[Secondary recurrent haemorrhage with peristomal varices complicating a urinary derivation according to Bricker and treated efficiently by endoscopic way]. / Hémorragie récidivante secondaire à des varices péristomiales compliquant une dérivation urinaire selon Bricker et traitée efficacement par voie endoscopique.

Stomal varices developed in patients with cirrhosis and enterostomy can be source of important haemorrhages. It is a rare event but often recurrent and difficult enough to treat efficiently. In certain cases, consequences can be severe. We report the case of a 63-years-old patient with medical history of hepatic cirrhosis who underwent a radical cystoprostatectomy with urinary derivation type Bricker. Five years afterwards, he developed stomal varices very haemorrhagic treated efficiently by endoscopic way, without any recurrence 12 months later. This observation shows that stomal haemorrhages can be treated by endoscopic way.

[Recommendations for best practice for prostate biopsy]. / Recommandations pour la bonne pratique des biopsies prostatiques.

OBJECTIVES: the aim of these recommendations is to help urologists to optimize prostate biopsy practice in order to improve diagnosis yield and to minimize associated morbidity. METHODS: online systematic literature search was performed on PubMed until April 2010. Regulation texts, published guidelines and results of recent urologists practice study, were taken into consideration. Level of evidence was assigned to each recommendation. RESULTS: patient information must be prior to the procedure and should be given through a medical exam by the physician performing the biopsies. The check for complication risk factors (allergic, infectious, hemorrhagic) had to be done preoperatively by the physician during the medical exam. The use of single systemic antibiotics is recommended and Quinolones are the drugs of choice (level of evidence 2). Biopsies should be performed on outpatient basis to assess the safety of the procedure. Transrectal route and ultrasound guidance are state-of-the-art. Local anaesthesia with peri-prostatic block is recommended (level of evidence 1). On baseline biopsies, extended 12-cores scheme should be performed. Urine retention and severe postbiopsies infections have been reported in less than 1% of cases. Optimal management of severe post-biopsies infections is based first on patient information and require hospital intravenous antibiotic therapy. CONCLUSION: to improve the sensitivity and to reduce the risk of complication, achievement of prostate biopsies should follow a standardized procedure.