[Antibiotic prophylaxis in urologic surgery]. / Antibioprophylaxie en chirurgie urologique.

Antibiotic prophylaxis is highly effective in prevention of postoperative infection. The aim is bacterial growth inhibition during operative procedure. To avoid side-effects, such as increase of bacterial resistant strains and modification of patient flora, some accurate rules are relevant and among them most important are: 1) never last more than 24 hours; 2) choose molecule active against bacteria generally responsible of infections according to the type of operation, but not used in therapeutic field; 3) of crucial importance is the timing of administration: it must start before operation, ideally 30 to 60 minutes before incision. Antibiotic prophylaxis cost must be considered as it accounts for more than 30% of total antibiotic use in hospital.

[Radioprotection in endo urology]. / La radioprotection en endo-urologie.

The aim of radioprotection is to protect people against harmful effects of radiation; those radiations come from electromagnetic wave or radioactivity that can be natural or related to human activity. Radiation risk is dose related and biological dose is expressed in millisievert (mSv). Mean dose received from natural radioactivity is about 3 mSv, which is a low and non-dangerous dose. Total annual biological dose received should not exceed 20 mSv a year. In endo-urology image intensifier is the main source of irradiation in operating theatre. Rules for utilisation are detailed.

[Recommendations for best practice for prostate biopsy]. / Recommandations pour la bonne pratique des biopsies prostatiques.

OBJECTIVES: the aim of these recommendations is to help urologists to optimize prostate biopsy practice in order to improve diagnosis yield and to minimize associated morbidity. METHODS: online systematic literature search was performed on PubMed until April 2010. Regulation texts, published guidelines and results of recent urologists practice study, were taken into consideration. Level of evidence was assigned to each recommendation. RESULTS: patient information must be prior to the procedure and should be given through a medical exam by the physician performing the biopsies. The check for complication risk factors (allergic, infectious, hemorrhagic) had to be done preoperatively by the physician during the medical exam. The use of single systemic antibiotics is recommended and Quinolones are the drugs of choice (level of evidence 2). Biopsies should be performed on outpatient basis to assess the safety of the procedure. Transrectal route and ultrasound guidance are state-of-the-art. Local anaesthesia with peri-prostatic block is recommended (level of evidence 1). On baseline biopsies, extended 12-cores scheme should be performed. Urine retention and severe postbiopsies infections have been reported in less than 1% of cases. Optimal management of severe post-biopsies infections is based first on patient information and require hospital intravenous antibiotic therapy. CONCLUSION: to improve the sensitivity and to reduce the risk of complication, achievement of prostate biopsies should follow a standardized procedure.

[Diagnosis and treatment of acute uncomplicated urethritis of men: guidelines from the French committee of infectious disease of the French association of urology (CIAFU)]. / Recommandations de bonnes pratiques cliniques : diagnostic et traitement des uréthrites aiguës non compliquées de l'homme, par le comité d'infectiologie de l'Association française d'urologie (CIAFU).

Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.

[Recommendations of the Infectious Disease Committee of the French Association of Urology (AFU): antibiotic prophylaxis for urological procedures]. / Recommandations de bonnes pratiques cliniques: l'antibioprophylaxie en chirurgie urologique, par le Comité d'infectiologie de l'association française d'urologie (CIAFU).

The French Association of anesthesiology (SFAR) has published in 1999 the Antibiotic prophylaxis guidelines. Antibiotic resistance has increased and new procedures appeared so new recommendations were needed. We present the antibiotic prophylaxis guidelines from the committee of infectious diseases of the French Association of Urology.

[Treatment of non-muscle invasive bladder tumours by instillations of mitomycin C and BCG: a survey on French urologists by the French Urological Association]. / Traitement par instillations vésicales de BCG et mitomycine C dans les tumeurs de vessie n'infiltrant pas le muscle : enquête de pratique de l'Afu auprès des urologues français.

AIM: To survey the French urologists in order to evaluate their practice of BCG and mitomycin C instillations in the treatment of non muscle invasive bladder tumours (NMIBT). MATERIAL AND METHOD: The survey was performed in 2008 on French urologists registered by the French Urological Association (AFU), using online self-administered questionnaires. RESULTS: One hundred and fifty-six urologists answered the questionnaire. The majority of responders reported indications for bladder instillations that were closed to the AFU recommendations, but for 25% of the respondents, indications were far away from the recommendations. Seventy-nine percent of respondents said that first line plus maintenance BCG therapy was more efficient than first line alone. However, many of the respondents reported that maintenance BCG therapy was not well accepted by patients (46%), was not easy to organize (28%), and was not well tolerated by patients (56%). Eighty-eight percent of respondents said using ofloxacin to prevent BCG adverse effects, but the protocol they were using was not clearly defined. Definition of BCG therapy failure given by respondents was close to the AFU one, but the way to manage it was heterogeneous. CONCLUSION: Responses of the 156 urologists who took part in this survey should help to evaluate French urologists attitude toward bladder instillations in the treatment of NMIBT. Although they were not so far from the AFU recommendations, urologists' practices of instillations appeared to be heterogeneous. Some points requiring clarification were highlighted in this study.

[Sterilization and disinfection of endoscopes in urology]. / Stérilisation et désinfection des endoscopes en urologie.

Sterilization and disinfection of endoscopes take account of the risk of transmitted infections and nosocomial infections. These risks are ruled by legal texts. Urology is a high risk speciality. The material which is used must be single use or at least sterilisable (18min at 134 degrees C). Flexible endoscopes are sensitive to high temperatures and needs disinfection, and immediate use. These steps are subjected to quality control rules and marking.

[Diagnosis, treatment and follow-up of community-acquired bacterial infections of the urinary system of men and women (acute cystitis and acute pyelonephritis) and of the genital system of men (acute prostatitis): general remarks]. / Généralités.

Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.

[Acute cystitis]. / Cystites aiguës.

The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.

[Acute pyelonephritis]. / Pyélonéphrites aiguës.

The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.

[Acute prostatitis]. / Prostatites aiguës.

A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.

[Endoscope disinfection]. / Désinfection des endoscopes.

Economic considerations currently limit the idea of the disposable flexible endoscope, which would guarantee absolute safety against the transmission of infections. Since the endoscope is made of a heat-sensitive material, it is impossible to sterilize it by autoclave. A disinfection procedure must therefore be applied, which, although it does not guarantee the same level of safety as classical sterilization, provides a sufficient reduction in the microorganism load. This procedure is carried out in two steps: first cleaning by mechanical action using a detergent, then the actual disinfection by soaking in a disinfectant bath. As urine is a sterile milieu, a high-level disinfection--bactericide, virucide, fungicide, and sporicide--should be implemented by soaking for 30 min in a peracetic acid bath. Prion risk, which must systematically be taken into account, can be controlled by a double cleaning method eliminating all proteic debris and by replacing glutaraldehyde with peracetic acid.

[Practice in private professional corporations]. / Exercice en Société d'exercice libéral practice in private professional corporation.

Since 1992, doctors may exert through a private professional corporation. The Decree no 94-680 of 3rd of August 1994 details the new regulation. For physicians used to the liberal scene, one of the greatest innovation is the payment mode. It is basically divided in two parts: the work remuneration as wages or management allowance, and capital remuneration as dividends. This last possibility offering important savings on social contribution, social contribution being calculated only on the work remuneration part. Taxation being in this case a taxation of the company and of the physician on his incomes and dividends. It is a precious instrument to take part in a regrouping and to integrate new associates. Nevertheless it still is an individual's choice and before getting engaged, consequences of the choices selected have to be appreciated with a qualified professional.

[Endoscopes in urology: disinfection, sterilization, labeling and tracking. Circulars and decrees. Modes of application and commentary. The Committee of Infectious Diseases of the French Association of Urology. Congressional forum UFA--Paris, November 1996. DGS Circular 20 October 1997]. / Les endoscopes en urologie: désinfection, stérilisation, marquage et traçage. Circulaires et décret. Modalités d'application et commentaires. Comité d'infectiologie de l'Association Française d'Urologie (CIAFU). Forum Congrès AFU-Paris, novembre 1996. Circulaire DGS 20 octobre 1997.

Administrative texts published in 1995, 1996 and 1997, have reinforced materiovigilance and impose disinfection precautions for endoscopes. The steps of disinfection of non-sterilizable endoscopes are: preliminary treatment, rinsing, actual disinfection, final rinsing, storage (see: Progrès en Urologie, 1997, 7, 505-507). Each procedure from collection of the endoscope until storage must be defined by written standard operating procedures validated by CLIN. The risk of transmission of Creutzfeld-Jakob disease requires autoclaving, which is only possible, at the present time, with the most recent rigid endoscopes. Until disinfection has become generalized, the traceability of endoscopes (labelling, utilization files) must be established on the model recommended for haemovigilance (circular of 02/04/96).

[How to control the Santorini's plexus easily]. / Comment contrôler facilement le plexus de Santorini?

Control of Santorini's plexus is one of the main difficulties of prostatectomy and total cystectomy. Two procedures allow easy control of this plexus: Perform a running haemostatic suture in the bladder neck, from one edge of the pelvic aponeurosis to the other. Apart from ensuring haemostatis by bringing Santorini's plexus together in the midline, this suture also provides excellent exposure of the prostate. Prepare the passage of the dissector at the prostatic apex by disrupting the fibrous tissue with a finger. The urethra is easily identified as it is intubated by the bladder catheter. The avascular plane between the urethra and Santorini's plexus is open to the finger and the dissector can be easily introduced into the correct plane. Section of the venous plexus is performed precisely to reveal the urethroprostatic junction.

[Short and long term complications of lithotripsy on renal function]. / Séquelles à court et moyen termes de la lithotripsie sur la fonction rénale.

Today, most stones can be removed by minimally invasive means. Extracorporeal Shock Wave Lithotripsy (ESWL) is the preferred form of treatment for symptomatic upper ureteral and renal calculi less than 2 cm a diameter. The short and long term complications of ESWL are underestimated. Thus, ESWL may cause renal trauma and such trauma may induce later hypertension. In this retrospective study, we reviewed the frequency of deleterious effects of ESWL in 45 patients who had undergone ESWL from January 1988 to September 1989. Short-term complications were macroscopic hematuria (15%), lumbar pain (11%) and peri- or intrarenal hematomas (4.4%). Two years later CT scan was performed in 20 patients. It was normal in 7 (35%). In others, it shown a recurrence of stone in 8 (40%) and a focal scarring in 5 (25%). Only 1 out of 43 patients had developed hypertension.

[Epidemiology of calcium calculi in a French region. Initial results after 4 years]. / Epidémiologie de la lithiase calcique dans une région française. Premiers résultats à 4 ans.

Between July 1, 1980 and August 1984, 222 patients (112 men and 112 women) were referred to the Nephrology out-patient clinic of a hospital serving a population of about 250,000. Urolithiasis was revealed by renal colics in 71% of the cases; 64 patients (29%) had been suffering from one or several attacks of renal colic before the study period. The first clinical symptoms appeared between the ages of 20 and 59 years in over 80% of the cases, with a peak of incidence between 30 and 39 years. Calcium stone lithiasis was as frequent in women as in men; the sex ratio was around 1 whatever the patient's age at the onset of the disease; 65% of patients had hypercalciuria on an unrestricted diet. The annual incidence of urolithiasis (hospital cases) was 15.6 for 100,000 inhabitants, and the theoretical prevalence (distribution of new patients aged about 50) 0.8 for 100 inhabitants. These epidemiological data compared with those in the literature, show a relatively low incidence of urolithiasis, notably among men, in that particular region of France.