Base bibliographique

Colpocléisis selon la technique de Lefort : une série rétrospective
2012
- Réf : Prog Urol, 2012, 17, 22, 1071-1076


Introduction



Objective

Treatments of pelvic organ prolapse are pelvic floor rehabilitation, surgery by abdominal or vaginal route, with or without prosthesis, and pessaries. Since last decade, increasing elderly patients seen for pelvic organ prolapse require to redefine the place of the obliterative vaginal surgery, among the existent surgical procedures. Our objectives were to describe the morbidity associated with colpocleisis, to determine the anatomical results of colpocleisis, and patient’s satisfaction.


Patients and methods

Retrospective case series of 27 patients who underwent a vaginal closure (Lefort) between 2004 and 2010.


Results

Twenty-seven patients underwent an obliterative vaginal surgery for genital prolapse. The mean age was 79years (range 74.5–82.5). The mean surgical time was 70minutes (range: 60–87.5). We did not notice any per-surgical complication. During follow-up (median: 3years, extremes: 1–10years), the global satisfaction rate was 94%. Objective cure rate, defined as the absence of prolapse to the hymen, was 96% (26/27). Only one (3.7%) case of pelvic organ prolapse recurrence occurred and needed surgery.


Conclusion

The current study showed that Lefort colpocleisis technique was associated with a good patients’ satisfaction and functional results in a population aged over 75.

Mots clés:
Colpocléisis / Intervention de Lefort / Prolpasus / Personnes âgées
Mots-clés:
Obliterative surgery / Lefort procedure / vaginal prolapse / Elderly people
Five years follow-up study and failures analysis of Botulinum toxin repeated injections to treat neurogenic detrusor overactivity
2012
- Réf : Prog Urol, 2012, 17, 22, 1064-1070


Abbreviations


Mots clés:
Botulinum toxin / Overactive bladder / Urinary incontinence / Neurogenic bladder / Treatment failure
Mots-clés:
S. / P. / B. / R. / K.
La névralgie clunéale inférieure par conflit au niveau de l'ischion : identification d'une entité clinique à partir d'une série de blocs anesthésiques chez 72 patients
2012
- Réf : Prog Urol, 2012, 17, 22, 1051-1057


Introduction



Introduction

Some patients have atypical perineal neuropathic pain that differs from a pudendal neuralgia. The purpose of this study was to define a new clinical entity of such pain and to evaluate the therapeutic benefit of corticosteroid infiltration.


Material and methods

Retrospective study of 72 patients presenting with atypical perineal pain. A nerve block was performed using added steroid anesthetic in cluneal inferior nerve, at the endo-ischial area. Pain assessment was recorded 8days and 10minutes before the injection and 5minutes and 3weeks after the procedure.


Results

The population included 40 (55%) women, mean age 55. Forty-nine (68%) patients presented with a positive block test. These patients were characterized by ischio-perineal neuropathic pain, respecting the penis or clitoris, worse sitting (98%), especially on hard seats, do not wake up at night, and not accompanied by superficial hypoesthesia. A decrease in VAS scores (>30%) at 23weeks follow-up following the addition of corticosteroids during infiltration was observed in only 29 (40%) patients.


Conclusion

The current series described the population characteristics of cluneal inferior neuralgia by ischial conflict.

Mots clés:
Névralgie clunéale inférieure / Névralgie pudendale / Bloc anesthésique
Mots-clés:
Cluneal inferior neuralgia / Pudendal neuralgia / Block
Le syndrome d'excitation génital permanent : revue de la littérature
2012
- Réf : Prog Urol, 2012, 17, 22, 1043-1050


Introduction



Purpose

Persistent genital arousal disorder (PGAD) is a newly recognized condition rarely reported. Its recognition is useful to avoid labelling women suffering from PGAD as “mad”.


Methods

A comprehensive literature review using Pubmed, Medline , Embase and Cochrane : “persistant genital arousal”, “restless genital syndrome”, “persitant genital arousal syndrome” and “persistant sexual arousal syndrome”. In the 300 articles, 37 really dealt with PGAD.


Results

PGAD prevalence seemed to be more common than suspected (1%). PGAD has officially been defined in terms of five diagnostic criteria. Patients were on average from 35 to 54 years old. Among them, 29.9% to 67% were menopausal. PGAD was highly associated with overactive bladder (OAB) (67%), restless legs syndrome (RLS) (67%) and pelvic varices (55%). Genital sensations were experienced as unwanted, intrusive, on the verge of an orgasm. The unwanted genital sensations were experienced at the clitoris, labia and vagina or a combination of these localizations in 78%, 28%, 55% and 44% women, respectively. There are many suspected etiologies. Clinical management is the need of an electric and multidisciplinary approach (history, examination, investigation as pelvic MRI, pelvic ultrasound, biological exam). Treatments were various including psychological therapies, psychotropic treatment (56% women reported a persistent reduction of symptom [50%–90%] with clonazepam), transcutaneous electrical nerve stimulation (TENS)…


Conclusion

This literature review provides readers with guidance on the management of PGAD.

Mots clés:
Syndrome d’excitation sexuel permanent / Syndrome des membres inférieurs sans repos / Syndrome d’excitation génital permanent / Syndrome génital sans repos
Mots-clés:
Persistent sexual arousal syndrome / Persistent genital arousal disorder / Restless leg syndrome / Restless genital syndrome
Résultats à moyen terme du traitement de la dyssynergie vésicosphinctérienne par sphinctérotomie prothétique permanente
2012
- Réf : Prog Urol, 2012, 17, 22, 1058-1063


Abréviations



Objectives

The aim of this study was to assess the outcomes of nitinol permanent urethral stents used in detrusor-striated sphincter dyssynergia (DSD) treatment on male patients with a spinal cord injury.


Materials

We investigated retrospectively all patients treated from 2004 to 2012. A total of 22 patients were included, with an age ranging from 22 to 76years old. The DSD syndrome was due to spinal cord injury (18) or various spinal cord diseases (four) and treated with a nitinol urethral stent (11 Ultraflex® and 11 Mémotherm®). Every patient had an urodynamical study. The follow-up reached at least 2years.


Results

The mean follow-up was 56months (±14). Complementary procedures after stenting included: five stent prolongation or displacement (mean interval 7.6months), six bladder neck incisions (12.2months), three urethrotomy (42months), ten obstruction treated by laser (47.3months). Eight patients had a change of their urinary pattern: four underwent ileal conduit diversion, one had a continent urinary diversion, one chose self intermittent catheterization, two were under indwelling catheterization waiting for another treatment. Stent retrieval was either harmful or impossible for four of them. Three patients were free of complementary procedures.


Conclusions

Nitinol urethral stent was an effective treatment initially. However, by the third year, urethral stenosis and hypertrophic growth of the urethral mucosa usually require iterative endoscopic procedures (0.31 per patient per year). Patients treated with permanent uretral stent deserve a yearly endoscopic follow-up. Safety and effectiveness of permanent uretral stent compared to surgical sphincterotomy to treat DSD are discussed.

Mots clés:
Endoprothèse urétrale / Dyssynergie vésicosphinctérienne / Complications / Urodynamique / Vessie
Mots-clés:
urethral stent / Detrusor sphincter dyssynergia / Urodynamics / Neurogenic bladder / spinal cord injury
Suspension utéro-vaginale par sacrospinofixation antérieure bilatérale prothétique par voie vaginale. Résultats préliminaires
2012
- Réf : Prog Urol, 2012, 17, 22, 1077-1083


Introduction



Objective

To assess anatomical and functional preliminary results, and safety of a new surgical approach for a combined treatment of pelvic organ prolapse (POP) of anterior and medium compartments, using a mesh attached through the sacrospinous ligaments with the UpHold® system (Boston Scientific) and the Capio®.


Material and methods

A longitudinal case series of 59 consecutive patients operated between October 2009 and January 2012, by five senior surgeons in a single tertiary unit.


Results

Mean age was 66.9 years. Ten patients (17%) had previous pelvic organ prolapse (POP) surgery. There was no intraoperative complication. Mean follow-up was 12 months. Anatomical success for both anterior and apical compartments, i.e. Ba and C/D point<1, was 93% (52/56). Anatomical results shown correction of cystocele with a mean Ba point from+0.79cm (range −3 to +8) to −2.35cm (range −3 to 0), correction of uterine/vaul prolapse with a mean C/D point from+0.14cm (range −6 to+8) to −7.29cm (range −9 to −1), and correction of rectocele with a mean Bp point from −0.68cm (range −3 to 7) to −2.77cm (range −3 to −1). Two patients required further surgery for mesh exposure (3.5%). One patient had a unilateral pudendal neuropathic pain postoperatively.


Conclusion

In the current series, utero-vaginal suspension using a bilateral vaginal anterior sacrospinous fixation with mesh was associated with good anatomical success rates. Prospective, comparative and long-term data are needed.

Mots clés:
Prolapsus génito-urinaire / Sacrospinofixation antérieure / Chirurgie vaginale / /
Mots-clés:
Genital prolapse / Anterior sacrospinous suspension / Vaginal surgery / UpHold /