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Deffieux X, Perrouin-Verbe MA, Campagne-Loiseau S, Donon L, Levesque A, Rigaud J, Stivalet N, Venara A, Thubert T, Vidart A, Bosset PO, Revel-Delhom C, Lucot JP, Hermieu JF. Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol 2024; 294:170-179. [PMID: 38280271 DOI: 10.1016/j.ejogrb.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/30/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
Complications associated with pelvic organ prolapse (POP) surgery using a synthetic non-absorbable mesh are uncommon (<5%) but may be severe and may hugely diminish the quality of life of some women. In drawing up these multidisciplinary clinical practice recommendations, the French National Authority for Health (Haute Autorité de santé, HAS) conducted an exhaustive review of the literature concerning the diagnosis, prevention, and management of complications associated with POP surgery using a synthetic mesh. Each recommendation for practice was allocated a grade (A,B or C; or expert opinion (EO)), which depends on the level of evidence (clinical practice guidelines). PREOPERATIVE PATIENTS' INFORMATION Each patient must be informed concerning the risks associated with POP surgery (EO). HEMORRHAGE, HEMATOMA Vaginal infiltration using a vasoconstrictive solution is not recommended during POP surgery by the vaginal route (grade C). The placement of vaginal packing is not recommended following POP surgery by the vaginal route (grade C). During laparoscopic sacral colpopexy, when the promontory seems highly dangerous or when severe adhesions prevent access to the anterior vertebral ligament, alternative surgical techniques should be discussed per operatively, including colpopexy by lateral mesh laparoscopic suspension, uterosacral ligament suspension, open abdominal mesh surgery, or surgery by the vaginal route (EO). BLADDER INJURY When a bladder injury is diagnosed, bladder repair by suturing is recommended, using a slow resorption suture thread, plus monitoring of the permeability of the ureters (before and after bladder repair) when the injury is located at the level of the trigone (EO). When a bladder injury is diagnosed, after bladder repair, a prosthetic mesh (polypropylene or polyester material) can be placed between the repaired bladder and the vagina, if the quality of the suturing is good. The recommended duration of bladder catheterization following bladder repair in this context of POP mesh surgery is from 5 to 10 days (EO). URETER INJURY After ureteral repair, it is possible to continue sacral colpopexy and place the mesh if it is located away from the ureteral repair (EO). RECTAL INJURY Regardless of the approach, when a rectal injury occurs, a posterior mesh should not be placed between the rectum and the vagina wall (EO). Concerning the anterior mesh, it is recommended to use a macroporous monofilament polypropylene mesh (EO). A polyester mesh is not recommended in this situation (EO). VAGINAL WALL INJURY After vaginal wall repair, an anterior or a posterior microporous polypropylene mesh can be placed, if the quality of the repair is found to be satisfactory (EO). A polyester mesh should not be used after vaginal wall repair (EO). MESH INFECTION (ABSCESS, CELLULITIS, SPONDYLODISCITIS) Regardless of the surgical approach, intravenous antibiotic prophylaxis is recommended (aminopenicillin + beta-lactamase inhibitor: 30 min before skin incision +/- repeated after 2 h if surgery lasts longer) (EO). When spondylodiscitis is diagnosed following sacral colpopexy, treatment should be discussed by a multidisciplinary group, including especially spine specialists (rheumatologists, orthopedists, neurosurgeons) and infectious disease specialists (EO). When a pelvic abscess occurs following synthetic mesh sacral colpopexy, it is recommended to carry out complete mesh removal as soon as possible, combined with collection of intraoperative bacteriological samples, drainage of the collection and targeted antibiotic therapy (EO). Non-surgical conservative management with antibiotic therapy may be an option (EO) in certain conditions (absence of signs of sepsis, macroporous monofilament polypropylene type 1 mesh, prior microbiological documentation and multidisciplinary consultation for the choice of type and duration of antibiotic therapy), associated with close monitoring of the patient. BOWEL OCCLUSION RELATED TO NON-CLOSURE OF THE PERITONEUM Peritoneal closure is recommended after placement of a synthetic mesh by the abdominal approach (EO). URINARY RETENTION Preoperative urodynamics is recommended in women presenting with urinary symptoms (bladder outlet obstruction symptoms, overactive bladder syndrome or incontinence) (EO). It is recommended to remove the bladder catheter at the end of the procedure or within 48 h after POP surgery (grade B). Bladder emptying and post-void residual should be checked following POP surgery, before discharge (EO). When postoperative urine retention occurs after POP surgery, it is recommended to carry out indwelling catheterization and to prefer intermittent self-catheterization (EO). POSTOPERATIVE PAIN Before POP surgery, the patient should be asked about risk factors for prolonged and chronic postoperative pain (pain sensitization, allodynia, chronic pelvic or non-pelvic pain) (EO). Concerning the prevention of postoperative pain, it is recommended to carry out a pre-, per- and postoperative multimodal pain treatment (grade B). The use of ketamine intraoperatively is recommended for the prevention of chronic postoperative pelvic pain, especially for patients with risk factors (preoperative painful sensitization, allodynia, chronic pelvic or non-pelvic pain) (EO). Postoperative prescription of opioids should be limited in quantity and duration (grade C). When acute neuropathic pain (sciatalgia or pudendal neuralgia) resistant to level I and II analgesics occurs following sacrospinous fixation, a reintervention is recommended for suspension suture removal (EO). When chronic postoperative pain occurs after POP surgery, it is recommended to systematically seek arguments in favor of neuropathic pain with the DN4 questionnaire (EO). When chronic postoperative pelvic pain occurs after POP surgery, central sensitization should be identified since it requires a consultation in a chronic pain department (EO). Concerning myofascial pain syndrome (clinical pain condition associated with increased muscle tension caused by myofascial trigger points), when chronic postoperative pain occurs after POP surgery, it is recommended to examine the levator ani, piriformis and obturator internus muscles, so as to identify trigger points on the pathway of the synthetic mesh (EO). Pelvic floor muscle training with muscle relaxation is recommended when myofascial pain syndrome is associated with chronic postoperative pain following POP surgery (EO). After failure of pelvic floor muscle training (3 months), it is recommended to discuss surgical removal of the synthetic mesh, during a multidisciplinary discussion group meeting (EO). Partial removal of synthetic mesh is indicated when a trigger point is located on the pathway of the mesh (EO). Total removal of synthetic mesh should be discussed during a multidisciplinary discussion group meeting when diffuse (no trigger point) chronic postoperative pain occurs following POP surgery, with or without central sensitization or neuropathic pain syndromes (EO). POSTOPERATIVE DYSPAREUNIA When de novo postoperative dyspareunia occurs after POP surgery, surgical removal of the mesh should be discussed (EO). VAGINAL MESH EXPOSURE To reduce the risk of vaginal mesh exposure, when hysterectomy is required during sacral colpopexy, subtotal hysterectomy is recommended (grade C). When asymptomatic vaginal macroporous monofilament polypropylene mesh exposure occurs, systematic imaging is not recommended. When vaginal polyester mesh exposure occurs, pelvic +/- lumbar MRI (EO) should be used to look for an abscess or spondylodiscitis, given the greater risk of infection associated with this type of material. When asymptomatic vaginal mesh exposure of less than 1 cm2 occurs in a woman with no sexual intercourse, the patient should be offered observation (no treatment) or local estrogen therapy (EO). However, if the patient wishes, partial excision of the mesh can be offered. When asymptomatic vaginal mesh exposure of more than 1 cm2 occurs or if the woman has sexual intercourse, or if it is a polyester prosthesis, partial mesh excision, either immediately or after local estrogen therapy, should be offered (EO). When symptomatic vaginal mesh exposure occurs, but without infectious complications, surgical removal of the exposed part of the mesh by the vaginal route is recommended (EO), and not systematic complete excision of the mesh. Following sacral colpopexy, complete removal of the mesh (by laparoscopy or laparotomy) is only required in the presence of an abscess or spondylodiscitis (EO). When vaginal mesh exposure recurs after a first reoperation, the patient should be treated by an experienced team specialized in this type of complication (EO). SUTURE THREAD VAGINAL EXPOSURE For women presenting with vaginal exposure to non-absorbable suture thread following POP surgery with mesh reinforcement, the suture thread should be removed by the vaginal route (EO). Removal of the surrounding mesh is only recommended when vaginal mesh exposure or associated abscess is diagnosed. BLADDER AND URETERAL MESH EXPOSURE When bladder mesh exposure occurs, removal of the exposed part of the mesh is recommended (grade B). Both alternatives (total or partial mesh removal) should be discussed with the patient and should be debated during a multidisciplinary discussion group meeting (EO).
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Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Marie-Aimée Perrouin-Verbe
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes F-44000, France
| | - Sandrine Campagne-Loiseau
- Centre Hospitalier Universitaire de Clermont Ferrand, Service de gynécologie obstétrique, Clermont-Ferrand F-63000, France
| | | | - Amélie Levesque
- Centre Hospitalier Universitaire Nantes, Service d'urologie, Nantes F-44093, France
| | - Jérome Rigaud
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes F-44000, France
| | - Nadja Stivalet
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris F-75017, France
| | - Aurélien Venara
- Université d'Angers, Centre Hospitalier Universitaire d'Angers, Service de chirurgie digestive, Angers F-49000, France
| | - Thibault Thubert
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service de gynécologie-obstétrique, Nantes F-44000, France
| | - Adrien Vidart
- Hôpital Foch, Service d'urologie, Suresnes F-92150, France
| | | | | | - Jean-Philippe Lucot
- Université catholique de Lille, Service de gynécologie-obstétrique, Lille F-59000, France
| | - Jean François Hermieu
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris F-75017, France
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Fourel M, Hafez S, Ramdane N, Perrouin-Verbe MA, De Wachter S, Vermersch P, Biardeau X. Response to tibial and sacral nerve modulation in overactive bladder: Is there any correlation? Neurourol Urodyn 2024; 43:415-423. [PMID: 38078739 DOI: 10.1002/nau.25352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To assess the correlation between the response to transcutaneous tibial nerve stimulation (TTNS) and subsequent response to sacral nerve modulation (SNM) to treat overactive bladder (OAB). MATERIALS AND METHODS All patients who consecutively received TTNS followed by a two-stage SNM between January 2016 and June 2022 to treat OAB in two university hospital centers were included. The response to each therapy was evaluated with success defined by a 50% or greater improvement in one or more bothersome urinary symptoms from baseline. The primary endpoint was the statistical relationship between the response to TTNS and the response to SNM, assessed by logistic regression. Secondary endpoints were the statistical relationship between the response to TTNS and the response to SNM when controlling for gender, age (<57 years vs. >57 years), presence of an underlying neurological disease, and presence of DO, adding the factor and interaction to the previous regression model. RESULTS Among the 92 patients enrolled in the study, 68 of them were women (73.9%), and the median age was 57.0 [41.0-69.0] years. The success was reported in 22 patients (23.9%) under TTNS and 66 patients (71.7%) during the SNM test phase. There was no statistical correlation between response to TTNS and response to SNM in the overall population (confidence interval: 95% [0.48-4.47], p = 0.51). Similarly, there was no statistical correlation when controlling for age <57 years or ≥57 years, with p = 1.0 and p = 0.69, respectively. No statistical study could be conducted for the other subpopulations due to small sample sizes. CONCLUSION The response to TTNS does not predict the response to SNM in the treatment of OAB. TTNS and SNM should be considered as separate therapies, and the decision-making process for OAB treatment should take this into account.
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Affiliation(s)
- Mathieu Fourel
- Department of Urology, Lille Academic Hospital, University of Lille, Lille, France
| | - Samy Hafez
- Centre Hospitalo-Universitaire de Nantes, Urology Department, Nantes Université, Nantes, France
| | | | | | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wlrijk, Belgium
| | - Patrick Vermersch
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, University of Lille, Lille, France
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
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Webb K, de Rijk MM, Gajewski JB, Kanai AJ, Perrouin-Verbe MA, van Koeveringe G, Wyndaele JJ, Drake MJ. Developing new ways to assess neural control of pelvic organ function in spinal conditions: ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 38048095 DOI: 10.1002/nau.25347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Several central nervous system (CNS) centers affect muscle groups of the lower urinary tract (LUT) and anorectal tract (ART) via autonomic and somatic pathways, working in different modes (storage or expulsion). Hence spinal cord dysfunction can affect the LUT and ART by several possible mechanisms. METHODS This review reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities of spinal dysfunction. RESULTS Discussion focussed on the levator ani nerve, mechanisms underpinning sensory function and sensation, functional imaging, dyssynergia, and experimental models. The following key research questions were identified. (1) Clinically, how can we evaluate the levator ani muscle to support assessment and identify prognosis for effective treatment selection? (2) How can we reliably measure levator ani tone? (3) How can we evaluate sensory information and sensation for the LUT and the ART? (4) What is the role of functional CNS imaging in development of scientific insights and clinical evaluation? (5) What is the relationship of detrusor sphincter dyssynergia to renal failure? CONCLUSIONS Spinal cord dysfunction can fundamentally disrupt LUT and ART function, with considerable clinical impact. The evaluation needs to reflect the full scope of potential problems, and new clinical and diagnostic approaches are needed, for prognosis and treatment. The preclinical science evaluating spinal cord function in both LUT and ART storage and elimination remains a major priority, even though it is a challenging experimental context. Without this underpinning evidence, development of new clinical evidence may be held back.
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Affiliation(s)
- Katie Webb
- Physiotherapy Department, Imperial College Healthcare Trust, St Mary's Hospital, London, UK
| | - Mathijs M de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony J Kanai
- Departments of Medicine-Renal-Electrolyte Division, and Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Gommert van Koeveringe
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK
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Sinha S, Everaert K, Kheir GB, Roberts N, Solomon E, Belal M, Selai C, Perrouin-Verbe MA, Spicchiale CF, Wein A, Abrams P. Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 37960931 DOI: 10.1002/nau.25329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The underlying pathophysiology behind a diagnosis of acontractile or underactive detrusor at invasive urodynamics is very heterogeneous. Lack of etiological classification currently limits the possibility of stratifying therapy. METHODS This subject was discussed at a think-tank on the subject at the International Consultation on Incontinence-Research Society held in Bristol, June 2023. This manuscript is a result of those deliberations and the subsequent discussions of the think-tank. RESULTS There are challenges in defining abnormalities of detrusor contraction with resultant implications for available evidence. Pathology at any level of the neuromuscular pathway can impair or prevent a detrusor voiding contraction. Attempts have been made to identify clinical markers that might predict an underactive detrusor but strong supporting evidence is lacking. Hence, a holistic approach to phenotyping requires specialized neuro-imaging as well as physiological investigations. Several general measures can help individuals with an abnormal detrusor contraction. The search for a molecule to enhance the detrusor voiding contraction remains elusive but there are promising new candidates. Neuromodulation can help select individuals but data is not well stratified by underlying etiology. Manipulation of central neurotransmitters might offer an alternate therapeutic option. CONCLUSIONS A better understanding of the underlying pathophysiologies behind an abnormality of the detrusor voiding contraction is needed for improving management. Towards this goal, the think-tank proposes a classification of the underactive detrusor that might help in selecting and reporting more well-defined patient cohorts.
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Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | | | - Neil Roberts
- Division of Cell Matrix Biology and Regenerative Medicine, The University of Manchester, Bristol, UK
| | - Eskinder Solomon
- Department of Functional Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohammed Belal
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, London, UK
| | | | | | - Alan Wein
- Department of Urology, Desai-Seth Institute of Urology, University of Miami, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Nasri J, Al Ashimi I, Tricard T, Fleury R, Matta I, Bey E, Mesnard B, Gaillet S, Martin C, Game X, Thuillier C, Chartier-Kastler E, Karsenty G, Perrouin-Verbe MA, Demeestere A, Wagner L, Ruffion A, Peyronnet B, Saussine C, Phé V, Vermersch P, De Wachter S, Biardeau X. Development of a predictive tool for sacral nerve modulation implantation in the treatment of non-obstructive urinary retention and/or slow urinary stream: a study from the Neuro-Urology Committee of the French Association of Urology. World J Urol 2023; 41:3075-3082. [PMID: 37783844 DOI: 10.1007/s00345-023-04638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE This study aimed to seek predictive factors and develop a predictive tool for sacral nerve modulation (SNM) implantation in patients with non-obstructive urinary retention and/or slow urinary stream (NOUR/SS). METHODS This study was designed as a retrospective study including all patients who have undergone a two-stage SNM for NOUR/SS between 2000 and 2021 in 11 academic hospitals. The primary outcome was defined as the implantation rate. Secondary outcomes included changes in bladder emptying parameters. Univariate and multivariable logistic regression analysis were performed and determined odds ratio for IPG implantation to build a predictive tool. The performance of the multivariable model discrimination was evaluated using the c-statistics and an internal validation was performed using bootstrap resampling. RESULTS Of the 357 patients included, 210 (58.8%) were finally implanted. After multivariable logistic regression, 4 predictive factors were found, including age (≤ 52 yo; OR = 3.31 CI95% [1.79; 6.14]), gender (female; OR = 2.62 CI95% [1.39; 4.92]), maximal urethral closure pressure (≥ 70 cmH2O; OR: 2.36 CI95% [1.17; 4.74]), and the absence of an underlying neurological disease affecting the lower motor neuron (OR = 2.25 CI95% [1.07; 4.76]). Combining these factors, we established 16 response profiles with distinct IPG implantation rates, ranging from 8.7 to 81.5%. Internal validation found a good discrimination value (c-statistic, 0.724; 95% CI 0.660-0.789) with a low optimism bias (0.013). This allowed us to develop a predictive tool ( https://predictivetool.wixsite.com/void ). CONCLUSION The present study identified 4 predictive factors, allowing to develop a predictive tool for SNM implantation in NOUR/SS patients, that may help in guiding therapeutic decision-making. External validation of the tool is warranted.
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Affiliation(s)
- Jordan Nasri
- Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France
| | - Intisar Al Ashimi
- Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France
| | - Raphael Fleury
- Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France
| | - Imad Matta
- Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France
| | - Elsa Bey
- Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France
| | - Benoit Mesnard
- Department of Urology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Sarah Gaillet
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | - Claire Martin
- Department of Biostatistics, CHU Lille, 59000, Lille, France
| | - Xavier Game
- Department of Urology, Rangueil Academic Hospital, University of Toulouse, Toulouse, France
| | - Caroline Thuillier
- Department of Urology, Grenoble Academic Hospital, University of Grenoble, Grenoble, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Sorbonne Université, Assistance Publique, Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Gilles Karsenty
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | | | - Amelie Demeestere
- Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France
- Department of Urology, Valenciennes Hospital, Valenciennes, France
| | - Laurent Wagner
- Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, 69310, Pierre-Bénite, France
- Equipe 2, Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, Villeurbanne, France
| | - Benoit Peyronnet
- Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France
| | - Christian Saussine
- Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université, Assistance Publique, Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Patrick Vermersch
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wlrijk, Belgium
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France.
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France.
- Department of Urology, Claude Huriez Hospital, 1 rue Michel Polonovski, 59037, Lille Cedex, France.
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Cardaillac C, Levesque A, Riant T, Mortier A, Neunlist M, Perrouin-Verbe MA, Volteau C, Thubert T, Brochard C, Ploteau S. Evaluation of a scoring system for the detection of central sensitization among women with chronic pelvic pain. Am J Obstet Gynecol 2023; 229:530.e1-530.e17. [PMID: 37516398 DOI: 10.1016/j.ajog.2023.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Central sensitization is frequently associated with chronic pelvic pain and requires specific management. The pain is described as hypersensitivity to an innocuous stimulus that is both widespread and persistent. However, no study has evaluated if central sensitization can be measured objectively with neurophysiological tests in the pelvic and perineal area to prove this concept in women with chronic pelvic pain. OBJECTIVE This study aimed to evaluate nociceptive thresholds (primary objective) and spatial and temporal diffusion of pain among women with chronic pelvic pain and high or low scores of central sensitization. STUDY DESIGN This prospective, assessor-blinded, comparative study compared a cohort of women with chronic pelvic pain and a high (>5/10; n=29) vs low (<5/10; n=24) score of sensitization according to the Convergences PP criteria. Participants underwent a noninvasive bladder sensory test, a rectal barostat test, and a muscular (algometer) and a vulvar (vulvagesiometer) sensory test. Poststimulation pain (minutes), quality of life (Medical Outcomes Study 36-Item Short Form Survey), and psychological state, comprising anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory Short Form), and catastrophizing (Pain Catastrophizing Scale), were assessed. RESULTS The participants mostly suffered from endometriosis (35.8%), irritable bowel syndrome (35.8%), bladder pain syndrome (32.1%), and vestibulodynia (28.3%). Baseline characteristics were similar. Women with a high sensitization score had more painful diseases diagnosed (2.7±1.3 vs 1.6±0.8; P=.002) and suffered for longer (11±8 vs 6±5 years; P=.028) than participants with a low score. The bladder maximum capacity was equivalent between participants (399±168 vs 465±164 mL; P=.18). However, the pain felt at each cystometric threshold was significantly increased in women with a high sensitization score. No difference was identified for the rectal pain pressure step (29.3±5.5 vs 30.7±6.5 mm Hg; P=.38). Rectal compliance was decreased in women with a high sensitization score with a considerable increase in pain felt. The average of pain pressure thresholds at the 5 vulvar sites tested was decreased in these participants (162.5±90.5 vs 358.7±196.5 g; P=.0003). Similar results were found for the average of the pain pressure thresholds at 6 muscles tested (1.34±0.41 vs 2.63±1.52 kg/m2; P=.0002). A longer period was needed for patients with high sensitization score to obtain a VAS <3 out of 10 after the stimulation of the bladder (4.52±5.26 vs 1.27±2.96 minutes; P=.01), the rectum (3.75±3.81 vs 1.19±1.23 minutes; P=.009), and the muscles (1.46±1.69 vs 0.64±0.40 minutes; P=.002). The psychological state was equivalent between groups. No association was found between the sensory thresholds and the psychological state results. The physical component of the quality of life score was reduced in women with high sensitization score (P=.0005), with no difference in the mental component. CONCLUSION Using neurophysiological tests, this study showed that there are objective elements to assess for the presence of central sensitization, independently of psychological factors.
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Affiliation(s)
- Claire Cardaillac
- Department of Obstetrics, Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France; Federative Pelvic Pain Center, Nantes University Hospital, Nantes, France; Bretagne Loire University, Nantes University, Institut des Maladies de l'Appareil Digestif, Inserm Unit 1235-The Enteric Nervous System in Gut and Brain Disorders, Nantes, France
| | - Amélie Levesque
- Federative Pelvic Pain Center, Nantes University Hospital, Nantes, France; Department of Urology, Nantes University Hospital, Nantes, France
| | - Thibault Riant
- Federative Pelvic Pain Center, Nantes University Hospital, Nantes, France; Maurice Bensignor Multidisciplinary Pain Center, Catherine de Sienne Center, Nantes, France
| | - Anaïs Mortier
- Department of Obstetrics, Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France; Bretagne Loire University, Nantes University, Institut des Maladies de l'Appareil Digestif, Inserm Unit 1235-The Enteric Nervous System in Gut and Brain Disorders, Nantes, France
| | - Michel Neunlist
- Bretagne Loire University, Nantes University, Institut des Maladies de l'Appareil Digestif, Inserm Unit 1235-The Enteric Nervous System in Gut and Brain Disorders, Nantes, France
| | - Marie-Aimée Perrouin-Verbe
- Federative Pelvic Pain Center, Nantes University Hospital, Nantes, France; Bretagne Loire University, Nantes University, Institut des Maladies de l'Appareil Digestif, Inserm Unit 1235-The Enteric Nervous System in Gut and Brain Disorders, Nantes, France; Department of Urology, Nantes University Hospital, Nantes, France
| | | | - Thibault Thubert
- Department of Obstetrics, Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | - Charlène Brochard
- Bretagne Loire University, Nantes University, Institut des Maladies de l'Appareil Digestif, Inserm Unit 1235-The Enteric Nervous System in Gut and Brain Disorders, Nantes, France; Department of Digestive Functional Exploration, Rennes University Hospital, Rennes, France
| | - Stéphane Ploteau
- Department of Obstetrics, Gynecology and Reproductive Medicine, Nantes University Hospital, Nantes, France; Federative Pelvic Pain Center, Nantes University Hospital, Nantes, France.
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Chartier-Kastler E, Le Normand L, Ruffion A, Saussine C, Braguet R, Rabut B, Ragni E, Perrouin-Verbe MA, Pierrevelcin J, Rousseau T, Gamé X, Tanneau Y, Dargent F, Biardeau X, Graziana JP, Stoica G, Brassart E, Fourmarier M, Yaghi N, Capon G, Ferchaud J, Berrogain N, Peyrat L, Pecoux F, Bryckaert PE, Karsenty G, Song S, Keller DUJ, Cornu JN. Five-year Results from the Prospective, Multicenter, Observational SOUNDS Study of Patients with Overactive Bladder Treated with the InterStim System for Sacral Neuromodulation. Eur Urol Focus 2023; 9:765-772. [PMID: 37019729 DOI: 10.1016/j.euf.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Although sacral neuromodulation (SNM) for overactive bladder (OAB) is an established therapy, there is a lack of high-quality, long-term data on real-life practice. OBJECTIVE To report on real-life therapeutic effectiveness, quality of life (QoL), disease severity, and safety as well as patient-reported symptom bother after approximately 5 yr of follow-up. DESIGN, SETTING, AND PARTICIPANTS A total of 291 OAB patients were enrolled at 25 French sites according to local standard of care. Sacral neuromOdUlation with InterStim therapy for intractable lower uriNary tract DySfunctions (SOUNDS) enrolled both de novo and replacement patients, and a total of 229 patients were permanently implanted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Over the course of the study, patients were followed up six times with two follow-ups in the year after implantation and annually thereafter. Of the patients, 154 completed the final follow-up after a mean of 57.7 ± 3.9 mo. RESULTS AND LIMITATIONS The mean number of daily leaks in urinary urge incontinence (UI) patients was reduced from 4.4 ± 3.3 at baseline to 1.8 ± 2.6 after 5 yr in de novo and from 5.4 ± 4.9 to 2.2 ± 3.0 in replacement patients (both p < 0.001). Likewise, the number of voids in urinary frequency patients was reduced compared with baseline (de novo: reduced from 12.6 ± 4.0 [baseline] to 9.6 ± 4.3 [5 yr]; replacements: reduced from 11.5 ± 4.3 [baseline] to 9.2 ± 3.1 [5 yr]; both p < 0.05). Complete continence rates after 5 yr were 44% (25/57) in de novo and 33% (5/15) in replacement UI patients, and 68% (39/57) and 67% (10/15) of UI patients were categorized as therapy responders by showing a >50% improvement in leaks. Disease severity (Urinary Symptom Profile domain 2), Numeric Rating Scale-based symptom bother, and disease-specific QoL (Ditrovie) improved significantly in both groups at all visits (p < 0.001). Adverse events related to device or procedure occurred in 51% (140/274) of patients, with 66% (152/229) of the events being classified as minor (Clavien-Dindo grade I and II). Surgical revisions were reported in 39% (89/229), which include permanent explants in 15% (34/229) of patients. CONCLUSIONS SOUNDS demonstrates the sustained effectiveness and QoL improvements of SNM in OAB patients after 5 yr in real-world conditions while maintaining an acceptable safety profile consistent with literature. PATIENT SUMMARY This study confirmed that French overactive bladder patients had a sustained symptom and bother reduction, and improvements in quality of life up to 5 yr after sacral neuromodulation device implantation.
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Affiliation(s)
| | | | | | | | | | | | - Evelyne Ragni
- Hôpital de la Timone - Centre Hôspitalier Universitaire de Marseille, France
| | | | | | | | - Xavier Gamé
- CHU Toulouse Hôpital Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gilles Karsenty
- Aix-Marseille University, Academic Hospital la Conception, AP-HM, Marseille, France
| | - Shannon Song
- Medtronic Global Clinical Data Solutions, Minneapolis, MN, USA
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Graveleau A, Kervella D, Kerleau C, Lavallée E, Chelghaf I, de Vergie S, Karam G, Perrouin-Verbe MA, Rigaud J, Blancho G, Giral M, Branchereau J. [Surgical outcomes and complications following third kidney transplantation]. Prog Urol 2023; 33:427-436. [PMID: 37169706 DOI: 10.1016/j.purol.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND After two consecutive kidney transplant failures, a third kidney transplantation improves survival for patients on the waiting list. The surgical outcomes and complications of third kidney transplantations remain poorly known. METHODS We analyzed the last 100 third kidney transplantations performed in our center between January 2000 and August 2018. The data, relating to donors and recipients, were extracted retrospectively from medical records and from the prospective DIVAT database (computerized and validated data in transplantation). Continuous variables are expressed as means, medians, first and third quartiles (median, [Q1;Q3]). Categorical variables are expressed as percentages. Patient and transplant survivals were calculated using the Kaplan-Meier method. RESULTS Mean age of recipients was 46.4 years (47, [36;53]). Thirty-five percent had kidney failure due to urinary tract malformations. Mean age of donors was 48.2 years (52, [39.75; 58]) with 63% of donors with standard criteria. Mean cold ischemia time was 22.4hours (21, [16.5; 29.2]). Surgical mortality rate was 2% and surgical complication rate was 45%. Third kidney transplants survival was 73.1% and 58.8% at 5 years and 10 years. Mortality rate with a functioning transplant was 18%. CONCLUSION A third kidney transplant offers satisfactory functional outcomes but remains associated with high morbi-mortality and a significant death rate with a functioning transplant. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Aurélien Graveleau
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Delphine Kervella
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Clarisse Kerleau
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Etienne Lavallée
- Département de chirurgie et centre de recherche sur le cancer, division d'urologie, université Laval, Québec, Canada
| | - Ismael Chelghaf
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Stéphane de Vergie
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Georges Karam
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | | | - Jérôme Rigaud
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Gilles Blancho
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Magali Giral
- Service de néphrologie et de transplantation, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France
| | - Julien Branchereau
- Service d'urologie, hôpital Hôtel-Dieu, centre hospitalier universitaire de Nantes, Nantes, France.
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Delaval S, Dequirez PL, Hentzen C, Baron M, Mille E, Tariel F, Peyronnet B, Perrouin-Verbe MA, Pierache A, Chartier-Kastler E, Capon G, Cornu JN, Castel-Lacanal E, Gamé X, Karsenty G, Ruffion A, Denys P, Even A, Joussain C, Amarenco G, Phé V, Biardeau X. Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation-A study from the neuro-urology committee of the French Association of Urology. Mult Scler 2023:13524585231174580. [PMID: 37264947 DOI: 10.1177/13524585231174580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND While intravesical injections of botulinum neurotoxin A (BoNT-A) are currently recommended for patients experiencing refractory neurogenic overactive bladder and/or detrusor overactivity (OAB/DO), it is unclear how much this therapy is effective and sustainable in the long-term in patients with multiple sclerosis (MS). OBJECTIVES To assess the mid-term continuation rate of BoNT-A injections to treat neurogenic OAB/DO in MS patients and to investigate MS-specific risk factors for discontinuation. METHODS This retrospective study involved 11 French university hospital centers. All MS patients who received BoNT-A to treat neurogenic OAB/DO between 2008 and 2013 and were subsequently followed up for at least 5 years were eligible. RESULTS Of the 196 MS patients included, 159 (81.1%) were still under BoNT-A 5 years after the first injection. The combination of the Expanded Disability Status Scale (EDSS < 6 or ⩾ 6) and of the MS type (relapsing-remitting vs progressive) predicted the risk of discontinuation. This risk was 5.5% for patients with no risk factor, whereas patients presenting with one or two risk factors were 3.3 and 5.7 times more likely to discontinue, respectively. CONCLUSION BoNT-A is a satisfying mid-term neurogenic OAB/DO therapy for most MS patients. Combining EDSS and MS type could help predict BoNT-A discontinuation.
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Affiliation(s)
- Stéphanie Delaval
- Department of Urology, University of Lille, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Pierre-Luc Dequirez
- Department of Urology, University of Lille, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Claire Hentzen
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Maximilien Baron
- Department of Urology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Eva Mille
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | - François Tariel
- Department of Urology, University of Rennes, Rennes Academic Hospital, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes Academic Hospital, Rennes, France
| | | | | | - Emmanuel Chartier-Kastler
- Department of Urology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux Academic Hospital, Bordeaux, France
| | - Jean-Nicolas Cornu
- Department of Urology, University of Rouen Normandy, Rouen Academic Hospital, Rouen, France
| | - Evelyne Castel-Lacanal
- Department of Rehabilitation and Physical Medicine, Université of Toulouse, Rangueil Academic Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Rangueil Academic Hospital, Toulouse, France
| | - Gilles Karsenty
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Pierre Denys
- Department of Rehabilitation and Physical Medicine, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France/Inserm UMR 1179, END-ICAP, Laboratoire Handicap Neuromusculaire: Physiopathologie, Biothérapie et Pharmacologie Appliquées, UFR Simone Veil, Université Paris-Saclay, Paris, France
| | - Alexia Even
- Department of Rehabilitation and Physical Medicine, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Charles Joussain
- Department of Rehabilitation and Physical Medicine, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Gérard Amarenco
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Xavier Biardeau
- Department of Urology, University of Lille, Claude Huriez Hospital, Lille University Hospital, Lille, France/Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, University of Lille, CHU Lille, Lille, France
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Poirier T, Karam G, Bouchot O, De Vergie S, Branchereau J, Perrouin-Verbe MA, Rigaud J. [Results of the management of kidney cancer with extension into the inferior vena cava: A retrospective, single-center, observational study]. Prog Urol 2023; 33:333-343. [PMID: 37076361 DOI: 10.1016/j.purol.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/26/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES The aim of our study was to evaluate the morbidity and mortality, as well as the oncogical results of patients who had undergone surgical procedure for a kidney cancer with thrombus extension into the inferior vena cava. MATERIALS AND METHODS Between January 2004 and April 2020, 57 patients were operated by enlarged nephrectomy with thrombectomy for kidney cancer with thrombus extension in the inferior vena cava. Twelve patients (21%) with the use of cardiopulmonary bypass because the thrombus was upper than the sus-hepatic veins. Twenty-three patients (40.4%) were metastatic at diagnosis. RESULTS Perioperative mortality was 10.5%, without difference according to surgical technique. Morbidity during hospitalization was 58%, without difference according to surgical technique. Median follow-up was 40.8±40.1months. Overall survival at 2 and 5years was 60% and 28%, respectively. At 5years, the principal prognostic factor was the metastatic status at diagnosis, in multivariate analysis (OR: 0.15, P=0.03). Progression free survival mean was 28.2±40.2months. Progression free survival at 2 and 5years was 28% and 18%, respectively. All the patients who were metastatic at diagnosis had a recurrence in an average time of 5.7months (median of 3months). Thirteen percent of patients can be considered cured at the end of the study. CONCLUSION Morbidity and mortality of this surgery remain important. The metastatic status at diagnosis has appeared to be the principal prognostic factor on the survival of these patients. LEVEL OF EVIDENCE Level 4: retrospective study.
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Affiliation(s)
- Thomas Poirier
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - Georges Karam
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Olivier Bouchot
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Stéphane De Vergie
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Julien Branchereau
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Marie-Aimée Perrouin-Verbe
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - Jérôme Rigaud
- Service d'urologie et de transplantations rénales, CHU de Nantes Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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11
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Jeanne-Julien A, Bouchot O, De Vergie S, Branchereau J, Perrouin-Verbe MA, Rigaud J. Long-term oncological results in penile cancer treated by inguinal lymphadenectomy. World J Urol 2023:10.1007/s00345-023-04390-3. [PMID: 37039906 DOI: 10.1007/s00345-023-04390-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023] Open
Abstract
PURPOSE In 95% of cases, penile cancer is a squamous cell carcinoma whose specificity is lymphatic spread with the inguinal lymph nodes as the first relay route. Inguinal lymph node dissection is a primordial part of the treatment. The objective was to assess the oncological results of inguinal lymph node dissection in penile cancer at our centre. METHODS We retrospectively included all patients having undergone inguinal lymph node dissection at our centre between 1 January 2004 and 1 January 2020 for the treatment of penile cancer. Patients for whom lymphadenopathy was palliative were excluded. Depending on indications, the procedures consisted in either dynamic sentinel node biopsy, modified lymphadenectomy or radical lymphadenectomy. All cancers were reclassified using the 2016 TNM classification system. Survival was analysed according to the Kaplan-Meier method. RESULTS 242 inguinal lymph node dissections were performed in 122 patients. There were 71 pN0 (58%), 9 pN1 (7%), 4 pN2 (3%) and 38 pN3 (31%). Mean follow-up was 51 ± 45 months. The 3-year recurrence-free survival rate was 76% in pN0 patients and 17% in pN3 patients. The 5-year specific and overall survival rates were, respectively, 82% and 73% for pN0 stages, and 14% and 17% for pN3 stages. Extracapsular extension on an inguinal lymphadenopathy appeared as a highly negative prognostic factor. CONCLUSION Inguinal lymph node dissection is essential in the treatment of penile cancer. Recurrence-free, specific and overall survival are closely linked to the lymph node stage. Extracapsular extension and pelvic lymph node invasion are highly negative prognostic factors.
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Affiliation(s)
- Antoine Jeanne-Julien
- Clinique Urologique, Hôpital Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France.
| | - Olivier Bouchot
- Clinique Urologique, Hôpital Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Stéphane De Vergie
- Clinique Urologique, Hôpital Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Julien Branchereau
- Clinique Urologique, Hôpital Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | | | - Jérôme Rigaud
- Clinique Urologique, Hôpital Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes, France
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12
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de Guerry ML, Demeestere A, Bergot C, de Hauteclocque A, Hascoet J, Bajeot AS, Ternynck C, Gamé X, Peyronnet B, Capon G, Perrouin-Verbe MA, Biardeau X. Adjustable Continence Therapy (ACT®) balloons to treat female stress urinary incontinence: effectiveness, safety and risk factors of failure and complication. Int Urogynecol J 2023; 34:877-883. [PMID: 35751672 DOI: 10.1007/s00192-022-05275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To assess the effectiveness, safety and risk factors of failure and complications associated with Adjustable Continence Therapy (ACT®) balloons as a treatment for female stress urinary incontinence (SUI). METHODS In the present multicentric retrospective study, all women implanted with ACT® balloons between 2000 and 2018 were considered eligible. Effectiveness and safety were assessed at 1 year, and risk factors for failure and complications were sought. The effectiveness was categorized into three distinct groups: Success = maximum 1 pad/day and patient's impression of improvement using a numerical rating scale (NRS) ≥ 8/10; Improvement = decrease of daily pad use and NRS ≥ 5/10; Failure = increase or stability of daily pad use or NRS < 5/10. The intra- and postoperative surgical complications were collected. RESULTS Over the study period, 281 women were included. Among them, 104 (37.0%), 94 (33.5%) and 83 (29.5%) were categorized as success, improvement, and failure, respectively. Intra-, early and late postoperative complications occurred in 13 (4.6%), 35 (12.5%) and 75 (26.7%) women, respectively. Most early surgical complications were minor according to the Dindo-Clavien classification. Of women that presented a late postoperative surgical complication, 64 (22.8%) underwent an explantation performed under local or general anesthesia without associated sequalae. CONCLUSIONS The short-term effectiveness associated with ACT® balloons, their minimally invasive implantation and the frequent but easily manageable and sequelae-free complications suggest that they should be part of the therapeutic arsenal for female SUI.
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Affiliation(s)
| | - Amélie Demeestere
- University of Lille, Department of Urology, CHU Lille, F-59000, Lille, France
| | - Christophe Bergot
- Department of Urology, CHU Nantes, Université de Nantes, Nantes, France
| | | | - Juliette Hascoet
- Department of Urology, CHU Rennes, Université de Rennes, Rennes, France
| | - Anne-Sophie Bajeot
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Xavier Gamé
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Benoît Peyronnet
- Department of Urology, CHU Rennes, Université de Rennes, Rennes, France
| | - Grégoire Capon
- Department of Urology, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Xavier Biardeau
- University of Lille, Department of Urology, CHU Lille, F-59000, Lille, France.
- University of Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, 59000, Lille, France.
- University of Lille, Department of Urology, Lille University Hospital, 1 rue Polonovski, 59037, Lille Cedex, France.
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13
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Pizzoferrato AC, Thuillier C, Vénara A, Bornsztein N, Bouquet S, Cayrac M, Cornillet-Bernard M, Cotelle O, Cour F, Cretinon S, De Reilhac P, Loriau J, Pellet F, Perrouin-Verbe MA, Pourcelot AG, Revel-Delhom C, Steenstrup B, Vogel T, Le Normand L, Fritel X. Management of female pelvic organ prolapse-Summary of the 2021 HAS guidelines. J Gynecol Obstet Hum Reprod 2023; 52:102535. [PMID: 36657614 DOI: 10.1016/j.jogoh.2023.102535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
When a patient presents with symptoms suggestive of pelvic organ prolapse (POP), clinical evaluation should include an assessment of symptoms, their impact on daily life and rule out other pelvic pathologies. The prolapse should be described compartment by compartment, indicating the extent of the externalization for each. The diagnosis of POP is clinical. Additional exams may be requested to explore the symptoms associated or not explained by the observed prolapse. Pelvic floor muscle training and pessaries are non-surgical conservative treatment options recommended as first-line therapy for pelvic organ prolapse. They can be offered in combination and be associated with the management of modifiable risk factors for prolapse. If the conservative therapeutic options do not meet the patient's expectations, surgery should be proposed if the symptoms are disabling, related to pelvic organ prolapse, detected on clinical examination and significant (stage 2 or more of the POP-Q classification). Surgical routes for POP repair can be abdominal with mesh placement, or vaginal with autologous tissue. Laparoscopic sacrocolpopexy is recommended for cases of apical and anterior prolapse. Autologous vaginal surgery (including colpocleisis) is a recommended option for elderly and fragile patients. For cases of isolated rectocele, the posterior vaginal route with autologous tissue should be preferentially performed over the transanal route. The decision to place a mesh must be made in consultation with a multidisciplinary team. After the surgery, the patient should be reassessed by the surgeon, even in the absence of symptoms or complications, and in the long term by a primary care or specialist doctor.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France, INSERM CIC 1402, Poitiers University, Poitiers, France.
| | - Caroline Thuillier
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | - Aurélien Vénara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - Nicole Bornsztein
- General practice office, Evry France, College of General Medicine, Paris, France
| | - Sylvain Bouquet
- General practice office, Lamastre, France, College of General Medicine, Paris, France
| | - Mélanie Cayrac
- GYNEPOLE, Obstetrics and Gynecology Center, Montpellier, France
| | | | - Odile Cotelle
- Department of Obstetrics and Gynaecology, AP-HP, GHU Sud, Antoine Béclère Hospital, Clamart, France
| | - Florence Cour
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Sophie Cretinon
- Department of Obstetrics and Gynaecology, AP-HP Louis Mourier Hospital, Colombes, France
| | | | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Françoise Pellet
- French Association of Gougerot Sjögren and Dry Syndromes, Paris, France
| | | | - Anne-Gaëlle Pourcelot
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Christine Revel-Delhom
- Clinical practice guidelines Unit, French National Authority for Health, Saint Denis La Plaine, France
| | | | - Thomas Vogel
- Geriatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Loïc Le Normand
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Xavier Fritel
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France, INSERM CIC 1402, Poitiers University, Poitiers, France
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14
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Calën L, Mesnard B, Hedhli O, Broudeur L, Reiss B, Loubersac T, Branchereau J, Baron M, Rigaud J, Le Fort M, Perrouin-Verbe B, Le Normand L, Lefevre C, Perrouin-Verbe MA. Robot-assisted laparoscopic cystectomy with non-continent urinary diversion for neurogenic lower urinary tract dysfunction: Midterm outcomes. Neurourol Urodyn 2023; 42:586-596. [PMID: 36695768 DOI: 10.1002/nau.25134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated. RESULTS One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12-49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I-II) and 29% (n = 17) major complications (Clavien III-V). Three patients died in the early postoperative period. Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre- and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1-2). CONCLUSION Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic lower urinary tract dysfunction who are unable to benefit from conservative treatment, as it provides midterm protection of the upper urinary tract and an improvement in quality of life.
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Affiliation(s)
- Laura Calën
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Benoît Mesnard
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Oussama Hedhli
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Lucas Broudeur
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Bénédicte Reiss
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Thomas Loubersac
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | | | - Maximilien Baron
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Marc Le Fort
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Chloé Lefevre
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
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15
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Paret F, Leclair MD, Karam G, Rigaud J, Baron M, Perrouin-Verbe MA. Long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children. Neurourol Urodyn 2023; 42:355-365. [PMID: 36434815 DOI: 10.1002/nau.25106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To report long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children. MATERIALS AND METHODS This retrospective monocentric study included all patients who underwent artificial urinary sphincter (AMS 800) implantation before 18 years of age between 1986 and October 2018 for intrinsic sphincter deficiency. The primary outcome was the continence rate at the last follow-up, defined by the daily use of 0 pads. The secondary outcome was the overall survival of the device, defined as the absence of any repeated surgery (revision or explantation) during follow-up. Reoperation-free, revision-free, and explantation-free device survival rates were estimated using the Kaplan-Meier method. RESULTS Thirty-six patients with a median age of 12 years (interquartile range [IQR]: 10-14) were included (15 females, 21 males). The median follow-up was 18.7 years (IQR: 9-26). The main underlying condition was spinal dysraphism (n = 24; 67%). The median time to the first reoperation was 9 years (IQR: 3.75-14.7). At the last follow-up, survival rates without revision were 84%, 71%, 55%, and 33% at 5, 10, 15, and 20 years, respectively. Survival rates without explantation were 91%, 84%, 80%, and 72% at 5, 10, 15, and 20 years, respectively. At the last follow-up, 29 patients had a functional device. The overall continence rate was 88%. All patients who had their device still in place were continent at the last follow-up. CONCLUSION The artificial urinary sphincter is an effective long-term treatment for urinary incontinence related to intrinsic sphincter deficiency in children, providing a high rate of continence, even if associated with a high rate of reoperation.
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Affiliation(s)
- Fanny Paret
- Urology Department, Nantes University Hospital, Nantes, France
| | - Marc-David Leclair
- Pediatric Surgery Department, Nantes University Hospital, Nantes, France
| | - Georges Karam
- Urology Department, Nantes University Hospital, Nantes, France
| | - Jérôme Rigaud
- Urology Department, Nantes University Hospital, Nantes, France
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16
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Chartier-Kastler E, Normand LL, Ruffion A, Saussine C, Braguet R, Rabut B, Ragni E, Perrouin-Verbe MA, Pierrevelcin J, Rousseau T, Gamé X, Tanneau Y, Dargent F, Biardeau X, Graziana JP, Stoica G, Brassart E, Fourmarier M, Yaghi N, Capon G, Ferchaud J, Berrogain N, Peyrat L, Pecoux F, Bryckaert PE, Melotti A, Abouihia A, Keller DUJ, Cornu JN. Sacral Neuromodulation with the InterStim System for Overactive Bladder: 3-Year Results from the French Prospective, Multicenter, Observational SOUNDS Study. Eur Urol Focus 2022; 8:1399-1407. [PMID: 34334342 DOI: 10.1016/j.euf.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND SOUNDS strengthens the evidence basis of sacral neuromodulation (SNM) for overactive bladder (OAB) through real-world data. OBJECTIVE To analyze diary-based effectiveness, quality of life (QoL), disease severity, symptom bother, and safety data for SNM with the InterStim system up to 3 yr after implantation. DESIGN, SETTING, AND PARTICIPANTS Twenty-five representative French sites enrolled 291 patients with OAB followed according to the local standard of care. Overall, 229 patients received a de novo or replacement InterStim implant and had four follow-up visits, two within the first yr and annually thereafter. A total of 190 patients completed the fourth follow-up visit after a mean of 33.7 ± 3.7 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The effectiveness outcomes measured were changes in daily voids and leaks and the therapy responder rates. Other outcomes included validated QoL data (Ditrovie and EuroQol 5-dimension 5-level questionnaires), disease severity (Urinary Symptom Profile [USP]), symptom bother rated using a numeric rating scale (NRS), and safety data. Follow-up data were compared to baseline results using the Wilcoxon signed-rank test. RESULTS AND LIMITATIONS Average daily voids and leaks were significantly reduced at all time points up to 3 yr after implantation (p < 0.05) except for voids at 21 mo in the group receiving a replacement device. The therapeutic response for urinary urge incontinence at the fourth follow-up was 72% for the de novo group and 86% for the replacement group. Disease-specific QoL (Ditrovie), OAB-specific symptom severity (USP domain 2), and NRS-rated disease bother were significantly improved at all visits (p < 0.001). Device- or procedure-related adverse events occurred in 49% of patients, with 68% of the events classified as minor (Clavien-Dindo grade I or II). Surgical revisions were performed in 33% of patients, including permanent removal in 13%, over a mean exposure time of 44.4 ± 15.3 mo. CONCLUSIONS This study confirms the safety and effectiveness of SNM for OAB and improvements in QoL and disease bother in real life. PATIENT SUMMARY Our study in French patients with overactive bladder showed that disease symptoms and bother were significantly reduced and quality of life was significantly improved over a study duration of approximately 3 yr after implantation of a device to stimulate nerves that control the bladder. This trial is registered at ClinicalTrials.gov as NCT02186041.
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Affiliation(s)
| | | | | | | | | | | | - Evelyne Ragni
- Hôpital de la Timone, Centre Hôspitalier Universitaire de Marseille, Marseille, France
| | | | | | | | - Xavier Gamé
- CHU Toulouse Hôpital Rangueil, Toulouse, France
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17
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Ricard H, Léon G, Branchereau J, Bouchot O, Karam G, Le Normand L, Rigaud J, Perrouin-Verbe MA. Adjustable continence balloons in postprostatectomy incontinence: Outcomes and complications. Neurourol Urodyn 2022; 41:1414-1422. [PMID: 35686550 DOI: 10.1002/nau.24967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study was to assess the mid-term efficacy and safety of adjustable continence therapy (ProACT™) for the treatment of male stress urinary incontinence (SUI) after radical prostatectomy (RP). PATIENTS AND METHODS Single-center retrospective study including male patients implanted with ProACT™ periurethral balloons for SUI after RP between 2007 and 2017, mainly with flexible cystoscopic guidance. Efficacy was assessed using a composite endpoint with subjective (patient's impression of improvement (PII), using a 0-100 numeral rating scale) and objective outcomes (decrease in daily pad use). Postoperative success was defined as a PII ≥ 80%, associated with the use of 0-1 pad daily. Improvement was defined as a PII ≥ 50% and a decrease ≥50% in the number of daily pads used. RESULTS Two hundred men with a median age of 68 (64-73) years were included. Seventeen percent (n = 34) had had prior radiotherapy and 15.5% (n = 31) had had prior SUI surgery. The median follow-up was 43 (19-71) months. The severity of SUI was as follows: mild in 119 (59.5%), moderate in 48 (24%), and severe in 33 patients (16.5%). Severe SUI and a history of prior radiotherapy were associated with a lower success rate (p = 0.033 and p < 0.0001). The overall reoperation rate was 34%, with 5.6% (n = 11) requiring a third implantation. Of the patients, 29.4% (n = 58) required an artificial urinary sphincter to treat SUI. At the last follow up, among the overall population, the success rate was 40.1% and the median PII was 18.3%. For patients in whom the balloons were still in place (n = 132), the cumulative success and improvement rate was 78%, with a median PII of 72%. CONCLUSION The minimally invasive ProACT™ device provides a clear beneficial continence outcome in patients with SUI after radical prostatectomy. Severe SUI or prior radiotherapy were associated with a lower success rate in our study.
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Affiliation(s)
- Hélène Ricard
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Grégoire Léon
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Julien Branchereau
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Olivier Bouchot
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Georges Karam
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Loic Le Normand
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
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18
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Blé O, Levy J, Lefèvre C, Perrouin-Verbe MA, Even A, Le Normand L, Kastler EC, Perrouin-Verbe B, Denys P, Joussain C. Neurogenic bladder in patients with paraplegia: a two-center study of the real-life experience of the patients' journey. World J Urol 2022; 40:1743-1749. [PMID: 35648199 DOI: 10.1007/s00345-022-04044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Several patterns of urological dysfunctions have been described following spinal cord injury (SCI), depending on the level and the completeness of the injury. A better understanding of the natural history of neurogenic bladder in patients with SCI, and the description of their successive therapeutic lines based on their clinical and urodynamic pattern is needed to improve their management. This study aimed to describe the real-life successive therapeutic lines in patients with neurogenic lower urinary tract dysfunction (NLUTD) following SCI. METHODS We conducted a two-center retrospective review of medical files of patients with SCI followed in two French specialized departments of Physical Medicine and Rehabilitation between January 2000 and January 2018. All patients with SCI with a level of lesion bellow T3 and older than 18 years old were eligible. The primary outcome was the description of the natural journey of neurogenic bladder in this population, from the awakening bladder contraction to the last therapeutic line. Survival curves were calculated with a 95-confidence interval using the Kaplan-Meier method. RESULTS One hundred and five patients were included in this study. Most of the patients were young men with a complete SCI lesion. The median time of treatment introduction was 1 and 9 years for anticholinergics and intradetrusor injection of BoNT/A, respectively. Median duration of effect of treatments was 4 and 6 years post-introduction of anticholinergics and BoNT/A, respectively. CONCLUSION This study describes NLUTD journey of patients with SCI demonstrating the mid-term efficacy of the two first therapeutic lines of NDO management. An improvement of non-surgical therapeutics is needed.
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Affiliation(s)
- O Blé
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
| | - J Levy
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France
| | - C Lefèvre
- Department of Neurological Physical Medicine and Rehabilitation, Saint-Jacques Hospital, Nantes University Hospital, Nantes, France
| | | | - A Even
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
| | - L Le Normand
- Department of Urology, Nantes University Hospital, Nantes, France
| | - E Chartier Kastler
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Saint-Jacques Hospital, Nantes University Hospital, Nantes, France
| | - P Denys
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France
| | - C Joussain
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France.
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France.
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19
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Hentzen C, Haddad R, Turmel N, Biardeau X, Bey E, Amarenco G, Denys P, Gamé X, Phé V, Peyronnet B, Perrouin-Verbe MA, Joussain C. [Prioritization of risk situations in neuro-urology: Guidelines based on the Delphi method from Association française d'urologie (AFU), Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), Groupe de neuro-urologie de langue française (GENULF), Société française de médecine physique et de réadaptation (SOFMER) and Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP)]. Prog Urol 2022; 32:635-655. [PMID: 35659166 DOI: 10.1016/j.purol.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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)). CONCLUSIONS 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.
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Affiliation(s)
- C Hentzen
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - R Haddad
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - N Turmel
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France; Département de médecine physique et de réadaptation, hôpital Danièle-Casanova, 93205 Saint-Denis, France
| | - X Biardeau
- Département d'urologie, université de Lille, CHU de Lille, hôpital Claude-Huriez, 59000 Lille, France
| | - E Bey
- Département d'urologie et d'andrologie, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - G Amarenco
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - P Denys
- Inserm, département de neuro-urologie et d'andrologie, service de médecine physique et de réadaptation, université Paris-Saclay, UMR 1179, hôpital Raymond-Poincaré, AP-HP, Paris, France
| | - X Gamé
- Département d'urologie, transplanttion rénale et andrologie, CHU de Rangueil, TSA 50032, 31059 Toulouse, France
| | - V Phé
- Département d'urologie, Sorbonne Université, hôpital Tenon, AP-HP, Paris, France
| | - B Peyronnet
- Département d'urologie, université de Rennes, Rennes, France
| | - M A Perrouin-Verbe
- Département d'urologie, University of Nantes, hôtel Dieu Hospital, Nantes, France
| | - C Joussain
- Inserm, département de neuro-urologie et d'andrologie, service de médecine physique et de réadaptation, université Paris-Saclay, UMR 1179, hôpital Raymond-Poincaré, AP-HP, Paris, France
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20
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Michel F, Cancrini F, Cancel-Tassin G, Gamé X, Huyghe E, Rock A, Léon G, Uzan A, Desfemmes FR, Peyronnet B, Fallot J, Léon P, Rolland E, Perrouin-Verbe MA, Wodey J, Capon G, Karsenty G, Rouprêt M, Cussenot O, Alshehhi H, Comperat E, Phé V. A study of the immunohistochemical profile of bladder cancer in neuro-urological patients by the French Association of Urology. World J Urol 2022; 40:1939-1947. [PMID: 35138436 DOI: 10.1007/s00345-022-03942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To establish whether the expression of markers of cell differentiation (CK7, CK14, CK20, GATA3), apoptosis (p53), proliferation (Ki67, STAG2) and peri-tumoural lymphocytes (CD3, CD8), provides specific information about urothelial carcinogenesis in neuro-urological patients with bladder cancer (NBC). METHODS Tissue samples from NBC were retrieved from 15 centres in France and compared to control samples from non neuro-urological patients with bladder cancer (NNBC) and from neuro-urological patients without bladder cancer (NB). The expression of CK7, CK14, CK20, GATA3, p53, Ki67, STAG2, CD3 and CD8 markers was analysed using immunohistochemistry of tissue microarray sections. RESULTS Overall, tissue samples from 124 patients were included in the study (n = 72 NBC, n = 26 NNBC and n = 26 NB). Muscle invasive bladder cancer (MIBC) was found in 52 NBC patients (72.2%) and squamous cell differentiation in 9 (12.5%). In NBC samples, the expression of CK20 and GATA3 was significantly more frequent in NMIBC compared to MIBC (p = 0.015 and p = 0.004, respectively). CK20 and GATA3 were significantly more expressed in NBC compared to NNBC (p < 0.001 and p = 0.010, respectively). The expression of CK14, Ki67, CD3 and CD8 was significantly more frequent in NBC than in NNBC samples (p = 0.005, p < 0.001, p < 0.001 and p < 0.001, respectively). The expression of CD3 and CD8 was similar in NBC and NB samples. CONCLUSION In NBC, markers of basal differentiation, proliferation and peri-tumoural lymphocytes were significantly more expressed compared to NNBC controls. These results suggest the aggressiveness of NBC and the role of chronic inflammation in the carcinogenesis of bladder cancer in neuro-urological patients.
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Affiliation(s)
- Floriane Michel
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 Boulevard Baille, 13005, Marseille, France. .,Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Fabiana Cancrini
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Géraldine Cancel-Tassin
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Gamé
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Eric Huyghe
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Aurélien Rock
- Department of Urology, Groupe Hospitalier de L'Institut Catholique Lillois, Lille, France
| | - Grégoire Léon
- Department of Urology and Transplantation, CHU de Caen, Caen, France
| | - Audrey Uzan
- Department of Urology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Jérémy Fallot
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Priscilla Léon
- Department of Urology, Clinique Urologie Royan, Royan, France
| | | | | | - Jacques Wodey
- Department of Urology, Clinique Rhône Durance, Avignon, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Morgan Rouprêt
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Urology, Sorbonne University, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Cussenot
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Urology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hussa Alshehhi
- Department of Pathology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eva Comperat
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pathology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Urology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Levesque A, Bautrant E, Quistrebert V, Valancogne G, Riant T, Beer Gabel M, Leroi AM, Jottard K, Bruyninx L, Amarenco G, Quintas L, Picard P, Vancaillie T, Leveque C, Mohy F, Rioult B, Ploteau S, Labat JJ, Guinet-Lacoste A, Quinio B, Cosson M, Haddad R, Deffieux X, Perrouin-Verbe MA, Garreau C, Robert R. Recommendations on the management of pudendal nerve entrapment syndrome: A formalised expert consensus. Eur J Pain 2021; 26:7-17. [PMID: 34643963 DOI: 10.1002/ejp.1861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since the development and publication of diagnostic criteria for pudendal nerve entrapment (PNE) syndrome in 2008, no comprehensive work has been published on the clinical knowledge in the management of this condition. The aim of this work was to develop recommendations on the diagnosis and the management of PNE. METHODS The methodology of this study was based on French High Authority for Health Method for the development of good practice and the literature review was based on the PRISMA method. The selected articles have all been evaluated according to the American Society of Interventional Pain Physicians assessment grid. RESULTS The results of the literature review and expert consensus are incorporated into 10 sections to describe diagnosis and management of PNE: (1) diagnosis of PNE, (2) patients advice and precautions, (3) drugs treatments, (4) physiotherapy, (5) transcutaneous electrostimulations (TENS), (6) psychotherapy, (7) injections, (8) surgery, (9) pulsed radiofrequency, and (10) Neuromodulation. The following major points should be noted: (i) the relevance of 4+1 Nantes criteria for diagnosis; (ii) the preference for initial monotherapy with tri-tetracyclics or gabapentinoids; (iii) the lack of effect of opiates, (iv) the likely relevance (pending more controlled studies) of physiotherapy, TENS and cognitive behavioural therapy; (v) the incertitudes (lack of data) regarding corticoid injections, (vi) surgery is a long term effective treatment and (vii) radiofrequency needs a longer follow-up to be currently proposed in this indication. CONCLUSION These recommendations should allow rational and homogeneous management of patients suffering from PNE. They should also allow to shorten the delays of management by directing the primary care. SIGNIFICANCE Pudendal nerve entrapment (PNE) has only been known for about 20 years and its management is heterogeneous from one practitioner to another. This work offers a synthesis of the literature and international experts' opinions on the diagnosis and management of PNE.
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Affiliation(s)
- Amélie Levesque
- Urology Department, Nantes University Hospital, Nantes, France
| | - Eric Bautrant
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre "l'Avancée-Clinique Axium", Aix en Provence, France
| | | | | | - Thibault Riant
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Marc Beer Gabel
- Neurogastroenterology and Pelvic Floor Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Gerard Amarenco
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Lara Quintas
- Department of Gynecology, Clinical Institute of Gynecology, Obstetrics, and Neonatology, Faculty of Medicine, Barcelona, Spain
| | - Pascale Picard
- Neurology Department, Clermont-Ferrand University Hospital, Inserm, Clermont-Ferrand, France
| | - Thierry Vancaillie
- School of Women and Children, University of New South Wales, Sydney, New South Wales, Australia
| | - Christine Leveque
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre "l'Avancée-Clinique Axium", Aix en Provence, France
| | - Frédérique Mohy
- Pain Management Center, University Hospital Felix Guyon, SAINT DENIS, La Reunion, France
| | - Bruno Rioult
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
| | - Stéphane Ploteau
- Department of Gynecology-Obstetrics and Reproductive Medicine, Nantes University Hospital, Nantes, France
| | | | - Amandine Guinet-Lacoste
- Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France
| | - Bertrand Quinio
- Pain Center, Regional University Hospital la Cavale Blanche, Brest, France
| | - Michel Cosson
- Departement of Gynecology, University Hopsital Jeanne De Flandre, Lille, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Xavier Deffieux
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Assistance Publique Hopitaux de Paris, Clamart University Paris-Saclay, Clamart, France
| | | | | | - Roger Robert
- Maurice Bensignor Multidisciplinary Pain Center, Centre Catherine de Sienne, Nantes, France
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Demeestere A, de Guerry ML, Bergot C, de Hauteclocque A, Hascoet J, Gamé X, Bajeot AS, Peyronnet B, Capon G, Perrouin-Verbe MA, Biardeau X. Adjustable continence therapy (ACT®) balloons to treat neurogenic and non-neurogenic female urinary incontinence. Neurourol Urodyn 2021; 41:313-322. [PMID: 34633672 DOI: 10.1002/nau.24822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/07/2022]
Abstract
AIMS To compare efficacy and safety between neurogenic and non-neurogenic women after adjustable continence therapy (ACT®) balloons implantation to treat stress urinary incontinence (SUI) due to intrinsic sphincter deficiency. METHODS In the present retrospective multicentric study, all neurogenic and non-neurogenic women implanted with ACT® balloons between 2000 and 2018 were considered for inclusion. Efficacy was compared 1 year after implantation, and women were allocated in three different groups as follows. Success: maximum 1 pad per day and patient's impression of improvement assessed using a numeral rating scale (NRS) ≥8/10. Improvement: decrease of daily pad use and/or NRS ≥5/10. Failure: increase or stability of daily pad use or NRS <5/10. Overall surgical complications and explantations were compared 1 year after implantation. RESULTS Among the 277 included women, 51 presented with a neurologic underlying disease. Mean age at implantation was 68.5 years. There was no significant difference in efficacy between neurogenic and non-neurogenic women with a success rate of 39.2% and 36.3%, respectively (p = 0.69). Similarly, improvement rate was reported to be 31.4% and 33.6%, in neurogenic and non-neurogenic women, respectively (p = 0.92). The overall surgical complications rate (24% vs. 34.5%, p = 0.15) and the explantation rate (19.6% vs. 28.8%, p = 0.18) were not significantly different. CONCLUSION ACT balloons may be proposed to treat mixed or SUI in females with ISD. Efficacy and safety profiles appear to be similar in both neurogenic and non-neurogenic patients.
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Affiliation(s)
- Amélie Demeestere
- Department of Urology, Claude Huriez Hospital, CHU Lille, Univ. Lille, Lille, France
| | | | | | | | - Juliette Hascoet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Xavier Gamé
- Department of Urology, University Hospital Paul Sabatier Toulouse III, Toulouse, France
| | | | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Grégoire Capon
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | | | - Xavier Biardeau
- Department of Urology, Claude Huriez Hospital, CHU Lille, Univ. Lille, Lille, France
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Guillot-Tantay C, Robert G, Ruffion A, Gamé X, Balanca A, Cousin T, Campello PV, Simon J, Baron M, Fleury R, Dequirez PL, Davidson S, Joussain C, Vangheluwe L, Anastay V, Léon P, Perrouin-Verbe MA, Peyronnet B, Biardeau X, Cornu JN, Karsenty G, Phé V. Impact of COVID-19 pandemic on functional urology procedures in France: a prospective study. World J Urol 2021; 40:277-282. [PMID: 34476595 PMCID: PMC8412852 DOI: 10.1007/s00345-021-03821-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the impact of COVID-19 pandemic on functional urology procedures in France. Methods A prospective study was conducted within 11 secondary and tertiary referral centers in France. Patients aged > 18 years who were diagnosed with a functional urology disease before the national lockdown (March 17th, 2020) and who required a surgery were included. Study period went from March 17th to September 30th 2020. The included interventions were listed according to the guidelines for functional urology enacted by the French Association of Urology and delay of reoperation was compared to the guidelines’ delay. The primary outcome was the number of procedures left unscheduled at the end of the study period. Descriptive statistics were performed. Results From March 17th 2020 to September 3 rd 2020, 1246 patients with a previous diagnosis of a functional urological disease requiring a surgery were included. The mean follow-up was 140.4 days (± 53.4). Overall, 316 interventions (25.4%) were maintained whereas 74 (5.9%) were canceled, 848 (68.1%) postponed and 8 patients (0.6%) died. At the end of the follow-up, 184 patients (21.7%) were still not rescheduled. If the intervention was postponed, the mean delay between the initial and final date was 85.7 days (± 64.4). Conclusion Overall, more than two thirds of interventions had to be postponed and the mean delay between the initial and final date was about three months.
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Affiliation(s)
- Cyrille Guillot-Tantay
- Department of Urology, Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Academic Hospital, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - Grégoire Robert
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Xavier Gamé
- Department of Urology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Astrid Balanca
- Department of Neuro-Urology, Assistance-Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Tiffany Cousin
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Jeanne Simon
- Department of Urology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Maximilien Baron
- Department of Urology, Nantes Academic Hospital, Hôtel Dieu, Nantes, France
| | - Raphael Fleury
- Centre Hospitalier Universitaire de Rennes, Service d'urologie, Rennes, France
| | - Pierre-Luc Dequirez
- Department of Urology, Lille Academic Hospital, Claude Huriez Hospital, Lille, France
| | - Sypre Davidson
- Department of Urology, Lille Academic Hospital, Claude Huriez Hospital, Lille, France
| | - Charles Joussain
- Department of Neuro-Urology, Assistance-Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Lucie Vangheluwe
- Department of Urology, Centre Hospitalier Universitaire Rouen, Rouen, France
| | - Vassily Anastay
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Hospital, Marseille, France
| | | | | | - Benoit Peyronnet
- Centre Hospitalier Universitaire de Rennes, Service d'urologie, Rennes, France
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, Claude Huriez Hospital, Lille, France
| | - Jean-Nicolas Cornu
- Department of Urology, Centre Hospitalier Universitaire Rouen, Rouen, France
| | - Gilles Karsenty
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Hospital, Marseille, France
| | - Véronique Phé
- Department of urology, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Tenon Academic Hospital, Paris, France.
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Broudeur L, Loubersac T, Le Normand L, Karam G, Branchereau J, Rigaud J, Perrouin-Verbe MA. New technique of robot-assisted laparoscopic artificial urinary sphincter implantation in female by a posterior approach with intraoperative cystoscopic monitoring. World J Urol 2021; 39:4221-4226. [PMID: 34050814 DOI: 10.1007/s00345-021-03739-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the early experience of a modified technique of robot-assisted artificial urinary sphincter (AUS) implantation in female, with a posterior approach to the bladder neck and intraoperative real-time cystoscopic monitoring. METHODS Retrospective monocentric study included all consecutive female who underwent a primary robot-assisted AUS implantation between 2017 and 2019. Real-time intraoperative cystoscopic monitoring was carried out to check the correct level of the dissection and to avoid any injury during bladder neck dissection. Perioperative and intraoperative data, functional outcomes and complications were assessed. Continence was defined as 0 to 1 pad per day. RESULTS Twenty-four patients were included, the median age was 66 years, 23/24 (96%) had previous SUI or prolapse surgery. Two conversions to open surgery and 2 modifications of the surgical technique with anterior dissection of the bladder neck were required due to major vesicovaginal adhesions. Overall, 20 patients underwent the robotic posterior approach. Eleven intraoperative complications in 10 patients (50%) occurred, including 7 bladder injuries 4 vaginal injuries, without the need to stop the procedure. The median hospital stay was 3 days (2-7). One AUS was removed at 1 year due to vaginal erosion. At last follow-up (median 26 months (22-36)), 95% of the devices were in place and activated and the continence rate was 84%. CONCLUSIONS Early functional results of robot-assisted AUS implantation with a posterior approach to the bladder neck and intraoperative cystoscopic monitoring are promising despite the high rate of intraoperative complications due to previous surgeries. Further evaluation of this technique is required.
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Affiliation(s)
- L Broudeur
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France.
| | - T Loubersac
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - L Le Normand
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - G Karam
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Branchereau
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - J Rigaud
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
| | - M A Perrouin-Verbe
- Department of Urology, Hôtel Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, Nantes CEDEX 03, 44093, Nantes, France
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25
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Perrouin-Verbe MA. Autres neuromodulations : pudendale, vaginale, suprapubienne, et cérébrale. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lepoittevin L, Leon G, Perrouin-Verbe B, Lefort M, Reiss B, Karam G, Rigaud J, Le Normand L, Perrouin-Verbe MA. [External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results]. Prog Urol 2021; 32:40-46. [PMID: 33541792 DOI: 10.1016/j.purol.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). METHODS Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary outcomes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. RESULTS The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n=41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P<0.001), urinary tract infections (UTI) (31 vs 15 patients, P<0.001) and a significant decrease in post-voiding residuals (200 vs 50mL, P<0.001). CONCLUSION ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is mandatory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Lepoittevin
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France.
| | - G Leon
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - B Perrouin-Verbe
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - M Lefort
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - B Reiss
- Service universitaire de médecine physique et réadaptation neurologique, centre hospitalier universitaire de Nantes, site Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France
| | - G Karam
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - J Rigaud
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - L Le Normand
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - M A Perrouin-Verbe
- Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Gasmi A, Perrouin-Verbe MA, Hascoet J, Bey E, Jezequel M, Voiry C, Perrouin-Verbe B, Gamé X, Manunta A, Lenormand L, Capon G, Peyronnet B. Long-term outcomes of artificial urinary sphincter in female patients with spina bifida. Neurourol Urodyn 2020; 40:412-420. [PMID: 33197064 DOI: 10.1002/nau.24576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 02/04/2023]
Abstract
AIMS To report the long-term functional outcomes of artificial urinary sphincter (AUS) implantation in female patients with spinal dysraphism and stress urinary incontinence (SUI) related to intrinsic sphincter deficiency (ISD). METHODS The charts of all spina bifida female patients with SUI due to ISD who underwent AUS (AMS 800) implantation between 2005 and 2019 at three academic departments of urology were retrospectively reviewed. Reoperation was defined as either revision or explantation of the AUS device. Reoperation-free survival of the AUS device was estimated using the Kaplan-Meier method. Continence status as per patients' subjective assessment was categorized as follows: complete continence (no pads), improved continence, unchanged SUI or worsened SUI. RESULTS Twenty-three patients were included, 69.6% were self-catheterizing. The median follow-up was 14 years. Median time to first reoperation was 10 years. Survival rates without reoperation were 85.9%, 41.8%, 34.6%, and 20.9% at 5, 10, 15, 20 years, respectively. Survival rates without AUS explantation were 90.7%, 66.3%, 55.2%, and 41.4% at 5, 10, 15, 20 years, respectively. None of the patients who underwent device explantation had a new AUS implanted. The only predictive factor of reoperation-free survival was the type of spinal dysraphism (hazards ratio = 3.60 for closed vs. open dysraphism; p = .04). At last follow-up, 17 of the 23 patients were fully continent (73.9%). CONCLUSION AUS in female patients with spina bifida may be associated with satisfactory long-term functional outcomes and a high reoperation rate. The median time to first reoperation was similar to what is reported in the male AUS literature (10 years).
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Affiliation(s)
- Anis Gasmi
- Department of Urology, University of Rennes, Rennes, France
| | | | - Juliette Hascoet
- Department of Urology, University of Rennes, Rennes, France
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Elsa Bey
- Department of Urology, University of Nantes, Nantes, France
| | - Magali Jezequel
- Department of Urology, University of Rennes, Rennes, France
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Caroline Voiry
- Department of Urology, University of Rennes, Rennes, France
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | | | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
- Department of Urology, University of Nantes, Nantes, France
| | - Loic Lenormand
- French referral network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France
- Department of Urology, University of Nantes, Nantes, France
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Lefèvre C, Bessard A, Aubert P, Joussain C, Giuliano F, Behr-Roussel D, Perrouin-Verbe MA, Perrouin-Verbe B, Brochard C, Neunlist M. Enteric Nervous System Remodeling in a Rat Model of Spinal Cord Injury: A Pilot Study. Neurotrauma Rep 2020; 1:125-136. [PMID: 34223537 PMCID: PMC8240894 DOI: 10.1089/neur.2020.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The physiopathology of digestive disorders in patients with spinal cord injury (SCI) remains largely unknown, particularly the involvement of the enteric nervous system (ENS). We aimed in a rat model of chronic thoracic SCI to characterize (1) changes in the neurochemical coding of enteric neurons and their putative consequences upon neuromuscular response, and (2) the inflammatory response of the colon. Ex vivo motility of proximal and distal colon segments of SCI and control (CT) rats were studied in an organ chamber in response to electrical field stimulation (EFS) and bethanechol. Immunohistochemical analysis of proximal and distal segments was performed using antibodies again Hu, neuronal nitric oxide synthase, (nNOS), and choline acetyltransferase. Colonic content of acetylcholine and acetylcholinesterase was measured; messenger RNA (mRNA) expression of inflammatory cytokines was measured using reverse transcription quantitative polymerase chain reaction (RT-qPCR) approaches. Compared with the CT rats, the contractile response to bethanechol was significantly decreased in the proximal colon of SCI rats but not in the distal colon. The proportion of nNOS immunoreactive (IR) neurons was significantly reduced in the proximal but not distal colon of SCI rats. No change in proportion of choline acetyltransferase (ChAT)-IR was reported; the tissue concentration of acetylcholine was significantly decreased in the proximal colon of SCI rats. The expression of tumor necrosis factor alpha (TNF-α) and intercellular adhesion molecule-1 (ICAM-1) was significantly reduced in the proximal and distal colon of SCI rats. This study demonstrates that functional motor and enteric neuroplastic changes affect preferentially the proximal colon compared with the distal colon. The underlying mechanisms and factors responsible for these changes remain to be discovered.
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Affiliation(s)
- Chloë Lefèvre
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Neurological Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Anne Bessard
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France
| | - Philippe Aubert
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France
| | - Charles Joussain
- UMR Inserm 1179, Research Unit, Neuromuscular Disability, Physiopathology, Biotherapy, and Applied Pharmacology (END-ICAP), University of Versailles-St-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - François Giuliano
- UMR Inserm 1179, Research Unit, Neuromuscular Disability, Physiopathology, Biotherapy, and Applied Pharmacology (END-ICAP), University of Versailles-St-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Delphine Behr-Roussel
- Pelvipharm, University of Versailles-St-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Marie-Aimée Perrouin-Verbe
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Urology Unit, University Hospital of Nantes, Nantes, France
| | - Brigitte Perrouin-Verbe
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Neurological Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Charlène Brochard
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Digestive Physiology Unit, University Hospital of Rennes, Rennes, France
| | - Michel Neunlist
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France
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Broudeur L, Karam G, Rana Magar R, Glemain P, Loubersac T, Fosse A, De Vergie S, Chelghaf I, Perrouin-Verbe MA, Rigaud J, Branchereau J. Right Kidney Mini-Invasive Living Donor Nephrectomy: A Safe and Efficient Alternative. Urol Int 2020; 104:859-864. [PMID: 32702689 DOI: 10.1159/000509064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Right kidney living donor transplantation is considered more difficult and associated with more complications. The objective was to evaluate donor safety and graft function of right hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS A total of 270 consecutive HALDN procedures have been performed in our institution up to April 2017. We retrospectively compared the outcomes of right-sided nephrectomy (R-HALDN) to left-sided nephrectomy (L-HALDN) to evaluate donor safety and graft function of R-HALDN. RESULTS Sixty-seven right kidneys were removed for functional asymmetry in favour of left kidney (35/67) or left kidney multiple arteries (28/67). Among the donors, neither conversion to open surgery nor preoperative blood transfusion was necessary. There was no significant difference in operative time, compared to L-HALDN group (170 ± 37 min vs. 171 ± 32 min; p value = 0.182). Warm ischaemia time was significantly longer for R-HALDN (4.0 ± 1.6 min vs. 3.0 ± 1.7 min; p < 0.001). There was no significant difference in terms of post-operative complications and serum Cr levels. Among the recipients, there were no graft venous thrombosis. There was no significant difference in delayed graft function (3 for R-HALDN group and 8 for L-HALDN group; p value = 0.847), serum Cr levels, and graft survival. CONCLUSION R-HALDN is a safe procedure for kidney donors, with excellent graft function for the recipients, compared to L-HALDN.
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Affiliation(s)
- Lucas Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France,
| | - Georges Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Reshma Rana Magar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Pascal Glemain
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Thomas Loubersac
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Arthur Fosse
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Stéphane De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Ismaël Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | | | - Jérôme Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.,Centre Hospitalier Universitaire de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
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Baron M, Perrouin-Verbe MA, Lacombe S, Paret F, Le Normand L, Cornu JN. Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder. Neurourol Urodyn 2020; 39:1012-1019. [PMID: 32108383 DOI: 10.1002/nau.24326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/17/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT-A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT-A injection after the failure of SNM for iOAB. METHODS We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT-A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. RESULTS Seventy-six patients (62 female) were included. The percentage of success of first BoNT-A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3-day bladder diary. Twenty-eight patients (36.8%) were put under clean intermittent self-catheterization transitory. After a mean follow-up of 57.7 (±38.5) months, median number of injections was 2 (1-15). Overall, 42 patients (55.2%) stopped injections during follow-up. The estimated 36-months discontinuation-free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). CONCLUSION BoNT-A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long-term discontinuation rate.
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Affiliation(s)
- Maximilien Baron
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | | | - Sandy Lacombe
- Clinical Research Department, CMC Beau Soleil, Montpellier, France
| | - Fanny Paret
- Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Loïc Le Normand
- Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Nicolas Cornu
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
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Perrouin-Verbe MA, Schoentgen N, Talagas M, Garlantezec R, Uguen A, Doucet L, Rosec S, Marcorelles P, Potier-Cartereau M, Vandier C, Ferec C, Fromont G, Fournier G, Valeri A, Mignen O. Overexpression of certain transient receptor potential and Orai channels in prostate cancer is associated with decreased risk of systemic recurrence after radical prostatectomy. Prostate 2019; 79:1793-1804. [PMID: 31475744 DOI: 10.1002/pros.23904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 08/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several studies had suggested the potential role of calcium signaling in prostate cancer (PCa) prognosis and agressiveness. We aimed to investigate selected proteins contributing to calcium (Ca2+ ) signaling, (Orai, stromal interaction molecule (STIM), and transient receptor potential (TRP) channels) and involved in cancer hallmarks, as independent predictors of systemic recurrence after radical prostatectomy (RP). METHODS A case-control study including 112 patients with clinically localized PCa treated by RP between 2002 and 2009 and with at least 6-years' follow-up. Patients were divided into two groups according to the absence or presence of systemic recurrence. Expression levels of 10 proteins involved in Ca2+ signaling (TRPC1, TRPC4, TRPV5, TRPV6, TRPM8, STIM1, STIM2, Orai1, Orai2, and Orai3), were assessed by immunohistochemistry using tissue microarrays (TMAs) constructed from paraffin-embedded PCa specimens. The level of expression of the various transcripts in PCa was assessed using quantitative polymerase chain reaction (qPCR) analysis. RNA samples for qPCR were obtained from fresh frozen tissue samples of PCa after laser capture microdissection on RP specimens. Relative gene expression was analyzed using the 2-▵▵Ct method. RESULTS Multivariate analysis showed that increased expression of TRPC1, TRPC4, TRPV5, TRPV6, TRPM8, and Orai2 was significantly associated with a lower risk of systemic recurrence after RP, independently of the prostate-specific antigen (PSA) level, percentage of positive biopsies, and surgical margin (SM) status (P = .007, P = .01, P < .001, P = .0065, P = .007, and P = .01, respectively). For TRPC4, TRPV5, and TRPV6, this association was also independent of Gleason score and pT stage. Moreover, overexpression of TRPV6 and Orai2 was significantly associated with longer time to recurrence after RP (P = .048 and .023, respectively). Overexpression of TRPC4, TRPV5, TRPV6, and Orai2 transcripts was observed in group R- (3.71-, 5.7-, 1.14-, and 2.65-fold increase, respectively). CONCLUSIONS This is the first study to suggest the independent prognostic value of certain proteins involved in Ca2+ influx in systemic recurrence after RP: overexpression of TRPC1, TRPC4, TRPV5, TRPV6, TRPM8, and Orai2 is associated with a lower risk of systemic recurrence. TRPC4, TRPV5, and TRPV6 appear to be particularly interesting, as they are independent of the five commonly used predictive factors, that is, PSA, percentage of positive biopsies, SM status, Gleason score, and pT stage.
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Affiliation(s)
- M A Perrouin-Verbe
- Department of Urology, CHRU-Université de Brest, Brest, France
- INSERM UMR1078, Université de Bretagne Occidentale, Brest, France
- Department of Urology, CHU-Université de Nantes, Nantes, France
| | - N Schoentgen
- Department of Urology, CHRU-Université de Brest, Brest, France
- INSERM UMR1078, Université de Bretagne Occidentale, Brest, France
| | - M Talagas
- Department of Pathology, CHRU-Université de Brest, Brest, France
- EA 4685 - LIEN, Université de Bretagne Occidentale, Brest, France
| | - R Garlantezec
- INSERM UMR1085-IRSET, Université Rennes 1, Rennes, France
| | - A Uguen
- Department of Pathology, CHRU-Université de Brest, Brest, France
| | - L Doucet
- Department of Pathology, CHRU-Université de Brest, Brest, France
| | - S Rosec
- INSERM UMR1412, Centre d'Investigation Clinique, CHRU-Université de Brest, Brest, France
| | - P Marcorelles
- Department of Pathology, CHRU-Université de Brest, Brest, France
| | | | - C Vandier
- INSERM UMR1069, Université François Rabelais, Tours, France
| | - C Ferec
- INSERM UMR1078, Université de Bretagne Occidentale, Brest, France
| | - G Fromont
- INSERM UMR1069, Université François Rabelais, Tours, France
- Department of Pathology, CHRU-Université de Tours, Tours, France
| | - G Fournier
- Department of Urology, CHRU-Université de Brest, Brest, France
| | - A Valeri
- Department of Urology, CHRU-Université de Brest, Brest, France
| | - O Mignen
- INSERM UMR1078, Université de Bretagne Occidentale, Brest, France
- INSERM UMR1227, Université de Bretagne Occidentale, Brest, France
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Iacazio S, Foisy A, Tessier A, Riant T, Ploteau S, Perrouin-Verbe MA, Rigaud J, Levesque A. Incidence des troubles posturaux chez les patients souffrant d’algies pelvi-périnéales chroniques. Neurophysiol Clin 2019. [DOI: 10.1016/j.neucli.2019.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Perrouin-Verbe MA, Léon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phé V. Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: A single-center experience in a multidisciplinary team. Neurourol Urodyn 2018; 38:330-337. [PMID: 30350892 DOI: 10.1002/nau.23857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022]
Abstract
AIM To report the very long-term functional outcomes of augmentation cystoplasty (AC) in adult spina bifida patients. METHODS All consecutive adult spina bifida patients who underwent AC between 1991 and 2008 were enrolled. Early postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed. RESULTS Twenty-eight patients with a median age of 20 years (IQR 17-25) were included. They all underwent AC with a supratrigonal cystectomy (SC). The median follow-up was 13.6 years (IQR 6-16.5). Thirteen early postoperative complications (12 grade I-II, 1 grade III) were observed in 11 patients (39%). Eight patients (29%) had upper urinary tract infections managed with antibiotics, with 2 patients requiring ureteral stents. Bladder stones occurred in 2 patients (7%) and were managed with endoscopy and cystostomy. One bladder perforation was reported. One bladder cancer was observed 26 years after surgery. Creatinine clearance and all urodynamic parameters were significantly improved post-operatively. The overall complication and reoperation rates were 57% and 14%, respectively. At last follow up, the continence rate was 71% (n = 20), with 93% (n = 26) performing intermittent self-catheterization. Quality of life was improved for 71% of patients. CONCLUSION In adult spina bifida population, AC is a high-risk procedure with an overall complication rate of 57% and a reoperation rate of 14%. However, AC is beneficial to the overall health of the patients since it provides a satisfying continence rate, an improvement of quality of life, and long-term protection of the upper urinary tract.
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Affiliation(s)
- Marie-Aimée Perrouin-Verbe
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Priscilla Léon
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | | | - Emmanuel Chartier-Kastler
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
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Peyronnet B, Even A, Capon G, De Seze M, Hascoet J, Biardeau X, Baron M, Perrouin-Verbe MA, Boutin JM, Saussine C, Phé V, Lenormand L, Chartier-Kastler E, Cornu JN, Karsenty G, Manunta A, Schurch B, Denys P, Amarenco G, Game X. Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism. J Urol 2018; 200:875-880. [PMID: 29746860 DOI: 10.1016/j.juro.2018.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida. MATERIALS AND METHODS All patients with spinal dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success. RESULTS A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (-12 cm H2O, p <0.001), maximum cystometric capacity (86.6 ml, p <0.001) and compliance (8.9 ml/cm H2O, p = 0.002). A total of 20 complications (3.6%) were recorded for the 561 intradetrusor botulinum toxin A injections, including 3 muscular weakness complications. The global success rate of the first injection was significantly lower in patients with poor compliance (34.4% vs 86.9%, OR 0.08, p <0.001). On multivariate analysis poor compliance was associated with a lower global success rate (OR 0.13, p <0.001). Female gender (OR 3.53, p = 0.01) and patient age (OR 39.9, p <0.001) were predictors of global success. CONCLUSIONS Intradetrusor botulinum toxin A injections were effective in adult patients with spina bifida who had detrusor overactivity. In contrast, effectiveness was much lower in adult patients with spina bifida who had poor bladder compliance. The other predictors of global success were female gender and older age.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes and French Referral Network of Spina Bifida, Rennes University Hospital, Rennes, France.
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Marianne De Seze
- Department of NeuroUrology, Clinique Saint-Augustin, Bordeaux, France
| | - Juliette Hascoet
- Department of Urology, University of Rennes and French Referral Network of Spina Bifida, Rennes University Hospital, Rennes, France
| | | | | | | | | | | | - Véronique Phé
- Department of Urology, Médecine Sorbonne Universite, Paris, France
| | - Loic Lenormand
- Department of Urology, University of Nantes, Nantes, France
| | | | | | - Gilles Karsenty
- Department of Urology, University of Marseille, Marseille, France
| | - Andrea Manunta
- Department of Urology, University of Rennes and French Referral Network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Brigitte Schurch
- Department of NeuroUrology, University of Lausanne, Lausanne, Switzerland
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 01 GREEN, Assistance publique-hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Xavier Game
- Department of Urology, University of Toulouse, Toulouse, France
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Guillot-Tantay C, Chartier-Kastler E, Perrouin-Verbe MA, Denys P, Léon P, Phé V. MP49-14 COMPLICATIONS OF NON-CONTINENT CUTANEOUS URINARY DIVERSION IN ADULT SPINAL CORD. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leonard G, Perrouin-Verbe MA, Levesque A, Riant T, Normand LL, Labat JJ, Rigaud J. Place of surgery in the management of post-operative chronic pain after placement of prosthetic material based on a series of 107 cases. Neurourol Urodyn 2018; 37:2177-2183. [PMID: 29573029 DOI: 10.1002/nau.23544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/25/2017] [Indexed: 01/01/2023]
Abstract
AIMS The objective of this study was to evaluate the efficacy of surgical removal of prosthetic material, possibly combined with nerve release, on chronic postoperative pain following placement of prosthetic material. MATERIAL AND METHODS Single-tertiary-centre study on 107 patients managed between November 2004 and April 2016 for removal of prosthetic material responsible for postoperative chronic pain: retropubic suburethral sling (n = 32), transobturator suburethral sling (n = 50), prolapse mesh (n = 16), and hernia mesh (n = 9). The primary endpoint was at least 50% reduction of pain evaluated by a pain numerical rating scale (NRS). RESULTS The mean interval between the initial operation involving placement of prosthetic material and reoperation for removal of prosthetic material was 41.2 ± 35.4 months. In all cases pain apperaed immediately following prosthetic material placement surgery. Pain presented neuropathic features in almost 30% of cases and was poorly systematized in more than one-half The mean follow-up of the study population was 8.4 ± 10.3 months. The mean pain NRS score for the overall population was seven preoperatively and three at last follow-up. At least 50% reduction of the pain NRS score was observed 67% of cases at last follow-up. During follow-up, 45% of patients experienced relapse of the disorder for which the prosthetic material was initially placed with, in particular, a 62% recurrence rate of urinary incontinence after removal of transobturator suburethral tape. CONCLUSION Surgical removal of prosthetic material to treat chronic postoperative pain, achieved global improvement of pain in about two-thirds of cases, but with a risk of recurrence of the initial disorders.
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Affiliation(s)
- Grégoire Leonard
- Service d'urologie, CHU Hôtel Dieu, Nantes, France.,Service d'urologie, CHU Bretonneau, Tours, France
| | | | | | - Thibault Riant
- Centre de la douleur, Le Confluent, Centre Catherine de Sienne, Nantes, France
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Guillot-Tantay C, Chartier-Kastler E, Perrouin-Verbe MA, Denys P, Léon P, Phé V. Complications of non-continent cutaneous urinary diversion in adults with spinal cord injury: a retrospective study. Spinal Cord 2018. [DOI: 10.1038/s41393-018-0083-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fourcade A, Payrard C, Tissot V, Perrouin-Verbe MA, Demany N, Serey-Effeil S, Callerot P, Coquet JB, Doucet L, Deruelle C, Joulin V, Nonent M, Fournier G, Valeri A. The combination of targeted and systematic prostate biopsies is the best protocol for the detection of clinically significant prostate cancer. Scand J Urol 2018; 52:174-179. [PMID: 29463177 DOI: 10.1080/21681805.2018.1438509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Compared with standard systematic transrectal ultrasound (TRUS)-guided biopsies (SBx), targeted biopsies (TBx) using magnetic resonance imaging (MRI)/TRUS fusion could increase the detection of clinically significant prostate cancer (PCa-s) and reduce non-significant PCa (PCa-ns). This study aimed to compare the performance of the two approaches. MATERIALS AND METHODS A prospective, single-center study was conducted on all consecutive patients with PCa suspicion who underwent prebiopsy multiparametric MRI (mpMRI) using the Prostate Imaging Reporting and Data System (PI-RADS). All patients underwent mpMRI/TRUS fusion TBx (two to four cores/target) using UroStation™ (Koelis, Grenoble, France) and SBx (10-12 cores) during the same session. PCa-s was defined as a maximal positive core length ≥4 mm or Gleason score ≥7. RESULTS The study included 191 patients (at least one suspicious lesion: PI-RADS ≥3). PCa was detected in 55.5% (106/191) of the cases. The overall PCa detection rate and the PCa-s detection rate were not significantly higher in TBx alone versus SBx (44.5% vs 46.1%, p = .7, and 38.2% vs 33.5%, p = .2, respectively). Combined TBx and SBx diagnosed significantly more PCa-s than SBx alone (45% vs 33.5%, p = .02). PCa-s was detected only by TBx in 12% of cases (23/191) and only by SBx in 7.3% (14/191). Gleason score was upgraded by TBx in 16.8% (32/191) and by SBx in 13.6% (26/191) of patients (p = .4). CONCLUSIONS The combination of TBx and SBx achieved the best results for the detection and prognosis of PCa-s. The use of SBx alone would have missed the detection of PCa-s in 12% of patients.
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Affiliation(s)
- Alexandre Fourcade
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Charlotte Payrard
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Valentin Tissot
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Marie-Aimée Perrouin-Verbe
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Nicolas Demany
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Sophie Serey-Effeil
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Pierre Callerot
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Jean-Baptiste Coquet
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France
| | - Laurent Doucet
- e Laboratoire d'Anatomo-Pathologie , CHU Brest , Brest , France
| | | | | | - Michel Nonent
- b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,d Service de Radiologie , CHU Brest , Brest , France
| | - Georges Fournier
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,f Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP) , Paris , France
| | - Antoine Valeri
- a Service Urologie , CHU Brest , Brest , France.,b Faculté de Médecine et des Sciences de la Santé , Université de Brest , Brest , France.,c Université Bretagne Loire , France.,f Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP) , Paris , France
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Lebdai S, Mathieu R, Leger J, Haillot O, Vincendeau S, Rioux-Leclercq N, Fournier G, Perrouin-Verbe MA, Doucet L, Azzouzi AR, Rigaud J, Renaudin K, Charles T, Bruyere F, Fromont G. Metabolic syndrome and low high-density lipoprotein cholesterol are associated with adverse pathological features in patients with prostate cancer treated by radical prostatectomy. Urol Oncol 2018; 36:80.e17-80.e24. [DOI: 10.1016/j.urolonc.2017.09.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
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Calves J, Thoulouzan M, Perrouin-Verbe MA, Joulin V, Valeri A, Fournier G. Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser. Eur Urol Focus 2017; 5:676-680. [PMID: 29102672 DOI: 10.1016/j.euf.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/13/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the long-term reported clinical outcomes after photovaporization of the prostate (PVP) with the XPS-GreenLight laser in patients with symptomatic benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS A prospective longitudinal study was performed for all consecutive patients with BPE who underwent PVP at our institution between 2010 and 2012. Patient-reported clinical outcomes were assessed at 1 mo, 3 mo, 12 mo, and 57 mo using International Prostate Symptoms Score, International Continence Society, and International Index of Erectile Function short-form questionnaires. Maximum flow rate (Qmax), postvoid residual urine measurements were assessed at 3 mo and 12 mo. Long-term satisfaction, complications, and reoperation rates were assessed by questionnaires. Prostate-specific antigen was measured at 3 mo, 12 mo, and 57 mo. INTERVENTION A single surgeon (GF) has practiced photovaporization with a Moxy fiber, under transrectal ultrasonography monitoring. Long-term clinical outcomes were evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary measurement was the reoperation. RESULTS AND LIMITATIONS Eighty-four patients of 102 answered the long-term questionnaire. The mean age was 68±7.2 yr. The mean follow-up was 57.4±6.8 mo. The mean prostate volume was 73±38ml. After treatment, the mean International Prostate Symptoms Score decreased significantly from 19.9±6.4 to 6.1±5.6, 3.9±3.4, and 5.9±5.8, respectively, at 3 mo, 12 mo, and 57 mo. The mean prostate-specific antigen level decreased significantly (-56%) from 4.5±4.3ng/ml preoperatively to 2.0±2.0ng/ml and 2.6±2.2ng/ml, respectively, at 12 mo and 57 mo. The mean Qmax increased from 9.6±3.8ml/s preoperatively to 23.9±11.5ml/s and 25.2±9.2ml/s, respectively, at 3 mo and 12 mo. Overall reoperation rate was 4.8%(4/84). Limitations include the single surgeon single center design study and the lack of long-term objectives data such as urodynamic parameters (postvoid residual urine and Qmax). CONCLUSIONS Photovaporization of the prostate with the XPS-GreenLight laser is an effective technique able to durably improve reported clinical outcomes in patients with BPE. PATIENT SUMMARY In this study we looked at the long-term outcomes after laser therapy with XPS-GreenLight laser for benign prostatic enlargement. We found a few reoperation rates and good stable reported clinical outcomes after a mean follow-up of 57 mo. We conclude that this laser technique can offer durably good reported clinical outcomes.
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Affiliation(s)
- Jehanne Calves
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France.
| | - Maxime Thoulouzan
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
| | | | - Vincent Joulin
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
| | - Antoine Valeri
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
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Ismail S, Chartier-Kastler E, Perrouin-Verbe MA, Rose-Dite-Modestine J, Denys P, Phé V. Long-Term Functional Outcomes of S3 Sacral Neuromodulation for the Treatment of Idiopathic Overactive Bladder. Neuromodulation 2017; 20:825-829. [PMID: 28967986 DOI: 10.1111/ner.12696] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the long-term functional outcomes of sacral neuromodulation (SNM) in the treatment of refractory idiopathic overactive bladder (IOAB) and to determine predictive factors for success. MATERIALS AND METHODS To obtain long-term data, all consecutive patients suffering from IOAB and treated by SNM at a single tertiary care center between December 1996 and December 2004 were included. Data regarding patient demographics, past medical, and surgical history, bladder diary, complications as well as device revision and removal rates were collected. Success was defined as an improvement ≥ 50% of any clinical parameter. RESULTS Overall, 34 patients, with a median age of 57.8 years (IQR 44.8-65.7) were included. Immediately after definitive implantation, 2 (6%) patients were lost to follow-up. After a median follow-up of 9.7 years (IQR 4.7-12.0), SNM was considered successful in 20 (63%) patients. Mean amount of protections used per 24 hours significantly decreased (4.1 preoperatively vs. 1.8 at the last follow-up visit, p = 0.02). Devices were removed in 2 (6%) patients due to pain and lack of efficacy. Twenty-two revision surgeries were performed in 15 (47%) patients. First revision surgery occurred after a mean of 6.2 years (± 3.1). Revision surgeries were mainly performed for end of battery life/device dysfunction (n = 18, 82%). No significant predictor for success was identified. CONCLUSIONS With a median follow-up time of 9.7 years, this retrospective SNM study reports a 63% efficacy rate (≥ 50% improvement) for the treatment of refractory IOAB. Moreover, it is a well-tolerated and minimally invasive therapy.
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Affiliation(s)
- Salima Ismail
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France.,Departments of Rehabilitation and Neurourology, Garches Academic Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France.,Inserm Research Unit 1179, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Marie-Aimée Perrouin-Verbe
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Johan Rose-Dite-Modestine
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
| | - Pierre Denys
- Departments of Rehabilitation and Neurourology, Garches Academic Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France.,Inserm Research Unit 1179, Versailles Saint Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, University Paris Sorbonne, Paris, France
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Madec FX, Hedhli O, Perrouin-Verbe MA, Levesque A, Le Normand L, Rigaud J. Feasibility, Morbidity, and Functional Results of Supratrigonal Cystectomy with Augmentation Ileocystoplasty by Combined Robot-Assisted Laparoscopy and Mini-Laparotomy Approach. J Endourol 2017; 31:655-660. [PMID: 28467725 DOI: 10.1089/end.2017.0107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Evaluation of the feasibility, morbidity, learning curve, and functional results of robotic supratrigonal cystectomy with augmentation ileocystoplasty (RSCAI). MATERIALS AND METHODS RSCAI was performed in 19 patients between 2012 and 2016. Thirteen patients (66.4%) presented refractory detrusor overactivity or impaired compliance and 6 patients (31.6%) had painful bladder syndrome. A combined robot-assisted laparoscopy and mini-laparotomy approach was performed. Early (<30 days) and late (>30 days) complications were reported according to the Clavien-Dindo classification. Functional results were analyzed according to the surgical indication. RESULTS Mean total operating time was 288.7 ± 92.1 minutes. Mean intraoperative blood loss was 147.4 ± 144.8 mL. Mean length of hospital stay in the surgical ward was 9.4 ± 3.7 days. Mean duration of bladder drainage was 23.3 ± 4.1 days. For surgeons who regularly performed robot-assisted laparoscopy, the learning curve of this technique, as assessed by the operating time, required almost five operations. No major (Clavien-Dindo >2) early (0%) or late (0%) postoperative complication was observed. Early minor complications were observed in 47.4% of cases, usually consisting of pyelonephritis (21.1%). Late minor complications (10.5%) were Clavien-Dindo grade I. Mean follow-up was 13.6 ± 10.1 months. The majority of patients (94.7%) obtained functional improvement of their disease in terms of pain, functional bladder capacity, or bladder compliance. CONCLUSION Our RSCAI technique is a reliable technique with no early or late major postoperative complications reported in this series. This technique allows patients to be operated by minimally invasive surgery with very satisfactory long-term functional results.
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Affiliation(s)
| | - Oussama Hedhli
- Department of Urology, Nantes University Hospital , Nantes, France
| | | | - Amélie Levesque
- Department of Urology, Nantes University Hospital , Nantes, France
| | - Loïc Le Normand
- Department of Urology, Nantes University Hospital , Nantes, France
| | - Jérôme Rigaud
- Department of Urology, Nantes University Hospital , Nantes, France
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Deboudt C, Perrouin-Verbe MA, Le Normand L, Perrouin-Verbe B, Buge F, Rigaud J. Comparison of the morbidity and mortality of cystectomy and ileal conduit urinary diversion for neurogenic lower urinary tract dysfunction according to the approach: Laparotomy, laparoscopy or robotic. Int J Urol 2016; 23:848-853. [DOI: 10.1111/iju.13166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Loic Le Normand
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation; University Hospital of Nantes; Nantes France
| | - François Buge
- Department of Urology; University Hospital of Nantes; Nantes France
| | - Jérôme Rigaud
- Department of Urology; University Hospital of Nantes; Nantes France
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Perrouin-Verbe MA, Chartier-Kastler E, Even A, Denys P, Rouprêt M, Phé V. Long-term complications of continent cutaneous urinary diversion in adult spinal cord injured patients. Neurourol Urodyn 2015; 35:1046-1050. [DOI: 10.1002/nau.22879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/01/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Marie-Aimée Perrouin-Verbe
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Emmanuel Chartier-Kastler
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré Hospital; Garches, Assistance Publique-Hôpitaux de Paris; Paris-Ouest Medical School; Versailles Saint-Quentin en Yvelines University; France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré Hospital; Garches, Assistance Publique-Hôpitaux de Paris; Paris-Ouest Medical School; Versailles Saint-Quentin en Yvelines University; France
| | - Morgan Rouprêt
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
| | - Véronique Phé
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris 6 University; Paris France
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Thoulouzan M, Huet R, Mathieu R, Bensalah K, Calves J, Coeurdacier P, Corbel L, Della Negra E, Fourcade A, Gires B, Grafeille V, Perrouin-Verbe MA, Serey-Eiffel S, Valeri A, Verhoest G, Vincendeau S, Fournier G. MP13-18 GREENLIGHT XPS PHOTOVAPORIZATION FOR LARGE PROSTATIC ADENOMAS (≥ 80 ML): A PROSPECTIVE MULTI-INSTITUTIONAL STUDY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Delage F, Emmanuelle LF, Perrouin-Verbe MA, Papin G, Loiselle A, Thoulouzan M, Coquet JB, Malhaire JP, Pradier O, Fournier G, Valeri A. MP58-10 EVALUATION OF PREDICTIVE FACTORS OF ERECTILE DYSFUNCTION AFTER BRACHYTHERAPY FOR LOW RISK PROSTATE CANCER : PROSPECTIVE STUDY OF PATIENTS WITH A BASELINE IIEF5 SCORE > 16. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Le Fur E, Malhaire JP, Nowak E, Rousseau B, Erauso A, Pene-Baverez D, Papin G, Delage F, Perrouin-Verbe MA, Fournier G, Pradier O, Valeri A. Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation. Brachytherapy 2013; 12:589-95. [PMID: 23669150 DOI: 10.1016/j.brachy.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/05/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy. METHODS AND MATERIALS From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity. RESULTS The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods. CONCLUSION The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity.
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Affiliation(s)
- Emmanuelle Le Fur
- Radiation Therapy Department, Centre Hospitalier Universitaire Morvan, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; Inserm U650, Laboratoire de Traitement de l'Information Médicale, Brest, France.
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Thoulouzan M, Perrouin-Verbe MA, Deruelle C, Joulin V, Valeri A, Fournier G. 2003 PHOTOSELECTIVE VAPORIZATION WITH GREENLIGHT™ XPS™ 180W LASER FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA: MID-TERM RESULTS. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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