[Assessment of the learning curves for intravesical adenoma morcellation using Piranha© device during endoscopic enucleation]. / Analyse de la courbe d'apprentissage de la morcellation intravésicale réalisée avec le système Piranha© au cours de l'énucléation endoscopique.

INTRODUCTION: Morcellation of intravesical adenoma (MIA) is an important part of the endoscopic enucleation procedure. The aim of this study was to analyse the learning curve of the MIA during endoscopic enucleation of the prostate. MATERIAL: We conducted a prospective study of the first 90 patients treated by endoscopic enucleation of the prostate by a single surgeon without previous experience of MIA. The population was divided into 3 consecutive groups of 30 patients. MIA was performed with the morcellator Pinranha (Wolf) and disposable blades (Vmax©). The criteria selected to assess the progress of MIA over time were: duration of MIA (min), the intraoperative complications encountered during MIA and weight morcelleted tissue. The efficacy of MIA was assessed with the ratio weight specimen/MIA duration (min/g) over time. RESULTS: The three groups were comparable in terms of age, ASA score of prostate volume. A significant decrease in the duration of MIA was found between groups 1 and 2 (12 versus 5.5min, P<0.0001), to reach a plateau in the group 3 (3min). A significant increase in the efficiency of MIA was found between group 1 and 2 (5.5 versus 11g/min, P<0.0001), to reach a plateau in the group 3 (20g/min). Bladder injuries were limited (7.7%), superficial and encountered in the early learning phase. CONCLUSION: In our experience, the MIA required a learning curve estimated between 30 and 60 procedures. LEVEL OF EVIDENCE: IV.

[Cardiovascular risks with prostate cancer hormonal treatment: rationale for a department of oncocardiology]. / Risques cardiovasculaires avec les hormonothérapies pour cancer de la prostate : rationnel pour une unité oncocardiologique.

Prostate cancer, the most frequent cancer in man, is an adenocarcinoma sensible to chemical castration in more than 80% of cases due to its hormonal dependency. Androgen deprivation is the treatment for advanced cancer and can be associated with radiotherapy locally or in locally advanced situations. Multidisciplinary therapeutic choice depends on patient age and co-morbidities and clinical stage. The impact of hormonal treatment confers varied side effects and cardiovascular effects are now better known. Responsible mechanisms of this cardiotoxicity are at the same time direct but also indirect by metabolic thermogenic effects. Analysis of these clinical or biological effects, their correlations to the used type of hormonal treatment and the possible precautions of prescription will be detailed in this analysis of the literature. The collaboration of the oncologist or the urologist with the cardiologist becomes necessary and the existence of a unit of oncocardiology could improve the evaluation of the risk-benefit balance and the tolerance of the treatment.

[XPS Greenlight photoselective vaporization for benign prostatic hyperplasia: analysis of the learning curve and contribution of transrectal ultrasound monitoring]. / Traitement de l'hyperplasie bénigne de prostate par photovaporisation au laser Greenlight XPS: analyse de la courbe d'apprentissage et apport de l'échographie endorectale peropératoire.

INTRODUCTION: The aim of this study was to analyze the XPS laser learning curve of one single surgeon with no previous experience of PVP and the impact of the use of reel time transrectal ultrasound (TRUS) monitoring. MATERIALS AND METHODS: Retrospective analysis of the first 100 patients: group 1 (1st-49th patient without TRUS) and group 2 (50th-100th with TRUS). The learning curve was analyzed through technical variables: vaporization time/intervention time (VT/IT) (%), energy delivered (J)/prostate volume (J/mL) and delivered energy (J/s or Watt), peroperative conversion into monopolar transurethral resection, postoperative complication, duration of catheterization and hospitalization and evolution of International Prostate Symptom Score (IPSS), PSA level, prostate residual volume and Qmax. Relationships between variables were evaluated by analysing the covariance (R 2 software. 14.2). RESULTS: A significant increase in VT/IT (P=0.0001) and the energy delivered per mL prostate (P=0.043) was reported in group 1. The average energy delivered per second was significantly higher in group 2 (P=0.0016). No difference was observed in terms of intra- or postoperative complication and catheterization time. The duration of hospitalization was significantly shorter in group 2 (P=0.03). The use of TRUS was associated with a gain of energy delivered by prostate volume at the end of learning curve (P=0.018). Prostate residual volume was significantly lower in the group 2 (P=0.0004). CONCLUSION: In our experience, 50 procedures are required to achieve the learning curve of PVP. The use of reel time TRUS would increase the energy delivered by prostate volume.

[Robotic partial nephrectomy: five years retrospective analysis at a single center]. / Néphrectomie partielle laparoscopique assistée par robot : analyse monocentrique et rétrospective sur cinq ans.

INTRODUCTION: The aim of this study is to assess perioperative outcomes in a large series of robotic partial nephrectomy. PATIENTS AND METHODS: We performed a retrospective analysis of 413 patients undergoing a robotic partial nephrectomy in a single center between June 2006 and December 2011. We analyzed demographic characteristics, operative and postoperative outcomes. RESULTS: Mean age was 58.6±11.9 years, body mass index was 30.5±7.1 kg/m2 and median ASA score 3. Mean tumor size was 3.2±1.66 cm and was divided in low, moderate and high RENAL nephrometry score respectively in 40%, 44% and 16%. Operative time and warm ischemia time were respectively 191 and 21min. Mean estimated blood loss was 200 mL and there were 4.3% major complications (Clavien-Dindo System). Mean length of stay was 3.6 days. The latest estimated glomerular filtration rate (eGFR) was 74.84 mL/min×1.73 m2 with a mean decrease of 8.6%. In multivariate analysis, Charlson comorbidity index (P=0.005), preoperative eGFR (P<0.001) and warm ischemia time (P=0.0025) were found to be independent predictors of latest postoperative renal function. CONCLUSION: Robotic partial nephrectomy is feasible and safe in experienced hands. In our study preoperative renal function, Charlson comorbidity index and warm ischemia time were independent predictors of latest eGFR.

[Greenlight(®) photoselective vaporisation for benign prostatic hyperplasia: a systematic review]. / Traitement de l'hyperplasie bénigne de prostate par photovaporisation au laser Greenlight(®) : analyse de la littérature.

INTRODUCTION: Transurethral resection of the prostate (TURP) is the most common surgical procedure in urology and remains the gold standard treatment of complicated benign prostatic hyperplasia or refractory to medical treatment. Routinely used since the 2000s, prostate photoselective vaporization (PVP) with Greenlight(®) laser has been developed to improve the safety of hemostasis in elderly patients and/or with high surgical risk. The purpose of this study was to review the results of PVP from the international literature. MATERIAL AND METHODS: [corrected] A systematic review of the literature on the research base Pubmed (http://www.ncbi.nlm.nih.gov/) was performed using the keywords benign prostatic hyperplasia; greenlight; photovaporisation; Laser; IPSS score; endoscopicsurgery; morbidity; complication. Prospective and retrospective studies in English and French were selected from its first use in 1998. Finally, we looked for studies that reported at least one of the following items: surgical technique; operative data; complications; anatomical and functional results and/or direct comparison between PVP and TURP. RESULTS: Regardless the PVP technique used to treat adenoma and identify the limits of the prostatic capsule, some parameters are well defined (sweepspeed, angle and distance of the fiber with the tissue) but others are still debated (number of joules per volume, when do we have to stop the PVP) and are reported in a heterogeneous manner due to the different generators. Versus TURP, PVP would offer the same functional results in the medium term but with a lower risk of per- and postoperative bleeding. The study of the risk of erectile dysfunction (ED) after PVP is made difficult due to the heterogeneity of DE assessment and study populations. However, PVP does not seem associated with an increased risk of ED versus TURP. The lack of histological material should lead to preoperative individual screening of prostate. The economy generated by PVP regarding the decrease in average length of stay has been clearly identified in Australia, Canada, Switzerland and USA. Studies will be published soon on French economic model. CONCLUSION: PVP with Greenlight(®) laser appears to be a safe and effective technique. With the new generator XPS, the PVP technique reaches maturity. Its development will certainly lead to a long-term evaluation with high levels of evidence based.

Impact of intermittent catheterization on the quality of life of multiple sclerosis patients.

PURPOSE: Lower urinary tract dysfunction is common in multiple sclerosis (MS). The purpose of this study was to prospectively evaluate the impact of intermittent catheterization (IC) on the quality of life of patients affected by MS. METHODS: Between 2007 and 2009, we admitted 23 patients to teach them the technique of IC. Their quality of life was evaluated before and more than 6 months after the beginning of learning the technique, when the urinary situation was stable. Two questionnaires were used: one specific for urinary disorders (QUALIVEEN(®)) and one general (SF-36(®)). RESULTS: Twenty-two patients followed this different way of bladder emptying. More than 6 months (9.3 ± 3 months on average) after first learning to use IC, the impact of urinary disorders explored by Qualiveen(®) had significantly decreased (the overall quality of life; bother with limitation; fears; feelings; Wilcoxon's test, respectively p = 0.004; 0.007; 0.02; 0.02) while the quality of life was not diminished. CONCLUSION: Intermittent catheterization (IC) in association with overall urinary management, among patients affected by MS, is well accepted and reduces the impact of urinary dysfunction on their quality of life.

[Should we consider a complementary treatment after a renal colic drained by an ureteral stent?]. / Faut-il envisager un traitement complémentaire après une colique néphrétique drainée par une sonde JJ ?

PURPOSE: The aim of the study was to evaluate if only ureteral stent removing after complicated renal colic (RC) could prevent from complementary treatment (shock-wawe lithortripsy or ureteroscopy). PATIENTS AND METHODS: Data from 95 patients, 39 women and 56 men, who had an ureteral stent for complicated RC from 2005 to 2010 were retrospectively collected. Mean age was 46.4 ± 17.2 years. After the initial management, another hospitalization was organized where patients had ureteral stent removing under local anesthesia, then an abdominal CT-scan without injection and complementary treatment of ureteral stones (none or ESWL or ureteroscopy). Parameters studied were age, sex, stone size, location of calcul. Quantitative values were compared with Student's t test. Qualitative values were compared with the Chi(2). P<0.05 was considered statistically significant. RESULTS: Mean duration between the two hospitalizations were 1.58 ± 1.84 months. Sixty-one patients (64.2%) had no more urolithiasis. In these patients, mean size of urolithiasis was 5.85 ± 2.33 mm. Location of urolithiasis in distal, mild and proximal ureter was 77%, 3% and 20% respectively. Thirty-four patients (35.8%) had persistant lithiasis after CT-scan. Location of stone in distal, mild and proximal ureter was 17.5%, 5.8% and 76.7% respectively. CONCLUSION: After management of complicated renal colic by ureteral stent, 64% of patients had spontaneous elimination of stones after removing of ureteral stent, especially in women and pelvic ureter.

[External sphincterotomy using bipolar vaporisation in saline. First results]. / Incontinentation par vaporisation bipolaire du sphincter externe de l'urèthre. Premiers résultats.

OBJECTIVES: The aim of this study was to assess the feasibility, efficacy and tolerance of external urethral sphincter vaporization in saline for treating detrusor-sphincter dyssynergia. MATERIAL: Between 2009 and 2011 a monocentric prospective study of ten men mean age 58±9 years with neurogenic detrusor-sphincter dyssynergia was carried out. Preoperative evaluation included kidney ultrasound scan, 24-hour creatinine clearance, urodynamics, retrograde and voiding urethrocystography and an at least 6 months temporary stent sphincterotomy. Postoperative assessment was composed of an ultrasound scan post-void residual volume measurement when the urethral catheter were removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and a flexible cystoscopy at 1 year. RESULTS: At the catheter removal, eight patients emptied their bladder at completion, a supra-pubic catheter was temporary left in one case and a patient had a permanent urinary retention. For a mean follow-up of 22±11 months, eight patients emptied their bladder at completion and two had a complete urinary retention related to a detrusor underactivity. An orchitis occurred in one case 1 month after the procedure and an urethral stricture in four cases in 12.75±5.68 months on average. CONCLUSION: External urethral sphincter vaporisation saline was feasible and efficient for treating detrusor-sphincter dyssynergia but was associated with a high risk of urethral stricture.

[Does the urologist in formation have a burnout syndrome? Evaluation by Maslach Burnout Inventory (MBI)]. / Les urologues en formation ont-ils un syndrome d'épuisement professionnel ? Évaluation par le Maslach Burn-out Inventory (MBI).

OBJECTIVES: To assess the burn-out syndrome in the population of urologists in training. MATERIAL AND METHODS: A trans-sectional study was carried out among the French urologists in training association (AFUF) members. A questionnaire including the Maslach Burnout Inventory and questions on the age, gender, professional and familial status, working time and hobbies was emailed. RESULTS: The response rate was 65.5 %. Mean burn-out, emotional exhaustion and depersonalization scores were 15.57 ± 8.55 (low burn-out), 8.56 ± 5.52 (moderate burn-out) and 37.19 ± 6.21 (moderate burn-out), respectively. Forty-five (24 %) had a severe burn-out syndrome, 11 an emotional exhaustion and 41 a depersonalization. Urologists in couple had a significant lower emotional exhaustion level than single. Depersonalization and low personal accomplishment scores were related to the age and working time. Having at least one hobby prevented emotional exhaustion and improved personal accomplishment levels. Gender had no impact on burn-out syndrome. CONCLUSION: Quarter of French urologists in training had a burn-out syndrome. Factors preventing it were working time reduction, being in couple and having at least one hobby. burn-out syndrome severity decreased with age and senior status.

[Alert on the predictable accessibility of the fellowship of urology until 2013: a study of the AFUF]. / Alerte sur l'accessibilité prévisible du postinternat d'urologie jusqu'en 2013: une étude de l'AFUF.

PURPOSE: To evaluate the accessibility of the fellowship for the residents of Urology expecting to accomplish their residentship between November 2010 and 2013. PATIENTS: Between November 2010 and January 2011, all the residents ongoing for the residentship of Urology in France were reached by an electronic mailing using the AFUF register. A questionnaire reported all the residents expecting to accomplish their residentship between November 2010 and 2013, and the number and the expected availability of fellow and specialist assistant posts during the same period. RESULTS: Our study counted 306 urologists on training (190 residents, 76 fellows, 30 assistants, 10 on other posts). On November 2010, 56 residents accomplished their residentship, while 68 and 79 residents expected to accomplish their residentship on November 2011 and 2012, respectively. One hundred and six posts validated the fellowship of Urology on November 2010 (76 fellows, 30 assistants), among 54 posts were available. Over the residents expecting to accomplish their residentship on November 2011 and 2012, 22 and 54 residents may not find a fellow post available. CONCLUSION: The number of residents expecting to accomplish the residentship of Urology between November 2010 and 2013 was increasing, showing a greater interest for this speciality and a lack of regulation for its accessibility. By reason of a discrepancy of fellow and specialist assistant posts, only 67.6 and 31.6% of the residents expecting to accomplish their residentship on November 2011 and 2012 may be able to find a post available.