[Which non pharmacological interventions should be offered to patients treated with androgen deprivation therapy for prostate cancer? A systematic review]. / Quelles interventions non médicamenteuses proposer aux patients traités par hormono-suppression pour un cancer de la prostate ? Revue systématique de la littérature.

AIM: Prostate cancer is a frequent disease and one of the main treatments used is androgen deprivation therapy, which is a therapy with disabling side effects. Non-pharmacological interventions (NPIs) are evidenced based, non-invasive interventions on human health. They are classified into five categories (physical, psychological, nutritional, digital, elemental). The NPIs sphere is booming and still remains underused in this context. METHODS: A systematic review concerning randomized controlled trials was executed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We used the "Medline" and "Kalya Research" databases. After searching and selecting eligible publications, we included 37 randomized controlled trials. RESULTS: The majority of articles concerned physical NPIs with 30 clinical studies, 3 publications dealt with nutritional NPIs, 2 with psychological NPIs and 2 articles concerned elemental NPIs. No publication about digital NPI was found. All of the studies aimed to manage and improve the side effects of treatment. No elemental NPI has demonstrated benefit. Only one psychological NPI and one nutritional NPI were effective. Five types of physical NPI protocols have shown efficacy. The main benefits related to physical abilities, body composition, osteoporosis, quality of life, fatigue, reduced cardiovascular risk and finally anxiety and depression. CONCLUSION: Non-pharmacological interventions, especially physical ones, are effective in managing and reducing the side effects associated with androgen deprivation therapy and should be offered to patients in this context.

[Bladder tumors in the Hérault department: Results of the Hérault tumor registry registration from1987 to 2019]. / Les tumeurs de la vessie dans le département de l'Hérault : résultats de l'enregistrement du registre des tumeurs de l'Hérault de1987 à 2019.

OBJECTIVES: The Hérault Tumor Registry (RTH) is a general registry qualified by the national committee of registries since 1987. The objective of this study is to present the evolution of the epidemiology of bladder cancer (stage≥T1) in the Hérault department based on data collected by the RTH over a period from 1987 to 2019. MATERIAL AND METHODS: We analyzed trends in bladder cancer incidence in Hérault between 1987 and 2019 by sex, age, and stage, as well as mortality trends between 1987 and 2017. For the years 2018-2019, which are the last two years validated by the registry, we described relative frequencies, sex ratio, mean and median age at diagnosis, cumulative risk, stages at diagnosis, pathology data, and primary treatments. Observed and net survival data are analyzed for those diagnosed between 01/01/2000 and 12/31/2015 with a point date of 06/30/2018. RESULTS: In 2018-2019, bladder cancer was the 7th most common cancer in Hérault (5th in men and 12th in women) with an incidence sex ratio of 3.9 men to one woman. The mean age at diagnosis was 75.3 years for men and 77.8 years for women. The probability of having bladder cancer before the age of 75 years was 1.68% for a man (1/59) and 0.34% for a woman (1/295). Urothelial carcinomas accounted for 90.7% of cancers. Between 1987 and 2019, bladder cancer incidence TSMs (worldwide standardized rates) decreased by 0.8% per year in men and remained stable in women. Mortality TSMs between 1987 and 2017 followed the same trends with a decrease of 2.2% per year in men and stability in women. For the 3304 bladder cancers diagnosed between 01/01/2000 and 12/31/2015, the observed 5-year survival was 38% (34% in women and 38% in men). CONCLUSIONS: Bladder cancer incidence and mortality rates have decreased slightly in men but remain stable in women in the Hérault. Registries collect only a limited number of variables for each patient. In 2018 the Hérault Registry Specialized in Onco-Urology (RHESOU) was created, to have comprehensive data.

[Adhesion of urologists to the recommendations of the French Urological Association Cancer Committee (CCAFU) in the imaging work-up of localized prostate cancer]. / L'adhésion des urologues aux recommandations du comité de cancérologie de l'association Française d'urologie (CCAFU) dans le bilan d'imagerie du cancer localisé de la prostate.

OBJECTIVES: The literature review shows a low adhesion of urologists to the recommendations of learned societies in the imaging work-up of localized prostate cancer (CaP), especially for low and intermediate risks of the D'Amico classification. We analyzed the adhesion of urologists in the Hérault region (France) to the CCAFU 2016/2018, 2018/2020 recommendations. MATERIAL AND METHODS: From the Hérault Onco Urology Registry (RHESOU) database, we identified localized CaP diagnosed between 01/01/2017 and 31/12/2019, and then classified them into 3 distinct risk groups according to the D'Amico classification. We compared the imaging workup performed by each patient to the CCAFU 2016/2018, 2018/2020 recommendations, according to the risk group. RESULTS: Of the 2,049 localized CaPs included in our study, 591 belonged to the low-risk group, 1059 to the intermediate-risk group, and 399 to the high-risk group. In the low-risk group 45.2% of the cases did not follow the CCAFU 2016/2018, 2018/2020 recommendations in the imaging workup, 77.3% in the intermediate-risk group and 80.9% in the high-risk group. For our entire study, 1,408 patients (68.7%) had an imaging workup that did not follow the CCAFU recommendations. CONCLUSION: Our results show a low adhesion of urologists to the CCAFU recommendations in the imaging assessment of localized CaP. The causes of this non-adhesion are multifactorial and difficult to analyze.

Malignancy after Augmentation Enterocystoplasty: A Nationwide Study of Natural History, Prognosis and Oncogene Panel Analysis.

PURPOSE: We report the natural history and prognosis of tumors after augmentation enterocystoplasty, with a molecular analysis using an oncogene panel to search for potential targeted therapies. MATERIALS AND METHODS: This multicenter, nationwide, retrospective study included 16 patients. A panel of 21 clinically relevant oncogenes was tested on archival tumor specimens using next-generation sequencing. Survival rate was the main clinical outcome and sequences were compared to the reference genome for the genetic outcome. RESULTS: Augmentation enterocystoplasties were performed mainly for congenital neurogenic bladder and bladder exstrophy at a median patient age of 17 years (range 4 months to 45 years). Most of the malignancies were diagnosed because of clinical manifestations, with a median latency period of 20 years. Adenocarcinomas were mainly found after gastrocystoplasty, whereas urothelial cell carcinomas were typically found after colocystoplasty. Of the 16 patients 13 were diagnosed at an advanced stage of the disease (positive lymph nodes in 7, distant metastases in 6). The overall 1-year survival rate was 56%. Only 3 patients remained disease-free at a median followup of 70 months. Of the 9 tumors with analyzable DNA 4 were wild-type and 5 harbored missense mutations (KIT-p.Pro573Ser, PDGFRA-p.Glu587Lys, KRAS-p.Gly12Asp, ERBB4p.Arg484Lys, CTNNB1-p.Ser37Phe and p.Ser47Asn). CONCLUSIONS: Malignancy after augmentation enterocystoplasty is diagnosed late with frequent metastases and a very low 1-year survival rate. More than half the tested samples harbored missense mutations in oncogenes accessible to targeted therapies. An international collaboration to enlarge the genetic panel analysis of these tumors may offer new therapeutic hope to patients.

[Radical prostatectomy for prostate cancer, perioperative management by French urologists in 2018]. / Évaluation de la gestion per- et périopératoire d'une prostatectomie totale pour cancer de la prostate par les urologues français en 2018.

INTRODUCTION: Prostatectomy (PT) is a common procedure performed by many urologists. In 2018, 20,207 prostatectomies were performed in France, and few studies evaluated the perioperative habits of urologists. As part of writing guidelines for enhanced recovery after surgery (ERAS) we wished to evaluate practice of urologists in their hospital management of a prostatectomy. MATERIEL AND METHODS: A questionnaire was sent by Survey Monkey in June and July 2018 to all urologists who are members of the French Association of Urology. RESULTS: One hundred and sixty seven urologists (14%) answered the questionnaire, 62% have private practice. The average number of operators per center performing PT was 4, with a median number of 70 interventions (0 to 486) per center in 2018. Open surgery is still gold standard (39.13%), followed by the robot-assisted transperitoneal laparoscopic (34.78%) and standard laparoscopic (24.22%). Alimentation, like first stand-up, was re-established on the first post-operative day, and the average hospital stay was 4±2 nights. The removal of the bladder catheter was most often performed at home by nurse (49.06%), one week after surgery. Only 10.06% of urologists systematically perform a cystography before removal urinary catheter. CONCLUSION: The perioperative management of prostatectomy in France is relatively homogeneous, between urologists. The length of hospital stay remains important and could be reduced by proposing an ERAS protocol as has been obtained for cystectomy. LEVEL OF EVIDENCE: III.

[RHESOU (Registry in HErault Specialized in Onco-Urology) : the first French Registry specialized in Onco-Urology. One-year experience]. / RHESOU (Registre de l'Hérault spécialisé en onco-urologie) : le premier registre français spécialisé en onco-urologie. Un outil méthodologique de recueil de données en onco-urologie. Bilan de faisabilité sur un an d'expérience.

PURPOSE: In 2016, the Herault tumor registry collected 1961cancers in urology (21.4 % from all Herault cancers this year). RHESOU was created to complete RTH' data with specific parameters in onco-urology. The aim of this study is to describe RHESOU and to give some examples with our first results. MATERIAL AND METHODS: In November 2018, RHESOU (Registry HErault Specialised in Onco-Urology) was founded with the same registry recommendations. It collects specific oncologic parameters and also complete RTH's data. For each urological cancer, a specific survey with different choices was performed to collect a maximum of data which could be present in patients' file. These surveys were used for urological cancers cases that live in Herault in 2017. RESULTS: In 2017, we collected 970 prostate cancers, 581 bladder cancers, 212 kidney cancers, 51 upper excretory tract cancers, 28 testicle cancers and 9 penil cancers. Our urological data collection gives many possibilities to create many requests for detailed analysis in urological cancers. In this article, we reported data from kidney, bladder and prostate cancers. CONCLUSIONS: RHESOU is a new tool opened to the different urologic corporations (urologists, pathologists, oncologists, radiotherapists, radiologists) that permits an overview in urological cancers in Herault. Finally, one important aim is that this tool will be adapted when new treatments or new important parameters appear in the years ahead. LEVEL OF EVIDENCE: 3.

[Short version of recommendations for enhanced recovery program (ERP) for cystectomy: Technical measures]. / Version courte des recommandations de la récupération ameliorée après chirurgie (RAAC) pour la cystectomie : mesures techniques.

INTRODUCTION: The enhanced recovery program (ERP) is a management mode whose objective is to reduce the risk of complications and allow the patient to recover more quickly all its functional capacities and to reintegrate at most quickly and safely in his usual environment. This intentionally synthetic document aims to disseminate in the urological community the main points of the ERP recommendations for cystectomy. This work, coordinated by AFU, involves several other partners. The full document is available on the "Urofrance" website. Another article will follow on organizational measures. METHOD: The development of the recommendations is based on the method "formalized consensus of experts" proposed by the HAS. The report is based on a systematic review of the literature (January 2006-May 2017), two rounds of iterative quotations and a national proofreading. Levels of proof of conclusions and gradation of recommendations are based on the HAS grid. RESULTS: The bibliographic strategy made it possible to retain 298 articles. Only the recommendations that obtained a strong agreement after the two rounds of iterative listing were retained. The recommendations presented here are in chronological form (before, during, after hospitalization). Twenty-six key points on the technical and organizational measures of ERP have been identified. CONCLUSION: The result of the literature review, supplemented by expert opinion, suggests a significant clinical interest in the application and dissemination of ERP for cystectomy, despite the limited data available for this indication.

[Place of partial nephrectomy assisted by robot: Review of the literature at the time of a request for a specific nomenclature]. / Place de la néphrectomie partielle assistée par robot : revue de la littérature à l'heure d'une demande de nomenclature spécifique.

INTRODUCTION: Robot-assisted surgery is practiced more and more frequently in urology. Besides its place in prostatectomy for cancer, it also concerns partial nephrectomy (NP), in the treatment of renal tumors. The objective of this review is to compare the robot-assisted approach with laparoscopic or open approaches in partial nephrectomy in terms of functional or oncological outcomes and per- and postoperative complications. MATERIAL AND METHODS: A systematic review of the literature published from 2009 was carried out on PubMed. Clinical studies or meta-analyzes comparing robot-assisted surgery versus laparoscopic or open surgery in the NP domain were used. RESULTS: The clinical data presented in this review of the literature are based mainly on meta-analyzes of comparative studies. Patients operated with robotic assistance (NPAR) had significantly fewer postoperative complications than patients operated by open (RR 0.61; P=0.0002) or laparoscopic surgery (RR 0.84; P=0.007). Positive margins, at equivalent pathological stages, are comparable to the open and appear to be lower than the laparoscopic surgery (RR 0.53; P<0.001). After NP, the change in postoperative glomerular filtration rate (GFR) appears to be identical between the 3 pathways. Hot ischemia time is significantly shorter for NPAR compared to NPL. Finally, the estimated blood loss and length of stay are less severe in patients operated by NPAR compared to those operated by open surgery. CONCLUSION: Robot-assisted surgery offers the same oncological results (in the short and medium term) and appears to improve functional outcomes and morbidity. However, these findings need to be carefully analyzed, due to the low level of evidence from the studies presented and included in the meta-analyzes, and the lack of randomized clinical studies.

[Postoperative C-reactive protein is a reliable marker to detect complications after radical cystectomy]. / La protéine C-réactive à j4 postopératoire, un marqueur fiable du risque de complications après cystectomie.

PURPOSE: Postoperative serum C-reactive protein (CRP) can be measured after major abdominal surgery to predict of complications at postoperative day (POD) 4. However, in urology, no studies have been conduced to analyze the role of CRP after radical cystectomy. The present study aims to analyze the relationship between a high postoperative level of CRP and the presence of complications after radical cystectomy for cancer. MATERIALS AND METHODS: This multicenter retrospective study included 313 patients treated with radical cystectomy for cancer between January 2013 and July 2016. Among the patients, 57.5% of patients received urinary diversion using a Bricker ileal conduit, 30.5% an orthotropic ileal neobladder, and 11.5% had an ureterocutaneostomy. RESULTS: Three hundred and thirteen patients were included (mean age 68.1±9.2 years). Among the patients, 26.5% had grade≥2 complications, according to the Clavien-Dindo classification. In multivariate analysis, only CRP level at POD 4 predicted the risk of a complication (P<0.001). CRP>150mg/L at POD 4 was strongly associated with a risk of a postoperative complication after a cystectomy (OR=81.42, 95% CI [25.6-258.3], P<0.001). CRP assessed on POD4 was reliable at ruling out the existence of an infectious complications with a negative predictive value of 0.94. The main limitation of our study was it observational design. CONCLUSIONS: CRP at POD4 with a threshold of 150mg/L would reliably predict the risk of postoperative complications after cystectomy. Monitoring postoperative CRP could help adapt rehabilitation protocols after radical cystectomy and also the early management of complications.

[Robot assisted radical prostatectomy: What are the evidences at the time of a specific funding?] / Prostatectomie radicale laparoscopique robot-assistée : quelles sont les preuves à l'heure d'une demande de nomenclature spécifique ?

INTRODUCTION: Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities. MATERIAL AND METHODS: A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected. RESULTS: There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP. CONCLUSION: RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.

Impact of preoperative immunonutrition on morbidity following cystectomy for bladder cancer: a case-control pilot study.

PURPOSE: To compare postoperative complications in patients with or without preoperative immunonutrition before cystectomy. METHODS: A prospective, multicenter, pilot, case-control study was conducted during 6 months. Patients with 7-day preoperative immunonutrition were prospectively included and compared with a retrospective, matched control group without immunonutrition. Early complication rates and the length of hospital stay were analyzed. The bilateral type I error was <0.05; the power was 90%. Thirty patients in each group were required. RESULTS: Thirty patients were included in each group, on a comparable basis. In the immunonutrition group, fewer postoperative complications (40 vs. 76.7%; p = 0.008), less paralytic ileus at D7 (6.6 vs. 33.3%; p = 0.02), fewer infections (23.3 vs. 60%; p = 0.008), and in particular less pyelonephritis (16.7 vs. 46.7%; p = 0.03) occurred. Clavien's grades for complications were higher in the control group (p = 0.04). Mortality, pulmonary embolism, anastomotic fistulae, and wound dehiscence were similar between two groups. The length of stay was reduced by 3 days in the immunonutrition group. CONCLUSIONS: In this pilot case-control study, immunonutrition is associated with a decrease in postoperative complications, urinary tract infections, Clavien's grade for complications, and paralytic ileus in patients undergoing cystectomy for bladder cancer. Prospective randomized placebo control studies are needed to confirm these promising results.

[Treatment of women urinary incontinence by artificial urinary sphincter: efficacy, complications and survival]. / Traitement de l'incontinence urinaire par sphincters urinaires artificiels chez la femme : efficacité, complications et survie.

OBJECTIVE: To analyze long-term results and mechanical survival of the artificial urinary sphincter (AUS) AMS 800™ (American Medical Systems, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). PATIENTS AND METHODS: Data were collected prospectively from women treated for SUI at one university hospital between 1987 and 2007. Inclusion criteria was SUI with severe ISD defined by low urodynamic closure pressure and negative continence tests. Endpoints were survival, complications and continence. RESULTS: A total of 376 AUS were implanted in 344 patients with a median age of 57 years (18-93 years). The median follow-up was 9 years (3-20 years). The 3, 5, and 10 years global device survival were 92, 88.6, and 69.2% respectively. The mean mechanical survival was 176 months (14.7 years). The two main risk factors for decreased AUS survival were the number of previous incontinence surgeries and the presence of neurogenic bladder. The continence rates assessed as full (no leakage) in 85.64% patients, social (some drops but no pad) in 8.78% and incontinence (1 pad or more) in 5.58%. CONCLUSIONS: The study has shown that in patients with ISD, the AUS represents an effective process, durable with an acceptable rate of complication.

Surface CD4 density remains constant on lymphocytes of HIV-infected patients in the progression of disease.

In an attempt to question the influence of circulating virus, soluble gp120 or CD4 self-reacting antibodies upon results of CD4+ T-cell immunophenotyping in AIDS patients, five anti-CD4 mAb defining several epitopes of the V1 and V2 domains of the CD4 molecule were used to analyse the epitopic density of CD4 on lymphocytes of seropositive patients taken at stages II, III and IV of HIV infection, according to the Centers for Disease Control (CDC, Atlanta) classification. Our results demonstrate that each CD4 epitopic density measured on circulating lymphocytes remains constant at a mean level of 46,000 epitopes per cell whatever the stage of the disease and whatever the serum p25 concentration. These data provide evidence that antibody accessibility to several CD4 epitopes is not altered by putative interactions between CD4 molecules and circulating virus, soluble gp120 or anti-CD4 autoantibodies. If such binding events, as expected, do occur in vivo, they are of too low a magnitude to influence the immunophenotyping. Furthermore, we show that mAb specific for different epitopes in the V1 and V2 domains of the CD4 molecule can be used interchangeably for the biological followup of the CD4+ cell population in blood samples of HIV-infected patients.