Medical review: Dr Maxime Vallée, urologist

After starting his medical studies at the University Hospital of Poitiers, Maxime Vallée completed his urology internship at the University Hospital of Nantes. In 2019, he returned to Poitiers University Hospital as head of clinic. He was appointed to the position of university teacher – hospital doctor in September 2022.

Why did you choose urology?

I chose urology because I liked that it is a medical-surgical specialty by definition. In urological surgery, we certainly focus on the urinary sphere, but it is an extremely broad specialty, both in terms of the number of organs treated (kidneys, bladder, prostate, etc.) and the type of treatment. In fact, it includes both oncological operations and functional operations, for example, urinary retention, etc. In particular, bladder tumors, prostate cancer, kidney tumors, lithiasis disease that causes the formation of kidney stones, etc. Kidney collection and transplantation activities are also the basis of our activity. Andrology and sexology are also part of the skills the urologist collaborates with medically assisted birth teams. It is an extremely broad specialty, so it is a subspecialty of urinary tract infection. All urologists are called upon to deal with urinary tract infections as it is part of the prerogatives of our profession, but it is a subspecialty in its infancy and we are not always well prepared during our course. I became interested in this problem during my internship because I realized that it is very important and that unfortunately few urological surgeons in France are interested in it. This is a special topic that at first glance is far from the daily concerns of a urological surgeon, but quite the opposite! This partly explains why I got into this thread. During my internship, I completed a six-month internship in infectious and tropical diseases at Nantes University Hospital. This very pleasant and formative period opened up many perspectives for me in the development of this subspecialty in urology.

What is your research about?

Doing research is a way for me to diversify our experience. The fact of doing both research and teaching is a constant stimulus to question myself. My specialty and research area is urinary tract infections. They affect both men and women of all social backgrounds without any discrimination, even if they have established risk factors. I am interested in care-associated urinary tract infection in a broad sense. Apart from infection, within the clinical research axis, I am particularly interested in urinary colonization, which corresponds to the presence of bacteria in the urine, without symptoms and especially before urological surgery. . This is a big problem in our profession. Currently, in case of urinary colonization, it is recommended to treat before any urological surgery with contact with urine. This is a very dogmatic recommendation that is often not based on any sound scientific argument and has a huge impact on our daily activities and the care of our patients. This has value, as urinary colonization is treated with antibiotics, and can have unwanted side effects for patients, not to mention the consequences in terms of antibiotic resistance. As for my basic research studies and as part of my research dissertation, I am working with Prof. France on the INSERM 1070 unit (pharmacology of anti-infectives and antibiotic resistance) directed by my dissertation co-director, Pr Sandrine Marchand. Cazenave-Roblot. It is a matter of estimating the diffusion in the target organ to know if the antibiotic molecules will travel far enough to the target organ to be effective and treat the infection. This is done by a special technique called microdialysis, which allows determining the pharmacokinetic and pharmacodynamic parameters of the antibiotic, in other words, how the antibiotic behaves in organs and the body. Since 2015, there has been no urology academic, and after my arrival in 2019, my colleagues supported and helped me to relaunch this valence in our service. I would like to sincerely thank Prof. Jean-Pierre Richer, head of the department, and Prof. Antoine Thierry, head of the digestion-urology-nephrology-endocrinology center (DUNE). This re-university of the service allows us to have a bit more perspective today, both in terms of training and research, and therefore complements and strengthens an already extremely dynamic team at a clinical level! This is an opportunity for me to once again thank all the medical, paramedical and medical-administrative teams.

What are your other activities?

At the medical school, I teach students general urology, especially urological semiology, that is, the study of clinical symptoms related to urinary pathologies. I teach second-year students about urinary pathologies in a broad sense, that is, the diagnostic and therapeutic management of these pathologies. I also teach paramedic students and midwives. I also teach at the regional level within the framework of the specialty education diploma in urology. And then, at the national level, I intervene as co-responsible for the infectious module within the teaching of the College of Urology with young urologists at the end of the internship or at the beginning of the post-internship. I address more specific topics related to urinary tract infectious pathology on several days, which allows us time to discuss very specific topics and develop experiments. Within the French urological association, I am an infectious disease specialist, microbiologist, hygienist, anesthetist, etc. I am a part of the infectious disease committee that unites experts from other fields. This allows us to develop and work on joint lines of research on various recommendation topics that allow us to again respond to the appeals of our colleagues. I am also an associate member of the infection committee of the European Association of Urology, which gives me the opportunity to meet colleagues from all over Europe. It is an incredible opportunity to work with experts in the field who are passionate about changing practices through research and science.

Your service has just been accredited by the Haute Autorité de Santé. What is it about?

This is the accreditation of doctors, which consists of the assessment of professional practices. Founded in 2006, this approach was originally intended for any practitioner who has decided whether or not to commit. In recent years, HAS has extended accreditation to teams. I coordinated the process in the department of urology and kidney transplantation. It’s a great way to question our practices, refresh ourselves, pursue continuing medical education, and simply advance our medical practice. We are the first service within CHU to receive accreditation valid for one year. While committing to this approach certainly requires work and personal and collective investment, it still brings significant benefits, particularly for risk management and improving the quality of care. We improve the patient journey, their care and the activities and interactions within our service. It really is a virtuous circle!