[Male stress urinary incontinence: medium-term results of treatment by sub-urethral bone anchored sling InVance™]. / Efficacité à moyen terme du traitement de l'incontinence urinaire d'effort masculine par bandelette prothétique sous-urétrale à ancrage osseux type InVance™

OBJECTIVE: To analyze the functional and urodynamic results of a compressive sub-urethral sling with bone anchoring InVance™. METHODS: One hundred and six successive patients were operated with this system between August 2004 and March 2009. Urinary incontinence was classified according to the number of daily protections. All the patients have benefited from a clinical, endoscopic and urodynamic pre and post-operative evaluation. The results were classified in four groups, at three months and at one year, according to whether the patients were dry (A), very improved (B), little improved (C), or with no improvement (D). RESULTS: The average age of the patients during the installation of the strip was 67.4 years (46-82). At three months, the rate of dry (A) or very improved patients (B) was of 81.2% (A=75.5%; B=5.7%), and at one year: 75.5% (A=61%; B=14.5%). At three months, the rate of patients little improved (C) or not improved (D) was of 18.8% (C=16%; D=2.8%), and at one year: 24.5% (C=20.3%; D=4.2%). These results deteriorated according to the initial rank of incontinence II, III, and I. Six patients (5.7%) were explanted because of a prosthetic infection which perished at an average of 9 months (3-18). Infection was linked to operative time (p=0.02), and patients age. No osteitis nor urethral erosion were noted. There was a significant rise in the pressures of maximum fence at rest and maximum urethral pressures in reserve (p=0.01). At one year, score ICIQ-UI SF decreased overall by 7.1 points. CONCLUSION: The medium-term results of under-urethral supporting with bone anchoring InVance™ are very encouraging. This technique presents an acceptable morbidity and a good tolerance. It can be proposed in first intention for a urinary incontinence whatever the rank is, even if the effectiveness is particularly present in incontinences of rank I and II.

[Radiotherapy influence, about results of the InVance(®) male sling in men with stress urinary incontinence]. / Influence de la radiothérapie, sur les résultats du traitement de l'incontinence urinaire d'effort chez l'homme, par soutènement sous urétral de type InVance(®).

AIMS: To study impact of previous radiotherapy on urodynamic parameters, continence and complication rate, after prosthetic implantation with InVance® device. PATIENTS AND METHODS: We included 106 patients between August 2004 and March 2009. We stratified urinary incontinence according to pads daily used, in grade I (one to two pads), II (three to four), or III (more than four or condom catheter use). We compared one group of 24 patients with previous radiotherapy (R) to 82 control patients (T) without one. Follow-up was made at three and six postoperative months and then annually. Results were classified into: no leaks, improved or failure. RESULTS: Mean follow-up was 14.8 months (median=12.8) in group R and 12.4 months (median=8.8) in group T. At three postoperative months, continence was achieved in 62.5% patients from group R and in 77% patients in group T (P: ns). At 12 months, results on continence were respectively 52.6% in group R and 63.2% in group T (P: ns). Six patients were explanted because of an infection (5.7%), among which two in group R (8.3%) and four in group T (4.8%). Infection was significantly linked to operative time (P: 0.02). CONCLUSION: Previous radiotherapy has no impact on urodynamic parameters and continence, on short- and mid-term analysis, after implantation of a bone-anchored suburethral sling with InVance® device, preferentially patients with mild to moderate incontinenec urinary.

[Prospective monocentric evaluation of bladder tumor targeting by Hexvix® fluorescence: preliminary results]. / Évaluation prospective monocentrique du ciblage diagnostique par hexaminolevulinate (Hexvix®) des tumeurs urothéliales de vessie: étude préliminaire.

PURPOSE: Prospective evaluation of bladder tumor targeting by Hexvix(®) fluorescence. PATIENT AND METHODS: From September 2008 to September 2009, 28 patients have been evaluated using Hexvix(®) technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected and patients have been classified using EORTC score. RESULTS: From the 28 patients, 14 have been identified with bladder cancer (31 tumors) and 90 samples have shown positive fluorescence in blue light. Compared to white light, four additional tumors have been diagnosed by Hexvix(®) for three patients (p=NS): two cis, one LMP, one pTa low grade. The false positive rate for Hexvix(®) was 65.5 versus 58.5% for white light. EORTC score for bladder cancer was associated with better bladder cancer targeting by Hexvix(®) (p<0.05). CONCLUSION: In our experience, Hexvix(®) targeting was associated with better diagnosis for bladder cancer. Thirteen percent of new positive samples have been found for 10.7% of patients. In our study false positive rate is a critical point (65.5%). EORTC score for recurrence and progression might allow to select patients to be targeted by Hexvix(®).

[Pheochromocytoma and cardiogenic failure: an indication for emergency adrenalectomy]. / Phéochromocytome et défaillance cardiaque : une indication exceptionnelle de surrénalectomie en urgence ou semi-urgence.

OBJECTIVE: To identify cardiogenic failure or cardiogenic shock associated with pheochromocytoma diagnosis and emergency adrenalectomy. Update this unusual presentation of pheochromocytoma. METHODS: Between 1998 and 2009, 119 adrenalectomies were performed in our department, among which 19 cases for pheochromocytoma. We reported three cases with cardiogenic failure or cardiogenic shock associated with emergency adrenalectomy. RESULTS: Patients were 36, 41 and 67 years old. The elapsed time between cardiogenic failure and surgery was 0, 7 and 19 days. The first diagnosis was a viral myocarditis in those three cases. The diagnosis of adrenal pheochromocytoma was done in a second step by the association of adrenal tumour on abdominal CT scan and detection of significantly elevated plasma/urine catecholamine. Severe systolic dysfunction with low ejection fraction was associated in all cases. Cardiac function was quickly restored after adrenalectomy. CONCLUSION: Cardiac emergency associated with pheochromocytoma is an unusual clinical presentation. When diagnosis fails to be performed, patients have a very poor prognosis. According to a review of the sparse literature, only early recognition and emergency adrenalectomy can improve the outcome.

[Demography of residents in urology in France: appraisal and perspectives]. / Etat des lieux et perspectives sur la démographie des internes en urologie en 2008.

PURPOSE: The objective was to identify the number of residents registered in the course of urology in France in 2008, and to make a forecast in the number of posts of fellow and specialist assistant available at the end of their course. MATERIAL: From January to February 2008, a questionnaire identified in all French University Hospital the number of residents enrolled in the urology course, and the number of posts of fellow and specialist assistant in urology in the region. The year of the end of the course has been determined for each resident in compliance with seniority, and taking into account the availability. The number of fellow and specialist assistant posts available in the same period was estimated by considering the duration of each postinternship, and any change in the number of posts. RESULTS: Our census counted 207 residents, 76 fellow posts, 10 specialist assistant posts. Of the 207 residents, 29 completed their studies in 2008, 57 in 2009, 60 in 2010, 61 in 2011. Following our methodology, there was a lack of fellow and specialist assistant posts available from November 2010 (-15 posts in 2010, -7 posts in 2011). CONCLUSION: Our study showed an increase in the number of residents enrolled in urology course by years of promotion, causing a lack of fellow and specialist assistant posts from 2010. Apart from an opening of additional fellows and specialist assistants at that time, our study highlights the long-term regulation of entries in the urology course ensuring a postinternship quality.

[Value of nitrous oxide-oxygen mixture (Entonox) in transrectal prostate biopsies]. / Intérêt du mélange équimolaire d'oxygène et de protoxyde d'azote (Meopa) dans les biopsies transrectales de prostate.

OBJECTIVE: The objective of this study was to evaluate the analgesic and anxiolytic properties of an equimolar nitrous oxide-oxygen mixture (Entonox) for transrectal prostate biopsies compared with the use of intrarectal lidocaine gel. The authors evaluated the pain experienced by patients during the procedure and the correlation between pain and anxiety. MATERIAL AND METHODS: One hundred and two patients were included in the study and were divided into two groups. Patients of group 1 (47 patients) received 15 ml of intrarectal 2% lidocaine gel and patients of group 2 (55 patients) inhaled Entonox for three minutes before the procedure. A visual analogue scale (VAS), graduated from 0 to 10, was used to evaluate pain intensity. Patients completed the Spielberger State-Trait Anxiety Inventory (forms Y and A), scored from 20 to 80, before the procedure. RESULTS: No significant difference in anxiety scores was observed between the two groups (p=0.85). In contrast, pain intensity evaluated by the patient tended to be lower in the Entonox group (mean VAS: 2.9 versus 3.5; p=0.10). A linear correlation was observed between the anxiety score and pain intensity in the lidocaine group (p=0.01), but not in the Entonox group (p=0.92). CONCLUSION: The use of Entonox tended to improve the tolerability of prostate biopsies, which can be explained by attenuation of the anxiogenic component of pain.

[Management of ureteral injuries]. / Prise en charge des lésions urétérales iatrogènes.

Ureteral injury is a rare but potential serious complication that can occur during a variety of general surgical procedures. Knowledge of the course of the ureter is the first step toward preventing ureteral injuries. While some injuries are noticed intraoperatively, most are missed and present later with pain, sepsis, urinary drainage or renal loss. The choice of treatment is based on the location, type and extend of ureteral injury. For injuries recognized during open surgery, when involving the distal 5 cm of the ureter, an antireflux ureterocystostomy such as the Politano-Leadbetter procedure or a vesicopsoas hitch can be performed. For the middle ureter, an ureteroureterostomy is satisfactory and for the proximal ureter, most injuries can be managed by transureteroureterostomy. In complex situations intestinal interposition, autotransplantation or even nephrectomy can be considered. The majority of patients with delayed diagnosed ureteral injuries should be managed by an initial endo-urologic approach.

[Laparoscopic adrenalectomy for large tumors]. / Exérèse laparoscopique des volumineuses tumeurs de la surrénale.

AIM OF THE STUDY: To analyze indications and results of laparoscopic adrenalectomy for large tumors (> 6 cm). METHODS: It is a retrospective study including patients between January 1994 and December 2003 operated on for large adrenal lesions > or =6 cm. The size was given by the pathologist. All the patients had a flank transperitoneal approach. Analysed Parameters were: operative difficulties; operative time; conversion rate; postoperative morbidity, follow-up and histologic data. RESULTS: Fourteen patients (10 female and 4 male) were included. Mean age at the time of the diagnosis was 52 years (range: 17-79). Mean size of the lesions was 7 cm (range: 6-10 cm). Mean operative time was 132 mn (range: 120-240 mn). None of the patients experienced surgical complications. Two conversions were needed (for vena cava attachments in one case and because of a retrocava localization in the other case). Three patients had morbidity: one intraperitoneal hemorrhage occurring at the second postoperative day and needing laparotomy; one left pneumopathy; and one case of neuralgia due to a port insertion. Mean hospital stay was 4,5 days. Histologic data showed: five ganglioneuromas, three pheochromocytomas, three adenomas, two adrenocortical carcinomas, and one postpancreatitis cytosteatonecrosis. CONCLUSION: Laparoscopic adrenalectomy is feasible for large lesions > or =6 cm when no evidence of malignity is demonstrated neither by the preoperative imaging study nor by the surgical exploration.