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Objectives: The Francophone Society of Sexual Medicine (SFMS) and the Andrology and Sexual Medicine Committee (CAMS) of the French Association of Urology (AFU) have brought together a panel of experts to develop French recommendations for the management of testosterone deficiency (TD)., Methods: Systematic review of the literature between 01/2000 and 07/2019. Use of the method of recommendations for clinical practice (RPC) and the AGREE II grid., Results: TD is defined as the association of clinical signs and symptoms suggestive of TD with a decrease in testosterone levels or serum androgen activity. Diagnosis requires a T lower than the reference values in young men on 2 successive assays. Sexual disorders are often at the forefront, and concern the whole male sexual function (desire, arousal, pleasure and orgasm). The most evocative symptoms are: decrease in sexual desire, disappearance of nocturnal erections, fatigue, loss of muscle strength. Overweight, depressed mood, anxiety, irritability and malaise are also frequently found. TD is more common in cases of metabolic, cardiovascular, chronic, andrological diseases, and in cases of corticosteroid, opioid, antipsychotic, anticonvulsant, antiretroviral, or cancer treatment. Since SHBG is frequently abnormal, we recommend that free or bioavailable T is preferred over total T. The treatment of TD requires a prior clinical (DRE, breast examination) and biological (PSA, CBC) assessment. Contraindications to T treatment are: progressive prostate or breast cancer, severe heart failure or recent cardiovascular event, polycytemia, complicated BPH, paternity project. It is possible in cases of sleep apnea syndrome, psychiatric history, stable heart disease, prostate cancer under active surveillance and after one year of complete remission of a low or intermediate risk localized prostate cancer treated in a curative manner. It includes long-term testosterone supplementation and life-style counseling. Treatment is monitored at 3, 6, 12 months and annually thereafter. It is clinical (annual DRE) and biological (total T, PSA, CBC), the most frequent side effect being polyglobulia., Conclusion: These recommendations should help improve the management of TD., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: This review studies rationale and outcome of vulvovaginal aesthetic surgery., Method: Medline search of the existing literature utilizing terms labiaplasty, clitoral hood reduction, hymenoplasty, vaginoplasty, perineoplasty, female genital surgery, sexual satisfaction/body image, and anterior/posterior colporrhaphy; references from bibliographies of papers found through the literature search and in the author's reading of available literature until January 2012. Clinicians who receive requests from patients for such procedures should discuss with the patient the reason for request and perform an evaluation for any physical signs or symptoms that may indicate the need for surgical intervention., Results: A physical psychological and sexological evaluation is mandatory before a procedure of female cosmetic genital surgery. Perineoplasties in wide vagina sensations should be proposed after careful evaluation of patients, by trained surgeons, in part of a multidisciplinary approach especially sexologic, after attempt of conservative treatments (pelvic floor rehabilitation). Patients should be informed of results and complications. Female genital mutilation repair with surgery is possible and improve majority of patients. Improvement mechanism is complex and clinical trials are ongoing. Asking for this surgery, is more often result of a deep reflexion for patient who integrate his own story and those of her family. She should be listened to, respected and managed in a reference center. Sexotherapy should be systematically proposed. Concerning hymenoplasty, the procedure is considered as "legally" by medical doctors. Several techniques are available, few described, and there is no evidence-based publication. Labioplasty is a procedure whose patient expectations should be properly evaluated by surgeon and benefits risks should be informed. A preliminary discussion around "normality" and a psychotherapy should be tried, in order to not treat a dysmorphobia by surgery. Vaginal "rejuvenation" and G spot ampliation principles and techniques are very controversial and there is no evidence-based study., Conclusion: Cosmetic surgery of the female genitalia covers a variety of techniques corresponding to extremely diverse situations. It requires careful and multidisciplinary evaluation as well as clear and honest information of patients. Reconstructive surgery of female genital mutilation and sexual crimes does not pose a real problem in term of indication or justification., (Copyright © 2013. Published by Elsevier Masson SAS.)

Erectile dysfunction is not the only sexual dysfunction that impact quality of life of patients following radical prostatectomy for prostate cancer. Patients must be informed about these consequences and also about the prevention and treatment modalities that could be proposed after surgery. Preoperative erectile function and couple motivation are predictive of the quality of the sexual relationship after radical prostatectomy. A preoperative erectile dysfunction must be investigated as well as if it was the main symptom (evaluation of comorbidities, cardiovascular and psychological risk factors). The quality of the preservation of the neurovascular bundles is the other main determinant that must be decided according to cancer characteristics and performed according to a mastered surgical technic., (Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.)

Objective: The objective of this survey was to describe medical reasons disclosed by men over 18 years old when visiting an urologist, to estimate the prevalence of male sexual dysfunction (MSD) including erectile dysfunction (ED) and to describe treatment options for ED., Methods: This survey was performed, with Urology French Association (AFU) partnership, in 150 urological clinics, sample representative of urologists in France regarding age, geographical distribution and practice. The survey was proposed to all adults' men consulting a participating urologist the defined day (Tuesday the 19th of June 2007 or an imminent day). A total of 1848 (92.5%) patients agreed to participate; analysis was performed on 1740 patients. Information related to urological disorders, sexual dysfunctions, their treatment and their impact on the patient's life were gathered by a patient auto-questionnaire. Erectile dysfunction was assessed through the single question of John B. McKinlay., Results: Among patients (mean age 63+/-14 years), 68% (IC95%=[65.2%; 70.7%]) had ED (44% severe); 25% were treated (of which 2/3 with IPDE5 alone or in association). Male sexual dysfunction was the first reason for visiting urologists (14%) following prostatic diseases (62%). About 60% of the patients had already talked about their ED to a physician, who was an urologist in 44.6% of cases. The perspective of living the rest of their life with this trouble was "unacceptable" for 21.1% of patients with ED and "fairly acceptable" for 34.4%., Conclusions: This first survey in French urologists' community emphasizes the high prevalence male sexual dysfunctions for inpatients visiting their urologists. Despite declared urologists' interest for male sexual dysfunction, the discrepancy between the high prevalence of ED and the low rate of patients consulting for this condition probably explains the low rate of patients using treatments.

Introduction: In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be "borderline" represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant., Materials and Methods: Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol., Results: Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l at six months (creatinine clearance according to MDRD formula: 57.3 ml/min per 1.73 m2), 118.8 mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function., Conclusion: In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.

There is growing interest in the hormonal changes of the ageing male, particularly in view of the expected growth of the population of males over the age of 50. Current research topics essentially concern androgen decline in the aging male (ADAM), or partial androgen deficiency of the aging male (PADAM), commonly called "andropause" in France. Although progress has been made in our knowledge concerning androgen deficiency of the aging male, it is still incomplete, sometimes confused, and some aspects of androgen replacement therapy remain controversial. The International Society for the Study of the Aging Male (ISSAM) therefore considered it appropriate to propose a series of practical and official guidelines concerning the investigation, treatment and surveillance of late-onset hypogonadism in males. The French translation of these recent international guidelines is presented and discussed in this article.

A 57 year-old patient with localized pseudo-tumoral amyloidosis of bladder is described. There was no past medical history. Hematuria was the main symptom. The treatment consisted in transurethral resection. Two recurrences occurred at 4 and at 6 years which were also treated by resections. Clinical and biological evaluation was normal. Localized pseudo-tumoral amyloidosis of the urinary tract is a rare affection of good prognosis. Lesions present as pseudo-tumoral masses which can be biopsied without any risk of hematuria. Investigations are required to eliminate a generalized amyloidosis or a malignant lymphoproliferation. Treatment should be as conservative as possible.

The main technical procedures in percutaneous nephrolithotomy are the direct puncture of the diverticulum (precise puncture may be required to place the tract directly on to the stone), and treatment duration the diverticulum could be coagulated and a large nephrostomy catheter could be left in place two days. No complication was encountered. One patient refused the treatment after unsuccessful puncture. The nephrostomy tube was left open for two days of drainage. Mean hospital stay was 5 days. Three patients required E.S.W.L because of persistent symptoms. One month after treatment 13 of 18 patients intravenous urography showed obliteration of the diverticulum (72%); Three months after 84% (15/18) of our patients were stone free and 94% (17/18) symptom free. Percutaneous nephrolithotomy should be performed for symptomatic patients, it has low complication rate and should be reserved for patients with persistent symptoms after E.S.W.L.

14 patients (mean age: 57 years) with posterior urethral stricture were treated by internal urethrotomy and implantation of one or several Wallsten prostheses. The stent had to be removed in 2 patients (15%), while 12 patients (85%) obtained satisfactory urethral patency (mean follow-up: 17.5 months). Complications were observed in 50% of cases. They were able to be treated endoscopically with a satisfactory result in 5 out of 6 cases (intraprosthetic calculi or stenosis of the ends of the stent; 2 patients who became incontinent after insertion of the stent regained normal continence after insertion of an artificial sphincter above the stent. The Wallsten endoprosthesis therefore appears to be a very satisfactory treatment for recurrent complex strictures of the posterior urethra.

100 percutaneous endopyelotomies were performed in 95 patients from October 1985 to February 1991 to treat 46 cases of acquired stenosis and 54 cases of congenital hydronephrosis. The acquired stenoses were treated by scalpel incision, while the congenital hydronephrosis were generally treated by electrocautery. The evaluable results for 81 ureteric units with a mean follow-up of 37 months showed an overall success rate of 84%. No significant difference in the results was observed in relation to the patient's age, the technique used or the stage of the hydronephrosis (81% success rate): the results in the treatment of congenital hydronephrosis (86%) are slightly inferior to the results of surgical pyeloplasty.

27 patients with histologically proven prostatic carcinoma were investigated by magnetic resonance imaging (MRI) (0.5 Tesla) in order to determine the local spread of the cancer. These patients then underwent ilio-obturator lymph node dissection with frozen section examination, followed by radical prostatectomy. Histological examination of the resection specimens was performed on slides prepared from large transverse sections every 5 mn. The MRI examination was especially designed to confirm the diagnosis of capsular effraction based on the signals of the periprostatic fat (PF), periprostatic venous plexuses (PVP) and seminal vesicles (SV). An abnormality of at least one of these structures was considered to indicate the diagnosis of capsular effraction. The MRI data were compared to the histological findings. The results demonstrated a sensitivity of 62% for the PF signal, 52% for the PVP signal and 40% for the SV signal. The overall MRI-Histology correlation was found to be exact in 23 out of 27 cases (Accuracy = 85%). All of our four errors represented understaging (Sensitivity = 81%). When a rigorous methodology is respected, the high accuracy and sensitivity of MRI makes this modality an investigation of choice for the study of the prostatic capsule, as part of the routine staging of prostatic cancer. It should allow a better selection of patients with intracapsular cancer (T1-2), who constitute candidates for radical treatment.

In a series of 525 renal transplantations performed between January 1987 and September 1990, 5 patients (i.e. 1%) presented with vesical, sphincteric and urethral lesions which prevented classical uretero-vesical or uretero-ureteric reimplantation and functionally satisfactory vesico-sphincteric reconstruction. Under these conditions, in which drainage of the urine into the bladder was impossible, a diversion was created using a continent intestinal reservoir constructed prior to the graft. Four Kock pouches and one Mainz pouch were created during the months preceding renal transplantation with a cadavre kidney. A sixth patient, transplanted in 1981, had to undergo continent urinary diversion in February 1988 after a non-functional bladder augmentation for problems of bladder drainage. We did not observe any mortality or major medical or surgical complications. The follow-up after transplantation in the first 5 patients is now 3, 6, 10, 37 and 40 months. Renal function is normal in all 5 cases with serum creatinine below 130 mmol/l. For the sixth patient, the follow-up is 9 years after the transplantation and 32 months after the continent urinary diversion; serum creatinine is 200 mmol/l and stable since the urinary diversion. Continence is excellent and the comfort of all of the patients is undeniable. However, all patients present with bacteriuria with no symptomatic urinary tract infection.