Mini-percutaneous nephrolithotomy: Is smaller better for kidney stones in patients with neurogenic bladder?

INTRODUCTION: Patients with neurologic bladder are at an increased risk for urolithiasis, and currently, data on mini-percutaneous nephrolithotomy in this population are limited. Our objective was to compare mini (15F)-percutaneous nephrolithotomy, standard (24F)-PCNL and flexible ureteroscopy in terms of efficacy and safety in treatment of kidney stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: We conducted a retrospective monocentric study in our neuro-urological referral centre. All consecutive patients with NLUTD and a cumulative size of renal calculi greater than 15mm or 10mm in the lower calyx, who had extraction surgery between 2005 and 2020, were included. The primary endpoint was the one-session stone-free rate (SFR) at 3 months on a CT scan. The secondary endpoints were complication (Clavien-Dindo grading system), operative time, blood loss and length of hospital stay. RESULTS: We performed 76 standard PCNL (sPCNL), 46 flexible ureteroscopy lithotripsy (fURL) and 25 miniaturized PCNL (mPCNL). The one-session SFR was 37.5% for the mPCNL group, 38.2% for the sPCNL group and 37% for the fURL group with no significant difference between the three procedures (P=0.99). Early complications, blood loss and transfusion rates were lower in the mPCNL group than in the sPCNL group (P=0.047) and comparable to fURL group. The final SFRs after a second intervention for mPCNL, sPCNL and fURL were 48%, 61.8% and 63%, respectively (P=0.67). CONCLUSION: The efficacy of mPCNL in patients with NLUTD was not different from other techniques, but a significantly lower rate of complications than sPCNL was observed. LEVEL OF PROOF: 3.

Nefroureterectomía radical asistida por robot para el carcinoma urotelial del tracto urinario superior: resultados peri y postoperatorios / Robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Peri and postoperative outcomes

Introducción La nefroureterectomía radical constituye el tratamiento de los tumores uroteliales del tracto urinario superior con alto riesgo de mortalidad específica. La nefroureterectomía radical laparoscópica asistida por robot (NURAR) todavía está siendo investigada para establecer de manera concluyente la seguridad del procedimiento en el tratamiento de los tumores uroteliales del tracto urinario superior. El objetivo principal es evaluar la seguridad intra y postoperatoria de la NURAR y, posteriormente, evaluar los resultados oncológicos a mediano plazo. Métodos Se trata de un estudio retrospectivo monocéntrico basado en una recopilación de NURAR realizadas entre el 1 de enero de 2015 y el 1 de octubre de 2021. Las NURAR se llevaron a cabo con la asistencia del robot Da Vinci Si® y, desde 2017, con el robot Da Vinci Xi®. Siempre que fue posible, la totalidad del procedimiento se llevó a cabo sin reacoplamiento (re-docking). Resultados Entre el 1 de enero de 2015 y el 1 de octubre de 2021, se realizaron 29 NURAR en nuestro centro. En el 80% de los casos se pudo realizar toda la cirugía sin reacoplamiento con el robot Da Vinci Xi®. Un paciente requirió conversión a cirugía abierta por dificultad en la disección. El 50% de los tumores se clasificaron como T3 o T4. La tasa de complicaciones a los 30 días fue del 31%. La duración media de la estancia hospitalaria fue de 5 días. La supervivencia libre de enfermedad en el tiempo medio de supervivencia (27,5 meses) fue del 75,2%. Un paciente tuvo una recidiva en el compartimento de la nefrectomía y ningún paciente tuvo recidiva peritoneal o en los orificios de los trocares. Conclusión La realización de NURAR para el tratamiento de los tumores del tracto urinario superior parece cumplir los criterios de seguridad quirúrgica y oncológica (AU)

Introduction The treatment of urothelial tumours of the upper urinary tract at high risk of specific mortality is based on radical nephroureterectomy. Robotic-assisted laparoscopic radical nephroureterectomy (RARNU) is still under investigation to definitively establish the safety of this procedure in the management of urothelial tumours of the upper urinary tract. The primary objective is to evaluate the intra- and postoperative safety of RARNU and, subsequently, to evaluate the medium-term oncological results. Methods Our study is a retrospective, mono-centric study with a collection of RARNUs conducted between 1st January 2015 and 1st October 2021. The RARNUs were performed with the assistance of the Da Vinci Si® robot, then from 2017 the Da Vinci Xi® robot. Whenever possible, the entire procedure was carried out without re-docking. Results Between 1st January 2015 and 1st October 2021, 29 RARNUs were carried out at our centre. Complete surgery without re-docking was possible in 80% of cases with the Da Vinci Xi® robot. One patient required conversion to open surgery due to difficult dissection. A percentage of 50 of tumours were classified as T3 or T4. The 30-day complication rate was 31%. The median length of hospitalisation was 5 days. The disease-free survival at the mean survival time (27.5 months) was of 75.2%. One patient had a recurrence in the nephrectomy compartment and no patient had a peritoneal or trocar orifice recurrence. Conclusion Performing RARNU for the management of tumours of the upper urinary tract appears to meet the criteria of surgical safety and those of oncological safety (AU)

Switching from onabotulinum toxin A to abobotulinum toxin A for treating detrusor overactivity in spinal cord injured patient, does it really work?

AIM: To assess the efficacy of switching to Abobotulinumtoxin A (ATA) intradetrusor injections (IDI) after failure of Onabotulinumtoxin A (OTA) IDI for the treatment of neurogenic detrusor overactivity in patients with spinal cord injury (SCI). MATERIALS AND METHODS: A single-centre retrospective chart review study. All SCI patients who started OTA IDI after 2011 and had an ATA IDI switch were included. The primary outcome was the clinical and urodynamic efficacy of the switch to ATA IIDs at the last follow-up. Secondary outcomes were initial efficacy, duration of ATA treatment, and patient outcome including the occurrence of augmentation enterocystoplasty at last follow-up. RESULTS: Sixty-two patients were included. Eighteen patients (28.9%) were initially responders to ATA IDI. Nine patients (14.5%) remained responders at last follow-up after a median of 17 months (AE 8.8-29). Thirty-two patients (51.6%) had had or were awaiting augmentation enterocystoplasty with a follow-up time of 18.5 months (IQR 8-27). Eleven patients (17.7%) were on ATA IDI with low efficacy. Seven patients (11.3%) were switched back to OTA and 3 patients (4.8%) changed their voiding pattern. CONCLUSION: Switching from OTA to ATA toxin for IDI in the treatment of detrusor overactivity after spinal cord injury have long-term efficacy for a limited number of patients but may delay the need for surgery.

Robot-assisted radical nephroureterectomy for upper tract urothelial carcinoma: Peri and postoperative outcomes.

INTRODUCTION: The treatment of urothelial tumours of the upper urinary tract at high risk of specific mortality is based on radical nephroureterectomy (RNU). Robotic-assisted laparoscopic radical nephroureterectomy (RARNU) is still under investigation to definitively establish the safety of this procedure in the management of urothelial tumours of the upper urinary tract. The primary objective is to evaluate the intra- and postoperative safety of RARNU and, subsequently, to evaluate the medium-term oncological results. METHODS: Our study is a retrospective, mono-centric study with a collection of RARNUs conducted between 1st January 2015 and 1st October 2021. The RARNUs were performed with the assistance of the Da Vinci Si® robot, then from 2017 the Da Vinci Xi® robot. Whenever possible, the entire procedure was carried out without re-docking. RESULTS: Between 1st January 2015 and 1st October 2021, 29 RARNUs were carried out at our centre. Complete surgery without re-docking was possible in 80% of cases with the Da Vinci Xi® robot. One patient required conversion to open surgery due to difficult dissection. 50% of tumours were classified as T3 or T4. The 30-day complication rate was 31%. The median length of hospitalisation was 5 days. The disease-free survival at the mean survival time (27.5 months) was of 75.2%. One patient had a recurrence in the nephrectomy compartment and no patient had a peritoneal or trocar orifice recurrence. CONCLUSION: Performing RARNU for the management of tumours of the upper urinary tract appears to meet the criteria of surgical safety and those of oncological safety.

[Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. / Recommandations sur la gestion du risque et la prise en charge urologique du patient adulte atteint de dysraphisme spinal (spina bifida).

INTRODUCTION: Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS: National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS: Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION: Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.

[Prostatic hyperplasia: Evaluation of practices in general practice, dissemination, and impact of recommendations]. / L'hypertrophie bénigne de prostate : évaluation des pratiques en médecine générale, diffusion et impact des recommandations.

INTRODUCTION: In 2015, the French Association of Urology, by the male lower urinary tract symptoms Committee, published a practices guideline for the management of prostatic hyperplasia in general practice. Five years after the publication of these recommendation, our objective is to assess their dissemination and their impact in general practice. MATERIAL: A specially designed questionnaire was distributed online via the departmental councils of the order and to all regional unions of liberal doctors. The distribution to general practitioners was at the discretion of each organisation depending on local policies. RESULTS: Two hundred and eighty responses were collected. Fifty-five percent of the population was female. 83 % of the general practitioners did not report having knowledge of the practice guideline. 77 % of doctors stated that they had not received training or information on prostatic hyperplasia in the past 5 years. Among the notable results, 51 % of general practitioners declared performing a digital rectal examination. 44 % prescribed an endorectal ultrasound. Only 7 % of doctors were aware of the existence of minimally invasive surgical techniques. CONCLUSION: The practices guideline for the management of prostatic hyperplasia in general practice proposed in 2015 by the male lower urinary tract symptoms Committee seems to be little known by general practitioners. Dissemination of these recommendations solely through publication in Progrès en Urologie seems ill-suited to consideration by general practitioners, and it seems necessary to consider other modes of dissemination. LEVEL OF EVIDENCE: 4, grade C.

[Prioritization of risk situations in neuro-urology: Guidelines based on the Delphi method from Association française d'urologie (AFU), Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), Groupe de neuro-urologie de langue française (GENULF), Société française de médecine physique et de réadaptation (SOFMER) and Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP)]. / Priorisation des situations à risque en neuro-urologie : recommandations par méthode Delphi de l'Association française d'urologie (AFU), l'Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), le Groupe de neuro-urologie de langue française (GENULF), la Société française de médecine physique et de réadaptation (SOFMER) et la Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP).

PURPOSE: During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology. METHODS: Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach. RESULTS: The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)). CONCLUSIONS: This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.

Neurogenic bladder in patients with paraplegia: a two-center study of the real-life experience of the patients' journey.

INTRODUCTION: Several patterns of urological dysfunctions have been described following spinal cord injury (SCI), depending on the level and the completeness of the injury. A better understanding of the natural history of neurogenic bladder in patients with SCI, and the description of their successive therapeutic lines based on their clinical and urodynamic pattern is needed to improve their management. This study aimed to describe the real-life successive therapeutic lines in patients with neurogenic lower urinary tract dysfunction (NLUTD) following SCI. METHODS: We conducted a two-center retrospective review of medical files of patients with SCI followed in two French specialized departments of Physical Medicine and Rehabilitation between January 2000 and January 2018. All patients with SCI with a level of lesion bellow T3 and older than 18 years old were eligible. The primary outcome was the description of the natural journey of neurogenic bladder in this population, from the awakening bladder contraction to the last therapeutic line. Survival curves were calculated with a 95-confidence interval using the Kaplan-Meier method. RESULTS: One hundred and five patients were included in this study. Most of the patients were young men with a complete SCI lesion. The median time of treatment introduction was 1 and 9 years for anticholinergics and intradetrusor injection of BoNT/A, respectively. Median duration of effect of treatments was 4 and 6 years post-introduction of anticholinergics and BoNT/A, respectively. CONCLUSION: This study describes NLUTD journey of patients with SCI demonstrating the mid-term efficacy of the two first therapeutic lines of NDO management. An improvement of non-surgical therapeutics is needed.

Sacral neuromodulation: Rechargeable versus non-rechargeable device. What would the patient preferences be in France?

AIMS: Sacral neuromodulation (SNM) is a minimally invasive technique that provides effective treatment for the management of refractory overactive bladder (OAB), non-obstructive urinary retention (NOUR), and fecal incontinence (FI). This study assessed patient preferences between the currently available non-rechargeable SNM device and a new, full-body magnetic resonance imaging (MRI)-safe, smaller, rechargeable device. METHODS: An online cross-sectional survey was conducted among French OAB, NOUR, FI patients, recruited via a market research vendor. To assess their preferences, patients were asked to indicate their level of agreement with 10 statements regarding the size of the device, its rechargeability, and the role of MRI using a 6-item Likert scale. A descriptive statistical analysis was performed. RESULTS: In all, 95 patients (68% women), mean age 50 years, were included in the study: 51% were treated for OAB; 44% received an oral treatment and 28% had SNM. Overall, 71% of the 95 patients indicated a preference for the new device; 75% considered that recharging the device would not impact their lifestyle; 74% believed that the smaller size of the rechargeable device would facilitate their choice to be treated with SNM; 80% found full-body MRI compatibility important. CONCLUSIONS: Most patients may prefer the new rechargeable SNM device over the current "standard". Compatibility with full-body MRI and the smaller device size seemed the key features of the newer device that would influence their choice of being treated with SNM. Future national and international recommendations should consider a shared decision-making process between the physician and the patient.

[Safety and efficacy of percutaneous nephrolithotomy in patients with neurogenic bladder]. / Néphrolithotomie percutanée chez les patients neurologiques : efficacité et morbidité à long terme.

INTRODUCTION: To assess the efficacy and morbidity of percutaneous nephrolithotomy (PNLT) in the treatment of renal stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: Retrospective, monocentric study including all patients with NLUTD who had undergone PNLT between 2005 and 2017. Pre-operative clinical data (neurological condition, voiding mode, preoperative urine culture…), peri-operative and post-operative data (success and morbidity) were collected from the patients' charts. Success was defined by the absence of residual fragment (RF), on imaging or intraoperative endoscopy. Partial efficacy was defined by the presence of RF lower than 4mm. Early complications were reported according to the Clavien-Dindo classification. RESULTS: In all, 53 PNLTs were performed, in 35 patients, mostly with spinal cord injury. The success and partial efficacy rates were 66.0% and 71.7% respectively. The failure rate was correlated with increased stone burden (P=0.03), increased size of the largest stone (P=0.02), and the presence of complex stones (P<0.02). The rate of early complications was 41.5%, with 27.3% major, mostly septic, and bleeding. The retreatment rate within 3 years was 41.5%. CONCLUSION: In patients with NLUTD, PNLT allows a high success rate, but with a significant rate of retreatment and infectious complications. However, NLPC remains the gold standard in this population, especially for renal stones larger 20mm, allowing a higher success rate than ureteroscopy and a lower retreatment rate.

[External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results]. / Résultat à court et moyen terme du traitement de la dyssynergie vésico-sphinctérienne par sphinctérotomie endoscopique.

BACKGROUND: To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). METHODS: Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary outcomes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. RESULTS: The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n=41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P<0.001), urinary tract infections (UTI) (31 vs 15 patients, P<0.001) and a significant decrease in post-voiding residuals (200 vs 50mL, P<0.001). CONCLUSION: ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is mandatory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. LEVEL OF EVIDENCE: III.

New technique of robot-assisted laparoscopic artificial urinary sphincter implantation in female by a posterior approach with intraoperative cystoscopic monitoring.

PURPOSE: To report the early experience of a modified technique of robot-assisted artificial urinary sphincter (AUS) implantation in female, with a posterior approach to the bladder neck and intraoperative real-time cystoscopic monitoring. METHODS: Retrospective monocentric study included all consecutive female who underwent a primary robot-assisted AUS implantation between 2017 and 2019. Real-time intraoperative cystoscopic monitoring was carried out to check the correct level of the dissection and to avoid any injury during bladder neck dissection. Perioperative and intraoperative data, functional outcomes and complications were assessed. Continence was defined as 0 to 1 pad per day. RESULTS: Twenty-four patients were included, the median age was 66 years, 23/24 (96%) had previous SUI or prolapse surgery. Two conversions to open surgery and 2 modifications of the surgical technique with anterior dissection of the bladder neck were required due to major vesicovaginal adhesions. Overall, 20 patients underwent the robotic posterior approach. Eleven intraoperative complications in 10 patients (50%) occurred, including 7 bladder injuries 4 vaginal injuries, without the need to stop the procedure. The median hospital stay was 3 days (2-7). One AUS was removed at 1 year due to vaginal erosion. At last follow-up (median 26 months (22-36)), 95% of the devices were in place and activated and the continence rate was 84%. CONCLUSIONS: Early functional results of robot-assisted AUS implantation with a posterior approach to the bladder neck and intraoperative cystoscopic monitoring are promising despite the high rate of intraoperative complications due to previous surgeries. Further evaluation of this technique is required.

Ileal ureter replacement: Early morbidity and long-term results.

INTRODUCTION: Ileal ureter is a technique that consists of replacing the ureter by a segment of ileum to treat a long ureteric lesion or a lesion involving the lumbar ureter. The primary objective of our study was to assess the early perioperative morbidity of ileal ureter according to the Clavien-Dindo classification. The secondary objectives were to assess the morbidity and the medium- and long-term outcome of renal function. MATERIALS AND METHODS: Single-centre retrospective study, collecting data from patients operated between February 2005 and October 2019. All patients who underwent ileal ureter replacement surgery in our unit were included in this analysis. The ureteric defect was longer than five centimetres and involved the pelvic and/or iliac and/or lumbar ureter. All ileal ureter replacements were performed by open surgery using isoperistaltic ileal grafts. RESULTS: Twenty-one patients (11 women and 10 men) underwent total or subtotal, unilateral or bilateral ileal ureter replacement, corresponding to 25 kidneys. The grade III early postoperative complication rate was 9.5% (two cases) mainly consisting of bleeding. No grade IV or V complications were observed. With a mean follow-up of 85 months, long-term morbidity essentially consisted of infectious complications. No patients developed anastomotic strictures. Mean serum creatinine was 116.3µmol/L preoperatively, 105.6µmol/L one month postoperatively and 112.2µmol/L at last follow-up. Renal function was generally preserved or even improved, except for patients with preoperative renal failure. CONCLUSION: Ileal ureter replacement is a surgical alternative associated with low morbidity and satisfactory long-term functional results. LEVEL OF EVIDENCE: 3.

[Pelvic and perineal pain after genital prolapse: A literature review]. / Douleur pelvi-périnéales et prolapsus génital : revue de la littérature.

INTRODUCTION: Pelvic and perineal pain after genital prolapse surgery is a serious and frequent post-operative complication which diagnosis and therapeutic management can be complex. MATERIALS ET METHODS: A literature review was carried out on the Pubmed database using the following words and MeSH : genital prolapse, pain, dyspareunia, genital prolapse and pain, genital prolapse and dyspareunia, genital prolapse and surgery, pain and surgery. RESULTS: Among the 133 articles found, 74 were selected. Post-operative chronic pelvic pain persisting more than 3 months after surgery according to the International Association for the Study of Pain. It can be nociceptive, neuropathic or dysfunctional. Its diagnosis is mainly clinical. Its incidence is estimated between 1% and 50% and the risk factors are young age, the presence of comorbidities, history of prolapse surgery, severe prolapse, preoperative pain, invasive surgical approach, simultaneous placement of several meshes, less operator experience, increased operative time and early post-operative pain. The vaginal approach can cause a change in compliance and vaginal length as well as injury to the pudendal, sciatic and obturator nerves and in some cases lead to myofascial pelvic pain syndrome, whereas the laparoscopic approach can lead to parietal nerve damage. Therapeutic management is multidisciplinary and complex. CONCLUSION: Pelvic pain after genital prolapse surgery is still obscure to this day.

Pregnancy and Delivery in Women with Lower Urinary Tract Reconstruction: A National Multicenter Retrospective Study from the French-Speaking Neuro-Urology Study Group (GENULF) and the Neuro-Urology Committee of the French Association of Urology.

PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.

Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature.

PURPOSE: To access the current status of the security and feasibility of right kidney (RK) and multiple-renal artery (MRA) laparoscopic living donor nephrectomy (LLDN) which are more challenging compared to left kidney (LK) and single renal artery (SRA) because of a shorter renal vein and more complex vascular anatomy. METHODS: We did a systematic review of the literature according to the PRISMA recommendations, reporting RK or MRA donor nephrectomy performed with a laparoscopic technique compared to LK or SRA kidney LLDN. The identified and analyzed primary outcomes of interest were operating time (OT), warm ischemia time (WIT), rate of conversion and transfusion, donor length of stay (LOS), delayed graft function (DGF) and rate of graft loss (GL). RESULTS: 16 comparative studies (1397 cases) of RK-LLDN and 12 comparative studies including 15 series (993 cases) of MRA-LLDN were selected. For RK-LLDN review, conversion rate was 0.8% and blood transfusion rate 0.2%, only one case of graft venous thrombosis was reported, OT was shorter in four studies and there was no any difference of DGF and GL rate compared to LK-LLDN. For MRA-LLDN review, conversion rate was 1.3% and blood transfusion rate 1.1%, OT and WIT were longer compared to SRA-LLDN, there were more ureteral complications in two studies, and no difference in terms of vascular complications and graft loss rate. CONCLUSION: RK-LLDN and MRA-LLDN would be similar to LK-LLDN and SRA-LLDN in terms of feasibility and safety for the donor as well as graft function results for RK-LLDN.

Overexpression of certain transient receptor potential and Orai channels in prostate cancer is associated with decreased risk of systemic recurrence after radical prostatectomy.

BACKGROUND: Several studies had suggested the potential role of calcium signaling in prostate cancer (PCa) prognosis and agressiveness. We aimed to investigate selected proteins contributing to calcium (Ca2+ ) signaling, (Orai, stromal interaction molecule (STIM), and transient receptor potential (TRP) channels) and involved in cancer hallmarks, as independent predictors of systemic recurrence after radical prostatectomy (RP). METHODS: A case-control study including 112 patients with clinically localized PCa treated by RP between 2002 and 2009 and with at least 6-years' follow-up. Patients were divided into two groups according to the absence or presence of systemic recurrence. Expression levels of 10 proteins involved in Ca2+ signaling (TRPC1, TRPC4, TRPV5, TRPV6, TRPM8, STIM1, STIM2, Orai1, Orai2, and Orai3), were assessed by immunohistochemistry using tissue microarrays (TMAs) constructed from paraffin-embedded PCa specimens. The level of expression of the various transcripts in PCa was assessed using quantitative polymerase chain reaction (qPCR) analysis. RNA samples for qPCR were obtained from fresh frozen tissue samples of PCa after laser capture microdissection on RP specimens. Relative gene expression was analyzed using the 2-▵▵Ct method. RESULTS: Multivariate analysis showed that increased expression of TRPC1, TRPC4, TRPV5, TRPV6, TRPM8, and Orai2 was significantly associated with a lower risk of systemic recurrence after RP, independently of the prostate-specific antigen (PSA) level, percentage of positive biopsies, and surgical margin (SM) status (P = .007, P = .01, P < .001, P = .0065, P = .007, and P = .01, respectively). For TRPC4, TRPV5, and TRPV6, this association was also independent of Gleason score and pT stage. Moreover, overexpression of TRPV6 and Orai2 was significantly associated with longer time to recurrence after RP (P = .048 and .023, respectively). Overexpression of TRPC4, TRPV5, TRPV6, and Orai2 transcripts was observed in group R- (3.71-, 5.7-, 1.14-, and 2.65-fold increase, respectively). CONCLUSIONS: This is the first study to suggest the independent prognostic value of certain proteins involved in Ca2+ influx in systemic recurrence after RP: overexpression of TRPC1, TRPC4, TRPV5, TRPV6, TRPM8, and Orai2 is associated with a lower risk of systemic recurrence. TRPC4, TRPV5, and TRPV6 appear to be particularly interesting, as they are independent of the five commonly used predictive factors, that is, PSA, percentage of positive biopsies, SM status, Gleason score, and pT stage.

[Robotic-assisted laparoscopic implantation of artificial urinary sphincter AMS 800® in woman: Single center experience]. / Implantation du sphincter artificiel AMS 800® chez la femme par cœlioscopie robot-assistée : expérience monocentrique.

INTRODUCTION: Artificial urinary sphincter (AUS) is the treatment of last resort of stress urinary incontinence (UI) due to intrinsic sphincter deficiency (IS). The implantation procedure has been described by open surgery and laparoscopy with a significative rate of complication by Lucas et al. (2012) and Costa et al. (2001). We report our experience of implantation of SUA by robotic-assisted laparoscopy (R-SUA) in 17 patients among 3 revisions. MATERIAL AND METHODS: Between 2012 and 2017, 17 patients have been consecutively included. The surgical technique was described by Fournier et al. The continence was defined by the absence of urine leakage. RESULTS: The median age at implantation was 66,8±7 years, in the primo-implantation (PI) group, one patient had a neurological acontractile bladder, and bladder was open in 11 patients (78,6%) to ensure the bladder neck dissection. In the revision group (R) 3 patients had a complete replacement of SUA for mechanical failure. One vaginal bound was reported, but did not compromise the implantation, and the survival of SUA. Duration of intervention, size of cuff, postoperative catheterization and hospitalization time were respectively 205±34 and 112±8min; 7,7±0.9 and 5.2±0.8cm; 5.9±2.1 and 4.3±4 days; 6.6±1.5 and 7±3.6 days for PI and R groups. At the end of a mean follow-up of 24.6±18.4 and 59±5 months, continence was respectively 86% and 100%, for the PI and R groups. CONCLUSION: The implantation of R-SUA was feasible and safe with encouraging results. Other studies must evaluate the place of R-SUA among the different enabled surgical techniques. LEVEL OF EVIDENCE: 4.

[Incidence of postural disorders in patients with chronic pelvic-perineal pain]. / Incidence des troubles posturaux chez les patients souffrant d'algies pelvipérinéales chroniques.

OBJECTIVE: Pelvic-perineal pain often accompanied by pain of the perineum and pelvi-trochanteric muscles, we sought to observe the frequency of postural disturbances in relation to the pelvi-perineal muscles in patients who consult for pelvic perineal pain compared to a control population free of these pain. MATERIAL AND METHODS: The prospective monocentric study was conducted during consultations of pelvic perineal pain in the urology department of Nantes and was based on 5 clinical tests successively looking for the presence of thoraco-lumbar hinge syndrome, myofascial syndrome in the pelvic diaphragm, pelvic instability, pelvic-pedic quadrilateral dysfunction and paravertebral muscle hypertonia. RESULTS: A total of 51 subjects were included in the study and divided into two populations: 26 patients, 25 controls. Thoraco-lumbar hinge syndrome was found in 28 % of patients vs 4 % of controls (P=0.024); myofascial syndromes were present in 68 % of patients vs 25 % of controls (P=0.005); pelvic instability concerned 76 % of patients vs 33 % of controls (P=0.002); the dysfunctions of the pelvic-pedic quadrilateral concerned 96 % of the patients vs 58 % of the controls (P=0.001); paravertebral muscle hypertonia was found bilaterally in 32 % of patients vs 4 % of controls (P=0.077) and unilaterally in 36 % of patients vs 0 % of controls (P=0.001). CONCLUSION: Patients with chronic pelvic perineal pain had significantly more posture problems than non-pain patients. It seemed relevant to us that the postural assessment was integrated into their usual clinical examination. LEVEL OF EVIDENCE: 4.

Influence of inguinal hernia repair on male fertility.

Male infertility is a rare but certainly underestimated iatrogenic complication of inguinal hernia repair. The use of polypropylene mesh, recommended by the European Hernia Society, either via the traditional, open or laparoscopic approach, is responsible for surrounding inflammation followed by fibrosis, but there is no proven increase in vas deferens obstruction found in the literature. Prevention is essential to reduce the incidence of this complication including screening for patients at risk and mastery of surgical techniques.