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To determine the usefulness of mid-urethral slings (MUS) in the surgical management of women presenting with urinary stress incontinence (USI) METHOD: A consensus committee of multidisciplinary experts (CUROPF) was convened and focused on PICO questions concerning the efficacy and safety of MUS surgery compared to other procedures and concerning which approach (retropubic (RP) vs transobturator (TO)) should be proposed as a first-line MUS surgery for specific subpopulations (obese; intrinsic sphincteric deficiency (ISD); elderly) RESULTS: As compared to other procedures (urethral bulking agents, traditional slings and open colposuspension), the MUS procedure should be proposed as the first-line surgical therapy (strong agreement). MUS surgery can be associated with complications and proper pre-operative informed consent is mandatory (strong agreement). Mini-slings (SIS/SIMS) should only be proposed in clinical trials (strong agreement). Both RP and TO approaches may be proposed for the insertion of MUS (strong agreement). However, if the woman is willing to accept a moderate increase in per-operative risk, the RP approach should be preferred (strong agreement) since it is associated with higher very long-term cure rates and as it is possible to completely remove the sling surgically if a severe complication occurs. The RP approach should be used for the insertion of MUS in a woman presenting with ISD (strong agreement). Either the RP or TO approach should be used for the insertion of MUS in an obese woman presenting with USI (strong agreement). In very obese women (BMI ≥35-40kg/m

Resume Introduction La mise en place d’une bandelette sous-uretrale est le gold standard dans la prise en charge chirurgicale de l’incontinence urinaire d’effort de la femme en France. L’efficacite de ce materiel n’est plus a demontrer mais les complications per- et postoperatoires font l’objet a l’heure actuelle d’une controverse importante en Europe mais egalement outre-Manche et outre-Atlantique ayant conduit a la modification des indications operatoires. En France, la reglementation evolue egalement avec un encadrement plus strict des indications operatoires par RCP et une obligation de suivi postoperatoire a court, moyen et long terme. Objectifs Dans ce contexte, le CUROPF a entrepris de realiser une revue de la litterature rassemblant les preuves scientifiques disponibles concernant la survenue de complications per- et postoperatoires relatives a la pose de BSU. Materiel et methode La recherche bibliographique a ete realisee a partir de la base de donnees Medline et 123 articles ont ete retenus. Resultats L’analyse des donnees met en evidence des complications variees, dependantes du materiel implante, du terrain initial et de l’indication operatoire. La bandelette sous-uretrale retro-pubienne est pourvoyeuse de plus d’effraction vesicale peroperatoire (jusqu’a 14 %), plus de douleurs sus pubiennes (4 %) et plus de retention aigue d’urine et dysurie en postoperatoire (jusqu’a respectivement 19,7 % et 26 %). La bandelette sous-uretrale trans obturatrice est responsable de plus d’effraction vaginale peroperatoire (10,9 %), plus de douleur de membre inferieur d’origine neurologique (jusqu’a 26,7 %). Le risque de survenue d’un syndrome d’HAV est similaire dans les 2 voies d’abord (33 %). Mais ces risques de complications sont a ponderer par un fort impact de la chirurgie de l’incontinence urinaire sur l’amelioration de la qualite de vie globale de ces femmes. Conclusion Ainsi la connaissance de ces risques ne doit pas limiter l’indication de la prise en charge de l’incontinence urinaire d’effort par la pose de la BSU mais doit permettre de ponderer les indications operatoires en fonction du terrain, d’informer les patientes de maniere eclairee et les surveiller etroitement sur long terme.

Resume Introduction Le traitement par LASER vaginal est une option therapeutique d’utilisation croissante en urogynecologie, mais son interet reste debattu. L’objectif de cette revue etait d’etablir les donnees de la litterature et d’en produire une analyse critique. Methodes Une revue systematique de la litterature a ete conduite jusque mars 2020 en utilisant les bases de donnees PubMed, Medline, Cochrane et Embase, pour identifier les etudes ayant utilise le LASER dans le domaine de l’urogynecologie. Resultats Quarante etudes ont ete inclues dans l’analyse (8 concernant le syndrome genito-urinaire de la menopause (SGUM), 19 pour l’incontinence urinaire a l’effort (IUE), 3 pour l’hyperactivite vesicale (HAV), 7 pour le prolapsus genital (POP), 3 pour d’autres indications). Les donnees etaient heterogenes, de niveau de preuve faible a tres faible. Une minorite etait comparative, et seules trois etaient randomisees. Les donnees etaient en faveur d’une efficacite modeste du LASER dans le traitement du SGUM, de l’incontinence, de l’HAV et du prolapsus a court terme sur les symptomes, la satisfaction et la qualite de vie. Peu d’effets secondaires ont ete rapportes. Cependant, des risques de biais methodologiques majeurs ont ete notes concernant l’evaluation de l’efficacite et de la securite. Aucune etude n’etait disponible a long terme. Conclusions Bien que le LASER semble montrer des resultats encourageants, le niveau de preuve de son efficacite et de sa securite d’emploi (notamment a long terme) etait faible. Des etudes de meilleure qualite apparaissaient donc necessaires, avant une hypothetique recommandation de son utilisation hors du champ de la recherche clinique.

Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term.In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected.Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women.Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.

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.

Vaginal LASER therapy is increasingly used in the field of urogynecology, but several points remain unclear. Our goal was to produce a systematic review of available evidence and provide a critical appraisal of available data.A systematic review until march 2020 was conducted using PubMed/MEDLINE, Cochrane and Embase databases. All studies about vaginal LASER use in the field of urogynecology were included.Forty studies have been included (8 for genitourinary syndrome of menopause, 19 for stress urinary incontinence, 3 for overactive bladder, 7 for urogenital prolapse, 3 for other indications). Data were heterogeneous, and level of evidence was weak or very weak. Few studies were comparative, and only 3 were randomized). Mild improvement of symptoms and quality of life and limited satisfaction were seen for genitourinary syndrome, stress urinary incontinence, overactive bladder and prolapse. Few adverse events were reported. However, major methodological biases were noted regarding efficacy and safety evaluation. No long-term results were available.While Vaginal LASER therapy seem to provide encouraging results, the level of evidence supporting its use was weak, especially regarding long-term outcomes. Studies of better quality are warranted before any recommendation can be made. Current use should be limited to clinical research.

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

INTRODUCTION AND OBJECTIVE:Several preliminary series have reported the use of a robotic approach for artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontin...

Objectifs Les reunions de concertation pluridisciplinaires (RCP) en pelvi-perineologie prennent une importance grandissante dans la prise en charge des cas complexes en pelvi-perineologie et leur tenue pourrait devenir obligatoire pour poser certaines indications dans un futur proche. Le but de cette etude etait d’etablir un etat de lieux sur le territoire national concernant l’existence et les modalites de ces reunions. Methodes Une enquete a ete realisee aupres des urologues francais membres de l’Association francaise d’urologie via un questionnaire en ligne en 15 questions. Des statistiques descriptives ont ete menees. Resultats Les donnees demographiques relatives aux 207 urologues ayant repondu sont detaillees dans le Tableau 1 . Un acces a une RCP de pelvi-perineologie existait dans 37 % des cas. Les RCP impliquaient les CHU dans 57 % des cas. Le responsable etait urologue, gynecologue, digestif, MPR ou autre dans respectivement 38 %, 28 %, 8 %, 12 % et 14 % des cas. Outres les urologues, participaient des gynecologues (88 %), chirurgiens digestifs (74 %), gastro-enterologues (44 %), radiologues (37 %), MPR (40 %), kinesitherapeutes (43 %), algologues (12 %), infirmieres (19 %), geriatres (5 %) ou sage-femmes (9 %). Les activites etaient toujours des discussions de dossiers ( Tableau 2 ), parfois des presentations pedagogiques (34 %) et tres rarement des examens physiques des patients. Une liste d’emergement et un compte rendu ecrit existaient dans deux tiers des cas, mais un secretariat dedie dans seulement 29 % des cas. Conclusion Les RCP de pelvi-perineologie sont heterogenes et insuffisamment developpees en France, car beaucoup d’urologues declarent ne pas y avoir acces. Leur structuration, leur developpement et leur coordination sont des enjeux majeurs a court terme.

Resume Objectif L’insuffisance sphincterienne (IS) et l’hypermobilite uretrale sont les causes essentielles de l’incontinence urinaire a l’effort (IUE) feminine. Malgre l’absence de definition consensuelle dans la litterature, l’IS doit etre finement evaluee pour etre correctement traitee. Le but de ce travail est de faire une mise au point sur l’insuffisance sphincterienne de la femme (ISF). Materiel et methode Il s’agit d’un travail de synthese du CUROPF apres analyse des articles publies dans la base de donnees Medline (Pubmed) selectionnes selon leur pertinence scientifique, des conferences de consensus et des recommandations publiees sur le sujet. Resultats Meme s’il n’existe pas de definition internationale consensuelle, on peut considerer que l’ISF est une notion composite associant des donnees urodynamiques (PCUM 2 0) et une ou plusieurs donnees cliniques (absence de mobilite uretrale, test de soutenement uretral negatif, echec d’une premiere chirurgie, fuites a la poussee abdominale, scores d’incontinence a l’effort eleves). L’imagerie peut apporter des elements supplementaires en faveur du diagnostic d’insuffisance sphincterienne, mais la correlation entre l’imagerie et la fonction reste modeste. Le traitement chirurgical de premiere intention peut etre l’implantation d’une bandelette sous-uretrale (BSU), de preference retropubienne, si les manœuvres de soutenement de l’uretre sont positives et que la contractilite vesicale est correcte. En l’absence de mobilite uretrale, le sphincter urinaire artificiel (SUA) reste le gold standard . Les ballons ACT ® sont une alternative au SUA lorsque celui-ci est contre-indique ou refuse par la patiente. La therapie cellulaire est encore du domaine de la recherche clinique. La place des agents de comblement peri-uretraux n’est pas clairement definie. L’IS chez la femme âgee necessite une attention particuliere en raison de la frequence de l’hypocontractilite vesicale et des comorbidites liees au vieillissement. Une evaluation geriatrique peut etre necessaire. Conclusion Il est important de reconnaitre une IS lors de la prise en charge de l’IUE feminine afin d’en informer les patientes et de proposer les options therapeutiques les mieux adaptees a chaque cas.

Summary Aims Standardise the injection technique with botulinum toxin type A (BoNT A) in the bladder of patients with overactive bladder (OAB) [idiopathic overactive bladder (iOAB) or neurogenic overactive bladder (nOAB) with urinary incontinence], using a literature review and a survey of an International expert panel. Methods PubMed literature searches of BoNT A in adults with iOAB/nOAB together with a survey of 13 experts from 10 countries. Results Data from 21 articles and completed questionnaires were collated. The procedure can be carried out in an out-/inpatient setting. Dose used in clinical studies vs. clinical practice was 300 and 200 U for nOAB and 200 and 100 U for iOAB. Recent studies have also demonstrated that there are no clinically relevant benefits between 100 and 150 U in iOAB or between 300 and 200 U in nOAB, though adverse effects are increased with higher doses. Usually, 30 sites for nOAB (range: 6.7–10 U/ml) and 20–30 sites for iOAB (range: 5–10 U/ml) are injected in clinical studies vs. 20–30 sites of 1 ml/injection for 200 U in nOAB and 10–20 sites of 0.5–1 ml/injection for 100 U in iOAB in clinical practice. BoNT A is usually injected directly into the detrusor, sparing the trigone. Flexible or rigid cystoscopes are used. The needle should be typically 22–27 gauge and 4 mm in length and should have a stopper to avoid any leakage or perforation of the bladder wall while ensuring a targeted injection. Conclusion Based on the literature and survey analysis, recommendations are proposed for the standardisation of the injection procedure.

Objectives To describe the surgical technique of transcorporal artificial urinary sphincter (AUS) implantation. To assess the efficacy of the AUS on continence and erectile function. Patients and Methods A prospective evaluation was conducted between December 2007 and October 2012 at a tertiary referral centre of all male patients treated by transcorporal AUS (AMS800™, AmericanMedicalSystems, Minnetonka, MN, USA) implantation for stress urinary incontinence (SUI) recurrence, after failure of previous anti-incontinence surgery. Functional urinary outcomes were assessed according to daily pad use, the Urinary Symptom Profile questionnaire, and International Consultation on Incontinence Questionnaire – Short-Form. Erectile function was evaluated using the five-item International Index of Erectile Function (IIEF-5) questionnaire and patient satisfaction was assessed by Patient Global Impression of Improvement questionnaire. Data were collected by telephone interview. Results A total of 23 patients were included. Their mean (sd; range) age was 70 (7; 60–85) years. Of these, 18 patients had urethral atrophy and/or erosion after placement of AUS (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiation therapy. The implantation of the AUS with transcorporal cuff placement was successful in all patients, with no peri-operative complications. Follow-up data over 1 year were available for 17 patients. After a median (sd; range) follow-up of 20 (15; 2–59) months, eight patients were perfectly dry (no pad use and no symptoms), five achieved social continence (less than one pad/day), and four still had SUI (required two or more pads/day). Among six patients who had good preoperative erectile function and were sexually active, four had no decrease in their IIEF-5 score. Conclusions Transcorporal AUS cuff placement is a useful alternative for challenging cases of male SUI after failure of previous surgical treatment, urethral atrophy or erosion. Erectile function can be maintained despite dissection of the corporal body.

Purpose of review The surgical armamentarium for stress urinary incontinence in men ranges from minimally invasive endoscopic procedures to artificial urinary sphincter implantation. In this rapidly moving field, respective indications of surgical options are also evolving, as evidence for the use of innovative devices is growing. This review is focused on recent data about injectables, stem cells and periurethral balloons implantation. Recent findings Periurethral injections are probably the most minimally invasive options, but are considered of low efficacy, with a high recurrence rate in the short term. Reinjections are often needed. However, the market share of periurethral bulking is decreasing relatively slowly. Innovative, so-called regenerative therapies, including injection of biological material, stem cells, myoblasts and muscle strings implantation have shown promising results but did not yet reach maturity for daily use in the clinic. Periurethral balloons implantation shows an acceptable success rate at mid-term follow-up, but are associated with a high rate of complications and reoperations. Summary Indications of periurethral bulking are decreasing. Regenerative therapies are still under investigation in men, and long-term studies are still required. Comparative studies against male slings and other compression devices are still awaited to accurately determine the role of periurethral balloons implantation.

Resume But Effectuer une revue de la litterature concernant le traitement de l’incontinence urinaire d’effort (IUE) de la femme d’origine non neurologique par les mini-bandelettes sous-urethrales. Methodes Revue de la base de donnees Medline/Pubmed jusqu’en juin 2013. La bandelette TVT-Secur™ a ete exclue, car ce dispositif n’est plus commercialise. Resultats Les deux dispositifs les plus etudies, hors TVT-Secur™, etaient Ajust™ et Mini-Arc™. Le Mini-Arc™ presentait des taux de succes entre 44 % et 91,4 % a un an. La bandelette Ajust™ etait le dispositif dont les resultats etaient les plus homogenes avec une efficacite a moyen terme d’environ 80 %. Un faible taux de complications per- et postoperatoires a ete rapporte dans tous les cas. Deux etudes randomisees ont ete publiees comparant mini-bandelette et bandelette traditionnelle avec un recul minimum de un an, ainsi qu’une meta-analyse. Ces differents travaux objectivaient des taux d’efficacite egaux ou inferieurs aux BSU traditionnelles. Conclusion Devant le faible recul, le niveau de preuve limite et l’heterogeneite des donnees publiees, les mini-bandelettes doivent etre evaluees dans le cadre de protocoles de recherche clinique.

Mesh erosion is one of the major complications of prolapse surgery conducted by transvaginal approach. Following the extensive use of meshes and warning about potential complications, a new classification of mesh-related adverse events has been proposed. Due to the wide scope of clinical features, no standardized approach has been proposed. Surgery is required after failure of conservative management, mostly based on mesh partial or total excision by transvaginal route, following the classic rules of re-do vaginal surgery. Complex cases are best managed in tertiary reference centers.

Resume Buts Evaluer les resultats fonctionnels et les complications apres implantation d’un sphincter artificiel urinaire (SAU) apres echec de bandelette sous-uretrale Advance™ pour incontinence urinaire apres prostatectomie. Patients Une evaluation prospective a ete menee, incluant tous les patients consecutifs traites par implantation d’un SAU apres echec d’une bandelette Advance™ dans un centre universitaire de reference pour le traitement de l’incontinence urinaire apres prostatectomie. Les donnees recueillies ont ete : les antecedents et l’histoire de la maladie, le nombre de protections utilisees par jour et les donnees operatoires (duree d’intervention, taille de la manchette utilisee, eventuelles difficultes techniques). Le suivi postoperatoire etait realise a un, six, 12 mois puis ensuite annuellement. Les resultats ont ete evalues par le nombre de protections utilisees par jour et le niveau de satisfaction au dernier suivi (selon l’echelle Patient Global Impression of Improvement [PGI-I]). Les complications ont egalement ete recueillies. Un patient etait dit sec s’il n’utilisait aucune protection. Resultats Douze patients ont ete inclus dans cette evaluation. La duree mediane de suivi etait de 20 mois (12–43). Aucun patient n’a ete perdu de vue. Quatre patients (33 %) avaient un antecedent de radiotherapie et tous les patients souffraient d’incontinence urinaire d’effort apres prostatectomie, d’intensite legere a moderee, non amelioree par l’implantation d’une bandelette Advance™. La duree mediane de l’intervention pour la pose du SAU a ete de 47 minutes (40–60). Aucun probleme technique n’est survenu lors des interventions. Les durees de sondage postoperatoire et de sejour hospitalier ont ete de 24 heures et deux jours, respectivement, dans tous les cas sauf un necessitant un jour de sondage supplementaire. Au dernier suivi, dix patients sur 12 (83 %) etaient secs et totalement satisfaits. Deux patients (17 %) etaient ameliores, portant une protection par jour. Des complications postoperatoires ont ete notees dans deux cas (17 %) (un cas d’erosion cutanee par les tubulures du SAU et un cas d’infection superficielle de la cicatrice de l’incision iliaque). Conclusions L’implantation d’un SAU apres echec de bandelette Advance™ pour incontinence urinaire apres prostatectomie etait faisable, donnant des resultats similaires a moyen terme a ceux obtenus apres implantation de SAU chez un patient naif.

INTRODUCTION AND HYPOTHESIS: The aim of the study was to assess the effectiveness of repeat mid-urethral sling after a failed primary sling for stress urinary incontinence. METHODS: A total of 112 women with recurrent stress incontinence after primary mid-urethral sling underwent a repeat procedure between 2000 and 2011. All patients had a preoperative clinical and urodynamic evaluation. Outcomes were divided into three groups: cured (no more leaks), improved (decrease of leaks), or failed. RESULTS: All patients had urethral hypermobility and 12.9 % had intrinsic sphincter deficiency [maximum urethral closure pressure (MUCP) ≤ 20 cmH2O]. Median MUCP was 41 cmH20. Overactive bladder was found in 5.7 % of women. The second sling placed was one of the following: retropubic Tension-free Vaginal Tape (49 %), transobturator tape (48 %), or mini-sling (3 %). No intraoperative morbidity was reported. After the second sling was placed, 68 (60.7 %) patients were subjectively cured and 18 (16.1 %) improved (76.8 % success overall) with a mean follow-up of 21 months. Success rates were 72.2 and 81.8 % for transobturator and retropubic slings, respectively, with no significant difference. Multivariable analysis showed higher odds of cure and improvement with the retropubic approach after adjusting for MUCP. Late complication rates were comparable to those observed after a first sling. Urodynamic parameters were not associated with postoperative success. CONCLUSIONS: Repeat mid-urethral sling for recurrent female stress urinary incontinence is nearly 77 % successful in a group of patients with persistent urethral hypermobility. A retropubic approach might be preferred for patients with low urethral closure pressures.

Data on the Ajust, a new single-incision sling procedure for female stress urinary incontinence (SUI) management, remain scarce and limited to a 1-year follow-up. Our goal was to assess the efficacy of this procedure after a 1-year follow-up.This prospective evaluation involved 95 consecutive patients implanted with Ajust at a single centre. All patients had SUI on urodynamics due to urethral hypermobility, 33 % had preoperative overactive bladder (OAB) symptoms and none had detrusor overactivity. Ninety-two patients were treated on an outpatient basis, and 3 patients had general anaesthesia. Postoperative assessment was conducted at 1, 6, 12 months, and yearly thereafter. The main outcome measure was pad usage. Secondary parameters were self-reported SUI episodes, OAB symptoms, data of clinical examination, satisfaction using the Patient Global Impression of Improvement (PGI-I) scale, postoperative pain, and adverse events.After a mean follow-up of 21 ± 6 months (12-32), 76 out of 95 patients used no pads or one dry security pad, showing a success rate of 80 %. Seventy-nine out of 95 patients had no more SUI-related leakage. Only 6 patients experienced late recurrence of SUI after 6 months' follow-up. Perioperative complications included 1 case of vaginal hematoma, 1 case of acute urinary retention, 2 cases of urinary tract infection, all managed conservatively. Half of the patients had no pain after day 1, free of medications. Late complications were vaginal erosion in 1 case, and pain during exertion in 2 cases.The Ajust single incision transobturator sling is a safe and effective procedure, with durable results after 1 year.

Objectifs Evaluer de facon prospective la prise en charge de la prostatectomie radicale cœlioscopique robot-assistee (PRR) en unite de chirurgie ambulatoire (UCA) pendant 1 an. Methodes Entre le 15/3/16 et le 31/5/17, 96 PRR ont ete realisees par le meme binome chirurgien-anesthesiste. Trente-quatre PRR ont ete programmees en UCA, apres avoir donne aux patients une information conforme aux recommandations de la HAS. Les interventions ont ete realisees suivant un protocole anesthesiste per- et postoperatoire specifique permettant la recuperation rapide apres chirurgie (RRAC). Les criteres de sortie etaient : EVA Resultats Toutes les PRR ont ete realisees en cœlioscopie transperitoneale, avec ou sans curage ilio-obturateur, avec ou sans preservation des bandelettes neurovasculaires. Trente et un des 34 patients programmes en UCA ont pu sortir le soir meme, donc moins de 12 h apres l’entree. Un patient sur les 31 sortis a du etre readmis en urgence le soir meme du fait d’une hematurie caillotante avec obstruction de la sonde vesicale. La sonde a simplement ete debouchee en chambre, et le patient est ressorti le lendemain, sans autre consequence. Deux patients n’ont pas pu sortir : l’un car son accompagnant pour la sortie et la nuit a eu un empechement, l’autre pour des raisons administratives de prise en charge. Tous les patients appeles le lendemain etaient satisfaits d’avoir pu passer la nuit a leur domicile. Tous les patients ont ete revus au 6e jour postoperatoire pour ablation de sonde vesicale. Conclusion La PRR peut etre proposee en UCA, sans en augmenter le risque de complications. Il s’agit d’un avantage specifique de la robotique, car aucune experience ambulatoire pour la prostatectomie n’avait ete tentee auparavant avec les autres abords chirurgicaux. La prise en charge en UCA diminue le stress lie a l’hospitalisation en permettant un retour rapide au domicile (

PURPOSE: Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. MATERIALS AND METHODS: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). RESULTS: 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). CONCLUSIONS: Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anticholinergic drugs fail to reduce NDO.

Resume But L’incontinence urinaire (IU) et la dysfonction erectile (DE) sont deux complications majeures de la prostatectomie totale (PT). Apres echec du traitement medical, la bandelette Advance™ et la prothese penienne sont des options therapeutiques validees. Notre but etait d’evaluer la faisabilite et les resultats de la combinaison de ces deux dispositifs. Patients Quatre patients ont ete traites pour IU et DE apres PT, par bandelette sous-uretrale et prothese penienne. Les criteres suivants etaient evalues en preoperatoire : âge, antecedents, score ASA, fibroscopie vesicale, pad-test, et bilan urodynamique. Deux patients ont recu les deux dispositifs en deux temps : la bandelette sous-uretrale puis la prothese penienne pour un, et la prothese penienne puis la bandelette sous-uretrale pour l’autre. Les deux autres patients ont ete traites en un temps : un a recu les deux dispositifs, et l’autre la bandelette sous-uretrale associee au remplacement d’une prothese penienne. Le suivi postoperatoire evaluait l’efficacite (nombre de protections par jour et echelle Patient Global Impression of Improvement [PGI-I] pour l’incontinence et la sexualite) et les complications. Resultats Il n’y a pas eu de complications peroperatoires. Apres un suivi minimum de 14 mois, les quatre patients ne portaient plus de protection. Le score PGI-I mettait en evidence un niveau de satisfaction optimal pour les quatre patients tant sur le plan urinaire que sexuel (score egal a 1). Conclusion Dans notre experience, la chirurgie combinee par bandelette transobturatrice Advance™ et prothese penienne etait possible, successivement ou simultanement, et menait a d’excellents resultats fonctionnels sans complications.

Resume But La chirurgie ambulatoire est une source potentielle d’economies pour le systeme de sante et de benefices pour le patient. Nous avons analyse notre experience de chirurgie ambulatoire en urologie sur une annee. Materiel Une base de donnees monocentrique, prospective, rassemblant l’âge, le score ASA, le type d’intervention et le mode de sortie de chaque patient opere en ambulatoire en 2009 a ete etablie. Un questionnaire individuel portant sur les antecedents de chirurgie ambulatoire, la satisfaction globale, la preference pour une hospitalisation traditionnelle et le recours aux urgences dans les 48 heures postoperatoires a ete adresse retrospectivement. Resultats En 2009, 465 patients d’un âge moyen de 52 ± 16 ans (15–98) ont ete operes en ambulatoire. Le score ASA median etait egal a 2 (1–3). Les operations realisees etaient principalement du domaine de l’endo-urologie (44,5 %), de la chirurgie de l’incontinence urinaire (32,5 %) et des organes genitaux externes (12,3 %). Le taux d’hospitalisation postoperatoire etait de 4,5 %. Le taux de reponse au questionnaire etait de 28 %. Quarante-six pour cent des patients avaient deja ete pris en charge en ambulatoire, la satisfaction globale moyenne etait de 3,3 (±1,06) sur 4 et 24 % des patients auraient prefere une hospitalisation conventionnelle. Le taux de recours aux urgences dans les 48 heures etait de 11 % et concernait tous les types d’intervention. Conclusion Une partie consequente de l’activite d’urologie a ete compatible avec une hospitalisation de jour sans compromettre la qualite des soins ni la satisfaction des patients.

Study Type – Therapy (outcomes research) Level of Evidence 2b OBJECTIVE • To assess clinical outcomes at mid-term follow-up and determine preoperative factors associated with the failure of the AdvanceTM male sling for post-prostatectomy incontinence (PPI). PATIENTS AND METHODS • A prospective evaluation was conducted of 136 consecutive patients implanted with the AdvanceTM male sling for mild to moderate stress urinary incontinence after prostatectomy. • Patients were preoperatively evaluated using medical history, ASA score, urodynamics, 24-h pad test and pad usage. • The clinical outcome was evaluated according to pad use and the Patient Global Impression of Improvement scale and by assessment of side effects. ‘Cure’ was defined as no pad usage and ‘improvement’ as a decrease in pad use by >50%. • Factors related to functional outcome were studied by univariate and multivariate analysis. RESULTS • After a mean ± SD (range) follow-up of 21 ± 6 (12–36) months, 62% of patients were cured, 16% improved and 22% not improved. • Failure (no cure or improvement) was associated with previous urethral stricture surgery (P= 0.013) and a 24-h pad-test >200 g/day (P= 0.026), and there was a trend for an association with previous radiation therapy (P= 0.053). • Age, learning curve and type of prostatectomy did not affect the results. • Immediate postoperative complications were limited to two cases of dysuria, one case of perineal haematoma and two cases of perineal paresthesia. During follow-up, 10% of patients had perineal pain and 14% of patients had mild dysuria. None required surgical management. CONCLUSION • The results of the present study, with a follow-up of up to 3 years, confirm that the AdvanceTM male sling is an efficient treatment for PPI. However, particular attention should be given to the preoperative data associated with failure.

Les traitements chirurgicaux des hyperactivites vesicales neurologiques sont reserves aux echecs des traitements medicaux, conservateurs. Le but de ces interventions est d’obtenir un reservoir vesical de bonne capacite qui se remplit a basse pression. Cela permet de diminuer les symptomes, de preserver le haut appareil urinaire et de diminuer les complications des vessies neurologiques. Plusieurs options therapeutiques sont a decrire : les methodes chirurgicales de denervation vesicale, la detrusoromyomectomie, les enterocystoplasties avec ou sans derivation urinaire continente et enfin les derivations urinaires non continentes. Nous ne parlerons pas de la neuromodulation sacree qui fera l’objet specifiquement d’un article.

Resume Ces deux dernieres decennies ont permis de voir apparaitre de nouveaux traitements medicaux ou chirurgicaux revolutionnant la prise en charge de l’incontinence urinaire feminine non neurologique. De nombreuses etudes souvent prospectives randomisees, avec des reculs suffisants, ont permis de valider les bons choix therapeutiques en dehors des effets de mode et des pressions commerciales. L’Association Francaise d’Urologie, par le biais de son Comite d’Urologie et de Pelviperineologie de la Femme, propose ses recommandations. Celles-ci ont ete etablies par un groupe d’experts des specialites concernees (Urologues, Gynecologues, Reeducateurs), a partir d’une revue de la litterature, mais en tenant compte des pratiques quotidiennes universitaires et liberales. Entre Evidence Base Medicine et realite du terrain, ces recommandations essayent de proposer des attitudes realistes et applicables.

Background Transobturator male slings have been proposed to manage stress urinary incontinence (SUI) after prostatic surgery, but data are still lacking. Objective To determine the safety and prospectively evaluate the clinical outcome after management of SUI after prostatic surgery by placement of a transobturator male sling. Design, setting, and participants We conducted a prospective evaluation on 102 patients treated in a single center between 2007 and 2009 for mild to moderate SUI following prostatic surgery. Interventions Placement of a suburethral transobturator sling and clinical follow-up. Measurements Patients were evaluated by medical history, preoperative urodynamics, maximum flow rate measurement, 24-h pad test, and daily pad use. During follow-up, data on patients' pad use, complications, and answers to the Patient Global Impression of Improvement (PGI-I) questionnaire were collected. Cure was defined as no pad usage or one pad for security reasons and improvement as reduction of pads ≥50%. Median follow-up was 13 mo (range: 6–26). Results and limitations Most patients (95%) presented post–radical prostatectomy incontinence (PRPI). Hospital stay was 2 d in 97 cases, and all patients were catheterized for 24h except two (48h). Of 102 patients, 64 were cured, 18 were improved, and 20 were not improved. According to the PGI-I questionnaire, 85%, 11%, and 4% of patients described a respectively better, unchanged, and worse urinary tract condition, respectively. Previous radiation was associated with higher rate of failure ( p =0.039). Neither severe complication nor postoperative urinary obstruction was noted during follow-up. Conclusions Placement of a transobturator sling is a safe and effective procedure, giving durable results after >1 yr of follow-up. Further evaluation and high-quality controlled, randomized studies are needed to assess long-term efficacy and precise indications of this procedure for post–prostatic-surgery SUI management.

La reeducacion perineal, las modificaciones del estilo de vida, los consejos higienicodieteticos y la reeducacion conductual forman parte de los tratamientos conservadores de la incontinencia urinaria de la mujer. La reeducacion perineal comprende la reeducacion perineal activa o refuerzo de los musculos del piso pelvico, la electroestimulacion (en la que se emplean corrientes electricas con fines terapeuticos para estimular la contraccion muscular por medio de la activacion de los nervios que gobiernan los musculos) y la biorretroalimentacion (que consiste en la toma de conciencia objetiva de una funcion fisiologica que escapa a la percepcion consciente). En la incontinencia urinaria, la reeducacion arroja unos porcentajes de exito muy variables, que van, segun las diversas publicaciones, del 12 al 90%. La interpretacion de estos estudios no siempre resulta facil, sobre todo por la gran diversidad de tecnicas empleadas. Sin embargo, diversos organismos y expertos, basandose en los numerosos estudios de calidad existentes, recomiendan la reeducacion perineal como tratamiento de la incontinencia urinaria.

Nous avons evalue l’eventuel caractere predictif d’une disparition des contractions non inhibees du detrusor sous stimulation aigue du sciatique poplite interne (SPI) a la cheville et de la racine S3 sur l’efficacite ulterieure d’une neuromodulation chronique des racines sacrees. Il s’agit d’une etude retrospective effectuee a partir de 150 patients ayant beneficie d’un test aigu de neuromodulation. Cinquante et un ont ete implantes, dont 30 pour un syndrome clinique d’hyperactivite vesicale. Parmi ces 30, 11 avaient une hyperactivite du detrusor. Dans ce groupe, l’âge moyen de ces 10 femmes et 1 homme etait de 57,2 ans. Le recul moyen pour juger de l’efficacite de la stimulation chronique etait de 9,45 mois. Une cystomanometrie etait realisee a l’etat basal, puis sous stimulation aigue de la racine S3 et du SPI, suivant un ordre randomise. Les parametres etudies etaient le volume de la premiere contraction non inhibee du detrusor et la capacite cystomanometrique maximale. Le test etait positif (doublement du volume d’apparition de la premiere contraction desinhibee, doublement de la capacite cystomanometrique maximale), 5/11 sous stimulation S3 et 4/11 sous stimulation du SPI. Il n’existait aucune correlation entre la positivite du test urodynamique et le devenir des patients sous neuromodulation chronique (6/11 gueris, 5/11 ameliores). La disparition d’une hyperactivite detrusorienne sous stimulation de S3 ou du SPI n’est pas un facteur predictif de l’efficacite ulterieure d’une neuromodulation chronique des racines sacrees. Les criteres d’implantation restent cliniques, principalement fondes sur le catalogue mictionnel.

Objectifs Evaluer de facon prospective la prise en charge de la prostatectomie radicale cœlioscopique robotique (PRR) en unite de chirurgie ambulatoire (UCA). Methodes Entre le 15/3/16 et le 31/5/16, 14 PRR ont ete realisees par le meme operateur au sein de notre equipe. Huit PRR ont ete programmees en UCA, apres avoir donne aux patients une information conforme aux recommandations de la HAS pour toute chirurgie ambulatoire. Les interventions ont ete realisees en 1 re position le matin, suivant un protocole anesthesiste per- et postoperatoire specifique permettant la recuperation rapide apres chirurgie (RRAC). Les criteres de sortie etaient : EVA e et la 6 e heure, redon 3 . La sortie a ete validee apres visite du chirurgien et de l’anesthesiste, en respectant les criteres de securite de l’UCA, et en accord avec le patient. L’appel du lendemain a permis d’evaluer la qualite de la nuit postoperatoire a domicile. Resultats Toutes les PRR ont ete realisees en cœlioscopie transperitoneale, sans curage ilio-obturateur, avec preservation bilaterale des bandelettes neurovasculaires. Six des 8 patients programmes en UCA ont pu sortir le soir meme, donc moins de 12 h apres l’entree. Aucun de ces 6 patients n’a du etre readmis apres la sortie. Deux patients n’ont pas pu sortir pour des raisons administratives. Tous les patients appeles le lendemain se sont declares satisfaits d’avoir pu passer la nuit a leur domicile. Tous les patients ont ete revus au 6 e jour postoperatoire pour ablation de sonde vesicale. Les donnees principales sont resumees dans le Tableau 1 . Conclusion La PRR peut etre proposee en UCA, sans en augmenter le risque de complications. La prise en charge en UCA diminue le stress lie a l’hospitalisation en permettant un retour rapide au domicile (

Stress urinary female incontinence (SUI) is primary due to intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite a lack of standardised international definition, ISD needs to be clearly diagnosed in order to be correctly treated. This work is an update about the female ISD produced from a review of a published article.This review of article published on this subject in the Medline (Pubmed database), selected according to their scientific relevants, of consensus conferences and published guidelines, has been performed by the committee for women pelvic floor surgery of the French Urological Association.Although there is no international consensus definition, we can consider that the ISD is a composite concept combining urodynamic data (MUCP20 or 30 cmH20) and one or more clinical information (no urethral mobility, negative urethral support test, failure of a first surgery, leakage during abdominal straining, high stress incontinence scores). Imaging can provide additional evidence for intrinsic sphincter deficiency diagnosis, but the correlation between imaging and function remains low. By standardizing methodology and interpretations to better diagnose women with ISD, it may be possible to improve preoperative planning and outcomes for these patients. A retropubic midurethral sling can be performed as a first surgery. In case of a lack of urethral mobility, the artificial urinary sphincter (AUS) remains the gold standard. Adjustable continence therapy (ACT(®)) can be proposed as an alternative option. The efficacy and safety of muscle-derived cell therapy in ISD needs more studies. Injection of bulking agents may be an option according to the severity and the expectations of the patient. Bladder overactivity needs to be treated as first-line in case of mixed urinary incontinence. In elderly women, a careful evaluation of the bladder contractility and comorbidity must be performed. A geriatric evaluation can be necessary.Clinical and paraclinical assessment allow to confirm the diagnosis of female ISD, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment.

Objectifs L’implantation d’un sphincter urinaire artificiel (SUA) chez l’homme est le traitement chirurgical de reference de l’incontinence urinaire d’effort (IUE) apres chirurgie prostatique. Le but de ce travail etait d’etablir la faisabilite de l’implantation de SUA pour IUE masculine non neurologique en chirurgie ambulatoire. Methodes Tous les patients operes entre 2013 et 2015 avec implantation d’un sphincter AMS800™ en ambulatoire (en l’absence de contre-indication anesthesique) ont ete inclus dans une evaluation prospective monocentrique. La sonde vesicale etait retiree avant le retour a domicile et les patients etaient revus a un mois postoperatoire pour l’activation en consultation. L’evaluation portait sur : le niveau de satisfaction vis a vis de la prise en charge en ambulatoire (echelle de Likert), la necessite de re-hospitalisation dans le mois, le nombre de protections par jour apres activation du dispositif, et l’amelioration subjective par rapport a la situation preoperatoire (Patient Global Impression of Improvement). Resultats Sur 43 patients operes (âge 67 ± 7 ans), 6 etaient des revisons de dispositif avec changement complet et 37 des implantations primaires. Trois patients avaient eu de la radiotherapie pelvienne. Un seul patient a du etre admis en hospitalisation conventionnelle le soir meme pour hematome postoperatoire. Tous les patients ont pu etre actives a un mois sauf un (reprise chirurgicale pour hematome). Un patient a presente une infection de la cicatrice traitee medicalement. Apres un suivi de 6 ± 1 mois, 21 patients etaient secs, 10 portaient une protection de securite et 12 portaient une protection ou plus. Soixante-seize pour cent etaient tres satisfaits (PGI-I 1 ou 2). Tous les patients sauf trois etaient satisfaits ou tres satisfaits de la prise en charge en ambulatoire et la recommanderaient. Conclusion L’implantation d’un SUA chez l’homme pour IUE non neurologique en ambulatoire est faisable, avec des resultats comparables a ceux obtenus en chirurgie traditionnelle.

To conduct a review about the use of single incision mini-slings (SIMS) to manage non-neurogenic stress urinary incontinence in women.Literature search in Pubmed/MEdline database until june 2013. TVT-Secur™ was excluded because this device is not anymore marketed.Ajust™ and Mini-Arc™ were the two main SIMS evaluated in the literature. Studies about Mini-Arc™ generated heterogeneous results, with a success rate between 44% and 91% after 1 year. Ajust™ was the most promising device with 80% efficacy after mid-term follow-up. All evaluated SIMS had a low rate of immediate complications. Two randomized controlled trials comparing SIMS and traditional mid-urethral slings were identified, as well as one meta-analysis; they all concluded to non-superiority or inferiority for the mini-sling versus traditional slings.Due to short follow-up, limited evidence and heterogeneous data, SIMS are not yet standard of care and further research is warranted.

To assess the clinical outcome following artificial urinary sphincter (AUS) implantation after failure of Advance™ sub-urethral male sling for post-prostatectomy incontinence (PPI).A prospective evaluation was conducted about consecutive patients who received an AUS after failure of Advance™ therapy in one tertiary reference center. Evaluation included medical history, pad use and operative data (duration, cuff size, technical difficulties). Follow-up was scheduled at 1, 6, 12 months and yearly thereafter. Clinical outcome was evaluated by pad use, patient global impression of improvement (PGI-I) scale and assessment of side effects. Cure was defined as no pad usage.Twelve patients were included in this evaluation. Median follow-up was 20 months (12-43). No patient was lost to follow-up. Four patients had a history of radiation therapy and all patients had mild or moderate PPI with previous failed Advance™ surgery. Median (range) operative time was 47 minutes (40-60). No technical problem occurred during AUS implantation. Hospital stay duration and catheterization duration were respectively 2 days and 24 hours in all but one case. At last follow-up, 10/12 patients (83%) were cured and fully satisfied. Two were improved, wearing only one pad per day. Postoperative complications were noted in two cases (17%) (one case of cutaneous erosion and one case of superficial iliac wound infection).AUS implantation is feasible in patients who have undergone Advance™ male sling implantation. Mid-term results of this procedure are comparable to those obtained after first line AUS implantation.

Objectifs L’implantation de materiel prothetique pour cure chirurgicale de prolapsus anterieur par voie vaginale est largement utilisee en pratique clinique, mais tres peu d’etudes rapportent les resultats de cette technique a long terme. L’objectif de ce travail etait de decrire les resultats du traitement du prolapsus par implantation de treillis Avaulta™ avec un recul minimum de 3 ans. Methodes Une evaluation prospective a ete realisee dans un centre de reference. Toutes les patientes ayant recu l’implantation d’une prothese Avaulta Anterior ™ (Bard, Covington, GA, Etats-Unis) entre 2008 et 2011 ont ete inclues. Les donnees preoperatoires et peroperatoires ont ete recueillies dans une base de donnees dediee, ainsi que les resultats postoperatoires. Une actualisation des donnees a ete realisee en fevrier 2014, sur les questionnaires valides de satisfaction (questionnaire Patient Global Impression of Improvement), de qualite de vie (Pelvic Floor Impact Questionnaire, PFIQ-7) et de symptomes (Pelvic Floor Distress Inventory PFDI-20), les effets secondaires, le taux et motifs de re-operation, la sexualite, la continence. Resultats Une cohorte de 48 patientes a ete evaluee avec un recul median [interquartile Q1–Q3] de 60 mois [47–64]. Les caracteristiques initiales et perioperatoires sont resumees dans le Tableau 1 . Les complications post-operatoires ont ete deux cas d’infection urinaire et un cas de perforation vesicale (suites simples). Au dernier suivi, 6 patientes etaient decedees et 6 perdues de vue. Cinq patientes avaient ete re-operees : une pour infection/explantation de prothese, une pour cure de rectocele apparue secondairement et trois pour implantation differee de bandelette sous-urethrale. Une recurrence du prolapsus anterieur (stade ≥ 2) etait notee dans trois cas, sans re-intervention. La grande majorite des patientes etait satisfaite ( Fig. 1 ), peu symptomatique (PDFI median 40/300 [18–77], et avaient un score de qualite de vie satisfaisant (PFIQ-7 median 12/300 [0–50]). Conclusion La cure de prolapsus genital de l’etage anterieur par voie vaginal, par implantation de treillis Avaulta™ etait a long terme efficace et sure, avec un seul cas de complication grave.

To report and prevent a serious complication of tension-free vaginal tape (TVT) procedure.One day after a TVT procedure, an emergency CT scan showed adhesion of intestinal loops with a pneumoperitoneum. The patient had previously had intra- and retroperitoneal surgery with a sacral cervicopexy and a Burch colposuspension.In such a case of previous surgery, a CT scan may be useful before a TVT procedure.

Duloxetine is effective in the management of stress urinary incontinence (SUI) in women but has been poorly evaluated in the treatment of SUI following radical prostatectomy (RP).To establish the superiority of duloxetine over placebo in SUI after RP.We conducted a prospective, randomised, placebo-controlled, double-blind, monocentric superiority trial. After a placebo run-in period of 2 wk, patients with SUI after RP were randomised to receive either 80mg of duloxetine daily or matching placebo for 3 mo.The primary outcome measure was the relative variation in incontinence episodes frequency (IEF) at the end of study compared to baseline. Secondary outcomes included quality of life (QoL) measures (Incontinence Impact Questionnaire Short Form [IIQ-SF], Urogenital Distress Inventory Short Form [UDI-SF], Incontinence Quality of Life [I-QoL]), symptom scores (Urinary Symptom Profile [USP] questionnaire, International Consultation on Incontinence/World Health Organisation Short Form questionnaire [ICIQ-SF], the Beck Depression Inventory [BDI-II] questionnaire), 1-h pad test, and assessment of adverse events.Thirty-one patients were randomised to either the treatment (n=16) or control group (n=15). Reduction in IEF was significant with duloxetine compared to placebo (mean±standard deviation [SD] variation: -52.2%±38.6 [range: -100 to +46] vs +19.0%±43.5 [range: -53 to +104]; mean difference: 71.2%; 95% confidence interval [CI] for the difference: 41.0-101.4; p0.0001). IIQ-SF total score, UDI-SF total score, SUI subscore of the USP questionnaire, and question 3 of the ICIQ-SF questionnaire showed improvement in the duloxetine group (p=0.006, p=0.02, p=0.0004, and p=0.003, respectively). Both treatments were well tolerated throughout the study period.Duloxetine is effective in the treatment of incontinence symptoms and improves QoL in patients with SUI after RP.

Ambulatory surgery is an alternative to traditional hospitalisation and an opportunity for savings for the healthcare system. Here, we analyze our experience in outpatient surgery in urology over a year.A prospective database concerning outpatient activity was established in 2009, gathering age, ASA score, type of intervention, discharge and recovery for each patient. An individual questionnaire was sent retrospectively in February 2010, to collect data about history of outpatient surgery, overall satisfaction, preference for traditional hospitalization and emergency department visits within 48 hours after surgery.In 2009, 465 patients aged of 52±16 years (15-98) underwent urologic surgery on an outpatient basis. Median ASA score was 2 (1-3). Types of intervention were mainly endo-urology (44.5%), surgery for urinary incontinence (32.5%), and circumcision (12.3%). The postoperative hospitalization rate was 4.5%. The questionnaire response rate was 28%. Forty-six percent of the patients had already been supported in ambulatory, overall satisfaction was 3.3 out of 4 (±1.06) and 24% of patients would have preferred a traditional hospitalization. 11% of patients required emergency department care within 48 hours whatever the surgery undergone.An important part of urological procedures has been done on an outpatient basis without compromising quality of care and patient satisfaction.