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Resume Un depistage precoce et une prise en charge adaptee des troubles urinaires lies a la sclerose en plaques (SEP) doivent en reduire la morbidite. Une enquete transversale a ete conduite afin d’evaluer la frequence et la severite des troubles vesico-sphincteriens lies a la SEP dans une population non selectionnee et suivie en milieu neurologique aussi bien en ville qu’a l’hopital. Cent vingt-cinq patients SEP dont 44,7 % evoluaient depuis moins de 10 ans (77,6 % de femmes, âge moyen 44,4 ± 13,0 ans) ont repondu a un auto-questionnaire. Quatre-vingt-neuf patients (79,2 %) presentaient des troubles urinaires dont 42 (33,6 %) des troubles urinaires severes. Parmi les 99 patients presentant des troubles urinaires, 10,1 %, 24,2 % et 65,7 % se plaignaient respectivement de dysurie isolee, d’urgenturies/fuites isolees ou des 2 symptomes. 26,8 % des patients avec troubles urinaires ont eu des infections urinaires ayant necessite la prise d’antibiotiques (contre 4 % chez ceux sans trouble urinaire), avec un nombre moyen de 2,7 ± 2,7 infections urinaires au cours des 12 derniers mois. Seuls un quart (23,8 %) des patients ayant un trouble urinaire severe declaraient etre suivis par un specialiste, urologue ou medecin de medecine physique et de readaptation (MPR). Une majorite des patients (73,7 %) aurait aime connaitre le lien possible entre leurs troubles urinaires et leur pathologie (SEP). De nombreux patients (20,6 %) ont exprime le souhait d’avoir de l’aide pour gerer leurs problemes urinaires, notamment en cas de troubles severes (35,7 % des cas). Cette etude a permis de confirmer que les troubles urinaires sont frequents chez les patients SEP, sous-estimes et pas totalement pris en charge. Ces patients sont en demande d’information sur les symptomes et en recherche d’aide sur la prise en charge. En reponse, il nous a semble important d’informer les patients sur la frequence de la relation entre SEP et troubles urinaires, d’evaluer ces derniers regulierement avec un questionnaire specifique et de mettre en place une prise en charge adaptee selon un algorithme decisionnel bien defini en integrant le suivi par un specialiste en neuro-urologie.

The aim of this study is to evaluate the success of the test phase of sacral neuromodulation in management of chronic non-obstructive urinary retention and the factors predictive of good response.This is a retrospective study carried out on a cohort of patients followed up in a tertiary University Hospital in France. Fifty-two patients with chronic non-obstructive urinary retention were included in this study. These patients were seen over the past 20 years, from the year 2000 to 2020. The initial evaluation of patients included a summary of medical and surgical history, age, BMI, history of pelvic floor disorders, initial voiding pattern, physical examination, voiding diary, initial uroflowmetry and a urodynamic study. Postoperative follow-up and analysis of complications were also carried out.A total of 52 patients were included in this study, 13 males and 39 females. Out of these patients, 17 patients (32.7%) with a median age of 47.3 years±18.1 benefited from definitive implantation of the sacral neuromodulation. The univariate analysis showed that age was the only significant variable in this study and the optimal age threshold was58.5 years.SNM is a therapy with significant clinical benefits and low morbidity for patients with chronic non-obstructive urinary retention. The results obtained need to be confirmed with a prospective study with a larger number of patients.

Resume Objectif Analyser la morbidite de la pratique des autodilatations (AD) quotidiennes chez les patients operes d’une prostatectomie totale, appareilles par sphincter urinaire artificiel (SUA) pour incontinence urinaire (IU) et qui ont presente une recidive d’une stenose de l’anastomose vesico-uretrale (SAVU) traitee par voie endoscopique. Materiel et methodes Cent trente-huit patients appareilles par SUA pour IU entre 1998 et 2007 ont ete divises en deux groupes. Trente-cinq ont pratique des AD pour SAVU recidivante (groupe AD) et 103 patients n’ont pas realise d’AD (groupe sans AD). Ces deux groupes ont ete compares pour le taux d’explantation (erosion-infection), de revisions (atrophie uretrale et defaillance mecanique) et les resultats fonctionnels a 2 ans. L’analyse statistique en uni- et multivariee a pris en consideration les facteurs de confusions tels que l’âge et l’antecedent de radiotherapie. L’evaluation fonctionnelle a ete faite par les questionnaires valides IQoL, Ditrovie et MHU. Resultats Les patients des deux groupes etaient comparables sauf pour l’importance de l’incontinence urinaire evaluee par PAD test et les questionnaires. Le taux d’explantation etait significativement plus eleve dans le groupe « AD » ( 20,0 % (5,6–32,2) vs 4,85 % (0,30–11,5)) et , p = 0,008). Il n’a pas ete constate de difference significative entre les deux groupes pour le taux de revision chirurgicale (32 % vs 20 %, OR = 0,44, p = 0,09). Les resultats fonctionnels a deux ans ne montraient pas de difference significative. Conclusions La pratique des autodilatations pour recidive de stenose d’une anastomose vesico-uretrale postprostatectomie expose les patients appareilles par un SUA a un taux d’explantation plus eleve. Niveau de preuve 3.

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Holmium laser enucleation of the prostate (HoLEP) is a proven surgical technique for the treatment of benign prostatic hyperplasia (BPH). However, its challenging learning curve prevents its widespread adoption by urologists. The aim of this study was to analyse the learning curve of HoLEP and to determine the factors accelerating it.This was a retrospective, monocentric cohort study of the first 60 cases of HoLEP performed by three operators. The primary outcome measure was operative efficiency, defined as the ratio of preoperative prostate volume estimated by trans-abdominal ultrasound (TAUS)to total surgical time in minutes. The studied learning curve parameters included the number of previously performed cases (NPPCs) and monthly case density (CD) (number of monthly performed cases before the studied one).Overall, 180 patients with a mean age of 71 (±9) years and a mean prostate volume (g) of 80.4 (±41) were included. The mean operative efficiency in the population was 0.74 (±0.37) g/min. Operative efficiency was increased in patients who had been operated on by surgeons with a CD ≥3 (CD ≤2: 0.66 (±0.27) g/min vs. CD ≥3: 0.79 (±0.43) g/min; P=0.012). At 3months, 46 patients (29%) developed stress urinary incontinence (SUI). Early SUI was significantly decreased in patients who had been operated on by surgeons with a CD ≥3 (CD ≤2: 37%, (n=26) vs CD ≥3: 22%, (n=20); P=0.045).A high frequency HoLEP procedures, set as one case per week, appeared to accelerate learning curves by improving operative efficiency. A high CD was also associated with reduced rates of early SUI.5.

The management of bladder pain syndrome (BPS) in our center is standardized although there is no real consensus and recommendations. The objectives of our study were to assess the effectiveness of the treatment offered and to identify predictive factors of response to treatment.Single-center retrospective study including all patients with BPS. Patient and outcome measures included ICSI and ICPI scores, daytime voiding interval (DVI), nocturnal pollakiuria (NPK), and subjective satisfaction (SS). The complete care protocol (CCP) was based on a hydrodistension test followed by a cimetidine treatment then by 6 instillations of dimethyl sulfoxide followed by a maintenance treatment with pentosan polysulfate. The main objective of our study was the patient's SS at 3months and at medium term. One of the secondary objectives was to study the predictive factors of response to treatment.From 2002 to 2019, 211 patients (90.5% women) were treated for BPS. Sixty-nine patients (35%) underwent the CCP that provided significant improvement in ICSI, ICPI, DVI and NPK and SS of 52.2%.). In the medium term, 149 patients were reassessed with a median follow-up of 99.6months (±3.6): 71.8% were satisfied and 54.2% were no longer receiving treatment. Among the 49 patients who initially received PSC, 74% were satisfied at 89.8 months of median follow-up (±2.9). In multivariate analysis, patients with a pain perception disorder (HR=0.17 IC95=0.05-0.52; P=0.002) or consuming anxiolytics (HR=0.3; IC95=0.13-0.69; P=0.004) had a statistically greater risk of not being satisfied.In our study, the CCP achieves subjective medium-term satisfaction in nearly 75% of patients with BPS. These data deserve to be confirmed on a larger scale in a prospective protocol.

Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.

Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence.The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day.Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group.AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings.4.

Trans-vaginal tape has become the gold standard for the cure of urinary stress incontinence, but post-operative voiding dysfunction is frequently reported. The purpose of this study is to assess the incidence of voiding dysfunction, dysuria, chronic urinary retention, and necessity of reoperation after retropubic TVT placement under local anaesthesia and sedation.We perform a retrospective study of a cohort of patient treated with the placement of a retropubic TVT under local anaesthesia and sedation between 1999 and 2019 for a SUI. Post-operative voiding dysfunction and necessity of reoperation were reviewed to access the principal aim of this study.Three hundred and two patients who met the eligibility criteria were included in the study. At 3 months, the dysuria rate and chronic urinary retention rate was 4.3% and 1%. At 12 months it was 2.6% and 0.3% respectively. The 12-month sling section rate was 1% and long-term self-catherization rate was 0.3%. The objective cure rate was 93% and subjective cure was 92%.TVT placement under local anaesthesia and sedation resulted in few voiding dysfunctions at medium/long-term, necessity of re-operation for refractory obstructive disorder and well functional results. Even if these results support more frequent use of this type of anaesthesia, it would be interesting to be able to follow them in a prospective study to conclude.4.

Study question What is the outcome of testicular sperm extraction (TESE) after microinjection of frozen–thawed sperm and the correlation with histological analysis in azoospermic patients? Summary answer In our cohort of 240 azoospermic patients, sperm could be retrieved in 167 patients (69.6%). What is known already Testicular biopsy is a crucial assessment in reproductive practice with diagnostic and prognostic importance for ICSI. Divers histological procedures are used throughout the centres. There is increasing need to accurately analyse histological biopsies in order to characterise different type of spermatogenic failure and allows data storage of value in clinical practice and research. Compared with Bouin’s and formalin, glutaraldehyde fixed and semithin section of testicular biopsies have the advantage of yielding not only good cellular morphology but also it allows the possibility of performing electron microscopy. Study design, size, duration This is a monocentric retrospective study of TESE practice in azoospermic patients in Strasbourg University Hospital from February 2011 to December 2019. Participants/materials, setting, methods A total of 240 azoospermic patients underwent TESE followed by sperm cryopreservation when sperm were present and data of histological analysis and clinical outcome of ICSI were analysed. The analysis include initial hormonal status, type of azoospermia, body max index, classification of histological findings, freezing rate and outcome of ICSI-IVF procedure. Main results and the role of chance The mean age of 240 patients was 34.5 years. Out of all patients, 42% were diagnosed with obstructive azoospermia (OA) and 58% patients with non-obstructive azoospermia (NOA). There was no correlation of sperm retrieval with the body mass index. Overall, sperm could be retrieved in 69.6% patients. Spermatozoa were always successfully recovered in patients with normal testicular histological findings, 41.7% patients (n 100). Histological analysis revealed a Sertoli cell-only (SCO) syndrome in 27.5% cases (n 66), hypospermatogenesis in 14.2% (n 34), germ cell arrest in 7.9 (n 19) and mixed pattern in 8.3% (n 20). In patients with serum FSH concentrations >12 IU/l, 46% of patients (n 42) sperm were present at TESE. In patients with no sperm retrieval, 31.5% had normal FSH levels. Out of all men with elevated FSH, 63% had SCO pattern, 4% germ cell arrest, 21% hypospermatogenesis and 12% mixt patterns. In the group of patients with no sperm retrieved at TESE, histological analysis showed SCO in 69.9% cases, germ cell arrest in 15% and hypospermatogenesis in 9.6% of cases. Out of 167 patients with TESE and sperm cryopreservation, 126 patients undergone ICSI-IVF procedure and 80 babies were born. Limitations, reasons for caution This study is a retrospective analysis in a single centre. The cohort was not compared with groups of patients with different histological and fixation techniques. Wider implications of the findings: Accurate histological diagnosis is a prerequisite for research and clinical data collection and open the possibilities to include patients with NOA in subsequent detailed genetic screen. Trial registration number NA

Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population.We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively.Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence.In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.

To analyze the morbidity of the practice of daily self-dilatation (SD) in patients undergoing total prostatectomy, who have had artificial urinary sphincter (AUS) for urinary incontinence (UI) and who have had a recurrence of endoscopically treated vesicourethral anastomosis (VUS) stenosis.One hundred and thirty-eight patients with SUA for urinary incontinence (UI) fitted between 1998 and 2007 were divided into two groups. Thirty-five patients have had used self-dilatation (SD) for recurrent anastomotic stenosis (SD group) and 103 patients did not perform SD (non-SD group). These two groups were compared for explantation rate (erosion-infection), revision rate (urethral atrophy and mechanical failure) and 2-year functional results. The uni- and multivariate statistical analysis taken into consideration confounding factors such as age and radiotherapy history. The functional assessment was done by the validated IQoL, Ditrovie and MHU tests.Patients in both groups were comparable except for the importance of urinary incontinence assessed by PAD test and questionnaires. The explantation rate was significantly higher in the "SD" group (28.5% vs 7.77%) and (OR=4.68, 95% CI [1.490-15.257], P=0.006). There was no significant difference between the two groups in the surgical revision rate (32% vs 20%, OR=0.44, P=0.09). The functional results at two years did not show any significant difference.The use of self-dilation for recurrence of stenosis of vesicourethral anastomosis after prostatectomy exposes patients fitted with an SUA to a higher explantation rate.3.

The intravesical instillation of dimethyl sulfoxide (iDMSO), performed without anesthestic, is a therapeutic option for the painful bladder syndrome/interstial cystitis (PBS/IC). Some patients are against those iDMSO because of bad tolerance. Our study evaluates the tolerance and the outcome of the iDMSO under general anesthetic (GA) after the failure of the iDMSO without anesthetic.From May 2013 to April 2016, 11 patients with a PBS, 9 women (81.8 %), have been treated by iDMSO without anesthetic, without improvement because of bad tolerance and no possibility to have a one hour contact between the bladder and the DMSO. The 11 patients were evaluated by mictional calendar and Sant O'Leary score. All the patients had a hydrodistension and a per os treatment without improvement.Six new iDMSO were performed under general anesthetic in ambulatory surgery with good tolerance for the 11 patients. The frequency and the nocturia before iDMSO without anesthetic and after iDMSO under general anesthetic were 32.2minutes [15; 60] and 6.3 per night [3; 10] and 126.9minutes [25; 240] and 3 per night [2; 6], so a variation respectively of 96.4minutes [0; 180] and of 3.75 per night [2; 6]. The symptom score and the problem index were 17.5 [13; 20] and 15.5 [13; 16] before and 13.5 [4; 20] and 12 [1; 16] after iDMSO under general anesthetic; a variation of 3.2 [0; 9] and 4 [0; 12].The iDMSO under general anesthetic seems to improve objectively and subjectively the patients who are not improved by the instillations without anesthetic because of bad tolerance.4.

Resume Objectifs Evaluer la morbidite et les suites fonctionnelles des cystectomies laparoscopiques avec derivation urinaire non continente chez les sujets neurologiques. Materiels Entre aout 2007 et octobre 2013 42 patients ayant une vessie neurologique ont eu une cystectomie laparoscopique suivie d’une courte laparotomie pour extraire la piece et faire une ureterostomie cutanee transileale. Leurs dossiers ont ete revus pour preciser l’indication et decrire les suites operatoires et fonctionnelles. Une evaluation telephonique des patients par l’echelle PGI-I qui porte sur l’amelioration de la qualite de vie urinaire ressentie par le patient ainsi que de leurs medecins traitants a ete realisee pour apprecier le resultat fonctionnel. Resultats L’indication a concerne 42 patients dont 18 avaient une sclerose en plaques, 9 sujets avaient une vessie neurologique post-traumatique, 5 avaient une vessie hyperactive, 2 avaient une incontinence mixte, 1 avait une maladie de Devic, 1 avait une incontinence d’effort, 1 avait un lichen vulvaire, 1 avait une maladie de Laurence Moon Biedle Bardet, 1 avait une neuropathie carentielle responsable d’une paraplegie spastique, 1 avait une vessie radique, 1 avait une spina bifida, 1 avait une vessie retentioniste. Sur les 42, 10 operes (23,81 %) ont recu moins d’un culot globulaire (1–7). Le taux global de complications precoces etait de 35,71 %. Le taux de complications tardives etait de 52,38 %. La mediane de la duree d’hospitalisation etait de 16 jours (9–70). Le recul median etait de 34 mois (1–76). La mediane du PGI-I etait de 2 (1–6). Tous les medecins traitants ont decrit une meilleure situation fonctionnelle. Conclusion La cystectomie avec derivation urinaire chez le patient neurologique reste une intervention chirurgicale exposee a un risque de complications post-operatoires non negligeable meme quand le temps de cystectomie est fait par voie laparoscopique. La balance benefice/risque doit donc bien etre evaluee individuellement avant de poser chaque indication. Niveau de preuve 5.

Resume La lithotritie extracorporelle (LEC) est un traitement de la lithiase urinaire par fragmentation grâce aux ondes de choc. Le principe de la LEC sera decrit ainsi que la fabrication, la diffusion et la focalisation des ondes de choc. Les moyens de reperage des calculs, les modes d’anesthesie ainsi que le deroulement d’une seance seront rappeles avec les contre-indications et le prerequis avant une seance. Les parametres influencant l’efficacite de la LEC seront ensuite exposes. Enfin, les complications, les resultats et les indications de la lEC seront passes en revue.

Resume But Evaluer la faisabilite, l’efficacite et la morbidite de l’implantation par laparoscopie de sphincter artificiel urinaire (SAU) chez des femmes ayant une incontinence urinaire d’effort (IUE) severe. Patientes et methodes Vingt-six patientes avec IUE ont ete appareillees par un SAU AMS 800™ (American medical Systems, Inc., Minnetonka, Minnesota) par laparoscopie entre octobre 2007 et janvier 2012. Dix-huit primo-implantations et huit changements complets pour probleme mecanique d’un SAU deja en place ont ete realisees. Dans trois cas, une promontofixation a ete associee. En moyenne, l’âge etait de 64 ans, l’indice de masse corporelle de 27,8 kg/m 2 , et la pression de cloture uretrale maximale (PCMU) de 26,75 cm H 2 O. La plupart des patientes (88 %) avaient des antecedents de chirurgie pelvienne ou de l’incontinence. L’etude etait retrospective avec analyse des parametres operatoires, de la survenue de complications et des resultats fonctionnels. Resultats Trois conversions en laparotomie et cinq plaies vesicales peroperatoires ont ete notees. En moyenne la duree operatoire etait de 149 minutes, la sonde vesicale etait retiree a j 3,8 et la duree de sejour postoperatoire etait de cinq jours. Les complications postoperatoires precoces etaient huit retentions aigues d’urines transitoires, deux migrations de pompe et une plaie vaginale meconnue. A distance, nous rapportons une erosion vaginale. Ces deux dernieres patientes ont ete explantees. Le suivi moyen etait de 20 mois. Seize patientes avaient une continence totale, cinq une continence sociale et trois portaient plus d’une protection quotidienne. Discussion Nos resultats ont confirme ceux deja publies sur la laparoscopie. L’abord mini-invasif a eu les memes resultats que la laparotomie classique, avec une courbe d’apprentissage courte. Conclusion L’implantation d’un SAU par laparoscopie chez des femmes avec une IUE severe a ete faisable et efficace.

Resume Introduction Les protheses uretrales prostatiques sont utilisees dans l’HBP dans des indications diverses mais limitees. Les buts de cet article sont de faire le point sur ces protheses et de rechercher les raisons d’une desaffection actuelle pour ces protheses. Methodes Recherche dans la litterature a partir des mots cles uretral stent OU prostatic stent OU metallic stent OU spiral stent ET BPH. Les differents types de protheses seront presentees avec leurs taux d’echec, les scores IPSS ou de Madsen, le debit urinaire maximal, le residu post-mictionnel et leurs complications. Resultat et analyse Les differentes protheses ont des taux d’echec variant de 0 a 40 % mais avec souvent des suivis courts depassant rarement 12 a 36 mois. Les complications sont dominees par les migrations avec necessite de les repositionner et les incrustations pour tous les types de protheses et par les douleurs et les irritations vesicales, les obstructions par hyperplasie tissulaire et les difficultes de retrait pour les protheses grillagees. Les raisons de la desaffection actuelle sont dominees par ces complications et le fait que la population concernee soit limitee. Conclusion Les protheses uretrales prostatiques occupent une place limitee dans la prise en charge de l’HBP. Seuls deux modeles de protheses temporaires sont encore disponibles en France en 2013. Les complications des protheses grillagees definitives et le faible nombre de patients pour lesquels elles sont indiquees expliquent cette situation.

Resume Introduction La colique nephretique chez la femme enceinte est une situation specifique qui necessite une bonne collaboration entre obstetricien et urologue. Methode Etude de la litterature concernant les differents aspects de la colique nephretique chez la femme enceinte. Les mots cles etaient grossesse et colique nephretique. Des mises au point sur l’epidemiologie, la physiopathologie, la clinique, le bilan d’imagerie et la prise en charge de la colique nephretique en cours de grossesse ont ete realisees. Resultat et analyse L’incidence de la lithiase urinaire chez la femme enceinte est equivalente a ce qui est observe chez la femme non gravide malgre des facteurs favorisants que sont l’hydronephrose et l’hypercalciurie. La presentation clinique en cours de grossesse est dominee par la douleur. Le bilan d’imagerie repose en premiere intention sur l’echographie. En cas de doute diagnostique ou de complication, le scanner a sa place apres avoir etabli un rapport benefice–risque favorable, en collaboration avec les obstetriciens. En l’absence d’evacuation du calcul sous l’effet du traitement medical ou en cas de complications, le drainage de la voie urinaire par sonde ureterale double J ou nephrostomie permettra d’attendre l’accouchement pour traiter specifiquement un calcul toujours en place. Conclusion La prise en charge d’une colique nephretique chez une femme enceinte implique le gynecologue et l’urologue avec des conduites a tenir relativement codifiees. La mere et le fœtus seront consideres en mesurant continuellement le benefice pour la mere et le risque de l’enfant a venir.

El sindrome de dolor vesical/cistitis intersticial (SDV/CI) o bladder pain syndrome/interstitial cystitis (BPS/IC) es un diagnostico clinico definido por la European Society for Study of Interstitial Cystitis (ESSIC), en el que un dolor vesical y/o pelvico va asociado con otros sintomas urinarios, como la miccion urgente y la polaquiuria. Inicialmente se llamo «cistitis intersticial», pero desde 2008 se prefiere «SDV/CI».

El sindrome de dolor vesical/cistitis intersticial (SDV/CI) es un diagnostico clinico que asocia manifestaciones dolorosas de la vejiga o la pelvis y sintomas urinarios tales como miccion urgente y polaquiuria. La fisiopatologia aun es imprecisa, pero una hipotesis actualmente aceptada es que el SDV/CI estaria relacionado con otros sindromes dolorosos como el colon irritable, la fibromialgia y el sindrome de fatiga cronica. En este articulo se hara hincapie en las modificaciones terminologicas recientes, los sintomas de sospecha de la enfermedad, las pruebas complementarias y los posibles tratamientos, ademas de un algoritmo terapeutico a modo de ejemplo.

Introduction Les mini-bandelettes sous-uretrales (BSU) sont encore en evaluation dans l’incontinence urinaire d’effort (IUE) feminine.

Ce report fait le point sur les nouveautes dans le domaine du syndrome de la douleur vesicale (SDV)-cystite interstitielle (CI) et met en valeur les connaissances actuelles qui sont necessaires au clinicien qui prend en charge le diagnostic et le traitement du SDV. Nous esperons ainsi procurer aux equipes medicales une mise au point leur permettant de suivre les nouveautes dans ce domaine.

La cystite interstitielle/syndrome de la vessie douloureuse est une pathologie qui reste meconnue du monde medical. Cette revue de la litterature met en valeur les connaissances actuelles et les nouveautes qui sont necessaires au clinicien qui prend en charge le diagnostic et le traitement de la cystite interstitielle. Nous esperons ainsi procurer aux praticiens une mise au point leur permettant de mieux gerer cette pathologie.

La incontinencia urinaria es una complicacion frecuente de la prostatectomia total que puede aparecer secundariamente a una afectacion esfinteriana, una disfuncion vesical o a la asociacion de ambos. En la literatura se observan incidencias variables, pero las ultimas publicaciones presentan un indice de menos del 10% de incontinencias definitivas tras una prostatectomia total. Se intenta disminuir este porcentaje mediante los constantes progresos de la tecnica quirurgica. No existe una definicion tipo de la incontinencia urinaria, pero en lugar de hacer apreciaciones subjetivas habra que evaluarla mediante cuestionarios validados y pruebas objetivas. Puesto que la incontinencia urinaria repercute sobre la actividad, las relaciones afectivas y la autoestima de los pacientes, es necesario evaluar la calidad de vida. Sobre todo durante los meses inmediatamente posteriores a la prostatectomia total, el tratamiento puede ser conservador, basado en la expectativa, el uso de productos absorbentes o no absorbentes, modificaciones de los habitos de vida, prescripcion de medicamentos y reeducacion funcional perineal. Si al cabo de un plazo aproximado de un ano no se obtiene una recuperacion suficiente, se debe pasar al tratamiento quirurgico: inyecciones peri o intrauretrales (entre ellas las de terapia celular, que se anuncian prometedoras), bandas suburetrales, balones periuretrales o esfinter urinario artificial. La indicacion terapeutica dependera de la clinica, el estudio complementario y la demanda y las expectativas del paciente.