[Anatomophysiological consideration on the sacral reflex]. / Considérations anatomo- physiologiques à propos du réftexe sacré.

Sacral reflex testing is a very specific one. Coming from sensory receptors afferent neuronal pudendal passway enters the spinal cord S2 to S4 via spinal dorsal roots and transmits the bioelectrical activity to a complex interneuronal circuitry. Information is processed at this level and dispached into spinal motoneurones for innervating the pelviperineal muscles according to their specific radicular origins. Selective staged sacral reflexes contribute to locate the site of compression. Sacral reflex configuration was based on clinical and electrophysiological findings which is actually confirmed and valided by anatomical studies. This testing is the most efficacious and useful procedure of assessing the pudendal neuralgia, the S2 to S4 reflexes and the pelvic floor dysfunctions.

[Female urinary incontinence: a review]. / L'incontinence urinaire de la femme: mise au point.

Female urinary incontinence is a frequent problem. The diagnosis is quite easy, but a precise interview and often an urodynamic exam have to be performed to assess the aetiology. Multiple pathologies cause incontinence. The therapeutic possibilities are various, especially for stress incontinence and urge. Stress, urge and mixed incontinence are the most frequent types. The diagnosis is clinical and in certain circumstances, paraclinic investigations and a specialised consultation are mandatory. Therapeutic success depends from a thorough diagnosis with a treatment based on several parameters, depending on the type of incontinence. The treatment will be medical, physiotherapy or surgery. Success rates varies in function of the type of incontinence. With new surgical techniques, the success rate for stress incontinence is as high as 90%.

Urodynamic parameters in patients with slight and severe genuine stress incontinence: is the stress profile useful?

This study evaluates the usefulness of the urethral pressure profile (UPP) parameters in assessing the severity of genuine stress incontinence (GSI). Functional length (FL), maximum urethral closure pressure (MUCP), pressure transmission ratio (PTR), residual area at stress (RAS), number of patients with incontinent spikes (IS), and distribution of IS on UPP were determined in supine and standing position for 54 patients (group 1) with a 1-hour pad test < 2 g and compared with the values of 63 patients (group 2) with a 1-hour pad test > 2 g. The results were similar: FL (supine: 24 mm +/- 6/26 mm +/- 7 [P:0.2]; standing: 26 mm +/- 8/24 mm +/- 11 [P:0.5]); MUCP (supine: 51 cm H2O +/- 23/47 cm H2O +/- 20 [P:0.3]; standing: 45 cm H2O +/- 21/38 cm H2O +/- 18 [P:0.1]); and PTR (supine: 83% +/- 27/84% +/- 31 [P:0.9]; standing: 81% +/- 25 and 88% +/- 27 [P:0.3]). But the RAS was lower (supine: 502 mm2 +/- 497/246 mm2 +/- 268 [P < 0.009]; standing: 500 mm2 +/- 534/271 mm2 +/- 306 [P < 0.05]) in group 2. If the percentage of patients with IS was higher (supine: 57/93% [P < 0.001]; standing: 54/84% [P < 0.01]) in group 2, the distribution of IS over the entire FL demonstrated no differences between group 1 and 2. In conclusion, except for the RAS, standard UPP parameters cannot be considered determinant in assessing the severity of GSI.