Real-life after sacral nerve modulation implantation: Rate, reasons, and risk factors for mid-term follow-up discontinuation.

OBJECTIVES: To evaluate follow-up after implantation of a sacral nerve modulation implantable pulse generator (IPG) and to investigate the reasons and risk factors for follow-up discontinuation. MATERIALS AND METHODS: All patients who underwent an IPG implantation to treat lower urinary tract symptoms between 2014-2019 within 6 hospital centers located in the district of "Hauts-de-France" (France) were systematically called during the year 2020 for a standardized (tele)consultation. Patients were divided into 3 distinct profiles according to the regularity of their 5-year postoperative follow-up: "Regular follow-up", "Irregular follow-up" and "Lost to follow-up". The primary outcome was the change in the annual proportion of the 3 follow-up profiles over the 5 years following IPG implantation. As secondary outcomes we described the reasons reported for follow-up discontinuation and looked for risk factors associated with. RESULTS: Overall, 259 patients were included. At the time of data collection, after a mean follow-up of 28.4 (± 19.8) months, 139 patients (53.7%) had a "Regular follow-up", 54 (20.8%) had an "Irregular follow-up" and 66 (25.5%) were "Lost to follow-up". The proportion of patients with a "Regular follow-up" decreased year by year, representing only 46.2% of patients at five-years. 175 patients (67.6%) underwent a standardized (tele)consultation. In multivariate analysis, only "lack of knowledge of the follow-up protocol" was statistically associated with follow-up discontinuation (OR=5.16; 95% CI [2.12-13.57]). CONCLUSION: The proportion of patients followed up after IPG implantation decreased steadily over the years, often related to a lack of therapeutic education.

[Influence of occupational exposures in nonmuscle infiltration bladder cancer: preliminary results of a prospective study from October 2005 to February 2009]. / Influence des expositions professionnelles dans les cancers n'infiltrant pas le muscle détrusor. Résultats préliminaires d'une étude prospective d'octobre2005 à février2009.

UNLABELLED: Bladder cancer is a common condition in industrialized countries. If tobacco is still the main risk factor in lung cancer, occupational exposures carcinogens should not be underestimated. GOAL: The significant excess of bladder cancer in the north part of France, with high manufacture concentration likely to have employees exposed to bladder carcinogens, has led us to study the influence of these exposures in the natural history of bladder cancer. PATIENTS AND METHODS: We prospectively conducted a descriptive case-control study. A questionnaire was developed by the department of occupational disease and clinical, radiological, histological, therapeutic data were registered at the University Hospital of Lille. From October 2005 to February 2009, 69 patients were included in the study, 37 exposed to occupational carcinogens and 32 in the control group. RESULTS: Mean age was 61.6 years vs. 61.8 years and the sex ratio of 7.33 men to one woman vs. one woman for three men respectively in the two groups. The average age of patients exposed to polycyclic aromatic hydrocarbons was 59.7 years. Smokers were 86.5% and 87.5% respectively. Follow-up was 38.4 and 32.9 months respectively. Nonmuscle invasive bladder cancer were more frequent (P=0.019) in the exposed group (84.4%) than in the unexposed group (67.8%) even after adjustment for smoking (P=0.0142). The histological type, grade, presence of CIS, the early recurrence at 3 months, the number of lesions at diagnosis does not differ in the two groups even after adjustment for smoking or after subgroup analysis of the most frequent exposure. The exposure to polycyclic aromatic hydrocarbons (62%) and aromatic amines (37.8%) were the most represented. Of 37 patients, 13 (35%) were making a statement as an occupational disease (eight according to Table 15 ter, two according to Table 16 bis and two presented to IRB). To date one single patient is recognized as an occupational disease. CONCLUSION: We did not observe any worsening of the prognosis of bladder cancer following occupational carcinogen exposure except for the mean age at diagnosis. The small size of the population studied and the importance of smoking partner have hampered the analysis of occupational exposures.

[Pyeloplasty for pyelo-ureteric junction syndrome in children: lombo-assisted procedure versus lombotomy]. / Pyéloplastie pour syndrome de la jonction pyélo-urétérale chez l'enfant : voie lombo-assistée versus lombotomie.

Surgical treatment of pyelo-ureteric junction syndromes was classically at the child's, a pyeloplasty by posterior way or by lombotomy. For several years, assisted video techniques are proposed for this gesture. The purpose of our study was to compare the lombo-assisted pyeloplasty procedure with the lombotomy procedure, within the framework of this coverage. We made a retrospective study of procedures performed from January 2000 to December 2005, based on a file review of children operated for pyelo-ureteric junction syndrome. Children under the age of 2 years were excluded. Fifty-two children were divided in 2 groups: group 1: 24 children, 7 girls and 17 boys, average age of 86 months (extremes: 27-172) benefited from a lombo-assisted pyeloplasty. Group 2: 28 children, 12 girls and 16 boys, average age of 69 months (extremes: 24-129) benefited from a pyeloplasty by lombotomy. Operating times were significantly shorter in opened surgery than with the lombo-assisted procedure. There was no significant difference in terms of per- or post-operating complication, use of analgesic and hospitalization duration. On the other hand, the lombo-assisted procedure provided the same undisputable aesthetic benefit and the same muscular preservation than pure lomboscopy procedure. As a consequence, this procedure could be set up at no risk for the patient, even if it had lead to longer operating times. However, operating times stayed shorter than with the pure lomboscopy or the celioscopy procedures, compared to the literature.