[Early detection of prostate cancer: Towards a new paradigm?] / Détection précoce du cancer de la prostate : vers un nouveau paradigme ?

Prostate cancer (PCa) is a public health issue. The diagnostic strategy for PCa is well codified and assessed by digital rectal examination, PSA testing and multiparametric MRI, which may or may not lead to prostate biopsies. The formal benefit of organized PCa screening, studied more than 10 years ago at an international scale and for all incomers, is not demonstrated. However, diagnostic and therapeutic modalities have evolved since the pivotal studies. The contribution of MRI and targeted biopsies, the widespread use of active surveillance for unsignificant PCa, the improvement of surgical techniques and radiotherapy… have allowed a better selection of patients and strengthened the interest for an individualized approach, reducing the risk of overtreatment. Aiming to enhance coverage and access to screening for the population, the European Commission recently promoted the evaluation of an organized PCa screening strategy, including MRI. The lack of screening programs has become detrimental to the population and must shift towards an early detection policy adapted to the risk of each individual.

[Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. / Recommandations sur la gestion du risque et la prise en charge urologique du patient adulte atteint de dysraphisme spinal (spina bifida).

INTRODUCTION: Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS: National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS: Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION: Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.

Feasibility of EXIME® temporary prosthesis placement and removal in men with acute or chronic urinary retention after failure or inability to selfcatheterize.

INTRODUCTION: Urological emergencies represent 7% of admissions, 29% of which are acute urine retention. We report the first results of a protocol evaluating a new device in case of failure of self-catheterization, replacing a permanent catheter: the urethral device EXIME®. METHOD: Intention-to-treat study on the feasibility of inserting the EXIME® prosthesis in a day hospital after simple urethral gel instillation in men with urine retention. EXIME® was proposed to all patients after failure of Foley catheter removal and refusal or inability to learn self-catheterization. The protocol was referenced (NCT04218942) after obtaining the agreement of the committee for the protection of individuals. RESULTS: Among 278 patients admitted for a trial of Foley catheter removal, 15 patients with failed voiding resumption and refusal or failure of self-catheterization were offered the prosthesis. The median age was 73 years with a median retention volume of 700mL. The median prostatic volume was 60g. Fourteen patients had their prosthesis inserted in good conditions of comfort for the practitioner and the patient. One failed placement was noted. The difficulty of insertion was estimated by the practitioner at 0 on median (VAS from 0 to 10), and for its removal at 0. The pain during the insertion of the device was evaluated by the patients at 2.00 and for the removal at 0 (VAS from 0 to 10). 6 patients had satisfactory voiding recovery at D0. DISCUSSION: We proposed the placement of EXIME to patients who had failed the trial of Foley removal and were unable and/or unwilling to self-catheterize. These were patients with poor bladder contractility and a high risk of retention recurrence. Despite this mixed result, the simplicity of the device and the comfortable expectation of an endoscopic procedure seem promising. CONCLUSION: Insertion and retrieval of EXIME®prostatic prosthesis were easy and well tolerated in our population. Insertion failed in one patient. A comparative prospective study with self catheterization is necessary to determine its effectiveness.

[Effectiveness of sacral neuromodulation in patients with Parkinson's disease]. / Efficacité de la neuromodulation sacrée chez le patient parkinsonien.

INTRODUCTION: The urinary disorders of the patients with Parkinson's disease are complex and have a negative impact on their quality of life. None of therapy is considered effective ; whether drug or surgical. Sacral neuromodulation, recommended in other neurological pathologies such as multiple sclerosis, has never been studied in the patients with Parkinson's disease. The objective of our study is to assess the efficacy of sacral neuromodulation in the patients with Parkinson's disease. MATERIAL AND METHOD: Multicentric retrospective cohort study, of 22 parkinsonian patients who underwent a sacral neuromodulation test. Epidemiological, clinical and urodynamic data were collected for each patient. A long-term effectiveness telephone survey was conducted. RESULTS: Twenty two patients with Parkinson's disease had a sacral neuromodulation test. 17/22 (77%) had Idiopathic Parkinson's Disease and 5/22 (23%) had Systematized Multi Atrophy. Clinically, the indication for the sacral neuromodulation test was overactive bladder in 68% of the cases. Urodynamically, detrusor hyperactivity is found in 12 patients (8 MPI, 4 AMS). Sacral neuromodulation was effective in only 7 patients (6 MPI and 1 AMS). Rather, the profile of the patient in whom NMS is effective is female, mature, and with PID. The long-term effectiveness of NMS is disappointing. Only 2 permanently implanted patients retained urinary benefit. CONCLUSION: NMS improves urinary symptoms in the patients with Parkinson's disease in 32% of cases. It fluctuates over time and loses its effectiveness in the long term.

[Isolated continent urinary diversion: An interesting or often regretted indication?] / Cystostomie continente isolée : une indication intéressante ou que l'on regrette souvent ?

INTRODUCTION: The aim of this study is to evaluate the percentage of patients developing vesical overactivity after the realization of a continent stoma without bladder enlargement. MATERIAL AND METHOD: This is a retrospective monocentric study between January 2007 and April 2021. Patients undergoing an isolated continent urinary diversion for neurological or non-neurological reasons were included. The data collected concerned the clinical symptoms of bladder overactivity and their treatment as well as the pre- and postoperative urodynamic information. RESULTS: During the period, 9 patients were included. The main indications for continent urinary diversion were patients with spinal cord injury. Clinical bladder overactivity was found postoperatively in 78% (7) of the patients, and detrusor overactivity in 57% (4) of them. The main symptoms were urinary incontinence (67%) and pollakiuria (56%, 5 patients). Most of the patients benefited from associated treatments (78% pre- and postoperative), mainly anticholinergic drugs. No patient required botulinum toxin injections preoperatively, compared with 6 (67%) postoperatively. The time of initiation of these injections varied between 3 and 8 months postoperatively. CONCLUSION: Isolated continent urinary diversion seems to induce or increase bladder overactivity. A larger multicentric study is necessary to validate our hypothesis.

Sacral neuromodulation: Rechargeable versus non-rechargeable device. What would the patient preferences be in France?

AIMS: Sacral neuromodulation (SNM) is a minimally invasive technique that provides effective treatment for the management of refractory overactive bladder (OAB), non-obstructive urinary retention (NOUR), and fecal incontinence (FI). This study assessed patient preferences between the currently available non-rechargeable SNM device and a new, full-body magnetic resonance imaging (MRI)-safe, smaller, rechargeable device. METHODS: An online cross-sectional survey was conducted among French OAB, NOUR, FI patients, recruited via a market research vendor. To assess their preferences, patients were asked to indicate their level of agreement with 10 statements regarding the size of the device, its rechargeability, and the role of MRI using a 6-item Likert scale. A descriptive statistical analysis was performed. RESULTS: In all, 95 patients (68% women), mean age 50 years, were included in the study: 51% were treated for OAB; 44% received an oral treatment and 28% had SNM. Overall, 71% of the 95 patients indicated a preference for the new device; 75% considered that recharging the device would not impact their lifestyle; 74% believed that the smaller size of the rechargeable device would facilitate their choice to be treated with SNM; 80% found full-body MRI compatibility important. CONCLUSIONS: Most patients may prefer the new rechargeable SNM device over the current "standard". Compatibility with full-body MRI and the smaller device size seemed the key features of the newer device that would influence their choice of being treated with SNM. Future national and international recommendations should consider a shared decision-making process between the physician and the patient.

[DNA repair gene alterations testing in prostate cancer : A practical update by the prostate cancer committee of the french association of urology]. / Recherche d'altérations des gènes de réparation de l'ADN dans le cancer de la prostate : mise au point pratique du Comité de cancérologie de l'association française d'urologie.

INTRODUCTION: Current therapeutic developments in prostate cancer (PCa) tend to increasingly personalize the treatment strategy, in particular as a function of tumor genomics. Recently, poly ADP-ribose polymerase (PARPi) inhibitors have shown their efficacy at the stage of castration resistance, in case of alteration of DNA repair genes in tumor tissue. MATERIAL AND METHODS: A narrative review was carried out on recent data in the literature since 2000. A consensus among the members of the Committee was obtained in order to synthesize the current data, with a particular focus on the practical considerations regarding indications and developments of molecular testing circuits concerning DNA repair genes, for theranostics purpose. RESULTS: The establishment of an efficient molecular testing network is based on the multidisciplinary organization of the various actors and the coordination of all material resources. Its goal is the routine search for somatic mutations (in tumor tissue) of BRCA1/2 genes in patients who may benefit from PARPi. The current indications are for BRCA1 or 2 mutated castration-resistant metastatic PCa after next-generation hormone therapy failure. The demand for molecular testing must be decided in the tumor board, giving priority to archived tissue less than 10 years old. In case of unsuccess, biopsies of the primary or metastases, or even analysis of circulating tumor DNA, may be necessary. Any demand for a genetic test on tumor tissue must be accompanied by detailed information for the patient on the possible familial consequences, in case of associated germline mutation. CONCLUSION: This article aims to guide the practical implementation of molecular testing circuits for DNA repair genes alterations, in order to guide the therapeutic management of patients with advanced PCa.

[Recent advances in the management of localized high-risk prostate cancer: An update by the Prostate Cancer Committee of the French Association of Urology]. / Avancées récentes dans la prise en charge du cancer de la prostate localisé à haut risque : mise au point par le Comité Prostate de l'Association française d'urologie.

INTRODUCTION: The risk of recurrence is increased in localized high-risk prostate cancer (PCa). The implementation of an appropriate diagnostic and therapeutic strategy is essential. The objective of this update by the Prostate Committee of the French Association of Urology was to report the most recent data in the management of localized high-risk PCa. MATERIAL AND METHODS: This update is based on the data available in the literature on localized high-risk PCa. A PubMed search and narrative review of the recent data were performed in March 2022. RESULTS: Compared with conventional imaging, PET-PSMA is more effective for the diagnosis of lymph nodes and distant metastases. Two recent randomized clinical trials have failed to prove the oncologic benefit of extended pelvic lymph node dissection during radical prostatectomy (RP). Postoperatively, early salvage radiotherapy is the standard of care, with adjuvant radiotherapy becoming an option in case of unfavorable pathological criteria (ISUP 4-5, pT3±positive margins) in young patients. Although promising, perioperative systemic therapies (chemotherapy, second-generation hormonotherapy) cannot be recommended at this time when the patient is treated by RP. Regarding radiotherapy, prophylactic lymph node irradiation during prostatic irradiation was associated with improved biochemical and metastasis-free survival in a recent randomized trial but it is still controversial. Since the publication of the results of the STAMPEDE trial, the addition of abiraterone acetate to radiation-hormone therapy should be considered the new standard of care for patients with localized (very) high-risk PCa, according to the inclusion criteria of the study. CONCLUSION: The most recent data of the literature regarding the management of high-risk localized PCa redefine the diagnostic performance of molecular imaging, the timing of postoperative radiotherapy, the oncologic benefit of pelvic lymph node treatment, and the intensification of systemic therapies.

French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Diagnosis and management of localised disease.

OBJECTIVE: The objective of the French Urology Association Cancer Committee is to propose an update of the recommendations for the diagnosis and management of prostate cancer (PC). METHODS: A systematic review of the literature from 2020 to 2022 was conducted by the CCAFU on the diagnosis and therapeutic management of localised PC, while evaluating the references and their levels of evidence. RESULTS: The recommendations specify the genetics, epidemiology and means of diagnosing prostate cancer, as well as the notions of screening and early detection. MRI, the gold standard imaging examination for localised cancer, is recommended before prostate biopsies are performed. The transperineal approach reduces the risks of infection. The therapeutic methods are described and recommended according to the clinical context. Active surveillance is the gold standard of treatment for tumours with a low risk for progression. Early salvage radiotherapy is recommended in case of biochemical recurrence after radical prostatectomy. Imaging, particularly molecular imaging, helps to guide the decision-making in the event of biochemical recurrence after local treatment, but should not delay early salvage radiotherapy in the event of biological recurrence after radical prostatectomy. CONCLUSION: This update of the French recommendations should help to improve the management of patients with PC.

French AFU Cancer Committee Guidelines - Update 2022-2024: prostate cancer - Management of metastatic disease and castration resistance.

OBJECTIVE: The objective of the French Urology Association Cancer Committee is to propose an update of the recommendations for the management of prostate cancer. METHODS: A systematic review of the literature from 2020 to 2022 was conducted by the CCAFU on the elements of therapeutic management of metastatic and castration-resistant prostate cancer (PC), while evaluating the references and their levels of evidence. RESULTS: Androgen deprivation therapy (ADT) remains the standard treatment for metastatic prostate cancer. ADT intensification is now a standard of care in the management of metastatic prostate cancer. This intensification is discussed in relation to the patient and the characteristics of the disease. For all metastatic hormone-sensitive PC (synchronous and metachronous), the overall survival benefit associated with good tolerability makes the combination of ADT and novel hormonal agents (NHA) a standard. For patients with high-volume/high-risk de novo metastatic disease, treatment with docetaxel in addition to ADT + NHA can be discussed for eligible patients. In patients with castration-resistant prostate cancer (CRPC), the contribution of new therapies that have become available in recent years, as well as the advent of precision medicine, help to improve the control of tumour progression and survival, and highlight the value of testing for alterations in DNA repair genes within the tumour tissue or constitutionally. CONCLUSION: This update of the French recommendations should help to improve the management of patients with prostate cancer.

Narrative review of PET/CT performances at biochemical recurrence in prostate cancer after radical prostatectomy and impact on patient disease management: Revue narrative à propos des performances de la TEP/TDM en cas de récidive biochimique après prostatectomie radicale dans le cancer de la prostate et impact sur la prise en charge des patients.

Patients treated by radical prostatectomy (RP) for localized prostate cancer (PCa) may experience biochemical recurrence (BCR) in approximately 30% of cases. Recently, advances in imaging modalities and in particular Positron-Emission Tomography with computed tomography (PET/CT) imaging allow for better detection and characterization of lesions outside the prostatic bed at recurrence. Thus, treatment at BCR can be significantly improved by a tailored strategy based on new generation imaging. A more precise and accurate staging of the disease at recurrence paves the way to more appropriate treatment, potentially translating into better survival outcomes of these patients. This review therefore highlights the interest of PET/CT at the time of BCR, its superiority over standard imaging in terms of staging, and its impact on guiding the different therapeutic possibilities depending on the site, number, and volumes of recurrence. Indeed, we will discuss below about different strategies and their indications: salvage radiotherapy of the prostate bed, systemic therapies, stereotactic body radiotherapy and others therapeutical strategies. The various innovative approaches based on PET/CT implementation are partly underway within protocol trials to prove their benefits on clinically meaningful endpoints. © 2022 Elsevier Masson SAS. All rights reserved.

How PET-CT is Changing the Management of Non-metastatic Castration-resistant Prostate Cancer?: Comment la TEP-TDM Peut Modifier la Prise en Charge du Cancer de la Prostate Non Métastatique Résistant à la Castration ?

INTRODUCTION: The aim of this narrative review conducted by the Prostate Cancer Committee of the French Association of Urology (CC-AFU) was to provide an update on the current evidence for the impact of PET/CT in the management of men with non-metastatic castration-resistant prostate cancer (nmCRPC). MATERIAL AND METHODS: This review is based on data available in the literature on PET/CT imaging for staging nmCRPC patients. A PubMed search and narrative review of the data were performed in March 2022. Only articles in French or English were considered. RESULTS: Current guidelines recommend bone scan and CT scan as standard imaging modalities for staging and follow-up of patients with nmCRPC. Nearly one-third of asymptomatic patients with presumed nmCRPC ultimately have metastatic disease on conventional imaging. Increasing reports have shown that conventional imaging has limited accuracy in detecting metastatic disease in nmCRPC patients, leading to the development of next-generation imaging techniques. In a retrospective study, 18F-choline PET/CT detected distant metastases in 27/58 high-risk nmCRPC patients with prior negative conventional imaging. The implementation of radiolabeled ligands of the prostate-specific membrane antigen (PSMA) PET/CT in staging strategy has resulted in metastasis detection in 45% to 98% of patients with presumptive nmCRPC on conventional imaging. Such an early diagnosis of metastatic CRPC may allow patients to be referred for metastasis-directed therapies (i.e. stereotactic body radiotherapy), aimed at prolonging the efficacy of systemic therapies and improving clinical outcomes. However, current data are not strong enough to recommend this strategy, which must be properly evaluated in clinical trials. Indeed, the use of molecular imaging may lead to inappropriate undertreatment if the second-generation androgen receptor inhibitors (darolutamide, enzalutamide, apalutamide), which prolong life, are not used in the subgroup of patients with high PSA velocity (PSA doubling time <10 months). CONCLUSION: Implementation of PSMA-PET/CT in the staging strategy would result in a migration of disease stage to extra-pelvic, M1 disease in at least half of presumed nmCRPC patients. The unprecedented accuracy of PSMA-PET/CT may pave the way for a more personalized treatment strategy. However, no data yet support this strategy for all nmCRPC patients as no oncologic benefit of early detection of M1 disease or MDT has been demonstrated. © 2022 Elsevier Masson SAS. All rights reserved.

Pregnancy and Delivery in Women with Lower Urinary Tract Reconstruction: A National Multicenter Retrospective Study from the French-Speaking Neuro-Urology Study Group (GENULF) and the Neuro-Urology Committee of the French Association of Urology.

PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.

[Plaque incision and Tachosil graft in Peyronie's Disease]. / Incision de plaque et greffe de Tachosil chez les patients atteints d'une maladie de Lapeyronie.

INTRODUCTION: Surgery is a treatment for correction of penile curvature in Peyronie's disease. Partial plaque excision and grafting is recommended for severe and complex curvature. METHODS: Patients with stable penile curvature who underwent a partial plaque excision and grafting between January 2017 and April 2018 were retrospectively included. The graft was realized using a self-adhesive collagen fleece (Tachosil®). Penile curvature, penile length and erection score were measured before and after surgery. RESULTS: Twenty-one patients, aged 52,13 (18-70 years) were included. The average follow-up after surgery was 8,36 months (1-14 months). Early complications included two hematomas and one dysuria (Clavien 1). One patient had a penile prosthesis hernia 3 months after surgery, and needed a new surgery (Clavien 3B). Patients stayed at the hospital 1.38 night (1-5) and operating time was 158min (102-249min). Average penile curvature after surgery was 5.88° (0-30°), while it was 82.75° (50-100°) before. Erection score increased from 7.62 (3-10) to 7.86 (4-10). There was no modification of the penile length 11.92cm (11-14.5) after surgery and 12.09cm (10-15cm) before. CONCLUSION: The use of TachoSil® reduces the operative time, is easy to use and has hemostatic properties at a low cost. However, prospective randomized trial and long terms results are required to confirm our encouraging results. LEVEL OF EVIDENCE: 3.

[Benign prostatic hyperplasia surgery and patient's information: What do patients understand and remember?] / Chirurgie de l'hypertrophie bénigne de prostate et information des patients : qu'est ce que les patients comprennent et retiennent ?

INTRODUCTION: Preoperative information is a key to adherence to treatment for the patients, but may be misunderstood because of its density and complexity. The aim of this study was to assess comprehension and satisfaction of patients about preoperative information of benign prostatic hyperplasia (BPH) surgery. Factors influencing patient understanding were also studied. PATIENTS AND METHODS: It was a monocentric study on questionnaires including every patients planned for BPH surgery, whatever the surgical technique. A survey was sent at patient's home after the preoperative consultation. RESULTS: One hundred and six of 210 patients (50,5 %) returned the questionnaire. 38,68 % (n=41) found the quality of information excellent (9 or 10 out of 10), and 45,28 % (n=48) found the quality of information good (7 or 8 out of 10). The main recalled complications were retrograde ejaculation (39.6 %, n=42/106), and bleeding (29,2 %, n=31/106). 57.6 % of patients (n=61) remembered receiving the written information sheet of the French Association of Urology. 5.7 % (n=6) hesitated having the procedure. Only patient's age was significantly associated with difference of comprehension (p<0.005). CONCLUSION: Information given before a BPH surgery seems satisfactory although it was poorly understood, notably about complications. Providing complete oral information, insisting on complications, and giving the written information sheet are essential for a good doctor-patient relationship and a forensic serenity. LEVEL OF EVIDENCE: 3.

[Long-term outcomes of intradetrusor botulinum toxin A in multiple sclerosis patients]. / Efficacité au long terme de la toxine botulique dans l'hyperactivité de vessie chez les patients atteints de sclérose en plaques.

INTRODUCTION: The objective of this study was to analyze the long-term efficiency and tolerance of TB in the management of anticholinergic refractory hyperactive bladder in patients with MS. MATERIAL AND METHOD: Retrospective mono-centric cohort study of all patients with MS who had a TB injection for anticholinergic refractory hyperactivity from 2005 to 2015. The primary endpoint was clinical efficiency based on the frequency of urinary leakage and symptomatic urinary tract infections. RESULTS: One hundred and nineteen patients received the first injection. Median follow-up was 26.5 months. After an injection, there was a significant decrease in the number of leaks, with 69.7% of patients without leaks and 93.3% of patients without urinary tract infections. After 7 injections 44% of the patients were still dry and 62.07% had no symptomatic urinary tract infections. The failure rate was 24.37%, the average duration before discharge was 34.7 months. 19 (66%) patients stop treatment for loss of efficacy, 9 (31%) for disease progression and 1 (3%) for cessation of treatment without cause. Of the 774 injections performed, there were complications for 26 of them (3.35%). CONCLUSION: Botulinum toxin remains the second-line reference treatment for detrusor overactivity of neurological origin. There is, at least in the short term, a good answer in a large number of cases. This response can be maintained for many years, especially if patients use intermittent catheterization, with excellent tolerance. LEVEL OF EVIDENCE: 4.

Efficacy and security of continent catheterizable channels at short and middle term for adult neurogenic bladder dysfunction.

AIMS: The objective of this study was to assess the effectiveness and the complications rate following continent cutaneous channels (CCC) procedures, at short and medium term follow-up (FU). MATERIALS & METHODS: A continuous retrospective case series (2008-2018): all patients who have undergone a CCC for neurogenic bladder were included in our department. The primary outcome was the effectiveness of CCC defined by the status of catheterizability (by the patient or a care-giver), continence of the tube, and absence of reintervention at 3 and 12 months FU. The secondary outcome was the prevalence of postoperative complications at 3 and 12 months FU. RESULTS: Fifty-three patients were included during the study period in our department. Median follow up was 3,3 years (1.5-6.1). The overall effectiveness of CCC was 67.9% (n=36/53) at 3 months FU and 45,3% (n=24) at 12 months FU. The global rate of complications was 60.4% (n=32/53) at 3 months, and 73.6% (n=39/73) at 12 months FU. The statistical analysis showed no statistical differences on efficacy and complications in the different subgroups of CCC. CONCLUSIONS: In the current series, the effectiveness and the complications rates following CCC were comparable across the procedure types. LEVEL OF EVIDENCE: 4.

[Enhanced recovery after robotic partial nephrectomy: Evaluation of patient's satisfaction]. / Réhabilitation précoce après tumorectomie rénale robot-assistée : quelle satisfaction des patients ?

INTRODUCTION: Several enhanced recovery protocols after surgery showed a benefit for postoperative recovery and reduction of hospital lengths of stay. Very few studies evaluated patient's satisfaction about these enhanced recovery protocols. The aim of this study was to evaluate patient's satisfaction about our enhanced recovery protocol for robotic-assisted partial nephrectomy (RAPN). METHODS: A validated survey EORTC In PATSAT32 with a specific questionnaire about protocol was sent to the first patients included in the enhanced recovery protocol for RAPN. The survey was sent after the postoperative consultation at postoperative day 30. Responses were anonymous. Satisfaction's scores for EORTC questionnaire were calculated for each dimension with Likert's method. Scores were transformed linearly into a scale ranging from 0 to 100, where 100 represent the highest level of care satisfaction (EORTC method). RESULTS: A total of 21 patients (50%) returned the completed questionnaire. The overall satisfaction score was 75.1% (37.3; 100) in the EORTC survey. In total, 71.4% of patients (n=15) were satisfied with the discharge at postoperative day 2 (POD2) and 5 patients (23.8%) found this premature. None of the patients had a negative impression on the clinical pathway. The average overall evaluation on the protocol by patients, on a satisfaction scale of 1 to 10 was 8.9/10. CONCLUSION: In this study, patients included in the enhanced recovery protocol after RAPN were very satisfied with their pre-, per- and postoperative care. Given patients satisfaction, reduction of LOS, patient's safety and the medicoeconomic advantage, these enhanced recovery protocol have become a priority to develop and evaluate. More large studies are needed to assess the patient's experience with these clinical pathways. LEVEL OF EVIDENCE: 4.

[Evolution of the number of incident cases, stage and first treatments for prostate cancer in France between 2001 and 2016]. / Évolution du nombre de cas incidents, du stade et des premiers traitements des cancers de la prostate en France entre 2001 et 2016. À partir de données hospitalières de 3 centres.

INTRODUCTION: No studies of French hospital registries for prostate cancer (PCa) have been published since the 2012 USPSTF recommendations. MATERIAL: This is a multicenter cohort study based on hospital data of prostate biopsies (PB) in 3 health centers between 2001 and 2016. The main objective is to describe the evolution of incident cases of PCa. The secondary objectives are to describe the number of cases per stage of PCa and the distribution of the first treatments. RESULTS: In total, 11,491 PB series diagnosed 5927 cases of PCa. The median age was 67 [61-73] years and the median PSA was 7.8 [5.5-13] ng/mL. The number of cases increased until 2006 before decreasing from 2006 to 2013 and then stabilizing from 2013 to 2016. The proportion of incident cases was: (1) for the stable metastatic stage around 8 [7-10]%, (2) for cases with PSA<10 ng/mL increasing from 46% to 75% in 2010 down to 64% in 2016, (3) for the grade 1 group decreasing from 59% to 33 % between 2011 and 2016. The proportion of active surveillance treatment for low-risk cancers increased from 5 to 60% and surgery decreased from 73 to 33%. CONCLUSION: The evolution of the incident cases showed a decrease from 2006 to 2013 and a stability until 2016. The number of cases with PSA<10 ng/mL decreased since 2010 and the proportion of the options of treatment by surveillance increased strongly to the detriment of the surgery for low risks. LEVEL OF EVIDENCE: 3.

[Focal HIFU vs robot-assisted total prostatectomy: Functionnal and oncologic outcomes at one year]. / Traitement focal par HIFU versus prostatectomie radicale robot-assistée pour cancer de la prostate localisé : résultats carcinologiques et fonctionnels à 1 an.

OBJECTIVE: To analyse the functional and oncologic outcomes at one year of focal therapy with HIFU compared with total prostatectomy in patients with localised prostate cancer (PCa). PATIENTS AND METHODS: Retrospective and monocentric study from 2008 to 2014 comparing 2 cohorts of patients with localised PCa (T1/T2 clinical stage, Gleason score≤3+4=7 and PSA<15ng/mL), one treated by focal therapy (HIFU-F group), one by robot-assisted total prostatectomy (RATP group). Primary outcome was a trifecta defined as: absence of urinary incontinence, erectile function with sexual relations without treatment, negative PSA with negative surgical margins (RATP group) or negative biopsy cores (HIFU-F group). RESULTS: The 53 patients included in the "HIFU-F" group and the 66 patients in the "RATP" group were similar in terms of preoperative PSA, D'Amico risk group, erectile function but were different in terms of age, prostatic volume, length of cancer, Gleason score. Complication rate was not different. In multivariate analyse with propensity score, "HIFU-F" group achieved a better trifecta score than "RATP" group (OR=8,3, p=0,005). CONCLUSION: In case of low or intermediate risk localised PCa, "HIFU-F" group had better functional outcomes than initial learning curse "RATP" group, at one year. A long-term evaluation by a common endpoint is necessary to judge the oncological equivalence of both techniques. LEVEL OF EVIDENCE: 3.