Transobturator tape sling for female stress incontinence with polypropylene tape and outside-in procedure: prospective study with 1 year of minimal follow-up and review of transobturator tape sling.

OBJECTIVES: To assess the efficacy and safety of a minimally invasive surgical procedure using a polypropylene transobturator tape to treat female stress urinary incontinence during a minimal follow-up of 1 year and to present a review of this technique. METHODS: A total of 206 women with stress urinary incontinence who underwent the transobturator tape procedure in a French multicenter prospective open tracker study, with a minimal follow-up of 1 year (range 12 to 33 months), were assessed. A nonelastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique used a vaginal and transobturator percutaneous approach. Postoperative assessments included clinical examination, cough-stress test (full bladder), uroflowmetry, and postvoid residual urine volume performed after 1, 6, 12, 18, and 24 months. RESULTS: The mean follow-up was 16 months (range 12 to 33). Of the 206 patients, 79.1% were completely cured, 13% improved, and 7% failed. No vascular, nervous system, or digestive perioperative complications were observed; however, 2.4% of the patients had postoperative urinary retention. CONCLUSIONS: The results of the present study have confirmed the optimal results in stress incontinence previously reported in short-term studies. These results suggest that the transobturator tape procedure is a valuable alternative to the transvaginal tape procedure, with a low rate of complications.

Intravesical glucidic capsaicin versus glucidic solvent in neurogenic detrusor overactivity: a double blind controlled randomized study.

AIMS: Many studies report the use of alcoholic capsaicin instillation to treat neurogenic detrusor overactivity (NDO) in spinal cord injured (SCI) and multiple sclerosis (MS) patients. However, poor tolerability due to the irritative effect of the ethanol solvent limits its use. Our study aimed to evaluate the efficacy and tolerability of a new formulation of capsaicin in a glucidic solution in a multicenter clinical trial. MATERIALS AND METHODS: Thirty-three patients (26MS/7SCI) suffering from urinary incontinence due to refractory NDO were prospectively enrolled in a double-blind placebo controlled study and randomized to capsaicin group (CG, N = 17) or solvent group (SG, N = 16). They respectively received an intravesical instillation of 100 ml capsaicin diluted in glucidic solvent (CG) or glucidic solvent alone (SG). Efficacy (voiding chart, maximum cystometric capacity (MCC)) and tolerability were evaluated on days 0 (D0), 30 and 90. RESULTS: On D0, groups were homogeneous. On D30, significant improvement of overactive bladder syndrome and an increase in MCC were shown in CG, whereas there were no improvement in SG. No significant improvement was shown on D90 in both groups. There were no significant differences between groups regarding prevalence, duration, or intensity of side effects, except for short duration pubic pain during instillation more often reported in CG (58.8%) than in SG (12.5%) (P < 0.01). CONCLUSION: This placebo controlled study using glucidic capsaicin confirms its short-term efficacy in NDO patients. Global tolerance of glucidic capsaicin appeared satisfactory. Long-term efficacy and tolerance of repeated glucidic capsaicin instillations need to be evaluated.

[Permanent iodine 125 implant brachytherapy in localized prostate cancer: results of the first 4 years of experience]. / La curiethérapie par implants permanents d'iode 125 dans le cancer localise de prostate: résultats des 4 premières années d'experience.

OBJECTIVE: This study reports the preliminary national results of permanent Iodine 125 implant brachytherapy for the treatment of localized prostate cancer with a follow-up of 4 years. MATERIAL AND METHODS: The authors analyse a series of 260 patients treated consecutively according to the same technique (single-centre, with estimated dosimetry and the use of fixed implants) in terms of morbidity, recorded prospectively, and in terms of cancer control. In the group of 260 patients with stage T1-T2 prostate cancer 68.4% belonged to the low-risk group (PSA < 10 and Gleason score < 7), 28.4% belonged to the intermediate-risk group (PSA > 10 or Gleason score > 6) and 3% belonged to the high-risk group (PSA > 10 and Gleason score > 6). The mean follow-up was 29.5 months (range: 8-56 months). Adverse effects were dominated by obstructive and/or irritating voiding disorders in the majority of cases, with progressive improvement in 98% of cases. Acute urinary retention required drainage in 10.7% of cases. An endoscopic disobstruction operation was performed after at least 6 months in 2.3% of cases. Anorectitis was reported in 21.91% of cases: stage I in 20.3% and stage II in 1.5%, treated medically in every case. In the year following implantation, 34.2% of patients complained of erectile dysfunction that was successfully treated medically. Analysis of the dosimetric data after implantation demonstrated a learning curve in which optimal coverage of the therapeutic target by the dose of irradiation prescribed was obtained between the first 20 and 30 patients. This systematic, patient-by-patient analysis allowed optimization of the implantation technique, especially by ensuring better coverage of the base and anterior part of the prostate. RESULTS: The 3-year laboratory recurrence-free survival was 93.8% for all patients and 97. 7% for the good prognosis group. Fifteen of the 16 recurrences occurred during the first 18 months of the experience. The results of this study are concordant with those of North American teams at the same stage of experience. In this programme, optimization of the technique and patient selection criteria achieved excellent results in terms of morbidity and cancer control. The authors propose elective brachytherapy to the group of patients with a poor prognosis, a prostate volume less than 50 ml and with no obvious urinary functional disorders. An analysis is underway to confirm these results with a longer follow-up.

Clinical outcome in patients with locally advanced bladder carcinoma treated with conservative multimodality therapy.

OBJECTIVES: To describe the outcome of patients with muscle-invasive bladder carcinoma treated with multimodality therapy in our institution from 1993 to 2002. METHODS: The charts of 60 patients with Stage T2-T4N0-N1M0 treated with transurethral resection of bladder tumor followed by a chemoradiotherapy combination were retrospectively reviewed. Of the 60 patients, 22 had received neoadjuvant chemotherapy (methotrexate, cisplatin, and vinblastine or methotrexate, adriamycin, cisplatin, and vinblastine) followed by concomitant chemoradiotherapy (weekly cisplatin/carboplatin or a cisplatin and 5-fluorouracil combination), and 38 had received concomitant chemoradiotherapy alone. Radiotherapy delivered a median dose of 45 Gy to the pelvis and 65 Gy to the bladder in a once-daily or twice-daily fractionation scheme. Follow-up evaluations included cystoscopy with biopsies at regular intervals. Salvage cystectomy was recommended in the case of local persistent tumor or bladder relapse. RESULTS: The median follow-up was 48.5 months (range 10 to 126). Of the 22 patients who received neoadjuvant chemotherapy, 18 (82%) had received two or more cycles; 51 (85%) of the 60 patients received the concomitant chemotherapy as planned. Radiotherapy was completed in 56 patients. Twenty-eight patients developed relapse either locally (14 did not achieve a complete local response after chemoradiotherapy and 6 had true local relapse during follow-up) or at distant sites. The actuarial 5-year disease-specific survival and freedom from local and distant relapse rate was 54% and 42%, respectively. The actuarial local control rate with an intact bladder was 56% at 5 years. When stratified according to stage and grade, patients with Stage T2-T3, grade 2 tumors had a statistically significantly better chance of remaining relapse free than did the others (P = 0.045). Salvage cystectomy (n = 11) for isolated local failure in this population achieved limited results. CONCLUSIONS: Transurethral resection of bladder tumor with this chemoradiotherapy combination achieved satisfactory results in this unfavorable population with invasive bladder carcinoma.

Urinary complications and sexual function after the tension-free vaginal tape procedure.

OBJECTIVE: The purpose of this prospective study was to evaluate urinary and sexual function after the tension-free vaginal tape (TVT) support procedure for stress urinary incontinence (SUI). METHODS: Between January 1999 and July 2002 a total of 71 patients underwent comprehensive examination including urodynamics and a mailed self-administered questionnaire for assessment of voiding and sexual function before and after treatment of SUI by TVT. RESULTS: Based on objective findings TVT was considered as curative in 48 patients (87.3%). Comparison of preoperative and postoperative urodynamic evidence demonstrated a significant outflow obstruction (<12 ml/s) in 19 patients (34.5%). A significant decrease in peak urinary flow during voiding (p < 0.001) was also observed. Of the 55 women (78.5%) who responded to the questionnaire before and after TVT, 42 (76.3%) reported satisfaction with the outcome. Postoperatively, 60% of patients reported voiding difficulty, 47.2% complained of urgency, and 32.7% of frequency. Regarding sexual function 20% reported impairment after surgery including dyspareunia in 14.5% (none preoperatively vs. eight postoperatively, <0.01) and loss of libido in 5.4%. CONCLUSION: The TVT procedure is an effective treatment for SUI. However, it can lead to postoperative voiding and sexual impairment.

Urethral device in women with chronic urinary retention: an alternative to self-catheterization?

OBJECTIVE: To assess the efficacy and safety of a new urethral prosthesis in the management of chronic urinary retention in women as an alternative to intermittent or indwelling catheterization. METHODS: Between May 1999 and July 2000, 60 women with chronic urinary retention were prospectively enrolled in the study. The prosthesis was inserted under local anaesthesia. A magnetic control unit activates the urethral device to achieve micturition. Duration of the experience, complications and compliance were evaluated. RESULTS: Thirty patients were satisfied with the device. Discontinuation occurred in the first two weeks following implantation in 50% of cases. Bladder migration of the prosthesis occurred in two cases, urinary leakage around the device in four patients, spontaneous expulsion in two women and cystitis was diagnosed in two cases. CONCLUSION: This intraurethral prosthesis is an attractive, simple technique for use as an alternative to catheterization. Some untoward events and technical complications explained the number of discontinuations.

Minimally invasive surgery for female urinary incontinence: experience with periurethral microballoon implantation.

PURPOSE: To assess the effectiveness of periurethral microballoon implantation for management of female urinary incontinence. PATIENTS AND METHODS: A total of 45 women with urinary incontinence (age range 47-88 years) were treated between May 2000 and June 2001. Microballoons were placed in the proximal periurethral tissue using endoscopic instrumentation under local anesthesia. Follow-up assessment including urodynamic study and quality- of-life assessment was performed at 1, 3, and 6 months. RESULTS: Implantation was successful in all cases with no significant adverse effects. Cure was achieved in 60% and improvement in 5%. The failure rate was 35%. Microballoon implantation significantly increased the mean urethral closure pressure, from 35.2 cm H(2)O (SD 14.9; range 15-72 cm H(2)O) to 46.5 cm H(2)O (SD 19.7; range 16-87 cm H(2)O) (P = 0.001). The best predictors of successful outcome in univariate analysis were initial urethral closure pressure (P = 0.047) and degree of incontinence (P < 0.001). CONCLUSIONS: Periurethral microballoon implantation is a useful technique for the management of female urinary incontinence, especially in elderly and inoperable patients. The microballoons do not present the adverse effects associated with other bulking agents.

Weekly administration of docetaxel for symptomatic metastatic hormone-refractory prostate carcinoma.

BACKGROUND: The current Phase II study investigated the clinical benefit, impact on quality of life (QOL), and tolerability of weekly docetaxel in symptomatic patients with metastatic hormone-refractory prostate carcinoma (HRPC). METHODS: Patients received weekly docetaxel 35 mg/m(2) intravenously for 6 consecutive weeks followed by a 2-week rest repeatedly for a maximum of 24 weeks of treatment. Clinical benefit evaluations, based on Karnofsky performance status (KPS) and pain, were assessed weekly during therapy. A clinical benefit response was defined as a sustained (> or = 4-week) improvement in at least one of these parameters without worsening in the other. Patient-assessed QOL (using the European Organization for Research and Treatment of Cancer QLQ-C30), changes in prostate-specific antigen (PSA) levels, tumoral response, and toxicity also were evaluated. RESULTS: Thirty men (median age, 67 years), 15 of whom had received previous chemotherapy, were treated. Overall, 46% of patients achieved a positive pain response and 48% achieved a 50%-or-greater reduction in PSA. KPS was high at baseline (80%), and no significant changes in this parameter were observed. Compared with baseline, all scores improved after the first cycle of therapy, particularly emotional (P = 0.015), pain (P = 0.001), constipation (P = 0.001), and global QOL (P = 0.011) scores. After the second cycle, dyspnea scores decreased (P = 0.010). At the last QOL assessment, there also was deterioration in terms of fatigue (P = 0.013), dyspnea (P = 0.010), and physical functioning (P = 0.017). Toxicity was mild and included neutropenia (Grade 3-4, n = 2). CONCLUSIONS: Of these elderly symptomatic patients with HRPC, half had received previous chemotherapy. Weekly docetaxel was found to be associated with improvements in clinical benefit response and in QOL and was well tolerated.

[Testicular epidermoid cyst]. / Kyste épidermoïde du testicule.

Epidermoid cyst of the testis is a rare benign tumour. The diagnosis is strongly suggested by ultrasound and MRI. Conservative surgery is possible in the case of a small isolated lesion and requires intraoperative histological confirmation. It is a constantly benign tumour that must be distinguished from testicular teratomas, justifying the search for associated neoplastic contingents requiring orchidectomy.