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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.

La Tomografía de Coherencia Óptica (OCT) (Drexler & Fujimoto, 2008) es una técnica basada en la interferometría de baja coherencia y permite obtener imágenes 3D de superficies y volúmenes interiores en diversos materiales. Este artículo presenta una propuesta que tiene como objetivo desarrollar un equipo modular, como un esquema experimental en módulos adaptables a diferentes configuraciones y aplicaciones, para obtener topografías y tomografías de materiales con alta resolución espacial (por debajo del micrón). Este equipo se basa en la técnica conocida como microscopía de fase de dominio espectral (SDPM)(Ding et al., 2013), y aunque el análisis de fase es muy utilizado en interferometría convencional, solo en los últimos años se ha implementado en combinación con OCT (Larin & Sampson, 2017) en topografía de superficie (Taudt et al., 2020) y aplicaciones de tomografía de materiales (Lan et al., 2017). Se presentan las primeras mediciones con resolución espacial axial inferior al micrón en perfilometrías de superficies de muestras donde la diferencia de camino óptico varía entre 30 y 150 nm.

Cardiac involvement in systemic lupus (SL) and antiphospholipid syndrome (APS) can be due to variables and involve different presentations. Pericarditis is the most common lupus manifestation and occurs in 16% to 25% of patients. While corticosteroids are usually very effective, colchicine may avoid steroids and prevent relapse. Myocarditis during SL is rare and often inaugural. They may manifest as chest pain, acute heart failure, arrhythmias or conduction disturbances, and may progress to dilated cardiomyopathy and/or permanent heart failure. Their prognosis is however generally good, even in the absence of treatment with cyclophosphamide for the less serious forms. Finally, coronary involvement in SL is most often due to atherosclerotic, thrombotic origin (generally in the context of associated APS), and exceptionally explained by coronary vasculitis. During APS, valve disease is frequent and usually asymptomatic. Thrombotic damage can be (1) coronary, typically manifesting as a myocardial infarction in a young subject with healthy coronary arteries, (2) much more rarely intracardiac, or (3) microcirculatory, generally as part of a catastrophic antiphospholipid syndrome (CAPS) leading to a multiorgan failure. Finally, iatrogenic cardiac manifestations can exceptionally be seen during treatment with cyclophosphamide or antimalarials characterized by conduction disorders and/or heart failure.

Resume En ORL, l’examen clinique et les gestes invasifs sur les voies respiratoires et leurs annexes exposent a la transmission directe du SARS-CoV-2 par inhalation ou projection oculaire de gouttelettes contaminees, ou indirecte manuportee ou par l’intermediaire d’objets ou de surfaces contaminees. L’estimation d’un R0 de la COVID-19 a environ 3 a justifie de reporter les rendez-vous des consultations presentielles non urgentes et de developper la tele-consultation afin de limiter les risques d’infection par le SARS-CoV-2 des patients ou des agents de sante et de participer au respect du confinement. L’autorite sanitaire a recommande de deprogrammer toute activite ORL chirurgicale ou medicale non urgente et sans prejudice de perte de chance pour les patients. Cette deprogrammation a eu pour objectif d’augmenter tres significativement la capacite de soins critiques, prioriser l’accueil de malades de patients COVID-19, prioriser l’affectation des personnels et la mise a disposition des materiels necessaires a leur fonctionnement, contribuer a la fluidite de l’aval des soins critiques au sein de leur etablissement. Il s’agissait egalement de ne pas exposer les malades concernes a un risque d’exposition infectieuse. Cet article propose des orientations concernant les indications et modalites de realisation de la chirurgie ORL et la gestion des reports d’intervention dans le contexte pandemique actuel. Il ne s’agit que de conseils de bonne pratique qui doivent naturellement etre modules dans chaque region en fonction de l’evolution de l’epidemie et des organisations preexistantes, et ce dans le cadre de concertations entre les equipes ORL, les unites operationnelles d’hygiene et toutes les autres specialites concernees.

In Otorhinolaryngology - Head and Neck Surgery, clinical examination and invasive procedures on the respiratory tract and on airway-connected cavities, such as paranasal sinuses and the middle ear, expose people to direct transmission of SARS-CoV-2 by inhalation or ocular projection of contaminated droplets, and to indirect transmission by contact with contaminated hands, objects or surfaces. Estimating an R0 of COVID-19 at around 3 justified postponing non-urgent face-to-face consultations and expanding the use of teleconsultation in order to limit the risks of SARS-CoV-2 infection of patients or health workers and comply with the lockdown. The health authority recommends cancellation of all medical or surgical activities, which are not urgent as long as this does not involve a loss of chance for the patient. The purpose of this cancellation is to significantly increase critical care capacity, prioritise the reception of patients with COVID-19, prioritise the allocation of staff and provision of the equipment necessary for their medical or surgical management, and contribute to the smooth running of downstream critical care within their establishment. Another goal is to reduce the risks of patient contamination within healthcare facilities. This document provides guidance on how to proceed with and adapt ENT surgery in the current pandemic context, as well as on the management of postponed operations. This best practice advice must of course be adapted in each region according to the development of the epidemic and pre-existing arrangements. Their local application can only be decided within the framework of collaboration between the ENT teams, the operational hygiene units and all the other specialties concerned.

A low-cost long-range frequency domain low-coherence interferometry (LCI) detector is presented: time Fourier domain LCI (TFD-LCI). Combining ideas of time domain and frequency domain techniques, the TFD-LCI detects the analog Fourier transform of the optical interference signal with no limitation for the maximum optical path, measuring the thickness of several centimeters with micrometer resolution. A complete characterization of the technique is presented with a mathematical demonstration, simulations, and experimental results. An evaluation of repeatability and accuracy is also included. Measurements of small and large monolayer and multilayer thicknesses were done. Characterization of the internal and external thicknesses of industrial products such as transparent packages and glass windshield is presented, showing the potentiality of TFD-LCI for industrial applications.

Resume Introduction L’information preoperatoire est determinante a l’adhesion du patient au traitement mais peut etre insuffisamment assimilee par le patient du fait de sa densite et de sa complexite. L’objectif de cette etude etait d’evaluer la comprehension et la satisfaction des patients de l’information preoperatoire de chirurgie de l’hypertrophie benigne de prostate (HBP). Les facteurs influencant la comprehension etaient egalement etudies. Methodes Il s’agissait d’une etude monocentrique sur questionnaire incluant tous les patients devant se faire operer d’une HBP quelle que soit la technique chirurgicale. Un questionnaire etait envoye a chaque patient, a domicile, apres la consultation urologique preoperatoire. Resultats Deux cent dix questionnaires ont ete envoyes et 106 patients (50,5 %) ont renvoye le questionnaire. L’information etait jugee excellente (cotee 9/10 et 10/10 sur l’echelle numerique) par 38,68 % (41/106) des patients et « tres bonne » (cotee 7–8) par 45,28 % des patients (48/106). Les complications postoperatoire les plus frequemment citees par les patients etaient l’ejaculation retrograde (39,6 % des patients, n = 42/106) et le saignement (29,2 %, n = 31/106). 57,6 % des patients (n = 61) se rappelaient avoir recu la fiche d’information ecrite. Apres rappel des complications eventuelles, 5,7 % des patients (n = 6/106) hesitaient a se faire operer. Seul l’âge des patients etait significativement associe a une difference de comprehension (p Conclusion L’information dispensee aux patients avant chirurgie d’HBP paraissait satisfaisante bien qu’elle semble mal comprise, notamment concernant les complications. Cette etude pourrait permettre de modifier notre vision de l’information du patient, en passant d’un modele paternaliste a un modele de « partenariat » avec le patient. Niveau de preuve 3.

Summary Aims The objective of this study was to assess the effectiveness and the complications rate following continent cutaneous channels (CCC) procedures, at short and medium term follow-up (FU). Materials & Methods A continuous retrospective case series (2008–2018): all patients who have undergone a CCC for neurogenic bladder were included in our department. The primary outcome was the effectiveness of CCC defined by the status of catheterizability (by the patient or a care-giver), continence of the tube, and absence of reintervention at 3 and 12 months FU. The secondary outcome was the prevalence of postoperative complications at 3 and 12 months FU. Results Fifty-three patients were included during the study period in our department. Median follow up was 3,3 years (1.5–6.1). The overall effectiveness of CCC was 67.9% (n = 36/53) at 3 months FU and 45,3% (n = 24) at 12 months FU. The global rate of complications was 60.4% (n = 32/53) at 3 months, and 73.6% (n = 39/73) at 12 months FU. The statistical analysis showed no statistical differences on efficacy and complications in the different subgroups of CCC. Conclusions In the current series, the effectiveness and the complications rates following CCC were comparable across the procedure types. Level of evidence 4.

Resume Introduction Plusieurs programmes de rehabilitation avancee apres chirurgie (RAAC) ont montre une amelioration des suites postoperatoires pour les patients permettant des durees d’hospitalisation diminuees. Tres peu d’etudes a notre connaissance ont evalue la satisfaction des patients sur ces protocoles. L’objectif de cette etude etait d’evaluer la satisfaction des patients ayant beneficie du protocole de RAAC pour nephrectomie partielle robot-assistee (NPRA). Materiels et methodes Un questionnaire valide EORTC IN-PATSAT32 associe a un questionnaire specifique sur la RAAC ont ete envoye aux 42 premiers patients inclus dans le protocole RAAC de RAPN apres leur consultation postoperatoire. Les reponses etaient anonymes. Les calculs des scores de satisfaction du questionnaire EORTC ont ete effectues pour chaque dimension par la methode de Likert. Les scores ont ensuite ete transformes lineairement en une echelle variant de 0 a 100, ou 100 represente le meilleur niveau de satisfaction sur les soins (methode EORTC). Resultats Au total, 21 patients ont renvoye les questionnaires (50 %). Le score moyen de satisfaction globale etait de 75,1 % (37,3 ; 100) dans le questionnaire EORTC. Au total, 71,4 % des patients (n = 15) trouvaient la sortie a j2 postoperatoire satisfaisante et 5 patients (23,8 %) trouvaient cela prematuree. Aucun des patients n’avait d’impression negative sur le protocole de RAAC. L’evaluation globale moyenne du protocole par les patients sur une echelle de satisfaction de 1 a 10 etait de 8,9/10. Conclusion Dans notre etude, les patients ayant beneficie du protocole de RAAC apres NPRA semblaient tres satisfaits de leur prise en charge pre-, per- et postoperatoire. Etant donnee la satisfaction des patients, la reduction des durees d’hospitalisation, la securite du patient et l’avantage medico-economique, ces protocoles de RAAC sont a developper et evaluer. Des etudes de plus grands effectifs sont necessaires pour evaluer le vecu des patients sur ces protocoles de RAAC. Niveau de preuve 4.

Background Transperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects. Objective To assess surgical and functional outcomes of this treatment of RUF. Design, setting, and participants A retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020. Surgical procedure The standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures. Measurements Fistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark’s score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality. Results and limitations The median (interquartile range) follow-up was 27 (8–47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark’s score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations. Conclusions The present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate. Patient summary We performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes. Take Home Message Transperineal repair of rectourethral fistula with gracilis muscle flap interposition is a safe surgery with a high success rate. Urinary continence is a serious issue, but patients may be reassured as to the impact on digestive continence, lower extremity functionality, and scar aesthetics.

IntroductionPeyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations.Materials and methodsThese recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography.ResultsThe assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered.ConclusionThe management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience., IntroductionLa maladie de Lapeyronie est un motif fréquent de consultation en urologie, dont le traitement reste sujet à de nombreuses controverses. Elle n’a fait l’objet d’aucune recommandation française jusqu’à présent. Le Comité d’Andrologie et de Médecine Sexuelle de l’Association Française d’Urologie propose donc une série de recommandations basées sur les preuves.Matériels et méthodesCes recommandations sont réalisées selon la méthode ADAPTE, en se basant sur les recommandations européennes (EAU, ESSM), américaines (AUA, ISSM) et canadiennes (CAU), en intégrant les spécificités françaises en raison de la disponibilité des traitements, et une mise à jour de la bibliographie récente.RésultatsL’évaluation de la maladie est clinique. Les patients présentant une gêne fonctionnelle ou un retentissement psychologique important peuvent se voir proposer un traitement. Les bénéfices et inconvénients de chaque traitement devront être explicités au patient. Concernant les traitements non chirurgicaux, aucun traitement disponible n’a l’autorisation de mise sur le marché en France. La vitamine E n’est pas recommandée. Des traitements à visée antalgiques (oraux ou ondes de choc de faible intensité) ou pro-érectiles peuvent être proposée selon le besoin, ainsi qu’une thérapie par traction. En raison de l’indisponibilité des injections de collagénase, les injections de vérapamil peuvent être proposées. Les traitements chirurgicaux sont à considérer en phase stabilisée de la maladie, et consistent en la réalisation d’une plicature, d’une incision-greffe ou de la pose d’un implant pénien en fonction du souhait du patient, de la courbure et de la taille de verge, ainsi que de la fonction érectile. Des traitements combinés peuvent être proposés.ConclusionLa prise en charge de la maladie de Lapeyronie est complexe, et les niveaux de preuve des traitements sont faibles dans l’ensemble. Le succès du traitement dépendra de la qualité de l’évaluation initiale, de l’information du patient et de sa compréhension des effets attendus, et de l’expérience du praticien.

Resume Introduction L’implant penien pour dysfonction erectile chez le patient blesse medullaire ou avec une sclerose en plaques est parfois discute apres echec des traitements medicamenteux ou instrumentaux (vacuum). L’objectif de cette etude etait d’evaluer les complications, l’evolution et la satisfaction du patient et de la partenaire apres la pose d’une prothese penienne pour dysfonction erectile chez le patient souffrant de trouble neurologique. Materiel et methode Etude retrospective multicentrique de 27 patients consecutifs dont 18 blesses medullaires et 9 patients presentant une sclerose en plaques beneficiant de la pose d’un implant penien pour dysfonction erectile sur deux centres francais entre 2009 et 2019. Ont ete evalue les complications post implantation, l’evolution de l’utilisation de la prothese et la satisfaction globale du patient a l’aide du questionnaire standardise Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) lors d’un appel telephonique entre mars et mai 2020. Resultats L’âge moyen a l’implantation etait de 46,4 ans (±12,74). La duree de suivi a date de l’appel etait de 6,05 ans (±2,86). 8/27 patients (29,6 %) ont presente au moins une complication tout grade Clavien-Dindo dont 2 infections. 2/27 patients (7,4 %) ont presente une panne mecanique de prothese durant le suivi. La dexterite du patient concernant le gonflage de la prothese etait parfaite dans 85 % des cas, et de 75 % pour le degonflage. Le taux de satisfaction de l’utilisation de la prothese a date de l’appel etait de 75,36/100pts pour le patient et de 66,88/100pts pour la partenaire. Conclusion Nous avons observe une prevalence d’infection de prothese augmentee par rapport a la population generale chez le patient neurologique mais une satisfaction du patient et de la partenaire perenne a plus de 5 ans d’implantation. La dexterite est conservee au long cours temoignant d’une bonne selection des indications. Ces donnees invitent a considerer favorablement la mise en place d’une prothese penienne chez le patient souffrant de trouble neurologique en cas d’echec des traitements de premiere ligne. Niveau de preuve 4.

Objectives To estimate the intra -and inter-rater consistency of radiologist and neurologist working in pairs attributing DWI-ASPECTS (Diffusion Alberta Stroke Program Early CT Score) in patients with acute middle cerebral artery ischemic stroke referred for mechanical thrombectomy, intravenous thrombolysis or bridging therapy. Methods Five neurologists and 5 radiologists working in pairs and in hour period scored independently and in two reading sessions anonymized DWI-ASPECTS of 80 patients presenting with acute anterior ischaemic stroke in our center. We measured agreement between pairs using intraclass correlation coefficients (ICCs). A Fleiss kappa was used for dichotomized (0-6;7-10) and trichotomized (0-3;4-6;7-10) ASPECTS. The interrater distribution of the score in the trichotomized (0-3;4-6;7-10) ASPECTS was calculated. We determined the interrater (Cohen kappa) and intrarater (Fleiss kappa) agreement on the ASPECTS regions. Results The average DWI-ASPECTS was 6.35 (SD ± 2.44) for the first reading, and 6.47 (SD ± 2.44) for the second one. The ICC was 0.853 (95%CI, 0.798-0.896) for the interrater, and 0.862 (95%CI, 0.834-0.885) for the intrarater evaluation. Kappa coefficients were high for dichotomized (k = 0.75) and trichotomized (k = 0.64) ASPECTS. Evaluators agreement on the ASPECTS category (0-3), (4-6) and (7-10) was 88, 76 and 93% respectively. The anatomic region infarcted was well identified (k = 0.70-0.77), except for the internal capsula (k = 0.57). Interrater agreement was fair for M5 (k = 0.37), moderate for internal capsula (0.52) and substantial for the other regions (0.60-0.79). Conclusions Reliability of DWI-ASPECTS is good when determined by radiologist and neurologist working in pairs, which corresponds to our current clinical practice. However, discrepancies are possible for cut-off determination, which may impact the indication of thrombectomy, and for the determination of the exact infarcted region. Agreement to propose category (4-6) is lower than for (0-3) and (8-10) ASPECTS categories.

Resume Contexte Des essais cliniques de therapie cellulaire ont recemment ete conduits pour la dysfonction erectile (DE) et la maladie de la Peyronie apres une phase de recherche fondamentale. Objectifs Mise au point sur les biotherapies de la DE et de la maladie de la Peyronie, et description du cadre reglementaire regissant ces nouvelles strategies therapeutiques. Sources documentaires Revue de la litterature sur PubMed et Clinical.trials.gov avec les principaux mots-clefs suivants : « erectile dysfunction », « Peyronie's disease », « stem cell », et « platelet-rich plasma ». Resultats et limites La recherche fondamentale a montre la possibilite d’ameliorer la fonction erectile dans des modeles murins de DE post-prostatectomie radicale ou metabolique. Les sources biologiques testees sont la moelle osseuse, le tissus adipeux et le sang (PRP, plasma riche en plaquette). Le mode d’action de ces biotherapies est probablement temporaire et principalement de nature paracrine. Quatre essais cliniques ont ete publies dans le cadre de la DE post-prostatectomie radicale ou chez des patients diabetiques, et 1 autre pour la maladie de la Peyronie. Onze essais cliniques dont trois randomises sont en cours pour les DE organiques. Les premiers resultats suggerent la possibilite d’ameliorer la fonction erectile spontanee et la reponse au traitement medical (chez des patients initialement non repondeurs) via une amelioration de la vascularisation penienne. Une reduction de la courbure penienne a ete notee apres injection cellulaire dans la plaque de la Peyronie. Aucun effet secondaire n’a ete rapporte. La plupart des procedes testes sont considerees comme des « medicaments de therapie innovante » avec des contraintes reglementaires lourdes, notamment s’il existe une modification « substantielle » des cellules. Pour les procedures de biotherapie extemporanee, sans modification substantielle et utilisant un tissu homologue, la qualification reglementaire reste floue et beaucoup plus permissive. Conclusion Les premiers resultats cliniques de biotherapie pour DE sont prometteurs. Le cadre reglementaire peut varier considerablement selon le mode de preparation des cellules a injecter et leur origine, generant ainsi des contraintes radicalement differentes pour un meme effet recherche. Cet aspect reglementaire est un facteur decisif a prendre en compte pour le choix de la procedure.

To update French guidelines concerning testicular germ cell cancer.- Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated.- Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm.- A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).

To update French urological guidelines on retroperitoneal sarcoma.- Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of retroperitoneal sarcoma. Level of evidence was evaluated.- Chest, abdomen and pelvis CT is mandatory to evaluate any suspected retroperitoneal sarcoma. MRI sometimes helps surgical planning. Before histological confirmation through biopsy, the patient must be registered in the French sarcoma pathology reference network. The biopsy standard should be an extraperitoneal coaxial percutaneous sampling before any retroperitoneal mass therapeutic decision. Surgery is retroperitoneal sarcoma cornerstone. The main objective is grossly negative margins and can be technically challenging. Multimodal treatment risks and benefits must be discussed in multidisciplinary teams. The relapse rate is related to tumor grade and surgical margins. Reported Negative margins rate thus encourage surgery in high-volume centers.- Retroperitoneal sarcoma prognosis is poor and closely related to the quality of initial management. Centralization through dedicated sarcoma pathology network in a high-volume center is mandatory.

To update French oncology guidelines concerning penile cancer.- Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II.- Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organ-sparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial.- Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.

The objective of this publication is to recall the initial oncological management of adrenal incidentalomas.- The multidisciplinary working group updated french urological guidelines established by the CCAFU in 2018, based on an exhaustive literature review carried out on PubMed.- Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by Adrenocortical Carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical / hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis which will make it possible to close the malignancy assessment and make the oncological diagnosis.- AC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE - adrenal cancer network (Appendix 1).

Trans people face more barriers when seeking healthcare than the cisgender population probably due to a lack of knowledge, education and comfort of healthcare workers. The purpose of this study was to assess the knowledge and comfort felt by healthcare professionals in managing trans people in a French university hospital.A self-questionnaire was emailed to healthcare professionals working in departments usually involved in the care of trans people in a French university hospital "not specialized" in medical and surgical gender transition. The questionnaire included demographic questions and Likert scales regarding their knowledge and comfort in taking care of trans people. Responses on the 7-point Likert scales were categorized into "low", "medium" and "high" groups, and responses on the 5-point Likert scales were categorized into "in favour", "neutral" and "against" groups.One hundred and two (29%) healthcare professionals answered the questionnaire. Half worked in surgical departments (urology, plastic surgery, gynecology), 24% worked in medical departments (endocrinology, reproductive medicine, cytogenetics) and 26% worked in psychiatry. The majority (60.3%) rated their level of knowledge as "low" and 39.7% as "medium". Sixteen percent rated their level of comfort in managing trans people as "low", 72.5% as "medium" and 11.5% as "high". A majority (77.5%) were in favor of having the costs of gender transition care covered by the national health insurance system, 16.4% were neutral and 6% were against this idea. Feelings about surgical and hormonal gender transition were overwhelmingly (96.4%) in favour or neutral and 91% were willing to get more training and education to manage trans people.The lack of comfort felt by healthcare professionals in university hospital in managing trans people seems to be related to a lack of knowledge and training in that field and not to a disagreement with the need of transgender healthcare.3.

The use of low-coherence interferometry (LCI) in industrial applications is increasing as it is a nondestructive technique with high resolution for material characterization. However, the measurement range of around 3 mm of the conventional spectrometer based Fourier Domain LCI systems limits its field of application. The employment of a heterodyne detection system for FD-LCI signals could increase the measurable optical depths to 5 cm at least. In this work, the study of the effect of the diffraction gratings used in this type of devices is presented. The characteristics of the gratings as well as its configuration played a determinant role in the detector bandwidth and dynamic range. Diffraction gratings with fewer lines per millimeter are shown to be more suitable for large axial range measurement without losing resolution.

Summary Introduction The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed. Methods A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period. Results We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis. Conclusion Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

Se estudio la función Interferométrica radial de transferencia para un haz esférico y un haz gaussiano en cavidades Fabry Perot medianas. Se simularon las múltiples reflexiones de los haces dentro de la cavidad para varias longitudes de onda y se observó el patrón de interferencia perpendicular al eje axial, el cual tiene forma de múltiples anillos concéntricos. Se estudiaron las condiciones necesarias de anchos de cavidades y cinturas de haces de centenas de micrones para poder observar los anillos. Se estudió la forma de estos patrones, en especial se analizó el ancho de los picos, el contraste y el rango espectral libre ya que son características que pueden permitir utilizar a la cavidad como detector de la técnica de Interferometría de Baja Coherencia.

La interferometría de baja coherencia está generando considerable interés en aplicaciones industriales donde es necesario realizar medidas más grandes con mayor resolución. Los sistemas convencionales en el dominio de Fourier alcanzan una profundidad limitante de alrededor de 3 mm, debido principalmente a los espectrómetros utilizados para la detección. En este trabajo se presentan los avances relacionados al diseño, desarrollo y caracterización de un sistema de detección heterodino el cual permite aumentar en un orden de magnitud el rango de trabajo.

Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations.These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography.The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered.The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.

Penile prosthesis for erectile dysfunction in patients with spinal cord injury or multiple sclerosis is sometimes discussed after failure of drug or instrumental treatments (vacuum). The objective of this study was to evaluate the complications, evolution and patient satisfaction after the implantation of a penile prosthesis in the neurological patient.Multi-center retrospective study of 27 consecutive patients including 18 spinal cord injured patients and 9 patients with multiple sclerosis benefiting from the implantation of a penile prosthesis for erectile dysfunction purposes in two French centers between 2009 and 2019. Post-implantation complications, evolution of the use of the prosthesis and global patient satisfaction were evaluated using the standardized questionnaire Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) during a telephone call between March and May 2020.The average age of implantation was 46.4 years (±12.74). The length of follow-up to date of call was 6.05 years (±2.86). 8/27 patients (29.6 %) had at least one complication of any Clavien-Dindo grade included 2 infection. 2/27 (7,4 %) patients had a mechanical prosthesis injury during follow-up. The patient's dexterity with inflation of the prosthesis was perfect in 85 % of cases, and 75 % for deflation. The satisfaction rate for prosthesis use at the time of the call was 75.36/100pts for the patient and 66.88/100pts for the partner.This study found an increased rate of prothesis infection compared to the general population in the neurologic patient, but patient and partner satisfaction remain sustainable after more than 5 years of implantation. Dexterity was maintained over the long term, demonstrating a good selection of indications. These data invite to favorably consider the installation of a penile prosthesis in neurological patients who have failed first-line treatments.4.