Six patients carrying bulky renal cysts located in the kidney lower pole were treated by percutaneous resection of the cystic wall. No complications were observed during the peri and postoperational period. In all cases disappearance of symptoms was observed, and the total success rate (absence of residual cavity) recorded was 4/6, two cases presenting persistence of a small residual cavity which originated one case of relapse. The paper presents the technique used, and the indications and possible therapeutic actions for the treatment of simple kidney cysts are discussed.

Evaluer l’efficacité et les complications du traitement par Radiofréquence (RF) des tumeurs rénales. Etude rétrospective de 19 patients (27 tumeurs, 5 patients avec métastases pré-existantes) traités par RF percutanée (13 patients, 13 tumeurs, 15 procédures) ou per-opératoire (8 patients, 14 tumeurs, 8 procédures). Tous les traitements ont été réalisés avec une aiguille de LeVeen (électrode déployable monitorant l’impédance). Vingt quatre des 27 tumeurs (16/19 patients) étaient totalement dévascularisées à la fin du traitement. Deux tumeurs résiduelles ont été totalement dévascularisées par une seconde procédure. Au cours du suivi (30,4 ± 21,9 mois), deux tumeurs qui avaient été totalement dévascularisées ont récidivé 11 et 48 mois après traitement. L’une a été traitée par néphrectomie partielle et l’autre n’a pas été traitée en raison de métastases osseuses évolutives. Un patient a été néphrectomisé en raison d’une sclérose rétractile du bassinet due au traitement. Six patients (9 procédures) ont eu un refroidissement du système excréteur pendant la procédure. Aucun n’a présenté de complication. Les résultats du traitement par RF des cancers du rein sont prometteurs. L’atteinte de la voie excrétrice est la complication la plus sérieuse ; une prophylaxie par refroidissement de la voie excrétrice mérite d’être évaluée.

OBJECTIVES:This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS:541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS:This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS:NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.

Evaluer une technique d’IRM dynamique très simple (faible résolution temporelle, critères diagnostiques visuels) dans la détection et la localisation des foyers d’adénocarcinome prostatique. Quarante-six patients ont été explorés par IRM avant prostatectomie radicale. En complément des séquences T2, une séquence dynamique (14 coupes, 30 secondes) a été répétée 3 fois après injection d’un bolus de Gd-DOTA. La prostate a été divisée en 20 secteurs (12 pour la zone périphérique, 6 pour les zones transitionnelles, 2 pour les vésicules séminales). Trois lecteurs ont indépendamment relu les images dynamiques et T2 et précisé la présence de cancer dans les 20 secteurs et le nombre de nodules tumoraux, en utilisant des critères purement visuels. Les résultats ont été comparés aux résultats histologiques. Pour la détection des secteurs envahis, la séquence dynamique était nettement plus sensible (0,46-0,58 versus 0,18-0,26, p < 0,05) et légèrement moins spécifique (0,91-0,97 versus 0,94-0,98, p < 0,05) que l’IRM T2. La séquence dynamique a aussi permis de détecter significativement plus de nodules de plus de 0,3cc que l’IRM T2 (79,4-81 % versus 49,6-60,3 %, p < 0,05). Même avec une technique simple, l’IRM dynamique est significativement plus sensible que l’IRM T2 dans la détection des nodules tumoraux intra-prostatiques.

OBJECTIVES:To retrospectively evaluate the complications, urinary reservoir function and quality of life of patients with Hautmann ileal bladder after cystectomy for bladder urothelial carcinoma.METHODS:From 1994 to 2004, 87 patients with a mean age of 61.1 years underwent total cystoprostatectomy (n = 85 men) or radical cystectomy (n = 2 women) with Hautmann replacement enterocystoplasty. The mean follow-up was 40.7 months. Continence, quality of voiding, and quality of life were evaluated by self-administered questionnaires (continence questionnaire, DITROVIE score, I-PSS score).RESULTS:The early complication rate was 30.1%, including 6.9% related to the ileal bladder. The late complication rate was 33.6%, including 20.9% related to the ileal bladder. Four patients died during the perioperative period, 14 patients (17%) died from progression of their cancer and 7 patients (8%) died from an independent cause. One patient was lost to follow-up. Questionnaires were sent to 56 patients and 52 replies were received: 96.2% of patients were continent during the day, 53.8% were continent at night. 4.9% of patients performed self-catheterization for chronic urine retention, 90.4% of patients were satisfied with their replacement bladder and only 5.8% of patients had an altered quality of life.CONCLUSION:Despite a considerable morbidity rate and a significant nocturnal incontinence rate, the orthotopic Hautmann W-shaped ileal bladder does not appear to alter the patients' quality of life.

Cystic lymphangioma of the adrenal gland are rarely encountered tumoural formations with no clinical expression. Pre-operative diagnosis is difficult. Echography and CT scan are essential exploratory techniques, diagnosis is histological. Usually surgical exploration is indicated due to uncertain diagnosis. We report a new case of cystic lymphangioma of the adrenal gland and a review of recent literature.

Cystic lymphangioma of the adrenal gland are rarely encountered tumoural formations with no clinical expression. Pre-operative diagnosis is difficult. Echography and CT scan are essential exploratory techniques, diagnosis is histological. Usually surgical exploration is indicated due to uncertain diagnosis. We report a new case of cystic lymphangioma of the adrenal gland and a review of recent literature. (C) 2003 Publie par Editions scientifiques et medicales Elsevier SAS.

Giant renal cysts measuring more than 15 cm in greatest diameter are uncommon and the association with erythrocytosis and hypertension is very rare. We present a case of a 22-year-old man with an incidental giant left renal cyst associated with hypertension and polycythemia that was treated by drainage and laparoscopic excision, followed by resolution of both hypertension and erythrocytosis.

OBJECTIVE:To study the feasibility and the innocuity of the treatment by radiofrequency of small renal tumours.MATERIAL AND METHODS:From June 2000 to September 2001, 10 renal tumours in 6 patients were treated by radiofrequency. The mean age of the patients was 57 years. The mean tumour diameter was 20 mm. Indications for partial surgery were 3 solitary kidneys, one patient with chronic renal failure, one patient with Von Hippel Lindau disease and one patient in whom several angiomyolipomas were discovered in the right kidney. 4 patients were treated via a lumbar incision and 2 were treated percutaneously (one with ultrasound guidance and the other with computed tomography guidance). Patients were reviewed by imaging (CT and/or MRI) with injection of contrast agent to demonstrate complete devascularization of the tumour.RESULTS:Treatment lasted an average of 180 minutes. The intraoperative complication rate was 16%. The mean hospital stay was 9 days (4 days for the percutaneous route). Nine tumours (5 patients) were devascularized after a single session. One patient (treated via the percutaneous route under ultrasound guidance) showed persistence of tumour tissue (identified by CT). A second session, performed 4 months later, allowed complete devascularization of the tumour. The mean follow-up is 13 months.CONCLUSION:This study demonstrates the feasibility and safety in terms of renal function of radiofrequency treatment of small renal tumours. However further studies are necessary to precisely define the radiological criteria of tumour necrosis and to evaluate the long-term results of this method (outcome of necrotic tumour tissue, metastatic risk, cancer recurrence along the needle track in the case of a percutaneous approach). This treatment must be reserved for selected patients.

Obstruction of the lower ureter by pelvic cancer requires a palliative treatment. Percutaneous derivation is often performed as an emergency. If obstruction is limited to the peri-meatic area (a few mm or a cm) resection of the ureteral orifice can be enough to catheterize the obstructed ureter. Stenting of the ureter can be done even if the obstruction is longer, using the extra vesical repermeabilization.A guide wire is passed via the nephrostomy, and ureteral stent is passed over the guide wire. Dye additionned with methylene blue is injected tovisualize the lower extremity of the ureter. A regular resectoscope is placed transuretraly, and resection is conducted using X ray localisation with a C arm and several incidences. The tissue resected first is usually extravesical, in the adipous perivesical tissue. Dissection of this area can be performed bluntly with the tip of the resectoscope until the ureter is reached. At this time, the resectoscope is used to open the lower extremity of the ureter, localized with the C arm. It is important to open widely the ureter, so as to be sure to catheterize easily this opening with a ureteral catheter. A double J can then be passed easily. Tunnel of several cm can be performed using this technique.Seven patients with pelvic cancer with obstruction of the last cm of the pelvic ureter were included in this series. They were recurrent prostate cancer already treated with hormone therapy, stage T3, T4. All procedures were performed under rachianesthesia or general anesthesia according to general status. After this procedure normal miction were obtain in all patients and nephrostomies were removed. This technique is possible for extended pelvic obstruction. Blunt dissection with the endoscope is usualy blood less. This palliative procedure can be done in patients with poor general condition and allows for a better quality of life than nephrostomy or urinary diversions.