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Résumé. Tout le monde a connu l’incontinence, dès le plus jeune âge. Elle affecterait cependant encore 200 millions de personnes dans le monde à l’âge adulte. Cette pathologie du quotidien est relativement peu rapportée des patient(e)s, mais limite la vie sociale de façon parfois dramatique. Sous réserve d’un sous-diagnostic pertinent, l’incontinence urinaire est une pathologie traitable avec des résultats élevés. Cet article propose une revue de la sémiologie essentielle ainsi que des traitements actuels afin que tout clinicien confronté au problème adopte une prise en charge adéquate.

Emerging in the last decades, sacral neuromodulation remains an underknown therapy in the general population and even in the medical field. It has proven itself in the treatment of urinary dysfunctions, such as overactive bladder syndrome and chronic non-obstructive urinary retention. Numerous applications are currently being validated and the innovations made open up encouraging prospects. This article aims to introduce the modalities of the intervention and to present the established and future medical indications of sacral neuromodulation.Émergeant au cours des dernières décennies, la neuromodulation sacrée reste une thérapie méconnue de la population et de la plupart du corps médical. Pourtant, elle a bien fait ses preuves dans la prise en charge des dysfonctionnements vésico-sphinctériens, comme le syndrome de la vessie hyperactive et la rétention urinaire chronique non obstructive. De nombreuses autres applications sont en cours de validation et les innovations apportées ouvrent des perspectives encourageantes. Cet article a pour objectif de présenter les modalités de l’intervention ainsi que les indications médicales établies et futures de la neuromodulation sacrée.

Stress urinary incontinence (SUI) in men is common, radical prostatectomy (RP) remaining its main cause. Despite improvements in surgical techniques, SUI rates range from 5 % to 48 %. Management begins with non-invasive and conservative methods. Surgical treatment includes implantation of an artificial urinary sphincter, a suburethral sling or periurethral balloons. This article summarizes the surgical treatments for male SUI.L’incontinence urinaire d’effort (IUE) chez l’homme est fréquente et a comme cause principale la prostatectomie radicale (PR). Malgré les progrès des techniques chirurgicales, les taux d’IUE se situent entre 5 et 48 %. La prise en charge débute par des méthodes non invasives et conservatrices. Le traitement chirurgical comprend l’implantation d’un sphincter urinaire artificiel, d’une bandelette sous-urétrale ou de ballonnets péri-urétraux. Dans cet article, nous résumons les traitements chirurgicaux de l’IUE chez l’homme.

Urinary tract infections (UTIs) are one of the main causes of morbidity and mortality in patients with neurogenic lower urinary tract dysfunction (nLUTD). In most cases, these are patients whose symptoms manifest differently from non-neurological patients, and it can be difficult to decide whether the infection should be treated or whether it is asymptomatic bacteriuria for which treatment is not indicated. Recurrent urinary tract infections should be investigated for an underlying urological cause. This article reviews the diagnosis and management of urinary tract infections in adults with neurogenic lower urinary tract dysfunction.Les infections urinaires sont l’une des principales causes de morbidité et mortalité chez les patients souffrant d’une dysfonction neurogène du bas appareil urinaire (nLUTD) d’origine médullaire. Dans la plupart des cas, les symptômes se manifestent différemment des patients non neurologiques. Il peut être difficile de décider si l’infection doit être traitée ou s’il s’agit d’une bactériurie asymptomatique pour laquelle le traitement n’est pas indiqué. Les infections urinaires récidivantes doivent faire rechercher une cause urologique sous-jacente. Cet article revoit le diagnostic et la prise en charge des infections urinaires de l’adulte atteint d’un dysfonctionnement neurogène du bas appareil urinaire.

To evaluate Enhanced recovery after surgery (ERAS®) protocol on oncological outcomes for patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).A prospectively maintained single-institutional database comprising 160 consecutive UCB patients who underwent open RC from 2012 to 2020 was analyzed. Patients receiving chemotherapy and those with a urinary diversion other than ileal conduit were excluded. Patients were divided into two groups according to the perioperative management (ERAS® and pre-ERAS®). The study aimed to evaluate the impact of the ERAS® protocol on survival at five years after surgery using a Kaplan-Meier log-rank test. A multivariable Cox proportional hazards model was used to identify prognostic factors for cancer-specific (CSS) and overall survival (OS).Of the 107 patients considered for the final analysis, 74 (69%) were included in the ERAS® group. Median follow-up for patients alive at last follow-up was 28 months (interquartile range [IQR] 12-48). Five-years CSS rate was 74% for ERAS® patients, compared to 48% for the control population (P = 0.02), while 5-years OS was 31% higher in the ERAS® (67% vs. 36%, P = .003). In the multivariable analysis, ERAS® protocol and tumor stage were independent factors of CSS, while ERAS®, tumor stage so as total blood loss were independent factors for OS.A dedicated ERAS® protocol for UCB patients treated with RC has a significant impact on survival. Reduction of stress after a major surgery and its potential improvement of perioperative patient's immunity may explain these data.

Background Augmentation cystoplasty as a third-line therapy for neurogenic detrusor overactivity performed by an open approach has long been studied. Few laparoscopic and robot-assisted series have been reported. Objective To evaluate the feasibility, safety, and functional outcomes of completely intracorporeal robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RASCAC) in patients with refractory neurogenic detrusor overactivity. Design, setting, and participants We identified all patients undergoing RASCAC, as treatment for refractory neurogenic detrusor overactivity, from August 2016 to April 2018. Surgical procedure RASCAC was performed in all cases using a standardized technique with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in a four-arm configuration. Measurements Perioperative data, and functional and urodynamic results at 1-yr follow-up were assessed. Statistical analysis was performed using Stata version 15.1. Results and limitations Ten patients were identified. No conversion to open surgery was needed. The median operative time was 250 (interquartile range 210–268) min, the median estimated blood loss was 75 (50–255) ml, and the median hospitalization time was 12 (10.5–13) d. The 30-d major complication rate was 10%. Two patients presented a late urinary fistula; in one of the cases, surgical revision was needed. In both cases, low compliance to intermittent self-catheterization was identified. At 1-yr follow-up, functional and urodynamic outcomes were excellent. Conclusions Robot-assisted augmentation cystoplasty has been shown to be safe and feasible, with a reasonable operative time and low complication rate in experienced hands. A higher number of patients and longer follow-up are, however, warranted to draw definitive conclusions. Patient summary In this report, we look at the outcomes of robot-assisted supratrigonal cystectomy and augmentation cystoplasty in neurourological patients. Perioperative, functional, and urodynamic results are promising. Further studies with a longer follow-up are needed to confirm these findings.

Urinary incontinence: a good diagnosis as a basis for treatment

Renal function evaluation is a key factor in the long-term follow-up of patients with neurogenic bladder dysfunction. It is as crucial as complex, since many of the tests available nowadays, lack accuracy, particularly in this group of patients [1]. Lawrenson et al. showed that patients with neural tube defects have an eightfold greater risk of developing renal failure, whereas spinal cord injury patients present a fivefold greater risk [2]. As it would be expected, this risk increases exponentially with age. In multiple sclerosis, the overall risk of upper tract damage is considerably lower, being almost similar to the general population [3–5]. Whatever the neurological condition, an accurate renal function evaluation is then key to early diagnosis and follow-up of various kidney diseases in this group of patients.

Context The use of the artificial urinary sphincter (AUS) for female non-neurogenic severe stress urinary incontinence (SUI) due to sphincter deficiency is either not specifically registered and/or reimbursed in some countries worldwide, as opposed to males, in whom it is considered the gold standard. With waning popularity of synthetic midurethral slings for the treatment of SUI, evidence-based assessment of AUS performance and safety is mandatory for patient counselling. Objective To conduct a systematic review of studies evaluating short- to long-term AUS performance and safety outcomes in non-neurogenic adult females with severe SUI. Evidence acquisition PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched, from 1987 to 2018, without language restriction. Included studies had to report outcomes after AUS implantation in at least five adult women with non-neurogenic SUI, after a minimum follow-up of 6 months. Evidence synthesis Twelve articles collecting data from 886 patients were identified, no study being randomised or prospective. The reported zero pad rates ranged from 42% to 86%, revision rates from 6% to 44%, and mechanical failure rates from 2% to 41%. Procedure serious adverse event rates ranged from 2% to 54% and rates of serious adverse device effects such as explantation ranged from 2% to 27%. Conclusions The level of evidence supporting the use of an AUS for non-neurogenic SUI in women is very low. AUS outcome assessments necessitate well-designed randomised trials, in accordance with current evidence-based medicine requirements. Patient summary In this article, reviewing the scientific literature over the last 30 yr, we looked at the short- to long-term efficacy and safety of the artificial urinary sphincter in adult women for the treatment of severe urine leakage. We conclude that the data analysed provide very low evidence and that further well-conducted trials with large populations are required.

Surgical treatments for female stress urinary incontinence is in perpetual evolution. This article reviews the current surgical treatments for stress urinary incontinence in female. Bulking agents, Burch colposuspension, autologous sling, midurethral slings, single incision slings, artificial urinary sphincter and adjustable continence therapy (ACT) are discussed.Les traitements chirurgicaux de l’incontinence urinaire d’effort chez la femme sont en perpétuelle évolution. Cet article passe en revue les options actuelles de traitement chirurgical de l’incontinence urinaire d’effort chez la femme. Les injections péri-urétrales d’agents de comblement, la colposuspension selon Burch, la bandelette sous-urétrale aponévrotique, les bandelettes sous-urétrales synthétiques, les mini-bandelettes (

Tourism is nowadays one of the world’s main social and economic activities, who’s origin dates to more than two millennia ago. Gamification, on the other hand, is a recent topic only initially referenced in 2008, and which became a subject of wide study in the present decade and has been applied to several sectors due to its capacity of improving experience, shaping user behaviour, motivating desired behaviours, increasing brand awareness among other advantages. Tourism has been no exception in the implementation of gamification, although appliance and research are still scarce on this subject compared to others. Existing technology provides tourists with an easy access to pricing information, therefor no longer can businesses in this sector effectively differentiate themselves through price, but rather being forced to adopt a differentiated service offer. Existing research concludes that gamification can be used to enhance tourist experiences and improve loyalty. This paper aims to contribute to this growing subject by testing the effect of using gamification in the context of visits to historical sites. We conducted a qualitative survey which first analysed the requirements that tourists have on the context of a visit to historical sites and based on that information designed a mobile application with game elements which aims to aid their visit and improve their satisfaction. The analysis of the developed prototype suggests that gamification does represent a well-designed way to present sites, shape user behaviour, aid visit and increase satisfaction through the creation of an interactive and informational environment. O turismo é uma das principais atividades sociais e económicas do mundo originada há mais de dois milênios atrás. Por outro lado, a gamificação é um tópico recente, referenciado inicialmente em 2008, que se tornou objeto de amplo estudo na década atual, tendo vindo a ser aplicado a vários sectores devido à sua capacidade de melhorar a experiência, moldar comportamento, aumentar reconhecimento de marca, entre outras vantagens. O turismo não foi uma exceção na implementação da gamificação, embora a sua aplicação e pesquisa sejam ainda escassas nesta área em comparação com outras. Atualmente, devido ao fácil acesso que os turistas possuem a informação relativa a preços, é cada vez mais necessário que as diversas ofertas turísticas existentes se distingam através da criação de serviços diferenciados, podendo-se recorrer à gamificação neste contexto para aprimorar as experiências turísticas e aumentar a lealdade dos clientes. Este artigo tem como objetivo contribuir para a pesquisa existente, testando o efeito do uso da gamificação no contexto de visitas a locais históricos. Realizamos uma pesquisa qualitativa que analisou primeiro os requisitos que os turistas têm no contexto de visita a estes locais, e com base nos resultados obtidos, projetamos uma aplicação móvel com elementos de jogo que visa auxiliar a visita e melhorar a satisfação. A análise do protótipo desenvolvido sugere que a gamificação representa uma maneira bem projetada de apresentar locais de interesse cultural, moldar o comportamento do utilizador, auxiliar a visita e aumentar a satisfação através da criação de um ambiente interativo e informativo.

INTRODUCTION AND OBJECTIVES:The objective of this study is to analyze the outcome of bladder neck/urethral closure as a treatment option for neurogenic and malformative stress incontinence in women...

Urine dipstick is a widely used and easily available test of screening for urinary tract infections (UTI). Its ability of detection of an UTI relies in two parameters, the presence of leukocytes and nitrites in the examined urine.