[Millin adenomectomy in the era of laser enucleation: results in a series of 240 cases]. / L'adénomectomie selon Millin à l'heure de l'énucléation laser : résultats d'une série de 240 cas.

INTRODUCTION: New techniques have been proposed for the surgical treatment of benign prostatic hypertrophy (BPH): laser enucleation and laparoscopic adenomectomy. The objective of this retrospective study was the comparison of the results of Millin adenomectomy realized under contemporary medical conditions, with the results of laser enucleation and laparoscopic adenomectomy. METHOD: Two hundred and forty consecutive Millin adenomectomy cases performed between January 2004 and December 2008 were analyzed. Patient evaluation before operation consisted in IPSS score, quality of life score, maximum flow rate (Qmax), post-void residual volume (PRV), total prostate volume (TPV) performed under trans-rectal ultrasound. Operation duration, adenoma weight, blood loss during operation, transfusion rate, duration of Foley catheterization, duration of hospital stay, and immediate postoperative complications according to Clavien classification were reported. Each patient was systematically controlled at 3 months and was invited by mail for a second control in 2012. Each of the two outpatient controls consisted in the realization of an IPSS, quality of life score, Qmax and PRV. Our results were compared to contemporary results published concerning open adenomectomy and new techniques of adenomectomy. RESULTS: Mean age was 69 years, TPV before operation 111 cc, adenomectomy specimen weight 82 gr, blood loss during operation 246 mL, transfusion rate 6 %, operation duration 88 min, Foley catheterization duration 3.8 days, mean hospital stay 5.6 days. Clinical results at 3 months were: IPSS decrease from 25 to 5 points, quality of life score decrease from 5 to 0.7 points, Qmax increase from 6.5 to 22 mL/sec, PRV decrease from 115 to 7.5 mL. According to the use of either the classical classification or of Clavien classification, the rate of early complications varied respectively from 36 to 49 %. No Clavien grade 4 or 5 complication was observed. Long-term results in 137 (57 %) of the patients with a mean age of 80 years, 5 years medial control (4; 8) after adenomectomy showed an IPSS varying from 2.5 to 6.6 points according to follow-up length, quality of life score varying from 0 to 1.2 points, Qmax varying from 13 to 23 mL/sec, PRV varying from 0 to 25 mL. CONCLUSION: The lack of exhaustivity of the results and the absence of use of Clavien classification rendered difficult any comparison between the different techniques. Urologist motivation in favor of a given technique represented a bias difficult to bypass, even with the realization of a randomized study comparing two techniques. Today, Millin operation still represented the gold standard for the evaluation of new techniques in the surgical treatment of large volume BPH. LEVEL OF EVIDENCE: 5.

[Surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia]. / Évaluation des résultats de la sphinctérotomie dans la dyssynergie vésico-sphinctérienne d'origine neurologique.

PURPOSE: To evaluate middle term results of surgical sphincterotomy in neurogenic bladder dysfunction with detrusor-sphincter dyssynergia. PATIENTS AND METHOD: Retrospective study about 44 patients whom underwent urinary sphincterotomy between January 2008 and September 2012. All patients had detrusor-sphincter dyssynergia. Mean age was 49.7 years. Seventy percent (n=30) of patients had spinal cord injury, 80% (n=34) underwent urethral stent. Sphincterotomy was performed in 55% (n=24) with monopolar resection and in 43% (n=19) with Revolix(®) laser, after urethral stent withdrawal. RESULTS: Mean follow-up was 30 months. Mean hospitalization stay was 5 days. Mean preoperative post-voiding residue (PVR) was 149mL and postoperative was 176mL. Twenty-nine percent (n=13) underwent new sphincterotomy with a final mean 116mL PVR, and a mean delay before new sphincterotomy of 9 months. Twenty percent (n=9) underwent other surgical procedure for sphincterotomy fail. CONCLUSION: In this series, we observed that surgical sphincterotomy is a well tolerated procedure, but with moderate immediate efficiency about 57%. It requires sometimes second procedure and long term follow-up in order not to fail to recognize stenosis, with best surgical success (80%).

[Economic and organizational impact of the use of a disposable sheath with a flexible cystoscope]. / Cystoscope flexible à gaine stérile à usage unique: impact organisationnel et économique et sécurité bactériologique.

PURPOSE: To assess both economical and organizational impact as well as bacteriologic safety of a flexible cystoscope with sterile disposable sheath (FCSDS) compared to standard flexible cystoscopy (SFC) in two French urologic academic units. PATIENTS: Two-center prospective study, comparing the use of the FCSDS to the SFC on two consecutive periods of time. Two hundred and five patients were included and divided into each group. Duration procedures and costs were analysed in the two techniques. The urinary tract infection rate was also described. A dedicated sheaths leaks test after use was performed systematically. RESULTS: The preparation time of the fibroscope was longer for the sheathed cystoscopy group: 16.2 minutes versus 10.9 minutes for the standard group. The mean duration of disinfection was significantly shorter for the sheathed cystoscopy group: 53.8 minutes saved compared to the standard group; 99.01% of the tested sheaths, after their use, had no breaches. Urinary tract infections rate were similar in the two groups. The average cost of a sheathed cystoscopy compared to the standard was significantly cheaper in Lyon and almost equivalent in Marseille. CONCLUSION: The FCSDS allows significant saving over the disinfection duration, consumable costs and staff costs, while ensuring patient bacteriologic safety similar to SFC.

Determination of the beta-blocker betaxolol and labelled analogues by gas chromatography/mass spectrometry with selected ion monitoring of the alpha-cleavage fragment (m/z 72).

Low concentrations of betaxolol in blood plasma and physiological buffers were determined by selected ion monitoring of the intense m/z 72 fragment [CH2 = NH-CH(CH3)2]+ formed by electron impact ionization of the O-trimethylsilyl derivative. At a mass spectrometric resolution of 3000, fewer potentially interfering peaks were seen than at low resolution. There remained a chemical interference, corresponding to 100 pg/sample, which arose during treatment of the samples. This method is more sensitive than previous ones, but it is restricted to situations where the specificity can be controlled. When the m/z 72 fragment was mass-shifted by using betaxolol appropriately labelled with deuterium or 13C, both the interference and the baseline noise were greatly reduced; concentrations of labelled betaxolol as low as 10-20 pg/sample can be determined with little difficulty.