Les ruptures post-traumatiques de l'urètre (à propos de 96 cas)

Objectif : Evaluer, de manière rétrospective, la prise en charge des patients traités pour des lésions post-traumatiques de l'urètre bulbo-membraneux à l'Hôpital Bichat entre janvier 1988 et octobre 2003. Matériel et Méthodes : 190 opérations ont été réalisées sur 96 patients, pour traitement de lésions post-traumatiques de l'urètre bulbo-membraneux, après traumatisme du bassin dans 76 cas (79,2%) et après traumatisme périnéal dans 20 cas (20,8%). 89 urétroplasties ont été pratiquées (46 urétroplasties anastomotiques, 6 urétroplasties en un temps et 37 urétroplasties en deux temps). Les traitements endoscopiques ont comportés 73 urétrotomies, 5 endoprothèses et 2 réalignements endoscopiques. Le suivi moyen est de 5,6 ans. Résultats : Les taux de résultats satisfaisants après urétroplastie à 1 an, 5 ans et 10 ans sont respectivement de 82,3%, 68,8% et 63,3%. Après urétroplasties anastomotiques, les résultats sont les meilleurs. Les facteurs de mauvais résultats sont : l'infection urinaire préopératoire, l'infection urinaire fébrile postopératoire, les sténoses après fracture du bassin, les antécédents d'urétroplastie. Les urétrotomies après urétroplastie ont des résultats meilleurs par rapport aux urétroplasties réalisées après le traumatisme. Le taux d'impuissance est de 63,9% initialement. Une régression totale ou partielle est observée respectivement dans 15,2% et 13% des cas. Le taux d'incontinence est de 10,4%. Conclusions : La prise en charge des ruptures traumatiques de l'urètre reste un exercice difficile. Cependant, de bons résultats à long terme peuvent être obtenus, au pris d'interventions à ciel ouvert souvent délicates.Patients treated at Bichat hospital for urethral traumatic disruption were retrospectively reviewed between 1988 and 2003. 190 procedures were performed after pelvic fracture (76 cases) and after perineal trauma (20 cases). 89 urethroplasties, 73 urethrotomies, 5 endoprothesis and 2 endoscopic realignements were done. Mean follow-up : 5.6 years. Satisfactory result rates at 1 year, 5 years ans 10 years were respectively 82.3 %, 68.8 % and 63.3 %. After anastomotic urethroplasty, results were better. Poorer results were observed for preoperative urinary infection, postoperative urinary infection with fever, after pelvic injury and after previous urethroplasty. Results of urethrotomy after urethroplasty were better than urethrotomy after trauma. Impotence rate were 63.9 % and incontinence rate 10.4 %.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact of retrograde flexible ureteroscopy and intracorporeal lithotripsy on kidney functional outcomes

ABSTRACT Objective: The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS) for kidney stones. Materials and Methods: We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD) to classify Glomerular Filtration Rate (GFR) in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant. Results: We included 163 patients. There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675). Significant renal function deterioration occurred in 8 cases (4.9%) and significant renal function amelioration occurred in 23 cases (14.1%). In univariate analysis, multiple procedures (p=0.023; HR: 5.4) and preoperative CKD (p=0.011; HR: 6.8) were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors. Conclusion: Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease

Renal function after partial nephrectomy following intra-arterial embolization of renal tumors

International audienceAbstract Laparoscopic Partial Nephrectomy (LPN) after intra-arterial Embolization of renal tumors (LPNE) in a hybrid operating room allows renal tumor enucleation without dissection and clamping of the renal pedicle. The purpose was to assess the potential negative impact of embolization on the renal function. This prospective monocentric study included all patients treated with LPNE between May 2015 and June 2019. Clinical data was collected and incorporated into the UroCCR database (NCT03293563). Glomerular Filtration Rate (GFR) and Computed Tomography Renal Volume (CTRV) were compared before and after 6 months following LPNE. The mean post-operative GFR was 86.6 mL/min (SD 22.9). The mean GFR loss was 9.4% (SD 15.1) and the median renal parenchyma loss was 21 mL (SD 20.6). Using a threshold of 25% GFR loss, age was the only significant predictive factor of renal function impairment according to bivariate (59.5 vs 69.3 years, p = 0.017) and multivariable analysis (OR 1.075, CI 1–1.2], p = 0.05). Significant renal function impairment was not correlated with the renal parenchymal volume loss (OR 0.987, CI [0.95–1.02], p = 0.435). Renal function impairment after LPNE seems to be comparable to other techniques of partial nephrectomy

Stopping or maintaining oral anticoagulation in patients undergoing photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial

International audienceBACKGROUND:Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP.METHODS:This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score < 2), using two-tailed 95% confidence intervals.DISCUSSION:This first multicentre RCT in the field is underway to evaluate the safety and efficacy of PVP in patients with ongoing OAC therapy. The study results could influence the perioperative management of OACs in BPO surgery with a high level of evidence