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Actualiser les recommandations du CCAFU pour la prise en charge des tumeurs de la vessie n'infiltrant pas le muscle vésical (TVNIM). Une revue systématique (Medline) de la littérature de 2022 à 2024 a été effectuée en prenant en compte les éléments du diagnostic, les options de traitement et la surveillance des TVNIM, en évaluant les références avec leur niveau de preuve. Le diagnostic de TVNIM (Ta, T1, CIS) se fait après une résection tumorale complète et profonde. L'utilisation de la fluorescence vésicale et l'indication d'un second look (4 à 6 semaines) contribuent à améliorer le diagnostic initial. Le risque de récidive et/ou progression tumorale est évalué en utilisant le score EORTC. La stratification des patients en faible, intermédiaire et haut risque permet de proposer le traitement adjuvant : instillations endovésicales de chimiothérapie (postopératoire immédiate, schéma d'attaque) ou de BCG (schéma d'attaque et d'entretien), voire l'indication d'une cystectomie pour les patients non répondeurs au BCG. L'actualisation des recommandations du CCAFU doit participer à améliorer la prise en charge des patients, mais aussi le diagnostic et la décision thérapeutique des TVNIM. To update the CCAFU recommendations for the management of non-muscle invasive bladder cancer (NMIBC). A systematic review (Medline) of the literature from 2022–2024 was performed, taking into account the elements of diagnosis, treatment options and monitoring of NMIBC and evaluating references with their level of evidence. The diagnosis of NMIBC (Ta, T1, or CIS) is made after complete and deep tumour resection. The use of bladder photodynamic diagnosis and the indication for a second TURBT (4 to 6 weeks later) help to improve the initial diagnosis. The risk of recurrence and/or tumour progression is assessed via the EORTC score. By stratifying patients into low-, intermediate- and high-risk groups, adjuvant treatment can be proposed, including endovesical instillations of chemotherapy (early postoperative intravesical chemotherapy), BCG (induction and maintenance regimen), or even the indication of cystectomy for BCG-unresponsive patients. Updating the CCAFU's recommendations should help improve patient management, as well as the diagnosis and treatment of NMIBC. [ABSTRACT FROM AUTHOR]

L'objectif de ce travail était de proposer une mise à jour des recommandations du Comité de cancérologie de l'Association française d'urologie pour la prise en charge des tumeurs de la voie excrétrice supérieure (TVES). Une revue systématique de la littérature (Medline) sur l'épidémiologie, les facteurs de risque, le diagnostic, le pronostic, les options de traitement et la surveillance des TVES a été effectuée de 2022 à 2024 afin d'évaluer les références disponibles et leur niveau de preuve. Le diagnostic de cette pathologie rare, dont les principaux facteurs de risque spécifiques sont l'exposition à l'acide aristolochique et le syndrome de Lynch, repose sur l'uro-TDM et l'urétérorénoscopie souple avec prélèvements biopsiques. On distingue les lésions de bas et haut risque principalement sur la base du grade tumoral (bas/haut) et de l'aspect en imagerie (non infiltrant/infiltrant). La taille tumorale (< 2/≥ 2 cm), la focalité (uni/multifocale) et l'hydronéphrose (absent/présent) sont des critères plus relatifs. Le traitement chirurgical curatif de référence des TVES de bas risque est le traitement conservateur principalement par urétérorénoscopie/laser alors qu'il s'agit de la néphro-urétérectomie totale (NUT) pour les lésions de haut risque. Les traitements adjuvants après la NUT incluent une instillation intravésicale postopératoire de chimiothérapie afin de diminuer le risque de récidive vésicale, et une chimiothérapie à base de sels de platine pour les tumeurs pT2–T4 et/ou pN+. Le traitement de 1re ligne des TVES métastatiques comprend principalement la combinaison de l'enfortumab vedotin et du pembrolizumab. En cas de contre-indication, une chimiothérapie à base de sels de platine associée à une immunothérapie par nivolumab suivie d'une maintenance par nivolumab seul en cas de maladie contrôlée ou une chimiothérapie à base de sels de platine seule suivie d'une maintenance par avélumab en cas de maladie contrôlée peuvent être proposées. Le rythme et les modalités de la surveillance dépendent du stade de la maladie. Ces nouvelles recommandations doivent contribuer à améliorer la prise en charge des patients présentant une TVES. The purpose of this article was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). A systematic Medline search for epidemiology, risk factors, diagnosis, prognosis, treatment options and follow-up of UTUC was performed between 2022 and 2024 to evaluate available references and their levels of evidence. UTUC is a rare malignancy with specific risk factors including exposition to aristolochic acid and Lynch syndrome. Its diagnosis is based on the use of computed tomography urography and ureterorenoscopy with biopsies. A prognostic classification has been proposed to discriminate low- and high-risk lesions mainly based on tumor grade (low/high) and imaging aspect (non-infiltrative/infiltrative). Tumor size (< 2/≥ 2 cm), focality (uni/multifocal), and hydronephrosis (absent/present) are more relative risk factors. The standard of care for low-risk patients is currently conservative treatment using mainly ureterorenoscopy laser ablation, while radical nephroureterectomy (RNU) is advised for those with high-risk disease. Adjuvant treatments after RNU include the intravesical instillation of chemotherapy to decrease the risk of bladder recurrence, and the delivery of platinum-based chemotherapy in pT2–T4 and/or pN+ patients. First-line treatment for metastatic UTUC is based on the use of the combination of Enfortumab Vedotin plus Pembrolizumab. For unfit patients, a platinum-based chemotherapy plus Nivolumab followed by maintenance Nivolumab in those with at least stable disease or a platinum-based chemotherapy followed by maintenance Avelumab in those with at least stable disease can be proposed. The surveillance regimen and schedule depend on the disease stage. These updated guidelines will contribute to improve the management of patients diagnosed with UTUC. [ABSTRACT FROM AUTHOR]

The second version of the Paris System for reporting urine cytology was published in 2022. It follows the first version of 2016, which was very successful and widely adopted by many cytopathologists from different countries. Thus, numerous publications using the Paris System have made possible to refine the criteria as well as discussing the limits. The diagnostic accuracy of urinary cytology is high for detection of high-grade urothelial carcinoma, but not for low-grade carcinoma where there are few cytological abnormalities. So, the chapter individualizing low-grade urothelial neoplasms was deleted; the latter were included in the category "negative for high-grade urothelial carcinoma". Indeed, the risk of malignancy is replaced by the risk of high-grade urothelial carcinoma. A new chapter has been devoted to urothelial tumors of the upper tract. Finally, the pitfalls linked to cellular degeneration are discussed for each category. The risk of high-grade malignancy associated with each category will help communication with the clinician and help patient care., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Urinary cytology using the Paris system is still the method of choice for screening high-grade urothelial carcinomas. However, the use of the objective criteria described in this terminology shows a lack of inter- and intra-observer reproducibility. Moreover, if its sensitivity is excellent on instrumented urine, it remains insufficient on voided urine samples. Urinary cytology appears to be an excellent model for the application of artificial intelligence to improve performance, since the objective criteria of the Paris system are defined at cellular level, and the resulting diagnostic approach is presented in a highly "algorithmic" way. Nevertheless, there is no commercially available morphological diagnostic aid, and very few predictive devices are still undergoing clinical validation. The analysis of different systems using artificial intelligence in urinary cytology rises clear prospects for mutual contributions., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Résumé L’examen cytobactériologique des urines représente l’une des principales activités de routine d’un laboratoire de microbiologie. Compte tenu de cette charge de travail, l’analyse cytologique par méthode microscopique manuelle est difficile à maîtriser et manque parfois d’objectivité. L’automatisation de la cytologie urinaire permet de standardiser cet examen. Les performances de l’UriSed ® (77 Electronica, Budapest, Hongrie) ont été évaluées et les résultats de la numération leucocytaire comparés à la méthode microscopique manuelle. La sensibilité (Se), la spécificité (Sp), la valeur prédictive positive (VPP) et négative (VPN) de l’automate étaient respectivement de : 85,1%, 88,7%, 85,1% et 88,7%. Une bonne corrélation entre les deux méthodes a été notée, notamment pour les échantillons dont le taux de leucocytes est inférieur à la valeur seuil de 10 leucocytes/mm 3 . Dans 67% des cas d’urines à culture positive, les résultats de la bactériurie déterminée par l’UriSed ® étaient concordants. En considérant une bactériurie à 1 (+) comme seuil de pathogénicité, les Se, Sp, VPP et VPN étaient respectivement de 66,7%, 66,1%, 29,3% et 90,4% alors qu’avec un seuil de (++), les Se, Sp, VPP et VPN étaient de : 37,9%, 94,2%, 57,9% et 87,7%. Malgré le fait qu’il ne permette pas un gain de temps technique par rapport à la méthode conventionnelle, l’UriSed ® permet de standardiser et de maîtriser l’analyse cytologique des urines avec une fiabilité globale acceptable. The cytobacteriological urinalysis represent one of the main activities of a routine microbiology laboratory. The conventional cytological analysis by manual microscopic method sometimes lacks objectivity and is difficult to control. The automation of urinary cytology this examination. The performances of UriSed ® (77Electronica, Budapest, Hungary) have been evaluated and leucocytic numeration results compared with the manual microscopic method. Sensitivity (Se), specificity (Sp), predictive positive value (PPV) and predictive negative value (PNV) were respectively: 85.1%, 88.7%, 85.1% and 88.7%. A good correlation between the two methods was noted, in particular for the samples whose rate of leucocytes was lower than 10 leucocytes/mm 3 . In 67% of urines with positive culture, bacteriuria results determined by UriSed ® were concordant. By regarding a bacteriuria with 1(+) as threshold of pathogenicity, Se, Sp, VPP and VPN were respectively of 66.7%, 66.1%, 29.3% and 90.4%. Whereas, with a threshold of (++), Se, Sp, VPP and VPN were of 37.9%, 94.2%, 57.9% and 87.7%. Although, it does not allow a technical time-saver compared to the conventional method, UriSed ® allows to standardize and to control the urine cytological analysis with an acceptable reliability. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC)., Methods: A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence., Results: The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0)., Conclusion: These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Objective: To update the ccAFU recommendations for the management of bladder tumours that do not infiltrate the bladder muscle (NBMIC)., Methods: A systematic review (Medline) of the literature from 2020 to 2022 was performed, taking account of the diagnosis, treatment options and surveillance of NMIBC, while evaluating the references with their levels of evidence., Results: The diagnosis of NMIBC (Ta, T1, CIS) is made after complete full-thickness tumour resection. The use of bladder fluorescence and the indication of a second look (4-6 weeks) help to improve the initial diagnosis. The EORTC score is used to assess the risk of recurrence and/or tumour progression. Through the stratification of patients in low, intermediate and high-risk categories, adjuvant treatment can be proposed: intravesical chemotherapy (immediate postoperative, initiation regimen) or BCG (initiation and maintenance regimen) instillations, or even the indication of cystectomy for BCG-resistant patients., Conclusion: Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and treatment of NMIBC., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Abstract: Microscopy urinalysis is one of the last manual analyses in laboratories and it is difficult to control. The automation of this analysis permits our laboratory to standardise this test. We performed an evaluation of the iQ®200 ELITE''s performances and compare the data to the manual microscopy method which is considered as “the gold standard”. The repeatability achieved at different levels of leukocytes and erythrocytes showed CVs below 10% for pathological values. Inter-run repeatability is 5,57% and carry-over is negligible if we take into consideration the linearity of the formed particles. Compared to the manual method, sensitivity (Se) of the analyser for leukocytes and erythrocytes are respectively 94.85 and 100%, the negative predictive value (NPV) are 92.91 and 100%, respectively. The weaknesses of the specificity (Sp) and positive predictive value (PPV) of erythrocytes (24.22 and 41.92%) are due to the lack of sensibility of the manual method. Also, the weak PPV of yeasts, casts and crystals are due to the better detection of those particles with the iQ®200''s image recognition system than with manual method. NPV for all the urine formed particles are excellent, they are between 98 and 100%. The iQ®200 ELITE permits us to standardise and control this test for a future accreditation of the laboratory. We also significantly increase the turn around time. [Copyright &y& Elsevier]

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Introduction: -The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC)., Methods: - A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence., Results: - The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease., Conclusion: - These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objective: - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC)., Methods: - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence., Results: - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival., Conclusion: - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

As for the Bethesda system for cervical and thyroid cytopathology, a terminology for reporting urinary cytology has been published in 2015. The new "Paris System" provides a consensus terminology for urinary cytology which underlines the criteria for the recognition of high-grade urothelial carcinoma (HGUC) and of those excluding HGUC, or suspicious for HGUC. It also focuses on new rules to recognize and report the subgroup of "atypical urothelial cells". Here we describe and illustrate the various categories as in the reference book. We analyse the main diagnostic criteria, including microscopic features as well as the risk of malignancy associated to every diagnostic category., (Copyright © 2019. Published by Elsevier Masson SAS.)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.005. C’est cette nouvelle version qui doit être utilisée pour citer l’article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.005. That newer version of the text should be used when citing the article., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006. C’est cette nouvelle version qui doit être utilisée pour citer l’article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.006. That newer version of the text should be used when citing the article., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objective: The purpose of the guidelines national committee CCAFU on bladder cancer was to propose updated french guidelines for non-muscle invasive (NMIBC) and invasive (MIBC) bladder cancers., Methods: A Medline search was achieved between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence., Results: Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment : instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan; MRI and FDG-PET remain optional. Cystectomy associated with extensive pelvic lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples. The interest of neoadjuvant chemotherapy is well known for all MIBC, wathever the stage. Thus, neoadjuvant chemotherapy is recommended for all eligible patients according PS (PS <2) and renal function (clearance > 60ml/mn). As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC). In second line treatment, only chemotherapy using vinflunine has been validated to date, even if results of immunotherapy clinical trials are encouraging., Conclusion: These updated french guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC. © 2016 Elsevier Masson SAS. All rights reserved., (© 2016 Elsevier Masson SAS. Tous droits réservés.)

Introduction: The purpose was to propose an update of the french guidelines from the national committee CCAFU on upper tract urothelial carcinomas (UTUC)., Methods: A systematic Medline search was performed between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence., Results: The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumour, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduced risk of baldder recurrence. The place of systemic therapy (adjuvant and neoadjuvant chemotherapy) remains to define., Conclusion: These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC. © 2016 Elsevier Masson SAS. All rights reserved., (© 2016 Elsevier Masson SAS. Tous droits réservés.)

Introduction: The objective was to update the guidelines of the French Urological Association Cancer Committee for upper tract urothelial carcinoma (UTUC)., Methods: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence., Results: The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Total nephro-urectomy remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed : unifocal tumour and diameter < 1 cm and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary., Conclusion: These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for UTUC., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC)., Methods: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence., Results: Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS<1) and renal function (creatinine clearance > 60 ml/min) permits (only in 50% of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)