Development of an Objective Structured Clinical Examination (OSCE) to evaluate the diagnosis announcement of chronic neurological disease by residents in neurology.

BACKGROUND: There is little consensus on how to make a diagnosis announcement of severe chronic disease in neurology. Other medical specialties, such as oncology, have developed assessment methods similar to the Objective Structured Clinical Examination (OSCE) to address this issue. Here we report the implementation of an OSCE focused on the diagnosis announcement of chronic disease in neurology by residents. OBJECTIVE: We aimed to evaluate the acceptability, feasibility and validity in routine practice of an OSCE combined with a theoretical course focused on diagnosis announcement in neurology. METHOD: Eighteen neurology residents were prospectively included between 2019 and 2022. First, they answered a questionnaire on their previous level of training in diagnosis announcement. Second, in a practical session with a simulated patient, they made a 15-min diagnosis announcement and then had 5mins of immediate feedback with an expert observer, present in the room. The OSCE consisted of 4 different stations, with standardized scenarios dedicated to the announcement of multiple sclerosis (MS), Parkinson's disease (PD), Alzheimer's disease (AD) and amyotrophic lateral sclerosis (ALS). Third, in a theory session, expert observers covered the essential theoretical points. All residents and expert observers completed an evaluation of the "practical session" and the "theory session". RESULTS: Residents estimated their previous level of diagnosis announcement training at 3.1/5. The most feared announcements were AD and ALS. The "practical session" was rated at a mean of 4.1/5 by the residents and 4.8/5 by the expert observers, and the "theory session" at a mean of 4.7/5 by the residents and 5/5 by the expert observers. After the OSCEs, 11 residents felt more confident about making an announcement. CONCLUSION: This study has shown a benefit of using an OSCE to learn how to make a diagnosis announcement of severe chronic disease in neurology. OSCEs could be used in many departments in routine practice and seem adapted to residents.

Differential impact of COVID-19 on urological surgeries in public and private institutions between 2019 and 2021 in France.

INTRODUCTION: The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021. MATERIALS AND METHODS: This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation. RESULTS: Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors. CONCLUSION: The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future.

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.

[Onco-TESE and testicular cancer]. / Onco-TESE et cancer du testicule.

INTRODUCTION: Fertility preservation is essential before cancer treatment. When ejaculated sperm preservation is not possible, testicular tissue can be surgically collected by Onco-TESE technic (Oncological Testicular Sperm Extraction) to isolate sperm. We report on our experience with Onco-TESE in testicular cancer patients at the Rouen University Hospital. MATERIAL AND METHOD: Retrospective study including all pubescent men, treated for testicular cancer, uni- or bilateral, before any carcinological therapy, who have undergone Onco-TESE at the Rouen University Hospital. Fragment weight, detection of sperm or its precursors were analysed. A histological interpretation of the testicular tumor was carried out. For each positive sample, straws were kept at the French Sperm Bank. RESULTS: Twenty-four patients had an Onco-TESE: 58.34% severe sperm alteration (SSA) and 41.36% sperm collection failure (SCF), between 1996 and 2019. The mean age was 26.6 (±5.29) years. The mean procedure and length of stay were 71minutes (±30.7) and 3.75 days (±2.83), respectively. The rate of positive testicular biopsies (TB) was 58.33% overall and 66,67% in the case of TB on tumour testis. One patient had a Clavian-Dindo III complication. The mean number of straws preserved per patient was 14.28 (±15.34) for 7.14% use. CONCLUSION: Our results seem to confirm that Onco-TESE is an effective solution for preserving fertility in men with testicular cancer in cases of SSA or SCF. LEVEL OF EVIDENCE: III.

Sperm chromatin condensation defects, but neither DNA fragmentation nor aneuploidy, are an independent predictor of clinical pregnancy after intracytoplasmic sperm injection.

PURPOSE: The impact of sperm DNA damage on intracytoplasmic sperm injection (ICSI) outcomes remains controversial. The purpose of the study was to evaluate the prognostic value of several types of sperm nuclear damage on ICSI clinical pregnancy. METHODS: Our retrospective study included a total of 132 couples who consulted for male or mixed-factor infertility that benefited from ICSI cycles from January 2006 to December 2015. All infertile males presented at least one conventional semen parameter alteration. Sperm nuclear damage was assessed using the Motile Sperm Organelle Morphological Examination for sperm head relative vacuolar area (RVA), aniline blue staining for chromatin condensation, terminal deoxynucleotidyl transferase dUTP nick-end labeling for DNA fragmentation, and fluorescence in situ hybridization for aneuploidy. RESULTS: Infertile males who achieved pregnancy after ICSI had fewer chromatin condensation defects than did males who did not achieve any pregnancy (15.8 ± 12.0% vs. 11.4 ± 7.9%, respectively, P = 0.0242), which remained significant in multivariate regression analysis (RR = 0.40 [0.18 to 0.86], P = 0.02). RVA, DNA fragmentation, and aneuploidy were not predictive factors of ICSI outcomes. The pregnancy rate was significantly decreased by number of progressive motile spermatozoa with normal morphology after migration (P = 0.04). In female partners, 17ß estradiol of less than 2000 pg/mL on the day of ovulation induction significantly reduced the occurrence of clinical pregnancy (P = 0.04). CONCLUSION: Sperm chromatin condensation defects were more frequently observed in couples with ICSI failure and should be considered a negative predictive factor for the occurrence of clinical pregnancy.

[Evaluation of practices and costs of vasectomy. French monocentric experience]. / Évaluation des pratiques et des coûts de la vasectomie. Expérience monocentrique française.

INTRODUCTION: Since the law of 4 July 2001, vasectomy has been recognized as a method of male contraception. We report the experience of vasectomy practice in a hospital-university center. METHODS: A monocentric retrospective cohort study of 45 patients who benefited from a contraceptive vasectomy between July 2001 and May 2016. For each patient were studied: modalities of implementation, compliance with the recommendations of the 2001 law, costs and benefits generated by the intervention, the effectiveness of the gesture on the control spermograms, the satisfaction of the patients by a telephone questionnaire. RESULTS: The mean age was 41.3 years. The second consultation was carried out in 91 % of the cases but the reflection period was not respected in 24 % of the cases. Written consent was signed in 89 % of cases. Vasectomy was performed on an outpatient basis in 73 % of cases, under local anaesthesia in 6.7 % of cases. The average cost per patient was 660.63 euros for an average gain of 524.50 euros, a loss of 136.13 euros. On the control spermogram, 54.3 % were azoosperms but the 3-month delay was not observed in 23 % of them. No patients expressed regret after surgery. CONCLUSION: The recommendations of the 2001 law were not systematically followed. This lack of standardization of practices, potential reflection of a lack of interest, is to be highlighted with the extra cost generated. The revaluation of the act should be integrated into the reflection of improvement of male sterilization practices. LEVEL OF PROOF: 4.

[HoLEP learning curve: Toward a standardised formation and a team strategy]. / Apprentissage de l'HoLEP : vers une formation standardisée et une stratégie d'équipe.

AIM: Holmium laser enucleation of prostate (HoLEP) is renowned for the difficulty of its learning curve. Our aim was to evaluate the interest of a three-step tutorial in the HoLEP learning curve, in a university center. METHODS: It is a retrospective, monocentric study of the 82 first procedures done consecutively by the same operator with a proctoring in early experience and after 40 procedures. For all patients were noted: enucleation efficiency (g/min), morcellation efficiency (g/min), percentage of enucleated tissue (enucleated tissue/adenome weigth evaluated by ultrasonography. g/g), perioperative morbidity (Clavien), length of hospital stay, length of urinary drainage, functional outcomes at short and middle term (Qmax, post-void residual volume [PVR], QOL scores and IPSS at 3 and 6months). RESULTS: Enucleation and morcellation efficiency were significantly higher after the second proctoring (0.87 vs 0.44g/min; P<0.0001 and 4.2 vs 3.37g/min, P=0.038, respectively) so as the prostatic volume (43.5 vs 68.1mL, P=0.0001). Percentage of enucleated tissue was higher in the second group, however, the difference was not significant (69.5% vs 80.4%, P=0.03). Per- and postoperative complications, hospital length of stay, urinary drainage length and functional results at 3 and 6months were not significantly different. CONCLUSION: The learning curve did not interfere with functional results. The second proctoring was essential to us in order to grasp the technique. These data underlined the necessity of a pedagogic reflexion in order to built a standardized formation technique to the HoLEP. LEVEL OF EVIDENCE: 4.

[Painful ejaculation]. / L'éjaculation douloureuse.

OBJECTIVE: To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE). MATERIAL AND METHODS: Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior. RESULTS: PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies. CONCLUSION: The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option.

[Penile gangrene: a rare complication of systemic calciphylaxis, to be screened]. / La gangrène de la verge: une rare complication de la calciphylaxie systémique, à dépister.

Gangrene of the penis is a rare and serious complication of end stage renal disease, being an expression of systemic calciphylaxis. We report the case of a 58-year-old patient with chronic renal failure and diabetes, who presented with a necrosis of the gland. MRI defined the limits of necrosis. The treatment consisted in partial amputation of the penis. Histological examination found a calciphylaxis.

The feasibility of fertility preservation in adolescents with Klinefelter syndrome.

STUDY QUESTION: Is fertility preservation feasible after the onset of puberty in adolescents with Klinefelter syndrome (KS)? SUMMARY ANSWER: Fertility preservation counseling should be an integral part of the care of XXY adolescents. Frozen ejaculated or testicular spermatozoa and even frozen immature germ cells can give them the potential to conceive their genetic progeny. However, no biological or clinical parameters were predictive of mature or immature germ cell retrieval. WHAT IS KNOWN ALREADY: KS is the commonest sex chromosome disorder observed in azoospermic infertile males. Testicular sperm extraction success decreases with age and after testosterone therapy. Arguably, spermatozoa should be retrieved from KS males at the onset of puberty and before testosterone therapy to increase the chance of success. STUDY DESIGN, SIZE, DURATION: A retrospective study was performed in eight KS adolescents, aged between 15 and 17 years, who were referred for counseling about their future fertility to the center CECOS (Centre d'Etude et de Conservation des Oeufs et du Sperme humain) at Rouen University Hospital between October 2008 and December 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS: The patients were first seen with their parents and then separately. It was proposed to them that they should provide a semen sample, if this was azoospermic, two other semen samples spaced by 3 months were collected. If azoospermia was confirmed, a bilateral testicular biopsy was proposed for sperm retrieval and testicular tissue preservation. Each adolescent met the psychologist before undergoing testicular biopsy. Paraffin-embedded testicular tissue was evaluated after staining with hematoxylin-eosin and saffron and immunostaining using vimentin, anti-Müllerian hormone, androgen receptor and MAGE-A4 antibodies. Sertoli cell maturity, germ cell identification and lamina propria alteration were assessed on seminiferous tubules. MAIN RESULTS AND THE ROLE OF CHANCE: KS adolescents were not deeply concerned about their future fertility and only became involved in the process of fertility preservation after at least three medical consultations. The parents agreed immediately that fertility preservation should be attempted. Seven non-mosaic XXY adolescents presented with azoospermia and one XXY/XY adolescent had oligozoospermia. Increased plasma levels of FSH and LH as well as bilateral testicular hypotrophy were observed in all patients. The XXY/XY adolescent banked four semen samples before testosterone replacement therapy. Two patients refused testicular biopsy. Five patients accepted a bilateral testicular biopsy. Spermatozoa were retrieved in one patient, elongated spermatids and spermatocytes I in a second patient. LIMITATIONS, REASONS FOR CAUTION: The number of patients enrolled in our study was low because the diagnosis of KS is only rarely made before or at the onset of puberty. Most XXY males are diagnosed in adulthood within the context of male infertility. WIDER IMPLICATIONS OF THE FINDINGS: Spermatozoa can be retrieved in semen sample and in testicular tissue of adolescent Klinefelter patients. Furthermore, the testis may also harbor spermatogonia and incompletely differentiated germ cells. However, the physician should discuss with the patient and his parents over a period of several months before collecting a semen sample and performing bilateral testicular biopsy. Fertility preservation might best be proposed to adolescent Klinefelter patients just after the onset of puberty when it is possible to collect a semen sample and when the patient is able to consider alternative options to achieve fatherhood and also to accept the failure of spermatozoa or immature germ cell retrieval.

Management of male infertility due to congenital bilateral absence of vas deferens should not ignore the diagnosis of cystic fibrosis.

Microsurgical or percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection (ICSI) are proposed to overcome male infertility due to congenital bilateral absence of vas deferens (CBAVD). CBAVD has been associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and consequently, genetic counselling has to be addressed before beginning ICSI procedure. However, management of male infertility due to CBAVD should not ignore a mild form of cystic fibrosis. We describe the case of cystic fibrosis late diagnosis performed in a 49-year-old infertile men with CBAVD. CFTR molecular testing detected two mutations F508del and A455E corresponding to a cystic fibrosis genotype. Pneumological evaluation revealed a severe obstructive respiratory disease, bronchiectasis and high sweat chloride levels. Symptoms consistent with a cystic fibrosis have to be identified in infertile men with CBAVD before beginning assisted reproductive procedures.

[Buccal mucosal graft for the treatment of urethral stricture]. / Greffe de muqueuse jugale pour le traitement d'une sténose urétrale.

INTRODUCTION: The indication of the buccal mucosal graft for urethroplasty has evolved over recent years. The ease of its harvesting, availability, and immunohistological properties, as well as its satisfactory results, has made the buccal mucosal graft the current procedure of choice. We report a case of use of a buccal mucosal graft to treat an urethral stricture correction. CASE REPORT: A 48-year-old man underwent a buccal mucosal graft for post-infectious urethral stricture correction. An inner right cheek graft of 50 × 30 mm was harvested and inserted into place after complete excision of the stricture. Postoperative evolution was satisfactory with no pain at the 5th day, resumption of normal diet at the 12th day, a significant improvement of peak flow rate at the 21st day. Follow-up examination at the 7th week revealed a mouth opening to 40 mm with complete healing. DISCUSSION: Buccal mucosal graft has currently the highest success rate compared to other surgical techniques as full thickness skin graft from hair or graft of bladder mucosa. Its harvesting can be single or multiple, however care must be taken as regards Stenon's duct and to the labial commissure. The complications of the donor site are infrequent and can be characterized by numbness and limited mouth opening. Tissues that contain immunohistological properties, which are similar to those of the urothelium, buccal mucosal graft, have become the gold standard for this type of correction.

[Assisted reproductive technologies with sperm donation]. / Assistance médicale à la procréation avec don de spermatozoïdes.

INTRODUCTION: The purpose of this review is to relate to the operating rules of CECOS in France and the legal, medical and ethical issues raised by sperm donation. MATERIAL AND METHODS: Review of articles and consensus conferences on this subject published in Medline (PubMed) selected from 1973 and 2011 according to their relevance and Acts recorded on official legislative French websites. RESULTS: The operating rules of CECOS were established by the Act of July 29, 2004, revised 6 August 2004 and July 7, 2011. Of the 21,759 children born of ART in France in 2009, 5.1% are from a sperm donation. From 1973 to 2006, 44,045 children are born after a sperm donation. Between 1973 and 2006, 16,971 donors are presented in the CECOS and only 10,347 donors have completely made their donation process. The main indication for use of donor sperm (75% of applications) is represented by men of infertile couples with nonobstructive azoospermia, the second indication is infertile men with oligospermia. In azoospermia, the application is usually performed after failure of testicular or epididymal surgical specimen. In oligozoospermia, claims made most often after several failures of intraconjugal ART. CONCLUSION: Many questions are still present around the conception of children by sperm donation. The legitimacy of maintaining anonymity in the gift remains widely debated.

[Identification of factors associated with performance in objective structured clinical examination in Rouen medical school]. / Identification des facteurs associés à la réussite aux examens cliniques objectifs et structurés dans la faculté de médecine de Rouen.

CONTEXT: Objective structured clinical examination (OSCE) became a national exam at the end of medical studies in France. The aim of this study was to identify the predictive factors for success at OSCEs. METHODS: Aurvey query after the OSCEs was completed by fifth-year medicine students at Rouen Uuniversity.. Data on continuous variables were compared using the Mann-Whitney test. Data on quantitative variables were compared using the Spearman's correlation. RESULTS: Two hundred and thirty-nine students, i.e., 98.7 % of the students, responded to the query. The median (IQR 25-75) OSCE score was 13.6/20 (12.5-14.2). Students' personal factors significantly associated with a higher OSCE performance were female sex (median score of 13.7 versus 13.4; P=0.03) and good health during the clerkship (median score of 13.6 versus 12.6; P=0.02). A higher OSCE performance was associated with an increased number (≥6)  of medicine clerkships (median score of 13.8 versus 13.3; P=0.02) and a decreased number (<3) of surgery clerkships (median score of 13.7 versus 12.9; P=0.009). There was no correlation between the OSCE score and medical school performance (Spearman's correlation, r=0.24). CONCLUSION: Homogenization of student's clerkships, assistance to students with health problems seem to be teaching approaches to promote success at OSCEs.

[The thermoformable spiral metallic stents in the treatment of localized ureteral stenosis: an alternative to JJ stent? Prospective multicenter study]. / Les endoprothèses métalliques spiralées thermoformables dans le traitement des sténoses urétérales localisées : une alternative aux sondes double J ? Étude prospective multicentrique.

INTRODUCTION: Evaluation of the effectiveness and tolerance of thermoformable metallic spiral stents Memokath(®) 051 (Bard, Pnn Medical) in the treatment of localized ureteral stenosis in non-operable patients who have JJ ureteral stents. MATERIAL AND METHOD: Prospective, descriptive and multicenter study of patients with ureteral strictures treated with metallic ureteral stents Memokath(®) 051. Assessment criteria (recurrent stenotic, permeability, tolerance) were measured by clinical, biological and radiological examination at 1 month, and then every 3 months. RESULTS: Fifteen stents (average length: 9.15 cm, range 6-15 cm) were implanted in 14 patients (mean age: 55 years, range: 38-72 years) with secondary suspended ureteral stenosis during 2 years in two centers. The median follow-up was 11 months (range 6 to 24 months). Technical difficulty was observed with two patients. Stents are still up in four patients. The stenosis recurred in four patients with spontaneous progression of stenosis but without endoprosthetics tissue invasion. Two and three migration were observed with spontaneous expulsions. Two lower urinary infections and one high occurred, resolved on antibiotic therapy, no inlay or hematuria, no pain (mean VAS score=3/10) or urinary disorders of the lower unit have been identified. CONCLUSION: Stents Memokath(®) 051 are well tolered and seem to position themselves as an interesting alternative to JJ ureteral stent in some frails patients. The refinement of contraindication should help to improve the stent's efficacity and to reduce the risk of migration and expulsion.

[Treatment of interstitial cystitis by intravesical instillation of hyaluronic acid: A prospective study on 31 patients]. / Traitement de la cystite interstitielle par instillation intravésicale d'acide hyaluronique : étude prospective sur 31 patientes.

PURPOSE: We evaluate the efficacy of hyaluronate acid instillation for treatment of interstitial cystitis (IC). PATIENTS AND METHODS: From March 2008 to May 2009, a prospective study included 31 patients. We used the new definition of IC established by the ICS in 2002. Patients have a urinalysis, a cystoscopy, a hydrodistension test and bladder biopsies. The urodynamic evaluation was not systematic. Patients received weekly six instillations of 40mg (50ml) intravesical hyaluronate acid. We evaluated the efficacy and safety of treatment with two specific questionnaires of interstitial cystitis filled before and after 6 weeks of treatment: the O'Leary-Sant and Pelvic pain and Urgency/Frequency (PUF). RESULTS: Four groups were defined: good response, partial response, poor response and no response. They were composed by 14 patients (45%), two (7%), seven (22%) and eight patients (26%). We obtained 52% positive response (good response and partial response) after 6 weeks of treatment. Patients with cystoscopy and histology abnormal had a response rate of 60%. No serious side effects were observed. CONCLUSIONS: Hyaluronate acid has a place in the treatment of interstitial cystitis with an efficiency comparable to other treatments and good tolerance. The response rate to treatment can be improved by better selection of patients, particularly those having a cystoscopy and histology abnormal.

[Chronic pelvic pain in urology: a nationwide questionnaire survey among French urologists]. / Douleurs pelvipérinéales chroniques en urologie: enquête auprès des urologues français.

OBJECTIVE: To know the opinion of French urologists concerning the importance of pelvic and perineal pain syndromes in their clinical activity, their management, self-admitted knowledge and training needs concerning this situation. MATERIAL AND METHODS: Eight hundred and seventy-eight urologists exercising in France, all French Urology Association (AFU) members, have been asked to fill in an online questionnaire concerning their daily management of chronic pelvic and perineal pain syndromes. RESULTS: Three hundred and fifty-two urologists answered (response rate 40%). For about 20%, chronic pelvic and perineal pain syndromes took up more than 5% of consult activity. More than half took care of between 20 and 100 new cases of chronic pelvic and perineal pain every year. More than two thirds deemed their knowledge concerning chronic pelvic and perineal pain fair to insufficient. Three quarters of urologists would like to benefit from an opinion from another specialist for more than one out of four patients. More than 56% deemed that the organization of their daily consult activity was inadequate for the management of this type of patient. Most of them deemed useful to develop additional specific training programs. CONCLUSION: This survey shows that pelvic and perineal pain syndromes are frequent in daily urological consult activity, despite the fact that urologists feel they lack in training and organization to manage properly these diseases.

[Evaluation of chronic pelvic and perineal pain]. / Évaluation des douleurs pelvipérinéales chroniques.

OBJECTIVE: To describe the tools allowing evaluation of chronic pelvic and perineal pain and to define their indications. MATERIAL AND METHODS: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either Medical subject heading (MeSH) keywords (pelvic pain, pain measurement, prostatitis, quality of life) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Various rating scales and questionnaires constitute useful tools for clinical evaluation of the patient's chronic pain. They cannot replace clinical interview and cannot be used to establish a diagnosis. The main clinical assessment tools include severity scales, body diagrams, descriptive assessment (sensory and affective), evaluation of the impact on sleep, activities of daily living, quality of life and behaviour and assessment of mood and anxiety. In addition to these general tools, specific questionnaire have been developed in the fields of interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome. These specific questionnaires are designed for evaluation of the severity of symptoms, assessment of the disability related to the symptoms and the impact on quality of life, and follow-up of the course of symptoms and the response to treatment. CONCLUSION: Rapid and easy to use tools are essential in routine clinical practice. The recommended assessment tools are VAS (visual analogue scale) or numerical severity scales, body diagrams and brief questionnaires such as the Questionnaire sur la Douleur de Saint-Antoine (QDSA) (Saint-Antoine pain questionnaire) or Questionnaire Concis sur les Douleurs (QCD) (validated French translation of the Brief Pain Inventory).

[Chronic pelvic pain: epidemiology and economic impact]. / Épidémiologie et aspects économiques des douleurs pelvipérinéales chroniques.

OBJECTIVE: To combine epidemiological and health economics data concerning urological chronic pelvic pain syndromes. MATERIAL: Review of articles concerning this topic in the Medline (PubMed) database, chosen according to their scientific relevance. RESULTS: Prevalences are about 10,000/100,000 for chronic pelvic pain syndrome/chronic prostatis, 239 to 306/100,000 for bladder pain syndrome/interstitial cystitis, 15,000 to 20,000/100,000 for post-vasectomy testis and epididymis pain, 14,000/100,000 concerning deep female dyspareunia, 1000 to 9000/100,000 for male ejaculation or orgasma-related pain, 15,000 to 21,000/100,000 for female chronic pelvic pain, of which one third is related to endometriosis. Little has been published about the frequency of other chronic pelvic and perineal pain syndromes. The financial impact is comparable to other more frequent chronic diseases, with costs definitely above what the prevalences would have led to believe. CONCLUSION: The frequency of pelvic disease association, their predisposing factors, common environments and comordities suggest a possible common origin. This epidemiological data highlights the benefit of a multidisciplinary approach of chronic pelvic and perineal pain. This could lead to a better understanding of involved mechanisms, and ultimately treatment options.

[Definitions, classifications and terminology of chronic pelvic and perineal pain]. / Définitions, classifications et lexique des douleurs pelvipérinéales chroniques.

OBJECTIVE: To review the definitions and classifications of chronic pelvic and perineal pain and to describe the concepts of chronic pelvic and perineal pain syndrome and the global diagnostic and aetiopathogenic approach. MATERIAL AND METHODS: A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (classification, complex regional pain syndrome, fibromyalgia, myofascial pain syndrome, neuralgia, pelvic pain, postoperative pain, prostatitis, referred pain, syndrome) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS: Chronic pelvic and perineal pain does not only consist of symptoms localized to an anatomical region present for 3 to 6 months, but also constitutes a distinct, complex, multidimensional disease entity, comprising psychological, organic and psychosomatic phenomena, called chronic pelvic and perineal pain syndromes. These syndromes are responsible for disability, impaired quality of life, and induce considerable health care consumption and sick leave. They alter the patient's personality and affect his or her behaviour, sex life, family life, social life and work life. The usual clinical approach to these syndromes, looking for an organ or tissue disease responsible for pain, is negative. The approach to this type of pain must be much more global and consists of looking for disturbances of the regulation of pelvic and perineal nociceptive messages and dysfunction of the organ or structure concerned. CONCLUSION: The current definitions and classifications of chronic pelvic and perineal pain comprise the concepts of syndrome, functional disease and global approach and differ from the strict organ-based context and the classical medical approach (infectious, inflammatory, metabolic, endocrine) in order to focus pain syndromes on the pain itself and the associated symptoms.