Base bibliographique

Introduction and objectives

The periurethral adjustable balloons (PUAB) Pro-ACT™ are less invasive technique to treat non-severe forms of post-radical prostatectomy urinary incontinence (pRP-UI), like sub-urethral trans-obturator male sling. Few data of efficiency are available for their use in second line treatment after male sling failure.

Objective

To evaluate the efficiency of PUAB Pro-ACT™ (Uromedica, Inc., MN, USA) in the second line treatment for non-severe pRP-UI after male sling failure.

Materials and methods

Single center retrospective study of patients treated with male sling (17 Advance™, 1 TOMS™) between 2009 and 2015. The continence results were evaluated by the number of pad per day and the quality of life assessment by the I-QOL questionnaire. The “cure” was defined as no pad and “improved” as decreased more than 50 % of pads use.

Results

Eighteen patients were included with median follow-up of 21.5 [14–44] months. Two patients (11.1 %) had a past history of pelvic radiotherapy. The median pads per day used was 2 [1–3] after male sling insertion and before Pro-ACT™ device insertion. After Pro-ACT™ device insertion, the median pads per day used was 0 [0–1], with 77.7 % of patients cured and 22.2 % improved. The median quality of life score I-QOL, was 52.2 [23.3–62.6] and 83 [31.8–97.7], respectively before and after Pro-ACT™ device insertion (P <0.001). Nine (60 %) patients rated their incontinence severity as mild, four (26.6 %) as middle and two (13.3 %) as severe, after balloon insertion. The median volume of adjustment was 3 [2–6] mL.

Conclusions

The PUAB Pro-ACT™ have a significant efficiency for use after male sling failure and can be used in second line therapy.

Level of evidence

3.

Introduction

The objective of this work was to evaluate the impact of the laparoscopic radical cystectomy learning curve on perioperative and oncological outcomes.

Patient and methods

This is a retrospective and single-center study of all patients who underwent laparoscopic radical cystectomy for bladder cancer from February 2007 to March 2016, (93 patients) Perioperative and oncological data were collected. We used mixed statistical models to predict the number of patients needed in the learning phase. We compared the perioperative parameters of the patients in the learning phase with those of the rest of the patients. Overall survival was estimated using the Kaplan–Meier method.

Results

Thirty-six patients are required for the learning phase (P1). The expertise phase begins after the 36th LRC (P2). In both phases, there was no significant difference in age, ASA score, and tumor stage (P =0.237, P =0.577, P =0.998). Mean operative time was 328.3min and 262.4min in P1 and P2 (P =0.0001), mean blood loss was 333.7mL and 194.3mL in P1 and P2 respectively (P =0.0003). The rate of major complications was high in the learning phase (P =0.042). There was no significant difference in lymph node yield, positive surgical margins and overall survival (P =0.068, P =0.194, P =0.703).

Conclusion

This learning experience was evaluated without compromising oncological results, but with a significantly higher rate of major complications.

Level of evidence

3.

Objectives

In the operating room, a high sound level is associated with a higher risk of complications and affects the communication between the various workers. The objective of this study was to assess the sound level at the operating room during urological procedures.

Material and methods

A monocentric cross-sectional study was carried out in 100 procedures in urology. They were divided into four groups: open surgical procedures, endoscopic procedures, pure laparoscopic procedures, and robotic-assisted laparoscopic procedures. The sound level was measured with the Sound Metter by Examobile application (Bielsko-Biała, Poland) for i-phone^®.

Results

For all procedures, mean sound level, mean minimum sound level and mean maximum sound level were 60.31±3.3 db, 52.42±2.6 db and 81.73±2.8 db, respectively. For endourological procedures, they were 61.6±4.1 db, 53.4±4.1 db and 81.3±3.1 db, respectively. For open surgery, they were 59.0±1.0 db, 51.6±1.8 db and 81.4±1.5 db, respectively. For laparoscopic surgery, they were 58.33±0.6 db, 50.66±1.2 db and 83.33±1.5 db, respectively. Robotic-assisted laparoscopic surgery, they were 60.0±2.4 db, 52.5±2.3 db and 83.56±1.8 db, respectively. No difference was found according to the type of surgical approach. However, the sound level in the operating room was increased for endourological procedures using the laser technology as compared to endourological procedures without laser used (58.7±1.1 vs. 66.3±0.1 db, P =0.01, respectively).

Conclusion

The sound level in the operating room during urological procedures was high. For the endourological procedures, the sound level was the highest when the laser technology was used.

Level of evidence

3.

Introduction

Active cancer is a risk factor in the occurrence of venous thromboembolism (VTE). This is the second cause of death for these patients. In onco-urology, some cancers are associated with an increased risk of VTE. The aim of this study was to propose a focus of epidemiology and VTE therapy management.

Material and methods

A systematic analysis of the PubMed^® database was performed through the PRISMA methodology using the followings keywords : “neoplasm”, “venous thromboembolism”, “prophylaxis”, “pulmonary embolism”, “urology”. The original papers were included with a priority on: meta-analyzes, literature reviews, randomized controlled trials and good-level proof cohort studies. Only publications in English or French have been selected.

Results

The incidence of VTE was more important in case of renal carcinomas (3.5%/year). When surgery was proposed cystectomy was the riskiest procedure (2.6 to 11.6% VTE). Chemotherapy alone was an important risk factor increasing by a factor of six the occurrence of VTE. Hormonotherapy also increased this risk by induced hypogonadism. The curative treatment for VTE associated with cancers has to be performed through the injection of low molecular weight heparin. The implantation of a prophylactic treatment was not systematic among patients diagnosed with urological cancer.

Conclusion

The understanding of mechanisms associated with the occurrence of VTE among these patients has enabled to improve patient management, especially those suffering from urological cancer. Undeniably, frequency of VTE is probably underestimated by urologists during clinical practice.

Spermatic cord sarcomas are rare tumors for which the most important is the initial diagnostic procedure. They are frequently misdiagnosed after surgery for inguinal hernia, inguinal lymphadenectomy or testicular malignancy. Any clinical suspicion has to lead to perform imaging with MRI and a core needle biopsy in order to obtain an accurate preoperative diagnosis. Liposarcoma and leiomyosarcoma are the most common histological subtypes in elderly adults, rhabdomyosarcoma in children or in young adults. A CT scan will precede the treatment in order to look for distant metastasis and abdominal involvement. The therapeutic strategy as well as the surgical planning are then adapted to the histological, morphological and prognostic factors. Surgery is the cornerstone for the treatment of spermatic cord sarcoma. The minimum requirements for the surgical procedure are a wide excision of the tumor en bloc with radical orchidectomy, excision of the ipsilateral scrotum and high spermatic cord ligation. It could be enlarged to the anterior abdominal wall and adjacent organs some required a soft tissue flap. Spermatic cord sarcoma and trunk wall sarcoma have the same prognosis for which local recurrence could significantly decrease survival. Consequently, surgeon in charge with these tumors has to be familiar with soft tissue sarcoma and the management of these patients must be carried out under the supervision of a multidisciplinary team within the Netsarc network.

Objective

Presentation of data collected on urology claims from the register of a French insurance company.

Material and method

Compensation claims involving urologists covering the period 2009–2018 were identified and analyzed.

Results

A total of 37 files were found. Oncological and functional surgical interventions accounts for 78% of repair claims. Postoperative complications represent 76% of the cases. The most represented acts are total prostatectomy (5) and promonto-fixation (4). The average time of complaint is 28.6 months [1–144 months], the average duration of a procedure (opening–closing) is 32.8 months [12–72 months]. The Conciliation and Compensation Commissions (CCC) and the High Court Courts (HCC) were solicited respectively in 51% and 33% of the proceedings. An amicable agreement is found in 16% of cases. There was no criminal or disciplinary proceedings. The average cost of a closed urology file is 7836 € [0–31,120 €]. In total, 64.8% of the expertises confirm practices in the respect of the rules of the art.

Conclusion

This series presents the first forensic analysis of a portfolio of urologists on a period of 9 years in French urology. There is a rate of responsibility retained against the practitioner in only 27% of cases. The low rate of faulty files, the absence of a conviction for breach of the duty to provide information and in connection with antibiotic prophylaxis seem to confirm that the practice of urology in France is of good quality, a further study on a longer period of time and on a larger cohort of urologists would allow a finer medico-legal approach.

Level of evidence

3.