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Resume Objectif Analyser la morbidite de la pratique des autodilatations (AD) quotidiennes chez les patients operes d’une prostatectomie totale, appareilles par sphincter urinaire artificiel (SUA) pour incontinence urinaire (IU) et qui ont presente une recidive d’une stenose de l’anastomose vesico-uretrale (SAVU) traitee par voie endoscopique. Materiel et methodes Cent trente-huit patients appareilles par SUA pour IU entre 1998 et 2007 ont ete divises en deux groupes. Trente-cinq ont pratique des AD pour SAVU recidivante (groupe AD) et 103 patients n’ont pas realise d’AD (groupe sans AD). Ces deux groupes ont ete compares pour le taux d’explantation (erosion-infection), de revisions (atrophie uretrale et defaillance mecanique) et les resultats fonctionnels a 2 ans. L’analyse statistique en uni- et multivariee a pris en consideration les facteurs de confusions tels que l’âge et l’antecedent de radiotherapie. L’evaluation fonctionnelle a ete faite par les questionnaires valides IQoL, Ditrovie et MHU. Resultats Les patients des deux groupes etaient comparables sauf pour l’importance de l’incontinence urinaire evaluee par PAD test et les questionnaires. Le taux d’explantation etait significativement plus eleve dans le groupe « AD » ( 20,0 % (5,6–32,2) vs 4,85 % (0,30–11,5)) et , p = 0,008). Il n’a pas ete constate de difference significative entre les deux groupes pour le taux de revision chirurgicale (32 % vs 20 %, OR = 0,44, p = 0,09). Les resultats fonctionnels a deux ans ne montraient pas de difference significative. Conclusions La pratique des autodilatations pour recidive de stenose d’une anastomose vesico-uretrale postprostatectomie expose les patients appareilles par un SUA a un taux d’explantation plus eleve. Niveau de preuve 3.

Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.

Study question What is the outcome of testicular sperm extraction (TESE) after microinjection of frozen–thawed sperm and the correlation with histological analysis in azoospermic patients? Summary answer In our cohort of 240 azoospermic patients, sperm could be retrieved in 167 patients (69.6%). What is known already Testicular biopsy is a crucial assessment in reproductive practice with diagnostic and prognostic importance for ICSI. Divers histological procedures are used throughout the centres. There is increasing need to accurately analyse histological biopsies in order to characterise different type of spermatogenic failure and allows data storage of value in clinical practice and research. Compared with Bouin’s and formalin, glutaraldehyde fixed and semithin section of testicular biopsies have the advantage of yielding not only good cellular morphology but also it allows the possibility of performing electron microscopy. Study design, size, duration This is a monocentric retrospective study of TESE practice in azoospermic patients in Strasbourg University Hospital from February 2011 to December 2019. Participants/materials, setting, methods A total of 240 azoospermic patients underwent TESE followed by sperm cryopreservation when sperm were present and data of histological analysis and clinical outcome of ICSI were analysed. The analysis include initial hormonal status, type of azoospermia, body max index, classification of histological findings, freezing rate and outcome of ICSI-IVF procedure. Main results and the role of chance The mean age of 240 patients was 34.5 years. Out of all patients, 42% were diagnosed with obstructive azoospermia (OA) and 58% patients with non-obstructive azoospermia (NOA). There was no correlation of sperm retrieval with the body mass index. Overall, sperm could be retrieved in 69.6% patients. Spermatozoa were always successfully recovered in patients with normal testicular histological findings, 41.7% patients (n 100). Histological analysis revealed a Sertoli cell-only (SCO) syndrome in 27.5% cases (n 66), hypospermatogenesis in 14.2% (n 34), germ cell arrest in 7.9 (n 19) and mixed pattern in 8.3% (n 20). In patients with serum FSH concentrations >12 IU/l, 46% of patients (n 42) sperm were present at TESE. In patients with no sperm retrieval, 31.5% had normal FSH levels. Out of all men with elevated FSH, 63% had SCO pattern, 4% germ cell arrest, 21% hypospermatogenesis and 12% mixt patterns. In the group of patients with no sperm retrieved at TESE, histological analysis showed SCO in 69.9% cases, germ cell arrest in 15% and hypospermatogenesis in 9.6% of cases. Out of 167 patients with TESE and sperm cryopreservation, 126 patients undergone ICSI-IVF procedure and 80 babies were born. Limitations, reasons for caution This study is a retrospective analysis in a single centre. The cohort was not compared with groups of patients with different histological and fixation techniques. Wider implications of the findings: Accurate histological diagnosis is a prerequisite for research and clinical data collection and open the possibilities to include patients with NOA in subsequent detailed genetic screen. Trial registration number NA

Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population.We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively.Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence.In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.

Resume Objectifs Evaluer la morbidite et les suites fonctionnelles des cystectomies laparoscopiques avec derivation urinaire non continente chez les sujets neurologiques. Materiels Entre aout 2007 et octobre 2013 42 patients ayant une vessie neurologique ont eu une cystectomie laparoscopique suivie d’une courte laparotomie pour extraire la piece et faire une ureterostomie cutanee transileale. Leurs dossiers ont ete revus pour preciser l’indication et decrire les suites operatoires et fonctionnelles. Une evaluation telephonique des patients par l’echelle PGI-I qui porte sur l’amelioration de la qualite de vie urinaire ressentie par le patient ainsi que de leurs medecins traitants a ete realisee pour apprecier le resultat fonctionnel. Resultats L’indication a concerne 42 patients dont 18 avaient une sclerose en plaques, 9 sujets avaient une vessie neurologique post-traumatique, 5 avaient une vessie hyperactive, 2 avaient une incontinence mixte, 1 avait une maladie de Devic, 1 avait une incontinence d’effort, 1 avait un lichen vulvaire, 1 avait une maladie de Laurence Moon Biedle Bardet, 1 avait une neuropathie carentielle responsable d’une paraplegie spastique, 1 avait une vessie radique, 1 avait une spina bifida, 1 avait une vessie retentioniste. Sur les 42, 10 operes (23,81 %) ont recu moins d’un culot globulaire (1–7). Le taux global de complications precoces etait de 35,71 %. Le taux de complications tardives etait de 52,38 %. La mediane de la duree d’hospitalisation etait de 16 jours (9–70). Le recul median etait de 34 mois (1–76). La mediane du PGI-I etait de 2 (1–6). Tous les medecins traitants ont decrit une meilleure situation fonctionnelle. Conclusion La cystectomie avec derivation urinaire chez le patient neurologique reste une intervention chirurgicale exposee a un risque de complications post-operatoires non negligeable meme quand le temps de cystectomie est fait par voie laparoscopique. La balance benefice/risque doit donc bien etre evaluee individuellement avant de poser chaque indication. Niveau de preuve 5.

Resume La lithotritie extracorporelle (LEC) est un traitement de la lithiase urinaire par fragmentation grâce aux ondes de choc. Le principe de la LEC sera decrit ainsi que la fabrication, la diffusion et la focalisation des ondes de choc. Les moyens de reperage des calculs, les modes d’anesthesie ainsi que le deroulement d’une seance seront rappeles avec les contre-indications et le prerequis avant une seance. Les parametres influencant l’efficacite de la LEC seront ensuite exposes. Enfin, les complications, les resultats et les indications de la lEC seront passes en revue.

Resume But Evaluer la faisabilite, l’efficacite et la morbidite de l’implantation par laparoscopie de sphincter artificiel urinaire (SAU) chez des femmes ayant une incontinence urinaire d’effort (IUE) severe. Patientes et methodes Vingt-six patientes avec IUE ont ete appareillees par un SAU AMS 800™ (American medical Systems, Inc., Minnetonka, Minnesota) par laparoscopie entre octobre 2007 et janvier 2012. Dix-huit primo-implantations et huit changements complets pour probleme mecanique d’un SAU deja en place ont ete realisees. Dans trois cas, une promontofixation a ete associee. En moyenne, l’âge etait de 64 ans, l’indice de masse corporelle de 27,8 kg/m 2 , et la pression de cloture uretrale maximale (PCMU) de 26,75 cm H 2 O. La plupart des patientes (88 %) avaient des antecedents de chirurgie pelvienne ou de l’incontinence. L’etude etait retrospective avec analyse des parametres operatoires, de la survenue de complications et des resultats fonctionnels. Resultats Trois conversions en laparotomie et cinq plaies vesicales peroperatoires ont ete notees. En moyenne la duree operatoire etait de 149 minutes, la sonde vesicale etait retiree a j 3,8 et la duree de sejour postoperatoire etait de cinq jours. Les complications postoperatoires precoces etaient huit retentions aigues d’urines transitoires, deux migrations de pompe et une plaie vaginale meconnue. A distance, nous rapportons une erosion vaginale. Ces deux dernieres patientes ont ete explantees. Le suivi moyen etait de 20 mois. Seize patientes avaient une continence totale, cinq une continence sociale et trois portaient plus d’une protection quotidienne. Discussion Nos resultats ont confirme ceux deja publies sur la laparoscopie. L’abord mini-invasif a eu les memes resultats que la laparotomie classique, avec une courbe d’apprentissage courte. Conclusion L’implantation d’un SAU par laparoscopie chez des femmes avec une IUE severe a ete faisable et efficace.

Introduction Les mini-bandelettes sous-uretrales (BSU) sont encore en evaluation dans l’incontinence urinaire d’effort (IUE) feminine.

Ce report fait le point sur les nouveautes dans le domaine du syndrome de la douleur vesicale (SDV)-cystite interstitielle (CI) et met en valeur les connaissances actuelles qui sont necessaires au clinicien qui prend en charge le diagnostic et le traitement du SDV. Nous esperons ainsi procurer aux equipes medicales une mise au point leur permettant de suivre les nouveautes dans ce domaine.

La cystite interstitielle/syndrome de la vessie douloureuse est une pathologie qui reste meconnue du monde medical. Cette revue de la litterature met en valeur les connaissances actuelles et les nouveautes qui sont necessaires au clinicien qui prend en charge le diagnostic et le traitement de la cystite interstitielle. Nous esperons ainsi procurer aux praticiens une mise au point leur permettant de mieux gerer cette pathologie.

Proximal ureteral stone less than 4-6mm may initially be treated by surveillance. Generally, extracorporeal shockwave lithotripsy (ESWL) is the first line treatment for proximal ureteral stones, specially for stones less than 1cm. For stones greater than 1cm, the results of ureteroscopy (URS) are better than the results of ESWL and in these cases URS may be an option. In case of failure of ESWL, URS can be proposed. URS can be the first line treatment in case of severe ureteral obstruction with no urinary infection. Proximal ureteroscopy must be careful because severe complications are not infrequent. Open surgery has very rare indication. Metabolic check-up and annually follow-up with at least a renal imaging at three months are recommended.

Interstitial cystitis (IC) is a chronic, debilitating condition that is often associated with late diagnosis and a delay in initiation of appropriate IC-specific therapy. The typical patient with interstitial cystitis (IC) is symptomatic for many years and consults multiple physicians before IC is diagnosed. These observations suggest that the clinical presentation of IC is not widely recognized. The resultant underdiagnosis may be explained in part by the nonspecific nature of IC symptoms, such as urinary urgency, frequency, nocturia and pain, as well as by the lack of an objective diagnostic test. Pelvic pain of bladder origin may refer to pain in any location in the pelvis, is affected by the menstrual cycle and flares with sexual intercourse. As a result of variations in disease definition and diagnostic criteria for interstitial cystitis (IC), the performance of epidemiologic studies has been challenging. The true prevalence of IC is much greater than the early studies suggested. Over the last decade, the recognized prevalence of IC has increased and it is consistently greater among women as compared to men.

Resume La laparoscopie s'est imposee comme une voie d'abord alternative a la chirurgie ouverte. L'apprentissage de cette voie d'abord passe comme toute la chirurgie par le compagnonnage et l'aide operatoire. Plus encore qu'en chirurgie ouverte, une aide operatoire efficace facilite le travail du chirurgien et raccourcit la duree d'intervention. Certains principes de bases sont indispensables pour optimiser l'aide operatoire, comme le choix du nombre et de la position des trocarts. D'autres permettent une aide plus efficace par une manipulation adequate de la camera et de l'aspiration. Les etapes du curage pelvien laparoscopique seront ensuite detaillees pour insister sur ce que doit faire l'aide operatoire a chacune de ces etapes en distinguant la voie transperitoneale et la voie extraperitoneale.

Purpose: We evaluate the relationship between the use of synthetic gonadotropin-releasing hormone (Gn-RH) agonists and bone loss in men.Materials and Methods: Bone mineral density and parameters of mineral metabolism were evaluated in 12 patients with stage C prostatic carcinoma before and after 6, 12 and 18 months of treatment with 3.75 mg. triptorelin intramuscularly every 4 weeks.Results: Of the 12 patients 9 were evaluated after 6, 7 after 12 and 6 after 18 months of therapy. In comparison with month 0, the lumbar and femoral neck bone mineral density tended to decrease at month 6 (-3 and -2.7%, p = 0.31 and 0.17, respectively), at month 12 (-4.6 and -3.9%, p = 0.13 and 0.13) and at month 18 (-7.1 and -6.6%, p = 0.12 and 0.027). A second analysis revealed that the lumbar and femoral neck bone mineral density was significantly decreased on the last evaluation compared to month 0 (p = 0.05 and 0.028, respectively). The serum osteocalcin was increased during treatment, suggesting an accelerated b...

Le role de l’alimentation comme facteur aggravant les symptomes de la cystite interstitielle (CI) est considere comme important. De nombreux patients atteints de CI ont remarque que certains aliments pouvaient exacerber leurs symptomes et que la modification du regime alimentaire suffisait a soulager significativement ces symptomes. Cependant, d’un patient a l’autre, ce ne sont pas les memes aliments qui aggravent les symptomes. D’autres, en revanche, n’ont constate qu’une influence minime de cette diete sur leur etat clinique.

Objectifs Le sphincter artificiel urinaire (SAU) est le traitement de reference de l’incontinence urinaire d’effort (IUE) severe par insuffisance sphincterienne chez la femme. Methodes Etude retrospective sur 54 patientes ayant ete appareillees par un SAU pour une IUE severe, de novembre 1994 a septembre 2004. Resultats Quarante-quatre patientes (81,5 %) avaient des antecedents chirurgicaux pelviens ou pour incontinence. Le taux de revision etait de 48 % ( n = 26). Le suivi moyen etait de 147,2 ± 77,3 mois (mediane de 185,5 mois [90,2–207]). Seize patientes (29,6 %) ont ete explantees. Trente et une patientes (57,4 %) avaient un SAU en place et fonctionnel. Pour ces 31 patientes, la continence etait : totale pour 23 (42,6 %), sociale pour 4 (7,4 %) et incontinente pour 4 (7,4 %). Les taux de continence (totale et sociale) a 3, 5 et 10 ans etaient respectivement 81,3 %, 79,4 % et 70 %. La duree de vie moyenne du premier SAU sans re intervention etait de 105,7 ± 73,9 mois. Le taux de survie sans re intervention a 10 ans etait de 53,1 % IC 95 % [40,9–68,9]. Conclusion Le SAU est un procede efficace et durable pour le traitement de l’IUE severe.

Isolated renal Aspergillus abscess is a very rare complication of HIV infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old HIV-infected homosexual male, a nonintravenous drug abuser, who developed a right renal Aspergillus abscess despite normalization of the CD4+ cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin B followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of Aspergillus renal abscess in HIV-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.

A very unusual CT appearance of renal cel carcinoma is presented, in which the fatty density mimicked a benign angiomyolipoma.

RNA synthesis was studied autoradiographically using [3H]-uridine at different stages of human spermatogenesis and especially at the pachytene stage. Morphological and functional evidence have shown the X Chromosome to be allocyclic relatively to the autosomes, and apparently inactive throughout the whole meiosis. No RNA precursor was incorporated by the X at any stage of male meiosis. The authors suggest that this technique could be used in cases of human rearranged chromosomes, in order to elucidate the mechanism of spermatogenic breakdown in cases of hypofertility or sterility in humans.

In an attempt to define the best conditions for an adjunctive treatment of residual colonic microtumors by photodynamic therapy (PDT), an experimental model has been defined. S.c. HT29 colonic-cancer-cell tumors grown in nude mice were used and, 48 hr after i.p. administration of 30 mg/kg Photofrin (PH), laser illumination was performed with 75 or 150 Joules/cm2. The efficiencies of 2 lasers, the classically used rhodamine laser (RL) and a copper metal vapor laser (CMVL), were compared. The effects of PDT were assessed by histological and immunocytochemical (detection of a digestive enzyme, dipeptidyl-peptidase IV, as a marker of cell viability) follow-up and by the growth curve of the tumors after illumination. We conclude that, although the depth of necrosis resulting from PDT was nearly 3 mm at 75 J/cm2 and nearly 4–5 mm at 150 J/cm2 with both lasers, complete necrosis was obtained only with the CMVL at 150 J/cm2 (in 50% of the tumors). Under the other conditions, a layer of unaffected cells persisted at the pole opposite to laser illumination, resulting in growth curves lower than but parallel to those of the controls. Analysis of drug concentrations in the tumors and various organs, 48 hr after injection, i.e., at the time of laser illumination, revealed the presence of 21 μg/g dry weight PH in the tumors. The tumor vs. host-organ ratios were equal to or higher than 1 for the small bowel, colon, stomach, lung, skin and muscle. In contrast, the ratios were below 1 for the spleen, pancreas, kidney and liver. © 1992 Wiley-Liss, Inc.