Progres En Urologie最新文献

{"title":"Mid-term oncologic outcomes of radical prostatectomy in lymph node metastatic prostate cancer patients","authors":"W. Berchiche , T. Long Depaquit , M. Baboudjian , É. Barret , F. Rozet , X. Cathelineau , C. Bastide","doi":"10.1016/j.purol.2023.05.001","DOIUrl":"10.1016/j.purol.2023.05.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Lymph node invasion (LNI) has been reported in 10–15% of pelvic lymph node dissection during radical prostatectomy (RP). The objective of this study was to describe the mid-term oncological outcomes in prostate cancer (PCa) patients with metastatic lymph node.</p></div><div><h3>Methods</h3><p>We conducted a retrospective study at two French referral centers including consecutive cN0 PCa patients who underwent RP and extended pelvic lymph node dissection and had lymph node metastases on final pathological analysis (pN1) between January 2000 and May 2020. Follow-up was per institution, which generally included a PSA level measurement every 3 to 12 months for 5 years and annually thereafter.</p></div><div><h3>Results</h3><p>A total of 123 patients were included: two (1.6%) low-risk, 64 (52%) intermediate-risk and 57 (46.4%) high-risk PCa according to the D’Amico risk classification. The median number of nodes removed and metastatic nodes per patient was 15 (IQR 11–22) and 1 (IQR 1–2), respectively. Adverse pathological features, i.e., ≥<!--> <!-->pT3a stage, ISUP grade ≥<!--> <!-->3, and positive surgical margins were reported in 113 (91.9%), 103 (83.7%), and 73 (59%) of cases, respectively. Postoperative treatment was administered in 104 patients, including radiotherapy alone (<em>n</em> <!-->=<!--> <!-->6), androgen deprivation therapy alone (<em>n</em> <!-->=<!--> <!-->27) or combination with androgen deprivation therapy and radiotherapy (<em>n</em> <!-->=<!--> <!-->71). The mean follow-up was 42.7 months. The estimated 3-year biochemical-free survival, clinical recurrence-free survival, and cancer-specific survival was 66% and 85% and 98.8%, respectively. In Cox regression analysis, the number of metastatic nodes was associated with clinical recurrence (<em>P</em> <!-->=<!--> <!-->0.04) and a persistently elevated PSA with biochemical recurrence (<em>P</em> <!--><<!--> <!-->0.001).</p></div><div><h3>Conclusion</h3><p>The management of lymph node metastatic PCa patients is challenging. Risk stratification of node-positive patients, based on postoperative PSA levels and pathologic features being identified, should help physicians determine which patient would best benefit from multimodal treatment.</p></div><div><h3>Level of evidence</h3><p>4</p></div><div><h3>Introduction</h3><p>Un envahissement ganglionnaire est reporté dans 10 à 20 % des curages ganglionnaires pelviens réalisés au cours d’une prostatectomie totale (PT). L’objectif de cette étude était de décrire les résultats oncologiques à moyen terme chez les patients atteints d’un cancer de la prostate (CaP) métastatique au niveau ganglionnaire.</p></div><div><h3>Méthodes</h3><p><span>Nous avons mené une étude rétrospective dans deux centres de référence français, incluant des patients consécutifs atteints d’un CaP cN0 ayant subi une PT et un curage ganglionnaire pelvien étendu et présentant des métastases ganglionnaires lors de l’analyse pathologique définitive","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 8","pages":"Pages 437-445"},"PeriodicalIF":1.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10231964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential impact of COVID-19 on urological surgeries in public and private institutions between 2019 and 2021 in France","authors":"M. Brument , G. Defortescu , H. Bugel , L. Sibert , T. Duflot , H. Dupuis , L. Surlemont , C. Pfister , J.-N. Cornu","doi":"10.1016/j.purol.2023.05.005","DOIUrl":"10.1016/j.purol.2023.05.005","url":null,"abstract":"<div><h3>Introduction</h3><p>The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021.</p></div><div><h3>Materials and methods</h3><p>This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation.</p></div><div><h3>Results</h3><p>Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors.</p></div><div><h3>Conclusion</h3><p>The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future.</p></div><div><h3>Level of evidence</h3><p>4.</p></div><div><h3>Introduction</h3><p>La pandémie de COVID-19 a perturbé tous les services de soins en 2020. À ce jour, les données concernant l’ajustement et le recouvrement du retard chirurgical dans l’ère post-COVID restent en fait rares. L’objectif de cette étude était de comparer le nombre d’actes chirurgicaux urologiques codés entre 2019 et 2021 dans les établissements publics et privés pour (i) quantifier la variation de l’activité chirurgicale en 2020 et (ii) étudier le rattrapage éventuel des actes en 2021.</p></div><div><h3>Matériels et méthodes</h3><p>Il s’agit d’une analyse rétrospective complète de toutes les chirurgies urologiques codées entre le 1<sup>er</sup> janvier 2019 et le 31 décembre 2021 en France. Les données ont été extraites du site internet en libre accès de l’agence technique de l’information sur l’hospitalisation (ATIH). Au total, 453 actes urologiques ont été retenus et répartis en 8 catégories. Le résultat principal était l’impact du COVID-19 analysé par la variation 2020/2019. Le critère de jugement secondaire était le recouvrement post-COVID analysé par la variation 2021/2019.</p></div><","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 8","pages":"Pages 412-420"},"PeriodicalIF":1.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10239898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9909577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chimiothérapie préopératoire des tumeurs des voies excrétrices supérieures : impact sur la fonction rénale","authors":"P.-E. Gabriel , T. Lambert , C. Dumont , H. Gauthier , A. Masson-Lecomte , S. Culine","doi":"10.1016/j.purol.2023.06.003","DOIUrl":"https://doi.org/10.1016/j.purol.2023.06.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Les tumeurs des voies excrétrices supérieures (TVES) sont des tumeurs rares avec un pronostic sombre au-delà du stade localisé. Au stade localisé, le traitement standard repose sur la néphro-urétérectomie totale (NUT) suivie, pour les patients éligibles et à risque de récidive, d’une chimiothérapie adjuvante à base de platine. Cependant, la perte néphronique liée à la NUT occasionne une altération de la fonction rénale pouvant contre-indiquer la chimiothérapie adjuvante. Dans ce contexte, la place de la chimiothérapie préopératoire (CPO) est à envisager bien que peu de données soient disponibles sur sa toxicité rénale et son efficacité.</p></div><div><h3>Méthodes</h3><p>Nous avons réalisé une étude rétrospective monocentrique sur des patients traités par CPO pour une TVES localisée ou localement avancée considérés comme éligibles à une NUT.</p></div><div><h3>Résultats</h3><p>Au total, 24 patients suivis pour une TVES ont été traités par CPO entre 2013 et 2022. Vingt et un patients ont bénéficié secondairement d’une NUT. Dans l’ensemble de la cohorte, la CPO n’a pas entraîné de dégradation de la fonction rénale (DFG médian pré-CPO : 70 versus 77<!--> <!-->mL/min en post-CPO, <em>p</em> <!-->=<!--> <!-->0,79), comparativement à la NUT (DFG médian post-CPO : 51,5<!--> <!-->mL/min, <em>p</em> <!--><<!--> <!-->0,001). Le taux de réponse complète pathologique était de 29 % sur la pièce opératoire et la survie globale et sans récidive étaient respectivement de 74 % et 46 % après un suivi médian de 27,4 mois.</p></div><div><h3>Conclusion</h3><p>La CPO dans les TVES montre un profil de toxicité rénale rassurant avec des résultats histologiques encourageants. Ces données incitent à mener des études prospectives évaluant sa place dans la prise en charge des TVES.</p></div><div><h3>Niveau de preuve</h3><p>3</p></div><div><h3>Purpose</h3><p>Upper tract urothelial carcinoma (UTUC) are rare tumors with a poor prognosis. The standard treatment for localized disease is based on total nephroureterectomy (NUT) followed by platinum-based adjuvant chemotherapy for eligible patients at risk of recurrence. However, many patients have renal failure after surgery preventing chemotherapy. Thus, the place of preoperative chemotherapy (POC) is questioned with little information available about renal toxicity and efficacity.</p></div><div><h3>Methods</h3><p>A single center retrospective study was performed on patients with UTUC who received POC.</p></div><div><h3>Results</h3><p>In all, 24 patients with localized UTUC were treated with POC between 2013 and 2022. Twenty-one (91%) had secondarily NUT. In this cohort, POC did not result in degradation of median renal function (pre-POC median GFR: 70<!--> <!-->mL/min, post-POC median GFR: 77<!--> <!-->mL/min, <em>P</em> <!-->=<!--> <!-->0.79), unlike NUT (post-NUT median GFR: 51.5<!--> <!-->mL/min, <em>P</em> <!--><<!--> <!-->0.001). In addition, the rate of complete pathological response to pat","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 8","pages":"Pages 446-455"},"PeriodicalIF":1.1,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49799756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new tool to investigate anorectal disorders in patients with multiple sclerosis: STAR-Q","authors":"E. Tan , N. Turmel , J. Kerdraon , A. Guinet-Lacoste , J.-G. Prévinaire , E. Castel-Lacanal , A. Even , C. Chesnel , C. Hentzen , G. Amarenco","doi":"10.1016/j.purol.2023.02.006","DOIUrl":"10.1016/j.purol.2023.02.006","url":null,"abstract":"<div><h3>Background</h3><p>Bowel symptoms are commonly experienced by patients with Multiple sclerosis (PwMS), but no specific questionnaire validated in this population allows a rigorous assessment.</p></div><div><h3>Objective</h3><p>Validation of a multidimensional questionnaire assessing bowel disorders in PwMS.</p></div><div><h3>Methods</h3><p>A prospective, multicenter study was conducted between April 2020 and April 2021. The STAR-Q (Symptoms’ assessmenT of AnoRectal dysfunction Questionnaire), was built in 3 steps. First, literature review and qualitative interviews were performed to create the first version, discussed with a panel of experts. Then, a pilot study assessed comprehension, acceptation and pertinence of items. Finally, the validation study was designed to measure content validity, internal consistency reliability (alpha coefficient of Cronbach) and test–retest reliability [intraclass correlation coefficient (ICC)]. The primary outcome was good psychometric properties with Cronbach's α<!--> <!-->><!--> <!-->0.7 and ICC<!--> <!-->><!--> <!-->0.7.</p></div><div><h3>Results</h3><p>We included 231 PwMS. Comprehension, acceptation and pertinence were good. STAR-Q showed a very good internal consistency reliability (Cronbach's α<!--> <!-->=<!--> <!-->0.84) and test-retest reliability (ICC<!--> <!-->=<!--> <!-->0.89). Final version of STAR-Q was composed of 3 domains corresponding in symptoms (Q1–Q14), treatment and constraints (Q15–Q18) and impact on quality of life (Q19). Three categories of severity were determined (STAR-Q<!--> <!-->≤<!--> <!-->16: minor, between 17 and 20: moderate, and<!--> <!-->≥<!--> <!-->21: severe).</p></div><div><h3>Conclusions</h3><p>STAR-Q presents very good psychometric properties and allows a multidimensional assessment of bowel disorders in PwMS.</p></div><div><h3>Level of evidence</h3><p>2</p></div><div><h3>Introduction</h3><p>Les troubles anorectaux touchent fréquemment les patients atteints de sclérose en plaques (PaSEP), mais aucun questionnaire spécifique validé dans cette population ne permet une évaluation rigoureuse. Cette étude vise à valider un questionnaire multidimensionnel évaluant les troubles anorectaux chez les PaSEP.</p></div><div><h3>Matériel</h3><p>Une étude prospective et multicentrique a été menée entre juin 2019 et avril 2021. Le STAR-Q a été construit en 3 étapes. Une revue de la littérature et des entretiens qualitatifs avec des patients ont été réalisés afin de créer la première version du questionnaire, validée par un panel d’experts. Une étude pilote vient ensuite valider la compréhension, l’acceptation et la pertinence des items. Enfin, une étude de validation a été effectuée afin de mesurer la validité de contenu, la cohérence interne (coefficient alpha de Cronbach) et la reproductibilité [coefficient de corrélation intraclasse (ICC)]. Le critère de jugement principal concernait l’obtention de bonnes propriétés psychométriques du questionnaire avec un α de Cronbach<!--","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 362-369"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9648857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized treatment of bladder pain syndrome in women: A fantasy or are we speaking the same language?","authors":"C. Saussine MD, PhD","doi":"10.1016/j.purol.2023.02.009","DOIUrl":"10.1016/j.purol.2023.02.009","url":null,"abstract":"","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 357-358"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9648067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized treatment strategy for bladder pain syndrome in female patients provides treatment recipes for successful management","authors":"J.C. Nickel","doi":"10.1016/j.purol.2023.01.001","DOIUrl":"10.1016/j.purol.2023.01.001","url":null,"abstract":"","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 359-361"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profil épidémiologique, étiologique et évolutif des fistules vésico-vaginales au Sénégal","authors":"Alioune Sarr , Cyrille Ze Ondo , Amath Thiam , Cheikh Abdourahmane Badji , Babacar Sine , Modou Ndiaye , Abdoulaye Ndiath , Ousmane Sow , Abdou Aziz Diouf , Yaya Sow , Papa Ahmed Fall , Alain Khassim Ndoye","doi":"10.1016/j.purol.2023.04.001","DOIUrl":"https://doi.org/10.1016/j.purol.2023.04.001","url":null,"abstract":"<div><h3>But</h3><p>Évaluer le profil épidémiologique, étiologique et évolutif des fistules vésico-vaginales (FVV) en milieu hospitalo-universitaire au Sénégal.</p></div><div><h3>Patients et méthode</h3><p>Il s’agit d’une étude rétrospective, descriptive et monocentrique, colligeant les dossiers des patientes suivies pour une FVV entre janvier 2014 et décembre 2019 au Service d’urologie et d’andrologie du Centre hospitalier universitaire Aristide Le Dantec, Dakar, Sénégal. Les paramètres suivants étaient étudiés : l’âge, l’origine géographique, la parité et l’étiologie des FVV. Pour apprécier l’évolution du profil épidémiologique et étiologique des FVV nous avons comparé nos résultats à ceux de séries publiées par notre structure.</p></div><div><h3>Résultats</h3><p>Quarante-cinq (45) FVV ont été recensées sur une période de 6 années. Soit une moyenne annuelle de 7,5 fistules. L’âge moyen était de 40 ± 15,13 ans avec des extrêmes de 13 ans et 75 ans ; 17 patientes (37,8 %) avaient plus de 45 ans. La parité moyenne était de 3 avec des extrêmes de 0 à 12 enfants. Les multipares représentaient 68,8 % des patientes. Les FVV obstétricales (FVVO) étaient plus fréquentes (48,9 %) suivies des FVV iatrogènes (FVVI) (33,3 %). L’âge moyen était plus élevé dans le groupe des patientes qui avaient une FVVI comparé au groupe de patientes qui avaient une FVVO (32 ans) (<em>p</em> = 0,0004). Trente patientes étaient originaires de la région de Dakar et de sa banlieue soit 66,6 %. L’étiologie des FVV ne variait pas suivant l’origine géographique des patientes (<em>p</em> <!-->=<!--> <!-->NS). La FVV était fréquemment associée à la prise en charge de cancer du col dans 42,2 % des cas. La comparaison de nos données actuelles avec celles des séries précédentes montre une réduction de l’incidence annuelle des FVV. Les FVVO bien qu’ayant fortement diminuées restent prédominantes. Il existe une augmentation constante du nombre de FVVI.</p></div><div><h3>Conclusion</h3><p>Il existe une évolution du profil épidémiologique et étiologique marquée par une diminution de la fréquence des FVVO et la hausse de celle des FVVI. À noter également l’association fréquente entre le cancer du col de l’utérus et les FVV.</p></div><div><h3>Niveau de preuve</h3><p>Niveau 4 : étude rétrospective</p></div><div><h3>Aim</h3><p>To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal.</p></div><div><h3>Patients and method</h3><p>This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published ","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 401-406"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49806228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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","authors":"S. Bassi , U. Pinar , S. Di Maria , D. Gambachidze , Q. Manach , E. Chartier-Kastler","doi":"10.1016/j.purol.2023.02.005","DOIUrl":"10.1016/j.purol.2023.02.005","url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div><div><h3>Level of evidence</h3><p>3.</p></div><div><h3>Introduction</h3><p>Notre objectif était d’évaluer la faisabilité, la sécurité et l’efficacité de la pose d’un sphincter urinaire artificiel (SUA) en ambulatoire.</p></div><div><h3>Matériel et méthodes</h3><p>Du mois d’avril 2018 au mois d’avril 2019, tous les patients consécutifs ayant bénéficié de la pose ou de la révision d’un SUA AMS 800 (Boston Scientific©) en secteur ambulatoire ont été inclus. Les données suivantes ont été recueillies prospectivement: antécédents médicaux, étiologie et sévérité de l’incontinence, procédure chirurgicale et complications postopératoires. La satisfaction des patients a de plus été évaluée en utilisant deux échelles validées.</p></div><div><h3>Résultats</h3><p>Au total, 28 patients ont été inclus dans l’étude représentant 30 procédures (22 poses, 6 révisions complètes et 2 révisions partielles) avec un suivi moyen de 223<!--> <!-->jours (±<!--> <!-->220,5). Quatorze patients avaient un antécédent de radiothérapie. Le taux de réadmission était de 6,7 % dans les 30<!--> <!-->jours postopératoires. Après chirurgie, le taux de révision et d’explantations étaient tous deux de 6,7 %. Il y a eu 26,7 % de complications dont la majorité était Clavien I. La satisfaction des patients était très élevée après la procédure ambulatoire (87,5 % étaient satisfaits ou très satisfaits). La continence était complète ou sociale pour respectiveme","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 377-383"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9702340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and sexual outcomes following surgical vaginal introital reduction","authors":"Asma Al Salehi , Mohammed Zakarya Zemmache , Lucie Allegre , Brigitte Fatton , Renaud de Tayrac","doi":"10.1016/j.purol.2023.05.003","DOIUrl":"10.1016/j.purol.2023.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>Surgical introital reduction procedures are commonly performed for the treatment of vaginal laxity (VL), yet poorly studied. The aim of this study was to assess clinical outcomes following surgical vaginal introital reduction for VL.</p></div><div><h3>Methods</h3><p>This was an ambidirectional cohort study conducted in a single urogynecology center. All sexually active women who had vaginal introital surgical reduction for VL between March 2015 and September 2020 were included in this study. VL was defined as a genital hiatus distance ≥<!--> <!-->4<!--> <!-->cm according to the POP-Q classification, associated with symptoms of laxity. The primary endpoint was sexual health assessed by the Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ), while the secondary endpoints included postoperative pain, perioperative complications, rate of dyspareunia, patient satisfaction and success rate based on the Patient Global Improvement Index (PGI-I) and Vaginal Laxity Questionnaire (VLQ).</p></div><div><h3>Results</h3><p>Of the 27 patients sent the questionnaires, 23 sexually active patients returned the completed ones and were included in the study. Participants had a mean age and BMI of 41 years (range 24–74) and 21.3 (range 17.6–31.9) respectively. The most prevalent preoperative symptom was feeling of VL in 82.6% followed by bulging sensation in 47.8%. Preoperative dyspareunia was reported in 8/23 (34.8%). Surgical interventions involved perineorrhaphy with (<em>n</em> <!-->=<!--> <!-->14) or without (<em>n</em> <!-->=<!--> <!-->9) levator ani plication. The PPSSQ mean sexual health score was 86.7/100 (SD 5.8; range 16.7–93.3) and the mean discomfort and pain score was 27.5/100 (SD 26.0; range 0-80). Postoperative sexuality was reported to better, identical or worse in 16 (69.6%), 2 (8.7%) and 5 (21.7%) patients respectively. On PGI-I, patients reported feeling much better, better, slightly better and no change in 10 (43.5%), 5 (21.7%), 5 (21.7%) and 3 (13.0%) respectively. None of the women reported feeling worse. The overall post-operative complication rate was 3/23 (13.0%), including a perineal hematoma, and two cases of reoperation for narrow introitus. De novo dyspareunia was reported by 11/18 (61.1%) patients, occurring often or more in 4/18 (22.2%) patients, due to narrow introitus (<em>n</em> <!-->=<!--> <!-->2), enlarge introitus (<em>n</em> <!-->=<!--> <!-->1) and vaginal dryness (<em>n</em> <!-->=<!--> <!-->1).</p></div><div><h3>Conclusion</h3><p>Vaginal introital reduction surgery is a viable treatment option for symptoms of vaginal laxity after failure of conservative measures. However, patients should be made aware of the risk of de novo dyspareunia.</p></div><div><h3>Level of evidence</h3><p>4.</p></div><div><h3>Objectif</h3><p>Différentes interventions chirurgicales sont couramment pratiquées pour le traitement de la béance vulvaire associée à un syndrome clinique d’hyperlaxité vaginale (HV), mais elles sont p","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 370-376"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9644330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional MRI in neuro-urology: A narrative review","authors":"C. Mazeaud , B.H. Salazar , M. Braun , G. Hossu , R. Khavari","doi":"10.1016/j.purol.2023.03.002","DOIUrl":"10.1016/j.purol.2023.03.002","url":null,"abstract":"<div><p>Neuro-imaging has given urologists a new tool to investigate the neural control of the lower urinary tract. Using functional magnetic resonance imaging (fMRI), it is now possible to understand which areas of the brain contribute to the proper function of the storage and voiding of the lower urinary tract. This field of research has evolved from simple anatomical descriptions to elucidating the complex micturition network. A keyword search of the Medline database was conducted by two reviewers for relevant studies from January 1, 2010, to August 2022. Of 2047 peer-reviewed articles, 49 are included in this review. In the last decade, a detailed understanding of the brain–bladder network has been described, elucidating a dedicated network, as well as activated areas in the brainstem, cerebellum, and cortex that share reproducible connectivity patterns. Research has shown that various urological diseases can lead to specific changes in this network and that therapies used by urologists to treat lower urinary tract symptoms (LUTS) are also able to modify neuronal activity. This represents a set of potential new therapeutic targets for the management of the lower urinary tract symptoms (LUTS). fMRI technology has made it possible to identify subgroups of responders to various treatments (biofeedback, anticholinergic, neuromodulation) and predict favourable outcomes. Lastly, this breakthrough understanding of neural control over bladder function has led to treatments that directly target brain regions of interest to improve LUTS. One such example is the use of non-invasive transcranial neuromodulation to improve voiding symptoms in individuals with multiple sclerosis.</p></div><div><p><span>L’imagerie cérébrale est un nouvel outil performant, permettant aux urologues d’explorer le contrôle neurologique du bas appareil urinaire. L’apport de l’IRM fonctionnelle (IRMf) ouvre de nouvelles perspectives pour expliquer comment certaines zones spécifiques du système nerveux central jouent un rôle sur les phases de remplissage et de vidange du bas appareil urinaire. Depuis plusieurs années, ce domaine de recherche a beaucoup progressé, partant de la simple description anatomique vers la modélisation d’un circuit mictionnel complexe. Deux auteurs ont sélectionné l’ensemble des articles publiés dans Medline de janvier 2010 à août 2022, selon une recherche par mots clés. Parmi 2047 articles selectionés, 49 ont été inclus dans cette revue. Ces dix dernières années ont permis de décrire et comprendre l’existence d’un réseau vessie–cerveau dédié possédant une grande plasticité. Il comprend des zones d’activation spécifiques dans le tronc cérébral, le cervelet et le cortex et un fonctionnement stéréotypique reproductible. De nombreuses pathologies urologiques et leurs traitements peuvent conduire à des modifications au sein de ces réseaux, modulant l’activité neuronale, représentant des cibles thérapeutiques potentielles pour traiter les symptômes du bas appar","PeriodicalId":20635,"journal":{"name":"Progres En Urologie","volume":"33 7","pages":"Pages 349-356"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9647179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}