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Purpose: To evaluate the predictable accessibility to the fellowship of urology for residents expecting to accomplish their residentship from November 2013 to November 2016., Material: Between September and November 2013, the representants of the residents ongoing for the residentship of urology in each region of France were reached to participate to the study. A questionnaire was given in aim at reporting all the local residents expecting to accomplish their residentship between November 2013 and 2016, and the number and the expected availability of fellow and specialist assistant posts in the region during the same period., Results: In November 2013, our study listed 334 junior urologists (197 residents, 81 fellows, 56 assistants). Fifty-five residents were ending their internship by November 2013, whereas 67, 50, 77 residents were expecting to accomplish their residentship from November 2014 to 2016 respectively. The predictable accessibility to the fellowship of urology was 96.4%, 82.1%, 90.0%, 74.0% respectively for the residents accomplishing their residentship from November 2013 to November 2016. The predictable deficit of fellow and assistant posts were -2, -12, -5, -20 posts from November 2013 to November 2016 respectively., Conclusion: The predictable number of fellow and assistant post in Urology remains insufficiently available for the 2013-2016 period. By reason of the unstable number of residents accomplishing their residentship from 2014 to 2016, the fellowship accessibility was measured at 82.1%, 90.0%, 74.0% from 2014 to 2016 respectively., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Purpose: Comparative medical economic study between total prostatectomy and laser in the treatment of benign prostatic hyperplasia in patients whose prostate is more than 80g., Materials and Methods: This study compared data registered retrospectively for the group AVH and prospective data for PVP patients. The patients whose prostate weighed more than 80g by echography were selected. The adopted point of view was the one of the hospital and the temporal horizon was of one year after the surgical operation. Direct costs per- and post-surgery were taken into account including specific surgical care and secondary surgical revision. The medical data per- and postoperative were also compared. Primary outcome measure was incremental cost per procedure., Results: Forty-one patients in the AVH group and 53 in the PVP group. The mean length of stay (LOS) is significantly shorter in the PVP group (3.0±1.0 days vs 10.4±4.0; P<0.001). Re-operation rate was significantly lower in the PVP group (1.9% vs 19.5% P<0.001). The cost analysis shows a mean additional cost of 1450 euros for the AVH group., Conclusion: PVP was cost-effective because it was more economic and it lead to lower re-operation rate until one year of follow-up than in the AVH group. Nevertheless, these data deserve to be nuanced by unfavorable results of the AVH in comparison with those of the literature., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: To study the place of simulation in the training curriculum of French urologists-in-training., Materials and Methods: An online questionnaire was sent to all residents and fellows members of the AFUF between February and May, 2013. Results are presented as the median (interquartile range)., Results: The answers of 125 urologists-in-training were computed (response rate 38%). They were residents in 90 cases (72%), and fellows in 35 cases (28%). Median age was 29 (27-30), male proportion 77%. All French academic urology departments were represented. Ninety of them (72%) had access to a pelvi-trainer and 66 (53%) to animal or cadaveric models, although they never used them or less than once a month in 83 and 97% of cases, respectively. Seventy-two (58%) had used a virtual-reality based simulator at least once and 38 (30%) had regular access to one, but without supervision in 64% of cases. Factors limiting simulation-based training were the lack of available simulators (70%), the lack of time (58%), the absence of incitement (34%) and supervision (20%). If these conditions were met, 86% of urologists-in-training would be ready to spend more than one hour a-week training on a simulator., Conclusion: This study revealed among the sample of respondents a limited use of simulation tools for skills aquisition. This was explained by a limited availability of these tools but also by an insufficient use of the tools when available., (Copyright © 2014. Published by Elsevier Masson SAS.)

Objectives: To assess motivations, the practical organization and the funding of a research fellowship in the training curriculum of French urologists-in-training., Materials and Methods: An online questionnaire was sent to members of the AFUF and to participants of a research training seminar "Graines et Sol" organised by the AFU, between July and September 2013. Results are presented as the median (interquartile range)., Results: Sixty answers out of 115 research fellows (response rate 52%) were computed. Median age was 29 years (28-30) during the research year and male proportion 75%. The AFU grant was obtained by 57.4% of applicants, 56.4% for various grants and 47.6% for the research fellowship university grant. The annual gross amount was 29,870€ (22,710-30,195), without any significant difference between residency subdivisions. Financial supplements were obtained by being on-duty (26.2%), on-call (28.6%) and replacements (25%). The research fellowship year was done between 4th and 5th years of residency (53%), for a one-year length (96.7%) and in France (86.6%). Urologic cancerology was the thematic the most studied (60%). The research fellowship was done in view of an academic career (31.7%) or was done to wait for a post-residency position (20.8%). About a quarter was being proposed a chief-residency position before the beginning of the research year. During this year, 76.7% published. About 63% were interested in pursuing with a PhD., Conclusion: This study confirmed the interest for a research fellowship by French urologists-in-training. Financial support thanks to grants facilitated the conduct of a research fellowship in the aim of an academic career for most of them., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: Photoselective vaporization of the prostate (PVP) is becoming a surgical treatment alternative of transurethral resection of the prostate for male lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). We evaluated the outcome and postoperative complications of PVP performed by 80-W KTP and 120-W HPS GreenLight lasers (AMS®) over a 4-year period., Materials and Methods: This is a prospective monocentric study that included all patients who underwent PVP. They had routine follow-up at 1 month, 3 months, 6 months and every year until the fourth postoperative year. Listed data were maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), post-void residual (PVR) volume, prostate-specific antigen (PSA) and prostate volume. We collected the postoperative complications., Results: From September 2005 to May 2008, 77 patients out of a 409 patients cohort underwent surgery and were followed during 4 years. At 4 years mean Qmax increase was 82.5%; mean IPSS, PVR volume, PSA and prostate volume decreases were 79.1, 69.8, 43.8 and 22.9%, respectively. The main side effects observed were storage LUTS. A urinary catheter was replaced after a first withdrawal failure in 10 patients (15.6%) after surgery., Conclusions: PVP showed a sustainable efficacy and an appealing tolerance profile during a 4-year period in patients with LUTS secondary to BPO., (2014 S. Karger AG, Basel.)

Purpose: To evaluate the accessibility of the fellowship for the residents of Urology expecting to accomplish their residentship between November 2010 and 2013., Patients: 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., Results: 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., Conclusion: 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., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

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