Pathologic Nodal Staging Score for Bladder Cancer: A Decision Tool for Adjuvant Therapy After Radical Cystectomy

Background

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard of care for high-risk non–muscle-invasive and muscle-invasive bladder cancer (BCa).

Objective

To develop a model that allows quantification of the likelihood that a pathologically node-negative patient has, indeed, no positive nodes.

Design, setting, and participants

We analyzed data from 4335 patients treated with RC and PLND without neoadjuvant chemotherapy at 12 international academic centers.

Interventions

Patients underwent RC and PLND.

Outcome measurements and statistical analysis

We estimated the sensitivity of pathologic nodal staging using a beta-binomial model and developed a pathologic (postoperative) nodal staging score (pNSS) that represents the probability that a patient is correctly staged as node negative as a function of the number of examined nodes.

Results and limitations

Overall, the probability of missing a positive node decreases with the increasing number of nodes examined (52% if 3 nodes are examined, 40% if 5 are examined, and 26% if 10 are examined). The proportion of having a positive node increased proportionally with advancing pathologic T stage and lymphovascular invasion (LVI). Patients with LVI who had 25 examined nodes would have a pNSS of 80% (pT1), 88% (pT2), and 66% (pT3–T4), whereas 10 examined nodes were sufficient for pNSS exceeding 90% in patients without LVI and pT0–T2 tumors. This study is limited because of its retrospective design and multicenter nature.

Conclusions

We developed a tool that estimates the likelihood of lymph node (LN) metastasis in BCa patients treated with RC by evaluating the number of examined nodes, the pathologic T stage, and LVI. The pNSS indicates the adequacy of nodal staging in LN-negative patients. This tool could help to refine clinical decision making regarding adjuvant chemotherapy, follow-up scheduling, and inclusion in clinical trials.     

Perineal recurrence of resected penile cancer. A case report]

The authors report an unusual case of perineal recurrence of squamous carcinoma of the penis in a 50-year-old, white man, circumcised during infancy and operated 5 years previously for stage T3N0M0 squamous carcinoma of the penis by total amputation of the penis. Clinical examination revealed a very large, infected perineal tumour associated with bilateral inguinal lymphadenopathy. This stage T4N2M0 tumour was treated palliatively by cystostomy, emasculation with perineal tumour reduction and antibiotics. The patient became afebrile and the infection resolved and was referred to the radiotherapy department for further treatment.     

Giant scrotal condyloma acuminata: a case report

In this study, the case has been reported of a scrotal tumor in a 50-year old male admitted with a large warty lesion at the base of the scrotum which resembled a giant condyloma accuminatum (Buschk-Lowenstein tumor). The HIV serology was negative, but the papillomavirus findings were positive. A complete resection of the tumor was performed. The histological findings confirmed the diagnosis of condyloma accuminatum without evidence of degenerative development into a squamous cell carcinoma. The clinical course was favorable, and no local recurrence was observed at 16 months follow-up. The problems that are frequently encountered in the diagnosis and therapy connected with this type of tumor have also been discussed.     

Retrovesical pseudocyst : difficult diagnosis of one case and literature review

Retrovesical localization of a cystic mass is rare. The authors report one observation of hematic retrovesical pseudocystic formation having a difficult diagnosis. In the light of this observation, different diagnostic patterns of cystic and pseudocystic retrovesical formation are discussed.     

Surgical complications of nephrectomy in living donors

Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.     

Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case

Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.     

Synthesis and characterization of some acrylic monomer/sulfur dioxide copolymers

The copolymerization of acrylic monomers (M) [acrolein (AL), methyl acrylate (MA), acrylamide (AM) and acrylonitrile (AN)] with liquid sulfur dioxide (S) at low temperature and high dilution in the presence of tert-butyl hydroperoxide gives high SO₂ incorporation into the resulting copolymers. Analysis of the composition of these polysulfones, by elemental analyses and ¹³C NMR, shows that they consist mostly of the MMM, SMM, MMS and MSM triad monomer sequences. Thermal (TG) analyses of selected samples demonstrate that their thermal stability, up to 30% weight loss, increases for different acrylic comonomers as follows: AL < AM < MA < AN. Preliminary flammability tests revealed that flame retardancy increases with increasing SO₂ content in the copolymer.     

Prostatic abscesses. A review]

We review the literature to the diagnosis and therapeutic aspect of prostatic abscess. The prostatic abscess having become an uncommon disease. The diagnosis of prostatic abscess has been nearly made by transrectal ultrasound and computed tomography scan. The best diagnostic method is considered to be the transrectal ultrasound. The choice therapy was intravenous antibiotic, and drainage by ultrasound guided transperineal percutaneous puncture.     

Bivalve anatrophic nephrolithotomy

PURPOSE: In the era of lithotripsy, surgery gets a limited place in the management of renal stones. This study has for a goal to evaluate the practice, indications and results of anatrophic nephrolithotomy in the treatment of staghorn calculi. PATIENTS AND METHODS: Between 1998 and 1999, six patients, mean age 37 years, had complete staghorn calculi treated by anatrophic nephrolithotomy, and two patients had a bilateral lithiasis. After lombar incision, the kidney was incised on the convexity after pedicular control. In this way, we have extracted all lithiases. The nephrorrhaphy permits hemostasis and parenchymal reparation. A ureteral stent was placed. RESULTS: The operatory follow-up was simple; hemostasis was controlled by fast extraction of the lithiasis and nephrorrhaphy. The operating time was 70 minutes (40-110). The stone free rate was 100% without alteration of renal function, patients with bilateral lithiasis have been operated twice time. CONCLUSION: The anatrophic nephrolithotomy is a safe technic without risk of haemorrhage or renal function alteration.     

Renal leiomyoma. Case report

The authors report a case of renal leiomyoma observed in a 56-year-old man. This cyst presented in the from of loin pain. Computed tomography revealed a homogeneous renal tumor. Treatment consisted of radical nephrectomy. Histological examination of the specimen showed benign renal leiomyoma.