[MRI of the axial skeleton for evaluation of prostate cancer extent in french Guyana]. / IRM du squelette axial pour le bilan du cancer de prostate en Guyane française.

INTRODUCTION: Spread evaluation of Prostate Cancer (PC) in French Guyana is bothered by the lack of bone scintigraphy. The availability of 4 MRI allows to develop alternatives using Axial Skeleton MRI (AS MRI). We report the related results. MATERIAL: AS MRI was done in patients with diagnosis of high risk PC: PSA>=10ng/ml and/or Gleason Score>=7 (predominant Gleason grade 4) and/or clinical T2b and/or T2b/T3 MRI and/or >50% positive biopsies. AS MRI was including spine, pelvis and skull assessement.The results were systematically compared to the clinical, biological and biopsy features. RESULTS: Amongst 163 AS MRI performed, 30 were positive and 133 negative. Of these 133 patients, 60 were submited to radical prostatectomy with or without lymphadenectomy. In these 133 patients with negative AS MRI, median PSA was 11ng/ml (1-51) and 27 (20,3%) had PSA>20ng/ml. In patients with positive AS MRI, only 1 had PSA<20ng/ml and predominant Gleason grade 3. CONCLUSION: Our study shows that AS MRI assessement is especially usefull in patients who are most likely to have bone metastasis that is to say those with PSA>20ng/ml and/or predominant Gleason grade 4. LEVEL OF EVIDENCE: 3.

[A long distance between home and hospital does not bother ambulatory surgery for ureteroscopy in French Guyana]. / Une grande distance entre le domicile et l'hôpital ne contre-indique pas l'ambulatoire pour urétéroscopie en Guyane française.

INTRODUCTION: French Guyana is 83,500 km2 wide (equivalent to 1/6 of France). Communes are distant. Public urology is set in Kourou only. These particularities led to develop ambulatory urological surgery including for patients living far away from the reference centre. We report our experience with patient ureteroscopy (URS). MATERIAL: The study is retrospective (2018-2019), and includes 125 patients. Among these patients, 19.2% live in Kourou, 71.1% live 40 to 100km from the hospital and 9.7% beyond 100km. Every patient had an outpatient procedure for rigid and/or flexible URS to treat stone disease, including in lower calyx [LC] (38.4%). Ambulatory surgery was also proposed to the patients living away with the usual restrictions. Complications, results and switch to conventional hospitalisation (CH) were studied. RESULTS: Mean stone size was 10,5mm (4-30), stone density was 1030 UH (470-1700). The postoperative complication rate was 4%. There were 90.4% 'stone free' patients (85.4% for LC). One patient was rehospitalised within 48hours for acute flank pain and 9 patients had a switch of ambulatory to CH: 6 for discharge too late and 3 for complication (fever and/or pain). Distance between home and hospital was linked neither to complication rate, nor to switch to CH. CONCLUSION: Ambulatory URS is possible without further complications in selected patients living beyond 100km from the hospital, because of a specific organisation and an appropriate training of the caregivers involved in postoperative patient care. LEVEL OF PROOF: 3.

[Epidemiology of prostate cancer (PCa) in French Guyana (FG) - Preliminary results]. / Épidémiologie du cancer de la prostate en Guyane française ­ Données préliminaires.

INTRODUCTION: Epidemiology of prostate cancer (PCa) in French Guyana (FG) is not well documented yet. It differs from the reported one in French West Indies due to a younger population, less exposed to agricultural pesticides with also much lower level of medical information and care. MATERIAL: The incidence and mortality rates available in the regional register of cancers are reported for the period 2010-2014. The characteristics of 242 consecutive prostate biopsy series performed between 2017 January and 2019 October for abnormal digital rectal examination (DRE) and/or PSA>4ng/mL are also described. RESULTS: PCa incidence in FG is 94.4°/°°°° and specific mortality 16.9°/°°°°. Among the biopsies, 77.7% (188/242) are positive with a mean PSA of 72.6ng/mL (1-4000) at a mean age of 66years (50-89), 34% (64/188) with an abnormal DRE, 12.3% (23/188) with a PSA>50ng/mL and 28.2% (53/188) with a Gleason score≥8. CONCLUSION: In spite of young population, less exposure to environmental risk factors and high rate of racial mixing, the early PCa diagnosis is still a challenge in FG. The observed incidence and mortality rates suggest underestimation of PCa cases and too late specific care what is also suggested by adverse pathological and biological characteristics of the tumors at the time of diagnosis. LEVEL OF EVIDENCE: 3.

[Evaluation of the operating results and costs associated with the implementation of a flexible ureteroscopy activity within a university hospital center]. / Évaluation des résultats opératoires et des coûts liés à la mise en place d'une activité d'urétéroscopie souple au sein d'un centre hospitalo-universitaire.

INTRODUCTION: The increasing use of flexible ureteroscopy (USSR) sets the cost problems inevitably associated with the fragility of these endoscopes. The aim of this work is to clear from a recent example (universitary hospital) results, costs during the implementation of this technique. MATERIAL AND METHODS: This is a retrospective study conducted from December 2012 (date of introduction of the activity) in March 2015 concerning the USSR made in a French universitary hospital for stone disease. In this analysis, the cost of consumables was not evaluated, nor the costs of the operating theater or hospitalization. RESULTS: One hundred forty-one hundred and thirteen patients USSR were conducted by seven surgeons. Seventeen breakages and failures have been identified and have led to the sending of the endoscope for repair. Breakage rate and failure was 12%. All failures were treated with a standard exchange of the device (including 4 standard exchanges made under warranty). The estimated average cost of outages was 3600 euros. This represents an average cost per procedure of about 625 euros (acquisition plus cost of failures) without counting the costs of sterilization or high-level disinfection. The impossibility of relocating the lower calyx stones is associated with an excess risk of breakage (odd ratio: 2.92 CI95: [1.02; 8.37]). CONCLUSION: This study is novel because it focuses on the cost of implementing a technique in a French university hospital. The use of flexible ureteroscope to unique uses might be an interesting source of savings in the implementation of this technique. This remains to be evaluated. LEVEL OF EVIDENCE: 5.

[Urethral strictures treated with excision and primary anastomosis: Impact of etiology on care pathways and management]. / L'urétroplastie par résection­anastomose en un temps : impact du mécanisme lésionnel sur la prise en charge et les résultats.

BACKGROUND AND OBJECTIVES: Excision and primary anastomosis is a common treatment of the short urethral posterior strictures. Strictures can be associated to pelvic bone fractures, endourological procedure (iatrogenic) or idiopathic. Whether outcomes are different with respect to etiology is still under reported. Herein, we aimed to explore the impact of etiology on care pathway and management of patients treated with excision and primary anastomosis for urethral strictures. PATIENTS AND METHODS: Between January 2004 and December 2015, 97 patients were referred and treated with excision and primary anastomosis for a short urethral stricture. Data were extracted from a single institutional registry and retrospectively analyzed. Patients were sorted into 3 groups with respect to the etiology: pelvic bone fracture (n=23), iatrogenic (n=24) and idiopathic (n=50). Preoperative patient's and stricture characteristics as well as postoperative outcomes of the three groups were compared using Student or Chi2 tests as appropriate. Specifically, recurrence rate and time to first recurrence was analyzed according to a Cox proportional hazard model. RESULTS: Patients with strictures caused by pelvic bone fracture were younger (P<0.001), more likely to have a suprapubic catheter (P=0.007), and no attempted procedures before the referral (P<0.001). Strictures length and maximum flowmetry were similar in all groups. Postoperatively, 90-d complications and flowmetry were similar in both groups. After a mean follow-up of 25±24 (range: 1-102) months, 27 (27.8 %) patients recurred. According to our model, etiology did not seem to impact overall recurrence rate. However, when the subgroup of patients with recurrence were analyzed, strictures associated with pelvic bone seemed to recur faster than the 2 remaining groups. CONCLUSION: With some limitations of due to the population size and the retrospective design of the analysis, etiology impacted care pathway in terms of referral and initial management of patients treated with excision and primary anastomosis for a short urethral posterior stricture. However, recurrence rate and mid-term outcomes seem less impacted. LEVEL OF EVIDENCE: 4.

[Introduction of the photoselective vaporization of the prostate in an outpatient setting: Outcomes after the first 100 cases]. / Introduction de la photovaporisation de prostate en ambulatoire : résultats sur les 100 premiers patients.

BACKGROUND AND OBJECTIVES: Our objective was to describe the progressive introduction of photoselective vaporization of the prostate (PVP) in an academic department of urology in an outpatient care setting and report our outcomes after the first 100 cases. PATIENTS AND METHODS: Since May 2014, XPS GreenLight™ (Boston Scientific-AMS, USA) PVP in the treatment of benign prostatic hyperplasia was introduced in our department. A prospective local registry was opened to collect patients' demographics, preoperative characteristics and surgical outcomes including operative time, length of stay, catheterization time, and postoperative complications as well as functional outcomes. We also assessed limitations to the outpatient care setting. RESULTS: Conversion to TURP was reported in 6 % for uncontrolled bleeding. Overall, 21 % patients needed more than 1-day catheterization. After 6 months of follow-up, 3 patients (prostate volume 50, 117, and 178mL) had reintervention (second PVP). Ninety days' complications were reported to be up to 6 % (3 urinary obstructions, 1 prostatitis, 1 transfusion and a severe sepsis). After 8 months, an 80 % plateau of outpatient care setting was achieved. Anesthesiologists counter-indicated outpatient care in 59 % of the cases. CONCLUSIONS: A progressive introduction of the PVP in an outpatient care setting is associated with a low complication rate. A plateau was achieved in less than 100 procedures. The major limitation of the outpatient care setting was patients' competitive comorbidities and not disease characteristics. LEVEL OF EVIDENCE: 4.

[Castration modalities in prostate cancer: Are they all equal?]. / Modalités de castration dans la prise en charge du cancer de la prostate: sont-elles toutes équivalentes ?

AIM: The aim of this literature review was to focus on the new highlights regarding oncologic and safety outcomes depending on the type of castration used. MATERIAL: Literature search using various algorithms "prostate cancer", "castration", "agonist", "antagonist", "orchiectomy", "GnRH", "FSH", "androgen deprivation therapy" has been performed in April 2015, through the PubMed and Embase databases. RESULTS: GnRH agonists and antagonists are both currently used in clinical practice. Nevertheless, differences regarding their pharmacologic properties have been highlighted in recent studies, specifically regarding the rapidity, sustainability and depth of the castration, but also the decrease in FSH level. Such differences may have oncological impact on the patient, regarding the disease biological control and the time to progression, and a tolerability impact, especially on the cardiovascular risks. The role of the depth and the sustainability of the castration in one hand, the FSH impact in the other hand, as well as a direct inhibition on extra-pituitary GnRH receptors by antagonist might explain these differences. CONCLUSIONS: Recent studies suggest differences between GnRH agonists and antagonist that could impact the patient clinical outcomes. However, further high level of evidence comparative studies remains warranted.

[Neoadjuvant chemotherapy in muscular invasive bladder cancer: Complications and consequences with cystectomy]. / Chimiothérapie néoadjuvante dans le cancer de vessie infiltrant le muscle : complications et conséquences sur la réalisation de la cystectomie.

INTRODUCTION: The fear of the deterioration of the patient's condition related to the toxicity of neoadjuvant chemotherapy is a barrier to its development. This multicenter retrospective study aims to present the secondary effects of neoadjuvant chemotherapy and its impact on the achievement of cystectomy. MATERIALS AND METHODS: Patients with urothelial carcinoma classified cT2 to cT4a N0M0 were included. Chemotherapy with 6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) followed by a cysto-prostatectomy or anterior pelvectomy was scheduled. RESULTS: A total 32 patients were included. Six cycles of neoadjuvant chemotherapy were performed in all 11 patients. Shutdown causes were toxicity in 85% of cases. Cystectomy was performed in 86.6% of patients. Surgery was not performed in 6 patients. The reasons were the alteration of the general condition in 2 cases, 2 patients had advanced cancers diagnosed intraoperatively, and 2 refused surgery. Complications of grades 3 and 4 according to the classification of Clavien and Dindo had occurred respectively in 15.3% and 11.5%. DISCUSSION: This study reports results close to what is found in the literature on the effects of neoadjuvant chemotherapy on achieving cystectomy, but it has some limitations: the retrospective analysis of data on surgery and the lack of control group. In addition, the short follow-up does not yet allow to know the long-term oncological results. CONCLUSION: This study supports the fact that the toxicity of neoadjuvant chemotherapy does not seem to cause a significant risk of non-completion of cystectomy. LEVEL OF EVIDENCE: 4.

[Practice uptake in France before and after the 2010 French guidelines on kidney cancer]. / Évolution des pratiques de la chirurgie rénale avant et après les recommandations de l'AFU de 2010.

INTRODUCTION AND OBJECTIVE: Compared to the 2007 edition, the 2010 French urological association onco-urology guidelines boarded the indications of partial nephrectomy (PN) as long as the procedure is technically feasible. The aim of this study was to assess national practice with respect to kidney surgery in the 2 years before and after current guidelines. MATERIALS AND METHODS: The national database of the Agence Technique de l'Information sur l'Hospitalisation (ATIH) was queried for procedures performed between 2009 and 2010 (era 1) and between 2011 and 2012 (era 2). The coding system of the Classification Commune des Actes Médicaux (CCAM) was used to extract kidney related procedures. For each era, procedures were sorted into partial versus radical nephrectomy (RN), laparoscopic/robotic versus open approach, and private versus public hospital. The two eras were then compared. RESULTS: Overall, 28,000 and 28,907 procedures were reported in era 1 and 2 with mean 14,000 and 14,450 procedures per year respectively. PN increased from 30% to 35% (P<0.0001) between the two eras. This uptake was similar in public and private hospitals. Accordingly, laparoscopic/robotic approach has significantly increased between the two eras (35% versus 39%, P<0.0001) and even more importantly in public hospitals (P=0.0017). There was a significant increase in laparoscopic/robotic PN as well as a decrease in open RN over the years of the study period. CONCLUSION: This study showed the development of PN and the minimally invasive approach. Over the study period, minimally invasive procedure uptake was higher in public hospitals.