[Autologous fascia pubovaginal slings in women with stress urinary incontinence at high risk of mesh/device-related complications]. / Bandelette aponévrotique pubovaginale pour incontinence urinaire d'effort chez les femmes à risque de complications prothétiques.

INTRODUCTION: Very popular in many parts of the world, autologous fascial pubovaginal sling (AFPVS) remains marginally used in France. However, it may be of particular interest in patients carrying a high risk of mesh-related or device-related related complications. The aim of the present series was to report the outcomes of AFPVS in this high-risk population. MATERIAL AND METHODS: The charts of all female patients who underwent a fascial sling for SUI at a single academic center between April 2019 and May 2021 were reviewed retrospectively. Only patients deemed at high-risk of device/mesh related complications were included in the present analysis: female with a neurological condition who were doing clean intermittent catheterization (CIC), female with SUI after radical cystectomy and ileal neobladder, female with urethral/bladder extrusion of any synthetic material placed for SUI. Success was defined as complete resolution of SUI at 3 months. RESULTS: Sixteen patients were included in this study: 13 rectus fascia slings and 3 fascia lata slings. The success rate was 56.3% (9/16 patients). Four patients were improved but not completely dry (25%). Two patients had major postoperative complications (i.e. Clavien grade 3 or higher, 11.2%). Two patients had a persisting significant post-void residual (PVR) postoperatively, managed by self-catheterization (transition to self-catheterization at 3 months: 2/8, 25%). CONCLUSION: The use of autologous fascia pubovaginal sling is an interesting option in female SUI patients with high risk of device/mesh related complications with satisfactory functional outcomes. LEVEL OF PROOF: 4.

[Treatment of female recurrent or not stress urinary incontinence with intrinsic sphincter deficiency: Sub-urethral retropubic adjustable sling (Remeex)]. / Traitement de l'incontinence urinaire d'effort féminine avec insuffisance sphinctérienne récidivée ou non : la bandelette rétropubienne ajustable Remeex.

INTRODUCTION: Recommendations for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincteric deficiency (ISD) or recurrent, are complex. They accept the use of sub-urethral slings (BSU), if unsuccessful the artificial urinary sphincter. The objective was to report the results in terms of continence and morbidity of the Remeex® Adjustable BSU in the treatment of SUI by ISD recurrent or non-recurrent. METHOD: Monocentric retrospective study of 70 patients with a mean age of 67.7 years (±12) operated of Remeex sling, between 2015 and 2019, was conducted. Preoperative and postoperative characteristics were analyzed from medical records. Two groups were analyzed: Group A (n=28) with no history of incontinence surgery and Group B (n=42) with history (recurrent). Patients who were totally continent (0 protection) and those who were socially continent (1 safety protection) were considered successful. RESULT: Postoperative success rate was similar between groups B (90 %) and A (92%) with respectively: 64% versus 71% of totally continent patients, 26% versus 21% wearing safety protection. The postoperative complications were mainly Clavien II (28%) such as urinary tract infections (6%), transient urinary retention (3%) and de novo bladder overactivity (20%) with no significant statistical difference between the groups. Six patients were reoperated (Clavien III): BSU detension (1%), vaginal exposure (4%) (including one total material removal for infection), varitensor explantation (1%) or scar disunion (1%). CONCLUSION: The Remeex® BSUA seems to lead to satisfactory perioperative results in patients with SUI with ISD recurrent or non-recurrent.

[Voiding dysfunction after TVT: A 20-year experience TVT-placement under local anesthesia and sedation]. / Troubles mictionnelles après pose de TVT : 20 ans d'expérience de pose sous diazanalgésie et anesthésie locale.

BACKGROUND: Trans-vaginal tape has become the gold standard for the cure of urinary stress incontinence, but post-operative voiding dysfunction is frequently reported. The purpose of this study is to assess the incidence of voiding dysfunction, dysuria, chronic urinary retention, and necessity of reoperation after retropubic TVT placement under local anaesthesia and sedation. MATERIAL AND METHOD: We perform a retrospective study of a cohort of patient treated with the placement of a retropubic TVT under local anaesthesia and sedation between 1999 and 2019 for a SUI. Post-operative voiding dysfunction and necessity of reoperation were reviewed to access the principal aim of this study. RESULTS: Three hundred and two patients who met the eligibility criteria were included in the study. At 3 months, the dysuria rate and chronic urinary retention rate was 4.3% and 1%. At 12 months it was 2.6% and 0.3% respectively. The 12-month sling section rate was 1% and long-term self-catherization rate was 0.3%. The objective cure rate was 93% and subjective cure was 92%. CONCLUSION: TVT placement under local anaesthesia and sedation resulted in few voiding dysfunctions at medium/long-term, necessity of re-operation for refractory obstructive disorder and well functional results. Even if these results support more frequent use of this type of anaesthesia, it would be interesting to be able to follow them in a prospective study to conclude. LEVEL OF EVIDENCE: 4.

[Trends in the use of midurethral slings after the new legislation: A nationwide survey]. / Évolution des pratiques après l'arrêté encadrant les bandelettes sous-urétrales : résultats d'une enquête nationale.

INTRODUCTION: The French Department of Health published on October 23, 2020 a decree governing acts associated with mid-urethral sling (MUS) operations. The aim of this study was to evaluate the changes in practice following this new legislation. METHODS: A cross-sectional study was carried out among French urologists and gynecologists using an online survey to collect changes in practices since the publication of the decree. RESULTS: From January to February 2021, 436 surgeons participated in the survey. Among these surgeons, 87% were aware of the new legislation and 56% of them considered the decree as useless. The order resulted in an increase in working time in 81% of cases. Among these surgeons, 66% of the surgeons worked in tertiary referral centers for the management of incontinence, of which 55% had a multidisciplinary meeting in urogynecology. Among the surgeons, 31% considered this meeting to be useful but 80% considered that it did not lead to any change in surgical indications, even though 33% of complications of BSU were discussed there. In conclusion, 61% of surgeons felt more reluctant to schedule a BSU placement with this new legislation. CONCLUSION: The majority of questioned surgeons considered the decree as useless. It generated few changes in practices which already respected the law on information, consultation, consent, experience and training. Most urologists and gynecologists are more reluctant to offer MUS after this new legislation. LEVEL OF EVIDENCE: 4.

[Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology]. / Complications des bandelettes sous urétrales : une revue de la littérature par le Comité d'urologie et pelvipérinéologie de la femme de l'Association française d'urologie.

INTRODUCTION: Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. OBJECTIVES: In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. RESULTS: Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. CONCLUSION: Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.

[Short-term evaluation of Altis® single-incision sling in women stress urinary incontinence]. / Évaluation à court terme de la mini-bandelette Altis® dans l'incontinence urinaire d'effort chez la femme.

INTRODUCTION: Midurethral slings are the main surgical treatment of stress urinary incontinence. Altis is a minimally invasive single-incision sling system. The aim of this study is to report the safety and efficacity results during a year of follow up. MATERIALS AND METHODS: This single-centre and retrospective study has been performed in a university hospital, between February 2015 and May 2018. We included women aged more than 18, complaining a stress urinary incontinence with a urethral hypermobility and positive support maneuvers, who had failed from non surgical treatment. A prospective data collection has been done at the moment of inclusion, peroperative time, at 6 weeks, 6 months and a year after the procedure. The main evaluation criteria was the cure rate at twelve months. RESULTS: Thirty patients were included in our study. The mean age was 45,4±12,9 years old, the mean ICIQ-UI score was 13,5±4,06 and the median pad test was at 12g. Ninety three percent of the procedures were done as ambulatory surgery. The average operating time was at 22,2minutes. Overall, 75% of our patients were objectively cured and 14,2% were in fail of this treatment. CONCLUSION: The short term results show a good efficacity and safety of this procedure. But its place remains to be defined in relation to other techniques, TVT, TOT and non-prosthetic techniques. LEVEL OF EVIDENCE: 3.

[Surgical management of suburethral sling complications and functional outcomes]. / Prise en charge chirurgicale des complications de bandelette sous-urétrale et résultats fonctionnels.

OBJECTIVES: To identify various clinical presentation leading to the diagnosis of mid-urethral sling (MUS) complications and to analyze the functional outcomes after surgical management of these complications. METHOD: Retrospective observational monocentric study of all patients treated by MUS section or removal, between December 2005 and October 2019, in a pelviperineology centre. RESULTS: During this study, 96 patients were included. MUS complications surgically managed were vaginal mesh exposure (48 %), urethral mesh exposure (17 %), bladder mesh exposure (10 %); dysuria (30 %), pain (6 %), and infection (3 %). The mean time to diagnosis was 2 years. This diagnosis delay was caused by a non-specific and heterogeneous symptomatology. Surgical management consisted in MUS partial removal (79 %) and MUS simple section (21 %) with low perioperative morbidity. At three months follow-up, 36 patients (53 %) had stress urinary incontinence (SUI), including 13 (19 %) de novo (meaning no SUI before MUS section/removal) and 19 (28 %) had overactive bladder, including 9 (13 %) de novo. Half of the patients with SUI after MUS section/removal were able to be treated by a second MUS with a success rate of 83 % at 3 years. CONCLUSION: Clinical presentation of MUS complications is heterogeneous. Surgical treatment was associated with low morbidity in our study. Post-operatively, half of the patients had SUI and a second MUS was a relevant treatment option after proper evaluation. LEVEL OF EVIDENCE: 4.

Evolution of patients with and without preoperative stress urinary incontinence after surgical cystocele repair by mesh implantation using a vaginal approach.

INTRODUCTION: To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. MATERIAL AND METHODS: Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. RESULTS: Thirty-six women were included (mean age: 72±7years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41±12min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n=6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR=2.0 [95% CI: 0.8175-4.8928]; P=0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. CONCLUSION: Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. LEVEL OF EVIDENCE: 4.

Efficacy of the VIRTUE male quadratic sling in the treatment of stress urinary incontinence: A retrospective study.

AIM: To assess the efficacy and the impact on the quality of life (QoL) of patients suffering stress urinary incontinence (SUI) treated with VIRTUE © sling. MATERIAL AND METHOD: Retrospective monocenteric study where patients treated with VIRTUE © sling were included between January 2016 and May 2018. The severity of the incontinence was judged based on the number of protection used per day (PPD) and/or on the 24hours pad test into mild, moderate and severe: ≥2 protections and/or <100ml/24h, 3-4 protections and/or 101-200ml/24h, >4 protections and/or>200ml/24h respectively. The criteria of success was achieved when the patient is dry or ameliorated. The ICIQ- UI sf questionnaire was used as a measure of QoL. RESULTS: Thirty-five patients were included in this study with mean follow up time of 11 months (range: 3-26). Twenty-nine patients had a radical prostatectomy, 3 had endoscopic treatment for benign prostatic hyperplasia, 9 patient had radiotherapy of which one had a complementary focal treatment (HIFU), and two patients had spinal cord injury. The success rate was 83%. The score ICIQ-UI sf showed a statistical difference between the pre and post-operative periods in both success and failure groups (P<0.001). History of radiotherapy, low bladder compliance, and severe incontinence were associated with negative result. Pain was the most recorded post-operative complication and no>grade 2 Clavien Dindo complications were encountered. CONCLUSION: The VIRTUE © sling seems to be an effective, safe tool treating SUI at short term. LEVEL OF EVIDENCE: 3.

[Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation]. / Évaluation urodynamique de patients guéris d'incontinence urinaire d'effort post-prostatectomie radicale après implantation d'une bandelette sous-urétrale transobturatrice.

INTRODUCTION: The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence. PATIENTS AND METHODS: In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®). RESULTS: Urodynamic studies were performed after a median time of 9months (min 4 - max 34) following sling implantation. Postoperatively, a rise of 11cm H2O in median MUCP (P=0.09) and an increase of 14mm in median FUL (P=0.13) were observed. None of the urodynamic changes was statistically significant. CONCLUSIONS: Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies. LEVEL OF EVIDENCE: 4.

[Adjustable retropubic suburethral sling Remeex® in the treatment of male stress urinary incontinence: One-year results]. / Bandelette sous-urétrale rétropubienne ajustable Remeex® dans le traitement de l'incontinence urinaire d'effort masculine : résultats à un an.

OBJECTIVE: To evaluate the efficacy and safety of the adjustable suburethral sling Remeex® in the treatment of male stress urinary incontinence (SUI). PATIENTS AND METHODS: Single-center prospective study of patients treated for SUI after radical prostatectomy or transurethral resection of prostate. The severity of incontinence was evaluated by the number of pads used per day. Success rate, complications and number of adjustments were studied. RESULTS: From February 2011 to May 2015, Remeex® was implanted in 25 patients. The average preoperative number of pads used per day was 3,8 (±1,8). Sling tension has been adjusted the day after surgery in all patients. Mean follow-up was 31 months (±15). During follow-up, 6 patients did not need any readjustment (24%) and 15 patients (60%) had to be readjusted. One Remeex system had to be completely removed because of a sub-occlusive syndrome. Three patients had early infection requiring partial system removal (Varitensor). At the end of follow-up, 9 patients were cured (36%), 9 patients (36%) were significantly improved and 7 patients (28%) were not improved. Five patients are waiting for a new readjustment. CONCLUSION: In this short series of patients who had prostatic surgery, at mid-term follow-up, the placement of a BSUA-R was associated with an improvement or cure of urinary incontinence symptoms in two-thirds of cases. LEVEL OF EVIDENCE: 4.

[Placement of tension-free vaginal tape in women with stress urinary incontinence: Long-term functional outcomes in a prospective series]. / Résultats fonctionnels à long terme de la bandelette sous-urétrale rétropubienne TVT (tension-free vaginal tape) pour le traitement de l'incontinence urinaire d'effort féminine : étude monocentrique prospective.

PURPOSE: To evaluate the long-term functional outcomes after retropubic tension-free vaginal tape (TVT) placement to treat female stress urinary incontinence (SUI). METHODS: From September 1998 to September 2000, we prospectively enrolled all consecutive women in our center suffering SUI caused by urethral hypermobility. All women had a retropubic TVT inserted by the same surgeon. Patients were evaluated at 1, 3, 6 and 12 months postoperatively, and annually thereafter. Postoperative assessment included a measurement of post-voiding residual volume, urinalysis, a 1-hour pad test, a urinary symptom questionnaire, and an assessment of quality-of-life. Objective continence (defined as no urine leakage at clinical examination) and subjective continence (defined as no urine leakage, whatever the mechanism, reported by the patient) were reported. RESULTS: Overall, 58 consecutive women (median age 59; IQR 49-67; min 21-max 78) were evaluated. Median follow-up was 10.2years (IQR 1.4-16.0; min 1-max 13.2). At the last follow-up, objective and subjective continence rates were 93% and 78%, respectively and remained stable in the long run. Pad tests, urinary symptom questionnaire scores and quality-of-life were significantly improved. Self-intermittent catheterisation was required by three women. A section of one TVT and removal of another tape was undertaken in two women with chronic pelvic pain. One patient had a chronic urinary infection. Rate of de novo urgency was 10%. CONCLUSIONS: TVT implantation offered good and stable functional long-term outcomes. This procedure enhanced quality-of-life and had low morbidity. LEVEL OF EVIDENCE: 3.

[Impact of laparoscopic sacrocolpopexy, with or without a midurethral sling, on lower urinary tract symptoms]. / Impact de la promonto-fixation cœlioscopique, avec ou sans bandelette sous-urétrale, sur les symptômes du bas appareil urinaire.

OBJECTIVE: To evaluate the impact of laparoscopic sacrocolpopexy, with or without simultaneous midurethral sling (MUS), on urinary symptoms and health-related quality of life of patients. MATERIALS: A prospective analysis was carried out including 83 women with symptomatic pelvic organ prolapse who had laparoscopic sacrocolpopexy between 2009 and 2011. Patients were classified according to the preoperative clinical examination (stress test). Thirty patients with patent (group A) stress urinary incontinence (SUI) and 15 patients with occult SUI (group B) had a MUS associated with sacrocolpopexy. Thirty-eight patients with negative stress test (group C) were treated by sacrocolpopexy without MUS, even if they had history of SUI. At each visit, urinary symptoms (UDI-6) and their impact on quality of life (UIQ-7) were evaluated using validated self-questionnaires, Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. RESULTS: After 3years of mean follow-up, SUI was improved in 22/30 (77%) of patients in group A and only one patient needed a second MUS. Dysuria was cured in 9/12 (75%), 5/7 (71%) and 16/19 (84%) of patients of groups A, B, C respectively and urge urinary incontinence in 13/19 (68%), 2/2 (100%) and 4/6 (67%) of patients. The rate of de novo urge incontinence was respectively 1/11 (9%), 2/13 (15%) and 6/32 (19%). De novo SUI appeared in 6/32 (19%) of patients in group C, but only 2 of them secondarily needed a MUS. After 3 years, our study showed a significant decrease of UDI-6 of 62, 63 and 48% comparing with preoperative score and of UIQ-7 of 77, 54 and 81%. CONCLUSION: Laparoscopic sacrocolpopexy associated with MUS for patent stress urinary incontinence improves significantly stress and urgency urinary incontinence. Laparoscopic sacrocolpopexy without MUS, when physical exam shows a negative stress test, significantly reduces voiding difficulties with very few cases of de novo stress and urge incontinence. LEVEL OF EVIDENCE: 4.

[Sexual function after transobturator tape procedure for stress urinary incontinence and overall patients' satisfaction]. / Sexualité après cure d'incontinence urinaire par bandelette sous-urétrale transobturatrice et satisfaction des patientes.

OBJECTIVE: To evaluate the quality of sexual activity after a transobturator tape procedure for urinary incontinence and to examine the global satisfaction reported by patients. MATERIALS AND METHODS: This is a bicentric retrospective study, postoperative questionnaires were sent to 247 women operated for urinary incontinence by TOT/TVT-O surgery, after 1 year, prolaps were excluded. Patients' overall improvement was assessed using the French version of Patient Global Impression and Improvement (PGI-I), urinary symptoms were assessed with the use of ICIQ-Fluts and quality of sexual function using Lemack and Zimmern questionnaire and ICIQ-Fluts-Sex. A logistic regression analysis was run to analyse the factors associated with women overall improvement. RESULTS: One hundred and sixty-five patients answered the questionnaire (66.8%). Average age was 55 (±11), and the average postoperative period was 39 months (±17.9). After surgery, according to the PGI-I: 135 women (81.8%) found an overall improvement, 22 (13.4%) found their condition unchanged and 8 (4.8%) women found it worse. Among the 165 women, 118 were sexually active, 37 (31.4%) reported improvement in intercourse satisfaction whereas 11 (9.3%) complained about sexual function deterioration and 70 (59.3%) felt unchanged. The 37 women who reported sexual improvement described decreased coital incontinence in 54% of the cases. Eleven women who felt sexually worse, reported dyspareunia. Results of the logistic regression analysis suggested that overall improvement after surgery depended not only on the incontinence score (OR 0.83) but also on the quality of the postoperative sexual activity (OR 12.96). CONCLUSION: One third of the women reported improvement of their sexuality after transobturator tape procedure. In fact, global satisfaction after surgery was as related to the improvement of urinary symptoms as it was to the quality of the sexual activity. LEVEL OF EVIDENCE: 5.

[Is initial success after Monarc(®) suburethral sling durable at mid-term evaluation?]. / Le succès thérapeutique après bandelette Monarc(®) est-il durable à moyen terme ?

OBJECTIVES: Suburethral sling is the gold standard treatment for stress urinary incontinence (SUI). Short-term cure rates are high, but only few studies are available for longer assessment after transobturator tape procedure. The objectives of this study were to assess mid-term functional outcome for Monarc(®) transobturator tape after initial success, and to identify risk factors for recurrence. MATERIAL AND METHODS: We conducted a single centre retrospective study (2004-2013) on consecutive women with SUI who underwent Monarc(®) transobturator tape procedure and were initially cured at the postoperative medical consultation. Pre- and postoperative data (age, weight, height, body mass index, hormonal status, surgical history, associated organ prolapse [Baden and Walker], associated urinary symptoms, postoperative complications [Clavien-Dindo]) were extracted from the electronic medical record. Subjective cure was defined by a score of zero from the ICIQ-SF questionnaire, no second intervention for recurrent SUI and no need for pads at latest news. Statistical analysis was performed using SAS(®) v9.3 (P<0.05). RESULTS: One hundred and thirty-three consecutive women underwent TOT Monarc(®) procedure, and 125 women were cured in the short-term. Among these women, 103 (82%) were available for mid-term evaluation. Sixty-four women (62%) had pure stress urinary incontinence. The mean follow-up period was 51 months [2-119]. At last follow-up, cure rate was 61%. Seventy-eight percent of women with recurrent urinary incontinence had SUI. Other women had mixed urinary incontinence (3/40), or de novo urgency (6/40). In univariate analysis, we could not identify pejorative prognostic factors for mid-term failure. CONCLUSION: In our experience, mid-term functional outcome after Monarc(®) transobturator tape procedure seems to deteriorate. After 4 years of follow-up, 61% of the women who were initially cured were still free from any leakage. LEVEL OF EVIDENCE: 4.

[Multicenter study of Advance ® suburethral sling for treatment of postoperative urinary incontinence of male]. / Évaluation multicentrique de la bandelette sous-urétrale Advance ® dans le traitement de l'incontinence urinaire masculine postopératoire.

OBJECTIVES: To estimate in the medium term, the efficiency and morbidity of Advance(®) for the treatment of postoperative urinary incontinence for male, and determine predictive preoperative factors of success or failure. MATERIAL AND METHODS: Retrospective multicentric clinical study of patients presenting a postoperative urinary incontinence and treated by Advance(®) suburethral sling. The importance of the preoperative incontinence was classified in three groups: light (pad-test<50 g/day or 1 pad/day), moderated (pad-test between 50 and 100 g/day or 2 or 3 pads/day), severe (pad-test>100 g/day or >3 pads/day). The functional results were classified in 4 categories: continence and improvement, defining the criterion of success and unchanged situation and deteriorated situation defining the criterion of failure. RESULTS: Sixty-six patients were included from 2008 till 2013. The radical prostatectomy was responsible in 85.5% of the cases. The incontinence was light, moderated and severe for respectively 43.4%, 35.6% and 21% of the patients. After treatment, 39.4% of the patients were continent and 78.9% in situation of success. The rate of success decreased with the severity of the incontinence (respectively 94%, 74% and 56%). For 9 patients, implantation of artificial urinary sphincter was performed without operative difficulties. Complications were urine retention (n=4), hematoma (n=3) and scrotal pains persistent more than one postoperative month (n=11). CONCLUSION: Advance(®) suburethral sling is a technique in which the efficiency decreases with the severity of the incontinence, but which does not seem to prevent from implanting artificial urinary sphincter. Its main problem is the apparition of scrotal pain.

[Erosive complications of mid urethral slings (MUS): 10 years of surgical experience]. / Complications érosives des bandelettes sous-urétrales (BSU): 10ans d'expérience chirurgicale.

OBJECTIVE: Evaluation of the diagnostic and therapeutic management of erosive complications after mid urethral sling (MUS) procedure: vaginal erosions (VE), bladder (BE) and urethral (UE). METHODS: Retrospective monocentric study concerning cohort of patients undergoing surgery from January 2002 to January 2013 supported for erosive complications of MSU: TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturateur Tape). RESULTS: Sixteen patients were diagnosed for erosive complications: 7 VE, 6 BE and 3 UE. Dyspareunia and vaginal discharge were observed in 86% patients (n=6/7) with VE. Conservative treatment by vaginal approach was systematically performed in cases of vaginal erosion. After removal of material, 100% dyspareunia were corrected. Postoperative continence was maintained in 57% of patients (n=4/7). Urinary infection was the main symptom of patients with BE. Severe dysuria was present in 66% of patients with a UE (n=2/3). First-line therapy by endoscopic treatment was performed in 77% of patients (n=7/9) with a BE or UE. A second surgery was required in 42% of patients treated with endoscopic first-line therapy (n=3/7) because of a new exposure of MUS. Three of nine patients recurred their incontinence after first-line therapy (33%). CONCLUSION: The removal of device exposed vaginally in case VE systematically corrected symptoms with about 60% of continence. In case of BE or UE, endoscopic treatment in first-line therapy was rarely definitive (42%) and recurrence of incontinence appeared in 30% cases.

[Functional results and treatment of functional dysfunctions after radical prostatectomy]. / Résultats fonctionnels et prise en charge des troubles fonctionnels après prostatectomie totale.

OBJECTIVE: To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. MATERIAL AND METHOD: Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. RESULTS: Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. CONCLUSION: Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.

[Intrinsic sphincter deficiency and female urinary incontinence]. / Insuffisance sphinctérienne et incontinence urinaire de la femme.

OBJECTIVE: Stress urinary female incontinence (SUI) is primary due to intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite a lack of standardised international definition, ISD needs to be clearly diagnosed in order to be correctly treated. This work is an update about the female ISD produced from a review of a published article. MATERIAL AND METHODS: This review of article published on this subject in the Medline (Pubmed database), selected according to their scientific relevants, of consensus conferences and published guidelines, has been performed by the committee for women pelvic floor surgery of the French Urological Association. RESULTS: Although there is no international consensus definition, we can consider that the ISD is a composite concept combining urodynamic data (MUCP < 20 or 30 cmH20) and one or more clinical information (no urethral mobility, negative urethral support test, failure of a first surgery, leakage during abdominal straining, high stress incontinence scores). Imaging can provide additional evidence for intrinsic sphincter deficiency diagnosis, but the correlation between imaging and function remains low. By standardizing methodology and interpretations to better diagnose women with ISD, it may be possible to improve preoperative planning and outcomes for these patients. A retropubic midurethral sling can be performed as a first surgery. In case of a lack of urethral mobility, the artificial urinary sphincter (AUS) remains the gold standard. Adjustable continence therapy (ACT(®)) can be proposed as an alternative option. The efficacy and safety of muscle-derived cell therapy in ISD needs more studies. Injection of bulking agents may be an option according to the severity and the expectations of the patient. Bladder overactivity needs to be treated as first-line in case of mixed urinary incontinence. In elderly women, a careful evaluation of the bladder contractility and comorbidity must be performed. A geriatric evaluation can be necessary. CONCLUSION: Clinical and paraclinical assessment allow to confirm the diagnosis of female ISD, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment.