Quality of life of patients treated for kidney stones 10-20mm in diameter in terms of the type of operation performed: A qualitative study.

INTRODUCTION: Urolithiasis is a common chronic disease whose effect on patients' quality of life (QOL) is considerable but depends on the treatment received, differing between types of surgery. Intrarenal stones can be treated with different techniques: extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (fURS), and mini percutaneous nephrolithotomy (mini-PCNL), with proportional success and complication rates. The aim of this study was to qualitatively explore the impact of the different techniques on patients' QOL and understand their experiences of treatment choices. METHODS: Patients treated for medium-sized kidney stones (10-20mm in diameter) were interviewed in a semi-structured manner. The interview data were transcribed and analyzed by theme according to consolidated criteria for reporting qualitative research (COREQ) guidelines. RESULTS: Data saturation was achieved after interviewing 15 patients. The mean interview time was 34min (standard deviation (SD), 6.8min). The mean patient age was 54 years (SD, 9.5 years). Eight patients underwent ESWL, 10 were treated with fURS, and 8 underwent mini-PCNL. Twenty-seven subthemes were coded and regrouped into eight major themes, namely: no sense of choice in the decision-making process for eleven patients; extremely negative experiences of double-J stents for fourteen patients; concern about the risk of recurrence or treatment failure for thirteen patients; complicated hygiene and dietary recommendations for nine patients; technique-dependent postoperative outcomes; relatively well-tolerated operations for thirteen patients; a poor experience of sick leave, often because of a double-J stent; different views regarding future operations. In fact, a third of patients would choose the most effective treatment, a third would choose the simplest procedure and the last third would trust their urologist. Patients' experiences of these operations are variable. CONCLUSION: Urologists must support their patients by presenting the different treatment options with clear, appropriate, and unbiased information. This should ensure patients take part in treatment decisions as part of a personalized treatment plan.

Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study).

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35-0.66]; severe: 0.29 [0.16-0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours.

Feasibility of EXIME® temporary prosthesis placement and removal in men with acute or chronic urinary retention after failure or inability to selfcatheterize.

INTRODUCTION: Urological emergencies represent 7% of admissions, 29% of which are acute urine retention. We report the first results of a protocol evaluating a new device in case of failure of self-catheterization, replacing a permanent catheter: the urethral device EXIME®. METHOD: Intention-to-treat study on the feasibility of inserting the EXIME® prosthesis in a day hospital after simple urethral gel instillation in men with urine retention. EXIME® was proposed to all patients after failure of Foley catheter removal and refusal or inability to learn self-catheterization. The protocol was referenced (NCT04218942) after obtaining the agreement of the committee for the protection of individuals. RESULTS: Among 278 patients admitted for a trial of Foley catheter removal, 15 patients with failed voiding resumption and refusal or failure of self-catheterization were offered the prosthesis. The median age was 73 years with a median retention volume of 700mL. The median prostatic volume was 60g. Fourteen patients had their prosthesis inserted in good conditions of comfort for the practitioner and the patient. One failed placement was noted. The difficulty of insertion was estimated by the practitioner at 0 on median (VAS from 0 to 10), and for its removal at 0. The pain during the insertion of the device was evaluated by the patients at 2.00 and for the removal at 0 (VAS from 0 to 10). 6 patients had satisfactory voiding recovery at D0. DISCUSSION: We proposed the placement of EXIME to patients who had failed the trial of Foley removal and were unable and/or unwilling to self-catheterize. These were patients with poor bladder contractility and a high risk of retention recurrence. Despite this mixed result, the simplicity of the device and the comfortable expectation of an endoscopic procedure seem promising. CONCLUSION: Insertion and retrieval of EXIME®prostatic prosthesis were easy and well tolerated in our population. Insertion failed in one patient. A comparative prospective study with self catheterization is necessary to determine its effectiveness.

[Benign prostatic hyperplasia surgery and patient's information: What do patients understand and remember?] / Chirurgie de l'hypertrophie bénigne de prostate et information des patients : qu'est ce que les patients comprennent et retiennent ?

INTRODUCTION: Preoperative information is a key to adherence to treatment for the patients, but may be misunderstood because of its density and complexity. The aim of this study was to assess comprehension and satisfaction of patients about preoperative information of benign prostatic hyperplasia (BPH) surgery. Factors influencing patient understanding were also studied. PATIENTS AND METHODS: It was a monocentric study on questionnaires including every patients planned for BPH surgery, whatever the surgical technique. A survey was sent at patient's home after the preoperative consultation. RESULTS: One hundred and six of 210 patients (50,5 %) returned the questionnaire. 38,68 % (n=41) found the quality of information excellent (9 or 10 out of 10), and 45,28 % (n=48) found the quality of information good (7 or 8 out of 10). The main recalled complications were retrograde ejaculation (39.6 %, n=42/106), and bleeding (29,2 %, n=31/106). 57.6 % of patients (n=61) remembered receiving the written information sheet of the French Association of Urology. 5.7 % (n=6) hesitated having the procedure. Only patient's age was significantly associated with difference of comprehension (p<0.005). CONCLUSION: Information given before a BPH surgery seems satisfactory although it was poorly understood, notably about complications. Providing complete oral information, insisting on complications, and giving the written information sheet are essential for a good doctor-patient relationship and a forensic serenity. LEVEL OF EVIDENCE: 3.

Efficacy and security of continent catheterizable channels at short and middle term for adult neurogenic bladder dysfunction.

AIMS: The objective of this study was to assess the effectiveness and the complications rate following continent cutaneous channels (CCC) procedures, at short and medium term follow-up (FU). MATERIALS & METHODS: A continuous retrospective case series (2008-2018): all patients who have undergone a CCC for neurogenic bladder were included in our department. The primary outcome was the effectiveness of CCC defined by the status of catheterizability (by the patient or a care-giver), continence of the tube, and absence of reintervention at 3 and 12 months FU. The secondary outcome was the prevalence of postoperative complications at 3 and 12 months FU. RESULTS: Fifty-three patients were included during the study period in our department. Median follow up was 3,3 years (1.5-6.1). The overall effectiveness of CCC was 67.9% (n=36/53) at 3 months FU and 45,3% (n=24) at 12 months FU. The global rate of complications was 60.4% (n=32/53) at 3 months, and 73.6% (n=39/73) at 12 months FU. The statistical analysis showed no statistical differences on efficacy and complications in the different subgroups of CCC. CONCLUSIONS: In the current series, the effectiveness and the complications rates following CCC were comparable across the procedure types. LEVEL OF EVIDENCE: 4.

[Enhanced recovery after robotic partial nephrectomy: Evaluation of patient's satisfaction]. / Réhabilitation précoce après tumorectomie rénale robot-assistée : quelle satisfaction des patients ?

INTRODUCTION: Several enhanced recovery protocols after surgery showed a benefit for postoperative recovery and reduction of hospital lengths of stay. Very few studies evaluated patient's satisfaction about these enhanced recovery protocols. The aim of this study was to evaluate patient's satisfaction about our enhanced recovery protocol for robotic-assisted partial nephrectomy (RAPN). METHODS: A validated survey EORTC In PATSAT32 with a specific questionnaire about protocol was sent to the first patients included in the enhanced recovery protocol for RAPN. The survey was sent after the postoperative consultation at postoperative day 30. Responses were anonymous. Satisfaction's scores for EORTC questionnaire were calculated for each dimension with Likert's method. Scores were transformed linearly into a scale ranging from 0 to 100, where 100 represent the highest level of care satisfaction (EORTC method). RESULTS: A total of 21 patients (50%) returned the completed questionnaire. The overall satisfaction score was 75.1% (37.3; 100) in the EORTC survey. In total, 71.4% of patients (n=15) were satisfied with the discharge at postoperative day 2 (POD2) and 5 patients (23.8%) found this premature. None of the patients had a negative impression on the clinical pathway. The average overall evaluation on the protocol by patients, on a satisfaction scale of 1 to 10 was 8.9/10. CONCLUSION: In this study, patients included in the enhanced recovery protocol after RAPN were very satisfied with their pre-, per- and postoperative care. Given patients satisfaction, reduction of LOS, patient's safety and the medicoeconomic advantage, these enhanced recovery protocol have become a priority to develop and evaluate. More large studies are needed to assess the patient's experience with these clinical pathways. LEVEL OF EVIDENCE: 4.

[Contribution of meb to endometriosis patients' diagnosis and treatment]. / Apport de la réunion de concertation pluridisciplinaire à la pertinence du diagnostic et du traitement de l'endométriose.

OBJECTIVES: Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB. METHODS: Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017. RESULTS: Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis. CONCLUSION: One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.

Management of endometriosis: CNGOF/HAS clinical practice guidelines - Short version.

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

[Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. / Prise en charge de l'endométriose : recommandations pour la pratique clinique CNGOF-HAS (texte court).

First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

[Urinary tract involvement by endometriosis. Techniques and outcomes of surgical management: CNGOF-HAS Endometriosis Guidelines]. / Localisations urinaires de l'endométriose. Résultats et modalités techniques de la prise en charge chirurgicale. RPC Endométriose CNGOF-HAS.

Urinary tract involvement by endometriosis is reported in 1% of endometriosis patients (NP3). Consequences range from pelvic pain for bladder localizations to silent kidney loss in case of chronic ureteral obstruction (NP3). The feasibility of laparoscopic management was widely proven (NP3) and may reduce hospital stay length (NP4). Radical surgery with partial cystectomy for bladder localizations was shown to significantly and durably reduce pain symptoms with low risk of a severe postoperative complications (NP3). Medical hormonal treatment also shows short-term reduction of pain symptoms (NP4). Transureteral resection of bladder endometriosis nodule is not recommended (grade C) because of a high postoperative recurrence rate (NP4). Given a high risk of silent kidney loss, it is recommended that patients with ureteral involvement by endometriosis are managed by a multidisciplinary team considering urinary and potential extra-urinary localizations of endometriosis (grade C). No recommendation can be made on which technique to prefer between conservative (ureterolysis) or radical surgical techniques or on benefit and length of ureteral stents in case of ureteral involvement. Surgical management of bladder and ureteral localizations of endometriosis do not seem to be associated with altered or improved postoperative fertility (NP4). Since late postoperative ureteral anastomosis stenosis were reported with silent kidney loss, repeated postoperative imaging monitoring is justified (expert opinion).

[Morbidity and functional long-term follow-up of patients with surgical treatment of urinary tract endometriosis]. / Morbidité et conséquences fonctionnelles de la chirurgie de l'endométriose urinaire.

OBJECTIVE: To assess postoperative complications, improvement of pain symptoms and residual urinary functional symptoms after surgery for deep infiltrative endometriosis affecting ureter or bladder. METHODS: Retrospective study of complications (Clavien-Dindo classification), pain (visual analog scale [VAS]) and urinary functional symptoms (Urinary Symptom Profile questionnaire [USP]) of patients surgically treated between 2007 and 2015 in University Hospitals of Lyon. RESULTS: Among 31 patients with endometriosis involving the bladder, 83.9% had a partial cystectomy and 16.1% an extra-mucosal resection. Among patients (n=20) with ureteral involvement, 85% had ureterectomy with ureterocystoneostomy and 15% had only ureterolysis. Grade III postoperative complications occurred in 6% and 0% of patients with bladder or ureteral surgery, respectively and no grade IV or V complications were reported. Mean bladder VAS dropped from 5.3±4.2 to 0.3±0.9 after a follow-up of 42 months (P<0.0001). In patients with ureteral involvement, mean flank VAS dropped from 3.6 to 0.9 after a follow-up of 33 months (P<0.0005). Mean postoperative USP score for dysuria and detrusor overactivity were 1.35/9 and 2.48/21 in case of bladder involvement, and 1.10/9 and 2.15/21 in case of ureteral involvement. CONCLUSION: Multidisciplinary surgical management of deep infiltrative endometriosis affecting urinary tract was associated to a low risk of severe postoperative complications and to a long-term significant improvement of pain symptoms without significant residual functional urinary symptoms.

[The Allium ureteral stent in the management of ureteral stenoses, a retrospective, multicenter study]. / Stent Allium urétéral dans la prise en charge des sténoses urétérales. Étude rétrospective multicentrique.

OBJECTIVE: To evaluate the performance of the Allium ureteral stent in the management of patients initially treated with double J stents for the long-term treatment of stenoses. MATERIALS AND METHODS: We performed a retrospective multicenter study involving 36 patients who received 37 Allium ureteral stents (metallic 24 Fr) between September 2011 and January 2015 in one of three French teaching hospital centers. The mean age of the patients was 63.8 years (min-max: 33-88 years) and most were women (70%). Of these patients, 5.6% had ureteral fistulae and 94.4% stenoses. Mean stenosis length was 4.15cm (min-max: 0.5-12cm). All analyses were two-tailed with an alpha risk of 0.05. Statistical significance was set at P<0.05. Results were expressed as hazard ratios (HR) with 95% confidence intervals and P-values. RESULTS: During the follow-up period, 37% of the stents were removed due to migration (complication occurring in 18.9% of the studied population), infection (10.8%) or intolerance (8.1%). The other stents were removed after 1 year. Clinical effectiveness, defined as a lack of stenosis or fistula recurrence, was 52.8% after a mean follow-up of 7.1 months. CONCLUSION: Clinically effective in more than 50% of cases, the Allium ureteral stent appears to be an alternative to indwelling double J stents. LEVEL OF EVIDENCE: 4.

Patient-reported long-term sexual outcomes following plication surgery for penile curvature: A retrospective 58-patient study.

OBJECTIVE: To evaluate long-term sexual function results following plication surgery for the correction of penile curvature using patient questionnaires. METHODS: We performed a single-center, retrospective study in a cohort of patients with Peyronie's disease or congenital penile curvature. All patients who underwent plication surgery on the convex aspect using the Nesbit, Yachia or diamond-shaped techniques were included. At a mean 34 months after the interventions, the patients were asked to respond to the IIEF5 questionnaire and a 19-item questionnaire. RESULTS: Forty-six patients operated for Peyronie's disease and 12 for congenital curvature (total: 58) were included in the study. The questionnaire response rate was 69% (40/58). The shortened penis bothered 47.5% of patients in their sexuality at least regularly. Involuntary exit from the vagina occurred for 35% of the patients in at least one out of two sexual intercourse sessions. Postoperative sexual life was as good as or better than preoperative sexual life for 35% of the patients and 95% stated that they could achieve erection at least sometimes, in coherence with the mean IIEF5 result of 19.3/25. CONCLUSION: Our study suggests that even when successful, a relatively high rate of patients may be unsatisfied with the results of plication surgery, and there may be a relatively low rate of maintenance or improvement of postoperative sexual life. Furthermore, our in-house questionnaire, although not validated, shed light on how bothersome the loss of penis length is in postoperative sexuality, an aspect the IIEF5 and its sole evaluation of erectile quality cannot detect. LEVEL OF EVIDENCE: 4.

[CCAFU french national guidelines 2016-2018 on renal cancer]. / Recommandations en onco-urologie 2016-2018 du CCAFU : Cancer du rein.

The previous guidelines from the Cancer Committee of the Association Française d'Urologie were published in 2013. We wanted this new version to be simple, clear and straightforward. All significant recent publications on kidney cancer have been included. The main changes compared to 2013 are the following: © 2016 Elsevier Masson SAS. All rights reserved.

[Impact of anastomotic strictures on treatment of post-prostatectomy stress incontinence by artificial urinary sphincter]. / Impact des sténoses anastomotiques sur le traitement de l'incontinence urinaire post-prostatectomie par sphincter artificiel.

INTRODUCTION: Stress urinary incontinence (SUI) is a degradation of the quality of life factor in the consequences of radical prostatectomy. Artificial urinary sphincter (AUS) is the standard treatment. Screening and preoperative treatment of anastomotic strictures (AS) is an essential step for the success of the intervention. The objective of the study was to assess the impact of AS on the results of AUA. METHODS: We retrospectively studied 147 AUS settlements from 2005 to 2013 in the urology department of the Centre Hospitalier Lyon by three operators. The demographic characteristics, the irradiation history, the severity of incontinence, the complications of AUS, the continence rate and the postoperative satisfaction were collected. Wilcoxon statistical tests and Fischer and a Kaplan-Meier curve were used to compare the two control groups and AS. Logistic regression analysis looked for predictors of surgical reintervention. RESULTS: Of the 147 patients included, 24 (16.3%) had a history of AS. Of these, 21 (87.5%) were treated with endoscopic urethrotomy. Patients in the AS group had more severe incontinence (P<0.05) than in the control group. Explantation rates, recurrence of incontinence and reoperation was 12.5%, 8.3% and 33.3% in the AS group against 4.9%, 15.4% and 27.6% in the control group. In logistic regression, history of AS has not been found as reoperation risk factor. Continents and satisfied patients rate were 77.8% and 76.5%, respectively in the AS group against 91.1% and 81.1% in the control group. CONCLUSION: The history of AS does not appear to be predictive of poor outcome after implementation of a AUS. Larger cohort studies are needed to confirm these results. LEVEL OF EVIDENCE: 4.

[Hospitalization rate in relation to severe complications of transrectal prostate biopsy: About 2715 patients biopsied]. / Taux d'hospitalisations en rapport avec des complications sévères des biopsies de prostate transrectales : à propos de 2715 patients biopsiés.

MAIN OBJECTIVE: To identify hospitalizations directly related to a complication occurring within 30 days following a transrectal prostate biopsy (PBP). SECONDARY OBJECTIVES: Overall hospitalization rates, mortality rates, potential predisposing factors for complications. PATIENTS AND METHODS: Single-center study including all patients who underwent PBP between January 2005 and January 2012. Any hospitalization occurring within 30 days of the PBP for urgent motive was considered potentially attributable to biopsy. We identified the reason for hospitalization with direct complications (urinary infection or fever, rectal bleeding, bladder caillotage, retention) and indirect (underlying comorbidities decompensation) of the biopsy. The contributing factors were anticoagulant or antiplatelet treatment well as waning immunity factors (corticosteroid therapy, HIV, chemotherapy or immunodulateur). RESULTS: Among 2715 men who underwent PBP, there were 120 (4.4%) hospitalizations including 28 (1.03%) caused by the biopsy. Twenty-five (0.92%) were related to a direct complication of biopsy: 14 (56%) for urinary tract infection or fever including 1 hospitalization in intensive care, 5 (20%) for rectal bleeding which required several transfusions 1, 10 (40%) urinary retention and 3 (0.11%) for an indirect complication (2 coronary syndromes and 1 respiratory failure). Several direct complications were associated in 3 cases. Only two hospitalizations associated with rectal bleeding were taking an antiplatelet or anticoagulant. There was no association between hospitalization for urinary tract infections and a decreased immune status. The first death observed in our study occurred at D31 of pulmonary embolism (advanced metastatic patient with bladder cancer). Twenty (60.6%) patients urgently hospitalized did not have prostate cancer. CONCLUSIONS: Within this large sample of patients the overall rate of hospitalization due to the realization of a PBP was 1%. It has not been found predictive of complications leading to hospitalization. LEVEL OF EVIDENCE: 4.

[Cryotherapy percutaneous for renal tumors: Our center's beginning experience]. / Cryothérapie pour les tumeurs rénales: le début d'expérience de notre centre.

OBJECTIVE: To evaluate oncologic and functional outcomes after percutaneous cryoablation (PCA) for renal masses based on our single center experience. PATIENTS AND METHODS: We retrospectively identified 26 patients who underwent PCA for 28 tumors between November 2006 and June 2011. Patient's demographics and baseline clinical characteristics, tumor features, perioperative information, and postoperative outcomes we rerecorded. A biopsy was performed systematically before each procedure. Control imaging was obtained at 1, 3, 6 and 12 months, and yearly thereafter. Oncological outcomes were determined by radiographic evidence of tumor recurrence, which was defined by contrast enhancement at the cryoablation site on control imaging at M3. RESULTS: Patients had mean age of 70.1 years, mean Charlson comorbidity index (CCI) and body mass index) were 6 and 29 kg/m(2) respectively. There were 11 kidney transplants, including 4 solitary. Mean tumor size was 29.5mm and was represented mainly by clear cell renal cell carcinomas (16/28), endophytic (17/28) and midkidney (14/28) (±9.8). Twenty-five cryoablations were performed percutaneously by two lumbotomy. Mean clearance preoperative MDRD was 66,1 mL/min. Mean length of stay was 3.3 days (±2.2). Intraoperative complications consisted of 2 pneumothorax and 6 minor complications postoperative (Clavien≤2). There were no major complications. Mean follow-up was 27.5 months (±15.7), MDRD clearance distance was 61.9 mL/min. Overall survival and disease-specific survival was 100%, while the recurrence-free survival was 78.6% (5 recurrences and 1 failure treatment). CONCLUSION: The percutaneous cryoablation provides a safe and oncologically to extirpative surgery for renal masses in patients with significant medical comorbidities. LEVEL OF EVIDENCE: 5.

[Urological complications after kidney transplantation from extended criteria donors: Ureteroneocystostomy versus pyelo-ureterostomy]. / Complications urologiques après transplantation de reins issus de donneurs à critères étendus : anastomoses urétéro-vésicales versus anastomoses pyélo-urétérales.

INTRODUCTION: The use of transplants from extended criteria donors increases the number of urological complications after renal transplantation. Two different anastomosis techniques used to restore urinary continuity are compared in this study. PATIENTS AND METHODS: Retrospective study, bi-center over a period of 5 years. One hundred and seventy six patients operated at Hospices Civils de Lyon benefited from ureteroneocystostomy according to De Campos-Freire (group 1) and 167 patients operated at the Necker Hospital in Paris had a pyelo-ureterostomy (group 2). The various urological complications (fistulas, strictures, seromas, haematomas and vesico-ureteric reflux) and their care were compared. Risk factors were sought. RESULTS: The waiting time before transplantation was longer in group 2 than in group 1 (51 and 33.84 months) as the percentage of anuric patients (52.9 % against 32.9 %) (P<0.001). The cold ischemic time was shorter in group 1 (939.3minutes on average against 1325.3minutes for group 2) (P<0.001). A double J stent was put in place in 97.6 % of cases in group 2 against 84.2 % for group 1 (P<0.001). We did not find any significant difference in the occurrence of stenosis and fistulas (major complications) between the 2 groups. There were more minor complications (hematoma, seroma and vesico-ureteric reflux) in group 1 (P=0.033). There was a difference in the treatment of these complications, especially stenosis (P=0.024) with a significantly more conservative approach in group 2. Multivariate analysis found anuria, sex of recipients and donor age as independent risk factors in the onset of complications and the double J stent as a protective factor. CONCLUSION: This study does not demonstrate the superiority of a urinary anastomosis technique. The establishment of a double J stent reduces the risk of complications. Analysis of risk factors allows to propose a decision tree to guide the surgical strategy, particularly in the population of anuric recipients. LEVEL OF EVIDENCE: 5.