[Factors predicting of failure after conservative treatment in III-V grade renal trauma]. / Facteurs prédictifs d'échec du traitement conservateur du traumatisme rénal grade III­V.

INTRODUCTION AND OBJECTIVES: Surgical exploration of renal injury secondary to major trauma often leads to nephrectomy. The aim of this work was to identify the factors associated with the need for surgery in patients with III-V grade renal trauma who were initially managed conservatively. MATERIALS AND METHODS: We retrospectively reviewed data from patients with Grade III-V kidney injury between June 2005 and June 2015. Demographic, clinical and bio-radiological characteristics at admission and follow-up, as well as management and complications, were recorded. Patient data, including conservative treatment, was a success without recourse to nephrectomy, and those patients who needed surgery were analyzed. RESULTS: Seventy three patients were included in this study. Grade III accounted for 45%, Grade IV: 49% and Grade V: 5%. The success rate for conservative treatment was 79%: 31 patients grade III (94%), 26 grade IV (72%) and no grade V patients. hypotension at admission (P=0.04), hematoma size greater than 3.5 centimeters (P=0.002), grade V (P=0.003), anemia (P=0.04), blood transfusion (P=0.01) and worsening of lesions of the control CT lesions (P=0.001), are the factors considered as predictive of failure of conservative treatment. CONCLUSION: Conservative management is the treatment of choice in III-V grade renal trauma, and the prognostic factors found in this study make it possible to better select patients. LEVEL OF EVIDENCE: 4.

[Evaluation of the learning curve of laparoscopic radical cystectomy for cancer: Morbidity and oncological results]. / Évaluation de la courbe d'apprentissage de la cystectomie radicale laparoscopique pour cancer : morbidité et résultats oncologiques.

INTRODUCTION: The objective of this work was to evaluate the impact of the laparoscopic radical cystectomy learning curve on perioperative and oncological outcomes. PATIENT AND METHODS: This is a retrospective and single-center study of all patients who underwent laparoscopic radical cystectomy for bladder cancer from February 2007 to March 2016, (93 patients) Perioperative and oncological data were collected. We used mixed statistical models to predict the number of patients needed in the learning phase. We compared the perioperative parameters of the patients in the learning phase with those of the rest of the patients. Overall survival was estimated using the Kaplan-Meier method. RESULTS: Thirty-six patients are required for the learning phase (P1). The expertise phase begins after the 36th LRC (P2). In both phases, there was no significant difference in age, ASA score, and tumor stage (P=0.237, P=0.577, P=0.998). Mean operative time was 328.3min and 262.4min in P1 and P2 (P=0.0001), mean blood loss was 333.7mL and 194.3mL in P1 and P2 respectively (P=0.0003). The rate of major complications was high in the learning phase (P=0.042). There was no significant difference in lymph node yield, positive surgical margins and overall survival (P=0.068, P=0.194, P=0.703). CONCLUSION: This learning experience was evaluated without compromising oncological results, but with a significantly higher rate of major complications. LEVEL OF EVIDENCE: 3.

[Oncological results of a series of 93 laparoscopic radical cystectomies: 5 years of follow-up]. / Résultats oncologiques d'une série de 93 cystectomies totales laparoscopiques : 5 ans de suivi.

OBJECTIVE: To report oncological results at 5 years after laparoscopic radical cystectomy (LRC) with lymph node dissection for bladder cancer (BC). PATIENTS AND METHODS: This is a retrospective single-center study of all patients who underwent LRC for BC by the same surgeon from February 2007 to March 2016. Demographic, perioperative and oncologic data were collected. We reported overall survival rate (OS), cancer specific (CSS) and recurrence-free survival (SSR), as primary indicators of oncologycal outcomes. These survival rates were estimated according to the Kaplan-Meier method. Log-rank tests were used to explore overall survival according tumor stage, lymph node involvement and surgical margins status. RESULTS: In all, 93 patients (82 men and 11 women) underwent LRC. Mean age was 59 years. Minor complications (Clavien I-II) occurred in 24.7%. Major complications (Clavien IIIa-V) were observed in 8.6%. No patients received neoadjuvant chemotherapy. Median lymph node (LN) yield was 15 and 26.5% patients had positive LN. The positive surgical margins (SMs) rate was 5.3%. Median follow-up for the entire patients was 50 months (19-84 months). Forty-three patients (46.2%) were followed for at least 71 months. Five year RFS, CSS and OS were 67%, 85% and 79%, respectively. Non organ confined desease, positive LN and positive SMs were associated with poorer OS (P<0.039, P<0.016 and P<0.001). CONCLUSION: LRC was associated with acceptable long-term oncologic outcomes, similar to those currently reported after open cystectomy for BC. LEVEL OF EVIDENCE: 3.

[Sensitivity to change of the USP score (Urinary Symptoms Profile) after surgical treatment of benign prostatic hyperplasia (BPH)]. / Sensibilité au changement du score USP (Urinary Symptoms Profile) après traitement chirurgical de l'hypertrophie bénigne de la prostate (HBP).

OBJECTIVE: To evaluate the sensitivity to change in USP score (Urinary Symptoms Profile) after surgical treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Prospective study collecting IPSS (International Prostatic Symptom Score) and USP scores before and 6 weeks after surgery for BPH. Sensitivity to change was assessed using effect size (ES) and mean standardized response (MSR). RESULTS: Thirty patients, mean age of 68±10 years (min: 52, max: 90) were included in this study. The mean IPSS and USP scores were 14.3 (e.t.: 5.42), 20.3 (e.t.: 5.22) and 3.53 (e.t.: 3.68), 3.43 (e.t.: 3.48) before and after surgery respectively. The overall USP score showed excellent sensitivity to change with a global value of ES and MSR of 1.986 and 2.322 respectively. CONCLUSION: The USP score has an excellent sensitivity to change. It seems to be a valid and reliable score that can be perfectly adapted to the assessment of symptoms associated with BPH, with good sensitivity to changes in the overall score, with the advantage over the IPSS of an exhaustive exploration of all urinary symptoms particularly in the field of urge urinary incontinence and stress urinary incontinence. LEVEL OF PROOF: 4.

[The local anesthesia for the prostatic biopsies echo-guided: forward-looking randomized study comparing two methods]. / L'anesthésie locale pour les biopsies prostatiques écho-guidées: étude prospective randomisée comparant deux méthodes.

INTRODUCTION: The realization of the prostatic biopsies is a painful act. The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol. PATIENTS AND METHODS: Between November 2007 and December 2009, 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups. The group 1 (30 patients) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2% intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2% injected at the level of periprostatics laterals and apicales. The pain was estimated by a visual analog scale (AVS) at the introduction of the probe of echography (AVS 1), at the time of the biopsy (AVS 2) and 20 minutes later (AVS 3). RESULTS: There was no significant difference between both groups concerning AVS 1 means. The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3. CONCLUSION: The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later, without increase of the complications. We recommend it to decrease the pain and the discomfort related to this technique.

[Perineal-scrotal gangrene: epidemiological and therapeutic aspects. About 45 cases]. / La gangrène périnéoscrotale: profil épidémiologique et aspects thérapeutiques. À propos de 45 cas.

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.

[Renal hydatid cyst: radiologic features and therapy]. / Kyste hydatique du rein : aspects radiologiques et thérapeutiques.

Hydatid disease is endemic in some Mediterranean countries. Kidney is a relatively rare site, representing 2 to 3 % of all visceral sites. The diagnosis of hydatid cyst of the kidney is suspected in epidemiological, clinical, radiological and biological arguments. It remains clinically silent for a long time and only presents at the stage of complications. Ultrasound can suspect the hydatid nature of the lesion in 50 % of cases. Computed tomography and magnetic resonance imaging are helpful in the event of problem of differential diagnosis. The standard treatment for renal hydatid cyst is resection of the prominent dome and nephrectomy is indicated in cases of destroyed kidney.

Mule bite to the male genitalia with complete penile and anterior urethra amputation: unusual case and review of the literature.

Animal bite is rare with few cases reported in the literature. The morbidity of animal bites is directly related to the severity of the initial wound. Most victims are boys, and dog bites are the most common injury. Infectious complications are unusual, since treatment is sought early (Wein 2007). Thus, urologists are not usually familiar with management and principles for treating this condition. The authors report the case of a 38-year-old male with a severe mule bite injury to the genitalia causing complete penile and anterior urethra amputation and scrotal wound with no involvement of its contents. To our knowledge, no such case had ever been reported in the medical literature. This kind of emergencies is challenging for urologists.