The French journal of urology最新文献

Background: Pelvic organ prolapse surgery is common, but postoperative recovery is rarely assessed from the patient's perspective.

Objective: To describe early patient-reported recovery using the Quality of Recovery-15 (QoR-15) score.

Methods: Preliminary single-center prospective observational study nested in an ongoing cohort. Patients completed the QoR-15 on postoperative days 1 to 3. Procedures were grouped as vaginal repair without sacrospinous fixation (n=3), vaginal repair with sacrospinous fixation (n=16) and laparoscopic sacrocolpopexy (n=12).

Results: Of 34 patients, 31 were analyzed; 85 of 93 questionnaires (91%) were completed. In the 25 patients assessed on days 1 and 3, the mean score increased from 109.4 to 116.7 (+7.3), exceeding the 6-point minimal clinically important difference, with wide individual variability. Psychological support scored highest from day 1, whereas physical independence and pain scored lowest.

Conclusion: The QoR-15 is feasible after prolapse surgery and captures clinically meaningful, multidimensional early recovery from the patient's perspective.

Objective: To identify the rate and predictive factors of spontaneous passage of ureteral stones <10 mm in patients with indwelling ureteral stents.

Materials and methods: A focused literature review was conducted in May 2025 using PubMed, Embase, Scopus, and Web of Science, focusing on English-language original studies reporting spontaneous passage of ureteral stones <10mm in adult patients with a ureteral stent placed in an emergency context (e.g., obstructive uropathy, acute renal colic, or sepsis).

Results: The database search identified 40 records after removal of duplicates. Following title and abstract screening, nine full-text articles were assessed for eligibility. Two articles were excluded at the full-text stage, one because it was not published in English and one because it did not exclusively concern ureteral stones. Seven studies were ultimately included in the narrative review. These studies involved symptomatic patients with single ureteral stones <10 mm initially managed with a double-J stent. Reported spontaneous stone passage (SSP) rates ranged from 8% to 61%. Stones ≤5 mm were significantly more likely to pass (up to 50%), while SSP was rare for stones ≥7 mm. Distal location and low stone density (<1000 HU) were also consistently identified as independent predictors of SSP. Prolonged stent dwell time (>4 weeks), female sex, and stone ureteral migration during stenting were also identified as contributing factors in some studies.

Conclusion: Stone size ≤5 mm, distal location, and low density appear to be the most consistently reported factors associated with spontaneous stone passage in patients with indwelling ureteral stents. However, given the limited number of retrospective single-center studies and their heterogeneity, these findings should be interpreted with caution. Rather than supporting definitive decision-making, these factors may help inform individualized clinical assessment.

Objectives: Low-capacity or defunctionalised bladder is a recurring urological dilemma before renal transplantation (RT), but the definitions, indications and protocols for programmed bladder cycling (PBC) remain poorly standardised. This scoping review aims to map bladder dysfunction definitions, patient populations, cycling protocols, urodynamic endpoints, adverse events and transplant-related outcomes.

Methods: This scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping review guidelines (PRISMA-ScR). All studies assessing bladder cycling before Renal Transplantation up to 11^th March 2026 were included. Findings were synthesized descriptively. PBC was defined as protocolised repeated or continuous bladder filling, retention and drainage before transplantation for assessment or conditioning.

Results: A total of 1,673 records were identified, of which 13 studies met inclusion criteria. Study designs were predominantly observational, with small sample sizes and substantial heterogeneity in patient selection, definitions of defunctionalised bladder, cycling protocols, and outcome reporting. Definitions varied from anuria, urinary diversion and low urine output to bladder capacity or pressure-based thresholds. Most studies reported increased measured bladder capacity (BC) after PBC and, in a subset of patients, improvements in urodynamic parameters. However, clinically relevant urological and transplant-related outcomes were infrequently reported. Only one study included a comparator group and demonstrated no significant difference in BC, compliance, or renal function between patients undergoing PBC and those managed without it.

Conclusions: PBC may increase measured bladder capacity in selected renal transplant candidates, but current evidence does not establish which patients require it, what endpoint should define adequate lower urinary tract optimisation, or whether it improves transplant-relevant outcomes. Future studies should distinguish adult disuse-related low-capacity bladder from paediatric congenital, neurogenic or reconstructed lower urinary tract dysfunction. In addition, the focus should shift from reporting of bladder capacity to clinically meaningful endpoints.

Introduction: Perilesional biopsy is increasingly proposed as a substitute for systematic biopsy, but the evidence is mostly retrospective, based on relabeled systematic cores. We aimed to assess the added value of perilesional and distant systematic sampling using a prospectively defined template.

Patients and methods: Consecutive patients with a suspicious magnetic resonance imaging lesion were included in a prospective institutional registry and underwent transperineal fusion biopsy with a predefined template. Targeted and perilesional cores of the suspicious lesion were taken for each patient, and distant systematic cores were left to the discretion of the operator. Each core was analyzed separately, using the 2019 ISUP recommendations. The primary endpoint was the incremental detection of clinically significant cancer (csPCa, i.e., ISUP grade group ≥2) and the grade change attributable to perilesional cores.

Results: Of 513 patients, 422 were analyzed. Targeted cores alone detected csPCa in 224 patients (53%), while targeted plus perilesional cores detected csPCa in 235 (56%) (+2.6, 95% CI 1.1-4.0; p=0.001). The aggregate grade (i.e., targeted plus perilesional cores) increased in 70 (17%) with no downgrade. Among 325 patients with systematic sampling, detection rose from 54% to 57% (+2, 95% CI 0.6-3.7; p=0.02). Systematic cores added nothing in 308 (95%) patients, cost 194 cores per additional csPCa, and yielded as many ISUP grade group 1 as significant cancers.

Conclusion: Perilesional cores mainly reclassify the index lesion, supporting systematic use. Distant systematic biopsy informs in a limited number of patients and may be discussed individually.

Background: Post-prostatectomy incontinence can substantially impair patients' quality of life. While rehabilitation typically targets the pelvic floor muscles, the role of the diaphragm and deep abdominal muscles is under-explored. This study aimed to determine the utility of evaluating and managing the transversus abdominis (TrA), diaphragm, and levator ani muscle (LAM) to facilitate post-prostatectomy urinary incontinence recovery.

Methods: This single-center observational cohort study included 90 patients. During post-prostatectomy rehabilitation, we regularly assessed muscle capacity using a standardized clinical examinations comprising nine tests. Capacity score ranges were 0-2, 0-3, and 0-4 for the TrA, diaphragm, and levator ani. Data were collected until continence was restored or improvement plateaued, generally by 8 months. Incontinence was classified as severe, moderate, mild, or corrected. Spearman's rho assessed associations between incontinence grade and muscle scores.

Results: Higher muscle scores were associated with lower incontinence severity. The most consistently significant correlation was with the TrA, followed by the diaphragm (p < 0.05). LAM scores were no longer significantly correlated with incontinence from month 4 onward. Only patients in the corrected-continence group passed both TrA tests.

Conclusion: Improved functional capacity of the TrA, diaphragm, and LAM was associated with the recovery of urinary continence. This association was strongest for the TrA. Our findings support the functional assessment of these three muscles in the evaluation and management of post-prostatectomy urinary incontinence.

Background: Although it is well known that prostate cancer treatments have a significant impact on sexuality and intimate relationships, this aspect is not given sufficient consideration in clinical practice. Thus, to date, there is no Francophone guideline on the onco-sexological care for prostate cancer. We therefore decided to proceed with a formalized expert consensus, using the method recommended by the French National Authority for Health. The aim was to provide the French urology and sexual medicine community with practice guidelines applicable to all patients treated for prostate cancer, regardless of the treatment, throughout the care pathway.

Methods: Twenty-five international experts met online for the consensus. A research committee carried out a comprehensive literature review and prepared the 64 statements submitted to the rating group. After one round of scoring, 58 recommendations were validated in July 2025, having achieved a consensus of more than 70% among the experts.

Results: The consensus focused on Informing patients and partners, assessing and treating sexual dysfunction and distress, providing lifestyle and psychosocial recommendations, as well as organisational and public health considerations. It is recommended that an oncosexological care pathway include: pre-treatment information, standardised screening based on patient-reported outcomes, early post-treatment assessment with regular reassessments, and access to a multidisciplinary care pathway.

Conclusions: The expert consensus on Onco-Sexological Care for Prostate Cancer led to the development of clinical guidelines based on the available literature and expert opinion. To achieve this, professionals must mobilize all available resources within the community and the cancer care network.

Introduction: To compare C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and inflammatory burden index (IBI) in Peyronie's disease (PD), assess their discriminatory performance and associations with recorded curvature duration and penile pain, and determine whether IBI provides additional information beyond CRP.

Materials and methods: This retrospective case-control study included 104 patients with PD and 127 controls. IBI was calculated as CRP × NLR. Group comparisons, ROC analyses with paired DeLong tests, and multivariable logistic regression were performed. PD-only analyses evaluated recorded curvature duration (≤12 vs >12 months) and pain-related associations.

Results: CRP and IBI were higher in patients with PD than controls [2.26 vs 0.50 mg/L and 3.74 vs 0.91, respectively; both p<0.001], whereas NLR did not differ (p=0.587). AUCs were 0.781 for CRP, 0.765 for IBI, and 0.521 for NLR; CRP and IBI showed similar discrimination (DeLong p=0.163). CRP and IBI remained independently associated with PD, while adding NLR to CRP did not improve model fit. Both were higher with shorter curvature duration. Pain-related analyses were inconsistent: CRP lost significance after adjustment, IBI was not associated with pain, and NLR showed an inverse association. IBI was not correlated with curvature degree or plaque dimensions.

Conclusion: CRP and IBI were elevated in PD and were higher with shorter recorded curvature duration. However, symptom-based analyses did not support either marker as a reliable indicator of clinically active disease. IBI did not outperform CRP or provide incremental information beyond it, and IBI did not reflect anatomical disease severity.

Introduction: Penile fracture (PF) is a rare urological emergency, resulting in poorly characterized risk factors and outcomes. Delayed complications mainly include erectile dysfunction (ED) and penile curvature (PC). The aim of this study was to identify factors associated with penile curvature 1 month after surgical repair of PF.

Methods: This multicenter retrospective study was conducted under the coordination of the French Association of Urology Residents (AFUF). Electronic medical records of patients who underwent surgical treatment for PF at 21 French referral centers between 2000 and 2024 were retrospectively reviewed. Preoperative, intraoperative, and postoperative data were analyzed to identify potential predictors of PC at 1-, 3-, and 12-month follow-up.

Results: Since 2000, 519 patients have been included. The mean age at treatment was 41.5 years, and more than 80% underwent surgery within 24 hours of injury. The overall postoperative complication rate was low (50 patients; 9.7%), with predominantly minor complications. 20% to 30% of patients experienced persistent penile curvature following surgical repair of PF. No variable, including patient characteristics, fracture pattern, or surgical factors, was significantly associated with the development of PC at 1 month.

Conclusion: The occurrence of PC 1 month after surgical management of PF appeared to be independent of patient- or injury-related factors, as well as surgical technique. Further studies involving larger cohorts and improved follow-up are needed to confirm these findings.

Level of evidence: 4:

Introduction: Calcium supplementation (CaS) and vitamin D supplementation (VitDS) are common among older women, but their association with health-related quality of life (HRQOL) in women with kidney stone disease (KSD) remains poorly characterized. We evaluated the association between CaS and/or VitDS and disease-specific HRQOL in women aged >50 years with KSD.

Materials: We performed a secondary analysis of a prospectively collected multicenter WISQOL database from 16 North American institutions (2014-2020). Women aged >50 years with a complete baseline Wisconsin Stone Quality of Life (WISQOL) assessment were included. Patients were classified as receiving neither supplement, CaS alone, VitDS alone, or combined CaS and VitDS. Multivariable general linear models evaluated associations with standardized WISQOL scores while adjusting for demographic, clinical, and contemporaneous stone-related characteristics.

Results: Among 734 women, 381 (51.9%) received neither supplement, 44 (6.0%) CaS alone, 206 (28.1%) VitDS alone, and 103 (14.0%) combined CaS and VitDS. Supplementation status was not significantly associated with total WISQOL score (global p=0.400). Compared with neither supplementation, adjusted differences were +4.06 points for CaS alone (95% CI -2.42 to 10.54), +0.34 for VitDS alone (95% CI -3.47 to 4.15), and +3.29 for combined CaS and VitDS (95% CI -1.53 to 8.11). No significant domain-specific associations were observed after correction for multiple testing.

Conclusion: CaS and/or VitDS was not independently associated with disease-specific HRQOL in women aged >50 years with KSD. Supplementation decisions should remain guided by clinical indication, skeletal health, and individual metabolic stone-risk profile rather than an expected association with stone-specific HRQOL.