[Screening of prostate cancer seen by general practitioners]. / Le dépistage du cancer de la prostate vu par les médecins généralistes.

INTRODUCTION: The screening of prostate cancer was recently the subject of international studies and debates in France. We decided to study the vision of the screening, in particular by the PSA, which have the general practitioners. METHODS: We sent a questionnaire to 456 general practitioners of Oise (French department) to be returned in an anonymous way on the prostate cancer, PSA, the economic impact of the PSA and we asked whether the doctors realized the screening or not, if they were favorable to it and for which reasons. RESULTS: We received 38% of answers. Eighty-one percent of the general practitioners considered that prostate cancer is frequent, 72% that it evolved slowly and 55% that it affected old men. For 79% of the general practitioners, the patients were asking for a screening by PSA. Eighty-eight percent thought that they had to be in front line of the screening, 58% that the functional consequences of the screening were satisfactory. Fifty-seven percent of the general practitioners realized the screening in a systematic way and 88% were favorable to it. CONCLUSION: The general practitioners of Oise remained favorable for the greater part to the screening of prostate cancer and the patients applicants in spite of various debates.

[Evolution of prostatic surgical interventions: analysis of French national coding database]. / Évolution de la prise en charge chirurgicale des pathologies prostatiques : analyse nationale du codage.

INTRODUCTION: Prostatic diseases are very important in urologist's practice. We wanted to study evolution of prostatic procedures using French national coding database. METHODS: We searched the Agence Technique d'Information sur l'Hospitalisation (ATIH) web server for prostatic procedures between 1997 and 2011 for both private and public sectors. RESULTS: The procedures were more often performed in private sector (up to 70%). There was a sustained increase (+332%) of the number of prostatectomies between 1997 and 2007 (more than 27,000 procedures), followed by a slight decrease. There is a rising use of laparoscopic approach from 35% in 2006 up to 58% in 2011. The use of brachytherapy and HIFU was marginal. Transurethral resection of the prostate number was stable between 56,000 and 60,000 procedures a year (for cancer for less than 7%). Adenomectomies number decreased from 9832 to 7963 procedures a year. CONCLUSION: The most noticeable data were upon prostatectomies number, with a peak effect in 2007. Laparoscopic procedures were more and more frequent. TURP number was stable, whereas adenomectomies number decreased.

[Cardiovascular risk associated with urolithiasis]. / Risque cardiovasculaire chez les lithiasiques.

OBJECTIVE: Urolithiasis appears to be associated with several cardiovascular risk factors (excess salt and animal proteins, hypertension, metabolic syndrome) and, more recently, the development of stroke. The authors describe the frequency of cardiovascular risk factors and cardiovascular events before and after management of urolithiasis. METHOD: The authors retrospectively collected data from patients born before 1956 and managed surgically or instrumentally for urolithiasis in our establishment in 1994 concerning the frequency of cardiovascular risk factors and the incidence of acute coronary syndrome, stroke or acute lower limb ischaemia before or after treatment of urolithiasis. RESULTS: Data were obtained for 33 patients, revealing 12 events including five previous events (four cases of acute coronary syndrome, one ischaemic stroke) and seven subsequent events (five cases of acute coronary syndrome with one death, one ischaemic stroke, one case of acute lower limb ischaemia) an average of 5.7 years after management. These 33 patients had an average of more than two risk factors. CONCLUSION: This retrospective study based on a small sample size demonstrated a high frequency of risk factors and cardiovascular events. This correlation needs to be studied in more detail. Urolithiasis could constitute an indirect cardiovascular risk factor dependent on "classical" risk factors, suggesting the need for integrated management of stone patients, in the same way as for patients with erectile dysfunction.

[Common bile duct lithiasis. Analysis of surgical treatment of 130 consecutive cases]. / Lithiase de la voie biliaire principale. Analyse du traitement chirurgical de 130 cas consécutifs.

OBJECTIVES: Common bile duct lithiasis can be treated either surgically or endoscopically. Generally, morbidity and mortality is thought to be greater for surgery. The aim of this work was to evaluate the results of surgical cure in 130 consecutive patients treated from 1983 to 1993. METHODS: Transcytic extraction was performed in 16 cases, ideal choledocotomy in 25, choledocotomy with external biliary drainage in 45, choledocojuodenal anastomosis in 14 and transduodenal sphincterotomy in 32. RESULTS: There were 3 deaths. Morbidity was 11.5%. The postoperative hospitalization time was 9.86 +/- 8.9 days for patients without drainage and 15.13 +/- 3.09 days with drainage. Stone extraction was unsuccessful in 2 cases. CONCLUSIONS: Morbidity and mortality for surgical cure of common duct lithiasis are comparable or lower than for endoscopic sphincterotomy. It is much more adapted for stone desobstruction via the choledoscopy. Supra-duodenal choledocotomy without external drainage was performed in most cases with a small incision and without touching the Oddi sphincter thus allowing a hospital stay equivalent to that for endoscopic sphincterotomy. Associating surgery with laparoscopic cholecystectomy would allow simple benign treatment in most cases of common bile duct lithiasis.