Continuous saline bladder irrigation after blue light transurethral resection of bladder tumor increases recurrence-free survival in low- to intermediate-risk non-muscle invasive bladder cancer.

OBJECTIVES: To evaluate the efficacy of Continuous Saline Bladder Irrigation (CSBI) after blue light transurethral resection of bladder tumor (TURBT) to prevent recurrence of low- to intermediate-risk Non-Muscle Invasive Bladder Cancer (NMIBC). PATIENTS AND METHODS: We conducted a retrospective study including patients with low- to intermediate-risk NMIBC who underwent TURBT in two urological centers between January 2017 and December 2018. Each TURBT was performed using blue light after intravesical instillation of hexaminolaevulinic acid. The experimental group included patients who received CSBI while the control group included patients without CSBI. When practice, CSBI was started immediately after the surgery and was interrupted 24 hours thereafter. Low-risk NMIBC had a surveillance while intermediate NMIBC had 8 adjuvant endovesical instillations of Mitomycin. The primary endpoint was bladder tumor recurrence free-survival which was defined as the time between the initial TURBT and the date of TURBT for bladder recurrence. RESULTS: A total of 167 patients (median age: 71 years) were included: 20% female, 15% low-risk, 85% intermediate-risk NMIBC. CSBI was performed in 95 cases (57%). No complication related to irrigation was reported. Bladder recurrence was observed in 55 cases (32.9%): 22 (23.1%) in the CSBI group vs. 33 (45.8%) in the control group (P=0.002). Multivariate stepwise logistic regression analysis with backward selection revealed that CSBI (HR 0.47 [0.27-0.81]; P=0.006) and MMC (HR 0.55 [0.31-0.95]; P=0.034) were significantly associated with reduced risk of bladder recurrence. CONCLUSIONS: Continuous saline bladder irrigation reduced the risk of bladder recurrence after blue light TURBT in patients with low- to intermediate-risk NMIBC while being safe. Prospective randomized study is needed to confirm these results. LEVEL OF EVIDENCE: 3.

[Intradetrusor injections of botulinum toxin A to treat urinary incontinence due to bladder overactivity during idiopathic Parkinson's disease]. / Injections intradétrusorienne de toxine botulique A (onabotuliniumtoxin A) pour traiter l'incontinence urinaire par urgenturie au cours de la maladie de parkinson idiopathique.

INTRODUCTION: During idiopathic Parkinson's disease (IPD), lower urinary tract symptoms and dysfunctions are frequent, dominated by overactive bladder and detrusor overactivity (OAB, DO). Intradetrusor Injection (IDI) of Botulinum Toxin A (BTA) is recommended as second-line treatment for neurogenic urinary incontinence related to DO in multiple sclerosis or spinal cord injury patients. However, there is little data on BTA IDI to treat incontinence owing to OAB and DO during idiopathic Parkinson's disease. The objective of this study is to evaluate efficacy and tolerance of BTA IDI in patients suffering IPD. PATIENTS AND METHODS: We conducted a retrospective study in IPD patients treated with BTA IDI from 2012 to 2018. For each patient we compared patient clinical and urodynamic data at baseline before the first injection and 8 weeks following the injection. We defined 3 levels of effects (perfect, improved, failure), corresponding to 3-dimension composite criteria: clinical, quality of life (Likert scale), urodynamics. RESULTS: Sixteen patients were included from 2012 to 2018. The median age was 73 (70-78.25). The median number of micturition/day before and after TBA was 13 (10-16) and 9 (6.75-13.25) (p=0.022). The median number of pad used/day before and after BTA was 5.4 (2-5) and 1 (0-5) (p=0.035). Median USP scores for OAB was 15.5 (11.75-20) and 14 (6.75-15.25). Median score on the Likert scale was 1 (0-1.5) meaning "slight improvement" felt by the patient. The median maximum cystometric capacity raised from 130cm3 (41.25-187.75) to 217cm3 (165-376.75) (p=0,013). Among the patients, 20% had a perfect result, 40% were significantly improved and in 40% TBA injections failed. After TBA 4/14 patients (28%) needed intermittent self-catheterization. No severe side effect was observed. CONCLUSION: In this retrospective study we observe some short-term efficacy of TBA IDI to treat urinary incontinence owing to OAB/DO in patients with IPD in 60% of patients. These results are consistent with findings from previous retrospective studies. Prospective data coming from larger cohorts are now tremendously needed to clarify the best patient responders profiles, the actual TBA dose, and eventually to define TBA IDI place in the therapeutic algorithm of IPD patients' incontinence. LEVEL OF EVIDENCE: 4.

Single use and reusable flexible ureteroscopies for the treatment of urinary stones: A comparative study of perioperative complications.

OBJECTIVE: To compare the perioperative complications of patients who underwent flexible ureteroscopy (fURS) for the treatment of urinary stones according to the type of ureteroscope used, single-use (suURS) or reusable (rURS) flexible ureteroscope. PATIENTS AND METHODS: A retrospective and single-center study was conducted between January 2017 and May 2019, including all fURS performed for nephrolithiasis management. During the study period, 5rURS and 1suURS (UscopePU3022™) were available. The primary endpoint was the occurrence of 30-days postoperative complications, especially infectious complications, classified according to Clavien-Dindo grading system. RESULTS: Overall, 322 consecutive fURS were included corresponding to 186 rURS (57.8%) and 136 suURS (42.2%). Respectively in rURS and suURS groups, the median (IQR) age was 57 (45-65) vs. 57 (44-66) years (P=0.75), 83 (44.6%) vs. 63 (46.3%) female were included (P=0.82), and median (IQR) Charlson score was 2 (1-3) vs. 2 (0-3) (P=0.15). Fifty-one patients (15.8%) developed postoperative complications, 28 patients (15%) in rURS group and 23 patients (17.6%) in suURS group (P=0.64). Most of them (n=47, 92.1% of overall complications) were minor (Clavien I-II). Occurrence of urinary tract infection in suURS group (n=13; 9.5%) was equally comparable with rURS group (n=10; 5.4%), P=0.15. CONCLUSIONS: Our data suggests that suURS represents a safe alternative to rURS. Compared to reusable devices, UscopePU3022™ use was associated with a similar complication rates, however, did not decrease the occurrence of infectious events. LEVEL OF EVIDENCE: 3.

[Long term renal function outcomes and predictive factors of chronic renal failure after living kidney donation]. / Devenir à long terme de la fonction rénale et facteurs prédictifs d'insuffisance rénale chronique après don vivant.

INTRODUCTION: Living donor kidney transplants give the best results in term of renal function and are the principal solutions for the transplant shortage. However, donors selection and kidney function evaluation after surgery are essential. The objective of this study was to evaluate the prevalence and to identify the predictive factors of chronic renal failure for the donor, after living donor nephrectomy. MATERIALS AND METHODS: It was a retrospective and monocentric study, including all the patients who underwent a living donor nephrectomy from 2007 to 2015 at the hospital of the Conception in Marseille. The primary study endpoint was renal function mesured by the glomerular filtration rate (GFR in mL/min) at 1 year and 5 years after surgery. The identification of moderate kidney failure predictive factors was achieved by an univariate and a multivariate analysis under Cox model. RESULTS: Ninety-one patients were included. There was 40,7 % of men and media nage was 49 years (21; 70). Median pre-operative GFR was 94mL/min (67; 160). Median follow-up was 24 months (1; 120). Post operative GFR at 1 month, 1 year and 5 years was respectively 63mL/min (33; 90), 65mL/min (38; 107) and 67mL/min (56; 126) ans significantly lower than pre operative GFR (respectively P<0,001, P<0,001 et P=0,005). The prevalence of moderate kidney failure at 1 month, 1 year and 5 years was respectively 43,1 %, 33,3 % ans 25 %. In univariate and multivariate analysis, the only parametre significantly associated with a 1 year GFR>60mL/min wasp re operative GFR>90mL/min OR 3,61 IC95 % (1,27; 10,28) P=0,02. CONCLUSION: Living donor nephrectomy leads to an important medium to long term loss of renal function. Donors with pre operative GFR<90mL/min should benefit from a rigorous supervision and nephrological care. LEVEL OF EVIDENCE: 3.