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Introduction: The screening of prostate cancer was recently the subject of international studies and debates in France. We decided to study the vision of the screening, in particular by the PSA, which have the general practitioners., Methods: We sent a questionnaire to 456 general practitioners of Oise (French department) to be returned in an anonymous way on the prostate cancer, PSA, the economic impact of the PSA and we asked whether the doctors realized the screening or not, if they were favorable to it and for which reasons., Results: We received 38% of answers. Eighty-one percent of the general practitioners considered that prostate cancer is frequent, 72% that it evolved slowly and 55% that it affected old men. For 79% of the general practitioners, the patients were asking for a screening by PSA. Eighty-eight percent thought that they had to be in front line of the screening, 58% that the functional consequences of the screening were satisfactory. Fifty-seven percent of the general practitioners realized the screening in a systematic way and 88% were favorable to it., Conclusion: The general practitioners of Oise remained favorable for the greater part to the screening of prostate cancer and the patients applicants in spite of various debates., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

This article reports a rare case of acute pyelonephritis with bacteriemia due to non-tiphoidal Salmonella associated with a mycotic aneurysm. The patient was a 75-year-old woman without histories of immunosuppression or urologic deformation. It was about a patient presenting a feverish access and urinary symptoms. Blood culture and urine culture showed Salmonella enteritidis; in spite of a prolonged antibiotic treatment, the multiple bacteriological explorations remained positive. The research for this infection source allowed the discovery of a thoracic aorta aneurysm with hypermetabolism in the PET-scan carrying the diagnosis of mycotic aneurysm. Urinary salmonellosis represents 0.07% (Tena et al., 2007 [1]) of the urinary tract infections. They are rarely found in healthy patients; their eradication can turn out to be difficult when the infection source persists., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Prostatic diseases are very important in urologist's practice. We wanted to study evolution of prostatic procedures using French national coding database., Methods: We searched the Agence Technique d'Information sur l'Hospitalisation (ATIH) web server for prostatic procedures between 1997 and 2011 for both private and public sectors., Results: The procedures were more often performed in private sector (up to 70%). There was a sustained increase (+332%) of the number of prostatectomies between 1997 and 2007 (more than 27,000 procedures), followed by a slight decrease. There is a rising use of laparoscopic approach from 35% in 2006 up to 58% in 2011. The use of brachytherapy and HIFU was marginal. Transurethral resection of the prostate number was stable between 56,000 and 60,000 procedures a year (for cancer for less than 7%). Adenomectomies number decreased from 9832 to 7963 procedures a year., Conclusion: The most noticeable data were upon prostatectomies number, with a peak effect in 2007. Laparoscopic procedures were more and more frequent. TURP number was stable, whereas adenomectomies number decreased., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Unlabelled: Urinary schistosomiasis is very frequent, but there are few data upon its epidemiology in western countries. We wanted to describe the cohort from Tenon hospital, in Paris, France, near a big subsaharian community., Methods: We searched in our clinical files database for "urinary schistosomiasis" encoding., Results: The cohort comprised 207 men and 34 women seen for the first time at the mean age of 34, mainly for haematuria or LUTS. Patients were mainly native from subsaharian Africa. The lost to follow up rate was 54%. Diagnosis was made on sole endoscopic finding in half of the cases. For non-tumor pathology, were made seven cystoplasties et 12 ureteral dilations. Tumoral pathology was frequent and severe (15/81 from the same age range), mainly represented by urothelial histology (8/14). Imported cases were rare (five cases)., Conclusion: Despite its limitations, different characteristics from this cohort seemed noticeable: frequency of sole lower urinary tract symptoms, frequency and severity of tumoral diseases, mainly with urothelial carcinoma as histology., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

We evaluated the value of combining noncontrast helical computerized tomography (NCHCT) and color Doppler ultrasound in the assessment of the composition of urinary stones. In vitro, we studied 120 stones of known composition, that separate into the five main types: 18 calcium oxalate monohydrate (COM) stones, 41 calcium oxalate dihydrate (COD) stones, 24 uric acid stones, 25 calcium phosphate stones and 12 cystine calculi. Stones were characterized in terms of their Hounsfield density (HU) in NCHCT and the presence of a twinkling artifact (TA) in color Doppler ultrasound. There were statistically significant HU differences between calcium and non-calcium stones (p < 0.001), calcium oxalate stones and calcium phosphate stones (p < 0.001) and uric acid stones and cystine calculi (p < 0.001) but not between COM and COD stones (p = 0.786). Hence, the HU was a predictive factor of the composition of all types of stones, other than for COM and COD stones within the calcium oxalate class (p > 0.05). We found that the TA does not enable differentiation between calcium and non-calcium stones (p > 0.999), calcium oxalate stones and calcium phosphate stones (p = 0.15), or uric acid stones and cystine calculi (p = 0.079). However, it did reveal a significant difference between COM and COD stones (p = 0.002). The absence of a TA is a predictive factor for the presence of COM stones (p = 0.008). Hence, the association of NCHCT and Doppler enables the accurate classification of the five types of stones in vitro., (Copyright © 2012 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Aims: To study impact of previous radiotherapy on urodynamic parameters, continence and complication rate, after prosthetic implantation with InVance® device., Patients and Methods: We included 106 patients between August 2004 and March 2009. We stratified urinary incontinence according to pads daily used, in grade I (one to two pads), II (three to four), or III (more than four or condom catheter use). We compared one group of 24 patients with previous radiotherapy (R) to 82 control patients (T) without one. Follow-up was made at three and six postoperative months and then annually. Results were classified into: no leaks, improved or failure., Results: Mean follow-up was 14.8 months (median=12.8) in group R and 12.4 months (median=8.8) in group T. At three postoperative months, continence was achieved in 62.5% patients from group R and in 77% patients in group T (P: ns). At 12 months, results on continence were respectively 52.6% in group R and 63.2% in group T (P: ns). Six patients were explanted because of an infection (5.7%), among which two in group R (8.3%) and four in group T (4.8%). Infection was significantly linked to operative time (P: 0.02)., Conclusion: Previous radiotherapy has no impact on urodynamic parameters and continence, on short- and mid-term analysis, after implantation of a bone-anchored suburethral sling with InVance® device, preferentially patients with mild to moderate incontinenec urinary., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Introduction: Urolithiasis is of health economics concern since it is very frequent. However, there is few data upon its issue in France., Methods: We have analyzed the data issued from the national coding system for in-hospital stays and interventions, using urolithiasis codes and compared between public and private sectors. We have observed evolution of procedures and stays until 2009., Results: Public and private sectors were quite similar in terms of stays numbers (144,324 in 2009, and an evaluated total cost of more than 168 millions of euros). Since 2000, there has been an increase of more than 20% in the number of stays in the public sector and a stagnation in the private one. Public and private sectors appeared different in terms of: (1) stays without intervention (53 vs 26%; p<0.0001); (2) stays without associated diagnosis (5.78 vs 8.41%; p<0.0001). Since 2006, there has been a stagnation for percutaneous and surgical interventions (less than 5% of the number of interventions) whereas there has been a clear increase in endoscopic (+29% in private sector and +16% in public one) and lithotriptic (+19 and +5%) interventions., Conclusion: There were strong disparities between public and private sectors. Endoscopic interventions and lithotrity sessions have shown a sustained increase. Surgical and percutaneous interventions have shown a stagnation., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Twinkling artifact characterized by a rapidly fluctuating mixture of Doppler signals occurs behind a strongly reflecting granular interface such as urinary tract stones or gallstones. It may occurs in association with several clinical situations, and may sometimes be helpful for diagnosis while it may sometimes be a pitfall that must be recognized by the sonographer. After reviewing the technical nature of this artifact, several cases will be presented to illustrate the advantages and pitfalls related to this artifact.

Objective: To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis., Patient and Methods: From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment., Results: Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75% (n = 16) for Politano-Leadbetter anastomosis versus 53% (n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P = .1)., Conclusion: Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.

Public health approach, in its different fields: observational epidemiology, interventional epidemiology, health economics or health education carries major problems that can influence everyday practice. We review some practical examples of what public health can afford to urology practice.

We report the case of a 67-year-old patient, renal transplanted for two years, taken care for carcinoma in situ in bladder and urethra, and treated by intravesical instillations with bacillus Calmette-Guerin (BCG). After failure of a first treatment by Amétycine, a treatment by BCG is instituted during nine weeks. Two months after the end of the treatment, the patient died after bone and liver metastatic invasion of urothelial carcinoma. Management of urothelial high-risk tumour among renal transplanted patient is not clear. Despite successful treatments of few patients reported in literature, this failure called the question of the effectiveness of the BCG therapy in renal transplant patient and suggested an earlier attempt at diagnosis with systematic detection and aggressive therapeutic among these immunodepressed patients.

Objective: Urolithiasis appears to be associated with several cardiovascular risk factors (excess salt and animal proteins, hypertension, metabolic syndrome) and, more recently, the development of stroke. The authors describe the frequency of cardiovascular risk factors and cardiovascular events before and after management of urolithiasis., Method: The authors retrospectively collected data from patients born before 1956 and managed surgically or instrumentally for urolithiasis in our establishment in 1994 concerning the frequency of cardiovascular risk factors and the incidence of acute coronary syndrome, stroke or acute lower limb ischaemia before or after treatment of urolithiasis., Results: Data were obtained for 33 patients, revealing 12 events including five previous events (four cases of acute coronary syndrome, one ischaemic stroke) and seven subsequent events (five cases of acute coronary syndrome with one death, one ischaemic stroke, one case of acute lower limb ischaemia) an average of 5.7 years after management. These 33 patients had an average of more than two risk factors., Conclusion: This retrospective study based on a small sample size demonstrated a high frequency of risk factors and cardiovascular events. This correlation needs to be studied in more detail. Urolithiasis could constitute an indirect cardiovascular risk factor dependent on "classical" risk factors, suggesting the need for integrated management of stone patients, in the same way as for patients with erectile dysfunction.

Many improvements have been made recently in the field of the ureteral smooth muscle pharmacology. After a brief summary on physiological basis, we review what is known about effects on ureter of different drugs class. In a second part, we review clinical applications for renal colic analgesia, calculi expulsive medical therapy, ESWL adjuvant treatment and preoperative treatment before retrograde access. There are now sufficient data on NSAID and alpha-blockers. beta-agonists, especially for beta3 selective ones, and topical drugs before retrograde access are interesting and should be further evaluated.

There are six described complications of sickle cell trait or disease : gross hematuria, renal infarction, papillary necrosis, nephrotic syndrome and urine concentration defects. Because of a high frequency of sickle cell trait patients among patients suffering from medullary kidney carcinoma, it has been called the seventh complication. We briefly review physiopatholgy and diagnosis of these complications.

A 4-year survey of seed-producing lucerne fields in the three main production regions of France, representing 10.000 ha and three types of climates, confirmed the presence of the foliar pathogens Pseudopeziza medicaginis, Ascochyta imperfecta, Stemphylium spp., Leptosphaerulina briosiana, and Uromyces striatus. Surprisingly, A. imperfecta often was found in association with Stemphylium-like symptoms. Further investigation revealed the presence of fungi until now only rarely found or unreported in France, such as Leptotrochila medicaginis, Cercospora medicaginis, and Stagonospora meliloti. The results showed that P. medicaginis and A. imperfecta were present on more than 50% of the samples. U. striatus and C. medicaginis also commonly were found and infected about 25% of the samples. L. medicaginis occurred primarily in the Southwest region.

We describe an immunochemiluminescence assay for human plasma serum amyloid A protein (SAA) in which specific rabbit polyclonal antibodies against synthetic peptides are used. The detection of the antigen-antibody reaction at 425 nm is based on a brief emission of light by a luminophor component (signal) in response to chemical energy. The working range of the assay covers plasma SAA concentrations from 5 to 100 micrograms/L. The lower detection limit is 5 micrograms/L, the within- and between-assay CVs are less than 12%. Bilirubin, cholesterol and triglyceride in final concentrations of up to 220 mumol/L, 8.1 mmol/L and 2.68 mmol/L, respectively, do not interfere with the assay. Results were correlated with those obtained by the enzyme-linked immunosorbent assay using the same antibodies (r = 0.95; p less than 0.001; n = 50). This method is inexpensive, simple and easily automated.

The authors have adapted a turbidimetric assay on centrifugal Cobas Fara analyser for cerebrospinal fluid proteins determinations. The later method is proposed by SFBC Protein Analysis Committee using benzethonium chloride as monoreagent. This adaptation is more sensitive than manual method. The linearity range is greater (0.08-1.85 g/l instead of 0.2-1.2 g/l). Sample assay and time of analysis were reduced by 90 p. cent.

Patients with myeloma disease showed in general very important abnormalities of circulating lipoproteins. Beside the presence of lipoprotein complexes with abnormal electrophoresis migration, we can observe either an hyperlipidemia associated with antilipoprotein auto-antibodies either, in contrary, an hypolipidemia. We studied 34 myeloma and one alpha heavy chain disease. In these subjects, all presenting clinical and biological myeloma tests but free of hepatic disease we evaluate after HDL separation their major lipid components: cholesterol and phospholipid. By electro immunodiffusion method we evaluate apolipoproteins A1 and B. We observe a decrease of Chol-HDL and PL-HDL in 51 p. cent of cases and a decrease of apo A1 in 80 p. cent of cases, this more marked in myeloma with gamma isotype. In contrary, apo B in all subjects studied remain normal. A correlation test with monoclonal immunoglobulin levels and its isotype is studied; the different parameters of monoclonal disease are discussed in relation with lipoprotein abnormalities.

A quantitative automated immunoturbidimetric procedure for the analysis of apolipoprotein A-II (Apo A-II) in human serum is described. Dilution of antibody with a 5% solution of PEG 6000 enhanced the quantification. The within- and between-assay coefficients of variation were less than 5%. Results correlated well with those obtained by classic electroimmunodiffusion and immunonephelometry. No extraction of samples with organic solvent was necessary, whatever the triglyceride concentration. Large lipoproteins such as VLDL and immunocomplexes did not affect the method, nor was there interference from icteric or hemolyzed serum or from serum with excessive hyperlipemia. Physiological values of Apo A-II were determined in a normal population. Concentrations were found to be age-dependent, and higher in women than in men. The procedure is very suitable for the rapid, precise, reproducible and inexpensive assay of Apo A-II.

Serum concentrations of lipids and apolipoprotein A-I, A-II and B were determined in patients with hepatic metastases of colorectal cancer, with primary liver cancer and with cirrhosis. In all three liver diseases, the HDL fraction and apolipoproteins A-I and A-II showed significantly low values, while apolipoprotein B was only increased in hepatic metastases. The decrease of apolipoprotein A-II levels was more prominent in cirrhosis, thereby enhancing the A-I/A-II ratio. This ratio is decreased in metastasis and normal in hepatomas. In patients with hepatic metastases a correlation was observed between alkaline phosphatase and apolipoprotein A-II (p less than 0.05), and between gamma-glutamyltransferase and the A-I/A-II ratio (p less than 0.05). The present work suggests that determination of apolipoproteins and lipids of the HDL fraction offers a new approach to the study of liver diseases.

The authors describe an immunoturbidimetric technique for the determination of the serum apolipoproteins A1 and B using a Cobas-Bio centrifugal analyser. This methods is sensitive and reproducible (CV less than 5%) and show a good correlation with electroimmunodiffusion which was taken as method of reference. It may be applied to serum stored at 4 degrees C or frozen at -20 degrees C. No light is transmitted in the case of either turbid hyperlipemic sera or sera extensively icteric or hemolyzed. The physiological values found in a large population of men and women of various ages are in agreement with those reported in the literature. The method described thus provides a suitable means of investigation adapted to large series for screening for coronary disease states.