ABSTRACT
INTRODUCTION: Information on prostate diseases, including prostate cancer, has been promoted by the Association Française d'Urologie (AFU) for several years, but is developing slowly in France. In 2005, a first communication was targeted to the male public and identified the reasons for the fatalistic attitude of men, and paradoxically, why the prostate incarnates the vulnerability of their sexual capital. As part of a second phase, this article presents the results of a complementary study conducted among general practitioners to identify their expectations and the most appropriate levers to promote screening. MATERIAL AND METHOD: The Ipsos survey company developed a Krisis qualitative protocol in October 2005 (after the first French prostate day on 15 September 2005). Three groups of general practitioners were defined: doctors who are very active in terms of screening, doctors who are uncomfortable with this problem and doctors who systematically refer their patients to urologists. RESULTS: The management of prostate diseases often highlights the ageing process for the patient. The ability to discuss these problems during the consultation depended on the doctor's degree of comfort with this subject, which is related to his/her training and relationships with urologists. To initiate the question of screening, general practitioners involved in this process asked simple questions about everyday practices without being afraid of making jokes or basing their approach on mediatization of the disease. Digital rectal examination is one of the important clinical elements but is not always easy to perform. PSA was found to be an examination that is not always appropriate, characterized by a lack of information on the conditions for ordering this test, its usefulness and its relevance for screening. Ultrasound could be a way of alerting the patient without dramatizing the situation, letting the urologist perform digital rectal examination. Female general practitioners preferred PSA and ultrasound. The doctors surveyed relied on mediatization of prostate diseases, a high level of interactivity with urologists and documents and brochures to be placed in waiting rooms to relay screening messages. CONCLUSION: General practitioners need their authorities, specialists and public health institutions to develop and mediatize andrology in the same way as gynaecology. Urologists play a major supportive role by means of conferences, postgraduate training or AFU invitations.
Subject(s)
Mass Screening , Prostatic Diseases/diagnosis , Prostatic Neoplasms/diagnosis , Aging/physiology , Attitude of Health Personnel , Attitude to Health , Communication , Digital Rectal Examination , Family Practice/education , Female , France , Health Education , Health Promotion , Humans , Interprofessional Relations , Male , Patient Education as Topic , Physician-Patient Relations , Prostate-Specific Antigen/analysis , Prostatic Diseases/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Public Health , Referral and Consultation , Ultrasonography , UrologyABSTRACT
Surgical repair of stress urinary incontinence by TVT was first performed in France in 1998, without any real evaluation of the morbidity related to this product before its release onto the market. In the context of the Necker 2002 report, a review of the literature and a multicentre study were performed to clarify this point. Bladder perforation, frequent during the early part of the learning curve, requires repositioning of the TVT and bladder catheterization for 48 hours, but does not cause any increase in postoperative morbidity. Urethral perforation, much less common, is a contraindication to maintenance of the TVT. Postoperative obstruction occurs in 5% to 12% of cases, and initially requires self-catheterization, as early section of TVT must be avoided. De novo instability is observed in 6% to 12% of cases, especially in the case of incomplete obstruction or a gaping bladder neck. Erosions due to TVT appear to be uncommon and are essentially vaginal.
