[Sexual consequences of BPH treatments]

OBJECTIVE

To review the literature on the sexual adverse effects of pharmacological, instrumental and surgical treatments of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH).

METHOD

A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review.

RESULTS AND CONCLUSION

Sexual dysfunction and SBAU/BPH are intimately linked by a cross-over effect in the population of men over 50, a possible common pathophysiology and treatments for BPH with sexual consequences. Evaluating the sexuality of patients in care for SBAU/BPH is therefore essential. Patients should be informed of potential adverse drug effects of BPH, including ejaculation disorders with alpha blockers and loss of libido and erectile dysfunction with 5 alpha reductase inhibitors. After BPH surgery, loss of antegrade ejaculation is common, although preservation possibilities exist. The improvement of urinary function and the decrease of possible ejaculatory pains have a beneficial effect on the sexuality of the BPH patients operated. More rarely, patients may experience orgasmic dysfunction or even erectile dysfunction with a possible thermal effect on the vasculo-nerve bundles.

LEVEL OF EVIDENCE

Consensus d'experts.

[Technique and management of urinary catheterization in men]

INTRODUCTION

In France, the urinary catheterization especially in men, is governed by Article R. 4311-10 of Decree No. 2004-802 of 29 July 2004 of the Public Health Code. Although this gesture is framed by law, there is currently no French guidelines formalized on a single and easily accessible support for the technique and management of the urinary catheterization. The aim of this study was to provide a simple reference about technical aspects and management of urinary catheterization in men.

MATERIALS AND METHODS

The European recommendations on urinary catheterization were updated and adapted with additional arguments in certain situations to cover all aspects of urinary catheterization. This work was conducted to improve the nurses knowledge about this topic.

RESULTS

We give here a reproducible technique in order to limit complications related to the most frequent invasive gesture in urology. We also propose a scheme to harmonize the management of indwelling urinary catheterization.

CONCLUSION

This work gives to nurses a practical document in order to standardize and to secure a gesture governed by dogmas since too long. The drafting of guidelines and the creation of educational tools for medical and para-medical personnel would probably improve practices in this topic.

LEVEL OF EVIDENCE

4.

[Partial nephrectomy for renal masses >7cm: Morbidity, oncological and functional outcomes (UroCCR-7 study)]

OBJECTIVES

To describe the morbidity, mortality, oncological and functional results of Partial nephrectomy (PN) for the treatment of renal tumors of more than 7cm.

MATERIAL AND METHODS

Thirty-seven partial nephrectomies for tumors larger than 7cm operated in a single center between 1987 and 2016 were analyzed retrospectively. The pre, per and postoperative clinico-biological data were collected within the UroCCR database. The GFR was assessed at day 5, 1 month and last follow-up. Intraoperative and postoperative surgical complications, the recurrence rate and the overall and specific mortality were collected.

RESULTS

The mean age of the patients was 57 years (44-68). The preoperative GFR and the median tumor size were 80mL/min and 8cm, respectively. The indication for surgery was elective in 21 cases (60%) and 19 tumors (54%) were malignant. Postoperative complications occurred in 24,3 cases (24.3%). The median post-operative GFR was respectively 77mL/min, 80mL/min and 77mL/min at day 5, 1month and at last follow-up. With a median follow up of 31 months [1-168], 5 patients (26,3%) had metastatic progression of whom 1 (5.3%) had a concomitant local recurrence and 3 (15.8%) had died from cancer.

CONCLUSION

This study confirms the feasibility of PN for large tumors with acceptable morbidity, limited risk of local recurrence and excellent functional results.

LEVEL OF EVIDENCE

4.

Subthalamic deep brain stimulation influences complex emotional musical experience in Parkinson's disease

Subthalamic deep brain stimulation (STN DBS) is an effective treatment for reducing the motor symptoms of patients with Parkinson's disease (PD), but several side effects have been reported, concerning the processing of emotions. Music has been shown to evoke powerful emotional experiences - not only basic emotions, but also complex, so-called aesthetic experiences. The goal of the present study was therefore to investigate how STN DBS influences the experience of both basic and more complex musical emotions in patients with PD. In a three-group between-participants design, we compared healthy controls (HC), patients receiving STN DBS (PD-DBS), and patients who were candidates for STN DBS and receiving medication only (PD-MO) on their assessments of subjectively experienced musical emotions. Results showed that in general, the experience of musical emotions differed only marginally between the PD-MO, PD-DBS, and HC groups. Nonetheless, we were able to discern subtle but distinct effects of PD and STN DBS in the emotional responses. Happy music, for instance, seemed to induce a heightened experience of negative emotions (tension) in PD-MO patients. STN DBS appeared to normalize this particular effect, but increased nostalgic feelings - a rather complex affective experience - in response to the same emotional stimuli. This should not be taken as indicating a bias for nostalgia in the PD-DBS subgroup, as these patients found music inducing melancholy to be less nostalgic and more joyful than HC did. In conclusion, our study showed that music elicits slightly altered emotional experiences in patients with and without STN DBS. In particular, STN DBS seems to induce less distinct emotional responses, blurring the boundaries between complex musical emotions.

[Where do we stand with benign prostatic hyperplasia day-case surgery: A laser effect?]

INTRODUCTION AND OBJECTIVES

Despite its feasibility has been proven, Benign Prostatic Hyperplasia (BPH) day-case surgery remains uncommon. Our objective was to describe the evolution of BPH day-case surgery in France according to the surgical technique employed.

MATERIALS AND METHODS

We extracted data from the Information System of Medicalization Program (PMSI) including all of the hospital stays in France from 2010 to 2016. Patients belonging to the transurethral prostatectomy homogeneous group of patients (GHM 12C04) and having as a main diagnosis prostatic hyperplasia (N40) or benign prostatic tumor (D291) were included in the analysis. From March 2016, specific codes were introduced to differentiate laser surgery and other types of surgery: JGFE023 (resection without laser), JGFE365 (laser resection) and JGNE171 (laser vaporization). We described the rates of day case surgery and the average length of stay from 2010 to 2016. From March 2016 we could study the influence of laser surgery on day-case and length of stay.

RESULTS

Regarding the all dataset analysis we found 328,781 hospital stays (318,549 patients) for BPH surgery, of which 2.7% (9047 hospital stays) were day-case. From 2010 to 2016, the lengths of stay decreased from 5.78 to 4.29 days. In the meantime, the number of day-case procedures increased from 14 patients (0.03%) to 3035 patients (5.63%). Regarding the last 9 months of 2016, we found 38,930 hospital stays including 5.4% (2104) day-cases. In total, 92.7% of day-case procedures had been performed with a laser technique, of which 47.9% (1008) were laser vaporization and 44.8% (944) were laser resection. There were only 7.1% (151.8%) of day-case procedures performed without laser.

CONCLUSION

The exponential development of the day-case procedures seems to be linked with the advent of laser technology. This tendency is expected to increase in the coming years according to the spreading of laser surgery.

LEVEL OF EVIDENCE

3.

[Endoscopic enucleation of the prostate: Indication, technique and results]

INTRODUCTION

Laser prostatic enucleation is an increasingly popular technique among surgical urology. It is now gradually becoming a contender for gold standard surgical treatments, trans-urethral resection of the prostate (TURP) and open prostatectomy (OP).

MATERIALS AND METHODS

This study is based on data collected from sources published between June 1995 and June 2017. Medline and Embase database have been used to research the following keywords: Holmium; Thulium; Greenlight; Laser; Prostate; Enucleation; Benign prostatic obstruction; Surgical technique.

RESULTS

With HoLEP process, catheterization time varies from 17,7hrs to 46,4hrs with 2 to 2.5 hospitalization days. With ThuLEP process, catheterization time varies from 2 to 2.5 days with 2.15 to 6.5 hospitalization days. With GreenLEP process, catheterization and hospitalization times are both 2 days. IPSS score after a year varies from 12.7 to 19.1 points in different publications.

CONCLUSION

Convincing results of Laser prostatic enucleation make it a valid alternative to existing treatments.

Influence du score de Gleason des marges chirurgicales de prostatectomie totale sur la récidive biologique

OBJECTIVES

The aim of this study was to assess the impact of the aggressiveness of cancer cells at the level of positive surgical margins (PSM) on the biochemical recurrence rate (BRR) by studying the Gleason score (GS) at this level.

METHODS

We included all radical prostatectomy (RP) procedures performed from January 2007 to November 2011. All of the RP specimens with PSM were reviewed to determine the GS at the level of PSM. We compared the GS at PSM with BRR.

RESULTS

A total of 658 RP were analysed, among which 16% had PSM. From the 101 patients with PSM included, 32% had biochemical recurrence (BR) with a median follow-up of 38 months. GS at PSM was significantly associated with earlier BR (P=0.008). Univariate analysis showed that GS at PSM (P=0.013), initial PSA (P<0.0001), pathologic GS (P<0.001), length of PSM (P=0.013), and seminal vesicle invasion (P<0.0001) were predictors of BR. Multivariate analysis confirmed that PSA greater than 10ng/mL and length of PSM greater than 3mm were independent prognostic factors for BR, but GS at the level of PSM was not.

CONCLUSION

GS at PSM was not confirmed as an independent risk factor for BR. Initial PSA greater than 10ng/mL and length of PSM greater than 3mm were the sole independent predictors for BR.

LEVEL OF PROOF

4.

Evaluation of bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction

OBJECTIVE

To evaluate bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction (BPO).

MATERIAL AND METHOD

Fifty-eight patients operated between 1998 and 2014, in seven French departments of Urology were included. Forty-five patients were operated by conventional surgery (transurethral resection of the prostate 38, open simple prostatectomies 7), and 13 patients were operated by Greenlight™ photovaporization of the prostate (PVP). In order to assess bleeding risk, blood transfusion was considered as the primary outcome.

RESULTS

Fifteen (26%) patients received blood transfusion in the postoperative period. Mean duration of hospitalization was 8.5 days. Secondary surgery was required in 12 cases (21%), including endoscopic clot removal under general anaesthesia in 10 patients, and suprapubic haemostasis in 3 patients. One patient died 72hours after transurethral resection of the prostate because of a massive pulmonary embolism. Two independent predictors of blood transfusion were identified: conventional surgery use versus PVP, and high preoperative PSA. Blood transfusion rate was significantly lower in the group of patients operated by PVP compared to conventional surgery (0% versus 33%, P=0.010). In addition, the laser surgery was associated with shorter duration of hospitalization (3.4 days versus 9.9 days, P=0.014). However, it was not found any significant difference between patients operated by PVP compared to conventional surgery in terms of secondary bleeding (3/13 vs 8/45, P=0.7), or second surgery (2/13 vs 10/45, P=0.5).

CONCLUSION

Bleeding risk of BPO surgery in patients with mechanical cardiac valve is high. The PVP seems to decrease significantly the early haemorrhagic risk compared to classic surgical procedures for patients with mechanical cardiac valve.

LEVEL OF EVIDENCE

4.

Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation

The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013-14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises 'focused vision' and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other.

Apathy in depression: An arterial spin labeling study

Introduction

Apathy is usually defined as a lack of goal-directed behavior. Although it is observed in about 30% of depressed patients, neurovascular mechanisms underpinning apathy remain little-known.

Objectives

The main objective of this study was to compare the cerebral perfusion of apathetic depressed patients with non-apathetic depressed patients by arterial spin labeling (ASL), a quantitative and non-invasive perfusion magnetic resonance imaging (MRI) technique. The secondary objectives were to study their clinical profile and their correlation with cerebral perfusion data.

Methods

This study was conducted from a cohort of depressed patients in Rennes, France. Eighty-three depressed patients were included, of whom 22 were apathetic (AES≥42), 61 non-apathetic (AES < 42). Everyone got a clinical evaluation with scale screenings, especially for apathy (AES), anxiety (STAI) and anhedonia (SHAPS) as well as a cerebral MRI, including a pseudo-continuous ASL sequence.

Results

Apathetic depressed patients were significantly less anxious and less anhedonic. Apathetic perfused better than non-apathetic in the inferior frontal gyrus (P = 0.022). We found a significant positive relationship between apathy and perfusion of the left frontal inferior gyrus (P = 0.05, r = 0.21). State-anxiety was positively correlated with perfusion of the cingulate cortex, the insula and the left amygdala. Anhedonia was positively correlated with the perfusion of the ventromedial prefrontal cortex, the cingulate cortex and the insula.

Conclusions

We have shown that the clinical and perfusional profiles of apathetic depressed and non-apathetic differ. This study suggests the existence of two distinct neurobiological networks for depressed patients; one involving motivational networks for apathetic patients, and another one involving emotional networks for more anhedonic patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.