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Présenter les moyens disponibles pour affirmer l'obstruction sous-vésicale (OSV), leurs valeurs diagnostiques et pronostiques respectives et leurs indications. Une revue de la littérature a été effectuée à l'aide de la base de données Medline/PubMed et SCOPUS recherchant les articles traitant de l'évaluation préopératoire de l'obstruction sous-vésicale. L'indication d'une chirurgie de désobstruction est basée sur un faisceau d'arguments cliniques et selon les cas radiologiques, endoscopiques et urodynamiques. Outre l'examen clinique et la débitmétrie avec mesure du résidu postmictionnel, l'échographie et l'endoscopie peuvent apporter des arguments en faveur d'une OSV. Bien que le bilan urodynamique ne soit pas systématique avant chirurgie de désobstruction (en particulier prostatique), l'étude pression débit reste le gold standard , l'OSV étant, en soi, un concept urodynamique. L'interprétation de l'étude pression débit se fait à l'aide du nomogramme de l'ICS chez l'homme avec calcul de l'index d'OSV (Bladder outlet obstruction index = PdetQmax−2 qmax). Chez la femme il n'existe pas de critère consensuel définissant l'OSV urodynamique. Bien que peu développé en France, l'examen vidéo-urodynamique qui associe la fluoroscopie au bilan urodynamique standard peut être un outil d'intérêt dans la recherche préopératoire d'une OSV. Plusieurs pistes d'alternatives non invasives à l'urodynamique ont été évaluées au cours des dernières années comme le condom test, le penile cuff test ou les biomarqueurs urinaires mais restent tous du domaine de la recherche clinique. L'affirmation de l'OSV en préopératoire repose, stricto sensu, sur l'examen urodynamique avec étude pression débit, l'OSV étant en soi un concept urodynamique. Toutefois l'urodynamique n'est pas indiqué de manière systématique avant chirurgie de désobstruction, notamment prostatique. L'examen clinique et la débitmétrie libre avec mesure du résidu post-mictionnel restent les bases indispensables de l'évaluation d'une OSV à pratiquer de manière systématique en préopératoire. To present the various evaluations possible to diagnose bladder outlet obstruction (BOO), their diagnostic performances and prognostic values along with their indications. A literature review was conducted on PubMed looking for studies addressing the preoperative assessment of BOO. The surgical decision for a bladder outlet procedure is based on a cluster of clinical arguments That might be completed with radiological, endoscopic and urodynamic parameters. Beyond physical examination and uroflowmetry with post-void residual, ultrasound, cystourethrography and cystoscopy may provide help diagnosing BOO. Although urodynamics are not systematic prior to a bladder outlet surgical procedure (especially benign prostatic obstruction surgery), the pressure flow study remains the gold standard, BOO being, per se , a urodynamic concept. The pressure flow study shall be interpreted suing the ICS nomogram in male patients, with calculation of the BOO index (BOOI = PdetQmax-2Qmax). In female patients, there is no consensual urodynamic definition of BOO. Despite its limited spread in France, video-urodynamics, which combine a "plain" urodynamic with a cystourethrography might be a useful tool to diagnose BOO preoperatively. Several non-invasive exams, such as the penile cuff test, the condom test or urinary biomarkers, have been described over the past few years but none has been assessed enough to be used in daily practice. The diagnosis of BOO preoperatively relies, per se , on urodynamics with pressure flow study, BOO being a urodynamic concept. However, a urodynamic study shall not be systematically performed before a bladder outlet surgical procedure, especially before BPO surgery. Physical examination, free uroflowmetry and post-void residuals remain the cornerstones of BOO assessment, and to be performed in all patients before an outlet procedure. [ABSTRACT FROM AUTHOR]

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Pressure ulcers are a great handicap for those who develop one. Pressure ulcers can take a long time to heal especially if detected late. These afflictions require a lot of time from the medical personnel and thus a great amount of money. We aim here to check the impact of continuous measurement on the performance of early pressure ulcer detection algorithms. To detect pressure ulcers early on we use a simulation of a human buttocks to simulate the reaction of it to pressure. This simulation considers the most recent findings about pressure ulcers. In particular, the phenomenon of muscle stiffening when pressure is applied for a long period of time, and the reperfusion phenomenon. We can then simulate pressure captors on the outside interface of the buttocks to use these measurements for detection. We then determine the best threshold on the measured pressures to create standard algorithms that we compare to novel algorithms using an optimized threshold on a calculated damage based on the pressure measurement of the last 2 hours. We compare these different algorithms for the early detection of pressure ulcers and show the need to take the measurement variation in time for a better detection. The detection error is improved by 7.3% for balanced classes and 2.7% for a dataset with a majority of healthy buttocks. We showed that taking the evolution of pressure instead of only instantaneous measurement can improve the early detection of pressure ulcer. • Pressure ulcer development is dependent on dynamic evolution of mechanical properties. • Reperfusion is a key factor in the development of pressure ulcers. • Time-dependent algorithms could improve the early detection of pressure ulcers. [ABSTRACT FROM AUTHOR]

En conséquence des multiples déficiences générées par la lésion médullaire, la perte de la marche pour le patient paraplégique constitue la fonction ressentie comme la plus difficile à compenser. Depuis les premières orthèses cruro-pédieuses des années 1950, la recherche s’est concentrée sur le développement de dispositifs de verticalisation et de suppléance de la locomotion en conditions ordinaires de vie mais le taux d’abandon à la sortie des centres reste élevé, principalement en raison du coût energétique et de leur absence de fonctionnalité. Issues de la recherche en robotique, les exosquelettes de marche ouvrent de nouvelles perspectives de suppléance de la marche pour le patient porteur d’une lésion médullaire en levant des verrous technologiques majeurs par rapport aux dispositifs de marche appareillée classique : d’une part, l’allègement du contrôle visuel permanent des membres inférieurs jusqu’alors requis pour limiter l’accrochage des pieds, d’autre part, leur coût énergétique réduit qui ouvre de nouvelles perspectives d’utilisation pour les niveaux métamériques les plus hauts. Les voies de recherche les plus actuelles s’attachent à lever le dernier verrou en libérant les membres supérieurs de l’usage des cannes. Si la sûreté de ces dispositifs a fait l’objet de quelques études, leur bénéfice thérapeutique dans la limitation des déficiences secondaires à la lésion médullaire traumatique ainsi que leur place dans les programmes de rééducation restent à mieux préciser. L’analyse des bénéfices attendus doit tenir compte des déterminants et de leur usage et acceptabilité sociale. Les études en cours sont présentées. [ABSTRACT FROM AUTHOR]

Abstract: Injections of botulinum toxin into the detrusor is a major evolution for treatment of neurogenic bladder. They are now considered as a treatment of choice, safe and efficient, in refractory neurogenic overactivity in catheterized patient. To date, there are no consensual practical guidelines for the follow-up of patients having been treated by intradetrusor botulinum toxin, whatever the indication of the treatment, functional, that is, for improving continence and overactive bladder syndrome or organic, that is, for treatment of high-detrusor pressure and their deleterious impact of urinary tract. This lack of guidelines leads to heterogeneity of treatment management and limit the definition of optimal modalities of intradetrusor botulinum toxin treatment in neurogenic patients. The aim of your work, prepared jointly with the International Francophone Neuro-Urological expert study group (GENULF), aimed at putting forward well-informed specific recommendations for the follow-up of patients having been treated by intradetrusor botulinum toxin for functional or organic indication of neurogenic detrusor overactivity. [Copyright &y& Elsevier]

Summary: Entrapment of the pudendal nerve may be at the origin of chronic perineal pain. This syndrome must be diagnosed because this can result in the indication of surgical decompression of the entrapped nerve for pain relief. Electroneuromyographic (ENMG) investigation is often performed in this context, based on needle electromyography and the study of sacral reflex and pudendal nerve motor latencies. The limits of ENMG investigation, owing to various pathophysiological and technical considerations, should be known. The employed techniques do not assess directly the pathophysiological mechanisms of pain but rather correlate to structural alterations of the pudendal nerve (demyelination or axonal loss). In addition, only direct or reflex motor innervation is investigated, whereas sensory nerve conduction studies should be more sensitive to detect nerve compression. Finally, ENMG cannot differentiate entrapment from other causes of pudendal nerve lesion (stretch induced by surgical procedures, obstetrical damage, chronic constipation…). Thus, perineal ENMG has a limited sensitivity and specificity in the diagnosis of pudendal nerve entrapment syndrome and does not give direct information about pain mechanisms. Pudendal neuralgia related to nerve entrapment is mainly suspected on specific clinical features and perineal ENMG examination provides additional, but no definitive clues, for the diagnosis or the localization of the site of compression. In fact, the main value of ENMG is to assess objectively pudendal motor innervation when a surgical decompression is considered. Perineal ENMG might predict the outcome of surgery but is of no value for intraoperative monitoring. [Copyright &y& Elsevier]

Abstract: Aim: The aim is to study the value of the pudendal nerve terminal motor latency (PNTML) testing, in respect to the painful side in patients with pudenda neuralgia, and to determine whether a possible increased latency in the painful side is predictive of a good result with the infiltration. Method: This retrospective study included 53 outpatients (42 women, mean age 62) with suffering from pudendal neuralgia, who were seen between 2000 and 2004. The mean duration of the pain was 30±47 months. The PNTMPNL was measured by the Saint-Mark hospital technique, by the same operator. The following criteria have been were defined: significant increased latency greater than above 6 ms, significant difference of 2 ms in latency between 2 sides from 2 ms, and side of the infiltration corresponding to the side of the neuralgia. The infiltrations were performed either by perineal (30 cases) or transgluteal (8 cases) way. The results on pain were have been considered as good when a substantial reduction of the pain was observed for 6 months or more. Statistical analysis involved was done by the exact Fischer''s test to seek for a possible relation between variables. Results: Of 53 patients (42 women, 11 men, mean age 62) suffered from a with perineal neuralgia. The duration of the neuralgia was 30±47 months. It was bilateral in 10 cases and unilateral in 43 cases. In 43 patients with When the pain was unilateral pain, PNTML we find that the MDLPN was increased in both sides in 39.5% of the population, in the painful side in 14% and in the side opposite side of the to pain in 11%. In 10 patients with the neuralgia was bilateral pain, in 10 patients. Among then, 4 had a bilateral increase of the latency, one patient had an increase only on the right side, and another one an increase only on the left side. We did not find any correlation between the increased of the PNTML TMPNL and, either neither the duration of the neuralgia nor the result of the infiltrations, whatever the method way of the infiltration. Conclusion: The PNTML can be increased whether it corresponds or not to an entrapment of the pudendal nerve. Thus, the management of perineal pain is based mainly, from us, on clinical findings. [Copyright &y& Elsevier]

Introduction/Background Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke especially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Material and method A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. Two hundred and twenty subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurrence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2 hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1 h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self-rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results Two hundred and eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not significantly different at day 30 nor any other secondary criteria except ARAT. Conclusion An additional time 1 h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study. [ABSTRACT FROM AUTHOR]

Introduction/Background Spinal dysraphism is the first congenital cause of neurogenic bladder. Open spinal dysraphism (mainly myelomeningocele) being diagnosed in the neonatal period, neurogenic lower urinary tract dysfunctions (NULTD) are well-known as they have been described in many series. Conversely, closed spinal dysraphisms are often diagnosed later and little data regarding NULTD exist. The aim of this study was to compare the NULTD in patients with closed dysraphism (CD) to those in patients with open dysraphism (OD). Material and method A prospective study was conducted between 2007 and 2016 including all spina bifida patients seen in a multidisciplinary national referral center. At the first visit, lower urinary tract function was assessed as follow: history of past urological surgery, type of spinal dysraphism, Abbreviated Injury Scale, method of bladder emptying, Urinary Symptom Profil (USP) and Qualiveen scores and urodynamic parameters. Results In total, 395 patients were included: 274 with OD (69.4%) and 121 with CD (30.6%). Patients in the CD group were older (35.9 vs. 29.5 years, P < 0.0001), and had lower BMI (23.8 vs. 28 years, P = 0.0002). The method of bladder emptying was spontaneous voiding, clean intermittent catheterization and transileal cutaneous ureterostomy in 47.1% vs. 29.3%; 47.1% vs. 59.4% and 5.7% vs. 11.2% of CD and OD patients respectively ( P = 0.01). The prevalence of urinary incontinence did not differ significantly between the two groups (44.7% vs. 53.5%), as well as the mean Qualiveen score (76.6 vs. 81.7). The main medical concern was NLUTD in 26% of patients with CD and in 27.8% of patients with OD ( P = 0.73). Surgery (augmentation cystoplasty, artificial urinary sphincter, continent cystostomy) was more common in patients with OD ( P < 0.01). Conclusion NLUTD were as frequent and troublesome in patients with open vs. closed spinal dysraphism. However the need for a surgical treatment was more common in patients with OD. [ABSTRACT FROM AUTHOR]

Introduction/Background Upper urinary tract damage due to neurogenic lower urinary tract dysfunction has long been reported as the first cause of death in spina bifida patients. However, recent data regarding the causes of death of patients with spinal dysraphism are scarce. The aim of the present study was to assess the current epidemiology of spina bifida in France report the contemporary causes of in-hospital death of spina bifida patients. Material and method We analyzed data from the French national code registry database (Programme de Médicalisation des Systemes d’Information) from 2009 to 2014 to estimate the number of living births of spina bifida patients and the number of in-hospital deaths and their cause categorized as follows: urological, pulmonary, neurological, digestive, muscular/skin, cardiovascular, skeletal, infectious, cancer, others. The prevalence was calculated by doing the ratio of spina bifida living births over the total number of living births per year based on the Institut National de la Statistique et des Études Économiques (INSEE) data. Results The number of spina bifida living births per year ranged from 113 (2009) to 131 (2013) and was stable over the study period. The total number of living births during this period was between 811,510 (2013) and 832,799 (2010). The prevalence of spina bifida in France was therefore estimated between 1.3 and 1.6/100,000. The number of in-hospital deaths of spina bifida patients per year fluctuated between 14 (2012) and 31 (2011) making a total of 138 in-hospital deaths over the study period. The leading cause of in-hospital death was urological disorders (17%). Other main causes of death were pulmonary disorders (17%), neurological disorders (14%) and bowel disorders (11%). Conclusion The current prevalence of spina bifida in France range from 1.3 to 1.6/100,000. Urological disorders remain the leading cause of death in spina bifida patients. [ABSTRACT FROM AUTHOR]