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Periprostatic fat has a metabolic activity on the prostate via cytokines that act paracrine on several signaling pathways including tumorigenesis. We investigated whether there was an association between preprostatic fat abundance and prostate cancer (PCa) aggressiveness.We performed a retrospective study including patients who underwent radical prostatectomy in our center from the prospective RESCAP database. Preoperative MRIs were re-read and different measurements of preprostatic fat (PPF) were performed. The maximum thickness (PPFmax) and the minimum thickness (PPFmin) were measured on a median T2 sagittal section. The total volume of preprostatic fat (PPFV) and volume normalized by prostate volume (NPPFV) were calculated semi-automatically by segmentation on continuous axial sections of 3mm. The association of these parameters with the aggressiveness criteria of PCa (ISUP 3-5 on biopsies and on operative specimen, intermediate or high-risk disease according to D'AMICO, PSA10, upgrading risk at radical prostatectomy) was measured as well as the association between normal, overweight, and obese BMI classes and the aggressiveness criteria used.One hundred and twenty-one men were included in this study. In both the univariate analysis and the multivariate analysis, none of the preprostatic fat measurements (PPFmax, PPFmin, PPFV and NPPFV) were associated with PCa aggressiveness criteria. There was also no association between BMI class and tumor aggressiveness.In this study, there is no association between the abundance of preprostatic fat and PCa aggressiveness according to the periprostatic fat measurements achieved.III.

International audience

International audience; Objective: To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology.Material and methods: Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies.Results: Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection.Conclusion: Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.; ObjectifRapporter la nature, les stratégies diagnostiques et thérapeutiques des urgences infectieuses en urologie.Matériel et méthodeRecherche bibliographique à partir de Pubmed, Embase et Google Scholar en juillet 2021. Synthèse des recommandations nationales du comité d’infectiologie de l’AFU (CIAFU) et de la Société de Pathologies Infectieuses de Langue Française (SPILF).RésultatsL’urosepsis et sepsis urinaire grave répondent à des critères diagnostiques stricts. La prise en charge infectieuse diagnostique et thérapeutique des pyélonéphrites graves, infections urinaires masculines graves, infections urinaires associées aux soins, candiduries symptomatiques et infections urinaires chez la personne âgée sont décrites. L’antibiothérapie doit être adaptée à la gravité, l’écologie bactérienne, aux particularités du patient et au site d’infection.ConclusionLes infections urinaires peuvent être graves et nécessitent une prise en charge en urgence. La connaissance des recommandations et des stratégies diagnostiques et thérapeutiques adaptées aux diverses présentations permet une optimisation de la prise en charge qui doit être la plus rapide possible, et collégiale.

Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence.The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day.Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group.AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings.4.

Prostate biopsy is sometimes complicated by infection which can lead to death. The risk factors remain controversial, notably the urine bacterial culture carried out before a prostate biopsy. The increase in resistance induces an increase in the number of complications and the need to define new antibiotic prophylaxis strategies. The urine bacterial culture remains widely discussed in cases with post-prostate biopsy infections and urologists or experts await clear recommendations on this subject. The Infectiology Committee of the French Association of Urology has therefore set up a literature analysis work in order to reach a consensus within the committee.A literature search was performed on Pubmed and Medline. We selected randomized studies or meta-analyzes using the keywords "prostate biopsy" and "infection" or "infectious complications". All abstracts and articles have been analyzed. The summary of the analysis was reviewed by all the members of the committee proposing the most consensual recommendation possible.The literature on the subject remains poor, but no evidence of a link between prebiopsy bacteriuria and post-biopsy infection has been demonstrated.Apart from a clinical situation which could evoke a male urinary tract infection, and moreover having to prefer the postponement of biopsies, it is not recommended to perform a routine urine culture before endo-rectal prostate biopsies (expert opinion).

Acute urinary tract infections (UTIs) in adult are now a major public health issue in terms of morbidity, mortality and in terms of costs for society. The latest French guidelines and the European Association of Urology guidelines differ in some points. The aim of this article is to compare the guidelines of these two societies in order to highlight their differences but also their common points in the management of UTIs.A comparative analysis of the latest French and European guidelines was carried out. The authors defined the following sub-sections: terminology, pyelonephritis, male UTIs, pregnancy urinary tract infections and cystitis.The guidelines of these two societies are not very different in terms of diagnostic and therapeutic management. The major differences are in the duration of antibiotic therapies, where French guidelines continue to recommend long term treatments where EAU sometimes recommends only 5 days of antibiotics, as in the case of simple acute pyelonephritis.3.

Urinary infection is a risk factor for lithiasis. Urinary tract infection is a factor of gravity of urinary stone. The stone can exist before the infection which colonizes the stone, infected stone. The infection can be the cause of the stone, infectious stone (struvite stone). Infectious stones can be secondary to a non urinary infectious agent, oxalobacter formigenes (OF) and nanobacteria. The first-line treatment of struvite stone is percutaneous surgery. Perioperative antibiotics, renal urines and stone cultures are obligatory.

To determine the prevalence of overactive bladder (OAB) syndrome in France and gather data about initial patient trajectories in the healthcare system.A dedicated questionnaire (41 questions) has been sent to a 12,000 sample of people representative of the global population. The following data were investigated: social and demographic features, medical history, Urinary Symptom Profile questionnaire, bother, history of symptoms, care seeking and treatments received. Patient were considered having OAB in case if presenting at least two episodes of urgency per week, or being under treatment of OAB. OAB prevalence was the main outcome, and associated factors were characterized by univariate and multivariate analysis.Based on 8842 available questionnaires, the global prevalence of OAB was estimated to be 14.4%. Prevalence was significantly higher in women, older age groups, as well as obesity, irritable bowel syndrome, urinary tract infections, enuresia, constipation, anxiety/depression, neurological diseases, sleep apnea syndrome, asthma, chronic obstructive pulmonary disease, diabetes and hypertension. Only 34.6% of patients with OAB had visited a health practitioner for this problem. General practitioners were most frequently implicated in patient primary care and evaluation. Seventy-two percent of patients with OAB had had additional investigations (mostly a urine culture) and only 6% of patients had to complete a bladder diary. The most frequent treatment option was oral antimuscarinics. Physical therapy and rehabilitation have been prescribed in 26% of cases, as well as dietary advice.OAB is a frequent syndrome. Its prevalence increases with age, and OAB frequently concern elderly frail people with many other associated diseases.3.

Objectifs Evaluer l’impact dans la strategie therapeutique de la TEP/TDM a la 18-FCH chez les hommes en recidive biochimique d’un cancer de la prostate. Methodes Il s’agit d’une etude retrospective, unicentrique, portant sur une cohorte de malades en recidive biochimique d’un cancer de la prostate qui ont beneficie d’une IRM pelvienne et d’un PET/TDM a la choline entre octobre 2012 et mars 2016. Afin d’evaluer de facon independante l’impact de la PET, les dossiers anonymisees de chaque malade etaient representees en reunion de concertation pluridisciplinaire (RCP), uniquement avec les resultats de l’IRM sans que ceux du PET soient devoiles. Une confrontation des resultats issus des 2 RCP etait ensuite realisee. Resultats Trente-six hommes, d’age median 70 ans, ont ete inclus. Les taux de PSA medians au moment de l’IRM et de la PET etaient respectivement de 4,8 et 4,6 ng/mL. Un changement de strategie decisionnelle induit par la PET a ete mis en evidence dans 45 % des cas. Parmi ces 16 changements de strategie, une hormonotherapie a ete evitee chez 37,5 % des hommes et un plus grand nombre de malades ont ete eligibles a un traitement cible (56 % contre 16 % initialement). La TEP a permis de mettre en evidence 27 % de lesions supplementaires comparativement a l’IRM pelvienne. Le taux de discordance entre TEP et IRM etait de 41 % au niveau locoregional (Kappa de Cohen = 0,207) dont 93 % situe dans le meme champ d’exploration que l’IRM. Conclusion La PET/TDM a la choline semble avoir un impact decisionnel important dans la prise en charge des hommes en recidive biochimique d’un cancer de la prostate, temoignant de son interet en association avec l’IRM pelvienne dans ces situations.

Resume L’hypertrophie benigne de prostate (HBP) concerne tous les hommes de plus de 60 ans. Seulement une partie aura des symptomes. Le traitement de l’HBP symptomatique consiste en un traitement medical, puis en cas d’echec en un traitement chirurgical. Le traitement classique est la resection transuretrale de prostate (RTUP) qui consiste a reduire la partie genante de la prostate au niveau de l’uretre prostatique par voie naturelle. D’autres alternatives se sont developpees et notamment la chirurgie laser qui permet, selon la meme voie d’abord, de vaporiser le tissu prostatique en reduisant les risques de saignements ou de reabsorption du glycocolle utilise classiquement dans la RTUP. L’etude de la litterature sur le sujet est de plus en plus vaste et confirme a court et moyen terme les tres bons resultats fonctionnels de la photovaporisation prostatique (PVP) par laser. Les avantages potentiels sont une diminution de la duree de sondage et d’hospitalisation, des saignements postoperatoires reduits, l’absence de syndrome de reabsorption du liquide d’irrigation (glycocolle) et la possibilite de traiter des malades sous anticoagulants ou a risques operatoires eleves. L’absence de possibilite de realiser un examen anatomopathologique du tissu reseque est un des arguments des detracteurs de cette technique. Des etudes medicoeconomiques sont en cours pour confirmer l’interet aussi financier pour la communaute d’utiliser cette technique.

Background Multisite information regarding surgical site infection (SSI) rates for cardiac surgery programmes is not widely available. Ward characteristics that may affect outcomes have not been analysed previously. Aim To determine individual- and ward-level factors associated with SSI occurrence after coronary artery bypass grafting (CABG) and valvular surgery. Methods A dataset from the French national SSI database ISO-RAISIN 2008–2011 was used. Only adult patients were included. A standardized questionnaire was completed for each patient who underwent surgery, and patients with and without SSI were characterized. Patients and ward risk factors for SSI were analysed using a multilevel logistic regression model with SSI as binary outcome (two levels: patient and ward). Results Out of 8569 patients from 39 wards, the SSI rate was 2.2%. Micro-organisms were isolated in 144 patients (74%): 35% coagulase-negative staphylococci (N = 51), 23% Staphylococcus aureus (N = 33), 6% Escherichia coli (N = 8). Higher probability of SSI was associated with the duration of preoperative hospitalization, the duration of follow-up, the duration of surgery >75th percentile and the SSI rate in the surgery ward. The residual heterogeneity between wards (median odds ratio: 1.53) was as relevant as duration of preoperative hospitalization (odds ratio: 1.57). Conclusion Although patient risk factors were more strongly associated with SSI occurrence, this study provided evidence for the existence of a ward-level effect. This should be taken into account when considering possible corrective interventions.

To describe drugs targeting urinary bladder to treat bladder dysfunctions such as OAB, NDO and bladder pain syndrome.Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM).Anticholinergics antimuscarinics remain the first-line treatment option for both OAB and NDO. Beta-3 adrenergics emerges as a new therapeutic class for OAB. Post approval safety as well as association with other micturition cycle's drugs need to be evaluated. Phosphodiesterase 5 inhibitors are effective to treat BPH-related LUTS including storage symptoms. Botulinum toxin type A injections within the detrusor are effective and approved to treat NDO in MS and spinal cord injured patients voiding with clean intermittent catheterization. Evaluation of such approach to treat OAB is ongoing. Drug therapy for bladder pain syndrome has limited efficacy including pentosan polyphosphate despite it has a temporary autorisation. There is no drug treatment to restore or improve bladder contraction.Armamenterium to treat bladder dysfunction has recently increased. Three new therapeutic classes emerged. Careful post approval evaluation is mandatory and study of these drugs' combination is expected. Results should drive changes in bladder dysfunction treatment algorithms.

To describe drugs used in bladder carcinoma.Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM).The drugs used in the treatment of bladder cancer are represented by the products referred to diagnosis (hexyl aminolevulinate), the intravesical instillations for the treatment of tumors not infiltrating the muscle and the infiltrating tumor chemotherapy (neo-adjuvant treatment or metastatic tumors). The hexyl aminolevulinate cystoscopy allows to identify a significantly greater number of lesions, including carcinoma in situ, compared to conventional white light cystoscopy. For intravesical instillations, BCG has a superior efficacy to mitomycin C with a lower tolerance. The chemotherapies for invasive tumors are effective in metastatic disease in 15-20% of cases with a mean survival of 12 to 14 months.Except the use of hexyl aminolevulinate for improving the diagnosis, there was no emergence in recent years of new drugs for the treatment of bladder cancer. Targeted therapies currently available for many neoplasms were ineffective for bladder cancer.

To describe drugs used in renal cell carcinoma.Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies websites (HAS and ANSM).Since 2007, a total of three different therapeutic classes in the management of metastatic renal cell carcinoma are available. These three classes are tyrosine kinase inhibitors with sunitinib and sorafenib, the anti-VEGF antibodies (bevacizumab which is associated with alpha interferon in the treatment of advanced kidney cancer) and mTOR inhibitors with temsirolimus and everolimus. These targeted therapies are a major progress in the treatment of patients with metastatic kidney cancer. The side effects encountered with these molecules are numerous but serious side effects are less than 5% of all reported side effects.A better understanding of molecular mechanisms has enabled the development of new therapies for the treatment of metastatic renal cell carcinoma. In the future, a personalized approach taking into account the biology of each tumor could be created to provide a more targeted treatment.

Photoselective vaporization of the prostate is a minimal invasive endoscopic treatment of benign prostatic hyperplasia (BPH) obstruction. It uses the light energy produced by a laser source to destroy and remove urethral obstruction due to BPH. Its main advantage over transurethral resection of prostate is the minimal bleeding allowing a short urethral catheterization and hospital stay. It is useful in patients with bleeding disorders.

Objectifs L’alimentation et obesite ont ete impliquees dans la progression du cancer prostatique. Certaines etudes suggerent que les cellules tumorales et le tissu adipeux peri-prostatique (TAPP) pourraient interagir par le biais de molecules, telles que les acides gras ou les adipokines. L’objectif est d’analyser l’effet d’acides gras insatures presents dans l’alimentation et de milieux conditionnes par du TAPP, sur trois lignees de cancer prostatique. Methodes Les effets de 3 acides gras [Acide arachidonique (AA), acide oleique (AO), acide docosahexaenoique (DHA), et de milieux conditionnes par du tissu adipeux peri-prostatique (TAPP)] provenant de patients ( n = 10) operes pour un cancer de prostate, ont ete testes sur les lignees LNCaP, DU 145 et PC-3. La migration a ete analysee sur chambre de Boyden, la proliferation par test WTS et immunohistochimie (Ki67), et l’expression de molecules d’adhesion impliquees dans la migration (syndecan, E-cadherine) par immunohistochimie. Les effets du TAPP ont ete correles au score de Gleason et a l’indice de masse corporelle (IMC) Resultats Les acides gras influent significativement sur la migration cellulaire (augmentee par l’AA, diminuee par le DHA), et sur l’expression de molecules d’adhesion (syndecan et E-cadherine diminuees par l’AA, augmentees par le DHA). Ils n’ont toutefois aucun effet significatif sur la proliferation cellulaire. Nous n’avons pas retrouve d’effet des milieux conditionnes sur la migration, mais ceux provenant de patients obeses (IMC > 30) augmentent la proliferation cellulaire. Conclusion Les effets pro-migratoire de l’AA et anti-migratoire du DHA sont en accord avec le role « protecteur » des omega-3 observes dans d’autres types de cancers. De plus, l’incidence sur la proliferation de TAPP provenant de patients obeses confirme l’association entre obesite et cancer de prostate agressif.

Laparoscopic pelvic lymphadenectomy in localized prostatic cancer is performed since the 1990s, lessens the postoperative complications and respects carcinologic's principles (No. lymph nodes removed and lymph nodes metastasis). In order to verify that these objectives are achieved, we compared our results of pelvic lymphadenectomy by laparotomy and by laparoscopy for the past 12 years.Between January 1997 and June 2008, 36 (23.8%) patients underwent open pelvic lymphadenectomy and 76.16% (115 cases) laparoscopic pelvic lymphadenectomy. We did a retrospective and comparative analysis of data including the preoperative characteristics, per- and postoperative complication as well pathologic results.Preoperative data were comparable between both groups. The comparison of the peroperative data showed an increased bleeding volume in the open group (105.6±420.9mL; 12.1±96.1mL: P=0.001) and longer operative time in the laparoscopic group (103.7±83.9min; 132.8±40.9min: P=0.006). Postoperative complications were similar. Pathologic results showed a significantly more important number of lymph nodes removed in the open group (7.2±3.5; 5.7±3.2: P=0.022), but the positive rate similar in both groups (13.9%; 22.6%: P=0.258). In order to remove "the learning curve effect", we compared 36 open pelvic lymphadenectomy to the last 36 laparoscopic pelvic lymphadenectomy. In the laparoscopic group the patients showed an upper Gleason score (6.3±1.1; 7±1: P=0.005); but there was no difference for the operative time, number of lymph nodes removed and the complications rates.After training, laparoscopic pelvic lymphadenectomy was similar to open pelvic lymphadenectomy.

Urinary infection is a risk factor for lithiasis. Urinary tract infection is a factor of gravity of urinary stone. The stone can exist before the infection which colonizes the stone, infected stone. The infection can be the cause of the stone, infectious stone (struvite stone). Infectious stones can be secondary to a non urinary infectious agent, oxalobacter formigenes (OF) and nanobacteria. The first-line treatment of struvite stone is percutaneous surgery. Perioperative antibiotics, renal urines and stone cultures are obligatory.

Objectifs Comparer l’evolution clinique et biologique apres nephrectomie donneur vivant par laparoscopie hand assisted (LMA) ou par laparoscopie robot-assistee (LRA). Methodes Etude retrospective de 2009 a 2014 comparant les resultats de 121 et 51 prelevements renaux dans deux services d’urologie francais. Dans la LMA la dissection etait guidee des le debut par la main de l’operateur introduite en intra-abdominal, via un abord de Pfannenstiel alors que dans la LRA la dissection etait completement mini-invasive et l’abord de Pfannenstiel etait realise pour l’extraction du rein. Pour les donneurs, les donnees comparees etaient : creatininemie, duree d’ischemie chaude, duree operatoire, complications, duree de sejour et pour les receveurs : fonction immediate du greffon, recours a l’hemodialyse, nombre de rejets traites et fonction renale a 1 an. Resultats Les 2 groupes (LMA et LRA) etaient comparables. En per-operatoire des differences significatives ont ete observees : duree d’ischemie chaude : 2,8 min ± 0,3 vs 6,2 ± 0,4 et duree operatoire : 163 min ± 3 vs 233 ± 5. En post-operatoire les complications Clavien 2 a 1 mois etaient : 10,7 % vs 2 % ( p = 0,054). N’etaient pas significativement differents : la diminution de la creatininemie du donneur a 1 an (28,8 μmol/L ± 1,5 vs 24,9 ± 2,8), la duree de sejour (5,4j ± 1,1 vs 5,1 ± 1,2), la reprise de fonction du greffon (80,2 % vs 82,4 %), le taux de dialyses (4,1 % vs 1,96 %), le taux de rejets traites (11,6 % vs 19,6 %) et la creatininemie du receveur a 1 an (122 μmol/L ± 4 vs 129,4 ± 6,4). Conclusion Si le temps d’ischemie chaude et la duree operatoire etaient significativement plus courts en LMA, il n’existait pas de difference sur la reprise immediate de la fonction du greffon et les differentes valeurs de creatininemie chez le donneur ou le receveur. Cependant, les complications post-operatoires Clavien 2 semblaient plus importantes en laparoscopie hand assisted .

The dependence of polarisation dependent gain (PDG) in erbium doped fibre amplifiers on both the degree of polarisation (DOP) of the input signal and gain compression is measured for the first time. PDG is found to depend quadratically on the input DOP.

Depending on the launched state of polarisation, 10 Gbit/s system impairments are investigated experimentally in the presence of chromatic dispersion and variable differential group delay caused by polarisation mode dispersion. In addition, an actual fibre cable, not an optical simulator, was used to bring polarisation mode dispersion.

The realisation and systems performance of an optical add drop multiplexer (OADM) based on a grating-assisted Mach-Zehnder interferometer imprinted on photosensitive-cladding fibre are reported. This component provides low short wavelength losses, a high return loss at the input port, low chromatic dispersion and low PMD. A thorough characterisation is presented of the device and its system performance for multiwavelength transmission at 10 Gbit/s per channel, showing compatibility with 50 GHz grid dense WDM systems.