Association between metabolic syndrome and severity of lower urinary tract symptoms (LUTS): an observational study in a 4666 European men cohort.

OBJECTIVES: To evaluate the relationship between metabolic syndrome and the frequency and severity of lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: In all, 4666 men aged 55-100 years consulting a general practitioner during a 12-day period in December 2009 have been included in this observational study. LUTS were defined according to the International Prostate Symptom Score (IPSS) and metabolic syndrome with the National Cholesterol Education Program/Adult Treatment Panel III definition. We studied the correlation between metabolic syndrome and its individual components, and the severity of LUTS (IPSS and treatment for LUTS). Analyses were adjusted for body mass index, age, and prostate-specific antigen level. RESULTS: Metabolic syndrome was reported in 51.5% of the patients and 47% were treated for LUTS. There was a significant link between metabolic syndrome and treated LUTS (P < 0.001). The risk of being treated for LUTS also increased with an increasing number of metabolic syndrome components present. Metabolic syndrome was positively correlated with the severity of the LUTS (P < 0.001) for overall IPSS and both voiding and storage scores (P < 0.001). Each component of the metabolic syndrome (except high-density lipoprotein-cholesterol) appeared as an independent risk factor of high IPSS and of LUTS treatment in multivariate analysis. Metabolic syndrome was positively correlated with prostate volume. CONCLUSIONS: Our results suggest a significant relationship between LUTS linked to benign prostatic hyperplasia and metabolic syndrome, in terms of frequency and severity. The risk of being treated for LUTS also increased with an increasing number of metabolic syndrome components present. The prevention of such modifiable factors by the promotion of dietary changes and regular physical activity practice may be of great importance for public health.

[Muscle-invasive bladder cancer]. / Tumeurs de la vessie infiltrant le muscle.

Muscle invasive bladder cancers represent 20 to 30% of bladder tumors and are metastatic at diagnosis in 10% of cases. The diagnosis is based on histological analysis of transuretral resection pieces. An invasion of the detrusor (stage pT2) signs the infiltrating nature of the tumor. The local and general staging is based on thoraco-abdominopelvic CT. The standard treatment for localized stages is cystoprostatectomy in men and anterior pelvic exenteration in women. For urinary diversion, the two choices are cutaneous non continent ileal conduit (Bricker) and ileal neobladder. Neoadjuvant chemotherapy can be discussed for locally advanced stages. The concomitant chemoradiotherapy is an alternative to surgical treatment in elderly or frail patients. The management of metastatic bladder cancer is based on systemic chemotherapy.

Renal Arterial Mycotic Aneurysm After Kidney Transplantation.

Mycotic aneurysm is a rare condition mostly attributable to Candida or Aspergillus species. About 20 cases of Candida-related arteritis have been reported in kidney transplant patients. Herein, we report the case of a 40-year-old man who received a kidney from a deceased donor in whom an accidental digestive wound was made during organ retrieval. He presented with sudden anuria 47 days after renal transplantation, revealing a large mycotic aneurysm of the kidney graft renal artery. Organs derived from donors in whom a digestive breach is noticed should be used with caution.

Laparoscopic Mitrofanoff procedure in children: critical analysis of difficulties and benefits.

OBJECTIVES: The Mitrofanoff principle is an accepted continent urinary diversion. We studied the feasibility and the possible benefits of using a laparoscopic approach in children with significant bladder dysfunction associated with difficulty doing efficient urethral catheterization. PATIENTS AND METHODS: A fully laparoscopic Mitrofanoff continent cystostomy was attempted in 15 children with a median age of 9 years (IQR 6), between 2003 and 2013. Before the Mitrofanoff procedure was considered, urodynamic evaluation was done for each patient, to study bladder compliance, detrusor activity, and bladder capacity. The procedure was performed using a transperitoneal four-port approach. A 30-degree down camera angle was optimal for viewing the appendix and the posterior wall of the bladder. The operative steps of the open procedure were replicated laparoscopically. The proximal end of the appendix was spatulated and anastomosed to the posterior wall of the bladder, providing an antireflux mechanism by an extramucosal tunnel. The distal end of the appendix was brought out as the cutaneous umbilical stoma. Some modifications were done because of the high rate of conversion due to early opening of the mucosa (harmonic hook) or difficult anastomosis: (a) use of 5-mm trocars to change the laparoscope position from the left to right subcostal area to better visualize the anastomosis, (b) the anastomosis was suspended at its two ends during suturing; a trans-abdominal traction suture of the bladder was inserted for better exposure of the anastomosis (hitch stitch) and to stabilize the anastomotic line during suturing, (c) use of a monopolar hook to cut the detrusor muscle fibers, to avoid incidental opening of the mucosa, and (d) the window between the appendix and the peritoneum was closed to avoid internal hernia. RESULTS: The procedure was totally completed by laparoscopy in 12 cases. Three were converted to an open procedure due to tearing of bladder mucosa (n = 2) or appendix ischemia (n = 1). Median operative time for fully laparoscopic Mitrofanoff was 255 min (IQR 52). Median follow-up was 18 months (IQR 35). No patient required stomal revision. Seven patients were continent, five experienced urinary leakage from urethra n = 1 and/or stoma n = 5. Three patients with stomal urinary leakage were successfully managed by Deflux (dextranomer-based implants) injection in the catheterizable channel. Two patients required an open revision of the appendicovesical anastomosis. The patient with both stomal and urethral urinary leakage also required the implantation of an artificial urinary sphincter 1.5 years after Mitrofanoff. One patient had bladder augmentation. CONCLUSION: Although our results of laparoscopic Mitrofanoff procedure in children are unsatisfying in cases of high-pressure bladders in terms of incontinent stoma, we still believe that it is justified to develop this challenging technique with more refinement and improvement, to provide a minimal invasive procedure that may postpone or even avoid bladder augmentation in pediatric age.