Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006 and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]).Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004).Between 2006 and 2013, the number of penile implants in France doubled (307 to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87 %) (228 to 552) (+142 %). The use of semi-rigid prostheses declined by 26.7 %. The distribution between the private and public sector was close to 1 in 2013. More than half of French penile prostheses were implanted in three regions (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). Nearly 62 % of surgeons implanted only one or two three-compartment prostheses in 2013.The number of penile prostheses in France doubled between 2006 and 2013. Three regions were particularly active as far as this surgery is concerned (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). They were boosted by 5 surgeons with more than 20 prostheses surgeries a year.4.

Objectives. Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006 and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]).Materials and methods. Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004).Results. Between 2006 and 2013, the number of penile implants in France doubled (307 to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87 %) (228 to 552) (+142 %). The use of semi-rigid prostheses declined by 26.7 %. The distribution between the private and public sector was close to 1 in 2013. More than half of French penile prostheses were implanted in three regions (Ile-de-France, Languedoc-Roussillon, Rhone-Alpes). Nearly 62 % of surgeons implanted only one or two three-compartment prostheses in 2013.Conclusion. The number of penile prostheses in France doubled between 2006 and 2013. Three regions were particularly active as far as this surgery is concerned (Ile-de-France, LanguedocRoussillon, Rhone-Alpes). They were boosted by 5 surgeons with more than 20 prostheses surgeries a year. Level of evidence. 4. (C) 2016 Elsevier Masson SAS. All rights reserved.

Complete, isolated trisomy of the short arm of chromosome 18 is very rare. To date, only 24 cases of trisomy 18p have been reported in the literature, making it difficult to define a potentially associated phenotype. However, the available evidence suggests that few clinical features are shared by these patients: only variable intellectual disability, variable facial dysmorphism and epilepsy are reported in a few patients. Although three inherited cases of trisomy 18p have already been reported, all were of maternal origin. We report on a patient carrying an isolated complete trisomy 18p translocated to the short arm of chromosome 14 and presenting with facial dysmorphism, mild intellectual disability and non-obstructive azoospermia. Chromosomal abnormalities are more frequent in infertile men with poor sperm quality than the general population. Both numerical and structural chromosomal aberrations have been already reported within the context of azoospermia. To our knowledge, this is the first patient with trisomy 18p to present a fertility impairment due to totally altered spermatogenesis and azoospermia. Although fertility disorders were not mentioned in the four previous reports of men with trisomy 18p, none of the latter had children. We suggest that azoospermia is a previously uncharacterized feature of trisomy 18p syndrome. We further hypothesize that two mechanisms could be responsible of the fertility impairment: a meiotic synapsis defect due to the additional 18p arm that blocks meiosis, and/or overexpression of a gene located on the 18p chromosome involved in the normal testicular development.

Objective. - The varicocele is a venous abnormality frequently found in humans (1/10). Although the recommendations for management of this pathology are clear, two therapeutic options can be discussed: surgery or radiological embolisation. We wanted to study the evolution of the therapeutic management of varicocele using the French national coding database.Methods. - Analysis of database from the "Agence technique de l'information sur hospitalisation" (ATIH) (number of surgical procedures and interventional radiology used in the treatment of varicocele for the period 2006-2014). The common classification of medical procedures (CCAM) was used to extract the codes for surgery and radiological embolisation. Then we recorded the corresponding "Groupes homogenes de malades" (GHM), excluding those with a different primary diagnosis of varicocele cure.Results. - The number of surgical procedures and radiological embolisation performed for the treatment of varicocele increased from 3626 to 4007 procedures (+10.5%) between 2006 and 2014. While the frequency of interventional radiology (embolization pampiniform plexus) increased by 73.9%, surgery procedures (by direct approach or laparoscopy) decreased by 31.4% throughout the study (2006-2014). Thus in 2006, 60.2% of therapeutic procedures were performed surgically and 39.8% by radiological embolisation. In 2014, 37.4% of therapeutic procedures were performed surgically and 62.6% by embolization.Conclusion. - The analysis of French national database has confirmed a change in the therapeutic management of varicocele between 2006 and 2014. The minimally invasive treatment by radiological embolisation is currently favored in France and surgery pushed into the background. In 2014, more than one therapeutic management out of two was performed in interventional radiology. (C) 2015 Elsevier Masson SAS. All rights reserved.

Purpose. - Prospective evaluation of bladder tumor targeting by Hexvix (R) fluorescence.Patients and methods. - From September 2008 to April 2012, 107 patients have been evaluated using Hexvix (R) technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected prospectively and patients have been classified using EORTC score.Results. - From the 107 patients, 67 have been identified with bladder cancer and 328 samples have shown positive fluorescence in blue light. Compared to white light, 13 additional tumors have been diagnosed by Hexvix (R) for 11 patients: Cis (n = 6), LMP (n = 3), pTa low grade (n = 3), pT1 low grade (n=1) (P=0.003). The false positive rate for Hexvix (R) was 53.4% versus 52% for white light. Previous TCC history, multifocality and EORTC score for recurrence and progression have been associated with better bladder cancer targeting by Hexvix (R) (P=0.007; P=0.01; P=0.03; P=0.04).Conclusion. - In our experience, Hexvix (R) targeting was associated with better diagnosis for bladder cancer with 9% (13/144) of new positive samples (P=0.003). In our study, false positive rate is a critical. point (53.4%). Multifocality, previous TCC, and EORTC score for recurrence and progression might allow selecting patients to be targeted by Hexvix (R). (C) 2012 Elsevier Masson SAS. All rights reserved.

Objective. - Evaluate epidemiology, diagnosis and outcome of de novo renal cell carcinoma in renal transplanted patients.Patients and method. - From June 1989 to December 2007, 824 renal transplantations were carried out and followed in annual consultation by an urologist with abdominal echography or tomodensitometry. The suspect renal lesions were treated by a widened nephrectomy. Incidence, diagnosis, treatment, histological type, and outcome of all patients were analysed.Results. - Thirty-three patients had nephrectomy for suspect renal lesions. Twenty-two de novo tumours of native kidneys among 21 patients were diagnosed (15 renal clear cell carcinoma and seven papillary tumours) with mean time after transplantation of 25,6 months (2.3-105.5). All tumours were classified pT1aNOMO. Only one patient died at 8 months of metastatic dissemination of a papillary tumour classified initially pT1aNOMO. All the other patients are alive with mean follow-up of 34.8 months (2.8-113.9). Specific survival to 5 years was 93.3%.Conclusion. - The increase risk of tumour at the renal transplanted patient led to propose in the event of suspect lesions of the native kidneys, a widened nephrectomy. In our series, 65% of the operated patients carried a cancer. The good forecast of these localized tumours justifies a regular radiological monitoring and an aggressive therapeutic attitude despite of absence of tumours in 35% of the transplanted patients. (C) 2010 Elsevier Masson SAS. All rights reserved.

OBJECTIVE:To evaluate the success of ureteral stent placement to treat or prepare for surgical treatment of urologic complications after renal transplantation, according to a type of ureteral anastomosis.PATIENT AND METHODS:From May 1989 to December 2006, we performed 703 kidney transplantations including 412 extravesical ureteroneocystostomy (according to Lich-Gregoire technique) and 265 transvesical ureteroneocystostomy (according to Politano-Leadbetter technique). We retrospectively analyzed our endoscopic management of urinary leaks and ureteral strictures. The criteria of success were the feasibility to place a ureteral stent, permitting good drainage of the upper renal graft tract before further endoscopic or surgical treatment.RESULTS:Forty-three urinary leaks or ureteral strictures occurred after extravesical ureteroneocystostomy (n = 21) or after Politano-Leadbetter anastomosis (n = 22). The success rate of endoscopic management was 75% (n = 16) for Politano-Leadbetter anastomosis versus 53% (n = 11) for the Lich-Gregoire anastomosis. There was no statistical difference (P = .1).CONCLUSION:Ureteroneocystostomy according to Lich-Gregoire procedure were twice less complicated than those according to the Politano-Leadbetter technique, but were associated with a rate of failure of ureteral stent placement in urgency higher to 25%.

Objective. - To determine the sensitivity and specificity of MRI to distinguish between superficial and invasive transitional cell bladder cancer.Material and methods. - Sixty patients (52 men and eight women) with a mean age of 66.8 years were assessed by bladder MRI between May 2002 and November 2005 for a primary bladder cancer diagnosed by endoscopy, followed by transurethral resection and histological examination of the bladder cancer. Patients presenting a discordance between MRI findings and histological examination were analysed.Results. - Imaging and pathology staging was concordant for 49 bladder cancers (40 superficial and nine invasive). Ten tumours considered to be invasive on MRI were superficial on histotogical, examination and six of them relapsed at the resection scar at one or three months. The sensitivity of MRI was 80% for a specificity of 90% and a positive predictive value of 97.5%.Conclusion. - MRI is a reliable examination to confirm the superficial nature of bladder cancer. When MRI and histological examination of a bladder cancer resection specimen are discordant, second took surgery is recommended to treat residual disease, which was present in 60% of cases in the present series. (C) 2008 Elsevier Masson SAS. Tous droits reserves.

OBJECTIVE:Human chorionic gonadotrophin (HCG) is secreted by 10 to 20% of seminomas. The authors evaluated variations of serum total HCG levels in patients with normal baseline levels for the surveillance of treated testicular seminomas in order to determine the value of assay of this tumour marker in the follow-up of testicular seminoma. PATIENTS AND METHODS:Retrospective study from January 1988 to March 2007, including 95 cases of operated testicular cancer, including 28 seminomas, 25 of which did not secrete HCG (baseline total HCG less than 15 IU/L). Patients were reviewed periodically: every three months for one year, every six months during the second year, then annually, comprising of clinical examination, CT examination and assay of tumour markers (HCG, LDH and AFP). RESULTS:Mean follow-up was 77.5 months (range: 6-120). Twenty-five patients had a total HCG level less than 15 IU/L three months after orchidectomy. Serum HCG remained stable at less than 15 IU/L in all patients with a follow-up of more than three years. Two patients developed non-regional lymph node recurrence with no modification of the serum HCG level. CONCLUSION:All treated non-HCG-secreting seminomas with or without recurrence had stable and normal HCG levels throughout follow-up, which raises the question of the value of HCG assay in the follow-up of these patients following histological confirmation of the diagnosis.

L’incidence du nombre de blessés médullaires est en constante augmentation et parmi eux 41% ont moins de 30 ans. Les possibilités de procréation sont des préoccupations essentielles chez ces jeunes patients.

Most men with spinal cord injury (SCI) men have fertility problems caused by anejaculation and decreased fertility of the ejaculate. There are two main causes for the impaired reproductive potential in SCI men: ejaculatory dysfunction and poor quality semen. However, current treatment techniques allow a large number of SCl males to achieve ejaculation (rectal electro-stimulation, penile vibrator stimulation).Firstly, masturbation and/or penile vibrator are used at home allowing the couple to perform insemination themselves.The semen of men with spinal cord injuries has commonly been characterised by small volume, abnormal count (low or high), decreased sperm mobility, increased formation of reactive oxygen species, sperm autoimmunity, necrospermia. This impairment is thought to be due to insufficient drainage, genitourinary infections and raised scrotal temperature. Testicular biopsy reveals varying degrees of tubule degeneration and decreased spermatogenetic activity.Semen could be used for various assisted reproductive technologies such as intrauterine insemination, in vitro fertilisation (IVF) and microinsemination (ICSI).The literature reports pregnancy rates by intrauterine insemination of about 15 to 20% per couple. Clinical pregnancy rates after IVF and ICSI techniques are 30% per cycle and these results are comparable to the clinical pregnancy rates when these techniques are performed for female infertility.However, semen must be frozen as soon as possible after the injury and the patient must be informed about the various available assisted reproductive technologies.

Evaluer en temps et en nombre d’actes, la part de l’activité consacrée à la chirurgie de l’insuffisance rénale chronique dans un bloc opératoire d’urologie et de transplantation. Analyse de l’activité opératoire du bloc d’urologie et de transplantation du CHU d’Amiens au cours d’une année (2003), en évaluant le nombre d’actes et le temps d’occupation du bloc (temps entre l’entrée et la sortie du bloc) recueillis partir des fiches d’écologies remplies pour chaque intervention. Ces actes regroupent d’une part ceux de la chirurgie urologique classique de l’adulte et d’autre part l’ensemble des actes de I’insuffisance rénale chronique (depuis la création des voies d’abord de l’épuration extra rénale jusqu’aux complications de la transplantation rénale). La prise en charge de l’insuffisance rénale chronique au bloc opératoire représente 22,6% des actes et 30,1% du temps d’occupation du bloc opératoire. Soixante neuf pour cent du temps opératoire des transplantations rénales et 95% de celui des prélèvements d’organes sont effectués sur l’astreinte. L’activité opératoire liée à l’insuffisance rénale chronique représente près d’un tiers de l’activité opératoire globale d’un Service qui prend en charge cette pathologie. Ces données justifient l’attribution de moyens chirurgicaux supplémentaires adaptés à cette activité dont l’importance croit parallèlement au nombre de patients insuffisants rénaux chroniques. To evaluate the proportion of surgical workload, in terms of time and number of procedures, devoted to chronic renal failure surgery in an urology and transplantation operating room. Analysis of the operative activity of the urology and transplantation operating room of Amiens Hospital over a period of one year (2003), by evaluating the number of procedures and the operating room occupation time (time between entry and exit from the operating room) recorded on ecology forms completed for each operation. Procedures performed in this operating room comprise conventional adult urological surgery and chronic renal failure procedures (from creation of venous access sites for haemodialysis to treatment of complications of renal transplantation). Surgical management of chronic renal failure in the operating room represents 22.6% of all procedures and 30.1% of the operating room occupation time. 69% of the renal transplantation operating time and 95% of kidney harvesting operating time are performed on an oncall basis. Operative activity related to chronic renal failure represents almost one third of the total surgical workload of a department managing this diseuse. These data justify the allocation of additional surgical resources adapted to this activity that is growing in parallel to the number of patients with chronic renal failure.

Objective: To evaluate the proportion of surgical workload, in terms of time and number of procedures, devoted to chronic renal failure surgery in an urology and transplantation operating room.Material and methods : Analysis of the operative activity of the urology and transplantation operating room of Amiens Hospital over a period of one year (2003), by evaluating the number of procedures and the operating room occupation time (time between entry and exit from the operating room) recorded on ecology forms completed for each operation. Procedures performed in this operating room comprise conventional adult urological surgery and chronic renal failure procedures (from creation of venous access sites for haemodialysis to treatment of complications of renal transplantation).Results: Surgical management of chronic renal failure in the operating room represents 22.6% (of all procedures and 30.1% of the operating room occupation time. 69% of the renal transplantation operating time and 95% of kidney harvesting operating time are performed on an oncall basis.Conclusion : Operative activity related to chronic renal failure represents almost one third of the total surgical workload of a department managing this disease. These data justify the allocation of additional surgical resources adapted to this activity that is growing in parallel to the number of patients with chronic renal failure.

Emphysematous cystitis is a rare disease mainly encountered in poorly controlled diabetics, immunodepressed patients or patients with infravesical obstruction. The pathophysiology of this disease is characterized by the formation of carbon dioxide (CO2) present in the lumen and/or bladder wall, derived from bacterial fermentation of carbohydrates. The bacteria most frequently responsible are facultative aerobes-anaerobes (Escherichia coli) and more rarely strict anaerobes (Clostridium perfringens). The authors report a case of emphysematous cystitis in a context of pelvic trauma and fracture of the pelvis, complicated by secondary bladder rupture. The diagnostic and therapeutic aspects are discussed.

Introduction: Nephrogenic adenoma (NA) or nephrogenic metaplasia is a rare, benign urothelial tumour. Material and Methods: This retrospective study evaluated the circumstances of discovery, predisposing factors, and clinical course of seven patients with nephrogenic adenoma diagnosed between 1988 and 2000. The mean age of these patients was 55.7 years (range: 16 to 88 years). The mean follow-up was 24 months (range: 4 to 108 months). Results: There are no specific endoscopic findings and the lesion was sometimes flat or papillary with an appearance that can be identical to that of bladder tumour. The diagnosis was always based on histological findings. Suggestive clinical signs were nonspecific and comprised: haematuria, dysuria, or urgency. Treatment was surgical with transurethral resection or electrocoagulation of the lesion, combined with elimination of the factors irritating the urothelial mucosa. In our experience, recurrences were observed in 28.5% of patients and occurred during the year following the initial treatment. Conclusion: Nephrogenic adenoma is a rare, benign urothelial tumour most frequently situated in the bladder. The presenting clinical signs are completely nonspecific and usually related to predisposing factors (infections, inflammation, bladder tumour). Only histological examination can provide the essential proof of the benign nature of this lesion. Endoscopic resection therefore has two objectives: diagnostic and therapeutic. The clinical course is characterized by recurrences.