The French Medical Corps employs surgical teams on the different conflict zones, associating a visceral surgeon with an orthopaedic surgeon in the same team.The polyvalent training in general surgery allows urologists in taking in charge the injured patients within surgical teams or role 3 military campaign hospitals with more important staff, as in Afghanistan today. With their experience in the different recent conflicts, the authors tried to precise the present role of the urologist within these surgical teams.

Several studies have tried to show a link between inflammation and cancer. In prostate cancer (PCa) development, this question is still not completely elucidated. The aim of the study was to investigate, whether the presence of inflammation in the first series of prostate biopsies was a factor of risk.

Le lymphome primitif de la prostate est une affection maligne rare. Les patients présentent initialement des signes urinaires locaux et des signes généraux. Plusieurs traitements ont été utilisés comme la prostatectomie radicale, la radiothérapie ou des associations de chimiothérapie et de radiothérapie. Une revue de la littérature fait état du mauvais pronostic du lymphome de la prostate, le diagnostic se faisant souvent à un stade tardif. Nous rapportons le cas d’un patient âgé de 73 ans présentant une rétention aiguë d’urines dans un contexte de constipation opiniâtre avec amaigrissement sévère. Il était diabétique, aux antécédents de carcinome urothélial de stade pT1 et de grade G3, traité par résection transurétrale et BCG thérapie. L’examen clinique a révélé une prostate très augmentée de volume, ce qui a été confirmé par les examens d’imagerie. L’analyse anatomo-pathologique des biopsies réalisées par voie transrectale a mis en évidence un lymphome malin non Hodgkinien de type B primitif de la prostate. La prise en charge a consisté en une chimiothérapie. Malgré une régression considérable du volume tumoral à partir de la troisième semaine, le patient est décédé au lendemain de son 5ème cycle de chimiothérapie.

Objective. - Several studies have tried to show a link between inflammation and cancer. In prostate cancer (PCa) development, this question is still not completely elucidated. The aim of the study was to investigate, whether the presence of inflammation in the first series of prostate biopsies was a factor of risk.Patients and methods. - In this retrospective study, we examined prostate biopsy specimen of 220 consecutive patients, who had undergone repeat prostate biopsies in our department. The first screening round was performed between 2000 and 2005. These first prostate biopsies were examined by two pathologists blinded to the patient's follow-up. Inflammation and several histological criterions were evaluated: acute/chronic and focal/diffuse inflammation, atrophy, high grade PIN (HGPIN) and ASAP. We compared PCa incidences rates (IR) for the different histologic markers using chi(2) analysis and estimated the relative risk (RR) of PCa.Results. - Two hundred and one patients were included definitively with a median follow-up of 2.1 years (42 days - 8.9 years, period between the first and the last biopsy). One hundred and twenty-six patients (62.7%) were identified with inflammation in the first biopsies (inflammatory group [IG]). Ninety-seven patients (48.3%) had PCa, 58 from the IG. PCa IR did not differ significantly between patients with or without inflammation (RR: 0.9, p = 0.6).Conclusions. - According to these data, the presence and type of histological inflammation on initial prostate biopsies did not seem to be a risk factor for the development of PCa. (C) 2010 Elsevier Masson SAS. All rights reserved.

The seven reported clinical cases illustrate the different circumstances when a retroperitoneal salvage surgery is needed. It can be justified by a relapse due to an initially incomplete surgery highlighting why the respect of retroperitoneal lymphadenectomy indications matters. It can also be necessary as salvage surgery when chemotherapy fails. Growing teratoma, either it happens during initial chemotherapy or later also justified this surgery. Finally late relapses are indications for this surgery.

Primary lymphoma of the prostate is a rare malignancy. Patients initially present with local and general symptoms. A variety of treatments have been used, including prostatectomy, radiotherapy, or a combination of chemotherapy and radiotherapy. Reports in the literature reflect the poor outcome of prostatic lymphoma due to the fact that it is usually diagnosed late. We report the case of a 73-year-old patient who presented with urinary retention associated with persistent constipation and considerable weight loss. He was diabetic and reported a history of transitional cell carcinoma stage pT1, grade G3, which had been treated with transurethral resection and BCG therapy. Physical examination revealed a considerably enlarged prostate which was confirmed by imaging studies. Histological analysis of the tissue obtained on transrectal biopsy revealed a primary malignant non-Hodgkin lymphoma, type B, of the prostate. The patient was treated with chemotherapy. Despite considerable reduction of the tumor size starting from the 3rd week, the patient died the day after his 5th course of chemotherapy.

The authors report the case of a bilateral rupture of the corpora cavernosa associated to a total disruption of the urethra resulting from blunt trauma during sexual intercourse. This association is a rare urologic case of emergency which most often take place during sexual intercourse (0.4% of the urologic cases of emergency). When both corpora cavernosa and urethra are fully disrupted, an internal penis amputation appears, compromising the vascularization and the erectional and micturitional prognosis. The rupture of the urethra is the first complication to search. Early diagnosis and surgical treatment allow a precise assessment of the lesions and a good functional result.

The authors report the case of a bilateral rupture of the corpora cavernosa associated to a total disruption of the urethra resulting from blunt trauma during sexual intercourse. This association is a rare urologic case of emergency which most often take place during sexual intercourse (0.4% of the urologic cases of emergency). When both corpora cavernosa and urethra are fully disrupted, an internal penis amputation appears, compromising the vascularization and the erectional and micturitional prognosis. The rupture of the urethra is the first complication to search. Early diagnosis and surgical treatment allow a precise assessment of the lesions and a good functional result. (c) 2008 Elsevier Masson SAS. All rights reserved.

Several studies have tried to show a link between inflammation and cancer. In prostate cancer (PCa) development, this question is still not completely elucidated. The aim of the study was to investigate, whether the presence of inflammation in the first series of prostate biopsies was a factor of risk.

The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels.

The authors report a case of stage N3 pure testicular seminoma associated with paradoxical elevation of alphafoetoprotein (AFP). Despite the absence of histological arguments after review of the slides, this lesion was considered to be a stage pT1 N3 M0 S3 non seminomatous germ cell tumour with a poor prognosis. Simple surveillance was proposed following normalization of tumour markers, regression of retroperitoneal masses and negative PET scan. Laboratory and then clinical relapse at three months was treated by salvage chemotherapy followed by retroperitoneal lymph node dissection. The presence of embryonic carcinoma in one of the residual masses led to a revision of the initial histological diagnosis. The rare data of the literature indicate a variable approach according to alphafoetoprotein levels. (C) 2008 Elsevier Masson SAS. Tous droits reserves

Objective. - To standardize interpretation and comments of prostate-specific antigen (PSA) assay results by clinical pathology laboratories in office practice.Material. - From September 2004 to May 2006, interpretation and comments of PSA assay results performed by 100 different laboratories were analysed retrospectively.Results. - Nineteen different PSA assay kits were used. The so-called "normal" value for total PSA was less than 4 ng/ml for two-thirds of kits. Determination of the free PSA/total PSA ratio (91 cases) was based on a cut-off value ranging from 10 to 25% and the frequent laboratory comments (89 cases) more often referred to benign prostatic hyperplasia (51 case) than prostate cancer (nine cases).Conclusion. - The marked diversity of PSA assay techniques currently used and the divergent interpretations by various laboratories lead to problems of interpretation for both practitioners and patients. (C) 2008 Elsevier Masson SAS. Tous droits reserves.

Le cancer de la prostate est actuellement le plus souvent diagnostique au stade precoce. Les stades localement avances ou metastatiques sont encore presents comme le montre notre experience portant sur 1157 patients. Cette etude permet non seulement de preciser les circonstances de decouverte de ces differents stades evolutifs mais egalement de rappeler l'interet du depistage dans le diagnostic precoce de ce cancer.

Mise en tension brutale de la voie excrétrice en amont d'un obstacle, la colique néphrétique est une urgence médicochirurgicale. Son diagnostic clinique est conforté par la réalisation d'une imagerie qui est le plus souvent un scanner spiralé sans injection. Le traitement fait appel aux anti-inflammatoires par voie intraveineuse. Dans certains cas (colique néphrétique fébrile, anurique ou hyperalgique), il sera nécessaire de mettre en place une dérivation urinaire en urgence avant de traiter la cause de l'obstruction qui est un calcul dans 90 % des cas.

Intraperitoneal bladder rupture represents 2% of all abdominal lesions requiring surgical exploration. It has a poor prognosis due to the frequent associated lesions, particularly involving abdominal and retroperitoneal organs. An associated small bowel injury is rarely reported in the literature. The limited intestinal symptoms, the poor sensitivity of emergency imaging and the minor lesions detected at surgical exploration justify a systematic search for ileal lesions in this type of trauma, by an incision providing broad exposure of the entire abdominal cavity.

The authors report a case of leiomyoma of the female urethra and review the literature concerning this disease. This is a rare tumour that only exceptionally involves the urethra and is therefore difficult to diagnose. Urethral leiomyoma can present in the form of urinary tract infections, detrusor instability, haematuria, dyspareunia, and, more rarely, dilatation of the proximal urinary tract. Treatment is surgical. There is no risk of metastases, but local recurrence can occur in the case of incomplete resection.

The diagnosis of solitary fibrous tumour usually a benign lesion, is rarely suggested in a case of renal mass due to the rarity of these lesions. The authors report a case of a very large hilar mass in a 35-year-old man. Histological examination was performed on the operative specimen, as preliminary CT-guided needle biopsy was non-diagnostic. The diagnosis of primary spindle cell tumour was confirmed by immunohistochemical analysis. Independently of the size of this tumour and its intimate relations with the hilar region, large surgical resection should be performed due to the possible presence of malignant contingents and the risk of local recurrence or metastatic spread.