[Experience of day case robotic prostatectomy. About thirty-two patients]. / Expérience de la prostatectomie totale robot-assistée ambulatoire. À propos de 32 cas.

OBJECTIVE: To report a monocentric experience of outpatient management of robot-assisted radical prostatectomy using a rapid recovery protocol. PATIENTS AND METHODS: In this retrospective observational study, thirty-two patients underwent a prostatectomy by the same surgeon between February 2017 and September 2018 as part of an outpatient hospitalization. The surgery was a transperitoneal robot-assisted prostatectomy with a urinary catheter duration of 7 days. A satisfaction questionnaire on outpatient care and functional results was sent to all patient during follow-up. RESULTS: Of the thirty-two patients initially planned for ambulatory care, two patients remained hospitalized overnight: the first at the request of his wife, the second because of severe nausea. Of the thirty ambulatory patients, nine (30%) required emergency attention in the days following their discharge, including one with Clavien complication IV. Seven patients would have preferred to be hospitalized one night, but twenty-six patients would recommend ambulatory care to one of their relatives, should they undergo prostatectomy. Oncological findings and functional are comparable to conventional hospitalization. CONCLUSION: Radical prostatectomy can be performed routinely in an outpatient setting with no increase in morbidity or decrease in functional and oncological results, with a high patient-family satisfaction rate. LEVEL OF EVIDENCE: 4.

The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery

Objective The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. Patients and Methods Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. Results At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. Conclusions Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules. .

The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery.

OBJECTIVE: The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. PATIENTS AND METHODS: Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. RESULTS: At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. CONCLUSIONS: Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.

[Rectourethral fistulae: diagnosis and management. Review of the literature]. / Fistules urétrorectales : quelle prise en charge diagnostique et thérapeutique ? Revue de la littérature et état de l'art.

INTRODUCTION: Rectourethral fistulae are predominantly of iatrogenous origin. They alter the patient's quality of life and are difficult to manage from a medical standpoint. PATIENTS AND METHODS: The major series of patients of the last 20 years have been analyzed, in order to define the best management of rectourethral fistulae. RESULTS: Many surgical techniques have been tried, as well as several protocols, ranging from simple urinary and fecal diversion to diversion followed by reconstruction and regional flap in case of tissue damage. CONCLUSION: The fistula's cause and the use of radiotherapy had a major impact on its prognosis. The best-suited protocol was the 3-step protocol, which has been described within. The flap, which seemed to have the best results, was the gracilis muscle flap.