Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence.

BACKGROUND: Nephrolithiasis is one of the most common conditions affecting the kidney and is characterized by a high risk of recurrence. Thiazide diuretic agents are widely used for prevention of the recurrence of kidney stones, but data regarding the efficacy of such agents as compared with placebo are limited. Furthermore, dose-response data are also limited. METHODS: In this double-blind trial, we randomly assigned patients with recurrent calcium-containing kidney stones to receive hydrochlorothiazide at a dose of 12.5 mg, 25 mg, or 50 mg once daily or placebo once daily. The main objective was to investigate the dose-response effect for the primary end point, a composite of symptomatic or radiologic recurrence of kidney stones. Radiologic recurrence was defined as the appearance of new stones on imaging or the enlargement of preexisting stones that had been observed on the baseline image. Safety was also assessed. RESULTS: In all, 416 patients underwent randomization and were followed for a median of 2.9 years. A primary end-point event occurred in 60 of 102 patients (59%) in the placebo group, in 62 of 105 patients (59%) in the 12.5-mg hydrochlorothiazide group (rate ratio vs. placebo, 1.33; 95% confidence interval [CI], 0.92 to 1.93), in 61 of 108 patients (56%) in the 25-mg group (rate ratio, 1.24; 95% CI, 0.86 to 1.79), and in 49 of 101 patients (49%) in the 50-mg group (rate ratio, 0.92; 95% CI, 0.63 to 1.36). There was no relation between the hydrochlorothiazide dose and the occurrence of a primary end-point event (P = 0.66). Hypokalemia, gout, new-onset diabetes mellitus, skin allergy, and a plasma creatinine level exceeding 150% of the baseline level were more common among patients who received hydrochlorothiazide than among those who received placebo. CONCLUSIONS: Among patients with recurrent kidney stones, the incidence of recurrence did not appear to differ substantially among patients receiving hydrochlorothiazide once daily at a dose of 12.5 mg, 25 mg, or 50 mg or placebo once daily. (Funded by the Swiss National Science Foundation and Inselspital; NOSTONE ClinicalTrials.gov number, NCT03057431.).

[Change in the prevention of kidney stones]. / Lithiase rénale, un changement de paradigme?

Kidney stone is one of the most frequent disorders of the urinary tract. Once the stone has passed, the management should be oriented on prevention. If changes in lifestyle and diet should be implemented in a true therapeutic education of the patient, prescription of drugs has been recently challenged by the NOSTONE trial. This randomized controlled trial did not show any benefit of hydrochlorothiazide in the prevention of recurrence of kidney stone event in patients with calcium-containing stone. Therefore, prescription of thiazide in the sole purpose of decreasing kidney stone recurrence should be limited and the risk/benefit of this treatment should be carefully balanced for each case.

La maladie rénale lithiasique est une des affections les plus fréquentes de l'axe urinaire. Une fois l'expulsion du calcul obtenue, la prise en charge est orientée sur la prévention. Si les modifications diététiques et comportementales doivent être implémentées dans le cadre d'une véritable éducation thérapeutique, la prescription de traitements médicamenteux préventifs est remise en question par l'étude NOSTONE. Cette étude randomisée contrôlée n'a pas montré de bénéfice de l'hydrochlorothiazide dans la prévention de la récidive des calculs à contenu calcique. Dès lors, la prescription de thiazide en monothérapie dans le but de diminuer les récidives de calculs doit être limitée et le risque/bénéfice soigneusement évalué dans chaque cas.

Assessing cancer risk in the anterior part of the prostate using micro-ultrasound: validation of a novel distinct protocol.

PURPOSE: To develop and validate a micro-ultrasound risk score that predicts the likelihood of significant prostate cancer in the anterior zone. METHODS: Patients were enrolled from three expert institutions familiar with micro-ultrasound. The study was conducted in two phases. First, the PRI-MUS anterior score was developed by assessing selected prostate videos from patients who subsequently underwent radical prostatectomy. Second, seven urology readers with varying levels of experience in micro-ultrasound examination evaluated prostate loops according to the PRI-MUS anterior score. Each reader watched the videos and recorded the likelihood of the presence of significant cancer in the anterior part of the prostate in a three-point scale. The coherence among the readers was calculated using the Fleiss kappa and the Cronbach alpha. RESULTS: A total of 102 selected prostate scans were used to develop the risk assessment for anterior zone cancer in the prostate. The score comprised three categories: likely, equivocal, and unlikely. The median (IQR) sensitivity, specificity, positive predictive value, and negative predictive value for the seven readers were 72% (68-84), 68% (64-84), 75% (72-81), and 73% (71-80), respectively. The mean SD ROC AUC was 0.75 ± 2%, while the Fleiss kappa and the Cronbach alpha were 0.179 and 0.56, respectively. CONCLUSION: Micro-ultrasound can detect cancerous lesions in the anterior part of the prostate. When combined with the PRI-MUS protocol to assess the peripheral part, it enables an assessment of the entire prostate gland. Pending external validation, the PRI-MUS anterior score developed in this study might be implemented in clinical practice.

The Swiss Kidney Stone Cohort: A Longitudinal, Multicentric, Observational Cohort to Study Course and Causes of Kidney Stone Disease in Switzerland.

BACKGROUND: Kidney stone disease has a high prevalence worldwide of approximately 10% of the population and is characterized by a high recurrence rate. Kidney stone disease results from a combination of genetic, environmental, and lifestyle risk factors, and the dissection of these factors is complex. METHODS: The Swiss Kidney Stone Cohort (SKSC) is an investigator-initiated prospective, multicentric longitudinal, observational study in patients with kidney stones followed with regular visits over a period of 3 years after inclusion. Ongoing follow-ups by biannual telephone interviews will provide long-term outcome data. SKSC comprises 782 adult patients (age >18 years) with either recurrent stones or a single stone event with at least one risk factor for recurrence. In addition, a control cohort of 207 individuals without kidney stone history and absence of kidney stones on a low-dose CT scan at enrolment has also been recruited. SKSC includes extensive collections of clinical data, biochemical data in blood and 24-h urine samples, and genetic data. Biosamples are stored at a dedicated biobank. Information on diet and dietary habits was collected through food frequency questionnaires and standardized recall interviews by trained dieticians with the Globodiet software. CONCLUSION: SKSC provides a unique opportunity and resource to further study cause and course of kidney disease in a large population with data and samples collected of a homogeneous collective of patients throughout the whole Swiss population.

Differences in the Food Consumption Between Kidney Stone Formers and Nonformers in the Swiss Kidney Stone Cohort.

OBJECTIVE: Diet has a major influence on the formation and management of kidney stones. However, kidney stone formers' diet is difficult to capture in a large population. Our objective was to describe the dietary intake of kidney stone formers in Switzerland and to compare it to nonstone formers. METHODS: We used data from the Swiss Kidney Stone Cohort (n = 261), a multicentric cohort of recurrent or incident kidney stone formers with additional risk factors, and a control group of computed tomography-scan proven nonstone formers (n = 197). Dieticians conducted two consecutive 24-h dietary recalls, using structured interviews and validated software (GloboDiet). We took the mean consumption per participant of the two 24-h dietary recalls to describe the dietary intake and used two-part models to compare the two groups. RESULTS: The dietary intake was overall similar between stone and nonstone formers. However, we identified that kidney stone formers had a higher probability of consuming cakes and biscuits (odds ratio (OR) [95% CI] = 1.56[1.03; 2.37]) and soft drinks (OR = 1.66[1.08; 2.55]). Kidney stone formers had a lower probability of consuming nuts and seeds (OR = 0.53[0.35; 0.82]), fresh cheese (OR = 0.54[0.30; 0.96]), teas (OR = 0.50[0.3; 0.84]), and alcoholic beverages (OR = 0.35[0.23; 0.54]), especially wine (OR = 0.42[0.27; 0.65]). Furthermore, among consumers, stone formers reported smaller quantities of vegetables (ß coeff[95% CI] = - 0.23[- 0.41; - 0.06]), coffee (ß coeff = - 0.21[- 0.37; - 0.05]), teas (ß coeff = - 0.52[- 0.92; - 0.11]) and alcoholic beverages (ß coeff = - 0.34[- 0.63; - 0.06]). CONCLUSION: Stone formers reported lower intakes of vegetables, tea, coffee, and alcoholic beverages, more specifically wine, but reported drinking more frequently soft drinks than nonstone formers. For the other food groups, stone formers and nonformers reported similar dietary intakes. Further research is needed to better understand the links between diet and kidney stone formation and develop dietary recommendations adapted to the local settings and cultural habits.

[Radical cystectomy in the geriatric population. Tools for screening postoperative complications]. / Cystectomie radicale chez les patients gériatriques. Outils de dépistage des complications postopératoires.

Radical cystectomy is the gold standard for the treatment of muscle-invasive bladder cancer. Advanced age is only a relative criterion when selecting patients eligible for radical cystectomy, and to reduce post-operative complications, the management of an elderly patient requires a multidisciplinary approach. The role of the geriatrician is therefore essential, in collaboration with the urologist, to ensure appropriate follow-up. A series of preoperative screening tests should be used to identify frailer patients who are at high risk of developing complications, so that appropriate follow-up can be carried out.

La cystectomie radicale est le traitement de choix du cancer de la vessie musculo-invasif. L'âge avancé ne représente qu'un critère relatif lors de la sélection des patients éligibles à une cystectomie radicale. Afin de réduire les complications postopératoires, la prise en charge d'un patient âgé nécessite une approche multidisciplinaire. Le rôle du gériatre est donc essentiel, en collaboration avec l'urologue, afin d'assurer un suivi approprié. Une série de tests de dépistage préopératoires identifie les patients plus fragiles, présentant un risque accru de complications, et permet de réaliser un suivi adapté.

[Bladder cancer : a comprehensive follow-up for an efficient and personalized care]. / Cancer de la vessie : un suivi personnalisé pour une prise en charge efficiente.

Bladder cancer is a common cancer in the Swiss population. The heterogeneous nature of the disease requires long-term oncological monitoring, as well as metabolic and functional follow-up. Patients' quality of life must also be considered during follow-up.

Le cancer de la vessie est fréquent dans la population suisse. Son évolution étant hétérogène, cela nécessite une surveillance oncologique sur le long terme, mais également un suivi sur les plans métabolique et fonctionnel. La qualité de vie des patients doit aussi être considérée pendant le suivi.

[A Swiss Urological Society register of cystectomies to improve surgical quality]. / Un registre des cystectomies de la Société suisse d'urologie pour une meilleure qualité chirurgicale.

In the era of highly specialised medicine, the Swiss Urological Society has set up a national register from January 2019 that will prospectively record all data relating to cystectomies. Doctors will be able to use this information to compare their activities at national level, refine surgical techniques and optimise the perioperative management of cystectomy patients. This article presents the register and provides an initial assessment of cystectomy surgery activity in Switzerland over the first four years of its set up.

Dans l'ère de la médecine hautement spécialisée, la Société suisse d'urologie a mis au point dès janvier 2019 un registre national permettant de répertorier prospectivement l'ensemble des données relatives aux cystectomies. Les médecins profitent de ces renseignements pour comparer leur activité au niveau national, affiner les techniques chirurgicales et optimiser la prise en charge périopératoire des patients opérés d'une cystectomie. Cet article est consacré à la présentation du registre et offre un bilan initial de l'activité chirurgicale de cystectomie en Suisse au cours des quatre premières années de sa mise en place.

A longitudinal study evaluating interim assessment of neoadjuvant chemotherapy for bladder cancer.

OBJECTIVES: To evaluate the usefulness of radiological re-staging after two and four cycles of neoadjuvant chemotherapy (NAC), the impact of re-staging on further patient management, and the correlation between clinical and final pathological tumour stage at radical cystectomy (RC). PATIENTS AND METHODS: We conducted a longitudinal, single-centre, cohort study of prospectively collected consecutive patients who underwent NAC and RC for urothelial muscle-invasive bladder cancer between July 2001 and December 2017. Patients underwent repeated computed tomography scans for re-staging after two cycles of NAC and after completion of NAC before RC. RESULTS: Of 180 patients, 110 had ≥four cycles of NAC and had complete imaging available. In the entire cohort, further patient management was only changed in 2/180 patients (1.1%) after two cycles of NAC based on radiological findings. Patients who were stable after two cycles but then downstaged after at least four cycles of NAC had a similarly lowered risk of death (hazard ratio [HR] 0.53). Only one patient downstaged after two cycles was subsequently upstaged after four cycles. Clinical downstaging was observed in 51 patients (46%), 55 patients (50%) had no change in clinical stage and four patients (3.6%) were clinically upstaged. Patients clinically downstaged after four cycles of NAC had a lower risk of death (HR 0.49, 95% confidence interval 0.25-0.94; P = 0.033) compared to those with no change or upstaged after completion of NAC. CONCLUSIONS: Re-staging of muscle-invasive bladder cancer after two cycles of NAC offers little additional information, rarely changes patient management, and may therefore be omitted, whereas re-staging after completion of NAC by CT is a strong predictor of overall survival.

Device-assisted intravesical chemotherapy treatment for nonmuscle invasive bladder cancer: 2022 update.

PURPOSE OF REVIEW: To critically analyze the oncological outcomes and safety profile of device-assisted intravesical chemotherapy studies reported in 2021. Studies were considered eligible if they included patients with nonmuscle invasive blood cancer (NMIBC), had a prospective or retrospective design, included at least 10 patients, were published in 2021, and assessed the oncological impact of device-assisted intravesical chemotherapy and/or reported standardized adverse effects (AEs). RECENT FINDINGS: Eight new studies reported oncological outcomes after hyperthermic intravesical chemotherapy (HIVEC). In Bacillus Calmette-Guérin (BCG) naive patients, the reported 2-yr. recurrence-free survival (RFS) ranged from 70.7% to 82.4%, with one study reporting 2 yr. progression free survival (PFS) of 92%. In both BCG naive and BCG refractory patients, the reported 1-yr. RFS ranged from 60.5% to 70% and PFS was 94% in one study. For radiofrequency-induced HIVEC, the reported 5-yr. estimates were 38%for RFS and 91.5%for PFS. Regarding AEs, 10.2% of patients had severe AEs. Six studies reported AEs after HIVEC; the majorities were grade 1-2 AEs. SUMMARY: Data coming from the studies published in the last years provides support for a consolidating role of device-assisted intravesical chemotherapy as a safe and effective alternative first- or second-line adjuvant treatment of patients with NMIBC.

Tumor-Microenvironment Characterization of the MB49 Non-Muscle-Invasive Bladder-Cancer Orthotopic Model towards New Therapeutic Strategies.

Bacillus Calmette-Guérin (BCG) instillations for the treatment of non-muscle-invasive bladder cancer patients can result in significant side effects and treatment failure. Immune checkpoint blockade and/or decreasing tumor-infiltrating myeloid suppressor cells may be alternative or complementary treatments. Here, we have characterized immune cell infiltration and chemoattractant molecules in mouse orthotopic MB49 bladder tumors. Our data show a 100-fold increase in CD45+ immune cells from day 5 to day 9 tumors including T cells and mainly myeloid cells. Both monocytic myeloid-derived suppressor-cells (M-MDSC) and polymorphonuclear (PMN)-MDSC were strongly increased in day 9 tumors, with PMN-MDSC representing ca. 70% of the myeloid cells in day 12 tumors, while tumor associated macrophages (TAM) were only modestly increased. The kinetic of PD-L1 tumor expression correlated with published data from patients with PD-L1 expressing bladder tumors and with efficacy of anti-PD-1 treatment, further validating the orthotopic MB49 bladder-tumor model as suitable for designing novel therapeutic strategies. Comparison of chemoattractants expression during MB49 bladder tumors grow highlighted CCL8 and CCL12 (CCR2-ligands), CCL9 and CCL6 (CCR-1-ligands), CXCL2 and CXCL5 (CXCR2-ligands), CXCL12 (CXCR4-ligand) and antagonist of C5/C5a as potential targets to decrease myeloid suppressive cells. Data obtained with a single CCR2 inhibitor however showed that the complex chemokine crosstalk would require targeting multiple chemokines for anti-tumor efficacy.

[Urinary tract infections in patients with neurogenic lower urinary tract dysfunction]. / Infections urinaires chez les patients avec dysfonction neurogène du bas appareil urinaire.

Urinary tract infections (UTIs) are one of the main causes of morbidity and mortality in patients with neurogenic lower urinary tract dysfunction (nLUTD). In most cases, these are patients whose symptoms manifest differently from non-neurological patients, and it can be difficult to decide whether the infection should be treated or whether it is asymptomatic bacteriuria for which treatment is not indicated. Recurrent urinary tract infections should be investigated for an underlying urological cause. This article reviews the diagnosis and management of urinary tract infections in adults with neurogenic lower urinary tract dysfunction.

Les infections urinaires sont l'une des principales causes de morbidité et mortalité chez les patients souffrant d'une dysfonction neurogène du bas appareil urinaire (nLUTD) d'origine médullaire. Dans la plupart des cas, les symptômes se manifestent différemment des patients non neurologiques. Il peut être difficile de décider si l'infection doit être traitée ou s'il s'agit d'une bactériurie asymptomatique pour laquelle le traitement n'est pas indiqué. Les infections urinaires récidivantes doivent faire rechercher une cause urologique sous-jacente. Cet article revoit le diagnostic et la prise en charge des infections urinaires de l'adulte atteint d'un dysfonctionnement neurogène du bas appareil urinaire.

[Surgical treatments for male stress urinary incontinence]. / Traitement chirurgical de l'incontinence urinaire d'effort chez l'homme.

Stress urinary incontinence (SUI) in men is common, radical prostatectomy (RP) remaining its main cause. Despite improvements in surgical techniques, SUI rates range from 5 % to 48 %. Management begins with non-invasive and conservative methods. Surgical treatment includes implantation of an artificial urinary sphincter, a suburethral sling or periurethral balloons. This article summarizes the surgical treatments for male SUI.

L'incontinence urinaire d'effort (IUE) chez l'homme est fréquente et a comme cause principale la prostatectomie radicale (PR). Malgré les progrès des techniques chirurgicales, les taux d'IUE se situent entre 5 et 48 %. La prise en charge débute par des méthodes non invasives et conservatrices. Le traitement chirurgical comprend l'implantation d'un sphincter urinaire artificiel, d'une bandelette sous-urétrale ou de ballonnets péri-urétraux. Dans cet article, nous résumons les traitements chirurgicaux de l'IUE chez l'homme.

[Sacral neuromodulation in urology: Indications, advancements and outcomes]. / Neuromodulation sacrée en urologie : indications, développements et résultats.

Emerging in the last decades, sacral neuromodulation remains an underknown therapy in the general population and even in the medical field. It has proven itself in the treatment of urinary dysfunctions, such as overactive bladder syndrome and chronic non-obstructive urinary retention. Numerous applications are currently being validated and the innovations made open up encouraging prospects. This article aims to introduce the modalities of the intervention and to present the established and future medical indications of sacral neuromodulation.

Émergeant au cours des dernières décennies, la neuromodulation sacrée reste une thérapie méconnue de la population et de la plupart du corps médical. Pourtant, elle a bien fait ses preuves dans la prise en charge des dysfonctionnements vésico-sphinctériens, comme le syndrome de la vessie hyperactive et la rétention urinaire chronique non obstructive. De nombreuses autres applications sont en cours de validation et les innovations apportées ouvrent des perspectives encourageantes. Cet article a pour objectif de présenter les modalités de l'intervention ainsi que les indications médicales établies et futures de la neuromodulation sacrée.

Seminal Vesical Sparing Cystectomy for Bladder Cancer is Feasible with Good Functional Results without Impairing Oncological Outcomes: A Longitudinal Long-Term Propensity-Matched Single Center Study.

PURPOSE: Seminal vesicle-sparing radical cystectomy has been reported to improve short-term functional results without compromising oncological outcomes. However, there is still a lack of data on long-term outcomes after seminal vesicle-sparing radical cystectomy. The aim of this study was to compare oncological and functional outcomes in patients after seminal vesicle-sparing vs nonseminal vesicle-sparing radical cystectomy. MATERIALS AND METHODS: Oncological and functional outcomes of 470 consecutive patients after radical cystectomy and orthotopic ileal reservoir from 2000 to 2017 were evaluated. They were stratified into 6 groups according to nerve-sparing and seminal vesicle-sparing status as attempted during surgery: no sparing at all (55), unilateral nerve sparing (159), bilateral nerve sparing (132), unilateral seminal vesicle-sparing and unilateral nerve sparing (30), unilateral seminal vesicle sparing and bilateral nerve sparing (45), and bilateral seminal vesicle sparing (49) and used propensity modeling to adjust for preoperative differences. RESULTS: Median followup among the entire cohort was 64 months. Among the 6 groups, our analysis showed no difference in local recurrence-free survival (p=0.173). However, progression-free, cancer-specific and overall survival were more favorable in patients with seminal vesicle-sparing radical cystectomy (p <0.001, p=0.006 and p <0.001, respectively). Proportions of patients with erectile function recovery were higher in the seminal vesicle-sparing groups at all time points in all analyses, respectively, with pronounced earlier recovery in patients with bilateral seminal vesicle sparing. Importantly, patients with seminal vesicle sparing were significantly less in need of erectile aids to achieve erection and intercourse. Over the whole period, daytime urinary-continence was significantly better in the seminal vesicle sparing groups (OR 2.64 to 5.21). CONCLUSIONS: In a highly selected group of patients, seminal vesicle sparing radical cystectomy is oncologically safe and results in excellent functional outcomes that are reached at an earlier time point after surgery and remain superior over a longer period of time.

[Emerging biomarkers of prostate cancer]. / Les biomarqueurs émergents du cancer de la prostate.

Despite recent innovation, the clinical pathway in prostate cancer is not perfect. The indication to first and control biopsy, as well as treatment choice and adjuvant treatment are clinical scenarios in which diagnostic and prognostic biomarkers might assist in clinical decision making. Some emerging biomarkers have been validated in specific clinical scenarios. Nevertheless, their utility and cost effectiveness in the current clinical pathway is yet to be proven. The aim of this article is to present the current available evidence on the novel biomarkers and discuss their role for each stage of prostate cancer care.

En dépit de nombreuses innovations, l'itinéraire clinique du cancer de la prostate reste à ce jour imparfait. Ainsi, l'indication à une première et une deuxième biopsie, le choix du traitement approprié et l'ajout d'un traitement adjuvant sont autant de situations où des biomarqueurs, diagnostiques comme pronostiques, pourraient améliorer des décisions parfois lourdes de conséquences. De nombreux biomarqueurs émergents, avec leurs caractéristiques propres, bénéficient déjà d'un certain degré de validation clinique dans des situations précises. Néanmoins, une évaluation prospective de leur performance et de leur intérêt médico-économique global reste essentielle. Nous proposons dans cet article un tour d'horizon de ces nouveaux outils, ce pour chaque étape dans la prise en charge d'un cancer de la prostate.

[Benign prostatic hyperplasia treatment: Surgical alternatives to transurethral resection of the prostate]. / Traitement de l'hyperplasie bénigne de la prostate - Alternatives chirurgicales à la résection transurétrale de la prostate.

Benign prostatic hyperplasia is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms. The gold standard of surgical treatments for benign prostatic hyperplasia for decades has been transurethral resection of the prostate. New minimally invasive techniques have been developed with the aim of reducing morbidity or resecting large prostate volumes endoscopically. In this article, we summarize the different surgical alternatives to transurethral resection of the prostate.

L'hyperplasie bénigne de la prostate est l'une des maladies les plus fréquentes de l'homme âgé et est la principale cause de symptômes du bas appareil urinaire. Depuis des décennies, le gold standard des traitements chirurgicaux pour soulager les symptômes du bas appareil urinaire, dus à l'hyperplasie bénigne de la prostate, est la résection transurétrale de la prostate. De nouvelles techniques mini-invasives se sont développées dans le but de réduire la morbidité ou de pouvoir prendre en charge des volumes prostatiques plus importants par voie endoscopique. Nous résumons dans cet article les différentes alternatives chirurgicales à la résection transurétrale de la prostate.

[Cancer center clinical nurse: The experience of the CHUV Prostate Cancer Center]. / Infirmière clinicienne de centre du cancer : l'expérience du Centre de la prostate du CHUV.

The University Hospital of Lausanne has heavily invested in the development of interdisciplinary oncology centers to improve the quality of care, and structure research and training. By integrating specialist nurses, it follows international recommendations. These specialists' nurses rephrase the information given by the doctor and ensure patients' understanding. They assess the patient's psychosocial situation and provides guidance if necessary. They support the patient in making informed choices about treatment and coping strategies. In addition to the outpatient clinics planned in accordance with the care pathway, she can be contacted between appointments to answer questions or concerns of any kind. This article shows the added value of these nurses in the care of oncology patients.

Le CHUV s'est fortement investi dans le développement de centres interdisciplinaires en oncologie afin d'améliorer la qualité de la prise en charge, de structurer la recherche et la formation. En y intégrant des infirmières cliniciennes, il suit les recommandations internationales. Ces infirmières reprennent les informations données par le médecin et s'assurent de la compréhension du patient. Elles évaluent sa situation psychosociale et l'orientent au besoin. Elles soutiennent le patient dans ses choix de traitement ainsi que dans ses stratégies d'adaptation. Outre les entretiens planifiés en fonction du parcours de soins, elles sont joignables entre les rendez-vous pour répondre à des questions ou préoccupations de tout ordre. Cet article montre la plus-value que la présence de ces infirmières offre à la prise en charge des patients oncologiques.

A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting.

PURPOSE: This study aimed at evaluating whether removal of the ureteral stent the day before scheduled secondary intervention facilitates spontaneous ureteral stone passage and thus can spare the pre-stented patient this surgery. METHODS: Retrospective analysis of a single-centre consecutive series of 216 patients after previous stenting due to a symptomatic ureteral stone from 01/2013 to 01/2018. Indwelling stents were removed under local anaesthesia. Patients were told to filter their urine overnight. Multivariate analysis was performed to assess predictive factors for spontaneous stone passage. RESULTS: 34% (74/216) of patients had spontaneous stone passage while the stent was indwelling. Of the remaining 142 patients, 41% (58/142) had spontaneous stone passage within 24 h after stent removal. Only 84/216 (39%) patients needed secondary intervention. Multivariate logistic regression analysis of all 216 patients showed a significant association between spontaneous stone passage and smaller stone size (p < 0.001), distal stone location (p = 0.046) and stent dwell time (p = 0.02). Predictive factors for spontaneous stone passage after stent removal were smaller size (p < 0.001), distal location (p = 0.001), and stone movement while the stent was indwelling (p = 0.016). A treatment strategy was established that helps select patients suitable for conservative management. CONCLUSIONS: The majority (61%) of ureteral stones passed spontaneously after pre-stenting; 34% while the stent was indwelling, 27% within 24 h after stent removal. Besides distal stone location, stone size (< 6 mm) and stone movement (≥ 5 cm) while the stent is indwelling indicate patients who are likely to pass their ureteral stone spontaneously after stent removal. The treatment strategy (decision tree) presented here helps identify those patients. TRIAL REGISTRATION: https://doi.org/10.1186/ISRCTN12112914 .