Cystinurie (place de l'urétéroscopie souple)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Le traitement endoscopique du reflux de l'anastomose urétéro-vésicale chez les transplantés rénaux

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Comparaison anatomopathologique entre les ponctions biopsies prostatiques et les pièces de prostatectomie totale

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Traitement par radiofréquence des tumeurs du rein localisées (à propos de vingt quatre cas)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact pédagogique d’un MOOC de technique chirurgicale de transplantation rénale

International audienceObjective: To evaluate the educational impact of a pilot MOOC (Massive Open Online Course), validated by the French College of Urology Teachers (FCUT), on the surgical technique of kidney transplantation.Materials and methods: We developed a MOOC on the surgical technique of kidney transplantation, based on a video of a surgical procedure, performed by an expert surgeon. The MOOC has been validated by the FCUT. We have created 2 student groups: 1) MOOC-pre-QCM group: visualization of the MOOC then answer to the MCQs and satisfaction questions; 2) MOOC-post-QCM group: answer to the MCQs then visualization of the MOOC then answers to the satisfaction questions. In total, 20 MCQs on the kidney transplantation technique were completed by the 2 groups. The answers were anonymous.Results: A total of 142 people answered the MCQs (MOOC-pre-QCM group (n=66) and MOOC-post-QCM group (n=76)). Twenty-nine percent (41/142) of the participants were fellows and 71 % (101/142) were residents. The proportion of fellows and residents was identical between the 2 groups. The rate of correct answers to the 20 MCQs was statistically higher in the MOOC-pre-QCM group, compared to the MOOC-post-QCM group (88.6 % versus 73.3 %, P<0.0001). Ninety-one percent of students found the MOOC "Very Useful" or "Useful". The median MOOC rating, given by students, was 8/10.Conclusion: This study showed a positive impact of the MOOC on theoretical knowledge of kidney transplantation surgical technique. This MOOC could serve as a pilot project for the development of other MOOCs on urological surgery.Level: 3.ObjectifÉvaluer l’impact pédagogique d’un MOOC (Massive Open Online Course) pilote, validé par le Collège français des enseignants en urologie (CFEU), sur la technique chirurgicale de transplantation rénale.Matériel et méthodesNous avons réalisé un MOOC sur la technique chirurgicale de transplantation rénale, à partir d’une vidéo d’une intervention chirurgicale, réalisée par un chirurgien expert. Le MOOC a été validé par le CFEU. Nous avons créé 2 groupes d’étudiants : 1) groupe MOOC-pré-QCM : visualisation du MOOC, puis réponse aux QCM et aux questions de satisfaction ; 2) groupe MOOC-post-QCM : réponse aux QCM, puis visualisation du MOOC, puis réponse aux questions de satisfaction. Au total, 20 QCM sur la technique transplantation rénale ont été remplis par les 2 groupes. Les réponses étaient anonymes.RésultatsAu total, 142 personnes ont répondu aux QCM (groupe MOOC-pré-QCM (n = 66) et groupe MOOC-post-QCM (n = 76)). 29 % (41/142) des participants étaient des CCA ou assistants et 71 % (101/142) étaient des internes. La proportion de CCA/assistants et d’internes était identique entre les 2 groupes. Le taux de réponses correctes aux 20 QCM était statistiquement supérieur dans le groupe MOOC-pré-QCM, en comparaison au groupe MOOC post-QCM (88,6 % contre 73,3 %, p < 0,0001). Au total, 91 % des étudiants ont trouvé le MOOC « Très Utile » ou « Utile ». La médiane de la note du MOOC, donnée par les étudiants, était de 8/10.ConclusionCette étude a montré un impact positif du MOOC sur les connaissances théoriques de la technique chirurgicale de transplantation rénale. Ce MOOC pourrait servir de projet pilote pour le développement d’autres MOOC sur la chirurgie urologique.Niveau3

HoSAGE: sarcopenia in older patient with intermediate / high-risk prostate cancer, prevalence and incidence after androgen deprivation therapy: study protocol for a cohort trial

International audienceAbstract Background Sarcopenia is defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. Ageing greatly contributes to sarcopenia as may many other factors such as cancer or androgen deprivation therapies (ADT). This cohort study aims to evaluate (1) the prevalence of muscle disorders and sarcopenia in older patients before initiation of intermediate to high risk prostate cancer treatment with ADT and radiotherapy, and (2) the occurrence and/or aggravation of muscle disorders and sarcopenia at the end of cancer treatment. Methods This cohort study is monocentric and prospective. The primary objectives are to determine the risk factor of sarcopenia prevalence and to study the relationship between ADT and sarcopenia incidence, in patients 70 years and older with histologically proven localized or locally advanced prostate cancer, addressed to a geriatrician (G8 score ≤14) for comprehensive geriatric assessment (CGA) in Marseille University Hospital. Secondary objectives encompass, measurement of sarcopenia clinical criteria along prostate oncological treatment; evaluation of the quality of life of patients with sarcopenia; evaluation of the impact of socio-behavioral and anthropological factors on sarcopenia evolution and incidence; finally the evaluation of the impact of ADT exposure on sarcopenia. Sarcopenia prevalence was estimated to be between 20 and 30%, therefore the study will enroll 200 patients. Discussion The current guidelines for older patients with prostate cancer recommend a pelvic radiotherapy treatment associated to variable duration (6 to 36 months) of ADT. However ADT impacts muscle mass and could exacerbate the risks of sarcopenia. Our study intends to assess the specific effect of ADT on sarcopenia incidence and/or worsening as well as to estimate sarcopenia prevalence in this population. The results of this cohort trial will lead to a better understanding of sarcopenia prevalence and incidence necessary to further elaborate a prevention plan. Trial registration The protocol was registered to the French drug and device regulation agency under the number 2019-A02319-48, before beginning the study (11/12/2019). The ClinicalTrials.gov identifier is NCT04484246, registration on the ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT04484246 )

Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trialResearch in context

Summary: Background: Prostatic artery embolisation (PAE) is a minimally invasive treatment of symptomatic benign prostatic hyperplasia (BPH). Our aim was to compare patient's symptoms improvement after PAE and medical treatment. Methods: A randomised, open-label, superiority trial was set in 10 French hospitals. Patients with bothersome lower urinary tract symptoms (LUTS) defined by International Prostatic Symptom Score (IPSS) > 11 and quality of life (QoL) > 3, and BPH ≥50 ml resistant to alpha-blocker monotherapy were randomly assigned (1:1) to PAE or Combined Therapy ([CT], oral dutasteride 0.5 mg/tamsulosin hydrochloride 0.4 mg per day). Randomisation was stratified by centre, IPSS and prostate volume with a minimisation procedure. The primary outcome was the 9-month IPSS change. Primary and safety analysis were done according to the intention-to-treat (ITT) principle among patients with an evaluable primary outcome. ClinicalTrials.gov Identifier: NCT02869971. Findings: Ninety patients were randomised from September 2016 to February 2020, and 44 and 43 patients assessed for primary endpoint in PAE and CT groups, respectively. The 9-month change of IPSS was −10.0 (95% confidence interval [CI]: −11.8 to −8.3) and −5.7 (95% CI: −7.5 to −3.8) in the PAE and CT groups, respectively. This reduction was significantly greater in the PAE group than in the CT group (−4.4 [95% CI: −6.9 to −1.9], p = 0.0008). The IIEF-15 score change was 8.2 (95% CI: 2.9–13.5) and −2.8 (95% CI: −8.4 to 2.8) in the PAE and CT groups, respectively. No treatment-related AE or hospitalisation was noticed. After 9 months, 5 and 18 patients had invasive prostate re-treatment in the PAE and CT group, respectively. Interpretation: In patients with BPH ≥50 ml and bothersome LUTS resistant to alpha-blocker monotherapy, PAE provides more urinary and sexual symptoms benefit than CT up to 24 months. Funding: French Ministry of Health and a complementary grant from Merit Medical