[Oncological and functional results of focal treatment of localized prostate cancer with HIFU]. / Résultats oncologiques et fonctionnels du traitement focal du cancer de prostate localisé par HIFU.

INTRODUCTION: In recent years, improved diagnosis of prostate cancer has allowed the development of focal therapy, in order to reduce the morbidity of treatments. Our study assesses the medium-term oncological and functional results of FocalOne® HIFU treatment in localized prostate cancer. METHODS: This is a retrospective, multicentre study including patients with low- or intermediate-risk localized prostate cancer treated with Focal one HIFU between November 2014 and December 2019. The primary endpoint was the retreatment rate and subgroup analyses were performed to identify predictive factors of retreatment. RESULTS: One hundred and thirty-seven patients were included with a median follow-up of 25.5 months. Seventy percent of patients had clinical stage T2, 64% had an ISUP score of 2 or 3 on initial biopsies and 38% were treated with hemi-ablation. Follow-up biopsies were performed in 76.6% of patients during follow-up with 21.8% having clinically significant cancers. The retreatment rate at 24 months was 37.2%, with positive biopsies being the primary criterion for retreatment. Patients with a PSA>8ng/mL had a significantly higher retreatment rate. Finally, morbidity remained acceptable with 5.8% of patients requiring reoperation for complications and 21% for de novo erectile dysfunction. CONCLUSION: Our results are in agreement with those of the literature, seeming to indicate a lower morbidity of the focal treatment by HIFU compared to the radical treatments while offering an acceptable oncological control. Prospective randomized trials are ongoing.

Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study).

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35-0.66]; severe: 0.29 [0.16-0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours.

[Digital transformation of perioperative nurse-coordinated protocols in renal surgery for enhanced recovery and outpatient surgery using UroConnect® application]. / Digitalisation de la coordination infirmière des parcours périopératoires de chirurgie rénale en réhabilitation améliorée et ambulatoire par l'application UroConnect®.

Robot Assisted Partial Nephrectomy (RAPN) is a standard of care for localized renal tumors. It allows a good carcinological control while limiting complications. Despite numerous benefits, the economic sustainability of robotic assistance remains a challenge in the French health care system. The introduction in our institution of two perioperative nurse-coordinated protocols for patients undergoing RAPN (Enhanced Recovery After Surgery: NP-RAAC in 2015 and Outpatient: Ambu-Rein in 2016) is associated with a shortening of the average length of hospital stay, thus reducing the cost of robotic assisted procedures. With the aim of improving efficiency of nursing support within these protocols, we have introduced digitalized nursing coordination by developing a urological perioperative application: UroConnect®. This device is offered to patients by the coordinating nurses during a preoperative visit. It provides information on the pathology and its surgical management. Self-completed questionnaires sent at key moments collect data from the first month after surgery and detect patients presenting difficulties or complications, allowing the nurses to respond with appropriate care. The application allows a secure discharge, a personalised follow-up and an increase in the patient's autonomy and compliance with care.

TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients.

BACKGROUNDS: Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration. METHODS: We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not. RESULTS: In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28). CONCLUSION: Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.