1
|
Management of high-grade papillary Ta or T1 bladder cancer after restaging transurethral resection: A retrospective study comparing Bacillus Calmette-Guerin therapy upfront versus a third resection. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102548. [PMID: 37980231 DOI: 10.1016/j.purol.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/04/2023] [Accepted: 10/09/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE Performing restaging transurethral bladder resection (reTURB) for high-risk non-muscle invasive bladder cancer (NMIBC) reduces the risk of recurrence and tumour understaging. Management of residual high-grade papillary Ta or T1 after reTURB has changed this last 10years in international recommendations. This study aimed to compare the recurrence free survival according to the different management procedures performed. MATERIALS AND METHODS Patients who underwent reTURB for initial high-risk NMIBC between 2011 and 2020 were included. Patients with residual high-grade papillary Ta or T1 tumour after reTURB were divided into two groups: BCG instillations upfront versus BCG following a third-look resection (3TURB). Patient and tumour characteristics, BCG instillations, recurrence-free survival were retrospectively analysed. RESULTS A total of 162 high-risk patients were included. Sixty-one (37.7%) had residual high-grade papillary Ta or T1 at reTURB: 35 (21.6%) had BCG instillations upfront, 18 (11.2%) had a 3TURB and 8 (5%) had other management. The mean follow-up was 34.2weeks±20.2. Recurrence-free survival was significantly better in patients who underwent BCG instillations upfront (P<0.0043). Recurrence after BCG therapy following reTURB was significantly lower in patients with no residual NMIBC at 6 (92.5% vs. 72.4%, P<0.004) and 12months (85% vs. 67.3%, P<0.03). CONCLUSIONS The efficacy of intravesical BCG is compromised in case of residual tumour following TURB. The role of a 3TURB following a positive reTURB is not yet determined. This study has confirmed that residual tumor following reTURB is a negative predictive factor but could not demonstrate the value of a 3TURB compared to upfront BCG. LEVEL OF EVIDENCE: 3
Collapse
|
2
|
Efficacy of hyperthermic intravesical chemotherapy (HIVEC) in patients with non-muscle invasive bladder cancer after BCG failure. World J Urol 2023; 41:3195-3203. [PMID: 36811732 DOI: 10.1007/s00345-023-04332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE To evaluate hyperthermic intravesical chemotherapy (HIVEC) efficacy regarding 1-year disease-free survival (RFS) rate and bladder preservation rate in patients with non-muscle invasive bladder cancer (NMIBC) who fail bacillus Calmette-Guérin (BCG) therapy. METHODS This is a multicenter retrospective series from a national database (7 expert centers). Between January 2016 and October 2021, patients treated with HIVEC for NMIBC who failed BCG have been included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it. RESULTS A total of 116 patients treated with HIVEC and with a follow-up > 6 months were included in this study and retrospectively analyzed. The median follow-up was 20.6 months. The 12 month-RFS (recurrence-free survival) rate was 62.9%. The bladder preservation rate was 87.1%. Fifteen patients (12.9%) progressed to muscle infiltration, three of them having a metastatic disease at the time of progression. Predictive factors of progression were T1 stage, high grade and very high-risk tumors according to the EORTC classification. CONCLUSION Chemohyperthermia using HIVEC achieved an RFS rate of 62.9% at 1 year and enabled a bladder preservation rate of 87.1%. However, the risk of progression to muscle-invasive disease is not negligible, particularly for patients with very high-risk tumors. In these patients who fail BCG, cystectomy should remain the standard of care and HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression.
Collapse
|
3
|
Les complications chirurgicales en urologie adulte : chirurgie des organes génitaux externes. Prog Urol 2022; 32:988-997. [DOI: 10.1016/j.purol.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022]
|
4
|
Les complications en chirurgie urologique. L’urologue acteur de la gestion des risques. Prog Urol 2022; 32:998-1008. [DOI: 10.1016/j.purol.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
|
5
|
Les complications chirurgicales en urologie adulte : chirurgie du pelvis et du périnée. Prog Urol 2022; 32:977-987. [DOI: 10.1016/j.purol.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/21/2022]
|
6
|
Les complications chirurgicales en urologie adulte : chirurgie de la prostate. Prog Urol 2022; 32:953-965. [DOI: 10.1016/j.purol.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
|
7
|
Les complications de la néphrectomie totale et de la néphrectomie partielle : quelles sont-elles, comment les prévenir et les prendre en charge ? Prog Urol 2022; 32:928-939. [DOI: 10.1016/j.purol.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022]
|
8
|
Complications en chirurgie urologique. Prog Urol 2022; 32:905. [DOI: 10.1016/j.purol.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Efficacy and toxicity following salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy. Brachytherapy 2022; 21:424-434. [PMID: 35331666 DOI: 10.1016/j.brachy.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The management of local relapse after prostate cancer radiotherapy is frequently based on androgen deprivation therapy. The aim of the study was to report Gustave Roussy's experience with salvage prostate brachytherapy. PATIENTS AND METHODS All cases of localized prostate cancer presenting in an irradiated area who received salvage high dose rate (HDR) brachytherapy from 2013 to 2020 were retrospectively reviewed. RESULTS A total of 64 patients were included. Median follow up was 30.5 months. Median initial EBRT dose was 70 Gy [Q1-Q3: 70 - 74]. Median PSA at brachytherapy was 6.8 ng/mL [Q1-Q3: 4.4 - 8.7] with a median interval between first and salvage irradiation of 10 years [Q1-Q3: 6.9 - 12.6]. The modality of the first irradiation was an exclusive EBRT in 73% of the cases, mostly with a 3D technique (82%). Dose prescription was two fractions of 12 Gy or 13 Gy associated with androgen deprivation therapy for 63% of the patients. About 23% of the patients were castrate-resistant. Disease free survival at 2 years was 58% in the whole population and 66% in hormone sensitive patients. The only factors associated with disease free survival on multivariate analysis was a high-risk disease at initial diagnosis (HR = 3.59, IC95 [1.75; 7.39], p = 0.0005). Grade 3 urinary and rectal toxicities occurred in 1.5% and 1.5% of the patients, respectively. CONCLUSION HDR salvage brachytherapy seems to be a safe option for patients presenting with an isolated local relapse of prostate cancer.
Collapse
|
10
|
Impact des marges chirurgicales positives après prostatectomie radicale chez les patients atteints d’un cancer de la prostate localisé pT2. Prog Urol 2022; 32:354-362. [DOI: 10.1016/j.purol.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
|
11
|
Recul à 10 ans des patients opérés pour un cancer de prostate Gleason 6 (ISUP1). Prog Urol 2021; 32:108-114. [DOI: 10.1016/j.purol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
|
12
|
Efficacy of HIVEC in patients with high-risk non-muscle invasive bladder cancer who are contraindicated to BCG and in patients who fail BCG therapy. Int J Hyperthermia 2021; 38:1633-1638. [PMID: 34775896 DOI: 10.1080/02656736.2021.2002435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate Hyperthermic-Intra-Vesical Chemotherapy (HIVEC) efficacy regarding 1-year disease-free survival (RFS) rate and bladder preservation rate in patients with High-risk Non-Muscle Invasive Bladder Cancer (NMIBC) who fail BCG therapy or are contraindicated to BCG. METHODS Between June 2016 and October 2019, patients treated with HIVEC for mostly high-risk NMIBC who failed BCG or BCG-naive if BCG contraindicated have been included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it. RESULTS Fifty-three patients, median age 72 [39-93] years, were included in this study (n = 29 BCG-failure and n = 24 BCG-naive). The median follow-up was 18 months. The bladder preservation rate was 92.4%. The 12 months-RFS rate was 60.5%. The RFS rates for BCG-naive and BCG-failure groups were respectively 70% and 52.2% at 12 months. Three patients progressed to muscle infiltration, all in the BCG-failure group and all in the very high-risk EORTC group. Two of them developed metastatic disease and died from bladder cancer. CONCLUSION Chemohyperthermia using HIVEC achieved a RFS rate of 60% at 1 year and enabled a bladder preservation rate of 92%. Given the low risk of progression in the BCG-naive group, HIVEC could be a good alternative. Conversely, for patients with very high-risk tumors that fail BCG, cystectomy should remain the standard of care and HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression to muscle-invasive disease.
Collapse
|
13
|
Impact oncologique d’une re-résection transuréthrale de vessie chez les patients atteints d’une tumeur de vessie ta de haut grade traités par BCG. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
14
|
Prostate cancer in kidney transplant recipients: large contemporary multicenter cohort study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
15
|
Pre-transplant morphometry by computed tomography scan and post-transplant dialysis risk in overweight or obese kidney transplant recipients. Int Urol Nephrol 2021; 53:2469-2475. [PMID: 34536192 DOI: 10.1007/s11255-021-02995-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Adipose distribution and sarcopenia could better assess kidney transplantation outcomes than body mass index (BMI) and have been poorly evaluated among obese and overweight recipients. We aimed to evaluate morphometric radiologic markers to predict post-operative dialysis within this population. METHODS We conducted a retrospective study including patients with a BMI > 25 kg/m2 undergoing kidney transplantation during 5 years. Subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), and psoas surface were measured on CT scans sections. A model predictive of post-transplantation dialysis was elaborated through a multivariable logistic regression and was compared to a model including only BMI. RESULTS Overall, 248 patients were included whom mean (SD) BMI and age were, respectively, 29.7 kg/m2 (3.6) and 56 years (12.7). Of them, 83 (33.5%) needed dialysis: 14 (5.7%) for primary kidney failure and 69 (27.8%) for delayed kidney function. On multivariable analysis, SAT, VAT and deceased donor were significantly associated with post-operative dialysis (respectively, OR [95%CI]:1.6 [1.1-2.6], 1.6[1.1-2.6], and 7.5 [1.6-56]). The area under the curve of this predictive model was 0.70 versus 0.64 for a BMI-based model. CONCLUSION High VAT and SAT were associated with post-transplantation dialysis. A predictive model based on these morphometrics could provide a better appreciation of graft recovery after transplantation among obese and overweight recipients. External validation is needed.
Collapse
|
16
|
Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study. Cancers (Basel) 2021; 13:4694. [PMID: 34572921 PMCID: PMC8468518 DOI: 10.3390/cancers13184694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023] Open
Abstract
The guidelines on prostate cancer treatment in older men recommend evaluating the patient's underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline-discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41-51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17-0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): -3.1 months (-5.3, -1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: -3.3 months (-6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics.
Collapse
|
17
|
Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients. Actas Urol Esp 2021; 45:473-478. [PMID: 34147426 DOI: 10.1016/j.acuroe.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. MATERIAL AND METHODS In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. RESULTS The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. CONCLUSIONS The most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.
Collapse
|
18
|
Facteurs associés et impact de l’écart entre les recommandations internationales et la décision de traitement en vie réelle chez les patients âgés atteints d’un cancer de la prostate. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
19
|
Prostate cancer in renal transplant recipients: Results from a large multicentre contemporary cohort. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Risque de complications chirurgicales chez les receveurs obèses et en surpoids : élaboration d’un modèle morphométrique prédictif basé sur la sarcopénie et la distance entre les vaisseaux et la peau. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
21
|
Prognostic Impact of pT3 Subclassification in a Multicentre Cohort of Patients with Urothelial Carcinoma of the Renal Pelvicalyceal System Undergoing Radical Nephroureterectomy: A Propensity Score-weighted Analysis After Central Pathology Review. Eur Urol Focus 2020; 7:1075-1083. [PMID: 33463527 DOI: 10.1016/j.euf.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current pathological tumour-node-metastasis (pTNM) classification for upper tract urothelial carcinoma (UTUC) does not include any risk stratification of pT3 renal pelvicalyceal tumours. OBJECTIVE To assess the prognostic impact of pT3 subclassification in a multicentre cohort of patients with UTUC of the renal pelvicalyceal system undergoing radical nephroureterectomy (RNU). DESIGN, SETTING, AND PARTICIPANTS Data from all consecutive patients treated with RNU for pT3 renal pelvicalyceal UTUC at 14 French centres from 1995 to 2013 were reviewed retrospectively. INTERVENTION A central pathology review (CPR) was used to stratify pT3 patients into those with infiltration of the renal parenchyma on a microscopic level (pT3a) versus those with infiltration of the renal parenchyma visible on gross inspection of the resection specimen and/or invasion of peripelvic fat (pT3b). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Inverse probability weighting (IPW)-adjusted Cox regression analyses were used to compare recurrence-free survival (RFS) and cancer-specific survival (CSS) between pT3a and pT3b patients. RESULTS AND LIMITATIONS Overall, 202 patients were included and further stratified into pT3a (n = 98; 48.5%) and pT3b (n = 104; 51.5%) subgroups. Median time to follow-up in the weighted population was 68 (interquartile range, 50-95) mo. In IPW-adjusted Cox regression analyses, pT3b versus pT3a substage was associated with a significant adverse effect on RFS (hazard ratio [HR] = 2.02; 95% confidence interval [CI] = [1.36-3.01]; p < 0.001) and CSS (HR = 1.84; 95% CI = [1.20-2.82]; p = 0.005). The study is limited by its retrospective design. CONCLUSIONS Using IPW-adjusted analyses after the CPR, we observed that RNU patients with pT3b renal pelvicalyceal UTUC had adverse prognosis as compared with those with pT3a disease. As such, this subclassification could help refine the current pTNM system for UTUC. PATIENT SUMMARY In this report, we looked at the prognostic interest of stratifying patients with pT3 renal pelvicalyceal upper tract urothelial carcinoma based on the extent of local invasion. We found that those with extensive infiltration (pT3b) had adverse prognosis as compared with those with limited infiltration (pT3a). This information could be provided on pathology reports to further guide clinical decision making.
Collapse
|
22
|
Surgical complications risk in obese and overweight recipients for kidney transplantation: a predictive morphometric model based on sarcopenia and vessel-to-skin distance. World J Urol 2020; 39:2223-2230. [PMID: 32785765 DOI: 10.1007/s00345-020-03407-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Sarcopenia or adipose tissue distribution within obese and overweight renal transplanted have been poorly evaluated. Our objective was to evaluate morphometric markers to predict surgical complications in kidney transplantation. METHODS We retrospectively included patients with a BMI > 25 kg/m2 undergoing kidney transplantation from 2012 to 2017. Following measurements were performed on CT-scan sections: Sub-cutaneous Adipose Tissue surface (SAT), Visceral Adipose Tissue surface (VAT), Vessel-to-Skin distance (VSK), Abdominal Perimeter (AP), and Psoas surface. A multivariable logistic regression model with BMI was compared to a model containing morphometric variables to determine the best predictive model for surgical complications. RESULTS 248 patients were included, 15 (6%) experienced transplant nephrectomy, 18 (7.3%) urinary leakage, and 29 (11.7%) subcapsular renal hematoma. Multivariable logistic regression evidenced that sarcopenia and VSK were risk factors of surgical complication within a year post-transplantation (respectively, OR = 0.9, 95%CI (0.8-0.9), p = 0.04 and OR = 1.2, 95%CI (1.1-1.3), p = 0.002). Area under the curve for a predictive model including VSK, age and psoas surface was 0.69, whereas BMI model was 0.65. CONCLUSION Combined morphometric parameters of obesity were associated with surgical complications in kidney transplantation. Morphometric threshold may provide a more accurate and objective criteria than BMI to evaluate kidney transplantation outcomes. External validation is needed.
Collapse
|
23
|
Urology surgical activity and COVID-19: risk assessment at the epidemic peak: a Parisian multicentre experience. BJU Int 2020; 126:436-440. [PMID: 32640121 PMCID: PMC7361920 DOI: 10.1111/bju.15164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
24
|
Clinical value of the integration of Prostate Health Index (PHI) in multiparametric MRI-based diagnostic strategies to detect clinically-significant prostate cancer. Results from the French prospective multicenter PHI-1 study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
[Impact of the COVID-19 pandemic on surgical activity within academic urological departments in Paris]. Prog Urol 2020; 30:439-447. [PMID: 32430140 PMCID: PMC7211572 DOI: 10.1016/j.purol.2020.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
Introduction En conséquence de la pandémie de COVID-19 en France, toute activité chirurgicale non urgente a dû être annulée à partir du 12 mars 2020. Afin d’anticiper la reprise des interventions décalées, une quantification de la réduction d’activité est nécessaire. L’objectif de l’étude était d’évaluer comparativement à 2019 la réduction d’activité chirurgicale urologique adulte pendant la pandémie de COVID-19. Matériel et méthodes Nous avons comparé le nombre d’interventions urologiques pratiquées dans les 8 services universitaires d’urologie de l’Assistance Publique – Hôpitaux de Paris (AP–HP) sur deux périodes comparables (14–29 mars 2019 et 12–27 mars 2020) à l’aide du logiciel de planification opératoire et du PMSI partagé par ces centres. L’intitulé d’intervention et le type de chirurgie ont été collectés et regroupées en 16 catégories. Résultats Une baisse de l’activité globale à l’AP–HP en urologie de 55 % entre 2019 et 2020 (995 et 444 interventions respectivement) a été constatée sur les 8 services. L’activité oncologique et les urgences ont diminué de 31 % et 44 %. L’activité de transplantation rénale, la chirurgie fonctionnelle et andrologique ont subi les plus fortes baisses d’activité par les interventions non oncologiques (−92 %, −85 % et −81 %, respectivement). Environ 1033 heures d’intervention devront être reprogrammées pour rattraper le programme opératoire annulé. Conclusion Le confinement et le report des interventions chirurgicales « non urgentes » ont entraîné une diminution drastique de l’activité chirurgicale au sein de l’AP–HP. Pendant cette période, les urologues ont été sollicités pour d’autres tâches mais doivent désormais s’atteler à organiser la période de reprise d’activité pour éviter une crise organisationnelle en urologique. Niveau de preuve 3.
Collapse
|
26
|
Temporary contraindication of obese recipients in kidney transplantation: A new morphometric tool for decision support. Clin Transplant 2020; 34:e13829. [PMID: 32065442 DOI: 10.1111/ctr.13829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/13/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Morbid obesity, based on body mass index (BMI) and/or clinical examination, can be a temporary contraindication (TCI) of kidney transplantation. However, BMI alone does not evaluate the intra- or extra-peritoneal distribution of fatty tissue, and clinical examination alone is subjective. The objective was to evaluate the interest of morphometric criteria to ensure reproducible and consensual decision of TCI. METHODS We retrospectively included patients with a BMI >30 transplanted or temporarily contraindicated because of their weight from 2012 to 2017. The following measurements were performed on CT scan sections using a semiautomatic Hounsfield density detection software: subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), vessel-to-skin distance (VSK), abdominal perimeter (AP), and psoas index. Performance of morphometric measures to predict TCI was assessed through ROC analysis. RESULTS Ninety-seven patients were included: 76 kidney transplant recipients and 21 on the TCI list. The area under the curve (AUC, 95%CI) for the BMI model to predict TCI was 0.81 (0.72-0.90). A 5-variable model including BMI, VAT, VSK, AP, and age gave an AUC of 0.88 (0.78-0.98). CONCLUSIONS Morphometric obesity parameters are associated with TCI decision-making for kidney transplantation: When combined with BMI in a "morphometric tool," they were predictive of a TCI decision.
Collapse
|
27
|
[Indocyanine green fluorescence to visualize the ureteric vascularization of kidney transplants: An exploratory study]. Prog Urol 2020; 30:155-161. [PMID: 32122748 DOI: 10.1016/j.purol.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Urinary complications after kidney transplantation are common and can compromise renal function. While they are mainly attributed to ischemic lesions of the ureter, there is no existing method to evaluate its vascularization during surgery. The aim of the study was to evaluate if indocyanine green, revealed by infra-red light andused to visualize tissue perfusion, could provide an appreciation of the ureter's vascularization during kidney transplantation. METHODS This feasibility study was conducted over one month, on eleven consecutive kidney transplants. During transplantation, an injection of indocyanine green enabled the surgeon to visualize in real time with an infra-red camera the ureter fluorescence. Its intensity was reported on a qualitative and semi-quantitative scale. Occurrence of urinary complications such as stenosis or ureteral fistula were collected during 6 months. RESULTS In all of the 11 cases (100%), the last centimeters of the ureters were not fluorescent. Three (27%) ureters were poorly or partiallly fluorescent. Out of these three cases, only one case of urinary fistula occurred, followed by ureteric stenosis. In the series, two fistulas (18%) and two ureteric stenoses (18%) occurred. No side effects were observed. The low number of events did not allow statistical analysis. CONCLUSION Infra-red fluorescence of indocyanine green could be a simple and innovative way to appreciate the transplant's ureteric vascularization during kidney transplantation. It could help surgeons to identify the level of ureter section and to decide the anastomosis technique, in order to limit urinary complications. LEVEL OF EVIDENCE 3.
Collapse
|
28
|
[Is sarcopenia a morbi-mortality factor in the treatment of localized muscle-invasive bladder cancer?]. Prog Urol 2019; 30:41-50. [PMID: 31818689 DOI: 10.1016/j.purol.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/14/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Sarcopenia evaluated from the measurement of skeletal muscle index (SMI) has been evaluated as a predictive factor of morbidity and mortality after surgery. The objective of this study was to evaluate whether it was predictive of morbidity and mortality in patients managed by cystectomy or tri-modality therapy (TMT), combining radiotherapy and chemotherapy after endoscopic resection of the tumour, for localized muscle-invasive bladder cancer. MATERIALS AND METHODS In all, 146 consecutive patients from 2 university hospital centres treated by cystectomy between January 2012 and April 2017 or TMT between October 2008 and October 2014 were included. The SMI was measured on axial computed-tomography at the level of the transverse process of L3, before treatment. Sarcopenia was assessed in two ways: either by SMI without muscle mass adjustment or according to the definition by Martin and al. based on gender and patient BMI, then called "adjusted sarcopenia". The primary endpoint was overall survival (OS) for sarcopenia. The secondary endpoints were OS, progression-free survival (PFS) and survival without re-admission (SRH) for the total population and for each treatment group. Survival analyses were performed using the Cox model. The association between sarcopenia and complications has been investigated by the Chi2 test. RESULTS The characteristics of sarcopenic (n=67) and non-sarcopenic (n=79) patients were comparable except for 2 criteria: older patients in the sarcopenic group and a higher proportion of neo-adjuvant chemotherapy in non-sarcopenic patients. Sarcopenia was not significantly associated with any type of survival. Sarcopenia was not associated with the proportion or severity of complications. CONCLUSION Unlike unadjusted SMI, sarcopenia was not associated with survival or complications. LEVEL OF EVIDENCE 3.
Collapse
|
29
|
Échographie moléculaire dans le cancer du rein : modèle pré-clinique de suivi des traitements anti-angiogéniques à partir de microbulles couplées au VEGFR1 et FSHR. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study). Eur Urol 2019; 76:790-813. [PMID: 31587989 DOI: 10.1016/j.eururo.2019.09.020] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised. OBJECTIVE To develop consensus statements for all domains of DAT. DESIGN, SETTING, AND PARTICIPANTS A protocol-driven, three phase study was undertaken by the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations, including the following: (1) a systematic review to describe heterogeneity across all domains; (2) a two-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) a consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted the consensus were strictly followed. RESULTS AND LIMITATIONS A total of 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and three patients, where consensus was achieved in additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low-risk disease, and the role of multiparametric magnetic resonance imaging in determining disease stage and aggressiveness as a criterion for inclusion and exclusion. CONCLUSIONS Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials. PATIENT SUMMARY We undertook a project aimed at standardising the elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (ie, consensus) regarding best practice, which will provide guidance to clinicians and researchers.
Collapse
|
31
|
Valeur pronostique de la testostéronémie lors de l’hormonothérapie intermittente du cancer de la prostate. Prog Urol 2019; 29:510-523. [DOI: 10.1016/j.purol.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/26/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022]
|
32
|
Efficacy and Toxicity Following Salvage High-Dose-Rate Brachytherapy for Locally Recurrent Prostate Cancer after Radiotherapy: A Single Center Retrospective Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
33
|
[Is it necessary to perform urine culture systematically prior to double J ureteral stent removal?]. Prog Urol 2019; 29:504-509. [PMID: 31387836 DOI: 10.1016/j.purol.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the value of systematic urine culture before ureteric double j removal. MATERIAL AND METHODS This prospective audit was performed to assess the validity of our current clinical practice. A cohort of informed patients without clinical signs of urinary tract infection and without predefined risk factors were programmed for ureteral double j stent removal in an outpatient setting. Urine was sampled for culture immediately before the procedure. Patients had to complete a self-questionnaire 15 days following stent removal, inquiring about tolerance and complications which were to be analyzed according to the culture results. The primary endpoint was the occurrence of febrile urinary tract infection. RESULTS Among the 56 participants, immediate preoperative urine culture revealed colonization in 9 patients (16.1%) and contamination in 6 patients (10.7%). A significant association was found between bacteriuria and double j placement following surgery with urinary tract injury (P<0.02) and diabetes (P<0.009). Two patients had fever including a man with sterile urine and a woman with Staphylococcus Aureus infection. No hospitalization was necessary. Twelve patients reported functional signs with lumbar pain being the most common. There was no significant association between functional signs and patients' clinical characteristics. CONCLUSION This evaluation was not in favor of modifying our protocol of care i.e. the lack of performing neither antibiotic prophylaxis nor systematic urine culture before JJ ureteral stent removal in a selected population. LEVEL OF EVIDENCE 4.
Collapse
|
34
|
Outcomes in a cohort of patients with a Gleason score 6 on radical prostatectomy specimen. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
112 Background: This retrospective study evaluates the outcome of a cohort of patients who had a radical prostatectomy with GS 6 on the prostatic specimen. Methods: Consecutive cases were extracted from prostatectomy database of 2 teaching hospitals between 2000 and 2006 for a prostate cancer and were scored GS 6 on the specimen. Overall, specific, metastasis and PSA progression-free survivals were analyzed. Cox model was used to evaluate predictive factors. PSA progression was defined by a level of 0.2 ng/mL or above. Results: Mean age of the 616 analyzed patients was 62.8 yrs (SD 6.4). Mean initial PSA was 8.2 ng/mL (SD 8.0). In 46 cases (7.5%) grade 4 was described on pre-operative prostatic biopsies. Median total tumor length (TTL) was 3 mm (IQ 7.7). Pelvic lymphadenectomy was performed in 213 cases and no positive lymph node was diagnosed. Positive margin (R1) was diagnosed in 79 patients (12.8%). pT3a and pT3b stages were described in 65 and 11 cases (10.5% and 1.8%) respectively. Mean follow-up (FU) was 57.2 months (SD 48). None of the 4 deaths were attributed to prostate cancer. PSA progression was observed in 73 patients (11.8%) of whom 48 had a secondary treatment. One patient developed metastasis. Independent predictive factors of PSA progression were TTL on prostatic biopsy (p = 0.007), R1 status (p = 0.005) and seminal vesicles invasion (p = 0.005). Center, initial PSA, number of positive cores and GS on prostatic biopsy were not associated with outcome. Conclusions: No specific mortality was observed in this cohort of prostatectomy GS 6 prostate cancer patients with the limitation of an insufficient FU. The number of positive cores on pre-operative prostatic biopsies was not predictive of outcome which calls into question its use as criterion for active surveillance.
Collapse
|
35
|
Clinical predictors of sarcomatoid kidney cancer: The results of a UCLA and french UroCCR network collaboration. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
598 Background: Predisposing factors for sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) remain unknown. We highlighted the association of potential contributing medical conditions with the presence of sRCC. Methods: Patients with a renal cell carcinoma (RCC) from UCLA and the French UroCCR-45 study (only sRCC) were included in the study. Characteristics of patients with sRCC were compared with patients with RCC without sarcomatoid features (nsRCC) in univariable and multivariable logistic regression analyses. We quantified the association of age, gender, smoking status, hypertension, kidney function, and endocrine disorders: diabetes and hypothyroidism with sRCC. Results: A total of 2764 were included in the study (586 sRCC vs. 2178 nsRCC). On univariable analysis, age (OR=1.02, 95%CI [1.01-1.03], p<.0001), male gender (OR=1.35, 95%CI [1.10-1.65], p=.004), active smoking (OR=1.87, 95%CI [1.48-2.36], p<.0001), and diabetes (OR=1.32, 95%CI [1.03-1.70], p=.026) were associated with the presence of sRCC (Table 1). On multivariable analysis, age (+2.1% per year, OR=1.02, 95%CI [1.01-1.03], p<0.0001), male gender (OR=1.33, 95%CI [1.08-1.64], p=.008), and active smoking (OR=1.95, 95%CI [1.54-2.47], p<0.0001) were independently associated with the presence of sRCC. The AUC of the model was 0.61. Conclusions: In this study we found that sarcomatoid dedifferentiation was associated with age, male gender, and active smoking. Further studies are needed to confirm these findings and establish the underlying biology. Univariable logistic regression analysis of the association between potential pathogenic factors and sRCC. N=2764 [Table: see text]
Collapse
|
36
|
Is it necessary to test the sterility of urine prior to outpatient cystoscopy? J Hosp Infect 2019; 101:483-485. [PMID: 30664914 DOI: 10.1016/j.jhin.2019.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
|
37
|
Evaluation of pain and catheter-related bladder discomfort relative to balloon volumes of indwelling urinary catheters: A prospective study. Investig Clin Urol 2018; 60:35-39. [PMID: 30637359 PMCID: PMC6318203 DOI: 10.4111/icu.2019.60.1.35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/10/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate patients' tolerance to indwelling urinary catheters (IUCs) before and after reducing their balloon volumes. IUCs are a source of discomfort or pain. Materials and Methods All consecutive patients hospitalized in our department with IUCs were included during the study period with some exclusion. Each patient was his/her own control before and two hours after reduction of the balloon volume (RBV) by half using two types of assessments, a visual analog scale for pain and a catheter-related bladder discomfort (CRBD) symptom questionnaire. Results Forty-nine patients were included in our study that completed the assessments. The mean scores for pain before and after RBVs were 2.80 and 2.02, respectively. The difference was significant (p<0.05). The mean grades of the CRBD before and after RBVs were 1.02 and 0.75, respectively. The difference was significant (p<0.05). Conclusions A 50% RBV has shown a significant amelioration in tolerating the catheter.
Collapse
|
38
|
Chirurgie conservatrice des tumeurs testiculaires : résultats périopératoires. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Facteurs prédictifs et pronostics du cancer du rein à composante sarcomatoïde. Résultats d’une étude UCLA et UroCCR 45. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
40
|
Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy. World J Urol 2018; 36:1775-1781. [PMID: 30171454 DOI: 10.1007/s00345-018-2450-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG. METHODS According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups. RESULTS Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS: Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.
Collapse
|
41
|
Comprehensive molecular classification of localized prostate adenocarcinoma reveals a tumour subtype predictive of non-aggressive disease. Ann Oncol 2018; 29:1814-1821. [DOI: 10.1093/annonc/mdy224] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
42
|
Epidemiology, biology and treatment of sarcomatoid RCC: current state of the art. World J Urol 2018; 37:115-123. [PMID: 29858701 DOI: 10.1007/s00345-018-2355-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
Long recognized to confer an extremely poor prognosis, sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) is a tumor phenotype that is finally beginning to be better understood on the molecular and genetic levels. With an overall incidence that ranges from 1 to 32% depending on associated RCC subtype, the survival of sarcomatoid RCC patients rarely exceeds 2 years. The main reasons for its poor outcome include its aggressive biology, its tendency to present at an advanced or metastatic stage at the time of diagnosis, its high rate of tumor recurrence after nephrectomy, and its limited response to systemic therapies. Molecular pathology studies suggest that sarcomatoid dedifferentiation originates from a focal epithelial-mesenchymal transition (EMT) arising in the carcinomatous component of the tumor. It is hoped that the growing understanding of the molecular biology of sRCC will soon make it possible to adapt treatments based on the identification of actionable tumor alterations. The deliberate inclusion of these patients in the multicenter clinical trials of immune, targeted and combination therapies is a necessary next step in pioneering future treatment strategies.
Collapse
|
43
|
MP61-11 TEMPORARY CONTRAINDICATION OF OBESE RECIPIENTS IN KIDNEY TRANSPLANTATION: A NEW MORPHOMETRIC TOOL FOR DECISION SUPPORT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
44
|
Fluorescence par vert d’indocyanine au cours de la greffe rénale pour visualisation de la vascularisation de l’uretère : étude exploratoire prospective. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
45
|
|
46
|
Observational Studies Requested by European Health Authorities: Governmental Interference or an Enhancement of Everyday Urological Practice? The Hexvix® Observational Patients Evaluation Study as an Example of What to Expect. Urol Int 2017; 99:358-366. [PMID: 28787725 DOI: 10.1159/000477973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/02/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Hexvix® Observational Patients Evaluation (HOPE) study was designed to determine the extent of distribution of the use of hexaminolevulinate in the diagnosis of non-muscle invasive bladder cancer (NMIBC) and assess patient and treatment characteristics associated with different endoscopic modalities and to address the French authorities' request for information on routine practices for NMIBC diagnosis and surveillance. PATIENTS AND METHODS A prospective, observational study in 30 centres in France with fluorescence endoscopy equipment available. All candidates for endoscopy with transurethral resection who gave their consent were eligible. The primary endpoint was the proportion of patients with an NMIBC diagnosis performed with hexaminolevulinate. RESULTS 506 patients were included: 252 (49.8%) diagnosed with hexaminolevulinate and 254 (50.2%) with white-light endoscopy alone. There were more patients with tumour recurrence, multiple lesions, lesions with a diameter <3 cm, stage Ta disease, and grade 1 lesions in the hexaminolevulinate group. The first quartile median recurrence-free survival time was 310 days in the hexaminolevulinate group and 144 days in the standard-endoscopy group (p = 0.0015). CONCLUSION Hexaminolevulinate was in frequent use in France with specific patient and disease characteristics associated with its use. HOPE illustrates the type of data that can be gained in post-authorisation studies to address requests from European health authorities.
Collapse
|
47
|
Oddities Sporadic Neurofibroma of the Urinary Bladder. A Case Report. Urol Case Rep 2017; 14:42-44. [PMID: 28736721 PMCID: PMC5510488 DOI: 10.1016/j.eucr.2017.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022] Open
Abstract
Neurofibromas of the urinary bladder are an exceedingly rare entity and are considered mostly in conjunction with the disease of neurofibromatosis type 1. The fortuitous discovery of vesical plexiform neurofibromas without other stigmata of the disease is presented in a 57-year-old male patient. The course of his condition, modalities of investigation and a non-precedent treatment plan are demonstrated.
Collapse
|
48
|
[The pathologist, urologist's air traffic controller]. Ann Pathol 2017. [PMID: 28623963 DOI: 10.1016/j.annpat.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
49
|
Percutaneous microwave ablation of renal cancers under CT guidance: safety and efficacy with a 2-year follow-up. Clin Radiol 2017; 72:786-792. [PMID: 28545682 DOI: 10.1016/j.crad.2017.03.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the safety and efficiency of percutaneous microwave ablation (MWA) of renal cell carcinomas (RCC) carried out under computed tomography (CT) guidance. MATERIALS AND METHODS A retrospective study was performed on RCC that was either histologically proven or diagnosed at imaging (Bosniak IV cyst) and treated by MWA under general anaesthesia with CT guidance. Indications for percutaneous ablation were based on the American Urological Association recommendations. Twenty-four months post-procedure follow-up was performed. RESULTS Sixty-two patients presenting one or more RCC (84 tumours ranging from 10-48 mm in diameter; mean diameter: 25.6 mm) were included. Technical success was achieved for 78 tumours (58 patients). For four patients, the treatment was stopped due to gas dissection failure. At 3 months, six residual tumours were observed (8%). At 6 months, two recurrences and one residual tumour (3.8%) were observed; all were retreated with complete success. At 12 months, local control of the disease was achieved in 94% of cases (100% in cases where treatment was performed). Two cases of distal metastasis were observed after 12 and 24 months. At 24 months, one patient presented with a contralateral tumour. The complication rate was 4.8% including one grade III complication and two grade II complications according to the Clavien-Dindo classification. At 2 years, the cumulative disease-free survival rate and overall survival were 95% and 97%, respectively. CONCLUSION MWA ablation under CT guidance to treat RCC is safe and provides a high rate of effectiveness at 24 months.
Collapse
|
50
|
Angiosarcoma of the Bladder: Review of the Literature and Discussion About a Clinical Case. Urol Case Rep 2017; 13:97-100. [PMID: 28480169 PMCID: PMC5412009 DOI: 10.1016/j.eucr.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/15/2016] [Indexed: 11/14/2022] Open
Abstract
Our reported case is a 72 year-old man who presented with hematuria. A transurethral resection of the bladder tumor (TURB-T) has been performed. Histopathological diagnosis was an epithelioid angiosarcoma. CT scan revealed a bladder thickening. The treatment consisted in a complete pelvectomy with urinary and digestive diversion. Following the operation, the patient developed liver and pulmonary metastasis. He died 5 months after the initial diagnosis.
Collapse
|