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Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence.The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day.Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group.AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings.4. more...

The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery.We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison.Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=0.001) as did the overall proportion of robotic by 45% to 85% (P=0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=0.001) and €27 vs €24/min (P=0.029), tending towards a break-even point (=zero deficit) at 430 operations per year.Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term.3. more...

OBJECTIVE: To assist urologists in the management of andrological and sexual medicine pathologies during the COVID-19 crisis. MATERIAL AND METHOD: Use of the formalized consensus method. RESULTS: The medical and surgical management of patients in andrology and sexual medicine must be adapted. Consultations should, as far as possible, be carried out by tele-consultation. For operative procedures, the delay between the operative decision and the date of (re)scheduling of the procedure will depend on: (1) the level of criticality of the clinical situation; (2) the type of intervention; (3) the functional and psychological repercussions, including quality of life while waiting for the procedure; (4) the notion of losing the chance of having an optimal outcome; (5) the risk of potential complications from delaying a procedure for too long; and (6) taking into account the patient's risk factors for severe forms of COVID-19. The protection of urologists from COVID-19 should be considered. Each urologist must make the best decision for the patient, taking into account the acceptable time frame and quality of life impact before surgical management, the COVID risk parameters, the technical and anesthetic feasibility and the structural possibility of the health care institution to ensure a specific dedicated pathway during the COVID-19 health crisis. CONCLUSION: The management of andrological and sexual medicine pathologies must be adapted to the COVID-19 crisis context. Some patients may require surgery, including in emergency. These recommendations are transitional and will end with the COVID-19 crisis. more...

Conventional open surgical approaches for the harvesting of the rectus abdominis muscle carry a high risk of morbidity. It is possible to reduce these risks by using laparoscopy or robot-assisted techniques. This work hypothesizes that a porcine model could be used for learning the robot-assisted collection of the rectus abdominis. The rectus abdominis was taken in 3 stages in 3 pigs: installation of the robot, surgical approaches with 4 trocars, dissection and collection of the muscle. The average operating time was 1h20min and the average muscular length was 16cm. Our results showed a learning curve for the robot-assisted harvesting of the rectus abdominis on a porcine model. more...

Controlateral C7 nerve root transfer in brachial plexus palsy requires a nerve graft and large incisions. This study investigated the feasibility of transferring the right C7 to the left C7 nerve root, without a graft, via a minimally invasive retropharyngeal approach. After installation of 6 trocars of 1cm diameter in the supraclavicular space, a Da Vinci SI® robot was placed. After locating the right brachial plexus, the C7 root was sectioned flush with the clavicle, transferred behind the pharynx and sutured to the left C7 root severed at the foramen level. The duration of the procedure was 2h40min. No technical difficulties were encountered. The hypothesis of this work was verified since it was possible to carry out a transfer of the right C7 root on the left C7 root by direct retropharyngeal suture without graft and by a minimally invasive technique. more...

Urological emergencies represent 7 % of the outpatients at the emergency department (ED). We assessed the effect of setting up a post-emergency consultation (CPU) after deferred urological medical regulation.All patients admitted to the ED in a university center over the period December 2017 to July 2018 and for whom a CPU was scheduled were included. The regulation concerned the date of CPU and supplementary exams. The main outcome was the ability to provide an efficient response according to a predefined grid of specific solutions.One hundred and twenty-eight patients were included. The median age was 57 years (18-97). Efficacy of the CPU was 76 %. This rate was lower in no-show patients or consulting for rare and complex motives (47 %, n=60). The no-show were not reachable on the first call in 51.6 % of cases, with a similar age and motives distribution to the others. Only 6,9 % (n=128) of all consultants (n=1863) had been referred to the CPU by emergency physicians. The decision was a second consultation in 70 % (48), a new exam in 10 % (7), deferred emergency surgery in 12 % (8) and finally 18 % (12) of no follow-up.CPU following early regulation by a urologist provides an effective response in 76 % of situations. Assessment of "no-shows" helped to identify groups at risk.III. more...

Controlateral C7 nerve root transfer in brachial plexus palsy requires a nerve graft and large incisions. This study investigated the feasibility of transferring the right C7 to the left C7 nerve root, without a graft, via a minimally invasive retropharyngeal approach. After installation of 6 trocars of 1cm diameter in the supraclavicular space, a Da Vinci SI more...

Resume Introduction La chirurgie est souvent le traitement de reference des deformations de la verge. Devant la presence de multiples techniques possibles et leurs resultats differents sur la correction de la deformation, le raccourcissement, le risque d’impuissance et le risque d’insensibilite, il est necessaire d’avoir une strategie therapeutique personnalisee. Methodes Mise au point des differentes techniques chirurgicales dans le traitement des deformations de la verge. Recherche bibliographique a l’aide de la base de donnees Medline en utilisant les mots cles : Lapeyronie, courbure congenitale, Yachia, Nesbit, incision-greffe, Excision-greffe. Resultats Orientation du choix de la technique selon la deformation et l’etiologie. Discussion Bilan preoperatoire et suivi postoperatoire de cette chirurgie. more...

Resume Introduction d’objectifs Le traitement medical des symptomes du bas appareil urinaire en rapport avec une hyperplasie benigne de la prostate (SBAU-HBP) a beaucoup evolue ces dernieres annees avec l’apparition de nouvelles molecules. L’impact de ces traitements sur la fonction sexuelle n’est pas negligeable. L’objectif primaire de ce travail, est de faire une mise au point sur les effets potentiels sexuels des traitements des SBAU-HBP. L’objectif secondaire est de proposer une methode d’evaluation et de prise en charge des ces troubles. Materiel et methodes Une revue systematique de la litterature scientifique a ete realisee a partir de la base de donnees Pub Med. La recherche a ete effectuee entre 1999 et 2012 avec les mots clefs suivants « benign prostatic hyperplasia » « medical treatment » « male sexual dysfunction ». Resultats De nombreuses therapeutiques medicales ont fait l’objet d’etudes randomisees pour le traitement des SBAU-HBP. Les effets secondaires sur la fonction sexuelle sont bien repertories et se resument a une diminution de la libido, dysfonction erectile, dysfonction d’ejaculation. Conclusion L’association SBAU-HBP et dysfonction sexuelle devient une entite a part entiere et reste independante d’autres facteurs susceptibles d’interagir sur la sexualite (âge, comorbidite cardio vasculaire, modification du style de vie) Il faut savoir evaluer la dysfonction sexuelle avant d’initier le traitement des SBAU-HBP. Tous ces traitements peuvent retentir sur la sexualite. Leur prise en charge peut s’averer delicate. more...

Resume Objectifs Decrire les indications et resultats des techniques permettant de modifier l’aspect exterieur du penis pour des raisons esthetiques. Proposer des recommandations de prise en charge en matiere de chirurgie cosmetique de l’appareil genital masculin. Materiel et methodes Nous avons effectue une revu de la litterature dans la base de donnee Medline de 1990 a 2011. Nous avons exclu les articles rapportant une population de patients operes inferieure a cinq cas par type de procedure. Quarante articles ont ete retenus. Resultats Il n’y a pas de consensus concernant la taille au-dessous de laquelle il est justifie d’accepter de tenter de modifier la taille du penis. Une longueur du penis en traction inferieure a 9,5 cm ou 10 cm en erection peut etre consideree comme une limite acceptable, chez un homme qui en souffre. L’evaluation des hommes en demande d’allongement doit comporter un avis psychosexologique, ou psychiatrique, a la recherche d’une dysmorphophobie ou d’une autre affection psychiatrique. Devant une demande justifiee d’allongement pour une verge de petite taille, une tentative d’allongement par traction mecanique sous controle medical doit etre proposee en premiere intention. En cas d’echec, trois techniques peuvent etre utilisees seules ou en association : une phalloplastie d’allongement par section du ligament suspenseur de la verge avec plastie cutanee en V-Y inverse, une lipoaspiration du mont du pubis et une section de palmure scrotale. Les resultats sont modestes, avec des taux de complications non negligeables et de satisfaction faible. Les techniques de phalloplastie d’elargissement par injection de graisse autologue donnent des resultats esthetiques inconstants avec un taux de satisfaction bas. Toutes les autres techniques sont experimentales. Conclusions La chirurgie cosmetique du penis est associee a un risque d’exposition medicolegale important et toute indication chirurgicale doit etre posee apres une concertation multidisciplinaire, a l’issu d’un temps de reflexion donne au patient apres une information complete. Les demandes dans le but d’une chirurgie de reconstruction apres traumatisme ou consequences des traitements des cancers sont justifiees. more...

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for kidney stones regardless of age. Elderly patients (EP)≥65years old, in growing numbers, have more comorbidities than the general population, may alter results of PCNL. The aim of this meta-analysis was to compare efficacy and complications of this procedure between EP and young patients (YP).Original studies of prospective and historical cohorts, in English or French, presenting PCNL series published on PubMed until 2015 were identified using the keywords percutaneous nephrolithotomy, elderly patients, kidney stones and staghorn calculi. Our analysis focused on therapeutic efficacy, defined by absence of residual fragment or the presence of residual fragments4mm at 3 postoperative months, and postoperative complications according to patient age: YP65 years old and EP≥65 years old. Binary qualitative data were analyzed using odds ratio (OR) and quantitative data by estimating the difference of means.In total 397 studies were identified among which 23 were checked and 8 included in the meta-analysis for methodological quality corresponding to 4995 YP and 820 EP. No efficacy difference (OR=0.96; [IC95 %: 0.80; 1.17]; P=0.71), operating time (+1.15min in EP [IC95 %: -2.83; 5.12]; P=0.57) and average length of stay (+0.29 days in EP [IC95 %: -0.14; 0.72]; P=0.19) has been reported. It was a trend to more urinary infections (OR=2.24; [IC95 %: 0.74-6.80]; P=0.16) and a significantly increase of postoperative blood transfusions in EP (OR=1.41; [IC95 %: 1.00-1.97]; P=0.04).PCNL for kidney stones n EP is effective with a significantly increase the risk of postoperative blood transfusions compared to YP. more...

Resume Introduction L’enseignement de la chirurgie repose sur un enseignement facultaire, un enseignement au bloc operatoire et au lit du malade associe eventuellement a une formation au sein des laboratoires d’anatomie ou de chirurgie experimentale. Celui-ci peut etre complete par un apprentissage utilisant les differentes techniques de simulation. L’apprentissage par simulation, largement repandu outre-atlantique, permet, sans aucun risque pour les patients, d’intervenir sur plusieurs elements de la formation chirurgicale. Methodes Le curriculum developpe au centre de simulation de la faculte de medecine de Nice Sophia-Antipolis concerne l’ensemble des internes en chirurgie de la faculte de medecine. Resultats Chaque interne beneficie d’une formation theorique (initiation a la check-list de bloc operatoire), une formation aux scenarii medicochirurgicaux sur mannequin haute-fidelite et une formation aux gestes techniques de chirurgie ouverte et cœlioscopique sur deux ans, suivie d’un examen de validation d’aptitude technique. Ce curriculum a ete accredite par l’ American College of Surgeons , constituant le premier programme de ce type en France. Conclusion Ce programme constitue un modele, repondant aux vœux de l’Academie de chirurgie de voir l’emergence d’ecoles de chirurgie. more...

Summary Introduction Surgical training relies on medical school lectures, practical training in patient care and in the operating room including instruction in anatomy and experimental surgery. Training with different techniques of simulators can complete this. Simulator-based training, widely used in North America, can be applied to several aspects of surgical training without any risk for patients: technical skills in both open and laparoscopic surgery, the notion of teamwork and the multidisciplinary management of acute medicosurgical situations. Method We present the curriculum developed in the Simulation Center of the Medical School of Nice Sophia-Antipolis. All residents in training at the Medical School participate in this curriculum. Results Each medical student is required to pursue theoretical training (familiarization with the operating room check-list), training in patient management using a high fidelity mannequin for various medical and surgical scenarios and training in technical gestures in open and laparoscopic surgery over a 2-year period, followed by an examination to validate all technical aptitudes. This curriculum has been approved and accredited by the prestigious American College of Surgeons, making this the first of its kind in France. Conclusion As such, it should be considered as a model and, in accordance to the wishes of the French Surgical Academy, the first step toward the creation of true schools of surgery. more...

Objectifs La simulation doit etre la norme de la formation medicochirurgicale initiale ou continue selon les directives nationales. Mais pour la chirurgie, elle est limitee par la distance entre les dispositifs disponibles et la realite du bloc operatoire. Nous proposons un nouveau modele de simulation utilisant des corps auxquels un dispositif de circulation pulsatile et de ventilation est associe. Methodes Le modele SimLife comprend un corps relie a un dispositif specifique permettant une circulation arterielle pulsatile par un liquide mimant le sang et permettant d’obtenir une couleur, une texture des tissus proches de la realite ( Fig. 1 : schema du module). Ce dispositif s’adapte aux conditions operatoires pour des procedures par voie ouverte et par cœlioscopie. SimLife System permet de plus une ventilation induisant les mouvements du thorax et du diaphragme. Ce modele a ete evalue pendant 24 mois, par 40 apprenants, au cours de sessions de formation en chirurgie en cœlioscopie : nephrectomie, prostatectomie pre peritoneale et sleeve gastrectomie en utilisant une echelle de Likert de 1 a 10. Resultats Pour les 4 criteres suivant : possibilite d’apprentissage d’une procedure avec ce modele, realisme general du modele ( Fig. 2 : plaie de l’artere renale gauche), realisme anatomique du modele et satisfaction globale, le taux de satisfaction est toujours superieur a 80 % (83–97 %). Conclusion En cœlioscopie, le SimLife est un dispositif d’enseignement par simulation a tres haut degre de realisme, utilisable pour evaluer l’acquisition de performance des apprenants dans un programme pedagogique. more...

Resume La prevalence de la rhinoconjonctivite allergique saisonniere dans la population augmente depuis plusieurs decennies. C’est pourquoi, l’identification et la validation de methodes de prevention des symptomes associes a cette maladie apparaissent comme des enjeux de sante publique importants. Cette etude epidemiologique d’intervention avait pour objectif de tester et de mesurer l’impact d’une prevention basee sur l’information precoce de l’apparition des pollens de graminees (i.e. des premiers pollens liberes au niveau des inflorescences des plantes). Elle s’est deroulee en 2007 a Nantes (France), les informations polliniques etant issues d’un jardin experimental dit pollinier sentinelle. Quatre-vingt-et-un patients volontaires, recrutes par des medecins allergologues, ont ete randomises en deux groupes paralleles (groupe I ou intervention et groupe T ou temoin). Les patients du groupe I ont ete avertis de l’apparition des pollens de graminees par telephone le 9 mars 2007, par ailleurs la consigne de se mettre sous traitement antihistaminique leur a ete donnee. Un carnet journalier rempli par l’ensemble des patients a permis de renseigner les symptomes de rhinoconjonctivite allergiques et la prise de traitement au cours des quatre mois de l’etude. Dans le groupe I, le nombre de jours avec symptomes est significativement plus faible que dans le groupe T (20 % en moins sur la periode d’etude chez les patients asymptomatiques avant l’intervention). Malgre quelques limites dues principalement a la grande precocite de la saison pollinique 2007, l’etude montre que ce type de prevention peut contribuer a diminuer les symptomes des patients souffrant de rhinoconjonctivite allergique saisonniere. more...

Testicular adrenal rest tumours are frequently associated with congenital adrenal hyperplasia (CAH). These ACTH-dependent tumours cannot be easily distinguished histologically from Leydig-cell tumours. We report the case of a 30-year-old man who was explored for infertility, azoospermia and unilateral testicular tumour. High levels of 17-OH progesterone and ACTH, low cortisol and undetectable gonadotropins levels, associated to bilateral adrenal hyperplasia, led to the diagnosis of CAH by 21-OH deficiency with a composite heterozygoty. The testicular tumour was first considered as adrenal rest. However, histological analysis of this unilateral painful tumour showed a steroid-hormone-secreting cell proliferation with atypical and frequent mitosis. To discriminate between a benign adrenal rest tumour and a possible malignant leydigioma, tumoral expression of specific gene products was analyzed by RT-PCR. No 11-beta-hydroxylase nor ACTH receptor mRNAs could be found in the tumour, which did not behave like usual adrenal rest cells. For this unilateral testicular tumour, the lack of adrenal-specific markers associated with a high rate of mitosis and pleiomorphism supported a leydigian origin with malignant potential. However, lack of tumoral LH-R mRNA expression and a tumour-free 3-year follow-up led us to retain the diagnosis of adrenal rest tumour with loss of adrenal gene expression and progressive autonomous behaviour. more...

Dans le cancer de prostate, si l’on oppose le depistage a l’absence de depistage et le traitement a la simple surveillance, les differences observees en terme d’esperance de vie (ajustees a la qualite de vie) sont marginales. Par consequent, une attention particuliere devrait etre portee a l’analyse de variables apparemment mineures telles que les consequences fonctionnelles potentielles iatrogenes de nos traitements, sur le confort de vie globale du patient. A ce titre, la sexualite occupe une place de choix, ce d’autant qu’il existe, concernant le cancer de prostate, de reels espoirs de guerison et que les donnees epidemiologiques font etat a l’heure actuelle d’un abaissement de l’âge du patient au moment du diagnostic. Les differentes etudes de qualite de vie effectuees aupres des patients presentant un cancer localise de prostate et traites selon les modalites actuelles (chirurgie, radiotherapie externe, curietherapie interstitielle, ultrasons focalises haute intensite) montrent que le retentissement sexuel de ces traitements (rapporte a l’âge et a l’etat pre-therapeutique du patient) est connu et attendu. Cet article se propose d’en faire une revue de la litterature. Differentes propositions therapeutiques visant a ameliorer la sexualite sont abordees. more...

Le diagnostic et le grading histologiques jouent un role important dans la prise en charge des cancers prostatiques. Une mise a jour de la classification OMS a ete publiee en 2004. Les cancers prostatiques sont classes en plusieurs types en fonction de leur site presume d’origine et de leur aspects morphologiques: (i) les adenocarcinomes acineux. Il s’agit de la forme la plus frequente. La majorite des etudes concernant le grade, le stade et la prise en charge therapeutique concernent ces tumeurs. Il existe des variantes histologiques correspondant aux formes atrophiques, pseudohyperplasiques, a cellules spumeuses, a cellules oncocytaires, aux formes de type lymphoepithelial et de type sarcomatoide. Le profil immunohistochimique de ces tumeurs est defini par plusieurs marqueurs: antigene prostatique specifique, phosphatase acide prostatique et alpha-methyl-CoA racemase. On utilise les anticorps anti cytokeratine 34βE12 et p63 pour mettre en evidence les cellules basales pour le diagnostic differentiel avec les lesions glandulaires benignes; (ii) les adenocarcinomes canalaires, les carcinomes urotheliaux et squameux, les carcinomes a cellules basales, les tumeurs neuroendocrines, qui sont des tumeurs rares et agressives; (iii) les tumeurs mesenchymateuses. more...

To evaluate the toxicity of therapeutic sequences High Intensity Focused Ultrasound (HIFU)-salvage radiotherapy (HIFU-RT) or radiotherapy-salvage HIFU (RT-HIFU) in case of locally recurrent prostate cancer.Nineteen patients had a local recurrence of prostate cancer. Among them, 10 patients were treated by HIFU-RT and 9 patients by RT- HIFU (4 by external beam radiotherapy [EBR] and 5 by brachytherapy [BRACHY]). Urinary side effects were assessed using CTCAE v4.At the time of the initial management, the median age was 66.5 years (53-72), the median PSA was 10.8ng/mL (3.4-50) and the median initial Gleason score was 6.3 (5-8). Median follow-up after salvage treatment was 46.3 months (2-108). Thirty percent of the patients in the HIFU-RT group and 33.3 % of the patients in the RT-HIFU group, all belonging to the sub-group BRACHY-HIFU, had urinary complication greater than or equal to grade 2. Among all the patients, only 1 had grade 1 gastrointestinal toxicity.BRACHY-HIFU sequence seems to be purveyor of many significant urinary side effects. A larger database is needed to confirm this conclusion. more...

Soil thin-layer chromatography with water or water-methanol as solvents allows observation and measurement of the mobility of labelled pesticides through soil microstructures. Eleven different sieved matrices were studied: pure humine, pure clays, schists and soils. Ionized compounds (paraquat, glyphosate) were tightly bound to these matrices. The other compounds, lipophilic and generally non-ionized ones, migrated in the same order on most of the studied matrices, either mineral or organic: R(F) atrazine=isoproturon>diuron=fipronil>phenmedipham. This order was roughly correlated to log P but much more complex correlations were suggested. The rate of water movement, VWR, widely changed from one matrix to another. Therefore, the pesticide movement, M, in soil microstructures under the action of rain may be described by the equation M = WR R(F). more...

Anti-Mullerian hormone (AMH) also known as Mullerian inhibiting substance or factor, is a Sertoli cell-secreted glycoprotein responsible in male embryos for Mullerian duct regression. However, its role in adults remains unknown. AMH seminal concentrations have been evaluated using an enzyme-linked immunoassay in three groups of young men: group 1, fertile donors (n = 18); group 2, obstructive azoospermia (n = 9) after vasectomy or associated with deferent duct agenesia; and group 3, non-obstructive azoospermia with spermatogenesis deficiency and normal karyotype (n = 23). AMH was present in seminal plasma of most fertile donors at concentrations ranging from undetectable ( more...

Resume Cinq cent trente-cinq urologues ont participe a l'etude Repair. Chacun a repondu a un questionnaire dit de ≪ pratique ≫ comportant des informations generates sur son mode d'exercice. Les urologues etaient egalement charges de remplir des ≪ fiches patient ≫ pour les 10 premiers patients vus en consultation et operes depuis moins de 12 mois d'une prostatectomie totate et remettre un autoquestionnaire a chaque patient eligible. Sur une periode d'observation de mai a septembre 2005, 2445 ≪ fiches patients ≫ ont ete analysees. Enfin, 2644 auto-questionnaires remplis par les patients eux-memes ont ete recus par la societe TNS SOFRES. Aussi bien les fiches ≪ patients ≫ que les autoquestionnaires etaient charges d'evaluer l'incidence des troubles fonctionnels apres prostatectomie totale, et la prise en charge des ces troubles, qu'ils soient urinaires ou sexuels. more...

Routh reduction is a standard process reducing the system of Lagrange equations in generalized coordinates to a lower dimension system by use of first integrals corresponding to cyclic coordinates (see [1, 2]). Here we demonstrate how this reduction can be performed for the Lagrange-Poincare system describing the motion of a rigid body about a fixed point written with dependent coordinates and nonholonomic velocities. Some examples from a rigid body dynamics are considered. The idea of this method arises to the paper of Lyapunov [3]. The theory of the Routh reduction for the systems described by equations involving non-holonomic coordinates was developed in [4, 5]. The development of the approach of Lyapunov was done in [6]. more...

Elastography is a novel imaging technology that shows promise in the identification of anatomic structures. The widespread use of ultrasound for screening testicular tumors in patients with cancer risk factors highlights unclassified testicular micronodules. We investigated the ability of elastography to accurately diagnose testicular nodules.Patients with clinical testicular nodules were assigned to undergo elastography in a prospective study. The imaging was carried out by a single radiologist using a static elastography unit with a 9-14MHz frequency linear transducer, to identify hardness score, loss of architecture of testicular parenchyma, and surrounding effect. When orchidectomy was required, the corresponding specimens were subjected to hematoxylin and eosin staining for histologic correlation.We imaged 34 testicular lesions: 26/34 (76%) malignant tumors and 8/34 (24%) non-tumor lesion including 4 hematomas, 3 orchitis and 1 ischemia. Se, Sp, PPV and NPV of hardness in elastography in differentiating between malignant and benign tissue was found to be 96.2%, 37.5%, 83%, and 75%, respectively. Further, for recognizing cancer, the loss of architecture of the testicular parenchyma detecting in elastography was 92.3%, 75%, 92.3%, and 75%, respectively, and the surrounding effect was 84.6%, 87.5%, 95.6% and 63.6%, respectively.Elastography may be a promising tool at diagnosing testicular tumor when the loss of architecture and the surrounding effect were present. Further studies are needed to evaluate whether the utility of elastography is worth pursuing to identify of unclassified testicular micronodules.3. more...

To evaluate satisfaction rates and results in patients with penile prosthesis (5 PP).From January 2000 till 2009, 50 patients with organic erectile dysfunction (ED) were implanted with hydraulics penile prosthesis by the same surgeon. Medical records were collected retrospectively. We analysed demographic characteristics, type of prosthesis used, per- and postoperative complications, prosthesis explantations and satisfaction rate measured by EDITS modified.Mean age of patients was 60.2 ± 8.46 years (35-75). Thirty implanted patients (60%) were diabetics. We used a peno-scrotal incision in all patients. Three types of prosthesis were used; AMS Ambicor, AMS 700, Titan OTR. A bi-compartment and three-compartment prosthesis were implanted respectively in 24 and 26 patients. The prosthesis was retrieved in two patients secondary to a mechanical failure, in three patients for prosthesis erosion, in two patients for prosthesis infection. In four out of the seven explanted patients, a second prosthesis was implanted. The EDITS questionnary was realized by telephonic interview in 47 patients after a mean follow-up of 45 months (5-114). The response rate was of 83%. The satisfaction rate was of 81%.In our series, the satisfaction rate was better for the three-compartment prosthesis. After 45 months of follow-up, 73% (31/42) of patients had a functional prosthesis. The non-satisfaction most frequently found were patients who have complications as sepsis; mechanical failure, and prosthesis erosion, and subjective feeling of penile length reduction. more...

To describe the indications and results of techniques to change the appearance of the penis for aesthetic reasons. Provide recommendations concerning cosmetic surgery of the male genitalia.We have selected from Medline Database, articles published between 1990 and 2011. Forty articles have been selected excluding papers reporting populations less than five cases per type of procedure.There is no consensus on the size below which it is justifiable to accept or attempt to modify the size of the penis. Length of the penis in maximal tension less than 9.5 cm or 10 cm in erection can be considered as an acceptable limit, in a patient who suffers from it. The assessment of men asking for penile enlargement must include a psychosexological or psychiatric evaluation, looking for a dysmorphophobia or another psychiatric condition. Penile extenders under medical control must be the first-line treatment option for patient seeking penile lenghtening procedure when justified. In case of failure, three techniques can be used alone or in combination: penile lengthening by section of the suspensory ligaments and suprapubic skin advancement, lipectomy of Mons pubis and scrotal webbing section. The results are modest, the rate of complications significant and satisfaction low. Girth enlargement techniques by injection of autologous fat give inconsistent aesthetic results and satisfaction rates are low. All other techniques remain experimental.Cosmetic surgery of the penis is associated with a high risk of forensic exposure and surgery should be only proposed after a multidisciplinary consensus, followed by a time of reflection given to the patient after full disclosure. Applications for the purpose of reconstruction surgery after trauma or consequences of cancer treatment are justified. more...