[Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. / Traitement chirurgical et interventionnel de l'obstruction sous-vésicale liée à une hyperplasie bénigne de prostate : revue systématique de la littérature et recommandations de bonne pratique clinique du Comité des Troubles Mictionnels de l'Homme.

OBJECTIVE: The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS: All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES: Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION: Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.

[Risk of rectal perforation during intention to treat laser photovaporization of prostate with transrectal ultrasound guidance: a report of 4 cases]. / Risque de perforation rectale liée à l'utilisation de l'échographie endorectale au cours de la photovaporisation prostatique au laser en intention de traiter : à propos de 4 cas.

CONTEXT: Transrectal ultrasound guidance (TUG) during prostate endoscopic surgery can optimize the procedure by reducing the risk of capsular perforation and ascertain the treatment completeness. TUG is proposed during photoselective vaporisation of prostate (PVP). OBJECTIVE: To report four cases of rectal perforations during PVP with TUG and assess their occurrence. MATERIALS AND METHODS: This is a retrospective study including prostate endoscopic surgeries with TUG, performed in two centers between November 2011 and May 2013. Rectal perforations were identified. Surgical data, treatment modalities and postoperative outcomes of rectal perforations were analysed. RESULTS: Four rectal perforations were identified among 450 surgical procedures. Median age and prostate volume were 80 years old [62-91] and 40mL [13-150], respectively. Two perforations occurred during PVP with Greenlight(®) XPS 180W. Two perforations occurred during transurethral resection of prostate or cervicoprostatic incision. Patients were treated by systematic urinary drainage associated with colostomy or direct suture. Two patients died from this complication and two patients have satisfying functional outcomes at one year. CONCLUSION: TUG during prostate endoscopic surgery could lead to rectal perforation by protusion of the prostate and therefore should be used cautiously. LEVEL OF EVIDENCE: 5.

[Ambulatory prostate photoselective vaporisation with GreenLight laser (180W): prospective evaluation from 115 patients]. / Vaporisation laser prostatique par GreenLight (180 W) en ambulatoire: évaluation prospective sur 115 patients.

OBJECTIVE: The goal of this prospective study was the evaluation of ambulatory (less than 12h) prostate photoselective vaporisation (PVP) with GreenLight laser XPS. MATERIEL AND METHODS: One hundred and fifteen consecutive patients eligible for ambulatory procedure according to selective criteria (age less than 80, no anticoagulation treatment, no diabetes, patient not alone at home) who underwent ambulatory PVP from 1st May 2012 to 30th June 2013 have been evaluated. The principal criterion was the success rate of ambulatory. Secondary criteria were 3 months functional results and complication rate and satisfaction rate on ambulatory procedure. RESULTS: Around 93.1% patients were successfully treated in ambulatory procedure. The main reason of failure was organizational. There were 2 conversions in monopolar resection and one operative complication. At 3 months, there were 11.5% grade 2 complications with 3.48% rehospitalizations and no reintervention. CONCLUSION: This study demonstrates the feasibility of ambulatory PVP. This procedure should be proposed to selected patients.

[Testicular trauma: report of 56 cases]. / Traumatismes testiculaires: à propos de 56 cas.

OBJECTIVES: To assess the diagnostic value of clinical examination and ultrasound in testicular trauma and to analyse the complications of the various treatments proposed (surgical and medical treatments), in order to more clearly define the place of medical treatment in this form of trauma in young adults. PATIENTS AND METHODS: 56 cases of testicular trauma in 50 patients were managed between January 1990 and January 2000. In the absence of clinical and ultrasonographic criteria of severity (haematocele, very large intratesticular haematoma, rupture of the tunica albuginea), medical treatment consisting of rest, anti-inflammatory drugs, and testicular support was instituted. Surgical exploration was performed when serious lesions of the testis were suspected. Three subgroup were defined: the medical treatment subgroup, the early surgical treatment subgroup, and the deferred surgical treatment subgroup (more than 3 days after trauma). The immediate morbidity and long-term sequelae were analysed in each of these three subgroups. RESULTS: The clinical features of pain and scrotal swelling make assessment of the lesions difficult. Testicular ultrasound can help the clinician, but it has a low sensitivity for the diagnosis of testicular rupture. No significant difference was observed between the three subgroups in terms of morbidity, orchidectomy, and long-term sequelae rates. CONCLUSION: In the absence of signs of severity, medical treatment with regular surveillance remains justified. However, in the case of doubtful clinical or ultrasound findings, surgical exploration must be performed as soon as possible.

[Spontaneous thrombosis of left varicocele]. / Thrombose spontanée d'une varicocèle gauche.

Spontaneous thrombosis of a varicocele is a rare event and difficult to diagnose, as the clinical symptoms during the acute phase can simulate torsion of the spermatic cord or strangulated inguinal hernia leading to a useless surgical exploration. The authors report a case of spontaneous thrombosis of a varicocele which was diagnosed clinically, allowing conservative medical treatment.

[Spermatic cord torsion in adults]. / Les torsions du cordon spermatique chez l'adulte.

OBJECTIVES: The objective of this retrospective study, conducted between January 1988 and December 1998, was to demonstrate that physical examination is sufficient to manage patients with torsion of the spermatic cord. MATERIAL AND METHODS: 72 patients, admitted with an empirical diagnosis of torsion of the spermatic cord based on physical examination, underwent emergency surgery via a scrotal incision. Orchidopexy was performed when the surgical diagnosis was in favour of torsion. We classified our series into 2 groups according to the presence or absence of torsion and we defined two subgroups in the torsion group: the orchidectomy subgroup and the non-orchidectomy subgroup. RESULTS: The suspicion of torsion of the spermatic cord was confirmed in 70.8% of cases. No mortality or morbidity were observed for wrongly operated patients. The study of the sensitivity (Se) and positive predictive value (PPV) of clinical signs defined a group of men requiring emergency surgical exploration: men presenting with scrotal pain in the absence of any urinary signs (Se = 98%, PPV = 72%), negative urinary dip-stick (Se = 97%, PPV = 71%), with pain described as violent (Se = 80%, PPV = 76%), an ascended testis (Se = 62%, PPV = 86%) and a subacute stage (Se = 68%, PPV = 79%). The only pejorative factor detected in the presence of testicular necrosis was a delay before management greater than 6 hours. The length of hospital stay (p < 0.041) and the complication rate (p < 0.023) were greater in the orchidectomy subgroup compared to the non-orchidectomy subgroup. CONCLUSION: This retrospective study confirms that physical examination is sufficient to ensure good management of torsion of the spermatic cord in adults and that emergency surgical exploration is justified at the slightest doubt.

Sleep apnoea syndrome secondary to rheumatoid arthritis.

A patient who developed severe sleepiness and sleep apnoea in association with adult acquired retrognathia and subluxation of the cervical spine at the level of C3-C4, both resulting from rheumatoid arthritis, is described. The possible causative factors of the association between sleep apnoea and rheumatoid arthritis include reduction of the size of the upper airway by temporomandibular joint destruction, brainstem compression due to rheumatoid arthritis affecting the cervical spine, sleep fragmentation, and drug effects.