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Introduction: To evaluate the mid term functional results of patients treated for RUF and to determine an optimal treatment strategy to improve their quality of life. Recto-urinary Fistula (RUF) is a rare complication following prostate cancer treatment, and can have a major impact on patients' quality of life. There is a lack of consensus concerning the best approach and different techniques have been proposed: endoscopic, transrectal, perineal and transperitoneal (open, laparoscopic or robotic)., Materials and Methods: We retrospectively reviewed the charts of patients who underwent RUF repair from January 2001 to December 2010 at our Institute. 16 patients who developed RUF following prostate cancer treatment were included in the study. The fistula had to be confirmed both clinically and by imaging. All patients had follow up consultation every 3 month for the first year and then annually. They were asked to fill questionnaires evaluating functional outcomes. The International Continence Society (ICS) score was used to assess the postoperative urinary continence. Fecal continence was evaluated with the Wexner score and sexual function was assessed with the International Index for erectile function (IIEF-5) score., Results: Eighty-seven percent patients (14/16) in our series developed RUF as a consequence of prostate cancer surgery and 13% (2/16) postbrachytherapy (BT). All patients initially had a diversion colostomy and a supra pubic catheter. 69% (11/16) underwent primary YM repair and 73% (8/11) were successful. 2/3 primary failures were successfully retreated with graciloplasty. Primary gracilis flap interposition (GFI), on 3 non-irradiated patients were successful (100%). Primary GFI postbrachytherapy, no patient had recover urinary and digestive continuity. In total primary GIF was successful in 60% (3/5). Over all long term, success rate with a urinary and digestive continuity and without recurrence of the fistula was 81% (13/16). Mid term functional results were evaluated at mean follow up of 40 months (14-92). 13% (2/16) achieved complete urinary continence, 48% (7/16) required single pad, 25% (4/16) developed major incontinence, 7% (1/16) required urinary diversion and 13% (2/16) developed complete urethral closure post BT requiring permanent suprapubic catheterization. Colostomy was reversed in 93% (15/16) cases. 75% (12/16) achieved complete faecal continence, minor incontinence (wexner score 3-4) was seen in 13% (2/16) and major incontinence (wexner score 14) in 7% (1/16) and 7% (1/16) required a long term colostomy. 19% (3/16) developed colostomy related complications. Only 13% (2/16) achieved adequate erections with the use of intra cavernosal prostaglandin injections., Conclusions: RUF following prostate cancer treatment is a serious complication with severe repercussion on patients' quality of life. Surgical repair with the York Mason technique or Gracilis Flap interposition is associated with good success rates. If available pediculed gracilis muscle should be used as it offers better success rates., Level of Evidence: 3., (Copyright © 2018. Published by Elsevier Masson SAS.)

Purpose: Review of various publications on stem cell therapy to treat erectile dysfunction of diabetic origin., Material and Methods: Bibliographic search in PUBMED performed using the keywords cell therapy strain/erectile dysfunction associated with diabetes. Among the 51 articles obtained from the PUBMED research, we selected 16 articles for their specificity of studying erectile dysfunction (DE) related to diabetes., Results: Different types of stem cells have been studied: adipose derived mesenchymal stem cells/bone marrow derived mesenchymal stem cells as well as progenitor endothelial cells. The experimental protocols are quite similar from one study to the next with nevertheless some specifications concerning the studied cells and the monitoring of the latter. Intracavernous pressure (ICP) measured after the injection of stem cells into the corpus cavernosum was always significantly higher than the control populations. The addition of certain growth factors to stem cells by gene transfection improve the efficacy of the cells. No ideal tracking markers of the cells have been identified., Conclusion: The positive effect of the injection of stem cells on the ICP belongs to the cellular trans-differentiation effect but especially to the paracrine effects which have not yet been completely elucidated., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Aim: To assess short term morbidity and renal function after robotic laparoscopic living donor nephrectomy., Patients and Methods: We performed a retrospective analysis of 100 consecutives patients undergoing a robotic laparoscopic living donors nephrectomy. We analyzed isotopic measure of the renal function before and 4 months after surgery, the side, the number of arteries, the blood loss, the operative time and warm ischemia time. In the outcomes, we collected the complications, the length of stay, and for the receiver, the renal function recovery time, dialysis, survival and renal function at one year., Results: Left kidney nephrectomy was performed in 85 patients and we observed 25 multiples renal arteries. Mean estimated blood loss was 0,8 g/dL. Mean operative time and warm ischemia time were respectively 174 ± 30 and 4.8 ± 1.7 minutes. Seven complications occured, with 2 major (Clavien-Dindo System). Mean length of stay was 5.1 ± 1.9 days. Mean glomerular filtration decrease was 26% and remains stable at one year after surgery. Grafts had an immediate renal function recovery for 99%, and were all functional after one year, with mean MDRD clearance of 57 ± 14mL/min., Conclusion: Robotic procedure in laparoscopic living donor nephrectomy seems to guarantee low morbidity and the stability of the renal function decrease of 26%., (Copyright © 2013. Published by Elsevier Masson SAS.)

Introduction: Partial nephrectomy (PN) is currently the reference treatment for renal tumors of less than 4 cm in size (T1a). Laparoscopic PN is difficult to perform, with the main consequence being an increase in warm ischemia time and morbidity. In facilitating the surgical procedure, robotics combines the benefits of minimally invasive and conservative surgery. We report here 8 years of experience with 110 robot-assisted partial nephrectomies (RAPN). The objective of this study was to analyze the oncological and functional outcomes., Patients and Methods: Between March 2005 and September 2012, 110 patients underwent RAPN. The epidemiological and surgical data and the oncological and functional outcomes were retrospectively collected and analyzed., Results: Seventy-six men and 34 women underwent surgery. The mean age was 59.6 ± 14.2 years. Mean operative time was 141.3 ± 36.1 minutes with a warm ischemia time of 21.2 ± 8.8 minutes. Mean hospital stay was 5.3 ± 2.2 days. Mean tumor size was 27.4 ± 9.8mm with 82.7% malignant tumors, of which 62.7% were clear cell carcinomas. Surgical margins were healthy in 100% of cases. After a mean follow-up of 28.7 ± 18.5 months, no recurrence was noted. On a functional level, there was no short-term or medium-term impairment of renal function. The frequency of postoperative complications was estimated as 12% including 7% of surgical complications (3 arterial pseudoaneurysms, 4 episodes of bleeding from the cut surface and 1 conversion to laparotomy)., Conclusion: Robotics brought surgeon dexterity, meticulousness and precision. These qualities are essential in conservative renal surgery and made RAPN a safe and effective technique that gives good short and medium-term oncological and functional results., (Copyright © 2013. Published by Elsevier Masson SAS.)

Objective: The objective of our study was to assess the frequency, circumstances of diagnosis and treatment of anastomotic arterial aneurysms and compare them to the literature., Material and Method: A single-center series of 3000 kidney transplants and 126 pancreas transplants between 1974 and 2010 was studied retrospectively. Ten patients had anastomotic arterial aneurysms: eight after kidney transplantation and two after pancreas-kidney transplantation. Diagnosis was based on the association Doppler ultrasonography-angioscanner., Results: Ten arterial anastomotic aneurysms were identified. The circumstances of discovery were clinical in eight cases, half of them by hemodynamic collapsus. A majority of our patients (60%) were diagnosed in the year following the transplantation and two cases were discovered after transplantectomy. Pancreas-kidney transplantation had a high risk for arterial anastomotic aneurysm. Candida albicans was isolated in preoperative samples in four cases. The management consisted to transplantectomy in seven patients, revascularization of the lower limb in six patients and one renal transplant preservation. We found two lower limb ischemia and two deaths by a fatal intraoperative haemorrhage and vascular cerebral haemorrhage. No recurrence was identified after in the follow-up ranged from 20 months to 12 years., Conclusion: Arterial anastomotic aneurysm was in our study a serious complication that requires emergency surgery. The transplantectomy followed by revascularization of the limb is the treatment of choice associated to an appropriate antifungal or antibiotic treatment., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Testicular biopsies are diagnostic and therapeutic tools involved in male infertility care. However, this surgery is invasive and not systematically successful. We studied the preoperative clinical and hormonal factors allowing to predict the obtaining of sperm cells., Patients and Methods: A retrospective study was conducted on 209 patients who all had a testicular biopsy for procreation medically assisted (PMA). The studied criteria were: the age at the time of the surgery, the male cause of the infertility, the testicular volume, the tobacco smoking exposure, the concentrations of estradiol, FSH, LH, prolactin, and testosterone. The comparison of both groups (successful biopsy versus failed biopsy) was made in bivariate analysis then in multivariate analysis., Results: The testicular volume average and the cause were the two only factors which had a real influence on the negativity of the biopsy. In it was added in bivariate analysis a statistically significant correlation of the smoking exposure and the FSH with the failed biopsy., Discussion: The existence of these factors, and their accumulation, was strongly predictive of a failure of the biopsy. However, we found germ cells in patients exposed to the studied factors, letting think that it is systematically necessary to propose the surgery at the risk of a limited profit., (Copyright © 2012. Published by Elsevier Masson SAS.)

Because of the low mortality rates associated with prostate cancer, treatments long-term adverse effects constitute an important parameter in the management of patients. In particular, androgen deprivation has been shown to be linked to several metabolic disorders which are already frequent in men after age 60, such as weight and fat gain, insulin resistance likely to evolve into diabetes, and dyslipidemia. So far no consensus guidelines have been published regarding the screening and treatment of metabolic disorders in men with prostate cancer. It is essential to detect and manage these metabolic disorders, all the more so as they seem to be associated with an increased aggressiveness of prostate cancer. Here we report the development of a new questionnaire, which might contribute to the systematic management, and potentially the screening and treatment or the prevention of these metabolic disorders in patients with prostate cancer. In accordance with recent reviews and on the basis of experience, our French board of experts also recommends systematic screening and selective treatment for diabetes, regular follow-up of fasting glucose rates, lipid profile and blood pressure in all patients under long-term androgen deprivation treatment, as well as lifestyle changes (practice of exercise, nutritional habits)., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: The aim of this prospective study was to investigate the effect of extracorporeal shock wave lithotripsy (SWL) on kidneys of patients with pyelic stone disease. The effects of SWL were assessed by high-resolution proton nuclear magnetic resonance (HNMR) spectroscopy of urine samples., Methods: Twenty-three patients, aged 31-80years (mean: 55years), with pyelic stone disease were investigated before and after SWL. Multiparameter analysis was performed by HNMR spectroscopy of urine samples collected before and 5h after SWL (second miction post-SWL)., Results: The most relevant resonances determined by HNMR spectroscopy were acetate, lactate, trimethylamine N-oxide and amino acids. Excretion of these markers increased significantly in comparison with pre-SWL urinary samples., Conclusion: These results show that early ischemic damage occurs after SWL. Post-SWL. HNMR spectroscopy is an effective tool for noninvasive follow-up of renal damage., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Unlabelled: Cancer in a brain-dead subject constitutes a contraindication to organ harvesting. However no data are available on prostatic assessment of brain-dead subjects prior to organ harvesting. The objective of this study was to evaluate prostate cancer screening by serum PSA assay in potential organ donors over the age of 50., Methods: From February to May 2006, serum PSA assays were performed in all male donors in 5 different organ harvesting centres. The donor's age and the duration of bladder catheterization were also recorded., Results: Of the 85 organ harvests performed, 30 (35.3%) concerned men over the age of 50 years (mean: 60.4 years, range: 50-82 years). The mean duration of catheterization was 3.1 days (range: 0.5-22 days). The mean PSA level was 8.7 ng/ml (range: 0.03-52.7) with a free PSA/total PSA ratio of 31% (range: 14-47). Twelve donors had a PSA level greater than 4 ng/ml (4.7 to 52 ng/ml), two others had a PSA level greater than 2.5 ng/ml (2.77 and 3.3 in subjects aged 72 and 57 years, respectively). There was no correlation between the donor's age, their PSA level and the duration of catheterization., Conclusion: The age of brain-dead donors is increasing and is reaching the age limit recommended by the Association Francaise d'Urologie for prostate cancer screening by digital rectal examination and PSA assay. Although the risk of transmission of prostate cancer after transplantation is currently unknown, at this stage when the majority of prostate cancers are discovered in a context of elevated PSA with normal digital rectal examination, the risk of transmission of a prostate cancer from the donor to the recipient is minimal or even non-existent. Digital rectal examination findings may be more relevant than PSA to contraindicate organ harvesting.

Angiomyofibroblastoma of the scrotum is a rare and benign tumour which affect old patient. It's treatment is surgical. A case of angiomyofibroblastoma of the scrotum is reported in a 34 years old man. The literature is reviewed with special reference to the ethiopathogenesis, clinical features and treatment of this tumour entity.

Introduction: The cold ischaemia time of a kidney before transplantation has a negative impact on the risk of acute tubular necrosis and graft survival. This cold ischaemia time can be reduced by a different organization of harvesting, organ distribution and transplantation., Material and Methods: Seventy nine organ donor case files from the same hospital were reviewed from reception of the donor until transplantation. 135 renal transplantations, including 60 kidneys and 14 kidney-pancreas transplants were performed on site with organs harvested from these donors. The various phases of harvesting were studied: reception and resuscitation of the patient took 30 hours, and the diagnosis of brain death, information of the families and transfer of the donor to the operating room for harvesting took 11 hours., Results: The mean cold ischaemia time was 6 hours when kidney-pancreas transplantation was performed and 22 hours 30 minutes for isolated local renal transplantation. The decisive factor is the time required to obtain HLA typing, which is only performed during organ harvesting for isolated renal transplantation. HLA typing and lymph node sampling in the intensive care unit would save 7 hours., Conclusion: The authors recommend that HLA typing and lymph node sampling for cross matches be performed in the intensive care unit in order to reduce the cold ischaemia time.

Unlabelled: The rules of organ allocation allow one of the two kidneys harvested to be transplanted locally while the other is exchanged. This rule of local priority does not exist in all countries. The purpose of this article is to determine whether this rule provides a benefit for the patient. 804 locally harvested kidneys were compared to 1196 exchanged kidneys transplanted between 1970 and 2000 by the same renal transplantation team., Results: The cold ischaemia time was shorter (-6 h), the number of cases of HLA identity was lower (-0.8), the rate of acute tubular necrosis was lower (-9), and the median graft survival of was 7 months longer for local kidneys., Discussion: An article analysing the North American register reached similar conclusions: the local attribution rule reduces the cold ischaemia and the graft loss at one year., Conclusion: The local attribution rule has the advantage of increasing the organ harvesting rate from borderline donors, reducing the cold ischaemia, and improving the results: this rule should therefore be maintained.

Objective: Urological procedures are hazardous for hemophilic patients. The aim of this work is to report the treatment of 22 hemophilic patients in order to define prognosis factors and treatment options., Material and Methods: 22 patients have been treated: 8 had severe hemophilia, 5 A (FVIII < 1%), 3 B (F IX < 1%), 2 had moderate hemophilia A (FVIII 2 to 6%) and 10 minor hemophilia A (F VIII 7 to 30%). Two had acquired hemophilia with auto-anti-FVIII antibodies (ab). Four patients were HIV+. Eighteen patients were first referred to our hospital, and 3 were transferred from an other institution for persistent hematuria: one with anuria, one after bladder neck incision, and the other following suprapubic prostatectomy., Results: For patients without FVIII ab, a sufficient level of FVIII or IX (> 60%), could be achieved pre-operatively and maintained post operatively (4 to 20 days, according to the surgical procedure) by injections of FVIII, FIX or by injections of desmopressin. For one haemophilia A patient with anti-F VIII ab, transferred for uncontrollable bleeding after bladder neck incision, selective arterial embolization was successful. But for 2 patients with acquired haemophilia, improvement of the coagulation was insufficient, with human or porcine FVIII, activated prothombic complex concentrates or recombinant activated FVII. In spite of surgical procedures and arterial embolizations the 2 patients died., Conclusion: The urological treatment of haemophilic patients needs to be performed in specialised centers. For patients without FVIII ab, classical urological procedures can be performed. But for patients with FVIII ab when alternative treatments (radiotherapy, LHRH agonists) can be used, the surgical procedures must be delayed; in emergency if hemostasis cannot be achieved arterial embolization could be useful.

Objective: The objective of this retrospective study was to determine whether the difference between the donor's weight (wd) and the recipient's dry weight (wr) could influence the function of renal transplants., Methods: Between 1987 and 1994, 185 patients with a mean age of 43.3 years +/- 12 were transplanted with a locally harvested cadaver kidney, corresponding to 120 men (42.2 years +/- 1.4) and 65 women (45 years +/- 12.8). The weight variation between donors and recipients (wd - wr) was 0.06 for men and 0.22 for women. The serum creatinine of recipients at 1 year was 147 mumol +/- 41.7. We used analysis of variance for univariate statistical analysis and multiple linear regression for multivariate analysis., Results: On univariate analysis, the serum creatinine at 1 and 2 years was significantly higher (p < 0.02 and p < 0.035 respectively) when the donor's weight was 10% lower than the recipient's weight. Multivariate analysis, taking into account the donor's age and sex and the recipient's serum creatinine, confirmed the influence of the donor-recipient weight difference on serum creatinine at 2 years (p0.03), but also the role of the donor's age at 1 and 2 years (p < 0.0001 and p < 0.0004, respectively)., Conclusion: In our study, the donor-recipient weight difference was a factor influencing the recipient's serum creatinine at 2 years. The donor's age also influences the recipient's serum creatinine, 1 and 2 years after renal transplantation.

95% of renal transplantations performed in France use cadaver donor kidneys. Two donor nephrectomy techniques are proposed: a beating heart technique and an arrested heart technique. In the very great majority of cases (80%), donor nephrectomy can be performed during multi-organ removal, performed according to bioethical regulations: unrelated, anonymity between donor and recipient, security, traceability and evaluation. The urologist has a role to play at each step of organ donation, in which he is the main protagonist. The first steps are performed in close collaboration with the intensive care unit which established the diagnosis of brain death of the potential donor. The following steps, guided by the French transplant establishment, are the urologist's responsibility: He is responsible for abdominal exploration looking for a tumour or any other abnormality. A strictly aseptic technique is essential to prevent contamination of the organ. He is responsible for removing kidneys in such a way as to ensure the shortest possible warm ischaemia time, the best storage solution, and the best preservation of their anatomical structure. He must be familiar with the outcome of transplants in order to adapt his technique to the results of transplants.

Twenty five double kidney-pancreas transplantations were performed according to the total pancreas transplantation technique with drainage of exocrine secretions into the bladder via a vesicoduodenostomy. 72% of kidney-pancreas grafts were functional at one year and 59% were functional at four years. The authors observed a slightly higher rejection rate (0.56 versus 0.34) and a higher incidence of urinary tract infection (60% versus 35%) following double pancreas and renal transplantation than after isolated renal transplantation. Complications were rare: two venous thromboses and two cases of urethritis requiring of rediversion of the duodenum into the intestine. These good results, comparable to those reported in the international registry, reflect the value of the pancreatic and renal transplantation technique using a total pancreas drained into the bladder. It would probably be preferable to transplant patients earlier, when chronic renal failure secondary to insulin-dependent diabetes induces end-stage renal failure and the need for haemodialysis.