[Pelvic radiotherapy and artificial urinary sphincter in women]. / Radiothérapie pelvienne et sphincter artificiel urinaire chez la femme.

OBJECTIVES: A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR). POPULATION AND METHODS: From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n=206) and the other group with PR (group 2; n=9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure. RESULTS: Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P<0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4-140) with AUS implantation. CONCLUSION: AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres.

[Adjustable Continence Therapy in women, middle term follow-up and a new technique for balloon positioning]. / Les ballonnets périurétraux ACT chez la femme : suivi à moyen terme et aide au positionnement.

OBJECTIVES: Evaluation of the results of Adjustable Continence Therapy (ACT) in women by a retrospective one-center study and exposure of a technique: bladder neck retrovision. PATIENTS AND METHODS: Between January 2001 and February 2009, 67 women had ACT implantation by the same surgeon for the indication of urinary incontinence by intrinsic sphincter deficiency, with mean age of 70.2 years. Mean follow-up was 24.8 months (1 to 89 months). Evaluation of functional results was realized with the research of urinary leakage when coughing or during abdominal thrust in the clinical exam, with the Urinary Symptom Profile (USP) questionnaire (since 2007), and with an analogical global satisfaction evaluation. RESULTS: More than 90% of women (n=67) have been improved at least at one medical consultation, and 60% (40/67) at last follow-up with a satisfaction index superior to 80% in 25 patients. Urinary leakage when coughing or doing abdominal thrust disappeared in 58% (36/62). An improvement of USP score was observed in 76% (19/25). Postoperative complications occurred in 37.3% (25 patients) with a mean period of 10.8 months after surgery. CONCLUSION: The ACT, indicated in stress urinary incontinence, is attractive because of the benefit-risk ratio. It could represent an alternative treatment when the artificial urinary sphincter is not technically possible, not accepted or when a reversibility is required. The bladder neck retrovision would improve the ACT surgery by precision and safety.