Base bibliographique

Sommaire :

Bifidité pyélo-urétérale et sténose de la jonction pyélo-urétérale
Pyelo-ureteral bifidity and stenosis of pyelo-ureteral junction
2010
- Cas cliniques
- Réf : Prog Urol, 2010, 3, 20, 238


Le cas clinique rapporté est intéressant, car rapportant une pathologie rare, comme le soulignent les auteurs. La duplication pyélo-urétérale est présente dans seulement 0.6 % dans la population générale [1 Cussenot O., Fournier G. Malformations de l’appareil urinaire et dysplasies kystiques des reins Prog Urol 2000 ;  10 : 989-1013

Mots clés:
G.
Mots-clés:
Incomplete renal duplication / Prenatal diagnosis / Upper pole pelvi-ureteric obstruction / embryology
Cystectomie radicale cœlioscopique pour cancer de vessie, chez les sujets de plus de 70 ans : faisabilité et étude de la morbidité
2010
- Réf : Prog Urol, 2010, 3, 20, 204-209


Introduction



Objectives

To evaluate the feasibility and morbidity and mortality of laparoscopic radical cystectomy for bladder cancer in elderly patients.


Methods

Prospective study conducted between January 2003 and May 2009 in 22 patients, one woman and 21 men, who underwent laparoscopic radical cystectomy for bladder cancer. Mean patient age was 76.2±4.3 years. The median preoperative ASA score was 2 (1–3). The indication for surgery was an invasive muscle bladder tumour in 18 cases and noninvasive muscle bladder cancer refractory to conservative treatment (chemotherapy, immunotherapy) in four cases. Ileal conduit was carried out in 15 cases. An ileal neobladder was fashioned in six cases using Camey’s technique. One bilateral cutaneous ureterostomy was performed.


Results

There was one conversion to open surgery. One intraoperative complication was noted (left obturator nerve injury). Mean blood loss was 377.5±341.2ml. No perioperative death was observed. Mean time to resumption of oral fluids was 2.4±1.6 days and mean time to resumption of solids was 4.5±1.6 days. Mean time to resumption of bowel movements was 3.9±1.9 days. Mean critical care unit was 4.2±1.4 days. Five patients (22.7 %) had postoperative complications. Postoperative narcotic analgesics were necessary in 60 % of cases. Mean hospital stay was 11.0±3.0 days. Mean patient follow-up was 46.4±20.8 months.


Conclusions

Laparoscopic radical cystectomy for bladder cancer in elderly patients is associated with low morbidity, and a limited hospital stay.

Mots clés:
Cystectomie radicale / laparoscopie / Cancer de vessie / sujet âgé / morbidité
Mots-clés:
bladder cancer / Laparoscopy / Morbidity / radical cystectomy / Elderly patients
Dysfonction érectile après prostatectomie totale : controverses et consensus
2010
- Réf : Prog Urol, 2010, 3, 20, 182-183

Mots clés:
J.
Mots-clés:
prostate cancer / radical prostatectomy / erectile dysfunction / Endothelial dysfunction / Sexual dysfunction
Dysfonction érectile après prostatectomie totale : physiopathologie, évaluation et traitement
2010
- Réf : Prog Urol, 2010, 3, 20, 172-182


Introduction



Radical prostatectomy (RP) is the gold standard treatment for localized prostate cancer; yet erectile dysfunction (ED) in selected series is still reported as high as 80% after this surgery. Patient selection and surgical technique (i.e., preservation of neurovascular bundles) are the major determinants of postoperative ED. Pharmacological treatment of postoperative ED, using either oral or local approaches, is effective and safe. Thus, most men need adjuvant treatments to be sexually active following RP. These include intracorporeal injections of vasoactive drugs, vacuum constriction devices and transurethral dilators, all of which have reported response rates of 50 to 70%. Unfortunately, long-term compliance is sub-optimal, with a discontinuation rate of nearly 50% at 1year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy (IPDE5) since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections is the gold standard for partients over 60years old and those who underwent non-sparing surgery. In younger patients and/or when preservation of nerve tissue was feasible, oral IPDE5 may be effective in promoting an earlier return of erectile function. Recent studies have shown that pharmacological prophylaxis early after RP can significantly improve the rate of erectile function recovery after surgery. Use of on-demand treatments for treatment of ED in patients subjected to RP has been shown to be highly effective, especially in cases of properly selected young patients treated with a bilateral nerve-sparing approach by experienced urologists.

Mots clés:
Cancer de la prostate / Prostatectomie totale / dysfonction érectile / Dysfonction endothéliale / érection
Mots-clés:
prostate cancer / radical prostatectomy / erectile dysfunction / Endothelial dysfunction / Sexual dysfunction
Dysfonction érectile et cellules endothéliales caverneuses
2010
- Réf : Prog Urol, 2010, 3, 20, 188-193


Introduction



The physiopathology of erectile dysfunction (ED) is multifactorial. The recent discovery of the precise role of cavernosal endothelium in the functional regulation of the smooth muscle cells allowed to understand the physiological bases of erection. The purpose of this article is to make a synthesis of the current knowledge on the endothelial function and to allow a better understanding of the pathological responsible mechanisms of ED. Endothelium provides cavernosal smooth muscle cells relaxation by two main pathways: the NO/cGMP pathway induced by production of neural nitric oxide (NO) in cavernosal nerve terminals, and the AC/cAMP pathway which by-passes the NO route by using other mediators. This action allows the initiation and maintenance of erection. Risk factor-associated cavernosal endothelial alterations (diabetes mellitus, hypertension, hypercholesterolemia) are mostly induced by unifying mechanisms, including oxidative stress and accumulation of reactive oxygen species, alteration of NO production, or decrease of VEGF expression. The same cellular mechanisms can also be observed during aging. To a comprehensive appraisal of physiological bases of viable endothelium in erectile function, it is crucial to understand its biological activities. The hemodynamic evaluation of endothelial function and the current therapeutic implications will be later approached.

Mots clés:
dysfonction érectile / Dysfonction endothéliale / Facteurs de risque cardiovasculaires
Mots-clés:
erectile dysfunction / Endothelial dysfunction / Vascular risk factors
La sténose du pyélon supérieur : complication rare d'une bifidité urétérale. Enquête embryologique
2010
- Réf : Prog Urol, 2010, 3, 20, 233-237


Introduction



A stenosis of the upper pole of an incomplete renal duplication is presented. The prenatal diagnosis of a right renal ureteropyelic junction syndrome, isolated, with a normal amniotic liquid was confirmed at birth. Intravenous pyelogram 8 days after birth showed three right dilated calical groups with a dilated renal ureteropyelic junction, but an normal inferior calical group suspected a renal bifidity. Renal MagIII scintigraphy evaluated the anatomical and functional stenosis and indicated surgery. Postoperative followings were simple and results good 3 years after. From this rare case, embryogenesis is discussed.

Mots clés:
Bifidité rénale / Diagnostic prénatal / Syndrome de la jonction pyélo-urétérale sur l’uretère du pyélon supérieur
Mots-clés:
Incomplete renal duplication / Prenatal diagnosis / Upper pole pelvi-ureteric obstruction / embryology
Le profil des urgences urologiques au CHU de Conakry, Guinée
2010
- Réf : Prog Urol, 2010, 3, 20, 214-218


Introduction



Objective

To stick out the profil urological emergencies at the Conakry University Teaching Hospital, Guinea.


Patients and methods

This retrospective study, carried out over a period of 3 years (January 2005–December 2007), included 757 urological emergencies admitted to the urology department of the university hospital of Conakry, Guinea.


Results

The mean age of patients was 56 years. These patients had an age equal to or higher than 60 years in 58% of the cases. The sex ratio (M/F) was 16.6. According to the social profession, the farmer (40,6%) and workers (21%) were the dominant patients. The most frequent illness was vesical urinary retention (73.9%), hematuria (9.6%) and genito-urinary system trauma (7%). The most performed procedures were the installation of a urethral catheter (55.25%) and the installation of a suprapubic catheter (24.14%).


Conclusion

The most frequent urological emergency in our country was vesical urinary retention, the hematuria and genito-urinary system trauma are not rare there.

Mots clés:
Profil / Urgence urologique / Clinique / Traitement
Mots-clés:
Profil / Urological emergencies / Clinical / treatment
Les fistules rénocoliques post-traumatiques : à propos d'une observation
2010
- Réf : Prog Urol, 2010, 3, 20, 230-232


Introduction



The renocolic fistula is a rare entity, which has occurred exceptionally in a traumatic not iatrogenic context, we report a case of renocolic fistula complicating penetrating abdominal trauma from a gunshot.

Mots clés:
Fistule / Rein / Côlon / traumatisme / Arme à feu
Mots-clés:
Fistula / kidney / Côlon / trauma / Gunshot
Place de l'embolisation artérielle percutanée en pathologie rénale
2010
- Réf : Prog Urol, 2010, 3, 20, 161-171


Introduction



Therapeutic embolization in renal pathology is used for various conditions in cancerology, traumatology, urology, nephrology and for iatrogenic complications of percutaneous manoeuvers. Any department of vascular radiology may be requested to use this technique, especially in emergent traumatology or palliative cancerology. The authors study the various conditions that may benefit from these procedures and give the highlights of the main indications and the main types of embolic agents used. Complications, side effects and the major precautions are also reviewed.

Mots clés:
Rein / Embolisation artérielle / Radiologie interventionnelle
Mots-clés:
kidney / Arterial embolization / Interventional radiology
Place de l'urétéroscopie dans le traitement de la lithiase chez l'enfant
2010
- Réf : Prog Urol, 2010, 3, 20, 224-229


Introduction



Objective

To determine the efficiency and the role of ureteroscopy in the treatment of urolithiasis in children.


Methods

A multicenter retrospective study was conducted between January 2006 and March 2008 in the department of pediatric surgery and urology of Besançon, Lyon and Grenoble. The clinical data of 17 children having benefited from one or more ureteroscopy procedures for urolithiasis were analyzed. These data concerned age, sex, antecedents of metabolic diseases, existence of a malformed uropathy, how the urolithiasis was discovered, therapeutic indications, endoscopic procedures, type of endoscopic treatment for urolithiasis, results and complications.


Results

Twenty-six ureteroscopies were carried out for 17 children (eight girls and nine boys) aged between 9 months and 12 years (mean: 5 ½ years old) as a first-line treatment or after extracorporeal shock wave lithotripsy. A 6/7,5 Fr semi-rigid ureteroscope was used in all case. Only once, the operator chose a flexible ureteroscope. Lithotripsy was carried out 15 times with YAG Holmium laser, four times with Swiss Lithoclast® and six times by simple extraction with a Dormia® type basket .A stent probe was left in place after endoscopy for 14 children. The “stone free” rate was 88% with an average hindsight of 11 months. Two incidents without major complication were recorded: a section of the guide by the laser beam and a perforation with extravasation of the contrast agent.


Conclusion

Ureteroscopy is the first-line treatment in isolated ureteral urolithiasis. On the other hand, LEC remains the treatment of choice for Starghon calculi, since LIC should be offered only in the event of failure of LEC.

Mots clés:
Enfant / Lithiase urinaire / Urétéroscopie / Lithotritie / Laser
Mots-clés:
children / Urolithiasis / Lithotripsy / Laser / Lithoclast
Pyéloplastie pour syndrome de la jonction pyélo-urétérale chez l'enfant : voie lombo-assistée versus lombotomie
2010
- Réf : Prog Urol, 2010, 3, 20, 219-223


Introduction



Surgical treatment of pyelo-ureteric junction syndromes was classically at the child’s, a pyeloplasty by posterior way or by lombotomy. For several years, assisted video techniques are proposed for this gesture. The purpose of our study was to compare the lombo-assisted pyeloplasty procedure with the lombotomy procedure, within the framework of this coverage. We made a retrospective study of procedures performed from January 2000 to December 2005, based on a file review of children operated for pyelo-ureteric junction syndrome. Children under the age of 2 years were excluded. Fifty-two children were divided in 2 groups: group 1: 24 children, 7 girls and 17 boys, average age of 86 months (extremes: 27–172) benefited from a lombo-assisted pyeloplasty. Group 2: 28 children, 12 girls and 16 boys, average age of 69 months (extremes: 24–129) benefited from a pyeloplasty by lombotomy. Operating times were significantly shorter in opened surgery than with the lombo-assisted procedure. There was no significant difference in terms of per- or post-operating complication, use of analgesic and hospitalization duration. On the other hand, the lombo-assisted procedure provided the same undisputable aesthetic benefit and the same muscular preservation than pure lomboscopy procedure. As a consequence, this procedure could be set up at no risk for the patient, even if it had lead to longer operating times. However, operating times stayed shorter than with the pure lomboscopy or the celioscopy procedures, compared to the literature.

Mots clés:
Voie lombo-assistée / Pyéloplastie / Syndrome de la jonction pyélo-urétérale / Enfants
Mots-clés:
Lombo-assisted procedure / pyeloplasty / Pyelo-ureteric junction / children
Recommandations de bonnes pratiques cliniques : diagnostic et traitement des uréthrites aiguës non compliquées de l'homme, par le comité d'infectiologie de l'Association française d'urologie (CIAFU)
2010
- Réf : Prog Urol, 2010, 3, 20, 184-187


Méthodologie



Resistance progression of the Neisseria gonorrhoeae to quinolones and the decreasing sensitivity to cephalosporin implicate to actualise the guidelines for managing urethritis. We present the guidelines from the committee of infectious diseases of the French Association of Urology to manage acute urethritis.

Mots clés:
Uréthrite aiguë / Infection / / /
Mots-clés:
Acute urethritis / Infection / / /
Tumeurs rénales complexes sur rein unique : résultats de la chirurgie partielle ex vivo avec autotransplantation
2010
- Réf : Prog Urol, 2010, 3, 20, 194-203


Introduction



Objective

To analyze the complications and the oncologic and functional results after ex vivo surgery and autotransplantation for the treatment of complex renal tumors.


Material and method

From 1996 to 2009, 11 patients, mean age 54.8 years, underwent ex vivo nephron-sparing surgery and autotransplantation for malignant complex renal tumors (centrorenal or hilar topography) on an anatomic or functional solitary kidney. Three patients (27.2 %) were treated for a metastatic disease.


Results

Mean operative time was 340minutes (240–440) and mean ischemia time was 162minutes (110–231). Five patients (45.4 %) needed peroperative blood transfusion. Mean hospital stay was 21.5 days (8–50). Eight patients (72.7 %) suffered complications: two urinary fistulas, two early vascular thrombosis leading to nephrectomy and permanent dialysis, two pneumopathies and four acute tubular necrosis leading to temporary dialysis. There was no death among patients in early postoperative period. Tumors TNM staging ranged from pT1 to pT3aN0. Surgical positive margins were observed in three cases (27.2 %). With a mean follow-up of 37.8 months (3–144), the mean MDRD creatinine clearance was of 45.4ml/min/1.73m2 and four patients (36.4 %) were presenting a complete remission. We observed two local recurrences (18.2 %) and five metastatic evolutions (45.4 %) leading to two deaths (18.2 %).


Conclusion

Ex vivo nephron-sparing surgery was an acceptable option in the treatment of complex renal tumors for imperative indications, when in situ surgery appeared to be technically unfeasible. Despite a significative morbidity, long-term functional results were satisfying.

Mots clés:
Rein / carcinome à cellules rénales / Néphrectomie / Transplantation autologue
Mots-clés:
kidney / Carcinoma / renal cell / nephrectomy / Transplantation
Validation en langue française du questionnaire « Ureteric Stent Symptom Questionnaire » (USSQ)
2010
- Réf : Prog Urol, 2010, 3, 20, 210-213


Introduction



Purpose

Translation and linguistic validation of the French version of the Ureteral Stent Symptom Questionnaire (USSQ).


Materials and methods

A double-back translation of the original Ureteral Stent Symptom Questionnaire was performed. First, two urologists translated the English version in French. Then a first consensus meeting between the translators and a group composed with three urologists, one general practitioner and two nurses was achieved. Back-translation of this version was then done by professional translators (Nagpal, Paris) to ensure that no distortion was detected between the two questionnaires. Finally, a pilot test followed by an interview was carried out among two men and two women who had an indwelling ureteral stent.


Results

The consensus version is attached to the article. No difficulties were reported by the pilot population to comprehend or to complete this USSQ French version.


Conclusion

This USSQ version – attached to the article – makes it possible for researchers among a French population to use this validated and internationally recognized tool that provides reproducible and measurable endpoints on tolerance of ureteral stents.

Mots clés:
Sonde urétérale / tolérance / questionnaire / France / Qualité de vie
Mots-clés:
ureter / Stents / questionnaire / France / Quality of life
Préface
2010
- Réf : Prog Urol, 2010, 3, 20, S93, suppl. S2


Le texte complet de cet article est disponible en PDF.
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Mots clés:
Jean-François
Mots-clés:
Incomplete renal duplication / Prenatal diagnosis / Upper pole pelvi-ureteric obstruction / embryology
Recommandations concernant la prise en charge des complications des bandelettes sous-urétrales
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S132, suppl. S2

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  Références

 

The complications of suburethral slings are rare but varied. The operative complications result most often from errors in surgical technique. Intraoperative cystoscopy is required when implanting a retropubic sling to diagnose vesical transfixion intraoperatively.

Functional complications are the most frequent. They require a true diagnostic strategy before proposing treatment adapted to the patient. The first examination should be an endoscopic urethrovesical exploration to eliminate vesicourethral transfixion by the suburethral slings.

Acute postoperative retention most often stems from surgical relaxation of the suburethral slings during the immediate postoperative period. Dysuria is more easily reversed if it is treated early with resection or ablation of the suburethral slings. De novo urge incontinence has many etiologies : infection, urethral obstruction, more rarely cystocele, and idiopathic causes. With recurrent stress incontinence after suburethral slings, management will depend on anamnesis, as well as the clinical and urodynamic workups. The treatment could involve the sling (second suburethral sling, kinking of the suburethral sling); however, another therapeutic alternative will have to be suggested relatively early (artificial sphincter, ACT balloons, etc.).

The recommended use of the large-mesh knitted monofilament polypropylene suburethral sling has considerably reduced the risk of infectious complications related to the prosthetic material. In case of vaginal erosion, prosthesis infection must be eliminated, which requires removing the sling. Simple erosion can be treated with partial resection of the exposed sling and vaginal suture.

Many nonabsorbant palliative treatments have been reported, often with small series. They can be grouped into three types: extra-urethral occlusive devices, intra-urethral obstructive devices, and intravaginal support devices. The use of a pessary or other vaginal devices can be proposed, in particular with associated prolapsus, which can be used when leakage is very occasional (sport, etc.) or in women who cannot have any other treatment.

Mots clés:
incontinence urinaire / Traitement / Chirurgie / Bandelette sous-urétrale / TVT
Mots-clés:
Urinary incontinence / treatment / surgery / Suburethral sling / TVT
Recommandations concernant la thérapie cellulaire pour l'incontinence urinaire
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S174, suppl. S2

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  Références

 

Several clinical trials on cell therapy have recently been conducted in the treatment of urinary incontinence. The cell preparation procedures and the inclusion criteria were different for each study. The feasibility of this technology, however, seems acquired. The indications for treatment and the long-term effects have yet to be specified. Cell therapy for urinary incontinence is only conceivable within the context of a clinical trial at this time. We encourage all investigator-urologists involved in a clinical trial on cell therapy to make themselves known on the website clinicaltrials.gov/ so as to inform the community and encourage the technique’s development.

Mots clés:
incontinence urinaire / Traitement / Thérapie cellulaire
Mots-clés:
Urinary incontinence / treatment / Cell therapy
Recommandations concernant les indications de la chirurgie conventionnelle de l'incontinence d'urine d'effort de la femme (colposuspension, soutènement aponévrotique du col)
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S143, suppl. S2

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  Références

 

The equivalence of the functional results of the suburethral sling and open colposuspension and the greater morbidity of colposuspension is such that the indications for traditional surgery correspond to the contraindications for suburethral sling: there no longer seem to be but few indications for supporting the bladder neck using an aponeurotic swing; caution recommends preferring colposuspension when the functional result of placing a suburethral sling risks being compromised by either vaginal trophicity abnormalities or previous repair to the urethra such as suburethral diverticulum or urethrovaginal fistula.

Laparoscopic colposuspension is not recommended to treat urinary stress incontinence in women. This technique may be warranted if other laparoscopic procedures are necessary and should be carried out by an experienced surgeon trained in this approach.

Mots clés:
incontinence urinaire / Traitement / Chirurgie / colposuspension / Frondes sous-cervicales
Mots-clés:
Urinary incontinence / treatment / surgery / colposuspension / Suburethral sling
Recommandations pour la prise en charge rééducative de l'incontinence urinaire non neurologique de la femme
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S104, suppl. S2

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  Références

 

Pelvic floor rehabilitation is prescribed as first-line treatment for women with stress urinary incontinence, particularly in cases of urinary incontinence with no first-degree uterine prolapse, with poor-quality perineal testing results or inverted perineal command.

Prescription of 15 sessions should suffice to evaluate the possibilities of improving the incontinence. The sessions can be continued if the patient feels she is progressing but has not reached sufficient results. With no progression despite properly conducted rehabilitation, the question of whether to continue the physical therapy arises. Currently, therapists determine the number of sessions. They are better apt to know whether sessions should be pursued and should relay a report to the prescribing physician. This type of rehabilitation is within the domain of physical therapists. Midwives can be responsible for postpartum rehabilitation.

On the other hand, the importance of the patient’s role in the results and their maintenance is well known. Occasionally a few sessions some time after the initial sessions can serve to verify the acquisitions and motivate the patient in her personal contribution to this rehabilitation.

The work of the physical therapist cannot be substituted with Keat-type home electrostimulation. The physical therapist plays an important role in the overall management of this condition. Currently, in absence of demonstrated efficacy, self-administration of electrostimulation is not recommended.

In urge incontinence, the rehabilitation approach will be used concomitantly with prescription of anticholergics with behavioral therapy and bladder biofeedback work. In addition, low-frequency electrostimulation can be done during the session. Starting with 10-12 sessions is sufficient.

In all cases, rehabilitation should take a multidisciplinary approach and be integrated into a medical and/or surgical management plan.

Mots clés:
incontinence urinaire / Traitement / Rééducation
Mots-clés:
Urinary incontinence / treatment / Rehabilitation
Recommandations pour le traitement chirurgical de l'incontinence urinaire d'effort de la femme par bandelettes sous-urétrales
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S112, suppl. S2

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  Références

 

Today, placement of a suburethral sling is the reference technique for cure of female stress incontinence. Use of slings made exclusively of knitted polypropylene monofi lament is recommended to the exclusion of all other materials. The NF indication is a guarantee that preclinical studies have been conducted before market authorization. Although biocompatible, the material remains synthetic, and this biocompatibility should not obviate the need for respecting the principles of asepsis, as in any prosthesis implantation. The sling can be placed via a retropubic or transobturator approach. These two approaches enjoy the same success rate but morbidity seems to be higher with the retropubic approach (bladder injury, dysuria, de novo urge incontinence). The type of anesthesia has no infl uence on the postoperative results. Mixed urinary incontinence, low urethral mobility, obesity, old age, and the desire for future pregnancies are situations that do not contraindicate placement of suburethral slings, but they can alter the quality of the results. Rigorous assessment of the risks and benefi ts as well as fair and honest information must be provided to patients in these situations. Without suffi cient studies proving their effi cacy and innocuousness, minislings cannot today be recommended to treat female urinary stress incontinence.

Mots clés:
incontinence urinaire / Traitement / Chirurgie / Bandelette sous-urétrale / TVT
Mots-clés:
Urinary incontinence / treatment / surgery / Suburethral sling / TVT
Recommandations pour le traitement de l'incontinence urinaire féminine non neurologique par ballons péri-urétraux
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S150, suppl. S2

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A new minimally invasive technique using an adjustable implantable material has recently been developed: adjustable periurethral balloons.

Initially designed by Uromedica, Inc., Plymouth, MN, USA, they are currently marketed in France by Medtronic (Minneapolis, MN, USA), called ACT® (Adjustable Continence Therapy).

Given the data reported in the literature today, ACT® devices in women should only be a lastresort technique. They can only be implanted in patients presenting urinary incontinence due to sphincter deficiency with no urethral hypermobility (negative support maneuvers), in cases of failure of other therapies, or when placing an AUS is contraindicated or refused by the patient (French National Health Authority).

Mots clés:
incontinence urinaire / Traitement / Chirurgie / Ballonnets péri-urétraux / ACT
Mots-clés:
Urinary incontinence / treatment / surgery / Periurethral balloons / ACT
Recommandations pour le traitement de l'incontinence urinaire féminine non neurologique par injections péri-urétrales
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S146, suppl. S2

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  Références

 

Currently there are no data reported in the literature supporting the recommendation for peri-urethral injections in first-line treatment. However, some authors emphasize that periurethral injection techniques can be used because of their good risk/benefit ratio in patients who are fragile, those who have already undergone surgery, and those who do not wish to have surgery. This option should be chosen based on efficacy, safety, and the patient’s wishes. The product used should remain based on safety, ease of use, price, and the urologist’s preferences.

In all cases, efficacy decreases with time and repeated injections are often necessary to maintain a satisfactory result. The injectables are a possible first-line choice in very elderly patients and in those who do not wish to undergo surgery. After failure of surgical treatment and/or if there is sphincter deficiency, peri-urethral injections can be an alternative to a new surgery, but one must be aware that the results are clearly inferior to balloons or the sphincter.

In cases where the urethra is attached due to previous interventions, peri-urethral injection is not indicated.

Mots clés:
incontinence urinaire / Traitement / Injections péri-urétrales
Mots-clés:
Urinary incontinence / treatment / peri-urethral injections
Recommandations pour le traitement de l'incontinence urinaire féminine non neurologique par le sphincter artificiel urinaire
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S155, suppl. S2

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  Références

 

The indication for artificial urinary sphincter implantation in women is based on several para meters: severity of incontinence, sphincter deficiency with negative urethral support maneuvers, the notion of postsurgery recurrence of incontinence, and absence of contraindication.

Quality preoperative clinical and urodynamic assessment is indispensable.

The factors for success depend on: implantation on tissue that has not been damaged by repeated interventions; well-codified technique based on regular surgical experience; sufficiently long deactivation; long-term monitoring with expertise in managing breakdowns and revisions.

Mots clés:
incontinence urinaire / Traitement / Chirurgie / Sphincter artificiel / AMS 800
Mots-clés:
Urinary incontinence / treatment / surgery / Artificial sphincter / AMS 800
Recommandations pour le traitement de l'incontinence urinaire féminine par hyperactivité vésicale idiopathique réfractaire par la toxine botulique A
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S170, suppl. S2

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  Références

 

The data reported in the literature today show that botulinum toxin A may have a certain value in the therapeutic arsenal for non-neurological vesical hyperactivity. However, the use of botulinum toxin cannot be recommended in daily practice of non-neurological vesical hyperactivity incontinence treatment.

In patients presenting non-neurological vesical hyperactivity, the use of botulinum toxin A (which in 2009 did not have market authorization for this indication, even in neurological patients) should be reserved for highly targeted, second- and third-line indications (failure or intolerance of recommended treatments), and certainly at first within clinical research or in specialized units.

Mots clés:
Toxine botulique A / Incontinence / Hyperactivité détrusorienne idiopathique
Mots-clés:
Botulinum toxin A / Incontinence / Idiopathic detrusor hyperactivity
Recommandations pour le traitement de l'incontinence urinaire féminine par hyperactivité vésicale idiopathique réfractaire par neuromodulation sacrée
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S161, suppl. S2

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Precise regulations should be respected when using neuromodulation of the sacral nerve roots in treating urinary incontinence in women with vesical hyperactivity.

It is not recommended to perform a neuromodulation test of the sacral roots in management of urinary incontinence caused by vesical hyperactivity if rehabilitation or anticholinergic treatment has not been attempted, unless a contraindication prevents use of these treatments.

The urologist implanting the device will have had specific training on the implantation material, the implantation technique, and parameterization.

Assessment of the efficacy during the test period should be rigorous and based on use of voiding diaries, symptom questionnaires, as well as the patient’s overall evaluation. Improvement greater than 50% and a counter test verifying the reappearance of symptoms after stimulation is interrupted are necessary to warrant implantation of a neuromodulator.

Complete information should be given to patients before the test is performed. This will detail the test procedure, how to keep a voiding diary, the safety precautions, and the incidents that may occur.

Mots clés:
incontinence urinaire / hyperactivité vésicale / urgenturie / Traitement / Chirurgie
Mots-clés:
Urinary incontinence / Vesical hyperactivity / Urge incontinence / treatment / surgery
Recommandations pour le traitement médicamenteux de l'incontinence urinaire non neurologique féminine
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S100, suppl. S2

S’il n’est pas possible d’agir par des médicaments sur les facteurs anatomiques de l’incontinence, en revanche, une meilleure compréhension de la physiopathologie des troubles mictionnels permet d’envisager le traitement pharmacologique de l’incontinence urinaire féminine. Toutefois, l’analyse de la littérature montre que peu de publications sont méthodologiquement satisfaisantes et surtout comparables. En présence d’une incontinence urinaire d’effort, il faut envisager un traitement hormonal vaginal s’il s’agit d’une patiente présentant une atrophie vaginale pour laquelle une rééducation ou une chirurgie est prévue. L’utilisation des inhibiteurs de la recapture de la noradrénaline et de la sérotonine ne peut être recommandée actuellement. Il n’y a pas d’indications aux traitements alpha adrénergiques. Dans le cas du traitement de l’incontinence par urgenturie, il faut envisager l’utilisation d’anticholinergiques associés ou non à un traitement hormonal vaginal s’il s’agit d’une patiente présentant une atrophie vaginale.

Although it is not possible to use medications on the anatomic features of incontinence, a better comprehension of the physiopathology of miction impairment can lead to pharmacological treatment of female urinary incontinence. However, analysis of the literature shows that few publications are methodologically satisfactory, nor are they comparable. In presence of stress urinary incontinence, vaginal hormone treatment must be provided if the patient presents vaginal atrophy with physical therapy or surgery planned. Use of noradrenaline recapture inhibitors and serotonin cannot be recommended today. There are no indications for alpha-adrenergic treatments. For urge incontinence treatment, use of anticholinergics should be provided, possibly associated with vaginal hormone treatment if the patient presents vaginal atrophy.

Mots clés:
incontinence urinaire / Traitement / anticholinergiques
Mots-clés:
Urinary incontinence / treatment / Anticholinergics
Recommandations pour le traitement palliatif de l'incontinence urinaire non neurologique de la femme
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S109, suppl. S2

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Absorbant products have greatly improved over the past few years in terms of both efficacy and comfort, but the problem of cost for patients persists. They can only be used for short periods of time while waiting for effective curative treatment or over longer periods if no other management option is possible. The model chosen must be adapted to the amount of leakage and the patient’s shape.

Many nonabsorbant palliative treatments have been reported, often with small series. They can be grouped into three types: extra-urethral occlusive devices, intra-urethral obstructive devices, and intravaginal support devices. The use of a pessary or other vaginal devices can be proposed, in particular with associated prolapsus, which can be used when leakage is very occasional (sport, etc.) or in women who cannot have any other treatment.

Mots clés:
incontinence urinaire / Traitement / Palliatifs / Protections / Pessaire
Mots-clés:
Urinary incontinence / treatment / Palliative / Protections / Pessary
Synthèse des recommandations pour le traitement de l'incontinence urinaire féminine non neurologique
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S94, suppl. S2

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The last two decades have brought about new medical and surgical treatments revolutionizing care for non-neurological urinary incontinence in women. Many studies, often randomized prospective studies with sufficient follow-up, have validated the therapeutic choices and shown them not to be part of a fad or marketing pressures. The French Association of Urology (L’Association Française d’Urologie) , through its Committee on Women’s Urology and Pelviperineology (Comité d’Urologie et de Pelvipérinéologie de la Femme) , proposes its recommendations. These were established by an expert group of specialists (urologists, gynecologists, and physical therapists), based on a review of the literature but taking into account the daily practices in academic and private practice settings. Between evidence-based medicine and reality in the field, these recommendations attempt to propose realistic and applicable strategies.

Mots clés:
incontinence urinaire / Traitement médical ;Traitement chirurgical
Mots-clés:
Urinary incontinence / Medical treatment / Surgical treatment
Traitement de l'incontinence urinaire féminine non neurologique : arbre décisionnel
2010
- Recommandations
- Réf : Prog Urol, 2010, 3, 20, S177, suppl. S2

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The physiopathology of urinary incontinence in women is complex. It must be thoroughly understood to orient the therapeutic choices available to patients. In urge incontinence, the initial management is above all conservatory, based on medical treatments and rehabilitation. In stress urinary incontinence, the quality of the urethra guides the indications for support techniques, with suburethral slings taking the lead and a preference for the retropubic approach in cases of sphincter deficiency with mobility of the urethrovesical junction preserved. In mixed urinary incontinence, the choices are always difficult and generally one begins with treating the component that is the most uncomfortable for the patient. Whatever choice is made, one must be aware that the first treatment often influences future treatments.

Mots clés:
incontinence urinaire / Traitement / Arbre décisionnel
Mots-clés:
Urinary incontinence / treatment / Decisional tree