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Branger N, Doumerc N, Waeckel T, Bigot P, Surlemont L, Knipper S, Pignot G, Audenet F, Bruyère F, Fontenil A, Parier B, Champy C, Rouprêt M, Patard JJ, Henon F, Fiard G, Guillotreau J, Beauval JB, Michel C, Bernardeau S, Taha F, Mallet R, Panthier F, Guy L, Vignot L, Khene ZE, Bernhard JC. Preparing for the Worst: Management and Predictive Factors of Open Conversion During Minimally Invasive Renal Tumor Surgery (UroCCR-135 Study). EUR UROL SUPPL 2024; 63:89-95. [PMID: 38585592 PMCID: PMC10997889 DOI: 10.1016/j.euros.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Data regarding open conversion (OC) during minimally invasive surgery (MIS) for renal tumors are reported from big databases, without precise description of the reason and management of OC. The objective of this study was to describe the rate, reasons, and perioperative outcomes of OC in a cohort of patients who underwent MIS for renal tumor initially. The secondary objective was to find the factors associated with OC. Methods Between 2008 and 2022, of the 8566 patients included in the UroCCR project prospective database (NCT03293563), who underwent laparoscopic or robot-assisted minimally invasive partial (MIPN) or radical (MIRN) nephrectomy, 163 experienced OC. Each center was contacted to enlighten the context of OC: "emergency OC" implied an immediate life-threatening situation not reasonably manageable with MIS, otherwise "elective OC". To evaluate the predictive factors of OC, a 2:1 paired cohort on the UroCCR database was used. Key findings and limitations The incidence rate of OC was 1.9% for all cases of MIS, 2.9% for MIRN, and 1.4% for MIPN. OC procedures were mostly elective (82.2%). The main reason for OC was a failure to progress due to anatomical difficulties (42.9%). Five patients (3.1%) died within 90 d after surgery. Increased body mass index (BMI; odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.009) and cT stage (OR: 2.22, 95% CI: 1.24-4.25, p = 0.008) were independent predictive factors of OC. Conclusions and clinical implications In MIS for renal tumors, OC was a rare event (1.9%), caused by various situations, leading to impaired perioperative outcomes. Emergency OC occurred once every 300 procedures. Increased BMI and cT stage were independent predictive factors of OC. Patient summary The incidence rate of open conversion (OC) in minimally invasive surgery for renal tumors is low. Only 20% of OC procedures occur in case of emergency, and others are caused by various situations. Increased body mass index and cT stage were independent predictive factors of OC.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Pierre Bigot
- Department of Urology, CHU Angers, Angers, France
| | | | - Sophie Knipper
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | - François Audenet
- Department of Urology, Hopital européen Georges Pompidou, Paris, France
| | | | | | | | - Cécile Champy
- Department of Urology, Hopital Henri Mondor, Créteil, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | | | | | - Gaëlle Fiard
- Department of Urology, CHU Grenoble, Grenoble, France
| | | | | | | | | | - Fayek Taha
- Department of Urology, CHU Reims, Reims, France
| | - Richard Mallet
- Department of Urology, Polyclinique Francheville, Périgueux, France
| | | | - Laurent Guy
- Department of Urology, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Chicaud M, Kutchukian S, Doizi S, Audenet F, Berthe L, Yonneau L, Lebret T, Timsit MO, Mejean A, Candela L, Solano C, Corrales M, Duquesne I, Descazeaud A, Traxer O, Panthier F. Is "Kidney Stone Calculator" efficient in predicting ureteroscopic lithotripsy duration? A holmium:YAG and thulium fiber lasers comparative analysis. World J Urol 2024; 42:233. [PMID: 38613608 DOI: 10.1007/s00345-024-04906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE This study aimed to evaluate the ability of Kidney Stone Calculator (KSC), a flexible ureteroscopy surgical planning software, to predict the lithotripsy duration with both holmium:YAG (Ho:YAG) and thulium fiber laser (TFL). METHODS A multicenter prospective study was conducted from January 2020 to April 2023. Patients with kidney or ureteral stones confirmed at non-contrast computed tomography and treated by flexible ureteroscopy with laser lithotripsy were enrolled. "Kidney Stone Calculator" provided stone volume and subsequent lithotripsy duration estimation using three-dimensional segmentation of the stone on computed tomography and the graphical user interface for laser settings. The primary endpoint was the quantitative and qualitative comparison between estimated and effective lithotripsy durations. Secondary endpoints included subgroup analysis (Ho:YAG-TFL) of differences between estimated and effective lithotripsy durations and intraoperative outcomes. Multivariate analysis assessed the association between pre- and intraoperative variables and these differences according to laser source. RESULTS 89 patients were included in this study, 43 and 46 in Ho:YAG and TFL groups, respectively. No significant difference was found between estimated and effective lithotripsy durations (27.37 vs 28.36 min, p = 0.43) with a significant correlation (r = + 0.89, p < 0.001). Among groups, this difference did not differ (p = 0.68 and 0.07, respectively), with a higher correlation between estimated and effective lithotripsy durations for TFL compared to Ho:YAG (r = + 0.95, p < 0.001 vs r = + 0.81, p < 0.001, respectively). At multivariate analysis, the difference was correlated with preoperative (volume > 2000 mm3 (Ho:YAG), 500-750 mm3 SV and calyceal diverticulum (TFL)), operative (fragmentation setting (p > 0.001), and basket utilization (p = 0.05) (Ho:YAG)) variables. CONCLUSION KSC is a reliable tool for predicting the lithotripsy duration estimation during flexible ureteroscopy for both Ho:YAG and TFL. However, some variables not including laser source may lead to underestimating this estimation.
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Affiliation(s)
- Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Service d'Urologie, Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King, 87000, Limoges, France
| | - Stessy Kutchukian
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000, Poitiers, France
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - François Audenet
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Européen George Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Laurent Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Laurent Yonneau
- Université Versailles Saint-Quentin-Service d'Urologie, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
| | - Thierry Lebret
- Université Versailles Saint-Quentin-Service d'Urologie, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
| | - Marc-Olivier Timsit
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Européen George Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Arnaud Mejean
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Européen George Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Luigi Candela
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Catalina Solano
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Department of Endourology, Uroclin SAS Medellin, Medellin, Colombia
| | - Mariela Corrales
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Igor Duquesne
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Cochin, Université Paris Cité, 123 boulevard de Port-Royal, 75014, Paris, France
| | - Aurélien Descazeaud
- Service d'Urologie, Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King, 87000, Limoges, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Fréderic Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.
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Suartz CV, Cordeiro MD, Botelho LAA, Gallucci FP, Cho DH, de Arruda Pessoa F, da Silva FR, Costa MSS, Cardili L, Audenet F, Mota JM, Toren P, Nahas WC, Ribeiro-Filho LA. Predicting individual outcomes after radical cystectomy in urothelial variants with Cancer of the Bladder Risk Assessment (COBRA) score. World J Urol 2024; 42:155. [PMID: 38483580 DOI: 10.1007/s00345-024-04798-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/14/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To validate the Cancer of the Bladder Risk Assessment (COBRA) score in patients with urothelial variants. METHODS Epidemiological, clinical, radiological, and anatomopathological data were collected from patients with urothelial carcinoma who underwent radical cystectomy at the Institute of Cancer of São Paulo between May 2008 and December 2022. Patients with the presence of at least 10% of any urothelial variants in the radical cystectomy specimens' anatomopathological exam were included in the study. The COBRA score and derivatives were applied and correlated with oncological outcomes. RESULTS A total of 680 patients [482 men (70.9%) and 198 women (29.1%)]; 66 years (IQR 59-73) underwent radical cystectomy for bladder tumor, and of these patients, a total of 167 patients presented any type of urothelial variant. The median follow-up time was 28.77 months (IQR 12-85). The three most prevalent UV were squamous differentiation (50.8%), glandular differentiation (31.3%), and micropapillary differentiation (11.3%). The subtypes with the worst prognosis were sarcomatoid with a median survival of 8 months (HR 1.161; 95% CI 0.555-2.432) and plasmacytoid with 14 months (HR 1.466; 95% CI 0.528-4.070). The COBRA score for patients with micropapillary variants demonstrated good predictive accuracy for OS (log-rank P = 0.009; 95% IC 6.78-29.21) and CSS (log-rank P = 0.002; 95% IC 13.06-26.93). CONCLUSIONS In our study, the COBRA score proved an effective risk stratification tool for urothelial histological variants, especially for the micropapillary urothelial variant. It may be helpful in the prognosis evaluation of UV patients after radical cystectomy.
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Affiliation(s)
- Caio Vinícius Suartz
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil.
| | - Maurício Dener Cordeiro
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Luiz Antonio Assan Botelho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Fábio Pescarmona Gallucci
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - David Hamilton Cho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Filipe de Arruda Pessoa
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Flávio Rossi da Silva
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Mateus Silva Santos Costa
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Leonardo Cardili
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - François Audenet
- Division of Urology, Université Paris Cité Faculté de Santé, Paris, France
| | - José Maurício Mota
- Genitourinary Medical Oncology Service, Institute of Cancer of São Paulo State, University of São Paulo, São Paulo, Brazil
| | - Paul Toren
- Division of Urology, Université Laval Faculté de Médecine, Quebec City, Canada
| | - William Carlos Nahas
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
| | - Leopoldo Alves Ribeiro-Filho
- Division of Urology, Institute of Cancer of São Paulo State, University of São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255 Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brazil
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Peyrottes A, Bodard S, Timsit MO, Méjean A, Panthier F, Audenet F. Primary angiosarcoma of the kidney: A challenging diagnosis. Fr J Urol 2024; 34:102609. [PMID: 38460936 DOI: 10.1016/j.fjurol.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/14/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
Angiosarcoma is a rare malignancy derived from endothelial cells, which behaves aggressively. Primary angiosarcoma of the kidney is even rarer, and its clinical and radiological presentations do not differ from clear cells renal cell carcinoma (ccRCC). Management protocols are not standardized, although nephrectomy is usually performed. Subsequent treatments (chemotherapy, radiotherapy, and lately, targeted therapies) vary considerably. Herein, we report the case of a middle-aged patient harboring primary angiosarcoma of the left kidney and discuss its presentation and management in light of current guidelines. The case is described for its rarity and masquerading nature.
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Affiliation(s)
- Arthur Peyrottes
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France.
| | - Sylvain Bodard
- Service d'Imagerie Adulte, Hôpital Necker-Enfants-Malades, AP-HP Centre, Université Paris Cité, Paris, France; Sorbonne Université, CNRS UMR 7371, Inserm U 1146, Laboratoire d'Imagerie Biomédicale (LIB), 75006 Paris, France
| | - Marc-Olivier Timsit
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France
| | - Arnaud Méjean
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France
| | - Frederic Panthier
- Service d'Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - François Audenet
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France
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Suartz CV, Cordeiro MD, de Carvalho PA, Gallucci FP, Ribeiro‐Filho LA, Cardili L, Sivaraman A, Audenet F, Mota JM, Nahas WC. Scoring system for prediction of overall survival in patients with renal cell carcinoma T3aN0M0. BJUI Compass 2024; 5:289-296. [PMID: 38371207 PMCID: PMC10869657 DOI: 10.1002/bco2.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 02/20/2024] Open
Abstract
Objective We aim to create a new score to predict postoperative overall survival in patients with nonmetastatic T3aN0 renal cell carcinoma. Methods We reviewed the clinical data of adult patients who underwent radical nephrectomy for renal cell carcinoma between December 2007 and January 2022 in a single tertiary oncological institution. Clinical characteristics, clinical-pathological staging and histopathological characteristics were analysed. Survival analyses were determined using the Kaplan-Meier curve. A nomogram was established using Cox proportional hazard regression to identify the prognostic factors affecting the overall survival. The area under the curve, calibration curves and decision curve analysis were used to evaluate prognostic efficacy. Results We analyzed 362 patients classified as pT3aN0M0 stage with a median follow-up of 40 months. According to Cox univariate and multivariate analyses, weight loss greater than 5% in 6 months before surgery, stage V chronic kidney disease after radical nephrectomy, sarcomatoid pattern, and coagulative tumor necrosis were identified as predictors of overall survival. We developed a score and performed internal and external validation. The time-dependent receiver operating characteristic curve, area under the curve value and calibration curve analysis showed good prediction ability of the score. The nomogram can effectively predict and stratify overall survival after radical nephrectomy in patients with pT3aN0M0 renal cell carcinoma. Conclusion Patients with pT3aN0MO renal cell carcinoma exhibited different characteristics, and those with unfavourable characteristics deserve greater attention during follow-up. This nomogram provides an accurate prediction of overall survival after radical nephrectomy.
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Affiliation(s)
- Caio Vinícius Suartz
- Department of Urology, Hôpital Européen Georges PompidouUniversité Paris CitéParisFrance
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Maurício Dener Cordeiro
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Paulo Afonso de Carvalho
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Fábio Pescarmona Gallucci
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | | | - Leonardo Cardili
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Arjun Sivaraman
- Department of UrologyWashington University in St. LouisSt. LouisMissouriUSA
| | - François Audenet
- Department of Urology, Hôpital Européen Georges PompidouUniversité Paris CitéParisFrance
| | - José Mauricio Mota
- Genitourinary Medical Oncology Service, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - William Carlos Nahas
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
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Alameda F, Audenet F, Mandron E, Timsit MO, Fontaine E, Pietak M, Mejean A, Hurel S. [CamiCon study: Evaluation of a new tool for automated and connected voiding calendar]. Fr J Urol 2024; 34:102582. [PMID: 38364362 DOI: 10.1016/j.fjurol.2024.102582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/12/2023] [Accepted: 01/04/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION A voiding diary (VD) is a key element in the evaluation of patients with overactive bladder (OAB) at initial presentation and during treatment to assess its effectiveness. In order to be clinically relevant, it must be performed over 3 days according to the International Continence Society (ICS). Unfortunately, some patients find it cumbersome. We aimed to evaluate the reliability and patient satisfaction when using a connected tank device. MATERIAL AND METHOD We conducted a single-center prospective study including 41 patients. Each patient completed a paper voiding diary and then a diary with Diary Pod® (DP) or inversely depending on the study arm. Data from 34 patients were collected. After completion of both diaries, patients completed a satisfaction questionnaire sent by email via GoogleForm. Study statistics were performed with Jamovi® and Excel® software. RESULT Data from 34 patients were analyzed. There was a statically significant difference (P=0.046) between the mean volume calculated from the paper VD and that calculated from the connected VD (DP). There was no statistically significant difference (P=0.112) between the mean number of daytime voids, mean number of nighttime voids (P=0.156), mean water intake (P=0.183) reported on the paper VD and the connected VD. Thirteen (42%) paper VD and 1 connected VD did not include documentation of the presence or absence of urine leakage or urgency. There was no statistically significant difference between the two calendars regarding the presence or absence of urine leakage (P=0.180) and urinary urgency (P=0.564). Eighty-four percent (26/31) preferred the connected tank to the usual method (paper/pen), while 55% (17/31) and 29% (9/31) of the participants respectively answered that the DP was "very definitely" or "definitely" an aid for performing VD. Nevertheless, 39% (12/31) and 55% (17/31) considered its price to be high or fair and only 22% (7/31) were inclined to buy it. CONCLUSION This study showed that the Diary connected reservoir Pod® is a reliable and innovative tool for voiding schedules. It facilitates data collection for the majority of patients (83%) and could, through better patient compliance, provide better quality data and help their interpretation by the physician. These factors could encourage the implementation of the connected voiding diary as a diagnostic tool. It would also be used for the assessment of treatment effectiveness in daily clinical practice as well as in research. Its cost remains a major obstacle, judged by 39% of patients to be too high, and could therefore be proposed in specific situations requiring precise data.
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Affiliation(s)
- Florence Alameda
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - François Audenet
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Eric Mandron
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Marc Olivier Timsit
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Eric Fontaine
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Michel Pietak
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Arnaud Mejean
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Sophie Hurel
- Hopital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Besombes T, Suartz CV, Poinard F, Plassais C, Dariane C, Hurel S, Timsit MO, Mejean A, Audenet F. Should You Fix Testicular Prosthesis? A Satisfaction Survey From a Monocentric Cohort. Urology 2024; 184:278-282. [PMID: 38056509 DOI: 10.1016/j.urology.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To evaluate whether testicular prosthesis should be fixed. METHODS Retrospective monocentric study including 169 patients who had implantation of testicular prosthesis between January 2013 and December 2022. Patients answered a telephone questionnaire regarding prosthesis characteristics and satisfaction. RESULTS Prosthesis was sutured for 59 patients (34.9%) out of 169. 146 patients answered the questionnaire. Satisfaction was excellent regarding size, weight, consistency, and shape. A position too high was a major complain in both groups. Pain and discomfort were significantly higher in the fixed group (30.8% vs 9.78%, P < .001). Few patients reported discomfort with the anchor prosthesis (22.9%). CONCLUSION Overall satisfaction of the prosthesis is high but discomfort and high positioning are the two items remaining to improve. Our study suggests that fixing prosthesis is a cause of discomfort and won't allow a better positioning.
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Affiliation(s)
- Thomas Besombes
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
| | - Caio Vinícius Suartz
- Division of Urology, Instituto do Cancer do Estado de São Paulo, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Florence Poinard
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Caroline Plassais
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Sophie Hurel
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
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8
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Calleris G, Rouprêt M, Seisen T, Bendjeddou L, Chevallier T, Masson-Lecomte A, Thibault C, Neuzillet Y, Audenet F, Xylinas E, Houédé N. Design and rationale of a single-arm phase II study of neoadjuvant Durvalumab and Gemcitabine associated with Cisplatin or Carboplatin for upper urinary tract urothelial cancer: the iNDUCT trial (NCT04617756). World J Urol 2023; 41:3413-3420. [PMID: 37698632 DOI: 10.1007/s00345-023-04596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Upper urinary tract urothelial carcinoma (UTUC) is often locally advanced at initial diagnosis and is associated with high recurrence and mortality rates after radical nephroureterectomy (RNU). Adjuvant platinum-based chemotherapy has shown a recurrence-free survival benefit in a randomised phase III trial, while neoadjuvant treatment seems promising in retrospective series. On the contrary, little is known about the role of perioperative immunotherapy and its combination with chemotherapy for UTUC patients, although initial positive results have been published for muscle-invasive bladder cancer. STUDY DESIGN AND ENDPOINTS Against this backdrop, we are running a multi-centre single-arm phase 2 trial of neoadjuvant Durvalumab, a monoclonal antibody targeting programmed cell death ligand 1, combined with Gemcitabine and Cisplatin or Carboplatin for high-risk UTUC patients. The primary outcome is pathological complete response rate at RNU. Secondary endpoints include the partial pathological response rate, safety, as well as disease-free and overall survival. A biomarker analysis is also planned. PATIENTS AND INTERVENTIONS Included patients must have a good performance status and harbour a non-metastatic UTUC, considered at high risk of progression, defined as either biopsy-proven high-grade disease or invasive features at imaging with or, more recently, without high-grade cytology at the multidisciplinary team discretion, as specified in the latest amendment. Enrolled patients receive 3 cycles of neoadjuvant immuno-chemotherapy before RNU, and the standard of care thereafter. The trial is registered as NCT04617756 and is supervised by an independent data monitoring committee.
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Affiliation(s)
- Giorgio Calleris
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013, Paris, France
- Department of Surgical Sciences, Urology, University of Turin, Turin, Italy
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013, Paris, France.
| | - Thomas Seisen
- GRC 5 Predictive Onco-Urology Research Group and Urology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75013, Paris, France
| | - Lyamin Bendjeddou
- Research and Innovation Department, Nimes University Hospital, 30029, Nimes, France
| | - Thierry Chevallier
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), Nimes University Hospital, 30029, Nimes, France
- UMR 1302, Institute Desbrest of Epidemiology and Public Health, INSERM, Univ. Montpellier, Montpellier, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, 75010, Paris, France
| | - Constance Thibault
- Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris, Hopital Européen Georges Pompidou, Paris, France
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Evanguelos Xylinas
- Service d'Urologie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nadine Houédé
- Gard Cancer Institute, Nimes University Hospital, University of Montpellier, 30029, Nimes, France
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9
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Lehrer R, Cornelis F, Bernhard JC, Bigot P, Champy C, Bruyère F, Rouprêt M, Doumerc N, Bensalah CK, Olivier J, Audenet F, Tricard T, Parier B, Durand X, Durand M, Charles T, Branger N, Surlemont L, Xylinas E, Beauval JB, Barral M. Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation. Eur Radiol 2023; 33:8426-8435. [PMID: 37466710 DOI: 10.1007/s00330-023-09975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. MATERIALS AND METHODS Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared. RESULTS A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88-5.5; p = 0.09; HR 2.1; 95% CI 0.86-5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87-12.72; p = 0.08). CONCLUSION Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. CLINICAL RELEVANCE STATEMENT Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. KEY POINTS • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.
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Affiliation(s)
- Raphaël Lehrer
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
- Department of Interventional Radiology, Sorbonne Université, Paris, France
| | - Francois Cornelis
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Jean-Christophe Bernhard
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Bigot
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Angers University Hospital, Angers, France
| | - Cécile Champy
- Department of Urology, University Hospital Henri Mondor, AP-HP, Créteil, France
- INSERM, U1430, Henri Mondor University Hospital, AP-HP, 94000, Creteil, France
| | - Franck Bruyère
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Tours University Hospital, Tours, France
| | - Morgan Rouprêt
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Nicolas Doumerc
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, University Hospital Rangueil, Toulouse, France
| | - Charles-Karim Bensalah
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - François Audenet
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Bastien Parier
- Department of Urology, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Xavier Durand
- Department of Urology, Paris Saint-Joseph Hospital, Paris, France
| | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice, France
- INSERM U1081 - CNRS, UMR 7284, Université de Nice Côte d'Azur, Nice, France
| | - Thomas Charles
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Louis Surlemont
- Department of Urology, Rouen University Hospital, Rouen, France
| | - Evanguelos Xylinas
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Jean-Baptiste Beauval
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Matthias Barral
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France.
- Department of Interventional Radiology, Sorbonne Université, Paris, France.
- Service d'Imagerie Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Sorbonne Université, AP-HP, 4 rue de la chine, 75020, Paris, France.
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10
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Lorette M, Bernhard JC, Bensalah CK, Bigot P, Villers A, Letouche ML, Doumerc N, Paparel P, Audenet F, Nouhaud FX, Parier B, Tricard T, Champy C, Brenier M, Pignot G, Long JA, Durand M, Vallee M, Waeckel T, Boissier R, Tambwe R, Ouzaid I, Olivier J, Khene ZE. Nephrometry scores to predict oncological outcomes following partial nephrectomy (UroCCR Study 70). World J Urol 2023; 41:3559-3566. [PMID: 37792008 DOI: 10.1007/s00345-023-04633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE Partial nephrectomy (PN) for large or complex renal tumors can be difficult and associated with a higher risk of recurrence than radical nephrectomy. We aim to evaluate the clinical useful of nephrometry scores for predicting oncological outcomes in a large cohort of patients who underwent PN for renal cell carcinomas. METHODS Our analysis included patients who underwent PN for renal cell carcinoma in 21 French academic centers (2010-2020). RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Uni- and multivariate cox models were performed to identify predictors of recurrence-free survival and overall survival. The area under the curve (AUC) was used to identify models with the highest discrimination. Decision curve analyses (DCAs) determined the net benefit associated with their use. RESULTS A total of 1927 patients were analyzed with a median follow-up of 32 months (14-45). RENAL score (p = 0.01), age (p = 0.002), histological type (p = 0.001), high nuclear grade (p = 0.001), necrotic component (p < 0.001), and positive margins (p = 0.005) were significantly related to recurrence in multivariate analyses. The discriminative performance of the 3 radiological scores was modest (65, 63, and 63%, respectively). All 3 scores showed good calibration, which, however, deteriorated with time. Decision curve analysis of the three models for the prediction of overall and recurrence-free survival was similar for all three scores and of limited clinical relevance. CONCLUSION The association between nephrometry scores and oncological outcomes after NP is very weak. The use of these scores for predicting oncological outcomes in routine practice is therefore of limited clinical value.
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Affiliation(s)
- Martin Lorette
- Department of Urology, Lille University Hospital, Lille, France.
- Service d'Urologie, Hôpital Claude Huriez, Rue Michel Polonowski, 59037, Lille, France.
| | | | | | - Pierre Bigot
- Department of Urology, University Hospital, Angers, France
| | - Arnauld Villers
- Department of Urology, Lille University Hospital, Lille, France
- Department of Urology, University Hospital, Lille, France
| | | | - Nicolas Doumerc
- Department of Urology, University Hospital of Rangueil, Toulouse, France
| | | | - François Audenet
- Department of Urology, Georges Pompidou European University Hospital, Paris, France
| | | | - Bastien Parier
- Department of Urology, Kremlin Bicetre University Hospital, Paris, France
| | | | - Cécile Champy
- Department of Urology, Mondor University Hospital, Créteil, France
| | - Martin Brenier
- Department of Urology, St Joseph Hospital, Paris, France
| | - Géraldine Pignot
- Department of Urology, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Maxime Vallee
- Department of Urology, University Hospital, Poitiers, France
| | | | - Romain Boissier
- Department of Urology, University Hospital, Marseille, France
| | - Ricky Tambwe
- Department of Urology, University Hospital, Reims, France
| | - Idir Ouzaid
- Department of Urology, Bichat University Hospital, Paris, France
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11
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Klein C, Margue G, Champy C, Parier B, Waeckel T, Bensalah K, Olivier J, Doumerc N, Audenet F, Branger N, Roupret M, Surlemont L, Bruyere F, Durand X, Durand M, Long JA, Gaillard V, Xylinas E, Vallee M, Rouget B, Bigot P, Bernhard JC. Can Simplified PADUA Renal (SPARE) Nephrometry scoring system help predict renal function outcomes after robot-assisted partial nephrectomy? (UroCCR study 93). Minerva Urol Nephrol 2023; 75:569-576. [PMID: 37728493 DOI: 10.23736/s2724-6051.23.05324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The SPARE Nephrometry Score (NS) is described as easier to implement than the RENAL and PADUA NSs, currently more widely used. Our objective was to compare the accuracy of SPARE NS in predicting renal function outcomes following RAPN. METHODS A multicentric retrospective study was conducted using French kidney cancer network (UroCCR, NCT03293563) database. All patients included had RAPN for cT1 renal tumors between May 2010 and March 2021. SPARE was compared to RENAL, PADUA and Tumor Size to predict postoperative acute kidney injury (AKI), chronic kidney disease (CKD) upstaging, de novo CKD at 3-6 months follow-up and Trifecta failure. The ability of the different NSs and tumor size to predict renal function outcomes was evaluated using uni- and multivariate logistic regression models. RESULTS According to our study criteria, 1171 patients were included. Mean preoperative tumor size and estimated glomerular filtration rate (eGFR) were 3.4±1.4 cm and 85.8 mL/min/1.73 m2. In total, 266 (22.7%), 87 (7.4%), 94 (8%), and 624 (53.3%) patients had AKI, de novo CKD, CKD upstaging, and Trifecta failure, respectively. In multivariate analysis, all three NSs and tumor size were independent predictors of AKI, CKD de novo, CKD upgrade and Trifecta failure. There was no significant difference between all three NS and tumor sizes in predicting renal function outcomes. CONCLUSIONS SPARE Score seems to be a valid alternative to predict renal function outcomes after RAPN. Nevertheless, in our study, tumor size was as accurate as NSs in predicting postoperative outcomes and, therefore, seems to be the logical choice for surgical decisions.
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Affiliation(s)
- Clément Klein
- Department of Urology, University Hospital of Bordeaux, Bordeaux, France -
| | - Gaelle Margue
- Department of Urology, University Hospital of Bordeaux, Bordeaux, France
| | - Cécile Champy
- Department of Urology, Henri Mondor Hospital, Paris, France
| | - Bastien Parier
- Department of Urology, Kremlin Bicêtre Hospital, Paris, France
| | - Thibaut Waeckel
- Department of Urology, Caen University Hospital, Caen, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Jonathan Olivier
- Department of Urology, University Hospital of Lille, Lille, France
| | - Nicolas Doumerc
- Department of Urology, University Hospital of Toulouse, Toulouse, France
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
| | - François Audenet
- Department of Urology, European Georges Pompidou Hospital, Paris, France
| | - Nicolas Branger
- Department of Urology, Paoli Calmettes Institute, Marseille, France
| | - Morgan Roupret
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
- Department of Urology, La Pitié Salpêtrière Hospital, Paris, France
| | - Louis Surlemont
- Department of Urology, University Hospital of Rouen, Rouen, France
| | - Franck Bruyere
- Department of Urology, University Hospital of Tours, Tours, France
| | - Xavier Durand
- Department of Urology, Saint Joseph Hospital, Paris, France
| | - Mathieu Durand
- Department of Urology, University Hospital of Nice, Nice, France
| | | | - Victor Gaillard
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Maxime Vallee
- Department of Urology, University Hospital of Poitiers, Poitiers, France
| | - Benjamin Rouget
- Department of Urology, Hospital of Libourne, Libourne, France
| | - Pierre Bigot
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
- Department of Urology, University Hospital of Angers, Angers, France
| | - Jean-Christophe Bernhard
- Department of Urology, University Hospital of Bordeaux, Bordeaux, France
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
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12
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Peyrottes A, Chicaud M, Fourniol C, Doizi S, Timsit MO, Méjean A, Yonneau L, Lebret T, Audenet F, Traxer O, Panthier F. Clinical Reproducibility of the Stone Volume Measurement: A "Kidney Stone Calculator" Study. J Clin Med 2023; 12:6274. [PMID: 37834918 PMCID: PMC10573675 DOI: 10.3390/jcm12196274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND An accurate estimation of the stone burden is the key factor for predicting retrograde intra-renal surgical outcomes. Volumetric calculations better stratify stone burden than linear measurements. We developed a free software to assess the stone volume and estimate the lithotrity duration according to 3D-segmented stone volumes, namely the Kidney Stone Calculator (KSC). The present study aimed to validate the KSC's reproducibility in clinical cases evaluating its inter-observer and intra-observer correlations. METHODS Fifty patients that harbored renal stones were retrospectively selected from a prospective cohort. For each patient, three urologists with different experience levels in stone management made five measurements of the stone volume on non-contrast-enhanced computed tomography (NCCT) images using the KSC. RESULTS the overall inter-observer correlation (Kendall's concordance coefficient) was 0.99 (p < 0.0001). All three paired analyses of the inter-observer reproducibility were superior to 0.8. The intra-observer variation coefficients varied from 4% to 6%, and Kendall's intra-observer concordance coefficient was found to be superior to 0.98 (p < 0.0001) for each participant. Subgroup analyses showed that the segmentation of complex stones seems to be less reproductible. CONCLUSIONS The Kidney Stone Calculator is a reliable tool for the stone burden estimation. Its extension for calculating the lithotrity duration is of major interest and could help the practitioner in surgical planning.
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Affiliation(s)
- Arthur Peyrottes
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (A.P.); (M.C.); (S.D.); (O.T.)
- Service D’Urologie, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris-Cité, 20 rue Leblanc, 75015 Paris, France; (C.F.); (M.-O.T.); (A.M.); (F.A.)
| | - Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (A.P.); (M.C.); (S.D.); (O.T.)
- Service D’Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
- PIMM Laboratory, UMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
- Service d’Urologie, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Cyril Fourniol
- Service D’Urologie, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris-Cité, 20 rue Leblanc, 75015 Paris, France; (C.F.); (M.-O.T.); (A.M.); (F.A.)
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (A.P.); (M.C.); (S.D.); (O.T.)
- Service D’Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
- PIMM Laboratory, UMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
| | - Marc-Olivier Timsit
- Service D’Urologie, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris-Cité, 20 rue Leblanc, 75015 Paris, France; (C.F.); (M.-O.T.); (A.M.); (F.A.)
| | - Arnaud Méjean
- Service D’Urologie, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris-Cité, 20 rue Leblanc, 75015 Paris, France; (C.F.); (M.-O.T.); (A.M.); (F.A.)
| | - Laurent Yonneau
- Service d’Urologie, Hôpital Foch-Université Paris Saclay-UVSQ, 40 rue Worth, 92150 Suresnes, France; (L.Y.); (T.L.)
| | - Thierry Lebret
- Service d’Urologie, Hôpital Foch-Université Paris Saclay-UVSQ, 40 rue Worth, 92150 Suresnes, France; (L.Y.); (T.L.)
| | - François Audenet
- Service D’Urologie, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris-Cité, 20 rue Leblanc, 75015 Paris, France; (C.F.); (M.-O.T.); (A.M.); (F.A.)
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (A.P.); (M.C.); (S.D.); (O.T.)
- Service D’Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
- PIMM Laboratory, UMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
| | - Frederic Panthier
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (A.P.); (M.C.); (S.D.); (O.T.)
- Service D’Urologie, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris-Cité, 20 rue Leblanc, 75015 Paris, France; (C.F.); (M.-O.T.); (A.M.); (F.A.)
- Service D’Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
- PIMM Laboratory, UMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
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Fourniol C, Dariane C, Correas J, Audenet F, Pinar U, Anract J, Hostettler A, Panthier F, Timsit MO, Mejean A. Volumetric and functional outcomes at 1-year between percutaneous-ablation and partial-nephrectomy for T1b renal tumors. Prog Urol 2023; 33:509-518. [PMID: 37633733 DOI: 10.1016/j.purol.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Indication for percutaneous-ablation (PA) is gradually expanding to renal tumors T1b (4-7cm). Few data exist on the alteration of renal functional volume (RFV) post-PA. Yet, it is a surrogate marker of post partial-nephrectomy (PN) glomerular filtration rate (GFR) impairment. The objective was to compare RFV and GFR at 1-year post-PN or PA, in this T1b population. METHODS Patients with unifocal renal tumor≥4cm treated between 2014 and 2019 were included. Tumor, homolateral (RFVh), contralateral RFV, and total volumes were assessed by manual segmentation (3D Slicer) before and at 1 year of treatment, as was GFR. The loss of RFV, contralateral hypertrophy, and preservation of GFR were compared between both groups (PN vs. PA). RESULTS 144 patients were included (87PN, 57PA). Preoperatively, PA group was older (74 vs. 59 years; P<0.0001), had more impaired GFR (73 vs. 85mL/min; P=0.0026) and smaller tumor volume(31.1 vs. 55.9cm3; P=0.0007) compared to PN group. At 1 year, the PN group had significantly more homolateral RFV loss (-19 vs. -14%; P=0.002), and contralateral compensatory hypertrophy (+4% vs. +1,8%; P=0.02, respectively). Total-RFV loss was similar between both (-21.7 vs. -19cm3; P=0.07). GFR preservation was better in the PN group (95.9 vs. 90.7%; P=0.03). In multivariate analysis, age and tumor size were associated with loss of RFVh. CONCLUSION For renal tumors T1b, PN is associated with superior compensatory hypertrophy compared with PA, compensating for the higher RFVh loss, resulting in similar ΔRFV-total between both groups. The superior post-PN GFR preservation suggests that the preserved quantitative RFV factor is insufficient. Therefore, the underlying quality of the parenchyma would play a major role in postoperative GFR.
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Affiliation(s)
- C Fourniol
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - C Dariane
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Correas
- Service de radiologie adulte, hôpital Necker-Enfants-Malades, AP-HP, centre, université de Paris, 245, rue de Sèvres, 75015 Paris, France
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - U Pinar
- Service d'urologie, hôpital Pitié-Salpêtrière, AP-HP-centre, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Anract
- Service d'urologie, hôpital Cochin, AP-HP-centre, université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Hostettler
- Département de recherche et développement, IRCAD France, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F Panthier
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Mejean
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
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14
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Margue G, Ingels A, Bensalah K, Doumerc N, Vaessen C, Roupret M, Audenet F, Mejean A, Bruyere F, Olivier J, Baumert H, Michel C, Paparel P, Parier B, Sebe P, Long JA, Lang H, Lebret T, Patard JJ, Bernhard JC. Late complications and 5 years outcomes of robotic partial nephrectomy in France: prospective assessment in the French Kidney Cancer Research Network (UroCCR 10). World J Urol 2023; 41:2281-2288. [PMID: 37407720 DOI: 10.1007/s00345-023-04491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To describe the practice of robotic-assisted partial nephrectomy (RAPN) in France and prospectively assess the late complications and long-term outcomes. METHODS Prospective, multicenter (n = 16), observational study including all patients diagnosed with a renal tumor who underwent RAPN. Preoperative, intraoperative, postoperative, and follow-up data were collected and stored in the French research network for kidney cancer database (UroCCR). Patients were included over a period of 12 months, then followed for 5 years. RESULTS In total, 466 patients were included, representing 472 RAPN. The mean tumor size was 3.4 ± 1.7 cm, most of moderate complexity (median PADUA and RENAL scores of 8 [7-10] and 7 [5-9]). Indication for nephron-sparing surgery was relative in 7.1% of cases and imperative in 11.8%. Intraoperative complications occurred in 6.8% of patients and 4.2% of RAPN had to be converted to open surgery. Severe postoperative complications were experienced in 2.3% of patients and late complications in 48 patients (10.3%), mostly within the first 3 months and mainly comprising vascular, infectious, or parietal complications. At 5 years, 29 patients (6.2%) had chronic kidney disease upstaging, 21 (4.5%) were diagnosed with local recurrence, eight (1.7%) with contralateral recurrence, 25 (5.4%) with metastatic progression, and 10 (2.1%) died of the disease. CONCLUSION Our results reflect the contemporary practice of French expert centers and is, to our knowledge, the first to provide prospective data on late complications associated with RAPN. We have shown that RAPN provides good functional and oncologic outcomes while limiting short- and long-term morbidity. TRIAL REGISTRATION NCT03292549.
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Affiliation(s)
- Gaëlle Margue
- Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France.
| | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, APHP, Paris, France
| | - Karim Bensalah
- Urology Department, Rennes University Hospital, Rennes, France
| | - Nicolas Doumerc
- Urology Department, Toulouse University Hospital, Toulouse, France
| | | | - Morgan Roupret
- Urology Department, Pitié-Saplétrière Hospital, APHP, Paris, France
| | - François Audenet
- Urology Department, European Georges Pompidou Hospital, Paris, France
| | - Arnaud Mejean
- Urology Department, European Georges Pompidou Hospital, Paris, France
| | - Franck Bruyere
- Urology Department, Tours University Hospital, Tours, France
| | | | - Hervé Baumert
- Urology Department, Saint Joseph Hospital, Paris, France
| | | | | | - Bastien Parier
- Urology Department, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Philippe Sebe
- Urology Department, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | | | - Hervé Lang
- Urology Department, Strasbourg University Hospital, Strasbourg, France
| | - Thierry Lebret
- Urology Department, Foch Hospital, Paris Saclay University, Suresnes, France
| | | | - Jean-Christophe Bernhard
- Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France
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15
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Soorojebally Y, Neuzillet Y, Lebret T, Allory Y, Descotes F, Ferlicot S, Kassab-Chahmi D, Lamy PJ, Oudard S, Rébillard X, Roy C, Roumiguié M, Rouprêt M, Audenet F. Photodynamic cystoscopy for bladder cancer diagnosis and for NMIBC follow-up: An overview of systematic reviews and meta-analyses. Prog Urol 2023; 33:307-318. [PMID: 37088584 DOI: 10.1016/j.purol.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Currently, bladder cancer detection is based on cytology and cystoscopy. White light cystoscopy (WLC) is an invasive procedure and may under-detect flat lesions. Blue light cystoscopy (BLC) and narrow band imaging (NBI) cystoscopy are new modalities that could improve the detection of non-muscle invasive bladder cancer (NMIBC) and its recurrence or progression to muscle invasive bladder cancer. We present a systematic review on BLC and NBI cystoscopy for bladder cancer diagnosis and NMIBC follow-up. MATERIAL AND METHODS All available systematic reviews and meta-analyses on cystoscopy published in PubMed® between May 2010 and March 2021 were identified and reviewed. The main endpoints were clinical performance for bladder cancer diagnosis and for recurrence or progression detection during NMIBC follow-up, and additional value compared with cytology and/or WLC. RESULTS Most of the meta-analyses and systematic reviews published suggest a better sensitivity of BLC and NBI cystoscopy compared to WLC, particularly for the detection of flat lesions (CIS). NBI- and BLC-guided TURBT could decrease the recurrence rates. However, their clinical utility to reduce progression rate and increase survival is still unclear. CONCLUSIONS BLC and NBI cystoscopy are efficient techniques for bladder cancer diagnosis and NMIBC follow-up. However, their clinical benefit remains to be confirmed.
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Affiliation(s)
- Y Soorojebally
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Y Neuzillet
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - T Lebret
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Y Allory
- Department of pathology, Institut Curie, Saint-Cloud, France
| | - F Descotes
- Biochemistry, biology and pathology centre South, Hospices civils de Lyon (HCL), Université Claude-Bernard Lyon I, Pierre-Bénite, France
| | - S Ferlicot
- Service d'anatomie pathologique, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | | | - P-J Lamy
- Biopathologie et génétique des cancers, Institut médical d'analyse génomique, Imagenome, Inovie, Montpellier, France
| | - S Oudard
- Department of medical oncology, Hôpital européen Georges-Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - X Rébillard
- Urology Department, Beausoleil Private Hospital, Montpellier, France
| | - C Roy
- Department of radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, France
| | - M Roumiguié
- Department of urology, andrology and renal transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse cedex, France
| | - M Rouprêt
- Sorbonne University, GRC 5 predictive Onco-Uro, Urology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - F Audenet
- Department of urology, Hôpital européen Georges-Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
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Guillaume Z, Allory Y, Auclin E, Gervais C, Auvray M, Rochand A, Mejean A, Audenet F, Vano YA, Oudard S, Thibault C. [Collecting duct carcinoma and renal medullary carcinoma in the age of new therapies]. Bull Cancer 2023; 110:450-462. [PMID: 36906403 DOI: 10.1016/j.bulcan.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
Collecting duct carcinoma (also known as Bellini tumour) and renal medullary carcinoma are two extremely rare and aggressive renal cancers. They are both less responsive to conventional treatments used in clear cell renal carcinoma. There are very few studies evaluating their optimal management and currently, at the metastatic stage, polychemotherapy based on platinum salts remains the most widely used. The emergence of new treatments such as anti-angiogenic TKIs, immunotherapy or treatments targeting specific genetic abnormalities, opens up a new field of possibilities in the management of these cancers. The evaluation of the response to these treatments is therefore essential. In this article, we will review the status of their management and the various studies that have evaluated recent treatments in these two cancers.
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Affiliation(s)
- Zoé Guillaume
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | | | - Edouard Auclin
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Claire Gervais
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Marie Auvray
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Adrien Rochand
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Arnaud Mejean
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - François Audenet
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Yann-Alexandre Vano
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Stéphane Oudard
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Constance Thibault
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France.
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17
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Thillou D, Timsit MO, Panthier F, Hurel S, Amrouche L, Anglicheau D, Méjean A, Audenet F. End-to-side versus end-to-end uretero-ureteral anastomosis in preemptive kidney transplantation from living donors: A monocentric experience. Prog Urol 2023; 33:118-124. [PMID: 36774268 DOI: 10.1016/j.purol.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/22/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE End-to-end (ETE) pyeloureterostomy is an alternative to ureteroneocystostomy for urinary anastomosis during kidney transplantation (KT). In preemptive KT from living donors (PKT-LD), end-to-side (ETS) uretero-ureteral anastomosis could have the benefits of pyeloureterostomy without ligation of the native kidney ureter. This study aimed to compare ETS to ETE uretero-ureteral anastomosis in PKT-LD. METHODS A monocentric retrospective 8-year study included all consecutive cases of PKT-LD, excluding ureteroneocystomy anastomosis and homolateral nephrectomy. Two groups were compared: ETS and ETE. Perioperative data on graft function and urological complications were collected. RESULTS One hundred and six patients were included: 48 patients in the ETS group and 58 patients in the ETE group. Median follow-up was 37.5 months [17.3; 57.5]. The estimated glomerular filtration rate at postoperative day ten and 3 months was similar in both groups. The overall complication rate was 16%, with no significant difference between the 2 groups. There was one ureteral stenosis in each group. None of the patients in the ETS group presented urinary fistula, whereas it occurred in one (1.7%) in the ETE group. Back pain due to native kidney obstruction occurred in 5 patients in the ETE group (8.6%), but not in the ETS group. CONCLUSION In preemptive kidney transplantation from living donors, urinary anastomosis can safely be performed as an end-to-side uretero-ureteral anastomosis, with low urological complications. It could prevent symptoms and complications due to native kidney obstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- D Thillou
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - F Panthier
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - S Hurel
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - L Amrouche
- Department of Nephrology and Kidney Transplantation, Hôpital Necker, AP-HP, Centre-Université Paris Cité, France
| | - D Anglicheau
- Department of Nephrology and Kidney Transplantation, Hôpital Necker, AP-HP, Centre-Université Paris Cité, France
| | - A Méjean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France
| | - F Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université Paris Cité, 20 rue Leblanc, 75015 Paris, France.
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18
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Benichou Y, Audenet F, Bensalah K, Roupret M, Paparel P, Lebacle C, Bruyère F, Beauval JB, Villers A, Lang H, Durand X, Bigot P, Long JA, Champy C, Lavolle A, Bernhard JC, Alezra E. Partial nephrectomy in solitary kidneys: comparison between open surgery and robotic-assisted laparoscopy on perioperative and functional outcomes (UroCCR-54 study). World J Urol 2023; 41:315-324. [PMID: 35723688 DOI: 10.1007/s00345-022-04026-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The management of solitary kidney tumors is a surgical challenge, requiring irreproachable results on both oncological and functional outcomes. The goal of our study was to compare the perioperative results of robotic-assisted partial nephrectomy (RAPN) to open surgery in this indication. METHODS We led a multicentric study based on the prospectively maintained French national database UroCCR. Patients who underwent partial nephrectomy on a solitary kidney between 1988 and 2020 were included. Clinical and pathological data were retrospectively analyzed. The main outcome of the study was the analysis of the variation of the estimated glomerular filtration rate (eGFR) calculated according to MDRD at 3, 6, 12, and 24 months depending on the chosen surgical approach. The secondary outcomes were the comparison of Trifecta success, perioperative complications, and length of hospital stay. RESULTS In total, 150 patients were included; 68 (45%) in the RAPN group and 82 (55%) in the open surgery group. The two groups were comparable for all data. The variation of eGFR at 3, 6, 12, or 24 months was comparable without any significant difference between the 2 groups (p = 0.45). Trifecta was achieved in 40% of the patients in the RAPN group and 33% in the open group (p = 0.42). A significant difference was observed for the length of stay, 5 days for the robot group versus 9 days for the open surgery group (p < 0.0001). CONCLUSION In our study, the surgical approach did not modify functional results and we noted a significant decrease in hospital stay and complications in the RAPN group. RAPN is a safe and efficient method for management of kidney tumors in solitary kidneys.
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Affiliation(s)
- Ygal Benichou
- Urology Department of Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - François Audenet
- Urology Department of Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | | | - Morgan Roupret
- Urology Department of La Pitié-Salpétrière, Paris, France
| | | | - Cedric Lebacle
- Urology Department of Le Kremlin-Bicètre, Le Kremlin Bicetre, France
| | | | | | | | - Hervé Lang
- Urology Department of Strasbourg, Strasbourg, France
| | | | - Pierre Bigot
- Urology Department of Angers, Angers Cedex 9, France
| | | | | | | | | | - Eric Alezra
- Urology Department of Bordeaux, Bordeaux, France
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19
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Audenet F, Neuzillet Y, Rouprêt M. [Photodynamic-guided transurethral resection: Uncertainties brought to light]. Prog Urol 2023; 33:56-57. [PMID: 36610848 DOI: 10.1016/j.purol.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Affiliation(s)
- F Audenet
- Comité de cancérologie de l'Association française d'urologie (CC-AFU), Maison de l'Urologie, 11 rue Viète, 75017 Paris, France.
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie (CC-AFU), Maison de l'Urologie, 11 rue Viète, 75017 Paris, France
| | - M Rouprêt
- Comité de cancérologie de l'Association française d'urologie (CC-AFU), Maison de l'Urologie, 11 rue Viète, 75017 Paris, France
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- Comité de cancérologie de l'Association française d'urologie (CC-AFU), Maison de l'Urologie, 11 rue Viète, 75017 Paris, France
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20
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Branger N, Bigot P, Pignot G, Lorusso V, Audenet F, Parier B, Doumerc N, Brenier M, Xylinas E, Boissier R, Rouprêt M, Champy C, Nouhaud FX, Lang H, Charles T, Mallet R, Ambrosetti D, Bensalah K, Bernhard JC. Oncocytoma on renal mass biopsy: is it still the same histology when surgery is performed? Results from UroCCR-104 study. World J Urol 2023; 41:483-489. [PMID: 36633650 DOI: 10.1007/s00345-022-04261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To describe clinical features of patients with oncocytoma on renal biopsy (RMB), correlation with final histology on surgically treated patients, and predictive factors of discrepancy between RMB and final histology. METHODS This was a retrospective study conducted in the framework of the UroCCR project (NCT03293563). All tumors with oncocytoma on RMB were selected and all pathological reports were reviewed. Patients with the RMB simultaneously performed with a focal treatment, synchronous bilateral tumors and ambiguous RMB report were excluded. Discrepancy between RMB and definitive histology was evaluated using a uni- and multivariable logistic regression analyses model. RESULTS Overall, 119 tumors with oncocytoma on RMB, from 15 centers, were included. Of those, 54 (45.4%) had upfront surgery and 65 (54.6%) had active surveillance (AS). In renal masses with initial active surveillance, with a median follow-up of 28 months, 23 (19.3%) underwent surgery, 4 (3.4%) received focal treatment and 38 (31.9%) remained on AS. On final pathology, only 51 of the 75 surgically treated tumors (68.0%) had oncocytoma, while 24 presented malignant tumors (mainly chromophobe carcinoma (19.2%), and hybrid oncocytic/chromophobe tumor (HOCT) (6.8%)) leading to a discrepancy of 32.0% between RMB and final pathology. The only predictive factor of a discrepancy between RMB and definitive histology was a biopsy done outside of the center (Odds ratio: 3.22 [95%-confidence interval: 1.08-9.61], p = 0.03). CONCLUSION Despite the increase of RMB in more and more centers, histologic discrepancy between RMB and definitive histology remains significant. This information should be discussed with patients and taken into consideration before treatment decision.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France.
| | - Pierre Bigot
- Department of Urology, CHU Angers, Angers, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - Vito Lorusso
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | - François Audenet
- Department of Urology, Hopital Européen Georges Pompidou, Paris, France
| | | | | | - Martin Brenier
- Department of Urology, Hopital Saint-Joseph, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris Cité University, Paris, France
| | | | - Morgan Rouprêt
- Department of Urology, La Pitié Salpêtrière, Paris, France
| | - Cecile Champy
- Department of Urology, Hopital Henri Mondor, Créteil, France
| | | | - Hervé Lang
- Department of Urology, CHU Strasbourg, Strasbourg, France
| | | | - Richard Mallet
- Department of Urology, Polyclinique Francheville, Périgueux, France
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Vaillant V, Roumiguié M, Lévy S, Pradère B, Peyromaure M, Duquesne I, De La Taille A, Lebâcle C, Panis A, Traxer O, Leon P, Hulin M, Xylinas E, Audenet F, Seisen T, Rouprêt M, Loriot Y, Allory Y, Neuzillet Y, Masson-Lecomte A. Oncological outcomes of distal ureterectomy for high risk urothelial carcinoma: A multicenter study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Klein C, Bensalah K, Champy C, Bensalah K, Champy C, Olivier J, Doumerc N, Audenet F, Branger N, Roupret M, Surlemont L, Bruyere F, Durand X, Parier B, Durand M, Waeckel T, Rouget B, Gaillard V, Xylinas E, Vallee M, Long J, Bernhard J. Does Simplified PADUA Renal (SPARE) Nephrometry scoring system can help predicting renal function outcomes after Robot-Assisted Partial Nephrectomy (RAPN) (UroCCR study 93)? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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23
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Soorojebally Y, Neuzillet Y, Roumiguié M, Lamy PJ, Allory Y, Descotes F, Ferlicot S, Kassab-Chahmi D, Oudard S, Rébillard X, Roy C, Lebret T, Rouprêt M, Audenet F. Urinary biomarkers for bladder cancer diagnosis and NMIBC follow-up: a systematic review. World J Urol 2023; 41:345-359. [PMID: 36592175 DOI: 10.1007/s00345-022-04253-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bladder cancer detection and follow-up is based on cystoscopy and/or cytology, but it remains imperfect and invasive. Current research focuses on diagnostic biomarkers that could improve bladder cancer detection and follow-up by discriminating patients at risk of aggressive cancer who need confirmatory TURBT (Transurethral Resection of Bladder Tumour) from patients at no risk of aggressive cancer who could be spared from useless explorations. OBJECTIVE To perform a systematic review of data on the clinical validity and clinical utility of eleven urinary biomarkers (VisioCyt®, Xpert®Bladder, BTA stat®, BTA TRAK™, NMP22 BC®, NMP22® BladderChek® Test, ImmunoCyt™/uCyt1+™, UroVysion Bladder Cancer Kit®, Cxbladder, ADXBLADDER, Urodiag®) for bladder cancer diagnosis and for non-muscle invasive bladder cancer (NMIBC) follow-up. METHODS All available studies on the 11 biomarkers published between May 2010 and March 2021 and present in MEDLINE® were reviewed. The main endpoints were clinical performance for bladder cancer detection, recurrence or progression during NMIBC monitoring, and additional value compared to cytology and/or cystoscopy. RESULTS Most studies on urinary biomarkers had a prospective design and high level of evidence. However, their results should be interpreted with caution given the heterogeneity among studies. Most of the biomarkers under study displayed higher detection sensitivity compared with cytology, but lower specificity. Some biomarkers may have clinical utility for NMIBC surveillance in patients with negative or equivocal cystoscopy or negative or atypical urinary cytology findings, and also for recurrence prediction. CONCLUSION Urinary biomarkers might have a complementary place in bladder cancer diagnosis and NMIBC surveillance. However, their clinical benefit remains to be confirmed.
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Affiliation(s)
- Yanish Soorojebally
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Pierre-Jean Lamy
- Biopathologie et Génétique des Cancers, Institut Médical d'Analyse Génomique, Imagenome, Inovie, Montpellier, France
| | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France
| | - Françoise Descotes
- Biochemistry, Biology and Pathology Center South, Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon I, Pierre-Bénite, France
| | - Sophie Ferlicot
- Service d'Anatomie Pathologique, AP-HP,, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | | | - Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Xavier Rébillard
- Urology Department, Beausoleil Private Hospital, Montpellier, France
| | - Catherine Roy
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, France
| | - Thierry Lebret
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, Sorbonne University, F-75013, Paris, France
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
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24
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de Ponthaud C, Roupret M, Vernerey D, Audenet F, Brouquet A, Cotte E, Cuvillier X, Kanso F, Meurette G, Ledaguenel P, Maggiori L, Neuzillet Y, Ouaissi M, Roumiguié M, Phé V, Vuong NS, Parc Y, Lefèvre JH. StomaCare: quality of life impact after enhanced follow-up of ostomy patients by a home healthcare nursing service-a multicentre, randomized, controlled trial. Colorectal Dis 2023; 25:128-143. [PMID: 36128685 PMCID: PMC10091978 DOI: 10.1111/codi.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/17/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
AIM A stoma exposes patients to several complications which could impair their quality of life (QoL). In the last decade, the market for stoma therapy in France has evolved, with a significant increase in the activities of home health providers, meeting a need for patient follow-up and companionship. International studies have demonstrated the impact of the stoma therapist (ST) follow-up on the improvement of an ostomy patient's QoL. However, the impact of home stoma nurse management has not been analysed. In this context we would like to assess the added value on health-related QoL from the enhanced follow-up of ostomy patients by STs. METHODS This is a randomized, controlled, open, national and multicentre trial (12 centres) which includes patients with an ostomy who benefit from either standard follow-up or from an enhanced and personalized follow-up with, in particular, regular consultations with an ST after discharge. The primary end-point is the 3-month QoL score obtained from the Stoma-QoL questionnaire. The secondary end-points are satisfaction of the care, comparison of QoL scores (Stoma-QoL and EuroQuol EQ-5D) and the economic gains by calculating the consumption of resources between the two arms. There will be a modified intention-to-treat analysis with 6-month follow-up in both study arms. DISCUSSION The StomaCare trial will be the first randomized controlled study in France to evaluate the impact on QoL of an enhanced follow-up at home of ostomy patients by an ST.
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Affiliation(s)
- Charles de Ponthaud
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Morgan Roupret
- Urology, GRC no. 5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Dewi Vernerey
- INSERM UMR 1098, Methodology and Quality of Life in Oncology, Besançon, France
| | - François Audenet
- Department of Urological Surgery, Georges Pompidou Hospital, AP-HP, Paris, France
| | - Antoine Brouquet
- Department of General and Oncologic Surgery, Bicêtre Hospital, AP-HP, Kremlin Bicêtre, France
| | - Eddy Cotte
- Department of General and Visceral Surgery, Lyon-Sud Hospital, Lyon, France
| | - Xavier Cuvillier
- Department of Urology, Clinique Esquirol Saint-Hilaire, Agen, France
| | - Frédéric Kanso
- Department of General and Visceral Surgery, Foch Hospital, Suresnes, France
| | | | - Patrick Ledaguenel
- Department of Digestive Surgery, Polyclinique Jean Villar, Bruges, Belgium
| | - Léon Maggiori
- Department of Visceral and Digestive Surgery, Saint Louis Hospital, AP-HP, Paris, France
| | - Yann Neuzillet
- Department of Urological Surgery, Foch Hospital, Suresnes, France
| | - Mehdi Ouaissi
- Departement of Digestive Surgery, CHU, Tours, France
| | - Mathieu Roumiguié
- Department of Urological Surgery, Rangueil Hospital, Toulouse, France
| | - Véronique Phé
- Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Nam-Son Vuong
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Yann Parc
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France
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25
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Neuzillet Y, Leon P, Seisen T, Allory Y, Audenet F, Loriot Y, Masson‐Lecomte A, Mejean A, Pradère B, Roumiguié M, Traxer O, Xylinas E, Fournier G, Roupret M. A Prospective descriptive one‐year study in France of all
BCG
therapy dispensations for
NMIBC
. BJU Int 2022; 131:611-616. [PMID: 36462164 DOI: 10.1111/bju.15941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To describe the clinico-pathological characteristics of non-muscle-invasive bladder cancer (NMIBC) treated in metropolitan France over 1 year when bacille Calmette-Guérin (BCG) was subject to a national quota, and to document, in the context of recurrent shortages of intravesical BCG for NMIBC, the real-life indications for adjuvant treatment. MATERIALS AND METHODS Between February 2021 and February 2022, the French National Agency for the Safety of Medicines (ANSM) asked the French Association of Urology to propose a science-based quota solution for BCG using a clinical score. The ANSM then asked the distributor of the drug, MEDAC, to collect the scores for all patients for whom BCG was requested by healthcare institutions and to prioritize the requests for patients with the highest scores. Tumour stage, grade, size, number, time to recurrence, carcinoma in situ, age, accessibility of alternative treatments (total cystectomy, radio-chemotherapy, thermo-chemotherapy) and BCG treatment progress (initiation or maintenance) were documented for each intravesical BCG prescription. A descriptive analysis of the data collected during the quota year was performed. RESULTS During the 1-year quota, 25 878 requests for BCG were made for 19 024 patients, 60.5% of whom were aged ≥70 years. Requests for induction and maintenance treatment accounted for 12 704 (49.1%) and 13 174 prescriptions (50.9%), respectively. NMIBC treated with BCG maintenance therapy was more frequently high-risk NMIBC (91.7% vs 90.2%; P < 0.0001) than NMIBC for which induction therapy was requested. The number of cases of NMIBC leading to BCG adjuvant treatment was estimated at 12 704 cases/66 062 188 inhabitants over 1 year in metropolitan France. CONCLUSIONS Our data suggest that the incidence of NMIBC at high risk of recurrence and progression is underestimated in reference epidemiological studies. These results should help to better define future care needs.
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Affiliation(s)
- Yann Neuzillet
- Service d’Urologie, hôpital Foch Université Paris Saclay Suresnes France
| | | | - Thomas Seisen
- Sorbonne Université GRC 5 Predictive Onco‐Uro, AP‐HP, Urologie, Hôpital Pitié‐Salpetrière, F‐75013 PARIS France
| | - Yves Allory
- Service d’Anatomopathologie, Institut Curie Université Paris Saclay Saint‐Cloud France
| | - François Audenet
- Service d’Urologie Hôpital Européen Georges Pompidou AP‐HP Centre, Université Paris Cité Paris France
| | - Yohann Loriot
- Service d’Oncologie Médicale Institut Gustave Roussy Villejuif France
| | | | - Arnaud Mejean
- Service d’Urologie Hôpital Européen Georges Pompidou AP‐HP Centre, Université Paris Cité Paris France
| | - Benjamin Pradère
- Service d’Urologie UROSUD Clinique Croix Du Sud, 31130 Quint‐Fonsegrives France
| | - Mathieu Roumiguié
- Service d’Urologie, CHU de Toulouse, UPS Université de Toulouse Toulouse France
| | - Olivier Traxer
- Sorbonne Université GRC#20 Lithiase Urinaire et EndoUrologie, AP‐HP, Urologie, Hôpital Tenon, F‐75020 Paris France
| | - Evanguelos Xylinas
- Service d’Urologie Hôpital Bichat‐Claude Bernard AP‐HP, Université Paris Cité Paris France
| | - Georges Fournier
- Service d’Urologie Centre Hospitalier Universitaire Brest France
| | - Morgan Roupret
- Sorbonne Université GRC 5 Predictive Onco‐Uro, AP‐HP, Urologie, Hôpital Pitié‐Salpetrière, F‐75013 PARIS France
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26
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Masson-Lecomte A, Vaillant V, Roumiguié M, Lévy S, Pradère B, Peyromaure M, Duquesne I, De La Taille A, Lebâcle C, Panis A, Traxer O, Leon P, Hulin M, Xylinas E, Audenet F, Seisen T, Loriot Y, Allory Y, Rouprêt M, Neuzillet Y. Oncological Outcomes of Distal Ureterectomy for High-Risk Urothelial Carcinoma: A Multicenter Study by The French Bladder Cancer Committee. Cancers (Basel) 2022; 14:cancers14215452. [PMID: 36358870 PMCID: PMC9656759 DOI: 10.3390/cancers14215452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Simple Summary Radical nephroureterectomy (RNU) is the standard treatment for high-risk upper tract urothelial carcinoma (UTUC). It implies significant reduction in the renal function, compromising adjuvant chemotherapy administration and leading to risk of end stage renal disease in frail patients. Distal ureterectomy (DU) might be an alternative for tumors of the distal ureter but its indications remain unclear mainly due to concern about potential upper tract recurrences. The objective of our retrospective study was to determine the oncologic outcomes of DU for high-risk UTUC of the pelvic ureter, and to assess factors associated with recurrence in the particular population. We showed that oncological outcomes after DU were similar to those after RNU. Some of the classical prognostic factors after RNU were not identified in this cohort, pinpointing the necessity to consider tumors of the distal ureter as a specific entity. Abstract Upper urinary tract urothelial carcinoma (UTUC) is an uncommon disease and its gold-standard treatment is radical nephroureterectomy (RNU). Distal ureterectomy (DU) might be an alternative for tumors of the distal ureter but its indications remain unclear. Here, we aimed to evaluate the oncological outcomes of DU for UTUC of the pelvic ureter. We performed a multicenter retrospective analysis of patients with UTUC who underwent DU. The primary endpoint was 5-year cancer-specific survival (CSS), followed by overall survival (OS), intravesical recurrence-free (IVR) and homolateral urinary tract recurrence-free (HUR) survivals as secondary endpoints. Univariate and multivariate Cox regressions were performed to assess factors associated with outcomes. 155 patients were included, 91% of which were high-risk. 5-year CSS was 84.4%, OS was 71.9%, IVR-free survival was 43.6% and HUR-free survival was 74.4%. Multifocality, high grade and tumor size were the most significant predictors of survival endpoints. Of note, neither hydronephrosis nor pre-operative diagnostic ureteroscopy/JJ stent were associated with any of the endpoints. Perioperative morbidity was minimal. In conclusion, DU stands as a possible alternative to RNU for UTUC of the pelvic ureter. Close monitoring is mandatory due to the high risk of recurrence in the remaining urinary tract.
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Affiliation(s)
- Alexandra Masson-Lecomte
- Department of Urology, APHP, Hôpital Saint Louis, 75010 Paris, France
- Inserm, CEA, HIPI, Université Paris Cité, 75475 Paris, France
- Correspondence:
| | - Victoire Vaillant
- Department of Urology, APHP, Hôpital Henri Mondor, Université Paris-Est Créteil, 94000 Créteil, France
| | - Mathieu Roumiguié
- Department of Urology, CHU de Toulouse, UPS, Université de Toulouse, 31000 Toulouse, France
| | - Stéphan Lévy
- Department of Urology, CHU de Toulouse, UPS, Université de Toulouse, 31000 Toulouse, France
| | - Benjamin Pradère
- Department of Urology-UROSUD, La Croix du Sud Hospital, 31130 Quint-Fonsegrives, France
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Michaël Peyromaure
- Department of Urology, APHP, Hôpital Cochin, Université Paris Cité, 75014 Paris, France
| | - Igor Duquesne
- Department of Urology, APHP, Hôpital Cochin, Université Paris Cité, 75014 Paris, France
| | - Alexandre De La Taille
- Department of Urology, APHP, Hôpital Henri Mondor, Université Paris-Est Créteil, 94000 Créteil, France
| | - Cédric Lebâcle
- Department of Urology, APHP, Hôpital Bicêtre, Université Paris Sud-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Adrien Panis
- Department of Urology, APHP, Hôpital Bicêtre, Université Paris Sud-Saclay, 94270 Le Kremlin-Bicêtre, France
| | - Olivier Traxer
- GRC 10 Lithiase Urinaire, Department of Urology, APHP, Tenon Hospital, Sorbonne University, 75020 Paris, France
| | - Priscilla Leon
- Department of Urology, clinique Pasteur, 17200 Royan, France
| | - Maud Hulin
- Department of Urology, clinique Pasteur, 17200 Royan, France
| | - Evanguelos Xylinas
- Department of Urology, APHP, Hôpital Bichat Claude-Bernard, Université Paris Cité, 75014 Paris, France
| | - François Audenet
- Department of Urology, APHP, Hôpital Européen Georges Pompidou, Université Paris Cité, 75014 Paris, France
| | - Thomas Seisen
- GRC 5 Predictive Onco-Urology, Department of Urology, APHP, Pitié Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - Yohann Loriot
- Department of Cancer Medicine, INSERM U981, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Yves Allory
- Department of Pathology, Curie Institute, University of Paris-Saclay–UVSQ, 92210 Saint-Cloud, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Urology, Department of Urology, APHP, Pitié Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, University of Paris-Saclay–UVSQ, 92150 Suresnes, France
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Neuzillet Y, Seisen T, Traxer O, Allory Y, Audenet F, Leon P, Loriot Y, Pradère B, Roumiguié M, Xylinas E, Masson-Lecomte A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Upper urinary tract urothelial cancer (UTUC). Prog Urol 2022; 32:1164-1194. [PMID: 36400481 DOI: 10.1016/j.purol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC). METHODS A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence. RESULTS The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0). CONCLUSION These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, Université Paris Saclay, Suresnes, France.
| | - T Seisen
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - O Traxer
- Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France
| | - Y Allory
- Service d'anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - F Audenet
- Service d'urologie, Hôpital européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - Y Loriot
- Service d'oncologie médicale, Institut Gustave-Roussy, Villejuif, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France
| | - E Xylinas
- Service d'urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France
| | - A Masson-Lecomte
- Service d'urologie, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France
| | - M Roupret
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
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Neuzillet Y, Audenet F, Loriot Y, Allory Y, Masson-Lecomte A, Leon P, Pradère B, Seisen T, Traxer O, Xylinas E, Roumiguié M, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Muscle-Invasive Bladder Cancer (MIBC). Prog Urol 2022; 32:1141-1163. [PMID: 36400480 DOI: 10.1016/j.purol.2022.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update the CCAFU recommendations for the management of muscle invasive bladder carcinoma (MIBC). METHODS A systematic review (Medline) of the literature from 2020 to 2022 was performed taking account of the diagnosis, treatment options and surveillance of NMIBC and MIBC, while evaluating the references with their levels of evidence. RESULTS MIBC is diagnosed after the most complete tumour resection possible. MIBC grading is based on CTU along with chest CT. Multiparametric pelvic MRI could be an alternative. Cystectomy with extensive lymphadenectomy is the gold standard treatment for non-metastatic MIBC. It should be preceded by platinum-based neoadjuvant chemotherapy in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed in men and women in the absence of contraindications and when the urethral resection is negative on extemporaneous examination. Otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. Inclusion of all patients in an ERAS (Enhanced Recovery After Surgery) protocol is recommended. For metastatic MIBC, first line treatment with platinum-based chemotherapy (GC or MVAC) is recommended, if general health (PS>1) and renal function (clearance>60mL/min) so allow (only 50% of the cases). Pembrolizumab immunotherapy has demonstrated an overall survival benefit in second-line treatment. CONCLUSION Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and decision-making concerning MIBC treatment.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, université Paris Saclay, Suresnes, France.
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP Centre, université Paris Cité, Paris, France
| | - Y Loriot
- Service d'oncologie médicale, institut Gustave Roussy, Villejuif, France
| | - Y Allory
- Service d'anatomopathologie, institut Curie, université Paris Saclay, Saint-Cloud, France
| | - A Masson-Lecomte
- Service d'urologie, hôpital Saint-Louis, AP-HP, université Paris Cité, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - T Seisen
- Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - O Traxer
- Sorbonne université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, urologie, hôpital Tenon, 75020 Paris, France
| | - E Xylinas
- Service d'urologie, hôpital Bichat-Claude Bernard, AP-HP, université Paris Cité, Paris, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, université de Toulouse, Toulouse, France
| | - M Roupret
- Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
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29
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Neuzillet Y, Pradère B, Xylinas E, Allory Y, Audenet F, Loriot Y, Masson-Lecomte A, Roumiguié M, Seisen T, Traxer O, Leon P, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Non-muscle-invasive bladder cancer (NMIBC). Prog Urol 2022; 32:1102-1140. [PMID: 36400479 DOI: 10.1016/j.purol.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update the ccAFU recommendations for the management of bladder tumours that do not infiltrate the bladder muscle (NBMIC). METHODS A systematic review (Medline) of the literature from 2020 to 2022 was performed, taking account of the diagnosis, treatment options and surveillance of NMIBC, while evaluating the references with their levels of evidence. RESULTS The diagnosis of NMIBC (Ta, T1, CIS) is made after complete full-thickness tumour resection. The use of bladder fluorescence and the indication of a second look (4-6 weeks) help to improve the initial diagnosis. The EORTC score is used to assess the risk of recurrence and/or tumour progression. Through the stratification of patients in low, intermediate and high-risk categories, adjuvant treatment can be proposed: intravesical chemotherapy (immediate postoperative, initiation regimen) or BCG (initiation and maintenance regimen) instillations, or even the indication of cystectomy for BCG-resistant patients. CONCLUSION Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and treatment of NMIBC.
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Affiliation(s)
- Y Neuzillet
- Service d'Urologie, hôpital Foch, Université Paris Saclay, Suresnes, France.
| | - B Pradère
- Service d'Urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - E Xylinas
- Service d'Urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France
| | - Y Allory
- Service d'Anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - F Audenet
- Service d'Urologie, Hôpital Européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France
| | - Y Loriot
- Service d'Oncologie Médicale, Institut Gustave Roussy, Villejuif, France
| | - A Masson-Lecomte
- Service d'Urologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - M Roumiguié
- Service d'Urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France
| | - T Seisen
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - O Traxer
- Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France
| | - P Leon
- Service d'Urologie, clinique Pasteur, Royan, France
| | - M Roupret
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
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30
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Morrone A, Bentellis I, Bernhard JC, Bensalah K, Champy C, Bruyere F, Doumerc N, Olivier J, Audenet F, Parier B, Brenier M, Long JA, Nouhaud FX, Branger N, Lang H, Charles T, Xylinas E, Waeckel T, Gomez F, Boissier R, Rouget B, Shaikh A, Chevallier D, Ambrosetti D, Durand M. Positive surgical margin's impact on short-term oncological prognosis after robot-assisted partial nephrectomy (MARGINS study: UroCCR no 96). Sci Rep 2022; 12:18342. [PMID: 36316438 PMCID: PMC9622828 DOI: 10.1038/s41598-022-23146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
The oncological impact of positive surgical margins (PSM) after robot-assisted partial nephrectomy (RAPN) is still under debate. We compared PSM and Negative Surgical Margins (NSM) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN, and we identified predictive factors of PSM. Multi-institutional study using the UroCCR database, which prospectively included 2166 RAPN between April 2010 and February 2021 (CNIL DR 2013-206; NCT03293563). Two groups were retrospectively compared: PSM versus NSM. Prognostic factors were assessed using Kaplan-Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. 136 patients had PSM (6.3%) and 2030 (93.7%) had NSM. During a median follow-up of 19 (9-36) months after RAPN, 160 (7.4%) recurrences were reported. Kaplan-Meier curves and analysis suggested that RFS, MFS and OS were not affected by a PSM (p = 0.68; 0.71; 0.88, respectively). In multivariate analysis predictors of PSM were a lower RENAL score (p = 0.001), longer warm ischemia time (WIT) (p = 0.003) and Chromophobe Renal Cell Carcinoma (chrRCC) (p = 0.043). This study found no impact of PSM on RFS, MFS or OS, and predictors of PSM were the RENAL score, WIT and chrRCC.
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Affiliation(s)
- Arnoult Morrone
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France ,grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, 30 voie Romaine, 06000 Nice, France
| | - Imad Bentellis
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - Jean-Christophe Bernhard
- grid.42399.350000 0004 0593 7118Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Karim Bensalah
- grid.411154.40000 0001 2175 0984Department of Urology, Rennes University Hospital, Rennes, France
| | - Cécile Champy
- grid.50550.350000 0001 2175 4109Department of Urology, Henri Mondor University Hospital, APHP, Paris, France
| | - Franck Bruyere
- grid.12366.300000 0001 2182 6141Department of Urology, Tours University and Regional Hospital, Tours, France
| | - Nicolas Doumerc
- grid.411175.70000 0001 1457 2980Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Jonathan Olivier
- grid.503422.20000 0001 2242 6780Department of Urology, Lille University and Regional Hospital, Lille, France
| | - François Audenet
- grid.508487.60000 0004 7885 7602Department of Urology, AP-HP Centre, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Bastien Parier
- grid.413784.d0000 0001 2181 7253Department of Urology, Hôpital Bicêtre, Université Paris Saclay, APHP, Le Kremlin-Bicêtre, France
| | - Martin Brenier
- Department of Urology, Paris Saint-Joseph Hospital Group, Paris, France
| | - Jean-Alexandre Long
- grid.410529.b0000 0001 0792 4829Department of Urology, Grenoble University Hospital, Grenoble, France
| | - François-Xavier Nouhaud
- grid.41724.340000 0001 2296 5231Department of Urology, Rouen University Hospital, Rouen, France
| | - Nicolas Branger
- grid.418443.e0000 0004 0598 4440Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Hervé Lang
- grid.11843.3f0000 0001 2157 9291Department of Urology, Strasbourg University and Regional Hospital, Strasbourg, France
| | - Thomas Charles
- grid.411162.10000 0000 9336 4276Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Evanguelos Xylinas
- grid.508487.60000 0004 7885 7602Department of Urology, Bichat-Claude Bernard Hospital, APHP, Paris Descartes University, Paris, France
| | - Thibaut Waeckel
- grid.411149.80000 0004 0472 0160Department of Urology, Caen University Hospital, Caen, France
| | - Florie Gomez
- grid.50550.350000 0001 2175 4109Department of Urology, Tenon Hospital, APHP, Paris, France
| | - Romain Boissier
- grid.414336.70000 0001 0407 1584Department of Urology and Renal transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | | | - Aysha Shaikh
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - Daniel Chevallier
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - Damien Ambrosetti
- grid.410528.a0000 0001 2322 4179Central Laboratory of Pathology, Nice University Hospital, Nice, France ,grid.460782.f0000 0004 4910 6551INSERM U1081 - CNRS UMR 7284, Nice University Côte d’Azur, Nice, France
| | - Matthieu Durand
- grid.410528.a0000 0001 2322 4179Urology, Andrology, Renal Transplant Unit, Hôpital Pasteur 2, Nice University Hospital, Nice, France ,grid.460782.f0000 0004 4910 6551INSERM U1081 - CNRS UMR 7284, Nice University Côte d’Azur, Nice, France
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Haberstich M, Pignot G, Rigaud J, Cancel M, Maillet D, Oudard S, Pouessel D, Serrate C, Campedel L, Dumont C, Borchiellini D, Barthelemy P, Boughalem E, Colomba E, Huillard O, Boyle H, Lefort F, Constans Schlurmann F, Audenet F, Thibault C. 1762P MERINOS: Metastatic non muscle invasive urothelial carcinoma - An observational study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Debedde E, Felber M, Coelho J, Fabiano E, Durdux C, Timsit MO, Méjean A, Audenet F. Management and outcomes of non-muscle invasive bladder recurrence after complete response to trimodality therapy for muscle-invasive bladder cancer: A monocentric experience. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00841-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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33
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Rollin P, Xylinas E, Lanz C, Audenet F, Brunelle S, Compérat E, Houédé N, Larré S, Masson-Lecomte A, Pignot G, Roumiguié M, Méjean A, Rouprêt M, Neuzillet Y. Instauration du traitement adjuvant endovésical par épirubicine des tumeurs de vessie n’infiltrant pas le muscle : premier retour national d’expérience du CC-AFU vessie. Prog Urol 2022; 32:326-331. [DOI: 10.1016/j.purol.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
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Leon P, Saint F, Audenet F, Roumiguié M, Allory Y, Loriot Y, Masson-Lecomte A, Pradère B, Seisen T, Traxer O, Xylinas E, Roupret M, Neuzillet Y. Recommandations du Comité de cancérologie de l’Association Française d’Urologie (CC-AFU) pour la bonne pratique des instillations intravésicales de mitomycine C, d’épirubicine et de BCG pour le traitement des tumeurs de la vessie n’infiltrant pas le muscle (TVNIM). Prog Urol 2022; 32:299-311. [DOI: 10.1016/j.purol.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
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35
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Surlemont L, Bernhard JC, Bensalah CK, Audenet F, Bigot P, Doumerc N, De La Taille A, Roupret M, Olivier J, Bruyère F, Parier B, Lang H, Brenier M, Waeckel T, Long JA, Durand M, Branger N, Tambwe R, Cussenot O, Boissier R, Charles T, Nouhaud FX. Impact of obesity in the management of kidney cancer, study URO-CCR n°87. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Timsit MO, Terrier N, Toinet T, Dariane C, Debedde E, Panthier F, Thiounn N, Audenet F, Méjean A. Posterior transperitoneal robot-assisted partial nephrectomy in the treatment of renal tumors: Feasibility of a hybrid approach. Prog Urol 2022; 32:217-225. [DOI: 10.1016/j.purol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/01/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Audenet F, Sotto A, Roumiguié M, Allory Y, Andrejak C, Leon P, Loriot Y, Masson-Lecomte A, Pradère B, Seisen T, Traxer O, Xylinas E, Bruyère F, Roupret M, Saint F, Neuzillet Y. Recommandations des Comités de cancérologie (CC-AFU) et d’infectiologie (CI-AFU) de l’Association française d’urologie pour la prise en charge effets indésirables et complications du BCG. Prog Urol 2022; 32:165-176. [DOI: 10.1016/j.purol.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
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Rousseau S, Audenet F, Mejean A, Descazeaud A. Quelles sont les caractéristiques des cancers de vessie survenant après irradiation prostatique ? Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Besombes T, Audenet F, Dariane C, Pietak M, Fournier C, Amrouche L, Anglicheau D, Hurel S, Méjean A, Timsit M. Facteurs associés à une lymphocèle symptomatique après transplantation rénale : étude multicentrique française. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Audenet F, Sapetti J, Delavaud C, Verkarre V, Correas JM, Mejean A, Timsit MO. Using Contrast-Enhanced Ultrasound in Addition to Cross-Sectional Imaging for Indeterminate Renal Cysts May Lead to Overclassification in Bosniak III Category: A Case-Control Study. Eur Surg Res 2021; 63:19-24. [PMID: 34289472 DOI: 10.1159/000517405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Indeterminate renal cysts may require several imaging modalities before clinical decision. The aim of this study was to investigate the effect of the imaging modality used to characterize indeterminate renal cysts on the pathological findings after surgical resection. METHODS From our institutional database, we identified all patients surgically treated for Bosniak III renal masses between January 2008 and January 2018. All complex renal cysts were characterized with a combination of computed tomography (CT) and/or magnetic resonance imaging (MRI), and/or contrast-enhanced ultrasound (CEUS) and discussed during a multidisciplinary tumor board. Potential association between clinical/radiological characteristics and the pathological findings were investigated, using univariate and multivariate analyses. RESULTS Of the 52 renal cystic lesions surgically removed, with a preoperative diagnosis of Bosniak III renal cyst, 19 (37%) were malignant and 33 (63%) were benign. The proportion of malignant lesions decreased from 47% when the renal cyst was characterized with cross-sectional imaging (CT and/or MRI) to 17% when the diagnosis required CEUS in addition to cross-sectional imaging. In multivariate analysis, prior history of renal cell carcinoma was associated with a higher risk of malignancy (p = 0.016) and diagnosis made with CEUS was associated with a lower risk of malignancy (p = 0.040). CONCLUSION We found that using CEUS in addition to cross-sectional imaging to characterize indeterminate renal cysts tends to redefine Bosniak III as lesions with a lower risk of malignancy and can lead to overclassification.
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Affiliation(s)
- François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Jordan Sapetti
- Department of Urology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
| | - Christophe Delavaud
- Department of Adult Radiology, Hôpital Necker, AP-HP Centre, Université de Paris, Paris, France
| | - Virginie Verkarre
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Jean-Michel Correas
- Department of Adult Radiology, Hôpital Necker, AP-HP Centre, Université de Paris, Paris, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France
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Luque Y, Jamme M, Aubert O, Roux A, Martinez F, Amrouche L, Tinel C, Galmiche L, Duong Van Huyen JP, Audenet F, Legendre C, Anglicheau D, Rabant M. A kidney discard decision strategy based on zero-time histology analysis could lead to an unjustified increase in the organ turndown rate among ECD. Transpl Int 2021; 34:1506-1516. [PMID: 34097778 DOI: 10.1111/tri.13933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 05/30/2021] [Indexed: 12/01/2022]
Abstract
The utility of zero-time kidney biopsies (KB) in deciding to accept expanded criteria donor (ECD) kidneys remains controversial. However, zero-time histology is one of the main causes for discarding kidneys in the United States. In a single-centre study, we examined the utility and impact on outcome of the use of frozen section zero-time KB among ECD. Ninety-two zero-time KB were analysed for accept/discard decision between 2005 and 2015 among ECD. 53% of kidneys were rejected after zero-time KB analysis; there was no difference in individual clinical and biological data between accepted/rejected groups. However, histology of rejected kidneys showed more sclerotic glomeruli (20% vs. 8%; P < 0.001), increased interstitial fibrosis (1.25 ± 0.12 vs. 0.47 ± 0.09; P < 0.0001), more arteriosclerosis (2.14 ± 0.17 vs. 1.71 ± 0.11; P = 0.0032) and arteriolar hyalinosis (2.15 ± 0.12 vs. 1.55 ± 0.11; P = 0.0006). Using propensity score matching, we generated a group of 42 kidney allograft recipients who received a transplant matched for donor zero-time histology and clinical characteristics with donors whose kidneys were rejected. Interestingly, their 1- and 5-year graft survival and function were similar to the global cohort of ECD recipients. In conclusion, when performed, zero-time KB was a decisive element for kidney discard decision. However, adverse zero-time histology was not associated with poorer graft survival and kidney function among ECD.
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Affiliation(s)
- Yosu Luque
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Renal Emergencies and Kidney Transplantation Department, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Inserm, UMR_S1155, Sorbonne Université, Paris, France
| | - Matthieu Jamme
- Intensive care Unit, Poissy-Saint-Germain-en-Laye hospital, Poissy, France
| | - Olivier Aubert
- UMR_S970, Paris Translational Research Center for Organ Transplantation, Inserm, Paris, France.,Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Arthur Roux
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Frank Martinez
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Lucile Amrouche
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Claire Tinel
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Louise Galmiche
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Audenet
- Urology Department, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France
| | - Dany Anglicheau
- Paris Cite and Kidney Transplantation Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University Sorbonne, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
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Rouprêt M, Audenet F, Roumiguié M, Pignot G, Masson-Lecomte A, Compérat E, Houédé N, Larré S, Brunelle S, Xylinas E, Neuzillet Y, Méjean A. [French ccAFU guidelines - update 2020-2022: upper urinary tract urothelial carcinoma]. Prog Urol 2021; 30:S52-S77. [PMID: 33349430 DOI: 10.1016/s1166-7087(20)30750-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION -The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). METHODS - A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS - The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2-T4 N0-3 M0 disease. CONCLUSION - These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-urology, AP-HP, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Descartes, Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Institut Paoli-Calmettes, Marseille, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Carémeau, Nîmes, Montpellier Université, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, Institut Paoli-Calmettes, Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, AP-HP, université Paris-Descartes, Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, Suresnes, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-urology, AP-HP, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
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Rouprêt M, Pignot G, Masson-Lecomte A, Compérat E, Audenet F, Roumiguié M, Houédé N, Larré S, Brunelle S, Xylinas E, Neuzillet Y, Méjean A. [French ccAFU guidelines - update 2020-2022: bladder cancer]. Prog Urol 2021; 30:S78-S135. [PMID: 33349431 DOI: 10.1016/s1166-7087(20)30751-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC). METHODS - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. RESULTS - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. CONCLUSION - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-uro, AP-HP, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, Université Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, 4, rue de la Chine, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, Université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Carémeau, Université de Montpellier, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, Université Paris-Descartes, 46, rue Henri-Huchard, 75018 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Université de Paris, 20, rue Leblanc, 75015 Paris, France
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Olejarz N, Audenet F, Verkarre V. [A rare tumor of the penis occurring in context of Peyronie's disease]. Ann Pathol 2021; 41:491-495. [PMID: 33896670 DOI: 10.1016/j.annpat.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole Olejarz
- Service de pathologie, centre, université de Paris, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - François Audenet
- Service d'urologie, centre, université de Paris, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Virginie Verkarre
- Service de pathologie, centre, université de Paris, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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Panthier F, Traxer O, Yonneau L, Lebret T, Berthe L, Illoul L, Timsit MO, Mejean A, Doizi S, Audenet F. Evaluation of a free 3D software for kidney stones' surgical planning: "kidney stone calculator" a pilot study. World J Urol 2021; 39:3607-3614. [PMID: 33779821 PMCID: PMC8006641 DOI: 10.1007/s00345-021-03671-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/13/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Kidney Stone Calculator (KSC) is a free, three-dimensional (3D) planning software for flexible ureteroscopy(fURS) with Holmium:YAG(Ho:YAG) endocorporeal lithotripsy (EL). KSC provides the stone volume (SV) and expected duration of lithotripsy (ExDL) estimations based on non-enhanced-CT scan (NECT) DICOM series. We aimed to provide a preclinical and clinical evaluation of KSC. Patients and methods A preclinical evaluation measured the SV by three operators (resident, endourology expert and research engineer) among 17 NECT cases. Between January and March 2020, a multicentric, prospective, observational double-blind clinical evaluation was conducted in patients presenting with renal stones treated with Ho:YAG-EL during fURS and preoperative NECT. Demographic and surgical data were collected. The primary endpoint was a significant median difference between ExDL and EffectiveDL (EfDL). Second, efficiency (J/mm3) and efficacy (mm3/min) ratios were calculated. Results The preclinical evaluation showed no significant difference in the SV measurements among operators (p > 0.05). Pearson and Kendall coefficients of 0.99 and 0.98, respectively, were found. Twenty-six patients were included in the clinical evaluation, with a median age of 55 years. In 66% of cases, there was a single stone located in the lower pole, with a density > 1000 Hounsfield Unit observed in 42% and 85% of cases. A 14% [Q1–Q3 (5.4–24.8); p = 0.36] median difference between ExDL and EfDL was noted, which was greater in the case of lower pole stones with no possible relocation (p = 0.008). Median values of 17.6 J/mm3 and 0.4 (0.32–0.56) mm3/s EL were also noted. Conclusions Kidney Stone Calculator is a reproducible and accurate software that allows for an estimation of the stone burden and provides an ExDL for URSf. Defining the influencing factors of EL will improve its ExDL. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03671-z.
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Affiliation(s)
- Frédéric Panthier
- Service D'Urologie, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, 20 rue Leblanc, 75015, Paris, France. .,GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Service D'Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,PIMMUMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Laurent Yonneau
- Service D'Urologie, Hôpital Foch-Université Paris Saclay-UVSQ, 40 rue Worth, 92150, Suresnes, France
| | - Thierry Lebret
- Service D'Urologie, Hôpital Foch-Université Paris Saclay-UVSQ, 40 rue Worth, 92150, Suresnes, France
| | - Laurent Berthe
- PIMMUMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Lounès Illoul
- PIMMUMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Marc-Olivier Timsit
- Service D'Urologie, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Arnaud Mejean
- Service D'Urologie, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, 20 rue Leblanc, 75015, Paris, France
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Service D'Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.,PIMMUMR 8006 CNRS-Arts Et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - François Audenet
- Service D'Urologie, Hôpital Européen Georges Pompidou, AP-HP, Centre-Université de Paris, 20 rue Leblanc, 75015, Paris, France
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Blanc T, Pinar U, Anract J, Assouad J, Audenet F, Borghese B, De La Taille A, El Ghoneimi A, Mongiat-Artus P, Mordant P, Penna C, Roupret M. Impact of the COVID-19 pandemic on oncological and functional robotic-assisted surgical procedures. J Robot Surg 2021; 15:937-944. [PMID: 33511526 PMCID: PMC7843004 DOI: 10.1007/s11701-021-01201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/17/2021] [Indexed: 12/20/2022]
Abstract
The COVID-19 pandemic led to a decrease in surgical activity to avoid nosocomial contamination. Robotic-assisted surgery safety is uncertain, since viral dissemination could be facilitated by gas environment. We assessed the impact and safety of the COVID-19 pandemic on robotic-assisted surgery. Data were collected prospectively during lockdown (March 16th–April 30th 2020) in 10 academic centres with robotic surgical activity and was compared to a reference period of similar length. After surgery, patients with suspected COVID-19 were tested by RT-PCR. During the COVID-19 lockdown we evidenced a 60% decrease in activity and a 49% decrease in oncological procedures. However, the overall proportion of oncological surgeries was significantly higher during the pandemic (p < 0.001). Thirteen (7.2%) patients had suspected COVID-19 contamination, but only three (1.6%) were confirmed by RT-PCR. The COVID-19 pandemic resulted in a significant decrease in robotic-assisted surgery. Robotic approach was safe with a low rate of postoperative COVID-19 contamination.
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Affiliation(s)
- Thomas Blanc
- Department of Paediatric Surgery and Urology, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Ugo Pinar
- Urology, Predictive Onco-Urology, GRC 5, APHP, Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France
| | - Julien Anract
- Urology, Predictive Onco-Urology, GRC 5, APHP, Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France
| | - Jalal Assouad
- Departement of Thoracic and Vascular Surgery, AP-HP, Hôpital Tenon, Sorbonne University, 75020, Paris, France
| | - François Audenet
- Department of Urology, AP-HP Centre, Hôpital Européen Georges Pompidou, Université de Paris, 75015, Paris, France
| | - Bruno Borghese
- Department of Gynaecologic Surgery, AP-HP. Centre, Hôpital Cochin, Université de Paris, 75014, Paris, France
| | - Alexandre De La Taille
- Department of Urology, APHP, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, 94010, Creteil, France
| | - Alaa El Ghoneimi
- Department of Paediatric Surgery and Urology, AP-HP. Nord, Hôpital Robert Debré, Université de Paris, 75019, Paris, France
| | - Pierre Mongiat-Artus
- Department of Urology, AP-HP. Nord, Hôpital Saint Louis, Université de Paris, 75010, Paris, France
| | - Pierre Mordant
- Department of Thoracic and Vascular Surgery, AP-HP. Nord, Hôpital Bichat, Université de Paris, 75010, Paris, France
| | - Christophe Penna
- Department of Digestive Surgery, APHP, Hôpital Bicêtre, Université Paris Saclay, 94270, Le Kremlin-Bicetre, France
| | - Morgan Roupret
- Urology, Predictive Onco-Urology, GRC 5, APHP, Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France.
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Such M, Lavolle A, Popelin MB, Thibault C, Fontaine E, Dariane C, Oudard S, Mejean A, Timsit MO, Audenet F. Administration of neoadjuvant chemotherapy for muscle-invasive bladder cancer in real life: Are urologists still too cautious? Prog Urol 2021; 31:332-339. [PMID: 33468415 DOI: 10.1016/j.purol.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is now recommended to treat muscle-invasive bladder cancer (MIBC) but is not always executed in real life. This study aims to evaluate the proportion of patients with MIBC who receive an optimal NAC, and to present the predictive factors of its achievement. METHODS This monocenter retrospective study included all the patients who underwent radical cystectomy for≥pT2NxM0 MIBC between 2013, January and 2018, December. NAC consisted in 4-6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) or 4 cycles of GC (gemcitabin, and carboplatin). Demographic (sex, age, ECOG-PS, glomerular filtration rate [GFR], and cN stage), surgical (urinary derivation, time of surgery, blood loss, and complications), and oncological characteristics were analyzed. Multivariate analysis are made to find predictors of administration of NAC. RESULTS One hundred and twenty-seven patients were included. Thirty received CNA (24%). Patients who underwent CNA were younger, with better ECOG and better GFR. Multivariate analysis showed that cN+ stage and better GFR were significantly associated to administration of NAC. Eight patients (27%) couldn't receive an optimal treatment due to toxicity. Perioperative complication rates were similar, with or without NAC. Patients who underwent NAC had a worse GFR after treatment (-17 versus +5mL/min, P<0.01). CONCLUSION Due to the risks of toxicity, NAC can only be proposed to selected population, which is not the current patients. Immunotherapy could allow to treat more patients because of better tolerance. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- M Such
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France.
| | - A Lavolle
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - M-B Popelin
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - C Thibault
- Service d'oncologie médicale, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, Paris, France
| | - E Fontaine
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - C Dariane
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - S Oudard
- Service d'oncologie médicale, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, Paris, France
| | - A Mejean
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - F Audenet
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
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Bertucat V, Luque P, Hurel S, Audenet F, Dariane C, Timsit M, Pineau J, Mejean A, Martelli N. Urétéroscope souple réutilisable ou non : de la souplesse à tous niveaux ? Comparaison des coûts et de l’impact organisationnel de ces dispositifs. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rollin P, Xylinas E, Neuzillet Y, Roumiguié M, Lanz C, Pignot G, Audenet F, Brunelle S, Compérat E, Houédé N, Larré S, Masson-Lecomte A, Méjean A, Rouprêt M. Instauration du traitement adjuvant endovésical par épirubicine des tumeurs de vessie n’infiltrant pas le muscle : premier retour national d’expérience du CCAFU vessie. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fournio C, Dariane C, Correas J, Audenet F, Anract J, Hostettler A, Delavaud C, Hurel S, Verkarre V, Mandron E, Timsit M, Mejean A. Résultats fonctionnels et perte de volume fonctionnel rénal à 1 an après traitements thermo-ablatifs versus néphrectomie partielle pour tumeurs > 4 cm. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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