[Non-heart-beating renal donors: organization in a non-university hospital]. / Prélèvement rénal sur donneur décédé par arrêt cardiaque (DDAC): organisation dans un centre hospitalier non universitaire.

INTRODUCTION: In 2011 in France, all kidneys from patients with brain death and from living donors cannot meet the demand for renal transplants. Since 2006, sampling protocols kidneys from non-heart-beating donors (NHBD) are developed to increase the number of renal transplants. The objective was to describe the organization of a protocol NHBD in a non-university hospital. MATERIALS AND METHODS: Patients with inclusion criteria of protocol NHBD of the Agency of Biomedicine were prospectively included between 1st July 2011 and 31 December 2012. The protocol data were comparable to national data. Vascular canulation was performed by urologists. The epidemiological, clinical and biological characteristics of patients included, the different times and deadlines of the protocol, and data of renal transplantation were collected and analyzed. RESULTS: Over the period of 18 months, 16 patients were included in the protocol NHBD, with a median age of 42 years, and 87.5% of males; 93.8% of patients made a cardiac arrest outside the hospital. The median duration of no-flow was 4.3 minutes (0; 23), the median time between the cardiac arrest and admission to hospital was 90 minutes (0; 116), the median time between the cardiac arrest and the start of the normothermic recirculation was 139 minutes (40; 150), and the median duration of normothermic recirculation was 212 minutes (186; 240). For urologists, the median duration of mobilization was 178 minutes and 97 minutes after 20 h. Twenty-four kidneys were collected (75%) and 22 kidneys were transplanted (91.7%). The median duration of cold ischemia was 9 h 12 (5 h 25; 18 h 02). No primary non-function of graft was observed. Delayed graft function was observed in 50% of cases and the median duration of dialysis was 2 days (0; 19). After 12 months of inclusion, our center accounted for 8% of the national census and 16% of transplanted kidneys NHBD. CONCLUSION: The involvement of rescue, coordination, anesthesiologists and urologists, and the concentration of jobs in our center have helped to minimize response times NHBD in the protocol for maximum quality of kidneys taken with transplant rates and results are very encouraging.

[Specific features of the early diagnosis of prostate cancer in the presence of neurogenic bladder]. / Les particularités du diagnostic précoce du cancer de la prostate en présence d'une vessie neurologique.

Due to their increased life expectancy, a growing number of neurological patients, particularly spinal cord injury patients, develop prostate cancer. Although prostate cancer appears to be slightly less frequent in spinal cord injury patients than in the general population (level of proof 3b), especially in the case of high and severe spinal cord injury (level of proof 3b), there is evidence to suggest that prostate cancer is responsible for morbidity (level of proof 4) and excess mortality (level of proof 5) in neurological patients with a life expectancy greater than 10 or 15 years. According to urology society guidelines, prostate cancer screening should be proposed to neurological patients with a life expectancy greater than 10 or 15 years (level of proof 5), particularly paraplegics aged 50 to 60 or 65 years. As in the general population, this screening could be based on digital rectal examination and annual PSA assay, which can still be interpreted, even in patients performing intermittent catheterization (level of proof 3b). However; PSA cannot be used in patients with an indwelling catheter (level of proof 3b). The histological diagnosis is based on prostatic biopsies, which should probably be preceded by systematic urine culture with appropriate antibiotic therapy, if necessary, to limit the risk of infection (level of proof 5). The treatment of localized prostate cancer in neurological patients, as in the general population, is based on radical prostatectomy and external beam radiotherapy. The indication must be adapted to each patient, taking into account the voiding mode and urodynamic assessment of lower urinary tract function. Brachytherapy does not appear to be an appropriate treatment modality because of its adverse effects (level of proof 5).