Long term efficacy of prosthetic inguinal herniorrhaphy concomitant with robot-assisted laparoscopic radical prostatectomy.

PURPOSE: Patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) may present concurrent or secondary inguinal hernia (IH). Surgical repair of IH simultaneously with RARP has been reported. We aimed to assess the long-term efficacy of concurrent prosthetic IH repair with RARP. METHODS: Data for consecutive patients undergoing concurrent IH repair with RARP for localized prostate cancer at our institution between 2006 and 2017 were retrospectively analysed. Patients were matched based on age, BMI, and year of surgery, with patients undergoing RARP alone. IH repair was performed with a polyester mesh. Efficacy of IH repair was the primary outcome. Patient characteristics, perioperative data, recurrence and treatment were recorded. RESULTS: A total of 136 men were included, 50% treated by RARP and concurrent IH, 50% by RARP alone. Mean age was 65 years (SD 6) and mean BMI 26.8 (SD 2.5). IH was diagnosed preoperatively in 42 patients (62%) or intraoperatively in 26 patients (38%). A total 18 patients (26%) had bilateral hernias and 50 patients had unilateral hernias (right 31%, left 43%). There was no significant difference between the two groups regarding perioperative data. The herniorrhaphy added 34 min to the operative time (p < 0.001). After a mean follow-up of 106 months [SD 38], 9 patients (13%) presented recurrence of IH, with a mean time to recurrence of 43 months [SD 35]. Age was significantly associated with IH recurrence (p = 0.0007). CONCLUSION: Concomitant IH repair and RARP appear to be a safe procedure with good long-term safety and efficacy, without significantly increasing morbidity.

Substaging of pT1 Urothelial Bladder Carcinoma Predicts Tumor Progression and Overall Survival.

INTRODUCTION: Limitations in tumor staging and the heterogeneous natural evolution of pT1 urothelial bladder carcinoma (UBC) make the choice of treatment challenging. We evaluated if histopathological substaging (pT1a, pT1b, and pT1c) helps predict disease recurrence, progression, and overall survival following transurethral resection of the bladder (TURB). METHODS: We included 239 consecutive patients diagnosed with pT1 UBC at TURB in a single institution since 2001. Each sample was interpreted by our specialized uropathologists trained to subclassify pT1 stage. Three groups were distinguished according to the degree of invasion: T1a (up to the muscularis mucosae [MM]), T1b (into the MM), and T1c (beyond the MM). RESULTS: T1 substaging was possible in 217/239 (90%) patients. pT1a, b, and c occurred in 124 (57), 59 (27), and 34 (16%), respectively. The median follow-up was 3.1 years, with a cumulative recurrence rate of 52%, progression rate of 20%, and survival rate of 54%. Recurrence was not significantly associated with tumor substage (p = 0.61). However, the Kaplan-Meier survival analysis showed a significantly higher progression rate among T1b (31) and T1c (26%) tumors than T1a (13%) (log-rank test: p = 0.001) stages. In a multivariable model including gender, age, ASA score, smoking, tumor grade, and presence of carcinoma in situ, T1 substage was the single variable significantly associated with progression-free survival (HR 1.7, p = 0.005). Nineteen patients (9%) needed radical cystectomy; among them, 12/19 (63%) had an invasive tumor. Overall survival was significantly associated with tumor substaging (p = 0.001). CONCLUSION: Histopathological substaging of pT1 UBC is significantly associated with tumor progression and overall survival and therefore appears to be a useful prognostic tool to counsel patients about treatment options.

[Urology]. / Urologie.

Over this last year, urology has progressed both in oncology and reconstructive surgery. Genomic tests have been since quite a few years foreseen as very promising prognostic factors of prostate cancer, however remaining not clearly convincing. At last, the present data available seem to favour their contribution to improve selecting patients for active surveillance. For the same cancer, but at a metastatic stage resistant to androgenic deprivation, therano stics is providing an elegant targeting of disseminated tumor cells using a PSMA radio-active ligand fatal for the latter. Finally, penile urethral strictures appear to convincingly benefit on a long-term basis from a new method to place the substitution tissue which will restore urethral caliber.

C'est entre l'oncologie et la chirurgie reconstructive que l'urologie a poursuivi, en 2021, sa quête de progrès et de mises au point. Voilà plusieurs années que la génomique est attendue comme pourvoyeuse de capacités pronostiques dépassant les facteurs classiques. Plus lentement qu'attendu, la surveillance active du cancer de la prostate apparaît en être la bénéficiaire principale. Ce même cancer, mais au stade métastatique résistant à la déprivation androgénique, profite de la théranostique, qui cible le récepteur du Prostate-Specific Membrane Antigen de la cellule tumorale, avec un ligand radioactif fatal pour cette dernière. Enfin, la chirurgie des sténoses urétrales péniennes se voit enrichie d'une nouvelle manière de placer le tissu de substitution qui agrandira le calibre urétral, conférant à ce type de reconstruction une durabilité et une esthétique probantes.

[Hyperbaric oxygen therapy for the treatment of radiation-induced cystitis]. / Oxygénothérapie hyperbare dans le traitement de la cystite radio-induite.

Radiation-induced cystitis (RIHC) is a late complication of pelvic radiation therapy defined by irritative lower urinary tract symptoms with recurrent and sometimes refractory hematuria. Conservative or endoscopic treatments are the first lines, but cystectomy in required in refractory cases. Hyperbaric oxygen therapy (HOT) has recently emerged in the management charts for recurrent and refractory hematuria. Thanks to its neoangiogenic and stem-cell stimulation properties, HOT achieves a complete resolution of hematuria in almost two third of patients and appears to be a good therapeutic alternative for this fragile population. However, its geographical availability is currently limited in Switzerland and its implementation can sometimes require long hospital stays.

La cystite radio-induite (CR) est une complication tardive de la radiothérapie pelvienne se présentant notamment sous forme de troubles mictionnels irritatifs ou de macrohématurie récidivante. Le traitement est initialement conservateur ou endoscopique mais peut, dans des cas réfractaires, aboutir à une cystectomie à visée hémostatique ou fonctionnelle. L'oxygénothérapie hyperbare (OHB) a récemment fait son apparition dans les diagrammes de prise en charge de la CR réfractaire. Grâce à ses propriétés néoangiogéniques et à la stimulation des cellules souches, elle permet une résolution complète de l'hématurie chez près de deux tiers des patients et semble être une alternative thérapeutique pour cette population fragile. Actuellement, sa disponibilité géographique reste toutefois limitée en Suisse et sa réalisation implique parfois de longues hospitalisations.

Postoperative peripheral neuropathies associated with patient positioning during robot-assisted laparoscopic radical prostatectomy (RARP): A systematic review of the literature.

OBJECTIVE: To perform a systematic review of the literature concerning postoperative peripheral neuropathies associated with patient positioning during robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS: A systematic review on articles published from January 1, 1990 to March 15, 2020 was performed in accordance with the PRISMA declaration (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The electronic search was done searching through the Cochrane Registry, PubMed/EMBASE, Medline, and Scopus. Relevant papers addressing postoperative peripheral neuropathies related to patient positioning during RARP were integrated into the analyses. RESULTS: After screening 4975 articles, one randomized controlled trial and five retrospective studies with a total of 63,667 patients were included in this review. Peripheral neuropathies of the upper extremities were documented in three articles with a total of 15 patients, peripheric neuropathies of the lower extremities were reported in five articles with a total of 76 patients. Analysis of the data was exploratory, since screening techniques, systematically reporting, and description of positioning techniques was not standardized or not reported. CONCLUSIONS: The incidence of peripheral neuropathies at RARP varies between 1.3% and 10.8%. Lower extremities are more affected than upper extremities and the most important risk factors are intraoperative time duration, patients comorbidities, and ASA score. High-quality prospective randomized studies to better assess the impact of patient positioning during RARP on the development postoperative peripheral neuropathies are needed.

Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic.

PURPOSE: The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. METHODS: Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3-4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan-Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cut-off. RESULTS: Median follow-up and surgical delay were 26 months (IQR 10-40) and 3 months (IQR 2-5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre- and post-operative variables. The lack of such association was observed across EAU risk categories. CONCLUSION: Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.

[Urology]. / Urologie.

Over the last year, urologic progress remains driven by the quick technologic evolution, with a focus on Laser and robotics. The latter appears to potentially contribute to the drift towards ambulatory surgery, in particular for distinct sub-populations harbouring kidney or prostate cancer. The Da Vinci robot appears also to increase the drive towards minimally invasiveness with respect to female incontinence and the laparoscopic placement of an artificial urethral sphincter. Last, a new Laser is in the midst to offer its polyvalence in terms of endoscopic stone surgery, so as that of benign prostatic hyperplasia. Facing this technologic pressure, it remains of utmost importance to scrupulously validate on a short so as longer-term basis the true hoped advantages.

Les progrès urologiques de cette dernière année restent, comme l'année précédente, sous le sceau des rapides avancées technologiques, notamment celles du laser et de la robotique. Cette dernière va contribuer à faire évoluer la chirurgie ambulatoire, notamment pour certaines interventions et sous-populations de malades porteurs d'un cancer du rein ou de la prostate. Elle est également en train d'exercer une nouvelle percée dans le domaine de l'incontinence féminine, en ce qui concerne la mise en place du sphincter urétral artificiel. Enfin, un nouveau laser est sur le point d'offrir sa polyvalence en termes de chirurgie endoscopique lithiasique ainsi que celle de l'hypertrophie bénigne de la prostate. Face à cette pression technologique, il faut rigoureusement valider à court et moyen termes les véritables avantages espérés.

[Chronic testicular pain: A multidisciplinary challenge]. / Douleurs testiculaires chroniques : un défi multidisciplinaire.

Chronic testicular pain represents up to 5% of urological consultations. A simple workup can help identify an organic etiology in 50 to 75% of cases, leading to a targeted treatment. If this is not the case, chronic idiopathic orchialgia is diagnosed and multidisciplinary management is necessary. Treatment is initially conservative but is only effective in 4 to 15% of patients. Spermatic block by infiltration of the cord confirms the testicular origin of the pain and provides temporary relief. Microsurgical denervation of the spermatic cord is the treatment of choice for responders. It provides significant pain relief in 77 to 100% of cases.

Les douleurs testiculaires chroniques représentent jusqu'à 5 % des consultations d'urologie. Un bilan simple retrouve une étiologie organique dans 50 à 75 % des cas permettant un traitement ciblé. Le cas échéant, le diagnostic d'exclusion d'orchialgie chronique idiopathique est retenu et une prise en charge multidisciplinaire est alors nécessaire. Le traitement est initialement conservateur, mais n'est efficace que chez 4 à 15 % des patients. La réalisation d'un bloc spermatique par infiltration du cordon permet de confirmer l'origine testiculaire des douleurs et apporte un soulagement temporaire. La dénervation microchirurgicale du cordon spermatique est le traitement de choix pour les répondeurs. Il permet un soulagement significatif des douleurs dans 77 à 100 % des cas.

[Update on management of genitourinary tract trauma]. / Prise en charge des traumatismes urogénitaux : mise au point.

Traumas are the leading cause of death in the 15 to 45 years old population and represent 10 % of all death causes. Hence, they are a public health problem. This article aims to review the most frequent uro-genital traumas from etiology to diagnostic evaluation and management to allow the general practitioner and the emergency doctors to familiarize themselves with the algorithms and treatment procedures.

Les traumatismes sont la cause la plus fréquente de décès de la population âgée de 15 à 45 ans et représentent environ 10 % de toutes les causes de décès. De ce fait, ils sont un problème de santé publique. Dans cet article, les principaux traumatismes urogénitaux seront passés en revue, de l'étiologie à la prise en charge en passant par les investigations diagnostiques, afin de permettre aux premiers intervenants de la chaîne de soins de se familiariser avec les algorithmes de décision et de traitement.

[Living donor nephrectomy]. / Prélèvement de rein chez le donneur vivant.

Kidney living donor is the best treatment of terminal kidney failure. Donors are remarkably altruistic. The first concern of the medical team is not to harm the donor and respect their will to give their kidney. The technological evolution towards mini-invasive approaches has largely contributed to a better post-operative recovery. The evolution of this trend has led us to use laparoscopic robot-assisted kidney harvesting as the optimal standard. This work describes our pathway to this option.

Recevoir un rein par un donneur vivant est à ce jour le meilleur traitement de l'insuffisance rénale terminale. Les donneurs font un geste remarquablement altruiste. Le but primaire de l'équipe médicale est de pouvoir soigner un patient insuffisant rénal grâce au don d'organe sans nuire au donneur. Les avancées technologiques vers des approches mini-invasives ont contribué à l'amélioration de la prise en charge des donneurs en augmentant considérablement leur confort postopératoire et en réduisant drastiquement les durées moyennes d'hospitalisation. La procédure standard aux HUG à ce jour est la laparoscopie robot-assistée. Cet article retrace l'évolution mini-invasive du don de rein dans le service.

[Early detection of prostate cancer: a summary of the past 10 years]. / Détection précoce du cancer de la prostate : résumé de ces dix dernières années.

Early detection of prostate cancer remains a controversial subject for the general practitioner. In fact, prostate cancer remains the most frequently diagnosed non skin tumor in men with a proportion of 15 %. However, while prostate specific antigen has massively contributed to its identification at a curable stage for 25 years, it has simultaneously appeared essential not to overtreat a cancer with a significant proportion of indolent tumors. In parallel with this controversial background, the prospective randomized study of the European Randomized Study of Screening for Prostate Cancer, and in particular its Swedish subpopulation, has validated during the last decade the benefit of at least early detection. However, due to the variety of treatment options and the potential side effects of some of them, it is recommended that this detection be performed only in properly informed patients.

La détection précoce du cancer de la prostate reste un sujet d'incertitude pour le praticien généraliste. Le cancer de la prostate est la tumeur non cutanée la plus fréquemment diagnostiquée chez l'homme avec une proportion de 15 %. Bien que l'antigène spécifique de la prostate ait massivement contribué à l'identification à un stade curable depuis 25 ans, il est simultanément indispensable de ne pas surtraiter un cancer dont le taux de tumeurs indolentes est significatif. Dans ce contexte controversé, l'étude prospective randomisée de l'European Randomized Study of Screening for Prostate Cancer, et en particulier sa sous-population suédoise, a validé le bénéfice d'une détection précoce au cours de cette dernière décennie. En raison des options thérapeutiques variées et des potentiels effets secondaires de certaines d'entre elles, il est recommandé de ne pratiquer cette détection que chez les patients dûment informés.

[Novelties in Urology 2019]. / Urologie.

At the turn of the second decade of the 21st century, advances in urology are driven by technobiologic progress and the strive for minimally invasiveness. Prostate disease benefits above all, with significant improvement in benign prostatic hyperplasia mini-invasive surgery and metastatic prostate cancer imaging. Chronic micturition syndromes also benefit from this trend, so as robotic surgery, whose latest promising innovation, the single port model, will have to find its place and confirm its non-inferiority as compared with the current latest multi-arm da Vinci robot.

À la fin de la deuxième décennie du 21e siècle, le progrès en urologie est conditionné par les avancées techno-biologiques et l'intention chirurgicale de diminuer l'invasivité des interventions. Les maladies prostatiques sont les principales bénéficiaires de cette évolution. Ainsi, les améliorations sont significatives dans la chirurgie de l'hyperplasie bénigne de la prostate ainsi que pour l'imagerie du cancer métastatique. Les syndromes de dysfonction mictionnelle chronique et la chirurgie robotique se positionnent également dans cette perspective, cette dernière notamment avec une nouvelle plateforme da Vinci à trocart unique, qui n'est actuellement pas encore disponible en Europe. La chirurgie robotique à trocart unique devra par ailleurs encore démontrer sa non-infériorité par rapport à la dernière version multi-bras en service du robot da Vinci.

[Urethral strictures: a variety of treatments requiring regular practice]. / Sténoses urétrales : une variété de traitements nécessitant une pratique régulière.

Urethral stricture is defined by a decrease in the caliber of the urethral lumen which can cause a decrease or an interruption of the urine flow. This disease is much more common in men than in women, and several causes can be identified. The diagnosis depends on a careful patient history focusing on obstructive and/or irritative lower urinary tract symptoms and is confirmed by a specific work-up. Treatment ranges from conservative management to open surgery and requires specialized surgeons, so as an adequate technical platform. The evolution of surgical techniques has fortunately significantly increased long term success rates. Hence, the classical saying heard about the outcome of urethral stenosis treatment : « once a stricture, always a stricture ¼ is no longer the rule.

La sténose urétrale est définie comme une diminution du calibre de la lumière urétrale qui peut engendrer une diminution du flux urinaire. Cette pathologie est plus fréquente chez l'homme et on l'attribue à de nombreuses causes. Le diagnostic dépend d'une bonne anamnèse, marquée essentiellement par des troubles mictionnels obstructifs et/ou irritatifs, et est confirmé par des examens complémentaires spécifiques. Le traitement peut aller de la prise en charge conservatrice à la chirurgie ouverte, et requiert toujours des chirurgiens spécialisés ainsi qu'un plateau technique adéquat. Ces 25 dernières années, le développement des techniques chirurgicales a permis d'augmenter le taux de succès, ce qui contredit l'adage classique du milieu du siècle dernier : « once a stricture, always a stricture ¼.

[Robot-assisted cystectomy and urinary diversion, new standard of care ? What are the benefits ?] / Cystectomie et dérivation urinaire laparoscopique robot-assistée, nouveau standard ? Pour quels bénéfices ?

Radical cystectomy with urinary diversion is the surgical treatment of invasive bladder cancer. Functional impairment is another indication. Robotic technique slowly started 15 years ago but its benefit remains questionable. We present the results of around thirty patients who underwent robotic cystectomy (RC) between 2016 and 2019 and were compared to an open cystectomy (OC) group. While this series is finishing its implementation phase, the results show that RC is equivalent to OC in terms of oncologic control as well as for the overall complication rate. Moreover, blood loss and the hospital length of stay are inferior for RC patients. These results participate to the actual trend towards putative further validation of RC.

La cystectomie radicale associée à la dérivation urinaire est le traitement chirurgical du cancer invasif de la vessie. L'atteinte fonctionnelle est une autre indication. La mise en route de la technique robotisée (cystectomie robotique (CR)) a lentement débuté il y a 15 ans, et son bénéfice reste questionné. Nous présentons les résultats de la première trentaine de CR opérées dans le service entre 2016 et 2019, et la comparons à une cohorte opérée à ciel ouvert (cystectomie ouverte (CO)). Alors que cette série représente la phase d'implémentation de la technique, les résultats montrent que la CR est équivalente à la CO tant pour le contrôle oncologique que pour les complications. De plus, elle occasionne moins de pertes sanguines et sa durée d'hospitalisation est inférieure à celle de la CO. Ces résultats participent à la tendance actuelle vers une possible validation future de la CR.

[Human papillomavirus (HPV) vaccination in males†: evidence and practice]. / Vaccination contre le papillomavirus humain (HPV) chez le sujet masculin†: évidence et pratique.

Human papillomavirus (HPV) vaccine has been covered under basic health insurance in Switzerland since July 1, 2016, in accordance with the OFSP immunization plan and with the support of the Federal Vaccine Commission (CFV). The decision to include the vaccine in young adult vaccination plans came as a response to mounting evidence showing its efficiency in reducing HPV infections and associated diseases, especially cervical cancer, ano-genital and oro-pharyngeal cancers. General practitioners, pediatricians, urologists and gynecologists are the first in line to diagnose this sexually transmitted infection and are essential actors in its treatment and prevention.

La vaccination contre le papillomavirus humain (HPV) est remboursée chez les garçons et les jeunes hommes (11-26 ans) en Suisse depuis le 1er juillet 2016 dans le cadre du plan de vaccination de l'Office fédéral de la santé publique (OFSP) et de la Commission fédérale pour les vaccinations (CFV). La décision de prendre en charge son coût répond à l'augmentation des évidences scientifiques démontrant son efficacité dans la réduction des infections à HPV et des maladies qui y sont associées, notamment les cancers du col de l'utérus, ano-génitaux et oro-pharyngés. Les médecins généralistes, les pédiatres, les urologues et les gynécologues sont en première ligne pour diagnostiquer cette maladie sexuellement transmissible et sont les acteurs essentiels de son traitement, mais surtout de sa prévention.

[Head To Toe, a medical knowledge distribution platform†: a practical example in urology]. / Head To Toe, une plateforme de distribution de connaissances médicales†: exemple pratique en urologie.

With the development of new technologies, smartphones are now ubiquitous and occupy a growing place in the medical world. More and more applications are developed in the medical field, either for medical education or as knowledge resources to help physicians guide their treatment, and have been regrouped under the name of mobile-learning or m-learning. Because of an increasing demand of students from the Faculty of Medicine in Geneva University, we developed a smartphone and tablet application, called Head To Toe, which is a mobile medical knowledge distribution platform. After successful implementation for students, the platform is now extending to postgraduate formation and to hospital physicians. We describe here how the application works, its role for students and physicians, with examples related to urology.

Avec le développement des nouvelles technologies, les smartphones sont ubiquitaires et occupent une place grandissante dans le monde médical. De plus en plus d'applications sont développées à visée d'éducation médicale ou d'aide décisionnelle médicale et sont regroupées sous le nom de mobile-learning ou m-learning. En raison d'une demande existante d'étudiants en médecine à l'Université de Genève, nous avons développé l'application smartphone et tablette Head To Toe qui est une plateforme de distribution mobile de connaissances médicales. Après un succès chez les étudiants, la plateforme s'étend à la formation post-graduée et aux médecins internes. Nous décrivons le fonctionnement de l'application, son rôle pour les étudiants et médecins internes en ciblant le domaine de l'urologie.

[Evolution and miniaturization of percutaneous nephrolithotomy]. / Évolution et miniaturisation de la néphrolithotomie percutanée.

Percutaneous nephrolithotomy (PCNL) was at first indicated for larger renal stones. Technological progress allowed a significant improvement of the available equipment, mostly to miniaturize the devices. However, this should not affect the stone clearance. Many different techniques arised aiming to reduce the complications of PCNL, in particular the risk of haemorrhage. As it becomes less invasive, the indications are greatly expanded, and a growing number of patients will benefit from it in the future. This explains the significance of knowing this procedure in continual development in greater detail.

La néphrolithotomie percutanée (NLPC) était initialement indiquée pour les calculs rénaux de grande taille. Les progrès technologiques ont permis une amélioration significative du matériel disponible, principalement dans le sens de la miniaturisation des instruments. Ceci ne doit cependant pas se faire au détriment de la plus grande clairance possible des calculs. Une multitude de techniques sont apparues sur le marché dans l'optique de diminuer les complications possibles des NLPC, en particulier le risque hémorragique. L'invasivité de cette intervention étant réduite, ses indications s'en trouvent considérablement élargies et un nombre croissant de patients vont en bénéficier à l'avenir. Ceci explique l'intérêt de connaître un peu mieux cette technique chirurgicale en constante évolution.

GreenLight Laser for benign prostatic hyperplasia.

PURPOSE OF REVIEW: GreenLight photoselective vaporization (GL-PV) is now established in the treatment of benign prostatic enlargement. The present review outlines the available technical armamentarium and summarizes the current best evidence on functional and safety outcomes. Moreover, future technical developments and refinements are presented. RECENT FINDINGS: GL-PV has evolved to be the most commonly performed procedure, second to conventional transurethral resection of the prostate (TURP) for surgical management of benign prostatic obstruction (BPO). On the basis of the data published in the randomized controlled Goliath study, GL-PV with 180-W technology is noninferior in terms of functional outcomes compared with TURP considering short and intermediate follow-up with a complication-free rate of around 80% after 24 months.The ongoing push towards high-power lasers can be explained by their more effective tissue ablative effect, leading to shorter operating times. Comparative analysis between high-power and low-power laser systems demonstrated similar retreatment rates and most institutions are, therefore, now performing 180-W GL-PV.Performed as an outpatient procedure, GL-PV is cost-effective with a low hospital re-admission rate. Plasma kinetic vaporization of the prostate (PKVP) has recently emerged as a potential contender in the field; also GreenLight enucleation of the prostate (GreenLEP) might be even more effective than GL-PV. SUMMARY: GL-PV appears to be a well tolerated surgical alternative for patients suffering from BPO. Long-term follow-up data from 120-W and 180-W laser systems are still pending. Potential competitors have recently been brought to the market and further trials and long-term data will show, whether GL-PV will stand the test of time. Regardless of technical specifications, surgeon's experience remains essential to achieve good functional and safety outcomes.

[Diagnosis and management of small solid renal masses]. / Diagnostic et prise en charge des lésions tissulaires rénales de petite taille.

Discovery of small solid renal masses via echography, CT-scan or MRI is common in current medical practice, with more than 70 % found incidentally. Although they include benign lesions, most are renal cell carcinomas. A radiological assessment, associated if necessary with a percutaneous renal biopsy, leads to their diagnosis in the vast majority of cases. Minimally invasive partial nephrectomy has become the standard surgical technique in specialized centers. Ablative therapies (radiofrequency and cryotherapy) and active surveillance are other possible therapeutic approaches. A benefit-risk assessment of these treatments considering patient age, kidney function and comorbidities, is key in the management of these small solid renal masses.

La mise en évidence de petites lésions tissulaires rénales par échographie, scanner ou IRM, est fréquente dans la pratique médicale actuelle, avec plus de 70 % de découvertes fortuites. Bien qu'elles comprennent des lésions bénignes, la plupart sont des carcinomes à cellules rénales. Un bilan radiologique, associé si nécessaire à une biopsie rénale percutanée, permet de déterminer leur diagnostic dans la majorité des cas. La néphrectomie partielle mini-invasive est devenue la technique chirurgicale de référence dans les centres spécialisés. Les traitements ablatifs (radiofréquence et cryothérapie) et la surveillance active sont d'autres approches thérapeutiques envisageables. Une balance des risques et bénéfices de ces traitements, pondérée avec l'âge, la fonction rénale et les comorbidités du patient, est essentielle dans la prise en charge de ces lésions rénales.

[Erectile dysfunction, an urologic and multidisciplinary approach]. / Dysfonction érectile, une prise en charge urologique et multidisciplinaire.

Erectile dysfunction (ED) is a common complaint, both in the general medicine and the urology out-patient clinic. The quite recent availability of effective treatments has profoundly changed the perception of sexual health in society, which has become more demanding. We should see erectile or sexual function as a health marker. Its causes are often diverse but we can classify them as somatic (vascular, neurological, endocrine, tissue-related, iatrogenic) or psychogenic. Management should be etiological if possible. It often goes first by reducing cardiovascular risk factors and then by prescribing a vasodilating agent functioning through the inhibition of phosphodiesterase 5. When modifiable cardiovascular risk factors are identified, we refer the patient to a specialized consultation. ED is to be seen as a warning sign of a preventable disease or cardiovascular event.

La dysfonction érectile (DE) est une plainte fréquente en consultation de médecine générale ou d'urologie. L'arrivée de traitements efficaces a modifié profondément la perception de la santé sexuelle dans la société, qui est devenue plus exigeante. Ainsi, la fonction érectile et sexuelle a désormais émergé comme un marqueur de santé globale. Les causes de la DE sont souvent mixtes : elles peuvent être somatiques (vasculaire, neurologique, endocrine, tissulaire, iatrogène) ou psychogènes. La prise en charge doit être étiologique si possible. Elle passe souvent d'abord par la réduction des facteurs de risque cardiovasculaire (FRCV) puis par un soutien médicamenteux vasodilatateur par inhibition de la phosphodiesérase 5. Lorsqu'on identifie des FRCV modifiables, nous adressons le patient en consultation spécialisée de prévention cardiovasculaire. La DE doit être vue comme un signe d'alerte prédictif de maladie ou d'événement cardiovasculaire évitable.