Efficacy of HIVEC in patients with high-risk non-muscle invasive bladder cancer who are contraindicated to BCG and in patients who fail BCG therapy

PURPOSE

To evaluate Hyperthermic-Intra-Vesical Chemotherapy (HIVEC) efficacy regarding 1-year disease-free survival (RFS) rate and bladder preservation rate in patients with High-risk Non-Muscle Invasive Bladder Cancer (NMIBC) who fail BCG therapy or are contraindicated to BCG.

METHODS

Between June 2016 and October 2019, patients treated with HIVEC for mostly high-risk NMIBC who failed BCG or BCG-naive if BCG contraindicated have been included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it.

RESULTS

Fifty-three patients, median age 72 [39-93] years, were included in this study (n = 29 BCG-failure and n = 24 BCG-naive). The median follow-up was 18 months. The bladder preservation rate was 92.4%. The 12 months-RFS rate was 60.5%. The RFS rates for BCG-naive and BCG-failure groups were respectively 70% and 52.2% at 12 months. Three patients progressed to muscle infiltration, all in the BCG-failure group and all in the very high-risk EORTC group. Two of them developed metastatic disease and died from bladder cancer.

CONCLUSION

Chemohyperthermia using HIVEC achieved a RFS rate of 60% at 1 year and enabled a bladder preservation rate of 92%. Given the low risk of progression in the BCG-naive group, HIVEC could be a good alternative. Conversely, for patients with very high-risk tumors that fail BCG, cystectomy should remain the standard of care and HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression to muscle-invasive disease.

Enhanced Recovery after Surgery for Radical Cystectomy Decreases Postoperative Complications at Different Times

INTRODUCTION

This study aimed to assess whether enhanced recovery after surgery (ERAS) improves, at different time points, postoperative complications in patients undergoing radical cystectomy.

METHODS

We performed a retrospective monocentric study using prospectively maintained databases including all patients treated by radical cystectomy between January 2015 and July 2019. An ERAS protocol was applied in all patients from February 2018. We analyzed and compared between non-ERAS and ERAS groups early and 90-day postoperative complications and 90-day readmission. ERAS was analyzed to know its implication in fast recovery improvement over time.

RESULTS

A total of 150 patients underwent radical cystectomy, 74 without ERAS and 76 with ERAS protocol. ERAS decreased significantly early (p = 0.039) and 90-day (0.012) postoperative complications. In multivariate analysis, ERAS was an independent factor associated with less early (OR: 0.48, 95% CI: 0.25-0.96; p = 0.37) and 90-day (OR: 0.31, 95% CI: 0.14-0.68; p = 0.004) postoperative complications. There was no significant difference between groups for 90-day readmission (p = 0.349). Mean length of stay did not differ significantly between ERAS and non-ERAS groups (12.7 ± 6.2 and 13.1 ± 5.7 days, respectively; p = 0.743).

DISCUSSION/CONCLUSION

Our study shows that ERAS has an early positive impact that lasts over time on postoperative complications. ERAS implementation has decreased early and 90-day postoperative complications without increasing 90-day readmission. In our cohort, length of stay was not improved with ERAS protocol.

Sexual-Sparing Robot Assisted Radical Cystectomy in Female: A Step-By-Step Guide

OBJECTIVE

To show different approaches for sexual-sparing robot assisted radical cystectomy in women.

MATERIALS AND METHODS

Radical cystectomy (RC) is a mainstay treatment for localized muscle invasive bladder cancer and high-risk non muscle invasive bladder cancer not responding to adequate endovesical therapy.¹ In women traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall, but this technique often brings sexual disorders. With time, vaginal sparing techniques have been developed to improve functional outcomes in women motivated to preserve their sexual function.^2-4 The indications for vaginal-sparing RC are absence of tumor in bladder neck or urethra and no sign of infiltration of anterior vaginal wall and parametria at preoperative staging.

RESULTS

Procedure steps as follows. Step 1: Bilateral adnexectomy and ureteral isolation until their distal portion. Step 2: Vesico-vaginal dissection. Step 3: Bilateral pelvic and common iliac node dissection. Step 4: Ureteral clamping and section. Step5: Posterolateral bladder pedicle dissection. Step 6: Anterior dissection of the bladder towards the urethra. In women, this should be achieved without injuring the Santorini plexus and innervation of the clitoris. Step 7: Bladder neck identification and urethral dissection. Cystectomy is completed. Step 8: En bloc hystero-adnexectomy with anterior vaginal wall preservation; the vaginal pedicles are spared too. Step 9: Specimen extraction from the vagina and vaginal suture.It is also possible to perform a fully sexual-sparing robotic RC by following the vesico-vaginal plan without dissecting the vaginal dome and leaving internal genitalia intact. This technique is typically carried out in case of young women with no pathological uterine and ovarian findings.Vesico-vaginal plan can also be developed after opening the vaginal dome. This approach gives the possibility to subsequently dissect the cervix, to identify and spare the vaginal pedicles and to perform an "en bloc" radical cystectomy, with preservation of the anterior vaginal wall.In case of neobladder, diversion is carried out intracorporeally following the principles of the Saint Augustin neobladder.⁵ CONCLUSIONS: Robot assisted anterior pelvectomy with anterior vaginal wall preservation is a feasible and mini-invasive technique. For a satisfying functional result, it is crucial to preserve the vaginal neurovascular pedicles. This sexual-sparing approach must be carried out after a correct patient selection: women motivated to preserve their sexual function and ideally in the neobladder setting, when a posterior support for the urinary diversion is needed. Absence of tumor in bladder neck and urethra at magnetic resonance imaging could help patient selection.

Feasibility and first results of digital patient-reported outcomes measures (PROMs) data collection for patients with localized prostate cancer at diagnosis

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Background: Patient-reported outcomes measures (PROMs) allow optimal evaluation of side effects of treatments and their impact on quality of life. In localized prostate cancer, these PROMs are an interesting tool for comparing the impact of different treatments. The objective of our study was to evaluate the feasibility of a PROMs assessment using a digital application and to analyze the functional outcomes at 1, 3 and 6 months for urinary continence and sexuality. Methods: Since May 2019, patients treated for localized prostate cancer in our center, regardless of the treatment choice, have been offered inclusion in a digital prospective program. PROMs questionnaires (EPIC-26, Q50 PR25, EQ- 5D and PRO-CTCAE) were sent via a dedicated digital application, before treatment (T0), at 1 month (M1), 3 months (M3), 6 months (M6) and 1 year. Program adherence was assessed by the proportion of patients who logged in to the app and the proportion of patients who responded to questionnaires. The first results, at T0, M1, M3 and M6, were analyzed for urinary continence and erectile function, and compared according to age, baseline characteristics and treatment strategy. Results: Between May 2019 and December 2020, 324 patients were included in the program. Thirty patients (9.3%) did not log into the app and 29 (8.9%) logged in but did not respond to the PROMs questionnaires sent out. The adherence rate was not related to age or treatment strategy. In the end, 265 patients (81.8%) answered the PROMs questionnaires, including 185 patients treated by surgery, 11 by brachytherapy, 15 by radiotherapy, 24 by radio-hormonotherapy and 30 under active surveillance. Before treatment (T0), 15.8% (42/265) of patients reported having urine leakage (at least once a week) and 41.5% (110/265) having poor or no erections. At M1, M3, and M6, the incontinence rate was 50.8%, 37.8% and 28.7% respectively, and the erectile dysfunction rate was 73.3%, 74.1% and 70.1% respectively. Sexual recovery was strongly associated with baseline erectile function (T0); patients with good sexual function at diagnosis had an erectile dysfunction rate of 53.8% at 1 month (versus 89.9% for patients with pre-existing sexual dysfunction, p < 0.001), and 51.1% at 3 months (versus 84.0%, p < 0.001). Age was not associated with continence or sexuality recovery. Patients treated with surgery had significantly poorer functional outcomes in terms of continence (p < 0.001) and sexuality (p < 0.001) compared to other strategies. Conclusions: The implementation of PROMs using a digital application achieves an adherence rate of over 80%. The incontinence rate decreases rapidly over the 6 months following treatment, while erectile dysfunction rate remains stable over time. Early side effects are more common after surgery, requiring appropriate supportive strategies.

Metastatic hormone sensitive prostate cancer: local treatment strategies

PURPOSE

The landscape of the management of metastatic prostate cancer is changing rapidly and there is growing interest in the local treatment of the primary in these patients. The effect of local treatment on the outcome of metastatic prostate cancer patients was addressed based on retrospective analysis but now also based on prospective randomized trials. This article provides an overview of the currently available literature in this field.

METHODS

A literature review was done searching the Medline database for English language articles using the keywords "metastatic prostate cancer", and "local treatment", "radiotherapy", "prostatectomy". The data of prospective randomized studies and the data of case-control studies or retrospective analysis were summarized in a narrative fashion.

RESULTS

Data from two prospective randomized trials exploring the effect of local treatment of the prostate in hormone-sensitive metastatic prostate cancer showed no improvement of overall survival in the individual overall cohorts as well as in the pooled analysis (HR 0.92, 95% CI 0.81-1.04). There was an improvement of failure-free survival (pooled analysis HR 0.76, 95% CI 0.69-0.0.84). There was also an improved overall survival associated with radiotherapy in patients with < 5 metastases and with low volume disease. Data from prospective non-randomized or retrospective studies are inconclusive and underlies major selection biases.

CONCLUSION

Based on prospective randomized trials, local treatment by radiotherapy does not improve the overall survival in unselected metastatic prostate cancer patients. An effect can be seen in low volume patients or patients with < 5 metastases.

Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy

BACKGROUND

Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery.

METHODS

Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm²/m² for men and SMI <35 cm²/m² for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models.

RESULTS

According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (P<0.001). Among patients non-sarcopenic before NAC, nine (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (P=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (P=0.01 and P=0.03, respectively).

CONCLUSIONS

We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.

Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy

BACKGROUND

Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery.

METHODS

Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm²/m² for men and SMI <35 cm²/m² for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models.

RESULTS

According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (P<0.001). Among patients non-sarcopenic before NAC, nine (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (P=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (P=0.01 and P=0.03, respectively).

CONCLUSIONS

We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.

[Safety of Hyperthermic IntraVEsical Chemotherapy (HIVEC) for BCG Unresponsive Non-Muscle Invasive Bladder Cancer Patients]

INTRODUCTION

There is increasing evidence that Hyperthermic Intravesical Chemotherapy is an effective treatment for non-muscle invasive bladder cancer (NMIBC). HIVEC (COMBAT BRS system) is an innovative hyperthermia delivering device. The aim of our study is to evaluate tolerance and safety of HIVEC in patients with BCG-refractory NMIBC.

MATERIALS AND METHODS

In this study, we included 22 patients between January 2017 and April 2018. The treatment consisted in a weekly instillation of Hyperthermic Mitomycin for a total of 6 weeks, with a follow-up every 3 months. In order to evaluate the tolerance, patients filled a questionnaire before each instillation. We analyzed collected data to evaluate safety and efficiency of the treatment after one year.

RESULTS

Among 22 patients included, no patient suffered from severe side effects. The minor side effects reported were : urinary urgency (40,1 %), urinary pain (40,1%), macroscopic hematuria (4,5%). The IPSS score didn't significantly varied before and after instillations (mean IPSS: 10.8 versus 10.1, p=0.77). The mean follow-up was 11.2 months. The recurrence rate was 27,3% with an average time to recurrence of 7.36 months. Two patients (9.1%) presented a progression to muscle-invasive disease. Four patients (18,2%) had a radical cystectomy.

CONCLUSION

Hyperthermic Mitomycin using the HIVEC® device is a rather safe and well tolerated treatment. Efficiency remains partial as 27.3% of patients experienced recurrence during the first year. These data should be confirmed by prospective multicentric studies.

[Is a routine second transurethral resection of the bladder still necessary after hexaminolévulinate photodynamic diagnosis-assisted TURBT?]

OBJECTIVES

The aim of our study was to assess the impact of blue light cystoscopy with hexaminolevulinate on residual tumor rates at second-look transurethral resection of the bladder (TURB).

MATERIAL AND METHODS

Among all patients undergoing TURB in our center between 2012 and 2017, 52 patients had a second-look after a first complete TURB with a delay<3months. We compare patients with standard white light cystoscopy/TURB then second-look blue light cystoscopy/re-TURB (group A, n=30) and patients with blue light cystoscopy/TURB at the initial procedure then white light cystoscopy/re-TURB (group B, n=22). The residual tumor rates at second-look, restaging and changing in therapeutic strategy, as well as recurrence free survival and progression rate were compared.

RESULTS

Residual tumor at the time of second-look cystoscopy was detected in 42.3% of cases in our cohort, with a significant difference between the two groups (63.3% in group A versus 0% in group B, <0.001). In group A, 16.7% (5/30) of patients had upstaging and/or upgrading at second-look cystoscopy, resulting in a change in therapeutic strategy in most cases (4/5) while none upstaging was observed in group B. In multivariate analysis, the use of luminofluorescence at the first TURB was the only independent predictive factor of residual tumor (P=0.0031).

CONCLUSION

The quality of the initial TURB, when performed by using blue light cystoscopy, had a significant impact on the rate of residual tumor at the second-look resection and could modify therapeutic strategy of NMIBC.

LEVEL OF EVIDENCE

4.

Impact of sarcopenia for patients with localized muscle invasive bladder cancer treated by neoadjuvant cisplatin based chemotherapy and radical cystectomy

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Background: Several studies suggested the prognostic importance of sarcopenia in survival or treatment complications in cancer. The concept of cancer prehabilitation before surgery is gaining wide recognition. The aim of our study was to assess the impact of sarcopenia on chemotherapy toxicities and survival in patients with localized muscle invasive bladder cancer (MIBC). Methods: Between January 2012 and December 2017, patients who underwent neoadjuvant platinum-based chemotherapy (NAC) followed by radical cystectomy (RC) for cT2-T4 N0 M0 MIBC were retrospectively selected, from a single institution cohort. Using CT scan: before NAC, after NAC and after cystectomy, sarcopenia was defined according to the Lumbar Skeletal Muscle Index (SMI) in L3 assessed by two observers blinded to patients’ status. Results: 82 patients were selected, 62 men (75.6%) and 20 women (24.4%), with a median age of 64.5 years (31 to 80). 35 were considered severe sarcopenic (SMI < 35cm2/m2 for women and SMI < 50 cm2/m2 for men) before NAC. The characteristics between severe and non-severe sarcopenic patients were not significantly different except for weight (71.7 vs 81.1kg, p = 0.006) and BMI (24.0 vs 28.4kg/m2, p = 8.0x10-6). Sarcopenia pre-chemotherapy was significantly associated with nausea (p = 0.003), hypokalemia (p = 0.023) and with platinum dose-intensity during NAC (p = 0.007) but was not significantly associated with overall survival (OS) or disease-free survival (DFS). Sarcopenia post-cystectomy was correlated with the OS (HR = 0.94, CI95% [0.89-0.99], p = 0.01), but not DFS. In multivariate analysis, factors associated with OS were post cystectomy sarcopenia (p = 0.038), pN status (p = 0.001) and glomerular filtration rate (p = 0.045). Conclusions: For localized MIBC, sarcopenic status before platinum based NAC could predict some chemotherapy toxicities. After radical cystectomy, sarcopenia is an independent prognostic factor for OS. Improve patients care by prehabilitation during NAC and before surgery, using physical, nutritional and psycho-social supports, could decrease chemotherapy toxicities and improve survival particularly for sarcopenic patients.

Impact of sarcopenia on kidney function during neoadjuvant chemotherapy and post cystectomy complications in patients treated for localized muscle-invasive bladder cancer

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Background: Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy. The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and radical cystectomy for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC and surgery. Methods: Between January 2012 and December2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 M0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers blinded to patient’s status. We defined severe sarcopenia as SMI < 50 cm2/m2 for men and SMI < 35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models. Results: According to the SMI cut offs, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients’ characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (p < 0.001). Among patients non-sarcopenic before NAC, 9 (19.1%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (OR 3.01; 95% CI 1.13–8.05; p = 0.02). There was a trend towards a higher rate of stage 3B kidney failure (GFR < 45 mL/min/1.73m2) after NAC in sarcopenic patients (OR 2.79; 95% CI 0.70–11.1) but the difference was not statistically significant (p = 0.14). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications ≤90 days (p = 0.01 and p = 0.02 respectively). Conclusions: We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.

Effect of nanoclay concentration level on the electrical properties of polypropylene under electron irradiation in a SEM

For studying the electrical properties (charge trapping, transport and secondary electron emission) of the polypropylene-based nanocomposites with different contents of natural clay, the specimens were submitted to electron irradiation of a scanning electron microscope. A device, suitably mounted on the sample holder of the scanning electron microscope, was used to measure two currents (i.e. leakage and displacement currents) induced in the polypropylene-based nanocomposites (polymer nanocomposites) under electron irradiation. The evolution of trapped charge during irradiation for each type of studied polymer nanocomposites is deduced. The amount of trapped charge at the steady state is also determined by measuring the change of secondary electron image size associated to the electron trajectory simulation. It is found, surprisingly, that not only the leakage current increases as a function of clay loading level but also trapped charge. However, this could be related to the increase of conductivity in one hand and to proliferation of interfaces between nanoparticles and neighbouring materials on the other hand. These two processes play crucial role in controlling the carrier transport (through polymer nanocomposites or/and along its surface) closely related to the charge storage and leakage current. Additional experiment using dielectric spectroscopy were performed to show the effect of clay concentration in changing the dielectric relaxation behaviour and to evidence the existence of interfaces between nanoparticles and polymer. The secondary electron emission during electron irradiation is also studied through the total electron yield that is deduced by correlating the measured leakage and displacement currents.

Does kidney transplantation with multiple arteries affect graft survival?

INTRODUCTION

We compared short- and long-term outcomes of renal transplants with single versus multiple arteries.

PATIENTS AND METHODS

We retrospectively analyzed data from kidney transplants from 208 living donors performed between 1994 and 2010. Renal grafts were divided into two groups: single renal artery (n = 164) versus multiple renal arteries (n = 44). The groups were compared regarding early and late vascular and urological complications. Patient and graft survivals were compared using Kaplan-Meier survivorship curves with comparisons using the log-rank test.

RESULTS

Both groups were comparable regarding acute rejection episodes, posttransplant hypertension, postsurgery renal artery stenosis, and urologic complications. Only hemorrhagic complications and renal artery thrombosis were significantly higher in the multiple renal arteries group (P = .027 and .03, respectively). Warm ischemia time was significantly longer in the multiple renal arteries group without any influence on the incidence of acute tubular necrosis (P = .2). Mean creatinine clearance at 1 year was 65 versus 50 mL/min/1.73 m(2) (P = .5) and at 5 years, 60 versus 55 mL/min/1.73 m(2) (P = .1) for the single versus multiple renal arteries groups, respectively. Return to hemodialysis was necessary for 18.8% of the single and 16.1% of the multiple renal arteries group.

CONCLUSION

The use of an allograft with multiple renal arteries is a safe, successful surgical procedure, that does not influence patient or graft survivals or increase surgical complication rates provided the surgical team is evolved with technical skill.

Evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle)

OBJECTIVE

To study the evolution of impaired renal function after external continent urinary diversion (Mitrofanoff principle) (ECUD-M) associated with ileocystoplasty.

PATIENTS AND METHODS

Over 18 years from 1992 to 2009, ECUD-M with ileocystoplasty was performed in 120 patients with mean age of 25.5 years. Renal impairment was evident in 43 patients (17 children and 26 adults).

RESULTS

Ninety percent of patients demonstrated a neurologic bladder and mild to moderate renal failure. Initially, all patients underwent continuous bladder drainage for a mean of 3 weeks. Renal function improved in 35 patients, although with persistent mild renal insufficiency. The other patients demonstrated moderate persistent residual renal insufficiency. During a mean follow-up of 10 years (range, 1-18 years), renal function returned to normal in 13 patients, stabilized at lower values in 15, and remained moderate in 5. After a mean follow-up of 8 years (range, 6-12 years), renal failure gradually worsened, increasing to higher values in 6 patients and leading to hemodialysis in 4. One patient underwent living-donor kidney transplantation, with good evolution.

CONCLUSION

ECUD-M with ileocystoplasty can lead to normalization unless stabilizationof impaired residual renal function by eliminating the obstructive factor provides self-adequate management of the diversion. The procedure delays for the need forhemodialysis therapy, and enables patients to prepare for kidney transplantation into a previously reconstructed lower urinary tract.

[Diagnostic and therapeutic aspects of lymphatic tuberculosis: apropos of 42 cases]

We report a retrospective study of 42 cases of lymph node tuberculosis. We noted symptoms of tuberculosis impregnation in 92%, cervical localization in 71%, positive tuberculin intra-dermo-reaction in 77%, and accelerated erythrocyte sedimentation rate in 73% of the cases. Koch bacillus was detected in expectoration, urine or gastric liquid at the rate of 11% of the cases. Lymph node function was suggestive in 4 out of 12 patients, showing giant cells with or without caseum. Lymph node biopsy, performed in 32 patients, was contributive in 94% of them. Another tuberculous localization was found in 14 cases mainly pulmonary (8 cases).