OBJECTIVE: To study infections associated with care in the urology department of the Gabriel Touré University Hospital.
METHODS: This was a prospective, descriptive study from April 1 to September 31, 2016 in the Urology Department of CHU Gabriel TOURE. Included in this study were all inpatients (operated and non-operated) in the department. Not included are non-consenting patients and patients admitted for necrosectomy. The following parameters were studied: age, sex, origin, nationality, ASA score, BMI, WHO performance index, duration and type of intervention, ECBU, ECB,GE, antibiotics, antiseptics used, mortality, morbidity.
RESULTS: We collected 203 patients, 30 (15%) of whom had healthcare-associated infections. The mean age of patients with a healthcare-associated infection was 58 years with a standard deviation of 24.5983 and a sex ratio of 5,2. ASA patients had a healthcare-associated infection in 70% of cases and ASA2 in 52% and ASA3 in 100% of cases. We recorded 13 patients infected with NNISS score=0 or 9%, 12 cases infected with NNISS score=1 or 24% and 3 cases infected with NNISS score=2 or 27%. Fever appeared in 35% of patients from the 4th day; fever was recorded from the 5th, 6th, 7th and 11th days, i.e. 5 to 30%. Organ suppurations dominated with 52%, followed by superficial suppurations of 38%, and 10% deep suppurations. The majority of patients had a suppuration between the 4th and 6th day of the operation, i.e. 65%. Germs are in order of frequency: E. coli (40.74%); Klebsiella pneumoniae (37.03%); Enterococcus faecalis (14.81%); Pseudomonas aeroginosa, (3.70%) and Acinetobacter baumannii (3.70%). Nitrofurantoin has been effective on E. coli, K. pneumoniae, and E. faecalis.
CONCLUSIONS: Care-associated infections are potentially serious and sometimes fatal, prolonging the duration of hospitalization with a definite impact on patients\' post-operative rehabilitation.
UNASSIGNED: Etudier les infections associées aux soins au service d\'urologie du CHU Gabriel Touré.
UNASSIGNED: Il s\'agissait d\'une étude prospective, descriptive, allant du 1er avril au 31 septembre 2016 dans le Service de d\'Urologie du CHU Gabriel TOURE.Lecritere d\'inclusion de cette étude etaient les malades hospitalisés (opérés et non opérés) dans le service. Non pas été inclus les patients non consentant et les patients admis pour necrosectomie. Les paramètres suivant ont été étudiés : âge, sexe, provenance, nationalité , score ASA, IMC, indice de performance OMS, durée et le type d\'intervention, ECBU, ECB,GE, antibiotiques, antiseptiques utilisés , mortalité, morbidité.
UNASSIGNED: Nous avons colligés 203 patients dont 30 (15%) ont présenté des infections associées aux soins. L\'âge moyen des patients qui avaient une infection associée aux soins était de 58ans avec un écartype de 24,5983 et un sex ratio de 5, 2. Les patients ASA avaient une infection associée aux soins dans 70%des cas et ASA2 dans 52% et ASA3 dans 100% des cas . Nous avons enregistré 13 malades infectés de score de NNISS=0 soit 9%, 12 cas infectés de score de NNISS=1 soit 24% et 3 cas infectés de score de NNISS=2 soit 27%.. La fièvre est apparue chez 35% des patients à partir du 4ème jour ; la fièvre a été enregistrée à partir des 5ème, 6ème, 7ème et 11ème jours soit 5 à 30%. Les suppurations d\'organes ont dominé avec 52%, suivies des suppurations du site operatoire de 38%, et 10% de suppurations profondes.La majorité des patients ont présenté une suppuration entre le 4èmeet le 6ème jour de l\'intervention soit 65%. Les germes sont par ordre de fréquence : E. coli (40,74%) ; Klebsiellapneumoniae (37,03%); Enterococcus faecalis (14,81%) ; Pseudomonas aeroginosa, (3,70%) et Acinetobacter baumannii (3,70%). Le Nitrofurantoine a été efficace sur E.coli, K. pneumoniae, et E. faecalis.
CONCLUSIONS: Les infections associées aux soins sont potentiellement graves et parfois mortelles, elles prolongent la durée d\'hospitalisation avec un retentissement certain sur la réhabilitation postopératoire des patients.

OBJECTIVE: To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway.
METHODS: All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year.
RESULTS: One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%.
CONCLUSIONS: A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care.
METHODS:

BACKGROUND: Physical examination appears to be a limiting factor of teleconsultation (TC). We evaluated the feasibility of self-percussion of the lumbar fossae (sPLF) and TC for simple renal colic (SRC) in comparison with a face-to-face consultation (FC).
METHODS: We performed a comparative prospective study in two steps. First: evaluation of the quality of an sPLF on a standardized patient in TC, without and with tutorial. Secondarily: evaluation of a TC and a FC for a SRC with a standardized patient in real conditions. Evaluation using objective clinical scores and qualitative scales by an observer, the standardized patient and the practitioner himself.
RESULTS: Forty-two practitioners were included in the study. In the absence of a tutorial, the sPLF was most often \"poorly done\". The tutorial led to a significant improvement in the quality of sPLF. There was no difference in diagnostic and therapeutic performance among senior physicians between TC and FC. The therapeutic performances of the interns were significantly lower in TC without his being aware of it. The qualitative scores were significantly lower in TC vs FC according to the practitioners, the standardized patient and the observer.
CONCLUSIONS: An sPLF is feasible but its practice should be taught. Unlike interns, senior physicians were able to perform a TC comparable to FC for the management of SRC. TC and telesemiology therefore require dedicated training and an experienced practitioner.
METHODS:

BACKGROUND: The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021.
METHODS: This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation.
RESULTS: Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors.
CONCLUSIONS: The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future.
METHODS:

暂无摘要。

There are still significant disparities between the sexes even if we are now witnessing a feminization of the urological profession. Women\'s roles in historically male-dominated services still vary widely based on inherent gender biases. Interventions to minimize the gender gap in urology should not constitute a form of positive discrimination in favor of minorities but on the contrary a form of positive action to eliminate the obstacles present that block the acceptance of women or their promotion. Recognizing the factors responsible for gender disparities remains a key step towards improving equity in still male-dominated fields such as urology.

The first part of this article deals with accreditation of the quality of the professional practice of urologists and medical teams working in public or private health care institutions. This is a voluntary national risk management process based on the reporting and analysis of medical risk events and the development and implementation of recommendations. The fundamental objective of the system is to reduce the frequency and severity of adverse events associated with care for the patient. The second part aims to describe the mechanisms and management of surgical complications. The perception of complications by the urologist is discussed, as it may be distorted by cognitive biases leading to inappropriate actions. Two important points were also emphasized: communication with the patient following an injury, therapeutic hazard or complication following an error, and proper maintenance of the medical record. A joint effort to cultivate a culture of safety and quality in urological surgical practice should be encouraged. Collective actions by urologists in the future should help to maintain a proactive attitude: - generalization of quality accreditation of urologic physicians\' professional practice; - national registry: which has demonstrated its advantages in the world of aeronautics; - creation of a specific module \"Management of complications in urology\" in teaching (ECU) and continuing education (SUC, website); - creation of an AFU \"Complications\" Committee; - management of social networks.

Prostate 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.

The objective of this article was to summarize the means and tools of prevention and safety of care to reduce non-random surgical complications in urology, related to the care environment and the patient. The prevention of complications is an essential strategy to be applied in a standardized way in urological surgery, as in the world of aeronautics, from which we can draw valuable lessons. This prevention is multifactorial and concerns interventions, systems and human factors. The essential points listed below must be traceable: the quality of the assessment of the patient and his co-morbidities. This is a multidisciplinary task; the relevance of the surgical indication, which must take into account the state of the art at the time it is given; the expertise of the urologist and his continuing education; the relevance of the surgical indication, which must take into account the state of the art at the time it is given; the quality of the information provided to the patient and his family, and to the medical and paramedical team involved in the patient\'s care; the quality of the professional environment and equipment; compliance with recommended safety rules (e.g. checklist, identity check). All these points are not isolated but interdependent. They must be recorded in the patient\'s file, the quality and completeness of which is essential to the patient\'s follow-up, to the prevention and management of complications and to the understanding, if necessary, of the truth of the medical facts.

The objective of this article was to discuss the statistics of surgical complications in urology and the methods of collection and classification. In the absence of a comprehensive national registry of complications, we used statistics from insurance companies as indicators. They are limited by the exclusion of complications that did not result in a claim. Overall, urology is less exposed to claims than other surgical specialties. It comes far behind orthopedic surgery, gynecology-obstetrics and visceral surgery. The new techniques in urological surgery and in particular the rise of robotic surgery do not seem to have modified the number of claims handled by medical insurance companies. It is unfortunate that complications in urological surgery are not collected, reported, and discussed in order to develop prevention, treatment, and strategies for educational purposes. The lack of an established definition and classification of surgical complications, as well as methodological differences in the collection of related information, has hampered the evaluation of their public health and health economics impact. Awareness of this problem is growing among learned societies and practitioners. Complication reporting should be organized on a national basis and should respect the following points: - definition of the collection process according to a validated system. For urology, the Martin table revised by the EAU working group would be adapted; - classification of complications according to a validated system such as Clavien-Dindo or CCI.