Xavier Tillou

Ureteral strictures and urinary fistulas remain the most frequent urological complications after kidney transplantation and may jeopardize graft function when drainage or endourological measures fail. We assessed outcomes of surgical reconstruction, using pyelo-ureteral anastomosis as the reference technique. We conducted a retrospective, single-center study (March 2008-June 2025) including adult kidney transplant recipients who required open surgical reconstruction for ureteral stricture or urinary fistula. Patients treated with endoscopy alone and those managed with simple early ureterovesical reimplantation were excluded. Reconstructions were grouped as pyelo-ureteral anastomosis (n = 21) or other techniques (n = 14): calico-ureteral anastomosis (n = 6), Boari-Küss flap (n = 3), ureterovesical reimplantation with psoas hitch (n = 3) and crossed pyelo-ureteral anastomosis (n = 2). The primary endpoint was functional success defined by recurrence-free status, i.e., no long-term dependence on secondary urinary diversion (JJ stent and/or nephrostomy) and no need for further reconstructive surgery. Secondary endpoints were renal function at last follow-up (creatinine and creatinine clearance) and graft survival. Among 1,137 transplantations, 90 patients (7.9%) developed urological complications: ureteral stenosis (n = 42) and urinary fistula (n = 54), with 4 fistulas evolving to stenosis. After a stepwise strategy, 35 patients underwent definitive reconstruction, while the overall institutional pathway achieved ultimate success in 81/90 cases (90%). In the surgical cohort, return to dialysis was observed only in the non-reference group (two calico-ureteral stricture cases), and failures clustered in crossed pyelo-ureteral repairs (2/2). At last follow-up, renal function tended to be better after pyelo-ureteral anastomosis (lower creatinine, similar clearance), with broadly comparable graft survival across techniques. Pyelo-ureteral anastomosis is a robust salvage option for post-transplant strictures and fistulas. Alternative reconstructions remain valuable when tailored to anatomy and intraoperative findings, whereas crossed pyelo-ureteral repair showed limited durability in our experience.

Contraception has consistently been a significant concern for couples, facilitating autonomy in family planning, a highly desired aspect for many. This responsibility predominantly falls on women, who often perceive it as burdensome. In this context, vasectomy, a straightforward, expedient, and dependable procedure, has gained popularity in France and other countries. This emerging trend necessitates an examination of the ethical considerations surrounding potential patient regret. This study aimed to assess the prevalence of regret among patients treated at our center and to analyze the factors contributing to this sentiment. After exclusions, a retrospective chart review was conducted on 274 patients who underwent vasectomy at our center between January 1, 2014, and December 31, 2022. The patients participated in semi-structured telephone interviews to assess their sociodemographic data and motivations. The overall rate of regret was low at 2.2% (n=6). The primary reasons for regret included a change in partner (n=4), post-vasectomy pain syndrome (n=1), and reconsideration of parenthood (n=1). Men whose decision to undergo vasectomy was initiated by their partner were significantly more likely to experience regret (66.7% vs. 22.8%, P=0.03). Age, number of children, and socioeconomic status were not significantly associated with regret. Although regret among men following vasectomy is relatively rare, it appears to be influenced by the decision-making process, which includes personal relationships. These findings emphasize the need to ensure autonomous decision-making.

Living donor nephrectomy (LDN) is a cornerstone of renal transplantation, enabling transplantation in patients with end-stage renal disease (ESRD) without the pain of being on a waiting list. Surgical techniques for living donor nephrectomy have evolved from open donor nephrectomy (ODN) to minimally invasive approaches, including laparoscopic donor nephrectomy (LDN), hand-assisted laparoscopic donor nephrectomy (HALDN), and robot-assisted donor nephrectomy (RADN). This review evaluated and compared the outcomes of these techniques across five categories: donor outcomes, recipient graft outcomes, perioperative metrics, cost and accessibility, and long-term donor satisfaction. Current evidence supports a shift toward minimally invasive methods as the gold standard, with laparoscopic techniques demonstrating superior donor recovery profiles and equivalent graft outcomes compared to open surgery. However, emerging techniques such as RADN require further research owing to cost and learning curve limitations.

The literature regarding robotic-assisted radical cystectomy in kidney transplant recipients is limited. We present the first reported case of robotic-assisted radical cystectomy with a full intracorporeal orthotopic neobladder in a kidney transplant recipient. A 36-year-old man was diagnosed with muscle-invasive urothelial carcinoma 12 years after kidney transplantation. His immunosuppressive regimen consisted of everolimus, mycophenolate mofetil, and prednisolone. After cystectomy and left lymph node dissection, we used a U-shaped neobladder technique slightly modified to adapt to the fixed position of the renal transplant ureter. The surgical time was 305 min, and the blood loss was 200 ml. The patient was discharged 16 days after hospitalization with no surgical complications. Histological analysis revealed no UC (pT0N0) with disseminated carcinoma in situ. Seven months after the surgery, no signs of recurrence or distant/lymph node metastasis were observed. No urinary leakage with complete bladder emptying was reported. Serum creatinine clearance rate was 51 ml/min. Immunosuppressive regimen was not modified after surgery.

Background: There are no specific recommendations for the management of patients with bleeding disorders (BD), such as haemophilia A (HA), haemophilia B (HB), or von Willebrand disease (WD), in urology surgery. Methods: We conducted a retrospective study of 32 patients with HA, HB, or WD of any severity. Fifty-seven procedures were performed between January 2017 and September 2023. Surgical interventions were divided into two groups: those with and without electrocoagulation. The control patients were successively matched in a 2:1 ratio. Results: The study group consisted of 30 men and 2 women, with 23 HA, 2 HB, and 7 WD. The median age of the patients was 69 years. The BD group had a longer hospital stay of 4 days compared to 1 day (p < 0.0001). The incidence of bleeding events was 21% versus 2% (p < 0.0001), and the incidence of complications was 21% versus 7% (p = 0.0036) for Clavien 1–2 respectively. In the subgroup with intraoperative coagulation, the readmission rate at 30 days was higher (17% vs. 3%, p = 0.00386), as was the transfusion rate (17% vs. 3%, p = 0.0386). Conclusions: This study showed that urological procedures in patients with bleeding disorders were associated with a higher risk of bleeding and complications.

Malabsorption is a consequence of gastric bypass (GB). GB increases the risk of kidney stone formation. This study aimed to evaluate the accuracy of a screening questionnaire for assessing the risk of lithiasis in this population. We performed a monocentric retrospective study to evaluate a screening questionnaire administered to patients who underwent gastric bypass surgery between 2014 and 2015. Patients were asked to answer a questionnaire that included 22 questions divided into four parts: medical history, episodes of renal colic before and after bypass surgery, and eating habits. A total of 143 patients were included in the study, and the mean age of the patients was 49.1 ± 10.8 years. The time between gastric bypass surgery and the completion of the questionnaire was 50.75 ± 4.95 months. The prevalence of kidney stones in the study population was 19.6%. We found that with a score of ≥6, the sensitivity and specificity were 92.9% and 76.5%, respectively. Positive and negative predictive values were 49.1% and 97.8%, respectively. The ROC curve showed an Area Under the Curve (AUC) of 0.932 ± 0.029 (p < 0.001). We developed a reliable and short questionnaire to identify patients at a high risk of kidney stones after gastric bypass. When the results of the questionnaire were equal to or greater than six, the patient was at a high risk of kidney stone formation. With a good predictive negative value, it could be used in daily practice to screen patients who have undergone gastric bypass and are at a high risk of renal lithiasis.

CIS of the bladder is associated with a high risk of progression. In the case of BCG failure, radical cystectomy should be performed. For patients who refuse or are ineligible, bladder-sparing alternatives are evaluated. This study aims to investigate the efficacy of Hyperthermic IntraVesical Chemotherapy (HIVEC) depending on the presence or absence of CIS. This retrospective, multicenter study was conducted between 2016 and 2021. Patients with non-muscle-invasive bladder cancer (NMIBC) with BCG failure received 6–8 adjuvant instillations of HIVEC. The co-primary endpoints were recurrence-free survival (RFS) and progression-free survival (PFS). A total of 116 consecutive patients met our inclusion criteria of whom 36 had concomitant CIS. The 2-year RFS rate was 19.9% and 43.7% in patients with and without CIS, respectively (p = 0.52). Fifteen patients (12.9%) experienced progression to muscle-invasive bladder cancer with no significant difference between patients with and without CIS (2-year PFS rate = 71.8% vs. 88.8%, p = 0.32). In multivariate analysis, CIS was not a significant prognostic factor in terms of recurrence or progression. In conclusion, CIS may not be considered a contraindication to HIVEC, as there is no significant association between CIS and the risk of progression or recurrence after treatment.