Flavoxate: present and future.

OBJECTIVE: This non-systematic review discusses the available evidence on the use of flavoxate in the treatment of overactive bladder (OAB). METHODS: Medline was searched for inclusion of relevant studies. No limitations in time were considered. RESULTS: Flavoxate hydrochloride is an antispasmodic agent which exerts an inhibition of the phosphodiesterases, a moderate calcium antagonistic activity, and a local anesthetic effect. Results from preclinical and clinical studies show that flavoxate significantly increases bladder volume capacity (BVC), with greater results if compared to other drugs such as emepronium bromide and propantheline. Moreover in clinical trials, both versus placebo or versus active comparators, flavoxate treatment was associated with a significant improvement in different low urinary tract symptoms, such as diurnal and night frequency, urgency and urinary incontinence, suprapubic pain, dysuria, hesitancy and burning. In addition flavoxate was associated with an overall more favourable safety profile than competitors. CONCLUSIONS: Several researches and a number of years of clinical practice have proven the efficacy and tolerability of flavoxate administration in the treatment of OAB and associated symptoms. However, new studies are necessary to collect more evidence on the role of this molecule in the treatment of OAB and to further explore its use in other indications such as symptomatic treatment of lower urinary tract infections.

[Prognostic factors of upper tract urothelial carcinoma]. / Facteurs pronostiques des tumeurs de la voie excrétrice urinaire supérieure.

INTRODUCTION: Upper urinary tract urothelial carcinoma (UTUC) is a rare disease. Thus, little evidence-based data are available to guide clinical decision-making. The aim of the study was to provide an overview of the currently available prognostic factors for UTUC. MATERIAL AND METHODS: A systematic literature search was conducted using the PubMed databases to identify original articles regarding prognostic factors in patients with UTUC. RESULTS: We divided the prognostic factors for UTUC in four different categories: clinical factors, preoperative characteristics, intraoperative/surgical factors and postoperative/pathologic factors. Prognostic factors described in order of importance are: tumor stage and grade, lymph node involvement, a concomitant cis, age at the diagnostic, lymphovascular invasion, tumor architecture and necrosis, tumor location and multifocality, gender. The impact of obesity, smoking and other comorbidities (ECOG, ASA) on outcomes has been recently reported but needs to be validated. The endoscopic approach of distal ureter management during radical nephroureterectomy has been shown to be at higher risk of bladder recurrence. CONCLUSION: The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.

[Guidelines from the Infectious Disease Committee of the French Association of Urology and The Neuro-Urology Committee of the AFU: antibiotic prophylaxis for sacral neuromodulation]. / Recommandations de bonnes pratiques cliniques : antibioprophylaxie et neuromodulation des racines sacrées par le Comité d'infectiologie de l'Association française d'urologie (CIAFU) et le Comité de neuro-urologie de l'AFU.

INTRODUCTION: In urology, antibiotic prophylaxis is advised by the French Association of anesthesiology (SFAR) and the Infectious Disease Committee of the French Association of urology guidelines published in 2010. No guideline exists concerning the implantation of neuromodulation implants. MATERIAL AND METHOD: A literature analysis was performed on sacral modulation and antibiotic prophylaxis. Then guidelines were discussed by reviewers. Items that showed no consensus were then discussed again to arrive at recommendations. RESULTS: Antibiotic prophylaxis is recommended during the test phase as well as in the case of installation of sacral neuromodulation (Grade C). Antibiotic recommended (Grade B) are: cefotetan or cefoxitin, 2g dose by slow intravenous injection or amoxicillin-clavulanic acid at a dose of 2 g, intravenously or, in the case of allergy vancomycin at a dose of 15 mg/kg or the clindamycin has 600 mg intravenously. CONCLUSIONS: Despite the lack of high level of evidence, antibiotic prophylaxis seems necessary when setting up of electrode case of sacral neuromodulation.

[Flexible cystoscopes: disinfection and microbiological surveillance practices among French urologists]. / Cystoscopes souples : pratiques de désinfection et de surveillance microbiologique parmi les urologues français. Une enquête du comité d'infectiologie de l'AFU.

INTRODUCTION: According to the French regulatory authorities, the highest level of disinfection must be achieved for flexible cystoscopes, as they enter a sterile cavity, the current method being peracetic acid disinfection and sterile water terminal rinsing. MATERIAL AND METHODS: The concordance between regulations and the routine was researched using a self-administered questionnaire sent to all French urologists. RESULTS: Responses from 78 urology units, totalling 317 urologists (26% response rate) were analysed. As a whole, 51.2% of centers followed all recommendations on disinfection. There was no microbiological surveillance in 16.6% of centers, although microbiological tests were performed in two out of three centers before using a new endoscope or when returning from maintenance. CONCLUSION: Improvements are needed, both in the disinfection process and the microbiological surveillance. Low temperature sterilization and the use of sterile disposable sheaths may represent an alternative.

[Intra-prostatic UroLift(®) implants for benign prostatic hyperplasia: preliminary results of the four first cases performed in France]. / Pose d'implants UroLift(®) intra-prostatiques pour hyperplasie bénigne de la prostate : résultats préliminaires des quatre premiers cas réalisés en France.

OBJECTIVES: To evaluate the feasibility, tolerance and short-term efficacy of intra-prostatic UroLift(®) implants in four patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHOD: Four patients with symptomatic BPH, already treated with alpha-blockers, were consecutively treated with intra-prostatic UroLift(®) implants under general anaesthesia. A bladder catheter was placed postoperatively. Alpha-blocker therapy was withdrawn 7 days postoperatively. The clinical and morphological characteristics of the patients were noted. Low urinary tract (IPSS) and sexual symptoms (IIEF5, MSHQ-EjD), maximum urinary flow rate and post voiding residual volume were evaluated preoperatively and at 1 month. RESULTS: Median age was of 69 [52-74] years old and median prostatic volume of 50 cm(3) [40-80]. Median procedure time was of 11 minutes [6-15]. Intra- and postoperative outcomes were uneventful. At 1 month, the mean IPSS and IPSS-QOL improvement were of 46 % and 58 %, respectively. One patient reported no improvement in his urinary and sexual symptoms. In the other three patients, the maximum urinary flow rate was improved, the post voiding residual improved in two patients and similar in one. No alteration in erection or ejaculation functions was reported. CONCLUSIONS: In our initial experience, intra-prostatic UroLift(®) implant procedure seemed feasible, efficacious for LUTS and well tolerated, especially concerning sexual outcomes. Further study of the UroLift(®) implant in France is currently being planned.

[Hybrid renal tumors: a report of two patients]. / Tumeurs rénales hybrides: à propos de deux patients.

PURPOSE: Renal hybrid tumors (HT) are characterized by the association of both oncocytes- and chromophobe-cells within the same tumor. They have been reported in patients with Birt-Hogg-Dube (BHD) syndrome. The aim of this report was to describe two cases of HT and summarize recent literature. PATIENT AND METHOD: Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database. RESULTS: Two patients were diagnosed with multiple but small tumors of the kidney, and were treated with partial nephrectomy. Pathological analysis of these tumors showed oncocytoma-like and chromophobe-like cells intermixed in the same stroma. CONCLUSIONS: HT may constitute a spectrum of tumors between renal oncocytoma and chromophobe renal cell carcinoma. From a pragmatic management perspective, it would be appropriate to consider such tumors as chromophobe carcinoma. In case of HT, a genetic study for BHD syndrome can be proposed to family relatives.

[Guidelines for the medical treatment of non-neurological urinary incontinence in women]. / Recommandations pour le traitement médicamenteux de l'incontinence urinaire non neurologique féminine.

Although it is not possible to use medications on the anatomic features of incontinence, a better comprehension of the physiopathology of miction impairment can lead to pharmacological treatment of female urinary incontinence. However, analysis of the literature shows that few publications are methodologically satisfactory, nor are they comparable. In presence of stress urinary incontinence, vaginal hormone treatment must be provided if the patient presents vaginal atrophy with physical therapy or surgery planned. Use of noradrenaline recapture inhibitors and serotonin cannot be recommended today. There are no indications for alpha-adrenergic treatments. For urge incontinence treatment, use of anticholinergics should be provided, possibly associated with vaginal hormone treatment if the patient presents vaginal atrophy.

[Guidelines for rehabilitation management of non-neurological urinary incontinence in women]. / Recommandations pour la prise en charge rééducative de l'incontinence urinaire non neurologique de la femme.

Pelvic floor rehabilitation is prescribed as first-line treatment for women with stress urinary incontinence, particularly in cases of urinary incontinence with no first-degree uterine prolapse, with poor-quality perineal testing results or inverted perineal command. Prescription of 15 sessions should suffice to evaluate the possibilities of improving the incontinence. The sessions can be continued if the patient feels she is progressing but has not reached sufficient results. With no progression despite properly conducted rehabilitation, the question of whether to continue the physical therapy arises. Currently, therapists determine the number of sessions. They are better apt to know whether sessions should be pursued and should relay a report to the prescribing physician. This type of rehabilitation is within the domain of physical therapists. Midwives can be responsible for postpartum rehabilitation. On the other hand, the importance of the patient's role in the results and their maintenance is well known. Occasionally a few sessions some time after the initial sessions can serve to verify the acquisitions and motivate the patient in her personal contribution to this rehabilitation. The work of the physical therapist cannot be substituted with Keat-type home electrostimulation. The physical therapist plays an important role in the overall management of this condition. Currently, in absence of demonstrated efficacy, self-administration of electrostimulation is not recommended. In urge incontinence, the rehabilitation approach will be used concomitantly with prescription of anticholergics with behavioral therapy and bladder biofeedback work. In addition, low-frequency electrostimulation can be done during the session. Starting with 10-12 sessions is sufficient. In all cases, rehabilitation should take a multidisciplinary approach and be integrated into a medical and/or surgical management plan.

[Guidelines for the palliative treatment of non-neurological urinary incontinence in women]. / Recommandations pour le traitement palliatif de l'incontinence urinaire non neurologique de la femme.

Absorbant products have greatly improved over the past few years in terms of both efficacy and comfort, but the problem of cost for patients persists. They can only be used for short periods of time while waiting for effective curative treatment or over longer periods if no other management option is possible. The model chosen must be adapted to the amount of leakage and the patient's shape. Many nonabsorbant palliative treatments have been reported, often with small series. They can be grouped into three types: extra-urethral occlusive devices, intra-urethral obstructive devices, and intravaginal support devices. The use of a pessary or other vaginal devices can be proposed, in particular with associated prolapse, which can be used when leakage is very occasional (sport, etc.) or in women who cannot have any other treatment.

[Synthesis of the guidelines for the treatment of non-neurological urinary incontinence in women]. / Synthèse des recommandations pour le traitement de l'incontinence urinaire féminine non neurologique.

The last two decades have brought about new medical and surgical treatments revolutionizing care for non-neurological urinary incontinence in women. Many studies, often randomized prospective studies with sufficient follow-up, have validated the therapeutic choices and shown them not to be part of a fad or marketing pressures. The French Association of Urology (L'Association Française d'Urologie), through its Committee on Women's Urology and Pelviperineology (Comité d'Urologie et de Pelvipérinéologie de la Femme), proposes its recommendations. These were established by an expert group of specialists (urologists, gynecologists, and physical therapists), based on a review of the literature but taking into account the daily practices in academic and private practice settings. Between evidence-based medicine and reality in the field, these recommendations attempt to propose realistic and applicable strategies.

[Primary metastatic urethral melanoma: a case study]. / Mélanome primitif de l'urètre découvert au stade métastatique: à propos d'un cas.

PURPOSE: Primary urethral melanoma is a rare pathology for which treatment strategies are controversial. The aim of this work was to report a case of metastatic primary urethral melanoma, and to discuss recent data available from literature. MATERIAL AND METHOD: Case study was summarized from the patient's medical chart. Review of literature was performed using the National Center for Biotechnology Information (NCBI) database. RESULTS: We reported the case of an 89-year-old woman who died from a primary metastatic melanoma of the urethra. This pathology encounters for less than 1% of melanomas and has an adverse prognosis. In case of metastasis, specific survival is only of a few months. When localized to the urethra, treatment relies on radical urethrectomy, followed by adjuvant chemo- and immunotherapy. CONCLUSIONS: The modalities of treatment of primary urethral melanoma rely only on reported case studies. When diagnosed at the metastatic stage, reported specific survival does not exceed a few months.

[Non surgical treatment of prolapse]. / Traitement non chirurgical du prolapsus.

Surgery is the treatment of pelvic prolapses. But in case of stage 1 prolapses or surgical contra-indication, some non surgical treatment can be proposed. There is no scientific proof of efficacy of an hormonal treatment. Pessaries are an alternate with satisfaction for voluntary patients, it gives 58 to 80% satisfaction; in young patients or if surgery is contra-indicated, pessaries can be proposed; vaginal discomfort induced by pessaries can be improved by local oestrogenotherapy. Pelvic floor training has been compared in some studies with no training: after 2 years, 72% versus 27% without worsening of the prolapse (Piya-Anant); in moderate prolapse, training can be useful. Prevention includes careful delivery management, struggle against overweight, carriage of weight, chronic cough, etc.

Intermittent androgen suppression in patients with prostate cancer.

OBJECTIVES: To evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression. PATIENTS AND METHODS: From 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen-deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re-instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others. RESULTS: After a mean (range) follow-up of 45.6 (12-196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5-year metastatic disease free survival of 91.3%. The overall 5-year biochemical recurrence-free survival was 68%. Using multivariate analysis, a Gleason score of >or= 8 (P = 0.021), first-phase duration with no treatment of < 1 year (P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS (P = 0.023) and age < 70 years (P = 0.037) were the strongest predictors of biochemical progression. CONCLUSION: IAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of

[Stage T1a prostatic cancer: long-term retrospective study of 27 patients]. / Cancer de prostate de stade T1a: étude rétrospective à long terme de 27 patients.

OBJECTIVE: The natural history of stage T1a prostate cancer is generally favourable, but is nevertheless associated with a considerable progression rate of 7% to 27% depending on the study. The objective of this study was to identify possible predictive criteria of tumour progression to improve patient surveillance and early treatment. MATERIAL AND METHODS: 27 patients with stage T1a prostate cancer according to the TNM 97 classification, were followed for a mean duration of 79 months (range: 24-132, median: 68). A complementary assessment was performed in patients under the age of 70 years, and a strict clinical (DRE) and laboratory (PSA) surveillance protocol was performed in all patients. The initial mean PSA was 7 ng/ml and the mean Gleason score was 4.8. RESULTS: 20 patients (75%) did not present any clinical and/or laboratory signs of progression and were therefore not treated. Seven patients (25%) received treatment with a mean follow-up of 63 months (radical prostatectomy in 2 cases, external beam radiotherapy in 1 case, endocrine therapy in 4 cases). All patients are alive and in complete remission at last follow-up. CONCLUSION: Based on our results and a review of the literature, conservative management based on strict, long-term surveillance, is a frequent approach to stage T1a prostate cancer confirmed by negative biopsies of the residual capsule. The PSA velocity is the key to surveillance, and the only factor of predictive of tumour progression that can be really used in routine clinical practice. However, our study showed tumour progression in 25% of cases, raising the question of curative treatment, especially in young patients.

[In vitro study of the modulation of human ureteral tonus by nitric oxide and zaprinast, a phosphodiesterase inhibitor]. / Etude in vitro de la modulation du tonus urétéral humain par le monoxyde d'azote et un inhibiteur des phosphodiestérases, le zaprinast.

AIM OF THE STUDY: To assess the role of nitric oxide (NO) and its second messenger, cGMP, on the mechanisms underlying human ureteral smooth muscle relaxation. METHODS: Proximal segments of ureter were dissected from nephrectomy, then cut into rings and suspended in organ chambers. Isometric tone was recorded at baseline and after preincubation with KCl (120 mumol). The Increasing concentration (10-8-10-4 M) of NO donors, Sodium nitroprusside, (SNP) and molsidomine (SIN-1) and a type V phosphodiesterase inhibitor, Zaprinast were added to the organ chambers and a dose response curve was constructed from each experiment. RESULTS: Dose-dependent relaxation was seen with all compounds. This was, however, more pronounced with SNP as compared with SIN-1. Zaprinast alone had marginal relaxant effect but markedly potentiated the relaxing effect of the NO donor SNP (p < 0.05). Inhibition of NO synthesis by the arginine analogue L-NA increased electrical-induced contraction (98 +/- 4% vs 122 +/- 3%, p < 0.001). CONCLUSION: Activation of the soluble guanylate cyclase by NO donors markedly relaxed significantly human ureteral smooth muscle but inhibition of phosphodiesterase did not affect the in vitro relaxation. Our results suggest that cGMP is an important second messenger in the transduction signalling pathway leading to relaxation of human ureteral smooth muscle. By contrast, basal activity of phosphodiesterase seems to be marginal under physiological condition.

[Risk of accidental contamination by the human immunodeficiency virus (HIV): review and management]. / Risques de contamination accidentelle par le virus de l'immuno-déficience humaine (VIH): mise au point et conduite à tenir.

In surgery practice, everyone must know what to do in case of injury with exposure to body fluids. The chimioprophylactic treatment has to be easy to take in case of high risk of VIH transmission. To prevent these accident, surgery on infected people must always be done by surgeon who have experience.

[Advances in surgical techniques and results of radical cystectomies for bladder cancer. 106 patients]. / Evolution des techniques chirurgicales et résultats des cystectomies à visée curative pour cancer de vessie. A propos de 106 patients.

AIM OF THE STUDY: Retrospective analysis of result of radical cystectomy at Cochin Hospital. PATIENTS AND METHODS: We report the results of a 106 patients series treated by radical cystectomy for bladder carcinoma after a 5-year period follow-up. RESULTS: The extent of the tumour invasion according to pathological analysis was: pT1 or less: 26%, pT2 and pT3a: 33%, pT3b and over: 41%. Morbidity rate was 19% with a 7.5% reintervention rate. Long term complication rate was 31%, concerning essentially ureteral stenosis. A local recurrence or distant metastasis occurred in 35% of patients. Local recurrence rate was 10.7%. Cancer specific survival rates were 88%, 81% and 42% for pT1, pT2-pT3a, and pT3b patients respectively. CONCLUSION: The present results confirm that radical cystectomy is the most effective curative treatment for invasive bladder carcinoma.

[Elaboration and validation of a specific quality of life questionnaire for urination urgency in women]. / Elaboration et validation d'un questionnaire qualité de vie spécifique de l'impériosité mictionnelle chez la femme.

Urgent micturition interferes with the quality of life (QoL) of women suffering from this symptom. In order to evaluate this disturbance of quality of life and the benefits of treatment, a self-administered questionnaire, specific to the disorders of urgent micturition in women, was developed from a pre-existing scale (Measurement of Urinary Handicap, MUH). The following developmental methodology was adopted: Generation of a first instrument from the patient's descriptions collected by a multidisciplinary group of clinicians: formulation of questions, regrouping of questions into dimensions, choice of reference period and modalities of response. Content validation and test of comprehension in 20 patients. Transverse pilot study (98 patients) designed to reduce the number of questions and analyse the internal reliability and clinical validity. Reproducibility study. The final questionnaire comprises 24 items grouped into 5 dimensions: activities (8 items), emotional repercussions (5), self-image (5), sleep (3), well-being (3). The relevance of regrouping of the questions in their dimension and of calculation of a global score was confirmed by a principal component analysis and multifactorial analysis. The internal reliability and reproducibility of the scores were satisfactory, with a Cronbach alpha of > 0.70 and an intraclass correlation coefficient > 0.80, respectively. The clinical validity of the questionnaire was verified: the QoL scores of patients became significantly lower as the symptoms became more severe. A specific, reliable and clinically valid questionnaire, expressed in the form of a global score and a profile, was able to be developed. The profile of patients suffering from urgent micturition reflects the repercussions of the disease on the major and specific domains of their QoL. This questionnaire presents the required properties to be used in clinical trials designed to evaluate the effects of treatments on the patients' QoL, as a complement to classical clinical evaluations.