Management of lower urinary tract symptoms in Parkinsonian disorders.

INTRODUCTION: The aim of the study was to present a narrative review of the literature on the management of lower urinary tract symptoms (LUTS) in patients presenting Parkinsonian disorders (PD). MATERIAL AND METHODS: We carried out a literature search in PubMed and Embase database, without time restriction. We used keywords and free-text words around "Parkinsonian disorders" AND "lower urinary tracts symptoms" without language restriction. We focused mainly on papers less than 10 years old. We included all studies evaluating LUTS in patients with PD. RESULTS: For the diagnostic management, authors emphasized the importance of differentiating Parkinson's disease with symptoms of bladder overactivity from multiple system atrophy with symptoms of bladder hypoactivity. Urodynamic evaluation was noted as the key element of diagnostic management. The therapeutic management proposed was symptomatic, based on functional urology techniques for the treatment of LUTS, both with drugs (especially anticholinergics) or surgery (intradetrusor injections of botulinum toxin, neuromodulation). Moreover, it was pointed out that it is always necessary to take into account the existence of a possible associated uropathy (prostate adenoma or pelvic prolapse). CONCLUSION: Urodynamic evaluation is the cornerstone of diagnostic management of LUTS in patients with PD. Therapeutic management is above all symptomatic and must be done in a collegial way involving the urologist, neurologist, gynecologist, and physical medicine and rehabilitation physician.

[Results of subinguinal microsurgical varicocelectomy]. / Résultats des cures de varicocèles microchirurgicales sous-inguinales.

INTRODUCTION: The subinguinal microsurgical varicocelectomy is considered as the gold standard surgical technique for the treatment of varicocele. The objective of this study is to evaluate the results of this technique on the resolution of pain and the parameters of sperm analysis. METHODS: Single-center, retrospective study that includes 22 patients who have been operated over a period of six months for a clinically palpable varicocele via the microsurgical subinguinal technique. Nine patients were operated for pain and 13 patients for infertility with an abnormality of their sperm analysis. RESULTS: All the patients operated for pain had a complete resolution of pain at the postoperative follow-up (3 months). Concerning the patients operated for infertility, 76.92% of the patients had a normal sperm analysis, 7.69% of the patients presented a partial improvement, and 15.39% of the patients without any improvement. Analysis of sperm's parameters at 3 months showed a significant improvement in the morphology (4.3% vs 6.69% of typical forms according to Kruger ; P<0.05) and mobility (progressive mobility 15.6% vs 23% postoperatively; P<0.01). A non-significant improvement (low sample) in the concentration was noted (21.58 million/mL preoperative vs 34.9 million/mL postoperative, P=0.08). Pregnancies are noted in 38.5% of patients. A postoperative complication was noted with surgical site infection resolved with antibiotics. CONCLUSION: This single-center study confirms that the treatment of varicocele by subinguinal microsurgical route is an effective therapeutic strategy on symptomatic varicocele and in infertile men. This technique is associated with few complications.

[Low-intensity extracorporeal shock wave therapy for erectile dysfunction: A systematic review]. / Traitement de la dysfonction érectile par ondes de choc extracorporelles de faible intensité : revue de la littérature.

INTRODUCTION: Our purpose was to assess the efficacy of low intensity extracorporeal shock waves (SW) for the treatment of organic erectile dysfunction (ED). METHODS: A systematic review of the literature published between 2000 and 2020 was conducted using the PRISMA methodology. We used Medline data with the following key words (MesH): "extracorporeal shock wave therapy"; "erectile dysfunction"; "sexuality". RESULTS: Nineteen articles were selected: thirteen randomised controlled trial and six meta-analyses. Most of them studied vascular etiology. Low intensity SW is beneficial ED is evaluated by the IIEF, EHS scores and penile hemodynamic. CONCLUSION: SW may have a theoretical impact on the vascular etiology of organic DE. Their use in this context is supported by the European Society of urology and the European Society of sexual medecine. However, there are discrepancies in current data to establish a protocol to follow in daily practice.

[Extracorporeal shock wave therapy for Peyronie's disease]. / Traitement de la maladie de Lapeyronie par ondes de choc extracorporelles.

INTRODUCTION: The efficiency of extracorporeal shock waves (SW) for Peyronie's disease (PD) is controversial. METHODS: A systematic review of the literature published between 2000 and 2019 was conducted using the PRISMA methodology. We used Medline data with the following. KEYWORDS: "extracorporeal shock wave therapy" ; "Peyronie's disease"; "Sexuality"; Penile erection. RESULTS: Thirteen articles were selected. Our review showed that SW were beneficial in terms of pain. Regarding plaques size and penile curvature, the results remain divergent. CONCLUSION: SW may be useful in the management of pain in selected patients with PD. Its effectiveness on plaques size and penile curvature needs to be demonstrated through controlled and randomized trials. The population has to be targeted, and the treatment protocol must also be standardized.

[Sacral neuromodulation: Indications and technical aspects]. / Neuromodulation des racines sacrées : indications et modalités thérapeutiques.

Sacral neuromodulation is a second line therapy, especially indicated in overactive bladder. The initial assessment includes a complete clinical examination with a frequency-volume chart. The cystoscopy and urodynamics are optional. There are two steps in the implantation of a sacral neuromodulation: first, the implantation of the electrode to test if the device is efficient and corrects the urinary disorder. Two, the implantation of the neuromodulation itself. During the follow-up, the role of the nurse is crucial in explaining to the patients how the device works. Post-operative follow-up is based on the frequency-volume chart and the feeling of the patient's back. It also includes the surveillance of the postoperative scares.

[Male neurogenic stress urinary incontinence treated by artificial urinary sphincter AMS 800™ (Boston Scientific, Boston, USA): Very long-term results (>25 years)]. / Traitement de l'incontinence urinaire masculine neurologique par le sphincter urinaire artificiel AMS 800™ (Boston Scientific, Boston, États-Unis) : résultats à très long terme (>25 ans).

OBJECTIVE: The aim of the study was to report the very long-term functional outcomes of artificial urinary sphincter (AUS) in male neurological patients. MATERIAL AND METHODS: Male neurological patients diagnosed with stress urinary incontinence due to sphincter deficiency and undergoing AUS (AMS 800®) implantation between 1985 and 1992 were enrolled. Continence, defined by no pad/condom usage, explantation and revision rates were reported. RESULTS: Fourteen patients with a median age of 27.3 years (IQR: 27.3-40.8) were included: four had a spinal cord injury and ten a spina bifida. Prior continence surgery was reported by 6 patients (42.9 %). Artificial urinary sphincter was implanted in a peribulbar (n=4) or periprostatic position (n=10). Median follow-up was 18.3 years (IQR: 10.1-20.3). At last follow-up, all patients were alive. Three native devices were still in place, eight were revised (four of them were secondarily explanted) and three were explanted due to erosion or infection. The 5-, 10-, 15-, 20-year explantation-free survival rates were respectively 85.7, 62.3, 52.0, 39.0 %. The 5-, 10-, 15-, 20-year revision-free survival rates were respectively 78.6, 42.9, 28.6, 7.1 %. At last follow-up, 50 % patients were continent. CONCLUSION: In the very long run, AUS provided a 50 % continence rate in male neurological patients but the revision rates were important. LEVEL OF EVIDENCE: 4.

[Medico-economic evaluation of urological cares of spinal cord injured patients: A review]. / Évaluation médico-économique des traitements urologiques chez les patients blessés médullaires : revue de la littérature.

INTRODUCTION: To provide an overview of the urological management of spinal cord injured patients based on an economic analysis. MATERIALS AND METHODS: A literature search from January 1994 to December 2014 was performed using Medline and Embase database using the following keywords: cost-effectiveness; cost-benefit; cost-utility; spinal cord injury; neurogenic bladder; intermittent catheterization; antimuscarinics; botulinum toxin; sacral neuromodulation; tibial nerve; Brindley; sphincterotomy. The tool used for comparison was the QALY ("quality adjusted life years"); an indicator between 0 and 1 allowing the comparison between two medical treatments using cost per QALY. RESULTS: Solifenacin (5 to 10mg) is the most cost-effective treatment with an incremental cost-effectiveness ratio (ICER) of 19,893 €/QALY compared to trospium 40mg, of 16,657 €/QALY compared to trospium 60mg, of 12,309 £/QALY compared to oxybutinin. Botulinum toxin A is also cost-effective with an ICER of 24,720 $/QALY compared to best supportive cares for anticholinergic-refractory neurogenic detrusor overactivity. CONCLUSION: Solifenacin and botulinum toxin A appears to be the most cost-effective treatments for spinal injured urological cares. There is a pressing need to both increase and improve data collection and research on spinal cord injury.

Evolution of prostate biopsy techniques. Looking back on a meaningful journey. / Evolución de las técnicas de biopsia prostática. Mirando hacia atrás en un viaje significativo.

BACKGROUND: The technique of prostate biopsy has evolved a long way since its inception to being a safe diagnostic procedure. The principles of the biopsy technique continue to improvise with the knowledge about prostate cancer and availability of newer treatment options like active surveillance and focal therapy. Currently, we depend on accurate cancer information from the biopsy more than ever for deciding the ideal treatment option. AIM: The aim of this review is to present the major milestones in prostate biopsy technique evolutions and its impact on the prostate cancer management. ACQUISITION OF EVIDENCE: We performed a detailed non-systematic literature review to present the historical facts on the transformations in prostate biopsy techniques and also the direction of present research to improve accurate cancer detection. SUMMARY OF EVIDENCE: There is a clear change in trend in biopsy technique before and after the introduction of transrectal ultrasound and prostate specific antigen. In the earlier era, the biopsies were aimed at palpable nodules and obtaining adequate prostatic tissue for diagnosis while the later era has moved towards detection of non-palpable and early prostate cancer. Recently, there is an increasing trend towards image guided targeted biopsies to extract maximum cancer information from minimum biopsy cores. CONCLUSION: Prostate biopsy techniques have seen major changes since its inception and have a major impact on prostate cancer management. There is a great potential for research which can further support the newer treatment options like focal therapy.

[Medical and surgical treatments of congenital and acquired penile curvatures: a review]. / Traitements médicaux et chirurgicaux des courbures de verge congénitales et acquises: revue de la littérature.

INTRODUCTION: The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. MATERIALS AND METHODS: [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. RESULTS: The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. CONCLUSION: Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.