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Beauval JB, Khene ZE, Roumiguié M, Rahota R, Mejean A, Doumerc N, Roupret M, Paparel P, Villers A, Bruyere F, Lebacle C, Nouhaud FX, Champy C, de la Taille A, Lang H, Rizk J, Durand M, Dariane C, Charles T, Boissier R, Long JA, Bigot P, Bensalah K, Bernhard JC. Open versus robotic partial nephrectomy in obese patients: a multi-institutional propensity score-matched analysis (UroCCR 43-Robese study). World J Urol 2024; 42:213. [PMID: 38581466 DOI: 10.1007/s00345-024-04890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/06/2023] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION There is limited evidence on the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN) in obese patients (BMI ≥ 30 kg/m2). In this study, we aimed to compare perioperative and oncological outcomes of RPN and OPN. METHODS We relied on data from patients who underwent PN from 2009 to 2017 at 16 departments of urology participating in the UroCCR network, which were collected prospectively. In an effort to adjust for potential confounders, a propensity-score matching was performed. Perioperative outcomes were compared between OPN and RPN patients. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS Overall, 1277 obese patients (932 robotic and 345 open were included. After propensity score matching, 166 OPN and 166 RPN individuals were considered for the study purposes; no statistically significant difference among baseline demographic or tumor-specific characteristics was present. A higher overall complication rate and major complications rate were recorded in the OPN group (37 vs. 25%, p = 0.01 and 21 vs. 10%, p = 0.007; respectively). The length of stay was also significantly longer in the OPN group, before and after propensity-score matching (p < 0.001). There were no significant differences in Warm ischemia time (p = 0.66), absolute change in eGFR (p = 0.45) and positive surgical margins (p = 0.12). At a median postoperative follow-up period of 24 (8-40) months, DFS and OS were similar in the two groups (all p > 0.05). CONCLUSIONS In this study, RPN was associated with better perioperative outcomes (improvement of major complications rate and LOS) than OPN. The oncological outcomes were found to be similar between the two approaches.
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Affiliation(s)
- Jean Baptiste Beauval
- Department of Urology, Clinique La Croix du Sud, Quint Fonsegrives, Toulouse, France.
| | | | - Mathieu Roumiguié
- Department of Urology, University Hospital of Rangueil, Toulouse, France
| | - Razvan Rahota
- Department of Urology, Clinique La Croix du Sud, Quint Fonsegrives, Toulouse, France
| | | | - Nicolas Doumerc
- Department of Urology, University Hospital of Rangueil, Toulouse, France
| | - Morgan Roupret
- Department of Urology, La Pitié Salpétrière, Paris, France
| | | | | | - Franck Bruyere
- Department of Urology, University Hospital, Tours, France
| | - Cédric Lebacle
- Department of Urology, Kremlin Bicetre University Hospital, Paris, France
- Department of Urology, University Hospital, Bordeaux, France
| | | | - Cécile Champy
- Department of Urology, Mondor University Hospital, Créteil, France
| | | | - Hervé Lang
- Department of Urology, University Hospital, Strasbourg, France
| | - Jérome Rizk
- Department of Urology, St Joseph Hospital, Paris, France
| | - Mathieu Durand
- Department of Urology, University Hospital, Nice, France
| | | | - Thomas Charles
- Department of Urology, University Hospital, Poitiers, France
| | - Romain Boissier
- Department of Urology, University Hospital, Marseille, France
| | | | - Pierre Bigot
- Department of Urology, University Hospital, Angers, France
| | - Karim Bensalah
- Department of Urology, University Hospital, Rennes, France
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Debard C, Doumerc N, Dariane C, Bruyère F, Rizk J, Lebacle C, Bigot P, De La Taille A, Nouhaud F, Lang H, Bensalah K, Mejean A, Bernhard J. Multifocal renal tumours: A matched comparative study between robotic and open partial nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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3
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Chebbi A, Peyronnet B, Giwerc A, Freton L, Hutin M, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Matillon X, Caes T, Patard PM, Szabla N, Brichart N, Boehm A, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Rod X, Fiard G, Pradere B, Pfister C, Nouhaud FX. Observation vs. early drainage for grade IV blunt renal trauma: a multicenter study. World J Urol 2020; 39:963-969. [PMID: 32447442 DOI: 10.1007/s00345-020-03255-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/11/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The aim of this study was to compare observation and early drainage by ureteral stenting in patients with blunt renal trauma and urinary extravasation. MATERIALS AND METHODS A retrospective national multicenter study was performed including all patients admitted for renal trauma at 17 hospitals between 2005 and 2015. Patients presenting with a urinary extravasation on initial imaging were considered for inclusion. Patients were divided in two groups according to the initial approach: observation vs. early drainage by ureteral stent (within 48 h after admission). The primary endpoint was the persistence of urinary extravasation on follow-up imaging. RESULTS Out of 1799 patients with renal trauma, 238 were included in the analysis (57 in the early drainage and 181 in the observation group). In the early drainage group, 29 patients had persistent urinary extravasation vs. 77 in the observation group (50.9% vs. 42.5%; p value = 0.27). The rates of secondary upper urinary tract drainage did not differ significantly between the early drainage group (26.4%) and the observation group (16%) (p = 0.14). There were no statistically significant differences between the two groups in terms of secondary nephrectomy (0% vs. 2.8%; p = 0.34), and death from trauma (0% vs. 1.8%; p = 0.99). In multivariate analysis, early drainage remained not statistically associated with persistence of urinary extravasation on follow-up imaging (OR = 1.35; p = 0.36) CONCLUSION: In this multicenter cohort, observation was not different from early drainage in terms of persistent urinary extravasation after grade IV blunt renal trauma. Further randomized controlled prospective trials are needed to confirm these findings.
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Affiliation(s)
- Ala Chebbi
- Urology, University of Rouen, Rouen, France.
- Service d'urologie, Hopital Charles Nicolle, 37 boulevard Gambetta, 76000, Rouen, France.
| | | | | | | | - Marine Hutin
- Urology, University of Montpellier, Montpellier, France
| | | | | | - Marina Ruggiero
- Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | | | | | - Reem Betari
- Urology, University of Amiens, Amiens, France
| | | | | | | | | | | | | | - Laura Sabourin
- Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Cédric Lebacle
- Urology, University of Paris Sud, CHU Bicetre, Paris, France
| | | | | | | | - Xavier Rod
- Urology, University of Nantes, Nantes, France
| | - Gaelle Fiard
- Urology, University of Grenoble, Grenoble, France
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Freton L, Pradere B, Fiard G, Chebbi A, Caes T, Hutin M, Olivier J, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Patard PM, Szabla N, Brichart N, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec FX, Rod X, Nouhaud FX, Matillon X, Peyronnet B. [Renal Trauma]. Prog Urol 2019; 29:936-942. [PMID: 31668829 DOI: 10.1016/j.purol.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Renal traumas are common, observed in 10% of patients with abdominal trauma. Most renal traumas are blunt, resulting from a direct hit or from an abrupt deceleration. MATERIAL AND METHODS We realized a synthesis of renal trauma management for nurses. RESULTS Clinical presentation often encompasses gross hematuria and lumbar pain. The best diagnostic tool is computed tomography (CT) urogram. Based on CT urogram images, renal traumas are classified according to the American Association for the Surgery of Trauma (AAST) classification in five grades of increasing severity. The management is conservative in the vast majority of cases and has been largely simplified over the past few years, being now mostly based on observation. Radiological interventional and endoscopic procedures are used only in very selected cases and surgical exploration has become extremely rare. CONCLUSION The prognosis has also considerably improved and renal trauma rarely result in death or loss of the kidney nowadays.
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Affiliation(s)
- L Freton
- Service d'urologie, université de Rennes, 35000 Rennes, France.
| | - B Pradere
- Service d'urologie, PRES Centre Val-de-Loire, CHRU de Tours et université François-Rabelais de Tours, 37000 Tours, France
| | - G Fiard
- Service d'urologie, université de Grenoble, 38700 Grenoble, France
| | - A Chebbi
- Service d'urologie, université de Rouen, 76000 Rouen, France
| | - T Caes
- Service d'urologie, université de Lille, 59000 Lille, France
| | - M Hutin
- Service d'urologie, université de Montpellier, 34000 Montpellier, France
| | - J Olivier
- Service d'urologie, université de Lille, 59000 Lille, France
| | - M Ruggiero
- Service d'urologie, université de Paris Sud, CHU de Bicêtre, 94270 Paris, France
| | - I Dominique
- Service d'urologie, université de Lyon, 69002 Lyon, France
| | - C Millet
- Service d'urologie, université de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - S Bergerat
- Service d'urologie, université de Strasbourg, 67000 Strasbourg, France
| | | | - R Betari
- Service d'urologie, université de Brest, 29200 Brest, France
| | - P-M Patard
- Service d'urologie, université de Toulouse, 31300 Toulouse, France
| | - N Szabla
- Service d'urologie, université de Caen, 14033 Caen, France
| | - N Brichart
- Service d'urologie, CHR d'Orléans, 45100 Orléans, France
| | - L Sabourin
- Service d'urologie, université de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - K Guleryuz
- Service d'urologie, université de Caen, 14033 Caen, France
| | - C Dariane
- Service d'urologie, université de Paris-Descartes, 75006 Paris, France
| | - C Lebacle
- Service d'urologie, université de Paris Sud, CHU de Bicêtre, 94270 Paris, France
| | - J Rizk
- Service d'urologie, université de Lille, 59000 Lille, France
| | - A Gryn
- Service d'urologie, université de Toulouse, 31300 Toulouse, France
| | - F-X Madec
- Service d'urologie, hôpital Saint-Joseph, 75014 Paris, France
| | - X Rod
- Service d'urologie, université de Nantes, 44000 Nantes, France
| | - F-X Nouhaud
- Service d'urologie, université de Rouen, 76000 Rouen, France
| | - X Matillon
- Service d'urologie, université de Lyon, 69002 Lyon, France
| | - B Peyronnet
- Service d'urologie, université de Rennes, 35000 Rennes, France
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Beauval J, Méjean A, Doumerc N, Roupret M, Paparel P, Villers A, Bruyere F, Lebacle C, Nouhaud F, De la Taille A, Rizk J, Lang H, Durand M, Dariane C, Charles T, Boissier R, Long J, Bensalah K, Bernard J. Résultats de la néphrectomie partielle RObot-assistée chez les patients oBESEs avec IMC >30 kg/m2 (étude UroCCR-43 : RoBèse). Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pradere B, Peyronnet B, Khene Z, Delporte G, Manach Q, Moulin M, Rizk J, Brichart N, Beauval J, Benoit T, Upret M, Bex A, Bruyere F, Bensalah K. Résultats oncologiques des tumeurs kystiques du rein comparées aux tumeurs solides : étude multicentrique. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Freton L, Scailteux L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Lebacle C, Rizk J, Matillon X, Gryn A, Madec F, Nouhaud F, Rod X, Hutin M, Fiard G, Pradere B, Peyronnet B. Traumatisme rénal de bas grade et durée de séjour : vers une prise en charge ambulatoire ? Résultats de l’étude multicentrique traumAFUf avec analyse par score de propension. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Marquette T, Klein C, De Graeve B, Mallet R, Houssin V, Rizk J, Comat V, Bernhard J, Capon G, Ferrière J, Robert G. Évaluation de la fonction érectile après énucléation prostatique au laser holmium. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Houssin V, Villers A, Robert G, Marquette T, Mallet R, Baumert H, Rizk J. Incidence de l’incontinence urinaire après holep : registre descriptif, prospectif, national, multicentrique. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Borojeni S, Rizk J, Corno L, Gaudillat C, Fizazi K, Baumert H. Néphrectomie partielle pour tumeur rénale complexe. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Rizk J, Latus H, Zimmermann J, Mkrtchyan N, Martinoff S, Hennemuth A, Stern H, Ewert P, Meierhofer C. P872Temporal and spatial distribution of wall shear stress in the main pulmonary artery in tetralogy of Fallot patients using four dimensional flow cardiovascular magnetic resonance. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Rizk
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - H Latus
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - J Zimmermann
- Technical University of Munich, Department of Computer Science, Munich, Germany
| | - N Mkrtchyan
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - S Martinoff
- Deutsches Herzzentrum Technische Universitat, Department of Radiology and Nuclear Medicine, Munich, Germany
| | - A Hennemuth
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Stern
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - P Ewert
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - C Meierhofer
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
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Pradere B, Peyronnet B, Delporte G, Manach Q, Khene ZE, Moulin M, Roumiguié M, Rizk J, Brichart N, Beauval JB, Cormier L, Bex A, Rouprêt M, Bruyère F, Bensalah K. Intraoperative Cyst Rupture during Partial Nephrectomy for Cystic Renal Masses-Does it Increase the Risk of Recurrence? J Urol 2018; 200:1200-1206. [PMID: 29935273 DOI: 10.1016/j.juro.2018.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Our objective was to assess the prevalence of intraoperative cyst rupture and its impact on oncologic outcomes. MATERIALS AND METHODS All patients who underwent partial nephrectomy for a cystic renal mass via an open or robot-assisted approach at a total of 8 academic institutions were included in this retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as cyst rupture. Multivariate logistic regression analysis was done to assess the variables associated with cyst rupture. Recurrence-free, cancer specific and overall survival was estimated by the Kaplan-Meier method and compared with the log rank test. RESULTS Overall 268 patients were included in study. There were 50 intraoperative cyst ruptures (18.7%) in the whole cohort. No preoperative parameter was significantly associated with a risk of intraoperative cyst rupture on univariate or multivariate analysis. Of the cystic renal masses 75% were malignant on the final pathology report. At a median followup of 32 months 5 patients (2.5%) had local recurrence while progression to metastasis was observed in 2%. There were no peritoneal carcinomatosis nor port site metastasis. There was also no local or metastatic recurrence in the subgroup with intraoperative cyst rupture. Estimated recurrence-free survival did not differ significantly between patients with vs without intraoperative cyst rupture at 100% vs 92.7% at 5 years (p = 0.20). CONCLUSIONS Intraoperative cyst rupture during partial nephrectomy is a relatively common occurrence but with few oncologic implications.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France.
| | - Benoit Peyronnet
- Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Gauthier Delporte
- Department of Urology, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - Quentin Manach
- Department of Urology, Hôpital Pitié-Salpetrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zine-Eddine Khene
- Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Morgan Moulin
- Department of Urology, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Mathieu Roumiguié
- Department of Urology, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Jérome Rizk
- Department of Urology, Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - Nicolas Brichart
- Department of Urology, Centre Hospitalier Orléans, Orléans, France
| | | | - Luc Cormier
- Department of Urology, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Axel Bex
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Department of Urology, Hôpital Pitié-Salpetrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Franck Bruyère
- Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France
| | - Karim Bensalah
- Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France
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Caës T, Rizk J, Olivier J, Hutin M, Bergerat S, Betari R, Freton L, Ruggiero M, Panayatopoulos P, Patard P, Dariane C, Fiard G, Peyronnet B, Pradere B, Nouhaud FX, Langouet Q, Dominique I, Matillon X, Chebbi A, Szabla N, Brichart N, Sabourin L, Guleryuz K, Bohem A, Millet C, Rod X, Lebacle C, Gryn A, Madec FX. Facteurs de risque d’échec du traitement conservateur des traumatismes du rein : une étude multicentrique (TRAUMAFUF). Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Patard P, Abbo O, Gryn A, Bergerat S, Matillon X, Betari R, Ruggiero M, Dominique I, Freton L, Rod X, Dariane C, Lebacle C, Pradere B, Fiard G, Peyronnet B, Panayatopoulos P, Olivier J, Langouet Q, Millet C, Hutin M, Chebbi A, Caes T, Szabla N, Brichart N, Sabourin L, Guleryuz K, Rizk J, Madec FX, Nouhaud FX. Comparaison des caractéristiques et de la prise en charge des traumatismes rénaux entre la population adulte et pédiatrique. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Helfrich O, Puech P, Betrouni N, Pinçon C, Ouzzane A, Rizk J, Marcq G, Randazzo M, Durand M, Lakroum S, Leroy X, Villers A. Quantified analysis of histological components and architectural patterns of gleason grades in apparent diffusion coefficient restricted areas upon diffusion weighted MRI for peripheral or transition zone cancer locations. J Magn Reson Imaging 2017; 46:1786-1796. [PMID: 28383776 DOI: 10.1002/jmri.25716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/14/2017] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To quantify and compare the histological components and architectural patterns of Gleason grades in cancerous areas with restriction on apparent diffusion coefficient (ADC) maps. MATERIALS AND METHODS Twelve consecutive cases with 14 separate ADC restriction areas, positive for cancer in the peripheral zone (PZ) and transition zone (TZ) were included. All had 3 Tesla MRI and radical prostatectomy. Ten regions of interest (ROIs) within and outside the 14 ADC restriction areas positive for cancer were selected. For each ROI, we performed quantitative analysis of (a) prostate benign and malignant histological component surface ratios, including stroma, glands, epithelium, lumen, cellular nuclei; (b) percent of Gleason grades and measures of ADC values. Means of histological components according to ADC restriction for cancerous area were compared with analyses of variance with repeated measures. RESULTS Independent predictors of the probability of cancer were median epithelium/ROI ratio (P = 0.001) and nuclei/ROI ratio (P = 0.03). Independent predictors of the probability of ADC restriction were malignant glands/ROI and luminal space/ROI (P < 0.0001). Effect of malignant glands/ROI area was different according to the localization of the ROI (P = 0.03). We observed an overall difference between the means for all of the histological components for the comparison of true positive and false negative (P < 0.0001), except for the percent of Gleason grade 4 (P = 0.18). In TZ cancers, a predominant grade 3 pattern was associated with low ADC values. In PZ cancers, a predominant grade 4 pattern was associated with low ADC values. CONCLUSION Determinants of low ADC were high ratio of malignant glands/ROI area which may be seen in Gleason grades 3 or 4 cancers. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1786-1796.
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Affiliation(s)
- Olivier Helfrich
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Philippe Puech
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France.,Department of Radiology, CHRU Lille, Lille university, Lille, France
| | - Nacim Betrouni
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Claire Pinçon
- EA 2694 - Lille university, Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Adil Ouzzane
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Jérome Rizk
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Gauthier Marcq
- Department of Urology, CHRU Lille, Lille university, Lille, France
| | - Marco Randazzo
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Matthieu Durand
- Department of Urology, CHU Nice, Nice-Sophia-Antipolis University, France
| | - Said Lakroum
- Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
| | - Xavier Leroy
- Department of Pathology, CHRU Lille, Lille university, Lille, France
| | - Arnauld Villers
- Department of Urology, CHRU Lille, Lille university, Lille, France.,Inserm, U1189 - ONCO-THAI, CHRU Lille, Lille university, France
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PRADERE B, PEYRONNET B, Manach Q, Khene Z, Delporte G, Rizk J, Beauval JB, Seisen T, Moulin M, Brichart N, Bex A, Roupret M, Bruyère F, BENSALAH K. MP55-09 OPEN PARTIAL NEPHRECTOMY VS. ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CYSTIC RENAL MASSES: IMPACT OF PEROPERATIVE CYSTIC SPILLAGE AND ONCOLOGICAL RESULTS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Freton L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayatopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Dariane C, Lebacle C, Rizk J, Gryn A, Madec F, Nouhaud F, Pradere B, Bensalah K, Fiard G, Peyronnet B. Traumatismes du rein de bas grade : vers une prise en charge en ambulatoire ? Résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pradere B, Freton L, Olivier J, Langouet Q, Ruggiero M, Dominique I, Millet C, Bergerat S, Panayotopoulos P, Betari R, Matillon X, Chebbi A, Caes T, Boehm A, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Lebacle C, Rizk J, Gryn A, Nouhaud F, Madec F, Dariane C, Bensalah K, Fiard G, Peyronnet B. Incidence et facteur prédictifs des pseudo-anévrysmes au cours des traumatismes du rein : résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peyronnet B, Bergerat S, Betari R, Freton L, Olivier J, Ruggiero M, Panayatopoulos P, Langouet Q, Dominique I, Matillon X, Chebbi A, Caes T, Patard P, Szabla N, Brichart N, Bohem A, Sabourin L, Guleryuz K, Millet C, Dariane C, Lebacle C, Rizk J, Gryn A, Madec F, Nouhaud F, Pradère B, Bensalah K, Fiard G. Faut-il maintenir les patients en décubitus dorsal après un traumatisme du rein ? Résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pradere B, Peyronnet B, Manach Q, Delporte G, Khene Z, Moulin M, Benoit T, Cormier L, Rizk J, Brichart N, Beauval J, Méjean A, Bex A, Roupret M, Bruyère F, Bensalah K. Néphrectomie partielle ouverte vs. robot assistée pour tumeurs kystiques : impact de la rupture de kyste peropératoire et résultats oncologiques. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dominique I, Ruffion A, Matillon X, Freton L, Betari R, Dariane C, Millet C, Ruggiero M, Chebbi A, Olivier J, Langouet Q, Bergerat S, Panayotopoulos P, Caes T, Patard P, Szabla N, Brichart N, Sabourin L, Guleryuz K, Lebacle C, Rizk J, Madec F, Nouhaud F, Pradere B, Saint F, Fiard G, Peyronnet B. Complications rénales à long terme des traumatismes rénaux : résultats de l’étude multicentrique nationale Traumafuf. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pradere B, Peyronnet B, Delporte G, Manach Q, Khene Z, Moulin M, Cormier L, Benoit T, Brichart N, Rizk J, Beauval J, Méjean A, Bex A, Roupret M, Bensalah K, Bruyère F. Résultats périopératoires des voies d’abord ouverte et robot assistée dans les néphrectomies partielles pour tumeurs kystiques : étude multicentrique internationale. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Madec FX, Dariane C, Pradere B, Amadane N, Bergerat S, Gryn A, Lebacle C, Matillon X, Olivier J, Nouhaud FX, Panayotopoulos P, Peyronnet B, Rizk J, Sanson S, Seisen T, Salomon L, Fiard G. [French resident's performance on laparoscopic surgery box trainer: 7-year results of pelvitrainer contests]. Prog Urol 2016; 26:1171-1177. [PMID: 28279367 DOI: 10.1016/j.purol.2016.09.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The study objectives were to analyze the resident's laparoscopic surgery performance in order to build a self-assessment data set, to identify discriminatory exercises and to investigate the suturing time changes. METHODS From 2007 to 2014, the French Association of Urologist in Training (AFUF) organized 7 pelvitrainer contests. Participant scores on 11 laparoscopic surgery exercises were evaluated. RESULTS Sixty-six residents participated to these contests and performed 11 exercises each. Twenty-two (33.3 %) participants were beginners, 26 (39.4 %) intermediates et 18 (27.3 %) experienced. The participant scores were gathered into a data set including the average time per exercise. We found a time scoring improvement related to the resident experience for all exercises. A significant decline in time was noted for exercise 8 and 9 between beginners and intermediates (139s [±71]), (173.9s [±118.3]) and between beginners and experienced (80.6s [±26.7]), (94,1s [±42.7]) with a P<0.05. The correlation coefficient for the exercise 11 duration (vesico-uretral anastomosis) was 0.04 over a 7-year period (P=0.44). CONCLUSION The study provided a data set on 11 laparoscopic surgery tasks which can be consulted by all residents as a reference in a self-assessment process. Two exercises (8 and 9) discriminated beginners from intermediates and experienced groups and could be used as a benchmark ahead of an operating room procedure. The vesico-uretral anastomosis duration (exercise 11) did not improve significantly between 2006 and 2014. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F-X Madec
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - C Dariane
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - B Pradere
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - N Amadane
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Giraud, 34295 Montpellier cedex 5, France
| | - S Bergerat
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier universitaire de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Gryn
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Département d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex, France
| | - C Lebacle
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Henri-Mondor, CHU Paris-Est, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - X Matillon
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et chirurgie de la transplantation, hôpital Édouard-Herriot, centre hospitalier universitaire de Lyon, 3, place d'Arsonval, 69003 Lyon, France
| | - J Olivier
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - F-X Nouhaud
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Rouen Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - P Panayotopoulos
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - B Peyronnet
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - J Rizk
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - S Sanson
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Département d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, 31059 Toulouse cedex, France
| | - T Seisen
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, université Pierre-and-Marie-Curie, 75013 Paris, France
| | - L Salomon
- Service d'urologie, hôpital Henri-Mondor, CHU Paris-Est, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - G Fiard
- Association française des urologues en formation (AFUF), 11, rue Viète, 75017 Paris, France; Service d'urologie et de la transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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Juaneda R, Thanigasalam R, Rizk J, Perrot E, Theveniaud P, Baumert H. Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas. Actas Urol Esp 2016; 40:43-8. [PMID: 26233479 DOI: 10.1016/j.acuro.2015.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. MATERIALS AND METHODS We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. RESULTS There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P<.0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P>.99). CONCLUSION Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay.
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Rizk J, Ouzzane A, Flamand V, Fantoni J, Leroy X, Villers A. Résultats carcinologiques après prostatectomie totale pour cancer par voie ouverte et laparoscopique avec ou sans assistance robotisée : résultats à 10 ans. Prog Urol 2014; 24:866. [DOI: 10.1016/j.purol.2014.08.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Celhay O, Brichart N, Audenet F, Capon G, Dariane C, Fiard G, Lebdaï S, Madec F, Maurin C, Sanson S, Rizk J, Tanchoux C, Thibault F, Terrasa J, Murez T, Terrier J. Accessibilité prévisible au post-internat d’urologie jusqu’en 2016. Prog Urol 2014; 24:836. [DOI: 10.1016/j.purol.2014.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Celhay O, Brichart N, Audenet F, Capon G, Dariane C, Fiard G, Lebdai S, Madec FX, Maurin C, Sanson S, Rizk J, Tanchoux C, Thibault F, Terrasa JB, Murez T, Terrier JÉ. Accessibilité prévisible au post-internat d’urologie en France jusqu’en 2016 : une mise à jour de l’AFUF. Prog Urol 2014; 24:658-64. [DOI: 10.1016/j.purol.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/23/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Dariane C, Rizk J, Meyer F, Audenet F, Brichart N, Capon G, Fiard G, Lebdai S, Madec FX, Maurin C, Murez T, Sanson S, Tanchoux C, Terrasa JB, Thibault F, Terrier JE. [Current state of compensation of on-duty and on-call urologists in France: a study from AFUF]. Prog Urol 2014; 24:456-62. [PMID: 24861686 DOI: 10.1016/j.purol.2013.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/13/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The French Association of Urologists-in-training (AFUF) aimed to assess the current state of remunerations of on-call and on-duty residents, assistants and lecturers in urology in France. MATERIAL AND METHODS Data were collected from February to May 2013 through a questionnaire sent to all members of the AFUF (327 members). Remunerations were given in gross values. RESULTS Forty-three residents took part in the study, 16 assistants and 16 lecturers, representing 62 % of the whole centers (54 hospitals out of the 92 centers practicing urology in France). Most of responders were on security or operational on-call. Twenty hospitals were practicing multi-organ removal. Median remunerations of residents were about 59.51€ per on-call when moving at hospital for work and about 119.02€ per onsite duty. Assistants and lecturers were paid a flat fee rate for 37.5 % of them (140€ for assistants [with variability from 40 to 195€] and 130€ for lecturers [42.5-180]) or an hourly rate depending on the hours spent at hospital for the others (62.5 %): first, second move or move<3h were paid 100€ for assistants and 65€ for lecturers, 233.5€ and 236€ respectively for the third one or above 3h, 365€ and 473€ respectively above 8h. Multi-organ removals were paid a flat fee rate (60 %) or an hourly rate (40 %) as well. Beyond a threshold of 2-3hours, the hourly rate was more interesting than the flat fee rate. CONCLUSION There were disparities in remuneration of on-call and on-duty urologists. Greater variability affected on-call flat fee rate remuneration beyond a certain threshold of hours and remuneration of multi-organ removal. These disparities should be considered in order to get a national harmonization.
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Affiliation(s)
- C Dariane
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - J Rizk
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Claude-Huriez, CHRU de Lille, 2, rue Michel-Polonovski, 59000 Lille, France
| | - F Meyer
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU Claude-Bichat, 46, rue Henri-Huchard, 75018 Paris, France
| | - F Audenet
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - N Brichart
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - G Capon
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - G Fiard
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - S Lebdai
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - F-X Madec
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Maurin
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU Conception, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - T Murez
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Lapeyronie, CHU de Montpellier, 317, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - S Sanson
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Rangueil, CHU de Toulouse, 1, avenue du Pr-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex, France
| | - C Tanchoux
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - J-B Terrasa
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU Tenon, 4, rue de la Chine, 75020 Paris, France
| | - F Thibault
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU Brabois, allée du Morvan, 54511 Vandœuvre-les-Nancy, France
| | - J-E Terrier
- Association française des urologues en formation, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Nord, CHU de Saint-Étienne, avenue A.-Raimond, 42270 St-Priest-en-Jarez, France
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Fiard G, Capon G, Rizk J, Maurin C, Dariane C, Audenet F, Tanchoux C, Brichart N, Lebdai S, Sanson S, Madec FX, Thibault F, Terrasa JB, Murez T, Terrier JE. Évaluation de l’utilisation de la simulation dans la formation des jeunes urologues français : une enquête de l’association française des urologues en formation (AFUF). Prog Urol 2014; 24:390-6. [DOI: 10.1016/j.purol.2013.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/11/2013] [Accepted: 10/26/2013] [Indexed: 11/28/2022]
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Dariane C, Rizk J, Audenet F, Brichart N, Capon G, Fiard G, Lebdai S, Madec F, Maurin C, Murez T, Sanson S, Tanchoux C, Terrasa J, Thibault F, Terrier J. Disparités inter- et intra-régionales de rémunération des astreintes et gardes des internes, assistants et chefs de clinique d’urologie en France : étude de l’AFUF. Prog Urol 2013. [DOI: 10.1016/j.purol.2013.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Brembilla-Perrot B, Moulin-Zinsch A, Sellal JM, Schwartz J, Olivier A, Zinzius PY, De Chillou C, Beurrier D, Rodermann M, Goudote G, Al Amoura H, Terrier de la Chaise A, Lemoine J, Rizk J, Lethor JP, Anne Tisserand JL, Taïhi S, Marçon F. Impact of transesophageal electrophysiologic study to elucidate the mechanism of arrhythmia on children with supraventricular tachycardia and no preexcitation. Pediatr Cardiol 2013; 34:1695-702. [PMID: 23609066 DOI: 10.1007/s00246-013-0703-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
An electrophysiologic study (EPS) of children and teenagers with paroxysmal supraventricular tachycardia (SVT) and normal electrocardiography (ECG) in sinus rhythm was evaluated. Generally, EPS is performed only before paroxysmal SVT ablation in these patients. In this study, 140 patients (mean age, 15 ± 3 years) with normal ECG in sinus rhythm were studied for SVT by a transesophageal route in baseline state and after isoproterenol. Idiopathic left or right ventricular tachycardia was diagnosed in four patients (3 %). Anterograde conduction over an atrioventricular (AV) left lateral (n = 10) or septal (n = 9) accessory pathway (AP) was noted in 19 patients (13.5 %) at atrial pacing. Orthodromic AV reentrant tachycardia (AVRT) was induced in these children. Five of the patients had a high rate conducted over AP (>240 bpm in baseline state or >290 bpm after isoproterenol). Two of the patients (a 10-year-old girl with well-tolerated SVT and a 17-year-old with syncope-related SVT) had the criteria for a malignant form with the induction of atrial fibrillation conducted over AP at a rate exceeding 290 bpm in baseline state. Of the 140 patients, 74 (53 %) had typical AV node reentrant tachycardia (AVNRT), nine had atypical AVNRT (6 %), 1 had atrial tachycardia (0.7 %), and 33 (23.5 %) had AVRT related to a concealed AP with only retrograde conduction. Electrophysiologic study is recommended for children with paroxysmal SVT and normal ECG in sinus rhythm. The data are helpful for guiding the treatment. Ventricular tachycardia or atrial tachycardia can be misdiagnosed. Masked preexcitation syndrome with anterograde conduction through AP was present in 13.5 % of the patients, and 1.4 % had a malignant preexcitation syndrome.
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Brembilla-Perrot B, Beurrier D, Houriez P, Claudon O, Rizk J, Lemoine C, Nippert M, Miljoen H, Khaldi E. Wide QRS complex tachycardia. Rapid method of prognostic evaluation. Int J Cardiol 2004; 97:83-8. [PMID: 15336812 DOI: 10.1016/j.ijcard.2003.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2003] [Accepted: 08/11/2003] [Indexed: 11/23/2022]
Abstract
UNLABELLED A wide QRS complex tachycardia suggests a ventricular tachycardia (VT); but supraventricular tachycardia (SVT) is also possible. Some authors reported on the electrocardiographic signs for the differential diagnosis of VT and SVT with aberrancy. Frequently these signs are debatable and the diagnosis is uncertain. The purpose of the study was to evaluate the interest of a non-invasive study by transesophageal route for the evaluation of the nature of a wide QRS complex tachycardia in which a reliable ECG algorithm does not permit to distinguish VT from SVT with aberrancy. METHODS Esophageal electrophysiologic study (EPS) was performed in 53 patients, aged from 16 to 85 years without bundle branch block (BBB) in sinus rhythm, but with wide-QRS tachycardia. The protocol consisted of atrial pacing at progressively higher rates and then programmed stimulation with one and two extrastimuli in control state and after isoproterenol infusion. Intracardiac EPS was performed in 49 of them. RESULTS (1) Study was negative in nine patients; intracardiac EPS remained negative in four of them, induced a VT in five; (2) clinical tachycardia was induced in 44 patients: (a) in 29 of them, atrial pacing induced a BBB similar to aberrancy noted in tachycardia and the diagnosis of SVT with aberrancy was made; (b) in 15 patients, QRS complex remained narrow during atrial pacing; the diagnosis of VT was made in presence of AV dissociation and confirmed by intracardiac study. VT was induced by atrial or ventricular stimulation or was spontaneous during isoproterenol infusion. VT mechanism were bundle branch reentry [Am. J. Cardiol. 65 (1990) 322], verapamilsensitive VT [Am. J. Cardiol. 65 (1990) 322], catecholamine-sensitive VT [J. Cardiovasc. Electrophysiol. 7 (1996) 2]. Two patients had tachycardias of both natures either supraventricular or ventricular. CONCLUSION Esophageal EPS was a safe, rapid and economic means to evaluate the mechanism of wide QRS tachycardia in 84% of patients; atrial pacing at progressively higher rates is very simple to reproduce the aberrancy of similar morphology in those patients who had wide-QRS tachycardia related to a SVT with aberrancy. If atrial pacing did not exactly reproduce the aberrancy in tachycardia, a VT should be suspected.
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Brembilla-Perrot B, Beurrier D, Houriez P, Claudon O, Rizk J, Lemoine C, Gregoire P, Nippert M. Transitory or permanent regular wide QRS complex tachycardia induced by atrial stimulation in patients without apparent heart disease. Significance. Ann Cardiol Angeiol (Paris) 2003; 52:226-31. [PMID: 14603703 DOI: 10.1016/s0003-3928(03)00090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVES The purpose of the study was to evaluate the frequency of transitory or permanent bundle branch block (BBB) associated with a paroxysmal tachycardia induced by atrial stimulation in patients without heart disease and its significance. METHODS Esophageal atrial stimulation was performed in 447 patients suspected to have supraventricular tachycardias (SVT). Sustained regular tachycardia was induced in all of them but three, either in control state (75%) or after administering isoproterenol. In 346 patients, only narrow complex SVTs were induced (77%); in 259 of them, the reentry occurred in the AV node and in remaining patients within a concealed accessory pathway. In 62 patients, a transitory functional BBB was recorded at the onset of the tachycardia (14%). In 33 of them, the reentry occurred in the AV node and in the remaining 29 patients within a concealed accessory pathway. In 36 patients (8%), a permanently wide QRS complex tachycardia was induced. Three patients had also inducible narrow complex SVT. Atrial pacing induced a BBB similar to the aberrancy in tachycardia in 22 patients: the reentry occurred in the AV node in 17 patients, within a concealed accessory pathway in three patients and in a Mahaim bundle in two patients. In other patients, QRS complex remained normal during atrial pacing: all 14 patients had a ventricular tachycardia (VT), either a verapamil-sensitive VT (n = 7) or catecholamine-sensitive VT (n = 4) or bundle branch reentry (n = 3). Followed from 2 to 12 years, the prognosis of these patients was excellent. CONCLUSION Transitory BBB at the onset of an SVT is noted in 14% of the population, is more frequent in patients with accessory pathway reentrant tachycardia, but is helpful for this diagnosis in only 12% of cases. A regular tachycardia with permanent left or right bundle branch morphology induced by atrial stimulation in a patient without heart disease and without BBB during atrial pacing is due to a VT even if this patient has also narrow complex tachycardias. This mechanism does not affect the excellent prognosis of this population.
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Brembilla-Perrot B, Blangy H, Holban I, Houriez P, Claudon O, Rizk J, Mauferon JB, Clavel A. [Value of transesophageal programmed atrial stimulation in the evaluation of unexplained cerebrovascular accidents]. Ann Cardiol Angeiol (Paris) 1999; 48:103-8. [PMID: 12555333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Certain embolic cerebrovascular accidents can be explained by the development of paroxysmal atrial fibrillation. When noninvasive complementary investigations are negative, programmed atrial stimulation can be proposed to detect increased atrial vulnerability. The objective of this study was to evaluate the reliability of this method performed via a transoesophageal approach in 59 subjects presenting with an embolic cerebrovascular accident and who were in sinus rhythm at the time of the accident. Seven of these patients had a history of paroxysmal atrial fibrillation (AF) or atrial tachycardia (AT) (group I). Three of these seven patients also presented AV nodal reentrant junctional tachycardia. The other 52 patients had no history of arrhythmia and their Holter recording did not reveal any episodes of sustained atrial tachycardia (group II). Transoesophageal programmed atrial stimulation used up to 2 extrastimuli under baseline conditions and during Isuprel infusion. The following results were obtained: sustained atrial tachycardia (> 1 min) was induced in all patients of group 1, 3 of them also presented inducible junctional tachycardias. 14 patients of group II (27%) presented inducible supraventricular tachycardia: atrial tachycardia in 7 cases. Patients in group II with inducible AT presented either heart disease (n = 3) or minor abnormalities on the Holter recording (runs of atrial premature complexes or sinus pauses (n = 3). Two of these patients subsequently developed sustained atrial fibrillation during follow-up. In 25 patients with normal Holter recording and no heart disease, programmed atrial stimulation induced junctional tachycardia in 4 cases. In conclusion, transoesophageal electrophysiological investigation is a useful way to identify various forms of supraventricular tachycardia able to explain an embolic cerebrovascular accident. The considerable incidence of inducible AV nodal reentrant junctional tachycardia must be emphasized, while the incidence of atrial fibrillation is much lower than during intracardiac investigations.
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Brembilla-Perrot B, Beurrier D, Jacquemin L, Houppe-Nousse MP, Rizk J, Demoulin M, Danchin N. [Complete atrioventricular block, a possible complication of radiofrequency ablation of reciprocating nodal tachycardia]. Arch Mal Coeur Vaiss 1996; 89:729-34. [PMID: 8760659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Radiofrequency ablation of the slow pathway of the reentry circuit is the usual radical treatment of nodal tachycardia. It is, however, possible to create atrioventricular conduction defects, the significance of which is not known. The aim on this study was to report the history of these conduction defects created during ablation of the slow pathway of the intranodal reentry circuit. Four cases were observed in a series of 27 patients. In one female patient, complete atrioventricular block was observed for 5 minutes before conduction returned to normal followed by recurrence of the tachycardias. Three other women developed complete atrioventricular block one to four days after the ablation. The block regressed after a maximum delay of 7 days. Six months to one year after the procedure, these three patients remain free of tachycardia and have only first degree atrioventricular block on the surface ECG. These patients were not implanted with a pacemaker. The authors conclude that complete atrioventricular block after ablation of the slow pathway may be treated conservatively, providing it is well tolerated. It normally regresses within few days.
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Perrot B, Thiel B, Clozel JP, Rizk J, Bara B, Cherrier F, Faivre G. [Diagnostic value of methods of ventricular and auricular stimulation in the evaluation of tachycardia]. Arch Mal Coeur Vaiss 1985; 78:569-77. [PMID: 3923984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The diagnostic value of programmed pacing in the investigation of tachycardia (greater than 5 premature complexes) was studied in 155 patients admitted for evaluation of dizzy attacks and/or tachycardia by determining a relationship between the induction of tachycardia by endocavitary pacing and the presence of spontaneous attacks on ECG and/or 24 hour Holter monitoring. Right atrial and ventricular programmed pacing comprised: an extrastimulus during sinus rhythm (method I), during paced rhythm (method II), 2 extrastimuli during sinus rhythm (method III) and paced rhythm (method IV). The protocol was applied in 20 cases of spontaneous atrial tachycardia (AT) and 40 patients without tachycardia, and in 20 cases of spontaneous sustained ventricular tachycardia (VTS) (Group A), 15 cases of non-sustained ventricular tachycardia (VTNS) (Group B), 20 cases of ventricular doublets or triplets on Holter monitoring (Group C) and 40 patients without ventricular arrhythmias. The following results were obtained: At atrial level, method I was associated with a 75% sensitivity and a 62.5 p. 100 specificity when the triggering of atrial echos was considered. It was difficult to induce AT with methods I, II and III (sensitivity 15, 20 and 45 p. 100 - but they were very specific (greater than 90 p. 100). The induction of echos with methods II, III and IV was very sensitive but not specific and could not be retained as a pathological criterion. Using method IV, only the triggering of sustained AT could be considered to have a good specificity (90 p. 100), but sensitivity remained low (30 p. 100). At ventricular level, more aggressive methods were needed to induce an arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
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