Purpose. - Photodynamic therapy (PDT) is an innovative therapeutic modality in urologic oncology.Material and methods. - We reviewed the current literature on principles and modalities of PDT in prostatic oncology.Results. - Focal therapy of prostate cancer is an application field of PDT. Clinical phase II studies are ongoing to determine PDT efficacy and safety in this indication. PDT as salvage treatment after prostatic radiotherapy has been tested. Carcinologic results were promising but important side effects were reported. Individual dosimetric planification is necessary to avoid this toxicity.Conclusion. - PDT first clinical experience for prostate cancer has showed its technical feasibility. Several research ways are currently in study to improve carcinologic efficacy and to limit potential side effects. (C) 2010 Elsevier Masson SAS. All rights reserved.

Bladder cancer is a common condition in industrialized countries. If tobacco is still the main risk factor in lung cancer, occupational exposures carcinogens should not be underestimated.The significant excess of bladder cancer in the north part of France, with high manufacture concentration likely to have employees exposed to bladder carcinogens, has led us to study the influence of these exposures in the natural history of bladder cancer.We prospectively conducted a descriptive case-control study. A questionnaire was developed by the department of occupational disease and clinical, radiological, histological, therapeutic data were registered at the University Hospital of Lille. From October 2005 to February 2009, 69 patients were included in the study, 37 exposed to occupational carcinogens and 32 in the control group.Mean age was 61.6 years vs. 61.8 years and the sex ratio of 7.33 men to one woman vs. one woman for three men respectively in the two groups. The average age of patients exposed to polycyclic aromatic hydrocarbons was 59.7 years. Smokers were 86.5% and 87.5% respectively. Follow-up was 38.4 and 32.9 months respectively. Nonmuscle invasive bladder cancer were more frequent (P=0.019) in the exposed group (84.4%) than in the unexposed group (67.8%) even after adjustment for smoking (P=0.0142). The histological type, grade, presence of CIS, the early recurrence at 3 months, the number of lesions at diagnosis does not differ in the two groups even after adjustment for smoking or after subgroup analysis of the most frequent exposure. The exposure to polycyclic aromatic hydrocarbons (62%) and aromatic amines (37.8%) were the most represented. Of 37 patients, 13 (35%) were making a statement as an occupational disease (eight according to Table 15 ter, two according to Table 16 bis and two presented to IRB). To date one single patient is recognized as an occupational disease.We did not observe any worsening of the prognosis of bladder cancer following occupational carcinogen exposure except for the mean age at diagnosis. The small size of the population studied and the importance of smoking partner have hampered the analysis of occupational exposures.

UNLABELLED:Bladder cancer is a common condition in industrialized countries. If tobacco is still the main risk factor in lung cancer, occupational exposures carcinogens should not be underestimated. GOAL:The significant excess of bladder cancer in the north part of France, with high manufacture concentration likely to have employees exposed to bladder carcinogens, has led us to study the influence of these exposures in the natural history of bladder cancer. PATIENTS AND METHODS:We prospectively conducted a descriptive case-control study. A questionnaire was developed by the department of occupational disease and clinical, radiological, histological, therapeutic data were registered at the University Hospital of Lille. From October 2005 to February 2009, 69 patients were included in the study, 37 exposed to occupational carcinogens and 32 in the control group. RESULTS:Mean age was 61.6 years vs. 61.8 years and the sex ratio of 7.33 men to one woman vs. one woman for three men respectively in the two groups. The average age of patients exposed to polycyclic aromatic hydrocarbons was 59.7 years. Smokers were 86.5% and 87.5% respectively. Follow-up was 38.4 and 32.9 months respectively. Nonmuscle invasive bladder cancer were more frequent (P=0.019) in the exposed group (84.4%) than in the unexposed group (67.8%) even after adjustment for smoking (P=0.0142). The histological type, grade, presence of CIS, the early recurrence at 3 months, the number of lesions at diagnosis does not differ in the two groups even after adjustment for smoking or after subgroup analysis of the most frequent exposure. The exposure to polycyclic aromatic hydrocarbons (62%) and aromatic amines (37.8%) were the most represented. Of 37 patients, 13 (35%) were making a statement as an occupational disease (eight according to Table 15 ter, two according to Table 16 bis and two presented to IRB). To date one single patient is recognized as an occupational disease. CONCLUSION:We did not observe any worsening of the prognosis of bladder cancer following occupational carcinogen exposure except for the mean age at diagnosis. The small size of the population studied and the importance of smoking partner have hampered the analysis of occupational exposures.

To analyse current practice patterns and to evaluate (long-term) effectiveness and adverse events of sacral neuromodulation with InterStim™ Therapy based on data collected in a national register and to discuss the strengths and weaknesses of the register.This is a French multicenter prospective observational trial including patients with a permanent implant (2003-2009). Voiding diary variables and patient satisfaction were analysed based on last follow-up visit since implantation.One thousand four hundred and eighteen patients (median age: 63 years, 1206 females) were included in the database (median follow-up: 12 months). One thousand and eighty-nine patients had non-neurological disease. The principal diagnosis was overactive bladder syndrome ([OAB], n=1170) and retention (n=151). Implantation occurred in 1358 patients; 1172 patients had greater than or equal to one registered follow-up. Clinical improvement of greater than or equal to 50% was seen in 447/527 patients with OAB at 12 months follow-up (median number of voids per 24 hours decreased from 15 at baseline to 8 at 12 months) and in 42/54 of patients with retention (median number of catheterization per 24 hours dropped from 5 at baseline to 0 at 12 months). Clinical improvement remained relatively stable up to 60 months. Median patient satisfaction with treatment was between 60 and 80%. Five hundred and twenty-four patients had at least one adverse event; loss of efficacy (n=244) occurred most frequently.In this large database sacral neuromodulation with InterStim™ Therapy seems to be an effective treatment through routine practice in the long-term (up to 60 months) for patients refractory to medical treatment.

AIM:To analyse current practice patterns and to evaluate (long-term) effectiveness and adverse events of sacral neuromodulation with InterStim™ Therapy based on data collected in a national register and to discuss the strengths and weaknesses of the register. PATIENTS AND METHODS:This is a French multicenter prospective observational trial including patients with a permanent implant (2003-2009). Voiding diary variables and patient satisfaction were analysed based on last follow-up visit since implantation. RESULTS:One thousand four hundred and eighteen patients (median age: 63 years, 1206 females) were included in the database (median follow-up: 12 months). One thousand and eighty-nine patients had non-neurological disease. The principal diagnosis was overactive bladder syndrome ([OAB], n=1170) and retention (n=151). Implantation occurred in 1358 patients; 1172 patients had greater than or equal to one registered follow-up. Clinical improvement of greater than or equal to 50% was seen in 447/527 patients with OAB at 12 months follow-up (median number of voids per 24 hours decreased from 15 at baseline to 8 at 12 months) and in 42/54 of patients with retention (median number of catheterization per 24 hours dropped from 5 at baseline to 0 at 12 months). Clinical improvement remained relatively stable up to 60 months. Median patient satisfaction with treatment was between 60 and 80%. Five hundred and twenty-four patients had at least one adverse event; loss of efficacy (n=244) occurred most frequently. CONCLUSIONS:In this large database sacral neuromodulation with InterStim™ Therapy seems to be an effective treatment through routine practice in the long-term (up to 60 months) for patients refractory to medical treatment.

PURPOSE:To validate the D'Amico risk group classification in French consecutive series and to analyse recurrence risk factor after radical prostatectomy (RP) for prostate cancer. MATERIAL:We retrospectively analyzed data collected from 10/2000 to 05/2009 for 730 consecutive patients who underwent RP for clinically localized or locally advanced prostate cancer (cT1-cT3) in our institution. Biochemical recurrence (BCR) was defined by prostate-specific antigen (PSA) of greater than 0.1 ng/ml, with rising PSA at two consecutive dosages. Postoperative survival was estimated using the Kaplan-Meier method after D'Amico's group stratification. The accuracy of the model was evaluated using the Harrell's concordance index. The impact on outcomes of preoperative PSA and pathological features was evaluated using a monovariate and multivariate Cox analysis. RESULTS:Median follow-up was 30 months [interquartile range: 13-51]. The overall 3-year and 5-year probability of freedom from BCR was 85% (95% Confidence Interval (CI), 81-88%) and 78% (95% CI, 74-83%), respectively. For low, intermediate, and high-risk group, the 5-year freedom from BCR was 92% (95% CI, 88-97%), 73% (95% CI, 65-81%) and 44% (95% CI, 28-59%), respectively (p<0.001). Harrell's concordance index was 0.71. Surgical margins were positive in 31% of all cases. In a multivariate analysis, preoperative PSA, pathological tumor stage, Gleason score and surgical margins status predicted BCR after RP. CONCLUSIONS:We externally validated the ability of the D'Amico's risk group stratification to predict disease progression following RP in European patients. Preoperative PSA, pathological stage, Gleason score and surgical margins status predicted BCR after RP in our series through a multivariate analysis.

Purpose. - To verify the effectiveness and safetiness of artificial urinary sphincter (SUA) AMS 800 (TM) in the management of urinary incontinence by sphincter incompetence.Patients and methods. - Retrospective study of patients who received SUA by the same operator between 1992 and 2006. Fifty-seven men and 27 women whose average age was 61 years (22-82) suffered from incontinence by sphincter incompetence: after radical prostatectomy (46%), primary stress or mixed incontinence (21.4%), transurethral resection of prostate (9.5%), injury and neurological malformations (9.5%), pelvic or urethral trauma (7.1%), rectal surgery (3.6%), adenomectomy (2.4%). Functional assessment was made by telephone based on a 23-item questionnaire (Appendix 2).Results. - The mean follow-up was 52.6 months (5.3-187.1): 64% had their original SUA, 50 re-interventions were necessary for 30 patients with 13.1% mechanical complications, 6.6% urethral atrophy, and 13.9% infectious complications, 2.5% failures and 9% definitive explant. The half-time survival without revision was 8.3 years. Sixty-seven percent of patients were contacted for the functional assessment: 77% success rate (<= 1 protection), 85% of patients improved, 87% satisfied or very satisfied and 94% would go again through the same operation.Conclusion. - The artificial urinary sphincter AMS 800 (TM) remains still the reference in the management of urinary incontinence by sphincter incompetence in improving the quality of life of patients implanted at the cost of a significant revision rate and frequent residual leaks. (c) 2010 Elsevier Masson SAS. All rights reserved.

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging I1 Apr 2010507 SPORADIC RENAL CELL CARCINOMA IN ADULTS 40 YEARS OLD OR LESS: RENAL TRANSLOCATION CARCINOMA RATE, CHARACTERISTICS AND SURVIVAL Tarek Ghoneim, Xavier Leroy, Laurent Lemaitre, Jacques Biserte, Arnauld Villers, and Laurent Zini Tarek GhoneimTarek Ghoneim More articles by this author , Xavier LeroyXavier Leroy More articles by this author , Laurent LemaitreLaurent Lemaitre More articles by this author , Jacques BiserteJacques Biserte More articles by this author , Arnauld VillersArnauld Villers More articles by this author , and Laurent ZiniLaurent Zini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.583AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The majority of renal cell carcinomas (RCCs) in adults are readily classified into one of several well-defined categories under the 2004 World Health Organization classification. In the past 5 years, the newly recognized family of Xp11 translocation RCCs was characterized by various chromosome translocations, all of which involve a breakpoint at Xp11.2 and all of which result in fusions involving the TFE3 transcription factor gene that maps to this locus. The rate of translocation RCCs in young adults and their clinico-pathological characteristics are unkown. The objective of our study was to compare consecutive cases of translocation RCCs with conventional RCCs in young adults. METHODS We reviewed the medical records of 37 consecutive patients 40 years or younger referred for the surgical management of sporadic RCC between August 2003 and July 2009. TFE3 immunohistochemical analysis was performed and allowed comparison between translocation RCCs and conventional RCC. Using univariable and multivariable analyses the pathological characteristics and outcome of the 2 groups were compared. RESULTS Of the 37 consecutive young patients, 10 (27%) were translocation RCCs. Mean age was significantly lower in translocation RCCs group relative to conventional RCCs group (26±5 years, range 20-40 vs. 33±5, range 17-38, respectively, P =0.005). N-stage was significantly higher in translocation RCCs group relative to conventional RCCs group (40% vs. 3.7% N1, respectively, p=0.007). The cancer-specific survival rate was at 12 and 36 months 100% and 78% for translocation RCC group vs. 91.5% and 73% for conventional RCC group (P=0.86). In multivariable analysis, tumor size was an independent prognostic factor of cancer-specific survival (HR= 1,29; P =0,02). CONCLUSIONS Approximately one third of young adults RCCs belong to the newly recognized family of Xp11 translocation RCCs. The cancer-specific survival rate at 36 months of follow-up was not different in translocation RCCs relative to conventional RCCs. Tumor size was an independent prognostic factor. Lille, France© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e200 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Ghoneim More articles by this author Xavier Leroy More articles by this author Laurent Lemaitre More articles by this author Jacques Biserte More articles by this author Arnauld Villers More articles by this author Laurent Zini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Los tumores del cordón espermático son infrecuentes, pero la diversidad de los elementos anatómicos que los constituyen crea una gran diversidad histológica. Un 80% de ellos tiene carácter benigno. Entre los malignos predominan los sarcomas, que se distribuyen de diversa manera según se trate de adultos (predominio de leiomiosarcomas) o de niños (predominio de rabdomiosarcomas). Se describen las metástasis secundarias y las muy variadas formas primitivas. Pueden encontrarse focos ectópicos de glándula suprarrenal incompleta y de tumores suprarrenales benignos (feocromocitoma). Las tumefacciones del cordón puede originarse en otras afecciones no tumorales, tales como infecciones (parasitarias, bacterianas, fúngicas), hidrocele, hematomas espontáneos o no y enfermedades inflamatorias crónicas (vasculitis, deferentitis). Los tumores obligan a practicar una exéresis quirúrgica, por lo general para confirmar el diagnóstico. En los tumores benignos típicos se puede utilizar una vía de acceso selectiva. En los demás casos se aborda el cordón espermático en la región inguinal. Cuando es posible conservar el testículo se puede practicar un estudio extemporáneo de la pieza quirúrgica, salvo en los casos de tumores malignos, que requieren una orquidectomía ampliada. Los tratamientos adyuvantes y neoadyuvantes (radioterapia, quimioterapia) no están codificados. El vaciamiento ganglionar lumboaórtico depende del tipo histológico y de la extensión. Para confirmar el diagnóstico de una tumefacción no tumoral puede ser necesario extirparla e incluso realizar una citopunción-biopsia. Luego se trata la enfermedad subyacente de la manera habitual.

Connaître les indications actuelles de l’exploration conventionnelle de l’urètre masculin. A partir d’un service de radiologie spécialisé rappeler la technique de l’urétrographie. Illustrer la séméiologie des principales pathologies de l’urètre. Connaître les limites de l’exploration radiologique. L’urétrographie rétrograde et mictionnelle reste une technique importante à connaître sur le plan technique et sémiologique.

Connaître la technique d’exploration de l’urètre masculin. Connaître les indications de cet examen. Quelle est la place de l’échographie et de l’IRM ? L’étude de l’urètre associe une étude rétrograde et mictionnelle. Outre le retentissement vésical, l’échographie recherche surtout une cause prostatique. L’IRM trouve sa place dans les tumeurs de l’urètre et de la verge. L’imagerie de l’urètre masculin repose toujours sur les explorations conventionnelles couplant les informations morphologiques de l’urétrographie rétrograde et les informations dynamiques de l’étude mictionnelle. Les indications restent la suspicion d’une sténose de l’urètre avec des troubles mictionnels sévères à type de dysurie, une débitmétrie faible et/ou un résidu postmictionnel, en l’absence de cause prostatique En dehors des techniques endoscopiques, les autres techniques ont peu de place dans l’arsenal des méthodes diagnostiques. L’évaluation de la fibrose autour de la sténose reste difficile. L’IRM trouve surtout sa place dans le bilan d’extension des tumeurs de l’urètre et de la verge.

Las pruebas de imagen del cáncer de próstata se han desarrollado ampliamente, con dos avances principales: el perfeccionamiento y la estandarización de los protocolos para las biopsias ecoguiadas de la próstata. Los adelantos de la resonancia magnética (RM) han proporcionado a esta técnica un nuevo lugar en el tratamiento del cáncer de próstata. Las correlaciones entre las piezas de prostatectomía radical y la RM permiten comprender la historia natural, las formas de progresión y las características del cáncer de próstata en las pruebas de imagen, ampliando los estudios de McNeal basados en la cartografía tumoral de las piezas de prostatectomía radical para la detección de focos tumorales mediante RM. El lugar de la RM, que durante mucho tiempo se mantuvo confinada a la evaluación de la extensión del cáncer de próstata, se extendió a la detección, al pronóstico y a la valoración preterapéutica; ofrece a los urólogos una cartografía tumoral cuya precisión ha de seguir aumentando con los progresos de las pruebas de imagen.

Purpose: The objective was to define the trends of PN use over time at six tertiary care European centers. Methods: Data were retrieved from institutional databases for patients treated with either PN or radical nephrectomy (RN) for stages T1-2N0M0 renal cell carcinoma (RCC) between 1987 and 2007. For purpose of temporal trend analyses patients were divided into five equally sized groups according to the date of surgery. Categorical and multivariable logistic regression analyses assessed predictors of PN use.Results: Overall 597 (31.7%) patients were treated with PN. Overall, a 4.5-fold increase of PN was recorded. The absolute increases were 41.7-86.3%, 14.9-69.3% and 8.1-35.3% for lesions <= 2 cm, 2.1-4 cm and 4.1-7 cm (chi-square trend test p < 0.001), respectively. In multivariable logistic regression models, decreasing tumor size, younger age, more contemporary date of surgery, male gender and institutional PN rate represented independent predictors of the individual probability of treatment with PN. Lack of data from community hospitals limits the generalizability of our findings.Conclusion: Based on data from six tertiary care centers, the contemporary rate of PN ranges from 86 to 35% for renal masses <= 2 cm to 4.1-7 cm and is indicative of excellent quality of care. (C) 2008 Elsevier Ltd. All rights reserved.

Les auteurs rapportent une observation d'insuffisance cardiaque à prédominance droite secondaire à une péricarditc constrictive. La cause est un processus fibrosant touchant également l'arbre aortique et le rétropéritoine. Cette affection pourrait être rattachée au cadre étiologique des fibroses systémiques idiopathiques et semblait sans liaison avec l'atteinte thyroïdienne et la prise de propranolol. La corticothérapie a transformé le tableau clinique et tomodensitométrique. La fibrose a pratiquement disparu de la région médiastinale. mais persistait dans le rétropéritoine.The authors report a case of right ventricular insufficiency by constrictive pericarditis revealing aortic and retroperitoneal fibrosis. Only one similar case has been published. We discuss the etiology of this affection, the possible analogies with idiopathic. systemic fibrosis and Takayasu's disease and the possible participation of thyroiditis disease and therapy (particularly propranolol).