Long-term anatomic and functional results of laparoscopic sacrocolpopexy: a prospective study.

PURPOSE: The aim of our study was to assess the impact of laparoscopic sacrocolpopexy on pelvic symptoms, quality of life and sexual function in patients with symptomatic pelvic organ prolapse. Secondary goals included the assessment of anatomical correction, recurrence and complication rates. METHODS: This is a prospective, single-center study that included 82 patients between 2009 and 2016. A clinical evaluation took place before surgery, and was repeated at 3, 12, 36 and 60 months postoperatively. Patients routinely received an anterior prosthesis, associated with a posterior prosthesis in case of symptomatic rectocele. Patients included self-administered questionnaires for functional pelvic problems (PFDI-20), quality of life (PFIQ-7), and sexual function (PISQ-12), and a clinical examination with POP-Q staging, at each medical visit. RESULTS: Functional pelvic problems derived from prolapse (PFDI-20 scores) and their impact on patients' quality of life (PFIQ-7 score) significantly improved at 3, 12, 36 and 60 months postoperatively. Improvement on sexual activity was significant at 3 and 60 months postoperatively. Effective prolapse anatomical correction (POP-Q score < 2) was found in 94.4% and 97.2% of patients at the anterior and middle stages, respectively, at the end of follow-up, but only in 80.3% at the posterior stage. Symptomatic recurrence required surgical intervention in 4 patients (5.3%). CONCLUSIONS: This long-term follow-up prospective analysis confirms the good functional and anatomical results of laparoscopic sacrocolpopexy for pelvic organ prolapse.

Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment.

PURPOSE: Ejaculatory dysfunction is the most common side effect related to surgical treatment of benign prostatic obstruction (BPO). Nowadays, modified surgical techniques and non-ablative techniques have emerged with the aim of preserving antegrade ejaculation. Our objective was to conduce a systematic review of the literature regarding efficacy on ejaculatory preservation of modified endoscopic surgical techniques, and mini-invasive non-ablatives techniques for BPO management. METHODS: A systematic review of the literature was carried out on the PubMed database using the following MESH terms: "Prostatic Hyperplasia/surgery" and "Ejaculation", in combination with the following keywords: "ejaculation preservation", "photoselective vaporization of the prostate", "photoselective vapo-enucleation of the prostate", "holmium laser enucleation of the prostate", "thulium laser", "prostatic artery embolization", "urolift", "rezum", and "aquablation". RESULTS: The ejaculation preservation rate of modified-TURP ranged from 66 to 91%. The ejaculation preservation rate of modified-prostate photo-vaporization ranged from 87 to 96%. The only high level of evidence studies available compared prostatic urethral lift (PUL) and aquablation versus regular TURP in prospective randomized-controlled trials. The ejaculation preservation rate of either PUL or aquablation compared to regular TURP was 100 and 90 versus 34%, respectively. CONCLUSIONS: Non-ablative therapies and modified endoscopic surgical techniques seemed to be reasonable options for patients eager to preserve their ejaculatory functions.

Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population.

AIMS: To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction. METHODS: Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability. RESULTS: Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up. CONCLUSION: In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.

Urinary Incontinence, Patient Satisfaction, and Decisional Regret after Prostate Cancer Treatment: A French National Study.

BACKGROUND: Complications of prostate cancer treatments have a substantial impact on the patient's quality of life. We evaluated the prevalence of urinary consequences and factors affecting patient satisfaction and decisional regret after treatment. METHODS: A retrospective self-administered questionnaire was sent to all members of the National Association of Prostate Cancer Patients in France. RESULTS: From the 226 completed questionnaires received, the following information was obtained: 110 patients underwent surgery only, 29 received radiotherapy plus hormone therapy, 28 received radiotherapy only, and 49 received other combination treatments. The median follow-up period was 58.1 months. After treatment, the presence of urinary incontinence was reported by 34.5% of patients treated by radical prostatectomy, by 10.3% treated by radiotherapy plus hormone therapy, by 17.8% treated by curitherapy or radiotherapy only, and by 38.7% treated by other combination therapy (p = 0.01). The main reasons for decisional regret were the fact that patients received incomplete information about prostate cancer (40%) and consequences of treatment that affected the urinary system (34%). The information received about cancer was considered complete in 32.3% of the satisfied group and 14.3% of the decisional regret group (p = 0.003) and with regard to urinary incontinence the information received was considered complete in 41.4 and 17.4% respectively (p < 0.01). CONCLUSIONS: Urinary consequences of prostate cancer treatment are common and impact the quality of life. Patients need clear information to be able to participate in therapeutic decision-making and to avoid subsequent decisional regret.

Cosmetic surgery of the penis / Chirurgie cosmétique du pénis

Cosmetic surgery of the penis. There is no consensus on the size below which it is justifiable to accept or attempt to modify the size of the penis. Length of the penis under 10 cm in erection can be considered as an acceptable limit, in a patient who suffers from it. The assessment of men asking for penile enlargement must include a psycho-sexological looking for a dysmorphophobia or another psychiatric condition. Penile extenders under medical control must be the first-line treatment option for patient seeking penile lenghtening procedure when justified. In case of failure, three techniques can be used alone or in combination: penile lengthening by section of the suspensory ligaments and suprapubic skin advancement, lipectomy of Mons pubis and scrotal webbing section. The results are modest, the rate of complications significant and satisfaction low. Girth enlargement techniques by injection of autologous fat, give inconsistent aesthetic results and satisfaction rates are low. All other techniques remain experimental. Cosmetic surgery of the penis is associated with a high risk of forensic exposure and surgery should be only proposed after a multidisciplinary consensus, followed by a time of reflection given to the patient after full and realistic disclosure. Applications for the purpose of reconstruction surgery after trauma or consequences of cancer treatment are justified.

Chirurgie cosmétique du pénis. Il n'y a pas de consensus concernant la taille au-dessous de laquelle il est justifié d'accepter de tenter de modifier la taille du pénis. Une longueur du pénis en érection inférieure 10 cm peut être considérée comme une limite acceptable, chez un homme qui en souffre. L'évaluation des hommes en demande d'augmentation du pénis doit comporter un avis psycho-sexologique à la recherche d'une dysmorphophobie ou d'une autre affection psychiatrique. Devant une demande justifiée d'allongement pour une verge de petite taille, une tentative d'allongement par traction mécanique doit être proposée en première intention. En cas d'échec, trois techniques peuvent être utilisées seules ou en association : un allongement par section du ligament suspenseur de la verge avec plastie cutanée en V-Y inversé, une lipoaspiration du mont du pubis et une section de palmure scrotale. Les résultats sont modestes, avec des taux de complications non négligeables et de satisfaction faibles. Les techniques d'élargissement par injection de graisse autologue ou d'acide hyaluronique donnent des résultats esthétiques inconstants avec un taux de satisfaction bas. Toutes les autres techniques sont expérimentales. La chirurgie cosmétique du pénis est associée à un risque médico-légal important et doit faire l'objet d'une concertation multidisciplinaire, à l'issue d'un temps de réflexion donné au patient après une information complète et réaliste. Les demandes dans le but d'une chirurgie de reconstruction après traumatisme ou conséquences des traitements des cancers sont justifiées.

Lapeyronie's disease / Maladie de Lapeyronie

Lapeyronie's disease. Lapeyronie's disease is a common condition responsible for an acquired penile curvature due to a fibrous albugineal plaque, affecting 3.4 to 9% of the male population. Its pathophysiology is still controversial. Medical treatments are ineffective. Intralesional Clostridium Histolyticum collagenase is the first non surgical option that allows a curvature improvement. Surgery should be proposed when the curvature is stabilized and responsible for a sexual handicap. The treatment of the concavity or convexity depends on the size of the erect penis, its curvature angle and erectile function. Penile implant must be proposed to patients when erectile dysfunction is combined with severe curvature.

Maladie de lapeyronie. La maladie de Lapeyronie se traduit par une courbure de la verge en érection, acquise, liée à l'apparition d'une plaque de fibrose albuginéale et touche 3,4 à 9 % de la population masculine adulte. Sa physiopathologie est encore mal connue. Les traitements médicaux sont peu efficaces. La mise sur le marché de la collagénase de Clostridium histolyticum en injection intraplaque est la première option thérapeutique non chirurgicale qui permet une réduction significative de la courbure. La chirurgie doit être proposée lorsque la courbure est stabilisée et responsable d'un handicap sexuel, et le traitement de la concavité ou de la convexité dépend de la longueur de la verge en érection, de sa courbure et de la qualité des érections. La pose d'un implant pénien peut être proposée aux patients atteints de dysfonction érectile sévère associée à une déformation importante.

Long-term efficacy and safety of tension free vaginal tape in a historic cohort of 463 women with stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: We report retrospective data on the long-term safety and efficacy of the retropubic midurethral sling (MUS) in a large series of women with stress urinary incontinence. METHODS: In all, 517 patients were treated during the period January 2005 to June 2012 at a single centre in France. The Urinary Symptoms Profile score was used to identify women who were subjectively cured or improved or in whom treatment had failed. The rates of peroperative, and early (<30 days) and late postoperative complications were recorded. RESULTS: A total of 463 patients were evaluable at a mean (±SD) follow-up of 71 ± 23 months. At the last follow-up, 344 patients (74.3 %) demonstrated subjective cure, 55 (11.9 %) were improved and 64 (13.8 %) had treatment failure. Bladder perforations occurred in 33 patients (7.1 %); however, this had no effect on cure rate. In the early postoperative period, temporary intermittent self-catheterization was required in 10 patients (2.2 %) due to voiding difficulties. The most frequent long-term postoperative complication was de novo urge incontinence that was reported by 59 patients (12.7 %); seven patients (1.5 %) needed tape excision due to voiding difficulties and six (1.3 %) needed tape removal due to erosion or chronic pain. CONCLUSIONS: The retropubic MUS was shown to be durable at a mean follow-up of 71 ± 23 months, with a high success/improvement rate and no serious long-term tape-induced adverse effects.