Eighteen years of experience in laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency.

INTRODUCTION AND OBJECTIVES: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients. METHODS: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated. RESULTS: In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency. CONCLUSIONS: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.

[Primary adenocarcinoma of the bladder and renal transplantation]. / Adénocarcinome primitif de vessie et transplantation rénale.

Primary bladder adenocarcinoma is a rare tumour which represents between 0.5% and 2% of malignant bladder tumours. The incidence of malignant tumours is increased in renal transplant recipients. The combination of primary bladder adenocarcinoma and renal transplantation is exceptional. The authors report a case of primary bladder adenocarcinoma in a 34-year-old patient who had undergone renal transplantation 5 years previously. In the light of this case, the authors discuss the various cases reported in the literature and the specific management of this rare tumour.

[Paraneoplastic urticarial vasculitis and renal carcinoma]. / Vasculite urticarienne paranéoplasique et carcinome rénal.

Paraneoplastic syndromes have been described in various types of tumours, but are rarely associated with renal cancer. Paraneoplastic cutaneous manifestations, consisting of urticarial vasculitis are exceptional and can sometimes constitute the presenting sign of a completely asymptomatic renal cancer. This vasculitis resolves after curative treatment of the tumour, confirming its paraneoplastic nature. The authors report a case of a paraneoplastic urticarial vasculitis associated with the discovery of an asymptomatic renal carcinoma in a 37-year-old man and discuss paraneoplastic cutaneous syndromes that must be recognised to allow earlier diagnosis of renal tumours.

[Pelvic pain caused by bladder leiomyoma: diagnostic and radiologic difficulties]. / Algies pelviennes d'un léiomyome de vessie: difficultés diagnostique et radiologique.

Uterine leiomyoma is a frequent benign lesion. It is usually asymptomatic and can be responsible for acquired dysmenorrhoea in some women, leading to gynaecological assessment. However, the development of this type of muscle lesions arising from the bladder wall and accompanied exclusively by dysmenorrhoea is rare. It is very difficult to study the anatomical relations of the lesion and distinguish it from other pelvic, genital or urinary tract tumours. The authors discuss the diagnostic aspects and therapeutic management in the light of a case of bladder leiomyoma in a 39-year-old woman.