[Prevalence of the tuberous sclerosis complex at patients taken care for a renal angiomyolipoma]. / Prévalence de la sclérose tubéreuse de Bourneville chez des patients pris en charge pour un angiomyolipome rénal.

INTRODUCTION: Bourneville's tuberous sclerosis or Tuberous Sclerosis Complex (TSC) is an autosomal dominant hereditary phakomatosis associated with angiomyolipomas (AML) of the kidney. The aim of this study was to identify the prevalence of TSC in patients diagnosed and cared for AML in our department of urology. MATERIALS AND METHODS: All the patients with AML were included between March 2009 and June 2016 in a French university hospital. Each patient was reviewed in consultation with a clinical examination and imaging. Specific clinical criteria were used to refer patients to genetic analysis. Patients with a high TSC probability had a genetic analysis to search TSC1 and TSC2 genes mutations. RESULTS: In all, 28 patients were included and 3 (11%) were diagnosed TSC. The median age of the patients was 62 years (36-82 years). The most frequent clinical criteria were facial angiofibromas in 7 patients (25%). Among the 8 patients (29%) with evocative clinical criteria, a mutation of the TSC1 and TSC2 genes was identified in 3 patients (11%) with a diagnosis of TSC made before the AML diagnosis. CONCLUSION: In this study, 8 patients (29%) presented clinical criteria suggestive of TSC, preferentially dermatological. The diagnosis was confirmed by screening TSC1 and TSC2 genes mutations in 3 patients (11%), nevertheless prevalence of TSC is most probably underestimated by the genetic mosaïcisme of this pathology.

Double J stenting evaluation after ureteroscopy for urolithiasis.

OBJECTIVES: During ureteroscopy for urolithiasis, postoperative ureteral drainage with double J stent is frequently used. It may reduce acute postoperative pain and late ureteral stenosis. Double J stent can have negative impact on life quality. After uncomplicated intervention, double J stent is not mandatory. Objective of our study was to evaluate pain and complications after ureteroscopy with or without stent. METHODS: We retrospectively analyzed ureteroscopy performed between May 2014 and January 2017. Interventions were compared regarding ureteral drainage with double J stent or not. Our primary outcome was early postoperative pain evaluated with an oral pain scale form 1 to 10 on day one after intervention. Clinical characteristics, per- and postoperative data were collected. We also looked for risks factors of complications. RESULTS: Three hundred and sixty-six interventions were included, 259 (70.8%) with and 107 (29.2%) without double J stent. Stone burden was higher in stented group (18.3 vs 9.4mm, P<0.0001). Patients without postoperative stents had more ureteral preparation with double J stent (78.5% vs 62.5%, P=0.0032) and had more ambulatory interventions (75.7% vs 52.5%, P<0.0001). Postoperative pain was not different (22% vs 17.75%, P=0.398). Complication rate was similar (29% vs 20.5%, P=0.1181), so was rehospitalization rate (0.8% vs 0.9%, P=1). In multivariate analysis, complications factors were unprepared ureter, experienced surgeons and access sheath. CONCLUSION: Not stenting after ureteroscopy do not increase pain or complications. Stenting should not be used after uncomplicated interventions for centimetric stones. LEVEL OF EVIDENCE: 4.

Medium-term Follow-up of Vascular-targeted Photodynamic Therapy of Localized Prostate Cancer Using TOOKAD Soluble WST-11 (Phase II Trials).

BACKGROUND AND OBJECTIVE: To assess the medium-term tumor control in patients with localized prostate cancer (PCa) treated with vascular-targeted photodynamic (VTP) therapy with TOOKAD Soluble WST11 (VTP) and to assess the medium-term tolerability of the treatment. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: During the clinical phase II studies, 68 patients were treated with VTP under optimal treatment conditions (WST11 at 4mg/kg, light energy at 200J/cm, and a light density index ≥1) and have been included in a 3.5-yr follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Post-interventional visits were scheduled every 6 mo and conducted as per local standard practice in each study center. Cancer-free status was assessed by means of prostate-specific antigen kinetics, multiparametric magnetic resonance imaging and/or prostate biopsies. RESULTS AND LIMITATIONS: At the end of the 3.5-yr follow-up, overall successful focal ablation was achieved for 51 patients (75%). Cancer was identified in the untreated lobe in 17 patients (25%). In total, 34 patients (50%) were cancer-free in both the prostate lobes. In case of recurrent/persistent malignancy, the Gleason score remained consistent or changed at the maximum by one point (upgrading by 1 Gleason point to 3+4 for eight patients and 4+3 for two patients). There were 64 related adverse events (AEs): 48% were Clavien grade I, 47% were grade II, and 5% were grade III. There were no Clavien grade IV and V AEs. Limitations included small sample size and heterogeneity in the follow-up for some centers. CONCLUSIONS: VTP is a safe and efficient treatment and represents an alternative option for localized low-risk PCa management over the medium term. Precise diagnostic methods and imaging tools are thereby essential requirements to ensure safe and complete targeted therapy. PATIENT SUMMARY: In this report, we looked at the medium-term outcomes of focal photodynamic therapy for early-stage prostate cancer. We found that this form of treatment is efficient and might have the potential to become a therapeutic option for low-risk cancer. Effectiveness depends on precise diagnostic methods, such as magnetic resonance imaging and accurate biopsy.

Expanding indication of padeliporfin (WST11) vascular-targeted photodynamic therapy: results of prostate cancer Latin-American multicenter study. / Extensión de la indicación de terapia fotodinámica dirigida vascular con padeliporfina (WST11): resultados de un estudio multicéntrico latinoamericano del cáncer de próstata.

OBJECTIVES: To explore the proportion of patients with higher risk localized prostate cancer (PCa) that would become safely biopsy negative 12 months after non-thermal focal therapy with padeliporfin vascular-targeted photodynamic therapy (VTP). METHODS: Multicenter study in a scenario of prostate-specific antigen (PSA) ≤20ng/ml and variable PCa target volumes Gleason pattern 3 or low-volume secondary Gleason pattern 4, all patients received VTP, consisting of intravenous 4mg/kg padeliporfin activated by light-diffusing fibers in the prostate. The prostate was biopsied at baseline, months 6 and 12, PSA, patient-reported functional outcomes and quality of life (QoL) questionnaires were recorded at baseline, months 3, 6, and 12 and adverse events (AE) throughout the study. RESULTS: In the intention-to-treat population (n=81), the proportion of patients with negative biopsies at month 12 was 74% (60/81 patients; 95% CI: 63.1%,83.2%). In the per-protocol population, the proportion was 79% (58/73 patients; 95% CI: 68.4%,88.0%). Questionnaire results indicated a slight improvement in urinary function and limited deterioration in sexual function. No difference in QoL was observed over time. A total of 42/81 (52%) patients reported mild or moderate and 4 of 81 (4.9%) experienced serious AE, all resolved without sequelae. No phototoxicity, cardiovascular event, fistula or prolonged urinary incontinence, secondary cancer or death was reported. CONCLUSIONS: Results support the efficacy, safety, and QoL associated with padeliporfin focal treatment for low/intermediate risk localized PCa.

Evaluation of bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction.

OBJECTIVE: To evaluate bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction (BPO). MATERIAL AND METHOD: Fifty-eight patients operated between 1998 and 2014, in seven French departments of Urology were included. Forty-five patients were operated by conventional surgery (transurethral resection of the prostate 38, open simple prostatectomies 7), and 13 patients were operated by Greenlight™ photovaporization of the prostate (PVP). In order to assess bleeding risk, blood transfusion was considered as the primary outcome. RESULTS: Fifteen (26%) patients received blood transfusion in the postoperative period. Mean duration of hospitalization was 8.5 days. Secondary surgery was required in 12 cases (21%), including endoscopic clot removal under general anaesthesia in 10 patients, and suprapubic haemostasis in 3 patients. One patient died 72hours after transurethral resection of the prostate because of a massive pulmonary embolism. Two independent predictors of blood transfusion were identified: conventional surgery use versus PVP, and high preoperative PSA. Blood transfusion rate was significantly lower in the group of patients operated by PVP compared to conventional surgery (0% versus 33%, P=0.010). In addition, the laser surgery was associated with shorter duration of hospitalization (3.4 days versus 9.9 days, P=0.014). However, it was not found any significant difference between patients operated by PVP compared to conventional surgery in terms of secondary bleeding (3/13 vs 8/45, P=0.7), or second surgery (2/13 vs 10/45, P=0.5). CONCLUSION: Bleeding risk of BPO surgery in patients with mechanical cardiac valve is high. The PVP seems to decrease significantly the early haemorrhagic risk compared to classic surgical procedures for patients with mechanical cardiac valve. LEVEL OF EVIDENCE: 4.

Perioperative and economic analysis of surgical treatments for benign prostatic hyperplasia: A study of the French committee on LUT.

PURPOSE: To evaluate perioperative cost related to surgical treatments of benign prostatic obstruction (BPO): photoselective vaporization of the prostate (pvp), holmium/thullium laser enucleation (HoLEP/ThuLEP), transurethral resection of the prostate (TURP) and open prostatectomy (OP). MATERIAL AND METHODS: We retrospectively collected data from 237 patients who consecutively underwent a surgical treatment for BPH between January 2012 and June 2013 at nine institutions in France. An economic simulation model was constructed to estimate the cost of hospitalization related to surgical procedure from the hospital perspective and a cost minimization analysis was performed. RESULTS: TURP, OP, HoLEP/ThuLEP and PVP were performed in 99 (42%), 23 (10%), 64 (27%) and 51 (21%) patients, respectively. For men with prostate size<80mL: mean operative time was shorter with mTURP and PVP than HoLEP/thuLEP (P<0.001); Mean postoperative length of stay were 1.9, 3 vs. 3.4 days, for HoLEP/Thulep, PVP and TURP respectively (P=0.006); Costs of first hospitalization were comparable between HoLEP/ThuLEP and TURP but higher with PVP (P<0.001). For men with prostate size≥80mL: Compared to PVP and HoLEP/ThuLEP, OP was associated with shorter operative time (P<0.001) but longer length of stay (2.4, 4.2 vs. 7.8 days, respectively, P<0.0001); Costs of first hospitalization were significantly higher with OP than HoLEP/ThuLEP or PVP (P<0.001). CONCLUSIONS: PVP and HoLEP/ThuLEP were associated with a shorter LOS than TURP and OP. This benefit suggests these procedures could be more cost effective than OP, but still not cheaper alternatives to TURP. LEVEL OF EVIDENCE: 5.

[Urinary catheters prevalence study in a university hospital]. / Enquête de prévalence sur le sondage vésical dans un centre hospitalo-universitaire.

INTRODUCTION: Urinary tract infection is the most common healthcare-association infection, especially because of urinary catheter. We evaluated our practices concerning catheter insertion and management in our institution. MATERIALS AND METHODS: We conducted a single-centre descriptive cross-sectional study during 1 week in September 2014 in all adult departments. We noted prevalence, indications, length, management of urinary catheter (UC) and symptomatic catheter-associated urinary tract infections (SCAUTI). RESULTS: Amongst 1046 patients audited, 125 (12%) had UC. The mean age was 72 years (64.8-79.2). UC prevalence was higher in surgical (88%) and medical (87%) intensive care, urology (50%), geriatrics (18%) and long-term care (18%) departments. The average catheterisation length was 7.8 days (3.8-11.8); it was shorter in surgery than in medicine departments (3.6 vs 9.7 days, P<0.001). Catheters were present for more than 4 days in 60% of the cases. Acute urinary retention was the most frequent indication (59%), significantly more in medical than surgical departments (75% vs 26%). Others indications were perioperative (17%), diuresis monitoring (12%), strict immobilization (4%) and unnecessary indications or staff comfort (4%). A SCAUTI was present in 10% of cases, mostly in medicine department (30% vs 8%). CONCLUSION: The prevalence of our institution is higher than the national prevalence (8.1%), but still below the European average (17.2%). Control of the risk of CAUTI requires compliance with UC appropriate indications, UC management, and prompt removal of unnecessary UC. LEVEL OF EVIDENCE: 4.

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project.

PURPOSE: To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa). METHODS: A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated. RESULTS: Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text. CONCLUSION: Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

[Medicoeconomic aspects of benign prostatic hyperplasia medical treatment]. / Aspects médicoéconomiques des traitements médicamenteux de l'hypertrophie bénigne de la prostate : une revue de la littérature du Comité des troubles mictionnels de l'homme de l'Association française d'urologie.

INTRODUCTION: The medicoeconomic issues of drug management of benign prostatic hyperplasia (BPH) are essential due to the aging population and the increasing number of therapeutic options. It is thus essential to assess the cost-effectiveness in order to define the most appropriate therapeutic strategies economically. The objective of this work was to conduct a literature review on the medicoeconomic studies on the drug therapy of BPH. METHOD: After analyzing the literature, 43 articles were found and 9 were selected for their relevance. RESULTS: Based on Markov models, we observed that: combination therapy and combined treatments (alphablockers and inhibitors of 5-alpha reductase [5ARI]) seemed to have the best cost-effectiveness. Then came the alphablockers, less expensive but exposing to a greater risk of progression and to the necessity of surgical treatments. Then came the 5ARI monotherapy and finally simple monitoring. CONCLUSION: The Markov models are imperfect tools, and resources invested in care depend on both the economic model and the value that individuals and society give to efficiency and cost.

[Serious and unexpected complications of benign prostatic obstruction surgery: Results of the LUTS Committee survey from urologists of the French Urological Association]. / Complications graves et inattendues de la chirurgie de l'hyperplasie bénigne de prostate : résultats de l'enquête du CTMH auprès des urologues de l'AFU.

PURPOSE: Rare and severe complications of benign prostatic hyperplasia (BPH) surgery are poorly documented in the literature. Our purpose was to make an inventory of severe and unexpected complications of BPH faced by urologists of the French Association of Urology (AFU). MATERIAL AND METHODS: A declarative 13-question survey was sent by e-mail 2 months before the 108th French Congress of Urology to the urologist's members of the AFU. Complications were split in complications due to material and complications directly related to the surgery. RESULTS: Overall, 216 (16.2%) urologists surveyed but only 85 forms were usable. Complications related to the material was divided into: excessive temperature of the serum irrigation leading to urethral and bladder burns (n=5), material default leading to interruption of the procedure (n=1) or incomplete hemostasis (n=2) and endoscope rupture (n=1). Peroperative complications related to surgery were divided into surgical complications: haemorrhage (n=7), urethral wounds (n=6), perforation and/or explosion (n=16), rectal wounds (n=11), obstructive renal failure (n=1); and medical complications: TURP syndrome (n=2), cardiovascular (n=5) and septic shock (n=6). CONCLUSION: This is the first French declarative study having allowed the identification of severe and unexpected complications of BPH surgery. The recorded occurred complications were very eclectic and secondary to all types of techniques used.

[Guide dedicated to general practitioner for the management of lower urinary tract symptoms related to benign prostatic hyperplasia]. / Guide de prise en charge en médecine générale des symptômes du bas appareil urinaire de l'homme liés à une hyperplasie bénigne de la prostate.

OBJECTIVE: 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). METHOD: 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. RESULTS: 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 volume>100ml), 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. CONCLUSION: 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. LEVEL OF EVIDENCE: 5.

[Do postoperative drainage types modify outcomes after retrograde intrarenal surgery?]. / Le type de drainage postopératoire modifie-t-il les résultats de l'urétérorénoscopie souple pour la fragmentation laser des calculs rénaux?

INTRODUCTION: The aim of the current study was to evaluate if the postoperative drainage type modified the outcomes after retrograde flexible ureteroscopy (f-URS) and intracorporeal lithotripsy f-URS for intrarenal stones. MATERIAL AND METHODS: We retrospectively analyzed 162 procedures of f-URS for intrarenal stones between January 2010 and January 2013 at a single institute. Independent-sample t-tests and chi-square tests were used for comparisons of means and proportions between patients with ureteral stent or double pigtail stents. RESULTS: There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8 ± 17 years. Double pigtail stents and ureteral stents were used in 117 (72.2%) and 45 (27.8%) cases, respectively. Cases with postoperative double pigtail stents had a longer operative time (96.2 ± 35 min vs 81.2 ± 5 min; P = 0.018) and were less often operated by an experienced surgeon (P = 0.001). Length of hospital staying (P = 0.804), postoperative complication (P = 0.148) and stone free status (P = 0.116) were not different between postoperative drainage by double pigtail and ureteral stents. CONCLUSION: Postoperative drainage by double pigtail stent was used more often by surgeons in the beginning of their RIRS experience and was associated with longer operation time. Nevertheless, the postoperative drainage type did not modify the outcomes regarding the postoperative complication rate, the length of hospital staying and the stones free rate.

TOOKAD® Soluble focal therapy: pooled analysis of three phase II studies assessing the minimally invasive ablation of localized prostate cancer.

PURPOSE: To evaluate the 6-month effects of the recommended drug and light dosage in focal vascular-targeted photodynamic therapy (VTP) using TOOKAD(®) Soluble in patients with localized prostate cancer (LPCa). METHODS: We performed a pooled analysis of 117 men with LPCa, PSA <10 ng/mL, and Gleason score ≤ 7 (3 + 4), from 3 studies who received a 10-min intravenous infusion of a single dose of 4 mg/kg TOOKAD(®) Soluble, activated by a 753-nm light at 200 J/cm delivered in the prostate by transperineal fibres under transrectal ultrasound guidance. Primary endpoint was 6-month negative biopsies in the treated lobe(s). PSA was measured at month 1, 3, and 6. Magnetic resonance imaging was performed at day 7, month 3, and 6. International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) and adverse events were reported at day 7, month 1, 3, and 6. RESULTS: Month 6 negative biopsy rate was 68.4 % in the overall evaluable population (N = 114) and 80.6 % for patients treated by hemiablation with light density index (LDI) ≥ 1 (N = 67). Mean prostate necroses at week-1 were 76.5 and 86.3 %, respectively. In both groups, PSA levels at month 6 decreased by 2.0 ng/mL. Small changes from baseline for IPSS and IIEF-5 indicated a slight improvement in urinary function and a slight deterioration in sexual function. CONCLUSIONS: Focal VTP treatment with TOOKAD(®) Soluble at 4 mg/kg and 200 J/cm resulted in a negative 6-month biopsy rate of 68.4 % for the whole population and 80.6 % for patients treated by hemiablation with LDI ≥ 1. The treatment was well tolerated. Two phase III studies will reach completion in early 2015.

Post-treatment MRI aspects of photodynamic therapy for prostate cancer.

OBJECTIVES: Photodynamic therapy is a new focal therapy for prostate cancer. METHODS: In this technique, a photosensitising agent is introduced intravenously, then activated by local laser illumination to induce tumour necrosis. Treatment efficacy is assessed by magnetic resonance imaging (MRI). RESULTS AND CONCLUSIONS: We illustrate specific post-treatment MRI aspects at early and late follow-up with pathological correlations. TEACHING POINTS: • Dynamic phototherapy is a new and promising focal therapy for prostate cancer. • One-week MRI shows increased volume of the treated lobe and large, homogeneous necrosis area. • Six-month MRI shows significant changes of the prostate shape and signal. • Six-month MRI becomes "base line" appearance for further follow-up or monitoring.

[Conservative treatment of male non-neurologic urinary incontinence: a review by the LUTS committee of the French Urological Association]. / Traitements palliatifs et conservateurs de l'incontinence urinaire masculine non neurologique: une revue de littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the conservative treatment of male non-neurologic urinary incontinence. METHOD: A systematic review was conducted using PubMed/MEDLINE with the following keywords: "incontinence", "male stress urinary incontinence", "pelvic floor training", "biofeedback", "absorbant products", "life style", "penile clamp". RESULTS: Palliative devices like penile clamps, penile sheaths and absorbent products were transitory options that were poorly evaluated. Life style modifications (scheduled voiding, controlled hydric absorption, decreased caffeine and spice intake) were useful in complement of other treatments especially in case of overactive bladder. Pelvic floor training (PFT) was useful after radical prostatectomy but remained optional for other types of incontinence. It accelerated the continence recovery postoperatively but it results at 1 year were uncertain. These results were maintained 1 year. Conservative treatments were useful postoperatively especially early supervised PFT. The benefit of biofeedback and perineal stimulation was controversial. Balder catheterization was a last resort option. Penile sheaths were better than urethral catheterization if there were no post-voiding residual urines. CONCLUSIONS: Palliative options have a limited efficacy but are mini-invasive and might be helpful complementary options.

[Treatment of localized prostate cancer by vascular-targeted photodynamic therapy with WST11]. / Traitement des cancers localisés de la prostate par photothérapie dynamique.

Focal therapies are new options for the treatment of localized prostate cancer. Vascular-targeted photodynamic therapy (VTP) with WST11 is one of these options. The aim of this treatment is to destroy a targeted area of the prostate by the associated action of the WST11 drug, light exposure and oxygen. The procedure is performed under general anesthesia. Fibers are introduced trans-perineally in the prostate by ultrasound guidance. The injection of WST11 is then performed with light illumination of the specific targeted area. Current data report 83% negative biopsies 6 months after treatment with good tolerance of the treatment. However, VTP still needs to be evaluated.

[Treatment of non-neurogenic masculine urinary incontinence due to overactive bladder: a review by the LUTS committee of the French Urological Association]. / Traitement de l'incontinence urinaire masculine non neurologique par hyperactivité vésicale : une revue de la littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder. METHOD: A systematic review was conducted using PubMed/MEDLINE with the following keywords: "overactive bladder", "male urinary incontinence", "urgency", "antimuscarinic", "onabotulinumtoxinA", "neurostimulation", "cystoplasty". RESULTS: Antimuscarinic treatments were the first line option for overactive bladder incontinence (decreased incontinence under tolterodine versus placebo respectively -71% vs. -40%, P < 0.05). Their main side effects were dry mouth (16-29.6%) and constipation (4%), which might decrease the observance. In case of failure, neuromostimulation could be prosed with a 67% efficacy rate. Intra-detrusorian injections of onabotulinumtoxinA were an option, however there were still not validated for this indication and their efficacy decreases with time and after repeated injections. The ultimate option in case of refractory major over-activity was cystoplasty, which involves major morbidity for inconstant efficacy. CONCLUSIONS: The same treatments are available for non-neurologic urinary incontinence by bladder over-activity for men and women: antimuscarinic drugs, neurostimulation, onabotulinumtoxinA. However, only few data is available for masculine population exclusively.

[Initial assessment of male non-neurogenic incontinence: systematic review of the literature by the LUTS committee of the French Urological Association]. / Bilan initial d'une incontinence urinaire masculine (non neurologique): revue de la littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the initial evaluation of male urinary incontinence (MUI). METHOD: A systematic review was conducted using Pubmed/Medline from 1995 to 2013. RESULTS: Definition of MUI and its prevalence is variable according its definition and the population. Tools for its evaluation have been mainly studied in female population or only in patients with UI after radical prostatectomy. Objectives of the initial evaluation are to assess the type of incontinence, to evaluate its severity and the bother associated, and define the choice of treatment. Medical history, clinical assessment, and urine analysis are the first steps of the evaluation. Bladder diary, questionnaires and pad test can be useful to evaluate MUI. Post-void residual volume assessment is necessary if lower urinary tract symptoms are associated. Imaging is not routinely used in MUI. A specialist referral and further investigations such as urethrocystoscopy and urodynamics should be considered in case of invasive treatment, recurrent incontinence and specific situations. CONCLUSIONS: Initial assessment of MUI should be sequential with systematic investigations and optional ones.

[Clinical impact of the intravesical prostatic protrusion: a review by the LUTS committee of the French Urological Association]. / Impact en pratique clinique de l'indice de protrusion prostatique intravésicale: une revue de la littérature du CTMH de l'AFU.

INTRODUCTION: Intravesical prostatic protrusion (IPP) is a protrusion of the lateral and/or median prostatic lobes into the bladder lumen. IPP can be estimated by suprapubic ultrasound. METHODS: A literature search was conducted in Pubmed/MEDLINE database using the following keywords: intravesical prostatic protrusion; benign prostatic enlargement; treatment outcome; ultrasonography. RESULTS: There are 3 grades of IPP: grade 1, 2 and 3 respectively if IPP ≤ 5mm, if 5-10mm, and if >10mm. IPP was a better prognosis factor than PSA and prostate volume for bladder outlet obstruction (BOO) with a sensibility of 80% and a sensitivity of 68% for grade 3. The progression risk of BOO increased with IPP (grade 1: OR=5.1 [95%CI: 1.6-16.2] and grade ≥ 2 OR=10.4 [95%CI: 3.3-33.4]). IPP was a predictive marker of failure of trial off catheter in patients with acute urinary retention with a 6 folds higher risk for grades ≥ 2. IPP was a prognosis factor for tamsulosine efficacy: 78% of patients with grade ≤ 2 had an improvement >35% of the IPSS-score versus 58% for grade >3 (P<0.01). Patients with grade >3 and a PV< 40cc had a poorer response to tamsulosine. After TURP, IPSS was more improved for grade ≥ 1 with an OR=3.43 (95%CI: 1.03-11.44, P=0.045). CONCLUSION: IPP can be a useful marker for the management of LUTS/BPH.