Recommendations to Balance Benefits and Risks Of Thromboprophylaxis and to Avoid Central Venous-access Devices During First-line Chemotherapy in Men with Metastatic Germ Cell Tumors: The European Association Of Urology Testicular Cancer Panel Position in 2021.

Men with metastatic germ cell tumors undergoing chemotherapy are at high risk of venous thromboembolic events and low risk of bleeding. A central venous-access device should be avoided whenever possible. Thromboprophylaxis may be prescribed after balancing the risks and benefits for each individual patient.

Haemostasis in laparoscopic partial nephrectomy: current status.

Laparoscopic partial nephrectomy (LPN) is increasingly performed all over the world. However, as in its open counterpart, achieving a satisfactory haemostasis may be challenging. Our goal is to describe the different methods employed to control bleeding during LPN. We performed a non-structured review of the literature on the different haemostatic methods used during LPN. The techniques and materials used are divided into two main groups: LPN with ischemia and LPN without ischemia. The techniques to achieve warm, cold and regional ischemia are described. Energy sources and sealants are discussed in the section on LPN without ischemia. Case selection is of capital importance in the choice the appropriate haemostatic tools for LPN. Some refinements, related to the nature of the laparoscopic procedure, are still required to reach an effective cold ischemia. A broad variety of energy sources have been tested in animal models and in human setting. Major disadvantages are tissue scarring, smoke creation and low progression speed. To date none has been demonstrated to be superior to the conventional suturing. Fibrin and thrombin promoters as bio-glues are an important adjuvant method during LPN. Bipolar current devices together with fibrin sealants or coagulation promoters are used in small peripheral tumors. In bigger or central tumors, additionally suturing over Surgicel bolsters, the most popular technique is to secure the suture by means of clips. The level of the recommendations is based on comparative cohorts. We conclude that haemostasis is achieved during LPN adapting the protocols used in open nephron sparing surgery to the laparoscopic approach. Renal ischemia and bolster sutures are still mandatory in complicated LPN while in case of small exophytic tumors a satisfactory haemostasis may be achieved by using only a sealant product.

Transurethral resection vs microwave thermotherapy of the prostate: a cost-consequences analysis.

OBJECTIVE: To compare the costs and outcome of high-energy transurethral microwave thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG). RESULTS: During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5-33.2)% and 13.2 (4.5-21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444-3456) and 6560 (5992-7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692-5908) and 7800 (7118-8482) NLG, respectively. CONCLUSIONS: In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.

[The double J catheter in the shock wave treatment of kidney calculi]. / Le cathéter double J dans le traitment par ondes de choc de la lithiase rénale.

Review of the literature concerning the use of Double J stents prior to extracorporeal shock were lithotripsy. The advantages and disadvantages of stenting are described together with the marked benefit derived from the pretreatment use of the stent. The authors also try to determine which stones are suitable for preliminary stenting, by noting the degree of stone mass.