Body composition may influence outcomes in muscle-invasive bladder cancer (MIBC), but its prognostic role remains unclear. In particular, the impact of adipose tissue distribution and muscle quality beyond BMI has been insufficiently studied. This study aimed to evaluate whether adipose tissue distribution and myosteatosis assessed by AI-based CT analysis are associated with OS in patients with MIBC treated with neoadjuvant chemotherapy followed by radical cystectomy. In this retrospective, bicentric study, we analyzed data from 87 patients with MIBC treated with neoadjuvant chemotherapy (NAC) followed by radical cystectomy. Artificial intelligence (AI)–based analysis was applied to CT scans obtained before chemotherapy (BC) and before surgery (BS), focusing on the L3 vertebral level. We assessed the association between body composition and OS, and secondarily progression-free survival (PFS). Evaluated parameters included myosteatosis (fat infiltration of skeletal muscle), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous fat ratio (VSR). Median follow-up was 24.6 months. A high SFI measured before surgery was significantly associated with improved OS (HR 0.41; 95

The incidence of urolithiasis is rising in France, with a prevalence approaching 10

Background The artificial urinary sphincter (AUS) is the reference surgical treatment for moderate-to-severe post-prostatectomy stress urinary incontinence. Despite durable functional outcomes, long-term device-related morbidity and explantation remain frequent. Nationwide real-world data jointly assessing postoperative complications and determinants of revision after AUS implantation remain limited. This study aimed to provide a comprehensive national overview of postoperative complications and identify risk factors for AUS revision or explantation. Methods We conducted a retrospective nationwide cohort study using the French Programme de Médicalisation des Systèmes d’Information (PMSI). All men undergoing primary AUS implantation after radical prostatectomy between 2017 and 2019 were included and followed until December 2023. Postoperative complications were identified using International Classification of Diseases, 10th (ICD-10) Revision codes and classified according to postoperative timing. Baseline comorbidities were analysed using univariate logistic regression, while post-implantation procedures were assessed using Poisson regression to estimate incidence rate ratios for revision or explantation. Results Among 1,790 patients, 268 (15.0%) underwent AUS explantation during follow-up. Most complication-coded rehospitalisations occurred during late follow-up. Urinary incontinence–related diagnoses were the most frequent events, whereas mechanical and infectious complications represented the most clinically relevant device-related outcomes. Urethral fragility conditions were the strongest predictors of explantation. Metabolic disorders, malnutrition, prior pelvic radiotherapy, anticoagulant therapy, tobacco use, and invasive procedures—including blood transfusion, indwelling catheterisation, and cystoscopy—were significantly associated with higher revision risk. Conclusion This nationwide PMSI-based study provides a comprehensive real-world assessment of postoperative morbidity and explantation risk after AUS implantation, highlighting the importance of optimised patient selection and cautious postoperative urethral instrumentation.

Background Data on longitudinal bladder cancer (BC) costs are scarce. Objective To assess the economic burden of non–muscle-invasive bladder cancer (NMIBC) by progression risk groups in France over a 1-yr and 5-yr time horizon after initial diagnosis. Design, setting, and participants We used data from the French national prospective COhort to study BLAdder CancEr (COBLAnCE) cohort. A total of 1101 patients diagnosed with a primary NMIBC between 2012 and 2018 were linked with the French National Healthcare System Database. Patients were classified into four risk groups according to the 2021 European Association of Urology risk stratification. Resources used included all BC-related hospitalizations, follow-up visits to urology and oncology clinics and related prescriptions, BC-related imaging procedures, transportation, and sick leaves. Costs were estimated from the perspective of the French health care system over the 5 yr after BC diagnosis. Outcome measurements and statistical analysis Across risk groups, mean per-patient cost ranged from €5838 to €20 678 and €11 697 to €40 519 over 1 yr and 5 yr, respectively. Surgical hospital stays accounted for 60% of costs in the first year. Over 5 yr, intravesical treatments, surveillance visits, and imaging were major cost drivers, especially among patients at lower risk of progression. Results and limitations Although claims databases are comprehensive, the economic burden of NMIBC may be underestimated owing to potential incomplete coding. Conclusions To our knowledge, this is the first national cohort study to provide robust cost estimates for patients with NMIBC stratified according to progression risk groups. These real-world data are particularly awaited for the economic evaluation of emerging treatments in patients with NMIBC.

Introduction In patients who cannot perform intermittent self-catheterization via the urethra, continent cutaneous urinary diversion (CCUD) represents a valuable alternative, often associated with enterocystoplasty (EC). The CCUD is created using the appendix or the ileum, which can be implanted into the native bladder (NB) or the EC using various surgical techniques. This study aimed to evaluate postoperative outcomes and functional results of CCUD according to these two surgical approaches. Materials and methods We conducted a retrospective, single-center study that included patients who underwent CCUD creation between 1991 and 2020. Clinical characteristics were compared using Fisher's exact test and the Mann–Whitney test. Postoperative complications were analyzed using Kaplan–Meier survival curves and compared using the Log-rank test. Results A total of 94 patients were included (60 children, 34 adults): 74 (79 %) CCUD were implanted into the native detrusor (NB group), and 20 (21 %) onto the anterior wall of the enterocystoplasty (EC group). Early complications occurred on average at 7.5 days [7–11.5], with an overall rate of 5 %. Forty patients (42 %) experienced at least one long-term complication (e.g., leakage, stenosis, kinks), with no significant difference between groups. Survival analysis revealed no significant difference in overall surgical revisions (NB: 42 %, EC: 46 %; p = 0.51) or endoscopic revision. However, the EC group had significantly more frequent subfascial revision procedures (p = 0.005) and less frequent superficial stoma revision (p = 0.02), but this was not significant on multivariate analysis. At the end of follow-up (median: 12 years [7–21]), 82 % of patients remained continent (NB: 83 %, EC: 75 %). Discussion A short and straight abdominal segment of the CCUD appears to reduce complication rates, as recommended by the technique involving implantation into a detrusor flap. However, preservation of the native bladder may contribute to persistent overactivity. The study is limited by its low external validity and the heterogeneity of patient characteristics, which may reduce statistical power. Nevertheless, the results reflect a real-life experience with a complex and uncommon surgical procedure. Conclusion Implantation of the conduit into the native bladder seems to be associated with better long-term continence outcomes and fewer subfascial revisions despite multiple confounding factors. Further studies are needed to refine surgical techniques and reduce complications.

Sarcopenia, characterized by a loss of skeletal muscle mass and function, is a poor prognosis risk factor in various cancers. Diagnosis typically involves quantifying skeletal muscle area at the L3 vertebral level (SMA) using CT imaging, however a universally accepted definition of sarcopenia does not exist. In a retrospective, multicenter study, we analyzed data from 87 muscle-invasive bladder cancer patients who received neoadjuvant chemotherapy followed by radical cystectomy. Artificial intelligence (AI) was used to evaluate CT scans obtained before chemotherapy (BC) and before surgery (BS), focusing on the L3 vertebral level. Sarcopenia was defined using four distinct criteria from the existing literature. The primary objective of this study was to assess the reliability of AI-based versus manual measurements of sarcopenia while secondary endpoints included, overall survival (OS), progression-free survival (PFS), and the impact of undernutrition and neutrophil-to-lymphocyte ratio (NLR) on OS. 87 patients were included in the final analysis. AI-based SMA measurements were highly correlated with manual measurements (r = 0.95; p < 0.001). Sarcopenia BC and BS, as defined by the Pardo criteria, was significantly associated with poorer OS (Prado BC: HR 2.26, 95

Purpose: Penile fracture is a rare urological emergency treated by surgical exploration. However, the indication for intra-operative drainage remains debated due to limited evidence. This study aimed to assess the impact of drainage on postoperative complications and symptoms after penile fracture repair. Methods: We performed a retrospective multicenter study including all patients who underwent surgery for clinically suspected penile fracture between 2000 and 2024 across 21 French centers. Patients were stratified according to intra-operative drain placement. The primary outcome was any early postoperative complication within 30 days (hematoma, surgical-site infection, wound dehiscence, painful edema, skin necrosis, or urinary retention). The key secondary outcome was a focused surgical-site composite (hematoma, surgical-site infection, or wound dehiscence). Operative time, hospital stay, and symptoms at 1 and 3 months were also evaluated. Multivariable logistic regression adjusted for surgical approach, urethral injury, and surgeon experience assessed associations with complications. Results: Among 519 patients, 158 (30%) received a drain. Drain placement was associated with longer operative time and hospital stay and more frequent degloving approach. The overall postoperative complication rate was 10%. Drain placement was not significantly associated with complications (OR 1.19, 95% CI 0.62–2.22; p = 0.59), whereas urethral injury was (OR 2.03; p = 0.04). At 1 month, 60% of patients reported at least one symptom; sexual pain was more frequent in the drain group (36% vs 23%; p = 0.04) but not at 3 months. Conclusion: Intra-operative drainage did not reduce early morbidity and was linked to longer operative time, hospital stay, and more sexual pain at 1 month. Drain use should therefore remain selective and tailored to intra-operative findings.

Introduction La robotique a connu un essor important dans le domaine civil et industriel depuis le milieu du 20e siècle, mais ses premières applications en chirurgie datent de la fin des années 1990, avec le robot AESOP puis ZEUS (Computer Motion, Goleta, Cal, États-Unis). À partir de 1999, la société Intuitive Surgical® (Sunnyvale, Cal, États-Unis) imposera son système Da Vinci dans ses différentes versions au fil des évolutions. Le développement exponentiel de la chirurgie robotique a créé de nouveaux problèmes éthiques auxquels la littérature apporte peu de réponses. Objectif L’objectif principal est de présenter une revue de la littérature sur les aspects éthiques de l’utilisation des robots en chirurgie. L’objectif secondaire est de déterminer les modalités d’apprentissage des gestes chirurgicaux réalisés avec le robot. Méthode Rechercher dans PubMed sous les rubriques éthique, bioéthique, robotique, formation, et chirurgie. Résultats Au total, 49 articles ont été sélectionnés pour développer une réflexion sur l’éthique appliquée à la chirurgie robotique. Les principes classiques de bienfaisance, de non-malfaisance, d’autonomie et de justice y sont applicables. La réflexion doit aussi prendre en compte les enjeux de demain que sont l’expérimentation animale et l’intelligence artificielle. Conclusions La chirurgie robotique est une réalité dans de nombreux établissements, ce qui rend indispensable une réflexion éthique sur les relations entre professionnels de santé, industriels, hôpitaux et patients, et en particulier sur la formation des équipes chirurgicales. L’évolution de notre société, accompagnée d’une judiciarisation croissante, nous incite à acquérir une formation initiale de qualité et à proposer un bilan de compétences, indispensable pour la protection des patients mais aussi des autres acteurs.

INTRODUCTION:Urological consultations for erectile dysfunction (ED) are increasing worldwide. Penile prosthesis (PP) implantations are performed when other treatments are unsuccessful. However, there is no data regarding PP implantations in France beyond the year 2016. OBJECTIVES:This study aimed to describe the changes in the number and type of PP implants used for the treatment of ED in France from 2016 to 2021 and the hospitalization rates following implantation using French national data from the Program for the Medicalization of Information Systems (PMSI). MATERIALS AND METHODS:We analyzed data on PP implantations in all France hospitals. PPs were coded into three types according to the Common Classification of Medical Procedures (CCAM). The number of patients admitted to hospital with complications twelve months after implantation was also recorded. RESULTS:During the study period, 3675 men received 3868 PPs in France. A gradual increase in the total number of implanted PPs was observed, with an overall increase of 33.8%. In 2020, there was a sharp decline in the number of implanted PPs, primarily owing to the COVID-19 pandemic. The most commonly used implant was PPs with an extracavernous compartment, comprising 85% of all PPs. Twelve months after implantation, only 1-2% of the patients were rehospitalized. CONCLUSION:PP implantation surgeries are highly reproducible and have a low incidence of complications, in terms of rehospitalization after one year of placement (1.8%). Moreover, there was an increase in the demand for penile prosthesis implantations in France between 2016 and 2021. LEVEL OF EVIDENCE:4: Descriptive epidemiological study.

PURPOSE:Prostate specific antigen (PSA) testing is a low-cost screening method for prostate cancer (PCa). However, its accuracy is limited. While progress is being made using medical imaging for PCa screening, PSA testing can still be improved as an easily accessible first step in the screening process. We aimed to develop and validate a new model by further personalizing the analysis of PSA with demographic, medical history, lifestyle parameters, and digital rectal examination (DRE) results. METHODS:Using data from 34,224 patients in the screening arm of the PLCO trial (22,188 for the training set and 12,036 for the validation set), we applied a gradient-boosting model whose features (Model 1) were one PSA value and the personal variables available in the PLCO trial except those that signaled an ex-ante assumption of PCa. A second algorithm (Model 2) included a DRE result. The primary outcome was the occurrence of PCa, while the aggressiveness of PCa was a secondary outcome. ROC analyses were used to compare both models to other initial screening tests. RESULTS:The areas under the curve (AUC) for Model 2 was 0.894 overall and 0.908 for patients with a suspicious DRE, compared to 0.808 for PSA for patients with a suspicious DRE. The AUC for Model 1 was 0.814 compared to 0.821 for PSA. Model 2 predicted 58% more high-risk PCa than PSA ≥4 combined with an abnormal DRE and had a positive predictive value of 74.7% (vs. 50.6%). CONCLUSION:Personalizing the interpretation of PSA values and DRE results with a gradient-boosting model showed promising results as a potential novel, low-cost method for the initial screening of PCa. The importance of DRE, when included in such a model, was also highlighted.

PURPOSE: Brachytherapy (BT) is a standard treatment for low- and favorable intermediate-risk prostate adenocarcinoma. Few studies have focused on young patients. We therefore evaluated long-term efficacy and toxicity of BT in patients aged <= 60 years with low- and favorable intermediate-risk prostate cancer. Materials and methods: This retrospective study included patients aged <= 60 years with low- or favorable intermediate-risk prostate adenocarcinoma treated with iodine BT alone between 1999 and 2014 at the Institut de Canc & eacute;rologie de Lorraine. Follow-up assessment included incidence of biochemical failure (BF) at 10 and 15 years after BT, as well as survival data and late toxicities. Results: A total of 177 patients of median age 56 years (54-58) were analyzed, with a median follow-up of 126 months (97-172). Incidence of BF at 10 and 15 years after BT was 5.4% and 11.7% respectively. PSA nadir (HR = 51.8 [95% CI 6.69-277], p < 0.001), age at treatment (HR = 1.78 [95% CI 1.19-2.65], p = 0.005) and prostate D-90% (HR = 1.08 [95% CI 1.01-1.15], p < 0.021) were identified as predictive factors of BF. Overall survival at 10 and 15 years after BT was 92.8% and 84.4% respectively. Cancer-specific survival at 10 and 15 years after BT was 99.3% and 97.7% respectively. No major toxicity was recorded. ConclusionS: Exclusive BT is a long-term effective treatment for patients aged <= 60 years with low- or favorable intermediate-risk prostate adenocarcinoma. (c) 2024 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Introduction L’incidence de la maladie lithiasique augmente en France et sa prévalence en population générale est proche de 10 %. L’avènement des techniques endoscopiques mini-invasives a modifié profondément sa prise en charge chirurgicale sur les dernières décennies. Le choix des différentes techniques, entre la lithotritie extracorporelle (LEC), l’urétéroscopie (URS) et la néphrolitotomie percutanée (NLPC), restent ouverts selon les recommandations. L’objectif de l’étude est d’étudier les pratiques au cours des dernières années. Méthodes À l’aide de la base de données nationale française du programme de médicalisation des systèmes d’information (PMSI), nous avons recueilli sur la période 2016–2022 le nombre d’interventions, la distribution en fonction du type d’établissement de santé (public, privé, CHU), les durées moyennes de séjour et les caractéristiques épidémiologiques des patients traités pour une lithiase du haut appareil. Résultats Entre 2016 et 2022 en France, le nombre total d’actes pour lithiase du haut appareil a augmenté de 12 %, avec une hausse de 37 % du nombre d’URS, alors que les LEC ont diminué de 36 % et les NLPC de 5 %. L’augmentation du nombre d’acte est régulière sauf pour l’année 2020. Le sexe ratio homme/femme est proche de 2/1 sauf pour les NLPC où il est de 1/1. Les profils d’âge sont similaires entre les techniques, avec une plus grande proportion de patients âgés de 51 à 60 ans. 75 % des LEC et 70 % des urétéroscopies sont réalisées dans un hôpital privé, alors que 60 % des NLPC ont lieu dans un hôpital public, et près de 50 % dans un CHU. Les durées moyennes de séjour ont diminué de 56 % pour les LEC, 32 % pour les URS et 22 % pour les NLPC, avec des durées les plus courtes au sein des établissements privés. Conclusion Le nombre total d’actes pour traitement de lithiase du haut appareil augmente en France au fil des ans, avec une proportion de plus en plus grande pour l’URS au détriment de la LEC, et avec des durées d’hospitalisation de plus en plus courtes. Ces résultats sont à confronter à des données médico-économiques afin d’orienter au mieux l’offre de soin.

Introduction Le test de l’antigène spécifique de la prostate (PSA) est une méthode de dépistage peu coûteuse pour le cancer de la prostate (PCa). Cependant, sa précision est limitée. Bien que des progrès soient réalisés dans l’utilisation de l’imagerie médicale pour le dépistage du PCa, le test PSA peut encore être amélioré en tant que première étape dans le processus de dépistage. Nous avons cherché à développer et valider un nouveau modèle en personnalisant davantage l’analyse du PSA avec des paramètres démographiques, des antécédents médicaux, des paramètres liés au mode de vie et les résultats de l’examen rectal digital (DRE). Méthodes En utilisant les données de 34 224 patients dans le bras de dépistage de l’essai PLCO (22 188 pour l’ensemble d’entraînement et 12 036 pour l’ensemble de validation), nous avons appliqué un modèle de gradient boosting dont les caractéristiques (modèle 1) étaient une valeur de PSA et les variables personnelles disponibles dans l’essai PLCO, à l’exception de celles qui indiquaient une présomption ex ante de PCa. Un deuxième algorithme (modèle 2) incluait un résultat de DRE. Le résultat principal était l’occurrence de PCa, tandis que l’agressivité du PCa était un résultat secondaire. Les analyses ROC ont été utilisées pour comparer les deux modèles à d’autres tests de dépistage initiaux. Résultats Les aires sous la courbe (AUC) pour le modèle 2 étaient de 0,894 dans l’ensemble et de 0,908 pour les patients avec un DRE suspect, contre 0,808 pour le PSA pour les patients avec un DRE suspect. L’AUC pour le modèle 1 était de 0,814 contre 0,821 pour le PSA. Le modèle 2 a prédit 58 % de PCa à haut risque de plus que le PSA ≥4 combiné à un DRE anormal et avait une valeur prédictive positive de 74,7 % (contre 50,6 %). Conclusion La personnalisation de l’interprétation des valeurs de PSA et des résultats de DRE avec un modèle de gradient boosting a montré des résultats prometteurs en tant que nouvelle méthode potentielle et peu coûteuse pour le dépistage initial du PCa. L’importance du DRE, lorsqu’il est inclus dans un tel modèle, a également été soulignée.

BackgroundLaparoscopic surgery is associated with a lower morbidity than open surgery. No recent data compared kidney cancer surgery in the French population using the National Health Insurance database (PMSI-MCO).AimsWe explore and compare the surgical morbidity rates between laparoscopic and open laparotomy for kidney cancer.MethodsThe initial length of stay and complications parameters during the three postoperative months were described for renal cancer in every French center in 2018. We compared Relative Risks (RR [95% CI]) between laparoscopic and open surgery for both radical and partial nephrectomy.ResultsAmong 8,162 patients, 3,525 had a radical nephrectomy, 978 open, 2,547 laparoscopic surgeries; 4,637 patients had partial nephrectomies, 1,778 open 2,859 laparoscopic surgeries. For radical surgery, the most common complications were urinary infections (7.8%), acute renal failure (8.9%), sepsis (8.4%), bleeding (9.3%), and postoperative anemia (5.9%); the RR for laparoscopic versus open surgery were respectively 0.68 [0.54;0.86], 0.71 [0.57;0.88], 0.69 [0.55;0.86], 0.83 [0.66;1.03], 0.56 [0.43;0.73]. For partial nephrectomies, the most common complications were urinary infections (7.7%), bleeding (11.6%), and postoperative anemia (5.8%), with RR of 0.71 [0.58;0.87], 0.61 [0.52;0.71], and 0.64 [0.51;0.81]. The mean length of stay was 7.7 for open radical nephrectomy, 6.3 for laparoscopic radical nephrectomy, 7.5 for open partial nephrectomy, and 5 for laparoscopic partial nephrectomy.ConclusionsThe laparoscopic approach had fewer postoperative complications and a shorter length of stay than open surgery for partial and radical nephrectomy. The PMSI analysis provided an exhaustive description of surgical practice for kidney cancer and surgical complications in France.Clinical trial numberNot applicable.

Background and purpose Prostate cancer can be treated using either brachytherapy or high-intensity focused ultrasound (HIFU), which are less invasive than surgery. Although both approaches have proved effective, few studies have looked at the specific causes of hospitalisation due to complications, following these treatments. The aim of this study was to compare the causes of hospitalisation. Methods A retrospective study was carried out examining the records of patients who had undergone brachytherapy or HIFU treatment for localized prostate cancer in 2019 and 2020, using the French national database: Programme de Médicalisation du Système d’Information − Médecine, Chirurgie, Obstétrique (PMSI-MSO). Data on post-treatment hospitalisations were analyzed. Results 3090 patients were included in the study, of whom 1699 underwent brachytherapy and 1391 HIFU procedures. The incidence of hospitalisation was much higher after HIFU than after brachytherapy, notably due to a higher rate of obstructive complications (12.94% vs 2.77%). Large differences were also found for infections (8.20% vs 1.47%) and bleeding (6.76% vs 2.18%) leading to hospitalisation. Most of the complications occurred at the initial hospitalization: 12% for HIFU, and 1.4% for brachytherapy. Conclusion Complications were more frequent after treatment with HIFU than with brachytherapy in the year following treatment for localized prostate cancer. Further the causes of hospitalisation differed between the two treatments. These differences need to be taken into account in the therapeutic strategy, as well as in post-treatment management.

The aim of the study was to determine the impact of positive surgical margins (PSM) after PN on very long-term recurrence in a contemporary cohort. Patients who underwent PN for a localized renal tumour were included. Patients were stratified according to the presence of PSM. Data on patients’ characteristics, the tumour, the peri- and postoperative events were collected. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan–Meier method and compared by the log-rank test. Sensitivity analyses using weighted propensity score analysis was performed to account for potential selection biases arising from the nonrandom allocation of patients to different groups. A total of 1115 patients were included in the study. The incidence of PSM was 5.4