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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.

The BEEC complex is the result of a failed cavitation and separation of the pelvic organs and a failed closure of the pelvic ring. During the first 2 months of gestation, the embryo (germinal disc) is subjected to a complex process (delimitation) [1] of cranio-caudal tubularization resulting in the cavitation and connection of the pelvic organs to the pelvic floor. This leads to the creation of separated urinary, genital and intestinal cavities independently connected to the perineal surface by distinct conduits and their corresponding sphincter. If the delimitation process is interrupted early, the distal bowels, the bladder and the urethra are not individualized and appear as contiguous and often duplicated plates. This is a cloacal exstrophy and is often associated with other abnormalities. If the process halts later in the gestation, the bowels are properly formed and connected, but the bladder and urethra are both widely open, presenting as a classical bladder exstrophy. Finally, when the process stops late, only the urethra and the urethral sphincter are open and incompetent, presenting as an epispadias. Depending on the timing of the cavitation failure, one should distinguish posterior epispadias where the sphincteric mechanisms are involved and the child incontinent at various degrees and anterior epispadias where the continence mechanisms are completely or partially respected but the genital tubercle remains abnormal. Epispadias exists both in males and females.

Osteoclast-associated receptor (OSCAR) is a costimulatory receptor implicated in osteoclast differentiation, with soluble and membranous forms.1 Its natural ligand appears to be collagen.2 Since the involvement of OSCAR in rheumatoid arthritis (RA) has been suggested,3 the present work assessed the levels of soluble OSCAR (sOSCAR) in RA and a possible link with disease severity and risk of cardiovascular events (CVE).4 sOSCAR was measured by indirect ELISA in 136 plasma samples from RA patients randomly selected from a large database according to the level of joint destruction at a 1:1 ratio and paired for sex and age. Clinical markers of disease severity and incidence of CVE are summarised in table 1. CVE (myocardial infarction, acute limb ischaemia, stoke, etc) were collected from the hospital chart and with a questionnaire to the patient and/or family physician. Only patients with CVE during the RA course were included. …