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IntroductionPeyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations.Materials and methodsThese recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography.ResultsThe assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered.ConclusionThe management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience., IntroductionLa maladie de Lapeyronie est un motif fréquent de consultation en urologie, dont le traitement reste sujet à de nombreuses controverses. Elle n’a fait l’objet d’aucune recommandation française jusqu’à présent. Le Comité d’Andrologie et de Médecine Sexuelle de l’Association Française d’Urologie propose donc une série de recommandations basées sur les preuves.Matériels et méthodesCes recommandations sont réalisées selon la méthode ADAPTE, en se basant sur les recommandations européennes (EAU, ESSM), américaines (AUA, ISSM) et canadiennes (CAU), en intégrant les spécificités françaises en raison de la disponibilité des traitements, et une mise à jour de la bibliographie récente.RésultatsL’évaluation de la maladie est clinique. Les patients présentant une gêne fonctionnelle ou un retentissement psychologique important peuvent se voir proposer un traitement. Les bénéfices et inconvénients de chaque traitement devront être explicités au patient. Concernant les traitements non chirurgicaux, aucun traitement disponible n’a l’autorisation de mise sur le marché en France. La vitamine E n’est pas recommandée. Des traitements à visée antalgiques (oraux ou ondes de choc de faible intensité) ou pro-érectiles peuvent être proposée selon le besoin, ainsi qu’une thérapie par traction. En raison de l’indisponibilité des injections de collagénase, les injections de vérapamil peuvent être proposées. Les traitements chirurgicaux sont à considérer en phase stabilisée de la maladie, et consistent en la réalisation d’une plicature, d’une incision-greffe ou de la pose d’un implant pénien en fonction du souhait du patient, de la courbure et de la taille de verge, ainsi que de la fonction érectile. Des traitements combinés peuvent être proposés.ConclusionLa prise en charge de la maladie de Lapeyronie est complexe, et les niveaux de preuve des traitements sont faibles dans l’ensemble. Le succès du traitement dépendra de la qualité de l’évaluation initiale, de l’information du patient et de sa compréhension des effets attendus, et de l’expérience du praticien.

Resume Contexte Des essais cliniques de therapie cellulaire ont recemment ete conduits pour la dysfonction erectile (DE) et la maladie de la Peyronie apres une phase de recherche fondamentale. Objectifs Mise au point sur les biotherapies de la DE et de la maladie de la Peyronie, et description du cadre reglementaire regissant ces nouvelles strategies therapeutiques. Sources documentaires Revue de la litterature sur PubMed et Clinical.trials.gov avec les principaux mots-clefs suivants : « erectile dysfunction », « Peyronie's disease », « stem cell », et « platelet-rich plasma ». Resultats et limites La recherche fondamentale a montre la possibilite d’ameliorer la fonction erectile dans des modeles murins de DE post-prostatectomie radicale ou metabolique. Les sources biologiques testees sont la moelle osseuse, le tissus adipeux et le sang (PRP, plasma riche en plaquette). Le mode d’action de ces biotherapies est probablement temporaire et principalement de nature paracrine. Quatre essais cliniques ont ete publies dans le cadre de la DE post-prostatectomie radicale ou chez des patients diabetiques, et 1 autre pour la maladie de la Peyronie. Onze essais cliniques dont trois randomises sont en cours pour les DE organiques. Les premiers resultats suggerent la possibilite d’ameliorer la fonction erectile spontanee et la reponse au traitement medical (chez des patients initialement non repondeurs) via une amelioration de la vascularisation penienne. Une reduction de la courbure penienne a ete notee apres injection cellulaire dans la plaque de la Peyronie. Aucun effet secondaire n’a ete rapporte. La plupart des procedes testes sont considerees comme des « medicaments de therapie innovante » avec des contraintes reglementaires lourdes, notamment s’il existe une modification « substantielle » des cellules. Pour les procedures de biotherapie extemporanee, sans modification substantielle et utilisant un tissu homologue, la qualification reglementaire reste floue et beaucoup plus permissive. Conclusion Les premiers resultats cliniques de biotherapie pour DE sont prometteurs. Le cadre reglementaire peut varier considerablement selon le mode de preparation des cellules a injecter et leur origine, generant ainsi des contraintes radicalement differentes pour un meme effet recherche. Cet aspect reglementaire est un facteur decisif a prendre en compte pour le choix de la procedure.

Peyronie's disease is a common cause for consultation in urology. Many controversies surround its treatment. No French Guidelines have been published so far. The Committee of Andrology and Sexual Medicine of the French Association of Urology therefore offers a series of evidence-based recommendations.These recommendations are made according to the ADAPTE method, based on European (EAU, ESSM), American (AUA, ISSM) and Canadian (CAU) recommendations, integrating French specificities due to the availability of treatments, and an update of the recent bibliography.The assessment of the disease is clinical. Patients with functional impairment or significant psychological repercussions may be offered treatment. The benefits and drawbacks of each treatment should be explained to the patient. Regarding non-surgical treatments, no available treatment has market authorization in France. Vitamin E is not recommended. Analgesic (oral or low-intensity shock waves) or proerectile treatments may be offered as needed, as well as traction therapy. Due to the unavailability of collagenase injections, verapamil injections may be offered. Surgical treatments are to be considered in the stabilized phase of the disease, and consist of performing a plication, an incision-graft or the placement of a penile implant according to the patient's wishes, the curvature and the penis size, as well as erectile function. Combination treatments can be offered.The management of Peyronie's disease is complex, and the levels of evidence for treatments are generally low. The success of treatment will depend on the quality of the initial assessment, the patient's information and understanding of the expected effects, and the practitioner's experience.

Clinical trials of cell therapy for erectile dysfunction (ED) and Peyronie's disease (PD) were recently conducted after preclinical studies.The aims of this study are to give an update on biotherapy for ED and PD and to describe the regulatory framework for these therapies.A literature review was performed through PubMed and Clinical.trials.gov addressing cell therapy for ED and PD and using following keywords "erectile dysfunction", "Peyronie's disease", "stem cell", and "platelet-rich plasma".Preclinical studies in rodent models have shown the potential benefit of cell therapy for ED after radical prostatectomy or caused by metabolic diseases, and PD. The tissues used to obtain the therapeutic product were bone marrow, adipose tissue and blood (PRP, platelet-rich plasma). Mechanism of action was shown to be temporary and mainly paracrine. Four clinical trials were published concerning ED after radical prostatectomy and in diabetic patients and one for PD. Eleven clinical trials including three randomized trials are currently going on. Preclinical and preliminary clinical results suggested the possibility to improve spontaneous erectile function and response to pharmaceutical treatment in initially non-responder patients. This effect is mediated by an improvement of penile vascularization. A reduction of penile curvature without side effect was noted after injections into the plaque of PD patients. Most of these therapeutic strategies using autologous cells were considered as "Advanced Therapy Medicinal Products" with strict regulatory frameworks imposing heavy constraints, in particular in case of "substantial" modification of the cells. The regulatory framework remains unclear and more permissive for PRP and cell therapy processes with extemporaneous preparation/injection and no "substantial" modifications.First results on cell therapy for ED and PD are promising. The regulatory framework can significantly change according to cell preparations and origins leading to various constraints. This regulatory framework is crucial to consider for the choice of the procedure.

Our aim was to present the indications and the outcomes of penile prosthesis implantation.A literature review was performed through PubMed using the following keywords: penile implantation ; penile prosthesis; erectile dysfunction.Evolution of penile prosthesis devices led to get a fiable and effective treatment for men with erectile dysfunction who do not respond to less invasive therapy. Penile implant can also be useful in the treatment of Peyronie's disease, priapism and transgender surgery. Precise information related to this surgery, especially complications, permits to obtain high satisfaction scores.Penile implant is a reliable and safe solution for the management of erectile dysfunction resulting to high couple satisfaction ratings.

Resume Introduction La prostatectomie radicale a beaucoup evolue durant les 20 dernieres annees avec, d’une part, une connaissance approfondie de l’anatomie de la prostate, et d’autre part, l’avenement de nouvelles techniques de conservation des bandelettes neuro-vasculaires. Malgre ces progres, le taux de dysfonction erectile post-prostatectomie varie entre 30 et 90 % selon les series et c’est l’element impactant la qualite de vie le plus souvent alteree apres prostatectomie radicale. L’objectif de ce travail etait d’effectuer une revue de la litterature evaluant les differents protocoles de reeducation erectile post-prostatectomie radicale. Patients et methodes Une revue systematique de la litterature a partir de la base de recherche PubMed a ete effectuee de 1995 a 2013 en utilisant les mots cles suivants : therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection . Resultats L’analyse critique des etudes selectionnees met en evidence l’absence de protocole standard etabli de reeducation erectile precoce post-prostatectomie radicale. Ces etudes ont demontre qu’une prise en charge precoce, par injections intra-caverneuses ou par IPDE5, ameliorait la recuperation des erections tel que le recommande l’Association francaise d’urologie. Conclusion La prise en charge des troubles de la sexualite post-prostatectomie radicale est essentielle, elle doit s’organiser dans un protocole bien etabli alliant l’aide pharmacologique et l’education therapeutique delivree par des praticiens ou des infirmieres formees. Il serait necessaire d’elaborer au sein d’un essai clinique un protocole standard de prise en charge.

ResumeObjectif Evaluer l’efficacite, la tolerance et la qualite de vie apres injection peri-uretrale de polyacrylamide hydrogel (PAHG, Bulkamid®, Ethicon) comme traitement de l’incontinence urinaire d’effort par insuffisance sphincterienne (IUE-IS) de la femme. Methodes Etude prospective monocentrique chez 80 patientes soufrant d’une incontinence urinaire severe, traitees par injection peri-uretrale de Bulkamid®, entre juin 2010 et octobre 2011 pour une IUE-IS. L’evaluation du retentissement sur la qualite de vie a ete realisee a l’aide du Patient Global Impression of Severity (PGI-S), de l’International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) et du Patient Global Impression of Improvement (PGI-I) avant et apres le traitement. Resultats Avec un suivi moyen de 18,6 ± 5,3 mois, 60 % des patientes etaient ameliorees sur le score PGI-I. Pour 30/74 (40 %), il n’y a pas eu d’amelioration ; aucune patiente n’a eu d’aggravation du PGI-I apres l’injection. Avant l’intervention, 55,4 % des patientes consideraient leur etat comme severe (PGI-S). Apres l’injection, 21/74 (28 %) et 11/74 (15 %) le consideraient comme severe et normal (zero fuite). Le score ICIQ-SF est passe de 17 ± 2,84 avant l’injection a 13 ± 5,52 en postoperatoire, avec une diminution significative de 30 % (p

ResumeBut Evaluer l’impact du traitement chirurgical des prolapsus pelviens par promontofixation sur la sexualite du couple mesuree par des auto-questionnaires. Patientes Etude prospective, monocentrique de patientes consecutives traitees par promontofixation. Les patientes, dont le prolapsus etait evalue a chaque visite avec la classification POPQ, et leurs conjoints etaient invites a remplir des questionnaires de qualite de vie et de qualite de vie sexuelle en pre- et post-chirurgie (6 mois) (auto-questionnaires PISQ12, PFDI-20 chez les patientes, antecedents medicaux, IIEF, PISQ12 modifie chez les conjoints). Resultats De mai a decembre 2010, 25 couples ont ete evalues. Les taux de correction anatomique (POPQ

Resume Objectifs Evaluer les resultats fonctionnels, les complications et la survie du sphincter urinaire artificiel (SUA) AMS 800™ (American Medical Systems, Minnetonka, MN, Etats-Unis) chez les femmes ayant une incontinence urinaire d’effort par insuffisance sphincterienne. Patientes et methodes Il s’agissait d’une etude de cohorte unicentrique prospective de 1987 a 2007. Seules les patientes avec manœuvre de soutenement uretrale negative et une faible pression de cloture uretrale, temoignant d’une insuffisance sphincterienne severe, ont ete incluses. Les parametres etudies ont ete la survie, les complications et la continence. Resultats Trois cent soixante seize SUA ont ete inclus dans cette evaluation. Le suivi median etait de neuf ans (3–20 ans). L’âge median a l’implantation etait de 57 ans (18–93 ans). Les survies globales a trois ans, cinq ans et dix ans ont ete respectivement de 92, 88,6 et 69,2 %. La survie globale moyenne etait estimee a 156 mois et la survie mecanique moyenne etait estimee a 176 mois. Deux facteurs de reduction de la survie globale ont ete mis en evidence : la population de patientes neurologiques et des antecedents d’intervention pour incontinence urinaire (≥ 2). La continence etait totale chez 85,64 %, les patientes avaient de rares fuites sans protection dans 8,78 % et des fuites avec au moins une protection par jour dans 5,58 % des cas. Conclusion L’etude a permis de montrer que l’implantation d’un sphincter urinaire chez la femme avec insuffisance sphincterienne represente un procede efficace, durable avec un taux de complication acceptable.

Resume Objectif Evaluer les performances de l’IRM fonctionnelle (IRMF) effectuee par des radiologues generalistes (RG) dans la detection de l’extension extracapsulaire lobe specifique (EECLS) du cancer de la prostate (CaP). Methode Nous avons analyse retrospectivement 79 patients ayant eu une IRMF avec antenne pelvienne avant une prostatectomie radicale (PR) realisee au CHU de Nimes. Douze RG (dont trois au CHU) ont interprete les images durant leur pratique quotidienne. Les resultats de l’IRMF ont ete dichotomises en positif ou negatif et confrontes a l’anatomopathologie pour l’EECLS et l’envahissement des vesicules seminales lobe specifique (EVSLS), avec calcul des valeurs diagnostiques. L’influence du delai entre biopsie et IRMF, de la sequence de diffusion et de l’intensite de l’IRMF sur les performances diagnostiques ont ete evaluees par un test de Fisher. Resultats Une EECLS et un EVSLS ont ete observes a l’IRMF et a l’anatomopathologie respectivement sur 14 (8,8 %) et 38 (24,1 %) lobes prostatiques et sur six (3,8 %) et sept (4,4 %) lobes prostatiques. La sensibilite, specificite, les valeurs predictives positives et negatives de l’IRMF pour l’EECLS etaient respectivement de 24 %, 96 %, 64 % et 80 % ; et pour l’EVSLS de 14 %, 97 %, 17 % et 96 %. Le delai entre biopsie et IRMF, l’intensite de l’IRMF et la sequence de diffusion, n’influencaient pas la sensibilite et la specificite de l’IRMF au test de Fisher. Conclusion Cette etude a observe que l’IRMF prostatique preoperatoire realisee par des RG avait une bonne specificite, mais une sensibilite mediocre dans la prediction de l’EEC lobe specifique presente sur la piece de PR.

Resume Objectifs Evaluer la faisabilite et les resultats de la realisation en consultation d’une videocystoscopie souple en lumiere bleue precedee d’une instillation d’Hexvix® (GE Healthcare) pour le diagnostic initial ou la surveillance des tumeurs vesicales (TV). L’objectif de cette etude etait de comparer le nombre de lesions vues en lumiere blanche et en lumiere bleue, et d’evaluer dans quel pourcentage de cas l’utilisation de l’Hexvix® en consultation modifiait la prise en charge. Patients et methodes Trente patients (26 hommes et quatre femmes) consecutifs ont ete evalues prospectivement par videofibroscopie vesicale en lumiere bleue (videocystoscope Wolf PDD®) realisee une heure apres une instillation endovesicale Hexvix®. Tous les examens ont ete realises en consultation externe sous anesthesie locale par gel de xylocaine : 23 (76,6 %) patients dans le cadre d’une surveillance de TV et sept (23,4 %) pour le diagnostic d’une hematurie a echographie normale. Lorsqu’une lesion suspecte ou une TV etait decouverte, les patients ont beneficie d’une resection endoscopique sous anesthesie avec nouvelle cystoscopie en lumiere bleue. Resultats Des lesions suspectes ont ete mises en evidence chez dix patients sur 30, cinq en lumiere blanche et bleue, cinq en lumiere bleue uniquement. Parmi les cinq lesions uniquement visibles en lumiere bleue, trois etaient des tumeurs urotheliales (toutes pTa de bas grade, moins de 5 mm) et deux des lesions non specifiques. Aucune lesion de CIS n’a ete mise en evidence lors de cette etude. La fibroscopie en lumiere bleue a permis de diagnostiquer des lesions invisibles en lumiere blanche chez trois patients (10 %) et a modifie la prise en charge de cinq patients (16,7 %). La duree de la cystoscopie etait en moyenne de 9,5 minutes. La tolerance de l’examen a ete bonne et aucune complication n’est survenue. Conclusion L’utilisation de la videocystoscopie souple en lumiere bleue +Hexvix® a permis d’ameliorer le taux de detection des TV. En dehors des lesions de CIS, cette amelioration a ete liee au diagnostic de TV de petite taille peu agressives. Les indications doivent etre precisees par des etudes de plus grande envergure et une evaluation medico-economique.

Resume Objectifs Evaluer la faisabilite et les resultats de la pose de bandelette sous-uretrale (BSU) dans l’incontinence urinaire d’effort (IUE) de la femme apres echec des injections trans-uretrales. Patientes et methode Etude retrospective. Onze patientes ont beneficie d’une pose de BSU apres echec d’au moins une injection trans-uretrale, de janvier 2005 a fevrier 2008. Resultats La duree moyenne operatoire etait de 26 minutes (20–35). Il n’y a pas eu de complication per-operatoire, ni de difficulte particuliere de dissection ou de pose. L’evaluation a court terme retrouve un taux de succes de 81 % (9/11). Le recul moyen par rapport a la chirurgie etait de 8,5 mois (1–20). Discussion et conclusion Le traitement de l’IUE par BSU apres echec d’injection trans-uretrale est faisable et non gene par le materiel injecte. Les resultats a court et moyen terme sont identiques a ceux trouves dans la litterature.

Radical prostatectomy has evolved considerably during the last 20 years, with one hand, a thorough knowledge of the anatomy of the prostate, and secondly, the introduction of new conservation techniques of neurovascular bundles. Despite this progress, the rate of post-prostatectomy erectile dysfunction varies between 30 and 90% depending on the series and this element impacts the quality of life after radical prostatectomy. The objective of this work was to conduct a review of the literature in order to evaluate the various protocols of post-radical prostatectomy erectile rehabilitation.A systematic review of the literature from the basic PubMed search was performed using the following keywords. Therapy erectile dysfunction, radical prostatectomy, penile rehabilitation, phosphodiesterase 5 inhibitor, intracavernous injection.The critical analysis of selected studies highlights the lack of standard protocol that established erectile rehabilitation early after radical prostatectomy. These studies have shown that early treatment, injections or intracavernous PDE5 inhibitors improved recovery of erections as recommended by the French Association of Urology.Management of disorders of post-radical prostatectomy sexuality is essential, it must be organized in a well-established protocol combining pharmacological and therapeutic education assistances delivered by practitioners or nurses. It would need to develop in a clinical trial a standard protocol.

This study was carried out to evaluate the efficacy of periurethral injection of polyacrylamide hydrogel (PAHG, Bulkamid(®), Ethicon) for the treatment of female stress urinary incontinence (SUI).Single-center prospective study: periurethral injection of Bulkamid(®) was performed in 80 patients with severe urinary incontinence between June 2010 and October 2011. The evaluation of the impact on quality of life was carried out using the Patient Global Impression of Severity (PGI-S), the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and Patient Global Impression of Improvement (PGI-I) before and after treatment.With a mean follow-up of 18.6 ± 5.3 months, 60% of patients had improved. For 30/74 (40%) there was no improvement and no patient had worsening of PGI-I after injection. Before surgery, 55.4% of patients considered their condition as severe (PGI-S). After injecting 21/74 (28%) and 11/74 (15%) considered it normal and severe (zero leakage). The ICIQ -SF score increased from 17 ± 2.84 before injection to 13 ± 5.52 after surgery, with a significant 30% decrease (P0.00001). The reinjection rate was 29%. The complication rate was 16% (17/108): 11 cases of transient postoperative retention, 2 cases of cystitis, dysuria four episodes. No abscess or infection at the injection site, no specific complication to the product used.With an (PGI-I) improvement rate of 60 and 15% of patients without leakage (PGI-S/ICIQ), periurethral injection of Bulkamid(®) is an effective and safe treatment option for women with a severe urinary incontinence especially in therapeutic failure.4.

To assess the impact on the sexuality of the couple of pelvic organ prolapse repair with coelioscopic sacrocolopoxy.Pilot, prospective, monocentre study conducted in Nîmes university hospital. Consecutive patients undergoing coelioscopic sacrocolpopexy and their partner were invited to participate. Women attended a pre-surgical visit and a 6-month post-surgery visit where pelvic organ prolapse status was clinically assessed. In the same time, they and their partner filled general quality of life and specific sexual quality of life questionnaires (questionnaires PISQ12, PFDI-20 in women, medical history, IIEF, modified PISQ12 questionnaires in men).From May to December 2010, 25 couples were assessed. Anatomical success rates (POPQ2) in the middle, anterior and posterior compartments were respectively of 100%, 95.4% and 66.7%. After surgery, 65.2% of pairs (n=15) reported an at least hebdomadal frequency of sexual intercourse, as compared with 54.2% (n=13) of pairs before surgery (P0.001). Two cases of decrease of sexual intercourses frequency were reported and appeared partner-related. There was an overall non-significant improvement in sexual quality of life in men and women. General pelvic organ distress, urinary incontinence and specific pelvic organ prolapse distresses were significantly improved after surgery.Coelioscopic sacrocolpopexy does not impair couple's sexuality, assessed as sexual intercourses frequency and could even improve it. Partner's assessment can bring important information with respect to the interpretation of functional sexual results of surgery.

Resume Objectif Evaluer l’efficacite et la tolerance de la bandelette sous-uretrale ajustable Remeex ® (BSUA-R) dans le traitement de l’incontinence urinaire d’effort (IUE) masculine. Patients et methodes Etude monocentrique prospective d’une serie consecutive de patients traites pour IUE survenue apres prostatectomie totale ou resection endoscopique de prostate. La severite de l’incontinence etait evaluee par le nombre de protections quotidiennes. Le taux de succes, les complications et le nombre d’ajustements ont ete etudies. Resultats De fevrier 2011 a mai 2015, une BSUA-R a ete implantee chez 25 patients. Le nombre moyen de protections quotidiennes preoperatoires etait de 3,8 (±1,8). Tous les patients ont ete ajustes le lendemain de l’intervention. Le suivi moyen a ete de 31 mois (±15). Durant le suivi, 6 patients n’ont pas necessite de nouvel ajustement (24 %) et 15 patients (60 %) ont du etre reajustes. Une bandelette a ete retiree dans les suites immediates en raison d’un syndrome sub-occlusif, les suites ont ete simples. Trois patients ont presente une infection precoce ayant necessite l’ablation partielle du materiel (Varitensor). A la fin du suivi, 9 patients etaient gueris (36 %), 9 patients (36 %) etaient ameliores et 7 patients (28 %) n’ont pas ete ameliores. Cinq patients sont en attente d’un nouvel ajustement. Conclusion Dans cette courte serie de patients ayant eu une chirurgie prostatique, a moyen terme, la mise en place d’une BSUA-R etait associee a une amelioration ou a une guerison des symptomes d’incontinence urinaire dans deux tiers des cas. Niveau de preuve 4.

To analyze long-term results and mechanical survival of the artificial urinary sphincter (AUS) AMS 800™ (American Medical Systems, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD).Data were collected prospectively from women treated for SUI at one university hospital between 1987 and 2007. Inclusion criteria was SUI with severe ISD defined by low urodynamic closure pressure and negative continence tests. Endpoints were survival, complications and continence.A total of 376 AUS were implanted in 344 patients with a median age of 57 years (18-93 years). The median follow-up was 9 years (3-20 years). The 3, 5, and 10 years global device survival were 92, 88.6, and 69.2% respectively. The mean mechanical survival was 176 months (14.7 years). The two main risk factors for decreased AUS survival were the number of previous incontinence surgeries and the presence of neurogenic bladder. The continence rates assessed as full (no leakage) in 85.64% patients, social (some drops but no pad) in 8.78% and incontinence (1 pad or more) in 5.58%.The study has shown that in patients with ISD, the AUS represents an effective process, durable with an acceptable rate of complication.

To evaluate the performance of functional MRI (FMRI) performed by general radiologists (GR) in detection of side-specific extracapsular extension (SSECE) prostate cancer (PCa).We retrospectively analyzed 79 patients who underwent FMRI with pelvic phased array coil before radical prostatectomy (RP) performed at University Hospital (UH) of Nîmes. Twelve GR (including three from UH) interpreted the images during their daily practice. FMRI results were dichotomized as positive or negative and confronted to pathological reports for SSECE and side-specific seminal vesicle invasion (SSSVI), with calculation of diagnostic values. The influence of interval between biopsy and FMRI, diffusion-weighted sequence (DWS) and intensity of FMRI, on the diagnostic performance were assessed by Fisher's exact test.A SSECE and a SSSVI were observed at FMRI and pathology respectively on 14 (8.8%) and 38 (24.1%) prostate lobes, and on six (3.8%) and seven (4.4%) prostate lobes. The sensitivity, specificity, positive and negative predictive values of FMRI for SSECE were respectively 24%, 96%, 64% and 80%; and for SSSVI were 14%, 97%, 17% and 96% respectively. The time between biopsy and FMRI, intensity of FMRI and DWS, did not influence the sensitivity and specificity of fMRI at Fisher test.This study found that preoperative prostate FMRI performed by GR has good specificity but poor sensitivity in predicting SSECE on pathological reports.

This paper presents a method to analytically model the magnetic field in the air gap of rotating electrical machines with cylindrical air gap. The field is expressed as a sum of sinusoidal functions of the azimuthal coordinate. The originality of this paper is to give an exact field solution in case of skewed sources (windings or magnets). That result can then be used for torque, inductances and magnetic losses computations in machines with Faulhaber or rhombic windings. The computation of the inductances of a Faulhaber motor is treated as an example.

Estimate the feasibility and the results of the realization in consultation of a flexible videocystoscopy in blue light preceded by an instillation of Hexvix(®) (GE Healthcare) for the initial diagnosis or the surveillance of vesicals tumors (VT). The objective of this study was to compare the number of hurts seen in white light and in blue light, and to estimate in which percentage of case the use of the Hexvix(®) in consultation modified the care.Thirty consecutive patients (26 men and four women) were estimated prospectively by vesical videofibroscopy in blue light (Wolf's PD videofibroscope) realized 1 hour after an endovesical instillation of Hexvix(®). All the examinations were realized in external consultation under local anesthetic by xylocaine gel: 23 (76.6%) patients within the framework of a surveillance of VT and seven (23.4%) for the diagnosis of a hematuria with normal echography. When a suspect hurt or a VT was discovered, the patients benefited from an endoscopic resection under anesthesia with new cystoscopy in blue light.Suspect hurts were revealed in 10 out of 30 patients, five in white and blue light, five in blue light only. Among the five only visible hurts in blue light, three were urothelial tumors (any pTa of bottom-rank, less of 5 mm) and two non-specific hurts. No CIS's hurt was revealed during this study. The fibroscopy in blue light allowed to diagnose invisible hurts in white light in three patients (10%) and has modified the care of five patients (16.7%). The duration of the cystoscopy was on average of 9.5 minutes. The tolerance of the examination was good and no complication arose.The use of the flexible videocystoscopy in blue light +Hexvix(®) has allowed to improve the rate of detection of VT. Except CIS's hurts, this improvement was bound to the diagnosis of little aggressive small-sized VT. The indications must be specified by studies of bigger scale and a medical economic evaluation.

To assess feasibility and results of mid-urethral sling placement for stress urinary incontinence (SUI) in adult women after transurethral injection therapy failure.Eleven patients were operated on for a mid-urethral sling placement after at least one transurethral injection therapy, from January 2005 to February 2008. Injections were performed for moderate non-daily SUI, or according to patient willingness, or for SUI surgical history. Mean age at the time of surgery was 59.9 years (range: 33 to 84).Mean operative time, including control cystoscopy time during TVT placement, was 26 minutes (20-35). There were no peri-operative complications, nor problems for dissection or tape placement. At a mean follow-up of 9.9 months (5-20), 9/11 (81%) patients were dry with no lower urinary tract disorders.SUI treatment by mid-urethral sling after transurethral injections failure is feasible not bothered by the injected material and effective at short-term.

Neuroendocrine bladder tumours are exceptional, and the positive diagnosis is only established when they are already large and advanced. We report an original case in view of its small dimensions. We discuss the differential diagnosis (mainly bladder metastases from lung cancer) and pathological specificities, particularly the value of epithelial immunolabelling allowing exclusion of lymphoma. Because of the similarities with bronchial neuroendocrine tumours, the potential value of serum NSE assay should be emphasized. Combined surgery-cisplatin-based adjuvant chemotherapy is recommended.

Using the lower and upper solutions method together with degree theory, we study the existence and multiplicity of positive solutions for the problem $$ (\varphi_{p}(u'))'+f(t,u)=0,\ \ a_{1}\varphi_{p}(u(a))-a_{2} \varphi_{p}(u'(a))=0,\ b_{1}\varphi_{p}(u(b))+b_{2} \varphi_{p}(u'(b))=0, $$ where $\varphi_{p} (s):=|s|^{p-2}s, \,p>1$, $a_1,b_1\in\Bbb R$, $a_2,b_2\in\Bbb R^+$, $a_1^2+a_2^2>0$, $b_1^2+b_2^2>0.$ The function $f$ satisfies assumptions related to the classically called sublinear, superlinear, subsuperlinear, or supersublinear cases. Our results improve the recent ones of L.H. Erbe-H. Wang ([21]) and L.H. Erbe-S. Hu-H. Wang ([20]).

has been recently considered by Smiley [11], using the alternative method. Here, ∆ = ( ∑n i=1 ∂ /∂xi ), B n a = {x ∈ R , ||x|| 1. In doing so we have realized that the spectral properties of the linear wave operator with periodic-Dirichlet boundary conditions on the ball depended upon the parity of space dimension n, a feature overlooked in [11]. Indeed, in contrast to the case of odd n, this operator has a compact resolvent when n is even, and hence the nonlinear problem can be approached by techniques of nonlinear functional analysis relying upon compactness. In particular the combination of sharp estimates for the inverse of the linear part and the Banach fixed point theorem can be replaced by the use of usual Leray-Schauder’s degree argument.