[Urological surgery : what's new in 2023]. / Chirurgie urologique : ce qui a changé en 2023.

Urology continues its development in minimally invasive surgery, and the year 2023 is marked by important innovations in the different approaches such as endoscopy, laparoscopy, and open surgery. The following innovations are instruments or medical devices which are still being evaluated. What they have in common is a questioning of our current practices, on the technical side but also for some of them on the ecological vision of our profession with the eternal debate of single use or reusable. Even if the evaluation of new devices is primarily medical and medico-economic, it is actually no longer possible to ignore the ecological aspect and the impact on the environment of the various new products. New technologies also make it possible to think about smart connected prostheses and precision intraoperative imaging that can ultimately guide the surgeon's hand.

L'urologie est une spécialité en constante évolution. L'année 2023 a été marquée par le développement de nouveautés en chirurgie minimalement invasive, tant en endoscopie qu'en laparoscopie ou chirurgie ouverte, principalement dans les domaines de la robotique, des technologies connectées, ainsi que dans les instruments médicaux réutilisables. Dans le domaine de l'imagerie, le TEP/CT peropératoire pourrait dans l'avenir guider le geste chirurgical afin d'améliorer les résultats oncologiques. Ces nouvelles technologies permettent le développement de nouveaux instruments ou dispositifs médicaux, dont l'évaluation doit se faire aujourd'hui tant sur le plan médical que socio-économique ou écologique.

[Renal colic: an update]. / Colique néphrétique : nouveautés 2023.

The prevalence of renal colic is 20 % with a high recurrence rate. It remains a frequent reason for consultation in the emergency room. In case of uncertainty about the diagnosis, a decisional aide, the STONE score, can be used. Low-dose CT remains the standard, but studies show a role for ultrasound in the diagnosis to reduce the costs and cumulative effects of radiation. Most simple renal colics are treated with medical expulsive therapy which consists of anti-inflammatory, and an alpha blocker. It is important to identify patients who require urgent urological consultation or follow-up by urologists.

La prévalence de la colique néphrétique s'élève à 20 %, avec un taux de récidives important. Elle reste un motif de consultation fréquent aux urgences. En cas d'incertitude concernant le diagnostic, un outil décisionnel, le score STONE, peut être utilisé. Le CT faible dose reste l'examen de choix, mais les études montrent un rôle de l'ultrasonographie afin de réduire les coûts et les effets cumulatifs des rayons. La plupart des coliques néphrétiques simples sont prises en charge avec une thérapie médicale expulsive qui consiste en des anti-inflammatoires et un alphabloquant. Il est important d'identifier les patients qui nécessitent un avis urologique urgent ou un suivi par les urologues.

[Urology: what's new in 2022]. / Urologie : ce qui a changé en 2022.

Over the last year, urologic progress remains driven by evolutions in oncological and functionnal urology. Prostate cancer imaging modalities are improving, as well as treatment options for advanced stages. Kidney and bladder cancer are benefiting from new treatment modalities including immunotherapy, whose role in the peri-operative setting is still unclear. Surveillance startegies for testicular cancer has been greatly simplified, for the benefit of the patients. In functional urology, a new therapeutic class in now available for the treatment of overactive bladder. Mutliples alternatives to transurethral resection are emerging in the surgical treatment of benign prostatic hypertrophy, whose expected benefits will need to be validated by long-term studies.

Les progrès de cette année sont marqués par des avancées en uro-oncologie et urologie fonctionnelle. La prise en charge du cancer de la prostate s'améliore tant dans la qualité de son diagnostic que dans le traitement des stades avancés. Les cancers du rein et de la vessie bénéficient de nouvelles options de traitement incluant l'immunothérapie, qui cherche encore sa place en périopératoire. Quant au cancer des testicules, il a vu sa surveillance grandement simplifiée au bénéfice des patients. En urologie fonctionnelle, une nouvelle classe thérapeutique est désormais disponible pour le traitement de l'hyperactivité vésicale et de multiples alternatives à la résection endoscopique de la prostate émergent dans le traitement chirurgical de l'hypertrophie bénigne de la prostate. Il faudra toutefois valider les avantages espérés par des études à long terme.

Robot-Assisted Laparoscopic Calyceo-Pyelostomy for Vascular Compression of the Upper Calyx (Fraley Syndrome).

Fraley's Syndrome is a rare anatomic vascular malformation described in 1966 where an aberrant crossing vessel compresses the upper infundibulum and leads to upper calyx massive dilation. It is mostly asymptomatic and the diagnosis often missed; however, surgery is usually required for symptomatic cases. Open surgery is still frequently used while minimally invasive management is anecdotal in the literature. We report the first robot-assisted calyceo-pyelostomy. An 18-year-old female patient presented with intermittent, recurring, severe left flank pain leading to insomnia, evolving in the last 3 months. A 3-phases computerized tomography scan (CT-scan) showed a rotated left kidney, with upper calyx massive dilation and thinning of the upper renal parenchyma without any evident obstacle. Cystocopy and retrograde pyelography were performed. It confirmed a single ureteral meatus, a single ureter, and a narrowed upper calyx with upper calyx dilation. An ureteral catheter (JJ stent) was inserted in the upper calyx and the patient was planned for surgical exploration. During robotic surgery, an abnormal crossing vessel was identified and the diagnosis of Fraley's syndrome was made intraoperatively. According to previous literature, a calyceo-pyelostomy with uncrossing of the upper major calyx and resection of the narrowed upper infundibulum was performed. Total operative time was 114 min, pneumoperitoneum time was 96 min, blood loss less than 10 ml, and patient was released on post-operative day 2. The ureteral stent was removed 4 weeks after the intervention. At 12 postoperative weeks, the patient had complete regression of pain and the 12 postoperative week CT-scan showed a reduction of the dilation and a patent anastomosis. Fraley's syndrome is a rare entity. In our case, the diagnosis of Fraley syndrome was made intraoperatively after an extensive previous workup, underlining the difficulty to make this diagnosis. We report and provide a video of the first robot-assisted procedure for Fraley's syndrome in a nephron-sparing technique. Patient was pain-free at the 3-month.

[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.