Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis.

Tuberculosis remains an important cause of death among patients infected with the human immunodeficiency virus (HIV). Robust data are lacking with regard to the timing for the initiation of antiretroviral therapy (ART) in relation to the start of antituberculosis therapy

Les entérobactéries résistantes aux céphalosporines de dernières générations : de l'animal à l'Homme

International audienceEnterobacteria resistant to third/fourth generation cephalosporins: from animals to humans This paper aims at presenting a short overview on resistance to third/fourth generation cephalosporins in enterobacteriaceae in animals, and to discuss possible issues for public health.Cet article a pour but de présenter un état des lieux rapide sur les entérobactéries animales résistantes aux C3G/C4G, et d'en discuter les conséquences pour l'Homme

Systematic Review of Neovaginal Prolapse After Vaginoplasty in Trans Women

Background and objective: Most trans women are requesting a gender affirming genital surgery by vulvovaginoplasty. However, long-term complications such as genital prolapse are unknown. Through this systematic review, our objective was to provide an overview of the published outcomes related to genital prolapse after vaginoplasty in male-to-female transgender individuals, including prevalence, identified risk factors, and treatment. Methods: We included all studies reporting genital prolapse rates following vulvovaginoplasty from 1995 to the present. Only studies that focused on the transgender population were included. The primary outcome was the genital prolapse rate. The secondary outcomes included risk factors and treatment of genital prolapse after vulvovaginoplasty. Article selection was performed by two independent reviewers. Key findings and limitations: Twenty-four studies, involving 3166 patients, that presented sufficient data were analyzed. The mean age at the time of vulvovaginoplasty was 37.7 yr. The mean follow-up time was 22.5 mo. Most of the studies were retrospective case series of low to intermediate quality. The penile skin inversion technique was the most frequently employed method (in 85% of the 3166 patients). The prevalence of prolapse ranged from 0% to 7% with the penile skin inversion technique and from 1.6% to 22.7% with intestinal vaginoplasty. Upon consolidating the results, an overall rate of 2.7% was observed. Specifically, the prolapse rate within the penile inversion technique subgroup was 2.5%, while the rate for the intestinal-derived neovagina subgroup was 3.5%. The only significant risk factor identified was a high body mass index at the time of surgery. The most employed intraoperative technique to prevent neovaginal prolapse involves fixation to the sacrospinous ligament, coupled with systematic vaginal packing. Few case reports addressed the surgical treatment of neovaginal prolapse, predominantly using open abdominal or laparoscopic approaches. None of these considered transvaginal or perineal approaches. No recommendation exists about the use of vaginal prosthesis. Conclusions and clinical implications: Neovaginal prolapse in male-to-female transgender patients remains a rare complication, but its significance is growing as the transgender population ages. Scarce information is available regarding preventative techniques and treatments, necessitating further exploration, hampered by its infrequent occurrence. Patient summary: Neovaginal prolapse in male-to-female transgender patients is a rare complication, with the only recognized risk factor being a high body mass index. However, its importance is growing with the aging of the transgender population. Long-term complications, preventive techniques, and management of these prolapses need to be explored through further research

Artificial Intelligence: Ready To Pass the European Board Examinations in Urology?

The role of artificial intelligence (AI) in the medical domain is increasing on an annual basis. AI allows instant access to the latest scientific data in urological surgery, facilitating a level of theoretical knowledge that previously required several years of practice and training. To evaluate the capability of AI to provide robust data in a specialized domain, we submitted the in-service assessment of the European Board of Urology to three different AI tools: ChatGPT 3.5, ChatGPT 4.0, and Bard. The assessment consists of 100 single-answer questions with four multiple-choice options. We compared the responses of 736 participants to the AI responses. The average score for the 736 participants was 67.20. ChatGPT 3.5 scored 59 points, ranking in 570th place. ChatGPT 4.0 scored 80 points, ranking 80th, just on the border of the top 10%. Google Bard scored 68 points, ranking 340th. Our study demonstrates that AI systems have the capability to participate in a urological examination and achieve satisfactory results. However, a critical perspective must be maintained, as current AI systems are not infallible. Finally, the role of AI in the acquisition of knowledge and the dissemination of information remains to be delineated. Patient summary: We submitted questions from the European Diploma in Urological Surgery to three artificial intelligence (AI) systems. Our findings reveal that AI tools show remarkable performance in assessments of urological surgical knowledge. However, certain limitations were also observed

Les complications chirurgicales en urologie adulte : chirurgie de la prostate

International audienceProstate surgery mainly addresses the treatment of the two most common pathologies of the prostate: benign prostatic hypertrophy (BPH), symptomatic or complicated, and prostate cancer (PCa). The objective of this manuscript was to present after review of the literature the main intraoperative and postoperative surgical complications associated with radical prostatectomy and surgery of the BPH whatever the surgical approach. The incidence and type of these complications may vary depending on the patient's comorbidities and the type of surgery. Regarding radical prostatectomy, the main complications are hemorrhagic, digestive and urinary. During or after surgery of BPH, hemorrhagic and urinary complications dominate. The management of these complications relies on general principles based on a low level of evidence, but usually associate a structured diagnostic pathway and an appropriate treatment decision. Copyrigh

Les complications de la néphrectomie totale et de la néphrectomie partielle : quelles sont-elles, comment les prévenir et les prendre en charge ?

International audienceINTRODUCTION: Surgical techniques of radical and partial nephrectomy have changed over the last 20years. Indications for partial nephrectomy have widened and mini-invasive surgery (laparoscopy and robotic assistance) has become widely used. However, both still have a significant morbidity. The objective of this article is to review complications of renal surgery and their predictive factors and to offer algorithms of management. METHODS: Recent literature regarding complications of radical and partial nephrectomy was queried using Pubmed engine search. The most relevant articles were analyzed and served as a basis for this work. RESULTS: The literature on complications of radical and partial nephrectomy has a low level of evidence. There are only retrospective series. The most frequent complications of radical nephrectomy occur during surgery in 5-10% of the cases: wound of the pedicle or of an adjacent organ. The management can often be conservative. Laparoscopy has a similar morbidity compare to the open approach but has greatly increased postoperative outcomes and comfort. Partial nephrectomy has a 20% complication rate. Many factors have an impact on the risk of complications (tumor size, inflammation of perirenal fat, access, surgeon experience, centre volume, comorbidities and age of the patient) and must be taken into consideration before advising partial nephrectomy. The two most feared complications of partial nephrectomy are bleeding (per- or postoperative, 10% of the cases) and urinary fistula (<5% of the cases). Robotic assistance is associated with a lower morbidity in many publications. CONCLUSION: Complications after partial and radical nephrectomy are quite frequent but have decreased with the improvement of surgical techniques. French urologists should maintain their interest in novel technologies and simplification of perioperative pathway to further improve patients' outcomes. Copyrigh

Les complications chirurgicales en urologie adulte : chirurgie de la prostate

International audienceProstate surgery mainly addresses the treatment of the two most common pathologies of the prostate: benign prostatic hypertrophy (BPH), symptomatic or complicated, and prostate cancer (PCa). The objective of this manuscript was to present after review of the literature the main intraoperative and postoperative surgical complications associated with radical prostatectomy and surgery of the BPH whatever the surgical approach. The incidence and type of these complications may vary depending on the patient's comorbidities and the type of surgery. Regarding radical prostatectomy, the main complications are hemorrhagic, digestive and urinary. During or after surgery of BPH, hemorrhagic and urinary complications dominate. The management of these complications relies on general principles based on a low level of evidence, but usually associate a structured diagnostic pathway and an appropriate treatment decision. Copyrigh

Adenosine deaminase is a useful biomarker to diagnose pleural tuberculosis in low to medium prevalence settings

International audienceAdenosine deaminase (ADA) activity measurement in pleural fluid is a relevant test to diagnose pleural tuberculosis (pTB) in high tuberculosis prevalence settings. We investigated the diagnostic utility of pleural ADA using a retrospective analysis of patients admitted with newly diagnosed pleural effusion without identified etiology between 2001 and 2008 in Paris suburb, a low to medium tuberculosis prevalence area. 104 adults (mean age 55 years; 34 with pTB, 70 with other diagnoses) were analyzed. Median follow-up was 15.6 months. Mean [interquartile range] pleural ADA was 119 U/L [IQR: 83-143] in pTB and 24 U/L [IQR: 15-31] in non-tuberculous effusions (P<0.001). With an optimal pleural ADA cut-off value of 41.5 U/L for pTB diagnosis, sensitivity and specificity were 97.1% and 92.9%, while positive and negative predictive values were 86.8% and 98.5%, respectively. We conclude that pleural ADA activity could be integrated in the diagnostic procedures of pTB in low to medium tuberculosis prevalence settings