Schistosomiasis, known as bilharzia, is a parasitic disease caused by trematodes of the genus Schistosoma, found primarily in Africa and pockets of the Middle East. Southern Europe seems to be a breeding ground for urogenital schistosomiasis emergence. Ten and five years have passed since the first and the last cases of urogenital schistosomiasis were identified in Corsica (patients who have bathed in the Cavu and/or Solenzara rivers between 2013 and 2019). Through a literature review, the authors aimed to clarify the epidemiological, clinical and diagnostic particularities of urinary schistosomiasis acquired in Corsica. LEVEL OF EVIDENCE: 4.

Bladder cancer (BC) is a common malignancy in Europe and North America. Among BCs, muscle-invasive BCs (MIBCs) are distinguished, as they require aggressive treatment due to their spreading potential and poor prognosis. Despite its clinical relevance, little information on MIBC in a general population setting is available. This study aims to report practice patterns and survival outcomes for MIBC patients in a general population setting. MIBCs among BC incidence in 2011 and 2012 recorded in a French population-based cancer registry (810 000 inhabitants) were included in the study. Data were extracted from the medical files. Individual, tumour-related characteristics and initial management including diagnostic tools, multidisciplinary team meeting (MDT) assessment, and treatment delivered were described. Cystectomy, chemoradiation, radiotherapy, and chemotherapy were considered as specific treatments. Matching between MDT decision and the treatment provided was detailed. Management practices were discussed according to the guideline's recommendations. Overall survival (using the Kaplan-Meier method) and net survival (using the Pohar-Perme estimator) were calculated. Among 538 incident BC cases, 147 (27.3%) were MIBCs. Diagnostic practices displayed a relevant locoregional assessment of BC. Almost all cases (n = 136, 92.5%) were assessed during an uro-oncological MDT with a median time from diagnosis of 18 days (first quartile:12-third quartile:32). Discrepancies appeared between MDT decisions and treatments delivered: 71 out of 86 subjects received the recommended cystectomy or chemoradiation (with or without neoadjuvant chemotherapy); 6 out of 11 had the recommended radio- or chemotherapy; and 9 patients did not undergo any specific treatment despite the MDT decision. Cystectomy was the most common treatment performed; the time to surgery appeared consistent with the guideline's recommendations. Forty people only received supportive care. Still, the 5-year overall and net survival was poor, with 19% (13-26) and 22% (14-31), respectively. The 5-year net survival was 35% (23-48) for people who underwent curative-intent treatments. MIBC management remains challenging even for cases assessed during an MDT. Many people did not undergo any specific treatment. Prognosis was poor even when curative-intent therapies were delivered. Efforts to reduce exposure to risk factors such as tobacco smoking and occupational exposures must be maintained.

Objective: Information on bladder cancer (BC) according to the risk scoring for recurrence or progression in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC). Materials: BC incident in 2011-2012 recorded in a population-based cancer registry were studied. Data was extracted from medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/ 31/2021) of HR-NMIBC were assessed. Results: Among 538 BC cases, 380 were NMIBC [119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk] and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management [imaging, re-TUR, multidisciplinary team meetings (MDT) assessment, specific treatment] revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed in an MDT with a median time from diagnosis of 18 days [first quartile: 12- third quartile: 32]. Globally, treatment agreed with MDT decisions. Intravesical instillation was the most common treatment (n n = 56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10 years overall survival was 52% [42-63] and 41% [31-51], respectively. Five years net survival was 63% [47-75]. Conclusions: Despite National cancer plans aiming to improve care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival. Level of evidence: 3 (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Impact of age on bladder cancer management practices: a general population study

You have accessJournal of UrologyAdrenal1 Apr 2018MP03-17 NON RENAL ORGIN OF THE PRIMARY TUMOR AND LARGER TUMOR SIZE COMPROMISE THE ONCOLOGICAL OUTCOMES OF ADRENALECTOMY FOR ADRENAL METASTASIS benoit peyronnet, nadja schoentgen, reem betari, anna goujon, benjamin pradere, victor vanalderwerelt, sammy oumakhlouf, alexandre gryn, georges fournier, karim bensalah, francois-xavier nouhaud, nicolas brichart, jean-baptiste beauval, adham rammal, mathieu thoulouzan, michel soulie, fabien saint, franck bruyere, vincent joulin, eric huyghe, and andrea manunta benoit peyronnetbenoit peyronnet More articles by this author , nadja schoentgennadja schoentgen More articles by this author , reem betarireem betari More articles by this author , anna goujonanna goujon More articles by this author , benjamin praderebenjamin pradere More articles by this author , victor vanalderwereltvictor vanalderwerelt More articles by this author , sammy oumakhloufsammy oumakhlouf More articles by this author , alexandre grynalexandre gryn More articles by this author , georges fourniergeorges fournier More articles by this author , karim bensalahkarim bensalah More articles by this author , francois-xavier nouhaudfrancois-xavier nouhaud More articles by this author , nicolas brichartnicolas brichart More articles by this author , jean-baptiste beauvaljean-baptiste beauval More articles by this author , adham rammaladham rammal More articles by this author , mathieu thoulouzanmathieu thoulouzan More articles by this author , michel souliemichel soulie More articles by this author , fabien saintfabien saint More articles by this author , franck bruyerefranck bruyere More articles by this author , vincent joulinvincent joulin More articles by this author , eric huygheeric huyghe More articles by this author , and andrea manuntaandrea manunta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3060AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Litlle studies, usually underpowered, have sought for prognostic factors of oncological outcomes after adrenalectomy for adrenal metastasis. The aim of this study was to assess prognostic factors of oncological outcomes after adrenalectomy for adrenal metatasis. METHODS All adrenalectomies for suspected adrenal metastases of any primary neoplasm performed in seven centers between 2006 and 2016 were included in a retrospective study. The adrenalectomies performed at the time of ipsilateral nephrectomy for renal cell carcinoma were excluded. Recurrence-free survival (RFS) and cancer specific survival (CSS) were estimated using the Kaplan-Meier method. Prognostic factors of CSS were sought by univariate and multivariate Cox regression analyzes. RESULTS One-hundred and six patients were included. Mean tumor size was 36.7 mm. Origin of the primary tumor was renal and pulmonary in most cases (47.6% and 32.4% respectively). After a median follow up of 24.8 months, Estimated RFS and CSS rates at 5 years were 20.7% and 63.7% respectively. In univariate analysis, tumor size (OR=3.8 ; p=0.04) and timing of the adrenal metastasis (synchronous vs.metachronous ; OR=2.1 ; p =0.02) were associated with RFS. In multivariate analysis, the only prognostic factor associated with RFS was tumor size (OR = 19.5; p = 0.004). In univariate analysis, renal origin of the primary tumor was associated with better CSS (OR=0.1 ; p<0.001) and positive surgical margins with poorer CSS (OR=3.4 ; p=0.01). In multivariate analysis, only the non renal origin of the primary tumor was associated with poorer CSS (OR=0.1 ; p<0.001). (figure 1) CONCLUSIONS In this multicenter study, tumor size was associated with poorer RFS. Non-renal origin of the primary tumor was associated with poorer CSS. These prognostic factors might help in patients information and treatment decision making in the management of adrenal metasasis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e29 Advertisement Copyright & Permissions© 2018MetricsAuthor Information benoit peyronnet More articles by this author nadja schoentgen More articles by this author reem betari More articles by this author anna goujon More articles by this author benjamin pradere More articles by this author victor vanalderwerelt More articles by this author sammy oumakhlouf More articles by this author alexandre gryn More articles by this author georges fournier More articles by this author karim bensalah More articles by this author francois-xavier nouhaud More articles by this author nicolas brichart More articles by this author jean-baptiste beauval More articles by this author adham rammal More articles by this author mathieu thoulouzan More articles by this author michel soulie More articles by this author fabien saint More articles by this author franck bruyere More articles by this author vincent joulin More articles by this author eric huyghe More articles by this author andrea manunta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The objective of this study was to assess at 3 years bacillus Calmette–Guerin (BCG) maintenance treatment for NMIBC using one-third dose schedule and fewer instillations every 3 or 6 months. This was a phase III randomized study including patients with intermediate-risk or high-risk NMIBC, who received, after a full-dose induction schedule, three-weekly instillations of one-third dose BCG every 6 months (group I) and two-weekly instillations every 3 months (group II) during 3 years. We assessed oncological efficacy, BCG side effects, leukocyturia, and prostate-specific antigen. No tumor recurrence was reported at 36 months for 55 (82.09%) patients in group I versus 64 (90.14%) patients in group II (P=0.241). Muscle invasion was observed in six patients at 36 months (P=0.942). In terms of BCG toxicity, grade II and III local or systemic side effects were, respectively, reported in 8.7 and 23.9% of patients during the first year. Nevertheless, the adverse events (AEs) score at 36 months underlined a lower median value of 0.8 in group I versus 1.1 in group II (P=0.037). Furthermore, 9.9% major AEs occurred in group II versus 3% in group I (P=0.031). Leukocyturia and prostate-specific antigen level were not associated significantly with either tumor recurrence or muscle progression. We observed a significant difference in the AEs score at 36 months, suggesting less toxicity in patients who were treated with one-third dose of BCG for 3 consecutive weeks every 6 months.

Biomarkers for the diagnosis and monitoring treatment response of kidney cancer are urgently needed. Neutrophil gelatinase-associated lipocalin (NGAL) is a relevant urinary biomarker for the diagnosis of a wide variety of acute and chronic kidney diseases. Its potential utility as a prognostic marker of kidney cancer is largely unknown and, therefore, was the subject of this investigation. A retrospective study was done on 50 kidney tumor patients (urine samples prospectively collected before nephrectomy between 2004 and 2012, stored at Biobank Resource Center). The specificity, sensitivity and the predictive value of NGAL were determined for progression-free and disease-specific survival after nephrectomy in renal cell carcinoma (particularly, the clear cell renal cell carcinoma (ccRCC)). Urinary NGAL concentration (u-NGAL) was determined by CMIA technique (ARCHITECT® urine NGAL essay/ABBOTT®). Out of the 50 kidney tumor patients, 40 had clear cell carcinoma with a median u-NGAL excretion of 1.4 (IQR: 5.76) ng/mg urinary creatinine (Ucr). u-NGAL was correlated to tumor stage (p = 0.005), and Fuhrman grade (p = 0.0002). Multivariate Cox regression analysis showed a significant association between u-NGAL excretion and clear cell renal cell carcinoma progression free survival and disease specific survival (p = 0.002; p = 0.0001). Urinary NGAL was significantly associated with the stage and the grade of kidney cancer. u-NGAL excretion could be considered as a potential biomarker to identify ccRCC patients with the more pejorative outcomes.

Purpose: To identify preoperative predictive factors for final ureteral section invasion after radical cystectomy (RC) and to validate significant factors on an external independent cohort. Material and methods: We retrospectively reviewed data of all consecutive RC performed for bladder cancer in 2 high-volume institutions. Clinical, pathological, and follow-up data were collected prospectively and reviewed retrospectively. Pathological evaluation was performed by 2 well-trained uropathologists in each center. Logistic regression analyses were performed to identify predictive factors for final ureteral sections involvement. Significant factors in cohort A were validated in cohort B. Receiver operating curve and area under curve were modeled to evaluate predictive accuracy of the markers. Results: A total of 441 RC were performed in center A and 307 RC were performed in center B. Mean follow-ups were 36.2 and 38.1 months, respectively. Invasion of the final ureteral section was observed on 5.5% of patients in cohort A and 4.8% of patients in cohort B. In cohort A, multivariable logistic regression identified preoperative hydronephrosis on computed tomography scan (odds ratio [OR] = 4.9, P = 0.004) and presence of Carcinoma in situ (CIS, OR = 3.9, P = 0.01) as the only factors associated with ureteral sections positivity. In cohort B, hydronephrosis and CIS were both associated with ureteral sections positivity in univariable analysis. In multivariable analysis, only hydronephrosis remained significant (OR = 5.9, P = 0.01). Predictive accuracy of hydronephrosis and CIS combined in 1 variable was 0.72. Conclusion: Hydronephrosis and bladder CIS have good accuracy in predicting ureteral sections positivity after RC. In the presence of those factors, ureteral frozen sections should be performed. (C) 2017 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyAdrenal1 Apr 2017MP37-13 OUTCOMES OF ADRENALECTOMY FOR ADRENAL METASTASIS OF RENAL CELL CARCINOMA IN THE ERA OF ADRENAL-SPARING RADICAL NEPHRECTOMY : A MULTICENTER STUDY benoit peyronnet, nadja schoentgen, andrea manunta, jean-baptiste beauval, franck bruyere, francois-xavier nouhaud, philippe grise, georges fournier, reem betari, nicolas brichart, alexandre gryn, tristan grevez, benjamin pradère, samy oumakhlouf, mathieu thoulouzan, adham rammal, anna goujon, michel soulié, fabien saint, vincent joulin, eric huyghe, and karim bensalah benoit peyronnetbenoit peyronnet More articles by this author , nadja schoentgennadja schoentgen More articles by this author , andrea manuntaandrea manunta More articles by this author , jean-baptiste beauvaljean-baptiste beauval More articles by this author , franck bruyerefranck bruyere More articles by this author , francois-xavier nouhaudfrancois-xavier nouhaud More articles by this author , philippe grisephilippe grise More articles by this author , georges fourniergeorges fournier More articles by this author , reem betarireem betari More articles by this author , nicolas brichartnicolas brichart More articles by this author , alexandre grynalexandre gryn More articles by this author , tristan greveztristan grevez More articles by this author , benjamin pradèrebenjamin pradère More articles by this author , samy oumakhloufsamy oumakhlouf More articles by this author , mathieu thoulouzanmathieu thoulouzan More articles by this author , adham rammaladham rammal More articles by this author , anna goujonanna goujon More articles by this author , michel souliémichel soulié More articles by this author , fabien saintfabien saint More articles by this author , vincent joulinvincent joulin More articles by this author , eric huygheeric huyghe More articles by this author , and karim bensalahkarim bensalah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1145AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Until the early 2000s, ipsilateral adrenalectomy at the time of radical nephrectomy was genrally recommended except in small tumors of the lower pole. In the current era, as radical nephrectomy sparing the adrenal gland has become the gold standard, the incidence of metachronous adrenal metastases has increased. However, to date no study has aimed to assess the outcomes of adrenalectomy for metastasis of renal cell carcinoma (RCC). The aim of this study was to report the outcomes of adrenalectomy for metastasis of RCC. METHODS All adrenalectomies for suspected adrenal metastases of RCC performed in seven centers between 2006 and 2016 were included in a retrospective study. The adrenalectomies performed at the time of ipsilateral nephrectomy were excluded. Recurrence-free survival (RFS) and specific survival (CSS) were estimated using the Kaplan-Meier method. Prognostic factors of CSS were sought by univariate and multivariate Cox regression analyzes. RESULTS Forty-eight patients were included. Mean tumor size was 40.8 mm. Histology of the primary tumor was clear cell renal cancer in most cases (94.8%). Metastases were unique in 77% of patients. Metastases were metachronous in 77% of cases and occurred after a mean interval of 8.1 months. The average hospital stay was 5.4 days. The rate of positive margins was 9%. The complication rate was 23.9% but with only three major complications (Clavien> 2; 6.2%). After a median follow up of 23 months, Estimated RFS and CSS rates at 5 years were 18.3% and 97.5% respectively. The only prognostic factor associated with CSS was the absence of other metastases at the time of adrenalectomy (OR = 6.1; p = 0.03). CONCLUSIONS In this multicenter study, adrenalectomy for adrenal metastasis of RCC offered satisfactory perioperative outcomes. Recurrence of disease was relatively common (5 year-RFS: 18.3%; only prognostic factor = single metastasis) but CSS was similar to those observed after partial nephrectomy for small renal tumors (5 year-CSS: 97.5%). © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e480 Advertisement Copyright & Permissions© 2017MetricsAuthor Information benoit peyronnet More articles by this author nadja schoentgen More articles by this author andrea manunta More articles by this author jean-baptiste beauval More articles by this author franck bruyere More articles by this author francois-xavier nouhaud More articles by this author philippe grise More articles by this author georges fournier More articles by this author reem betari More articles by this author nicolas brichart More articles by this author alexandre gryn More articles by this author tristan grevez More articles by this author benjamin pradère More articles by this author samy oumakhlouf More articles by this author mathieu thoulouzan More articles by this author adham rammal More articles by this author anna goujon More articles by this author michel soulié More articles by this author fabien saint More articles by this author vincent joulin More articles by this author eric huyghe More articles by this author karim bensalah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Encrusted uretero-pyelitis is a rare and serious disease, related to the presence of calcifications in the pelvicalyceal system and ureter, associated with chronic urinary tract infection. In most cases, the causal agent of this infection lithiasis is corynebacterium urealyticum. The specific aspect of calcifications on CT scan can help to suggest diagnosis. To avoid a delay in diagnosis (which is frequent), an accurate exploration by the bacteriologist is crucial. The combination of a glycopeptides antibiotherapy and urine acidification has proved its effectiveness, as described in the medical literature. We report the case of a 77-year-old male patient, successfully treated for a bilateral encrusted uretero-pyelitis by local acidification (Thomas's solution) followed by oral acidification (ammonium chloride).

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2016MP38-08 PROGNOSTICS FACTORS OF POSITIVES URETERAL SECTION DURING CYSTECTOMY FOR BLADDER CANCER. francois thomas, alezra eric, forzini thomas, and saint fabien francois thomasfrancois thomas More articles by this author , alezra ericalezra eric More articles by this author , forzini thomasforzini thomas More articles by this author , and saint fabiensaint fabien More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES radical cystectomy is the standard treatment for muscle invasive bladder cancer. Analysis of ureterals sections ensures intraoperative or postoperative no residual carcinoma of the urinary tract. There are no specific recommendations on prognostics factors of positive ureteral section justifying the frozen section. Objectives: Identify the prognostic factors of tumor reached ureteral section. To evaluate the sensitivity and specificity of frozen section during radical cystectomy. METHODS : single-center retrospective study, involving 441 cystectomy (cystoprostatectomy or anterior pelvectomy) for bladder cancer between 1980 and 2013. The parameters studied were: age, gender, histological type, stage, grade, tumor location, presence of Cis, urétéro- hydronephrosis, number of previous bladder resection, ureteral frozen section analysis and final ureteral analysis. RESULTS Mean follow-up was 36.2 months [12-255]. Pathological stages were: 91pT2, 163pT3, 73pT4 among which 111 patients were N +. The average age was 65.3 years [35-87]. The ureteral frozen section was proposed for 178 renal units (173 negative and 5 positive). The final review of ureteral section included 566 renal units (24 positive and 542 negative) and has always confirmed the results of the frozen section (sensitivity and specificity of 100%). Cis was associated with bladder tumor in 12% of cases (n = 54). Uretero-hydronephrosis unilateral or bilateral was present in 33.6% of cases (n = 148). In univariate analysis only hydronephrosis (p = 0.002) and the presence of CIS (p = 0.06) were associated with the risk of ureteral recoupes positive. The specificity, sensitivity, NPV and PPV of the uretero-hydronephrosis Cis-association for the result of the ureteral cuts was 96% respectively 33%, 99% and 14%. In multivariate analysis only the Cis was an independent prognostic factor for ureteral intersects positive (p = 0.02) (OR = 0.26 [0.08 to 0.80]). CONCLUSIONS The absence of CIS and uretero-hydronephrosis eliminates 99% the risk of ureteral intersects positive and the need for a frozen section. The presence of Cis is the only independent factor overlaps ureteral positive. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e535-e536 Advertisement Copyright & Permissions© 2016MetricsAuthor Information francois thomas More articles by this author alezra eric More articles by this author forzini thomas More articles by this author saint fabien More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-11 FLEXIBLE URETEROSCOPE DAMAGES RISK FACTORS IN AN ACADEMIC CENTER Julien Lasselin, Fabien Saint, Ludovic Viart, and Gauthier Raynal Julien LasselinJulien Lasselin More articles by this author , Fabien SaintFabien Saint More articles by this author , Ludovic ViartLudovic Viart More articles by this author , and Gauthier RaynalGauthier Raynal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2448AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate risk factors for flexible ureterorenoscopes breakages and optical beam damages. METHODS Retrospective, single center analysis on 393 interventions with 4 flexible ureterorenoscopes at Amiens University Hospital between January 2009 and March 2013. We analyzed patient factors, pathology and surgical technique. RESULTS We identified 21 major accidents which accounts for a breakage rate of 5.34%. We identified 76 black spots appeared during the maintenance of endoscopes and 10 during procedure. The only statistically significant predictor of breakages was the cumulative duration of operating time since the last repair (p = 0.04, OR = 1.001 [1-1001]). For lesions of the optical beam between the procedures, parameters appearing as significant were the use of instruments into working channel : laser (p = 0.02, OR 2.06 95% CI [1109-3827]), or endoluminal graspers (p = 0.007, OR 0.467, 95% CI [0269-0809]). Intraoperatively, the number of open or laparoscopic surgery (p = 0.007, OR = 3.105, 95% CI [1364-7068]), duration of intervention (p = 0.01, OR = 1.023, 95% CI [1.006 - 1041] and the cumulative duration of intervention (p = 0.003, OR = 1.001, 95% CI [1-1002]) appeared to be statistically significant. CONCLUSIONS The only identified risk factor for breakage was the cumulative duration of operation. No difference between ureterorenoscopes has been demonstrated. The majority of optical beam lesions took place during disinfection. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e905 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Julien Lasselin More articles by this author Fabien Saint More articles by this author Ludovic Viart More articles by this author Gauthier Raynal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To assess oncologic outcomes after salvage radiotherapy (SRT) without androgen deprivation therapy (ADT) in patients with persistently detectable PSA after radical prostatectomy (RT).Two hundred and one patients who failed to achieve an undetectable PSA received SRT without ADT. The primary endpoint was failure to SRT that was defined by clinical progression or use of second-line ADT. Clinicopathological parameters, 6-week PSA level, PSAV and pre-SRT PSA levels were assessed using time-dependent analyses.Median postoperative 6-week PSA and pre-SRT PSA levels were 0.25 and 0.48 ng/mL, respectively. Median time between surgery and SRT was 7 months. Failure to SRT was reported in 42.8 % of cases with the need for second-line ADT in 26.9 % of cases. Pre-SRT PSA was strongly correlated with postoperative 6-week PSA (p < 0.001) but not with PSAV. The risk of SRT failure was increased by threefold in case of Gleason score 8-10 (p = 0.036) or pT3b cancer (p = 0.006). Risk group classification based on these prognostic factors improved SRT failure prediction. Survival curves confirmed that 5-year ADT-free survival rates were significantly influenced by PSAV (p = 0.002) and pre-SRT PSA (p = 0.030).In patients with persistently detectable PSA after RP and selected for local salvage treatment, SRT offers good oncologic clinical outcomes. The most powerful pathologic predictive factors of SRT failure include a pT3b stage, a Gleason score 8 or more cancer and high PSAV and pre-SRT PSA levels. Patients having a high PSAV > 0.04 ng/mL/mo would be potentially better candidates for a systemic therapy due to a high SRT failure rate.

The influence of a positive surgical margin (PSM) on survival outcome of post radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC) is unclear. The objectives of this study were to determine the significance of PSM on cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS) post RNU.

Prognostic impact of lymphadenectomy during radical nephroureterectomy (RNU) for urothelial carcinoma of the upper urinary tract (UTUC) is controversial. Our aim was to assess the impact of lymph node status (LNS) on survival in patients treated by RNU.

Study Type – Diagnostic (exploratory cohort)Level of Evidence 3aWhat's known on the subject? and What does the study add?Hereditary non‐polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is an autosomal dominant multi‐organ cancer syndrome. Upper urinary tract urothelial carcinomas belong to HNPCC‐related tumours and rank third within this group after colorectal and endometrial cancer. However, many urologists are not aware of this association and it is presumed that some hereditary cancers are misclassified as sporadic and that their incidence is underestimated. Consequently, family members of patients with upper urinary tract urothelial carcinomas secondary to HNPCC may be denied appropriate surveillance and early detection.A significant proportion of patients (21.3%) with newly diagnosed upper urinary tract urothelial carcinomas may have underlying HNPCC. Demographic and epidemiological characteristics suggest different mechanisms of carcinogenesis among this population. Recognition of such potential is essential for appropriate clinical and genetic management of patients and family. In order to help to identify these patients, we propose a patient‐specific checklist.OBJECTIVE To identify, based on previously described clinical criteria, hereditary upper urinary tract urothelial carcinomas (UUT‐UCs) that are likely to be misclassified as sporadic although they may belong to the spectrum of hereditary non‐polyposis colorectal cancer (HNPCC) associated cancers. PATIENTS AND METHODS We identified, using established clinical criteria, suspected hereditary UUT‐UC among 1122 patients included in the French national database for UUT‐UC. Patients were considered at risk for hereditary status in the following situations: age at diagnosis <60 years with no previous history of bladder cancer; previous history of HNPCC‐related cancer regardless of age; one first‐degree relative with HNPCC‐related cancer diagnosed before 50 years of age or two first‐degree relatives diagnosed regardless of age. RESULTS Overall, 239 patients (21.3%) were considered to be at risk of hereditary UUT‐UC. Compared with sporadic cases, hereditary cases are more likely to be female (P= 0.047) with less exposure to tobacco (P= 0.012) and occupational carcinogens (P= 0.037). A greater proportion of tumours were located in the renal pelvis (54.5% vs 48.4%; P= 0.026) and were lower grade (40% vs 30.1%; P= 0.015) in the hereditary cohort. The overall, cancer‐specific and recurrence‐free survival rates were similar in both cohorts. We propose a patient‐specific risk identification tool. CONCLUSIONS A significant proportion (21.3%) of patients with newly diagnosed UUT‐UC may have underlying HNPCC as a cause. Recognition of such potential and application of a patient‐specific checklist upon diagnosis will allow identification and appropriate clinical and genetic management for patient and family.