Is YouTube™ a reliable source for patient information about Holmium Laser Enucleation of Prostate?

OBJECTIVES: Prior to benign prostate surgery, the patient's informed consent is mandatory. Among the multiple source of information for patients, social networks are very popular, but the quality of information delivered is unknown. The aim of this study was to evaluate the quality of the information freely available for patients on YouTube™ regarding HoLEP. MATERIALS AND METHODS: The term "HOLEP" was searched on YouTube™ on December 24, 2020. Videos that were not in English, French or Arabic, specifically destined to the medical community, with no written or oral comment, patient testimonials, pure surgical technique or had content unrelated to HoLEP were excluded from the study. The patient information sheet by the French Urology Association (AFU) was used to create a list of 31 items classified into 4 categories as follows: anatomy and pathophysiology (6 items), technique and perioperative preparation (10 items), usual outcomes (10 items) and complications (5 items). For each item on the predefined list, correct, missing and incorrect information were rated respectively 1, 0 and -1. RESULTS: Thirty-five videos met the inclusion criteria. Their average length was 6'06"±7'03" [00'20"; 31'30"], with an average number of views of 5279±17,821 [8; 87,354]. The information provided on the videos was written and oral, oral-only and written-only in 51%, 34% and 14% of cases, respectively. 23% of the videos showed surgery sequences, 40% animations and 62% a doctor speaking. Only one video had a quality score greater than 80% and 7 videos got a score below 20%. CONCLUSION: The information about HoLEP on YouTube™ seemed not of sufficiently high quality to allow patients to make informed decisions, and was occasionally misleading. Surgeons still have the duty to give the best quality information, and may point patients towards adequate sources of information, especially those delivered by national and international professional societies.

[Nurse's role in functional urology]. / Rôle de l'IDE en urologie fonctionnelle.

INTRODUCTION: The management of patients in functional urology is complex and requires the expertise of the medical team but also of the nurse team. The aim of this article is to detail the roles of the nurses in functional urology. METHODS: Exchanges with the nurses of our unit, analysis of the literature using the terms "nurse", "urology", "urodynamics" in the PubMed search engine, and a search for regulatory texts relating to the practice of nurses in urology units were conducted. RESULTS: Since the creation of the Inter-University Diploma of Nurse Expert in Urology in 2002 and the inter-professional cooperation protocols in 2009, the urologist can rely on the specific skills of nurses to optimise the patient's management: from endoscopic or urodynamic explorations, to stomatherapy or sexology, from therapeutic education to specialised treatments such as posterior tibial nerve stimulation, sacral neuromodulation or botulinum toxin injections. Their expertise is an undeniable asset in the patient support and for the quality of care. The cooperation protocols respond to the current problems of the healthcare system: attractiveness for paramedical professionals, medical demographics and ambulatory care. The increasingly frequent practice of multidisciplinary consultation meetings also gives them a coordinating role. CONCLUSION: Nurses in functional urology plays a major role in diagnostic and therapeutic management as the patient's privileged contact and collaborator with the referring urologist.

Long-term follow-up reveals a low persistence rate of abobotulinumtoxinA injections for idiopathic overactive bladder.

INTRODUCTION: Little is known about long-term efficacy and tolerance of intra-detrusor injections of abobotulinumtoxinA for management of idiopathic overactive bladder (OAB). We report long-term efficacy and compliance of abobotulinumtoxinA in patients treated for OAB. METHODS: All patients treated with abotulinumtoxinA for OAB in a tertiary reference centre between 2005 and 2012 were included in a retrospective analysis. Patients received 150, 250 or 500 U of abotulinumtoxinA as first injection. The primary endpoint was the discontinuation rate at 5 years. Other outcomes of interest were: rate of failure, reasons for discontinuation and subsequent treatment elected in those who did not persist with abobotulinumtoxinA. RESULTS: Fifty-nine patients (50 women and 9 men) were included. Forty-one patients (69.4%) received 250 U of abobotulinumtoxinA as first injection. Thirteen patients (22%) received 500 U and 5 (8.4%) received 150 U of BoNT-A. Median follow-up was 83.6 months [0.3-183.6]. Median number of injections per patient was 2 [1-15] and median reinjection interval was 10.7 [3-86.4] months. The estimated 5-year discontinuation-free survival rate was 23.4%. Fourteen patients (23.7%) experienced persistent improvement of symptoms and 12 patients (20.3%) stopped the injections because of tolerability issues. Main cause of discontinuation was primary failure, which occurred in 21 patients (35.5%). CONCLUSION: Overall, 59.3% of patients were successfully treated with first abobotulinumtoxinA injection. Although the estimated 5-year discontinuation-free survival rate is low, abobotulinumtoxinA could be considered as an alternative off-labelled in patients not responders to onabotulinumtoxinA after failure of other conservative measures. LEVEL OF PROOF: 3.

[Partial nephrectomy vs. radical nephrectomy for tumor>7cm]. / Résultats de la néphrectomie partielle pour les tumeurs de plus de 7cm : comparaison avec la néphrectomie élargie.

INTRODUCTION: The usefulness of partial nephrectomy (PN) has been demonstrated for the treatment of renal tumor<7cm and it is now the standard treatment for such lesions. However, few studies are available regarding tumors≥T2. The objective of this study was to assess PN results for the treatment of renal tumors>7cm. MATERIALS AND METHODS: A retrospective two-center study was performed, including 170 patients treated. Thirty-two patients underwent PN and 138 radical nephrectomy (RN) for renal cT2 tumors between 2004 and 2014. The biological and clinical characteristics including perioperative morbidity as well as the survival rate were compared between these 2 groups. RESULTS: The median age was 59.5 years and the median follow-up was 47 months. More cT2b tumors were treated through RN (34.1% vs. 12.5%, P=0.01). The postoperative decrease in creatinine clearance was higher for the RN group (-24.3mL/min vs. -16.8; P=0.04). This difference was no longer significant at last follow-up. Perioperative complications were more frequent in the PN group (50.0% vs. 18.1%; P=0.008), and more severe (Clavien≥3 18.7% vs. 5.1%, P=0.01). No difference was found regarding the overall survival. Surgical margins were more frequent in the PN group (9.1% vs. 0.85%; P=0.01). CONCLUSION: Our results suggested the feasibility of PN for renal tumors>7cm, involving however a higher perioperative complication risk. Cautious patient selection appeared to be required for the indication of PN for large tumors. LEVEL OF EVIDENCE: 4.