The present study assessed the incidence and histopathological features of incidentally diagnosed prostate cancer (PCa) in specimens from radical cystoprostatectomy (RCP) for bladder cancer. The patient outcomes also were evaluated.

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.

To assess the risk factors of metastasis relapse in pT2-3 upper tract urothelial carcinomas (UTUCs) treated by radical nephroureterectomy (RNU) without lymphadenectomy (LN).

Study Type – Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT‐UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT‐UC. Using a multi‐institutional French database, we have shown that the 5‐year cancer‐specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P = 0.01). ASA status had a significant impact on cancer‐specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients ( P = 0.04). OBJECTIVE To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT‐UC). PATIENTS AND METHODS A retrospective multi‐institutional cohort study of the French collaborative national database of UUT‐UC treated by RNU in 20 centres from 1995 to 2010. The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS Overall, 554 patients were included. The median follow‐up was 26 months (10–48 months), and the median age was 69.5 years (61–76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. The 5‐year recurrence‐free survival ( P = 0.21) and metastasis‐free survival ( P = 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). The 5‐year cancer‐specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P = 0.01). ASA status had a significant impact on cancer‐specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients ( P = 0.04). CONCLUSIONS ASA classification correlates significantly with cancer‐specific survival after RNU for UUT‐UC. It is a further pre‐operative clinical variable that can be incorporated into future risk prediction tools for UUT‐UC to improve their accuracy.

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111411 ONCOLOGIC OUTCOMES AND EVOLUTION IN PATIENTS WITH PT0 DISEASE FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER. A MULTICENTRIC STUDY Sarah J. Drouin, Morgan Roupret, Yann Neuzillet, Jerome Rigaud, Mariam Hitier, Evanguelos Xylinas, François Iborra, Jean-Nicolas Cornu, Denis Champetier, Henry Botto, François Rozet, Vincent Flamand, Cyrille Bastide, Laurent Salomon, Luc Cormier, Xavier Durand, Pierre Lunardi, François-Xavier Nouhaud, Catherine Mazerolles, Marc-Olivier Bitker, Pascal Rischmann, Jean-Jacques Patard, Sophie Ferlicot, Hervé Wallerand, Julien Casenave, Aurelie paule, Karim Bensalalh, Pascal Gres, Benoit Peyronnet, Stephane Droupy, Laura Poissonnier, Jacques Irani, Michel Soulie, and Christian Pfister Sarah J. DrouinSarah J. Drouin Paris, France More articles by this author , Morgan RoupretMorgan Roupret Paris, France More articles by this author , Yann NeuzilletYann Neuzillet Paris, France More articles by this author , Jerome RigaudJerome Rigaud Paris, France More articles by this author , Mariam HitierMariam Hitier Paris, France More articles by this author , Evanguelos XylinasEvanguelos Xylinas Paris, France More articles by this author , François IborraFrançois Iborra Paris, France More articles by this author , Jean-Nicolas CornuJean-Nicolas Cornu Paris, France More articles by this author , Denis ChampetierDenis Champetier Paris, France More articles by this author , Henry BottoHenry Botto Paris, France More articles by this author , François RozetFrançois Rozet Paris, France More articles by this author , Vincent FlamandVincent Flamand Paris, France More articles by this author , Cyrille BastideCyrille Bastide Paris, France More articles by this author , Laurent SalomonLaurent Salomon Paris, France More articles by this author , Luc CormierLuc Cormier Paris, France More articles by this author , Xavier DurandXavier Durand Paris, France More articles by this author , Pierre LunardiPierre Lunardi Paris, France More articles by this author , François-Xavier NouhaudFrançois-Xavier Nouhaud Paris, France More articles by this author , Catherine MazerollesCatherine Mazerolles Paris, France More articles by this author , Marc-Olivier BitkerMarc-Olivier Bitker Paris, France More articles by this author , Pascal RischmannPascal Rischmann Paris, France More articles by this author , Jean-Jacques PatardJean-Jacques Patard Paris, France More articles by this author , Sophie FerlicotSophie Ferlicot Paris, France More articles by this author , Hervé WallerandHervé Wallerand Paris, France More articles by this author , Julien CasenaveJulien Casenave Paris, France More articles by this author , Aurelie pauleAurelie paule Paris, France More articles by this author , Karim BensalalhKarim Bensalalh Paris, France More articles by this author , Pascal GresPascal Gres Paris, France More articles by this author , Benoit PeyronnetBenoit Peyronnet Paris, France More articles by this author , Stephane DroupyStephane Droupy Paris, France More articles by this author , Laura PoissonnierLaura Poissonnier Paris, France More articles by this author , Jacques IraniJacques Irani Paris, France More articles by this author , Michel SoulieMichel Soulie Paris, France More articles by this author , and Christian PfisterChristian Pfister Paris, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1302AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Assessing oncologic outcomes and evolution for patients who underwent cystectomy for bladder cancer with no evidence of disease (i.e., pT0 ) on the cystectomy specimen. METHODS In total, 4200 cases of radical cystectomy for bladder cancer were reviewed in 20 centers. We selected all patients who were pT0 on definitive pathological specimen. The following data were retrieved: age, sex, grade, stage, concomitant CIS, intravesical instillation, pathological data, recurrence and survival. Patients who received combined neoadjuvant radiation and chemotherapy were excluded. RESULTS Overall, 266 patients (6.3%) were pT0 and included. Overall, the mean follow-up was 46.7±49 (1–254) months, the mean age at diagnosis was 62.4±9.6 (32–85) years and the male to female ratio was 9/1. At the time of resection, stages were distributed as follows: 14.3% Tis / Ta (n=38), 31.2% T1 (n=83), 54.1% T2 (n=144) and 0.4% T3 (n=1). Intravesical instillations (BCG, mitomycin C) were performed in 93 patients (35%). The median length of time between the last resection and the bladder removal was 2 months. Cystectomy was proposed for : a muscle-infiltrating tumor (n=160, 60.2%), recurrences after intravesical instillation (n=71, 26.6%), presence of high grade or carcinoma in situ (n=23, 8.7%) and incapacitating clinical symptoms (n=12, 4.5%). Lymphadenectomy were performed in 241 cases (90.6%) and 14 patients (5.3%) had lymph nodes metastases. Neoadjuvant chemotherapy alone was administered to 16 patients (6%). There were 38 cases of recurrence (14.3%) and 29 patients received adjuvant chemotherapy. Overall, 50 patients died, including 18 from bladder cancer (6.8%). The 5 years overall, specific and recurrence-free survivals were 79.4%, 89.2% and 85.2%, respectively. CONCLUSIONS Unexpectedly, pT0 patients need to undergo careful surveillance as every other patients who had a radical cystectomy. Indeed, a significant proportion of these patients is likely to recur or evolve, despite their apparent favourable initial pathological status. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e565 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah J. Drouin Paris, France More articles by this author Morgan Roupret Paris, France More articles by this author Yann Neuzillet Paris, France More articles by this author Jerome Rigaud Paris, France More articles by this author Mariam Hitier Paris, France More articles by this author Evanguelos Xylinas Paris, France More articles by this author François Iborra Paris, France More articles by this author Jean-Nicolas Cornu Paris, France More articles by this author Denis Champetier Paris, France More articles by this author Henry Botto Paris, France More articles by this author François Rozet Paris, France More articles by this author Vincent Flamand Paris, France More articles by this author Cyrille Bastide Paris, France More articles by this author Laurent Salomon Paris, France More articles by this author Luc Cormier Paris, France More articles by this author Xavier Durand Paris, France More articles by this author Pierre Lunardi Paris, France More articles by this author François-Xavier Nouhaud Paris, France More articles by this author Catherine Mazerolles Paris, France More articles by this author Marc-Olivier Bitker Paris, France More articles by this author Pascal Rischmann Paris, France More articles by this author Jean-Jacques Patard Paris, France More articles by this author Sophie Ferlicot Paris, France More articles by this author Hervé Wallerand Paris, France More articles by this author Julien Casenave Paris, France More articles by this author Aurelie paule Paris, France More articles by this author Karim Bensalalh Paris, France More articles by this author Pascal Gres Paris, France More articles by this author Benoit Peyronnet Paris, France More articles by this author Stephane Droupy Paris, France More articles by this author Laura Poissonnier Paris, France More articles by this author Jacques Irani Paris, France More articles by this author Michel Soulie Paris, France More articles by this author Christian Pfister Paris, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bleeding of the ureteral wall during an anticoagulant treatment is a rare complication. We report the case of a 57-year-old white woman presented with macroscopic haematuria and lumbar pain with an overdose of anticoagulant treatment. Computed tomographic scan revealed the bleeding of the ureteral wall. Clinical improvement was excellent after correction of the haemostasis disorder.

Evaluer la morbidité du prélèvement rénal chez le donneur vivant (DV), les conséquences médicales et l’impact sur la qualité de vie (QdV) à long terme. Analyse rétrospective des données médico chirurgicales de 114 patients prélevés dans un seul centre universitaire entre 1977 et 2005. La survenue de complications a été évaluée par rapport à la voie d’abord chirurgicale et à l’indice de masse corporel (IMC) en utilisant le test du chi 2 ou le test exact de Fisher. Les évolutions de la fonction rénale (créatininémie, clairance de la créatinine), de la protéinurie et de la pression artérielle (PA) ont été étudiées par le test t de Student ou le test non paramétrique U de Mann et Withney Wilcoxon. La QdV à long terme a été évaluée par le questionnaire MOS SF-36 et par un questionnaire local puis comparée à celle de la population générale française. Le suivi médian était de 63 mois. La morbidité du prélèvement était significativement corrélée à la voie d’abord (p=0,018) et à un IMC ≥ 25 kg/m2 (p=0,014). La mortalité était nulle. Une élévation modérée de la créatininémie a été enregistrée au cours du suivi (créatininémie moyenne de 82,2μmol/1 [+/- 16,3] à 104,5 [+/-19,9]), ainsi qu’une baisse de la clairance (de 113,4 ml/min [+/- 27,6] à 76 [+/- 29,9]). La protéinurie et la PA ont été peu influencées. La QdV n’a pas été altérée par le prélèvement rénal. Le taux de complications péri opératoire est corrélé à l’IMC et à l’abord par lombotomie. Le prélèvement rénal réduit la filtration glomérulaire mais la clairance demeure stable durant le suivi. Une macro albuminurie ou une HTA peuvent apparaître. Leur fréquence n’est pas majorée par rapport à la population générale. La QdV des DV n’est pas altérée. Une information claire auprès du grand public permettrait la promotion de la transplantation à partir de DV. To evaluate the morbidity of living donor kidney harvesting and the long-term medical consequences and impact on quality oflife (QoL). Retrospective analysis of medical and surgical data for 114 living kidney donors in a single teaching hospital between 1977 and 2005. Complications were evaluated in relation to the surgical approach and body mass index (BMI) using a Chi-square test or Fisher's exact test. Changes in renal function (serum creatinine, crea-tinine clearance), proteinuria and blood pressure (BP) were studied by Student's t test or a Mann-Whitney U or Wilcoxon nonparametric test. Long-term QoL was evaluated by the MOS SF-36 questionnaire and a local questionnaire and was then compared to that ofthe French general population. The median follow-up was 63 months. The morbidity of kidney harvesting was significantly correlated with the surgical approach (p=0.018) and a BMI ≥ 25 kg/m2 (p=0.014). No mortality was observed in this series. A moderate elevation of serum creatinine was obser-ved during follow-up (mean serum creatinine increased from 82.2 μmol/l [± 16.3] to 104.5 μmol/l [± 19.9]), and mean creatinine clearance decreased from 113.4 ml/min [±27.6] to 76 ml/min [±29.9]. Little impact was observed on proteinuria and BP and QoL was not altered by kidney harvesting. The perioperative complication rate is correlated with BMI and a flank incision. Kidney harvesting lowers glomerular filtration, but clearance remained stable during follow-up. Macroalbuminuria or hypertension may be observed, but their frequency is not higher than in the general population. The QoL of living donors is not altered. Clear information for the general public would allow promotion of living donor transplantation.

OBJECTIVE:To evaluate the morbidity of living donor kidney harvesting and the long-term medical consequences and impact on quality of life (QoL).MATERIAL AND METHODS:Retrospective analysis of medical and surgical data for 114 living kidney donors in a single teaching hospital between 1977 and 2005. Complications were evaluated in relation to the surgical approach and body mass index (BMI) using a Chi-square test or Fisher's exact test. Changes in renal function (serum creatinine, creatinine clearance), proteinuria and blood pressure (BP) were studied by Student's t test or a Mann-Whitney U or Wilcoxon nonparametric test. Long-term QoL was evaluated by the MOS SF-36 questionnaire and a local questionnaire and was then compared to that of the French general population.RESULTS:The median follow-up was 63 months. The morbidity of kidney harvesting was significantly correlated with the surgical approach (p = 0.018) and a BMI > or = 25 kg/m2 (p = 0.014). No mortality was observed in this series. A moderate elevation of serum creatinine was observed during follow-up (mean serum creatinine increased from 82.2 micromol/l [+/- 16.3] to 104.5 micromol/l [+/- 19.9]), and mean creatinine clearance decreased from 113.4 ml/min [+/- 27.6] to 76 ml/min [+/- 29.9]. Little impact was observed on proteinuria and BP and QoL was not altered by kidney harvesting.CONCLUSION:The perioperative complication rate is correlated with BMI and a flank incision. Kidney harvesting lowers glomerular filtration, but clearance remained stable during follow-up. Macroalbuminuria or hypertension may be observed, but their frequency is not higher than in the general population. The QoL of living donors is not altered. Clear information for the general public would allow promotion of living donor transplantation.