Base bibliographique

Diffusion des recommandations pour la pratique clinique concernant l'incontinence urinaire de la femme
2012
- Réf : Prog Urol, 2012, 4, 22, 233-239




 


Objective

Recommendations for good clinical practice concerning the treatment of urinary incontinence in women are available from the HAS (Haute Autorité de santé or French National Authority for Health), the Collège national des gynécologues obstétriciens français (French national college of gynaecologists and obstetricians) and Association française des urologues (French association of urologists). We wanted to conduct the first investigation of these recommendations to primary care physicians (GPs) and gynaecologists in the cities located in the same area of health.


Methods

A questionnaire was sent to GPs and gynaecologists (French administrative divisions 78 and 92), with questions on the recommendations, as well as the methods of dissemination of these recommendations. Response rate: 22 %.


Results

A total of 72 questionnaires were usable from 51 (71 %) GPs and 21 (29 %) gynaecologists. Of these, 76 % of gynecologists and 47 % of GPs were aware of recommendations from the HAS for clinical practice for urinary incontinence in women (P =0.04). Only 56 % of doctors prescribed a urinalysis (dipstick or bacteriological urinalysis) and evaluated the residual urine in women seeking care for symptoms of urinary incontinence. Training for one or two days was the most desirable/popular method of dissemination of the recommendations (30 out of 72 doctors), followed by journals such as Prescrire , then the mailing and forms provided by the HAS, especially when combined with office visits from a representative of the HAS.


Conclusion

This study provided an interesting perspective on the knowledge, dissemination and application of recommendations for good clinical practice concerning urinary incontinence in women.

Hyperactivité vésicale idiopathique de la femme et système nerveux autonome
2012
- Réf : Prog Urol, 2012, 4, 22, 199-206




 


Purpose

To analyse the hypothesis of an autonomic nervous system dysfunction in the female’s idiopathic overactive bladder syndrome, by a literature review.


Method

A systematic literature review (Pubmed, Medline, Cochrane database) concerning women presenting with overactive bladder syndrome and cardiovascular explorations of the autonomic nervous system (heart rate variability and cardiovascular tests). Keywords used for search: overactive bladder syndrome, female urinary incontinence, urge incontinence, autonomic nervous system.


Results

Heart rate variability (HRV) analysis among women with overactive bladder syndrome and controls has shown a difference between both, with is a global decrease of the heart rate variability parameters, or a relative increase of the sympathetic tone in overactive bladder syndrome. The sympathetic cardiovascular tests were more frequently abnormal among women presenting with overactive bladder syndrome than controls.


Conclusion

All these studies suggest a sympathetic dysfunction of the autonomic nervous system in female’s overactive bladder syndrome, but methodologies are too variable and the studies population too small to establish a pathophysiological link.

Injections intradétrusoriennes de toxine botulique A en consultation : expérience d'un centre pendant deux ans
2012
- Réf : Prog Urol, 2012, 4, 22, 214-219




 


Objectives

In departments of urology, intradetrusor botulinum toxin injections are routinely performed in ambulatory outpatient clinic. The aim of the study was to assess the satisfaction level of patients treated with this technique.


Patients and methods

A satisfaction questionnaire was carried out by telephone for all patients treated in ambulatory outpatient clinic from 2009 to 2010.


Results

Twenty-six patients were treated in consultation during the studied period for a total of 46 sessions of injections. The average age was 48.81 (±16.78) years. An injection programme containing 20 or 30 points was performed after a local anesthetic. Twenty patients answered the questionnaire. As regards the organization of the injections, 12 patients (60%) declared to have been satisfied and seven very satisfied (35%). Eight patients (40%) were very satisfied with the management of the pain and six (30%) satisfied versus only one (5%) not satisfied at all. For the time spent in the hospital during the injections, 10 (50%) were satisfied and seven (35%) very satisfied. Only 4 patients (20%) would have preferred to be hospitalized in an outpatient facility. In cases of new injections, 18 (90%) patients would have preferred an identical coverage. Finally, 17 (85%) would recommend this procedure to one of their close relations.


Conclusion

Our results showed that the majority of patients were completely satisfied with the injection programme. However, as patients are not currently covered by the national health system for these injections, this might hinder the development of this procedure.

Late post-partum dyspareunia: Does delivery play a role?
2012
- Réf : Prog Urol, 2012, 4, 22, 225-232




 

Proctalgies fugaces et neuropathie pudendale : étude neurophysiologique périnéale chez 55 patients
2012
- Réf : Prog Urol, 2012, 4, 22, 220-224




 


Objective

Proctalgia fugax (PF) is a very common condition especially in women. Causes and pathophysiological mechanisms of PF are unknown. Recently, a pudendal neuropathy was clinically suspected in women with PF. The goal of our study was to demonstrate, or not, such abnormalities by means electrophysiological testing.


Patients and methods

Fifty-five patients with PF (45 female and 10 male, mean age 50.2 years) were evaluated. EMG testing with motor unit potential analysis of pelvic floor muscles (bulbocavernosus muscle and striated external anal sphincter), study of bulbocavernosus reflex and pudendal nerve terminal motor latencies (PNTML) were performed.


Results

EMG testing was altered in two males out of 10 (20%) and 29/45 females (64%). In women, denervation was found bilateral in 25/29 (86%). Sacral latency was delayed in eight out of 29 (bilateral in five cases, unilateral in three cases) and PNTML altered in 17 cases (13 bilateral alteration, four unilateral). A significant difference (P <0.002 Chi2 test) was demonstrated between male and female concerning pelvic floor muscles denervation.


Conclusion

Pelvic floor muscles denervation was a common feature in women suffering from PF, due to a stretch bilateral pudendal neuropathy. Distal lesions of the pudendal nerves, principally due to a stretch perineal neuropathy, can be imagined as a factor or co-factor of PF.

Progrès pelvi-périnéologie , la nouvelle revue de la SIFUD-PP
2012
- Réf : Prog Urol, 2012, 4, 22, 197-198




 

Traitement de la rectocèle par une prothèse biologique de derme porcin inter-rectovaginale associé à une sacropexie infracoccygienne
2012
- Réf : Prog Urol, 2012, 4, 22, 240-244




 


Objectives

To evaluate an infracoccygeal colpopexy procedure by tension-free synthetic tape for vaginal apical prolapse associated with a posterior mesh procedure using porcine dermal graft for rectocele repair.


Methods

A retrospective study concerning 35 women. The surgical procedure included rectocele repair with porcine dermal collagen implant (porcine dermal matrix, native) associated with transgluteal infracoccygeal sacropexy using a polypropylene sling.


Results

Median follow up was 48 months (42–54). A vaginal hysterectomy was associated in 43% and a cure of cystocele was associated in 63% of cases. No intra-operative complication was noted. The prevalence of dyschesia decreased from 25% (eight patients) preoperatively to 3% (one patient) postoperatively. No cases of de novo dyspareunia was noted. Five (14%) patients had a recurrent prolapse (two cases of rectocele stage 2, one case of grade 3 rectocele associated with a cystocele, a case of uterine prolapse associated with cystocele and one case of recurrent isolated uterine prolapse). Among them, three patients (9%) required a re-intervention for prolapse recurrence. No vaginal mesh exposure was observed. Perineal pain was reported by 12 (33%) patients at one month follow-up, but no patient complained with perineal pain one year follow-up.


Conclusion

Infracoccygeal sacropexy associated with rectocele repair using porcine dermal collagen implant was associated with satisfactory results at medium term follow-up.

Troubles vésicosphinctériens et syndrome métabolique
2012
- Réf : Prog Urol, 2012, 4, 22, 207-213




 


Objective

The goal of this article is to review and discuss the various and numerous links between metabolic syndrome (MetS) and bladder, specially overactive bladder syndrome.


Methods

Pubmed/Medline analysis, without date or language limits, was conducted using the following keywords: “metabolic syndrome” and “bladder (or “incontinence” or “overactive bladder”). All types of papers were analysed (117).


Results

MetS is defined as the presence of three or more of the following five characteristics: 1) waist circumference greater than 102cm; 2) systolic blood pressure 130mmHg or greater or diastolic blood pressure 85mmHg or greater, or antihypertensive medication use; 3) HDL cholesterol less than 40mg/dL or lipid medication use; 4) self- reported type 2 diabetes or increased blood sugar or diabetes medication use; 5) triglycerides greater than 150mg/dL. In regard of epidemiolgy, there is a strong correlation between MetS and overactive bladder. Pathophysiological mechanisms to explain the relationship of storage symptoms rather than voiding phase symptoms with MetS include the influence of sustained hyperglycemia on the viability of parasympathetic neurons in the pelvic ganglion. A link or overlaps between MetS and alteration of autonomic nervous system can be hypothezised.


Conclusion

Links between Mets and urinary disorders are frequent and common pathophysiological factors can be frequently observed, particularly autonomic nervous system alterations.