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Viegas V, Freton L, Richard C, Haudebert C, Khene ZE, Hascoet J, Verhoest G, Mathieu R, Vesval Q, Zhao LC, Bensalah K, Peyronnet B. Robotic YV plasty outcomes for bladder neck contracture vs. vesico-urethral anastomotic stricture. World J Urol 2024; 42:172. [PMID: 38506927 DOI: 10.1007/s00345-024-04814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To compare the outcomes of patients undergoing robotic YV plasty for bladder neck contracture (BNC) vs. vesico-urethral anastomotic stricture (VUAS). METHODS A retrospective study included male patients who underwent robotic YV plasty for BNC after endoscopic treatment of BPH or VUAS between August 2019 and March 2023 at a single academic center. The primary assessed was the patency rate at 1 month post-YV plasty and during the last follow-up visit. RESULTS A total of 21 patients were analyzed, comprising 6 in the VUAS group and 15 in the BNC group. Patients with VUAS had significantly longer operative times (277.5 vs. 146.7 min; p = 0.008) and hospital stay (3.2 vs. 1.7 days; p = 0.03). Postoperative complications were more common in the VUAS group (66.7% vs. 26.7%; p = 0.14). All patients resumed spontaneous voiding postoperatively. Five patients (23.8%) who developed de novo stress urinary incontinence had already an AUS (n = 1) or required concomitant AUS implantation (n = 3), all of whom were in the VUAS group (83.3% vs. 0%; p < 0.0001). The proportion of patients improved was similar in both groups (PGII = 1 or 2: 83.3% vs. 80%; p = 0.31). Stricture recurrence occurred in 9.5% of patients in the whole cohort, with no significant difference between the groups (p = 0.50). Long-term reoperation was required in three VUAS patients, showing a statistically significant difference between the groups (p = 0.05). CONCLUSION Robotic YV plasty is feasible for both VUAS and BNC. While functional outcomes and stricture-free survival may be similar for both conditions, the perioperative outcomes were less favorable for VUAS patients.
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Affiliation(s)
- Vanessa Viegas
- Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | | | | | | | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Quentin Vesval
- Department of Urology, University of Rennes, Rennes, France
| | - Lee C Zhao
- Department of Urology, New York University, New York, USA
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
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Courboin E, Mathieu R, Panetta V, Mjaess G, Diamand R, Verhoest G, Roumiguié M, Bajeot AS, Soria F, Lonati C, Simeone C, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Mertens LS, Sanchez-Salas R, Colomer A, Cerruto MA, Antonelli A, Krajewski W, Quackels T, Peltier A, Montorsi F, Briganti A, Teoh JYC, Pradere B, Moschini M, Roumeguère T, Albisinni S. Comparing Robotic-Assisted to Open Radical Cystectomy in the Management of Non-Muscle-Invasive Bladder Cancer: A Propensity Score Matched-Pair Analysis. Cancers (Basel) 2023; 15:4732. [PMID: 37835425 PMCID: PMC10571883 DOI: 10.3390/cancers15194732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND For non-muscle-invasive bladder cancer (NMIBC) requiring radical surgery, limited data are available comparing robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) to open radical cystectomy (ORC). The objective of this study was to compare the two surgical techniques. METHODS A multicentric cohort of 593 patients with NMIBC undergoing iRARC or ORC between 2015 and 2020 was prospectively gathered. Perioperative and pathologic outcomes were compared. RESULTS A total of 143 patients operated on via iRARC were matched to 143 ORC patients. Operative time was longer in the iRARC group (p = 0.034). Blood loss was higher in the ORC group (p < 0.001), with a consequent increased post-operative transfusion rate in the ORC group (p = 0.003). Length of stay was longer in the ORC group (p = 0.007). Post-operative complications did not differ significantly (all p > 0.05). DFS at 60 months was 55.9% in ORC and 75.2% in iRARC with a statistically significant difference (p = 0.033) found in the univariate analysis. CONCLUSION We found that iRARC for patients with NMIBC is safe, associated with a lower blood loss, a lower transfusion rate and a shorter hospital stay compared to ORC. Complication rates were similar. No significant differences in survival analyses emerged across the two techniques.
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Affiliation(s)
- Etienne Courboin
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
- Department of Urology, CHU Rennes, 35000 Rennes, France; (R.M.); (G.V.)
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 35000 Rennes, France; (R.M.); (G.V.)
| | - Valentina Panetta
- L’altrastatistica S.R.L., Consultancy & Training, Biostatistics Office, 00100 Rome, Italy;
| | - Georges Mjaess
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.D.); (A.P.)
| | - Gregory Verhoest
- Department of Urology, CHU Rennes, 35000 Rennes, France; (R.M.); (G.V.)
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 31000 Toulouse, France; (M.R.); (A.S.B.)
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 31000 Toulouse, France; (M.R.); (A.S.B.)
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10024 Turin, Italy;
| | - Chiara Lonati
- Department of Urology, Spedali Civili di Brescia, 25123 Brescia, Italy; (C.L.); (C.S.)
| | - Claudio Simeone
- Department of Urology, Spedali Civili di Brescia, 25123 Brescia, Italy; (C.L.); (C.S.)
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, 00100 Rome, Italy; (G.S.); (U.A.)
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, 00100 Rome, Italy; (G.S.); (U.A.)
| | - Paolo Umari
- Departement of Urology, Ospedale Maggiore della Caritá di Novara, Universitá del Piemonte Orientale, 28100 Novarra, Italy;
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK; (A.S.); (J.K.)
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London WC1E 6BT, UK; (A.S.); (J.K.)
| | - Laura S. Mertens
- Department of Urology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, 70123 Paris, France; (R.S.-S.); (A.C.)
| | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, 70123 Paris, France; (R.S.-S.); (A.C.)
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37100 Verona, Italy; (M.A.C.); (A.A.)
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37100 Verona, Italy; (M.A.C.); (A.A.)
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland;
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.D.); (A.P.)
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (F.M.); (A.B.); (M.M.)
| | - Alberto Briganti
- Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (F.M.); (A.B.); (M.M.)
| | - Jeremy Y. C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China;
| | - Benjamin Pradere
- Department of Urology, University of Vienna, 1010 Vienna, Austria;
- Department of Urology, Hopital La Croix du Sud, 31000 Toulouse, France
| | - Marco Moschini
- Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (F.M.); (A.B.); (M.M.)
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium; (R.D.); (A.P.)
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium; (G.M.); (T.Q.); (T.R.); (S.A.)
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, 00100 Rome, Italy
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Branger N, Bladou F, Verhoest G, Knipper S, Robert G, Bernhard JC, Beauval JB, Khaddad A, Mauger De Varennes A, Fléchon A, Walz J, Bageot AS, Doumerc N, Rouprêt M, Murez T. Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes. World J Urol 2023; 41:2405-2411. [PMID: 37507528 DOI: 10.1007/s00345-023-04536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To evaluate the feasibility, safety, and early oncologic outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND) for metastatic germ cell tumors (mGCT). METHODS We retrospectively analyzed patients from four tertiary centers who underwent PC-RARPLND for mGCT, from 2011 to 2021. Previous treatment of mGCT, intraoperative and postoperative complications, and early oncologic outcomes were assessed. RESULTS Overall, 66 patients were included. The majority of patients had non-seminoma mTGCT (89%). Median size of retroperitoneal lymph node (RLN) before surgery was 26 mm. Templates of PC-RARPLND were left modified, right modified, and full bilateral in 56%, 27%, and 14%, respectively. Median estimated blood loss and length of stay were 50 mL [50-150] and 2 [1-3] days. Four patients (6.1%) had a vascular injury, only one with significant blood loss and conversion to open surgery (OS). Two other patients had a conversion to OS for difficulty of dissection. No patient had transfusion, most frequent complications were ileus (10.6%) and symptomatic lymphorrea (7.6%) and no complications grade IIIb or more occurred. With a median follow-up of 16 months, two patients had a relapse, all outside of the surgical template (one in the retrocrural space with reascending markers, one in lungs). CONCLUSION PC-RARPLND is a challenging surgery. In expert centers and for selected patients, it seemed safe and feasible, with a low morbidity. Further prospective evaluation of this procedure and long-term oncologic results are needed.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France.
| | - Franck Bladou
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | | | - Sophie Knipper
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | | | | | | | | | - Aude Fléchon
- Department of Oncology, Centre Léon Bérard, Lyon, France
| | - Jochen Walz
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | | | - Morgan Rouprêt
- Department of Urology, La Pitié Salpêtrière, Paris, France
| | - Thibault Murez
- Department of Urology, CHU Montpellier, Montpellier, France
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Poinard F, Bessede T, Barrou B, Drouin S, Karam G, Branchereau J, Alezra E, Thuret R, Verhoest G, Goujon A, Millet C, Boissier R, Delaporte V, Sallusto F, Prudhomme T, Boutin JM, Culty T, Timsit MO. Impact of newly diagnosed prostate cancer at time of evaluation for renal transplantation. Clin Transplant 2023; 37:e14998. [PMID: 37138463 DOI: 10.1111/ctr.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
Systematic screening for prostate cancer is widely recommended in candidates for renal transplant at the time of listing. There are concerns that overdiagnosis of low-risk prostate cancer may result in reducing access to transplant without demonstrated oncological benefits. The objective of the study was to assess the outcome of newly diagnosed prostate cancer in candidates for transplant at the time of listing, and its impact on transplant access and transplant outcomes according to treatment options. This retrospective study was conducted over 10 years in 12 French transplant centers. Patients included were candidates for renal transplant at the time of prostate cancer diagnosis. Demographical and clinical data regarding renal disease, prostate cancer, and transplant surgery were collected. The primary outcome of the study was the interval between prostate cancer diagnosis and active listing according to treatment options. Overall median time from prostate cancer diagnosis to active listing was 25.0 months [16.4-40.2], with statistically significant differences in median time between the radiotherapy and the active surveillance groups (p = .03). Prostate cancer treatment modalities had limited impact on access and outcome of renal transplantation. Active surveillance in low-risk patients does not seem to compromise access to renal transplantation, nor does it impact oncological outcomes.
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Affiliation(s)
- Florence Poinard
- Department of Urology and Renal Transplantation, Georges Pompidou European Hospital, Paris, France
| | - Thomas Bessede
- Urology Department, Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Benoit Barrou
- Department of Urology and Renal Transplantation, APHP - Sorbonne University, Pitié Salpêtrière University Hospital, Paris, France
| | - Sarah Drouin
- Department of Urology and Renal Transplantation, APHP - Sorbonne University, Pitié Salpêtrière University Hospital, Paris, France
| | - Georges Karam
- Department of Urology & Renal Transplantation, Hotel Dieu University Hospital, Nantes, France
| | - Julien Branchereau
- Department of Urology & Renal Transplantation, Hotel Dieu University Hospital, Nantes, France
| | - Eric Alezra
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Rodolphe Thuret
- Department of Urology and Transplantation, Montpellier University Hospital, Montpellier, France
| | - Gregory Verhoest
- Department of Urology and Transplantation, Rennes University Hospital, Rennes, France
| | - Anna Goujon
- Department of Urology and Transplantation, Rennes University Hospital, Rennes, France
| | - Clementine Millet
- Department of Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Romain Boissier
- Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, Aix-Marseille University, Marseille, France
| | - Veronique Delaporte
- Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, Aix-Marseille University, Marseille, France
| | - Federico Sallusto
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | | | - Thibaut Culty
- Department of Urology, Angers University Hospital, Angers, France
| | - Marc-Olivier Timsit
- Department of Urology and Renal Transplantation, Georges Pompidou European Hospital, Paris, France
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Mjaess G, Diamand R, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Tay A, Issa R, Roumiguié M, Bajeot AS, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Mertens LS, Sanchez-Salas R, Gallardo AC, Quackels T, Peltier A, Pradere B, Moschini M, Roumeguère T, Albisinni S. Cost-analysis of robot-assisted radical cystectomy in Europe: A cross-country comparison. Eur J Surg Oncol 2023; 49:1511-1518. [PMID: 35970622 DOI: 10.1016/j.ejso.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is surging worldwide. Aim of the study was to perform a multicentric cost-analysis of RARC by comparing the gross cost of the intervention across hospitals in four different European countries. METHODS Patients who underwent RARC + ICUD were recruited from eleven European centers in four European countries (Belgium, France, Netherlands, and UK) between 2015 and 2020. Costs were divided into six parts: cost for hospital stay, cost for ICU stay, cost for surgical theater occupation, cost for transfusion, cost for robotic instruments, and cost for stapling instruments. These costs were individually assessed for each patient. RESULTS A total of 490 patients were included. Median operative time was 300(270-360) minutes and median hospital length-of-stay was 11(8-15) days. The average total cost of RARC was 14.794€ (95%CI 14.300-15.200€). A significant difference was found for the total cost, as well as the various subcosts abovementioned, between the four included countries. Different sets and types of robotic instruments were used by each center, leading to a difference in cost of robotic instrumentation. Nearly 84% of costs of RARC were due to hospital stay (42%), ICU stay (3%) and operative time (39%), while 16% of costs were due to robotic (8%) and stapling (8%) instruments. CONCLUSION Costs and subcosts of RARC + ICUD vary significantly across European countries and are mainly dependent of hospital length-of-stay and operative time rather than robotic instrumentation. Decreasing length-of-stay and reducing operative time could help to decrease the cost of RARC and make it more widely accessible.
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Affiliation(s)
- Georges Mjaess
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France; Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Anna Colomer Gallardo
- Department of Urology, Institut Mutualiste Montsouris, Paris, France; Department of Urology, Hospital Universitari Germans Trias i Pujol, Badolona, Spain
| | - Thierry Quackels
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Marco Moschini
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium; Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
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6
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Sarkis J, Diamand R, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Minervini A, Tay A, Issa R, Roumiguié M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Mertens LS, Sanchez-Salas R, Colomer A, Quackels T, Peltier A, Montorsi F, Briganti A, Pradere B, Moschini M, Roumeguère T, Albisinni S. Do perioperative blood transfusions impact oncological outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion? Results from a large multi-institutional registry. Minerva Urol Nephrol 2023; 75:50-58. [PMID: 36800680 DOI: 10.23736/s2724-6051.22.05109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Blood transfusions (BT) have been associated with adverse oncologic outcomes in multiple malignancies including open radical cystectomy (ORC) for urothelial carcinoma of the bladder (UCB). Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) delivers similar oncologic outcomes compared to ORC, yet with lower blood loss and reduced transfusions. However, the impact of BT after robotic cystectomy is still unknown. METHODS This is a multicenter study including patients treated for UCB with RARC and ICUD in 15 academic institutions, between January 2015 and January 2022. BT were administered during surgery (intraoperative blood transfusions, iBT) or during the first 30 days after surgery (post-operative blood transfusions, pBT). The association of iBT and pBT with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were evaluated by univariate and multivariate regression analysis. RESULTS A total of 635 patients were included in the study. Overall, 35/635 patients (5.51%) received iBT while 70/635 (11.0%) received pBT. After a mean follow-up of 23±18 months, 116 patients (18.3%) had died, including 96 (15.1%) from bladder cancer. Recurrence occurred in 146 patients (23%). iBT were associated with decreased RFS, CSS and OS (P<0.001) on univariate Cox analysis. After adjusting for clinicopathologic covariates, iBT were associated only with the risk of recurrence (HR: 1.7; 95% CI, 1.0-2.8, P=0.04). pBT were not significantly associated to RFS, CSS or OS on univariate and multivariate Cox regression models (P>0.05). CONCLUSIONS In the present study, patients treated by RARC with ICUD for UCB have a higher risk of recurrence after iBT, yet no significant association with CSS and OS was found. pBT are not associated with worse oncological prognosis.
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Affiliation(s)
- Julien Sarkis
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium -
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France.,Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne S Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College of London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College of London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College of London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Anna Colomer
- Department of Urology, Montsouris Mutualiste Institute, Paris, France
| | - Thierry Quackels
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology UROSUD, Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Marco Moschini
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.,Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium.,Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
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7
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Freton L, Graffeille V, Khene Z, Hascoet J, Mathieu R, Vesval Q, Verhoest G, Bensalah K, Peyronnet B. YV plasty for vesico-urethral anastomosis stenosis by combined robotic and perineal approach and concomitant artificial urinary sphincter implantation. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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8
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Haudebert C, Hascoet J, Bryckaert P.E, Freton L, Richard C, Khene Z.E, Voiry C, Samson E, Mathieu R, Verhoest G, Bensalah K, Manunta A, Peyronnet B. Robot-assisted intracorporeal Monti catheterizable channel. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01439-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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9
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Szabla N, Matillon X, Calves J, Branchereau J, Champy C, Neuzillet Y, Bessede T, Bouhié S, Boutin JM, Caillet K, Cognard N, Culty T, De Fortescu G, Drouin S, Bentellis I, Hubert J, Boissier R, Sallusto F, Sénéchal C, Terrier N, Thuret R, Verhoest G, Waeckel T, Tillou X. Updated National Study of Functional Graft Renal Cell Carcinomas: Are They a Different Entity? Urology 2023; 171:152-157. [PMID: 36243142 DOI: 10.1016/j.urology.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze de novo graft carcinoma characteristics from our updated national multicentric retrospective cohort. METHODS Thirty-two transplant centers have retrospectively completed the database. This database concerns all kidney graft tumors including urothelial, and others type but excludes renal lymphomas over 31 years. RESULTS One hundred and fifty twokidney graft carcinomas were diagnosed in functional grafts. Among them 130 tumors were Renal Cell Carcinomas. The calculated incidence was 0.18%. Median age of the allograft at diagnosis was 45.4 years old. The median time between transplantation and diagnosis was 147.1 months. 60 tumors were papillary carcinomas and 64 were clear cell carcinomas. Median tumor size was 25 mm. 18, 64, 21 and 1 tumors were respectively Fuhrman grade 1, 2, 3 and 4. Nephron sparing surgery (NSS) was performed on 68 (52.3%) recipients. Ablative therapy was performed in 23 cases (17.7%). Specific survival rate was 96.8%. CONCLUSION This study confirmed that renal graft carcinomas are a different entity: with a younger age of diagnosis; a lower stage at diagnosis; a higher incidence of papillary subtypes.
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Affiliation(s)
- Nicolas Szabla
- CHU de Caen, Urology and Transplantation, Caen Calvados, France
| | - Xavier Matillon
- Hôpital Edouard Herriot, Urology and Transplantation, Lyon, Rhone, France
| | - Jehanne Calves
- CHU de Brest, Urology and Transplantation, Brest, Britanny, France
| | | | - Cécile Champy
- CHU Henri Mondor, Urology and Transplantation, Créteil, Val de Marne, France
| | - Yann Neuzillet
- Hôpital Foch, Urology and Transplantation, Suresnes, Huats de siene, France
| | - Thomas Bessede
- Hôpital Kremlin Bicetre, Urology and Transplantation, Paris, Paris, France
| | | | - Jean-Marie Boutin
- Hôpital Bretonneaux, Urology and Transplantation, Tours, Val de Loire, France
| | - Kevin Caillet
- CHU d'Amiens, Urology and Transplantation, Amiens, Somne, France
| | - Noelle Cognard
- CHU de Strasbourg, Urology and Transplantation, Strasbourg, Bas-Rhin, France
| | - Thibaut Culty
- CHU d'Angers, Urology and Transplantation, Angers, Maine et Loire, France
| | | | - Sarah Drouin
- Hôpital La Pitié Salpêtrière, Transplantation, Paris, Paris, France
| | - Imad Bentellis
- CHU Félix Guyon, Urology and Transplantation, La Réunion, La Reunion, France
| | - Jacques Hubert
- CHU de Nancy, Urology and Transplantation, Nancy, Meurthe-et-Moselle, France
| | - Romain Boissier
- Hôpital de la Conception, Urology and Transplantation, Marseille, Provence, France
| | - Federico Sallusto
- CHU de Toulouse, Urology and Transplantation, Toulouse ,Haute Gronnea, France
| | - Cédric Sénéchal
- CHU de Point à Pitre, Urology and Transplantation, Point à Pitre, Guadeloupe, France
| | - Nicolas Terrier
- CHU de Grenoble, Urology and Transplantation, Grenoble, Isare, France
| | - Rodolphe Thuret
- CHU de Montpellier, Urology and Transplantation, Montpellier, Herault, France
| | - Gregory Verhoest
- CHU de Rennes, Urology and Transplantation, Rennes, Ille-et-Vilaine, France
| | - Thibaut Waeckel
- CHU de Bordeaux, Urology and Transplantation, Bordeaux, Gironde, France
| | - Xavier Tillou
- CHU de Caen, Urology and Transplantation, Caen Calvados, France.
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10
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Goujon A, Khene ZE, Thenault R, Vigneau C, Peyronnet B, Belabbas D, Guérin S, Chemouny J, Gasmi A, Verhoest G, Shariat S, Bensalah K, Mathieu R. Contrast-enhanced CT texture analysis for the prediction of delayed graft function following kidney transplantation from cadaveric donors. Prog Urol 2022; 32:868-874. [DOI: 10.1016/j.purol.2022.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 10/15/2022]
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11
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Laukhtina E, Boehm A, Peyronnet B, Bravi CA, Batista Da Costa J, Soria F, D'Andrea D, Rajwa P, Quhal F, Yanagisawa T, König F, Mostafaei H, Enikeev D, Ingels A, Verhoest G, D'Hondt F, Mottrie A, Joniau S, Van Poppel H, de la Taille A, Bensalah K, Bruyère F, Shariat SF, Pradere B. Urethrectomy at the time of radical cystectomy for non-metastatic urothelial carcinoma of the bladder: a collaborative multicenter study. World J Urol 2022; 40:1689-1696. [PMID: 35596017 PMCID: PMC9236994 DOI: 10.1007/s00345-022-04025-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB). MATERIALS AND METHODS We assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement). RESULTS A total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04). CONCLUSION In our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients' history may allow for better clinical decision-making and patient counseling.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Axelle Boehm
- Department of Urology, University Hospital of Tours, Tours, France
| | - Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Carlo Andrea Bravi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Jose Batista Da Costa
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Turin, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France
| | - Gregory Verhoest
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Alexandre de la Taille
- Department of Urology, University Hospital Henri Mondor, AP-HP, UPEC, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 95010, Créteil Cedex, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, Tours, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France.
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Lebret T, Radulescu C, Guy L, Roumiguié M, Courtade-Saïdi M, Piaton E, Verhoest G, Rioux N, Savareux L, De Vergie S, Renaudin K, Kandel C, Gonzalez S, Borgès R, Cochand-Priollet B, Nivet S, Pignot G. VISIOCYT1 clinical trial: Artificial intelligence for the diagnosis of bladder urothelial lesions. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16558 Background: Voided urinary cytology is a non-invasive test, but it suffers from a lack of sensitivity (Se), particularly in low-grade urothelial lesions, and it remains pathologist-dependent. In order to improve the performance of urinary cytopathology, the VitaDX company (France) developed a medical device which uses whole-slide digitalization and artificial intelligence algorithms to identify tumor cells. The device allows complete analysis of morphological characters of voided urothelial cells, such as the shape, size and color of the nuclei. Methods: VISIOCYT1 is a prospective, multicenter clinical trial involving 319 patients divided into two groups: 1) patients with non-muscle invasive bladder tumors (NMIBC) confirmed by histology, and 2) control patients with negative urinary cytology and cystoscopy. The primary objective of the study was to evaluate the Se of the VisioCyt test. Specificity (Sp) and comparison of Se and Sp of conventional urinary cytology vs. the VisioCyt test were also calculated. Results: A total of 319 patients were included (170 in the NIMBC group vs. 149 controls). Overall Se was 80.9% and 45.9% for VisioCyt test and conventional urinary cytology, respectively (p = .002). Negative cytology being an inclusion criterion, a 100% Sp was attributed to the control group. It was calculated at 61.8% for the VisioCyt test. Concerning grade, the VisioCyt test allowed higher Se to be obtained in the low grade tumor category (66.7% vs. 26.1% for conventional urinary cytology, Mc Nemar test, p < .0001). A higher Se was also observed in high grade tumors: 93.7% vs. 62.8% (p < .0001). Conclusions: The VisioCyt test greatly improves the performance of urinary cytopathology in the diagnosis of urothelial bladder tumors, particularly in low grade, pTa lesions. Its implementation could dramatically reduce the need for cystoscopy in patients followed after conservative treatment of bladder cancer. Clinical trial information: NCT02966691. [Table: see text]
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Affiliation(s)
| | | | - Laurent Guy
- Hopital Gabriel Montpied CHU, Clermont-Ferrand, France
| | - Mathieu Roumiguié
- Centre Hospitalier Universitaire Toulouse Rangueil, Toulouse, France
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13
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Albisinni S, Diamand R, Mjaess G, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Minervini A, Tay A, Issa R, Roumiguie M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Sandel N, Sanchez-Salas R, Colore A, Quackels T, Peltier A, Montorsi F, Briganti A, Teoh JYC, Pradere B, Moschini M, Roumeguere T. Defining the morbidity of Robotic-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: adoption of the Comprehensive Complication Index. J Endourol 2022; 36:785-792. [PMID: 35109696 DOI: 10.1089/end.2021.0843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND & OBJECTIVE The Clavien-Dindo Classification (CDC) only reports the post-operative complication of highest grade. It is thus of limited value for radical cystectomy after which patients usually experience multiple complications. The CCI is a novel scoring system which incorporates all post-operative events in one single value. To adopt the Comprehensive Complication Index (CCI) for the evaluation of complications in patients undergoing Robot-Assisted Radical Cystectomy (RARC) with Intra-Corporeal Urinary Diversion (ICUD) and explore its advantages in the analysis of the morbidity of RARC with ICUD. PATIENTS AND METHODS Multicentric cohort of 959 patients undergoing RARC+ICUD between 2015-2020, whose complications are encoded in local prospective registries. Post-operative complications at 30 days were assessed using both the CDC and CCI. The CCI was calculated using an online tool (assessurgery.com). Risk factors for overall, major complications (CDC≥III) and CCI were evaluated using uni- and multivariable logistic and linear regressions. To analyse the potential advantage of using the CCI in clinical trials, a sample size calculation of a hypothetic clinical trial was performed using as endpoint reduction of morbidity with either the CDC or CCI. RESULTS Overall, 885 post-operative complications were reported in 507 patients (53%). The CCI improved the definition of post-operative morbidity in 22.6% of patients. Male sex and neobladder were associated to major complications and to a significant increase in CCI on adjusted regressions. In a hypothetical clinical trial, 80 patients would be needed to demonstrate a ten point reduction in CCI, compared to 186 needed to demonstrate an absolute risk reduction of 20% in overall morbidity using the CDC. CONCLUSION CCI improves the evaluation of post-operative morbidity by considering the cumulative aspect of complications compared to the CDC. Implementing the CCI for radical cystectomy would help reducing sample sizes in clinical trials.
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Affiliation(s)
- Simone Albisinni
- Hopital Erasme, 70496, Route de Lennik 808, Bruxelles, Belgium, 1070;
| | - Romain Diamand
- Institut Jules Bordet, 60210, Bruxelles, Bruxelles, Belgium;
| | | | | | | | | | | | - Serge Holz
- Ambroise Pare Ziekenhuis, 82241, Mons, Wallonie, Belgium;
| | - Michel Naudin
- Ambroise Pare Ziekenhuis, 82241, Mons, Wallonie, Belgium;
| | - Guillaume Ploussard
- Clinique Capio La Croix du Sud, 538719, Quint-Fonsegrives, Occitanie, France;
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Largo Brambilla 3, Firenze, Italy, 50100.,University of Florence, Careggi Hospital, Florence, Italy.;
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze., Largo Brambilla 3 - San Luca Nuovo Padiglione 16/Settore C/Piano II, Florence, Italy, 50134;
| | - Andrea Tay
- St George's Healthcare NHS Trust, 4968, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Rami Issa
- St George's Healthcare NHS Trust, 4968, London, London, United Kingdom of Great Britain and Northern Ireland;
| | | | | | - Giuseppe Simone
- Regina Elena, urology, via elio chianesi 53, Roma, Italy, 00144.,Italy;
| | | | - Paolo Umari
- University of Eastern Piedmont Amedeo Avogadro Department of Translational Medicine, 370891, Department of Urology, Via Solaroli 17, 28100, Novara, Italy, Novara, Italy, 28100.,United States;
| | - Ashwin Sridhar
- UCLH, 8964, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - John Kelly
- UCLH, 8964, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Kees Hendricksen
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Sarah Einerhand
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Noah Sandel
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Rafael Sanchez-Salas
- Institute Mutualiste Monsouris, Urology, 142, Bd. Jourdan, Paris, Not Applicable, France, 75014;
| | - Anne Colore
- Institut Mutualiste Montsouris, 26953, Paris, Île-de-France, France;
| | | | | | | | | | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Benjamin Pradere
- Medical University of Vienna, 27271, Department of urology, Wien, Wien, Austria;
| | - Marco Moschini
- Luzerner Kantonsspital, 30748, Luzern, Switzerland.,Vita-Salute University, urology, Milan, Italy;
| | - Thierry Roumeguere
- Hôpital Erasme, 70496, Urology, route de Lennik 808, Bruxelles, Belgium, 1070.,United States;
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14
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Freton L, Graffeille V, Khene Z, Hascoet J, Verhoest G, Mathieu R, Vesval Q, Zhao L, Bensalah K, Peyronnet B. Robotic YV plasty for bladder neck vs. vesico-urethral anastomotic stricture. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Peyronnet B, Lecoanet P, Mellouki A, Hascoet J, Tibi B, Durand M, Verhoest G, Bensalah K, Allahal Y, Manunta A, Bentellis I. Robot-assisted supratrigonal cystectomy and augmentation cystoplasty for neurological bladder in adults: Comparison of extracorporeal vs. intracorporeal diversion. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Mermier M, Baron P, Roumiguie M, Bajeot AS, Pignot G, Lannes F, Ploussard G, Gasmi A, Bensalah K, Perrot O, Rouprêt M, Bruyere F, Pradere B, Verhoest G. Predictive factors of early postoperative complications after robot-assisted radical cystectomy for urothelial bladder carcinoma. J Endourol 2021; 36:634-640. [PMID: 34931545 DOI: 10.1089/end.2021.0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To identify protective and risk factors of early postoperative complications after robot-assisted radical cystectomy for urothelial bladder carcinoma. METHODS Data of all robot-assisted cystectomy performed in six french centers between February 2010 and December 2019 were retrospectively reviewed. All robot-assisted radical cystectomy for bladder cancer (muscle-invasive and high-risk or BCG-resistant non muscle-invasive bladder cancer) were included. Perioperative outcomes and early postoperative complications (in the first 30 days) were collected. Multivariate analysis was performed to identify factors associated to early postoperative complications. RESULTS 270 patients were included. The overall incidence of early postoperative complications after robot-assisted radical cystectomy was 52.2% (27% of major complications). Most frequent complications were infectious complications (24.4%) and paralytic ileus (15.6%). Anticoagulant therapy (OR=2.909, 95%CI 1.003 to 8.432) and uretero-enteric anastomosis type Wallace II (OR=4.4, 95%CI 1.435 to 13.489) were associated with a higher rate of overall complications. Complete intracorporeal derivation was a protective factor (OR=0.399, 95%CI 0.222 to 0.718). Tabacco consumption, anticoagulant therapy, uretero-enteric anastomosis type Wallace II were associated with a higher rate of minor complications (OR=2.01, 95%CI 1.079 to 3.744; OR=2.495, 95%CI 1.022 to 6.089; OR=3.836, 95%CI 1.384 to 10.63 respectively). Opioid-Free Anaesthesia was associated with a lower rate of infectious complications (OR=0.148, 95%CI 0.034 to 0.644). CONCLUSION Early postoperative complications rate after robot-assisted radical cystectomy for urothelial bladder carcinoma is high. Encouraging complete intracorporeal diversion and promoting Opioid-Free Anaesthesia seem to reduce postoperative complications in the first 30 days. Prospective studies are needed to provide a high level of evidence.
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Affiliation(s)
- Marie Mermier
- CHU Rennes, 36684, 2 rue Henri Le Guilloux, Rennes, France, 35000;
| | | | - Mathieu Roumiguie
- Centre Hospitalier Universitaire de Toulouse, 36760, urology, Toulouse, Midi-Pyrénées, France;
| | | | | | | | - Guillaume Ploussard
- Clinique Capio La Croix du Sud, 538719, Quint-Fonsegrives, Occitanie, France;
| | | | - Karim Bensalah
- Rennes University Hospital (France), Urology, 2 rue Henri Le Guillou, Rennes, France, 35000;
| | | | - Morgan Rouprêt
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Paris, France;
| | - Franck Bruyere
- CHRU Tours, 26928, urology, 2 bd Tonnellé, Tours, France, 37044;
| | - Benjamin Pradere
- CHU Tours, Department of urology, 2 boulevard tonnellé, Tours, France, 37000;
| | - Gregory Verhoest
- RENNES Univeristy Hospital, Urology, Henri Le Guillou St, RENNES, France, 35033;
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Dupuis H, Khene Z, Verhoest G, Mathieu R, Peyronnet B, Bensalah K. Néphrectomie partielle robot-assistée pour les tumeurs CT2 : morbidité, résultats oncologiques et fonctionnels. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Neveu P, Ouzaid I, Roumiguié M, Moschini M, Mathieu R, Verhoest G, Shariat S, Hermieu J, Xylinas E. Impact de la taille tumorale sur le pronostic des tumeurs de la voie excrétrice urinaire supérieure de bas risque. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Freton L, Richard C, Zhao L, Graffeille V, Thenault R, Hascoet J, Verhoest G, Khene Z, Bensalah K, Mathieu R, Peyronnet B. Plastie YV de sténose d’anastomose urétrovésicale par voie combinée robotique et périnéale associé à la pose d’un sphincter urinaire artificiel. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Haudebert C, Hascoet J, Bryckaert P, Richard C, Freton L, Khene Z, Voiry C, Samson E, Mathieu R, Verhoest G, Bensalah K, Manunta A, Peyronnet B. Cystostomie continente de type Mitrofanoff (appendicovésicostomie) par voie cœlioscopique robot-assistée. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Haudebert C, Richard C, Manunta A, Khene Z, Graffeille V, Hascoet J, Verhoest G, Bensalah K, Mathieu R, Peyronnet B, Freton L. Réalignement endoscopique précoce des ruptures urétrales post-traumatiques chez l’Homme. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Albisinni S, Diamand R, Mjaess G, Assenmacher G, Assenmacher C, Loos S, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Di Maida F, Minervini A, Aoun F, Tay A, Issa R, Roumiguié M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Sanchez-Salas R, Colomer A, Quackels T, Peltier A, Montorsi F, Briganti A, Pradere B, Moschini M, Roumeguère T. Continuing acetylsalicylic acid during Robotic-Assisted Radical Cystectomy with intracorporeal urinary diversion does not increase hemorrhagic complications: results from a large multicentric cohort. Urol Oncol 2021; 40:163.e11-163.e17. [PMID: 34580028 DOI: 10.1016/j.urolonc.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether continuing the antiplatelet drug acetylsalicylic acid≤100mg (ASA) during Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) increases the risk of peri-and postoperative hemorrhagic complications and overall morbidity. Indeed, guidelines recommend interrupting antiplatelet therapy before radical cystectomy; however, RARC with ICUD is associated to reduced estimated blood loss and blood transfusions compared to its open counterpart. METHODS Data from a multicentric European database were analyzed. All participating centers maintained a prospective database of patients undergoing RARC with ICUD. We identified patients receiving antiplatelet therapy by acetylsalicylic acid ≤100mg. Patients were divided into three groups: those not taking acetylsalicylic acid (no-ASA), those where ASA was continued perioperatively (c-ASA) and those where ASA was interrupted perioperatively (i-ASA). Estimated blood loss and peri-and post-operative transfusions were recorded. Hemorrhagic complications, ischemic, thrombotic and cardiac morbidity was recorded and classified using the Clavien-Dindo score by a senior urologist. RESULTS 640 patients were analyzed. Patients on acetylsalicylic acid were significantly older and had more comorbidities. No significant difference was found for estimated blood loss between no-ASA, c-ASA and i-ASA (280 vs. 300 vs. 200ml respectively; P = 0.09). Similarly, no significant difference was found for intraoperative (5% vs. 9% vs. 11%; P = 0.07) and postoperative transfusion rate (11% vs. 13% vs. 18%; P = 0.17). Higher ischemic complications were noted in the i-ASA group compared to no-ASA and c-ASA (4% vs. 0.6% vs. 1.4%; P = 0.03). On uni and multivariate logistic regression, continuing acetylsalicylic acid was not significantly associated to either major complications or post-operative transfusions. CONCLUSIONS Peri-operative acetylsalicylic acid continuation in RARC with ICUD does not increase hemorrhagic complications. Interrupting acetylsalicylic acid peri-operatively may expose patients to a higher risk of ischemic events.
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Affiliation(s)
- Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Romain Diamand
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | | | | | - Shirley Loos
- Department of Urology, Cliniques de l'Europe-Saint Elisabeth, Brussels, Belgium
| | | | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Fouad Aoun
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Hotel Dieu de France, Beirut, Lebanon
| | - Andrea Tay
- Department of Urology, Saint Georges Hospital, London, UK
| | - Rami Issa
- Department of Urology, Saint Georges Hospital, London, UK
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Anne Sophie Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Ashwin Sridhar
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sarah Einerhand
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Anna Colomer
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Thierry Quackels
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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23
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Timsit MO, Branchereau J, Matillon X, Verhoest G, Bessede T, LeQuintrec M, Boissier R, Badet L, Smadja DM. [Use of antiplatelet therapy and direct oral anticoagulants in candidates for renal transplantation: The French guidelines from the CTAFU]. Prog Urol 2021; 31:39-44. [PMID: 33423745 DOI: 10.1016/j.purol.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To define guidelines for the use of antiplatelet therapy (AT) and direct oral anticoagulants (DOAC) in candidates for kidney allotransplantation. METHOD A review of the medical literature following a systematic approach was conducted by the CTAFU to report the use of AT and DOAC before major surgery and in the setting of advanced chronic kidney disease, defining their managment prior to kidney transplantation with the corresponding level of evidence. RESULTS DOAC are not recommended in patients under dialysis. Aspirin therapy, but not anti-P2Y12 and DOAC, may be maintained during renal transplantation. Anti-P2Y12 and DOAC should not be use in patients awaiting a kidney transplant, except when a living donor is scheduled, therefore authorizing treatment interruption in optimal conditions. Further data regarding DOAC reversion and monitoring may improve their use in this setting. Global level of evidence is weak. CONCLUSION These French recommendations should contribute to improve surgical management of kidney transplant candidates exposed to AT or DOA.
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Affiliation(s)
- M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France.
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 01, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université de Paris-Saclay, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - M LeQuintrec
- Service de néphrologie et transplantation rénale, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34070 Montpellier, France
| | - R Boissier
- Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille, 13005 Marseille, France
| | - L Badet
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - D M Smadja
- Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'hématologie et laboratoire de recherches biochirurgicales, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Branchereau J, Prudhomme T, Bessede T, Verhoest G, Boissier R, Culty T, Matillon X, Defortescu G, Sallusto F, Terrier N, Drouin S, Karam G, Badet L, Timsit MO. [Living donor nephrectomy: The French guidelines from CTAFU]. Prog Urol 2021; 31:50-56. [PMID: 33423748 DOI: 10.1016/j.purol.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To propose surgical recommendations for living donor nephrectomy. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU regarding functional and anatomical assessment of kidney donors, including which side the kidney should be harvested from. Distinct surgical techniques and approaches were evaluated. References were considered with a predefined process to propose recommendations with the corresponding levels of evidence. RESULTS The recommendations clarify the legal and regulatory framework for kidney donation in France. A rigorous assessment of the donor is one of the essential prerequisites for donor safety. The impact of nephrectomy on kidney function needs to be anticipated. In case of modal vascularization of both kidneys without a relative difference in function or urologic abnormality, removal of the left kidney is the preferred choice to favor a longer vein. Mini-invasive approaches for nephrectomy provide faster donor recovery, less donor pain and shorter hospital stay than open surgery. CONCLUSION These French recommendations must contribute to improving surgical management of candidates for kidney donation.
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Affiliation(s)
- J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Boissier
- Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - F Sallusto
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - N Terrier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - G Karam
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - L Badet
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, 56, rue Leblanc, université de Paris, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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Drouin S, Defortescu G, Prudhomme T, Culty T, Verhoest G, Doerfler A, Goujon A, Branchereau J, Timsit MO. [Lower urinary tract symptoms and urinary incontinence in renal transplant recipients and candidates: The French guidelines from CTAFU]. Prog Urol 2021; 31:45-49. [PMID: 33423747 DOI: 10.1016/j.purol.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To propose surgical recommendations for the management of lower urinary tract symptoms (LUTS) and urinary incontinence in kidney transplant recipients and candidates. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU focusing on medical and surgical treatment of LUTS and urinary incontinence in kidney transplant recipients and candidates. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS Functional bladder capacity and bladder compliance are impaired during dialysis. LUTS, related to pre-kidney transplantion alterations, frequently improve spontaneously after kidney transplantation. LUTS secondary to benign prostatic hyperplasia (BPH) may be underestimated before kidney transplantation due to oliguria, low bladder compliance and low bladder capacity. In LUTS associated with BPH, anticholinergics require dosage adjustment with creatinine clearance. If surgery is indicated after kidney transplantation, procedure can be safely performed in the early post-transplant course after removal of ureteral stent. Surgical management of urinary incontinence does not seem to be associated with an icreased risk for infectious complications in kidney transplant recipients. Particular attention should be paid to the management of postvoid residual and bladder pressures in case of neurological bladder disease. Optimal care of neurological bladder should be provided prior to transplantation: with a cautious management, and despite an increased occurrence of febrile urinary tract infections, transplant survival is not compromised. CONCLUSION These recommendations must contribute to improve the management of lower urinary tract symptoms and urinary incontinence in kidney transplant patients and kidney transplant candidates.
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Affiliation(s)
- S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, Sorbonne université, , APHP-6, 47, boulevard de l'Hôpital, 75013 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille 13005 Marseille, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille 13005 Marseille, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Île Gloriette, 44093 Nantes cedex 01, France; PARCC, Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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Tillou X, Doerfler A, Szabla N, Verhoest G, Defortescu G, Bessede T, Prudhomme T, Culty T, Bigot P, Bensalah K, Méjean A, Timsit MO. [Renal cell carcinoma of the kidney transplant: The French guidelines from CTAFU]. Prog Urol 2021; 31:24-30. [PMID: 33423743 DOI: 10.1016/j.purol.2020.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To propose recommendations for the management of renal cell carcinomas (RCC) of the renal transplant. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to evaluate prevalence, diagnosis and management of RCC arousing in the renal transplant. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS Renal cell carcinomas of the renal transplant affect approximately 0.2% of recipients. Mostly asymptomatic, these tumors are mainly diagnosed on a routine imaging of the renal transplant. Predominant pathology is clear cell carcinomas but papillary carcinomas are more frequent than in general population (up to 40-50%). RCC of the renal transplant is often localized, of low stage and low grade. According to tumor characteristics and renal function, preferred treatment is radical (transplantectomy) or nephron sparing through partial nephrectomy (open or minimally invasive approach) or thermoablation after percutaneous biopsy. Although no robust data support a switch of immunosuppressive regimen, some authors suggest to favor the use of mTOR inhibitors. CTAFU does not recommend a mandatory waiting time after transplantectomy for RCC in candidates for a subsequent renal tranplantation when tumor stage<T3 and low ISUP grade. CONCLUSION These French recommendations should contribute to improving the oncological and functional prognosis of renal transplant recipients by improving the management of RCC of the renal transplant.
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Affiliation(s)
- X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - N Szabla
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université de Paris-Saclay, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - P Bigot
- Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France; Comité de cancérologie de l'association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - K Bensalah
- Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; Comité de cancérologie de l'association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - A Méjean
- Comité de cancérologie de l'association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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Pizzighella M, Bruyere F, Peyronnet B, Grafeille V, Brichart N, Mori K, Verhoest G, Bensalah K, Moschini M, Xylinas E, Pradere B. THE MANAGEMENT OF DISTAL URETER DURING RADICAL NEPHROURETERECTOMY DOES NOT INFLUENCE BLADDER RECURRENCE. J Endourol 2021; 36:77-82. [PMID: 34121446 DOI: 10.1089/end.2021.0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The bladder cuff management and its surgical approach represent an essential and debated step in radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The objective of our study was to determine which bladder-cuff management has the best oncological outcomes in terms of bladder recurrence-free survival ( BRFS). METHODS We retrospectively analyzed all patients who underwent an open robot-assisted laparoscopic (RNU) or a combined RNU between March 2012 and March 2019 in three academic hospitals. Bladder-cuff management approaches were divided into two categories: (O-cuff) open bladder cuff and (R-cuff) robot-assisted bladder cuff. We assessed demographic characteristics, distal ureter approach, pathology, and operative details as well as oncological outcomes including BRFS. Survival was analysed using the Kaplan-Meier method and compared using the log-rank test. A multivariable analysis was performed to identify predictive factors of bladder recurrence. RESULTS A total of 117 patients were included with a mean follow-up of 40.4 months. Patients with a history of bladder cancer, RNU with pure laparoscopic approach and endoscopic bladder cuff were excluded. There were 53 (45%) patients in the O-cuff group and 64 (55%) in the R-cuff group. BRFS at 2 years was 73.3% and 72.7% for O-cuff and R-cuff respectively (p=0.9). On multivariable analysis, distal ureter tumor (odds ratio (OR): 6.24, 95% CI: 1.95- 21.5; p < 0.01) was associated with bladder recurrence (BR). CONCLUSION There was no statistically significant difference in BRFS between the O-cuff and R-cuff groups. Nevertheless, we underlined that distal ureter tumor was associated with bladder recurrence. Although we did not find differences regarding the surgical approach, bladder-cuff remains a very important step of RNU and caution should be taken when performed laparoscopically to avoid any tumor spillage. Risk factors for bladder cancer recurrence might be taken into account for the choice of its surgical approach. .
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Affiliation(s)
| | - Franck Bruyere
- CHRU Tours, 26928, urology, 2 bd Tonnellé, Tours, France, 37044;
| | - Benoit Peyronnet
- CHU Rennes, Department of urology, 2 rue Henri Le Guilloux, Rennes, France, 35000;
| | - Vivien Grafeille
- CHU Rennes, 36684, Department of urology, Rennes, Bretagne, France;
| | - Nicolas Brichart
- CHR Orleans, 52817, Department of urology, Orleans, Centre, France;
| | - Keiichiro Mori
- The Jikei University School of Medicine, Urology, Minato, Tokyo, Japan;
| | - Gregory Verhoest
- RENNES Univeristy Hospital, Urology, Henri Le Guillou St, RENNES, France, 35033;
| | - Karim Bensalah
- Rennes University Hospital (France), Urology, 2 rue Henri Le Guillou, Rennes, France, 35000;
| | - Marco Moschini
- Luzerner Kantonsspital, 30748, Luzerner Kantonsspital, Luzern, Switzerland, 6000.,United States;
| | | | - Benjamin Pradere
- CHU Tours, Department of urology, Tours, France.,Medical University of Vienna, 27271, urology, Wien, Wien, Austria;
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Freton L, Richard C, Hascoet J, Khene ZE, Alimi Q, Graffeille V, Verhoest G, Mathieu R, Manunta A, Zhao L, Bensalah K, Peyronnet B. Robotic YV plasty for bladder neck contracture or vesico-urethral anastomosis stenosis in a French university hospital: Preliminary results. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dagher J, Brunot A, Evrard B, Kammerer-Jacquet SF, Beaumont M, Cornevin L, Derquin F, Verhoest G, Bensalah K, Lespagnol A, Dugay F, Belaud-Rotureau MA, Chalmel F, Rioux-Leclercq N. Multiple metastatic clones assessed by an integrative multiomics strategy in clear cell renal carcinoma: a case study. J Clin Pathol 2021; 75:426-430. [PMID: 33766955 DOI: 10.1136/jclinpath-2020-207326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
The dynamics of metastatic evolution in clear cell renal cell carcinoma (ccRCC) are complex. We report a case study where tumour heterogeneity resulting from clonal evolution is a frequent feature and could play a role in metastatic dissemination.We used an integrative multiomics strategy combining genomic and transcriptomic data to classify fourteen specimens from spatially different areas of a kidney tumour and three non-primary sites including a vein thrombus and two adrenal metastases.All sites were heterogeneous and polyclonal, each tumour site containing two different aggressive subclonal populations, with differentially expressed genes implicated in distinct biological functions. These are rare primary metastatic samples prior to any medical treatment, where we showed a multiple metastatic seeding of two subclonal populations.Multiple interdependent lineages could be the source of metastatic heterogeneity in ccRCC. By sampling metastases, patients with resistance to therapies could benefit a combination of targeted therapies based on more than one aggressive clone.
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Affiliation(s)
- Julien Dagher
- Univ Rennes, Inserm, EHESP, Irset - UMR_S1085, F-35000, Rennes 1 University, Rennes, Bretagne, France.,Department of Pathology, University Hospital, Rennes, Bretagne, France
| | - Angelique Brunot
- Univ Rennes, Inserm, EHESP, Irset - UMR_S1085, F-35000, Rennes 1 University, Rennes, Bretagne, France.,Department of Oncology, University Hospital of Rennes, Rennes, France
| | - Bertrand Evrard
- Univ Rennes, Inserm, EHESP, Irset - UMR_S1085, F-35000, Rennes 1 University, Rennes, Bretagne, France
| | | | - Marion Beaumont
- Department of Cytogenetics and Cell Biology, CHU de Rennes, Rennes, France
| | - Laurence Cornevin
- Department of Cytogenetics and Cell Biology, CHU de Rennes, Rennes, France
| | - Fanny Derquin
- Department of Oncology, University Hospital of Rennes, Rennes, France
| | - Gregory Verhoest
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Frederic Dugay
- Department of Cytogenetics and Cell Biology, CHU de Rennes, Rennes, France
| | - Marc-Antoine Belaud-Rotureau
- Univ Rennes, Inserm, EHESP, Irset - UMR_S1085, F-35000, Rennes 1 University, Rennes, Bretagne, France.,Department of Cytogenetics and Cell Biology, CHU de Rennes, Rennes, France
| | - Frédéric Chalmel
- Univ Rennes, Inserm, EHESP, Irset - UMR_S1085, F-35000, Rennes 1 University, Rennes, Bretagne, France
| | - Nathalie Rioux-Leclercq
- Univ Rennes, Inserm, EHESP, Irset - UMR_S1085, F-35000, Rennes 1 University, Rennes, Bretagne, France.,Department of Pathology, University Hospital, Rennes, Bretagne, France
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Culty T, Goujon A, Defortescu G, Bessede T, Kleinclauss F, Boissier R, Drouin S, Branchereau J, Doerfler A, Prudhomme T, Matillon X, Verhoest G, Tillou X, Ploussard G, Rozet F, Méjean A, Timsit MO. [Localized Prostate cancer in candidates for renal transplantation and recipients of a kidney transplant: The French Guidelines from CTAFU]. Prog Urol 2021; 31:4-17. [PMID: 33423746 DOI: 10.1016/j.purol.2020.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To define guidelines for the management of localized prostate cancer (PCa) in kidney transplant (KTx) candidates and recipients. METHOD A systematic review (Medline) of the literature was conducted by the CTAFU to report prostate cancer epidemiology, screening, diagnosis and management in KTx candidates and recipients with the corresponding level of evidence. RESULTS KTx recipients are at similar risk for PCa as general population. Thus, PCa screening in this setting is defined according to global French guidelines from CCAFU. Systematic screening is proposed in candidates for renal transplant over 50 y-o. PCa diagnosis is based on prostate biopsies performed after multiparametric MRI and preventive antibiotics. CCAFU guidelines remain applicable for PCa treatment in KTx recipients with some specificities, especially regarding lymph nodes management. Treatment options in candidates for KTx need to integrate waiting time and access to transplantation. Current data allows the CTAFU to propose mandatory waiting times after PCa treatment in KTx candidates with a weak level of evidence. CONCLUSION These French recommendations should contribute to improve PCa management in KTx recipients and candidates, integrating oncological objectives with access to transplantation.
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Affiliation(s)
- T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - F Kleinclauss
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - R Boissier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Ploussard
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - F Rozet
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, université de Paris, 56, rue Leblanc, 75015 Paris, France.
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Bessede T, Branchereau J, Goujon A, Boissier R, Alezra E, Verhoest G, Culty T, Matillon X, Doerfler A, Tillou X, Sallusto F, Terrier N, Thuret R, Drouin S, Timsit MO. [Urinary stones in renal transplant recipients and donors: The French guidelines from CTAFU]. Prog Urol 2021; 31:57-62. [PMID: 33423749 DOI: 10.1016/j.purol.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define guidelines for the management of kidney stones in kidney transplant (KTx) donor or recipients. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to report kidney stone epidemiology, diagnosis and management in KTx donors and recipients with the corresponding level of evidence. RESULTS Prevalence of kidney stones in deceased donor is unknown but reaches 9.3% in living donors in industrialized countries. Except in Maastrich 2 donors, diagnosis is done on systematic pre-donation CT scan according to standard french procedure. No prospective study has compared therapeutic strategies available for the management of kidney stones in KTx donor: ureteroscopy or an extra corporeal lithotripsy in case of living donor prior to donation, ex vivo approach (pyelotomy or ureteroscopy), ureterocopy in the KTx recipient or surveillance. De novo kidney stones result from a lithogenesis process to be identified and treated in order to avoid recurrences. The context of solitary functional kidney renders the prevention of recurrence of great importance. Diagnosis is suspected when identification of a renal graft dysfunction, hematuria or urinary tract infection with renal pelvis dilatation. Stone size and location are determined by computed tomography. There are no prospective, controlled studies on kidney stone management in the KTx. The therapeutic strategies are similar to standard management in general population. CONCLUSION These French recommendations should contribute to improve kidney stones management in KTx donor and recipients.
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Affiliation(s)
- T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Paris Saclay, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Ile Gloriette, 44093 Nantes cedex 01, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Boissier
- Service d'urologie et transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille, 13005 Marseille, France
| | - E Alezra
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - F Sallusto
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - N Terrier
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - R Thuret
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34070 Montpellier, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université Paris Sorbonne, hôpital de la Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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Verhoest G, Brassier M, Mathieu R, Peyronnet B, Vincendeau S, Manunta A, Bensalah K. Lymphangiome kystique de veine cave inférieure par chirurgie robotique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baron P, Khene Z, Ploussard G, Bruyere F, Gasmi A, Verhoest G, Perrot O, Roupret M, Bajeot A, Roumiguie M, Lannes F, Pignot G, Pradere B. Validation française d’un pentafecta pour une évaluation standardisée des résultats de la cystectomie totale laparoscopique robot-assistée pour cancer de vessie. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Richard C, Hascoet J, Mazouin C, Freton L, Tondut L, Dosin G, Manunta A, Khene Z, Mathieu R, Verhoest G, Bensalah K, Peyronnet B. Explantation d’une prothèse de promontofixation par voie transvésicale et exérèse des bras d’une bandelette tvt laparoscopique robot-assistée. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Freton L, Hascoet J, Khene Z, Alimi Q, Mazouin C, Graffeille V, Verhoest G, Mathieu R, Manunta A, Zhao L, Bensalah K, Peyronnet B. Plastie yv et plastie postérieur robotique pour sclérose de col vésical post-pvp. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Freton L, Khene Z, Hascoet J, Alimi Q, Verhoest G, Mathieu R, Manunta A, Duval E, Vassal L, Berteuil N, Ravel C, Guénégo A, Bensalah K, Peyronnet B. Auto-évaluation de professionnels de santé concernant la prise en charge des patient.e.s transgenres. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Richard C, Hascoet J, Mazouin C, Freton L, Dosin G, Buisset J, Graffeille V, Manunta A, Khene Z, Mathieu R, Verhoest G, Bensalah K, Peyronnet B. Cure de fistule vésico-vaginale par voie vaginale avec interposition d’un lambeau de martius en position du jockey. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dosin G, Mazouin C, Manunta A, Hascoet J, Bensalah K, Verhoest G, Freton L, Mathieu R, Graffeille V, Khene Z, Voiry C, Samson E, Haudebert C, Pradere B, Peyronnet B. Cystectomie et dérivation cutanée non continente par conduit iléal robotique intracorporelle pour vessie neurologique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mazouin C, Khene Z, Peyronnet B, Gasmi A, Dosin G, Brassier M, Thi Dang V, Ouzaid I, Larcher A, Roumiguié M, Verhoest G, Pradère B, Shariat S, Mathieu R, Bigot P, Doumerc N, Bensalah K. Prédire la morbidité de la néphrectomie partielle : retour à la simplicité. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Peyronnet B, Manunta A, Buisser J, Richard C, Dosin G, Alimi Q, Freton L, Mathieu R, Verhoest G, Bensalah K, Hascoet J. Implantation robot-assistée d’un sphincter artificiel urinaire ams 800 chez les patientes neurologique après entérocystoplastie d’agrandissement et cystostomie continente. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dosin G, Hascoet J, Mazouin C, Freton L, Zineddine K, Voiry C, Samson E, Richard C, Haudebert C, Bensalah K, Verhoest G, Mathieu R, Courboin E, Manunta A, Peyronnet B. Réfection chirurgicale robot assistée des anastomoses urétéro-iléale pour sténose urétérale distale après chirurgie de cystectomie bricker chez le patient neurologique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tostivint V, Verhoest G, Cabarrou B, Gas J, Coloby P, Zgheib J, Thoulouzan M, Soulié M, Gamé X, Beauval JB, Pons-Tostivint E, Roumiguié M. Quality of life and functional outcomes after radical cystectomy with ileal orthotopic neobladder replacement for bladder cancer: a multicentre observational study. World J Urol 2020; 39:2525-2530. [PMID: 33067727 DOI: 10.1007/s00345-020-03484-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors. METHODS Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score. RESULTS Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12-96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score > 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL. CONCLUSION Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists.
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Affiliation(s)
- V Tostivint
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France.
| | - G Verhoest
- Department of Urology, University Hospital, Rennes, France
| | - B Cabarrou
- Department of Biostatistics, Claudius Regaud Institute, Toulouse University Cancer Institute-Oncopole, Toulouse, France
| | - J Gas
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
- Department of Urology, René Dubos Hospital, Pontoise, France
| | - P Coloby
- Department of Urology, René Dubos Hospital, Pontoise, France
| | - J Zgheib
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
| | - M Thoulouzan
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
| | - M Soulié
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
| | - X Gamé
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
| | - J B Beauval
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
| | - E Pons-Tostivint
- Medical Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute-Oncopole, Toulouse, France
| | - M Roumiguié
- Department of Urology, Andrology and Renal Transplantation, Rangueil University Hospital, 1, Avenue du Pr Jean Poulhès, 31400, Toulouse, France
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Gournay M, Dugay F, Belaud-Rotureau MA, Peyronnet B, Mathieu R, Verhoest G, Bensalah K, Odent S, Denizeau P, Vigneau C, Morini A, Rioux-Leclercq N, Kammerer-Jacquet SF. Renal cell carcinoma with leiomyomatous stroma in tuberous sclerosis complex: a distinct entity. Virchows Arch 2020; 478:793-799. [PMID: 32845354 DOI: 10.1007/s00428-020-02910-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023]
Abstract
Renal cell carcinoma with leiomyomatous stroma (RCCLS) is an emerging entity frequently associated with tuberous sclerosis complex (TSC). We described herein a series of RCCLS in TSC patients at pathological and cytogenetic levels. Three male patients with TSC and RCCLS were identified between 2000 and 2019 at the University Hospital of Rennes. Histologically, the architecture was tubulo-papillary with thick bundles of smooth muscle cells. The tumor cells showed clear cytoplasm with eosinophilic globules. The immunohistochemical profile was identical with an intense positivity of CK7, CAIX, and CD10 and a heterogeneous positivity of CK20. SDHB was low but positive and TFE3 was not expressed. Comparative genomic hybridization (CGH) did not show any quantitative chromosome abnormality. No recurrence was observed with a median follow-up of 4 years. RCCLS in TSC patients has morphological, immunohistochemical, and cytogenetic distinct features that could constitute a distinct entity and a sentinel manifestation for the diagnosis of TSC.
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Affiliation(s)
- Marjorie Gournay
- Department of Pathology, University Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France.
| | - Frédéric Dugay
- Department of Cytogenetics, University Hospital, 35000, Rennes, France
| | | | - Benoit Peyronnet
- Department of Urology, University Hospital, 35000, Rennes, France
| | - Romain Mathieu
- Department of Urology, University Hospital, 35000, Rennes, France
| | - Gregory Verhoest
- Department of Urology, University Hospital, 35000, Rennes, France
| | - Karim Bensalah
- Department of Urology, University Hospital, 35000, Rennes, France
| | - Sylvie Odent
- Department of Genetic, University Hospital, 35000, Rennes, France
| | | | - Cécile Vigneau
- Department of Nephrology, University Hospital, 35000, Rennes, France
| | - Aurélien Morini
- Department of Pathology, Georges Pompidou European Hospital, Paris, France
| | - Nathalie Rioux-Leclercq
- Department of Pathology, University Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France
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Roumiguié M, Compérat E, Chaltiel L, Nouhaud FX, Verhoest G, Masson-Lecomte A, Colin P, Audenet F, Houédé N, Larré S, Xylinas E, Brunelle S, Piana-Thomassin J, Cotte J, Pignot G, Neuzillet Y, Rouprêt M. PD-L1 expression and pattern of immune cells in pre-treatment specimens are associated with disease-free survival for HR-NMIBC undergoing BCG treatment. World J Urol 2020; 39:4055-4065. [PMID: 32666225 DOI: 10.1007/s00345-020-03329-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the association between PD-L1 expression and disease-free survival (DFS) in High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) patients treated with intravesical Bacillus Calmette-Guerin (BCG) instillations (IBI). METHODS Retrospective study in five French centres between 2001 and 2015. Participants were 140 patients with histologically confirmed HR-NMIBC. All patients received induction and maintenance IBI. Pathological stage/grade, concomitant carcinoma in situ, lesion number and tumour size were recorded. CD3, CD8 and PD-L1 expression in tumour cells and in T cells in the tumour microenvironment (TME) was determined immunohistochemically. Median follow-up was 54.2 months. The primary outcome measure was DFS. Univariable and multivariable analyses were performed using the log rank test and Cox proportional hazards model. RESULTS Of the 140 NMIBC, 52 (37.1%) were Ta, 88 (62.9%) were T1 and 100% were high grade. Median number of maintenance IBI was six (range 1-30). Twenty-five (17.9%) patients had recurrence/progression. In multivariable analysis, age (HR 1.07 [95% CI 1.02-1.13], p = 0.009), PD-L1 expression in tumour cells (HR per 10 units = 1.96 [95% CI 1.28-3.00], p = 0.02) and CD3/CD8 ratio (HR per 10 units = 3.38 [95% CI 1.61-7.11], p = 0.01) were significantly associated with DFS. However, using the cut-off corresponding for each PD-L1 antibodies, PD-L1 + status was not associated with DFS. CONCLUSION Despite an association between PD-L1 expression and BCG failure in HR-NMIBC, the PD-L1 + status was not a prognostic factor in the response of BCG. Moreover, we confirmed the key role played by the IC within the microenvironment in BCG treatment. These findings highlighted the rationale to combine BCG and PD-L1/PD-1 antibodies in early bladder cancer.
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Affiliation(s)
- Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer de Toulouse Oncopole, Rangueil University Hospital, 31059, Toulouse, France.
| | - Eva Compérat
- GRC n°5, PREDICTIVE ONCO-URO, AP-HP Service de Pathology, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Léonor Chaltiel
- Biostatistics Unit, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - François Xavier Nouhaud
- Urology Department, Rouen University Hospital, Rouen, France.,UNIROUEN, IRON Group, Rouen University Hospital, Normandy University, Rouen, France
| | - Gregory Verhoest
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - Pierre Colin
- Urology Department, Hôpital privé de la Louvière, 59042, Lille, France
| | - François Audenet
- Urology Department, Georges Pompidou European Hospital, University Paris Descartes, AP-HP, 75015, Paris, France
| | - Nadine Houédé
- Department of Medical Oncology, CHU Caremeau, Montpellier University, 30029, Nimes, France
| | | | - Evanguelos Xylinas
- Urology Department, Bichat-Claude Bernard Hospital, Paris Descartes University, AP-HP, 75018, Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009, Marseille, France
| | | | - Juliette Cotte
- Urology Department, GRC n°5, PREDICTIVE ONCO-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, 13009, Marseille, France
| | - Yann Neuzillet
- Urology Department, Foch Hospital, Versailles-Saint-Quentin-en-Yvelines University, 92150, Suresnes, France
| | - Morgan Rouprêt
- Urology Department, GRC n°5, PREDICTIVE ONCO-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France.
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Haudebert C, Huet R, Mathieu R, Vincendeau S, Bensalah K, Verhoest G, Hascoet J, Manunta A, Peyronnet B. Diabetes may compromise the functional outcomes of GreenLight laser XPS-180W photoselective vaporization of the prostate. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Peyronnet B, Hascoet J, Freton L, Khene Z, Graffeille V, Alimi Q, El-Akri M, Richard C, Kerdraon J, Voiry C, Bensalah K, Verhoest G, Manunta A. Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robot-assisted approaches. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Deleuze A, Saout J, Dugay F, Peyronnet B, Mathieu R, Verhoest G, Bensalah K, Crouzet L, Laguerre B, Belaud-Rotureau MA, Rioux-Leclercq N, Kammerer-Jacquet SF. Immunotherapy in Renal Cell Carcinoma: The Future Is Now. Int J Mol Sci 2020; 21:ijms21072532. [PMID: 32260578 PMCID: PMC7177761 DOI: 10.3390/ijms21072532] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma is the third type of urologic cancer and has a poor prognosis with 30% of metastatic patients at diagnosis. The antiangiogenics and targeted immunotherapies led to treatment remodeling emphasizing the role of the tumour microenvironment. However, long-term responses are rare with a high rate of resistance. New strategies are emerging to improve the efficacy and the emerging drugs are under evaluation in ongoing trials. With the different treatment options, there is an urgent need to identify biomarkers in order to predict the efficacy of drugs and to better stratify patients. Owing to the limitations of programmed death-ligand 1 (PD-L1), the most studied immunohistochemistry biomarkers, and of the tumor mutational burden, the identification of more reliable markers is an unmet need. New technologies could help in this purpose.
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Affiliation(s)
- Antoine Deleuze
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
- Department of Medical Oncology, Centre Eugene Marquis, 35000 Rennes, France; (L.C.); (B.L.)
| | - Judikaël Saout
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
| | - Frédéric Dugay
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
- Department of Cytogenetics, University Hospital, 35000 Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University Hospital, 35000 Rennes, France; (B.P.); (G.V.); (K.B.)
| | - Romain Mathieu
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
- Department of Urology, University Hospital, 35000 Rennes, France; (B.P.); (G.V.); (K.B.)
| | - Gregory Verhoest
- Department of Urology, University Hospital, 35000 Rennes, France; (B.P.); (G.V.); (K.B.)
| | - Karim Bensalah
- Department of Urology, University Hospital, 35000 Rennes, France; (B.P.); (G.V.); (K.B.)
| | - Laurence Crouzet
- Department of Medical Oncology, Centre Eugene Marquis, 35000 Rennes, France; (L.C.); (B.L.)
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugene Marquis, 35000 Rennes, France; (L.C.); (B.L.)
| | - Marc-Antoine Belaud-Rotureau
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
- Department of Cytogenetics, University Hospital, 35000 Rennes, France
| | - Nathalie Rioux-Leclercq
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
- Department of Pathology, University Hospital, 35000 Rennes, France
| | - Solène-Florence Kammerer-Jacquet
- Université Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), IRSET (Institut de recherche en santé, environnement et travail), UMR 1085, 35000 Rennes, France; (A.D.); (J.S.); (F.D.); (R.M.); (M.-A.B.-R.); (N.R.-L.)
- Department of Pathology, University Hospital, 35000 Rennes, France
- Correspondence: ; Tel.: +33-2-99-28-42-79; Fax: +33-2-99-28-42-84
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Vaudreuil L, Bessede T, Boissier R, Bouye S, Branchereau J, Caillet K, Kleinclauss F, Verhoest G, Tillou X. De novo renal carcinoma arising in non-functional kidney graft: a national retrospective study. Int Urol Nephrol 2020; 52:1235-1241. [PMID: 32107673 DOI: 10.1007/s11255-020-02422-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 01/20/2023]
Abstract
AIM Characteristics of renal carcinoma arising in non-functional graft in renal transplant recipients (RTR) are unknown. We studied a large national retrospective cohort to analyze circumstances of diagnosis, treatment and outcome compared to the literature. METHODS Study included all RTR presenting with kidney graft tumors irrespective of the histology, except those with lymphoma and including those tumors arising in non-functional renal graft. Between January 1988 and December 2018, 56,806 patients had renal transplantation in the 32 centers participating in this study. Among this cohort, 18 renal graft tumors were diagnosed in non-functional grafts. RESULTS The median patient age at the time of diagnosis was 42.1 years (31.7-51.3). Median age of kidney grafts at the time of diagnosis was 56.4 (23.2-63.4). Eight (44.4%) tumors were discovered fortuitously on renal graft histologic analysis. Fourteen tumors (77.8%) were papillary carcinomas. Two patients had clear cell carcinomas and one patient had a pTa high-grade multifocal urothelial carcinoma in the graft of the upper tract with an in situ carcinoma. CONCLUSION Renal carcinomas in non-functional grafts are rare entities and most of them are diagnosed fortuitously. Despite the fact that these tumors are small, low grade and with a good prognosis, regular monitoring of non-functional grafts should be performed with at least an annual ultrasonography.
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Affiliation(s)
- Lionel Vaudreuil
- Department of Urology and Renal Transplantation, CHU de Caen, Urology and Transplantation, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Thomas Bessede
- Hôpital Kremlin-Bicêtre, Urology and Transplantation, Paris, France
| | - Romain Boissier
- Hôpital de La Conception, Urology and Transplantation, Marseille, France
| | | | | | - Kevin Caillet
- CHU d'Amiens, Urology and Transplantation, Amiens, France
| | | | | | - Xavier Tillou
- Department of Urology and Renal Transplantation, CHU de Caen, Urology and Transplantation, Avenue de La Côte de Nacre, 14000, Caen, France.
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Biardeau X, Lamande N, Tondut L, Peyronnet B, Verhoest G, Kyheng M, Soulie M, Game X, Fantoni JC, Marcelli F. Quality of life associated with orthotopic neobladder and ileal conduit in women: A multicentric cross-sectional study. Prog Urol 2020; 30:80-88. [PMID: 32061497 DOI: 10.1016/j.purol.2019.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/27/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare quality of life and functional outcomes associated with orthotopic neobladder (ONB) and ileal conduit (IC) after anterior pelvic exenteration for bladder cancer in women, through a multicentric cross-sectional study. METHODS All women who have undergone an anterior pelvic exenteration associated with ONB or IC for a bladder cancer between January 2004 and December 2014 within the three participating university hospital centers and that were still alive in February 2016 were included. Three distinct auto-administered questionnaires were submitted to the patients: the EORTC QLQ-C30, the EORTC QLQ-BLmi30 and the SF-12. Comparison of response to these questionnaires between women with ONB and those with IC were studied with Mann-Whitney U tests, with a statistically significant P-value set at<0.05. The primary endpoint was the "global health status" sub-score extracted from the EORTC QLQ-C30 questionnaire. The secondary endpoints were the functional sub-scores and symptoms sub-scores obtained with the EORTC QLQ-C30 questionnaire as well as the sub-scores obtained with the EORTC QLQ-BLmi30 and the SF-12 questionnaires. RESULTS Forty women were included in the study (17 ONB, 23 IC). The primary endpoint was comparable between the ONB and IC women (83.3 vs. 66.7 P=0.22). Similarly, no significant statistical difference could be pointed between the ONB and IC women in terms of secondary endpoints. CONCLUSION The present study did not report any significance difference in terms of quality of life and functional outcomes between women with ONB and those with IC after pelvic exenteration for bladder cancer. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- X Biardeau
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France.
| | - N Lamande
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France
| | - L Tondut
- Department of urology, Rennes university hospital, 35000 Rennes, France
| | - B Peyronnet
- Department of urology, Rennes university hospital, 35000 Rennes, France
| | - G Verhoest
- Department of urology, Rennes university hospital, 35000 Rennes, France
| | - M Kyheng
- EA2694, department of biostatistics, CHU Lille, 59000 Lille, France
| | - M Soulie
- Department of urology, Toulouse university hospital, Rangueil hospital, Toulouse, France
| | - X Game
- Department of urology, Toulouse university hospital, Rangueil hospital, Toulouse, France
| | - J-C Fantoni
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France
| | - F Marcelli
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France
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50
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Lenfant L, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, de La Taille A, Roumiguie M, Lesourd M, Taksin L, Misraï V, Granger B, Ploussard G, Vaessen C, Verhoest G, Rouprêt M. Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study. World J Urol 2019; 38:1951-1958. [PMID: 31720765 DOI: 10.1007/s00345-019-02998-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted radical cystectomy (RARC) has been shown to be non-inferior to open radical cystectomy (ORC) for the treatment of bladder cancer (BC). However, most data on RARC come from high-volume surgeons at high-volume centers. The objective of the study was to compare perioperative and mid-term oncologic outcomes of RARC versus ORC in a real-life cohort of patients treated by surgeons starting their experience with RARC. MATERIALS AND METHODS Data were prospectively collected from consecutive patients undergoing RARC and ORC at five referral Centers between 2010 and 2016 by five surgeons (one per center) with no prior experience in RARC. Patients with high-risk non-muscle-invasive or organ-confined muscle-invasive (T2N0M0) bladder cancer were considered for RARC. The main study endpoints were perioperative outcomes, postoperative surgical complications, and mid-term oncologic outcomes. RESULTS Overall, 124 and 118 patients underwent RARC and ORC, respectively. Baseline patients' and tumors' characteristics were comparable between the two groups. Yet, the proportion of patients receiving neoadjuvant chemotherapy was significantly higher in the RARC cohort. Median operative time was significantly higher, while median EBL, LOH, and transfusion rates were significantly lower after RARC. Median number of lymph nodes removed was significantly higher after RARC. All other histopathological outcomes, as well as the rate of early (< 30 days) and late postoperative complications, were comparable to ORC. At a median follow-up of 2 years, 29 (23%) and 41 (35%) patients developed disease recurrence (p = 0.05), while 20 (16%) and 37 (31%) died of bladder cancer (p = 0.005) after RARC and ORC, respectively. CONCLUSIONS With proper patient selection, RARC was non-inferior to ORC throughout the surgeons' learning phase. Yet, the observed differences in oncologic outcomes suggest selection bias toward adoption of RARC for patients with more favorable disease characteristics.
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Affiliation(s)
- Louis Lenfant
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Riccardo Campi
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Jérôme Parra
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Vivien Graffeille
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Dimitri Vordos
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Alexandre de La Taille
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Mathieu Roumiguie
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Marine Lesourd
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Lionel Taksin
- Hôpital privé d'Antony, 1 rue Velpeau, 92160, Antony, France
| | - Vincent Misraï
- Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France
| | - Benjamin Granger
- Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Sorbonne, Paris, France
| | | | - Christophe Vaessen
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gregory Verhoest
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Morgan Rouprêt
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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