[Mechanical evaluation of various suburethral tapes used for the treatment of stress urinary incontinence]. / Evaluation mécanique de différentes bandelettes sous-urétrales utilisées pour le traitement de l'incontinence urinaire d'effort.

OBJECTIVE: The objective of this study is to compare the mechanical characteristics of a series of suburethral tapes marketed for the treatment of stress urinary incontinence, often considered to be identical in the clinical practice. MATERIAL AND METHOD: Six suburethral tapes were studied: TVT (Gynecare-Ethicon, USA), IVS (Tyco Healthcare, USA), Sparc (AMS, USA), Uretex (Sofradim, France distributed by BARD), I-stop (CL médical, France), and Uratape (Porgès, France). The surface was studied by scanning electron microscopy. Mechanical properties were evaluated on an Instron traction apparatus equipped with a 500 Newton transducer and elongation was performed at a rate of 10 mm/min. Deformation curves, Young's elastic modulus, and maximum load were calculated. Possible release of particles was investigated by weighing each sample before and after gentle 0.01 kN traction. RESULTS: From a purely mechanical point of view, completely opposite properties were observed. The maximum load ranged from 0.012 +/- 0.002 to 0.047 +/- 0.013 kN. Young's elastic modulus ranged from 4.31 +/- 1.1 to 41.99 +/- 14.3 Mpa. Maximum deformity ranged from 31% to 108%. Release of particles was estimated, according to the tape, to represent a variation of the initial weight of between 0.01% and 8.5%. CONCLUSION: It is difficult to compare tapes that are theoretically marketed for the same application, suggesting that the same tape should probably not be used for the same application. Clinicians must more extensively evaluate the required properties. The authors believe that tapes with a high elastic modulus should be proposed for transobturator procedures to provide real perineal support, while tapes with a lower elastic modulus should be used for retropubic techniques.

Case study of the month. Complete histologic remission after sunitinib neoadjuvant therapy in T3b renal cell carcinoma.

The authors present the first case report of complete histologic remission after neoadjuvant sunitinib treatment on primary renal tumour and vena cava thrombus. A 78-yr-old woman with an Eastern Cooperative Oncology Group (ECOG) score of 0 presented with a T3b renal tumour. She refused surgical treatment but agreed to percutaneous biopsy and medical treatment. A Fuhrman III renal cell carcinoma was histologically confirmed on percutaneous biopsy, and sunitinib treatment was administered over 6 mo. A significant objective response was observed for tumour size and thrombus. The patient finally accepted surgical treatment. Pathologic examination concluded with a complete response of primary tumour and thrombus.

Laparoscopic insertion of artificial periprostatic urinary sphincter.

The objective of this case report is to describe the laparoscopic insertion of an artificial periprostatic urinary sphincter. We report the case of a paraplegic patient in whom an artificial urinary sphincter was inserted in a periprostatic position by way of laparoscopy to treat stress urinary incontinence. In addition to laparoscopy being minimally invasive, its advantages include the excellent quality of retroprostatic dissection and the perfect visualization it gives at the level of cuff positioning with respect to the anatomic landmarks. It is more appropriate to be able to cleave the interprostatorectal space to ensure passage of the cuff under perfectly safe conditions.