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Haudebert C, Florin M, Fatton B, Campagne-Loiseau S, Tse V. Trans-labial or introital ultrasounds for midurethral slings. Prog Urol 2023; 33:526-532. [PMID: 37500351 DOI: 10.1016/j.purol.2023.07.008] [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: 03/08/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Stress urinary incontinence is common in adult women. The use of introital or trans-labial ultrasound can help the surgeon (urologist or gynecologist) to better assess the type of incontinence the patient presents in order to guide him in the management of the patient. Often, surgical treatment with a mid-urethral sling (MSU) placement can be chosen in case of failure of non-invasive therapies (such as local estrogen or physical therapy) and if the clinical examination shows an urethral hypermobility. The use of ultrasound can help in this choice. Although rare, complications of MSU can sometimes cause disabling symptoms and be difficult to diagnose. Introital or trans-labial ltrasound can help diagnose them. The objective of this work was to describe the realization of ultrasound of stress urinary incontinence before or after the placement of a MSU, in order to make their realization easier for young surgeons which can use them in current practice.
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Affiliation(s)
- C Haudebert
- Department of Urology, University of Rennes, Rennes, France.
| | - M Florin
- Department of Radiology, AP-HP, Hôpital Tenon, Paris, France
| | - B Fatton
- Department of Gynecology, Nimes, France
| | | | - V Tse
- Department of Urology, Concord Hospital, University of Sydney, Sydney, Australia
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Bassi S, Pinar U, Di Maria S, Gambachidze D, Manach Q, Chartier-Kastler E. Ambulatory peri-bulbar implantation, revision and replacement of Artificial Urinary Sphincter in neurogenic and non-neurogenic male patients: A preliminary feasibility study over a one-year experience. Prog Urol 2023:S1166-7087(23)00061-1. [PMID: 36925358 DOI: 10.1016/j.purol.2023.02.005] [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: 11/27/2022] [Revised: 01/16/2023] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate. MATERIAL AND METHODS Between April 2018 and April 2019, 28 consecutive patients underwent AUS implantation in a newly organised ambulatory setting. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction. RESULTS Twenty-eight patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223±220.5 days. Fourteen patients had prior radiotherapy. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo I. Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Full continence & social continence were achieved for, respectively, 55.6% and 88.9% of procedures. CONCLUSION Ambulatory placement of AUS is safe and can be performed successfully. Larger patient cohorts and randomised trials are crucial to improve knowledge on non-indications for full ambulatory AUS implantation in men. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- S Bassi
- Department of Urology, University of Verona, Piazzale Aristide Stefani, 1, 37126 Verona (VR), Italy; Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - U Pinar
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Di Maria
- Department of Anaesthesiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - D Gambachidze
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Q Manach
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - E Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
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Ruggiero M, Pinar U, Popelin MB, Rod X, Denys P, Bazinet A, Chartier-Kastler E. Single center experience and long-term outcomes of implantable devices ACT and Pro-ACT (Uromedica, Irvin, CA, USA) - Adjustable continence Therapy for treatment of stress urinary incontinence. Prog Urol 2023; 33:96-102. [PMID: 36572628 DOI: 10.1016/j.purol.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/27/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE In this study, we aimed at evaluating the long-term adjustable peri-urethral balloons (PUB) durability in both male and female with neurogenic or non-neurogenic stress urinary incontinence. MATERIAL AND METHODS Each consecutive patient who underwent surgery for PUB placement before 2008 was included in this study. A PUB was proposed for patients with refractory to perineal reeducation stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency. There were no exclusion criteria. Demographic, clinical and perioperative data were collected retrospectively from our clinical follow-up notes. RESULTS A total of 177 patients were included in the study. Median [IQR] follow-up was 5 years [1.8-11.2]. The 3 main causes of SUI were radical prostatectomy (n=82, 46.3%), idiopathic intrinsic sphincter deficiency (n=55, 31.1%) and neurogenic sphincter deficiency (n=32, 18.1%). Complete continence (no pad necessary) was achieved for 109 patients (61.6%). At the end of the follow-up, the PUB global survival rate was 47.5% (Fig. 1). Median [IQR] PUB survival without removal was 57.8 months [42.3-81.7]. PUB survival without failure rate was 68.4% accounting for a median [IQR] survival duration of 116.9 months [86.2-176.9] CONCLUSION: In this study, we evidenced acceptable long-term efficiency and survival of PUB in the management of SUI in both neurogenic and non-neurogenic population. Given those results it could be a good alternative to AUS on unfit or unwilling population. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- M Ruggiero
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - U Pinar
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - M-B Popelin
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - X Rod
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - P Denys
- Université Paris Saclay, hôpital R.-Poincaré, AP-HP, neurourology department, Garches, France
| | - A Bazinet
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France
| | - E Chartier-Kastler
- Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, department of urology, Paris, France.
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Flochlay M, Bey E, Bruneaux E, Mazancourt ESD, Wagner L. [Treatment of female recurrent or not stress urinary incontinence with intrinsic sphincter deficiency: Sub-urethral retropubic adjustable sling (Remeex)]. Prog Urol 2022; 32:101-107. [PMID: 35027283 DOI: 10.1016/j.purol.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Recommendations for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD) or recurrent, are complex. They accept the use of sub-urethral slings (BSU), if unsuccessful the artificial urinary sphincter. The objective was to report the results in terms of continence and morbidity of the Remeex® Adjustable BSU in the treatment of SUI by ISD recurrent or non-recurrent. METHOD Monocentric retrospective study of 70 patients with a mean age of 67.7 years (±12) operated of Remeex sling, between 2015 and 2019, was conducted. Preoperative and postoperative characteristics were analyzed from medical records. Two groups were analyzed: Group A (n=28) with no history of incontinence surgery and Group B (n=42) with history (recurrent). Patients who were totally continent (0 protection) and those who were socially continent (1 safety protection) were considered successful. RESULT Postoperative success rate was similar between groups B (90 %) and A (92%) with respectively: 64% versus 71% of totally continent patients, 26% versus 21% wearing safety protection. The postoperative complications were mainly Clavien II (28%) such as urinary tract infections (6%), transient urinary retention (3%) and de novo bladder overactivity (20%) with no significant statistical difference between the groups. Six patients were reoperated (Clavien III): BSU detension (1%), vaginal exposure (4%) (including one total material removal for infection), varitensor explantation (1%) or scar disunion (1%). CONCLUSION The Remeex® BSUA seems to lead to satisfactory perioperative results in patients with SUI with ISD recurrent or non-recurrent.
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Affiliation(s)
- Morgane Flochlay
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France.
| | - Elsa Bey
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France
| | - Elodie Bruneaux
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France
| | | | - Laurent Wagner
- Service d'Urologie et Andrologie CHU de Nîmes, Univ Montpellier, Nîmes, France
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Schmitt M, Tricard T, Saussine C. [Voiding dysfunction after TVT: A 20-year experience TVT-placement under local anesthesia and sedation]. Prog Urol 2021; 32:268-275. [PMID: 34916134 DOI: 10.1016/j.purol.2021.10.003] [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: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Trans-vaginal tape has become the gold standard for the cure of urinary stress incontinence, but post-operative voiding dysfunction is frequently reported. The purpose of this study is to assess the incidence of voiding dysfunction, dysuria, chronic urinary retention, and necessity of reoperation after retropubic TVT placement under local anaesthesia and sedation. MATERIAL AND METHOD We perform a retrospective study of a cohort of patient treated with the placement of a retropubic TVT under local anaesthesia and sedation between 1999 and 2019 for a SUI. Post-operative voiding dysfunction and necessity of reoperation were reviewed to access the principal aim of this study. RESULTS Three hundred and two patients who met the eligibility criteria were included in the study. At 3 months, the dysuria rate and chronic urinary retention rate was 4.3% and 1%. At 12 months it was 2.6% and 0.3% respectively. The 12-month sling section rate was 1% and long-term self-catherization rate was 0.3%. The objective cure rate was 93% and subjective cure was 92%. CONCLUSION TVT placement under local anaesthesia and sedation resulted in few voiding dysfunctions at medium/long-term, necessity of re-operation for refractory obstructive disorder and well functional results. Even if these results support more frequent use of this type of anaesthesia, it would be interesting to be able to follow them in a prospective study to conclude. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Schmitt
- Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - T Tricard
- Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - C Saussine
- Service de chirurgie urologique, nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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Even L, Tibi B, Bentellis I, Treacy PJ, Berrogain N, Bosset PO, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu JF, Hurel S, Klap J, Meyer F, Peyrat L, Thuillier C, Vidart A, Wagner L, Cornu JN. [Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology]. Prog Urol 2021; 31:1141-1166. [PMID: 34794867 DOI: 10.1016/j.purol.2021.09.007] [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: 07/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. OBJECTIVES In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. RESULTS Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. CONCLUSION Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.
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Affiliation(s)
- L Even
- Cabinet d'urologie, espace santé 3 83500 La Seyne sur Mer, clinique du Cap d'Or, 83500 La Seyne sur mer, Polyclinique Les Fleurs, 83190 Ollioules, France
| | - B Tibi
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - I Bentellis
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - P J Treacy
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU Estaing, Clermont-Ferrand, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot Fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - S Hurel
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 91480 Quincy-sous-Sénart, France
| | - F Meyer
- Service d'urologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J N Cornu
- Service d'urologie, université de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Lamblin G, Chene G, Hamid D, Galea M, Lebail-Carval K, Chabert P, Nohuz E. [How I do… an uretral bulk agent injection of polyacrylamide hydrogel (Bulkamid®) under local anesthesia]. Gynecol Obstet Fertil Senol 2021; 49:635-640. [PMID: 33316437 DOI: 10.1016/j.gofs.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 06/12/2023]
Affiliation(s)
- G Lamblin
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - G Chene
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - D Hamid
- Groupe hospitalier Saint-Vincent, clinique Sainte-Barbe, 67000 Strasbourg, France
| | - M Galea
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France
| | - K Lebail-Carval
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France
| | - P Chabert
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France
| | - E Nohuz
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France
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Hermieu N, Schoentgen N, Aoun R, Neveu P, Grassano Y, Egrot C, Kassem A, Xylinas E, Ouzaid I, Hermieu JF. [Surgical management of suburethral sling complications and functional outcomes]. Prog Urol 2020; 30:402-410. [PMID: 32409239 DOI: 10.1016/j.purol.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify various clinical presentation leading to the diagnosis of mid-urethral sling (MUS) complications and to analyze the functional outcomes after surgical management of these complications. METHOD Retrospective observational monocentric study of all patients treated by MUS section or removal, between December 2005 and October 2019, in a pelviperineology centre. RESULTS During this study, 96 patients were included. MUS complications surgically managed were vaginal mesh exposure (48 %), urethral mesh exposure (17 %), bladder mesh exposure (10 %); dysuria (30 %), pain (6 %), and infection (3 %). The mean time to diagnosis was 2 years. This diagnosis delay was caused by a non-specific and heterogeneous symptomatology. Surgical management consisted in MUS partial removal (79 %) and MUS simple section (21 %) with low perioperative morbidity. At three months follow-up, 36 patients (53 %) had stress urinary incontinence (SUI), including 13 (19 %) de novo (meaning no SUI before MUS section/removal) and 19 (28 %) had overactive bladder, including 9 (13 %) de novo. Half of the patients with SUI after MUS section/removal were able to be treated by a second MUS with a success rate of 83 % at 3 years. CONCLUSION Clinical presentation of MUS complications is heterogeneous. Surgical treatment was associated with low morbidity in our study. Post-operatively, half of the patients had SUI and a second MUS was a relevant treatment option after proper evaluation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - N Schoentgen
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - R Aoun
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Neveu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - Y Grassano
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Egrot
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Kassem
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Xylinas
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - I Ouzaid
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - J F Hermieu
- Service de chirurgie urologique, centre hospitalier universitaire Bichat Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Université de Paris, Paris, France
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Grison P, Tixier S, Descamps P, Bigot P, Catala L, Legendre G. [Mini-sling versus transobturator sling: Efficiency and morbidity]. ACTA ACUST UNITED AC 2018; 46:673-80. [PMID: 30301618 DOI: 10.1016/j.gofs.2018.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the effectiveness of an ALTIS® mini-sling and a conventionnal suburethral sling TVT-ABBREVO® for treatment of female stress urinary incontinence. METHODS A single-center retrospective study included all female patients fitted with a conventional transobturator tape (TVT-ABBREVO®) or mini-sling (ALTIS®), during 2015, in Angers university hospital. The success rate was defined by no urine leakage during a cough test on clinical examination, improved quality of life defined by a PGI-I (Patient Global Impression of Improvement) score of 1 to 3, and no stress urinary incontinence on USP (Urinary Symptom Profile) questionnaire. Morbidity associated with slings and perioperative data were also recorded. RESULTS Ninety-two patients were included (39 in the ALTIS group and 53 in the ABBREVO group). The average follow-up was 13.55 months. The success rate was not significantly different in ALTIS group for the negative cough test (89.7% vs 94.3% in ABBREVO group, P=0.45), for the absence of urinary leakage reported on the USP questionnaire (87.2% vs 90.6% in ABBREVO group, P=0.61), or for the improvement of the quality of life with a PGI-I score between 1 and 3 (82.1% vs 86.8% in ABBREVO group, P=0.53). On the other hand, more patients were fully satisfied, with a PGI-I quality of life score of 1, in ABBREVO group than in ALTIS group (67.9% compared with 46.2%, P=0.03). Immediate postoperative pain was significantly less intense in ALTIS group than in ABBREVO group (average VAS score of 0.5 comparated with 1.3, P=0.01), but this difference had disappeared one week after surgery. The rates of other complications were similar in both groups. CONCLUSION The functional results of the ALTIS and TVT-ABBREVO® slings appear similar in the treatment of female stress urinary incontinence.
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Conté C, Jauffret T, Vieillefosse S, Hermieu JF, Deffieux X. Laser procedure for female urinary stress incontinence: A review of the literature. Prog Urol 2017; 27:1076-1083. [PMID: 29033365 DOI: 10.1016/j.purol.2017.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/09/2017] [Accepted: 09/06/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is increasing interest in noninvasive treatment of female stress urinary incontinence (SUI), including a vaginal laser procedure. In view of a lack of data on this technique, we conducted a non-systematic review of the literature. METHODS We reviewed studies concerning the laser treatment of SUI from PubMed, Medline, the Cochrane Library and Web of Science. Study design, outcome measure, number of participants, procedural complications and results were analyzed. RESULTS The use of laser treatment of female SUI has been described in 7 prospective, single-center and non-comparative (no control group) studies, all of which used an erbium YAG or a CO2 laser in thermal non-ablative treatment. Primary outcome was ICIQ-UI-SF score in six studies, and pad tests in one study. Follow-up ranged from 5 to 36months. Improvement rates ranged from 62% to 78%. No major adverse events were noted. Minor side effects included sensation of warmth, increased vaginal discharge and transient urge urinary incontinence. CONCLUSION The efficacy of vaginal laser treatment of SUI has not been assessed in comparative studies. More rigorous and adequately powered trials are required to assess the relative benefits and adverse event profile of laser treatment of SUI, as compared with other minimally invasive procedures.
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Affiliation(s)
- C Conté
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France
| | - T Jauffret
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France
| | - S Vieillefosse
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France
| | - J F Hermieu
- Clinique urologique, hôpital Bichat, AP-HP, 75018 Paris, France
| | - X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 92141 Clamart, France.
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11
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Manach Q, Bouquot M, Rouprêt M, Ambrogi V, Richard F, Bitker MO, Chartier-Kastler E, Phé V. [Placement of tension-free vaginal tape in women with stress urinary incontinence: Long-term functional outcomes in a prospective series]. Prog Urol 2017; 27:640-646. [PMID: 28651995 DOI: 10.1016/j.purol.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/01/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the long-term functional outcomes after retropubic tension-free vaginal tape (TVT) placement to treat female stress urinary incontinence (SUI). METHODS From September 1998 to September 2000, we prospectively enrolled all consecutive women in our center suffering SUI caused by urethral hypermobility. All women had a retropubic TVT inserted by the same surgeon. Patients were evaluated at 1, 3, 6 and 12 months postoperatively, and annually thereafter. Postoperative assessment included a measurement of post-voiding residual volume, urinalysis, a 1-hour pad test, a urinary symptom questionnaire, and an assessment of quality-of-life. Objective continence (defined as no urine leakage at clinical examination) and subjective continence (defined as no urine leakage, whatever the mechanism, reported by the patient) were reported. RESULTS Overall, 58 consecutive women (median age 59; IQR 49-67; min 21-max 78) were evaluated. Median follow-up was 10.2years (IQR 1.4-16.0; min 1-max 13.2). At the last follow-up, objective and subjective continence rates were 93% and 78%, respectively and remained stable in the long run. Pad tests, urinary symptom questionnaire scores and quality-of-life were significantly improved. Self-intermittent catheterisation was required by three women. A section of one TVT and removal of another tape was undertaken in two women with chronic pelvic pain. One patient had a chronic urinary infection. Rate of de novo urgency was 10%. CONCLUSIONS TVT implantation offered good and stable functional long-term outcomes. This procedure enhanced quality-of-life and had low morbidity. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Q Manach
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M Bouquot
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M Rouprêt
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - V Ambrogi
- Service de santé publique, informatique médicale et biostatistique, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.
| | - F Richard
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M O Bitker
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - E Chartier-Kastler
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - V Phé
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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12
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Betari R, Meynier J, Forzini T, François T, Hakami F, Saint F. [Is initial success after Monarc(®) suburethral sling durable at mid-term evaluation?]. Prog Urol 2016; 26:409-14. [PMID: 27032312 DOI: 10.1016/j.purol.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Suburethral sling is the gold standard treatment for stress urinary incontinence (SUI). Short-term cure rates are high, but only few studies are available for longer assessment after transobturator tape procedure. The objectives of this study were to assess mid-term functional outcome for Monarc(®) transobturator tape after initial success, and to identify risk factors for recurrence. MATERIAL AND METHODS We conducted a single centre retrospective study (2004-2013) on consecutive women with SUI who underwent Monarc(®) transobturator tape procedure and were initially cured at the postoperative medical consultation. Pre- and postoperative data (age, weight, height, body mass index, hormonal status, surgical history, associated organ prolapse [Baden and Walker], associated urinary symptoms, postoperative complications [Clavien-Dindo]) were extracted from the electronic medical record. Subjective cure was defined by a score of zero from the ICIQ-SF questionnaire, no second intervention for recurrent SUI and no need for pads at latest news. Statistical analysis was performed using SAS(®) v9.3 (P<0.05). RESULTS One hundred and thirty-three consecutive women underwent TOT Monarc(®) procedure, and 125 women were cured in the short-term. Among these women, 103 (82%) were available for mid-term evaluation. Sixty-four women (62%) had pure stress urinary incontinence. The mean follow-up period was 51 months [2-119]. At last follow-up, cure rate was 61%. Seventy-eight percent of women with recurrent urinary incontinence had SUI. Other women had mixed urinary incontinence (3/40), or de novo urgency (6/40). In univariate analysis, we could not identify pejorative prognostic factors for mid-term failure. CONCLUSION In our experience, mid-term functional outcome after Monarc(®) transobturator tape procedure seems to deteriorate. After 4 years of follow-up, 61% of the women who were initially cured were still free from any leakage. LEVEL OF EVIDENCE 4.
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13
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Sarreau M, Bon D, Estrade V, Villemonteix P, Fritel X. [Sexual function after transobturator tape procedure for stress urinary incontinence and overall patients' satisfaction]. Prog Urol 2015; 26:24-33. [PMID: 26586638 DOI: 10.1016/j.purol.2015.10.003] [Citation(s) in RCA: 2] [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: 01/31/2015] [Revised: 09/08/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the quality of sexual activity after a transobturator tape procedure for urinary incontinence and to examine the global satisfaction reported by patients. MATERIALS AND METHODS This is a bicentric retrospective study, postoperative questionnaires were sent to 247 women operated for urinary incontinence by TOT/TVT-O surgery, after 1 year, prolaps were excluded. Patients' overall improvement was assessed using the French version of Patient Global Impression and Improvement (PGI-I), urinary symptoms were assessed with the use of ICIQ-Fluts and quality of sexual function using Lemack and Zimmern questionnaire and ICIQ-Fluts-Sex. A logistic regression analysis was run to analyse the factors associated with women overall improvement. RESULTS One hundred and sixty-five patients answered the questionnaire (66.8%). Average age was 55 (±11), and the average postoperative period was 39 months (±17.9). After surgery, according to the PGI-I 135 women (81.8%) found an overall improvement, 22 (13.4%) found their condition unchanged and 8 (4.8%) women found it worse. Among the 165 women, 118 were sexually active, 37 (31.4%) reported improvement in intercourse satisfaction whereas 11 (9.3%) complained about sexual function deterioration and 70 (59.3%) felt unchanged. The 37 women who reported sexual improvement described decreased coital incontinence in 54% of the cases. Eleven women who felt sexually worse, reported dyspareunia. Results of the logistic regression analysis suggested that overall improvement after surgery depended not only on the incontinence score (OR 0.83) but also on the quality of the postoperative sexual activity (OR 12.96). CONCLUSION One third of the women reported improvement of their sexuality after transobturator tape procedure. In fact, global satisfaction after surgery was as related to the improvement of urinary symptoms as it was to the quality of the sexual activity. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- M Sarreau
- Service de gynécologie-obstétrique, CHG Angoulême, rond-point de Girac, 16000 Angoulême, France; Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - D Bon
- Service d'urologie, CHG Angoulême, rond-point de Girac, 16000 Angoulême, France; Pôle de la femme, Inserm U947 IADI, maternité régionale universitaire de Nancy, université de Lorraine, 54000 Nancy, France
| | - V Estrade
- Service d'urologie, CHG Angoulême, rond-point de Girac, 16000 Angoulême, France; Pôle de la femme, Inserm U947 IADI, maternité régionale universitaire de Nancy, université de Lorraine, 54000 Nancy, France
| | - P Villemonteix
- Service de gynécologie-obstétrique, CHG Nord Deux-Sèvres, 79800 Bressuire, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Inserm U1018 CESP, équipe 7, genre, santé sexuelle et reproductive, Inserm CIC-P 1402, centre investigation, clinique plurithématique, CHU de Poitiers, 86000 Poitiers, France
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Malaterre J, Viart L, Forzini T, Lewandowski E, Saint F. [Evolution of surgical activity related to the female stress urinary incontinence (SUI) with regard to the ageing of the French female population]. Prog Urol 2015; 25:396-403. [PMID: 25934592 DOI: 10.1016/j.purol.2015.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/06/2015] [Accepted: 03/14/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE One of the main factors associated with urinary incontinence of women is aging. The total female French population seems to grow for 10 years, with more and more women over 60 years. The authors wanted to assess the evolution of the surgical activity related to the treatment of the urinary incontinence with regard to the aging of the female French population. MATERIALS AND METHODS The number of surgical procedures for the treatment of stress urinary incontinence was obtained by querying the database of the Agence Technique de l'Information sur l'Hospitalisation (ATIH) for the period 2002-2013. The Catalogue Des Actes Médicaux (CDAM) and the Classification Commune des Actes Médicaux (CCAM) were used to extract the codes relating to surgery of the female urinary incontinence during this period. Demographics data were obtained from the website of the National Institute of Demographic studies (INED). The results were then compared. RESULTS On the 2002-2010 period, the total female French population increased by 5%. In the class of age over 60 years, it increased by 12.7%. Support-related surgical activity continued to decrease until 2013 with 17.3% interventions less than in 2002. CONCLUSION The evolution of surgical activity does not seem to follow the evolution of the ageing of the population, even if age is a risk factor essential for the female urinary incontinence. The improvement of risk factors (gynecological, obstetrical), over the past decade, could explain this evolution. LEVEL OF EVIDENCE 3.
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Forzini T, Viart L, Alezra E, Saint F. [Erosive complications of mid urethral slings (MUS): 10 years of surgical experience]. Prog Urol 2015; 25:240-8. [PMID: 25617074 DOI: 10.1016/j.purol.2014.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 04/25/2014] [Revised: 12/07/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Evaluation of the diagnostic and therapeutic management of erosive complications after mid urethral sling (MUS) procedure: vaginal erosions (VE), bladder (BE) and urethral (UE). METHODS Retrospective monocentric study concerning cohort of patients undergoing surgery from January 2002 to January 2013 supported for erosive complications of MSU: TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturateur Tape). RESULTS Sixteen patients were diagnosed for erosive complications: 7 VE, 6 BE and 3 UE. Dyspareunia and vaginal discharge were observed in 86% patients (n=6/7) with VE. Conservative treatment by vaginal approach was systematically performed in cases of vaginal erosion. After removal of material, 100% dyspareunia were corrected. Postoperative continence was maintained in 57% of patients (n=4/7). Urinary infection was the main symptom of patients with BE. Severe dysuria was present in 66% of patients with a UE (n=2/3). First-line therapy by endoscopic treatment was performed in 77% of patients (n=7/9) with a BE or UE. A second surgery was required in 42% of patients treated with endoscopic first-line therapy (n=3/7) because of a new exposure of MUS. Three of nine patients recurred their incontinence after first-line therapy (33%). CONCLUSION The removal of device exposed vaginally in case VE systematically corrected symptoms with about 60% of continence. In case of BE or UE, endoscopic treatment in first-line therapy was rarely definitive (42%) and recurrence of incontinence appeared in 30% cases.
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Affiliation(s)
- T Forzini
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France.
| | - L Viart
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire d'anatomie et d'organogénèse, UFR de médecine d'Amiens, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Alezra
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France
| | - F Saint
- Service d'urologie-transplantation, CHU Amiens-Picardie, avenue Laënnec, 80480 Salouël, France; Laboratoire de recherche HeRVI (EA 3801), CURS-CHU Amiens-Picardie, 150, avenue de la Croix-Jourdain, 80480 Salouël, France
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Lousquy R, Jean-Baptiste J, Barranger E, Hermieux JF. [Sport and urinary incontinence in women]. ACTA ACUST UNITED AC 2014; 42:597-603. [PMID: 24996876 DOI: 10.1016/j.gyobfe.2014.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/14/2014] [Indexed: 11/21/2022]
Abstract
Women are more attentive to their physical appearance and a quarter of French women use to practice a regular physical activity. Benefits of sport on general health are recognized. However, sport may be the cause of various diseases when it is poorly chosen or improperly performed. In literature, intensive exercise is a risk factor for urinary incontinence, defined as "the complaint of any involuntary leakage of urine". It is essentially stress urinary incontinence, occurring because of the phenomenon of intrabdominal hyperpressure, inherent with certain activities, and excess capacity of sphincters. Some sports are more risky than others, and high-level sportswomen are the most exposed. Health professionals must invest in information, screening, prevention, counseling and treatment track athletes So, the general practitioner and the doctor of sports play a vital role in informing, screening, prevention, therapeutic and monitoring of sportswomen. Better information is needed because according to the severity of incontinence and its impact, there are simple, effective, more or less invasive treatment options. The aim of this study was to establish an inventory of scientific knowledge and to improve the management of these patients.
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Amarenco G, Gamé X, Petit AC, Fatton B, Jeandel C, Robain G, Scheiber-Nogueira C, Vetel JM, Mares P; Groupe de recherche appliquée à la pathologie pelvi-périnéale de la personne âgée (GRAPPPA). [Guidelines concerning urinary incontinence in elderly: construction and validation of GRAPPPA algorithm]. Prog Urol 2014; 24:215-21. [PMID: 24560289 DOI: 10.1016/j.purol.2013.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 11/18/2013] [Accepted: 11/28/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Provide guidelines presented as an algorithm for practical evaluation and first line therapy of urinary incontinence in elderly. PATIENTS AND METHODS Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 40 experts quoting proposals, subsequently reviewed by an independent group of multidisciplinary experts (urologist, general practitioner, neurologist, gynecologist, geriatrist, specialist in physical medicine and rehabilitation). RESULTS By means of 3 rounds of interrogation of the expert panel, GRAPPPA algorithm was constructed. This algorithm take in account both evaluation and first line therapeutic options in the different type of incontinences observed in this population (urge, stress and mixed incontinence). Initial evaluation consists to track down urinary retention (and subsequently fecal stool impaction, use of anticholinergic or morphinic drugs), urinary tract infection and cognitive impairment. Haematuria, bladder-pelvic pain, history of radiotherapy or recent pelvic surgery, lead to refer the patient to a specialized unit. First line therapy is in all the cases pelvic floor training, use of local oestrogenotherapy and dietetic measures. In urge incontinence, anticholinergic drugs may be used. CONCLUSIONS Implementation of this algorithm may promote best practice in management of urinary incontinence in elderly.
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Sergent F, Gay-Crosier G, Resch B, Pons JC, Marpeau L. [A comparative study between two procedures of TVT retropubic mid-urethral sling placement for treatment of female stress urinary incontinence]. ACTA ACUST UNITED AC 2013; 43:235-43. [PMID: 24332758 DOI: 10.1016/j.jgyn.2013.08.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/24/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. PATIENTS AND METHODS Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. RESULTS One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (P<0.05), those of reoperations for pulling the sling downward 11.1% and 1.5% (P<0.05). A 1 year and more, healing and satisfaction rates were respectively 83.3% and 79.2% for the standard TVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (P<0.05). CONCLUSION By modifying the placement of the classic TVT, it is possible to reduce its complications while maintaining its efficacy.
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Affiliation(s)
- F Sergent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France.
| | - G Gay-Crosier
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - B Resch
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - J-C Pons
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France
| | - L Marpeau
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Faculté mixte de médecine et de pharmacie de Rouen, 22, boulevard Gambetta, CS 76183, 76183 Rouen cedex 01, France
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