Search

Summary Introduction To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. Material and methods Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. Results Thirty-six women were included (mean age: 72 ± 7 years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41 ± 12 min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n = 6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR = 2.0 [95% CI: 0.8175–4.8928]; P = 0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. Conclusion Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. Level of evidence 4.

International audience; Background: Many guidelines now recommend multiparametric MRI (mpMRI) prior to an initial or repeat prostate biopsy. However, clinical decision making for men with a non-suspicious mpMRI (Likert or PIRADS score 1-2) varies.Objectives: To review the most recent literature to answer three questions. 1) Should we consider systematic biopsy if mpMRI is not suspicious? 2) Are there additional predictive factors that can help decide which patient should have a biopsy? 3) Can the low visibility of some cancers be explained and what are the implications?Sources: A narrative review was performed in Medline databases using two searches with the terms "MRI” AND “prostate cancer” AND (“diagnosis” OR “biopsy”) AND (“non-suspicious” OR “negative” OR “invisible”); “prostate cancer MRI visible”. References of the selected articles were screened for additional articles. Study selection: Studies published in the last 5 years in English language were assessed for eligibility and selected if data was available to answer one of the three study questions. Results: Considering clinically significant cancer as ISUP grade  2, the negative predictive value (NPV) of mpMRI in various settings and populations ranges from 76% to 99%, depending on cancer prevalence and the type of confirmatory reference test used. NPV is higher among patients with prior negative biopsy (88-96%), and lower for active surveillance patients (85-90%). The PSA density (PSAd) with a threshold of PSAd= 2 cliniquement significatifs, la valeur prédictive négative (VPN) de l’IRMmp était comprise entre 76% et 99%, dépendante de la prévalence du cancer et du type de test de référence utilisé. La VPN était plus élevée chez les patients aux antécédents de biopsie négative (88-96%), et plus faible chez les patients en surveillance active (85-90%). La densité de PSA (PSAd) avec un seuil de PSAd

International audience; Introduction: the aim of this study was to assess whether early discharge could be non-inferior to inpatient management in selected patients with low-grade renal trauma (AAST grades 1–3).Materials and methods: A retrospective national multicenter study was conducted including all patients who presented with renal trauma at 17 hospitals between 2005 and 2015. Exclusion criteria were iatrogenic and AAST grades 4 and 5 trauma, non-conservative initial management, Hb 48 h (inpatient). The primary outcome was “Intervention” defined as any interventional procedure needed within the first 30 days. A Stabilized Inverse Probability of Treatment Weighting (SIPTW) propensity score based binary response model was used to estimate risk difference.Results: Out of 1764 patients with renal trauma, 311 were included in the analysis (44 in the early discharge and 267 in the inpatient group). In the early discharge group, only one patient required an intervention within the first 30 days vs. 10 in the inpatient group (3.7% vs. 5.2%; p = 0.99). Adjusted analysis using SIPTW propensity score showed a risk difference of − 2.8% [− 9.3% to + 3.7%] of “interventions” between the two groups meeting the non-inferiority criteria.Conclusion: In a highly selected cohort, early discharge management of low-grade renal trauma was not associated with an increased risk of early “intervention” compared to inpatient management. Further prospective randomized controlled trials are needed to confirm these findings.

International audience; 3D ultrasound imaging can be used in the context of robotic needle steering to reach a physical target with a flexible, steerable needle. During the insertion, the tissue may be deformed by the inserted needle, patient breathing or external force application. It may therefore be necessary to track intra-operatively the displacement of the target. Most ultrasound based needle steering works concentrate on 2D ultrasound probes [1], [2], [3] which do not allow to simultaneously track both the target and the needle during 3D needle steering. Physical target tracking in 3D ultrasound-guided needle steering is seldom carried out [4][5], and may require computational power that is precious for intra-operative needle steering. This paper proposes a new approach for computationally inexpensive and precise tracking of a moving target in 3D B-mode ultrasound volumes. It is based on the interconnection of intensity-based tracking and motion estimation algorithms. The intensity-based tracking consists in a 3D extension of the Diamond Shape block matching algorithm, used here for the first time in 3D ultrasound volumes for tissue tracking. The motion estimation is done by linear Kalman filtering. It predicts the next target position and ensures faster and more robust convergence of the Diamond Shape block matching algorithm. An experimental validation on ex-vivo tissue is proposed with promising tracking precision (estimated average error of 0.3mm) while significantly lowering the computational cost when compared to classical block matching based tracking.

International audience; Purpose: The Briganti nomogram can be used with a threshold of 5% to decide when to offer lymph node dissection during radical prostatectomy. The objective of the study was to assess the accuracy of the Briganti nomogram on intermediate-risk prostate cancer patients managed in a single academic department. Methods: We retrospectively reviewed the files of all patients managed by radical prostatectomy (RP) and bilateral pelvic lymph node dissection (BPLND) in our center between 2005 and 2017. The overall accuracy of the model in predicting metastatic lymph node disease was quantified by the construction of a receiver-operator characteristic (ROC) curve. A calibration plot was drawn to represent the relationship between the predicted and observed frequencies.Results: We included 285 patients, among whom 175 (61.4%) were classified as intermediate risk as defined by D’Amico. The median follow-up was 60 (34-93) months. Twenty-seven patients (9.5%) were diagnosed with lymph node metastases. The median number of lymph nodes removed was 10 (7-14). The mean Briganti score was 19.3% in patients with lymph node involvement (LNI) and 6.3% in patients without LNI. Focusing on intermediate-risk patients, 91(52%) and 84 (48%) had a Briganti score

International audience; OBJECTIVES: To evaluate the ability of students to reproduce the skills acquired on a prostate biopsy simulator in a real-life situation. DESIGN: A prospective randomized controlled study was conducted. Medical students with no experience of prostate biopsy were randomized between arm A « conventional training » and arm B « simulator-enhanced training. » The training was performed for both groups on the simulator. The students in arm B were provided with visual and numerical feedback. The transfer of skills was assessed by recording the position of the 12 biopsies performed by each student on an unembalmed human cadaver using a 3D ultrasound mapping device. SETTING: The study was conducted in an academic urol-ogy department and the cadaver experiments in the adjoining anatomy laboratory. RESULTS: Twenty-four students were included, and 22 completed the study. The median score obtained on the simulator at the end of the training was 57% (53-61) for arm A and 66% (59-71) for arm B. The median score obtained on the cadaver by students trained with the simulator was 75% (60-80), statistically superior to the score obtained by students trained conventionally of 45% (30-60), p < 0.0001. The median score obtained by all students when performing biopsies in a real-life situation was 63% (50-80) versus 60% (56-70) for their last training on the simulator. CONCLUSION: These results support the transfer of skills acquired on the simulator, and the superiority of a training curriculum integrating simulation, and performance feedback. (J Surg Ed 77:953À960. Ó 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. Methods Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3–4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan–Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cut-off. Results Median follow-up and surgical delay were 26 months (IQR 10–40) and 3 months (IQR 2–5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre- and post-operative variables. The lack of such association was observed across EAU risk categories. Conclusion Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.

Intermediate-risk prostate cancer regroups heterogeneous patients with different oncologic outcomes. Aim of the study is to validate a novel intermediate-risk subclassification ("magnetic resonance imaging [MRI] subclassification") that defines favorable and unfavorable diseases based on multiparametric MRI parameters and compare it to NCCN and AUA intermediate-risk subclassifications.A total of 429 patients treated with radical prostatectomy for NCCN intermediate-risk prostate cancer were identified. Using MRI subclassification, a favorable disease was defined as an organ-confined disease on MRI and international society of urological pathology Grade Group 1 to 2 on targeted biopsy. Remaining was classified as unfavorable. Univariable and multivariable analysis tested MRI subclassification in predicting overall unfavorable disease (OUD: pT3-4 and/or pN1 and/or International Society of Urological Pathology Grade Group ≥ 3), the need for adjuvant therapy and early biochemical recurrence (eBCR). Performance of NCCN, AUA, and MRI models was compared in term of OUD proportion and eBCR prediction using Harrell's c-index, calibrations plots, and decision curve analysis.Median (interquartile range) follow-up was 12 months (4-28). In multivariable analysis, MRI subclassification was an independent factor for OUD (odds ratio [OR]: 4.54 [2.85-7.22], P0.001), the need for adjuvant therapy (OR: 3.42 [1.36-8.57], P = 0.009), and eBCR (HR: 2.62 [1.18-5.83], P = 0.018). Using this model, the proportion of unfavorable disease decreased from 73.7% and 63.9% to 35.9% (P0.001) associated to an increasing proportion of OUD when compared to NCCN and AUA models (63.9% and 67.1%-77.9% respectively, P0.001). Performance of the 3 models for eBCR prediction tended to be similar with a poor accuracy ranged from 58.7% to 66.7% (P0.05), permanent miscalibration and a net benefit at decision curve analysis.We validated an intermediate-risk subclassification based on MRI and targeted biopsy that potentially improves patient selection by reducing the number of patients considered at unfavorable risk while increasing proportion of patients harboring poor oncologic outcomes. Its performance for eBCR detection was comparable to NCCN and AUA models.

Background: Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. Objective: To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Design, setting, and participants: Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). Intervention: PN. Outcome measurements and statistical analysis: Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. Results and limitations: We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n = 264). Trifecta patients had less transfusion (p < 0.001), lower intraoperative (5.3% vs 27%, p < 0.001) and postoperative (25.4% vs 37.8%, p = 0.001) complications, shorter hospital stay (p = 0.045), and lower ΔeGFR (p < 0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07–1.51, p = 0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32–0.62, p < 0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p < 0.001) and CKD upstaging (84.3% vs 8.2%, p < 0.001). Limitations include retrospective design. Conclusions: PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. Patient summary: We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation. Partial nephrectomy in elderly patients provides quality outcomes as measured by trifecta. Tumor complexity is a key determinant for trifecta achievement, and trifecta attainment is associated with improved function. Increasing utilization of robotics has benefits in recovery without compromising quality.

Resume Objectifs Les progres de l’imagerie et l’avenement de l’IRM multiparametrique ont rendu possible la definition de cibles et la realisation de biopsies ciblees de la prostate. Celles-ci peuvent etre realisees selon differentes methodes. Les objectifs de ce travail etaient de faire le point sur les techniques de fusion echographie-IRM et les dispositifs disponibles en 2018. Methodes Une revue ciblee de la litterature a ete realisee afin de relever les differents dispositifs disponibles. Les industriels ont ete ensuite contactes en cas de besoin pour preciser les informations manquantes. Nous nous sommes attaches a decrire le mode de fonctionnement de chaque dispositif ainsi que ses avantages et inconvenients. Resultats La fusion cognitive suppose une courbe d’apprentissage et une expertise importante. Elle est limitee par le risque d’erreur important qu’elle engendre et l’absence de controle qualite. Les systemes disponibles peuvent etre classes selon la methode utilisee pour le ciblage des zones suspectes : suivi de la sonde, de la biopsie, de la prostate et de la biopsie. Les dispositifs suivant la sonde sont les moins onereux, modifient peu les pratiques et permettent un guidage temps reel, au prix d’une precision moindre. Les dispositifs suivant la biopsie et la prostate offrent une precision de l’ordre de 3–4 mm en permettant de prendre en compte les deplacements de la prostate, au prix d’un cout plus important et d’une duree operatoire plus longue. Les biopsies peuvent etre realisees par voie transrectale ou transperineale selon les dispositifs. Conclusion Les progres de l’imagerie prostatique actuels et a venir et le developpement des traitements focaux sont en voie de faire des biopsies prostatiques ciblees une etape incontournable dans la prise en charge initiale du cancer de prostate. Le marche des dispositifs de fusion est en plein developpement et permet actuellement de faire un choix en mettant dans la balance precision, cout, modification des pratiques et duree operatoire.

Resume Introduction L’objectif a ete de decrire la prise en charge des pseudo-anevrismes (PA) post-traumatiques, intraparenchymateux, dans notre centre ; de la comparer aux donnees de la litterature afin de proposer un algorithme de prise en charge. Materiel et methodes Les dossiers de 325 traumatises renaux inclus dans une base de donnees prospective entre janvier 2004 et mai 2016 ont ete revus. Une revue des cas publies de PA a ete realisee sur Pubmed a l’aide des termes « blunt renal trauma » et « pseudoaneurysm » (excluant les cas de fistules arterioveineuses, de traumatismes ouverts et de PA extraparenchymateux) a permis l’analyse de 29 cas supplementaires. La prise en charge des traumatises renaux dans notre centre est decrite. Resultats Parmi les 325 patients traumatises renaux, 160 (49,3 %) etaient des traumatismes de grade IV et V. Un traitement conservateur a ete realise dans 93,2 % des cas. Huit cas de PA ont ete recenses, soit une incidence de 2,5 %. Quatre ont ete embolises d’emblee. Parmi les 4 cas surveilles, on a note 2 cas de thrombose spontanee, 1 cas d’absence de regression motivant une embolisation et 1 cas de recidive hemorragique occulte. Les PA surveilles ayant evolue favorablement avaient tous une taille inferieure a 1 cm. La fonction relative scintigraphique moyenne a 6 mois des reins ayant presente un PA embolise etait de 71,6 %. La revue de la litterature a permis de rapporter 29 cas publies, embolises pour 26 d’entre eux, avec un taux de succes de 84,6 %. Deux patients ont ete surveilles, mais l’un a finalement ete embolise devant la persistance de la lesion. Conclusion La formation d’un PA post-traumatique est une complication rare (2,5 %) des traumatismes fermes du rein. L’embolisation en presence de symptomes ou a fortiori d’une instabilite hemodynamique permet une bonne preservation renale. Les PA detectes de maniere fortuite (imagerie de suivi) et de taille inferieure a 1 cm semblent pouvoir etre surveilles. Niveau de preuve 5.

Resume Introduction Les lesions ureterales post-traumatiques sont majoritairement traitees par sonde double J. Une minorite necessite des prises en charges complementaires. Les stents ureteraux presentent une alternative chirurgicale. Pour evaluer les resultats de la mise en place des protheses Allium ® ureterales dans la prise en charge des patients porteurs de sonde double J au long cours pour des stenoses ureterales. Materiels et methodes Etude de cohorte retrospective, multicentrique, de 36 patients ayant beneficies de la pose de 37 stents ureteraux Allium ® (metallique 24 Ch) de septembre 2011 a janvier 2015 dans trois centres hospitalo-universitaire francais. La moyenne d’âge des patients operes etait de 63,8 ans (33 a 88 ans). La majorite des patients etaient des femmes (70 %). Un pourcentage de 5,6 presentaient une fistule ureterale et 94,4 % une stenose. La longueur moyenne de la stenose etait de 4,15 cm (0,5 a 12 cm). Toutes les analyses ont ete realisees en formulation bilaterale pour un risque d’erreur de premiere espece de 5 %. Une difference a ete consideree comme statistiquement significative quand le degre de signification ( p ) etait inferieur a 0,05 (risque α = 5 %). Les resultats sont exprimes en termes d’hasard-ratios (HR), intervalles de confiance a 95 % associes et p -values. Resultats Trente-sept pour cent des stents ont ete retire au decours du suivi pour des complications a type de migration (18,9 %), d’infection (10,8 %) et d’intolerance (8,1 %). Les autres stents ont ete retires au bout d’un an. L’efficacite de la mise en place du stent, definie comme l’absence de recidive de la stenose ou de la fistule, etait de 52,8 % avec un suivi moyen de 7,1 mois. Conclusions La mise en place des stents Allium ureteraux offre une alternative chez les patients en sonde double J a demeure avec une efficacite de plus de 50 %. Niveau de preuve 4.

International audience

Background The 2 main objectives regarding living kidney transplant are to provide optimal graft function and to ensure the safety of donation. Our study hypothesized that the glomerular filtration rate of a single kidney (skGFR), when transplanted, might predict graft function and that the skGFR of the remaining kidney could predict donor functional gain. Methods A prospective monocentric study was conducted at Grenoble-Alpes University Hospital. Twenty couples of donors and recipients were included. Dimercaptosuccinic acid renal scintigraphy and 51Cr-ethylene-diamine tetra-acetic acid clearance were evaluated predonation to calculate skGFR. All patients had renal function according to 51Cr-ethylene-diamine tetra-acetic acid clearance at 1 year post transplant to assess graft function and donor functional gain. All donors had normal renal function predonation. Results At 1 year post transplant, median glomerular filtration rate of the graft was 50 mL/min/1.73 m2 (range, 46-56 mL/min/1.73 m2) and donor median glomerular filtration rate was 59 mL/min/1.73 m2 (range, 55-74 mL/min/1.73 m2). Median functional gain was 20 mL/min/1.73 m2 (range, 12-22 mL/min/1.73 m2). No statistical correlation was found between skGFR of the transplanted kidney and graft function at 1 year (R2 = 0.096, P = .7). For the donor, functional gain was not associated with predonation skGFR of the remaining kidney (R2 = 0.17, P = .5). A statistical difference was found between donor functional gain (18 [SD, 10] mL/min) and recipient gain (delta between skGFR before and after transplant, 7 [SD, 16] mL/min; P = .02). Conclusion Predonation skGFR of the transplanted kidney had no influence on renal allograft function at 1 year post transplant. Similarly, there was no association between measured skGFR of the remaining kidney and donor functional gain at 1 year.

BACKGROUND Tacrolimus trough concentrations (mean/variability), as well as concentration-to-dose ratio (C/D ratio), affect kidney allograft outcomes. We investigated the link between the C/D ratio and death-censored kidney graft survival (DCGS). METHODS We performed a retrospective study on 1029 kidney transplant patients (2004-2016) with the following criteria: tacrolimus-based immunosuppression, >1-year graft survival, no initial use of everolimus, and available anti-human leukocyte antigen antibody data. We analyzed the impact of the time-varying C/D ratio on DCGS. Fast metabolizers were defined by a C/D ratio < 1.05. We also investigated the effect of an early (mo 3 to mo 6 post transplantation) C/D ratio below 1.05. Cox survival analyses were performed, adjusting for potential confounders (tacrolimus trough, variability of tacrolimus trough, de novo donor-specific antibody development, cytochrome P450 3A5 genotype, pregraft sensitization, mo 3 glomerular filtration rate). RESULTS Time-varying C/D ratio was significantly associated with DCGS (hazard ratio [HR], 2.35; P < 0.001) in a univariate model, on the full analysis set comprising 1029 patients. In the multivariate time-varying model, based on 666 patients with available cytochrome P450 3A5 genotypes, the effect of the C/D ratio remained significant (HR, 2.26; P = 0.015); even when glomerular filtration rate at month 3 < 30 mL/min/1.73 m (HR, 2.61; P = 0.011), de novo donor-specific antibody development (HR, 4.09; P < 0.001) and continued steroid prescription (HR=2.08, P = 0.014) were taken into account (other covariates, including tacrolimus trough concentrations, were nonsignificant). In the same multivariate model, the effect of early C/D ratio (median at mo 3 and mo 6) remained significantly associated with DCGS (HR, 2.25; P = 0.041). CONCLUSIONS C/D ratio is an independent and early predictor of DCGS. Identification of fast metabolizers could be a strategy to improve graft survival, for example, by optimizing tacrolimus formulation. Mechanistic studies to understand the C/D ratio effect are required.

OBJECTIVE To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients >= 80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity. (C) 2019 Elsevier Inc.

INTRODUCTION AND OBJECTIVES:In a large multicenter series, we assessed the impact of performing a standard systematic sampling of the prostate in addition to mpMRI-targeted biopsies, in terms of pr...

International audience; OBJECTIVE:To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing histopathology between systematic biopsies (SB), targeted biopsies (TB) and the combination of both (SB + TB) with the final histopathologic outcomes of radical prostatectomy specimens.MATERIALS AND METHODS:Retrospective, multicentric study of 443 patients who underwent SB and TB using MRI/US fusion technique (Urostation® and Trinity®) prior to radical prostatectomy between 2010 and 2017. Cochran's Q test and McNemar test were conducted as a post hoc test. Uni-multivariable analyses were performed on several clinic-pathological variables to analyze factors predicting histopathological concordance for targeted biopsies.RESULTS:Concordance in ISUP (International Society of Urological Pathology) grade between SB, TB and SB + TB with final histopathology was 49.4%, 51.2%, and 63.2% for overall prostate cancer and 41.2%, 48.3%, and 56.7% for significant prostate cancer (ISUP grade ≥ 2), respectively. Significant difference in terms of concordance, downgrading and upgrading was found between SB and TB (ISUP grade ≥ 2 only), SB and SB + TB, TB and SB + TB (overall ISUP grade and ISUP grade ≥ 2) (p

International audience; Objectives: The Biopsym simulator, a virtual-reality simulator for prostate biopsies, was designed to offer enhanced teaching of the biopsy procedure. The objectives of the present article are to describe the new version of the simulator and report the results of a new validation study. Material and methods: A prospective validation study was conducted between January and March 2017. The new version of the simulator, with improved physical realism, ultrasound image deformation, and a new scoring system, was evaluated by novice and confirmed users. Results: Twenty-one users evaluated the simulator, including ten novices and 11 confirmed users. The overall realism of the biopsy procedure was rated at 7.7/10 (IQR 5.7-9). The differences between the rates given by confirmed users and novices were not statistically significant. The median overall score obtained for the performance of 12 systematic ultrasound-guided biopsies was 43% (IQR 33-55). The median score obtained by confirmed users was 54% (IQR 46-62), and the median score obtained by novices was 31% (IQR 20-35). The difference between the scores was statistically significant (p = 0.005). Conclusions: This study allowed us to gather evidence towards the validation, and particularly towards the construct validation of the new version of the Biopsym simulator.

International audience; PURPOSE:To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor.PATIENTS AND METHODS:A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM).RESULTS:A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p = 0.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13-63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p

Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians' education (especially young nephrologists) on mineral-based alkaline waters should be intensified.

IntroductionFocal therapy has emerged as a promising treatment option for men with localised prostate cancer. However, most of the evaluation of postoperative function has taken place at a relatively high, non-granular level. Most of the data we use to provide informed consent for our patients is obtained from retrospective series, or derived from prospective studies whose primary outcome was oncological. Finally, most studies have focused on erectile function and overlooked other, presumably important, elements of male sexual function. The present study aims at studying in-depth the sexual consequences of focal therapy with various energy sources.Methods and analysisThis will be a mixed-methods research study based on a retrospective and prospective cohort, recruited in parallel. The retrospective cohort will consist of patients treated with focal irreversible electroporation, and the prospective cohort of patients treated with three focal therapy energies. Participants will be recruited from two UK urology centres, one National Health Service and one private. On consent, patients will fill in self-administered validated questionnaires (International Index of Erectile Function-15 (IIEF-15), Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF)) and semistructured interviews will be organised to collect patients’ expectations and postoperative changes in domains such as erection, ejaculation, orgasm, libido/sexual desire, masculinity/virility, penile morphology, pain or discomfort, regret, shame, cancer-related stress, overall impact and partner satisfaction. An exploratory thematic analysis will be performed to detail recurring themes that will be grouped into clusters of experiences. We will then be able to find clusters of agreement and disagreement that will be illustrated using exemplar patient quotations.Ethics and disseminationEthical approval was obtained (Regional Ethics Committee reference 20/NW/0335), as well as Health Research Authority approval. Results will be published in open-access peer-reviewed journals. Findings will also be translated into patient information resources (leaflets, online information sheets).Trial registration numberISRCTN11634296; Pre-results.

To validate a nomogram predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy taking into consideration multiparametric-magnetic resonance imaging (mp-MRI) parameters and targeted biopsies in a western European cohort.A total of 473 men diagnosed by targeted biopsies, using software-based MRI-ultrasound image fusion system, and operated by radical prostatectomy with extended pelvic lymph node dissection across 11 Europeans centers between 2012 and 2019 were identified. Area under the curve of the receiver operator characteristic curve, calibration plot and decision curve analysis were used to evaluated the performance of the model.Overall, 56 (11.8%) patients had LNI on final pathologic examination with a median (IQR) of 13 (9-18) resected nodes. Significant differences (all P0.05) were found between patients with and without LNI in terms of preoperative PSA, clinical stage at DRE and mp-MRI, maximum diameter of the index lesion, PI-RADS score, Grade Group on systematic and targeted biopsies, total number of dissected lymph nodes, final pathologic staging and Grade Group. External validation of the prediction model showed a good accuracy with an area under the curve calculated as 0.8 (CI 95% 0.75-0.86). Graphic analysis of calibration plot and decision curve analysis showed a slight underestimation for predictive probability for LNI between 3% and 22% and a high net benefit. A cut-off at 7% was associated with a risk of missing LNI in 2.6%, avoiding unnecessary surgeries in 55.9%.We report an external validation of the nomogram predicting LNI in patients treated with extended pelvic lymph node dissection in a western European cohort and a cut-off at 7% seems appropriate.

Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP. This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score

International audience; OBJECTIVES:To assess the accuracy of Koelis fusion biopsy for the detection of prostate cancer and clinically significant prostate cancer in the everyday practice.METHODS:We retrospectively enrolled 2115 patients from 15 institutions in four European countries undergoing transrectal Koelis fusion biopsy from 2010 to 2017. A variable number of target (usually 2-4) and random cores (usually 10-14) were carried out, depending on the clinical case and institution habits. The overall and clinically significant prostate cancer detection rates were assessed, evaluating the diagnostic role of additional random biopsies. The cancer detection rate was correlated to multiparametric magnetic resonance imaging features and clinical variables.RESULTS:The mean number of targeted and random cores taken were 3.9 (standard deviation 2.1) and 10.5 (standard deviation 5.0), respectively. The cancer detection rate of Koelis biopsies was 58% for all cancers and 43% for clinically significant prostate cancer. The performance of additional, random cores improved the cancer detection rate of 13% for all cancers (P < 0.001) and 9% for clinically significant prostate cancer (P < 0.001). Prostate cancer was detected in 31%, 66% and 89% of patients with lesions scored as Prostate Imaging Reporting and Data System 3, 4 and 5, respectively. Clinical stage and Prostate Imaging Reporting and Data System score were predictors of prostate cancer detection in multivariate analyses. Prostate-specific antigen was associated with prostate cancer detection only for clinically significant prostate cancer.CONCLUSIONS:Koelis fusion biopsy offers a good cancer detection rate, which is increased in patients with a high Prostate Imaging Reporting and Data System score and clinical stage. The performance of additional, random cores seems unavoidable for correct sampling. In our experience, the Prostate Imaging Reporting and Data System score and clinical stage are predictors of prostate cancer and clinically significant prostate cancer detection; prostate-specific antigen is associated only with clinically significant prostate cancer detection, and a higher number of biopsy cores are not associated with a higher cancer detection rate.

ARTICLE InFO ______________________________________________________________ ______________________ Introduction: Super-selective clamping of tumor-specific segmental arteries was developed to eliminate ischemia of the remnant kidney while limiting hemorrhage during partial nephrectomy. The objective is to evaluate the benefice of super-selective clamping on renal functional outcome, compared to early-unclamping of the renal artery. Materials and Methods: From March 2015 to July 2016, data from 30 patients undergoing super-selective robot-assisted PN (RAPN) for a solitary tumor by a single surgeon were prospectively collected. Tumor devascularization was assessed using indocyanine green near-infrared fluorescence. A matched-pair analysis with a retrospective cohort undergoing early-unclamping was conducted, adjusting on tumor complexity and pre-operative eGFR. Perioperative, oncologic and functional outcomes using DMSA-renal scintigraphy were assessed. Multivariate analysis was performed to identify predictors of postoperative renal function and de novo chronic kidney disease (CKD). Results: Super-selective RAPN was successful in 23/30 patients (76.7%), 5 requiring secondary main artery clamping due to persistent tumor fluorescence. Matched-pair analysis showed similar operating time, blood loss, positives margins and complication rates. Super-selective clamping was associated with an improved eGFR variation at discharge (p=0.002), 1-month (p=0.01) and 6-month post-op (-2%vs-16% p=0.001). It also led to a better relative function on scintigraphy (46%vs40% p=0.04) and homo-lateral eGFR (p=0.04), and fewer upstaging to CKD stage ≥3 (p=0.03). On multivariate analysis, super-selective clamping was a predictor of postoperative renal function. Conclusion: Super-selective RAPN leads to an improved preservation of renal function and a reduced risk of de novo CKD stage≥3, while keeping the benefit of main artery clamping on perioperative outcomes.

The management of bladder cancer, initially exclusively surgical, was recently improved by the development of chemotherapy. Chemotherapy can thus be proposed as bladder instillations in order to prevent recurrences of non-muscle-invasive cancer (NMIC), and systemically in case of muscle-invasive cancer (MIC). Chemotherapy can then be administered prior to surgery (neoadjuvant), as a complement to surgery (adjuvant), as an alternative to surgery as part of a multimodality treatment, and alone in palliative intent in case of metastatic cancer. Renal function and general health status of the patient help the decision-making and the choice of the chemotherapy regimen, which should be validated during a multidisciplinary meeting and presented to the patient during a dedicated medical and paramedical appointment.

Introduction: The aim of this study was to compare the results of ultrasound-guided prostate biopsies (US-PB) and magnetic resonance imaging-ultrasound fusion biopsies (MRI-PB) in two contemporary cohorts and to describe the parameters orienting the choice of technique.Methods: Two contemporary cohorts of patients undergoing US-PB or MR-PB using the Urostation® (Koelis, Grenoble, France) between November 2010 and July 2015 were analyzed retrospectively. Patients with metastatic cancer or recurrence after treatment, saturation biopsies, and US-PB performed after a negative MRI were excluded. Comparison of populations, biopsy results, and clinical and biological parameters guiding the choice of technique were studied on multivariate analysis (logistic regression) taking into account the following confounding factors: age, prostate-specific antigen (PSA) rate, prostatic volume, number of previous biopsies, and abnormal digital rectal examination.Results: One hundred fourteen patients were included in the US-PB group and 118 in the MR-PB group. Prostate cancer was diagnosed among 65 patients in the US-PB group (detection rate 57.0%) and 70 patients in the MR-PB group (detection rate 59.3%) (odds ratio [OR] 3.00; 95% confidence interval [CI] 1.52–6.17; p=0.002). Among the cancers diagnosed in the MR-PB group, 21 were diagnosed by the two targeted biopsy cores only (15.5%). Patients undergoing MR-PB were significantly younger (p=0.0005), with a higher number of previous biopsy sessions (p

Resume But Evaluer l’accessibilite previsible au post-internat pour les internes d’urologie terminant leur internat entre novembre 2013 et 2016. Materiel De septembre a novembre 2013, les representants des internes d’urologie inscrits en DESC dans chaque region ont ete contactes pour participer a l’etude. Un questionnaire leur a ete soumis afin de recenser localement le nombre d’internes prevoyant de terminer leur internat entre novembre 2013 et 2016, ainsi que le nombre de postes de chef de clinique-assistant (CCA) et d’assistant specialiste (AS) d’urologie permanents et provisoires dans la region, et leur occupation prevue durant la meme periode. Resultats En novembre 2013, notre etude a recense 334 urologues en formation (197 internes inscrits en DESC, 81 CCA, 56 AS). Cinquante-cinq internes ont termine leur internat en novembre 2013, alors que 67, 50, 77 internes ont prevu de terminer leur formation respectivement de novembre 2014 a 2016. L’accessibilite previsible au post-internat d’urologie a ete evaluee a 96,4 %, 82,1 %, 90,0 %, 74,0 % respectivement pour les internes terminant leur formation de novembre 2013 a 2016. Le deficit previsible de postes de post-internat a ete calcule a –2, –12, –5, –20 postes respectivement de novembre 2013 a 2016. Conclusion Le nombre previsible de postes de post-internat d’urologie reste insuffisant en France pour la periode 2013–2016. En raison d’un flux non stabilise d’internes prevoyant de terminer leur internat de novembre 2014 a 2016, leur accessibilite immediate a un post-internat a ete mesuree a 82,1 %, 90,0 %, 74,0 % respectivement sur la meme periode. Niveau de preuve 5.

Resume Introduction L’objectif de ce travail de l’AFUF etait d’etablir un etat des lieux des remunerations des gardes et astreintes des internes, assistants et chefs de clinique d’urologie en France. Materiel et methodes Les donnees ont ete recueillies de fevrier a mai 2013 par l’intermediaire d’un questionnaire envoye a tous les membres de l’AFUF (327 membres). Les remunerations etaient donnees en valeurs brutes. Resultats Quarante-trois internes ont participe a l’etude, 16 assistants et 16 chefs de clinique, permettant d’obtenir une representativite nationale de 62 % (54 hopitaux sur les 92 centres pratiquant l’urologie en France). La majorite des repondants etait d’astreinte operationnelle ou de securite. Vingt hopitaux (38 %) avaient une activite de prelevements multi-organes (PMO). Les remunerations medianes des internes etaient de 59,51 € par astreinte deplacee (demi-garde) et de 119,02 € par garde. Les assistants et chefs de clinique etaient remuneres de maniere forfaitisee pour 37,5 % d’entre eux (140 € pour les assistants [avec des variabilites de 40 a 195 €] et 130 € pour les chefs de clinique [42,5–180]) ou selon un tarif qui dependait du nombre ou du temps de deplacement pour les autres (62,5 %) : les deux premiers deplacements ou un deplacement e ou au-dela de 3 h et 365 et 473 € respectivement au-dela de 8 h. Les PMO etaient egalement remuneres de maniere forfaitisee (60 %) ou au tarif horaire (40 %). Au-dela d’un seuil de 2–3 heures, la remuneration horaire etait plus interessante que la remuneration forfaitisee. Conclusion Des disparites de remuneration des astreintes et gardes d’urologie ont ete mises en evidence. Les plus grandes variabilites concernaient la remuneration des astreintes forfaitisees au-dela d’un certain seuil d’heures deplacees et les astreintes de PMO des assistants et chefs de clinique. Ces differences meritent d’etre reconsiderees en vue d’une harmonisation nationale. Niveau de preuve 3.

A global endoscopic view of the surgical field could help avoid complications such as perforation of occluded organs and may reduce the endoscope displacements and also the usual time of laparoscopic procedure using a conventional endoscopy system. An augmented laparoscopy system was developed by increasing the field of view of a traditional endoscope. This system was implemented and tested in vitro using a testbench. High-definition miniature cameras were integrated into a traditional endoscope to obtain a panoramic vision device with a large field of view of the abdominal cavity. The additional cameras are mounted around the endoscopy body as a pair of glasses providing a global view of the abdominal cavity completing the traditional endoscopic view. Each camera can reach a frame rate of 30 images/second with a resolution of 1,600 $$\times $$ 1,200 pixels. To be able to fix the cameras to the endoscope, a deployment, fixation and rapid extraction system of the proposed device through the trocar was designed and validated in preclinical experiments (testbench and human cadaver). The preclinical experiments compared the time required to perform a pick-and-place task with the traditional endoscope alone and with the proposed system alone. A statistically significant reduction in procedure time was found using an augmented video endoscopy system for a pick-and-place task. An augmented laparoscopy system with increased field of view is feasible and may be advantageous compared with a traditional endoscope. In vivo testing of the system should be done to establish the clinical utility of this innovation.

Resume Objectif Evaluer les motivations, l’organisation pratique et le financement du Master 2 chez les jeunes urologues francais. Materiels et methodes Un questionnaire electronique a ete diffuse aux membres de l’AFUF ainsi qu’aux participants du seminaire de formation a la recherche « Graines et Sol » de l’AFU, entre juillet et septembre 2013. Les resultats sont presentes sous forme de mediane (ecart interquartile). Resultats Soixante reponses sur 115 etudiants ayant fait un Master 2 (52 %) ont ete analysees. L’âge median etait de 29 ans (28–30) lors de la realisation du Master 2 et la proportion masculine de 75 %. La bourse de l’AFU etait obtenue par 57,4 % des postulants, 56,4 % pour les diverses bourses et 47,6 % pour la bourse annee recherche. Le montant median brut annuel etait de 29 870 € (22 710–30 195) sans difference significative entre les subdivisions. Les complements financiers provenaient essentiellement de gardes (26,2 %), d’astreintes (28,6 %) et de remplacements (25 %). L’annee de Master 2 etait le plus souvent realisee entre la quatrieme et la cinquieme annee d’internat (53 %), pour une duree d’un an (96,7 %) et en France (86,6 %). La cancerologie urologique (60 %) etait la thematique la plus etudiee. Le Master 2 etait realise dans un projet de carriere hospitalo-universitaire (31,7 %) ou dans l’attente d’un post-internat (20,8 %). Environ un quart se voyait proposer un poste de CCA avant le Master 2. Cette annee etait source de publication pour 76,7 %. La these de Sciences interessait 63,3 % des repondants. Conclusion Cette etude confirmait l’interet des jeunes urologues francais pour une annee de Master 2. Le financement grâce aux bourses facilitait le deroulement de cette annee dans l’optique d’une carriere universitaire pour nombre d’entre eux. Niveau de preuve Niveau 3.

Resume Objectifs Les objectifs de cette etude etaient d’evaluer la place de la simulation dans la formation initiale des jeunes urologues francais. Materiels et methodes Un questionnaire electronique a ete diffuse a l’ensemble des internes et chefs de clinique, membres de l’AFUF entre fevrier et mai 2013. Les resultats sont presentes sous forme de mediane (ecart interquartile). Resultats Les reponses de 125 urologues en formation ont ete analysees (taux de reponse 38 %). Il s’agissait d’internes dans 90 cas (72 %), et de chefs de clinique ou assistants dans 35 cas (28 %). L’âge median etait de 29 ans (27–30), la proportion masculine de 77 %. Tous les CHU etaient representes. Quatre-vingt-dix (72 %) d’entre eux avaient acces a un pelvi-trainer et 66 (53 %) a des modeles animaux ou cadaveriques, mais ne l’utilisaient jamais ou moins d’une fois par mois dans 83 et 97 % des cas, respectivement. Soixante-douze (58 %) avaient utilise au moins une fois un simulateur utilisant la realite virtuelle et 38 (30 %) y avaient acces regulierement, mais sans encadrement dans 64 % des cas. Les facteurs limitant l’entrainement sur simulateur etaient l’absence de simulateur a disposition (70 %), le manque de temps (58 %), d’incitation (34 %) et d’encadrement (20 %). Si ces conditions etaient reunies, 86 % des jeunes urologues seraient prets a consacrer plus d’une heure par semaine a l’entrainement sur simulateur. Conclusion Cette etude a revele parmi l’echantillon interroge une sous-utilisation de la simulation dans la formation pratique. Cela etait explique par un manque d’accessibilite, mais surtout d’utilisation des moyens a disposition. Niveau preuve 3

Objectifs Evaluer la securite et le suivi des endoprotheses Allium mises en place dans notre centre au niveau uretral ou ureteral. Methodes Etude de cohorte retrospective, unicentrique a partir des dossiers medicaux de 32 patients pris en charge pour la mise en place d’une endoprothese Allium entre 2011 et 2018. Resultats Quatorze stents uretraux et 20 stents ureteraux (chez 17 patients) ont ete poses. Parmi les 14 stents uretraux, 10 ont ete retires de maniere non programmee (migration n = 5, calcification n = 2, mauvaise tolerance ou inefficacite n = 3) apres un delai median de 93 jours (33–153). Les 20 stents ureteraux ont ete poses pour stenose ureterale ou compression extrinseque. Huit (40 %) ont ete retires a une mediane de 10 mois (migration intravesicale n = 2, migration pyelique n = 1, calcifications, obstruction et surinfection n = 4, fistule ureterale n = 1, inefficacite n = 1) dont 2 suivis d’une nephrectomie. Le suivi des stents uretraux etait regulier sauf pour 1 patient perdu de vue pendant 3 ans jusqu’a calcification. Deux patients porteurs de stents ureteraux ont ete perdus de vue et 3 patients ont presente des complications severes malgre un suivi echographique. Conclusion Les complications apres mise en place d’une endoprothese Allium sont frequentes et la plupart du temps gerees simplement (migration). Les complications potentielles des stents ureteraux justifient un suivi regulier comportant un uroscanner.

Objectif Comparer les resultats peri-operatoires et fonctionnels d’une adenomectomie prostatique par voie haute robot-assistee (AVHRA) a ceux d’une voie ouverte (AVHO) pour des hypertrophies benignes de la prostate (HBP) de plus de 100 ml. Methodes Etude retrospective monocentrique appariee de 20 cas consecutifs d’AVH robot-assistee sur un score de propension a une serie de 20 cas d’AVH ouverte retropubienne selon Millin. Etaient retenus les patients operes par 1 chirurgien experimente pour AVHRA et 2 par AVHO. Les AVHA etaient operes de janvier 2017 a janvier 2019 (n = 20), les AVHO de janvier 2006 a janvier 2019 (n = 51). Une « pseudo-randomisation » par appariement sur un score de propension etait realisee en ajustant sur le volume prostatique et le score de Charlson (CCI) retenant 20 patients dans chaque groupe. Resultats Les 2 groupes etaient comparables en termes de volume prostatique, âge et score de Charlson. Plus de patients operee par AVHO etaient en RAU (70 vs 29,4 %, p = 0,025). Les pertes sanguines per-operatoires etaient moindres dans le groupe AVHRA vs AVHO (200 vs 500 ml, p = 0,021), ainsi que les durees d’hospitalisation (3,5 vs 7, p Conclusion L’AVHRO permet une amelioration des durees de sondage et d’hospitalisation post-operatoires en comparaison de l’AHHO. La technique de l’AVHRO est une alternative valable a la chirurgie ouverte chez les patients ayant une HBP > 100 ml permettant des resultats fonctionnels post-operatoires similaires en ameliorant les suites peri-operatoires. Cette technique est a opposer a d’autres techniques mini-invasives comme l’enucleation endoscopique.

Contexte La TEP/TDM a la 18F-Choline (FCH) est actuellement consideree comme l’examen diagnostique de reference en medecine nucleaire chez des patients en recidive biochimique (RB) de cancer de prostate, alors que la scintigraphie osseuse (SO) est controversee dans cette indication, en particulier lorsque le PSA est inferieur a 10 ng/mL. Les objectifs de l’etude etaient de determiner les performances diagnostiques de la SO avec double TEMP/TDM systematique en comparaison a la TEP/TDM a la FCH pour la detection des metastases osseuses chez des patients presentant une RB de cancer de prostate, independamment du taux de PSA, et d’identifier une sous-population pour laquelle la SO avec TEMP/TDM avant la TEP/TDM a la FCH pourrait etre pertinente. Methodes Les patients adresses pour une RB de cancer de prostate et qui ont beneficie d’une SO couplee a une TEMP/TDM double champ systematique et d’une TEP/TDM a la FCH dans un delai de trois mois ont ete retrospectivement inclus. Les examens ont ete classes comme positifs, equivoques ou negatifs pour l’atteinte osseuse par deux medecins nucleaires en aveugle. La FCH etait consideree comme le gold standard. Dans la perspective de realiser la SO avec TEMP/TDM avant la TEP/TDM a la FCH, les SO equivoques etaient considerees comme negatives dans l’analyse. Resultats De janvier 2011 a novembre 2017, 115 patients consecutifs en RB de cancer de prostate ont ete evalues. La sensibilite, specificite, valeur predictive positive et negative de la SO avec TEMP/TDM etaient de 92,9 % [76,5–99,1], 98,9 % [93,8–100], 96,3 % [81–99,9] et 97,7 % [92–99,7] respectivement. Les patients presentant une SO avec TEMP/TDM positive avaient un score de Gleason (p Conclusion La SO avec TEMP/TDM a de bonnes performances pour le diagnostic des metastases osseuses dans la RB du cancer de prostate par rapport a la TEP/TDM a la FCH. Cependant, les patients pour lesquels cette strategie apparait pertinente se limitent desormais a ceux qui ont un haut volume tumoral metastatique osseux (8 % de nos patients).