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One half of French patients over the age of 50 with BPH are not diagnosed. Real difficulties are also currently encountered in the use of the I-PSS in general practice. In this context, the objective of this pilot study was to evaluate the concordance between the I-PSS score and a visual analogue scale (VAS), proposed as a new, precise and easy to use aid to the diagnosis of BPH.Sixty five patients (mean age: 66 +/- 9 years, mean I-PSS: 13.6 +/- 7.0) recruited by two urology departments quantified their urinary symptoms by answering the question "How much difficulty do you have problems to urinate?": 7 patients used a 10 cm and a 35 cm VAS, 30 patients used a 15 cm VAS and 28 patients used a 20 cm VAS. All patients also completed the self-administered I-PSS questionnaire.The VAS scores were independent the patient's age. The 4 classes of I-PSS severity were also represented in the VAS groups (p=0.999). The strongest correlation with the I-PSS score was observed with the 20 cm VAS (R=0.91, p0.0001). This coefficient was 0.26, 0.67 and 0.72 for the 10 cm, 15 cm and 35 cm VAS, respectively. A very close correlation was observed between the evaluation on the 20 cm VAS and the classes of the I-PSS score. Finally, the relationship between the I-PSS subscores and the 20 cm VAS was statistically significant (p0.0001) with high correlation coefficients (R=0.75 and R=0.87 for irritative and obstructive symptoms, respectively). This VAS did not appear to favour one type of symptoms over another.This pilot study on a small number of patients showed that a 20 cm VAS can constitute a simple and precise aid to the detection of BPH. These results must now be validated by a large-scale study, under real general practice conditions.

The current management of blunt trauma of the kidney is based on the 5-grade classification of lesions established by the ASST (American Society of the Surgery of Trauma). The indications for imaging are now clearly defined and spiral CT represents the reference examination. Over the last decade, the debate concerning the management of severe trauma has divided the supporters of surgical treatment from those who recommended conservative management. The contribution of interventional radiology and endourological treatments and the efficacy of intensive care now limit the complications related to trauma and reduce the need for surgery. However, the morbidity related to trauma is considerable in the presence of fragments of devascularized renal parenchyma, urine extravasation and associated lesions. These complications can be anticipated by a better definition of the traumatic lesions. The American classification presents certain limitations in relation to these combinations of poor prognostic factors. This review was designed to define the most recent biomechanical considerations, the place of imaging and finally the indications and results of management of blunt trauma of the kidney, in the light of the data of the literature.

The objective of this study is to assess the results of our therapeutic management of blunt kidney trauma in patients hospitalised over the last 10 years.From January 1993 to January 2003, 105 patients were hospitalised in our department for blunt kidney trauma. We retrospectively studied age, gender, injured side, mechanism of trauma (direct, indirect or deceleration), aetiology, presence of associated lesions (visceral, orthopaedic), and clinical and laboratory signs on admission (haematuria, blood pressure, haemoglobin and serum creatinine). The grade of the lesions was defined by radiological assessment, specifying the presence or absence of devascularized fragments and urine extravasation. All complications were noted and studied according to the initial therapeutic management and grade. Follow-up was clinical (BP and search for renal pain) and radiological (CT and/or DMSA scan).105 cases of blunt trauma of the kidney were hospitalised between January 1993 and January 2003 in our department. The mean age of the patients was 28.7 years (range: 7-75 years). Trauma was classified into 5 grades on the basis of the radiological assessment according to the ASST (American Society of Surgery of Trauma): 51 (49%) cases of grade 1 (n = 26) and grade 2 (n = 25) trauma, and 54 (51%) cases of major grade 3 to 5 trauma: 17 grade 3 (16%), 28 grade 4 (27%) and 9 grade 5 (8%) were diagnosed. Among the cases of major trauma, 7 (13%) were operated urgently during the first 24 hours: 4 cases of grade 5 trauma with renal artery dissection and 3 cases of grade 4 trauma with immediate uncontrolled bleeding. The nephrectomy rate (partial and total), when major renal trauma (grade 3, 4 and 5) (n = 47) was managed conservatively was 23% (11 nephrectomies) with the loss of 9.5 renal units (20%); this rate was 57% for grade 4 trauma presenting urine extravasation and devascularized fragments (n = 14). Twelve patients (7 with grade 4 trauma and 5 with grade 3 trauma) were reviewed by DMSA scintigraphy with a mean follow-up of 63 months (range: 26-108 months). Traumatized kidneys presented a mean function of 41.8% (range: 26.4-50%).Blunt kidney trauma is usually managed conservatively. The development of interventional radiology, endourological drainage techniques and medical intensive care helps to maintain this attitude by decreasing the need for surgery, even in the most severe trauma.

Control of the renal vascular pedicle in a context of severe renal trauma in a haemodynamically unstable patient is difficult due to the large retroperitoneal haematoma. Laparotomy in these exsanguinated patients is associated with a risk of cardiac arrest due to hypovolaemia. The authors describe an endovascular aortic balloon catheter occlusion technique prior to laparotomy for haemostasis nephrectomy in a haemodynamically unstable patient presenting an abdominal compartment syndrome. In the light of this case, the authors discuss vascular control in the context of surgical management of severe renal trauma.

Introduction : Organ shortage has resulted in the emergence of living donor kidney transplantation. Evaluation of surgical practices is essential to ensure safety and optimal management of donors. Methods: We carried out a bi-centric retrospective study between 1997 and 2017. The main objective was to study the intraoperative difficulties and the outcomes of the donors. The various surgical techniques and predicting factors of operative difficulties or complications were evaluated. Results: Four hundred and twenty-five patients were included. Median age at the time of donation was 50 years old. The procedures were performed by laparoscopy in 88% of cases. The surgical conversion rate was 4,9%. Postoperative complications were found in 32% patients. The major complication rate (Clavien> 2) was 4.2%. The average loss of GFR at one year of the donation was 25%. The overall complication rate was not different according to the technique. The presence of an anatomical variant was predictive of surgical difficulties (OR 2.30, 95% CI 1.16-4.55). In one third of cases the variation was not described by preoperative imaging.The MAP score was predictive of intraoperative difficulties (OR 13.05, 95% CI 5.25-32.47), conversion (OR 18.96, 95% CI 3.42-105.14), and postoperative complication (OR 2.37, 95% CI 1.13-5.00). Conclusion: Living donor nephrectomy for transplantation is a surgery at risk that needs to be done by experts. Special attention should be given to preoperative imaging to anticipate surgical difficulties. The MAP score seems to be an innovative tool to predict the risk of complications. These data must to be confirmed by a prospective study.; Introduction : Face à une pénurie d’organe, la transplantation rénale à donneur vivant se développe. L’évaluation des pratiques est essentielle afin de garantir la sécurité et une prise en charge optimale des donneurs. Matériel et méthode : Nous avons réalisé une étude rétrospective bicentrique entre 1997 et 2017. L’objectif principal était d’étudier les difficultés chirurgicales et les suites opératoires des donneurs. Les différentes techniques chirurgicales et les facteurs prédictifs de difficultés opératoires ou de complications ont été évalués. Résultats : Nous avons inclus 425 patients. L’âge médian au moment du don était de 50 ans. La laparoscopie représentait 88% des prélèvements. Le taux de conversion chirurgicale était de 4,9%. Le taux de complication global était de 32 %. Le taux de complication majeur (Clavien >2) était de 4%. La perte moyenne de DFG à un an du don était de 25%. Le taux de complication n’était pas différent selon la technique. La présence d’une variante anatomique était prédictive de difficulté opératoire (OR 2,30 ; IC95% 1,16-4,55). Dans un tiers des cas elle n’était pas décrite par l’imagerie préopératoire. Le MAP score était un facteur prédictif de difficulté per opératoire (OR 13,05 ; IC95% 5,25-32,47), de conversion (OR 18,96 ; IC95% 3,42-105,14) et de complication post-opératoire (OR 2,37 ; IC95% 1,13-5,00). Conclusion : La néphrectomie pour transplantation à donneur vivant est une chirurgie à risque qui doit être réalisé par des experts. Une attention particulière doit être porté à l’imagerie pré-opératoire. Le MAP score semble être un outil innovant pour prédire le risque de complication.