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The incidence of cancer increases with age, especially for urological cancers. The frailty of the elderly persons may expose them to more postoperative complications resulting in prolonged hospitalization, increased morbidity or even increased mortality, and delayed or impossible return to normal life. In such cases, the benefit of surgery and therefore its realization can be questioned.This article reports the experience of a pre-operative risk assessment in a population of elderly patients treated for urologic cancer. This retrospective study aims to report the feasibility and the main results of this systematic preoperative multi-professional evaluation.Between April 2016 and February 2017, 31 elderly patients were evaluated. The evaluation revealed: moderate to severe malnutrition in 59 % of cases, a patient judged from a geriatric point of view fit, intermediate or fragile in respectively 25 %, 35 % and 40 % of cases. This evaluation led to propose a modification of an element of care for 66 % of patients and to propose therapeutic abstention for only 3 patients.An evaluation whose purpose is to adapt to the physiological age of patients and their overall state of health, surgical treatment and postoperative management is feasible and seems to help unmask elements of fragility usually not detected.4.

To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms.This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit.Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly.A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.

Assess the early morbidity after HOLEP, the urinary incontinence in particular, and specify its different types, evolution, and predictive factors.We conducted an observational, analytical, retrospective, monocentric study including all patients undergoing surgery for benign prostatic hypertrophy (HBP) by HoLEP between November 2015 and January 2017. The data were collected pre-, per- and postoperatively. The follow-up was for 6 months.One hundred and seventy one patients were included. 23 patients (14.6%) had a complication according to Clavien-Dindo classification [4]: 19 (83%) Clavien 2, 1 (4%) Clavien 3b et 3 (13%) Clavien 4. At one month of the surgery, 64 (42.7%) patients had urinary incontinence of which 55 (86.1%) presented pure stress urinary incontinence. 18 (32.7%) were still incontinent at 6 months of the surgery. The delivered amount of energy during the surgery and the preoperative IIEF5 score were statistically significantly associated with the occurrence rate of stress urinary incontinence. There was no correlation between the surgeon's learning curve and the occurrence of incontinence.The occurrence rate of urinary incontinence post HoLEP might be related to the adopted surgical technique ; It is crucial to keep the patient well informed of the risk of this complication postoperatively.4.

Our objective was to validate the VPSS (visual prostatic symptom score) score in the French language for the identification and monitoring of BPH-related LUTS in urological practice.A prospective observational survey was carried out between September the 15th 2014 and July the 30th 2015 in urology practices. The first 4 consecutive patients aged over 60 years, with BPH-related LUTS requiring prescription of an alpha-blocker, were enrolled. We translated a "visual prostatic symptom score" (VPSS) into French and adapted it slightly. At the first visit and follow-up visit (1-3 months after the first visit), the patient completed 2 questionnaires: the French language version of the IPSS and the VPSS.Of the urologists contacted, 169 enrolled at least one patient and returned information; 550 questionnaires were included in the statistical analysis. The median IPSS and VPSS total scores, subscores and quality of life scores all decreased significantly (P0.0001) between enrolment and the follow-up visit 1-3 months later. Correlations between the IPSS and VPSS at enrolment and the follow-up visit and their variation were all significant. Total VPSS was significantly correlated with total IPSS, as were the irritative, obstructive and quality of life subscores evaluated on the corresponding pictograms.This study showed the VPSS to be a simple and useful tool for identifying and monitoring BPH-related LUTS.4.

To confirm gender specific differences in pathologic factors and survival rates of urothelial bladder cancer patients treated with radical cystectomy.We conducted a retrospective monocentric study on 701 patients treated with radical cystectomy and pelvic lymphadenectomy for muscle invasive bladder cancer. Impact of gender on recurrence rate, specific and non-specific mortality rate were evaluated using Cox regression models in univariate and multivariate analysis.We collected data on 553 males (78.9%) and 148 females (21.1%) between 1998 and 2011. Both groups were comparable at inclusion regarding age, pathologic stage, nodal status and lymphovascular invasion. Mean follow-up time was 45 months (interquartile 23-73) and by that time, 163 patients (23.3%) had recurrence of their tumor and 127 (18.1%) died from their disease. In multivariable Cox regression analyses, female gender was independently associated with disease recurrence (RR: 1.73; 95% CI 1.22-2.47; P=0.02) and cancer-specific mortality (RR=2.50, 95% CI=1.71-3.68; P0.001).We confirmed female gender to be an independent negative prognosis factor for patients following a radical cystectomy and lymphadenectomy for an invasive muscle bladder cancer.

The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice.This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3 months.Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2 ± 6.1 to 9.7 ± 5.5, P0.0001) and USP score (from 10.6 ± 5.1 to 6 0 ± 4.6, P0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3 months of treatment silodosin was continued in 86.9% of patients.This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.

Upper tract urinary carcinoma (UTUC) pT3 tumors are a heterogeneous entity including tumors invading the renal parenchyma, tumors with peripelvic fat invasion or peri-ureteral fat invasion. The aim of this study was to evaluate the prognostic significance of these three different groups of pT3 tumors.Between 1998 and 2012, 205 patients with UTUC were operated in two centers, including 52 patients with pT3 tumor stage. pT3 tumors were divided into three groups: peri-ureteral fat invasion (pT3U, n = 16), peripelvic fat invasion (pT3G, n = 21), and renal parenchyma invasion (pT3P, n = 15). The prognostic significance of the type of tumor infiltration was evaluated on specific and disease-free survival.Median follow-up was 18.9 months [6-133.4]. In univariate analysis, renal parenchyma invasion was associated with a better prognostic in both specific (P = 0.026) and disease-free survival (P = 0.031) compared with peripelvic or peri-ureteral fat invasion. Mutivariate analysis retained the pT3 subgroup as an independant prognostic factor in both specific and disease-free survival (P = 0.02).pT3 tumors with renal parenchyma invasion had a better prognosis than those with peripelvic or peri-ureteral fat invasion. The heterogeneity of the pT3 group should be taken into account to improve the care of patients.

Objectives : In a European, prospective, 1 :2 randomized phase II multicentre study, 237 patients with advanced or metastatic prostate cancer were treated with either the 1M- (80 patients) or 3M-depot formulation (157 patients) of leuprorelin acetate for 9 months to compare efficacy and safety. Methods : Standard clinical investigations and methods were employed in the study. Leuprorelin levels were determined using a specially modified RIA. Results : The two formulations produced virtually identical effects with a pronounced fall in testosterone and gonadotropin serum levels and a marked reduction in PSA levels. After 9 months' treatment, PSA was normalized (≤4 ng/ml) in 65.2 and 66.1% of the 1M and 3M depot patients, respectively. The best response to 1M vs. 3M depot during the study was as follows : complete remission in 5 vs. 5.7%, partial remission in 36.3 vs. 33.8% and stabilization in 40.0 vs. 40.8%. The main side effects of both formulations were related to androgen deprivation. Conclusions : Comparable results were recorded for the two formulations ofleuprorelin acetate in terms of clinical response, endocrine effects and tolerability. The newly developed leuprorelin acetate 3M depot, as a refinement of the established 1M depot, offers an opportunity to improve patient compliance and provides individualized and optimized, patient-orientated treatment by reducing the number of injections to four per year.

The aim of this study was to evaluate the prognostic significance of the ureteral location of the upper tract urinary carcinoma (UTUC).Between January 1998 and December 2007, 161 patients with UTUC were operated in our center. Tumors were located on renal pelvis in 51% of cases, on the ureter in 34% of cases and in both locations in 15% of cases. Nephroureterectomy was performed in 79.5% of cases (128/161) whereas a conservative treatment was performed in 20.5% of cases (33/161).In our series, 29.8% of patients had primary bladder cancer and 14.3% had synchronous bladder tumor. At a median follow-up of 42.5 months, 38.6% of patients developed bladder recurrence and 4.8% developed controlateral upper tract tumor. In multivariate analysis, ureteral location and existence of synchronous bladder tumor were independent prognostic factors of bladder recurrence (P=0.009 and P=0.025, respectively). Multivariate analysis retained T-stage and ureteral location as independent prognostic factors in both overall and disease-free survival (P=0.002 and P=0.0008 respectively for ureteral location).Ureteral location was an independent prognostic factor of bladder recurrence and was associated with a poorer prognosis.

To evaluate the feasibility, tolerance and short-term efficacy of intra-prostatic UroLift(®) implants in four patients with symptomatic benign prostatic hyperplasia.Four patients with symptomatic BPH, already treated with alpha-blockers, were consecutively treated with intra-prostatic UroLift(®) implants under general anaesthesia. A bladder catheter was placed postoperatively. Alpha-blocker therapy was withdrawn 7 days postoperatively. The clinical and morphological characteristics of the patients were noted. Low urinary tract (IPSS) and sexual symptoms (IIEF5, MSHQ-EjD), maximum urinary flow rate and post voiding residual volume were evaluated preoperatively and at 1 month.Median age was of 69 [52-74] years old and median prostatic volume of 50 cm(3) [40-80]. Median procedure time was of 11 minutes [6-15]. Intra- and postoperative outcomes were uneventful. At 1 month, the mean IPSS and IPSS-QOL improvement were of 46 % and 58 %, respectively. One patient reported no improvement in his urinary and sexual symptoms. In the other three patients, the maximum urinary flow rate was improved, the post voiding residual improved in two patients and similar in one. No alteration in erection or ejaculation functions was reported.In our initial experience, intra-prostatic UroLift(®) implant procedure seemed feasible, efficacious for LUTS and well tolerated, especially concerning sexual outcomes. Further study of the UroLift(®) implant in France is currently being planned.

Radiotherapy of prostate cancers, over the last few years, has been an alternative choice to radical prostatectomy in the case of localised cancers as well as being the preferred treatment in both advanced localised cancers and those of the elderly. A conventional course of prostate radiotherapy consisting of four to five sessions a week, lasts between 7 and 8 weeks plus about one week of preparation.A systematic review of the scientific literature based on Pubmed, along with an exhaustive review of randomised studies presented at international congresses, have made it possible to analyse the numerous therapeutic regimens available other than the conventional normofractioned one (i.e. with doses per session ranging between 1.8 and 2.2 grays).Five randomised trials reported since 2005, plus several thousand patients treated by stereotaxic radiotherapy, have given rise to numerous scientific questions; these alternative hypofractioned courses (dose per fraction higher than 2.2 grays) have a potentially enhanced antitumoral efficacity along with the practical advantages of a shortened duration of radiotherapy.The aim of this analysis of the scientific literature on hypofractioning in prostate cancer radiotherapy is to gather all the scientific evidence we currently have at our disposal. Further mature results of future randomised trials will have to be examined before modifying current practice.

To evaluate the value of multiparametric MRI-targeted prostate biopsies in patients with suspected low-risk prostate cancer.Patients with normal digital rectal examination and a PSA level between 4 and 10 ng/mL were prospectively included. A multiparametric MRI of the prostate was performed prospectively before the biopsies. 12-core randomized biopsies were performed, with additional targeted samples in each suspicious area identified on MRI. Detected cancers and their histological characteristics were compared between those two biopsy protocols. A micro focal cancer (MFC) was defined by the presence of less than 4mm of Gleason score 3+3 cancer on a single core.Seventy-one consecutive patients were included. The overall detection rate was of 53% (38/71). It was of 70% (26/37) in the presence of suspicious area on MRI versus 35% (12/34) in the absence of any suspicious area (P=0.004). MRI-targeted biopsies alone detected three cancers, none of which was a MFC. 12-core biopsies alone detected 14 cancers, including ten MFC (71%). In 21 patients, prostate cancer was detected by both the MRI-targeted and 12-core biopsies. The Gleason score in the MRI-targeted area was the highest Gleason score in 90% of the cases. It was high (6) in 76% (16/21) of the patients.MRI-targeted biopsies detected less micro focal cancers than randomized 12-core biopsies. They did not seem however to decrease the detection of clinically significant cancers.

To evaluate biological free survival in patients with locally advanced prostate cancer treated with radical prostatectomy (RP) as sole treatment, and to analyse predictive factors of recurrence.We retrospectively studied patients treated between 1996 and 2006 for a pT3N0 prostate cancer with RP without any adjuvant treatment. The main endpoint was PSA relapse, defined as two successive elevations of PSA0.2 ng/mL. An association between PSA free survival and PSA, Gleason score, pathological stage and surgical margins status was statistically assessed.A total of 147 patients were included. Median preoperative PSA was of 10 ng/mL. Pathological stage was pT3b in 30% of the cases and surgical margins showed cancer involvement in 63% of the cases. Gleason score was ≥3+4 in 74% of the cases. Postoperative PSA was undetectable in 121 (82%) patients. Median follow up following RP was of 5 years. The 5-year-PSA free survival was of 48%. Multivariate analysis showed that preoperative and postoperative PSA, as well as Gleason score were predictors of PSA relapse (P0.05). In patients with undetectable postoperative PSA, 5-year-PSA free survival was of 56%. Seminal vesicle involvement and Gleason score ≥3+4 were the only independent predictors of PSA relapse.After RP for pT3N0 prostate cancer, the only predictive factors of recurrence were postoperative PSA and Gleason score. In case of undetectable postoperative PSA, surveillance seems acceptable if Gleason score is3+4 and in the absence of seminal vesicle involvement.

Immediate intravesical chemotherapy after transurethral resection decrease recurrences in non-muscle-invasive bladder cancer. Guidelines recommend immediate, intravesical instillation for all patients with Ta/T1 tumours. Instillation has to be avoided when there is a bladder perforation, a large resection (3cm) or gross haematuria. Tolerance is good and morbidity is low.

The treatment of prostate cancer is experiencing important innovations. Hormone therapy includes a new class of drugs: LHRH antagonists, which induce a rapid, fast and sustained reduction of testosterone levels. Active surveillance enables to avoid an aggressive treatment without decreasing survival, provided that strict eligibility and follow-up criteria are applied. New imaging techniques and laboratory assays lead to early diagnosis of small size tumors. Lastly, focal therapy has the potential to target localized cancers without deterioration of surrounding structures. These concomitant improvements offer the clinician and the patient attractive options for prostate cancer management. However, they are not devoid of limitations and constraints. Thus, it is crucial to define the most appropriate patient's profile for each therapeutic option, taking into account the objective characteristics of the tumor and the psychological features of the patient.

Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature.Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database.Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma.HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives.

to clarify the patterns of diagnosis and management of adult spermatic cord sarcoma.between 1996 and 2009, seven patients with spermatic cord sarcoma were treated at Cochin hospital. After updating the pathological diagnosis according to the new classification of sarcoma we found that all patients had well-differentiated or dedifferentiated liposarcoma. We analysed their clinical presentation, management and carcinological outcome.the patients' age ranged from 51 to 77 years, and their follow-up from 7 to 68 months. In five patients, the diagnosis of well-differentiated liposarcoma (lipoma-like) with some dedifferentiated sectors was made straightaway. In the two other patients, the initial diagnosis was that of leiomyosarcoma, which was reconsidered as dedifferentiated liposarcoma according to the cytogenetical and immunohistochemical techniques available since 2005. In 6/7 patients, a tumour resection with an orchiectomy at the same time (four patients) or secondarily (two patients) was performed. In one patient, only a tumour resection, without orchiectomy, was made. Multiple recurrences were observed in the two patients who were initially diagnosed as leiomyosarcoma. They needed multiple reintervention. One of them died after 68 months of evolution, the other one was treated with chemotherapy and died after 47 months of evolution. Four patients are out of recurrence. One patient was lost to follow-up.the diagnosis of liposarcoma must be considered in all adult patients aged of more than 50 with fatty-shaped or containing fibomuscular nodules paratesticular tumours. The surgeon and the pathologist must be well informed and an early and wide resection of fatty masses of the sperm cord with negative margins is advocated. The quality of resection is crucial but its appreciation and carrying out are difficult. The role of complementary treatments, especially radiotherapy, has to be determined.

The utilization of androgen deprivation therapy in prostate cancer has evolved over time. Unquestionably considered first line treatment in metastatic cancers or in case of lymph node involvement, it is increasingly used in locally advanced and high-risk cancers, combined with radiation therapy. However, the practical modalities of treatment are still controversial (neoadjuvant, concomitant/adjuvant) and should be discussed on a case-by-case basis, taking into account tumor stage and risk level, which depends mainly on Gleason score and PSA levels and kinetics. Hormone therapy is also indicated in case of systemic relapse, especially if PSA doubling time is less than 12 months. LHRH agonists have become the standard care; antiandrogens can be added at the beginning of the LHRH agonist therapy to obtain a complete androgen blockade. Intermittent androgen deprivation therapy has recently proved efficacious and might be more widely used in the future, provided that strict prescription and follow-up recommendations are clearly established.

Chemotherapy is indicated in metastatic castration-refractory prostate cancer. It aims at alleviating symptoms and increasing survival, without impairing quality of life. Docetaxel is considered as the reference treatment in this indication. However, several studies demonstrated the relevance of associating estramustin with docetaxel, due to the synergistic effect of the combination and the action of estramustin on resistance mechanisms. Moreover, the addition of estramustin to chemotherapy demonstrated a survival benefit for patients. Thrombotic events are frequent in patients with advanced prostate cancer and estramustine is known to increase the risk. Optimization of treatment requires a thorough assessment of the individual risk in each patient as well as the prescription of an anti-thrombotic prophylaxis, which should be currently based on low molecular weight heparin.

To analyze pathological data of the radical prostatectomy specimen in patients operated for clinically-localized prostate cancer and who meet strict criteria for active surveillance.The data of patients who underwent a radical prostatectomy by a single surgeon between 2002 and 2007 were reviewed. We only included the patients that met the usual criteria for active surveillance: clinical stage T1-2a tumor, PSAor =10 ng/mL, biopsy Gleason sum inferior or equal to 6 with no pattern of grade 4 or 5, cancer involvement inferior or equal to two biopsy cores, inferior to 50% of malignant tissue in each positive biopsy core and a PSA density inferior or equal to 0.15 ng/ml/cc.Two hundred and seventy-three patients were operated, including 25 (9.2%) who met all the criteria for active surveillance. Mean age was 61 years (55-68). The mean preoperative PSA was 6.6 ng/mL (2.5-10). Clinical stage of the tumor was T1c in 84% of patients and T2a in 16%. Biopsy Gleason score was 3+3 in 92%, 2+3 in 4% and 2+2 in 4%. Pathological study of the surgical specimen showed that 28% of the tumors were pT2a, 8% pT2b, 40% pT2c and 20% pT3a. One tumor was pT0. The pathological Gleason score was 3+3 in 68% of patients and 3+4 in 28%. Surgical specimen showed a higher Gleason score in 44% of cases, but there were no cases of predominant grade 4. After a mean follow-up of 19.2 months, there was no clinical or biological recurrence.In our experience, 20% of patients who meet the criteria for active surveillance show an extracapsular extent of the tumor on pathological analysis. Active surveillance is still under evaluation. Its main risk is to underestimate the aggressiveness of the tumor at the time of diagnosis.

Prostate cancer is the first cancer in men. Its incidence is constantly increasing. The significant evolution of diagnostic and therapeutic means during the two last decades contrasts with the scarcity of medicoeconomic studies. The aim of this review is to present a synthesis of the different studies published and to respond to questions about the economic aspects of this disease, with the evaluation of its direct and indirect costs. The cost-effectiveness and the benefits of the prevention and the screening are still being studied. The costs of the surgery and the radiotherapy are roughly similar. The new surgical techniques, especially the laparoscopic and the robotic surgeries, are not necessarily associated with higher costs, in condition of a high-volume laparoscopic surgery program and a faster discharge. The indirect costs of prostate cancer concern the loss of economic production associated with the disease and death and are more difficult to determine.

To explain the high incidence of misdiagnosis of angiomyolipoma (AML) prior to surgery.Between 1989 and 2007, 2,657 patients were operated for a renal tumor at Dupuytren hospital in Limoges and at Cochin hospital in Paris. In 85 cases (3.2%), tumors were AMLs on pathology. The group of patients in which the diagnosis was done preoperatively was compared to the one in which the diagnosis was missed.Mean age of patients was 57-years-old and the sex-ratio was five women for one man. The mean size of AMLs was 5.4 cm. The patients were symptomatic in 46% of cases (39/85). The diagnosis of AML was ignored preoperatively in 62 patients (73%). In multivariate analysis, the small size of the AML, low proportion of fat and male sex were significantly associated with misdiagnosis of AML (p0.001, p0.018 and p0.008, respectively).The incidence of misdiagnosis of AML preoperatively is high. The diagnosis seems particularly difficult when the tumor is small or contains a small proportion of fat. In addition, this study highlights that the diagnosis of AML is frequently ignored in men. The increased resolution of CTscan and the use of preoperative biopsies for tumors less than 4 cm could be helpful to decrease the incidence of useless surgery of AMLs.

To assess the satisfaction of men and of their partner towards their testicular implants after undergoing orchidectomy.Hundred and twenty-four consecutive patients, who had undergone orchidectomy, and their partner were sent an anonymous questionnaire. The follow-up after the implantation was at least one year. The testicular implants used were all Perthèse.Seventy-two patients answered to the questionnaire, among whom 63 had a testicular implant. Fifty-eight partners answered. From the patients with implant, 5% thought their body image was worse than before the operation and 80% thought their sexual activity was unchanged. Ninety-six percent thought the implantation was worthwhile and would do it again if they had to do the choice again. The reasons for dissatisfaction were: for the shape (n=8), for the size (n=3), for the position (n=2) and one patient thought the implant was too cold. Forty percent of the partners did not care about the implants and 58% thought the implant was essential. The dissatisfaction rate for the partners was 26% and reasons for were: for the shape (n=5), for the size (n=2), and one partner thought the implant was too cold. From the patients without implant, only one is thinking about having one.Testicular implants are well accepted, but some reasons of dissatisfaction appeared in our study. It was the first evaluation of the partner's satisfaction.

The aim of the study was to compare ureteroileal anastomosis strictures rates in patients receiving either double J stent or open-ended ureteral stent, after bladder replacement for cancer.Medical charts from 75 patients who underwent cystectomy and Z pouch bladder substitution for bladder cancer, between 2001 and 2005, were retrospectively reviewed. Ureteroileal anastomosis was direct, spatulated end-to-side fashioned in all patients. Double J stents were used in 39 patients (group A) and open-ended ureteral stent were used in 36 patients (group B). Mean hospital stay, early and late complications were also observed.Seventeen anastomotic strictures have been documented during the follow-up: 5.2% in group A versus 18.3% in group B (p=0.012). Mean catheterization period was six weeks in group A and 12 days in group B. No significant differences were found in mean hospital stay, early and late complications.The use of internal double J ureteral stent is now a feasible option and can decrease the rate of anastomotic stricture. The fact that the double J stent is removed after the anastomosis healing period may be a possible explanation.

The contribution of LHRH analogs is enormous in prostate cancer management at nearly all stages of the disease, the Leading cancer in males over 50 years of age. They make it possible to use hormone therapy reliably, with Little morbidity, and can be reversed. Their use can be immediate or delayed, continuous or intermittent, whether or not they are associated with an antiandrogen, and can be associated with chemotherapy for patients who have reached the stage of hormone-refractory prostate cancer.

Rising PSA after radical prostatectomy corresponds to a biochemical recurrence, i.e., a new rise in PSA levels. Several definitions of biochemical recurrence exist. Predictive factors can differentiate Local recurrence and distant metastasis. Depending on the case, the therapeutic options for managing these recurrences are radiotherapy, hormone therapy, and chemotherapy.

Intermittent hormone therapy in prostate cancer consists in disrupting treatment after the nadir PSA has been reached, and reinitiating treatment when the PSA increases over a certain threshold. Theoretical advantages of intermittent hormone therapy are to delay the occurrence of hormone-independence and to decrease treatment-related side effects. Some phase II trials have demonstrated the feasibility of intermittent hormone therapy. The percent time without treatment varies between 40 and 50%. Oncologic results of intermittent hormone therapy are, at least, equivalent to those of continuous therapy. Moreover, the side effects of treatment are decreased and the quality of life is improved during off treatment phases. Due to the lack of comparative studies, the superiority of intermittent upon continuous treatment has not been established at long-term follow-up. Prospective comparative trials are ongoing; they will determine the true benefit of intermittent hormone therapy in prostate cancer.

Radiation therapy is commonly used to treat pelvic or retroperitoneal cancers but has some impact on genito-urinary system: short-term side effects are frequent with usually a completed regression. However, the incidence of major complications is about 12% and is probably underestimated due to a long delay between radiation therapy and diagnosis of some adverse events such as ureteral strictures or fistula. Clinical follow-up must absolutely include an early diagnosis and treatment of radiation therapy complications such as renal dysfunction, ureteral stricture, ureteral fistula, chronic bladder injury, bladder fistula, urethral stricture, infertility or erectile dysfunction.

OBJECTIVES To report our experience with T1G3 bladder tumours over the last 10 years. PATIENTS AND METHODS We analysed the outcome of 74 consecutive patients treated for a T1G3 bladder cancer between 1991 and 2001. Fifty-seven patients (77%) were treated with transurethral resection (TUR) plus six weekly instillations of bacillus Calmette-Guerin (BCG) therapy. Ten patients (13.5%) with contraindications to BCG or with a small T1a tumour were treated with TUR plus mitomycin-C, and seven (9.5%) were treated with TUR alone because of their age. Patients treated with BCG had systematic biopsies taken at the end of the first course. Patients with residual tumour received a second course of six weekly instillations. Patients with negative biopsies received maintenance BCG therapy consisting of intravesical instillations each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months after the first course. RESULTS The median follow-up was 53 months. The overall recurrence rate was 46% and the overall progression rate 19%. The rate of delayed cystectomy was 8% and that of disease-specific survival 91%. In patients who received BCG therapy, the recurrence and progression rates were 42% and 23%, respectively. In this group the rate of disease-specific survival was 88%. CONCLUSION This study confirms that maintenance BCG therapy is an effective treatment for T1G3 bladder tumours, with an acceptable rate of bladder preservation.

The natural history of stage T1a prostate cancer is generally favourable, but is nevertheless associated with a considerable progression rate of 7% to 27% depending on the study. The objective of this study was to identify possible predictive criteria of tumour progression to improve patient surveillance and early treatment.27 patients with stage T1a prostate cancer according to the TNM 97 classification, were followed for a mean duration of 79 months (range: 24-132, median: 68). A complementary assessment was performed in patients under the age of 70 years, and a strict clinical (DRE) and laboratory (PSA) surveillance protocol was performed in all patients. The initial mean PSA was 7 ng/ml and the mean Gleason score was 4.8.20 patients (75%) did not present any clinical and/or laboratory signs of progression and were therefore not treated. Seven patients (25%) received treatment with a mean follow-up of 63 months (radical prostatectomy in 2 cases, external beam radiotherapy in 1 case, endocrine therapy in 4 cases). All patients are alive and in complete remission at last follow-up.Based on our results and a review of the literature, conservative management based on strict, long-term surveillance, is a frequent approach to stage T1a prostate cancer confirmed by negative biopsies of the residual capsule. The PSA velocity is the key to surveillance, and the only factor of predictive of tumour progression that can be really used in routine clinical practice. However, our study showed tumour progression in 25% of cases, raising the question of curative treatment, especially in young patients.

To describe the clinical and histological characteristics and natural history of clear cell renal carcinoma.The case files of 35 patients (22 men and 13 women, with a mean age of 58 +/- 13.8 years) operated for clear cell renal carcinoma were reviewed. The circumstances of diagnosis and the histological features of the tumour were analysed. The outcome of the patients was studied with a mean follow-up of 70 +/- 20.2 months.The diagnosis was incidental in 66% of cases. The macroscopic appearance of the tumour was characteristic: homogeneous and beige or white colour. On light microscopy, tumours were composed of variable proportions of clear cells and eosinophilic cells. The were classified as 15 predominantly eosinophilic tumours (43%), 9 predominantly clear cell tumours (26%) and 11 tumours composed of equal number of clear cells and eosinophilic cells (31%). Nuclei were irregular and indented. Hale stain was positive in every case. The majority of tumours were confined to the kidney (T1: 65% and T2: 29%) with a low nuclear grade (91% of grades 1 and 2). No patient developed local recurrence or metastasis during follow-up. The overall 5-year survival rate was 92%. No death related to the disease was reported.The histological diagnosis of clear cell renal cancer is now easy and can be suggested even on macroscopic examination of the operative specimen. This tumour appears to have a good prognosis, as it is usually confined to the kidney with a low nuclear grade.

A radical prostatectomy for localized prostate cancer is indicated after evaluation of the disease (initial PSA, clinical stage, biopsy mapping, results of radiologic explorations with an endorectal MRI) and the patient (age, morbidity, life expectancy and wishes of potency conservation). The surgical approaches, retropubic or laparoscopic, depend on the surgeon's experience. Radical prostatectomy provides good disease-free survival for organ-confined disease close to the natural life expectancy. Post-radical prostatectomy morbidity is essentially represented by orthostatic incontinence (up to 6.8%), stress incontinence (up to 27%) and impotence (30 to 95%), depending on the published series and patient age.

Cystine stones is a rare disease, related to a genetic metabolic disease. Its management must treat both the stones and their complications, and prevent recurrences by controlling cystinuria.The objective of this study was to define the natural history of cystine stones, identify reliable diagnostic criteria and propose a simple treatment regimen.The authors studied the clinical, biochemical and radiological data of a retrospective series of 116 cases, treated by the same urologist between 1953 and 1999.Cystinuria is often diagnosed in young adults on the basis of urine biochemistry (Brand's reaction, urinary cystine assay) or spectrophotometric analysis of the stones or urinary crystals. This assessment, not performed routinely, must be guided by a family history, recurrent stones or following failure of lithotripsy. The appearance of the stones, macroscopically a waxy yellow, radiologically only slightly opaque with a large component in the renal pelvis associated with a small round caliceal stones, is highly suggestive. Radiological assessment by IVU is generally sufficient. Treatment of the disease is medical and surgical: dietary measures, alkalinization of the urine and possibly drug treatments, are associated with extracorporeal lithotripsy or surgical treatment. These modalities eliminate cystine stones in 70% of cases. Recurrent stones are observed in 42% of cases followed for more than 5 years, mainly due to the presence of residual fragments (60% of recurrences). Surveillance and dietary measures must be maintained for life. Surveillance is based on biannual radiographic follow-up (plain x-rays +/- ultrasound) to detect and consequently treat small stones. A test for cystinuria must be proposed to all relatives of affected patients.This disease presents very polymorphic clinical features and clinical course. It can be responsible for impaired renal function and must therefore be investigated in the presence of suggestive clinical signs or history to avoid a delayed diagnosis, as treatment modalities are available to decrease the frequency of recurrence and which can potentiate treatment by surgical or lithotripsy. However, there are no predictive factors of deterioration of the disease, and biannual surveillance, for life, is essential to detect and treat small stones.

We report two cases of tissue reactions to wear debris after large joint prostheses. In the first case, a septic loosening of a hip arthroplasty was suspected after emergence of an inguinal mass. In the second case, a patient with loose hip prosthesis had surgery for a prostatic adenocarcinoma and pelvic lymph nodes were discovered during surgery. They were first suspected to be metastatic carcinoma. These two diagnostic problems were resolved by histology which revealed sinusal histiocytic reaction to wear debris. The peculiar sign of this reaction is the presence of birefringent components such as polyethylene seen with polarized light. These problems will become more frequent in the future because of the increasing number of elderly patients who have had hip replacement and will undergo surgery for pelvic cancer. A close medico-surgical collaboration should help pathologists in such cases.

Retrospective analysis of result of radical cystectomy at Cochin Hospital.We report the results of a 106 patients series treated by radical cystectomy for bladder carcinoma after a 5-year period follow-up.The extent of the tumour invasion according to pathological analysis was: pT1 or less: 26%, pT2 and pT3a: 33%, pT3b and over: 41%. Morbidity rate was 19% with a 7.5% reintervention rate. Long term complication rate was 31%, concerning essentially ureteral stenosis. A local recurrence or distant metastasis occurred in 35% of patients. Local recurrence rate was 10.7%. Cancer specific survival rates were 88%, 81% and 42% for pT1, pT2-pT3a, and pT3b patients respectively.The present results confirm that radical cystectomy is the most effective curative treatment for invasive bladder carcinoma.

The most effective chemotherapy of metastatic bladder cancer in M-VAC (methotrexate, vinblastine, cisplatin), as it was shown M-VAC by phase III trials. The complete remission rate is 15-20%. The toxicity is severe, and M-VAC cannot be delivered to fragile patients. Survival is improved. This increase in survival results in an increased incidence in brain metastases. The Cochin Hospital experience with 50 patients treated with M-VAC for a metastatic bladder cancer is presented.

Distal ureteral obstruction is a common complication in advanced prostatic cancer, secondary to direct compression at the ureterovesical junction and/or invasion of the ureteral orifice and/or of the intramural ureter by the tumor. The ureteral orifice may not be readily visible to the trigone-infiltrating tumor, but remains superficial as it is pushed upward by the tumoral tissue. The indications for palliative diversion in patients with pelvic malignant disease and renal failure from ureteral obstruction remain controversial. We present the results of our endoscopic ureteroneocystostomy technique by which the trigone is resected to restore continuity of the ureteral orifice and to place a double pigtail ureteral stent. Of the 31 operations performed for obstructive prostate cancer, continuity was restored in 76% of cases. Length of hospital stay was gradually reduced to a few days. Median survival after surgery was 8 months (0.25 to 27.5 months). Palliative diversion may be considered a reasonable option for many patients, even in the case of an apparently unpassable obstruction of the pelvic ureter, thereby prolonging survival and improving quality of life.

OBJECTIVES: To evaluate a computerized method of artifact detection and correction of uroflow and compare the quantitative assessment of maximum flow obtained by the computer with visual correction by experts. METHODS: A total of 90 randomly chosen flows was scanned into the computer whereafter automated artifact detection and correction was performed according to pre-established rules implemented in the software. Three experts visually corrected the flows using the same artifact detection and correction specifications as the computer. Measuring agreement between different methods of assessment of maximum flow was evaluated by calculating the difference and the standard deviation (SD) of the differences. The repeatability of assessing the maximum flow value by the computer and by expert 1 was assessed by calculating the difference between 2 readings and the coefficient of repeatability. RESULTS: The coefficient of repeatability of maximum flow after detection and correction of artifacts by the computer (0.38 ml/s) was slightly better when compared with the coefficient of repeatability between 2 observations by 1 expert (1.12 ml/s). The interobserver variation for the quantitative assessment of maximum flow appeared to be great. A total of 51% of the maximum flow values assessed by expert 2 was 1 ml/s or more greater than those assessed by expert 1. When comparing the results of the computer with those of the experts, the mean value of maximum flow from expert 1 was 0.71 ml/s smaller than the computer value (p

To establish the pharmacodynamic and safety equivalence between 2 sustained-release forms of leuprorelin 11.25 mg and 3.75 mg, in the treatment of metastatic prostatic carcinoma.44 patients received subcutaneous injections of leuprorelin for 9 months (randomization: 2/l): either 11.25 mg every three months (n = 29) or 3.75 mg monthly (n = 15). Main criterion: centralized monthly assay of plasma testosterone (T).The equivalence of the 2 forms in terms of mean plasma testosterone was demonstrated (p = 0.002): 1 month: T = 0.19 +/- 0.03 ng/ml; 3 months: T = 0.27 +/- 0.04 ng/ml. Exploratory analysis did not reveal any significant difference between the groups for the number of patients castrated at each visit or for the number of patients with all T valuesor = 0.5 ng/ml, or for clinical responses or safety.The 2 forms have a comparable efficacy and safety.

Electrohydraulic lithotripters use a R-wave triggering system as episodes of cardiac arrhythmia were observed during early clinical experiments. This study was designed to assess the safety of non triggered shock wave treatments using an external fixed rate device (120/min) on the Sonolith 4000 Plus (*), a non bathtub electroconductive lithotripter.Our study is the first prospective evaluation of non-EKG-gated lithotripsy where the patient under continuous Holter monitoring served as his own control during a randomized alternation of periods with or without R-wave triggering. This design allowed for a direct comparison of the effect of EKG-gated and non-EKG-gated lithotripsy respectively. The sequence of the different periods was randomly assigned. The recordings were compared to a pre-treatment recording, the cardiologist ignoring the randomization.25 consecutive patients without cardiac history have been treated for urinary stones. Ventricular and supraventricular excitability disorders have been noted in 7 patients, always during a non-EKG-triggered period. There was no correlation with stone location. No cardiac rhythm disturbances have been observed during triggered periods in the 25 patients. Auricular extrasystoles (0.1-0.5/min) were observed in 6 patients, and auricular couplets (0.5/min) in one. Ventricular extrasystoles were noted in 4 patients, and ventricular couplets in one. One patient had an asymptomatic non sustained ventricular tachycardia which resolved spontaneously. No clinically significant disorder occurred. Treatment time and analgesics requirements were reduced by non-EKG-triggering.Non-EKG-triggering lithotripsy has a definite potential for cardiac disturbances, but appeared to be clinically safe in these patients with no cardiac history.

Endorectal surface coil magnetic resonance imaging (MRI) was used in the local staging of prostate cancer in 47 patients. We used an 1.5 Tesla General Electric magnet. Fast spin echo sequences were acquired in all cases. All pathological specimen were reviewed by one pathologist. Pathological study showed that 19 patients had a locally confined cancer of the prostate (pT2), and 28 had an extraglandular extension (pT3). MRI correctly predicted a pT3 tumor in 15 of 28 cases, and a pT2 tumor in 18 of 19 patients. MRI was 70% accurate in the differenciation of stage pT2 from stage pT3 cancer. One case was overestimated and 13 cases were underestimated. The latter 13 patients had microscopic extracapsular invasion only.

The authors report an uncommon case of renal adenoma, a metanephric adenoma in a 21 year-old man. Treatment consisted in a tumorectomy. The review of the literature, shows it to be a benign tumor with no malignant potential.

The authors report 1 case of particularly severe reflex neurovascular dystrophy whose clinical course was marked by the discovery of a carcinoma of the prostate. There was improvement in the reflex neurovascular dystrophy despite hormonal therapy of the cancer. Reflex neurovascular dystrophy cannot be considered as a form of a paraneoplastic syndrome.

Twenty five patients with symptomatic BPH and normal PSA underwent electrovaporization. The mean IPSS was 21.5 before and 7.8 three months after treatment while the mean peakflow was 7.1 ml/s and became 16.9. With a short hospital stay (3 days) and a very low morbidity, electrovaporization seems to be a good alternative to TURP. A longer follow-up is necessary.

A Sertoli cell mesenchymal tumour was observed in a 19-year-old male. The prognosis of this rare tumour is good.

Urinary fistulization to the skin is a rare complication of cystoprostatectomy with replacement enterocystoplasty. In two cases, fistulization did not respond to continuous drainage of the urine and was treated with a muscle flap using the abdominus rectus. This method offers rapid parietal repair giving a reliable rapid cicatrization since the interpositioned flap is well vascularized in an area of poor tissue quality.