Patients' related sexual outcomes in colorectal surgery.

Background: Patients undergoing colorectal surgery (CRS) have an increased risk of developing sexual disorders, attributed to different mechanisms. In this context, sexual function (SF) assessment of patients before and after surgery is essential: to identify risk factors for sexual disorders as well as to minimize their impact on overall quality of life (QoL), allowing them a satisfying relationship and sexual life. Material and methods: Patients over 18 years of age who underwent a CRS in the University Hospital of Geneva, Switzerland, between June 2014 and February 2016 were included. Our main objective was to compare and analyze the evolution of SF, QoL, and marital satisfaction (MS) before and after CRS. Specific and standardized tests were used. Results: A cohort of 72 patients with a median age of 58.73 was analyzed. The majority of CRS was elective (91.5%). A percentage of 52.8% of patients underwent surgery for oncological reasons. There was no statistical difference in SF, sexual QoL, and MS before and after elective or emergency CRS for men. Interestingly, a significant decrease in women's SF (FSFI) as well as their satisfaction within their couple (Locke-Wallace) until 12 months after surgery was found (p = 0.021). However, they showed a steady SF (GRISS) within their couple until 12 months after surgery. Conclusion: Regarding knowledge about difficulties to talk about this intimate topic and gender differences, this general overview raises the question of the necessity to introduce in a long-course follow-up different methods of sexual health assessment with specific stakeholders.

[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.

[Preservation of sexual function : a challenge for the colorectal surgeon]. / Préservation de la fonction sexuelle : un défi pour le chirurgien colorectal.

Patients with rectal cancer have an increased risk of developing sexual disorders. These dysfunctions are caused by the disease itself (negative psychological impact, nerve compression in the pelvis), as well as by the treatments (radiotherapy, chemotherapy and surgery). Most sexual disorders are due to the surgery and can be attributed to injuries of the retroperitoneal nerves. Sexuality assessment of patients before and after treatment, a precise knowledge of the pelvic anatomy by the surgeon, and an appropriate care by specialists (gynaecologists, urologists and sexologists) are essential to reduce the risk of sexual disorders and to minimize their impact on overall quality of life.

Les patients atteints d'un cancer du rectum présentent un risque accru de développer ou d'aggraver des troubles de la sexualité. Ces dysfonctions sont causées par la maladie (impact psychologique négatif, compression nerveuse dans le petit bassin) d'une part, et par les traitements (radio, chimiothérapie et chirurgie) d'autre part. Parmi ceux-ci, la chirurgie est responsable de la plupart des troubles sexuels, par lésion des plexus neurovégétatifs. Une évaluation de la sexualité des patients avant et après traitement, une connaissance précise de l'anatomie du petit bassin par le chirurgien ainsi qu'une prise en charge adaptée par des spécialistes (gynécologues, urologues, sexologues) constituent les étapes essentielles afin de diminuer le risque de survenue de troubles sexuels et leur impact sur la qualité de vie globale des patients.

80-W GreenLight Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Obstruction: 5-Year Outcomes of a Single-center Prospective Randomized Trial.

OBJECTIVE: To assess long term functional and safety follow-up data after 80-W GreenLight photoselective vaporization (GL PV) of the prostate and transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Prospective randomized trial at a single tertiary referral center (Geneva, Switzerland). Patients were recruited in the outpatient clinic if they met the criteria for surgical treatment of benign prostatic obstruction. At baseline, 238 patients were treated either with the 80-W GL PV or monopolar TURP. After 5 years, data were available from 105 patients: 44 GL PV patients and 61 TURP patients. The primary outcome measure was the International Prostate Symptom Score (IPSS). Secondary outcome measures included maximum urinary flow rate (Qmax), postvoidal residual (PVR) and reoperation rate. Statistical analyses were performed using Stata 14 (StataCorp). RESULTS: After 5 years of follow-up, mean improvements in International Prostate Symptom Score, postvoidal residual and maximum urinary flow rate were similar in both groups. The re-treatment rate was 14.3% in the GL PV group vs 11.9% in the TURP group (P = .9). CONCLUSION: Noninferiority of the GL PV to TURP was confirmed in all functional and safety outcomes at 5-year follow-up. GL-PV could be a safe surgical alternative for patients suffering from benign prostatic obstruction.

Post-kidney Transplant Robot-assisted Laparoscopic Ureteral (Donor-receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease.

OBJECTIVE: To report our experience with robot-assisted ureteral anastomosis for kidney graft. Kidney graft complex ureteral strictures or symptomatic vesicoureteral reflux may require complex reconstruction. This is classically done through an open surgical access, which adds to the morbidity of kidney transplantation. The da Vinci robot enables performance of complex laparoscopic procedures and may hence be used for such reconstructions. PATIENTS AND METHODS: We retrospectively reviewed all patients undergoing robotic surgical revision for stricture or reflux disease over a 3-year period. Contemporary patients who underwent open surgery were used as a control group. RESULTS: Ten patients underwent a robotic attempt, of whom 4 needed conversion to open surgery. Seven patients underwent an open surgery. Preoperative demographics were similar in both groups. The median operative time was 293 minutes, with a shorter operative time in the open group. The group of patients who could be completed robotically had a significantly lower postoperative length of stay (5 vs 9 days), quicker return to normal food intake (postoperative day 1 vs 3), and quicker control of pain without opiates (postoperative day 1 vs 4) than the converted or open group. Morbidity was comparable with 1 late Clavien IIIb complication in each subgroup (open, converted, and robotic group). After a median follow-up of 43 months, renal function was stable and there were no recurrent graft infections. CONCLUSION: Robotic ureteral reconstruction for kidney graft patients is feasible and efficient, and offers the classical advantages of minimally invasive surgery with outcomes comparable with open series.

Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques.

INTRODUCTION: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. PATIENTS AND METHODS: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. RESULTS: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). CONCLUSIONS: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.

[Frequent uro-geriatric symptoms : helpful tools for general practitioners]. / L'urogériatrie du médecin généraliste.

Each developed country faces an aging population. Increase of age rises the risk to develop urologic pathology especially in men. Routine investigation and diagnostic of urologic pathology important, however must take into account the patient in his globality (including age, comorbidities, drug medication as well as sociocultural environment). The aim of this article is to help the general practitioner in taking decisions with frequent uro-geriatric symptoms. Bladder catheterization remains an invasive treatment and indication should be regularly re-evaluated. Urinary infections must be distinguished from bacterial colonisations, with some exceptions, don't need any specific treatment. We will resume two algorithms on the management of hematuria and the management of prostate cancer suitable for the elderly.

Tout pays développé voit vieillir sa population et le risque de développer une pathologie urologique augmente avec l'âge, notamment chez les hommes. La prise en charge d'un symptôme urologique doit prendre en compte la personne âgée dans sa globalité. Cet article rappelle les éléments principaux de la gestion initiale d'un prostatisme : dépister les symptômes, débuter un traitement et surtout l'adapter au quotidien du patient. La sonde urinaire est un traitement invasif dont l'indication doit être remise en cause. Les infections urinaires sont à différencier des colonisations bactériennes qu'il ne faut pas traiter, sauf dans certaines situations. Nous reprendrons deux arbres décisionnels sur la prise en charge de l'hématurie et d'un cancer prostatique adaptés à la personne âgée.

Histologic confirmation of a biochemical recurrence after radical prostatectomy by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance imaging.

OBJECTIVE: To obtain a histologic confirmation of biochemical recurrence after radical prostatectomy, which still remains a challenge. Historically, biopsy protocols have been designed but have provided rather unsatisfactory results. We report the first case of histologic confirmation of a biochemical recurrence in the prostatectomy bed by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance images. MATERIALS AND METHODS: A 66-year-old man who underwent laparoscopic prostatectomy for a localized prostate cancer of Gleason sum 3+3=6 and preoperative prostate-specific antigen (PSA) level of 8.9 ng/L was followed up yearly. Postoperative serum PSA value was <0.04 ng/L. Nine years later, the patient developed a biochemical recurrence with an elevation of serum PSA level to 1.27 ng/mL. A 3-T endorectal positron emission tomography-magnetic resonance imaging (MRI) scan showed a 5 × 3 mm nodule in the prostatectomy bed in contact with the vesicourethral anastomosis without hypermetabolism. Two biopsies of this nodule were performed by using a 3-dimensional endorectal ultrasonography probe connected to the Koelis navigation system (Urostation; Koelis, Grenoble, France) with fusion to MRI images. RESULTS: Histologic findings confirmed the presence of a recurrence of the prostate cancer of Gleason sum 4+3=7 in both biopsies, and the patient was addressed to the radio-oncologist for salvage therapy. CONCLUSION: The use of a transrectal approach with 3-dimensional guidance and MRI fusion allows correct sampling of prostate cancer recurrence nodules in the prostate bed. This procedure is easily performed in the outpatient clinic but still has to be validated in a larger series.

[3D ultrasound guidance for prostate biopsy with MRI-image fusion]. / Biopsies de la prostate sous guidage échographique 3D avec fusion à l'IRM.

Endorectal prostate biopsies by using 2D ultrasound guidance remain the gold standard for diagnosing prostate cancer. However this technique is limited by a low yield knowing that only 20-30% of all prostate biopsies detect prostate cancer. Since a few years it is possible to do these biopsies by using 3D endorectal ultrasound guidance with fusion to MRI images in order to increase the yield. This new technique permits to visualize the exact localization of all biopsies and gives the certitude of a good mapping of the prostate tissue increasing the yield up to 40%. By fusioning images of the MRI with the 3D ultrasound, it is even possible to target suspect lesions visualized on the MRI, which permits to increase the yield up to 100% in favorable cases.

Calcifying bowel inflammation: a case report.

We report about a previously healthy 72-year-old woman, presented with 6 days of left lower quadrant abdominal pain and constipation. There was no report of fever, melena, hematochezia or change in appetite. The physical exam demonstrated a distended abdomen with palpable left lower quadrant pain, without guarding. CT showed images compatible with a sigmoid diverticulitis and a calcification of the sigmoid colon. After antibiotic threatment, a colonoscopy was performed which revealed the presence of a shell in the sigmoid colon. Our case illustrates the need for a colonoscopy following an attack of diverticulitis to look for a cancer or rarely a foreign body.