Candida nivariensis: Identification strategy in mycological laboratories.

Candida nivariensis is a cryptic fungal species classified within the Candida glabrata complex. It was described for the first time in 2005 by the means of DNA sequencing. We report a rare case of C. nivariensis deep-seated infection occurring in a 77-year-old man hospitalized for cysto-prostatectomy. Phenotypic testing based on the direct examination and the macroscopic features of the in vitro culture initially suggested C. glabrata species, while MALDI-TOF mass spectrometry enables correct identification. The isolate was found resistant to fluconazole, like in almost 20% of the reported cases. Herein, we present our practical strategy to reliably characterize this rare cryptic species. To date, MALDI-TOF mass spectrometry-based analysis showed very good results for such a purpose.

Perioperative and economic analysis of surgical treatments for benign prostatic hyperplasia: A study of the French committee on LUT.

PURPOSE: To evaluate perioperative cost related to surgical treatments of benign prostatic obstruction (BPO): photoselective vaporization of the prostate (pvp), holmium/thullium laser enucleation (HoLEP/ThuLEP), transurethral resection of the prostate (TURP) and open prostatectomy (OP). MATERIAL AND METHODS: We retrospectively collected data from 237 patients who consecutively underwent a surgical treatment for BPH between January 2012 and June 2013 at nine institutions in France. An economic simulation model was constructed to estimate the cost of hospitalization related to surgical procedure from the hospital perspective and a cost minimization analysis was performed. RESULTS: TURP, OP, HoLEP/ThuLEP and PVP were performed in 99 (42%), 23 (10%), 64 (27%) and 51 (21%) patients, respectively. For men with prostate size<80mL: mean operative time was shorter with mTURP and PVP than HoLEP/thuLEP (P<0.001); Mean postoperative length of stay were 1.9, 3 vs. 3.4 days, for HoLEP/Thulep, PVP and TURP respectively (P=0.006); Costs of first hospitalization were comparable between HoLEP/ThuLEP and TURP but higher with PVP (P<0.001). For men with prostate size≥80mL: Compared to PVP and HoLEP/ThuLEP, OP was associated with shorter operative time (P<0.001) but longer length of stay (2.4, 4.2 vs. 7.8 days, respectively, P<0.0001); Costs of first hospitalization were significantly higher with OP than HoLEP/ThuLEP or PVP (P<0.001). CONCLUSIONS: PVP and HoLEP/ThuLEP were associated with a shorter LOS than TURP and OP. This benefit suggests these procedures could be more cost effective than OP, but still not cheaper alternatives to TURP. LEVEL OF EVIDENCE: 5.

[Medicoeconomic aspects of benign prostatic hyperplasia medical treatment]. / Aspects médicoéconomiques des traitements médicamenteux de l'hypertrophie bénigne de la prostate : une revue de la littérature du Comité des troubles mictionnels de l'homme de l'Association française d'urologie.

INTRODUCTION: The medicoeconomic issues of drug management of benign prostatic hyperplasia (BPH) are essential due to the aging population and the increasing number of therapeutic options. It is thus essential to assess the cost-effectiveness in order to define the most appropriate therapeutic strategies economically. The objective of this work was to conduct a literature review on the medicoeconomic studies on the drug therapy of BPH. METHOD: After analyzing the literature, 43 articles were found and 9 were selected for their relevance. RESULTS: Based on Markov models, we observed that: combination therapy and combined treatments (alphablockers and inhibitors of 5-alpha reductase [5ARI]) seemed to have the best cost-effectiveness. Then came the alphablockers, less expensive but exposing to a greater risk of progression and to the necessity of surgical treatments. Then came the 5ARI monotherapy and finally simple monitoring. CONCLUSION: The Markov models are imperfect tools, and resources invested in care depend on both the economic model and the value that individuals and society give to efficiency and cost.

[Serious and unexpected complications of benign prostatic obstruction surgery: Results of the LUTS Committee survey from urologists of the French Urological Association]. / Complications graves et inattendues de la chirurgie de l'hyperplasie bénigne de prostate : résultats de l'enquête du CTMH auprès des urologues de l'AFU.

PURPOSE: Rare and severe complications of benign prostatic hyperplasia (BPH) surgery are poorly documented in the literature. Our purpose was to make an inventory of severe and unexpected complications of BPH faced by urologists of the French Association of Urology (AFU). MATERIAL AND METHODS: A declarative 13-question survey was sent by e-mail 2 months before the 108th French Congress of Urology to the urologist's members of the AFU. Complications were split in complications due to material and complications directly related to the surgery. RESULTS: Overall, 216 (16.2%) urologists surveyed but only 85 forms were usable. Complications related to the material was divided into: excessive temperature of the serum irrigation leading to urethral and bladder burns (n=5), material default leading to interruption of the procedure (n=1) or incomplete hemostasis (n=2) and endoscope rupture (n=1). Peroperative complications related to surgery were divided into surgical complications: haemorrhage (n=7), urethral wounds (n=6), perforation and/or explosion (n=16), rectal wounds (n=11), obstructive renal failure (n=1); and medical complications: TURP syndrome (n=2), cardiovascular (n=5) and septic shock (n=6). CONCLUSION: This is the first French declarative study having allowed the identification of severe and unexpected complications of BPH surgery. The recorded occurred complications were very eclectic and secondary to all types of techniques used.

[Guide dedicated to general practitioner for the management of lower urinary tract symptoms related to benign prostatic hyperplasia]. / Guide de prise en charge en médecine générale des symptômes du bas appareil urinaire de l'homme liés à une hyperplasie bénigne de la prostate.

OBJECTIVE: To establish a guide dedicated to general practitioner for the diagnosis, the follow-up, and the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHOD: Guidelines already published for urologists were modified to make them relevant for general practitioners. The role of specialist's referral was defined. The whole content of the document was submitted to the formal consensus process in which urologists and general medicine teachers were involved. RESULTS: Initial assessment has several aims: making sure that LUTS are related to BPH, assessing bother related to LUTS, and checking for a possible complication. Initial assessment should include: medical history, physical examination with digital rectal examination, and urinalysis. Some other explorations such as frequency volume chart, serum PSA or creatinine, and ultrasonography of the urinary tract were found optional, meaning they are necessary only in specific situations. Referring to urologist is justified when LUTS might not be related to BPH (particularly when urgencies are predominant), or when a severe bladder outlet obstruction is suspected (severe symptoms, palpable bladder, post-voiding residual volume>100ml), or when a complication is assessed. Follow-up without treatment is justified for patients with no bothersome symptoms related to not complicated BPH. Several drugs are available for the treatment of bothersome symptoms related to BPH. Alpha-blockers and plants extracts might be offered as monotherapy. Five alpha reductase inhibitors might be offered to patients with LUTS related to a significant prostate hypertrophy (>40 ml) ; they might be given for a minimum duration of one year, alone or in association with alpha-blocker. The association of antimuscarinic and alpha-blocker might be used in patients with persistent storage LUTS in spite of alpha-blocker treatment. Phosphodiesterase 5 inhibitors might be offered to patients with erectile dysfunction associated with LUTS related to BPH. In case of complicated BPH, or when medical treatment is not efficacious or not tolerated, a surgical option should be discussed. CONCLUSION: The male lower urinary tract symptom committee of the French Urological Association and general practitioner present the first guide for the management of LUTS related to BPH dedicated to general practitioner. LEVEL OF EVIDENCE: 5.

[Evaluation of the impact of CTMH guidelines on the management of benign prostatic hyperplasia]. / Évaluation de l'impact des recommandations du Comité des troubles mictionnels de l'homme sur la prise en charge de l'hypertrophie bénigne de prostate.

INTRODUCTION: The French guidelines on the management of benign prostatic hyperplasia (BPH) have been published in 2012 by the LUTS committee of the French Urological Association. The aim of this study was to evaluate the impact of these guidelines on the BPH management by French urologists. MATERIAL AND METHODS: A questionnaire has been distributed by email to 1141 urologists members of the French Association of Urologists in November 2013. RESULTS: We collected 222 responses (response rate: 19%). The guidelines have been read by 73% of the urologists. The guidelines were followed most of the time by 76% of them, 11% followed them systematically and 4.5% did not follow them. The new terminology was used by 28 to 52% according to the items. The symptoms were evaluated by the IPSS score (33%), by interrogatory alone (64%) or by neither of them (3%). Prostate volume was not systematically taken for account in the treatment strategy by 57% of the urologists. Sexual function was assessed systematically by 28% of the urologists, 11% used a questionnaire (IIEF: 92%). PSA was tested respectively by 70 and 51% of the urologists at the initial evaluation and the follow-up. After introduction of a monotherapy, 56% of the urologists evaluated the efficacy at 3 months. CONCLUSION: The French guidelines for the management of benign prostatic hyperplasia (BPH) by the LUTS committee of the French Urological Association were well known and used by French urologists. Some improvements can be expected for the use of the IPSS score, the evaluation of the sexual function, and the use of the new terminology. LEVEL OF EVIDENCE: 4.

[Conservative treatment of male non-neurologic urinary incontinence: a review by the LUTS committee of the French Urological Association]. / Traitements palliatifs et conservateurs de l'incontinence urinaire masculine non neurologique: une revue de littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the conservative treatment of male non-neurologic urinary incontinence. METHOD: A systematic review was conducted using PubMed/MEDLINE with the following keywords: "incontinence", "male stress urinary incontinence", "pelvic floor training", "biofeedback", "absorbant products", "life style", "penile clamp". RESULTS: Palliative devices like penile clamps, penile sheaths and absorbent products were transitory options that were poorly evaluated. Life style modifications (scheduled voiding, controlled hydric absorption, decreased caffeine and spice intake) were useful in complement of other treatments especially in case of overactive bladder. Pelvic floor training (PFT) was useful after radical prostatectomy but remained optional for other types of incontinence. It accelerated the continence recovery postoperatively but it results at 1 year were uncertain. These results were maintained 1 year. Conservative treatments were useful postoperatively especially early supervised PFT. The benefit of biofeedback and perineal stimulation was controversial. Balder catheterization was a last resort option. Penile sheaths were better than urethral catheterization if there were no post-voiding residual urines. CONCLUSIONS: Palliative options have a limited efficacy but are mini-invasive and might be helpful complementary options.

[Treatment of non-neurogenic masculine urinary incontinence due to overactive bladder: a review by the LUTS committee of the French Urological Association]. / Traitement de l'incontinence urinaire masculine non neurologique par hyperactivité vésicale : une revue de la littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder. METHOD: A systematic review was conducted using PubMed/MEDLINE with the following keywords: "overactive bladder", "male urinary incontinence", "urgency", "antimuscarinic", "onabotulinumtoxinA", "neurostimulation", "cystoplasty". RESULTS: Antimuscarinic treatments were the first line option for overactive bladder incontinence (decreased incontinence under tolterodine versus placebo respectively -71% vs. -40%, P < 0.05). Their main side effects were dry mouth (16-29.6%) and constipation (4%), which might decrease the observance. In case of failure, neuromostimulation could be prosed with a 67% efficacy rate. Intra-detrusorian injections of onabotulinumtoxinA were an option, however there were still not validated for this indication and their efficacy decreases with time and after repeated injections. The ultimate option in case of refractory major over-activity was cystoplasty, which involves major morbidity for inconstant efficacy. CONCLUSIONS: The same treatments are available for non-neurologic urinary incontinence by bladder over-activity for men and women: antimuscarinic drugs, neurostimulation, onabotulinumtoxinA. However, only few data is available for masculine population exclusively.

[Initial assessment of male non-neurogenic incontinence: systematic review of the literature by the LUTS committee of the French Urological Association]. / Bilan initial d'une incontinence urinaire masculine (non neurologique): revue de la littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the initial evaluation of male urinary incontinence (MUI). METHOD: A systematic review was conducted using Pubmed/Medline from 1995 to 2013. RESULTS: Definition of MUI and its prevalence is variable according its definition and the population. Tools for its evaluation have been mainly studied in female population or only in patients with UI after radical prostatectomy. Objectives of the initial evaluation are to assess the type of incontinence, to evaluate its severity and the bother associated, and define the choice of treatment. Medical history, clinical assessment, and urine analysis are the first steps of the evaluation. Bladder diary, questionnaires and pad test can be useful to evaluate MUI. Post-void residual volume assessment is necessary if lower urinary tract symptoms are associated. Imaging is not routinely used in MUI. A specialist referral and further investigations such as urethrocystoscopy and urodynamics should be considered in case of invasive treatment, recurrent incontinence and specific situations. CONCLUSIONS: Initial assessment of MUI should be sequential with systematic investigations and optional ones.

[Initial assessment, follow-up and treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: guidelines of the LUTS committee of the French Urological Association]. / Bilan initial, suivi et traitement des troubles mictionnels en rapport avec hyperplasie bénigne de prostate : recommandations du CTMH de l'AFU.

AIM: To elaborate guidelines for the diagnosis, the follow-up, and the treatment of benign prostatic hyperplasia (BPH). METHOD: A systematic review of the literature was conducted to select more relevant publications. The level of evidence was evaluated. Graded recommendations were written by a working group, and then reviewed by a reviewer group according to the formalized consensus technique. RESULTS: Terminology of the International Continence Society was used. Initial assessment has several aims: making sure that lower urinary tract symptoms (LUTS) are related to BPH, assessing bother related to LUTS and checking for a possible complicated bladder outlet obstruction (BOO). Initial assessment should include: medical history, LUTS assessment using a symptomatic score, physical examination including digital rectal examination, urinalysis, flow rate recording, and residual urine volume. Frequency volume chart is recommended when storage symptoms are predominant. Serum PSA should be done when the diagnosis of prostate cancer can modify the management. When a surgical treatment is discussed, serum PSA, serum creatinine and ultrasonography of the urinary tract are recommended. BPH patients should be informed of the benign and possibly progressive patterns of the disease. When LUTS cause no bother, annual follow-up should be planned. Medical treatment includes some phytotherapy agents, alpha-blockers and 5-alpha reductase inhibitors. The last two can be associated. The association of antimuscarinics and alpha-blockers can be offered to patients with residual storage symptoms when already under alpha-blockers therapy, after checking for the absence of severe BOO (residual volume more than 200mL or max urinary flow less than 10mL/s). Phosphodiesterase-5 inhibitors could be used in patients complaining for both LUTS and erectile dysfunction. In case of complication, or when medical treatment is inefficient or not tolerated, then a surgical treatment should be discussed. Treatment decision should be done according to type of LUTS and related bother, prostate anatomy, level of obstruction and its consequences on urinary tract, patient co-morbidities, experience of practitioner, and choice of patient. Surgical treatments with the higher level of evidence of efficacy include monopolar or bipolar transurethral resection of the prostate, open prostatectomy, transurethral incision of the prostate, photoselective vaporization of the prostate, and Holmium laser enuclation of the prostate. CONCLUSION: Here are the first guidelines of the French Urological Association for the initial assessment, the follow-up and the treatment of urinary disorders related to BPH.

[Surgical management of benign prostatic hyperplasia by endoscopic techniques using electricity and open prostatectomy: A review of the literature by the LUTS committee of the French Urological Association]. / Traitement de l'hyperplasie bénigne de prostate par techniques endoscopiques électriques et adénomectomie voie haute : revue de littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the surgical treatment of benign prostatic hyperplasia (BPH) by endoscopic electric resection and vaporization, and by open prostatectomy. METHOD: A systematic review of recent literature was performed. The level of evidence of each report was evaluated, and only recent publications of high level of evidence were included. RESULTS AND CONCLUSIONS: Both monopolar transurethral resection of the prostate (TURP) and open prostatectomy remain the gold standards. Endoscopic electric alternatives are monopolar and bipolar prostate vaporisation as well as bipolar resection. These techniques seem to show similar functional results than TURP and open prostatectomy, as well as an advantage in terms of bleeding.

[Surgical management of BPH by laser therapies: A review of the literature by the LUTS committee of the French urological association]. / Traitement chirurgical de l'hyperplasie bénigne de la prostate par laser : revue de littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the surgical treatment of benign prostatic hyperplasia (BPH) by laser. METHOD: A systematic review of recent literature was performed. The level of evidence of each report was evaluated, and only recent publications of high level of evidence were included. RESULTS AND CONCLUSIONS: Monopolar transurethral resection of the prostate (TURP) and open prostatectomy remain the gold standards. Alternative endoscopic options are laser photoselective vaporisation, holmium enucleation and thulium resection. These techniques seem to show functional results similar to those obtained after TURP and open prostatectomy, as well as an advantage in terms of bleeding.

[Surgical management of benign prostatic hyperplasia by thermotherapy and other emerging techniques: A review of the literature by the LUTS committee of the French Urological Association]. / Traitement chirurgical de l'hyperplasie bénigne de la prostate par thermothérapie et autres techniques émergentes : revue de littérature du CTMH de l'AFU.

PURPOSE: To perform an update on mini-invasive surgical treatment of benign prostatic hyperplasia (BPH) by thermotherapy and other emerging techniques. METHOD: A systematic review of literature was performed in Pubmed database for the period running from 1980 to 2011. The level of evidence of each report was evaluated, and only recent publications of high level of evidence were included. RESULTS AND CONCLUSIONS: Monopolar transurethral resection of the prostate (TURP) and open prostatectomy remain the gold standards. Thermotherapy using transurethral microwaves or needle ablation is an alternative to medical management. Urethral stents should only be proposed in exceptional cases of surgical contra-indication, because of their related complications. Botulinium toxin and ethanol intra-prostatic injections are currently under evaluation.

[Initial assessment and follow-up of benign prostatic hyperplasia: systematic review of the literature by the LUTS committee of the French Urological Association]. / Bilan initial et suivi de l'hyperplasie bénigne de prostate: revue de littérature du CTMH de l'AFU.

PURPOSE: To perform an update on the initial evaluation and follow-up of benign prostatic hyperplasia (BPH). METHOD: A systematic review of recent literature was performed. Level of evidence of publications was evaluated. RESULTS AND CONCLUSIONS: Objectives of the initial evaluation are to assess the link between low urinary tract symptoms (LUTS) and BPH, to evaluate the bother associated to LUTS, assess a complicated bladder outlet obstruction (BOO), diagnose an adenocarcinoma of the prostate if it modifies the therapeutic strategy, and establish an evolutive profile of the disease. Clinical assessment with digital rectal examination, evaluation of symptoms by a dedicated questionnaire and urine analysis are the first steps of BPH evaluation. Bladder diary is useful to objective storage symptoms. Uroflowmetry and post-void residual volume assessment are useful if BOO is suspected. Measure of serum creatinine and ultrasound exam of the urinary tract are second line explorations. Urine cytology, neurological evaluation, urethrocystoscopy, urodynamics with pressure-flow studies are useful if the link between LUTS and BPH is unclear. PSA dosage is used for prostate cancer screening or as a prognostic marker of BPH evolution.

[Benign prostatic hyperplasia medical treatment: systematic review of the literature by the CTMH/AFU]. / Traitement médical de l'hyperplasie bénigne de la prostate: revue de littérature par le CTMH/AFU.

INTRODUCTION AND OBJECTIVES: The medical treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS-BPH) has dramatically evolved within the last years: new drugs have been commercialized and others that used to be contra-indicated may now be prescribed. Our objective was to provide with an updated review of the scientific literature on the medical treatment of LUTS-BPH. PATIENT AND METHOD: A systematic review of the most recent scientific literature was performed. The query was addressed to the PubMed database using the following keywords: "benign prostatic hyperplasia" and "medical treatment". A very large amount of publications, from year 1990 until 2011, were reviewed to select the publications with level of evidence 1 and 2. These publications were analysed and the 30 most relevant were selected to serve as references for this article. RESULTS: There are many randomized clinical trials in the field of LUTS-BPH medical treatment. Recently, anti-muscarinic agents have been assessed and have proven their efficacy and tolerance as long as the storage symptoms are predominant over the voiding symptoms. Combination therapies using alpha-blockers and 5-alpha reductase (5-ARI) inhibitors, but also anti-muscarinic agents and PDEF-5 inhibitors may also be prescribed depending on the patient' complaint. CONCLUSION: The publication of recent randomized clinical trials allows the urologists to use new drugs and new combination therapies in the medical treatment of LUTS-BPH. In 2011, the medical treatment decision-making may better integrate the patient' complaint and medical history.

[Seminal vesicle biopsies: Interest in the prostate cancer staging before radiation therapy or brachytherapy]. / Biopsies des vésicules séminales : intérêt dans le bilan d'extension du cancer de la prostate avant radiothérapie ou curiethérapie.

OBJECTIVE: Seminal vesicle biopsies (SVB) in the staging of prostate cancer are controversial. Our main objective was to assess their contribution before radiation therapy or brachytherapy. Our secondary objective was to compare pathologic findings of the SVB to the magnetic resonance imaging's (MRI) results. PATIENTS AND METHODS: From 2000 to 2008, 135 men (median age: 70 years) with prostate cancer (cT1a to cT3) underwent SVB right and left. The median PSA was 12 ng/ml. The median Gleason score was 7. Forty-one patients had an endorectal MRI. The median follow-up was 47 months. RESULTS: Seminal vesicle involvement was found in 10% of patients. In 9.2% of cases, the biopsy was not contributive. The risk of invasion was significantly associated with the stage T3, the Gleason score up to 7 and the percentage of prostate positive biopsies. A MRI was performed in 41 cases: the correlation between MRI and SVB for the invasion of seminal vesicle was significant but moderate (kappa=0.38). The complications rate of SVB was 10%. CONCLUSION: SVB were a simple and profitable method. They have provided supplementary information that could improve the staging and that could lead to the make use of an appropriate treatment. This information was comparable to the information provided by MRI. Further studies should establish their role in relation to MRI and in particular confirm the best specificity of the SVB.

[Pelvic lymphadenectomy in prostate cancer: Should it be realized by laparoscopy?]. / Le curage ilio-obturateur dans le cancer de la prostate doit-il être réalisé par voie coelioscopique ?

AIM: Laparoscopic pelvic lymphadenectomy in localized prostatic cancer is performed since the 1990s, lessens the postoperative complications and respects carcinologic's principles (No. lymph nodes removed and lymph nodes metastasis). In order to verify that these objectives are achieved, we compared our results of pelvic lymphadenectomy by laparotomy and by laparoscopy for the past 12 years. PATIENTS AND METHODS: Between January 1997 and June 2008, 36 (23.8%) patients underwent open pelvic lymphadenectomy and 76.16% (115 cases) laparoscopic pelvic lymphadenectomy. We did a retrospective and comparative analysis of data including the preoperative characteristics, per- and postoperative complication as well pathologic results. RESULTS: Preoperative data were comparable between both groups. The comparison of the peroperative data showed an increased bleeding volume in the open group (105.6±420.9mL; 12.1±96.1mL: P=0.001) and longer operative time in the laparoscopic group (103.7±83.9min; 132.8±40.9min: P=0.006). Postoperative complications were similar. Pathologic results showed a significantly more important number of lymph nodes removed in the open group (7.2±3.5; 5.7±3.2: P=0.022), but the positive rate similar in both groups (13.9%; 22.6%: P=0.258). In order to remove "the learning curve effect", we compared 36 open pelvic lymphadenectomy to the last 36 laparoscopic pelvic lymphadenectomy. In the laparoscopic group the patients showed an upper Gleason score (6.3±1.1; 7±1: P=0.005); but there was no difference for the operative time, number of lymph nodes removed and the complications rates. CONCLUSIONS: After training, laparoscopic pelvic lymphadenectomy was similar to open pelvic lymphadenectomy.