Prognostic significance of PI-RADS 5 lesions in patients treated by radical prostatectomy.

PURPOSE: To analyse the pathological features and survival of patients with a PI-RADS 5 lesion on pre-biopsy MRI. METHODS: We extracted from a European multicentre prospectively gathered database the data of patients with a PI-RADS 5 lesion on pre-biopsy MRI, diagnosed using both systematic and targeted biopsies and subsequently treated by radical prostatectomy. The Kaplan-Meier model was used to assess the biochemical-free survival of the whole cohort and univariable and multivariable Cox models were set up to study factors associated with survival. RESULTS: Between 2013 and 2019, 539 consecutive patients with a PI-RADS 5 lesion on pre-biopsy MRI were treated by radical prostatectomy and included in the analysis. Follow-up data were available for 448 patients. Radical prostatectomy and lymph node dissection specimens showed non-organ confined disease in 297/539 (55%), (including 2 patients with a locally staged pT2 lesion and lymph node involvement (LNI)). With a median follow-up of 25 months (12-39), the median biochemical recurrence-free survival was 54% at 2 years (95% CI 45-61) and 28% at 5 years (95% CI 18-39). Among the factors studied, MRI T stage [T3a vs T2 HR 3.57 (95%CI 1.78-7.16); T3b vs T2 HR 6.17 (95% CI 2.99-12.72)] and PSA density (HR 4.47 95% CI 1.55-12.89) were significantly associated with a higher risk of biochemical recurrence in multivariable analysis. CONCLUSION: Patients with a PI-RADS 5 lesion on pre-biopsy MRI have a high risk of early biochemical recurrence after radical prostatectomy. MRI T stage and PSA density can be used to improve patient selection and counselling.

[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.

[Effectiveness of sacral neuromodulation in patients with Parkinson's disease]. / Efficacité de la neuromodulation sacrée chez le patient parkinsonien.

INTRODUCTION: The urinary disorders of the patients with Parkinson's disease are complex and have a negative impact on their quality of life. None of therapy is considered effective ; whether drug or surgical. Sacral neuromodulation, recommended in other neurological pathologies such as multiple sclerosis, has never been studied in the patients with Parkinson's disease. The objective of our study is to assess the efficacy of sacral neuromodulation in the patients with Parkinson's disease. MATERIAL AND METHOD: Multicentric retrospective cohort study, of 22 parkinsonian patients who underwent a sacral neuromodulation test. Epidemiological, clinical and urodynamic data were collected for each patient. A long-term effectiveness telephone survey was conducted. RESULTS: Twenty two patients with Parkinson's disease had a sacral neuromodulation test. 17/22 (77%) had Idiopathic Parkinson's Disease and 5/22 (23%) had Systematized Multi Atrophy. Clinically, the indication for the sacral neuromodulation test was overactive bladder in 68% of the cases. Urodynamically, detrusor hyperactivity is found in 12 patients (8 MPI, 4 AMS). Sacral neuromodulation was effective in only 7 patients (6 MPI and 1 AMS). Rather, the profile of the patient in whom NMS is effective is female, mature, and with PID. The long-term effectiveness of NMS is disappointing. Only 2 permanently implanted patients retained urinary benefit. CONCLUSION: NMS improves urinary symptoms in the patients with Parkinson's disease in 32% of cases. It fluctuates over time and loses its effectiveness in the long term.

Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of lower pole renal stones.

OBJECTIVES: Miniaturization of percutaneous nephrolithotomy techniques have led to their increased consideration for lower pole renal stones that can prove more challenging to reach using retrograde intrarenal surgery. The objectives of the present study were to evaluate and compare the outcomes of miniaturized percutaneous nephrolithotomy (miniPCNL) and retrograde intrarenal surgery (RIRS) for the treatment of lower pole renal stones. MATERIALS AND METHODS: A retrospective study was performed in two academic urology departments between January 2016 and June 2019. Patients presenting with one or multiple stones of the lower calyx and/or renal pelvis, between 10 and 40mm based on CT-scan treated by miniPCNL or RIRS were included. RESULTS: In all, 115 miniPCNL and 118 RIRS procedures were included. The rate of patients with no significant residual fragment (stone free rate) after the first procedure was higher in the miniPCNL group (69% vs. 52% P=0.01), especially for stones>20mm (63% vs. 24% respectively, P<0.001) and stones with a density≥1000HU (69% vs. 42% respectively, P=0.009). The higher stone free rate of miniPCNL was confirmed in multivariate analysis, adjusting for stone size and number of stones, OR 4.02 (95% CI 2.08-8.11, P<0.0001). The overall postoperative complication rate was higher in the miniPCNL group than in the RIRS group (23% vs. 11%, P=0.01). A second intervention for the treatment of residual fragments was necessary for 9.6% of patients in the miniPCNL group versus 30.5% of patients in the RIRS group (P<0.001). Pre-stenting rate and duration of ureteral drainage (2 [1-8] vs. 25 days [7-37], P<0.001) were lower in the miniPCNL group. CONCLUSIONS: The stone free rate was higher after miniPCNL, especially for stones>20mm and with a density>1000 HU, but was associated with a higher risk of postoperative complications and a longer hospital stay. RIRS resulted in fewer complications at the cost of a higher retreatment rate and longer ureteral stenting. LEVEL OF EVIDENCE: 3.

Evolution of patients with and without preoperative stress urinary incontinence after surgical cystocele repair by mesh implantation using a vaginal approach.

INTRODUCTION: To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. MATERIAL AND METHODS: Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. RESULTS: Thirty-six women were included (mean age: 72±7years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41±12min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n=6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR=2.0 [95% CI: 0.8175-4.8928]; P=0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. CONCLUSION: Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. LEVEL OF EVIDENCE: 4.

Elastic fusion biopsy versus systematic biopsy for prostate cancer detection: Results of a multicentric study on 1,119 patients. / Evaluación de la biopsia de fusión elástica vs. biopsia sistemática para la detección del cáncer de próstata: resultados de un estudio multicéntrico en 1.119 pacientes.

OBJECTIVES: To assess the accuracy of targeted and systematic biopsies for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in the everyday practice, evaluating the need for additional systematic biopsies at the time of targeted biopsy. PATIENTS AND METHODS: From our multicentric database gathering data on 2,115 patients who underwent fusion biopsy with Koelis™ system between 2010 and 2017, we selected 1,119 patients who received targeted biopsies (a median of 3 for each target), followed by systematic sampling of the prostate (12 to 14 cores). Overall and clinically significant cancer detection rate (CDR) of Koelis™ fusion biopsies were assessed, comparing target and systematic biopsies. Secondary endpoint was the identification of predictors of PCa detection. RESULTS: The CDR of targeted biopsies only was 48% for all cancers and 33% for csPCa. The performance of additional, systematic prostate sampling improved the CDR of 15% for all cancers and of 12% for csPCa. PCa was detected in 35%, 69%, and 92% of patients with lesions scored as PI-RADS 3, 4 and 5, respectively. Elevated PI-RADS score and positive digital rectal examination were predictors of PCa, whereas biopsy-naïve status was associated with csPCa. CONCLUSION: In the everyday practice target biopsy with Koelis™ achieves a good CDR for all PCa and csPCa, which is significantly improved by subsequent systematic sampling of the prostate. The outstanding outcomes of fusion biopsy are confirmed also in biopsy-naïve patients. Elevated PI-RADS score and positive digital rectal examination are strongly associated with presence of PCa.

[Simulation-based training in urology: A systematic literature review]. / Formation par la simulation : de quels outils disposons-nous en urologie ? Revue systématique de la littérature.

CONTEXT: Simulation-based training is taking an increasingly important place in surgical training and is becoming mandatory with the latest reform of the French medical studies. OBJECTIVES: The objectives of this work were to report the various simulation tools available for the surgical training in urology, along with their validation level, through a systematic literature review. DOCUMENTARY SOURCES: A search was conducted using Medline® with the terms "urology" and "simulator". Articles in English and French were selected. STUDY SELECTION: Two hundred and ninety-one abstracts were read, allowing for the selection of 154 articles read to assess their eligibility. Studies whose main objective was not the validation of a simulator, studies describing animal models or studies whose full text was not available were excluded. RESULTS: One hundred and six studies were analyzed in this review. The simulators described were classified in 7 categories: laparoscopic surgery, robotic surgery, ureteroscopy, percutaneous nephrolithotomy, endoscopic bladder and prostate surgery, basic skills in urology, and ultrasound-guided prostate interventions simulators. Apparent and content validity were demonstrated for most simulators, but construct and predictive validity were often lacking. LIMITATIONS: We did not consider the use of simulators as competency evaluation tools. Besides, the latest terminology proposed to define the various validation steps was not taken into account. CONCLUSION: Many simulators are available in the field of urology and allow the reproduction of a large variety of urological procedures. However, their validation level is inconsistent, and has to be taken into account when choosing a simulator for surgical training, along with its cost, the eagerness of students to use the simulator and its availability.

[Long-term follow-up of continent cystostomy with the Mitrofanoff procedure: 5 years later]. / Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l'adulte : résultats à 5 ans.

INTRODUCTION: This study analyzed long-term functional outcome of continent catheterizable channels with the Mitrofanoff procedure, their continence, complications and the satisfaction of the patients. MATERIAL AND METHOD: Data from patients who underwent a Mitrofanoff procedure at our institution from June 1997 to March 2015 were retrospectively collected. All patients were contacted at the end of the study, a survey was submitted to them. RESULTS: Sixty-seven patients underwent a continent cystostomy with the Mirtrofanoff procedure. Forty-five patients had the inclusion criteria: 18 years old or older, no previous urinary diversion with a minimum of 6 months of follow-up. The cohort comprised mainly neurologic bladder (84 %) with spinal cord injuries (54 %) or spina-bifida patients (15 %). Median age was 35 years old [22-49]. Median follow-up was 64months [39-90]. The surgical procedure used an appendicular channel: 30 patients (67 %) or a continent ileal plasty: 15 patients (33 %). At the end of follow-up: 88 % patients have a full cystostomy continence, 89 % full uretral continence. Twenty-nine patients had one (41 %) or more reinterventions. Reasons for the 58 reinterventions were: stomal stenosis (31 %), uretral incontinence (29 %), cystostomy incontinence (15 %), lithiasis (9 %). Those reinterventions were done with a local surgery (31 %) or an endoscopic surgery (35 %). Overall early adverse events (<30days) or delayed (>30days) adverse events were similar (P=0.93) in appendicovesicostomy group or continent ileal plasty group. Ninety-four percent patients described a satisfactory urinary comfort. The cystostomy was considered esthetic by 71 %, its realization allowed an improvement of the quality of life for 89 % of them. CONCLUSION: Continent channels in adults demonstrate favorable long-term outcomes even if reinterventions could be necessary to maintain a continent and catheterizable channel. Despite reinterventions, patients remain satisfied by the Mitrofanoff procedure which facilitate the process of clean intermittent catheterization. LEVEL OF EVIDENCE: 4.

A multicentric study on accurate grading of prostate cancer with systematic and MRI/US fusion targeted biopsies: comparison with final histopathology after radical prostatectomy.

OBJECTIVE: To evaluate the accuracy in histologic grading of MRI/US image fusion biopsy by comparing histopathology between systematic biopsies (SB), targeted biopsies (TB) and the combination of both (SB + TB) with the final histopathologic outcomes of radical prostatectomy specimens. MATERIALS AND METHODS: Retrospective, multicentric study of 443 patients who underwent SB and TB using MRI/US fusion technique (Urostation® and Trinity®) prior to radical prostatectomy between 2010 and 2017. Cochran's Q test and McNemar test were conducted as a post hoc test. Uni-multivariable analyses were performed on several clinic-pathological variables to analyze factors predicting histopathological concordance for targeted biopsies. RESULTS: Concordance in ISUP (International Society of Urological Pathology) grade between SB, TB and SB + TB with final histopathology was 49.4%, 51.2%, and 63.2% for overall prostate cancer and 41.2%, 48.3%, and 56.7% for significant prostate cancer (ISUP grade ≥ 2), respectively. Significant difference in terms of concordance, downgrading and upgrading was found between SB and TB (ISUP grade ≥ 2 only), SB and SB + TB, TB and SB + TB (overall ISUP grade and ISUP grade ≥ 2) (p < 0.001). Total number of cores and previous biopsies were significant independent predictive factors for concordance with TB technique. CONCLUSION: In this retrospective study, combination of SB and TB significantly increased concordance with final histopathology despite a limited additional number of cores needed.

[Place of partial nephrectomy assisted by robot: Review of the literature at the time of a request for a specific nomenclature]. / Place de la néphrectomie partielle assistée par robot : revue de la littérature à l'heure d'une demande de nomenclature spécifique.

INTRODUCTION: Robot-assisted surgery is practiced more and more frequently in urology. Besides its place in prostatectomy for cancer, it also concerns partial nephrectomy (NP), in the treatment of renal tumors. The objective of this review is to compare the robot-assisted approach with laparoscopic or open approaches in partial nephrectomy in terms of functional or oncological outcomes and per- and postoperative complications. MATERIAL AND METHODS: A systematic review of the literature published from 2009 was carried out on PubMed. Clinical studies or meta-analyzes comparing robot-assisted surgery versus laparoscopic or open surgery in the NP domain were used. RESULTS: The clinical data presented in this review of the literature are based mainly on meta-analyzes of comparative studies. Patients operated with robotic assistance (NPAR) had significantly fewer postoperative complications than patients operated by open (RR 0.61; P=0.0002) or laparoscopic surgery (RR 0.84; P=0.007). Positive margins, at equivalent pathological stages, are comparable to the open and appear to be lower than the laparoscopic surgery (RR 0.53; P<0.001). After NP, the change in postoperative glomerular filtration rate (GFR) appears to be identical between the 3 pathways. Hot ischemia time is significantly shorter for NPAR compared to NPL. Finally, the estimated blood loss and length of stay are less severe in patients operated by NPAR compared to those operated by open surgery. CONCLUSION: Robot-assisted surgery offers the same oncological results (in the short and medium term) and appears to improve functional outcomes and morbidity. However, these findings need to be carefully analyzed, due to the low level of evidence from the studies presented and included in the meta-analyzes, and the lack of randomized clinical studies.

Open prostatectomy versus 180-W XPS GreenLight laser vaporization: Long-term functional outcome for prostatic adenomas>80 g.

INTRODUCTION: GreenLight photoselective vaporisation of the prostate (PVP) offers an endoscopic alternative to open prostatectomy (OP) for treatment of large adenomas. This study compares long-term functional outcome of both techniques in patients with Benign prostatic obstruction (BPO)>80g. MATERIAL AND METHOD: Data from patients who underwent surgical treatment for BPO>80g from January 2010 to February 2015 at our institution were retrospectively collected and compared according to surgical technique. Patient's demographics, surgeon's experience, operative data and long-term functional results were analyzed, using IPSS and International continence society (ICS) male questionnaire associated with Quality of life scores (IPSS-QL and ICS-QL). Predictors of long-term outcome were also assessed. RESULTS: In total, 111 consecutive patients, 57 PVP and 54 OP, were included in the study with a mean follow-up of 24 and 33 month respectively. Patient's age, Charlson score, preoperative IPSS and urinary retention rates were similar. Mean prostatic volume was superior in the OP group (142 versus 103g, P<0.001). Transfusion rate was lower after PVP (P=0.02), despite a more frequent anticoagulant use. Length of hospital stay and urinary catheterization were shorter after PVP (P<0.001), with however a higher rate of recatheterization (RR=4.74) and rehospitalization (RR=10.42). Long-term scores were better after OP for IPSS (1 versus 5, P<0.001), IPSS-QL, ICS, ICS-QL. On multivariate analysis, prostatic residual volume was the only predictor of long-term IPSS but not ICS. CONCLUSION: Long-term functional outcome are better after OP compared to PVP. However, PVP offers good results, allowing to safely operate patients taking anticoagulants, regardless of prostatic volume. Endoscopic enucleation may the compromise between both techniques. LEVEL OF EVIDENCE: 4.

[Evaluation of the French practices in brachytherapy using surveys]. / Évaluation par questionnaire des pratiques de la curiethérapie de prostate en France.

INTRODUCTION: Prostate cancer brachytherapy can be used as an alternative to the radical prostatectomy and radiotherapy. In the low-risk group, specific survivals are up to 95% after 10years. The aim of the study is to describe the practices in brachytherapy in France. MATERIALS AND METHODS: A survey made by AFU (French Urologic Association) and SFRO (French Society Of Oncological Radiotherapy) assessing the practices in brachytherapy in France was sent to all the urologists and radiotherapists even if they did not practice it. RESULTS: In total, 1417 surveys were sent, 285 were received coming from 211 urologists (74%) and 74 radiotherapists (26%). Sixty (21%) practiced brachytherapy (31 urologists, 29 radiotherapists). Low dose rate with permanent implants was used in 83,3%. Brachytherapy was advised for low-risk group by 90% who responded the survey, 73% used it in intermediate risk and only 13% in high risk. CONCLUSION: Brachytherapy is hardly used in low risk prostate cancer. It probably needs a reconsideration of recommendations due to the good results in association with a good picking. The urologist-radiotherapist couple is essential in the overall care of the patient. LEVEL OF EVIDENCE: 4.

[Robot assisted radical prostatectomy: What are the evidences at the time of a specific funding?] / Prostatectomie radicale laparoscopique robot-assistée : quelles sont les preuves à l'heure d'une demande de nomenclature spécifique ?

INTRODUCTION: Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities. MATERIAL AND METHODS: A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected. RESULTS: There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP. CONCLUSION: RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.

[Management of intraparenchymal pseudoaneurysm after blunt renal trauma: Results from a series of 325 patients]. / Prise en charge des pseudo-anévrismes rénaux intraparenchymateux post-traumatiques : à propos d'une série de 325 patients traumatisés rénaux.

INTRODUCTION: The purpose was to describe the management of intraparenchymal pseudoaneurysm (PA) after blunt renal trauma in our center, and to review the cases published in the literature, in order to propose a management algorithm. MATERIALS AND METHODS: We reviewed the files of 325 patients included in a prospective database, from July, 2004, to May, 2016. A systematic review of the published cases was done with the keywords "blunt renal trauma" and "pseudoaneurysm" in Pubmed (excluding arteriovenous fistulas, open renal traumas and extraparenchymal PA) allowing us to analyze 29 extra cases. Management of these patients in our center is decribed. RESULTS: Among 325 kidney trauma patients, 160 (49.3%) had grade IV and V renal trauma. Conservative management was done in 93.2%. We noted 8 cases of PA, with an incidence of 2.5%. Four patients required angioembolization. Four patients were treated by watchful waiting, with 2 cases of spontaneous occlusion, one case of absence of regression and embolization, and one case of occult hemorrhage. All PA with a favorable outcome were less than 1cm. The mean relative renal scintigraphic function at 6 months of the kidneys requiring embolization was 71.6%. The literature review reported 29 published cases, among whom 26 required embolization, with a success rate of 84.6%. Two cases were just watched, but one was finally embolized in the absence of regression. CONCLUSION: Pseudoneurysm formation after blunt renal trauma is a rare complication (2.5%). In case of clinical symptoms or hemodynamic instability, embolization allows a good renal preservation. Watchful waiting seems to be an option in asymptomatic cases with a PA less than 1cm. LEVEL OF EVIDENCE: 5.

[The PSA caught out]. / Le PSA pris en défaut.

INTRODUCTION: With the widespread use of prostate specific antigen (PSA) prescription and despite the automatization of PSA assessment, clinicians should not forget the analytical interference of PSA immunoassays due to the presence of heterophilic autoantibodies in a patient. MATERIAL AND METHODS: This article details some clinical cases, mechanisms involved in the interference and how to overcome this problem. RESULTS: The reported and documented interferences led to useless explorations even erroneous diagnosis. CONCLUSION: Before any unexpected PSA value in relation to the clinical symptomatology, it is strongly recommended to verify the absence of any interference before any invasive procedure or therapy modification.

[Renal transplantation using a Maastricht category III non-heartbeating donor: First French experience and review of the literature]. / Transplantation rénale à partir d'un donneur décédé par arrêt circulatoire Maastricht III : première expérience française et revue de la littérature.

In 2015, Annecy Hospital was the first French hospital to perform non-heartbeating organ donation from a Maastricht category III donor (patient awaiting cardiac arrest after withdrawal of treatment). Non-heartbeating organ donation (NHBD), performed in France since 2006, had initially excluded this category, due to ethical questions concerning end of life and treatment withdrawal, as well as technical specificities linked to this procedure. Grenoble University Hospital and Edouard-Herriot Hospital in Lyon then performed the first kidney transplants, with satisfactory outcomes in both recipients. This article presents the details and results of this new experience, challenging both on a deontological and organizational level. Functional outcomes of kidney grafts from NHBD are now well known in the literature and confirm their benefit for patients, with similar results to those from heartbeating donors (HBD). International experiences concerning specifically Maastricht category III NHBD are encouraging and promising.

[Ablative treatments in localized renal cancer: literature review for 2014]. / Les traitements ablatifs dans le cancer du rein localisé : revue de la littérature en 2014.

OBJECTIVE AND METHOD: To focus on indications and results of ablative treatments (cyoablation, radiofrequency) for small renal masses, a bibliographic research was conducted in MedLine database using terms of "ablative treatment", "cryotherapy", "radiofrequency", "kidney cancer", "renal cell carcinoma". Sixty-four articles were selected. RESULTS: Carcinologic outcomes seem to be better with cryoablation than with radiofrequency. Available results have to be balanced according to surgical approach, teams' experience and duration of follow-up. Tumour's size and central localization are the main factors of failure. The size of 3cm is the most generally validated. Hospital stay and complications seem to be better with ablative therapies than with surgical approach, especially with percutaneous approach. The renal function preservation appears to be better with ablative therapies. It could be an interesting alternative to partial nephrectomy for small masses, in particular for fragile patients or in particular indications (multifocal tumors, in case of solitary kidney or transplanted kidney). The indications in elderly people must be proposed with care after the comorbidities have been evaluated. CONCLUSION: Indications of ablative treatment for small renal masses improve, but the gold standard treatment remains partial nephrectomy and indications must be individually discussed. Other ablative treatments are under-development, needing further studies.

[Use of social media by French urologists: Results from a study of the National French Urological Association]. / Utilisation des réseaux sociaux par les urologues français : résultats d'une étude de l'Association française d'urologie.

PURPOSE: Social Media (SoMe) have changed the face of modern medicine. Our purpose was to make an inventory on the use of SoMe within urologists members of the French Urological Association (AFU). MATERIAL AND METHODS: A 15 questions-survey was sent by email 2 months to urologists AFU members before the 108th French Congress of Urology (#CFU2014). At the same time, the activity of urologists using Twitter was analyzed over the period of the national conference with the symplur software (www.symplur.com). RESULTS: Overall, 270 (17.3%) surveys were completed. Only 50% of responders had an online SoMe account. The most commonly used social media platforms were: Facebook (36.1%) followed by LinkedIn (28.2%), Google+ (19.6%), YouTube (18.7%) and Twitter (17.4%). The use of SoMe was higher in the age groups 30-40 and 40-50 years than in older age groups (83% versus 36%). Only 38.7% of respondents reported using SoMe in a professional field. At the congress #CFU2014, there were over 1000 tweets generated by 173 different contributors. CONCLUSION: Only a minority of French urologists have reported to be connected to SoMe and a predominantly personal use. The emergence of Twitter in French urological conferences is very new but seems promising. Further studies are needed, especially within the members of the residents French urological association to better characterize the true impact of SoMe in urology. LEVEL OF EVIDENCE: 4.

[Biochemical recurrence after curative treatment for localized prostate cancer: Performance of choline PET/CT in the assessment of local recurrence]. / Récidive biochimique après traitement curatif d'un adénocarcinome prostatique localisé: intérêt de la TEP à la choline dans l'évaluation de la récidive locale.

OBJECTIVE: To establish 18 fluorocholine-positron emission tomography/computed tomography (F-PET/CT) performances for the detection of local recurrence in a population of patients with biochemical failure after primary curative treatment for localized prostate carcinoma. MATERIAL AND METHOD: From February 2011 to February 2014, 55 patients underwent a F-PET/CT for biochemical relapse after primary radical therapy for prostate cancer localized or locally advanced. Primary therapies for prostate cancer were 19 radical prostatectomy, 18 radiotherapy, 13 radiotherapy with hormonal treatment, 3 brachytherapy. The median age was 65 years (50-79). The initial staging was 17 T1, 23 T2 and 15 T3, 52 were N0 and N1 3. The median PSA was 12 (3-127). The Gleason score was less than 7, equal to 7 and greater than 7 at 21, 25 and 9 patients respectively. The average time to recurrence was 69.5 months (8-147) with a median PSA of 2.9 ng/mL (0.48-41). RESULTS: In 42 cases, F-PET/CT showed uptake, suggesting a recurrence, metastatic (6), nodal (26) or local isolated (10). The focal uptake in PET commissioned in 5 cases prostate biopsy, confirming the histological recurrence of prostate cancer in 4 cases. Among the 10 patients with isolated local recurrence, 8 underwent salvage radiotherapy. Of the 13 cases where the (F-PET/CT) showed no recurrence, 7 multiparametric MRI were performed. The MRI showed a local recurrence in 3 patients, the diagnoses were confirmed with prostate biopsy for two of them. CONCLUSION: In our study, for the patients with biochemical relapse of prostate adenocarcinoma localized or locally advanced, (F-PET/CT) was able to detect local recurrence isolated in nearly half the cases but did not show sufficient sensitivity to exclude recurrence local if negative. It does not replace MRI or additional prostate biopsy.