F. Kleinclauss

Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma.

OBJECTIVESnThe aim of this study is to determine the accuracy of ultrasonography for the diagnosis of testis rupture after scrotal trauma and its sensitivity and specificity for testis rupture, tunica albuginea breach, testicular hematoma, testis avulsion, epididymis injuries, and hematocele.nnnMETHODSnBetween 1996 and 2006, 33 patients underwent surgical exploration for blunt scrotal trauma. All these patients had an emergency scrotal ultrasonography with the use of a 7.5 or 10 MHz linear transducer. Ultrasonographic findings were compared with surgical findings to calculate sensitivity and specificity of ultrasonography for each type of lesion.nnnRESULTSnOf 33 patients, 16 presented a testis rupture. Testis rupture was in all cases suspected ultrasonographically by the loss of contour of the testis and heterogeneous parenchyma. Tunica albuginea breach was visualized in only 8 patients. Sensitivity and specificity of ultrasound for testis rupture were 100% and 65%, respectively. Moreover, ultrasonography allowed diagnosis of hematocele (sensitivity: 87% and specificity: 89%), testicular hematoma (sensitivity: 71%, specificity: 77%), and testis avulsion (sensitivity: 100%, specificity: 97%). Ultrasonography results for epididymis injuries were poor. On 7 patients, 3 epididymis lesions were misdiagnosed by ultrasound examination.nnnCONCLUSIONSnUltrasonography can distinguish various scrotal injuries. Testicular rupture is probably the most severe injury that needs early surgical treatment to improve testis salvage rate. In our work, ultrasonography is highly sensitive in the diagnosis of testis rupture and can provide information on the scrotal contents integrity that can help the physician to determine the optimal treatment.

Prostate cancer in renal transplant recipients

BACKGROUNDnWe conducted a retrospective multi-centre study to determine the characteristics of prostate cancer in renal transplant recipients (RTR) and to analyse the relation with immunosuppressive maintenance therapies.nnnMETHODSnPatients from 19 French transplant centres diagnosed with prostate cancer at least 1 year after kidney transplantation were included in this study. Data regarding demographics, kidney transplantation, prostate cancer and immunosuppressive treatment were analysed.nnnRESULTSnSixty-two patients met the eligibility criteria for this study. Thirty-eight patients (61.3%) received calcineurin inhibitors (CNI) and azathioprine (AZA) with or without steroids, twenty received CNI with or without steroids (32.2%) and four received CNI and mycophenolate mofetil (6.5%). Patients with CNI and AZA immunosuppressive therapy presented more high-stage cancer (T3 and T4) when compared to patients receiving CNI alone (47.5% versus 15%, respectively, P = 0.03). A non-significant increase in lymph node invasion was found in patients receiving CNI and AZA compared to patients receiving CNI alone (21% versus 5%, P = 0.16). In the multivariate analysis, the immunosuppressive regimen with CNI and AZA was the only independent risk factor for locally advanced disease (P = 0.007).nnnCONCLUSIONnOur results showed that RTR are at risk for early occurrence and for locally advanced prostate cancer, especially when they received a CNI and AZA maintenance immunosuppressive therapy.

Morbidity of Retropubic Radical Prostatectomy for Prostate Cancer in Renal Transplant Recipients: Multicenter Study from Renal Transplantation Committee of French Urological Association

OBJECTIVESnTo evaluate the morbidity and surgical complications of retropubic radical prostatectomy (RRP) in renal transplant recipients (RTRs) and compare these results with the observed morbidity in a control group of nontransplanted patients.nnnMETHODSnWe conducted a multicenter retrospective study and reviewed the charts and records of 20 RTRs who had undergone RRP for localized prostate cancer at four French renal transplant centers belonging to the Renal Transplantation Committee of the French Urological Association from April 1996 to April 2007. A total of 40 patients who had undergone RRP at the same centers, by the same surgeons, were analyzed as the case-control population.nnnRESULTSnThe mean operating time (163 +/- 41 vs 160 +/- 66 minutes), blood loss (516 +/- 279 vs 566 +/- 449 mL), transfusion rate (20% vs 22.5%), and hospital stay (11.9 +/- 5.44 vs 9.45 +/- 2.8 days) were similar in the RTR and case-control populations. No graft loss or graft injury was reported in the RTRs, except for two ureteral injuries that were immediately repaired during RRP. No decrease in the kidney graft function was observed after RRP. The rate of medical complication (deep venous thrombosis, pulmonary embolism, urinary tract infection) was similar in both groups, except for the rate of bacterial systemic infection, which was significantly greater in the RTRs than in the controls (15% vs 2.5%, P = .01).nnnCONCLUSIONSnIn our study, RRP was a safe procedure to treat localized prostate cancer in RTRs. RRP resulted in the same morbidity in RTRs as in the case-control population.

Positive surgical margins and their locations in specimens are adverse prognosis features after radical cystectomy in non-metastatic carcinoma invading bladder muscle: results from a nationwide case–control study

Positive surgical margin (PSM) frequency after radical cystectomy has been estimated to be 4–15%. Studies that have not distinguished between the different sites of PSM have failed to show that they are an independent prognostic factor for disease‐free survival. Only perivesical soft tissue PSMs have been associated with an increased risk of cancer recurrence and cancer‐specific death. This is the first comprehensive published analysis of PSMs occurring during radical cystectomy for pTx pN0 M0 bladder cancer according to their location, comparing their cancer‐specific survival (CSS) and other outcomes with those of a control group paired according to TNM status, age, sex and urinary diversion method. Local recurrence‐free survival rates were found to be lower in patients with both soft tissue and urethral PSMs. Moreover, soft‐tissue PSMs were associated with lower metastatic recurrence‐free and CSS rates.

Prise en charge de la colique néphrétique chez la femme enceinte : à propos de 48 cas

INTRODUCTIONnUrinary stones are relatively frequent in pregnant women and raise specific diagnostic and therapeutic problems. The authors conducted a retrospective review of the management of this disease in their establishment.nnnPATIENTS AND METHODSnBetween January 1999 and December 2003, out of a total of 10,398 parturients, 48 pregnant women were hospitalised for renal colic, that is, incidence of 0.04%. The medical records of these patients were retrospectively reviewed and clinical, laboratory, treatment and outcome data were analysed.nnnRESULTSnStandard analgesic treatment, comprising paracetamol and an antispasmodic, achieved pain relief in 84% of cases. A concomitant short course of corticosteroid therapy in cases of renal colic refractory to standard treatment was effective in 71% of patients and allowed deferral of surgical management in five out of seven cases. A double J stent was placed in all patients requiring urinary diversion, followed by closer ultrasound and bacteriological monitoring throughout pregnancy. Only two patients required surgical management of their stone after delivery. The only obstetric event related to renal colic was induction of labour at term in two cases because of foetal distress.nnnCONCLUSIONnThe authors propose a two-stage management plan for renal colic in pregnant women resulting in a low maternal and foetal complication rate.

Complications urologiques de la transplantation rénale.

INTRODUCTIONnUrinary fistula and ureteral stenosis occur respectively in 2-5% and 2-7.5% after kidney transplantation. The aim of the study was to do an overview about the complex management of these complications.nnnMATERIAL AND METHODSnA bibliographical research in French and English language was carried out. Debates on the topic held within a meeting organized by the transplantation Committee of the French association of urology (CTAFU) have incremented the work.nnnRESULTSnWithin the different causes of stenosis and fistula after kidney transplantation, ischemic diseases of the complex blood supply of the ureter are usually involved. The diagnosis is not always easy to establish. It is based on clinical assessment, blood and urinary biochemical exams, ultrasonography and CT-scan. Pyelography or retrograde ureteropyelography are essential in the management. Definitive treatment is surgical: uretero-vesical reimplatation, uretero-uretral anastomosis, pyelo-ureteral anastomosis.nnnCONCLUSIONnUrologic complications of the kidney transplantation usually do not affect the transplant survival if treated accurately and on time. The surgical management remains complex.

Transplantation rénale et receveurs obèses : revue du comité de transplantation de l’Association française d’urologie

INTRODUCTIONnTransplantation Committee of the French Association of Urology (CTAFU) conducted a review of the complication of kidney transplantation in obese recipients.nnnMATERIAL AND METHODSnA bibliographic research in French and English using Medline with the keywords obesity, body mass index, kidney transplantation, graft function, survival, wound complications, graft rejection and graft survival was performed. We limited the review for the last fifteen years because of the change in immunosuppressive treatment area. Only studies with more than 20xa0obese patients were selected.nnnRESULTSnWound or infectious postoperative complications and delayed graft function are more frequent in obese patients than in non-obese recipients. Similarly, transplant survival at 5xa0years is lower in obese patients. On the other hand, patient survival and acute rejection are the same between the two groups if recipient selection is carefully made, particularly with regard to heart complication.nnnCONCLUSIONnKidney transplantation in obese patients is not an easy surgery with known complication. Obese patients will take time before transplantation to explain all the risk and a regular heart follow-up is crucial if we dont want to reduce patient survival. But obese survival is better if we proceed to kidney transplantation than if they stay on dialysis, arguing for a non-exclusion of the waiting list. So there is the need for a national study concerning obese patients on waiting list to enact future guidelines.

Loss of central and peripheral CD8+T‐cell tolerance to HFE in mouse models of human familial hemochromatosis

HFE, an MHC class Ib molecule that controls iron metabolism, can be directly targeted by cytotoxic TCR αβ T lymphocytes. Transgenic DBA/2 mice expressing, in a Rag 2 KO context, an αβ TCR that directly recognizes mouse HFE (mHFE) were created to further explore the interface of HFE with the immune system. TCR‐transgenic mHfe WT mice deleted mHFE‐reactive T cells in the thymus, but a fraction of reprogrammed cells were able to escape deletion. In contrast, TCR‐transgenic mice deprived of mHFE molecules (mHfe KO mice) or expressing a C282→Y mutated mHFE molecule – the most frequent mutation associated with human hereditary hemochromatosis – positively selected mHFE‐reactive CD8+ T lymphocytes and were not tolerant toward mHFE. By engrafting these mice with DBA/2 WT (mHFE+) skin, it was established, as suspected on the basis of similar engraftments performed on DBA/2 mHfe KO mice, that mHFE behaves as an autonomous skin‐associated histocompatibility antigen, even for mHFE‐C282→Y mutated mice. By contrast, infusion of DBA/2 mHFE+ mice with naïve mHFE‐reactive transgenic CD8+ T lymphocytes did not induce GVHD. Thus, tolerance toward HFE in mHfe WT mice can be acquired at either thymic or peripheral levels but is disrupted in mice reproducing human familial hemochromatosis.

Traitement de la maladie de Lapeyronie

Lapeyronies disease occurs mostly in middle age men and consists in pain and bending or arching of the penis during erection. This could negatively impact quality of life. A good knowledge of the physiopathology is necessary to adapt the different treatment modalities.

Transplantation rénale pédiatrique

AIMSnTo describe indications, surgical aspects, results and outcomes of kidney transplantation in children.nnnMATERIAL AND METHODSnAn exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): kidney transplantation, pediatric, children, outcomes. Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 2608 articles. After reading titles and abstracts, 18 were included in the text based on their relevance.nnnRESULTSnKidney transplantation is the gold-standard treatment for end stage renal kidney disease in children. The surgical procedure is well standardized with a retroperitoneal approach when child and kidney size allow it or a transperitoneal approach in child less than 15xa0kg and big size kidney graft. Anastomosis sites include iliac vessels in the retroperitoneal approach, and inferior vena cava and aorta in case of transperitoneal procedure. Ureteral reimplantation used most of the time a Campos Freire technique. Sometimes, particular conditions in the recipient (such as vena cava thrombosis) required procedure adaptation.nnnCONCLUSIONnGraft survival dramatically increased over the past few years and is now superior to those observed in adult kidney transplantation, particularly in experienced team with microsurgery skills. Immunosuppressive treatments are similar to adults. Viral infections and post-transplant lymphoproliferative disorder are the main complications of renal transplantation in children and may lead to lethal outcomes. An increase graft loss is observed during boyhood due to immunosuppressive drugs uncompliance.