[Mirror survey of patients with urge urinary incontinence and healthcare professionals]. / Enquête miroir auprès de patients et de professionnels de santé portant sur l'incontinence urinaire par urgenturie ou mixte.

BACKGROUND: This survey assessed how much of a taboo surrounds urge or mixed urinary incontinence (UI), through questions to affected patients and healthcare professionals using online questionnaires, with the objective to contrast the patients' perceptions with that of the doctors. METHODS: This quantitative study was preceded by a qualitative phase carried out with general practitioners, specialists, and UI patients. Following these phases, questionnaires were made available on the internet. They covered questions pertaining to perceptions of UI, degree of embarrassment and its consequences, patient-doctor relationship, and treatments. RESULTS: Overall, 310 UI patients of male or female gender participated in the study, as did 101 general practitioners, 50 urologists, and 30 gynecologists. The analysis revealed that 60% of patients felt embarrassment about UI, the condition representing for them a taboo topic similar to cancer. This taboo was shown to be seen further enhanced by doctors. UI was associated with a loss of self-esteem (51%) and restriction to daily life (44%). The patients' answers revealed that UI was only brought up by doctors in 6% of cases, whereas the patient was the first to bring it up in 55%, primarily with their general practitioner (80%). Thus, in 4 out of 10 cases, the issue was not addressed; 49% of patients stated they did not discuss their condition with their partner and 33% did not discuss it with anybody. CONCLUSION: UI is still a major taboo and we have a long way to go to change attitudes. LEVEL OF EVIDENCE: 3.

Quality of life and functional outcomes after radical cystectomy with ileal orthotopic neobladder replacement for bladder cancer: a multicentre observational study.

PURPOSE: Ileal orthotopic neobladder (IONB) reconstruction is the preferred urinary diversion among selected patients who have undergone radical cystectomy (RC) for bladder cancer (BCa). There is insufficient data regarding patients' quality of life (QoL), sexual and urinary outcomes. Our objectives were to assess QoL in a multicentre cohort study, and to identify related clinical, oncological and functional factors. METHODS: Patients who underwent RC with IONB reconstruction for BCa from 2010 to 2017 at one of the three French hospitals completed the following self-reported questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Univariate and multivariate analyses were computed to identify clinical, pathological, and functional predictors of global QoL score. RESULTS: Seventy-three patients completed questionnaires. The median age was 64 years and 86.3% were men. The median interval between surgery and responses to questionnaires was 36 months (range 12-96). Fifty-five percent of patients presented a high global QoL (EORTC-QLQC30, median score 75). A pre-RC American Society of Anesthesiologists score > 2, active neoplasia, sexual inactivity, and stress urinary incontinence were associated with a worse QoL. After a multivariate analysis, sexual inactivity was the only independent factor related to an altered QoL. CONCLUSION: Patients with IONB reconstruction after RC have a high global QoL. Sexual activity could independently impact the global QoL, and it should be assessed pre- and post-operatively by urologists.

Evaluation of care given to patients suffering from erectile dysfunction by French urologists in 2018.

Erectile dysfunction varied by country, affecting between 20 to 40% of men aged 60 and 69 and more than 50% of men aged over 75. Our objective was to evaluate the habits of urologists in 2018 and also evaluate the need for additional, objective tools to aid physicians when providing care. A questionnaire was sent from the French Urology Association to 1158 physicians between November and December 2018. In all, 177 urologists (15.28%) took part in the study. Only 22% of urologists regularly used a questionnaire, such as the IIEF-5. When faced with erection problems, 56.5% of them did not carry out systematic cardiology evaluations. More than half of urologists requested fasting glucose, lipid and total testosterone levels. Twenty-seven percent did not carry out additional tests. First line treatment included a phosphodiesterase 5 inhibitor in 81% of cases. Two thirds of urologists (78%) rated themselves as being correctly trained in the area of erectile dysfunction. However, only 49% systematically inquired about erection problems when faced with benign prostatic hyperplasia and 65% thought that erectile dysfunction was not treated optimally. Despite existing recommendations, only half of urologists carry out a cardiac evaluation when a finding of erectile dysfunction is made. One third of urologists do not request additional testing. Greater training, along with the use of an objective diagnostic tool could help urologists to optimise the care they provide for patients suffering from erectile dysfunction, allowing them to keep working within current guidelines. LEVEL OF EVIDENCE: 3.

[Non-surgical management of Peyronie's disease: State of current knowledge]. / Les thérapeutiques non chirurgicales de la maladie de Lapeyronie : état des lieux des connaissances actuelles.

BACKGROUND: Peyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition. MATERIAL AND METHODS: A literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner. RESULTS: Multiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement. CONCLUSION: Multiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.

[Orthotopic neobladder reconstruction for bladder cancer: robotic-assisted versus open-radical cystectomy for perioperative outcomes, functional results and quality of life]. / Morbidité, résultat fonctionnel, et qualité de vie des néovessies après cystectomie pour cancer : comparaison de la voie ouverte vs robotique.

INTRODUCTION: Open radical cystectomy (ORC) is the gold standard technique for carcinologic cystectomies. Robotic-assisted radical cystectomy (RARC) was introduced in 2003 and its development is booming. OBJECTIVE: To compare ORC and RARC with totally intracorporal (IC) orthotopic neobladder (ONB) reconstruction, in terms of perioperative outcomes, morbidity, functional results and quality of life (Qol). PATIENTS AND METHODS: From February 2010 to February 2017, a French multicentric, prospective study on patients who had a RC and ONB reconstruction for bladder cancer was performed. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and the bladder cancer specific instruments (QLQ-BLM30). To assess urinary symptoms, patients also completed the Urinary Symptom Profile questionnaire (USP) and a three-day voiding diary. Patients were divided in two groups: ORC and RARC. RESULTS: We included 72 patients: 55 in the ORC group (76,4%) and 17 (33,6%) in the RARC group. Operative time was longer in RARC group (median 360 vs 300min; P<0.001) but length of stay was 5 days shorter (median 12 vs 17 days; P<0,05). Patients in RARC group had less blood transfusion (0 vs 23.6%; P<0.05), but a higher rate of uretero-ileal anastomosis stenosis and eventration at long term (respectively 25.5 vs 3.6% et 23 vs 2%; P<0.05). No statistical differences were found concerning quality of life items and functional results between the groups. CONCLUSION: RARC with totally IC ONB reconstruction lead to less perioperative morbidity with a reduced rate of blood transfusion and a reduced hospital length of stay. At long term, RARC could provide higher rates of uretero-ileal stenosis and eventration. RARC and ORC do not have any differences in terms of functional outcomes and Qol at long term after ONB reconstruction. LEVEL OF EVIDENCE: 3.

Perioperative infectious risk in urology: Management of preoperative polymicrobial urine culture. A systematic review. By the infectious disease Committee of the French Association of urology.

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.

[Interest of a systematic assessment of the treatment of the lower urinary tract symptoms in the management of benign prostatic hypertrophy in general practice (1380 patients) - Study EVALURO]. / Intérêt d'une évaluation systématique du traitement des symptômes du bas appareil urinaire dans la prise en charge d'une hypertrophie bénigne de la prostate en médecine générale (1380 patients) ­ Étude EVALURO.

OBJECTIVE: To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms. METHODS: This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit. RESULTS: Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly. CONCLUSION: A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.

[Short version of recommendations for enhanced recovery program (ERP) for cystectomy: Technical measures]. / Version courte des recommandations de la récupération ameliorée après chirurgie (RAAC) pour la cystectomie : mesures techniques.

INTRODUCTION: The enhanced recovery program (ERP) is a management mode whose objective is to reduce the risk of complications and allow the patient to recover more quickly all its functional capacities and to reintegrate at most quickly and safely in his usual environment. This intentionally synthetic document aims to disseminate in the urological community the main points of the ERP recommendations for cystectomy. This work, coordinated by AFU, involves several other partners. The full document is available on the "Urofrance" website. Another article will follow on organizational measures. METHOD: The development of the recommendations is based on the method "formalized consensus of experts" proposed by the HAS. The report is based on a systematic review of the literature (January 2006-May 2017), two rounds of iterative quotations and a national proofreading. Levels of proof of conclusions and gradation of recommendations are based on the HAS grid. RESULTS: The bibliographic strategy made it possible to retain 298 articles. Only the recommendations that obtained a strong agreement after the two rounds of iterative listing were retained. The recommendations presented here are in chronological form (before, during, after hospitalization). Twenty-six key points on the technical and organizational measures of ERP have been identified. CONCLUSION: The result of the literature review, supplemented by expert opinion, suggests a significant clinical interest in the application and dissemination of ERP for cystectomy, despite the limited data available for this indication.

[Validation of visual prostate symptom score, VPSS, in the evaluation of lower urinary tract symptoms associated with benign prostatic hyperplasia (550 patients)]. / Validation du score visuel prostatique en images SVPI dans l'évaluation des symptômes du bas appareil urinaire associés à une hyperplasie bénigne de la prostate (550 patients).

OBJECTIVES: Our objective was to validate the VPSS (visual prostatic symptom score) score in the French language for the identification and monitoring of BPH-related LUTS in urological practice. METHODS: A prospective observational survey was carried out between September the 15th 2014 and July the 30th 2015 in urology practices. The first 4 consecutive patients aged over 60 years, with BPH-related LUTS requiring prescription of an alpha-blocker, were enrolled. We translated a "visual prostatic symptom score" (VPSS) into French and adapted it slightly. At the first visit and follow-up visit (1-3 months after the first visit), the patient completed 2 questionnaires: the French language version of the IPSS and the VPSS. RESULTS: Of the urologists contacted, 169 enrolled at least one patient and returned information; 550 questionnaires were included in the statistical analysis. The median IPSS and VPSS total scores, subscores and quality of life scores all decreased significantly (P<0.0001) between enrolment and the follow-up visit 1-3 months later. Correlations between the IPSS and VPSS at enrolment and the follow-up visit and their variation were all significant. Total VPSS was significantly correlated with total IPSS, as were the irritative, obstructive and quality of life subscores evaluated on the corresponding pictograms. CONCLUSIONS: This study showed the VPSS to be a simple and useful tool for identifying and monitoring BPH-related LUTS. LEVEL OF EVIDENCE: 4.

[Guide dedicated to general practitioner for the management of lower urinary tract symptoms related to benign prostatic hyperplasia]. / Guide de prise en charge en médecine générale des symptômes du bas appareil urinaire de l'homme liés à une hyperplasie bénigne de la prostate.

OBJECTIVE: To establish a guide dedicated to general practitioner for the diagnosis, the follow-up, and the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). METHOD: Guidelines already published for urologists were modified to make them relevant for general practitioners. The role of specialist's referral was defined. The whole content of the document was submitted to the formal consensus process in which urologists and general medicine teachers were involved. RESULTS: Initial assessment has several aims: making sure that LUTS are related to BPH, assessing bother related to LUTS, and checking for a possible complication. Initial assessment should include: medical history, physical examination with digital rectal examination, and urinalysis. Some other explorations such as frequency volume chart, serum PSA or creatinine, and ultrasonography of the urinary tract were found optional, meaning they are necessary only in specific situations. Referring to urologist is justified when LUTS might not be related to BPH (particularly when urgencies are predominant), or when a severe bladder outlet obstruction is suspected (severe symptoms, palpable bladder, post-voiding residual volume>100ml), or when a complication is assessed. Follow-up without treatment is justified for patients with no bothersome symptoms related to not complicated BPH. Several drugs are available for the treatment of bothersome symptoms related to BPH. Alpha-blockers and plants extracts might be offered as monotherapy. Five alpha reductase inhibitors might be offered to patients with LUTS related to a significant prostate hypertrophy (>40 ml) ; they might be given for a minimum duration of one year, alone or in association with alpha-blocker. The association of antimuscarinic and alpha-blocker might be used in patients with persistent storage LUTS in spite of alpha-blocker treatment. Phosphodiesterase 5 inhibitors might be offered to patients with erectile dysfunction associated with LUTS related to BPH. In case of complicated BPH, or when medical treatment is not efficacious or not tolerated, a surgical option should be discussed. CONCLUSION: The male lower urinary tract symptom committee of the French Urological Association and general practitioner present the first guide for the management of LUTS related to BPH dedicated to general practitioner. LEVEL OF EVIDENCE: 5.

[Observational survey of the French Urological Association evaluating intermittent hormonal modalities treatment in prostate cancer in France]. / Enquête observationnelle, transversale de l'Association française d'urologie (AFU) sur la pratique du traitement hormonal intermittent dans le cancer de la prostate en France.

OBJECTIVE: To assess clinical practice of intermittent hormone therapy (IHT) among urologists members of the French Association of Urology. METHODS: Internet-based observational survey evaluating IHT modalities in prostate cancer using questionnaire sent to 941 urologists. RESULTS: Two hundred and sixty nine urologists participated in the survey (response rate 28.6 %) including 90.3 % prescribing IHT. The main reasons for IHT were improvement of quality of life in 94.2 %, clinical tolerance in 73.7 %, decreased costs and oncological equivalence in 44 %. The indications were localized prostate cancer (low risk 22.6 %, intermediate 19.8 %, high 14 %), locally advanced (59.7 %), metastatic (63.4 %), biochemical recurrence after local treatment (prostatectomy 62.1 %, radiotherapy 73.7 %). A PSA <2 ng/mL was considered as the threshold for androgen deprivation therapy break in 70 % of cases regardless of the IHT indication. The PSA threshold selected for the re-initiation of treatment was 4 ng/mL in 37.9 % and 10 ng/mL in 36.6 % of cases. The cycle of IHT was 6 months in 60 % of cases. CONCLUSION: This survey provided a snapshot of the practice of IHT in France. Even in the absence of level of evidence 1 trials in the literature, most urologists used IHT in their clinical practice, for many indications, especially in case of biochemical recurrence after local treatment. LEVEL OF PROOF: 3.

[Evolution of lower urinary tract symptoms under silodosin: factors influencing patients' satisfaction]. / Évolution des symptômes du bas appareil urinaire sous silodosine: facteurs influençant la satisfaction des patients.

UNLABELLED: The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice. METHOD: This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3 months. RESULTS: Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2 ± 6.1 to 9.7 ± 5.5, P<0.0001) and USP score (from 10.6 ± 5.1 to 6 0 ± 4.6, P<0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P<0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P<0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3 months of treatment silodosin was continued in 86.9% of patients. CONCLUSION: This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.

[Antibiotic treatments in urology]. / Les médicaments antibiotiques en urologie.

OBJECTIVE: To define prescription modalities for the use of antibiotics in urology. METHODS: A bibliographic research was performed using the MEDLINE database concerning all the antibiotics usable in urology. Treatments were classified by families; modes of action, indications in urology and adverse events have been detailed. Administrative files for commercial use have been consulted and associated with literature analysis. RESULTS: About 8 classes of antibiotics are usable in urology in a routine use. How they work, indications in urology and adverse events are discussed. CONCLUSION: Knowing that bacterial resistance to quinilones is increasing dramatically, it seems imperative to control the use of 8 classes of antibiotics.

[Guidelines from the Infectious Disease Committee of the French Association of Urology and The Neuro-Urology Committee of the AFU: antibiotic prophylaxis for sacral neuromodulation]. / Recommandations de bonnes pratiques cliniques : antibioprophylaxie et neuromodulation des racines sacrées par le Comité d'infectiologie de l'Association française d'urologie (CIAFU) et le Comité de neuro-urologie de l'AFU.

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, 2g 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.

[CCAFU Recommendations 2013: Bladder carcinoma]. / Recommandations en onco-urologie 2013 du CCAFU : Tumeurs de la vessie.

INTRODUCTION: The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC). METHODS: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. RESULTS: Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS<1) and renal function (creatinine clearance > 60 ml/min) permits (only in 50% of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC.

[CCAFU Recommendations 2013: Upper urinary tract carcinoma]. / Recommandations en onco-urologie 2013 du CCAFU : Tumeurs de la voie excrétrice urinaire supérieure.

INTRODUCTION: The objective was to update the guidelines of the French Urological Association Cancer Committee for upper tract urothelial carcinoma (UTUC). METHODS: A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS: The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Total nephro-urectomy remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed : unifocal tumour and diameter < 1 cm and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. CONCLUSION: These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for UTUC.

[CCAFU Recommendations 2013: Penile cancer]. / Recommandations en onco-urologie 2013 du CCAFU : Tumeurs malignes du pénis.

INTRODUCTION: Malignant tumours of the penis are rare tumours. The objective of this article is to propose guidelines for the management of these tumours. MATERIAL AND METHODS: A review of the literature was performed by selecting articles on penile cancer published in PUBMED. RESULTS: The most common histological type is squamous cell carcinoma. Clinical examination of the penis is usually sufficient to assess local extension of the primary tumour, but it can be completed by MRI to assess deeper extension. Inguinal lymph nodes must be systematically palpated on both sides to assess regional extension. In the presence of palpable lymph nodes, aspiration cytology is recommended in combination with abdomen and pelvis computed tomography and (18)F-FDG PET-CT. Sentinel lymph node biopsy is recommended in the case of penile cancer at high risk of lymph node extension with no palpable lymph nodes. Treatment of the primary tumour is usually surgical. It must be as conservative as possible while ensuring negative surgical margins. Brachytherapy or local treatment (laser, cytotoxic cream, etc.) can be proposed in some cases. Bilateral lymph node chains must be systematically treated at the time of diagnosis of the disease. Inguinal lymphadenectomy alone has a curative role in patients with metastatic invasion of a single lymph node (stage pN1). In the case of more extensive lymph node involvement, multimodal management combining chemotherapy, surgery and possibly radiotherapy, must be considered. CONCLUSION: The treatment of penile cancer is usually surgical possibly in combination with chemotherapy in the presence of lymph node extension. The main prognostic factor is lymph node involvement, requiring appropriate management right from the time of diagnosis.