[Multidisciplinary meetings in pelvic floor disease in women: A national survey by the CUROPF among French urologists]. / Réunion de concertation pluridisciplinaire en pelvipérinéologie en France : résultats d'une enquête nationale du CUROPF auprès des urologues français.

INTRODUCTION: Multidisciplinary team meetings (MTMs) in the field of pelvic floor diseases in women tend to generalize, as they are required as mandatory before mid-urethral sling implantation or sacrocolpopexy by recent decrees published by the French health authorities. However, access to these meetings is variable in the French territory. The goal of the present study was to describe the existence and the settings of these kinds of meetings in France. MATERIEL AND METHODS: An on-line survey was conducted between June and July 2020 (stage 1) then between November 2021 and January 2022 (stage 2). A 15-item questionnaire was sent to all members of the Association française d'urologie (AFU). A descriptive analysis was conducted. RESULTS: Three hundred and twenty-two completed questionnaires were sent back during stage 1 and 158 during stage 2. Early 2022, 61.3% of respondents had access to a pelviperineology MTM, with important difference according to geographical areas. Main activity of MTMs was case discussion of complex situations (68% of meetings). At the end of 2021, 22% of the respondents declared willing to stop partially or totally their pelviperineology activity, given the new regulations set in place by the authorities. CONCLUSION: Despite being absolutely mandatory in current clinical practice, MTMs in pelvic floor disease have spread slowly. MTMs implementation was still insufficient in 2022, and variable on the French territory. Some urologists declare having no access to such resources and about 1 out of 5 were considering to voluntary stop of decrease significantly their activity in this difficult context.

A systematic review of the treatment for female stress urinary incontinence by ACT® balloon placement (Uromedica, Irvine, CA, USA).

PURPOSE: (1) To describe the minimally invasive adjustable continence therapy (ACT)(®) balloon placement surgical technique. (2) To analyse the results of ACT(®) balloon in the treatment for female stress urinary incontinence (SUI). METHOD: A review of the literature was performed by searching the PubMed database using the following search terms: ACT balloons, female urinary incontinence, and female continence. RESULTS: Eight studies were published between 2007 and 2013. The mean follow-up of these studies was 1-6 years. The mean age of the patients ranged between 62 and 73 years; 40-100 % of patients had already been treated surgically for their SUI. A significant reduction in the number of pads used per day was observed after ACT(®) balloon placement, with improvement of short pad tests from 49.6 to 77.3 g preoperatively to 11.2-25.7 g after ACT(®) balloon placement. Fifteen to 44 % of patients considered that their SUI had been cured and 66-78.4 % were satisfied with the result. The explantation rate ranged between 18.7 and 30.8 %. Quality of life was significantly improved, and no major complication was reported. CONCLUSION: ACT(®) balloons constitute a reasonable, minimally invasive alternative for the treatment for female SUI due to intrinsic sphincter disorder, especially in patients who have already experienced failure of standard surgical treatment and in clinical settings incompatible with invasive surgical placement of an artificial urinary sphincter (especially women over the age of 80 years). Long-term results are essential to evaluate the efficacy of this treatment.

Treatment of neurogenic stress urinary incontinence using an adjustable continence device: 4-year followup.

PURPOSE: We evaluated the long-term safety and efficacy of an adjustable continence device (ACT® or ProACT™) in male and female patients with neurogenic stress urinary incontinence. MATERIALS AND METHODS: Data on patients consecutively treated with implantation of an adjustable continence device due to neurogenic stress urinary incontinence were reviewed from the start of our experience to the current 4-year followup. RESULTS: We reviewed data on 13 male and 24 female patients with neurogenic stress urinary incontinence due to different forms of pelvic nerve or spinal cord lesions. Mean ± SD age at implantation was 46.2 ± 17.4 years. Of the patients 92% performed clean intermittent self-catheterization. The device was implanted bilaterally using general and local anesthesia in 16.2% and 83.8% of cases, respectively. From before implantation to 48-month followup the mean number of urinary incontinence episodes decreased from 6.1 ± 2.4 to 2.8 ± 3.1 and the mean number of pads used per 24 hours decreased from 4.2 ± 2.7 to 2.2 ± 2.2. Of the patients 54.5% indicated more than 50% improvement of stress urinary incontinence symptoms after 48 months, of whom 38.9% indicated complete continence. Adverse events included erosion/migration, device infection or failure, implantation site pain, bladder stone formation and difficult clean intermittent self-catheterization. CONCLUSIONS: Implantation of the ProACT/ACT device in patients with neurogenic stress urinary incontinence is minimally invasive and safe. It can significantly improve neurogenic stress urinary incontinence in the long term. Thus, it might be a reasonable option for patients who are not willing, not suitable or not yet ready for more invasive surgery, such as artificial urinary sphincter or fascial suspension sling placement.

Laparoscopic approach for artificial urinary sphincter implantation in women with intrinsic sphincter deficiency incontinence: a single-centre preliminary experience.

BACKGROUND: Implantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI). OBJECTIVE: To assess the early functional outcome after laparoscopic placement of an AUS in women. DESIGN, SETTING, AND PARTICIPANTS: Twelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures. INTERVENTION: The AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. MEASUREMENTS: Perioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter. RESULTS AND LIMITATIONS: The mean age of subjects was 56.7+/-12 yr (33-78). The mean body mass index was 24+/-2.3 (20-25). The mean preoperative closure pressure was 22+/-10.9 cmH(2)O (4-35). The mean operative time was 181+/-39 min [110-240]. Intraoperative complications occurred in three women (25%), with bladder (n=2) and vaginal (n=2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7+/-2.3 d (3-11). The bladder catheter was removed after a mean time of 10+/-8 d (2-30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4-14 wk after implantation. Mean follow-up was 12.1+/-8 mo (5.2-27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up. CONCLUSIONS: AUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy.

Intestinal obstruction by an enterolith from a perforated giant Meckel's diverticulum: diagnosis with CT reconstructed images.

Complications caused by Meckel's enteroliths are very rare. Diagnosis is not usually made before surgery because symptoms are often of little value and imaging may be difficult to interpret. Computed tomography (CT) scanning, which is increasingly performed in emergency situations, could help make the diagnosis. We describe a 37-year-old man with intestinal obstruction caused by an enterolith resulting from a giant Meckel's diverticulum. The diagnosis was suggested preoperatively through the use of abdominal CT scanning with reconstructed pictures. A resection of the small bowel and diverticulum was performed with immediate anastomosis. The postoperative course was uneventful. Diagnosis of enterolith from Meckel's diverticulum can be suggested by CT frontal reconstructed sections in patients with small bowel obstruction and abdominal calcified opacities. This procedure could reduce the delay between onset of symptoms and adequate treatment before perforation and peritonitis occur.

[Recommendations for the clinical evaluation of non-neurological female urinary incontinence]. / Recommandations pour l'évaluation clinique d'une incontinence urinaire féminine non neurologique.

The diagnosis of female urinary incontinence is clinical. CLINICAL INTERVIEW: It must be precise and guided. It allows subjective assessment of the patient's history, triggering factors, volume of urine leakage. It is recommended to classify the type of urinary incontinence: stress. urge or mixed urinary incontinence. Other voiding disorders must be noted: dysuria, frequency, pain. These disorders can be recorded on a voiding diary kept for at least 2 days. which is recommended in the investigation of female urinary incontinence. The clinical interview also looks for any associated anorectal disorders (anal incontinence and altered bowel habit). CLINICAL EXAMINATION: The full bladder examination and the cough test to confirm urine leakage and correction of the leakage by bladder neck support (Bonney test) and urethral support are recommended in the investigation of female urinary incontinence, The Q-tip test is not recommended to measure urethral hypermobility. A pad-test is not recommended in the evaluation of documented stress incontinence, but is recommended to confirm urinary incontinence not diagnosed clinically or in clinical trials evaluating a treatment for urinary incontinence. A Valsalva manoeuvre to detect associated prolapse and perineal muscle testing are recommended as part of the clinical examination of all cases of incontinence. In the case of prolapse associated with urinary incontinence, the Baden-Walker classification or the Pop-Q classification proposed by the ICS (International Continence Society) should be used. The ICS classification has the advantage of being objective and reproducible, but is complicated and may be reserved for clinical trials. In routine clinical practice, the 4-stage Baden-Walker classification is sufficient.

[Renal cell carcinoma and trichloroethylene]. / Carcinome rénal et trichloréthylène.

The authors report the case of a 51-year-old man with a history of trichloroethylene (TCE) poisoning. He was treated by radical nephrectomy after discovery ofa right renal mass corresponding to renal cell carcinoma. The objective of this study is to discuss the role of TCE abuse as a renal carcinogen. TCE is an excellent solvent used to degrease metal parts. It can enter the body by inhalation, ingestion or cutaneous contact, but the respiratory tract is the main route of absorption of TCE. Many epidemiological studies have been conducted on workers exposed to TCE, but they have not been able to clearly establish a link between exposure by inhalation to TCE and cancer. The International Agency for Research on Cancer has accumulated sufficient evidence to consider TCE to be carcinogenic to animals and considers that TCE is probably carcinogenic to humans. Toxic metabolites derived from TCE induce chronic renal tubular lesions and may exert a genotoxic effect on the proximal convoluted tubule. The initial genotoxic effect appears to be related to mutations of the VHL suppressor gene. The chronic toxic effects and the possible role of TCE in the development of cancer have not been specifically studied in the context of TCE abuse behaviour. To our knowledge, this is the first case of renal cell carcinoma reported in a TCE addict.

[Spontaneous splenic rupture during intrasplenic Kaposi's sarcoma in an HIV-positive patient]. / Rupture spontanée de la rate sur sarcome de Kaposi intrasplénique chez un patient séropositif pour le VIH.

Spontaneous splenic rupture is a rare cause of peritoneal bleeding. Etiology is usually infections (viral, bacterial or parasitic) and blood diseases (leukemia, lymphoma, dysglobulinemia). We report the first case of spontaneous splenic rupture secondary to hilar Kaposi's sarcoma in an HIV positive patient. Emergency splenectomy was performed to achieve hemostasis, and the etiological diagnosis of this spontaneous splenic rupture was based on the histological analysis.

Small-bowel infarction from disseminated aspergillosis.

INTRODUCTION: Despite the use of new, effective drugs, the disseminated invasive aspergillosis often remains lethal in neutropenic patients. Diagnosis is difficult because early symptoms are nonspecific. New tools could help in diagnosis and lead to early surgery when needed. METHODS: A neutropenic patient developed an acute abdomen. CT findings were a diffuse, small-bowel distention with a thickened, distal, ileum wall. Emergency surgery was performed with resection and immediate anastomosis of the distal ileum. Pathology of the small bowel showed a wall necrosis and invasion by Aspergillus fumigatus. RESULTS: The postoperative course was uneventful except for persisting diarrhea secondary to a coexistent infection with Clostridium difficile. Aspergillus antigene in serum was positive, whereas neither pulmonary nor central nervous system aspergillosis was observed on CT scan. CONCLUSIONS: This diagnosis should be considered when neutropenic patients show abdominal pain and distention with fever. Repetition of Aspergillus antigenemia, search for others aspergillosis localizations, CT scan, and colonoscopy with biopsies should be performed until diagnosis allows the administration of early antifungal therapy.