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Bladder outlet obstruction alters detrusor contractility, reducing the bladder's ability to respond to large filling with a risk of urinary retention. The objective was to assess the effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction.A prospective multicenter study in two pelviperineology departments. Male patients eligible for urodynamics (IPSS score 7) were included from January to July 2022. In case of absence of bladder outlet obstruction on pressure-flow studies, they were secondarily excluded. The primary endpoint was the maximum isometric detrusor pressure during a stop-test, corresponding to detrusor contractility, measured at 3 filling volumes (50%, 75%, and 100% of cystometric capacity).Fifty-two patients performed urodynamics, of whom 12 were excluded because of lack of obstruction or inability to perform the stop-test. Detrusor contractility was significantly higher for a 75% bladder filling than 50% and for a 75% filling than 100%, with a mean difference of 19.5; confidence interval (CI) 95% [14.3; 24.8] and 12.2; CI 95% [6.9; 17.5] cmHIn case of bladder outlet obstruction in men, detrusor contractility depends on bladder filling volume, with reduced contractility when the bladder was underfilled or overfilled. This phenomenon could help to explain the mechanisms of urinary retention in men with bladder outlet obstruction.

Retrospective cohort study.Bowel and anorectal dysfunctions are common in patients with multiple sclerosis (pwMS). The use of validated questionnaires is recommended in the initial assessment and patient's follow-up. The Neurogenic Bowel Dysfunction (NBD) score is the most used questionnaire but has been developed in spinal cord injured patients and has never been validated in other neurological diseases. We aimed to assess NBD's relevance in pwMS.Monocentric study in a tertiary neuro-urology department.A retrospective study in pwMS consulting for the first time in our department, that fulfilled the NBD questionnaire between 2010 and 2021 was performed. Qualitative and quantitative answers for each question were analyzed. Content validity and internal consistency were evaluated.One hundred thirty-five pwMS (mean age 47.1, 58% of women) fulfilled the NBD questionnaire. Mean NBD score was 6.0 (SD 6.1) and 75% of patients had a score9. Content validity analysis revealed 4 items not appropriate, 1 item with irrelevant calibration, and omission of some treatment widely used in pwMS. Internal consistency was appreciated with Cronbach's alpha = 0.48 IC 95% [0.31; 0.6].NBD questionnaire lacks content validity and presents a weak internal consistency in pwMS. A specific questionnaire is therefore required in pwMS to optimize bowel management and follow-up.

Background Lower urinary tract Symptoms (LUTS) and Sexual dysfunction (SD) are common in women with MS and affect quality of life. Aim The aim of this study was to determine the relationship between sexual dysfunction (SD) and overactive bladder in women with Multiple Sclerosis (MS). Methods From January 2019 to January 2021, we evaluated 89 female MS patients admitted for LUTS in a Neuro-Urology Department. SD was investigated using the Female Sexual Function Index (FSFI). All subjects completed the Urinary Symptom Profile scale (USP) and Hospital Anxiety and Depression Scale (HAD A/HAD D). Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS). All patients underwent neurological examination and urodynamic studies. Univariate analysis and Multivariate logistic regression analysis were performed to identify predictors of SD in women with MS (FSFI Outcomes Primary outcome was to determine the association between sexual dysfunction in women with MS and LUTS (overactive bladder, stress incontinence or voiding dysfunction). Results Sexual dysfunction (FSFI Clinical implications Sexual disorders in women with MS should be assessed as much as urinary disorder. Strengths and limitations this study included the largest cohort of women with MS. But the sample was obtained in an outpatient setting with low neurological impairment. Conclusion In our study, SD was frequent affecting young women with no anticholinergic treatment and low physical impairment. Overactive bladder seemed to be independent predictor of sexual dysfunction. Conversely, SD was not associated with detrusor overactivity, neurological impairment, or duration of disease but was strongly associated with depression.

Neurogenic lower urinary tract dysfunction (NLUTD) is frequent in multiple sclerosis (MS) and renal prognosis is a key point of bladder management.To assess upper urinary tract damage risk using voiding cystourethrography (VCUG) in patients with (PwMS) and NLUTD.We conducted a retrospective study between 2010 and 2020. Demographic data, urinary symptoms, urinary tract infection (UTI), renal ultrasounds findings, glomerular filtration rate (GFR), VCUG data, and urodynamic parameters were collected in PwMS with NLUTD.Among 325 PwMS included, 67% were female, mean age was 51.6 ± 12.0 years, and mean EDSS 4.6 ± 1.8. VCUG showed vesicoureteral reflux (VUR) in 18 patients. A link was found between VUR and progressive MS course (p = 0.04), hydronephrosis (odds ratio [OR] = 17.44; 95% confidence interval [CI] = 3.46-87.87; p = 0.001), low GFR (p 0.001), and detrusor overactivity (p = 0.04). No association with UTIs, EDSS, detrusor sphincter dyssynergia, were elicited. On multivariate analysis, alteration of GFR was independently related to the presence of VUR (OR = 0.95; 95% CI = 0.92-0.98).VUR elicited on VCUG is associated with lower GFR and hydronephrosis. However, due to the low prevalence (5.5%) of this abnormality in PwMS, VCUG should be performed in selected cases and not in routinary practice.

Resume Introduction L’activite sexuelle se definit en plusieurs phases (excitation, plateau, resolution) associees a des modifications cardiovasculaires, respiratoires, musculaires et hormonales, pouvant avoir une influence sur le systeme nerveux. Cet impact a ete beaucoup decrit dans la litterature par de nombreuses etudes de cas, mais peu d’etudes ont synthetise les complications liees au coit ou a l’orgasme. Methode Revue systematique de la litterature sur les complications neurologiques hors cephalees du coit a partir des bases Medline et Embase. Resultats Nous avons screene 1424 articles et selectionne 46 pour cette revue. 7 (15 %) etaient des etudes cliniques ou epidemiologiques, 6 (13 %) des revues de la litterature et 33 (72 %) etaient des etudes de cas multiples ou uniques. 12 articles (26 %) avaient pour sujet des accidents vasculaires cerebraux ischemiques, 10 (22 %) des hemorragies sous arachnoidiennes, 9 (20 %) des syndromes de vasoconstrictions reversibles, les hematomes intraparenchymateux et les crises d’epilepsie etaient representes par 4 (9 %) articles chacun, 3 (7 %) articles traitaient d’hypereflexies autonomes. Nous avons inclus qu’un article pour la cataplexie, les lesions medullaires, l’ictus amnesique et les radiculalgies. Ces evenements restent tout de meme rares car les urgences en lien avec l’activite sexuelle ne representent que 0,1 % des passages, et seulement 12 % d’entre elles sont d’ordre neurologique. Sur les 31 cas de pathologies vasculaires (accidents vasculaires cerebraux, hemorragies sous arachnoidiennes) decrites, 18 (58 %) avaient une malformation sous-jacente (anevrysme, shunt intracardiaque, foramen ovale perfore). Conclusion Il s’agit d’une des premieres revues de la litterature essayant de synthetiser les complications neurologiques possibles de l’activite sexuelle. De nombreux articles existent dans la litterature. Il est necessaire de prevenir l’apparition de ces complications dans des populations a risque.

Aims To measure the time required to perform clean intermittent self-catheterization (CISC) in daily life and to assess its impact on adherence and quality of life. Methods Patients performing CISC for more than 1 month were invited to participate. At home, patients were asked to complete a 1-day diary to assess the specific duration of the CISC (time from when the equipment and environment are brought together to perform CISC) and the next day to complete a second diary for the total duration of the CISC (starting when the patient intent to self-catheterize to the return to the initial activity, including the displacement, and gathering the required device). Adherence, difficulties with CISC, and quality of life were measured with validated questionnaires: Intermittent Catheterization Satisfaction Questionnaire, Intermittent Catheterization Difficulty Questionnaire, Intermittent Catheterization Adherence Scale, and SF Qualiveen Questionnaire. Results Thirty-six patients agreed to participate but only 25 patients completed the entire protocol. The participants performed CISC for an average of 7 years. The median specific duration of CISC was 2 min and 23 s (ranging from 47'' to 11'50''). The median total duration of CISC was 3 min and 40 s (1'35''; 18'47''). No significant correlation was found between the duration of CISC and patient characteristics, adherence, difficulty to self-catheterize, or quality of life. Conclusion The time to perform CISC was brief, and less than 2-3 min on average. The impact on adherence and quality of life should be assessed in a larger cohort.

Aim The COVID‐19 pandemic led to limit patients’ visits to the neuro‐urology department. Telemedicine was seen as a pragmatic solution to provide follow‐up care. This study aimed to assess the efficiency and satisfaction of a telephone consultation in neuro‐urology. Methods During the pandemic, the scheduled medical visits were converted into telephone consultation. For each teleconsultation, the physician assessed the efficiency and the patient‐rated global satisfaction of the teleconsultation. The physician and the patient assessed whether this teleconsultation replaced a physical visit. Results About 358 neurologic patients were included in the study. The mean efficiency of the telephone consultation was 9.3/10 (±1.5). The mean global satisfaction was 9.0/10 (±1.3). The majority of the patients (52.4%) would prefer a physical consultation. 90.2% might convert some clinic visits to teleconsultations in the future. No agreement was found between the patient and the physician when they were asked if the teleconsultation replaced the physical consultation initially scheduled (weight kappa = 0.02; 95% confidence interval = [−0.06 to 0.11]). Cognitive impairment, difficulty to obtain relevant information, and lack of physical examination were unfavorable to the efficiency of the teleconsultation. Cognitive impairment, embarrassing nature of the teleconsultation, and preference for a physical consultation were unfavorable to satisfaction of the patient. Conclusion Telemedicine in neuro‐urology was associated with a high satisfaction of the patients and was described as efficient by the physicians. Despite this, the majority of the patients reported a preference for physical consultation. The COVID‐19 pandemic might be an opportunity to refine our practices in neuro‐urology and to develop telemedicine.

Background/Aims External anal sphincter (EAS) plays an important role in fecal and gas voluntary continence. Like every muscle, it can be affected by repeated efforts due to fatigability (physiological response) and/or fatigue (pathological response). No standardized fatiguing protocol and measure method to assess EAS fatigability has existed. The aim is to test a simple, standardized protocol for fatiguing and measuring EAS fatigability and fatigue to understand better the part of EAS fatigability in the pathophysiology of fecal incontinence. Methods Patients with anorectal disorders evaluated with anorectal manometry were included. They had to perform 10 repetitions of maximum voluntary contraction (MVC) of 20 seconds. Measurement was made with an anorectal manometry catheter and a surface recording electromyography (EMG). The primary outcome was the difference in EMG root mean square between the first and the last MVC. Secondary outcomes were differences in other EMG and manometry parameters between the first and the last MVC. Difficulties and adverse effects were recorded. Results Nineteen patients underwent the fatiguing protocol. All patients completed the entire protocol and no complications were found. No difficulty was declared by the examiner. A significant decrease in root mean square was found between the first and last MVC (0.01020 ± 0.00834 mV vs 0.00661 ± 0.00587 mV; P = 0.002), in maximum anal pressure area under the curve of continuous recordings of anal pressure and mean and total EMG power (P < 0.05). Conclusions This protocol is simple and minimally invasive to measure EAS fatigue and fatigability. We highlighted a fatigue of EAS in many patients with anorectal disorders.

Resume Introduction Les troubles sexuels chez la patiente neurologique ont peu ete evalues en pratique quotidienne, en particulier, les troubles de l’orgasme. La prevalence semblait multipliee par deux chez les patientes medullaires comparativement a la population generale (Sipski, 2001). Objectifs Analyser la prevalence, la typologie et l’impact des troubles de l’orgasme chez les patientes neurologiques (accident vasculaire cerebral [AVC] [50 %], sclerose en plaques [SEP] [>65 %], maladie de Parkinson idiopathique [MPI], blessees medullaires [BM] [>50 %] et neuropathies peripheriques [NP]). Methode Revue systematique de la litterature a partir de Medline via l’outil Pubmed et The Cochrane Database of Systematic Review (Cochrane library). Resultats Les dysorgasmies feminines ont peu ete etudiees au cours des maladies neurologiques. Il s’agissait d’etudes pour la plupart retrospectives, realisees sur de petits effectifs. Elles s’appuyaient sur des donnees cliniques a base de questionnaires generalistes etudiant la fonction sexuelle parfois associees a une exploration neuroperineale. SEP et BM ont ete les deux populations les plus etudiees. La prevalence des troubles de l’orgasme etait importante (plus de 1/3 des patientes), souvent associes a d’autres troubles sexuels (alteration de la libido) et a des troubles urinaires et anorectaux. Les lesions medullaires completes et l’atteinte de l’arc reflexe sacre avaient un impact negatif sur ces troubles et sur la qualite de vie sexuelle (p Conclusion L’evaluation specifique des troubles sexuels et en particulier des troubles de l’orgasme chez les patientes neurologiques semblait importante dans la prise en charge globale du handicap pelviperineal afin d’ameliorer la qualite de vie de ces patientes. L’education therapeutique et des therapies sexuelles ciblees paraissaient indiquees dans le traitement de ces troubles.

AIMS The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population. METHODS Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. RESULTS The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P

Resume Introduction L’evaluation des traitements en pelvi perineologie s’est beaucoup modifiee au cours des dernieres annees. Initialement centree sur l’evaluation des symptomes, de la qualite de vie ou de la satisfaction des patients, celle ci s’est progressivement tournee vers de nouveaux concepts, tels que les Patient Reported Outcome (ou resultats rapportes par les patients) (PRO) et le Goal Attainment (GA), soit l’atteinte des objectifs. Objectif Decrire les differents concepts et methodes d’evaluation disponibles, au cours des dernieres annees, dans le cadre des pathologies fonctionnelles, en pelvi perineologie. Methodes Nous avons realise une revue de litterature, afin d’identifier les principaux questionnaires et outils disponibles pour evaluer les resultats des traitements. Ont ete exclus les questionnaires valides en cancerologie et en pediatrie. Resultats En pathologie fonctionnelle (hyperactivite vesicale ou incontinence), l’objectif du traitement est de repondre aux attentes des patients et il est capital de pouvoir evaluer le ressenti des patients. Dans ce contexte, de nouveaux questionnaires specifiques ont ete developpes afin d’evaluer les PRO. Depuis une dizaine d’annees, ces criteres subjectifs, sont de plus en plus repandus dans l’evaluation des traitements. Un nouveau domaine est ensuite apparu, a savoir le Goal Attainment Scaling (GAS) et le Self assessement Goal Attainment (SAGA), permettant de determiner avec le patient, les objectifs attendus du traitement. Conclusion Ces concepts de PRO et GAS ouvrent un nouveau domaine dans l’evaluation des traitements, avec une vue subjective sur les resultats. Ils meritent d’etre integres aux evaluations habituelles, objectives, afin d’adapter la prise en charge des patients, en fonction de l’impact reel du traitement.

Assessment of motor and cognitive functions is recommended before clean intermittent catheterization training. Two validated instruments, the Functional Independence Measure (FIM) and the Pencil and Paper Test (PP-Test), are associated with the ability to learn self-catheterization in people with multiple sclerosis.We aimed to compare the performance of these tools in predicting the outcome of clean intermittent catheterization training in multiple sclerosis.All people with multiple sclerosis attending a tertiary neuro-urology department between 2011 and 2019 and eligible for clean intermittent catheterization were included in this retrospective study. The reference standard was the ability to perform at least 2 trials of self-catheterization at the end of the training session. The 2 index tests, the FIM and PP-Test, were administered before the teaching session. Their diagnostic performance was estimated by calculating sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The AUC values were compared by a two-sided DeLong test.We included 395 individuals (mean [SD] age 49.8 [12] years; 70% women). At the end of the session, 87% of the patients succeeded in learning self-catheterization. The optimal cut-offs for the FIM (107) and PP-Test (13) were estimated, resulting in sensitivity of 73% (95% confidence interval [68-77) and 73% (67-77) and specificity 73% (59-84) and 63% (49-76), respectively. The AUC values for the FIM and PP-Test were significantly different (0.79 vs 0.73, p = 0.049). The effect size was large for both the FIM (Cohen's d = 1.14) and PP-Test (Cohen's d = 0.87).An FIM value ≥107 has the best specificity to predict outcome after clean intermittent catheterization training for people with multiple sclerosis. The sensitivity of the FIM and PP-Test is similar, and both have a large effect size for the outcome of self-catheterization training in multiple sclerosis.

International audience; BackgroundLower urinary tract symptoms (LUTSs), especially overactive bladder, are frequent in people with multiple sclerosis (PwMS). Urinary urgency and urge urinary incontinence could lead to precipitation and thus could increase the risk of falling in these individuals.ObjectiveWe aimed to assess the association between severity of LUTSs and risk of falling in PwMS.MethodsPwMS with LUTSs were recruited in a neuro-urology department. Participants were asked about the number of falls in the past 3 months and their circumstances. Severity of LUTSs was assessed by the Urinary Symptoms Profile (USP) score, and individuals were classified as with or without urinary incontinence.ResultsThis cross-sectional study included 154 patients (69% women); the mean (SD) age was 50.1 (11.5) years and median EDSS was 5 (interquartile range 3–6). Overall, 20 (13%) patients reported one fall during the past 3 months, and 43 (28%) reported at least 2 falls. Only 9 (6%) patients reported a fall on the way to the toilet, 6 during a urinary urgency. No link was found between falls and urinary incontinence (P = 0.71), type or severity of urinary symptoms (overactivity, voiding dysfunction or stress incontinence, P > 0.05). Falls on the way to the bathroom was associated with high USP score related to overactive bladder (P = 0.03) and severe nocturia (> 2 nocturnal micturitions) (P < 0.01). Falling at night was also associated with severe nocturia (P < 0.001).ConclusionsThe severity of LUTSs and presence of urinary incontinence do not appear related to the risk of falling in PwMS and urinary disorders but rather to the specific risk of falling on the way to the bathroom. Severe nocturia increases the risk of falling at night. Further studies are needed to assess the impact of LUTS treatment on the risk of falling. ClinicalTrials.gov (NCT04338646).

Objective: Prostate cancer is the most frequent cancer in men and radical retropubic prostatectomy (RRP) is one of the first-line treatment. However, RRP has some side effects and can lead to chronic perineal pain. The objective of the study was to determine in patients suffering from perineal pain after RRP the possibility of a neurogenic damage by means of a specific questionnaire dedicated to track down neuropathic pain. Methods: Forty patients were explored by a specific and validated questionnaire, the Neuropathic Pain Symptom Inventory (NPSI). Patients were divided into two groups: Group A with an NSPI score ≥4 was considered as suffering from neuropathic pain, and Group B was considered as a control group without neuropathic pain (NSPI score

Resume Introduction Les troubles vesico-sphincteriens (TVS) sont frequents dans la sclerose en plaques (SEP), largement domines par l’hyperactivite vesicale (HAV). Pour autant, leur origine n’est pas forcement univoque. L’obesite, frequente dans la SEP, est reconnue comme facteur de risque d’incontinence urinaire a l’effort (IUE) et d’HAV dans la population generale. Nous avons voulu evaluer l’influence de l’indice de masse corporelle (IMC) sur les troubles urinaires de la SEP. Materiels et methodes Nous avons realise une etude retrospective monocentrique chez 260 sujets classes en 4 groupes: insuffisance ponderale, poids normal, surpoids, obesite. Les TVS ont ete evalues grâce au questionnaire USP. Des comparaisons de moyennes (test de Mann–Whitney) ont ete effectuees entre ces groupes, dans la population globale puis en fonction du sexe. Resultats Chez la femme, le score HAV moyen etait plus eleve chez l’obese, 10,27 (SD = 4,5) qu’en cas de poids normal, 7,96 (SD = 4,58), p = 0,024. Le score IUE etait plus faible en cas de poids normal, 1,69 (SD = 2,38) qu’en cas de surpoids, 3,19 (SD = 2,91), p = 0,002 et d’obesite, 3,80 (SD = 3,23), p = 0,0005. Comme retrouve dans la population globale, le score dysurie etait plus eleve chez les sujets ayant un poids normal, 4,09 (SD = 3,33) que chez les sujets presentant un surpoids, 1,91 (SD = 2,03), p = 0,0003 ainsi que chez les sujets obeses, 2,33 (SD = 2,37), p = 0,013. Les memes comparaisons effectuees chez l’homme n’etaient pas significatives. Conclusion Dans cette serie de patients affectes d’une SEP, un IMC eleve etait associe a des scores de symptomes USP plus eleves (IUE et HAV) pour les femmes. Niveau de preuve 4.

Resume Objectif Les autosondages intermittents (ASI) sont le traitement de reference de la retention urinaire chronique. En regle generale bien toleres, ils sont parfois compliques de douleurs uretrales lors de l’insertion ou du retrait du catheter, penalisant ainsi adherence au traitement. L’objectif de cette etude etait de determiner la proportion de patients ayant des douleurs lors de la realisation de l’ASI et en verifier l’impact en termes d’adherence. Methodes Etude retrospective, avec evaluation objective des douleurs lors de l’ASI, un mois apres leur apprentissage. Donnees recueillies par les scores ICDQ (difficultes aux ASI), InCaSaQ (satisfaction aux ASI) et ICAS (compliance et adherence aux ASI). Resultats Sur 77 patients inclus, 28 (36 %) ressentaient une douleur lors de l’ASI. En analyse univariee, une douleur a l’ASI etait correlee a une mauvaise adhesion a la realisation du geste (p 25 kg/m2 semblait etre un facteur protecteur vis-a-vis de ces douleurs (OR 0,31 (IC 95 % 0,31–0,99) p = 0,04). Conclusion Dans cette serie, les douleurs uretrales etaient correlees a une mauvaise adhesion a l’ASI et le sexe feminin semblait etre un facteur aggravant des douleurs. Niveau de preuve 4.

Resume Introduction Le present article constitue le rapport de la reunion de travail multi-disciplinaire organisee par le GRAPPPA (groupe de recherche appliquee a la pathologie pelvi-perineale des personnes âgees). L’objectif est de dresser une synthese de l’utilisation de la toxine botulinique A (TBA) dans la prise en charge des troubles pelvi-perineaux du sujet âge. Methodes Le present article a ete construit comme une revue comprehensive de la litterature, associant donnees issues de la litterature scientifique et avis d’experts. La revue systematique de la litterature a ete menee a partir de la base de donnees bibliographique MedLine (National Library of Medicine). Concernant les injections intra-detrusoriennes de TBA, seuls les articles rapportant des resultats specifiques chez les sujets âges (> 65 ans) etaient inclus. Concernant les autres localisations, compte-tenu du nombre restreint de donnees, tous les articles rapportant les resultats de la TBA etaient systematiquement inclus, quelle que soient la population etudiee. En cas de donnees manquantes ou insuffisantes, des avis d’expert etaient formules. Resultats Bien que les donnees issues de cette population specifique soient limitees, il semble que la TBA pourrait etre proposee chez le sujet âge sans critere de fragilite dans la prise en charge de l’HAV, avec taux de succes comparable aux patients jeunes a 3 mois (88,9 % vs 91,2 %), 6 mois (49,4 % vs 52,1 %) et 12 mois (23,1 % vs 22,3 %), et une diminution significative du nombre de mictions quotidiennes (11,4 vs 5,29 p Conclusion La TBA presente un interet dans la prise en charge de divers troubles pelvi-perineaux du sujet âge, et ses differentes applications devraient etre mieux evaluees au sein de cette population specifique tant en termes de securite que d’efficacite.

Resume Introduction Si aujourd’hui la prise en charge de l’incontinence urinaire (IU) est bien codifiee, il n’existe aucune precision concernant la place ou la strategie d’utilisation des protections quelle que soit l’etiologie de l’incontinence ou le terrain. Methodes Nous avons effectue une recherche a partir de la base de donnees PubMed a partir des mots cles suivants : (urinary incontinence[MeSH Terms]) AND absorbent pad[MeSH Terms] permettant d’isoler 362 articles. Resultats De nombreux design de protections sont disponibles en vente libre sans prescription medicale et sans remboursement en France. Pour l’IU legere, les serviettes hygieniques sont le design qui semble etre le plus adapte chez la femme compare aux protections menstruelles OR = 0,27 [0,14, 0,52], aux protections avec serviettes hygieniques lavables integrees OR = 0,12 [0,06, 0,26] ou aux serviettes hygieniques lavables OR = 0,05 [0,02, 0,26]. Pour l’IU moderee a severe, il n’existe pas de « meilleur produit universel ». Les preferences varient entre les deux sexes et l’utilisation d’un panel de protections semble le plus adapte. La femme comme l’homme preferent la couche culotte aux serviettes hygieniques OR = 0,41 [0,20, 0,87] et OR = 0,39 [0,22, 0,68]. Au total, 70 % des hommes ont une preference pour les etuis peniens en comparaison aux protections habituellement utilisees (p = 0,02). L’utilisation des protections permet d’ameliorer l’independance dans les activites du quotidien OR = 0,102 [0,046, 0,158] et la qualite de vie liee a l’IU OR = 4,40 [1,74, 7,07] en comparaison aux patients n’utilisant pas de protections. Malgre cela, leur usage doit rester prudent en raison des potentielles complications infectieuses urinaires, plus frequentes en particulier en milieu institutionnel, avec 41 % des utilisateurs developpant au moins une infection urinaire sur une periode d’evaluation de 12 mois vs 11 % des non-utilisateurs (p = 0,001) ou immuno-allergiques avec notamment la « dermatite associee a l’incontinence » dont la prevalence peut atteindre un taux de 50 %. Conclusion Les analyses comparatives precises de benefices-risques, des couts economiques, de satisfaction manquent. Il est necessaire de poursuivre le developpement de ces produits et de comparer plus precisement leurs caracteristiques intrinseques, afin d’orienter au mieux les patients dans leurs choix.

Introduction Multiple sclerosis (MS) is often associated with urological disorders, mainly urinary incontinence and retention, the management of which being necessary to improve patient's quality of life (QOL) and to reduce potential urological complications. Besides the classical treatments based mainly on anticholinergics and/or self-catheterization, several neuromodulation techniques have been tried in recent years to improve these urinary disorders. By this review, we aim at providing an overview of neuromodulation and electrostimulation approaches to manage urinary symptoms in MS patients. Materials and methods A literature search using MEDLINE was performed. Only papers in English, and describing the effects of neuromodulation in MS patients, were considered. Results A total of 18 studies met inclusion criteria and were reviewed. Of them, four related to sacral neuromodulation (SNM), seven to percutaneous tibial nerve stimulation (PTNS), six to spinal cord stimulation (SCS), and one to transcranial magnetic stimulation (TMS). Discussion PTNS and SNM seem to be effective and safe therapeutic options for treating lower urinary tract symptoms in MS patients principally in case of overactive bladder (OAB) symptoms. Similarly, also SCS and TMS have been shown to be effective, despite the very limited number of patients and the small number of studies found in the literature. Interestingly, these techniques are effective even in patients who do not respond well to conservative therapies, such as anticholinergics. Furthermore, given their safety and efficacy, stimulations such as PTNS could be considered as a first-line treatment for OAB in MS patients, also considering that they are often preferred by patients to other commonly used treatments.

While the prevalence of chronic constipation and fecal incontinence increases with age, few data on transanal irrigation in older adults are available. The aim of this study was to assess the adherence and predictive factors for adherence to transanal irrigation during the first year of use in older adults. This retrospective study included all patients over 65 years old, who had therapeutic education for transanal irrigation with the Peristeen® device between January 2010 and July 2019 in a neuro–urology department of a university hospital in France. The adherence rate was assessed at 1, 3, 6, and 12 months. Predictive factors for adherence were looked for by comparing persistent population and non-persistent population at 1, 3, 6, and 12 months. Sixty-nine patients over 65 years old were included. The adherence rate was 73.9% at 1 month, 55.1% at 3 months, 46.4% at 6 months, and 40.1% at 1 year. No predictive factor for adherence to transanal irrigation was identified. Adherence to transanal irrigation during the first year in older adults remains close to that in the adult general population. Predictive factors of adherence remain unclear.

Summary Purpose The aim of this study was to describe verbal instructions used to obtain a voluntary pelvic floor muscle contraction and to evaluate their understanding and acceptability. Methods This prospective study led in two phases. A questionnaire was submitted to experts to collect the most frequently used instructions to obtain a PFMC. Then a questionnaire was submitted to subjects in order to: estimate the pelvic floor anatomical knowledge; estimate understanding and acceptability of these instructions; select the best instruction. Results First phase: 46 experts proposed 356 instructions. Forty-four percent were functional instructions (“hold a gas”), 40% anatomical (“squeeze your anus”) and 16% allied both. Fifteen instructions for the women and 11 for the men were selected. Second phase: 33 subjects completed the questionnaire. More than 75% had correct answers for anatomical knowledge. The instructions judged by the subjects as the most adapted to obtain a PFMC were: “contract the anus”, “do as if you wanted to hold a strong desire to void”. The items including “perineum” or “vagina” were less understood. Conclusions The more understandable and acceptable instruction to assess the PFMC is the association of two simple instructions: one anatomical and one functional. Level of evidence 4.

Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown as there are no clear established guidelines. To a better understanding, we performed a systematic review to characterize the different types of FI (active, passive, or mixed) on the basis of clinical presentation and complementary explorations. This systematic literature review was performed in reference to recommendations for systematic review using PRISMA guidelines without date restriction, until May 2020. This systematic review was performed without temporal limitation using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases. Six hundred nine unique citations were identified from all the databases combined. Of those, 21 studies met the inclusion criteria, with 8 retrospective observational studies and 13 prospective observational studies. There was a lack of homogeneity in definitions of passive and urge (active) FI among studies. Prevalence of passive and urge FI was respectively of 4.0–5.0 and 15.0–35.0%. Clinical characteristics, physical examination, and endoanal imaging were not evaluated in most studies. In anorectal manometry, maximal squeeze pressure was higher in passive FI subgroup in most studies and results regarding maximal resting pressure remain discordant. There seemed to be no difference regarding first sensation volume and maximal tolerable volume among subgroups. A few studies evaluated pudendal terminal nerve motor latency with no difference among subgroups. There is a lack of well-conducted prospective studies comparing the different subtypes of FI with validated definitions in both clinical and paraclinical examinations.

Introduction The anal tone allows the maintenance of anorectal continence. Its regulation depends on spinal segmental mechanisms under supra-sacral control. Material and methods A systematic review was performed using Medline database, according to PRISMA methodology, using following keywords anal tone ; anal sphincter ; anorectal function ; reflex ; digital rectal examination. Results Anal hypertonia is an increase in the muscle's resistance to passive stretching. Muscular hypotonia is a decrease in muscle tone. It is associated with a decrease in resistance to passive mobilization. It is not possible to quantify the prevalence of anal tone alterations in the general population and in specific pathological conditions (urinary disorders, neurogenic or non-neurogenic anorectal disorders). In case of hypotonia, most often due to a lower motor neuron lesion, fecal incontinence may occur. Hypertonia (anal sphincter overactivity) is not always due to perineal spasticity. Indeed, in the majority of the cases, the cause of this anal hypertonia in a neurologic context, can be secondary to an upper motor neuron disease due to spinal or encephalic lesion, leading to recto-anal dyssynergia, giving distal constipation. In another way, this anal hypertonia can be purely behavioral, with no direct pathological significance. The evaluation of anal tone is clinical with validated scores but whose sensitivity is not absolute, and instrumental with, on the one hand, the measurement of anal pressure in manometry and, on the other hand, electrophysiological testing which still require validation in this indication. Conclusion Anal tone assessment is of interest in clinical practice because it gives diagnostic arguments for the neurological lesion and its level, in the presence of urinary or anorectal symptoms.

Resume Objectifs Les potentiels evoques somesthesiques corticaux (PES) sont habituellement utilises pour tester l’integrite des voies lemniscales et donner ainsi des arguments en faveur de l’etiologie neurogene de symptomes sensoriels. Ainsi, les PES par stimulation perineale (PES-P), ont ete demontres alteres dans l’incontinence ou les troubles sexuels neurogenes. Nous avons voulu verifier integrite, structuration et amplitude des reponses en champ lointain des PES-P dans deux conditions, la premiere sans sensation de besoin d’uriner (B0), la seconde avec besoin imperieux (BI). Methodes Les PES-P ont ete enregistres chez dix patients sans pathologie neurologique dans les deux conditions B0 et BI apres stimulation du nerf dorsal du penis/clitoris. Trois reponses consecutives moyennees chacune sur 1000 passages a une frequence 3 Hz ont ete enregistrees. Resultats Sept hommes, 3 femmes, d’âge moyen 53,8, (sd 16,8) ont ete inclus. Tous les patients avaient des PES-P normaux en termes d’amplitude et de latence du complexe P40 et totalement reproductibles notamment pour les reponses tardives. Ces reponses precoces P40 etaient identiques dans les deux etats BO et BI. Inversement, les potentiels de champ lointain, c’est-a-dire, les reponses tardives, etaient differentes dans les deux etats, avec une importante diminution des amplitudes moyennes et maximales des reponses corticales dans l’etat BI (p Conclusion Nous avons observe que les composantes tardives des PES-P sont alterees lors du besoin urgent d’uriner accompagne d’une attention soutenue et selective sur ce besoin. Ces composantes tardives du PES-P pourraient etre utiles pour mieux specifier les mecanismes attentionnels impliques dans le cycle continence-miction et pour preciser les dysfonctionnements sensoriels pathologiques (urgence, vessie douloureuse, frequence…). Niveau de preuve 4.

AIMS The aim of this study was to define the prevalence of comorbidities among multiple sclerosis patients with lower urinary tract symptoms. METHODS A retrospective study of data collected prospectively from January 2000 to March 2016 was carried out using a database. Comorbidities were divided into several classes according to the International Classification of Diseases (ICD-10). RESULTS One hundred and fifty-five patients were included. All had a neurogenic bladder with 150 (96%) overactive bladder. EDSS score was≥6 in 44 patients (28%). Comorbidities were present in 79 (50,9%) and the most frequent ones were cardiovascular (14,2%), endocrinological (10,3%), urological (8,4%), abdominal (7,7%). Overweight (BMI≥25) was observed in 63 (40%). A strict relationship was found for BMI and stress urinary incontinence (P

Objective To assess the reproducibility of detrusor activity cystometric pattern in multiple sclerosis (MS) patients, which is poorly documented in the medical literature, by means of successive filling. Methods We conducted a prospective study in MS patients; cystometry was repeated twice at 5minutes of interval if a detrusor overactivity before 300mL of filling was observed. Thus, 3 successive cystometries were analysed. The following characteristics were recorded: detrusor maximum pressure (Pmax), volume at the first involuntary detrusor contraction (IDC), maximum cystometric capacity (MCC), pressure at the first IDC, the existence of an overactive detrusor classified as phasic or terminal. Results We included 31 patients (19 women and 12 men); only 6 patients were naive-treatment, the mean EDSS was: 5.3 (±1.6) and the mean age was 48.4 (±12.5) years. All the patients had an overactive detrusor for each cystometry. The reproducibility was good for all the parameters (range ICC between 0.7 and 0.83). Conclusion Quantitative and qualitative cystometric data have a good reproducibility in MS patients with detrusor overactivity before 300mL of filling. Level of proof 3.

Summary Introduction To examine patient preferences and perceptions regarding physician dress code in a neuro-urology department. Material A questionnaire presenting with different physician dress codes was submitted to patients in a neuro-urology department: casual outfit with white coat, scrubs and scrubs with white coat. Respondents selected their ideal dress code and mentioned if any dress code shock them. Respondents’ general opinions regarding physician attire, its importance and relation with patient satisfaction were collected. Results 163 questionnaires were completed. The three physician attires were chosen equally by the respondents. 71.4% of the respondents felt comfortable with the three attires. When an attire appeared to be offending, the casual attire with white coat was mentioned in 68.2%. 52.5% of the patients reported that the way their doctor dressed was important to them. 36.3% of respondents reported that physician attire influenced how confident they felt about the care they received. Male respondents preferred scrubs with white coat (44.0%) while female respondents preferred casual attire with white coat (42.0%), P = 0.02. Neither the age, nor the reason of the consult, the knowledge of the department, the presence of neurological disease, the occupational category and the education level of the patient had an influence on the preference for one specific physician attire. Conclusion Physician attire in neuro-urology may influence the way that patients perceive care. Physicians must not be restricted to one particular attire in neuro-urology department. However since almost 20% of the patients feel uncomfortable with the casual attire and white coat, it should be avoided. Level of evidence 4.

Summary Aims Beside motor control alteration and tremor, the main symptoms in Parkinsonian disorders, lower urinary tract dysfunction is very common and thus often associated with gait disorder. No studies have assessed their association yet. The aim of this study was to assess the effect of the need to void on walking speed in this particular population. The secondary aim was to assess the effect of desire to void in a double task condition on the walking speed, and on the time to raise up from the floor. Methods This prospective study included all Parkinsonian disorders who had a follow-up for overactive bladder (OAB). We invited them to drink until a desire to void or equivalent (DV), then they performed three ten-meters walk tests, one double-task ten-meters walk test, one timed-up-and-go test (TUG), one timed raise of the floor (GMT). We repeated the same tests just after bladder emptying. Results Nine men and two women (age 69 ± 6) were included in the study (seven Parkinson's Diseases, two multisystem atrophies, two not yet characterized). Mean scores of UPDRS-III were 17 ± 6.5, Hoehn & Yahr scale were 1.9 ± 0.7, time since onset 7 ± 4.4 years, levodopa daily equivalent 691 ± 478 mg. Patients performed the walking tests at DV with a mean bladder volume from 220 ± 189 mL. The mean speed was 1 m/s at DV and 1.1 m/s at PV (P Conclusion In Parkinsonian disorders, need to void may impact the walking speed, a strong desire to void worsening gait velocity. Level of evidence 4.

Objective To analyze and quantify sacral spinal excitability through bulbocavernosus reflex (BCR) stimulus-response curves. Methods Thirty subjects with upper motor neuron lesions (UMN) and nine controls were included in this prospective, monocentric study. Sacral spinal excitability was assessed using stimulus-response curves of the BCR, modeled at different bladder filling volumes relative to the desire to void (as defined by the International Continence Society) during a cystometry. Variations in α (i.e. the slope of the stimulus-response curve) were considered as an indicator of the modulation of sacral spinal excitability. Results In all subjects, α increased during bladder filling suggesting the modulation of spinal sacral excitability during the filling phase. This increase was over 30% in 96.7% of neurological subjects and 88.9% of controls. The increase was higher before the first sensation to void in the neurological population (163.15%), compared to controls, (29.91%), p Conclusions We showed the possibility of using BCR stimulus-response curves to characterize sacral spinal response with an amplification of this response during bladder filling as well as a difference in this response amplification in patients with UMN in comparison with a control group. Significance BCR, through stimulus-response curves, might be an indicator of pelvic-perineal exaggerated reflex response and possibly a tool for evaluating treatment effectiveness.

Resume Introduction La demence a corps de Lewy (DCL) est un syndrome parkinsonien, dont nous savons qu’il est pourvoyeur de troubles urinaires et particulierement d’un syndrome clinique d’hyperactivite vesicale. La typologie des troubles neuro-perineaux specifiques a la DCL a ete peu decrite dans la litterature, nous avons donc realise une etude retrospective descriptive de ces troubles. Methode Etude retrospective monocentrique. Resultats Dix-neuf patients ayant un diagnostic confirme de DCL ont ete retrouves, (63 % d’hommes, 74 ans d’âge moyen). Le symptome principal etait le syndrome clinique d’hyperactivite vesicale (100 % des patients) avec une incontinence urinaire sur urgenturie tres frequente (94 %), sous-tendue par une hyperactivite du detrusor (93 %) a haut-regime de pression intra-vesicale (79 %). La dysurie etait retrouvee a l’interrogatoire chez 16 % des patients, et chez 53 % en urodynamique. Au total, 92 % des patients se plaignaient d’une constipation, et notamment 44 % de troubles de la continence aux matieres. Discussion Sur le plan urinaire, le symptome le plus frequemment decrit est l’incontinence sur urgenturie. Nous avons egalement retrouve dans une moindre mesure une dysurie, parfois associee a une pathologie prostatique. Sur le plan topographique, ces symptomes pourraient s’expliquer par des depots d’alpha-synucleine dans le cortex fronto-temporal et le pont. L’association aux troubles ano-rectaux et genito-sexuels est frequente. Le risque uro-nephrologique etant faible dans cette population, l’importance du depistage est plutot lie a l’alteration de la qualite de vie. Conclusion Le symptome urinaire le plus frequent dans la DCL est le syndrome clinique d’hyperactivite vesicale sous-tendu par une hyperactivite detrusorienne et dans une moindre mesure la dysurie avec possible participation organique (hypertrophie prostatique). Niveau de preuve 3.

Resume Le syndrome de Wolfram est un trouble neurodegeneratif rare, caracterise par un diabete sucre, une atrophie du nerf optique, un diabete insipide, une deficience auditive, une atteinte du tronc cerebral et generalement un dysfonctionnement de la vessie et des intestins. Objectif Nous rapportons ici 6 nouveaux cas de troubles urinaires observes au cours de cette maladie orpheline. Resultats Tous les patients avaient une retention d’urine, accompagnee d’une hyperactivite vesicale. Le bilan urodynamique retrouvait une hyperactivite du detrusor dans 3 cas. Cinq patients sur 6 realisaient des autosondages urinaires et etaient traites par anticholinergiques ou injection intradetrusorienne de toxine botulique. Le suivi a 5 ans retrouve une alteration du haut appareil et une insuffisance renale 3/6. Conclusion L’atteinte vesicale est frequente au cours du syndrome de Wolfram, essentiellement caracterisee par une hyperactivite vesicale et une retention d’urine. Le risque uro-nephrologique est majeur, imposant un suivi regulier de ces patients. Niveau de preuve 4.

International audience; Background: Lower urinary tract symptoms, especially overactive bladder, are frequent and disabling in individuals with multiple sclerosis (IwMS). An association with gait disorders is common, which could aggravate continence difficulties and affect quality of life. The association between the need to void and walking has never been studied in this population.Objective: The primary aim of this study was to assess the effect of a strong desire to void (SDV) on walking speed in IwMS and lower urinary tract symptoms. The secondary aim was to identify clinical or urodynamic factors associated with walking speed impairment at SDV in this population.Methods: We included IwMS with urinary disorders and Expanded Disability Status Scale score

International audience; Background: Urgency urinary incontinence is one of the major disabling urinary symptoms in people with multiple sclerosis (PwMS). The warning time (time from first sensation of urgency to voiding or incontinence) only partially reflects the possibility of continence. Other factors such as mobility, difficulties in transfer or undressing can influence this time.Objectives: The aim was to create a specific test for PwMS to assess the global time required to be ready to perform micturition and to assess its reliability.Methods: The Time to be Ready to Void (TRV) was based on 2 timed steps: "mobility" stage, including standing up and walking 6m to the toilet, and the "settled" stage, starting as soon as the individual opens the toilet door until readiness for micturition. All participants performed the TRV twice. Reliability were assessed by the intraclass correlation coefficient (ICC) and convergent validity by Spearman correlation coefficient.Results: We included 71 PwMS (mean [SD] age 54.4 [11.7] years). Inter-rater reliability was excellent for the TRV mobility stage (ICC: 0.97), settled stage (ICC: 0.99) and total test (ICC: 0.99). Test-retest reliability was good for the mobility stage (ICC: 0.88) and total test (ICC: 0.81) and moderate for the settled stage (ICC: 0.67). Test-retest reliability assessed by a Likert-type scale was good for each stage (κ 0.75 and 0.88). The mobility stage was correlated with the scores for the Timed Up and Go test, 10-Meter Walk Test, and Tinetti Mobility Test (ρ=0.89; ρ=0.88; ρ=-0.67, respectively; P

International audience; Beyond its effect on vegetative functions, the activation of the vagus nerve inhibits inflammation and reduces pain signaling. The aim of this open-label pilot study was to determine the efficacy and tolerance of transcutaneous auricular VNS (taVNS) on erosive hand osteoarthritis (EHOA) symptoms. Symptomatic EHOA patients with hand pain VAS ≥ 40/100 mm and ≥1 interphalangeal swollen joint(s) were included. The taVNS was performed for 4 weeks using an auricular electrode applied one hour per day and connected to a TENS device with pre-established settings. Clinical efficacy was evaluated by changes between baseline and at 4 weeks with hand pain VAS and the functional index FIHOA score, using a Wilcoxon t-test. The treatment tolerance was also evaluated. Eighteen patients (median age 69 years old, 83% women) were analyzed. At baseline, hand pain VAS was 60 mm [IQR 50; 78.2] and FIHOA 15 [10.7; 20.2]. After 4 weeks, taVNS significantly reduced hand pain VAS, with a median decrease of 23.5 mm [7.7; 37.2] (p = 0.001), as well as FIHOA, with a median decrease of 2 points [0.75; 5.2] (p = 0.01). No serious adverse events were reported. One patient stopped taVNS because of auricular discomfort. This first proof-of-concept trial indicated that taVNS is feasible and may decrease joint inflammation and clinical symptoms in EHOA, arguing for a randomized controlled study versus sham stimulation.

Objectives: To determine whether diffusion-weighted magnetic resonance imaging (DWMRI), a noninvasive procedure, can contribute to the diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC). Methods: The pelvic DWMRI of patients with chronic pelvic pain syndrome was selected between January 2012 and June 2017. A radiologist analyzed the bladder wall signal; he was blinded to the patients’ clinical data. According to the 2008 European Society for the Study of Bladder Pain Syndrome/Interstitial Cystitis criteria, 2 groups of patients were determined: BPS/IC and no BPS/IC. The association between BPS/IC and the wall signal intensity was compared. Results: In the 106 patients included, 82 had criteria for BPS/IC and 24 did not. A significant difference in the distribution of the signal was found between the 2 groups (p = 0.01). High signal intensity of the bladder wall was related to the presence of a BPS/IC with a sensitivity of 28% and a specificity of 88%. No signal intensity of the bladder wall was related to the absence of a BPS/IC with a sensitivity of 96% and a specificity of 29%. Conclusions: In ­DWMRI, high bladder wall signal intensity helps to affirm a BPS/IC, whereas the absence of signal helps to exclude the diagnosis. Further studies are needed to confirm these preliminary results.

Resume Introduction L’intensite du besoin mictionnel depend de deux parametres essentiels, le volume vesical et l’attention. S’il est bien connu que la contraction volontaire maximale des muscles perineaux peut inhiber transitoirement le reflexe mictionnel lui-meme, aucun travail ne demontre l’effet de cette contraction sur l’intensite du besoin lui-meme. Methodes Une etude experimentale, prospective, ouverte, monocentrique a ete menee entre mars et avril 2017. Au total, 15 sujets sans antecedent neurologique ni troubles neuro-perineaux consultant pour constipation fonctionnelle etaient inclus. L’intensite de besoin mictionnel etait evaluee via un urgentometre electronique. Une consigne de contraction controle des muscles thenariens de la main dominante etait comparee a une contraction volontaire du sphincter anal externe lors d’un besoin urgent (B3), contractions verifiees electromyographiquement. Le critere d’evaluation principal etait la comparaison entre la difference de score d’echelle visuelle analogique intensite du besoin avant (EVA-base) et apres effort de contraction controle (EVA-pouce) lors d’un B3 versus le meme index (EVA-base puis EVA-anal apres contraction du sphincter anal externe) lors d’un nouveau B3. La comparaison des capacites vesicales fonctionnelles (CVF) mesurees apres chaque enregistrement etait le critere d’evaluation secondaire. L’analyse statistique etait faite par un test des rangs signes de Wilcoxon. Resultats L’EVA intensite du besoin etait significativement diminuee (−13,14 ± 12 vs −1,5 ± 6 ; p = 0,03) et la CVF significativement augmentee (502,43 ± 96,71 mL vs 435,78 ± 125,54 mL ; p = 0,02) apres une contraction perineale comparativement a la contraction controle des muscles de la main. Conclusion Cette etude suggere l’existence d’une inhibition des voies sensitives mictionnelles par la contraction perineale via un reflexe perineo-vesico-sensitif inhibiteur. Niveau de preuve 3.

Purpose The aim of this study was to describe lower urinary tract symptoms in neuromyelitis optica (NMO), and to compare these data with urinary disorders observed in multiple sclerosis (MS) patients. Methods Retrospective study of data collected from January 1997 to July 2017 using the database from a Neuro-Urology Department of a university hospital. NMO and MS patients were matched for sex, age, and Expanded Disability Status Scale (EDSS). Results Twenty-six patients with NMO were included and compared with 33 MS patients. Mean age was 41.6 years (standard deviation [SD], 14,8), mostly female patients (24 vs. 2 males). Mean EDSS was 4.6 (SD, 1.8) in the 2 groups. In NMO group, 57% of the patients (n=15) had overactive bladder with urgency and urge incontinence and 38.5% (n=10) of them had nocturia. Voiding symptoms was observed in 69.2% of the patients (n=18); 42.3% of NMO patients performed self-intermittent catheterization versus 12.1% in MS patients (P=0.012). Low bladder compliance and severe urinary tract infections (pyelonephritis) were more frequent in NMO than in MS patients (respectively 15% vs. 0%, P=0.016 and 42% vs. 12%, P=0.024). Conclusion Lower urinary tract symptoms, especially overactive bladder and urinary retention, are frequent in NMO. Low bladder compliance, serious urinary infections, and high prevalence of urinary retention requiring self-intermittent catheterization are the main symptoms significantly more frequent than in MS.

Resume Introduction Le menthol est un compose naturel dont les effets en physiologie humaine connus sont nombreux (sensation de fraicheur, decongestionnant, antispasmodique intestinale). Son implication dans la physiopathologie vesicosphincterienne est evoquee depuis les annees 90. Methode Faire la revue de la litterature des travaux ayant impliques le menthol dans la physiologie vesicosphincterienne a travers des articles indexes sur Pubmed avec les mots cles menthol, menthol and bladder, menthol and toxicity, et TRPM8. Seuls les articles en langue anglaise etaient selectionnes. Resultats Au total 30 articles ont ete inclus. La plupart mettaient en evidence l’existence d’un reflexe mictionnel au menthol et au froid, medie des fibres nerveuses de type C a destination medullaire, par activation de recepteurs urotheliaux TRPM8. Des experiences plus recentes montraient paradoxalement un effet inhibiteur du menthol sur la contractilite detrusorienne lorsque le tissu musculaire y est expose directement, independamment du TRPM8. Il a egalement ete mis en evidence des effets similaires d’une exposition cutanee ciblee ou urotheliale sur la fonction detrusorienne via le TRPM8. Ce recepteur semble egalement etre implique dans les cystites interstitielles et l’hyperactivite detrusorienne idiopathique. Enfin la toxicite potentielle du menthol parait negligeable. La plupart des etudes concernait des experimentations animales, 3 seulement concernaient l’humain. Seule une etude evoquait des perspectives therapeutiques. Conclusion Il apparait donc que le menthol et ses recepteurs sont impliques dans la physiopathologie vesicosphincterienne. Ceci pourrait ouvrir des perspectives therapeutiques dans l’hyperactivite detrusorienne et les cystites interstitielles avec un potentiel de toxicite reduit.

Resume Objectif Le but de cet article est d’effectuer une revue de la litterature sur les gaz vaginaux (GV) Methodes Une revue de la litterature (base de donnees Medline-PubMed, Cochrane Library, Google Scholar) sans limite temporelle a ete effectuee a partir des mots cles : “vaginal winds », « vaginal noise », « vaginal gas », « flatus vaginalis », « vaginal flatus », « colpophony », « Garrulitas vulvae », « vaginal laxity ». Resultats Sur 412 articles portant possiblement sur les GV, 15 ont ete retenus et 99 sur 110 concernant l’hyperlaxite vaginale. Les GV apparaissent volontiers au cours de l’exercice physique mais aussi pendant et au decours immediat du coit. Leur prevalence est variable, d’environ 20 %. Les mecanismes physiopathologiques sont mal elucides mais temoignent probablement d’une hyperlaxite vaginale, elle-meme secondaire a une defaillance musculaire du plancher pelvien conduisant a une augmentation du diametre de l’hiatus vaginal. Les GV alterent la fonction sexuelle chez la femme mais pas forcement celle du partenaire. Tampons et pessaires sont actuellement les traitements les plus proposes mais naturellement impossible a utiliser pendant les rapports sexuels. Certains resultats des traitements par lasers vaginaux semblent prometteurs. Conclusion Les GV semblent un symptome frequent, meconnu mais qui pourtant impacte parfois de maniere importante la qualite de vie sexuelle des femmes. Accouchements et grossesses et plus generalement l’hyperlaxite vaginale en sont les causes principales. Reeducation perineale, obturateurs vaginaux, chirurgie et laser vaginal sont les options therapeutiques a proposer aux patientes demandeuses d’une prise en charge.

Aim Patients who have successfully acquired the intermittent self-catheterization (ISC) technique can be expected to use it on a long-term basis. The aim of the present study is to present a validated evaluation scale, referred to as the ICAS (Intermittent Catheterization Adherence Scale), which can be used to assess long-term patient adherence to prescribed ISC treatment. Methods The scale was validated in neurologic and non neurologic patients in an experienced French neurourology center, between September 2014 and February 2016. Eight items were chosen, providing a relatively objective insight into the degree to which patients reduce the frequency of their ISC procedures. Various factors, including the patients' understanding of the procedure, its relevance to their specific condition, as well as their acceptance of its psychological and inherently time-consuming drawbacks, were evaluated. The ISC construct validity and reproducibility, based on internal test-retest consistency and test-retest reliability, were measured using the Intra-class Correlation Coefficient (ICC). Results The ICAS was validated in 222 patients (133 females, 89 males, mean age 53 ± 11 years). The patients' comprehension of the questions was found to be good, and the questionnaire was well accepted. Cronbach's alpha was 0.73. The ICC test-retest consistency was also found to be good. Conclusion The ICAS is a simple, acceptable, valid and reproducible test, and in some cases it may facilitate the medical follow-up of ISC patients. In the clinical environment, it is found to be a valuable tool, which can assist medical staff in the prevention of complications related to ISC non-compliance.

Resume Introduction L’importante variabilite des symptomes dans la sclerose en plaques (SEP) interroge sur la reproductibilite du calendrier mictionnel (CM) dans cette population. L’objectif de cette etude est d’evaluer la stabilite intra individuelle des resultats du CM dans la SEP et ses facteurs d’influence. Materiel et methodes Un CM de 21 jours precisant la frequence mictionnelle (FM) par jour a ete rempli par des patients atteints de SEP. Le critere de jugement principal etait la stabilite de la FM quotidienne sur les 21 jours, exprimee par le coefficient de variation (CV = ecart-type/moyenne) distinguant 2 groupes : le groupe stable (CV ≤ 15 %) et le groupe instable (CV > 15 %). Les criteres de jugement secondaires etaient le remplissage complet ou partiel du CM et la variation de la FM entre le week-end et la semaine. Resultats Trente et un patients ont ete inclus (âge moyen 51 ans, DS 11,3) dont 65 % de femmes. Le CM est rempli en moyenne 19,35 jours (DS 3,99). Le CV moyen est de 23 % (DS 0,1). Huit patients presentent un CV ≤ 15 %. Hormis un âge plus eleve dans le groupe stable (p = 0,03), il n’existe pas de difference significative entre les groupes. La FM du week-end est fortement correlee a celle de la semaine (ρ = 0,94, p Conclusion Le CM dans la SEP n’est guere reproductible. Il reste a savoir s’il s’agit d’une veritable fluctuation des TVS de la SEP et/ou d’un manque de stabilite en lien avec la duree et le remplissage du CM. Niveau de preuve 4.