[Urinary tract infections in adults: Comparison of the French and the European guidelines]. / Infections urinaires de l'adulte : comparaison des recommandations françaises et européennes. Par le Comité d'infectiologie de l'Association française d'urologie (CIAFU).

INTRODUCTION: Acute urinary tract infections (UTIs) in adult are now a major public health issue in terms of morbidity, mortality and in terms of costs for society. The latest French guidelines and the European Association of Urology guidelines differ in some points. The aim of this article is to compare the guidelines of these two societies in order to highlight their differences but also their common points in the management of UTIs. METHODS: A comparative analysis of the latest French and European guidelines was carried out. The authors defined the following sub-sections: terminology, pyelonephritis, male UTIs, pregnancy urinary tract infections and cystitis. RESULTS AND CONCLUSION: The guidelines of these two societies are not very different in terms of diagnostic and therapeutic management. The major differences are in the duration of antibiotic therapies, where French guidelines continue to recommend long term treatments where EAU sometimes recommends only 5 days of antibiotics, as in the case of simple acute pyelonephritis. 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.

[Can the urine dipstick be used in the diagnosis of urinary bacterial colonizations in a preoperative urological assessment?]. / La bandelette urinaire peut-elle être utilisée pour le diagnostic des colonisations bactériennes urinaires dans le bilan préopératoire urologique?

PURPOSE: The use of the dipstick urinalysis has been validated for the diagnosis of symptomatic urinary infections, cystitis and pyelonephritis thanks to an excellent negative predictive value. For prostatitis, it is rather its positive predictive value that is interesting. The aim of this study is to validate its use in the screening of urinary colonizations in the preoperative assessment in urology. METHODS: A monocentric prospective study was carried out for one year in 2011 comparing the data from the urine dipstick test with a fresh-voided midstream urinary examination and culture performed on the day of admission with the same urine sample in 598 asymptomatic patients programmed for a urological procedure. The gold standard to diagnose a microbiological-confirmed urinary tract infection or colonization was uropathogen growth of ≥10(3) colony-forming units per ml (cfu/mL) with or without leucocyturia. RESULTS: The study disclosed 5% of colonized patients. The urine dipstick test had a 65% sensitivity and a 97% negative predictive value. However, the low sensitivity of the urine dipstick test entailed 34% of false negatives. CONCLUSION: In spite of a good negative predictive value linked to a low prevalence of colonized patients (5%), the low sensitivity of the urine dipstick test entails a non-negligible number of false negatives. Its use as a single test of preoperative screening would expose colonized patients to the prospect of an operation, which seems to be unacceptable for some of them, notably endoscopic ones. LEVEL OF EVIDENCE: 4.

[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.

[Recommendations of the Infectious Disease Committee of the French Association of Urology. Diagnosis, treatment and monitoring candiduria]. / Recommandations du comité d'infectiologie de l'AFU. Diagnostic, traitement et suivi des candiduries.

The candiduria are frequently encountered in urology. We present the recommendations of the Infectious Diseases Committee of the French Association of Urology for diagnosis, treatment and monitoring of urinary tract infections. C. albicans is the most frequently isolated species, representing 60% of the isolates. Immunosuppression, diabetes mellitus, age extremes of life, the presence of catheters or procedures on the urinary tract are risk factors for Candida urinary tract infection. The candiduria is usually asymptomatic and does not need treatment. Only 4-14% of patients with candiduria have symptoms of urinary infection. It is necessary before choosing candiduria isolated on a first urinalysis to eliminate contamination by conducting a second harvest. In patients surveyed, the removal of the material allows the resolution of the candiduria nearly half the time and represents the first step of management. Oral fluconazole is the recommended treatment for cystitis (400 mg on day 1 and 200 mg daily for 7 to 14 days). In cases of pyelonephritis without associated candidemia, the first-line therapy is fluconazole (3-6 mg/kg/day) for 14 days or amphotericin B at a dose of 0.5 to 0.7 mg/kg/day with or not associated to flucytosine when potentially resistant strain (C. glabrata).

[Diagnosis and treatment of acute uncomplicated urethritis of men: guidelines from the French committee of infectious disease of the French association of urology (CIAFU)]. / Recommandations de bonnes pratiques cliniques : diagnostic et traitement des uréthrites aiguës non compliquées de l'homme, par le comité d'infectiologie de l'Association française d'urologie (CIAFU).

Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.

[Recommendations of the Infectious Disease Committee of the French Association of Urology (AFU): antibiotic prophylaxis for urological procedures]. / Recommandations de bonnes pratiques cliniques: l'antibioprophylaxie en chirurgie urologique, par le Comité d'infectiologie de l'association française d'urologie (CIAFU).

The French Association of anesthesiology (SFAR) has published in 1999 the Antibiotic prophylaxis guidelines. Antibiotic resistance has increased and new procedures appeared so new recommendations were needed. We present the antibiotic prophylaxis guidelines from the committee of infectious diseases of the French Association of Urology.

[Diagnosis, treatment and follow-up of community-acquired bacterial infections of the urinary system of men and women (acute cystitis and acute pyelonephritis) and of the genital system of men (acute prostatitis): general remarks]. / Généralités.

Urinary tract infections are frequent. The aim of these guidelines is to improve the management of urionary tract infections. Increasing antibiotic prescriptions may increase bacterial drug resistance. Asymptomatic bacteriuria, bacterial count, pyuria are defined and the clinical value of the bacterial culture and urinary dipstick test are discussed. The good antibiotic use depends on bacteriological, pharmaceutical, patient characteristics and economic findings which are precised in these guidelines.

[Acute cystitis]. / Cystites aiguës.

The management of uncomplicated lower urinary tract infections (UTI) implicate to look for risk factors and complications. Bacterial or radiological exams are not recommanded and short course of antibiotic is effective for treating uncomplicated UTI. Complicated UTI needs clinical, bacteriological and radiological exams, longer treatments are recommanded. Recurrent UTI definition is precised in these guidelines.

[Acute pyelonephritis]. / Pyélonéphrites aiguës.

The initial management of pyelonephritis needs to look for complicating factors. Ultrasound and X ray of the abdomen are able to rule out a urinary dilatation or a stone. The treatment is then surgical with renal drainage. Additional investigations such as a CT scan should be performed in patients with complicating factors or recurrence. In uncomplicated pyelonephritis a ambulatory treatment with 2 weeks of fluoroquinolones or cephalosporine Gr3 is sufficient. More severe cases should be admitted to a hospital and treated with initial cephalosporin Gr 3 plus aminoside for 3 to 6 weeks.

[Acute prostatitis]. / Prostatites aiguës.

A urinary infection in a febrile man is classiquely defined as a prostatitis. Investigation exams look for complicating factors or post voiding residual which should be drained. Antibiotic treatment should begin with a fluroquinolone or cephalosporin gr 3 for 3 to 6 weeks.

[Uretrovaginal reflux during micturition: A case report]. / Le reflux urétro-vaginal permictionnel.

Reflux into vagina during micturition is a rare phenomenon in adults. We report a case of a 22-old-year woman who presented with intravaginal influx of urine. This case illustrates the anatomic basis, diagnostic examinations and clinical and bacteriological implications of this phenomenon.

Intraoperative localization of renal calculi by real-time ultrasonography.

Experimental and intraoperative experiences in ultrasonographic localization of calculi are reported. With a small high-resolution real-time probe, we localized 1-mm calculi introduced in ex situ cadaver kidneys. During 13 operations all calculi of various sizes and nature were localized 11 times. This method seems to have many advantages: it is easy to use, it localizes calcific and noncalcific small calculi bidimensionally, and it shortens operative time.

Correlations between radiography, ultrasonography, computed tomography and pathologic findings in prostatic disease.

A total of 20 macroscopically normal or hypertropic prostates were taken from cadavers of men older than fifty, who died of causes other than urologic ones. The samples were studied in vitro by nonscreen x-ray films, ultrasonography, computed tomography, and then by a pathologist. There were 4 normal prostates, 12 with benign prostatic hypertrophy, 3 with carcinoma, and 1 with prostatitis. Conventional radiography which showed only prostatic calcifications was of no pathologic interest. Computed tomography is by no means of diagnostic use in distinguishing between benign prostatic hypertrophy and carcinoma, and should be used only as an alternative in the evaluation of regional extension of prostatic carcinoma. On the other hand, ultrasonography appears to be sensitive to detection of very small nonpalpable nodules. However, its specificity is poor and its use should be restricted as a guide in obtaining biopsy specimens or as a means of evaluating tumor volume.

[Tubulo-papillary tumor of the kidney. Apropos of a case]. / Les tumeurs tubulo-papillaires du rein. A propos d'un cas.

Tubulopapillary tumors represent a particular group of the renal tumors. Beyond their characteristic histological features, these tumors can be distinguished from the other renal tumors by the frequency of stage I on histology and by a more favorable prognosis.

[The intratesticular leiomyoma: an unusual location. Report of a case]. / Le léiomyome intratesticulaire: une localisation exceptionnelle. A propos d'un cas.

Intratesticular location of leiomyoma is unusual. A single case has been published in the literature. We report a case of what we consider to be an intratesticular leiomyoma, with a description of its pathology, a discussion of its differential diagnosis and histogenesis.

[Enkephalinergic receptors at the level of the lower urinary tract]. / Les récepteurs enképhalinergiques au niveau du bas appareil urinaire.

After describing the autonomic nervous system of the lower urinary tract and its neurotransmitters, the authors discuss the recent discovery of new endomorphine group mediators--the enkephalins. There exist enkephalin immunoreactive nerve fibers in the smooth muscles of the bladder and the prostate. This neuromediator is synthetized in the spinal cord in the body of the preganglionic neuron and is carried by the axon flow towards the intramural parasympathetic ganglions of the bladder. The physiological effects of enkephalins are similar to those of morphinics and are antagonized by naloxone. Enkephalins inhibit spontaneous or provoked contractions of the bladder by inhibiting action on the parasympathetic neurons. This property of relaxing the muscles of the bladder, in both volume and pressure, may open up new vistas for uropharmacological research.

[Treatment of renal cancer extending supradiaphragmatically with fibrinolytics following surgery under extracorporeal circulation, hypothermia and circulatory arrest]. / Traitement d'un cancer du rein avec extension supra-diaphragmatique par fibrinolytiques puis chirurgie sous circulation extra-corporelle, hypothermie et arrêt circulatoire.

The authors report a case of right renal carcinoma with a supradiaphragmatic vena cava thrombus. The patient presented to the emergency ward with a severe pulmonary embolus managed by fibrinolytic treatment. After alcohol embolization of the tumor, the patient underwent a right radical nephrectomy with cavectomy. A large tumor extending to the heart was removed by cardiopulmonary bypass combined with hypothermia and cardiac arrest. The immediate postoperative course was satisfactory. Eighteen months later, a CT scan revealed a suprarenal growth. A cytological study was performed on a specimen obtained by percutaneous fine needle aspiration under CT guidance and revealed local a recurrence of the renal cell carcinoma. This was removed without any problems. Two years later, no pulmonary metastases have been noted despite, the fibrinolytic therapy.

[Unilateral bladder neck incision: endoscopic treatment of bladder neck obstruction. Results in 100 patients]. / L'incision cervico-prostatique unilatérale: traitement endoscopique de l'obstruction cervico-prostatique. Résultats sur cent malades.

Endoscopic diathermy unilateral incision of the bladder neck was carried out in 100 consecutive male patients. This procedure was performed for bladder neck obstruction and small benign prostate. The operative details of this technique are given. Follow-up after 2 months revealed excellent symptomatic and urodynamic results. Morbidity was low. Results remain stable after 13 +/- 9 months. One patient needed a transurethral resection of the prostate. Retrograde ejaculation occurred in 5% of the patients. Unilateral bladder neck incision is a simple procedure safe, and easy to learn, with a low risk of retrograde ejaculation. It is the operation of choice for small benign prostate, bladder neck obstruction and young patients.

[Percutaneous renal surgery. Analysis of 100 cases of percutaneous nephrolithotomy]. / La chirurgie rénale percutanée. Analyse de cent cas de néphrolithotomies percutanées.

The authors review a series of 100 consecutive patients treated by elective percutaneous nephrolithotomy. The success rate was 83%, and the complication rate, under 2%. For these reasons, percutaneous nephrolithotomy is becoming an established procedure for the surgical management of kidney stones. After an initial phase, the one-stage manipulation was performed with a mean hospital stay of 4 days in 70% of cases.