[Use of transvaginal polypropylene mesh (Gynemesh) for the treatment of pelvic floor disorders in women. Prospective study in 52 patients]. / Utilisation d'un treillis de Polypropylène (Gynemesh) par voie vaginale dans le traitement des troubles de la statique pelvienne de la femme: etude prospective chez 52 patientes.

OBJECTIVES: To evaluate the efficacy and safety of strict transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of female genital prolapse. MATERIALS AND METHODS: The anatomical and functional results of 52 women operated between September 1999 and December 2002 were evaluated prospectively. The mean age of the patients was 62 years. All patients presented a cystocele, associated with a hysterocele, an elytrocele or a rectocele in 28%, 9.5% and 38% of cases, respectively. Urinary incontinence was reported in 65% of patients, and 30% of women had a history of previous pelvic surgery. Depending on the components of the prolapse, the operation comprised anterior or posterior mesh implantation, hysterectomy and TVT insertion. Patients were reviewed by a different surgeon from the operator at 3 months, 6 months and then annually. RESULTS: With a mean follow-up of 27 months, the anatomical success rate was 95% for correction of cystocele, and 100% for correction of rectocele. Vaginal erosion by the mesh occurred in two cases after cystocele repair (3.8%). CONCLUSION: Transvaginal implantation of a polypropylene prosthesis is a safe and reproducible technique, which is effective in the medium term for the treatment of prolapse, but further studies are required to confirm this technique as a valid alternative to existing techniques.

[Post-traumatic high-flow priapism in an adolescent]. / Priapisme post-traumatique a haut débit chez un adolescent.

The authors report a case of high-flow priapism in an adolescent due to rupture of the deep penile artery after falling astride, confirmed by Doppler ultrasound on the third day after the accident, and treated successfully by highly selective embolization with no harmful effects on erectile function.

Intravesical capsaicin versus resiniferatoxin for the treatment of detrusor hyperreflexia in spinal cord injured patients: a double-blind, randomized, controlled study.

PURPOSE: Chemical defunctionalization of C-fiber bladder afferents with intravesical vanilloids such as capsaicin (CAP) or resiniferatoxin (RTX) improves detrusor hyperreflexia in humans and animals. The little existing data comparing the efficacy and tolerance of these 2 vanilloid agents seem to favor RTX in 10% alcohol over CAP, which is usually diluted in 30% alcohol. We compared the efficacy and tolerability of the 2 vanilloid agonists in what to our knowledge is the first randomized, controlled study comparing nonalcohol CAP vs RTX in 10% alcohol in neurogenic patients with detrusor hyperreflexia. MATERIALS AND METHODS: This single center, randomized, double-blind, parallel groups study included 39 spinal cord injured adults with detrusor hyperreflexia. On day 0 patients were randomized to receive 1, 100 ml intravesical instillation of 100 nMol/l RTX diluted in 10% ethanol or 1 mmol/l CAP diluted in glucidic solvent. Efficacy (voiding chart and cystomanometry) and tolerability were evaluated during a 3-month followup. RESULTS: On day 30 clinical and urodynamical improvement was found in 78% and 83% of patients with CAP vs 80% and 60% with RTX, respectively, without a significant difference between the 2 treated groups. The benefit remained in two-thirds of the 2 groups on day 90. There were no significant differences in regard to the incidence, nature or duration of side effects in CAP vs RTX treated patients. CONCLUSIONS: Our results strongly argue for the importance of accounting for the role of vanilloid solute when interpreting the efficacy and tolerance of vesical vanilloid instillation in detrusor hyperreflexia cases. They suggest that a glucidic solute is a valuable solvent for vanilloid instillation.

[Evaluation of the results of TVT in a series of 29 major sphincter incompetence]. / Evaluation des résultats de la bandelette TVT en cas d'insuffisance sphinctérienne majeure.

OBJECTIVE: The objective of this study was to evaluate the results of TVT in patients with stress urinary incontinence due to major sphincter incompetence and a closing pressure less than 20 cm H2O. MATERIALS AND METHODS: From March 1998 to March 2001, 29 patients with a mean age of 69 years (range: 36-92) with incontinence due to major sphincter incompetence were treated by this technique. The patients were reviewed at 3 months and then annually. RESULTS: The mean follow-up is 30 months (range: 12-48). 25 patients (87%) obtained a good result, including 16 (55%) with perfect continence, while 9 (32%) were improved and 4 (13%) were considered to be failures. CONCLUSION: TVT constitutes a justified treatment for major sphincter incompetence compared to suburethral slings and in patients who would have been candidates for artificial sphincter implantation before the arrival of TVT. This minimally invasive surgery considerably improves the patient's quality of life. The existence of moderate residual urine or dysuria after insertion of TVT does not alter the functional result or the upper urinary tract.