[Cancer plans apply to surgical treatment of prostate cancer: A geographically isolated center balance]. / Les plans cancer appliqués au traitement chirurgical du cancer de prostate : le bilan d'un centre isolé géographiquement.

INTRODUCTION: Since 2003, fight against cancer was structured by 3 national cancer programs (CP). The objective of this study is to evaluate the application of these measures in the case of surgical prostate cancer (PCa) treatment in a geographically isolated center. MATERIAL: Monocentric retrospective study carried in a 100-bed clinic located 2hours away from a Cancer Regional Reference Center. Between August 2009 and December 2014, 251 consecutive patients were treated by total laparoscopic prostatectomy (TLP). Fifty-seven patients (22.7 %) received a secondary treatment after TLP. The study focused on the delay between prostate biopsies and PTL, the traceability of AD elements, the return of active patients, inclusion in clinical trials (GETUG 17, GETUG 20 and GETUG 22). Data were collected in September 2016. The follow-up defined by the time between the date of the last visit and the prostate biopsy allows a median follow-up of 43.1 months (2.4-80.5). RESULTS: All elements of the CAP are totally gathered on 45 % of the patients (113/251). Thirty-four (13.5 %) patients were active at the time of the intervention. Thirty-one (91.2 %) will return to an identical activity after a median work stoppage of 1.7 month (0.25-6). Fourteen percent (35/251) of the patients are eligible to a clinical trial. Seventeen percent (6/35) of them were proposed to one of a trial after multidisciplinary meeting and 5.7 % (2/35) are eventually included in one trial. CONCLUSION: CP define a course of high quality care. A better transparency of the founding of the enforceable measures and a better consideration for the local specificities should facilitate their application. The TLP treat the PCa with the reasonable objective of a return to an identical professional activity. The multidisciplinary meeting does not guarantee the participation to clinical trial, which depends mainly on distance from the Cancer Regional Reference Center and the vigilance of the Urologist. LEVEL OF EVIDENCE: 4.

[Quality score in pathological report of prostate biopsies improve professional practice]. / La mention systématique d'un indice de qualité dans les comptes rendus de biopsies prostatiques influence les pratiques professionnelles.

OBJECTIVE: Evaluate the influence on professional practices of a systematic indication of a quality score (IGap) in the conclusion of the pathologic reports (CRFS) of prostatic biopsies (PB). MATERIALS AND METHOD: Prospective study carried over 339 consecutive 10 core extended standardized PB performed by two urologists over a period of 22 months. The CRFS were computerized. The conclusion included an IGap ranking from 0 to 1, automatically computed from three criteria: the average length of the PB, the number of PB with identified capsules or periprostatic tissues and the average number of fragments per PB. The quality was best when the index is close to 1. A quarterly monitoring of the average of IGap was performed for the two urologists. The student t test was used to compare the averages. RESULTS: The average of IGap of the urologists A and B was, respectively, of 0.57 (s=0.1; n=184) and 0.66 (s=0.1; n=155): p<0.001. At quarter 1, the averages of IGap of the urologists A and B are, wads of respectively, of 0.47 (s=0.14; n=25) and 0.7 (s=0.12; n=14) (p<0.001). The significant difference of the average of IGap of the urologists A and B observed on quarter 1 progressively decline to disappear from the quarter 4. CONCLUSIONS: At equivalent protocols, the urologists do not necessarily perform PB of comparable quality. A systematic indication of an IGap in the pathological reports of PB seems to prompt the urologists to modify their practices toward an improvement of the score.

[Length of needle and size of prostatic biopsies influence identification of capsular and extracapsular elements]. / La longueur des biopsies prostatiques conditionne l'identification des éléments capsulaires et périprostatiques.

OBJECTIVE: To evaluate the influence of the length of prostate biopsies (PB) on identification of prostatic capsule and periprostatic tissue. MATERIALS AND METHOD: A prospective study was carried out in one center by two urologists during 22 months on 339 consecutive protocols of standardized ten-needle PB (PSA<10ng/ml regardless of digital rectal examination). Pathologic reports were standardized. The conclusion of the pathologic report included the average length of the ten-needle PB (Lm) and the number of prostatic core biopsies on which pathologist identified prostatic capsule and periprostatic tissue (BCI). Protocols of PB were spread in 16 groups depending on the value of Lm in millimeter: [0-1], [1-2], [2-3]... [15-16]. Relationship between Lm's and BCI's was evaluated using the linear regression and the correlation coefficient (r). RESULTS: Average Lm=10.7 (2.1-15.7; s=2.3) (n=339). Average BCI=6.6 (0-10; s=2.3) (n=339). The value of IGap increased when the value of Lm increased (r=0.89). CONCLUSIONS: The pathologists better identify the capsule of the prostate and the periprostatic tissue when the PB's are of large size. PB's of small size are of poor quality either for samplings of the prostatic gland or samplings of the capsule and the periprostatic tissues.

[Development of a pathological quality score of prostate biopsies]. / Elaboration d'un indice de qualité anatomopathologique des biopsies prostatiques.

OBJECTIVES: Develop a score allowing the pathologist to objectively report on the overall quality of extended standardized prostatic biopsy (EPB). METHODS: A prospective study was carried out on 339 consecutive protocols of 10 core EPB (PSA<10 ng/ml). Reports are standardized and computerized. The conclusion of the reports includes an estimate of the overall quality of the EPB based on three items to classify the protocols in three groups: protocol of "good" quality (group 1), "medium" quality (group 2) and "poor" quality (group 3). The score (IGap) is automatically computed from three objective criteria also shown on the conclusion of the report: the average length of the 10 biopsies (LM), the number of biopsies on which capsular elements can be identified (BCI) and the average number of fragment per biopsy (Fm). The IGap index rank from 0 to 1. The average IGap of the three groups is computed using the t-test. RESULTS: The average IGaps of the groups 1, 2 and 3 are respectively of 0,65 (0,37-0,89 ; n=250), 0,52 (0,36-0,71 ; n=69) and 0,43 (0,22-0,6 ; n=20), (p<0,001). CONCLUSION: IGap is a pertinent score reporting objectively of the overall quality of EPB. An IGap close to one indicates a good quality of EPB. An IGap close to zero indicate a poor quality of EPB.

Anatomic and functional results of transperitoneal-transvesical vesicovaginal fistula repair.

OBJECTIVES: To evaluate the anatomic and functional results of transperitoneal-transvesical repair of simple and complex vesicovaginal fistulas (VVFs). METHODS: Between 1978 and 1995, 30 VVFs in 28 patients (mean age 44.6 years, range 21 to 80) were treated by way of a transperitoneal-transvesical approach. VVFs were secondary to hysterectomy in 67.8% of cases; 46.7% of VVFs were considered complex fistulas. Fifty percent of the VVFs were retrotrigonal and 40% were trigonal. A flap was interposed in 70% of cases. The vaginal fistula orifice was left open in 66% of cases, and 33% of VVFs required ureteral reimplantation. The mean duration of bladder drainage was 15.8 days (range 6 to 42), and the mean follow-up was 30 months (range 23 days to 14.6 years). The anatomic and functional results were evaluated by physical examination, cystoscopy, and a self-assessment questionnaire. Success was defined as the disappearance of the fistula. RESULTS: The overall success rate was 85% (24 of 28). The success rate was 87.5% for simple VVFs, 71% for complex VVFs, 93% for retrotrigonal VVFs, 66% for cervicotrigonal VVFs, and 80% for fistulas requiring ureteral reimplantation. Postoperative voiding disorders were reported in 38% of patients. CONCLUSIONS: Transperitoneal-transvesical repair of simple and complex VVFs remains the reference treatment for a disease that has become rare in countries with a well-developed healthcare system, but that is disabling and poorly tolerated by patients after the treatment of another disease.

[Surgical treatment of stress urinary incontinence in women]. / Traitements chirurgicaux de l'incontinence urinaire d'effort de la femme.

UNLABELLED: INDICATION FOR SURGERY: Exercise-induced urinary incontinence is responsible for more than 75% of all cases of urinary incontinence in women. Surgery can provide excellent cure if the initial indication is established properly. SURGICAL PROCEDURES: The aim is to correct the mechanical alterations leading to urine leakage: sphincter anomalies and cervico-urethral hypermobility. Colpo-suspension using the indirect Burch procedure and the direct Goebell-Stoeckel procedure are indicated for physically active patients. For sphincter failure, an artificial sphincter with a fixed bladder neck is indicated. Simplified transvaginal colpo-suspension is indicated for elderly women. TENSION FREE VAGINAL TAPE: The recently developed, this new technique appears extremely promising for the treatment of urethral hypermobility.

[Repair of anterior hypospadias with transurethral vesical catheter: comparison of ambulatory surgery with the "between 2 diapers" catheter and traditional hospitalization]. / La cure d'hypospadias antérieur avec une sonde vésicale trans-urétrale: comparaison des hospitalisations ambulatoire avec la sonde "entre 2 couches" et traditionnelle.

OBJECTIVE: To evaluate the morbidity of ambulatory repair of anterior hypospadias with a transurethral vesical catheter (TUVC) draining the urine between 2 diapers. MATERIAL AND METHODS: 34 children divided into two comparable groups were operated for anterior hypospadias. Group A comprised 17 children operated by ambulatory surgery, with catheter drainage of urine between 2 diapers. Group B consisted of 17 children operated by a conventional inpatient procedure, with the catheter connected to a urine collector. Postoperative complications and the results of a satisfaction questionnaire sent to the parents of children in group A are reported. RESULTS: In group A, one case of TUVC dysfunction was reported and 13 parents declared to be satisfied. One urethral fistula occurred in group B. CONCLUSION: Ambulatory repair of anterior hypospadias with TUVC draining urine between 2 diapers does not induce a higher complication rate than when repair is performed by conventional hospitalisation with the TUVC connected to a urine collector. Urine drainage by TUVC is not a contraindication to ambulatory surgical repair of anterior hypospadias in children.

Partial ureteral duplication in an inverted Y with epididymal ureteric ectopia and intrasinusal ureteral junction.

Partial ureteral duplication in an inverted Y is evidenced by the presence of a ureter duplicated at a variable level before reaching the bladder, in either an orthotopic or an ectopic position. A case of ureteral duplication at the level of the renal hilum with opening of a ureter at the level of the epididymis is reported. The description of this original case is compared with the data in the literature. The stages of organogenesis of the superior excretory pathway leading to ureteral ectopia and ureteral anomalies of number are reviewed.

[Inverted Y partial ureteral duplication. Apropos of an unusual case]. / Duplication urétérale partielle en Y inversé. A propos d'un cas particulier.

Inverted Y partial ureteric duplication corresponds to the presence of a variable length of duplicated ureter before entering the bladder in an orthotopic or ectopic position. A case od inverted Y partial ureteric duplication with ureteric confluence in the hilum of the kidney associated with anastomosis of an ectopic ureter in the epididymis is reported. The description of this original case is compared with the data of the literature.

Urethral graciloplasty for treatment of female intrinsic sphincter deficiency: rationale for the transvaginal approach: an anatomical study.

PURPOSE: To compare the retropubic and transvaginal approaches in terms of the length of gracilis muscle available for female urethral graciloplasty. MATERIALS AND METHODS: Two groups of female cadavers were submitted to bilateral gracilis muscle dissection, followed by urethral graciloplasty using either the standard retropubic approach or the transvaginal approach. The two groups were studied in terms of various muscle characteristics, in particular the length of muscle that could effectively be wrapped around the bladder neck. RESULTS: Because muscle transfer to the perineum was more direct, the transvaginal approach provided a greater functional length of gracilis for effective periurethral wrapping than the retropubic approach (mean: 8.4 cm. versus 5.2 cm., p = 0.0022). CONCLUSION: The transvaginal approach allows a more "proximal" graciloplasty and should therefore be evaluated clinically to provide circumferential bladder neck support without tension.