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Objective: To assess the efficacy of photoselective vaporization of the prostate (PVP) and the predictive factors of treatment failure in patients with refractory urinary retention., Materials and Methods: From January 2006 to December 2013, we prospectively included all patients treated by PVP preoperatively catheterized for urinary retention. The primary end point was the number of patients free of indwelling catheters 3 months after the procedure. Univariate and multivariate analyses were performed to identify the predictive factors of treatment failure., Results: One hundred fifty-two patients were included in the final analysis. The percentage of patients free of indwelling catheters was 91.5% 3 months after PVP. Two factors were identified as predictive of treatment failure at 3 months in multivariate analysis: a smaller preoperative ultrasonographic prostate volume (UPV; odds ratio [OR] = 0.91; P = .008) and a higher volume of primary urinary retention (OR = 1.03; P = .003). Forty-two patients (27.6%) required early recatheterization within 7 days after surgery. Smaller UPV was the only predictive factor of treatment failure in the early postoperative in multivariate analysis (OR = 0.97; P = .01)., Conclusion: Nearly one-third of patients treated for refractory urinary retention fail the first trial without catheter after PVP, but 91.5% are free of indwelling catheter 3 months after surgery. A smaller preoperative UPV and a higher retention volume were predictive of PVP failure in patients with preoperative indwelling catheters., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To devise and validate a system to categorize GreenLight photoselective vaporization of prostate (PVP) complications according to Clavien score (CS), to report complications of PVP using this categorization, and to determine risk factors., Materials and Methods: A survey questionnaire was distributed to all participants of the second meeting of the Group of GreenLight Users. They were asked to grade PVP complications according to CS. We calculated the mode CS for each complication from the survey data to propose a categorization system for complications of PVP. Complications encountered in a large single-center cohort of 370 patients were reported according to this system. We assessed the reproducibility of CS by estimating inter-rater agreement by the Fleiss kappa. We performed univariate and multivariate analyses to determine risk factors for complications., Results: Of the 67 meeting participants, 42 (62.7%) completed the survey. Overall agreement between urologists was fair (Fleiss kappa = 0.356). Among the 370 patients, 21 (5.7%) had intraoperative complications, 147 (39.7%) had postoperative complications, and 70 (18.9%) had long-term complications. Among the postoperative complications, 125 patients (33.8%) were classified as Clavien grade I, 58 (15.7%) as Clavien grade II, 4 (1.1%) as Clavien grade IIIb, 5 (1.3%) as Clavien grade IVa, 1 (0.3%) as Clavien grade IVb, and 1 (0.3%) as Clavien grade V. In multivariate analysis, the only predictor of overall complications was a polymicrobial preoperative urine culture., Conclusion: The grading of PVP complications by CS is fairly reproducible. We are the first to propose a system for the categorization of PVP complications. PVP complications are frequent but most often minor., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours., Objective: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population., Design, Setting, and Participants: Twenty-four French university departments of urology participated in this retrospective study., Intervention: All patients were treated according to current European Association of Urology guidelines., Measurements: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods., Results and Limitations: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design., Conclusions: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population., (Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Even though transurethral resection of the prostate remains the gold standard treatment for lower urinary tract symptoms (LUTS) refractory to medical therapy, photoselective vaporization of the prostate (PVP) has become a popular alternative. Early PVP studies seem encouraging, but few data exist regarding the effect of PVP on sexual function at long-term follow-up., Objective: Our aim was to evaluate the impact of PVP on erectile function (EF) at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH)., Design, Setting, and Participants: One hundred forty-nine consecutive patients who underwent a prostate vaporization with the GreenLight laser performed by a single surgeon (FB) were prospectively enrolled in this study., Intervention: All patients underwent PVP with the GreenLight laser performed by one experienced surgeon., Measurements: All patients were evaluated by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, and 12 mo and then once a year. At each visit, the questionnaires were collected, and each patient's maximum flow rate and postvoid residual volume were measured with ultrasound. Biologic data were also collected at each visit, including prostate-specific antigen, creatinine, and bacterial urine culture., Results and Limitations: One hundred forty-nine patients were enrolled in the study. Median patient age was 74 yr. Urinary function was significantly improved over baseline in both men with normal or abnormal preoperative erectile function. Energy used was 255+/-129kJ. Hospitalization stay was 2.2+/-3.1 d. Other than a temporary difference at 1 yr, IIEF-5 scores were comparable preoperatively and postoperatively if we consider all the population. However, considering patients with preoperative IIEF-5 >19, the postoperative IIEF-5 scores were significantly decreased at 6, 12, and 24 mo., Conclusions: Sexual function appears to be maintained after PVP; however, in patients with normal preoperative EF, we showed a significant decrease in EF after PVP., (Copyright (c) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.)