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L’incontinence urinaire d’effort est un symptome, secondaire a une hypermobilite cervico-uretrale (HU) et/ou a une insuffisance sphincterienne (IS). De tres nombreuses techniques chirurgicales ont ete decrites pour le traitement de l’IUE. Dans l’HU, les soutenements, les suspensions ou les frondes qui utilisent des materiaux autologues ou synthetiques ont pour but de positionner le col vesical dans l’enceinte manometrique abdominale. Ils repondent a la theorie de defaut de transmission des pressions abdominales a l’uretre (1), et a l’ecrasement du col vesical et de l’uretre sur les structures de suspension (2). Une nouvelle technique, le Tension-free Vaginal Tape, consiste a soutenir la partie moyenne de l’uretre et non plus le col vesical. Elle resulte de la theorie integrale des mecanismes de cloture uretrale chez la femme (3, 4). Dans le cas de l’IS isolee avec uretre fixe, l’approche chirurgicale est polymorphe avec trois techniques chirurgicales validees : les frondes sous-uretrales, les injections para-uretrales, et le sphincter urinaire artificiel. Les deux premieres techniques sont passives et tendent a retablir la continence en creant une dysurie par obstruction uretrale. Le sphincter urinaire artificiel vise a retablir un cycle continence-miction quasi physiologique en obtenant une continence complete entre des mictions qui s’effectuent sans obstacle au niveau de l’uretre. Les techniques chirurgicales les plus utilisees actuellement pour le traitement de l’IUE, se resument aux colposuspensions, aux frondes, au TVT, aux injections para-uretrales et au sphincter urinaire artificiel. Les troubles de la statique pelvienne sont souvent associes a l’IUE. Ils concernent les etages anterieur (cystocele), moyen (colpocele, hysterocele et ptose du dome vaginal), et posterieur (rectocele et elytrocele). Les modalites chirurgicales sont multiples. Toutes visent a retablir une anatomie normale.

After clinical evaluation, imaging is extremely important in determining the type of treatment and approach of micturition disorders in elderly. In this article, the advantages and limitations of each of the relevant techniques are reviewed and highlighting, with correlation to clinical evaluation. Sonography has become the most widely used technique to study bladder dysfunction. CT and MRI have specific indications.

To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bladder hyperreflexia.The international medical literature was reviewed from the Medline and Pubmed database.The usual first line treatment of detrusor hyperreflexia is parasympathicolytic drugs and self cathterization. In case of lack of efficacy or severe side effects, a surgical procedure (enterocystoplasty) can be performed. 300 units of Botox injected into the detrusor permit a significant increase of bladder capacity and a significant decrease of maximal detrusor pressure for at last 6 months. But we did not find any double blind controlled studies in this indication and no fundamental studies focused on the mechanism of action of botulinum toxin on the bladder muscle. It is now impossible to conclude on the long term efficacy and toxicity.Botulinum toxin injected into the detrusor muscle seems to be an efficient treatment of bladder hyperreflexia for 6 months in patients resistant to parasympathicolytic drugs. Long term efficacy and mechanism of action is actually not known.

We examine the relationship of nonsteroidal anti-inflammatory drugs and finasteride on the risk of prostate cancer.Participants in this case control study using a prospective collection of data were drawn from consecutive patients who underwent prostate biopsy at 12 different departments of urology from January 1999 to June 2000. Medication use was assessed by self-questionnaire as well as questions about dietary and lifestyle factors that might be relevant for prostate cancer risk.The study included 639 patients with prostate cancer and 659 cancer-free controls. Univariate analysis showed no significant impact of aspirin and finasteride on prostate cancer risk while the nonaspirin nonsteroidal anti-inflammatory drug users had a lower risk (OR 0.80, 95% CI 0.64-0.99). After adjusting for potential confounders, the protective effect of nonaspirin nonsteroidal anti-inflammatory drugs was no longer significant (OR, 0.84, 95% CI 0.66-1.07), while finasteride showed a significant protective effect (OR 0.58, 95% CI 0.37-0.92).The results suggest that finasteride could have a chemopreventive role in prostate cancer. While aspirin did not show any impact on prostate cancer risk, the role of nonaspirin nonsteroidal anti-inflammatory drugs warrants further studies.

Objectifs L’expression de Foxp3 est correlee a la progression tumorale dans differents types de tumeurs malignes a differenciation epidermoide ainsi que dans les tumeurs de vessie (TV) chez les patients non neurologiques. Notre objectif etait d’evaluer le role de Foxp3 dans les TV chez les patients ayant une vessie neurologique afin d’etablir le role de l’inflammation dans la carcinogenese urotheliale. Methodes Des TV infiltrant et non infiltrant la musculeuse issues de patients ayant une vessie neurologique ont ete analysees. L’expression de Foxp3 et de CD8 a ete quantifiee dans le tissu tumoral et non tumoral par immunohistochimie. Une correlation entre l’expression de Foxp3 et de CD8, d’une part, et le stade tumoral et la differenciation histologique, d’autre part, a ete recherchee. Resultats Au total, 20 TV issues de patients neurologiques ont ete incluses. L’âge median etait de 54,5 ans (IQR 48,2–66,2). Les analyses histologiques ont montre que 65 % des tumeurs infiltraient la musculeuse. CD8 et Foxp3 etaient exprimees par 25 % des TV pTa, 71 % des TV pT3 et 100 % des TV pT4. Une augmentation de l’expression de Foxp3 etait associee a un grade tumoral plus agressif et une differenciation tumorale atypique. En effet, les TV pTa bas grade n’exprimaient ni CD8 ni Foxp3. Quatre-vingt-trois pour cent des TV pT3-pT4 exprimaient Foxp3 et CD8 et les seules TV qui n’exprimaient pas Foxp3 etaient sarcomatoide ou micropapillaires. L’expression de foxp3 etait augmentee dans le tissu tumoral en comparaison avec le tissu non tumoral du meme patient. Conclusion Un profil immunosuppresseur, medie par Foxp3 dans le tissu tumoral semble exister chez les patients neurologiques ayant une TV agressive. Les lymphocytes T regulateurs exprimant Foxp3 pourraient representer de nouvelles cibles pour l’immunotherapie.

Focused ultrasound is now well known to urologists in the context of its validated application in extracorporeal lithotripsy. High Intensity Focused Ultrasound (HIFU) represents a potential therapeutic modality for tissue destruction due to its very high energy and its capacity to precisely reach a target with a very short emission time. The authors review the current state of art of HIFU in urology at a time when its indication in prostate cancer is being defined.After a brief description of the main physical principles of ultrasound and the main data determining focussing of high energy ultrasound, the main machines available (research and clinical) are described. The published clinical literature concerning the tissue destructive action in urology is reviewed.HIFU has been used in urology to treat renal, vesical, prostatic (BPH and cancer), and external genital organ lesions. Purely extracorporeal machines are gradually being replaced by intracorporeal procedures, especially transrectal techniques for prostatic lesions. The quality of ultrasound detection of the target still limits the use of this minimally invasive modality. The intervening tissues are spared with a good therapeutic efficacy on the target tissues, provided optimal firing parameters are used.HIFU has a demonstrated potential in the treatment of prostate cancer and studies conducted by several teams have defined the technique and its efficacy. Other indications have been studied, but must be validated by further clinical trials. The future will probably see the design of machines adapted to a specific target tissue rather than a single multidisciplinary extracorporeal machine.

Evaluation of the efficacy at 1 year of the Prostatron 2.5 in the treatment of BPH weighing more than 40 grams.46 patients over the age of 50 years presenting with BPH40 grams responsible for a maximum flow rate (MFR)9 ml/s and a mean IPSS score of 18 were prospectively included without randomization, by 5 French Urological Centres. These patients were reviewed at 3, 6 and 12 months. Primary endpoint: MFR; secondary endpoints: Madsen score and IPSS.No major complications were observed. The mean postoperative catheterization time was 10 days, causing discomfort with a mean score of 5 on a visual analogue scale from 0 to 10.. Maximum flow rate waas 13.4 ML/s at 3 months, 13.4 ml/s at 6 months and 14.7 ml/s at 12 months. The IPSS was improved by 75%.Treatment by Prostatron 2.5 improves the MFR and the patient's quality of life, which is maintained for at least 1 year after treatment.

Suburethral sling is a classical method of surgical repair of female stress urinary incontinence (SUI). Initially reserved for SUI due to sphincter incompetence, this method now appears to be indicated for other types of SUI. A large number of organic and synthetic materials have been used in published series. The long-term functional results reported in the literature vary between 65 and 98%, regardless of the materials used. Some of the complications observed are specific to the type of material. Synthetic slings appear to be associated with a higher complication rate. It is too early, based on data of the literature, to determine the real role of Prolene tape (TVT).

Diabetic neuropathy of can induce multi-organ dysfunction. The diabetes simultaneously has profound repercussions on gastrointestinal, sexual and erectile functions. One of the main sequelae of diabetic neuropathy is autonomic neuropathy affecting the vesicosphincteric control. The objective of this study was to review the epidemiological, clinical, laboratory and therapeutic data concerning voiding disorders observed in diabetes. Although the therapeutic management of an isolated voiding disorder in diabetics still remains symptomatic, it raises aetiological problems due to the comorbidity, particularly prostatic obstructive syndromes in men, pelvic dysfunction in women and ageing. Diabetic patients in renal failure also present specific vesicosphincteric disorders which are reviewed. Diabetic patients should be more systematically screened for the development of diabetic bladder disease, especially for associated factors which participate in its clinical expression. This implies extreme caution in the management of benign prostatic hyperplasia in the case of comorbidity, to avoid deteriorating a sometimes fragile detrusor-sphincter equilibrium. Diabetic detrusor hyperactivity must be better known in order to be more effectively detected. Pharmacological treatment of this condition raises problems related to detrusor hypocontractility also related to diabetic bladder disease. Clinical examination should be able to select those patients requiring further urodynamic studies in order to assess the individual detrusor-sphincter equilibrium. These investigations are required when surgical treatment of an associated urological or gynaecological disorder is considered.

The objective of this study was to assess the feasibitity, technical data and use of intrathecal catheter implantation with subcutaneous port for clonidine test injections and individual evaluation.According to approval of the local ethics committee, 9 consecutive SCI patients (6 men, 3 women) had catheter and port implantation between January 1998 and May 1999. All did not respond to systemic drug therapy in combination to self-clean intermittent catheterisation (SCIC). Implantation was done under general anesthesia. Needle and catheter were Medtronic Infusion Synchromed Intraspinal catheter (Induratrade mark, 8703W). Clonidine test injections were allowed at D5.There were no complications during operation. Follow-up was 8.2 months (0.5-17). After clonidine bolus injection test and validation, 6 patients decided to have permanent pump implantation, 2 chose other therapies and one did not tolerate clonidine intrathecal injections for blood arterial pressure side effects.Intrathecal clonidine may represent a useful conservative treatment of both severe bladder hyperreflexia and spinal spasticity. Its short-term effects can be individually evaluated through bolus injection in subcutaneous port before definitive pump implantation.

Surgical treatment, mainly transurethral resection of the prostate, still remains the reference treatment for benign prostatic hyperplasia (BPH). Two studies conducted in the Urology Department of the Pitié-Salpêtrière Hospital have tried to define certain characteristics of this surgery. The first study tried to evaluate the long-term outcome of patients operated for benign prostatic hyperplasia. Analysis of 881 replies to a questionnaire sent to 3,147 patients operated for BPH (between 1976 and 1989) assessed functional status (by Madsen's symptom score), quality of life (by Fowler's method), and sex life (by two specific questions), with a follow-up ranging from 5 to 14 years. At this follow-up, 90% of patients declared to be satisfied with their voiding status, 95% considered their quality of life to be excellent and about 50% had maintained a sex life. The second study was designed to evaluate the morbidity of this treatment in elderly patients. A group of 33 operated patients over the age of 80 was compared to a control group composed of 66 patients between the ages of 60 and 70 years, treated in a similar way, in the same centre and in the same year. Morbidity was higher in the first group, but age itself did not appear to constitute a poor prognostic factor for surgery; it only intervenes by allowing certain complications of benign prostatic hyperplasia (acute retention) to create emergency situations complicating the perioperative period. Following demonstration of the short-term and long-term efficacy of this conventional surgery, many new technologies were subsequently developed in order to reduce perioperative discomfort, anaesthetic requirements, duration of catheterization and hospital stay. Some of them constitute a new approach to endoscopic surgery, such as prostatic tissue vaporization techniques (electrovaporization, laser contact vaporization), which have a comparable efficacy to that of TURP, while reducing bleeding, catheterization time and hospital stay. However, the duration of postoperative irritative symptoms is much longer. Other techniques use a thermal effect to obtain coagulation necrosis of prostatic tissue, using various energy sources: microwaves (thermotherapy), laser (interstitial laser), radiofrequency waves (TUNA). These techniques are perfectly adapted to outpatient surgery with local or regional anaesthesia. They do not interfere with continence, sexual function, but may be followed by high dysuria or retention rates, with a variable cathererization time, sometimes several weeks. Finally, urethroprostatic stents are easy to insert, provide a solution in critical situations and have replaced old indwelling catheters. The current choice of treatment therefore comprises several approaches: more effective, but still purely symptomatic medical treatment, safe conventional surgery providing excellent long-term results, but generating a certain perioperative discomfort and a certain morbidity, or, on the contrary "minimally invasive" techniques, greatly simplifying the therapeutic procedure, but whose morbidity has not yet been determined and whose results are still uncertain.

Evaluation of the treatment of complicated ureteric stones in patients treated with indinavir.From March 1997 to May 1998, 10 patients (7 males, 3 females, aged 30 to 56 years), treated by triple combination therapy for HIV infection, were drained for stones attributed to indinavir (CRIXIVAN), which had become obstructive and complicated. The duration of treatment with indinavir ranged from 14 days to 2 years. No patient had a history of urological disease. One patient presented with bilateral stones. All patients presented complicated clinical features: fever in 3 cases; severe pain in 8 cases, with delayed excretion more than 4 hours on IVU in 6 cases. All stones were radiolucent except for one slightly radioopaque stone. The stone was situated in the lumbar ureter in 3 cases, iliac ureter in 1 case and pelvic ureter in 8 cases.In 10 out of 11 cases, a double J stent was inserted, preceded by drainage by simple ureteric catheter (infected urine) in 1 case and by percutaneous nephrostomy (PCN) with antegrade insertion of the stent (failure of the retrograde route) in 1 case. No complementary stone fragmentation or extraction treatment was necessary after this procedure. Stents were left in place for 3 to 7 weeks. In one case, a stone of the lumbar ureter required PCN followed by extracorporeal lithotripsy.In the case of complications requiring a urological procedure, insertion of a double J stent allows curative treatment of very friable indinavir stones, which are fragmented by passage of the stent.

For a long time, retransplanted patients were considered to be high-risk subjects, but a number of studies have shown that retransplantation can give good short-term results.Between October 1987 and February 1997, 51 retransplanted patients (Group 1) were compared with 96 patients (Group 2), matched for age, sex and date of transplantation, receiving a first kidney, with a mean age of 41 +/- 10 years and a mean follow-up of 44 +/- 32 months.The patient did not differ in terms of aetiology of the renal disease, mismatches and duration of dialysis before the first transplant and the duration of dialysis before the second transplant was 53 +/- 54 months. In Group 1, transplant loss was due to an immunological [34], surgical [8], or medical [3] cause, or due to recurrence of the disease [3] and discontinuation of treatment [5]. Hyperimmunized subjects were more numerous in Group 1: 21.4% vs 5.2% (p0.01). Immunosuppression only differed in terms of Cyclosporin: 65% for Group 1 vs 45% for Group 2 (p0.05). The two groups did not differ in terms of acute rejection (33% for Group 1 vs 48% for Group 2), serum creatinine at last review (140 +/- 51 +/- 65 m mol/l) and 5-year and 8-year patient (92 vs 82% and 92 vs 76%) and graft survival curves (85 vs 75% and 59 vs 61%).This study confirms that retransplantation can be successfully performed, even in terms of long-term results.

Resume La technique de l’electro-stimulation intravesicale a pour but d’obtenir une contraction vesicale mictionnelle par stimulation directe dans un objectif immediat de reeducation de la contraction vesicale. Son efficacite semble reelle et la neurourologie pediatrique est sans doute le domaine d’election de cette therapie. Sa diffusion reste restreinte devant le faible niveau de preuve d’efficacite et l’autosondage reste le traitement de choix de la retention chronique neurologique aujourd’hui encore en France.

Resume L’article traite des problemes particuliers lies a la prise en charge des prolapsus genitaux chez les patientes ayant une neuro-vessie. Parce que la litterature sur le sujet est particulierement pauvre, il nous a semble important de souligner les risques evolutifs dans ce cadre particulier.

An unusual case of spontaneous intraperitoneal rupture of the ureter was observed in adult with acute renal pain. Diagnosis was best established with CT rather than intravenous urography. CT demonstrated ureteral leakage with the contrast medium extravasating into the peritoneal cavity. The patient was initially managed successfully by endourology. Secondary stenosis of the ureter required surgery for partial resection of the distal ureter.

Laparoscopic surgery is one of the treatment modalities available to urologists, who must be familiar with the concepts of the physiology of CO2 and its clinical consequences. CO2 is absorbed during insufflation, leading to hypercapnia, reaching a steady-state from the 20th minute. The insufflation pressure must be between 10 and 14 mmHg. Intraoperative surveillance is based on oxygen saturation (pulse oximeter) and capnography, which measures the CO2 concentration of expired air. The causes of hypercapnia must be prevented: untimely recovery, retroperitoneal dissection, excessive intra-abdominal pressure. If hypercapnia occurs, the patient must be exsufflated and the operation should be resumed after a certain interval. The specific complications of laparoscopy (gas embolism, arrhythmias, pneumothorax) can be avoided by respecting the rules of security and by maintaining surveillance during recovery. The pain due to diaphragmatic peritoneal irritation can also be decreased by complete exsufflation.

Burch indirect colposuspension remains the reference surgical operation in the treatment of female urinary stress incontinence. The stability of the results is highly controversial and the causes of failure remain hypothetical. The objective of this study was to analyse the long-term results of this technique.100 women suffering from pure urinary stress incontinence, in whom a Burch indirect colposuspension was performed, were included in this study. These patients were reviewed with a mean follow-up of 5.2 years and a questionnaire designed to assess the results was sent to their homes.64% of patients no longer suffered from incontinence. Deterioration of the results was observed up to 5 years after the operation, but subsequently remained stable. The results were operator-independent. Low sphincter pressure (30 cm H2O), preoperative detrusor instability, insufficient hormonal impregnation and a history of pelvic surgery were the main factors predictive of failure of this technique.This study confirms the benefit provided by this technique in almost two-thirds of patients and indicates the risk factors of failure which must be taken into account before proposing Burch indirect colposuspension to a woman suffering from urinary stress incontinence.

In 80 to 90% of the cases of partial or complete rupture of the membranous urethra, early en-to-end urethroplasy is successful in re-establishing the urethra. Secondary or delayed treatment of urethral injuries is required in unsuccessful cases or when a surgical procedure cannot be performed within the first 10 days following injury as often occurs in polytrauma patients with fractured pelvis, pulmonary or cerebral contusions, or spinal fractures. Over the last 5 years, at the urology unit at the Pitié Hospital we have treated an equal number of patients immediately after injury and in procedures delayed for 4 to 6 weeks.

The authors report a case of haematuria secondary to ureteric varices due to a complex venous malformation. After excluding a neoplastic and infectious cause, this rare cause of haematuria must be considered in patients presenting with unilateral upper tract haematuria. In this case, the diagnosis was made during adulthood. It was suspected on intravenous urography and confirmed by computed tomography.

From October 1987 to June 1992, 359 renal transplantations were performed, while, over the same period, 25 patients with a follow-up of more than six months underwent repeat renal transplantation: 23 for a second transplant and 2 for a third transplant. The initial disease was glomerular for 17 patients and interstitial for 6 patients. The mean age of the patients at the time of the repeat transplantation was 36.9 years (range: 20 to 53 years). The mean survival after the first transplantation was 3 years and 10 months (range: 1 week to 10 years). The reasons for loss of the first transplant can be classified as follows: acute rejection (n = 5), chronic rejection (n = 14), surgical failure (n = 5) or sepsis (n = 1). 9 patients received conventional immunosuppressant therapy, while 16 patients (64%) received four-drug therapy including cyclosporin. The actuarial one-year survival of the patients and the transplants was 100% and 92%, respectively. The mean serum creatinine was 136.4 +/- 65 mumol/l (range: 59 to 298 mumol/l). Ten patients developed rejection after a mean of 18.6 days (range: 6 to 30 days) and 2 patients suffered from 2 episodes of rejection within 4 months. These results illustrate the low postoperative surgical and immunological complication rate in this group of patients whose long-term results are at least comparable to those of first transplantations in our group.

Urethral diverticulum in women is not a frequent disease. The diagnosis of this lesion is based on history and careful physical examination looking for a swelling on the anterior vaginal wall. A study of 15 cases is reported. The authors insist on investigations as a help to confirm and localise the diverticulum. A new technique of retrograde urethrography using a prehension cannula ("Bomelaer") is described. By this well tolerated and minimally invasive test, the visualisation of the urethral diverticulum was obtained in 14/15 patients. Associated with intravenous urography, it is certainly the most adapted strategy for diagnosis and management.

Localised amyloidosis of the urethra is an extremely rare condition and we report one case of induration of the corpus spongiosum. This one is painful and increasingly obstructive. The first differential diagnosis we think about was an inflammatory process or carcinoma. The diagnosis can only be done after biopsies and microscopic observation. Localized amyloidosis must be recognized and this lesion must be locally treated. Since 40 years, about 25 such cases were described.

We report a series of 13 infants with failed surgery for pyeloureteric junction (PUJ) obstruction. Failure was defined as the necessity for further surgery, either refashioning of the anastomosis or nephrectomy. These infants were part of a series of 306 with 322 PUJ. Of the 258 surgically treated infants, 232 (90%) had a post operative course without complication or need for reoperation. The failure rate was significantly higher in infants operated before the age of 4 months (8/65: 12.3%) when compared with those over 4 months of age (5/193: 2.59%). The use of postoperative drainage via a nephrostomy significantly reduced the percentage of early complications (e.g. fistula) but did not affect the final failure rate. The severity of the obstruction at presentation correlated with a bad outcome after reoperation. Of the cases which resulted in failure after reoperation (7/258: 2.7%) all occurred in cases of severe obstruction with parenchymal damage. While the failure of surgery is often evident early (persistant fistula, urinoma, non-functioning kidney on IVP) this may only become obvious some years later. Reoperations were successful in half the cases irrespective of the time between the initial operation and the reoperation. Long term follow-up of all infants operated for PUJ obstruction is recommended.

Introduction: This Prospective, multicentre clinical investigation sought to assess the feasibility and efficacy of the adjustable balloons ACT® for treatment of female Stress Urinary Incontinence SUI with ISD. Materials and Methods: The ACT® implant consists of a two-lumen conduit of variable length with an expandable silicone balloon (0.5–8 cc) on the proximal end and a distal subcutaneous titanium port. Two balloons were placed periurethrally at the bladder neck. Continence rate (no leakage during direct visual stress test with 250 ml placed in the bladder), improvement, failures, quality of life (I-QoL) and morbidity were assessed. Results: Sixty-seven patients (62 ± 9.8-years-old) were implanted in France during 75 procedures (8 revisions). Average follow-up was 12 months. At baseline, urethral closure pressure was 22.5 ± 10.8 cm H2Oand 39 patients (58%) had previously undergone at least one surgery for SUI. Continence increased from 0% at baseline to 57% at1 year and I-QoL improved from 39.4 ± 19 at baseline to 63.7 ± 23.3 at one year. Balloon adjustment was required in 64% of patients. Complications included erosion (11%), spontaneously resolved retention (2%) and infection (4%). Conclusion: ACT® offers a viable alternative for the treatment of SUI in female with ISD. The implantation is a minimally invasive and efficient procedure and stable over time therapy for patients with severe SUI with ISD. Implantation can be done under local anaesthesia. The positioning of ACT® treatment versus artificial urinary sphincter still needs to be determined.

Introduction: The study assessed the treatment of intrinsic sphincter deficiency with the ACT™ system in neurogenic patients. Material and methods: The ACT™ consists of two postoperatively adjustable silicone balloons placed paraurethrally in females and at the prostatic apex, or vesico-urethral anastomosis in males. Balloon titration is via tubing connected to a titanium port in the labia majora or scrotum. Efficacy assessment was based on technical feasibility and patient assessment of leakage and acceptance. Results: Eighteen implantations including three revisions were performed on 12 females and three males. Mean age was 51.9 years, mean follow-up was 18 (8–40) months with a mean neurogenic history of 15 years (1 to 54). Aetiology of neurogenic disease was mixed and included degenerative; spinal cord injury; oncological, vascular and congenital disorders with most patients self catheterising and using either anticholinergics and/ or Botox or had previously undergone enterocystoplasty. Procedure was performed using local (72%), general (5.5%) or no anaesthesia (22%). At follow up, seven patients were dry and pad free(46%), six improved (not requesting any further adjustment)(40%), two failed. 8/30 devices were explanted in five patients due to erosion (six), device failure (one) and treatment failure (one). 3/5 have been reimplanted, with 1/5 planned for reimplantation. Of these three patients, two were dry and one significantly improved. No major complication has been described. Conclusion: ACT balloons may be considered for treatment of ISD in neurogenic patients provided that patients are informed of the increased risk of erosion, and the possibility of secondary implantation.

Introduction: This study assessed the feasibility and efficacy of ProACT™ for treatment of postprostatectomy incontinence. Material and methods: Using fluoroscopic control two percutaneous balloons are placed at the vesico-urethral anastomosis (Prostatectomy; Ablatherm) or the apex (TURP) and filled with isotonic solution. Postoperatively, 1 ml can be titrated monthly until optimum continence is achieved. Results: Fifty-eight patients were implanted, 52 postcancer treatment (51 Radical Prostatectomy with 11/51 postradiotherapy and 1/52 Ablatherm) and six following benign surgery (four TURP and two other prostatectomies). Mean age was 70.8 years old (56.6–87.2) with time since initial surgery 5.3 years (6 months–20.6 years). Prior surgical incontinence treatments included artificial urinary sphincters (eight), bulking agent injections (three) and male sling (one). Mean urethral closure pressure (n = 36) was 49 cm of H2O at baseline. Average pads/day was 2.9 (1 to 10). Mean quality of life (I-QoL) was 45 (2–85). At median follow-up (14 months), 11 patients (19%) were dry, 21 (36%) improved, 17 (29 %) unchanged; 2 (3.4%) worse and seven (12%) had undergone explanation. Quality of Life increased to 61 (17–100). Of the 24 postradical prostatectomy patients without radiotherapy, 92 % are improved, 38 % being completely dry. However six (55%) of postradiotherapy patients failed. Sixteen patients required explanation due to infection (two); urinary retention (one); urethral erosion (one); pain (one), defective balloons (two); other (one) non-response (eight). Four patients were successfully re-implanted. Conclusion: ProACT is an effective treatment option as an alternative to the artificial urinary sphincter.