Long term efficacy of prosthetic inguinal herniorrhaphy concomitant with robot-assisted laparoscopic radical prostatectomy.

PURPOSE: Patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP. METHODS: Data for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded. RESULTS: A total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007). CONCLUSION: Concomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity.

Patient and General Population Preferences Regarding the Benefits and Harms of Treatment for Metastatic Prostate Cancer: A Discrete Choice Experiment.

Background: Patient preferences for treatment outcomes are important to guide decision-making in clinical practice, but little is known about the preferences of patients with metastatic hormone-sensitive prostate cancer (mHSPC). Objective: To evaluate patient preferences regarding the attributed benefits and harms of systemic treatments for mHSPC and preference heterogeneity between individuals and specific subgroups. Design setting and participants: We conducted an online discrete choice experiment (DCE) preference survey among 77 patients with metastatic prostate cancer (mPC) and 311 men from the general population in Switzerland between November 2021 and August 2022. Outcome measurements and statistical analysis: We evaluated preferences and preference heterogeneity related to survival benefits and treatment-related adverse effects using mixed multinomial logit models and estimated the maximum survival time participants were willing to trade to avert specific adverse effects. We further assessed characteristics associated with different preference patterns via subgroup and latent class analyses. Results and limitations: Patients with mPC showed an overall stronger preference for survival benefits in comparison to men from the general population (p = 0.004), with substantial preference heterogeneity between individuals within the two samples (both p < 0.001). There was no evidence of differences in preferences for men aged 45-65 yr versus ≥65 yr, patients with mPC in different disease stages or with different adverse effect experiences, or general population participants with and without experiences with cancer. Latent class analyses suggested the presence of two groups strongly preferring either survival or the absence of adverse effects, with no specific characteristic clearly associated with belonging to either group. Potential biases due to participant selection, cognitive burden, and hypothetical choice scenarios may limit the study results. Conclusions: Given the relevant heterogeneity in participant preferences regarding the benefits and harms of treatment for mHSPC, patient preferences should be explicitly discussed during decision-making in clinical practice and reflected in clinical practice guidelines and regulatory assessment regarding treatment for mHSPC. Patient summary: We examined the preferences (values and perceptions) of patients and men from the general population regarding the benefits and harms of treatment for metastatic prostate cancer. There were large differences between men in how they balanced the expected survival benefits and potential adverse effects. While some men strongly valued survival, others more strongly valued the absence of adverse effects. Therefore, it is important to discuss patient preferences in clinical practice.

[Hyperbaric oxygen therapy for the treatment of radiation-induced cystitis]. / Oxygénothérapie hyperbare dans le traitement de la cystite radio-induite.

Radiation-induced cystitis (RIHC) is a late complication of pelvic radiation therapy defined by irritative lower urinary tract symptoms with recurrent and sometimes refractory hematuria. Conservative or endoscopic treatments are the first lines, but cystectomy in required in refractory cases. Hyperbaric oxygen therapy (HOT) has recently emerged in the management charts for recurrent and refractory hematuria. Thanks to its neoangiogenic and stem-cell stimulation properties, HOT achieves a complete resolution of hematuria in almost two third of patients and appears to be a good therapeutic alternative for this fragile population. However, its geographical availability is currently limited in Switzerland and its implementation can sometimes require long hospital stays.

La cystite radio-induite (CR) est une complication tardive de la radiothérapie pelvienne se présentant notamment sous forme de troubles mictionnels irritatifs ou de macrohématurie récidivante. Le traitement est initialement conservateur ou endoscopique mais peut, dans des cas réfractaires, aboutir à une cystectomie à visée hémostatique ou fonctionnelle. L'oxygénothérapie hyperbare (OHB) a récemment fait son apparition dans les diagrammes de prise en charge de la CR réfractaire. Grâce à ses propriétés néoangiogéniques et à la stimulation des cellules souches, elle permet une résolution complète de l'hématurie chez près de deux tiers des patients et semble être une alternative thérapeutique pour cette population fragile. Actuellement, sa disponibilité géographique reste toutefois limitée en Suisse et sa réalisation implique parfois de longues hospitalisations.

Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation.

Robot-assisted donor nephrectomy (RDN) is increasingly used due to its advantages such as its precision and reduced learning curve when compared to laparoscopic techniques. Concerns remain among surgeons regarding possible longer warm ischemia time. This study aimed to compare patients undergoing robotic living donor nephrectomy to the more frequently used hand-assisted laparoscopic nephrectomy (HLDN) technique, focusing on warm ischemia time, total operative time, learning curve, hospital length of stay, donor renal function and post-operative complications. Retrospective study comparing RDN to HLDN in a collaborative transplant network. 176 patients were included, 72 in RDN and 104 in HLDN. Left-sided nephrectomy was favored in RDN (82% vs 52%, p < 0.01). Operative time was longer in RDN (287 vs 160 min; p < 0.01), while warm ischemia time was similar (221 vs 213 secs, p = 0.446). The hospital stay was shorter in RDN (3.9 vs 5.7 days, p < 0.01).Concerning renal function, a slightpersistent increase of 7% of the creatinine ratio was observed in the RDN compared to the HLDN group (1.56 vs 1.44 at 1-month checkup, p < 0.01). The results show that RDN appears safe and efficient in comparison to the gold-standard HLDN technique. Warm ischemia time was similar for both techniques, whereas RDN operative time was longer. Patients undergoing RDN had a shorter hospital stay, this being possibly mitigated by differences in center release criteria. Donor renal function needs to be assessed on a longer-term basis for both techniques.

[Urology]. / Urologie.

Over this last year, urology has progressed both in oncology and reconstructive surgery. Genomic tests have been since quite a few years foreseen as very promising prognostic factors of prostate cancer, however remaining not clearly convincing. At last, the present data available seem to favour their contribution to improve selecting patients for active surveillance. For the same cancer, but at a metastatic stage resistant to androgenic deprivation, therano stics is providing an elegant targeting of disseminated tumor cells using a PSMA radio-active ligand fatal for the latter. Finally, penile urethral strictures appear to convincingly benefit on a long-term basis from a new method to place the substitution tissue which will restore urethral caliber.

C'est entre l'oncologie et la chirurgie reconstructive que l'urologie a poursuivi, en 2021, sa quête de progrès et de mises au point. Voilà plusieurs années que la génomique est attendue comme pourvoyeuse de capacités pronostiques dépassant les facteurs classiques. Plus lentement qu'attendu, la surveillance active du cancer de la prostate apparaît en être la bénéficiaire principale. Ce même cancer, mais au stade métastatique résistant à la déprivation androgénique, profite de la théranostique, qui cible le récepteur du Prostate-Specific Membrane Antigen de la cellule tumorale, avec un ligand radioactif fatal pour cette dernière. Enfin, la chirurgie des sténoses urétrales péniennes se voit enrichie d'une nouvelle manière de placer le tissu de substitution qui agrandira le calibre urétral, conférant à ce type de reconstruction une durabilité et une esthétique probantes.

Substaging of pT1 Urothelial Bladder Carcinoma Predicts Tumor Progression and Overall Survival.

INTRODUCTION: Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). METHODS: We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). RESULTS: T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (p = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: p = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, p = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (p = 0.001). CONCLUSION: Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options.

[Chronic testicular pain: A multidisciplinary challenge]. / Douleurs testiculaires chroniques : un défi multidisciplinaire.

Chronic testicular pain represents up to 5% of urological consultations. A simple workup can help identify an organic etiology in 50 to 75% of cases, leading to a targeted treatment. If this is not the case, chronic idiopathic orchialgia is diagnosed and multidisciplinary management is necessary. Treatment is initially conservative but is only effective in 4 to 15% of patients. Spermatic block by infiltration of the cord confirms the testicular origin of the pain and provides temporary relief. Microsurgical denervation of the spermatic cord is the treatment of choice for responders. It provides significant pain relief in 77 to 100% of cases.

Les douleurs testiculaires chroniques représentent jusqu'à 5 % des consultations d'urologie. Un bilan simple retrouve une étiologie organique dans 50 à 75 % des cas permettant un traitement ciblé. Le cas échéant, le diagnostic d'exclusion d'orchialgie chronique idiopathique est retenu et une prise en charge multidisciplinaire est alors nécessaire. Le traitement est initialement conservateur, mais n'est efficace que chez 4 à 15 % des patients. La réalisation d'un bloc spermatique par infiltration du cordon permet de confirmer l'origine testiculaire des douleurs et apporte un soulagement temporaire. La dénervation microchirurgicale du cordon spermatique est le traitement de choix pour les répondeurs. Il permet un soulagement significatif des douleurs dans 77 à 100 % des cas.

[Living donor nephrectomy]. / Prélèvement de rein chez le donneur vivant.

Kidney living donor is the best treatment of terminal kidney failure. Donors are remarkably altruistic. The first concern of the medical team is not to harm the donor and respect their will to give their kidney. The technological evolution towards mini-invasive approaches has largely contributed to a better post-operative recovery. The evolution of this trend has led us to use laparoscopic robot-assisted kidney harvesting as the optimal standard. This work describes our pathway to this option.

Recevoir un rein par un donneur vivant est à ce jour le meilleur traitement de l'insuffisance rénale terminale. Les donneurs font un geste remarquablement altruiste. Le but primaire de l'équipe médicale est de pouvoir soigner un patient insuffisant rénal grâce au don d'organe sans nuire au donneur. Les avancées technologiques vers des approches mini-invasives ont contribué à l'amélioration de la prise en charge des donneurs en augmentant considérablement leur confort postopératoire et en réduisant drastiquement les durées moyennes d'hospitalisation. La procédure standard aux HUG à ce jour est la laparoscopie robot-assistée. Cet article retrace l'évolution mini-invasive du don de rein dans le service.

[Update on management of genitourinary tract trauma]. / Prise en charge des traumatismes urogénitaux : mise au point.

Traumas are the leading cause of death in the 15 to 45 years old population and represent 10 % of all death causes. Hence, they are a public health problem. This article aims to review the most frequent uro-genital traumas from etiology to diagnostic evaluation and management to allow the general practitioner and the emergency doctors to familiarize themselves with the algorithms and treatment procedures.

Les traumatismes sont la cause la plus fréquente de décès de la population âgée de 15 à 45 ans et représentent environ 10 % de toutes les causes de décès. De ce fait, ils sont un problème de santé publique. Dans cet article, les principaux traumatismes urogénitaux seront passés en revue, de l'étiologie à la prise en charge en passant par les investigations diagnostiques, afin de permettre aux premiers intervenants de la chaîne de soins de se familiariser avec les algorithmes de décision et de traitement.

Blood-Based Multi-Cancer Detection Using a Novel Variant Calling Assay (DEEPGENTM): Early Clinical Results.

This is an early clinical analysis of the DEEPGENTM platform for cancer detection. Newly diagnosed cancer patients and individuals with no known malignancy were included in a prospective open-label case-controlled study (NCT03517332). Plasma cfDNA that was extracted from peripheral blood was sequenced and data were processed using machine-learning algorithms to derive cancer prediction scores. A total of 260 cancer patients and 415 controls were included in the study. Overall, sensitivity for all cancers was 57% (95% CI: 52, 64) at 95% specificity, and 43% (95% CI: 37, 49) at 99% specificity. With 51% sensitivity and 95% specificity for all stage 1 cancers, the stage-specific sensitivities trended to improve with higher stages. Early results from this preliminary clinical, prospective evaluation of the DEEPGENTM liquid biopsy platform suggests the platform offers a clinically relevant ability to differentiate individuals with and without known cancer, even at early stages of cancer.

Postoperative peripheral neuropathies associated with patient positioning during robot-assisted laparoscopic radical prostatectomy (RARP): A systematic review of the literature.

OBJECTIVE: To perform a systematic review of the literature concerning postoperative peripheral neuropathies associated with patient positioning during robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS: A systematic review on articles published from January 1, 1990 to March 15, 2020 was performed in accordance with the PRISMA declaration (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The electronic search was done searching through the Cochrane Registry, PubMed/EMBASE, Medline, and Scopus. Relevant papers addressing postoperative peripheral neuropathies related to patient positioning during RARP were integrated into the analyses. RESULTS: After screening 4975 articles, one randomized controlled trial and five retrospective studies with a total of 63,667 patients were included in this review. Peripheral neuropathies of the upper extremities were documented in three articles with a total of 15 patients, peripheric neuropathies of the lower extremities were reported in five articles with a total of 76 patients. Analysis of the data was exploratory, since screening techniques, systematically reporting, and description of positioning techniques was not standardized or not reported. CONCLUSIONS: The incidence of peripheral neuropathies at RARP varies between 1.3% and 10.8%. Lower extremities are more affected than upper extremities and the most important risk factors are intraoperative time duration, patients comorbidities, and ASA score. High-quality prospective randomized studies to better assess the impact of patient positioning during RARP on the development postoperative peripheral neuropathies are needed.

[Urology]. / Urologie.

Over the last year, urologic progress remains driven by the quick technologic evolution, with a focus on Laser and robotics. The latter appears to potentially contribute to the drift towards ambulatory surgery, in particular for distinct sub-populations harbouring kidney or prostate cancer. The Da Vinci robot appears also to increase the drive towards minimally invasiveness with respect to female incontinence and the laparoscopic placement of an artificial urethral sphincter. Last, a new Laser is in the midst to offer its polyvalence in terms of endoscopic stone surgery, so as that of benign prostatic hyperplasia. Facing this technologic pressure, it remains of utmost importance to scrupulously validate on a short so as longer-term basis the true hoped advantages.

Les progrès urologiques de cette dernière année restent, comme l'année précédente, sous le sceau des rapides avancées technologiques, notamment celles du laser et de la robotique. Cette dernière va contribuer à faire évoluer la chirurgie ambulatoire, notamment pour certaines interventions et sous-populations de malades porteurs d'un cancer du rein ou de la prostate. Elle est également en train d'exercer une nouvelle percée dans le domaine de l'incontinence féminine, en ce qui concerne la mise en place du sphincter urétral artificiel. Enfin, un nouveau laser est sur le point d'offrir sa polyvalence en termes de chirurgie endoscopique lithiasique ainsi que celle de l'hypertrophie bénigne de la prostate. Face à cette pression technologique, il faut rigoureusement valider à court et moyen termes les véritables avantages espérés.

Stratifying patients with intermediate-risk prostate cancer: Validation of a new model based on MRI parameters and targeted biopsy and comparison with NCCN and AUA subclassifications.

OBJECTIVE: Intermediate-risk prostate cancer regroups heterogeneous patients with different oncologic outcomes. Aim of the study is to validate a novel intermediate-risk subclassification ("magnetic resonance imaging [MRI] subclassification") that defines favorable and unfavorable diseases based on multiparametric MRI parameters and compare it to NCCN and AUA intermediate-risk subclassifications. METHODS: A total of 429 patients treated with radical prostatectomy for NCCN intermediate-risk prostate cancer were identified. Using MRI subclassification, a favorable disease was defined as an organ-confined disease on MRI and international society of urological pathology Grade Group 1 to 2 on targeted biopsy. Remaining was classified as unfavorable. Univariable and multivariable analysis tested MRI subclassification in predicting overall unfavorable disease (OUD: pT3-4 and/or pN1 and/or International Society of Urological Pathology Grade Group ≥ 3), the need for adjuvant therapy and early biochemical recurrence (eBCR). Performance of NCCN, AUA, and MRI models was compared in term of OUD proportion and eBCR prediction using Harrell's c-index, calibrations plots, and decision curve analysis. RESULTS: Median (interquartile range) follow-up was 12 months (4-28). In multivariable analysis, MRI subclassification was an independent factor for OUD (odds ratio [OR]: 4.54 [2.85-7.22], P < 0.001), the need for adjuvant therapy (OR: 3.42 [1.36-8.57], P = 0.009), and eBCR (HR: 2.62 [1.18-5.83], P = 0.018). Using this model, the proportion of unfavorable disease decreased from 73.7% and 63.9% to 35.9% (P < 0.001) associated to an increasing proportion of OUD when compared to NCCN and AUA models (63.9% and 67.1%-77.9% respectively, P < 0.001). Performance of the 3 models for eBCR prediction tended to be similar with a poor accuracy ranged from 58.7% to 66.7% (P > 0.05), permanent miscalibration and a net benefit at decision curve analysis. CONCLUSIONS: We validated an intermediate-risk subclassification based on MRI and targeted biopsy that potentially improves patient selection by reducing the number of patients considered at unfavorable risk while increasing proportion of patients harboring poor oncologic outcomes. Its performance for eBCR detection was comparable to NCCN and AUA models.

External Validation of a Multiparametric Magnetic Resonance Imaging-based Nomogram for the Prediction of Extracapsular Extension and Seminal Vesicle Invasion in Prostate Cancer Patients Undergoing Radical Prostatectomy.

The nomogram reported by Gandaglia et al (The key combined value of multiparametric magnetic resonance imaging, and magnetic resonance imaging-targeted and concomitant systematic biopsies for the prediction of adverse pathological features in prostate cancer patients undergoing radical prostatectomy. Eur Urol 2020;77:733-41) predicting extracapsular extension (ECE) or seminal vesicle invasion (SVI) has been developed using multiparametric magnetic resonance imaging (MRI) parameters and MRI-targeted biopsy. We aimed to validate this nomogram externally by analyzing 566 patients harboring prostate cancer diagnosed on MRI-targeted biopsy followed by radical prostatectomy. At final pathology, 37% and 12% patients had ECE and SVI, respectively. Performance of the nomogram, in comparison with the Memorial Sloan Kettering Cancer Center (MSKCC) model and Partin tables, was evaluated using discrimination, calibration, and decision curve analysis. Regarding ECE prediction, the nomogram showed higher discrimination (71.8% vs 69.8%, p = 0.3 and 71.8% vs 61.3%, p < 0.001), and similar miscalibration and net benefit for probability threshold above 30% when compared with MSKCC model and Partin tables, respectively. Performance of the nomogram with regard to SVI was comparable in terms of discrimination (68.5% vs 70.4% vs 67.8%, p ≥ 0.6), presenting a slight overestimation on calibration plots and a net benefit for probability threshold above 7.5%. This is the first multicentric study that externally validates a nomogram predicting ECE and SVI in patients diagnosed with MRI-targeted biopsy. Its performance was less optimistic than expected, and implementation of MRI in this setting was not associated with a clear improvement in patient selection and clinical usefulness when compared with available models. We proposed an updated version of the nomogram predicting ECE using the recalibration method, which leads to an improvement in its performance and needs to be validated in another external set. PATIENT SUMMARY: We validate a prediction tool based on multiparametric magnetic resonance imaging (MRI) parameters and MRI-targeted biopsy predicting extracapsular extension and seminal vesicle invasion at radical prostatectomy. An improvement of patient selection was not clearly demonstrated when compared with available models based on clinical parameters, and implementation of MRI in this setting still needs to be clarified.

Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic.

PURPOSE: The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. METHODS: Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3-4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan-Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cut-off. RESULTS: Median follow-up and surgical delay were 26 months (IQR 10-40) and 3 months (IQR 2-5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre- and post-operative variables. The lack of such association was observed across EAU risk categories. CONCLUSION: Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.

[Urethral strictures: a variety of treatments requiring regular practice]. / Sténoses urétrales : une variété de traitements nécessitant une pratique régulière.

Urethral stricture is defined by a decrease in the caliber of the urethral lumen which can cause a decrease or an interruption of the urine flow. This disease is much more common in men than in women, and several causes can be identified. The diagnosis depends on a careful patient history focusing on obstructive and/or irritative lower urinary tract symptoms and is confirmed by a specific work-up. Treatment ranges from conservative management to open surgery and requires specialized surgeons, so as an adequate technical platform. The evolution of surgical techniques has fortunately significantly increased long term success rates. Hence, the classical saying heard about the outcome of urethral stenosis treatment : « once a stricture, always a stricture ¼ is no longer the rule.

La sténose urétrale est définie comme une diminution du calibre de la lumière urétrale qui peut engendrer une diminution du flux urinaire. Cette pathologie est plus fréquente chez l'homme et on l'attribue à de nombreuses causes. Le diagnostic dépend d'une bonne anamnèse, marquée essentiellement par des troubles mictionnels obstructifs et/ou irritatifs, et est confirmé par des examens complémentaires spécifiques. Le traitement peut aller de la prise en charge conservatrice à la chirurgie ouverte, et requiert toujours des chirurgiens spécialisés ainsi qu'un plateau technique adéquat. Ces 25 dernières années, le développement des techniques chirurgicales a permis d'augmenter le taux de succès, ce qui contredit l'adage classique du milieu du siècle dernier : « once a stricture, always a stricture ¼.

[Robot-assisted cystectomy and urinary diversion, new standard of care ? What are the benefits ?] / Cystectomie et dérivation urinaire laparoscopique robot-assistée, nouveau standard ? Pour quels bénéfices ?

Radical cystectomy with urinary diversion is the surgical treatment of invasive bladder cancer. Functional impairment is another indication. Robotic technique slowly started 15 years ago but its benefit remains questionable. We present the results of around thirty patients who underwent robotic cystectomy (RC) between 2016 and 2019 and were compared to an open cystectomy (OC) group. While this series is finishing its implementation phase, the results show that RC is equivalent to OC in terms of oncologic control as well as for the overall complication rate. Moreover, blood loss and the hospital length of stay are inferior for RC patients. These results participate to the actual trend towards putative further validation of RC.

La cystectomie radicale associée à la dérivation urinaire est le traitement chirurgical du cancer invasif de la vessie. L'atteinte fonctionnelle est une autre indication. La mise en route de la technique robotisée (cystectomie robotique (CR)) a lentement débuté il y a 15 ans, et son bénéfice reste questionné. Nous présentons les résultats de la première trentaine de CR opérées dans le service entre 2016 et 2019, et la comparons à une cohorte opérée à ciel ouvert (cystectomie ouverte (CO)). Alors que cette série représente la phase d'implémentation de la technique, les résultats montrent que la CR est équivalente à la CO tant pour le contrôle oncologique que pour les complications. De plus, elle occasionne moins de pertes sanguines et sa durée d'hospitalisation est inférieure à celle de la CO. Ces résultats participent à la tendance actuelle vers une possible validation future de la CR.

[Early detection of prostate cancer: a summary of the past 10 years]. / Détection précoce du cancer de la prostate : résumé de ces dix dernières années.

Early detection of prostate cancer remains a controversial subject for the general practitioner. In fact, prostate cancer remains the most frequently diagnosed non skin tumor in men with a proportion of 15 %. However, while prostate specific antigen has massively contributed to its identification at a curable stage for 25 years, it has simultaneously appeared essential not to overtreat a cancer with a significant proportion of indolent tumors. In parallel with this controversial background, the prospective randomized study of the European Randomized Study of Screening for Prostate Cancer, and in particular its Swedish subpopulation, has validated during the last decade the benefit of at least early detection. However, due to the variety of treatment options and the potential side effects of some of them, it is recommended that this detection be performed only in properly informed patients.

La détection précoce du cancer de la prostate reste un sujet d'incertitude pour le praticien généraliste. Le cancer de la prostate est la tumeur non cutanée la plus fréquemment diagnostiquée chez l'homme avec une proportion de 15 %. Bien que l'antigène spécifique de la prostate ait massivement contribué à l'identification à un stade curable depuis 25 ans, il est simultanément indispensable de ne pas surtraiter un cancer dont le taux de tumeurs indolentes est significatif. Dans ce contexte controversé, l'étude prospective randomisée de l'European Randomized Study of Screening for Prostate Cancer, et en particulier sa sous-population suédoise, a validé le bénéfice d'une détection précoce au cours de cette dernière décennie. En raison des options thérapeutiques variées et des potentiels effets secondaires de certaines d'entre elles, il est recommandé de ne pratiquer cette détection que chez les patients dûment informés.