Abstract: INTRODUCTION: The incidence of kidney cancer is constantly increasing. The objective of this study was to report the characteristics of sporadic kidney tumours observed in a population of patients under the age of 45 years and to define prognostic factors based on a 5-year follow-up. MATERIAL AND METHODS: Between 1985 and 2003, 64 patients, with a mean age of 38 +/- 7 years, presenting with sporadic kidney cancer were included in this retrospective study. RESULTS: Sporadic kidney cancer was discovered incidentally in 39.1% of young adults, predominantly in women. Radical nephrectomy was performed in 57 cases and partial nephrectomy was performed in 5 cases. The distribution by histological type was comparable to that of the general population, but pathological examination of carcinomas showed a high Führman grade in 66% of cases. The mean follow-up was 72 59 months. The 3-year and 5-year overall survival was 79% and 76.7% respectively. The mortality rate was 25%: 13 specific deaths and 3 nonspecific deaths. TNM stage was a prognostic factor on univariate and multivariate analysis. The mode of discovery and the ASA score were also identified as prognostic factors on univariate analysis. CONCLUSION: Sporadic kidney cancer is rare in adults before the age of 45 years and presents with symptoms. Earlier detection would allow an improvement of the prognosis.

Abstract: OBJECTIVE: Obturator neuralgia consists of pain radiating from the obturator nerve territory to the inner thigh. METHODS: We report a case of idiopathic obturator neuralgia resulting from compression of the obturator nerve in the obturator canal, causing a case of nerve entrapment syndrome. The pain was characterized by its localization in the inguinal region and anterointernal side of the thigh, going down to the internal side of the knee. It was worse when standing or in a monopodal stance. Walking caused pain and a limp. RESULTS: The diagnosis was confirmed by an analgesic block. The analgesic was infiltrated using a posterior approach and computer-assisted tomography, allowing the quality and specificity of the infiltration to be judged. CONCLUSION: We describe, for the first time, a treatment of obturator neuralgia by a minimally invasive laparoscopic approach. This involved an obturator nerve neurolysis and section of the internal obturator muscle and the obturator membrane.

Abstract: AIMS: The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no pathognomonic criteria, but various clinical features can be suggestive of the diagnosis. We defined criteria that can help to the diagnosis. MATERIALS AND METHODS: A working party has validated a set of simple diagnostic criteria (Nantes criteria). RESULTS: The five essentials diagnostic criteria are: (1) Pain in the anatomical territory of the pudendal nerve. (2) Worsened by sitting. (3) The patient is not woken at night by the pain. (4) No objective sensory loss on clinical examination. (5) Positive anesthetic pudendal nerve block. Other clinical criteria can provide additional arguments in favor of the diagnosis of pudendal neuralgia. Exclusion criteria are also proposed: purely coccygeal, gluteal, or hypogastric pain, exclusively paroxysmal pain, exclusive pruritus, presence of imaging abnormalities able to explain the symptoms. CONCLUSION: The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no specific clinical signs or complementary test results of this disease. However, a combination of criteria can be suggestive of the diagnosis. Neurourol. Urodynam. (c) 2007 Wiley-Liss, Inc.

Abstract: OBJECTIVES: The aim of our survey was to evaluate surgical care, morbidity, mortality and follow-up of patients who had undergone surgical exeresis of a renal cancer with extension of tumor thrombus into the inferior vena cava. PATIENTS AND METHODS: Between June 1991 and March 2003, 40 (5.4%) patients were operated on for an enlarged nephrectomy with thrombectomy. The upper limit of the tumor thrombus was below the sus-hepatic veins in 21 (52.5%) patients and above the sus-hepatic veins in 19 (47.5%) patients with six (15%) located in the right atrium. RESULTS: Cardiopulmonary bypass (CPB) was used for 12 patients (30%). A per-operative embolism was noted for three (7.5%) patients: two cases of cruoric embolism and one case of gaseous embolism, systematically occurring in patients operated on without CPB. Early mortality was 7.5% (three patients) attributable to hemorrhagic complications. Overall survival at 2 and 5 years was 45.2% and 38.7%, respectively. Disease-free survival at 2 and 5 years was 28.3% and 8.9% respectively. Only the pN stage had a statistically significant prognosis value for overall survival but not for disease-free survival. At the end of the study, only one (2.5%) patient could be considered free of the disease with sufficient follow-up after the surgery. CONCLUSION: Patients with renal cancer and tumor extension in the inferior vena cava need multidisciplinary cooperation to adapt a good surgical strategy, particularly with the use of CPB. However, the rate of patients free of disease after such surgery was low.

Abstract: OBJECTIVE: The objective of this study was to evaluate survival and risk of recurrence in patients undergoing nephrectomy with resection of inferior vena cava tumour thrombus in our department. MATERIAL AND METHODS: From June 1991 to March 2003, 40 patients underwent radical nephrectomy with resection of inferior vena cava tumour thrombus. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.5%), with thrombus in the right atrium in 6 cases (15%). Cardiopulmonary bypass (CPB) was used in 12 patients (30%) RESULTS: With a mean follow-up of 28.5 +/- 36.8 months (range: 0-150), 22 patients (55%) have died. The 2- and 5-year overall survival rates were 45.2% and 38. 7%, respectively. Local and/or metastatic recurrence was observed in 28 patients (70%) after a mean interval of 18 +/- 22.9 months (range: 1-104). Patients with tumour thrombus derived from the left kidney had a higher local recurrence rate than patients with thrombus derived from the right kidney (p = 0.0194). The 2- and 5-year recurrence-free survival rates were 28.3% and 8.9%, respectively. Only stage pN had a statistically significant prognostic value on overall survival, but not on recurrence-free survival. At the end of the study, only 1 patient (2.5%) can be considered to be cured with no disease progression with a sufficient follow-up (52 months) after nephrectomy. CONCLUSION: Nephrectomy with resection of tumour thrombus from the inferior vena cava provides a gain in terms of medium-term survival, but the majority of patients are not cured by this major surgery. Only lymph node status has a prognostic value.

Abstract: OBJECTIVE: The objective of this study was to analyse the practices of general practitioners in the Loire-Atlantique region and their patients' knowledge about prostate cancer screening. MATERIAL AND METHODS: A "doctor" questionnaire focussing on prostate cancer screening practices was sent by mail to 1,086 general practitioners of the Loire-Atlantique region. "Patient" questionnaires were enclosed to be completed by 5 consecutive male patients over the age of 50. RESULTS: The doctor participation rate was 4.7%. Prostate cancer screening was performed by 98% of doctors. However 63% of doctors performed digital rectal examination and PSA annually, but only 27% in the specific age-group from 50 to 75 years. The "patient" questionnaire was completed in 233 cases. 88% of patients were informed about prostate cancer screening, essentially by their doctor or the media. 33% of patients indicated digital rectal examination and 23% indicated PSA as prostate cancer screening methods. Only 33% of patients declared to know one of the treatments for prostate cancer, reporting surgery in 78% of cases and radiotherapy in 32% of cases. CONCLUSION: General practitioners answering the questionnaire performed prostate cancer screening, but according to AFU guidelines only in 1/3 of cases. The majority of patients considered that they had been informed about prostate cancer screening, but with many imperfections.

Abstract: Protection of urinary anastomoses using a ureteral catheter is a frequent option in urology but such use in a systematic manner remains debated in renal transplantation. Some consider that systematic insertion of a double J sound decreases the incidence of ureteral complications (fistula and stenosis). Others who prefer a selective use in some situations with a related risk consider that the implementation of a double J catheter cannot compensate a technical defect. It is even responsible for specific complications (infections, incrustation, haemorrhages); it increases implantation costs and is useless in more than 90% of the cases. This article analyses the risks related to systematic implementation of a double J catheter in Lich-Gregoir ureterovesical anastomoses for renal transplantation, together with the related costs and the infectious risk. The benefits in terms of prevention of ureteral complications are evaluated.