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Resume Des urgenturies sont classiquement decrites apres photovaporisation de prostate (PVP). L’objectif de notre etude etait d’analyser les urgenturies induites par la PVP, en utilisant le questionnaire de l’International Prostate Symptom Score (IPSS) pour repertorier les urgenturies induites. Methode Il s’agit d’une etude de cohorte prospective monocentrique de suivi des patients operes entre mai 2005 et janvier 2011. Les questions 2 et 4 de l’International Prostate Symptom Score (IPSS) ainsi qu’un interrogatoire ont ete choisis pour evaluer l’imperiosite lors du suivi. Les reponses aux questions 2 et 4 de l’IPSS ont ete comparees a des questions ouvertes sur l’imperiosites. Resultats Deux cent quatre patients ont ete operes pendant cette periode et 93 dossiers complets ont ete analyses. Vingt-et-un pour cent des patients presentaient des urgenturies clinique a un mois et 1,9 % a 12 mois (amelioration significative, p

Resume Introduction Les instillations endovesicales de BCG constituent le traitement de reference des TVNIM de risque intermediaire et eleve. Un traitement d’entretien est fortement recommande, neanmoins la frequence des effets secondaire responsable de l’arret du traitement d’entretien chez plus de quatre patients sur cinq avant la troisieme annee pourrait justifier une diminution voire un espacement des instillations. L’objectif de l’etude URO-BCG-4 etait l’evaluation d’un nouveau schema d’entretien par instillations endovesicales de BCG associant une diminution de dose (un tiers de dose) mais aussi une diminution du nombre d’instillation par cycle (deux ou trois). Patients et methodes Etude multicentrique du CCAFU (12 centres hospitalo-universitaires), randomisee, prospective, comparant le schema de reference de BCG-therapie d’entretien au un tiers de dose usuelle (groupe I) a un schema associant un tiers de dose et diminution du nombre d’instillations par cycle (deux au lieu de trois) (groupe II). Nous presentons les resultats preliminaires a un an de ce programme hospitalier de recherche clinique (2003-081 CHU de Rouen Promoteur). Resultats Le taux de recidive tumorale etait respectivement de 9 et 7 % ( p = 0,678) dans les groupes I et II. Le taux de progression tumorale etait de 3 et 2,8 % dans les groupes I et II ( p = 1). La tolerance des instillations endovesicales de BCG evaluee selon la classification OMS (Geneve 1979) etait comparable dans les deux groupes. Conclusion La diminution de la dose de BCG (un tiers de dose) et la modification du nombre et du rythme des instillations n’a pas modifie le taux de survie sans recidive tumorale. La toxicite des instillations endovesicales de BCG etait identique dans les deux groupes. L’utilisation de la classification OMS a montre ses limites dans l’etude des effets secondaires du BCG car trop complexe et souvent non exhaustive. Le taux de progression musculaire etait comparable dans les deux groupes neanmoins un recul clinique plus important est necessaire.

Resume Objectifs Adapter en pratique quotidienne, dans un service d’urologie, les recommandations de bonne pratique clinique pour le suivi des patients neurologiques presentant une hyperactivite neurogene du detrusor traitee par injections de toxine botulique de type A (TBA) en faisant intervenir une infirmiere referente en neuro-urologie. Methode Une consultation infirmiere referente en neuro-urologie a ete creee en juin 2007 afin d’intervenir a chaque consultation de suivi a j0, j8, j45 puis par telephone jusqu’a reapparition des signes fonctionnels afin d’organiser une nouvelle injection de toxine botulique. Il s’agissait d’une experience pilote afin d’apprecier la faisabilite, l’impact sur la charge de travail et le benefice relationnel patient-soignant. Resultats Une amelioration de la qualite de prise en charge a ete apportee au patient du premier contact au suivi. Le nombre de deplacements du patient neurologique a ete diminue ainsi que le temps d’attente entre la reapparition des signes fonctionnels et leur nouvelle prise en charge therapeutique. Le nombre de consultations medicales a ete diminue permettant un gain de temps a redistribuer sur d’autres activites. Un enrichissement personnel et une relation privilegiee avec le patient et le medecin ont ete observes par l’infirmiere referente. Conclusion La participation d’une infirmiere referente en neuro-urologie a permis d’ameliorer la qualite de la prise en charge de ces patients du premier contact au suivi et d’adapter les recommandations dans la pratique de soin d’un service d’urologie.

Angiomyolipoma is generally a benign and noninvasive tumor. We report a case of angiomyolipoma with tumor thrombus from the renal vein into the inferior vena cava suggesting a malignant disease.

Urgencies are classically described after prostate photovaporization (PVP). The objective of this study was to analyze the incidence of urgency in patients who underwent PVP using the International Prostate Symptom Score (IPSS) to defined urgencies.This is a single-center prospective cohort study assessing patients who underwent surgery between May 2005 and January 2011. The questions 2 and 4 of the IPSS and open questions were selected to evaluate urgency during the follow-up.Two-hundred and four patients were operated during this period and 93 complete records were analyzed. Twenty-one percent of these patients had a clinical urgency after 1 month and 1,9% at 12 months (significant improvement, P0.001) corresponding to scores greater than 4 for questions 2 and 4 of the IPSS. Answer scores to questions 2 and 4 improved significantly over 12 months (P0.001). The clinical urgencies decreased significantly as well as answers to questions 2 and 4 of the IPSS.Urgencies decreased significantly between 3 and 12 months of postoperative follow. Questions 2 and 4 of the IPSS score appeared to be a standardized definition of these urgencies.

Intravesical instillations of BCG remains the gold standard for intermediate and high risk NMIBC management. Maintenance treatment is recommended, however, the frequency of side effects responsible for the discontinuation of maintenance therapy over four out of five patients before the third year suggest a reduction or even spacing instillations. The objective of the study URO-BCG-4 was the evaluation of a new maintenance schedule by intravesical instillations of BCG combined reduced dose (third dose) and a decrease number of instillations per cycle (two or three).Multicenter study of the French Association Oncologic Committee (12 university hospital centers), randomized, prospective, comparing reference diagram of BCG maintenance therapy one third of usual dose (group I) to a regimen combining third dose and decrease the number of instillations per cycle (two instead of three) (group II). We present the preliminary results at 1year of this Program of Clinical Research (CHU Rouen Promoter 2003-081).The rate of recurrence was respectively 9 and 7% (P=0.678) in groups I and II. The rate of tumor progression are 3 and 2.8% in groups I and II (P=1). Tolerance of intravesical instillations of BCG scored according to the WHO classification (Geneva 1979) was similar in the two groups.The decrease in the BCG dose (third dose) and the changes in the number and rate of instillations did not alter free tumor recurrence survival. The toxicity of intravesical instillations of BCG was identical in both groups. The use of the WHO classification has shown its limitations in the study of side effects of BCG as too complex and often not exhaustive. The rate of increase muscle was comparable in the two groups; however, a larger clinical experience is required.

To adapt in daily practice, in a urology department, recommendations for good clinical practice for follow-up of neurological patients with neurogenic detrusor overactivity treated with injections of botulinum toxin type A by involving a referent nurse in neuro-urology.A nurse consultation in neuro-urology has been created in June 2007 to intervene at each follow-up consultation at D0, D8, D45, then by phone until reappearance of functional signs to organize a new injection of botulinum toxin. This pilot study evaluated the faisability, the input on clinical workload, and the benefit on relationship between the patient and the caregiver.An improvement of the quality of care has been given to the patient since first contact to follow-up. The number of neurological patient transfers and waiting time between the recurrence of functional signs and new therapeutic care were reduced. The number of medical consultations has been reduced saving time to redistribute on other activities. Knowledge improvement and privileged relationship with the patient and the doctor were reported by the referent nurse.The participation of a referent nurse in neuro-urology has improved the quality of care of these patients from first contact to follow-up and has allowed adaptation of the recommendations in the practice of caring of an urology department.

Angiomyolipoma is generally a benign and noninvasive tumor. We report a case of angiomyolipoma with tumor thrombus from the renal vein into the inferior vena cava suggesting a malignant disease.