[Vasectomy under local anesthesia, retrospective evaluation of patient satisfaction in CH Annecy Genevois]. / La vasectomie sous anesthésie locale, évaluation rétrospective de la satisfaction des patients au CH Annecy Genevois.

Contraceptive vasectomy is a male sterilization technique by interrupting the continuity of the vas deferens. The primary endpoint of our study was to evaluate patients' feelings of vasectomy under local anesthesia. We collected responses from 108 patients who had a vasectomy under local anesthesia at the Center Hospitalier Annecy Genevois between January 1, 2020 and April 30, 2022. The average age of patients at the time of the vasectomy was 40years old. Patients were satisfied with the level of information before vasectomy for 104 of them (96%). The level of pain felt during the intervention evaluated by Visual Analog Scale had an average of 3.4/10 (standard deviation 2.4). The degree of satisfaction during the procedure was excellent/good for 103 patients (95%). In the follow-up, we reported 10 patients (10%) with a complication (hematoma, infection or healing problem). The retrospective evaluation found 103 patients (95%) who would repeat the procedure under the same modalities and 106 patients (98%) who would recommend vasectomy under local anesthesia to a relative/friend. Vasectomy under local anesthesia is increasingly common, so it is important to assess the feelings of patients with this modality. Our study had the advantage of bringing together a large number of patients over a short period with several different operators. Overall satisfaction with the hospitalization process and the procedure was very satisfactory. The patient journey was significantly simplified with local anesthesia instead of general anesthesia. LEVEL OF EVIDENCE: 4.

[Non-heart-beating renal donors: organization in a non-university hospital]. / Prélèvement rénal sur donneur décédé par arrêt cardiaque (DDAC): organisation dans un centre hospitalier non universitaire.

INTRODUCTION: In 2011 in France, all kidneys from patients with brain death and from living donors cannot meet the demand for renal transplants. Since 2006, sampling protocols kidneys from non-heart-beating donors (NHBD) are developed to increase the number of renal transplants. The objective was to describe the organization of a protocol NHBD in a non-university hospital. MATERIALS AND METHODS: Patients with inclusion criteria of protocol NHBD of the Agency of Biomedicine were prospectively included between 1st July 2011 and 31 December 2012. The protocol data were comparable to national data. Vascular canulation was performed by urologists. The epidemiological, clinical and biological characteristics of patients included, the different times and deadlines of the protocol, and data of renal transplantation were collected and analyzed. RESULTS: Over the period of 18 months, 16 patients were included in the protocol NHBD, with a median age of 42 years, and 87.5% of males; 93.8% of patients made a cardiac arrest outside the hospital. The median duration of no-flow was 4.3 minutes (0; 23), the median time between the cardiac arrest and admission to hospital was 90 minutes (0; 116), the median time between the cardiac arrest and the start of the normothermic recirculation was 139 minutes (40; 150), and the median duration of normothermic recirculation was 212 minutes (186; 240). For urologists, the median duration of mobilization was 178 minutes and 97 minutes after 20 h. Twenty-four kidneys were collected (75%) and 22 kidneys were transplanted (91.7%). The median duration of cold ischemia was 9 h 12 (5 h 25; 18 h 02). No primary non-function of graft was observed. Delayed graft function was observed in 50% of cases and the median duration of dialysis was 2 days (0; 19). After 12 months of inclusion, our center accounted for 8% of the national census and 16% of transplanted kidneys NHBD. CONCLUSION: The involvement of rescue, coordination, anesthesiologists and urologists, and the concentration of jobs in our center have helped to minimize response times NHBD in the protocol for maximum quality of kidneys taken with transplant rates and results are very encouraging.

Long-term recurrence of primary amyloidosis of the bladder.

An 84-year-old man presented to our department with a recurrence of a primary amyloidosis of the bladder 14 years after the first diagnosis. Follow-up had been stopped 5 years after the first procedure because no cystoscopic anomalies were noted. General evaluation confirmed the diagnosis of primary amyloidosis. The lesions were endoscopically resected. At the 3-year follow-up, the patient was free of symptoms and had remained cystoscopically free of disease. However, stable amyloidosis deposits have always been noted on the computed tomography scans. This case emphasizes the necessity of a longer follow-up, including computed tomography of the pelvis, during the 10 to 15 years after the first occurrence of the disease.

[Intravesical BCG-therapy: comparison of side effects of Connaught (Toronto) and Pasteur (Paris) strains]. / BCG-thérapie intravésicale: comparaison des effets secondaires des souches Connaught (Toronto) et Pasteur (Paris).

INTRODUCTION: Urologists have felt that the adverse effects of intravesical BCG-therapy have been more serious and more frequent since the use of the Connaught strain. The objective of this retrospective study was to compare the toxicity of this new strain with that previously used in France (Pasteur strain). MATERIAL AND METHODS: After endoscopic resection, 89 patients with stage Ta grade 1-2 recurrent or T1 grade 3 and/or CIS bladder tumour were treated with 6 instillations of 150 mg of BCG Pasteur from 1992 to 1996 (50 patients: group 1) or 81 mg of BCG Connaught from January 1997 to December 1998 (39 patients: group 2). Adverse effects were classified as minor, lasting less than 48 hours (bladder irritation syndrome and/or macroscopic haematuria and/or fever less than 38 degrees C), moderate (requiring symptomatic treatment, reduction of the dose or an increased interval between instillations), and major (contraindication to continuation of treatment). RESULTS: 74% of patients in group 1 presented at least one adverse effect versus 77% in group 2. The reasons for permanent discontinuation of BCG-therapy in groups 1 and 2, respectively, were as follows: malaise during instillation (1 vs 0), bladder irritation syndrome not controlled by symptomatic treatment (4 vs 5) and epididymitis (0 vs 1). Pulmonary tuberculosis was diagnosed in one patient from group 2, one year after the last instillation. The frequency and severity of adverse effects were not statistically different between the two groups. The number of patients discontinuing BCG-therapy because of severe complications was also not statistically different between the two groups. CONCLUSION: This study did not reveal any difference of toxicity between Connaught and Pasteur strain in intravesical BCG-therapy of superficial bladder tumours.

Observation/delayed treatment for rising PSA after radical prostatectomy: pros and cons.

The protracted natural history of prostate cancer and the absence of a documented effective seconde line curative therapy, once primary treatment has failed, has led in the presence of biochemical failure after radical prostatectomy to a dual attitude: early treatment versus observation with delayed therapy. The objective of this review is to define the subsets of patients who might benefit from either of these attitudes. Depending on the risk of progression, three subgroups of patients may be individualized: a high-risk group (PN1, pT3 B, Gleason score equal or superior to 8), a moderate-risk group (pT3 A, NO with positive margins, and a Gleason score equal or less than 7), and a low-risk group (pT2 NO or pT3 A NO without positive margins and Gleason score equal or lower than 7). As of today, observation seems to be the appropriate option in men with a low or moderate risk of progression, whereas in the high-risk group, early therapy is a reasonable option. New treatment options with intermittent hormonal therapy or with combined adjuvant hormonoradiotherapy show a promising efficacy that may lead to reconsider this attitude.

[Pseudotumor eosinophilic cystitis with very acute course. Report of a case]. / Cystite à éosinophiles pseudo tumorale d'évolution suraiguë. A propos d'un cas.

The authors report a case of eosinophilic cystitis with a very acute course after partial cystectomy, requiring semi-urgent total cystoprostatectomy with ileal bladder replacement. The patient is completely asymptomatic ten years after the operation. This case can be classified with the pseudoneoplastic forms of interstitial cystitis occurring in patients with a history of urological surgery. The two-stage course of the disease suggests the combination of two pathophysiological mechanisms: repeated aggression to the urothelial wall responsible for an intense inflammatory reaction and allergy to suture material, accounting for the subsequent rapid development.

[Contribution of computed tomography in the staging of upper urinary tract urothelial tumors. Importance of the tumor diameter measurement]. / Apport de la tomodensitométrie dans la stadification des tumeurs urothéliales de la voie excrétrice supérieure. Importance de la mesure du diamètre tumoral.

OBJECTIVES: To demonstrate a correlation between abdominal computed tomography (CT) data and the histological stage of upper urinary tract tumour (UUTT) in order to more accurately define therapeutic indications. MATERIALS AND METHODS: From 1984 to 1995, 51 patients were treated for UUTT and were assessed by preoperative abdominal CT. 41 of the 51 CT scans were considered to be interpretable and were reviewed retrospectively by a single radiologist. The CT stage and tumour diameter were compared to the pathological stage. RESULTS: CT staging had a reliability of 76%, by combining stages Ta-T2, which could not be distinguished. The sensitivity of CT to assess invasion of the renal parenchyma and ureteric or perirenal fat was 100% and 70%, respectively, with a specificity of 82% and 97%. The accuracy can be improved by decreasing the thickness of sections of the tumour. Tumour diameters (d) of pyelocaliceal tumours, measured by CT and pathology, were closely correlated (r2 = 0.83). All UUTTs less than 3 cm in diameter were found to be superficial on histology. CT correctly estimated the size of these small tumours in 14/15 cases. Overall, by setting the limit at 3 cm, CT was able to detect a superficial pyelocaliceal tumour with a specificity of 92% and a PPV of 93%; however, a CT size > or = 3 cm is not predictive of the histological stage of the lesion. CONCLUSIONS: CT is still imprecise for the staging of UUTT, as it cannot distinguish between Ta, T1 and T2 lesions, and is still not sufficiently reliable in the assessment of invasion of the periurothelial fat or of the renal parenchyma. CT measurement of the diameter of pyelocaliceal tumours can provide an argument in favour of the superficial nature of the lesion and therefore guide the therapeutic decision towards a conservative approach.

Management of primary obstructive megaureter without reflux in neonates.

Systematic antenatal ultrasonography has significantly altered the conditions of diagnosis of megaureters. Pediatric urologists are now confronted with a large group of neonates with asymptomatic megaureter. Furthermore, reports of spontaneous resolution of primary megaureter without reflux have become common. We were confronted with 59 renal units in 48 neonates. We postulated that primary megaureter represented a significant obstructive uropathy when the kidney exhibited stasis and large pelvic and caliceal dilatations. So, 35 ureters were operated on initially. The other 24 cases were managed conservatively but among these patients, 11 ureters were operated on secondarily 7-29 months after the diagnosis because they were unchanged [6] or worsened [5]. 13 ureters are currently without treatment: 7 total regressions and 6 incomplete regressions with persistent mild pelvic dilatation. The results of reimplantation, early or delayed, have been excellent (1 postoperative necrosis reoperated, 1 secondary reimplantation, 2 persistent mild dilatations). Relief of obstruction without reflux was obtained in 36/39 long-term follow-up cases (92%). There is a disagreement about the relative merits of various modalities in the assessment of ureteral obstruction and impairment of renal function. Therefore, we chose to use essentially intravenous pyelography (IVP) and to operate initially when there was a delayed appearance of the contrast agent, a massive dilatation and delayed drainage from the ureter into the bladder. This attitude is open to question but no more illogical than waiting for impairment of renal function to decide on surgery.