquement par regression polynomiale apres splines cubiques. Resultats Les scores RENAL etaient plus eleves (7,8 vs 5,7 p Tableau 1 ), ainsi que le taux de MCP (3,9 % vs 24 % p Tableau 2 ). L’experience avait un impact significatif dans le groupe 2 (OR = 0,9, p Fig. 1 ). Conclusion L’influence de l’apprentissage sur le TIC et les CD semble plus importante pour la seconde generation, temoignant d’un transfert de connaissance contrairement a l’etablissement des standards d’une technique. Ce phenomene ne s’observe pas sur le taux de MCP ni pour les recidives, sous reserve du faible suivi median. Enfin, 50 procedures semblent marquer une amelioration significative dans le TIC.

Face, content, and construct validity of robotic surgery simulators were confirmed in the literature by several studies, but elements to build a training program are still lacking. The aim of our study was to validate a progressive training program and to assess according to prior surgical experience the amount of training needed with a robotic simulator to complete the program.Exercises using the Da Vinci Skill Simulator were chosen to ensure progressive learning. A new exercise could only be started if a minimal score of 80% was achieved in the prior one. The number of repetitions to achieve an exercise was not limited. We devised a "performance index" by calculating the ratio of the sum of scores for each exercise over the number of repetitions needed to complete the exercise with at least an 80% score.The study took place at the François Baclesse Cancer Center. Participants all work at the primary care university Hospital located next to the cancer center.A total of 32 surgeons participated in the study- 2 experienced surgeons, 8 junior and 8 senior residents in surgery, 6 registrars, and 6 attending surgeons.There was no difference between junior and senior residents, whereas the registrars had better results (p0.0001). The registrars performed less exercise repetitions compared to the junior or senior residents (p = 0.012). Attending surgeons performed significantly more repetitions than registrars (p = 0.024), but they performed fewer repetitions than junior or senior residents with no statistical difference (p = 0.09). The registrars had a performance index of 50, which is the best result among all novice groups. Attending surgeons were between senior and junior residents with an index at 33.85.Choice of basic exercises to manipulate different elements of the robotic surgery console in a specific and progressive order enables rapid progress. The level of prior experience in laparoscopic surgery affects outcomes. More advanced laparoscopic expertise seems to slow down learning, surgeons having to "unlearn" to acquire a new technique.

Kidney transplantation in small animals has been crucial in the development of anti-rejection therapies. While there is no substitute for a skilled microsurgeon, there are many aspects of the transplant procedure that can be modified to optimize the reproducibility and utility of the technique. This article provides a detailed description, including video recording, of orthotopic kidney transplantation in the rat. The key variables in the technique are also discussed.

The occurrence of a kidney transplant tumor is a rare but serious issue with a double risk: the return to dialysis and the development of metastatic cancer. Publications on this topic are mainly case reports. The purpose of this review was to report an exhaustive literature review of functional graft renal cell carcinomas to highlight the impact of tumors on the renal graft outcomes. 201 de novo renal carcinomas in functional renal grafts from 69 publications were included. Incidence was estimated at 0.18%. Graft tumors were mostly asymptomatic (85.9%). Whatever the discovery circumstances of graft tumors, they were mostly documented by graft ultrasounds supplemented by CT-scanning or MR imaging. Nephron sparing surgery (95 patients) was the first treatment performed followed by radiofrequency ablation (38 patients) and cryotherapy (10 patients). The most common tumor graft histology was clear cell carcinoma (46.4%), followed by papillary carcinoma (43.7%). Specific mortality was 2.9% with 6 deaths. Renal graft cell carcinoma is a rare pathology with a low specific death. When possible, conservative treatment should be the first choice.

Introduction. Le bypass gastrique est une chirurgie bariatrique malabsorptive en plein essor. Il augmente le risque de formation de calcul renal comparativement aux patients obeses et la population generale. Le but de notre etude est de mettre en place un questionnaire de depistage du risque lithiasique dans cette population. Materiel et methodes. Il s’agit d’une etude clinique monocentrique pour evaluer un questionnaire de depistage sur des patients operes d’un bypass gastrique entre 2014 et 2015. Les patients ont ete contactes pour repondre au questionnaire comprenant 22 questions repartis en 4 parties : les antecedents, les episodes de colique nephretique avant et apres chirurgie de bypass et les habitudes alimentaires. Resultats. Nous avons inclus 143 patients qui ont accepte de repondre aux questions. L’âge moyen lors du questionnaire est de 49,1 ±10,8 ans. Le delai entre la chirurgie de bypass gastrique et la realisation du questionnaire est de 50,8 ±5,0 mois. La courbe ROC montre une AUC de 0,932±0,029 (p

While either pancreas or pancreatic islet transplantation can restore endogenous insulin secretion in patients with diabetes, no beta-cell replacement strategies are recommended in the literature. For this reason, the aim of this national expert panel statement is to provide information on the different kinds of beta-cell replacement, their benefit-risk ratios and indications for each type of transplantation, according to type of diabetes, its control and association with end-stage renal disease. Allotransplantation requires immunosuppression, a risk that should be weighed against the risks of poor glycaemic control, diabetic lability and severe hypoglycaemia, especially in cases of unawareness. Pancreas transplantation is associated with improvement in diabetic micro- and macro-angiopathy, but has the associated morbidity of major surgery. Islet transplantation is a minimally invasive radiological or mini-surgical procedure involving infusion of purified islets via the hepatic portal vein, but needs to be repeated two or three times to achieve insulin independence and long-term functionality. Simultaneous pancreas-kidney and pancreas after kidney transplantations should be proposed for kidney recipients with type 1 diabetes with no surgical, especially cardiovascular, contraindications. In cases of high surgical risk, islet after or simultaneously with kidney transplantation may be proposed. Pancreas, or more often islet, transplantation alone is appropriate for non-uraemic patients with labile diabetes. Various factors influencing the therapeutic strategy are also detailed in this report.

International audience; PURPOSE:Urolithiasis is rare among renal transplant recipients and its management has not been clearly defined.METHODS:This multicentre retrospective study was organised by the Comité de Transplantation de l'Association Française d'Urologie (French Urology Association transplantation committee). Statistical analysis was performed with SPSS 19 software.RESULTS:Ninety-five patients were included in this study. Renal transplant urolithiasis was an incidental finding in 55% of cases, mostly on a routine follow-up ultrasound examination. One half of symptomatic stones were due to urinary tract infection and the other half were due to an episode of acute renal failure. The initial management following diagnosis of urolithiasis was double J stenting (27%), nephrostomy tube placement (21%), or watchful waiting (52%). Definitive management consisted of: watchful waiting (48%), extracorporeal lithotripsy (13%), rigid or flexible ureteroscopy (26%), percutaneous nephrolithotomy (11%) and surgical pyelotomy (2%). All transplants remained functional following treatment of the stone. The main limitation is the retrospective design.CONCLUSIONS:The incidence of lithiasis could be higher in kidney transplanted patients due to a possible anatomical or metabolical abnormalities. The therapeutic management of renal transplant urolithiasis appears to be comparable to that of native kidney urolithiasis.

Objectifs Le clampage arteriel permet de reduire le saignement operatoire, donc une meilleure visibilite, ce qui pourrait impacter la qualite chirurgicale et les resultats oncologiques. L’objectif de cette etude est d’evaluer l’impact du type de controle arteriel (clampage vs sans clampage) sur les resultats oncologiques des nephrectomies partielle robot-assistee (RAPN). Methodes Au total, 1277 patients traites par RAPN ont fait objet d’une analyse multicentrique retrospective a partir de la base de donnees collectee prospectivement UroCCR. Nous avons analyse les variables suivantes : âge, sexe, ECOG, RENAL score, TNM, le type de clampage arteriel (clampage vs sans clampage) et les resultats oncologiques : marges chirurgicales, recidive locale, survie sans metastase, et survie globale. Pour les variables continues nous avons utilise les tests de Mann–Whitney et Student ; pour les variables discretes, Chi2 et Kruskal–Wallis ; Kaplan–Meier avec un test du log-rank pour l’analyse de survie ; ainsi qu’un modele de regression logistique pour l’analyse multivariee. Resultats Les medianes d’âge, l’IMC, la taille tumorale et le RENAL score etaient respectivement 63 ans, 26,70 kg/m2, 3,00 cm et 7 dans le groupe sans clampage (n = 220) et 62, 26,1, 3,50 cm et 7,00 dans le groupe avec clampage (n = 1057) avec des valeur p = 0,412, 0,103, 0,003 et 0,097 respectivement. Le taux de marges chirurgicales positives etait de 3 % dans le groupe sans clampage et 6,4 % dans le groupe avec clampage (p = 0,09). A 60 mois de duree de suivi moyenne, aucune difference significative entre les deux groupes en matiere de recidive locoregionale (p = 0,93), survie sans metastases (p = 0,097) et globale (p = 0,19) n’etait retrouvee ( Tableau 1 , Fig. 1 , Fig. 2 ). Conclusion Les resultats oncologiques en matiere de marges chirurgicales, de recidive locoregionale, survie sans metastase et survie globale semblent equivalent quel que soit le type de controle hilaire choisi. Les chirurgiens realisant des RAPN sans clampage ont probablement plus d’experience chirurgicale ce qui pourrait en partie expliquer nos resultats. Des essais controles randomises pour confirmer ces resultats semblent necessaires.

To determinate feasibility and results of the flush technique by hands for the surgical management of renal cell carcinoma (RCC) with levels III and IV inferior vena cava thrombus (VCT). We conducted a retrospective study for all patients who underwent a surgical treatment for RCC with levels III and IV VCT in our department between June 2010 and July 2017. Sixteen patients were identified. All tumors were resected using a subcostal incision for right RCC and a chevron incision for the left RCC. Vena cava control was performed only on its subhepatic portion. After renal artery ligature, anesthesiologists were asked to generate a positive pressure in the small circulation. Subsequently, the vena cava was incised longitudinally to the orifice of the renal vein and the thrombus dissected and extracted of the upper part of the vena cava. Only once the supra-renal part of the vena cava was free of thrombus, the supra-renal portion of the vena cava could be clamped. We never had to perform neither thoracotomy nor hepatic mobilization. Therefore, support of a hepatic, vascular or cardiac surgeon was not necessary. The mean operative time was 201 min. The mean estimated blood loss was 2040 ml. No patient died during hospitalization, and mean hospitalization stay duration was 16.6 days. The flush technique allows a limitation of the dissection extent. It requires neither hepatic mobilization nor thoracotomy. This results in a decrease in the operative time and blood loss.

Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.

Aims: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. Subjects and Methods: This study was conducted for patients undergoing partial nephrectomy (PN) with T1–T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. Results: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

Summary 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 59.8 years old. Results The median PSA rate at diagnosis was 7 ng/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 180 min (IQR 150–190; min 90–max 310) with a median intraoperative bleeding of 200 mL (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 36 months. 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.

Summary Introduction Cold storage of organs for preservation and transplantation is reaching its limits especially with extended criteria for heart beating donors and donation after cardiac death. We will discuss recent findings and perspectives in normothermic kidney preservation. Methods A literature review was performed from original articles and syntheses selected by the search engine PubMed . Keywords used were: cold ischemia; warm ischemia, normothermic, organ preservation, preconditioning, organ perfusion. Results We identified several ways to improve kidney preservation: Ischemic normothermic preconditioning; Pharmacologic normothermic preconditioning; Ex vivo normothermic reperfusion; Remote ischemic transplantation preconditioning; Ischemic postconditioning. In clinical practice, only uses of ECMO for organ preconditioning or ex vivo normothermic organ perfusion were used. Conclusion Promising experimental and clinical results make challenge cold preservation. The most suitable and physiological method seems to be a normothermic perfusion and conservation with autologous oxygenated blood using Extra Corporeal Membrane Oxygenation or Regional Normothermic Circulation.

BACKGROUND We describe a surgical technique to manage anastomotic transplant renal artery stenosis (TRAS). TRAS is one of the most common vascular complications and is usually treated by percutaneous angioplasty (PA) with good results. To our knowledge, management of early (less than a month) anastomotic TRAS with a prosthetic enlargement patch has never been described in the literature. CASE REPORTS Two men (ages 67 and 57 years) underwent deceased and living donor renal transplantation, respectively. At 1 week post-transplantation, they each presented with a tight arterial anastomotic stenosis. Because percutaneous angioplasty soon after renal transplantation has a risk of acute bleeding, it was decided that a surgical intervention should be used. Follow-up at 4 months showed that surgical addition of the prosthetic enlargement patch normalized arterial pressure and improved kidney function as documented by decreased serum creatinine levels. No surgical complications were associated with these cases. CONCLUSIONS This technique provided significant benefits in terms of technical simplicity and safety. When a new anastomosis seems to be difficult to perform, this approach represents a good alternative if percutaneous angioplasty is not available or is medically unadvisable.

Objectifs L’efficacite d’un traitement adjuvant antiangiogenique pour les cancers a cellules renales (CCR) dits a haut risque n’est pas demontree actuellement. La negativite des essais pourrait etre liee a l’heterogeneite des tumeurs incluses et la difficulte de cibler les tumeurs a haut risque de recidive. L’objectif de cette etude etait d’evaluer l’interet d’un traitement medical adjuvant dans le CCR avec thrombus de la veine renale/cave. Methodes Analyse retrospective comparative, multicentrique portant sur les patients inclus prospectivement apres consentement ecrit dans la base de donnees francaise UroCCR (CNIL DR 2013-206 ; NCT03293563 ) et operes pour CCR ≥ pT3a M0, avec thrombus de la veine renale ou de la veine cave. Comparaison du groupe experimental (traitement adjuvant) au groupe temoin (sans traitement adjuvant). Les criteres de jugements etaient la survie sans metastase et la survie globale, evaluees selon la methode de Kaplan – Meier et compares par un test de Log-rank. Analyse multivariee selon modele de Cox pour recherche de facteurs predictifs de survie globale. Resultats Au total, 542 patients ont ete inclus : 40 nephrectomies + traitement adjuvant et 502 nephrectomies + surveillance. Les caracteristiques demographiques et tumorale des 2 groupes etaient comparables, excepte pour l’âge et le sous-type histologique ( Tableau 1 ). Le suivi median etait 24 ± 26 mois. Dans les groupes Adjuvant− et Adjuvant + la survie sans metastase a 1 an, 2 ans, 5 ans etait respectivement 68 vs 86 %, 58 vs 68 % et 38 vs 53 % (p = 0,03). La survie globale a 1 an, 2 ans, 5 ans etait respectivement 83 vs 100 %, 73 vs 96 % et 58 vs 82 % (p = 0,02). Dans un modele multivarie incluant les caracteristiques epidemiologiques, histologiques et le stade (modele de Cox), les facteurs predictifs de survie globale etaient : le traitement adjuvant OR = 0,3[0,1–0,9] p = 0,04, le contingent sarcomatoide OR = 2,2[1,4–3,6] p = 0,001, les emboles vasculaires OR = 2,2[1,3–3,9] p = 0,004 et le stade OR = 9,3[4,0–21,8] p Conclusion Dans cette etude retrospective ciblant les CCR avec thrombus de la veine renale/cave, un traitement adjuvant (TKI, immunotherapie) etait associe a une amelioration de la survie sans metastase et de la survie globale.

Resume Objectif Le recours a la nephrectomie en urgence est de plus en plus rare grâce a l’amelioration de la prise en charge des sepsis urinaires et au developpement de la radio-embolisation. Peu de series de patients ont ete rapportees sur ce sujet. L’objectif de notre etude est d’evaluer les indications, la morbi-mortalite et les resultats des nephrectomies realisees en urgence dans notre hopital. Patients et methodes De janvier 2011 a novembre 2012, huit patients ont ete operes d’une nephrectomie en urgence au CHU de Caen. Les caracteristiques de ces nephrectomies d’urgence ainsi que leurs morbi-mortalites ont ete analysees et evaluees. Resultats Six femmes et deux hommes ont ete analyses retrospectivement de janvier 2011 a novembre 2012. Tous les patients operes sauf un ont necessite des soins intensifs pour une defaillance multiviscerale. Toutes ces nephrectomies en urgence concernaient un rein natif avec un abord a type de lombotomie ou de laparotomie sous-costale. Tous les patients ont survecu a l’issue de leur prise en charge. Un patient a conserve par la suite une insuffisance renale justifiant le recours a une epuration extra-renale. Conclusion Les nephrectomies en urgence ont ete rares. Les sepsis urinaires non controles ont ete l’indication principale. L’identification des populations a risque d’evolution vers le choc septique est indispensable pour une prise en charge plus rapide et permettre ainsi une reduction de la mortalite liee au sepsis.

Resume Objectif Le but de cette etude etait d’evaluer la faisabilite de l’echographie ex vivo par l’urologue et son efficacite de detection des marges de resection lors de la nephrectomie partielle (NP). Patients et methodes Tous les patients operes dans notre service entre juillet 2010 et novembre 2012 d’une NP pour une tumeur du rein classee T1 ou T2 a la tomodensitometrie ont ete inclus dans l’etude. A chaque fois, une echographie ex vivo de la piece de tumorectomie a ete pratiquee par l’operateur pour analyser les marges de resection. Les donnees de l’echographie ex vivo ont ete correlees aux resultats anatomopathologiques. Resultats Vingt-six hommes et 15 femmes d’un âge median de 61 ans (30–82) ont eu une NP. L’echographie ex vivo a mis en evidence 38 marges negatives et deux marges positives, alors que les resultats anatomopathologiques definitifs ont mis en evidence des marges negatives dans tous les cas sauf un. La sensibilite et specificite etaient respectivement de 100 % et 97 %. La duree moyenne de realisation de l’echographie a ete d’une minute ± 1. La taille moyenne des tumeurs et la taille des marges ont ete respectivement de 3,4 ± 1,8 cm et 2,38 ± 1,76 mm. Conclusion La technique de controle des marges de resection des NP par echographie ex vivo nous a semble efficiente, efficace et facile de realisation par un urologue.

To determine the impact of non-functional renal graft nephrectomy on second kidney transplantation survival.We performed a retrospective study on patients managed in our department from April 1989 to April 2011. We compared the number of acute graft rejections and graft survival between patients undergoing second transplantation with (Group I) or without (Group II) prior graft nephrectomy.A total of ninety-one patients received a second renal graft: 43 underwent graft nephrectomy and 48 kept their non-functional renal graft. There were 5 episodes of acute graft rejection in Group I and 12 in Group II (p = 0.3). Six (13.9 %) grafts failed in Group I and eight (16.6 %) in Group II. Five and 10 years actuarial graft survival in Group I were, respectively, 91 and 85 %, while in Group II were 82.7 % and 69 % (p = 0.2). PRA level and number of acute rejection episodes did not have a statistically significant influence on graft survival, whether the patient had a nephrectomy or not (p = 0.2).Nephrectomy of a failed allograft did not significantly improve the survival of a subsequent graft. Graft nephrectomy should be indicated in case of graft-related pain or a chronic inflammation syndrome.

BACKGROUND The aim of this study was to compare 2 preservation solutions in kidney transplant recipients in the same center during the same period since initiation of the use of High Na+; low K+ solution (Celsior). MATERIAL AND METHODS From January 1999 to April 2011, 610 consecutive renal transplantations were done in our department with deceased donor kidneys. Data were collected prospectively. Organ procurement was performed in our center for 305 kidneys. We washed and preserved 409 kidneys in UW, and 201 in Celsior solution. RESULTS Donors criteria were worse in the Celsior group for age, male sex, creatinemia, and cold ischemia. Populations of recipients were comparable. There were no differences at 1 and 12 months in creatinine levels (p=0.9 and 0.8, respectively) and in number of delayed graft functions (DGF) (p=0.8 and relative risk =0.9) between groups. There were no differences in post-transplantation outcomes for all variables. At 5 years, graft survival was 90.4% for UW and 93.5% for Celsior (p=0.44). CONCLUSIONS Our retrospective study did not succeed in demonstrating superiority of a High Na+; low K+ solution compared to a UW type reference solution. Celsior has the same effectiveness as UW during kidney cold storage.

Background: To investigate the incidence, the clinical characteristics and outcomes of renal graft carcinomas in the same renal transplant population. Methods: From April 1989 to April 2012, 1,037 consecutive renal transplantations were performed in our department. Data were collected prospectively in an extensively maintained database. For all recipients, monitoring consisted of clinical examination and an abdominopelvic CT scan or ultrasonography at least once a year. Results: After 1,037 renal transplantations, 48 men and 14 women (sex ratio 3:4) with a mean age of 54 years (25.1–78.9) were included for urological malignancies. Eight graft carcinomas were identified: 7 renal cell carcinomas (5 papillary carcinomas and 2 clear cell carcinomas of the renal graft) and 1 transitional cell carcinoma of the ureteral graft (incidence 0.78%). Nephron-sparing surgery was chosen for 5 patients with good outcomes. All graft renal cell carcinomas were classified as pT1a and the mean size of tumors was 28.4 mm (range 6–45). The 5-year specific survival rate was 100%. No recurrence was observed with a mean follow-up of 36.8 months (4.1–84.3). Conclusion: Thus confirming an increased risk of de novo graft cancer, close monitoring of renal transplant recipients should be discussed with at least an abdominopelvic ultrasonography and PSA measurement once a year. Renal cell graft carcinomas seemed to be mostly small and of papillary type and low grade.

Summary Background: Our objective was to clarify the clinical outcome of renal transplantation based on residual daily urine output (RDUO). Material/Methods: We retrospectively analyzed a prospective database of 276 patients who underwent renal transplantation (Tx) between January 2008 and December 2012. Patients had pre-transplantation daily urine output measurement of 24-h proteinuria and were clinically re-evaluated the day before transplantation. We included patients with no daily urine output and those with residual daily urine output. Real bladder capacity was not measured. We excluded patients with a history of lower urinary tract malformation, those treated by trans-ileal conduit or enterocystoplasty, and those with early graft thrombosis or graft primary non-function. Results: Sex ratio, age at Tx, pre-Tx MHC antibodies levels, donor age, and cold ischemia duration were not significantly different between the 2 groups. Dialysis duration was longer in group I (p

Background The objective of this study is to explore the impact of PSA nadirs on detection rates of prostate cancer (PCa) recurrence with 18F-choline (CH) PET/CT after external beam radiation therapy (EBRT). Methods In this retrospective study, data were collected from 54 patients with suspicion of PCa biochemical recurrence after EBRT (28 patients treated initially with EBRT and 26 as salvage therapy in the absence of PSA decrease after initial treatment), who underwent 18F-CH PET/CT between 2010 and 2015. PSA nadir and trigger PSA were collected from patient files. Relative PSA was calculated by subtracting the nadir from the trigger PSA. Results Median PSA nadir was 0.31 (0.01–13.31) ng/mL, trigger PSA was 7.85 (0.47–111.60) ng/mL, and relative PSA was 6.05 (0.24–104.59) ng/mL. Overall, 40 (74%) PET/CT scans were positive: recurrence was local and/or regional in 29 patients, distant in 15 and combined both in four, with no association between PSA values and sites of recurrence. In univariate analysis, trigger (p = 0.015) and relative (p = 0.0005) PSA values and PSA velocity (p = 0.01) were significantly linked to positive PET/CT, but PSA nadir was not. In subgroup analysis, these significant differences were only found in the salvage EBRT group. Akaike Information Criterion multivariate model comparison found that relative PSA was a better predictor of positive PET/CT than trigger PSA (PSAt). 18F-CH PET/CT detection rates increased with trigger and relative PSA: 0% (0/4 patients), 71% (5/7 patients), and 81% (35/43 patients) for PSAt 4 ng/mL, respectively, and 14% (1/7 patients), 50% (5/10 patients), and 92% (34/37 patients) when relative PSA was taken into account instead of trigger PSA, with seven (13%) patients changing subgroups. Conclusions We found a high overall detection rate and an increase in detection rates proportional to trigger and relative PSAs. Although relative PSA, taking into account PSA nadir, was a better predictive factor of PET/CT positivity in univariate analysis, this was most noticeable for high PSAs. For low PSAs, trigger PSA remains most relevant. Larger series with intermediate PSA values need to be studied to fully apprehend nadir impact.

Resume Objectifs Realiser un etat de l’art sur la polykystose renale autosomique dominante acquise (PRADA), la prise en charge de ses complications urologiques et les modalites de traitement de l’insuffisance renale. Materiel et methodes Une recherche bibliographique exhaustive a partir de Medline ( http://www.ncbi.nlm.nih.gov ) et Embase ( http://www.embase.com ) a ete realisee en utilisant les mots cles suivants (MeSH) seuls ou en combinaison : « autosomal dominant polykystic kidney disease », « complications », « native nephrectomy », « kidney transplantation ». Les articles obtenus ont ensuite ete selectionnes sur leur methodologie, leur langue de publication (anglais/francais), leur pertinence par rapport au sujet traite et leur date de publication. Seules les etudes prospectives et retrospectives en anglais et en francais, articles de revue, de meta-analyse ou de recommandations ont ete selectionnes (3779 articles). Apres selection en fonction du titre et du resume, 52 articles ont ete analyses et inclus. Resultats La PRADA est la premiere cause d’atteinte genetique renale (touchant 1 personne/1000 en France) aboutissant dans 50 % des cas a une insuffisance renale chronique terminale necessitant le recours aux techniques de suppleance ou a la transplantation. La PRADA est source de nombreuses complications urologiques comme l’hematurie macroscopique, les surinfections kystiques, douleurs renales et les calculs de l’appareil urinaire pour lesquelles l’urologue peut etre sollicite. Dans le cadre du bilan pretransplantation, la discussion portera sur la necessite ou non de realiser une nephrectomie des reins natifs dont les indications sont soit des complications recidivantes soit le manque de place pour l’implantation du greffon. Le moment optimum de la nephrectomie sera discute selon plusieurs criteres (dialyse ou greffe preemptive, severite des complications, anurie, acces a la greffe, potentiel donneur vivant). Conclusion La prise en charge de la PRADA dans l’evaluation pretransplantation renale est complexe. L’attitude doit etre la plus conservatrice possible afin de limiter les troubles electrolytiques secondaires a l’oligoanurie, de conserver un appareil urinaire fonctionnel et une bonne qualite de vie. La chirurgie reste le traitement de reference, cependant, l’embolisation renale semble une alternative efficace et associee a une faible morbidite.

International audience; BACKGROUND:Results of the conservative treatment of renal cell carcinomas arising in functional renal transplants are unknown compared to transplant nephrectomy. Only small series or case reports have been reported.METHODS:Data were collected from 32 transplantation centers nationwide on cases of de novo tumors in functional renal transplants presumed to be malignant between January 1988 and December 2013.RESULTS:Among 116 de novo transplant tumors, 62 were treated conservatively including: 48 by partial nephrectomy (PN) and 14 by thermal ablation (TA). These patients were compared to 30 other patients who were treated by transplant nephrectomy. The median age of the transplanted kidneys at the time of diagnosis was 43.5 years old as calculated from the donor's age. Tumors treated by transplant nephrectomy presented more often with symptoms (pain, fever, impaired condition, hematuria) than tumors treated conservatively (P = .019). After PN, final histology showed 27 (47.5%) papillary carcinomas, 19 (32.2%) clear cell carcinomas, 1 mixed carcinoma, and 2 oncocytomas. The median tumor size treated by PN was 24 mm with no difference in comparison to the TA group. Nine patients treated by PN had postoperative complications (21%), including 4 requiring operative intervention (Clavien IIIb). None of the patients treated by TA had complications. Specific survival was 100% at the time of last follow-up (median time after treatment 37 months) for patients treated by PN or TA.CONCLUSION:PN proved to be efficient in the treatment of small tumors of transplanted kidneys with good long-term functional and oncologic outcomes, including avoiding return to dialysis. TA seems to be an alternative therapy with good results in selected patients.

Background Outpatient surgery is critical to improve health care costs. The aim of the study was to prospectively evaluate the results of outpatient treatment of upper tract urinary stones by rigid or flexible ureteroscopy in a routine care setting. Methods A database was created at the creation of the outpatient surgery department. 87 patients underwent 100 ureteroscopic procedures for urinary lithiasis from June 2013 to March 2015. Results Most of our patients were male with 53 men (sex ratio M/F 1.13), with a mean age of 52.9 ± 15 years old (23.4–82.4). 44 % of ureteroscopies performed were flexible ureteroscopies, 31 % rigid ureteroscopies and 25 % associated rigid and flexible ureteroscopies. The average stone load was 10.1 ± 5.7 mm (2–30) The mean operating time was 58.3 ± 21.1 min (20–150). 82.9 % of patients had a single urinary stone and 17.1 % (n = 14) had 2 or more. 114 stones were treated, 57,1 % intrarenal. There were 6 (6 %) postoperative complications: three Clavien stage 2 infections; three Clavien stage 3b complications (two renal colics requiring ureteral stenting 48 h after discharge and 1 symptomatic perirenal urinoma 48 h after discharge). There was one intraoperative complication (1 %): a ureteral wound with contrast leakage. The rate of transfer to conventional hospitalization was 2.2 %. Stone size influenced the stone-free status (p

International audience; Objectives To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following nephron sparing surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death. Materials and methods An international multicentre retrospective study involving 19 institutions and the French network for research on kidney cancer was conducted after IRB approval. We analyzed data of all patients with pRCC who were treated by NSS between 2004 and 2014. Results We included 486 patients. Tumors were type 1 pRCC in 369 (76 %) cases and type 2 pRCC in 117 (24 %) cases. After a mean follow-up of 35 (1–120) months, 8 (1.6 %) patients experienced a local recurrence, 12 (1.5 %) had a metastatic progression, 24 (4.9 %) died, and 7 (1.4 %) died from cancer. Patients with type I pRCC had more grade II (66.3 vs. 46.1 %; p \textless 0.001) and less grade III (20 vs. 41 %; p \textless 0.001) tumors. Three-year estimated cancer-free survival (CFS) rate for type 1 pRCC was 96.5 % and for type 2 pRCC was 95.1 % (p = 0.894), respectively. Three-year estimated cancer-specific survival rate for type 1 pRCC was 98.4 % and for type 2 pRCC was 97.3 % (p = 0.947), respectively. Tumor stage superior to pT1 was the only prognostic factor for CFS (HR 3.5; p = 0.03). Conclusion Histological subtyping of pRCC has no impact on oncologic outcomes after nephron sparing surgery. In this selected population of pRCC tumors, we found that tumor stage is the only prognostic factor for cancer-free survival

Resume Objectif Comparer les complications apres transplantation renale chez les patients obeses et non obeses. Methode Une recherche bibliographique a ete menee a partir de la base de donnees Medline et les mots cles utilises ont ete : obesity , body mass index , kidney transplantation , graft function , survival , wound complications , graft rejection , graft survival . Les etudes issues de revues a comite de lecture et incluant un effectif suffisant de patients obeses ( n ≥ 20) ont ete selectionnees. De plus, en raison des modifications importantes des protocoles d’immunosuppression ainsi que des traitements prophylactiques anti-infectieux durant ces dernieres decennies, nous avons limite notre recherche aux 15 dernieres annees. Au total, 76 articles ont ete utilises comme references bibliographiques. Resultats Les complications chirurgicales postoperatoires infectieuses ou parietales sont plus frequentes chez les patients obeses. De meme, on note plus de retard de reprise de fonction ainsi qu’une diminution de la survie a cinq ans du transplant. En revanche, il ne semble pas y avoir plus de rejet aigu. La survie du patient a cinq ans est quant-a elle, a priori, similaire entre les deux populations si une selection attentive et notamment cardiaque des receveurs est realisee avant inscription sur liste d’attente. Conclusions La transplantation renale chez les patients obeses n’est pas une chirurgie facile et comporte plus de risque que la transplantation chez les receveurs non obeses. Ces patients demandent du temps pour pouvoir leur expliquer les complications supplementaires qui pourront leur arriver au decours de la transplantation et necessitent un bilan cardiaque regulier. En effet, un non-suivi strict de cette regle greve le pronostic vital de ces patients apres la transplantation. Mais la survie des obeses est meilleure apres transplantation que lorsqu’ils sont laisses en dialyse. Sortir systematiquement ces patients des listes d’attente de transplantation n’est donc pas ethique. L’instauration d’un protocole national de prise en charge de ces patients en fonction de leur IMC apparait donc tres interessante pour en degager des recommandations claires.

UNLABELLED What's known on the subject? and What does the study add? Patients with end-stage renal disease (ESRD) have an increased risk of developing RCC in their native kidneys. The prevalence of RCC is 3-4% in cases of ESRD in dialyzed and/or transplanted patients, which corresponds to a rate 100-times higher than that in the general population. This is the first study, to our knowledge, comparing the characteristics of kidney cancer in the ESRD population according to their dialysis or transplantation status at the time of diagnosis. The differences in stage and survival we observed may be due to differences in surveillance strategies between transplanted and not transplanted patients, nevertheless, the differences in pathological subtypes suggest they could also be due to differences in the tumorigenesis process. OBJECTIVE • To compare clinical, pathological and outcome features of renal cell carcinomas (RCCs) arising in patients with chronic renal failure (CRF) with or without renal transplantation. PATIENTS AND METHODS • In all, 24 French University Departments of Urology and Kidney Transplantation participated in this retrospective study comparing RCCs arising in patients with CRF according to their dialysis or transplantation status at the time of diagnosis. • Information about age, sex, symptoms, duration of CRF, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. • Qualitative and quantitative variables were compared by using chi-square and Student statistical analysis. Survival was assessed by Kaplan-Meier and Cox methods. RESULTS • Data on 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). • Transplanted and not transplanted patients accounted for 213 (70.3%) and 90 cases (29.7%), respectively. • In transplant recipients, RCC was diagnosed at a younger age [mean (sd) 53 (11) vs 61 (14) years, P < 0.001), the mean tumour size was smaller [3.4 (2.3) vs 4.2 (3.1) cm, P= 0.02), pT1a stage (75 vs 60%, P= 0.009) and papillary histological subtype (44 vs 22%, P < 0.001) were more frequent than in their dialysis-only counterparts. • Nodal (1 vs 6%, P= 0.03) and distant metastases rates (0 vs 5%, P < 0.001) were significantly increased in patients who had not had a transplant. However, Furhman grading, symptoms, tumour multifocality or bilaterality, presence of acquired cystic kidney disease, were not significantly different between the groups. • Estimated 5-year survival rates were 97% and 77% for transplanted and not transplanted patients, respectively (P < 0.001). In univariate analysis, presence of symptoms (P= 0.008), poor performance status (P= 0.04), large tumour size, advanced TNM stage (P < 0.001), high Fuhrman grade (P= 0.005) and absence of transplantation (P < 0.001) were all adverse prognostic factors. In multivariate analysis, only T stage remained an independent predictor for cancer-related death (P < 0.001). CONCLUSION • RCC arising in native kidneys of transplant patients seems to exhibit many favourable clinical, pathological and outcome features compared with those diagnosed in dialysis-only patients. Further research is needed to determine whether it is due to particular molecular pathways or to biases in relation to mode of diagnosis.