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To propose recommendations for the management of renal cell carcinomas (RCC) of the renal transplant.Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to evaluate prevalence, diagnosis and management of RCC arousing in the renal transplant. References were assessed according to a predefined process to propose recommendations with levels of evidence.Renal cell carcinomas of the renal transplant affect approximately 0.2% of recipients. Mostly asymptomatic, these tumors are mainly diagnosed on a routine imaging of the renal transplant. Predominant pathology is clear cell carcinomas but papillary carcinomas are more frequent than in general population (up to 40-50%). RCC of the renal transplant is often localized, of low stage and low grade. According to tumor characteristics and renal function, preferred treatment is radical (transplantectomy) or nephron sparing through partial nephrectomy (open or minimally invasive approach) or thermoablation after percutaneous biopsy. Although no robust data support a switch of immunosuppressive regimen, some authors suggest to favor the use of mTOR inhibitors. CTAFU does not recommend a mandatory waiting time after transplantectomy for RCC in candidates for a subsequent renal tranplantation when tumor stageT3 and low ISUP grade.These French recommendations should contribute to improving the oncological and functional prognosis of renal transplant recipients by improving the management of RCC of the renal transplant.

To define guidelines for the management of localized prostate cancer (PCa) in kidney transplant (KTx) candidates and recipients.A systematic review (Medline) of the literature was conducted by the CTAFU to report prostate cancer epidemiology, screening, diagnosis and management in KTx candidates and recipients with the corresponding level of evidence.KTx recipients are at similar risk for PCa as general population. Thus, PCa screening in this setting is defined according to global French guidelines from CCAFU. Systematic screening is proposed in candidates for renal transplant over 50 y-o. PCa diagnosis is based on prostate biopsies performed after multiparametric MRI and preventive antibiotics. CCAFU guidelines remain applicable for PCa treatment in KTx recipients with some specificities, especially regarding lymph nodes management. Treatment options in candidates for KTx need to integrate waiting time and access to transplantation. Current data allows the CTAFU to propose mandatory waiting times after PCa treatment in KTx candidates with a weak level of evidence.These French recommendations should contribute to improve PCa management in KTx recipients and candidates, integrating oncological objectives with access to transplantation.

To define guidelines for the management of kidney stones in kidney transplant (KTx) donor or recipients.Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to report kidney stone epidemiology, diagnosis and management in KTx donors and recipients with the corresponding level of evidence.Prevalence of kidney stones in deceased donor is unknown but reaches 9.3% in living donors in industrialized countries. Except in Maastrich 2 donors, diagnosis is done on systematic pre-donation CT scan according to standard french procedure. No prospective study has compared therapeutic strategies available for the management of kidney stones in KTx donor: ureteroscopy or an extra corporeal lithotripsy in case of living donor prior to donation, ex vivo approach (pyelotomy or ureteroscopy), ureterocopy in the KTx recipient or surveillance. De novo kidney stones result from a lithogenesis process to be identified and treated in order to avoid recurrences. The context of solitary functional kidney renders the prevention of recurrence of great importance. Diagnosis is suspected when identification of a renal graft dysfunction, hematuria or urinary tract infection with renal pelvis dilatation. Stone size and location are determined by computed tomography. There are no prospective, controlled studies on kidney stone management in the KTx. The therapeutic strategies are similar to standard management in general population.These French recommendations should contribute to improve kidney stones management in KTx donor and recipients.

Resume Introduction Apres le developpement de la nephrectomie laparoscopique de donneur vivant en 1995, puis l’evolution vers la laparoscopie robot-assistee en 1999, certaines equipes ont evalue l’apport de ces techniques en transplantation renale. Methodes Une revue de la litterature a ete menee colligeant les etudes cliniques evaluant la chirurgie laporoscopique robot-assistee pour le prelevement renal a donneur vivant et pour la transplantation renale. Resultats Le prelevement renal donneur vivant robot-assiste a une tres faible morbidite et de bons resultats a long terme concernant donneurs et receveurs. Elle permet notamment une amelioration des douleurs postoperatoire. L’apport de la chirurgie robotique en transplantation renale semble plus limite. Les differentes series semblent mettre en lumiere un interet chez les patients obeses et/ou sous anticoagulants en diminuant la morbidite parietale.

Resume Introduction La formation pratique de l’interne de chirurgie repose sur le compagnonnage rendu difficile actuellement notamment par l’augmentation du nombre d’internes en formation. Nous avons cree un outil pedagogique visant a favoriser l’apprentissage d’une technique de chirurgie urologique classique, l’abaissement testiculaire et sa validation. L’objectif etait d’evaluer l’applicabilite et la pertinence de cet outil. Materiel et methodes L’outil etait une fiche d’evaluation technique realisee a partir de documentation de reference. Les formateurs devaient evaluer les internes a 3 moments du semestre (0, 3 et 6 mois). Les internes s’evaluaient mensuellement avec la meme fiche (auto-evaluations). Resultats Trois formateurs et 6 internes en stage de chirurgie pediatrique ont participe a l’etude entre mai et novembre 2013. L’evaluation initiale a permis de verifier les acquis theoriques avant le debut de cet apprentissage pratique. Le niveau des internes etait tres inegal en debut de semestre et homogene a la fin. Les evaluations mensuelles ont montre une augmentation significative et progressive des notes. Les notes des evaluations intermediaire et finale ont ete progressivement croissantes et toujours superieures aux notes des auto-evaluations precedentes (p Conclusion L’outil propose etait applicable et pertinent pour l’apprentissage technique de l’abaissement testiculaire dans cette population d’internes. Une etude a plus grande echelle serait utile pour le confirmer. Ce type d’outil pourrait etre applique aux techniques simples et courantes de chirurgie afin d’enrichir les outils pedagogiques utilises dans cette formation. Niveau de preuve 4.

Objectifs Alors que la surveillance active et les traitements focaux conservateurs (ablathermies et nephrectomie partielle) deviennent des strategies preponderantes de prise en charge des tumeurs renales, leur securite oncologique pour les lesions les plus agressives restent meconnues. Nous avons souhaite determiner les facteurs predictifs de passage d’une tumeur cliniquement localisee a localement avancee sur l’examen histopathologique definitif (upstaging). Methodes Une etude retrospective multicentrique internationale dans le cadre du Reseau UroCCR (CNIL DR2013-206 ; NCT03293563 ) a inclus les patients operes d’une nephrectomie partielle (NP) ou totale (NT) entre 2006 et 2018 pour tumeur localisee de moins de 10 cm (≤ cT2aM0). Les donnees clinico-radiologiques, chirurgicales et histologiques ont ete collectees prospectivement apres consentement ecrit a partir de la base UroCCR et comparees entre les tumeurs pT3a et les autres grâce aux tests du Chi2 et Fisher. Une regression logistique multivariee a ete realisee pour determiner les facteurs predictifs d’upstaging vers un stade pT3a. Une comparaison de la survie entre NP et NT a egalement ete effectuee. Resultats Parmi 5404 patients presentant initialement une tumeur localisee (≤ cT2a), 714 (13 %) avaient finalement une tumeur classee pT3a. En analyse univariee, le risque d’upstaging pathologique etait significativement correle a un âge eleve (65,2 vs 59,6 ; p Conclusion Nous avons pu determiner un nombre limite de 3 facteurs de risque independants d’upstaging pathologique en pT3a des tumeurs renales cliniquement localisees. Leur connaissance pourrait aider a guider la decision de strategie therapeutique (contre-indication d’une surveillance active ou d’une ablathermie). Il s’agit d’une des plus grandes series de la litterature sur le sujet.

To perform a state of the art about autosomal dominant polykystic kidney disease (ADPKD), management of its urological complications and end stage renal disease treatment modalities.An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "autosomal dominant polykystic kidney disease", "complications", "native nephrectomy", "kidney transplantation". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 3779 articles. After reading titles and abstracts, 52 were included in the text, based on their relevance.ADPKD is the most inherited renal disease, leading to end stage renal disease requiring dialysis or renal transplantation in about 50% of the patients. Many urological complications (gross hematuria, cysts infection, renal pain, lithiasis) of ADPKD required urological management. The pretransplant evaluation will ask the challenging question of native nephrectomy only in case of recurrent kidney complications or large kidney not allowing graft implantation. The optimum timing for native nephrectomy will depend on many factors (dialysis or preemptive transplantation, complication severity, anuria, easy access to transplantation, potential living donor).Pretransplant management of ADPKD is challenging. A conservative strategy should be promoted to avoid anuria (and its metabolic complications) and to preserve a functioning low urinary tract and quality of life. When native nephrectomy should be performed, surgery remains the gold standard but renal arterial embolization may be a safe option due to its low morbidity.

Practical training of the surgery resident is based on the companionship currently hampered in particular by the increase of the number of residents in training. We created a teaching tool to promote learning and validation of a technique of classic urologic surgery, inguinal orchidopexy. The objective is to evaluate the applicability and the relevance of this tool.The tool is a technical evaluation sheet made from reference documentation. The trainers evaluated the residents at 3 times of the semester (hetero-evaluation at 0, 3 and 6 months). Residents evaluated themselves monthly on the same items.Three trainers and 6 residents in surgery participated in the study between May and November 2013. The initial evaluation confirmed that the theoretical knowledge was acquired prior to the practical learning. The level of residents was very uneven at the beginning of the study but not at the end of the semester. The monthly evaluations gave a progressive and significant increase of notes. The notes of the intermediate and final hetero-evaluations rose gradually and they were always superior to those previous self-assessments (P0.05). The tool was considered simple and useful for the participants.This tool is applicable and relevant to the technical teaching of inguinal orchidopexy in this population. A larger study would be helpful to confirm it. This type of tool could be applied to the simple and common surgery techniques to enrich the educational tools used in the training.4.

Resume But L’objectif de cette etude a ete de presenter le role de l’embolisation dans le traitement des angiomyolipomes (AML) renaux, a visee preventive ou en cas d’hemorragie. Patients et methode De mars 1995 a mars 2007, 22 AML chez 21 patients (16 femmes et cinq hommes, d’âge moyen 38 ans) ont ete embolises : cinq AML ont ete traites en urgence pour choc hemorragique et 16 ont ete des embolisations preventives. Huit AML etaient de decouverte fortuite et neuf des patients presentaient des douleurs ou une hematurie macroscopique. La taille moyenne des AML etait de 70 mm (20 a 130 mm). L’embolisation a ete realisee avec des coils ou des embospheres. Resultats Trois patients n’ont pu etre embolises par echec de catheterisme renal. L’embolisation a ete efficace dans 100 % des cas chez les patients traites en urgence. Les six patients pris en charge pour hematurie macroscopique et les six patients presentant des douleurs etaient asymptomatiques apres embolisation. La reduction tumorale moyenne a ete de 32 % avec un recul moyen de 53,2 mois (cinq a 101 mois). Trois patients (14 %) au total ont beneficie d’un geste chirurgical a distance. Conclusion L’embolisation est la technique de choix pour traiter les hemorragies secondaires aux AML. En traitement preventif ou symptomatique, l’embolisation des AML est un traitement a proposer avant d’envisager un geste chirurgical.

Prostatic laser vaporization resection is a new and fast growing technique. Most publications compare this technique to the standard diathermic snare prostate resection without considering its particular complications. Septic arthritis of the trapezio-metacarpal joint is particularly rare if it has a haematogenous origin. We present here the case of a 65-year-old man with an isolated trapezio-metacarpal Pseudomonas aeruginosa arthritis with a haematogenous origin following a laser vaporization prostate resection.

The aim of this paper was to review the risk and incidence of urological malignancies and the clinical characteristics and outcomes of renal transplant urological malignancies. Medline/PubMed from January 1980 to February 2013 was searched to identify all medical literature about native kidney, graft bladder and prostate cancers. Comparing to general population, risk of kidney cancer was found to be 7 to 10 times greater and most of them are incidental low-stage, low-grade tumors with a good prognosis. Open and laparoscopic radical nephrectomies without lymph nodes dissection were reported to be safe. Incidence of graft RCC was 0.19%. Papillary carcinomas represented more than 50% of de novo graft carcinomas, which seemed to be low-grade carcinomas with good prognosis. Risk of prostate cancer was two times higher. Open or laparoscopic radical prostatectomy is safe and feasible for management of localized prostate cancer in patients with kidney allograft. Upper urinary tract (UUT) transitional cell carcinoma (TCC) incidence was reported between 0.7% and 3.8%. Reports suggested a 3-fold increased risk of developing bladder TCC. Intravesical BCG in superficial bladder cancer and/or CIS is a valid option. For invasive urothelial tumor, radical cystectomy in renal transplant patients remains the best treatment. Oncological outcomes of urological cancers in renal transplant recipients are good and conservative treatment should be preferred each time it is feasible to prevent returning to dialysis following recommendations of urological cancer treatment. Close monitoring of renal transplant recipient must be performed with at least an abdominopelvic US and PSA measurement once a year.

To evaluate the feasibility and the efficiency of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by urologist.Patients undergoing partial nephrectomy from July 2010 to November 2012 for T1-T2 renal tumors were included in analysis. Tumor margin status was immediately determined by ex vivo ultrasound done by the surgeon himself. Results were compared with margin status on definitive pathological evaluation.A total of 26 men and 15 women with a median age of 61 (30-82) years old were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 38 cases and positive margins in two. Final pathological results revealed negative margins in all except one case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Mean ultrasound duration was 1minute±1. Mean tumor and margin sizes were 3.4±1.8cm and 2.38±1.76mm, respectively.Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by a urologist seemed to be feasible, efficient and easy.

Objectifs Le benefice de la radiotherapie adjuvante (RA) ou de rattrapage (RR) apres prostatectomie n’est pas claire actuellement. Nous avons voulu comparer ces deux types de radiotherapie de loge de prostatectomie en termes de resultats carcinologiques et fonctionnels. Methodes Nous avons inclus 173 patients traites dans un seul centre entre janvier 2005 et decembre 2008. Tous les patients etaient traites par radiotherapie 3D conformationnelle accelerateur 6MV, 66 GY. La radiotherapie adjuvante etait faite chez les patients avec un PSA detectable apres prostatectomie 0,2 ng/mL au moment du traitement conformement aux criteres de phoenix. Les aires ganglionnaires etaient irradiees si le patient n’avait pas eu de curage et que le risque d’atteinte ganglionnaire etait superieur a 10 %. Resultats Quatre-vingt-six patients ont eu une radiotherapie adjuvante avec un delai median apres chirurgie de 6,7 mois et 87 une radiotherapie de rattrapage avec un delai median de 21,4 mois. La mediane de suivi etait de 6,7 ans. Les deux groupes etaient comparables sauf en termes de PSA et d’âge au moment de la radiotherapie. La survie sans recidive metastatique a 6 ans etait meilleure dans le bras RA (95 % et 89 % respectivement [95 % IC : 0,83–0,99] p = 0,01). A 6 ans, la survie specifique et globale etait meilleure dans le bras RA (100 % versus 95 % [95 % IC : 0,9–0,99] p = 0,02 et 100 % versus 94 % [95 % IC : 0,89–0,99] p = 0,02 respectivement). La radiotherapie adjuvante ameliorait significativement la survie sans recidive biologique (85 % versus 63 % [95 % IC : 0,54–0,93] p Conclusion Notre etude suggere que la radiotherapie adjuvante avait de meilleurs resultats en termes de survie globale, survie specifique, survie sans recidive metastatique et survie sans recidive biologique comparee a la radiotherapie de rattrapage. La toxicite etait comparable entre les deux groupes.

Transplantation Committee of the French Association of Urology (CTAFU) conducted a review of the complication of kidney transplantation in obese recipients.A bibliographic research in French and English using Medline with the keywords "obesity", "body mass index", "kidney transplantation", "graft function", "survival", "wound complications", "graft rejection" and "graft survival" was performed. We limited the review for the last fifteen years because of the change in immunosuppressive treatment area. Only studies with more than 20 obese patients were selected.Wound or infectious postoperative complications and delayed graft function are more frequent in obese patients than in non-obese recipients. Similarly, transplant survival at 5 years is lower in obese patients. On the other hand, patient survival and acute rejection are the same between the two groups if recipient selection is carefully made, particularly with regard to heart complication.Kidney transplantation in obese patients is not an easy surgery with known complication. Obese patients will take time before transplantation to explain all the risk and a regular heart follow-up is crucial if we don't want to reduce patient survival. But obese survival is better if we proceed to kidney transplantation than if they stay on dialysis, arguing for a non-exclusion of the waiting list. So there is the need for a national study concerning obese patients on waiting list to enact future guidelines.

To report the feasibility of radical retropubic prostatectomy (RRP) without postoperative bladder catheter.We report our experience in 14 patients (mean age 62 [48-75]) who underwent radical retropubic prostatectomy for localised prostatic adenocarcinoma from May 2006 to January 2010. The surgical technique was performed as classically described, without bladder neck preservation (tennis-racket closure), with or without nerve sparing (JP). The criteria that led us not to drain were the satisfactory urethral length, a tension-free anastomosis performed on a bladder catheter with separate sutures, and a lack of anastomotic leack after bladder filling with 200cc.The mean hospital stay was 4 days (3-8). Ten patients (71.4%) needed intermittent bladder catherism four times (1-11) before starting micturitions, without any technical difficulties. No anastomic leack was reported. Nine patients (64.3%) were continent leaving the hospital. With a mean follow-up of 30 months (5-48), all of 14 patients (100%) were perfectly continent. No anastomotic stricture was reported.RRP without postoperative bladder catheter was feasible, with no other early or late complication associated. Early and late continence were perfect (100% at 2 years).

Evaluate epidemiology, diagnosis and outcome of de novo renal cell carcinoma in renal transplanted patients.From June 1989 to December 2007, 824 renal transplantations were carried out and followed in annual consultation by an urologist with abdominal echography or tomodensitometry. The suspect renal lesions were treated by a widened nephrectomy. Incidence, diagnosis, treatment, histological type, and outcome of all patients were analysed.Thirty-three patients had nephrectomy for suspect renal lesions. Twenty-two de novo tumours of native kidneys among 21 patients were diagnosed (15 renal clear cell carcinoma and seven papillary tumours) with mean time after transplantation of 25,6 months (2.3-105.5). All tumours were classified pT1aN0M0. Only one patient died at 8 months of metastatic dissemination of a papillary tumour classified initially pT1aN0M0. All the other patients are alive with mean follow-up of 34.8 months (2.8-113.9). Specific survival to 5 years was 93.3%.The increase risk of tumour at the renal transplanted patient led to propose in the event of suspect lesions of the native kidneys, a widened nephrectomy. In our series, 65% of the operated patients carried a cancer. The good forecast of these localized tumours justifies a regular radiological monitoring and an aggressive therapeutic attitude despite of absence of tumours in 35% of the transplanted patients.

The purpose of this study was to present the role of embolization in the treatment of kidney angiomyolipomas (AML), for preventive care or in case of bleeding.From March 1995 to March 2007, 22 AML in 21 patients (16 women and five men, mean age 38 years) were embolized: five AML were treated for hemorrhagic shock emergency and 16 were preventive embolization. Eight AML were discovered incidentally and nine patients had pain or hematuria. The average size of AML was 70 mm (20 to 130 mm). The embolization was performed with coils or embospheres.Three patients have not been embolized because of renal failure catheterization. The embolization was effective in 100% of patients treated in emergency. The six patients cared for gross hematuria and pain were asymptomatic after embolization. The average tumor size reduction was 32% with a mean time of 53.2 months (five to 101 months). Three patients (14%) have benefited from surgery remotely.Embolization is the best technique for treating bleeding secondary to AML. In preventive treatment or symptomatic, AML embolization is a treatment to offer before considering surgery.

We report the case of a 67-year-old patient, renal transplanted for two years, taken care for carcinoma in situ in bladder and urethra, and treated by intravesical instillations with bacillus Calmette-Guerin (BCG). After failure of a first treatment by Amétycine, a treatment by BCG is instituted during nine weeks. Two months after the end of the treatment, the patient died after bone and liver metastatic invasion of urothelial carcinoma. Management of urothelial high-risk tumour among renal transplanted patient is not clear. Despite successful treatments of few patients reported in literature, this failure called the question of the effectiveness of the BCG therapy in renal transplant patient and suggested an earlier attempt at diagnosis with systematic detection and aggressive therapeutic among these immunodepressed patients.

To determine the sensitivity and specificity of MRI to distinguish between superficial and invasive transitional cell bladder cancer.Sixty patients (52 men and eight women) with a mean age of 66.8 years were assessed by bladder MRI between May 2002 and November 2005 for a primary bladder cancer diagnosed by endoscopy, followed by transurethral resection and histological examination of the bladder cancer. Patients presenting a discordance between MRI findings and histological examination were analysed.Imaging and pathology staging was concordant for 49 bladder cancers (40 superficial and nine invasive). Ten tumours considered to be invasive on MRI were superficial on histological examination and six of them relapsed at the resection scar at one or three months. The sensitivity of MRI was 80% for a specificity of 90% and a positive predictive value of 97.5%.MRI is a reliable examination to confirm the superficial nature of bladder cancer. When MRI and histological examination of a bladder cancer resection specimen are discordant, second look surgery is recommended to treat residual disease, which was present in 60% of cases in the present series.

Many improvements have been made recently in the field of the ureteral smooth muscle pharmacology. After a brief summary on physiological basis, we review what is known about effects on ureter of different drugs class. In a second part, we review clinical applications for renal colic analgesia, calculi expulsive medical therapy, ESWL adjuvant treatment and preoperative treatment before retrograde access. There are now sufficient data on NSAID and alpha-blockers. beta-agonists, especially for beta3 selective ones, and topical drugs before retrograde access are interesting and should be further evaluated.