[The many urological consequences of smoking]. / Les nombreux impacts urologiques du tabagisme.

The detrimental consequences of tobacco use in urology are often underestimated, despite its strong association with urological pathologies, including malignancies, sexual dysfunction, and urinary tract symptoms. Tobacco's components damage DNA, increasing the risk of bladder and urinary tract cancers, as well as renal cancer. In males, it's also correlated with prostate and penile cancers. Functionally, it leads to sexual dysfunctions, reducing erectile capacity and fertility in males. In females, it's linked to elevated urinary incontinence. In both genders, urinary tract symptoms worsen. Smoking cessation is consistently beneficial and should be encouraged by healthcare practitioners.

Les méfaits du tabagisme en urologie sont peu connus, pourtant il provoque diverses pathologies, incluant des cancers urologiques et des troubles sexuels et mictionnels. Les composants du tabac endommagent l'ADN, favorisant la survenue de cancers de la vessie et des voies urinaires, dont il est le principal facteur de risque, ainsi que du rein. Chez l'homme, le tabac accroît également le risque de cancer de la prostate et du pénis. Sur le plan fonctionnel, il induit des troubles sexuels, réduisant l'érection et la fertilité chez l'homme. Chez la femme, l'exposition au tabac est associée à une prévalence augmentée d'incontinence urinaire. Chez les deux sexes, les symptômes mictionnels sont aggravés. Une désintoxication tabagique est toujours bénéfique à court et long termes et doit être encouragée par les praticiens à chaque consultation médicale.

Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study.

BACKGROUND: The aim of this study was to determine the rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries (PRI). METHODS: This retrospective cohort study was conducted in a level I trauma center serving 500,000 inhabitants. A total of 127 consecutive patients with high-energy blunt PRI were included between January 1st, 2014 and December 31st, 2017. Every patient had a total body or thoraco-abdominal computed tomography scan including contrast enhanced arterial sequences. A board-certified radiologist reviewed all the vascular images and precisely described every intra-pelvic arterial lesion in terms of localization. Complete pelvic series (standard radiographs and fine cut computed tomography images) were reviewed by three board-certified orthopedic surgeons experienced in PRI management, and Young and Burgess and AO/OTA classifications were determined. Demographic, clinical, therapeutic and outcome data were extracted from the institutional severely injured patients' registry. RESULTS: Patients' mean age was 45.3 years and 58.3% were males. Fifteen (11.8%) had a total of 21 intra-pelvic arterial lesions: seven lesions of the obturator artery, four of the superior gluteal artery, three of the inferior gluteal artery, two of the vesical artery, and one of each of the following arteries: internal iliac, internal pudendal, fifth lumbar, lateral sacral, ilio-lumbar. These lesions occurred in 8.6% of lateral compression injuries, 33.3% of anteroposterior compression injuries and 23.5% of vertical shear and combined mechanism injuries (Young and Burgess classification, p = 0.003); and in 0% of type A injuries, 9.9% of type B injuries and 35% of type C injuries (AO/OTA classification, p = 0.001). Patients with an intra-pelvic arterial lesion were more likely to present with pre-hospital hemodynamic instability (p = 0.046) and to need packed red blood cells transfusion within the first 24 h (p = 0.023; they needed a mean of 7.53 units vs. 1.88, p = 0.0016); however, they did not have a worst outcome in terms of complications or mortality. CONCLUSIONS: This systematic study found an 11.8% rate of intra-pelvic arterial lesion related to high-energy blunt PRI. The obturator, superior gluteal and inferior gluteal arteries were most often injured. These findings are important for the aggressive management of high-energy blunt PRI.

Management of high-energy blunt pelvic ring injuries: A retrospective cohort study evaluating an institutional protocol.

INTRODUCTION: High-energy blunt pelvic ring injuries with hemodynamic instability are complicated by a high mortality rate (up to 32%). There is no consensus on the best management strategy for these injuries. The aim of this study was to evaluate the high-energy blunt pelvic ring injury management protocol implemented in the authors' institution. PATIENTS AND METHODS: This retrospective cohort study was performed in an academic level I trauma center. The institutional protocol incorporates urgent pelvic mechanical stabilization of hemodynamically unstable patients not responding to a pelvic belt, fluids, and transfusions. If hemodynamic instability persists, angiography ± embolization is performed. Adult patients sustaining a high-energy blunt pelvic ring injury between 2014.01.01 and 2019.12.31 were included in the study. The primary outcome was mortality at 1, 2, 30 and 60 days. The secondary outcomes were the number of packed red blood cell units transfused during the first 24 h, intensive care unit stay, and total hospitalization length of stay. RESULTS: 192 high-energy blunt pelvic ring injury patients were analyzed. Of these, 71 (37%) were hemodynamically unstable, and 121 (63%) were stable. The overall in-hospital mortality of the hemodynamically unstable and stable groups was 20/71 (28.2%) and 4/121 (3.3%) respectively (p<0.001). Cumulative mortality rates for hemodynamically unstable patients were 15.5% at day 1, 16.9% at day 2, 26.8% at day 30 and 28.2% at day 60, and for hemodynamically stable patients, rates were 0% at day 1 and 2, 2.5% at day 30 and 3.3% at day 60. Unstable patients required a higher number of packed red blood cell units than stable patients during the first 24 h (5.1 vs. 0.1; p<0.001). Intensive care unit length of stay and total hospitalization duration was 11.25 and 37.4 days for unstable patients and 1.9 and 20.9 days for stable patients (p<0.001). CONCLUSIONS: For both hemodynamically unstable and stable patients, the institutional protocol showed favorable mortality rates when compared to available literature. Comparative studies are needed to determine the management strategies with the best clinical outcome and survival.

High-energy blunt pelvic ring injury: dataset of patients and injury characteristics from a severely injured patients' registry.

Since mid-2013, data on high-energy trauma patients admitted to the Emergency Department of the University Hospitals of Geneva, Switzerland, are prospectively recorded in a dedicated registry. This includes data on patients with high-energy blunt pelvic ring injuries (PRI), defined as closed fracture of the pelvic ring following falls from a height >1 m, road traffic accidents, sport, crush, farm and industrial injuries. The registry was screened for patients aged ≥16 years with high-energy blunt PRI admitted to the aforementioned academic level I trauma center between 2014.01.01 et 2019.12.31, to assess the outcome of the institutional PRI management protocol. Data on 195 patients were collected and analyzed for this purpose [1]. The dataset "patients' demographic and injury characteristics" provides the raw demographics and Abbreviated Injury Scale (AIS) of these 195 patients. These data can contribute to the knowledge of patients' demographics and injury characteristics of high-energy blunt PRI patients.