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Flochlay M, Bey E, Bruneaux E, Mazancourt ESD, Wagner L. [Treatment of female recurrent or not stress urinary incontinence with intrinsic sphincter deficiency: Sub-urethral retropubic adjustable sling (Remeex)]. Prog Urol 2022; 32:101-107. [PMID: 35027283 DOI: 10.1016/j.purol.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Recommendations for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD) or recurrent, are complex. They accept the use of sub-urethral slings (BSU), if unsuccessful the artificial urinary sphincter. The objective was to report the results in terms of continence and morbidity of the Remeex® Adjustable BSU in the treatment of SUI by ISD recurrent or non-recurrent. METHOD Monocentric retrospective study of 70 patients with a mean age of 67.7 years (±12) operated of Remeex sling, between 2015 and 2019, was conducted. Preoperative and postoperative characteristics were analyzed from medical records. Two groups were analyzed: Group A (n=28) with no history of incontinence surgery and Group B (n=42) with history (recurrent). Patients who were totally continent (0 protection) and those who were socially continent (1 safety protection) were considered successful. RESULT Postoperative success rate was similar between groups B (90 %) and A (92%) with respectively: 64% versus 71% of totally continent patients, 26% versus 21% wearing safety protection. The postoperative complications were mainly Clavien II (28%) such as urinary tract infections (6%), transient urinary retention (3%) and de novo bladder overactivity (20%) with no significant statistical difference between the groups. Six patients were reoperated (Clavien III): BSU detension (1%), vaginal exposure (4%) (including one total material removal for infection), varitensor explantation (1%) or scar disunion (1%). CONCLUSION The Remeex® BSUA seems to lead to satisfactory perioperative results in patients with SUI with ISD recurrent or non-recurrent.
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Affiliation(s)
- Morgane Flochlay
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France.
| | - Elsa Bey
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France
| | - Elodie Bruneaux
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France
| | | | - Laurent Wagner
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France
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Ballons ACT chez la femme : évolution de l’efficacité au cours des 24 mois suivant l’implantation. Prog Urol 2018; 28:927-934. [DOI: 10.1016/j.purol.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/28/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
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A double-blind, randomized, placebo-controlled clinical trial evaluating the safety and efficacy of autologous muscle derived cells in female subjects with stress urinary incontinence. Int Urol Nephrol 2018; 50:2153-2165. [PMID: 30324580 DOI: 10.1007/s11255-018-2005-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of the study was to assess safety and efficacy of autologous muscle derived cells for urinary sphincter repair (AMDC-USR) in female subjects with predominant stress urinary incontinence. METHODS A randomized, double-blind, multicenter trial examined intra-sphincteric injection of 150 × 106 AMDC-USR versus placebo in female subjects with stress or stress predominant, mixed urinary incontinence. AMDC-USR products were generated from vastus lateralis needle biopsies. Subjects were randomized 2:1 to receive AMDC-USR or placebo and 1:1 to receive 1 or 2 treatments (6 months after the first). Primary outcome was composite of ≥ 50% reduction in stress incontinence episode frequency (IEF), 24-h or in-office pad weight tests at 12 months. Other outcome data included validated subject-recorded questionnaires. Subjects randomized to placebo could elect to receive open-label AMDC-USR treatment after 12 months. Subject follow-up was up to 2 years. RESULTS AMDC-USR was safe and well-tolerated with no product-related serious adverse events or discontinuations due to adverse events. Interim analysis revealed an unexpectedly high placebo response rate (90%) using the composite primary outcome which prevented assessment of treatment effect as designed and thus enrollment was halted at 61% of planned subjects. Post hoc analyses suggested that more stringent endpoints lowered placebo response rates and revealed a possible treatment effect. CONCLUSIONS Although the primary efficacy finding was inconclusive, these results inform future trial design of AMDC-USR to identify clinically meaningful efficacy endpoints based on IEF reduction, understanding of placebo response rate, and refinement of subject selection criteria to more appropriately align with AMDC-USR's proposed mechanism of action.
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Peyronnet B, O'Connor E, Khavari R, Capon G, Manunta A, Allue M, Hascoet J, Nitti VW, Gamé X, Gilleran J, Castro-Sader L, Cornu JN, Waltregny D, Ahyai S, Chung E, Elliott DS, Fournier G, Brucker BM. AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review. Neurourol Urodyn 2018; 38 Suppl 4:S28-S41. [PMID: 30298943 DOI: 10.1002/nau.23833] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/26/2018] [Indexed: 11/06/2022]
Abstract
AIMS To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). METHODS A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. RESULTS Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. CONCLUSIONS AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.
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Affiliation(s)
| | - Eabhann O'Connor
- Department of Urology, Galway University Hospital, Galway, Ireland
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Marta Allue
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Victor W Nitti
- Department of Urology, New York University, New York, New York
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Jason Gilleran
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
| | - Luis Castro-Sader
- Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - David Waltregny
- Department of Urology, University Hospital of Liege, Liege, Belgium
| | - Sascha Ahyai
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Eric Chung
- Department of Urology, The University of Queensland, Brisbane, Australia
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