Objectives. - Assessment of the Adjustable Continence Therapy device (ACT (R)) in the treatment of female stress or mixed urinary incontinence in terms of efficacy and complications.Material. - Between April 2005 and September 2011, the device ACT (R) was put by two different operators to treat a stress and/or mixed urinary incontinence at women. The results were studied under two shutters: complications and efficacy.Results. - Seventy-seven women were operated. Mean age of the patients was of 68 years (34-87). Mean follow-up was of 22 months (1-72). Over the 77 patients, eight peroperative complications (10%) were noted. Twenty-five explantations were required in 22 patients (28%). In terms of efficacy, after an average follow-up of 22 months, the results were: 19 patients (25%) were continents, 25 (33%) very improved and five (6%) improved regards to the initial stage preceding the implantation. Fifteen patients (19%) were in failure. Seven patients (9%) were unchanged and in the course of adjustment (recent implantation) and six others (8%) explanted waiting for another implantation.Conclusion. - The ACT (R) procedure was feasible on a population of multi-operated women with 64% of improvement in our hands. Complications were rare, easily detected and repaired. The risk of explantation was reported to be 28%. (C) 2013 Published by Elsevier Masson SAS.

The apex is a particular region of the prostate in its surgical dissection and pathological analysis. We sought to evaluate the prognostic value of the apical localization of prostate tumors.From 1988 to 2010, data pre- (age, clinical stage, preoperative PSA, biopsy Gleason score) and postoperative (prostate weight, pathologic stage TNM 2010, Gleason score, margin status) of 2765 total prostatectomies were collected prospectively. These data were compared according to existence or absence of tumor at the apex. The prognostic impact of tumor at the apex on biochemical recurrence-free survival (PSA>0.2 ng/mL) has been studied in univariate and multivariate models.One thousand eight hundred seventeen tumors had a location at the apex (65.7%). In univariate analysis, there was a significant difference in the clinical stage, the biopsy and pathological Gleason score, the result of curage, the pathological stage and the margin status between apical tumors and others. With a mean decline of 34.6 months, 502 patients had a biochemical recurrence (18.1%). Disease-free survival at 10 years was 60.7% for tumor at the apex versus 65.9% in other cases. The location at the apex was significantly associated with biochemical recurrence on univariate analysis (P=0.01). After adjustment for clinical and pathological stage, PSA level, Gleason score and surgical margins, the apex was not anymore a pejorative independent predictor (P=0.0087).The existence of tumor in the prostatic apex was associated with more aggressive tumoral criteria and was an independent and pejorative predictor of biochemical recurrence-free survival at 10 years in univariate analysis. The apical localization could be an additional argument in the decision of adjuvant therapy after prostatectomy.

L’angiosarcome primitif du rein est une tumeur rarissime. Nous rapportons, ici, un cas d’angiosarcome du rein droit chez un homme de 60ans. L’aspect tomodensitométrique était celui d’une tumeur solide compatible avec un carcinome à cellules rénales. L’examen anatomopathologique de la pièce de néphrectomie a corrigé le diagnostic et a affirmé la nature angiosarcomateuse. Chez ce patient métastatique osseux et pulmonaire synchrone, l’évolution a été foudroyante avec un décès survenu en moins de trois mois. La revue de la littérature confirme le fort potentiel de malignité de ce type de tumeur (métastases quasi constantes et survie très courte en dépit des traitements locaux et généraux).

The primary angiosarcoma of the kidney is a rare tumor. We report a case of angiosarcoma of the right kidney in a man of 60 years. The CT-scan appearance is the one of a solid tumor compatible with renal cell carcinoma. Histological examination of the piece of nephrectomy straightens diagnosis and reveals the angiosarcomatous nature. In this patient with bone and lung synchronous metastasis, evolution has been a lightning death in less than three months. The literature review confirms the high potential of malignancy of these tumors (metastases almost constant and very short survival in spite of local and systemic treatment).

A healthy 30-year-old man was referred with pain in the right lumbar region and with a history of macroscopic hematuria. He had arrived from Mali 5 years previously, and questioning of the patient revealed that he would often wade barefoot through freshwater lakes, falls and streams. Findings on physical examination were unremarkable. The results of blood tests were normal except for a peripheral blood eosinophilia of 0.65 × 109/l (10.7%). A urinary dipstick test was positive for protein and blood. A computed tomography scan revealed linear calcification occupying the entire bladder wall circumference and nearly throughout the length of the left and right ureters (Figure 1, Figure 2).1Kehinde E.O. Anim J.T. Hira P.R. Parasites of urological importance.Urol Int. 2008; 81: 1-13Crossref PubMed Scopus (12) Google ScholarFigure 2Initial non-enhanced computed tomography scan showing calcification of the bladder wall circumference.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The urine sediment allowed the detection and identification of terminally spined Schistosoma haematobium ova.2Alvarez Maestro M. Rios Gonzalez E. Dominguez Garcia P. Vallejo Herrador J. Diez Rodriguez J. Martinez-Piñeiro L. Bladder schistosomiasis: case report and bibliographic review.Arch Esp Urol. 2010; 63: 554-558Crossref PubMed Google Scholar Concurrently, cystoscopy demonstrated a large number of white tubercules surrounded by a zone of hyperemia in the bladder wall. Histological examination of biopsy specimens revealed S. haematobium ova in the submucosa with granuloma formation. The serum anti-schistosomal antibody measurement was positive by direct immunofluorescence at 1/160 (positive threshold level, 1/10). The patient was successfully treated with praziquantel, given as a split dose of 40 mg/kg on a single day.3Danso-Appiah A. Utzinger J. Liu J. Olliaro P. Drugs for treating urinary schistosomiasis.Cochrane Database Syst Rev. 2008; (CD000053)PubMed Google Scholar Timely recognition and treatment are necessary to prevent the development of Schistosoma-related complications, commonly represented by ureteral obstruction, secondary hydronephrosis or metaplastic cell changes.4Salem S. Mitchell R.E. El-Alim El-Dorey A. Smith J.A. Barocas D.A. Successful control of schistosomiasis and the changing epidemiology of bladder cancer in Egypt.BJU Int. 2011; 107: 206-211Crossref PubMed Scopus (35) Google Scholar Conflict of interest: No conflict of interest to declare.