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El tamaño del pene es una cuestión de gran interés para los varones. Las técnicas quirúrgicas de faloplastia de aumento carecen de recomendaciones validadas y presentan un riesgo elevado de complicaciones. Se han descrito varios tratamientos no invasivos de aumento, tanto de diámetro como de longitud, como el vacío, el extensor de pene, así como los ejercicios físicos de extensión. La mayoría de estas técnicas carecen de una evidencia de eficacia significativa, salvo el extensor de pene. En cuanto a los tratamientos quirúrgicos, tanto la lipectomía suprapúbica como la sección del ligamento suspensorio del pene o slidingtechniquepresentan un balance beneficio/riesgo poco favorable a la intervención. Las ganancias de longitud son de 0,5-1,7 cm para las técnicas no invasivas y de 0,8-3,1 cm con la cirugía. En la actualidad, ni la Association Française d’Urologie (AFU), ni la European Association of Urology (EAU) han publicado recomendaciones sobre las indicaciones y técnicas quirúrgicas para el alargamiento del pene. En este artículo sólo se describen las técnicas de faloplastia de aumento. Las técnicas de ensanchamiento se describen en otro artículo.

El síndrome de la unión pieloureteral (SUPU) se define por una dilatación de la pelvis y los cálices con un uréter fino, en un contexto de malformación funcional o anatómica de la unión pieloureteral, primaria o adquirida, intrínseca o extrínseca (vasos polares frecuentes) Las exploraciones de referencia que permiten confirmar este diagnóstico son la urotomografía computarizada (uro-TC) y la gammagrafía con MAG3 (mercaptoacetiltriglicina). Permiten estudiar la morfología y la función renales, así como el carácter obstructivo de un obstáculo sospechado. Si se confirma la obstrucción, la indicación quirúrgica depende de la presencia de síntomas (dolor lumbar), de una complicación (cálculo renal, infección urinaria) o de una alteración de la función renal general o propia del riñón afectado. En ocasiones, se puede proponer una vigilancia. La decisión de saber a quién y cuándo operar probablemente sea la más difícil de tomar, debido a la variabilidad de la historia natural del síndrome de la unión pieloureteral. En los casos graves, la obstrucción da lugar a una destrucción completa del parénquima renal. Si se opta por un tratamiento quirúrgico, la pieloplastia, recomendada sobre todo por laparoscopia (asistida por robot o no) es el tratamiento de referencia. Como segunda elección, en particular en caso de recidiva de una estenosis corta, sin repercusión importante sobre el riñón (función preservada, dilatación moderada), los procedimientos de endopielotomía con láser por vía retrógrada o anterógrada pueden ofrecer resultados interesantes. Por último, cuando fracasan los tratamientos convencionales, la uretroplastia con injerto de mucosa yugal es atractiva, tanto desde el punto de vista fisiopatológico como técnico para una estenosis larga, mientras que una intervención más antigua, como la anastomosis ureterocalicial puede proporcionar buenos resultados, modernizada por el uso del robot.

Modern technological developments and intensive research efforts have primarily fueled the worldwide interest in solar energy. The risks that conventional energy sources pose to both human health and the environment are what have driven this change. Various solar energy solutions are available today, such as solar collectors, PV panels, solar ponds, solar chimneys, solar stills and Trombe walls. The current article aims to study the impact of porous media on the performance of Thermal solar systems, including steel foam, aluminium foam, wood, gravel, metal foam, metal balls, and glass balls. The study reviewed the most important published research that conducted analytical and experimental studies to maintain the low operating temperature as much as possible because it had a significant impact on improving efficiency, as one of the proposed methods is the use of porous media and through the results obtained indicate a significant increase in efficiency in one of the studies the addition of porous medium led to a decrease in the temperature of the photovoltaic cell by 5 to 25 degrees Celsius and the overall efficiency increased from 10% to 28%. In contrast, the electrical efficiency increased from 1% to 4%. The result of another experimental work was a decrease in the temperature of the device between 3.9 and 18.3, an increase in energy consumption by 6.6%, improved Electrical efficiency by 2.7%in another research, the solar energy efficiency of a solar distiller using oyster shells as a porous medium was 0.73% and 1.2%.

Percutaneous nephrolithotomy (Labate et al.) is the standard procedure for the treatment of large (≥2cm) kidney stones. The patient can be in prone or modified supine position. The puncture is performed under fluoroscopy and/or ultrasound guidance. The stone-free rate seems to be comparable between miniaturized and standard PCNL. Procedures performed with smaller diameter instruments tend to be associated with significant lower blood loss, but longer procedure times. The limitation of the number of percutaneous tracts results in better preservation of the kidney function and lowers the risk of complications. The use of tranexamic acid during PCNL may be interesting for reducing the bleeding risk, the transfusion rate, and possibly the intervention duration.

Only few hundred interventions are performed in France each year to remove upper urinary tract stones using a laparoscopic/robotic transperitoneal or retroperitoneal approach. These interventions are proposed to patients with large (>20mm) and complex stones, sometimes after failure of endoscopic techniques or in the presence of malformations that can be treated at the same time. The major interest of these interventions is the possibility to remove the whole stone without prior fragmentation. Some anatomical situations can increase the technical difficulty, particularly the presence of an intrarenal pelvis and the presence of pelvic and periureteral adhesions. The reported complications are essentially urinary fistula and ureteral stenosis, the risks of which are reduced by the use of double J stenting. As struvite stones are more friable, their whole removal is more difficult and may lead to dispersion of fragments, particularly during laparoscopy. Conventional open surgery has a higher stone-free rate, but comes with a greater kidney function loss.

Endocorporeal lithotripsy has progressed thanks to the development of lasers. Two laser sources are currently available: Holmium:YAG (Ho:YAG) and more recently Thulium Fiber Laser (TFL). The settings generally used are dusting, fragmentation, and “pop-corning”. These are the first recommendations on laser use for stone management and their settings. Settings must be modulated and can be changed during the treatment according to the expected and obtained effects, the location and stone type that is treated.

The primary objective of the combined approach is to limit the number of percutaneous access tracts for the treatment of staghorn, or complex kidney stones by simultaneous percutaneous antegrade and retrograde ureteroscopy. The other indication is the simultaneous presence of several kidney and ureteral stones or of an impacted pelvic stone. The combination of the two techniques may increase the stone-free rate and decrease the retreatment rate of complex stones compared with percutaneous nephrolithotomy alone. The patient is usually in the modified supine position.

Chronic kidney disease, diabetes and hypertension are risk factors of kidney function impairment. The relative risk of kidney failure is 1.52 in patients with urinary stone disease. The various techniques used to remove upper urinary tract stones generally do not alter kidney function in patients with normal kidney function and may sometimes improve kidney function or slow its deterioration in patients with kidney disease. Compared to the asynchronous treatment of bilateral renal and ureteral stones, concomitant treatment is associated with higher risk of anuria and the need of additional interventions, in the absence of postoperative stenting. For the treatment of solitary kidney stones, the absence of postoperative stenting increases the risk of postoperative anuria. Moreover, the multiplication of percutaneous nephrolithotomy access tracts increases the risk of bleeding and that of kidney function impairment.

The incidence of urinary lithiasis is rising steadily in industrialized countries, and its prevalence in the general population of France is estimated at 10%. Renal colic accounts for 1–2% of emergency department consultations. At a time when the new LASER stone fragmentation techniques available to urologists will lead to ever finer in situ pulverization of stones, the exact identification of the compounds that form the stone is essential for etiological diagnosis. Constitutional analysis by infrared spectrophotometry or X-ray diffraction is therefore recommended, to be complemented by morphological typing of the calculi.

Endoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to the development of in situ laser lithotripsy. These are the first practical recommendations on the endoscopic description of renal papillae and stones.

The choice of imaging modality is guided by the clinical presentation and the context (acute or not). Although ultrasound is safe (no radiation) and easily available, non-contrast-enhanced CT has become the gold standard in the diagnostic strategy for patients with acute flank pain because of its sensitivity (93.1%) and specificity (96.6%). It also allows determining the stone size, volume and density, visualizing their internal structure, and assessing their distance from the skin and the adjacent anatomy. All these parameters can influence the stone management and the choice of intervention modality.

The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy.

Extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive technique for the fragmentation of urinary tract stones using shock waves under fluoroscopic and/or ultrasound guidance. ESWL results depend on the indication (stone size/composition, clinical context) and also on how it is performed. The stone structure, nature and density (Hounsfield units; evaluated by CT without contrast agent) influence the fragmentation achieved by ESWL. The upper size limit of kidney stones has been lowered to 15mm (1.68cm3) due to the increased risk of steinstrasse with larger sizes and the potential need of anesthesia and ureteral stenting. Conversely, the development of endourological technologies allows a finer stone fragmentation and/or better elimination, thus reducing the risk of steinstrasse and decreasing the potential number of sessions or additional interventions.

Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury.

It has been shown that the relative risk of cancer is higher in patients with urinary stone disease, probably due to the repeated radiological exams and procedures under fluoroscopic guidance. Reducing the radiation doses delivered to the patient also decreases the doses delivered to the operators and their assistants. The doses delivered during endoscopic procedures decrease with the urologist's experience. Training in radiation protection and the use of protocols can decrease the use of ionizing radiation in the operating room.

Postural therapy is a postural procedure to fight against the gravity phenomenon responsible for the non-elimination of lower calyceal stones. It allows improving or accelerating their expulsion and it increases the stone-free rate. This procedure associates forced diuresis, postural inversion, and lumbar percussion. It allows a 50% improvement and an acceleration of fragment elimination. Despite its positive impact, postural therapy remains under-used. These are the first practical recommendations on postural therapy.

The main objectives of interventional stone treatment are stone removal, symptom elimination, and kidney function preservation. After treatment of kidney stones (extracorporeal shock wave lithotripsy [ESWL], or endoscopy), fragments may remain in the kidney, either deliberately left in place or due to treatment failure (i.e. residual stone [RS], resistant to ESWL, left or inaccessible by endoscopy), or due to failure to eliminate the obtained fragments (i.e. residual fragments [RF]). Their management may differ. The most commonly used definition of RF in the literature is based on a size cut-off (≤4mm) and on three criteria: spontaneous clearance rate, secondary intervention rate, and disease progression rate. RF may be spontaneously eliminated (42%), persist and increase in size (32%), or become complicated and require a secondary urological procedure (36%). Like for the initial treatment, it is important to consider the stone composition for the treatment decision-making concerning RS/RF.

The spontaneous elimination rate of ureteral stones decreases with their size, but also in function of their location. The objectives of stone surveillance are to detect the occurrence of a complication (e.g., fever, clinical tolerance) and to verify the potential stone migration/elimination. The use of urological procedures and the choice of technique are based on many different factors. Kidney stone surveillance is proposed mainly to people with low risk of progression or complications (size<4mm and/or lower calyx location and non-infection stone). Surveillance may be extended to patients with larger stones, in function of the clinical context and comorbidities. Conversely, a urological procedure may also be proposed to patients with stones<4mm for professional (e.g., soldier, pilot, expatriate) or social reasons or if travelling is planned. The choice of technique is based on the stone composition (if already known) and density, the advantages and limitations of each technique, and also the clinical context, while trying to choose the least invasive procedure for a stone-free objective.

The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required.

Le choix de la technique pour le traitement chirurgical de l’hypertrophie bénigne de prostate>80 grammes ne fait pas consensus. L’objectif de cette étude était de comparer les résultats fonctionnels de l’adénomectomie voie haute robot-assistée (AVH-R) vs énucléation endoscopique par laser Holmium (HoLEP).

La chirurgie ambulatoire est une priorité médico-économique car elle optimise la rééducation post opératoire tout en désengorgeant les services hospitaliers. La résection transurétrale des tumeurs de la vessie (RTUV) en ambulatoire est peu répandue (5 % des patients). Notre objectif était d’évaluer la faisabilité de la RTUV en ambulatoire ainsi que les facteurs éventuellement associés aux complications postopératoires.

La pratique clinique laisse évoquer la possibilité d’un lien épidémiologique entre cancers du rein et cancers du sein. Des hypothèses hormonales et environnementales peuvent être avancées comme causales. L’objectif de cette étude était de décrire les caractéristiques cliniques et histologiques des patientes atteintes d’un cancer du rein après un cancer du sein.