This narrative review aims to examine the biological mechanisms of toxicity in patients with benign prostatic hyperplasia (BPH) receiving prostate cancer (PCa) external beam radiotherapy (RT), as well as possible strategies to prevent genitourinary (GU) toxicity following PCa RT in men with BPH, through the adaptation of both medical, surgical, and irradiation strategies. A broad literature search was performed in November 2024 in the PubMed database with the terms “prostate cancer”, “prostate epithelial cells”, “prostate stromal cells”, “radiation therapy”, “lower urinary tract symptoms”, “stereotactic body radiotherapy”, “transurethral resection of the prostate”, “enucleation”. RT affects several pathophysiological contributors to LUTS, such as urothelial dysfunction, prostatic inflammation and bladder fibrosis. While preexisting LUTS appear to be a risk factor to develop severe GU toxicity following PCa RT, the development of strategies reducing the incidental dose delivered to urinary structures appears to be particularly relevant. Urethra-sparing strategies holds the potential to reduce the onset of severe GU toxicity following PCa RT. The relationship between the highest doses delivered to the bladder and the onset of severe GU toxicity highlight the pivotal role of image-guided radiotherapy (IGRT) for PCa RT. Aggressive margin reduction from 4 mm to 2 mm demonstrated its ability to halve the risk to develop severe GU toxicity 2 years following SBRT. De-escalation in either dose or target volume represent appealing strategies, currently assessed within prospective trials. Both assessment and optimization of urinary function through medical or surgical approaches is mandatory before RT. Strategies designed to reduce the planned and delivered dose to functional structures hold promise for the limitation of urinary toxicity after PCa RT. Further efforts should be made to adapt surgical and irradiation techniques in men with BPH, with the development of studies dedicated to this population of patients.

Purpose: Penile fracture is a rare urological emergency treated by surgical exploration. However, the indication for intra-operative drainage remains debated due to limited evidence. This study aimed to assess the impact of drainage on postoperative complications and symptoms after penile fracture repair. Methods: We performed a retrospective multicenter study including all patients who underwent surgery for clinically suspected penile fracture between 2000 and 2024 across 21 French centers. Patients were stratified according to intra-operative drain placement. The primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Operative time, hospital stay, and symptoms at 1 and 3 months were also evaluated. Multivariable logistic regression adjusted for surgical approach, urethral injury, and surgeon experience assessed associations with complications. Results: Among 519 patients, 158 (30%) received a drain. Drain placement was associated with longer operative time and hospital stay and more frequent degloving approach. The overall postoperative complication rate was 10%. Drain placement was not significantly associated with complications (OR 1.19, 95% CI 0.62–2.22; p = 0.59), whereas urethral injury was (OR 2.03; p = 0.04). At 1 month, 60% of patients reported at least one symptom; sexual pain was more frequent in the drain group (36% vs 23%; p = 0.04) but not at 3 months. Conclusion: Intra-operative drainage did not reduce early morbidity and was linked to longer operative time, hospital stay, and more sexual pain at 1 month. Drain use should therefore remain selective and tailored to intra-operative findings.

Alkali therapy is frequently used during chronic kidney disease and nephrolithiasis: nephrologists and urologists are the key operators. Very few is known about the underlying conditions of such a prescription: the aim of this study was to delineate those determinants. We conducted a prospective survey where French nephrologists and urologists were involved. Responders were without gender distinction and principally nephrologists. Prescription frequency was associated with gender (women), specialty (nephrologists), indications and perceived efficiency. Urologists prescribe more often during nephrolithiasis and nephrologists during chronic kidney disease. Urologists were more expert (by scoring on mineral-based alkaline waters compositions knowledge). By multivariate analysis, prescription frequency is associated with gender (women), indications and perceived efficiency by prescribers, which is itself influenced by feedback from patients. These results could have been influenced by a huge representation of nephrologists but foster physicians to go on listening to feedback from patients, due to a lack of clinical trials on the efficiency of mineral-based alkaline waters in such a field. Finally, physicians' education (especially young nephrologists) on mineral-based alkaline waters should be intensified. (C) 2015 Association Societe de nephrologie. Published by Elsevier Masson SAS. All rights reserved.

Le bicarbonate est utilisé notamment dans l’insuffisance rénale chronique et certaines maladies lithiasiques rénales : néphrologues et urologues en sont les premiers acteurs. Peu d’informations sont disponibles sur les déterminants de la prescription des eaux riches en bicarbonate en France. L’objectif de cette étude est de les évaluer : une enquête prospective a été réalisée auprès des néphrologues et des urologues. Les répondants étaient, sans distinction de genre, principalement des néphrologues. La majorité indique prescrire le traitement pour de longues périodes (>1 mois). Les répondants prescrivant fréquemment du bicarbonate (>50 % de leurs patients) étaient plus souvent des femmes et des néphrologues. La fréquence de prescription était, par ailleurs, associée au type de pathologies rencontrées et à l’efficacité perçue (par les médecins) du traitement. Les urologues indiquaient le prescrire majoritairement au cours de la maladie lithiasique rénale et les néphrologues au cours de la maladie rénale chronique. Les urologues avaient un meilleur score d’expertise sur la composition des eaux riches en bicarbonate. En analyse multivariée, les déterminants de la fréquence de prescription étaient le genre féminin, l’indication et l’efficacité perçue par les médecins, qui était elle-même influencée par le retour qu’ils avaient de la part des patients. Ces résultats peuvent avoir été influencés par la participation importante des néphrologues, mais ils encouragent les praticiens à poursuivre leur écoute des malades, en l’absence d’études cliniques sur l’efficacité des eaux riches en bicarbonate. Enfin, la formation des médecins (particulièrement les jeunes néphrologues) sur les eaux riches en bicarbonate devrait être intensifiée.