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The effect of ERAS protocols in a population of radical cystectomy (RC) patients fit for neoadjuvant chemotherapy has not been specifically explored.To compare perioperative outcomes of open RC according to the application of an ERAS protocol in a population of patients treated by cisplatin-based NAC.All consecutive patients treated by NAC and RC between 2016 and 2019 were included. The ERAS pathway was implemented in June 2018 and followed the EAU recommendations. All data were prospectively collected. Patients' characteristics, operative outcomes, length of stay (LOS), complication rate according to Clavien-Dindo and pathological results were compared between pre- and post-ERAS. Statistical analysis was performed using R.In total, 79 patients were included, 29 in the ERAS group and 50 in the non-ERAS group. A median number of 19 out of 22 ERAS criteria were followed. Mean number of NAC cycles was 4.45 vs. 4.79 in the pre- and post-ERAS groups respectively (P=0.24). Median time between NAC and RC was 3.8months. Thirty-eight percent vs. 48% of patients received an ileal neobladder in the pre- and post-ERAS group respectively (P=0.51). No differences were observed regarding operative time, blood loss or operative transfusion rates. LOS was drastically reduced in the ERAS period (18.94 vs. 12.10days, P0.001) as well as major (Clavien 2) complications rate (65% vs. 28%, P=0.004).ERAS drastically reduced the LOS and the rate of high-grade complications and can be effectively applied to patients receiving NAC without delaying RC.

Surgical activity contributes to global warming though the production of greenhouse gases and consumption of resources. To date, no clinical practice guidelines have been made to promote and implement climate-smart actions.To perform a systematic review of the available actions that could limit COMEDLINE and Cochrane databases were searched from January 1, 1990 to April 2021. We included studies assessing carbon footprint (CF) in the OR and articles detailing actions that limit or reduce CF.Thirty-eight studies met the inclusion criteria. We identified six core climate-smart actions: (1) waste reduction by segregation; (2) waste reduction by recycling, reuse, and reprocessing; (3) sterilisation; (4) anaesthesia gas management; and (5) improvement of energy use. Quantitative analysis regarding the CF was not possible due to the lack of homogeneous data. For climate-smart actions, the analysis was limited by discrepancies in study scope and in the methodology of COThis review provides arguments for many climate-smart actions that could be implemented in our daily practice. Improving awareness and education are important to act collectively in a sustainable way. Further studies are mandatory to assess the impact of these climate-smart actions in the OR.We performed a systematic review of the available scientific literature to reference all the climate-smart actions proposed to improve the sustainability of surgical activities. Waste segregation, waste reduction and recycling, reuse and reprocessing, sterilisation, anaesthesia gas changes, and improvement of energy use in the operating room were found to be the main areas of research. There is still a long way to go to homogenise and improve the quality of our climate-smart actions.

Summary Background We present the long-term results and complications of the DETOUR® prosthesis, a permanent subcutaneous pyelovesical bypass for the treatment of ureteral obstruction. Patients and methods Between 2006 et 2018, 34 prosthesis were implanted in 28 patients (mean age 65,8 years) with ureteral obstruction of malignant or benign etiologies. The prosthesis, composed to an inner tube of silicone and an outer tube of expanded polytetrafluoroethylene, is placed subcutaneously between the kidney and the bladder. We are performed infrared spectrophotometry and scanning electron microscopy on two removed prostheses to explore the prosthetic encrustation. Results The average follow-up was 25,8 months (Maximum: 64 months). Stent revision was required for early bladder fistula in three patients. The major long-term complications were infection (46%), obstruction (3 patients) and bladder fistula (7 patients). The most frequently infection are non-severe, but two patients died from septic shock after fungic colonization of the prosthesis. The infrared spectrophotometry and scanning electron microscopy analysis showed that the obstruction was favored by urinary infection and an alkaline medium. The functional prosthesis rate at 1,2 and 3 years was 94%, 71% and 62%, respectively. Conclusion The DETOUR® subcutaneous extra-anatomical urinary bypass is an effective and minimally invasive alternative to permanent percutaneous nephrostomy, for both malignant and benign ureteral obstructions in selected patients. Level of evidence 3.

Resumen Confrontés à une crise d’une ampleur exceptionnelle liée à la pandémie à coronavirus COVID-19 responsable d’une saturation selon les régions des urgences et des places en réanimation, le Comité Lithiase de l’Association Française d’Urologie (CLAFU) a élaboré pour la première fois les recommandations de prise en charge des calculs urinaires durant cette crise sanitaire.Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis.

Resume Introduction Les neoplasies intra-epitheliales (NIE) du penis sont des lesions genitales definies sur le plan histologique par la presence d’atypies cytologiques et architecturales intra-epitheliales et pouvant evoluer vers un carcinome epidermoide invasif. Methode Une revue de la litterature portant sur la classification, la description clinique et la prise en charge des NIE a ete realisee en considerant les articles traitant des NIE du penis, repertories sur la base de donnee Medline entre octobre 2007 et octobre 2017, a l’aide des mots cles « intraepithelial neoplasia » ou « Bowen's disease » ou « erythroplasia of Queyrat » ou « bowenoid papulosis » et « penis ». Les articles ont ete selectionnes selon leur langue de publication (anglais et francais) et la pertinence par rapport au sujet. Resultats Cent-soixante-quatorze articles relatifs aux NIE du penis ont ete repertories, dont vingt-cinq ont ete selectionnes pour leur pertinence. L’analyse bibliographique de ces vingt-cinq articles a identifie six articles d’interet anterieurs en octobre 2007, qui ont ete pris en compte dans cette revue systematique, totalisant ainsi trente et un articles. Nous decrivons les NIE du penis en precisant leurs aspects cliniques et histologiques ainsi que leur prise en charge. Conclusion L’urologue, en collaboration avec l’anatomopathologiste, doit savoir distinguer les NIE bowenoides HPV-induites des NIE differenciees non HPV-induites, cliniquement proches, mais differentes sur le plan histologique et therapeutique.

Overtreatment is an actual problem in low risk localized prostate cancer (PC) management. Active surveillance (AS) is a solution to limit this problem, but eligibility criteria remained discussed. The aim was to assess possibilities of widening selection criteria for patient in AS, studying curative treatment free survival (CTFS) according to restricted or expanded eligibility criteria.We retrospectively studied patients beginning AS between 2008 and 2014, for Gleason 6 localized PC, PSA15ng/ml,cT3. The group "strict criteria" was defined:≤cT2a, PSA10ng/ml, 2≤positive biopsies (PB+), total tumoral length≤3mm, tumoral invading≤50%, PSA density≤0,15ng/ml/cmOne hundred eighty patients were included (follow-up 46 months). One hundred and eleven patients had "strict" criteria vs. 69 "expanded" criteria. Eighty-two patients (45%) were treated with median time of 18.2 months (CTFS was 71% at 2 years, 52% at 5 years.). The widening of the inclusion criteria was not associated with CTFS (65 vs 54% at 5 years, P=0.13). Factors significatively associated with discontinuation of AS were bilaterality (HR=2.12) and abnormal rectal digital examination cT2 (HR=2,07); MRI target (HR=2,48)) tended towards significance.Our study concludes that curative treatment free survival is similar for patients included with expanded criteria compared with those included with strict criteria. However, high initial cancer volume) is associated with AS discontinuation.3.

Objectifs Le but de ce travail etait d’evaluer la classification proposee en 2016 des anomalies papillaires renales en ureteroscopie souple dans la maladie lithiasique. Methodes Depuis la publication de la classification Sx nPx Rx, nous avons realise une collecte prospective monocentrique mono-operateur des donnees descriptives utilisant cette classification durant 88 consecutives ureteroscopies souples dans le traitement de calculs. Les calculs ont ete analyses par microscope et spectrophotometrie et des bilans metaboliques systematiquement effectues. Les donnees ont ete comparees statistiquement. Resultats Quatre-vingt-trois pour cent des patients avaient des plaques de Randall (PR), et seulement 4,5 % avaient des papilles normales. Les calculs ancres papillaires etaient observes dans 30,7 % des cas et un aspect de cristallisation intraductale dans 15,9 %. Des erosions papillaires etaient presentes dans 55,7 % et des papilles extrophiques dans 8 % des cas. Les calculs ancres sombres (Sa1) et les erosions avec depots (Pa2) etaient significativement correlees a la presence de PR. Les papilles erodees etaient significativement liees a la presence de calculs ancres et les calculs de phosphate de calcium a la cristallisation intraductale. Une hypercalciurie etait diagnostiquee de maniere plus significative en cas de calcul ancre clair (Sa2) que sombre (Sa1) ( Tableau 1 et Fig. 1 ). Conclusion Les descriptions de la classification 2016 sont confirmees par les resultats de cette etude. Les anomalies papillaires sont des consequences du developpement des calculs. Leurs descriptions pourraient ainsi ameliorer le suivi des patients lithiasiques et le diagnostic de l’origine de la lithogenese. Nous recommandons donc leur description systematique. Quelques ameliorations peuvent etre apportees sur une version 2019.

Platinum-based neoadjvant chemotherapy (NAC) before radical cystectomy (RC) is the gold standard in the treatment of muscle invasive bladder cancer (MIBC). We aimed to compare the peri-operative morbidity in patients treated by NAC then RC and patients having RC alone.Between 1st January 2008 and 31st December 2015, we retrospectively included consecutive patients undergoing RC for MIBC in 2centers. We collected clinical, pathological and peri-operative data (30day post operative complications according to the Clavien-Dindo score, delayed complications, pathological results). Patients treated by NAC (NAC-RC group) before RC were compared to patients performing RC alone. The NAC-RC group received 1 to 6cycle of high-dose MVAC, MVAC or gemcitabine-cisplatine chemotherapy. Logistic regression identified independant factors of peri-operative complications.We included 199 patients: 48in the NAC-RC group and 151in the RC group. Complications rate was 73.9% in the NAC-RC group versus 73.8% in the RC group (P=1.0). In multivariate analyses, only the Charlson score was associated with an increased risk of peri-operative complications (P=0.05). PT0 tumour rate was significantly higher in the NAC-CR group (50% vs 7%, P0.001).NAC does not increase the peri-operative morbidity of the RC. Patients' pre operative comorbidities is the main risk factor for peri-operative complications.

Penile intra-epithelial neoplasia (PIN) are precancerous lesions, characterized by architectural and cytological abnormalities of the genital epithelium, from which can arise squamous carcinomas.A literature review was performed on the Medline database, considering the articles listed between October 2007 and October 2017 dealing with PIN, using the following keywords "intraepithelial neoplasia" or "Bowen's disease" or "erythroplasia of Queyrat" or "bowenoid papulosis" and "penis ». Papers were selected according to their language (English and French) and their relevance.One hundred seventy four articles related to PIN were listed. Twenty-five of them were selected for their relevance. The analysis of the references of these articles identified 6 relevant papers published before October 2007, which were considered for this review based on a total of thirty-one articles. We describe clinical and pathological characteristics of PIN, emphasizing treatment modalities.Urologists should distinguish HPV-related and non HPV-related PIN, both of them sharing clinical presentation, but needing different management.

Objectifs L’alteration de la qualite de vie est la plainte principale des patients presentant une lithiase urinaire. Plusieurs etudes ont compare URSS et NLPC pour le taux de stone free, les complications, les durees operatoires et d’hospitalisaton, etc. Mais aucune ne compare la qualite de vie (QDV) postoperatoire pour des calculs de taille importante. Nous avons donc cherche a evaluer la faisabilite d’une telle etude au niveau national. Methodes Il s’agissait d’une etude prospective, nationale, realisee en partenariat avec le comite lithiase de l’AFU. Les patients devaient presenter un calcul de plus de 15 mm et parler francais. Un questionnaire de QDV multidimensionnel (symptomes urinaires, douleur, etat general, exercice professionnel, sexualite, plus le score etait eleve plus la QDV etait alteree) valide (l’USS-q) etait distribue en preoperatoire, apres recueil du consentement et etait envoye par courrier, ou courriel, ou realise au telephone a j7, m1, m3 et la difference entre le score preoperatoire et chaque temps postoperatoire etait calculee. Etaient aussi analysees la difference d’echelle numerique (en), le taux de reintervention et le nombre de jours d’arret de travail. Resultats Du 01/12/17 au 16/04/18, 19 NLPC et 25 URSS ont ete incluses dans l’etude dans 8 centres differents. La taille moyenne des calculs etait de 25 mm pour les nlpc et 20,5 mm pour les URSS. Les taux de reponses etaient respectivement de 100 %, 88 % et 100 % a j7, m1, m3 (NLPC) versus 70 %, 72 % et 74 % (URSS). Le taux de reintervention etait de 36 versus 44 %. La duree moyenne d’arret de travail etait de 32 jours versus 29,5 jours La difference de score total etait respectivement de −8,06, 1,5 et 6,72 a j7, m1 et m3 (NLPC) versus 1,94, 4,36 et 28,1 (URSS). La difference de score d’en etait de 0,58, 1,29 et 1,38 (NLPC) versus 0,51, 0,57 et 2,9 (URSS) ( Figure 1 , Figure 2 , Figure 3 ). Conclusion Cette evaluation montre que l’etude est donc faisable a une echelle nationale avec un taux de reponse acceptable. La puissance de l’etude avec un nombre faible de patients n’est pas suffisante car les scores sont eleves (total sur 180). A ce stade, les resultats montrent une amelioration de la qualite de vie significativement superieure au 3e mois pour les URSS.

International audience; Introduction: The presence of pathological calcifications, which can be either concretions or ectopic call for physicochemical characterisation techniques in order to define a significant diagnosis. The aim of this review is to present a set of characterisation techniques able to describe at the micrometer scale their structural and chemical characteristics and show their place at the hospital.Method: Results already published in the last ten years based on characterisation techniques present in laboratories or specific to large-scale instruments are presented. Their usefulness for the clinician is discussed.Results: The presence and role of heavy metals in urinary stones through data collected through μX-ray fluorescence is debated. If these data suggest a simple substitution process of calcium, recent data suggest that weddellite is associated to a Zn-rich environment, partly favoured by an inflammation process. Investigation on the chemistry and the structure of unusual deposits in kidney biopsies show a great chemical diversity of ectopic calcifications. Such diversity shows that staining procedures to characterize such deposits are obsolete. Finally, several diseases which can be assessed through techniques specific to large-scale instruments and defined by the clinician are presented.Conclusion: The chemical and structural complexity of pathological calcifications call for a characterization through physicochemical techniques. Only such approach allows the clinician to define a significant diagnosis and to care the patient.; Introduction: Les calcifications pathologiques rénales qu’elles s’apparentent à des concrétions ou à des calcifications tissulaires impliquent de savoir déterminer correctement les composés chimiques qui les composent afin de porter un diagnostic menant à une prise en charge adéquate. Le but de cet article de revue est de dépeindre les techniques physicochimiques aptes à réaliser cette caractérisation structurale et chimique à l’échelle du micromètre et de montrer leur insertion au sein même de l’hôpital.Méthode: Les résultats acquis ces dix dernières années utilisant des techniques de caractérisation de laboratoire ou spécifiques aux grands instruments comme le synchrotron Soleil ou le laboratoire Léon-Brillouin sont présentés. Leur pertinence dans l’activité du clinicien a été examinée.Résultats: Le rôle des éléments traces dans la pathogenèse des calculs rénaux au travers de données acquises par fluorescence X est discuté. Si leurs propriétés catalytiques ne sont pas confirmées par les données expérimentales, l’analyse fine a dévoilé certaines particularités intéressantes concernant les teneurs en Zn des deux composés d’oxalate de calcium, i.e. whewellite et weddellite. En effet, les calculs de weddellite présentent des bipyramides aux angles et arêtes vifs susceptibles d’induire une inflammation tissulaire. L’analyse morphoconstitutionnelle des biopsies rénales dévoile une grande diversité chimique puisque 22 corps différents ont été identifiés. Cette diversité indique que les méthodes de coloration dont l’anatomopathologiste dispose sont insuffisantes pour caractériser ces corps. Enfin, nous énumérons différentes problématiques abordées par les grands instruments et définies par le clinicien.Conclusion: La complexité structurale et la diversité chimique des calcifications pathologiques invitent à la mise en œuvre de techniques de caractérisation physicochimiques. Seule cette approche permet au clinicien la pose d’un diagnostic fiable et donc une prise en charge adéquate du patient.

Résumé Objectif Évaluer prospectivement les résultats fonctionnels de la thermothérapie prostatique par radiofréquence (Prostiva©) sur la gêne urinaire et la vie sexuelle dans le cadre du traitement d’une hypertrophie bénigne de la prostate (HBP) symptomatique non compliquée résistante aux traitements médicamenteux. Patients et méthodes Les patients répondant aux critères d’éligibilité à ce traitement édités selon la HAS ont été traités dans notre unité d’urologie. Ils ont été convoqués de façon systématique à un mois pour un examen clinique et paraclinique (débit urinaire maximum [Qmax], résidu postmictionnel [RPM], International Prostate Symptom Score [IPSS]). Ils ont été contactés en décembre 2009 et soumis à un hétéroquestionnaire téléphonique portant sur des scores de gêne urinaire (IPSS), de qualité de vie (question 8 de l’IPSS), d’évaluation des fonctions sexuelles (IIEF, DAN SEX), et d’évaluation subjective du traitement (échelle de Likert). Résultats De décembre 2006 à janvier 2009, 20 patients (âge médian: 63 ans) ont été traités par Prostiva©. Quatre patients ont présenté une rétention aiguë d’urine dans le postopératoire immédiat nécessitant un sondage vésical en urgence. Nous avons réalisé l’évaluation systématique de l’ensemble des patients à un mois et en décembre 2009. Le suivi médian était de 20,6 mois (valeurs maximales [12–37 mois]). On a constaté une amélioration significative de l’IPSS (−6,7 points; IC95= [−10,3; −3,1]), une amélioration des fonctions sexuelles, des scores de qualité de vie, et un sentiment d’amélioration globale des symptômes urinaires (+ 1,08 = amélioré sur l’échelle de Likert). Quatre patients ont été considérés comme des échecs du Prostiva©: trois patients ayant repris un traitement médicamenteux, un patient ayant bénéficié d’une résection de la prostate. Conclusion Notre étude monocentrique réalisée chez des patients sélectionnés selon les critères de l’HAS a conforté les résultats de la littérature avec des résultats positifs sur la gêne urinaire, une faible morbidité et une amélioration de la qualité de vie déclarée. Elle a démontré l’innocuité de la thermothérapie sur la sexualité des patients et mieux encore, l’impact positif du traitement sur la qualité des érections et la satisfaction des rapports.

Background. Donation after circulatory determination of death (DCDD), formerly non-heart-beating donation and donation after cardiac death, has been re-introduced into clinical practice in France since June 2006 as a potential solution to organ shortage, but this kidney transplantation programme is not popular yet, mainly because of logistical concerns and uncertainty about the long-term warm ischaemia impact on transplanted kidneys. Methods. Our institution started the DCDD programme in January 2007, following the national ‘BioMedicine Agency’ protocol. We only considered uncontrolled donors with an initial no-flow period (i.e. delay between collapse and external cardiac massage start)

Resume Objectifs Evaluation de l’efficacite et de la tolerance des endoprotheses metalliques spiralees thermoformables Memokath® 051 (Bard, Pnn Medical) dans le traitement des stenoses ureterales suspendues chez des patients inoperables ou fragiles et relevant d’une endoprothese ureterale longue duree. Materiel et methodes Etude prospective descriptive, multicentrique de patients avec stenoses ureterales suspendues traites par endoprotheses ureterales metalliques Memokath® 051. Pour mesurer les criteres de jugement (recidive stenotique, permeabilite, tolerance), le suivi a consiste en une evaluation complete par examen clinique, biologique et radiologique a un mois, puis tous les trois mois. Resultats Quinze endoprotheses (longueur moyenne : 9,15 cm, extremes : 6–15 cm) ont ete implantees chez 14 patients (âge moyen : 55 ans, extremes : 38–72 ans) ayant une stenose ureterale suspendue secondaire sur une periode de deux ans dans deux centres. Le recul moyen etait de 11 mois (extremes : 6–24 mois). Deux echecs de pose ont ete constates. Les endoprotheses etaient encore en place chez quatre patients. La stenose a recidive chez quatre patients par progression spontanee de la stenose mais sans envahissement tissulaire endoprothetique. Deux migrations et trois expulsions spontanees ont ete observees. Deux infections urinaires basses et une haute sont survenues, resolutives sous antibiotherapie, aucune incrustation ou hematurie, aucune douleur (EVA moyenne = 3/10) ni troubles urinaires du bas-appareil n’ont ete releves. Conclusion D’apres notre experience, la tolerance des endoprotheses Memokath® 051 a ete tres bonne et il nous semble que ces stents peuvent se positionner comme une alternative interessante a la pose de sonde JJ chez certains patients fragiles. L’affinement des contre-indications devrait permettre d’ameliorer l’efficacite de ces stents et de diminuer les risques de migration et d’expulsion.

Objectifs Evaluation et mise au point vis-a-vis de l’impact economique des differents procedes d’extraction de sondes double j sous anesthesie locale actuellement disponibles. Methodes Evaluation economique basee sur la collecte des prix catalogue non negocies des dispositifs magnetic blackstar (mbs) (aseptinmed/urotech) et isiris (coloplast), les cotations ccam et se1 ( www.ameli.fr ). Une comparaison a ete effectuee avec les resultats publies (progres en urologie 2017) de la technique classique a l’aide d’un fibroscope resterilisable sous anesthesie locale en externe sans hospitalisation, et renforcee par des donnees retrospectives d’echec d’extraction avec ces nouveaux dispositifs, source potentielle de majoration du cout par le recours complementaire a la technique classique. Resultats L’acte ccam jcge004 (48 €) en externe donnait acces au forfait se1 (73,71 € prive, 75,89 € public). L’extraction en consultation (cs) ne donnait acces qu’au tarif cs (23 €) ou cs + mpc + mcs (30 €) selon l’adhesion a l’optam. Prix catalogue non negocies : isiris 350 €ht, mbs jj + extracteur 92 € ht. Couts : – extraction classique 51,336 € ttc en 2016 ; – mbs : cotation cs induisant une reduction de remuneration des praticiens 18–25 € et des etablissements 22,374 € prive et 24,554 € public. Surcout materiel 77,9 € ttc. Part des consommables 2,25 € ttc. Economie pour l’assurance maladie (am) 91,71–98,71 € ; – isiris : cotations endoscopiques jcge004 et se1. Couts : consommables (3,63 € ttc), materiel (420 € ttc). Deficit de 349,92 € ttc prive et 347,74 € ttc public, sans economie pour l’am ; – cout des dechets majore pour mbs et isiris. Echecs d’extraction : – mbs : uniquement chez les hommes dans 7,7 %, soit 4,65 % tous sexes confondus ; – isiris : 2,98 % d’echecs tous sexes confondus. Conclusion L’utilisation des nouveaux dispositifs induit un surcout pour les etablissements, mais avec cependant : une disparition du risque de transmission virale, une planification plus aisee et une augmentation de la duree de vie des endoscopes resterilisables non quantifiable. Seules les mbs apportent une economie a l’am. Resultats a moduler aux contrats et fonctionnements des differentes structures.

Cyclosporine nephrotoxicity remains a major side effect in solid organ transplantation, and can be exacerbated by concomitant administration of sirolimus. Cyclosporine and sirolimus are P-glycoprotein (Pgp) substrates. We hypothesized that the Pgp activity level may affect cyclosporine cytotoxicity by interfering with the ability of Pgp to remove cyclosporine from within tubular cells, and that an interaction between cyclosporine and sirolimus on Pgp function may explain the enhancement of cyclosporine nephrotoxicity by sirolimus. Cyclosporine cytotoxicity was evaluated in primary cultures of normal human renal epithelial cells (HRECs) by cell viability and cytotoxicity assays. Verapamil, quinine, PSC833, and PGP-4008 were used as Pgp inhibitors. Rhodamine-123 (R-123), a fluorescent substrate of Pgp, was used to assess Pgp-mediated transport. Cellular cyclosporine concentration was measured by high-performance liquid chromatography coupled to tandem mass spectrometry. Pgp expression and function were confirmed in HRECs and cyclosporine and sirolimus were shown to be Pgp inhibitors in this model. Verapamil-induced inhibition of Pgp led to a significant increase in cellular concentration of cyclosporine (P

Objectifs Cette etude a comme objectif de decrire les anomalies des papilles renales dans une nouvelle classification et d’analyser leurs relations avec la composition des calculs. Methodes Etude monocentrique mono-operateur prospective. Collecte de donnees au cours de 164 ureteroscopies souples consecutives realisees dans le traitement de calculs renaux entre mai 2011 et mars 2015. Les calculs ont ete analyses en SPIR et des evaluations metaboliques ont ete pratiquees. Resultats Un total de 74 patients (45,1 %) avaient des anomalies sur au moins une papille, sans compter les plaques de Randall isolees. Plusieurs anomalies ont ete rapportees, pouvant etre associees chez un meme patient : erosion papillaire (51,3 %), calculs ancres aux papilles (47,3 %), calculs sous epitheliaux (18,9 %), papilles cryptiques (10,8 %), papilles extrophiques (9,46 %) et depots intraductaux (2,7 %). Des associations entre les anomalies papillaires et les calculs ont ete identifiees ? Les depots intraductaux etait associes systematiquement a des calculs de CA IVa2 et une hypocitraturie. Une premiere classification a ete elaboree pour tenter de standardiser la description. Conclusion Cette etude met en avant la necessite de la description des papilles lors des ureteroscopies souples. La classification demande une validation multicentrique. La meilleure connaissance de ces anomalies devrait aider les nephrologues et les urologues dans la comprehension de la maladie lithiasique. Elle devrait aussi faire evoluer la prise en charge medicale ou chirurgicale pour limiter le risque de recidive.

The Lithiasis Committee of the French Association of Urology (CLAFU) aimed to update the current knowledge about urolithiasis. This update will be divided into four parts: 1) general considerations; 2) the management of ureteral stones; 3) the management of kidney stones; 4) metabolic assessment and medical treatment of urolithiasis. Recent technicals advances helped the urologists to improve stones management: new extracorporeal shockwave lithotripsy (ESWL) devices, new flexible ureterorenoscopes, development of laser fragmentation. ESWL, semi-rigid and flexible ureteroscopy and the percutaneous nephrolithotomy (PCNL) remain currently the main therapeutic options. The first part of this update deals with the description and classification of stones, preoperative assessment, post-operative management and clinical follow-up. Main criteria of therapeutic choices are stone location, stone composition and stone size. Stone composition is assessed with infrared spectrophotometry analysis and its hardness is correlated with U.H. density on CT scan assessment. Preoperative assessment consists in urinary cytobacteriological examine, urinary PH, blood creatininemia, hemostasis. Low-dose CT scan is recommended before urological treatment. The result of the treatment must be done 1 or 3 months later with plain abdominal film and ultrasonography. Medical management of urolithiasis will be based on stone composition, metabolic and nutritional evaluation. Treatment success is definited by absence of residual fragments. Annual follow-up is recommended and based either on plain abdominal film and ultrasonography or low-dose CT scan.

This text summarizes the CLAFU first-line screening guidelines for renal stone disease patients. We have focused on the useful information provided by renal stone analysis and also the identification of relevant stone risk factors detected in a 24-hour urine collection. Indeed, evaluation of water, sodium and protein intake may be easily achieved in a current clinical setting and allows a useful pedagogic tool for patients' advices and follow-up: daily diuresis above 2000 mL, calcium intake between 800 mg and 1 g/day, a moderate daily sodium and proteins restricted diet (9 g and1.2 g/kg per day respectively). General therapeutical principles are reviewed, including circumstances requiring specialized management.

Since the publication of the latest recommendations of the Lithiasis Comity of the French Association of Urology (CLAFU) on the management of ureteral and renal stones, practices have evolved. This text provides an update for the treatment of kidney stones. It is especially the important advances in the field of laser-ureterorenoscopy that changed practices. Percutaneous nephrolithotomy has been enriched by technical modifications and extracorporeal shockwave lithotripsy confirmed its predominant place in the first line of treatment. For stones less than 20mm, extracorporeal lithotripsy remains the standard, but in some cases the possibility of recommending a flexible ureterorenoscopy is possible in first line. For stones more than 20mm, percutaneous nephrolithotomy is the standard treatment, but optional flexible ureteroscopy and extracorporeal lithotripsy are possible. The treatment carried out, collect the stone fragments for a morpho-constitutional analysis and achieve a metabolic evaluation is necessary, to investigate etiologic and give dietary advices to prevent recurrence.

The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation.Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney.Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI30), anticoagulation or anti platelet aggregation, calculations Hard (UH1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient.The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL).

Evaluation of the effectiveness and tolerance of thermoformable metallic spiral stents Memokath(®) 051 (Bard, Pnn Medical) in the treatment of localized ureteral stenosis in non-operable patients who have JJ ureteral stents.Prospective, descriptive and multicenter study of patients with ureteral strictures treated with metallic ureteral stents Memokath(®) 051. Assessment criteria (recurrent stenotic, permeability, tolerance) were measured by clinical, biological and radiological examination at 1 month, and then every 3 months.Fifteen stents (average length: 9.15 cm, range 6-15 cm) were implanted in 14 patients (mean age: 55 years, range: 38-72 years) with secondary suspended ureteral stenosis during 2 years in two centers. The median follow-up was 11 months (range 6 to 24 months). Technical difficulty was observed with two patients. Stents are still up in four patients. The stenosis recurred in four patients with spontaneous progression of stenosis but without endoprosthetics tissue invasion. Two and three migration were observed with spontaneous expulsions. Two lower urinary infections and one high occurred, resolved on antibiotic therapy, no inlay or hematuria, no pain (mean VAS score=3/10) or urinary disorders of the lower unit have been identified.Stents Memokath(®) 051 are well tolered and seem to position themselves as an interesting alternative to JJ ureteral stent in some frails patients. The refinement of contraindication should help to improve the stent's efficacity and to reduce the risk of migration and expulsion.

We studied the efficiency and the morbidity of endoscopic removal of kidney stones during laparoscopic removal of ureteral stone.Six patients presenting with an ureteral stone resisting to ESWL and four patients presenting with an UPJ obstruction were studied. Every patient had one to five associated kidney stones. The patients were operated with transperitoneal laparoscopic ureterolithotomy or pyeloplasty. An endoscopy of the upper urinary tract was realized during the same operating time through laparoscopic access. A flexible ureteroscope (five cases) or semi-flexible ureteroscope (one case) were used after ureterolithotomy. A fibroscope (four cases) was used before pyeloplasty. The endoscope was introduced through the port of the iliac fossa and the stones were extracted with a basket grasper. The patients were followed by abdominal plain film 12 weeks after surgery, by IPV six weeks after surgery and then annually with abdominal plain film and ultrasound.No operative complication arose. Nine of 10 patients had a complete extraction of the kidney stones (one patient had an extraction only of four out of five kidney stones). No damage of any endoscope was observed. At a minimum follow-up of 18 months, no fistula nor stenosis of the ureter was diagnosed.Endoscopic removal of kidney stones through laparoscopic access of the upper urinary tract is effective, sure and reproducible. Such procedure requires experience in laparoscopy and endoscopy of the upper urinary tract. The evaluation of this procedure must be pursued.

Rapamycin inhibits human renal epithelial cell proliferation: Effect on cyclin D3 mRNA expression and stability. Background Recent data have suggested that rapamycin use during the initial period after transplantation is associated with prolonged delayed graft function (DGF). Because of the known effects of rapamycin in other cell types, we speculated that this action may be secondary to human renal epithelial cells (HRECs) inhibition of proliferation. Methods Primary cultures of HRECs were incubated with various concentrations of rapamycin. Cell proliferation was evaluated by cytotoxicity assays. The cell cycle was analyzed by flow cytometry. Protein expression levels were assessed by Western blot. Cyclin D3 mRNA levels were measured by quantitative real-time polymerase chain reaction (PCR). The transcriptional activity of the cyclin D3 gene was evaluated using transient transfection. Results Rapamycin exerted a significant concentration-dependent antiproliferative effect on growing HRECs by inhibiting the G 1 to S transition. The p70 S6 kinase pathway leading to cell cycle progression was found to be active, and low concentrations of rapamycin dramatically reduced p70 S6 kinase phosphorylation. Rapamycin completely inhibited the increase in cyclin D3 protein expression and mRNA accumulation induced by fetal calf serum, but did not affect cyclin E or cdk-inhibitor expression levels. This regulation of cyclin D3 protein expression is mainly due to a destabilization of its mRNA. Rapamycin reduced the mRNA half-life by 26% (4.8 ± 1.3 hours vs. 6.5 ± 1.0 hours, P Conclusion Rapamycin inhibits the proliferative response of HRECs to mitogenic stimuli, and causes cell cycle arrest in the early G 1 phase, not only by a nonspecific process due to inhibition of the p70 S6k pathway, but also by a direct effect on cyclin D3 mRNA stability.