[Epidemiology and treatment of acute prostatitis after prostatic biopsy]. / Epidémiologie et traitement des prostatites aigues après biopsie prostatique.

OBJECTIVE: Acute prostatitis is the main complication of prostatic biopsies (PB) and sometimes requires hospitalisation and appropriate antibiotic therapy. This study evaluated the pathogens responsible and proposes a statistically adapted empirical antibiotic therapy. PATIENTS AND METHODS: This retrospective (from 2000 to 2006) two-centre study included 17 patients hospitalised for acute prostatitis after PB in a series of 1,216 biopsies. Bacteriological documentation was based on urine cultures, blood cultures, identification of bacteria and antibiotic susceptibility testing. RESULTS: All patients received prophylactic antibiotics with a single dose of systemic fluoroquinolone at least 1 h before PB. Bacterial identification was possible in fourteen cases: E. coli (nine cases), Proteus mirabilis (one case), Klebsiella pneumoniae (one case), Enterococcus faecalis (one case), Staphylococcus Spp (one case), Clostridium perfringens (one case). Only urine culture was positive in 6 cases (35%), only blood culture was positive in 3 cases (17%), and urine cultures and blood cultures were positive and concordant in 5 cases (29%). A high rate of resistance of E. coli to fluoroquinolones was observed in 88% of cases and to cotrimoxazole in 77% of cases. However, the strain was susceptible to second and third generation cephalosporins (2GC and 3GC) and amikacin in 100% of cases. Prostatitis was associated with epididymo-orchitis (3 cases), acute urinary retention (4 cases) and infective endocarditis (1 case). CONCLUSIONS: Identification of the micro-organism responsible for acute prostatitis after biopsy requires a combination of blood cultures and urine cultures. Empirical antibiotic therapy is based on the use of 2GC or 3GC, alone or in combination with amikacin depending on the severity of the clinical features.

Prospective multicenter clinical trial of Uretex Sup for surgical treatment of stress urinary incontinence.

AIM: To evaluate in a prospective multicenter study the efficacy and safety of the suburethral support Uretex (Sofradim, Trevoux, France) delivered by a suprapubic approach in the treatment of female stress urinary incontinence. METHODS: Between March 2002 and March 2003, 57 patients were treated for stress urinary incontinence with Uretex. Preoperative evaluation included urodynamic examination and questionnaires (symptoms and quality of life, Contilife). Forty patients had pure stress urinary incontinence and 17 mixed urinary incontinence. No associated procedure was performed. The objective cure rate was evaluated by clinical examination and pad-test, and the subjective cure rate was assessed through questionnaires at 1, 3 and 12 months. RESULTS: The mean follow-up was 13 months (range 11-24 months). During follow up, chronic urinary retention requiring a tape section occurred in one patient, and in another patient a delay of vaginal healing was followed by a sling exposure and resection at 4 months. No infection or urethral erosion was reported. The objective cure rate was 96.2%, and the subjective cure rate was 79.2%; four patients reported low leakage on stress and nine patients complained of urge incontinence (four de novo and five persistent). CONCLUSION: The suprapubic Uretex Sup procedure is a safe and effective treatment for women with stress urinary incontinence.

Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study.

OBJECTIVES: To investigate efficacy, safety, and impact on quality of sleep of desmopressin in the treatment of nocturia. METHODS: Adults aged > or =18 yr with nocturia (> or =2 voids/night) received desmopressin tablets (0.1, 0.2, or 0.4 mg) during a 3-wk dose-titration period. Patients should show sufficient response during the dose-titration period (> or =20% reduction in nocturnal diuresis) and a return of nocturnal diuresis to > or =80% of baseline levels during washout. Eligible patients then entered a 3-wk double-blind treatment period and received either desmopressin or placebo. RESULTS: 127 patients were randomised to either desmopressin (n=61) or placebo (n=66). Twenty (33%) desmopressin-treated patients compared with seven (11%) placebo-treated patients showed a clinical response, defined as a > or =50% reduction in the number of nocturnal voids compared with baseline (p=0.0014). Compared with placebo, desmopressin resulted in a significant reduction in the mean number of nocturnal voids (39% reduction with desmopressin vs. 15% with placebo; absolute difference -0.84, p<0.0001) and duration of the first sleep period (prolonged by 108 min with desmopressin vs. 41 min with placebo; p<0.0001). Quality of sleep was also improved with desmopressin versus placebo (statistically significant for one of the two parameters evaluated). Adverse events were mainly mild. CONCLUSIONS: Oral desmopressin tablets provide an effective and well-tolerated treatment for nocturia. Compared with placebo, nocturnal voiding frequency is reduced, duration of the first sleep period is increased, and sleep quality may be improved.

[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.

Non-invasive molecular detection of bladder cancer recurrence.

Transitional cell carcinoma (TCC) is the most common bladder tumor and approximately 90% of bladder TCC are superficial at initial diagnosis. High recurrence rate and possible progression to muscle invasive disease that is eventually indicated for radical cystectomy are established features of these tumors. Therefore, reliable predictors of tumor recurrence are of critical importance for management of superficial bladder TCC. Successful molecular diagnosis of bladder cancer by detecting genetic lesions: loss of heterozygosity (LOH) or microsatellite instability (MSI) in cells exfoliated in urine has been reported by several groups including ours. The aim of our study was to evaluate the predictive potential of microsatellite analysis of cells exfoliated in urine in the detection of superficial bladder TCC recurrence. We studied 47 Caucasian patients with confirmed superficial bladder TCC (37 pTa, 10 pT1) at initial diagnosis. Blood samples were obtained once from every patient whereas urine samples were collected before each cystoscopy (initial and follow-up). Matched DNAs from blood and urine were subjected to microsatellite analysis in a blinded fashion. The follow-up period ranged 12-48 months after tumor resection. Microsatellite analysis correctly identified 94% (44/47) of primary tumors and 92% (12/13) of tumor recurrences. Interestingly enough, 75% (9/12) of tumor recurrences were molecularly detected 1-9 months before cystoscopic evidence of recurrent disease. This study demonstrated clearly that not only urine microsatellite analysis reliably detected superficial bladder tumors, but also was a reliable test for detecting and predicting tumor recurrence in Caucasian patients. These results warrant multicenter randomized trials.