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Bernard C, Bentellis I, El-Akri M, Durand M, Guérin O, Cornu JN, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Lecoanet P, Bruyère F, Capon G, Biardeau X, Karam E, Saussine C, Hermieu JF, Peyronnet B, Game X, Brierre T. Primary implantation of an artificial urinary sphincter using the perineal and penoscrotal approaches: Functional results and assessment of reoperative procedures. Fr J Urol 2024; 34:102604. [PMID: 38417628 DOI: 10.1016/j.fjurol.2024.102604] [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] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Artificial urinary sphincter (AUS) is the standard treatment for severe stress urinary incontinence in men. While the perineal access is considered the gold standard, some authors have proposed penoscrotal AUS in order to facilitate the procedure. The main objective of our study was to evaluate the duration of survival without revision surgery (SSRC) according to the surgical approach for primary implantation. MATERIAL AND METHODS Data from 1179 patients implanted in France between 1991 and 2020 with an AMS 800 AUS were retrospectively analyzed. A total of 762 men were implanted perineally (VP) and 417 penoscrotally (VPS). RESULTS Median follow-up was 20 vs. 25months respectively. The groups were equivalent overall, apart from the use of anticoagulants (11% VP vs. 6.3% VPS P=0.014). In our population, 54% patients were considered as "dry" in the case of VPS vs. 42% for VP. There was no significant difference in terms of survival time without reoperation, revision, replacement or explantation. In univariate and multivariate analysis, age over 70years was predictive of more reinterventions, whereas the use of a 4.5cm cuff was protective, with hazard ratios of 1.42 (P=0.001) and 0.78 (P=0.04), respectively. CONCLUSION The penoscrotal approach does not appear to be associated with more complications, has good functional results and no significant difference in reoperation-free survival. A prospective multicenter non-inferiority study could be of interest to confirm our findings. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Clémence Bernard
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France.
| | - Imad Bentellis
- Urology Department, Nice University Hospital, Nice, France
| | - Mehdi El-Akri
- Urology Department, Rennes University Hospital, Rennes, France
| | | | - Olivier Guérin
- Urology Department, Nice University Hospital, Nice, France
| | | | - Tiffany Cousin
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Hugo Dupuis
- Urology Department, CHU de Rouen, Rouen, France
| | | | | | - Pierre Lecoanet
- Urology Department, Nancy University Hospital, Nancy, France
| | | | - Grégoire Capon
- Urology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Biardeau
- Urology Department, Lille University Hospital, Lille, France
| | - Elias Karam
- Visceral Surgery and Liver Transplant Unit, CHU de Tours, Tours, France
| | | | | | | | - Xavier Game
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - Thibaut Brierre
- Department of Urology, Renal Transplantation and Andrology, CHU Rangueil, TSA 50032, 31059 Toulouse, France
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Thiruchelvam N, Landauro MH, Biardeau X, Rovsing C, Hahn M, Nascimento OFD, Gardner S, Amarenco G, Bagi P. Improved emptying performance with a new micro-hole zone catheter in adult male intermittent catheter users: A comparative multi-center randomized controlled cross-over study. Neurourol Urodyn 2024; 43:464-478. [PMID: 38196237 DOI: 10.1002/nau.25383] [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: 07/13/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIMS To confirm the improved performance of the micro-hole zone catheter (MHZC) compared to a conventional eyelet catheter (CEC) in male users of clean intermittent catheterizations (CICs). METHODS Male self-catheterizing subjects, who used hydrophilic sleeved soft/flexible CIC as the only bladder emptying method, were enrolled into a multi-center, randomized, cross-over study performed across six European sites. Subjects tested the MHZC, featuring a drainage zone with 120 micro-holes and a CEC with two eyelets. The study consisted of four study visits (V0-V3), during which endpoints related to catheter performance (urinary flow-stops, bladder emptying, and intra-catheter pressure) were measured and two 4-week test periods at home (T1 and T2) where dipstick hematuria and user perception between catheters were evaluated. RESULTS Seventy-three male subjects with non-neurogenic and neurogenic bladder dysfunction (3:2) were enrolled. On average, catheterizations with the MHZC led to close to mean zero flow-stops compared to ≥1 flow-stops with the CEC, during both HCP- and self-led catheterizations (both p < 0.001). Residual urine at first flow-stop was significantly reduced for the MHZC compared to CEC (p = 0.001 and p = 0.004, for HCP- and self-led catheterizations, respectively). This was substantiated by a significantly smaller pressure peak at first flow-stop, a proxy for minimized mucosal suction (both HCP- and self-led catheterizations, p < 0.001). After home-use catheterizations, dipstick hematuria was comparable between catheters, whereas catheterizations were associated with significantly improved perception in favor of MHZC regarding bladder emptying, less blocking sensation, and improved hygienic catheterization compared to the CEC. CONCLUSION This study confirmed the evidence of improved bladder emptying with the MHZC compared to a CEC without the need to reposition the catheter. The MHZC therefore offers an enhanced benefit for the dependent CIC user securing complete bladder emptying in an uninterrupted free flow and reducing the need to reposition the catheter during emptying.
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Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | | | - Xavier Biardeau
- Centre Hospitalier Universitaire de Lille, Lille Cedex, France
| | | | - Markus Hahn
- ARTIMED Medical Consulting GmbH, Kassel, Germany
| | | | | | | | - Per Bagi
- Department of Urology, Rigshospitalet, København Ø, Denmark
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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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Puyuelo O, Seguier D, Bommelaere T, Duquenne M, Lokmane EM, Pecoux F, Amara N, Lecornet E, Goasdoué H, Vermersch P, De Wachter S, Biardeau X. Real-life after sacral nerve modulation implantation: Rate, reasons, and risk factors for mid-term follow-up discontinuation. Prog Urol 2023; 33:1047-1061. [PMID: 37949799 DOI: 10.1016/j.purol.2023.10.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To evaluate follow-up after implantation of a sacral nerve modulation implantable pulse generator (IPG) and to investigate the reasons and risk factors for follow-up discontinuation. MATERIALS AND METHODS All patients who underwent an IPG implantation to treat lower urinary tract symptoms between 2014-2019 within 6 hospital centers located in the district of "Hauts-de-France" (France) were systematically called during the year 2020 for a standardized (tele)consultation. Patients were divided into 3 distinct profiles according to the regularity of their 5-year postoperative follow-up: "Regular follow-up", "Irregular follow-up" and "Lost to follow-up". The primary outcome was the change in the annual proportion of the 3 follow-up profiles over the 5 years following IPG implantation. As secondary outcomes we described the reasons reported for follow-up discontinuation and looked for risk factors associated with. RESULTS Overall, 259 patients were included. At the time of data collection, after a mean follow-up of 28.4 (± 19.8) months, 139 patients (53.7%) had a "Regular follow-up", 54 (20.8%) had an "Irregular follow-up" and 66 (25.5%) were "Lost to follow-up". The proportion of patients with a "Regular follow-up" decreased year by year, representing only 46.2% of patients at five-years. 175 patients (67.6%) underwent a standardized (tele)consultation. In multivariate analysis, only "lack of knowledge of the follow-up protocol" was statistically associated with follow-up discontinuation (OR=5.16; 95% CI [2.12-13.57]). CONCLUSION The proportion of patients followed up after IPG implantation decreased steadily over the years, often related to a lack of therapeutic education. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- O Puyuelo
- Department of Urology, Claude-Huriez Hospital, CHU de Lille, University of Lille, 59000 Lille, France.
| | - D Seguier
- Department of Urology, Claude-Huriez Hospital, CHU de Lille, University of Lille, 59000 Lille, France
| | - T Bommelaere
- Department of Urology, Claude-Huriez Hospital, CHU de Lille, University of Lille, 59000 Lille, France
| | - M Duquenne
- Department of Urology, Claude-Huriez Hospital, CHU de Lille, University of Lille, 59000 Lille, France
| | - E M Lokmane
- Department of Urology, Valenciennes Hospital, Valenciennes, France
| | - F Pecoux
- Department of Urology, Victor Provo Hospital, Roubaix, France
| | - N Amara
- Department of Urology, Dunkerque Hospital, Dunkerque, France
| | - E Lecornet
- Department of Urology, Henin-Beaumont Polyclinic, Henin-Beaumont, France
| | - H Goasdoué
- Department of Urology, Abbeville Hospital, Abbeville, France
| | - P Vermersch
- University Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, FHU Precise, 59000 Lille, France
| | - S 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
| | - X Biardeau
- Department of Urology, Claude-Huriez Hospital, CHU de Lille, University of Lille, 59000 Lille, France; University Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, FHU Precise, 59000 Lille, France
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5
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Dequirez PL, Pues M, Queval L, Vercleyen S, Carpentier A, Lebuffe G, Seguy D, Blanchard A, Vermersch P, Biardeau X. Standardized one-day evaluation before urinary reconstructive surgery for neurogenic lower urinary tract dysfunction: Feasibility and impact on surgical strategy and care pathway. Prog Urol 2023; 33:1014-1025. [PMID: 37858377 DOI: 10.1016/j.purol.2023.09.032] [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: 07/13/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway. MATERIALS AND METHODS All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year. RESULTS One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%. CONCLUSION A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- P-L Dequirez
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France.
| | - M Pues
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - L Queval
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - S Vercleyen
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Carpentier
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France
| | - G Lebuffe
- Department of Anesthesiology and Critical Care Anesthesiology, CHU de Lille, université de Lille, 59000 Lille, France
| | - D Seguy
- Department of Nutrition, CHU de Lille, université de Lille, 59000 Lille, France
| | - A Blanchard
- Department of Physical and Rehabilitation Medicine, CHU de Lille, université de Lille, 59000 Lille, France
| | - P Vermersch
- UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
| | - X Biardeau
- Department of Urology, CHU de Lille, université de Lille, 59000 Lille, France; UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU de Lille, Inserm, université de Lille, 59000 Lille, France
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6
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Cousin T, Peyronnet B, Bentellis I, Lasri S, Taha F, Hermieu N, Boileau A, Zelmar A, Ciolek C, Dubois A, Leon P, Hermieu JF, Brierre T, Gamé X, Tricard T, Saussine C, Lecoanet P, Vidart A, Bruyère F, Cornu JN, Monsaint H, Biardeau X, Capon G. Which revision strategy is the best for non-mechanical failure of male artificial urinary sphincter? World J Urol 2023; 41:3663-3669. [PMID: 37902863 DOI: 10.1007/s00345-023-04670-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: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Persistence or recurrence of stress urinary incontinence (prSUI) after artificial urinary sphincter (AUS) implantation may be secondary to non-mechanical failure (NOMECA). It have for long been assumed to result from urethral atrophy. Its existence is now debated. As the pathophysiology of NOMECA is not elucidated, the most appropriate management remains unclear. We aimed to compare the several revision techniques for NOMECA of AUS in men. METHODS NOMECA was defined as prSUI, with normally functioning device, no erosion, infection or fluid loss. Exclusion criteria were neurogenic SUI, revision or explantation for other causes. From 1991 to 2022, 143 AUS revisions for NOMECA, including 99 cuff DOWNSIZING, 10 cuff repositioning (RELOC), 13 TANDEM-CUFF placement, 18 cuff changing (CHANGE), three increasing balloon pressure (BALLOON-UP), were performed in 10 centers. BALLOON-UP patients weren't included in comparative analysis due to small sample size. All components could be changed during the revision. Patients were also categorized in COMPLETE-CHANGE vs. PARTIAL-CHANGE of the device. RESULTS The three-months complete continence rate was 70.8% with a significant difference between RELOC and DOWNSIZING groups (p = 0.04). COMPLETE CHANGE was significantly associated with complete continence status at three months in multivariate analysis (83.3% vs. 63.3%, OR = 2.7; CI 95% [1.1-7.1], p = 0.03). Estimated five-year reoperation-free and explantation-free survival were respectively 63.4% and 75.9% (p = 0.16; p = 0.30). Those were significantly longer in COMPLETE-CHANGE vs PARTIAL-CHANGE (82.2% vs. 69.6%, p = 0.03); (71.2% vs. 58.2%, p = 0.047). CONCLUSIONS AUS revision for prSUI due to NOMECA yields satisfactory outcomes regardless of the technique used. We observed better functional outcomes when repositioning the new cuff. COMPLETE-CHANGE may improve functional outcomes, explantation-free and reoperation-free survivals.
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Affiliation(s)
- Tiffany Cousin
- Department of Urology, University of Bordeaux, Bordeaux, France.
| | | | | | - Sami Lasri
- Department of Urology, University of Lille, Lille, France
| | - Fayek Taha
- Department of Urology, University of Reims, Reims, France
| | | | - Adrien Boileau
- Department of Urology, University of Toulouse, Toulouse, France
| | - Augustin Zelmar
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Clement Ciolek
- Department of Urology, University of Nancy, Nancy, France
| | | | - Priscilla Leon
- Department of Urology, University of Reims, Reims, France
| | | | | | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | | | - Adrien Vidart
- Department of Urology, Foch Hospital, Suresnes, France
| | - Franck Bruyère
- Department of Urology, University of Tours, Tours, France
| | | | | | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
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7
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Biardeau X. [Male urinary incontinence]. Rev Prat 2023; 73:1012-1008. [PMID: 38294456] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
MALE URINARY INCONTINENCE. Male urinary incontinence is a common condition that tends to increase with age and can significantly impact the quality of life. Beyond the clinical diagnosis made through patient history and examination, healthcare practitioners must strive to identify the underlying mechanism(s) and assess the degree of discomfort to initiate appropriate treatment. Two main types of urinary incontinence are distinguished: stress urinary incontinence, which can often benefit from pelvic floor muscle training, and urgency urinary incontinence, which typically responds to drug therapies (such as anticholinergics or β3-adrenergic agonists) and posterior tibial nerve stimulation as first-line options. Moreover, a certain number of red flags must be systematically sought to avoid missing, among other things, a urinary retention or an underlying local condition, and to identify as early as possible men requiring specialized urological care. It is also crucial for the general practitioner to discuss with the patient the various palliative approaches when necessary, such as the use of protective pads, penile sheaths, or a clamp, to improve the patient's comfort and quality of life.
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Affiliation(s)
- Xavier Biardeau
- Université de Lille, Service d'urologie, hôpital Claude Huriez, CHU de Lille, Lille, France
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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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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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10
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Girard C, El-Akri M, Durand M, Guérin O, Cornu JN, Brierre T, Cousin T, Gaillard V, Dupuis H, Tricard T, Hermieu N, Leon P, Chevallier D, Bruyere F, Biardeau X, Hermieu JF, Lecoanet P, Capon G, Game X, Saussine C, Rambaud C, Peyronnet B, Bentellis I. Efficacy, Safety, and Reoperation-free Survival of Artificial Urinary Sphincter in Non-neurological Male Patients over 75 Years of Age. EUR UROL SUPPL 2023; 53:23-30. [PMID: 37441348 PMCID: PMC10334236 DOI: 10.1016/j.euros.2023.03.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 07/15/2023] Open
Abstract
Background Artificial urinary sphincter (AUS) is a gold standard treatment in male stress urinary incontinence but remains poorly used in elderly patients. Objective To assess the efficacy, safety, and reoperation-free survival of AUS implantation in male patients over 75 yr of age. Design setting and participants We retrospectively reviewed the charts of all 1233 non-neurological male AUS implantations between 2005 and 2020 at 13 French centers. We compared 330 patients ≥75 yr old (GROUP75+) with 903 patients <75 yr old (GROUP75-) at the time of AUS implantation. Outcome measurements and statistical analysis Our primary endpoint was social continence at 3 mo defined as the use of one or fewer pad daily. We used Kaplan-Meier analyses to assess reoperation-free survival. We sought factors of erosion using logistic regression. Results and limitations Early postoperative continence was comparable in both groups (74.4% vs 80.1%, p = 0.114). We observed a higher rate of postoperative complications in GROUP75+ (18.8% vs 12.6%, p = 0.014), but the complications were more frequently of low grade in GROUP75+ (p = 0.025). The overall reoperation-free survival was similar (p = 0.076) after a median follow-up of 2 yr. However, patients in GROUP75+ had poorer explantation-free survival (p < 0.0001). A history of radiotherapy was a predictive factor of erosion (odds ratio [OR] = 5.31, p < 0.01), but age was not (OR = 1.08, p = 0.87). Unfortunately, our dataset did not include a systematic geriatric evaluation. Conclusions AUS in elderly patients appears to be an effective option to treat stress urinary incontinence. However, we observed more postoperative complications and explantations, although age was not associated with the onset of erosion. A prospective study is required to determine whether a geriatric evaluation would be an effective strategy to select patients before surgery. Patient summary In this study, we looked at outcomes of artificial urinary sphincter in elderly men in a large population. We found satisfying efficacy but slightly more postoperative complications and device infections.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Game
- University Hospital of Toulouse, Toulouse, 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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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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Girard C, El-Akri M, Durand M, Guérin O, Rambaud C, Cornu J, Brierre T, Cousin T, Gaillard V, Tricard T, Dupuis H, Hermieu N, Bertrand-Leon P, Chevallier D, Bruyere F, Biardeau X, Hermieu J, Lecoanet P, Capon G, Game X, Saussine C, Peyronnet B, Bentellis I. Efficacy, safety and reoperation-free survival of artificial urinary sphincter in non neurological male patients over 75 years of age. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00819-9] [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: 02/12/2023]
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14
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Gamé X, Peyronnet B, Karsenty G, Loche C, Phé V, Chartier-Kastler E, Biardeau X, Even A, Denys P, Guinet-Lacoste A, Ruffion A, Bart S, Castel-Lacanal E. Transcutaneous electrical neurostimulation (TENS) of the tibial nerve for lower urinary tract symptoms secondary to parkinson’s syndromes: A multicenter randomized double blind placebo-controlled study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00746-7] [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: 02/12/2023]
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15
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Peyronnet B, Cousin T, Bentellis I, Lasri S, Taha F, Hermieu N, Boileau A, Zelmar A, Ciolek C, Dubois A, Leon P, Hermieu J, Brierre T, Gamé X, Tricard T, Saussine C, Lecoanet P, Vidart A, Bruyère F, Cornu JN, Biardeau X, Capon G. Which revision strategy is the best in case of non-mechanical failure of male artificial urinary sphincter? A multicenter study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00818-7] [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: 02/12/2023]
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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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Lionet A, Roger C, Biardeau X, Daudon M, Letavernier E. Chronic urine acidification by fludrocortisone to treat infectious kidney stones. CR CHIM 2022. [DOI: 10.5802/crchim.126] [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: 11/24/2022]
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18
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Chkir S, Michel F, Akakpo W, Chinier E, Capon G, Peyronnet B, Saussine C, Baron M, Biardeau X, Ruffion A, Gamé X, Denys P, Chartier-Kastler E, Phé V, Karsenty G. Non-continent urinary diversion (ileal conduit) as salvage therapy in patients with refractory lower urinary tract dysfunctions due to multiple sclerosis: results of a national cohort from the French Association of Urology (AFU) Neurourology Committee and the French-speaking Neurourology Study Group (GENULF). Urology 2022; 168:216-221. [PMID: 35768028 DOI: 10.1016/j.urology.2022.06.014] [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: 02/14/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe the outcomes of ileal conduit as a salvage therapy for refractory lower urinary tract dysfunctions (LUTDs) due to multiple sclerosis (MS) in a national neurourology referral center network. METHODS A retrospective multicenter French study was carried out to identify MS patients who underwent non-continent urinary diversion for refractory LUTDs from January 2010 to December 2015. Multiple sclerosis status, urological history, surgical indication and technique, postoperative complications, renal anatomy and function at last follow-up as well as number of rehospitalizations for urinary tract infections (UTI) were collected. Preoperative and postoperative urinary-related quality of life (urQoL) through the QualiveenTM short-form questionnaire (QSFTM) and patient global impression of improvement (PGI-I) were collected and analyzed. RESULTS Overall, 10 centers identified 211 patients with a mean age of 54±11 and mean preoperative EDSS (expanded disability status scale) score of 7.3±0.9. The main indication for diversion was MS progression leading to impossible intermittent self-catheterization (55%). Cystectomy was performed either by open (34.6%), laparoscopic (39.3%) or robotic (21.8%) approach (unknown: 4.2%) with cystectomy in all cases. Early complications were reported in 42% of the patients, mainly Clavien I or II grades. There was no difference in GFR (glomerular filtration rate) after surgery. After diversion, patients had fewer hospitalizations for UTI and better urQoL on QSF™ confirmed by evaluation of PGI-I. CONCLUSION This study, reporting the largest series of ileal conduit in selected MS patients with end-stage LUTDs, showed significant improvement in symptomatic UTI and quality of life with a low high-grade complication rate.
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Affiliation(s)
- Sadok Chkir
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - Floriane Michel
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - William Akakpo
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Eva Chinier
- Neuro-Rehabilitation, University of Nantes, Hôpital Saint Jacques, Nantes, France.
| | - Gregoire Capon
- Urology, University of Bordeaux, Hôpital Pellegrin, Bordeaux France.
| | - Benoit Peyronnet
- Urology, University of Rennes, Hôpital Pontchaillou, Renne, France.
| | - Christian Saussine
- Urology, University of Strasbourg, Hôpital Hautepierre, Strasbourg, France.
| | | | | | - Alain Ruffion
- Urology, University Claude Bernard Lyon 1, Hôpital Lyon Sud, HCL, Pierre Bénite, France.
| | - Xavier Gamé
- Urology, University of Toulouse Purpan, Hôpital Rangueil, Toulouse, France.
| | - Pierre Denys
- Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Emmanuel Chartier-Kastler
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France; Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Véronique Phé
- Urology, Sorbonne University, Tenon Academic Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Gilles Karsenty
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
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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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Vamour N, Dequirez PL, Seguier D, Vermersch P, De Wachter S, Biardeau X. Early interventions to prevent lower urinary tract dysfunction after spinal cord injury: a systematic review. Spinal Cord 2022; 60:382-394. [PMID: 35379959 DOI: 10.1038/s41393-022-00784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To synthetise the available scientific literature reporting early interventions to prevent neurogenic lower urinary tract dysfunction (NLUTD) after acute supra-sacral spinal cord injury (SCI). METHODS The present systematic review is reported according to the PRISMA guidelines and identified articles published through April 2021 in the PubMed, Embase, ScienceDirect and Scopus databases with terms for early interventions to prevent NLUTD after SCI. Abstract and full-text screenings were performed by three reviewers independently, while two reviewers performed data extraction independently. An article was considered relevant if it assessed: an in-vivo model of supra-sacral SCI, including a group undergoing an early intervention compared with at least one control group, and reporting clinical, urodynamic, biological and/or histological data. RESULTS Of the 30 studies included in the final synthesis, 9 focused on neurotransmission, 2 on the inflammatory response, 10 on neurotrophicity, 9 on electrical nerve modulation and 1 on multi-system neuroprosthetic training. Overall, 29/30 studies reported significant improvement in urodynamic parameters, for both the storage and the voiding phase. These findings were often associated with substantial modifications at the bladder and spinal cord level, including up/downregulation of neurotransmitters and receptors expression, neural proliferation or axonal sprouting and a reduction of inflammatory response and apoptosis. CONCLUSIONS The present review supports the concept of early interventions to prevent NLUTD after supra-sacral SCI, allowing for the emergence of a potential preventive approach in the coming decades.
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Affiliation(s)
| | | | | | - Patrick Vermersch
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, F-59000, Lille, 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
| | - Xavier Biardeau
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France
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21
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Peyronnet B, Cornu JN, Belas O, Capon G, Biardeau X, Lecoanet P, Castro-Sader L, Borojeni S, Hein R, Hascoet J, Thibault F, Dubois F, Cardot V, Vidart A, Descazeaud A, Fournier G, Van Der Aa F. Robot-assisted artificial urinary sphincter implantation in female patients: An international multicenter series of 182 patients. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00658-3] [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: 11/04/2022]
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22
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El Akri M, Bentellis I, Tricard T, Brierre T, Cousin T, Dupuis H, Hermieu N, Gaillard V, Poussot B, Robin D, Pitout A, Bertrand-Leon P, Chevallier D, Bruyere F, Biardeau X, Monsaint H, Corbel L, Saussine C, Hermieu J, Lecoanet P, Capon G, Cornu JN, Game X, Ruffion A, Peyronnet B. Transcorporal vs. bulbar artificial urinary sphincter implantation in male patients with fragile urethra. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00664-9] [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: 11/04/2022]
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23
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Robin D, Peyronnet B, Bentellis I, El-Akri M, Cornu JN, Brierre T, Cousin T, Gaillard V, Poussot B, Dupuis H, Tricard T, Hermieu N, Pitout A, Beraud F, Chevallier D, Bruyere F, Biardeau X, Monsaint H, Corbel L, Hermieu JF, Lecoanet P, Capon G, Saussine C, Gamé X, Léon P. Sphincter urinaire artificiel chez les patients présentant une incontinence urinaire après High Intensivity Focused Ultrasound Therapy. Prog Urol 2022; 32:284-290. [DOI: 10.1016/j.purol.2021.11.004] [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] [Received: 08/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
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24
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Mamane J, Sanchez S, Lellouch AG, Gaillard V, Poussot B, Tricard T, Saussine C, Brierre T, Game X, Beraud F, Biardeau X, Bruyere F, Robin D, El-Akri M, Chevallier D, Durand M, Bentellis I, Cousin T, Capon G, Cornu JN, Dupuis H, Monsaint H, Corbel L, Hermieu N, Hermieu JF, Pitout A, Lecoanet P, Peyronnet B, Leon P. Impact of radiation therapy on artificial urinary sphincter implantation in male patients: A multicenter study. Neurourol Urodyn 2021; 41:332-339. [PMID: 34816473 DOI: 10.1002/nau.24825] [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: 07/10/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the impact of an history of radiation therapy on the outcomes of artificial urinary sphincter (AUS) implantation in male patients. METHODS The charts of all patients who underwent AUS implantation for stress urinary incontinence (SUI) after prostate surgery in thirteen centers between 2004 and 2020 were retrospectively reviewed. We excluded patients with neurogenic SUI. Continence rates and incidence of complications, revision and cuff erosion were evaluated. The outcomes in irradiated men were compared to those of non irradiated men. RESULTS A total of 1277 patients who had an AUS met the inclusion criteria with a median age of 70 years, of which 437 had an history of prior radiotherapy. There was no difference in comorbidities. In irradiated patients, postoperative social continence, urethral atrophy and infection rates were respectively 75.6%, 2.4% and 9.5% and 76.8%, 5.4%, and 5.8% in nonirradiated men (respectively, p = 0.799, p = 0.128, p = 0.148). There were more urethral erosion in irradiated male patients. After a mean follow up of 36.8 months, the explantation free survival was poorer in irradiated patients (p = 0.001). CONCLUSION These data suggest that pelvic radiotherapy before AUS adversely affect device survival with and increased greater occurrence of infection-erosion and therefore of explantation.
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Affiliation(s)
- Jordan Mamane
- Department of Urology, University of Reims, Reims, France
| | - Stéphane Sanchez
- Department of Medical Information Evaluation and Performance, Troyes Hospital, Troyes, France
| | - Alexandre G Lellouch
- Department of Plastic Reconstructive Surgery, European Georges Pompidou Hospital, Paris, France.,Division of Plastic and Reconstructive Surgery, and Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Gaillard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Baptiste Poussot
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | - Thibaut Brierre
- Department of Urology, University of Toulouse, Toulouse, France
| | - Xavier Game
- Department of Urology, University of Toulouse, Toulouse, France
| | - Florian Beraud
- Department of Urology, University of Lille, Lille, France
| | | | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | - Damien Robin
- Department of Urology, University of Reims, Reims, France
| | - Mehdi El-Akri
- Department of Urology, University of Nice, Nice, France
| | | | | | - Imad Bentellis
- Department of Urology, University of Rennes, Rennes, France
| | - Tiffany Cousin
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Hugo Dupuis
- Department of Urology, University of Rouen, Rouen, France
| | | | - Luc Corbel
- Department of Urology, Clinic Plérin, Plérin, France
| | | | | | - Alice Pitout
- Department of Urology, University of Nancy, Nancy, France
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Puyuelo O, Seguier D, Bommelaere T, Duquenne M, Lokmane E, Pecoux F, Amara N, Lecornet E, Goasdoué H, Vermersch P, De wachter S, Biardeau X. Suivi après implantation définitive d’un boitier de neuro-modulation sacrée. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.232] [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: 11/25/2022]
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26
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Flochlay M, Peyronnet B, Lasri S, Broudeur L, Gondran-Tellier B, Karsenty G, Perrouin-Verbe M, Biardeau X, Wagner L, Bey E. Sphincter urinaire artificiel par voie robotique : comparaison préliminaire des voies d’abord antérieure et postérieure du col vésical chez les femmes présentant une incontinence urinaire à l’effort par insuffisance sphinctérienne. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.094] [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: 10/19/2022]
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27
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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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28
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Dupuis HGA, Bentellis I, El-Akri M, Brierre T, Cousin T, Gaillard V, Poussot B, Tricard T, Hermieu N, Robin D, Pitout A, Beraud F, Durand M, Chevallier D, Bruyere F, Biardeau X, Monsaint H, Corbel L, Leon P, Hermieu JF, Lecoanet P, Capon G, Game X, Saussine C, Peyronnet B, Cornu JN. Early Efficacy and Safety Outcomes of Artificial Urinary Sphincter for Stress Urinary Incontinence Following Radical Prostatectomy or Benign Prostatic Obstruction Surgery: Results of a Large Multicentric Study. Eur Urol Focus 2021; 8:1053-1059. [PMID: 34548254 DOI: 10.1016/j.euf.2021.09.006] [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: 05/17/2021] [Revised: 08/10/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Artificial urinary sphincter (AUS) is the gold standard for the management of moderate to severe stress urinary incontinence (SUI) in the male population. While outcomes of this device in postprostatectomy incontinence (PPI) are widely described, those obtained for incontinence after benign prostatic obstruction (BPO) surgery remains poorly explored. OBJECTIVE To compare continence outcomes after AUS implantation in a PPI population with those obtained in men incontinent after BPO surgery. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of all cases of AUS implantation between 2005 and 2020 in 16 different French centers was conducted. Only patients with primary implantation whose indication was moderate to severe SUI after prostatectomy or BPO surgery were included (excluding those with a history of radiation therapy, brachytherapy, cystectomy, high-intensity focused ultrasound therapy, or neurogenic disease). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the rate of social continence (zero or one pad per day) at 3 mo. Complications were also noted within 90 d of implantation. RESULTS AND LIMITATIONS A total of 417 patients were included in the PPI group and 50 in the BPO surgery group. Social continence rates at 3 mo were similar between the groups (79% vs 72%, p = 0.701). Complication rate was significantly higher in the BPO group (8% vs 18%, p = 0.044). The same was found for the Clavien-Dindo type 2 complication rate (20.6% vs 44.4%, p = 0.026). The retrospective nature and lack of precise definition of incontinence are the main limitations of this study. CONCLUSIONS This multicentric study strengthens the position of AUS as gold standard for SUI after radical prostatectomy. Comparable efficacy results were found for incontinence after BPO surgery, with nevertheless a higher rate of complications. PATIENT SUMMARY Artificial urinary sphincter represents the gold standard for the treatment of moderate to severe stress urinary incontinence. Efficacy results are comparable between postprostatectomy incontinence and incontinence after benign prostatic obstruction surgery.
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Affiliation(s)
| | | | - Mehdi El-Akri
- Department of Urology, University of Rennes, Rennes, France
| | - Thibaut Brierre
- Department of Urology, University of Toulouse, Toulouse, France
| | - Tiffany Cousin
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Victor Gaillard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Baptiste Poussot
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, University of Strasbourg, Strasbourg, France
| | | | - Damien Robin
- Department of Urology, University of Reims, Reims, France
| | - Alice Pitout
- Department of Urology, University of Nancy, Nancy, France
| | - Florian Beraud
- Department of Urology, University of Lille, Lille, France
| | | | | | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | | | | | - Luc Corbel
- Department of Urology, Clinique Plérin, Plérin, France
| | | | | | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Xavier Game
- Department of Urology, University of Toulouse, Toulouse, France
| | | | | | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen, 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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30
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Hentzen C, Biardeau X, Turmel N, Haddad R, Bey E, Amarenco G, Denys P, Phé V, Perrouin-Verbe MA, Peyronnet B, Joussain C. Prioritization of risk situations in neuro-urology: guidelines from Association Française d'Urologie (AFU), Association Francophone Internationale des Groupes d'Animation de la Paraplégie (A.F.I.G.A.P.), 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). World J Urol 2021; 40:133-139. [PMID: 34402945 PMCID: PMC8369873 DOI: 10.1007/s00345-021-03804-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The current health crisis has drastically impacted patient management in many fields, including neuro-urology, leading to a mandatory reorganization. The aim of this work was to establish guidelines regarding the prioritization and optimal timing of each step of neurogenic lower urinary tract dysfunction management. Methods A steering committee included urologists and physical medicine and rehabilitation practitioners. Based on a literature review and their own expertise, they established a comprehensive risk-situation list and built a risk scale, allowing multiple other experts to score each clinical situation. New recommendations were generated using a Delphi process approach. Results Forty-nine experts participated in the rating group. Among the 206 initial items, 163 were selected and 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, dysraphism, lower motor neuron lesions)]. The resulted guidelines are expert opinions established by a panel of French-speaking specialists, which could limit the scalability of this work. Conclusions The present multidisciplinary collaborative work generates recommendations which complement existing guidelines and help clinicians to reorganize their patients’ list in the long term with a personalized medicine approach, in the context of health crisis or not. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03804-4.
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Affiliation(s)
- Claire Hentzen
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France.
| | - Xavier Biardeau
- Department of Urology, University of Lille, Claude Huriez Hospital, CHU Lille, 59000, Lille, France
| | - Nicolas Turmel
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
- Rehabilitation department, Danièle Casanova Hospital, 93205, Saint Denis, France
| | - Rebecca Haddad
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Elsa Bey
- Urology and Andrology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Gérard Amarenco
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Pierre Denys
- Neurourology and Andrology Unit, Department of Physical Medecine and Rehabilitation, Raymond-Poincaré, AP-HP, Université Paris-Saclay, UMR 1179 Inserm, Paris, France
| | - Véronique Phé
- Department of Urology, Sorbonne University, AP-HP, Pitié-Salpêtrière Academic Hospital, Paris, France
| | | | | | - Charles Joussain
- Neurourology and Andrology Unit, Department of Physical Medecine and Rehabilitation, Raymond-Poincaré, AP-HP, Université Paris-Saclay, UMR 1179 Inserm, Paris, France
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Bentellis I, El-Akri M, Cornu JN, Brierre T, Cousin T, Gaillard V, Poussot B, Dupuis H, Hermieu N, Robin D, Pitout A, Beraud F, Bertrand-Leon P, Chevallier D, Bruyere F, Biardeau X, Monsaint H, Corbel L, Hermieu JF, Lecoanet P, Capon G, Game X, Saussine C, Durand M, Peyronnet B. Impact of the center volume activity on the results of artificial urinary sphincter in non-neurological male patients. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00506-6] [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: 11/16/2022]
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Bentellis I, El-Akri M, Cornu J, Brierre T, Cousin T, Gaillard V, Poussot B, Dupuis H, Hermieu N, Robin D, Pitout A, Beraud F, Bertrand-Leon P, Chevallier D, Bruyere F, Biardeau X, Monsaint H, Corbel L, Hermieu J, Lecoanet P, Capon G, Game X, Saussine C, Durand M, Peyronnet B. Prevalence and risk factors of artificial urinary sphincter revision in non-neurological male patients. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00507-8] [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: 11/29/2022]
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Nasri J, Beraud F, Seguier D, Delporte G, Behal H, Olivier J, Villers A, Marcelli F, Biardeau X. Artificial urinary sphincter implantation in non-neurogenic men: a place for out-patient surgery. World J Urol 2021; 39:3541-3547. [PMID: 33772605 DOI: 10.1007/s00345-021-03673-x] [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: 11/12/2020] [Accepted: 03/13/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess feasibility, safety and risk factors for failure associated with out-patient surgery for artificial urinary sphincter (AUS) implantation/revision in non-neurogenic men. MATERIALS In the present retrospective monocentric study conducted between May 2016 and March 2020, 81 patients undergoing AUS implantation or revision during an out-patient surgery were included. The primary outcome was the success rate of out-patient surgery. Success was assessed using two distinct definitions, a narrow definition, where success was defined as a one-day hospitalization and the absence of any unscheduled consultation or re-hospitalization within the 3 days following surgery, a broad definition, where success was defined as a one-day hospitalization and the absence of any unscheduled re-hospitalization within the 3 days following surgery. In parallel, risk factors for failure of out-patient surgery, as well as efficacy and safety were assessed. RESULTS Eighty-one patients were enrolled, with a mean age of 71.2 years ± 5.9. Out-patient surgery was successfully completed in 58 men (71.6% [95% CI 60.5-81.1]) and in 76 men (93.8% [95% CI 86.2-97.9]) according to the narrow and the broad definition, respectively. After multivariate analysis, anticoagulant therapy (OR 25.97 [95% CI 4.44-152.04]) and low socio-professional status (OR 22.1 [95% CI 3.701-131.95]) were statistically associated with failure of out-patient surgery. The continence rate after a 90-day follow-up was 79%. CONCLUSION AUS implantation/revision in non-neurogenic men could be safely proposed in out-patient surgery. Special attention may however be paid to patients undergoing anticoagulant therapy or belonging to a low socio-professional category. TRIAL REGISTRATION NUMBER DEC20-173 (French National Commission for Data Protection and Liberties).
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Affiliation(s)
- Jordan Nasri
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France.
| | - Florian Beraud
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Denis Seguier
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Gauthier Delporte
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Hélène Behal
- ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, CHU Lille, Univ. Lille, 59000, Lille, France
| | - Jonathan Olivier
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Arnauld Villers
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - François Marcelli
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Xavier Biardeau
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
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Demeestere A, De Guerry M, Bergot C, De Hauteclocque A, Hascoet J, Gamé X, Bajeot A, Peyronnet B, Capon G, Perrouin-Verbe M, Biardeau X. Ballons ACT® (adjustable continence therapy) comme traitement de l’incontinence urinaire d’effort : comparaison entre les femmes neurologiques et non neurologiques. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.103] [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: 10/23/2022]
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Cornu J, Wagner L, Ruffion A, Gamé X, Perrouin-Verbe M, Boillot B, Rock A, Marcelli F, Biardeau X, Mouton D, Capon G, Houivet E, Grise P. Neuromodulation sacrée secondaire bilatérale ou controlatérale dans l’hyperactivité vésicale en échec secondaire de neuromodulation unilatérale (NEUROBIL). Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.175] [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: 10/23/2022]
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Peyronnet B, Capon G, Belas O, Biardeau X, Lecoanet P, Castro-Sader L, Allue M, Hein R, Daher M, Hascoet J, Auble A, Thibault F, Cornu J, Dubois F, Gamé X, Cardot V, Vidart A, Descazeaud A, Fournier G, Van Der Aa F. Implantation robot-assistée du sphincter artificiel urinaire AMS-800 chez la femme : une série multicentrique internationale de 125 patientes. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.104] [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: 10/23/2022]
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Dequirez P, Queval L, Vercleyen S, Carpentier A, Seguy D, Lebuffe G, Blanchard A, Biardeau X. Hôpital de jour pour évaluation préopératoire standardisée avant chirurgie lourde en neuro-urologie : concept, faisabilité et résultats. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.183] [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: 10/23/2022]
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Beraud F, Biardeau X, Marlière F, Clément G. Chirurgie de la lithiase rénale chez les patients neurologiques : plus fréquente, plus de complications, plus de récidives. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.182] [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: 11/26/2022]
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Nasri J, Biardeau X, Marcelli F, Villers A, Olivier J. Sphincter urinaire artificiel en chirurgie ambulatoire : faisabilité et facteurs de risque d’échec. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.147] [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: 10/23/2022]
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Chartier-Kastler E, Le Normand L, Ruffion A, Dargent F, Braguet R, Saussine C, Tanneau Y, Graziana JP, Ragni E, Rabut B, Rousseau T, Biardeau X, Gamé X, Pierrevelcin J, Brassart E, Fourmarier M, Stoica G, Berrogain N, Yaghi N, Pecoux F, Capon G, Ferchaud J, Peyrat L, Bryckaert PE, Karsenty G, Melotti A, Abouihia A, Keller DUJ, Cornu JN. Sacral Neuromodulation with the InterStim™ System for Intractable Lower Urinary Tract Dysfunctions (SOUNDS): Results of Clinical Effectiveness, Quality of Life, Patient-Reported Outcomes and Safety in a French Multicenter Observational Study. Eur Urol Focus 2020; 7:1430-1437. [DOI: 10.1016/j.euf.2020.06.026] [Citation(s) in RCA: 5] [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: 04/03/2020] [Revised: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
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Peyronnet B, Capon G, Biardeau X, Belas O, Lecoanet P, Castro-Sader L, Allue M, Hein R, Daher M, Manunta A, Robert G, Hascoet J, Dubois F, Thibault F, Cardot V, Vidart A, Descazeaud A, Fournier G, Everaerts W, Van Der Aa F. Robot-assisted artificial urinary sphincter implantation in female patients: An international multicenter study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32974-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Biardeau X, Lamande N, Tondut L, Peyronnet B, Verhoest G, Kyheng M, Soulie M, Game X, Fantoni JC, Marcelli F. Quality of life associated with orthotopic neobladder and ileal conduit in women: A multicentric cross-sectional study. Prog Urol 2020; 30:80-88. [PMID: 32061497 DOI: 10.1016/j.purol.2019.11.010] [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: 08/05/2019] [Revised: 10/27/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare quality of life and functional outcomes associated with orthotopic neobladder (ONB) and ileal conduit (IC) after anterior pelvic exenteration for bladder cancer in women, through a multicentric cross-sectional study. METHODS All women who have undergone an anterior pelvic exenteration associated with ONB or IC for a bladder cancer between January 2004 and December 2014 within the three participating university hospital centers and that were still alive in February 2016 were included. Three distinct auto-administered questionnaires were submitted to the patients: the EORTC QLQ-C30, the EORTC QLQ-BLmi30 and the SF-12. Comparison of response to these questionnaires between women with ONB and those with IC were studied with Mann-Whitney U tests, with a statistically significant P-value set at<0.05. The primary endpoint was the "global health status" sub-score extracted from the EORTC QLQ-C30 questionnaire. The secondary endpoints were the functional sub-scores and symptoms sub-scores obtained with the EORTC QLQ-C30 questionnaire as well as the sub-scores obtained with the EORTC QLQ-BLmi30 and the SF-12 questionnaires. RESULTS Forty women were included in the study (17 ONB, 23 IC). The primary endpoint was comparable between the ONB and IC women (83.3 vs. 66.7 P=0.22). Similarly, no significant statistical difference could be pointed between the ONB and IC women in terms of secondary endpoints. CONCLUSION The present study did not report any significance difference in terms of quality of life and functional outcomes between women with ONB and those with IC after pelvic exenteration for bladder cancer. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- X Biardeau
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France.
| | - N Lamande
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France
| | - L Tondut
- Department of urology, Rennes university hospital, 35000 Rennes, France
| | - B Peyronnet
- Department of urology, Rennes university hospital, 35000 Rennes, France
| | - G Verhoest
- Department of urology, Rennes university hospital, 35000 Rennes, France
| | - M Kyheng
- EA2694, department of biostatistics, CHU Lille, 59000 Lille, France
| | - M Soulie
- Department of urology, Toulouse university hospital, Rangueil hospital, Toulouse, France
| | - X Game
- Department of urology, Toulouse university hospital, Rangueil hospital, Toulouse, France
| | - J-C Fantoni
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France
| | - F Marcelli
- Department of urology, CHU Lille, university Lille, Claude Huriez hospital, 59000 Lille, France
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Soust I, Filiette A, Blanchard A, Biardeau X. [Non continent urinary diversion and other bladder managements in patients with multiple sclerosis]. Prog Urol 2019; 29:572-578. [PMID: 31495496 DOI: 10.1016/j.purol.2019.08.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/31/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To compare non-continent urinary diversion (NCUD) and other bladder managements in patients with multiple sclerosis (MS), in terms of satisfaction and burden of care. MATERIAL AND METHODS All patients with MS that were proposed a NCUD in our center for refractory lower urinary tract disorders between January 2005 and March 2018 were eligible. Patients were attributed to two distinct groups: "NCUD" and "Other bladder management". The primary endpoint was the satisfaction related to the bladder management quoted by a numerical rating scale (NRS) from 0 to 10. The secondary endpoints included, among other things, the evaluation of the burden of care associated with the bladder management. RESULTS Twenty-three patients were included in the "NCUD" group and 11 in the "Other bladder management" group, with 4 patients pursuing with spontaneous voiding, 3 with intermittent catheterization, 2 that have undergone a sphincterotomy, 1 still performing self-intermittent catheterization and 1 with a supra-pubic catheter. The "NCUD" group had a significant higher NRS than the "Other bladder management" group (8.22±1.78 vs. 6.27±2.45; P=0.0056). The daily average duration of care was 16.42minutes in the "NCUD" group and 35.6minutes in the "Other bladder management" group (P=0.1111) CONCLUSION: This exploratory study, even if not conclusive, brings to light the preliminary results needed to elaborate a high level of evidence protocol regarding the satisfaction and the burden of care associated with NCUD in MS patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- I Soust
- Service affections neurologiques chroniques, CHU de Lille, université Lille, hôpital Pierre-Swynghedauw, 59000 Lille, France.
| | - A Filiette
- Service affections neurologiques chroniques, CHU de Lille, université Lille, hôpital Pierre-Swynghedauw, 59000 Lille, France
| | - A Blanchard
- Service affections neurologiques chroniques, CHU de Lille, université Lille, hôpital Pierre-Swynghedauw, 59000 Lille, France
| | - X Biardeau
- Service d'urologie, andrologie et transplantation rénale, CHU de Lille, université Lille, hôpital Claude-Huriez, 59000 Lille, France
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Biardeau X, Haddad R, Chesnel C, Charlanes A, Hentzen C, Turmel N, Campagne S, Capon G, Fatton B, Gamé X, Jeandel C, Kerdraon J, Mares P, Mezzadri M, Petit AC, Peyronnet B, Soler JM, Thuillier C, Deffieux X, Robain G, Amarenco G, Manceau P. [Use of botulinum toxin A in pelvic floor dysfunctions in the elderly: A review]. Prog Urol 2019; 29:216-225. [PMID: 30621961 DOI: 10.1016/j.purol.2018.11.001] [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: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The present article is the final report of a multi-disciplinary meeting supported by the GRAPPPA (group for research applied to pelvic floor dysfunctions in the elderly). The objective was to conduct a comprehensive review on the role of botulinum toxin A (BonTA) in the treatment of pelvic floor dysfunctions in the elderly. METHODS The present article, written as a comprehensive review of the literature, combines data issued from the scientific literature with expert's opinions. Review of the literature was performed using the online bibliographic database MedLine (National Library of Medicine). Regarding intra-detrusor BonTA injections, only articles focusing on elderly patients (>65 yo) were included. Regarding other localizations, given the limited number of data, all articles reporting outcomes of BonTA were included, regardless of studies population age. In case of missing or insufficient data, expert's opinions were formulated. RESULTS Although, available data are lacking in this specific population, it appears that BonTA could be used in the non-fraily elderly patients to treat overactive bladder or even neurogenic detrusor overactivity, with a success rate comparable to younger population at 3 months (88.9% vs. 91.2%), 6 months (49.4% vs. 52.1%) and 12 months (23.1% vs. 22.3%), as well as a significant decrease in number of voids per day (11.4 vs. 5.29 P<0.001) and in the number of pads per day (4.0 vs. 1.3, P<0.01). Furthermore, BonTA is likely to be offered in the future as a treatment of fecal incontinence and obstructed defecation syndrome symptoms. Concerning bladder outlet obstruction/voiding dysfunction symptoms, intra-urethral sphincter BonTA should not be recommended. CONCLUSION BonTA injections are of interest in the management of various pelvic floor dysfunctions in the elderly, and its various applications should be better evaluated in this specific population in order to further determine its safety and efficacy.
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Affiliation(s)
- X Biardeau
- Service d'urologie et d'andrologie, hôpital Claude-Huriez, université Lille, CHU Lille, 59000 Lille, France.
| | - R Haddad
- Service de médecine physique et réadaptation, hôpital Rotschild, 75012 Paris, France
| | - C Chesnel
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - C Hentzen
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - N Turmel
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - S Campagne
- Service de gynécologie, CHU Estaing, 63003 Clermont-Ferrand, France
| | - G Capon
- Service d'urologie, centre hospitalier Pellegrin, 33076 Bordeaux, France
| | - B Fatton
- Service de gynécologie, CHU de Nîmes, 30000 Nîmes, France
| | - X Gamé
- Service d'urologie, transplantation rénale et andrologie, CHU Rangueil, 31000 Toulouse, France
| | - C Jeandel
- Service de gériatrie, CHU de Montpellier, 34000 Montpellier, France
| | - J Kerdraon
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Centre mutualiste de rééducation et réadaptation Kerpape, BP 78, 56275 Ploemeur cedex, France
| | - P Mares
- Service d'urologie, CHRU Carémeau, 30029 Nîmes cedex 9, France
| | - M Mezzadri
- Service de gynécologie, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - A-C Petit
- Centre de santé, 8, rue Neibecker, 93440 Dugny, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - J-M Soler
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de médecine physique et réadaptation, centre Bouffard-Vercelli, 66290 Cerbère, France
| | - C Thuillier
- Service d'urologie, CHU de Grenoble, 38700 La Tronche, France
| | - X Deffieux
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de gynécologie, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - G Robain
- Service de médecine physique et réadaptation, hôpital Rotschild, 75012 Paris, France; GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France
| | - G Amarenco
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Manceau
- GRC 01, Green-groupe de recherche clinique en neuro-urologie, hôpital Tenon, Sorbonne universités, AP-HP, 75020 Paris, France; Service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de neurologie, hôpital Avicennes, 93000 Bobigny, France
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- Groupe de recherche appliquée à la pathologie pelvi-périnéale des personnes âgées (GRAPPPA), 75020 Paris, France
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Delaval S, Baron, Mille E, Tariel F, Peyronnet B, Perrouin-Verbe M, Capon G, Castel-Lacanal E, Gamé X, Cornu J, Karsenty G, Denys P, Even A, Chartier-Kastler E, Phé V, Biardeau X. Injections intradétrusoriennes de toxine botulinique a chez les patients atteints de sclérose en plaques : survie et facteurs de risque d’interruption à 60 mois. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.169] [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: 11/25/2022]
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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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Sanson C, Guiffart P, Peyronnet B, Gamé X, Biardeau X. MP75-11 FUNCTIONAL OUTCOMES OF ADJUSTABLE CONTINENCE THERAPY BALLOONS IN WOMEN : A MULTICENTRIC RETROSPECTIVE STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2103] [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: 12/01/2022]
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Biardeau X, Hached S, Loutochin O, Campeau L, Sawan M, Corcos J. Montreal electronic artificial urinary sphincters: Our futuristic alternatives to the AMS800™. Can Urol Assoc J 2017; 11:E396-E404. [PMID: 29384472 DOI: 10.5489/cuaj.4493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to present three novel remotely controlled hydromechanical artificial urinary sphincters (AUSs) and report their in-vitro and ex-vivo results. METHODS We successively developed three distinct hydromechanical AUSs on the basis of the existing AMS800™ device by incorporating an electronic pump. No changes were made to the cuff and balloon. The AUS#1 was designed as an electromagnetically controlled device. The AUS#2 and AUS#3 were conceived as Bluetooth 2.1 remotely controlled and Bluetooth 4.0 remotely-controlled, adaptive devices, respectively. In-vitro experiments profiled occlusive cuff pressure (OCP) during a complete device cycle, with different predetermined OCP. Ex-vivo experiments were performed on a fresh pig bladder with 4 cm cuff placed around the urethra. Leak point pressure with different predetermined OCP values was successively measured during cystometry via a catheter at the bladder dome. RESULTS Our in-vitro and ex-vivo experiments demonstrated that these three novel AUSs provided stable and predetermined OCP - within the physiological range - and completely deflated the cuff, when required, in a limited time compatible with physiological voiding cycles. CONCLUSIONS Our three novel, remotely controlled AUSs showed promising results that should be confirmed by in-vivo experiments focusing on efficacy and safety.
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Affiliation(s)
- Xavier Biardeau
- Jewish General Hospital, McGill University; Montreal, QC, Canada
| | | | - Oleg Loutochin
- Jewish General Hospital, McGill University; Montreal, QC, Canada
| | - Lysanne Campeau
- Jewish General Hospital, McGill University; Montreal, QC, Canada
| | | | - Jacques Corcos
- Jewish General Hospital, McGill University; Montreal, QC, Canada
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Biardeau X, Lam O, Ba V, Campeau L, Corcos J. Prospective evaluation of anxiety, pain, and embarrassment associated with cystoscopy and urodynamic testing in clinical practice. Can Urol Assoc J 2017; 11:104-110. [PMID: 28515809 DOI: 10.5489/cuaj.4127] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to prospectively assess anxiety, pain, and embarrassment associated with diagnostic cystoscopy and multi-channel urodynamic study (UDS). METHODS All consecutive patients undergoing diagnostic cystoscopy or UDS in our department over a period of nine months were asked to participate. Two anonymous auto-administered questionnaires were specifically designed to collect basic epidemiological data, document medical history, and assess the quality of information provided, along with prevalence and level (0-10 numerical visual analog rating scale) of anxiety, pain, and embarrassment experienced before and/or during the procedures. Statistical analysis was carried out to identify underlying factors that could have influenced patients' experience and ascertain potential correlations between anxiety, pain, and embarrassment. RESULTS 101 and 185 patients were respectively evaluated immediately after cystoscopy and UDS. Multivariate analysis repeatedly showed statistical correlations between anxiety, pain, and embarrassment, with regard to prevalence and level of intensity in both cystoscopy and UDS populations. Males and young patients were more likely to present anxiety, pain, or embarrassment during cystoscopy and UDS. Interestingly, patients who reported having received complete information before cystoscopy were significantly more likely to experience anxiety (62.6% vs. 20.0%; p=0.009). CONCLUSIONS The present study demonstrated the major impact of gender and age on patients' experience. Interestingly, information provided before cystoscopy was reported to have a negative impact on patients' perception of anxiety; this could be partly prevented by optimizing the way information is provided to patients.
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Affiliation(s)
- Xavier Biardeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ornella Lam
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Van Ba
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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Biardeau X, Lam O, Ba V, Campeau L, Corcos J. Supplementary data: Prospective evaluation of anxiety, pain, and embarrassment associated with cystoscopy and urodynamic testing in clinical practice. Can Urol Assoc J 2017. [DOI: 10.5489/cuaj.4616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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