[Surgical treatments for male stress urinary incontinence]. / Traitement chirurgical de l'incontinence urinaire d'effort chez l'homme.

Stress urinary incontinence (SUI) in men is common, radical prostatectomy (RP) remaining its main cause. Despite improvements in surgical techniques, SUI rates range from 5 % to 48 %. Management begins with non-invasive and conservative methods. Surgical treatment includes implantation of an artificial urinary sphincter, a suburethral sling or periurethral balloons. This article summarizes the surgical treatments for male SUI.

L'incontinence urinaire d'effort (IUE) chez l'homme est fréquente et a comme cause principale la prostatectomie radicale (PR). Malgré les progrès des techniques chirurgicales, les taux d'IUE se situent entre 5 et 48 %. La prise en charge débute par des méthodes non invasives et conservatrices. Le traitement chirurgical comprend l'implantation d'un sphincter urinaire artificiel, d'une bandelette sous-urétrale ou de ballonnets péri-urétraux. Dans cet article, nous résumons les traitements chirurgicaux de l'IUE chez l'homme.

[Benign prostatic hyperplasia treatment: Surgical alternatives to transurethral resection of the prostate]. / Traitement de l'hyperplasie bénigne de la prostate - Alternatives chirurgicales à la résection transurétrale de la prostate.

Benign prostatic hyperplasia is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms. The gold standard of surgical treatments for benign prostatic hyperplasia for decades has been transurethral resection of the prostate. New minimally invasive techniques have been developed with the aim of reducing morbidity or resecting large prostate volumes endoscopically. In this article, we summarize the different surgical alternatives to transurethral resection of the prostate.

L'hyperplasie bénigne de la prostate est l'une des maladies les plus fréquentes de l'homme âgé et est la principale cause de symptômes du bas appareil urinaire. Depuis des décennies, le gold standard des traitements chirurgicaux pour soulager les symptômes du bas appareil urinaire, dus à l'hyperplasie bénigne de la prostate, est la résection transurétrale de la prostate. De nouvelles techniques mini-invasives se sont développées dans le but de réduire la morbidité ou de pouvoir prendre en charge des volumes prostatiques plus importants par voie endoscopique. Nous résumons dans cet article les différentes alternatives chirurgicales à la résection transurétrale de la prostate.

[Overview of ureteral stone management]. / Prise en charge de la lithiase urétérale.

Ureteral stones are a major health concern with a worldwide rising prevalence. In countries with a high standard of living, the prevalence urolithiasis is notably high with over 10%. Ureteral stones formed in the kidney and then descending the ureter commonly manifest themselves as renal colic. The treatment of ureteral stones includes conservative treatment, medical expulsion therapy, interventional stone treatment such as ureteral stenting, ureteroscopy and extracorporeal shock wave lithotripsy as well as (oral) chemolysis in selected cases. This article presents a comprehensive overview on the treatment of ureteral stones and an outlook on advancements in treatment.

La maladie lithiasique est un problème de santé majeur en augmentation. Dans les pays industrialisés, la prévalence de la maladie lithiasique est particulièrement élevée, plus de 10 %. Les lithiases sont formées dans le rein, puis elles migrent dans l'uretère où elles se manifestent couramment par des coliques néphrétiques. La prise en charge des lithiases urétérales comprend les traitements conservateur, médical expulsif, interventionnels comme la pose de stent urétéral, l'urétéroscopie ou la lithotripsie extracorporelle, ainsi que la chimiolyse orale dans certains cas. Cet article présente un résumé de la prise en charge de la lithiase urétérale ainsi que les progrès réalisés en matière de traitement.

[Prevention of nephrolithiasis - Preliminary results of the Swiss Kidney Stone Cohort (SKSC) and the NOSTONE trial]. / Prévention de la lithiase urinaire ­ Résultats préliminaires de la Cohorte suisse des patients souffrant de calculs rénaux et de l'étude NOSTONE.

Nephrolithiasis is a major health care problem with increasing incidence and prevalence worldwide. Prevention consists mainly of conservative therapeutic measures, including dietary measures and drug treatments. However, the understanding of the pathophysiology and molecular genetic basis of nephrolithiasis is incomplete and complicates the development of new treatments. In this context, the Swiss Kidney Stone Cohort (SKSC) aims to improve the understanding of nephrolithiasis and the NOSTONE trial aims to confirm the efficacy of hydrochlorothiazide in the recurrence prevention of calcium containing kidney stones.

La maladie lithiasique est un problème de santé majeur avec une incidence et une prévalence en augmentation au niveau mondial. Sa prévention est constituée essentiellement de mesures thérapeutiques conservatrices, incluant mesures diététiques et traitements médicamenteux. La compréhension de la physiopathologie et des bases génétiques moléculaires de la maladie lithiasique est cependant incomplète et entrave le développement de nouveau traitement. Dans ce contexte, la Cohorte suisse des patients souffrant de calculs rénaux cherche à améliorer la compréhension de la maladie lithiasique et l'étude interventionnelle NOSTONE à confirmer l'efficacité de l'hydrochlorothiazide dans la prévention de la récurrence de lithiases urinaires calciques.

[Current surgical treatments for women with stress urinary incontinence]. / Actualité du traitement chirurgical de l'incontinence urinaire d'effort chez la femme.

Surgical treatments for female stress urinary incontinence is in perpetual evolution. This article reviews the current surgical treatments for stress urinary incontinence in female. Bulking agents, Burch colposuspension, autologous sling, midurethral slings, single incision slings, artificial urinary sphincter and adjustable continence therapy (ACT) are discussed.

Les traitements chirurgicaux de l'incontinence urinaire d'effort chez la femme sont en perpétuelle évolution. Cet article passe en revue les options actuelles de traitement chirurgical de l'incontinence urinaire d'effort chez la femme. Les injections péri-urétrales d'agents de comblement, la colposuspension selon Burch, la bandelette sous-urétrale aponévrotique, les bandelettes sous-urétrales synthétiques, les mini-bandelettes (single incision sling), le sphincter urinaire artificiel et les ballonnets péri-urétraux (ACT) y sont présentés.

Respiratory Complications after Cystectomy with Urinary Diversion: Avoidable Complications or Ineluctable Destiny?

Background: Cystectomy with urinary diversion (CUD) is a highly morbid surgery. Despite implementing an enhanced recovery after surgery (ERAS®) protocol, postoperative respiratory complications (PRC) within 30 days after surgery remain frequent. This study aims to identify patients at higher risk of developing PRC after CUD. Methods: We conducted a retrospective analysis of 242 patients who underwent CUD at Lausanne University Hospital from 2012 to 2022, adhering to ERAS® guidelines. Data on postoperative complications, including pneumonia, respiratory failure, pulmonary embolism, lobar atelectasis, and pleural effusion, were analyzed. Chi-square and Mann-Whitney U tests compared patients with and without PRC. A multivariable Cox model identified independent prognostic factors. Results: PRC occurred in 41 patients (17%). Those with PRC experienced longer hospital stays and higher 30-day mortality rates. Poor ERAS® compliance was a significant risk factor. Multivariable analysis showed pneumonia was associated with postoperative ileus, while pulmonary embolism correlated with infectious and cardiovascular complications. Conclusions: PRC result in extended hospitalization and decreased survival. Rigorous adherence to ERAS® protocols, including early mobilization, respiratory physiotherapy, and avoiding nasogastric tubes, is essential for preventing PRC.

[Follow-up after urolithiasis management]. / Nachsorge nach Steinsanierung bei Urolithiasis.

BACKGROUND: Urinary stones often affect younger people. Because the risk of recurrence is high, regular follow-up is important for individuals at risk. OBJECTIVE: To summarize the extent of urinary stones and the health and economic impact in the population; to provide recommendations for general and stone-specific follow-up. MATERIALS AND METHODS: Analysis and discussion of publications and guideline recommendations. RESULTS: The risk of recurrence after a stone attack can be high depending on the risk profile. An initial metabolic workup should be performed promptly after stone therapy. General dietary management should be intensified by stone-specific dietary management depending on the risk profile. Nutritional counseling may be helpful. Imaging after stone therapy is used to monitor the success of treatment and detect recurrences early. Since the risk of recurrence can vary greatly depending on the stone composition, not only the type of imaging but also its frequency should be adjusted accordingly. The same applies to the various stone therapies, which help determine the frequency and type of imaging follow-up. Exact guidelines and cost-effectiveness analyses of follow-up examinations after stone therapy are unfortunately missing. CONCLUSIONS: Acute urolithiasis represents an excruciating experience for patients. Accordingly, their willingness to undergo metaphylaxis and follow-up shortly after the event is strong. Since the risk of recurrence after a stone attack can be very high, regular follow-up after stone therapy is essential. The frequency of follow-up should be adapted to the probability of stone recurrence.

Is EDSS Enough to Predict Risk of Upper Urinary Tract Damage in Patients with Multiple Sclerosis?

Lower urinary tract dysfunction is often observed in patients with multiple sclerosis (MS) and may be responsible for an increased risk of upper urinary tract (UUT) damage. Although there are well-known urodynamic risk factors for UUT damage, no clinical prediction parameters are clearly identified. We aimed to confirm the accuracy of the Expanded Disability Status Scale (EDSS) in predicting urodynamic risk factors for UUT deterioration and to assess other clinical parameters potentially predicting urodynamic risk factors. We retrospectively reviewed 201 patients with MS referred for primary neuro-urological work-up, including a video-urodynamic study (VUDS) from August 2009 to February 2020. Multivariate modeling revealed EDSS, male gender, and a number of LUTS as clinical parameters significantly associated with urodynamic risk factors for UUT damage (p = 0.06, p = 0.01, p = 0.02, respectively). A nomogram combining EDSS, male gender, and a number of different LUTS was created to predict the presence of at least one urodynamic risk factor for UUT damage. In conclusion, the presence of high EDSS combined with male gender and several different LUTS is significantly associated with urodynamic risk factors and can be used to stratify MS patients for further neuro-urological assessment and treatment.

The impact of stenting prior to oral chemolysis of upper urinary tract uric acid stones.

PURPOSE: To evaluate the impact of ureteral stenting on the success rate of oral chemolysis in the management of suspected uric acid upper urinary tract (UUT) stones. METHODS: Retrospective matched-pair analysis of 172 patients treated with oral chemolysis from 01/2010 to 12/2019. Patients with low density (upon non-contrast enhanced computer tomography [NCCT]), radiolucent (on plain radiography) urinary stones, a low urine pH (< 6) and/or history of uric acid urolithiasis were included. Potassium citrate and/or sodium bicarbonate were used for alkalization (target urine pH: 6.5-7.2). Patient 1:1 matching was performed for the presence of indwelling ureteral stent, stone diameter, stone density, and stone localization. Stone-free status was evaluated after 12 weeks using NCCT. Multivariable logistic regression analysis was used to assess factors affecting the outcome. RESULTS: Mean patient age was 61 years (73% males). Mean stone size was 12 mm. Overall success rates after 12-weeks of chemolysis for stones at any localization in the UUT and ureteral stones were 60.5 and 77.3%, respectively. Smaller stone size (OR = 0.94; CI 0.888-0.992; p = 0.026) and lower pre-treatment urine pH (OR = 0.131; CI 0.023-0.737; p = 0.021) significantly increased the success of oral chemolysis. Ureteral stenting did not have any impact on the efficacy of oral chemolysis. CONCLUSION: Oral chemolysis is an effective treatment modality for patients with UUT stones suspected of uric acid content irrespective of ureteral stenting. Smaller stone diameter and lower urine pH at diagnosis increase its efficacy.