Bilan initial d’une incontinence urinaire masculine (non neurologique) : revue de la littérature du CTMH de l’AFU

Efficacy of the VIRTUE male quadratic sling in the treatment of stress urinary incontinence: A retrospective study

AIM

To assess the efficacy and the impact on the quality of life (QoL) of patients suffering stress urinary incontinence (SUI) treated with VIRTUE © sling.

MATERIAL AND METHOD

Retrospective monocenteric study where patients treated with VIRTUE © sling were included between January 2016 and May 2018. The severity of the incontinence was judged based on the number of protection used per day (PPD) and/or on the 24hours pad test into mild, moderate and severe: ≥2 protections and/or <100ml/24h, 3-4 protections and/or 101-200ml/24h, >4 protections and/or>200ml/24h respectively. The criteria of success was achieved when the patient is dry or ameliorated. The ICIQ- UI sf questionnaire was used as a measure of QoL.

RESULTS

Thirty-five patients were included in this study with mean follow up time of 11 months (range: 3-26). Twenty-nine patients had a radical prostatectomy, 3 had endoscopic treatment for benign prostatic hyperplasia, 9 patient had radiotherapy of which one had a complementary focal treatment (HIFU), and two patients had spinal cord injury. The success rate was 83%. The score ICIQ-UI sf showed a statistical difference between the pre and post-operative periods in both success and failure groups (P<0.001). History of radiotherapy, low bladder compliance, and severe incontinence were associated with negative result. Pain was the most recorded post-operative complication and no>grade 2 Clavien Dindo complications were encountered.

CONCLUSION

The VIRTUE © sling seems to be an effective, safe tool treating SUI at short term.

LEVEL OF EVIDENCE

3.

[Prevalence and impact on quality of life of urinary incontinence in an adult population with chronic obstructive pulmonary diseases, literature review]

INTRODUCTION

Patients with obstructive lung diseases (OLD) are at-risk population for urinary incontinence (UI) with high frequency of increased intra-abdominal pressure because of chronic cough symptoms.

AIM OF THE STUDY

This review is aimed at determining the prevalence of UI and its impact on quality of life, patient healthcare research, diagnosis and treatment of UI among this population.

MATERIALS AND METHOD

Literature review from January 2001 to 2018 on Medline (PubMed) using keywords urinary incontinence, chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, quality of life.

RESULTS

The largest study showed that in a population of 14,828 people, whose 995 were diagnosed COPD, UI prevalence was 34.9% in people with COPD, versus 27.3% among the general population of the study (P=0.0048). Results in the other studies of the review were similar. UI was more severe in OLD patients and occurred on young subjects. Stress urinary incontinence symptoms were predominant, during cough but also during spirometry and chest rehabilitation sessions. Despite an impact on quality of life and treatment of OLD, UI was neglected.

CONCLUSION

UI prevalence seemed higher on population with OLD, to a greater degree of severity. Quality of life self-evaluation was further decreased when UI was associated with pulmonary disease.

Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence

Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction.

Current consensus and controversy on the diagnosis of male lower urinary tract symptoms/benign prostatic hyperplasia

Traditionally, male lower urinary tract symptoms (LUTS) have been considered a synonym for benign prostate hyperplasia (BPH) because most male LUTS develops in aging men. Medical treatment should be the first-line treatment for BPH and surgical intervention should be performed when there are complications or LUTS refractory to medical treatment. Recent investigations have revealed that bladder dysfunction and bladder outlet dysfunction contribute equally to male LUTS. In the diagnosis of LUTS suggestive of BPH (LUTS/BPH), the following questions should be considered: Is there an obstruction? Are the LUTS caused by an enlarged prostate? What are the appropriate tools to diagnose an obstructive BPH? Should patients with LUTS be treated before bladder outlet obstruction is confirmed? This article discusses the current consensus and controversies in the diagnosis of LUTS/BPH.

[Are the patients not carrying protections after radical prostatectomy really continent?]

AIM

To analyse urinary continence and related quality of life in patients not wearing any pad after robotic assisted radical prostatectomy (RARP).

METHOD

Two hundred and sixteen patients operated consecutively by RARP between January 2009 and June 2011 were evaluated by the ICS (International Continence Society) Male Self-questionnaire. The questionnaires were sent by mail and mailed back by patients with a minimum of 14 months following surgery. The ICS questionnaire contains a symptom score (ICS 1) and a quality of life score (ICS 2).

RESULTS

Out of 216 sent questionnaires, 145 (67%) were received. The subgroup of 121 patients who replied that they were not wearing any pad was analysed. Fifty-three (43,8%) of them reported not having leakage when coughing or sneezing, 65 (53,7%) reported not having spontaneous leakage, and 102 (84,3%) reported not having leakage when sleeping. The ICS 1 and ICS 2 scores were strongly correlated (Pearson correlation coefficient 0.96).

CONCLUSION

Within a group of patients not wearing any pad following RARP, the continence as assessed by self-questionnaires remains altered. This analysis might help counselling patients who are about to choose a surgical treatment for their prostate cancer.