[Prognostic factors for severe infection after flexible ureteroscopy: Clinical interest of urine culture the day before surgery?]

OBJECTIVES

The objectives of this study have been to determine prognostic factors for acute pyelonephritis (AP) after flexible ureteroscopy (FU), to assess the frequency of readmission for AP and to study the usefulness of urinalysis the day before surgery.

METHODS

Between 2010 and 2013, 266 patients have had at least one ureteroscopy (n=325). All infectious complications and unplanned readmissions within the month after FU were retrospectively evaluated. Several data have been collected: age, sex, BMI, surgical indication (calculis or tumor), number of previous ureteroscopies, number of previous surgeries for calculis, stones number, size and location, bilateral interventions, operating time, preoperative ureteral stenting, postoperative stenting, hospitalization stay, urine culture the day before surgery (j-1) and prescription of antibiotic therapy the week before FU. Correlation between these variables and acute pyelonephritis (AP) the month following the USSR was tested (StatView 4.5, SAS Institute) (P<0.05 significant).

RESULTS

We observed 24 postoperative APs (7.4%), 17 prior to hospital discharge and 7 requiring rehospitalization. In univariate analysis, the significant prognostic factors of postoperative AP have been: stone size (>14 mm) (P=0.03); operating time (70 minutes) (P<0.005); positive day - 1 urine culture (P<0.001); antibiotics treatment the week before FU (P<0.001). In multivariate analysis, antibiotics prescription during the week before USSR remained significant (P<0.002; RR 5.8 [1.9-15]).

CONCLUSION

Acute pyelonephritis requiring unplanned admission after ureteroscopy is a rare complication (2.4%). Urinalysis one day before ureteroscopy could allow early antibiotic therapy and may reduce 63% of unplanned hospital admissions for acute pyelonephritis.

LEVEL OF EVIDENCE

5.

[Persistent Müllerian ducts syndrome: one case of late hypofertility]

We report the case of a 35-year-old patient with a syndrome of persistent Müllerian ducts (PMDS) of the female type (group A). The diagnosis was made in adulthood during an infertility workup. Clinical examination revealed an empty scrotum, a normal penis and bilateral inguinal cystic masses. The spermogram found azoospermia. Imaging using MRI and tomotensidometry found the presence of an uterus, two fallopian tubes and two inguinal positions of polycystic testes. A surgical management was performed for surgical testicular biopsy. Histological examination then found a cystic formation of multi-celled mesothelial origin, with atrophic testis Sertoli cell involution and without sperm. PMDS is a rare form of pseudo-internal hermaphroditism characterized by the presence in a man of the uterus, fallopian tubes and upper vagina with external male genitalia and virilized characters. About 200 cases are reported in the literature. The diagnosis is often made in children intraoperatively during a cure of testicular ectopia. The karyotype is 46 XY type. The pathogenesis is related to a deficiency of anti-Müllerian hormone (AMH) or tissue resistance to its action by receptor abnormalities. The regression of the Müllerian duct derivatives can give three types of PMDS : masculine type, feminine type and a transverse type. Surgical treatment is difficult but necessary because of the risk of infertility and ectopic testicular degeneration.

[Flexible ureteroscope damages. Evaluation of university hospital service equipment]

OBJECTIVE

To evaluate predictors of flexible ureterorenoscopes breakage and damage of their optical beam.

MATERIALS AND METHODS

Retrospective survey, single center on 393 interventions with 4 flexible ureterorenoscopes between January 2009 and March 2013. We analyzed factors linked to patient, pathology and surgical technique.

RESULTS

We identified 21 major accidents, a breakage rate of 5.34% and 76 pixels losses in the maintenance of endoscopes and 10 during the procedure. The only statistically significant predictor of loss was the cumulative duration of operating time since the last repair (P=0.04, OR=1.001 [1-1001]). For lesions of the optical beam between the procedures, parameters appearing as significant were the ureterorenoscope model (P=0.01, OR=2.558, 95% CI [1229-5326]), the use of instruments by the working channel: the laser (P=0.02, OR=2.06, 95% CI [1109-3827]), or the use of endoluminal graspers (P=0.007, OR=0.467, 95% CI [0269-0809]). Intraoperatively, the number of open or laparoscopic surgery (P=0.007, OR=3.105, 95% CI [1364-7068]), duration of intervention (P=0.01, OR=1.023, 95% CI [1.006-1041]) and the cumulative duration of intervention (P=0.003, OR=1.001, 95% CI [1-1002]) appeared to be statistically significant.

CONCLUSION

The only predictor of loss of equipment under repair was the cumulative duration of operation time. It has not been demonstrated any difference between ureterorenoscopes. It was during the endoscopes disinfection that the majority of optical beam lesions take place.

[Erosive complications of mid urethral slings (MUS): 10 years of surgical experience]

OBJECTIVE

Evaluation of the diagnostic and therapeutic management of erosive complications after mid urethral sling (MUS) procedure: vaginal erosions (VE), bladder (BE) and urethral (UE).

METHODS

Retrospective monocentric study concerning cohort of patients undergoing surgery from January 2002 to January 2013 supported for erosive complications of MSU: TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturateur Tape).

RESULTS

Sixteen patients were diagnosed for erosive complications: 7 VE, 6 BE and 3 UE. Dyspareunia and vaginal discharge were observed in 86% patients (n=6/7) with VE. Conservative treatment by vaginal approach was systematically performed in cases of vaginal erosion. After removal of material, 100% dyspareunia were corrected. Postoperative continence was maintained in 57% of patients (n=4/7). Urinary infection was the main symptom of patients with BE. Severe dysuria was present in 66% of patients with a UE (n=2/3). First-line therapy by endoscopic treatment was performed in 77% of patients (n=7/9) with a BE or UE. A second surgery was required in 42% of patients treated with endoscopic first-line therapy (n=3/7) because of a new exposure of MUS. Three of nine patients recurred their incontinence after first-line therapy (33%).

CONCLUSION

The removal of device exposed vaginally in case VE systematically corrected symptoms with about 60% of continence. In case of BE or UE, endoscopic treatment in first-line therapy was rarely definitive (42%) and recurrence of incontinence appeared in 30% cases.

[Screening of prostate cancer seen by general practitioners]

INTRODUCTION

The screening of prostate cancer was recently the subject of international studies and debates in France. We decided to study the vision of the screening, in particular by the PSA, which have the general practitioners.

METHODS

We sent a questionnaire to 456 general practitioners of Oise (French department) to be returned in an anonymous way on the prostate cancer, PSA, the economic impact of the PSA and we asked whether the doctors realized the screening or not, if they were favorable to it and for which reasons.

RESULTS

We received 38% of answers. Eighty-one percent of the general practitioners considered that prostate cancer is frequent, 72% that it evolved slowly and 55% that it affected old men. For 79% of the general practitioners, the patients were asking for a screening by PSA. Eighty-eight percent thought that they had to be in front line of the screening, 58% that the functional consequences of the screening were satisfactory. Fifty-seven percent of the general practitioners realized the screening in a systematic way and 88% were favorable to it.

CONCLUSION

The general practitioners of Oise remained favorable for the greater part to the screening of prostate cancer and the patients applicants in spite of various debates.

[Radical retropubic prostatectomy (RRP) without postoperative bladder catheter: study about 14 cases]

OBJECTIVES

To report the feasibility of radical retropubic prostatectomy (RRP) without postoperative bladder catheter.

MATERIAL & METHODS

We report our experience in 14 patients (mean age 62 [48-75]) who underwent radical retropubic prostatectomy for localised prostatic adenocarcinoma from May 2006 to January 2010. The surgical technique was performed as classically described, without bladder neck preservation (tennis-racket closure), with or without nerve sparing (JP). The criteria that led us not to drain were the satisfactory urethral length, a tension-free anastomosis performed on a bladder catheter with separate sutures, and a lack of anastomotic leack after bladder filling with 200cc.

RESULTS

The mean hospital stay was 4 days (3-8). Ten patients (71.4%) needed intermittent bladder catherism four times (1-11) before starting micturitions, without any technical difficulties. No anastomic leack was reported. Nine patients (64.3%) were continent leaving the hospital. With a mean follow-up of 30 months (5-48), all of 14 patients (100%) were perfectly continent. No anastomotic stricture was reported.

CONCLUSION

RRP without postoperative bladder catheter was feasible, with no other early or late complication associated. Early and late continence were perfect (100% at 2 years).