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Resume Contexte L’injection peri-uretrale d’agents comblant est une option therapeutique peu invasive pour l’incontinence urinaire d’effort (IUE). Objectif Nous presentons une revue de la litterature a propos des agents comblant dans le traitement de l’IUE, leurs indications et les differentes techniques d’injection. Materiel et methodes La revue a ete realisee selon la strategie PRISMA en utilisant la base de donnees PubMed et les termes Mesh : « urinary », « incontinence » et « bulking ». Tous les articles publies en francais ou en anglais jusqu’a 29 juin 2020 ont ete examines. Les de toutes modalites ont ete incluses et les listes des references ont ete etudiees. La recherche a identifie 60 articles publies entre 2001 et 2020. L’etude des listes des references a identifie 40 articles supplementaires. Au total, 54 articles ont ete retenus pour l’etude descriptive. Resultats Les materiaux comblant utilises actuellement sont le collagene reticule par du glutaraldehyde, les polymeres de silicone, l’hydroxyapatite de calcium, le derme porcin, les billes de zirconium recouverts de carbone et l’hydrogel de polyacrylamide. Ils offrent des taux de guerison inferieurs par rapport a la chirurgie. C’est une alternative attirante pour les patientes qui refusent ou qui ne sont pas candidates aux interventions chirurgicales, ou apres echec de ces dernieres. Les voies d’injection para-uretrale et transuretrale sont pratiquees avec une efficacite comparable. Un controle echographique, radiologique ou endoscopique permet une meilleure precision et controle de la procedure. La voie para-uretrale necessite un volume injectable plus important, avec un cout et un risque de complications superieurs. L’efficacite des injections parait superieure lorsqu’elle est pratiquee en mi-uretral, en forme circonferentielle ou en fer a cheval. Conclusion L’identification d’un agent optimale est difficile. La selection de l’agent depend actuellement de la disponibilite du produit, la preference du medecin, le cout et la facilite d’utilisation.

Purpose: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. Material and methods: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. Results: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade. Conclusions: This review highlights that focal HIFU therapy appears to be a safe procedure, while short-term cancer control rate is encouraging. Though, second-line treatment or active surveillance seems to be necessary in a significant number of patients.

Purpose: The Société Internationale d’Urologie (SIU) conducted a survey to determine whether the pandemic has harmed the mental health of practicing urologists worldwide. Methods: Members of the Executive Board of the SIU designed a self-selected survey consisting of multiple-choice questions about the safety and mental health of urologists during the COVID-19 pandemic. The survey was disseminated by email to SIU members worldwide. Results: A total of 3448 SIU members from 109 countries responded to the survey, which sought to determine the extent of mental health symptoms, including depression, anxiety, insomnia, and distress—experienced during the COVID-19 pandemic. Overall, 21% of urologists who responded reported that their mental health was very challenged, with 58% indicating increased stress levels, and 15% indicating greatly increased stress levels. Older urologists were less likely to report any of the negative mental health symptom queried (ie, delirium [rs = −0.06, P = 0.001], psychosis [rs = −0.04, P = 0.019], anxiety [rs = −0.09, P < 0.001], depression [rs = −0.08, P 0.20). Furthermore, 29% of urologists indicated they were afraid to go to work, while 53% reported being afraid to go home to their families after work. Conclusion: In this worldwide survey of practicing urologists, more than half of the participants reported an increase in insomnia, distress, and other psychological symptoms as they managed patients during the COVID-19 pandemic, although half of respondents did not experience any mental health symptoms. Institutions should provide psychological coping resources to all health care staff, not only for the front-line workers during the pandemic.

Summary Erectile dysfunction varied by country, affecting between 20 to 40% of men aged 60 and 69 and more than 50% of men aged over 75. Our objective was to evaluate the habits of urologists in 2018 and also evaluate the need for additional, objective tools to aid physicians when providing care. A questionnaire was sent from the French Urology Association to 1158 physicians between November and December 2018. In all, 177 urologists (15.28%) took part in the study. Only 22% of urologists regularly used a questionnaire, such as the IIEF-5. When faced with erection problems, 56.5% of them did not carry out systematic cardiology evaluations. More than half of urologists requested fasting glucose, lipid and total testosterone levels. Twenty-seven percent did not carry out additional tests. First line treatment included a phosphodiesterase 5 inhibitor in 81% of cases. Two thirds of urologists (78%) rated themselves as being correctly trained in the area of erectile dysfunction. However, only 49% systematically inquired about erection problems when faced with benign prostatic hyperplasia and 65% thought that erectile dysfunction was not treated optimally. Despite existing recommendations, only half of urologists carry out a cardiac evaluation when a finding of erectile dysfunction is made. One third of urologists do not request additional testing. Greater training, along with the use of an objective diagnostic tool could help urologists to optimise the care they provide for patients suffering from erectile dysfunction, allowing them to keep working within current guidelines. Level of evidence 3.

INTRODUCTION Open radical cystectomy (ORC) is the gold standard technique for carcinologic cystectomies. Robotic-assisted radical cystectomy (RARC) was introduced in 2003 and its development is booming. OBJECTIVE To compare ORC and RARC with totally intracorporal (IC) orthotopic neobladder (ONB) reconstruction, in terms of perioperative outcomes, morbidity, functional results and quality of life (Qol). PATIENTS AND METHODS From February 2010 to February 2017, a French multicentric, prospective study on patients who had a RC and ONB reconstruction for bladder cancer was performed. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and the bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients also completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Patients were divided in two groups: ORC and RARC. RESULTS We included 72 patients: 55 in the ORC group (76,4%) and 17 (33,6%) in the RARC group. Operative time was longer in RARC group (median 360 vs 300min; P

International audience; Objectifs : étude prospective multicentrique ouverte comparant l’efficacité carcinologique d’un traitement conservateur par ultrasons focalisés de haute intensité (HIFU) à la prostatectomie totale (PT) pour adénocarcinome prostatique localisé de stades ISUP 1 (non éligibles à la surveillance active) et ISUP 2. Nous communiquons des données carcinologiques intermédiaires à 18 mois.Méthodes : de février 2015 à septembre 2019, 3 364 patients (HIFU : 1 988, PT : 1 376) ont été inclus de façon prospective dans 42 centres. Âge médian : 74,6 vs 65 ; PSA médian : 7,11 vs 6,97 (p = 0,4) ; ISUP 1 : 0,39 ; ISUP 2 : 0,61. Objectif principal : survie sans traitement de rattrapage. Objectifs secondaires : bras HIFU : récidive biologique (RB) = PSA > Nadir + 2, PBP contrôle ; bras PT : R1, RB = PSA > 0,2 ng/mL.Résultats : objectif principal : à 18 mois, la probabilité de survie sans traitement de rattrapage est plus importante dans le bras HIFU comparé au bras prostatectomie HR = 0,31 IC95 % [0,23–0,42] soit un risque 3 fois plus élevé dans le groupe prostatectomie (p < 0,01). Objectifs secondaires : bras HIFU : récidives biologiques : 141 (10,6 %), PBP positives : 99 (7 %) ; bras PT : R1 = 25 % ; RB : 77 (9 %) à 18 mois.Conclusion : ces données intermédiaires à 18 mois ne permettent pas encore une comparaison équitable des deux bras en raison d’un profil évolutif spécifique à chaque groupe. Concernant l’objectif principal, la radiothérapie de rattrapage est probablement indiquée plus précocement après PT en raison de décisions de principe en RCP face à des marges positives. Le suivi des données carcinologiques pendant 30 mois, prévu dans l’étude, est justifié.

Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors.Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score.Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12-96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL.Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists.

This survey assessed how much of a taboo surrounds urge or mixed urinary incontinence (UI), through questions to affected patients and healthcare professionals using online questionnaires, with the objective to contrast the patients' perceptions with that of the doctors.This quantitative study was preceded by a qualitative phase carried out with general practitioners, specialists, and UI patients. Following these phases, questionnaires were made available on the internet. They covered questions pertaining to perceptions of UI, degree of embarrassment and its consequences, patient-doctor relationship, and treatments.Overall, 310 UI patients of male or female gender participated in the study, as did 101 general practitioners, 50 urologists, and 30 gynecologists. The analysis revealed that 60% of patients felt embarrassment about UI, the condition representing for them a taboo topic similar to cancer. This taboo was shown to be seen further enhanced by doctors. UI was associated with a loss of self-esteem (51%) and restriction to daily life (44%). The patients' answers revealed that UI was only brought up by doctors in 6% of cases, whereas the patient was the first to bring it up in 55%, primarily with their general practitioner (80%). Thus, in 4 out of 10 cases, the issue was not addressed; 49% of patients stated they did not discuss their condition with their partner and 33% did not discuss it with anybody.UI is still a major taboo and we have a long way to go to change attitudes.3.

Resume Contexte La maladie de Lapeyronie (ML) est une maladie inflammatoire de la verge, qui entraine la formation de plaques fibreuses cicatricielles de l’albugine avec une courbure et un raccourcissement du penis lors des erections. Il n’existe pas de standard international pour l’evaluation, le suivi ou le traitement de cette pathologie. Nous presentons dans cet article une revue de la litterature concentree sur les strategies therapeutiques decrites. Un algorithme est suggere pour faciliter l’evaluation et la prise en charge des patients. Materiels et methode La revue de la litterature a ete realisee selon la strategie PRISMA en utilisant la base de donnees PubMed et les termes Mesh : « Peyronie », « disease », « treatment » et « diagnosis ». Les resultats sont presentes d’une maniere descriptive. Resultats Plusieurs traitements ont ete proposes sans etudes randomisees prospectives englobant assez de patients. L’efficacite des therapies par voie orale est superieure dans le cadre d’une prise en charge multimodale de la phase aigue de la maladie. Les anti-inflammatoires non steroidiens et le para-aminobenzoate de potassium sont superieurs aux autres molecules pour le controle de la douleur. Le traitement local par verapamil gel, l’iontophorese et les injections intra-lesionnelles de verapamil, d’interferon alfa-2b et de collagenase clostridium histolyticum (CCH) ont revolutionne le traitement de la ML en modifiant la taille de la plaque et l’angulation du penis. Les therapies alternatives par traction ou par ondes de choc extracorporelles paraissent prometteuses. La CCH intra-lesionnelle est le seul medicament approuve par l’agence americaine des produits alimentaires et medicamenteux (FDA). Le tunellage de la plaque avant les injections de CCH ameliore davantage l’angulation. Conclusion Il existe une myriade de therapeutiques non chirurgicales disponibles pour la prise en charge de la ML, mais les preuves scientifiques de leur utilisation sont faibles. Des etudes supplementaires a grande echelle sont necessaires pour evaluer les pratiques actuelles, et concevoir des traitements plus efficaces.

La cistectomia totale con la conservazione dell’uretra e la ricostruzione della vescica nelle donne richiede di preservare le strutture anatomiche coinvolte nel mantenimento della continenza garantendo, nel contempo, la radicalita oncologica in caso di indicazione per cancro. I diversi tempi operatori comprendono la linfoadenectomia pelvica, l’isterectomia totale, la resezione vaginale anteriore e la cistectomia totale con conservazione dell’uretra subcervicale. La cistectomia viene sempre eseguita dall’alto verso il basso e dall’indietro in avanti. Gli ureteri vengono scollati da cima a fondo, fino al loro ingresso nella vescica, legando gradualmente i vasi che incontrano (uterini e vescicali) e sempre restando a livello dell’uretere o di fronte ad esso. L’apertura del cul-de-sac vaginale posteriore consente di localizzare con precisione la parete vaginale anteriore, per mettere in tensione i peduncoli vescicovaginali e, quindi, per allontanare i nervi pelvici che corrono paralleli alla parete vaginale laterale. I peduncoli della vescica sono, quindi, legati a livello della parete vaginale anteriore, che viene resecata in blocco con la vescica, lontano dai nervi pelvici. La parete vaginale anteriore viene, quindi, separata dalla vescica a livello del collo della vescica. Il pezzo operatorio rimane, quindi, attaccato solo attraverso l’uretra. Questo e legato alla sonda sotto il palloncino, quindi sezionato 5-10 mm sotto questo nodo. Pertanto, non viene eseguita alcuna dissecazione dell’uretra subcervicale, lasciando intatta la fascia pelvica che la copre, i legamenti pubouretrali e uretropelvici e, naturalmente, lo sfintere urogenitale striato. La vagina viene, quindi, chiusa ricostituendo una cavita vaginale spesso funzionalmente sufficiente. Una neovescica ileale detubulizzata viene, quindi, anastomizzata nell’uretra. Il neo-orifizio uretrale deve essere adeguatamente scelto nel punto piu declive della neovescica. La selezione di queste pazienti deve essere rigorosa, sia sul piano oncologico che su quello psicologico. Questa tecnica e semplice e riproducibile e offre alle donne che hanno bisogno di una cistectomia le stesse possibilita di ricostruzione della vescica degli uomini, con risultati funzionali equivalenti.

La cistectomia total con preservacion de la uretra y reconstruccion vesical en la mujer requiere la preservacion de las estructuras anatomicas implicadas en el mantenimiento de la continencia a la vez que se garantiza la radicalidad oncologica si la indicacion es por un cancer. Los distintos tiempos quirurgicos consisten en una linfadenectomia pelvica, una histerectomia total, una reseccion vaginal anterior y una cistectomia total con preservacion de la uretra subcervical. La cistectomia siempre se realiza de arriba hacia abajo y de atras hacia delante. Los ureteres se disecan de arriba hacia abajo, hasta su entrada vesical, ligando progresivamente los vasos que se van encontrando (uterinos y vesicales) y manteniendose siempre al nivel del ureter o por delante de el. La abertura del fondo de saco vaginal posterior permite identificar con precision la pared vaginal anterior, tensar los pediculos vesicovaginales y, de ese modo, alejar los nervios pelvicos que discurren en paralelo a la pared vaginal lateral. Los pediculos vesicales se ligan al nivel de la pared vaginal anterior, que se reseca en bloque con la vejiga, a distancia de los nervios pelvicos. La pared vaginal anterior se separa a continuacion de la vejiga al nivel del cuello vesical. En ese momento, la pieza quirurgica solo queda unida por la uretra. Esta se liga sobre la sonda por debajo del balon, tras lo que se secciona a 5-10 mm por debajo de este nudo. De este modo, no se realiza ninguna diseccion de la uretra subcervical, dejando intactas la fascia pelvica que la recubre, los ligamentos pubouretrales y uretropelvicos y el esfinter estriado urogenital. A continuacion, se cierra la vagina, reconstruyendo una cavidad vaginal que suele ser suficiente desde el punto de vista funcional. A continuacion, una neovejiga ileal destubularizada se anastomosa a la uretra. El neoorificio uretral debe escogerse adecuadamente en el punto mas declive de la neovejiga. La seleccion de estas pacientes debe ser rigurosa, tanto desde el punto de vista oncologico como psicologico. Esta tecnica es sencilla y reproducible, y permite ofrecer a las mujeres que requieren una cistectomia las mismas posibilidades de reconstruccion vesical que en los varones, con unos resultados funcionales equivalentes.

Objectifs Durant la pandemie COVID-19 les activites operatoires et de consultations ont ete reduites. Des recommandations de modifications de pratiques ont ete publiees par l’AFU sur la priorisation des procedures de diagnostic et des interventions. Une enquete a ete faite aupres des urologues pour analyser leurs pratiques a l’issue de ces recommandations. Methodes Nous avons effectue une enquete en ligne parmi les urologues de France membres de l’AFU, apres la diffusion des recommandations. Le questionnaire en langue anglaise avait ete etabli par la Societe internationale d’urologie (SIU) dans le cadre d’une enquete a l’echelle internationale. Nous avons compare les modifications declarees par les urologues a celles proposees par les recommandations. Resultats Au total, 254 urologues francais ont repondu. Quatre-vingt pour cent etaient âges de plus 40 ans et 63 % exercaient en secteur liberal. Soixante-six pour cent avaient restreint les consultations physiques et utilisaient la telemedecine. Cinquante et un pour cent des biopsies prostatiques etaient differees ; 81,5 % avaient restreint leur activite de bloc de plus de 75 %. Les RTU de vessies, cystectomies, nephro-ureterectomies, nephrectomies et prostatectomies etaient maintenues respectivement dans 91 %, 93,6 %, 87,7 %, 61,4 % et 51,2 %. Concernant les orchidectomies/penectomies et les curages retroperitoneaux ils etaient maintenus dans 95,2 % et 77,6 %. Conclusion Les resultats de l’enquete revelaient globalement une pratique des urologues volontaires pour repondre, conforme aux recommandations du CCAFU. La limite de l’etude etait que les items du questionnaire ne comprenaient pas la pratique des instillations endovesicales ni la programmation des cancers du rein ou de la prostate en fonction de facteurs pronostiques, contrairement aux recommandations.

Peyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition.A literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner.Multiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement.Multiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.

International audience; Objectifs : étude prospective multicentrique ouverte comparant l’efficacité carcinologique et les conséquences fonctionnelles d’un traitement conservateur par ultrasons focalisés de haute intensité (HIFU) à la prostatectomie totale (PT) pour adénocarcinome prostatique localisé de stades ISUP 1 (non éligibles à la surveillance active) et ISUP 2. Nous rapportons ici les EIG et résultats fonctionnels à 12 mois.Méthodes : de février 2015 à septembre 2019, 3364 patients (HIFU : 1988, PT : 1376) ont été inclus de façon prospective dans 42 centres. Âge médian : 74,6 vs 65 ; PSA médian : 7,11 vs 6,97 (p = 0,4). Les EIG ont été transmis à l’Agence nationale selon les standards internationaux.Objectifs fonctionnels de l’étude : IPSS, continence (USP), fonction érectile (IIEF5), qualité de vie (EORTC QLQ-C30) à 12 mois.Résultats : les durées médianes d’hospitalisation initiale ont été respectivement de 1 et 4 jours. Cinquante-trois EIG Clavien–Dindo ≥ IIIa : 32 HIFU (1,6 %) et 21 PT (1,5 %). Aucun risque préalablement inconnu n’a été mis en évidence. Onze cas de fistules ont été rapportés : bras HIFU : 3/1988 (1,5/1000) fistules (2 uro-digestives, 1 urinaire) ; bras PT : 8/1376 (5,8/1000) fistules (7 urinaires, 1 digestive). Tous les cas ont été guéris. Vingt-trois décès ont été enregistrés et sont non imputables. Résultats fonctionnels (HIFU vs PT) : IPSS médian : 4 vs 3, IPSS QdV médian : 1 vs 1 ; continence score médian : 0 vs 1 (p < 0,005) ; IIEF5 (Δ médianes pré- et postopératoires) 1 vs −9 (p < 0,0001) ; EORTC QLQ-C30 : 90,7 vs 93,4.Conclusion : une proportion supérieure de réhospitalisations a été constatée après HIFU. Plusieurs explications sont suggérées : l’âge plus élevé des patients, la durée d’hospitalisation initiale très brève et la gestion non standardisée des accidents rétentionnels. En dehors de l’IPSS, les conséquences fonctionnelles (incontinence, dysfonction érectile) sont significativement moins importantes pour l’HIFU que pour la prostatectomie à 12 mois postopératoires. La qualité de vie post-thérapeutique des deux groupes reste élevée, et malgré une différence d’âge de près de dix ans, est comparable.

Open radical cystectomy (ORC) is the gold standard technique for carcinologic cystectomies. Robotic-assisted radical cystectomy (RARC) was introduced in 2003 and its development is booming.To compare ORC and RARC with totally intracorporal (IC) orthotopic neobladder (ONB) reconstruction, in terms of perioperative outcomes, morbidity, functional results and quality of life (Qol).From February 2010 to February 2017, a French multicentric, prospective study on patients who had a RC and ONB reconstruction for bladder cancer was performed. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and the bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients also completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Patients were divided in two groups: ORC and RARC.We included 72 patients: 55 in the ORC group (76,4%) and 17 (33,6%) in the RARC group. Operative time was longer in RARC group (median 360 vs 300min; P0.001) but length of stay was 5 days shorter (median 12 vs 17 days; P0,05). Patients in RARC group had less blood transfusion (0 vs 23.6%; P0.05), but a higher rate of uretero-ileal anastomosis stenosis and eventration at long term (respectively 25.5 vs 3.6% et 23 vs 2%; P0.05). No statistical differences were found concerning quality of life items and functional results between the groups.RARC with totally IC ONB reconstruction lead to less perioperative morbidity with a reduced rate of blood transfusion and a reduced hospital length of stay. At long term, RARC could provide higher rates of uretero-ileal stenosis and eventration. RARC and ORC do not have any differences in terms of functional outcomes and Qol at long term after ONB reconstruction.3.

To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms.This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit.Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly.A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.

Resume Objectif Le but du Comite de cancerologie de l'Association francaise d'urologie (CCAFU) etait de proposer une mise a jour des recommandations dans la prise en charge des tumeurs de la vessie n'infiltrant pas le muscle vesical (TVNIM) et infiltrant le muscle vesical (TVIM). Methodes Une revue systematique (Medline) de la litterature de 2013 a 2016 a ete conduite par le CCAFU concernant les elements du diagnostic, les options de traitement et la surveillance des TVNIM et TVIM, en evaluant les references avec leur niveau de preuve. Resultats Le diagnostic de TVNIM (Ta, T1, carcinome in situ [CIS]) se fait apres une resection tumorale complete et profonde. L'utilisation de la fluorescence vesicale et l'indication d'un second look (4 a 6 semaines) contribuent a ameliorer le diagnostic initial. Le risque de recidive et/ou progression tumorale est evalue en utilisant le score European Organisation for Research and Treatment of Cancer (EORTC). La stratification des patients en faible, intermediaire et haut risque permet de proposer le traitement adjuvant : instillations endovesicales de chimiotherapie (postoperatoire immediate, schema d'attaque) ou de bacille de Calmette et Guerin (BCG) (schema d'attaque et d'entretien), voire l'indication d'une cystectomie pour les patients resistant au BCG. Le bilan d'extension d'une TVIM repose sur l'examen TDM abdomino-pelvien et thoracique ; l'imagerie par resonance magnetique (IRM) et le Positron Emission Tomography (PET)-fluorodeoxyglucose (FDG) sont encore non-recommandes. La cystectomie associee a un curage ganglionnaire pelvien etendu est le traitement de reference des TVIM non metastatiques. Une enterocystoplastie est proposee chez l'homme et la femme en l'absence de contre-indication et lorsque la recoupe uretrale est negative a l'examen extemporane. L'interet de la chimiotherapie neo-adjuvante est reconnu pour toute TVIM quel que soit le stade ; celle-ci est recommandee des lors que l'etat general (PS 60 ml/mn) l'autorisent (patients « fit »). Pour les TVIM metastatiques, une premiere ligne de chimiotherapie a base de sels de platine (Gemcitabine and Cisplatin [GC] ou Methotrexate, Vinblastin, Doxorubicin and Cisplatin [MVAC]) est recommandee. En deuxieme ligne de traitement, seule l'indication de la vinflunine est aujourd'hui validee, meme si les resultats des essais cliniques concernant l'immunotherapie sont encourageants. Conclusion Cette actualisation des recommandations francaises doit contribuer a ameliorer non seulement la prise en charge des patients, mais aussi le diagnostic et la decision therapeutique des TVNIM et TVIM. © 2016 Elsevier Masson SAS. Tous droits reserves.

Our objective was to validate the VPSS (visual prostatic symptom score) score in the French language for the identification and monitoring of BPH-related LUTS in urological practice.A prospective observational survey was carried out between September the 15th 2014 and July the 30th 2015 in urology practices. The first 4 consecutive patients aged over 60 years, with BPH-related LUTS requiring prescription of an alpha-blocker, were enrolled. We translated a "visual prostatic symptom score" (VPSS) into French and adapted it slightly. At the first visit and follow-up visit (1-3 months after the first visit), the patient completed 2 questionnaires: the French language version of the IPSS and the VPSS.Of the urologists contacted, 169 enrolled at least one patient and returned information; 550 questionnaires were included in the statistical analysis. The median IPSS and VPSS total scores, subscores and quality of life scores all decreased significantly (P0.0001) between enrolment and the follow-up visit 1-3 months later. Correlations between the IPSS and VPSS at enrolment and the follow-up visit and their variation were all significant. Total VPSS was significantly correlated with total IPSS, as were the irritative, obstructive and quality of life subscores evaluated on the corresponding pictograms.This study showed the VPSS to be a simple and useful tool for identifying and monitoring BPH-related LUTS.4.

Objectifs La cystectomie totale ouverte (CTO) est la technique de reference des cystectomies pour cancer. La cystectomie laparoscopique robot-assistee (CLRA) a ete introduite en 2003, son developpement est en plein essor. Comparaison de la voie ouverte et robotique totalement intracorporelle (IC) pour les cystectomies avec remplacement orthotopique en termes de : morbidite perioperatoires, complications, resultats fonctionnels et qualite de vie (QDV) a long terme. Methodes Une etude retrospective, multicentrique, a ete conduite sur les patients operes par ct avec derivation urinaire par neovessie orthotopique ileale (NVOI) pour cancer de vessie, entre fevrier 2010 et fevrier 2017. Les questionnaires de QDV (EORTC QLQ-c30 et BLM30) et de fonction urinaire (questionnaire USP et calendrier mictionnel) etaient distribues au cours d’une consultation de suivi ou bien par voie postale. Les patients traites par CT et NVOI de remplacement etaient divises en 2 groupes : un groupe CLRA-IC, et un groupe CTO. Resultats Au total, 72 patients etaient inclus. La voie ouverte etait majoritaire avec 55 patients (76,4 %), 17 patients (33,6 %) etaient operes par voie robotique. Les caracteristiques initiales des deux groupes etaient comparables. La duree operatoire etait plus longue dans le groupe CLRA-IC (mediane 360 vs 300 min ; p Conclusion La CLRA avec NVOI totalement IC pourrait etre associee a une diminution de la duree d’hospitalisation et de la morbidite perioperatoire. Les patients ayant eu une clra presenteraient un risque plus important de stenose uretero-ileale. La CLRA avec NVOI en IC ne presente aucune difference avec la CTO en termes de fonction urinaire et de QDV a long terme.

To establish a guide dedicated to general practitioner for the diagnosis, the follow-up, and the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH).Guidelines already published for urologists were modified to make them relevant for general practitioners. The role of specialist's referral was defined. The whole content of the document was submitted to the formal consensus process in which urologists and general medicine teachers were involved.Initial assessment has several aims: making sure that LUTS are related to BPH, assessing bother related to LUTS, and checking for a possible complication. Initial assessment should include: medical history, physical examination with digital rectal examination, and urinalysis. Some other explorations such as frequency volume chart, serum PSA or creatinine, and ultrasonography of the urinary tract were found optional, meaning they are necessary only in specific situations. Referring to urologist is justified when LUTS might not be related to BPH (particularly when urgencies are predominant), or when a severe bladder outlet obstruction is suspected (severe symptoms, palpable bladder, post-voiding residual volume100ml), or when a complication is assessed. Follow-up without treatment is justified for patients with no bothersome symptoms related to not complicated BPH. Several drugs are available for the treatment of bothersome symptoms related to BPH. Alpha-blockers and plants extracts might be offered as monotherapy. Five alpha reductase inhibitors might be offered to patients with LUTS related to a significant prostate hypertrophy (40 ml) ; they might be given for a minimum duration of one year, alone or in association with alpha-blocker. The association of antimuscarinic and alpha-blocker might be used in patients with persistent storage LUTS in spite of alpha-blocker treatment. Phosphodiesterase 5 inhibitors might be offered to patients with erectile dysfunction associated with LUTS related to BPH. In case of complicated BPH, or when medical treatment is not efficacious or not tolerated, a surgical option should be discussed.The male lower urinary tract symptom committee of the French Urological Association and general practitioner present the first guide for the management of LUTS related to BPH dedicated to general practitioner.5.

Objectives To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented. Materials and methods An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points. Results In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement kappa 0.89) and they included: need for a training curriculum (inter-rater agreement kappa 0.85); identification of learning needs (kappa 0.83); development of the curriculum contents (kappa 0.81); an overview of available curricula (kappa 0.79); settings for robotic surgery training ((kappa 0.89); assessment and training of trainers (kappa 0.92); requirements for certification and patient safety (kappa 0.83); and need for a universally standardised curriculum (kappa 0.78). A training curriculum was proposed based on the above discussions. Conclusion This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room.

Resumen La cistectomia total con preservacion de la uretra y reconstruccion vesical en la mujer exige preservar las estructuras anatomicas implicadas en el mantenimiento de la continencia, y asegurar al mismo tiempo la radicalidad carcinologica en caso de indicacion por cancer. Los diferentes tiempos operatorios incluyen linfadenectomia pelvica, histerectomia total, reseccion vaginal anterior y cistectomia total con preservacion de la uretra subcervical. La cistectomia se realiza siempre de arriba abajo y de atras adelante. Se diseccionan los ureteres de arriba abajo hasta su entrada vesical, ligando progresivamente los vasos (uterinos y vesicales) y permaneciendo siempre a la altura del ureter o delante de el. La abertura del fondo de saco vaginal posterior permite, gracias a la insercion de un dedo en la vagina, localizar de modo preciso la pared vaginal anterior, poner en tension los pediculos vesicovaginales y alejar de este modo los nervios pelvicos que discurren paralelamente a la pared vaginal lateral. Los pediculos vesicales se ligan de este modo a nivel de la pared vaginal anterior, que es resecada en bloque con la vejiga, a distancia de los nervios pelvicos. A continuacion, la pared vaginal anterior se separa de la vejiga, a nivel del cuello vesical. La pieza operatoria solamente queda adherida por la uretra. Esta se liga con la sonda por debajo del balon y, a continuacion, se secciona 5–10 mm bajo este nudo. Asi, no se realiza diseccion alguna de la uretra subcervical, lo que permite dejar intactos la fascia pelvica que la recubre, los ligamentos pubouretrales y uretropelvicos y el esfinter estriado urogenital. En general, la vagina se cierra transversalmente, reconstituyendo una cavidad vaginal a menudo suficiente desde el punto de vista funcional. A continuacion, se anastomosa a la uretra una neovejiga ileal destubulada. Debe elegirse adecuadamente el neo-orificio uretral en el punto mas declive de la neovejiga. La seleccion de las pacientes debe ser rigurosa, tanto desde el punto de vista carcinologico como psicologico. Esta tecnica es sencilla y facil de reproducir y permite ofrecer a las mujeres que necesitan una cistectomia las mismas posibilidades de reconstruccion vesical que en el hombre, con resultados funcionales equivalentes.

Resume Les tumeurs corticosurrenaliennes a cellules oxyphiles sont rares. Nous rapportons un cas. A notre connaissance, 34 cas ont ete releves dans la litterature. Ils s’agissaient de tumeurs asymptomatiques et non-secretantes dans la majorite des cas. L’examen histologique etait le moyen diagnostique. Les cellules oxyphiles etaient caracterisees par l’abondance des mitochondries hypertrophiees. L’etiologie restait inconnue. Le pronostic etait favorable malgre l’existence de trois cas de « carcinome » et de dix cas de « tumeurs a potentiel de malignite incertain ». La chirurgie etait curative pour toutes les tumeurs y compris les carcinomes. La conduite a tenir et le suivi etaient etablis en fonction du pronostic.

Introduction Data on the epidemiology and prevention of venous thromboembolism in patients undergoing abdominal or pelvic cancer surgery in real practice are limited. The primary objective of this observational study was to describe the thromboprophylactic strategy implemented in routine practice. The main secondary objective was to assess the incidence of outcomes. Materials and Methods Patients admitted to public or private hospitals for abdominal or pelvic cancer surgery were included between November 2009 and November 2010; endoscopic route for surgery was the only exclusion criterion. Study outcomes were recorded at hospital discharge and at routine follow-up (generally 9 ± 3 weeks). Results 2380 patients (mean ± SD age: 66.4 ± 11.6 years, women: 36.8%) admitted to hospital for abdominal (47.8%), urological (41%), or gynaecological (11.2%) cancer surgery were included in the analysis. Of these, 2179 had data available at study end. Perioperative antithrombotic prophylaxis, consisting mainly of low-molecular-weight heparin, was given to 99.5% of patients. At hospital discharge, thromboprophylaxis was continued in 91.7% of patients, 57.4% receiving a 4-6 week prophylaxis. This management strategy was associated with an overall venous thromboembolic event rate of 1.9%, 34.7% of events occurring after discharge. Incidences of fatal bleeding, bleeding in a critical organ and bleeding necessitating re-intervention were 0.1%, 0.3% and 1.7%, respectively. Overall mortality was 1.5%. Conclusions Thromboprophylaxis is routinely used in French patients undergoing major cancer surgery. For more than a third of patients, however, treatment duration did not comply with best-practice recommendations, which might explain the non-negligible rate of thromboembolic complications still observed in this patient population.

Retroperitoneal sarcomas are rare tumours. The objective of this article is to propose management guidelines.A review of the literature was performed using the PubMed search engine (1985-2013) with the key words: retroperitoneal sarcoma, prognosis, recurrence, surgery, radiation therapy, chemotherapy.Chest, abdomen and pelvis computed tomography is the reference examination. Other examinations are optional. PET scan is not indicated for the primary diagnosis. CT-guided retroperitoneal biopsy is recommended and must be systematically performed before any management of a suspicious retroperitoneal mass. All retroperitoneal sarcomas must be registered and presented to a multidisciplinary consultation meeting devoted to the management of sarcomas (regional meetings) prior to any therapeutic intervention. Treatment is essentially surgical and is primarily designed to achieve negative surgical margins (R0). Neoadjuvant or adjuvant radiotherapy and chemotherapy can be proposed depending on the risk of progression and the resectability. The recurrence rate is related to tumour grade and surgical margins. The final prognosis is intimately related to the quality of initial management and the number of cases treated by each centre.Retroperitoneal sarcomas have a poor prognosis. The quality of initial management directly impacts recurrence-free survival and overall survival. The prognosis is improved by multidisciplinary management conducted in a reference centre.

The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC).A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS1) and renal function (creatinine clearance60 ml/min) permits (only in 50% of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC.