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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.

International audience; ObjectifsLa voie robot-assistée a récemment été décrite pour l’implantation du sphincter artificiel urinaire (SAU) chez la femme pour tenter de diminuer la morbidité périopératoire. L’objectif de cette étude était de rapporter les résultats périopératoires et fonctionnelles de la première série multicentrique internationale de sphincter artificiel urinaire robot-assistée.MéthodesToutes les patientes ayant eu une implantation robot-assistée d’un SAU en utilisant une technique standardisée (voie antérieure) entre 2013 et 2020 dans quinze institutions européennes ont été incluses dans une étude rétrospective. L’indication du SAU était une incontinence urinaire d’effort par insuffisance sphinctérienne définie comme la combinaison d’une faible pression de clôture urétrale et un urètre peu mobile/figé. Le principal critère d’évaluation était le résultat fonctionnel classé comme sec (aucune protection), amélioré ou inchangé.RésultatsCent vingt-cinq patientes ont été incluses. Les caractéristiques des patientes sont résumées dans le Tableau 1. Il y a eu 20 complications peropératoires (16 %) : 12 plaies du col vésical et huit plaie vaginales. Dans un cas de plaies multiples du col vésical, l’intervention a été interrompue mais elle a été poursuivie dans tous les autres cas. Vingt-deux patientes ont eu une complication postopératoire (17,6 %) mais seulement quatre étaient Clavien ≥ 3 (3,2 %) : trois explantations précoces (2 pour érosion vaginale et une pour infection) et une réintervention pour fistule vésicale. Après un suivi moyen de 13 mois, il y a eu 7 explantations (4,1 %) : les 3 précoces rapportées ci-dessus, une pour rétention chronique d’urine et trois pour érosions tardives (2 vaginales et une urétrale). Au dernier suivi, 101 patientes étaient sèches (80,8 %), 11 étaient améliorées (8,8 %) et 13 étaient inchangées (10,4 %).ConclusionCette série est la première série multicentrique internationale évaluant les Résultats de l’implantation du SAU chez la femme par voie robot-assistée selon une technique standardisée. Cette étude confirme les résultats périopératoires et fonctionnels prometteurs rapportés dans les précédentes séries.

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.

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...

INTRODUCTION AND OBJECTIVE:The main drawback of the artificial urinary sphincter (AUS) in women is the technical complexity of its implantation. Over the past five years, several teams have reporte...

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 Prolapsus et incontinence urinaire sont frequemment associes. L’incontinence urinaire a l’effort (lUE) patente ou averee est definie par une fuite d’urine survenant a la toux ou au Valsalva, en l’absence de toute manœuvre de reduction du prolapsus. L’incontinence urinaire masquee se traduit par une fuite d’urine survenant lors de la reduction du prolapsus au cours de l’examen clinique chez une patiente ne decrivant pas de symptomes d’incontinence a l’etat basal. L’objet de ce chapitre est de reflechir a la question de la prise en charge systematique ou non d’une IUE, patente ou masquee, lors de la cure d’un prolapsus des organes pelviens par voie haute ou par voie basse. Materiel et methodes Ce travail s’appuie sur une revue systematique de la litterature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) concernant les meta-analyses, essais randomises, registres, revues de la litterature, etudes controlees et grandes etudes non controlees publies sur le sujet. Sa realisation a suivi la methodologie de la Haute Autorite de Sante (HAS) concernant les recommandations pour la pratique clinique, avec un argumentaire scientifique (accompagne du niveau de preuve, NP) et un grade de recommandation (A, B, C et accord professionnel, AP). Resultats En cas d’IUE patente, la cure concomitante du prolapsus et de l’IUE reduit le risque d’IUE postoperatoire. Cependant le traitement isole du prolapsus permet de traiter jusqu’a 30 % des IUE preoperatoires. Le traitement concomitant de l’IUE expose a une morbidite specifique d’hyperactivite vesicale et de dysurie. La presence d’une IUE masquee represente un risque d’IUE postoperatoire, mais il n’existe pas de test clinique ou urodynamique permettant de predire de maniere individuelle le risque d’IUE postoperatoire. Par ailleurs, le traitement isole du prolapsus permet de traiter jusqu’a 60 % des IUE masquees. Le traitement concomitant de l’IUE masquee expose donc la aussi a un surtraitement et a une morbidite specifique d’hyperactivite vesicale et de dysurie. Conclusion En cas d’IUE, patente ou masquee, le traitement concomitant de l’IUE et du prolapsus reduit le risque d’IUE postoperatoire mais expose a une morbidite specifique de dysurie et d’hyperactivite vesicale (NP3). Le traitement isole du prolapsus permet souvent a lui seul de traiter une IUE preoperatoire. On peut proposer de ne pas traiter l’IUE, qu’elle soit patente ou masquee, dans le meme temps a condition de prevenir les patientes de l’eventualite d’une chirurgie en deux temps (grade C). © 2016 Publie par Elsevier Masson SAS.

Objectifs Le principal inconvenient du sphincter artificiel urinaire AMS 800 (SAU) chez la femme est la difficulte technique de l’implantation. Au cours des 5 dernieres annees, plusieurs equipes francaises ont rapporte leur experience preliminaire concernant l’implantation robot-assistee du SAU chez la femme par voie anterieure. L’objectif de cette video etait de presenter une mise a jour de la technique utilisee dans plus de 10 centres francais. Methodes La technique d’implantation robot-assistee par voie anterieure du SAU AMS-800 chez la femme souffrant d’incontinence urinaire d’effort par insuffisance sphincterienne s’est progressivement epuree au cours des 5 dernieres annees au fur et a mesure de l’experience. Une technique standardisee d’implantation robotique du SAU chez la femme a ete developpee afin de faciliter sa reproductibilite. Cette technique est decrite en insistant sur les points techniques et astuces proposes pour faciliter l’apprentissage de cette technique. Resultats L’intervention est realisee en double equipe. La patiente est positionnee en Tredelenburg a 23°. On realise un abord laparoscopique transperitoneal. Le robot est amarre lateralement (« side-docking »). Apres avoir rempli la vessie, dissection du Retzius jusqu’a l’aponevrose pelvienne qui est incisee de part et d’autre du col vesical. Dissection prudente de chaque cul de sac vaginal, mis en tension par le doigt de l’aide place dans le vagin. Le plan inter-vesico-vaginal est amorce aux ciseaux et est ensuite developpe a la pince prograsp en privilegiant une dissection mousse. Passage du mesureur et mise en place ensuite d’une manchette introduite par le trocart de 12 mm. Mise en place du ballonnet et de la pompe par une courte incision sus-pubienne et connexions entre manchette ballonnet et pompe. Conclusion L’implantation robot-assistee du sphincter AMS-800 chez la femme par voie anterieure est de plus en plus standardisee et est desormais utilisee dans plus de 10 centres francais. Cette standardisation pourrait favoriser sa reproductibilite, comme suggere par les resultats preliminaires des etudes cliniques.

Prolapse and urinary incontinence are frequently associated. Patente (or proven) stress urinary incontinence (SUI) is defined by a leakage of urine that occurs with coughing or Valsalva, in the absence of any prolapse reduction manipulation. Masked urinary incontinence results in leakage of urine occurring during reduction of prolapse during the clinical examination in a patient who does not describe incontinence symptoms at baseline. The purpose of this chapter is to consider on the issue of systematic support or not of urinary incontinence, patent or hidden, during the cure of pelvic organs prolapse by abdominal or vaginal approach.This work is based on an systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane database of systematic reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement).In case of patent IUE, concomitant treatment of prolapse and SUI reduces the risk of postoperative SUI. However, the isolated treatment of prolapse can treat up to 30% of preoperative SUI. Concomitant treatment of SUI exposed to a specific overactive bladder and dysuria morbidity. The presence of a hidden IUE represents a risk of postoperative SUI, but there is no clinical or urodynamic test to predict individually the risk of postoperative SUI. Moreover, the isolated treatment of prolapse can treat up to 60% of the masked SUI. Concomitant treatment of the hidden IUE therefore exposes again to overtreatment and a specific overactive bladder and dysuria morbidity.In case of overt or hidden urinary incontinence, concomitant treatment of SUI and prolapse reduces the risk of postoperative SUI but exposes to a specific overactive bladder and dysuria morbidity (NP3). The isolated treatment of prolapse often allows itself to treat preoperative SUI. We can suggest not to treat SUI (whether patent or hidden) at the same time, providing that women are informed of the possibility of 2 stages surgery (Grade C). © 2016 Published by Elsevier Masson SAS.

Resume Objectif Evaluation retrospective de l’efficacite et la morbidite de la nephrolithotomie percutanee bilaterale en un temps. Materiel et methode De janvier 1993 a juillet 2009, 60 patients ayant subi une nephrolithomie percutanee (NLPC) bilaterale en un temps ont ete revus parmi 1709 dossiers de NLPC. Il s’agissait de 30 hommes et 30 femmes d’âge moyen 45 ans (13–78 ans). Ils avaient tous des calculs renaux bilateraux (120 unites renales atteintes). Leur surface moyenne etait de 1177 mm 2 (268–4972 mm 2 ) ; 25 etaient coralliformes complets. Resultats La duree moyenne de la NLPC du premier cote a ete de 80 minutes (30–270) et de 45 minutes (10–90) pour le second cote. La duree totale de l’intervention a ete de 188 minutes (90–360). Quarante-cinq patients etaient sans fragment apres une seance ; 15 patients (25 %) ont eu un geste supplementaire pour etre gueris : cinq NLPC dont une bilaterale ; huit ont eu une lithotripsie extracorporelle (LEC) (quatre avec sonde JJ) et deux autres une ureteroscopie souple. Aucune transfusion n’a ete necessaire. La fonction renale est inchangee a terme. Ont ete rapportees les complications selon Clavien : deux grade IIIb, un grade IVa et un grade IVb. La duree moyenne de sejour a ete de 8,4 ± 4,9 jours (de deux a 35). Conclusion Dans cette NLPC bilaterale, en un temps, a eu une morbidite comparable a celle de la NLPC unilaterale avec la meme efficacite qu’une NLPC bilaterale en deux temps. Elle doit etre reservee a des patients selectionnes et realisee dans des centres entraines.

Resume Un cadre reglementaire precis doit etre respecte pour l’utilisation de la neuromodulation des racines sacrees pour le traitement de l’incontinence urinaire feminine par hyperactivite vesicale. Il n’est pas recommande d’effectuer un test de neuromodulation des racines sacrees pour la prise en charge de l’incontinence urinaire par hyperactivite vesicale si un traitement par reeducation ou un traitement par anticholinergique n’a pas ete essaye, a moins qu’une contre-indication interdise l’utilisation de ces traitements. L’urologue implanteur doit avoir recu une formation specifique sur le materiel, la technique d’implantation et le parametrage. L’evaluation de l’efficacite pendant la periode de test doit etre rigoureuse et repose sur l’utilisation de calendriers mictionnels, de questionnaires de symptomes ainsi que de l’appreciation globale par la patiente. Une amelioration superieure a 50% et un contretest verifiant la reapparition des symptomes apres l’arret de la stimulation sont necessaires pour justifier de l’implantation d’un neuromodulateur. Une information complete doit etre donnee aux patientes avant la realisation du test. Il precise le deroulement du test, la realisation des calendriers mictionnels, les precautions a respecter et les incidents pouvant survenir

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.

In France, the prevalence of urinary incontinence is about 44%. Obesity, defined by a Body Mass Index (BMI) above 30kg/m(2), is well established as a risk factor of stress urinary incontinence. Odds ratio (OR) varies between 1.7 and 2.4. Urge or mixed incontinence also occurs in obesity. Urinary incontinence epidemiology is not well-known in obese women. Weight loss, obtained by a weight reduction diet program or bariatric surgery, improves urinary symptoms of stress, urge or mixed incontinence. Functional outcome of urge incontinence surgery is not influenced by obesity. Typically, functional outcome and morbidity of tension-free vaginal tape are not influenced by BMI variations.

(1) To describe the minimally invasive adjustable continence therapy (ACT)(®) balloon placement surgical technique. (2) To analyse the results of ACT(®) balloon in the treatment for female stress urinary incontinence (SUI).A review of the literature was performed by searching the PubMed database using the following search terms: ACT balloons, female urinary incontinence, and female continence.Eight studies were published between 2007 and 2013. The mean follow-up of these studies was 1-6 years. The mean age of the patients ranged between 62 and 73 years; 40-100 % of patients had already been treated surgically for their SUI. A significant reduction in the number of pads used per day was observed after ACT(®) balloon placement, with improvement of short pad tests from 49.6 to 77.3 g preoperatively to 11.2-25.7 g after ACT(®) balloon placement. Fifteen to 44 % of patients considered that their SUI had been cured and 66-78.4 % were satisfied with the result. The explantation rate ranged between 18.7 and 30.8 %. Quality of life was significantly improved, and no major complication was reported.ACT(®) balloons constitute a reasonable, minimally invasive alternative for the treatment for female SUI due to intrinsic sphincter disorder, especially in patients who have already experienced failure of standard surgical treatment and in clinical settings incompatible with invasive surgical placement of an artificial urinary sphincter (especially women over the age of 80 years). Long-term results are essential to evaluate the efficacy of this treatment.

We evaluated the long-term safety and efficacy of an adjustable continence device (ACT® or ProACT™) in male and female patients with neurogenic stress urinary incontinence.Data on patients consecutively treated with implantation of an adjustable continence device due to neurogenic stress urinary incontinence were reviewed from the start of our experience to the current 4-year followup.We reviewed data on 13 male and 24 female patients with neurogenic stress urinary incontinence due to different forms of pelvic nerve or spinal cord lesions. Mean ± SD age at implantation was 46.2 ± 17.4 years. Of the patients 92% performed clean intermittent self-catheterization. The device was implanted bilaterally using general and local anesthesia in 16.2% and 83.8% of cases, respectively. From before implantation to 48-month followup the mean number of urinary incontinence episodes decreased from 6.1 ± 2.4 to 2.8 ± 3.1 and the mean number of pads used per 24 hours decreased from 4.2 ± 2.7 to 2.2 ± 2.2. Of the patients 54.5% indicated more than 50% improvement of stress urinary incontinence symptoms after 48 months, of whom 38.9% indicated complete continence. Adverse events included erosion/migration, device infection or failure, implantation site pain, bladder stone formation and difficult clean intermittent self-catheterization.Implantation of the ProACT/ACT device in patients with neurogenic stress urinary incontinence is minimally invasive and safe. It can significantly improve neurogenic stress urinary incontinence in the long term. Thus, it might be a reasonable option for patients who are not willing, not suitable or not yet ready for more invasive surgery, such as artificial urinary sphincter or fascial suspension sling placement.

INTRODUCTION AND OBJECTIVES: To analyse the efficacy and safety of sacral neuromodulation with InterStimTM Therapy in patients with urinary incontinence and retention implanted at our centre. METHODS: This prospective observational study included all patients undergoing permanent implantation of a neurostimulator for SNM at our centre between 1996 and July 2010. Baseline and follow-up voiding diary variables, clinical improvement, and patient satisfaction were evaluated. The impact of age, sex, disease duration, and diagnosis (neurogenic or non-neurogenic), and implantation methodology (oneor two-stage implant) on clinical outcome was evaluated. RESULTS: The database included 165 patients (mean age 59 years, 85% females), including 69% with non-neurogenic cause of dysfunction. The principal diagnoses were overactive bladder syndrome (OAB, N 137) and urinary retention (N 22). At last follow-up, mean patient satisfaction with treatment at 0–12 months, 12–60 months and 60 months was 65.8%, 67.5%, and 75.0%, respectively. No differences were observed between retention and incontinence patients or between patients with neurogenic and non-neurogenic dysfunction. At last follow-up, clinical improvement of 50% and 90% was seen in 80% and 34% of patients, respectively. Clinical improvement of 50% or 90% was seen significantly more in patients with two-stage implant than in patients with one-stage implant (p 0.0001 and P 0.0023, respectively). Diagnosis (neurogenic or non-neurogenic; OAB or retention), sex, or disease duration before implantation ( 5 years or 5 years) were not significantly predictive of clinical improvement. 49 patients (29.7%) had 1 adverse event (AEs), of which pain (12.7%) occurred most frequently. Loss of efficacy occurred in 26.7% of patients. CONCLUSIONS: Sacral neuromodulation with InterStim Therapy seems to be an effective and well tolerated treatment in the short and the long term for patients with OAB and retention.

Precise regulations should be respected when using neuromodulation of the sacral nerve roots in treating urinary incontinence in women with vesical hyperactivity. It is not recommended to perform a neuromodulation test of the sacral roots in management of urinary incontinence caused by vesical hyperactivity if rehabilitation or anticholinergic treatment has not been attempted, unless a contraindication prevents use of these treatments. The urologist implanting the device will have had specific training on the implantation material, the implantation technique, and parameterization. Assessment of the efficacy during the test period should be rigorous and based on use of voiding diaries, symptom questionnaires, as well as the patient's overall evaluation. Improvement greater than 50% and a counter test verifying the reappearance of symptoms after stimulation is interrupted are necessary to warrant implantation of a neuromodulator. Complete information should be given to patients before the test is performed. This will detail the test procedure, how to keep a voiding diary, the safety precautions, and the incidents that may occur.

Retrospective evaluation of the efficacy and morbidity of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL).From January 1993 to July 2009, 60 patients have undergone SB-PCNL over a series of 1709 PCNL. Thirty men and 30 women, mean age 45 years old (13-78), were treated for bilateral renal stones (120 kidneys) of 1177 mm(2) (268-4972 mm(2)); 25 were complete staghorn stones.Operating time for the first side of PCNL was 80 min (30-270) and 45 min (10-90) for the opposite side. Overall OR occupation was 188 min (90-360). Forty-five patients were stone free after one session; 15 patients (25%) have a complementary treatment to be stone free: five PCNL (one bilateral); eight ESWL (four with JJ stent) and two flexible ureteroscopy. No blood transfusion was required. Renal function was unchanged at 1 month. Clavien grade for complications were as follows: two grade IIIb, one grade IVa and one grade IVb. Hospitalization stay was 4±4.9 days (2-35) taking account of two major sepsis (one pulmonary and one septicemia).SB-PCNL was well tolerated with comparable morbidity and efficacy to PCNL performed on each side in two separate sessions. Nevertheless, SB-PCNL has to be performed for selected patients in expert centers.

International audience; The water intake of 41 lactating dairy cows managed according to current dairy farm practices was individually and continuously monitored to 1) investigate drinking behavior and 2) determine factors affecting water intake. The cows were housed in a free-stall barn and fed once daily with a corn silage and concentrate-based total mixed ration (48% dry matter content; 20.6 ± 3.3 kg/d of dry matter intake). Cows were milked twice daily, with a yield of 26.5 ± 5.9 kg/d. The daily free water intake (FWI) was 83.6 ± 17.1 L, achieved during 7.3 ± 2.8 drinking bouts. The drinking bout water intake was 12.9 ± 5.0 L. Almost three-fourths of the FWI occurred during working hours (0600 to 1900 h). Consumption peaks corresponded to feeding and milking times. More than one quarter of the daily FWI was met during the 2 h after each milking. About 75% of the present cows visited the watering point at least once during the 2 h after the evening milking. It is probable that drinking behavior evolved with lactation, but further studies are required to identify the relationship between lactation stage and drinking behavior. The most relevant factors affecting the daily FWI of lactating cows were best combined according to the following predictive equation: (R2 = 0.45; n = 41 cows, n = 1,837): FWI, L/d = 1.53 x dry matter intake (kg/d) + 1.33 x milk yield (kg/d) + 0.89 x dry matter content (%) + 0.57 x minimum temperature (°C) – 0.30 x rainfall (mm/d) – 25.65. The results obtained using these equations were in agreement with the equations developed by other researchers.

Introduction: The study assessed the treatment of intrinsic sphincter deficiency with the ACT™ system in neurogenic patients. Material and methods: The ACT™ consists of two postoperatively adjustable silicone balloons placed paraurethrally in females and at the prostatic apex, or vesico-urethral anastomosis in males. Balloon titration is via tubing connected to a titanium port in the labia majora or scrotum. Efficacy assessment was based on technical feasibility and patient assessment of leakage and acceptance. Results: Eighteen implantations including three revisions were performed on 12 females and three males. Mean age was 51.9 years, mean follow-up was 18 (8–40) months with a mean neurogenic history of 15 years (1 to 54). Aetiology of neurogenic disease was mixed and included degenerative; spinal cord injury; oncological, vascular and congenital disorders with most patients self catheterising and using either anticholinergics and/ or Botox or had previously undergone enterocystoplasty. Procedure was performed using local (72%), general (5.5%) or no anaesthesia (22%). At follow up, seven patients were dry and pad free(46%), six improved (not requesting any further adjustment)(40%), two failed. 8/30 devices were explanted in five patients due to erosion (six), device failure (one) and treatment failure (one). 3/5 have been reimplanted, with 1/5 planned for reimplantation. Of these three patients, two were dry and one significantly improved. No major complication has been described. Conclusion: ACT balloons may be considered for treatment of ISD in neurogenic patients provided that patients are informed of the increased risk of erosion, and the possibility of secondary implantation.