one day after surgery. The primary endpoint was same-day discharge after Microperc without emergency department visits or unplanned readmission within 30 days of the procedure. The secondary endpoints included treatment outcomes and the 30-day complication rate. Results. - Out of 72 consecutive patients included, 32 patients (44.4%) had same-day discharge. Median Charlson score (1 [0-2]) and cumulative stone size (15 [12-20] mm) were comparable between both groups. At one month post procedure, 32 patients (44.4%) were stone free and 23 patients (32%) had residual micro-fragments < 3 mm, conferring an overall success rate of 76.4% (inpatient Microperc group: 77.5% vs outpatient Microperc group: 75%, P = 1). Analysis of the 30-day complication rate showed similar results between the two groups (Clavien I-II: 18.1%, Clavien > III: 4.1%). After outpatient care, the rate of immediate admission and unplanned readmission was 12.5% (n = 4), mainly due to urinary tract infection. Conclusion. - In this multi-institutional study, we report that outpatient Microperc is feasible in selected patients with no significant impact on postoperative outcome. Level of evidence.- 3 (c) 2022 Published by Elsevier Masson SAS.

La faible morbidité associée à la Néphrolithotomie MicroPercutanée (MicroPERC) dans notre expérience initiale nous a conduit à évaluer la faisabilité de l’intervention en ambulatoire. L’objectif de cette étude était de rapporter notre expérience multicentrique de la MicroPERC et d’évaluer sa faisabilité en chirurgie ambulatoire. Les patients consécutifs ayant été traités par MicroPERC pour des calculs rénaux dans trois centres entre mai 2015 et mars 2021 ont été rétrospectivement inclus. Les interventions ont été réalisées par trois chirurgiens entraînés. Un premier opérateur réalisait la MicroPERC en chirurgie ambulatoire, tandis que les deux autres opérateurs programmaient la MicroPERC en hospitalisation conventionnelle. Le critère de jugement principal était le succès de la chirurgie ambulatoire défini comme le retour à domicile le jour de l’intervention sans reconsultation ou réadmission non planifiée dans les 30 jours postopératoire. Les critères de jugement secondaires étaient le taux sans fragments ≥ 3 mm et le taux de complications dans les 30 jours postopératoire. 72 patients consécutifs ont été inclus dont 32 patients (44,4 %) programmés en chirurgie ambulatoire. Le score de Charlson médian (1 [0-2]) et la taille cumulative des calculs (15 [12-20] mm) étaient comparables entre les deux groupes. À 1 mois postopératoire, 32 patients (44,4 %) n’avaient pas de calcul résiduel et 23 patients (32 %) avaient des micro-fragments résiduels < 3 mm, soit un succès global de 76,4 %. Le taux de succès était similaire entre les groupes Microperc hospitalisation conventionnelle (77,5 %) et Microperc ambulatoire (75 %, p = 1). Le taux de complications dans les 30 jours postopératoire (Clavien I-II : 18,1 %, Clavien ≥ III : 4,1 %) était similaire entre les deux groupes. Dans le groupe chirurgie ambulatoire, le taux d’admission immédiate et de réadmission non planifiée était de 12,5 % (n = 4), principalement en raison d’une infection urinaire. Dans une étude multi-institutionnelle, nous rapportons que la MicroPERC a été faisable en chirurgie ambulatoire chez des patients sélectionnés sans impact significatif sur les résultats postopératoires. De futures études prospectives sont nécessaires pour évaluer la satisfaction du patient et réaliser une étude médico-économique évaluant l’intérêt de la chirurgie ambulatoire dans ce cadre.

Les pyélonéphrites aiguës obstructives sont des urgences médicochirurgicales pouvant mettre en jeu le pronostic vital du patient. L’objectif de cette étude était d’évaluer l’intérêt pronostique de la procalcitonine sur la survenue de complications dans la prise en charge de la pyélonéphrite obstructive. Étude monocentrique, rétrospective, incluant les patients hospitalisés pour pyélonéphrite aiguë obstructive entre janvier 2015 et avril 2016. Les critères d’inclusion étaient : dilatation des cavités pyélocalicielles à l’échographie/TDM, et au moins un des critères suivants : fièvre, frissons, ECBU positive et une dérivation urinaire par sonde JJ/néphrostomie. Le critère de jugement principal était : état septique sévère (ESS) (sepsis sévère, choc septique, admission dans un service de soins continus ou réanimation) durant l’hospitalisation. Les critères de jugement secondaires étaient : hémoculture positive, durée d’hospitalisation. Tous les patients ont eu un dosage de PCT sérique à l’admission. Le seuil de PCT choisi était de 1 ng/mL. Quarante-huit patients ont été inclus : âge médian 68 ans [17–90], 22 (46 %) hommes, 26 (54 %) femmes. La cause de l’obstruction était : 29 (60 %) calculs, 7 (15 %) sondes urétérales bouchées, 4 (8 %) sténoses urétérales, 2 (4 %) compressions extrinsèques, 6 (13 %) sans cause. Trente-trois sur 43 hémocultures positives ont principalement mis en évidence 3 germes : 14 Escherichia coli, 5 Klebsiela pneumoniae, 4 Proteus mirabilis. Une PCT > 1 ng/mL à l’admission était : – un facteur de risque d’ESS : 0/17 (0 %) si PCT < 1 ng/mL versus 17/31 (55 %) si PCT > 1 ng/mL (OR = 21) (p = 0,001) ; – un facteur de risque d’hémoculture positive : 1/15 (7 %) si PCT < 1 ng/mL versus 14/28 (50 %) si PCT >1 ng/mL (OR = 15) (p = 0,001) ; – un facteur de risque d’hospitalisation plus longue : 4,2 vs 7,6 jours (p = 0,03). Les patients pris en charge pour une pyélonéphrite aiguë obstructive ayant une PCT > 1 ng/mL à l’admission avaient un risque augmenté de ESS. Le dosage systématique de la PCT lors de la prise en charge initiale d’une pyélonéphrite aiguë obstructive pourrait permettre d’identifier les patients à risque de complications infectieuse, et de prioriser leur prise en charge.

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.

Angiomyolipoma is the most frequent benign renal solid tumor. Because of the lack of fat component on the CT scan, diagnosis of this tumor is hard and can require percutaneous biopsy of unknown renal tumor. The follow-up of the poor fat CT scan component AML (PFCT AML) is uncertain.Five hundred percutaneous renal biopsy under tomodenstitometry have been realised between 1998 and 2008. There was 41 PFCT AML on the 500 biopsy. By definition, a PFCT AML is an AML where the diagnosis is done on a percutaneous biopsy but where there was no fat component on the first CT scan. We studied and compared clinical, tomodensitometric and histologic parameters of these 41 patients (mean age: 56, 9±11.04; sexe rate M/F: 6/35) where renal AML was diagnosed on percutaneous renal biopsy but without fat component on CT scan. Average size was 26.44±14.68mm. We phone-called 16 patients for the long-term follow-up. Average follow-up was 41±28.3 months. For four patients on 16, initial diagnosis was done in front of local symptoms, for one of the 16 diagnosis was done in front of general symptoms, for one of the diagnosis was done during Bourneville tuberous sclerosis evolution and 10 of the 16 was done fortuitously.After review of the initial CT scan, fat density was found on 24% of them. Ten percent was epithelioid angiomyolipoma. Four renal biopsy on 41 (10%) was epithelioid AML. No epithelioid AML had fat component after the second look of the CT scan. Among the 16 patients who were phone-called, three (19%) underwent a complication. Two had abdominal pain and was treated medically. Initial sizes were 26 and 30mm. Only one patient must be operated by radical nephrectomy for acute hemorrhage. Initial size was 45mm. No neoplasic degeneration was identified for those 16 patients.In our study, the PFCT AML rate was 8.2%. In 25% cases, CT scan read-through shown a fat component and could help for the diagnosis. PFCT AML evolution seems to be the same as a classic AML. Conservative treatment had a good covering because there was no death and no malignant evolution. However, we found 10% of epithelioid angiomyolipoma in which malignant risk is high. PFCT AML diagnosed on renal percutaneous biopsy of unknown renal tumor requires the same management than the classic AML.

OBJECTIVE:We report a case of laparoscopic nephrectomy of a cross-fused ectopic kidney in a 4-year-old girl with renal hypertension and Fanconi anemia.MATERIALS AND METHODS:We performed a transperitoneal laparoscopy. Ectopic kidney resection was done after dissection of the pathological kidney and after clamping vessels, using an ultrasonic device. Hospitalization time was 4 days.RESULTS:At 6 months, blood pressure was normalized and the patient showed an adequate growth curve.CONCLUSION:The transperitoneal route is very effective when a nephrectomy is necessary. It offers perfect exposure with limited risk of complications.

We report the case of an early local recurrence after a laparoscopic partial nephrectomy (LPN) for a Furhman grade 1-2 clear cell renal carcinoma (CCRC). CT scan at 6 months revealed a local recurrence. An open total nephrectomy was performed. There were six nodules in the perirenal fat from a grade 3 CCRC. Twenty-six months after the LPN, the patient had a wound recurrence, which was surgically removed. Four months after the wound recurrence, the patient had pulmonary, liver and adrenal glands metastasis. He received an oral treatment with sunitinib. At 4 months after the initiation of the sunitinib, he had a total response.

No study on side effects had showed that conformal radiation therapy for prostate cancer is more harmful in patients older than 70 years to patients younger. The aim of this study was to evaluate acute and late toxicities of conformal radiotherapy, with high dose for localized prostate cancer in patients older than 70 years and compared to patients younger than 70 years. Between 1996 and 2009, 104 patients were treated with radiation therapy and hormonal therapy for localized cancer prostate. Median follow-up was 105 months (9-300). Acute (occurred at ≤ three months) and late side effects of 55 patients older than 70 years (median age: 75 [71-92]) were graded according to the CTCAE 3.0 criteria and compared to the younger population. Median dose to the prostate was 75.6 Gy (67-80) in both groups. There were no significant differences in acute and late side effects between age groups. For patients above 70 years, the incidence of grade II or higher acute and late side effects were respectively 27 and 22% for urologic symptoms and 13 and 16% for rectal symptoms. The frequency of grade III late symptoms was low and ranged between 0 and 6% for the evaluated symptoms, irrespective of age group. Older patients had a better biochemical recurrence-free survival than younger patients (86 versus 77% at four years, P=ns). High dose 3D conformal radiotherapy for localized prostate cancer was well tolerated in patients older than 70 years. Age is not a limiting factor for conformal radiation therapy and hormonotherapy for older patients.

The possibilities of the combined use of neural networks and fuzzy set theory in the form of constructing a so-called fuzzy neural network (FNN) or granular neural network (GNN) [1] for predicting crop yields in the Rostov oblast and Krasnodar and Stavropol krais are examined. The results of modeling plant growth on the basis of the CGMS simulation model as well as the values of the vegetation index NDVI, calculated from the SPOT VEGETATION satellite data, are the input parameters. As a result of training the neural network, the accuracy of predicting yields is on average about 75%.

The Joint Research Centre (JRC), in collaboration with the Food Agriculture Organization (FAO), has developed for East Africa an operational crop yield monitoring and forecasting system (CYMFS). The CYMFS integrates into a Geographical Information System (GIS): the meteorological information of the European Centre for Medium-Range Weather Forecast (ECMWF), the Crop-Specific Water Balance (CSWB) model, and the Crop Production System Zones database (CPSZ). Additional and independent real-time satellite data from SPOT VEGETATION were analyzed using a specific crop mask to concentrate the analysis only on agricultural areas. This approach gives to the food analyst a qualitative picture of crop yield expectation for rain-fed crops at different stages of the growing season. The proposed methodology was applied to the first crop season of 2001 and 2002 and demonstrated a clear potential in crop monitoring and yield forecasting. The results obtained during the extremely dry year of 2002 proved that the crop monitoring system was timely and geographically precise. A new crop cycle progress index (CCPI) was developed to take into consideration the agro-ecological heterogeneity of the region.

Relative time NDVI mosaics are proposed as a tool for crop growth monitoring and yield forecasting. The mosaics are constructed for the region of interest for a given phenological phase of crop development (for example, flowering). Mosaics for different years, created for the same characteristic time of crop development, are used for crop growth monitoring and yield forecasting. The approach is illustrated through two case studies: - forecasting of wheat yield in the countries of Northern Africa (relative time NDVI mosaics are constructed for the flowering stage of crop development); - assessing winter crop status in southern areas of Russia after the winter season (mosaics are constructed two dekads before the establishment of snow cover and two dekads after its disappearance). NDVI values, calculated from SPOT4-Vegetation data, were used in both cases. Dates of crop phenological phases were determined applying the WOFOST crop growth model and ECMWF-derived meteorological grid data. Results demonstrate the validity of the approach and the improvements obtained as compared with traditional methods.

The objective of the research presented here is to obtain crop yield forecasts basing on the information of NOAA- AVHRR/NDVI and CORINE land cover data. The methodology described in Genovese et al. (2001) consists of extracting yield indicators from CNDVI (CORINE-NDVI) time series at a regional scale. In Genovese et al. (2001), a preliminary study on Spain for a four year span (1995-1998) has shown that indicators extracted from the CNDVI profiles can be more closely related to crop yield performances than indicators based on simple NDVI profiles. To prove the validity of this approach, a more complete experiment was realised on France for the same period. Linear regressions were calculated using regional CNDVI-based indicators versus regional wheat yield data (EUROSTAT NEW CRONOS database). A French national wheat yield forecast was then derived by aggregation of regional results. The goodness of the results confirms the advantages of such approach. The combination of a CNDVI-based indicator with the linear trend observed on yields between 1975 and 1997 led to very good regression criteria (coefficient of determination higher than 86%) and allowed a satisfying prediction of wheat yields.