Factors associated with psychological symptoms in hospital workers of a French hospital during the COVID-19 pandemic: Lessons from the first wave.

PURPOSE: The COVID-19 pandemic has put hospital workers around the world in an unprecedented and difficult situation, possibly leading to emotional difficulties and mental health problems. We aimed to analyze psychological symptoms of the hospital employees of the Paris Saint-Joseph Hospital Group a few months after the 1st wave of the pandemic. PARTICIPANTS AND METHODS: From July 15 to October 1, 2020, a cross-sectional survey was conducted among hospital workers in the two locations of our hospital group using the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) to measure anxiety, depression, and PTSD symptoms. Factors independently associated with these symptoms were identified. RESULTS: In total, 780 participants (47% caregivers, 18% health administrative workers, 16% physicians, and 19% other professionals) completed the survey. Significant symptoms of anxiety, depression, and PTSD were reported by 41%, 21%, and 14% of the participants, respectively. Hierarchical regression analysis showed a higher risk of having psychological symptoms among those (1) who were infected by SARS-CoV-2 or had colleagues or relatives infected by the virus, (2) who retrospectively reported to have had an anxious experience during the first wave, and (3) with a previous history of burnout or depression. In contrast, job satisfaction appeared to be a protective factor. Overall, hospital workers showed the statistically same levels of anxiety, depression, and PTSD symptoms, regardless of their profession and whether they had worked in units with COVID-19 patients or not. CONCLUSIONS: Our cross-sectional survey of 780 hospital workers shows that after the first wave, hospital employees had a significant burden of mental health symptoms. Specific preventive measures to promote mental well-being among hospital workers exposed to COVID-19 need to be implemented, first among particularly vulnerable staff, and then, for all hospital staff for whom anxiety is detected early, and not only those who were directly exposed to infected patients.

Management of Lindbom's hernia (ureterosciatic hernia).

Lindbom's hernia is very rare; treatment in symptomatic patients is hernia reduction. This can be temporary, performed endoscopically, but definitive cure is surgical. The surgeon can choose between simple reduction or resection followed by anastomosis of the involved ureteral segment, occasionally with associated hernioplasty.

RETRACTED: Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : sarcomes rétropéritonéaux French ccAFU guidelines ­ Update 2018­2020: Retroperitoneal sarcoma / Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : sarcomes rétropéritonéaux.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.010. C'est cette nouvelle version qui doit être utilisée pour citer l'article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.010. That newer version of the text should be used when citing the article.

[Non-palpable testicular tumors in adults: A management based on imaging? Issue from the French Urologic Association Genital Cancer committee's edit]. / Tumeurs testiculaires non palpables chez l'adulte : vers une prise en charge guidée par l'imagerie ? Une mise au point du Groupe organe génitaux externes du comité de cancérologie de l'Association française d'urologie.

BACKGROUND: Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. OBJECTIVES: To review their characterization at imaging findings of non-palpable testicular tumors. DOCUMENTARY SOURCES: Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. RESULTS: Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. LIMITS: Non-randomized study - a very few prospective studies. CONCLUSION: The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors.

[French ccAFU guidelines - Update 2018-2020: Retroperitoneal sarcoma]. / Recommandations françaises du Comité de Cancérologie de l'AFU ­ Actualisation 2018­2020 : sarcomes rétropéritonéaux.

OBJECTIVE: To update French urological guidelines on retroperitoneal sarcoma. METHODS: Comprehensive Medline search between 2016 and 2018 upon diagnosis, treatment and follow-up of retroperitoneal sarcoma. Level of evidence was evaluated. RESULTS: Chest, abdomen and pelvis CT is mandatory to evaluate any suspected retroperitoneal sarcoma. MRI sometimes helps surgical planning. Before histological confirmation through biopsy, the patient must be registered in the French sarcoma pathology reference network. The biopsy standard should be an extraperitoneal coaxial percutaneous sampling before any retroperitoneal mass therapeutic decision. Surgery is retroperitoneal sarcoma cornerstone. The main objective is grossly negative margins and can be technically challenging. Multimodal treatment risks and benefits must be discussed in multidisciplinary teams. The relapse rate is related to tumor grade and surgical margins. CONCLUSION: Retroperitoneal sarcoma prognosis is poor and closely related to the quality of initial management. Centralization through dedicated sarcoma pathology network in a high-volume center is mandatory.

[CCAFU french national guidelines 2016-2018 on testicular germ cell tumors]. / Recommandations en onco-urologie 2016-2018 du CCAFU : Tumeurs germinales testiculaires.

INTRODUCTION: The purpose of the oncologic comitee of the french association of urology was to establish guidelines proposed by the external genital organ group, for the diagnosis, treatment and follow-up of the germ cell tumours of the testis. MATERIAL AND METHODS: The multidisciplinary working group studied 2013 guidelines, exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommandation. RESULTS: The initial workup of testicular cancer is based on clinical, laboratory (AFP, total hCG, LDH) and imaging assessment (scrotal ultrasound and chest, abdomen and pelvis computed tomography). Inguinal orchiectomy is the first line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. The management of stage I tumors is based on surveillance or on a risk-adapted approach with explaining to the patient the benefits/disadvantages of active treatment or watchful waiting as a function of the risk of relapse. Treatment options for stage I seminomas comprise: surveillance, chemotherapy (1cycle of carboplatin) or para-aortic radiotherapy. Treatment options for stage I nonseminomatous germ cell tumours comprise: surveillance, chemotherapy (1cycle of BEP) or staging retroperitoneal lymphadenectomy. The management of metastatic tumors essentially comprises chemotherapy with 3, 4 cycles of BEP or dose-dense chemotherapy according to the IGCCCG. Radiotherapy may be indicated in seminomas with lymph node metastasis < 3cm. Review 3 to 4 weeks postchemotherapy is essentially based on tumor marker assays and chest, abdomen and pelvis computed tomography. Surgical retroperitoneal lymph node dissection is indicated for all residual NSGCT masses > 1cm and for persistent residual seminoma masses > 3cm with 18F- FDG PET- CT uptake. CONCLUSIONS: Good Germ cell tumors specific survival rates (99% CSI, 85% CSII, III) are based on precise initial staging, adapted and strictly defined treatment and close surveillance. © 2016 Elsevier Masson SAS. All rights reserved.

[CCAFU french national guidelines 2016-2018 on retroperitoneal sarcoma]. / Recommandations en onco-urologie 2016-2018 du CCAFU : Sarcomes rétropéritonéaux.

INTRODUCTION: The purpose of this article was established by the external genitalia group CCAFU recommandations for diagnosis, treatment and monitoring of retroperitoneal sarcomas, intended for urologists. MATERIAL AND METHODS: The multidisciplinary working group has updated the 2013 guidelines, based on an exhaustive review of the literature on PubMed, valued references, level of evidence, to assign grades of recommendation. RESULTS: From a clinical suspicion evoking a RPS, computed tomography thoraco abdominal and pelvic is the gold standard. MRI is useful for surgical planning. Before the biopsy confirmation, the inclusion of the file in the French sarcoma pathology reference network should be the rule. The biopsy under scanner performed by retroperitoneal approach is recommended and should be achieve before any therapeutic management of a suspicious retroperitoneal solid mass. Treatment is primarily surgical with the main objective resection in healthy margins (R0) obtained by a technically challenging compartmental resection surgery. Instead of radiation therapy and chemotherapy within a multimodal treatment (neo adjuvant or adjuvant) is discussed based on the evolving risks and opportunities excision. The relapse rate is related to tumor grade and surgical margin. The final prognosis is closely related to the quality of initial management and the volume of cases handled by the center. CONCLUSION: The RPS has a poor prognosis. The quality of the initial management directly impacts the disease-free survival and overall survival. The multidisciplinary management coordinated within a referent care network of sarcoma pathology is an imperative necessity. © 2016 Elsevier Masson SAS. All rights reserved.

[CCAFU french national guidelines 2016-2018 on penile cancer]. / Recommandations en onco-urologie 2016-2018 du CCAFU : Tumeurs malignes du pénis.

INTRODUCTION: The aim of this work is to establish guidelines proposed by the external genital organ group of the CCAFU for the diagnosis, treatment and follow-up of penile cancer. MATERIAL AND METHODS: The multidisciplinary working party studied 2013 guidelines exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommandation. RESULTS: The most common histological type is squamous cell carcinoma. Clinical examination of the penis is usually sufficient to access local extension. It can be completed by MRI to assess deeper extension. Physical examination of both groins must evaluate inguinal regional lymph nodes involvement. In the presence of palpable lymph nodes, abdomen and pelvis computed tomography and 18F-FDG PET-CT are recommended. Sentinel lymph node biopsy is recommended in the case of penile cancer with high risk of lymph node extension with no palpable lymph nodes. Treatment of the primary tumour is usually surgical. It must be as conservative as possible while ensuring negative surgical margins. Brachytherapy or local treatment can be proposed in some cases. Bilateral inguinal lymph node areas must be systematically treated. Inguinal lymphadenectomy alone has a curative role in patients with metastatic invasion of a single node (stage pN1). In the case of more extensive lymph node involvement, multimodal management combining chemotherapy, surgery, and possibly radiotherapy has to be considered. CONCLUSIONS: The treatment of penile cancer is usually surgical possibly in combination with chemotherapy in the presence of lymph node extension. The main prognostic factor is lymph node involvement, requiring appropriate management at the time of diagnosis.x © 2016 Elsevier Masson SAS. All rights reserved.

Grade IV renal trauma management. A revision of the AAST renal injury grading scale is mandatory.

INTRODUCTION: The AAST renal injury grading scale is currently the most important variable predicting the need for kidney repair or removal, morbidity and mortality after blunt or penetrating kidney injuries. The 2011 revised version included renal pelvis, uretero-pelvic junction and segmental vascular injuries as grade IV, limiting grade V to severe hilar injuries. However, patients requiring surgery cannot be properly identified because of hemodynamic instability due to grade IV renal injuries. This study proposes an add-on for the AAST grade IV renal injury scale to improve the management of these patients. METHOD: We searched the Medline and Scopus databases up to September 2014. Searches were not restricted by date, language or publication status. Pediatric studies were excluded. RESULTS: 71 articles were found, 57 were pertinent, including 6 directly related to the topic. 3 risk factors were identified to be associated with surgery for hemodynamic instability: perirenal hematoma >3.5 cm, intravascular contrast extravasation and medial renal laceration. Presence of two or more of these criteria has been validated in two other studies to predict the need for intervention. Patients with >25 % devascularized fragments also have poor prognosis and should be treated more aggressively. CONCLUSION: These elements should be included in future classification reassessment to efficiently determine the time for surgery in grade IV renal traumas, generally leading to nephrectomy.

The French Advanced Course for Deployment Surgery (ACDS) called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX): history of its development and future prospects.

INTRODUCTION: The composition of a French Forward Surgical Team (FST) has remained constant since its creation in the early 1950s: 12 personnel, including a general and an orthopaedic surgeon. The training of military surgeons, however, has had to evolve to adapt to the growing complexities of modern warfare injuries in the context of increasing subspecialisation within surgery. The Advanced Course for Deployment Surgery (ACDS)-called Cours Avancé de Chirurgie en Mission Extérieure (CACHIRMEX)-has been designed to extend, reinforce and adapt the surgical skill set of the FST that will be deployed. METHODS: Created in 2007 by the French Military Health Service Academy (Ecole du Val-de-Grâce), this annual course is composed of five modules. The surgical knowledge and skills necessary to manage complex military trauma and give medical support to populations during deployment are provided through a combination of didactic lectures, deployment experience reports and hands-on workshops. RESULTS: The course is now a compulsory component of initial surgical training for junior military surgeons and part of the Continuous Medical Education programme for senior military surgeons. From 2012, the standardised content of the ACDS paved the way for the development of two more team-training courses: the FST and the Special Operation Surgical Team training. The content of this French military original war surgery course is described, emphasising its practical implications and future prospects. CONCLUSION: The military surgical training needs to be regularly assessed to deliver the best quality of care in an context of evolving modern warfare casualties.

[Use of French version of Ureteral Stent Symptom Questionnaire for tolerance evaluation of ureteral double J-stent]. / Évaluation de la tolérance de la sonde JJ par l'utilisation de l'autoquestionnaire USSQ.

OBJECTIVES: To evaluate the quality of life of the holders of a ureteral double J stent (US) using the USSQ questionnaire (Ureteral Stent Symptom Questionnaire), validated in French in 2010. METHODS: Between January 2009 and December 2011, 249 patients underwent flexible ureteroscopy for urolithiais in our service. Among them, 160 received a US in perioperative, and they were sent self-questionnaire USSQ-FR retrospectively. The questionnaire includes 38 questions, concerning the perioperative period with US, and 4 weeks after its removal, grouped into 6 sections: urinary symptoms, pain, general health, professional resounding, sexual resounding, and other problems. A subgroup analysis was performed, comparing US used in emergency and planned US, active patients or retired, male or female. Statistical analysis used the Chi(2) test for paired data, the Fisher exact test and the Kruskal Wallis test. RESULTS: Of the 157 questionnaires sent (two patients who died, one mentally retarded), we obtained 80 responses. Quality of life appears to be significantly altered in all areas explored by the questionnaire. Urinary symptoms: 26.9 versus 19.9 score (P<0.0001), pain: 16.1 versus 10.7 (P=0.003), general health: 13.9 versus 9.1 (P<0.0001), professional practice: 6.1 versus 3.6 (P=0.0002), female: 3.3 versus 1.8 (P=0.001). There was no significant difference if the US was placed in emergency or programmatically, if patients were professionally active or retired. In addition, women had a significantly impaired quality of life compared to men for urinary symptoms, general health and professional practice. CONCLUSION: US are responsible for a significant impairment of quality of life for patients. The validated, self-administered, USSQ-FR questionnaire is a reliable tool for this evaluation. LEVEL OF EVIDENCE: 5.

[Management of testicular teratoma: update by the Oncology Committee of the French Urology Association, section of External Genital Organs (CCAFU-OGE)]. / Prise en charge des tératomes testiculaires: mise au point par le Comité de cancérologie de l'Association française d'urologie groupe organes génitaux externes (CCAFU-OGE).

INTRODUCTION: The objective of this article was to focus on the pathological, clinical and therapeutic aspects of the different forms of testicular teratoma in adults. MATERIAL AND METHODS: The multidisciplinary working group has conducted a literature search on Pubmed with keywords: adult teratoma; malignant transformation; growing teratoma; chemotherapy; surgery with focus on the different forms of adult testicular teratoma. RESULTS: Teratomas of the adults are malignant and subdivided into localized and metastatic forms that may be distinguished under exclusive teratoma form, growing teratoma or teratoma with malignant transformation. The management is based on an enlarged surgical excision (testis and metastasis) with, in metastatic forms, a chemotherapy adjusted with histology. Extended follow-up beyond 10 years is necessary because of the risk of late relapse. CONCLUSIONS: Testicular teratoma is a rare tumor, which is considered malignant with a potential of metastasis. The treatment is based mainly on surgical management.

[Epidemiology of urinary stones in the French military during the operation Serval]. / Épidémiologie de la lithiase urinaire chez les militaires français au cours de l'opération Serval.

OBJECTIVES: The renal colic crisis is a pathology frequently encountered in foreign operations recently conducted by the French army and often requires a medical repatriation in mainland France. Soldiers deployed in arid areas are at increased risk of developing urolithiasis. The purpose of our study is to analyze the risk factors, the frequency and the methods of management of symptomatic urinary stone disease for French military returnees for renal colic during Serval operation. METHODS: Our study focused on French soldiers repatriated from Mali for a renal colic care between January 11th and November 30th, 2013. For each patient, we recorded: age, sex, deployment date, crisis date, personal and family histories of urolithiasis, initial medical treatment, diagnosis and treatment to return to France. RESULTS: Three hundred and forty-eight soldiers were evacuated during Serval operation, among which 41 were due to the occurrence of renal colic crisis (11.7%). Twenty-nine percent of patients had a personal history of kidney stone disease symptomatically. The average residence time when the crisis appears is 60 days (10-120 days). Ninety-five percent of patients were asymptomatic at their arrival in France and 39% of patients had no stone found in CT scan. The average size of the stones found on the imaging was 2.71 mm (1-8mm). One patient required drainage by JJ ureteral endoprothese in order to have a quick ureteroscopy for recovery of its capacity. CONCLUSION: The French military sent to Serval operation are exposed to multiple contributing factors of urolithiasis as the dehydration and the strong temperature. The analysis of our series reveals that the history of renal stone disease is the main factor favoring and the medical treatment is effective in almost all renal colic cases. The operational impact associated with this common condition in the Sahel region deserves an awareness of field practitioners to the screening and management of this disease in a precarious situation and a reflection of the staffs concerning the access onto the operating theater to appropriate diagnostic and therapeutic means that could facilitate the return to the combat unit.

[Single center experience of (18F)-fluorocholine positron emission tomography: analysis of its impact on salvage local therapy in patients with prostate adenocarcinoma]. / Expérience monocentrique de la tomographie par émission de positons à la (18F)-fluorocholine : analyse de son impact sur les indications de traitement local de rattrapage dans la prise en charge des adénocarcinomes prostatiques.

PURPOSE: To assess usefulness of ((18)F)-fluorocholine positron emission tomography (PET) for localizing relapse in patients with biochemical relapse from prostate adenocarcinoma and its impact on indications of salvage local therapy. PATIENTS AND METHODS: An ((18)F)-fluorocholine PET coupled with computed tomography was performed in 28 patients with biochemical progression from prostate adenocarcinoma. At the time of ((18)F)-fluorocholine PET, median prostate specific antigen (PSA) was 3.0 ng/mL (from 0.34 to 93 ng/mL) and 17 patients (60.7%) received hormone therapy. Eighteen patients from this cohort were potentially candidates to salvage radiotherapy. RESULTS: A pathologic uptake was shown in 11 patients (39.3%) and 17 patients (60.7%) had no pathologic uptake. Median PSA was 2.4 ng/mL (0.33 to 36 ng/mL) in case of negative ((18)F)-fluorocholine PET, versus 6.75 ng/mL (1.21 to 93 ng/mL) in case of pathologic uptake (P=0.04). Among the 17 patients candidates to salvage radiotherapy, ((18)F)-fluorocholine PET helped deciding for salvage radiotherapy in five patients, since it showed only centropelvic pathologic uptake (27.7%). In one patient, it showed metastatic and radiotherapy was contraindicated. After prostatectomy, ((18)F)-fluorocholine PET was positive in only one patient candidate to salvage radiotherapy (9.1%), showing anastomotic relapse. CONCLUSION: ((18)F)-fluorocholine was positive in about a third of patients with biochemical progression. Its clinical impact is being prospectively investigated.