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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.

Resumen Las afecciones de las vesiculas seminales (VS) son infrecuentes y poco conocidas por los urologos. Los sintomas mas frecuentes son la hemospermia y el dolor perineal. Se han beneficiado mucho de la llegada de las pruebas de imagen, en particular de la resonancia magnetica, permitiendo establecer un diagnostico preciso. Las etiologias no tumorales son en su mayoria vesiculitis infecciosas. Los tumores benignos son poco frecuentes y se trata principalmente de quistes simples cuya sintomatologia depende de su tamano. Su tratamiento adaptado depende de la importancia de los sintomas y de las molestias que ocasionan. Los canceres de las VS corresponden con mucha frecuencia a una invasion por un adenocarcinoma de prostata. Los tumores malignos primarios son carcinomas en los dos tercios de los casos y con mucha menor frecuencia sarcomas. Las metastasis de las VS son muy infrecuentes. Ademas de estas enfermedades infecciosas y tumorales, existen las anomalias congenitas de las VS, que se diagnostican al aparecer trastornos de la fertilidad asociados con frecuencia a una hipospermia. Se observa en estos casos una agenesia uni o bilateral de las vesiculas, que obliga a descartar una mucoviscidosis. En caso de duda sobre una patologia tumoral, se realiza una biopsia por via endorrectal, salvo en caso de alta sospecha de sarcoma. El tratamiento quirurgico de las VS consiste en una vesiculectomia unilateral que puede realizarse por via de acceso abierta o laparoscopica, con un auge creciente de la cirugia robotica.

International audience

A pre-operative shower is recommended before surgery to prevent surgical site infections (SSIs).We modelled the occurrence of SSIs and the potential savings for patients undergoing an antimicrobial soap (AS) shower prior to surgery at a French University Hospital level.AS shower prevented 209 SSIs, generating a potential saving of €632,210 per year. Results grouped by type of surgery showed annual savings of €26,537, €20,520 and €14,377 for orthopaedic, gynaecologic and obstetric, and digestive surgery, respectively.Despite the lack of published data surrounding the efficacy of AS in preventing SSIs, we demonstrated the potential savings and benefits of generalizing AS before surgical interventions.

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.

Objective To devise and validate a system to categorize GreenLight photoselective vaporization of prostate (PVP) complications according to Clavien score (CS), to report complications of PVP using this categorization, and to determine risk factors. Materials and Methods A survey questionnaire was distributed to all participants of the second meeting of the Group of GreenLight Users. They were asked to grade PVP complications according to CS. We calculated the mode CS for each complication from the survey data to propose a categorization system for complications of PVP. Complications encountered in a large single-center cohort of 370 patients were reported according to this system. We assessed the reproducibility of CS by estimating inter-rater agreement by the Fleiss kappa. We performed univariate and multivariate analyses to determine risk factors for complications. Results Of the 67 meeting participants, 42 (62.7%) completed the survey. Overall agreement between urologists was fair (Fleiss kappa = 0.356). Among the 370 patients, 21 (5.7%) had intraoperative complications, 147 (39.7%) had postoperative complications, and 70 (18.9%) had long-term complications. Among the postoperative complications, 125 patients (33.8%) were classified as Clavien grade I, 58 (15.7%) as Clavien grade II, 4 (1.1%) as Clavien grade IIIb, 5 (1.3%) as Clavien grade IVa, 1 (0.3%) as Clavien grade IVb, and 1 (0.3%) as Clavien grade V. In multivariate analysis, the only predictor of overall complications was a polymicrobial preoperative urine culture. Conclusion The grading of PVP complications by CS is fairly reproducible. We are the first to propose a system for the categorization of PVP complications. PVP complications are frequent but most often minor.

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.

RADIOLOGIE ET IMAGERIE MEDICALE : Genito-urinaire - Gyneco-obstetricale - Mammaire - 34-425-A-10

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 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.

The objective of this paper is to give an overview of the different studies we have performed at the research level regarding the design and implementation of a photonic wavelength division multiplexing (WDM) layer providing transparent transport services to client layers (SONET/SDH, ATM, etc.). Such a network requires a number of enabling factors to be assessed in order to become a reality. Among these factors are the availability of high-capacity WDM transmission systems and efficient optical routing nodes based on mature technology, the design of robust networks optimizing the utilization of resources, and the development of a management system in accordance with presently applied standards for transport networks. We review our achievements in these different fields.

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.