[De novo or secondary metastatic prostate cancer management in France: Observational study from "sentinel multidisciplinary meeting" of the French Association of Urology]. / Prise en charge des cancers de la prostate métastatiques synchrones et métachrones en France : étude observationnelle à partir des « RCP sentinelles ¼ de l'AFU.

INTRODUCTION: Metastatic prostate cancer (mPCa) is an heterogeneous disease. Metachronous mPCa (MM) seems to have a better prognosis than synchronous mPCa (SM). However, it is difficult to analyze their specificities from national registries. Data from the so-called "sentinel multidisciplinary meeting" (SMDM) would represent a "real life" data collection. The objective of this national pilot study was to evaluate the concept of SMDM through the description and comparison of the diagnosis, management and follow-up of patients with synchronous or metachronous mPCa in 2018. METHODS: A survey covering clinical, biological, radiological data as well as treatment initiated and follow-up at 3 and 6 months was sent to the SMDM. All patients diagnosed with metastatic disease (SM or MM) between 01/01/2018 and 11/30/2018 were included. RESULTS: In total, 780 patients from 39 centers were included, 408 SM and 372 MM. SM were more symptomatic and had a higher metastatic burden than MM. PET were mostly performed in MM without a prior standard staging. SM patients received more chemotherapy than MM patients whereas new generation androgen deprivation therapy was mostly given to MM patients. At 6 months, there were no more significant difference in clinical presentation between the two groups. CONCLUSION: Specificities of SM and MM patients in terms of clinical presentation, metastatic burden and management were described, validating the concept of SMDM as a source of reliable informations.

[Artificial urinary sphincter in patients with urinary incontinence after High Intensity Focused ultrasound]. / Sphincter urinaire artificiel chez les patients présentant une incontinence urinaire après High Intensivity Focused Ultrasound Therapy.

INTRODUCTION: Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence. METHODS: The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day. RESULTS: Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group. CONCLUSION: AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings. LEVEL OF EVIDENCE: 4.

[Radical prostatectomy for prostate cancer, perioperative management by French urologists in 2018]. / Évaluation de la gestion per- et périopératoire d'une prostatectomie totale pour cancer de la prostate par les urologues français en 2018.

INTRODUCTION: Prostatectomy (PT) is a common procedure performed by many urologists. In 2018, 20,207 prostatectomies were performed in France, and few studies evaluated the perioperative habits of urologists. As part of writing guidelines for enhanced recovery after surgery (ERAS) we wished to evaluate practice of urologists in their hospital management of a prostatectomy. MATERIEL AND METHODS: A questionnaire was sent by Survey Monkey in June and July 2018 to all urologists who are members of the French Association of Urology. RESULTS: One hundred and sixty seven urologists (14%) answered the questionnaire, 62% have private practice. The average number of operators per center performing PT was 4, with a median number of 70 interventions (0 to 486) per center in 2018. Open surgery is still gold standard (39.13%), followed by the robot-assisted transperitoneal laparoscopic (34.78%) and standard laparoscopic (24.22%). Alimentation, like first stand-up, was re-established on the first post-operative day, and the average hospital stay was 4±2 nights. The removal of the bladder catheter was most often performed at home by nurse (49.06%), one week after surgery. Only 10.06% of urologists systematically perform a cystography before removal urinary catheter. CONCLUSION: The perioperative management of prostatectomy in France is relatively homogeneous, between urologists. The length of hospital stay remains important and could be reduced by proposing an ERAS protocol as has been obtained for cystectomy. LEVEL OF EVIDENCE: III.

[Risk of rectal perforation during intention to treat laser photovaporization of prostate with transrectal ultrasound guidance: a report of 4 cases]. / Risque de perforation rectale liée à l'utilisation de l'échographie endorectale au cours de la photovaporisation prostatique au laser en intention de traiter : à propos de 4 cas.

CONTEXT: Transrectal ultrasound guidance (TUG) during prostate endoscopic surgery can optimize the procedure by reducing the risk of capsular perforation and ascertain the treatment completeness. TUG is proposed during photoselective vaporisation of prostate (PVP). OBJECTIVE: To report four cases of rectal perforations during PVP with TUG and assess their occurrence. MATERIALS AND METHODS: This is a retrospective study including prostate endoscopic surgeries with TUG, performed in two centers between November 2011 and May 2013. Rectal perforations were identified. Surgical data, treatment modalities and postoperative outcomes of rectal perforations were analysed. RESULTS: Four rectal perforations were identified among 450 surgical procedures. Median age and prostate volume were 80 years old [62-91] and 40mL [13-150], respectively. Two perforations occurred during PVP with Greenlight(®) XPS 180W. Two perforations occurred during transurethral resection of prostate or cervicoprostatic incision. Patients were treated by systematic urinary drainage associated with colostomy or direct suture. Two patients died from this complication and two patients have satisfying functional outcomes at one year. CONCLUSION: TUG during prostate endoscopic surgery could lead to rectal perforation by protusion of the prostate and therefore should be used cautiously. LEVEL OF EVIDENCE: 5.

[Ambulatory prostate photoselective vaporisation with GreenLight laser (180W): prospective evaluation from 115 patients]. / Vaporisation laser prostatique par GreenLight (180 W) en ambulatoire: évaluation prospective sur 115 patients.

OBJECTIVE: The goal of this prospective study was the evaluation of ambulatory (less than 12h) prostate photoselective vaporisation (PVP) with GreenLight laser XPS. MATERIEL AND METHODS: One hundred and fifteen consecutive patients eligible for ambulatory procedure according to selective criteria (age less than 80, no anticoagulation treatment, no diabetes, patient not alone at home) who underwent ambulatory PVP from 1st May 2012 to 30th June 2013 have been evaluated. The principal criterion was the success rate of ambulatory. Secondary criteria were 3 months functional results and complication rate and satisfaction rate on ambulatory procedure. RESULTS: Around 93.1% patients were successfully treated in ambulatory procedure. The main reason of failure was organizational. There were 2 conversions in monopolar resection and one operative complication. At 3 months, there were 11.5% grade 2 complications with 3.48% rehospitalizations and no reintervention. CONCLUSION: This study demonstrates the feasibility of ambulatory PVP. This procedure should be proposed to selected patients.

[Sacral neuromodulation with InterStim™ system: Results from the French national register]. / Neuromodulation sacrée avec le système InterStim™ : résultats du registre national français.

AIM: To analyse current practice patterns and to evaluate (long-term) effectiveness and adverse events of sacral neuromodulation with InterStim™ Therapy based on data collected in a national register and to discuss the strengths and weaknesses of the register. PATIENTS AND METHODS: This is a French multicenter prospective observational trial including patients with a permanent implant (2003-2009). Voiding diary variables and patient satisfaction were analysed based on last follow-up visit since implantation. RESULTS: One thousand four hundred and eighteen patients (median age: 63 years, 1206 females) were included in the database (median follow-up: 12 months). One thousand and eighty-nine patients had non-neurological disease. The principal diagnosis was overactive bladder syndrome ([OAB], n=1170) and retention (n=151). Implantation occurred in 1358 patients; 1172 patients had greater than or equal to one registered follow-up. Clinical improvement of greater than or equal to 50% was seen in 447/527 patients with OAB at 12 months follow-up (median number of voids per 24 hours decreased from 15 at baseline to 8 at 12 months) and in 42/54 of patients with retention (median number of catheterization per 24 hours dropped from 5 at baseline to 0 at 12 months). Clinical improvement remained relatively stable up to 60 months. Median patient satisfaction with treatment was between 60 and 80%. Five hundred and twenty-four patients had at least one adverse event; loss of efficacy (n=244) occurred most frequently. CONCLUSIONS: In this large database sacral neuromodulation with InterStim™ Therapy seems to be an effective treatment through routine practice in the long-term (up to 60 months) for patients refractory to medical treatment.

[PSA and benign prostatic hyperplasia]. / PSA et hypertrophie bénigne de la prostate.

In the opinion of many urologists, prostate-specific antigen (PSA), which is not specific of any disease, is not considered in the diagnosis and follow-up of benign prostatic hyperplasia (BPH). Nonetheless, prostate cancer diagnosis is based on PSA screening. PSA value is thus available for a majority of men above 50. Recent data suggest that there is a link between PSA value and BPH natural history, turning PSA into a tool for BPH management and prevention of complications such as retention. It hasn't got into practice so far, as recommended criteria for PSA screening in BPH have not been issued. The debate over this topic is only at its beginning.

[Synchronous bladder metastasis of a clear-cell adenocarcinoma of the kidney]. / Métastase vésicale synchrone d'un adénocarcinome du rein à cellules claires.

Urinary bladder synchronous metastases from renal cell carcinoma are rare, three cases were reported in the literature and we present the fourth. In these four published cases, the bladder metastases followed a left kidney tumor and in three, a brain metastases was also found. A possible retrograde metastatic dissemination through the left genital and vertebral veins has to be taken in consideration. The short survival after the extirpation of the tumor and the bladder metastases implies a less aggressive approach in the presence of a bladder metastases.

[Extracorporeal lithotripsy for urinary calculi: a non invasive technique? Report of 150 patients treated with the Nova lithotriptor]. / La lithotripsie extra-corporelle pour calcul urinaire: une technique non invasive? A propos de 150 patients traités avec le lithotripteur Nova.

The NOVA apparatus is an electrohydraulic lithotriptor not yet available in France. The authors present an evaluation of the first 150 patients treated with this machine. 92.2% of the 185 stones treated were fragmented. 141 patients were reviewed at 1 month and, if necessary, 3 months after the first session; 4/24 patients and 1/3 patients were not reviewed after their second and third treatment session, respectively. Evaluation of the 177 sessions performed (16% of second sessions and 2% of third sessions), 69.11% of patients did not have any residual stones. The success rate was 52% for renal stones; 96% for stones of the lumbar ureter and 50% for pelvic stones. The morbidity was low (10% of renal colic, 5% of obstructive stone) but in combination with second treatment sessions, it generated a risk of being rehospitalised after the first session of 26%. When the procedures performed under anaesthesia before and after ECL (apart from repeated sessions) are added, the risk of this supplementary anaesthetic for a given patient is 18.66%. Lastly, the risk of undergoing another anaesthetic after the 1st ECL was 33%. These data indicate the limits of the "noninvasive" nature of a modern and effective lithotriptor.

[How to control the Santorini's plexus easily]. / Comment contrôler facilement le plexus de Santorini?

Control of Santorini's plexus is one of the main difficulties of prostatectomy and total cystectomy. Two procedures allow easy control of this plexus: Perform a running haemostatic suture in the bladder neck, from one edge of the pelvic aponeurosis to the other. Apart from ensuring haemostatis by bringing Santorini's plexus together in the midline, this suture also provides excellent exposure of the prostate. Prepare the passage of the dissector at the prostatic apex by disrupting the fibrous tissue with a finger. The urethra is easily identified as it is intubated by the bladder catheter. The avascular plane between the urethra and Santorini's plexus is open to the finger and the dissector can be easily introduced into the correct plane. Section of the venous plexus is performed precisely to reveal the urethroprostatic junction.

Erythrocyte polyamines and prognosis in stage D2 prostatic carcinoma patients.

We studied 43 patients with newly diagnosed, untreated, stage D2 prostatic carcinoma, and correlated the initial performance status, hemoglobin, prostate specific antigen levels, tumor Gleason grade, extent of disease on the bone scan, and erythrocyte spermidine and spermine levels with progression. Three patients died of unrelated causes and were excluded from the study, 16 remained in remission with a mean 28 +/- 11 months of followup and 24 had progression (18, or 75%, of whom died of the cancer) with a mean 12 +/- 9 months of followup (p < 0.05 for followup) after initiation of hormonal therapy. Pretreatment performance status, hemoglobin, and erythrocyte spermidine and spermine levels were correlated with progression, hemoglobin and spermine being the most significant independent variables (p = 0.006 and p = 0.001, respectively). Concerning cause-specific survival, only hemoglobin and spermine erythrocyte levels were significant independent variables (p = 0.02 and p = 0.0025, respectively). If confirmed, polyamine erythrocyte levels obtained by a simple blood sample could discriminate at diagnosis patients with a high risk of rapid hormonal relapse who may benefit from a more aggressive primary management.

[Acquired experience in anesthesia and perioperative intensive care in percutaneous nephrolithotomy. Current approach in the endoscopic treatment of lithiasis and pyelo-ureteral junction anomalies]. / Expérience acquise en anesthésie et réanimation péri-opératoire dans la néphrolithotomie percutanée. Attitude actuelle dans le traitement endoscopique de la lithiase et de l'anomalie de la jonction pyélo-urétérale.

Percutaneous endoscopic treatment of the kidney retains a place in the treatment of renal stones (percutaneous nephrolithotomy--PCNL) and ureteropelvic junction abnormalities (endopyeloplasty). It requires anaesthesia ensuring surgical comfort and safety for the patients despite changes in position and the prolonged ventral supine position. The operation carries certain iatrogenic risks related to caliceal irrigation in patients with more or less documented episodes of infection and carries risks of haemorrhage and effraction of adjacent organs. 282 patients treated by PCNL between 1984 and 1991 were reviewed in order to define the respective indications for general anaesthesia and peridural anaesthesia and to determine the modalities, to evaluate the risk and severity of absorption of irrigation fluid and to assess the risk of infection by defining the indications for prophylactic antibiotics. General anaesthesia, using etomidate and propofol via an infusion pump, ensures surgical comfort, anaesthetic safety and better control of intraoperative complications. The renewed interest in this technique must be counterbalanced by the growing incidence of anaphylactic reactions related to anaesthetic drugs. Operations lasting more than 2 hours, raised intracaliceal pressure, the initially exclusive use of glycine for irrigation induce haemodilution complications, possibly aggravated by glycine intoxication. Repeated surgery is preferable with the use of an Amplatz tube as often as possible and physiological saline, except when required by the operation. Patients with a history of urinary tract infection or infected stones should receive prolonged and effective antibiotics before, during and after the operation. Prophylactic antibiotics are reserved for those patients with no history of infection. These principles equally apply to percutaneous nephrolithotomy and endopyeloplasty.

Accuracy of ultrasound diagnosis after blunt testicular trauma.

The aim of this study is to determine the value of ultrasound evaluation for the diagnosis of testis rupture due to blunt scrotal trauma. We reviewed 16 operated cases of blunt scrotal trauma with hematocele, which were evaluated by ultrasound preoperatively. In 2 cases a tunica albuginea rupture was correctly diagnosed by ultrasonography but there were 2 false-positive and 5 false-negative diagnoses of rupture. Systematic exploration of the 16 cases revealed testicular rupture in 7, simple hematocele in 7 and hematocele associated with spermatic cord injury in 2. In 2 cases orchiectomy was necessary. From our experience the accuracy rate of ultrasound evaluation of blunt scrotal trauma was 56%, with a 58% negative predictive value. Considering these results, ultrasound examination of blunt scrotal trauma with hematocele is not sufficiently accurate to eliminate surgical exploration and, therefore, we recommended early surgical exploration as primary therapy in these cases.

Does detubularization improve continence in bladder replacement?

Camey in the seventies promoted bladder replacement. In 1987, the French Association of Urology gave us the opportunity to review 729 Tubularized Ileocystoplasty (Camey operation) [1]. The day time continence was excellent or acceptable (mild stress incontinence) on 91% of the patients, the night time continence was excellent (no pads, no leakage) or acceptable (one pad or less than 3 wakes at night) for 44% of the patients (56% had to use a device). Since 1985, the detubularization attempted to improve the continence rate. Today, the review of the literature shows that day time continence has not changed and the night time continence improved less than 20% arising from 44% to 60%. Bladder replacement after prostatocystectomy has been proved to be superior to continent urinary diversion in patients whose urethral and external sphincter can be preserved. Day time continence is excellent in tubularized and detubularized bowel reservoirs. Night time continence, in 30 to 50% of patients, remains an unresolved problem also in detubularized low pressure reservoirs, even if they are of great capacity. The literature is therefore too optimistic when describing night time continence in 85% of the patients. These results are stated in spite of the absence of sensitivity in the neobladder, the loss of reflexic increase in sphincteric activity during bladder filling, and the low sphincteric tonus during sleeping. These optimistic results are due to lack of unanimous criteria for evaluating continence after bladder replacement and not taking into consideration as continence failure the abundant although not frequent nighttime incontinence. In order to improve continence, muscle reeducation and artificial sphincter implantation are the most adequate solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Can we do better than surgery in the treatment of benign prostatic hypertrophy? Results after 10 years in endoscopic resection and adenomectomy in urination and sexual disorders]. / Peut-on mieux faire que la chirurgie dans le traitment de l'hypertrophie bénigne de prostate? Les résultats à 10 ans de la résection endoscopique et de l'adénomectomie sur les troubles mictionnels et la sexualité.

Surgery is considered to be the reference treatment for obstructive benign prostatic hypertrophy (NPH). Transurethral resection of the prostate (TURP) and suprapubic prostatectomy are the operations most frequently performed by urologists. However, little information is available concerning the long-term results of this surgery. In order to assess the long-term efficacy, we recalled 618 consecutive patients operated for benign prostatic hypertrophy between 1979 and 1982 (390 by TURP and 228 by suprapubic prostatectomy (SP). 167 patients were reviewed and investigated, 150 had died and 301 were lost to follow-up. Ten years after the operation, 85% of the patients reviewed had good or satisfactory micturition and 72% of them were satisfied, regardless of the technique used. In 80% of patients, no complementary procedure was required to ensure urinary comfort. However, the effects of this surgery on sexual function were considerable, as one half of patients reporting sexual intercourse before the operation reported a deterioration of sexual function after the operation. Lastly, long-term morbidity affected 10 to 41% of patients and 9 to 12% of them were reoperated. Although, overall, surgery gave excellent results at 10 years, 15% of patients did not derive any benefit from the procedure. It is therefore important, in the future, to more clearly define the indications for surgery and the place of noninvasive treatments. At the present time, young subjects wishing to preserve their sex life may benefit from noninvasive first-line treatments, provided their quality of life is sufficiently altered by the severity of the urinary symptoms.

[Percutaneous surgery for lithiasis: results and perspectives. Apropos of 390 operations]. / La chirurgie percutanée pour lithiase: résultats et perspectives. A propos de 390 interventions.

Percutaneous nephrolithotomy (PCNL) has radically changed the treatment of renal stones. The indications for this technique have been modified by the development and refinement of extracorporeal lithotripsy (ECL). The authors present their experience of 390 PCNL performed between 1984 and 1991, for solitary stones in 75% of cases. There were only 11 cases of failed puncture (3.8%). The overall morbidity was 18% with only 4.4% of major complications, i.e. life threatening or requiring reoperation. There were two deaths (0.5%). Stones were completely eliminated in 80.25% of patients, after a second operation (PCNL or other technique) in 32 cases (11%). 45 staghorn calculi were treated with 11% of complications and a 51% complete cure rate. The mean hospital stay was 6 days (2 to 30). PCNL is a safe and reliable technique. Its indications have decreased (6.5% of our patients treated for renal stones), but it still retains a place in the therapeutic approach to patients with renal stones.

Resection of anatomical segments of the liver.

The aim of this report is to review recent experience of removal of anatomical segments of the liver. Resection of one or more segments of the liver was undertaken in 49 patients; in 32 patients, the resection was for malignant disease and in the remainder it was for benign disease. Operating time was 130 (60-600) min and the median transfusion requirement was 0 (0-15) units, with 31 patients having a resection without the need for a blood transfusion. There was no postoperative or in-hospital mortality. The removal of anatomical segments of the liver is a very useful technique for the safe removal of benign and malignant lesions.