[Feminization of urology and glass ceiling: Survey of women urologists in France]. / Féminisation de l'urologie et plafond de verre : enquête auprès des femmes urologues en France.

INTRODUCTION: Urology has long remained the least feminized specialty. The objective of this study was to assess the demographic characteristics of female urologists and their feelings in terms of discrimination. MATERIAL: The survey consisted of a questionnaire of 12 questions, sent by mailing to all female urologists, a first time in May 2016 (n=84), then a second time in January 2020 (n=98). The anonymized answers were analyzed and compared in order to assess the evolution over the last 4 years. The participation rate was 46.4% in 2016 (n=39 respondents) and 50% in 2020 (n=49 respondents). RESULTS: The majority of women worked full time (73.5%), with a hospital (38.8%), liberal (46.9%) or mixed (14.3%) activity. Their main theme was women's urology (57.1%). In 2020, 59.2% of respondents had encountered difficulties related to their status as women during their career and 28.1% difficulties related to motherhood. Female urologists in private practice were significantly less concerned than their counterparts with hospital or mixed activity (43.5% versus 73.1%, P=0.035). Women felt that they were underrepresented in association committees at 95.9% (vs. 82.1% in 2016) and in university positions at 79.6% (vs. 89.7% in 2016). Finally, 91.8% were in favor of the creation of an association of women urologists (vs. 53.8% in 2016). CONCLUSION: Women urologists may encounter difficulties related to their status as women during their professional career. Between 2016 and 2020, there is an increase in the feeling of under-representation within association committees and an increase in the need to federate. NIVEAU DE PREUVE: III, étude rétrospective cas-témoins.

[Comparison of operative and oncologic results between partial nephrectomy and radiofrequency ablation for treatment of renal tumors in patients older than 75]. / Comparaison des résultats opératoires et oncologiques de la néphrectomie partielle et de l'ablation par radiofréquence pour traitement des tumeurs rénales chez les patients de plus de 75 ans.

INTRODUCTION: Elderly patients represent a growing part of our society for who treatment strategy for localized renal tumors has to be chosen knowing iatrogen effects and renal function morbidity. The aim was to analyze oncological and functional results of nephron sparing surgery (PN) versus radiofrequency ablation (RFA). MATERIALS AND METHODS: All patients aged more than 75 treated by partial nephrectomy or radiofrequency ablation between 2007 and 2014 in our centre were included. Patient and tumors data were compared and these criteria were analyzed: survival (overall and without recurrence) and loss of renal function (pre- and postoperative MDRD). RESULTS: In total, 100 patients were included (26 partial nephrectomies, group 1 and 74 radiofrequency ablation, group 2) with a 32-months medium follow-up. Medium age and tumor size were significantly different (respectively, 78 versus 81 years old, P=0.001, 38mm versus 29mm, P=0.003). Perioperative results showed no differences in complications. Transfusion rate and duration of hospital stay were significantly higher in the PN group. Median overall survival were 45 vs. 27 months (P=0.23) for PN and RFA and median recurrence-free survival were 28 vs. 10 months (P=0.34). On a multivariate analysis, operative technique (PN or RFA) were not significantly linked to survival (HR 2.37 [95% CI: 0.66-8.5]), P=0.19. Loss of renal function were 1.5±14mL/min/1.73m2 for PN and 3±14mL/min/1.73m2 for RFA (P=0.69). CONCLUSION: Our study showed better perioperative results for RFA than for PN, without significant different survival. Loss of renal function were little and similar. LEVEL OF EVIDENCE: 4.

[Prostate cancer diagnostic by saturation randomized biopsy versus rigid targeted biopsy]. / Détection du cancer de prostate par biopsies de saturation versus biopsies ciblées fusion d'image rigide.

INTRODUCTION: Optimal diagram teaming up randomized biopsy (BR) to targeted biopsy (BC) is still missing for the diagnostic of prostate cancer (CP). This study compares diagram of 6, 12 or 18 BR with or without BC rigid. METHODS: Between January 2014 and May 2016, 120 patients had prostate biopsy BR and BC. Each patient had 18 BR and BC. Results compared sextant (6 BR), standard (12 BR) and saturation (18 BR) protocol with or without the adding of BC for the detection of CP. RESULTS: Rectal examination was normal, mean PSA at 8.99ng/mL and mean volume at 54cm3. It was first round for 48% of patients. Forty-four cancers were found by the group 18 BR+BC (control). The detection rate was respectively, for 6, 12 and 18 BR of 61%, 82% and 91%. The add of BC increased this detection of +27% for 6 BR+BC, +13% for 12 BR+BC and +9% for 18 BR+BC. BC found 70% of all CP. Nine percent of CP were missed by BR only. Significant CP (Gleason≥7) diagnostic was the same for 12 BR+BC and 18 BR+BC. CONCLUSION: The add of BC to BR increase the detection of CP by 10%. Twelve BR+BC is the optimal diagram for the diagnostic of CP finding 95% of CP and 97% of significant CP. LEVEL OF EVIDENCE: 4.

[Is obesity a barrier to kidney transplantation?]. / L'obésité est-elle un frein à la transplantation rénale ?

INTRODUCTION: Kidney transplantation is the most suitable of ESRD care. The proportion of obese people is increasing in the general population and patients with kidney impairment. It is important to assess the impact of obesity on surgical complications of kidney transplantation. The aim of this retrospective study was to signify the correlation between obesity and the occurrence of postoperative urological complications during the first year. METHODS: We conducted a retrospective study from March 1999 to December 2009. We conducted a chart review of patients undergoing kidney transplantation. The kidneys were taken from cadaveric donors. Data collected included age, weight, height, preoperative BMI; causal nephropathy, smoking, hypertension, diabetes, anticoagulation therapy. Intraoperative data included operative time (DO), cold ischemia. Urological complications were recorded during the first year after the kidney transplantation (vascular anastomotic strictures, ureterovesical stenosis, lymphorrheas, pyelonephritis, hematoma, wound infection). Statistical analysis consisted of a t-test for independent samples and univariate and multivariate logistic regression for the occurrence of complications. RESULTS: Four hundred and twenty-two patients were transplanted in total. We excluded 20 patients. BMI and duration of surgery patients with complications were significantly different from those of patients with no complications (P=0.016 and P=0.039, respectively). Obese (n=48) had more diabetes (12.5% versus 3.7%, P=0.014), were more often smoking (35.4% versus 22%, P=0.012), had a longer DO (203.64minutes versus 182.46minutes, P=0.006), and complications (62.5% versus 50.28%, P=0.03) than patients with a BMI <30 (n=354). After adjusting for age, smoking, DO, diabetes and BMI showed that only BMI was an independent predictor of the occurrence of postoperative complications with P=0.048 and RR=1.058 [CI: 1 to 1.119]. However, there was no more transplantectomy obese (P=0.911). CONCLUSION: Our study showed that there is a significant risk of surgical complications after kidney transplantation in obese patients. But ultimately, this does not affect graft survival because there are no more transplantectomies or return to dialysis. LEVEL OF EVIDENCE: 5.

[The impact of obesity on renal function at one year after kidney transplantation: single-center experience]. / Impact de l'obésité sur la fonction rénale à 1 an chez les transplantés rénaux: expérience mono centrique.

INTRODUCTION: Kidney transplantation is the treatment of choice for ESRD. Several studies have investigated the factors that may affect kidney function at 1 year. The factors mentioned are anemia, hypercholesterolemia, immunosuppressors, etc. We studied the independent predictors of serum creatinine>100µmol/L at 1 year. MATERIALS AND METHODS: We conducted a retrospective study from March 1999 to December 2009. We conducted a chart review of 402 kidney transplant patients. The kidneys were removed from cadaveric donors. Data collected included age, weight, height, preoperative BMI, the causal nephropathy, smoking, hypertension, diabetes, anticoagulation. Intraoperative data included operative time, and cold ischemia. Statistical analysis consisted of a t-test for independent samples comparing the group with a creatinine≤100µmol/L vs>100 group, and univariate and multivariate Cox regression for a serum creatinine>100µmol/L at 1 year and test of correlation between BMI and serum creatinine at 1 year postoperatively. RESULTS: We found a significant difference in BMI and cold ischemia with P=0.008 and P=0.002, respectively. In contrast there was no difference in age, operative time and blood loss, P=0.758, P=0.941 and P=0.963, respectively. Multivariate Cox regression showed that donor age P=0.004 (HR: 1.016 and CI: 1.005-1.027), a recipient age P=0.023 (HR: 0.986 and CI: 0.974-0.998) and BMI P=0.001 (HR: 1.019 and CI: 1.010-1.028) were independent predictors of serum creatinine>100µmol/L at 1 year. The Pearson correlation coefficient r=0.154 (P=0.004) showed a significant correlation between BMI and serum creatinine. CONCLUSION: Our study showed that donor age, recipient age and BMI were independent predictors of renal function>100µmol/L at 1 year. Our results highlight the difficulty of the management of obesity in renal transplant patients. LEVEL OF EVIDENCE: 5.