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In 2015, the French Association of Urology, by the male lower urinary tract symptoms Committee, published a practices guideline for the management of prostatic hyperplasia in general practice. Five years after the publication of these recommendation, our objective is to assess their dissemination and their impact in general practice.A specially designed questionnaire was distributed online via the departmental councils of the order and to all regional unions of liberal doctors. The distribution to general practitioners was at the discretion of each organisation depending on local policies.Two hundred and eighty responses were collected. Fifty-five percent of the population was female. 83 % of the general practitioners did not report having knowledge of the practice guideline. 77 % of doctors stated that they had not received training or information on prostatic hyperplasia in the past 5 years. Among the notable results, 51 % of general practitioners declared performing a digital rectal examination. 44 % prescribed an endorectal ultrasound. Only 7 % of doctors were aware of the existence of minimally invasive surgical techniques.The practices guideline for the management of prostatic hyperplasia in general practice proposed in 2015 by the male lower urinary tract symptoms Committee seems to be little known by general practitioners. Dissemination of these recommendations solely through publication in Progrès en Urologie seems ill-suited to consideration by general practitioners, and it seems necessary to consider other modes of dissemination.4, grade C.

Flowering date is a trait of main interest in perennial fruit species including sweet cherry (Prunus avium L.). It is highly dependent on the environment and has a major impact on fruit formation: as already observed, a poor synchronization between flowering date and the environmental conditions can lead to significant economic losses. Understanding the genetic determinism of the flowering date is therefore essential to optimize selection strategies and create new varieties better adapted to future climatic conditions.The first objective of this thesis is to study the genotype-by-environment (G × E) and QTL-by-environment (QTL × E) interactions. To do this, an intra-specific population called 'Regina' × 'Lapins' (n = 122) was planted in five locations with contrasting climates distributed in four European countries. It was thus possible to identify two major QTLs. The first one, located on linkage group 4, is found in all environments except the site located in Murcia (Spain), characterized by the highest temperatures. In the latter environment, the major QTL is localized on linkage group 1. Highly significant G×E and QTL×E interactions were assessed using different statistical models.The second objective of this thesis is to fine-map the QTL on linkage group 4 using a second population, 'Regina' x 'Garnet' (n = 1386). This QTL, very stable across years, explains the most important part of the phenotypic variation in this plant material. This QTL was detected in a 68-kb interval, containing twelve candidate genes that were functionally characterized using the new cherry genome sequence of the cultivar 'Regina'. In addition, their expression was studied in 'Regina' and 'Garnet' cultivars during the period from dormancy to flowering, leading to the identification of a few promising candidates. Also, two KASP markers have been developed and validated on different genetic backgrounds and can be used in marker-assisted selection (MAS) for flowering date.In the long term, these results should help breeders to create new varieties that are well adapted to their planting site and to ensure the production of sweet cherries in geographical areas covering a wide range of climates., La date de floraison est un caractère d’intérêt majeur chez les espèces pérennes fruitières dont le cerisier (Prunus avium L.). Elle est très dépendante de l’environnement et a un impact majeur sur la formation des fruits : comme déjà observé, une mauvaise adéquation entre la date de floraison et les conditions environnementales peut entrainer d’importantes pertes économiques. La compréhension du déterminisme génétique de la date de floraison est donc primordiale pour optimiser les stratégies de sélection et créer de nouvelles variétés mieux adaptées aux conditions climatiques futures.Le premier objectif de cette thèse est d’étudier les interactions génotype x environnement (G × E) et QTL x environnement (QTL × E). Pour ce faire, une population intra-spécifique ‘Regina’ × ‘Lapins’ (n = 122) a été implantée dans cinq sites aux climats contrastés répartis dans quatre pays d’Europe. Il a ainsi été possible d’identifier deux QTL majeurs. Le premier, localisé sur le groupe de liaison 4, est trouvé dans tous les environnements sauf celui caractérisé par les températures les plus élevées (Murcie, en Espagne). Dans ce dernier environnement, le QTL majeur est localisé sur le groupe de liaison 1. Des interactions G × E et QTL × E fortement significatives ont été évaluées au moyen de différents modèles statistiques.Le second objectif de cette thèse est de cartographier finement le QTL du groupe de liaison 4 en utilisant une seconde population, ‘Regina’ x ‘Garnet’ (n = 1386). Ce QTL très stable, détecté durant toutes les années étudiées, explique la part la plus importante de la variance phénotypique dans ce matériel végétal. Ce QTL a pu être localisé dans un intervalle de 68kb, contenant douze gènes candidats caractérisés fonctionnellement en utilisant la nouvelle séquence du génome du cerisier issue du cultivar ‘Regina’. De plus, leur expression a été étudiée chez les cultivars ‘Regina’ et ‘Garnet’ au cours de la période allant de l’entrée en dormance jusqu’à la floraison, permettant d’identifier quelques candidats prometteurs. Aussi, deux marqueurs de type KASP ont été développés et validés sur différents fonds génétiques, et pourront être utilisés en sélection assistée par marqueurs (SAM) pour la date de floraison.A terme, l’ensemble de ces résultats devrait contribuer à accroître l’efficacité des programmes de sélection afin de créer de nouvelles variétés bien adaptées à leur site de plantation et d’assurer la production de cerises dans des zones géographiques couvrant une large gamme de climats.

To evaluate the educational impact of a pilot MOOC (Massive Open Online Course), validated by the French College of Urology Teachers (FCUT), on the surgical technique of kidney transplantation.We developed a MOOC on the surgical technique of kidney transplantation, based on a video of a surgical procedure, performed by an expert surgeon. The MOOC has been validated by the FCUT. We have created 2 student groups: 1) MOOC-pre-QCM group: visualization of the MOOC then answer to the MCQs and satisfaction questions; 2) MOOC-post-QCM group: answer to the MCQs then visualization of the MOOC then answers to the satisfaction questions. In total, 20 MCQs on the kidney transplantation technique were completed by the 2 groups. The answers were anonymous.A total of 142 people answered the MCQs (MOOC-pre-QCM group (n=66) and MOOC-post-QCM group (n=76)). Twenty-nine percent (41/142) of the participants were fellows and 71 % (101/142) were residents. The proportion of fellows and residents was identical between the 2 groups. The rate of correct answers to the 20 MCQs was statistically higher in the MOOC-pre-QCM group, compared to the MOOC-post-QCM group (88.6 % versus 73.3 %, P0.0001). Ninety-one percent of students found the MOOC "Very Useful" or "Useful". The median MOOC rating, given by students, was 8/10.This study showed a positive impact of the MOOC on theoretical knowledge of kidney transplantation surgical technique. This MOOC could serve as a pilot project for the development of other MOOCs on urological surgery.3.

To assess the efficacy and morbidity of percutaneous nephrolithotomy (PNLT) in the treatment of renal stones in patients with neurogenic lower urinary tract dysfunction (NLUTD).Retrospective, monocentric study including all patients with NLUTD who had undergone PNLT between 2005 and 2017. Pre-operative clinical data (neurological condition, voiding mode, preoperative urine culture…), peri-operative and post-operative data (success and morbidity) were collected from the patients' charts. Success was defined by the absence of residual fragment (RF), on imaging or intraoperative endoscopy. Partial efficacy was defined by the presence of RF lower than 4mm. Early complications were reported according to the Clavien-Dindo classification.In all, 53 PNLTs were performed, in 35 patients, mostly with spinal cord injury. The success and partial efficacy rates were 66.0% and 71.7% respectively. The failure rate was correlated with increased stone burden (P=0.03), increased size of the largest stone (P=0.02), and the presence of complex stones (P0.02). The rate of early complications was 41.5%, with 27.3% major, mostly septic, and bleeding. The retreatment rate within 3 years was 41.5%.In patients with NLUTD, PNLT allows a high success rate, but with a significant rate of retreatment and infectious complications. However, NLPC remains the gold standard in this population, especially for renal stones larger 20mm, allowing a higher success rate than ureteroscopy and a lower retreatment rate.