Presentation of two cases of imperforate anus managed in infancy. In first case, at age of 19, surgical closure of recto-urethral fistula associated to excision of a rectal pouch complicated with infected lithiasis and renal damage provides definitive therapy. In second case, recto-urethral fistula was well tolerated for more than 50 years without renal damage. Simple removal of a prostatic lithiasis partially obstructing fistula, provided fair good result. Etiology of these fistulae, well known in pediatric patients, is then discussed. Management must be adapted to complaints and risks.
5091 Background: Renal cell carcinoma (RCC) occurs twice as often in men as in women; however, the influence of gender on stage, grade, subtype and survival has not been studied in detail. If this imbalance in RCC incidence was related to gender-specific hormone levels, age could be a further significant variable. Methods: This study included 5,654 patients treated by nephrectomy at 10 international academic centers. Differences in gender, age, T, N, and M stage, Fuhrman grade, and histological subtype were evaluated with chi- square and Student’s t-tests. Kaplan-Meier survival estimates and Cox proportional hazards models addressed the impact of gender and age on disease-specific survival (DSS). Results: Of the 5,654 patients, 3,777 (67%) were men and 1,877 (33%) were women. Generally, women presented at lower T stages (p<0.001), less frequently had distant metastases (p<0.001) and had lower grade tumors (p<0.001). In addition, women more frequently had clear-cell (87% vs. 82%) and less frequently had papillary RCC (7% vs. 12%) than men (p<0.001). As a group, women had a 19% reduced risk of death from RCC than men (HR 0.81, 95% CI 0.73–0.90, p<0.001). Interestingly, the survival advantage for women was present to the greatest degree in the age group <40 years (p=0.0136), was intermediate in women aged 40–59 (p<0.001), and disappeared in patients aged 60 years and older (p=0.248). Among women, age was an independent predictor of DSS in multivariate analysis (HR 1.011, 95% CI 1.004–1.019, p=0.004). In contrast, age was not related to prognosis in men. Conclusions: Among women, age is an independent prognostic factor of DSS with the risk of RCC-specific death increasing by 1% with each year increase in age. As a group, women present with less advanced tumors, leading to a 19% reduced risk of RCC-specific death compared with men. This survival difference is present only in patients aged <60 years, but disappears in older patients. Since this gender based survival difference is not related to T, N, M stage, ECOG PS, or histological subtype, the role of estrogen on the development and progression of RCC needs to be studied. If a true estrogen effect on RCC does exists then the potential for hormone-targeted therapy in women will also need to be investigated. No significant financial relationships to disclose.
