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The prostate biopsy is a current and well-codified act. To date, there have been no reported risks of viral transmission between patients linked to contaminated ultrasound probe. We report the case of a patient having contracted the virus of hepatitis C after transrectal prostate biopsy during an individual screening of prostate cancer., (Copyright © 2013. Published by Elsevier Masson SAS.)

Prostate biopsy is a current and well-codified procedure; antibiotic prophylaxis and rectal enema limit the risk of infection. To date, there has been no reported viral transmission between patients due to a contaminated ultrasound probe. In this study, we report the case of a patient who contracted the hepatitis C virus after transrectal prostate biopsy as part of an individual screening for prostate cancer.

Background: The robot-assisted laparoscopic approach for radical prostatectomy (RARP) is being performed increasingly worldwide to treat localized prostate cancer (PCa). The aim of this study was to compare the learning curves of two surgeons with different surgical experiences., Methods: A prospective collection of peri-operative data was made: age, body mass index, PSA, clinical stage, biopsy Gleason score, operative time (OT), blood loss (BL), pathological stages, final Gleason scores, and complications. Patients were included, in two groups. The first group comprised the first 100 patients undergoing RARP by an expert laparoscopic surgeon. The second group of 100 patients was operated on by a junior surgeon without robotic console experience. Post-operative complications were defined according to the Clavien grading system for surgical morbidity, Results: For groups 1 and 2 median age was 63 and 62 years, respectively; median pre-operative PSA level was 10 and 8, respectively; the median BMI was 24 and 25, respectively. The median operative time (OT) was 179 and 160 min, respectively (p > 0.05); and median blood loss was 217 and 346 ml, respectively (p = 0.04). The overall transfusion rate was 1.5% and two major complications were recorded in group 1 and four in group 2., Conclusions: RARP is safe and reproducible even during the initial learning curve. Overcoming the learning curve is multifactorial and is necessarily dependent on the surgeon. However, joining a well-trained team probably affects positively the performance of the surgeon. The value of expert centers to train new surgeons to RARP needs to be evaluated., (Copyright © 2011 John Wiley & Sons, Ltd.)

Background: A robot-assisted laparoscopic approach for radical prostatectomy (RALRP) is being adopted increasingly worldwide for the treatment of localized prostate cancer (CaP). Complications assessment is essential to the objective evaluation of any new procedure. This study aimed to assess the perioperative complications encountered during the implementation of a robot-assisted urologic surgery program., Methods: A prospective data collection for all men with a diagnosis of CaP who underwent RALRP between 2005 and 2009 in our department was achieved. Together with perioperative data, all the perioperative complications encountered were specifically recorded, including robot dysfunctions. The RALRP was performed with the three-arm Da Vinci system using a transperitoneal approach with six ports. To assess the perioperative complications, the validated Clavien-Dindo classification of surgical procedures was used. Two surgeons were involved in these procedures. A modified Clavien-Dindo classification also was used to account for intraoperative complications., Results: According to the Clavien-Dindo classification, 16 complications (6.7% complication rate) were recorded during the first 240 procedures. Besides postoperative complications, five procedures (2.1%) were directly affected by robot malfunctions without notable consequences for the patients. Considering these five additional complications, an 8.8% complication rate was recorded using a modified Clavien-Dindo classification. The main limitation of the study was its design restricted to RALRP procedures alone. The second limitation was that the authors' modified classification needs to be validated with a larger series and for different surgical procedures., Conclusions: The findings show that RALRP is a safe alternative to classical surgery and that the robotic approach is reliable. The authors believe that the reliability of technological devices should be systematically discussed when outcome analysis of a new procedure is performed.

The authors report the case of a patient aged of 27 years who presented in the past a testicular torsion with loss of the ipsilateral testis and fixation of the contralateral one. Ten years later, he presented with pain on the remaining testis, which evolved to necrosis, and led to a second orchidectomy. In retrospective, it appears that the assumption that the testis had been adequately fixed ten years earlier led to the loss of the remaining testis. We thus recommend an urgent surgical exploration when facing a suspicion of spermatic cord torsion, regardless of previous history of orchidopexy., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Peyronie's disease (PD) is due to a fibrotic plaque forms in the tunica albuginea layer of the penis. It is responsible of penile pain, angulation, and erectile dysfunction. Even though the aetiology remains unknown, the knowledge of the pathophysiology has evolved in recent years. Recent studies indicate that PD has prevalence of 3 to 9% in adult men. During the initial acute phase (6 to 18 months), the condition may progress, stabilize or regress in 20%. Therefore, a conservative treatment approach has been advocated. An initial discussion about evaluation, information, and reassurance is necessary in most cases. The most commonly employed oral therapies include tocopherol (vitamin E), and para-aminobenzoate (Potaba), which have failed to demonstrate efficiency. Intralesional injection therapies with interferon alpha-2B, verapamil are frequently used as a first-line treatment modality, and can provide an improvement in decreasing penile pain and penile curvature. Current literature has shown that extracorporeal shock wave lithotripsy was only active on the pain. Regarding penile curvature, there are discrepancies in the published series. The surgical approach is restricted to men unresponsive to nonoperative therapies (i.e., 10% of patients). In such cases, plication, grafting or even penile prosthesis implantation are conceivable management options., ((c) 2009 Elsevier Masson SAS. All rights reserved.)

The management of ureteropelvic junction (UPJ) obstruction has evolved over the past 20 years in response to the development of new technology. Open surgery is still the reference standard against which all other surgical interventions must be measured. The surgical approach has, however, gone through rapid changes, and the open procedure initially described has evolved considerably. Endoscopic and laparoscopic approaches have largely supplanted open pyeloplasty for the majority of primary ureteropelvic junction obstruction cases. Laparoscopic approaches provide a balance between a highly successful technique in all patients and improved postoperative recovery. It has been shown to improve postoperative outcomes with shorter recovery times and hospital stays, and to provide equivalent functional results with a success rate of 95%. Nevertheless, laparoscopic pyeloplasty is not a simple procedure. There are a certain number of disadvantages, such as the limited range of laparoscopic instrument movement, the two dimensional image, the unfamiliar hand-eye coordination and the relatively inefficient ergonomic position. Since 2000, however, robots have provided a magnified three-dimensional view giving a greater degree of freedom. This system has simplified suturing and has improved precision of the operating technique. However, the system is very expensive and, providing it is available in their institution, it seems easier for beginners to learn the robotic technique. Additionally, it has similar success rates (both radiological and clinical) to those obtained with open techniques.

From 2000, the robot-assisted laparoscopic approach has been developed for the management of ureteropelvic junction obstruction (UJO) with equivalent outcomes to conventional laparoscopic access regarding functional results. This system has simplified the suturing and has improved the precision of operative technique. The main surgical steps of the transperitoneal laparoscopic robot-assisted pyeloplasty are as follows: four or five port arrangement; initial dissection and early identification of the ureteropelvic junction; renal pelvis section; transection of the ureter and preparation of a spatula; continuous posterior suture; confection of a handle racket suture; placement of a double J stent; ending of the anastomosis. Outcomes after robotic and pure laparoscopic pyeloplasties are equivalent nowadays. Despite the financial cost, it seems easier and technically feasible and accessible for surgeons accustomed to the laparoscopic techniques and even beginners to learn the robotic technique if the system is available in their institution with success rate (radiologic and clinical) almost similar with those obtain with open techniques.

Prevalence of erectile dysfunction (ED) has a higher incidence in patients treated for diabetes mellitus as it concerns more than 30% of them. ED's physiopathology is complex and multifactorial, involving a combination of classical risk factors (endothelial dysfunction), specific factors (e.g., diabetic neuropathy) and psychological factors. ED is most often forewarning a cardiovascular disease. Therefore, it needs to be detected by the physician who is taking care of the diabetic patient. ED is responsible for a deterioration of the quality of life. Therapeutic management relies, on one hand, on specific measures such as prevention of diabetic complications and, on the other hand, on psychological accompaniment of the patient. Phosphodiesterase-5 inhibitors have become the first-line treatment as they are efficient and safe in most cases. As a second line, intracavernous injections remain a gold-standard treatment but the vacuum can be proposed as well. In case of failure, penile prosthesis can even be considered. The psychological dimension of ED has to be considered as much as organic matters.

Purpose: To assess the effectiveness of robot-assisted pyeloplasty in patients with clinically symptomatic ureteropelvic junction obstruction (UPJO)., Patients and Methods: We retrospectively reviewed our database for all patients who were treated for UPJO by a single surgeon using a robot-assisted procedure between 2005 and 2007. We collected the following: Patient age, clinical presentation, perioperative data, complications, length of hospital stay, and outcome. Preoperative evaluation of UPJO always included an injected renal CT scan and furosemide-mercaptoacetyltriglycine (MAG-3) renal scintigraphy. Patients were seen at 3 and 6 months after surgery and once a year thereafter. Postoperative success was defined as symptomatic response and radiographic evidence of no further obstruction., Results: Twenty patients with a mean age of 36.8 +/- 16 years (range 15-69 yr) were included. Six (30%) patients had previously undergone endoscopic treatment. The mean operative time was 150.3 +/- 36.22 minutes (range 150-240 min). The mean follow-up was 19.9 +/- 10.03 months (range 3-37 mos). Two (10%) procedures necessitated conversion to laparoscopic procedures, and there was no conversion to laparotomy. Four (20%) patients experienced minor complications: Two urinary tract infections and two urinomas. Repeated early surgery was needed in one patient for temporary (ie, 8 days) stent placement in the case of urinoma. There was no recurrence of the UPJO, and no repeated surgery was deemed necessary during the follow-up period. The success rate was estimated to be 95%., Conclusions: Functional outcomes after robot-assisted procedures for alleviation of UPJO are very promising. Our data showed that the robot-assisted procedure was safe and featured negligible morbidity. Therefore, we conclude that our approach is a viable alternative to open surgery.

The study was performed to determine factors affecting successful sperm retrieval by testicular sperm extraction in patients with nonmosaic Klinefelter's syndrome (KS). From May 2001 to February 2007, 27 azoospermic patients were diagnosed as having nonmosaic KS. All patients underwent sperm testicular extraction. Patient's age, testicular volume, serum follicle-stimulating hormone (FSH) and inhibin B were assessed as predictive factors for successful sperm recovery. Of the 27 Klinefelter's patients examined, eight (29.6%) had successful sperm recovery. The comparisons of serum FSH, inhibin B and testicular volume between patients with and without successful sperm retrieval did not show any statistical significance. The patients with successful sperm recovery were significantly younger (28.6 +/- 3.11 years) than those with failed attempts (33.9 +/- 4.5 years, P = 0.002). The rate of positive sperm retrieval was significantly higher in patients younger than 32 years compared with patients older than 32 years (P = 0.01, chi-squared test). The study showed that clinical parameters such as FSH, inhibin B and testicular volume do not have predictive value for sperm recovery in patients with KS. The mean age of our patients with successful sperm recovery was significantly lower than that of men with unsuccessful results. Testicular sperm extraction or testicular sperm aspiration should be performed before the critical age of 32 years.

The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques.

Erectile dysfunction (ED) has a higher incidence in patients treated for chronic renal insufficiency or in patients who underwent kidney transplanation as it concerns more than 50% of them. Its severity is directly linked with the seriousness of the renal disease. ED is responsible of a deterioration of the quality of life. ED's physiopathology is complex and multifactorial, involving a combination of classical risk factors (endothelial dysfunction), specific factors (e.g., chronic hyperuremia and co-morbidities) and psychological factors. Management of ED must take into account both sides of the disease in order to propose appropriate treatment; i.e, psychological concerns and organic matters. Although literature remains poor in this area, phosphodiesterase-5 inhibitors are increasingly used for these patients as they are safe and efficient most of the time. Pharmacokinetics of phosphodiesterase-5 inhibitors can be disturbed by the simultaneous use of immunosuppressor. As a second line, intra-cavernous injections remain a gold-standard treatment. In case of failure, penile prosthesis can even be considered in case of renal chronic insufficiency and in transplanted patients.

Purpose: The purpose of this article is to report our experience concerning the indications and results for combined liver-kidney transplantation in our centre., Material and Method: From July 1991 to October 2006, 26 patients underwent combined liver-kidney transplantation in our establishment. This group comprised 16 men and 10 women with a mean age of 50.1 years (range: 19 to 68 years). The main indications were as follows: hepatorenal polycystic disease, type I hyperoxaluria, cirrhosis associated with end-stage renal failure., Result: The median follow-up was 62.73 (+/-50.9) months. Only two patients of this series died, one at 70 months from gastric cancer, and the other at 89 months from cerebral metastases. Nine patients developed surgical complications (29%). Liver function was normal in the 24 surviving patients. Only one case of loss of renal graft was observed at 12 years and this patient is currently on dialysis. The mean creatinine level in these patients (apart from the dialysed patient) at the last follow-up visit was 120.3 (+/-30.43)micromol/l., Conclusion: Combined liver-kidney transplantation can be performed with acceptable morbidity and mortality and excellent long-term results.

Objective: The objective of this study was to evaluate the results of S3 sacral neuromodulation on certain voiding disorders (overactive bladder and chronic retention) and its impact on the sexuality of these patients., Material and Method: A S3 sacral root neuromodulator was implanted in 41 patients with a mean of age of 53 years between January 1999 and March 2004. This study comprised two groups: one group composed of patients with overactive bladder (32 subjects) and the other composed of patients with chronic retention without obstruction (nine subjects)., Results: The mean follow-up of this study was 34 months (range: 12 to 72 months). In the group of patients with overactive bladder, after the operation, the daily voiding frequency decreased from 20.8 to 7.8 (p<0.0001), episodes of incontinence decreased from 3.7 to 1.4 per day (p<0.0001), the number of pads decreased from 2.5 to 1 per day (p<0.001) and 72% of these patients reported an improvement of their continence time. In the group with chronic retention, the number of intermittent self-catheterizations decreased from 4.77 to 0.44 per day (p=0.0169) and 72% of these patients resumed spontaneous voiding (7/9). Among this patient population, 41.5% reported sexual problems, which were improved after implantation of the neurostimulator in 41.2% of cases., Conclusion: In the light of these results, sacral neuromodulation appears to be an effective treatment for certain refractory chronic voiding disorders such as overactive bladder and chronic retention without obstructive syndrome. This study showed that improvement of clinical signs could have a positive impact on the sexuality of these patients, especially for patients with chronic retention without obstruction.

Introduction: Prolapse is a common disease with a multifactorial aetiology that may be either isolated or associated with other pelviperineal defects. Surgical reconstruction of the infravesical anterior segment by isolated colpomyorraphy of prolapse is often disappointing with a recurrence rate of 40% according to the literature. Several procedures, consisting of strengthening of the anterior vaginal wall have been proposed. The use of prosthetic material has revolutionized the treatment of cystocele with a reduction of the recurrence rate but at the price of a poorly defined morbidity. Few published studies have assessed the use of xenogeneic tissue in the treatment of anterior vaginal prolapse. The objective of this study was to demonstrate the feasibility, morbidity and short-term results of the use of Pelvicol reticulated collagen mesh in the treatment of cystoceles., Objective: To demonstrate the feasibility and short-term results of the transvaginal treatment of cystoceles using collagen implant transobturator (TO) fixation. Many new prosthesis-based techniques are designed to decrease recurrences after repair without prosthesis, but they are often non-standardized, with inadequate evaluation and insufficient follow-up. In contrast with synthetic material, few published studies have investigated the use of xenogeneic tissue., Patients and Methods: Twenty-eight patients with a mean age of 70.6 years (range: 53-84) with grade 2 and 3 cystocele and a history of transvaginal prolapse repair in 7 cases, were operated by 2 operators according to an identical technique: the bladder was dissected via a transvaginal approach and a 4 x 7 cm porcine dermis collagen prosthesis was then placed underneath the bladder and fixed, at its anterolateral angles via a TO approach to the midline suburethral part by a resorbable suture. Vaginal hysterectomy was associated in 11 cases., Results: The mean specific prosthesis insertion time was 25 minutes. No intraoperative complication and no serious bleeding were reported. The mean hospital stay was 3.6 days (range: 2-9). The mean follow-up was 8 months (range: 6-16). One case of mesh expulsion was observed on D15, followed by complete healing without recurrence of the cystocele. One case of slight pain of the medial aspect of the thigh was observed with a favourable secondary outcome. The postoperative anatomical results showed complete repair of the prolapse at 1 month and on review. Two cases of de novo SUI were treated by transobturator suburethral tape with a good postoperative result., Conclusion: The technique is feasible, simple, safe and ensures very satisfactory short-term results. Follow-up of these patients will be continued.

Study Objective: To evaluate the aesthetic benefit of lumboscopy versus lumbotomy in a group of patients undergoing pyeloplasty., Material and Method: A telephone survey was conducted in 103 people operated by pyeloplasty via lumboscopy or lumbotomy. The questions concerned the appearance of the scar (size, relief; visible or invisible), skin complications, satisfaction with the scar, postoperative pain, length of hospital stay and return to physical activity or work., Results: The response rate was 58.2% corresponding to 32 lumboscopies and 29 lumbotomies. Lumboscopy scars were shorter (2.7 vs 15.6 cm for lumbotomies, p<0.001). Lumbotomy scars were palpable in 75% of cases versus 53.1% of lumboscopy scars of (p=0.037). Almost 96.5% of lumbotomy scars were visible versus only 68.7% of lumboscopy scars (p=0.0057). Lumbotomies were complicated by incisional hernia in 14.2% of cases, while no incisional hernias were observed in the lumboscopy group (p=0.02). 85% of patients were satisfied with their scars in the lumboscopy group versus 56% of patients operated by lumbotomy (p=0.0286)., Conclusion: This study showed a statistically significant difference in terms of a purely aesthetic benefit and scar solidity in favour of lumboscopy, which supports the growing place of this surgical technique in urology.

The authors report a case of fibro-epithelial polyp in a young woman with Turner syndrome with features of a right ureteropelvic junction syndrome in a horseshoe kidney. The patient presented a history of chronic low back pain associated with macroscopic haematuria leading to various complementary investigations including ureteroscopy. The endoscopic appearance of the tumour suggested the diagnosis despite the presence of atypical renal pelvis cytology. Pyeloplasty and proximal ureterectomy allowed confirmation and treatment of this rare lesion.