A great contributor to the French urological science: Michel Daudon

AbstractThe 40years of Michel Daudon’s working life in the field of urolithiasis are difficult to sum up in a few lines. His knowledge, expertise and publications in the fields of biology, chemistry, nephrology, and eventually urology have contributed to make him a national and international recognized researcher in the understanding of the complex mechanisms of urolithogenesis. His great collaboration with the community of nephrologists, kidney physiologists, biologists, and urologists, seniors or in training, has widely contributed to improve modern and complete treatments of urolithiasis, which is at the origin of complicated urinary stones causing severe consequences on renal function and true public health problems. His hard working, his willingness, and the clarity of his presentations contributed to make him a national and international recognized lecturer in France and North Africa, where he created a network connecting laboratories with clinicians. Always looking forward in his scientific field, he has established links with approved research teams, making them interested in working on urolithiasis, even though research on urolithiasis disease seems to be less important than research on cancer

Prise en charge des sténoses de l'uretère par endoprothèses métalliques résonance® (Principe, Efficacité et Tolérance. A propos d'une étude rétrospective de 23 patients)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Value of Provoked or Spontaneous Flank Pain in Men with Febrile Urinary Tract Infections

Background: Our objective was to identify the clinical, laboratory and radiological characteristics of febrile urinary tract infections (UTI) in men and to focus on the value of flank pain in these men managed in an ambulatory care system. Methods: A network was designed to manage men with febrile UTI without hospitalization according to an algorithm designed with different specialists. The patients’ characteristics were prospectively recorded and each patient was followed up until completely cured. We artificially divided patients into two groups. Group 1: men without flank pain diagnosed as prostatitis and a second group (Group 2) of men with flank pain or provoked flank pain more likely to have a pyelonephritis. Groups were compared to find arguments to differentiate prostatitis to pyelonephritis. Results: 350 men were included in the study, half of these men reported urinary symptoms (dysuria, urgency and burning urination). The negative predictive values of the nitrite and leukocytes test were poor alone or in combination. The renal ultrasound was never informative. None of the patients failed to respond to the treatment. No difference was found between groups. Conclusions: Laboratory test results and radiological features had a poor predictive value. Men with suspected pyelonephritis did not evolve differently from those with suspected prostatitis. Monitoring and treatment of men with febrile UTI does not seem to depend on the existence of a pyelonephritis suspected after the presence of a lumbar pain. Ambulatory management of febrile UTI is feasible and safe, requiring an efficient network for patient’s surveillance

Fatal septic shock caused by Corynebacterium D2.

BACKGROUND: Septic shock remains one of the leading causes of mortality in critically ill patients. Optimal management depends on prompt diagnosis with identification of the causative organisms to allow appropriate antibiotic therapy. PATIENT: We report the first case of septic shock caused by Corynebacterium D2, a micro-organism that can cause encrusted cystitis and pyelitis of transplanted kidneys or, more rarely, native kidneys. Diagnosis rests on identification of risk factors, positive urine cultures, and computed tomography results. Despite optimal treatment our patient died with persistent encrusted pyelitis. CONCLUSIONS: Corynebacterium D2 is known to cause chronic inflammation of the bladder and proximal urinary tract but can also cause severe septic shock in immunocompetent patients

Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review

Introduction: The increasing efficiency of the different lasers and the improved performance of endoscopic devices have led to smaller stone fragments that impact the accuracy of microscopic evaluation (morphological and infrared). Before the stone destruction, the urologist has the opportunity to analyze the stone and the papillary abnormalities endoscopically (endoscopic papillary recognition (EPR) and endoscopic stone recognition (ESR)). Our objective was to evaluate the value for those endoscopic descriptions. Methods: The MEDLINE and EMBASE databases were searched in February 2021 for studies on endoscopic papillary recognition and endoscopic stone recognition. Results: If the ESR provided information concerning the main crystallization process, EPR provided information concerning the origin of the lithogenesis and its severity. Despite many actual limitations, those complementary descriptions could support the preventive care of the stone formers in improving the diagnosis of the lithogenesis mechanism and in identifying high-risk stone formers. Conclusion: Until the development of an Artificial Intelligence recognition, the endourologist has to learn EPSR to minimize the distortion effect of the new lasers on the stone analysis and to improve care efficiency of the stone formers patients

Toward improved endoscopic examination of urinary stones: a concordance study between endoscopic digital pictures vs. Microscopy

Objective: To improve endoscopic recognition of the most frequently encountered kidney stone morphologies for a better etiological approach in lithiasis by urologists.Materials and methods: An expert urologist intra-operatively and prospectively (between June 2015 and June 2018) examined the surface, the section and the nucleus of all encountered kidney stones. Fragmented stones were subsequently analysed by a biologist based on both microscopic morphological (i.e. binocular magnifying glass) and infrared (i.e. FTIR) examinations (microscopists were blinded to the endoscopic data). Morphological criteria were collected and classified for the endoscopic and microscopic studies. The Wilcoxon–Mann–Whitney test was carried out to detect differences between the endoscopic and microscopic diagnoses. A diagnosis for a given urinary stone was considered "confirmed" for a non-statistically significant difference.Results: A total of 399 urinary stones were included in this study: 51.4% of the stones exhibited only one morphological type while 48.6% were mixed stones (41% had at least two morphologies and 7.6% had three morphologies). The overall matching rate was 81.6%. Diagnostics were confirmed for the following morphologies: whewellite (Ia or Ib), weddellite (IIa or IIb), uric acid (IIIa or IIIb), carbapatite-struvite association (IVb), brushite (IVd).Conclusions: Our preliminary study demonstrates the feasibility of using endoscopic morphology for the most frequently encountered urinary stones and didactic boards of confirmed endoscopic images are provided. The current study constitutes the first step toward endoscopic stone recognition, which is essential in lithiasis. We provide didactic boards of confirmed endoscopic images which paves the way for automatic computer-aided in-situ recognition

Encrusted Urinary Tract Infections Due to Corynebacteria Species

International audienceIntroduction: Encrusted pyelitis and cystitis are peculiar disorders characterized by the calcification of the vesical, the pyelic, and/or the ureteral walls. These calcifications are composed of struvite and calcium carbonate‒apatite due to the presence of Corynebacterium urealyticum.Methods: We have identified the clinical features and outcomes of 17 patients with encrusted pyelitis (n = 15) or encrusted cystitis (n = 2). Diagnosis was based on computed tomography scan and sonography including thickening and calcified lesions of the urinary tract.Results: The main clinical presentation was suggestive of subacute urinary tract infection with fever and urologic symptoms, mostly gross hematuria. Biologic features were characterized by the presence of struvite crystals and alkaline urine. Acute kidney injury was reported in 70.6% of cases. Predisposing factors were mostly due to urologic background (82.4%) with a history of urologic procedure (71%) and prior exposure to antibiotics (59%). All patients received appropriate antibiotherapy and 15 were treated with topical urinary acidification. A significant reduction of encrusted calcifications was observed in 88% of cases. Renal function improved in 71% of the patients. Nevertheless, poor tolerance of the treatment and side effects were common, affecting 71% of patients, with Gram-negative bacilli urinary tract infections (53%) being the most frequent. At last follow-up, 4 patients (23.5%) progressed to end-stage renal disease and only 1 had a clinical relapse.Conclusions: Encrusted urinary tract infections are rare, characterized by a severe renal and overall prognosis in the absence of appropriate treatment. Topical urinary acidification and appropriate antibiotherapy are efficient but may be burdened by significant adverse events