[Short-term evaluation of Altis® single-incision sling in women stress urinary incontinence]

INTRODUCTION

Midurethral slings are the main surgical treatment of stress urinary incontinence. Altis is a minimally invasive single-incision sling system. The aim of this study is to report the safety and efficacity results during a year of follow up.

MATERIALS AND METHODS

This single-centre and retrospective study has been performed in a university hospital, between February 2015 and May 2018. We included women aged more than 18, complaining a stress urinary incontinence with a urethral hypermobility and positive support maneuvers, who had failed from non surgical treatment. A prospective data collection has been done at the moment of inclusion, peroperative time, at 6 weeks, 6 months and a year after the procedure. The main evaluation criteria was the cure rate at twelve months.

RESULTS

Thirty patients were included in our study. The mean age was 45,4±12,9 years old, the mean ICIQ-UI score was 13,5±4,06 and the median pad test was at 12g. Ninety three percent of the procedures were done as ambulatory surgery. The average operating time was at 22,2minutes. Overall, 75% of our patients were objectively cured and 14,2% were in fail of this treatment.

CONCLUSION

The short term results show a good efficacity and safety of this procedure. But its place remains to be defined in relation to other techniques, TVT, TOT and non-prosthetic techniques.

LEVEL OF EVIDENCE

3.

[Retrospective multicentric evaluation of the efficacy of four-arms and adjustable male slings in the management of mild and moderate urinary incontinence after radical prostatectomy]

INTRODUCTION

Objective of the study to carry out a retrospective multicentric evaluation of the efficacy of male slings in the management of mild and moderate urinary incontinence after radical prostatectomy.

METHOD

We performed a multi-center study that included all patients with mild to moderate urinary stress incontinence after radical prostatectomy with adjustable slings or four-arm slings. We collected the number of protections before the procedure and one year after the application of the male sling.

RESULTS

A 4 arms or adjustable sling was put to 65 men. The cure rate was 33.3% (n=5) for Remeex, 52% (n=13) for TOMS, and 46.7% (n=12) for Virtue (P=0.07). The failure rate was 26.7% (n=4) for Remeex, 24% (n=6) for TOMS, and 40% (n=10) for Virtue (P=0.18). The overall complication rate was 40% (n=6) for Remeex, 28% (n=7) for TOMS, and 16% (n=4) for Virtue (P=0.19).

CONCLUSION

This multicentric retrospective series confirms that male slings are a usefull therapy for patients with mild or moderate urinary incontinence.

LEVEL OF EVIDENCE

4.

[Processing of interaural time differences in normal-hearing subjects and cochlear implant users with FSP and HDCIS coding strategy]

BACKGROUND

Sound localization is necessary for social interaction and remains challenging for bilateral cochlear implant (CI) users. This study investigated the influence of fine structure processing (FSP) coding strategies on temporal accuracy and source localization. The ability to discriminate between different interaural time differences (ITD) was measured objectively and compared.

MATERIALS AND METHODS

Fifteen normal-hearing subjects and five CI users participated in this study. Electrophysiological recording of mismatch negativity (MMN) and psychoacoustic tests with headphones and loudspeakers were conducted to measure and compare the discrimination of ITDs.

RESULTS

In normal-hearing subjects the discrimination threshold for ITD was 83-117 µs. Localization ability in a free sound field was below the limit of resolution. A significant MMN was measured. CI users showed a mean angle detection error of more than 30° and a discrimination threshold between 1100 and 2100 µs. Due to artifacts, no clear MMN component could be recorded.

CONCLUSION

This study shows that MMN can be used as an objective measure of ITD discrimination in normal-hearing participants. An indication that improvements in directional hearing can be achieved with the transfer of fine structure could not be provided by this study.

Long-term anatomic and functional results of laparoscopic sacrocolpopexy: a prospective study

PURPOSE

The aim of our study was to assess the impact of laparoscopic sacrocolpopexy on pelvic symptoms, quality of life and sexual function in patients with symptomatic pelvic organ prolapse. Secondary goals included the assessment of anatomical correction, recurrence and complication rates.

METHODS

This is a prospective, single-center study that included 82 patients between 2009 and 2016. A clinical evaluation took place before surgery, and was repeated at 3, 12, 36 and 60 months postoperatively. Patients routinely received an anterior prosthesis, associated with a posterior prosthesis in case of symptomatic rectocele. Patients included self-administered questionnaires for functional pelvic problems (PFDI-20), quality of life (PFIQ-7), and sexual function (PISQ-12), and a clinical examination with POP-Q staging, at each medical visit.

RESULTS

Functional pelvic problems derived from prolapse (PFDI-20 scores) and their impact on patients' quality of life (PFIQ-7 score) significantly improved at 3, 12, 36 and 60 months postoperatively. Improvement on sexual activity was significant at 3 and 60 months postoperatively. Effective prolapse anatomical correction (POP-Q score < 2) was found in 94.4% and 97.2% of patients at the anterior and middle stages, respectively, at the end of follow-up, but only in 80.3% at the posterior stage. Symptomatic recurrence required surgical intervention in 4 patients (5.3%).

CONCLUSIONS

This long-term follow-up prospective analysis confirms the good functional and anatomical results of laparoscopic sacrocolpopexy for pelvic organ prolapse.

A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors

PURPOSE

This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds.

METHODS

Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians.

RESULTS

Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants.

CONCLUSIONS

Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.