La dérivation transiléale non continente après cystectomie, l'un des traitements du cancer vésical, est réalisée selon deux principales techniques d'anastomose urétéro-iléales : le Wallace et l'anastomose urétéro-iléale séparée (AUIS). Parmi ses complications tardives, la sténose anastomotique n'est pas rare, et parfois pourvoyeuse de réhospitalisations itératives voire de réinterventions chirurgicales. Notre étude vise à comparer la prévalence de sténoses anastomotiques bénignes (SAB) selon la technique utilisée. Nous avons inclus rétrospectivement 241 patients traités par cystectomie radicale pour tumeur vésicale avec dérivation transiléale non continente, réalisées entre janvier 2015 et décembre 2021, dans 3 centres. Le critère de jugement principal était l'évènement SAB, défini par une dilatation urétéro-pyélocalicielle en amont de l'anastomose, sans argument histologique pour une récidive tumorale, avec indication clinique à un drainage des excrétrices supérieures, ou avec élément objectif d'obstruction (scintigraphie MAG3, rein détruit au scanner). Nous avons recueilli la technique chirurgicale, les principales comorbidités et antécédents, le statut anatomopathologique, la fonction rénale pré et postopératoire, les complications postopératoires précoces et tardives. Parmi les 241 patients, l'anastomose a été réalisée chez 114 patients selon Wallace (47,3 %) et chez 127 patients en AUIS (52,7 %). La durée moyenne de suivi était de 3 ans. L'âge médian était de 66 ans [60;73] ; l'IMC moyen était à 26,5. Cinquante-six patients (23 %) étaient artériopathes ; 48 patients (20 %) étaient diabétiques ; 70 (29 %) avaient un antécédent de chirurgie abdominopelvienne ; 14 patients (5,8 %) présentaient un antécédent de radiothérapie abdominopelvienne. Les groupes Wallace et AUIS incluaient respectivement 217 et 252 unités rénales. Nous avons observé 43 (19,8 %) unités rénales atteintes de SAB dans le groupe Wallace versus 24 (9,5 %) dans le groupe AUIS (p = 0,001). Au total, le diagnostic de SAB a été posé chez 27 (23,7 %) patients du groupe Wallace versus 17 (13,4 %) patients du groupe AUIS (p = 0,039). Notre étude monte que l'AUIS est moins pourvoyeuse de SAB que l'anastomose selon Wallace, avec une significativité plus marquée lorsqu'on analyse chaque unité rénale séparément. D'autres facteurs techniques, notamment la réalisation de points séparés plutôt qu'un surjet, ou encore le fil utilisé pour l'anastomose, tendent à avoir un impact sur la survenue de SAB, bien que non significatif.

Introduction. - The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021. Materials and methods. - This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation. Results. - Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors. Conclusion. - The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future. Level of evidence. - 4. & COPY; 2023 Elsevier Masson SAS. All rights reserved.

BACKGROUND:With an increasing prevalence in industrialized countries, lithiasis represents a public health problem with significant economic cost. Ureteroscopy is nowadays the main treatment for kidney and ureteral stones with increasingly broad indications. While this treatment is relatively safe and effective, the complications can be severe.AIM:The aim of this study was to investigate the preoperative risk factors of complication in the 30 days following a rigid or flexible ureteroscopy in a large cohort of patients.METHODS:A retrospective multicenter study was conducted in 5 French centers between January 1st 2017 and 31st December 2018. All flexible and rigid ureteroscopies performed were included. All preoperative and per operative data were collected in an electronic database. Outcomes and complications within 30 days of the procedure were also collected. Univariate and multivariable analyses evaluated for potential predictors of postoperative complications.RESULTS:1124 procedures were included. According to the occurrence of a postoperative complication, patients were divided into two groups, 109 in the group with complications. The majority of complications were minor, with only 13.7% classified as Clavien 3-4. In univariate analysis, ASA score>2 (odd ratio, OR=1.68, P=0.04), WHO performance status≥1 (OR=1.50, P=0.04) and neurologic disease (OR=2.78, P=0.005) were predictors of postoperative complications. In multivariable analysis, Charlson's score (OR=0.79, P=0.01) and ASA score>2 (OR=1.48, P=0.03) were independents risk factors of postoperative complication. Concerning major complications, in univariate analysis, cardiovascular disease (OR=3.71, P=0.032) and BMI (OR=0.87, P=0.02) were the only predictors of major complications after ureteroscopy. Only BMI was found In multivariable analysis (OR=0.86, P=0.01) CONCLUSION: Baseline characteristics and comorbidities of the patients, especially neurological diseases, were the main risk factors for short-term complications after ureteroscopy. Ureteroscopy remains a relatively safe and effective procedure. However, we advise surgeons to take precautions with fragile patients with multiple comorbidities or neurological disease.LEVEL OF EVIDENCE: 4:

INTRODUCTION:The aim was to assess the risk of postoperative infections in patients with preoperative polymicrobial urine culture and to provide the urologist with practices to minimise the risk of infection in these clinical situations. METHODS:A systematic literature review was carried. All national and international recommendations have been reviewed. Data collection has been performed from the Cochrane, LILACS and the Medline database. 31 publications were selected for inclusion. RESULTS:Risk of infection in patients without ureteral stents or urinary catheters with previous polymicrobial urine culture is low. In the absence of leukocyturia, the urine sample can be considered as sterile. With ureteral stents or urinary catheters, the colonisation by biofilm ranges from 4 to 100% depending on the duration and ureteral stents or urinary catheters type. Urine culture is positive 24 to 45% of the time when ureteral stents or urinary catheters are known to be colonised. The post-operative risk of infection in endo-urological surgery in a patient with ureteral stents or urinary catheters is estimated around 8 to 11% depending on the type of surgery. A retrospective study reports a postoperative infections rate of 18.5% in photo selective vaporization of the prostate with preoperative polymicrobial urine culture. CONCLUSIONS:Scientific data are limited but for patients without ureteral stents or urinary catheters, in the absence of leukocyturia, the polymicrobial urine culture can be considered as negative. Considering a preoperative polymicrobial urine culture as sterile in patients with colonised ureteral stents or urinary catheters is at risk of neglecting a high risk of postoperative infections or sepsis even in case of perioperative antibiotic prophylaxis. It should not always be considered sterile and therefore, a perioperative antibiotic therapy could be an acceptable option.

Évaluer les résultats carcinologiques et fonctionnels du traitement par HIFU des adénocarcinomes prostatiques localisés (CaP) à un seul lobe. Étude prospective non randomisée. Les critères d’inclusion principaux ont été : consentement éclairé, CaP localisé à un seul lobe (IRM + biopsies randomisées + biopsies ciblées), T1C ou T2A, PSA ≤ 15, SG ≤ 7 (3 + 4), M0, distance tumeur-apex < 5 mm. Le traitement du seul lobe pathologique a été réalisé avec l’appareil AblathermR (Edap TMS, Vaux-en-Velin, France). Un geste endoscopique était autorisé en cas de dysurie ou de volume prostatique supérieur à 50 cm3. Tous les patients ont été évalués à un an (PSA, IRM, biopsies, questionnaires) puis suivis. Au total, 110 patients traités dans 10 centres, âge 65 ± 6 ans, PSA moyen 5,53 ng/mL, volume prostatique 45 ± 21 cm3, SG ≤ 6 (74 cas) et 7 (26 cas). PBP positives par patient : 2,1, longueur maximum envahie moyenne 3,3 mm. Volume moyen traité : 17 cm3. Suivi moyen : 27 mois. PSA nadir moyen : 2 ± 1,5 ng/mL. Cent un patients biopsiés à un an : 14 positives dans le lobe traité, 19 dans le lobe controlatéral. Le taux de cancer résiduel significatif (>3 mm et/ou SG 7) était de 5 % côté traité et 7 % en controlatéral. Le taux de survie sans traitement radical à 24 mois est de 89 %. Trois patients ont une incontinence grade 1. Le score IIEF5 moyen a varié de 17,4 pré-HIFU à 16,6 post-HIFU. Le traitement par hémi-ablation HIFU est faisable avec des effets secondaires très modérés. Les traitements radicaux de rattrapage n’ont concerné que 12/110 patients (11 %) avec un recul de plus de 2 ans.

Rapporter les résultats fonctionnels et oncologiques préliminaires du traitement HIFU limité à un seul lobe (hémi-ablation) chez des patients présentant un cancer de prostate en première intention. Étude multicentrique (13 centres français), AFU promoteur. Critère d’inclusion : patient d’âge > 50 ans, stade T1c ou T2a, PSA < 10 ng/ml, IRM multiparametrique, 12 biopsies randomisées + 2 biopsies par cibles IRM, score de Gleason ≤ 7 (3 + 4), REUP possible, biopsies de contrôle à 6 ou 12mois. Traitement : Hémi-ablation par Ablatherm®. Treize centres, 110 patients, âge : 64,8 ans [50–78 ans], PSA : 5,42 ± 3, volume prostatique 38,9 ± 16,8, nombre de biopsies positives : 2,06/patient (Gleason 6 : 71 % et Gleason 7 : 29 %). Résections concomitantes : 55,4 %. À un an, diminution du PSA de 44,6 %, du volume de 26,3 % et de l’IPSS de 27,2 %. Biopsies de contrôle (91 patients, entre 6 et 12 mois) : 87 % de biopsies négatives dans le lobe traité (ensemble de la prostate, 65,9 %). Trente biopsies positives : 25 Gleason 6 et 5 Gleason 7 (3 + 4). Patients avec biopsies positives : 18 surveillances active, 10 : 2e session HIFU, 4 PR robot et 4 radiothérapies. Aucun patient n’est sous hormonothérapie. À un an, 84,5 % des patients sans traitement radical. Taux d’incontinence : 1,8 %. Le taux d’IIEF-5 ≥ 17 à un an est de 75 % (53 patients). Le traitement par hemi-ablation HIFU est faisable avec des effets secondaires très modérés. Le pourcentage de biopsies négatives dans le lobe traité à un an était de 87 %. Un traitement de rattrapage par chirurgie, radiothérapie ou HIFU est possible.

La colistine et les imipeneme gardent leur efficacite avec un taux de resistance inferieur a 10%. Les germes presentant une betalactamase a spectre Elargi (BLSE) representent la grande majorite, temoin des prescriptions abusifs, et des conditions de sondage et de soins de sonde. Conclusion.— Il devient necessaire de revoir les protocoles de sondage, de prendre en compte l’epidemiologie locale des resistances bacterienne lors de la prescription des antibiotiques, et de rationaliser cette prescription afin de diminuer le risque de developpement des resistances.

Introduction. - In urology, antibiotic prophylaxis is advised by the French Association of anesthesiology (SFAR) and the Infectious Disease Committee of the French Association of urology guidelines published in 2010. No guideline exists concerning the implantation of neuromodulation implants.Material and method. - A literature analysis was performed on sacral modulation and antibiotic prophylaxis. Then guidelines were discussed by reviewers. Items that showed no consensus were then discussed again to arrive at recommendations.Results. - Antibiotic prophylaxis is recommended during the test phase as well as in the case of installation of sacral neuromodulation (Grade C). Antibiotic recommended (Grade B) are: cefotetan or cefoxitin, 2 g dose by slow intravenous injection or amoxicillin-clavulanic acid at a dose of 2 g, intravenously or, in the case of allergy vancomycin at a dose of 15 mg/kg or the clindamycin has 600 mg intravenously.Conclusions. - Despite the lack of high level of evidence, antibiotic prophylaxis seems necessary when setting up of electrode case of sacral neuromodulation. (c) 2013 Elsevier Masson SAS. All rights reserved.

According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing.The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists.Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance.Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.

According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing.The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists.Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance.Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.

A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post-voiding residual that should be drained. PSA and endorectal ultrasound value are discussed in these guidelines. Antibiotic treatment should begin with a fluoroquinolone or cephalosporin gr 3 for 3-6 weeks.

Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.

La prise en charge de la cystite aiguë recherche des facteurs de gravité, de risque ou de complication. La cystite aiguë simple ne nécessite aucun examen complémentaire, un traitement court est recommandé. La cystite aiguë compliquée nécessite parfois une évaluation clinique, bactériologique et radiologique, un traitement plus long est recommandé. La définition de la cystite récidivante est précisée dans ces recommandations.

The French Association of anesthesiology (SFAR) has published in 1999 the Antibiotic prophylaxis guidelines. Antibiotic resistance has increased and new procedures appeared so new recommendations were needed. We present the antibiotic prophylaxis guidelines from the committee of infectious diseases of the French Association of Urology.

Objective. - The aims of this study are to describe the implantation technique of an artificial urinary sphincter (AUS) with intracavernous cuff, define the indications and report the preliminary results of this technique.Material and method. - A single-centre retrospective study was carried out in 10 patients with a median age of 66 years. The aetiotogy of urinary incontinence was radical prostatectomy alone in four cases, combined with radiotherapy in four cases and transurethral resection of the prostate in two cases. The initial treatment consisted of AUS in seven cases and suburethral tape in two cases and the last patient had not been previously treated. Failure of AUS was due to atrophy in three cases and urethral erosion in four cases. Six patients needed to use more than three pads per day. Erections were absent in all patients. All patients were treated by insertion of an intracavernous cuff according to the same technique: perineoscrotal incision on the median raphe, dissection of the bulbar urethra and inferior aspect of the corpora cavernosa, vertical incision of the tunica albuginea on either side of the urethra, passage of the cuff from one incision to the other behind the tunica albuginea and leaving the tunica albuginea against the urethra, and closure of the tunica albuginea by interrupted sutures leaving a passage for the cuff. The median follow-up was 15.5 months.Results. - The median operating time was 90 min. No intraoperative complication was observed. Two patients had to be explanted because of infection of the material. Seven of the remaining eight patients were satisfied and six of them needed less than one pad per day. A history pelvic irradiation did not appear to have any impact on the results.Conclusion. - The treatment of mate urinary incontinence by artificial urinary sphincter with intracavernous cuff is a simple technique that improves the trophicity and calibre of the urethra underneath the cuff. This technique achieved good results in patients with a history of pelvic irradiation. (c) 2008 Elsevier Masson SAS. Taus droits reserves.

Le carcinome urothelial a type de nid (Nested Variant Urothelial Carcinoma) est une variante de carcinome urothelial recemment identifiee, dont le diagnostic reste difficile du fait de sa ressemblance avec d'autres lesions vesicales benignes, telle l'hyperplasie des ilots de Von Brunn. Les auteurs presentent trois cas cliniques de cette variete de lesion urotheliale et insistent sur l'importance des criteres cliniques, cytologiques, histologiques et immuno-histochimiques pour le diagnostic et la necessite d'une prise en charge therapeutique precoce et adaptee. En effet, consideree a tort jusqu'au debut des annees 1990 comme benigne, ce type de tumeur vesicale presente une agressivite identique a celle d'une lesion urotheliale de haut grade cellulaire.

Nested variant urothelial carcinoma is a recently identified variant of urothelial carcinoma which is difficult to diagnose due to its resemblance to other benign bladder lesions, such as hyperplasia of Von Brünn nests. The authors present three clinical cases of this variant of urothelial carcinoma and emphasize the importance of clinical, cytological, histological and immunohistochemical criteria for the diagnosis and the need for early and adapted therapeutic management, as this type of bladder tumour, wrongly considered to be benign up until the early 1990s, is just as invasive as high-grade urothelial carcinoma.