Eliciting men's preferences for decision-making relative to treatments of localized prostate cancer with a good or moderate prognosis.

PURPOSE: In diseases where there is no real consensus regarding treatment modalities, promoting shared decision-making can contribute to improving safety and quality of care. This is the case in low- or intermediate-risk localized prostate cancer (PC) treatment. The aim of this study was to investigate the preferences guiding men's decisions regarding the characteristics of the treatment strategies for PC to help physicians adopt a more patient-centered approach. METHODS: This prospective multicenter study used a discrete choice experiment (DCE). The attributes and the modalities were identified from a qualitative study and a literature review. Relative preferences were estimated using a logistic regression model. Interaction terms (demographic, clinical and socio-economic characteristics) were added to the model to assess heterogeneity in preferences. RESULTS: 652 men were enrolled in the study and completed a questionnaire with 12 pairs of hypothetical therapeutic alternatives between which they had to choose. Men's choices were significantly negatively influenced by the risk of impotence and urinary incontinence, death, and the length and frequency of care. They preferred treatments with a rescue possibility in case of deterioration or recurrence and the use of innovative technology. Surprisingly, the possibility of undergoing prostate ablation negatively influenced their choice. The results also highlighted differences in trade-offs according to socio-economic level. CONCLUSION: This study confirmed the importance of considering patients' preferences in the decision-making process. It appears essential to better understand these preferences to allow physicians to improve communication and promote case-by-case decision-making.

Ductal adenocarcinoma of the prostate: Clinical and biological profiles.

BACKGROUND: Ductal adenocarcinoma (DAC) is a rare and aggressive subtype of prostate cancer (PCa). In the present study, we analyzed the clinical and biological characteristics of DAC, in comparison with high grade conventional acinar PCa. METHODS: Samples and data were retrospectively collected from seven institutions and centrally reviewed. Immunohistochemistry was performed on tissue microarrays to assess the expression of candidate proteins, based on the molecular classification of PCa, including ERG, PTEN, and SPINK1. SPOP mutations were investigated from tumor DNA by Sanger sequencing. Relationships with outcome were analyzed using log-rank analysis and multivariable Cox regression. RESULTS: Among 56 reviewed prostatectomy specimens, 45 cases of DAC were finally confirmed. The pathological stage was pT3 in more than 66% of cases. ERG was expressed in 42% of DAC, SPINK1 in 9% (all ERG-negative), and two cases (ERG-negative) harbored a SPOP mutation. Compared to high grade conventional PCa matched for the pathological stage, cell proliferation was higher (P = 0.04) in DAC, and complete PTEN loss more frequent (P = 0.023). In multivariate analysis, SPINK1 overexpression (P = 0.017) and loss of PSA immunostaining (P = 0.02) were significantly associated with biochemical recurrence. CONCLUSION: these results suggest that, despite biological differences that highlighted DAC aggressiveness, the molecular classification recently proposed in conventional PCa could also be applied in DAC.

Surgimesh M-SLING(®) transobturator and prepubic four-arm urethral sling for post-prostatectomy stress urinary incontinence: clinical prospective assessment at 24 months.

OBJECTIVE: To assess tolerance and mid-term clinical outcomes of treatment, with a new four-arm mesh sling, of post-prostatectomy incontinence (PPI) in men. MATERIAL AND METHODS: This was a French multicentre prospective study that included 93 patients who underwent radical prostatectomy at least 1 year before Surgimesh M-SLING(®) implantation for the treatment of PPI. Data were collected preoperatively, and patients were followed at 3, 12 and 24 months postoperatively. Objective outcome measures included number of pads per day, 24-h pad-test, maximum urinary flow rate (Qmax ) and urinary retention. We also analysed Urinary Symptom Profile (USP(®) ) score, degree of erectile dysfunction, patients' satisfaction level, postoperative pain and procedure complications. Length of catheterization and hospitalization periods were also recorded. Patients were considered cured if no protection was used and/or daily pad weight was <2 g. Patients whose condition was considered to have improved reduced their daily urinary losses by >50%. Those not included in any of the aforementioned groups were assessed as unchanged or to have deteriorated, and were considered as treatment failures. RESULTS: The mean hospitalization period was 1.57 ± 0.70 days. All patients remained catheterized for 1.17 ± 0.48 days. Intention-to-treat analysis at 24 months showed that 34.4% of patients were cured, 27.1% had improved, and 19.4% were considered failures. Two patients experienced transient urinary retention. USP questionnaire scores showed a significant decrease in incontinence and prevalence of hyperactive bladder. There was a nonsignificant tendency for reduced severe erectile dysfunction (ED), and a shift towards moderate ED was observed. No severe complications occurred. CONCLUSION: The Surgimesh M-SLING transobturator and prepubic four-arm urethral sling represents an easy-to-deploy, safe and durable therapeutic alternative for mild to moderate PPI. Its implantation did not have a negative influence on sexual performance outcomes.

Transurethral plasma vaporization of the prostate: 3-month functional outcome and complications.

UNLABELLED: Study Type - Therapy (multi-centre cohort). Level of Evidence 2b. OBJECTIVE: To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study. PATIENTS AND METHODS: A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer's recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded. RESULTS: Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation. CONCLUSIONS: The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.

Impact of oral anticoagulation on morbidity of transurethral resection of the prostate.

AIM: To assess the impact of oral anticoagulation (OA) on morbidity of transurethral resection of the prostate (TURP). OA included warfarin and platelet aggregation inhibitors (PAI). PATIENTS AND METHOD: Multicenter analysis of patients operated for symptomatic benign prostatic hyperplasia (BPH) by TURP. Patients under OA were compared to those with no OA. RESULTS: Out of 612 patients included in the analysis, 206 (33%) were on OA prior surgery (55 warfarin, 142 PAI, and 9 warfarin and PAI). No patient continued warfarin and clopidogrel during the operating period. Patients under OA were significantly older (75 vs. 71 yo, P < 0.001), had larger prostate volume (56 vs. 49 ml, P = 0.05), and had higher rate of bladder catheter prior surgery (26 vs. 17%, P = 0.02). At 3 months follow-up, patients in the OA group had a higher weight of resected tissue (24 vs. 21.7 g, P < 0.001), a longer duration of hospitalization (6.4 vs. 4.7 days P < 0.001), a higher rate of bladder clots (13 vs. 4.7%, P < 0.001), red cell transfusion (1.9 vs. 1.0%, P = 0.026), late hematuria (15.0 vs. 8.4%, P = 0.004), and thromboembolic events (2.4 vs. 0.7, P = 0.02). In multivariable analysis, OA status was the sole independent parameter associated with bladder clots (P = 0.004) and with late hematuria (P = 0.03). CONCLUSION: OA had a significant and independent impact on TURP outcome in terms of bleeding complications. This data could be used for treatment decision and for patient's information prior BPH surgery.

Surgical management of BPH in patients on oral anticoagulation: transurethral bipolar plasma vaporization in saline versus transurethral monopolar resection of the prostate.

INTRODUCTION: To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers. Types of OA and perioperative management were collected. Postoperative outcomes were statistically compared between the two groups. RESULTS: A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively. Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group. Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both. PAI was withdrawn preoperatively in 50 patients. All treatments with warfarin were switched for heparin. Comparison of the two groups showed significantly less hemorrhagic complications after TUVis. Patients treated with TUVis experienced less bladder washouts (2% versus 18%, p = 0.008), less late hematuria (4% versus 19%, p = 0.02), and lower decrease of serum hemoglobin (mean decrease of 0.66 versus 1.47 g/dL, p = 0.02). Postoperative bladder catheterization and hospital stay were significantly shorter, whereas the rate of urinary retention was significantly higher. Three months after surgery, functional results were not significantly different between the two groups. CONCLUSIONS: In patients on OA, TUVis led to significantly less bleeding, as well as shorter bladder catheterization and hospital stay than TURP.

Impact of lower urinary tract symptoms on discomfort in men aged between 50 and 80 years.

BACKGROUND/AIMS: There are only a few surveys on the prevalence of lower urinary tract symptoms (LUTS) among the general population. The aim of this survey was to assess the prevalence of LUTS and their impact on discomfort in men. METHODS: A questionnaire was mailed to 3,877 men aged 50-80 years, which included questions on their medical history, demographic and sociological status, and also the International Prostate Symptom Score (IPSS) with additional questions on discomfort related to urinary symptoms. RESULTS: The response rate was 81.5%. Prevalence of mild and severe IPSS was 89.2%. Specific bother for each urinary symptom depended on symptom frequency: urgency, frequency, weak stream, nocturia, incomplete emptying, intermittency and straining 1 time out of 5 were responsible for discomfort in respectively 4.9, 6.1, 7.1, 7.5, 8.7 and 9.9%; the same symptoms more than half of the time were responsible for discomfort in respectively 32.8, 38, 45.3, 45.6, 53.2 and 58.7%. Urgency was much more deeply implicated in discomfort than frequency of nocturia. CONCLUSIONS: Urinary symptoms in men are very common. Nocturia is the most frequent but has a low impact on discomfort. Urgency has a higher impact on discomfort and should therefore be considered in treatment decision-making.

Effect of dutasteride, tamsulosin and the combination on patient-reported quality of life and treatment satisfaction in men with moderate-to-severe benign prostatic hyperplasia: 2-year data from the CombAT trial.

OBJECTIVE: To investigate the effect of dutasteride and tamsulosin as combined therapy compared with each monotherapy for improving patient-reported health outcomes in men with moderate-to-severe urinary symptoms and prostate enlargement, reporting the pre-planned 2-year analyses from the CombAT trial. PATIENTS AND METHODS: The CombAT study is an ongoing, international, double-blind, randomized, parallel-group trial. Men aged >or=50 years with a clinical diagnosis of benign prostatic hyperplasia (BPH), an International Prostate Symptom Score (IPSS) of >or=12 units, a prostate volume of >or=30 mL, a total serum prostate-specific antigen level of 1.5-10 ng/mL and a peak urinary flow of >5 and or=125 mL, were randomized to receive 0.5 mg dutasteride, 0.4 mg tamsulosin or the combination once daily for 4 years. Symptoms were assessed every 3 months. The primary endpoint at 2 years was the change in IPSS from baseline. Secondary endpoints included various measures of health outcomes, which included the BPH Impact Index (BII), IPSS Question 8 (Q8), and the Patient Perception of Study Medication (PPSM) questionnaire. RESULTS: Combined therapy resulted in significantly greater improvements in BII and IPSS Q8 from baseline than did dutasteride from 3 months and compared with tamsulosin from 9 months (BII) or 12 months (IPSS Q8). Assessments using the PPSM questionnaire showed that a significantly higher proportion of patients were satisfied with and would request dutasteride and tamsulosin combined therapy than with each monotherapy at 24 months. CONCLUSIONS: Dutasteride and tamsulosin combined therapy provides significantly greater improvements in patient-reported quality of life and treatment satisfaction than both monotherapies at 2 years, following the trends for clinical improvements in symptom scores and peak urinary flow rates, in men with moderate-to-severe BPH symptoms.

Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review.

We assessed the therapeutic efficacy and safety of laser prostatectomy (LP) for treating benign prostatic hyperplasia (BPH) in patients on oral anticoagulation. We systematically reviewed previous reports, using the Pubmed database and bibliographies of retrieved articles and reviews. The oral anticoagulation included coumarin derivatives and platelet-aggregation inhibitors (PAI). Previous studies do not allow the establishment of definitive conclusions for managing patients on oral anticoagulation and who require BPH surgery. No randomized studies are available. Nevertheless, compared to transurethral resection of the prostate (TURP), LP seems to decrease the risk of haemorrhage in patients taking PAI or coumarin derivatives. Therefore, LP is a useful alternative to TURP for managing patients on oral anticoagulation, and could be proposed as the first intention for those patients. Continuing PAI during the procedure is feasible. A replacement of coumarin derivatives by low molecular weight heparin is preferable. No conclusion can be reached on the preferred type of laser technique to treat these patients, but data on laser enucleation is much less abundant and conclusive than that on laser vaporization.

Effectiveness and Complications of the AMS AdVance™ Male Sling System for the Treatment of Stress Urinary Incontinence: A Prospective Multicenter Study.

OBJECTIVE: To evaluate the effectiveness and tolerance of the AdVance Male Sling System for the treatment of male stress urinary incontinence in patients after prostatic surgery. METHODS: An international, observational, prospective, multicenter study was conducted on male patients with urinary incontinence after prostatic surgery. Patients underwent a 24-hour pad test with a threshold at 250 g. All patients were operated with the same AdVance implant procedure. They were seen 6 weeks later, and examined again at 3, 6, 12, and 24 months. Incontinence was measured using 1-hour and 24-hour pad tests, the number of protective pads used, ICIQ-SF and IQoL questionnaires. Success was defined as no urinary leakage and no pad use. Patient improvement was defined as a reduction of more than 50% in leakage and no more than one pad used per day. Any perioperative and late complications were documented. RESULTS: From January 2007 to November 2012, 113 patients were successfully operated on. At 24 months after surgery, the mean weight of the 1-hour pad test had decreased from 48.7 g to 6.6 g (P < 0.001) while that of the 24-hour pad test decreased to 45.0 g from 113.9 g (P < 0.001). Success and improvement occurred in 22.6% and 58.0% of the patients, respectively. Seventy-five patients (80.6%) used none or one protective pad daily, and the IQoL and ICIQ-SF scores were both significantly improved. Fourteen patients (12.4%) required a second intervention. Three patients (2.7%) had a Clavien IIIb complication. CONCLUSION: The AdVance Male Sling System is an effective treatment for mild to moderate male stress urinary incontinence. Complications from its use are rare and 24-month results are satisfactory.

Metabolic syndrome and low high-density lipoprotein cholesterol are associated with adverse pathological features in patients with prostate cancer treated by radical prostatectomy.

BACKGROUND: Previous studies have suggested a link between metabolic syndrome (MetS) and prostate cancer (PCa). In the present study, we aimed to assess the association between MetS and markers of PCa aggressiveness on radical prostatectomy (RP). METHODS: All patients consecutively treated for PCa by RP in 6 academic institutions between August 2013 and July 2016 were included. MetS was defined as at least 3 of 5 components (obesity, elevated blood pressure, diabetes, low high-density lipoprotein (HDL)-cholesterol, and hypertriglyceridemia). Demographic, biological, and clinical parameters were prospectively collected, including: age, biopsy results, preoperative serum prostate-specific antigen, surgical procedure, and pathological data of RP specimen. Locally advanced disease was defined as a pT-stage ≥3. International Society of Urological Pathology (ISUP) groups were used for pathological grading. Qualitative and quantitative variables were compared using chi-square and Wilcoxon tests; logistic regression analyses assessed the association of MetS and its components with pathological data. Statistical significance was defined as a P<0.05. RESULTS: Among 567 men, 249 (44%) had MetS. In a multivariate model including preoperative prostate-specific antigen, biopsy ISUP-score, clinical T-stage, age, and ethnicity: we found that MetS was an independent risk factor for positive margins, and ISUP group ≥4 on the RP specimen (odds ratio [OR] = 1.5; 95% CI: 1.1-2.3; P = 0.035; OR = 2.0; 95% CI: 1.1-4.0; P = 0.044, respectively). In addition, low HDL-cholesterol level was associated with locally advanced PCa (OR = 1.6; 95% CI: 1.1-2.4; P = 0.024). Risks of adverse pathological features increased with the number of MetS components: having ≥ 4 MetS components was significantly associated with higher risk of ISUP group ≥ 4 and higher risk of positive margins (OR = 1.9; 95% CI: 1.1-3.3; P = 0.017; OR = 1.8; 95% CI: 1.1-2.8; P = 0.007, respectively). CONCLUSION: MetS was an independent predictive factor for higher ISUP group and positive margins at RP. Low HDL-cholesterol alone, and having 4 and more MetS components were also associated with higher risk of adverse pathological features.

Fatty acid profile in peri-prostatic adipose tissue and prostate cancer aggressiveness in African-Caribbean and Caucasian patients.

BACKGROUND: Genetic and nutritional factors have been linked to the risk of aggressive prostate cancer (PCa). The fatty acid (FA) composition of peri-prostatic adipose tissue (PPAT), which reflects the past FA intake, is potentially involved in PCa progression. We analysed the FA composition of PPAT, in correlation with the ethno-geographical origin of the patients and markers of tumour aggressiveness. METHODS: From a cohort of 1000 men treated for PCa by radical prostatectomy, FA composition of PPAT was analysed in 156 patients (106 Caucasians and 50 African-Caribbeans), 78 with an indolent tumour (ISUP group 1 + pT2 + PSA <10 ng/mL) and 78 with an aggressive tumour (ISUP group 4-5 + pT3). The effect of FA extracted from PPAT on in-vitro migration of PCa cells DU145 was studied in 72 patients, 36 Caucasians, and 36 African-Caribbeans. RESULTS: FA composition differed according to the ethno-geographical origin. Linoleic acid, an essential n-6 FA, was 2-fold higher in African-Caribbeans compared with Caucasian patients, regardless of disease aggressiveness. In African-Caribbeans, the FA profile associated with PCa aggressiveness was characterised by low level of linoleic acid along with high levels of saturates. In Caucasians, a weak and negative association was observed between eicosapentaenoic acid level (an n-3 FA) and disease aggressiveness. In-vitro migration of PCa cells using PPAT from African-Caribbean patients was associated with lower content of linoleic acid. CONCLUSION: These results highlight an important ethno-geographical variation of PPAT, in both their FA content and association with tumour aggressiveness.

[Medical management of uncomplicated benign prostatic hyperplasia: a new decision algorithm]. / Prise en charge médicale de l'hypertrophie bénigne de la prostatenoncompliquée: proposition d'un nouvel algorithme décisionnel.

Management of benign prostatic hyperplasia (BPH) is currently undergoing profound changes. Medical treatment is not only symptomatic, but may also seek to modify the natural history of the disease, especially by reducing the risk of acute urinary retention. Medical treatment is no longer limited to a single drug: the combination of 2 different drugs from different treatment categories appears superior to single-drug treatment in some patients. Two instrumental techniques - microwave or radiofrequency thermotherapy, previously proposed as alternatives to surgery - are more appropriate as alternatives to medical treatment. These various items make it possible to construct a decision algorithm that is based at each stage on a decision shared with the patient. This algorithm to provide decision aid in management of uncomplicated symptomatic HBP takes initial disease indicators and other patient indicators into account together with its course under treatment, which has not previously been considered by international guidelines.

[Lessons to be drawn from one year of surveillance of Escherichia coli in a urology department]. / Les leçons a tirer d'un an de surveillance de Escherichia coli dans un service d'urologie.

UNLABELLED: Escherichia coli (E. coli) is the micro-organism most frequently identified in urinary tract infections in adults. The authors analysed the nalidixic acid resistance rate of E. coli isolated over 12 consecutive months in a urology department. MATERIAL AND METHOD: All E. coli-positive bacteriological examinations from a urology department during 2004 were retrospectively reviewed. Seventy five bacteriological examinations from 68 patients were positive for E. coli, corresponding to 67 urine cultures, 6 blood cultures and 2 drained collections. Twenty patients had taken fluoroquinolones during the previous 6 months and 10 patients were diabetic. A nalidixic acid-resistant (NR) E. coli was isolated in 11 patients (16%) aged 22 to 81 years (median: 58 years). Patients with nalidixic acid-resistant (NR) E. coli were compared to patients with nalidixic acid-susceptible (NS) E. coli. RESULTS: Predictive factors for nalidixic acid resistance of E. coli were fever higher than 38.4 degrees C (p = 0.022), leukocytosis (p = 0.002) and use of fluoroquinolones during the previous 6 months (p = 0.046). CONCLUSIONS: Prescription of a non-fluoroquinolone antibiotic may be preferable in the case of recent use of fluoroquinolones and signs of severe infection (leukocytosis and fever higher than 38.4 degrees C).

[Value of antidiuretic, anticholinergic, and anti-inflammatory drugs and botulinum toxin for the treatment of voiding disorders related to BPH (CTMH-AFU forum 2005)]. / Intérêts des antidiurétiques, des anticholinergiques, des anti-inflammatoires et de la toxine botulinique pour le traitement des troubles mictionnels liés à l'HBP (forum CTMH-AFU 2005).

New therapeutic approaches have recently been investigated in order to improve the voiding disorders of patient with lower urinary tract symptoms related to benign prostatic hyperplasia. The purpose of this article is to provide a review of these treatments: anti-inflammatory, antidiuretic, anticholinergic and botulinum toxin. Anticholinergic drugs associated with a risk of urinary retention, appear to be effective for irritative disorders in combination with an alpha-blocker. Antidiuretics can be proposed in patients younger than 65 with disabling polyuria confirmed by a voiding diary, related to BPH and refractory to conventional treatment of BPH. The interaction between inflammation and BPH has not yet been clarified, but anti-inflammatory drugs appear to improve symptoms and may have a place in short-term treatment of BPH, as their long-term use is not recommended and COX-2 inhibitors have been withdrawn from the market. Finally, botulinum toxin could have a place in the treatment of disorders related to BPH if clinical studies confirm the recently published promising results. These new approaches will probably be integrated into guidelines and flow-charts for the treatment of voiding disorders related to BPH.

[The role of the IPSS (International Prostate Symptoms Score) to evaluate the frequency of disability induced by each of the 7 symptoms. (CTMH-AFU study)]. / Comment pondérer directement l'IPSS par la fréquence de la gêne induite par chacun des 7 symptômes ? (etude du CTMH-aFU).

INTRODUCTION: Evaluation of a patient with voiding disorders related to benign prostatic hyperplasia is theoretically performed by means of the IPSS score, which comprises only one global quality of life question. This study used a questionnaire to evaluate the frequency of disability induced by each of the symptoms of the IPSS in a representative sample of the French population and then proposed a weighting of the IPSS score by the statistical weight of disability of each symptom without having to increase the number of questions. METHODS: A survey on the voiding behaviour of French men was performed by TNS Sofres Healthcare by questionnaire between 18/4/03 and 27/5/03 in a panel of 3877 men aged 50 to 80 years representative of the French population. This survey comprised demographic and sociological questions as well as the IPSS score. A specific question concerning the disability induced by each of the 7 symptoms ("Does it bother you enormously, a lot, slightly, not at all? ") was added. RESULTS: Each symptom induced a different type of disability: the most marked disability was induced by urgent micturition and uri nary frequency, while interrupted stream only had a minor impact. Statistical modelling was performed to obtain a coefficient for each level of frequency of the symptom, directly integrating the theoretical statistical weight of the specific disability. With this statistical method, the frequency of each of the 7 symptoms was weighted by a coefficient from 0.00 to 1.54 according to the disorder and its frequency. A total of 35 coefficients were necessary to construct the score as a function of the frequencies of disability of the 7 symptoms. This method was used to classify disorders according to the degree of disability that they induced, the most disabling being urgency (from 0 to 1.54), followed by straining to urinate (0 to 1.17), and then each of the other 5 symptoms. CONCLUSION: The original feature of this new score is that it directly integrates the frequency and theoretical specific disability of each of the 7 symptoms of the IPSS score. However, it needs to be validated by a prospective clinical trial.

[Role of prostatic stents and transurethral microwave thermotherapy in the treatment of voiding disorders related to benign prostatic hyperplasia (CTMH-AFU forum 2005)]. / Place des endoprothèses prostatiques et de la thermothérapie micro-ondes transuréthrales dans le traitement des troubles mictionnels liés à l'HBP? (Forum CTMH-aFU 2005).

Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment of voiding disorders related to benign prostatic hyperplasia. A review of the literature evaluates the place of these treatments in 2006. Permanent prostatic stenting is rarely used, but remains a treatment option for patients with obstructive disorders and a formal anaesthetic contraindication. Temporary stenting can be used to predict the effect of resection in selected patients. Finally, microwave thermotherapy, not widely used in France, has a promising clinical efficacy and occupies a place between medical treatment and surgery.

[Section of intravesical TVT tape by a suprapubic trocar]. / Section d'une bandelette TVT intravésicale par un trocart sus pubien.

Since its first description in 1995, treatment of female urinary incontinence by TVT has become a routine procedure. The ascending retropubic approach can lead to a number of complications. Bladder trauma is observed in 2% to 20% of cases depending on the series. They do not have any repercussions if they are diagnosed and repaired intraoperatively, but, when they are detected later, they raise problems of diagnosis and management. The authors report 2 cases in which a combination of cystoscopy and laparoscopy was used to section intravesical TVT.

[Treatment of benign prostatic hyperplasia (BPH) by transurethral needle ablation (TUNA) and 36-month follow-up of the retreatment rate]. / Traitement de l'hyperplasie bénigne de prostate (HBP) par thermocoagulation au moyen d'aiguilles par voie trans-urétrale (TUNA) et suivi a 36 mois du taux de retraitement.

OBJECTIVE: Benign prostatic hyperplasia (BPH) is a disease affecting about 25% of men over the age of 40. One half of these men report symptoms that interfere with their daily activities. MATERIAL AND METHODS: In this multicentre study, 102 patients with BPH were treated by transurethral needle ablation (TUNA). The efficacy of treatment was evaluated for 12 months after the operation by means of Madsen and IPSS (International Prostate Symptom Score) scores. The course of uroflowmetry and quality of life (International Score) and sexual function were also assessed for one year. The safety of treatment was evaluated according to the type and frequency of complications. The results show an immediate and significant improvement of symptoms (p < 0.0001 for Madsen and IPSS scores and maximum flow rate between M0 and M12) demonstrating the efficacy of the TUNA system. A very positive impact of TUNA was demonstrated on quality of life. No negative impact was reported on sexual function and the operation had very few repercussions with a low adverse event rate. The retreatment rate (surgical and/or drug) was evaluated 36 months after the operation by means of an optional follow-up questionnaire subsequently completed by the investigators. RESULTS: After 3 years, based on the 80 questionnaires returned, 43 patients (53.8%) were stable and did not need any other medical or surgical treatment for BPH. Thirty-seven (37) patients (46.3%) required retreatment: 21 were treated with drugs (26%), 17 were treated surgically (21.25%) including 1 patient who was also retreated with drugs. This study demonstrates the significant and lasting improvement of BPH symptoms by TUNA, which constitutes an alternative attractive to surgery in young patients and/or patients worried about their sexuality.