Le priapisme veineux aigu (PVA) est urgent en raison de séquelles érectiles éventuelles. Sa rareté et l’absence de procédure expliquent des traitements encore inégaux, peu normés.
Objectif
: ...Optimiser la prise en charge initiale d’un PVA grâce à une procédure décisionnelle, adaptée aux urgentistes.
Matériel et méthode
: Une revue systématique de la littérature recense les algorithmes schématisés ainsi que des articles de revue et mises au point récents. Les critères diagnostiques et thérapeutiques ont été analysés puis comparés pour vérifier s’ils répondaient aux besoins. La validation de cette procédure par des experts a été recherchée.
Résultats
: L’originalité de notre procédure réside dans sa cible (urgentistes), sa hiérarchisation, « Que faire ? Comment faire ? Quand faire ? Qui fait ? », de façon graduée et séquentielle via une chronologie détaillée, et une priorité donnée à la gazométrie caverneuse, fil conducteur de la prise en charge, facilement disponible. À cela s’ajoutent des tableaux, des check-lists (contexte étiologique et souffrance ischémique), des schémas descriptifs des traitements médicaux indiqués en première ligne (technique, matériel de ponction décompressive et d’injection intracaverneuse d’alpha-stimulant), critères de recours à l’urologue, suivi et hospitalisation. Cette procédure a été validée par le conseil scientifique du réseau nord-alpin des Urgences, le comité d’andrologie et médecine sexuelle de l’Association française d’urologie.
Conclusion
: Facile à utiliser, cette procédure inédite répond à un réel besoin. Son appropriation et sa diffusion s’inscrivent dans une démarche qualité adaptée au parcours de soins du PVA en France afin de prévenir les séquelles érectiles de cette urgence affectant majoritairement des sujets jeunes.
Low-flow or ischemic priapism is the only urgent one because of after-effect erectile risk. In France, all patients are seen at first in emergency unit and usually without urologic consultation (this point depends on the institution) without practical guidelines to follow. Low-flow priapism is rare and the lack of a standardized and dedicated procedure explains that the treatment is still too inappropriate.
Objective
: To optimize and to homogenize the initial care by providing a simple decision-making procedure adapted to the previously identified medical requirements of emergency physicians.
Material and method
: A systematic literature review lists all the decision-making algorithms and the review articles. Their main diagnostic and therapeutic criteria were analyzed and compared to check if they actually met the medical requirements. Validation of this procedure by experts was sought.
Results
: Many gaps and inaccuracies in the initial care led us to improve our 2015 decision algorithm. Already published as a procedure, its originality is based on its target (emergency physicians), its ranking in the “What to do? How to do? When to do? Who does what?” gradual and sequential manner, as stipulated by the international guidelines but with a more detailed chronology the priority given to cavernous blood gas analysis, a new central cornerstone of all management because it is always readily available. The addition of tables and practical diagrams like checklists (assessment of etiological context and ischemic pain), description of first intention medical treatments (technic and material of decompressive puncture and alpha-stimulant intra-cavernous injection), criteria of resort to urologist, of follow-up and hospitalization. This procedure has been validated by the scientific council of the North-Alpine Emergency Network and the sexual medicine committee of the French Urological Association.
Conclusions
: This simplified procedure is easy to use, without existing equivalent. It meets a real need for nonspecialist emergency physicians of low flow priapism. Its appropriation and dissemination are part of a quality approach adapted to the primary care path of low-flow priapism in France, in order to prevent or minimize its erectile consequences of this emergency, which primarily affects young people.
Quoique rarement confronté, le sexologue doit savoir qu’une érection « priapiforme », c’est-à-dire, consciente supérieure à 15minutes hors tout contexte sexuel, est anormale et devient ...potentiellement dangereuse après une heure. Jusqu’à preuve du contraire, c’est une urgence thérapeutique en raison du risque de séquelles érectiles (si non traité avant la 24e heure) spécifique au type veineux aigu (95 % des cas). Les trois points-clé du traitement sont de préciser la durée, le mécanisme physiopathologique et l’étiologie. Dans la majorité des cas, la clinique et, si besoin, la gazométrie distinguent le type veineux chronique, subaigu ou aigu (le plus dangereux) du rarissime type artériel. Le traitement est toujours adapté au type artériel ou veineux et à la souffrance hypoxique (rôle de la gazométrie). Pour le type veineux aigu, le traitement médical est quasi toujours efficace avant la 24e heure. La chirurgie n’est indiquée qu’en cas d’échec du traitement médical ou de cas vus après la 24e heure. Le sexologue peut être en 1re ligne en cas de priapisme veineux chronique ou surtout, subaigu provoqué par une injection intracaverneuse de médicaments proérectiles. Après avoir évalué le degré d’urgence, il ne doit pas hésiter à démarrer le traitement médical de 1re ligne avant de l’adresser, si besoin, aux urgences ou à l’urologue. De fait, la meilleure prévention des séquelles érectiles postpriapisme passe par la sensibilisation des professionnels de santé et des sujets à risque concernés à ces dangers ainsi que par le traitement précoce des érections priapiformes.
Although rarely confronted, the sexologist must be aware that a “priapiform” erection, i.e. conscious>15minutes, outside any sexual context, is abnormal and may become potentially dangerous after one hour. Until proven otherwise, any priapism is a therapeutic emergency due to the risk of ischemic erectile sequelae (if not treated before the 24th hour) specific to the acute venous type (95% of cases). The three key points of treatment are to precise the duration, the pathophysiological mechanism and the etiology. In the majority of cases, the clinic and, if necessary, the blood gas distinguish the chronic, subacute or acute (the most dangerous) venous type from the very rare arterial type. The treatment is always adapted to the arterial or venous type and to hypoxic suffering (blood gas role). Medical treatment is almost always effective before the 24th hour for the acute venous type. Surgery is only indicated if medical treatment has failed or cases seen after 24th hour. The sexologist may be in the 1st care line in case of chronic venous priapism or especially, iatrogenic one caused by an intracavernous injection of proerectile drugs. After evaluating the emergency degree, he should not hesitate to start first-line medical treatment before referring, if necessary, to the emergency room or to the urologist. In fact, the best prevention of post-priapism erectile sequelae involves educating all both concerned health professionals and at-risk subjects about these dangers as well as prompt treatment of priapiform erections.
The interest in the development of nanoscale plasmonic technologies has dramatically increased in recent years. The photonic properties of plasmonic nanopatterns can be controlled and tuned via their ...size, shape, or the arrangement of their constituents. In this work, we propose a 2D hybrid metallic polymeric nanostructure based on the octupolar framework with enhanced sensing property. We analyze its plasmonic features both numerically and experimentally, demonstrating the higher values of their relevant figures of merit: we estimated a surface-enhanced Raman spectroscopy (SERS) enhancement factor of 9 × 107 and a SPR bulk sensitivity of 430 nm/RIU. In addition, our nanostructure exhibits a dual resonance in the visible and near-infrared region, enabling our system toward multispectral plasmonic analysis. Finally, we illustrate our design engineering strategy as enabled by electron beam lithography by the outstanding performance of a SERS-based biosensor that targets the Shiga toxin 2a, a clinically relevant bacterial toxin. To the best of our knowledge, this is the first time that a SERS fingerprint of this toxin has been evidenced.
Our aim was to present a synthesis on the diagnosis and treatment of priapism.
For this purpose, a literature search was performed through PubMed to analyze literature reviews and guidelines ...regarding priapism.
Priapism is an erection that persists more than 4hours. There are 3 types of priapism: ischemic priapism, non-ischemic priapism and recurrent (stuttering) priapism. Ischemic priapism, often idiopathic, is the most frequent. When diagnosed, an urgent management is required to limit erectile dysfunction. Sickle-cell patients are prone to have ischemic and stuttering priapism. Non-ischemic priapism usually occurs after perineal trauma. Priapism management depends on the type of priapism. Medical treatment (corporal aspiration and injection of sympathomimetics) then if failed, surgery are indicated for ischemic priapism. The persistence of a non-ischemic priapism most likely requires a radiologic embolization.
Priapism is a condition that often requires emergency treatment to spare erectile function. It appears crucial to know this condition and its management.
Le couple, mode de vie majoritaire des malades, est un paramètre important pour la vie sexuelle et le cancer, qui impacte aussi la sphère domestique privée. Intégrer la problématique oncosexuelle du ...couple répond à plusieurs priorités du 3e plan cancer : personnaliser la prise en charge, réduire les inégalités de soins et prévenir/minimiser les impacts négatifs, aigus ou chroniques, médicaux, psychosociaux et… conjugaux. Malgré son effet protecteur documenté contre le cancer (plus net chez l’homme), la dimension couple est trop régulièrement négligée. Si peu se séparent, trop de couples souffrent longtemps en silence car ils se sentent mal préparés aux changements réels ou supposés de leur vie intime, par défaut d’information des professionnels de santé, sur la morbidité sexuelle et sur les solutions disponibles. Malgré leur forte demande et l’efficacité des outils traitant les problématiques oncosexuelles, les réponses soignantes et institutionnelles restent très insuffisantes, source inconsciente de maltraitance et d’inégalité de soins d’autant moins acceptables qu’elles peuvent aggraver le cancer. Quel que soit l’âge, concilier les parcours de vie et de soins du couple est souvent possible sous réserve : (a) d’être sensibilisé aux dimensions oncosexuelles et psychosociales, (b) de s’en préoccuper tôt, (c) de privilégier une approche interdisciplinaire, (d) de connaître les spécificités propres au cancer : brutalité, iatrogénie prépondérante, rôle aidant du partenaire, complexité d’être conjoint malade ou garde-malade, rôle révélateur de la qualité de la relation, (e) de dépister les facteurs de vulnérabilité, souvent masqués, liés au cancer, au genre et au couple. Quoique les enjeux, les priorités et les impacts sexuels varient beaucoup selon les cancers et les couples, l’« insécurité sexuelle » risque d’altérer le dialogue puis de déstabiliser la dynamique du couple, aggravant sa détresse et sa souffrance en l’absence de dépistage et/ou de prise en charge des couples les plus vulnérables.
The couple, main way of life of cancer patients, is an important parameter for both sexual life and cancer that changes the home private life. To integrate the oncosexual couple problem is an adequate response to many priorities of the 3rd cancer plan as to personalize the treatment, to improve the inequality of healthcare, to reduce or to prevent the acute or chronic medical, psychosocial and couple negative impacts. In spite of its cancer protective proved effect, the couple dimension is too often underestimated. If separations are rare, too many couples silently suffer because they feel themselves insufficiently prepared to the real or supposed intimate life changes owing to the information lack by healthcare professionals concerning the sexual morbidity and the available solutions. In spite of both strong demand and treatment efficacy, the healthcare and institutional responses remain very insufficient. This represents an unconscious inequality of care that is no more acceptable as the cancer treatment may be impaired. Whatever the age, to council both healthcare and life pathways is often possible at the condition to: (a) to be sensitized to oncosexual and psychosocial dimensions, (b) to take care soon, (c) to favour a multidisciplinary approach, (d) to know the cancer couple particularities: brutality, major iatrogenic component, partner helping role, complexity to be the sick-person or the partner, revealing role for the relationship quality, (e) to screen the often masked vulnerability factors linked to cancer, gender and couple. Although, the sexual priorities and impacts largely change according to cancers and couples, any sexual insecurity may change the dialogue then the couple dynamic, impairing both distress and suffering in the absence of screening/treatment of the most vulnerable couples.
GreenLight photoselective vaporisation of the prostate (PVP) offers an endoscopic alternative to open prostatectomy (OP) for treatment of large adenomas. This study compares long-term functional ...outcome of both techniques in patients with Benign prostatic obstruction (BPO)>80g.
Data from patients who underwent surgical treatment for BPO>80g from January 2010 to February 2015 at our institution were retrospectively collected and compared according to surgical technique. Patient's demographics, surgeon's experience, operative data and long-term functional results were analyzed, using IPSS and International continence society (ICS) male questionnaire associated with Quality of life scores (IPSS-QL and ICS-QL). Predictors of long-term outcome were also assessed.
In total, 111 consecutive patients, 57 PVP and 54 OP, were included in the study with a mean follow-up of 24 and 33 month respectively. Patient's age, Charlson score, preoperative IPSS and urinary retention rates were similar. Mean prostatic volume was superior in the OP group (142 versus 103g, P<0.001). Transfusion rate was lower after PVP (P=0.02), despite a more frequent anticoagulant use. Length of hospital stay and urinary catheterization were shorter after PVP (P<0.001), with however a higher rate of recatheterization (RR=4.74) and rehospitalization (RR=10.42). Long-term scores were better after OP for IPSS (1 versus 5, P<0.001), IPSS-QL, ICS, ICS-QL. On multivariate analysis, prostatic residual volume was the only predictor of long-term IPSS but not ICS.
Long-term functional outcome are better after OP compared to PVP. However, PVP offers good results, allowing to safely operate patients taking anticoagulants, regardless of prostatic volume. Endoscopic enucleation may the compromise between both techniques.
4.
Our aim was to present the indications and the outcomes of penile prosthesis implantation.
A literature review was performed through PubMed using the following keywords: penile implantation ; penile ...prosthesis; erectile dysfunction.
Evolution of penile prosthesis devices led to get a fiable and effective treatment for men with erectile dysfunction who do not respond to less invasive therapy. Penile implant can also be useful in the treatment of Peyronie's disease, priapism and transgender surgery. Precise information related to this surgery, especially complications, permits to obtain high satisfaction scores.
Penile implant is a reliable and safe solution for the management of erectile dysfunction resulting to high couple satisfaction ratings.
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