2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones.

The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.

2022 Recommendations of the AFU Lithiasis Committee: Ureteroscopy and ureterorenoscopy.

Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.

2022 recommendations of the AFU Lithiasis Committee: Objectives, results, residual stones and fragments.

The main objectives of interventional stone treatment are stone removal, symptom elimination, and kidney function preservation. After treatment of kidney stones (extracorporeal shock wave lithotripsy [ESWL], or endoscopy), fragments may remain in the kidney, either deliberately left in place or due to treatment failure (i.e. residual stone [RS], resistant to ESWL, left or inaccessible by endoscopy), or due to failure to eliminate the obtained fragments (i.e. residual fragments [RF]). Their management may differ. The most commonly used definition of RF in the literature is based on a size cut-off (≤4mm) and on three criteria: spontaneous clearance rate, secondary intervention rate, and disease progression rate. RF may be spontaneously eliminated (42%), persist and increase in size (32%), or become complicated and require a secondary urological procedure (36%). Like for the initial treatment, it is important to consider the stone composition for the treatment decision-making concerning RS/RF. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) (EAU, 2022) and their adaptability to the French context.

[Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]. / Recommandations du Comité Lithiase de l'Association Française d'Urologie pour la prise en charge des calculs urinaires durant la crise sanitaire liée à la pandémie à COVID-19.

For the first time, faced with a crisis with an exceptional magnitude due to the COVID-19 pandemic responsible for saturation of emergency services and intensive care units, the urolithiasis committee of the French Urology Association designed the recommendations for care and treatment of stone-forming patients and their treatment during crisis.

[Evolution of urolithiasis treatment over 30 years in a French academic institution]. / Évolution du traitement chirurgical de la lithiase urinaire sur 30ans dans un centre hospitalo-universitaire.

OBJECTIVE: To assess the evolution of the annual number of surgical procedures and the surgical management for urolithiasis. METHODS: A retrospective monocentric study was conducted between 1985 and 2014 in a French academic institution. The study population was divided into four groups: extracorporeal shock wave lithotripsy (SWL), flexible and rigid ureteroscopy (URS), percutaneous nephrolithotomy (PCNL) and open surgery. The annual number of surgical procedures as well as the distribution of each technique was determinated by using the operating records. RESULTS: In all, 23,162 procedures were performed during this period. The annual number of procedures rose from 410 in 1985 to 1071 in 2014, representing a rise of 161%. SWL represented 85.6% (351/410) of all surgeries in 1985 then 21.3% in 2014 (228/1071). In contrast, URS accounted for 4.4% (18/410) of all surgeries in 1985 and rose to 76% (814/1071) in 2014. The number of URS has reached the SWL in 2007 and then became the main surgical treatment. The number of PCNL remained stable during the study period but its proportion decreased due to the increased activity, representing 7.1% (29/410) in 1985 and 2.6% (28/1071) in 2014. Open surgery is rarely practiced and represents currently 0.1%. CONCLUSION: The number of surgical procedures for urolithiasis has more than doubled in 30years. SWL represented the main treatment until 2007 and its number decreased whereas ureteroscopy represents now the most common stone treatment in our institution, PCNL remaining stable. LEVEL OF EVIDENCE: 5.

[Flexible ureteroscope damages. Evaluation of university hospital service equipment]. / Sinistralité des urétérorénoscopes souples. Évaluation du parc matériel d'un service hospitalier universitaire.

OBJECTIVE: To evaluate predictors of flexible ureterorenoscopes breakage and damage of their optical beam. MATERIALS AND METHODS: Retrospective survey, single center on 393 interventions with 4 flexible ureterorenoscopes between January 2009 and March 2013. We analyzed factors linked to patient, pathology and surgical technique. RESULTS: We identified 21 major accidents, a breakage rate of 5.34% and 76 pixels losses in the maintenance of endoscopes and 10 during the procedure. The only statistically significant predictor of loss was the cumulative duration of operating time since the last repair (P=0.04, OR=1.001 [1-1001]). For lesions of the optical beam between the procedures, parameters appearing as significant were the ureterorenoscope model (P=0.01, OR=2.558, 95% CI [1229-5326]), the use of instruments by the working channel: the laser (P=0.02, OR=2.06, 95% CI [1109-3827]), or the use of endoluminal graspers (P=0.007, OR=0.467, 95% CI [0269-0809]). Intraoperatively, the number of open or laparoscopic surgery (P=0.007, OR=3.105, 95% CI [1364-7068]), duration of intervention (P=0.01, OR=1.023, 95% CI [1.006-1041]) and the cumulative duration of intervention (P=0.003, OR=1.001, 95% CI [1-1002]) appeared to be statistically significant. CONCLUSION: The only predictor of loss of equipment under repair was the cumulative duration of operation time. It has not been demonstrated any difference between ureterorenoscopes. It was during the endoscopes disinfection that the majority of optical beam lesions take place.

[Screening of prostate cancer seen by general practitioners]. / Le dépistage du cancer de la prostate vu par les médecins généralistes.

INTRODUCTION: The screening of prostate cancer was recently the subject of international studies and debates in France. We decided to study the vision of the screening, in particular by the PSA, which have the general practitioners. METHODS: We sent a questionnaire to 456 general practitioners of Oise (French department) to be returned in an anonymous way on the prostate cancer, PSA, the economic impact of the PSA and we asked whether the doctors realized the screening or not, if they were favorable to it and for which reasons. RESULTS: We received 38% of answers. Eighty-one percent of the general practitioners considered that prostate cancer is frequent, 72% that it evolved slowly and 55% that it affected old men. For 79% of the general practitioners, the patients were asking for a screening by PSA. Eighty-eight percent thought that they had to be in front line of the screening, 58% that the functional consequences of the screening were satisfactory. Fifty-seven percent of the general practitioners realized the screening in a systematic way and 88% were favorable to it. CONCLUSION: The general practitioners of Oise remained favorable for the greater part to the screening of prostate cancer and the patients applicants in spite of various debates.

[Vascular complication of an acute pyelonephritis]. / Complication vasculaire d'une pyélonéphrite aiguë

This article reports a rare case of acute pyelonephritis with bacteriemia due to non-tiphoidal Salmonella associated with a mycotic aneurysm. The patient was a 75-year-old woman without histories of immunosuppression or urologic deformation. It was about a patient presenting a feverish access and urinary symptoms. Blood culture and urine culture showed Salmonella enteritidis; in spite of a prolonged antibiotic treatment, the multiple bacteriological explorations remained positive. The research for this infection source allowed the discovery of a thoracic aorta aneurysm with hypermetabolism in the PET-scan carrying the diagnosis of mycotic aneurysm. Urinary salmonellosis represents 0.07% (Tena et al., 2007 [1]) of the urinary tract infections. They are rarely found in healthy patients; their eradication can turn out to be difficult when the infection source persists.

[Evolution of prostatic surgical interventions: analysis of French national coding database]. / Évolution de la prise en charge chirurgicale des pathologies prostatiques : analyse nationale du codage.

INTRODUCTION: Prostatic diseases are very important in urologist's practice. We wanted to study evolution of prostatic procedures using French national coding database. METHODS: We searched the Agence Technique d'Information sur l'Hospitalisation (ATIH) web server for prostatic procedures between 1997 and 2011 for both private and public sectors. RESULTS: The procedures were more often performed in private sector (up to 70%). There was a sustained increase (+332%) of the number of prostatectomies between 1997 and 2007 (more than 27,000 procedures), followed by a slight decrease. There is a rising use of laparoscopic approach from 35% in 2006 up to 58% in 2011. The use of brachytherapy and HIFU was marginal. Transurethral resection of the prostate number was stable between 56,000 and 60,000 procedures a year (for cancer for less than 7%). Adenomectomies number decreased from 9832 to 7963 procedures a year. CONCLUSION: The most noticeable data were upon prostatectomies number, with a peak effect in 2007. Laparoscopic procedures were more and more frequent. TURP number was stable, whereas adenomectomies number decreased.

[A western cohort of urinary schistosomiasis]. / Bilharziose urinaire : une série française.

UNLABELLED: Urinary schistosomiasis is very frequent, but there are few data upon its epidemiology in western countries. We wanted to describe the cohort from Tenon hospital, in Paris, France, near a big subsaharian community. METHODS: We searched in our clinical files database for "urinary schistosomiasis" encoding. RESULTS: The cohort comprised 207 men and 34 women seen for the first time at the mean age of 34, mainly for haematuria or LUTS. Patients were mainly native from subsaharian Africa. The lost to follow up rate was 54%. Diagnosis was made on sole endoscopic finding in half of the cases. For non-tumor pathology, were made seven cystoplasties et 12 ureteral dilations. Tumoral pathology was frequent and severe (15/81 from the same age range), mainly represented by urothelial histology (8/14). Imported cases were rare (five cases). CONCLUSION: Despite its limitations, different characteristics from this cohort seemed noticeable: frequency of sole lower urinary tract symptoms, frequency and severity of tumoral diseases, mainly with urothelial carcinoma as histology.

[Radiotherapy influence, about results of the InVance(®) male sling in men with stress urinary incontinence]. / Influence de la radiothérapie, sur les résultats du traitement de l'incontinence urinaire d'effort chez l'homme, par soutènement sous urétral de type InVance(®).

AIMS: To study impact of previous radiotherapy on urodynamic parameters, continence and complication rate, after prosthetic implantation with InVance® device. PATIENTS AND METHODS: We included 106 patients between August 2004 and March 2009. We stratified urinary incontinence according to pads daily used, in grade I (one to two pads), II (three to four), or III (more than four or condom catheter use). We compared one group of 24 patients with previous radiotherapy (R) to 82 control patients (T) without one. Follow-up was made at three and six postoperative months and then annually. Results were classified into: no leaks, improved or failure. RESULTS: Mean follow-up was 14.8 months (median=12.8) in group R and 12.4 months (median=8.8) in group T. At three postoperative months, continence was achieved in 62.5% patients from group R and in 77% patients in group T (P: ns). At 12 months, results on continence were respectively 52.6% in group R and 63.2% in group T (P: ns). Six patients were explanted because of an infection (5.7%), among which two in group R (8.3%) and four in group T (4.8%). Infection was significantly linked to operative time (P: 0.02). CONCLUSION: Previous radiotherapy has no impact on urodynamic parameters and continence, on short- and mid-term analysis, after implantation of a bone-anchored suburethral sling with InVance® device, preferentially patients with mild to moderate incontinenec urinary.

[In-hospital stays for urolithiasis: analysis of French national data]. / Séjours hospitaliers pour lithiase : analyse des données nationales.

INTRODUCTION: Urolithiasis is of health economics concern since it is very frequent. However, there is few data upon its issue in France. METHODS: We have analyzed the data issued from the national coding system for in-hospital stays and interventions, using urolithiasis codes and compared between public and private sectors. We have observed evolution of procedures and stays until 2009. RESULTS: Public and private sectors were quite similar in terms of stays numbers (144,324 in 2009, and an evaluated total cost of more than 168 millions of euros). Since 2000, there has been an increase of more than 20% in the number of stays in the public sector and a stagnation in the private one. Public and private sectors appeared different in terms of: (1) stays without intervention (53 vs 26%; p<0.0001); (2) stays without associated diagnosis (5.78 vs 8.41%; p<0.0001). Since 2006, there has been a stagnation for percutaneous and surgical interventions (less than 5% of the number of interventions) whereas there has been a clear increase in endoscopic (+29% in private sector and +16% in public one) and lithotriptic (+19 and +5%) interventions. CONCLUSION: There were strong disparities between public and private sectors. Endoscopic interventions and lithotrity sessions have shown a sustained increase. Surgical and percutaneous interventions have shown a stagnation.

[Twinkling artifact on Doppler US: clinical presentations]. / L'artefact de scintillement en écho-Doppler et situations cliniques.

Twinkling artifact characterized by a rapidly fluctuating mixture of Doppler signals occurs behind a strongly reflecting granular interface such as urinary tract stones or gallstones. It may occurs in association with several clinical situations, and may sometimes be helpful for diagnosis while it may sometimes be a pitfall that must be recognized by the sonographer. After reviewing the technical nature of this artifact, several cases will be presented to illustrate the advantages and pitfalls related to this artifact.

Endoscopic management of urologic complications following renal transplantation: impact of ureteral anastomosis.

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%.

[Public health approach and urology]. / La démarche de Santé publique en urologie.

Public health approach, in its different fields: observational epidemiology, interventional epidemiology, health economics or health education carries major problems that can influence everyday practice. We review some practical examples of what public health can afford to urology practice.