Complications des néphrectomies partielles (étude prospective comparant la voie ouverte, coelioscopique et robot assistée. Données multicentriques de l'étude NEPHRON)

Objectifs: Evaluer l'incidence des complications des néphrectomies: partielles (NP) faites en France en associant la voie d'abord utilisée aux caractéristiques des patients et celle des tumeurs sur une série prospective de 567 NP. Méthodes: Analyse de sous groupe de l'observatoire NEphrectomies Partielles et pratique de l'Hémostase: Registre Observationnel National. Résultats: Le taux de complications était respectivement de 11 %, 9%, et 9% pour les NP ouvertes (NPO), coelioscopiques (NPL) ou robotiques (NPRA). Il n'y avait pas de différence en terme de taux de transfusion entre les différentes voies d'abord. La majorité des complications étaient mineures selon la classification de Clavien (grade 1 et 2). On avait 27,2 %, 20,4% et 14,9% de complications totales respectivement pour des tumeurs polaires supérieures, moyennes ou inférieures (p=0,01). L'état du rein controlatéral était un facteur prédictif de survenu de complications avec un taux de 19,2% ; 27,9% et 40,7% respectivement chez les patients présent nt un rein controlatéral sain, pathologique ou absent (p=0,01). La taille moyenne des tumeurs était respectivement de 4,5cm ; 3,1 cm et 3,3 cm pour les NPO, NPL ou NPRA (p=4cm avec des temps d'ischémie chaude plus élevée de 20.6 +- 9.9min comparé au groupe des tumeurs =4cm, la localisation polaire supérieure et l'état du rein controlatéral sont des facteurs prédictifs de complications des NP.MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

A Case of Adrenal Metastasis in Seminoma

We report an uncommon case of testicular cancer with adrenal metastasis without retroperitoneal or distant metastatic disease. This situation is highly unusual. In fact, no similar case was reported in the literature. Our case is the first adrenalectomy that has been performed for secondary localization of testicular cancer. After eighteen-month followup, the patient was doing well, with no evidence of disease

Laparoscopy in Ureteral Engineering: A Feasibility Study.

OBJECTIVE: We recently bioengineered a ureter substitute from a seeded scaffold implanted by open surgery in the omentum. In view of the development of laparoscopy in the treatment of benign conditions of the ureter, obtaining a ureter substitute by minimally invasive techniques would be a desirable objective. However, conflicting results about the biological impact of carbon dioxide insufflation on the microcirculation of intra-abdominal organs prompted us to investigate first whether the results obtained by open surgery, in terms of vascular supply and maturation, could be reproduced laparoscopically. MATERIALS AND METHODS: Bladder full-thickness tissue was harvested laparoscopically from three pigs for urothelial and smooth muscle cell primary cultures subsequently used to seed a small intestinal submucosa (SIS) matrix. After 2 wk, the in vitro seeded constructs were shaped around silicone drains and transferred laparoscopically into the abdomen for omental maturation. Three weeks later, the constructs were harvested for histological, immunohistochemical, and electron microscopic analysis. RESULTS: The laparoscopic procedures were performed successfully in all animals. After omental maturation, the constructs were vascularized and comprised of a well-differentiated multilayered urothelium with umbrella cells, over connective tissue and smooth muscle cells, with no evidence of fibrosis or inflammation. Electron microscopic analysis showed characteristics of a terminally differentiated urothelium. CONCLUSION: As shown by conventional microscopy, immunochemistry, and electron microscopy, carbon dioxide insufflation does not impact cell growth and differentiation. These findings validate the laparoscopic approach for omental maturation of ureter substitutes

Avancées et synthèse des derniers congrès : ASCO-GU, EAU, AUA, ASCO concernant la prise en charge médicale du cancer du rein localement avancé ou métastatique. [Progress and summary of recent congress: ASCO-GU, EAU, AUA, ASCO about the medical management of locally advanced or metastatic kidney cancer]

International audienceDuring the recent congress of urology and oncology key topics discussed were the evolution of survival data in metastatic kidney cancer which median is now around 40 months, persistent questions about the role of nephrectomy, including access to the systemic treatment of nephrectomized patients and tumor resectability induced by systemic therapies, the emergence of new prognostic models which are adapted to new therapeutic standards, and the emergence of promising new drugs including pazopanib. This article describes these advances

Phase II study of axitinib for downstaging cT2a to cT1 renal tumors for allowing partial nephrectomy (AXIPAN).

International audienceno abstrac

Early PSA level decline is an independent predictor of biochemical and clinical control for salvage postprostatectomy radiotherapy

International audienceBACKGROUND: To improve the early detection of responders to salvage external beam radiotherapy (RT) after radical prostatectomy (RP). METHODS: Between 2002 and 2007, in a single institution, 136 consecutive patients received salvage RT to a dose of 66 Gy without androgen-deprivation therapy after RP for a rising prostate-specific antigen (PSA) level. PSA measurements were systematically performed before RT (PSART), at the fifth week of RT (PSA5), and in the follow-up at least twice a year (every 6 mo). The PSA level decline during RT was expressed as PSA ratio (PSA5/PSART). Two different definitions of biochemical failure after salvage RT were considered: PSA level\textgreater0.4 ng/ml and PSA\textgreaterPSA nadir post-RT +0.4 ng/ml. Statistical analyses included univariate and multivariate Cox regression models. RESULTS: The median follow-up was 60 months. The 5-year freedom from biochemical and clinical failure rates were 57% (95% CI: 48%-66%) and 92% (95% CI: 87%-97%), respectively. The mean PSA5 was 0.61 ng/ml (range: 0-7) and the mean PSA ratio was 0.67 (0-1.7). A PSA ratio\textless1 was a significant prognostic factor in multivariate analysis for both definitions of biochemical failure (P = 0.01 for both) and for clinical failure (P = 0.005). CONCLUSIONS: For patients undergoing salvage RT after RP for a rising PSA level, the absence of PSA level decline during RT is predictive of biochemical and clinical failure and may be used to rapidly identify poor responder

L'alimentation demain.: Cultures et médiations

Gastronomie, food tech, santé, big data et génétique sont, entre autres, au menu de cet Essentiel entièrement inédit. Les chercheurs réunis ici nous éclairent sur les comportements alimentaires et les nouvelles pratiques ou tendances qui façonnent, à travers le monde, l’alimentation de demain.Depuis quelques années, l’alimentation est un objet de controverses... La communication est devenue cruciale pour comprendre les crises alimentaires (scandales sanitaires, OGM, avaries dans la distribution ou la restauration). Le mécanisme est partout le même : pléthorique et contradictoire, l’information circule à la vitesse de la lumière, elle se déforme, affole ou séduit les mangeurs. Les individus, notamment les « millennials », sont pris entre renoncement et pratiques alternatives, nourris par une défiance croissante envers l’industrie agroalimentaire. Ces médiations mettent les chercheurs au défi de comprendre comment les consommateurs construisent leurs systèmes de confiance et réinventent la façon dont nous mangerons demain

Modalités de clampage au cours de la néphrectomie partielle : aspects techniques et conséquences fonctionnelles. Revue du sous-comité rein du Comité de cancérologie de l'Association française d'urologie (CCAFU). [Clamping modalities during partial nephrectomy: Technical aspects and functional consequences. Review by the Comité de cancérologie de l'Association française d'urologie (CCAFU).]

International audiencePartial nephrectomy requires control of renal blood flow by using renal vessels clamping. Multiple clamping techniques are available. The clamping procedure can be parenchymal or vascular, involving enbloc arterial and veinous clamping or arterial onlone, being continuous or intermittent, associated or not with renal cooling. The purpose of this present review was to analyze technical aspects of clamping methods during partial nephrectomy and their functional consequences in terms of blood loss, surgical margins status and changes in renal function