[Half-day case robotic radical prostatectomy. Surgery of the future? A case report]. / La prostatectomie radicale robotique ambulatoire. Une chirurgie de l'avenir ? À propos d'un cas.

INTRODUCTION: Robotics and ambulatory are modern applications of surgery. This case study proves the feasibility of robot-assisted radical prostatectomy as an outpatient procedure. METHOD: This report highlights the first, half-day, robotic prostatectomy performed on a 57-year-old man with localized prostate cancer. This operation was proposed to the subject because of his excellent physical condition and favorable environmental factors. He chose to undergo the surgery voluntarily. He underwent a nerve sparing radical prostatectomy. Target-controlled infusion propofol was used in perioperative sedation and analgesia. Postoperative evaluation criteria was made with the Visual Analog Scale of Pain Intensity (VASPI), Chung score and a patient satisfaction survey. RESULTS: No perioperative or postoperative complications were reported. Blood loss was low (75 mL). The patient stayed less than 12 hours in the ambulatory unit thanks to a rapid recovery. The patient returned home after reporting a Chung score of 10. No hospital readmission was necessary. Functional results were: a bowel movement on day 1, back to work on day 2, normal urinary continence on day 8, a correct erectile function on day 9. Oncological results revealed negative surgical margins for cancer and PSA postoperative<0.03 ng/mL. CONCLUSION: Ambulatory robotic radical prostatectomies can be performed on voluntarily-selected patients without affecting the high quality of urological surgery outcomes.

[Transvaginal repair of genital prolapse using the Prolift technique: a prospective study]. / Traitement du prolapsus génital par renfort transvaginal Prolift: une étude prospective.

OBJECTIVE: To evaluate the efficacy and to report the follow-up of transvaginal repair of genital prolapse using a tension free vaginal mesh. PATIENTS AND METHODS: Twenty-eight women were treated for genital prolapse with the Prolift technique and followed prospectively. Preoperative prolapse treatment, associated treatment, complications were reported. Postoperatively, efficacy and complications were reported. Patients were examined at one, three, six and 12 months then yearly. Treatment failure defined as Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. RESULTS: The mean age was 68 years. The median follow-up was 12 months. Ten (35%) and 14 (50%) patients had a stage II and III/IV cystocele respectively. Nineteen (67%) patients had stage II/III rectocele. We reported one bladder injury (3.5%) sutured during surgery and one haematoma (3.5%) requiring secondary management. Important buttock pain appeared in two patients (7%) treated with a total mesh on day 1 and 6 weeks after surgery respectively. They were both relieved after cutting one posterior arm of the mesh. De novo stress incontinence appeared in one (3.5%) patient and urgency in two (7%) patients. Mesh exposure occurred in one (3.5%) patient requiring a minimal surgical management. One patient (3.5%) declared dyspareunia. Success was reached in 96.5% patients. CONCLUSION: The transvaginal mesh was a safe and efficient technique to treat genital prolapse.

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

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

[Does traditional colporraphy still have a role to play in the treatment of anterior colpocele?]. / La colporraphie traditionnelle a-t-elle encore une place dans le traitement de la colpocèle antérieure?

The aim of this review was to summarize the available literature on transvaginal anterior colporrhaphy (AC) in the management of anterior vaginal wall prolapse. A medline search from 1978 to 2008 was performed. Anatomical results were assessed for each study according to the severity of cystocele, the previous pelvic organ prolapse (POP) procedure and the numbers of procedures preformed concomitantly to the AC. The anatomic success rates of single anterior colporrhaphy varied between 0 and 100 % with a follow-up ranged from 1 month to 20 years. The highest rates of anatomical recurrence were reported in series which encompassed a large number of women with high grade cystocele and/or previous POP procedures. However, the excellent short-term results and the feasibility of this technique suggest that AC can still be performed in selected cases.

[Colpocleisis: indications, technique and results]. / Le cloisonnement vaginal : indications, technique et résultats.

The aim of this review was to summarize recent published data about indications, surgical technique and results of colpocleisis. We conducted a literature search on Medline using PubMed from 1990 to 2008. Anatomical and functional results were assessed for each selected study according to the age and the morbidity of the surgical procedure. As the colpocleisis was complete or partial, anatomic success rates were reported near 100 % with a follow-up ranged from one month to six years. Colpocleisis is an effective procedure for treatment of advanced pelvic organ prolapse in selected patient who no longer desire preservation of coital function. Concomitant anti-incontinence procedure is not associated with increased postoperative morbidity. However, preoperative urodynamics remain to be established for an optimal management of urinary incontinence.

[Pure laparoscopic versus robotic-assisted laparoscopic radical prostatectomy: comparative study to assess functional urinary outcomes]. / Prostatectomie totale laparoscopique standard versus laparoscopique robot-assistée : étude comparative sur les résultats fonctionnels urinaires.

PURPOSE: To compare urinary functional outcomes after LP prostatectomy or robotic assisted laparoscopic prostatectomy performed by a single surgeon regarding to his initial experience. MATERIAL: Between March 2005 and April 2007, 247 consecutive patients underwent radical prostatectomy, either by LP approach (125) or by robotic-assisted laparoscopic (RALP) approach (122). The only criteria to chose robot or not, was the Robot Da Vinci's availability. RESULTS: There was no statistical difference between the two groups in terms of preoperative characteristics. The continence rate was 83% in PL group versus 81% in RALP group. More precisely, among men wearing at least one pad, 71% of patients in PL groups wear one pad/day versus 87% of patients in RALP group. Multivariate analysis on continence appears to be in favors of RALP group (Odd Ratio 2.1 [CI: 0,86-5,48]). CONCLUSION: Incontinence appears to be less severe and frequent in the RALP group. In practice, surgeon's impression of the robot's interest is evident, but more important number of patients and longer follow-up is necessary.

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

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

Laparoscopic radical prostatectomy in kidney transplant patient: our first experience-a case report.

The association between prostate cancer and kidney transplantation has an unknown incidence despite an increased screening in that population. Radical prostatectomy remains the gold standard in treating localized tumors. Retropubic or perineal approaches are usually considered. The surgical aspects and successful outcome of laparoscopic radical prostatectomy in a kidney transplant recipient are reviewed.

[Laparoscopic total prostatectomy in renal transplant recipients: a case report]. / Prostatectomie totale laparoscopique chez le greffé rénal: à propos d'un cas.

Despite increased screening in renal transplant recipients, the prostate cancer-renal transplantation association is not well-known. Treatment of localized forms must be curative. Total prostatectomy is performed according to the classically described incisions, either retropubic or perineal. The authors describe the technique and results of laparoscopic total prostatectomy in a renal transplant recipient.