[Surgical approach and sexual outcomes after radical prostatectomy]. / Voie d'abord chirurgicale et fonction sexuelle post-prostatectomie totale.

BACKGROUND: Radical prostatectomy is curative surgical treatment of choice for localized prostate cancer. The objectives are cancer control, preservation of continence and preservation of sexuality, the combination of the three constituting the Trifecta. OBJECTIVE: The objective of this study was to assess, through the analysis of the literature, the sexual outcomes according to surgical approach: radical prostatectomy by laparotomy (PRL), laparoscopic radical prostatectomy (PRLa) and laparoscopic robot-assisted radical prostatectomy (PRLaRA), when nerve sparing was practiced. METHODS: An exhaustive and retrospective review of literature was conducted using the Pubmed search with the following keywords: "Prostatic Neoplasms" [Mesh], "Prostatectomy" [Mesh], "Erectile Dysfunction" [Mesh], "Robotics" [Mesh], "Laparoscopy" [Mesh], Nerve sparing. SELECTION CRITERIA: The selected articles were prospective or retrospective series including more than 200 patients, randomized trials and meta-analyses published between 1990 and 2014. RESULTS: A total of 21 prospective studies (6 on PRL, 4 on PRLa and 11 on PRLaRA), 12 retrospective studies (6 on PRL, 1 on PRLa and 5 on PRLaRA), 2 randomized controlled trial and 3 meta-analyses were selected from 1992 to 2013. There was no evidence of the superiority of one surgical approach compared to others in terms of sexuality. LIMITS: Articles with level 1 of scientific evidence have discordant results, due to heterogeneity in the assessment criteria of postoperative sexual function. CONCLUSION: According to our knowledge, there is currently no difference in terms of sexual outcomes between PRL, PRLA and PRLaRA approaches.

[Evolution of the number and type of penile prostheses implanted in France for erectile dysfunction: Analysis of French national coding database (2006-2013)]. / Évolution du nombre et du type de prothèses péniennes posées en France pour dysfonction érectile : analyse des données nationales de codage pour la période 2006-2013.

OBJECTIVES: Patients who are not responding to injectable and/or vacuum oral pharmacological treatments can receive a penile prosthesis. Three types of penile prostheses are used in France: rigid, semi-rigid and inflatable prostheses 3-piece or 2-piece. We have assessed the National surgical insertion practices between 2006 and 2013 (number of prostheses insertions, types, procedure locations, number of surgeons and distribution [public or private sectors]). MATERIALS AND METHODS: Data analysis from the French Technical Agency of Information on Hospitals (ATIH) (2006-2013) using the common classification of medical acts (CCAM) and after code extractions related to this surgery (JHLA002, JHLA003, JHLA004). RESULTS: Between 2006 and 2013, the number of penile implants in France doubled (307 to 633), inflatable penile prostheses with an extracavernous component remained the most frequently used (87 %) (228 to 552) (+142 %). The use of semi-rigid prostheses declined by 26.7 %. The distribution between the private and public sector was close to 1 in 2013. More than half of French penile prostheses were implanted in three regions (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). Nearly 62 % of surgeons implanted only one or two three-compartment prostheses in 2013. CONCLUSION: The number of penile prostheses in France doubled between 2006 and 2013. Three regions were particularly active as far as this surgery is concerned (Île-de-France, Languedoc-Roussillon, Rhône-Alpes). They were boosted by 5 surgeons with more than 20 prostheses surgeries a year. LEVEL OF EVIDENCE: 4.

[Should we propose a systematic second transurethral resection of the bladder for all high-risk non-muscle invasive bladder cancers?]. / Faut-il proposer une seconde résection systématique pour toutes les tumeurs de vessie n'infiltrant pas le muscle vésical à risque élevé ?

OBJECTIVE: Quantify the rate of residual bladder tumor following systematic second look resection of pTa high-grade versus pT1 high-grade patients. MATERIAL AND METHODS: From January 2010 to July 2013, 53 patients with a non-muscle-invasive bladder cancer with high-risk of recurrence and progression underwent a second systematic resection in accordance with the current guidelines of the French Association of Urology (AFU). RESULTS: Among the 53 patients with a high-risk non-muscle-invasive bladder cancer, histological examination of the initial resection identified: 17 pTa high-grade (32.1%) and 36 pT1 high-grade (67.9%). There was a significant difference between the 2 groups of patients (Ta high-grade versus T1 high-grade) concerning the rate of residual tumor on second look resection (11.8% versus 66.7%, P=0.0002). The predictive factors of residual tumor after second resection were the pT1 stage (P=0.0002), tumor multifocality (P=0.02) and presence of associated Cis (P=0.0005). CONCLUSION: The high rate of residual tumor in our series confirmed the importance of a systematic second look resection for high-risk non-muscle-invasive bladder cancers. However, for the pTa tumors without associated Cis, the interest of this second look seemed of less concern. LEVEL OF EVIDENCE: 5.

Omental torsion, a rare cause of acute surgical abdomen.

Torsion of the greater omentum is a rare cause of acute abdominal pain. The symptoms of this pathology are non-specific and abdominal CT is usually necessary to make the diagnosis. Treatment is surgical and can often be performed laparoscopically.