[Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]. / Recommandations du Comité Lithiase de l'Association Française d'Urologie pour la prise en charge des calculs urinaires durant la crise sanitaire liée à la pandémie à COVID-19.

For the first time, faced with a crisis with an exceptional magnitude due to the COVID-19 pandemic responsible for saturation of emergency services and intensive care units, the urolithiasis committee of the French Urology Association designed the recommendations for care and treatment of stone-forming patients and their treatment during crisis.

[Double J stent removal's cost estimate using a re-sterilizable fibroscope in a French private structure]. / Évaluation du coût en structure privée d'une ablation de sonde double J en externe à l'aide d'un fibroscope re-stérilisable.

In front of the arrival of new devices intended to simplify the removal of double J stent, it poses the problem of the knowledge of the real cost of such an ablation under the current conditions of realization. MATERIAL AND METHOD: This is a monocentric economic evaluation of cost and remuneration needed data-gathering of quotation (CCAM, GHS/SE, …), estimate of the associated costs of wear and damping of the endoscopic equipments (endoscopes, cables, …), estimate of the cost of sterilization, estimate of the associated costs to the intervention of staff (Auxiliary nurse [AS] and Nurse [IDE]) with timing of the various tasks. RESULTS: Quotation CCAM JCGE004 (48€) gives access to fixed price SE1 (73.71€ for private clinic, and 75.89€ for public institution) without hospitalization nor anaesthesia. The costs were reported to an act of single double J removal. Concerning the equipments: 4.42€HT for the fibroscopes, graspers, cable and light. The costs of sterilization were: 17.95€HT. The timed workforce's costs were: 7.61-9.51€ for AS and 9.92-10.84€ for IDE. The cost of consumable was about 1.37 €HT, by excluding the common base from the extractions (1.876€HT). The total costs in France in 2016 were thus about 47.4 to 50.496€ including all taxes. CONCLUSIONS: This estimate will be used certainly for reflection on the investments and the future studies of the economic impact of the new devices of extraction, by correlating it of course with the various maintenance contracts from each institution. LEVEL OF PROOF: 4.

[Management of adult's renal and ureteral stones. Update of the Lithiasis Committee of the French Association of Urology (CLAFU). General considerations]. / Prise en charge urologique des calculs rénaux et urétéraux de l'adulte. Mise au point du Comité Lithiase de l'Association Française d'Urologie (CLAFU). Aspects généraux.

The Lithiasis Committee of the French Association of Urology (CLAFU) aimed to update the current knowledge about urolithiasis. This update will be divided into four parts: 1) general considerations; 2) the management of ureteral stones; 3) the management of kidney stones; 4) metabolic assessment and medical treatment of urolithiasis. Recent technicals advances helped the urologists to improve stones management: new extracorporeal shockwave lithotripsy (ESWL) devices, new flexible ureterorenoscopes, development of laser fragmentation. ESWL, semi-rigid and flexible ureteroscopy and the percutaneous nephrolithotomy (PCNL) remain currently the main therapeutic options. The first part of this update deals with the description and classification of stones, preoperative assessment, post-operative management and clinical follow-up. Main criteria of therapeutic choices are stone location, stone composition and stone size. Stone composition is assessed with infrared spectrophotometry analysis and its hardness is correlated with U.H. density on CT scan assessment. Preoperative assessment consists in urinary cytobacteriological examine, urinary PH, blood creatininemia, hemostasis. Low-dose CT scan is recommended before urological treatment. The result of the treatment must be done 1 or 3 months later with plain abdominal film and ultrasonography. Medical management of urolithiasis will be based on stone composition, metabolic and nutritional evaluation. Treatment success is definited by absence of residual fragments. Annual follow-up is recommended and based either on plain abdominal film and ultrasonography or low-dose CT scan.

[Place of the flexible ureterorenoscopy first choice for the treatment of kidney stones. Survey results practice committee of the AFU lithiasis completed in 2011]. / Place de l'urétérorénoscopie souple en première intention pour le traitement des calculs du rein. Résultats de l'enquête de pratique du comité lithiase de l'AFU réalisée en 2011.

UNLABELLED: The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation. METHODS: Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney. RESULTS: Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient. CONCLUSION: The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL).

Morbidity of radical retropubic prostatectomy following previous prostate resection.

A total of 153 patients with prior prostate surgery underwent a radical retropubic prostatectomy for carcinoma of the prostate. Ninety-seven patients had undergone transurethral resection of the prostate (TURP), and 56 patients had undergone suprapubic transvesical prostatectomy (SPP). In 115 patients, the diagnosis of malignancy was made at the time of transurethral resection or enucleation. No perioperative deaths occurred and no patient suffered rectal injury or ureteral transection. Operative time and blood loss were similar between the TURP and SPP groups and were not different in a group of patients who had not had prior prostate surgery. Early and late complications occurred in eight patients (5.2%), of whom seven had had previous TURP. Complete urinary control was achieved in 96% (147) of the patients; stress incontinence was present in 4% (6 patients); and no patient was totally incontinent. Postoperative complications and the occurrence of stress incontinence were not related to the time elapsed between the previous prostate surgery and the radical prostatectomy. Sexual function was preserved in 32 (71%) of the 45 patients in whom we performed a nerve-sparing radical prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 77 (67%) of the stage A patients. Twenty-nine (25%) of the stage A and 13 (34%) of the stage B patients had pathological evidence of disease extension beyond the confined prostate. Follow-up was 6-92 months, with a mean of 32 months. Four patients died of prostatic cancer, two patients died without cancer, and five have evidence of disease progression; 142 (93%) are alive without evidence of disease. Although radical prostatectomy sometimes is more difficult after previous prostate surgery, operative complication rates, patient morbidity, and the opportunity for surgical cure are not different from those seen in patients with no history of previous prostate operations.

Urinary continence following radical retropubic prostatectomy.

Between 1983 and 1989, 484 men (46-82 years old) underwent radical retropubic prostatectomy for prostate cancer. Six months after surgery, 434 patients (90%) achieved complete urinary control; stress incontinence was present in 50 patients (10%) and no patient was totally incontinent. Of the 398 patients who were followed up for more than 1 year, 377 (95%) achieved complete urinary control and 21 (5%) experienced stress incontinence. Prior open prostatectomy or transurethral resection of the prostate had no influence on the return of urinary control. Pathological stage and preservation or not of the neurovascular bundles also had no significant influence on the long-term state of continence. Age was the only factor that adversely affected the return of urinary continence. The average interval between surgery and return of continence was shorter in patients less than 70 years old. When the impact of age was examined 1 year or more after surgery, no significant difference was noted between the age groups. Several technical considerations that contribute to these results are discussed, especially the use of a gradual approach to the apex of the prostate to facilitate exposure and haemostasis and to preserve as much of the striated urethral sphincter as possible.

Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive cases.

We describe our experience and complications of radical retropubic prostatectomy. From March 1983 through December 1990, 620 consecutive patients have undergone an anatomical radical retropubic prostatectomy for the treatment of prostatic carcinoma. The surgical technique we used is described. In 167 patients the procedure included preservation of the neurovascular bundles. There were no modifications in the surgical technique during this period. There were no operative deaths. Mean operating time was reduced from 3 hours in the first 100 patients to 1.5 hours in the last 220 patients. The average blood loss was reduced remarkably as well. There were only 3 cases of rectal injury, which were closed primarily and healed completely. One patient died of acute myocardial infarction 12 days after an uneventful operation. This patient accounted for the only perioperative death in our experience. Early complications occurred in 43 patients (6.9%), including only 2 cases (0.3%) of anastomotic urinary leakage. The late complication rate, excluding incontinence and impotence, was 1.3%. No patient was totally incontinent. Among the patients who were followed for 1 year or longer 95% achieved complete urinary control and 5% experienced stress urinary incontinence. Preservation of sexual function in patients who underwent a nerve-sparing operation was achieved in 71%. Our results indicate that radical retropubic prostatectomy can be performed with low morbidity and without affecting the quality of life in the majority of patients.

Preservation of urinary continence and potency after cystoprostatectomy.

Between 1980-1989 a total of 349 patients underwent one-stage radical cystoprostatectomy and an orthotopic bladder substitution. 278 patients underwent the Camey I bladder replacement and in 71 patients a detubularized ileal loop was utilized (Camey II). 75 patients underwent a potency-sparing cystectomy (32 patients of the Camey I and 43 patients of the Camey II groups). All patients were followed at least one year and had continence and potency assessment. Among the patients who underwent the Camey I procedure, 66% achieved daytime continence and 21% night-time continence 6 months after surgery. One year after surgery 86% of patients had normal continence during the day and 47% was continent during the night. 14% of patients had episodes of day-time incontinence one year after surgery. Among the patients who underwent the Camey II bladder replacement 86% achieved day-time continence and 59% night-time continence 6 months after surgery. At one year after surgery 91% was continent during the day, 72% was dry during the night and only 9% had episodes of diurnal incontinence. Potency was achieved in 24 of 32 patients (75%) with the Camey I bladder substitution, and in 34 of the 43 patients (79%) with the Camey II bladder substitution. Our data demonstrate that excellent rates of continence and potency are achievable in the post-cystectomy population. Patients with the Camey II bladder replacement achieve continence earlier than patients with the Camey I bladder substitution. Diurnal continence is slightly better after the Camey II procedure, one year after surgery, but the difference is not statistically significant. Nocturnal continence is significantly better with the Camey II bladder substitution.

Radical prostatectomy in the management of stage A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimens in 11 of the 29 stage A1 patients (38%) and in 66 of the 86 stage A2 patients (77%). Fourteen percent of the stage A1 patients and 29.5% of the stage A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients were alive at the time of this study and only 3 patients suffered disease progression. These 3 patients were among the stage A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. Twenty-six patients who also had evidence of disease extension were alive without evidence of disease. These data demonstrate that patients with stage A disease are at risk for disease progression if left untreated and with a morbidity as low as that achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.

Radical retropubic prostatectomy: complications and quality of life (429 cases, 1983-1989).

From March 1983 to December 1989 we have performed radical prostatectomy on 429 patients with prostate cancer. With 117 of the cases we performed the sparing nerve procedure. Follow-up was 6-72 months. Early postoperative complications concerned 36 patients (8.4%). We have not had any total incontinence. After a 6-month postoperative period we had a rate of 13.8 +/- 3% of stress incontinence with a confidence level of 95%. This percentage changed to 6.2 +/- 3% after a 12-month period. 33% of the patients after 6 months and 68.5% after 1 year reported full potency with similar pre- and postoperative quality of sexual intercourse. To manage localized prostate cancer it is important to know that with radical prostatectomy we can obtain an excellent quality of life with low morbidity even if the best management of localized prostate cancer is not resolved.

Radical prostatectomy in the management of stage-A carcinoma of the prostate.

A total of 115 patients (29 with stage A1 and 86 with stage A2 prostate cancer) underwent radical retropubic prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 11 of the 29 stage-A1 patients (38%) and in 66 of the 86 stage-A2 patients (77%). 14% of the stage-A1 patients and 29.5% of the stage-A2 patients had pathological evidence of disease extension beyond the confined prostate. No perioperative death occurred and no patient suffered rectal injury or was totally incontinent. Early postoperative complications occurred in 6 patients (5%). There were no late complications. Complete urinary control was achieved in 111 patients (96.5%) and stress urinary incontinence was present in 4 patients (3.5%). Sexual function was preserved in 21 of the 26 patients (81%) who underwent a nerve-sparing radical prostatectomy. Follow-up ranged from 12 to 84 months with a mean of 30 months. All patients are alive, and only 3 patients suffered disease progression. These 3 patients were among the stage-A2 group and had pathological evidence of tumor extension beyond the prostatic capsule. 26 patients who also had evidence of disease extension are alive without evidence of disease. These data demonstrate that patients with stage-A disease are at risk for disease progression if left untreated and, with morbidity as low as achieved in our series, radical prostatectomy should remain an optimal option for tumor control in these patients.

[Rigid ureteroscopy and the pulsed laser. Apropos of 325 treated calculi]. / Urétéroscopie rigide et laser pulsé à colorant. A propos de 325 calculs traités.

A pulsed dye laser (Candela) was used in our lithiasis treatment center during the period 02/88-09/89 to remove 325 calculi in 278 patients, requiring 285 endoscopic instrumentations. The pulsed laser allowed to obtain fragmentation of 318 calculi, 238 of which were reduced to thin sand and 80 to coarser fragments. The latter were either cleared using a Dormia probe or further disintegrated by electrohydrolytic shock wave treatment or extracorporeal shock wave lithotripsy (ESWL). No complication imputable to laser stone fragmentation was noted. Failure of stone clearance was chiefly due to the nature and shape of the stone (black, smooth monohydrated calcium oxalate calculi). The thinness of the laser fiber has made it possible to use small caliber ureteroscopes, thereby increasing the reliability of ureteroscopy. Coupled with ESWL (EDAP LT01), this technique has caused the rate of open surgical removal of ureter confined calculi to fall from 11% to 1%.

Ileal low-pressure bladder replacement: Camey type II. Stapling technique and preliminary results (57 cases, 1987-1989).

In keeping with the basic principles of Camey's procedure and with a view to improve continence, we decided in 1987 to experiment with the technique of ileal low-pressure bladder replacement (Camey II). We introduced the stapling technique in order to save time and to obtain watertight, reliable sutures. 57 patients underwent a Camey II intervention following radical cystectomy. Follow-up was 3-24 months. No operation mortality was observed and only 5 perioperative complications were recorded. Continence during the day and at night increased rapidly with Camey II (50% at 3 months, 90% at 6 months). Camey II improves the patients' quality of life; the procedure is simple, fast and reliable thanks to the stapling technique.

Pulsed dye laser in the treatment of 325 calculi of the urinary tract.

The pulsed dye laser (Candela) has been used from February 1988 to September 1989 in order to treat 325 stones in 278 patients. A total of 285 endoscopies has been performed. The pulsed laser has helped to achieve the fragmentation of 318 stones. Laser fragmentation has not induced any complication at all. The main failures can be attributed to the nature and shape of the stone. Thanks to the thin laser fiber, the use of small diameter ureteroscopes has increased the reliability of ureteroscopy. The use of this technique combined to extracorporeal shock wave lithotripsy (ESWL) has reduced the rate of open surgery for ureteral stones down to less than 1%.

[Treatment of ureteral lithiasis using rigid ureteroscopy]. / Traitement des lithiases urétérales par urétéroscopie rigide.

The authors report 46 cases of rigid ureteroscopy for ureteral stone removal. Ureteroscopy procedures for extraction of lithiasis are the next-ones: stone forceps, stone basket, ultrasonic lithotripsy and electrohydraulic lithotripsy. Manipulation of calculi is done under direct vision. A success rate of ureteroscopy was of 89% (41 patients). All of the patients with stone removal failure underwent immediate operative intervention (open ureterolithotomy in 4 patients and ureteral reimplantation in 1). The best results were obtained for distal calculi (pelvic lithiasis): success rate of 91.4%. The success rate of lumbar lithiasis was of 87.5% and of iliac lithiasis of 66.7%. Complications did not preclude a successful stone manipulation. These results are compared with other series and procedures for stone extraction are discussed.

[External radiotherapy after radical prostatectomy for cancer of the prostate, stage C or DI. Preliminary study]. / Radiothérapie externe après prostatectomie radicale pour cancer de la prostate, stade C ou D1. Etude préliminaire.

Between february 1985 and february 1988, 45 patients upstaged to stages C or D 1 cancer after radical prostatectomy, were treated by adjuvant radiotherapy with a view to control the risk of local recurrence and distant metastases. Radical prostatectomy has a low morbidity (less than 10%) whereas the radiotherapy morbidity rate is important (40% with 10% severe complications). With an average 33.4 months follow-up, we observe cancer dissemination in 37.7% of the cases and local recurrence in 13.3% of the cases. The prognosis seems to be worse, on one hand when the urethral margins are invaded and/or when the seminal vesicles are macroscopically invaded (C3) and on the other hand when the pelvic nodes are macroscopically invaded. Radiotherapy avoids locals recurrence in some cases but does not permit a general control of the disease. This observation leads us to recommend an early postoperative hormonotherapy in patients upstaged to stage C3 or with positive nodes.

The frequency of Chlamydia trachomatis in acute epididymitis.

Twenty-five patients with bacteriologically proven epididymitis were studied between 1984 and 1986. Thirteen were less than 35 years old and in 11 of them Chlamydia trachomatis was isolated; of the 2 remaining patients Escherichia coli was found in 1 and Neisseria gonorrhoeae in the other. In patients more than 35 years old, gram negative bacteria were the cause of infection in 10 and only 1 case was attributable to Chlamydia trachomatis. These results suggest that Chlamydia trachomatis is much more frequent in men under the age of 35 and the difference is statistically significant.

[Epididymitis. Apropos of 82 cases]. / Epididymites. A propos de 82 cas.

The authors report 82 cases of epididymitis, studied from 1976 to 1985: 66 acute epididymitis and 16 chronicle epididymitis. It is the affection of young patients: middle age 39 years. The frequency of epididymitis seems to increase the last years. The coliform organisms were the predominant pathogens isolated from the patients more than 35 years old; for patients less than 35 years old, in most cases, the Chlamydia trachomatis was the cause of infection. Among 12 patients with Chlamydia trachomatis infection, 11 were less than 35 years old. The treatment before the results of the sample has to be the Doxycycline; if Chlamydia trachomatis is not the cause of infection, the treatment will be changed. The corticotherapy is always associated with antibiotics, and his action is discussed.

[Varicocelectomy for infertility is more effective in cases of sperm count less than 5 million/ml. Apropos of 70 cases]. / Varicocélectomie pour infertilité est plus efficace dans les cas de numération inférieure à cinq millions/ml. A propos de soixante-dix cas.

70 patients, out of a total of 664 infertile subjects with a varicocele, presenting a sperm count of less than 5 X 10(6)/ml, were operated and followed for a mean period of 8 months. 80% of the 70 varicoceles were voluminous, compared with 23% in the general population. There was a statistically significant difference between the presence of a large varicocele and the presence of testicular hypotrophy or a sperm count of less than 5 X 10(6)/ml. Histological examination of 80 testes revealed a defect of maturation in 36% of cases (T2), corresponding to reversible histological lesions. The histological lesions predominantly involved the tube (66%) followed by the basement membrane (52%) and the interstitium (42%). The difference between the pre- and post-operative sperm counts was statistically significant (p less than 0.001). We obtained a 36% paternity rate after a mean post-operative delay of 8 months. The authors consider that the larger the varicocele, the more severe the histological lesions (maturation defect = T2). These cases have a very good chance of post-operative improvement as a result of restoration of spermatogenesis. This improvement is more marked when the lesions of the basement membrane and interstitial lesions are less severe. This concept of a "large pathogenic varicocele" which responds well to surgical cure raises doubts about the concept of sub-clinical pathogenic reflux detected by Doppler examination or by phlebography resulting, far too often at the present time, in an embolisation procedure.

[Epididymal prognostic factor in epididymo-deferential anastomosis]. / Le facteur de pronostic épididymaire de l'anastomose épididymo-déférentielle.

Results of a 1981 study are complemented and analyzed with respect to epididymal histology in 94 patients undergoing uni- or bilateral epididymo-deferential anastomosis. Testicular histology was normal in all patients. Epididymal histology could be differentiated into two main groups: one with normal or only slightly altered epididymis, the other with major epididymal lesions. Repermeabilization was more frequent and of better quality (10 X 10(6) sperm/ml or more) in the first group, in which there were also all the pregnancies. Previous genital infection or injury is of poor prognosis due to the severe epididymal lesions present.