Search

Introduction: The aim of the study was to report the 30-day mortality (30DM) after renal trauma and identify the risk factors associated with death. Methods: The TRAUMAFUF project was a retrospective multi-institutional study including all patients with renal trauma admitted to 17 French hospitals between 2005 and 2015. The included population focused on patients of all age groups who underwent renal trauma during the study period. The primary outcome was death within 30 days following trauma. The multivariate logistic regression model with a stepwise backward elimination was used to identify predictive factors of 30DM. Results: Data on 1,799 renal trauma were recorded over the 10-year period. There were 59 deaths within 30 days of renal trauma, conferring a 30DM rate of 3.27%. Renal trauma was directly involved in 5 deaths (8.5% of all deaths, 0.3% of all renal trauma). Multivariate stepwise logistic regression analysis revealed that age >40 years (odds ratio [OR] 2.18; 95% confidence interval [CI]: 1.20–3.99; p = 0.01), hemodynamic instability (OR 4.67; 95% CI: 2.49–9; p < 0.001), anemia (OR 3.89; 95% CI: 1.94–8.37; p < 0.001), bilateral renal trauma (OR 6.77; 95% CI: 2.83–15.61; p < 0.001), arterial contrast extravasation (OR 2.09; 95% CI: 1.09–3.96; p = 0.02), and concomitant visceral and bone injuries (OR 6.57; 95% CI: 2.41–23.14; p < 0.001) were independent predictors of 30DM. Conclusion: Our large multi-institutional study supports that the 30DM of 3.27% after renal trauma is due to the high degree of associated injuries and was rarely a consequence of renal trauma alone. Age >40 years, hemodynamic instability, anemia, bilateral renal trauma, arterial contrast extravasation, and concomitant visceral and bone lesions were predictors of death. These results can help clinicians to identify high-risk patients.

International audience; Genetic factors are responsible for 15% of male infertility conditions. Numerical and structural chromosomal anomalies are validated genetic factors leading to spermatogenic quantitative defects, with a frequency depending on the severity of the phenotype. Among the structural chromosomal rearrangements, dicentric chromosomes are generally observed in robertsonian translocations or in cases of Y chromosome isodicentrics. In X-autosome translocations, male carriers are generally infertile, regardless of the position of the breakpoint, due to interrupted spermatogenesis. We report an infertile man bearing an unusual balanced (X;22) translocation, with a centromeric X breakpoint generating a derivative pseudodicentric chromosome psu dic(22;X). Extensive cytogenetic analyses were necessary to determine the precise nature of the derivative chromosome. The likely cause of the reproductive phenotype of the patient is discussed based on meiotic chromosomal conformation.

International audience; Aim The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD). Methods The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups. Results After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches. Conclusion Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications.

Resume Introduction Les personnes trans sont moins bien pris en charge par la communaute medicale que la population cisgenre probablement a cause d’un manque de connaissance, d’enseignement et de confort de la part des professionnels de sante. Le but de cette etude etait d’evaluer les connaissances et le confort ressentis par les professionnels de sante dans la prise en charge des personnes trans dans un centre hospitalo-universitaire (CHU) francais. Methodes Un auto-questionnaire a ete envoye par mail a des professionnels de sante travaillant dans des services habituellement impliques dans la prise en charge de personnes transgenres dans un CHU francais « non specialise » dans la transition hormono-chirurgicale trans. Le questionnaire comprenait des questions demographiques et des echelles de Likert concernant leur connaissance et leur confort ressentis dans la prise en charge des personnes trans. Les reponses des echelles de Likert de 7 degres etaient reparties selon des groupes « faible », « moyen » et « eleve » et celles de 5 degres etaient reparties selon des groupes « en faveur », « neutre » et « en defaveur ». Resultats Cent-deux (29 %) professionnels ont repondu au questionnaire. La moitie travaillaient en chirurgie (urologie, chirurgie plastique, gynecologie), 24 % travaillaient en medecine (endocrinologie, PMA, cytogenetique) et 26 % travaillaient en psychiatrie. La majorite (60,3 %) evaluaient leur niveau de connaissance comme « faible » et 39,7 % comme « moyen ». Seize pour cent evaluaient leur niveau de confort dans la prise en charge des trans comme « faible », 72,5 % comme « moyen » et 11,5 % comme « eleve ». Une majorite (77,5 %) etaient en faveur d’une prise en charge par la securite sociale de la transition hormonale, chirurgicale ou d’un soutien psychologique, 16,4 % etaient neutres et 6 % etaient en defaveur. Les sentiments concernant la transition hormono-chirurgicale etaient tres majoritairement (96,4 %) en faveur ou neutre et 91 % souhaitaient plus de formation. Conclusion Le manque de confort des professionnels de sante d’un CHU non specialise dans la prise en charge des personnes transgenres semble etre en rapport avec un manque de connaissance et de formation et non pas avec un desaccord concernant la necessite de l’offre de soins aux personnes transgenres. Niveau de preuve 3.

Objective To describe and assess the outcomes of dorsal onlay oral mucosa graft urethroplasty for female urethral stricture. Methods We retrospectively reviewed the charts of all female patients who underwent dorsal onlay oral (buccal or lingual) mucosa urethroplasty for urethral stricture between 2011 and 2020 at two academic institutions. The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 1-3 months after catheter removal. Four surgeons performed the urethroplasties using a standardized technique: suprameatal incision, dissection and longitudinal opening of the dorsal aspect of the urethra, harvest of the oral mucosa graft, graft onlay sutured into the urethral opening. Results Nineteen patients were included. The clinical success rate was 94.7% at 1-3 months and 90.9% at 1 year. After a median follow-up of 12 months (range 1-49) there was one recurrence (5.3%), clinical success was achieved in 17 patients (89.5%) and both the maximum urinary flow rate and post void residual were significantly improved (15.2 vs 7.4 ml/s preoperatively; P = .008 and 71.5 vs 161.1 ml preoperatively; P = .001 respectively). The de novo stress urinary incontinence rate was 15.7% at 1-3 months and 9.1% at 1 year. Conclusion Dorsal onlay oral mucosa graft urethroplasty for female urethral stricture appears feasible across multiple surgeons and is associated with a low perioperative morbidity, satisfactory functional outcomes and a low recurrence rate. Other series with larger sample size and longer follow-up are needed to confirm these findings.

Resume Les troubles de la vidange vesicale de la femme existent et sont actuellement largement sous diagnostiques, particulierement en France. Ils sont sous-tendus par deux grands mecanismes : l’hypocontractilite vesicale et l’obstruction sous vesicale, dont la physiopathologie et les modalites de prise en charge sont tres differentes. Il existe beaucoup d’options therapeutiques, y compris chirurgicales, en alternative aux auto-sondages souvent contraignants pour les patientes. En depistant les troubles de la vidange vesicale chez les femmes et en recherchant leur cause pour la traiter, un changement de paradigme dans la prise en charge des patientes est possible : d’un traitement standardise vers une prise en charge personnalisee. L’infirmier(e) diplome(e) d’Etat (IDE) peut depister un certain nombre de signes d’alerte faisant suspecter un trouble de la vidange vesicale, et a donc un role a jouer dans l’amelioration du depistage, de la prise en charge et dans l’education des autres professionnels de sante autour des troubles de la vidange vesicale chez la femme.

PurposeThe emergence of new communication media such as digital contents are progressively replacing more traditional medias in the field of educational programs. Our purpose was to assess urologist in training aspirations regarding urological education.MethodsMembers of a national urologist in training association were sent an anonymous online questionnaire regarding their medical formation in the field of urology. Responders interest for urological sub-specialty or education support (new tools and traditional support) were evaluated through a 5-point Likert scale.ResultsOverall, 109 young urologists (26%) responded to the survey. Most of the respondents worked during their training in an academic hospital (n = 89, 82%). The three favorite tools for training chosen by the responders were: videos, workshop or masterclass, and podcasts (responders very interested were respectively n = 64 (58.7%), n = 50 (45.9%), and n = 49 (45%)). E-mail newsletters were reported as the less useful educational tool by participants (n = 38, 34.9%). Participants were very interested in improving their surgical skills and their radiological knowledge. Responders who were the most attracted by PCa were much more looking to improve their systemic treatment and radiological knowledges.ConclusionsUrologic-oncology was a priority regarding education for urologists in training. A majority of participants expressed a lack in their surgical education, revealing a reduced OR access and underlining utilization of new tools such as simulation. New digital contents such as social media or podcast achieved high interest for the participants, instead of more traditional media. There is a need that educational content evolve and uses new digital media., ButDans la formation médicale, les nouveaux médias de communication tels que les contenus numériques se développent très rapidement et tendent à remplacer les médias plus traditionnels. Notre objectif était d’évaluer les aspirations des urologues en matière de formation en onco-urologie.MatérielLes membres de l’Associations française des urologues en formation ont répondu à un questionnaire en ligne anonyme concernant leur formation en onco-urologie. L’intérêt des participants pour les différents moyens de formation ainsi que pour les spécialités d’organes ont été évalués avec une échelle de Likert à 5-points.RésultatsAu total, 109 urologues en formation ont répondu à l’enquête (26 %). La plupart ont effectué leur formation exclusivement dans un hôpital universitaire (n = 89, 82 %). Les trois outils de formation préférés des participants étaient : les supports vidéo, les ateliers ou masterclass, et les podcast (étaient très intéressés respectivement n = 64 (59 %), n = 50 (46 %) et n = 49 (45 %)). Les newsletters ont été considérées comme l’outil éducatif le moins utile (n = 39, 35 %). Les participants étaient très intéressés par l’amélioration de leurs compétences chirurgicales et de leurs connaissances radiologiques. Les participants qui s’intéressaient le plus au cancer de la prostate cherchaient à consolider leurs connaissances sur les traitements systémiques ainsi qu’en radiologie.ConclusionL’onco-urologie est une priorité pour les urologues en formation. Les nouveaux contenus numériques tels que les réseaux sociaux ou les podcasts ont suscité un grand intérêt chez les participants, supplantant les médias plus traditionnels. Il est nécessaire que le contenu éducatif évolue et se repose sur les nouveaux médias numériques.

Summary Introduction The objective was to evaluate, by self-questionnaire, the feeling of participants in surgical training sessions on a live porcine model. Methods A computerized questionnaire (GoogleForm ©) was sent to the members of the French Association of Urologists-in-Training (AFUF) (fellows and residents). Only questionnaires from Urologists-in-training who had participated in surgical training sessions were included. The sessions consisted of performing surgeries such as laparoscopic nephrectomies or laparoscopic cystectomies. Results Overall, 198 met the inclusion criteria. A total of 36.4% (72/198) of the participants were fellows and 63.6% (126/198) were residents. According to the participants, the main interest of sessions was to be able to train for emergency situations. A total of 79.8% (158/198) of the participants wanted surgical simulation to become compulsory. To their opinion, the main advantage of surgical simulation on a live porcine model was: technical progress in 87.4% (173/198) of cases. A total of 13.1% (26/198) of the participants found it was unethical to perform the first technical procedures on live animal models. A total of 65.7% (130/198) of the participants considered that there is currently no system of substitution. Conclusion For the participants, surgical training on a live porcine model allows technical progress while training for serious emergency situations. Surgeons and patients could benefit from this risk-free mock surgical scenario. Level of evidence 3.

The aim of this study was to compare observation and early drainage by ureteral stenting in patients with blunt renal trauma and urinary extravasation.A retrospective national multicenter study was performed including all patients admitted for renal trauma at 17 hospitals between 2005 and 2015. Patients presenting with a urinary extravasation on initial imaging were considered for inclusion. Patients were divided in two groups according to the initial approach: observation vs. early drainage by ureteral stent (within 48 h after admission). The primary endpoint was the persistence of urinary extravasation on follow-up imaging.Out of 1799 patients with renal trauma, 238 were included in the analysis (57 in the early drainage and 181 in the observation group). In the early drainage group, 29 patients had persistent urinary extravasation vs. 77 in the observation group (50.9% vs. 42.5%; p value = 0.27). The rates of secondary upper urinary tract drainage did not differ significantly between the early drainage group (26.4%) and the observation group (16%) (p = 0.14). There were no statistically significant differences between the two groups in terms of secondary nephrectomy (0% vs. 2.8%; p = 0.34), and death from trauma (0% vs. 1.8%; p = 0.99). In multivariate analysis, early drainage remained not statistically associated with persistence of urinary extravasation on follow-up imaging (OR = 1.35; p = 0.36) CONCLUSION: In this multicenter cohort, observation was not different from early drainage in terms of persistent urinary extravasation after grade IV blunt renal trauma. Further randomized controlled prospective trials are needed to confirm these findings.

Resume Introduction Les traumatismes renaux sont frequents, retrouves dans 10 % de l’ensemble des traumatismes abdominaux. Ils sont majoritairement fermes, en rapport avec un choc direct ou une deceleration brutale. Materiel et methodes Nous avons une realise une synthese de la prise en charge des traumatismes du rein a destination des infirmieres et infirmiers. Resultats Les signes cliniques les plus frequents sont l’hematurie et la lombalgie. Le meilleur examen diagnostique est l’uroscanner. La classification la plus utilisee est celle de l’American Association for the Surgery of Trauma (AAST) qui classe les traumatismes renaux en 5 grades de gravite croissante sur la base des images scannographiques. Le traitement est conservateur dans l’immense majorite des cas et s’est largement simplifie ces dernieres annees, etant essentiellement base sur une surveillance clinique. Les traitements radio-interventionnels et endoscopiques sont reserves a des cas tres selectionnes et le recours a l’exploration chirurgicale est exceptionnel. Conclusion Le pronostic s’est egalement considerablement ameliore et les traumatismes renaux aboutissent desormais tres rarement au deces ou a la perte du rein.

INTRODUCTION AND OBJECTIVE:Female urethral stricture is a rare condition. Distal stricture have usually been managed using meatoplasty. Advancement urethroplasty might be an interesting surgical al...

INTRODUCTION AND OBJECTIVE:Ureteral stricture are mostly iatrogenic and are a frequent complication of pelvic and abdominal surgeries or radiation therapy. Their management differ depending on the ...

Purpose We aimed to review the current knowledge on the epidemiology, diagnosis, and management of urinary and sexual dysfunction in patients with TTR amyloidosis (ATTR). Methods We performed a review of the literature, screening for randomized controlled trials, prospective and retrospective series, position papers, and guidelines on urinary and sexual dysfunction in ATTR patients published in PubMed and Embase. Results Lower urinary tract dysfunction is present in up to 83% of patients with ATTR. Voiding symptoms are the most common, reported in 34.8−87.5% of patients, while urinary tract infections are reported in up to 50%. Urinary incontinence is observed in 16.7−37.5% of the ATTR population, mostly due to decreased urethral resistance. Sexual dysfunction affects over 40% of ATTR patients, with erectile dysfunction and sexual arousal disorder being the most common symptoms in male and female patients, respectively. In addition to a thorough clinical examination, invasive pressure-flow urodynamic testing is a cornerstone in the assessment of ATTR lower urinary tract dysfunction. The most common finding is detrusor underactivity and intrinsic sphincter deficiency. Poor bladder compliance can also be observed in patients, due to amyloid deposits on the bladder wall. Urinary tract imaging may be of interest to rule out upper urinary tract deterioration. Given the paucity of data in the ATTR population, treatment should be tailored to the individual patient. Conclusion Urinary and sexual dysfunction are highly prevalent in ATTR patients. Comprehensive assessment and multidisciplinary management are keys to avoiding upper urinary tract damage and improving patients’ quality of life.

Objectifs La cystectomie chez les sujets neurologiques reste une intervention peu pratiquee, dont les indications sont limitees. La plupart des donnees sur les complications peri-operatoires dont nous disposons concernent les patients ayant eu une cystectomie avec derivation ileale pour cancer. L’objectif de cette etude etait d’evaluer les complications de la cystectomie avec derivation non continente par conduit ileal pour vessie neurologique et leurs facteurs de risque. Methodes Tous les patients ayant eu une cystectomie avec derivation cutanee trans-ileale non continente de type Bricker pour vessie neurologique entre octobre 2004 et novembre 2020 dans un centre ont ete inclus dans une etude retrospective. La voie d’abord etait ouverte, laparoscopique ou robot-assistee selon la periode. La derivation etait realisee en extra-corporel ou en intra-corporel. La survenue d’une complication precoce ( Resultats Apres exclusion de 10 patients traites pour une pathologie non neurologique, 126 patients ont ete inclus sur la periode d’etude. Les pathologies neurologiques les plus frequentes etaient la SEP (36,5 %) et la lesion medullaire traumatique (25,4 %). La voie d’abord etait ouverte, laparoscopique et robotique dans 31 (24,6 %), 26 (20,6 %) et 69 cas (54,7 %) respectivement. Soixante-douze patients ont presente une complication precoce (57,1 %) dont 21 une complication majeure (16,7 %) comprenant un deces (0,8 %). Apres un suivi median de 23 mois, 22 patients ont presente des complications tardives (17,6 %) essentiellement des eventrations (5 ; 4 %) et des stenoses uretero-ileales (9 ; 7,2 %). L’utilisation de la voie robotique etait le seul facteur associe a un risque significativement reduit de complication majeure (OR = 0,30 ; CI95 % = 0,09-0,87 ; p = 0,027) ( Tableau 1 , Tableau 2 ). Conclusion La cystectomie avec derivation ileale non continente pour vessie neurologique est associee a une morbidite peri-operatoire importante, similaire a celle retrouvee pour la cystectomie totale oncologique. L’utilisation de la voie robotique pourrait diminuer le risque de complications majeures pour cette population.

Background Use of Doppler ultrasonography (DUS) for patients with suspected testicular torsion (TT) is highly controversial and remains debated, as it can delay surgery and its performance may vary. Objective To assess the role, impact, safety, and performance of DUS in the management of patients with suspected TT before scrotal exploration. Design, setting, and participants The TORSAFUF cohort retrospectively included patients older than 12 yr who underwent surgery for suspected TT in 14 academic hospitals between 2005 and 2019. Perioperative data and surgical and DUS reports were collected. Outcome measurements and statistical analysis Clinical factors influencing DUS utilisation were analysed using multivariate logistic regression. The orchidectomy rate and delay to surgery were compared by group with and without DUS receipt using one-to-one propensity score (PS) matching to assess imaging safety. For the group with preoperative imaging, DUS performance was evaluated using a contingency table. Results and limitations Overall, 2922 patients were included, of whom 956 (32.7%) underwent DUS before surgery. DUS was more likely to be performed in older patients (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.1–1.2), those who experienced progressive onset of pain (OR 1.5, 95% CI 1.1–2), and patients who presented at the emergency department more than 6 h after their first scrotal symptoms (OR 2.3, 95% CI 1.9–2.8). After PS matching, DUS receipt was not significantly associated with orchidectomy but the delay to surgery was 1 h longer. DUS demonstrated strong sensitivity of 85.2% (95% CI 82.1–88.3%) and specificity of 52.7% (95% CI 48.8–56.6%). The performance was better for younger patients and for those with time since onset of pain of >6 h. Conclusions In this large retrospective study, DUS before surgery was safe, feasible, and useful in selected cases with suspected TT, but it should not delay or replace surgery in cases with a strong clinical suspicion. Patient summary We analysed the performance and safety of an ultrasound scan of the scrotum before surgery for patients with a suspected twisted testicle (TT). This scan before surgery was not associated with a higher risk of negative outcomes but was only moderate in accurately diagnosing TT. Surgery to correct TT should not be delayed.

Background Angiography with selective angioembolization (SAE) is safe and effective in addressing bleeding in patients with renal trauma. However, there are no validated criteria to predict SAE efficacy. Objective To evaluate factors predictive of SAE failure after moderate- to high-grade renal trauma. Design, setting, and participants TRAUMAFUF was a retrospective multi-institutional study including all patients who underwent upfront SAE for renal trauma in 17 French hospitals between 2005 and 2015. Outcome measurements and statistical analysis The primary outcome was SAE efficacy, defined as the absence of repeat SAE, salvage nephrectomy, and/or death for each patient. Results and limitations Out of 1770 consecutive patients with renal trauma, 170 (9.6%) with moderate- to high-grade renal trauma underwent SAE. Overall upfront SAE was successful in 131 patients (77%) and failed in 39 patients: six patients died after the embolization, ten underwent repeat SAE, 22 underwent open nephrectomy, and one underwent open surgical exploration. In multivariate logistic regression analysis, gross hematuria (odds ratio [OR] 3.16, 95% confidence interval [CI] 1.29–8.49; p = 0.015), hemodynamic instability (OR 3.29, 95% CI 1.37–8.22; p = 0.009), grade V trauma (OR 2.86, 95% CI 1.06–7.72; p = 0.036), and urinary extravasation (OR 3.49, 95% CI 1.42–8.83; p = 0.007) were predictors of SAE failure. The success rate was 64.7% (22/34) for patients with grade V trauma and 59.6% (31/52) for those with hemodynamic instability. The study was limited by its retrospective design and the lack of a control group managed with either surgery or surveillance. Conclusions We found that gross hematuria, hemodynamic instability, grade V trauma, and urinary extravasation were significant predictors of SAE failure. However, success rates in these subgroups remained relatively high, suggesting that SAE might be appropriate for those patients as well. Patient summary Selective angioembolization (SAE) is a useful alternative to nephrectomy to address bleeding in patients with renal trauma. Currently, there are no validated criteria to predict SAE efficacy. We found that gross hematuria, hemodynamic instability, grade V trauma, and urinary extravasation were significant predictors of SAE failure.

Summary Introduction The COVID-19 outbreak in France is disturbing our health system. Urologists in training who are already known to have burnout, are in the front line to face this disease. The aim of our study was to assess the psychological impact of COVID-19 pandemic on young French urologists in training. Material and methods A self-administered anonymous questionnaire evaluating the pandemic added stress, and its negative impact on work and training quality, was e-mailed to the members of the French Association of Urologists in Training (AFUF). The association includes all French junior and senior residents. The survey lasted 3 days. Multivariable analyses using logistic regression was performed to identify the predictive factors. Results Two hundred and seventy-five (55.5%) of the 495 AFUF members responded to the questionnaire. More than 90% of responders felt more stressed by the pandemic. Fellows and senior residents were more likely to feel that the crisis had an important impact on their work quality (OR = 1.76, IC95 = [1.01–3.13]), even more when COVID 19 patients were present in their department (OR = 2.31, IC95 = [1.20–4.65]). Past medical history of respiratory disease (OR = 2.57, IC95 = [1.31–5.98]) and taking in charge COVID19 patients (OR = 1.85, IC95 = [0.98–3.59]) were additional risk factors. Conclusion COVID19 pandemic has a negative impact on young French urologists in training and on their work and training quality. Managing their psychosocial well-being during this time is as important as managing their physical health. Level of evidence 3.

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.

INTRODUCTION AND OBJECTIVE:Several preliminary series have reported the use of a robotic approach for artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontin...

Objectif La stenose de l’uretre feminin est une cause d’obstruction sous vesicale anatomique chez la femme rare, mais aussi largement sous-diagnostiquee. Sa prise en charge est un challenge en urologie reconstructrice. Methodes Nous presentons le cas d’une femme âgee de 47 ans, avec une stenose uretrale due a un lichen atrophique sclereux vulvovaginal responsable de troubles de la vidange vesicale et d’infections urinaires recidivantes. Un greffon de muqueuse linguale a ete utilise car la muqueuse buccale etait egalement atteinte par le lichen. Le but de cette video etait de decrire la technique d’uretroplastie dorsale par greffon de muqueuse linguale dans les stenoses de l’uretre feminin. Resultats Le temps operatoire etait de 70 min. La procedure commence par une infiltration de xylocaine-adrenalinee. Une incision en U-inverse est realisee en avant de l’uretre. Le plan entre l’uretre et les corps caverneux du clitoris est disseque. Une ureterotomie dorsale est realise a 12 h jusqu’en zone uretrale proximale saine. Le greffon de muqueuse buccale est preleve apres reperage des orifices des canaux de Wharton. Le greffon est suture aux berges de l’uretre incise. La partie distale du greffon est fixee au tissus periuretral sus-jacent de maniere a recreer un aspect de meat uretral. Une sonde vesicale CH18 est mise en place en fin de procedure. Il n’y a pas eu de complication. La patiente a pu quitter l’hopital a j2. A 6 mois, la vidange vesicale est complete avec un debit satisfaisant, sans residus post-mictionnel. Conclusion L’uretroplastie dorsale par greffon de muqueuse linguale pour les stenoses de l’uretre feminin semble etre une technique faisable et reproductible avec des resultats fonctionnels satisfaisants.

Objectif La stenose ureterale est une complication bien connue de l’ureteroscopie, en particulier lors de procedure repetees. Il n’y a actuellement pas de consensus sur la prise en charge de ces stenoses iatrogenes. La technique de reconstruction ureterale par greffe de muqueuse buccale a ete decrite recemment comme une option prometteuse pour les stenoses ureterales hautes ou moyennes entre 2 et 10 cm. Methodes Nous presentons le cas d’un homme âge de 42 ans, presentant une stenose ureterale iatrogene suite a 4 ureteroscopies realisees dans le cadre du traitement d’un calcul ureteral. Une tentative d’incision endoscopique a ete realisee sans succes. La stenose mesurait 3 cm de long et etait situee au niveau de l’uretere iliaque gauche, avec des fragments lithiasiques residuels enclaves dans la paroi ureterale. Le but de cette video etait de decrire la technique d’ureteroplastie robot-assistee par greffe de muqueuse buccale. Resultats La procedure etait supervisee par un expert international par telementoring. La duree operatoire etait de 180 minutes. L’injection intraveineuse de vert d’indocyanine aidait a visualiser la vascularisation ureterale en amont et en aval de la zone stenosee par fluorescence FireFly™. La stenose mesuree, une deuxieme equipe commencait a prelever le greffon de muqueuse orale. La partie anterieure de la stenose etait incisee longitudinalement, jusqu’a ce qu’un ureteroscopie flexible CH9 puisse etre insere. L’ureteroscopie souple permettait de s’assurer de la bonne qualite des tissus de chaque cote de la stenose. Une sonde double J etait mise en place. Le greffon etait ensuite suture sur l’incision ureterale par 2 surjets de PDS 5/0. En fin d’intervention, l’omentum etait appose sur le greffon pour assurer un apport sanguin adequate. Aucune complication ni recidive sont survenues en postoperatoire. Conclusion L’ureteroplastie robot-assistee par greffe de muqueuse buccale est une technique faisable qui pourrait diminuer la morbidite perioperatoire liee aux options chirurgicales existantes. Les technologies innovantes telles que la fluorescence FireFly™ peuvent etre utiles pour ce type de procedure.