Pelvic autonomic dysfunction is common in patients with pure autonomic failure.

BACKGROUND AND PURPOSE: Pure autonomic failure (PAF) presents primarily as cardiovascular autonomic failure and may phenoconvert to other neurodegenerative disorders. However, the involvement of other autonomic functions has been poorly evaluated. This study aims to characterize genitourinary and bowel dysfunction and explore their relationship with cardiovascular autonomic dysfunction. METHODS: Pure autonomic failure patients underwent cardiovascular autonomic testing and an assessment of pelvic autonomic dysfunction using urinary, sexual symptoms questionnaires and a bladder diary. Demographic, clinical features and related medical comorbidities were assessed. RESULTS: Twenty-five patients (10 males) with PAF were included (mean age 71 ± 8 years; disease duration 13 ± 8 years). 96% (24/25) reported lower urinary tract symptoms, of which overactive bladder symptoms were most commonly reported (n = 23; 92%; median overactive subscore 8, interquartile range [IQR] 3-11), followed by voiding difficulties (n = 19; 76%; median low stream subscore 2, IQR 1-3) using the Urinary Symptom Profile; however, only four (16%) required clean intermittent self-catheterization. Sexual dysfunction was common (n = 21; 84%) using the Arizona Sexual Experience Scale. Mild faecal incontinence and constipation were reported. 86% (19/22) had nocturnal polyuria (NP) and the median NP index was 47% (IQR 38%-51%; normal range <33%). 77% (10/13) had voiding dysfunction and 31% (4/13) had post-void residual urine >100 mL. There were no significant correlations between the need for catheterization and the degree of NP with age, disease duration and cardiovascular autonomic parameters (p > 0.05). CONCLUSIONS: Nocturnal polyuria, genitourinary and bowel symptoms are commonly seen in PAF. The pathophysiology of NP in PAF is most likely multifactorial and may occur independent of cardiovascular autonomic failure.

[Intermittent catheterization: What are the environmental impacts and how can they be reduced?] / Sondage intermittent : quels sont les impacts environnementaux et comment les réduire ?

INTRODUCTION: If the use of intermittent catheterization has revolutionized the prognosis of neuro-urology patients, it seems necessary to question the ecological cost of single-use catheters, in a process of decarbonization of the health sector. The aim of this work is to identify the environmental impact of intermittent catheterization and potential solutions to reduce it. METHODS: A review of the literature on the environmental impact of intermittent catheterizations was conducted. Potential solutions to reduce this impact and possible alternatives were then studied based on data from the literature. RESULTS: Only two studies were identified. The first estimated the amount of waste generated by intermittent catheterization in the USA to be between 4400 and 38,964 tons per year. The second study showed a higher overall environmental impact of thermoplastic polyurethane (TPU) catheters than polyvinyl chloride (PVC) catheters and catheters made from polyolefin material. Reuse of catheters would reduce the amount of waste, but the paucity of data does not allow us to determine if the incidence of urinary tract infection would be affected. Alternative micturition methods, in addition to the complications they may cause, require the use of collection bags or pads, which also have an environmental impact. Other treatments for dysuria exist, but the evidence is limited and does not cover all patient populations. CONCLUSION: With limited alternatives, it appears essential to develop more environmentally friendly catheters.

A new tool to investigate anorectal disorders in patients with multiple sclerosis: STAR-Q.

BACKGROUND: Bowel symptoms are commonly experienced by patients with Multiple sclerosis (PwMS), but no specific questionnaire validated in this population allows a rigorous assessment. OBJECTIVE: Validation of a multidimensional questionnaire assessing bowel disorders in PwMS. METHODS: A prospective, multicenter study was conducted between April 2020 and April 2021. The STAR-Q (Symptoms' assessmenT of AnoRectal dysfunction Questionnaire), was built in 3 steps. First, literature review and qualitative interviews were performed to create the first version, discussed with a panel of experts. Then, a pilot study assessed comprehension, acceptation and pertinence of items. Finally, the validation study was designed to measure content validity, internal consistency reliability (alpha coefficient of Cronbach) and test-retest reliability [intraclass correlation coefficient (ICC)]. The primary outcome was good psychometric properties with Cronbach's α>0.7 and ICC>0.7. RESULTS: We included 231 PwMS. Comprehension, acceptation and pertinence were good. STAR-Q showed a very good internal consistency reliability (Cronbach's α=0.84) and test-retest reliability (ICC=0.89). Final version of STAR-Q was composed of 3 domains corresponding in symptoms (Q1-Q14), treatment and constraints (Q15-Q18) and impact on quality of life (Q19). Three categories of severity were determined (STAR-Q≤16: minor, between 17 and 20: moderate, and≥21: severe). CONCLUSIONS: STAR-Q presents very good psychometric properties and allows a multidimensional assessment of bowel disorders in PwMS.

Aqua: A new questionnaire assessing anticholinergic side effects in neurogenic population (Aqua: Anticholinergic side effects questionnaire).

AIMS: Validate a new questionnaire to assess the side effects secondary to anticholinergics in neurogenic population suffering from Adult neurogenic lower urinary tract dysfunction (ANLUTD). METHODS: We conducted a prospective, monocentric study in a Neuro-urology Department of a University Hospital between February 2015 and April 2020. To allow a full psychometric validation of a questionnaire, the study protocol included 3 steps: qualitative interviews, feasibility study and validation study. The primary outcome was good psychometric properties defined with good internal consistency reliability (Cronbach's α>0.7) and good test-retest reliability (intraclass correlation coefficient (ICC)>0.7). RESULTS: we included 64 patients with ANLUTD secondary to neurogenic disorders. Feasibility study demonstrate very good acceptation and comprehension for 97% of patients. Validation study showed good internal consistency with Cronbach's α=0,69 and very good ICC=0,73. AQUA is composed with 8 items scoring 0 (no side effect) to 2 (major side effect) for a total score between 0 to 16. Time to fulfill is very quick. Mean score in our population was 4,1 (sd 2,9). CONCLUSION: AQUA is the first validated tool to assess side effects secondary to antimuscarinic treatment for neurogenic population suffering from ANLUTD. LEVEL OF PROOF: 2.

[An initial lack of knowledge of the perineal anatomy does not influence the learning of intermittent self-catheterization in women]. / La méconnaissance initiale de l'anatomie périnéale n'influence pas l'apprentissage de l'auto-sondage intermittent chez la femme.

AIM: To evaluate the impact of female perineal anatomy knowledge on the success of a first learning of intermittent self-catheterization (ISC). METHODS: Thirty subjects benefited from educational diagnosis, training and follow-up during 2 visits in a neuro-urology department. Three knowledge anatomical tests were carried out: a freehand drawing, then a diagram to be annotated and a self-location of the following 6 structures (labia majora, labia minora, clitoris, urethral meatus, vaginal orifice, anus) as well as a physiological knowledge test. A correction was made after annotating the diagram to perfect the learning process before performing the procedure. RESULTS: Of the women studied, 83.3% had a neurological pathology and 77.7% had a gyneco-obstetrical history. Half of them had undergone perineal rehabilitation. Our study shows a lack of knowledge of the perineum prior to learning self-catheterization: 43.3% thought they knew it partially and 46.7% reported that they did not know it. Fifty-three percent of the subjects did not indicate the urethral meatus and 43.3% did not annotate the vaginal orifice on the diagram. Difficulties in anatomical transposition were observed: the urethral meatus was self-located in only 43.3% of subjects and 30% did not locate the vaginal orifice. Previous perineal rehabilitation was not benefical in the self-recognition of anatomical structures. However, all the patients, including those who did not initially locate the urethral meatus, acquired the technique of ISC. CONCLUSION: Intial perineal anatomy ignorance in women was frequent but was not an obstacle to learning ISC. LEVEL OF PROOF: 4.

[Prioritization of risk situations in neuro-urology: Guidelines based on the Delphi method from Association française d'urologie (AFU), Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), Groupe de neuro-urologie de langue française (GENULF), Société française de médecine physique et de réadaptation (SOFMER) and Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP)]. / Priorisation des situations à risque en neuro-urologie : recommandations par méthode Delphi de l'Association française d'urologie (AFU), l'Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), le Groupe de neuro-urologie de langue française (GENULF), la Société française de médecine physique et de réadaptation (SOFMER) et la Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP).

PURPOSE: During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology. METHODS: Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach. RESULTS: The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)). CONCLUSIONS: This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.

Comparison of clinical and paraclinical characteristics of patients with urge, mixed, and passive fecal incontinence: a systematic literature review.

PURPOSE: Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown as there are no clear established guidelines. To a better understanding, we performed a systematic review to characterize the different types of FI (active, passive, or mixed) on the basis of clinical presentation and complementary explorations. METHODS: This systematic literature review was performed in reference to recommendations for systematic review using PRISMA guidelines without date restriction, until May 2020. This systematic review was performed without temporal limitation using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases. RESULTS: Six hundred nine unique citations were identified from all the databases combined. Of those, 21 studies met the inclusion criteria, with 8 retrospective observational studies and 13 prospective observational studies. There was a lack of homogeneity in definitions of passive and urge (active) FI among studies. Prevalence of passive and urge FI was respectively of 4.0-5.0 and 15.0-35.0%. Clinical characteristics, physical examination, and endoanal imaging were not evaluated in most studies. In anorectal manometry, maximal squeeze pressure was higher in passive FI subgroup in most studies and results regarding maximal resting pressure remain discordant. There seemed to be no difference regarding first sensation volume and maximal tolerable volume among subgroups. A few studies evaluated pudendal terminal nerve motor latency with no difference among subgroups. CONCLUSION: There is a lack of well-conducted prospective studies comparing the different subtypes of FI with validated definitions in both clinical and paraclinical examinations.

Adherence to transanal irrigation in older adults: first-year assessment.

BACKGROUND: While the prevalence of chronic constipation and fecal incontinence increases with age, few data on transanal irrigation in older adults are available. The aim of this study was to assess the adherence and predictive factors for adherence to transanal irrigation during the first year of use in older adults. METHODS: This retrospective study included all patients over 65 years old, who had therapeutic education for transanal irrigation with the Peristeen® device between January 2010 and July 2019 in a neuro-urology department of a university hospital in France. The adherence rate was assessed at 1, 3, 6, and 12 months. Predictive factors for adherence were looked for by comparing persistent population and non-persistent population at 1, 3, 6, and 12 months. RESULTS: Sixty-nine patients over 65 years old were included. The adherence rate was 73.9% at 1 month, 55.1% at 3 months, 46.4% at 6 months, and 40.1% at 1 year. No predictive factor for adherence to transanal irrigation was identified. CONCLUSIONS: Adherence to transanal irrigation during the first year in older adults remains close to that in the adult general population. Predictive factors of adherence remain unclear.

Verbal instruction to obtain voluntary pelvic floor muscle contraction: Acceptability, and understanding.

PURPOSE: The aim of this study was to describe verbal instructions used to obtain a voluntary pelvic floor muscle contraction and to evaluate their understanding and acceptability. METHODS: This prospective study led in two phases. A questionnaire was submitted to experts to collect the most frequently used instructions to obtain a PFMC. Then a questionnaire was submitted to subjects in order to: estimate the pelvic floor anatomical knowledge; estimate understanding and acceptability of these instructions; select the best instruction. RESULTS: First phase: 46 experts proposed 356 instructions. Forty-four percent were functional instructions ("hold a gas"), 40% anatomical ("squeeze your anus") and 16% allied both. Fifteen instructions for the women and 11 for the men were selected. Second phase: 33 subjects completed the questionnaire. More than 75% had correct answers for anatomical knowledge. The instructions judged by the subjects as the most adapted to obtain a PFMC were: "contract the anus", "do as if you wanted to hold a strong desire to void". The items including "perineum" or "vagina" were less understood. CONCLUSIONS: The more understandable and acceptable instruction to assess the PFMC is the association of two simple instructions: one anatomical and one functional. LEVEL OF EVIDENCE: 4.

[Neurological complications of coitus: Review of literature]. / Complications neurologiques du coït : revue de la littérature.

INTRODUCTION: Sexual activity is composed of different phases (excitation, plateau, resolution). Each phase is associated with cardiovascular, respiratory, muscular and hormonal modification which can have an influence on the nervous system. This impact has been studied many times in literature, but no study has synthetized the complications related to coitus or orgasm. METHOD: Systematic review of literature on neurological complications, except headache, of coitus based on Medline and Embase. RESULTS: We screened 1424 articles and selected 46 for this review. 7 (15 %) were clinical or epidemiologic studies, 6 (13 %) were reviews of literature and 33 (72 %) were cases or series of cases reports. 12 articles (26 %) talked about strokes, 10 (22 %) about subarachnoid hemorrhage, 9 (20 %) about reversible cerebral vasoconstriction syndrome. We found 3 (7 %) articles for each of the following complication: intraparenchymal, hematoma and epilepsy. Autonomic hypereflexia was treated in 3 articles (7 %). Only 1 article was included concerning ictus, spinal cord injury, neuralgia and cataplexia. These events can be considered as rare as emergencies related to sexual activity represent only 0.1 % of all emergencies and among these, 12 % are neurological. 31 of the reported cases concerned vascular events (stroke or hemorrhage) and 18 (58 %) of these patients had a patent malformation (aneurism, intracardiac shunt, foramen ovale). CONCLUSION: This is one of the first review of literature trying to synthetise the neurological complications of coitus. Many articles exist in literature. It is necessary to prevent the occurrence of these complications in a population already at risk of neurological events.

[Urethral reflexes: A review]. / Les réflexes urétraux : revue de la littérature.

INTRODUCTION: The urethrosphincter complex is involved not only in maintaining urinary continence, particularly during effort, but also for the achievement of a complete and effective micturition. Indeed, the urethra is not a simple passive channel for the evacuation of urine from the bladder to the urethral meatus, since its resistive capacities and its possibilities of modulation of the micturition reflex depend on its reflex role either as a sensory afferent or as a neuro-muscular effector. It also participates in many genito-sexual and ano-rectal réflexes. MATERIAL AND METHOD: This review of the literature describes the various reflexes of the urethra as a sensory stimulus or a neuromuscular effector. All articles referenced in this review were obtained from articles indexed on Pubmed-Medline, using the keywords: "urethral reflexes; "reflex bladder"; "urination reflex"; "intravaginal; vaginal"; "anorectal; sphincter"; "Storage and voiding"; "reflexes sneezing"; "cough reflex". Other articles were selected through references of the articles issued from the first research. Only articles in English and French have been selected. The articles concerned animal and human experiments. RESULTS: Eight hundred and sixty-four referenced articles were founded and a total of 75 articles were included, describing the various reflexes mediated by the urethra acting as a sensory afferent or mechanical effector. We differentiated the known data in humans and animals. CONCLUSION: The urethra is a complex anatomical structure ensuring, through numerous reflex mechanisms, urinary continence. Urethral resistances are modulated during efforts and depends on the bladder capacity and the intensity of the efforts. During micturition, the coordination between the bladder and the urethra is mediated by reflex pathways organized at the cerebral, spinal and lumbosacral levels. The modulation of the micturition in term of efficacy and velocity, is due in part, to the re-afferentation of the spinal reflex by continuous stimulus of the urethral canal. Many of these reflexes are imperfectly described. Finally, the urethra is implicated in reflex loops of anal continence and sexual functions.

[Urinary disorders of Wolfram syndrome. Clinical and urodynamic analysis from 6 observations]. / Les troubles vésico-sphinctériens du syndrome de Wolfram. Analyse clinique et urodynamique à partir de 6 observations.

Wolfram syndrome is a neurodegenerative disorder characterized by childhood onset diabetes mellitus, optic nerve atrophy, diabetes insipidus, hearing impairment, brainstem alteration and commonly bladder and bowel dysfunction. OBJECTIVE: We present here, 6 new cases of urinary dysfunction in this rare disease. RESULTS: All patients had urinary retention with overactive bladder. The urodynamic assessment found overactive detrusor in 3 cases. Five out of six patients performed self-catheterization and were treated with anticholinergics or intradetrusor injection of botulinum toxin. The follow-up at 5 years found an alteration of the upper urinary tracts and a renal failure 3/6. CONCLUSION: Urinary dysfunction is common in Wolfram syndrome, mainly characterized by overactive bladder and urinary retention. The urological risk is major requiring a systelmatic follow-up of these patients. LEVEL OF EVIDENCE: 4.

[Concepts and assessment methods in lower urinary tract symptoms: From symptom score to Patient-Reported Outcomes and Outcomes (PRO)]. / Concepts et méthodes d'évaluation en pelvi périnéologie : du score de symptômes aux attentes et résultats rapportés par les patients (PRO).

INTRODUCTION: The evaluation of pelvic perineal treatments has changed significantly in recent years. Initially focused on the assessment of symptoms, quality of life or patient satisfaction, it has gradually turned to new concepts, such as Patient Reported Outcome (PRO) and Goal Attainment (GA). OBJECTIVE: To describe the different concepts and methods of assessment available, in recent years, in the context of urinary functional pathologies such as bladder overactivity or urinary incontinence. METHODS: We conducted a non-systematic literature review to identify the main questionnaires and tools available to evaluate treatment outcomes. Oncology and pediatrics questionnaire has been excluded. RESULTS: In functional pathology (overactive bladder or incontinence), the objective of treatment is to meet the expectations of patients and it is important to be able to assess the feelings of patients. In this context, new specific questionnaires have been developed to evaluate the PROs. For about ten years, these subjective criteria, are more and more widespread in the evaluation of treatments. A new field then appeared, namely Goal Attainment Scaling (GAS) and Self Appreciation Goal Attainment (SAGA), allowing to determine with the patient, the expected objectives of the treatment. CONCLUSION: These concepts of PRO and GAS open up a new domain in the evaluation of treatments, with a subjective view of the results. They deserve to be integrated into the usual, objective evaluations, in order to adapt the treatment of the patients, according to the real impact of the treatment.

[Effects of attention and desire to void on sensory evoked cortical potentials following perineal stimulation]. / Modification de la structuration des potentiels évoqués cérébraux sensoriels par stimulation périnéale lors d'une focalisation attentionnelle sur le besoin d'uriner.

OBJECTIVE: Cortical somatosensory evoked potentials (SEP) are usually used to test the integrity of lemniscal pathways and thus provide arguments for the neurogenic etiology of sensory symptoms. For example, PES by perineal stimulation (SEP-P) has been shown to be altered in incontinence or neurogenic sexual dysfunction. We wanted to verify the integrity, structure and amplitude of far-field responses of PES-P in two conditions, the first without feeling the need to urinate (S0), the second with urgency (US). METHODS: SEP-P were recorded in ten patients without neurological pathology in both conditions S0 and US after stimulation of the dorsal nerve of the penis/clitoris. Three consecutive responses each averaged over 1000 passages at a frequency of 3Hz were recorded. RESULTS: Seven men and 3 women were included. All patients had normal SEP-P in terms of amplitude and latency of the P40 complex and fully reproducible especially for late responses. These early P40 responses were identical in both S0 and US states. Conversely, the far-field potentials, i.e. the late responses, were different in the two states, with a significant decrease (P<0.008 paired T-test) in the amplitude of cortical responses in the US state. CONCLUSION: We observe that the late components of SEP-P were altered by the need to urinate urgently with sustained and selective attention to this need. These late components of SEP-P could be useful to better specify the attentional mechanisms involved in the continence-voiding cycle and to specify pathological sensory dysfunctions (urgency, painful bladder, frequency…). LEVEL OF EVIDENCE: 4.

Effect of need to void on Parkinsonian gait.

AIMS: Beside motor control alteration and tremor, the main symptoms in Parkinsonian disorders, lower urinary tract dysfunction is very common and thus often associated with gait disorder. No studies have assessed their association yet. The aim of this study was to assess the effect of the need to void on walking speed in this particular population. The secondary aim was to assess the effect of desire to void in a double task condition on the walking speed, and on the time to raise up from the floor. METHODS: This prospective study included all Parkinsonian disorders who had a follow-up for overactive bladder (OAB). We invited them to drink until a desire to void or equivalent (DV), then they performed three ten-meters walk tests, one double-task ten-meters walk test, one timed-up-and-go test (TUG), one timed raise of the floor (GMT). We repeated the same tests just after bladder emptying. RESULTS: Nine men and two women (age 69±6) were included in the study (seven Parkinson's Diseases, two multisystem atrophies, two not yet characterized). Mean scores of UPDRS-III were 17±6.5, Hoehn & Yahr scale were 1.9±0.7, time since onset 7±4.4 years, levodopa daily equivalent 691±478mg. Patients performed the walking tests at DV with a mean bladder volume from 220±189mL. The mean speed was 1m/s at DV and 1.1m/s at PV (P<0.001). TUG was also increased for patients at DV: mean 9.8 s at DV versus 8.8sec at PV (P<0.003). CONCLUSION: In Parkinsonian disorders, need to void may impact the walking speed, a strong desire to void worsening gait velocity. LEVEL OF EVIDENCE: 4.

How to dress up in Neuro-urology department?

INTRODUCTION: To examine patient preferences and perceptions regarding physician dress code in a neuro-urology department. MATERIAL: A questionnaire presenting with different physician dress codes was submitted to patients in a neuro-urology department: casual outfit with white coat, scrubs and scrubs with white coat. Respondents selected their ideal dress code and mentioned if any dress code shock them. Respondents' general opinions regarding physician attire, its importance and relation with patient satisfaction were collected. RESULTS: 163 questionnaires were completed. The three physician attires were chosen equally by the respondents. 71.4% of the respondents felt comfortable with the three attires. When an attire appeared to be offending, the casual attire with white coat was mentioned in 68.2%. 52.5% of the patients reported that the way their doctor dressed was important to them. 36.3% of respondents reported that physician attire influenced how confident they felt about the care they received. Male respondents preferred scrubs with white coat (44.0%) while female respondents preferred casual attire with white coat (42.0%), P=0.02. Neither the age, nor the reason of the consult, the knowledge of the department, the presence of neurological disease, the occupational category and the education level of the patient had an influence on the preference for one specific physician attire. CONCLUSION: Physician attire in neuro-urology may influence the way that patients perceive care. Physicians must not be restricted to one particular attire in neuro-urology department. However since almost 20% of the patients feel uncomfortable with the casual attire and white coat, it should be avoided. LEVEL OF EVIDENCE: 4.

[Anal tone: Physiology, clinical and instrumental characteristics]. / Tonus anal : déterminant physiologique, évaluation clinique et paraclinique, caractéristique pathologique.

INTRODUCTION: The anal tone allows the maintenance of anorectal continence. Its regulation depends on spinal segmental mechanisms under supra-sacral control. MATERIAL AND METHODS: A systematic review was performed using Medline database, according to PRISMA methodology, using following keywords anal tone ; anal sphincter ; anorectal function ; reflex ; digital rectal examination. RESULTS: Anal hypertonia is an increase in the muscle's resistance to passive stretching. Muscular hypotonia is a decrease in muscle tone. It is associated with a decrease in resistance to passive mobilization. It is not possible to quantify the prevalence of anal tone alterations in the general population and in specific pathological conditions (urinary disorders, neurogenic or non-neurogenic anorectal disorders). In case of hypotonia, most often due to a lower motor neuron lesion, fecal incontinence may occur. Hypertonia (anal sphincter overactivity) is not always due to perineal spasticity. Indeed, in the majority of the cases, the cause of this anal hypertonia in a neurologic context, can be secondary to an upper motor neuron disease due to spinal or encephalic lesion, leading to recto-anal dyssynergia, giving distal constipation. In another way, this anal hypertonia can be purely behavioral, with no direct pathological significance. The evaluation of anal tone is clinical with validated scores but whose sensitivity is not absolute, and instrumental with, on the one hand, the measurement of anal pressure in manometry and, on the other hand, electrophysiological testing which still require validation in this indication. CONCLUSION: Anal tone assessment is of interest in clinical practice because it gives diagnostic arguments for the neurological lesion and its level, in the presence of urinary or anorectal symptoms.

[Ejaculation disorders in multiple sclerosis: Prospective study of 44 patients]. / Troubles de l'éjaculation et sclérose en plaques : étude prospective de 44 patients.

INTRODUCTION: To analyze in a descriptive way the ejaculation disorders during MS and to study the correlations between dysejaculations, other sexual, urinary and anorectal disorders. MATERIAL: Prospective, monocentric, non-interventional study. Ejaculation disorders were assessed by Premature Ejaculation Profile (PEP) scores, intravaginal latency, and the Male Sexual Health Questionnaire - Ejaculation (MSHQ-Ej). The sexual disorders were evaluated by the International Index of Erectile Function (IIEF15) and the Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ). RESULTS: Forty-four men of mean age 46.8 (±10.3) years, with an average EDSS of 5.0 (±1.5) were included. According to the MSHQ-Ej score, ejaculation disorders were present in 28 out of 44 patients included (64%); 26/44 (59%) had an orgasm disorder, 23/44 (52%) a delay in ejaculation, 26/44 (59%) a decrease in ejaculation flow, 24/44 (55%) decreased ejaculated volume, 18/44 (41%) decreased ejaculation frequency, 15/44 (33%) ejaculatory pain and 11 34 (25%) showed systematic non ejaculation. The PEP score showed premature ejaculation in 14 patients (32%). The intra-vaginal latency time was less than 1minute in 6 patients (13.6%). There was a statistically significant correlation between ejaculation disorders and erectile dysfunction (P<0.05, correlation coefficient at 0.53) but no statistically significant correlation between ejaculation disorders and urinary or ano-rectal disorders. CONCLUSIONS: Dysejaculation was present in 64% of MS. These disorders were mainly characterized by a decrease in the volume of the ejaculation, the strength of ejaculation and the delay in ejaculation. LEVEL OF EVIDENCE: 4.

[Impact of body mass index on lower urinary tract disorders in multiple sclerosis]. / Influence de l'indice de masse corporelle sur les troubles urinaires de la sclérose en plaques.

INTRODUCTION: Lower urinary tract symptoms (LUTS), and principally overactive bladder, are common in multiple sclerosis (MS). However, their origin is not necessarily unique. Obesity is widely recognized as a risk factor for stress urinary incontinence (SUI) and overactive bladder (OAB) in the general population. We wanted to evaluate the influence of body mass index (BMI) on LUTS in the MS population. MATERIALS AND METHODS: We conducted an uncontrolled monocentric retrospective study in 260 subjects classified into 4 BMI groups: underweight, normal weight, overweight, obese people. Comparisons by Mann-Whitney test were made between different BMI groups, in the overall population and then by gender. LUTS (SUI, OAB, BOO (bladder outlet obstruction) were assessed using USP questionnaire. RESULTS: In women, the mean OAB score was higher for obese women, 10.27 (SD=4.5) than for normal weight women, 7.96 (SD=4.58), P=0.024. The SUI score was lower for normal weight, 1.69 (SD=2.38) than for overweight, 3.19 (SD=2.91), P=0.002 and obese subjects, 3.80 (SD=3.23), P=0.0005. As in the overall population, the BOO score was higher in subjects with normal weight, 4.09 (SD=3.33) than in subjects with overweight, 1.91 (SD=2.03), P=0.0003 and in obese subjects, 2.33 (SD=2.37), P=0.013. The same comparisons in men were not significant. CONCLUSION: In this series, increased BMI was associated with higher OAB and SUI USP questionnaire scores, in women presenting with MS. LEVEL OF EVIDENCE: 4.

[Vaginal gas: Review]. / Gaz vaginaux : revue de la littérature.

OBJECTIVE: The aim of this article was to review the literature about vaginal winds (VW). METHODS: A literature review (Medline database, Cochrane Library and Google scholar) with no time limit was performed using keywords "vaginal winds", "vaginal noise", "vaginal gaz", "flatus vaginalis", "vaginal flatus", "colpophony", "Garrulitas vulvae", "vaginal laxity". RESULTS: From 412 articles about VW, 15 have been selected and 99 from 110 about vaginal laxity. VW occurs during physical exercises but also during and just after coïtus. The prevalence is about 20%. The pathophyiology of VW is probably a vaginal hyperlaxity itself secondary to pelvic floor muscles weakness and thus increased diameter of vaginal hiatus. VW alter sexual function in female patients but this sexual function seems not influenced in male partners. Tampons or pessaries are currently the most commonly proposed treatment (but naturally impossible to use during sexual intercourse), but some results from vaginal laser therapy are encouraging. CONCLUSION: Data from the literature suggest that vaginal winds are frequent and seriously impact quality of life of female patients. Childbirth and more generally vaginal laxity are the main causes. Pelvic-floor exercises, tampons, pessaries, surgery and laser can be proposed in order to improve sexual function in patients seeking treatment.