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Standard treatment modalities of caliceal diverticular calculi range from extracorporal shockwave lithotripsy (SWL) over retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PNL) and laparoscopic stone removal. A 55-year-old woman presented with a history of pyelonephritis based on a caliceal diverticular calculus. Due to the narrow infundibulum and anterior location, a robot-assisted laparoscopic calicotomy with extraction of the calculi and fulguration of the diverticulum was performed, with no specific perioperative problems and good stone-free results. This article shows technical feasibility with minimal morbidity of robot-assisted laparoscopic stone removal and obliteration of a caliceal diverticulum.

Study Type – Therapy (multi-centre cohort) Level of Evidence 2b OBJECTIVE To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study. PATIENTS AND METHODS A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer’s recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded. RESULTS Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation. CONCLUSIONS The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.

To evaluate blood loss during transurethral resection of the prostate (TURP), and its predictive factors, using the chromium 51 (51Cr) labeling method.From January to June 2008, 41 patients who underwent TURP for symptomatic benign prostatic hyperplasia (BPH) at four French urology centers were included in the analysis. Red cells volume was measured by the 51Cr method 1 day before TURP, and on postoperative day 3. Overall blood loss was estimated by multiplication of red cells volume loss and preoperative venous hematocrit value.Mean preoperative red cells volume was 1997 mL. Mean loss of red cells volume was 209 ml, which corresponds to an estimated blood loss of 507 mL. Mean delta of hematocrit and hemoglobin were 1.4% and 0.71 g/dL, respectively. In univariate analysis, prostate volume, weight of resected tissue, preoperative red cells volume, and resection time were significantly and directly associated with loss of red cells volume (P = 0.038, P = 0.004, P = 0.002, and P = 0.039, respectively). Bipolar and monopolar TURP did not lead to significant difference of red cells loss. In multivariate analysis, both preoperative red cells volume and weight of resected tissue were independent predictors of red cells loss (P = 0.017 and P = 0.048 respectively).We present the first study to measure blood loss secondary to TURP using the 51Cr method. This technique allowed evaluating blood loss not only during the surgical procedure but also during the postoperative period. We learned from this study that, on average, blood loss from the procedure until postoperative day 3 was more than 500 mL, which is larger than previously reported amounts as measured by other methods. Because significant blood loss might occur during the postoperative period, the 51Cr method should be used to measure blood loss when evaluating new emerging techniques to manage BPH.

Upper urinary tract urothelial cell carcinomas (UUT UCC) are rare sporadic tumors. Recent epidemiologic and molecular data have shown a singular susceptibility of UUT UCCs for specific risk factors. The main exogenic factors involved in UUT UCCs carcinogenesis remain tobacco and occupational exposure (aromatic amines, polycyclic hydrocarbures and chlored solvents). Enzymatic variants of detoxification system may be responsible of carcinogenesis with these toxics. Tumors induced by phenacetine consumption are decreasing since it was banned in the 1970s. Also, acid aristolochic exposure (Balkan nephropathy, Chinese Herb nephropathy) has been demonstrated to specifically induce UUT UCCs. Familial genic polymorphism of detoxification system would explain geographic distribution in endemic areas. In Taiwan, chronic arsenic exposition would constitute the main risk factor of UUT UCC. However, theses mechanisms of carcinogenesis remain unclear. The knowledge of UUT UCC development mechanisms implying toxic detoxification systems is still incomplete. To date, there is a growing body of evidence supporting that the interaction between individual genetic susceptibilities and environmental toxic exposure is a key to explain carcinogenesis in the majority of sporadic UUT UCC occurrence.

Plusieurs interventions en urologie se pretent a une pratique en chirurgie ambulatoire. Le but de cet article est de revoir l’organisation necessaire et les cadres legislatifs. Le CHRU de Lille developpe depuis plusieurs annees la chirurgie ambulatoire et son exemple est repris afin d’illustrer les propos.

Purpose Given that postprostatectomy recurrence of prostate cancer occurs in 10–40% of patients, the best use of immediate postoperative radiotherapy (RT) in high-risk patients and salvage RT for biochemical recurrence remains a topic of debate. We assessed the levels of evidence (in terms of efficacy, prognostic factors, and toxicity) for the following treatment strategies: immediate postoperative RT alone, salvage RT alone, and the addition of androgen deprivation therapy to the two RT strategies. Methods and Materials A systematic literature search for controlled randomized trials, noncontrolled trials, and retrospective studies between 1990 and 2008 was performed on PubMed, CancerLit, and MEDLINE. Only relevant articles that had appeared in peer-reviewed journals were selected. We report on the levels of evidence (according to the National Cancer Institute guidelines) supporting the various treatment strategies. Results Immediate postoperative RT improves biochemical and clinical progression-free survival (Level of evidence, 1.ii) but has no significant effect on metastasis-free survival or overall survival. A pathologic review is of particular importance for correctly analyzing the treatment strategies. Low-grade morbidity has been significantly greater in the postoperative groups, but no severe toxicity has been observed. The influence of immediate postoperative RT on postprostatectomy continence appears to be slight; therefore, immediate postoperative RT should be considered in patients with major risk factors for local relapse (Level of evidence, 1.ii). On the basis of extensive retrospective data, salvage RT is effective in biochemical relapse after prostatectomy; some patients with few adverse prognostic factors might also benefit from salvage RT (Level of evidence, 3.ii). The addition of androgen deprivation therapy to immediate postoperative or salvage RT has only been supported by weak, retrospective data (Level of evidence, 3.ii). Conclusion Prospective randomized trials are needed to compare immediate postoperative RT with salvage RT and to assess the value of androgen deprivation therapy in this setting.

Resume Recemment, de nouvelles voies therapeutiques ont ete explorees afin d’ameliorer les troubles mictionnels des patients presentant des troubles urinaires du bas appareil lies a une hyperplasie benigne de la prostate. L’objectif de cet article est de realiser une mise au point sur ces traitements : anti-inflammatoire, antidiuretique, anticholinergique et toxine botulinique. Les anticholinergiques, associes au risque de retention urinaire se revelent efficaces pour les troubles irritatifs en association a un alpha-bloquant. Les antidiuretiques peuvent etre proposes chez les patients de moins de 65 ans presentant une polyurie confirmee par un calendrier mictionnel, invalidante, liee a une HBP et refractaire au traitement classique de I’HBP. L’interaction entre l’inflammation et HBP n’est pas encore clarifiee. Les anti-inflammatoires semblant ameliorer les symptomes trouveraient peut etre une place dans un traitement ponctuel de 1’HBP car leur utilisation au long cours n’est pas recommandee. Les inhibiteurs de cox-2 ont ete retires du marche. Enfm, la toxine botulinique pourrait avoir une place dans le traitement des troubles lies a I’HBP si les etudes cliniques confirment les resultats prometteurs recemment publies. Ces nouvelles approches seront probablement a integrer dans les recommandations et les arbres decisionnels du traitement des troubles mictionnels lies a I’HBP.

We externally validated a previously designed neural network model to predict outcome and duration of passage for ureteral/renal calculi. The model was also evaluated using a 6 mm largest stone dimension cutoff in predicting stone outcome.The model was previously designed on 301 patients at Albany Medical Center (free shareware from www.uroengineering.com). The model had a prediction accuracy of 86% for passage outcome and 87% for passage duration. In this study we tested the model on a separate 384 patients from 6 different external institutions to assess the prediction accuracy. All patients had a single renal/ureteral calculus by evaluation in an emergency room setting or by primary physicians and were then referred for further treatment. Model accuracy was also compared to using a 6 mm largest stone dimension cutoff in predicting the need for intervention.Testing on the 384 patients from all 6 external institutions revealed an outcome prediction accuracy of 88%. The area under the ROC curve was 0.9. Using a 6 mm stone size cutoff provided 79% (ROC 0.8) accuracy. The model duration of passage prediction accuracy was 80% (133 patients passed the stone, area under ROC of 0.8).The model provided high stone outcome prediction accuracy (ROC of 0.9 and 0.8) at the 6 external institutions, comparable to that of the design institution. The model provided higher accuracy than using only the largest stone dimension as a cutoff. Increasing experience will further assess the model's accuracy.

Objectifs Les objectifs sont de decrire les caracteristiques anatomocytopathologiques des tumeurs de vessie incidentes en population generale, dans la zone de proximite de Lille et la prise en charge therapeutique initiale des personnes atteintes de tumeur de vessie non infiltrant le muscle (TVNIM) a risque fort de progression/recurrence et des personnes ayant une tumeur de vessie infiltrant le muscle (TVIM) au moment du diagnostic. Methodes La ZL (780 000 habitants) est couverte par le registre general des cancers de Lille et de sa region. Les tumeurs y sont enregistrees et codees selon les standards internationaux et nationaux. Les tumeurs de vessie incidentes en 2011 et 2012 sont analysees a l’exception des tumeurs benignes et des carcinomes de l’ouraque (N = 517). Resultats Une analyse anatomopathologique a ete effectuee pour 510 tumeurs. Vingt-trois pour cent des tumeurs etaient des TVNIM a faible risque de recurrence/progression, 30,8 % des TVNIM a risque intermediaire, 17,4 % des TVNIM a haut risque et 27,5 % des TVIM. Pour les 90 tumeurs a haut risque, l’âge median de survenue etait 74 ans ; 61 cas ont ete presentes en reunion de concertation multidisciplinaire (RCP) ; 49 personnes ont beneficie d’instillations endovesicales, 9 d’une chirurgie d’emblee ; pour 90,2 %, la prise en charge initiale correspondait a la recommandation de la reunion. Pour les 142 TVIM, l’âge median de survenue etait 72 ans ; 131 cas ont ete presentes en RPC ; 65 personnes ont beneficie d’une cystectomie initiale, 32 n’ont recu aucun traitement specifique ; 81,5 % des personnes ont recu le traitement preconise. Conclusion Cette description est l’une des rares etudes realisees en France permettant de faire un etat des lieux des tumeurs de vessie en population generale et de leur prise en charge, etape achevee par l’analyse du bilan realise et du timing de la prise en charge.

Objectives: To determine the value of frozen section examination for the management of small incidental testis tumors. Methods: We reviewed all cases of incidental nonpalpable testis tumors that have been examined in frozen section during the period 1996–2002. For each case, frozen section and definitive histological slides were available and were reviewed. Results: Fifteen cases were retrieved in the files of the Department of Pathology. Nine cases were discovered by ultrasonography examination in patients presenting with infertility. Six cases were discovered incidentally by sonography for testis trauma or scrotal pain. The patients were aged from 18 to 43 years. The tumors measured from 4 to 16mm. Frozen section examination concluded in 9 cases to a benign lesion "Leydig cell nodule", in four cases a diagnosis of malignancy was retained and the last two cases were inconclusive. The standard microscopic examination confirmed the 9 cases of Leydig cell tumors; malignancy was confirmed in the 4 cases (3 seminomas and one teratoma) and the uncertain cases were benign Sertoli cells tumors. Benign lesions were treated by a conservative approach. Conclusion: Frozen section examination is a useful method for the management of small incidental masses of the testis.

Background/Aims: There are only a few surveys on the prevalence of lower urinary tract symptoms (LUTS) among the general population. The aim of this survey was to assess the prevalence of LUTS and their impact on discomfort in men. Methods: A questionnaire was mailed to 3,877 men aged 50–80 years, which included questions on their medical history, demographic and sociological status, and also the International Prostate Symptom Score (IPSS) with additional questions on discomfort related to urinary symptoms. Results: The response rate was 81.5%. Prevalence of mild and severe IPSS was 89.2%. Specific bother for each urinary symptom depended on symptom frequency: urgency, frequency, weak stream, nocturia, incomplete emptying, intermittency and straining 1 time out of 5 were responsible for discomfort in respectively 4.9, 6.1, 7.1, 7.5, 8.7 and 9.9%; the same symptoms more than half of the time were responsible for discomfort in respectively 32.8, 38, 45.3, 45.6, 53.2 and 58.7%. Urgency was much more deeply implicated in discomfort than frequency of nocturia. Conclusions: Urinary symptoms in men are very common. Nocturia is the most frequent but has a low impact on discomfort. Urgency has a higher impact on discomfort and should therefore be considered in treatment decision-making.

Context.—Adult renal cell carcinoma (RCC) with rhabdoid features is a recently recognized morphologic variant of kidney carcinoma. To date, only very few studies have been published on this subject and p53 was not previously studied. Objective.—To evaluate clinical attributes, morphology, and immunohistochemistry in RCC with rhabdoid component. Design.—Reviewing a consecutive series of 310 RCCs, we identified 14 cases of RCC with rhabdoid features. All cases were reviewed and subjected to detailed clinical and pathologic studies with immunohistochemical evaluation of p53. Results.—All tumors were clear RCCs with rhabdoid component representing from 5% to 50% of the tumor volume. Rhabdoid cells were large with a central eosinophilic intracytoplasmic inclusion and an eccentric atypical nucleus. Tumor necrosis was common (13/14) and sometimes extensive. Nine of 14 tumors were staged pT3, 4 of 14 were pT2, and only 1 tumor was pT1. On immunohistochemistry, rhabdoid cells were positive for vimentin (14/ 14), epithelial membrane antigen (11/14), and cytokeratin (9/14). Desmin and smooth muscle actin were always negative. p53 was positive in 10 of 14 tumors in the rhabdoid areas (5%–50% of tumor cells stained) but only in 5 of 14 cases in usual clear renal cell areas. In the follow-up, 10 of 14 patients developed metastases and 6 of 14 died of the disease. The median of survival was 8 months. Conclusions.—We showed that RCC with rhabdoid features is a very aggressive neoplasm with a poor prognosis. We observed an overexpression of p53 in the rhabdoid component that may be implicated in the tumor dedifferentiation.

We assessed the value of pelvic phased array dynamic contrast enhanced magnetic resonance imaging for predicting the intraprostatic location and volume of clinically localized prostate cancers.Suspicious areas on prospective pre-biopsy magnetic resonance imaging in 24 patients were assigned a magnetic resonance imaging malignancy score and located with respect to anatomical features, gland side, and transition and peripheral zone boundaries. The largest surface area and volume were measured. These magnetic resonance imaging findings were compared with radical prostatectomy specimen histopathology findings.Histopathology maps detected 56 separate cancer foci. The largest tumor focus was located in the peripheral zone in 14 patients and in the transition zone in 10. T1-weighted dynamic contrast enhanced magnetic resonance imaging identified 30 of the 39 tumor foci greater than 0.2 cc and 27 of the 30 greater than 0.5 cc. T2-weighted sequences were suspicious in 22 of 30 foci greater than 0.2 cc that were identified by T1-weighted dynamic contrast enhanced magnetic resonance imaging sequences. Sensitivity, specificity, and positive and negative predictive values for cancer detection by magnetic resonance imaging were 77%, 91%, 86% and 85% for foci greater than 0.2 cc, and 90%, 88%, 77% and 95% for foci greater than 0.5 cc, respectively. Median focus volume was 1.37 cc (range 0.338 to 6.32) for foci greater than 0.2 cc detected by magnetic resonance imaging in the peripheral zone and 0.503 cc (range 0.337 to 1.345) for those not detected by magnetic resonance imaging (p0.05). Corresponding median values for transition zone foci were 2.54 (range 0.75 to 16.87) and 0.435 (range 0.26 to 0.58).Pre-biopsy pelvic phased array dynamic contrast enhanced magnetic resonance imaging is an accurate technique for detecting and quantifying intracapsular transition or peripheral zone tumor foci greater than 0.2 cc. It has promising implications for cancer detection, prognosis and treatment.

To investigate, by real-time quantitative reverse transcriptase-polymerase chain reaction, the expression of MUC3 and vascular endothelial growth factor (VEGF) to correlate them with histologic parameters and with prognosis. Human mucins are large O-glycoproteins expressed in epithelial tissues. Deregulation of mucin genes has been demonstrated in several epithelial neoplasms. In the kidney, MUC3 is expressed in normal convoluted tubules and in renal clear cell carcinoma.Twenty-six renal clear cell carcinoma specimens were studied. For all tumors, samples of normal and tumor kidney were frozen. After RNA extraction, using ultracentrifugation through a cesium chloride cushion, VEGF and MUC3 mRNA were analyzed by real-time quantitative reverse transcriptase-polymerase chain reaction. The pathologic parameters included Fuhrman nuclear grade and TNM stage. All follow-up data were available.The median level of MUC3 and VEGF expression was greater in tumor areas compared with normal areas (P0.002 and P0.001, respectively). The MUC3 tumor/normal tissue expression ratio was greater in nuclear grade 3 tumor than in low grades (grade 1-2; P0.005). No statistically significant relationship was found with the prognosis for MUC3 and VEGF in our study.The results of this study demonstrate that MUC3 and VEGF are overexpressed in renal clear cell carcinoma, and the MUC3 expression ratio is greater in nuclear grade 3 than in grades 1 and 2 (low grades) tumor. These findings suggest the implication of MUC3 in renal carcinogenesis.

Aims: To establish the clinicopathological features of minimal volume prostate adenocarcinoma on prostate biopsy. Methods: Twenty four cases of minimal adenocarcinoma diagnosed on prostate biopsy and treated by radical prostatectomy were reviewed. Results: The major microscopic criteria were nuclear enlargement (22 of 24), infiltrative pattern (19 of 24), prominent nucleoli (19 of 24), intraluminal eosinophilic secretions (15 of 24), and high grade intraepithelial neoplasia associated (11 of 24). Sixteen of 24 cases were assigned a Gleason score 6 on biopsy. When the whole gland was assessed, 22 of these tumours were localised to the prostate (stage pT2), and only two cases were stage pT3. Conclusions: Minimal focus of adenocarcinoma on prostate biopsy is not an uncommon finding. It is usually an intermediate grade and localised stage neoplasm.

We report a case of an elderly man with bladder cancer, in whom the first manifestation of Erdheim-Chester disease was retroperitoneal infiltration detected during routine follow-up. The disease was diagnosed on the basis of histology and immunochemistry findings (presence of histiocytes) and of imaging findings (plain radiography, computed tomography, magnetic resonance imaging, and bone scintigraphy). The differential diagnosis with respect to other causes of retroperitoneal infiltration is discussed.

Primary testicular lymphomas account for less than 5% of all testicular neoplasms. Testicular natural killer (NK)/T-cell lymphomas are exceptional and have a very poor prognosis. We report the case of a 30-year-old French Caucasian man with testicular NK/T-cell lymphoma of the following immunophenotype: CD2+, CD3ɛ+ and CD56+. Despite intensive chemotherapy, the disease progressed rapidly, with death occurring 2 months after diagnosis.