Objectives. - Transcutaneous posterior tibial nerve stimulation (TC-PTNS) is a validated option for lower urinary tract symptoms (LUTS) management, with a short-term success rate of around 60% and few adverse events. Our goal was to report the efficacy and safety results of TC-PTNS using the newly issued device TENSI+ for LUTS management.Patients and methods. - A multicenter, retrospective study was conducted in 7 urology departments in France. All patients treated with TC-PTNS for LUTS using the TENSI+ device between September 2021 and February 2022 were included. All patients received supervised at-home training by a specialized nurse. All patients were asked to do daily, 20 minutes sessions of TC-PTNS. Patient demographics, history, initial symptoms and previous treatment were collected at inclusion. A follow-up visit was scheduled at 3 months. Efficacy was evaluated through treatment persistence at 3 months and PGI-I (Patient Global Impression of Improvement) score. Adverse events were recorded.Results. - One hundred and three patients (86 women and 17 men) were included. All patients had overactive bladder symptoms, 64 suffered from urgency incontinence, and 24 had asso-ciated voiding symptoms. Eighteen patients had neurogenic background, and 30 previously received anticholinergics. After a median follow-up of 12 [10-21] weeks, 70 patients were still using the device (68%). PGI-I score reflected an improvement in 70.9% and was 1, 2 and 3 in 28, 26 and 19 patients respectively, while 24 were unchanged and 6 were worse. No clinical baseline parameter was predictive of success. Adverse events included pain at stimulation site (two cases) and pelvic pain (two patients), which rapidly resolved after treatment interruption.Conclusions. - TC-PTNS with TENSI+ device is an effective option for LUTS management, with results that seem similar to other TC-PTNS approaches. Adverse events were mild and reversible after treatment interruption.Level of evidence.- 4 (c) 2023 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Multidisciplinary team meetings (MTMs) in the field of pelvic floor diseases in women tend to generalize, as they are required as mandatory before mid-urethral sling implantation or sacrocolpopexy by recent decrees published by the French health authorities. However, access to these meetings is variable in the French territory. The goal of the present study was to describe the existence and the settings of these kinds of meetings in France. MATERIEL AND METHODS:An on-line survey was conducted between June and July 2020 (stage 1) then between November 2021 and January 2022 (stage 2). A 15-item questionnaire was sent to all members of the Association française d'urologie (AFU). A descriptive analysis was conducted. RESULTS:Three hundred and twenty-two completed questionnaires were sent back during stage 1 and 158 during stage 2. Early 2022, 61.3% of respondents had access to a pelviperineology MTM, with important difference according to geographical areas. Main activity of MTMs was case discussion of complex situations (68% of meetings). At the end of 2021, 22% of the respondents declared willing to stop partially or totally their pelviperineology activity, given the new regulations set in place by the authorities. CONCLUSION:Despite being absolutely mandatory in current clinical practice, MTMs in pelvic floor disease have spread slowly. MTMs implementation was still insufficient in 2022, and variable on the French territory. Some urologists declare having no access to such resources and about 1 out of 5 were considering to voluntary stop of decrease significantly their activity in this difficult context. LEVEL OF EVIDENCE: 4:

INTRODUCTION:Inflammatory and sensory chronic bladder diseases have a significant impact on quality of life. These pathologies share alteration of the layer between urine and urothelium, making the use of topical agents appropriate. OBJECTIVES:Review the efficacy and tolerance of intravesical treatments for these pathologies. Give practical guidelines for the use of agents currently available in France. METHOD:A narrative review was performed in March 2021 using PubMed/MEDLINE, Google Scholar and the international guidelines. Pharmaceutical companies and pharmacies were interviewed. RESULTS:Although numerous molecules were tested over the last 5 decades, only dimethylsulfoxyde and glycosaminoglycans are available in France today. Results are promising: response rates are up to 95% and 84% respectively in bladder pain syndrome. In urinary tract infections, glycosaminoglycans could decrease annual number of cystitis by 2.56 (95% confidence interval (CI) -3.86, -1.26; P<0.001) and increase the time to first cystitis recurrence by 130 days (95% CI: 5.84 - 254.26; P=0.04). In radiation cystitis, results could be comparable to hyperbaric oxygen regarding pain and frequency of voiding (-1.31±1.3 visual analogic scale et -1.5±1.4 voiding per day, respectively, at 12 months, P<0.01). However, literature has a low level of evidence. CONCLUSION:Chronic bladder diseases have limited treatment options. Intravesical agents are a good alternative, although their cost is significant and their outcome uncertain.

IntroductionLes cystopathies chroniques inflammatoires et douloureuses sont des pathologies impactant lourdement la qualité de vie des patients qui en sont atteints. Bien qu’avec des physiopathologies différentes, les cystopathies chroniques ont en commun une altération de la couche, faisant interface entre l’urine et l’urothélium, rendant appropriée l’utilisation d’agents topiques.ObjectifsFaire une revue de l’efficacité et de la tolérance des traitements endovésicaux pour ces pathologies, ainsi qu’un guide pratique pour l’utilisation des molécules actuellement disponibles sur le marché français.MéthodeUne revue narrative de la littérature a été effectuée en mars 2021 sur PubMed/MEDLINE et Google Scholar, ainsi qu’une revue des recommandations françaises et internationales. Les laboratoires et pharmacies ont été interrogés.RésultatsDe nombreuses molécules ont été essayées au cours des 50 dernières années, mais ne sont disponibles, actuellement, que le diméthylsulfoxyde et les glycosaminoglycanes. Les résultats en sont prometteurs : leurs taux d’amélioration des douleurs vont jusqu’à 95 % et 84 % de réponse, respectivement dans le syndrome douloureux vésical. Dans les cystites bactériennes, les glycosaminoglycanes permettent de réduire le nombre moyen annuel de cystites de 2,56 (intervalle de confiance (IC) à 95 % −3,86 – −1,26 ; p<0,001), avec une augmentation du délai avant récidive de 130 jours (IC à 95 % : 5,84–254,26 ; p=0,04). Dans la cystite radique, ils ont montré des résultats comparables à l’oxygénothérapie hyperbare sur l’amélioration de la douleur et de la pollakiurie (−1,31±1,3 points sur l’échelle EVA et −1,5±1,4 mictions par jour respectivement, à 12 mois, p<0,01). La littérature reste cependant à faible niveau de preuve.ConclusionLes cystopathies chroniques ont des options de traitement limitées. Les instillations endovésicales sont une option de traitement à ne pas négliger avec, pour limite, un coût non négligeable pour un résultat incertain.

Radical Prostatectomy (RP) remains a standard and effective treatment option for localized prostate cancer [1]. The benefit of this treatment depends on the clinical and pathological characteristics of the cancer and on comorbidity. Several studies have concluded that comorbidity conditions are an important predictor of post-RP survival [2,3]. Tools for quantifying comorbidity include life tables, comorbidity indices and nomograms. These facilitate patient counseling and estimation of life expectancy prior to choosing RP [4,5]. Although there is no consensus on which comorbidity tool is the most useful, the Charlson Comorbidity Index (CCI) is one of the most extensively studied in the case of prostate cancer. Introduced in 1989 by Mary Charlson and colleagues, the CCI was built from 1-year analyses of mortality in association with comorbidity in patients hospitalized in an internal medicine ward. Further validation focused on cancer patients, first in breast cancer cohorts with 10 years of follow-up [3,4,6]. The CCI is now validated for a wide range of clinical conditions, such as amputation, arthritis and cancer [7]. In prostate cancer patients, comorbidity has been shown to predict mortality due to other causes but not prostate cancer-specific mortality [8,9]. However, these studies were focused on only the first 10 years after RP. To the best of our knowledge, no study has examined the long-term (>10 years) predictive ability of CCI in this context. Meanwhile, current prostate cancer guidelines continue to claim that life expectancy following curative treatment for localized tumors should be greater than 10 years to consider treatment with curative intent [10]. It therefore appears necessary to assess the time effect on the capacity of the CCI measurement at surgery to predict patient’s survival and to evaluate the impact of baseline comorbidity Abstract Objectives: To validate the Charlson Comorbidity Index (CCI) in prostate cancer and to assess the impact of comorbidity on survival, both beyond 10 years following Radical Prostatectomy (RP).

In a previous work, we showed that IL-6 serum levels and tobacco consumption were two independent predictors of second primary cancers (SPC) in head and neck cancer (HNC) patients. The objectives of this study were to assess 1) whether tobacco exposure was a determinant of IL-6 serum levels, and 2) whether the effect of tobacco on the occurrence of SPC was partly mediated by IL-6. This study was conducted as part of a multicenter, randomized, controlled trial evaluating the effect of antioxidants in the prevention of SPC in 540 HNC patients with stages I-II. IL-6 was measured in 527 pretreatment serum samples using chemiluminescent immunometric assays. Current and lifetime exposure to tobacco products were assessed using a structured questionnaire. Tobacco consumption during the year preceding the randomization was used for the main analyses. For objective 1, IL-6 was log-transformed and multivariate linear regressions were used. In addition, tests for linear trend were done to verify that IL-6 levels increased with cumulative past exposures of cigarette consumption. For objective 2, the excess relative risks (ERR= relative risk-1) were calculated using a particular case of the parametric g-formula for estimating the direct effect and the indirect effect via the IL-6 pathway of tobacco consumption on the 5-year risk of SPC. In the 527 HNC patients, the 5-year risk of SPC was 21.0% (95% CI=17.0%-24.8%). The median of IL-6 serum level was 3.1 ng/L (interquartile range: 2.2-4.4 ng/L) and 63.4% of the HNC patients consumed tobacco during the previous year. Compared to non-users, those who consumed tobacco during the previous year had a relative increase of 73% of their risk of SPC (95% CI: 15.1-172.5%). Tobacco users in the previous year had higher IL-6 serum levels than those who did not consumed tobacco (adjusted β (SE): 0.19 (0.06), P-value=.002). In addition, analyses conducted among cigarette smokers showed that IL-6 serum levels increased with longer durations of cigarette smoking (P-value for trend=.03) and with the number of pack-years consumed (P-value for trend=.04). ERRs associated with the direct and indirect effects of tobacco use on SPC were respectively 59.8% (95% CI: 6.8%; 151.9%) and 13.1% (95%CI: 3.8%, 31.5%). The indirect effect of tobacco consumption via the IL-6 pathway contributed to 18% of the total effect of tobacco on the occurrence of SPC. Tobacco is a determinant of serum IL-6 levels, a strong predictor of SPC in HNC patients. Although modest, a statistically significant part of the effect of tobacco on the occurrence of SPC appears to be mediated by IL-6. This suggests that the effect of tobacco on the occurrence of SPC is also mediated by an inflammatory process.

BACKGROUND:Circulating interleukin-6 (IL-6) improves outcome prediction for second primary cancer (SPC) in head and neck cancer (HNC) patients. This study aimed to identify factors associated with IL-6 serum levels in HNC patients.METHODS:This study was conducted as part of a phase III chemoprevention trial. IL-6 was measured using chemiluminescent immunometric assay on pretreatment serum sample obtained from 527 stage I-II HNC patients. Patients' lifestyle habits, sociodemographic, medical and tumor characteristics were evaluated before radiation therapy (RT). Factors independently associated with IL-6 levels before RT were identified using multiple linear regression.RESULTS:The median IL-6 serum level was 3.1 ng/L. In the multivariate analysis, eight factors were significantly associated (p < 0.05) with IL-6: age, gender, marital status, body mass index, tobacco consumption, comorbidities, Karnofsky Performance Status and HNC site. Smoking duration and lifetime pack-years were positively associated with IL-6 serum levels in a dose-response relationship (p-value for trend ≤0.03).CONCLUSIONS:Circulating IL-6 is a strong predictor of the occurrence of SPC in HNC patients. We identified eight factors independently associated with serum IL-6 levels in 527 stage I-II HNC patients.The dose-response relationship between lifetime smoking and IL-6 serum levels suggested a causal role of tobacco exposure on IL-6 production. Further studies are needed to establish whether the effect of tobacco exposure on SPC could be partly mediated by IL-6, a pro-inflammatory cytokine.

Purpose: This study investigated the role that variables related to children and their environment play in the prediction of outcomes at 4 years of age for children with a language delay at 2 years. Method: A longitudinal study was undertaken where 64 children (45 boys, 19 girls; mean age = 53.3 months; SD = 4.4) with language delay at age 2 years were re-evaluated at age 4 years. Three developmental trajectories were analysed. Result: The early stages of grammar, as estimated by mean length of utterance at 3.5 years, are an important prognosis factor of subsequent language impairment (LI). Children who are exposed to several risk factors simultaneously are more likely to have a language delay (LD) or a LI, but the profile of LD children is more akin to that of the typically developing (TD) children. Children with LI tend to have profiles with a greater number of risk factors. Conclusion: The results of this study encourage different intervention approaches depending on the child's language profile at 2 years, due to differing language prognosis. The results also point to the need to assess the child's environment. Future studies with large diverse population samples may give more precise information on potential risk factors and their cumulative effect.

En cas de récidive locale post-radiothérapie (RLPR), la place des traitements ablatifs comme la cryothérapie reste peu évaluée. L’objectif de cette étude était de décrire les résultats opératoires et oncologiques à court terme de la cryothérapie en cas de RLPR. Tous les patients traités par cryothérapie prostatique totale ou focale pour une récidive locale après radiothérapie ou curiethérapie pour cancer de la prostate entre 2011 et 2016 dans un centre ont été inclus rétrospectivement. Toutes les RLPR ont été confirmées par mesure du PSA, biopsies prostatiques, IRM et PET à la choline. L’évaluation était clinicobiologique à M1, M3, M6 et 1 an. Les critères de jugement de l’efficacité du traitement étaient le PSA, l’introduction d’une hormonothérapie et la progression clinique. Dix-neuf hommes de 70 ans en moyenne ont été inclus : 16 (84,2 %) traité par radiothérapie, 3 (15,8 %) par curiethérapie. Le délai moyen de prise en charge après traitement initial était de 93,83 mois. Le PSA médian avant cryothérapie était de 5,27 ng/mL. Le PSA médian à 1, 3, 6, 12 mois post-cryothérapie était respectivement de 2, 0,63, 1,24 et 2,32 ng/mL. La durée moyenne d’hospitalisation était de 1,58 jours. Quatre patients (21 %) ont présenté une complication Clavien 2 (RAU) lors de l’hospitalisation. À un an, il existait 3 complications tardives (16 %) (2 incontinences urinaires sévères, 1 sténose urétrale). Quatre patients (21 %) présentaient des signes irritatifs invalidants à 1 an. Le taux de récidive biologique et d’évolution clinique à 1 an était de 15,8 % (3 patients) et 26,3 % (5 patients), respectivement. Au total, 8 patients (42 %) ont été mis sous hormonothérapie depuis la cryothérapie. La cryothérapie prostatique est faisable, avec des résultats opératoires satisfaisants mais au prix d’un taux significatif de complications tardives. Le taux de complications semble inférieur pour les cryothérapies focales par rapport aux totales. Plus d’un patient sur deux n’ont pas présenté de reprise évolutive à 1 an.

e17560 Background: The hearing loss due to cisplatin cochlear damage is frequent and severe. Antioxidants, such as sodium thiosulfate (STS), can neutralize the effects of cisplatin, but, when administered systemically, they decrease its efficacy. In animal experiments, STS deposited in the middle ear reached the cochlea and reduced cisplatin ototoxicity. We conducted a randomized controlled trial to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity. Methods: Eligible participants were patients with symmetrical hearing treated for a locally advanced head and neck cancer with chemoradiation including 3 cisplatin cycles (100 mg/m 2 ). For each participant, one randomly selected ear received the injections while the other ear did not. On the eve of each cisplatin treatment, a trans-tympanic injection deposited 0.1 ml of an immediately prepared STS-hyaluronate gel (0.5 M) on the round window. The main outcome was assessed blindly using the shift of hearing threshold in decibels (dB) from before chemoradiation to one month thereafter for pure-tone air conduction at 0.5-14 kHz frequencies. Adverse effects were noted according to CTCAE. Assuming a lower hearing loss of 7.0 dB for the treated ears, 0.90 power and 0.05 two-sided statistical significance, 25 patients were needed. The main outcome was assessed in a mixed linear model with hearing threshold shift as dependent variable and intervention, frequency and radiation dose to the cochlea as independent variables. Results: From January to December 2015, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.5 dB less for the treated ears than for the control ears. The difference was not statistically (p = 0.56) nor clinically significant, but was consistently in favor of the treated ears for all frequencies between 3 and 10 kHz. The intervention adverse effects were mild. Conclusions: Our trial suggests that STS deposited in the middle ear reached the cochlea but was not clinically effective. More work is needed to improve the efficacy of trans-tympanic administration of cisplatin antidotes. Clinical trial information: NTC02281006.

Background: Carcinomas of the oral cavity, pharynx and larynx are referred to as head and neck cancers (HNC); together they account for 2-3% of all newly diagnosed cancers in North America. Between 40-50% of HNC are early diagnosed at stages I-II. The 5-year and 10-year relative survival rates are 61% and 50%, respectively. Germline genetic sequence variants (GSV) have become increasingly found to have prognostic implications in a variety of cancers. Identifying these variants may have important clinical and biological implications.Methods: We conducted a genome-wide association study (GWAS) in 531 Stage I-II radiation-treated HNC patients (originally recruited for alpha-tocopherol/beta-carotene placebo-controlled secondary prevention study) and used a replication cohort of 566 HNC patients of all stages, of mostly non-HPV-related cancers. Survival rates were estimated by the Kaplan-Meier method. Cox proportional hazards models adjusted for potential clinical factors and principal components were used to test for associations between the GSV and overall survival (OS) in these tumors.Results: The median follow-up time for OS was 9.21 years (GWAS cohort) and 2.37 years (replication cohort). In both cohorts, CACNA2D1: rs2299187, ESRRG: rs946465 and ESRRG: rs1416612 were each individually significantly associated with survival. In silico analysis of ESRRG: rs946465 identifies that it produces a splice variant in ESRRG. Variant alleles of CACNA2D1: rs2299187 and ESRRG: rs946465 were associated with higher expression of the corresponding protein.Conclusions: Putatively functional polymorphisms in the MAP-Kinase and estrogen pathways, identified through GWAS and replicated in an independent dataset were associated with the survival of HNC patients. (C) 2016 Elsevier Ltd. All rights reserved.

Men with Prostate volume greater than 50 mL often need cytoreductive therapy prior to permanent implant prostate brachytherapy (PIPB) for low-risk or low-tier intermediate-risk prostate cancer. Luteinizing hormone-releasing hormone (LHRH) agonists offer an effective cytoreduction with known blood testosterone level reduction and sexual function alteration. The objective of this study was to determine if a non-LHRH agonist cytoreductive therapy could cause less sexual and hormonal perturbation after a 3-month treatment prior to PIPB. Randomization was done between LHRH agonist (3-month dose) with bicalutamide daily for 1 month (LHRH group) versus dutasteride 0.5 mg, bicalutamide 50 mg, and tamoxifen 10 mg daily for 3 months (D+B group). Prostate-specific antigen (PSA), testosterone, and Sexual Health Inventory for Men, International Prostate Symptom Score, and EPIC questionnaires were completed at baseline, preimplant, and at 1, 3, 6, 12, 18, and 24 months posttreatment. Fifty-eight patients were analyzed (29 in each arm). Age, stage, Gleason score, PSA, and D'Amico's risk grouping were evenly distributed in the groups. The LHRH agonist group produced a steeper PSA reduction from the start of therapy up to 6 months (See table 1). The D+B group reached PSA level drop to a no longer statistically significant difference between treatment groups at 12 months and over. The blood testosterone levels were increase from baseline levels and kept significantly higher in the D+B group up to 3 months after brachytherapy. The EPIC score dropped in each cohort, but was kept significantly higher in the D+B group at 6 weeks and 3 months following brachytherapy. D+B for prostate volume reduction provides a different PSA dynamic than LHRH agonists after PIPB. It also allows a lesser alteration of testosterone homeostasis while keeping a better sexual function score post-PIPB.Oral Scientific Abstracts 281; Table 1Comparative mean PSA and testosterone over time per treatment group (t test).Time (months):0Pre-implant136121824Mean PSA LHRH6.730.790.710.420.400.450.450.42 D+B7.191.782.921.511.010.620.540.54 P value.59<.001<.001<.001<.001.08.32.61Mean testosterone LHRH12.941.996.6010.1614.4414.7414.6416.50 D+B12.3128.0717.4415.2716.0513.8114.9414.00 P value.53<.001.02.01.34.52.81.60 Open table in a new tab

OBJECTIVE:To determine the efficacy and toxicity of a 3-month regimen of Dutasteride and Bicalutamide compared to LHRH agonists for prostate volume (PV) reduction prior to permanent implant prostate brachytherapy (PIPB).MATERIAL AND METHODS:Patients with low-risk or low-tier intermediate risk prostate cancer eligible for PIPB with a prostate volume greater than 50 cc were randomized to either Dutasteride 0.5 mg Bicalutamide 50 mg daily and Tamoxifen 10 mg daily for 3 months (D+B group) or to a 3 month dose of an LHRH agonist and Bicalutamide daily for 1 month (LHRH group). Their PV was measured at baseline and at pre-implant. Non-inferiority analysis was completed for the relative (%) PV reduction. IPSS and EPIC questionnaires were completed at baseline, pre-implant and at 1, 3, 6, 12, 18 and 24 months post-treatment. IPSS and EPIC comparisons were based on superiority analysisRESULTS:60 patients were randomized (31 to LHRH group and 29 to D+B group). Mean relative PV reduction (SD) was 35.5% (8.9) in the LHRH group and 31.7% (9.6) in the D+B group. The upper bound of the 95% confidence for the interval for the difference between groups favouring LHRH agonists for PV reduction was 8.6 which did not cross the 10% non-inferiority margin meaning D+B is non-inferior to LHRH agonist for PV reduction, although 5/29 (17%) of those in the D+B group required longer duration of D+B to achieve adequate volume reduction. There were no statistically significant differences in IPSS scores over the entire follow-up period. EPIC sexual summary score was significantly better in the D+B group at pre-implant, 1 month, 3 months post-implant.CONCLUSION:Dutasteride and Bicalutamide is a regimen of non-inferior efficacy to LHRH agonist based regimens for prostate volume reduction prior to permanent implant prostate brachytherapy. D+B has less sexual toxicity compared to LHRH agonists prior to implant and for the first 6 months after implant. D+B is therefore an option to be considered for prostate volume reduction prior to PIPB.

A general method to create adjusted survival trees is developed. Prognostic survival trees have been used to automatically uncover complicated GxG and GxE interactions, however scientist soften want to uncover this structure while adjusting for confounding factors not of interest. Interaction survival trees automatically identify the best treatment choice for patients and area promising model to enable personalized medicine, but simulations to assess their performance on the high dimensional data found in personalized medicine have not been conducted. We develop a general framework to adjust for confounding factors in prognostic and interaction survival trees. These factors are numerous in practice and can include age, gender, study site in a randomized multicenter clinical trial, and the principal components of ancestry difference to control for population stratification in genetic studies. Extensive simulations show the performance of our methods to be well controlled under the null and are robust to large dimensional covariate spaces under the alternative. In a real data example, our adjusted interaction tree successfully identifies subgroups of head and neck cancer patients that respond positively to having antioxidant vitamins added to their treatment regime. Applications, guidelines for use, and areas for future research are discussed.

Introduction. - The French Association of Urologists-in-training (AFUF) aimed to assess the current state of remunerations of on-call and on-duty residents, assistants and lecturers in urology in France.Material and methods. - Data were collected from February to May 2013 through a questionnaire sent to all members of the AFUF (327 members). Remunerations were given in gross values.Results. - Forty-three residents took part in the study, 16 assistants and 16 lecturers, representing 62% of the whole centers (54 hospitals out of the 92 centers practicing urology in France). Most of responders were on security or operational on-call. Twenty hospitals were practicing multi-organ removal. Median remunerations of residents were about 59.51 (sic) per on-call when moving at hospital for work and about 119.02 (sic) per onsite duty. Assistants and lecturers were paid a flat fee rate for 37.5% of them (140 (sic) for assistants [with variability from 40 to 195 (sic)] and 130 (sic) for lecturers [42.5-180]) or an hourly rate depending on the hours spent at hospital for the others (62.5%): first, second move or move < 3 h were paid 100 for assistants and 65 (sic) for lecturers, 233.5 (sic) and 236 (sic) respectively for the third one or above 3 h, 365 (sic) and 473 (sic) respectively above 8 h. Multi-organ removals were paid a flat fee rate (60%) or an hourly rate (40%) as well. Beyond a threshold of 2-3 hours, the hourly rate was more interesting than the flat fee rate.Conclusion. - There were disparities in remuneration of on-call and on-duty urologists. Greater variability affected on-call flat fee rate remuneration beyond a certain threshold of hours and remuneration of multi-organ removal. These disparities should be considered in order to get a national harmonization. (C) 2013 Published by Elsevier Masson SAS.