Notes

An iron deficiency anaemia while being pregnant: A modern evaluate.
ed with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m2), weight loss should be preferred prior to MUS surgery and bariatric surgery should be discussed (strong agreement) CONCLUSION The current Opinion provides an appropriate strategy for both the selection of patients and the best therapeutic approach in women presenting with USI.
Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration.

We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not.

In total, 2940 had surgical exploration 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR 1.04; 95% CI 1.01-1.06; P=0.005), medical history of cryptorchism (OR 4.14; 95% CI 1.05-16.31; P=0.042) and VAS pain score (OR 0.91; 95% CI 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28).

Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.
Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.
To evaluate extraprostatic extension and 10 years cancer specific survival in a population of patients with Gleason 6 (ISUP 1) prostate cancer (PCa) treated by radical prostatectomy (RP) in two French third referral centers.

The data were extracted from 2 university hospital databases according to the following criteria PCa classified ISUP 1 following both biopsy (PB) and surgery (RP) between 1998 and 2008. check details Pathology slides of patients having presented an extraprostatic extension and/or a recurrence were reviewed by a uropathologist.

Among the 534 patients who met the inclusion criteria, 66 (12.2%) had a pT3 stage. One patient out of 198 who received lymph node dissection had a positive node. Median follow-up was 10.3 years. Only one patient presented with metastatic progression. No cancer specific death was observed. An independent pathologist reviewed the slides of 58 out of the 70 patients who presented pT3 disease and/or a recurrence (in 12 cases, pathological material was not available). After review, all pT3b stages and 12 pT3a (out of 14) were upgraded to ISUP2 or higher. Similarly, the patient with a positive node and the patient who progressed towards a metastatic disease were both upgraded to ISUP 3.

No pT3b or pN+stage was associated with ISUP 1 PCa in our study. With a median follow-up of more than 10 years, biological progression was the only type of progression observed.
No pT3b or pN+stage was associated with ISUP 1 PCa in our study. With a median follow-up of more than 10 years, biological progression was the only type of progression observed.
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.

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 2student 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, 20MCQs on the kidney transplantation technique were completed by the 2groups. The answers were anonymous.

A total of 142people 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 2groups. The rate of correct answers to the 20MCQs 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.

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.

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Scrotal calcinosis is a benign idiopathic cutaneous calcinosis characterized by the presence of calcified nodules of the scrotal skin. The aim of the study is to report the clinical, histological and therapeutic aspects.

This was a prospective descriptive study from 2014 to 2020 in the department of urology. Patients were included, aged at least 15years, consulting for nodules of the scrotal skin whose clinical and paraclinical assessment concluded to scrotal calcinosis. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Informed consent of the patients and anonymity in the use of scientific photographs were observed.

In 6years, 8 cases of scrotal calcinosis were diagnosed and operated on, i.e. 1.3 per year. The average age of the patients was 36.2years. The average age of the lesions was 4.2years, the general condition was good (n=8). The unsightly appearance (n=5), pruritus (n=2), recommendation of the spouse (n=2), psychological trauma (n=5), and fear of cancerous degeneration (n=3) were the reasons for consultation. The lesions were scattered or in clusters. Serologies were positive HIV (n=2), chlamydia (n=4) and syphilis (n=3). Treatment was surgical (n=8). Histological analysis concluded to scrotal calcinosis. The average hospital stay was 2days. The mean time to complete healing was 19.6days without recurrence.

Scrotal calcinosis is a benign, rare idiopathic pathology. The treatment is surgical.
Scrotal calcinosis is a benign, rare idiopathic pathology. The treatment is surgical.
Evaluation of repeated (at least 4) intra-detrusor injections of toxin botulinum A (IDI-TBA) for neurogenic bladder in a pediatric cohort.

Patients who underwent at least 4 IDI-TBA between 2005 and 2017 for neurogenic bladder related issues were included (detrusor overactivity and low compliance). Clinical and cystometric data were collected before and after the first injection and after the last injection. The primary endpoint was the proportion of patients with non-abnormal cystometry (no detrusor overactivity and normal compliance). Secondary outcomes were the evolution of the observed bladder capacity/expected ratio, surgical complications and acquired kidney impairment.

From the 832 patients referred to our institution for neurogenic bladder, 48 underwent IDI-TBA, and 17 at least 4 injections. Among them, a total of 95 procedures were performed (median per patient 5 [4-8]). While the first injection had a significant effect for 82.3% patients, the last injection improved the medical condition for only 53.0% cases. The bladder capacity ratio, initially 36.1%, increased to 80.3% after the first injection but decreased to a level of 57.1% at last. After a median follow-up of 57 [34-102] months, no severe complications were reported but 11.8% of patients presented with repeated pyelonephritis. A bladder augmentation surgery was finally indicated for 35.3% cases.

Despite a low complication rate and impressive cystometric results after the first injection, IDI-TBA efficacy decreased with time and repetition. These findings prone a long-term follow-up and a "à-la-carte" management of this specific population depending on the long-term response to IDI-TBA.

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Because the tyrosine kinases c-MET and vascular endothelial growth factor receptors (VEGFR) are often overexpressed in salivary gland cancer (SGC), this study evaluated the efficacy and safety of cabozantinib in patients with recurrent/metastatic (R/M) SGC.

A single-centre phase II study was conducted. Patients with immunohistochemical c-MET-positive R/M SGCwere included in three cohorts adenoid cystic carcinoma (ACC); salivary duct carcinoma (SDC)and other miscellaneous SGCs. No prior systemic treatments were required. Patients started cabozantinib 60mg once daily. The primary outcome was the objective response rate (ORR). Secondary outcomes included survival, safety and quality of life. Per Simon-two-stage design, depending on efficacy, a maximum of 43 patients would be included.

In total, 25 patients were included until premature closure owing to severe toxicity. Six patients (24%) had grade 3-5 wound complications, occurring at a median of 7.1 months on cabozantinib treatment (range 2.1-12.6). Remarkably, fourof these six patients developed this complication in the area prior exposed to high-dose radiotherapy. Other grade ≥3 adverse events in >1 patient were hypertension (20%), diarrhoea (8%) and dehydration (8%). Twenty-one patients were evaluable for response; 1/15 ACC (ORR 7%); 1/4 SDCand 0/2 patients with other miscellaneous SGCresponded. Median progression-free survival was 9.4 months (95% confidence interval [CI] 7.4-11.4 months), 7.2 months (95%CI 0.0-15.1)and 6.9 months (95%CI 0.0-15.1), respectively.

This study showed too many severe cabozantinib-associated wound complications in patients with SGC, especially in prior irradiated areas. Therefore, the study closed prematurely. The efficacy in the limited number of evaluable patients was low to moderate.

This trial was registered on ClinicalTrials.gov NCT03729297.
This trial was registered on ClinicalTrials.gov NCT03729297.
Within gender-diverse populations, gender-affirming changes in gender on record may improve mental or behavioral health. This study uses claims data to investigate whether sex assigned at birth modifies the association between change in gender on record and mental or behavioral health.

Adult Oregon Medicaid beneficiaries with gender identity-related diagnoses and enrolled during 2010-2019 were included. Sex assigned at birth was inferred from medical and pharmacy claims and was categorized as assigned female, assigned male, or unknown sex assigned at birth. Self-reported gender ascertained at initial enrollment differing from sex assigned at birth indicated a change in gender on record. Multivariable logistic regression estimated the association between change in gender on record and mental (anxiety, depression, suicidal ideation, post-traumatic stress disorder) or behavioral (alcohol, substance, or tobacco use disorders) health. Analyses were conducted in February 2021.

This study included 2,940 transgender and nonbinary adults.
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