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Secourgeon A, Bigot P, Martin L, Lebdai S. [Prospective controlled study evaluating teleconsultation and tele-semiology for the management of renal colic]. Prog Urol 2023; 33:1033-1040. [PMID: 37806910 DOI: 10.1016/j.purol.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION 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). MATERIAL AND 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. CONCLUSION 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. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Secourgeon
- Service d'urologie, CHU d'Angers, Angers, France.
| | - P Bigot
- Service d'urologie, CHU d'Angers, Angers, France
| | - L Martin
- Service de dermatologie, CHU d'Angers, Angers, France; Centre de simulation All'Sims, CHU et Université d'Angers, Angers, France
| | - S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France; Centre de simulation All'Sims, CHU et Université d'Angers, Angers, France
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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Savoie PH, Boissier R, Long JA. [Renal colic: How to calm and optimize the stone expulsion? Which treatment for pregnant women and children?]. Prog Urol 2021; 31:956-966. [PMID: 34814989 DOI: 10.1016/j.purol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aims of this narrative review was to report on the contemporary data of renal colic (RC) in terms of epidemiology and pressure on emergency structures and also to describe the latest therapeutic developments about uncomplicated RC, depending on the pediatric, adult and pregnancy population. MATERIAL AND METHODS A request to the health surveillance network for emergencies and deaths (SurSaUD®, Santé Publique France) revealed original data on the contemporary epidemiology of renal colic. A narrative synthesis of the articles (French, English) available on the Pubmed database was produced in June 2021. RESULTS Renal colic represents 1.1% of the annual total of emergency room visits. The mean age at admission was 45 years and 62% of patients were men. NSAIDs and Paracetamol are the most effective analgesic treatments and should be given priority over opioids. Non-drug analgesic treatments by tactile stimulation probably have a place in the CN management, particularly in case of contraindications. Among the validated treatments, alphablockers allow better expulsion when the stone is located in the pelvic ureter and if its size is between 5 and 10mm in diameter. In pregnant women, the predominant problem is to confirm the diagnostic. If there is a strong suspicion, MRI or a low-dose CT scan is possible. Ureteroscopy is feasible in particular in the first part of pregnancy to avoid iterative ureteral catheter changes. The care for children is now based on that of adults. CONCLUSION The renal colic care pathway in 2021 can benefit from various optimizations in the field of expulsion and analgesic treatments. Good knowledge of the specific situations in pregnant women and children allowing to improve the quality of care.
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Affiliation(s)
- P-H Savoie
- Hôpital d'instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France.
| | - R Boissier
- Aix-Marseille université, service de chirurgie urologique et de transplantation rénale. CHU Conception, AP-HM, 13005 Marseille, France
| | - J-A Long
- Centre Hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche Cedex 9, France
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Abstract
INTRODUCTION To report the epidemiology and the care pathway for urological emergencies in France for the official report of the 115th Congres Francais d'Urologie. METHODS We made a request to the Institut de Veille Sanitaire and its network Surveillance Sanitaire des Urgences et des Décès (SurSaUD®). Within this system, the OSCOUR® network (Organisation de la surveillance coordonnée des urgences) centralizes in real time the data of emergency visits from more than 720 emergency departments throughout the national territory (>93% of the national territory covered by the OSCOUR® network). For each emergency defined by its CIM-10 code, the following data were collected from 2014 to 2019: age, gender, length of stay and post-emergency status (hospitalization vs. return home). RESULTS From 2014 to 2019, urological emergencies represented on average 4.2% of all emergencies, with an average 591,080±66,782 passages/year including 25% that resulted in hospitalization. Infectious disease represented 35% of all urological emergencies. The 3 most common urologic emergencies were: renal colic, acute urine retention and hematuria for men; acute cystitis, pyelonephritis and renal colic for women. CONCLUSION In an analysis of the OSCOUR® (Organisation de la surveillance coordonnée des urgences) registry, we determined the epidemiological profiles of the main urological emergencies with contemporary data.
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Affiliation(s)
- R Boissier
- Université Aix-Marseille, Service d'Urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
| | - P H Savoie
- Service d'urologie, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France
| | - J-A Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, France
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Bailly V, Le Ray I, Bardonnaud N, Pillot P, Martin L, Pastori J, Balssa L, Guichard G, Bittard H, Kleinclauss F. [Meteo-U-rology: climate impact on urological emergencies]. Prog Urol 2014; 24:535-9. [PMID: 24975786 DOI: 10.1016/j.purol.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyze the weather influence on the onset of renal colic (RC), acute urinary retention (AUR) and testicular torsion (TT). MATERIALS AND METHODS We correlated the daily number of RC, AUR and TT cases admitted to our urology department and weather conditions between 2005 and 2009 on day-to-day basis. Eight hundred and seventy-six RC, 453 AUR and 50 TT were analyzed. Information on temperature, atmospheric pressure, relative humidity, vapor pressure, wind force, evapotranspiration and sunshine level were collected from the national meteorological office (Meteo-France) in Besançon, France. We performed a univariate and a multivariate Stepwise method in linear regression using Akaike Information Criterion. RESULTS We reported a statistically significant increased risk of renal colic at higher vapor pressure. Likewise, temperature seemed to be a risk factor for occurrence of renal colics. We determined an increased daily rate when maximal daily temperature rises above 20 Celsius degrees (P = 0.05). Furthermore, we observed a positive link between mean (P = 0.05) and minimal (P = 0.08) daily temperature and urolithiasis. Contrarywise AUR was more frequent when the mean temperature falls below zero Celsius degree. We also demonstrated a non-significant influence of temperature on TT, with 3 fold higher events during cold period. Much more mystic, we noted a higher AUR rate on new moon days, and fewer renal colic on full moon. CONCLUSIONS Further investigations are necessary to understand the mechanisms underlying the relationship between urologic diseases and climate. But our findings could help us justify healthy living messages.
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Affiliation(s)
- V Bailly
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - I Le Ray
- Inserm 803, centre d'investigation, clinique plurithématique, CHU de Dijon, 21000 Dijon, France
| | - N Bardonnaud
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - P Pillot
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - L Martin
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - J Pastori
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - L Balssa
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - G Guichard
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - H Bittard
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France
| | - F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, UFR SMP, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
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Fontaine-Poitrineau C, Branchereau J, Rigaud J, Bouchot O, Caroit-Cambazard Y, Glémain P. [Renal colic in pregnancy: series of 103 cases]. Prog Urol 2014; 24:294-300. [PMID: 24674335 DOI: 10.1016/j.purol.2013.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/10/2013] [Accepted: 09/20/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the management of renal colic in pregnant woman in our hospital. MATERIAL AND METHODS A retrospective study of 103 pregnant patients, hospitalized for back pain of renal colic type, associated or not with a urinary tract infection, between January 2005 and October 2010. Three groups of patients were identified from the initial clinical and paraclinical (ultrasound). Group I involved patients with dilatation of the renal cavities associated with septic syndrome, they received analgesic treatment and empiric antibiotic therapy. Group II involved patients with dilatation of the renal cavities isolated, without fever, they received only analgesic treatment. Group III involved patients without dilatation of the renal cavities, they received analgesic treatment and antibiotics in case of fever, and then another cause of pain was sought. RESULTS The renal colic was due to a stone in 19.4 % of cases. A urinary infection was associated in 28 % of patients. Ultrasond was sufficient to confirm the diagnosis in 96 % of cases. In 4 % of cases, MRI or low-dose CT were necessary. Therapeutic management based on analgesic treatment, associated with probabilistic antibiotherapy or adapted in case of documented infection, allowed sedation of pain in two-third of cases. In case of failure or signs of severity, the urinary diversion by a double J stent was efficient, without consequences on pregnancy issue. One stone was treated by ureteroscopy during pregnancy without complication. CONCLUSION The management of renal colic in pregnant woman based on ultrasound diagnosis, symptomatic treatment and urinary diversion by double J stent in case of failure therefore seemed quite sure on mother and fetus.
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