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OBJECTIVE To compare the potential of two diagnostic methods for detecting recurrence of urothelial cell carcinoma (UCC) of the bladder, by (i) detecting alterations in microsatellite DNA markers and loss of heterozygosity (LOH), and (ii) detecting aberrant gene hypermethylation, as UCC has a high recurrence rate in the urinary tract and the disease can invade muscle if new tumours are overlooked. PATIENTS AND METHODS Over 1 year, urine samples were retrieved from 40 patients already diagnosed with bladder UCC (30 pTa, two pTis, eight pT1). Samples were collected 6 months after bladder tumour resection, during the follow-up schedule. We used samples to analyse nine microsatellite markers and the methylation status of 11 gene promoters. Receiver operating characteristic curves were generated and Bayesian statistics used to create an interaction network between recurrence and the biomarkers. RESULTS During the study, 15 of the 40 patients (38%) had a tumour recurrence and 14 were identified by cystoscopy (reference method). Overall, microsatellite markers (area under curve, AUC 0.819, 95% confidence interval, CI, 0.677–0.961) had better performance characteristics than promoter hypermethylation (AUC 0.448, 0.259–0.637) for detecting recurrence. A marker panel of IFNA, MBP, ACTBP2, D9S162 and of RASSF1A, and WIF1 generated a higher diagnostic accuracy of 86% (AUC 0.92, 0.772–0.981). CONCLUSION Microsatellite markers have better performance characteristics than promoter hypermethylation for detecting UCC recurrence. These data support the further development of a combination of only six markers from both methods in urinary DNA. Once validated, it could be used routinely during the follow-up for the early detection and surveillance of UCC from the lower and upper urinary tract.

Occupational exposure to polycyclic aromatic hydrocarbons (PAH) is associated with an increased risk of urothelial carcinoma (UC). FGFR3 is found mutated in about 70% of Ta tumors, which represent the major group at diagnosis. The influence of PAH on FGFR3 mutations and whether it is related to the emergence or shaping of these mutations is not yet known. We investigated the influence of occupational PAH on the frequency and spectrum of FGFR3 mutations. We included on 170 primary urothelial tumors from five hospitals from France. Patients (median age, 64 yr) were interviewed to gather data on occupational exposure to PAH, revealing 104 non- and possibly PAH exposed patients, 66 probably and definitely exposed patients. Tumors were classified as follows: 75 pTa, 52 pT1, and 43 > or =pT2. Tumor grades were as follows: 6 low malignant potential neoplasms (LMPN) and 41 low-grade and 123 high-grade carcinomas. The SnaPshot method was used to screen for the following FGFR3 mutations: R248C, S249C, G372C, Y375C, A393E, K652E, K652Q, K652M, and K652T. Occupational PAH exposure was not associated with a particular stage or grade of tumors. Thirty-nine percent of the tumors harbored FGFR3 mutations. After adjustment for smoking, occupational exposure to PAH did not influence the frequency [OR, 1.10; 95% CI, 0.78-1.52], or spectrum of FGFR3 mutations. Occupational exposure to PAH influenced neither the frequency nor the spectrum of FGFR3 mutations and there was no direct relationship between these mutations and this occupational hazard.

Resume Objectif Etudier l’interet d’une stimulation visuelle sexuelle combinee aux injections intra-caverneuses (IIC) chez les patients traites pour une dysfonction erectile severe. Materiels et methodes Entre 2005 et 2006, tous les patients ayant une dysfonction erectile severe ont ete inclus prospectivement. Le protocole en consultation consistait a comparer l’efficacite d’une IIC seule d’alprostadil a J0, puis d’une IIC combinee a une stimulation erotique a J8. Les criteres de jugement etaient : le delai d’apparition et la rigidite de l’erection. Une echelle de cotation subjective (1 a 5) a permis de quantifier l’erection. Resultats Quarante patients ont ete inclus. L’âge moyen etait de 64,5 ans (52-70). Tous les patients avaient un score IIEF5 inferieur a 15. Un acte de chirurgie urologique etait a l’origine de la dysfonction erectile dans 35% des cas. A JO et a J8, le delai moyen d’obtention de l’erection a ete respectivement de 10 mn 18 s (2-20) et de 10 mn 50 s (2-20). Concernant la rigidite et la qualite de l’erection, aucune difference significative n’a ete constatee entre J0 et J8 et les erections ont ete evalues respectivement a 5 dans 30 cas (75%), a 4 dans 8 cas (20%) et a 3 dans 2 cas (5%), lors de chaque consultation. Conclusion La stimulation visuelle sexuelle n’a pas fait la preuve de son efficacite reelle en milieu hospitalier en association avec les injections intra-caverneuses. Pour augmenter le taux de satisfaction des patients, l’urologue doit veiller avant tout a eduquer le patient aux injections intra-caverneuses dans un environnement adapte. Objective To assess the value of visual sexual stimulation combined with intracavernous injections (ICI) in patients treated for severe erectile dysfunction. Materials and methods Al1 patients with severe erectile dysfunction were prospectively included in this study between 2005 and 2006. The outpatient protocol consisted of comparing the efficacy of alprostadil ICI alone on DO and ICI combined with erotic stimulation on D8. Endpoints were: time to onset and rigidity of erection. A subjective score (1 to 5) was used to quantify erection. Results Forty patients with a mean age of 64.5 years (range: 52-70 years) were included in the study. Allpatients had an IIEF5 score less than 15. Erectile dysfunction was secondary to uroiogical surgery in 35% of cases. The mean time to onset of erection was I0 min 18 s (range: 2-20 min) on D0 and 10 min 50 s (range: 2-20 min) on D8. No signifcant difference for rigidity and quality of erection was observed between D0 and D8 and erections were scored as 5 in 30 cases (75%), 4 in 8 cases (20%) and 3 in 2 cases (5%) at each visit. Conclusion Visual sexual stimulation has not been demonstrated to be truly effective in the hospital setting in combination with intracavernous injections. In order to increase the patient satisfaction rate, the urologist must above al1 educate the patient in the intracavernous injection technique in an appropriate environment.

Objectives To determine the deterioration in the maximal active deflection and flow capabilities of a new-generation flexible ureteroscope (URS). Methods We performed 50 ureterorenoscopies using the same URS: a Karl Storz 11278 AU1 Flex-X, which is capable of a 270° active deflection in the ventral and dorsal directions. Postoperatively, we evaluated the maximal active ventral and dorsal deflection, irrigation flow at 100 cm H 2 O, and the number of broken optical fibers. Results The URS was used for a total of 76 hours, 15 minutes (average 95 minutes per procedure). The maximal ventral deflection had deteriorated from 270° to 208° at the last procedure. The maximal dorsal deflection had decreased from 270° to 133°. The irrigation flow at 100 cm H 2 O had decreased from 50 mL/min initially to 40 mL/min at the last procedure. The number of broken image fibers had reached six at the 50th procedure. One repair was necessary at the 50th procedure because of a laser perforation of the working channel. Conclusions The need for repair occurs less frequently with the new-generation of URSs, especially when they are used by an experienced endourologist. In the future, improvements in the durability of the flexible URS will still be key for widespread use of the technique and especially to limit damage by the laser to the working channel.

To establish the cancer control afforded by radical prostatectomy in patients aged 50 years or younger with sporadic, familial, or hereditary prostate cancer.We collected data on all patients 50 years old or younger among 5880 patients treated for prostate cancer between 1994 and 2004. We recorded age, ethnic origin, clinical presentation, family history of prostate cancer, preoperative prostate-specific antigen (PSA) level, treatment, Gleason score, 2002 TNM stage, surgical margin status, and disease progression. Radical prostatectomy was offered as first-line treatment to all patients with localized prostate cancer (T1-T2N0M0) and negative lymph nodes. PSA-free survival was calculated.We analyzed the data from 110 patients (1.9%), of whom 37 had familial cancer (33.6%) and 15 hereditary cancer (13.6%). A total of 85 patients (77.3%) had undergone radical prostatectomy, 39 (45.9%) by open retropubic surgery and 46 (54.1%) laparoscopically. The surgical margins were positive in 11 patients (12.9%). The mean follow-up after prostatectomy was 39.1 +/- 36.8 months (range 4 to 125). Nine patients (10.6%) experienced biochemical recurrence (PSA level greater than 0.2 ng/mL). Longer PSA-free survival after surgery was significantly associated with high-risk and intermediate-risk patients (P = 0.01 and P = 0.02, respectively) but not with the surgical procedure (P = 0.6) or family history of cancer (P = 0.46).Radical prostatectomy is an effective treatment of localized cancer in patients younger than 50 years old. Nearly one half of our cases of prostate cancer in younger men were forms of familial cancer. Detecting familial forms is a key objective in early screening and in the timely identification of candidates for prostatectomy.

Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two-thirds are associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis. We report a case of video laparoscopic ablation of seminal vesicle cysts.

Objectives: This phase 3a study assessed the efficacy and safety of two different doses of a new formulation of tamsulosin (the oral controlled absorption system: OCAS) in comparison with placebo and the old modified release (MR) formulation of tamsulosin. Methods: After a two-week single-blind, placebo run-in period, older men (≥45 years) with lower urinary tract symptoms (LUTS: total International Prostate Symptom Score (I-PSS) ≥13) suggestive of benign prostatic hyperplasia (BPH: maximum flow rate 4–12ml/s) were randomised to 12 weeks of treatment with placebo, tamsulosin OCAS 0.4mg, tamsulosin OCAS 0.8mg or tamsulosin MR 0.4mg once daily in a 1:1:2:2 ratio. The primary efficacy variable was the mean change from baseline to endpoint in total I-PSS. Tolerability was mainly assessed by documenting adverse events (AEs) reported by the patient and vital signs. Results: A total of 2152 patients were randomised to placebo ( N =357), tamsulosin OCAS 0.4mg ( N =361), tamsulosin MR 0.4mg ( N =710) or tamsulosin OCAS 0.8mg ( N =724). For the mean reduction in total I-PSS from baseline to endpoint, there was no statistically significant difference between tamsulosin OCAS 0.8mg (8.0 points or 42.4%) and tamsulosin MR 0.4mg (8.0 points or 43.2%; p =0.9909). Both tamsulosin OCAS 0.4mg (7.7 points or 41.7%) and tamsulosin MR 0.4mg were similarly superior to placebo (5.8 points or 32.0%; p 1 -adrenoceptor (AR) antagonists: dizziness and abnormal ejaculation. The incidence of dizziness was comparable for the 0.4mg dose (1.4%) and placebo (1.4%) and increased slightly with tamsulosin MR 0.4mg (1.7%) and tamsulosin OCAS 0.8mg (2.4%) although none of the comparisons was statistically significant. However, the incidence of abnormal ejaculation more clearly increased from tamsulosin OCAS 0.4mg (1.9%) to tamsulosin MR (3.1%) and tamsulosin OCAS 0.8mg (5.3%). Furthermore, whereas the incidence of abnormal ejaculation for tamsulosin MR 0.4mg and tamsulosin OCAS 0.8mg was statistically significantly higher than with placebo (0.3%), the difference between tamsulosin OCAS 0.4mg and placebo was not statistically significant. Tamsulosin OCAS 0.4mg had the lowest incidence of those AEs attributable to α 1 -AR antagonists and was also associated with the smallest reduction in blood pressure. Conclusions: Tamsulosin OCAS 0.8mg is not superior to tamsulosin MR 0.4mg and is associated with a higher incidence of AEs. Therefore, 0.4mg is the recommended dose of tamsulosin OCAS in the treatment of patients with LUTS/BPH. The efficacy of tamsulosin OCAS 0.4mg is superior to placebo and comparable to tamsulosin MR 0.4mg with a tendency towards a better efficacy/tolerability ratio than with tamsulosin MR 0.4mg.

Objective: Flexible ureteroscopy is nowadays an alternative effective option for treatment of upper urinary tract stones, especially in the lower renal pole. Access in this case is often limited by active deflection capabilities of the instrument which is always deteriorated by the passage of different tools through the working channel. Insertion of them limits also the irrigation flow and so that the visibility. These deteriorations vary largely following the tool inserted. We performed an in vitro evaluation of deterioration of active deflection, possibility of tool insertion in maximal active deflection and irrigation flow in 6 different flexible ureteroscopes with almost all of tools available. Methods: A total of 546 measures of maximal deflection, test of passage of tools in maximal deflection and measures of irrigation flow passage through the working channel were made on 6 different ureteroscopes, the ACMI DUR-8, the ACMI DUR-8 "Elite", the Karl Storz 11274 AA, the Karl Storz 11278 AU1 "Flex-X", the Wolf 7325.172 and the Olympus URF/P-3 without any tool inserted and with 22 different tools (14 extraction devices and 8 lithotripsy probes). Results: Larger caliber tools resulted in more deflection degradation than smaller ones but it is more evident in case of use of non-nitinol tools instead of the nitinol ones. Generally lithotripsy probes affected active deflection more than nitinol extractions tools but different brand laser fibres present different results. Usually 1.6 and 1.9F electro hydraulic probes offer a slightly better deflection than does the 200μ laser fibre. Ballistic shock probes are so stiff that can not be used for treating lower renal pole stones. Conclusions: An array of different instruments are nowadays available for upper renal endoscopic treatment but they differ largely on stiffness and on obstruction to irrigation flow. Laser probes are very problematic to insert in the already deflected instruments, something that is less evident with the EHL probes and the smaller nitinol extraction tools. Irrigation flow is inversely proportional to the diameter of the tool inserted. Tools with a diameter of 3 French or more block totally the flow.

This article is a summary of the 2001 French Urological Association (AFU) report on superficial bladder cancer. Major topics include histopathological classification, risk categories, natural history of the disease, standard treatments, the impact of molecular biology on clinical practice, the place of cystectomy, and modalities of intravesical instillations.

Background. Hemorrhagic cystitis (HC) is a common complication following allogeneic stem cell transplantation (SCT). In rare cases, it can be severe, inducing kidney failure and sepsis, and become life-threatening. Methods. We report three cases of severe HC in stem cell transplant recipients. Risk factors and the management of these patients were studied, as well as severe HC cases reported in the literature. Results. All three patients received high-dose cyclophosphamide in addition to total body irradiation or busulfan in their preparative regimen. They underwent allogeneic SCT, one of them from unrelated cord blood. BK viruria was detected in two cases at the onset of hematuria. HC lasted for more than 3 months, resulting in urinary tract obstruction and sepsis. Ultimately, cystectomy was the last therapeutic procedure available to treat this life-threatening complication. Conclusion. We describe three patients, among a total of more than 1300 patients treated in our unit by allogeneic bone marrow transplantation, in whom HC was severe and long lasting enough to require cystectomy as a life-saving procedure.

Purpose: We assessed the value of breath-hold, gadolinium (Gd) enhanced magnetic resonance urography for diagnosing urinary tract disease. Materials and Methods: Dynamic magnetic resonance urography was performed in 38 consecutive patients presenting with urological disease in whom excretory urography was contraindicated. Renal function was impaired in 18 cases with a serum creatinine of 140 to 400 μmol./l. Fast spoiled, gradient echo sequences were acquired during breath-holding 5, 10 and 15 minutes after intravenous injection of 10 ml. of a Gd chelate. Opacification of the collecting system was evaluated using a scale of 0 to 3. Diagnostic value of the examinations was also analyzed. Results: Dynamic magnetic resonance urography was sufficient for making the diagnosis in 95% of cases. We identified 71 pathological findings and the surgical anastomosis was always well visualized. Mean image quality score was 2.34 points for renal calices, 2.86 for renal pelves and 2.48 for ureters. Image quality significantly improved after injecting a diuretic. Conclusions: Gd enhanced magnetic resonance urography provides quality dynamic imaging of the urinary tract. It is a new approach for diagnosing urinary tract disorders in patients in whom excretory urography should be avoided.

Summary Introduction Infertility in men may be associated with an elevated risk of testicular cancer. The authors report a case of testicular seminoma discovered fortuitously during a workup for infertility. Case A 30 year-old male was seen for infertility. Physical examination and testicular ultrasonography were normal. The sperm count found oligoasthenospermia related to the excretory ducts. The patient underwent testicular biopsies for infertility, which showed an intratubular germ cell tumor. Tumor markers (beta HCG, alpha FP, LDH) were normal. Computed tomography was normal for the thorax, abdomen, and pelvis. We performed an inguinal orchiectomy. The pathology examination found seminoma, at a pT1 stage. One course of chemotherapy followed. Discussion The incidence of testicular cancer is increasing throughout the world. Recent studies show a strong relation between infertility and an increased risk of testicular cancer, and some authors even suggest a causal relation.

Transurethral resection of bladder tumour is a common procedure (10,711 new cases of bladder tumour diagnosed in France in 2000), associated with a certain morbidity. Intra- or extraperitoneal perforation of the bladder wall is a possible complication. The diagnosis is generally established intraoperatively and cystography can be performed in the operating room to demonstrate the diameter of the perforation. Most cases of extraperitoneal perforation can be treated conservatively by simple bladder drainage. Intraperitoneal perforations may require surgical repair Laparoscopy is currently tending to replace open surgery for this repair. One of the risks of perforation is also tumour seeding outside of the bladder However metastases related to perforation appear to be rare and occur rapidly requiring close surveillance.

Purpose: The purpose of our study was to evaluate the accuracy of 3D helical CT and its value in surgical planning for the treatment of ureteropelvic junction obstruction (UPJO). Method: CT scans and 3D reconstruction of renal vessels and the renal pelvis were performed in 20 cases of UPJO treated by open surgery. We analyzed scans in search of a vessel at the junction and its position relative to the UPJ. Helical CT scans and 3D reconstructions were correlated with macroscopic surgical findings. Results: CT scans demonstrated the presence of a UPJO in all cases. Crossing vessels were present at the junction in 13 of 20 cases. The vessel crossed the junction posteriorly in six cases and anteriorly in seven cases. Macroscopic surgical findings were in agreement with helical CT reconstructions in 100% of the cases. Conclusion: Axial scans together with 3D reconstruction are an accurate way of detecting crossing vessels when UPJO occurs. and the choice of the most adequate surgical technique is facilitated.

Renal cell carcinomas account for 4.6% of post-transplant cancers, 10% of which occur in allograft kidneys. We report three such cases among kidney grafts that were performed or followed from 1970 to 2004. In all patients, we performed a partial allograft nephrectomy after consideration of the tumor size, location, and absence of metastases and local extension. Renal function has remained stable, and there has been no sign of graft rejection, tumor recurrence or metastases. The surgery was technically feasible without exposing the patients to increased postoperative risks. The lateral, peripherally located tumor allowed excision without renal hilar dissection or entry into the collecting system. In agreement with data emerging from the literature, the present cases confirm that even in the setting of long-standing immunosuppression, de novo RCC of the kidney graft warrants a minimally invasive approach to spare patients graft loss and return to hemodialysis.

Retroperitoneal laparoscopic nephrectomy (RLN) is a relatively recent technique whose performance needs to be firmly established. The aim of this study was to compare the results of RLNs in 19 patients with retrospective results for 10 cases of open surgery. Ten of the RLN patients had transplanted kidneys. We used a slightly modified, already published technique with only three trocars that did not require balloon dilatation of the retroperitoneal space. It was successful in patients with and without transplants. The average operative times of RLN and open surgery were 115 and 110 minutes, respectively. In no instance did the laparoscopic procedure need to be converted to open surgery. There were no peri- or postoperative complications that could be related to the RLN technique. The average length of hospitalization after RLN was considerably shorter (3.8 days) than after open surgery (7.9 days). In conclusion, our experience shows that RLN is a safe, reproducible technique that reduces recovery time. It has become our first-line approach for simple nephrectomy, nephroureterectomy for ureteral tumors, and removal of the native kidney in transplant recipients.

De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis.

Transurethral resection of bladder tumour is a common procedure (10,711 new cases of bladder tumour diagnosed in France in 2000), associated with a certain morbidity. Intra- or extraperitoneal perforation of the bladder wall is a possible complication. The diagnosis is generally established intraoperatively and cystography can be performed in the operating room to demonstrate the diameter of the perforation. Most cases of extraperitoneal perforation can be treated conservatively by simple bladder drainage. Intraperitoneal perforations may require surgical repair Laparoscopy is currently tending to replace open surgery for this repair. One of the risks of perforation is also tumour seeding outside of the bladder However metastases related to perforation appear to be rare and occur rapidly requiring close surveillance.

To assess the value of visual sexual stimulation combined with intracavernous injections (ICI) in patients treated for severe erectile dysfunction.All patients with severe erectile dysfunction were prospectively included in this study between 2005 and 2006. The outpatient protocol consisted of comparing the efficacy of alprostadil ICI alone on D0 and ICI combined with erotic stimulation on D8. End-points were: time to onset and rigidity of erection. A subjective score (1 to 5) was used to quantify erection.Forty patients with a mean age of 64.5 years (range: 52-70 years) were included in the study. All patients had an IIEF5 score less than 15. Erectile dysfunction was secondary to urological surgery in 35% of cases. The mean time to onset of erection was 10 min 18 s (range: 2-20 min) on D0 and 10 min 50 s (range: 2-20 min) on D8. No significant difference for rigidity and quality of erection was observed between D0 and D8 and erections were scored as 5 in 30 cases (75%), 4 in 8 cases (20%) and 3 in 2 cases (5%) at each visit.Visual sexual stimulation has not been demonstrated to be truly effective in the hospital setting in combination with intracavernous injections. In order to increase the patient satisfaction rate, the urologist must above all educate the patient in the intracavernous injection technique in an appropriate environment.

In prostate cancer, use of FDG, the radiopharmaceutical currently most widely used in oncology, is limited to the most aggressive cancers and, in the absence of another tracer, to attempting to localise occult recurrences detected biochemically (elevated PSA serum levels). Four other PET tracers are currently suggested in various situations of prostate cancer development: for guiding biopsies, for diagnosis and staging of the primary cancer and of local or metastatic recurrences, especially in bone, and for localizing occult biochemical recurrence. This article is illustrated by cases summarising our experience with fluoromethylcholine-(18F) and PET/CT. They cover a wide spectrum of clinical settings: localisation of intraprostatic neoplastic lesions, initial staging, monitoring treatment by ultrasound, detection of occult recurrences and characterisation of images on conventional imaging modalities, which are questionable or difficult to interpret.

The incidence of stones after urinary diversion is variable but considerable. The authors report the case of a patient with a stone of the uretero-sigmoid junction of a Mainz II pouch occurring three years after radical cystectomy for recurrent carcinoma in situ refractory to conservative treatment. The patient was treated by anterograde Holmium:YAG laser flexible ureteroscopy. This clinical case illustrates the role of anterograde flexible ureteroscopy combined with Holmium:YAG laser as a minimally invasive, sale and effective technique for the management of stones in a urinary diversion.

Endoscopic placement of ureteric stents was first described in 1967 by Zimskind. Few studies have evaluated the impact of double J ureteric stents on the patient's quality of life. This prospective study was designed to evaluate the safety and morbidity associated with ureteric stents.From February 2001 to June 2003, 115 patients (64 men and 51 women; mean age: 49.5 years [range: 19-90]) were included in this study. Ureteric stents were placed under general anaesthesia for urolithiasis (80 cases), ureteroplasty (25 cases) and extrinsic ureteric compression (10 cases). 28 cm 7F polyurethane stents were used in every case. Patients with double J stent for renal transplantation or pregnancy were excluded. The safety of stents was evaluated on the day of removal by a questionnaire based on a 100 mm visual analogue scale (VAS).The mean duration of stenting was 91.8 days (range: 10-287). Macroscopic haematuria was reported in 56% of cases, dysuria was reported in 36% of cases and urgency was reported in 78% of cases. The mean score on the VAS was 44 (0-100) for global impression, 41 (0-100) for bladder pain, 41 (0100) for low back pain, 62 (2-100) for low back pain during micturition and 32 (0-100) for straining on the stent.Double J stents are associated with high morbidity, which is sometimes underestimated by operators. Our study confirms that the duration of stenting must be as short as possible in order to improve patient comfort, which implies rapid organization of the aetiological management of these patients.

OBJECTIVE To evaluate the prevalence, prognosis and possible risk factors of renal cell carcinoma (RCC) of the native kidney in renal transplant recipients. PATIENTS AND METHODS We retrospectively re-examined the follow-up data of 373 consecutive renal transplant recipients at our institution between August 1993 and September 2004. We collected the data of all de novo RCC of the native kidney in the current analysis. RESULTS Of the 373 patients examined, 12 tumours of the native kidney were diagnosed in 10 individuals. The mean ages at transplantation and diagnosis were 33 and 45.8 years, respectively. Thirteen malignancies were discovered fortuitously. Among the renal ultrasonograms there were two false-negative results. The mean tumour size was 21 mm. Nephrectomy was performed in all cases. Among the 12 kidney malignancies, there were five conventional RCCs and seven papillary RCCs. Half of all tumours were Furhman Grade 3 lesions, and pT1aN0M0 tumours also accounted for all malignancies in the current cohort. One of the 10 patients died, from progression of metastases 6 years after diagnosis. One patient had a local recurrence 2 years after diagnosis. The other eight patients were alive with no evidence of disease at the time of the current report. No significant relationship was detected between RCC occurrence and clinical patient characteristics. CONCLUSIONS There appears to be a greater risk of RCC of the native kidney in patients with end-stage renal disease. The present results suggest that an annual examination of the native kidney before and after renal transplantation is essential.

Multiple endocrine neoplasia (MEN) is defined by the presence of at least two functionally unrelated endocrine gland tumours in the same subject. There are three types of MEN. MEN type 1 (or Wermer syndrome) is an autosomal dominant cancer syndrome. In the light of a case report, the authors recall the characteristics of MEN type 1 responsible for severe and recurrent urolithiasis and emphasize the need for systematic aetiological work-up for all patients presenting a first episode of urolithiasis according to the guidelines of the Association Française d'Urologie Stone Committee (CLAFU).

Flexible ureterorenoscopy is recommended for the treatment of inferior calyx stones, 10 to 15 mm in diameter, particularly after failure of extracorporeal lithotripsy. It is recommended to mobilize an inferior calyx stone towards the renal pelvis or superior calyx before starting fragmentation. This manoeuvre is essential to preserve the ureterorenoscope. The objective of this technical note is to explain the stone "relocalization" manoeuvre and describe how in situ treatment of an inferior calyx stone can be dangerous for the flexible ureterorenoscope.

Renal cell carcinoma metastasis to the submaxillary gland after tumor nephrectomy has not been previously recorded in the literature. Most reported cases have involved the parotid gland. We report in this article the first case of solitary submaxillary gland metastasis from clear cell renal cell carcinoma in an 83-year-old man who presented 10 years after primary treatment. The submaxillary gland was excised with preservation of the facial nerve.

Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two-thirds are associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis. We report a case of video laparoscopic ablation of seminal vesicle cysts.

Infertility in men may be associated with an elevated risk of testicular cancer. The authors report a case of testicular seminoma discovered fortuitously during a workup for infertility.A 30 year-old male was seen for infertility. Physical examination and testicular ultrasonography were normal. The sperm count found oligoasthenospermia related to the excretory ducts. The patient underwent testicular biopsies for infertility, which showed an intratubular germ cell tumor. Tumor markers (beta HCG, alpha FP, LDH) were normal. Computed tomography was normal for the thorax, abdomen, and pelvis. We performed an inguinal orchiectomy. The pathology examination found seminoma, at a pT1 stage. One course of chemotherapy followed.The incidence of testicular cancer is increasing throughout the world. Recent studies show a strong relation between infertility and an increased risk of testicular cancer, and some authors even suggest a causal relation.

Miniaturization and development of flexible instruments have led to the development of flexible ureterorenoscopy. The objective of this study was to compare the capacities of active deflection of two latest generation flexible ureterorenoscopes and to evaluate alteration of deflection and flow of irrigating fluid in the presence of instruments in the operating channel.Two ureterorenoscopes were evaluated in this study. The Karl STORZ Flex-X and the ACMI DUR-8 Elite. Comparison of deflection movements was performed ex situ by super-imposing all active movements of the two ureterorenoscopes. Alteration of deflection was performed by alternately placing an extraction or fragmentation instrument of variable dimensions in the operating channel. Alteration of flow was also assessed in the presence of the same instruments.The ex situ deflection capacities of the DUR-8 Elite flexible ureterorenoscope were more extensive than those of the Flex-X, but it was more complicated to manipulate. Alterations of deflection and flow of irrigation fluid were comparable for the two ureterorenoscopes.On the basis of these data, we can confirm that the two latest generation ureterorenoscopes present comparable capacities, but different functioning modalities. We therefore recommend that each operator test the two ureterorenoscopes to become familiar with their manipulation. Other studies are necessary to evaluate the optical properties, ease of use in clinical practice and fragility of these new ureterorenoscopes.

FREDDY laser technology was developed for endocorporeal lithotripsy. The purpose of this study was to evaluate, based on our initial experience, the efficacy and place of this technology in the treatment of urinary calculi by ureterorenoscopy. (World of Medicine) to treat 26 patients (29 stones) by ureterorenoscopy. This was the second procedure for 25 stones: after ESWL (23 cases) or percutaneous nephrolithotomy (2 cases) and the first procedure for 4 stones. The mean stone diameter was 9 mm (range: 6-15 mm). Thirteen stones were situated in the kidney and 16 were in the ureter. Success of treatment was defined by the absence of residual fragments immediately after the operation or at one month on plain abdominal x-ray.Twenty-six stones were satisfactorily fragmented. At three months, 21 out of 26 (80.7%) patients were stone-free corresponding to 21 out of 29 (72.4%) stones). Failures concerned 8 stones (5 patients). For five stones, measuring more than 10 mm, residual fragments persisted at three months. For three other stones, two cystine stones and one calcium oxalate monohydrate stone, fragmentation was insufficient or even nonexistent for the cystine stones. The mean length of hospital stay was 1.5 days (range: 1-3 days). A ureteric perforation due to a stone impacted in the ureteric wall was observed.FREDDY laser endoscopic lithotripsy is a safe and effective method due to the wavelength used. This laser could constitute an alternative treatment option in view of its moderate cost and the fact that it is adapted to flexible ureterorenoscopy. However, it presents certain limitations in terms of fragmentation, particularly in the case of cystine stones, and cannot be used to treat solid lesions (urinary tract strictures and tumours).

The purpose of the present study was to evaluate in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of obstructing ureteral stones causing acute renal colic. In situ ESWL with an EDAP LT-02 piezo-electric lithotriptor was used in a prospective study to treat 67 patients with obstructing ureteral stones causing acute renal colic. Patients were treated without anesthesia on an out-patient basis or during a one-day hospital stay. The overall one month stone-free rate was 94% (94% for proximal stones and 95% for distal stones). The overall success rate after a single ESWL session was 81%. Treatment was well tolerated in 90% (60/67) of patients. There was one case of non-obstructive pyelonephritis and one of ureteral edema. These rates compare well with published reports for delayed treatment in patients without renal colic. Immediate ESWL for cases of acute renal colic due to obstructing ureteral stones is an effective treatment strategy that warrants wider consideration.

To compare the outcomes in patients who had undergone either open nephroureterectomy or conservative endoscopic surgery (ureteroscopic or percutaneous management) for upper urinary tract transitional cell carcinoma.We performed a retrospective review of the data for patients treated surgically for upper urinary tract transitional cell carcinoma from 1990 to 2004. The data included patient sex, age at diagnosis, mode of diagnosis, smoking history, history of bladder cancer, type of surgery, complications, and tumor site, size, stage, grade, recurrence, and progression. We also evaluated the recurrence and survival rates.Data were analyzed for 97 patients. The median patient age was 68 years. Sixteen patients had a history of bladder tumor. The surgical procedure was open nephroureterectomy in 54 patients, ureteroscopy in 27, and percutaneous endoscopic ablation in 16. The tumor stage, grade, and site were independent prognostic factors for survival in a multivariate analysis (P0.05). The 5-year disease-specific survival rate was 81.9% for low-grade tumors and 47.3% for high-grade tumors (P = 0.0001). A correlation (P = 0.002) was found between low-grade tumors and superficial tumors. In patients with low-grade tumors (n = 46), the 5-year disease-specific survival rate after nephroureterectomy, ureteroscopy, and percutaneous endoscopy was 84%, 80.7%, and 80%, respectively (P = 0.89); the corresponding 5-year tumor-free survival rates were 75.3%, 71.5%, and 72% (P = 0.78).Conservative surgery can be recommended as an alternative to nephroureterectomy for low-grade or superficial upper urinary tract transitional cell carcinoma. For patients with high-grade or invasive tumors to be candidates for conservative surgery will require the development of additional prognostic factors (eg, molecular markers). These patients require long-term postoperative surveillance.

A single stone analysis is necessary during the patient's clinical history in order to institute specific drug treatment and health and dietary measures to prevent stone recurrence. In practice, only one in every two stones is recovered for morpho-constitutional analysis. The objective of this study was to determine the place of double J stent encrustation analysis for indirect determination of stone composition.Double J stents and stones from all patients treated in the same centre over 24 months were consecutively analysed by infrared spectrophotometry. The correlation coefficient 1, evaluating the concordance between the composition of stones and double J stent encrustation was estimated statistically by SPSS 12.0 software (011; 1=0: no concordance; 1=1: perfect concordance).45 males and 27 females with a mean age of 45.3 years (range: 29-70) were included Double J stents were placed for: febrile obstruction (N=52; 72%), acute renal colic (N=15; 21%) and impaired renal function (N=5; 7%). Calculated values for 1 were: 0.78 for the concordance between the predominant constituent of the stone and the encrustation (N=72; p0.0005); 0.91 for the concordance between the nature of the encrustation of the upper loop and that of the lower loop of the stent (N=30, p0.0005).The composition of mineral encrustation of double J stents is a good marker of stone formation. This constitutes an alternative method that can be used by urologists when no stone is available for spectrophotometric analysis.

Flexible ureterorenoscopy combined with Holmium:YAG laser is an emerging technology that already has its place among the urologist's treatment options for the management of urinary stones. The main indication for the technique is renal stones, particularly lower caliceal stones. After mobilization of the stone in the renal pelvis or upper caliceal group, fragmentation is achieved by Holmium:YAG laser and the largest fragments are removed. When small fragments persist that are difficult to extract, the patient's blood is injected into the lower caliceal group to obtain a blood clot This clot then fills the lower caliceal group and prevents secondary accumulation of residual stone fragments, facilitating elimination of fragments towards the ureter. This article describes this technique.

A caliceal diverticulum corresponds to a cavity communicating with the renal excretory tract via a neck. Surgical treatment is required when the caliceal diverticulum is symptomatic with repercussions on the patient's quality of life. A retrograde approach via holmium:YAG laser ureterorenoscopy has been recently used to treat the stone and externalize the caliceal diverticulum into the pyelocaliceal cavities. The problem raised by this approach is identification of the diverticular neck. The objective of this technical note is to describe a technique to facilitate identification of the diverticular neck.

To determine the value of mid-infrared spectroscopy (MIRS) of ureteral stent encrustations in predicting urinary stone composition.A retrospective study analyzed the composition of stent encrustations and urinary stones by MIRS in patients who had had a stent for ureteral obstruction between 2001 and 2003. The overall correlation was evaluated. The correlation coefficient kappa for agreement between the proportions of each component was calculated.A total of 72 stents and 72 stones from 72 patients were analyzed. The mean stent indwelling time was 55.5 days (range 14 to 102). The stents had been placed for fever (52 cases, 72%), pain refractory to analgesics (15 cases, 21%), and impairment of kidney function (5 cases, 7%). The overall correlation between stone composition and stent encrustation was 71.4%, excluding biofilm analysis. The kappa value was 0.78 for the main component (n = 72; P0.0005), 0.61 for the secondary component (n = 72; P0.0005), and 0.91 for the agreement between the composition of encrustations at each end of a stent (n = 30; P0.0005).MIRS analysis of stent encrustations is a reliable method of predicting stone composition when the stone cannot be retrieved. Systematic MIRS analysis of stent encrustations is not recommended but can be very useful in clinical situations in which no stone is available.

Spontaneous renal haematomas are rare. The authors discuss the aetiological diagnosis and management of these haematomas.Seven cases (3 females and 4 males) of spontaneous renal haematoma were managed between July 1999 and December 2002 and the case files were studied retrospectively.The circumstances of discovery were nonspecific. One patient presented with haemorrhagic shock. Radiological work-up comprised abdominal ultrasound and CT scan in almost every case. Ultrasound failed to demonstrate the aetiological diagnosis. CT revealed the cause of bleeding in 7 cases. MRI was performed in 4 cases, but urgent angiography was not performed. Four total nephrectomies were necessary, while two patients were treated by conservative surgery. One patient was simply followed by repeat CT scan. The short-term course was favourable with a mean follow-up of 23 months.Spontaneous renal haematomas raise 2 problems, that of their aetiology: tumours are the commonest causes (angiomyolipoma and renal cell carcinoma), and that of their management. Three therapeutic approaches are possible: radical surgery in the case of uncontrollable bleeding, conservative surgery or surveillance in the absence of a life-threatening emergency and when the aetiological diagnosis has not been established. Rigorous and repeated radiological surveillance can identify the cause of the bleeding allowing conservative surgery to be performed when indicated.

Primary hyperparathyroidism (PHPT) is not a rare disease. Renal stones are the most frequent complication of PHPT The authors report the case of a patient with giant parathyroid adenoma responsible for early recurrence of renal stones. Ultrasound examination of the neck, parathyroid MRI and Technetium99m-Sestamibi scintigraphy confirmed the parathyroid adenoma. Surgical exploration allowed resection of a giant adenoma (6.5 x 2.5 x 1.5 cm weighing 17 g). In the light of this case, the authors describe the characteristics of HPT define the place of preoperative imaging and emphasize the need for systematic aetiological work-up looking for HPT in all patients with a first episode of renal stones.

Based on 12 years of experience, laparoscopic nephrectomy has become the reference approach to benign kidney disease. This technique is effective, safe and reproducible. The complication rate is comparable or even lower than that of open nephrectomy and the postoperative course is more favourable. Based on a review of the literature, this paper reviews the technique, indications and results of laparoscopic nephrectomy for benign kidney disease.

Animal bites to the scrotum are rare, but potentially serious. In the light of a personal case, the authors discuss the management of these lesions. An animal bite comprises a triple infectious risk: bacterial, tetanus and rabies. Surgical exploration is indicated for assessment of the structures involved and debridement. The morbidity is related to the severity of the bite and the waiting time before consultation, and complications are rare. Orchidectomy is sometimes necessary, as in the case reported here, and the patient must be warned about this possibility. Antibiotic therapy is empirical: tetracycline and anti-anaerobe antibiotic. Rabies and tetanus prophylaxis must be performed according to vaccine guidelines.

The rationale for intravesical chemotherapy in the treatment of superficial bladder tumours is based on the knowledge of their natural history, particularly the propensity of a majority of tumours to relapses, while only a small proportion of these tumours present a risk of progression. The objective of intravesical chemotherapy is to prevent tumour implantation on the site of resection and to eliminate any residual disease responsible for recurrences; this treatment therefore constitutes "chemoprophylaxis". The objective of this technical note is to recall the practical modalities of early postoperative mitomycin C instillation with particular emphasis on two technical points.

The popularity of vitamin C can be attributed to Linus Pauling who, in the 1970s, recommended the use of vitamin C for the prevention of influenza. Vitamin C has subsequently been used extensively in a wide range of diseases. Ascorbic acid (vitamin C) has been incriminated as a possible risk factor for calcium oxalate stones due to its enzymatic conversion into oxalate. However, this lithogenic role has never been clearly established. Studies evaluating the effect of ascorbic acid on lithogenesis have reported contradictory results. Ascorbic acid has also been extensively used as an urine acidifier for the treatment of chronic or recurrent urinary tract infection. Once again, the data of the literature are contradictory. The purpose of this article was to review the effects of ascorbic acid on lithogenesis and urinary pH based on a review of the literature.

To evaluate cystectomy with preservation of the prostate in the treatment of bladder tumours.A review of the literature (Medline, key words: cancer, bladder, cystectomy, prostate, urinary incontinence, sexual impotence) was performed. Three cystectomy techniques with preservation of the prostate were recently described; their anatomical basis, surgical techniques and indications are reported. Their morbidity and oncological and functional results were then studied and compared to contemporary total cystectomy series.The morbidity is not worsened. The functional results were globally improved, especially in terms of erectile function. In terms of cancer control, local recurrences were not more frequent, but metastatic recurrence rates appeared to be higher.Compared to total cystectomy, cystectomy with preservation of the prostate is not associated with increased morbidity, improves functional results, but does not appear to ensure an equivalent level of cancer control.

Secondary deflection of a flexible ureterorenoscope (FUR) is a passive mechanism, which can only be performed under certain anatomical conditions. The objective of this study was to present a new double active deflection FUR and to assess its value based on our initial experience.From October 2002 to February 2003, we performed flexible retrograde ureterorenoscopy in 30 consecutive patients (34 renal units) using a double active deflection FUR (ACMI DUR 8 Elite). Bilateral ureterorenoscopy was performed during the same operating time in four patients. Ureterorenoscopy was diagnostic for 9 patients (macroscopic haematuria, urinary tract tumour), and therapeutic for 21 patients (stones, urinary tract tumour, ureteropelvic junction stenosis with stone). The value of double deflection as well as the efficacy and morbidity of the technique were evaluated.The main indication for flexible ureterorenoscopy was the treatment of urinary stones (73.6%), followed by the diagnosis of macroscopic haematuria and urinary tract tumours (26.4%). Ureteric dilatation was necessary in 38.3% of cases. The use of active secondary deflection was essential in 20% of cases (7/34) for complete investigation of the pyelocaliceal cavities. Access to the lower calices was not possible in one patient with a left pelvic kidney. 19 patients with urinary stones had no fragments (79.2%) at the end of the operation, while 4 had residual fragments in the lower calices. The global success rate for all operations was 85% (29/34). Two patients developed acute pyelonephritis during the 48 hours after the procedure and another two patients experienced acute renal colic.Our study confirms the data of the literature on flexible ureterorenoscopy in terms of indications and efficacy. The URS DUR 8 Elite allowed complete exploration of the pyelocaliceal cavities in more than 97% of cases. The use of active secondary deflection was unnecessary for the majority of patients (80%), but it represents a major technical progress which should be taken into account in the design of future flexible ureterorenoscopes.

Objective: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. Patients and Methods: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Results: Mean stone size was 7mm (3–20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy ( n =23) or lithotripsy with a Dornier ® machine ( n =13). Conclusion: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

The bladder is a rare site of scleroderma. The frequency of bladder involvement is difficult to estimate, as only about thirty cases have been reported in the literature. Scleroderma bladder involvement usually presents in the form of frequency and burning, but may sometimes cause urgency or recurrent urinary tract infections. The authors report a case of bladder scleroderma responsible for severe haematuria in a 56-year-old woman and discuss this rare cause of macroscopic haematuria in the light of the histological findings and a review of the literature.