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Objectives: To evaluate the early clinical experience associated with radio-frequency (RF) ablation in patients with solitary adrenal gland metastasis of renal cell carcinoma (RCC)., Methods: A total of 5 patients were treated with RF ablation of adrenal gland metastasis from RCC under computed tomography (CT) guidance between 2006 and 2007. Radiotherapeutics generator (Boston Scientific, Natick, MA) and Radiotherapeutics RF ablation probe with "umbrella" array tip (Boston Scientific, Natick, MA) were used. These patients were contraindicated for surgery due to several associated morbidities. All patients underwent a tumor biopsy before RF. The access was percutaneous in all patients. Tumor control was defined as the absence of contrast enhancement in the tumor on CT. Data were collected in a retrospective manner., Results: Five patients were treated with a RF ablation of the adrenal metastasis. The average age of the patients was 69.4 +/- 11.1 years (57-87), the average time between the radical nephrectomy and the onset of adrenal metastasis was 5.2 +/- 1.3 years (4-7), and average diameter of the tumor was 3.9 +/- 1.4 cm (2-6). A year after RF, four patients had a total necrosis of their tumor on CT and 1 had an active tumor for which the patient received a second course of RF. An abscess of the adrenal gland had occurred in 1 case requiring a percutaneous drainage., Conclusions: The treatment of metastatic adrenal gland with RF broadens the range of treatment of metastatic RCC. The efficacy of this therapeutic modality must be confirmed by larger series with the longest follow-up.

Objective: The prognostic significance of seminal vesicle invasion on the radical prostatectomy specimen was evaluated according to the proximal or distal site of this invasion., Materials and Methods: 52 consecutive patients undergoing radical prostatectomy for stage pT3b N0 M0 prostatic cancer were classified into two groups: group A (18 patients): patients with invasion limited to the proximal part of the seminal vesicles (stage T3b limited); group B (34 patients): patients with invasion extending to the free part of the seminal vesicles (stage T3b extensive). The PSA progression-free curves were compared between the two groups. A multivariable regression model was performed to determine independent prognostic factors., Results: Overall, the 5-year PSA progression free rate of the 52 patients was 14.4%. The 5-year PSA progression-free rate of the patients in group A was 45.4 vs. 4.2% at 4 years in group B (p = 0.0004). The stage of seminal vesicle invasion and the Gleason score were the only independent predictive factors of PSA progression (p = 0.02 and p = 0.04, respectively)., Conclusions: The prognostic significance of seminal vesicle invasion is not constant and depends on the site of invasion. Preoperative seminal vesicles biopsies can select patients with invasion extending to the free part of seminal vesicles and who have a poor prognosis in terms of PSA progression after radical prostatectomy.

Objective: To allow the diagnosis of pathological stage C prostatic cancer before deciding on treatment., Method: Seminal vesicle biopsy was performed as an outpatient procedure without anaesthesia. An identical antibiotic prophylaxis to that used for prostatic biopsy was performed. Biopsies were performed by longitudinal vision using a transrectal probe. A seminal vesicle needle biopsy was performed lateral to the prostate in the medial third of the seminal vesicle., Result: When seminal vesicle biopsies are positive, the final pathology report after radical prostatectomy confirmed the diagnosis in 100% of cases. When seminal vesicle biopsies were negative, seminal vesicle invasion was detected on the final pathology examination in one third of cases, mostly corresponding to exclusively intraprostatic involvement of the seminal vesicle. Biopsies are useful when at least one of the two prostatic bases is involved. In the series of the last 42 radical prostatectomies performed because of negative seminal vesicle biopsies, we detected only 11% of capsular lesions, almost always less than 1 mm, and 0% of ilio-obturator lymph node invasion., Conclusion: Although the digital rectal examination findings, the PSA level, the Gleason score, and the number of positive biopsies and their length, allow an approach to preoperative staging, only seminal vesicle biopsies can provide a better preoperative staging of prostatic cancer for a given patient and no longer just statistically.

Objective: To identify patients at high risk of extraprostatic seminal vesicle infiltration, in whom preoperative seminal vesicle biopsies should be performed., Materials and Methods: We studied the relationship between extraprostatic seminal vesicle infiltration and the available preoperative data [age, clinical stage, prostate-specific antigen (PSA) level, number and site of positive prostatic sextant biopsies, Gleason score] in a total of 75 patients suffering from clinically localized prostatic adenocarcinoma who were candidates for radical prostatectomy., Results: The chi 2 test showed that the preoperative data most significantly correlated with extraprostatic seminal vesicle infiltration were the presence of positive basal biopsies (p < 0.001). The PSA level did not have any predictive value. The most discriminant preoperative parameter of the state of the seminal vesicles (analysis of variance on a univariate model) was the state of the basal prostatic biopsies. The importance of this parameter was confirmed by cluster analysis. Overall, the risk of extraprostatic seminal vesicle invasion was 0 (0/21 patients) when the 2 basal prostatic biopsies were negative, 10.25% (4/39 patients) when 1 of the 2 basal prostatic biopsies was positive and 73.33% (11/15 patients) when both basal prostatic biopsies were positive., Conclusions: In a patient with clinically localized prostatic adenocarcinoma who is a candidate for radical prostatectomy, seminal vesicle biopsies are useless when basal prostatic biopsies are negative, regardless of the state of other preoperative parameters. When 1 or 2 basal prostatic biopsies are positive, seminal vesicle biopsies can improve the pretreatment pathological staging.

Purpose: This study was undertaken to evaluate the potential metabolic complications of 1.5 percent glycine irrigating solution during endoscopic transanal resection (ETAR) of rectal tumors., Methods: Thirteen consecutive frail patients (mean age, 81 (range, 57-91) years) undergoing 18 ETAR were prospectively studied from July 1993 to January 1995. Indications for ETAR included palliation of advanced rectal cancer (12 patients) and an extensive villous tumor (1 patient). A 27-French two-way Iglesias resectoscope was used. Packed cell volume, blood glucose, and serum concentrations of sodium, potassium, and creatinine were measured before, during (at 45 minutes), and after (at 6 and 24 hours) ETAR. Plasma concentration of glycine and hemoglobin levels were both measured preoperatively and at 45 minutes and 24 hours, respectively. Variables studied included resection time, volume and rate of irrigating fluid, height of irrigating fluid bag above operating table, resectate weight, occurrence of intraperitoneal and extraperitoneal perforation, blood loss, and clinical symptoms., Results: Two patients were excluded. Mean operating time was 456 minutes. A mean of 192.3 liters of irrigant was infused into the rectum. Mean irrigation rate was 43,330 ml/minutes. Mean height of irrigating fluid bag was 692 cm. Extraperitoneal perforation occurred in two patients. Blood loss exceeded 200 ml in four patients, one of whom complained of nausea (operating time, 110 minutes). Mean rise in p-glycine at 45 minutes (10,028 mol/l; 387 percent of preoperative values) was significant (P = 0.006). Changes in packed cell volume, b-hemoglobin, b-glucose, s-sodium, and s-creatinine levels were not significant. There was significant correlation between p-glycine and s-creatinine levels at six hours (P = 0.033), between p-glycine levels and fall in s-sodium at 24 hours (P = 0.037), and between levels of b-hemoglobin and packed cell volume at 24 hours (P = 0.0004). There was a positive linear correlation between p-glycine and operating time (r = 0.7; P = 0.0026) and between p-glycine and volume of irrigating fluid (r = 0.5; P = 0.0386)., Conclusions: Operating time best predicts increase of p-glycine in ETAR.

The prostate specific antigen (PSA) level represents all of the immunoreactive serum PSA, either free or bound to alpha-1-anti-chymotrypsin. Isolated assay of free PSA has demonstrated a higher free PSA/total PSA ratio in cases of benign prostatic hyperplasia (BPH) than in cases of cancer, suggesting the possible use of this ratio in the detection of prostatic cancer when the PSA level is between 4 and 10 ng/mL. We retrospectively assayed free PSA in 64 cases of localized prostate cancer, 90 cases of BPH before transurethral resection and 59 healthy controls. By comparing the mean values of the 3 populations and the ROC curves, we confirmed the superiority of the free PSA/total PSA ratio over total PSA in the detection of prostatic cancer, but these results, established in a retrospectively constituted population, need to be confirmed by prospective epidemiological studies. Nevertheless, in routine urological practice, we propose that free PSA assay be performed in all men with a PSA level between 4 and 10 ng/mL and a normal prostate on digital rectal examination.

We report a case of aortoesophageal fistula occurring as a complication of colonic esophagoplasty. Emergency treatment during the hemorrhagic phase combined aortic replacement using a cryopreserved arterial allograft and digestive tract exclusion. Immediate recovery and follow-up at 8 months were good. This is the first reported case of successful in situ aortic replacement using a cryopreserved allograft for an aortoesophageal fistula. The lack of previous reports of successful treatment and related treatment modalities are discussed.

Palliative treatment for patients with rectal carcinoma affect more than 10% of the 8000 cases diagnosed each year in France. Twenty-four patients underwent endoscopic trans-anal resection using a urological resectoscope. The morbidity rate was 18,5% and there were no postoperative deaths. The median hospital stay for the procedure alone was 4 days. Good palliation was obtained in 89% of cases. This simple, minimally invasive and economic method should join palliative treatment for patients with rectal carcinoma beside laser destruction and external beam radiotherapy.

Palliative treatment for patients with rectal carcinoma concerns more than 10% of the 8000 cases diagnosed each year in France. Seventeen patients (median age: 83 years) underwent 27 endoscopic transanal resections using a urological resectoscope. The morbidity was 18.5% and there were no postoperative deaths. The median hospital stay for the procedure alone was 4 days. Local control was obtained in 13 (76%) patients with good palliation of obstruction, bleeding and tenesmus. The mean survival time was six months. This simple, minimally invasive and economic method should be part of palliative treatment for patients with rectal carcinoma together with laser destruction and external beam radiotherapy.

The authors report a case of pure small cell carcinoma of the prostate expressing neuroendocrine markers on immunohistochemistry. Treatment consisted of chemotherapy with cisplatin and etoposide combined with regional external beam radiotherapy. The result is encouraging with complete remission 15 months after the diagnosis.