Annales D Urologie最新文献

Kidney transplantation has become the treatment of choice for patients with end stage renal disease since it offers an excellent quality of life. Moreover, the economic impact is considerable, particularly beyond the first year. Indeed, the annual cost of a successful renal transplantation is ten fold lower than haemodialysis. But surgical complications remain one of our main concerns. Surgical complications are various. They may be non-specific as haematomas, incision-induced hernias and wound infections. They may also be directly related to the procedure as vascular thrombosis and urinary fistula in the early post-operative period or arterial stenosis and ureteral obstruction in the late post-operative period. The accurate diagnosis and the appropriate management of these complications are the most important tasks for the surgical team. This review is based upon our experience in kidney transplantation and upon the medical published data.

Born in the late 90s, robotic-assisted laparoscopy has today an exponential growth. It presents some disadvantages, the first of them being a very high cost, similarly to all new medical technologies. On the other hand, its advantages are very important and allow the open surgeon to apply his natural skills to the endoscopic approach, while recovering the 3-dimensional vision. Urology is the specialty that has the most benefited from this new technology. If this technique progresses as rapidly as computers, it is likely to become associated to new indications.

Kidney cancer occurs rarely and late in renal transplants. The lack of grafts and the increasing age of the cadaver donors are likely to result in an increasing number of such cancers. To date, the treatment of choice is the transplant removal. Nevertheless partial nephrectomy may be discussed in selected cases. Ultrasonographic screening should allow detection of low volume tumours suitable for partial nephrectomy. Alternative techniques (radiofrequency, cryoablation) are to be assessed in such patients.

Kidney transplantation has become the treatment of choice in end-stage chronic renal failure since it significantly improves both the quality of life and the life duration of affected patients, when compared with dialysis. Some of these better results that were observed over the last thirty years are obviously due to significant improvements in the quality of immunosuppression. In the first part of this chapter, the allo-immune response is schematically described regarding the various signals. Then, the mechanisms of action of the available or future immunosuppressive therapies are described in the same order as the allo-immune response. In the third part, the various combinations of immunosuppressive regimens are presented from a historical perspective, outlining not only the positive aspects of each class of drugs but also their side effects and consequences on the practical use of immunosuppression over time. Finally, a brief review of current and future perspectives regarding the improvement of both efficacy and tolerability of immunosuppression in kidney transplantation is presented.

Since the introduction of mini-invasive surgery approximately thirty years ago, laparoscopic surgery has significantly evolved both in terms of its extended field of application and of the tools used which were diversified and improved. More recently, the development of robotic-assisted laparoscopy has brought, among other improvements, three-dimensional vision, dexterity, and a comfortable working position, which have reduced the surgeon's fatigability, the difficulties related to the operations and the learning curves of standard laparoscopy. Urology, which makes slightly less use of standard laparoscopy than general or gynaecological surgery, largely benefits from robotics concerning the precision of movements, and has much increased the operating indications of laparoscopy, including the treatment of pyelo-ureteral junction, kidney tumourectomy, living donor nephrectomy and radical prostactectomy. This chapter describes the operative technique used for the treatment of the ureteropyelic junction stenosis by robotic-assisted laparoscopy, as carried out in Nancy University Hospital with the da Vinci robot (Intuitive Surgical).

Before radical prostatectomy, the pathologist analyzes the prostate biopsies. He has to affirm the diagnosis of cancer when present, and to provide prognosis parameters such as the Gleason score, the percentage of tumor, and to report an extraprostatic extension when present. After the radical prostatectomy, the pathologist has to analyze the surgical specimen. Two main features have to be reported including the tumor stage and the Gleason score