[Early postoperative complications in a multidisciplinary surgical center exclusively dedicated to endometriosis: A 491-patients series]. / Complications postopératoires immédiates dans un centre chirurgical multidisciplinaire exclusivement dédié à l'endométriose : une série de 491 patientes.

OBJECTIVE: The objective of our study is to present the activity volume and postoperative complications in a center exclusively destined to endometriosis surgery. METHODS: Retrospective mono-centric study analyzing data collected prospectively in patients surgically managed for endometriosis from September 2018 to August 2019. RESULTS: Four hundred and ninety-one patients underwent surgery for endometriosis during 12 consecutive months: 268 for colorectal localizations (54.6%), 51 for endometriosis of the urinary tract (10.4%), 17 for nodules of ileum and right colon (3.5%), 43 for nodules of parametriums (8.8%), 12 for nodules of sacral roots and sciatic nerves (2.4%), 7 for diaphragmatic localizations (1.4%). Among 268 patients with colorectal endometrioses, of which 48.1% concerned the low and mid rectum, shaving was performed in 102 cases, disc excision in 96 cases and colorectal resection in 100 cases. Stoma was performed in 13.1% of the cases. Patients could have 2 different procedures for multiple colorectal nodules. One hundred and ninety-nine ovarian endometriomas were managed by plasma energy ablation in 64.8%, sclerotherapy in 11.1%, cystectomy in 13.1%, oophorectomy in 11.1%. Major postoperative complications included 12 rectovaginal fistulas, while 18 other surgical procedures were carried out for various complications. In all, 38.1% of procedures involved a general surgeon and 5.3% an urologist. CONCLUSION: The creation of centers exclusively destined to endometriosis surgery allows the multidisciplinary management of a high number of patients, with an over-representation of severe forms and rare locations of the disease, followed by satisfactory complication rates.

[Estimating minimum period of time to perform prostate MRI after prostate biopsy: Clinical and histological bleeding risk factors; from a prospective study]. / Évaluation prospective du délai minimum de réalisation de l'IRM prostatique après une biopsie de prostate : facteurs prédictifs cliniques et anatomopathologiques de remaniements hémorragiques.

A minimum delay of 4 to 6 weeks between biopsy and multiparametric prostatic MRI (mpMRI) is admitted due to post-biopsy hemorrhage that can impact MRI reading without strong scientific evidence. The objective of the study was to evaluate the best period between prostate biopsy and 3Tesla mpMRI and searching for predictive factors of intraprostatic blood. METHOD: A prostate biopsy followed by a 4-week prostate MRI (MRIp M1) was performed. In case of hemorrhage, MRI was rescheduled at 8 and 12 weeks (M2/M3). We analyzed the persistant bleeding to identify risk factors: anticoagulant/antiaggregant, post-biopsy side effects, histological criteria. RESULTS: In this prospective, single-center study, we included 40 patients followed for suspected prostate cancer between December 2014 and March 2016. At the MRIpM1, blood was found for 97.5 % of the patients. The rates were 90.9 % and 88.9 % respectively at the M2 and M3 mpMRI. Compared to initial blood volume on MRIpM1, a significant decrease in blood volume was observed between M1 and M2 (55 %; P=0.0091). We showed a 75 % decrease between M1 and M3 (P=0.0003). Low urinary tract symptoms (LUTS) suggesting urinary infection at 4 weeks were significantly correlated with blood volume on MRIpM1 (P=0.0063). The blood volume was higher in case of unconformity between biopsy and mpMRI results for detection of significant tumors (11.3 vs. 2.3; P=0.0051). CONCLUSIONS: A minimum of 8-week biopsy and mpMRI period would limit post-biopsy hemorrhage, predicted by LUTS suggesting urinary infection. A delay of 12 weeks would be optimal without delaying the management of the patient. LEVEL OF EVIDENCE: 4.

Assessing technical competence in laparoscopic surgery in France: Ratification of the GOALS rating scale.

BACKGROUND: The question of assessing surgical competence is the focus of mainly Anglo-Saxon studies. The GOALS questionnaire (Global Operative Assessment of Laparoscopic Skills) specific to laparoscopic surgery assessment has been developed since 2005. The aim of the study was to assess the metrological qualities of the GOALS questionnaire after ratification in French language. METHODS: To produce a French version of the GOALS surgical competence assessing tool according to an established method (translation - backward translation - retranslation) and to check the metrological qualities (user satisfaction, acceptability, reliability and validity) of this questionnaire through observing residents while in training program on 22 residents in Gynaecology Obstetrics during the laparoscopy training, with the performance of a nephrectomy on a porcine model. RESULTS: The discrepancies in the initial translations were mainly due literal translations. Only synonymous differences were observed in the two backward translations. Comparison with original version led to 8 minor changes. No changes occurred between the 2 French versions. Satisfaction surveys when using the GOALS questionnaire by both examiners and students are similar. Face and content validity seemed good and there is no significant discrepancy between the examiners and the students (11.5 [9-15]; 12.4 [9-15]; P=0.40). Assessment by examiners showed an median value of 17.8 [9-26] with good correlation (α=0.80). By contrast, self-assessment, although there is no significant discrepancy, showed heterogeneity. GOALS French version was able to prove a significant progression both in self-assessment and external evaluation between the act performed on the first nephrectomy on the first day of the first session of the training and the fourth nephrectomy performed on the first day of the second session of the training. CONCLUSION: Our work allowed obtaining a GOALS French version with acceptable validity, good consistency between the assessments and ability to measure progress.

[Predictable access to the fellowship of urology in France till 2016: an update of the AFUF]. / Accessibilité prévisible au post-internat d'urologie en France jusqu'en 2016: une mise à jour de l'AFUF.

PURPOSE: To evaluate the predictable accessibility to the fellowship of urology for residents expecting to accomplish their residentship from November 2013 to November 2016. MATERIAL: Between September and November 2013, the representants of the residents ongoing for the residentship of urology in each region of France were reached to participate to the study. A questionnaire was given in aim at reporting all the local residents expecting to accomplish their residentship between November 2013 and 2016, and the number and the expected availability of fellow and specialist assistant posts in the region during the same period. RESULTS: In November 2013, our study listed 334 junior urologists (197 residents, 81 fellows, 56 assistants). Fifty-five residents were ending their internship by November 2013, whereas 67, 50, 77 residents were expecting to accomplish their residentship from November 2014 to 2016 respectively. The predictable accessibility to the fellowship of urology was 96.4%, 82.1%, 90.0%, 74.0% respectively for the residents accomplishing their residentship from November 2013 to November 2016. The predictable deficit of fellow and assistant posts were -2, -12, -5, -20 posts from November 2013 to November 2016 respectively. CONCLUSION: The predictable number of fellow and assistant post in Urology remains insufficiently available for the 2013-2016 period. By reason of the unstable number of residents accomplishing their residentship from 2014 to 2016, the fellowship accessibility was measured at 82.1%, 90.0%, 74.0% from 2014 to 2016 respectively.

[Longitudinal follow-up of the IPSS within the 5 years following treatment of a localized prostate cancer: overall analysis and by type of treatment]. / Suivi longitudinal de l'IPSS dans les cinq ans suivant un traitement d'un cancer de prostate localisé: analyse globale et par type de traitement.

OBJECTIVES: The International Prostate Score Symptom (IPSS) and the question of quality of life (QOL-Q) associated were used in this study for monitoring patients treated for localized prostate cancer (P-Ca). PATIENTS AND METHODS: Three groups treated with radical prostatectomy (RP), external beam radiotherapy (RT) or brachytherapy (BRACHY) completed the self-administered questionnaire IPSS and Q-QOL before treatment (bef-TT), after 3 months and once a year for 5 years. RESULTS: The study included 40 PR, 40 RT and 40 BRACHY. There was no difference between the three groups in bef-TT for the IPSS and Q-QOL or in the patients' characteristics, and P-Ca except for age and a higher PSA in the RT group (70.6 years old and 10.0 ng/mL vs. 66.5/66.2 and 7.1/6.2 for RP and CURIE respectively). The impact, no matter what treatment they received, was significant after the third month and then went back to the pre-AN1 at TT. The analysis by group treatment showed no significant difference between groups at 3months and during the first 4 years of follow-up. In the fifth year the RT group had a greater IPSS than BRACHY and PR groups (P<0.04). CONCLUSION: This study showed no degradation of the IPSS or Q-QOL remote treatment of localized prostate cancer. Urinary incontinence has been partially exploring. His study would have allowed a better urinary quality of life analysis in these patients.

[A majority of useless call of an on-call urology resident: a study of the AFUF]. / Une majorité d'appels évitables au cours des astreintes d'urologie en CHU : l'étude de l'AFUF.

GOAL: To assess the workload of an on-call urology resident at a French University Hospital. MATERIAL: A prospective study was performed during 15 days in February 2012. The data recorded in our database regarded the resident (sex, age, time to go to work), the call (emergency, type and reason) and the person who called (grade, department). RESULTS: Seven centres including 18 residents participated. On average five calls were received per day [0-17]. After midnight, the resident was called less than twice (1.6). There was an actual emergency in 64% of cases [0-13]. The urology-related call motives (73%) mainly consisted in acute urine retention (AUR) and catheter problems (73), renal colic (RC) (49), acute pyelonephritis (23), and hematuria (22). Residents had to go to the hospital in 55% of AUR and catheter problems, 30% of acute pyelonephritis, 17% of RC and 14% of hematuria. The emergency department (ED) called the urology resident in 39% of cases but only 18% required the presence of the resident. A call made by a senior was more likely to be an emergency (67%) than by a resident or a nurse (51%, P=0.02). CONCLUSION: The urology resident when on-call is mainly asked for an advice by the ED. Among urology-related advice, bladder catheterization problems were the most frequent. RC was the second call motive but most of the time was not an actual emergency.

[Does the urologist in formation have a burnout syndrome? Evaluation by Maslach Burnout Inventory (MBI)]. / Les urologues en formation ont-ils un syndrome d'épuisement professionnel ? Évaluation par le Maslach Burn-out Inventory (MBI).

OBJECTIVES: To assess the burn-out syndrome in the population of urologists in training. MATERIAL AND METHODS: A trans-sectional study was carried out among the French urologists in training association (AFUF) members. A questionnaire including the Maslach Burnout Inventory and questions on the age, gender, professional and familial status, working time and hobbies was emailed. RESULTS: The response rate was 65.5 %. Mean burn-out, emotional exhaustion and depersonalization scores were 15.57 ± 8.55 (low burn-out), 8.56 ± 5.52 (moderate burn-out) and 37.19 ± 6.21 (moderate burn-out), respectively. Forty-five (24 %) had a severe burn-out syndrome, 11 an emotional exhaustion and 41 a depersonalization. Urologists in couple had a significant lower emotional exhaustion level than single. Depersonalization and low personal accomplishment scores were related to the age and working time. Having at least one hobby prevented emotional exhaustion and improved personal accomplishment levels. Gender had no impact on burn-out syndrome. CONCLUSION: Quarter of French urologists in training had a burn-out syndrome. Factors preventing it were working time reduction, being in couple and having at least one hobby. burn-out syndrome severity decreased with age and senior status.

[Alert on the predictable accessibility of the fellowship of urology until 2013: a study of the AFUF]. / Alerte sur l'accessibilité prévisible du postinternat d'urologie jusqu'en 2013: une étude de l'AFUF.

PURPOSE: To evaluate the accessibility of the fellowship for the residents of Urology expecting to accomplish their residentship between November 2010 and 2013. PATIENTS: Between November 2010 and January 2011, all the residents ongoing for the residentship of Urology in France were reached by an electronic mailing using the AFUF register. A questionnaire reported all the residents expecting to accomplish their residentship between November 2010 and 2013, and the number and the expected availability of fellow and specialist assistant posts during the same period. RESULTS: Our study counted 306 urologists on training (190 residents, 76 fellows, 30 assistants, 10 on other posts). On November 2010, 56 residents accomplished their residentship, while 68 and 79 residents expected to accomplish their residentship on November 2011 and 2012, respectively. One hundred and six posts validated the fellowship of Urology on November 2010 (76 fellows, 30 assistants), among 54 posts were available. Over the residents expecting to accomplish their residentship on November 2011 and 2012, 22 and 54 residents may not find a fellow post available. CONCLUSION: The number of residents expecting to accomplish the residentship of Urology between November 2010 and 2013 was increasing, showing a greater interest for this speciality and a lack of regulation for its accessibility. By reason of a discrepancy of fellow and specialist assistant posts, only 67.6 and 31.6% of the residents expecting to accomplish their residentship on November 2011 and 2012 may be able to find a post available.

[Variation of urinary PCA3 following transrectal ultrasound-guided prostate biopsy]. / Variation du PCA3 urinaire après biopsie de prostate transrectale échoguidée.

INTRODUCTION: Serum PSA is known to rise slightly following an attentive digital rectal examination (DRE) and dramatically following prostatic biopsy. The aim of this study was to evaluate the PCA3 response in these situations. PATIENTS AND METHODS: In 15 consecutive men undergoing transrectal ultrasound-guided needle biopsy of the prostate and who gave their informed consent, urinary PCA3 was determined twice: at a first consultation, urine being sampled immediately after an attentive DRE and second within 2 hours after the biopsy. The mean interval between the two samplings was 14 days (median 15). PCA3 measurements were centralized and performed by the same biologist. At least twelve cores were taken using a biopsy gun with an 18-gauge needle. Changes in PCA3 levels were studied. RESULTS: Mean age of the 15 men was 67.3 years (range 50.9-79.1). Mean (median) pre-biopsy total and %free PSA were respectively 6.6 ng/ml (5.7) and 15.8% (15.5). Mean prostate volume was 43.6 cm(3). Seven patients complained of mild LUTS. DRE was suspicious in eight patients. Of the 15 men, 6 (40%) had adenocarcinoma on biopsy (all clinically confined to the prostate). Median (range) Gleason score was 6 (6-7). Median PCA3 score (range) before and after prostatic biopsy were respectively 36 (9-287) and 27 (5-287) with no significant difference between the two groups (sign test for matched series p > 0.05). The median variation between pre- and post-biopsy PCA3 was -18%. When considering a PCA3 cut-off of 35, two patients changed group: one patient had 51 before and 31 after (PSA 4.6; no cancer on prostate biopsy) and the second had 36 before and 27 after (PSA 5.6; low-risk PCa). The figure represents the PCA3 values for each case (squares for the pre-biopsy and diamonds for the post-biopsy). When considering only the six patients with PCA, median (mean) PCA3 score before and after prostatic biopsy were respectively 51.5 (60.8) and 44.5 (54.8) with no significant difference between the two groups (sign test for matched series p > 0.5) and a median variation between pre- and post-biopsy PCA3 of 1.5%. CONCLUSIONS: Prostate biopsy did not alter significantly urinary PCA3 value. This confirms what was theoretically expected.

[T1 bladder carcinoma: prognostic value of the muscularis mucosae invasion (T1a/T1b). A multicenter study by the French Urological Association (CCAFU)]. / Tumeur urothéliale de vessie T1 : valeur pronostique du franchissement de la muscularis mucosae (T1a/T1b). Etude multicentrique du Comité de cancérologie de l'Association française d'urologie (CCAFU).

OBJECTIVE: The aim of this multicenter study was to determine the prognostic value of the depth of invasion of lamina propria and more specifically the influence of the invasion of the muscularis mucosae on survival parameters in T1 bladder carcinoma. PATIENTS: Six urological centers included patients between 1994 and 2004 who had an initial T1 bladder tumor. All T1 tumors were substaged according to the muscularis mucosae (MM) invasion into T1a (no invasion beyond the MM) and T1b (invasion beyond MM but preserving the muscle). Among the 387 patients included, 269 (69.5%) were found T1a and 118 (30.5%) T1b. Mean follow-up was 45.4 months. T1a and T1b groups were comparable except for tumor grade that was higher in T1b (p<0.001). RESULTS: Survival without recurrence was not significantly different between T1a and T1b groups (p<0.3) but T1a stage was found as an independent factor for survival without progression (RR=0.49; IC 95%=[0.71-0.90]), specific survival (RR=0.33; IC 95%=[0.16-0.67]) and global survival (RR=0.52; IC 95%=[0.32-0.85]). CONCLUSION: This study, the largest on the subject to our knowledge, have shown that muscularis mucosae invasion was a prognostic factor for survival without progression, specific survival, and global survival. We support that routine pathological assessment of the level of MM invasion in patients with stage T1 bladder cancer should be included in the histopathological report.

[Results of an investigation by questionnaire into interest in neuro-urology of urology residents]. / Résultat d'une enquête par questionnaire sur l'intérêt porté à la neuro-urologie par les urologues en formation.

OBJECTIVES: To evaluate the interest borne towards neuro-urology within the community of the urology residents. MATERIALS AND METHODS: Between January and May 2009, all urology residents received an anonymous questionnaire by e-mail estimating their interest for neuro-urology. The analyzed data were: epidemiologic data; participation in theoretical learning and training courses practices; interest and investment in the speciality; opinion on the current formation. The qualitative variables were compared by the chi-2 test. P values <0,05 were considered significant. RESULTS: The rate of answer was 45,3 %. The middle age was 28,7+/-2,3 years. Ninety-two (70,7 %) of the 130 urologist residents questioned wished to exert full-time or divided in a hospital structure. They were 40 % to have a multidisciplinary neuro-urology staff, and 80 % were in a service which dealt with suffering patients of neurological bladder. The percentage of urologist residents interested by neuro-urology was 69,2 %, and 61,5 % of them wished to practice this activity in their future exercise. This wish was significantly higher for those resulting from the ENC (p<0,05), for those wishing to exert at the hospital (p<0,01) and for those who practice urology at a level of expertise in neuro-urology (p<0,01). The theoretical and practical teaching of neuro-urology were considered as being insufficient for respectively 73,9 % and 64,2 % of the urologist residents. In contrast, the average note allotted to the neuro-urology module of the ECU was of 7,47 out of 10. CONCLUSION: Neuro-urology seems to be particularly attractive for the urologist residents, and many wished to integrate it in their future exercise. The motivation was more important for those who wished to carry out a career in hospital. Even if the quality of the teaching was very noted, their modalities were considered to be insufficient by most of them.

[Prospective evaluation of urology residents' interest in andrology]. / Evaluation prospective de l'intérêt des urologues en formation pour l'andrologie.

OBJECTIVE: To evaluate the interest carried in andrology within the community of the urology residents. MATERIAL AND METHODS: Between June and October 2008, all urology residents received an anonymous questionnaire by e-mail estimating their interest for andrology. The following elements were reported: age, sex, current status, future activity, participation in theoretical learning and training courses practices, interest for the speciality and the opinion on the current formation. The statistical analysis was performed with the SEM software. RESULTS: Seventy-seven of the 238 urology residents (32.4%) answered the sent questionnaire. The mean age was 29.2 years (25-36). Thirty-two of them were from a Parisian center (41.6%) and 45 (58.4%) from another city. There are 40.3% of urology residents who wished work on the hospital, 27.3% wished develop an exclusive liberal activity. There are 81.8% of the urology residents who declared to be interested in andrology and 29.9% were registered or wished to join the diplôme d'études spécialisées complémentaires (DESC) of Andrology. Concerning the current formation, only 4% of the participants considered that the theoretical education of the andrology was sufficient and only 6.6% of them considered to have acquired a sufficient practical training in andrology during the cursus. CONCLUSION: The andrology is a particularly attractive speciality for the urology residents and the current modalities of formation are considered insufficient by most of them.

[Percentage of positive biopsy cores at the onset of hormone therapy for prostate cancer: prognostic significance]. / Pourcentage de biopsies positives chez les patients traités par hormonothérapie pour cancer de la prostate : valeur pronostique.

INTRODUCTION: We hypothesized that it would predict time to hormonal independence and survival in prostate cancer patients treated by androgen deprivation therapy (ADT). MATERIAL AND METHODS: We used clinical data from 403 men treated with ADT between 1980 and 1999 and focused on a subgroup of 220 patients treated with GnRH analogue. Percentage PBC was defined as the number of positive biopsy cores multiplied by 100 and divided by the total number of biopsy cores. RESULTS: Median percentage PBC was 83.3% (16.7-100%). Mean follow-up was 57.4 months. Survival at 5 years in men with 83.3% PBC or less was 62.3, 89.1 and 82.6% for recurrence-free, specific and overall survival respectively, significantly better than that of men with a percentage PBC of more than 83.3% (32.2, 74.7 and 67.7%, respectively; p<0.004). Among the factors available in the pretreatment setting, namely age, clinical stage, PSA, Gleason score, bone scan and percentage PBC, the latter was independently associated with survival in multivariate analysis. CONCLUSIONS: Percentage PBC may improve the ability to predict time to hormonal resistance and survival in patients treated with ADT for prostate cancer. This finding warrants further investigation.

[Demography of residents in urology in France: appraisal and perspectives]. / Etat des lieux et perspectives sur la démographie des internes en urologie en 2008.

PURPOSE: The objective was to identify the number of residents registered in the course of urology in France in 2008, and to make a forecast in the number of posts of fellow and specialist assistant available at the end of their course. MATERIAL: From January to February 2008, a questionnaire identified in all French University Hospital the number of residents enrolled in the urology course, and the number of posts of fellow and specialist assistant in urology in the region. The year of the end of the course has been determined for each resident in compliance with seniority, and taking into account the availability. The number of fellow and specialist assistant posts available in the same period was estimated by considering the duration of each postinternship, and any change in the number of posts. RESULTS: Our census counted 207 residents, 76 fellow posts, 10 specialist assistant posts. Of the 207 residents, 29 completed their studies in 2008, 57 in 2009, 60 in 2010, 61 in 2011. Following our methodology, there was a lack of fellow and specialist assistant posts available from November 2010 (-15 posts in 2010, -7 posts in 2011). CONCLUSION: Our study showed an increase in the number of residents enrolled in urology course by years of promotion, causing a lack of fellow and specialist assistant posts from 2010. Apart from an opening of additional fellows and specialist assistants at that time, our study highlights the long-term regulation of entries in the urology course ensuring a postinternship quality.