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Retrospective cohort study. To assess the effectiveness and complications of treatment for neurogenic stress urinary incontinence (nSUI) by Adjustable Continence Therapy (ACT™ and ProACT™). France. A retrospective multicentre study of consecutive patients with neurological pathologies treated for nSUI with ACT balloons. From January 2001 to January 2013, 102 patients were implanted. Mean (SD) age at implantation was 48.4 (16.5) years. Patients were followed-up for a mean 2.7 (2.3) years. After implantation, 5.9% of patients were totally continent, 51.2% had an improvement in symptoms of at least 50% (including 14.6% with improvements of at least 90%), and 48.8% had improvements of

INTRODUCTION AND OBJECTIVE:Several preliminary series have reported the use of a robotic approach for artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontin...

Purpose: We investigated improvements in overactive bladder and patient reported outcomes in patients with overactive bladder and refractory incontinence treated with mirabegron 50 mg plus solifenacin 5 mg vs solifenacin 5 or 10 mg.Materials and Methods: Patients with overactive bladder who were incontinent despite 4 weeks of single-blind daily solifenacin 5 mg were randomized 1:1:1 to a double-blind daily combination of mirabegron 50 mg/solifenacin 5 mg, or solifenacin 5 or 10 mg for 12 weeks. The mirabegron dose was increased from 25 to 50 mg after week 4. Symptom bother, health related quality of life and patient perception of bladder condition were assessed by OAB-q (Overactive Bladder Questionnaire) and the PPBC (Patient Perception of Bladder Condition) questionnaire, respectively. Responder rates were based on a 50% reduction in daily incontinence, zero incontinence episodes and fewer than 8 micturitions per 24 hours with minimal important differences in OAB-q and PPBC.Results: Overall 2,174 patient...

Purpose to assess the efficacy of transcorporal artificial urinary sphincter (AUS) implantation on continence for male stress urinary incontinence in cases of prior surgical treatment or/and radiation failure, and as a first option in radiation patients. Materials and Methods From March 2007 to August 2012, 37 male patients were treated with transcorporal AUS AMS™ 800. Twelve patients had primary placement of transcorporal cuff, a surgical option due to a previous history of radiation and 25 patients had secondary procedure after failure of AUS or urinary incontinence surgery. Functional urinary outcomes were assessed by daily pad use, 24-hour Pad-test and ICIQ-SF questionnaire. Quality of life and satisfaction were assessed based on I-QoL and PGI-I questionnaires. Results After a median of 32 months, the continence rate (0 to 1 pad) was 69.7%. Median pad test was 17.5g (0-159), mean ICIQ-SF score was 7.3/21 (±5.4) and mean I-QoL score was 93.9/110. A total of 88% of the patients reported satisfaction with the AUS. The 5-year actuarial revision-free for AUS total device was 51%. Patients for primary implant for radiation were not more likely to experience revision than non-radiation patients. Preservation of erections was reported in half of the potent patients. Conclusions Transcorporal AUS cuff placement is a useful alternative procedure option for severe male UI treatment, especially in patients with a compromised urethra after prior surgery or radiation. A high continence rate was reported and implantation as first option in radiation patients should be considered.

Introduction and Hypothesis To our knowledge a study regarding the efficacy of Pelvisoft® Biomesh for cystocele repair has not previously been reported in the literature. The aim of our study was to assess the long-term efficacy, subjective outcomes and complications in the use of a non-synthetic porcine skin mesh graft (Pelvisoft® Biomesh) associated with transvaginal anterior colporrhaphy in the treatment of cystocele prolapse. Materials and Methods A retrospective study was performed at a single centre. Thirty-three women aged 35-77 years underwent cystocele repair using Pelvisoft® graft between December 2005 and June 2009. Twenty-nine women who underwent transvaginal cystocele repair with Pelvisoft® Biomesh for over a 2 years period were assessed. Four patients were lost to follow-up. Cystocele repair was performed via the vaginal route using Pelvisoft®Biomesh implant by inserting it in the anterior vaginal wall. The median follow-up time was 54.0 months. The rate of recurrence was 17.3%. A total of 6.9% of patients presented early mesh exposure treated by conservative treatment. The mean PFDI-20 score was 72.2. Among sexually active women, the mean PISQ 12 was 33.9 but 56.2% had dyspareunia. After surgery, 6 patients had de novo intercourse. Our results show that the use of Pelvisoft® biomaterial associated with anterior colporrhaphy for cystocele repair appears to be safe with acceptable failure and complication rates at long term. Nevertheless, an adverse impact on sexual function was reported by the majority of patients.

Background Urinary incontinence (UI) following treatment for localized prostate cancer is a significant adverse consequence most commonly seen after radical prostatectomy. UI can significantly impair the quality of life of patients who can otherwise expect a long survival. Methods The authors review past and present literature on UI following treatment for localized prostate cancer. Special focus is placed on the rate of UI following different modes of therapy, the effect of posttreatment UI on patients’ quality of life, and the success of different methods used to treat the incontinence. Results Postprostatectomy UI has been reported in 25%-70% of cases, but few patients report being significantly bothered by the symptom. Postradiation adverse effects are mainly acute inflammatory, while late complications are rare but usually more serious. Comparative studies estimate UI following prostatectomy to be two times more common than following radiation, and surgical patients are three times more likely to continue to use pads. Watchful waiting carries a risk of incontinence related to prostate tumor progression. Several interventions can improve UI. Conclusions UI is the most common adverse consequence from treatment for localized prostate cancer. All of the possible treatment modalities carry some risk of UI. Providing accurate information to patients allows them to make informed decisions regarding treatment and can improve the quality of life in the posttreatment period.

Contexte : Bien que l'Examen Clinique Objectif Structure (ECOS) soit considere comme le meilleur instrument pour l'evaluation de la competence clinique, l'experience de ce type d'examen est encore limitee en France. But : Evaluer la faisabilite et l'acceptabilite d'un ECOS destine aux internes en Urologie. Materiel et Methodes : 20 internes d'urologie ont passe un circuit de 5 stations de 10 minutes chacune avec patients simules. La selection des problemes a ete effectuee en fonction des objectifs d'apprentissage des programmes d'enseignement de l'urologie. Un questionnaire ecrit avec echelle de Likert a ete utilise pour evaluer l'acceptabilite de l'ECOS. Les performances des internes juniors et seniors ont ete comparees avec un test t de Student. Resultats : La performance des internes seniors a ete globalement superieure a celle des juniors, mais sans difference significative. Les internes seniors ont ete significativement meilleurs concernant les problemes de consultation et la majorite d'entre eux ont obtenu une note superieure a la moyenne totale du groupe. Malgre notre manque d'experience et les difficultes logistiques, nous n'avons pas rencontre de difficulte dans le developpement et l'organisation de l'examen. Tous les participants ont confirme que les situations cliniques presentees etaient realistes et que les patients simules etaient credibles. Conclusions : Les resultats de cette experience pilote d'ECOS en urologie prouvent la faisabilite d'un tel instrument pour evaluer la performance des internes et les deficiences eventuelles de l'enseignement, notamment l'activite de consultation. Cette experience doit etre developpee afin d'explorer ses qualites psychometriques.

Intradetrusor injections of botulinum toxin are the cornerstone of medical treatment of neurogenic detrusor overactivity. The primary aim of this treatment is to ensure a low pressure regimen in the urinary bladder, but the mechanisms leading to long-term protection of the urinary tract remain poorly understood. In this paper, we highlight the potential benefits of intradetrusor injections of botulinum toxin regarding local effects on the bladder structures, urinary tract infections, stone disease, vesico ureteral reflux, hydronephrosis, renal function based on a comprehensive literature review.

Bilateral micronodular adrenal hyperplasia and ectopic adrenocortical adenoma are two rare causes of ACTH-independent Cushing's syndrome.The aim of the study was to evaluate a 35-yr-old woman with ACTH-independent hypercortisolism associated with both micronodular adrenal hyperplasia and ectopic pararenal adrenocortical adenoma.In vivo and in vitro studies were performed in a University Hospital Department and academic research laboratories.Mutations of the PRKAR1A, PDE8B, and PDE11A genes were searched for in leukocytes and adrenocortical tissues. The ability of adrenal and adenoma tissues to synthesize cortisol was investigated by immunohistochemistry, quantitative PCR, and/or cell culture studies.Detection of 17alpha-hydroxylase and 21-hydroxylase immunoreactivities, quantification of CYP11B1 mRNA in adrenal and adenoma tissues, and measurement of cortisol levels in supernatants by radioimmunological assays were the main outcomes.Histological examination of the adrenals revealed nonpigmented micronodular cortical hyperplasia associated with relative atrophy of internodular cortex. No genomic and/or somatic adrenal mutations of the PRKAR1A, PDE8B, and PDE11A genes were detected. 17alpha-Hydroxylase and 21-hydroxylase immunoreactivities as well as CYP11B1 mRNA were detected in adrenal and adenoma tissues. ACTH and dexamethasone activated cortisol secretion from adenoma cells. The stimulatory action of dexamethasone was mediated by a nongenomic effect involving the protein kinase A pathway.This case suggests that unknown molecular defects can favor both micronodular adrenal hyperplasia and ectopic adrenocortical adenoma associated with Cushing's syndrome.

Aims The committee was charged with the responsibility of reviewing and evaluating all published data relating to surgical treatment of male urinary incontinence since the previous consultation in 2004. Methods Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The articles were evaluated using Levels of Evidences adapted by the ICUD from the Oxford Centre for Evidence Based Medicine. The Recommendations for Care were based on the level of evidence and discussed among the committee members to reach consensus. The incontinence problems were classified according to their etiology, that is, either primarily sphincter or bladder related. Results Specialist evaluation of the patient is primarily a clinical approach with history, frequency-volume chart, physical examination, and post-void residual urine. Other investigations such as radiographic imaging of the lower urinary tract, cystoscopy, and urodynamic studies can provide important information for the clinician. For stress incontinence of various etiologies the artificial urinary sphincter (AUS) has the longest record of satisfactory results. Consideration must be given to the need for revisions for mechanical breakdown, erosion/infection, and recurrent incontinence, as well as cost. Sling procedures are increasingly being reported to have good outcomes for mild to moderate incontinence. Injectable agents have not shown durable results but newer technologies such as volume-adjustable balloons have shown favorable early results. Incontinence following cystectomy with neobladder and pelvic trauma has been treated most commonly with the AUS. Conclusions Although the literature is replete with well-done cohort studies, there is a need for prospective randomized clinical trials. Recommendations for trials include standardized workup and outcome measures and complete reporting of adverse events and long-term results. Further research is also needed to elucidate the mechanism of post-prostatectomy incontinence. Neurourol. Urodynam. 29: 179–190, 2010. © 2009 Wiley-Liss, Inc.

A 69-yr-old woman was referred for a left adrenal mass incidentally discovered at computed tomography (CT) scan that was performed for abdominal pain. Clinical examination showed no signs of corticosteroid or catecholamine excess, and hormone assays revealed no abnormality. At CT scan, the lesion appeared as a 6-cm heterogeneous mass containing low-density fat surrounded by dense tissue (Fig. 1A). The neoplasm was associated with infiltration of the left perirenal fascia evocative of an inflammatory process (Fig. 1B). The diagnosis of adrenal myelolipoma complicated by extracapsular hemorrhage was suggested (1), and surgical removal of the lesion was performed through retroperitoneoscopy. Pathology showed no adrenal neoplasm but revealed an invasion of the periadrenal fat tissue by proliferation of monomorphic small lymphocytes (Fig. 1, C and D, and Fig. 2A). Immunolabeling of the tissue (Fig. 2, B and C) allowed establishing the diagnosis of marginal-zone B-cell lymphoma (MZL). Staging procedures showed involvement of spleen and bone marrow. Considering the good prognosis of MZL, therapeutic abstention was decided. Non-Hodgkin’s adrenal lymphomas are usually diffuse extranodal large B-cell lymphomas with poor prognosis. When bilateral, destruction of the adrenals by the proliferative lymphocytic process frequently results in adrenal insufficiency (2). Very rarely, lymphomas of the adrenal areas belong to the MZL subtype, also called small B-cell lymphoma (2, 3). MZLs arise from a marginal-zone B cell present in lymph nodes and extranodal tissues and are considered as indolent malignancies (3). In the patient’s case, invasion of periadrenal fat tissue by lymphocytic proliferation mimicked the appearance of adrenal myelolipoma on CT scan, i.e. a heterogeneous mass with mature fat intermingled with dense myeloid tissue (4).