Diseases related to fatty liver, independently of alcohol consumption («non-alcoholic fatty liver disease» or NAFLD), are increasing because of the epidemics of obesity and type 2 diabetes. These disorders reflect a continuum that comprises isolated steatosis, steatohepatitis (NASH) and fibrosis, with, at the end, an increased risk of cirrhosis and hepatocarcinoma. It has been recently proposed to replace the term NAFLD by MAFLD, i.e. «Metabolic (dysfunction) Associated Fatty Liver Disease», which better reflects the pathogenesis of the disease. Inflammation plays a crucial role in the aggravation of the disorder and profoundly influences the prognostic evolution. This article illustrates the natural history of this underestimated metabolic disorder, recall the diagnostic criteria used in clinical practice, emphasizes the deleterious role of inflammation and discusses some therapeutic perspectives.

Introduction. - In France, the urinary catheterization especially in men, is governed by Article R. 4311-10 of Decree No. 2004-802 of 29 July 2004 of the Public Health Code. Although this gesture is framed by law, there is currently no French guidelines formalized on a single and easily accessible support for the technique and management of the urinary catheterization. The aim of this study was to provide a simple reference about technical aspects and management of urinary catheterization in men. Materials and methods. - The European recommendations on urinary catheterization were updated and adapted with additional arguments in certain situations to cover all aspects of urinary catheterization. This work was conducted to improve the nurses knowledge about this topic. Results. - We give here a reproducible technique in order to limit complications related to the most frequent invasive gesture in urology. We also propose a scheme to harmonize the management of indwelling urinary catheterization. Conclusion. - This work gives to nurses a practical document in order to standardize and to secure a gesture governed by dogmas since too long. The drafting of guidelines and the creation of educational tools for medical and para-medical personnel would probably improve practices in this topic. (C) 2018 Elsevier Masson SAS. All rights reserved.

Purpose To determine the impact of transplant nephrectomy on morbidity and mortality and HLA immunization. Methods All patients who underwent transplant nephrectomy in our centre between 2000 and 2016 were included in this study. A total of 2822 renal transplantations and 180 transplant nephrectomies were performed during this period. Results The indications for transplant nephrectomy were graft intolerance syndrome: 47.2%, sepsis: 22.2%, vascular thrombosis: 15.5%, tumour: 8.3% and other 6.8%. Transplant nephrectomies were performed via an intracapsular approach in 61.7% of cases. The blood transfusion rate was 50%, the morbidity rate was 38% and the mortality rate was 3%. Transplant nephrectomies more than 12 months after renal transplant failure were associated with more complications ( p = 0.006). Transfusions in the context of transplant nephrectomy had no significant impact on alloimmunization. Conclusion The risk of bleeding, and therefore of transfusion, constitutes the major challenge of this surgery in patients eligible for retransplantation. Even if transfusions in this context of transplant nephrectomy had no significant impact on alloimmunization, this high-risk surgery, whenever possible, must be performed electively in a well-prepared patient.

Introduction. - The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cNO) and pelvic lymph node metastasis (pN +) treated with radical prostatectomy and pelvic lymph node dissection. Patients and methods. - This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. Results. - Thus, 30 patients were included. Median follow-up was 89.9 +/- 27.4 months. After surgery, patients were treated with surveillance (n = 4, 13.5%), adjuvant hormone therapy (n = 22, 73%) or combination of radio and hormone therapy, (n = 4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38 30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P = 0.00021) and pathological margin status (P = 0.0065) were independent predictors of 5-year RFS. Conclusion. - Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. (C) 2017 Elsevier Masson SAS. All rights reserved.

Objectifs Évaluer l’efficacité et la morbidité de l’urétérorénoscopie souple (URSS) dans le traitement des calculs du haut appareil urinaire, chez les patients atteints d’une maladie du système nerveux avec un handicap moteur sévère. Méthodes De 2006 à 2013, nous avons analysé 83 interventions d’URSS effectuées pour traiter 63 reins atteints de calculs du haut appareil urinaire chez 42 patients. L’absence de fragment résiduel (SF) dans le rein traité sur les examens d’imagerie (ASP, échographie, scanner) postopératoire ou sur les constatations endoscopiques en fin d’intervention était considérée comme un succès. Les complications postopératoires précoces étaient rapportées selon la classification de Clavien-Dindo. Résultats Le taux de succès est de 49,2 %, de 57,1 % et 58,7 % respectivement après une, deux ou trois interventions d’URSS. Pour les calculs de moins de 20mm, 64,3 % des reins traités étaient sans fragment résiduel après une intervention. Il n’y a pas eu de complication majeure (Clavien-Dindo>2) (0 %). Le taux de complication postopératoire précoce mineur était de 44,7 % avec 31,6 % de Clavien-Dindo 2 et la principale complication était l’urosepsis dans 27,6 % des cas (Fig. 1). Conclusion Pour les patients présentant un handicap moteur sévère, l’URSS est d’une efficacité plus faible que dans la population générale avec une morbidité fréquente mais modérée. En pratique, les indications de l’URSS dans ce groupe de patients semblent plus restreintes.

Male urethral stricture disease is prevalent and has an important impact on quality of life. Direct visual urethrotomy and dilatations have high rates of recurrence.Objectives. - The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra.Methods. - We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of. urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required.Results.- From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5 cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7 cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36 cm. Overall, 19/20 studies used buccal mucosal graft.Conclusion. - The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture. (C) 2016 Elsevier Masson SAS. All rights reserved.

Objective. - The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability.Methods. - Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system.Results. - Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20 mm stones. No major complication (Clavien-Dindo > 2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases.Conclusion. - Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted. (C) 2017 Elsevier Masson SAS. All rights reserved.

Introduction. - The lengthening of life expectancy associated with multiple comorbidities leads physicians and nurses to manage more and more patients with long-term urinary catheterization (LTUC). No recommendation is written about the management of LTUC patients. To assess the need to publish recommendations and tools to help nurses in a better management of LTUC, we conducted a survey of theoretical and practical knowledge of French nurses.Materials and methods. - Epidemiological prospective study, type of practical studies in a declarative fashion, anonymous, made via computerized poll released on the website www.infirmiers.com.Results. - A total of 1254 registered nurses fulfilled the questionnaire. We observed a massive heterogeneity in different aspects of LTUC: local care and products used in them, urine bag change rhythm, lubrication of the catheter, respect of closed system, the rhythm of catheter change and in the management of blocked catheters. In total, 76% of nurses desire a theoretical and practical help for LTUC.Conclusion. - We found a great diversity of knowledge and practices in terms of LTUC. In total, 40.67% of nurses realized at least a technical error during catheterization. To standardize the management of LTUC, we propose to draft recommendations under the aegis of the French Association of Urology. This will allow a better education of students, and providing online available support. (C) 2016 Elsevier Masson SAS. All rights reserved.

La pose de ballonnets péri-urétraux proACT® est une alterantive mini-invasive au sphincter artificiel dans l’incontinence urinaire après prostatectomie. Evaluer à moyen terme l’efficacité des ballonnets proACT™®. Déterminer les facteurs prédicitifs de succès et d’échec du traitement. Évaluation rétrospective monocentrique, consécutive d’hommes traités pour une incontinence urinaire d’effort après prostatectomie par pose de ballonnets périuréthraux proACT® depuis mai 2006 jusqu’à décembre 2013. Nous avons comparé trois populations : prostatectomie seule, prostatectomie avec radiothérapie complémentaire, et antécédent de chirurgie de l’incontinence. Le succès était défini comme un pourcentage d’amélioration estimée par le patient supérieur à 80 % et le port d’une protection de sécurité au maximum. L’amélioration était définie par un pourcentage d’amélioration estimée par le patient supérieur à 50 % et une diminution du nombre de protections quotidiennes supérieure à 50 %. Le questionnaire USP était utilisé pour l’évaluation initiale et le suivi. Au total, 163 patients ont reçu cette technique. L’âge moyen était de 68,6 ans [67,6–69,6]. La durée moyenne de suivi était de 34,4 mois (± 3,7 mois). Respectivement, 16,56 % et 14,11 % des patients avaient eu de la radiothérapie et un antécédent de chirurgie d’incontinence. À terme, le taux de succès est de 38,85 % et le taux d’échec de 41,40 %. Le pourcentage d’amélioration estimée moyen était de 60,9 % [55,1–66,8]. Le nombre de protections quotidiennes final était de 1,7 [1,4–2,1], soit une diminution de 31,5 %. 17,8 % des patients ont été révisés. Trente-six patients ont eu recours à un sphincter avec un taux de succès de 91,5 %. La radiothérapie est un facteur associé à l’échec (p = 0,002). Le groupe succès avait un nombre de protections quotidiennes moins élevé que les autres groupes (2,1 vs 3,3 p < 0,001). À moyen terme, deux patients sur cinq étaient guéris et un sur cinq amélioré. La technique a une morbidité faible et une bonne tolérance. Le seuil de moins de trois protections quotidiennes semble être prédictif de succès et la radiothérapie semble être un facteur prédictif d’échec.

Recently, Moore et al. [2] built the STONE score, a 13-point scale including risk factors for uncomplicated ureteral stone. It encloses sex risk factors, origin, duration of pain to presentation, nausea, and haematuria. This score, built upon a large series, confirms the relevance of clinical examination (patient history and physical examination) when evaluating the risk of nephrolithiasis in order to choose the proper imaging method. Has the «likelihood of kidney stones» been calculated upon such a score or was it a subjective score written by the practitionists? The «likelihood of kidney stones» was of 50 % in 32.1 to 37.1 % of the patients over the three groups. It may be explained by the poor reliability of the symptoms used to include patients. Furthermore, this may explain the unusual description of the population, far from the nephrolithiasis populations (as an example a M:F sex ratio of 1:1 in this study, 2:1 in the nephrolithiasis populations [2]).

Objective. - Portal veinous thrombosis (VT) in the pancreatic transplant (6 to 20% of the cases) is the first cause of early loss of the transplant. Our objective was to identify the risk factors of VT in our experiment.Method. - The sample group includes 106 patients who underwent pancreas transplantation (portal venous drainage, enteric-drained pancreas) within our institute of transplantation from 2004 until 2010. We completed a portal vein extension graft in 25% of the cases. First of all, risk factors were selected from preoperative and operative data with an univariate analysis. We then carried out a multivariate analysis of these factors (binary logistic regression). The threshold P was 0.05.Results. - Sixteen patients (15%) showed a VT. Eight of them developed a total thrombosis and required a transplantectomy. Three risk factors of VT were isolated by the multivariate analysis: a BMI of the receiver > 25 kg/m(2) (Odds Ratio [OR] = 6.977), a portal vein extension graft (OR = 4.1) and an age of the donor > 45 years (OR = 4.432).Conclusions. - The knowledge of these risk factors of thrombosis allows the implementation of preventive measures (selection of the donor, nutritional support of the receiver in the registration if BMI > 25 kg/m(2)). The portal lengthening should be avoided by an attentive retrieval of the transplant (without shorter section of the portal vein). Nevertheless, the presence of one of these risk factors in a transplant patient should lead to start an antithrombotic treatment. (C) 2012 Elsevier Masson SAS. All rights reserved.

Purpose. - To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol.Patients and methods. - The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T3MRI PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR + core biopsy) were assessed by comparison to whole-mount step section pathology.Results. - 85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD) = 8.2%, Gleason sum score > 6 = 39.2%). A new exclusion criterion has been assessed: T3MRI +/- NPS > 1 as a predictor tool of significant tumor. ("T3MRI +/- NPS > 1" = Non OCD at MR number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI +/- NPS > 1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score > 6 rates (20%).Conclusion. - Endorectal MR at 1.5 Testa with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR +/- NSP > 1" may represent an exclusion citeria due to its ability to predict significant tumor. (C) 2010 Elsevier Masson SAS. All rights reserved.

Background: The artificial urinary sphincter (AUS) has become a commonly used therapy for severeurinary incontinence (UI) due to intrinsic sphincter deficiency (ISD).Objective: To evaluate retrospectively the efficacy and risk factors for failure and complications of AUS implantation in women with nonneurologic UI.Design, setting, and participants: From May 1987 to December 2009, 215 women with ISD were treated by AUS implantation, with a mean age of 62.8 yr and a mean follow-up of 6 yr (standard deviation: 5.6 yr). Previous surgical procedures to treat incontinence had been performed in 88.8% of the patients. Urodynamic assessment was required. Patients using only 0 or 1 pad at the end of follow-up were considered continent. The patient's level of satisfaction was evaluated by a global analogue scale and clinical interview.Intervention: All women had AUS implantation.Measurements: Patients were evaluated for continence rate, risk factors for failures, and complications.Results and limitations: At the end of follow-up, 158 patients (73.5%) were continent, and 170 (79%) were satisfied. The redo rate was 15.3% after a mean interval of 8.47 yr for the first redo procedure. Fifteen explantations (7%) were performed. The only risk factor for intraoperative complications (10.7%) was smoking (p < 0.004). Six patients (2.8%) were lost to follow-up. AUS failed to treat incontinence in 51 patients (23.7%) due to defective manipulation in 27.4% of the cases. On multivariate analysis, risk factors for failure were age > 70 yr (odds ratio [OR]: 2.46), a history of the Burch procedure (OR: 2.28), or pelvic radiotherapy (OR: 4.37) (p < 0.05).Conclusions: The place for this safe and long-lasting effective technique in the treatment of UI due to recurrent sphincter deficiency is confirmed. Screening for these risk factors should allow better patient selection. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Antopol-Goldman lesions are extremely rare. This kind of lesion is a subepithelial pelvic hematoma. This syndrome is certainly of rare occurrence and that is why a differential diagnosis of urothelial cancer in young patients who had problems with clotting must be raised. We reported a case of a 43-year-old haemophiliac with a severe congenital factor V deficit and presenting a bilateral and asynchronous Antopol Goldman syndrome. The diagnosis has been based on CT scans. The subepithelial aetiology bleeding has been shown on selective renal arteriography that allowed to cover a micro-aneurysm through the setting up of a vascular stent and a selective embolization. (C) 2009 Elsevier Masson SAS. All rights reserved.

Évaluation rétrospective des résultats de ballonnets périurétraux chez la femme et description d’un geste opératoire complémentaire : la rétrovision du col vésical par cystoscopie souple.

La técnica del trasplante renal no ha experimentado modificaciones significativas desde su descripción por Kuss en la década de 1950. En cambio, se ha extendido a pacientes con anomalías urológicas o que necesitan el trasplante de otro órgano, como el páncreas. Se han hecho necesarias determinadas adaptaciones técnicas. En este artículo, se describe la técnica básica y, a continuación, todas las variantes en función del receptor y de sus antecedentes quirúrgicos y también dependiendo del órgano trasplantado y de sus anomalías. En una época en la que los órganos para trasplantar son escasos y muy valiosos, es imprescindible conocer todas las posibilidades quirúrgicas con el fin de optimizar su utilización y evitar su pérdida.