Young urologists and kidney transplantation training: A survey designed by the French Transplantation Committee of the French Association of Urology (CTAFU) and the French Association of Urologists in training (AFUF).

OBJECTIVE: In France, kidney transplantations (KT) are mainly performed by urologist. Young urologists and residents are involved in this activity mostly performed in emergency. How do they feel about KT training? Is KT an attractive part of the urologist activity? METHODS: This survey has been designed in the form of a questionnaire by the French Committee of Kidney Transplantation (CTAFU) and the French Association of Urologists in training (AFUF). It has been sent by e-mail to all the AFUF members. Interest in KT and performance of the training were evaluated. RESULTS: In total, 126 members filed the form. Among the residents, 51.5% feel secure to perform KT at the end of their residency. KT is considered as an interesting surgery for 92.1% of the participants: 76.5% are willing to get involved in KT during their residency/fellowship. Among the participants, 44% are willing to continue a long-term involvement. Among the residents, 65.9% consider their practical training insufficient: 56.8% have been supervised for a KT performance during their residency and 86% declare a lack of practical training and had a patient-based learning. Among the residents, 92.1% declare an insufficient theorical training. Among the residents, 33.3% say the schedules of transplantation limit their interest in KT. Among the participants, 34.4% receive a transplant bonus in addition to the usual on-call salary. CONCLUSION: Young urologists wish to continue their involvement in KT activity, but improved theoretical and practical training are essential. In addition, the conditions under which this activity is performed and remunerated are a matter of concern.

Impact of newly diagnosed prostate cancer at time of evaluation for renal transplantation.

Systematic screening for prostate cancer is widely recommended in candidates for renal transplant at the time of listing. There are concerns that overdiagnosis of low-risk prostate cancer may result in reducing access to transplant without demonstrated oncological benefits. The objective of the study was to assess the outcome of newly diagnosed prostate cancer in candidates for transplant at the time of listing, and its impact on transplant access and transplant outcomes according to treatment options. This retrospective study was conducted over 10 years in 12 French transplant centers. Patients included were candidates for renal transplant at the time of prostate cancer diagnosis. Demographical and clinical data regarding renal disease, prostate cancer, and transplant surgery were collected. The primary outcome of the study was the interval between prostate cancer diagnosis and active listing according to treatment options. Overall median time from prostate cancer diagnosis to active listing was 25.0 months [16.4-40.2], with statistically significant differences in median time between the radiotherapy and the active surveillance groups (p = .03). Prostate cancer treatment modalities had limited impact on access and outcome of renal transplantation. Active surveillance in low-risk patients does not seem to compromise access to renal transplantation, nor does it impact oncological outcomes.

Outcomes of kidney-transplanted patients with history of intestinal reconstruction of the urinary tract.

Background: Due to increased risk of pyelonephritis, patients with intestinal reconstruction of the lower urinary tract (IRLUT) have long been advised against kidney transplantation. The aim of this study was to compare the outcomes of transplantation between patients with IRLUT and patients with normal LUT (NLUT) using propensity score matching method. Methods: The study included 23 kidney recipients with IRLUT matched to 46 kidney recipients with NLUT using known allograft survival and pyelonephritis risk factors as covariates. One-, 5-, and 10-year graft survival, pyelonephritis, and surgical complications occurrence and graft function were compared. Results: One-, 5-, and 10-year graft survival were 96%, 91%, and 63% in the IRLUT group and 96%, 88%, and 70% in the NLUT group, respectively (p = 0.72). Patients with IRLUT had increased cumulative risk of pyelonephritis at 10 years (70% vs. 19%; log-rank < 0.01) without impacting graft function or rejection occurrence. There was no difference in overall surgical complication, but patients with IRLUT had more urological complications than patients with NLUT (62% vs. 28%; p < 0.01). Conclusions: Our case-control study consolidates the results regarding the safety of transplantation in patients with IRLUT using a strong validated matching method and provides new insights regarding graft function, pyelonephritis, and surgical complications in this population.

Oncological and Postoperative Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Transplant Recipients: A Multicenter and Comparative Study.

BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RARP) has been poorly studied in men with renal graft. OBJECTIVE: To determine the predictive factors for oncologic outcomes and complications after RARP in renal transplants recipients (RTRs). DESIGN AND PARTICIPANTS: A retrospective multicenter controlled study identified all RTRs who had undergone RARP between 2008 and 2016 in 2 experts departments. All RTRs were matched 1:1 with patients who had also undergone RARP but with no history of renal transplant (control group). INTERVENTION: Robot-assisted laparoscopic radical prostatectomy. OUTCOME MEASUREMENTS: Incontinence, oncologic outcomes, and complications according to the Clavien-Dindo classification. STATISTICAL ANALYSIS: Comparisons of the quantitative variables using Student's t tests, and comparisons of the qualitative variables using χ2 tests. Statistical analyses were performed using SAS (version 9.3). Independent risk factors of biochemical recurrence (BCR), postoperative complications, or incontinence were searched by using a multivariate linear regression. RESULTS: Twenty-seven RTRs were included in the transplant group and compared with 27 men in the control group with similar preoperative characteristics. Univariate analysis showed a shorter BCR-free survival in RTRs, with 26.9 months vs 49.3 months in the control group (P = .018). BCR rate was similar in each group (7.4% vs 11.1%, P = .639). No difference between groups was showed for immediate postoperative complications (29.6% vs 22.2%, P = .279). Multivariate analysis showed that a renal graft history was an independent risk factor of shorter BCR-free survival (hazard ratio = 4.291; 95% confidence interval, 2.102-8.761 and P < .001). Even if it is the first comparative study on this topic, the low number of men included is the main limitation of our study. CONCLUSIONS: These findings show the reliability of RARP in RTRs. The rate of BCR does not appear more frequently but BCR-free survival seems shorter in these patients. A prospective comparative study remains necessary with more patients to confirm our results.

First-in-human use of a marine oxygen carrier (M101) for organ preservation: A safety and proof-of-principle study.

The medical device M101 is an extracellular hemoglobin featuring high oxygen-carrying capabilities. Preclinical studies demonstrated its safety as an additive to organ preservation solutions and its beneficial effect on ischemia/reperfusion injuries. OXYgen carrier for Organ Preservation (OXYOP) is a multicenter open-label study evaluating for the first time the safety of M101 added (1 g/L) to the preservation solution of one of two kidneys from the same donor. All adverse events (AEs) were analyzed by an independent data and safety monitoring board. Among the 58 donors, 38% were extended criteria donors. Grafts were preserved in cold storage (64%) or machine perfusion (36%) with a mean cold ischemia time (CIT) of 740 minutes. At 3 months, 490 AEs (41 serious) were reported, including two graft losses and two acute rejections (3.4%). No immunological, allergic, or prothrombotic effects were reported. Preimplantation and 3-month biopsies did not show thrombosis or altered microcirculation. Secondary efficacy end points showed less delayed graft function (DGF) and better renal function in the M101 group than in the contralateral kidneys. In the subgroup of grafts preserved in cold storage, Kaplan-Meier survival and Cox regression analysis showed beneficial effects on DGF independent of CIT (P = .048). This study confirms that M101 is safe and shows promising efficacy data.

Renal outcome after simultaneous heart and kidney transplantation.

Simultaneous heart-kidney transplant (HKTx) is a valid treatment for patients with coexisting heart and renal failure. The aim of this study was to assess renal outcome in HKTx and to identify predictive factors for renal loss. A retrospective study was conducted among 73 HKTx recipients: Donors' and recipients' records were reviewed to evaluate patients' and renal transplants' survival and their prognostic factors. The mean follow-up was 5.36 years. Renal primary non-function occurred in 2.7%, and complications Clavien IIIb or higher were observed in 67.1% including 16 (22%) postoperative deaths. Five-year overall survival and renal survival were 74.5% and 69.4%. Among survivors, seven returned to dialysis during follow-up. The postoperative use of ECMO (HR = 6.04, P = 0.006), dialysis (HR = 1.04/day, P = 0.022), and occurrence of complications (HR = 31.79, P = 0.022) were independent predictors of postoperative mortality but not the history of previous HTx or KTx nor renal function prior to transplantation. History of KTx (HR = 2.52, P = 0.026) and increased delay between the two transplantations (HR = 1.25/hour, P = 0.018) were associated with renal transplant failure. HKTx provides good renal transplant survival and function, among survivors. Early mortality rate of 22% underlines the need to identify perioperative risk factors that would lead to more judicious and responsible allocation of a scarce resource.

Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism.

PURPOSE: The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida. MATERIALS AND METHODS: All patients with spinal dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success. RESULTS: A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (-12 cm H2O, p <0.001), maximum cystometric capacity (86.6 ml, p <0.001) and compliance (8.9 ml/cm H2O, p = 0.002). A total of 20 complications (3.6%) were recorded for the 561 intradetrusor botulinum toxin A injections, including 3 muscular weakness complications. The global success rate of the first injection was significantly lower in patients with poor compliance (34.4% vs 86.9%, OR 0.08, p <0.001). On multivariate analysis poor compliance was associated with a lower global success rate (OR 0.13, p <0.001). Female gender (OR 3.53, p = 0.01) and patient age (OR 39.9, p <0.001) were predictors of global success. CONCLUSIONS: Intradetrusor botulinum toxin A injections were effective in adult patients with spina bifida who had detrusor overactivity. In contrast, effectiveness was much lower in adult patients with spina bifida who had poor bladder compliance. The other predictors of global success were female gender and older age.

Renal cell carcinoma (RCC) arising in native kidneys of dialyzed and transplant patients: are they different entities?

UNLABELLED: What's known on the subject? and What does the study add? Patients with end-stage renal disease (ESRD) have an increased risk of developing RCC in their native kidneys. The prevalence of RCC is 3-4% in cases of ESRD in dialyzed and/or transplanted patients, which corresponds to a rate 100-times higher than that in the general population. This is the first study, to our knowledge, comparing the characteristics of kidney cancer in the ESRD population according to their dialysis or transplantation status at the time of diagnosis. The differences in stage and survival we observed may be due to differences in surveillance strategies between transplanted and not transplanted patients, nevertheless, the differences in pathological subtypes suggest they could also be due to differences in the tumorigenesis process. OBJECTIVE: • To compare clinical, pathological and outcome features of renal cell carcinomas (RCCs) arising in patients with chronic renal failure (CRF) with or without renal transplantation. PATIENTS AND METHODS: • In all, 24 French University Departments of Urology and Kidney Transplantation participated in this retrospective study comparing RCCs arising in patients with CRF according to their dialysis or transplantation status at the time of diagnosis. • Information about age, sex, symptoms, duration of CRF, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. • Qualitative and quantitative variables were compared by using chi-square and Student statistical analysis. Survival was assessed by Kaplan-Meier and Cox methods. RESULTS: • Data on 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). • Transplanted and not transplanted patients accounted for 213 (70.3%) and 90 cases (29.7%), respectively. • In transplant recipients, RCC was diagnosed at a younger age [mean (sd) 53 (11) vs 61 (14) years, P < 0.001), the mean tumour size was smaller [3.4 (2.3) vs 4.2 (3.1) cm, P= 0.02), pT1a stage (75 vs 60%, P= 0.009) and papillary histological subtype (44 vs 22%, P < 0.001) were more frequent than in their dialysis-only counterparts. • Nodal (1 vs 6%, P= 0.03) and distant metastases rates (0 vs 5%, P < 0.001) were significantly increased in patients who had not had a transplant. However, Fürhman grading, symptoms, tumour multifocality or bilaterality, presence of acquired cystic kidney disease, were not significantly different between the groups. • Estimated 5-year survival rates were 97% and 77% for transplanted and not transplanted patients, respectively (P < 0.001). In univariate analysis, presence of symptoms (P= 0.008), poor performance status (P= 0.04), large tumour size, advanced TNM stage (P < 0.001), high Führman grade (P= 0.005) and absence of transplantation (P < 0.001) were all adverse prognostic factors. In multivariate analysis, only T stage remained an independent predictor for cancer-related death (P < 0.001). CONCLUSION: • RCC arising in native kidneys of transplant patients seems to exhibit many favourable clinical, pathological and outcome features compared with those diagnosed in dialysis-only patients. Further research is needed to determine whether it is due to particular molecular pathways or to biases in relation to mode of diagnosis.

Kidney transplant with multiple renal artery grafts from deceased donors: are long-term graft and patient survival compromised?

BACKGROUND: Kidneys with multiple arteries are often transplanted. However, the long-term outcome of such kidneys recovered exclusively from deceased donors is not clear. OBJECTIVE: To determine whether use of renal grafts with multiple arteries affects long-term graft survival and function. METHODS: The outcomes of 259 consecutive kidney transplants between 1996 and 2000 were retrospectively reviewed. Patients were divided into 2 groups, multiple renal artery graft recipients (n = 70) and single renal artery graft recipients (n = 189). Short-term complications and long-term outcomes (survival rates, blood pressure after transplant, creatinine clearance, and proteinuria levels at 1, 3, 5, and 7 years after transplant) were compared between the 2 groups. RESULTS: Early vascular complications were more common (P = .02) in multiple artery graft recipients (18.6%) than in single artery graft recipients (7.9%), mainly because of occlusion of a polar artery in grafts with multiple renal arteries (7.1%). Urologic complications were no more frequent in one group than in the other (5.7% vs 5.3%; P = .89). The 2 groups did not differ significantly (P = .33) in long-term graft survival, with a median follow-up of 9.05 years (range, 0.1-12.7 years). Mean (SD) for creatinine clearance (59.4 [22.6] vs 55.9 [20.3] mL/min; P = .47), proteinuria (0.77 [2.1] vs 0.4 [0.8] g/24 h; P = .19), and systolic blood pressure (133.6 [14.5] vs 133.7 [17.5] mm Hg; P = .85) did not differ significantly between the 2 groups 7 years after transplant. CONCLUSIONS: Kidney transplant with grafts containing multiple renal arteries rather than grafts with a single renal artery does not significantly influence patient and graft outcomes.

Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population.

BACKGROUND: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. OBJECTIVE: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. DESIGN, SETTING, AND PARTICIPANTS: Twenty-four French university departments of urology participated in this retrospective study. INTERVENTION: All patients were treated according to current European Association of Urology guidelines. MEASUREMENTS: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods. RESULTS AND LIMITATIONS: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design. CONCLUSIONS: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population.

Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis.

OBJECTIVE: Radial-cephalic fistulas (RCFs) perianastomotic stenoses (PASs) are on and around the fistula anastomosis. This group of lesions encompasses juxta-anastomotic stenosis (stenosis located on the venous side within 3 cm away from the anastomosis), anastomotic, and arterial stenosis. The purpose of our study was to assess the postintervention primary patency and assisted postintervention primary patency (APP) rates for surgery and angioplasty when treating these stenoses. The secondary endpoint was to identify factors that might influence the procedure's patency rates. MATERIALS AND METHODS: This retrospective study included 73 consecutive patients treated for lack of maturation PASs between January 1999 and December 2005 in two interventional centers. Patients' mean age was 65 years old. Stenoses were treated by surgery (n = 21) or percutaneous transluminal angioplasty (PTA; n = 52). Surgery meant creation of a new anastomosis excluding the area of stenosis. Preoperative characteristics including the patient's age, gender, comorbidities, stenosis location, and length were not statistically different between the two groups. The mean follow-up was 39 months for PTA and 49 months for surgery. RESULTS: Anatomical and clinical success rates were 86% and 90% for surgery, and 75% and 92% for PTA. At 1 year, the primary patency rates were 71 ± 10% for surgery and 41 ± 6% for PTA, respectively (P < .02). There was no significant difference between the two groups with respect to assisted primary patency (95% vs 92%). In the PTA group, stenosis location at the anastomosis itself was a risk factor of early recurrence (P = .047). The complication rate was similar between surgery and PTA. CONCLUSION: Our results suggest that the treatment of anastomotic stenoses should be surgical rather than endovascular. Angioplasty and surgery have shown similar results when used to treat other perianastomotic stenoses, but repeat procedures were more frequent with angioplasty.

Percutaneous dilation of the radial artery in nonmaturing autogenous radial-cephalic fistulas for haemodialysis.

BACKGROUND: Delayed maturation of radial-cephalic fistulas can be due to lesions of the radial artery that are amenable to percutaneous dilation. METHODS: Over a period of 7 years, 74 consecutive patients underwent angiography of an immature fistula that showed either stenosis or an insufficient enlargement of the radial artery that was treated by percutaneous dilation. Success, complications and secondary interventions were recorded according to consensus definitions. Patency following angioplasty was estimated with the Kaplan-Meier technique. RESULTS: The mean patient age was 70 years, 44% were women, 69% had diabetes, 23% were smokers, 76% had hypertension, 64% had coronary disease and 46% had peripheral artery occlusive disease. Concomitant venous stenosis was diagnosed in 53% of patients. Arterial stenosis was >5 cm long in 53 cases. Technical success was achieved in 73/74 cases following angioplasty. All but two fistulas were then successfully used for dialysis. Dilation-induced rupture occurred in 13 cases (17%) but required only two stent placements. Five cases (7%) of hand ischaemia within 1 month of dilation were treated successfully by ligation of the distal artery. Primary patency rates at 12 and 24 months were significantly better for pure arterial lesions, with 65% and 61% compared to 42% and 35% in cases of concomitant venous stenosis (P < 0.04). The secondary patency rates were 96% and 94% at 1 and 2 years, respectively. CONCLUSION: Dilation of the radial artery yields higher patency rates than for veins. Surgeons might therefore be less demanding about the initial quality of the radial artery prior to creation of radial-cephalic fistulas.

[Renal transplantation in patients with autosomal dominant polycystic kidney disease: pre-transplantation evaluation and follow-up]. / Transplantation rénale pour polykystose rénale autosomique dominante: spécificités de la préparation et du suivi des patients.

Autosomal dominant polycystic kidney disease (ADPKD) which accounts for 15% of all renal transplantations emerges as the third cause of kidney transplantation in France. In addition to routine evaluation before transplantation, the ADPKD patient requires special assessment of three aspects: should potential kidney complications (recurrent upper tract infection or haemorrhage) or kidney size assessed by computed tomography require nephrectomy prior to transplantation? Is it advisable to detect intracranial aneurysm (ICA) in patients with a relative having experienced ruptured ICA? When transplantation from a living relative is considered, the existence of ADPKD in the donor should be formally ruled out by imaging or genetic studies. The risk of recurrence of ADPKD post-transplantation does not exist. Nevertheless other complications may occur. Thus, an increased incidence of colonic perforation has been reported. In addition, as compared to non-ADPKD patients, an increased risk for both skin cancer and new-onset post-transplant diabetes mellitus has been reported recently after kidney transplantation. Finally, because these patients suffer from an inherited syndrome, physicians should carefully consider the personal and familial history before and after transplantation in order to respond to fatalism in some cases, or to attenuate excessive enthusiasm in the others. Altogether, it apears that a specific approach is needed for ADPKD patients when considering renal transplantation.

Effect of patient position on pain experienced during prostate biopsy.

OBJECTIVES: To compare pain during prostate biopsy performed in two different positions. METHODS: We carried out a prospective, randomized study to compare the pain experienced during biopsy in two different positions: lithotomy (group 1) and lateral (group 2). Pain was evaluated using a visual analog scale (VAS). RESULTS: 70 patients were randomized to the two positions for biopsy. The median number of samples taken was the same for both groups (n = 10). The median VAS rating after biopsy was 30 in group 1 and 45 in group 2. 96.6% of the men in group 1 were prepared to undergo a repeat examination according to the same modalities, against only 86.7% in group 2. Only 14.3% of the men in group 1 would have preferred more analgesic against 37.1% in group 2. Pain after biopsy was less in group 1. The men with prostate adenocarcinoma tolerated biopsies better than the others. CONCLUSION: Our results suggest that the lithotomy position induced less pain and less post-biopsy hematuria than did the lateral position during prostate biopsy. Men with prostate adenocarcinoma tolerated the procedures better.

[National prospective survey on the surgical quality of renal transplants in France. Study conducted by the Association Française d'Urologie Transplantation Committee]. / Enquête nationale prospective sur la qualité chirurgicale des greffons rénaux en France. Etude du Comité de Transplantation de l'Association française d'Urologie.

STUDY OBJECTIVE: The objective of this prospective study was to describe the nature of the lesions observed during brain-dead cadavre donor kidney harvesting in France and to identify the risk factors for these lesions. MATERIAL AND METHODS: A questionnaire elaborated by the AFU Transplantation Committee concerning the quality of kidneys harvested from cadavre donors was sent to all centres performing renal transplantation in France in 2000. This prospective study was conducted over a period of 1 year and concerned the overall multi-organ harvesting procedure based on all data concerning the renal parenchyma, arteriovenous and ureteric characteristics, and the outcome of the transplants. RESULTS: Twelve centres completed the survey, allowing analysis of the data of 201 donor kidneys. 91% of harvesting surgeons were urologists. Various incidents were reported during 11% of harvesting procedures, but 1/3 of the abnormalities were not recorded by the harvesting surgeon. Isolated kidney harvesting was found to be a risk factor (20% vs 8.6%). The rate of parenchymal abnormalities was 50%, 2/3 of which were related to inadequate removal of perirenal fat. Atheroma was a risk factor for arterial lesions during harvesting (21% vs 6.50). Venous abnormalities were detected in 9% of cases: 89% of them were due to the harvesting procedure and 59% of them were not identified by the harvesting surgeon. The fact of not being a transplant surgeon was a risk factor for venous lesions (21.9% vs 6.5%). 4% of ureteric lesions were observed with no consequence on graft outcome. CONCLUSION: Adequate removal of perirenal fat before conditioning is not acquired. Isolated kidney harvesting and atheroma were risk factors for parenchymal and arterial lesions, respectively. Venous harvesting anomalies were more frequent among non-transplant surgeons.

[Laparoscopic treatment of a symptomatic seminal vesicle cyst]. / Un kyste symptomatique des vésicules séminales traité par laparoscopie.

Most seminal vesicle cysts have an embryological origin and are often associated with homolateral renal agenesis. The diagnosis of seminal vesicle cyst has been greatly improved by progress in medical imaging, particularly ultrasound, which reveals a retrovesical cystic image and homolateral renal agenesis. Transperineal or laparoscopic vesiculectomy is technically difficult and is associated with high morbidity. The authors report a case of laparoscopic vesiculectomy with an uneventful postoperative course.

[Prevalence and risk factors of urinary incontinence in young women]. / Prévalence et facteurs de risque de l'incontinence urinaire chez la femme jeune.

OBJECTIVE: Urinary incontinence is a very common disease among women but only few studies have been published in young adult and middle-aged population. We studied urinary incontinence prevalence and risk factors in this young and middle-aged population. MATERIAL AND METHODS: We studied during the year 1998 the prevalence of global incontinence and stress, urge and mixed urinary incontinence in 1700 women working in a French academic hospital (n = 2800). Women received the questionnaire at the same time than their convocation for their yearly visit in occupational medicine. Usual risk factors of constitutional events (increasing âge, obesity defined by a Body Mass Index > or = 25); obstetric events (pregnancy, previous caesarean delivery, previous vaginal delivery, post-partum incontinence) and gynaecological event (hysterectomy) were evaluated. RESULTS: 177 women (mean âge 40.0 years) returned the questionnaire. 467 women (27.5% 95% CI = 25.4-29.7) reported urinary incontinence, 210 (12.4% 95% CI = 10.8-14.0) stress urinary incontinence, 28 (1.6% 95% CI = 1.1-2.4) urge urinary incontinence and 229 (13.5% 995% CI = 11.9-15.2) mixed urinary incontinence. 38 women (8.1%) suffered from frequent urinary leakage corresponding to 1 (0.5%), 4 (14.3%) and 33 (14.4%) stress, urge and mixed urinary incontinence. The prevalence of urinary incontinence increased significantly with âge > or = 40 years (RR = 2.16 95% CI = 1.86-2.57) pregnancy (RR = 2.22 95% CI = 1.71-2.87), previous vaginal delivery (RR = 2.15 95% CI = 1.72-2.69), post-partum incontinence (RR = 2.57 95% CI = 2.22-2.97, hysterectomy (RR = 1.52 95% CI = 1.11-2.08). Obesity (RR = 1.14 95% CI = 0.99-1.32) and previous caesarean delivery (RR = 2.15 95% CI = 1.72-2.69) did not increase the risk of urinary incontinence. The risk factors for stress urinary incontinence were âge > or = 40 years (RR = 2.18 95% CI = 1.66-2.87), pregnancy (RR = 2.36 95% CI = 1.55-3.58), previous vaginal delivery (RR = 2.47 95% CI = 1.70-3.59), post-partum incontinence (RR = 2.78 95% CI = 2.14-3.61) and hysterectomy (RR = 2.83 95% CI = 1.93-4.15). No relationship was found between stress urinary incontinence and obesity (RR = 1.25 95% CI = 0.96-1.64) and previous caesarean delivery (RR = 1.02 95% CI = 0.45-2.32). CONCLUSION: A high prevalence of urinary incontinence was observed among young adult and middle-aged female hospital workers with an easy access to medical resources. Gynaecological and obstetric event (pregnancy particularly previous vaginal delivery and hysterectomy) were the most prominent risk factors, especially for stress urinary incontinence.