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Summary Introduction Factors predicting response to adjuvant chemotherapy (AC) are required to identify patients who will most benefit from it. The aim of this study was to evaluate the impact of carcinoma in situ (CIS) at radical cystectomy (RC) on recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) of patients treated by AC. Materials and methods A single-center retrospective study was performed on patients who received AC after RC without pre-RC chemotherapy or trimodal therapy. Results Among the 150 patients analyzed, 52,7% had CIS on the RC specimens. Baseline characteristics were not significantly different between the CIS negative and positive groups. Most patients received a cisplatin-based AC (74%). The median follow-up of the cohort was 36,4 months. The presence of CIS was not significantly associated to disease-recurrence (OR = 0.67; 95%CI = 0.35–1.29; P = 0.23), cancer related death (OR = 0.70; 95%CI = 0.36–1.33; P = 0.27) or death by any cause (OR = 0.80; 95%CI = 0.42–1.52; P = 0.50). The presence of CIS had no significant impact on RFS (HR = 0.86; 95%CI = 0.56–1.33; P = 0.49), CSS (HR = 0.85; 95%CI = 0.53–1.36; P = 0.50) or OS (HR = 0.93; 95%CI = 0.60–1.45; P = 0.74). Conclusion The presence of CIS on RC specimens did not have an impact on survival of patients treated by AC. CIS could be evaluated as a prognostic factor of response to novel adjuvant regimens such as immunotherapy.

Summary Objectif Evaluate kidney autotransplantation (KAT) and ileal ureter substitution (IUS) practice and outcome as alternatives to indwelling ureteral stents for the management of long ureteral stenosis (US). Material We included all patients treated for US with KAT or IUS in 5 French university urology centers between 2010 and 2018. We excluded US due to urothelial carcinoma. Primary endpoint was the preservation of ipsilateral kidney and renal function without any urinary diversion. Results 22 patients were treated with KAT (n = 8, 36.4%) and IUS (n = 14, 63.6%). Mean US length was 4.6 cm and 6 cm (P = 0.52) in KAT and IUS groups respectively. US etiologies were lithiasis, iatrogenic, retroperitoneal fibrosis or extrinsic compression. US level was varied. The surgery was described as difficult because of peritoneal adhesions or major peri-ureteral fibrosis. Mean operating time and hospital stay were 336 and 346 minutes (P = 0.87) and 8 and 15 days respectively (P = 0.001). Postoperative complications were mostly Clavien ≤ 2 (n = 17, 77.3%). Revision surgery was required in the KAT group in 3 cases (37.5%), for textiles, renal vein thrombosis and anastomotic leak, none in the IUS group. The mean follow-up was 15.7 months. All but one (in the KAT group) ipsilateral kidneys were preserved, without renal function impairment (Δcreat +2.1 vs. +2.4 μmol/l respectively, P = 0.67), nor urinary diversion. Conclusion KAT and IUS are safe alternatives whose indication depends on surgeons expertise. Our study pointed out the scarcity of this practice suggesting the need to refer patients to expert centers. Level of evidence 3.

Summary 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 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.

Fibroblast growth factor receptor 3 (FGFR3) is an actionable target in bladder cancer (BC). FGFR3 mutations are common in noninvasive BC and associated with favorable BC prognosis. Overexpression was reported in up to 40% of FGFR3 wild-type muscle-invasive BC. We analyzed FGFR3 mutations, FGFR3, and p53 protein expression and assessed their prognostic value in a cohort of 1000 chemotherapy-naive radical cystectomy specimens. FGFR3 mutations were found in 11%, FGFR3 overexpression was found in 28%, and p53 overexpression was found in 69% of tumors. Among FGFR3 mutant tumors, 73% had FGFR3 overexpression versus 22% among FGFR3 wild-type tumors. FGFR3 mutations were significantly associated with lower pT stage, tumor grade, absence of carcinoma in situ, pN0, low-level p53, and longer disease-specific survival (DSS). FGFR3 overexpression was associated only with lower pT stage and tumor grade. Moreover, FGFR3 overexpression was not associated with DSS in patients with FGFR3 wild-type tumors. In conclusion, FGFR3 mutations identified patients with favorable BC at cystectomy. Our results suggest that FGFR3 mutations have a driver role and are functionally distinct from FGFR3 overexpression. Hence, patients with FGFR3 mutations would be more likely to benefit from anti-FGFR3 therapy. Ideally, further research is needed to test this hypothesis. Patient summary: Oncogenic fibroblast growth factor receptor 3 (FGFR3) mutations are very common in bladder cancer. In this report, we found that these FGFR3 mutations were associated with favorable features and prognosis of bladder cancer compared with patients with FGFR3 overexpressed tumors only. As a consequence, patients with FGFR3 mutant tumors would be more likely to benefit from anti-FGFR3 therapy than patients with FGFR3 protein overexpression only.

Intravesical instillations of BCG are recommended for the treatment of high-risk non-muscle-invasive bladder cancer. However, their prolonged use remains limited by the associated potentially serious adverse effects or complications. The purpose of this article was to provide updated recommendations for the diagnosis and management of adverse events (AEs) or complications of intravesical BCG instillations.Review of the literature in Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using the following MeSH keywords or a combination of these keywords: "bladder," "BCG," "complication," "toxicity," "adverse events," "prevention," and "treatment".AEs or complications of BCG included genitourinary and systemic symptoms. The most common complications (cystitis, moderate fever) should be treated symptomatically and may require adjustment to allow patients to have the most complete BCG treatment possible. Serious complications are rare but must be identified promptly because of the life-threatening nature of the disease. Their management is based on the combination of anti-tuberculosis treatments, anti-inflammatory drugs and the definitive discontinuation of BCG.The management of BCG AEs requires early identification, rational and effective treatment if necessary, and discussion of the continuation of treatment for each situation.

Intravesical instillations of mitomycin C, epirubicin and BCG are considered as the standard treatment for most patients diagnosed with non-muscle invasive bladder cancer. These guidelines aim to optimize the adjuvant intravesical treatment in order to increase the efficacy and lower the morbidity associated with its administration.We conducted a daily practice survey, an online search of available national regulation recommendations and of published guidelines. A bibliography search in French and English using Medline® and Embase® with the keywords "BCG"; "mitomycin C"; "epirubicin"; "bladder"; "complication"; "toxicity"; "adverse reaction"; "prevention" and "treatment" was performed November 2021.Patient information should be given by the attending physician before the first intravesical instillation. A medical exam to look for specific contraindications is also mandatory to select adequate candidates. Intravesical instillations should be delivered in health-care centers where urologic endoscopic procedures are routinely performed. Attending urologist or specialized nurse should check for negative pretreatment urine test. Intravesical instillation can only be delivered after bladder catheter has been inserted in the bladder without any injury of the lower urinary tract. The pharmaceutical agent should be kept in the bladder for two hours. Finally, voiding within the 6hours following intravesical instillations should be done in the sitting position and the patient should drink at least 2 liters of water per day for 2 days.The delivery of intravesical instillations of mitomycin C, epirubicin and BCG should follow a standardized procedure for better efficacy and lower morbidity.

Mitomycin C is the gold standard intravesical adjuvant therapy for intermediate-risk non-muscle-invasive bladder cancer (NMIBC). Tensions in the supply of mitomycin have emerged in France since late 2019. The ANSM in agreement with the AFU proposed to use epirubicin, already available in other European countries in this indication. The objective of our study was to report the initial French experience with the use of epirubicin in adjuvant treatment of NMIBC.We undertook a French multicenter retrospective descriptive study to collect, from the centers of the members of the CC-AFU bladder, the clinico-pathological data of the patients, the indications, the modalities of use (dose, indication, circuit in the pharmacy) and the tolerance data of epirubicin. The impact of the COVID-19 epidemic on treatment interruptions was also identified. Of the 20 centers contacted, 5 (25%) had implemented the epirubicin administration protocol developed by the CC-AFU bladder subcommittee. A total of 61 patients were treated with endovesical instillations of epirubicin between November 2019 and November 2020 for NMIBC at a single dose of 50mg.A total of 61 patients (mean age 67 years, 64-77 years) were treated with epirubicin, of which 45 (73.8%) were male. The patients had intermediate-risk NMIBC in 88.5%, the rest had high-risk disease. Induction therapy without or with maintenance was planned for 48 (78.7%) and 13 patients (21.3%), respectively. The preparation and administration of epirubicin was similar to that of mitomycin: central pharmacy preparation for same-day dispensing with immediate outpatient instillation. Unlike mitomycin, urinary alkalinization was not required. Of the 498 total instillations scheduled, 345 were performed (69.3%). The COVID-19 epidemic significantly impacted epirubicin delivery: one patient could not start treatment (1.6%), 8 patients (13.1%) had to discontinue it permanently; the rest of the patients underwent delayed instillations (18%). Other causes of discontinuation included infectious complications (9.8%). No major toxicities were reported.The implementation of an adjuvant epirubicin treatment protocol presented a good feasibility with low toxicity, without modifying the organization of the patients' care pathway. In the context of unpredictable mitomycin shortage, epirubicin represents a good therapeutic alternative in the endovesical adjuvant treatment of intermediate-risk NMIBC.3.

To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC).- 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.- 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 (PS1) and renal function (creatinine clearance60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival.- 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.

The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC).- 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.- 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.- These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.

Objectifs La mitomycine C est le traitement adjuvant intravesical de reference des TVNIM de risque intermediaire. Des tensions d’approvisionnement en mitomycine ont vu le jour en France depuis la fin de 2019. L’ANSM a propose d’utiliser l’epirubicine, disponible dans d’autres pays europeens. L’objectif de notre etude etait de rapporter l’experience initiale francaise de l’utilisation de l’epirubicine en traitement adjuvant des TVNIM. Methodes Une etude retrospective descriptive multicentrique francaise a permis de colliger, aupres des centres des membres du CCAFU vessie, les donnees clinicopathologiques des patients, les indications, les modalites d’utilisation (dose, indication, circuit a la pharmacie) et les donnees de tolerance de l’epirubicine. L’impact de l’epidemie de COVID-19 sur les interruptions de traitement a egalement ete recense. Sur les 20 centres contactes, 5 (25 %) ont instaure le protocole d’administration de l’epirubicine elabore par le sous-comite vessie du CCAFU. Au total, 61 patients ont ete traites par instillations endovesicales d’epirubicine entre novembre 2019 et mai 2020 pour une TVNIM a la dose unique de 50 mg. Resultats Au total, 61 patients (âge moyen 68,7 ans, 64–77 ans) ont ete traites dont 45 (73,8 %) etaient des hommes. Les patients presentaient une TVNIM de risque intermediaire pour 86,9 % (13,1 % haut risque). Un traitement d’induction sans/avec entretien etait prevu pour 48 (78,7 %) et 13 patients (21,3 %), respectivement. La preparation et l’administration de l’epirubicine etaient semblables a la mitomycine : preparation en pharmacie centrale, delivrance le jour de l’instillation en consultation sans alcalinisation urinaire. Sur les 498 instillations totales programmees, 345 ont ete realisees (69,3 %). L’epidemie de COVID-19 a considerablement impacte la delivrance d’epirubicine : un patient n’a pas pu demarrer son traitement (1,6 %), 8 patients (13,1 %) ont du l’interrompre definitivement ; le reste des patients ont subi des instillations decalees (18 %). Les autres causes d’arret comprenaient des complications infectieuses (9,8 %). Aucune toxicite majeure n’a ete deploree. Conclusion La mise en place d’un protocole de traitement adjuvant par epirubicine a presente une bonne faisabilite avec une faible toxicite, sans modifier l’organisation du parcours de soin du patient. Dans le contexte actuel de penurie de mitomycine de duree indeterminee, l’epirubicine represente une bonne alternative therapeutique dans le traitement adjuvant endovesical des TVNIM de risque intermediaire.

International audience; Objectifs : la prise en charge des tumeurs vésicales (TV) est complexe tant dans la réalisation du diagnostic endoscopique que dans les traitements itératifs et la surveillance. Malgré l’existence de recommandations, cette complexité peut faire suspecter une hétérogénéité des pratiques. L’objectif de cette étude était d’évaluer les pratiques des urologues français dans la prise en charge des TV.Méthodes : le questionnaire développé avec le logiciel SurveyMonkey évaluait les pratiques quotidiennes à partir de 27 questions divisées en 4 parties : informations générales sur le répondeur (3), fibroscopie (10), résection transurétrale de vessie (RTUV) (7), postopératoire (7). Ces questions étaient validées par le groupe vessie du comité de cancérologie de l’Association française d’urologie (CCAFU) et diffusées à la mailing-list des membres de l’AFU et des urologues entre avril et mai 2020. Les données ont été analysées puis comparées selon les sous-groupes suivants : l’âge, l’expérience, le secteur d’activité.Résultats : les caractéristiques des 224/1769 (12,7 %) répondeurs sont rapportées sur la Fig. 1. Lors du diagnostic, 60,1 % (n = 130) ne réalisaient pas de fibroscopie si une échographie suspectait une TV. Les résultats de l’endoscopie étaient rapportés sous la forme d’un rapport écrit (90,3 %, n = 196), par schéma (13 %, n = 30) ou photos (14 %, n = 31). Le courant électrique utilisé était monopolaire ou bipolaire exclusivement chez 38,9 (n = 84) et 32,7 % (n = 71) des répondeurs. La RTUV était réalisée indifféremment en monobloc ou copeaux par 57 % (n = 123) des répondeurs. Les mauvaises indications théoriques du monobloc suggérées par les urologues sont résumées sur la Fig. 2. Quarante-huit pour cent (n = 104) opéraient en lumière blanche exclusive. En cas de récidive supposée de faible risque, 65 % (n = 142) évoquaient une surveillance (traitement différé) mais 75 % (n = 164) refusaient un traitement sans histologie (fulguration). Les comparaisons entre groupes de praticiens sont rapportées dans le Tableau 1.Conclusion : les prises en charge des TV restent aujourd’hui variées dans la population des urologues français, avec une répartition homogène selon l’âge et l’expérience, et le secteur d’activité, comme le montrent les analyses en sous-groupes.

Objectifs La prise en charge des prolapsus genito-urinaires connait un tournant majeur en 2020 suite au retrait des protheses vaginales. Nous presentons les resultats d’une serie retrospective de reparation vaginale autologue de prolapsus uterin predominant avec cystocele d’entrainement par hysterectomie totale voie basse (HTVB) et soutenement sous-vesical par croisement des ligaments uterosacres selon la technique de Campbell (C-SLUS) avec pour objectif l’evaluation du taux de recidive. Methodes Notre etude a inclus les patientes operees entre 2011 et 2018 d’une HTVB avec C-SLUS, sans implant prothetique, soit 94 patientes. Notre objectif etait d’evaluer le taux de recidive de prolapsus anterieur et/ou apical. La recidive etait definie par un critere composite incluant recidives symptomatique et asymptomatique avec stade POP-Q ≥ 2. La survie sans recidive (SSR) a 2 ans a ete etudiee par methode de Kaplan–Meier. Une analyse univariee puis multivariee a ete effectuee pour determiner les facteurs associes a la recidive. Les objectifs secondaires etaient l’analyse des complications postoperatoires precoces, les resultats fonctionnels urinaires et sexuels et le taux de chirurgie pour recidive. Resultats Quatre-vingt-trois (88,3 %) et 65 (69 %) patientes avaient respectivement une hysterocele et cystocele de stade ≥ 3. Avec un suivi moyen de 36 mois, le taux de recidive etait de 21,3 % incluant 3 cystoceles (3,2 %). La SSR a 2 ans etait de 80 %. En analyse multivariee, l’âge, l’indice de masse corporelle, le stade POP-Q pre operatoire et un geste peroperatoire sur le compartiment posterieur n’etaient significativement pas associes au risque de recidive. Le taux de complications precoces etait de 21,2 % (95 % de grade ≤ 2). Onze patientes (11,7 %) ont presente des symptomes urinaires de novo. Les taux de guerison d’incontinence urinaire d’effort et d’urgenturie etaient respectivement de 80 % et 80,6 %. Le taux de satisfaction sexuelle parmi les patientes declarees actives etait de 95,8 %. Treize patientes (13,8 %) ont ete operees pour recidive symptomatique. Conclusion L’HTVB avec C-SLUS a ete un traitement de premiere intention efficace des prolapsus uterins symptomatiques predominants avec cystocele d’entrainement, avec des resultats fonctionnels satisfaisants a moyen terme. Cette technique s’inscrit dans les reparations vaginales autologues qui devraient connaitre un nouvel essor suite a l’arret de commercialisation des protheses vaginales developpees pour corriger les etages anterieur et moyen.

The French population is facing the COVID-19 pandemic and the health system have been reoriented in emergency for the care of patients with coronavirus. The management of cancers of the urinary and male genital tracts must be adapted to this context.An expert opinion documented by a literature review was formulated by the Cancerology Committee of the French Association of Urology (CCAFU).The medical and surgical management of patients with any cancers of the urinary and male genital tracts must be adapted by modifying the consultation methods, by prioritizing interventions according to the intrinsic prognosis of cancers, taking into account the patient's comorbidities. The protection of urologists from COVID-19 must be considered.The CCAFU issues an expert opinion on the measure to be taken to adapt the management of cancers of the male urinary and genital tract to the context of pandemic by COVID-19.

Objectifs Durant la pandemie COVID-19 les activites operatoires et de consultations ont ete reduites. Des recommandations de modifications de pratiques ont ete publiees par l’AFU sur la priorisation des procedures de diagnostic et des interventions. Une enquete a ete faite aupres des urologues pour analyser leurs pratiques a l’issue de ces recommandations. Methodes Nous avons effectue une enquete en ligne parmi les urologues de France membres de l’AFU, apres la diffusion des recommandations. Le questionnaire en langue anglaise avait ete etabli par la Societe internationale d’urologie (SIU) dans le cadre d’une enquete a l’echelle internationale. Nous avons compare les modifications declarees par les urologues a celles proposees par les recommandations. Resultats Au total, 254 urologues francais ont repondu. Quatre-vingt pour cent etaient âges de plus 40 ans et 63 % exercaient en secteur liberal. Soixante-six pour cent avaient restreint les consultations physiques et utilisaient la telemedecine. Cinquante et un pour cent des biopsies prostatiques etaient differees ; 81,5 % avaient restreint leur activite de bloc de plus de 75 %. Les RTU de vessies, cystectomies, nephro-ureterectomies, nephrectomies et prostatectomies etaient maintenues respectivement dans 91 %, 93,6 %, 87,7 %, 61,4 % et 51,2 %. Concernant les orchidectomies/penectomies et les curages retroperitoneaux ils etaient maintenus dans 95,2 % et 77,6 %. Conclusion Les resultats de l’enquete revelaient globalement une pratique des urologues volontaires pour repondre, conforme aux recommandations du CCAFU. La limite de l’etude etait que les items du questionnaire ne comprenaient pas la pratique des instillations endovesicales ni la programmation des cancers du rein ou de la prostate en fonction de facteurs pronostiques, contrairement aux recommandations.

To describe the epidemiology of prostate cancer (PCa) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to PCa. Recall therapeutic options and the treatment options specific to elderly patients.Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, prostate cancer, diagnosis, treatment.The median age at diagnosis for PCa is 69 years old, making PCa the very type of cancer of the elderly. The specific mortality of the disease increases with age. This translates two of its characteristics. First, a diagnosis at higher grade and stage is more common in older patients than in younger patients. Secondly, use of curative therapeutic options is less common in elderly patients than in younger patients. SIOG recommends a specific geriatric assessment for patients with PCa, which may be useful, but the need for an initial detection of cognitive disorders is open to criticism. There is no therapeutic trial, if only prospective, dedicated to elderly patients with PCa. However, decision-making in the elderly patient with PCa must pursue two goals: first, the respect of the expectations specific to each patient and secondly, the search for the global clinical benefit; goals that should not be restricted to elderly patients.PCa in the elderly patient follow the current guidelines for diagnostic and for treatment. Compliance with these guidelines should eliminate both the late diagnosis and the under-treatment actually observed.

First, to present the epidemiological data of aging and of cancers and to describe the respectives expected evolutions. Second, to present biological and genetic data on aging and on the relationships between aging and oncogenesis.Bibliographic search from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as from the web sites of geriatric scientific societies, the United Nations, the World Bank, the World Health Organization, the Institut National du Cancer and the Ligue Contre le Cancer from the following keywords: aging, elderly, cancer, epidemiology, biology, genetics.The entire world population is aging very significantly and very rapidly. In France, new cases of cancer are diagnosed in 62.4% of cases in patients over 65 and in 11.5% of cases in patients over 80 years. Cancer mortality occurs in 75.3% of cases in patients over 65 years of age and in 24.8% of cases in patients over 80 years of age. Cancer-specific mortality is consistently higher in patients older than 75 years compared to younger patients; this reflects, among other things, an age discrimination which is called agism. It has been established that cellular aging is marked by 9 major families of biological and genomic abnormalities. Biological aging and oncogenesis are intertwined with increasingly well established relationships. They are both the product of natural selection and they are found in all species with both renewal tissues and a distinction between germinal tissue and somatic tissue.Epidemiological data predict that oncology, including urological oncology, is becoming very predominantly geriatric oncology; it is critical and urgent that society be prepared for it and that every care-giver be prepared, that is, be specifically trained. Biological and genetic data argue for a great entanglement between aging and oncogenesis; research in each of these areas should be reconciled for mutual benefit.

To describe the epidemiology of renal cell carcinoma (RCC) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to RCC. Recall therapeutic options and the treatment options specific to elderly patients.Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, renal cell carcinoma, small renal mass, diagnosis, treatment.The incidence of RCC increases in France and peaks between 70 and 80 years. This increase in incidence is mainly due to the diagnosis of small renal masses (SMR). The specific mortality of RCC increases with age (at least between 75 and 95 years). Tumor biopsy, especially of SMR, should be considered in the elderly patient. The geriatric assessment of patients with CaR has no specificity apart from specific evaluation of renal function and operative risk. There is no prospective therapeutic trials dedicated to elderly patients with localized RCC. Surgical treatment requires the use of fast track protocol (the modalities of which are being elaborated) in which geriatricians play a key role throughout the process. The role of percutaneous ablative treatment should be better defined in elderly patients. However, given their low specific mortality, surveillance of SRM (at least initially) is probably an interesting option, certainly under-used, although its impact on quality of life remains to be clarified. The overarching goal of geriatric oncology must guide the decisions of care in the older patient with CaR: first, the respect of patient-specific expectations and secondly the search for an overall clinical benefit; objectives that have no reason to be restricted to elderly patients.RCC is becoming a predominantly elderly cancer. It responds to the current general diagnostic and therapeutic guidelines. It is desirable that clinical research help to better define the respective roles of percutaneous biopsy and treatment of localized RCC.

To explain the notion of frailty, then to explain how crucial is the detection of frailty detection in the elderly patient, and, in cases of suspected frailty, how crucial is the need for geriatric assessment. To describe (i) how this assessment of the elderly cancer patient is performed, (ii) how the results of this geriatric assessment must drive the decision making, and (iii) the role of the geriatrician in the care pathway.Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific geriatric societies, from the National Cancer Institute using the following keywords: elderly, geriatrics, cancer, frailty, assessment, decision making.The goal of frailty detection is to optimize care, to maintain the independence and the survival of the patient. The prevalence of frailty increases with the age and the diagnosis of cancer. Detection of frailty in the elderly patient with cancer is performed using the G8 questionnaire recommended by the INCa. In case of anomaly or clinical justification, the patient receives a geriatric assessment, which is a multidimensional and multidisciplinary procedure. The clinician can call on the UCOG of the region in which he practices. The relevance of medical decisions will be based on the results of this geriatric assessment. The geriatrician plays a crucial role and will be involved throughout the care.The detection of frailty in the elderly patient with cancer is obligatory. Consecutive geriatric assessment can be performed by the UCOG of the region. The results of the geriatric assessment must serve as a basis for any therapeutic decision making and the preservation of the independence of the patient must remain the priority.

To define the necessary arrangements of medical treatment with anti-angiogenics, mTOR inhibitor or systemic immunotherapies in the management of metastatic renal cell carcinoma in elderly patients.Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: metastatic renal cell carcinoma, elderly, treatment.The selection criteria for the medical treatment of metastatic renal cell carcinoma in elderly patients are the IMDC score, necessarily complemented by performance status, the tolerability profile of treatments, more frequent drug interactions, treatment adherence, management capacity of side effects, and patient preference. Each of these criteria is detailed in critical ways.The efficacy and tolerability of medical treatments for metastatic renal cancer have not been reported as different depending on age. No dosage adjustment is recommended in principle. However, prevention and early treatment of side effects of treatment should be strengthened in elderly patients.

To define and present potential improvements for the management of bladder cancer in older patients.Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, treatment, BCG, chemotherapy, cystectomy, and elderly.The oncological principles of medico-surgical management of bladder cancer do not differ according to age. On the other hand, the patient comorbidities have been likely to alter the tolerance of these treatments. At the NMIBC stages, no adaptation of the standard treatment has demonstrated any interest. At the MIBC stages, the prognosis was improved by geriatric multidisciplinary perioperative management.The indications and principles of surgical treatments must be identical regardless of the patient age. At the NMIBC stages, adjuvant therapy, including BCG therapy, should not be questioned because of the age of the patient. On the other hand, at the localized MIBC stages, neoadjuvant and adjuvant chemotherapy should not be considered as a standard and their indications assessed individually after geriatric assessment.

To define and present explanations for the epidemiological, pathological and prognostic differences in bladder cancer in elderly patients.Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: bladder cancer, carcinogenesis, elderly, epidemiology, prognosis.Bladder cancer is a growing concern for the elderly first and foremost and with an impact, mainly those who are consumers or former users of tobacco, whose therefore frequently have comorbidities associated with this consumption. The initiated carcinogenesis extends with the life length of patients, increasing the prevalence of bladder cancer. Aging promotes carcinogenesis by both potentiating its genetic abnormalities and reducing the immune system performance of the aged host to destroy cancer cells. The delay in the diagnosis of bladder cancer in elderly patients is explained and make up for the time could improve the prognosis.Regardless of variations in therapeutic effect and morbidity and mortality of treatments, aging promotes the occurrence and aggressiveness of bladder cancer. The incentive to stop exposure to carcinogens and the search for bladder cancer in patients with hematuria should not reduce with advanced age but instead be promoted in order to improve the prognosis.

To determine the usefulness of the frozen section exams of lymph nodes dissection, ureteral and urethral section during radical cystectomy for urothelial carcinoma and define the impact on the surgical procedure.A retrospective, single-center study of data collected from 182 patients who underwent radical cystectomy for an cT=3bN0M0 urothelial bladder cancer between 2016 and 2018. Bladder cancer extension was determined by thoracoabdominal CT with contrast enhancement and urography and an 18-FDG PET scanner. No patient received neoadjuvant chemotherapy. The diagnostic performance of the frozen section exams was related to final examinations. The impact of the result on the initial intervention was determined.The frozen section were positive in 29 lymph nodes dissections (15.9 %), 59 (16.6 %) ureteral and 20 (10.9 %) ureteral recessions. With lymph nodes exams, sensitivity, specificity and positive and negative predictive values were 93.5 %, 100 %, 100 %, and 98.7 %, respectively. With ureteral sections exams the same values were 91.5 %, 100 %, 100 %, and 98.4 % respectively. With urethral section exams, all the values were of 100 %. Finally, all the procedure has been modified for all patients with positive frozen section exam except one positive urethral section that did not give rise to radical urethrectomy.Frozen section exams were useful to the urologist during radical cystectomy for urothelial carcinoma. The performances of the frozen section exams carried out were excellent. The information of the urologist of the positive frozen section leeds to modify its management during the intervention in all the studied cases with the exception of one case.

To analyze the indications of radical prostatectomy and lymph node dissection retained during the last 12 years in an academic surgical center in the Paris region in order to ensure their adequacy in relation to the current clinical guidelines.Monocentric retrospective study of prospectively collected data, between 2007 and 2019. Analysis of the clinical and pathological characteristics which were taken into account during multidisciplinary meeting discussion for the treatment decision, and comparison of their evolution over the four 3-year period corresponding to the clinical guideline updates.Two thousand eighty-eight consecutive patients treated by radical prostatectomy between 16/03/2007 and 17/03/2019 were included. The proportion of patients classified as low, intermediate or high risk according to D'Amico system was 13.2%, 80.8% and 6.0% respectively. An increase in the frequency of surgical treatment of high-risk cancers has been observed. At the same time, there has been a decrease in the frequency of prostatectomies to treat low-risk cancers.The indications for radical prostatectomy and lymph node dissection have evolved in line with the current clinical guidelines which were taken into consideration in a onco-urological multidisciplinary meeting.3.

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.

Objectifs La prise en charge des TVNIM a evolue au cours de ces dernieres annees. Le but de ce travail etait d’evaluer la prise en charge des TVNIMs a haut risque au sein des RCPs dans le cadre d’une enquete de pratique de l’AFU. Methodes En octobre 2019, le reseau sentinelle des RCPs de l’AFU a ete sollicite par le biais d’un questionnaire proposant un cas clinique prepare par un des membres du CCAFU. Le cas clinique interrogeait sur la prise en charge d’une TVNIM (pT1 haut grade + CIS) revelee par une hematurie chez un homme de 65 ans. Les questions abordaient le bilan diagnostique (cystoscopie, cytologie, uro-TDM), la technique de resection (lumiere blanche/bleue, second look), les instillations adjuvantes (BCG, induction, entretien) et les options a envisager en cas de recidive. Resultats Au total, 72 equipes ont ete sollicitees et 30 RCPs ont repondu au questionnaire, soit 41,6 %. Ces 30 equipes regroupaient 120 medecins dont 70 % au moins etait des urologues. Le nombre minimum de medecins etait de 3 par RCP (2 specialistes d’organe et 1 specialiste non clinicien) conformement a la regle etablie. Le bilan diagnostique en presence d’une hematurie macroscopique chez un fumeur etait conforme aux recommandations du CCAFU dans 75 % des cas. La primo-resection etait volontiers proposee en lumiere bleue (55 %), puis en lumiere blanche (35 %) voir au NBI (10 %). En presence de pT1, 97 % des collegues ont propose une re-resection de principe. S’agissant des instillations, 70 % des collegues proposaient des instillations de BCG d’induction puis d’entretien pour 1 a 3 ans. En cas de recidive precoce et de tumeur « non repondeuse au BCG » l’option de la cystectomie restait majoritaire (60 %) mais avec un taux d’adhesion plus limite des medecins mettant en avant le risque de refus de certains patients. En l’etat des connaissances actuelles, les options therapeutiques chez les patients refractaires au BCG sont trop limites ( Fig. 1 , Tableau 1 , Tableau 2 ). Conclusion L’enquete de pratique de l’AFU discutait d’un cas de TVNIM a haut risque pour lequel les recommandations du CCAFU etaient suivies par la majorite des collegues. Neanmoins, certaines situations cliniques ne sont pas couvertes par les recommandations car les donnees de la litterature sont pauvres et traduisent le manque d’option therapeutique, notamment dans les cas de tumeurs refractaires au BCG.

Objectifs La strategie de prise en charge des oncocytomes reste heterogene de par la crainte d’une croissance tumorale alterant le parenchyme renal restant et de la meconnaissance d’une tumeur mixte. L’objectif de ce travail etait d’evaluer les strategies de prise en charge et l’evolution clinique et radiologique d’une cohorte d’oncocytomes biopsies. Methodes Nous avons revu retrospectivement tous les dossiers de biopsies renales realisees dans deux centres universitaires francais entre 2009 et 2019. Tous les cas d’oncocytomes identifies sur la biopsie renale ont ete extraits. Les donnees suivantes ont ete analysees : âge de la population, terrain genetique, taille de la tumeur sur imagerie et modalites de prise en charge de l’oncocytome. Resultats Cinquante-deux patients ont ete identifies, âge moyen au diagnostic 63 ans, dont un syndrome de Birt–Hogg–Dube. Au total, 18 patients ont ete traites d’emblee (12 par chirurgie partielle et 6 par traitement ablatif percutanee) et 34 n’ont pas eu de traitement actif immediat (25 surveilles et 9 abstentions therapeutiques). La croissance tumorale de l’oncocytome a pu etre evaluee en moyenne a 2 mm par an. La correspondance histologique des biopsies des oncocytomes par rapport a la piece definitive etait de 79 % (1 cellule claire grade 2 et 2 tumeurs hybrides retrouvees). Chez les 25 patients ayant eu une surveillance initiale 5 ont finalement subi un traitement actif (3 cryotherapies, 1 nephrectomie partielle et 1 nephrectomie elargie) motive a chaque fois par croissance tumorale (moyenne 5,2 mm/an). Conclusion Dans notre cohorte, la croissance tumorale etait faible et la surveillance le traitement de choix, cette attitude therapeutique etant adaptee en fonction de la croissance tumorale (plus de 5 mm par an dans notre cohorte) et du terrain particulier (âge jeune, forme familiale connue) faisant craindre une tumeur mixte.

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.

Objectifs L’infiltration lymphocytaire intratumorale est un biomarqueur potentiel a visee pronostique et predictive de la reponse aux immunotherapies dans de multiples types tumoraux, dont les carcinomes urotheliaux. Cependant, differentes methodes de quantification peuvent etre utilisees et le niveau de concordance entre l’evaluation morphologique des lymphocytes (score TILs), la densite des lymphocytes T (CD3 + ) et de lymphocytes cytotoxiques (CD8 + ) caracterises par immunohistochimie est inconnu. Methodes Nous avons evalue ces 3 parametres sur une serie retrospective de carcinomes urotheliaux primaires naifs de tout traitement (n = 78). Les stades pathologiques comprenaient 10 pTa, 29 pT1, 17 pT2, 15 pT3, et 7 pT4. L’infiltration lymphocytaire morphologique globale etait evaluee par le pathologiste a partir d’une coloration HES (score TIL). La densite intratumorale des cellules CD3+ et CD8+ etait determinee par analyse d’images. Nous avons etudie la correlation de ces parametres entre eux ainsi qu’avec le stade pathologique de la tumeur primitive. Resultats L’infiltration lymphocytaire intratumorale par les cellules CD8+ augmentait de maniere significative avec le stade pathologique (pTa/1 vs pT2-4 : moyenne 186 vs 320 cellules/mm2 ; p Conclusion La densite de cellules CD8+ et le ratio CD8+/CD3+ etaient correles au stade tumoral, suggerant un augmentation de la reponse immunitaire T cytotoxique avec la progression tumorale. L’evaluation morphologique des TILs rend imparfaitement compte de la presence de lymphocytes T (CD3 + ) et ne permet pas d’evaluer la presence de lymphocytes T cytotoxiques (CD8 + ) dans les carcinomes urotheliaux de stade localise.