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.

[Urology: what's new in 2022]. / Urologie : ce qui a changé en 2022.

Over the last year, urologic progress remains driven by evolutions in oncological and functionnal urology. Prostate cancer imaging modalities are improving, as well as treatment options for advanced stages. Kidney and bladder cancer are benefiting from new treatment modalities including immunotherapy, whose role in the peri-operative setting is still unclear. Surveillance startegies for testicular cancer has been greatly simplified, for the benefit of the patients. In functional urology, a new therapeutic class in now available for the treatment of overactive bladder. Mutliples alternatives to transurethral resection are emerging in the surgical treatment of benign prostatic hypertrophy, whose expected benefits will need to be validated by long-term studies.

Les progrès de cette année sont marqués par des avancées en uro-oncologie et urologie fonctionnelle. La prise en charge du cancer de la prostate s'améliore tant dans la qualité de son diagnostic que dans le traitement des stades avancés. Les cancers du rein et de la vessie bénéficient de nouvelles options de traitement incluant l'immunothérapie, qui cherche encore sa place en périopératoire. Quant au cancer des testicules, il a vu sa surveillance grandement simplifiée au bénéfice des patients. En urologie fonctionnelle, une nouvelle classe thérapeutique est désormais disponible pour le traitement de l'hyperactivité vésicale et de multiples alternatives à la résection endoscopique de la prostate émergent dans le traitement chirurgical de l'hypertrophie bénigne de la prostate. Il faudra toutefois valider les avantages espérés par des études à long terme.

[Erectile dysfunction, an urologic and multidisciplinary approach]. / Dysfonction érectile, une prise en charge urologique et multidisciplinaire.

Erectile dysfunction (ED) is a common complaint, both in the general medicine and the urology out-patient clinic. The quite recent availability of effective treatments has profoundly changed the perception of sexual health in society, which has become more demanding. We should see erectile or sexual function as a health marker. Its causes are often diverse but we can classify them as somatic (vascular, neurological, endocrine, tissue-related, iatrogenic) or psychogenic. Management should be etiological if possible. It often goes first by reducing cardiovascular risk factors and then by prescribing a vasodilating agent functioning through the inhibition of phosphodiesterase 5. When modifiable cardiovascular risk factors are identified, we refer the patient to a specialized consultation. ED is to be seen as a warning sign of a preventable disease or cardiovascular event.

La dysfonction érectile (DE) est une plainte fréquente en consultation de médecine générale ou d'urologie. L'arrivée de traitements efficaces a modifié profondément la perception de la santé sexuelle dans la société, qui est devenue plus exigeante. Ainsi, la fonction érectile et sexuelle a désormais émergé comme un marqueur de santé globale. Les causes de la DE sont souvent mixtes : elles peuvent être somatiques (vasculaire, neurologique, endocrine, tissulaire, iatrogène) ou psychogènes. La prise en charge doit être étiologique si possible. Elle passe souvent d'abord par la réduction des facteurs de risque cardiovasculaire (FRCV) puis par un soutien médicamenteux vasodilatateur par inhibition de la phosphodiesérase 5. Lorsqu'on identifie des FRCV modifiables, nous adressons le patient en consultation spécialisée de prévention cardiovasculaire. La DE doit être vue comme un signe d'alerte prédictif de maladie ou d'événement cardiovasculaire évitable.

Rectal gastrointestinal stromal tumour: What do we know in 2017? A systematic review protocol.

INTRODUCTION: Gastrointestinal stromal tumour is a pathology that originates from the interstitial cells of Cajal and differentiates from other mesenchymal neoplasm by expression of CD117 oncogene on Immunohistochemistry test. Colon and Rectal GISTs constitutes of approximately 5% of all gastrointestinal GISTs. The past decade has witnessed a dramatic change in the treatment of rectal cancer. Preoperative, perioperative and postoperative, management has changed thanks to new chemotherapy regimens and emergence of novel surgical techniques. Our aim is to investigate if same change can be implemented for rectal GISTs management. METHODS AND ANALYSIS: This protocol is compliant with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols (PRISMA-P) guidelines. Exclusion and inclusion criteria are outlined within this protocol. Points of interest and objectives are described within this protocol. The search strategy, aims to identify all articles on "Rectal GISTs". DISCUSSION: The choice of resection type surgery depends upon the location and size of rectal GIST. Neoadjuvant Imatinib therapy yields tumour shrinkage in at least 50% and is associated with a prolonged disease-free survival for intermediate and high-risk patients. This review will also allow a summary clinicopathological features and prognostic factors of rectal GISTs. ETHICS AND DISSEMINATION: The Centre for Reviews and Dissemination, University of York acknowledged that this systematic review is within the register scope. This review will be published in a peer-reviewed journal and will be presented at various national and international conferences.

O rio, a inundação e a cidade: A várzea do Tietê como situação crítica / The river, the flood and the city: The Tietê meadow as a critical situation

As metrópoles brasileiras estão passando por grandes transformações. As periferias se converteram em situações críticas, onde conflitam diferentes políticas públicas, assentamentos de moradia precária e sistemas ambientais desconfigurados. As várzeas dos rios, como o Tietê na zona leste de São Paulo, são paradigmáticas das condições de não equilíbrio, exigindo repensar os fenômenos extremos que afetam a paisagem urbana: as chuvas torrenciais, as inundações; desenvolver estratégias sociais e instrumentos técnicos para lidar com as instabilidades; recolocar as relações entre o rio e a cidade, integrando os dispositivos de contenção de enchentes e o meio ambiente, em outras bases conceituais e operacionais.(AU)

The Brazilian metropolises are undergoing great transformations. The peripheries have become critical situations, where different public policies, settlements of precarious housing units and disaggregated environmental systems conflict. River floodplains, such as that of the Tietê river in eastern São Paulo, are paradigmatic of a condition of non-equilibrium, requiring a new perspective on the extreme phenomena that affect the urban landscape: torrential rains, floods. It is necessary to develop social strategies and technical tools to deal with climatic instabilities and to re-evaluate the relations between the river and the city, integrating flood containment devices and the environment into other conceptual and operational foundations.(AU)