[Management of testicular teratoma: update by the Oncology Committee of the French Urology Association, section of External Genital Organs (CCAFU-OGE)]

INTRODUCTION

The objective of this article was to focus on the pathological, clinical and therapeutic aspects of the different forms of testicular teratoma in adults.

MATERIAL AND METHODS

The multidisciplinary working group has conducted a literature search on Pubmed with keywords: adult teratoma; malignant transformation; growing teratoma; chemotherapy; surgery with focus on the different forms of adult testicular teratoma.

RESULTS

Teratomas of the adults are malignant and subdivided into localized and metastatic forms that may be distinguished under exclusive teratoma form, growing teratoma or teratoma with malignant transformation. The management is based on an enlarged surgical excision (testis and metastasis) with, in metastatic forms, a chemotherapy adjusted with histology. Extended follow-up beyond 10 years is necessary because of the risk of late relapse.

CONCLUSIONS

Testicular teratoma is a rare tumor, which is considered malignant with a potential of metastasis. The treatment is based mainly on surgical management.

[Laparoscopic nephrectomy for polycystic kidneys: principles and results]

OBJECTIVE

To evaluate the feasibility and morbidity of laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPK).

PATIENTS AND METHOD

This is a retrospective multi-centre study (University Hospitals of Lyons, Toulouse, Nantes and Rennes). Sixty-eight patients who had undergone laparoscopic nephrectomy for polycystic kidney disease between November 1999 and May 2009 were included. This involved unilateral nephrectomy 64 cases, one-stage bilateral in one case and two-stage bilateral in three cases.

RESULTS

The mean operating time was 218±74min (100-420) Conversion was necessary in 7 cases. The mean weight of the removed kidney was 1291±646g (240-3400). We regret to report 20 postoperative complications, including one death on postoperative day 50, following an abscess in the renal pelvis, 6 retroperitoneal haemoatomas and 5 arteriovenous fistula thromboses. Postoperative analgesia involved PCA treatment with morphine for a mean period of 1.59±0.8 days (0.5-4). The mean length of hospital stay was 8.3±6.1 days (3-50).

CONCLUSION

This study shows the feasibility of the laparoscopic approach for nephrectomy in ADPK. This procedure should be performed by experienced laparoscopic surgeons. Indeed, the complication rate is moderate but there is still a risk of severe complications.

LEVEL OF EVIDENCE

5.

[CCAFU's contribution to the French National Cancer Institute's reference frame: Retroperitoneal sarcomas]

INTRODUCTION

Retroperitoneal sarcomas are rare tumours. The objective of this article is to propose management guidelines.

MATERIAL AND METHODS

A review of the literature was performed using the PubMed search engine (1985-2013) with the key words: retroperitoneal sarcoma, prognosis, recurrence, surgery, radiation therapy, chemotherapy.

RESULTS

Chest, abdomen and pelvis computed tomography is the reference examination. Other examinations are optional. PET scan is not indicated for the primary diagnosis. CT-guided retroperitoneal biopsy is recommended and must be systematically performed before any management of a suspicious retroperitoneal mass. All retroperitoneal sarcomas must be registered and presented to a multidisciplinary consultation meeting devoted to the management of sarcomas (regional meetings) prior to any therapeutic intervention. Treatment is essentially surgical and is primarily designed to achieve negative surgical margins (R0). Neoadjuvant or adjuvant radiotherapy and chemotherapy can be proposed depending on the risk of progression and the resectability. The recurrence rate is related to tumour grade and surgical margins. The final prognosis is intimately related to the quality of initial management and the number of cases treated by each centre.

CONCLUSION

Retroperitoneal sarcomas have a poor prognosis. The quality of initial management directly impacts recurrence-free survival and overall survival. The prognosis is improved by multidisciplinary management conducted in a reference centre.

[Painful ejaculation]

OBJECTIVE

To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE).

MATERIAL AND METHODS

Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior.

RESULTS

PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies.

CONCLUSION

The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option.

[Multicentric evaluation of a self-screening questionnaire for occupational bladder cancer]

OBJECTIVE

Evaluate a self-screening questionnaire for bladder cancer of occupational origin and analyse an influence of exposure to a carcinogen bladder tumor on prognosis.

PATIENTS AND METHODS

Five hundred and thirty-one patients followed, between 2005 and 2010, for bladder cancer in two university centers have received a self-screening questionnaire derived from questionnaire KVP 08. Patients who responded positively to at least one of the items were considered to have a self-screening questionnaire "positive". Patients were finally invited to take an appointment for consultation in occupational pathology.

RESULTS

The response rate to self-screening questionnaire was 39.9% (212/531). It was "positive" in 82 cases (38.7%). Among the 82 patients with a self-screening questionnaire "positive", 46 patients consulted in occupational pathology (56%). Occupational exposure to a bladder carcinogen was documented in 91.3% of cases. Among the 22 patients who consulted in occupational pathology with a self-screening questionnaire "negative", an occupational exposure to a bladder carcinogen was documented in 13.6% of cases. The sensibility of the self-screening questionnaire was 91.3%, the specificity 86.4% and the accuracy 89.7%. The relative risk to have an occupational exposure if the self-screening questionnaire was "positive" was 6.69. The analysis of groups "positive" versus "negative" does not reveal any statistically significant difference in terms of tumor aggressiveness and disease-free survival.

CONCLUSION

The self-screening questionnaire was considered relevant with good reliability for detection of occupational exposure to a bladder carcinogen.

Is robotic-assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation?

AIM

Function, morbidity and recurrence of symptoms after robotic-assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for pelvic floor disorders (PFDs) were compared.

METHOD

Forty-four patients operated on for PFD with RVMR were compared with 74 of 144 patients who had had LVMR performed between 2008 and 2011. The groups were matched for age, body mass index, American Society of Anesthesiologists status and previous hysterectomy. The same surgical technique and type of mesh were used. Early postoperative morbidity and function [obstructed defaecation syndrome (ODS), incontinence scores (CCF) and sexual activity] were compared.

RESULTS

Operation time was longer in RVMR compared with LVMR (191 ± 26 vs 163 ± 39 min; P = 0.0002). RVMR showed less blood loss (8 ± 34 vs 42 ± 88 ml; P = 0.012) and fewer early complications (2% vs 11%; P = 0.019). ODS and CCF scores improved in both groups. Patients after RVMR reported a better improvement in digitation, straining and satisfaction after defaecation. There was a statistically significant difference in the postoperative ODS score in favour of RVMR (P = 0.004). Sexually active patients in both groups reported a similar improvement. There was no difference in early recurrence (P = 0.692).

CONCLUSION

Although not a randomized comparison, this study shows that ventral mesh rectopexy performed by the robot was followed by better function then LVMR.

Sexual function and laparoscopic ventral rectopexy for complex rectocoele

AIM

Laparoscopic ventral rectopexy (LVR) has recently been shown to be feasible, safe and efficient in restoring anatomy and improving rectal emptying in female patients presenting with a posterior pelvic floor prolapse. However, little is known about the sexual function of these patients. This study aimed to assess sexual activity in a group of patients referred for complex rectocoele and the consequences on sexual comfort of their treatment after LVR.

METHOD

We prospectively assessed 41 consecutive patients who underwent LVR (either laparoscopic or robotic-assisted) for symptomatic complex rectocoele from January 2009 to January 2010. We first identified sexually active patients in the cohort using a nonvalidated simplified questionnaire. The Brief Index Sexual Functioning for Women (BISF-W) questionnaire was used postoperatively to assess the impact of LVR on sexual function. Acceptability of the assessment of sexuality was also tested. The postoperative outcome of the sexually active patients was compared with data obtained from the French general population.

RESULTS

Among 38 patients in whom a successful LVR had been performed (three conversions), 22 (57.9%) were sexually active preoperatively and 18 (47.4%) were sexually active postoperatively at a mean of 7±4.2months of follow-up (P=0.44). No de novo dyspareunia was reported. At baseline, 13 patients experienced dyspareunia compared with six after LVR (P=0.02). A significant improvement in dyspareunia was observed (seven patients vs two patients; P=0.03). 19 (86%) of the 22 patients responded to the BISF-W questionnaire. The mean composite score was 26.7±8.2, with 63.2% of patients estimating sexual activity as important or very important. Compared with a reference population, sexual comfort was similar in LVR patients (32.2±12.6 vs 26.7±8.2; P=0.14).

CONCLUSION

Assessment of sexual function is accepted by the majority of patients suffering from pelvic floor disorders. In addition to the benefit on anatomical restoration and bowel function, LVR improves sexual function and dyspareunia in patients operated on for complex rectocoele.