Introduction Le système Rezum est un traitement mini-invasif de l’hypertrophie bénigne de prostate recommandée pour des volumes prostatiques entre 30 à 80 grammes. Nous comparons les résultats après traitement entre des petites prostates<80 grammes (PP) et des grosses prostates>80 grammes (GP). Méthodes Les patients traités entre août 2020 et février 2024 ont été divisés en deux groupes (<80 grammes et>80 grammes). Les données ont été recueillies rétrospectivement et dans un seul centre, comprenant notamment le volume prostatique échographique (Vp), l’International Prostate Score Symptom (IPSS), l’indice de qualité de vie (IQV), le débit maximal (Qmax), le résidu post-mictionnel (RPM) et l’International Index Erectile Function-5 Score (IIEF-5) pré- et postopératoires à 3 mois. Les complications immédiates et les échecs de traitement ont également été évalués. Résultats Au total, 108 patients ont été traités par Rezum dont 36 (33 %) présentaient un volume>80 grammes. Le volume prostatique moyen dans ce groupe était de 101,7 grammes (47,8 grammes dans le groupe PP). Huit patients (22 %) avaient une sonde vésicale en préopératoire (4,1 % dans le groupe PP). L’amélioration à 3 mois après traitement était statistiquement significative dans le groupe GP en matière d’IPSS et de QoL, de 23,3 à 3 (p=0,001) et 4,6 à 0,6 (p=0,002) respectivement. Le débit maximal s’améliore significativement passant de 9,3 à 15,3mL/sec (p=0,002). Concernant les patients sondés à demeure, 87,5 % des patients dans le groupe GP ont pu être sevrés contre 100 % dans le groupe PP (p>0,9). Le taux de retraitement chirurgical à 3 mois est de 2,7 % dans le groupe GP (0 % dans le groupe PP, p>0,9). La durée de sondage vésical postopératoire dans les groupes GP et PP était respectivement de 10,7jours et 4,4jours (p=0,003). Le taux de complications postopératoires était significatif pour la rétention aiguë d’urine (GP : 25 %, PP : 7 %, p=0,001) et les infections urinaires (GP : 19 %, PP : 4 %, p=0,001). Conclusion Le système Rezum semble efficace pour des prostates>80 grammes avec des améliorations objectives et subjectives comparables au groupe des prostates<80 grammes au prix d’un sondage vésical plus long et des taux de rétentions aiguës d’urine et d’infections urinaires postopératoires plus élevés.

PURPOSE:To report our preliminary experience with water vapor thermal therapy with the Rezūm™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients.PATIENTS AND METHODS:A multi-institutional study was conducted including all patients who underwent Rezūm™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezūm™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence.RESULTS:Eleven patients from the Rezūm™ group were matched to 11 embolized patients. PAE and Rezūm™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezūm™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezūm™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezūm™ patients (P=0.54).CONCLUSIONS:Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezūm™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezūm™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient.LEVEL OF EVIDENCE:3.

Purpose. - To perform a cost analysis of the current gold standard operation of Holmium Laser Enucleation of the prostate (HoLEP) compared to the new technique of water vapor thermal therapy with the RezumTM system for the treatment of symptomatic benign prostatic hyperplasia (BPH). Patients and methods. - Between October 2017 and January 2020, consecutive patients with invalidating lower urinary tract symptoms due to BPH who underwent Rezu over line mTM and HoLEP procedures from the Aix regional hospital were identified. The outcome of each technique was assessed in terms of cost from the institutional perspective. Detailed expense reports based were provided by the accounts department of the hospital. These were used to compare in-hospital costs for each procedure. Results. - A total of 53 and 94 consecutive patients underwent respectively water vapor thermal therapy and HoLEP. The median costs for the surgical procedure were (sic)1344 (IQR 1331-1361) and (sic)669 (IQR 584-824), respectively for Rezu (u) over barm (TM) and HoLEP (median difference (sic)675; P < 0.001). The median costs of the hospital stay were (sic) 869 (IQR 869-869) for Rezu<(u)over bar>m (TM) and (sic)1295 (IQR 1295-1330) for HoLEP (median difference (sic) 426; P < 0.001). Finally, the median total costs per patient were lower for HoLEP ((sic) 2005 [IQR 1902-2150]) than for Rezu over line mTM ((sic)2228 [IQR 2209-2243]) procedure, and the median difference of (sic)233 was significant (P < 0.001). Conclusions. - One of the anticipated benefits of Rezu (u) over barm (TM), reduced length of hospital stay with an associated reduction in cost, did not materialize within this study. The patient's clinical condition and expectations should also be taken into account when deciding between Rezum (TM) and standard therapies. (C) 2021 Elsevier Masson SAS. All rights reserved.

Purpose. - To report the results of convective radiofrequency (RF) water vapor thermal therapy in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperptasia (BPH) with one-year follow-up evaluation. Material and method. - The study was conducted in 2 French hospitals, for men with moderate to severe LUTS secondary to BPH, as an alternative to classical surgery treatment. The pre- and postoperative evaluation of urinary symptomatology was based on the International Prostate Symptom Score (IPSS) questionnaire, measures of peak urinary flow rate (Qmax) and post-void residual volume (PVR). Erectile and ejaculatory functions were evaluated via the IIEF5 and MSHQ-ejd questionnaires. Rates of retreatment and complications were also reported. Results. - Sixty-two outpatients including 8 with urinary retention were treated. The median preoperative prostate volume was 47 (27-200) mL. At 6 months postoperative, the IPSS had decreased significantly by 13.9 points (68.1%, P<0.001) and, at one year, by 12 points (61.5%, P< 0.001). The quality of life (QoL) score at one year had decreased by 3.2 points (P < 0.001) and the Qmax had improved by 6 mL/s (P < 0.001). Alt patients with urinary retention were weaned from bladder catheterization. No serious side effects (> Clavien II) were observed. No cases of de novo erectile dysfunction and an anejaculation rate of 10.8% was reported. The surgical retreatment rate at one year was 2.1%. Conclusion. - The short-term results are encouraging, with significant efficacy on urinary symptoms and respect of sexual function. Nevertheless, it will be necessary to pursue the follow-up of this cohort to evaluate the mid-term and long-term evolution. (C) 2020 Published by Elsevier Masson SAS.

Depuis des décennies, le « gold standard » des traitements chirurgicaux pour les Symptômes du Bas Appareil Urinaire (SBAU), dus à l’Hyperplasie Bénigne de Prostate, est la Résection Trans-urétrale de Prostate (RTUP). De nouvelles techniques mini-invasives se sont développées afin de réduire la morbidité. Cette vidéo en décrit l’une d’elle réalisée sous sédation-hypnose. Il s’agit d’une vidéo réalisée au bloc opératoire lors d’un traitement par thermothérapie à la vapeur d’eau pour une prostate de 65 gr de volume total et 46 gr de volume de la zone de transition. L’intervention est réalisée sous sédation-hypnose. Nous décrivons l’installation, le matériel et la technique. Le traitement débute par une première ponction latérale à 1 cm en aval du col vésical. L‘aiguille est rétractée après chaque traitement et doit être repositionnée plus distalement avec un incrément d’un centimètre et cela jusqu’à la fin de l’urètre prostatique en regard du veru-montanum. On réitère la même procédure pour le lobe controlatéral. Le système Rezum, fabriqué par Boston Scientific, transforme l’eau stérile en énergie thermique (sous forme de vapeur) pour détruire le tissu prostatique principalement dans le cadre de l’ambulatoire. Contrairement à d’autres techniques mini-invasives, les patients présentant un lobe médian obstructif sont des bons candidats à cette thérapie. Cette procédure est sure et présente peu de complications périopératoires. Les avantages les plus importants sont clairement la facilité de réalisation (procédure ambulatoire sans nécessité d’anesthésie générale) et peu d’effets secondaires sexuels. Ce dispositif autorise une grande flexibilité dans le traitement puisqu’il permet de cibler les zones obstructives quel que soit la morphologie prostatique. Cette technique est rapide et permet donc sa réalisation sous sédation-hypnose avec une excellente tolérance et de bons résultats cliniques.

Introduction. - The REVELA13 observatory is a unique epidemiological tool listing the new cases of kidney tumors, bladder tumors and acute leukaemias in the Bouches-du-Rhone county (France). Aim was to exploit for the first time data from this observatory regarding new cases of bladder tumors >= T1 in women from 2012 to 2014. Materials. - This epidemiological study was observational and descriptive. Fifteen non nominative variables from the REVELA13 database were analyzed in order to describe the clinical and pathological characteristics of the incident cases as well as their spatial and temporal distribution. The incidence rates expressed in new cases per year per 100000 inhabitants were standardized on the world age, calculated with 95 % confidence intervals and compared to national estimates for the same period. Results. - Incident bladder tumor cases were recorded in 291 women, corresponding to a standardized incidence on the world age of 3.85 [3.32-4.37] new cases per year per 100,000 population, 54 % higher than the national estimates of 2012 and 2015. Median age of diagnostic was 75.9 years. Sex ratio was 19.41 % (W/M). Tumors were predominantly non-muscle-invasive (52 %), high grade (69 %) and without associated carcinoma in situ (Cis) (49 %). The two most affected territories were Marseille and Aubagne-La Ciotat. Conclusion. - The REVELA13 observatory has improved our epidemiological knowledge on female bladder tumors in Bouches-du-Rhone county and highlighted a local over incidence. (C) 2018 Elsevier Masson SAS. All rights reserved.

The REVELA13 observatory is a unique epidemiological tool listing the new cases of kidney tumors, bladder tumors and acute leukaemias in the Bouches-du-Rhône county (France). Aim was to exploit for the first time data from this observatory regarding new cases of bladder tumors≥T1 in women from 2012 to 2014.This epidemiological study was observational and descriptive. Fifteen non-nominative variables from the REVELA13 database were analyzed in order to describe the clinical and pathological characteristics of the incident cases as well as their spatial and temporal distribution. The incidence rates expressed in new cases per year per 100000 inhabitants were standardized on the world age, calculated with 95 % confidence intervals and compared to national estimates for the same period.Incident bladder tumor cases were recorded in 291 women, corresponding to a standardized incidence on the world age of 3.85 [3.32-4.37] new cases per year per 100,000 population, 54 % higher than the national estimates of 2012 and 2015. Median age of diagnostic was 75.9 years. Sex ratio was 19.41 % (W/M). Tumors were predominantly non-muscle-invasive (52 %), high grade (69 %) and without associated carcinoma in situ (Cis) (49 %). The two most affected territories were Marseille and Aubagne-La Ciotat.The REVELA13 observatory has improved our epidemiological knowledge on female bladder tumors in Bouches-du-Rhône county and highlighted a local over incidence.3.

Évaluer l’efficacité et la tolérance de l’hypnose dans le contrôle de la douleur lors d’une séance de lithotripsie extracorporelle pour le traitement de la lithiase du haut appareil. Entre juin 2013 et juin 2014, étude prospective, monocentrique et non randomisée sur 90 patients consécutifs porteurs de lithiases rénales et divisés en 3 groupes de 30 patients. Le groupe 1 a bénéficié d’une séance d’hypnose par une infirmière, le groupe 2 a reçu un comprimé d’hydroxyzine 50 mg et le groupe 3 n’a rien reçu. La douleur a été évaluée sur une échelle visuelle analogique (EVA). L’âge, la taille des lithiases, la localisation des lithiases, la durée, le nombre de chocs administrés et le niveau d’énergie moyen (Kv) ont été enregistrés. Les effets indésirables et la satisfaction des patients ont également été évalués. Les paramètres démographiques des trois groupes sont similaires. Les résultats sont résumés dans le Tableau 1. Pas de différence significative entre les groupes concernant les antalgiques supplémentaires et les effets indésirables. Par contre, il existe une différence statistiquement significative entre les groupes I et III en terme d’EVA (p = 0,01). Le taux de satisfaction des patients dans le groupe « hypnose » est de 100 % et la perception de la durée de la séance dans ce groupe est en moyenne de 21 minutes pour un temps moyen réel de 43 minutes. Alors qu’aucune méthode idéale d’anesthésie n’a été standardisée dans le traitement de la douleur lors d’une séance de LEC, l’usage d’hypnose permet un excellent contrôle de la douleur et augmente le taux de succès de la LEC, offrant ainsi à cette technique une place de choix dans l’arsenal thérapeutique.

Évaluer les effets de l’énucléation de la prostate au laser Holmium (HoLEP) sur la fonction sexuelle. Réalisation d’une étude rétrospective sur 100 patients ayant bénéficié d’une HoLEP divisés en quatre groupes selon les scores IIEF-5 (groupe I = dysfonction érectile sévère, groupe II = dysfonction érectile modérée, groupe III = dysfonction érectile légère et groupe IV = fonction érectile normale). Les patients ont été évalués en préopératoire et en postopératoire à 3, 6 et 12 mois. Les paramètres de l’évaluation sont le débit urinaire, le résidu post-mictionnel et les questionnaires de symptômes scores (IPSS, QoL et IIEF-5). L’âge moyen dans les groupes I, II, III et IV est respectivement 73, 71, 67 et 62 ans. Bien qu’il n’existe pas de différence significative entre les résultats des scores IIEF-5 pré- et postopératoires dans le groupe IV, 12 % des patients ont vu leur score s’améliorer et 14 % ont vu leur score diminuer à 1 an de l’intervention. Le Tableau 1 résume l’évolution des scores IIEF-5. À 12 mois postopératoire, 70 % des patients déclarent une éjaculation rétrograde et 16 % une diminution notoire de l’éjaculation. Tous les groupes ont vu une amélioration significative des questionnaires IPSS et QoL. Cette étude montre que l’HoLEP n’affecte pas la fonction érectile si ce n’est, comme attendu, l’éjaculation. Ce travail confirme également une satisfaction de la sexualité proportionnelle à l’amélioration des symptômes urinaires du bas appareil.

Introduction. - Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive technique, independent of the size of the prostate for benign prostatic hyperplasia with excellent surgical results in the long term. The purpose of this article is to describe the details of the technique step by step.Method. - Description of all steps of the HoLEP procedure by listing all the practical aspects based on personal experience of the author and documented review of the literature.Results. - Tips and tricks on the preoperative preparation, medial and lateral lobes enucleation, hemostasis, morcellation, postoperative outcomes are discussed point by point.Conclusion. - HoLEP technique has become an alternative to conventional transurethral resection of prostate or prostatectomy way to high for its efficiency and its low morbidity. Respect and understanding of the different steps of the procedure are important to optimize the learning curve. (C) 2014 Elsevier Masson SAS. All rights reserved.

C’est en 1995 que Gilling et al. décrivent les premiers la résection de la prostate par laser Holmium. Cette dernière va alors évoluer en énucléation de la prostate par laser Holmium grâce à l’avènement d’un morcellateur intravésical de tissus mous. L’intervention implique une dissection anatomique de la prostate dans le plan de la capsule par voie rétrograde. Elle nécessite l’usage d’un laser Holmium de haute puissance suivie d’une morcellation intravésicale du tissu prostatique. Certaines publications défendent l’idée que cette technique est l’équivalent endoscopique de l’adénomectomie par voie haute avec des résultats équivalents, voire supérieurs, non seulement sur cette dernière mais également sur la résection transurétrale de prostate.

Transrectal ultrasound-guided needle biopsy of the prostate is routinely performed to diagnose prostate cancer. We performed a prospective study to assess the pain and identify risk factors of pain during prostate biopsy. Prospectively, 131 patients were enrolled. Transrectal ultrasound-guided needle prostate biopsies were performed without any anesthesia. Pain was assessed by using an immediate postbiopsy anonymous questionnaire including a linear visual analog scale ( VAS). Six factors were studied ( age, prostate volume, cores number, operator, previous biopsy and first core location). Most of the patients tolerated the biopsy with acceptable discomfort. Among the risk factors studied, only first core location influenced the pain. Apex biopsy first was more painful. We recommend starting biopsy with the base.

OBJECTIVE:For many years, intravenous urography has been the first-line investigation for renal colic. Since the middle of the 1990s, non-enhanced spiral CT has become a more efficient, less invasive and less expensive alternative to IVU. The aim of this study was to compare non-enhanced spiral CT and IVU in the assessment of renal colic and to evaluate the possibility of exclusive CT assessment in this disease.MATERIAL AND METHODS:Prospective study including 81 patients all undergoing urgent non-enhanced spiral CT, while the first 30 patients were investigated by non-enhanced spiral CT and IVU.RESULTS:Comparison of IVU versus CT: better sensitivity of CT for the diagnosis of renal colic (96% vs 92%) and for the detection of stones (95% vs 59%). CT diagnosis: A definitive diagnosis of renal colic was established in 72/81 patients: stone visualized in 64 cases and post colic syndrome in 8 cases, while the other 9 patients presented a non-urological abdominal disease.DISCUSSION:Comparison of our series with results reported in the literature confirms the superiority of CT over IVU with better visualization of the stone at a lower cost, with a shorter examination time, without injection and allowing the detection of non-urological disease. Analysis of CT signs emphasizes the importance of secondary signs for the diagnosis of renal colic (dilatation, perirenal or ureteric oedema, rim sign). Delayed excretion demonstrated by IVU and not directly evaluable by non-enhanced CT is no longer an argument in favour of IVU as first-line examination for the assessment of renal colic.CONCLUSION:The superiority of CT for the diagnosis of renal colic has now been demonstrated. Renal colic can now be assessed exclusively by first-line non-enhanced helical CT. IVU or contrast-enhanced CT may be indicated in rare cases when there is a doubt about the diagnosis on non-enhanced CT.

PURPOSE:To evaluate the feasibility, accuracy, and clinical role of fine-needle percutaneous biopsy of renal masses, with helical computed tomographic (CT) guidance.MATERIALS AND METHODS:In 63 patients (mean age, 62 years), 73 biopsies were performed. The median tumor size was 4.0 cm. Tumor biopsy was performed with an 18-gauge needle by using helical CT guidance in an outpatient setting. Two to four cores per tumor were obtained.RESULTS:Biopsy material was insufficient for analysis in 15 (21%) procedures. The median tumor size of failed or successful biopsies was 3.0 or 4.8 cm, respectively (P =.03). A benign lesion was found at eight biopsies. Two samples were suspicious for renal cell carcinoma (RCC). RCC was found in 38 biopsy samples. The remainder were transitional cell carcinoma, metastasis, lymphoma, or sarcoma. Twenty-six patients underwent nephrectomy. The accuracies of biopsy for histopathologic and Fuhrman nuclear grade evaluation were 89% and 78%, respectively. For tumors of 3.0 cm or smaller or larger than 3.0 cm, 37% (11 of 30) or 9% (four of 43) had failure of biopsy, respectively (P =.006). No substantial morbidity occurred.CONCLUSION:Fine-needle biopsy with helical CT guidance is accurate for the histopathologic evaluation of renal masses without morbidity. Indications are renal lesions that do not have the typical radiologic features of RCC, Bosniak category III or IV cystic lesions, and locally advanced or metastatic RCC.

INTRODUCTION The management of upper urinary tract disease has been improved by miniaturization of endoscopes. Our objective was to assess the value of flexible mini-ureteroscopes for the diagnosis and treatment of upper urinary tract lesions. PATIENTS AND METHODS 33 consecutive patients (mean age: 49 +/- 16 years; 23 men) underwent first-line flexible ureteroscopy for upper urinary tract disease, consisting of: stones: 21, filling defect: 6, stenosis: 3, haematuria: 2, positive cytology: 1 and situated in the kidney + renal pelvis: 14 or ureter: 19. The 21 stones were situated in: the calyx: 5, renal pelvis: 1, lumbar ureter: 8, iliac ureter: 3, pelvic ureter: 4. Their mean dimensions were 9.7 +/- 4 x 5.3 +/- 2.3 mm. Previous treatment had failed for 13 stones. There 7.5 F flexible ureteroscopes of various brands were used. RESULTS All patients were operated under general anaesthesia. Antegrade ureteroscopy was performed in 2 patients. Advancement of the ureteroscope was considered to be difficult in 5 cases, including the 2 antegrade cases. 13 stones were fragmented by hydroelectric waves. The mean duration of ureteroscopy was 40 +/- 15 min. The mean hospital stay was 2.8 +/- 1 days. There was no intraoperative or perioperative morbidity. Ureteroscopy was considered to be successful in 27 cases (82%) and a failure in 6 cases: fragmentation: 3 and progression: 3. Fifteen patients were reviewed after more than one month (3 +/- 2 months) with no morbidity. CONCLUSION Ureteroscopy with flexible mini-ureteroscopes is an effective, reproducible and minimally traumatic diagnostic and therapeutic technique. It is particularly useful for lesions situated above the iliac vessels and is indicated for diagnostic assessment and stones, but also upper tract malformations and strictures.

Objectives. To evaluate the effects of digital rectal examination (DRE) on serum total, calculated complexed, and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations of PSA.Methods. Serum total and free PSA and the percent free PSA ratio were determined in 91 urologically referred men (mean age 64 +/- 9 years) before and 30 minutes after DRE, with the Hybritech Tandem-R assay. Complexed PSA was calculated as the difference between total and free PSA. DRE effects on PSA were analyzed comparing pre-DRE and post-DRE values and by calculating the difference between pre-DRE and post-DRE PSA and the post/pre-DRE geometric ratio as a coefficient of variation.Results. Thirty minutes after DRE, the increase in total, calculated complexed, and free PSA and the percent free PSA ratio was statistically significant. The difference between post-DRE and pre-DRE values of serum total, calculated complexed, and free PSA and percent free PSA was +0.9, +0.3, and +0.6 ng/mL and +10%, respectively. The post/pre-DRE ratio of serum total, calculated complexed, and free PSA and percent free PSA was x1.5, x1.22, and x2.5 and x1.7, respectively. Patient age, DRE findings, prostate volume, prostate histologic features, and the initial value of total PSA had no statistically significant effect on the change of percent free PSA after DRE. The initial percent free PSA had a statistically significant effect on the change of percent free PSA after DRE. The values of calculated complexed PSA before and after DRE were significantly higher in patients with a prostate volume greater than 40 cc, prostate cancer on biopsy, and an initial free/total PSA ratio greater than 18%.Conclusions. In this study, DRE significantly increased total, calculated complexed, and free PSA and percent free PSA. The increase of PSA immediately after DRE was mainly due to the increase of free PSA. The change of percent free PSA after DRE depended on the initial percentage of free PSA. Complexed PSA seems less sensitive to DRE, and its changes after DRE were clinically modest. Free PSA measurement should be done before DRE and percent free PSA should be used only when the venipuncture is done before the DRE, UROLOGY 54: 857-861, 1999. (C) 1999, Elsevier Science Inc.