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.

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.

Study Type – Therapy (multi‐centre retrospective cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Upper urinary tract urothelial carcinomas (UUT‐UCs) are rare tumours. Because of the aggressive pattern of UC, radical nephroureterectomy (RNU) with bladder cuff removal remains the ‘gold‐standard’ treatment. However, conservative strategies, such as segmental ureterectomy (SU) or endourological management, have also been developed in patients with imperative indications. Some teams are now advocating the use of conservative management more commonly in cases of elective indications of UUT‐UCs. Due to the paucity of cases of UUT‐UC, only limited data are available on the oncological outcomes afforded by conservative management.We retrospectively investigated the oncological outcomes after SU and RNU in a large multi‐institutional database. Overall, 52 patients were treated with SU and 416 with RNU. There was no statistical difference between the RNU and SU groups for the 5‐year probability of cancer‐specific survival, recurrence‐free survival and metastasis‐free survival. The type of surgery was not a significant prognostic factor in univariate analysis. The results were the same in a subgroup analysis of only unifocal tumours of the distal ureter with a diameter of <2 cm and of low stage (≤T2). Our results suggest that oncological outcomes after conservative treatment with SU are comparable to RNU for the management of UUT‐UC in select cases.OBJECTIVE To compare recurrence‐free survival (RFS), metastasis‐free survival (MFS) and cancer‐specific survival (CSS) after segmental ureterectomy (SU) vs radical nephroureterectomy (RNU) for urothelial carcinoma (UC) of the upper urinary tract (UUT‐UC) located in the ureter. PATIENTS AND METHODS We performed a multi‐institutional retrospective review of patients with UUT‐UC who had undergone RNU or SU between 1995 and 2010. Type of surgery, Tumour‐Node‐Metastasis status, tumour grade, lymphovascular invasion and positive surgical margin were tested as prognostic factors for survival. RESULTS In all, 52 patients were treated with SU and 416 with RNU. The median (range) follow‐up was 26 (10–48) months. The 5‐year probability of CSS, RFS and MFS for SU and RNU were 87.9% and 86.3%, respectively (P= 0.99); 37% and 47.9%, respectively (P= 0.48); 81.9% and 85.4%, respectively (P= 0.51). In univariable analysis, type of surgery (SU vs RNU) failed to affect CSS, RFS and MFS (P= 0.94, 0.42 and 0.53, respectively). In multivariable analyses, pT stage and pN stage achieved independent predictor status for CSS (P= 0.005 and 0.007, respectively); the positive surgical margin and pT stage were independent prognostic factors of RFS and MFS (P= 0.001, 0.04, 0.009 and 0.001, respectively). The main limitation of the study is its retrospective design, which is due to the rarity of the disease. CONCLUSIONS Short‐term oncological outcomes after conservative treatment with SU are comparable to RNU for the management of UUT‐UC in select cases and should be considered an option. In every other case, RNU still represents the ‘gold standard’ for the treatment of UUT‐UC.

Purpose. - To assess the association of soft tissue surgical margins (STSM) and/or lymph node metatstasis (pN+) with characteristics and outcomes of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).Materials and methods. - We retrospectively collected the data of 242 patients treated with RC and pelvic lymphadenectomy for UCB between January 2005 and June 2009. Different parameters were studied: age, PSAt, pathological stage of cystectomy specimen (PT and pN), tumor grade, number (nb) of nodes (N) in lymphadenectomy, nb of metastatic nodes (nb N+), bigger diameter of N+, ganglionic density, nb of N with capsular ruptur, associated CIS, associated prostate cancer, follow-up, global and specific survival, date and etiology of death.Results. - Positive STSM were identified in 22 patients (9.1%) and lymph node metastasis in 59 (24.4%). pN+ status was significantly associated with lower global (GS) and specific survival (SS) (P<0.003). So was it for patients with positive STSM R+ with actuarial 3-year GS and SS respectively of 5% and 25% versus 35% and 43.9% no STSM (P < 0.001).Conclusions. - Positive soft tissue surgical margin and/or lymph node metatstasis on cystectomy specimen is a strong predictor of GS and SS from urothelial carcinoma of the bladder. So it is for capsular rupture, ganglionic density greater or equal to 0.10 and nb of N in lymphadenectomy less than 14 for pN+ patients. (C) 2012 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.

Study Type – Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Upper urinary tract urothelial carcinoma (UUT‐UC) is a rare disease, usually treated by nephroureterectomy, occurring in a population with a median age of 70 years and with frequent tobacco use and other comorbidities. We know that the American Society of Anesthesiologists (ASA) score has prognostic value in urological oncology but this has not been assessed in UUT‐UC. Using a multi‐institutional French database, we have shown that the 5‐year cancer‐specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P = 0.01). ASA status had a significant impact on cancer‐specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients ( P = 0.04). OBJECTIVE To evaluate the impact of American Society of Anesthesiologists (ASA) scores on the survival of patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT‐UC). PATIENTS AND METHODS A retrospective multi‐institutional cohort study of the French collaborative national database of UUT‐UC treated by RNU in 20 centres from 1995 to 2010. The influence of age, gender and ASA score on survival was assessed using a univariable and multivariable Cox regression analysis with pathological features used as covariables. RESULTS Overall, 554 patients were included. The median follow‐up was 26 months (10–48 months), and the median age was 69.5 years (61–76 years). In total, 114 (20.6%) patients were classified as ASA 1, 326 (58.8%) as ASA 2 and 114 (20.6%) as ASA 3. The 5‐year recurrence‐free survival ( P = 0.21) and metastasis‐free survival ( P = 0.22) were not significantly different between ASA 1 (52.8% and 76%), ASA 2 (51.9% and 75.3%) and ASA 3 patients (44.1% and 68.2%, respectively). The 5‐year cancer‐specific survival differed significantly between ASA 1, ASA 2 and ASA 3 patients (83.8%, 76.9% and 70.6%, respectively; P = 0.01). ASA status had a significant impact on cancer‐specific survival in univariate and multivariate analyses, with a threefold higher risk of mortality at 5 years for ASA 3 compared with ASA 1 patients ( P = 0.04). CONCLUSIONS ASA classification correlates significantly with cancer‐specific survival after RNU for UUT‐UC. It is a further pre‐operative clinical variable that can be incorporated into future risk prediction tools for UUT‐UC to improve their accuracy.

To evaluate risk factors for bladder cancer recurrence in a cohort of patients treated with radical nephroureterectomy (RNU).At 10 Canadian University Centers, we retrospectively evaluated data, between 1990 and 2010, from 743 patients who were free from bladder cancer and were previously treated with RNU for upper tract urothelial cancer.Of 743 patients, 167 (22.5%) developed bladder tumors after a median time of 17.2 months after RNU. Multivariable analysis detected age (hazard ratio [HR] = 1.028; 95% CI: 1.010–1.046; P = 0.0018), tumor location in both the renal pelvis and the ureter (HR = 2.205; 95% CI: 1.355–3.589; P = 0.0015), the use of adjuvant systemic chemotherapy (HR = 2.309; 95% CI: 1.439–3.705; P = 0.0005), and laparoscopic surgery (HR = 1.876; 95% CI: 1.226–2.87; P = 0.0037) as risk factors for bladder cancer recurrence. Open excision of a bladder cuff (HR = 0.661; 95% CI: 0.453–0.965; P = 0.0319) and transurethral resection of the intramural ureter (HR = 0.548; 95% CI: 0.306–0.981; P = 0.0429) on comparison with extravesical resection decreased the risk of bladder cancer recurrence significantly. Major limitations were the retrospective design and partially missing data, although the significance of variables did not change in the imputation analysis.Older patients, those with tumor location in both the renal pelvis and the ureter, and those treated with adjuvant systemic chemotherapy were found at higher risk for intravesical recurrence, as were those having undergone extravesical ureterectomy or laparoscopic RNU.

The purpose of this study was to compare the postsurgical survival of UUT-UC patients treated with ONU and LNU.

Renal artery pseudoaneurysm (RAP) is a well-documented complication of percutaneous urologic procedures (biopsy, nephrostomy, nephrolithotomy) and renal trauma. Only few cases occurring after partial nephrectomy for cancer have been reported in the literature. We describe the case of one patient who presented with postoperative haemorrhage due to a RAP after partial nephrectomy. He has been successfully treated by angiographic selective embolization. This complication is rare but potentially life threatening. We describe its clinical and radiological diagnosis, and its management along with the current medical literature. (C) 2009 Elsevier Masson SAS. All rights reserved.

Cytoreductive nephrectomy is an established treatment option prior immunotherapy in well-selected patients with metastatic renal cell carcinoma. With the recent introduction of new targeted agents, the role of surgery has been source of controversy. This review examines the role of cytoreductive nephrectomy during the immunotherapy era, then in the new targeted therapies era. This review also summarizes the optimal timing of these treatments, the prognostic factors predicting outcome following cytoreductive nephrectomy, the role of metastasectomy, partial and laparoscopic cytoreductive nephrectomy. (c) 2010 Elsevier Masson SAS. All rights reserved.

Objectives. - To evaluate carcinologic outcomes and biologic recurrence (BR) factor after radical prostatectomy (RP) for high-risk (HR) prostate cancer.Material and methods. - Between 1996 and 2006, 81 consecutives RP (65 with standard lymphadenectomy) have been done by a single surgeon for HR cancer according to d'Amico classification. No patient received neo-adjuvant therapy. Minimum follow-up required was 2 years. The BR was defined by two consecutives PSA greater than 0.2 ng/ml. Forty patients required immediate adjuvant therapy. Thirty for patients required secondary therapy. A multivariate analysis have been done for the following factors: age at RP, TNM stage, pre- and postoperative PSA, Gleason score, number of positive core biopsy, number of HR factor, positive surgical margin and immediate adjuvant therapy.Results. - Mean age was 64 years. Median follow-up was 71 month. Forty-nine patients was pT3 (60.5%), seven was pN + (8.7%) and 40 had positive surgical margin (49.4%). The 5 years biological recurrence free survival rate was 42%. The Gleason score (p = 0.003, RR = 1.688, IC = 1.193-2.387), the preoperative PSA (p = 0.001, RR = 1.06, IC = 1.032-1.089) and the number of positive core biopsy (p = 0.006, RR = 5.316, IC = 1.605-17.607) were significant independent prognostic factors for the BR. The number of HR factor, positive surgical margin and immediate adjuvant therapy were not significant independent prognostic factors for the BR.Conclusions. - At 5 years, RP in HR prostate cancer allowed carcinologic control without BR in 34 patients (42%). This result was not influenced by the number of HR factor, surgical positive margin and immediate adjuvant therapy. (C) 2010 Elsevier Masson SAS. All rights reserved.

Objectives. - To evaluate the oncologicat and functional results in patients treated by conservative surgery for kidney cancer and to study the intraoperative and postoperative morbidity.Material and methods. - Retrospective, single-centre study based on 40 consecutive patients undergoing a conservative surgery for kidney cancer between March 1997 and July 2006. Patients had a mean age of 60 years (range: 26-81 years) and the surgical indication was elective in 75% of cases (n = 30) and mandatory in 25% of cases (n = 10). Preoperative mean creatinine and creatinine clearance were 101 mol/l (53-237 mol/l) and 80 ml/min (35-147 ml/min), respectively. Tumours were classified according to the TNM 2002 classification as stage T1a (75%), T1b (20%) and T2 (5%). Guided kidney aspiration biopsy was performed in 80% of patients. The main endpoints were positive surgical margins, local recurrence, intraoperative complications and postoperative renal function. Secondary endpoints were postoperative complications, need for blood transfusion, surgical revision, operating time and hospital stay, metastatic disease and overall and specific survival. Statistical analysis was performed with SPSS 13.0.1 soft-ware.Results. - With a mean follow-up of 44 months (range: 15-134 months), one patient (2.5%) presented local recurrence. The positive surgical margin rate was 5% and overall and specific survivals were 97.5%. No metastases have been observed. Serum creatinine was increased and creatinine clearance was significantly decreased (P<0.05) after the operation, with no clinical consequences. The urinary fistula rate was 5%, blood transfusion and surgical revision were required in 5% of cases respectively, the mean operating time was 128 minutes and the mean hospital stay was 8.1 days.Conclusion. - Mandatory, relative or elective conservative kidney surgery gives functional and oncological results at least equivalent to those of radical nephrectomy, with the advantage of nephron-sparing surgery. It should be suggested as first-line procedure whenever possible, even when the contralateral kidney is healthy. (C) 2008 Elsevier Masson SAS. Tous droits reserves.