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To describe the outcomes of ileal conduit as a salvage therapy for refractory lower urinary tract dysfunctions (LUTDs) due to multiple sclerosis (MS) in a national neurourology referral center network.A retrospective multicenter French study was carried out to identify MS patients who underwent non-continent urinary diversion for refractory LUTDs from January 2010 to December 2015. Multiple sclerosis status, urological history, surgical indication and technique, postoperative complications, renal anatomy and function at last follow-up as well as number of rehospitalizations for urinary tract infections (UTI) were collected. Preoperative and postoperative urinary-related quality of life (urQoL) through the Qualiveen short-form questionnaire (QSF) and patient global impression of improvement (PGI-I) were collected and analyzed.Overall, 10 centers identified 211 patients with a mean age of 54±11 and mean preoperative EDSS (expanded disability status scale) score of 7.3±0.9. The main indication for diversion was MS progression leading to impossible intermittent self-catheterization (55%). Cystectomy was performed either by open (34.6%), laparoscopic (39.3%) or robotic (21.8%) approach (unknown: 4.2%) with cystectomy in all cases. Early complications were reported in 42% of the patients, mainly Clavien I or II grades. There was no difference in GFR (glomerular filtration rate) after surgery. After diversion, patients had fewer hospitalizations for UTI and better urQoL on QSF confirmed by evaluation of PGI-I.This study, reporting the largest series of ileal conduit in selected MS patients with end-stage LUTDs, showed significant improvement in symptomatic UTI and quality of life with a low high-grade complication rate.

Introduction and hypothesis The objective was to describe the different laparoscopic and vaginal steps of sub-urethral infected mesh explantation as well as an unexpected and unusual complication: a sub-mucosal calcification on the sub-urethral segment of the sling that was not infiltrating the urethra. Methods This was carried out at our University Teaching Hospital of Strasbourg. Results We show the complete removal of an infected retropubic sling in a patient who had already undergone three previous surgeries without resolution of symptoms. This is a difficult case requiring a laparoscopic approach of the space of Retzius, which has been less familiar to surgeons since the advent of the midurethral sling. We show how to approach this space in an inflammatory environment by specifying its anatomical limits. Moreover, a great deal can be learned from the occurrence of an infectious complication after the surgery and the presence of a large calcification on the prosthesis. In this context, we advise a systematic antibiotic treatment to avoid this kind of complication. Conclusions Knowing the guidelines and the different surgical steps will help urogynecological surgeons to perform similar procedures in patients requiring removal of retropubic slings for complications such as infection and pain, where conservative management has not been successful. These cases must be discussed in a multidisciplinary meeting, as recommended by the French National Authority for Health, and managed in an expert establishment.

To assess the efficacy and safety of intradetrusor botulinum toxin type A injections (IBTI) for idiopathic overactive bladder (iOAB) in non-neurological adults with an artificial urinary sphincter (AUS). We retrospectively selected, in the 11 French centers, members of a collaborative network (GENULF (Groupe d’etude de neuro-urologie de langue francaise)), the patients who had had an artificial urinary sphincter implantation and who had subsequently developed iOAB requiring IBTI. This study was approved by the French association of urology ethics committee (no 2018012). Between 2006 and 2020, 33 patients were included from 5 French centers. Mean follow-up after the first IBTI was 47 months. The average age of the studied population was 68 years, with 70% of females. A complete resolution of symptoms at optimal IBTI dose was experienced by 21 (64%) patients. Seven (21%) patients had partial improvement. Five non-responder patients (15%) had no improvement at all. Maximum cystometric bladder capacity was 240 ml pre-IBTI and 335 ml post IBTI. Discontinuation free survival at 60 months was 50%. Two erosions occurred during the 6 months following an IBTI both in male patients with a perineal implantation. There were four AUS balloon perforations that occurred during the 6 months following an IBTI, all of them in female patients. IBTI has a good efficacy for the treatment of iOAB in patients with an AUS. However, both patients and practicians must be aware of the risk of rare and usually mild complications.

To compare transcorporal vs bulbar artificial urinary sphincter (AUS) implantation in men with fragile urethra and to investigate the risk factors of AUS explantation in this population. The charts of all male patients who had an AUS implantation between 2004 and 2020 in 16 centers were reviewed retrospectively. The primary endpoint was device explantation-free survival. Only patients with a fragile urethra were included in the present analysis. Fragile urethra was defined as a urethra carrying a high risk of cuff erosion because of prior radiotherapy and/or history of AUS explantation and/or history of urethral stricture surgery. The patients were divided in two groups according to the implantation site: bulbar vs transcorporal. 464 patients were included for analysis. 88 patients underwent a transcorporal AUS implantation and 376 underwent a bulbar AUS implantation. Explantation-free survival was similar in both groups (estimated 5-year explantation free survival rates 55.3% vs. 58.4%; p=0.98). In the subgroup of patients with a history of previous AUS explantation, transcorporal approach tended to bring longer explantation-free survival (2-year explantation-free survival: 61.9% vs. 58.2%; p=0.096). In multivariate analysis, the only risk factor of shorter explantation-free survival was the history of previous AUS explantation (HR=2.65; p=0.01). Transcorporal AUS implantation was not associated with longer explantation-free survival. History of previous AUS explantation was the only risk factor associated with shorter explantation-free survival and this subgroup of patients may be the only one to draw benefits of transcorporal AUS implantation.

Artificial urinary sphincter (AUS) implantation in female patients results in high satisfaction rates and high functional outcomes, but implantation can be challenging and explantation of the device is fairly common. The objective of this study was to review outcomes after AUS explantation in women. This is a retrospective, monocentric study of all women who underwent open or laparoscopic AUS implantation between November 1994 and July 2019, and patients with AUS explantation were included. Management after AUS explantation using descriptive analysis was assessed. Over a span of 26 years, 111 women had an AUS implanted by a single surgeon. Of these surgeries, 35 explantations in 29 patients were later required: 20 initial AUSs, nine revised AUSs and six reimplanted AUS (rAUSs). The median time to explantation was 15.5 month (± 0.55). After explantation, 13 rAUSs in 10 patients were successful and two attempts failed. The median time between explantation and rAUS was 8 months (± 0.95). At the last follow-up, five patients still had their rAUS and six rAUSs had required explantation after a median time of 6.5 months (± 0.65). Surgery was still possible for 12 patients who did not have a rAUS: three cystectomies, one bladder neck closure with continent urinary diversion, and six mid-urethral slings or adjustable continence therapy balloon implantations. Among the 23 patients who did not need a cystectomy or a bladder neck closure with continent urinary diversion, four were completely dry (17.4%), 11 were improved (47.8%), and eight (34.8%) experienced unchanged incontinence with the post-explantation management. Limitations include retrospective design, heterogeneous management over time and a relatively small population of patients in our cohort. Reimplantation of an AUS after an explantation seems feasible after at least 6 months. However, the surgery will be more difficult and satisfaction is not guaranteed. Multicenter databases should be created to help surgeons and patients decide on appropriate management strategies after explantation of an AUS.

Although artificial urinary sphincter (AUS) has become an established treatment for moderate to severe stress urinary incontinence (SUI), implantation can be challenging. This study aimed to review the outcomes of laparoscopic AUS (LAUS) implantation and revision in women presenting with SUI. We reviewed the files of female patients presenting with moderate to severe SUI treated with LAUS implantation from October 2007 to July 2017. Surgeries were performed by one surgeon experienced in open AUS implantation and starting LAUS implantation. The primary endpoint was postoperative urinary continence, which was divided into three categories: complete continence, improved continence, and unchanged incontinence. The secondary outcomes were complications, explantation-free and revision-free time. A total of 49 women (mean age 64 years, range 40–80) had LAUS implantation. Among the 42 patients (85.7%) with an AUS in place at the last follow-up, 25 (59.5%) were fully continent, 16 (38.1%) had improved continence, and 1 (2.4%) had unchanged incontinence. At the last follow-up, 29 (59.2%) patients had their initial AUS and 13 (26.5%) had at least one reintervention. There were 9 (18.4%) intraoperative complications and 25 (51%) postoperative complications, of which 9 (18.4%) were Clavien⩾3. After a median follow-up of 4 years, 9 (18.4%) explantations and 11 (22.5%) revisions occurred. The average period without explantation or revision was 3.7 and 3.1 years, respectively. Our study shows that the laparoscopic approach for AUS implantation is an efficient treatment option for women with moderate to severe SUI.

To report the outcomes of AUS in women with neurological SUI resulting from intrinsic sphincter deficiency after a follow-up from 3 to 20 years. The charts of female with moderate to severe neurological SUI who underwent open or laparoscopic AUS implantation between November 1994 and July 2014 were reviewed retrospectively. All patients were operated by a single experienced surgeon. Primary endpoint was a postoperative continence categorized as complete continence (no pads used), improved incontinence or unchanged incontinence. Twenty-three women (mean age 54 years, range 19–77) underwent open or laparoscopic AUS implantation. At the last follow-up, 7 (30.4%) initial artificial urinary sphincters remained in situ and 9 (39.1%) patients had at least one revision or reimplantation. Sixteen patients were fully continent (69.6%), four (17.4%) had improved incontinence and three (13.0%) had unchanged incontinence. After a median follow-up of 11.6 years (3–22), 8 (34.8%) explanations in 7 patients and 16 (69.6%) revisions in 11 patients occurred. The average time without explanation or revision was 10.9 and 8.5 years, respectively. Survival rates without AUS explanation were 94.4%, 76.5%, 72.8%, 50% and without revision were 83.3%, 64.7%, 45.5% and 16.7% at 5, 10, 15 and 20 years, respectively. Although all methods are imperfect at best, AUS remain toward our experience a good way to achieve long-term continence in female patients suffering from neurological SUI with preserved manual dexterity.

New follow-up models of care are needed to ensure long-term comprehensive care for cancer survivors. We investigated the impact of a general practitioner (GP)-led follow-up program for prostate cancer (PCa) and renal cell cancer (RCC) survivors.This retrospective monocentric study compared standard urologist-led follow-up to experimental GP-led follow-up within a nurse-led network for PCa and RCC survivors. To assess the safe continuity of follow-up, the number of patients lost to follow-up (LFU) was collected. A microcosting analysis from the French national health system perspective was conducted to describe incremental costs associated with experimental follow-up. A satisfaction survey was conducted to determine participating patient's and GP's satisfaction scores, ranging from 0 to 4 and 0 to 5, respectively.Among the 1274 patients included, 92/753 (12.2%) were LFU during standard follow-up vs 0/521 (0%) during experimental follow-up (p 0.001). In the latter, the median management delay of suspected recurrence for PCa and RCC survivors was 20 [12-27] and 16 [10.5-31.25] days, and the mean incremental cost on a per-patient basis was 34.68 ± 105.87€ and 64.24 ± 93.55€, respectively. Patient and GP mean satisfaction scores were 3.6/4 and 3.9/5, respectively.The GP-led follow-up of PCa and RCC survivors within a nurse-led network seems to provide safe continuity of follow-up and seems not to be associated with major incremental costs. The surveys indicated high level of patient's satisfaction and encouraging results regarding GP's satisfaction. Randomized clinical trials are needed to confirm these findings and promote larger implementation of this type of follow-up care.

Purpose:The main objective of this study was to assess the prevalence and risk factors of male artificial urinary sphincter (AUS) mechanical failures and nonmechanical failures.Materials and Method...

Background Artificial urinary sphincter (AUS) is the gold standard for the management of moderate to severe stress urinary incontinence (SUI) in the male population. While outcomes of this device in postprostatectomy incontinence (PPI) are widely described, those obtained for incontinence after benign prostatic obstruction (BPO) surgery remains poorly explored. Objective To compare continence outcomes after AUS implantation in a PPI population with those obtained in men incontinent after BPO surgery. Design, setting, and participants A retrospective review of all cases of AUS implantation between 2005 and 2020 in 16 different French centers was conducted. Only patients with primary implantation whose indication was moderate to severe SUI after prostatectomy or BPO surgery were included (excluding those with a history of radiation therapy, brachytherapy, cystectomy, high-intensity focused ultrasound therapy, or neurogenic disease). Outcome measurements and statistical analysis The primary endpoint was the rate of social continence (zero or one pad per day) at 3 mo. Complications were also noted within 90 d of implantation. Results and limitations A total of 417 patients were included in the PPI group and 50 in the BPO surgery group. Social continence rates at 3 mo were similar between the groups (79% vs 72%, p = 0.701). Complication rate was significantly higher in the BPO group (8% vs 18%, p = 0.044). The same was found for the Clavien-Dindo type 2 complication rate (20.6% vs 44.4%, p = 0.026). The retrospective nature and lack of precise definition of incontinence are the main limitations of this study. Conclusions This multicentric study strengthens the position of AUS as gold standard for SUI after radical prostatectomy. Comparable efficacy results were found for incontinence after BPO surgery, with nevertheless a higher rate of complications. Patient summary Artificial urinary sphincter represents the gold standard for the treatment of moderate to severe stress urinary incontinence. Efficacy results are comparable between postprostatectomy incontinence and incontinence after benign prostatic obstruction surgery.

To assess the efficacy and safety of intravesical instillation of high molecular weight sodium hyaluronate (HMW-HA) for the treatment of radiation-induced cystitis. This prospective cohort study was conducted in seven centers in France. Eligible patients with radiation-induced cystitis were recruited between April 2020 and March 2021. A sterile disposable 50 ml prefilled solution containing 0.16% (80 mg/50 mL) HMW-HA (INSTYLAN) was instilled weekly into the bladder. The treatment consisted of 6 sessions (V1 to V6). Outcomes were assessed 1 week (V7) and 4 weeks (V8) after the last session and were compared with baseline (V0). The primary endpoint was bladder pain, evaluated by a Questionnaire with 5 closed-ended response options. Secondary endpoints included changes from baseline for hematuria, urinary frequency, and the effect of urgencies on Quality of Life (QoL). Adverse events (AEs) were graded according to the CTCAE 3.0 classification. A total of 30 participants were enrolled. The Intent-to-Treat analysis showed a significant reduction in pelvic pain intensity (− 45.81%, p

Resume Introduction Le traitement de reference de la dyssynergie vesicosphincterienne (DVS) neurologique repose sur la realisation d’auto-sondages intermittents mais, certains patients presentent une incapacite a la realisation des auto-sondages. Dans cette population, un traitement endoscopique peut etre propose. Nous avons pris le parti d’evaluer les changements iteratifs de protheses trans-sphincteriennes temporaires comme une alternative a la sphincterotomie chirurgicale. Materiel et methode Nous avons realise une etude monocentrique retrospective descriptive incluant tous les patients neurologiques appareilles par une prothese uretrale trans-sphincterienne entre avril 2005 et septembre 2017. Les changements prothetiques etaient realises tous les 12 a dix-huit mois selon les resultats de la fibroscopie de controle. Le critere de jugement principal etait la poursuite des changements de protheses. Resultats Quarante-quatre patients suivis durant 46 mois [18,5–53,25] etaient inclus. Quatorze (32 %) patients presentaient un echec primaire de traitement principalement a la suite de difficultes d’appareillage (n = 3) et de retention urinaire chronique persistante (n = 2). Quatre patients etaient decedes. Le traitement etait initialement efficace pour 30 (68 %) patients. Parmi ceux-ci 10 (33 %) ont adopte un autre mode mictionnel lors du suivi. Cinq (11 %) patients etaient perdus de vue. Les complications les plus frequentes etaient les retentions urinaires (29 %), les infections urinaires (27 %), et la migration prothetiques. Quinze (34 %) presentaient une complication de grade Clavien III–IV. Conclusion Les changements iteratifs de protheses trans-sphincteriennes sont une alternative a la sphincterotomie chirurgicale chez des patients selectionnes pour la prise en charge de la DVS mais avec une morbidite significative. Niveau de preuve 4.

Objective To evaluate the clinical efficacy, urodynamic effect and safety of Botulinum Toxin A (BTXA) injections after failure of augmentation enterocystoplasty (AE) performed for neurogenic detrusor overactivity. Patients and Methods We performed a multicenter retrospective study that included patients who had AE and at least one injection of BTXA after AE in 15 GENULF (French Speaking Neuro-Urology Study Group) centers. Clinical and urodynamic data were collected from medical files according to a standardized questionnaire and colligated in an anonymous database. Results Thirty-three patients with an injection of BTXA after AC in 9 out of 15 centers were included. Mean age at the time of AE was 24 ± 15 years. Overall efficacy (defined by clinical efficacy associated with a request by the patient for reinjection) was observed in 58% of the patients. Mean maximum cystomanometric capacity increased by 28% (333 ± 145 vs 426 ± 131 mL; P = .007) and maximum detrusor pressure (Pdet max) decreased by 43% (44 ± 37 vs 25 ± 18 cm H2O; P = .02) after BTXA. Only one side effect was recorded out of the 152 procedures (transient generalized muscle weakness without respiratory distress). Conclusion In patients with failure after AE performed for neurogenic detrusor overactivity, injection of BTXA in the enlarged bladder was effective in over half of the cases with low morbidity. If this therapeutic approach were confirmed, it could be proposed as an alternative to AE surgical revision.

SOUNDS strengthens the evidence basis of sacral neuromodulation (SNM) for overactive bladder (OAB) through real-world data.To analyze diary-based effectiveness, quality of life (QoL), disease severity, symptom bother, and safety data for SNM with the InterStim system up to 3 yr after implantation.Twenty-five representative French sites enrolled 291 patients with OAB followed according to the local standard of care. Overall, 229 patients received a de novo or replacement InterStim implant and had four follow-up visits, two within the first yr and annually thereafter. A total of 190 patients completed the fourth follow-up visit after a mean of 33.7 ± 3.7 mo.The effectiveness outcomes measured were changes in daily voids and leaks and the therapy responder rates. Other outcomes included validated QoL data (Ditrovie and EuroQol 5-dimension 5-level questionnaires), disease severity (Urinary Symptom Profile [USP]), symptom bother rated using a numeric rating scale (NRS), and safety data. Follow-up data were compared to baseline results using the Wilcoxon signed-rank test.Average daily voids and leaks were significantly reduced at all time points up to 3 yr after implantation (p0.05) except for voids at 21 mo in the group receiving a replacement device. The therapeutic response for urinary urge incontinence at the fourth follow-up was 72% for the de novo group and 86% for the replacement group. Disease-specific QoL (Ditrovie), OAB-specific symptom severity (USP domain 2), and NRS-rated disease bother were significantly improved at all visits (p0.001). Device- or procedure-related adverse events occurred in 49% of patients, with 68% of the events classified as minor (Clavien-Dindo grade I or II). Surgical revisions were performed in 33% of patients, including permanent removal in 13%, over a mean exposure time of 44.4 ± 15.3 mo.This study confirms the safety and effectiveness of SNM for OAB and improvements in QoL and disease bother in real life.Our study in French patients with overactive bladder showed that disease symptoms and bother were significantly reduced and quality of life was significantly improved over a study duration of approximately 3 yr after implantation of a device to stimulate nerves that control the bladder. This trial is registered at ClinicalTrials.gov as NCT02186041.

AIMS To prospectively evaluate the performance of a last generation magnetic resonance imaging (MRI) device with tractography to identify the normal female urethral sphincters in terms of morphology and quantification on a large cohort of continent women. METHODS We have recorded the data of 75 continent women who underwent a diffusion tensor imaging (DTI) sequence with fiber tractography during a pelvic MR examination. Three groups of age were analyzed in terms of color fiber tracking quality and quantitative parameters (fractional anisotropy [FA] and mean diffusibility [MD]). Statistical analysis was done for the qualitative assessment using weighted kappa statistics of Cohen and for the quantitative parameters using a non-parametric Kruskal-Wallis test. RESULTS For all cases, fiber-tracking resulted in a satisfactory representation of the complexity of the orientation of the fibers. The interobserver concordance of qualitative data was substantial, calculated at 0.78 (confidence interval: 0.71-0.85). For FA, there was no statistically significant difference with the age between the three urethral segments (p > 0.05). However, we registered a significant difference inside each group between the different segments (p

Objectifs Certaines options therapeutiques sont disponibles dans le traitement de la cystite radique. L’Oxygenotherapie Hyperbare (OHB) est l’option la plus etudiee mais le traitement est couteux, peu accessible, 30 a 40 seances sont necessaires et des recidives restent observees. L’objectif etait d’evaluer l’efficacite et la tolerance des instillations endovesicale de Hyaluronate de Sodium a haut poids moleculaire (HA) dans le traitement de la cystite radique. Methodes Etude prospective conduite dans huit centres francais entre avril 2020 et mars 2021. Le traitement consistait en une instillation endovesicale hebdomadaire pendant 6 semaines consecutives (V1 a V6) de HA (80 mg/50 mL) (INSTYLAN). Les resultats, compares a l’inclusion (V1), ont ete evalues 1 semaine (V7) et 4 semaines (V8) apres la derniere instillation. Le critere de jugement principal etait la douleur vesicale evaluee par un Questionnaire standardise (Echelle Verbale). Les criteres de jugement secondaires etaient l’effet sur l’hematurie, la frequence mictionnelle et l’impact de l’urgenturie sur la qualite de vie (QdV). Les evenements indesirables (EI) ont ete reportes selon la classification CTCAE version 3.0. Resultats Au total, 30 patients ont ete inclus. L’âge moyen etait de 75 ans (± 2,8) et 29 (96 %) des 30 patients inclus etaient de sexe masculin. En analyse en Intention-de-Traiter, une reduction significative de l’intensite de la douleur (−45,59 %, p Fig. 1 ). Le traitement par instillation endovesicale a ete bien tolere. Deux EI lies au traitement (6,6 %) ont ete rapportes et correspondaient a deux cas d’hematurie de grade 1. Aucun EI grave n’a ete enregistre. Conclusion Dans une etude pilote, prospective et multicentrique, nous rapportons que le traitement de la cystite radique par instillation endovesicale de HA est efficace et bien tolere. Le traitement par INSTYLAN ne necessite aucun plateau technique specialise et pourrait etre une alternative prometteuse a l’OHB. De futures etudes comparatives sont necessaires pour evaluer les resultats a long terme.

International audience; Objectives: The aim of the present study was to compare the perioperative outcomes of extracorporeal (EXTRA) vs intracorporeal (INTRA) urinary diversion in patients undergoing robotic cystectomy and ileal conduit for neurogenic bladder. Methods: All consecutive patients who underwent robot-assisted cystectomy and ileal conduit for neurogenic bladder in six centers between 2011 and 2020 were included in a retrospective study. Four centers performed exclusively INTRA urinary diversion all over the study period, one center performed exclusively EXTRA urinary diversion, and the last center performed EXTRA urinary diversion during a first period and INTRA during the subsequent period. Results: Ninety-seven patients were included: 66 in the EXTRA group and 31 in the INTRA group. There were 11 major (Clavien grade >= 3) postoperative complications in the overall population (11.3%) with no statistically significant difference between both groups (EXTRA = 12.1% vs INTRA = 9.7%; p = 0.99). The mean length of stay did not differ significantly between INTRA and EXTRA (13.1 vs 14.1 days; p = 0.44). The mean times to oral feeding and to return of bowel function were similar in the two groups (3.9 vs 3.5 days; p = 0.28 and 4.1 vs 4.1 days; p = 0.51, respectively). There was no incisional hernia in the INTRA group vs five in the EXTRA group (0% vs 7.6%; p = 0.17). Conclusion: The perioperative morbidity of robotic cystectomy and ileal conduit for neurogenic bladder appears to be relatively limited compared with the historical open series. Possibly due to the relatively small sample size, no difference was found between INTRA and EXTRA urinary diversion in terms of perioperative outcomes.

International audience; Objectifs : la chirurgie de l’incontinence urinaire d’effort (IUE) par bandelettes sous-urétrales (BSU) fait l’objet d’essais cliniques limités en taille, rapportant peu les complications rares et la qualité de vie (QdV). Les registres permettent de rapporter ces complications rares dans la pratique courante et de mesurer la QdV globale, du point du vue des troubles urinaires et pelviens.Méthodes : l’objectif du registre VIGI-MESH est de spécifier l’incidence de ces complications rares et graves en fonction des différents types de BSU (rétropubiennes, transobturatrices, à incision unique/mini-bandelettes) ainsi que de mesurer cette QdV après la pose de BSU. Entre février 2017 et novembre 2019, chaque chirurgie initiale ou de reprise de BSU dans un des 18 centres participants était colligée sur un formulaire par le chirurgien. Un contrôle était effectué à partir des pharmacies délivrant les dispositifs médicaux implantés et des actes codés par les centres participants. Un questionnaire recherchant une complication était envoyé à toutes les patientes à un an. Il comportait également des questions validées en français sur le bien-être ressenti et l’amélioration des symptômes (WHO, European Quality of life Questionnaire 5 Dimensions [EQ5D], Patient Global Impression of Improvement [PGI-I]) Les complications ont été gradées selon la classification de Clavien–Dindo : arrêt de l’intervention sans pose de matériel (grade III), intervention chirurgicale ultérieure secondaire à une complication (grade III), complication menaçant la vie (grade IV), décès de la patiente (grade V).Résultats : quatre-vingt-deux patientes ont eu des complications de grade ≥ III : 5,7 % (53/923) voie rétropubienne, 4,0 % (21/521) voie transobturatrice et 2,2 % (8/370) mini-bandelette. Dix complications peropératoires ont empêché la pose de BSU. La BSU a été desserrée dans les 48 h dans 6 cas. Le risque de complication était 3 fois plus faible avec une mini-bandellette par rapport à une BSU rétropubienne (RR = 0,36 [0,170,75]), le risque n’était pas significativement différent entre les approches transobturatrice et rétropubienne (RR = 0,67 [0,40–1,11]). Vingt-sept femmes (1,5 %) ont eu une reprise chirurgicale pour échec ou récidive, 15 après BSU rétropubienne (1,6 %), 7 après bandelette transobturatrice (1,4 %) et 5 après mini-bandelette (1,4 % ; p = 0,95) (Fig. 1). La procédure a consisté à retendre la BSU (9 cas), injection de Bulkamid® (2 cas) et mise en place d’une seconde BSU (16 cas). Parmi les 1167 patientes contactées par courrier, 692 réponses (59,3 %) ont été retournées à un an ou plus après la chirurgie. À la question « Que pensez-vous de votre état de santé actuel par rapport à ce qu’il était avant votre chirurgie pour incontinence ou prolapsus ? » 91,4 % (608/665) se sentaient mieux (beaucoup mieux, mieux ou un peu mieux) (PGI-I). L’amélioration ressentie était meilleure en l’absence de complications graves ≥ III (p = 0,008). Parmi les patientes, 96,2 % (630/655) ont évalué leur état de santé général comme étant bon (très bon, bon ou assez bon). L’état de santé général ressenti était similaire qu’elles aient eu ou non des complications. Par rapport à la population française du même âge, les patientes opérées d’une BSU ont déclaré avoir un meilleur état de la santé.Conclusion : les premiers résultats du registre VIGI-MESH montrent que les mini-bandelettes sont une option thérapeutique avec une efficacité à moyen terme similaire aux voies rétropubiennes et transobturatrices avec moins de complications. Ils montrent également que plus de 90 % des patientes rapportent avoir été améliorées par la mise en place d’une BSU pour IUE. Le ressenti de l’état de santé global des patientes opérées était meilleur que celui de la population française féminine du même âge. Néanmoins, une analyse à plus long terme est nécessaire pour confirmer ces premiers résultats.

International audience; BackgroundReal-world data that support the use of sacral neuromodulation (SNM) for lower urinary tract dysfunctions are of continued interest.ObjectiveTo evaluate the effectiveness, quality of life (QoL), patient-reported outcomes (PROs), and safety of SNM with the InterStim™ system in real life during 1-yr postimplant.Design, setting, and participantsThis is a prospective, multicenter, observational study at 25 representative public and private French sites. Eligible patients received SNM therapy for overactive bladder (OAB) and non-obstructive urinary retention based on local standard of care. Overall, 320 patients were enrolled; 247 received permanent implant or replacement; 204 implanted patients completed second follow-up after mean of 10.0 ± 3.8 mo.Outcome measurements and statistical analysisEffectiveness outcomes were change in voids, leaks, and catheterizations/day. Other outcomes included validated QoL and disease severity scores as well as PROs and adverse event data. Outcomes at follow-ups were compared with baseline using the Wilcoxon signed-rank test.Results and limitationsVoids in urinary frequency (UF) and leaks/day in urinary urge incontinence (UI) patients were significantly reduced after 10 mo in both de novo (mean baseline voids/day UF de novo: 12.7 vs 8.6 after 10 mo; p < 0.001; mean baseline leaks/day UI de novo: 4.3 vs 1.1 after 10 mo; p < 0.001) and replacement patients (mean baseline voids/day UF replacement: 11.5 vs 7.9 after 10 mo; p < 0.001; mean baseline leaks/day UI replacement: 5.4 vs 1.0 after 10 mo; p < 0.001). Disease bother, Urinary Symptom Profile score, and Ditrovie questionnaire score were also significantly improved. Revisions postimplant occurred in 20% of patients including in 9% due to permanent explantation during a mean exposure time of 24.3 mo.ConclusionsThrough a real-life study, SOUNDS (Sacral neuromOdUlation with InterStim™ therapy for intractable lower uriNary tract DySfunctions) confirms the clinical effectiveness, safety, and positive effect of SNM on QoL and PROs for the treatment of OAB patients.Patient summaryThese analyses on French patients who received sacral neuromodulation (SNM) for retention or OAB during a 10-mo period showed that SNM improved OAB symptoms, quality of life, and reduced disease bother.Trial registrationClinicalTrials.gov: NCT02186041

International audience; Background: Stress urinary incontinence (SUI) is a major component of the post radical prostatectomy (RP) trifecta. Surgical treatments are sub-urethral slings, artificial urinary sphincter (AUS) and adjustable peri-urethral balloons (PUB) ProACT. All options are imperfect at best and persistent SUI is challenging when AUS is not manageable.Aims: This study analyzed the cumulate experience of our 2 centers with offering PUB implantation for SUI post RP in patients with insufficient improvement from slings.Materials & methods: This retrospective study reviewed all patients implanted with second line ProACT. The primary endpoint was continence, defined as 0 pads per day (PPD). The secondary endpoints were 50% decrease in PPD and increases in the Incontinence Quality of Life score (IQOL). Refilling and complications were reported.Results: Between 2007 and 2016, 26 patients were implanted. Five patients have had adjuvant radiotherapy (18%). The mean follow-up was 36 months (±20; min 14-max 128). All patient presented with persistent SUI, using 2.3 PPD (±1; min 1-max 6), and only one sling was removed due to infection. After ProACT with an average 3 mL refilling (±1.2 min 2-max 6), 18 patients (66.7%) were continent. Eight of the remaining patients (29.6%) were improved; their number of PPD decreased from 2.6 to 1. The average IQOL score of those 8 patients increased by 20 points, from 53.4 up to 74.2 (P = .005). Overall 26 patients (96.3%) were improved. The remaining patient was not implanted because of an intraoperative urethral injury and is considered a failed case (3.7%). He had instead an AUS implantation. Three patients (14.8%) needed PUB replacement.Conclusion: The limited population of patients from both our centers who presented with persistent SUI after RP, despite sling placement, improved with PUB ProACT implantations without significant complications.

International audience; Purpose:The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida.Materials and methods:All patients with spinal dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success.Results:A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (–12 cm H 2O, p

Objectifs L’instillation de dimethyl sulfoxide (iDMSO) realise sans anesthesie fait partie des options therapeutiques du syndrome de la douleur vesicale (SDV). Certains patients sont refractaires a ces iDMSO par mauvaise tolerance. Notre etude evalue la tolerance et les resultats des iDMSO sous anesthesie generale (AG) apres echec des iDMSO mal tolerees sans anesthesie. Methodes De mai 2013 a avril 2016, 11 patients avec un SDV, dont 9 femmes (81,8 %), d’âge moyen de 41,9 ans, ont ete traites par iDMSO sans anesthesie et etaient en echec par mauvaise tolerance empechant un temps de contact souhaite entre DMSO et vessie de 1 heure. Les 11 patients, etaient evalues par interrogatoire et questionnaires (catalogue mictionnel, Score Sant O’Leary). Tous avaient eu un test d’hydrodistension vesicale sous AG et un traitement per os par Cimetidine sans impact significatif sur leurs symptomes. Resultats Six nouvelles iDMSO etaient realisees sous AG en ambulatoire et etaient bien tolerees. Les moyennes d’intervalle mictionnel diurne et pollakiurie nocturne pre-iDMSO sans anesthesie et post-iDMSO sous AG etaient de 32,2 minutes (± 18,4) et 6,3 levers (± 2,6) et de 126,9 minutes (± 62,7 minutes) et de 3 levers (± 1,6) soit une variation de respectivement 96,4 minutes (± 54 minutes) et de 3,75 levers (± 1,6). Les scores symptomes et gene de Sant O’Leary etaient de 17,5 (± 2,9) et 15,5 (± 1,2) et de 13,5 (± 6) et 12 (± 5,8) ; soit une variation de 3 (± 4,1) et 4 (± 5,1). Conclusion Les iDMSO sous AG ameliorent significativement les patients refractaires aux instillations sans anesthesie par mauvaise tolerance. Ce mode d’instillations devrait etre utilise plus souvent pour le benefice des patients.

Introduction: Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage. Methods: The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use. Results: Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p=0.050), higher stone-free rates (SFRs) (2.8%; p

International audience; Objectifs : le prolapsus des organes pelviens (POP) de la femme est une situation fréquente qui mène dans 19 % des cas à un traitement chirurgical. Le registre VIGI-MESH a permis de collecter les interventions chirurgicales de POP dans 19 centres et à surveiller les complications et les révisions chirurgicales. Nous présentons ici les premiers résultats à moyen terme de notre registre.Méthodes : l’analyse comprend 2 341 patientes dont la chirurgie prévue était une promontofixation par laparoscopie avec prothèse (n = 1 143), une chirurgie transvaginale avec prothèse (n = 694) ou sans prothèse (n = 504). La promontofixation a été converti dix fois (0,9 %) : 5 par laparotomie, 2 fixations latérales par laparoscopie, 3 voies transvaginale dont 2 avec prothèse. Les patientes étaient plus jeunes, avec moins de comorbidités dans le groupe promontofixation, et avec plus d’antécédents chirurgicaux chez les patients opérés par voie vaginale. Il y a une majorité de chirurgie avec prothèse en cas de prolapsus antérieur ou apical.Résultats : avec 15 mois de suivi médian, nous avons observé des complications Clavien–Dindo grade III ou plus chez 48 patientes (2,05 %). L’incidence de complications graves à 12 mois est significativement supérieure pour la réparation vaginale prothétique soit 3,71 % [2,28–5,13] versus 1,27 pour la réparation vaginale non prothétique [0,25–2,29] et 1,44 pour la promontofixation [0,71–2,167] avec p = 0,005 (Fig. 1). Il y a 29 réinterventions (1,24 %) en raison d’échec ou de récidive du prolapsus : 11 après promontofixation (0,96 %), 6 après prothèse vaginale (0,86 %) et 12 après réparation vaginale autologue (2,38 %). La réparation vaginale native comporte un risque de reprise chirurgicale pour prolapsus récidivé trois fois plus élevé qu’en cas de promontofixation (RR 0,34 [0,15–0,77]) ou de prothèse vaginale (RR = 0,29 [0,11–0,76]) .Conclusion : dans notre registre, la promontofixation présente le meilleur ratio bénéfice/risque par rapport à la réparation vaginale. Cette dernière expose à un faible risque de complications en cas de réparation autologue mais avec un risque de récidive 3 fois plus élevé et à l’inverse à un faible risque de récidive en cas de chirurgie prothétique mais avec un risque de complication grave 3 fois plus élevé.

Objectifs Il existe a ce jour peu de donnees sur les facteurs associes aux causes specifiques de revision d’un sphincter artificiel urinaire (SAU) chez l’homme et les resultats des differentes strategies de prise en charge. L’objectif principal de cette etude etait d’evaluer les facteurs lies aux deux grandes causes d’echec : les defaillances mecaniques pures et les defaillances non mecaniques. Methodes Les dossiers de tous les patients de sexe masculin ayant eu l’implantation d’un SAU entre 2004 et 2020 dans 12 centres universitaires ont ete revus retrospectivement. Les patients ayant une incontinence d’effort d’origine neurogene etaient exclus. Les causes de revision etaient divisees en : defaillances mecaniques (systeme perce et/ou bloque), defaillances non mecaniques (atrophie uretrale, recidive/persistance incontinence malgre dispositif fonctionnel) et autres (repositionnement pompe, hernie reservoir, douleurs). L’indication etait categorisee en : prostatectomie radicale (PR), chirurgie endoscopique de la prostate (ENDO), radiotherapie pelvienne (RAD) ou chirurgie pelvienne (PELV). Les facteurs predictifs de dysfonctions mecaniques et non mecaniques etaient determines par modele de regression de Cox. Resultats Mille cent-sept patients repondaient aux criteres d’inclusion. L’âge median etait de 70 ans [65–75], l’etiologie de l’incontinence etait dans 85,9 % (n = 920) des cas la PR et dans 8,4 % des cas (n = 90) une ENDO. Il y avait 76,8 % de patients ayant recouvre une continence sociale a 3 mois. Apres un suivi median de 25 mois, il y avait eu 158 revisions (14,3 %) : 45 defaillances mecaniques, 93 defaillances non mecaniques et 20 causes autres. Les facteurs associes a la defaillance non mecanique etaient le score de Charlson (HR = 1,27 ; IC95 % : 1,06–1,50 ; p = 0,01) et la position transcaverneuse de la manchette (HR = 2 ; IC95 % : 1,01–3,61 ; p = 0,04 ; Fig. 1 ). Ces deux facteurs restaient associes a la defaillance non mecanique en analyse multivariee ajustant sur le volume annuel du centre, la voie d’abord, et l’antecedent de radiotherapie (HR = 1,21 ; p = 0,04 et HR = 2,86 ; p = 0,02, respectivement). Conclusion Les defaillances non mecaniques constituent la premiere cause de revision d’un SAU chez l’homme. Leurs principaux facteurs de risque sont les comorbidites (score de Charlson) et la position transcaverneuse de la manchette.

Objectifs L’impact du volume d’activite annuel, largement etudie en onco-urologie, n’a ete que tres peu evalue en urologie fonctionnelle. L’objectif principal de cette etude etait d’evaluer l’impact du volume annuel d’implantation de chaque centre sur les Resultats du sphincter artificiel urinaire (SAU) chez l’homme. Methodes Les dossiers de tous les patients de sexe masculin ayant eu l’implantation d’un SAU entre 2004 et 2020 dans 11 centres universitaires ont ete revus retrospectivement. Les patients ayant une incontinence d’effort d’origine neurogene etaient exclus. Deux groupes de volume ont ete constitues : Resultats Mille cinquante patients repondaient aux criteres d’inclusion : 527 dans le groupe FAIBLEVOL et 523 dans le groupe HAUTVOL. Le taux de complications postoperatoires etait plus eleve dans le groupe FAIBLEVOL (17,1 % vs 11,9 % ; p = 0,03) de meme que le taux de complications Clavien ≥ 3 (6,1 % vs 2,3 % ; p Fig. 1 , Tableau 1 , Tableau 2 ). Conclusion Le volume annuel d’implantation de SAU n’avait pas d’impact sur les resultats fonctionnels mais les centres implantant > 10 SAU chez l’homme avaient de meilleurs resultats perioperatoires. A l’inverse, de facon surprenante, la survie sans revision etait meilleure dans les groupes de faible volume.

Resume But La bandelette sous-uretrale (BSU) s’est imposee comme un des traitements courants de l’incontinence urinaire d’effort (IUE) feminine. Le but de cette etude etait d’evaluer les resultats de la BSU trans-obturatrice apres un recul fixe de 10 ans. Materiel Etude retrospective realisee sur une cohorte de patientes suivies entre novembre 2002 et novembre 2004. Soixante-treize patientes operees d’une bandelette sous uretrale-transobturator tape (BSU-TOT) pendant cette periode et ayant un recul d’au moins 10 ans ont ete incluses dans notre etude. L’indication chirurgicale etait posee sur une IUE mais 26 (35,6 %) patientes presentaient une incontinence urinaire mixte. L’appreciation du resultat de BSU-TOT etait recueillie par un questionnaire telephonique. Les questions portaient sur la presence ou non de fuites urinaires, leur abondance, sur le caractere a l’effort ou non, le nombre de protections par jour et par nuit, la satisfaction de l’intervention. Un questionnaire Ditrovie a egalement ete envoye par courrier postal. Resultats Sur les 73 patientes, 5 patientes ont ete exclues. Soixante-huit patientes ont ete contactees. Le taux de reponse etait de 72 %. Trente-quatre patientes (69,3 %) decrivaient des episodes d’incontinence urinaire (52,9 % a l’effort et 47,1 % par urgenturie). Quinze patientes (30,7 %) etaient continentes. Parmi les 34 patientes qui avaient des fuites, 26 (76,5 %) portaient des protections la journee et 18 (52,9 %) devaient la changer au moins une fois. Douze (35,3 %) patientes devaient porter des protections la nuit et trois (8,8 %) devaient la changer au moins une fois. Trente-neuf patientes (79,6 %) se disaient satisfaites de l’intervention. Vingt-neuf patientes ont rempli le questionnaire Ditrovie (42,6 %). La moyenne du score Ditrovie a 10 ans etait de 1,6 ± 0,7 avec une nette amelioration par rapport au score Ditrovie preoperatoire. Les limites de l’etude etaient le caractere retrospectif, l’absence de questionnaire valide, le caractere declaratif exclusif. Conclusion Cette etude aux limites nombreuses a montre un taux de satisfaction eleve 10 ans apres un traitement par BSU de type TOT malgre un taux subjectif de recidive de l’incontinence urinaire important. Niveau de preuve 4.

To evaluate medical treatments, in terms of adverse events (AEs) and therapeutic goals, in a large series of patients with cystinuria.Data from 442 patients with cystinuria were recorded retrospectively. Crystalluria was studied in 89 patients. A mixed-effects logistic regression model was used to estimate how urine pH, specific gravity and cysteine-binding thiols (CBT) correlate with risk of cystine crystalluria.Alkalizing agents and CBT agents were given to 88.8% (n = 381) and 55.3% (n = 238) of patients, respectively. Gastrointestinal AEs were reported in 12.3%, 10.4% and 2.6% of patients treated with potassium bicarbonate, potassium citrate and sodium bicarbonate, respectively (P = 0.008). The percentages of patients who experienced at least one AE with tiopronin (24.6%) and with D-penicillamine (29.5%) were similar (P = 0.45). Increasing urine pH and decreasing urine specific gravity significantly reduced the risk of cystine crystalluria, whereas D-penicillamine and tiopronin treatments did not reduce this risk (odds ratio [OR] 1 for pH ≤6.5; OR 0.52 [95% confidence interval {95% CI} 0.28-0.95] for 7.0pH ≤7.5, P = 0.03; OR 0.26 [95% CI 0.13-0.53] for 7.5pH ≤8.0, P0.001; OR 1 for specific gravity ≤1.005 OR 5.76 [95% CI 1.45-22.85] for 1.006 ≤ specific gravity ≤1.010, P = 0.01; and OR 11.06 [95% CI 2.76-44.26] for 1.011 ≤ specific gravity ≤ 1.014, P0.001). Increased urine pH significantly increased the risk of calcium phosphate crystalluria (OR 1 for pH≤ 6.5; OR 6.09 [95% CI 2.15-17.25] for pH8.0, P0.001).Adverse events were frequent with D-penicillamine and tiopronin. Alkaline hyperdiuresis was well tolerated and reduced cystine crystalluria. Urine specific gravity ≤1.005 and urine pH7.5, while warning about calcium-phosphate crystallization, should be the goals of medical therapy.

Background: The aim of this study was to report the outcomes of artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency after a follow up of 10 years. Methods: The charts of female patients with moderate-to-severe SUI who underwent open AUS implantation between November 1994 and April 2007 were reviewed retrospectively. All patients were operated on by a single experienced surgeon through an open retropubic approach with systematic bladder incision. Primary endpoint was postoperative continence categorized as complete continence (no pads used), improved incontinence, or unchanged incontinence. Results: A total of 63 women (mean age: 58 years, range: 17–82) underwent open AUS implantation. There were seven (11.1%) intraoperative complications. At the last follow up, 26 (41.3%) initial AUSs remained in situ and 21 (33.3%) patients had at least one revision or reimplantation. Of these 47 patients (74.6%), 35 (74.5%) were fully continent, 3 (6.4%) had improved incontinence, and 9 (19.1%) had unchanged incontinence. A total of 20 patients (31.7%) experienced postoperative complications, but only 2 (3.2%) were Clavien ⩾3. After a median follow up of 14 ± 6 years, 20 (31.7%) explantations and 29 (46%) revisions occurred. The average time without explantation or revision was 11.6 and 9 years, respectively. Conclusions: In our experience, AUS is a good option for women with moderate to severe SUI, with good long-term outcomes.

INTRODUCTION AND OBJECTIVES:Pelvic organ prolapse (POP) is a frequent and invalidating condition in women, and surgery is an option for women with troublesome prolapse. The challenge in prolapse re...

To assess tolerance and mid-term clinical outcomes of treatment, with a new four-arm mesh sling, of post-prostatectomy incontinence (PPI) in men.This was a French multicentre prospective study that included 93 patients who underwent radical prostatectomy at least 1 year before Surgimesh M-SLING(®) implantation for the treatment of PPI. Data were collected preoperatively, and patients were followed at 3, 12 and 24 months postoperatively. Objective outcome measures included number of pads per day, 24-h pad-test, maximum urinary flow rate (Qmax ) and urinary retention. We also analysed Urinary Symptom Profile (USP(®) ) score, degree of erectile dysfunction, patients' satisfaction level, postoperative pain and procedure complications. Length of catheterization and hospitalization periods were also recorded. Patients were considered cured if no protection was used and/or daily pad weight was2 g. Patients whose condition was considered to have improved reduced their daily urinary losses by50%. Those not included in any of the aforementioned groups were assessed as unchanged or to have deteriorated, and were considered as treatment failures.The mean hospitalization period was 1.57 ± 0.70 days. All patients remained catheterized for 1.17 ± 0.48 days. Intention-to-treat analysis at 24 months showed that 34.4% of patients were cured, 27.1% had improved, and 19.4% were considered failures. Two patients experienced transient urinary retention. USP questionnaire scores showed a significant decrease in incontinence and prevalence of hyperactive bladder. There was a nonsignificant tendency for reduced severe erectile dysfunction (ED), and a shift towards moderate ED was observed. No severe complications occurred.The Surgimesh M-SLING transobturator and prepubic four-arm urethral sling represents an easy-to-deploy, safe and durable therapeutic alternative for mild to moderate PPI. Its implantation did not have a negative influence on sexual performance outcomes.

Resume Introduction A ce jour, il n’existe ni definition de l’echec d’une premiere injection intra-detrusorienne de toxine botulique Botox ® 200 U pour hyperactivite detrusorienne neurogene (HDN), ni recommandation sur sa prise en charge. L’objectif principal de cette enquete etait de determiner la definition en pratique de cet echec et l’objectif secondaire de rapporter les pratiques actuelles dans sa prise en charge. Materiels et methodes Un questionnaire, etabli en s’appuyant sur les donnees de la litterature, a ete envoye par courrier electronique aux experts membres du comite de neuro-urologie de l’Association francaise d’urologie et du Groupe d’etude en neuro-urologie de langue francaise. Il leurs etait demande de completer le questionnaire en ligne. Les experts n’ayant pas repondu au premier courrier ont ete chacun sollicites deux fois, toujours par courrier electronique. Resultats Vingt et un des 42 experts sollicites ont repondu au questionnaire. Pour 19 des experts (90,5 %), la definition de l’echec etait une combinaison de criteres cliniques et urodynamiques. Parmi les criteres urodynamiques proposes, la persistance d’une pression detrusorienne > 40 cm H 2 O etait le plus plebiscite (18/21 ; 85,7 %). Dix-neuf experts (19/21 ; 90,5 %) consideraient que l’effet de la toxine botulique sur l’incontinence urinaire devait etre pris en compte dans la definition de l’echec. Concernant la prise en charge de l’echec, une large majorite des participants (15/20 ; 75 %) consideraient que le traitement de premiere ligne en cas d’echec d’une premiere injection de Botox ® 200 U devrait etre une injection de Botox ® a un dosage plus eleve (300 U) qu’il y ait ou non des facteurs de risque urodynamiques (16/20 ; 80 %). Conclusion Ce travail a permis d’obtenir une premiere vue d’ensemble de la definition de l’echec des injections intra-detrusoriennes de toxine botulique dans l’HDN et de sa prise en charge. Pour 90,5 % des experts repondeurs, la definition de l’echec des injections intra-detrusoriennes de toxine botulique pour HDN devrait etre clinique et urodynamique et 75 % des personnes ayant repondu consideraient qu’en cas d’echec d’une premiere injection de Botox ® 200 U, la reinjection de Botox ® a la dose de 300 U etait l’option therapeutique a preferer. Niveau de preuve 4.

Objectifs Le sphincter urinaire artificiel est considere comme le traitement de reference de l’incontinence urinaire de l’homme par insuffisance sphincterienne. L’objectif de notre etude etait de comparer les resultats fonctionnels et les complications de la voie peno-scrotale et de la voie perineale pour l’implantation d’un sphincter urinaire artificiel. Methodes Une etude retrospective, multicentrique, comparant les resultats perioperatoires et a long terme, des primo-implantations de sphincter urinaire artificiel chez l’homme, realisees par voie peno-scrotale ou par voie perineale a ete menee dans plusieurs centre francais. Les patients ayant un antecedent d’implantation de sphincter urinaire artificiel, ceux qui avaient une manchette periprostatique, sous-cervicale, transcaverneuse, ou une double manchette, ainsi que ceux dont les donnees sur la voie d’abord chirurgicale etaient manquantes ont ete exclus. Les patients ayant deja eu un traitement chirurgical d’incontinence urinaire autre qu’un sphincter urinaire artificiel, ou un antecedent de stenose uretrale n’ont pas ete exclus. Resultats Entre janvier 1991 et mars 2020, 965 patients ont ete implantes (369 par voie peno-scrotale et 596 par voie perineale). Le suivi moyen etait de 41,1 ± 44,4 mois. La taille des manchettes implantees etait inferieure dans le groupe peno-scrotale (41,3 ± 4,26 vs 45,6 ± 6,68 ; p En fin de suivi, il n’y avait pas de difference significative concernant le taux de continence sociale (79 % vs 77 % ; p = 0,56), il y avait plus de patient sec dans le groupe peno-scrotal (64 % vs 44 % ; p Conclusion Les resultats de la voie peno-scrotale etaient equivalents a la voie perineale, avec cependant plus de patients secs et moins de revision dans le groupe peno-scrotal. Des etudes prospectives multicentriques sont necessaires afin de confirmer ces resultats.