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Resume Introduction La cystite interstitielle est une pathologie frequente, caracterisee par une sensation d’inconfort liee a la sphere urinaire, dont la definition et l’ethiopathogenie sont encore debattues. Materiel et methode Nous presentons dans cet article les principaux traitements disponibles en 2021, a partir des recommandations internationales et de l’experience de notre centre, et proposons un algorithme therapeutique adapte aux decisions du regulateur francais. Resultats Les mesures comportementales, les regles hygienodietetiques et la prise en charge algologique sont a proposer en premiere intention. Apres echec des traitements par voie orale ou intravesicale, la cystoscopie avec hydrodistension sous anesthesie generale est indispensable. Les traitements chirurgicaux tels que la destruction des lesions de Hunner, la neuromodulation sacree, les injections de toxine botulique et la chirurgie radicale peuvent permettre de soulager efficacement les symptomes. Conclusion La prise en charge est frequemment chronique. Une cooperation entre urologue et algologue ainsi qu’une evaluation du rapport benefice/risque a chaque etape sont indispensables.

International audience

During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology.Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach.The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)).This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.

Resume Introduction Le present article a pour objectif de presenter la cystostomie continente aux infirmier(e) diplome(e) d’Etat (IDE) exercant au sein d’un service d’urologie. Methodes Cet article est fonde sur l'analyse de la litterature et l'experience des auteurs concernant les cystostomies continentes. Resultats La cystostomie continente consiste a confectionner une conduite entre la vessie et la paroi abdominale au moyen d’un segment digestif. Elle s’adresse aux patients presentant un trouble de la vidange vesicale et ne pouvant pas realiser les auto-sondages propres intermittents par l’uretre. Le taux eleve de succes (> 84 %) ne doit cependant pas faire oublier les complications du conduit qui restent frequentes. Conclusion Bien qu’elle presente de bon resultats fonctionnels a moyen et long terme, la cystostomie continente necessite un suivi regulier et parfois quelques « ajustements ».

Urinary incontinence after High Intensity Focused ultrasound (HIFU) is a poorly documented issue. To our knowledge, no study has evaluated the outcomes of artificial urinary sphincter (AUS) after HIFU. The aim of this study was to evaluate the functional outcomes of AUS for post-HIFU urinary incontinence.The charts of all male patients who underwent an AUS implantation between 2004 and 2020 in 13 centers were reviewed retrospectively. Only men with a history of HIFU were included. The primary endpoint was social continence at 3 months defined as wearing 0 to 1 pad per day.Out of 1318 procedures, nine men were implanted with an AUS after HIFU including four men with an history of pelvic irradiation: 3 pelvic radiation therapy and 1 prostatic brachytherapy. The patients were divided into two groups, 5 in the HIFU group without a history of pelvic irradiation, 4 patients in the HIRX group with a history of pelvic irradiation. The median age was 74 years (IQR 71-76). There was no perioperative complication. The median follow-up was 47.5 (IQR 25-85.5) months. Social continence at 3 months was 75% in the total cohort: 80% in the HIFU group and 67% in the HIRX group.AUS implantation may provide satisfactory long-term functional outcomes in the treatment of stress urinary incontinence resulting from HIFU. Larger series are needed to confirm these findings.4.

Resume Introduction La chirurgie de desobstruction dans le cadre de l’hypertrophie benigne de prostate (HBP) est une intervention courante dont l’indication est le plus souvent aisee au sein de la population generale. Au contraire, chez les patients neurologiques, du fait des troubles vesicosphincteriens frequemment associes, le recours a une chirurgie de desobstruction est parfois plus discutable. Methodes En pratique, deux situations distinctes — les syndromes parkinsoniens et les accidents vasculaires cerebraux (AVC) — doivent attirer notre attention. En effet, pour ces deux pathologies, l’âge de survenue et la typologie des symptomes urinaires viennent classiquement chevauches ceux de l’HBP. Resultats Face a un patient presentant un syndrome parkinsonien, et avant d’envisager une chirurgie de desobstruction, l’urologue doit s’efforcer de rechercher les « drapeaux rouges », signes evocateurs d’une atrophie multi-systematisee (AMS). En effet, si les resultats de cette chirurgie menee chez les patients presentant une maladie de parkinson idiopathique (MPI) semblent etre equivalents a ceux de la population generale, il n’en est pas de meme chez les patients presentant une AMS, chez qui le taux d’incontinence postoperatoire est particulierement eleve. Chez les patients presentant un antecedent d’AVC, il est frequent d’observer une amelioration voire une resolution complete des troubles vesicosphincteriens dans les premiers mois suivant l’AVC. Cette notion devrait inciter l’urologue a differer l’intervention au cours de la premiere annee. Lorsque la chirurgie de desobstruction est envisagee, elle permet cependant d’ameliorer la vidange vesicale chez la majorite des patients, avec pour autant des resultats qui semblent moins satisfaisants que ceux rapportes dans la population generale. Conclusion Lorsqu’une chirurgie de desobstruction est envisagee chez un patient neurologique, un bilan urodynamique devrait systematiquement etre propose afin d’authentifier l’obstruction sous-vesicale.

Objectifs Comparer l’incidence du traitement chirurgical de la lithiase, ses modalites et ses complications, entre les patients ayant une pathologie neurologique et les patients issus de la population generale. Methodes Il s’agit d’une etude retrospective s’appuyant sur les donnees issues du Programme de medicalisation des systemes d’information (PMSI). Tous les patients francais ayant beneficie d’une procedure chirurgicale d’une lithiase renale entre le 1er janvier 2009 et le 31 decembre 2018 etaient eligibles. Les patients presentant une pathologie neurologique telle qu’une sclerose en plaques, une paraplegie, une tetraplegie ou un dysraphisme medullaire etaient identifies. Les patients neurologiques etaient compares aux patients issus de la population generale. Le critere de jugement principal etait l’incidence du traitement chirurgical de la lithiase. Les criteres de jugement secondaires comprenaient les modalites et les complications associees a ce traitement. Resultats Sur la periode, 404 729 patients issus de la population generale et 2106 patients ayant une pathologie neurologique ont beneficie d’un traitement chirurgical de la lithiase renale. Les patients atteints de sclerose en plaques (OR = 1,34), de dysraphisme medullaire (OR = 5,18), d’une paraplegie (OR = 1,40) ou d’une tetraplegie (OR = 2,75) presentaient une incidence chirurgicale significativement plus elevee. La nephrolithotomie percutanee etait plus frequemment utilisee, notamment chez les patients ayant un dysraphisme medullaire (p Tableau 1 , Tableau 2 , Tableau 3 ). Conclusion L’incidence du traitement chirurgical de la lithiase renale, ainsi que les complications infectieuses et le taux de recidive, sont systematiquement plus eleves dans la population neurologique, et a fortiori chez les patients presentant une dysraphisme medullaire ou une tetraplegie.

To specifically introduce continent cystostomy - indications, surgical technique, complications and management - to the nurses working in a urology department.The present article is based on a review of the literature and author's experience in continent cystostomy.Continent cystostomy is a neo-conduit placed between the bladder and the anterior abdominal wall using the digestive tract. It is usually performed in patients with bladder voiding dysfunction who cannot undergo clean self-intermittent catheterization through the urethra. The high success rate (84%) associated with this procedure should not hide the frequent associated complications with the conduit.Even if continent cystostomy is associated with good mid- and long-term functional outcomes, it requires a close follow-up and in some cases "adjustments".

To compare non-continent urinary diversion (NCUD) and other bladder managements in patients with multiple sclerosis (MS), in terms of satisfaction and burden of care.All patients with MS that were proposed a NCUD in our center for refractory lower urinary tract disorders between January 2005 and March 2018 were eligible. Patients were attributed to two distinct groups: "NCUD" and "Other bladder management". The primary endpoint was the satisfaction related to the bladder management quoted by a numerical rating scale (NRS) from 0 to 10. The secondary endpoints included, among other things, the evaluation of the burden of care associated with the bladder management.Twenty-three patients were included in the "NCUD" group and 11 in the "Other bladder management" group, with 4 patients pursuing with spontaneous voiding, 3 with intermittent catheterization, 2 that have undergone a sphincterotomy, 1 still performing self-intermittent catheterization and 1 with a supra-pubic catheter. The "NCUD" group had a significant higher NRS than the "Other bladder management" group (8.22±1.78 vs. 6.27±2.45; P=0.0056). The daily average duration of care was 16.42minutes in the "NCUD" group and 35.6minutes in the "Other bladder management" group (P=0.1111) CONCLUSION: This exploratory study, even if not conclusive, brings to light the preliminary results needed to elaborate a high level of evidence protocol regarding the satisfaction and the burden of care associated with NCUD in MS patients.4.

International audience; The present article is the final report of a multi-disciplinary meeting supported by the GRAPPPA (group for research applied to pelvic floor dysfunctions in the elderly). The objective was to conduct a comprehensive review on the role of botulinum toxin A (BonTA) in the treatment of pelvic floor dysfunctions in the elderly.Methods: The present article, written as a comprehensive review of the literature, combines data issued from the scientific literature with expert's opinions. Review of the literature was performed using the online bibliographic database MedLine (National Library of Medicine). Regarding intra-detrusor BonTA injections, only articles focusing on elderly patients (>65 yo) were included. Regarding other localizations, given the limited number of data, all articles reporting outcomes of BonTA were included, regardless of studies population age. In case of missing or insufficient data, expert's opinions were formulated.Results: Although, available data are lacking in this specific population, it appears that BonTA could be used in the non-fraily elderly patients to treat overactive bladder or even neurogenic detrusor overactivity, with a success rate comparable to younger population at 3 months (88.9% vs. 91.2%), 6 months (49.4% vs. 52.1%) and 12 months (23.1% vs. 22.3%), as well as a significant decrease in number of voids per day (11.4 vs. 5.29 P

Purpose The AMS800™ device, by far the most frequently implanted artificial urinary sphincter (AUS) worldwide, is considered to be the “gold-standard” when male incontinence surgical treatment is contemplated. Despite 40 years of experience, it is still a specialized procedure with a number of challenges. Here, we present the recommendations issued from the AUS Consensus Group, regarding indications, management, and follow-up AMS800™ implantation or revision. Materials and Methods Under ICS auspices, an expert panel met on July 10, 2015 in Chicago, IL, USA in an attempt to reach a consensus on diverse issues related to the AMS800™ device. Participants were selected by the two co-chairs on the basis of their practice in a University hospital and their experience: number of implanted AUSs according to AMS (American Medical System Holdings Inc., Minnetonka, MN) records and/or major published articles. Topics listed were the result of a pre-meeting email brainstorming by all participants. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short evidence-based presentation, when possible. Results A total of 25 urologists were invited to participate, 19 able to attend the conference. The present recommendations, based on the most recent and relevant data available in literature as well as expert opinions, successively address multiple specific and problematic issues associated with the AMS800™ trough a eight-chapter structure: pre-operative assessment, pre operative challenges, implantation technique, post-operative care, trouble-shooting, outcomes, special populations, and the future of AUSs. Conclusion These guidelines undoubtedly constitute a reference document, which will help urologists to carefully select patients and apply the most adapted management to implantation, follow-up and trouble-shooting of the AMS800™. Neurourol. Urodynam. 35:S8–S24, 2016. © 2016 Wiley Periodicals, Inc.

Intermittent catheterization is considered the standard of care in most neurologic patients with lower urinary tract disorders. However, in this context, genitourinary tract infection and urethral trauma represent specific challenges. Such conditions have been found to significantly deteriorate quality of life and complicate subsequent treatments. Only optimal prevention associated with appropriate treatment allows for the long-term continuation of such bladder management. Here, we discuss the diagnosis and therapeutic and preventive approaches associated with genitourinary tract infection and urethral trauma in this specific population. This "state-of-the-art" article results from a literature review (MEDLINE articles and scientific society guidelines) and the authors' experience. It was structured in a didactic way to facilitate comprehension and promote the implementation of advice and recommendations in daily practice. Genitourinary tract infection and urethral trauma associated with intermittent catheterization in neurologic patients should be managed with a global approach, including patient and caregiver education, optimal catheterization with hydrophilic-coated or pre-lubricated catheters and adequate use of antibiotic therapy.

PURPOSE The AMS800™ device is considered to be the "gold-standard" when male incontinence surgical treatment is contemplated. Despite 40 years of experience, it is still a specialized procedure with a number of challenges. Here, we present the recommendations issued from the AUS Consensus Group, regarding indications, management and follow-up AMS800™ implantation or revision. MATERIALS AND METHODS Under ICS auspices, an expert panel met on July 10, 2015 in Chicago, IL, USA in an attempt to reach a consensus on diverse issues related to the AMS800™ device. Participants were selected by the two co-chairs on the basis of their practice in a University hospital and their experience: number of implanted AUSs according to AMS (American Medical System Holdings Inc., Minnetonka, MN) records and/or major published articles. Topics listed were the result of a pre-meeting email brainstorming by all participants. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short evidence-based presentation, when possible. RESULTS The present recommendations, based on the most recent and relevant data available in literature as well as expert opinions, successively address multiple specific and problematic issues associated with the AMS800™ trough a 6-chapter structure: pre-operative assessment, pre operative challenges, implantation technique, post-operative care, trouble-shooting, and special populations. CONCLUSION These guidelines undoubtedly constitute a reference document, which will help urologists to carefully select patients and apply the most adapted management to implantation, follow-up and trouble-shooting of the AMS800™. Neurourol. Urodynam. 35:437-443, 2016. © 2016 Wiley Periodicals, Inc.

To analyze the functional outcomes over time of ACT balloon in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD).All patients with SUI secondary to ISD who underwent bilateral ACT balloon implantation between September 2008 and November 2015 and regularly monitored for a period of at least 24 months were eligible. The results were studied at 6, 12 and 24 months. Efficacy was defined as: Success - maximum 1 safety pad per day and visual analogue scale (VAS) rating≥9/10. Improvement - decrease in the number of pads used per day and VAS≥5/10. Failure - increase or stability of the number of pads used per day and/or VAS5/10. Failure was considered as primary when it occurred without any success or improvement. It was considered as secondary when it occurred after an initial period of success or improvement.18 patients were monitored during 24 months. The success rate was respectively 17 %, 33 % and 33 % at 6, 12 and 24 months of follow-up. The improvement rate was respectively 61 %, 39 % and 17 % at 6, 12 and 24 months of follow-up. The primary failure rate was 22 %. The secondary failure rate was 6 % at 12 months and 33 % at 24 months of follow-up.ACT balloon efficacy tends to decrease with time requiring a long-term follow-up of implanted patients.4.

The AMS800™ device, by far the most frequently implanted artificial urinary sphincter (AUS) worldwide, is considered to be the "gold-standard" when male incontinence surgical treatment is contemplated. Despite 40 years of experience, it is still a specialized procedure with a number of challenges. Here, we present the recommendations issued from the AUS Consensus Group, regarding indications, management, and follow-up AMS800™ implantation or revision.Under ICS auspices, an expert panel met on July 10, 2015 in Chicago, IL, USA in an attempt to reach a consensus on diverse issues related to the AMS800™ device. Participants were selected by the two co-chairs on the basis of their practice in a University hospital and their experience: number of implanted AUSs according to AMS (American Medical System Holdings Inc., Minnetonka, MN) records and/or major published articles. Topics listed were the result of a pre-meeting email brainstorming by all participants. The co-chairs distributed topics randomly to all participants, who then had to propose a statement on each topic for approval by the conference after a short evidence-based presentation, when possible.A total of 25 urologists were invited to participate, 19 able to attend the conference. The present recommendations, based on the most recent and relevant data available in literature as well as expert opinions, successively address multiple specific and problematic issues associated with the AMS800™ trough a eight-chapter structure: pre-operative assessment, pre operative challenges, implantation technique, post-operative care, trouble-shooting, outcomes, special populations, and the future of AUSs.These guidelines undoubtedly constitute a reference document, which will help urologists to carefully select patients and apply the most adapted management to implantation, follow-up and trouble-shooting of the AMS800™.

We aim to assess the complications associated with different approaches used in female suburethral sling surgery.We performed a research on Medline using the following keywords: "suburethral slings", "complications", "safety" and "randomized". Only randomized clinical trials including women and reporting intra- and postoperative complications associated with the retropubic (RP) approach; TOT and/or TVT-O were included. The meta-analysis was conducted using the Review Manager (RevMan 5.3) software delivered by the "Cochrane Library".Out of 176 articles, 23 were included in synthesis. Risks of bladder perforation during surgery (60/1482 vs 5/1479; OR=6.44; 95% CI [3.32-12.50]) and postoperative urinary retention (48/1160 vs 24/1159; OR=1.93; 95% CI [1.26-3.12]) were significantly higher with the RP approach, when compared with the transobturator (TO) approach (TOT or TVT-O). Conversely, the risk of prolonged postoperative pain was significantly lower after RP approach, when compared with TO approach (24/1156 vs 69/1149; OR=0.36; 95% CI [0.23-0.56]). Risks of intraoperative urethral injury, postoperative erosion and de novo overactive bladder were comparable between the two approaches. Data regarding the comparison between TOT and TVT-O were scarce and did not allow us to conclude about complications associated with.The RP approach was associated with a significant risk of bladder perforation and postoperative urinary retention. The TO approach was associated with a higher risk of prolonged postoperative pain.

Objectifs Le mirabegron (Myrbetriq™), indique dans le traitement de l’hyperactivite vesicale, est actuellement recommande en deuxieme ligne en cas d’inefficacite ou d’intolerance aux anticholinergiques. Les essais cliniques randomises menes contre placebo ont rapporte des resultats encourageants. Nous presentons ici notre experience initiale du mirabegron en termes d’efficacite et de tolerance dans le cadre de notre pratique urologique quotidienne. Methodes Nous avons retrospectivement revu les donnees de 77 patients ayant beneficie d’un traitement par mirabegron (25 mg ou 50 mg) dans le cadre d’une hyperactivite vesicale. L’âge, le sexe, la posologie, la duree de traitement ainsi que l’amelioration subjective rapportee par les patients etaient systematiquement recueillis. De plus, lorsqu’ils etaient disponibles, les scores obtenus au questionnaire OABss (Overactive Bladder Symptom Score) avant et apres l’introduction du traitement etaient compares et soumis a analyse statistique (test de Mann-Whitney). Resultats Au total, 102 patients ont beneficie d’un traitement par mirabegron. Les donnees etaient cependant completes chez 77 d’entre eux (28 hommes, 49 femmes). L’âge moyen lors de l’initiation du traitement etait de 71,6 (± 11,4) ans. La majorite des patients (75,3 %) beneficiaient d’un traitement par mirabegron en deuxieme intention, apres echec ou intolerance d’un traitement anti-cholinergique prealable, et seulement 24,7 % se sont vu prescrire un traitement par mirabegron en premiere intention. Au cours de la premiere visite de suivi (99,1 ± 65,8 jours), 59 d’entre eux (76,6 %) rapportaient une amelioration de leur symptomatologie et poursuivaient le traitement. Les scores obtenus au questionnaire OABss etaient remplis avant et apres le traitement chez 46 patients. Le score total avait significativement diminue entre l’initiation du traitement et la consultation de suivi (27,8 vs 24,8 ; p = 0,002). Conclusion En tenant compte de l’amelioration subjective rapportee par le patient et l’evolution du score au questionnaire OABss, le mirabegron semblait ameliorer les symptomes d’hyperactivite vesicale chez la plupart des patients. La population des patients ne repondant pas au traitement par mirabegron doit cependant encore etre definie.

Introduction: We sought to prospectively assess anxiety, pain, and embarrassment associated with diagnostic cystoscopy and multichannel urodynamic study (UDS).Methods: All consecutive patients undergoing diagnostic cystoscopy or UDS in our department over a period of nine months were asked to participate. Two anonymous auto-administered questionnaires were specifically designed to collect basic epidemiological data, document medical history, and assess the quality of information provided, along with prevalence and level (0‒10 numerical visual analog rating scale) of anxiety, pain, and embarrassment experienced before and/or during the procedures. Statistical analysis was carried out to identify underlying factors that could have influenced patients’ experience and ascertain potential correlations between anxiety, pain, and embarrassment.Results: 101 and 185 patients were respectively evaluated immediately after cystoscopy and UDS. Multivariate analysis repeatedly showed statistical correlations between anxiety, pain, and embarrassment, with regard to prevalence and level of intensity in both cystoscopy and UDS populations. Males and young patients were more likely to present anxiety, pain, or embarrassment during cystoscopy and UDS. Interestingly, patients who reported having received complete information before cystoscopy were significantly more likely to experience anxiety (62.6% vs. 20.0%; p=0.009).Conclusions: The present study demonstrated the major impact of gender and age on patients’ experience. Interestingly, information provided before cystoscopy was reported to have a negative impact on patients’ perception of anxiety; this could be partly prevented by optimizing the way information is provided to patients.

Background In spinal cord injury, onset of detrusor overactivity (DO) is detrimental for quality of life (incontinence) and renal risk. Prevention has only been achieved with complex sophisticated electrical neuromodulation techniques. Purpose To assess the efficacy of early fesoterodine fumarate (FF) administration in preventing bladder overactivity in a spinal cord transected (SCT) rat model. Methods 33 Sprague-Dawley rats were allocated to 6 groups-Group 1: 3 normal controls; Group 2: 6 SCT controls; Group 3: 6 SCT rats + FF 0.18 mg/kg/d; Group 4: 6 SCT rats + FF 0.12 mg/kg/d; Group 5: 6 SCT rats + FF 0.18 mg/kg/d + 72-h wash-out period; Group 6: 6 SCT rats + FF 0.12 mg/kg/d + 72-h wash-out period. SCT was performed at T10. FF was continuously administered. Cystometry was undertaken 6 weeks after SCT in awake rats recording intermicturition pressure (IMP), baseline pressure, threshold pressure (Pthres) and maximum pressure (Pmax). Normal controls and SCT controls were initially compared using the Mann-Whitney U tests in order to confirm the SCT effect on cystometric parameters. The comparisons in cystometric and metabolic cage parameters between SCT controls and treated rats were done using post-hoc Dunn's tests for Kruskal-Wallis analysis. Statistical testing was conducted at the two-tailed α-level of 0.05. Results Pressure parameters were significantly higher in SCT control group compared to normal controls. Six weeks after SCT, IMP was significantly lower in low dose treated group than in SCT controls. Pmax was significantly lower in 3 treated groups compared to SCT controls. Pthres was significantly lower in full time treated groups than in SCT controls. Conclusion Early administration of FF modulates bladder overactivity in a SCT rat model. Whereas short-term prevention has been demonstrated, the long-term should be further analyzed. Clinical application of these results should confirm this finding through randomized research protocols.

The association between Lynch syndrome and prostate cancer has been studied. Recent studies report an association between these two diseases.Literature review based on PubMed search was performed using the following keywords: Lynch syndrome and prostate cancer.Eight articles analyzing cohorts of subjects carrying Lynch syndrome were analysed including 6786 patients with 175 cancers. Prostate cancers were more frequent with a standardized incidence ratio (SIR) from 0.93 (95% CI: 0.19-2.7) and 5.9 (95% CI 4.1-17.1) and occurs at a younger age than in the general population mainly for mutations in the MSH2 gene.Prostate cancer seem more frequent and occur earlier in individuals harboring a mutation in the MSH2 gene while it does not appear to be any difference compared to the general population for other mutations in Lynch syndrome.

Objectifs Les lesions medullaires completes supra-sacrees sont classiquement associees a des dysfonctionnements vesico-sphincteriens complexes pour lesquels les ressources therapeutiques sont actuellement limitees. Dans ce contexte, la chirurgie de « rerouting » nerveux lombo-sacre pourrait permettre de restaurer la miction via un reflexe cutaneo-spino-vesical. Nous presentons ici les resultats d’une etude pilote menee a partir d’un modele felin spinalise (T10) avec « rerouting » nerveux L7-S1 unilateral. Methodes Nous avons evalue l’interet d’une chirurgie de « rerouting » nerveux lombo-sacre dans la restauration de la miction chez 8 chats spinalises. La section medullaire complete etait realisee en regard de T9-10. Parmi les 8 animaux, 6 ont beneficie, 1 mois plus tard, d’une anastomose unilaterale des racines anterieures L7-S1. Les deux autres chats servaient de temoin. Une evaluation etait realisee a 3, 5, 7 et 9 mois. Elle consistait en la realisation de stimulations cutanees (electriques et manuelles) au niveau des dermatomes correspondant aux deux racines posterieures L7. Ces stimulations etaient realisees au cours d’un bilan urodynamique couple a un enregistrement electro-myographique. Resultats A 9 mois, 2 des 6 chats (33 %), ayant beneficie d’une chirurgie de « rerouting » nerveux lombo-sacre, presentaient une contraction vesicale a la stimulation du dermatome L7 ipsi-lateral. On rapportait par ailleurs chez 4 chats, une augmentation de la pression detrusorienne lors de cette meme stimulation cutanee. Aucun des 8 chats inclus ne presentait de miction ou d’augmentation significative de la pression detrusorienne apres stimulation du dermatome contro-lateral. Tous les chats etaient vivants a la fin du suivi. Conclusion La chirurgie de « rerouting » L7-S1 unilaterale apres section medullaire complete T10 pourrait permettre d’induire une augmentation de la pression intra-detrusorienne ainsi qu’une miction chez certains chats, via une stimulation cutanee. Ces resultats encourageants, justifient la realisation d’etudes complementaires incluant plus d’animaux avec une duree de suivi plus longue.

Objectifs Le sphincter urinaire artificiel (SUA) constitue le traitement de reference de l’incontinence urinaire d’effort severe. Sa conception impose de manipuler regulierement la pompe et limite son indication a une categorie restreinte de patients ayant une dexterite manuelle satisfaisante. Afin de s’affranchir de cette contrainte, nous avons recemment developpe un SUA electroniquement ajustable. Nous presentons ici sa version simplifiee (SUA electromecanique) et nos resultats in vitro. Methodes Le developpement a ete realise en partenariat avec des ingenieurs de l’ecole polytechnique de Montreal, a partir d’un SUA de type AMS800™ dont la pompe a ete remplacee par un dispositif electromecanique de type « on/off ». L’ouverture du sphincter est activee par la simple application d’un aimant au contact du dispositif. Comme dans un AMS800™ classique, la fermeture est rendue possible en quelques minutes par l’equilibre des pressions au sein du systeme. L’efficacite de ce nouveau dispositif a ete evaluee in vitro sur des uretres et des vessies de porc soumis a differents niveaux de pression. Resultats In vitro, le dispositif s’est revele efficace, permettant d’assurer une occlusion complete de l’uretre a des niveaux de pression = 70 cmH 2 O tout en permettant une ouverture complete de la manchette lorsque l’aimant etait mis au contact du dispositif. En outre, le faible niveau de consommation energetique du dispositif pourrait lui assurer une autonomie de 18 ans. Conclusion La mise sur le marche d’un SUA electromecanique permettrait d’elargir les indications actuelles aux patients les moins dextres. Des etudes complementaires in vitro et in vivo doivent au prealable etre realisee afin de confirmer l’efficacite et l’innocuite d’un tel dispositif.

Objectifs Les injections intra-detrusoriennes de toxine botulique A (TBA) constituent un traitement de deuxieme ligne de l’hyperactivite vesicale neurogenique (HAV) et idiopathique (HAVi). L’Association francaise d’urologie recommande la realisation prealable d’un examen cyto-bacteriologique des urines (ECBU) et le report de la procedure en cas de resultat positif. L’objectif est d’etudier l’efficacite et les complications des injections de TBA realisees dans un contexte de bacteriurie asymptomatique. Methodes Aucun ECBU n’etait exige avant l’intervention. Seule une bandelette urinaire (BU) etait systematiquement realisee avant de debuter la procedure. La presence d’une pyurie ou d’une infection urinaire symptomatique contre-indiquait l’intervention. Tous les patients asymptomatiques (BU+ et BU–) beneficiaient d’une serie d’injections et d’un ECBU preleve au debut de la procedure. Les patients BU+ recevaient une antibiotherapie orale probabiliste secondairement adaptee aux resultats de l’ECBU. Le critere permettant d’evaluer l’efficacite etait la variation ( %) de la capacite vesicale avant et apres les injections intra-detrusoriennes de TBA. Les complications comprenaient la presence d’une infection urinaire symptomatique, d’une hematurie ou d’une hospitalisation dans le mois suivant le geste. Resultats L’analyse des complications a ete realisee sur une cohorte de 458 series d’injections (171 HAVi, 287 HAV). La survenue d’une infection urinaire symptomatique etait significativement plus frequente chez les patients BU+ au moment des injections, que ce soit en analyse uni- ou multivariee (RR= 15,9 ; p Conclusion Bien que la presence d’une bacteriurie asymptomatique puisse augmenter significativement le risque d’infection urinaire symptomatique au decours des injections intra-detrusoriennes de TBA, elle n’augmente pas le risque d’infection urinaire grave ou de re-hospitalisation. L’efficacite ne semble pas non plus influencee par la presence d’une bacteriurie asymptomatique. Ces resultats devraient aider a revoir et adapter nos pratiques.