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The effect of prostate artery embolization (PAE) on male sexual function is currently the subject of debate in the literature. The main purpose of this study was to define changes in all domains of sexual activity after PAE, using the international index of erectile function score (IIEF-15). A single-center retrospective study was conducted on 129 patients (mean age of 65.5 ± 7 years), who underwent PAE from February 2014 to January 2017 for symptomatic benign prostatic hyperplasia (BPH). Fifty consecutive patients fulfilling the inclusion criteria were evaluated before and after PAE follow-up using the IIEF-15, IPSS, prostate volume (PV) and cardiovascular risk factor and BPH drugs. The IIEF-15 domains analyzed were: erectile function (EF) ejaculation and orgasm (Ej/O), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A paired sample t test or Wilcoxon signed-rank test was used to compare IIEF-15 between baseline and follow-up. The study showed nonsignificant change in IIEF-15 total score (58.0 ± 13.8 SD; p = 0.71) and the five domains (EF 24.5 ± 7.0 SD, p = 0.82; EJ/O 8.2 ± 2.3 SD, p = 0.50; SD 7.2 ± 2.7 SD, p = 0.57; IS 10.3 ± 3.0 SD, p = 0.77; OS 8.2 ± 2.7 SD; p = 0.11) after PAE. We also found a significant improvement in IPSS score after PAE. Based on the IIEF-15 questionnaire, PAE was showed to allow good urinary symptoms results and no deterioration in sexual function.

Background Iodine seed implant brachytherapy is indicated for low risk and selected favorable intermediate risk prostate cancers. A percentage of positive biopsies > 50% is usually considered as a contra-indication, and the tumor location could also influence the treatment efficacy. We studied the association of the percentage of positive biopsy cores, and tumor location, with progression-free survival. Methods Among the 382 patients treated at our center by permanent implant iodine seed brachytherapy for a localized prostate cancer between 2006 and 2013, 282 had accessible detailed pathology reports, a minimum follow-up of 6 months, and were included. Progression was defined as a biochemical, local, nodal, or distant metastatic relapse. We studied cancer location on biopsies (base, midgland or apex of the prostate) and percentage of positive biopsy cores, as well as potential confounders (pre-treatment PSA, tumor stage, Gleason score, risk group according to D’Amico’s classification modified by Zumsteg, adjunction of androgen deprivation therapy, and dosimetric data). Results Most patients (197; 69.9%) had a low risk, 67 (23.8%) a favorable intermediate risk, 16 (5.7%) an unfavorable intermediate risk, and 1 (0.3%) a high-risk prostate cancer. An involvement of the apex was found for 131 patients (46,5%), of the midgland for 149 (52,8%), and of the base for 145 (51,4%). The median percentage of positive biopsy cores was 17% [3–75%]. The median follow-up was 64 months [12–140]. Twenty patients (7%) progressed: 4 progressions (20%) were biochemical only, 7 (35%) were prostatic or seminal, 6 (30%) were nodal, and 3 (15%) were metastatic. The median time to failure was 39.5 months [9–108]. There were more Gleason scores ≥7 among patients who progressed (40% vs 19%; p = 0.042). None of the studied covariates (including tumor location, and percentage of positive biopsy cores), were significantly associated with progression-free survival. The risk group showed a trend towards an association (p = 0.055). Conclusions Brachytherapy is an efficient treatment (5-year control rate of 93%) for patients carefully selected with classical criteria. The percentage and location of positive biopsies were not significantly associated with progression-free survival. A Gleason score ≥ 7 was more frequent in case of progression.

Benign Prostatic Hyperplasia (BPH) concerns 50% of men older that 60 Years old and can induce symptoms also earlier. Medical treatment are mostly alpha blockers (AB), 5-alpha reductase inhibitors (5ARI) and phospho-diesterase inhibitors. In case of failure or poor tolerance of drug treatment, surgery can be indicated, after evaluation of the Bladder Outlet Obstruction (BOO), based on urodynamic studies. Endoscopic or open surgery is selected according to the size of the prostate, the expertise of the urologist and patient preference. Surgical treatment is very efficient but carries frequent complications, especially retrograde ejaculation which is very frequent and can compromise fertility and sexual pleasure. Prostatic Artery Embolisation, an outpatient intervention performed by Interventional Radiologists and available in France since 2012 is a new alternative to surgery in case of failure or poor tolerance of medical treatment. It consists in super-selective injection of calibrated micro-particles into both prostatic arteries after femoral artery puncture at the groin. It is safe and efficient and provides appropriate symptomatic improvement BOO related to BPH.

To evaluate trimodal conservative treatment as an alternative to radical surgery for urothelial muscle-invasive bladder cancer (MIBC). This retrospective study reported the carcinologic and functional results of patients (pts) presenting a cT2/T3 N0M0 operable MIBC and fit for surgery, treated by a conservative strategy. Treatment consisted of a transurethral resection (TURB) followed by concomitant bi-fractionated split-course radiochemotherapy (RCT) with 5FU-Cisplatine. A control cystoscopy was performed six weeks after the induction RCT (eq45Gy) with systematic biopsies. Patients with complete histologic response achieved RCT protocol. Salvage surgery was proposed to pts with persistent tumor. 313 pts (83% cT2 and 17% cT3) treated between 1988 and 2013 were included, with a median follow-up of 59 months and 67-year mean age. After the induction RCT, the histologic response rate was 83%. After five years, overall, disease-free, and functional bladder-intact survival rates were respectively 69%, 61%, and 69%, significantly better for pts in complete response after induction RCT. Late urinary and digestive toxicities were limited, with respective rates of 4% and 1.5% of grade 3 toxicity. Trimodal strategy with RCT after TURB showed interesting functional and oncologic results and should be considered as an alternative to surgery in well-selected pts.

The development of prostatic artery embolization has led to better understand the complex male pelvic arterial anatomy. To the best of our knowledge, there is still no precise description of the distribution of the branches of the prostatic artery (PA) after its origin. In this study, the patterns of prostatic feeders near to and into the prostate were analyzed, and a classification was proposed. This study is based on angiograms of 101 consecutive male patients, mean age 70, who underwent PAE between December 2013 and June 2016, to treat symptomatic benign prostatic hyperplasia. The proposed classification is derived from the analysis of 143 solitary PAs from 199 hemipelves (72%). Pattern A was defined as an artery feeding only the prostate, patterns B and C as a PA with a concomitant large supply to the penis (pattern B) or to the rectum (pattern C). A pattern A was found in 89/143 (62%), a pattern B in 16/143 (12%) and pattern C in 38/143 (26%). Protection of a penile/rectal supply was never required in pattern A, while it was performed in 14/16 (87%) of pattern B, and in 7/38 (18%) of pattern C PAs. The PErFecTED technique could be performed in 51%, 50 and 55% of cases in pattern A to C. This study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.

Resume Introduction Les patients âges representent une part de la population grandissante pour laquelle la strategie du traitement des tumeurs renales localisees doit integrer la morbidite liee au choix therapeutique et a la fonction renale. L’objectif etait d’analyser les resultats oncologiques et fonctionnels de la chirurgie conservatrice (NP) versus ablation par radiofrequence (RFA). Materiel et methodes Tous les patients de plus de 75 ans traites par NP et RFA entre 2007 et 2014 pour une tumeur renale localisee dans notre centre ont ete inclus. Les caracteristiques des patients et des tumeurs ont ete comparees et les criteres suivants ont ete analyses : survie (globale et sans recidive) et perte de fonction renale (delta MDRD en pre- et postoperatoire). Resultats Cent patients ont ete inclus (26 nephrectomies partielles groupe 1, et 74 radiofrequences, groupe 2) avec un suivi moyen de 32 mois. L’âge moyen et la taille tumorale differaient significativement entre les deux groupes (respectivement 78 ans versus 81 ans, p = 0,001, 38 mm versus 29 mm, p = 0,003). Les resultats perioperatoires etaient comparables dans les deux groupes en termes de complications. En revanche, le taux de transfusion et la duree d’hospitalisation etaient significativement superieurs dans le groupe NP. Les medianes de survie etaient respectivement de 45 mois vs 27 mois en survie globale ( p = 0,23) et de 28 mois vs 10 mois en survie sans recidive ( p = 0,34) pour les deux groupes (NP vs RFA) respectivement. En analyse multivariee, le mode operatoire (NP vs RF) n’etait pas significativement associe a la survie (HR 2,37 [IC95 % : 0,66 a 8,5]) pour la survie du groupe RFA vs NP ( p = 0,19). La perte de debit de filtration glomerulaire calculee etait de 1,5 ± 14 mL/min/1,73 m 2 pour les NP et de 3 ± 14 mL/min/1,73 m 2 pour les RFA ( p = 0,69). Conclusion Notre etude a retrouve des resultats perioperatoires meilleurs pour la RFA par rapport a la NP sans difference significative de survie. La perte de fonction renale etait minime et comparable dans les deux groupes. Niveau de preuve 4.

Objectifs Plusieurs pathologies testiculaires peuvent conduire a la realisation d’une orchidectomie totale. La pose d’une prothese est frequemment proposee a visee cosmetique et psychologique. Cependant, aucune etude n’a etudie l’interet de fixer ou non la prothese. L’objectif de cette etude etait d’evaluer la satisfaction des patients apres mise en place d’une prothese testiculaire, selon qu’elle a ete fixee ou non. Methodes Il s’agit d’une etude retrospective, monocentrique, incluant tous les patients ayant eu une prothese testiculaire entre janvier 2010 et decembre 2019. L’indication operatoire, l’âge du patient et la fixation ou non la prothese ont ete analyses. Les patients ont ete contactes pour un entretien telephonique au cours duquel un questionnaire standardise leur a ete pose. Quatorze questions evaluaient la satisfaction des patients concernant la taille, le poids, la forme, la consistance, la position, les douleurs, la traction postoperatoire, la vie sexuelle et l’image corporelle. Resultats Au total, 169 patients ont ete inclus. L’orchidectomie etait en rapport avec une tumeur (76 %), une torsion (12 %), une atrophie/cryptorchidie (10 %) ou un traumatisme (2 %). La prothese etait fixee chez 69 patients (35 %). Sur 146 patients (86 %) ayant repondu au questionnaire, 74 % etaient tres satisfaits et 96 % referaient l’intervention. La majorite des patients etait satisfaite du poids (93 %), de la forme (76 %) ou de la consistance (93 %) de la prothese. Vingt-deux pour cent des patients la trouvaient trop petite, 37 % trop haute et 23 % se sont dit genes par l’attache situee a l’extremite de la prothese. Les patients chez qui la prothese etait fixee signalaient davantage de douleur (33 % vs 10 %, p = 0,001). La traction reguliere de la prothese n’a pas montre d’effet sur la position ou la douleur ( Fig. 1 ). Conclusion La prothese testiculaire est associee a un taux de satisfaction eleve. Les douleurs semblent plus importantes lorsque la prothese est fixee. Par consequent, il ne semble pas necessaire de fixer les protheses testiculaires et les industriels pourraient supprimer l’attache genante situee a son extremite.

PURPOSE To study the subscore improvement in International Prostate Symptom Scores (IPSS) after prostatic artery embolization (PAE). MATERIALS AND METHODS A single-center retrospective study was carried out with follow-up from December 2013 to July 2019 in 37 consecutive patients (66.0 ± 8.8 years old) who underwent PAE, comparing resultant scores before and after PAE. IPSS were divided into storage (IPSS-s) subscores and voiding (IPSS-v) subscores. The changes between IPSS-s and IPSS-v at 1, 3, 6, and 12 months' follow-up as well as the last follow-up were compared with baseline scores. The changes in percentages of IPSS-s and IPSS-v and the changes in average IPSS-s-to-total IPSS ratios (IPSS-s/IPSS-t) and IPSS-v-to-IPSS-t ratios (IPSS-v/IPSS-t) were also analyzed. RESULTS In the study population, consisting of 37 patients, IPSS-t significantly decreased from 16.5 ± 7.2 at baseline to 8.3 ± 5.7 at the last follow-up (4 years later) (P < .0001). Additionally, the changes in IPSS-v symptoms were greater than the changes in IPSS-s symptoms at 1, 3, 6, and 12 months' follow-up, reaching a statistical significance at 6 months with a decrease of 72.9% ± 42.4% for IPSS-v and a decrease of 50.1% ± 52.2% for IPSS-s (P = .009). CONCLUSIONS PAE can successfully reduce both IPSS-s and IPSS-v with predominant IPSS-v reduction. The improvements in both subscores were sustained for up to 4 years of follow-up.

Background This prospective study assessed the efficacy of prostate artery embolization after failure of a trial without catheter in patients suffering a first episode of acute urinary retention as a result of benign prostatic hyperplasia (BPH). Methods Patients with failure of a trial without catheter despite alpha-blocker therapy were invited to participate in this protocol. Twenty patients were included in the study, and all underwent prostate artery embolization with calibrated polyvinyl alcohol (PVA) microspheres (Bead Block, BTG Ltd., Farnham, UK). Results Successful removal of the indwelling bladder catheter and spontaneous voiding was achieved in 15 of 20 (75%) patients, and the overall clinical success at 6 months after prostate embolization was 14 of 20 (70%). No patient experienced severe adverse events. Conclusions Prostate artery embolization might be a valuable treatment after a failure of a trial without catheter. Further studies are needed to better define its place in this setting.

During PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.We treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL 3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.We had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.PAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.

To analyse long-term overall survival, relapse-free survival and late toxicities in a series of 675 patients treated between 1999 and 2003, with a median follow-up of 132 months.The cohort included low-risk patients and a selection of "favourable-intermediate" risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125 iodine seeds. Hormone therapy, consisting most often of an anti-androgen alone, was given in 393 patients (58%).The 10-year overall survival was 92% (95% confidence interval [CI]: 90-94) without a significant difference between the low and the select intermediate-risk groups (P=0.17). The 10-year relapse-free survival rate for the entire cohort was 82% (95% CI: 79-85), and was significantly higher in the low-risk group than in the intermediate one (87 vs 71%; P0.0001). Twenty-six percent of the relapses observed in this series occurred after more than 10 years of follow-up. The 10-year cumulative incidence of grade 3-4 urinary toxicity (whatever the delay and the recovery) was 5.78%. The cumulative incidence of grades 3-4 rectal toxicity in the present series was 1.65% at 10 years. As for sexual toxicity, 61% of our patients retained an erectile capacity at 10 years (with or without oral medication), with age being a major factor.With a median follow-up of more than 11 years, this series appears to confirm the excellent long-term results of low-dose rate prostate brachytherapy, both in terms of survival and in terms of toxicity.

To assess the impact of prostatic arterial embolisation (PAE) on various prostate gland anatomical zones. We retrospectively reviewed paired MRI scans obtained before and after PAE for 25 patients and evaluated changes in volumes of the median lobe (ML), central gland (CG), peripheral zone (PZ) and whole prostate gland (WPV) following PAE. We used manual segmentation to calculate volume on axial view T2-weighted images for ML, CG and WPV. We calculated PZ volume by subtracting CG volume from WPV. Enhanced phase on dynamic contrasted-enhanced MRI was used to evaluate the infarction areas after PAE. Clinical results of International Prostate Symptom Score and International Index of Erectile Function questionnaires and the urodynamic study were evaluated before and after PAE. Significant reductions in volume were observed after PAE for ML (26.2 % decrease), CG (18.8 %), PZ (16.4 %) and WPV (19.1 %; p

Objectifs Evaluer la pertinence des traitements chirurgicaux de sauvetage des patients en recidive biologique (RB) de cancer de la prostate apres prostatectomie, decide sur la base des resultats du TEP/TDM au 68Ga-PSMA-11. Methode A partir de la base de donnees des patients ayant eu au sein de l’institution une TEP/TDM au 68Ga-PSMA-11 entre avril 2016 et avril 2018, ont ete revus les patients en RB apres prostatectomie radicale et ayant beneficie d’un traitement de sauvetage chirurgical. Resultats Treize patients en RB âges en moyenne de 70 ans [53–78] et ayant un grade histologique initial ISUP 1 pour 3 d’entre eux, ISUP 2 pour 5 et ISUP3 pour 5 ont ete inclus. La valeur mediane du PSA etait de 1,23 ng/mL [0,2–12,5] et son temps de doublement de 6,4 mois [0,6–33,6]. La TEP/TDM au 68Ga-PSMA-11 a permis une prise en charge chirurgicale dans 11 cas : 6 curages ganglionnaires pelviens etendu et 1 lombo-aortique, 2 orchidectomies, 2 electroporations, 1 cryotherapie et 1 chirurgie de carcinose. Les resultats histologiques retrouvaient un adenocarcinome prostatique sur les 7 curages ganglionnaires, la carcinose et une orchidectomie. L’efficacite du traitement base sur un PSA indosable apres traitement etait notee dans 8 cas sur 11. La duree mediane de suivi etait de 9 mois ( Fig. 1 ). Conclusion L’acces a la TEP/TDM aux ligands du PSMA, encore limite en France, apporte des elements informatifs pour la prise en charge de la recidive biologique apres chirurgie et guide le traitement en ameliorant le controle de la maladie a court terme. Le suivi a moyen/long terme et l’inclusion d’autres patients confirmeront la prise en compte de cet examen.

Purpose To analyse the rate of secondary malignancies observed in a series of 675 prostate cancer patients who underwent a permanent implant brachytherapy between 1999 and 2003, and to compare the incidence with the expected rate in a matched general French population. Material and methods The cohort included low-risk patients and a selection of “favourable-intermediate” risk patients. All patients were homogeneously treated using an intraoperative dynamic planning prostate brachytherapy technique, with loose 125-iodine seeds and a prescription dose of 145 Gy. The mean follow-up was 132 months. Results The 10-year overall survival for the entire cohort was 92% (95% confidence interval [CI]: 90–94). The 10-year relapse-free survival rate was 82% (95% CI: 79–85). Overall, 61 second cancers were registered. When comparing with a matched general French population, the standard incidence ratio (SIR) for bladder cancer was 1.02 (95% CI: 0.46–1.93). For colorectal cancer, the SIR was 0.45 (95% CI: 0.19–0.89). For lung cancer, the SIR was 0.38 (95% CI: 0.17–0.76). The SIR for all cancers was 0.61 (95% CI: 0.47–0.79). When excluding secondary colorectal and lung cancers (both with low SIRs in this series), the SIR for all cancers was 1.06 (95% CI: 0.77–1.29). Conclusion With a mean follow-up of more than 11 years, this series does not detect any excess risk of second cancers associated with permanent implant prostate brachytherapy. However, due to power limitation, a small increase in the risk of secondary malignancies cannot be totally ruled out.

Peri-prostatic shunts are frequent during PAE, carrying the risk of non-target embolization of penis/corpus cavernosum or rectum but also the potential advantage to irrigate the contralateral lobe. Sometimes, bilateral embolization is impossible, carrying the risk of limited clinical success. The possibility to reach contralateral prostatic territory from the ipsilateral prostatic artery (PA) and embolize it via peri/intra-prostatic anastomoses could be of interest in this situation. We describe a series of three consecutive patients (among 89 consecutive patients treated by PAE for symptomatic BPH) who underwent successful embolization of both prostatic lobes through catheterization of a PA on only one side. All patients had clinical success after a mean follow-up of 3.3 months. Dosimetry of these three procedures indicates that there may be radiation dose savings.

Background: Androgens play a role in the development of both androgenic alopecia, commonly known as male pattern baldness, and prostate cancer. We set out to study if early-onset androgenic alopecia was associated with an increased risk of prostate cancer later in life. Patients and methods: A total of 669 subjects (388 with a history of prostate cancer and 281 without) were enrolled in this study. All subjects were asked to score their balding pattern at ages 20, 30 and 40. Statistical comparison was subsequently done between both groups of patients. Results: Our study revealed that patients with prostate cancer were twice as likely to have androgenic alopecia at age 20 [odds ratio (OR) 2.01, P = 0.0285]. The pattern of hair loss was not a predictive factor for the development of cancer. There was no association between early-onset alopecia and an earlier diagnosis of prostate cancer or with the development of more aggressive tumors. Conclusions: This study shows an association between early-onset androgenic alopecia and the development of prostate cancer. Whether this population can benefit from routine prostate cancer screening or systematic use of 5-alpha reductase inhibitors as primary prevention remains to be determined.

Objective To collect follow-up data for infertile men with Y microdeletion. Design Retrospective, observational survey. Setting Multicenter IVF units associated with genetics laboratories. Patient(s) Sixty-three patients with Y microdeletion. Intervention(s) Karyotype analysis, Y microdeletion screening, and assisted reproductive technology. Main Outcome Measures Medical history, karyotype, nature of the AZF deletion, semen parameters, testis biopsy results, choice of assisted reproductive technology, and results of intracytoplasmic sperm injection (ICSI). Results Abnormal karyotypes were found in 8 men (12.7%), who were azoospermic except 1. Of these 8 men, 5 presented a combined AZFb+c deletion, and 3 had a deletion in AZFc only. Most men (39 of 63) were azoospermic, 3 were cryptoazoospermic, and 19 had extreme oligozoospermia (sperm concentration ≤1.10 6 /mL). Sperm concentration above 1.10 6 /mL was found for 2 men (3.1%). A testis biopsy was performed in 27 azoospermic men, resulting in positive sperm extraction in 6 cases. To date, 42 ICSI cycles with either testicular (n = 5) or ejaculated spermatozoa (n = 37) have been carried out in 23 couples with male partners with AZFc deletion. Eighteen clinical pregnancies were obtained, leading to the birth of 14 babies. Donor insemination had been chosen by 28 couples, leading to the birth of 9 children. Conclusion Karyotype analysis should be systematically performed in Y microdeleted men. Intracytoplasmic sperm injection can be offered to half of AZFc-deleted patients, providing real opportunities to have a child.

Resume Objectif Evaluer l’impact de l’indication imperative sur le taux de complication et les resultats carcinologiques a long terme apres nephrectomie partielle (NP). Patients et methodes Entre 1985 et 2005, tous les patients operes d’une NP pour cancer localise dans deux centres ont ete revus. Les taux de complication global, hemorragique et urinaire ont ete compares entre le groupe I (indication elective) et le groupe II (indication imperative). Les survies sans recidive et specifique a cinq, dix et 20 ans ont ete comparees entre ces deux groupes. Une analyse multivariee selon le modele de Cox a ete realisee pour rechercher les facteurs associes a la recidive et au deces sur l’ensemble de la serie. Resultats Trois cent cinq patients ont ete inclus dans l’etude. Aucune difference significative n’a ete retrouvee entre le groupe I et le groupe II en ce qui concerne le taux de complication global (17 vs 20 %), le taux de complication hemorragique (3,5 vs 3,8 %) et le taux de complication urinaire (3,9 vs 2,5 %). Les patients operes pour une indication imperative avaient des survies sans recidive et specifique significativement plus faibles a cinq, dix et 20 ans. Sur l’ensemble de la serie, l’indication imperative etait le seul facteur independant associe a la recidive et au deces en analyse multivariee. Conclusions Si le taux de complication ne semblait pas significativement associe a l’indication operatoire, les patients a l’indication imperative representaient un groupe heterogene de moins bon pronostic. Ce facteur devrait etre pris en compte dans les etudes portant sur la NP.

Resume Objectif Preciser les indications, les resultats et la place de la nephrectomie pour polykystose autosomique dominante de l’adulte (Prada) par rapport a la transplantation renale. Materiel et methodes Entre octobre 1998 et fevrier 2006, 145 patients atteints de Prada etaient suivis dans notre institution. Parmi eux, 38 patients ont eu une nephrectomie par voie sous-costale, principalement en preparation a la greffe. La decision de nephrectomie en preparation a l’implantation etait prise en fonction de l’examen clinique et des donnees tomodensitometriques. Resultats Les indications de nephrectomies etaient pour la preparation a la greffe : n = 28 (68 %) ; pour des complications urologiques severes : n = 12 et pour une tumeur maligne : n = 1. Nous avons realise 41 nephrectomies, 36 en pretransplantation (88 %) et cinq en post-transplantation chez trois patients. Le taux de nephrectomies etait de 26 %. Le poids median des reins etait de 2800 grammes. La duree operatoire moyenne etait de 100 minutes, les pertes sanguines moyennes de 76 ml. La morbidite globale etait de 36,6 % dont 7,3 % de complications graves. La duree moyenne d’hospitalisation a ete de 14,5 jours. Aucun patient nephrectomise avant la greffe ( n = 13) n’a presente de complications sur le rein natif controlateral avec un recul moyen de 33 mois. Le delai moyen entre la mise en dialyse et la greffe, d’une part, et entre la nephrectomie et la greffe, d’autre part, etait respectivement de 30 et 16 mois. Conclusions La question du moment et de la voie d’abord de la nephrectomie pour Prada reste d’actualite. En l’absence de complication urologique, la nephrectomie, dont la morbidite est consequente, ne doit etre realisee que lorsque les reins tres volumineux genent vraiment l’implantation du greffon. Ainsi, la nephrectomie systematique uni ou bilaterale ne doit plus etre proposee. Afin d’eviter les complications de l’anephrie, nous recommandons d’attendre, si possible, la mise en dialyse du patient, mais le developpement des greffes preemptives pose la question de la nephrectomie concomitante a la greffe qui merite d’etre debattue.

Resume Introduction Recemment, plusieurs equipes ont confirme la faisabilite technique de la nephrectomie partielle laparoscopique (NPL). Toutefois, cette intervention reste encore peu pratiquee car difficile techniquement et grevee d’un taux de complication hemorragique important meme pour des equipes entrainees. Dans cette etude, nous avons etudie la courbe d’apprentissage de la NPL sur un modele porcin d’un interne d’urologie. Les criteres etudies etaient le temps operatoire, le temps d’ischemie chaude et le saignement per- et postoperatoire. Materiels et methodes Quarante NPL ont ete realisees par le meme operateur. Toutes les interventions etaient realisees apres clampage arterielle et heparinisation de l’animal. La section renale etait toujours la meme, elle emportait 40 % du rein et interessait toujours les voies excretrices (VE). Un surjet continu sur les VE, puis des points separes sur le parenchyme etaient realises. Les temps operatoires et d’ischemie chaude etaient releves. Les animaux etaient surveilles pendant dix jours. Le saignement per- et postoperatoire par les drainages etait comptabilise et une opacification retrograde etait faite au dixieme jour pour verifier l’etancheite des VE. Des tests statistiques de regression lineaire ont recherche une correlation entre ces differents criteres et le nombre de cas realises. Resultats La duree totale d’intervention, le temps d’ischemie chaude et le saignement global (per- et postoperatoire) etaient en moyenne de 108 minutes (70–140 minutes), 38 minutes (22–50 minutes) et 95 ml (10–300 ml), respectivement. L’analyse de regression statistique retrouvait une correlation directe entre le nombre de cas effectues et le saignement peroperatoire ( p p Conclusion Le temps operatoire et la duree d’ischemie chaude ont ete directement correles au nombre de cas effectues. Un entrainement sur un modele porcin nous a semble etre un bon moyen de reduire la courbe d’apprentissage chez l’homme. Dix interventions ont ete necessaires pour acquerir les differents temps operatoires.

Resume Objectif de l’etude Decrire les modalites therapeutiques pour les cancers localises de la prostate traites par irradiation conformationnelle de 76 Gy avec ou sans hormonotherapie. Evaluer les resultats preliminaires en termes de survie, de controle biochimique et de toxicite. Patients et methode Entre janvier 1998 et juin 2001, 321 patients atteints d’un cancer localise de la prostate ont ete irradies a l’institut Curie. Pour cette etude, les tumeurs ont ete stratifiees selon les trois groupes pronostiques du Memorial Sloan-Kettering Cancer Center (1998) : favorable (23 %), intermediaire (36,5 %), defavorable (40,5 %). Une privation androgenique, principalement neoadjuvante, inferieure ou egale a un an a ete prescrite a 93,8 % des patients (72,6 % inferieure ou egale a six mois). Les doses d’irradiation prescrites dans les volumes cibles previsionnels etaient les suivantes : prostate : 76 Gy ; vesicules seminales : 56 a 76 Gy ; ganglions pelviens : 44 Gy pour 16,8 % des patients. Resultats La probabilite de survie actuarielle globale a cinq ans etait de 94 % (intervalle de confiance a 95 % : 90–97 %). La duree mediane du suivi post-therapeutique etait de 36 mois (neuf a 66 mois). Les probabilites de survie actuarielle sans echec biochimique a 48 mois etaient statistiquement differentes entre les trois groupes pronostiques, que ce soit selon la definition de l’echec biologique proposee par le consensus de l’American Society for Therapeutic Radiology and Oncology (ASTRO) de 1997 ou celle du Fox Chase Cancer Center (FCCC) de 2000, respectivement 87 et 94 %, 78 et 84 %, 54 et 58 % dans les groupes favorable, intermediaire et defavorable (p Conclusions Ces resultats sont comparables a ceux des series publiees precedemment pour un suivi equivalent. L’impact de l’escalade de dose associee a une courte privation androgenique sur le controle local, la survie et les complications necessitent un suivi de longue duree et une analyse approfondie.

Resume Par arrete en date du 3 fevrier 2005, les grains d'iode 125 de plusieurs fabricants pour implantation permanente en curietherapie prostatique ont ete inscrits sur la liste des produits et prestations remboursables (LPP). Dans ce cadre, le Comite economique des produits de sante (CEPS) a demande qu'un rapport annuel lui soit fourni sur le suivi de l'utilisation de ces grains, avec publication des resultats. Ce rapport a pour objectifs essentiels de s'assurer que les patients traites correspondaient bien aux criteres d'inclusion definis par les instances nationales et internationales, de controler les criteres de qualite dosimetriques des implantations, et enfin d'analyser les donnees relatives aux effets secondaires et aux complications, voire aux accidents ou incidents en rapport avec ces implantations. Nous rapportons donc ici le bilan clinique et dosimetrique de 469 patients traites en France dans neuf centres en 2005 a l'aide des grains d'iode 125 IsoSeed Bebig. Ce bilan montre : 1) que les recommandations nationales pour l'inclusion des patients ont ete respectees dans la quasi-totalite des cas (97 %) ; 2) que les criteres de qualite des implantations etaient optimaux dans la tres grande majorite des cas de cette serie ; 98 % des patients avaient une D90 superieure a 145 Gy et 96 % des patients un V100 superieur a 95 % ; 3) que la toxicite precoce se situe dans la fourchette basse des donnees de la litterature, avec en particulier un taux de retention urinaire precoce de seulement 2,4 %.

Resume Objectifs Evaluer la frequence du phenomene de « rebond » (elevation secondaire transitoire de la concentration serique du PSA) du PSA apres curietherapie de prostate et rechercher une correlation entre le rebond et les parametres cliniques et dosimetriques. Evaluer comment ce rebond du PSA peut mimer les criteres de rechute biochimique. Patients et methodes De mai 1998 a mai 2005, 1000 patients ont eu une curietherapie pour un cancer localise de la prostate de bas risque a l'institut Curie. Apres l'implantation, un dosage serique de PSA a ete realise tous les six mois. Nous avons defini le « rebond » comme toute augmentation du PSA d'au moins 0,1 ng/ml, suivie d'une diminution spontanee de celui-ci. Nous avons utilise les criteres de rechute biochimique definis par le consensus de l'ASTRO (trois elevations successives de la concentration serique de PSA), et analyse les correlations entre les rebonds de PSA, les parametres cliniques et dosimetriques, en analyse multifactorielle. Pour evaluer le phenomene de rebond avec un recul suffisant, cette serie a donc porte sur les patients traites par la technique en temps reel, avec grains libres d'125I (Isoseed, Bebig), jusqu'a decembre 2001. Dans ce groupe de 295 patients, la duree moyenne de suivi a ete de 40,3 mois (9–66 mois). Resultats Dans notre serie, 161 patients (55 %) ont eu une elevation transitoire de la concentration serique de PSA (« rebond ») d'au moins 0,1 ng/ml ; 145 patients (49 %) un rebond d'au moins 0,2 ng/ml, 93 patients (32 %) un rebond d'au moins 0,4 ng/ml, 43 patients (15 %) un rebond d'au moins 1 ng/ml. Le delai moyen d'apparition de cette elevation a ete de 19 mois (6–58), et la duree moyenne de six mois. L'amplitude moyenne de l'elevation a ete de 0,8 ng/ml (0,1–4,1 ng/ml). Trente-deux patients, soit 11 % du nombre total des patients, ont eu trois elevations successives du PSA avec un intervalle significatif entre les dosages (trois mois) et etaient donc en situation de rechute biochimique selon les criteres de l'ASTRO. Parmi ces 32 patients, 18 (56 %) ont vu leur PSA se normaliser completement et spontanement. Au total, seuls dix patients ont vu leur concentration serique de PSA continuer a augmenter et ont donc eu une authentique recidive biochimique. Pour les quatre derniers patients, la situation restait encore ambigue compte tenu des fluctuations persistantes du PSA et du recul insuffisant. En analyse multifactorielle, l'âge inferieur a 70 ans (p Conclusions Dans notre serie, 32 % des patients ont eu un rebond de la concentration serique de PSA d'au moins 0,4 ng/ml, en accord avec les donnees de la litterature. Ce rebond a ete observe jusqu'a cinq ans apres l'implantation, a atteint jusqu'a 4 ng/ml, et a dure six mois en moyenne. Parmi les 32 patients avec les criteres de rechute biochimique de l'ASTRO, 18 (56 %) avaient en fait un simple rebond. Les criteres de l'ASTRO ne sont donc pas adaptes au suivi biolochimique precoce apres curietherapie de prostate, et les resultats de la curietherapie doivent etre evalues avec un recul suffisant pour tenir compte du phenomene de rebond. Cela a des consequences cliniques pratiques evidentes, sur le diagnostic de recidive et la decision d'un eventuel traitement complementaire.

Prostatic artery embolization (PAE) has been performed for a few years, but there is no report on PAE using the PErFecTED technique outside from the team that initiated this approach. This single-center retrospective open label study reports our experience and clinical results on patients suffering from symptomatic BPH, who underwent PAE aiming at using the PErFecTED technique. We treated 32 consecutive patients, mean age 65 (52–84 years old) between December 2013 and January 2015. Patients were referred for PAE after failure of medical treatment and refusal or contra-indication to surgery. They were treated using the PErFecTED technique, when feasible, with 300–500 µm calibrated microspheres (two-night hospital stay or outpatient procedure). Follow-up was performed at 3, 6, and 12 months. We had a 100 % immediate technical success of embolization (68 % of feasibility of the PErFecTED technique) with no immediate complications. After a mean follow-up of 7.7 months, we observed a 78 % rate of clinical success. Mean IPSS decreased from 15.3 to 4.2 (p = .03), mean QoL from 5.4 to 2 (p = .03), mean Qmax increased from 9.2 to 19.2 (p = .25), mean prostatic volume decreased from 91 to 62 (p = .009) mL. There was no retrograde ejaculation and no major complication. PAE using the PErFecTED technique is a safe and efficient technique to treat bothersome LUTS related to BPH. It is of interest to note that the PErFecTED technique cannot be performed in some cases for anatomical reasons.

Prostate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS. To assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change. Prospective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30–500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months. PAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q max) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045). Patients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.

To review current knowledge on clinical outcomes and peri-operative complications of prostatic arterial embolization (PAE) in patients treated for lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). A systematic review of the literature published from January 2008 to January 2015 was performed on PubMed/MEDLINE. Fifty-seven articles were identified, and four were selected for inclusion in this review. Only one randomized clinical trial compared transurethral resection of the prostate (TURP) to PAE. At 3 months after the procedure, mean IPSS reduction from baseline ranged from 7.2 to 15.6 points. Mean urine peak-flow improvement ranged from +3.21 ml/s to +9.5 ml/s. When compared to TURP, PAE was associated with a significantly lower IPSS reduction 1 and 3 months after the procedure. A trend toward similar symptoms improvement was however reported without statistical significance from 6 to 24 months. Major complications were rare with one bladder partial necrosis due to non-selective embolization. Mild adverse events occurred in 10 % of the patients and included transient hyperthermia, hematuria, rectal bleeding, painful urination or acute urinary retention. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures. Early reports suggest that PAE may be a promising procedure for the treatment of patients with LUTS due to BPO. However, the low level of evidence and short follow-up of published reports preclude any firm conclusion on its mid-term efficiency. Further clinical trials are warranted before any use in clinical practice.

Objectives To evaluate prospectively a healthy parenchymal safety margin during conservative surgery for renal cell carcinoma. Methods From 1997 to 2001, elective nephron-sparing surgery was performed through a flank incision in 61 consecutive patients (mean age 59.4 years, range 34.2 to 78.5). The mean tumor size was 32 mm (range 12 to 50). The tumor localization was juxtahilar in 10 and distant in 51. Prospective margin assessment used the following protocol. Margins were evaluated macroscopically by the surgeon, controlled by frozen section analysis, and subsequently measured during histologic examination. All patients were monitored with computed tomography scans, with a mean follow-up of 72.5 months (range 46 to 95). Results The histologic type was clear cell in 42 patients, papillary in 17, and chromophobic cell in 2. Of the 61 patients, 57 had 1997 TNM Stage pT1 and 4 had Stage pT2. The Furhman grade was grade 1 in 16, grade 2 in 35, and grade 3 in 10. No tumor margin was positive. Frozen section analysis and routine histologic examination yielded 53 complete and 8 incomplete margins compared with 51 and 10, respectively, as assessed by the surgeons. The mean peritumoral margin was 7 mm (range 4 to 10) for the cortex and 2 mm (range 0 to 5) for the deep part. No patient developed locoregional or metastatic relapse. Conclusions No apparent relationship was observed between peritumoral margin width and the risk of disease progression, even for tumors abutting the hilum, rendering illusory a safety margin greater than 1 cm. Although the surgeons’ macroscopic margin evaluations were accurate, frozen section analysis is mandatory when the margin status is in doubt. In all cases, margin negativity remains an oncologic imperative.

To assess the frequency and features of the PSA bounce phenomenon in a series of patients treated with permanent implant brachytherapy for prostate cancer, and to evaluate the percentage of cases in which this bounce could have mimicked a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology consensus criteria.From January 1999 to December 2001, 295 patients were treated with a permanent prostate implantation (real-time technique, with free (125)I seeds) by the Paris Institut Curie/Hospital Cochin/Hospital Necker Paris group. Duration of followup is 40.3 months (9-66 months). PSA level was reported at intervals not exceeding 6 months. Bounce was defined by temporary elevation in PSA level, followed by a spontaneous decrease.In our series, 161 patients (55%) showed a transitory PSA increase (bounce) of at least 0.1 ng/mL; 145 patients (49%) a bounce of 0.2 ng/mL; 93 patients (32%) a bounce of 0.4 ng/mL; and 43 patients (15%) a bounce of at least 1 ng/mL. Mean PSA bounce was 0.8 ng/mL (0.1-4.1), and mean time to bounce was 19 months. Thirty-two patients (11% of total) presented three successive PSA increases, and therefore were to be considered as experiencing a biochemical relapse according to the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria. Among those 32 patients, 18 (56%) subsequently showed, without any treatment, a complete normalization of their PSA. In multivariate analysis, age70 (p0.0001) and D90200Gy (p0.003) were identified as independent factors for a PSA bounce of at least 0.4 ng/mL.The observed rate of 32% of patients showing a PSA bounce of at least 0.4 ng/mL in our series is in good agreement with what has been previously reported in the literature. Among 32 patients fulfilling the classical ASTRO criteria for a biochemical relapse, 18 (56%) subsequently showed a spontaneous PSA decrease, questioning the ASTRO consensus for the biochemical followup of patients undergoing permanent implant prostate brachytherapy.

BACKGROUND: Sterility in men with cystic fibrosis (CF) raises the question of the use of assisted reproductive techniques (ART). A multidisciplinary network including adult CF centre and reproductive medicine units was set up to answer requests for ART. METHODS: This retrospective study included 25 men with CF between 1994 and 2004. Clinical status, semen analysis, CF mutations analysis and artificial insemination by donor (AID) or ICSI after surgical retrieval of sperm were monitored. RESULTS: All CF men had azoospermia. Two chose AID first (one delivery); 23 chose ICSI. Sperm were surgically retrieved in 21 cases, and ICSI was performed in 19. Pregnancies occurred in 12 of these 19 couples (63%) (two ectopic pregnancies, two spontaneous abortions, one termination of pregnancy for polymalformed twins and 11 single deliveries in nine couples). Two couples tried AID after ICSI failed; one had twins. Another adopted a child, and two had a spontaneous pregnancy. After a follow-up of 4.1±2.3 years, two patients died, two underwent lung transplantation and 21 remained stable. CONCLUSION: ART can help men with CF to become a father, but their health status and short survival need careful counselling and multidisciplinary medical care.

For more than 60 years, the treatment of metastatic prostate cancer has been based on andro- gen deprivation. In the case of asymptomatic metastatic disease, the timing of hormonal therapy remains controversial. No evidence of a beneficial effect of neoadjuvant hormonal therapy before radical prostatectomy has been docu- mented. Radical prostatectomy and adjuvant therapy cannot be consi- dered as a standard treatment. There is a general consensus at this time that patients with high-grade localized tumors benefit from hormone therapy (2-3 years) in conjunction with external beam radiation therapy.

Pour les patients porteurs de cancers prostatiques localises et bien selectionnes (PSA < 10, Geason < 7, pas d’extension extracapsulaire, volume < 50-60 g), la curietherapie de prostate par implants permanents (grains d’iode 125 ou plus rarement de Palladium 103) offre des resultats a 10-15 ans qui paraissent superposables a ceux de la chirurgie. Les taux d’incontinence et d’impuissance sexuelle semblent significativement inferieurs a ceux de la chirurgie classique. Par contre, les premiers mois post-implantation sont greves d’une toxicite urinaire (essentiellement de grades 1-2) qui ne doit pas etre occultee. La curietherapie a haut debit de dose (HDR), quant a elle, pourrait trouver une place, en association avec une radiotherapie conformationnelle, dans le traitement de formes plus evoluees (a risque «intermediaire» et «eleve»). La curietherapie du cancer prostatique devrait donc trouver de plus en plus d’indications, du fait de l’augmentation attendue du nombre global de cancers prostatiques (vieillissement de la population), de l’augmentation previsible des formes de debut (role du depistage), de la demande de plus en plus pressante des patients d’une moindre toxicite, et enfin du fait d’un cout qui est actuellement equivalent a celui de la chirurgie et qui pourrait diminuer dans un proche avenir.

BACKGROUND Chromophobe renal cell carcinoma (CRCC) is often associated with a favorable prognosis. However, to the authors' knowledge, only few clinical data are available regarding this variant of tumor. In the current study, the authors report their experience with CRCC over the last 14 years. METHODS Since 1989, 61 patients have been treated at the study institution for CRCC. Tumor characteristics and patient outcome were analyzed retrospectively. Data were obtained from the patients' medical records. RESULTS The mean age of the patients was 58 years. Of the 61 tumors, 68.8% were discovered incidentally. The mean tumor size was 6.9 cm. Fifty-seven patients (93.4%) were treated with radical nephrectomy and 4 patients (6.6%) underwent partial nephrectomy. According to the 1997 TNM classification, the pathologic tumor stage was T1 in 65.6% of cases, T2 in 31.1% of cases, and T3a in 3.3% of cases. All tumors were staged as N0M0. Nuclear grade was low (1 or 2) in 88.5% of cases. In no case of CRCC was a sarcomatoid component observed. At a mean follow-up of 49.5 months (range, 5–135 months), no patient had experienced tumor recurrence or disease progression, and none had died of renal carcinoma. CONCLUSIONS In the authors' experience, CRCC carries an excellent prognosis, possibly due to the high rate of low-stage and low-grade tumors. Cancer 2004;100:1406–10. © 2004 American Cancer Society.

This study was conducted in prostate cancer patients in biochemical relapse after radical prostatectomy, to assess the feasibility, safety, and immunogenicity of therapeutic vaccination with autologous dendritic cells (DCs) pulsed with human recombinant prostate-specific antigen (PSA) (Dendritophage-rPSA). Twenty-four patients with histologically proven prostate carcinoma and an isolated postoperative rise of serum PSA (1 ng/ml to 10 ng/ml) after radical prostatectomy were included. The patients received nine administrations of PSA-loaded DCs by combined intravenous, subcutaneous, and intradermal routes over 21 weeks. Postbaseline blood tests were performed at months 1, 3, 6, 9, and 12 (PSA levels), at months 6 and 12 (circulating prostate cancer cells), at month 6 (anti-PSA IgG and IgM antibodies), and at up to eight time points before, during, and after immunization (PSA-specific T cells). Circulating prostate cancer cells detected in six patients at baseline were undetectable at 6 months and remained undetectable at 12 months. Eleven patients had a postbaseline transient PSA decrease on one to three occasions, predominantly occurring at month 1 (7 patients) or month 3 (2 patients). Maximum PSA decrease ranged from 6% to 39%. PSA decrease on at least one occasion was more frequent in patients with low Gleason score ( p=0.016) at prostatectomy and with positive skin tests at study baseline ( p=0.04). PSA-specific T cells were detected ex vivo by ELISpot for IFN-gamma in 7 patients before vaccination and in 11 patients after vaccination. Of the latter 11 patients, 5 had detectable T cells both before and during the vaccination period, 4 only during the vaccination period, while 2 patients could for technical reasons not be assessed prevaccination. No induction of anti-PSA IgG or IgM antibodies was detected. There were no serious adverse events or otherwise severe toxicities observed during the trial. Immunization with Dendritophage-rPSA was feasible and safe in this cohort of patients. An immune response specific for PSA could be detected in some patients. A notable effect was the disappearance of circulating prostate cells in all patients who were RT-PCR positive before vaccination.

We reviewed the efficacy and safety of nephron sparing surgery for renal cell carcinoma in patients with von Hippel-Lindau disease.Data were collated for all 56 patients with a mean age of 37.2 +/- 11.3 years (range 14 to 62) with von Hippel-Lindau disease who underwent radical nephrectomy or nephron sparing surgery at our department for 1 or more 25 to 60 mm renal cell carcinomas between 1988 and 2001.Overall 30 nephrectomies (33%) and 62 enucleations (67%) were performed for 62 bilateral and 30 unilateral tumors. For nephron sparing surgery estimated intraoperative blood loss was 175 +/- 231.7 cc (range 50 to 1,300), 97% of surgeries had vascular pedicle clamping for 32 +/- 10.4 minutes (range 10 to 50) and there were 4 immediate complications (1 perinephric abscess, 2 urinary fistulas and 1 acute renal failure requiring temporary dialysis). Renal atrophy was noted in 7.3% of cases. Tumor diameter was 31.2 +/- 10.7 mm (range 15 to 60) and recurrence diameter was 22 +/- 7.8 mm (range 4 to 45). Hospital stay was 7.6 +/- 2.4 days (range 5 to 21). Preoperative and postoperative creatinine was 1.0 +/- 0.2 (range 0.6 to 1.7) and 1.2 +/- 0.9 mg/dl (range 0.7 to 6.5), respectively. Median followup was 55.9 months. There were 17 local recurrences (27.4%) and no metastases at recurrence. The overall survival rate was 100% at 5 years and 67% at 10 years.Nephron sparing surgery is effective and, when feasible, it need not be called into question. However, it may probably be superseded by less invasive techniques for tumors less than 20 mm diagnosed early after these techniques have been validated in long-term trials.

We identified prognostic factors of papillary renal cell carcinoma (PRCC) types 1 (PRCC1) and 2 (PRCC2).Between 1985 and 1998, 759 patients underwent surgery for renal cell carcinoma, of whom 88 (11.6%), including 69 males and 19 females with a mean age of 61.8 years (range 21.3 to 85.9) who had PRCC. Multifocality was defined as 2 or greater tumors separated by 10 mm or greater. Small basophilic cells defined PRCC1 and large eosinophilic cells defined PRCC2. Mean followup in 79 cases was 71.1 months (range 1 to 196.6). Survival rates were calculated and statistical analyses were done.The 88 patients underwent radical nephrectomy (65) or conservative surgery (28, that is elective in 17 and imperative in 11). Mean tumor size was 62 mm (range 10 to 190) and 41% of lesions were multifocal, independent of PRCC size, stage, grade or type. Comparing the 56 PRCC1s (63.6%) to the 32 PRCC2s (36.4%) showed that PRCC2 grade and stage were significantly higher (p = 0.024 and 0.025, respectively). A total of 51 patients (64.6%) remained relapse-free and progression-free. Local relapses occurred only after imperative conservative surgery in 2 cases (2.5%). Of the 26 deaths 15 (4 PRCC 1 and 11 PRCC 2) were tumor associated. Mean survival was 26.6 months (range 1 to 112.5). The overall 10-year survival rate was 73% with PRCC1 and PRCC2 10-year rates of 80% and 59%, respectively (p0.003). Univariate analysis identified stage (p0.0001), grade (p0.0001) and histological type (p0.003) as prognostic factors. Multivariate analysis retained stage (p = 0.006) and grade (p = 0.004).PRCC multifocality was not associated with stage, grade or histological type and it seems not to be an argument against conservative surgery. Univariate analysis of PRCC prognostic factors identified stage, grade and histological type but the latter was not retained on multivariate analysis.

We describe diagnostic and therapeutic characteristics, and long-term followup of collecting (Bellini) duct carcinoma.Ten patients underwent surgery, including radical nephrectomy in 9 and partial nephrectomy in 1, for collecting duct carcinoma diagnosed by histological and immunohistochemical criteria.Collecting duct carcinoma, which represented 1.3% of renal cell carcinomas diagnosed between 1986 and 1999, developed at a mean patient age of 66.2 years (range: 50.7 to 81). It was detected clinically but never because of macroscopic hematuria. Mean tumor size was 94 mm. (range 30 to 150). Stage was pT3, pT2 and pT1 in 7, 1 and 2 cases, respectively. Seven patients had lymph node or extranodal metastases, and 8 and 2 had Fuhrman grades 3 and 4 disease, respectively. Eight patients died, including 3 early during the perioperative or postoperative period, which was attributable to major surgical difficulties associated with these invasive tumors. Two of the 3 patients who did not have metastases were alive 99 and 100 months after surgery, respectively. Median overall survival +/- SD was 9 +/- 6 and 6 +/- 8 months for patients with metastases. The all survival rate was 20% at 2 years.Most collecting duct carcinomas are already metastatic at presentation. Because the prognosis is dismal despite radical nephrectomy, biopsy should be performed first when radiological findings are suggestive of collecting duct carcinoma. For metastatic collecting duct carcinoma radical nephrectomy alone does not seem to be useful except for palliative reasons or in the framework of new multicentric chemotherapy protocols in progress.

OBJECTIVES To evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression. PATIENTS AND METHODS From 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen-deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re-instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others. RESULTS After a mean (range) follow-up of 45.6 (12–196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5-year metastatic disease free survival of 91.3%. The overall 5-year biochemical recurrence-free survival was 68%. Using multivariate analysis, a Gleason score of ≥ 8 (P = 0.021), first-phase duration with no treatment of < 1 year (P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS (P = 0.023) and age < 70 years (P = 0.037) were the strongest predictors of biochemical progression. CONCLUSION IAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of ≤ 7.

We assessed the efficacy and safety of adoptive immunotherapy administered to 17 patients with TaGIII or recurrent TaGII superficial bladder cancer following transurethral tumor resection.Macrophage activated killer (MAK) cells were obtained from autologous mononuclear cells harvested by apheresis, after in vitro culture for 7 days and activation with interferon-gamma on the last day of culture. The patients received 6 weekly intravesical infusions of approximately 2 x 10(8) cells each. Additionally, 5 patients received 2 or 3 more infusions at 3-month intervals. Each patient was followed for 1 year or until tumor recurrence, whichever came first.A total of 112 intravesical infusions were performed. During the 12-month followup period 8 patients experienced 11 common toxicity criteria grade 1 or grade 2 adverse events considered possibly related to protocol. No clinically relevant grade 1 or 2 laboratory test results were reported while the patients received treatment. In 17 patients 8 tumors recurred compared to 34 recurrences during the year before the first MAK cell infusion. This difference was highly significant (p/=0.0005).The promising efficacy and safety results of this study and the fact that the MAK cell treatment regimen proved feasible should encourage initiation of further large scale studies to confirm these data.

Objective To assess the efficacy of salvage/adjuvant radiation therapy (RT) for patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). Patients and methods Between 1997 and 2001, 52 patients were treated in our institution with RT for PSA recurrence after RP. The mean (range) delay between RP and RT was 30.5 (0.16–105.6) months. Eighteen patients received no hormonal therapy before RT. The failure of RT was defined as three consecutive increases in PSA levels with intervals of ≥ 6 weeks. Results Within a mean (range) follow-up of 27.7 (6–69) months, 18 patients presented with biochemical progression. The 3-year biochemical progression-free survival was 51%. Using univariate analysis, an age

Resume Dans les dix dernieres annees, la curietherapie prostatique par implantation permanente s’est imposee comme une reelle alternative therapeutique dans le traitement des cancers localises de la prostate. La publication recente de resultats a 10-12 ans montre des resultats equivalents, pour une population selectionnee, a ceux de la chirurgie et de la radiotherapie conformationnelle, avec un faible taux de complications. Les criteres de selection ont bien ete definis par les societes savantes : tumeur classee T1 ou T2, concentration serique de PSA

Objectives To determine whether coloepiploic mobilization (CEM) is indicated to reduce the incidence of iatrogenic splenectomy during left radical nephrectomy for renal cell carcinoma. The incidence of iatrogenic splenectomy during a left nephrectomy is estimated to be between 1.4% and 24%. In a recent study, we reported that the incidence of iatrogenic splenectomy was 8% during a left nephrectomy performed for renal cell carcinoma through a transperitoneal anterior subcostal incision. Methods A left radical nephrectomy was performed in 233 consecutive patients for renal cell carcinoma through a transperitoneal anterior subcostal incision with a CEM procedure in which the left colonic flexure was completely detached from the epiploa. Perioperative and postoperative complications, including splenic injury, were noted in a database. The mean patient age was 51.3 years (range 21.3 to 90.2). The mean tumor size was 58 mm (range 15 to 230). Results An iatrogenic splenectomy was required in 3 patients, and in 1 patient, a splenic injury was treated conservatively. The incidence of iatrogenic splenectomy accompanying left radical nephrectomy was 1.3%. The mean operative time was 120 minutes (range 80 to 240). The mean time to normal gut motility was 3.4 days (range 2 to 11) and to discharge from the hospital it was 9.3 days (range 6 to 19). Regarding CEM, we did not observe any significant abdominal complications. Conclusions The incidence of iatrogenic splenectomy during a left radical nephrectomy through a transperitoneal anterior subcostal incision may be reduced by performing the technique of CEM.

Interleukin-18 (IL-18) plays a central role in the immune response by acting on Th1 cell differentiation, cell-mediated cytotoxicity and inflammation. The role of IL-18 in cancers and inflammatory diseases is discussed in the light of our investigations on IL-18 synthesis in normal colonic mucosa, colonic cancer and Crohn's disease (CD).

The production in colon cancer of interferon-gamma (IFN-gamma), a type-1 T-helper (TH1) cytokine, is considered as a marker of good prognosis. We asked whether interleukin-18 (IL-18), which strongly induces IFN-gamma and regulates Fas ligand (Fas-L)-dependent cytotoxicity, may play a role in colon homeostasis, and if its expression was modulated in colon adenocarcinomas. We analyzed 14 specimens of colon adenocarcinomas, 6 of normal colon mucosa of the series, and 6 colon-tumor cell lines. The expression of IL-18, of ICE protease, involved in the processing of this cytokine, and of the downstream effectors of IL-18, IFN-gamma and Fas-L was analyzed by RT-PCR. We further performed IL-18 immunostaining of normal and tumor specimens. The results were correlated with tumor dissemination and clinical outcome. We report the synthesis of IL-18 in human normal colon, mainly by epithelial cells of the mucosa. Out of the 6 tumor cell lines, 4 expressed IL-18 transcripts, but neither ICE mRNA nor secreted forms of IL-18 were detected. We observed decreased or abolished synthesis of IL-18 in colon adenocarcinomas, as compared with normal mucosa. Thus, half of the colon-cancer tissues (7/14 cases) expressed neither IFN-gamma nor Fas-L. This feature was correlated with the existence of distant metastases (Fischer's exact test, p = 0.02) and an unfavorable outcome. These findings suggest that production of IL-18 in human colon may play a role in homeostasis and in tumor immune surveillance, by enhancing IFN-gamma production and Fas-L-dependent cytotoxicity of immune cells.

Objectifs Les patients âges representent une part de la population grandissante pour laquelle la strategie du traitement du carcinome a cellules renales (CCR) localise doit integrer la morbidite liee au choix therapeutique et a la fonction renale. L’objectif ici etait d’analyser les resultats oncologiques et fonctionnels de la chirurgie conservatrice (NP) vs ablation par radiofrequence (RFA). Methodes Tous les patients de plus de 75 ans traites par NP et RFA entre 2007 et 2014 pour un carcinome a cellules renales dans notre centre ont ete inclus. Les caracteristiques des patients et des tumeurs ont ete comparees et les criteres suivants ont ete analyses : survie (globale et sans recidive ou metastase) et perte de fonction renale (delta MDRD en pre- et postoperatoire). Resultats Cent patients ont ete inclus (26 nephrectomies partielles groupe 1, et 74 radiofrequences, groupe 2) avec un suivi moyen de 32 mois. Il n’existait pas de difference significative pour le genre, l’IMC, le sore ASA, le score de Charlson, le statut metastatique ni le Renal Score, sauf l’âge moyen des groupes (respectivement 78 vs 81, p = 0,001). Les medianes de survie etaient respectivement pour les groupes (NP vs RFA), de 45 mois vs 27 mois en survie globale (p = 0,23) et de 28 mois vs 10 mois en survie sans recidive (p = 0,34). Le hazard ratio ajuste etait de 2,37 (IC 95 %, 0,66 a 8,51) pour la survie du groupe RFA vs NP (p = 0,19). La perte de debit de filtration glomerulaire calculee etait respectivement (NP vs RFA) de 1,5 ± 14 mL/min/1,73 m2 et de 3 ± 14 mL/min/1,73 m2 (p = 0,69). Conclusion Notre etude n’a pas permis de montrer un avantage significatif en survie dans le groupe NP malgre un âge significativement inferieur au groupe RFA. La perte de fonction renale etait minime et comparable dans les deux groupes. Les deux principales limites de notre etude sont sa puissance limitee et l’absence de comparaison avec un groupe surveillance.

We describe a method to reduce the number of shocks necessary to fragment renal stones during extracorporeal shock wave lithotripsy by automatically taking into account stone movements.Echotrack computer software was developed and implemented on a lithotriptor. One software module uses image processing to detect instantaneous stone location based on ultrasound images generated by the lithotriptor. A second module uses the detected location to control the shock wave generator position, and automatically adjusts it to improve coincidence between the focal volume and stone. The reliability of the tracking algorithm was clinically tested in 65 patients with renal stones. These in vivo tests were qualitative and the goal was to assess software ability to track stones during actual treatments. A quantitative evaluation of the reduction in shocks necessary for fragmentation was performed in vitro. Artificial stones were moved according to computer generated trajectories. Each trajectory was applied once with and once without automatic adjustment of the generator position.The in vivo tests demonstrated software ability to track stones as far as they were visible in the images. During in vitro tests automatic adjustments of the generator position reduced the number of shocks necessary to fragment stones completely by a factor of 1.64.Image based renal stone tracking software that automatically adjusts the shock wave generator position according to the displacement of renal stones is useful during extracorporeal shock wave lithotripsy. Treatment time was significantly shorter with this software.

Resume Objectif de l'etude Analyse retrospective des resultats de la cystectomie totale a visee curative a l'hopital Cochin. Patients et methodes Une cystectomie a visee curative a ete faite pour une tumeur de vessie chez 106 patients (97 hommes et neuf femmes) et realisee entre 1988 et 1993 dans le service d'urologie de l'hopital Cochin. Resultats L'examen anatomopathologique definitif a montre qu'il y avait 26 % de tumeurs de stade inferieur ou egal a pT1, 33 % de stade pT2 ou pT3a et 41 % de stade superieur ou egal a pT3b. La morbidite a interesse 19 % des patients avec un taux de reintervention precoce de 7,5 %. Trente et un pour cent des patients ont souffert d'une complication a long terme liee au traitement chirurgical de leur cancer de vessie, la stenose de l'anastomose ureteroileale etant la plus frequente. Trente-cinq pour cent des patients ont eu une recidive ou des metastases. Une recidive pelvienne isolee a ete observee dans 10,7 % des cas. Le taux de survie specifique a 5 ans etait de 88 % en cas de cancer de stade inferieur ou egal a pT1, de 81 % en cas de pT2 ou pT3a et de 42 % en cas de stade superieur ou egal a pT3b. Des facteurs de pronostic defavorable ont pu etre mis en evidence: presence d'emboles neoplasiques, tumeur depassant la paroi vesicale, association d'une uretrectomie a la cystectomie. Conclusion Ces taux de survie confirment que la cystectomie radicale reste actuellement le meilleur traitement des tumeurs de vessies infiltrantes.