Jean Baptiste Beauval

A new surgical area opened in renal transplantation: a pure robot‐assisted approach for both living donor nephrectomy and kidney transplantation using transvaginal route

Dear Sirs, Minimally invasive kidney transplantation using a robotic device has already been described and has shown real benefit especially in selected patient group [1]. The transvaginal approach for kidney extraction with living donor has previously been emphasized showing advantages in recovery and cosmesis [2,3]. The robotic approach was demonstrated to be safe, reproducible, with improving postoperative pain,

Localized chromophobe carcinomas treated by nephron-sparing surgery have excellent oncologic outcomes

OBJECTIVE To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC). MATERIAL AND METHODS We performed a multicenter international study involving the French Network for Research on Kidney Cancer (UroCCR) and 5 international teams. Data from 808 patients treated with NSS between 2004 and 2014 for non-clear cell RCCs were analyzed. RESULTS We included 234 patients with cRCC. There were 123 (52.6%) females. Median age was 61 (23-88) years. Median tumor size was 3 (1-11)cm. A positive surgical margin was identified in 14 specimens (6%). Pathologic stages were T1, T2, and T3a in 202 (86.3%), 9 (3.8%), and 23 (9.8%) cases, respectively. After a mean follow-up of 46.6 ± 36 months, 2 (0.8%) patients experienced a local recurrence. No patient had metastatic progression, and no patient died from cancer. Three-years estimated cancer-free survival and cancer-specific survival were 99.1% and 100%, respectively. CONCLUSION Oncological results of NSS for localized cRCC are excellent. In this series, only 2 patients had a local recurrence, and no patient had metastatic progression or died from cancer.

What risk of prostate cancer led urologist to recommend prostate biopsies

OBJECTIVE The aim of this study was to estimate the risk of prostate cancer that led urologists to perform prostate biopsies. PATIENTS AND METHODS Eight hundred and eight patients had prostate biopsies in 5 tertiary centres in 2010. Following data were collected: age, PSA, DRE, prostate volume, negative prior prostate biopsy and estimated life expectancy (> or <10 years). The risk of prostate cancer was calculated by validated nomogram of PCPT-CRC and SWOP-PRI and correlated with pathological biopsy results. RESULTS In final analysis, 625 patients were included, 568 (90.9%) had a life expectancy greater than 10 years. Prostate cancer was found in 291 (46.6%) cases. These patients were older (66.7 ± 6.8 vs 64.3 ± 5.6 years, P < 0.001), had higher PSA values (10 ± 7.9 vs 7.7 ± 4.3 ng/mL, P < 0.0001) and the prostate volume decreased (43.8 ± 19.8 vs 51.3 ± 20.7 mL, P < 0.0001) compared with healthy subjects. Digital Rectal Examination was more frequently suspicious in the group of patients with prostate cancer (43.6% vs 18.9%, P < 0.0001). Risk of prostate cancer estimated was 50.6 ± 14% for PCPT-CRC without ATCD, 56.2 ± 12.8% with PCPT-CRC ATCD and 31.2 ± 17.3% for SWOP-PRI. The likelihood of high-risk prostate cancer was 22.4 ± 16.9% with the PCPT-CRC, and 14.8 ± 18.2% with SWOP-PRI. CONCLUSION This study showed that urologists performed prostate biopsies when the risk of cancer was high.

Faut-il envisager un traitement complémentaire après une colique néphrétique drainée par une sonde JJ ?

PURPOSE The aim of the study was to evaluate if only ureteral stent removing after complicated renal colic (RC) could prevent from complementary treatment (shock-wawe lithortripsy or ureteroscopy). PATIENTS AND METHODS Data from 95 patients, 39 women and 56 men, who had an ureteral stent for complicated RC from 2005 to 2010 were retrospectively collected. Mean age was 46.4 ± 17.2 years. After the initial management, another hospitalization was organized where patients had ureteral stent removing under local anesthesia, then an abdominal CT-scan without injection and complementary treatment of ureteral stones (none or ESWL or ureteroscopy). Parameters studied were age, sex, stone size, location of calcul. Quantitative values were compared with Students t test. Qualitative values were compared with the Chi(2). P<0.05 was considered statistically significant. RESULTS Mean duration between the two hospitalizations were 1.58 ± 1.84 months. Sixty-one patients (64.2%) had no more urolithiasis. In these patients, mean size of urolithiasis was 5.85 ± 2.33 mm. Location of urolithiasis in distal, mild and proximal ureter was 77%, 3% and 20% respectively. Thirty-four patients (35.8%) had persistant lithiasis after CT-scan. Location of stone in distal, mild and proximal ureter was 17.5%, 5.8% and 76.7% respectively. CONCLUSION After management of complicated renal colic by ureteral stent, 64% of patients had spontaneous elimination of stones after removing of ureteral stent, especially in women and pelvic ureter.

Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR

BACKGROUND Partial nephrectomy (PN) is recommended as first-line treatment for cT1 stage kidney tumors because of a better renal function and probably a better overall survival than radical nephrectomy (RN). For larger tumors, PN has a controversial position due to lack of evidence showing good cancer control. The aim of this study was to compare the results of PN and RN in cT2a stage on overall survival and oncological results. METHOD A retrospective international multicenter study was conducted in the frame of the French kidney cancer research network (UroCCR). We considered all patients aged≥18 years who underwent surgical treatment for localized renal cell carcinoma (RCC) stage cT2a (7.1-10cm) between 2000 and 2014. Cox and Fine-Gray models were performed to analyze overall survival (OS), cancer specific survival (CSS) and cancer-free survival (CFS). Comparison between PN and RN was realized after an adjustment by propensity score considering predefined confounding factors: age, sex, tumor size, pT stage of the TNM classification, histological type, ISUP grade, ASA score. RESULTS A total of 267 patients were included. OS at 3 and 5 years was 93.6% and 78.7% after PN and 88.0% and 76.2% after RN, respectively. CSS at 3 and 5 years was 95.4% and 80.2% after PN and 91.0% and 85.0% after RN. No significant difference between groups was found after propensity score adjustment for OS (HR 0.87, 95% CI: 0.37-2.05, P=0.75), CSS (HR 0.52, 95% CI: 0.18-1.54, P=0.24) and CFS (HR 1.02, 95% CI: 0.50-2.09, P=0.96). CONCLUSION PN seems equivalent to RN for OS, CSS and CFS in cT2a stage kidney tumors. The risk of recurrence is probably more related to prognostic factors than the surgical technique. The decision to perform a PN should depend on technical feasibility rather than tumor size, both to imperative and elective situation. LEVEL OF EVIDENCE 4.

MP55-09 OPEN PARTIAL NEPHRECTOMY VS. ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CYSTIC RENAL MASSES: IMPACT OF PEROPERATIVE CYSTIC SPILLAGE AND ONCOLOGICAL RESULTS.

INTRODUCTION AND OBJECTIVES: Complex cystic masses pose a clinical challenge given lack of certainty for malignant potential. Cystic changes are common in renal cell carcinoma (RCC); however, there is limited data on cystic RCC (cRCC) specifically. The Bosniak classification system is used to categorize these lesions and help predict risk of malignancy. Current literature suggests that cRCC has a more favorable and benign course, but with no consensus on proper diagnosis and intervention. We aim to better categorize cRCC and the natural history of this disease. METHODS: We identified all patients with pathologically confirmed cRCC, multilocular cRCC, or RCC with cystic features between Jan 2000 Dec 2015 from our institutional database. Patients with follow-up of <1 year, previous history of RCC, familial syndromes, multifocal tumors, and lesions with >50% solid component on imaging were excluded from our analysis. Available imaging was re-reviewed by a single expert radiologist (AH). Radiological, clinical, and pathological characteristics were recorded. RESULTS: Of 128 patients identified for analysis, 76 (59.4%) were male and 52 (40.6%) were female. Median age at surgery was 54.4 years (17.3-78.4). Twenty (15.6%) patients had a family history of RCC. The majority of lesions were found incidentally on imaging (89.1%). Fourteen (10.9%) patients had local symptoms, with flank pain (8.6%) being the most common. Partial nephrectomy was performed on 116 (90.6%) patients and radical nephrectomy on 12 (9.4%); open technique was used in >80% of cases. Pathologic and imaging characteristics are shown in Table 1. On median follow-up of 66.1 months, there were no tumor recurrences or metastatic disease. A total of 5 (3.9%) patients died from other conditions. CONCLUSIONS: Diagnosis of cRCC should include cystic lesions with <50% solid component on imaging. Our data shows that cRCC includes a wide variety of tumors, most commonly with clear cell features. Most of these lesions are discovered incidentally on imaging as Bosniak grades 3 or 4 and are surgically resected. These patients uniformly do well with minimal risk of recurrence or metastasis on follow-up, thus, nephron sparing surgery is recommended. Given the indolent nature cRCC, enrollment of these patients into active surveillance protocols should be considered. Source of Funding: Funded in part by the Sidney Kimmel Center for Prostate and Urologic Cancers and the National Cancer Institute Training Grant T32 CA082088 (BM, GM)