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Resume Objectif Proposer des recommandations pour la prise en charge des symptomes du bas appareil urinaire (SBAU) et de l’incontinence urinaire du patient transplante renal et du candidat a la transplantation renale. Methode Une revue de la litterature (Medline) avec approche systematique a ete conduite par le CTAFU concernant les modalites therapeutiques des SBAU et des troubles de la continence du patient transplante renal et du candidat a la transplantation renale, en evaluant les references et leur niveau de preuve. Resultats La capacite vesicale fonctionnelle et la compliance vesicale sont alterees lors de la dialyse. Les SBAU, lies aux alterations pre-transplantation renale, s’ameliorent le plus frequemment spontanement apres transplantation renale. Les SBAU lies a une hyperplasie benigne de prostate (HBP) peuvent etre masques en pre-transplantation en raison de l’oligurie, des troubles de la compliance et de la capacite vesicale. En cas de SBAU lies a une HBP, seuls les anticholinergiques necessitent une adaptation de la posologie en fonction de la clairance de la creatinine. Si indiquee, la chirurgie de l’HBP peut etre realisee precocement apres transplantation renale. Concernant la prise en charge chirurgicale de l’incontinence urinaire, il ne semble pas exister d’augmentation des complications infectieuses chez le patient transplante renal. Une attention particuliere doit etre portee a la prise en charge du residu post mictionnel et des pressions vesicales en cas de vessie neurologique. La prise en charge adaptee d’un patient presentant une vessie neurologique permet une transplantation renale sans augmentation du risque de perte du transplant renal, au prix d’une augmentation de l’incidence des infections urinaires febriles. Conclusion Ces recommandations francaises doivent contribuer a ameliorer la prise en charge des symptomes du bas appareil urinaire et de l’incontinence urinaire du patient transplante renal et du candidat a la transplantation renale.

Resume Introduction Apres le developpement de la nephrectomie laparoscopique de donneur vivant en 1995, puis l’evolution vers la laparoscopie robot-assistee en 1999, certaines equipes ont evalue l’apport de ces techniques en transplantation renale. Methodes Une revue de la litterature a ete menee colligeant les etudes cliniques evaluant la chirurgie laporoscopique robot-assistee pour le prelevement renal a donneur vivant et pour la transplantation renale. Resultats Le prelevement renal donneur vivant robot-assiste a une tres faible morbidite et de bons resultats a long terme concernant donneurs et receveurs. Elle permet notamment une amelioration des douleurs postoperatoire. L’apport de la chirurgie robotique en transplantation renale semble plus limite. Les differentes series semblent mettre en lumiere un interet chez les patients obeses et/ou sous anticoagulants en diminuant la morbidite parietale.

Solitary Pancreas (SPT) and simultaneous kidney-pancreas (SPKT) transplants carry a high risk of surgical complications that may lead to the loss of the pancreas graft and impact later kidney function. The purpose of this study was to investigate the role of MDCT in the diagnosis of early complications and its impact on kidney function.All patients receiving SPT or SPKT over 5 years were retrospectively included. Complications that occurred within the first 15 days were registered and MDCT data analyzed. Data regarding donor, transplant, and recipient characteristics as well as transplantation procedures were analyzed according to the occurrence of early complications. Kidney function at day 3 following MDCT was evaluated.One hundred and forty-one patients were included (85 men, 56 women; mean age 40.1 years, SD 7.7) with 119 SPKT and 22 SPT. Sixty-four complications were registered in 50 patients. Partial (P-) or complete venous thrombosis (C-VT) occurred in 12.1 % (n = 17), arterial thrombosis (AT) in 1.4 % (n = 2), and hemorrhage in 8.5 % (n = 12) of all patients. For venous thrombosis, the predominant risk factor was body mass index (BMI) for either recipients (P 0.05) or donors (P 0.01). Median time for venous thrombosis diagnosis with MDCT was 4 days. Kidney function was not altered following MDCT. Fourteen pancreatectomies were necessary. All patients with C-VT and AT had to undergo graftectomy.Vascular complications occurred early following grafting. Systematic early-enhanced MDCT at day 2-3 should be adequate to detect early thrombosis, especially if risk factors have been identified, without induced kidney function alteration.

To assess the workload of an on-call urology resident at a French University Hospital.A prospective study was performed during 15 days in February 2012. The data recorded in our database regarded the resident (sex, age, time to go to work), the call (emergency, type and reason) and the person who called (grade, department).Seven centres including 18 residents participated. On average five calls were received per day [0-17]. After midnight, the resident was called less than twice (1.6). There was an actual emergency in 64% of cases [0-13]. The urology-related call motives (73%) mainly consisted in acute urine retention (AUR) and catheter problems (73), renal colic (RC) (49), acute pyelonephritis (23), and hematuria (22). Residents had to go to the hospital in 55% of AUR and catheter problems, 30% of acute pyelonephritis, 17% of RC and 14% of hematuria. The emergency department (ED) called the urology resident in 39% of cases but only 18% required the presence of the resident. A call made by a senior was more likely to be an emergency (67%) than by a resident or a nurse (51%, P=0.02).The urology resident when on-call is mainly asked for an advice by the ED. Among urology-related advice, bladder catheterization problems were the most frequent. RC was the second call motive but most of the time was not an actual emergency.

To evaluate the accessibility of the fellowship for the residents of Urology expecting to accomplish their residentship between November 2010 and 2013.Between November 2010 and January 2011, all the residents ongoing for the residentship of Urology in France were reached by an electronic mailing using the AFUF register. A questionnaire reported all the residents expecting to accomplish their residentship between November 2010 and 2013, and the number and the expected availability of fellow and specialist assistant posts during the same period.Our study counted 306 urologists on training (190 residents, 76 fellows, 30 assistants, 10 on other posts). On November 2010, 56 residents accomplished their residentship, while 68 and 79 residents expected to accomplish their residentship on November 2011 and 2012, respectively. One hundred and six posts validated the fellowship of Urology on November 2010 (76 fellows, 30 assistants), among 54 posts were available. Over the residents expecting to accomplish their residentship on November 2011 and 2012, 22 and 54 residents may not find a fellow post available.The number of residents expecting to accomplish the residentship of Urology between November 2010 and 2013 was increasing, showing a greater interest for this speciality and a lack of regulation for its accessibility. By reason of a discrepancy of fellow and specialist assistant posts, only 67.6 and 31.6% of the residents expecting to accomplish their residentship on November 2011 and 2012 may be able to find a post available.