Les lésions urétérales iatrogènes peuvent succéder à toute chirurgie pelvienne. Elles sont graves pouvant mettre en jeu le pronostic fonctionnel du rein et même le pronostic vital. But du travail: est de préciser les aspects cliniques et les modalités thérapeutiques de cet accident. Il s’agit d’une étude rétrospective sur six observations de lésion urétérale iatrogène, après chirurgie gynécologique ou obstétricale, colligées dans le service d’urologie de Kairouan sur une période de 4 ans (2012-2016). L’âge moyen de nos patientes est de 46 ans. Elles sont toutes des multipares. La symptomatologie clinique est variable selon le type lésionnel. L’urographie intraveineuse demeure très utile au diagnostic, nous l’avons pratiqué dans 4 cas revenues toutes anormales. Le traitement a consisté en une montée de sonde dans un cas et 5 réimplantations urétéro-vésicales. Les suites opératoires sont émaillées par une néphrectomie. Les lésions urétérales iatrogènes sont devenues rares. Elles sont corrélées au degré de médicalisation du pays. La chirurgie gynécologique ou obstétricale est la plus grande pourvoyeuse. Leur pronostic est conditionné par la précocité du diagnostic et l’état anatomique de l’uretère.

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1077 Background: In MBC, positive HR constitute a favourable prognostic factor and predict response to an hormonal therapy. Conversely HER-2 overexpression is an adverse prognostic factor associated with a more aggressive tumor. In this retrospective study we analysed overall survival (OS) and disease-free interval (DFI) of three phenotypes: HR-/HER-2- (triple negative); HR+/HER-2- (luminal) and HER-2 overexpression (HER-2+). Methods: We evaluated 511 patients with a MBC treated at Centre Jean Perrin from 1973 to 2006. A comparative lecture of oestrogenic, progestative and HER-2 receptors was performed by IHC. At present, HR and HER-2 status were re-evaluated on 166 initial tumor sample of this data base by two pathologists (study currently ongoing). Median age of patients was 54.8 years. 120 (23.6%) patients were directly metastatic (M1), 391 (76.4%) relapsed distantly (M0). Metastatic patients received a median number of 2 lines of chemotherapy (range, 0–14) and/or a median number of 1 line (range, 0–8) of hormonotherapy. 92 (55.4%) patients had a luminal phenotype, 48 patients (28.9%) were HER-2+ and 26 patients (15.7%) were triple negative. Results: Among these 166 tumors, OS was significantly different between these three populations (p=0.00056). DFI variation was not signicant (p=0.083). These data showed that: - Luminal phenotype had the better OS (median survival of 36.5 months) and DFI (51.09 months) - HER-2+ phenotype (33 of 48 patients were treated with trastuzumab from 1999) had an intermediate prognostic on OS (median survival of 31.1 months) and DFI (42.2 months) - Triple negative phenotype had a poor prognostic on OS (median survival of 12.8 months) and the worse DFI (32.64 months) Conclusions: In metastatic breast cancer, luminal phenotype patients had the best OS; HER-2+ phenotype (treated by herceptin) had an intermediate OS, and triple negative phenotype had the worse OS. No significant financial relationships to disclose.

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