PURPOSE:To report our preliminary experience with water vapor thermal therapy with the Rezūm™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients.PATIENTS AND METHODS:A multi-institutional study was conducted including all patients who underwent Rezūm™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezūm™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence.RESULTS:Eleven patients from the Rezūm™ group were matched to 11 embolized patients. PAE and Rezūm™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezūm™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezūm™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezūm™ patients (P=0.54).CONCLUSIONS:Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezūm™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezūm™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient.LEVEL OF EVIDENCE:3.

We evaluated the feasibility and outcomes of immediate preoperative renal artery embolization (IPRAE) before complex nephrectomy for locally advanced RCC ± inferior vena cava thrombus (IVCT). A comparative retrospective (2007–2017) multicenter study which included 145 patients with locally advanced RCC ± IVCT: 99 radical nephrectomies vs. 46 radical nephrectomies with IPRAE identified in the prospective UroCCR national database (CNIL DR 2013–206; NCT03293563). IPRAE was performed under local anesthesia the day of nephrectomy (< 4 h prior to nephrectomy). The primary endpoint was peroperative blood loss (mL). Secondary outcomes were: tolerance of embolization (pain visual scale), success rate of IPRAE defined by complete devascularization of the kidney, perioperative complications according to Clavien score and postoperative GFR. The baseline characteristics of IPRAE and the control groups were similar. Tumor staging was 14% T2b, 41% T3a, 27% T3b, 13% T3c, 6% T4. The success rate of IPRAE was 98%. Median artery embolizated per patient was 2 (Agochukwu and Shuch in World J Urol 32:581–589, 2014; Marshall et al. in J Urol 139:1166–1172, 1988; Yap et al. in BJU Int 110:1283–1288, 2012;Gill et al. in J Urol. 194:929–938, 2015; Wang et al. in Eur Urol 69:1112–1119, 2016). No severe complications occurred after IPRAE. Postembolization syndrome was reported in 7% (Clavien I-II). Mean peroperative blood losses in the IPRAE and control groups were: 726 ± 118 ml and 1083 ± 114 ml (P = 0.03). In a multivariate analysis that included: age, Karnofsky index, IPRAE (yes vs. no), IVCT (yes vs. no), tumor size and synchronous metastasis, no IPRAE and IVCT were significantly associated with increased peroperative bleeding. IPRAE before nephrectomy for locally advanced and/or IVCT tumors was well tolerated, was associated with lower peroperative bleeding and did not increase the incidence or severity of postoperative complications.

Actuellement le CCAFU recommande de réaliser une biopsie rénale dans des situations bien spécifiques (avant surveillance, traitement ablatif, traitement systémique chez le patient M+, doute diagnostic) et plus globalement chaque fois que la biopsie est susceptible de modifier la prise en charge. Nous avons mené une revue bibliographique Pubmed sur la performance diagnostique et les complications de la biopsie de tumeur rénale. La biopsie rénale est un examen fiable, sûr et performant pour la caractérisation des tumeurs du rein, avec un niveau de preuve scientifique élevée. Les sensibilités et spécificité de la biopsie pour la détermination de la malignité/bénignité sont ainsi de 99,1 % de 99,7 % au prix d’une morbidité faible. Plusieurs études récentes rapportent que la biopsie tumorale modifie de façon significative la prise en charge thérapeutique des petites masses rénales en particulier, et dans une moindre mesure des tumeurs localement avancées, la biopsie ayant pour conséquence la diminution des chirurgies pour tumeur bénigne. Dans cette revue nous faisons le point sur la technique de biopsie et son intérêt potentiel pour les petites masses, les tumeurs > 7 cm et les tumeurs métastatiques. Currently the CCAFU recommends performing a renal biopsy in very specific situations (before surveillance, ablative treatment, systemic treatment in metastatic patient, undetermined tumor) and more generally when the biopsy is likely to change the management. We performed a review on Pubmed dealing with the diagnostic accuracy and complication of renal tumor biopsy. Renal biopsy is a reliable, safe and effective technic for the characterization of renal tumors, with a high level of evidence. The sensitivity and specificity of the biopsy for the determination of the malignancy/benignity are 99.1% of 99.7% respectively. Recent studies reported that tumor biopsy significantly modified the therapeutic management of small renal masses in particular, and to a lesser extent locally advanced tumors, the biopsy resulting in the reduction of benign tumor surgeries. In this review we propose a state of the art on the technique of biopsy and its potential interest for small renal masses, tumors > 7 cm and metastatic tumors.

Le priapisme artériel est une pathologie rare mais classique dont l’étiologie principale est le traumatisme périnéal suite à une chute à califourchon. Ce traumatisme est responsable d’une lésion vasculaire d’une artère caverneuse ou d’une de ses branches conduisant à une fistule artériocaverneuse et une dérégulation du flux artériel des corps caverneux. L’érection est le plus souvent incomplète et non douloureuse. La prise en charge n’est pas urgente mais doit être planifiée afin de ne pas compromettre la fonction érectile future. Dans un premier temps, le traitement est conservateur par compression échoguidée du faux-anévrysme et glaçage du périnée. En cas d’échec, un traitement par radiologie interventionnelle par une équipe spécialisée doit être proposé.

La radiofréquence et la cryothérapie sont les deux principales techniques ablatives et les principales alternatives à la chirurgie pour le traitement des petites masses rénales. Deux méta-analyses ont comparé radiofréquence et cryothérapie, et conclu à leur équivalence en termes de succès, de récidive et de complications. La cryothérapie est plus coûteuse, techniquement plus compliquée (plusieurs ponctions pour plusieurs cryodes, durée de traitement plus longue), et paraît plus adaptée aux tumeurs complexes (centrorénale et/ou au contact de la voie excrétrice). La voie d’abord percutanée est privilégiée par rapport à la laparoscopie pour sa morbidité moindre et un positionnement des aiguilles guidé par l’imagerie qui est plus précis.

Tubulocystic renal cell carcinoma (TC-RCC) is a recently identified renal malignancy. While approximately 100 cases of TC-RCC have been reported in the pathology literature, imaging features have not yet been clearly described. The purpose of this review is to describe the main radiologic features of this rare sub-type of RCC on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), based jointly on the literature and findings from a multi-institutional retrospective HIPAA-compliant review of pathology and imaging databases. Using a combination of sonographic and CT/MRI features, diagnosis of TC-RCC appeared to be strongly suggested in many cases.

We report the case of an early local recurrence after a laparoscopic partial nephrectomy (LPN) for a Furhman grade 1-2 clear cell renal carcinoma (CCRC). CT scan at 6 months revealed a local recurrence. An open total nephrectomy was performed. There were six nodules in the perirenal fat from a grade 3 CCRC. Twenty-six months after the LPN, the patient had a wound recurrence, which was surgically removed. Four months after the wound recurrence, the patient had pulmonary, liver and adrenal glands metastasis. He received an oral treatment with sunitinib. At 4 months after the initiation of the sunitinib, he had a total response.