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Stress urinary incontinence with low urethral closure pressure and urethral mobility is often treated by artificial urinary sphincter. Our retrospective report in 19 patients evaluates the sling procedure as an alternative to the artificial urinary sphincter (7 patients). All patients had a preoperative clinical and urodynamic evaluation. 13 patients were continent (68.4%) in the sling procedure group and 5 in the sphincter group. Continence remained stable with a mean follow-up of 77 months (range: 39-110 months). 2 patients had urgency and none had dysuria. The sling procedure gave us the same results as sphincter with less morbidity.

Eighteen patients with stress urinary incontinence and normal maximal closure pressure underwent Burch procedure with pelvioscopy. A small (3 cm) incision is necessary to introduce the pelvioscope which allowed suture under visual control. Six month clinical results were 93% success and 7% improvement.

Twenty five patients with symptomatic BPH and normal PSA underwent electrovaporization. The mean IPSS was 21.5 before and 7.8 three months after treatment while the mean peakflow was 7.1 ml/s and became 16.9. With a short hospital stay (3 days) and a very low morbidity, electrovaporization seems to be a good alternative to TURP. A longer follow-up is necessary.

Stress urinary incontinence may be treated by different techniques. This study is based on a retrospective analysis of 59 patients treated between 1985 and 1993, by the Goebell-Stoeckel technique. 48 patients were questionned by phone in March 1995 to estimate the long term results. Two groups were defined; group A: follow-up between 15-60 months and group B: follow-up between 72-120 months (Total average follow-up: 68 months). The majority of patients were elderly, menopaused (88%) and had had one or more surgical procedure for incontinence (60%). Among 59 patients, 8 developped minor early complications. The mean length of hospital stay was 14 days and the mean duration of indwelling catheterization was 6.5 days. 60% of patients have had urinary retention after catheter ablation and have required intermittent catheterization at home for a mean duration of 14 days. Continence was achieved in 84% of cases at 3 months and had persisted in 96% of cases for group A and 91.5% of cases for group B. With a mean follow-up of 68 months, 37.5% of cases had irritative symptoms, 12.5% had minor urethral obstruction. 52% of patients obtained a very excellent result (normal continence, no urgency, no dysuria), 9% obtained an excellent result (normal continence, urgency with no leaked, and/or minor dysuria); 12 obtained a moderate result (normal continence, urgency with minor leakage without toilet set, and/or minor dysuria) and 27% obtained a poor result (incontinence, urgency with leakage necessitating toilet set, and/or dysuria).

24 men (mean age 71.2 years) with micturition disorders and parkinson disease have been studied: irritative symptoms are present in 62.5%. Urodynamics were specially usefull when obstructive symptoms (37.5%). In these cases, 3/4 had a mechanical obstruction to be treated by surgery. 3 men had a neurologic bladder and needed a pharmacological treatment. In this high risk population, urodynamics seemed to be necessary.

Twenty-three patients having undergone enterocystoplasty with a detubulated graft has an urodynamic study on an empty stomach and after a standardized meal. All patients (average age 62.9 years) had been operated more than 6 months earlier, and 30% still presented with urine leakages at night. The urodynamic study included a cystomanometric measurement with rapid water filling, an urethral profile and a micturating cystography. It was repeated 60 to 90 minutes after a meal composed of glucids, lipids and protids. Feeding had variable effects on the intestinal graft: increase in peristaltic intensity and/or earlier onset of contractions (10/23); apparently paradoxical decrease in contractions (6/23); sometimes no modification (7/23). This short work without any obvious physiopathological explanation has led us to advocating breaking up feeding for patients who were improved by the meals.

From 1985 to 1990, 119 female patients underwent a cure for urinary incontinence on exertion according to a technique that varied according to the period and to the data of the literature. From 1985 to 1988, 42 patients were operated with the Goebbel-Stoeckel technique; from 1986 to 1988, 32 patients were operated with Stamey's procedure, and 47 patients with Gittes' procedure from 1988 to 1990. These three groups of patients with comparable ages, previous history and degree of urinary incontinence on exertion were analyzed by the same surgeon for functional results and morbidity, both in the immediate three months after surgery and in July, 1991, with an average distance in time of 29 months. The patients with no leakage of urine were regarded as healed, those presenting with occasional leakages on violent exertion but requiring no napkins were regarded as improved. All other patients were regarded as failures. The percentage of failure is similar for the three technical procedures when analyzing long-term results and according to our criteria, 66% of patients only are healed or improved. These figures are noticeably higher if surgery has been performed in a patient with normal preoperative closing pressure. The analysis of this series and comparison with series in the literature seem to allow outlining a therapeutic pattern for urinary incontinence on exertion, whether recurrent or not, with or without sphincter hypotonia.

Adenocarcinoma of the prostate is the most frequent cancer of male over 60 years of age. Radical prostatectomy is one of the preferred modes of treatment for localized stages. Surgical morbidity decreases with experience and consists mainly in bleeding and rectal injury. Delayed morbidity comprises loss of erection, anastomosis stricture, incontinence. A retrospective study of 100 patients is reported.

For about the last 10 years, transrectal hyperthermia has been used to treat obstructive manifestations of adenoma of prostate. This procedure induces interstitial edema and acts preferentially on the fibrous elements of the prostate. Several therapeutic regimens have been used successively by different teams, after objective and subjective inclusion screening programmes. Results published up to the present show about 45% of objective responders (against 3% in a placebo group) with improvement sustained in 3 out of 4 cases. Morbidity rate (infection and urinary retention) was 3%. Data from a retrospective study of a series of personally treated patients was w used to determine those with the greatest chance of a successful outcome, even though this is never comparable with that of surgical treatment.

Between March 1988 and February 1991, 47 patients with urinary stress incontinence (USI) were treated by Gittes' operation, suspension thread traction being determined by perioperative ultrasonography in 31 of these cases. All patients were re-examined on February 1992 after a mean follow-up of 26 months (range 12 to 24 mths). The global success rate (recovery and improvement) was assessed as 72% at 3 months and 56% at follow-up. Rated as a function of closure pressure (CP), the success rate at evaluation was 62% with normal CP, 42% with CP low for age, and 33% with CP < 30 cm H20. For the 31 patients with perioperative ultrasonography examination the success rate was 80% at 3 months and 70% at follow up. As a function of CP the rate was 83% at follow up with a normal CP, 50% with a CP low for age, 37.5% with a CP < 30 cm H20. Although Gittes' operation is a simple, fairly non-aggressive intervention, results diverge widely from those obtained with "classical" techniques. Optimization of indications is essential, therefore, only patients with pure USI without hypotonia of the sphincter obtaining maximum benefit from the intervention, carried out preferably under perioperative by control ultrasonography.

Today's treatment of female urinary incontinence is not merely surgical. Provided the indications are clearly established (stress incontinence due to sphincter hypotonia, bladder instability and overflow urination in some cases, sensitive frequency) and the therapist properly trained, vesicosphincteral physiotherapy represents an alternative or a complement to the other therapies. The various aspects of this rehabilitation (manual techniques, electrostimulation, biofeedback) are reported here.

A prospective study was carried out in 100 consecutive male patients coming to consultation in the department. These men, whose average age was 65 years (32-82), and who had come for various reasons, answered a questionnaire on the quality of their urine flow, which was rated on a scale ranging from 1 to 4. The results of flow rate measurements were classified in 4 categories according to the maximum flow rate and to the volume of micturation, which always was greater than 150 ml. The comparison of the subjective appreciation and of the objective value showed frequent discrepancies (over- or under-evaluation). These results were analysed according to various parameters, and in particular to the patients' age. It thus appears that one third of the patients only have an accurate appreciation of the quality of their micturation.

The results of 40 consecutive patients who underwent bladder replacement following cystoprostatectomy for invasive bladder cancer are reported. A 30 cm detubularized ileal segment was used to make the neobladder. Mean follow-up was 19 months (over 2 years in 17 patients). All patients achieved diurnal continence. Nocturnal continence was obtained in 70.5% of patients: 41% had no leakage and nocturia less than 2, while 29.5% had some occasional leakage. Urodynamic evaluation showed the average peak flow to be at 18.3 ml/s and an average neobladder capacity of 410 ml. Six patients had spontaneous contractions of the enteric bladder of greater than 40 cm H20, always associated with elevated urethral pressure. Post-void residue was smaller than 100 cc in all cases. This procedure is simple to do, and led to an excellent diurnal continence, although it cannot assure nocturnal continence in every single patient.

A urodynamic assessment with an anticholinergic test has been performed on 145 patients suffering of urge incontinence or micturition frequency. Eighty per cent had a detrusor instability and in those the test has shown to be positive in three half of the cases. In this group there was also an improvement with the oral treatment. In the others groups, the anticholinergic per os was almost never usefull. Anticholinergic drugs (not always well tolerated) are usefull when there is an instability and when the test is positive but not in the other cases.