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Corral R, Boissier R, Depaquit TL, Gondran-Tellier B, Bastide C, Lechevallier E, Baboudjian M. Saline bladder infusion vs standard catheter removal in patients with acute urinary retention related to benign prostatic hyperplasia: The BLAPERF Study. Prog Urol 2023; 33:319-324. [PMID: 36842924 DOI: 10.1016/j.purol.2023.02.002] [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: 09/19/2022] [Revised: 10/19/2022] [Accepted: 02/10/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE Bladder infusion, which involves filling the bladder with saline prior to catheter removal, has been associated with reduced time-to-discharge and increased success rates in trials without catheter (TWOCs) in perioperative setting. The objective of this study was to evaluate the applicability of this protocol in patients with acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS We conducted a retrospective single-center study comparing bladder infusion with at least 150mL of warm saline vs. standard catheter removal during TWOC in patients with BPH-related AUR between January and December 2021. The primary outcome was time to discharge. Secondary outcomes included: TWOC success, and early recurrence of urinary retention defined as recurrence within three months of successful TWOC. RESULTS A total of 75 men were included: 35 in the bladder infusion protocol and 40 in the standard protocol. Baseline characteristics were well balanced between groups. Overall, 35 patients (46.7%) had a successful TWOC without statistically significant difference between groups (P=0.10). Bladder infusion protocol was associated with a shorter median time to discharge (200 vs. 240min, P=0.003). However, patients in the bladder infusion group were associated with a higher risk of early recurrence of urinary retention (30% vs. 0%, P=0.02). CONCLUSION In patients with BPH-related AUR, the saline bladder infusion method reduced time-to-discharge with similar TWOC success rates. Larger studies are needed to properly analyze the risk of early recurrence of urinary retention before any clinical application. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R Corral
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - R Boissier
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - T L Depaquit
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - B Gondran-Tellier
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - C Bastide
- Department of Urology, North Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - E Lechevallier
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - M Baboudjian
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France; Department of Urology, North Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France.
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Boulma R, Charfi M, Trigui M, Daoud MF, Sahnoun M, Bouhaouala MH, Chouchen A. [Correlation between detrusor thickness, intravesical prostatic protrusion and maximum urinary flow in the monitoring of benign prostatic hyperplasia]. Prog Urol 2021; 32:291-297. [PMID: 34801388 DOI: 10.1016/j.purol.2021.10.004] [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: 02/02/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Detrusor thickness (DT) and intravesical prostatic protrusion (IPP) are closely related to bladder outlet obstruction. The aim of our study was to look for correlation between DT, IPP and maximum urinary flow (Qmax). METHODS It is a prospective, observational study including men over fifty managed for benign prostatic hyperplasia. Low urinary tract symptoms were assessed with the International Prostatic Symptom Score (IPSS). Pelvic ultrasound was performed for all patients measuring prostatic volume, bladder volume, post- void residual, DT and IPP. Uroflowmetry was performed for all patients, Qmax was noted. Qmax equal or less than 15ml/s was considered pathologic. RESULTS Sixty patients were included for our study. Strong negative correlation was noted between DT, IPP and Qmax (r=-0.59, r=-0.61 respectively). Patients with pathologic Qmax had higher DT and IPP than those with normal Qmax, the difference was significant (P<0.01). Threshold values predicting pathologic Qmax were 3mm for DT and 7mm for IPP. ROC analysis reveals for DT an AUC of 0.84 (95% CI 0.76-0.92) and for IPP an AUC of 0.88 (95% CI 0.80-0.97). CONCLUSION Detrusor thickness and intravesical prostatic protrusion have strong negative correlation with Qmax. These parameters could be an alternative to Qmax measurement if uroflowmetry is unavailable. LEVEL OF EVIDENCE Grade B.
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Affiliation(s)
- Rami Boulma
- Service d'urologie, hôpital FSI La Marsa, Tunis, Tunisie.
| | - Mehdi Charfi
- Service de radiologie, hôpital FSI La Marsa, Tunis, Tunisie.
| | - Mohamed Trigui
- Service d'urologie, hôpital FSI La Marsa, Tunis, Tunisie.
| | | | - Moez Sahnoun
- Service de chirurgie générale, hôpital FSI La Marsa, Tunis, Tunisie.
| | | | - Adnen Chouchen
- Service de chirurgie générale, hôpital FSI La Marsa, Tunis, Tunisie.
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Richard C, Robert G, Pradère B, Wilisch J, Doizi S, Le Calvez S, Negra ED. [Cost analysis of GreenLight photoselective vaporization of the prostate versus standard transurethral resection of the prostate: Benefit of ambulatory care]. Prog Urol 2021; 31:275-281. [PMID: 33461866 DOI: 10.1016/j.purol.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/16/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital. MATERIAL AND METHODS A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method. RESULTS 871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays. CONCLUSION In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- C Richard
- Service d'urologie, CHU de Rennes, Rennes, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
| | - B Pradère
- Service d'urologie, CHU Tours, Tours, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - J Wilisch
- Service d'urologie, Hôpital Privé Natecia, Lyon, France
| | - S Doizi
- Service d'urologie, Hôpital Thenon, Paris, France
| | - S Le Calvez
- Département d'information médicale, hôpital privé des côtes d'armor, Plérin, France
| | - E D Negra
- Centre briochin d'urologie, hôpital privé des côtes d'armor, Plérin, France
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Descazeaud A, Coloby P, De La Taille A, Kouri G, Mallet R, Rossi D, Rozet F, Zerbib M, Carrois F. [Interest of a systematic assessment of the treatment of the lower urinary tract symptoms in the management of benign prostatic hypertrophy in general practice (1380 patients) - Study EVALURO]. Prog Urol 2019; 29:116-26. [PMID: 30665818 DOI: 10.1016/j.purol.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/22/2018] [Accepted: 12/01/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms. METHODS This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit. RESULTS Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly. CONCLUSION A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.
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Jendoubi A, Malouch A, Bouzouita A, Riahi Y, Necib H, Ghedira S, Houissa M. [Safety and efficacy of intravenous tranexamic acid in endoscopic transurethral resections in urology: Prospective randomized trial]. Prog Urol 2017; 27:1036-1042. [PMID: 29074352 DOI: 10.1016/j.purol.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/29/2016] [Revised: 07/15/2017] [Accepted: 09/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic urological procedures (transurethral resection of the prostate TURP/transurethral resection of bladder tumor TURBT) are not without risk of significant bleeding. This risk is due to the vascular nature of the tissues and their high levels of fibrinolytic enzymes in the tissues and urine. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid (TXA) in reducing blood loss in patients undergoing TURP/TURBT and transfusion requirement. METHODS This study was a prospective, randomized, double-blind, placebo controlled clinical trial. One hundred and thirty-one patients of ASA physical status I or II, undergoing TURP (60 patients) or TURBT (71 patients) were randomly allocated to receive IV TXA: bolus of 10mg/kg at the induction of anesthesia followed by infusion of 1mg/kg/h intraoperatively and for 24h postoperatively or an equal volume of saline (control group). Blood loss was evaluated in terms of reduction in the serum hemoglobin level (delta Hb=Hb H24-Hb H0). RESULTS There was no difference between two groups in terms of transfusion requirements and episodes of retention. TXA did not significantly reduce mean blood loss compared with placebo during TURP (1.37±0.69 vs. 1.72±1.23g/dL respectively, P=0.256) or TURBT (1.15±0.95 vs. 1.07±0.88g/dL; P=0.532). No thrombotic complications were noted in any patient. CONCLUSION Tranexamic acid did not reduce transfusion requirements or perioperative blood loss in transurethral resection of the prostate or bladder tumor. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Jendoubi
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - A Malouch
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - A Bouzouita
- Department of urology, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - Y Riahi
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - H Necib
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - S Ghedira
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
| | - M Houissa
- Department of anaesthesia and intensive care, faculty of medicine of Tunis, Charles-Nicolle hospital of Tunis, university of Tunis El Manar, Tunis, Tunisie.
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Evrard PL, Mongiat-Artus P, Desgrandchamps F. [Morbi-mortality of transurethral resection of the prostate in patients aged 75 and over]. Prog Urol 2017; 27:312-318. [PMID: 28377079 DOI: 10.1016/j.purol.2017.02.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monopolar transurethral resection of the prostate is one of standard surgical treatment of benign prostatic hyperplasia. The objective of this study was to evaluate early postoperative complications in patients aged 75 years old and more using a standardized classification. MATERIAL AND METHODS We included all patients aged at least 75 on the day of surgery between 1 January 2008 and 31 December 2013. The reporting of complications was carried from the Clavien-Dindo classification. RESULTS One hundred and seventy-six patients were included in this study. A total of 47.2% of patients experienced at least one complication. The majority of patients (79.5%) had complications grade 1 or 2 according to Clavien-Dindo classification. One patient died postoperatively at day 27. Most complications were urological (55%). A high Charlson score and low plasma hemoglobin levels have been identified as a risk factor for complications. CONCLUSION Monopolar transurethral resection of the prostate is followed by significant morbidity in older patients, higher than in the general population. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- P-L Evrard
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France.
| | - P Mongiat-Artus
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France
| | - F Desgrandchamps
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France
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Descazeaud A, de La Taille A, Giuliano F, Desgrandchamps F, Doridot G. [Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia]. Prog Urol 2015; 25:115-27. [PMID: 25605342 DOI: 10.1016/j.purol.2014.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/21/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to discuss the negative effects on sexual function of medications for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS-BPH). METHODS An international non-systematic literature review was performed. It included randomized trials of seven drugs of interest and the summaries of the characteristics of these products. This work did not aim comparison between the drugs. RESULTS Only maximal reported frequencies are presented in this abstract. With prolonged-release alfuzosin, they were 2.8% vs. 1.3% for erectile dysfunction, compared to placebo and 1% vs. 0% for ejaculatory dysfunction. With doxazosin, the incidence was 5.8% vs. 3.3% for erectile dysfunction, 3.6% vs. 1.9% for reduced libido and 0.4% vs. 1.4% for ejaculatory disorders. The incidence of ejaculatory disorders with tamsulosin, was 11% vs. <1% with the placebo and with silodosin, it was 28.1% vs. 1.1%. With finasteride, at 12 months, the highest frequency was 9% vs. 5% for erectile dysfunction, 4.4% vs. 1.5% for ejaculatory disorders and 6.4% vs. 3.4% for reduced libido. At 24 months, for dutatsteride, frequencies were 7.3% vs. 4.0% for erectile dysfunction, 2.2% vs. 0.8% for ejaculatory disorders and 4.2% vs. 2.1% for reduced libido. For tadalafil, a phosphodiesterase-5 inhibitor, and tolerodine, an anticholinergic drug, no negative effect on ejaculation or libido has been reported. For plant extracts, no sexual adverse effects (AEs) were reported among the most common AEs. CONCLUSION The medications for LUTS-BPH may alter erection, ejaculation or libido. A greater knowledge of the adverse effects of each of these drugs could guide physicians in the clinical management of men with BPH-LUTS.
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Affiliation(s)
- A Descazeaud
- Service de chirurgie urologique, CHU de Limoges, 87042 Limoges cedex, France.
| | - A de La Taille
- Service d'urologie, faculté de médecine de Créteil, groupe hospitalier Henri-Mondor, 94000 Créteil, France
| | - F Giuliano
- Service de médecine physique et de réadaptation, faculté des sciences de la santé, université de Versailles Saint-Quentin en Yvelines, hôpital Raymond-Poincaré, 92380 Garches, France
| | - F Desgrandchamps
- Service d'urologie et de transplantation, hôpital Saint-Louis, université Paris 7, institut des maladies émergentes et des thérapies innovantes (iMETI), 75010 Paris, France
| | - G Doridot
- 24, boulevard Vital-Bouhot, 92521 Neuilly-Sur-Seine cedex, France
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Lebdai S, Rahmène Azzouzi A, Delongchamps NB, Benchikh A, Campeggi A, Cornu JN, Dumonceau O, Faix A, Fourmarier M, Haillot O, Lukacs B, Mathieu R, Misrai V, Robert G, de La Taille A, Descazeaud A. [Evaluation of the impact of CTMH guidelines on the management of benign prostatic hyperplasia]. Prog Urol 2014; 25:47-53. [PMID: 25453357 DOI: 10.1016/j.purol.2014.09.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/16/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The French guidelines on the management of benign prostatic hyperplasia (BPH) have been published in 2012 by the LUTS committee of the French Urological Association. The aim of this study was to evaluate the impact of these guidelines on the BPH management by French urologists. MATERIAL AND METHODS A questionnaire has been distributed by email to 1141 urologists members of the French Association of Urologists in November 2013. RESULTS We collected 222 responses (response rate: 19%). The guidelines have been read by 73% of the urologists. The guidelines were followed most of the time by 76% of them, 11% followed them systematically and 4.5% did not follow them. The new terminology was used by 28 to 52% according to the items. The symptoms were evaluated by the IPSS score (33%), by interrogatory alone (64%) or by neither of them (3%). Prostate volume was not systematically taken for account in the treatment strategy by 57% of the urologists. Sexual function was assessed systematically by 28% of the urologists, 11% used a questionnaire (IIEF: 92%). PSA was tested respectively by 70 and 51% of the urologists at the initial evaluation and the follow-up. After introduction of a monotherapy, 56% of the urologists evaluated the efficacy at 3 months. CONCLUSION The French guidelines for the management of benign prostatic hyperplasia (BPH) by the LUTS committee of the French Urological Association were well known and used by French urologists. Some improvements can be expected for the use of the IPSS score, the evaluation of the sexual function, and the use of the new terminology. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - A Rahmène Azzouzi
- Service d'urologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | | | - A Benchikh
- Service d'urologie, hôpital Bichat - Claude-Bernard, groupe des hôpitaux universitaires Paris-Nord-Val-de-Seine, université Denis-Diderot, Paris-VII, 75018 Paris, France
| | - A Campeggi
- Service d'urologie, CHU Mondor, 75000 Paris, France
| | - J N Cornu
- Service d'urologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie - Paris-6, 75020 Paris, France
| | - O Dumonceau
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - A Faix
- Clinique mutualiste Beausoleil, 34070 Montpellier, France
| | - M Fourmarier
- Service d'urologie, centre hospitalier d'Aix-en-Provence, 13616 Aix-en-Provence, France
| | - O Haillot
- Service d'urologie, CHU de Tours, 37044 Tours, France
| | - B Lukacs
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - R Mathieu
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 35000 Rennes, France
| | - V Misrai
- Service d'urologie, clinique Pasteur, 31300 Toulouse, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, université Bordeaux-Segalen, 33076 Bordeaux, France
| | | | - A Descazeaud
- Service de chirurgie urologique, CHU de Limoges, 87042 Limoges, France
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