Base bibliographique

Critères cliniques et biologiques pertinents pour poser un diagnostic de déficit androgénique lié à l'âge (DALA)
2012
- Réf : Prog Urol, 2012, 4, 22, S21, suppl. S1


Introduction



Introduction

The androgen deficiency in the aging male (ADAM) affects 30 % of men after 70. It’s responsible for many minor symptoms but also major complications. The objective of this study was to establish the clinical and biological criteria for the diagnosis of ADAM.


Material and method

Data on clinical and biological criteria for the diagnosis of ADAM have been explored in Medline and Embase using the MeSH keywords : androgen deficiency ; testosterone deficiency ; late-onset hypogonadism ; aging. The articles were selected based on their methodology, relevance, date and language of publication.


Relevant clinical criteria for the diagnosis of ADAM

The prevalence of symptomatic ADAM in the old male ranges from 6 % to 12 %. The main clinical manifestations of ADAM include various sexual disorders associated with many nonspecific symptoms which can even be present without androgen deficiency. ADAM may induce type 2 diabetes or some cardiovascular complications which increase the risk of death. Because of low specificity, the use of diagnostic tools is not recommended to screen ADAM.


Variation in the androgen secretion during aging

The annual decrease rate of testosterone is 1.6 % after 30 leading to androgen deficiency in 50 % of patients after 80. ADAM is due to a concomitant reduction of testosterone and gonadotropin secretion.


Relevant biological criteria for the diagnosis of ADAM

The biological diagnosis of androgen deficit is based on two determinations of total testosterone obtained between 7AM and 11AM. Levels below 8nmol/L are an indication to hormonal substitution while patients with levels above 12nmol/L don’t seem to benefit from this type of treatment. Between 8 and 12nmol/L, it is recommended to assess free testosterone levels. Because of a decrease in gonadotrophin secretion during aging, the LH levels are abnormally normal in ADAM.


Conclusion

ADAM is a biological and clinical syndrome characterized by the association of nonspecific symptoms and decrease testosterone levels. Hormone replacement therapy appears to benefit patients at risk of metabolic, cardiovascular or bone complications.

Mots clés:
Déficit androgénique lié à l’âge (DALA) / Testostérone / Hypogonadisme / vieillissement
Mots-clés:
Androgen deficiency in the aging male (ADAM) / Testostérone / Late-onset hypogonadism / Aging
Dysfonction uro-érectile : une nouvelle entité nosologique
Erectile urogenital dysfunction: a new nosological entity
2012
- Réf : Prog Urol, 2012, 4, 22, S27, suppl. S1

Mots clés:
M.
Mots-clés:
Androgen deficiency in the aging male (ADAM) / Testostérone / Late-onset hypogonadism / Aging
Influence de l'âge sur la santé sexuelle masculine
2012
- Réf : Prog Urol, 2012, 4, 22, S7, suppl. S1


Introduction



Introduction

With the increase in life expectancy, men’s sexual health has become a major concern for elderly couples. Erectile dysfunction (ED) is responsible for a 50 % decrease of sexually active men between 60 and 85. The aim of this study was to identify objective elements to evaluate the influence of age on male sexual health.


Materials and method

Data on the effects of aging on men’s sexual health have been explored in Medline and Embase using the MeSH keywords : prostate ; sexuality and erectile dysfunction ; aging. The articles were selected based on their methodology, relevance, date and language of publication.


Results

ED concerns 64 % of 70 years old patients and up to 77.5 % after 75 years. The screening of this pathology is based on standardized diagnostic tools. The most used of them remains the “International Index of Erectile function” which, in its simplified version with 5 items (IIEF-5 or SHIM), presents at the cutoff score of 21, a sensitivity of 98 %, a specificity of 88 % and a kappa index of 0.82. The ED is often responsible for a decrease in the quality of life for 60 % of elderly couples wishing to pursue sexual activity. Some diagnostic tools, such as the «Self-Esteem And Relationship» (SEAR) questionnaire or the «Sexual Experience Questionnaire» (SEX-Q) assess individual and couple satisfaction. Physiological aging seems to favor erection disorders by the development of an Androgen Deficiency of the Aging Male (ADAM) but pathological aging appears to be primarily responsible. Cardiovascular or neurological diseases and lower urinary tract symptoms (LUTS) are, with the polymedication, modifiable risk factors of ED to systematically screen in elderly subjects.


Conclusion

Many diagnostic tools allow to detect ED and assess the impact on the quality of life of elderly men. The fundamental element of the management of ED is the research of modifiable risk factors including cardiovascular.

Mots clés:
prostate / sexualité / dysfonction érectile / vieillissement / prostate
Mots-clés:
T. / M. / P. / F.
La prostate : une glande au carrefour uro-génital
2012
- Réf : Prog Urol, 2012, 4, 22, S2, suppl. S1


Introduction



The prostate’s location at the crossroad between the urethra and ejaculatory ducts could explain her urinary and génital function. The currently anatomical model has been proposed by McNeal et al. in 1968. The prostate gland is divided in 4 zones surrounding the urethra in its vertical path from the bladder to the striated sphincter. Transition, Central and peripheral zones consist of tubulo-alveolar glandular tissue secreting the spermatic fluid while the anterior fibro-muscular zone consists of smooth muscle which may start voiding. The confluence between the urinary and genital tract in the prostate explains the anatomic proximity and the intimate relationship between male genital and urinary organs. Elderly anatomical changes of the prostate may therefore be involved in sexual and urinary symptoms. The development of prostate medications may be effective both on voiding and erectile dysfunction.

Mots clés:
prostate / Urètre / vésicules séminales / Appareil urinaire / Appareil génital
Mots-clés:
prostate / urethra / Ejaculatory ducts / seminal vesicles / urinary tract
La prostate : une glande énigmatique
The prostate: a mysterious gland
2012
- Éditorial
- Réf : Prog Urol, 2012, 4, 22, S1, suppl. S1

Mots clés:
M. / T.
Mots-clés:
Androgen deficiency in the aging male (ADAM) / Testostérone / Late-onset hypogonadism / Aging
Les points forts du Congrès de l'EAU 2012
2012
- Réf : Prog Urol, 2012, 4, 22, 1-8
Mots clés:
Pr Aurélien
Mots-clés:
S. / F. / H. / P. / C.
Nouveautés dans la prise en charge de l'hyperactivité vésicale et des symptômes du bas appareil urinaire de l'homme
2012
- Réf : Prog Urol, 2012, 4, 22, 9-13
Mots clés:
Walter / Marcus / Con / John / Matthias
Mots-clés:
S. / F. / H. / P. / C.
Troubles sexuels associés aux maladies de la prostate
2012
- Réf : Prog Urol, 2012, 4, 22, S14, suppl. S1


Introduction



Introduction

The lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) and the treatment of prostate cancer (PCa) are linked to erectile dysfunction (ED). The objective of this work was to evaluate the influence of prostatic diseases on ED.


Materials and method

Data on the influence of BPH and PCa on ED have been explored in Medline and Embase using the MeSH keywords : benign prostatic hyperplasia, prostate cancer, prostatectomy, external beam radiotherapy ; androgen deprivation therapy ; erectile dysfunction. The articles were selected based on their methodology, relevance, date and language of publication.


Results

The rate of ED in patients with BPH ranged from 30 to 70 %. The LUTS were an independent risk factor of ED. The pathophysiology linking BPH to ED has not been elucidated but seems to involve the path of Nitric Oxide - cyclic Guanosine Monophosphate (cGMP-No.), the RhoA - Rho - Kinase (ROCK) signal, the sympathetic autonomic nervous system and pelvic atherosclerosis. The rate of ED after radical prostatectomy (RP) ranged from 60 to 89 %. The bilateral preservation of neurovascular bundels improved these results. Risk factors of ED after RP were age, PSA levels, pretreatment erectile function and surgical technique. The rate of ED after prostate external beam radiotherapy ranged from 6 to 84 %. Risk factors of ED after external beam radiotherapy were age, pretreatment erectile function and association of androgen deprivation therapy. The rate of ED with androgen deprivation therapy was 85 %. Risk factors of ED with androgen deprivation therapy were age > 70 years, diabetes and pretreatment erectile function. Intermittent androgen deprivation therapy was associated with better results on erectile function than continue androgen deprivation therapy.


Conclusion

ED is responsible for a decrease of elderly patients life quality already affected by urinary symptoms and prostate disease progression. The development of drugs effective on both ED and BPH or PCa symptoms is then full of meaning.

Mots clés:
hypertrophie bénigne de la prostate / cancer de prostate / dysfonction érectile / vieillissement
Mots-clés:
Benign prostatic hyperplasia / prostate cancer / erectile dysfunction / Aging
Diffusion des recommandations pour la pratique clinique concernant l'incontinence urinaire de la femme
2012
- Réf : Prog Urol, 2012, 4, 22, 233-239


Introduction



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.

Mots clés:
Recommandations / Pratique clinique / incontinence urinaire
Mots-clés:
guidelines / Clinical practice guidelines / Urinary incontinence
Hyperactivité vésicale idiopathique de la femme et système nerveux autonome
2012
- Réf : Prog Urol, 2012, 4, 22, 199-206


Introduction



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.

Mots clés:
hyperactivité vésicale / incontinence urinaire féminine / Incontinence urinaire sur urgenturie / système nerveux autonome / Maladies du système nerveux autonome
Mots-clés:
Overactive bladder syndrome / Female urinary incontinence / Urge incontinence / autonomic nervous system / Autonomic nervous system diseases
Injections intradétrusoriennes de toxine botulique A en consultation : expérience d'un centre pendant deux ans
2012
- Réf : Prog Urol, 2012, 4, 22, 214-219


Introduction



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.

Mots clés:
Toxine botulique / Injection intradétrusorienne / consultation / Satisfaction / Coût
Mots-clés:
Botulinum toxin / Intradetrusor injection / Ambulatory / Outpatient clinic / Satisfaction
Late post-partum dyspareunia: Does delivery play a role?
2012
- Réf : Prog Urol, 2012, 4, 22, 225-232


Introduction


Mots clés:
Delivery / Satisfaction / Post-partum / Sexuality / Episiotomy
Mots-clés:
A. / A. / F. / J. / B.
Proctalgies fugaces et neuropathie pudendale : étude neurophysiologique périnéale chez 55 patients
2012
- Réf : Prog Urol, 2012, 4, 22, 220-224


Introduction



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.

Mots clés:
Proctalgie fugace / Neuropathie pudendale / Électromyographie
Mots-clés:
Proctalgia fugax / Pudendal neuropathy / Electromyography
Progrès pelvi-périnéologie , la nouvelle revue de la SIFUD-PP
2012
- Réf : Prog Urol, 2012, 4, 22, 197-198

Cher(e)s lectrices et lecteurs,

Mots clés:
X.
Mots-clés:
Erdheim-Chester disease / Hystiocytose / Retroperitonale fibrosis
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


Introduction



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.

Mots clés:
Rectocèle / prolapsus / polypropylène / Voie glutéale et plaque biologique
Mots-clés:
Vaginal apical prolapse / Rectocèle / Tension-free Vaginal Tape / Trans-ischio-anal / Biologic implant
Troubles vésicosphinctériens et syndrome métabolique
2012
- Réf : Prog Urol, 2012, 4, 22, 207-213


Introduction



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.

Mots clés:
Syndrome métabolique / Obésité / diabète / hyperactivité vésicale
Mots-clés:
Metabolic syndrome / Obesity / Diabetes / Overactive bladder