Benefits of Urologic-Dermatologic Consultations for the Diagnosis of Cutaneous Penile Lesions: A Prospective Study.

INTRODUCTION: We evaluated the benefits of a specialized consultation created in 2014 for cutaneous penile lesions. MATERIALS AND METHODS: We performed a descriptive prospective study evaluating all patients sent for a monthly urologic-dermatologic consultation at a French university hospital from September 2014 to September 2015 for cutaneous penile lesions. All patients evaluated were included. We collected the demographic data, clinical examination findings, and the proposed diagnosis and treatment for every patient. RESULTS: A total of 27 patients were included; 4 (14.8%) had been referred by a general physician and 23 (85.2%) by a specialist. Cutaneous penile lesions had evolved within 12 months in 15 patients (55.6%). Penile cancer was diagnosed in 5 patients (18.5%), of which 3 were squamous cell carcinoma (11.1%), 1 was metastasis of melanoma (3.7%), and 1 was extramammary Paget disease (3.7%). In addition, 1 patient (3.7%) had a premalignant lesion on a condyloma, 12 (44.4%) had balanitis, 2 (7.4%) had psoriasis lesions, 3 (11.1%) had condylomas, 1 (3.7%) had genital melanosis, and 3 (11.2%) had normal findings. Four patients (16.6%) underwent biopsy, 8 (33.3%) underwent surgery, and 12 (50%) received local treatment. CONCLUSION: The use of urologic-dermatology specialized consultations resulted in encouraging findings. Patients can benefit from multidisciplinary expertise and rapid treatment of various disorders. Thus, it seems important to develop reference centers created specifically for cancerous disease.

Geriatric Assessment Can Predict Outcomes of Endoscopic Surgery for Benign Prostatic Hyperplasia in Elderly Patients.

Ojectives: Surgical management of benign prostatic hyperplasia (BPH) in elderly patients is associated with higher morbidity and mortality rate. This raises the question of benefice and risk balance. We conducted a prospective observational study to evaluate the results of endoscopic surgery for BPH in elderly patients, according to geriatric assessment. PATIENTS AND METHODS: We included prospectively 60 patients older than 75 years, with an indwelling catheter for acute or chronic retention, who were candidates to endoscopic surgery for BPH. Patients underwent the brief geriatric assessment (BGA) and the comprehensive geriatric assessment (CGA) to classify them into three groups: "vigorous," "vulnerable," and "sick." Success was defined by the bladder catheter withdrawal after surgery. RESULTS: After geriatric assessment, 33 patients were classified in the "vigorous" group (55%), 25 in the "vulnerable" group (42%), and 2 in the "sick" group (3%). The success rate immediately after surgery was 85% and 41% in the "vigorous patient" group and the "vulnerable and sick" patient group, respectively (p < 0.05). The success rate at 3 months after surgery was 94% and 55% (p < 0.05). The morbidity was higher for the "vulnerable and sick" group (44%) compared with the "vigorous" group (15%) (p < 0.05). The BGA also allowed predicting a higher risk of failure in patients with a score ≥3 immediately after surgery (odds ratio 5.9, confidence interval [95% CI] 1.61, 29.9) and 3 months after surgery (odds ratio 6.9, 95% CI 1.31, 70.8). CONCLUSION: Geriatric assessment can predict the outcome of endoscopic surgery for BPH for patients in retention older than 75 years. "Vulnerable and sick" patients had a higher risk to keep their indwelling catheter after the surgery compared with "vigorous" patients. The complication rate is also higher. The BGA can although predict a poor result of surgery when its score is equal or above 3/6.