Crown for the 303 Study GroupPurpose: This phase III study compared docetaxel and doxorubicin in patients with metastatic breast cancer who had received previous alkylating agent-containing chemotherapy.Patients and Methods: Patients were randomized to receive an intravenous infusion of docetaxel 100 mg/m 2 or doxorubicin 75 mg/m 2 every 3 weeks for a maximum of seven treatment cycles.Results: A total of 326 patients were randomized, 165 to receive doxorubicin and 161 to receive docetaxel. Overall, docetaxel produced a significantly higher rate of objective response than did doxorubicin (47.8% v 33.3%; P ‫؍‬ .008). Docetaxel was also significantly more active than doxorubicin in patients with negative prognostic factors, such as visceral metastases (objective response, 46% v 29%) and resistance to prior chemotherapy (47% v 25%). Median time to progression was longer in the docetaxel group (26 weeks v 21 weeks; difference not significant). Median overall survival was similar in the two groups (docetaxel, 15 months; doxorubicin, 14 months). There was one death due to infection in each group, and an additional four deaths due to cardiotoxicity in the doxorubicin group. Although neutropenia was similar in both groups, febrile neutropenia and severe infection occurred more frequently in the doxorubicin group. For severe nonhematologic toxicity, the incidences of cardiac toxicity, nausea, vomiting, and stomatitis were higher among patients receiving doxorubicin, whereas diarrhea, neuropathy, fluid retention, and skin and nail changes were higher among patients receiving docetaxel.Conclusion: The observed differences in activity and toxicity profiles provide a basis for therapy choice and confirms the rationale for combination studies in early breast cancer.

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There are four papers in this section, from Turkey, Japan and two from Brazil. The topics dealt with are VUR, PUJ and vesico‐ureteric junction obstruction, the non‐pharmocological treatment of lower urinary tract dysfunction, and laparoscopic nephrectomy for Wilms’ tumour after chemotherapy. OBJECTIVE To report the results of laparoscopic nephrectomy for unilateral Wilms’ tumour in children treated with chemotherapy before surgery. PATIENTS AND METHODS Eight children with unilateral nonmetastatic Wilms’ tumour included in the International Society of Pediatric Oncology 2001 protocol were treated with vincristine/actinomycin D and then had laparoscopic nephrectomy and lymph‐node sampling. A Veress needle puncture was made and a four‐trocar transperitoneal approach was used in all cases. The tumour was extracted with no morcellation through a Pfannenstiel incision. RESULTS All eight tumours were completely removed, with lymph node samples; intraoperative bleeding was minimal (50 mL). There were no complications after surgery and patients were discharged after 2–3 days. No recurrences of disease, port‐site implantation or long‐term complications were detected. CONCLUSIONS Laparoscopic nephrectomy for unilateral Wilms’ tumour is feasible in children after chemotherapy; it is safe and allows the complete surgical approach required for treating this tumour. Although the patients had a good long‐term follow‐up, more patients are needed to compare the results of laparoscopic techniques with open surgery.

The role of minimally invasive surgery for the treatment of pediatric urological tumors has been limited to biopsies and resection for small neuroblastomas and benign tumors. The purpose of this study is to present the experience of a Brazilian group pioneering laparoscopic nephrectomy for Wilms' tumor. A total of 15 children with unilateral non-metastatic Wilms' tumor were preoperatively treated with vincristine and actinomycin D, and afterwards were submitted to laparoscopic nephrectomy and lymph node sampling. A Veress needle umbilical punction was performed and a four-trocar transperitoneal approach was used. The tumor was extracted inside a plastic bag and without morcellation through a Pfannenstiel incision. In all 15 patients the tumor was completely removed, as well as lymph node samples and no ruptures occurred. A fibrous capsule involved the tumor, making the dissection easy to perform. Intraoperative bleeding was minimal. The postoperative course was free of complications and all the patients were discharged early. No recurrences or long-term complications have been detected in 7-61 months or more of follow-up. We conclude that laparoscopic nephrectomy for Wilms' tumor is a feasible and safe procedure in a selected group of children after chemotherapy. It reproduces all the steps of the open surgical approach required to treat this tumor, with the advantages of a short hospital stay and cosmetically more acceptable incisions.

Tumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management.

Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP) and with the extraperitoneal LRP (ELRP) during the learning curve (LC). Materials and Methods: Data of the initial 40 TLRP (Group 1) were retrospectively compared with the initial 40 ELRP (Group 2). Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001) and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001) were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5%) represented by one case of bleeding and one case of rectal injury, whereas four complications (10%) were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675). Open conversion occurred once in each Group (2.5%). Overall postoperative complications were similar (52.5% x 35%; p = 0.365). Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary), leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.Key words: prostate�� prostatic neoplasms�� prostatectomy�� laparoscopy prostate�� prostatic neoplasms�� prostatectomy�� laparoscopy Int Braz J Urol. 2010; 36: 450-7

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