Active surveillance of low-grade prostate cancer using the SurACaP Criteria: A multi-institutional series with a median follow-up of 10years.

PURPOSE: To report on the oncological outcomes of active surveillance (AS) in low-grade prostate cancer (PCa) patients using the French SurACaP protocol, with a focus on long-term outcomes. METHODS: This multicenter study recruited patients with low-grade PCa between 2007 and 2013 in four referral centers in France. The cohort included patients meeting the SurACaP inclusion criteria, i.e., aged ≤75years, with low-grade PCa (i.e., ISUP 1), clinical stage T1c/T2a, PSA ≤10ng/mL and ≤3 positive cores and tumor length ≤3mm per core. The SurACaP protocol included a digital rectal examination every six months, PSA level measurement every three months for the first two years after inclusion and twice a year thereafter, a confirmatory biopsy in the first year after inclusion, and then follow-up biopsy every two years or if disease progression was suspected. Multiparametric magnetic resonance imaging (mpMRI) was progressively included over the study period. RESULTS: A total of 86 consecutive patients were included, with a median follow-up of 10.6 years. Only one patient developed metastases and died of PCa. The estimated rates of grade reclassification and treatment-free survival at 15 years were 53.4% and 21.2%, respectively. A negative mpMRI at baseline and a negative confirmatory biopsy were significantly associated with a lower risk of disease progression (P<0.05). CONCLUSIONS: AS using the French SurACaP protocol is a safe and valuable strategy for patients with low-risk PCa, with excellent oncological outcomes after more than 10 years' follow-up. Future studies are crucial to broaden the inclusion criteria and develop a personalized, risk based AS protocol with the aim of de-escalating follow-up examinations. LEVEL OF EVIDENCE: Grade 4.

Active surveillance in favorable intermediate-risk prostate cancer: A single-center experience.

PURPOSE: To report the long-term oncological outcomes of active surveillance (AS) in selected patients with favorable intermediate-risk (IR) prostate cancer (PCa). METHODS: A retrospective database review of two academic centers was conducted to identify favorable IR PCa patients initially managed by AS between 2014 and 2022. Favorable IR PCa was defined by the presence of one single element of IR disease (i.e., PSA 10-20ng/mL, Gleason Grade Group [GG] 2, or cT2b). All patients were diagnosed and followed up according to a contemporary scheme, including MRI and image-guided biopsies. The primary endpoint was metastasis-free survival. RESULTS: A total of 57 patients met our inclusion criteria and the median follow-up was 56months. During follow-up, there were no cases of metastasis or death due to PCa, but 6 deaths due to competing causes. A total of 25 (44%) and 6 patients (11%) had definitive treatment and GG 3 reclassification during follow-up, respectively. In multivariable Cox hazard regression analysis, the risk of undergoing definitive treatment was significantly associated with PSA density>0.15 (HR: 4.82, 95% CI: 1.47 to 15; P=0.01) and PI-RADS 4-5 lesions on mpMRI (HR: 2.48, 95% CI: 1.06 to 5.19; P=0.006). Interestingly, tumor burden (P=0.3) and GG (P=0.7) on biopsy were not associated with definitive treatment. CONCLUSIONS: AS is a safe and valuable strategy for well-selected patients with favorable IR prostate cancer, with excellent oncological outcomes after five years' follow-up.

[Bladder augmentation in the era of botulinum toxin: Indications and results]. / L'entérocystoplastie d'agrandissement à l'ère de la toxine botulique : indications et résultats.

AIM: To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection. MATERIAL: We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context. RESULTS: We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%). CONCLUSION: In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team. LEVEL OF EVIDENCE: Weak.

Saline bladder infusion vs standard catheter removal in patients with acute urinary retention related to benign prostatic hyperplasia: The BLAPERF Study.

PURPOSE: Bladder infusion, which involves filling the bladder with saline prior to catheter removal, has been associated with reduced time-to-discharge and increased success rates in trials without catheter (TWOCs) in perioperative setting. The objective of this study was to evaluate the applicability of this protocol in patients with acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS: We conducted a retrospective single-center study comparing bladder infusion with at least 150mL of warm saline vs. standard catheter removal during TWOC in patients with BPH-related AUR between January and December 2021. The primary outcome was time to discharge. Secondary outcomes included: TWOC success, and early recurrence of urinary retention defined as recurrence within three months of successful TWOC. RESULTS: A total of 75 men were included: 35 in the bladder infusion protocol and 40 in the standard protocol. Baseline characteristics were well balanced between groups. Overall, 35 patients (46.7%) had a successful TWOC without statistically significant difference between groups (P=0.10). Bladder infusion protocol was associated with a shorter median time to discharge (200 vs. 240min, P=0.003). However, patients in the bladder infusion group were associated with a higher risk of early recurrence of urinary retention (30% vs. 0%, P=0.02). CONCLUSION: In patients with BPH-related AUR, the saline bladder infusion method reduced time-to-discharge with similar TWOC success rates. Larger studies are needed to properly analyze the risk of early recurrence of urinary retention before any clinical application. LEVEL OF EVIDENCE: III.

[Evaluation of the results and feasibility of vibration, diuresis and inversion therapy in the treatment of upper urinary tract stones]. / Évaluation des résultats et de la faisabilité de la posturothérapie (hydratation, inversion, vibration) dans le traitement des calculs des voies urinaires supérieures.

OBJECTIVES: To evaluate the feasibility, efficiency, and predictive factors of therapeutic success of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones. METHODS: It is a retrospective, single-center study at the CHU - La Conception, Marseille, France including all patients treated with VDI from 2013 to 2018. VDI was indicated for stones <6mm in first-line treatment or for residual fragments <6mm after ureteroscopy, PCNL, microPCNL. The protocol included 4 sessions in outpatient care from 2013 to 2015 then 6 sessions from 2015 to 2018 and a final radiological evaluation. RESULTS: In total, 109 patients or 489 sessions are reported: median age was 55 years [14-84], median BMI 25kg/m2 [15-37], average cumulative size of kidney stones 3mm ±4. VDI was performed after flexible ureteroscopy (62%), SWL (20%), percutaneous treatment (9%) or as a first-line treatment (9%). Compliance was 87 %. The median VAS during the session was 0[0-8]. The incidence of post-session renal colic was 4% (all Clavien I). The postoperative fragment-free and microfragment rates were respectively 39% and 21%, i.e. an overall success of 60% for kidney stones, and 43% and 21%, i.e. an overall success of 64% for lower pole kidney stones. CONCLUSION: VDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment.

A multi-institutional experience of Micro-percutaneous Nephrolithotomy (MicroPERC) for renal stones: Results and feasibility of day case surgery.

PURPOSE: To report the multi-institutional outcomes of Microperc for nephrolithiasis and to assess its feasibility in outpatient care. METHODS: We retrospectively identified all adult patients who underwent Microperc for renal stones at three centres between May 2015 and March 2021. Interventions were performed by three Surgeons. One Surgeon adopted a "one-way" strategy and all Microperc were performed on an outpatient basis, while the other two Surgeons provided inpatient monitoring for at least one day after surgery. The primary endpoint was same-day discharge after Microperc without emergency department visits or unplanned readmission within 30 days of the procedure. The secondary endpoints included treatment outcomes and the 30-day complication rate. RESULTS: Out of 72 consecutive patients included, 32 patients (44.4%) had same-day discharge. Median Charlson score (1 [0-2]) and cumulative stone size (15 [12-20] mm) were comparable between both groups. At one month post procedure, 32 patients (44.4%) were stone free and 23 patients (32%) had residual micro-fragments<3mm, conferring an overall success rate of 76.4% (inpatient Microperc group: 77.5% vs outpatient Microperc group: 75%, P=1). Analysis of the 30-day complication rate showed similar results between the two groups (Clavien I-II: 18.1%, Clavien≥III: 4.1%). After outpatient care, the rate of immediate admission and unplanned readmission was 12.5% (n=4), mainly due to urinary tract infection. CONCLUSION: In this multi-institutional study, we report that outpatient Microperc is feasible in selected patients with no significant impact on postoperative outcome.

Preoperative polymicrobial urine culture: An analysis of the risk of perioperative urinary tract infection.

PURPOSE: To report our management of preoperative polymicrobial urine culture and to determine its correlation with the risk of postoperative urinary tract infection (UTI). PATIENTS AND METHODS: We retrospectively identified all patients with preoperative polymicrobial urine culture in our center between January 2017 and October 2019. Preoperative urine cultures were collected 5 to 8 days before the surgery. No antibiotic prophylaxis was administered preoperatively in the absence of pyuria. Patients with pyuria (≥10 leukocytes/mm3) were treated preoperatively with Ceftriaxone. In case of beta-lactam allergy, the choice between other antibiotic therapies was left to the surgeon's discretion. A second urine culture was collected the day before surgery. The primary endpoint was the occurrence of UTI within 15 days following surgery. RESULTS: In all, 690 patients were included in the study. In line with our protocol, patients had Ceftriaxone, Fluoroquinolones, another antibiotic or no antibiotic prophylaxis in 492 cases (71.3%), 22 cases (3.2%), 31 cases (4.5%), and 145 cases (21%), respectively. The overall sterilization rate of 40.4% was similar between each treatment arm (P=0.54). Postoperative UTI occurred in 68 cases (10.5%). In multivariate analysis, a sterile urine culture the day before surgery was the only factor decreasing the risk of postoperative UTI (OR 0.39, 95%CI, 0.17-0.84; P=0.022). CONCLUSIONS: Our findings suggest that empirical antibiotic therapy for the treatment of preoperative polymicrobial urine culture is no longer adequate. Further evaluation of organisms isolated may provide the necessary antibiograms for initiation of susceptibility based antibiotic therapy that could decrease postoperative UTI rates.

Comparison of water vapor thermal therapy and prostate artery embolization for fragile patients with indwelling urinary catheters: Preliminary results from a multi-institutional study.

PURPOSE: To report our preliminary experience with water vapor thermal therapy with the Rezum™ System and Prostate Artery Embolization (PAE) for treatment of medically refractory, complete urinary retention to achieve successful cessation of catheter dependency in frail-patients. PATIENTS AND METHODS: A multi-institutional study was conducted including all patients who underwent Rezum™ procedure and PAE between October 2017 and June 2020. The included population focused on frail-patients unsuitable for conventional surgery with complete urinary retention. Rezum™ patients were identified and matched (1:1) with patients who underwent PAE. The matching criteria were age, Charlson score, prostate volume and duration of follow-up. The primary outcome was catheter-free survival, defined as spontaneous voiding and release from catheter dependence. RESULTS: Eleven patients from the Rezum™ group were matched to 11 embolized patients. PAE and Rezum™ patients were comparable in age (median: 77 vs. 75 years), Charlson score (median: 6 vs. 6) and prostate volume (74 vs. 60 cc). Procedures were significantly longer in the PAE group compared to the Rezum™ procedures (median: 148 vs. 8min, P<0.001). After a median follow-up of 12 months, spontaneous voiding was conserved in all cases (100%) after the Rezum™ procedure and in 5 cases (45.4%) after PAE (P=0.01). In catheter-free patients, the rate of benign prostatic hyperplasia medication use after procedure was 40% for PAE and 18.2% for Rezum™ patients (P=0.54). CONCLUSIONS: Our preliminary experience for treatment of complete urinary retention in frail-patients shows the feasibility of PAE and Rezum™ to restore spontaneous urination without being associated with the occurrence of major complications. Early data suggests that Rezum™ may provide superior results in terms of cessation of catheter dependence. Future studies are needed to definitively assess which treatment would be best suited for each patient. LEVEL OF EVIDENCE: 3.

[Assessment of trainee urologists' knowledge in urogenital anatomy]. / Évaluation des connaissances en anatomie uro-génitale des urologues en formation.

The purpose of this study was to assess trainee urologists' [interns and assistant heads of university hospitals (CHU)] knowledge of the anatomy of the urogenital system. An examination consisting of 10 timed (16minutes) multiple-choice questions (MCQ) based on urogenital anatomy assessments for students in third year of the general medical science diploma program (DFGSM3) was sent to members of the French Association of Trainee Urologists (AFUF) in May 2018 in order to compare the average scores of these two populations. In addition, a questionnaire consisting of epidemiological data, their opinion on the quality of education in anatomy and the willingness to have more courses on this subject was included in the examination. The same scale based on a score out of 20 was applied to both populations. Of the 501 AFUF members solicited, 144 answered all the questions (28.7%). The mean score for urologists was lower than that of DFGSM3 students (10.56±1.82 vs. 11.4±2.37 respectively) (P=0.0013). Moreover, the desire for further education in anatomy was widespread among urologists (87%). According to our study, urologists have less knowledge of urogenital anatomy than third year medical students. Many means are being implemented or are available to rectify this failing, especially since the majority of trainee urologists consider that there are insufficient anatomy lessons in the curriculum and would like to receive further education in anatomy. LEVEL IF EVIDENCE: 3.

Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter? A systematic review. Does Size Really Matter?

BACKGROUND: The adage is to use the largest anastomotic coupler device (coupler) size possible, since smaller an anastomosis might be more susceptible to thrombosis. It is unclear if this wisdom is supported by data. This study tests the hypothesis that there is no difference in the reported literature in thrombosis rate between different coupler sizes. METHODS: We searched PubMed, Embase, and the Cochrane Library. After screening 235 studies, we included 11 retrospective case-series. According to the criteria of Newcastle-Ottowa Scale, quality score ranged from 2 to 4 (out of 5) and funnel plots indicated publication bias. We included a total of 5930 coupled anastomoses. We calculated thrombosis rate per coupler diameter with exact confidence intervals (CIs). We regard non-overlapping CIs as a significant difference. RESULTS: Nine studies reported no difference in thrombosis rate based on coupler size. Two studies report a potentially greater thrombosis rates in smaller sizes: (1) 2.0 mm 27% (95% CI 17%-40%, 17/62 cases) vs. 3.0 mm 6.3% (95% CI 2.8%-12%, 8/126 cases) and (2) 1.5 mm 6.9% (95% CI 2.8%-14%, 7/101 cases) vs. 3.0 mm group 1.2% (95% CI 0.64%-2.1%, 13/1079). CONCLUSION: There is some evidence that suggests that smaller coupler sizes are associated with greater thrombosis rate, but the current available evidence has limitations. Performing a second anastomosis, in case, the first anastomosis is performed with a coupler size of 1.0, 1.5, or even 2.0 mm, can potentially reduce this rate, however, this remains to be determined.

Residents and patients benefit from surgical simulation on a live porcine model, could we consider it as ethical?

INTRODUCTION: The objective was to evaluate, by self-questionnaire, the feeling of participants in surgical training sessions on a live porcine model. METHODS: A computerized questionnaire (GoogleForm ©) was sent to the members of the French Association of Urologists-in-Training (AFUF) (fellows and residents). Only questionnaires from Urologists-in-training who had participated in surgical training sessions were included. The sessions consisted of performing surgeries such as laparoscopic nephrectomies or laparoscopic cystectomies. RESULTS: Overall, 198 met the inclusion criteria. A total of 36.4% (72/198) of the participants were fellows and 63.6% (126/198) were residents. According to the participants, the main interest of sessions was to be able to train for emergency situations. A total of 79.8% (158/198) of the participants wanted surgical simulation to become compulsory. To their opinion, the main advantage of surgical simulation on a live porcine model was: technical progress in 87.4% (173/198) of cases. A total of 13.1% (26/198) of the participants found it was unethical to perform the first technical procedures on live animal models. A total of 65.7% (130/198) of the participants considered that there is currently no system of substitution. CONCLUSION: For the participants, surgical training on a live porcine model allows technical progress while training for serious emergency situations. Surgeons and patients could benefit from this risk-free mock surgical scenario. LEVEL OF EVIDENCE: 3.

Educational program in onco-urology for young urologists: What are their needs?

PURPOSE: The emergence of new communication media such as digital contents are progressively replacing more traditional medias in the field of educational programs. Our purpose was to assess urologist in training aspirations regarding urological education. METHODS: Members of a national urologist in training association were sent an anonymous online questionnaire regarding their medical formation in the field of urology. Responders interest for urological sub-specialty or education support (new tools and traditional support) were evaluated through a 5-point Likert scale. RESULTS: Overall, 109 young urologists (26%) responded to the survey. Most of the respondents worked during their training in an academic hospital (n=89, 82%). The three favorite tools for training chosen by the responders were: videos, workshop or masterclass, and podcasts (responders very interested were respectively n=64 (58.7%), n=50 (45.9%), and n=49 (45%)). E-mail newsletters were reported as the less useful educational tool by participants (n=38, 34.9%). Participants were very interested in improving their surgical skills and their radiological knowledge. Responders who were the most attracted by PCa were much more looking to improve their systemic treatment and radiological knowledges. CONCLUSIONS: Urologic-oncology was a priority regarding education for urologists in training. A majority of participants expressed a lack in their surgical education, revealing a reduced OR access and underlining utilization of new tools such as simulation. New digital contents such as social media or podcast achieved high interest for the participants, instead of more traditional media. There is a need that educational content evolve and uses new digital media. LEVEL OF EVIDENCE: 3.

Continuous saline bladder irrigation after blue light transurethral resection of bladder tumor increases recurrence-free survival in low- to intermediate-risk non-muscle invasive bladder cancer.

OBJECTIVES: To evaluate the efficacy of Continuous Saline Bladder Irrigation (CSBI) after blue light transurethral resection of bladder tumor (TURBT) to prevent recurrence of low- to intermediate-risk Non-Muscle Invasive Bladder Cancer (NMIBC). PATIENTS AND METHODS: We conducted a retrospective study including patients with low- to intermediate-risk NMIBC who underwent TURBT in two urological centers between January 2017 and December 2018. Each TURBT was performed using blue light after intravesical instillation of hexaminolaevulinic acid. The experimental group included patients who received CSBI while the control group included patients without CSBI. When practice, CSBI was started immediately after the surgery and was interrupted 24 hours thereafter. Low-risk NMIBC had a surveillance while intermediate NMIBC had 8 adjuvant endovesical instillations of Mitomycin. The primary endpoint was bladder tumor recurrence free-survival which was defined as the time between the initial TURBT and the date of TURBT for bladder recurrence. RESULTS: A total of 167 patients (median age: 71 years) were included: 20% female, 15% low-risk, 85% intermediate-risk NMIBC. CSBI was performed in 95 cases (57%). No complication related to irrigation was reported. Bladder recurrence was observed in 55 cases (32.9%): 22 (23.1%) in the CSBI group vs. 33 (45.8%) in the control group (P=0.002). Multivariate stepwise logistic regression analysis with backward selection revealed that CSBI (HR 0.47 [0.27-0.81]; P=0.006) and MMC (HR 0.55 [0.31-0.95]; P=0.034) were significantly associated with reduced risk of bladder recurrence. CONCLUSIONS: Continuous saline bladder irrigation reduced the risk of bladder recurrence after blue light TURBT in patients with low- to intermediate-risk NMIBC while being safe. Prospective randomized study is needed to confirm these results. LEVEL OF EVIDENCE: 3.

[Long-term follow-up of renal cell carcinomas T1a treated by percutaneous radiofrequency]. / Suivi à long terme des carcinomes à cellules rénales T1a traités par radiofréquence percutanée.

OBJECTIVE: To evaluate the long-term oncological and functional results of the ablative treatment of T1a kidney malignancies by percutaneous radiofrequency (RF). MATERIALS AND METHODS: Monocentric retrospective study including all patients treated for renal cell carcinoma (RCC) T1a by radiofrequency, in our center, from 2005 to 2009. All patients had a tumor biopsy before treatment. The primary endpoint was local recurrence. A total of 44 RCCs in 41 consecutive patients were treated (1 patient had 3 synchronous tumors and 1 patient had 2 tumors). There were 26 clear cell RCCs, 13 papillary RCCs and 5 chromophobe RCCs. The median age at diagnosis was 70 years [48-82]. The median American Society of Anesthesiologists (ASA) score was 2 [1-3] and the median glomerular filtration rate (GFR) was 64mL/min [26-109]. Furhman grade was defined for 39 tumors (Clear cell RCC and papillary RCC), of which 82% were grade 1-2. The median tumor size was 20mm [11-40], and the median RENAL score was 4 [4-6]. Complications were assessed according to the Clavien-Dindo classification. Overall survival, recurrence-free survival and metastasis-free survival were calculated using the Kaplan-Meier method. RESULTS: Median follow-up was 90.5 months [17.8-145.3]. Three (7%) local recurrences were reported within a median of 26 months [12-93]. All were treated by a 2nd RF. The overall 10-year survival was 70% (95% CI [56-85]). The 10-year recurrence-free survival was 72% (95% CI [57-88]). The 10-year metastasis-free survival was 87% (95% CI [74-97]). The median GFR on the date of the last news was 51mL/min [16-98] (P=0.05). Post-RFA complications consisted in 5 (11.3%) Clavien-Dindo 1-2 complications. No high grade (Clavien ≥3). CONCLUSION: Percutaneous radiofrequency for RCC T1a is an alternative. It appears to be safe with low morbidity, satisfaying long-term oncological and functional results, but a risk of reprocessing of 7%. LEVEL OF EVIDENCE: 3.

Single use and reusable flexible ureteroscopies for the treatment of urinary stones: A comparative study of perioperative complications.

OBJECTIVE: To compare the perioperative complications of patients who underwent flexible ureteroscopy (fURS) for the treatment of urinary stones according to the type of ureteroscope used, single-use (suURS) or reusable (rURS) flexible ureteroscope. PATIENTS AND METHODS: A retrospective and single-center study was conducted between January 2017 and May 2019, including all fURS performed for nephrolithiasis management. During the study period, 5rURS and 1suURS (UscopePU3022™) were available. The primary endpoint was the occurrence of 30-days postoperative complications, especially infectious complications, classified according to Clavien-Dindo grading system. RESULTS: Overall, 322 consecutive fURS were included corresponding to 186 rURS (57.8%) and 136 suURS (42.2%). Respectively in rURS and suURS groups, the median (IQR) age was 57 (45-65) vs. 57 (44-66) years (P=0.75), 83 (44.6%) vs. 63 (46.3%) female were included (P=0.82), and median (IQR) Charlson score was 2 (1-3) vs. 2 (0-3) (P=0.15). Fifty-one patients (15.8%) developed postoperative complications, 28 patients (15%) in rURS group and 23 patients (17.6%) in suURS group (P=0.64). Most of them (n=47, 92.1% of overall complications) were minor (Clavien I-II). Occurrence of urinary tract infection in suURS group (n=13; 9.5%) was equally comparable with rURS group (n=10; 5.4%), P=0.15. CONCLUSIONS: Our data suggests that suURS represents a safe alternative to rURS. Compared to reusable devices, UscopePU3022™ use was associated with a similar complication rates, however, did not decrease the occurrence of infectious events. LEVEL OF EVIDENCE: 3.

Immediate preoperative renal artery embolization in the resection of complex renal tumors (UroCCR-48 Reinbol study).

PURPOSE: We evaluated the feasibility and outcomes of immediate preoperative renal artery embolization (IPRAE) before complex nephrectomy for locally advanced RCC ± inferior vena cava thrombus (IVCT). METHODS: A comparative retrospective (2007-2017) multicenter study which included 145 patients with locally advanced RCC ± IVCT: 99 radical nephrectomies vs. 46 radical nephrectomies with IPRAE identified in the prospective UroCCR national database (CNIL DR 2013-206; NCT03293563). IPRAE was performed under local anesthesia the day of nephrectomy (< 4 h prior to nephrectomy). The primary endpoint was peroperative blood loss (mL). Secondary outcomes were: tolerance of embolization (pain visual scale), success rate of IPRAE defined by complete devascularization of the kidney, perioperative complications according to Clavien score and postoperative GFR. RESULTS: The baseline characteristics of IPRAE and the control groups were similar. Tumor staging was 14% T2b, 41% T3a, 27% T3b, 13% T3c, 6% T4. The success rate of IPRAE was 98%. Median artery embolizated per patient was 2 (Agochukwu and Shuch in World J Urol 32:581-589, 2014; Marshall et al. in J Urol 139:1166-1172, 1988; Yap et al. in BJU Int 110:1283-1288, 2012;Gill et al. in J Urol. 194:929-938, 2015; Wang et al. in Eur Urol 69:1112-1119, 2016). No severe complications occurred after IPRAE. Postembolization syndrome was reported in 7% (Clavien I-II). Mean peroperative blood losses in the IPRAE and control groups were: 726 ± 118 ml and 1083 ± 114 ml (P = 0.03). In a multivariate analysis that included: age, Karnofsky index, IPRAE (yes vs. no), IVCT (yes vs. no), tumor size and synchronous metastasis, no IPRAE and IVCT were significantly associated with increased peroperative bleeding. CONCLUSION: IPRAE before nephrectomy for locally advanced and/or IVCT tumors was well tolerated, was associated with lower peroperative bleeding and did not increase the incidence or severity of postoperative complications.

[Renal transplantation, for whom, why and how ?] / La transplantation rénale, pourquoi, pour qui et comment ?

Chronic kidney disease is a gradual and irreversible decrease in the functioning of the kidneys, which no longer filter the body's blood properly. The main causes are diabetes and high blood pressure. With the aging of the population, it is a disease whose incidence is increasing. In the terminal stage of the disease, treatment of replacement of the renal function is necessary (by hemodialysis, peritoneal dialysis or renal transplantation). Currently, kidney transplantation is the best replacement treatment for kidney function, because it is more efficient than dialysis in terms of survival, quality of life and cost to the health system. But it requires the maintenance and monitoring of immunosuppressive therapy. In France, kidney transplants are mainly from deceased donors or from living donors. Kidney transplantation is a scheduled surgery when the transplant is from a living donor, and an emergency when the transplant is from a deceased donor. The surgical technique is standardized and consists of suturing the artery and vein of the transplant onto the recipient's iliac vessels and the ureter in the bladder, through an ilio-inguinal incision. The average survival time of a transplant is 10 years and some patients may receive 1, 2, 3 or more kidney transplants in succession during their lifetime.

COVID19 pandemic impacts on anxiety of French urologist in training: Outcomes from a national survey.

INTRODUCTION: The COVID-19 outbreak in France is disturbing our health system. Urologists in training who are already known to have burnout, are in the front line to face this disease. The aim of our study was to assess the psychological impact of COVID-19 pandemic on young French urologists in training. MATERIAL AND METHODS: A self-administered anonymous questionnaire evaluating the pandemic added stress, and its negative impact on work and training quality, was e-mailed to the members of the French Association of Urologists in Training (AFUF). The association includes all French junior and senior residents. The survey lasted 3 days. Multivariable analyses using logistic regression was performed to identify the predictive factors. RESULTS: Two hundred and seventy-five (55.5%) of the 495 AFUF members responded to the questionnaire. More than 90% of responders felt more stressed by the pandemic. Fellows and senior residents were more likely to feel that the crisis had an important impact on their work quality (OR=1.76, IC95=[1.01-3.13]), even more when COVID 19 patients were present in their department (OR=2.31, IC95=[1.20-4.65]). Past medical history of respiratory disease (OR=2.57, IC95=[1.31-5.98]) and taking in charge COVID19 patients (OR=1.85, IC95=[0.98-3.59]) were additional risk factors. CONCLUSION: COVID19 pandemic has a negative impact on young French urologists in training and on their work and training quality. Managing their psychosocial well-being during this time is as important as managing their physical health. LEVEL OF EVIDENCE: 3.