[Botulinum toxin injection for refractory non-neurogenic overactive bladder. Systematic review]. / Traitement de I'hyperactivité vésicale réfractaire non neurogène par la toxine botulique. Revue de la literature.

BACKGROUND: OAB is common with a potential negative impact on quality of life. Anticholinergics and ß3-mimetics are the first-line medical treatment. This treatment meets only 50% of patients given a lack of efficacy and adverse effects. Used in the treatment of neurogenic overactive bladder, botulinum toxin is now evaluated for the treatment of refractory non-neurogenic overactive bladder. The objective of this work is to review the literature data concerning the efficacy and safety of intradetrusor botulinum toxin injections to treat refractory idiopathic overactive bladder. METHODOLOGY: A systematic literature review was conducted to identify articles published between May 1988 and April 2013 in Medline for the treatment of refractory idiopathic overactive bladder with botulinum toxin. RESULTS: 37 studies with original samples were selected including 8 randomized controlled trials against placebo. The effectiveness of intra- detrusor injections is demonstrated to reduce the frequency, urgency, nighttime urination, incontinence episodes and to improve bladder capacity and quality of life. The most common side effects are incomplete bladder emptying, intermittent catheterization and increased risk of urinary tract infection. A dose of 100 to 150 U of onabotulinumtoxinA allows the best compromise between efficiency and tolerance. Duration of the effects varies between 3 to 12 months and repeating the injections did not seem to affect the efficiency. Injections including the trigone zone do not cause vesicoureteral reflux. The absence of detrusor hyperactivity does not alter the clinical response. CONCLUSION: The detrusor injections of botulinum toxin can be considered as an effective second-line treatment for refractory non-neurogenic overactive bladder. Information on intermittent catheterization risk must be provided. The very long-term effectiveness and the absence of urothelium alterations are still outstanding issues.

[Acute renal failure following rectosigmoidoscopy]. / Insuffisance rénale aiguë après rectosigmoïdoscopie.

We report the case of a 24-year old man with a past history of vesical extrophy and ureterosigmoidostomy in childhood, admitted with acute left flank pain and acute renal failure. The complaints started the day following the endoscopic resection of a sigmoid polyp. The stricture of the ureterosigmoid junction was diagnosed by intravenous urography. Conservative treatment with endo-ureteral dilatation was successfully performed. At 2 years of follow-up, the patient is still asymptomatic, without any residual hydronephrosis.

[Erectile dysfunction: conservative treatment and new approaches]. / Dysfonction erectile: traitements conservateurs et nouvelles approches.

Recent societal evolutions have enabled more and more men to talk about erectile dysfunction (ED). There is a strong association between ED and cardiovascular disease and ED should now be considered as an early clinical evidence of vascular disorder. Inhibitors of the PDE-5 have revolutionized the treatment of ED. The three currently drugs (sildenafil, vardenafil and tadalafil) available as first-line therapeutic option, are well tolerated and highly effective in improving erectile function. All the potential cardiac and vascular effects of PDE-5 inhibitors have recently been reviewed. Despite the fact that million patients with ED worldwide have been successfully treated with one of these PDE5 inhibitors, some men are always difficult to treat. Several new PDE-5 inhibitors have recently been developed and are now being investigated in trials. However 30% of patients need alternative therapies and intracavernous injections are the most successful second-line treatment. Some of new therapeutic approaches are currently under investigation such as gene transfer therapy and stem cells therapy, melanocortin activators or extracorporeal shockwave therapy. Such approaches are still at an early stage but remain exciting new targets in difficult to treat patients.