[Evaluation of practices and costs of vasectomy. French monocentric experience]. / Évaluation des pratiques et des coûts de la vasectomie. Expérience monocentrique française.

INTRODUCTION: Since the law of 4 July 2001, vasectomy has been recognized as a method of male contraception. We report the experience of vasectomy practice in a hospital-university center. METHODS: A monocentric retrospective cohort study of 45 patients who benefited from a contraceptive vasectomy between July 2001 and May 2016. For each patient were studied: modalities of implementation, compliance with the recommendations of the 2001 law, costs and benefits generated by the intervention, the effectiveness of the gesture on the control spermograms, the satisfaction of the patients by a telephone questionnaire. RESULTS: The mean age was 41.3 years. The second consultation was carried out in 91 % of the cases but the reflection period was not respected in 24 % of the cases. Written consent was signed in 89 % of cases. Vasectomy was performed on an outpatient basis in 73 % of cases, under local anaesthesia in 6.7 % of cases. The average cost per patient was 660.63 euros for an average gain of 524.50 euros, a loss of 136.13 euros. On the control spermogram, 54.3 % were azoosperms but the 3-month delay was not observed in 23 % of them. No patients expressed regret after surgery. CONCLUSION: The recommendations of the 2001 law were not systematically followed. This lack of standardization of practices, potential reflection of a lack of interest, is to be highlighted with the extra cost generated. The revaluation of the act should be integrated into the reflection of improvement of male sterilization practices. LEVEL OF PROOF: 4.

[External sphincterotomy in neurological patients: A monocentric experience]. / Sphinctérotomie laser chez le patient porteur d'une vessie neurologique : une expérience monocentrique.

AIM: The aim of this study was to assess the feasibility, efficacy and tolerance of Greenlight™ and Holmium sphincterotomy for treating detrusor-sphincter dyssynergia. METHODS: All men treated with this two techniques between may 2012 and june 2015 were analyzed. Preoperative evaluation included kidney ultrasound scan, urodynamic, retrograde and voiding urethrocystography. Postoperative assessment was composed of a post-void residual volume measurement when the urethral catheter was removed and 1 year after the procedure, a retrograde and voiding urethrocystography at 3 months and telephonic Likert scale questionnaire. RESULTS: Twelve patients were operated with Greenlight™ and 12 with Holmium. Eleven had a memocath urethral stent preoperatively. Post-void residual volume median for both techniques was 285 cc preoperatively vs 137.5 cc postoperatively (P<0.001). Likert scale global satisfaction was 75%. Five stenosis (20.8%) were observed within a median of 4 months. CONCLUSION: Greenligth™ and Holmium procedures are efficient techniques with low morbidity. However, superiority toward monopolar incision remains to be demonstrated through complementary studies. LEVEL OF EVIDENCE: 4.